I am furious, and not afraid to admit it, with the results. The test captures a picture of brain function via 12 exercises, from the ‘Monkey Ladder’ which asks you to remember the order numbers appear in boxes that move around the screen, to ‘Digit Span’ – remembering the order of numbers in a chain, like a phone number – and ‘Paired Associates’, in which a variety of images appear briefly and you try to recall the order in which they appeared. This is a measure of episodic memory, and I’m able to laugh at my “average” score, putting me in the 43rd percentile, when I learn it relates to tasks such as remembering which cupboard you put the groceries in.
“You did really well!” says Natalie Mackenzie, kindly. Mackenzie is a cognitive health and brain injury expert who wants us all to take better care of the squidgy stuff between our ears. “There are very few things that require that amount of cognitive activity for so long. And with this test you’re jumping from one thing to another,” she points out. “It’s a very focused cognitive activity.”
“They’re average,” I complain. “I don’t want to be average.” I console myself with the fact that Mackenzie’s complex assessment looks at so many different kinds of brain activity that it’s no surprise I don’t score highly on all of them. In half, I am very nearly “above average”. When I look at the percentile my score puts me in, I am over 70 in half, too.
“You’re a high average,” Mackenzie insists. I want to do better, though. That’s the point of the test. It’s designed to show users how they can improve. Mackenzie has worked in the field of neuropsychology for over 20 years, primarily as a rehabilitation therapist for people with brain injuries. But she wishes that more people took a preventive approach to their cognitive health.
If we had a cognitive assessment, she believes, we would understand where our strengths and weaknesses are, and this would help us to measure and track cognitive decline as we age. Her plans start from £97 for an assessment and £196 coupled with a 50-minute personal assessment.
We discuss my results via Zoom and she explains how well I have done on the tests related to my job. The aforementioned Monkey Ladder, for example, measures visuospatial working memory, which is the ability to remember information about objects in space, and update memory based on changing circumstances. This makes sense, as when I am writing or interviewing, the information I have, and what is required of me to respond, can change from moment to moment. I also do well with working memory, short-term memory, and response inhibition, the latter two coming in at above average.
Response inhibition is the ability to concentrate on relevant information despite interference, such as keeping your eyes on the road while driving, or inhibiting a gut reaction to a social media post – I wish! I suppose this explains my skill for eavesdropping on others’ conversations while my husband talks to me about cycling.
We all want to stay smart into old(er) age, but in recent years, I have noticed memory loss of various kinds. I am 44 but frequently forget words, usually names or key pieces of vocabulary. This happens so often it doesn’t even embarrass me anymore, though I was ashamed a few weeks’ ago when I couldn’t remember the name of the place where I got married.
I’m not too worried about early onset anything. But I do recognise that I am tired and overloaded, and often struggle under the weight of small details, which can lead to a chaotic working day, switching erratically between tasks and windows, research and meetings, writing and scrolling.
So can I game the health of my brain? Mackenzie insists this is possible, and gives me various tasks which she says will boost my brain function.
Sleep overhaul
Mackenzie says that a good place to start is my sleep. Having read up on so-called ‘sleep hygiene’ – developing good habits and an environment that will help you to get good quality sleep – I am fairly proud of my mostly organised and screen-free bedroom. I tend to leave my phone elsewhere. My husband has his by his bedside.
We discuss other distractions and Mackenzie says that blackout blinds aren’t necessary if our bodies are ready for sleep, and reading or listening to an audiobook is fine. I tell her about the tall pile of books by my bed, some for pleasure, some for work, some I’ve been meaning to read for months, along with a notebook to write down any life-changing ideas that come to me as I’m nodding off.
She points out that all this work and rumination could interrupt my sleep. I see her point immediately. The pile is always there, reminding me of all the things I haven’t yet read, but must. I tidy it away and have stuck to keeping just one book by my bedside. “When people ask how can I improve, it’s all about the environmental things,” Mackenzie says. “Not only practising the cognitive skills. Cognition is massively impacted by our physical health, mental health, sleep and diet.”
Fight your night wees
I am aware that drinking alcohol disrupts my sleep because it makes me more likely to wake up in the night, but I hadn’t considered that needing a wee because my bladder was full of water could also be a problem. I wake at 4am almost every night. Mackenzie recommends I stop drinking at least two hours before I go to sleep – and says getting uninterrupted sleep each night is one of the most powerful ways to improve memory and brain function. It is hard, but the results are remarkable. On the nights I manage to not drink, my sleep scores are so much better, as are my waking moods.
Time-blocking
I used to track my working hours carefully. I know it’s a requirement of many jobs, but I found the struggle to get enough hours in amid constant distraction made me feel I was always failing. To help focus, Mackenzie suggests time-blocking instead of tracking, marking out chunks of time for specific tasks before rewarding myself with time for lifemin or doomscrolling. I continue to fail.
I have tried the Pomodoro technique before, where you give yourself a timed 25 minutes for focused work, followed by a five-minute break. I am not good at this. A lot of my work requires me to be present and react to changing conditions, so maybe I’ll never be any good at “deep” work.
Nine weeks after my first test, following six weeks of putting the advice into practice, I take the test again. The results really cheer me up. I am now above average in four of the 12 measures, and can see my weaknesses far more clearly. Most of all, I feel like I have something to work with, that I don’t need to blame all my mistakes or forgetfulness on broken sleep or alcohol, and can instead try and work on these areas.
Don’t rely on apps
I ask Mackenzie whether I should spend more time testing my brain. “These brain training apps have their place in terms of keeping people ticking over,” she says. “They build up tolerance and stamina, and we use them primarily for this in my brain injury clients. But there’s very little evidence of how they actually impact us functionally.” She says that older people may as well do Sudoku or crosswords, then do something stimulating and social, like take a new dance class.
Keep learning
“Learning is key,” she says. “Repetition is great, but learning a new thing is where the magic happens.” I started taking piano classes after the first lockdown because of fear of cognitive decline. I was probably just in shock from the circumstances of Covid, but there was something both indulgent and meditative to the combination of physical and mental skills that playing an instrument demands, in particular asking each hand to move differently, as piano does. I wish I had continued to play, but I ditched it with the excuse of being “too busy”.
I have a way to go in this area – the one Mackenzie identifies as most crucial, in everyone, for overall cognitive health, but have formulated the idea of learning Mandarin so I can help my daughter with her homework, it being the only subject she does that I never have. If only I didn’t keep forgetting to download Duolingo…
Mackenzie laughs and introduces me to her 80 per cent rule. “Having a goal is great,” she agrees. “But it has to be attainable. People will drop off if they can’t maintain the high levels of energy needed. You’ve got to reframe, and say: ‘OK, I’d like to do it at 100 per cent, but could I be OK with getting to 80 per cent?’” TBC.