Why Brain Health Screening Must Become Part of a Patient’s Annual Exam

Interview with: Tom O'Neill, President & CEO, Cognivue, Inc.

“Every physician knows that the earlier they catch cognitive impairments the quicker they can intervene, but most of the time they don’t test for impairment unless specifically asked for by a patient or caregiver. Brain health screening needs to become another vital sign that is checked at annual exams. We need to make brain health a critical component to a person’s overall health,” says Tom O'Neill, President & CEO, Cognivue, Inc.

Cognivue, Inc. was a solution provider at the Marcus Evans National Healthcare CMO Summit 2023, and
the National Healthcare CMO Summit 2024.

What are healthcare leaders struggling with today, as it relates to cognitive function testing or assessing?

The biggest challenge right now in testing for mild cognitive impairment - before it becomes more permanent suchas dementia or Alzheimer’s disease - is that it is not done. There should be consistent cognition assessment in mass, across healthcare organizations, in the primary care setting as well as
other clinical settings, but it isn’t being done. It has been paper and pencil testing for over 40 years. Health
systems aren’t set up to manage the tremendous staff time and resources needed to administer and score tests, then have a conversation with the patient. Not only that, there is no pill they can prescribe so they have to leverage modifiable risks factors such as diabetes, smoking, diet etc. Doctors need to be able to intervene with those patients in a much bigger way. They see patients for ten minutes, which is not enough time to incorporate a proper cognitive test, so they do a Mini-cog test to check the box. Payers also make it difficult for primary care to get reimbursed for those tests. These arethe biggest healthcare system issues today.

Unfortunately, if a cognitive issue is delayed, over time it progresses from mild to moderate, which then becomes a neurologist’s issue, who is likely to be booked up for six months. What we need is a very specific,  innovative system that is focused on making brain health screening as common as screening of vital signs like blood pressure, heart rate and so on. We need to make brain health a critical component to a person’s overall health. The systems managing a strategic population health model have a real opportunity to drive this.

What technology does Cognivue use to test cognitive function? How does it remove human error and variability?

With paper and pencil tests, Mini-cogs, every doctor and nurse in the office will administer it differently. When you remove biases and human errors that can come into play, you can get a good snapshot of a patient’s cognitive function. Our test removes as much of those as possible. It is an FDA cleared,
computerized test using adaptive psychophysics technology. It is selfadministered and self-scored in the
doctor’s or clinician’s office, but it just needs someone to enter the patient’s name, birth date and sex at birth. It takes the patient through ten exercises, and it brings out a simple two-page report on six brain domains and two performance measures. It is a nice clean report for a doctor to review and take appropriate action.

How would routine screening with Cognivue improve the overall standard of care?

The earliest you catch cognitive impairment, the quicker you can intervene, and possibly slow progress or
reverse it through the modifiable risk factors. There are three systemic issues that drive dementia: circulation, inflammation and toxins in the brain. If you test earlier and catch those issues, you can have a real impact on the patient. We hear doctors saying they already counsel patients on eating right and exercising, but their words often fall on deaf ears. Now they have an inflection point for them, a report on
their brain health. That will really help them take their condition more seriously.

How does this impact the efficacy of new drugs coming into market?

There are new drugs coming into market that can take care of plaques and tangles, the issues that cause dementia, but mild cognitive impairment must be caught at an early phase for these drugs to have an effect.

Any final comments?

There is definitely a pushback from primary care doctors who are forced to see many patients every day. They pick the simplest test, whether it is effective or not. The simple Mini-cog has been challenged by the American Association of Neurology for being prone to human error, bias and variability. This requires
a very innovative, deliberate, and strategic approach from healthcare systems. Dementia is a big and growing issue across the world.

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