University of Iowa Health Science Relations and
Kevin Duff, PhD, MA
Assistant Professor of Psychiatry
First Published: 2004
Last Revised: April 2004
Peer Review Status: Internally Peer Reviewed
Increasingly, older adults take cognitive tests to assess possible problems
with their abilities to pay attention, learn, remember things and solve problems.
Some people are apprehensive about taking the tests or learning the results,
but knowing more about the process may help alleviate worries.
It is important to recognize that results from cognitive testing do not provide
a definitive prognosis but are assessment and general predictive tools, said
a University of Iowa clinical neuropsychologist who administers such tests
and studies ways to improve their usefulness. Just as a cardiologist is a specialist
who can focus on problems with a person's heart function, a neuropsychologist
is a specialist who can focus on a person's cognitive function.
Neuropsychological testing, which includes cognitive tests, helps determine
if a person has a psychiatric, neurological or medical condition that contributes
to problems with thinking. The results can help identify steps for the person's
"Cognitive testing results can provide the patient, their families and their
physician information to make decisions that are best for the individual. The
testing may help determine if someone with mild dementia still can live independently
or if they currently have depression that affects their thinking," said Kevin
Duff, PhD, assistant professor, UI Hospitals and Clinics Department of Psychiatry.
"The testing gives the most likely probability about what will happen to
a person's thinking skills, but the tests are not crystal balls that reveal
what the rest of a person's life is going to be like," added Duff, who sees
patients through the Neuropsychological Service of UI Hospitals and Clinics.
Most patients come to the UI for testing through physician referrals, after
patients report or physicians notice problems with attention, memory or reasoning.
The testing, which also is available through the UI Department of Neurology,
can assess possible dementia, including Alzheimer's disease, or problems due
to stroke, neurodegenerative disease, head injuries or emotional or psychiatric
conditions such as depression or bipolar disorder. The adult service also assesses
college students who might have attention deficit disorders or learning disabilities
that were not apparent in high school.
Neuropsychological evaluations can take two to five hours to complete. An
evaluation begins with interviews with the patient and sometimes family members
or significant others. The evaluation also reviews the person's medical and
psychiatric background as well as education, work history and social background.
Experts use the background information to appropriately interpret the test
After the interview portions are completed, the cognitive testing begins--and
the main tools are paper and pencil, not tools like MRI or CAT scans that actually
provide brain images. Even though a machine is not involved, the test gives
the person with a possible cognitive condition a challenge, similar to how
a person with a heart condition gets a stress test to pinpoint problems.
"Normally, people may not jog on a treadmill for an extended length of time,
but the cardiologist really needs to push them to find out where they are at
and what kinds of problems they might be having," Duff said. "In our case,
we're stretching a person's cognitive function more than they usually do on
a day-to-day basis, so that we can get an accurate picture of what's going
Abilities assessed by cognitive testing involve these types of tasks or questions:
- Attention: focusing on two different tasks at the same time
- Language skills: generating an appropriate amount of input or naming objects
- Perceptual abilities: noticing if details are missing from a picture
- Constructual abilities: drawing a one-dimensional object
- Memory: testing how a person takes in and stores information
- Ability to problem-solve: asking "What would you do?" about a commonplace
- Emotional functioning: asking about mood, sleep, appetite and energy
If the results show problem areas, weaknesses or deficits, these may suggest
a condition or pattern that experts can diagnose and then make recommendations
for treatment or intervention. For example, some people who thought they were
in the early stages of Alzheimer's disease find through the testing that they
actually have depression, which is treatable and reversible, unlike some dementias.
"Often people are relieved to find out what the likely problem is, although
sometimes they are surprised by the cause of the problem," Duff said.
An individual's cognitive function is always interpreted relative to a "normative
group"--people of similar age, education and work background. In addition,
test interpretation takes into account the normal aging process, which includes
some memory and other cognitive declines.
"We wouldn't want to hold a 75-year-old to the same standard as a 25-year-old,
just as we wouldn't want to time an older person in the 50-yard dash and expect
them to be as fast as a 25-year-old," Duff said.
Along these lines, Duff studies how to make the tests better. A major focus
is to make the normative groups more representative of the general population.
In the past, many groups turned out to be based on "supernormals," people with
more advanced education and few, if any, medical problems such as heart disease
"Many of the initial normative groups were made up of high-functioning people
who did intellectual work for a living and had good health care. They tended
to do really well on the tests," Duff explained. "Now we are trying to collect
data on individuals who better represent the general population in terms of
range of education, medical history, work experience and other background."