Memory and cognitive assessment (Cognitive assessment for memory and thinking problems)
An assessment of memory and thinking to understand why someone is having difficulties, what might be causing them, and whether anything treatable is involved.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- The assessment measures memory and thinking and looks for treatable causes, rather than assuming the worst.
- Test scores (such as MoCA or MMSE) are one part of the picture and cannot diagnose dementia on their own.
- Scores can be affected by education, language, mood, anxiety, tiredness and medicines, so they are interpreted carefully.
- A normal result is reassuring but not a guarantee, and an abnormal result usually leads to further tests rather than an immediate label.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Gives a clearer picture of how memory and thinking are working
A sudden change in memory or alertness over hours or days, which needs urgent medical assessment rather than a routine appointment.
You talk through your concerns and complete the tests. Some general feedback may be given, but firm conclusions often wait for further results.
A clear explanation of the scores in context, including what could be affecting them.
You talk through your concerns and complete the tests. Some general feedback may be given, but firm conclusions...
Tests to exclude treatable causes, such as thyroid problems or vitamin deficiency, are usually taken. Results...
A CT or MRI scan may be suggested and is reported separately, which takes longer. Not everyone needs a scan.
The clinician explains the test scores, blood results and any scan together, rather than relying on one part, and...
What is a memory and cognitive assessment?
A memory and cognitive assessment looks at how well your memory and thinking are working, and tries to understand why you, or someone close to you, have noticed changes. It usually involves a conversation about your symptoms, some pen-and-paper or spoken tests of memory, attention, language and problem-solving, and a review of your health and medicines. It is often carried out by a GP first, and then by a specialist team in a memory service.
The tests used have names such as the GPCOG, 6CIT, MMSE or MoCA. They give a score, but a score alone does not diagnose anything – it is one piece of a wider picture. The assessment also looks for treatable things that can affect memory and thinking, such as depression, anxiety, poor sleep, thyroid problems, vitamin deficiencies, alcohol, and side effects of medicines.
The assessment gathers information; it is not a treatment. It may reassure you that your memory is normal for your age, identify a treatable cause, point to mild cognitive impairment, or be the first step towards diagnosing a condition such as dementia. Scores can be affected by education, language, tiredness, mood and anxiety, so they are always interpreted with care and not used on their own.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Two common memory tests compared
| Feature | MMSE | MoCA |
|---|---|---|
| Score | Out of 30 | Out of 30 |
| Difficulty | Generally easier | Generally harder |
| Picks up mild problems | Less sensitive | More sensitive |
| Affected by education | Yes | Yes |
| Used for | Screening and tracking | Screening, especially milder problems |
Neither test diagnoses dementia on its own. A 'pass' does not rule out a problem and a low score does not confirm one; results are always interpreted alongside history, blood tests and sometimes a scan.
Preparing for your test
- If possible, bring someone who knows you well, as their account of any changes is very useful.
- Bring a list of all your medicines and supplements, as some affect memory and concentration.
- Note when you first noticed problems and give examples of how they affect daily life.
- Mention low mood, anxiety, stress, poor sleep or alcohol use, as these strongly affect memory and thinking.
- Bring your glasses and hearing aids if you use them, as poor sight or hearing can affect the tests.
- Try to attend rested rather than exhausted, as tiredness lowers scores.
- Write down your questions, including what the result would mean and what happens next.
What happens
The clinician begins by asking about the changes you or others have noticed: what is affected, when it started, whether it is getting worse, and how it affects everyday tasks. They ask about your general health, mood, sleep, alcohol and medicines, because many of these affect memory and thinking.
You are then asked to do some tests. These might include remembering and recalling words, naming objects, copying a drawing, doing simple calculations, and saying what day and place you are in. The tests are not meant to catch you out, and it is normal to find some parts harder than others. If a relative or friend is with you, the clinician may ask them about changes they have seen.
Depending on the findings, blood tests are usually arranged to exclude treatable causes, and a brain scan may be suggested. Some feedback may be given at the time, but a clear explanation often has to wait until the tests and any scan are back. You should leave knowing what was found, what is still pending, and what happens next.
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…
- A sudden change in memory or alertness over hours or days, which needs urgent medical assessment rather than a routine appointment.
- As a stand-alone way to diagnose dementia, since scores must be interpreted alongside history, blood tests and sometimes a scan.
- When severe untreated depression, anxiety or another condition is likely to dominate the result and should be addressed first.
- As a one-off test in someone who is acutely unwell, in pain, or very tired, where the score may not reflect their true ability.
Delay or rearrange if…
- You are acutely unwell, in pain, or recovering from a recent illness or hospital stay, which can lower scores temporarily.
