Why Worrying About a Cognitive Test Leads to Poorer Performance

Say you go to the movies with a 20-something. After, neither of you can recall which previews were shown. Or the star’s name. Or, um, where you parked the car.

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Only one of you is probably thinking, “Oh no, am I losing it?”

Not the 20-year-old.

“We all have memory failings,” says psychologist Ayanna K. Thomas, director of the Cognitive Aging and Memory Lab at Tufts University in Medford, Mass. “Older adults, though, are more sensitive to them.”

Fixating on forgetfulness can have big repercussions. It can ding your self-image, self-confidence and even how well you do on cognitive tests designed to ferret out whether you’re slipping. That’s no small thing given that the annual Medicare wellness visit now includes memory screening, and the Alzheimer’s Association says everyone over 65 should be assessed (although, the U.S. Preventative Services Task Force disagrees).

“You can be not cognitively impaired, but if you’re worried, that worry can impair your performance,” Thomas says.

Blame the worry on something psychologists call “stereotype threat.” The more you identify as a member of a marginalized group with negative stereotypes — in this case, older adults — the more you believe those stereotypes. “With aging, the negative stereotype is that your memory fails,” Thomas says.

Interestingly, hitting a milestone birthday like 50, 60, 65 or 70 can make you more vulnerable to stereotype threat. “We all have these landmarks in our lives that can really affect how we perceive ourselves,” she says. “We start to hyper-focus: ‘Am I changing?’” An 85-year-old, deeper in aging, on the other hand, may fixate less, she adds.

Like so many stereotypes, there’s some truth here. Many people, though not all, do experience some age-related changes, Thomas says. But it’s our focus on the possibility of change, she adds, that wreaks special havoc.

Some reassurance: Memory gets snagged for many reasons other than encroaching dementia. For example:

• A failure to encode the information. We forget names of people we were just introduced to because we didn’t pay attention or didn’t use a mental hack like repeating the name aloud.
• Environmental disruptors. Overly tired, hungry or tipsy? You’ll recall less well.
• Changes in our sensory systems. Over time, we lose some ability to hear certain frequencies or to select visual information (hello, bifocals). Though the brain is fine, the encoding of input gets altered.
• Failures in retrieving the information. All ages get “blocked” sometimes, like tip-of-the-tongue syndrome. One reason, said neuroscientist Daniel J. Levitin in a New York Times opinion piece made viral by thousands of relieved midlifers: “crowdedness.” Basically, older adults have a lot more information in their brains to sort through!

“It can become a vicious cycle — if you believe your memory is getting worse, you use it less, and then it can get worse,” says psychologist Dayna Touron, director of the University of North Carolina Greensboro Adult Cognition Lab, who studies perceptions of aging.

Over half of older adults show “memory avoidance” when learning new things, she says. To learn, we all use arduous concentration at first — picture a child learning to read by sounding out letters before just memorizing words. You might carefully follow a new recipe step by step or turn on GPS the first time driving somewhere. Eventually, you streamline these tasks, replacing the early effortful approach with experience and memory to make the dish or find your way.

Touron’s research shows that when older adults lose memory confidence, they persist in using slow, effortful approaches instead of making that shift to relying on memory. This takes longer and deprives the brain of cognitive exercise that, ironically, would improve memory. And it reinforces a negative self-image of having a crummy memory.

All this can also affect performance on cognitive testing. Subjects often enter Thomas’ lab bemoaning their terrible memories. And, sure enough, the more nervous or insecure they are, the worse they do. “If you’re feeling stressed, you may perform less well — not because of cognitive impairment, but because of social-emotional constructs,” she says.

Given that age-related changes are a real possibility, what’s a worried forgetter to do? Both Thomas and Touron have several suggestions:

• Give yourself chances to succeed. Instead of automatically pulling out the cookbook, turning on GPS or asking Google, see what you can remember. Take your time. “You might find you’re more capable than you realize, and that feedback has been shown to raise confidence,” Touron says.
• Remind yourself that people of all ages misplace keys and forget names. “If you weren’t worried about losing your keys in your twenties, why worry now? Twenty-year-olds just laugh more about it,” Touron says. If they dwell at all, it’s to blame lack of sleep, stress or distractions.
• Avoid negative self-talk (“I have such a bad memory”) and applaud your strengths. Cognitive abilities that get better with age include general knowledge and vocabulary, Touron says. In fact, older adults use their greater informational knowledge to compensate for forgetting things in the moment. We’re good at filling in gaps with guesses based on our extensive knowledge base.
• Before cognitive screening, relax. Remember most people pass these tests with flying colors; they’re designed to catch pathologies. Thomas wishes health care providers did more to construct testing environments that lower stress, such as in-home testing, revising questions to reflect everyday activities and training test administrators to be more reassuring.
• Remember that simple cognitive screenings don't tell the whole story. If a screening raises a red flag, it’s only one data point in an assessment. No doctor should diagnose Alzheimer’s disease based on a three-minute Mini-Cog screening, Thomas says.
• If you’re truly worried about memory, first ask your spouse, other family or friends what they think. They can make more reliable assessments of any changes in you than you can.
• Skip the computerized brain-training software. There's little evidence shows it boosts memory. Thomas and Touron say a better strategy is to exercise and stay active in your community. “See friends, read books and talk about the books you read,” Thomas says.

Above all, she adds, “Try not to freak out! Worry only makes things worse.”

Paula Spencer Scott is the author of more than a dozen books, including Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers, a series of interactive journals and health/family guides with doctors at Harvard, UCLA and Duke. Her latest is When Your Aging Parent Needs Help with Dr. Leslie Kernisan. A longtime journalist and former Woman's Day columnist, she's also an Alzheimer's, caregiving, and brain-health educator.
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