OVERVIEW: COGNITIVE TESTING

Physician practices are seeing more patients who have concerns over their memory health. Since older age groups are among the fastest growing sub-groups in the world, over the coming decades doctors will continue to see an increasing number of patients with memory concerns.

In order to establish if their patient’s memory problems are just a part of normal aging, or if they are symptomatic of more severe underlying issues, such as Alzheimer’s, many physician organizations are turning to specialty neurocognitive testing companies like Screen Inc. for help.

Adequate test batteries examine the patient’s cognitive ability over several domains: such as memory, fluency and mental control executive functions. By analyzing the test results both relative to sub-populations with similar education and longitudinally, tests are capable of recognizing cognitive impairments very early in patients. The best tests also recommend directions for diagnostic evaluations by placing the results in context. For example, the CANS-MCI evaluates cognitive test results in the contexts of reported head injuries, solvent exposure, exercise, and progressive scales for depression, medications, and alcohol use.

In 2011 Medicare is mandating a preventative wellness exam that includes cognitive testing for the detection of impending dementia and Alzheimer’s disease.

 

IDEAL FOR PHYSICIAN PRACTICES

Effective cognitive testing is able to differentiate between those memory problems that are consistent with the person’s age and education, and those that are more serious. Our tests are ideal for internists, family, geriatric and neurology practices, community health clinics, hospitals, HMOs and life care centers (assisted living).

In the pre-diagnostic phase, neuropsychological tests help physicians detect important cognitive changes. This detection allows referral to specialists or follow-up with additional testing (imaging, full neuropsychological evaluation, or brain wave study for diagnostic accuracy).

For patients who have already been diagnosed by their physician, continued testing helps physicians judge the rate of cognitive ability changes and the effectiveness of treatment interventions.

 

PHYSICIANS ASK: “SHOULD I PERFORM COGNITIVE TESTS, IMAGING, OR ANOTHER PROCEDURE?”

There are several reasons that cognitive testing is preferable to any of the other detection procedures:

1. Basic neuropsychological testing is more likely to provide decision-making information. The amount of change in cognitive ability can be precisely measured by periodic testing. It is at the first point of actual decline, beyond that expected with normal aging, that more invasive tests will be useful.
2. A major study in the Archives of Neurology concluded that “an elderly person with a significant amyloid burden can remain cognitively normal”. In other words, a PET imaging test that costs thousands may tell you whether or not you have a PROPENSITY to develop Alzheimer’s but not whether or not you are actually starting to develop a disease.
3. The inexpensive cognitive tests, such as the CANS-MCI, are even covered without an existing diagnosis as a part of annual Medicare visits, starting in January of 2011. Primary care doctors are fully reimbursed by Medicare, more than it costs them in staff time and in payment to Screen, Inc.
4. Computerized neuropsychological testing does not involve intimidating or invasive procedures that deter elderly patients from being evaluated. Imagine the reactions to saying, "We would like to take a tap of your spinal fluid to see if you are likely to develop Alzheimer’s."

 

WHY TEST?

There are at least six good reasons to offer routine cognitive testing for senior patients:

1. Many seniors who begin to have memory lapses worry unnecessarily about Alzheimer’s. Regular cognitive testing would help alleviate those worries. In most cases, testing will show that the patient has normal cognitive functioning (for age and education).
2. In some cases, testing will show that the patient’s memory and executive functions are poor, not due to neurological damage, but because of emotional interference. More extensive evaluation and effective treatment can then be prescribed.
3. If early testing indicates MCI, and it is diagnosed by follow-up testing, the first stages of Alzheimer's might be slowed. Drugs can be given at its earliest stages. In addition, the earlier other treatment programs are initiated, such as treatment for depression, heart health medications, increased social activity and proper nutrition, the more effective they are in slowing the progression of Alzheimer’s. Thus, early detection through annual testing is critical.
4. Medical researchers have found that the likelihood of stroke is predictably higher for people who have cognitive declines. Therefore, detecting declining cognitive patterns through annual testing allows physicians to be medically proactive with respect to circulatory health. Medication errors are seriously exacerbated by cognitive symptoms.
5. For those patients who have been identified as having cognitive declines that is becoming progressively more serious, physicians and caregivers can implement early safety programs and policies for driving, cooking, and finances.
6. Early detection of active progression toward Alzheimer’s is a gift of time to patients who otherwise would have missed the chances to discuss medical options, to be part of family planning for their future, and to do the things they’ve always wanted to do with friends and family.

For these reasons, many recommend that people over the age of 50 should be screened for cognitive impairments once a year. Annual memory screening is even going to be a mandatory part of the Medicare Welcome office visit and part of annual Medicare wellness visits.

 

PHYSICIANS ASK: “WHICH MEMORY TESTING COMPANY SHOULD I WORK WITH?”

Regardless of the type of healthcare organization you represent—a general practice, specialty practice, HMO, community health clinic, or assisted living center—at some point you may want to use the outsourced services of a specialty memory testing company like Screen Inc. Which one should you use?

We hope you’ll choose us, but even if you don’t, we hope that you will begin to work with a specialty memory testing company, like ours, so seniors get reliable early screening and physician follow-up. The cost of training your staff to administer tests the same way each time, much less in exactly the same way as one another, should be considered when evaluating the cost of the CANS-MCI touch-screen-only tests. Cognitive screening has now become mandatory as a part of the Medicare Annual Wellness evaluation.

If you evaluate other specialty memory testing companies, here are some questions that you might ask:

1. Does the memory testing company make a very economical testing service available to its physicians?
2. Are the testing equipment and software easy to set up and begin using?
3. Is the battery of tests exceptionally easy for the elderly to take (no keyboard, mouse, or computer skills needed)?
4. Is the staff time needed to administer the tests minimal, even for staff training?
5. Do the tests have the ability to evaluate cognitive domains other than just memory (such as executive functions), making the tests valid detectors of ALL the patterns that are predictive of decline towards dementia?
6. Can the tests detect early cognitive problems, or do they only track the degree of established dementia?
7. When the tests are completed, are they evaluated by a live neuropsychological testing technician who prepares a detailed report that takes into account the background of the patient (e.g. age, education, depression level, alcohol use, head injuries) in addition to the cognitive scores?
8. Are detailed physician reports sent to the physician within an hour after the patient finishes the test?
9. Do the tests compare the patient's abilities to sample populations based on education grouping as well as on the patient's own past scores, in order to provide two relevant frames-of-reference (cross-sectional and longitudinal)?
10. Does the physician report present visually intuitive and easy-to-interpret data, including an overall probability of MCI?

Screen’s tests meet all these criteria. We would appreciate the chance to talk with you about how our services can help your practice and your patients more than the alternatives.

 

CONCLUSION: SPECIALTY MEMORY TESTING IS RAPIDLY INCREASING

In response to greater demand from senior patients, and encouraged by the Medicare mandate and by allowance of physician fees for memory testing and patient follow-up, physician practices are increasingly turning to specialty memory testing companies like Screen to test their patients’ cognitive health.

Screen hopes you will choose us as a partner in this effort, but even if you choose one of our competitors, the fact that testing is being advanced is very good news for our elderly.