Cognitive impairment is on the rise, and this makes effective and efficient cognitive testing an absolute must-have for providers. Primary care physicians (PCPs) have the potential to step in at the earliest point when a patient experiencing symptoms of Mild Cognitive Impairment (MCI) enters the healthcare system. However, despite the increasing prevalence of these conditions, many PCPs struggle to diagnose cognitive impairments.
In 2025, over seven million Americans are living with Alzheimer’s disease; by 2060, research predicts that number will nearly double, and 13.85 million elderly patients will have mild cognitive impairment (MCI) or Alzheimer’s disease (Rajan et al., 2021).
Dementia is also chronically underdiagnosed in the United States, and research indicates that the insufficient resources and training for general practitioners contribute to a lack of confidence in their ability to accurately detect and diagnose cognitive decline (Cox et al., 2025).
The good news is that digital cognitive assessments offer a promising solution. In this article, we break down how these digitized solutions enable PCPs, neurologists, and psychiatrists to capture comprehensive data on a patient’s cognitive functions, facilitating early detection and informed cognitive health management.
What Is a Cognitive Test?
First, let's define what cognitive tests are and what they generally do. Cognitive testing refers to the process of assessing cognitive impairment or dementia, providing valuable information for diagnosis and treatment planning. A cognitive test is a tool used by healthcare providers to evaluate how a person’s brain is functioning.
Cognitive tests are often used in primary care to screen for cognitive impairment, track changes over time, or help with early detection of conditions like MCI, dementia, and Alzheimer’s disease.
Cognitive tests assess various cognitive domains, including:
- Memory
- Reasoning
- Concentration
- Verbal ability
- Executive function
- Processing speed
Two of the most commonly used traditional cognitive assessments are the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).
The MMSE is a short 30-point questionnaire that evaluates general cognitive functioning, while the MoCA is slightly more detailed. Both are administered in person, usually by a clinician in a medical setting.
Understanding Cognitive Function and Impairment
Cognitive function encompasses the mental processes by which people acquire knowledge and understanding, make decisions, and solve problems. These functions are essential for daily activities and overall quality of life. Cognitive tests are used to detect potential signs of impairment in these domains.
As individuals age, the risk of developing chronic cognitive impairments may increase. Common conditions include dementia, Alzheimer’s disease, and mild cognitive impairment (MCI).
The Limitations of Traditional Cognitive Screeners
Traditional cognitive screeners like the MoCA and MMSE are typically used to screen for cognitive function in the context of primary care. However, these pen-and-paper assessments come with several limitations that can impact diagnosis and long-term management of cognitive impairments.
Without adequate tools and support, primary care physicians (PCPs) may struggle to provide timely and effective care for patients with cognitive impairments. Prevention and intervention strategies like addressing modifiable risk factors through lifestyle changes are vital during the early stages of impairment and may even prevent or slow dementia (Omura et al., 2022).
Limitations of Traditional Cognitive Tests in Diagnosing Cognitive Conditions
Low Sensitivity to Subtle Impairments
Research shows that the mini-mental state exam (MMSE) often struggles to detect the early signs of cognitive decline and isn't comprehensive enough to serve as a stand-alone test for diagnostic purposes (Arevalo-Rodriguez et al., 2021). Pen-and-paper questionnaires can only capture subjective measurements, which are not enough for most PCPs to make a confident diagnosis.
Impact of Cultural and Educational Biases
Some traditional screeners may have skewed results when administered to patients from diverse educational or cultural backgrounds. For instance, the MoCA requires a certain level of literacy and familiarity with abstract concepts, which may skew results in diverse urban populations (Stimmel et al., 2024).
Tracking Changes in Cognitive Function Over Time
Not Designed for Longitudinal Tracking
While the MMSE has alternate versions for retesting, it still isn't an ideal solution for tracking changes in cognitive function over time. While the MMSE generally performs well for retesting purposes when alternate versions are used, the results captured for cognitive areas like visual-constructional ability, registration, and recall may be unreliable (Lee et al., 2022). Patients may remember tasks from earlier visits, and performance differences can be difficult to quantify precisely, making it harder to identify trends or treatment effects.
Inflexibility and Time Constraints in Clinical Workflows
In a 15-minute appointment, allocating 10–15 minutes for a single cognitive screener can be challenging, if not impossible. This time frame doesn’t allow for the busywork involved with physically administering a test—printing and setting up the assessment, verbally explaining the process, and scoring by hand.
