The Limitations of Standardized Cognitive Assessments

When patients are dealing with mental or other neuropsychological issues, providers work to determine an accurate diagnosis and develop an effective treatment plan. The first step to this process often includes administering one of the many standardized cognitive assessments. Unfortunately, current assessment tools have limitations that stand in the way of a crucial step in measuring cognition.

Current Challenges with Standardized Cognitive Assessments in Evaluating Brain Health

When treating a cognitive or mental health disorder, specific interventions like weaning off medication, making sure therapy is on track, or choosing the suitable form of rehab involve big decisions that can enormously impact a patient’s life. Assessing interventions and tracking the impact on cognition are currently accomplished through:

• Self-reported information from the patient, parent, or caregiver
• Symptom checklists and rating scales
• Pen and paper tests like the MoCA, MMSE, WAIS

However, evaluating brain health using these traditional methods creates numerous barriers in cognitive care.

Diagnosing and Establishing a Reliable Baseline

Diagnosis is often the first and most critical part of the patient care journey—and, unsurprisingly, often the most complex. For example, one study found that about 20%—or 900,000—of the 4.5 million children identified as having ADHD likely have been misdiagnosed, possibly due to the subjective nature of current standardized cognitive assessment methods. Today, individualized care approaches (i.e., patient-centered care models that assess the unique needs of individual patients) are becoming increasingly more accepted and commonplace due to the many benefits they offer. However, obtaining a diagnosis informed by individual data can be difficult, inconvenient, time-consuming, or expensive. In addition, traditional standardized cognitive assessment tools fail to directly connect the condition in question to brain health and its impact on cognitive function.

Having tools to move beyond standardized cognitive assessments is critical. It’s essential to supplement self-reported data with more complete objective data to help a clinician confirm or rule out diagnostic hypotheses and ensure a more comprehensive view of the patient’s health. Mental disorders or injuries can significantly impact cognitive functioning. For example, consider a neurologist with a patient who has just suffered a head injury. Self-report measures do not fully describe symptoms, so supplementing them with objective cognitive function measures allows the neurologist to confirm or rule out cognitive consequences of the injury. The same applies to mental health professionals treating disorders with known cognitive consequences, such as depression, anxiety, and ADHD. Since diagnosing a patient is one of the more significant decisions clinicians are charged with making, better diagnostic aids are needed to support these potentially life-changing determinations.

Furthermore, cognitive function is complex and made up of multiple components, and an informed diagnosis may require measuring specific areas of cognition rather than broad composite measures or categories. For example, someone may have perfectly normal reasoning skills, but their memory skills are being affected by a condition for which they are seeking treatment. Likewise, depression is known to affect some aspects of short-term memory and reasoning, but broad measures of cognitive function can miss specific deficits that could have aided a diagnosis and accurately measured the symptoms of the diagnosed condition.

Collecting an accurate baseline measurement can complement a diagnosis and provide a starting point for measuring change over time. For example, cognitive deficits due to a neurological condition may be missed if a patient’s cognitive function is in a normal range for their age but showed a significant drop in function over the past year. An accurate cognitive function baseline provides a comparison point for the individual patient that can be used to measure improvements due to treatment or to monitor for concerning changes.

Despite their importance, many measures used within standardized cognitive assessments to evaluate function are rarely used or are skipped entirely due to being resource-intensive (e.g., three to six hours of neuropsychological exams or expensive brain scans). This makes them impractical for everyday use as a diagnostic aid or baseline measurement. In addition, quicker screening tools are often highly specialized for specific conditions or administered when it’s too late to reverse the condition’s course of action (e.g., the MoCA). Due to these constraints, clinicians must rely largely on subjective patient interviews or templatized self-report checklists and rating scales, which are helpful but can be influenced by biases. These tools alone cannot provide an entirely objective view of cognitive function, and biases may ultimately impact diagnosis and treatment. Without enhanced solutions and more reliable data, care teams wage an uphill battle to determine a precise diagnosis and gain an accurate baseline.

