What Happens During a Cognitive Assessment?

Cognitive assessments—a jargony phrase for tests of thinking—form the backbone of care for older adults with cognitive concerns, cognitive impairment, and diseases like Alzheimer's disease, the most common cause of dementia. 

That said, the purpose of cognitive assessments and how they are performed are a mystery for many people. 

Read on to learn about this common but poorly understood type of medical testing. 

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Key Takeaways

• Cognitive assessments examine thinking, emotions, and movement to arrive at an overall impression of a person’s mental ability. 

• Cognitive assessments are tests of a person’s thinking ability in specific, defined areas of thinking, including attention, memory, language, reasoning, and visuospatial ability.

• A comprehensive cognitive assessment involves more than a single screening test, although the initial test performed is often a screening test. More in-depth, thorough, domain-specific testing is called neuropsychological testing. 

• Cognitive assessments can be repeated over time, either to monitor for change over time or to investigate reported changes in thinking ability.

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What is a Cognitive Assessment?

A cognitive assessment is a tool for evaluating different types of mental ability. In other words, it tests thinking. 

Because many conditions can simultaneously affect thinking, mood, and movement, evaluations of emotional and motor functioning are typically conducted alongside assessments of cognitive abilities.

These thinking tests help determine whether a person's thinking falls within the normal range for their age and educational level or if cognitive impairment—that is, performing below expected levels—is present. 

Repeating the thinking tests over time permits monitoring of cognitive changes occurring due to aging or other factors.  

The testing examines a person’s thinking ability in specific, defined cognitive domains. Some key types of thinking that are checked are:

• Attention
• The speed with which new information is processed
• Memory and its multiple subtypes (eg, short-term memory for temporarily holding and manipulating information, memory for general knowledge and facts, memory for personal life experiences, and even memory for doing physical things, like riding a bicycle) 
• Language (eg, reading, writing, understanding, naming things, repeating, and speech rate)
• Perception and visual-spatial abilities
• Reasoning (eg, decision-making, calculations, multi-tasking)
• Problem-solving ability

The testing typically involves a group of multiple, interrelated standardized thinking tests. 

Psychologists, neuropsychologists, and other qualified clinicians administer and interpret the tests.

When the thinking tests are complete, benefits include:

• Establishing a baseline measure of a person's cognitive abilities. Future comparisons can be made against this baseline data. 
• Identifying problems in specific areas of thinking, known as cognitive domains.
• Diagnosing cognitive disorders or other conditions that affect thinking, like mood disorders.
• Tracking cognitive changes over time.
• Targeting interventions and developing treatment plans.

Screening versus Comprehensive Assessments

Screening tests are designed to be relatively quick, easy to administer, and cost-effective for use in large populations. They function like the “canary in the coal mine,” an early warning about a developing or growing problem. A “failed” screening test typically requires follow-up testing for confirmation; they are not designed to make diagnoses of any kind by themselves. 

Most initial cognitive assessments are completed using one of several standard screening tests. Screening cognitive tests usually have ultra-short assessments of the various types of thinking. Many times, these are snippets of longer, full-length tests. 

The Mini-Mental State Examination (MMSE) is a commonly used test developed in the 1960s. Licensing is required but rarely enforced. The MMSE is overly simplistic and culturally biased, so it is now used mainly in research studies rather than clinical practice. 

Developed by a Canadian neurologist in the late 1900s, the Montreal Cognitive Assessment (MoCA) is now the most frequently administered cognitive screening test. As with the MMSE, licensing is required but rarely enforced. 

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How does Sunday Health Perform Cognitive Assessments? 

At Sunday Health, cognitive assessments are crucial to every patient’s journey. 

Depending on the required depth of the assessment, testing comes in one of several “flavors.” Some people will have only one or two types of testing, while others will eventually have all of them. 

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Pre-Visit Online Testing

• For most people seen at Sunday Health, the first assessment is done online at a time and place of the individual’s convenience. 
• The testing platform is a standardized and computerized group of tests that can be completed in about 15 minutes on a tablet, laptop, or desktop computer. 
• This first step tests thinking ability in attention, mental flexibility, and memory. It also screens for depression and anxiety using valid and reliable scales. 
• The results are shared with Sunday Health clinicians, who then review them with the patient during the following face-to-face appointments. 

