Memory and thinking tests

Memory and thinking tests are short sets of questions and tasks. A doctor or nurse may ask you to remember a few words, draw a clock, or name the date. These tests are often the first step when you or your family notice changes in memory.

A test score alone cannot tell you that you have dementia.¹ It is one clue that the doctor puts together with your history, a physical exam, lab work and sometimes brain scans. This page explains the common tests, what the scores mean, and why things like language and schooling can change results.

Why doctors use these tests

Everyone forgets things at times. Memory tests help a doctor see whether changes go beyond what is expected with age. They check skills such as short-term memory, attention, language, planning and knowing the date and place.¹

You may get a brief test in these situations:

• A Medicare Annual Wellness Visit. This yearly visit includes a check for signs of dementia. If the doctor sees a possible problem, you can come back for a longer, more detailed visit.¹⁰ See the first doctor visit about memory.
• You or your family raise a concern. Telling the doctor what you have noticed is one of the most useful things you can do.

The U.S. Preventive Services Task Force (an expert panel that reviews screening tests) has not taken a side on testing older adults who have no symptoms. In 2020, it said there was not enough evidence to weigh the benefits and harms. An update is in progress.⁹ This is about people with no concerns. If you or your family have noticed changes, a check is reasonable.

The common short tests

These tests are quick. Most can be done in a regular office visit by a doctor, nurse or trained staff member.²

Sources for the table: Alzheimer's Association and test makers.^2,3,5,6,7,8

Mini-Cog

The Mini-Cog has two parts. You hear three words and try to recall them a few minutes later. In between, you draw a clock face with the hands set to a certain time.³

Each word you remember is worth 1 point. A normal clock is worth 2 points. A score of 0 to 2 means a higher chance of a real memory or thinking problem. A score of 3 to 5 makes dementia less likely, but it does not rule out all problems.³

Because part of it is a drawing, the Mini-Cog is less affected by language and schooling than many other tests.² It has been translated into more than 20 languages, including Spanish, Chinese, Vietnamese, Arabic, Hindi and Tagalog.⁴

MoCA (Montreal Cognitive Assessment)

The MoCA checks more skills than the Mini-Cog. These include short-term recall, attention, language, drawing a clock, simple reasoning, and knowing the date and place.⁵ It takes about 10 minutes, sometimes longer.⁷

A score of 26 or higher out of 30 is usually called normal. People with 12 or fewer years of school get 1 extra point.⁵ The MoCA was designed to catch milder problems. In the first study, it picked up about 9 in 10 people with mild cognitive impairment. The MMSE picked up fewer than 1 in 5 of the same people.⁷

The paper test is available in nearly 100 languages. There is also a version for people with vision loss and extra forms so that repeat tests do not use the same items.⁵

MMSE (Mini-Mental State Exam)

The MMSE is one of the oldest and most studied tests. It dates to 1975. It asks about the date and place, has you remember a few words, do simple math, and follow directions.^1,8

A score below 24 out of 30 is often used as a sign of possible impairment.⁸ In a review of 14 studies, the MMSE found about 9 in 10 people who had dementia, using a cutoff near 24.⁹ But it is less good at spotting mild problems. Many people with mild cognitive impairment still score near the top.⁸

MMSE scores are affected by age, schooling, reading skill and cultural background.² The current version is a paid, copyrighted test, so some clinics use other tests instead.⁸

SLUMS (Saint Louis University Mental Status Exam)

The SLUMS was created with the St. Louis Veterans Affairs medical center for adults age 60 and older. It is free for health and social service staff to use after training.⁶ It has 11 questions. They include the date, a money problem, naming animals, repeating numbers, a clock drawing, and remembering a short story.⁶

The cutoff depends on schooling. For people with a high school education, 26 or below suggests a possible problem. For people with less schooling, the cutoff is 24 or below.² It should not be given by phone or video, and usually not more than once a year.⁶

Other tools you may hear about

• Questions for a family member. Tools like the AD8 and IQCODE ask someone who knows you well about changes over time. The AD8 takes about 3 minutes.² These help when the person being tested does not notice their own changes. See when the person doesn't know they are ill.
• Tests built to be fairer across cultures. The RUDAS was designed for people from many cultures and languages. The 5-Cog uses pictures and a walking task and was built to depend less on reading.²
• Computer tests. Some computer-based tests have FDA clearance and are used in clinics.¹
• At-home or online tests. The Alzheimer's Association says home screening tests have not been proven accurate. They should not replace a visit with a doctor.¹

What a score means

A screening test is like a smoke alarm. It tells you to check further, not what is wrong.

