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.