- President Donald Trump recently said he took a cognitive test. He previously completed the Montreal Cognitive Assessment (MoCA).
- The MoCA is a brief screening test used in hospitals to check for delirium or cognitive impairment.
- Even if someone passes a screening test, it’s not a guarantee their brain is functioning optimally.
Last week, cognitive testing made headlines after President Donald Trump announced he’d taken a test to assess his cognition.
According to Trump, results implied he wasn’t experiencing any sort of cognitive impairment.
Trump hasn’t disclosed the type of cognitive test he recently took, but he previously completed the Montreal Cognitive Assessment (MoCA), a brief screening test used in hospitals to check for delirium or cognitive impairment.
Here’s what to know about cognitive testing, what it looks for, and how it works.
Understanding cognitive testing
Screening tests — such as the MoCA and other tests, like the Mini-Cog and Mini-Mental State Exam (MMSE) — are helpful in gauging whether a person needs further cognitive testing.
But even if someone passes a screening test, it’s not a guarantee their brain is functioning optimally.
Typically, it takes a comprehensive neuropsychological assessment conducted by a trained professional to identify whether someone’s experiencing impairment.
Here’s what to know about the different types of cognitive tests.
What are cognitive screening tests, like the MoCA?
The MoCA typically takes around 10 minutes and involves simplistic tasks designed to screen for impairment in an individual.
The Mini-Cog and MMSE are two other quick screening tests used to determine whether someone’s cognition may be off due to a health issue like dementia, delirium, stroke, or even a head injury.
Brittany LeMonda, PhD, a senior neuropsychologist at Lenox Hill Hospital in New York City, says these sorts of tests are often administered in hospital settings by a nurse or physician who may not always have a background in brain sciences.
Screening tests are mostly used to quickly determine whether someone has any brain dysfunction and if they need additional diagnostic testing.
“There are standardized scores for these tests, which illuminate if an impairment in one or more cognitive domains is significant and warrants further testing and treatment planning,” said Sarah McEwen, PhD, director of research and programming for the Pacific Neuroscience Institute at Providence Saint John’s Health Center.
Past research suggests they shouldn’t be used alone to diagnose neurodegenerative disorders.
The threshold for gauging any sort of dysfunction is so low, according to LeMonda, that the tests don’t give too much insight into what’s going on.
“If someone performs poorly, then that’s really an indication that there’s some kind of brain dysfunction. If someone performs well, it doesn’t necessarily rule out an underlying brain issue, because the cut-off scores are so high,” LeMonda told Healthline.
Because the tests are so basic, a high score doesn’t always mean there are no impairments, LeMonda adds.
Cognitive screening measures like the MoCA also don’t reveal why the impairment is there or exactly where it is.
How do neuropsychological assessments work?
The gold standard for evaluating a person’s cognitive state is a neuropsychological assessment, according to LeMonda.
This is far different from a simple cognitive test.
LeMonda says these are “much more thorough, comprehensive standardized assessments” that must be completed by a trained brain behavior professional.
These assessments, which can only be accessed by a licensed clinician, can take anywhere from 3 to 7 hours and involve a wide variety of brain functioning tasks: attention, motor skills, spatial functioning, reasoning skills, working memory, learning, language, and recall.
They can also look at how someone’s mood affects their cognition.
“A true neuropsychological evaluation will also look at mood components and personality components that can influence our cognitive functioning,” LeMonda said.
The results for these types of extensive exams are then compared to data representative of people with the same age, gender, and years of education, according to McEwen.
Each individual test doesn’t indicate whether someone has a cognitive impairment, but rather the neuropsychologist looks for certain patterns across all the tests administered.
Those patterns can shed light on what part of the brain may be functioning suboptimally — and that informs what the diagnosis might be.
Neuropsychological assessments yield different results depending on the patient, says LeMonda.
Sometimes they show someone is dealing with mild cognitive impairment, a precursor to dementia, or different types of dementia.
They can also identify how epilepsy is affecting brain function, or if someone had a stroke in the brain’s left hemisphere.
They’re used on concussion patients to measure their injury, and can identify neurodevelopmental disorders like attention deficit hyperactivity disorder (ADHD).
Some older adults may sometimes have pseudo-dementia, in which they present with dementia-like symptoms that are caused by depression rather than dementia.
The tests can also help predict whether a person may eventually experience cognitive impairment.
“Results from neuropsychological testing may also be useful in identifying normal individuals who are likely to progress to mild impairment,” McEwen said.
Depending on the findings, doctors can tailor certain therapies or medications for the patient.
The patient will also be tracked and repeatedly examined so doctors can monitor the progression of their condition, according to McEwen.
Neuropsychological assessments provide a clearer picture
Brief screening measures like the MoCA or Mini-Cog can help identify whether cognitive changes are occurring.
McEwen says there are several cautions against relying solely on these types of brief screening tests to evaluate a person’s overall functioning.
“There are much more extensive tests that are typically done if we’re actually going to try to identify real brain disease or impairment,” LeMonda said.
The best way to identify cognitive impairment and brain dysfunction is to complete a comprehensive neuropsychological assessment conducted by a neuropsychologist
“A detailed clinical and medical history is required in addition to neuropsychological testing to better determine the primary cause of the cognitive impairments, including knowing any underlying physiological or genetic abnormalities or acute trauma that may have caused the cognitive disturbance,” McEwen said.
The bottom line
Cognitive screening tests — such as the MoCA and other tests like the Mini-Cog and Mini-Mental State Exam (MMSE) — can be helpful in gauging whether a person may have cognitive impairment and need further cognitive testing.
However, to make a diagnosis and understand where and why any impairment or brain dysfunction is occurring, a comprehensive neuropsychological assessment — which can take several hours — should be administered by a neuropsychologist.