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Taking a Cognitive Assessment
Recently I had a doctor’s appointment; fortunately one of the “come back in six months” variety. That is excellent news when you’re 85. But I have been noticing signs that my memory has more glitches than it used to, and the doctor gave me a referral to one of the hospital’s clinics that does cognitive assessments, and now I’ve taken one.
Two observations prompted me to ask for a referral. Perhaps you will recognize them as things that happen to you, or to someone you know well.
One concern is “missing words”—in mid-thought, there’s suddenly a hole in my memory where a word ought to be. For example, I was doing a crossword with the clue, “city destroyed by a volcano.” Readily available to memory were Vesuvius, Herculaneum (too long for the crossword grid), A.D. 79, Pliny the Elder …
No, wait. When I looked up details about the eruption, it was Pliny the Younger. How odd that I (mis)remembered that detail, and couldn’t remember Pompeii, the name of a city that I’ve actually visited.
And suddenly such a missing word will just appear as if it had never been gone. This is not something new, but it has been happening noticeably more often.
The other concern is that if I’m in the middle of one thing (going to the kitchen to thaw something for dinner, say), and I stop to do something else along the way, I find myself in the kitchen wondering, “Now what was I going to do here?”
Sound familiar?
I already knew some of the items on a cognitive assessment, since they’re part of a yearly checkup. “Draw a clock with the hands at 10 minutes past 11.” “What were those five words I asked you to repeat a few minutes ago?”
But knowing that I would be attempting the full sequence, I naturally looked it up. There are several such tests, and the one with the clock, the Montreal Cognitive Assessment, is the one I took. It’s not secret; you can find images online of the page the therapist will show you, and also of the instructions she is following. (The five words on the version she started with are face-velvet-church-daisy-red, and you can use that to search Google.) I thought it only fair to tell her that I already knew the answer to the question she hadn’t asked yet, and she laughed and fetched a different version.
One task was, “Tell me as many words as you can in one minute that start with the letter F.” As it happens, doing that is one of my falling-asleep tactics (I must have encountered it somewhere a long while ago).
Fa, fab, fact/face, fad/fade, fee, [REDACTED] (cigarette), fair, fake, fall, family—and that’s already 12, and you need only 11 to earn that point.
You’re warned that you can’t use different forms of the same word, so if you’ve said “walk,” you can’t use any of walks/walking/walked. But what about feel/felt? Felt is also a kind of fabric. Or fare (taxi), fare(menu), fare(well)?
The second version she used asked for words beginning with S instead. I don’t know whether she counted both safe(baseball) and safety(football), but I had more than 11 before I ran out of time or “sa_” words.
Another task was, “Count backwards from 100 by 7s.” That is supposed to test mental arithmetic, specifically subtraction. On the second version, though, it was instead “… from 70 by 7s.” But that is a cognitively different task. You don’t need to subtract, because all the answers are multiples of 7, and most people already know the multiplication table. I pointed that out and she asked whether she ought to report it as a problem. She was probably joking, but I said “Yes,” and I wasn’t joking.
There are 30 points total, and scores of 26 or higher are considered normal. One of the tasks is to copy a stick-figure version of a chair. I know what it is supposed to look like, but I have nerve damage in my hands, and the pen doesn’t always go where I intend it to, or in a straight line. So I managed only 29 out of 30 points. (She said that was amazing for 85.)
It was an interesting exercise. I am pleased that I have a baseline and don’t need to worry (yet). I will, however, continue to set out a week’s worth of meds every Sunday, a compensatory tactic I invented all by myself, and I didn’t even need to buy a special 7-day container to put them in.
Published in General
When they give me the clock test, the one where you draw a clock and point the hands at the appropriate time, I ask the doctor what they are going to use when my grandchildren are my age.
He always laughs nervously.
Congratulations. I doubt that I would have done as well.
Doing one this week: Both of your instances happen regularly. But more importantly, after some 20 years I had two auto accidents less than a month apart. (One was trivial and the other my truck was totaled.)
I really really really don’t want to stop driving.
I keep hoping self-driving cars get perfected before I have to stop driving. That won’t be for another 10-15 years, God willing. So maybe.
Would require a move in any case, as we live in the boonies.
I play golf 2-3 times per week with the same group of 20-30 guys, and when I get home my wife always asks who was in my foursome today.
I often have a hard time remembering that, but I can remember the specifics of every shot I made (anywhere from 80 to 90 or so).
When I have an upcoming appointment of any kind I will make a note of it and tape it on the big bathroom mirror, where I am likely to see it several times before the appointment, making it hard to overlook.
But I had a surprising memory lapse this past week. I’d posted a note about a 1:20pm appointment. I went in to wash my hands before lunch, so of course I saw the note.
After lunch, I wondered if the weather was nice enough to go for a walk, totally forgetting about the appointment. Luckily, I saw the reminder, laughed at myself, and went to the appointment on time.
By the way, I’ll be taking a cognitive test this coming week at my annual Medicare “wellness visit.” Stay tuned.
For 85 I think you are doing very well, if you have just recently noticed these problems. I’m 79 and first noticed them about ten years ago.
