It’s both gratifying and reassuring when readers leave comments reporting that they, too, are making errors similar to the ones I describe in a post. If you are of a certain age, you worry about these things. It’s nice for all of us to know that there is a community out there that embraces us.
But I don’t want to mislead anyone. Just because I am making mistakes that I can write about doesn’t necessarily mean that they are not a problem…for me or for you. You see, I don’t know whether what I’m describing is normal aging, a mild neurocognitive disorder or early signs of dementia. I don’t want to scare you with this blog, but neither do I want to give you a false sense of security.
So now would be a good time to talk about what it takes to determine where one actually stands. In other words, to make a diagnosis.
A diagnosis is a traffic light on the journey to nowhere. Normal aging is green: full speed ahead. A mild neurocognitive disorder is yellow: proceed with caution. Dementia is red: stop and revise your travel plans.
The first criterion for earning a diagnosis is that the mistakes are disrupting your life in a meaningful way. If they are occasional and only mildly irritating, then it’s probably normal aging. If they are more frequent, have actual negative but minor consequences, and you have difficulty compensating for them, then it might be a mild neurocognitive disorder. If the errors are significant, disrupt your daily activities, place you in danger, or you are unaware of them, then they might reflect the onset of a dementia.
Unfortunately, the above paragraph isn’t really all that helpful. There are too many squishy, undefined adjectives like ‘meaningful,’ ‘mildly,’ and ‘significant.’ We need to drill down.
The second criterion is that the changes you are noticing in your thinking and behavior represent declines from your normal or prior levels of performance. I’ve never been good at remembering faces or last names, so not being able to do so now doesn’t necessarily tell me anything about my status today. It’s new problems that we’re looking for.
But satisfying these first two criteria alone won’t earn you a diagnosis. Your performance should also fall below what is considered average among your peers. ‘Peers’ are often defined as those of the same age, gender and educational background. ‘Average’ is defined as scoring between the 16th and 84th percentiles on standardized cognitive tests. If you score between the 2.5 and 16th percentiles, you will meet the criteria for a mild neurocognitive disorder. If you fall below that level, it is most likely indicative of a dementia.
Finally, this isn’t just about memory. There are 6 broad areas of brain functioning that need to be evaluated. Significant problems in any one of them are sufficient to earn the diagnosis of mild neurocognitive disorder. Significant problems with memory and in at least one other domain are required for a diagnosis of dementia:
- Complex attention
- Executive function
- Learning and memory
- Language
- Perceptual-motor
- Social cognition
I hope to discuss them all in future posts. Meanwhile, here’s a link where you can learn a little more about these categories: https://rb.gy/xdhwnu.
Bottom line: The only way to know where you stand is to be tested. I have not yet been evaluated, so I don’t know where I stand. I can have no sense of security.
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The Octogenarian 
Regarding cognitive testing…..to have a diagnosis of a major cognitive disorder would be earth shattering. I would rather not know. It would become evident soon enough. And the results of any testing are really only for that moment. I really don’t think they serve a useful purpose for someone who is living and functioning independently, but is just a little forgetful. It would cause untold worry and depression. As a geriatric care manager, I would accompany many of my clients to their doctor’s appointments. On one such appointment, an elderly woman and her middle aged daughter were sitting near me. The daughter had made up a “cheat sheet” for her mom and was grilling her before they went in to see the doctor. “OK, Mom. The three words you will need to remember are ‘apple, table, penny’. The President of the United States is Obama (at the time). The date is (whatever).” Now what was the purpose of that? LOL! I figure that as long as I can do the NYT puzzles (Spelling Bee is my favorite!), I’m doing OK. That’s all the testing I need. It’s just much more fun to stay oblivious and not ruminate on this. I once took one of those FB “IQ” tests, and I flunked miserably! I was barely in the educable column! So…..nope. No testing!
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Wayne,Well, I keep flunking the cognitive test of figuring out how your WordPress site works! It keeps telling me that I don’t have an acct, then I create one, and it tells me that I already have one. Then I think I’m posting a comment, but it is nowhere to be found. Then it tells me that I already posted that comment when I try again. So now I get it…….this whole “Mistakes on the Road to Nowhere” is a cognitive test! I fell for it! Sheesh!KHere was my latest comment: Regarding cognitive testing…..to have a diagnosis of a major cognitive disorder would be earth shattering. I would rather not know. It would become evident so
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Sorry that the site is doing that to you! The good news is that you show up on my screen as a subscriber…and that’s all that really matters, right? 😀
You raise an important point about the meaning of a dementia diagnosis. I hope to visit that difficult issue in the not-too-distant future.
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A few questions (that May discussed in the future): what happens if you have never “tested” well under pressure and how often should you take these tests to determine how you are functioning? Will read the information in the link you provided😊
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Not really a problem. Test results are not the only data that will be used to determine if a diagnosis is warranted. If the test data indicates a possible weakness in any of the 6 domains, the person administering the exam will ask a number of follow-up questions to see if that deficit is impacting your daily activities. If not, then there is most likely no problem and a follow-up evaluation might be suggested in 6 months to a year. Once tested, you will have established a baseline that controls for your historical test-taking problem. Remember: what we’re looking for is changes in performance over time.
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Thank you for your thoughtful analysis of something that many of us of a certain age worry about. I have been to the Penn Memory Center for evaluation. They are very thoroug. I was there for about three hours.They required my wife to accompany me and also interviewed her. They told me I have mild cognitive imparment but not Alzheimers.
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Thank you for sharing that, Nick. I hope others will feel safe enough on this blog to share their experiences, fears and victories, as well.
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