Cognitive Testing

Could you be over- or under-estimating the extent of your cognitive issues?  Over-estimating the extent of cognitive blips puts people in a state of undue worry.  Under-estimation comes with the risk of not getting treatment at an early neurodegenerative stage when the Bredesen ReCODE Protocol™ is most effective at reversing cognitive problems. 

Some people have a family history of dementia or genetic predisposition for Alzheimer’s disease that makes them understandably anxious about their future.  A sensitive, clinically-validated cognitive assessment can measure your cognitive functioning relative to others your age and help determine whether further neurological evaluation is warranted.   Therefore, whether or not you are aware of any memory or cognition troubles, Dr. Dale Bredesen recommends that everyone over the age of 45 years gets a cognitive assessment.  Getting an objective, quantitative, baseline measure of your cognition is a valuable part of a “cognoscopy” for future comparison before any significant cognitive problems arise.   Results of average or typical functioning can be welcome news.

When people report that they’re “not quite right” or “having senior moments“, Dr. Bredesen elucidates, based on his vast experience, that there’s usually something wrong and the underlying pathology should be addressed as early as possible.  Early, subtle abnormalities in cognition commonly go on for a decade before a medical diagnosis of mild cognitive decline.

Others are simply unaware of gradual cognitive declineDenial can be merciful when you’re not ready to face a diagnosis of something like pre-Alzheimer’s, especially when you don’t yet appreciate the promise of treatment and evidence of efficacy of the Bredesen Protocol™ or you’re not ready to take on the demands of this extensive holistic therapy. 

Cognitive impairment is not narrowly memory loss.  I hear people report a subtly slowed pace of thinking, difficulties articulating, an attenuated ability to figure things out, word choice errors, and other nuanced alterations below previous cognitive functioning.  Many of the quick, cheap cognitive tests do not detect the earlier signs of impairment.

cloudyMeasuring where you stand cognitively will guide your best path forward toward optimal vitality and cognitive clarity.  Despite agreement with this statement, most people are understandably hesitant to take a cognitive test.  Emotions vary from subtle apprehension to pained anxiety over the possibility of not performing well.  Recognizing cognitive decline could jeopardize how a person sees themself and their future.  Tuning out signs of cognitive declining can seem less burdensome in the short-term; nevertheless, identifying impairment as early as possible potentiates a far better outcome over the long-term. 


Braving the test

I always try to ease a person’s mind before administering  a cognitive test–most commonly the MoCA or CNS-VS tests described below.  Oftentimes, those who start out nervous end up breezing through a MoCA test.  Other times, those who initially describe their memory issues as quite modest perform in a way that reveals much more significant cognitive impairment.   The CNS-VS is a more sensitive assessment designed to be cognitively challenging for everyone; thereby, nearly everyone doubts their performance while taking the CNS-VS—those who are young, high-functioning and healthy as well as those who are older and cognitively-impaired.  Cognitive tests are meant to gauge age-matched cognitive functioning and are NOT designed as a measure of intelligence.   I try to help people do their best without wasting mental energy on self-judgment about their performance.

The bottom line: We need to test and not guess.   That’s why I offer cognitive testing with my individual PreCODE/ReCODE™ health coaching and group coaching.   I also offer private cognitive testing within a single paid consultation for PreCODE/ReCODE™ subscribers.  (To ensure that individuals will be embraced by appropriate medical follow-up in the event of a lower score, I do not offer stand-alone cognitive testing to the general public.)


Bredesen ReCODE Protocol™ Cognitive Assessment Options


The MoCA (Montreal Cognitive Assessment) is a quick screening test for Mild Cognitive Impairment (MCI) when a person reports memory or cognition problems.  It takes a practitioner about 15 minutes to administer the brief MoCA examination of memory performance, executive function, calculation, and verbal function.  Although a MoCA score of 26-30 is considered normal, Dr. Bredesen considers a score below 28 to be cause for further follow-up. 

If you relate concerns about memory loss to your doctor,  you may receive the MoCA test through your health insurance.  I’m also able to provide a MoCA test during a coaching sessions or consultation, either over videoconference or in-person (or by phone when that’s the only option).  MoCA results from our meeting are your private record and never shared anywhere else without your explicit authorization.  Although it’s a simple test, a trained professional needs to carefully administer and score a MoCA in a standardized, repeatable manner for the score to be accurate and useful to compare changes over time.   I am MoCA-certified to deliver reliable test scoring.  Unfortunately, I have seen numerous self-administered MoCA scores wildly mismatched from the person’s actual cognitive status, giving them a false impression. 


