Cogstate

FAQ Categories

• Doctor / Athletic Trainer FAQ
• Is Cogstate and its CCAT subject to the Health Insurance Portability and Accountability Act (HIPAA )?

  Cogstate and its Computerized Cognitive Assessment Tool (CCAT) are not subject to the Health Insurance Portability and Accountability Act (HIPAA) because:

  1. HIPAA applies only to the transmission of certain protected kinds of health information transmitted by ‘covered entities’ as defined under the Act.

  2. In general, a ‘covered entity’ must be a health plan, a healthcare clearinghouse or a healthcare provider who electronically transmits protected health information in connection with certain standard transactions.

  3. Those standard transactions are specifically related to the billing of health plans, or the payment for healthcare services by health plans.

  Cogstate is not a covered entity, nor do we engage in the kind of transactions which HIPAA is meant to cover–Cogstate is neither a Healthcare Provider nor a health plan, and we do not bill insurance plans or receive payments directly from such health plans. Baseline and After Injury test results are stored in the Athlete’s account. Each Athlete and their family can make their own decisions about whom to share the test results with.

• I’ve been given an Athlete’s Cogstate Baseline test result. What now?

  The Cogstate Computerized Cognitive Assessment Tool (CCAT) is a validated series of simple cognitive tasks that can aid rapid measurement of cognitive performance pre- and post-concussive injury as one part of a complete concussion management program. The Cogstate CCAT measures the speed and accuracy of processing speed, attention, learning and working memory. The Baseline test is completed annually before contact sport participation, often in conjunction with the physical examination. Athletes can set up accounts to store test results and link these to a Medical (clinic) account. We recommend that a responsible adult supervise Athletes who use the Cogstate CCAT at school or home.
  
  Best-effort Baseline test results are acceptable for future comparisons. These are indicated by a green checkmark at the top right of a report. Some Athletes will not get an acceptable Baseline result the first time they use the Cogstate CCAT and will need encouragement to complete the test faster or more accurately the next time. They can repeat testing (without further charge) until they get an acceptable Baseline result. Three or more best-effort attempts marked with a red “X” suggest that specialty neurological and/or neuropsychological evaluation may be considered to determine a cause and the Athlete’s Baseline level on other measures prior to any sports participation.
  
  If you have been emailed or presented with a copy of an Athlete’s Baseline results, we suggest you consider storing the Baseline report with that Athlete’s medical records so that they are available to you in the event the Athlete suffers a concussion or other brain trauma. We also invite you to create an Cogstate Medical account. Through this free account an Athlete may share their past, present and future results.
  
  If you want to know how to get started, read the Medical Quick Start Guide.  If you want to learn more about the Cogstate CCAT, full details are available in the Medical Guide to the Cogstate CCAT which includes example reports and interpretations.  This document is available in the Doctor / Athletic Trainer Resource Center.

• How do I set up a Clinic account so my patients can automatically share their results with me through Cogstate?

  The simplest way to set up an account is to follow the steps in the Medical Quick Start Guide. When you provide your Athletes with your registered email address, Athletes can then share their individual test results with you. If you are distributing vouchers to Athletes, use the Easy Link feature to automatically have access to the test results. You may want to consider purchasing After Injury test credits (perhaps making use of the discounted rate for bulk purchases) which you can use to test Athletes inexpensively when they seek your care following a suspected concussion.

• How do I interpret an Cogstate Baseline test result?

  Baseline test results are designed to indicate whether they are acceptable for comparisons in the future with After Injury tests or not. If they are acceptable, there is a green checkmark at the top right. Baseline reports that are marked as acceptable usually indicate best effort and no further testing is required that season until after a suspected concussion. Baseline reports that are not acceptable are marked with a red X indicating the Athlete should repeat the Baseline test (at no extra charge), trying to be faster and/or more accurate depending upon the explanation on the report. Three or more best-effort Baseline reports with a red X suggest that specialty neurological and/or neuropsychological evaluation may be considered to determine a cause and their Baseline level using other measures prior to any sports participation. An Advanced report is also available which gives more detail about the performance. For more help on interpreting test results, please see the Cogstate Medical Guide to the CCAT.

• A Baseline result is mildly worse than a previous result. What does this mean?

  There are many factors that can influence the results of an Cogstate CCAT--motivation or best effort, emotional, environmental and medical. The Cogstate CCAT will not differentiate between these possibilities. A Healthcare Provider will need to evaluate all clinical issues to form a diagnosis of the likely causes. A repeat Baseline test after encouraging best effort from the Athlete and under optimal environmental conditions may be the only action required. For further discussion of this situation see the Cogstate Medical Guide to the CCAT.

• Can I add a Baseline test to an Athlete’s annual physical?

  Great idea! An annual acceptable Baseline test result using the Cogstate Computerized Cognitive Assessment Tool (CCAT) is recommended to ensure cognitive assessments keep up with maturational changes (present in Athletes through age 15 year, at least) and any substantial changes that occurred prior to the sports season. Therefore, adding the Cogstate CCAT to an annual physical examination is a good idea if the Athlete has not already established a recent Baseline independently within the last 12 months. The test can either be paid for by the Athlete's family directly, or through a Baseline voucher provided by the clinic. Specific financial modeling can vary between practices, but offering Baseline tests as a clinic service to local schools and organizations (utilizing volume discounts), coupled with information about After Injury care during informational sessions, can lead to increased After Injury consultations that in many regions offset Baseline test expenditures.

