Screening for cognitive decline and impairment during annual health visits can last anywhere between 15 minutes to hours. But a new cognitive test that’s completely digital aims to screen brain health as quickly and easily as checking your pulse or measuring your heart rate.
The test is only three minutes long and hopes to help providers quickly screen for cognitive decline and impairment in their patients during annual primary care visits, according to Neurotrack, the biotechnology company that launched the assessment.
“This solution could increase the number of annual cognitive assessments completed and provide opportunities for early intervention,” officials said in a statement.
Research from the University of Southern California found that among adults with either Medicare Advantage or fee-for-service Medicare only about a quarter of patients reported receiving a structured cognitive assessment at an annual wellness visit, despite cognitive tests being a required component of the visit under the Affordable Care Act.
Neurotrack said its digital exam hopes to increase the number of screenings during wellness visits due to its speed and ease of use. In addition, it can help screen patients for cognitive issues, regardless of symptoms.
“Early detection is critical for patients facing a diagnosis like Alzheimer’s or dementia, but unfortunately most patients aren’t screened for cognitive impairment until they show symptoms, which can appear more than 20 years after initial brain changes have occurred,” Elli Kaplan, founder and CEO of Neurotrack, said in a statement.
“We want to empower providers to integrate cognitive testing as a new vital sign in annual physical exams starting at age 65, with the hope that an earlier diagnosis for patients with dementia will lead to more effective interventions,” she added.
The three-minute test is currently being piloted and tested by select health systems and will be rolling out more broadly over the next several months.
The three-minute test is currently being piloted and tested by select health systems and will be rolling out more broadly over the next several months.
Caregivers and older adults interested in taking the test should speak with their health care provider about its availability within their care network.
How does the three-minute cognitive assessment work?
The three-minute cognitive test can be taken on a tablet, computer or smartphone, said Alex Newby, a spokesperson from Neurotrack. For example, a medical assistant can give the patient a tablet to take the test in an exam room as they wait for the doctor. Test results are provided immediately to the patient and doctor, allowing physicians to discuss potential issues and next steps as they would if blood pressure or weight was identified as a problem.
“Patients can also be given a link to the test even before the visit and walk in with their results ready for discussion,” Newby said. “The exam enables physicians – for the first time ever – to screen brain health as they would any other vital such as weight, height, temperature and blood pressure.”
The test screens for two key measures of cognitive health: attention (specifically processing speed) and executive function (such as problem-solving and mental agility). If the results show potential cognitive impairments, providers are encouraged to complete longer cognitive assessments.
Is the test reliable and effective?
David Cutler, MD, family medicine physician at Providence Saint John’s Health Center in Santa Monica, California, said that every new test comes with concerns over accuracy and effectiveness. Just like COVID-19 testing, people needed to test three or more times at home before showing a positive result.
“That accuracy problem could be the same thing with this test,” he said. “I think only time will tell and they’ll need to do studies with doctors who are already doing other types of testing and this type of testing to see if they get better results.”
Cutler added sensitivity is a big factor in measuring accuracy.
“If you have a very subtle amount of cognitive decline, many of these cognitive assessments will not detect it,” he explained. “Even the traditional tests we’ve been using are only about 80 to 90% sensitive.”
The other problem is specificity. Cutler said some patients may be somewhat absent-minded and may have poor memories, which can lead to incorrect answers on tests—but that doesn’t mean they have cognitive decline.
“They’ll score poorly on the test, and you’ll think they have dementia or some other cognitive decline diseases, when in fact, they don’t,” he said. “That’s just their personality, they have poor memories, and they just don’t pay close attention to the questions they are being asked.”
More research and information are needed, Cutler said, to determine if Neurotrack test is reliable and effective.
“I don’t see any reason why providers shouldn’t start using it. The question is, what value will that information have once they do start using it?” he said. “Since we don’t know the sensitivity, specificity and overall accuracy of the test, or what to do with the information once we have it, those are sort of the long-term questions that might take many years to answer.”
Does early detection and screening matter?
While no cure for dementia and Alzheimer’s disease exists, early detection and screenings are crucial in preventing or slowing cognitive decline. The earlier a problem is detected, the more impactful interventions can be.
“It’s critical that every person knows their cognitive risk as early as possible, and that physicians test for brain health as they would with any other vitals during annual appointments,” Newby said.
Cutler added behavioral and lifestyle changes – like proper nutrition, consistent exercise and adequate sleep – can also help prevent, slow or stop the progression of cognitive decline.
“There are things we can do to prevent cognitive decline, but it is very important to recognize it early,” Cutler said. “It’s important to be doing those things even before you recognize cognitive decline.”