Your dad misplacing his car keys once in a while. Becoming confused about the week but quickly figuring it out. Your mom walking into a room and forgetting why she entered it. All examples of typical, age-related memory issues—nothing to be alarmed about here.
However, putting milk in the pantry instead of the refrigerator? Forgetting newly learned information or important dates? What about difficulty completing familiar tasks, like preparing a recipe that was mastered long ago? All are warning signs of cognitive impairment.
To determine if your suspicions of memory loss in your loved one require further exploration by medical professionals, first review the 10 signs of memory loss and early Alzheimer’s or dementia from the Alzheimer’s Association. Then, help them take advantage of one or more of the free, at-home cognitive tests developed by doctors available online.
Free tests to measure cognitive impairment
“Online tests are best when deciding whether you need to seek a professional evaluation,” said neurologist Hurmina Muqtadar, MD, with the Illinois-based Edward Neurosciences Institute. “If you think a loved one has memory problems, a good screening tool to begin with is SAGE.”
Developed by the Department of Neurology at Ohio State University, SAGE is a downloadable, pen-and-paper self-assessment that covers all aspects of cognition – memory, problem-solving and language – to detect early impairment. Studies show this test is 95% effective at identifying memory challenges.
On average, it takes about 10 to 15 minutes to complete the four-page test, but there is no time limit. Your loved one may be asked to draw an analog clock that displays a specific time. An accurate clock indicates the absence of dementia; an abnormal clock suggests further testing is necessary. (This test is also available as a stand-alone test, called the Alzheimer’s Clock-Drawing Test.) The test might also ask them to identify commonly known animals and calculate basic math problems. You can bring the completed test to your loved one’s doctor’s appointment. Your physician will score it for them, discuss the results and determine if further exploration is needed.
“It gives us an idea of the status of their memory and cognition,” Muqtadar said. “Early diagnosis [gives patients] the benefit of starting treatment early and delaying the progression of the disease.”
Mini-Mental Status Exam (MMSE)
The home version of MMSE takes about 10 minutes to complete on your smartphone, computer or with pen and paper. It can be administered and scored by a family member, but you’ll need a doctor to review the results. According to Dementia Care Central, MMSE is a 30-point test that measures a person’s thinking ability or cognitive impairment, including:
- Orientation to time and place (your loved one knowing where they are, the season or day of the week)
- Short-term memory (recall)
- Attention and ability to solve problems (like spelling a simple word backward)
- Language (identifying common objects by name)
- Comprehension and motor skills (drawing a slightly complicated shape like two pentagons intersecting)
Sample questions might be:
- What city, state and country are we in?
- Name three unrelated objects.
- Repeat the following: “No ifs, ands or buts.”
- What is this called? (Tester shows the subject a pencil or watch.)
A score below 24 is considered indicative of dementia, but it’s not used on its own to diagnose. A neurologist would consider it along with other test results, including brain scans, a neurological exam, an evaluation of medical history, and possibly genetic testing. It can be used by patients to screen for suspected dementia and by doctors to estimate the stage and severity of dementia. If taken annually, it can indicate changes over time, but it does have reliability issues: An educated person with dementia might score about 24, the test is not good at detecting early dementia, and low education (less than eighth grade) often contributes to misdiagnosis. Overall, studies have shown the MMSE is better at ruling out dementia than revealing it.
The Mini-Cog test checks word recall: Can the test-taker repeat the three words they just heard? Next, the administrator asks them to draw a clock and write in the requested time and, when they finish, recite the three words again. Someone without a cognitive impairment will be able to successfully complete all the tasks.
When to see a doctor
If any of these online tests raise a concern, you should see your loved one’s doctor and get them screened for Alzheimer’s and dementia.
“It’s a complex disease to diagnose,” said Melissa Tucker, director of family services with the Alzheimer’s Association, Illinois Chapter. “We want people to get the best information and best care that they can.”
If issues with memory are happening on a consistent basis and interfere with everyday functioning, Tucker suggests a visit to your loved one’s primary care physician or geriatric doctor for a complete diagnostic work-up – blood work, brain imaging, thorough psychological testing and a family history – to rule out treatable conditions that can present as memory loss, such as:
- Anxiety and depression – If older adults are stressed, they often cannot solve the problems; if they have consistent anxiety, their brain is not recording the information in the first place. A dementia workup should include a screening for depression because a depressed brain is not working well.
- Brain tumor
- Hormonal imbalance
- Over-medication – Drug interactions can negatively impact cognitive functioning.
“It takes time to get a diagnosis, but if you catch it early, it has a significant impact on you and your family,” Tucker explained. “Early diagnosis gives you more agency over your care. You can do advance planning, designate health care and financial power of attorney, say what care you want in the future, and take steps to maintain quality of life.”
Those steps might include crossing off items on their bucket list, adopting a healthy diet, taking medications that help the brain function longer, joining a support group and getting involved in a clinical trial.
The Alzheimer’s Association offers tips on its website for talking to your doctor and preparing for that initial appointment.