Most talk of brain health involves nebulous terms that are difficult to measure, like emotional resilience, good attention and focus, and good motor function. We talk about all the signs of a healthy brain in Episode 34: Women & Brain Health. You may know something is a little off, but the lack of concrete metrics prevents you from knowing how far off the mark you are or tracking any improvement.

You may not have access to all the options presented, but don't get hung up on the ones you can't do. Focus on what you can do. There will be plenty of those! 

And keep in mind, with brain health, there are neurological conditions and psychiatric conditions, but your brain is one organ, and there are no neurological cells and psychiatric cells. Tests, however, are divided into these clean lines. This is primarily because neurological conditions can show up on scans and tests, while psychiatric conditions don’t - at least not in an easily accessible, definitive, diagnosable way.

Disclaimer: There is no way to diagnose yourself with neurological or psychiatric conditions.
Self-administered tests can help you establish baselines and notice changes. If you notice changes or have concerns, then you can seek professional help for diagnosis and treatment.

Think of brain imaging scans as different types of cameras for your brain - each one captures something unique, and doctors usually start with the basic snapshots before moving on to the high-tech stuff. You may be referred for a scan if you have a head injury, unexplained neurological symptoms, or to diagnose dementia.

CT scans show detailed images of the body including the bones, muscles, fat, organs, and blood vessels. It can diagnose tumors, internal injuries, and damage. This is usually the first scan that's done when you come in for brain concerns. It's the right tool for any issues caused by a physical condition in the brain. With dementia, a CT scan can show changes in the brain, but it's not a diagnostic tool.

An MRI more detailed than a CT scan. The most significant difference is that an MRI can show a more detailed visual of the hippocampus, which is the area of the brain that is most affected by Alzheimer’s.

An fMRI is used to look at brain activity and is primarily used in research rather than in diagnosis. A person is given a task to complete, and the researchers compare someone with a condition, like dementia, to someone without the condition.

An EEG is a recording of overall brain activity. It is used to diagnose conditions that cause abnormal electrical patterns in the brain, like epilepsy and is also used to diagnose different types of dementia.

PET scans detect specific molecules in the brain and is typically used for research purposes. It shows the abnormal build-up of protein (specifically amyloid) and the amount of glucose present in the brain, as well as how the brain is utilizing it. So, it can show insulin resistance in your brain and how effectively your brain is using energy.

Unlike CTs and MRIs, which produce a 2D image, a SPECT scan provides a 3D image. And shows how blood is flowing through the brain. It is used to differentiate between the various types of dementia, as each type is associated with distinct patterns of blood flow. It has started to be used for ADHD. Brain images of people with ADHD show blood flowing into areas of the brain that differ from neurotypical people. This is a great advancement, and hopefully, it will lead to more accurate diagnoses and less overmedication.

Cognitive screens are like a standardized test for your brain. It's the mental equivalent of taking your temperature or checking your blood pressure. They're simple, relatively quick assessments that test things like memory, attention, problem-solving, and basic mental functions.
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​You may consider a cognitive screen if you (or someone close to you) notice changes - maybe you're forgetting things more often, having trouble following conversations, or just feel like your thinking isn't as sharp as it used to be. Your doctor might suggest a cognitive screen to establish where you're at right now, so they can track any changes over time.

The key thing to understand is that these aren't meant to diagnose anything on their own. They're more like a "brain check-up" that can flag whether something needs further investigation. If you score well, great! If not, it doesn't mean you have dementia – it just means it's worth digging deeper with more comprehensive testing.

The frustrating part? These are mostly designed for older adults who are already showing symptoms. If you're younger and just want to know your baseline brain health for preventative reasons, you might have to ask specifically for one – or look into some of the online options that are starting to pop up (which we'll cover later).

Mini-Mental State Exam (MMSE)
​This is an 11 question tool that tests five areas of cognitive function.
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​The Montreal Cognitive Assessment (MoCA)
​There is a self-test option for the general public called Xpresso. If you register for an account, you will gain access to their brain health tools.
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​The Mini-Cog
​During this short test, the patient is asked to remember three random words. Then the patient completes the clock drawing test, a common cognitive test question where you are asked the draw a clock depicting a certain time. After drawing the clock, the patient is asked to recall the three random words.
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​Self-Administered Gerocognitive Exam
​There are four interchangeable test forms to choose from. You download it and fill it out without assistance. It includes basic questions about your health. You also answer basic math questions, identify images, and draw pictures.

