Comparing memory tests
Put your memory to the test
Search for a memory test and you will find free quizzes, clinic screens, brain training games and full neuropsychological assessment, all described in roughly the same language. They are not the same thing and they do not answer the same question.
Here is how each one differs.
Free online quizzes
An online quiz usually consists of a handful of multiple-choice questions or a game that measures reaction time. They are free, immediate and entertaining.
The limitation is in what they measure. For instance, recognizing the correct answer from a multiple-choice list is a much easier task than recalling something unprompted. And recognition can remain intact even as other aspects of memory begin to change. As a result, recognition-based quizzes may not give you the full picture of your cognitive health.
They also lack a meaningful point of comparison. Without normative data, a score alone cannot tell you how your results compare with other people of your age and educational background.
A score needs something to be measured against
A number on its own tells you very little. It becomes useful next to people of your age and education, or next to your own earlier result as a baseline. Before you take an online test, check to see which of these comparisons it can give you.
Clinic screening tests
The MMSE and MoCA are short screens designed to be administered by a clinician in a consulting room. They are well-studied and widely used, and if your doctor gives you one, that's a good thing. SAGE is different: it was built to be filled in by the person taking it, on paper, and handed to a doctor to score.
What all three share is brevity, and brevity costs accuracy at the earliest stage. Brief screens hold up well once dementia is established: across 102 studies and more than 10,000 patients, the MMSE identified it about 81% of the time. They are markedly weaker at mild cognitive impairment, the stage before that. Across 34 studies, the MMSE told mild cognitive impairment apart from normal ageing about 78% of the time, where 100% would be perfect and 50% is a coin toss. The MoCA did better at about 88%, and still missed people.
That gap is the reason this exam exists. The early stage is where knowing changes what you can do about it, and it is the stage a short screen is least suited to finding.
The other constraints are practical. The clinic screens require an appointment. They are often given once, at the point when somebody is already worried, which means there is rarely a baseline to compare against. And because they are brief and widely circulated, repeat exposure to the same items can flatter a second attempt.
Where this information comes from
Pinto TCC, Machado L, Bulgacov TM, and others. Is the Montreal Cognitive Assessment screening superior to the Mini-Mental State Examination in the detection of mild cognitive impairment and Alzheimer's disease in the elderly? International Psychogeriatrics 2019;31(4).
Tsoi KKF, Chan JYC, Hirai HW, Wong SYS, Kwok TCY. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Internal Medicine 2015;175(9).
Block C, Johnson-Greene D, Pliskin N, Boake C. Discriminating cognitive screening and cognitive testing from neuropsychological assessment. The Clinical Neuropsychologist 2017;31(3).
Full neuropsychological assessment
This type of test spans several hours with a clinical neuropsychologist, covering memory, language, attention, executive function and mood, and is interpreted alongside your history and often your brain imaging.
This is the most informative option by a wide margin, and it is the right answer when there is a real diagnostic question. It is also expensive, often has a long waiting list and is not the most sensible way to put everyday concerns into perspective.
Where Memory Exam fits
Memory Exam is a screening test that uses spoken recall rather than recognition, scores against normative data for your age and education, and is taken at home without an appointment.
It is not a substitute for neuropsychological assessment and it does not diagnose. What it does that the other options largely do not is let you establish a baseline inexpensively and repeat it later, ensuring a future result can be compared against your own earlier performance rather than solely against a population average.
Its approach has been evaluated against standard neuropsychological assessment in peer-reviewed research published in Archives of Clinical Neuropsychology, Neurology and Alzheimer's & Dementia. Read the research behind the Memory Exam.
Which test should you take?
- Something has changed suddenly, over hours or days. That is not a screening question. Seek medical help now.
- You or a family member have a specific, growing concern. Start with a screening, then take the results to a doctor.
- A doctor has a diagnostic question. Full neuropsychological assessment is the right tool.
- You want to know where you stand and track it. Take a screening that can monitor your baseline over time.
No screening test, ours included, can tell you why your memory has changed. Understanding why memory changes requires a conversation with a clinician. Screening can be a useful first step, giving you insightful information to bring to the conversation so it's more efficient and you are better prepared.
