Why cognitive assessments should be part of every mental health practitioner’s diagnostic toolkit
There are many good reasons to apply cognitive tests to measure mental acuity. After all, good cognitive function enables people to think clearly and effectively to perform their daily activities, whether at work, at home or in their social life.
Cognitive tests help reveal various aspects of brain function, including general intellectual function (IQ), reading ability, concentration, memory, problem solving and verbal fluency. And while these tests are commonly used to screen for mild cognitive impairment, they are rarely used to assess people presenting with mental illnesses such as anxiety and depression.
This is an important omission, because a patient’s recovery from a mental illness can be derailed by underlying problems with the brain.
“Cognitive difficulties can get in the way of functional recovery,” explains Professor Kelly Allott, a Principal Research Fellow and clinical neuropsychologist who studies the link between cognition and mental health issues in young people in Australia, and collaborates with other researchers in the Asia Pacific and elsewhere.
“When we talk about functional recovery, we mean beyond the presenting condition – so once mental health symptoms are treated, how does a patient’s life improve in terms of their school, work, relationships, or social life? If we take the example of someone with depression, and no longer feeling low/down, but cognitive problems remain – which is very common – that can really impact their functional recovery,” she says.
The aim of Prof Allott’s work is to better understand cognition and how it affects and is affected by functional and symptomatic aspects of psychosis and other mental illnesses over time.
She says cognitive difficulties are “transdiagnostic”, meaning they are present across all mental illnesses. They are more pronounced in the more severe mental illnesses like schizophrenia and psychotic disorders, but also exist in other conditions like bipolar disorder, depression, anxiety, PTSD, and eating disorders.
“Cognition is often overlooked in treatment for these issues,” Prof Allott says. “I think there is an assumption often that if the mental illness is treated, the cognitive difficulties will improve. That's not always the case – in fact, it's often not the case.”
“I think there is an assumption often that if the mental illness is treated, the cognitive difficulties will improve. That's not always the case – in fact, it's often not the case.” - Prof. Kelly Allott
A full suite of tools and assessments
Cognitive assessments can be a highly valuable part of the wider suite of tools and assessments that clinicians and researchers use for patients of all ages. While cognitive tests aren’t relied upon to diagnose specific disorders, they do identify problems that require more in-depth testing.
That’s why a holistic patient approach using multiple diagnostic tools can help mental health professionals and researchers identify and understand mental health disorders more accurately, leading to better quality of patient care and outcomes.
Moreover, multiple diagnostic inputs give researchers more reliable data and insight into mental health issues, which can lead to the development of more effective treatments.
Prof Allott says digital tools, like Pearson Clinical’s global online assessment platform, Q-Global, to allow remote assessment and boost research participation around the world – are particularly useful for working with young people, for whom cognition is high on the treatment priority list.
“We recently surveyed young people with mental health challenges about their treatment priorities. From that, we extracted a list of 20 areas of life they wanted to address in treatment. Thinking skills, or cognition, was fourth or fifth on the list of their top 20 priorities, after mental health symptoms, emotional management, and sleep.
“The feedback we get from young people is that it's really validating for them when they have their cognition assessed. They know the areas they're having trouble in, but if we can give them a formal assessment, and start to provide some education and a plan once we’ve identified the issues, then that validates their concerns,” she says.
Including family members in the discussion around cognitive assessments is also helpful for people undergoing treatment.
“One common theme we hear from parents is that they might view their teenager’s behaviour as lazy, or they don't try hard enough. When we're able to explain that their child has a problem with their attention or focus, and we can reframe it as a cognitive issue, then that can bring more understanding within the family,” Prof Allott says.
Multiple diagnostic inputs give researchers more reliable data and insight into mental health issues, which can lead to the development of more effective treatments.
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Addressing the gap in patient need
Cognitive assessments can help identify strengths and weaknesses to support individuals in their learning and independence through tailored strategies. But there is a gap between what patients need and what happens in treatment, often to do with a lack of training or expertise in cognition. That can include social workers and other non-psychologists who may not have the professional training to use the assessments themselves.
Prof Allott says the earlier clinicians can assess cognition, the better they can tailor their treatments, and have a more positive impact on the patient’s outcomes.
“It can be really powerful to open up a conversation with a patient to see whether you need to be doing further assessments,” she says.
‘'We really encourage mental health professionals to enquire about cognitive assessments as part of their overall process. And if they don't have the expertise or access to the tools, then to refer the patient to someone who does. Cognitive assessments are an important piece of the holistic treatment puzzle.”