After you complete the test, ideally, you would take it to your physician for interpretation, but the site also provides a resource for physicians on how to interpret the test, which you can access. Truthfully, if you can accurately score your results based on the instructions, then it’s doubtful you have cognitive decline. You really should go see a doctor if you have concerns.

Digital and online cognitive tests can be administered in an office setting with a trained provided, but there are many available that can be taken from the comfort of home.
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​A word of caution:
​Many of the at-home versions are not validated and are not representative of real-world brain function. These are not meant to diagnose any condition you think you may have. If any of the screens reveal areas of concern, bring it to your doctor.
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​The best screens are one supported by organizations doing research on brain health. In many cases, you are exchanging results and information about yourself for resources on how to improve brain health. And be wary of any company trying to sell you something (often supplements touting improved brain function).
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​Tests Administered in a Medical Setting:

​Automated Neuropsychological Assessment Metrics
​This is a collection of 22 neurocognitive tests originally designed for the military. Military members takes the tests before and after deployments to detect any changes. It's now available to the general public and used for research purposes.
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​Cogstate & CantabMobile
​These are digital exams that can be licensed to physicians and other health practitioners. It is used to establish cognitive baselines and track progress or decline over a period of time.
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​Self-Administered Tests:
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​Food for the Brain Foundation
​Located in the UK, this non-profit foundation is "working to inform organizations and empower individuals to change their diet and lifestyle and take greater control of their own mental health. You can register for the Cognitive Function Test and get reminders to re-test as part of their ongoing research. Plus, it tracks your progress along the way.
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​Cogniciti
​Cogniciti is a free 20-30 minute assessment for brain health. You get feedback on your results and, if needed, a recommendation to see a doctor along with a report to take with you.
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​Test My Brain
​Test My Brain is a US-based nonprofit, digital cognitive research initiative that began in 2005. They conduct several different brain research studies and offer multiple tests that you can take.

Brain Track App
Dementia Australia offers a free app to access and track your brain health. It's free because they collect your info for research. You start by taking a quiz that assesses your brain health and lifestyle behaviors, such as diet, exercise, sleep, and smoking. Then it encourages you to continue doing things that promote brain health and provides tips for improving in areas that are lacking. Each month, the app populates new games to play that test different brain metrics, including attention to detail, basic math, emotions, and problem-solving. You can download your results to take to your doctor or if you live in Australia, use it to find a specialist.

Because your brain isn't some isolated computer sitting in your skull, separate from the rest of you, it's crucial to understand the health of your body. The brain is one of the most demanding organs in your body, and it's completely dependent on everything else working properly. 
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​There are a variety of tests and screens that will give you feedback on your physical health. We'll go through several, but don't fret if you can't do them all or it all gets overwhelming. Take a deep breath and keep reading. We'll organize it all for you at the end.

Okay, this one isn't technically a test, but it's good to know. As best you can (given your specific family situation and dynamics), find out the health conditions your family members. Include parents, siblings, and grandparents. 

The APOE gene has known effects on Alzheimer's disease risk. There are 3 variants: e2, e3, e4. Having one or two copies of APOE4 ups your risk for Alzheimer’s while having the e2 variant seems to be protective against dementia. Before testing your DNA, ask yourself what you plan to do with the information. If knowing your Alzheimer's risk will only cause added stress, don't get the test. On the other hand, if the information spurs you to action, you may consider it. And keep in mind, a higher than average risk is not a death sentence and it in no way means you will be diagnosed with Alzheimer's. 

Have you ever been in a crowded restaurant, struggling to hear your dinner companions? You kinda check out, right? That's what it's like to have hearing loss. You disconnect and subsequently your brain disconnects. Getting your hearing checked and addressing any hearing loss keeps your brain in the game. 
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​If you haven't had your hearing checked since grade school, get a baseline measurement sooner rather than later so you have a metric for comparison as you get older. The get regular retests based on these recommendations:

Visual input provides the brain with information about your world. When vision declines, the brain has to work overtime to make sense of blurry words and images. And the tricky thing about vision is that it declines gradually, making it difficult to spot problems until that change is significant.

