I had a disappointing test result. Why?
Either the test has identified that you may have a slight degree of cognitive impairment in which case you might wish to follow the guidance on the results page. Alternatively there may have been another problem with the test. This could be one or more of the following:
A technical problem with the Cognitive Function Test (CFT)
Connection. As the CFT is online and involves timing, it requires that you have a reasonably fast and consistent connection. Therefore it is important that the network and your computer are all functioning properly. A broadband connection, if it is functioning correctly, should be adequate for the test, however if you have a dial up connection which is not working well, this could cause the pages of the test to load slowly which could have affected your test result. If your computer was running slowly for any reason such as running a scheduled scan, affected by a virus or suffering a problem with any software, this may have affected the speed with which it loaded the pages of the test.
Browser. The CFT should work on modern browsers, PC/Windows: Internet Explorer 9 onwards, Firefox, Safari, Chrome; Mac: Safari, Chrome, Firefox. However malware and virus may affect the performance of your browser.
Screen size. As specified at the introduction the test is designed for a computer with a minimum screen size of 1024 x 768 pixels (e.g. a 12 inch-wide screen), with normal settings. If you had to scroll down to during the test to see the whole page this could have affected your results. For this reason the CFT will not work correctly on iPhones or blackberries.
It is important to follow the instructions about not being disturbed, wearing glasses if necessary and ensuring your mouse is working well. If you were interrupted and had to restart the test this will have affected your result.
Completing the examples
Our pilot study showed that it is important that you do complete the examples. If you did skip the examples and then started a test unsure of exactly what to do, this could have affected your result.
I have taken the test and my result was ‘at risk’, should I be worried?
Your result means that you scored a little less well than the average person of your age, which could be for a number of reasons. For example, your concentration may not have been optimal while taking the test. It is important to remember that the Cognitive Function Test (CFT) is a useful tool to help to identify mild cognitive impairment, however it does not diagnose Alzheimer’s Disease nor impending Alzheimer’s Disease. It is advisable to follow up your CFT with a homocysteine test. If your homocysteine level is high you may be at some risk of memory decline. Please follow the instructions on your results letter and the lifestyle advice on preventing Alzheimer’s disease. Also, take the test again in 6 months time and see if your results improve or not. If they improve you should have no cause for concern.
I find a mouse difficult to use, will this affect my test result?
The Cognitive Function Test has been updated so that it can be conducted with, or without a mouse, ie. using a touch pad on a laptop or a tablet. However, it would still be wise to take the test with a mouse that you are familiar and can ‘select’ and ‘click’ with ease. The ability to control a mouse may be affected by issues such as tremor and arthritis, and therefore we have included a click speed test. The results of this are used to derive the test result appropriately using a complex algorithm, in this way we take computer skills into account. Please ensure that your mouse is working well before starting and is on a suitable mouse pad. If you are using an optical mouse it is a good idea to ensure that you are not using it on a reflective surface, similarly a mechanical mouse should have a very clean roller ball.
Why was I not told that I would need to remember the location of the items in the last test?
This test is designed to look at how you remember the locations of items even though you were not asked to learn their locations consciously. If you had been asked to remember the items it would have changed the kind of brain function that the test was designed to measure.
My test result was good, what does that mean?
This means that your score is similar to that of other people your age. It shows you had a quick response time on the computer, with good attentional skills and memory performance. This test does not give a comprehensive assessment of all cognitive abilities. Therefore, if you have concerns about your memory you might wish to try the test again in one year’s time, or visit your GP. It is important to remember that the Cognitive Function Test (CFT) is a useful tool to help to identify mild cognitive impairment; however it does not diagnose nor preclude Alzheimer’s Disease. Please see ‘Interpreting your cognitive function test results’ for more information.
I am dyslexic. Will that affect my CFT test score?
We state on the results letter that some forms of dyslexia may affect your results, and we are researching this further. However, the pilot showed that different manifestations of dyslexia affect the test in different ways. For example those whose dyslexia coping strategy meant that they recognised the shapes of whole words did better than the norm in some parts of the test, whilst those who struggled with strings of letters did less well in other parts of the test.
Has the Cognitive Function Test been researched for accuracy?
Yes – A study published in the International Journal of Geriatric Psychiatry in January 2014, confirms that Food for the Brain’s free online Cognitive Function Test accurately measures the most sensitive memory functions that are the first indicators of increasing risk of Alzheimer’s Disease. Brain changes that affect memory often start 30 years before diagnosis, in people in their 50s.
In the study, the Test, which measures the three aspects of memory and cognition that decline in Alzheimer’s (episodic memory, executive function and processing speed) was compared to the best paper and pencil tests currently used to diagnose mild cognitive impairment, the forerunner of dementia/Alzheimer’s. There was almost perfect correlation showing the CFT test to be highly sensitive.
Who owns or designed the test?
