What are the next steps for someone with Cognifit results indicating reduced focus and visual scanning?

Cognitive Assessment and Next Steps for Reduced Focus and Visual Scanning

Cognifit results showing reduced focus and visual scanning require formal neuropsychological evaluation and comprehensive ophthalmologic examination to determine the underlying cause and guide appropriate intervention, as Cognifit lacks sufficient validation as a standalone diagnostic tool.

Critical Limitation of Cognifit Testing

• Cognifit has not been adequately validated for clinical decision-making. A direct comparison study found only 43% agreement between Cognifit (Cognivue®) and the Montreal Cognitive Assessment (MoCA) in identifying cognitive impairment, with weak correlations between individual subtests 1
• The MoCA demonstrated superior psychometric properties with 100% sensitivity and 87% specificity for cognitive impairment screening, making it the preferred instrument 1
• Cognitive screening tools should never be used to diagnose neurocognitive disorders—they only determine whether further evaluation is warranted 1

Recommended Evaluation Pathway

1. Comprehensive Cognitive Assessment

Formal neuropsychological evaluation is essential to properly characterize deficits in focus and visual scanning:

• Attention and processing speed are among the most commonly affected cognitive domains in vascular and age-related cognitive impairment 2
• Visual scanning deficits require specialized neuropsychological tests that measure visuoperceptual, visuospatial, visuoconstructive abilities, and visual attention/memory 3
• Assessment should not be limited to domains where the individual reports changes—comprehensive evaluation across multiple cognitive domains is necessary 2
• Executive function assessment should include specific sub-elements: initiation, inhibition, shifting, insight, planning and organization, judgment, problem solving, and abstract reasoning 2

2. Ophthalmologic Examination

Visual acuity impairment can functionally mimic cognitive deficits and must be ruled out:

• Better visual acuity is associated with higher concurrent cognitive abilities and slower rates of cognitive decline over 9 years in both vision-dependent and vision-independent tests 4
• Deficits in the ocular-motor system may mimic cognitive impairment functionally 5
• Comprehensive eye examination should include best-corrected visual acuity, refraction, contrast sensitivity testing, and evaluation for cataracts, age-related macular degeneration, and refractive errors 2
• Visual field testing may be necessary if peripheral vision loss is suspected 2

3. Specific Considerations for Visual Scanning Deficits

Visual scanning problems have distinct etiologies requiring targeted assessment:

• Homonymous visual field defects from postchiasmatic brain injury commonly cause mobility-related difficulties and scanning deficits 6
• Convergence insufficiency presents with difficulty focusing at near distances, eyestrain, headaches, blurred vision, and difficulty concentrating while reading—symptoms that overlap with "reduced focus" 2
• Sensorimotor examination should assess for exophoria greater at near than distance, insufficient positive fusional vergence, and distant near point of convergence (>6 cm) 2

4. Rule Out Underlying Neurological Conditions

Several conditions present with combined attention and visual scanning deficits:

• Vascular cognitive impairment commonly affects attention, processing speed, and executive function 2
• Stroke/ischemia can cause visual blurring and scanning difficulties 5
• Progressive multifocal leukoencephalopathy presents with cognitive dysfunction, visual field cuts, and retrochiasmal visual deficits 7
• Depression can worsen cognitive impairment severity and mimic cognitive deficits in the context of neurological disease 2

Treatment Considerations Based on Etiology

If Visual Impairment is Primary:

• Corrective lenses for refractive errors improve visual acuity and may improve cognitive test performance 2, 4
• Compensatory scanning training using systematic horizontal scanning rhythm improves mobility-related activities in patients with visual field defects, particularly in dual-task situations 6
• Convergence orthoptic exercises (office-based training preferred over home-based) for convergence insufficiency 2

If Cognitive Impairment is Primary:

• Personalized management and rehabilitation plans using a person-centered approach with culturally appropriate goals 2
• Cognitive rehabilitation targeting specific impaired domains identified through formal testing 2
• Timing matters: Those identified as at-risk should be screened at different stages of care as impacts can change with time 2

Critical Pitfalls to Avoid

• Do not rely on Cognifit results alone for diagnosis or treatment planning—misdiagnosis can cause unnecessary psychological harm and lead to incorrect treatment 1
• Do not assume visual scanning deficits are purely cognitive without ophthalmologic evaluation 4
• Do not overlook that different types of compensatory strategies are appropriate for different activities—scanning training improves mobility but not reading or visual search tasks 6
• Ensure optical correction is appropriate for near activities before attributing symptoms to cognitive deficits 2