There are several cognitive tests for dementia that healthcare professionals can use when someone is experiencing changes in memory, thinking, language or other cognitive abilities.
Often, the first signs are noticed by the person themselves or by a family member. They may become more forgetful, have difficulty following conversations, struggle with familiar tasks or show other changes in thinking and behavior.
Cognitive tests provide a more structured way to assess these concerns. Some can be completed in only a few minutes, while more detailed neuropsychological assessments may take several hours.
However, an important point is that no single cognitive test can diagnose dementia on its own. A diagnosis normally involves a broader medical evaluation that may include a health history, physical and neurological examination, medication review, laboratory tests and, in some cases, brain imaging such as MRI, CT or PET scans.
The Alzheimer’s Association recommends using cognitive screening tools to identify people who may need further evaluation rather than treating a screening score as a definitive diagnosis.
In this article, we look at eight cognitive tests and assessment methods that may be used when dementia or cognitive impairment is suspected.
Who Performs Cognitive Tests for Dementia?
An initial cognitive assessment can often be performed by a primary care physician.
Depending on the person’s symptoms and circumstances, they may also be assessed by specialists such as neurologists, geriatricians, psychiatrists or psychologists and neuropsychologists.
The Alzheimer’s Association notes that referral to a specialist may be particularly helpful when the diagnosis is unclear, symptoms are unusual, dementia begins at a younger age, significant behavioral or psychiatric symptoms are present, or a second opinion is wanted.
Cognitive testing may be used as part of the process of determining whether someone has dementia or mild cognitive impairment. Tests may also be repeated at appropriate intervals to help healthcare professionals monitor changes in cognitive function.
8 Cognitive Tests for Dementia
Different cognitive tests examine different aspects of thinking and memory.
They may assess areas such as memory, orientation, attention, language, executive function, visuospatial abilities and problem-solving.
The appropriate test depends on factors such as the person’s symptoms, age, language, education, medical history and the clinical setting.
1. Mini-Mental State Examination (MMSE)
The Mini-Mental State Examination, commonly known as the MMSE, is one of the best-known cognitive screening tests.
It examines areas including orientation, memory, attention, calculation, language and visuospatial ability.
The original MMSE is scored out of 30 points and usually takes only a few minutes to administer. A newer version, the MMSE-2, is also available in standard, brief and expanded forms.
The MMSE and MMSE-2 are professional assessment instruments. Unlike some cognitive screening tools, they are commercially published rather than freely available for unrestricted online use. More information is available from the official MMSE-2 publisher.
A person’s score should not be interpreted in isolation. Factors such as age, education, language, hearing, vision and other medical conditions can influence cognitive test performance.
2. Montreal Cognitive Assessment (MoCA)
The Montreal Cognitive Assessment, or MoCA, is another widely used cognitive screening tool.
The full MoCA is scored out of 30 and generally takes around 10 minutes to administer. It assesses several areas of cognition, including short-term memory, visuospatial abilities, executive function, attention, concentration, working memory, language and orientation.
The MoCA was developed particularly to help identify mild cognitive impairment and can detect difficulties that may not be obvious during a routine conversation or medical appointment.
Official information about the assessment is available from MoCA Cognition.
MoCA administration and scoring should follow the official instructions and applicable training requirements. A particular score should not be viewed as proof that someone does or does not have dementia.
3. Saint Louis University Mental Status Examination (SLUMS)
The Saint Louis University Mental Status Examination, usually shortened to SLUMS, is another cognitive screening assessment.
It evaluates areas such as orientation, memory, attention, calculation, executive function and visuospatial ability.
Saint Louis University describes SLUMS as a screening tool for mild cognitive impairment and dementia in adults aged 60 and older.
The university provides the assessment and professional guidance through its official SLU Mental Status Exam resource.
Importantly, Saint Louis University states that SLUMS results do not represent a clinical diagnosis. An abnormal result should be interpreted as part of a broader evaluation by a qualified healthcare professional.
4. Clock Drawing Test
The Clock Drawing Test is a simple cognitive task commonly incorporated into other assessments.
A person may be asked to draw a clock face, place the numbers correctly and position the hands at a specified time.
Although the task looks simple, successful clock drawing requires several cognitive abilities working together. These can include visuospatial skills, planning, executive function, attention, comprehension and motor skills.
Difficulty completing a clock drawing can indicate that further assessment may be appropriate, but the result does not by itself diagnose dementia.
Clock drawing is also incorporated into screening tools including the Mini-Cog and SLUMS.
5. Mini-Cog
The Mini-Cog is a brief cognitive screening test designed to take approximately three minutes.
It combines two tasks: recalling three unrelated words and completing a clock drawing task.
The Mini-Cog is intended to help identify people who may have cognitive impairment and therefore require a more detailed assessment.
According to the official Mini-Cog resource, the test is a screening tool rather than a diagnostic test for dementia.
If the result suggests possible cognitive impairment, the next step is normally a more comprehensive medical and cognitive evaluation.
6. General Practitioner Assessment of Cognition (GPCOG)
The General Practitioner Assessment of Cognition, or GPCOG, is another brief screening tool commonly associated with primary care.
