One Size Does Not Fit All: Choosing Practical Cognitive Screening Tools for Your Practice

Area of Science:

• Geriatrics
• Cognitive Neurology
• Health Services Research

Background:

• Millions undergo cognitive testing annually, but access to free tools is increasingly unstable.
• The Mini-Mental State Examination and Montreal Cognitive Assessment have associated costs, limiting accessibility.
• A
• free-to-fee
• cycle emerges where initially free tools become monetized, forcing clinicians to seek alternatives.

Purpose of the Study:

• To outline the disruptive "free-to-fee" cycle affecting free open access cognitive screening tools.
• To provide recommendations for breaking this cycle and ensuring sustained accessibility.
• To introduce the PRACTICAL.1 Criteria for selecting validated, accessible cognitive screening tools.

Main Methods:

• Analysis of the emerging "free-to-fee" cycle in cognitive screening tool accessibility.
• Development of the PRACTICAL.1 Criteria (PRACTIcing Clinician Accessibility and Logistical Criteria Version 1) for tool selection.
• Discussion of methodological issues, training needs, and ethnolinguistic diversity in cognitive screening.

Main Results:

• The "free-to-fee" cycle creates barriers to consistent use of valuable cognitive screening tools.
• The PRACTICAL.1 Criteria offer a framework for clinicians to evaluate and select appropriate tools based on accessibility and logistical factors.
• Recommendations include creating toolkits of permanently free, validated tools and embedding PRACTICAL.1 Criteria in future reviews.

Conclusions:

• Breaking the "free-to-fee" cycle is crucial for equitable access to cognitive screening.
• The PRACTICAL.1 Criteria provide a practical solution for clinicians navigating tool selection.
• Future efforts should prioritize open access, user training, and cultural/linguistic adaptability in cognitive screening tools.