Describe cognitive problems that the Veteran or Servicemember demonstrates or reports. Ask the Servicemember or Veteran to describe any functional limitations associated with reported cognitive problems. Reports of difficulty with attention, concentration, and memory should always be followed up with brief objective testing such as a Mini-Mental State Exam (MMSE) or Montreal Cognitive Assessment (MoCA). Providers should be aware that additional fees may be required to use objective outcome measures that are not in the public domain, including MMSE and MoCA.

Screening measures can be helpful for identifying and describing gross cognitive difficulties, although they can miss subtle, yet impactful cognitive problems. Further, such tests can indicate the presence of impairment, but they are rarely specific as to the cause of cognitive disorders such as TBI, depression, anxiety, sleep disorder, pain, or other functional deficit. Thorough neuropsychological assessment can help to specify causes of observed cognitive deficits, including TBI. In addition, assessment of symptom and performance validity can help to assure that interpretable results are obtained. The examiner should request any testing he or she deems necessary, based on the types of symptoms, deficits, and functional limitations the Veteran or Servicemember is reporting. Positive cognitive screening may indicate a need for referral for more specific evaluations. If you are unsure as to which type of evaluation to request, contact your supervisor.

If a neurocognitive assessment was performed in the last six months, repeat testing is usually not necessary. Assessments older than six months may need to be repeated if there is evidence of change in functional status. Remember that any required testing must be completed prior to submitting your report.