In-clinic mental health, cognitive screening can benefit patients with sickle cell disease
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SAN DIEGO — Psychological and neurocognitive screening may help monitor mental and physical health among people with sickle cell disease, according to a speaker at ASH Annual Meeting and Exposition.
Emily Franco, a fourth-year medical student at the Warren Alpert Medical School of Brown University, told attendees at a special interest session about a study conducted at her institution that evaluated a brief in-clinic neuropsychological assessment, as well as an in-clinic depression and anxiety screening.
A multidisciplinary team of providers at Brown’s Comprehensive Sickle Cell Center conducted the screenings.
“It’s important to always keep in mind that patients with sickle cell disease are at increased risk for neurocognitive and mental health concerns,” Franco told Healio. “It’s our responsibility to either work to get them to formal testing or work to implement a screening in the clinic. By implementing routine screening for every patient, we can identify subtle deficits that we might otherwise miss.”
Subtle symptoms, screening barriers
Sickle cell disease is associated with a range of physical and psychosocial challenges, including neurocognitive deficits that may be difficult to detect.
These cognitive deficits frequently begin early in life and can impact school performance and retention, and the ability to find employment, Franco said.
“Unfortunately, formal neuropsychological testing is often a barrier for patients, as there is a lack of access, and it requires several visits and includes up to 8 hours of testing,” Franco said. “Thus, a clinic-administered assessment of cognitive function, in addition to well-validated measures of depression and anxiety, are appealing screening options.”
To address the potential mental health and neurocognitive challenges among people with sickle cell disease, Franco and her team evaluated the feasibility of less time-consuming, in-clinic screeners for neurocognitive deficits, as well as depression and anxiety.
Researchers screened 74 participants for depression and anxiety using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 scales. Patients self-completed the questionnaires during routine comprehensive clinic visits.
Through a linked study, investigators also conducted a brief neuropsychological evaluation of 21 patients using the NIH Toolbox: Cognition Battery, which assesses components of executive functioning and attention.
Of the 74 patients who completed the depression and anxiety screenings, 31 (42%) tested positive for at least mild depression, and 27 (36%) screened positive for at least mild anxiety. Additionally, 21 patients (28%) screened positive for both depression and anxiety.
Of the 21 patients who completed the NIH Toolbox neurocognitive assessment, eight (38%) scored abnormally, demonstrating that over one-third of those patients have some level of neurocognitive deficit.
“Ultimately, we identified a high number of patients who screened positive for depression and anxiety, as well as patients who scored low on the cognitive test,” Franco said. “The idea is, when those patients screen positive for mental health concerns and/or neurocognitive deficits, we can connect them with a social worker or psychologist in real time rather than waiting for an issue to arise down the line, when it might be too late for meaningful intervention.”
Connecting patients with resources
Franco said the screening tests both demonstrated feasibility and efficiency in this patient population.
However, even though the NIH Toolbox: Cognition Battery test is much briefer than 8-hour formal neuropsychological evaluations, it still takes 30 to 40 minutes.
“The cognitive test takes a good amount of time, when they’re already there [in clinic] for an hour to an hour and a half,” Franco said. “Of course, families are busy — they can’t be in the clinic too long. We’re working on ways to incorporate it into the clinic workflow a bit better.”
Patients and families are open to consulting with multiple specialists during their in-clinic visits, Franco said. Through this screening, they could work with their psychosocial team (psychology, social work) to direct several patients to resources they needed.
Her team aims to publish a manuscript with these data within the next year since Brown’s comprehensive sickle cell clinic could serve as a model of routine, in-clinic mental health and neurocognitive screening.
Even in the absence of a comprehensive clinic with a multidisciplinary team, clinicians can take steps to become more aware of potential cognitive or mental health issues among patients with sickle cell disease, Franco said.
“It’s difficult living with sickle cell disease, so we want to identify and address any issues patients might have,” she said. “We want to make sure they’re having the best possible quality of life, and that we’re doing everything we can to help them.”
Reference:
- Franco E. Prioritizing mental health in sickle cell disease: implementing routine psychological and neurocognitive assessments in a comprehensive sickle cell disease clinic. Presented at: ASH Annual Meeting and Exposition; Dec. 7-10, 2024; San Diego.
For more information:
Emily Franco can be reached at emily_franco@brown.edu.
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