This morning at my most recent physical, the nurse measured my pulse, respiratory rate, temperature, and blood pressure in three minutes. The nurse presented the data on my four vital signs to my physician when she walked in to examine me.
Our vital signs are essential to managing our health. They are simple to measure and the results help healthcare professionals monitor their patients. Vital signs also provide valuable information to track an individual's health over time.
Our brains are as essential to our health as the functional capacity of our cardiovascular system. Yet, despite the crucial role the brain plays in maintaining our health, our cognitive health is not part of the annual physical.
Why is cognition not measured routinely? Mainly because traditional pen-and-paper cognitive tests are expensive and require a trained healthcare specialist to administer, score, and report on the results of the assessment. There are just over one thousand board-certified neuropsychologists in practice in the US and Canada who are trained to deliver and report on these tests, and this has created a bottleneck in terms of access. In addition, most doctors today do not have the time or the expertise to measure cognition. This is because the length of time each doctor spends with a patient has decreased dramatically over the years due to managed care and other changes in the healthcare system.
And that's a shame. Measuring a patient's blood pressure at every office visit gives a physician a way to track a patient's cardiovascular health over time and step in if there is a problem. In an ideal world, primary care physicians would also be able to track an individual’s cognitive data over time and intervene early if there are signs of trouble.
The need to measure our cognitive health is growing as individuals live longer. As we age, there is a clear-cut need for objective measures to track and monitor our health in multiple domains. Another reason is that cognitive illnesses, such as dementia and Alzheimer's disease, cost billions of dollars annually and is becoming ever more evident that we will make strides through early detection and prevention not through treatment after progressive decline has begun.
According to the RAND Corporation, the monetary cost of dementia in the United States ranges from $159 billion to $215 billion annually. This means that dementia is costlier to the nation than either heart disease or cancer. The average total cost for the last five years for a patient with dementia was $287,038, according to another study. This cost is significantly greater than heart disease ($175,136), cancer ($173,383) and all other diseases on average ($197,286).
As we have learned from both diabetes and hypertension, it is better for patients and more cost-effective for healthcare systems to prevent or delay the onset of an illness than to treat it. To help ensure good brain health, everyone should have a baseline cognitive assessment, as part of the routine healthcare checkup. By tracking a person’s brain health over time, individuals and physicians can make cognition a part of a healthy agingprogram and allow for the opportunity to intervene at the first sign of a problem.
To be a true vital sign, healthcare providers must be able to measure the sign quickly and accurately. I realized there was a real unmet medical need for a simple, cost-effective cognitive assessment, which is why I left my academic and clinical position at Stanford to found Savonix. At Savonix we developed an app that delivers a set of digitized neurocognitive tests within 30 to 45 minutes via Android and iOS mobile operating systems and is supported by a web-based clinical data dashboard with integrated analytics.
Given cognition's importance and the ability to rapidly assess it, cognition should be the fifth vital sign. To not do so harms not only the individual and their family but our society in terms of health and financial costs.