Person. Woman. Man. Camera. TV. Politics is shining a spotlight on these five words associated with the Montreal Cognitive Assessment (MoCA), as the cognitive abilities of President Trump and former vice president Biden have become a headline in a national conversation. That’s a good thing. No matter your political beliefs, cognitive health status and the value of assessments are important to understand—for candidates and the electorate. But as with most headlines, “Person, Woman, Man, Camera, TV” is just the opening message in a much bigger story.
Since it was developed in 1995, MoCA has been used by neuroscience professionals as an index of cognitive ability. Specifically, it detects early dementia as well as mild cognitive impairment (MCI) that’s greater than expected for an individual’s age and education level but is not interfering with their daily life. MoCA has had an important role in establishing general baselines for a person’s cognitive condition. It was once thought of as a good starting point for cognitive assessment, but many sophisticated assessment tools have been developed since 1995, and it’s no longer the most useful test for brain health.
Using the test in 2020 to determine something as vital as the president’s cognitive ability is like asking the wrong question but still expecting to get the right answer. MoCA may be the mother of cognitive tests, but it has spawned many children that are achieving far greater results. As cognition expert Professor John Harrison tells me, “MoCA is an acceptable brief test of some general cognitive skills, but it is often inappropriately applied. We see plenty of individuals who record normal MoCA scores but on further assessment are found to have clear deficits of memory, concentration, and problem solving.”
What does modern day cognitive testing look like? Advancements in assessment made possible by digital technology reveal shortfalls in traditional paper-based tests like the MoCA. The categories of cognitive performance are vast—attention, response time, information processing, flexibility, memory, category formation, pattern recognition, judgment, decision making. To get a true reading on those behaviors, you need to get inside the brain with something that can capture all of that at once.
When it comes to digital assessment, the eyes are the window to the brain. When someone sits for a digital cognitive assessment, they look into the lens of their smart device and respond to questions that show not only what they can recognize and remember, but how their brain processing is working. Digital assessments like this give a much more complete profile of a person’s cognitive strength—from robust function, to mild impairment, to signs of dementia and Alzheimer’s.
Modernizing the old cognitive test has made assessment more effective and accessible. Everyone should have their cognition tested—that’s the goal. With the paper-and-pencil method, the tests aren’t easily accessed and take a long time, and the results can be inconclusive or sometimes incorrect. The breakthrough of the new tests is not only the technology, but what it can do for the larger population—anyone can test from home and have detailed results delivered almost immediately.
If the attention to cognitive assessment generated by the presidential campaigns helps to raise awareness about the benefits and availability of advanced testing, I’d consider that a victory for the country. Of course, being able to know the state of our presidential candidates’ cognitive health is vital ahead of the 2020 election. But increased awareness of testing can also encourage people to regularly check their own cognitive health. Early intervention can be the most effective way to improve cognitive strength and reduce the risk of dementias like Alzheimer’s disease, which affects 5.8 million Americans and is the sixth leading cause of death in the U.S. It’s a public health issue that would be helped by greater participation in testing.
Harrison shared the same view with me. “Has putting cognitive testing at the top of the news been helpful? Absolutely,” he says. “The healthcare community has made huge progress in informing people about the importance of monitoring and managing their physical health. We need to now ensure that we do the same for cognitive health.”
Person. Woman. Man. Camera. TV. Even if President Trump misinterpreted what the MoCA actually can assess, the attention brought to cognitive testing is valuable. Now it’s time to take a deeper look. Driving more people to get tested will be a step in the right direction.
Elli Kaplan is the cofounder and CEO of Neurotrack.