CNS-VS (Central Nervous System-Vital Signs) is an online test you take from the comfort of your home or in the clinic.  The CNS-VS test is more appropriate for those at the stage of prevention, for people with subtle cognitive concerns, and for high achievers likely to preform perfectly on the MoCA despite cognitive functioning below their previous norm.  The CNS-VS test can detect signs of Subjective Cognitive Impairment (SCI) that the MoCA won’t pick up.  It takes about a half-hour to evaluate fifty evidence-based markers of cognitive functioning. 

I make the CNS-VS full report of age-matched performance in twelve cognitive domains available to anyone who I see in a coaching session or consultation.  I’ve completed basic training with CNS-VS to help you understand your report.   I currently charge an add-on fee of $45 for the CNS-VS–$40 is required to directly pay CNS-VS for each online test.   While my time arranging the test is worth more than $5, I subsidize the test expense because I value an objective, detailed, clinically-validated measure of cognitive functioning for guiding better therapeutic decisions going forward

Note that a subscription to Apollo Health’s ReCODE™ or PreCODE™ includes access to CNS-VS tests or shorter NeuroQ tests, respectively.  If not subscribed to Apollo Health, the $45 CNS-VS fee added to a consultation or coaching will include the full CNS-VS Report  (while Apollo Health charges $35 for the full CNS-VS Report).   The CNS-VS report can help the person considering PreCODE™ or ReCODE™ or other options, due to family history of dementia, other risk factors, budget concerns, readiness, etc., make a more informed decision.

Other Options

The Saint Lous University Mental Status (SLUMS) Examination is a brief cognitive assessment designed to distinguish between normal cognition and mild cognitive impairment or dementia.  It is similar to the MoCA described above.  I administer the SLUMS upon request, but prefer the more widely recognized and utilized MoCA.

A full neuropsychological examination is a more comprehensive option referred by your doctor.  It entails a multi-hour extensive cognitive evaluation of multiple cognitive domains. 

In addition, a quantitative magnetic resonance imagery (MRI) scan of brain anatomy is often recommended as part of your “cognoscopy”.   A NeuroQuant or NeuroReader quantitative analysis of the MRI provides relative volumetric measurements that additionally help with brain health diagnosis and tracking progress over time.   If you are at high risk of dementia, talk with your doctor about whether a quantitative MRI, FDG-PET, Amyloid-PET, or quantitative EEG is a needed diagnostic test in conjunction with a cognitive assessment.

Other quick, simple assessments for mild cognitive impairment (MCI) or Alzheimer’s include the MMSE, Cogstate, ADAS-Cog, and ACE-R.

For a loose cognitive gauge, you can get an overall percentile result of memory and executive functioning for your age with a paid subscription to the brain training applications BrainHQ or Luminosity.  These brain games provide some feedback on cognitive performance, but neither are clinically-validated tests such as the MoCA and CNS-VS.

The Alzheimer’s Questionnaire known as the AQ-21 is a clinically-validated tool to help distinguish normal cognition from memory issues associated with Mild Cognitive Impairment.  Your significant other answers 21 yes/no questions on the AQ-21.  Sum up the points to get a total from 0-27, with higher scores reflective of cognitive dysfunction.  A score of 0-4 is generally regarded as no cause for concern.  Dr. Bredesen recommends follow-up on any who score 3 or above.  If interested, here’s a link to the AQ-21 for a spouse or loved one to provide input.

Overall, choose the cognitive test with the dynamic range appropriate to the degree to which you’re experiencing cognitive issues.

Kudos to all who have braved cognitive testing

woman sitting on mountainPlease do not boot-strap the Bredesen ReCODE Protocol™ on your own without completing a cognitive assessment.  Sweeping memory or cognitive issues under the rug without proper evaluation jeopardizes your future.  Uninformed people may falsely attribute your concerns to “normal aging” when they could be early symptoms of underlying pathology that needs treatment.

A perfect MoCA score can be cause for celebration.  Nonetheless, it doesn’t rule out subclinical cognitive impairment below your previous high functioning.  The MoCA is not a sensitive of a tool–consider taking the CNS-VS.  If you cannot confidently say that you’re happy with BOTH your cognitive test results AND with your brain fully functioning in daily life, then it’s time to consult a doctor for further evaluation

If your results confirm your good fortune at the stage of prevention, please keep it that way through brain healthy diet and lifestyle through your own diligence or with professional guidance

If a cognitive assessment reveals  impairment, Dr. Bredesen explains that there’s always a reason for memory and/or cognition losses.  Cognitive symptoms need a medical work-up and diagnosis to check for  guide an effective course of treatment.   The full Bredesen ReCODE Protocol™ with guidance from a ReCODE Report™ and ReCODE Qualified™ practitioner is the best and only treatment demonstrated to reverse subjective cognitive impairment, mild cognitive impairment, and early stage Alzheimer’s Disease (K Toups et al 2021).  If cognitive impairment is revealed, I hope you’ll begin the journey toward reversal.