Sensitivity and Specificity of Cognitive Health Screening in a Coordinated Specialty Care Setting

Cognitive health should be addressed as part of routine clinical care for people with schizophrenia spectrum disorder, including those with early psychosis. Providers need an efficient workflow that includes screening tools with adequate sensitivity and specificity to facilitate appropriate cognitive symptom management. This study aimed to examine the utility of a cognitive health screening protocol by analyzing data from 102 participants in OnTrackNY, a specialized network of programs for people experiencing early psychosis.

Screening elicited participants' perceptions of the usefulness of better memory, attention, and critical thinking skills and aimed to detect the presence of cognitive difficulties via participant and clinician reports. The screening protocol's sensitivity and specificity for detecting cognitive impairment, as defined by scores on a brief cognitive assessment, were evaluated.

About half the sample had global cognitive impairment, whereas more than 90% demonstrated impairment in at least one cognitive domain. Screening items demonstrated high sensitivity to detect global (≥0.80) and specific cognitive impairment (≥0.74), such that individuals with objectively measured cognitive impairment were likely to be correctly identified, although specificity remained low (≤0.34).

The screening protocol may best be considered as a means to initiate shared decision making for next steps, which may include brief cognitive assessment or more resource-intensive evaluation, and to inform appropriate treatment recommendations.