You feel like your focus or memory is awful but the tests say otherwise. What now?
Introduction
Have you ever found yourself zoning out during a conversation, forgetting what you were about to do, or struggling to stay organized? If so, you've probably wondered, "Is something wrong with my brain?" So you go in for neuropsychological testing and are then surprised to hear that the results came out normal. Ummm ok, now what? This disconnect between how you feel and what the tests show is actually really common. You're not imagining things. There are several reasons for why this happens and understanding them can be a big relief.
What neuropsychological testing measures (and what it doesn't)
Neuropsychological tests assess cognitive functions like memory, attention, language, and executive functioning using standardized tasks. It's kind of like taking a snapshot of how your brain is doing at any given time. These tasks are designed to be objective, structured, and unaffected by the highs and lows of daily life.
However, the mental hiccups you notice in daily life (fancily called "subjective cognitive complaints") can’t always be captured by our tests. These complaints can include forgetfulness, distractibility, difficulty planning or following through on tasks, or trouble finding the right words. When you feel like your brain is letting you down but your scores say everything is fine, it’s confusing. To understand what could be behind this disconnect, we need to look beyond the test results to what's happening in the context of your everyday life.
Why you might feel more distracted or forgetful than you actually are
Hint: psychological factors play a big role
Depression and anxiety: Feeling anxious or down can make small cognitive issues seem bigger. For example, let's say you forgot someone's name. But maybe when the person told you their name you weren’t fully focused because you were worried about a work deadline or something else important. Depression can also make it harder to concentrate and retain information. In turn, there is more forgetfulness and frustration.
Stress and fatigue: Chronic stress and fatigue can hamper attention and make it harder to process and remember things. Who has been there feeling like your brain is on vacation because you couldn’t sleep the night before? I’m raising my hand! The cognitive impact of poor sleep or burnout is very real and very underappreciated in our daily conversations. Plainly said, the brain just doesn't function well when it's running on empty.
High self-monitoring: Some people are more tuned in to their mental slips in general. This heightened awareness can make these lapses seem worse than they are. The more you worry about your thinking, the more you notice every stutter or pause. The result? A feedback loop of concern.
Medical and neurological influences
Early signs of a memory problem: Sometimes, our complaints are actual early warning signs of conditions like Alzheimer’s disease or other types of dementia. This is even when standardized tests show no issues. The research literature has suggested that changes in brain chemistry or structure can begin years before symptoms become measurable on paper. What I’d like you to keep in mind though is that conditions like Alzheimer’s are rare before older adulthood. For most younger adults, other explanations are far more likely.
Functional cognitive disorders: When a person doesn’t have a diagnosed neurological disorder, cognitive issues may come from how the brain processes information. These "functional" cognitive difficulties can be very real and annoying, even when they aren't actually caused by brain damage. For example, people with fibromyalgia or chronic fatigue syndrome often report differences in their attention or memory even though their testing looks okay. Another good example involves recovering from a mild head injury. These "subjective cognitive complaints" can stick around for a while despite neuropsych testing looking good.
Medication side effects or health conditions: Certain medications, like ones for mood, sleep, or pain, can contribute to cognitive complaints. So can medical conditions like thyroid disorders, vitamin deficiencies, or autoimmune issues. A thorough medical workup can sometimes reveal a contributing factor that’s been flying under the radar.
Self-perception and cognitive biases
The “worried well” phenomenon: Concerns about aging and cognitive changes are common. This is especially the case with how dementia is portrayed online. Because there is more awareness around what dementia is and how it manifests, there can be some over-interpretation of everyday forgetfulness. I'd love for you to tell yourself that just because you're forgetting where you put your keys or why you walked into a room doesn’t necessarily mean you're on a slippery slope.
Negative self-talk and perfectionism: If you're someone who tends to be hard on yourself, you might interpret completely normal lapses as failures. Perfectionists hold themselves to impossible standards (or at least very high ones) and see forgetfulness or disorganization as personal flaws rather than things that can happen to anyone at any given time.
How does your neuropsychologist think about these discrepancies?
The short answer is that we consider both test results and personal experiences to understand the root of cognitive complaints. It’s never just about the numbers on a page. Your lived experience matters a great deal.
With that said, here are some key things we're thinking about or doing:
Screening for mood disorders: It’s worthwhile to screen for things like depression and anxiety because treating these issues often improves cognitive symptoms. You read that right. It's a fact that less depression or anxiety can leave you feeling better about your thinking skills.
Looking at sleep and other lifestyle factors: I'm talking about sleep quality, stress levels, and daily habits. These factors can have a huge impact on how your brain feels and functions. Addressing the fundamentals is often the first step toward feeling sharper and more capable.
Monitoring over time: If there are reasons that you may be at a higher risk for memory problems (like if there’s a significant family history of Alzheimer’s), we will usually recommend follow-up testing around 12–18 months after your first evaluation. We want to be able to catch any changes and intervene as soon as possible. Bonus points to you and/or your loved one if you keep your own notes about what has gone on in the time frame between evaluations!
Contextualizing your results: Neuropsychologists are trained to interpret your scores in the context of who you are. This means thinking about your background, education, life experiences, and current challenges. We don't just look at numbers and data. It's our job to think about the big picture.
What you can do if you're worried about your cognitive skills
If cognitive difficulties are bothersome in your daily life, start with these steps:
Prioritize sleep: Aim for 7–8 hours of quality sleep each night. I know that can be a big ask but give it some thought. If it’s unclear why you’re having trouble sleeping, don’t hesitate to talk to your doctor. Sometimes a sleep study or tailored treatment for insomnia can make a huge difference.
Manage stress and anxiety: Things like mindfulness, regular exercise, deep breathing, and therapy can help clear the fog. I know it sounds clichéd, but the research has spoken! Stress management isn't just good for your mood; it’s good for your brain too.
Challenge your brain: Keep your mind sharp with reading, puzzles, learning new skills, or anything that gets you thinking. People often ask me if there’s a certain type of puzzle or app they should try. The answer is no. The rule of thumb is that it just needs to be hard enough that you have to work at it and not so hard that you’re tempted to throw your new sudoku book out the window in frustration.
Maintain physical health: Regular movement, hydration, balanced meals, and consistent routines all help your brain function at its best. A sluggish body can lead to a sluggish mind.
Seek professional help: If your concerns continue after covering the rest of these tips, think about getting a neuropsychological evaluation. Full Stack Psychology is here to help you get answers, clarify what’s going on, and guide your next steps.
Final Thoughts
Experiencing cognitive challenges while test results show no issues can be super frustrating. But these experiences are often influenced by factors like mood, sleep, and stress. The good news is that we can identify and address these factors readily. For those with early signs of cognitive decline, figuring out those changes early opens the door to interventions that can help maintain brain health and daily function.
I'd like to leave you with this thought -- your concerns are valid. It'll say it again: your concerns are valid. They always will be. A normal test result doesn’t mean you’re imagining things or being overly dramatic. It simply means there’s more to explore. By looking at both neuropsychological testing results and personal experiences, we can offer compassionate care that is tailored to your situation. Diagnosing or ruling things our is only part of the overall goal. Ultimately, we want to help you understand what’s going on so you can get back to living life with more clarity and peace of mind.
