Cognitive Testing and Screening in Health Care

Cognitive testing in primary care settings like a doctor’s office or community health clinic is still a rare occurrence. While some health care practices are beginning to take notice of the need for preventive cognitive screening for conditions like memory loss and mild cognitive impairment (which could be the early stages of Alzheimer’s), most medical practices do not conduct cognitive testing until a patient has obvious symptoms of cognitive impairment or dementia.

Many primary health care professionals will reach first for a paper and pencil test like the Mini Mental State Exam (MMSE), Clock Drawing Test (CDT), or Blessed Test of Orientation/Memory/Concentration (BOMC). These paper-based tests are reasonable starting points, but there are several drawbacks, including relative test insensitivity to the early stages of Alzheimer’s and other forms of dementia.

With the increasing wave of Alzheimer’s and dementia cases in the US and globally, administering paper and pencil cognitive tests to millions of patients isn’t very practical. Computerized cognitive testing is more efficient, reliable, and more detailed than most paper based tests.

There are several computerized cognitive tests that do have good test-retest reliability (when a patient takes the test a second or third time the results are still reliable), and are also sensitive enough to pick up early signs of memory loss and mild cognitive impairment (MCI). Computer based cognitive tests also use an objective, automatic scoring process, which helps increase the reliability of test results.

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Three computerized cognitive tests in particular are designed for use in a physician’s office and other primary care settings:

1. CANS-MCI (by Screen, Inc.) is a 30 minute cognitive test using a computer and touch screen that measures memory, executive function (planning & reasoning), and language skills. The CANS-MCI test has demonstrated the ability to detect early memory impairments.

2. MCI Screen (by Medical Care Corp.) is a 15 minute cognitive test based on the 10-Word Recall Test included in the CERAD (Consortium to Establish a Registry for Alzheimer’s Disease) assessment battery. MCI Screen is used to detect early signs of cognitive impairment.

3. MindStreams (by Neurotrax) provides a 20 minute MCI assessment battery that measures memory, attention, executive function, and visual-spatial skills. MindStreams has demonstrated the ability to distinguish between MCI and “normal” age related memory decline.

The main benefits of using computerized cognitive assessment tools are two-fold: a baseline cognitive test and subsequent re-tests can form the basis for a patient’s historical cognitive health record, and well-validated cognitive tests are now sensitive enough to catch early signs of brain health problems, allowing for early therapeutic interventions.

In addition to the cognitive assessment tools described above, Brain Resource, CANTAB, CogState, CNS Vital Signs, and HeadMinder offer computer based cognitive tests that may be used in a doctor’s office and other clinical care settings.