When all these tasks are added up, some PCPs may feel they lack the time or training to administer these tests effectively, limiting their integration into routine care. While digital assessments take approximately the same 10-15 minutes to administer, the physical tasks required for preparation are minimal, as the digital environment automates some steps, allowing PCPs to save more time per appointment.
Discussing Cognitive Health
Patient Discomfort and Accessibility Challenges
In-person test administration requires patients to physically attend clinics, which can be stressful for older adults or individuals living in rural or remote areas where healthcare access is limited (Krasniuk et al., 2023). This can potentially deter patients from follow-up testing, narrowing the opportunities for early detection and ongoing cognitive care.
Limitations in Normative Comparisons and Cutoff Clarity
While traditional screening tools like the MMSE and Montreal Cognitive Assessment (MoCA) provide objective data, a key limitation lies in their lack of standardized comparisons to normative databases and the ambiguity of ideal cutoff scores. Cutoff values for these screeners often vary depending on factors like the patient's age, education level, culture, and ethnicity, making it challenging for PCPs to interpret results confidently (Rossetti et al., 2011; Ratcliffe et al., 2023). In contrast, digital assessment tools can instantly compare patient scores to large, demographically matched normative databases, enabling PCPs to better identify deviations from expected performance.
Due to these limitations, PCPs often refer patients to specialists for more in-depth evaluations. A study found that 66% of PCPs referred more than half of their patients with suspected neurocognitive disorders for neuropsychological testing with a specialist (Bernstein et al., 2019). The referral process can lead to several challenges for both providers and patients, including disrupted continuity of care, extended wait times, and greater barriers to accessibility.
These challenges underscore the need for more accessible and efficient tools in primary care settings to assess and manage cognitive health effectively.
What are Digital Cognitive Tests?
Digitized cognitive tests are computer-based tools designed to evaluate core aspects of brain function, like memory, attention, reasoning, and processing speed. These assessments can be delivered through a variety of digital interfaces like tablets, computers, or mobile devices, and often consist of interactive tasks.
Unlike traditional cognitive screeners, which are often administered with pen-and-paper, effective digital cognitive assessments are built to be accessed remotely and are characterized by high sensitivity to subtle changes in cognition, making them highly effective in identifying cognitive impairment. Some digital cognitive assessments have also been associated with the earliest, most subtle signs of cognitive impairment and dementia, supporting early intervention.
Cognitive testing platforms like Creyos offer scientifically validated, gamified assessments that measure performance across multiple tasks and generate intuitive reports, modernizing how healthcare providers assess and monitor brain health in primary care.
The Benefits of Digital Cognitive Tests
As the demand for early detection and management of cognitive impairment grows, digital cognitive assessments have the potential to transform how primary care physicians approach cognitive care. These computerized cognitive tests address some of the limitations of traditional screeners, while offering new opportunities for efficient, accurate, and patient-friendly testing.
Capturing Subjective and Objective Measures
Cognitive tests make it easier to capture subjective and objective metrics like attention, executive function, and patient impact.
Objective Metrics
Digital cognitive tests can utilize scientifically validated, condition-focused protocols that combine cognitive tasks and behavioral health questionnaires, helping providers add more objectivity to patient evaluations. Objective metrics, like the ability to measure attention and executive function for ADHD patients, help PCPs track subtle changes in cognitive functioning that might be missed by traditional tools.
Subjective Self-Reports
While objective data is vital for diagnosis, patient-reported outcomes or symptom questionnaires provide valuable supporting information that can help clinicians better understand how cognition impacts daily life. Digital cognitive assessments utilize both subjective and objective measurements to reduce the reliance on clinical or patient judgment alone and provide actionable insights to guide diagnosis, care planning, and discussions about patients’ cognitive abilities.
Measuring Longitudinal Data
Cognitive tests make it easier to measure longitudinal data through re-administration and repeatability.
Re-Administration and Repeatability
Digital tests are designed for convenient re-administration in remote or in-clinic settings. Because of their digital and gamified format, these tests can randomize test item generation, allowing for frequent re-testing without the risk of patients memorizing items.
The Value of Longitudinal Data
Trends in cognitive function can be visualized across months or years, helping physicians detect meaningful changes that may show the efficacy of treatment or further deterioration. Tracking symptom progression over time is a form of evidence-based practice that helps healthcare providers address patient concerns and make informed treatment decisions.
