Refining Cognitive Function Assessment Tools To Better Support Physicians

According to the Alzheimer’s Association, in 2021, Alzheimer’s disease and other forms of dementia will cost the nation $355 billion, including $239 billion in Medicare and Medicaid payments combined. Without reliable, accessible, and cost-efficient cognitive function assessment tools to provide early diagnosis and treatments to slow, stop, or prevent Alzheimer’s, the projected cost from Alzheimer’s alone is projected to reach $1.1 trillion in 2050.

The prevention and treatment of neurological diseases, including Alzheimer’s, depends heavily on early detection, but historically, there has been a lack of proper diagnostic tools. The limitations of existing cognitive and functional assessments have led to inadequate cognitive screening in older adults. Only half of all seniors are being assessed for cognitive impairment, and only one in seven seniors are receiving regular brief cognitive assessments.

Below we detail the need to refine cognitive function assessment tools, the limitations of traditional tools, and the shift towards multimodal assessments.

The Need to Refine Cognitive Function Assessment Tools

There is an overwhelming need to refine cognitive function assessment tools to better support physicians in their efforts to detect cognitive and functional impairment before the clinical onset of neurological diseases. Early detection means early intervention and treatment, which ultimately leads to better health outcomes.

An immense amount of research has expanded our understanding of neurological diseases like Alzheimer’s disease and Parkinson's disease, providing a better understanding of disease signatures, yet providers are still left with tools that are outdated, narrow, and produce highly variable results.

Limitations of Traditional Cognitive Function Assessment Tools

Traditional cognitive function assessment tools have a multitude of limitations that may be contributing factors to the inadequate cognitive screening of older adults. Limitations and challenges include the following:

• Administration challenges: A healthcare professional is required to administer and interpret the results of traditional assessments, introducing the risk of bias or human-to-human variability as well as prolonging diagnostic timelines.
• Lack of ecological validity: Traditional cognitive function assessment tools are not ecologically valid, meaning the design of the evaluation does not match and align with neurocognitive states representative of Activities of Daily Living (ADLs).
• Language bias: Tools like the Mini-Mental State Exam (MMSE) and Montreal Cognitive Assessment (MoCA) are highly variable from one subject to another, as they introduce language and cultural bias. 
• The ceiling effect: The ceiling effect present in assessments such as the MMSE and MoCA can cause highly educated impaired individuals to score high, thus overestimating their neurocognitive abilities and contributing to missed diagnoses.
• Variable results: Results from traditional assessments become even more variable beyond language, education, and cultural bias, as the patient’s performance is highly subject to their “good” and “bad” days.

A Shift Towards Multimodal Assessments

Within our industry, we are beginning to see a shift towards multimodal assessments. Multimodal neurocognitive assessments that require patients to use more than one modality are the future of truly assessing their abilities to complete complex ADLs. 

By requiring patients to complete tasks while using multiple modalities such as visual, auditory, and spatial to track aspects like eye movement, speech, and gait, we can paint a full and detailed picture of a patient’s true neurocognitive abilities. This will allow providers to detect signs of cognitive or functional impairments early on, before the clinical onset of neurological disease symptoms.