What are the three words used in the medicare memory test? Unpacking the cognitive assessment

According to the Centers for Disease Control, nearly one-third of Americans experience some form of cognitive impairment, emphasizing the importance of regular memory screenings. During your Annual Wellness Visit, you might wonder what are the three words used in the medicare memory test as part of a simple cognitive evaluation.

Quick Summary

There is no single set of three words used universally in Medicare memory tests; the specific words depend on the screening tool your provider uses, such as "apple, penny, table" for the Mini-Cog or "banana, sunrise, chair" for other assessments. This quick verbal recall test is a common component of cognitive screenings during the Annual Wellness Visit.

Key Points

• No Single Test: The specific three words used depend on which standardized cognitive screening tool your healthcare provider uses during the Medicare Annual Wellness Visit.

• Mini-Cog Words: A very common version of the test, the Mini-Cog, uses the words "apple, penny, and table".

• Other Word Sets: Other tests, such as the BIMS, use different words like "sock, blue, and bed", while some older sources mention "banana, sunrise, chair".

• Testing Short-Term Memory: The purpose of the three-word recall is to check a person's short-term memory by having them recall the words after a brief, distracting task, such as drawing a clock.

• Follow-Up is Key: A poor result on the screening does not equal a dementia diagnosis; it simply indicates that further evaluation may be necessary to identify any underlying causes for memory changes.

No single list of words: It depends on the screening tool

One of the most common misconceptions about the Medicare cognitive assessment is that there's a single, official list of words used for every test. In reality, healthcare providers have the flexibility to choose from several validated screening tools, each with its own set of words. The words used are carefully chosen to be common and unrelated, preventing a person from using associative memory to aid recall.

The Mini-Cog: A common three-word test

Perhaps the most well-known three-word test used in clinical settings, including the Medicare Annual Wellness Visit, is the Mini-Cog. This screening combines a three-word recall with a clock-drawing task to assess cognitive function. For the Mini-Cog, the three words are typically:

• Apple
• Penny
• Table

BIMS: Another three-word assessment

Another screening tool you might encounter, particularly in long-term care settings, is the Brief Interview for Mental Status (BIMS). This assessment also uses a three-word recall component. One common word set for the BIMS test is:

• Sock
• Blue
• Bed

Why are these words used?

These tests are not designed to be difficult for someone without cognitive decline. The words are used to challenge the brain's ability to encode, store, and retrieve new information. The brief distraction task, such as drawing a clock, is a key element designed to challenge a person's short-term memory. The inability to remember the words after the distraction can be an early indicator of memory or cognitive issues that warrant further evaluation.

How the three-word test is administered

The process for a three-word recall test is straightforward and brief, usually taking only a few minutes. Here are the steps involved:

1. Present the words: The provider will say the three unrelated words clearly and ask you to repeat them immediately to confirm you heard them correctly. For example, using the Mini-Cog words: "I am going to say three words that I want you to remember now and later. The words are banana, sunrise, chair. Please say them now".
2. Introduce a distraction: A brief, unrelated task is given. For the Mini-Cog, this is the clock-drawing task.
3. Ask for recall: After the distraction, the provider will ask you to recall the three words you were asked to remember earlier.

Comparison of cognitive screening tools

Several different tools may be used for cognitive screening during a Medicare Annual Wellness Visit. The Mini-Cog and the Montreal Cognitive Assessment (MoCA) are two examples that incorporate word recall but differ in their comprehensiveness.

Feature	Mini-Cog	MoCA
Number of Words	Three words	Five words
Recall Method	After a distraction (e.g., clock drawing)	After a distraction (e.g., repeating numbers, subtracting)
Additional Tasks	Clock-drawing test	Visuospatial skills, attention, language, abstraction, delayed recall
Administration Time	About 3–5 minutes	About 10–15 minutes
Sensitivity	Good for detecting mild cognitive impairment	Generally considered more sensitive for early cognitive decline

Preparing for your cognitive assessment

There is no need to study or research to prepare for a cognitive screening. The goal is to provide an accurate snapshot of your current cognitive function. However, you can ensure a smooth process by following these tips:

• Bring a companion: If you have noticed any memory changes, a family member or friend can provide additional context and observations to the provider.
• Gather health information: Have a list of all current medications, medical conditions, and any concerns you have about your memory or cognition.
• Be rested and relaxed: A good night's sleep can help you feel more comfortable and perform better on any test. Avoid unnecessary stress about the test itself.

What happens after the test?

If your screening results suggest a potential issue, it does not mean you have dementia. Many factors can affect memory, including vitamin deficiencies, medications, and depression. Your provider may recommend further testing, which could include more detailed neuropsychological testing, blood tests, or other medical evaluations to determine the cause of any memory changes. The screening is simply a starting point to determine if a more in-depth assessment is needed.

For more information on the Mini-Cog test and its administration, you can find detailed instructions and resources online Mini-Cog Scale & Instructions - PsychU.

Conclusion

While the specific words may vary, the core purpose of the three-word recall during a Medicare memory test is to provide a quick, simple, and effective screening for cognitive function. Understanding that different tests like the Mini-Cog ("apple, penny, table") and BIMS ("sock, blue, bed") use different words helps demystify the process. These screenings, conducted during your Annual Wellness Visit, are a vital part of proactive senior healthcare, allowing for early detection and intervention if any concerns arise. Remember, the assessment is a tool to start a conversation with your doctor about your brain health, not a definitive diagnosis.

Frequently Asked Questions

What is the Mini-Cog test and how is it related to the Medicare memory test?

The Mini-Cog is a quick cognitive screening tool often used during a Medicare Annual Wellness Visit. It involves two parts: a three-word recall and a clock-drawing task. Your doctor will use the results to assess your cognitive function.

Why does the three-word test include a clock-drawing task?

The clock-drawing task serves as a brief distraction between when you first hear the words and when you are asked to recall them. This helps test your short-term memory retention by preventing you from simply rehearsing the words in your head.

Can I refuse the memory test during my Medicare Annual Wellness Visit?

Yes, you have the right to refuse any part of your medical examination, including the cognitive assessment. However, it is a covered benefit under Medicare designed to proactively monitor your health.

What happens if I forget the words during the Medicare memory test?

Forgetting the words does not automatically mean you have dementia. It indicates that further evaluation might be needed. Many factors, such as stress, sleep deprivation, or medication side effects, can affect memory.

Are there other memory tests used for Medicare assessments?

Yes, aside from three-word tests like the Mini-Cog and BIMS, other tools like the Montreal Cognitive Assessment (MoCA) are also used. The MoCA is more comprehensive and uses a five-word recall list.

How can I prepare for the Medicare memory test?

There is no special preparation needed for the test, as it's meant to be a baseline assessment of your current function. Getting a good night's sleep and being well-rested is the best preparation. You can also bring a family member to share any observations.

Does a poor memory test score automatically mean I have dementia?

No. The cognitive assessment is a screening tool, not a diagnostic test. If the results are concerning, your doctor will perform more comprehensive testing to rule out other potential causes and reach a definitive diagnosis, if necessary.