Improving the Cognitive Health Care Experience for Patients
Cognitive tests help to improve patient experience through accessibility and easy-to-interpret reports.
Convenient Access From Any Location
Remote testing capabilities allow patients to complete assessments from home. This can encourage patients to engage with follow-up testing, as the inconvenience and stress of travelling to the clinic for testing is completely removed, improving the patient experience.
Facilitating Discussions About Cognitive Health
Results are automatically captured in easy-to-interpret reports that make it easier for PCPs to discuss brain health with patients and caregivers. By providing concrete data, these tools facilitate sensitive but essential conversations.
Digital cognitive assessments give PCPs the tools they need to deliver comprehensive cognitive care, from screening and monitoring to patient education and intervention planning, without disrupting clinical workflows.
How to Administer Digital Cognitive Assessments
Digital cognitive assessments are designed to fit seamlessly into clinical workflows, from initial screening through diagnosis and ongoing care planning. Here’s how primary care physicians can implement them effectively in practice:
Online Cognitive Screener
Digital cognitive tools can serve as accurate, online screening without the time constraints or accessibility challenges of traditional tests. Creyos cognitive screening tools can be categorized based on different use cases:
- Dementia screener: takes five minutes to administer and is designed to only assess age-related impairments.
- Cognitive assessments: take longer than five minutes, but assess multiple cognitive domains—like memory, attention, and executive function—and can function as an initial screener to determine the general presence of cognitive impairment.
- Subjective questionnaires: used to screen for various mental health conditions.
For example, GT Healthcare, a mental health clinic, integrated our digital cognitive assessments into their practice. With Creyos, clinicians were able to remotely screen for cognitive impairment, allowing mental health professionals to reach a diagnostic decision within two to three online appointments. The digital format enabled more frequent and accessible testing, reduced administration times by about an hour per day, and enabled providers to establish treatment plans more quickly, leading to improved mental health outcomes.
Using Cognitive Assessments for Data-Driven Diagnosis
Once screening has detected a potential issue, digital cognitive assessments can be used to support a diagnosis by providing detailed, objective, quantifiable data alongside other measurements acquired from the initial screening process. Combined, this data can be used by physicians to make a confident diagnosis and have conversations with patients about their cognitive health based on both objective measurements and subjective experiences.
SohoMD, a psychiatry practice, leveraged cognitive assessments and subjective questionnaires from Creyos to track the symptoms of ADHD in patients across multiple visits. As a result, clinicians were able to reach accurate diagnoses and help patients manage mood symptoms in less than four appointments. This is a vast improvement compared to referring patients out to specialists for diagnosis, which can take weeks or months.
Using Cognitive Assessments for Digital Cognitive Tracking and Care Planning
After a diagnosis is made, digital assessments offer a way to monitor cognitive function longitudinally. With regular reassessments, providers can visualize trends in patient symptoms and adapt care plans over time. Through the accurate monitoring of a patient's cognitive abilities, physicians are equipped to more effectively identify gaps or inefficiencies in treatment methods, potentially leading to better patient health outcomes.
At Telapsychiatry, Dr. Ozan Toy was able to reduce ADHD overdiagnoses by 30% through the use of the Creyos ADHD Condition-Focused Protocol. The digital protocol allowed him to accurately determine which patients with inattention symptoms actually had ADHD, while putting confirmed ADHD patients on a care plan that led to faster symptom improvement within two to three months.
Transforming Cognitive Care in Primary Settings with Digital Tools
Without the right tools, addressing cognitive health in primary care can be a time-consuming and inefficient process, leaving both patients and physicians underserved. Traditional assessments often lack sensitivity, accessibility, and clinical utility for early detection or ongoing monitoring of health conditions, resulting in patients being referred to specialists with appointments that can take months to schedule.
Digital cognitive assessments, like those offered by Creyos, overcome these challenges with online tools that deliver actionable insights across multiple cognitive domains, capturing both subjective and objective data. As cognitive concerns continue to rise among older adults, Digital cognitive assessments from Creyos offer a scalable, data-driven solution to support timely intervention and improve patient outcomes at the level of primary care.
Written by Lawrence Stewen
Lawrence Stewen is an SEO copywriter and content marketer based in Vancouver, Canada. Transforming complex, technical concepts into copy that’s simply human is what he does best. In his free time, you can find him hiking, reading at a local café, or working on his many creative writing projects. Learn more about his work at: www.lawrencestewen.com
Reviewed by Mike Battista, Director of Science & Research at Creyos
Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.