Cognition is The Next Vital Sign: An Interview with David J Libon, PhD

"One thing to keep in mind is that the assessment of cognition provides something that could be described as a cognitive vital sign. It’s as integral and important to assess cognition as it is to check blood pressure, pulse oximetry, or any of the other vital signs that are routinely obtained in a primary care setting."

Neurocognitive researcher David J Libon, PhD, has a strong and positive message about the future of digital cognitive assessment and it sounds like this: It's not outlandish at all to posit that as digital cognitive assessment technology becomes more widely available and it's true value understood, assessment for the very earliest signs of troubled cognition will begin in adults as young as age 45 or 50 years and will be a standard of care—in primary care. The equipment required, an iPad or similar digital device, can be scaled easily and the cost, well, "you can't do an MRI at the drop of a hat," Libon said in a recent interview with Patient Care.

In the short video above, Libon, joined by his close colleague Rodney Swenson, PhD, talks about the future of the research he and others are conducting now into cognition as a vital sign and how the refined tools available will change the landscape of assessment for and identification and management of cognitive impairment.

The following transcript has been lightly edited for style and clarity.

Patient Care: What does the future of your research, or the research at large in the field look like? What are the what are the next avenues for exploration, and do you see any challenges or barriers ahead?

David J Libon, PhD: Well, I think one thing to keep in mind is that the assessment of cognition provides something that could be described as a cognitive vital sign. It’s as integral and important to assess cognition as it is to check blood pressure, pulse oximetry, or any of the other vital signs that are routinely obtained in a primary care setting. I think as digital assessment technology becomes more widely available, understood, and deployed, you're going to see digital cognitive assessments introduced as early as age 45 or 48, certainly by age 50. Depending on how the technology is used and what future research shows, I believe digital platforms have the potential to flag emergent problems earlier than any other method. The scalability and affordability are key advantages. You can't just order an MRI at the drop of a hat—it's expensive and not always available. In contrast, digital assessments are low-cost and accessible.

One thing I'm doing is partnering with colleagues around the country who are conducting longitudinal and epidemiological research. What we’re seeing is that on some of these digital outcome variables, even individuals in their mid-40s or 50s, people whose blood glucose or systolic blood pressure are medically well managed, are still performing less well on certain cognitive parameters. That’s incredibly important. It suggests that digital tools may detect subtle cognitive changes even when traditional health metrics are controlled.

Where I get excited is in thinking about the potential for this technology to become routine in clinical practice. Once the research is completed and the value becomes more widely known, I believe digital cognitive assessment will become a standard part of care, right alongside other vital signs in your doctor’s office.

In terms of barriers, well, it’s like anything else that’s new. New things can be intimidating. People don’t know how it works, whether they need it, or why they should change what they’ve always done. I’m as guilty of that mindset as anyone else. But the truth is, the skill set needed to use these digital assessments is quite minimal. Any healthcare provider can be trained to use this technology effectively.

For more from our conversation with Drs Libon and Swenson, see:

• In Testing for Cognitive Decline, It May Not Be What the Patient Says, But How It's Said That Matters
• In Screening for Dementia, Time Can Tell A Lot: A Conversation with Researcher David Libon, PhD
• Refined Digital Tools Have Revolutionized the Return on Cognitive Screening: Investigator Rodney Swenson, PhD, Explains
• What is Precision Neurocognition? David J Libon, PhD, Provides an Overview