The exam in the room, and the thinking and memory tests

Two different things get talked about in the same breath. One is the short exam your team does at every visit. The other is the longer day of thinking and memory tests. What each one is, and how long each takes. And why neither is something you can fail.

The short version

Two different things get talked about in the same breath, and it helps to know which one you are being sent for.

The exam in the room is the short one your team does at almost every visit. They check your strength, your feeling, your balance and your eyes. It can take minutes, and a fuller one takes longer.

The thinking and memory tests are a different appointment altogether: a psychologist or a trained tester takes you through word lists, puzzles and timed tasks, often for two to three hours and sometimes for most of the day.

Neither is something you can fail. Both get measured, and being measured is not the same as being graded. What comes out of them is a description of how you are doing now, and it is used to work out what help would suit you.

Two different things, often in the same conversation

The exam in the room is a set of quick checks on how your brain and nerves are working right now. Your team looks at your reflexes, your muscle strength, your vision, how your eyes and mouth move, your coordination, your balance and how alert you are. The proper name for it is a neurological exam. Every part of it is you being asked to move, look or answer while somebody watches.

The thinking and memory tests are a much longer appointment with a specialist. The person who reads it is a neuropsychologistneuropsychologist: A psychologist who looks at how a brain problem changes thinking. They read the tests of memory, attention and language. Then they write the report that says what would help. See the glossary, and the proper name for the day is neuropsychological testing. Often the person who actually hands you the tasks is a trained tester called a psychometrist, working under that specialist.

They look at different things, and that is why you can be sent for both:

• The exam in the room is about what can be seen from the outside: how you move, what you feel, how you see and speak, how alert you are.
• The tests are about how your thinking is working: attention, memory, language, planning and the speed you work at.

Someone can do well on one and find the other hard. Being sent for one is not a hint about the other.

Why am I having this?

The exam in the room is how your team notices change early. It is done at the start, and then again at visits afterwards, alongside asking how you have been. Being examined is not itself a sign that something has been found.

The thinking and memory tests are usually asked for one of three reasons:

• Before an operation, to know what your thinking is like beforehand. Doctors say plainly that knowing this is essential for planning care and for watching the longer term, and it is easier to see a change later if somebody wrote down the starting point.
• Because something has felt different, to yourself or to the people around you.
• To work out what would help, which is the reason people are least often told about and often the most useful one.

One short question is worth asking: what will you do with the result? An appointment you know the purpose of is a different experience from one you were simply sent to.

What happens, step by step

The exam in the room. It is mostly you being asked to do small things while somebody watches.

1. They ask how you have been. What you say shapes what they look at hardest, so it is worth answering properly rather than politely.
2. They test strength. Push, pull, squeeze, hold your arms out.
3. They tap for reflexes, usually at the knee, elbow and ankle, with a small rubber hammer.
4. They check feeling, sometimes with a small sharp point. Can you feel this on both sides, and does it feel the same on each.
5. They follow your eyes and face. Follow my finger. Smile. Puff out your cheeks.
6. They watch you move. Touch your nose, then my finger. Walk to the door and back.

The thinking and memory tests. This one is an appointment, not an examination hall.

1. You talk first. What you have noticed, what your days are like, what you are worried about.
2. You do tasks, one at a time. Lists of words to remember. Shapes to copy. Puzzles. Things done against a clock. Questions about your mood.
3. Some of it is easy and some of it is hard. A clinic that runs these says most people find exactly that, so hitting something you cannot do is the day going normally rather than going wrong.
4. You take breaks. One clinic that runs these days gives a break for lunch and says you can ask for others as you need them.
5. It gets scored afterwards, without you. The scoring and the writing up happen after you go home.

How long does it take?

The two answers are very different, and an average of them would be no use to anybody.

• The exam in the room: minutes. The short, set version made for brain tumor care takes about four or five minutes, and it is designed to fit inside an ordinary appointment.
• The exam in the room, done in full: longer. One medical center tells people to expect anywhere from half an hour to an hour, and says the length depends on your symptoms and on how thorough the examination is.
• The thinking and memory tests: two to three hours, and sometimes most of the day. One brain tumor center gives two to three hours and says it is sometimes split over a series of appointments. Another tells people to plan on being there for most of the day, and that you may finish early.

Ask which one yours is when the appointment is made, and ask whether it can be split. The answer changes how you plan the day and who comes with you.

Some of the time quoted for testing is not time you are there for. The scoring and the report are written up afterwards, and that work is counted in some hospitals' figures.

What does it feel like?

The exam in the room feels like being checked over. The reflex hammer is odd rather than painful. The sharp point used to check feeling is meant to be felt rather than to hurt. If any of it does hurt, say so.

The thinking and memory tests are tiring, and people say so. A clinic that does them puts it plainly: several hours of this can leave people feeling tired, over-stimulated and worked up. That is the day being long, not your brain failing.

Two things make it easier, and both are allowed. Take the breaks rather than pushing straight through. And say out loud when something is hard, because the person testing you would rather know than guess.