Plus, vision exams allow doctors to see your optic nerve, which is part of the central nervous system. Changes in the optic nerve can signal problems with circulation and some eye diseases are linked to an increased risk of dementia. So getting regular eye exams are more than just seeing clearly - it's about catching potential brain-related issued before they become bigger problems. Here are the recommendations:

The relationship between your mouth and your brain is not fully understood, but after studying brain images, people with poor oral health were associated with negative neuroimaging brain health profiles. There's also a link between gum disease and stroke and Alzheimer's. Infected gums provide a gateway for bacteria to enter the bloodstream, which cause inflammation. Inflammation is strongly tied to poor brain health.
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​It's difficult to parse out correlation vs causation. Someone with healthy teeth and gums is more likely not only to have access to dental care, but they are also more likely to be doing other healthy activities. Despite this, it is important to do daily teeth maintenance and get regular check-ups. The recommendations:

Balance seems like a simple thing, but it actually involves several parts of your brain to work together to accomplish. Testing your balance can alert us if something is amiss.
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​In-Office Tests:
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​Posturography
​This is used to assess balance control and identify potential problems with your sensory systems: vision, proprioception (body awareness), and vestibular system (inner ear). It's usually administered by specialists like neurologists, audiologists, or physical therapists.
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​Otolith Tests
​These tests assess the function of the otolith organs, which are the sensory organs located in the inner ear. They provide the brain with info about the head position and movement, thus essential for balance. There are a lot of different versions of these tests, and the test administered depend on the symptoms you’re having. These are also administered by specialists, such as neurologists, audiologists, and ENTs.
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​Rotary Chair Test
​This test evaluates the vestibulo-ocular reflex, which is the reflex that allows you to see clearly when your head moves. The vestibular system is the sensory system that helps you maintain balance and spatial awareness. It includes the inner ear, vestibular nerve, brainstem, and cerebellum, which is everything this test is assessing. You sit in a rotating chair in a dark room with goggles that record your eye movements. And the chair rotates at varying speed as your eye movements are recorded. Audiologists and ENTs administer these tests.
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​Self-Administered Tests

Sleep is critical for the health of your brain. While you are asleep, your brain it doing its maintenance work - tidying up, clearing out toxic proteins, and consolidating memories. If you are not sleeping well, the lack of brain maintenance will add up.
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​You may be thinking you're just a "bad sleeper," but the truth is there could be a legitimate problem with your sleep. A polysomnogram (or sleep study) can help you figure it out. While you sleep, you are monitored by sensors that track your brain waves, breathing, heart rate, eye movements, and how much you toss and turn. Then your healthcare provider can recommend treatments to improve your sleep.
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​Signs you may need a sleep study:

Why check labs? Lab tests give you feedback on your body, and if your body is healthy, then your brain is healthy. These tests give you insight into your heart, liver, kidneys, pancreas, and nutrition status. It can quickly get overwhelming and expensive when faced with the sheer number of things you can test and labs you can get. But the good news is that you don't have to test everything to get useful feedback. 

We are including a list of basic labs, which are likely covered by insurance and may be included with an annual physical exam and a few advanced labs. The advanced labs may be available from your doctor's office through special request (insurance coverage is spotty) or can be requested through a third party lab (like Labcorp).

Basic Lab Tests

Advanced Labs

Brain health is more than physical and neurological conditions. It's your mental health, too. Here are several mental health screens that assess different aspects of your mental health:

Once again, these are not to diagnose. This can only be done by a mental health provider. And we don't recommend taking all of the tests. Only take the ones addressing your concerns. Take it once as a baseline, before making any changes. Then do a periodic check-in after making any diet or lifestyles changes to note any progress.

Getting healthy and then maintaining that health can feel like a full time job. And we're not going to pretend that it won't take work and sacrifice. But we're making one thing easier - keeping track of it all!