Should I Get A Mental Health Evaluation?

A few weeks ago a jubilant president Trump declared that his annual
physical examination went exceptionally well; Rear admiral Dr. Ronny
Jackson, the president’s physician further endorsed this comment. Of note
was Dr. Jackson’s statement that the president requested a mental health
evaluation, which yielded perfect results on the Montreal Cognitive
Assessment [MOCA]. Not surprisingly, many people engaged a frenzied
online search for the MOCA – this overwhelming volume of inquiries
reportedly crashed the website that provided information on this particular
assessment. Most of my neuropsychologist colleagues report a deluge of
requests for cognitive evaluations, likely as a result of the president’s recent
examination. These requests for cognitive assessment are equally
pronounced in our own region. So, what is the MOCA and what does it really
tell us about mental health? In addition, when does one need to consider
undertaking an evaluation for herself/himself?
The MOCA is a brief cognitive screening task that is designed to assess the
possibility of problems in thinking – attention, memory, language and so
forth. It is important to realize that as a screener, the MOCA is not a
thorough or comprehensive examination of one’s mental status. For
example, if we wanted to measure someone’s weight, we would feel more
comfortable with scores obtained from a digital weight scale as opposed to
looking at the depth of their footprint in snow. Similarly, we would feel much
better about someone’s bike riding ability by watching him/her operate a
Harley Davidson as opposed to a fancy tricycle. The challenge paused by
screeners is that they are less sensitive at detecting subtle and complex
difficulties. While the MOCA is a decent screener, it would be unwise for
anyone to assume that a perfect score on such a test necessarily means
perfect functioning.
If the MOCA is not enough, what then does one need to consider when
undertaking a mental health examination? Further, when would one engage
a mental health evaluation? These questions will be answered in reverse
sequence. There are many reasons why one might need a
neuropsychological exam. One reason for participating in such an
evaluation may be to establish a baseline level of functioning. That is, it may
be helpful to know what is normal or typical functioning for you in order to
compare problematic performance at a later date. Baseline assessment helps
answer the question, “what has changed compared to what is typical or
normal in your memory skills?” The second reason for obtaining such
evaluations, akin to the president’s recent screening, is to address questions
others may have about our abilities; these questions range from the capacity
to live independently to the ability to pay attention on your schoolwork. In
this case the question may be stated as, “does John still have the ability to
make the best decisions for his corporation?” One of the challenges of
measures like the MOCA is that they simply sample functions that are too
complex to be fully vetted by a gross examination. Most people would hardly
consider a small appetizer to be a satisfactory meal although it provides a
taste of what is available. Ideally anyone who would undertake such
evaluations gets an opportunity to participate in rich and robust activities
that provide meaningful information about thinking [intelligence, attention,
memory, language, executive skills, etc.] as well as measures that address
emotional wellbeing. One may do well on screening tests and yet harbor
undetected problems that can be highlighted by more thorough
examinations, this approach is especially important when attempting to
answer complex questions.
The president’s recent evaluation and his proclamation of excellent health
appear to have heightened interest in cognitive evaluations. These are
worthwhile matters and we are fortunate to live in time marked by an
abundance of resources designed to best describe physical, cognitive and
behavioral health functioning.

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