The owner of the Cognitive Function Test is the Food for the Brain (FfB) Foundation. The CFT composes three elements:
Episodic memory, using cued recall and paired associate learning test constructs, developed by Catharine Trustram Eve for FfB, with the advice of Dr Celeste de Jager.
Executive Function, using a Symbol Matching test, similar in design to the Symbol Digits Modalities Test (Smith, 1995) developed as an integral part of the CFT. Reference: Smith A. Symbol Digits Modalities Test. 1995 (Eds) WPS, LA.
Processing Speed, using the Pattern and Letter Comparison Speed test, developed by Professor Salthouse, with permission to use as an integral part of the CFT, on a non-exclusive basis. Professor Salthouse retains the rights to this part of the test for use elsewhere.
Does the CFT diagnose dementia, Alzheimer’s disease or Mild Cognitive Impairment?
No. The CFT is not a diagnostic test, but a test designed to inform/educate the user about their cognitive function. If the result is below a threshold we suggest that they visit their GP who can perform whatever diagnostic tests are required at their discretion.
Did the charity seek IRB/ethical approval for either the pilot studies or the collection of data?
IRB approval is not required for such testing and data collection provided the information obtained is stored anonymously, with no identifier to the subject’s identification.
Is confidential information, which might in any way compromise the individual who has taken the test stored, or shared with any third parties?
In relation to the data, firstly, we only ask for a first name. We have an email address only if a person chooses to give it for the purposes of receiving an annual reminder, and we have their age. The programme calculates their CFT score. The participant is then assigned a number, and their score and other details such as age, is only stored against this number. This dataset is available to us, and may be made available to other parties on request and subject to approval of the Scientific Advisory Board and the charity. So, the subject cannot be identified, directly or through identifiers linked to the subjects. The participant is required to give consent for their data to be used, anonymously, for such research purposes.
Are you concerned that the test may either create undue fear or alarm in those receiving a poor score, or undue ease in those scoring well?
If an individual has cognitive impairment it is unlikely that it is possible to score well on this test. We do, however, still recommend homocysteine testing, because raised homocysteine is an independent risk factor for cognitive impairment. On the basis of current evidence a person scoring well on a cognitive function test measuring all three factors included in the CFT, and having a homocysteine below 9.5 micromol/l is currently unlikely to be ‘at risk’, although of course we do not assess other known risk factors. We also encourage repeating the test annually to ensure that this status does not change.
If a person scores poorly there are three possibilities. The first is that the result has arisen by chance; the second is that there might be genuine cognitive impairment, which can be caused or contributed to by a number of factors, and we encourage them to see their GP since early identification of cognitive impairment is essential, give that there is no evidence that Alzheimer’s disease, the most prevalent cause of dementia, is reversible. In our opinion, the ‘results report’ that the individual receives makes this clear (see below).
The third possibility is that they scored poorly due to other factors, including interruptions or technical problems during the test. We make this clear in the report and further explain the results, and possible confounding factors in linked web pages. No doubt, as we learn more we can make improvements and refinements to the test. In the ‘worst case’ scenario, where someone becomes unduly concerned due to, for example, an operator error, one imagines it will motivate them to see their GP, test their homocysteine, and/or improve diet and lifestyle factors that predispose to increased risk. None of these actions can be deemed to be harmful and may prove to be beneficial. We do our best to eliminate and adjust for these confounding factors (for example, the mouse speed test adjusts time allocated for each test; we put up copious notes about having a good internet connection, suitable screen size, no interruptions etc)
With 550 people diagnosed with dementia every day in the UK alone, most of which is Alzheimer’s, the need for early screening of decline in cognitive function is of paramount importance to the prevention of dementia and Alzheimer’s disease. We hope that the NHS will instigate a policy of early screening, with tests similar to the Cognitive Function Test, and homocysteine testing, sooner rather than later. We hope to conduct further research regarding this association, and also to research the impact of diet and lifestyle changes inspired by the test.
We have received literally hundreds of thank you letters, and remarkably few expressing undue concern.
I am outside the recommended age limit, can I still do the test?
The test has been designed for those aged 50 to 70. If you are older than this when you take the test the results may be less accurate. It is likely that for older people the risk is slightly less for a lower score as one expects test performance to decline with age.
If you are still having test related problems email us at firstname.lastname@example.org
Can I compare my Annual Retest Score with My Previous CFT Score
The Cognitive Function Test is a screening test only therefore any green result is a good result. Hence you should not compare scores from last year’s Cognitive Function Test to this year’s as only the colour is relevant.
If you received a red or amber result this may indicate lowered cognitive function, however it may also be the result of a number of other factors. It is therefore important to see your GP to be tested in a more controlled environment.
If your annual test results differ considerably please consider the factors that may have influenced your test, in particular basic elements such as internet speed and screen size. If you are concerned please contact your GP and, as ever, follow the 6 Alzheimer’s prevention steps.