It includes questions and cognitive tasks for the patient and may also include questions for a family member, friend or other person who knows the patient well.
This can be particularly useful because changes in everyday function may be noticed by family members before they become obvious during a short medical appointment.
The Alzheimer’s Association includes GPCOG among brief cognitive assessment tools that may help determine whether a person needs a more complete dementia evaluation.
Like other screening tools, GPCOG is not intended to establish a dementia diagnosis by itself.
7. Addenbrooke’s Cognitive Examination-III (ACE-III)
The Addenbrooke’s Cognitive Examination-III, or ACE-III, is a more detailed clinician-administered cognitive screening assessment.
It evaluates several cognitive areas, including attention, memory, verbal fluency, language and visuospatial ability.
The ACE-III is used to assess cognitive function and can help support the clinical investigation of dementia.
The University of Sydney, which provides the current ACE-III resources, recommends that clinicians and researchers become familiar with the official administration and scoring procedures before using the assessment.
As with other cognitive tests for dementia, ACE-III results need to be considered alongside the person’s medical history, symptoms and other clinical findings.
8. Formal Neuropsychological Testing
Formal neuropsychological testing is much more detailed than a brief cognitive screening test.
Rather than relying on one short questionnaire, a neuropsychologist may use a battery of assessments to examine areas including memory, attention, language, executive function, processing speed, judgment and visuospatial ability.
More comprehensive testing can be particularly helpful when symptoms are subtle, the diagnosis is uncertain or a person has cognitive concerns despite performing relatively well on a short screening test.
The Alzheimer’s Association notes that comprehensive cognitive testing is often performed by a neuropsychologist and may be used to examine executive function, judgment, attention and language in greater detail.
Specialist batteries may include assessments such as the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Battery, commonly known as CERAD-NP.
Neuropsychological evaluation can take considerably longer than brief screening tests and usually requires referral to a qualified professional.
It is not necessary for every person being evaluated for dementia, but it can provide valuable information in more complex cases.
Can Cognitive Tests for Dementia Diagnose Dementia?
No cognitive screening test should be used by itself to diagnose dementia.
A low score may indicate cognitive impairment, but there are many reasons why someone may perform poorly on a test. These can include depression, medication effects, hearing or vision difficulties, language differences, fatigue, anxiety and other medical conditions.
Likewise, performing well on a brief screening test does not necessarily rule out early or subtle cognitive problems.
The Alzheimer’s Association advises that people whose cognitive screening results raise concerns should receive further evaluation or be referred to an appropriate specialist.
A full dementia evaluation may consider:
- the person’s symptoms and medical history
- information from family members or caregivers
- changes in everyday functioning
- physical and neurological examination
- medications and other health conditions
- laboratory testing
- cognitive assessment
- brain imaging when appropriate
The combination of these findings helps the healthcare professional determine whether dementia or another condition may be responsible for the symptoms.
Can You Take a Dementia Test Online?
It can be tempting to take an online memory or dementia test when you are worried about yourself or someone close to you.
However, online or self-administered tests should not be treated as a substitute for a professional assessment.
The Alzheimer’s Association cautions against relying on home dementia screening tests because results can be misleading and may produce false positives.
If you or someone you know is experiencing persistent changes in memory or thinking, it is better to discuss the symptoms with a healthcare professional.
How Are Cognitive Test Results Interpreted?
Cognitive test scores need to be interpreted in context.
Healthcare professionals consider more than whether a score falls above or below a single number. Education, language, age, cultural background, sensory impairments and medical conditions can all influence performance.
Different tests also have different scoring systems and purposes.
For this reason, it is generally more useful to think of cognitive testing as one part of the diagnostic process rather than as a pass-or-fail dementia test.
When tests are repeated over time, clinicians may also look for meaningful changes in performance rather than relying only on a single result.
Closing Thoughts
There are many cognitive tests for dementia, ranging from brief screening tools such as the Mini-Cog to more detailed assessments performed by neuropsychologists.
Tests such as the MMSE, MoCA, SLUMS, clock drawing test, Mini-Cog, GPCOG and ACE-III can provide useful information about memory and other areas of cognitive function.
However, none should be considered a stand-alone dementia diagnosis.
If cognitive changes are affecting everyday life or causing concern, the most appropriate next step is to speak with a doctor. A healthcare professional can decide which cognitive assessment is appropriate and whether further testing or specialist referral is needed.
References and Further Reading
Alzheimer’s Association. Cognitive Screening and Assessment.
Alzheimer’s Association. Medical Tests for Diagnosing Alzheimer’s and Dementia.
Saint Louis University. SLU Mental Status Exam.
MoCA Cognition. Montreal Cognitive Assessment.
Mini-Cog. Cognitive Screening Resource.
University of Sydney. Addenbrooke’s Cognitive Examination-III.
Geldmacher DS, Whitehouse PJ. Evaluation of dementia. N Engl J Med. 1996;335:330.
Tsoi KK, Chan JY, Hirai HW, et al. Cognitive Tests to Detect Dementia: A Systematic Review and Meta-analysis. JAMA Intern Med. 2015;175:1450.
