Parents Say "I'm Fine"? This Test Is More Accurate Than Your Worries

Disclaimer: This article is based on scientific research and real cases. All names have been changed and institution names have been anonymized.

Last week, a woman in her 50s brought her 76-year-old mother to the clinic. She told me that her mother had been forgetting things lately, but the elderly woman insisted "everyone's like this at my age."

I had the elderly woman take a simple Stroop test. Five minutes later, the data showed her attention-switching ability was only 45% of the average for her age group. When I showed the results to her daughter, she broke down in tears: "Doctor, I should have brought her in earlier."

After 30 years as a neurologist, I've observed too many families like this in my research. Children sense something is wrong but don't know what to do. The elderly person denies there's a problem or is afraid to go to the hospital. By the time they actually come to the hospital, they've often missed the optimal intervention window.

Signals That Are Easy to Miss

Many people think cognitive problems manifest as "forgetfulness." In reality, attention decline often appears earlier than memory deterioration, but it's more subtle.

My mother-in-law turned 70 last year. One day during a family dinner, she was cooking and the food in the pan burned, but she didn't even notice. It wasn't an olfactory problem—she had her entire attention on chopping vegetables, completely "blocking out" other information.

This is a typical manifestation of declining attention allocation ability. Before, she could cook while chatting with us, but now if she gets even slightly distracted, problems occur.

There are some even more subtle signals:

Can't Follow TV Plots It's not poor hearing, but rather that attention can't switch between multiple threads. One elderly person used to love mystery shows, now only watches war dramas—because the plot is simple and doesn't require much mental effort.

Driving Becomes Overly Cautious This isn't a good thing. When elderly people become overly cautious while driving, it's often because their attention resources are insufficient, and they can only compensate with "slowness." One of my patients used to drive very smoothly, but after turning 60 suddenly became particularly slow and often took wrong turns. Testing showed her attention-switching speed had decreased by 60%.

Getting "Stuck" While Doing Things For example, cooking halfway through and suddenly not knowing what to do next. Or speaking and forgetting what you were going to say. This isn't a memory problem, but "working memory" capacity becoming smaller—the brain's ability to process information simultaneously has declined.

Slower Adaptation to Changes One elderly person got a new phone last year. After being taught dozens of times, still couldn't use it. She said "I'm old, I can't learn anymore." But actually, the problem wasn't memory, but cognitive flexibility—the ability to switch from old habits to new ways had declined.

Why Is the Stroop Test Particularly Suitable for the Elderly?

Common cognitive tests used in hospitals, like clock drawing tests or word memory tests, are often resisted by elderly people. They feel "do you think I'm senile?"

But the Stroop test is different. It looks like a game, without the pressure of being right or wrong. In research, we often tell elderly people: "Come, let's play a color game." Most elderly people cooperate well and even enjoy it.

More importantly, the Stroop test can capture very early cognitive changes.

In 2021, research from Huashan Hospital affiliated with a key university in Shanghai found that among elderly people diagnosed with Mild Cognitive Impairment (MCI), 82% showed abnormalities on the Stroop test 1-2 years before diagnosis. At that time, routine physical examinations and memory tests were still normal.

In other words, the Stroop test can detect problems 1-2 years in advance. These 1-2 years happen to be the golden window for intervention.

Data Speaks: Critical Values You Should Pay Attention To

One researcher summarized a practical standard in clinical practice, specifically for elderly people:

Ages 60-70

• Excellent: Stroop effect < 250 milliseconds
• Normal: 250-400 milliseconds
• Warning: 400-600 milliseconds
• Recommend medical consultation: > 600 milliseconds

Ages 70-80

• Excellent: < 300 milliseconds
• Normal: 300-500 milliseconds
• Warning: 500-700 milliseconds
• Recommend medical consultation: > 700 milliseconds

Ages 80+

• Excellent: < 400 milliseconds
• Normal: 400-600 milliseconds
• Warning: 600-800 milliseconds
• Recommend medical consultation: > 800 milliseconds

But remember, longitudinal comparison is more important than cross-sectional comparison.

I have a patient, Auntie Wang, who tested at 280 milliseconds last year at age 68, and this year at 520 milliseconds. Although still in the "normal" range, an 85% increase in one year is a clear warning signal. Sure enough, six months later she was diagnosed with mild cognitive impairment.

Fortunately, because it was discovered early, through medication and cognitive training, her disease progression was effectively delayed. Now at 70, her quality of life is not much different from two years ago.

Three Real Stories

Story One: The Warning That Was Almost Ignored

Grandma Li is 75, her son lives abroad and comes home once a year. Last Spring Festival when he came home, the son felt his mother "seemed to have gotten dumber," but couldn't specify what was wrong.

