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Understanding the Limitations of Testing Cognitive Function

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Cognitive deficits are a primary symptom of various neurological disorders and are vital to establishing a diagnosis, determining treatment, and assessing outcomes. However, providers have limited tools to effectively measure cognition over time and must rely on traditional methods designed to only detect severe impairments. Ultimately, many common cognitive assessment tools result in challenges that lead to limited insights, which can cause milder impairments or early symptoms to be missed. This creates a gap in patient care that can lead to poor clinical outcomes.


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Top 3 Limitations of Testing Cognitive Function

Current Assessment Options Leave a Gap in Cognition Data

One of the main challenges in testing cognitive function, especially in neurology, is that assessment methods are all or nothing. Complete neuropsychological evaluations and MRIs are often necessary when treating neurological conditions, but come with costs and complications that may deter referrals when impairment is not already established. At this point, quick pen-and-paper screening tools come into play. Unfortunately, those screening methods catch only severe impairment and reveal almost nothing about people within a normal range or only mildly impaired.

It’s a bit of a catch-22: cognitive assessments are performed only if an impairment is present, but objective impairment can be detected only in extreme cases.

This issue is multiplied in cases where cognitive impairment is not the main focus or is in early stages, such as with pain, Parkinson’s, MS, epilepsy, and other disorders treated by neurologists. They need an “in-between” solution for routine cognitive assessments to fill these gaps.

 

Comprehensive Evaluations are Costly

Another obstacle when testing cognitive function is that a full neuropsychological evaluation requires a specialist referral. Adults wait for an average of 5 to 10 months to see a neuropsychologist, while children often wait for at least 12 months. These extensive wait times and a 4+ hour evaluation make it difficult to leverage these evaluations for longitudinal monitoring.

MRI scans have similar limitations. Although they excel at identifying physical brain problems, such as injuries and disorders, they cannot always predict functional deficits with the accuracy of behavioral measures and are time-consuming and expensive.

Neuropsychological evaluations and brain imaging are not conducive to regular assessments, given the high costs in both time and money. Unfortunately, these are just a few factors that lead to an underutilization of cognitive testing and poor—or at least poorly measured—patient outcomes.

 

MMSE, MoCA, and Other Quick Screening Methods Generate Limited Results

Aside from referring patients to a specialist, the other common option is to conduct screenings like the MMSE, MoCA, and SLUMS. These traditional assessments are quicker than a full neuropsychological evaluation and can provide an adequate starting point, but yield limited insights. Static items and in-person testing make routine assessments impractical and place patients in broad categories, making it difficult to obtain a complete patient profile. In addition, these exams don’t allow for tracking subtle changes over time and do not provide insights into different cognitive domains, both of which are critical to creating a comprehensive picture of cognitive health.

It is difficult to obtain dependable, quantifiable data via this method. In older educated adult patient populations, over 98% are not considered impaired on the MMSE, and over 50% score near perfect. The MMSE ultimately does not provide helpful diagnostic information about cognitive function unless there is a severe impairment.

Self-reports are another source of quick brain health information but are limited in accuracy. For example, patients may complain of “brain fog” or that they “feel worse” before or after treatment. They may even deny any cognitive impairments at all, despite obvious signs noticed by clinicians and family. While self-reports are still valuable pieces of information to obtain, they are nonspecific, unreliable, and often wholly inaccurate compared to objective measures.

Over 43% of Parkinson’s patients eligible for a dementia diagnosis deny any functional impairment, and 93% of people with moderate to severe dementia overestimate their performance on cognitive measures.

 

New Solutions Make It Easy to Overcome the Challenges Associated with Testing Cognitive Function

While it’s clear that there are many challenges associated with traditional assessments, modern computerized cognitive assessment solutions, like the CBS Health platform, have been designed to combat them all. CBS Health provides neurologists with a trusted and efficient method of testing and monitoring cognitive function. CBS Health measures the cognitive domains known to be associated with neurological disorders, using tasks that are scientifically validated, easy to administer, and sensitive to change.


Want to explore a few modern cognitive assessment use cases?

Read our blog post

Want to save this information for later and see how this applies in real-world scenarios?

Download our eBook: Bridging the Gap in the Neurology Toolkit: How Modern Cognitive Assessments Improve Neurological Care

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