Memory and thinking tests (ACE / MoCA)
Pen-and-paper thinking tests, such as the ACE-III or MoCA, that measure memory, attention and language to help build a picture of how the brain is working.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Cognitive tests like the ACE-III and MoCA measure memory and thinking, but they are one part of an assessment — not a diagnosis on their own.
- Scores are affected by education, language, hearing, eyesight, anxiety, low mood, pain and tiredness, so the result is always read in context.
- You get a score on the day, but what it means is explained alongside your history, examination, blood tests and sometimes a scan.
- A normal score does not rule out a problem, and a low score does not on its own prove dementia — ask what the result will and will not tell you.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your psychiatrist will give you advice for your situation.
Gives a structured measure of memory and thinking rather than relying on impressions alone.
When sudden confusion suggests delirium or an acute illness — that needs urgent medical assessment first, not a memory test.
You answer questions and do short tasks. You can ask for things to be repeated and say if you feel tired or unwell.
A clear explanation of the score and what it means in the person's own situation.
You answer questions and do short tasks. You can ask for things to be repeated and say if you feel tired or unwell.
The clinician has a score, but will usually want other information before drawing conclusions. You may feel tired...
The clinician explains what the score suggests so far and whether blood tests, a scan or a further appointment are...
Results are pulled together. You may be given a diagnosis, told more tests are needed, or reassured and offered a...
What is cognitive testing (ACE / MoCA)?
Cognitive testing means doing short, structured thinking tasks with a trained person. Common tests in the UK include the Addenbrooke's Cognitive Examination (ACE-III) and the Montreal Cognitive Assessment (MoCA). They ask you to do things like remember a name and address, draw a clock, name pictures, follow instructions and do simple sums. Each task gives points, and the points add up to a score.
The test is used to measure different parts of thinking — memory, attention, language, and the way you see and place things in space. It can help show whether there is a problem, how big it might be, and which parts of thinking are most affected.
A cognitive test is only one piece of the picture. On its own, a score cannot diagnose dementia or say what is causing a change. A low score can be caused by many things, and a normal score does not always mean everything is fine. The result has to be read together with your story, a physical check, blood tests and sometimes a brain scan.
It is also important to know that scores are affected by things that have nothing to do with dementia — such as how much schooling you had, the language you grew up speaking, poor hearing or eyesight, tiredness, pain, low mood and feeling anxious on the day.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
MoCA and ACE-III at a glance
| Feature | MoCA | ACE-III |
|---|---|---|
| Time to do | About 10–15 min | About 15–30 min |
| Detail | Good general screen | More detailed across thinking areas |
| Picks up mild changes | Often yes | Often yes, with more breakdown |
| Tells you the cause | No | No |
Neither test diagnoses dementia or names a cause on its own. They guide the next steps in an assessment.
Preparing for your test
- Wear your glasses and hearing aids and bring them to the appointment, as eyesight and hearing affect the score.
- Bring a list of your medicines, as some can affect concentration and memory.
- If you can, bring someone who knows you well, as their account of any changes is very useful.
- Try to come rested and, if you can, at a time of day when you feel at your best.
- Tell the clinician your first language and how much schooling you had, as both affect how the test is scored.
- Mention low mood, anxiety, poor sleep, pain or recent illness, as these can lower your score on the day.
- There is nothing to revise — the test is not something you can pass or fail by studying.
What happens
A trained clinician — often a GP, nurse, doctor or psychologist — sits with you in a quiet room and explains what will happen. The test is a conversation with some written and drawing tasks. You might be asked to remember words or an address, name objects, copy a drawing, do simple calculations, follow instructions and answer questions about the date and place.
The clinician writes down your answers and adds up the score. They will usually also ask about your memory and day-to-day life, take a history from you and anyone with you, and may arrange blood tests and a brain scan. Many people feel nervous or worry they are being caught out — it is fine to take your time, ask for a question to be repeated, and say if you need a break.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- When sudden confusion suggests delirium or an acute illness — that needs urgent medical assessment first, not a memory test.
- When severe anxiety, depression, pain or acute illness mean the score will not reflect true thinking ability on the day.
- When uncorrected hearing or sight loss, or a strong language mismatch, would make the standard test unfair or uninterpretable.
- As a stand-alone test expected to give a diagnosis without the rest of the assessment.
Delay or rearrange if…
- There is an acute illness, infection or recent hospital stay that may be clouding thinking.
- The person is very tired, in pain, or acutely distressed on the day.
- Hearing aids or glasses are missing and could be brought to a rearranged appointment.
- A treatable cause such as low mood or poor sleep is being addressed and may improve the result.
