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Understanding Cognitive Screening
If you or a loved one are experiencing changes in thinking or memory, you may be given a cognitive screen. Since 2011, physicians caring for Medicare patients have been encouraged to include a cognitive screen as part of an Annual Wellness Visit (AWV). But what exactly is a cognitive screen, and what can it tell you about your cognitive health?
What Is a Cognitive Screen?
A cognitive screen is a brief test that assesses mental functioning. It typically lasts between 3 to 20 minutes. The results are compared to a "cutoff score," which helps determine if cognitive function falls within the normal range. If the score is below this threshold, further testing is needed to rule out a cognitive impairment.
Limitations of Cognitive Screening
Like all screening tools, cognitive screens have limitations. It is important to stress that cognitive screens are not intended to diagnose. Their primary purpose is to answer a simple yes/no question: Is further testing needed?
Because a cognitive screen is not a diagnostic test, it cannot determine the severity of cognitive decline or pinpoint specific areas of difficulty, such as memory or attention. More in-depth cognitive testing is needed for a detailed assessment.
Cognitive screens were originally designed to detect dementia. As a result, they are less reliable in identifying Mild Cognitive Impairment (MCI)—a condition that falls between normal aging and dementia. Since early intervention is key in MCI and dementia, the limitations of cognitive screening in this area are a concern. Studies have demonstrated that some screens perform better than others in identifying MCI and early signs of dementia. And even with the more rigorous screening tools, there is still no consensus on cutoff scores to identify MCI (read on to learn about how to improve accuracy of cognitive screens).
Benefits of Cognitive Screening
Routine cognitive screening has benefits for everyone, even those who are not experiencing cognitive changes. It provides a snapshot of overall cognitive function and helps establish a baseline. If changes occur over time, having a previous score for comparison makes it easier to identify subtle declines early.
Not All Cognitive Screens Are Equal
There is a wide range of cognitive screens available, and they vary in length and "depth." Some physicians utilize screens consisting of just 3-5 questions. Other screens are 6 pages long and provide more comprehensive information in specific cognitive domains. Naturally, longer screens take more time to administer and score but provide a more complete picture.
It's important to note that some cognitive screens in use today were developed over 50 years ago with limited updates despite advances in research on early detection and intervention of cognitive decline. Another important consideration is visuospatial deficits can be an early sign of dementia and few screening tools include a visuospatial component to facilitate early detection.
Even if someone scores within the "normal" range on a cognitive screen, it does not mean that there is not sufficient evidence that they are experiencing a cognitive decline. I find that this can be especially troubling to someone who is experiencing subjective cognitive decline (SCD) and scores within the normal range on a cognitive screen. It can be frustrating to be turned away from care when they know they are truly experiencing a change in cognition. To improve accuracy, a cognitive screen can be combined with a patient-reported measure, such as a questionnaire. For example, at Amplify Speech Therapy, cognitive screens are supplemented with the AD8 questionnaire, developed by the Alzheimer’s Disease Research Center. This tool gathers input from the individual and their family to identify subtle cognitive changes. It's important to consider the overall picture and the individual and family experience when trying to rule out a cognitive change.
Knowledge Is Empowering
In the past, cognitive decline was often met with avoidance, and the assumption that dementia was inevitable. However, research now shows that early detection and intervention can slow or even halt cognitive decline.
Early identification of cognitive changes allows for timely referrals to specialists, such as speech-language pathologists trained in cognitive therapy. Working with a specialist can help pinpoint which cognitive domains are affected and develop personalized strategies to manage symptoms. Speech therapy can also support cognitive stimulation exercises to help maintain or strengthen cognitive abilities.
Studies show that interventions like these can help prevent MCI from progressing to dementia. In fact, only 10-15% of individuals with MCI go on to develop dementia, a relatively low number.
Even if dementia is diagnosed, speech therapy can identify strategies that may improve daily functioning and overall quality of life. Increased confidence in communication, social engagement, and day-to-day activities can help prevent social withdrawal and depression—two factors that can accelerate cognitive decline.
Final Thoughts
Cognitive screening is a valuable tool for early detection, but it is just the first step. If you have concerns about your cognitive health, don’t hesitate to seek further evaluation and support. Knowledge is power, and with the right interventions, you can take control of your cognitive well-being and live a fulfilling life.
In an effort to combat the growing incidence of dementia, Amplify Speech Therapy offers free cognitive screens. If you're in the area, get in touch to take the first step for your brain health.