One Size Does Not Fit All: Choosing Practical Cognitive Screening Tools for Your Practice

Abstract

Every year, millions of patients worldwide undergo cognitive testing. Unfortunately, new barriers to the use of free open access cognitive screening tools have arisen over time, making accessibility of tools unstable. This article is in follow-up to an editorial discussing alternative cognitive screening tools for those who cannot afford the costs of the Mini-Mental State Examination and Montreal Cognitive Assessment (see www.dementiascreen.ca). The current article outlines an emerging disruptive "free-to-fee" cycle where free open access cognitive screening tools are integrated into clinical practice and guidelines, where fees are then levied for the use of the tools, resulting in clinicians moving on to other tools. This article provides recommendations on means to break this cycle, including the development of tool kits of valid cognitive screening tools that authors have contracted not to charge for (i.e., have agreed to keep free open access). The PRACTICAL.1 Criteria (PRACTIcing Clinician Accessibility and Logistical Criteria Version 1) are introduced to help clinicians select from validated cognitive screening tools, considering barriers and facilitators, such as whether the cognitive screening tools are easy to score and free of cost. It is suggested that future systematic reviews embed the PRACTICAL.1 criteria, or refined future versions, as part of the standard of review. Methodological issues, the need for open access training to insure proper use of cognitive screening tools, and the need to anticipate growing ethnolinguistic diversity by developing tools that are less sensitive to educational, cultural, and linguistic bias are discussed in this opinion piece.

Is neuroticism relevant for old cancer survivors? A controlled, population-based study (the Norwegian HUNT-3 survey)

“…If this pattern of socio-demographic impact, impaired general health issues, problematic lifestyle issues, loss of energy, and poor life satisfaction represent all OCSs, health care personnel must be aware of those with high neuroticism since they are an extremely vulnerable subgroup among OCSs. Based on the findings from this study, we recommend comprehensive geriatric assessment (i.e., easy accessible, standardized tests to evaluate frailty; physical, mental, cognitive, and social function) [13,15,28], to be exceeded with six questions on neuroticism suggested from The Eysenck Personality Questionnaire. As Ahles and Root emphasize, we need a multidimensional perspective to examine OCS [1].…”

Navigating the controversies of cognitive screening

“…The number of Canadians with dementia is increasing, a fact apparent to family physicians in their daily work. At the same time, commonly used tests to screen for cognitive impairment, such as the Montreal Cognitive Assessment (MoCA) instrument, have become less accessible owing to introduction of new copyright or training fees (a phenomenon Molnar et al 1 call the "free to fee" cycle).…”

Comprehensive Geriatric Assessment

“…The Montreal Cognitive Assessment (MoCA) has gained credibility due to improvement in sensitivity and lesser bias from cultural and educational factors (Ismail et al 2010;Molnar et al 2020). It takes more than 10 min to complete, is somewhat cumbersome, but is designed to detect mild cognitive impairment.…”

“…The intellectual rights for the MMSE were transferred two decades ago, and it appears that the same may happen for the Montreal Cognitive Assessment (MoCA). As a result, many providers may have stopped using the MMSE (Molnar et al 2020). It appears that after providers of care become accustomed to a tool for cognitive testing, when charges are levied for use of the tool, there results a "cost affordability," which renders the tool hard to use thereafter (Molnar et al 2020).…”

“…As a result, many providers may have stopped using the MMSE (Molnar et al 2020). It appears that after providers of care become accustomed to a tool for cognitive testing, when charges are levied for use of the tool, there results a "cost affordability," which renders the tool hard to use thereafter (Molnar et al 2020). At this time, the Mini-Cog requires only a paper and pen.…”