Assessing Dementia Risk And Progress
In this lesson we will be covering 3 different types of tools for assessing (1) Risk for dementia, (2) Biological vulnerabilities, and (3) Ability and Progress, as well as 6 different tools you can use. To watch a video just click on the link for a YouTube private viewing on each subject.
Functional Ability and Pre-Post Tests
Once you have identified individuals at risk for significant cognitive decline or dementia there are a variety of valid and reliable instruments you can use, at no cost, to measure their ability levels, i.e. the depth of functional impairment if any, or the severity of symptoms. These are not intended to diagnose, or treat any disease or disorder, but rather to help you and them identify their ability levels, to establish a baseline to measure functional or symptom improvements or progress.
There are 6 good tests we suggest you consider for assessing functional status, and measuring progress. Two of these are paper pencil tests, a third can be done either by computer or printed off to be completed via paper, pencil. The other three will require a computer. One of these is free, the other two come with either BrainHQ or Cognifit as part of a Personalized Brain Fitness program. These later tests are also the most comprehensive, and sensitive to changes.
We would encourage you to use two or more of these with every person you see for the reasons noted above.
Trails_Think_Test_(2) is perhaps the quickest and easiest tool for conducting a valid test of one’s cognitive ability. All that is required here is a copy of the test, a watch, pencil or pen. This is a simple connect the dots, timed activity. It comes in two forms: “A” which is a simple timed test to see how fast they can connect 25 numbers scattered across a page. (This should not take much more than 90 seconds.) And “B” which requires them to connect both numbers and the alphabet, in order, alternating back and forth. (This should not take much more than 3 minutes.) These are both standardized tests, meaning that we know how long it takes the average person to complete these. And processing speed is a good indicator of brain health, as the brain tends to slow down with age and cognitive decline. So this becomes a quick, easy, valid way of measuring how well they perform on this task in comparison to other adults.
If they are high functioning I usually begin with part B. If they are older, or have some impairments it may be best to begin with part A, and see how well they do on that first.
The test sample linked to above for download was developed at UMass-Lowell, to be used as a pre and post test in conjunction with their nutritional formulation, used in half a dozen clinical trials to reverse symptoms of cognitive decline, called Perceptiv™. As you will see this comes with a simple set of instructions. If you would like to subtly advertise that supplement you can use this with their logo. If not you can start with page 2, or use the generic version linked to below.
Here’s another generic set of instructions for that. http://doa.alaska.gov/dmv/akol/pdfs/uiowa_trailmaking.pdf
MoCA (Montreal Cognitive Assessment)-Test-English is another simple, valid, paper pencil exam. As you will see this is a compilation of mini versions of several other cognitive tests beginning with a short version of the Trails test part B.
The next test requiring them to copy on paper a three dimensional box, test spatial abilities, as does the clock test which comes next. Which is another good valid assessment of various cognitive abilities including memory. Other segments include vocabulary recall, a test of one’s ability to make lasting memories, retain numbers, verbal statements, abstractions, basic math, attention and orientation in time. All in about 15 to 20 minutes.
Normal high functioning adults should have little problem with these various quizzes, however, you may be surprised. As many people who can carry on a normal conversation, will have a surprisingly difficulty time with some of these tasks.
For instructions on what to say, how to conduct and score this simple test click on this link MoCA-Instructions-English
Here’s a website for more info. but you will likely have to pay to use this version. But it’s not that hard. See instructions above. http://www.mocatest.org/ or here below: http://www.mocatest.org/wp-content/uploads/2015/tests-instructions/MoCA_alt_version_3_English-instructions-June_13_2011.pdf
For a comparison with a more popular screening tool called the mini mental which most MD’s use See also http://www.todaysgeriatricmedicine.com/news/ex_012511_01.shtml
The SAGE (Self-Administered Gerocognitive Exam) is a set of downloadable paper pencil tests designed at Ohio State University “to detect early signs of cognitive, memory or thinking impairments.” In some ways it is easier and in other ways more difficult than the MOCA, but it’s a good valid test, especially for any you are working with remotely, who would be able to download a test from the internet. Go to the link above to learn more.
MyBrainTrainer.com is a simple free online test purported to measure one’s brain age and brain power. When you go there you will notice that it asks for an email address and password. That is for those who would like to practice with their simple activities, but taking their quiz does not require a login. All you do is click on the third box down in the middle titled: Let us calculate your brain age and brain power. On the next page you can read more about what those measure, and how to obtain a reliable base score. Then click on your age category in the pull down next to age, and Proceed to test instructions. Again this is a fairly basic test but it is both a valid and reliable measure of cognitive abilities. You will get two practice runs. After your third run you will receive a score and a ranking to see how your score compares with all others and others in your age group.
Those taking these test at home should be directed to write these down and then send them to you for their baseline record.
Other measurements of cognitive ability and progress can be provided, on a regular basis for those who have a computer, through BrainHQ and Cognifit Personal Trainer. This is the ideal for those working on cognitive enhancement, or brain health, as they will enable them to track their progress on a daily basis if needs be. Thus you and they will be able to determine more easily what is helping and what is not.
The additional lessons in this module will be posted shortly.