• A low score means the doctor should look more closely. Many things can lower a score for a day: poor sleep, pain, worry, depression, an infection, a new medicine, or trouble hearing. Some causes of memory problems can be treated.¹ See treatable conditions that look like dementia and depression in later life.
• A normal score is good news, but it is not the last word. If you or your family still notice changes, ask for a more detailed check.³
• One score is a snapshot. Doctors often compare scores over months or years. A change over time can say more than a single number.¹³

If the test suggests a problem, the next steps may include blood work, a brain scan, blood tests for Alzheimer's, or a visit with a specialist.¹

Neuropsychological testing

A neuropsychological evaluation is a detailed look at how the brain is working. It is done by a neuropsychologist (a psychologist with special training in brain and behavior). Some tests may be given by a trained technician.¹²

What happens. The neuropsychologist reviews your records and talks with you. With your permission, they may also talk with a family member.¹² Then you do many kinds of tasks. These can include answering questions, paper-and-pencil tasks, computer tasks, and puzzles or blocks.¹² The tests cover memory, attention, language, reasoning, problem solving, visual skills and mood.^11,12

How long it takes. Most full evaluations take several hours. Some are spread over more than one visit.^11,12 Breaks are normal. Bring snacks, water, glasses and hearing aids.

Why it helps. Your results are compared with those of healthy people of about your age.¹¹ This can help:

• Tell normal aging from mild cognitive impairment or early dementia¹¹
• Point toward a type of dementia, such as Alzheimer's, Lewy body or vascular dementia¹¹
• Tell memory problems from depression or other mental health conditions¹¹
• Guide decisions about driving, decision-making and treatment¹¹
• Give a starting point to compare against in the future¹³

After the test. You get a written report and usually a meeting to go over results.¹² Ask what your strengths are, not just your weak spots. Ask for recommendations in plain words.

Doctors often suggest this testing when the diagnosis is unclear, or when care planning needs more detail.¹¹ For example, it may help when a short test is normal but worries continue. Ask your insurance plan about coverage before you go.

Language, culture and schooling can affect scores

Each test was built and checked with certain groups of people. It may not fit people from other backgrounds as well.¹³ That can lead to wrong results.

• Schooling and reading. People with fewer years of school may score lower even when their brain is healthy. That is why the MoCA adds a point and the SLUMS uses different cutoffs.^2,5
• Different groups may need different cutoffs. Experts say short tests can perform differently across racial, ethnic and education groups.¹³ For example, one study of African American adults found that a MoCA cutoff of 22 worked better than 26 for spotting mild cognitive impairment.⁷
• Culture. Some questions use pictures, words or ideas that are not familiar in every culture. Psychologists are asked to choose tests and comparison groups that fit a person's background.¹³
• Hearing and vision. Hearing and vision loss are common in later life and can lower test scores. Testers should make changes to help, such as a quiet room and large print.¹³ See hearing, vision and brain health.

Tests in other languages

If English is not your first language, ask to be tested in the language you think in. Many tests come in translated versions. The MoCA is available in nearly 100 languages, the Mini-Cog in more than 20, and the SLUMS in 23 translations.^4,5,6 Translated tests should be given by a trained person who speaks that language well.⁶

Health care providers that get federal money must offer language help for free. That includes medical interpreters.¹⁴ Ask for a trained interpreter when you book the visit. Try not to rely on a child or other family member to interpret. They may add hints or change words without meaning to. If an interpreter was used, the report should say so, because it can affect results.¹³

People who grew up speaking two or more languages may need a tester who understands that background. If a fair test is not possible, the tester should say so or refer you to someone who can do it.¹³

How to prepare for a memory test

It is normal to feel nervous. Tell the tester if you are tired, in pain or did not hear a question.

Questions to ask the doctor

What did the test show?

• What was my score, and what does it mean for someone with my schooling and background?
• Could something else, like sleep, mood, a medicine or my hearing, have affected it?
• Will you repeat the test later to compare?

What comes next?

• Do I need blood tests, a brain scan or a referral to a specialist?
• Would a neuropsychological evaluation help in my case?
• Does my insurance cover these tests?

Was the test fair for me?

• Was the test given in my best language?
• Should a trained interpreter or a bilingual tester be used next time?

For the full picture of the steps, see getting a dementia diagnosis. For Medicare coverage, see what Medicare covers in dementia.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.