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Dr. Nathaniel Chin, a geriatrician and Alzheimer’s researcher at UW Health, argues in a Being Patient essay that repeat cognitive testing is more informative than a single test because it shows whether an individual is declining over time. A single score compares a person to population averages, but cannot answer whether performance has changed for that specific person. He also notes limitations of repeat testing, including practice effects.
Dr. Nathaniel Chin, a geriatrician and memory-care physician at UW Health, published an essay on Being Patient on September 29, 2026 arguing that a single cognitive test is a limited snapshot — and that repeat testing over months or years is what actually reveals whether a person is declining. Chin, who serves as medical director of the Wisconsin Alzheimer’s Disease Research Center, writes that the most valuable information in a memory evaluation is not how someone performs once, but how performance changes over time.
Most cognitive tests, Chin explains, compare a person’s performance against a normative group — people of similar age and, depending on the test, similar educational or demographic background. That comparison helps determine whether a score suggests true impairment or normal age-related change. But normative data cannot answer a key question, he writes: “Is this different for this person?”
Chin illustrates the problem with individual variation. Someone may have always struggled with names but have exceptional visuospatial skills; a person with high educational attainment may experience meaningful decline and still score within the “normal” range. Conversely, another person may score below average while performing exactly as they have throughout adulthood. “When we are concerned about a neurodegenerative disease such as Alzheimer’s, we are looking for change, not simply low scores,” he writes.
Repeat testing also accounts for the uncontrolled circumstances of any single evaluation, Chin notes. Poor sleep, anxiety, depression, stress, medications that affect attention, recovery from illness, or simply a bad day can all influence performance. If repeat testing shows stable or improved performance, he writes, that is reassuring and may point toward potentially reversible contributors; consistent decline across evaluations, particularly in a recognizable pattern, raises greater concern for an underlying neurodegenerative process. Chin adds that comprehensive assessments should cover multiple domains — memory, attention, language, executive function, processing speed and visuospatial abilities — because not all cognitive change presents as memory loss and not every brain disease is Alzheimer’s.
Why Serial Testing Changes Diagnosis
The essay’s argument matters because it addresses a practical gap in how memory concerns are evaluated. For many years, according to Chin, cognitive evaluation was pursued only after impairment became obvious — when a person was repeatedly forgetting important information or struggling with daily activities. He writes that researchers now recognize Alzheimer’s disease develops over many years, with subtle changes appearing well before dementia, making concepts like subjective cognitive decline (SCD) and mild cognitive impairment (MCI) increasingly relevant. Earlier serial testing, in his view, becomes more valuable as detection moves earlier in the disease course, when change over time may be the only reliable signal.
For patients and families, the piece also carries a practical message: an unexpectedly low single score is not grounds for alarm, and a “normal” score does not rule out decline for that individual. Establishing a personal baseline early gives future comparisons meaning.
From Late Diagnosis to Early Baselines
Dr. Chin is an associate professor at the University of Wisconsin–Madison and Clinical Core co-leader of the Wisconsin Alzheimer’s Disease Research Center, where he studies Alzheimer’s risk, prevention and biomarkers. He hosts the Dementia Matters podcast and is the author of “When Memory Fades.” After his father was diagnosed with early-onset Alzheimer’s, Chin became one of his caregivers — an experience he says shaped his approach to patient care.
The essay reflects a broader shift in the field toward earlier detection, driven in part by biomarker research showing that Alzheimer’s pathology accumulates years before symptoms interfere with daily life. That shift has increased attention to SCD, in which people notice changes in memory or thinking even when standard testing may still appear normal.
Limits of Repeat Testing
Chin acknowledges that repeat testing carries its own limitations. Scores can improve simply because a person has seen the material before — a practice effect. He writes that this is why the interval between evaluations matters and why good testing often uses alternate versions of the same tasks. He frames this as an argument for careful testing, not against repeating it.
It remains the case, as the essay notes, that borderline or unexpectedly low single results can be hard to interpret, and factors like sleep, mood, stress and medication can confound any one evaluation. The essay is a physician’s perspective rather than new clinical trial data, and it does not specify how often testing should be repeated or which specific tests are best suited for serial use — decisions that in practice depend on individual circumstances and a clinician’s judgment.
What Patients Can Do Now
Chin’s essay suggests patients concerned about memory or thinking raise the question of establishing a cognitive baseline with their physician, so future comparisons are possible. People who notice their own memory or thinking changing — the hallmark of subjective cognitive decline — can discuss whether formal evaluation is warranted rather than waiting for impairment to affect daily activities. Anyone with questions about cognitive symptoms or testing decisions should consult a qualified healthcare professional. The essay itself does not announce new guidelines, trials or policy changes; it contributes a clinician’s argument to an ongoing discussion about earlier and more individualized detection of neurodegenerative disease.
Key Questions
Why is one cognitive test not enough, according to Dr. Chin?
Chin writes that a single test compares a person to a normative group of similar age and background, but cannot show whether performance has changed for that individual. Someone with high educational attainment, for example, could decline meaningfully and still score in the “normal” range.
What is a cognitive baseline and why does it matter?
A baseline is a person’s established performance on cognitive testing. Once it exists, future results can be compared not only with the general population but with the person’s own prior performance, allowing the question to shift from “Is this score normal?” to “Is this person declining?”
Can a low score on one test mean dementia?
Not necessarily. Chin notes that poor sleep, anxiety, depression, stress, illness, medications or a bad day can all affect a single result. He writes that stable or improved performance on repeat testing is reassuring and may point toward reversible contributors rather than a neurodegenerative process.
Are there downsides to repeating cognitive tests?
Yes — scores can improve because a person has seen the material before, a practice effect. Chin says careful testing addresses this by using appropriate intervals between evaluations and alternate versions of the same tasks.
What is subjective cognitive decline (SCD)?
SCD describes situations in which a person notices their memory or thinking has changed even though standard cognitive testing may still appear normal. Chin’s essay identifies it, along with mild cognitive impairment, as an important concept as detection moves earlier in the disease course.
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