A new cognitive health screen for routine clinical care

Dr Alice Saperstein, Associate Professor of Medical Psychology, Columbia University Medical Center

Cognitive health refers to the brain’s ability to support thinking, learning, and the skills needed to perceive, acquire, understand, and respond to information. It has substantial impact on daily life and health-related quality of life, with implications for meaningful engagement in school, work, social relationships, and mental health treatments. Cognitive health should therefore be addressed as part of routine clinical care for people with a diagnosis of schizophrenia. Addressing cognitive health early could support engagement in valued activities and independence, so it would be useful to systematically screen for individuals who might benefit from addressing cognitive challenges in community mental health early intervention services.  However, comprehensive cognitive assessments may be impractical for routine use when time and financial resources are limited.

To address this problem, clinical researchers in the United States partnered with OnTrackNY, a network of early psychosis intervention services, to develop and test the usefulness of a 5-question screening protocol to identify who might benefit from receiving cognitive health services. The 5-minute screen starts with three questions asking the individual if it would be helpful if their memory, attention, or critical thinking skills were better. The questions are framed positively to avoid a potentially stigmatizing focus on deficits and are oriented toward functioning to help ground the assessment in the context of daily life. For example, they ask whether the person would like to be able to get more done during the day or get better at remembering appointments, events, or tasks. After that, the individual and a clinician are asked self-report questions about their experience of any cognitive difficulties. The clinician’s report is based on their observations, reports from the individual and others, and/or cognitive testing.

My colleagues and I analyzed the screening results of 102 OnTrackNY participants who had also received cognitive testing. The detailed results can be found here. We found that the screening questions were accurate overall in detecting cognitive impairment, though some individuals who were flagged did not have impaired cognitive performance. This means this quick-to-administer screen is clinically useful to identify individuals likely to have cognitive difficulties.

As it may flag individuals who do not have cognitive impairments, the screening protocol should not be considered diagnostic. However, it can be a valuable tool for beginning conversations with clients about cognitive health and their treatment priorities and preferences. When concerns are identified, further assessment can be recommended to aid treatment planning, particularly if cognitive remediation might address the problems. Psychoeducation may also address any concerns, as may working alongside family members for home support.

This cognitive health screening protocol can facilitate shared decision-making by centering first-person perspectives, engaging clients in the assessment of their own needs and treatment priorities. It isn’t a substitute for a comprehensive assessment but may help providers narrow the stream of referrals for further evaluation, addressing the cognitive health concerns of young people with psychosis. Future research could build on these findings to evaluate applications of this screening protocol in other clinical settings.

The full version of the paper presenting this work is available to read and download at https://psychiatryonline.org/doi/full/10.1176/appi.ps.2024052