A Better Standard of Practice:
Baseline Cognition Assessment for All
This presentation will discuss how recent advances in digital mobile technology have progressed to the point that accurate and low-cost baseline cognitive testing should become the standard of practice in patient care.  Over the last 15 years there has been increasing awareness of the need to acquire baseline cognition for athletes so that informed return to play decisions can be made and treatments can begin as soon as possible.  Preseason baseline cognitive testing has made a positive impact upon the treatment and secondary injury reduction of athletes. This push has undoubtedly been very beneficial to the athletic community and may hopefully reduce serious injuries in the future.  However, while athletes are receiving the majority of the press coverage about head injuries, the actual quantity of head injuries incurred from athletics is relatively small as compared to the general population.  In fact, the majority of brain injuries do not occur in athletes. According to the Brain and Spinal Cord Organization 1 the breakdown of head injuries is 28% falls, 20% motor vehicle accidents, 19% struck by objects or against objects, and 11% violence.   
The CDC 2 reports that half of all head injuries go undiagnosed and untreated.  Without baseline comparison, it is much harder to evaluate for cognitive change in the general population. Multiple challenges exist including premorbid cognitive abilities, premorbid and concurrent emotional health, learning disorders, ADHD, and difficulties obtaining and verifying history. In the elderly population, concerns for premorbid dementia can be a significant confound in evaluating for new cognitive decline following a head injury.  

Access to a neuropsychologist is challenging in many parts of the world. In the US there are approximately 43.4 million people with diagnosed cognitive disorders and approximately 1,129 board certified neuropsychologists to provide cognitive testing. Globally there are approximately 4,000 neuropsychologists but hundreds of millions of people in need around the world and, in many places, it is just not possible to a see a neuropsychologist. Additionally, neuropsychological exams tend to be expensive (estimates between from $500 to $3,000), and time intensive (average time from consult to report varies from 4 to 8 weeks). 
This presentation will discuss how to use the Savonix mobile app to assess baseline cognition and re-administer testing when a suspected head injury has occurred which will streamline assessment to treatment. We propose that acquiring baseline cognitive data will lead to more efficient use of fiduciary resources, neuropsychologists time, and streamline treatment and outcomes of patients with head injuries.  
References
1)	Brain and Spinal Cord Organization (https://www.brainandspinalcord.org/brain-injury-statistics)
2)	CDC: FAQs about baseline testing (https://www.cdc.gov/headsup/basics/baseline_testing.html).

A Better Standard of Practice: Baseline Cognitive Assessment for All