Neurologists care for one of the most critical and elusive systems in the body. Over the last few years, there have been incredible advances in identifying and treating specific neurological issues, such as significant updates in neuroimaging analysis and new techniques for tackling drug-resistant disorders. However, when it comes to ongoing care, the tools available to neurologists today still have many limitations, especially when it comes to neurocognitive testing.
Meanwhile, it has become widely accepted that preventive actions and proactive monitoring in healthcare can drastically improve patient outcomes. By applying these principles of preventive care in the neurology space, physicians can make a positive and ongoing impact on their patients’ lives.
Cognitive deficits are a primary symptom of various neurological disorders and can be key to determining a diagnosis, making decisions about treatments, and assessing outcomes. To measure cognitive function throughout the patient journey, providers typically rely on traditional methods that are not particularly robust or flexible. Neurologists can be limited to specialized tools offering limited insights, such as the MMSE or the MoCA, that are useful only in detecting severe impairments, causing milder impairments or early symptoms to be missed. They may refer to a neuropsychologist; however, this often presents patients with long wait times and lengthy evaluations. Of course, brain imaging is always an option, but this tends to be costly to both the patient and the healthcare system and serves as only one piece of the puzzle alongside behavioral measures of cognition.
The unfortunate reality is that neurologists have had limited options to test for cognitive function, which means valuable information on cognition is often missed.
Challenges of Current Neurocognitive Testing Methods
When it comes to neurocognitive testing, there are a few key challenges that face neurologists:
- Current assessment options leave a gap in cognition data: Traditional neurocognitive testing methods are all or nothing. Clinicians either invest in comprehensive testing or rely on quick-screen methods, which are really only effective in detecting severe impairment. What’s missing is a reliable method for catching mild impairment and early stages of cognitive decline.
- Comprehensive evaluations are costly: Comprehensive exams require specialists that often have long wait lists, and the exams themselves can take hours. This significant time and monetary investment makes it hard to gather longitudinal data that is needed to detect change.
- Quick screening methods are limited: Quick screening methods, such as MoCA, MMSE and SLUMS, combat the specialist wait time issue, but they still have major limitations. 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. Self-report measures are another source of this data but have limited accuracy. In general, these methods are not ideal for generating the dependable and quantifiable data needed to create a complete picture of cognition.
Neurocognitive Testing Usage Examples
Historically, neurologists have been left with limited options and no middle-ground solution. Neurologists need an assessment method that can measure cognitive function in detail, is appropriate for any patient (whether currently impaired or not), and is easy to integrate into routine processes and evaluations. Modern computerized neurocognitive assessments, like Creyos Health, provide this middle ground by helping neurologists measure and monitor brain health accurately in all patients, including those with neurodegenerative diseases, chronic pain, and brain injuries. Here are just a few ways these neurocognitive assessments have made a difference in real-world applications.
New digital neurocognitive assessment technology provides neurologists with a better option to evaluate cognition.
Supporting a Dementia Diagnosis
Clinicians who see patients with suspected cognitive decline or dementia use Creyos Health’s objective neurocognitive testing as a diagnostic aid to provide detailed information about a patient’s function. The testing provides information similar to a neuropsychological evaluation, but in less time, and can be administered directly in a neurologist’s practice without waiting for a specialist. Computerized assessments help determine whether subjective self-reports have merit, whether further evaluation by a neuropsychologist is necessary, and whether cognitive symptoms of dementia are likely. While a short, computerized assessment will not be the sole determinant of a dementia diagnosis, it can act as a diagnostic aid when making decisions about these complex conditions.
Medication Management for Neurodegenerative Diseases
Ongoing monitoring is vital when treating neurodegenerative diseases, such as Parkinson’s. These diseases are often characterized by cognitive decline and other long-term symptoms. For example, up to 80% of Parkinson’s patients develop dementia. The available medications to treat such symptoms have varying impacts and may ease cognitive symptoms or cause side effects. The pattern of cognitive deficits can be different in Parkinson’s patients on and off medication. It can also differ in patients with related diseases that cause dementia, such as Alzheimer’s.
Furthermore, the pattern of deficits can shift over the course of treatment. In one study, only medicated patients with severe symptoms were impaired in a paired-associate learning task, while medicated and non-medicated patients were impaired in a working memory task. Working memory declined further in patients who withdrew from medication. Results like these highlight the importance of measuring multiple cognitive domains to assess the effects of Parkinson’s symptoms and medication on brain health.
Monitoring the Long-Term Effects of Chronic Pain
Chronic pain has a variety of effects on cognition. Cognitive decline can indicate a change in a patient’s pain level, making it critical to measure cognition after treating a patient whose pain is a direct or indirect symptom. Ignoring these signs can have long-term impacts. For example, the odds of cognitive impairment increase by 21% for every two years of chronic pain. In the case of a traumatic brain injury, chronic pain can linger long after the immediate effects on the brain have subsided.
Cognition is the key to successful recovery from chronic pain, yet there is rarely a long-term follow-up period that includes neurocognitive testing. It is during this period that warning signs of relapse and side effects of treatments are often missed. Between 30% and 60% of chronic pain patients show evidence of relapse after successful treatment, which plays a role in the opioid crisis. These additional gaps in the patient journey can be partially filled with the use of modern, automated neurocognitive tests.
Creyos Health: The Modern Neurocognitive Testing Solution
For physicians, the decision to bring a new solution into their practice is not a casual one. Any new method must offer improved patient results without increasing administrative workload or costs. Creyos Health provides a tested and proven advancement in neurological care that can be implemented within days. The platform offers valuable insights about a patient’s brain function, becoming a valuable aid for diagnosis and tracking of symptoms. With these assessments in your toolkit, essential information about patient brain health becomes less elusive—and the way forward more certain.