Maybe you struggle to remember the name of the TV show you watched last night. Or you get lost on your way to the grocery store. It could be nothing. Age-related changes in memory are normal, and not all memory lapses are signs of serious long-term memory loss. An online memory loss test seems like an easy way to check—and it’s less frightening than calling a doctor.
There’s just one problem: The differences between normal forgetfulness, mild cognitive impairment (MCI) and dementia are hard to spot—and the tests aren’t reliable, says Cordula Dick-Muehlke, Ph.D. Dick-Muehlke is a licensed psychologist and founder of Cordula Cares, which helps organizations, professionals, lay audiences and everyday families develop, implement and research ways to enhance care for people with dementia.
A memory loss test is typically designed to ask about one thing: memory. But memory problems are often related to other health issues that may not be addressed by the test.
“There is a laundry list of things that cause confusion in the elderly,” Dick-Muehlke says, including medication side effects, vitamin deficiencies, tumors or infections in the brain, and mental health issues such as depression and anxiety. “Someone with a hearing problem could look like they have a cognitive problem, but if you improve their hearing, then the world is not confusing anymore.”
Without a doctor cross-checking, a false positive response becomes more likely. Thinking there’s a problem where there may not be could lead to major anxiety and the actual issue going untreated.
On the other hand, false negatives are also possible and could stop you or a loved one from seeking help. And if you’re actually experiencing memory loss or confusion, you might be using the test improperly.
“It may be tempting to use an online tool, but memory tests need to be administered by a physician or other trained professional,” Dick-Muehlke says. “We want to guard against people thinking they can interpret tools themselves. It’s too complicated.”
Warning Signs of Serious Memory Problems
Some kinds of memory problems are serious, but others are not. The changes in memory and cognitive ability that require professional attention are the ones that disrupt daily life, says Dick-Muehlke. Here are 10 signs and symptoms from the Alzheimer's Association.
- Memory loss that disrupts daily life
- Challenges in developing and following a plan or solving problems
- Difficulty completing familiar daily tasks
- Losing track of time or place
- Difficulty reading and understanding visual images
- Problems having a conversation or struggling when writing
- Losing things and being unable to retrace steps to find them
- Poor judgment and decision-making
- Withdrawing from hobbies and social obligations
- Becoming confused, easily upset or depressed
What to Expect in a Diagnostic Appointment
If you or your family members notice changes in your memory or thinking, start by visiting your regular doctor for a screening. One benefit is they know how you usually act and think, so it could be easier for them to spot changes in your cognition. Although a routine screening isn’t enough to diagnose dementia, it can determine the need for a diagnostic appointment.
Dick-Muehlke compares it to getting a mammogram or having a colonoscopy. “If you see something on a mammogram, you get feedback, not a diagnosis,” she says. “It’s the same with a memory screening. It’s only the beginning.”
Positive screening results warrant further evaluation, ideally with a neurologist who specializes in the diagnosis and treatment of Alzheimer’s disease and related dementias, Dick-Muehlke says. Your doctor may also refer you to a psychiatrist who specializes in disorders that affect mood or the way the mind works, or a psychologist with special training in evaluating memory and other mental functions.
To evaluate your memory and thinking, the specialist will likely go through four steps:
- Medical history and physical exam: In addition to asking about the history of your memory problems and how they’ve progressed, the doctor will assess your overall health, and ask about possible head trauma and drug and alcohol abuse.
- Lab tests: To help rule out other potential causes for your symptoms, your doctor may order blood work, request a urine sample or order a spinal tap to conduct a cerebrospinal fluid analysis.
- Mental health and cognitive status tests: Your doctor may conduct a screening for depression as well as a neuropsychological exam, which will help differentiate between what type of dementia you may have, such as Alzheimer’s disease, vascular dementia, Parkinson's disease or frontotemporal dementia.
- Brain imaging: Your doctor may order a variety of scans, such as computed tomography (CT scan), magnetic resonance imaging (MRI) or a positron emission tomography scan (PET scan), to look at the structure and function of your brain.
The Benefits of Early Screening
Some people—and their caregivers—are hesitant to mention memory issues because they fear a diagnosis of dementia and what that would mean for the future. But there are many benefits of finding out what may be causing cognitive impairment. If the screening is negative or if the cause of the memory issue is determined to be an underlying disease or condition, the health issue can often be treated and reversed.
If the screening is positive, patients can begin treatment that may help lessen symptoms, enabling them to maintain independence longer. There’s also a chance to participate in clinical studies that help advance dementia research.
Early detection also lets family members and caregivers recognize that a loved one who is having memory, thinking or behavior changes is not just being lazy, unusually irritable or withdrawn, but has a disease. “We see families that don’t really understand what is going on,” Dick-Muehlke says. “When there is an identification of the problem, it can really decrease family stress. While there is no cure for Alzheimer’s disease, there are medications that can help, and many resources and support services that can make it easier for families to cope.”
Assessing cognitive impairment at an early stage gives patients more time to plan for their future, whether it’s taking a trip they’ve always dreamed about or outlining wishes for long-term care. “There are so many reasons you want to be proactive instead of reactive,” Dick-Muehlke says.