Is There More Than One Screening for Dementia? Does It Matter Which One I Take?
There’s not an official statement or agreement among experts about which screening is the best; the most important thing is to get screened, says Cleveland. “And that can be once you turn 65 or maybe earlier if you have a family history of dementia or Alzheimer’s disease,” she says.
The more widely used screening tools typically take 10 minutes or less and include the Mini-Mental State Exam, Montreal Cognitive Assessment, Mini-Cog, and Saint Louis University Mental State Exam.
What’s Involved in a Cognitive Screening?
The screening will be given by a healthcare provider — usually a doctor or a nurse — and there’s nothing you need to do to prepare for the screening.
The Mini-Cog is basically two parts: Your provider will give you three words and ask you to repeat them back a few minutes later. Then they will have you draw a circular clock with the hands pointed to a specific time.
Cognitive screening tests check different areas of brain function, including orientation (date, where you are, your name), attention and short-term learning, short- and long-term memory, concentration, and the ability to use and understand language, according to the Cleveland Clinic.
Are There Online Screenings That Can Be Performed at Home?
The Self-Administered Gerocognitive Exam (SAGE) is a brief written screening tool designed to detect early signs of cognitive, memory, or thinking impairments, and it can be taken at home. Unlike other assessments, it doesn’t require an experienced or trained professional; you just need to be able to print out the test.
“People can take this test if they or a loved one notices that they are a little more forgetful than they used to be. It’s a helpful tool to assess if further evaluation is necessary,” says SAGE creator Douglas Scharre, MD, the director of the division of cognitive neurology at The Ohio State University Wexner Medical Center in Columbus.
The test takes about 10 to 15 minutes, and it measures a wide range of cognitive domains, such as orientation, language, reasoning, and memory. There is no answer key or scoring provided. After completing the test, you need to take it to your primary care doctor, who can score the test, interpret the results, and decide if you need further evaluation.
What Are the Next Steps After Cognitive Testing?
If your results indicate some level of cognitive impairment, more testing will be necessary to learn more about what’s causing it, says Cleveland. “Those will likely be performed by your primary care doctor,” she says.
Mild cognitive impairment doesn’t always mean that you’re going to get dementia. About half of people who have mild cognitive impairment have it for some other reason than the foreshadowing of dementia, says Cleveland.
One of the first steps to determining a cause is ususally looking at all the medications that a person is taking. “Sometimes it’s a medication that’s causing the cognitive issue. A common example is the antihistamine drug meclizine; it seems to affect memory in some people,” she says.
Thyroid issues, sleep issues, and vitamin deficiencies — especially vitamin B12 deficiency — can also cause cognitive problems, says Dr. Scharre. “If an underlying cause is identified and treated, the impairment will likely improve,” he says.
In some cases, a brain scan might be performed. “We’re looking for any evidence of small strokes, inflammation, tumors, infections, structural issues — any of these could be causing a person to not be thinking as well,” says Scharre.
What if I’m Diagnosed With MCI?
In some people, further testing will lead to a diagnosis of MCI. This is the space between expected cognitive decline that comes with aging and the more serious decline of dementia, says Cleveland.
Common signs of MCI include losing things more often than normal, forgetting appointments, or having trouble finding the right words. It can be easy to miss or to mistake for normal signs of aging, even by doctors. One study that examined Medicare data found that only about 8 percent of the 8 million people with MCI the researchers expected to find in these health records were actually there — meaning that more than 9 in 10 people with MCI may not realize they have it.
Although having MCI increases your risk for eventually developing dementia or Alzheimer’s disease, the symptoms of MCI can stay the same or even improve, according to the National Institute on Aging.
Your doctor can recommend lifestyle measures that may help slow any further cognitive decline.
Expert Lifestyle Recommendations for Brain Health
Scharre recommends good sleep, socialization, physical exercise, and good nutrition for brain health. “Sleep is very important. It seems to be a time where we remove toxins from our brains,” he says.
For the social piece, this can include chatting with people, interpreting information, and discussing issues, he says. “Your brain is like your muscles: Use it or lose it,” says Scharre.
“The best brain-healthy diet seems to be a Mediterranean-type diet — less red meat, more fruits and vegetables,” says Cleveland.
Both the MIND (Mediterranean-DASH Intervention for Neurogenerative Delay) and Mediterranean diets are associated with fewer signs of Alzheimer’s disease in the brains of older adults, according to a study funded by the National Institute on Aging.
Of all the lifestyle modifications, exercise has the strongest evidence. A review of 65 studies found that exercise was the most promising lifestyle intervention — meaning it improved various cognitive functions — for both MCI and dementia, and was most effective in MCI.
Talk With Your Doctor About Medications for Cognitive Impairment
Medications may help with MCI and early Alzheimer’s disease, says Cleveland. “These may help a certain segment of the population. This is a decision that can be made in partnership with your doctor,” she says.
Options include lecanemab (Leqembi) and donanemab (Kisunla), which was approved by the U.S. Food and Drug Administration in July 2024. Both drugs remove beta-amyloid from the brain, the accumulation of which is associated with damage to the brain in Alzheimer’s disease.
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