723 - Clinical Perspectives on Cognitive Screening in Acquired Brain Injury: Identifying Key Gaps

Cognitive screening tools such as the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Saint Louis University Mental Status (SLUMS) are commonly used to assess individuals with acquired brain injury (ABI), including both traumatic and non-traumatic causes. However, no study has systematically examined clinicians’ perceptions of these tools in everyday practice. Understanding these views is key to guiding the development of more comprehensive, ecologically valid screening tools for the ABI population.

Design:

A cross-sectional electronic survey was distributed through professional networks (APA Division 22, ASHA-SIG) to clinicians under age 65 who work directly with patients. Academics not involved in clinical care and non-English speakers were excluded. Respondents rated cognitive screeners and identified perceived gaps in assessment. Data were analyzed using descriptive statistics and thematic analysis of open-ended responses.

Results:

A total of 108 U.S.-based clinicians participated (44% neuropsychologists, 47% speech-language pathologists). Most worked with adults (90%) and elderly patients (99%) in rehabilitation settings (60%). The majority (89%) regularly used cognitive screeners, mainly for clinical purposes (99%). The MoCA was most frequently used (86%), followed by the SLUMS (51%) and MMSE (47%). The MoCA was preferred for its availability, ease of use, standardization, and clinical utility. Despite widespread use, 69% of respondents felt current tools inadequately assess key domains such as executive function, attention, and social cognition. Many highlighted concerns about ecological validity and limited sensitivity to subtle or complex deficits, particularly in moderate to severe ABI cases.

Conclusions:

There is a clear disconnect between current screening practices and the complex needs of ABI patients. While widely used, existing tools fall short in evaluating critical cognitive domains. Findings support the need for improved screening instruments that are more sensitive, comprehensive, and reflective of real-world cognitive demands.