Am I being judged?

No. But both of them get measured, and you should know how, because being measured is not the same as being graded.

The exam in the room may be scored, and the score is not a mark out of ten. There is a short, set version of it made for brain tumor care. Where your team uses that one, it rates things the examiner can see: walking, strength, speech, sight and a few more. The number is there so that today can be set beside your last visit. A change in it is one of the things that tells your team the picture has moved.

The thinking and memory tests are scored differently, and here is exactly how. Your answers are compared with people of the same age, and often the same amount of schooling. Where there is an earlier result, they are compared with that too. The two comparisons do not always agree. Researchers looked at this in people with brain tumors and found the two ways of judging gave different answers. That is a known limit, and it is why a number on its own is never the whole finding.

So the measuring is real. A pass mark is not. A clinic that runs these tests puts it plainly: most people find some of them quite easy and others difficult, you are not expected to get everything right, and no one fails. There is no line you fall below that makes you a failure.

What a low score does is name something. It turns "I am not coping and I do not know why" into a specific list, and a specific list is the thing anybody can act on.

And a score is read next to the week you had. The clinics that run these tests ask you to get a good night's sleep first. They ask you to take your medicines as usual. They ask about your mood as part of the testing itself. All of that is there because a single sitting is a description of a single day, not a verdict on you.

What the report is used for

The exam in the room produces no report. The thinking and memory tests do, and it is a real document.

It goes to the people treating you. A clinic that does this testing says the results are shared with your healthcare team with your permission.

It is used to get you things, which is the part most worth knowing:

• Help with the difficulties it found. Therapists work on memory, concentration, speech and the practical side of a day, and a report naming what is hard is how that help gets arranged.
• Planning an operation, where the tumor sits near the parts that handle speech, movement or memory.
• The driving conversation. Testing like this is one of the things that feeds into whether driving is safe. The rules themselves are set where you live, and they are not ours to print. Driving and seizures covers who sets them and how to find out what yours are.
• Work. Thinking and memory are part of what makes work feel possible, and so are your mood and the way the job itself is set up. A report does not decide anybody's job. What it can do is explain why work has become harder, and say what would make it easier. Work after a diagnosis covers how much you have to tell an employer.

Ask who yours will be sent to before the day, and ask what happens if you want a copy. Both are easier to sort out beforehand than afterwards.

What to sort out beforehand

For the exam in the room, nothing. It happens inside an appointment you were already having. You do not prepare for it and you cannot revise for it.

For the thinking and memory tests, four things are worth doing.

• Bring your glasses and your hearing aids. Clinics that do this testing ask for this, and the reason is plain once you see it. A test of reading or listening measures your eyes and ears first. Bring your medicines too if you take any while you are there.
• Bring a drink, a snack and some lunch. One clinic says you may bring food and a drink, and on a long day it matters more than it sounds.
• Ask whether it can be split. A brain tumor center that does this testing says it is sometimes spread over a series of appointments. If a whole day is not realistic for you, that is worth saying when the appointment is made rather than on the day.
• Plan the journey home before you go. You will be more tired at the end than at the start, and it is easier to arrange a ride in advance than to work it out when you are worn out.

Why am I having this again?

Because one result is a single snapshot, and what your team needs is the change over time.

Both of these are repeated on purpose. The exam in the room is done at visits afterwards precisely so that a change can be seen against your own earlier checks, and the short, set version exists to measure exactly that, where your team uses it. The tests may be repeated after treatment, or later on, for the same reason.

Being asked again is not a sign that something was wrong the first time. It is the opposite: a single result has nothing to sit beside, and the second one is what makes the first one useful.

Who reads it, and how do I get the result?

The exam in the room: there and then. The person doing it is the person reading it. If they do not say anything, ask before you leave what they found, because "no change" is a finding and it is worth hearing out loud.

The thinking and memory tests: not on the day. A neuropsychologist reads and interprets the results after the scoring is done, and there is a written report at the end of it. Ask whether you come back for the results or whether your own doctor goes through them with you.

Ask before you leave when it will be ready and who will explain it. Waiting times are set by each hospital, and no website knows yours. What you can get on the day is the plan: who writes to whom, and which of them you should hear from. Ask who to contact if nothing arrives.

What to ask your team

• What will this be used for, and would the answer change anything?
• How long should I plan for, and can it be split over more than one visit?
• Should somebody come with me, and will I be able to get myself home?
• Should I bring my glasses, my hearing aids, or a list of my medicines?
• Is there a written report, how do I get a copy, and who else is it sent to?
• Would my report be sent to anyone outside the hospital, and would you need my permission first?
• Does anything in this change what help I can be referred for?
• Will this be repeated, and roughly when?

Where to go next

• Getting ready for surgery covers the other appointments that come before an operation.
• Your MRI scan is the test people are most often sent for alongside these.
• Follow-up scans goes through the check-ups that carry on afterwards, and what the waiting is like.
• Living with seizures has driving, and what to ask about the rules where you live.
• Radiation therapy explains what treatment itself can do to thinking and memory.