Cognitive Testing

Are you someone who doesn’t know if you’re over- or under-estimating the extent of your cognitive issues?  Under-estimation comes with the risk of not getting treatment at an early neurodegenerative stage when the Bredesen Protocol™ is most effective at reversing cognitive problems.  Over-estimating the extent of cognitive blips puts people in a state of undue worry.

Based on his vast review of numerous cases, Dr. Bredesen tells us that when people say they’re “not quite right” or “having senior moments”, there’s usually something wrong.  To know where you stand, you need a clinically-validated cognitive assessment with a dynamic range appropriate to the degree to which you’re experiencing cognitive issues.

On the prevention side, getting an objective, quantitative measure of your cognition is a valuable part of a “cognoscopy” for future comparison before any significant cognitive problems arise.   A cognitive assessment will help determine whether further medical evaluation is warranted.  Even if you aren’t aware of any memory or cognition troubles, Dr. Bredesen recommends that everyone over the age of 45 years take one of the cognitive assessments below.  

cloudyTotally understandably, most people are 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 stressful in the short-term, but identifying impairment as early as possible potentiates a far better outcome over the longer term.  Early diagnosis and implementation the Bredesen Protocol™ provide the best chance for reversing symptoms.

I always try to put a person’s mind more at ease before administering  a cognitive test.  Oftentimes, those who start out nervous end up breezing through a MoCA test.  On the other hand, sometimes, those who initially describe their memory issues as quite modest perform in a way that reflects much more significant cognitive impairment.  The bottom line: We need to test and not guess.  The results will match your healthcare to your condition.


Clinically-Validated Cognitive Tests


The MoCA (Montreal Cognitive Assessment) is a simple screening test for Mild Cognitive Impairment (MCI).  It takes a practitioner about 15 minutes to administer the MoCA sample of memory performance, executive function, calculation, and verbal function. MoCA scoring is 0-30 with a score of 26-30 considered normal.  Dr. Bredesen’s optimal range is 28-30. 

If you speak with your doctor about memory loss, insurance could cover this test.  I am MoCA-certified and provide the option for a MoCA test during any of my coaching sessions or consultations, 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 provided anywhere else without your explicit authorization.  Although it’s a simple test, a trained professional needs to carefully administer and score a MoCA in the standardized, repeatable manner for the score to be accurate and useful to compare changes over time.  (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 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 30-40 minutes 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 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 know how important an objective, detailed (more than the MoCA), clinically-validated measure of cognitive functioning is for making good 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).   I make this offer because the CNS-VS report can be quite helpful to the person interested in prevention and considering PreCODE™ or ReCODE™ or something else, depending on family history, other risk factors, budget, readiness, etc.


Other options

A full neuropsychological examination plus quantitative MRI is a more comprehensive option when appropriate.  This entails a multi-hour extensive cognitive evaluation of multiple cognitive domains.  A magnetic resonance imagery (MRI) scan examines your brain anatomy.   A NeuroQuant or NeuroReader quantitative analysis of the MRI provides relative volumetric measurements that additionally help with diagnosis and tracking progress over time.   If you are at high risk of dementia, talk with your doctor about whether a neuropsychological exam and/or MRI is warranted.   Your doctor will determine if MRI, FDG-PET, Amyloid-PET, Quantitative EEG, CSF is a needed diagnostic 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 of cognitive performance, but neither are clinically-validated testing like 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 follows up on any who score 3 or above.  In case you’re interested, here’s a link to the AQ-21 for a spouse or loved one to provide input.

Kudos to all who have braved cognitive testing

woman sitting on mountainPlease do not boot-strap the Bredesen Protocol™ on your own without completing some sort of 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 you’re having early symptoms of underlying pathology that’s been untreated for years, perhaps decades.

A perfect MoCA score can be celebrated; nonetheless, it doesn’t rule out subclinical cognitive impairment below your previous high functioning.  The MoCA is not that 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 you are indeed fortunately in the prevention phase, you may be able to enhance your brain health via diet and lifestyle with through your own diligence or with professional guidance.   If instead your results reflect cognitive impairment that has already manifested,  the full Bredesen ReCODE Protocol™ is in order with guidance from a ReCODE Report™ and ReCODE Qualified™ practitioner.


If a cognitive assessment reveals a cognitive concern, please follow-up

Dr. Bredesen tells us that there is always a reason for memory and/or cognition losses.  Many of these causes cannot be fixed with diet and lifestyle alone and need medical intervention.  About 40% of dementia is not due to Alzheimer’s etiology.   Besides the gradual onset of Alzheimer’s disease, memory loss can be due to Lewy Body dementia, Parkinson’s disease, Huntington’s disease, excessive alcohol use, brain tumors, adverse effects of prescription drugs, head injury, and/or other causes.  Cognitive symptoms need a medical work-up and diagnosis to guide an effective course of treatment. 

Please measure where you stand cognitively to guide your best path forward toward optimal vitality and cognitive clarity.