- You are very anxious, exhausted or low in mood on the day, which can affect performance.
- You have started or stopped a medicine that affects concentration, so the picture may settle.
- Key information is missing, such as a medicines list or an account from someone who knows you.
Alternatives to discuss
- Initial assessment by a GP with a brief cognitive test before any specialist referral.
- Treating mood, sleep, alcohol or medicine problems first and then reassessing.
- A period of watchful waiting with a planned review if symptoms are mild.
- Referral to a memory service or specialist if the picture is unclear.
- Support and information for the person and family while the situation is monitored.
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 clearer picture of how memory and thinking are working
- Identifies treatable causes such as depression, thyroid problems, vitamin deficiency or medicines
- Can reassure you that your memory is within the normal range for your age
- Provides a baseline so any change over time can be measured
- Guides whether further tests, a scan or referral are needed
- Helps you and your family plan and access support if a problem is found
Risks & complications
- Anxiety or low mood on the day can lower scores and affect the picture
- The tests can feel stressful or upsetting, especially if you fear the result
- A score that is normal for your age but does not fully reassure you
- Needing blood tests, a scan or a repeat assessment before anything is clear
- An unclear result that sits between normal and abnormal and needs review over time
- A finding of mild cognitive impairment, which may or may not progress
- Identifying an unexpected problem that leads to further investigation
- False reassurance if an early problem is not yet detectable
- Over-interpretation of a single low score in someone who is simply anxious, unwell or tired
The assessment is talking and testing, so there is no physical risk. The main pitfalls are about interpretation: scores are affected by education, language, mood, anxiety, tiredness, sight and hearing, so a single number can mislead. Ask what the result means in your situation, what could be affecting it, and what the plan is if it is normal, borderline or abnormal.
Published figures to discuss
The assessment causes no physical harm, so the meaningful uncertainty is about how well the tests reflect the truth. Brief cognitive tests are screening tools, not diagnostic on their own: they trade off sensitivity (catching problems) against specificity (avoiding false alarms), and the cut-off score used changes both. The figures below come from research studies and depend heavily on the population, the cut-off chosen, and factors such as education and language, so they should be treated as a guide rather than a fixed accuracy for any individual.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| MoCA sensitivity for mild cognitive impairment | Reported around 85–94% at common cut-offs | More sensitive than the MMSE for mild problems, but at the cost of more false alarms. | Comparing MoCA and MMSE for mild cognitive impairment and dementia – PubMedpubmed.ncbi.nlm.nih.govPublished figure |
| MoCA specificity at a common cut-off (below 26) | Reported as low as around 59% in some studies | Means a low score is often a false alarm; a lower cut-off improves specificity but misses some cases. | Comparing MoCA and MMSE for mild cognitive impairment and dementia – PubMedpubmed.ncbi.nlm.nih.govPublished figure |
| MMSE sensitivity for mild cognitive impairment | Reported around 18–61%, lower than the MoCA | A normal MMSE does not rule out mild problems, which is why milder cases can be missed. | Comparing MoCA and MMSE for mild cognitive impairment and dementia – PubMedpubmed.ncbi.nlm.nih.govPublished figure |
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 nothing to recover from physically. What matters afterwards is understanding what was found, what is still being checked, and what the next step is – whether that is reassurance, treating a cause, further tests, or referral.
- No physical after-effects from the assessment
- Feeling tired or emotionally drained after testing, which is common
- Waiting days to weeks for blood tests or a scan before a clear answer
- Some uncertainty, especially if the result is borderline
- Being asked to come back for review if the picture is not yet clear
Aftercare
- Make sure you understand what the tests showed and what is still being checked.
- Check whether blood tests or a scan are pending and how you will get the results.
- If a treatable cause is found, follow the advice and ask how you will know if it helps.
- Address mood, sleep, alcohol and medicines, as improving these can improve memory and thinking.
- Bring someone you trust to results appointments, so the information is shared.
- Know who to contact if things get noticeably worse before your next appointment.
- Use reliable information sources rather than relying on adverts for tests or supplements.
- Someone who knows you well to attend with you
- An up-to-date list of your medicines and supplements
- Examples of how memory or thinking affects daily life
- Your glasses and hearing aids if you use them
- A note of mood, sleep and alcohol, which affect the results
- Your questions about what the result means and what happens next
- Knowing how and when you will get any test or scan results
⚠ Get urgent help if…
- A sudden change in memory, confusion or alertness over hours or days – seek urgent help
- Memory or confusion with fever, severe headache, or feeling very unwell
- New weakness, numbness, slurred speech or difficulty walking – this could be a stroke, call 999
- Sudden severe confusion or agitation that is new and out of character
- Thoughts of harming yourself, or feeling unable to keep yourself safe – seek help now
- Rapidly worsening confusion over days to weeks rather than a slow change
- Any symptom your clinician told you to treat as urgent
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 specialist gives you.
