Why Providers Should Move to 21st Century Cognitive Tests

Cognitive screening tools such as the Montreal-Cognitive Assessment (MoCA) and positron emission tomography (PET) brain scans were in the news this summer.

The MoCA was likely taken by the President to assess his cognitive health, while a $100 million study examined whether Medicare should cover PET brain scans for Alzheimer’s detection.

These put the spotlight on cognitive health, the importance of testing, and the various tools available. We shed light on these detection tools and examine why digital cognitive tests supersede them in cost, accessibility, and accuracy.

Why Screen Cognitive Health?

Just as we monitor our blood pressure to be alerted of small changes before a serious cardiovascular disease develops, we should also test and monitor our cognitive health regularly–even if there are no symptoms–so that a baseline can be established, any decline addressed, and a care plan created to slow its progression.

While it is true that Alzheimer’s and other dementia have no current cure or treatment, changes can be incorporated early enough into one’s lifestyle as preventative measures.

Cognitive decline doesn’t automatically mean a dementia diagnosis. In fact, mild cognitive impairment can be attributed to medication side effects, hearing and vision impairment, depression, lifestyle factors, or other reasons. Up to 44 percent of mild cognitive impairment cases are reversible. So, yes, cognitive health screening is important even if there’s no cure.

“It’s a question we get all the time,” said Helena Chang Chui, MD, chair and professor of neurology at the Keck School of Medicine of USC. “Having the knowledge about what you will face helps increase your quality of life — and that of your family.”

Another reason for cognitive tests? According to the Alzheimer’s Association, early cognitive screening help identifies those who are eligible to participate in a wider variety of clinical trials, which advance research and will, hopefully, find a cure in the future.

Every 65 seconds, someone in the United States is diagnosed with Alzheimer’s, and on a global level, the World Health Organization reports that there is a new diagnosis every three seconds. These numbers stress the dire need for a cure and make the push for early cognitive tests and clinical trial participation critical.

Leaning Away from PET Brain Scans

About 15 to 25 percent of adults 65 and older living with dementia are undiagnosed. And with the growing aging population, that statistic is predicted to increase. The need for more accurate, accessible, affordable testing is pressing.

But PET brain scans, whilst highly effective at detecting amyloid in the brain, do not provide the most practical and effective solution to fill that need.

In a 2013 review of PET as a diagnostic tool, the Centers for Medicare & Medicaid Services determined that “the evidence is insufficient to conclude that the use of [PET brain scans] is reasonable and necessary for the diagnosis or treatment of illness or injury for Medicare beneficiaries with dementia or neurodegenerative disease.”

And if the actions of physicians are to be considered as evidence, it is clear. Primary care providers (PCP) and neurologists report greater use of cognitive testing than PET scans. Recent research showed that only 15 percent of PCPs and 40 percent of neurologists found brain scans to be useful in dementia diagnosis, whereas only 9 percent of PCPs (and 13 percent neurologists) order PET Imaging.

In contrast, 50 percent of PCPs or their care team, and 66 percent of neurologists administered a cognitive screening test to more than half of their patients with cognitive concerns. Thirty-five percent of PCPs found standardized cognitive screens highly useful for identifying neurocognitive disorders.

To emphasize this point, the Amyloid Imaging Taskforce (AIT)–formed jointly by the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer’s Association–in 2013 determined that while PET brain scans are appropriate in situations with a cognitive complaint with objectively confirmed impairment, they are inappropriate in situations where patients have a cognitive complaint that is unconfirmed on clinical examination. In other words, the determination of objective evidence of cognitive impairment, as a first step, is a necessary precondition of the use of PET.

Another reason why PET brain scans are not favored? They are expensive and not all physicians have access to this technology. Costing an average of $4,000 to $5,000 per scan in a tertiary hospital or clinic, cognitive screening tests, in comparison, are relatively inexpensive. For instance, digital cognitive tests can cost as little as one-tenth this cost, and with the increasing use of mobile technology, are highly accessible to people in their homes.

With the number of Alzheimer’s and dementia cases predicted to increase to 13.8 million by mid-century, and the increasing reluctance of people to visit hospitals due to COVID-19, PET is unlikely to provide an accessible or cost-effective method of detecting the disease.

Savonix vs. MoCA and MMSE

While PCPs and neurologists prefer cognitive tests over PET brain scans, not all cognitive tests are created equal.

First off, digital cognitive tests like Savonix are more sensitive than MoCA and the Mini-Mental State Exam (MMSE). The MoCA, a brief, 30-question test, detects mild cognitive impairment (MCI) 83 percent of the time, while the MMSE, identifies 63 percent of MCI cases and involves a health professional asking the patient a series of questions designed to test a range of everyday mental skills. In comparison, Savonix detects MCI cases 93 percent of the time.

The MoCA and MMSE only provide cut-off scores with no report, and clinicians need about 45 minutes for administration (scoring and reporting included).

With Savonix Mobile, no proctor is needed, and our gold standard-based tests mapped to DSM-V and CMS criteria, take about 30 minutes (scoring and reporting included). Our tests–available in English, Japanese, and Chinese–are easily accessible and can be done remotely on any mobile device.

