We spend our lives scheduling physicals, blood tests, eye exams, and even dental cleanings, yet the most vital organ in our body, the brain, often goes unchecked. Imagine discovering years too late that something could have been done to delay Alzheimer’s,  if only you had asked for a simple test.

Early diagnosis can mean the difference between living independently for years longer or losing that chance forever. Today, newly approved Alzheimer’s-delaying drugs like Leqembi and Kisunla offer that chance, but only if the disease is caught early. The problem? Most people never know they’re in those first, silent stages.

 There’s a reason most doctors don’t include cognitive screening in their routine recommendations, and it begins with the history of how these tests have been viewed within medicine.  As recently as 2017, the prevailing medical and academic opinion reflected caution and uncertainty about their use of cognitive tests. 

“Diagnosing dementia in the primary care setting might be challenging. Early symptoms of dementia may not be apparent and are sometimes even concealed during short office visits initiated for other complaints. As a consequence, a substantial proportion of subjects with dementia remain undiagnosed until later stages.” (Laurence Seematter-Bagnoud, n.d.) (Seematter-Bagnoud & Bula, 2018)

 However,

 “Given the absence of effective pharmacological treatments for Alzheimer-related disease and the fear of the potential negative and stigmatizing effects of such diagnoses, current evidence is considered insufficient to encourage systematic screening for dementia in older patients.” (Cognitive Impairments in Older Adults: Screening, 2020)

For decades, this perspective shaped how physicians were trained. If there was no effective treatment and a diagnosis could cause distress, why screen for it? That mindset still lingers among many doctors educated before 2023, the year Leqembi became the first FDA-approved drug shown to delay Alzheimer’s progression.

 That’s why it’s now up to you (for yourself or someone you love) to ask for a cognitive screening test. These tests have long been part of medical training, but because Alzheimer’s doesn’t present as pain or a visible condition, doctors rarely have a clear reason to suggest one. Many still fear that bringing it up might seem unnecessary or even inappropriate; unless you ask.

  What does a screening test look like and how long does it take are good questions.

 Mini-Mental State Examination (MMSE)

• Introduced: 1975

• Developed by: Drs. Marshall & Susan Folstein and Dr. Paul McHugh (Johns Hopkins University)

• Purpose: A quick (5–10 min) test to screen for cognitive impairment and track changes over time.

• Content: Orientation (date, place), attention, recall, language, and simple commands.

• Scoring: Out of 30 points; scores below 24 typically indicate impairment.

• Limitations:

• Less sensitive to mild cognitive impairment (MCI) or early Alzheimer’s.

• Biased by education level and cultural background.

• Does not test executive function well (e.g., planning, problem solving).

Montreal Cognitive Assessment (MoCA)

• Introduced: 2005

• Developed by: Dr. Ziad Nasreddine (Montreal, Canada)

• Purpose: Designed to detect MCI — often the earliest stage of Alzheimer’s.

• Content: Includes tasks for executive function, visuospatial skills, delayed recall, attention, language, and abstraction.

• Scoring: Out of 30; scores below 26 suggest impairment.

• Strengths:

• More sensitive for early Alzheimer’s and subtle deficits.

• Covers more complex cognitive tasks.

• Limitations: Takes slightly longer (~10–15 min) and requires more clinician training.

 Saint Louis University Mental Status Exam (SLUMS)

• Introduced: 2006

• Developed by: Dr. John Morley and colleagues at Saint Louis University

• Purpose: Detect both dementia and mild neurocognitive disorder (MCI).

• Content: Combines memory, attention, executive function, and story recall.

• Scoring: Out of 30; cutoffs adjusted for education level.

• Strengths:

• More sensitive than MMSE for early changes.

• Education-adjusted scoring improves fairness.

• Limitations: Less standardized internationally than the MoCA.

 Now that you know what these tests are, the next step is yours. Don’t wait until symptoms appear, because by then, options are limited. Ask your doctor to include a cognitive screening test in your next check-up. It’s quick, painless, and often no more costly than a routine visit.

 Your physical health matters, but so does your mind. With today’s medical advances, early detection can mean staying connected to who you are and the people you love.  At your next appointment, look your doctor in the eye and ask for a cognitive screening test. Don’t assume they’ll bring it up , they probably won’t. But you have every right to know the truth about your brain health.