I am participating in Emory University’s Healthy Brain Study, part of the university’s Healthy Aging Study. While the Aging Study, the largest of its kind, uses on-line feedback to research multiple health issues related to aging, the Brain Study takes a more involved approach to researching the predictors of Alzheimer’s.
In other words, I can expect to be tested and prodded for about six hours ever two years. I like the idea that I have found a way to participate actively, not simply as Ralph’s caregiver. However, my first visit was frankly disconcerting: I HAD TO TAKE THE SAME COGNITIVE TEST RALPH HAS BEEN TAKING.
I remember Ralph’s first test experience. Or I remember my experience: sitting in a waiting room for two hours reading gossip magazines until he emerged slightly gray around the gills. On the drive home he complained about how much he hated the process while I put on a cheery, encouraging face aware he’d probably not done well. (He had not.)
Since then, every time we head to the Emory Brain Health Center, Ralph asks worriedly if he’s going to be tested. I have learned to say, ‘I don’t know,’ to avoid making him more anxious than he already is. I am told that he is always quite cheerful and communicative in the actual testing, but he leaves each visit saying he feels “disoriented,” and “more foggy than usual.”
I am always sympathetic. Or I try to be. I admit that I have grown just a teensy bit callous after hearing the same phrases over and over; a small, not nice part of me shrugs off his complaints, secretly thinking, It’s a test, get over it.
So there I was, only a few weeks after Ralph’s most recent test, sitting at a desk about to embark on my own mental examination. It didn’t help that the test giver and I actually knew each other slightly, having worked together on a hospital improvement project. Once the test began she was a neutral blank.
I started sweating at the first easy question. It didn’t help that I recognized I was facing the same slate of mental exercises that Ralph has faced, that I knew how many words he remembered in one exercise and how many mistakes he made in another and how much time he took to complete a third task.
I started strong but could feel myself tiring mentally as the tests wore on. My concentration wandered when it shouldn’t. I missed some obvious answers. I began to struggle. And in the follow-the-dots a-1-b-2, a test in which Ralph made two mistakes this year but none last year, I somehow skipped my last letter; not a good feeling even if I was at least twice as fast.
The Bottom Line: I WAS TAKING THE SAME COGNITIVE TEST RALPH HAS BEEN TAKING AND I DIDN’T LIKE IT ONE BIT.
I knew rationally that everyone who takes the test feels that she screwed up, and I knew I basically did okay. No matter. By the time I stumbled out into the daylight I felt, you guessed it, “disoriented” and “more foggy than usual.”
Not great feelings but an excellent wake up call. I felt a new infusion of empathy for Ralph (and others in his situation). Most of us can laugh off our mental lapses—misplaced keys, names on the tips of our tongues—but Ralph goes into each test, lives each day, each minute, struggling against dark impenetrable holes that he feels deepening. Having had my little taste of fear, I admire his bravery (and the bravery of his fellow travelers in Alzheimer’s) all the more.
Alice in Memoryland 
LOL! I really enjoyed that post, Alice – especially as I recently finished my 3rd annual set of 6 hours of testing (no results yet). It is exhausting. I messed up the connect the dots tests myself for the first times (twice) this year! It seemed so simple, but . . . I’ve learned to cheat on some tests. For example, if a word on a list matches something in the room (e.g., “carpet”), I stare continuously at it. If a word is a body part (“elbow” was on my list last week), I hold onto it. Then I save those words until the end when repeating back the list. It gives me fewer words that I have to remember (or at least remember via cued recall in a test that is meant to measure free recall). It probably doesn’t add to my scores much, but every little bit helps!
Heading Somewhere
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So glad you enjoyed. Was actually thinking about you as I wrote. I think those “cheats” are pretty smart actually! May pass them on to Ralph…
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Having administered a variety of speech, language, cognitive and other tests, even taken a few myself, I can appreciate your reaction. Often people approach the task expecting of themselves to score 100% creating their own stress levels. Some think of the tests only as revealing their functional level with the results simply markers to make them aware of strengths and weaknesses, not so threatened thinking about striving for that desired score. A few do react by perceiving they’re being insulted by the more simple questions — occasionally privately worried the results might show they’re “crazy” they’ve revealed to me. I was frustrated with a portion of one timed naming test I took when most of the pictured celebrities were current ones about which I had little interest so tended to not recall their names, unlike those of my generation. I saw this as a weakness in this cognitive research test of my memory, but then I don’t know what the overall test was trying to determine. I was never provided the results of this doctoral graduate’s research, or how valid it was ultimately judged to be.
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Thanks for this angle on test taking. We all do react with expectations, good or bad, and I wonder how they color the results.
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What an interesting post, Alice. It’s made me wonder how much of an allowance they make for the stress levels of the person being tested. It also seems like a more useful/truthful way of allowing people to understand what it’s like – better than those weird glasses and splints they let people try which supposedly mimics what it’s like to have dementia.
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I am not sure, but I think there is allowance for stress because even the tester mentioned how stressed she has felt when she’s taken the test. Or maybe since everyone is stressed, it is a wash in tabulating. I think (but am not sure) that the scores place you in a percentile in comparison to others. However, stress definitely must affect performance. I think I will ask about during Ralph’s next visit actually. Thanks for making me think about this.
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You’re welcome. You often make me think about things!
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My mom used to hate the tests and found them beneath her. “Kindergarten questions!”, she’d complain, and claim she knew all the answers but “I don’t have to tell you’. The saving grace was she never remembered taking those tests every 6 months.
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Yes, the not remembering is a kind of blessing in this case. Thanks for writing.
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ps. I have always meant to tell you how much I love you choice of “name” frangipani. Just saying the word puts me in a good mood
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