Cognitive and mental health concerns have become increasingly common in our society, yet discussing cognitive care with patients can be challenging. With over 55 million people living with dementia worldwide (World Health Organization, 2023), it’s crucial for healthcare providers to use tools and strategies that will help to effectively navigate these conversations.
Because of the stigma and discomfort patients may feel when discussing cognitive concerns, brain health can often be overlooked. Just as recording indicators of physiological health is a standard part of regular check ups, tracking brain health should be too—and it starts with open communication with patients.
In this article, we will explore:
- The different aspects of cognitive health
- When to start having conversations about cognitive function
- Common cognitive health questions from patients
- How to effectively administer cognitive screeners and assessments
What is Cognitive Health?
Cognitive health refers to a collective set of abilities, such as thinking, learning, and clearly recalling information (National Institute on Aging, 2024). It influences everything from decision-making to performing everyday tasks, and is often tied to mental, behavioral, and physical health.
Healthy cognitive function plays a large role in patients’ quality of life, allowing them to move through the world independently. As a result, many people may fear cognitive decline, with 49% of people of all ages saying dementia is the health condition they fear most (Alzheimer’s Research UK, 2023).
Cognitive health also encompasses the prevention and treatment of cognitive impairment, as it relates to many different health conditions. Some examples of cognitive impairment include:
- Dementia. There are multiple types of dementia, such as Lewy body dementia and frontotemporal dementia, but Alzheimer’s disease is the most common (Alzheimer’s Association). Its primary symptoms include memory loss, challenges with focus and reasoning, as well as drastic changes in language, behavior, and mood (Alzheimer’s Association).
- Mild cognitive impairment (MCI). The symptoms of mild cognitive impairment may not be as severe as dementia, but can be an early sign of more advanced dementia or Alzheimer's. An estimated 10 to 20% of people over age 65 are impacted by MCI, and its most common symptoms are forgetfulness and struggles to recall words (Alzheimers.gov). Symptoms associated with MCI lie in the space between what are considered normal age-related changes and dementia. Contrary to what many people think, MCI is not a normal part of aging (World Alzheimer’s Report 2024).
- Cognitive impairment from traumatic brain injury (TBI). Brain injuries often have a negative impact on cognitive health, with approximately 65% of moderate to severe TBI patients reporting long-term problems with cognition (Whiteneck, Gale G. et al., 2004; Rabinowitz and Levin, 2015).
And of course, there are many other conditions that impact cognitive health. For more examples, which can be measured using objective tools and health questionnaires, see the Condition Based Research Guide.
Why do cognitive health conversations matter?
There are several important reasons to include cognitive health discussions as a standard part of the patient experience:
- Dementia is a global health concern. Every year, there are roughly 10 million new cases of dementia worldwide—implying one new case every 3.2 seconds (Alzheimer’s Disease International). Normalizing cognitive health care in a primary care setting keeps providers up to date with patient needs.
- Improve early detection of cognitive disorders. Routine testing and frequent conversations about cognitive health equip healthcare providers to detect early signs of cognitive decline, offer timely treatment, or improve quality of care through processes such as care planning.
- Comorbidities between cognitive and mental health disorders. Impacts on cognitive function are common in psychiatric conditions (Millan et al., 2012). For example, dementia and depression can present with similar symptoms, to the point where the term “pseudodementia” has been termed (Harvard Health Publishing, 2024). Cognitive health assessments and behavioural evaluation can help providers determine an appropriate diagnosis for the most effective treatment plan.
- Reducing the stigma. Open conversations about cognitive health can help reduce stigma, provide education and resources, and help patients overcome hesitation to disclose information about their cognition. Why does the stigma persist? 88% of people living with dementia indicate experiencing discrimination, and often avoid seeking medical treatment and isolate themselves from relationships as a result (World Alzheimer Report 2024).
- Promoting health equity. Patients with educational and financial barriers, as well as patients who live in rural areas, experience obstacles to accessing cognitive health care (Lock et al., 2023). Including cognitive health conversations and assessment as part of regular check ups gives them the opportunity to raise any concerns.