Clinicians need an accessible solution to objectively evaluate their patients’ cognitive function—at baseline and on an ongoing basis—that goes beyond limited standardized cognitive assessments.

Tracking Improvement and Adjusting Treatment

Once an accurate diagnosis is made, the path to a superior patient outcome lies in the effectiveness of the treatment plan. But how can a healthcare provider quickly and efficiently determine whether a treatment is having the desired effect?

Today, most practitioners gauge progress with traditional standardized cognitive assessments that produce subjective data from patients and family members. While clinicians know that this information is some of the most valuable, a sensitive and objective measure can provide greater confidence in how interventions impact cognitive function. Without objective measurements, reports may contain biases, placebo effects, and a lack of specificity about the areas of brain health that have changed. More accurate information may help adjust current treatments, plan additional interventions, predict adherence to treatment programs, monitor for signs of relapse, and avoid costly mistakes.

Current standardized cognitive assessments for evaluating cognitive function tend to be too time-consuming to perform regularly and are unsuitable for administering multiple times due to limited forms and practice effects. Designed for one-time assessment, they may also lack sensitivity to the subtle changes resulting from treating mental or physical health conditions with cognitive consequences.

In the context of establishing or adjusting a care plan, it’s important to understand the strengths and weaknesses of that specific patient. Treatment may not be aiming to improve brain health across the board but instead to address particular weaknesses or deficits connected to a disorder, which many tools are not equipped to measure.

Traditional standardized cognitive assessment tools, such as self-reported information, symptom checklists, and paper and pen tests have the same limitations for detecting change as they do for diagnosis, particularly when they must be administered several times. It is often impractical to ask a patient to physically visit a clinic after treatment is completed or to refer to a neuropsychologist multiple times for a quick progress report.

Without quick, automatically administered, objective clinical assessment tools that are highly sensitive to change, clinicians are missing out on the ability to collect valuable progress data.

Traditional methods for evaluating changes due to treatment are resource-intensive and rely on subjective data and templatized checklists.

Communicating Results to Patients

Properly communicating symptoms and demonstrating progress are critical next steps that allow clinicians to not only understand a patient’s cognition themselves but help the patient understand it in a clear and digestible way.

Clinicians often find it difficult to communicate results from the solely subjective information generated from traditional standardized cognitive assessments. This can make it particularly difficult to demonstrate to the patient that there are specific brain health concerns to work on or that there has been a meaningful change that may affect their quality of life. In addition, patients are often going through treatments for the first time and have only subjective feelings to indicate if cognitive symptoms are getting better.

When cognition is measured via a neuropsychological examination, the results may be comprehensive enough to inform clinicians, but advanced training and extensive time is required to translate the numerical results into a written report for the patient, family members, or other parties. At the other extreme, quick standardized cognitive assessment tools, like the MoCA or other specialized screening tools, may provide a simple yes or no answer regarding severe overall impairment; however, they lack specificity about which areas of cognition could be impaired and may only provide information about extreme impairment. In addition, many patients are dealing with only mild cognitive symptoms. Thus, they may have weaknesses that can inform diagnosis, be impaired relative to their own baseline, or have measurable improvements due to treatment, even if their scores are not low enough to reach a screening cutoff.

Feeling better is part of the picture, but today, clinicians rarely have examples of how measurable cognitive function may translate to deficits or improvements in a patient’s everyday life. That information can keep patients engaged and motivated throughout their programs and highlight the benefits provided by healthcare providers.

Clinicians need an easy way to communicate information about patient cognition.

It Is Time to Move Beyond Traditional Standardized Cognitive Assessments

There is a clear need for more objective, reliable cognitive data to supplement the gaps inherent in subjective measures and traditional standardized cognitive assessment methods. Access to this critical data can support a new diagnosis, be tracked over time to understand treatment effectiveness, and communicate important information to patients.

Clinicians need a modernized, comprehensive tool to obtain a reliable and objective baseline assessment while easily tracking cognition regularly to help providers generate post-treatment longitudinal data. This makes it possible to create an effective treatment plan to improve or maintain cognitive functionality, monitor intervention effectiveness, and clearly communicate with patients.