Why you should get a cognitive assessment, and what to expect
In the waiting room for his annual physical, Jim Gulley marked “memory concerns” on his pre-appointment paperwork. He quickly scribbled it out, not sure he was ready to broach the subject with his doctor. But his physician noticed the crossed-out item and asked, “Are you sure there isn’t anything else you want to talk about?”
Jim finally admitted that he had concerns about his memory, which prompted a series of tests and a referral to a neurologist. After further testing, Jim was diagnosed with Alzheimer’s.
The American Academy of Neurology recommends that adults aged 65 and older receive annual cognitive health assessments. However, according to a recent Alzheimer’s Association report, only 16% of seniors say they receive regular screenings for memory or thinking issues during routine checkups, unlike checks for blood pressure or cholesterol levels. These facts point to a major disconnect: Seniors expect their doctors to recommend testing, but doctors are waiting for patients or family members to report symptoms.
“Fear was holding me back,” says Jim. “I knew, going in the door, that things were going to change. I felt like I just wasn’t ready yet."
Physicians experience their own unique set of challenges. According to an Alzheimer’s Association survey, 94% of primary care physicians say it’s important to assess all seniors for cognitive impairment, yet report assessing only half. This was largely attributed to the absence of symptoms or complaints, lack of time during the visit, and fear of patient resistance.
“Some doctors may feel bringing up memory concerns will be embarrassing to the patient, or that the patient may get upset and choose to avoid the situation,” says Rainer Chan, M.D., chief medical officer for AdventHealth West Florida Division. “Doctors may also be focused on other health complaints that brought the patient there.”
One opportunity to assess cognitive function is through the Medicare Annual Wellness Visit, a yearly appointment with a primary care provider to create or update a personalized prevention plan. An assessment for cognitive impairment is a mandated part of the visit, but patients should ask for one if it isn’t offered.
“It all starts with awareness,” says Dr. Chan. “It’s helpful for patients to bring information about the Medicare Annual Wellness Visit with them and ask questions. It’s also helpful to bring a family member.”
Memory loss that disrupts daily life is one of the early symptoms of Alzheimer's. If you notice any signs in yourself or someone you know, please see a doctor.
Learn the Signs
For those who are experiencing problems with memory or thinking, getting checked by a doctor can help determine if it’s Alzheimer’s or some other — perhaps even treatable — condition. If Alzheimer’s is the cause, an early diagnosis allows the person living with the disease and their family to plan for the future, join support programs, access treatments that may lessen symptoms, or sign up for a clinical trial.
Ultimately, Jim is glad that he was proactive in getting a diagnosis. He put legal and financial plans in place to give his wife and children peace of mind, remodeled his bathroom to prevent falls, and started volunteering at his church. But most importantly, he talks to others about his experience.
“I was relieved by my diagnosis — even liberated by it. Because I didn’t have to hide," Jim says. "Now, I tell everyone who has similar concerns to go see your doctor as soon as you sense things are going awry. It’s only going to help you.”
What to Expect During a Cognitive Assessment
- The person experiencing symptoms, and a friend or family member accompanying them to the appointment, will be asked to describe any changes in memory or thinking.
- The doctor will ask about other health problems, current medications and any family history of memory issues.
- The person may be asked to perform a mental status test to evaluate their memory, ability to solve simple problems and other thinking skills. For example, the person may be asked to remember a short list of words or perform tasks like drawing a clock or doing basic math problems.
- The doctor may recommend additional tests or refer the person to a specialist.
- Most screenings during an annual check-up should take less than 10 minutes and are noninvasive.
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