- Challenging misinformation. In 2024, 80% of the general public and 65% of health care professionals incorrectly believed that dementia was a normal part of aging (World Alzheimer Report 2024). Accurate information is essential for giving patients strategies for maintaining cognitive health.
When to Start Addressing Patients’ Cognitive Health
A 2016 study found that 56% of people were putting off seeking a dementia diagnosis for a year for fear that their “lives would be over” (Alzheimer’s Society UK, 2016). Regular conversations about a patient’s cognitive health are part of a preventive approach to care and can reduce patient fears.
Here are some suggestions for how cognitive testing can help clinicians connect with patients about their cognitive health:
- Patients with healthy cognition. Regular cognitive testing establishes a true baseline for patients without any signs of cognitive impairment. Along with this, educating these patients about lifestyle factors can help them take steps to help prevent dementia in the long run.
- Patients with mild signs of cognitive decline. Using cognitive screens to establish a baseline for patients with emerging health concerns is equally important. This equips clinicians for early detection, timely intervention, effective and measurable treatment, and creating a care plan to best support patients.
- Patients with poor cognitive health. For patients with severe cognitive impairment, such as dementia and related diagnoses, routine cognitive health care helps track the effectiveness of ongoing treatment as well as the progression of neurodegenerative disease. Regular conversations about cognition also can help introduce the idea of advance care planning, allowing patients to advocate for themselves.
Family members often play a caregiving role for patients with dementia, which can lead to symptoms of burnout (de Souza Alves et al., 2019). Including caregivers in conversations about cognitive health can give providers a more robust picture of their patients’ care needs, and promote overall wellness in the home.
Answering Common Cognitive Health Questions
Here are a few questions that patients may have about their cognitive health:
How can I improve my cognitive health?
Physical, mental, and emotional health play a large role in cognitive function, and patients may find they can improve their overall brain health with lifestyle changes (Sandison et al., 2023; Wild et al., 2018) such as:
- Better stress management
- A balanced diet
- Increased social interaction
- Physical activity
- Getting enough sleep
Addressing this question is a great way to emphasize why preventative care is important.
What are some of the first signs of cognitive decline?
According to the Alzheimer’s Association, early signs of cognitive decline that can lead to dementia include:
- Memory loss that disrupts daily life
- Difficulty with planning, problem-solving and judgment
- Struggles to complete familiar everyday tasks
- Confusion regarding time and place
- Trouble understanding images or spatial relationships
- Often misplacing things without the ability to retrace steps
- Withdrawal from work or social activities
- Changes in mood or personality
What causes dementia?
Based on current research, the exact cause of dementia is unknown although studies have uncovered various physiological markers or patterns of neurodegeneration characteristic of the condition (Breijyeh and Karaman, 2020). These markers include:
- Cognitive and behavioral markers: Progressive memory loss, impaired daily-life activity, and other symptoms like aphasia, in the absence of other psychiatric disorders or brain disorders that could explain symptoms.
- Biomarkers: Markers of brain amyloid showing up in imaging and cerebrospinal fluid (CSF), as well as signs of atrophy or synaptic loss.
There are several risk factors associated with dementia (World Health Organization) including:
- Age (65+)
- Hypertension
- Diabetes
- Poor diet and obesity
- Smoking
- Excessive alcohol use
- Physical inactivity
- Social isolation
- Depression
Certain cases of dementia have also been linked to a genetic component, and ongoing scientific research is helping health professionals learn more every year (National Institute on Aging, 2024).
Are there any treatments for dementia?
While there is currently no cure for dementia, there are emerging therapies and medications for management of its symptoms. Lifestyle factors such as diet, exercise, social interaction, and sleep play a key role in the overall well being of dementia patients (Hafiz et al., 2023).
Key Steps in Administering a Cognitive Assessment
Given the crucial role cognitive markers play in diagnosing conditions such as dementia, cognitive assessments can support conversations about cognitive health—long before dysfunction and disease appear. Data-driven platforms can help make cognitive health clearer and easier to understand for patients, as well as support the diagnostic process and value-based care delivery for providers.
