When patients are experiencing cognitive or behavioral health concerns, providers must collect all necessary information in order to accurately diagnose any underlying health condition and create an effective treatment plan. The first step to this process often includes administering one of the many existing standardized cognitive assessments. Unfortunately, current assessment tools have limitations that can make determining the root cause of symptoms difficult.
When treatment planning for cognitive disorders (like dementia), brain injuries like concussion, or behavioral health disorders (like ADHD), detailed brain health insights gained from objective assessment data are critical for making the right choice. Understanding patients’ cognitive abilities provides important context when determining which interventions, like therapy, medication, or rehabilitation, make the most sense.
What Are Traditional Cognitive Assessments?
Cognitive diagnosis and treatment planning involve complex decisions that enormously impact patients’ lives. Measuring cognitive skills, assessing behavior, and tracking treatment progress are commonly done with industry-standard cognitive assessments conducted by a clinician. Cognitive assessments often consist of:
- Self-reported information from a patient, parent, or caregiver
- Questionnaires and rating scales
- Pen and paper tests like the clock drawing test (CDT), the Montreal Cognitive Assessment (MoCA), the Mini–Mental State Examination (MMSE), and more
While evaluating brain health using these traditional methods can be helpful, they do have their limitations. When used on their own without further, more detailed cognitive assessment, these can create barriers to effective cognitive care.
Challenges Using Traditional Cognitive Assessments for Diagnostic Information
Diagnosis is often the most critical part of the patient care journey. Unsurprisingly, it can also be the most complex. For example, one study found that about 1 million children in the United States are misdiagnosed with ADHD. There are several reasons why misdiagnosis may occur, but this study specifically proposes that the subjective nature of some current standardized assessment methods leaves room for error.
Using Creyos for Better Cognitive Testing
Today, a patient-centered care approach (a care model that assesses the unique needs of each individual patient) is becoming increasingly more popular. This approach to care has many benefits, but it can also be time-consuming and expensive.
Having the most up-to-date, advanced digital tools for cognitive screening lets providers move beyond the constraints of traditional pen-and-paper assessments. Creyos offers effective digital cognitive testing to complement and enhance standard practice.
Based on traditional neuropsychological tasks and validated through over 400 peer-reviewed research studies, this science-backed platform combines objective data derived from cognitive tasks with subjective information collected from industry-standard behavioral questionnaires for well-rounded, comprehensive results.
Some Use Cases for Comprehensive Cognitive Assessments
Cognitive function is complex and composed of various cognitive domains, and effective cognitive testing should reflect the complexity of the brain itself. Different providers may have different cognitive assessment requirements depending on their area of specialization, but all can benefit from leveraging both objective and subjective data insights to support a confident diagnosis.
Cognitive Assessments for Concussion
Neurologists may use cognitive assessments to test traumatic brain injury (TBI) patients when objective cognitive function measures are needed to confirm or rule out concussion. Supplementing self-report measures with data-driven cognitive screening allows providers to more confidently diagnose concussion or TBI.
Cognitive Assessments for Mental and Behavioral Health Disorders
For psychiatrists treating behavioral and mental health disorders with known cognitive effects and/or symptoms, cognitive testing is not only an effective tool but a critical one. Conditions like depression, anxiety, and ADHD have all been shown to impact patients’ cognitive abilities. Since diagnosing a patient is a significant clinician responsibility, better diagnostic aids are necessary to support these potentially life-changing decisions.
Cognitive Testing to Establish an Accurate Baseline
Collecting an accurate baseline measurement of cognitive ability can provide a starting point for monitoring change over time. For example, cognitive deficits related to a neurological condition may be missed if a patient’s cognitive function is sitting within a normal range for their age, but showing a significant drop in their own ability over the past year. Finding a baseline and repeating testing can highlight areas of decline that might not otherwise be apparent.
Baselines are also a strong foundation for measuring the effectiveness of treatment. In addition to highlighting decline, repeated testing can highlight the effects of medication, treatment, and recovery over time.