Savonix Mobile also measures brain function across 13 domains such as memory, focus, and attention. Why is this important? Studies show that up to 20 percent of people who later develop dementia show no signs of memory impairment in the early stages and that impairments in one domain alone are often benign. And with multidomain assessments, like Savonix Mobile, a range of cognitive problems are detected at an early stage, which is crucial for intervention as up to 60 percent of people who later develop dementia present multidomain impairments at the mild cognitive impairment stage.

More reasons to move to a digital cognitive test like Savonix? We provide diagnostic and care plan support to accelerate proper care management and reimbursement, while MMSE and MoCA do not.

After the completion of the Savonix assessment, a Personal Summary Report (PSR) is available immediately so physicians and their patients can view test results. A personalized plan for each patient can be created (remotely or in-office) to improve their cognitive health. The PSR includes results from the Lifestyle Questionnaire that shows patients how their daily behavior relates to brain health.

Out with Pen-and-Paper Tests, In with Savonix

Why spend up to six hours administering a cognitive test when providers can spend quality time with their patients, and get reimbursed? Traditional pen-and-paper tests are antiquated with inconsistent results across providers– it is time to move to 21st-century cognitive tests.

As iterated, Savonix assessments mirror the gold standard for neuropsychological assessment and are sensitive and accurate.

And with the COVID-19 pandemic not letting up, many are still wary about leaving their homes to seek preventative care. Savonix Mobile fits perfectly with telehealth. Physicians can order the test for patients to take remotely in the safety of their own homes, and thereafter consult with them when needed.

RELATED: Cognitive Testing While Staying at Home

The Bottomline

Primary care providers are usually the first to screen patients with neurocognitive disorders, yet two-thirds may be misdiagnosed. If providers are looking to implement an accurate, non-invasive, inexpensive, and accessible cognitive screening tool, they should look no further.

It is time to invest in digital cognitive tests, like Savonix Mobile, that are able to detect mild cognitive impairment 93 percent of the time, in less than 30 minutes, that are accessible remotely, and able to reach large populations.

Contact us for a demo or for more information.

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Bernstein, A., Rogers, K.M., Possin, K.L. et al. (2019). Dementia assessment and management in primary care settings: a survey of current provider practices in the United States. BMC Health Serv Res 19, 919. https://doi.org/10.1186/s12913-019-4603-2

Johnsona, K., Minoshimab, S., Bohnenc, N., et al (2013). Appropriate use criteria for amyloid PET: A report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer’s Association. Alzheimer’s and Dementia. https://www.alz.org/media/documents/appropriate-use-criteria-for-amyloid-pet-alz-dem-1-2013.pdf

Medicare coverage for Alzheimer’s brain scans in question. (2020, July 30). Modern Healthcare. Retrieved from https://www.modernhealthcare.com/medicare/medicare-coverage-alzheimers-brain-scans-question

Baker, S. (2020, July 23). Trump keeps boasting he ‘aced’ a ‘very hard’ cognitive test: Here’s one like it you can take — see if you can match him. Business Insider. Retrieved from https://www.businessinsider.com/trump-cognitive-test-how-to-take-moca-2020-7

Mitchell, A. J. (2009). A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. Journal of psychiatric research, 43(4), 411-431.

Smith, T., Gildeh, N., & Holmes, C. (2007). The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. The Canadian Journal of Psychiatry, 52(5), 329-332.

Decision Memo for Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease (CAG-00431N). (n.d.). CMS. Retrieved from https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=265#

Why You Should Get Screened for Early Signs of Dementia and Alzheimer’s Disease. (n.d.). Keck Medicine of USC. Retrieved from https://www.keckmedicine.org/getting-screened-for-early-signs-dementia-alzheimers-disease/

Gao, Q., Gwee, X., Feng, L., Nyunt, M. S. Z., Feng, L., Collinson, S. L., … & Yap, K. B. (2018). Mild Cognitive Impairment Reversion and Progression: Rates and Predictors in Community-Living Older Persons in the Singapore Longitudinal Ageing Studies Cohort. Dementia and Geriatric Cognitive Disorders Extra, 8, 226-237.

Alzheimer’s Disease Facts And Statistics. (n.d.). Fisher Center for Alzheimer’s Research Foundation. Retrieved from https://www.alzinfo.org/understand-alzheimers/alzheimers-disease-facts-and-statistics/

Nordlund, A., Rolstad, S., Klang, O., Edman, Å., Hansen, S., & Wallin, A. (2010). Two-year outcome of MCI subtypes and aetiologies in the Göteborg MCI study. Journal of Neurology, Neurosurgery & Psychiatry, 81(5), 541-546.

Hessen, E., Reinvang, I., Eliassen, C. F., Nordlund, A., Gjerstad, L., Fladby, T., & Wallin, A. (2014). The combination of dysexecutive and amnestic deficits strongly predicts conversion to dementia in young mild cognitive impairment patients: A report from the Gothenburg-Oslo MCI Study. Dementia and geriatric cognitive disorders extra, 4(1), 76-85.

10 Facts on Dementia. (2019, September). World Health Organization. Retrieved from https://www.who.int/features/factfiles/dementia/en/#