Cognitive Screening and Clinical Decision Support at a Distance
1. Cognitive Screening and
Clinical Decision Support
at a Distance
A presentation for the Georgia
Partnership for TeleHealth
March 15th 2012
Gregory Bayer, PhD
Brain Resource, Inc
2. New Technologies for Cognitive
Assessment and Remediation
Technologies Exist Today For Rapid Neuropsychological Screening
• Psychiatric screening that can be done in under 10 minutes and at a distance with 85%
sensitivity and 84% specificity for identifying risk across a broad spectrum of disorders.
• Neuropsychological screening can be accomplished at home or in a clinic environment
using a standardized and objective measure of emotional and cognitive skills plus self-
reported measure of behavior in a 35 minute evaluation.
• Brain health programs and biofeedback tools that can be used with minimal or no
supervision at an individual’s own pace.
These technologies allow providers to:
• Obtain neuropsychological evaluation quickly, efficiently, and inexpensively
• Support psychiatric diagnosis and medication decisions with objective cognitive markers
• Improve diagnostic accuracy, permitting more individualized biopsychosocial treatment
• Assess and monitor psychotropic mediations more effectively
• Augment rehabilitation activities with a self-administered brain-health improvement
program.
3. Integrative Neuroscience Assessment
Scalable brain health assessments can be built from existing
neuropsychological batteries and deployed via the web for easy
administration and use.
Questions [Feeling and Self Regulation] (<5 min)
“I Find it “I respond best
difficult to to positive
relax” feedback”
Objective Cognitive Tasks [Emotion and Thinking] (30 min)
Motor Choice Reaction Memory Emotion Digit Span Verbal
Tapping Time Recognition Identification Interference
Switching of Go/No-Go Delayed Emotion Continuous Maze
Attention Memory Recognition Performance
Recognition Test
4. A Web-Based Model of Psychiatric Practice
Neurocognitive assessments and brain training exercises can be used in
combination to provide personalized assessment and treatment options.
1. Rapid Neurodiagonistic Screener
Brief Screening 2. Identifies early risk for brain health condition
3. Broad spectrum screen with high sensitivity
Assessment
Neuropsychological 1. Objective & Rapid Assessment of strengths/deficits
2. Treatment decision support & change monitoring
Assessment 3. Effective screener for ADHD, Depression, Dementia,
TBI
1. Interactive Brain Training
Training Program 2. Promotes Resilience
3. Remediates cognitive and emotional deficit areas
Treatment
Biofeedback-based 1. Heart Rate Variability training
2. Personalized Stress Management
stress management 3. Adjunctive non-medicative therapy
5. BRISC For Mental Health Screening
BRISC (Brain Resource brain health screen) includes 15 questions to assess
Negative-Positive Bias, Emotional Resilience, and Social Skills
Helps identify individuals who have and/or are susceptible to a mental health
disorder.
Negativity Bias has 85% sensitivity an 84% specificity for identifying risk across a
broad spectrum of disorders.
Williams, Cooper, Wisniewski, Gatt, Koslow,
Kulkarni, Gordon, Rush (2011). Sensitivity,
specificity and predictive power of the “BRISC”, a
cross-sectional study on a brief web screen for
brain health. J Clinical Psychiatry (in review)
6. Cognitive Markers + Clinical Algorithms =
Powerful Tools For Dx and Tx
1. Assess core cognitive and emotional capacities
2. Apply data-based clinical algorithms to individual responses
3. Use resulting clinical profile to support practice-at-a-distance
decision making
10. Sensitivity and specificity of
web-based tests for ADHD
Sensitivity Specificity
Markers from
• Sustained Attention
• Impulsivity
• Intrusions
• Inhibition
88% 91%
• Response Variability
Williams LM, Using brain-based cognitive measures to support
clinical decisions in ADHD. Pediatric Neurol. 2010 Feb;42(2):118-26.
11. CPT Code Information for Web-Based Testing
Neuropsychological tests for clinical use
96116 96118 96119 96120
Neurobehavioral Clinician time for Technician time for Non-facilitated
Status Exam facilitating test facilitating test test administration
Clinician time for administration administration
interpreting results Clinician time for Clinician time for
and report interpreting results Clinician time for interpreting results
Most reimbursed in and interpreting results and report
telehealth settings report and report
Medicare Payment
Medicare Payment Medicare Payment Medicare Payment (Source: AMA
(Source: AMA (Source: AMA (Source: AMA Website)
Website) Website) Website) Non-facility = $78.85
Non-facility = $72.61 Non-facility = $106.01 Non-facility = $72.89 Facility = $24.84
Facility = $66.91 Facility = $85.75 Facility = $25.63
ONE TIME CHARGE
PER HOUR PER HOUR PER HOUR
12. MyBrainSolutions.com Brain Training Experience
Know Your Brain Train Your Brain Optimize Yourself
A brain assessment and report to discover Interactive games and exercises designed A dashboard with tools to monitor
your personal strengths/weaknesses and based on proven techniques to develop brain training results and progress towards
personalize your training. healthy habits. achieving health goals.
13. Behavioral Change with Fun Online Tools
Traditional behavioral change strategies made fun and accessible.
Thought Challenger Relaxation Room Training with Positive Positive Reflections
Learn about the connection A meditation room allows user to Affirmations helps Employees Writing down at least one thing
between thoughts, feeling and practice relaxation strategies like develop positive self-talk in areas that went well each day is a tactic
behaving by challenging specific progressive muscle relaxation and where they often have negative to help strengthen our positive
negative thoughts and creating slow breathing. thoughts or doubts. For ex. ‘I feel memories. Positive Reflections
more productive thinking habits. healthy and happy’ vs. ‘I know I’m then encourages you to associate
going to get sick soon’. any event with a person strength of
yours to build a sense of self
efficacy – that you have the power
to influence your outcomes each
and every day.
14. Non-medication Stress Management
MyCalmBeat provides accessible, intuitive bio-feedback for members
to reduce stress, sharpen focus, and improve health outcomes
2. Train using your iPhone, iPod Touch, iPad,
Blackberry, Android and over the web.
Scie
3. Train using biofeedback on your desktop.
Guides patients through 3 Stages:
1. Identification of Optimal Breathing Rate
2. Training
3. Progress Monitoring
