In 2008 when I was assisting in a neuroscience research lab at University of California San Diego, I evaluated several computerized neurocognitive assessment tools. We were conducting a rewarded learning experiment with Parkinson’s subjects and age-matched controls that used a touch screen monitor, and I wanted to investigate the viability of replacing the paper-based Mini-Mental State Exam test (MMSE) with an equivalent computer-based test.
What I discovered was both intriguing and frustrating. There were dozens of computerized cognitive testing and screening tools available, but it quickly became apparent that there was no common process or standard for how these tools were packaged and implemented. Imagine trying to build a car with “off the shelf” components that don’t adhere to any particular size, shape or standard, and you get the picture.
I realized this was a solvable problem that also has some important implications for improving quality of health care at all stages of life. Consider the following:
- 5.3 million people in the US have Alzheimer’s Disease as of 2010. New cases are being diagnosed at a rate of 450,000 per year, and nearly 8 million in the US alone are projected to have this disease by 2030. (Alzheimer’s Facts and Figures 2010. Alzheimer’s Association)
- There are 1.4 million cases of Traumatic Brain Injury (TBI) each year in the US, with children and young adults comprising the majority. In addition, over 300,000 US service members have sustained blast related and other TBI injuries in the course of Iraq and Afghanistan deployments. (CDC 2010. Invisible Wounds Study, RAND Corp. 2008)
- Attention deficit problems affect both children and adults, with negative outcomes for learning and productivity. Over 4% of the US population (12 million people in 2010) are affected by ADHD. (Attention Deficit Disorder Assoc.)
- Autism is a cognitive developmental disability affecting 1.5 million people in the US. Recent data indicate that autism spectrum disorder has a prevalence of 1 in 110 births, or about 40,000 new cases every year. (Autism Society)
With these large numbers above, using paper-based cognitive screening tests to help diagnose conditions (individually administered by a skilled practitioner) won’t be very workable.
The best solution is a reliable collection of computer-based brain tests and cognitive assessments, backed by very large normative population data, that produce a standard reporting format which is easily understood.
As with any straightforward concept, however, the devil is in the details.