The neurologist who built the test that was used on the President of the United States explains what memory tests actually tell you, and why even a perfect score isn't the whole picture.

We sit down with Dr. Ziad Nasreddine, the neurologist who created the Montreal Cognitive Assessment (MoCA), to look at how memory is actually measured, why a score can be shaped by your education and how comfortable you are with tests, and what separates a quick screen from a full neuropsychological evaluation.

The conversation opens with a patient who passed a short memory screen but whose family knew something was wrong, and what a deeper test revealed. From there it moves to how the MoCA works, how it became famous after a presidential exam (and the memorization problem that followed), why your education and nerves can shift a score, and why the real progress against dementia is happening in detection and prevention, not treatment.

A memory test is not a verdict. Its value is early, honest information, and what you can do once you have it.

In this episode:

• What the Montreal Cognitive Assessment (MoCA) measures, and why it was designed to catch the earliest changes rather than advanced dementia
• How a quick memory screen differs from a full neuropsychological evaluation, and what a score actually represents
• Why education, language, and familiarity with testing can change your score even when your cognition is fine
• The story behind the MoCA becoming famous after a US presidential exam, and the memorization problem that followed
• XpressO, a free at-home cognitive pre-screener, and what a green result does and does not mean
• Why detection and prevention, not treatment, are where the real progress against dementia is happening right now
• The difference between slowing decline and reversing it, and why a diagnosis of dementia cannot be undone
• What the 2024 Lancet Commission's modifiable risk factors mean for your everyday choices
• How movement and social connection show up in the data on cognitive decline
• How to read a health headline: effect size, clinical versus statistical significance, and why a small change can be sold as a breakthrough

Dr. Ziad Nasreddine is a neurologist and the creator of the Montreal Cognitive Assessment (MoCA), which he first developed in 1996 and spent nine years validating. It has since been translated into more than 50 languages and is used in over 100 countries, making it one of the most widely used cognitive tests in medicine. He completed his cognitive neurology fellowship at UCLA under Dr. Jeffrey Cummings. His more recent work includes XpressO, a free at-home pre-screener, and MoCA Solo, an AI-administered version of the test.

Resources:

• The MoCA (Montreal Cognitive Assessment)
• XpressO (free at-home cognitive pre-screener)
• Our 2026 Brain Health Retreat

Hosted by Drs. Ayesha & Dean Sherzai

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