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First Face-to-Face Appointment 

• The first face-to-face appointment is conducted virtually, using an encrypted version of Zoom that meets patient confidentiality standards. 
• A second brief screening is performed at the first face-to-face appointment, and results are compared against the pre-visit online screening. 
• If the results are consistent and show no deficits, testing may end at this point. 

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When Additional Assessments are Necessary

• If impairment is found or the two initial assessments yield inconsistent results, Sunday Health may recommend more in-depth testing. This additional testing is called neuropsychological testing. Neuropsychological testing examines the same types of thinking as the screening tests but goes into greater depth in each area by performing multiple tests. 
• Sometimes, a Sunday Health neurologist can perform the neuropsychological testing; in other cases, a referral to a neuropsychologist will be needed. 

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In all cases, the Sunday Health clinician will ask many questions about a person’s life to flesh out their cognitive profile as fully and precisely as possible. Important topics include: 

• Whether they (or their loved ones) have one or more active concerns about their thinking abilities
• How far they went in school
• The kind of work they did (or do)
• How they like to spend their leisure time
• Information about home safety, warning signs of cognitive decline, family history, medical history, and medications. 

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What Insights Will a Sunday Health Cognitive Assessment Provide About My Cognitive Abilities?

Thinking tests provide valuable insights into your thinking abilities and functioning across various types of thinking. 

The thinking tests can teach you about your thinking abilities in many ways:

• Overall cognitive status: The testing gathers data about your general thinking abilities. It also checks whether you are performing within the normal range for your age, education level, and background or if any notable impairments or deficits are present.
• Strengths and weaknesses: The testing identifies your relative strengths and weaknesses across different types of thinking. In other words, the testing maps out where you are doing well and where you may need additional cognitive support.
• Attention and concentration: The testing measures your ability to focus and sustain attention. It also checks how easily you are distracted, which can impact cognitive performance.
• Processing speed: The testing looks at how quickly you can take in and process information, which influences the efficiency of your thinking.
• Memory profile: You'll learn about your memory capabilities, including your ability to learn, store, and retrieve information across different types of memory.
• Language skills. Your ability to understand and produce language will be assessed, including comprehending, naming, vocabulary, and quickly accessing and selecting the right words when speaking or writing.
• Executive functioning. You'll gain insights into your ability for higher-order thinking, such as abstract reasoning, planning, decision-making, mental flexibility, and ultra-short-term memory.
• Impact of medical/psychological conditions. If you have a medical or psychological condition, the assessment can determine whether and how it may affect your thinking.

Once all the data has been analyzed, the results can suggest strategies to support and improve your thinking abilities in areas of need. 

The testing results can also guide potential interventions and suggest necessary accommodations.

When the Tests are Done, What Do I Get? 

For everyone, an experienced Sunday Health clinician will review the results and answer all questions. This review will go over the areas tested, the results, and whether diagnostic criteria for any thinking abnormalities have been met. It will also consider a person’s other medical problems and medications. 

The Sunday Health clinician will provide an opportunity to discuss recommendations, goals, and desires for the future.

In all cases, the Sunday Health clinician will prepare a report summarizing the work done, the results, what they mean, and the next steps to be taken. This report is for you, the patient, and it becomes a part of Sunday Health’s medical records. We strongly recommend sharing the report with your primary care clinician. Beyond that, however, you control whether the report is shared and with whom. 

The thinking tests can be repeated as frequently as every 6 months. In many cases, however, repeat testing will be done as needed or every few years. 

Interested in a cognitive assessment for yourself or a loved one?

Sunday Health is accepting new patients on Medicare Part B residing in Maryland, Virginia, and Washington, DC. To learn more, click here to schedule an introductory call with our care navigator or call (571) 517-1564.

Do you have another question that the Sunday Health brain health experts can answer? We invite you to send your questions to hello@sundayhealth.com.

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