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Simple Tests for Measuring Cognitive Impairment
New developments in brain imaging technology are significant advances in Alzheimer’s research and diagnosis. But some decidedly low-tech screening tests
may offer quick and inexpensive snapshots of a person’s cognitive health. Whether any of these tests is accurate enough to be used widely for screening remains to be seen, but one or several may be useful on an individual basis.
Clock Drawing Test. The Clock Drawing Test is the most well known of the screening tests for dementia. Patients are asked to draw a clock with the hands pointing to a specified time—for example, 2:45. The most complete,well-organized, accurate, and spatially correct drawing is rated a “10,” and the least representative is rated a “1.” The more distorted and inaccurate the drawings are, the more likely the person has dementia. 
Time and Change Test. This test measures the ability to tell time and perform a simple math task. In the time test, the patient is given 60 seconds to read the time on a clock and gets two attempts to get it right. In the change test, the person is given three quarters, seven dimes, and seven nickels and asked to make change for a dollar. The change test has a three-minute limit, and two attempts are allowed.
Sniff Test. Researchers have known for some time that loss of the sense of smell is an early warning sign of Alzheimer’s. The beta-amyloid plaques that ultimately destroy memory and other cognitive abilities accumulate first in areas of the brain that are responsible for perception of odors. In a paper presented at a recent meeting of the American College of Neuropsychopharmacology,people with mild cognitive impairment were given a 10-item sniff test. The odors were lemon, strawberry, pineapple, lilac, clove, menthol, smoke, natural gas, soap, and leather. Study participants who misidentified more than two of the odors were five times more likely to progress to Alzheimer’s disease than were those who performed better on the test.
More Quick Tests. If dementia is suspected, doctors may give a person several tests that examine specific cognitive abilities. To test language ability, the patient will be asked to name as many items as possible in a given category, such as fruits or animals. Naming fewer than 10 items in one minute suggests slowed mentalfunctioning. Counting backwards by sevens, spelling a word backwards and forwards, and listing the months of the year backwards are tests of working memory and attention. To test the ability to reason and plan, the doctor may ask the patient to describe similarities and differences between two items, such as an apple and an orange. Listening to a list of words and reciting them back is a common memory test. A person without memory problems should be able to remember at least three words. Often, the person will be given a distracting task to complete before recalling the words. Someone who cannot remember at least two words out of three may have cognitive impairment.
Bottom line: It’s important to realize that these are screening tests, not diagnostic tests. They are designed to be administered and interpreted by a healthcare professional. Poor results are an indication of probable cognitive impairment, but more sophisticated testing is necessary to make a diagnosis of Alzheimer’s disease.
Distinguishing Normal “Senior Moments” From More Worrisome Memory Lapses
Occasional memory lapses, such as forgetting why you walked into a room or having difficulty recalling a person’s name, become more common as we approach our 50s and 60s. It’s comforting to know that this minor forgetfulness is a normal sign of aging, not a sign of dementia. But other types of memory loss, such as forgetting appointments or becoming momentarily disoriented in a familiar place, may indicate mild
cognitive impairment. In the most serious form of memory impairment—dementia—people often find
themselves disoriented in time and place and unable to name common objects or recognize oncefamiliar people. The chart below gives examples of the types of memory problems common in normal age-related forgetfulness, mild cognitive impairment, and dementia.
Normal Age-Related:

Sometimes misplaces keys,
eyeglasses, or other items.
Momentarily forgets an acquaintance’s
Occasionally has to “search”
for a word.
Occasionally forgets to run an
May forget an event from the
distant past.
When driving, may momentarily
forget where to turn; quickly
orients self.
Jokes about memory loss.
Mild Cognitive Impairment:

Frequently misplaces items.
Frequently forgets people’s
names and is slow to recall
Has more difficulty using the
right words.
Begins to forget important
events and appointments.
May forget more recent events
or newly learned information.
May temporarily become lost
more often. May have trouble
understanding and following
a map.  Worries about memory loss.
Family and friends notice the

Forgets what an item is used for or
puts it in an inappropriate place.
May not remember knowing a
Begins to lose language skills. May
withdraw from social interaction.
Loses sense of time. Doesn’t know
what day it is.
Has serious impairment of shortterm
memory. Has difficulty learning
and remembering new information.
Becomes easily disoriented or lost
in familiar places, sometimes for
May have little or no awareness of
cognitive problems.