I had her do a Stroop test, and her score was 680 milliseconds—clearly over the threshold. Further examination revealed she had early vascular cognitive impairment. Her blood pressure medication was adjusted in time, plus daily cognitive training, and six months later when tested again, it had dropped to 450 milliseconds.

If the son had just thought "everyone's like this when they're old" and didn't take it seriously, waiting another year or two, the damage would have been irreversible.

Story Two: An Unexpected Discovery

Uncle Zhang is 68 and came for a physical examination on his own initiative. He said he'd been losing at mahjong lately and wondered if it was dementia. Test result: 230 milliseconds, very excellent.

I told him with a smile: "Your brain is very healthy, losing at mahjong might just be bad luck." He was relieved and joked: "Then I need to change my mahjong partners."

This story tells us that proactive testing isn't embarrassing. Rather than anxious guessing, better to let data do the talking.

Story Three: The Decision That Changed the Whole Family

Auntie Zhao is 70, her daughter is my colleague. Last year during her physical examination, an expert suggested she take the test. Result: 750 milliseconds, far above the warning line.

Her daughter panicked and asked me: "Is my mom going to get dementia?" The expert said: "Not necessarily, but it does need attention."

Later it was found to be hypothyroidism—a completely treatable disease. After three months of medication, when tested again, it had dropped to 380 milliseconds. If not for that test, this disease might have gone undetected for years, and cognitive function would have gotten worse and worse.

Now Auntie Zhao tests once every six months, and her scores have remained stable. Her daughter says: "That test was the best decision I ever made."

How to Convince Parents to Take the Test?

This is the question children ask me most. My suggestion:

Don't Use the Word "Examination" Don't say "Mom, I'm worried about your memory, let's go get checked out." Elderly people will feel you're implying they have a problem, which easily causes resentment.

Try saying this: "Mom, a researcher I saw online has a cognitive game, says everyone over 60 should play it, it exercises the brain. Let's try it together?"

Do It as a Family Don't only have parents do it, do it yourself too. Even have children participate. Turn it into a family activity, not an "examination" targeting elderly people.

Regular Monitoring, Not Just Testing When Suspicious Recommend testing once a year during physical examinations after age 60. Like measuring blood pressure and blood sugar, make it a routine item. This way elderly people won't feel "do you think I have a problem?"

Use Data to Talk, Don't Argue Based on Feelings Many families argue endlessly over elderly people's cognitive issues. Children say "Your memory has gotten worse," elderly person insists "I'm fine."

Testing can give you an objective basis for dialogue. Not "I think," but "data shows."

Test Results Are Abnormal, Then What?

First, don't panic. Poor Stroop test scores have many causes:

• Insufficient sleep (most common)
• Drug side effects (blood pressure medication, sleeping pills, etc.)
• Thyroid problems
• Vitamin B12 deficiency
• Depression and anxiety
• Actual cognitive impairment

The first 5 are reversible, and scores will improve significantly after treatment.

The correct process is:

1. Don't speculate at home—Take parents to a neurologist for comprehensive assessment
2. Screen for reversible factors—Blood tests, sleep evaluation, medication adjustment
3. If diagnosed with cognitive impairment—Earlier intervention, better results
4. Even if there's no problem—Establish baseline data for future comparison

One of my patient's daughters said it well: "Testing isn't to prove parents have a problem, but to prove they don't. Even if there really is a problem, early discovery is always better than late discovery."

Action Checklist for Children

If you really care about your parents' cognitive health, here's what to do:

After Age 60, Test Once a Year Just like testing blood pressure and blood sugar during annual physical examinations, add the Stroop test to routine items.

Record Data, Watch Trends Don't just look at this score, compare with last year and the year before. If it declines more than 30% for two consecutive years, you should go to the hospital for detailed examination.

Observe Daily Life After Testing If test scores are poor, pay attention to whether parents really have difficulties in daily life. Sometimes nervousness during testing affects performance.

Don't Use Test Results to Label Parents Poor scores don't equal "senile," it's very likely other solvable problems.

Final Words

After 30 years working in neurology, my biggest feeling is: many families don't not care about elderly people, they just don't know how to care.

Children see their parents aging and feel anxious inside, but don't dare face it. Elderly people themselves are also afraid, so subconsciously avoid it. The result is that problems are dragged out until they're exposed very late.

The Stroop test gives you a pressure-free, quantifiable, easy-to-operate tool. Five minutes, one objective data point, better than countless worries and arguments.

Test with your parents now, not because you suspect them, but because you care about them.

Remember, discovering problems isn't scary, what's scary is having problems but not knowing. One day earlier discovery means one more degree of composure.