Routine Neuropsychological Testing Can Be Resource-Intensive
In-depth neuropsychological assessments can be very resource-intensive. For example, formal neuropsychological evaluations can take between six to eight hours to complete. The time and financial weight of these tests make them impractical for regular use.
While clinicians can use quicker screening tools such as self-report questionnaires, these tests are largely subjective and can be influenced by biases. These tools, while helpful when used in conjunction with objective cognitive assessment, don’t provide a full picture of brain health. More enhanced solutions like digital cognitive testing from Creyos provide reliable data—both subjective questionnaire reports and objective cognitive assessment—so that care teams have the best information possible to reach an accurate diagnosis.
How Can Providers Track Improvement and Adjust Treatment?
Once a diagnosis is made, the path to a superior patient outcome lies in an effective treatment plan. While subjective self-report patient information is helpful in treatment planning, objective cognitive data provides a strong foundation for measurement-based care.
Adjusting Cognitive Care Plans
In the context of establishing or adjusting a care plan, it’s important to have a strong baseline assessment and continually retest to understand patient progress and adapt accordingly.
As well as the intent and design to improve brain health overall, treatment is often intended to slow disease progression, especially in the case of dementia patients.
Many traditional tools, like the MoCA, are not equipped to efficiently measure cognition on a repeatable, ongoing basis for optimal monitoring of long-term cognitive symptoms. Traditional cognitive assessment tools, including self-report questionnaires, symptom checklists, and paper-and-pen tests, also have limitations when it comes to monitoring disease or treatment progress. It is often impractical to ask a patient to visit a clinic in person after treatment is completed or to refer to a neuropsychologist multiple times for a quick progress report.
Quick, objective clinical assessment tools that are highly sensitive to change give clinicians more detailed and easy-to-understand data for adjusting treatment plans over time for the best possible patient outcomes.
How Can Providers Better Communicate Results to Patients?
Properly communicating test results, options for symptom management, and updates regarding disease/treatment progress are critical to effective patient care. Clear results not only help clinicians understand a patient’s cognition themselves but also help the patient understand their own brain health in a straightforward and digestible way.
Translating Complex Cognitive Screening Results
Clinicians often may find it difficult to communicate results from in-depth cognitive assessment tools. Since these results can be complex to interpret, they may be harder to communicate clearly and empathetically to patients.
For instance, when cognition is measured with a neuropsychological examination, the results may be comprehensive enough to inform clinicians, but additional time and effort are required to translate the numerical results and findings into a written report for the patient, family members, or other parties.
Over-Simplified Test Results
Quick standardized cognitive assessment tools, like the MoCA or other specialized screeners, may lack detail regarding overall impairment. The MoCA suffers from a lack of detailed domain-specific information about cognition, no easily available comparisons with a normative database, and overly simple cutoffs that have been called into question. These gaps not only make it difficult to diagnose a condition, but they also make it difficult to give patients a detailed understanding of what might be contributing to their symptoms.
Easy-to-read reports that include both objective and subjective accounts of impairment, like those from Creyos, make it easier to discuss detailed results in a straightforward manner with patients and help them better understand their own brain health.
Providers Need Objective, Data-Driven Insights
Objective insights are crucial for effective patient care. More accurate and detailed information about cognitive performance and psychological health can help clinicians make better-informed diagnoses and appropriately adjust treatment plans.
There is a clear need for objective, reliable cognitive assessment tools to address the gaps inherent in subjective measures and traditional methods of cognitive testing. Clinicians should lean on modernized, comprehensive tools to obtain a reliable baseline measurement, detect impairment early, and easily track performance change over time. Digital cognitive assessments like those from Creyos can support a more definitive diagnosis, help providers monitor symptoms, and assist in clearer patient communication.
Reviewed by Sydni Paleczny, Staff Scientist
Sydni earned her MSc in Neurosciences at Western University under Dr. Adrian Owen. Her research explores neuropsychological outcomes after cardiac surgery, with interests in cognitive neuroscience, critical care, and brain health. At Creyos, she supports scientific validity, health technology, and ongoing research.