At Creyos, we support measurement-based care by offering objective screens and protocols for cognitive health, as well as standardized behavioral health questionnaires to understand the whole picture of brain health. At the same time, we’ve thoroughly considered the time efficiency and workflow needs of healthcare providers—most of our cognitive screens and protocols can be completed in under ten minutes.
There are many components of cognitive assessment that are important to consider. We explore these more in depth below:
Pre-Assessment
A large part of working within the patient-centered care framework involves helping patients gain a full understanding of their mental, cognitive, and physical health. Dedicating time to pre-assessment helps ensure that results aren’t skewed by misunderstanding.
Prior to administering a cognitive assessment, it may be helpful to review and explain to patients:
- The importance of cognitive health
- The reasons to monitor cognitive health over time
- The type of assessment the patient will be taking
- What the assessment will determine
- Directions for the assessment
Post-Assessment
If the patient’s cognitive assessment does not reveal any concerns or indication for further assessment, it’s still important to continue preventative care conversations, especially with older patients.
However, if markers of MCI were flagged, further testing and clinical interpretation may be required in order to formulate a diagnosis and treatment plan. The next steps could include:
- Exploring causes of impairment
- Treatments for reversible causes of MCI
- Identifying personhood, life goals, and care preferences
- Telling the patient and their care team what they can expect over time
- Providing ways to respond to these new changes to increase quality of life
Based on what the person shares, a personalized medicine approach helps make the treatment plan that’s ideal for the patient as an individual.
Ongoing Assessment
Regular monitoring is key to tracking any changes to a patient’s cognitive baseline. Including cognitive screens at regular physicals gathers that data, and helps patients trust that their brain is being given equal consideration to the rest of their bodies.
For patients who are undergoing treatment for disorders that may affect cognition, cognitive assessments help indicate:
- How effectively the treatment is working
- If further specialist intervention is necessary
- If this treatment might be useful for other patients
It is likely that any patient with severe cognitive decline will eventually require a specialist referral. Objective, scientifically-backed reports keep patient data visible for both primary care providers and specialists. Together, they can help the patient build the treatment plan that meets their wants and needs.
Common Cognitive Assessments
Long neuropsychological assessments are an important and thorough way to screen for brain health disorders like dementia. However, there may be long wait times to get appointments, and the assessment itself can be time-consuming.
As a result, many shorter screening tools have been created to test cognitive function, each with different benefits and drawbacks.
As a result, many shorter screening tools have been created to test cognitive function, such as the Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Saint Louis University Mental Status (SLUMS). However, while these quicker screeners have their strengths, they also have limitations.
How Creyos is Transforming Cognitive Health Care
One of the challenges in cognitive health care is determining which assessment tools are best for your patients. Addressing limitations of traditional screeners, Creyos has created modern, scientifically-backed screening and assessment tools that easily integrate into your practice’s operations.
Our user-friendly platform provides objective and meaningful insights into patient brain health, which is beneficial for patients and providers alike.
Benefits for Patients
Creyos is an accessible, non-invasive cognitive assessment platform that includes:
- Engaging gamified tasks linked to specific domains of cognition
- Self-guided assessments that can be taken remotely and with minimal administration requirements from a practitioner or trained professional
- Easy-to-understand results for providers to communicate findings meaningfully with patients and their families
- Reimbursable evaluation under most insurance policies
- Customizable options from sound settings to time limits
Benefits for Providers
Creyos offers providers a robust suite of reliable and scientifically-validated cognitive assessment tools that:
- Use validated measures of cognition with tasks that have been linked to distinct brain networks and used in over 300 peer-reviewed studies.
- Generate revenue with reimbursements using CPT codes for a variety of services
- Include standardized mental and behavioral health questionnaires for comprehensive assessment of psychological conditions
- Provide reports in as little as 5 minutes that integrate into patients’ electronic health records
Contact us today to discover what Creyos can offer your clinic!
A Proactive Approach to Cognitive Care
Cognitive changes are often difficult to identify, and discussions with patients about their cognitive health can be hard to navigate considering fears of diagnosis or stigma. However, fostering open conversations about cognition may help normalize this standard of care by taking a proactive approach to brain health. Prioritizing cognitive health assessment can improve patient health outcomes and allow them a safe place to open up about their cognitive wellness.