Alternatives to discuss
- A detailed history from the person and someone who knows them, which is sometimes more informative than a test.
- More in-depth neuropsychological assessment by a clinical psychologist when the picture is complex.
- Watchful waiting with a repeat test in several months when changes are mild or uncertain.
- Treating mood, sleep, hearing or eyesight problems first and then reassessing.
- Referral to an NHS memory clinic for a full multidisciplinary assessment.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Gives a structured measure of memory and thinking rather than relying on impressions alone.
- Can show which parts of thinking are most affected, which helps point to the next steps.
- Can be repeated over time to see whether thinking is stable, improving or changing.
- Helps decide whether more tests, such as a scan or detailed psychology assessment, are needed.
- Can reassure when worry about memory is out of step with how thinking is actually working.
Risks & complications
- Feeling anxious, embarrassed or upset during the test.
- A score that is lowered by tiredness, anxiety, low mood, pain, poor hearing or eyesight rather than a brain problem.
- A result that is unclear and needs repeating or further tests.
- False reassurance from a normal score when a real problem is developing.
- Worry caused by a low score that later turns out to have another explanation.
- A test that does not fit your language or background well, making the score harder to interpret.
- A wrong conclusion if the score is treated as a diagnosis on its own without the rest of the assessment.
The biggest risk is reading too much into the number. A score is only meaningful when it is interpreted alongside your history, an examination, blood tests and sometimes a scan, and after taking account of your education, language, mood, hearing and eyesight. Ask the clinician what your score means in your situation and what will happen next, rather than treating it as a verdict.
Published figures to discuss
Cognitive tests do not have meaningful complication rates, but they do have limits in accuracy. No single test is perfect: any test can give a normal score in someone who has a real problem (a false negative) or a low score in someone who does not (a false positive), especially in people with very high or very low levels of education, language differences, sensory loss, anxiety or low mood. Because of this, results are interpreted in context and the published figures for how well each test separates dementia from normal ageing vary widely between studies and settings.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Normal score despite real-world impairment | Recognised limitation | Education, language, high baseline ability and test anxiety can affect screening tests. | Guide sourcesClinical context |
| Low score from non-dementia cause | Common | Delirium, depression, pain, poor sleep, hearing/vision loss, medicines and language barriers can reduce scores. | Guide sourcesClinical context |
| Diagnosis made from one score alone | Avoidable | NICE-style dementia assessment uses history, informant evidence, function, examination, blood tests and imaging where appropriate. | NICE NG97 — Dementia: assessment, management and supportnice.org.ukSource-linked context |
| Capacity incorrectly inferred from cognition score | Legal risk | Capacity must be assessed for the specific decision, not assumed from MoCA/ACE/MMSE results. | Reliability of ACE-III in dementia and MCI — PMC reviewncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery. "Afterwards" is mainly about understanding what the result means and what the next steps are.
- Feeling tired or drained after concentrating.
- Feeling worried or low while waiting to understand the result.
- Not remembering exactly how you did — this is normal and expected.
- Wanting to talk things over with family before any decisions are made.
Aftercare
- Ask for your score and what it means in plain language.
- Ask whether any other tests, such as blood tests or a scan, are planned.
- Bring someone with you to the feedback, as it can be a lot to take in.
- Write down any questions before the next appointment.
- Ask whether and when the test might be repeated.
- Ask who to contact if your memory or thinking gets noticeably worse in the meantime.
- If you are low or anxious, tell your GP, as treating this can sometimes improve thinking.
- Glasses and hearing aids brought to the appointment
- List of current medicines
- Someone who knows you well, if possible
- Notes on the changes you have noticed and when they started
- Questions written down in advance
- A way to record or write down the feedback
⚠ Get urgent help if…
- Sudden confusion or a fast change in thinking over hours or days — this can be delirium and needs urgent medical help. If it is life-threatening, call 999 or go to A&E. For urgent advice that is not life-threatening, call NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours service or your area's Phone First service.
- New weakness, drooping of the face, slurred speech or loss of vision — call 999, as these can be signs of a stroke.
- A sudden severe headache, or confusion after a fall or head injury.
- Becoming very drowsy, feverish or physically unwell alongside the confusion.
- New thoughts of not wanting to be here, or of harming yourself — if there is immediate danger, call 999 or go to A&E anywhere in the UK. For urgent mental-health support, call NHS 111 and choose the mental health option in England, Scotland or Wales; in Northern Ireland, call Lifeline free on 0808 808 8000 or contact your GP or GP out-of-hours service. You can also call the Samaritans free on 116 123 at any time.
- Seeing or hearing things that are not there, or becoming very frightened or suspicious.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your psychiatrist gives you.
