Will the Current Method of Cognitive Assessment Stand the Test of Time?

Last updated: January 2023

My grandma had a doctor's appointment recently, which included a basic cognitive screening questionnaire. Her answers indicated she is experiencing moderate cognitive impairment.

When she had these tests before, her inability to answer certain questions was a bit jarring, and she didn't like the psychiatrist or people who were asking her the questions, likely for this reason.

However, over the past few years, whenever certain aspects of the cognitive assessment come up, I always have questions because at certain times in my own life, for various reasons, I also may not perform well on the cognitive assessment. While I have ADHD, which has impacted my executive functioning, I don't think that it is always the full story of why that is.

Because of this, I have questions about if the current methods we use to assess someone's cognition will continue to be usable in years to come.

The culprit: Technology

I have what was once described as "severe" Attention Deficit Hyperactivity Disorder, so while I don't experience cognitive impairment, my brain is wired differently than many.

I'm generally moderately organized when it comes to commitments and appointments, less so when it comes to getting from point A to B (approximating time) and being able to find my stuff. However, I know when I need to be where because of technology, not because my brain is good at remembering stuff.

And why do we need to remember as much when it's at a glance? Those who work from home, have experienced unemployment, or heck, have gotten through the COVID-19 pandemic, and various stages of lockdown monotony have surely had to check, "Hold up, is it Wednesday or Thursday?"

Will the current way of assessing cognitive ability and decline remain relevant?

And this is where my question comes in.

A basic cognitive assessment will typically require a few different tasks depending on the test used. Tests can vary in length, but screening tests are often 5 to 10 minutes long and include different areas of cognitive function.1,2

Key aspects here include orientation. Understanding the context the person is in: where they are, what day of the week it is, who others in the room are, and the time of day. Plus, memory, which includes word recall, conversation, comprehension, ability to use language, and identify objects. These things are assessed as a whole to give a picture of a person's level of cognitive impairment, if any.1,2

Making the case

When I've spoken about these tests with my family, we've all agreed that certain questions may pose problems some days, too!

Case in point: the days of the week question. Fortunately for us, we would have gotten ourselves to the appointment after all. I've wondered if the monotony of the pandemic and lockdowns has accelerated the decline for people with, and even without, dementia as events weren't available to them.

Maybe the church they visited every Sunday was shut down, they no longer went for coffee Monday, Wednesday, and Friday mornings, and they didn't have lawn bowling on Tuesday at 3, or Saturday Night Football was canceled on TV? And, of course, what's the point of keeping track of the days of the week if nothing is happening?

My experience with cognitive testing

In 2013, when I was being tested for ADHD, the process began with a cognitive assessment. I did fine, other than my inability to draw a clock correctly. I never did learn to read an analog clock properly, likely due to my undiagnosed visual memory and processing issues, but I know I'm not the only one my age with this challenge.

Based on this, does the clock drawing get the axe in the future? My memory testing indicates that all my memory scores were not great, but my auditory memory is way better than my visual memory. But, if I didn't remember the words given to me in the word recall part of the Mini-Cog test (totally possible!), well...

Not all tests are created equal

Not all parts of the tests are created equal, of course. Some signs and changes to functional ability are, of course, bigger red flags than others. But it does make me curious how and if cognitive assessment methods change in the next 25 to 50 years!

What are your thoughts on the current cognitive testing methods? Do you foresee changes being made to address shifts in how (currently!) younger individuals think and interact with the world? I'd love to hear your thoughts in the comments!

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