Cognitive Screening Tests Versus Comprehensive Neuropsychological Test Batteries: A National Academy of Neuropsychology Education Paper†

Abstract

The American Medical Association Current Procedural Panel developed a new billing code making behavioral health screening a reimbursable healthcare service. The use of computerized testing as a means for cognitive screening and brief cognitive testing is increasing at a rapid rate. The purpose of this education paper is to provide information to clinicians, healthcare administrators, and policy developers about the purpose, strengths, and limitations of cognitive screening tests versus comprehensive neuropsychological evaluations. Screening tests are generally brief and narrow in scope, they can be administered during a routine clinical visit, and they can be helpful for identifying individuals in need of more comprehensive assessment. Some screening tests can also be helpful for monitoring treatment outcomes. Comprehensive neuropsychological assessments are multidimensional in nature and used for purposes such as identifying primary and secondary diagnoses, determining the nature and severity of a person's cognitive difficulties, determining functional limitations, and planning treatment and rehabilitation. Cognitive screening tests are expected to play an increasingly important role in identifying individuals with cognitive impairment and in determining which individuals should be referred for further neuropsychological assessment. However, limitations of existing cognitive screening tests are present and cognitive screening tests should not be used as a replacement for comprehensive neuropsychological testing.

The Mini Mental State Examination does not accurately screen for objective cognitive impairment in Fabry Disease

“…Neuropsychological examination, the golden standard in the assessment of cognitive function, is time consuming and burdensome. 8 The administration of cognitive screening instruments is a method to select patients that are likely to have OCI. The most widely used cognitive screening instrument is the Mini Mental State Examination (MMSE 9 ).…”

Sensitivity and specificity of a briefer version of the Cambridge Cognitive Examination (CAMCog‐Short) in the detection of cognitive decline in the elderly: An exploratory study

“…Cognitive screening tests are extremely helpful in a variety of clinical settings, as they allow a reasonably comprehensive assessment of various cognitive domains in situations where a formal neuropsychological assessment would otherwise prove difficult or expensive, such as primary and secondary levels of care. 6 However, even screening tests can sometimes be lengthy, time-consuming, and complex to administer in everyday practice. Moreover, many patients, especially the elderly, are prone to get tired during the evaluation, thus creating an overestimation bias towards cognitive decline.…”

“…They must be sensitive and specific enough to detect most diseased patients without falsely labelling normal subjects. Positive screening implies the need for further testing, such as neuropsychological assessment and neuroimaging . Therefore, efforts have been made to improve the accuracy of cognitive screening tests, in the pursuit of better time‐ and cost‐effectiveness.…”

“…Positive screening implies the need for further testing, such as neuropsychological assessment and neuroimaging. 6 Therefore, efforts have been made to improve the accuracy of cognitive screening tests, in the pursuit of better time-and cost-effectiveness. Such need considers the worldwide increase of global population life expectancy, which has transformed cognitive decline and dementia into a growing concern in public health, demanding attention at primary and secondary levels of health care.…”

Mild cognitive impairment in primary care: a clinical review

“…Patients who test positive for MCI with brief cognitive assessment instrument should be referred to have formal neuropsychological testing to confirm the diagnosis 11. Neuropsychological assessments are ‘used for purposes such as identifying primary and secondary diagnoses, determining the nature and severity of a person's cognitive difficulties, determining functional limitations and planning treatment and rehabilitation’ 17. The complementary use of neuropsychological measures of memory and non-memory functions can lower the rate of false positive MCI diagnoses 18.…”