Detecting early cognitive impairment

By Dr. Angela Troyer

Early and accessible detection of cognitive impairment is critical in order to provide clients and their families with information, resources, and support, and direct them to pharmacological and non-pharmacological treatments for Alzheimer’s and related dementias. The Baycrest-developed Cogniciti Brain Health Assessment, which is self-administered and available online, helps to address this need.

According to a recent study, the Brain Health Assessment performs as well as, and in certain areas even better than, the widely used Montreal Cognitive Assessment (MoCA). The assessment accurately identifies problems with memory and attention and can detect very subtle cognitive decline and impairment. As well, the Brain Health Assessment can be taken at home, meaning that it may save time for both patients and clinicians and improve access to early assessment for individuals with mobility or other challenges that make it difficult to travel to a clinic. In comparison, the MoCA must be completed in person at a clinic.

This is important because in cases where cognitive decline is present, accessible and accurate tests allow clinicians to detect changes in cognition early and to prescribe interventions for patients and their families to help manage their brain health. Individuals with early signs of cognitive decline may be able to slow this decline by following a healthy lifestyle, such as eating a heart-healthy diet, getting regular exercise, sleeping well and staying cognitively and socially engaged.

The Brain Health Assessment, which was developed with a team of Baycrest clinicians and scientists, takes around 20 minutes to complete and consists of a background questionnaire and four cognitive tasks assessing memory and attention. It was specifically designed for older adults and includes tasks sensitive to changes in the brain associated with aging and age-related cognitive disorders.

With the assessment, we can more quickly identify patients who have a high probability of having mild cognitive impairment, a preclinical stage of dementia. Clinicians in the Sam and Ida Ross Memory Clinic at Baycrest use the tool’s results, combined with other information, to refer patients to specialty programs to improve healthy lifestyle behaviours and better manage their memory.

As a publicly available instrument that produces a personalized report for each user to access, the Brain Health Assessment has been taken over 115,000 times on However, in our recent study, we were interested in a different use of this tool: by clinicians as part of a broader assessment of patients’ cognition.

To investigate this, ninety-one older adults took a full diagnostic 3-4 hour neuropsychological assessment with a trained examiner to see if they met criteria for mild cognitive impairment. All participants also completed both the at-home Brain Health Assessment and the clinician-administered MoCA. Our team then looked at the results of the Brain Health Assessment and the MoCA, using the results of the full diagnostic neuropsychological assessment as the benchmark.

When combined with additional clinical information, we found that the Brain Health Assessment was effective at providing a reassuring normal result in the case of normal cognitive function, reducing the need for further testing. The Brain Health Assessment detected mild cognitive impairment as accurately as the clinician-administered MoCA did, but the Brain Health Assessment was superior in detecting normal cognitive function, with 23 per cent of the sample correctly identified as normal, versus 8 per cent for the MoCA.

These results, published in The Journals of Gerontology, suggest that the Brain Health Assessment can be a useful tool in the clinical assessment of memory and thinking, and help direct clients and their families to resources and support to manage their memory.

Our team is currently validating a French version of the Brain Health Assessment, with plans to eventually extend it to other languages as well, in order to increase the reach of this tool.

This study was supported by funding from the Centre for Aging + Brain Health Innovation (CABHI), powered by Baycrest, as well as the Saul A. Silverman Family Foundation and the Morris Kerzner Memorial Fund.

Dr. Angela Troyer, Program Director of Neuropsychology and Cognitive Health, and Professional Practice Chief of Psychology at Baycrest



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