I’ve been doing both of those since I was a kid. A lot. I still do them. The only difference is that now people give me a different look when I do them.
Good job! I think I’d pass the tests!
My 94-year-old mother was killed in a car crash (her fault). If you’re having issues, stop driving – now! Before you get yourself killed or kill someone else.
She had already stopped driving at night years before, and was a safe driver. She had a just gotten a new car a few months earlier, and my brother went driving with her first to make sure she was still up to it.
She made one mistake and got t-boned at 50 mph leaving the grocery store. Fortunately the other guy wasn’t hurt.
But what did you shoot on the front nine? I know, it was way too long ago to remember.
Anyone who can write a post as cohesive and polished as this post does not have a cognitive or memory problem. :) :)
In looking at aging, modern doctors are way oversimplifying how the mind and memory work. There is more going on there than a few tests can ever capture. At no time in my life could I ever count backward by seven from a hundred. :) :)
In fact, if I were to take the cognitive test described so well in the post, my results would confuse any practitioner in health care. I went to extremely progressive schools as a kid, and my teachers were dead set against memorization. I didn’t have a great memory to begin with, and nothing in my k-12 education helped that. Being against rote memorization was an extremist fad in the liberal schools I went to, very much like the “new math” fad was for my kids.
My point is that the boomer generation is a mixed bag of cognitive strengths and weaknesses. This most recent excitement in health care will be like the covid scare: as researchers get more into this subject, they will find their original ideas were incorrect.
For now, just know that the moment of reckoning between what they think is happening and reality is fast approaching. But we are not there yet. In the meantime, don’t let them affect your opinion of your own thinking.
I read an interesting article many years ago about a study in which patients in a nursing home were asked to complete some math problems. The patients had some difficulty doing the problems. Then the researchers gave them some coffee (caffeine), and all of the problems went away.
I think in many cases we are probably confusing simple grogginess with some cognition-threatening serious condition.
Before people worry too much, they should try some fresh air, a card game with some good friends, and a cup of coffee. :) If those things don’t clear their mind, then maybe they should talk to someone, but when they do, they should go into it assuming that whatever it is is minor and fixable. They should start with a review of all their medications and supplements and their current fears and anxieties. Any of those can create temporary mild apparent confusion.
But keep in mind that the media and medical profession are really hyped up on this idea–everything new is exciting to them. They will often see things that aren’t there or exaggerate small things they do see.
Let’s meet this challenge with the same intelligence we’ve met every other challenge in our lives. Stand up straight, look them right in the eye, and say, “I don’t know. What do you think?” If you look these inquisitors in the eye, it throws them completely off track. :)
Channel your inner Maggie Smith in Downton Abbey: “If you give people a little power, it goes right to their head like strong drink. It happens every time.”
Thanks @Seawriter! I’ve done that too. Once, the nurse who was doing the assessment confided that she had missed a point on the assessment when she was in training because she was thinking about how silly the questions were.
–Linda
I’m sorry about your mother’s death. It must be hard thinking that it might have been avoided.
I did stop driving some years ago, but not because I was worried about my memory, it was that I use a walker (and have for more than 20 years, because my feet do not reliably tell me which way is up, and I need something to hang onto or I may tip over). Hassling the walker into and out of the car got to be more trouble than it was worth. And I live in a senior facility (for safety, because of the balance issues) and they have van service for residents. And I can order groceries and just about anything else and have them delivered.
Since turning 65 four years ago, I have received a “cognitive test” from my doctor a time or two. I have trouble with the “repeat the words” element, especially if it’s “repeat the words in reverse order.”
If I don’t write it down (or repeat it a bajillion times a la rehearsing a choir anthem), it does not enter my brain. I was one of those school nerds who took copious notes in class because if I wrote it down I might remember it. I still take copious notes on Sunday sermons and Wednesday Pastor’s Bible Study. If I write it down, I might remember it.
I (only half-jokingly) say that my memory really went out at age 26. I concurrently got married and started working in a professional environment (law firm) in which I had a secretary. Anything I needed to remember to do at home I had my wife to remember it and remind me of it. Anything I needed to remember to do at work I had my secretary to remember it and remind me of it. I no longer needed to remember anything. (At work my secretary was later partially replaced by an electronic memory and reminder system on a Palm Pilot and subsequently a “smart phone.”) So my memory atrophied.
44-40 on Friday. Won $13.
Money helps memory. :-)
Nice!
I laughed and spit a little coffee on the cat. MarciN summed it up perfectly. Your all set.
[REDACTED]?! That came as a surprise to me. It’s not what I wrote. Was it always like that? I think I would have noticed.
The fa_ word I mention in my list of words beginning with those letters is British (and Australian) slang for “cigarette,” and I explicitly disambiguated which word with the same spelling was intended. Just as I did with other homonyms mentioned in the article.@podunk
Also a term for pieces of firewood.
Ricochet has an automatic profanity filter. I haven’t tested it, myself, but I presume you can type what you want, but when you hit the Publish button, the software makes the redaction.