Misplacing the keys, searching for your glasses when they’re atop your head, forgetting why you got up and walked into the other room, having the name of a movie you just saw at the tip of your tongue: These are classic examples of the memory lapses we all experience from time to time. As you grow older, though, it’s natural to wonder, when is a lost key more than that? If you’re not as sharp as you used to be, is that “normal aging” or a sign that something’s wrong?
There are no easy answers. There are, however, many online self-tests that promise to help. The claims are similar: Using a short series of questions, these tests will gauge your “brain health” and detect signs of early problems, including mild cognitive impairment, or MCI.
MCI is common, affecting an estimated 12 to 18 percent of Americans ages 60 and older. Those individuals may frequently lose things, forget appointments, or have trouble finding the words they want to say—but they can still manage day-to-day tasks and take care of themselves just fine. Some people with MCI eventually develop Alzheimer’s disease or other forms of dementia, while others see their cognitive symptoms stabilize or even improve.
In theory, it’s good to have simple tests for MCI that you can take at home. But at this point, DIY testing raises some critical issues. One is whether currently available online tests are accurate. And even if some of them are, what do you do with the results?
At least one cognitive self-test has published research to back it up: the Self-Administered Gerocognitive Exam, or SAGE. Developed by researchers at The Ohio State University, SAGE can be downloaded for free from the university’s website, and takes 10 to 15 minutes to complete. It assesses memory, language, and problem-solving skills—asking test-takers to, for example, name a dozen animals or do basic math.
Studies suggest SAGE can detect MCI with a good degree of accuracy, similar to some standard tests used by healthcare professionals. As a study in Frontiers in Medicine reported this past June, the test may also help primary care doctors identify many more “new cognitive concerns” among their patients than they otherwise would.
But while the test may be useful, the key point is, your primary care doctor has to be on board. You can complete SAGE at home, with pencil and paper, but you’d need to bring it to your doctor to have it scored—and, crucially, to figure out what to do next, if anything.
What does a “bad” score mean? First, it’s important to be aware that SAGE cannot give you a definitive diagnosis (nor can any other online screening tool). A low score may indicate problems with certain aspects of your cognition, but it can’t tell you the reason. So your primary care doctor would need to follow up, by ordering certain blood tests or brain scans or possibly referring you to a specialist for a more extensive battery of cognitive tests. That deeper dive is necessary, in part, because MCI symptoms sometimes have reversible or treatable causes—such as medication side effects, depression, sleep apnea or other sleep disorders, thyroid conditions, and nutrient deficiencies.
In other cases, MCI is an early part of the dementia process. And unfortunately, there’s currently no way to stop it from advancing. There are some medications, recently approved by the FDA, that can be prescribed to some people with early Alzheimer’s, including MCI that can be attributed specifically to Alzheimer’s. The goal there is slowing the progression of the disease. But the drugs are costly, are difficult to take (they’re given by IV), and can only be prescribed after tests confirm a person has the brain abnormalities that are hallmarks of Alzheimer’s.
There’s no question that older adults and their doctors should be talking about cognitive function and ways to support brain health. In fact, if you’re on Medicare, your doctor is required to take stock of your cognitive function at your yearly “wellness visit” (though the rule lacks specifics on the best way to do that). Despite the requirement, research suggests that most Medicare beneficiaries do not get that cognitive checkup—partly because many don’t get to an annual wellness visit at all.
Clearly, there’s room for improvement in how our healthcare system addresses cognitive health, but I do believe the best place to start is with your doctor. Make that annual wellness appointment, and make sure you get a cognitive assessment. If you develop symptoms that are troubling you, bring them up to your doctor. You could ask whether you should take a test like SAGE at home, or wait for an in-office screening test that your doctor may already use, like the MMSE (Mini-Mental State Examination).
Although we have no way to halt the dementia process, detecting early cognitive problems can be valuable for a number of reasons: Besides the possible treatable causes mentioned above, knowing your cognitive status might help you plan for the future. You might choose to focus on ways to stay generally healthy (eating well, exercising, and getting enough sleep, for example) and manage cognitive symptoms (using memory aids like calendars and notes to yourself, for instance). Your doctor can also track your cognitive function over time, to diagnose dementia early should it develop.
Right now, we’re in a transition phase in dementia care, with ongoing research investigating new treatments and better tests. If and when therapies that arrest, or even reverse, the dementia process emerge, at-home screening tools may become key in getting those treatments to the right people. But we’re not there yet.
