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Emerging developments in the field of cognitive screening will significantly impact long term care insurance agents and the LTC insurance industry, as well as society in general.

“Cognitive screens” attempt to determine if a persons reasoning skills and understanding have deteriorated. Screens dont diagnose the cause and may or may not identify severity. Screens simply identify abnormal performance.

Many disciplines are interested in cognitive testing, whether for the purpose of prescribing drugs, providing appropriate care, selling screens to the “worried well” or to family members, protecting against deterioration in employee performance, avoiding an early LTC insurance claim, etc. Fortunately, research from these different disciplines is starting to converge.

As a result, tests will become less expensive, easier to administer and more prevalent. They will be given in doctors offices, senior centers and malls. Screens will be taken at home (face to face, over the phone or via the Internet). It will become increasingly common for para-professionals, non-professionals and family members to administer cognitive screening tests. Individuals in the worried well category may even self-test.

Furthermore, cognitive screens are being developed with improved sensitivity (less risk of failing to identify an individual with Alzheimers disease) and/or specificity (less likely to trigger a false alarm). More importantly, they seek to identify cognitive impairment at earlier stages of development.

Mild cognitive impairment (MCI) is now generally considered to be an early stage of Alzheimers. Early identification of MCI may allow earlier and different types of intervention to slow the disease while victims can still function independently.

Such treatments hopefully will extend the productive lifetime of people with Alzheimers. However, such treatments are unlikely to delay death. With onset (but not death) delayed, those with Alzheimers could have significantly shorter periods during which they and their families bear the crushing impact of Alzheimers.

Screens employ various strategies to detect cognitive impairment, including testing of: short-term memory (e.g., delayed word recall); “orientation” (awareness of the current time, date, location); ability to follow a series of instructions; mathematical skills, such as counting backwards by 7; the subjects (or familys) answers to questions (data-mining technology); and ability to rapidly identify characteristics (color, shape, etc.).

Many approaches use a battery of screens. For example, a test now commonly used in the LTC insurance industry comprises 9 categories: orientation, attention, comprehension, repetition, naming, computation, verbal fluency, delayed word recall and judgment.

Researchers are attempting to narrow the necessary testing in order to save time and money. It is quite challenging to identify Alzheimers earlier (while avoiding false positives), with tests that are faster, cheaper and do not require a professional administrator.

Insurers will scramble to keep ahead of the curve. Improved screens will protect their bottom line, avoiding the risk that applicants might know more about their cognitive status than the insurer does. Effective screens will produce a healthier pool of insureds, thereby allowing lower prices. Expect to see cognitive testing at younger ages, perhaps more accessing of medical records (because of cognitive test results in the records), and perhaps a direct question about cognitive testing on the application.

From an agents point of view, the impact of these screens will cut several ways. Of course, some applicants will be rejected who might currently be approved. On the other hand, it is also likely that some applicants will be approved, who would have been rejected using current practices. For example, doctors records of a vague complaint about memory often lead to a “decline” decision. In the future, the doctors records might show a normal cognitive test, thereby erasing such concern; the insurer might trust its underwriting cognitive screen to distinguish between significant and insignificant notes of such type.

If early detection and treatment of Alzheimers result in less catastrophic outcomes, interest in LTC insurance may decline or people may feel less need for long benefit periods. On the other hand, people will increasingly understand that, at any time, they could suddenly become uninsurable.

Agents might become involved by sponsoring a screening program at a local senior center or church. They could directly offer a cognitive test to clients or prospects, either for people worried about themselves or people worried about loved ones. Providing such service can build an agents “brand” and produce more referrals. (Note: Although agents could administer the tests, they may prefer to provide access without administering the test or seeing the results.)

Developments in cognitive testing will significantly impact marketing, selling, underwriting and claims handling in the LTC insurance industry. It may behoove agents to consider how to succeed in the new environment.

is president of Thau Inc., a Mission, Kan., consulting and wholesaling firm focused on the LTC insurance industry. He can be reached at cthau@targetins.com.


Reproduced from National Underwriter Edition, January 20, 2005. Copyright 2005 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.