Results & realistic expectations
A useful result is a clear explanation of how your memory and thinking are working, what might be affecting them, and what it means for you. The scores are interpreted alongside your history, the account of someone who knows you, blood tests and any scan – never on their own. Often the most reassuring outcome is finding a treatable cause, or that your memory is within the normal range for your age.
A normal assessment is reassuring but cannot guarantee that no problem will ever develop, and an abnormal result usually leads to further tests rather than an instant diagnosis. A borderline result may simply need reviewing over time. The clinician should be honest about how confident they are and what the result can and cannot tell you.
A memory and cognitive assessment is a snapshot. Memory and thinking can change over time, and a single set of scores is most useful as a baseline to compare against later. If symptoms progress, or a result was borderline, a repeat assessment is often more informative than the first. Any conclusions may need revisiting as the situation changes or further information comes in.
Related tests, treatments or support
A memory and cognitive assessment is usually combined with blood tests to exclude treatable causes, and sometimes a brain scan (CT or MRI). It may be part of a broader assessment of mood, sleep and general health. If the picture points towards dementia, it leads into the separate process of dementia diagnosis. Treating contributing factors such as depression or poor sleep is often done alongside.
Follow-up & long-term care
After the assessment you should know what the tests showed, what is still being checked, and how you will get the results. If a treatable cause is found, follow-up checks whether treatment is helping. If the result is borderline or symptoms continue, a planned reassessment is often arranged. You should be told who to contact if things get noticeably worse in the meantime.
Repeat, follow-on and what comes next
- A borderline result is often only clarified by repeating the assessment over time.
- Scores can improve when a treatable cause, such as depression or poor sleep, is addressed.
- An initial impression may be revised once blood tests, a scan or an informant account are available.
- A normal baseline is most useful for comparison if symptoms change later.
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 scores in context, including what could be affecting them.
- A plan for any pending blood tests or scan, and how results will be shared.
- Attention to treatable causes such as mood, sleep, alcohol and medicines.
- A named contact and a planned review if the result is borderline or symptoms progress.
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:
- The length and depth of the assessment
- Whether brief or detailed cognitive tests are used
- Who carries it out (GP, psychologist, geriatrician or neurologist)
- Blood tests to exclude treatable causes, charged separately
- Whether a brain scan is needed and who reports it
- Any follow-up appointments or repeat assessment
- Letters or reports requested for other purposes
- The clinician's assessment fee and how long it covers
- Whether cognitive testing and a written report are included
- Whether blood tests are included or charged separately
- The cost of a brain scan if needed, including reporting
- The cost and timing of any follow-up or repeat assessment
- What happens, and what it costs, if the result is borderline and review is needed
- The cancellation policy
On the NHS? Memory and cognitive assessment is available on the NHS through GPs and memory services when clinically indicated; private assessment may be used for speed, choice or a second opinion.
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
- Treating a single score as a diagnosis rather than one part of a wider assessment.
- Not explaining how education, language, mood, anxiety, sight and hearing affect the result.
- Not looking for treatable causes before suggesting a serious diagnosis.
- Not making clear who will see the result and any report, especially in private care.
- Not setting out what happens if the result is normal, borderline or abnormal.
Marketing red flags
- Offering an online or app-based 'memory test' as if it can diagnose dementia.
- Promising a definitive answer from a single test in one appointment.
- Selling brain scans or supplements off the back of a low screening score.
- Implying a normal score is a guarantee that nothing will ever develop.
Choosing a specialist safely
- Check the specialist 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 specialist 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 specialist will welcome every one of these.
- What did the tests show, and what could be affecting my scores?
- Could a treatable cause, such as mood, sleep, thyroid or medicines, be involved?
- Do I need blood tests or a brain scan, and what would they add?
- What does this result mean if it is normal, borderline or abnormal?
- Is this likely to be mild cognitive impairment, and what does that mean for the future?
- When would you want to reassess me, and who do I contact if things get worse?
- 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 specialist 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?
What is the difference between the MMSE and the MoCA?
Should I bring someone with me?
Can my memory problems be something treatable?
Will I need a brain scan?
Is a memory assessment available on the NHS?
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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: NHS – Tests for diagnosing dementia Alzheimer's Society – Tests and scans to diagnose dementia Comparing MoCA and MMSE for mild cognitive impairment and dementia – PubMed Validity of the MoCA and MMSE in detecting MCI and dementia – PMC NHS England – Dementia diagnosis and management (primary care resource)
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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