Results & realistic expectations
Your result is a score, plus a breakdown of how you did on different tasks. A clinician uses this, together with your history, examination and any scans or blood tests, to decide whether your thinking is in the expected range, whether there is mild change, or whether there is a more significant problem.
A score cannot, on its own, tell you the cause of any change or predict exactly what will happen in the future. The same score can mean different things in different people. If the result is unclear, the test may be repeated after several months, because how a score changes over time is often more useful than a single snapshot.
A cognitive score is a snapshot of one day. It can change with mood, illness, sleep and medicines, as well as with any underlying condition. Because of this, a single result has a limited shelf-life, and clinicians often repeat the test over months or years to see the trend rather than relying on one number.
Related tests, treatments or support
Cognitive testing is usually combined with a detailed history from you and someone who knows you, a physical examination, blood tests to look for treatable causes such as thyroid problems or low vitamin levels, and sometimes a brain scan. It is also often paired with checks of mood, hearing and eyesight, because these all affect thinking.
Follow-up & long-term care
After testing, the clinician explains the result and the plan. This may mean further tests, a referral to a memory clinic or specialist, a repeat test in several months, or reassurance with advice on what to watch for. You should be told who to contact if things change before the next appointment.
- Keeping hearing aids and glasses up to date so future tests reflect your thinking, not your senses.
- Treating low mood, anxiety and poor sleep, which can all weigh on thinking and test scores.
- Reviewing medicines with a clinician, as some affect concentration and memory.
- Repeating the test over time if advised, to track any change.
Repeat, follow-on and what comes next
- Borderline or unclear results are common and often need a repeat test after several months.
- A normal test may still be followed by further assessment if the history is concerning.
- Detailed neuropsychological testing is sometimes needed when brief tests are inconclusive.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of the score and what it means in the person's own situation.
- A written record or letter, and agreement on who else can see it.
- A defined next step — further tests, referral, repeat test or reassurance.
- A named contact and advice on what to do if thinking gets noticeably worse.
- Attention to treatable contributors such as low mood, poor sleep, hearing and eyesight.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the test is a brief screen or a longer, detailed assessment.
- Who carries it out — a nurse, doctor or clinical psychologist.
- The length of the appointment and whether a full history is taken at the same time.
- Whether blood tests, a brain scan or a follow-up appointment are included.
- Whether a written report or letter is provided.
- Whether a repeat test is included to track change over time.
- Which test will be used and how long the appointment will take.
- Who will carry out and interpret the test.
- Whether a history, examination and blood tests are included.
- Whether a brain scan is arranged separately and at what cost.
- Whether a written report or letter is provided.
- What happens, and what it costs, if a repeat test or further assessment is needed.
- What follow-up or feedback appointment is included.
On the NHS? Cognitive testing is a routine part of NHS memory assessment through GPs and memory clinics; private assessment may be used for speed, choice or a second opinion, but the tests themselves are the same.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Presenting the score as a diagnosis rather than one part of an assessment.
- Not accounting for education, first language, hearing, eyesight, mood or tiredness.
- Not explaining what an abnormal, borderline or normal result will actually change.
- Not saying who will see the report, or what the next steps and timescales are.
- Giving false reassurance from a single normal score despite a worrying history.
Marketing red flags
- Claims that a quick test can diagnose dementia or rule it out on its own.
- Apps or online tests sold as a definitive memory check without clinical interpretation.
- Promises of a same-day dementia diagnosis from a single appointment.
- Pressure to pay for unnecessary repeat testing or scans without clear reasons.
Choosing a specialist safely
- Check the psychiatrist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good psychiatrist will welcome every one of these.
- What exactly does my score mean, taking my background, mood and senses into account?
- What will this result change about my care or next steps?
- What happens if it is normal, borderline or clearly abnormal?
- Do I need blood tests or a brain scan as well?
- Could my mood, hearing, eyesight, sleep or medicines be affecting the result?
- Will the test be repeated, and if so, when?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the psychiatrist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does a low score mean I have dementia?
Can I fail the test?
Will my score get better if I do the test again?
Is the test available on the NHS?
Why do they ask about my education and first language?
What happens if my score is normal but I am still worried?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG97 — Dementia: assessment, management and support NHS — Diagnosis of dementia Royal College of Psychiatrists — Memory problems and dementia Reliability of ACE-III in dementia and MCI — PMC review nidirect — Urgent and emergency care services (NI) nidirect — GP out-of-hours service (NI) NHS England — NHS 111 mental-health crisis support NHS inform (Scotland) — Urgent mental-health help NHS 111 Wales — Mental health and wellbeing nidirect — Mental health emergency: Lifeline and crisis help (NI)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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