Moving Cognitive Screening into the Doctor’s Office

A recent article on a new iPad health care application to screen for early signs of Alzheimer’s Disease points to how innovation is beginning to drive research lab tools for cognitive testing into the physician’s office. Developed by Cambridge Cognition, a commercial spin-off from Cambridge University, the screening application is based on Cantab PAL, a visual working memory test.

The iPad version of Cantab Pal is being tested by the British National Health Service (NHS) over the next year to determine if it is suitable for use by general health care clinicians and staff. The tool adds to a growing list of computerized cognitive assessment products that are targeted for a variety of general health care applications.

There is a growing realization in medical research and health care that Alzheimer’s and other types of dementia are typically diagnosed far after cognitive impairment is present in the affected patient. The historical lack of cognitive screening tools has contributed to the problem.

Also, Medicare recently added a preventive screening benefit called the Annual Wellness Visit (AWV). The AWV includes a loosely defined “detection of cognitive impairment”, which can serve as a springboard for implementing a more routine, comprehensive cognitive health screening process.

One of the major benefits to computerized cognitive screening tools is the ability to establish a baseline cognitive test for each patient, and then compare subsequent annual re-tests to the baseline test — this testing method is far more informative and accurate to detect small cognitive changes associated with mild cognitive impairment (MCI), which can be a precursor to Alzheimer’s.

It will be interesting to learn the results from the NHS on using a mobile tablet approach for cognitive screening in primary care. There are some pros and cons to using a more traditional computer/keyboard/mouse method for cognitive testing versus a small touchscreen; it could be that testing certain cognitive domains like visual memory will lend themselves more towards the mobile tablet option.