• How can I administer After Injury tests in my clinic?

  An After Injury test is taken at your recommendation post-concussion and usually after the Athlete’s physical, sleep and mood symptoms are improved or resolved. After Injury tests can be completed using any Internet-connected computer with a modern web browser, and take about 10 minutes to complete. A quiet, distraction-free testing environment is required (headphones may help to reduce extraneous noise).  The test can either be paid for by the Athlete's family directly, or through an After Injury voucher provided by the clinic (for which insurance reimbursement is obtainable). Some Healthcare Providers also perform After Injury testing at initial presentation by the Athlete to document the maximum cognitive impairment, aid counseling, and to follow a time-recovery curve.

• My patient has established an acceptable Baseline and now has suffered a concussion. How can I use the Cogstate CCAT in my concussion management?

  The Cogstate Computerized Cognitive Assessment Tool (CCAT) can be used after a concussion to help determine cognitive recovery by comparing After Injury performance with Baseline performance. It is only one part of a complete concussion management program, which includes evaluation of symptoms, neurological and other clinical features and graduated return to normal activities when all features indicate recovery. An After Injury test is usually done after symptoms have improved or resolved, since full cognitive recovery, as demonstrated with the Cogstate CCAT, often is delayed two to three days or more than reported symptoms. After Injury assessments help track improvement back to Baseline cognitive performance. Cognitive recovery usually occurs within five to seven days, but more prolonged recovery might warrant referral to a specialist in concussion management.
  
  On the After Injury Test Report, return to Baseline is indicated by a green check mark and the text in the explanation section. Incomplete recovery is indicated by a red X.  In addition, the graphs show all prior test results for each task. The Processing Speed and Attention task results are reaction time measures which are often the most sensitive to the effects of acute concussion. Testing can be repeated (without further charge) until cognitive performance returns to Baseline levels.  If you want to learn how to get started, read the Medical Quick Start Guide. If you would like to learn more about the Cogstate CCAT and its use in concussion management, read the Cogstate Medical Guide to the CCAT (which includes examples of test results and their interpretations).
  
   

• How do I interpret an Cogstate After Injury test?

  After Injury reports are designed to compare current performance with a stored (usually preseason) Baseline performance on the same tasks. If there is no significant difference between these performances, there is a green check mark at top right. If there has been a significant decline in performance, there is a red “X” instead. After Injury reports that are marked with a green check mark suggest that cognitive recovery has occurred but must be considered within the whole medical context of that Athlete’s concussion episode in formulating return-to-play or other decisions. The automated analysis underlying this result uses a statistical threshold of 1.65 standard deviations deterioration, which equates to the change seen with a blood alcohol concentration change of 0.08 percent. Lesser degrees of deterioration are possible but will not be flagged by the automated analysis. After Injury reports that are marked with a red “X” suggest cognitive recovery has not yet occurred (and at least one result is abnormal for that Athlete). Repeat testing (without further charge) hours or days later is recommended based on clinical judgment until an acceptable After Injury performance is achieved. Persistent failure to recover to Baseline and a performance plateau may indicate incomplete cognitive recovery and suggests that specialty neurological and/or neuropsychological evaluation should be considered.
  
  An Advanced Report is also available using the “Advanced Report” button giving more detail about the Athlete’s After Injury performance. For more help on interpreting these, please see the Cogstate Medical Guide to the CCAT.
   

• How do I use the Cogstate CCAT after concussion if the Athlete has not completed and stored an acceptable Baseline test result?

  This is a difficult situation to manage medically since there is no definite method of determining the Athlete’s true pre-morbid level of cognitive performance, or Baseline, if only tested after the injury. In these cases, sports medicine, neurological and/or neuropsychological evaluation is usually recommended to assist with management of the concussion. If there is no Baseline test result, then an After Injury test performance has no comparison performance and its test report will always be marked with a red X.  Comparison to normative data is not an adequate substitute since performance may have declined but still remain within the population’s normative ranges. However, repeated After Injury testing may aid determinations in the stabilization of cognitive function. This is a time when the Healthcare Provider may consider referral to other specialists in sports medicine, neurology and/or neuropsychology to help determine the extent of recovery and further management. For more help on using the Cogstate CCAT in this situation, please see the Cogstate Medical Guide to the CCAT.

• What is the validity of the Cogstate CCAT?

  The Cogstate Computerized Cognitive Assessment Tool (CCAT) is powered by a cognitive testing battery developed by CogState. This test battery has been validated in children and healthy adults for single and repeated administration to determine normative data, stability and test-retest reliability, and under diverse pathological conditions including concussion, fatigue, pharmaceuticals, drugs and alcohol, anaesthesia and surgery, infectious, traumatic, psychiatric and neurological diseases. These studies are reported in peer-reviewed publications and attest to the sensitivity of the battery to all causes of cognitive change in individuals over time and provide information on the patterns of cognitive impairment in these serious conditions helping to understand the presentation of impairment in milder conditions like concussion.
  
  Sensitivity to any cause of cognitive impairment including concussive injury means that when the Cogstate CCAT detects change in an Athlete’s cognitive performance, a medical assessment in context is required to determine the likely reasons for that individual athlete’s change. Further information is summarized in the Cogstate Medical Guide to the CCAT.
   

• How do I learn more about concussion and its current management?

  There are many resources available on this web site to aid concussion recognition and treatment, as well as links to other sites. Please visit the Resource Center for access to:

  • The International Consensus Statement on Concussion in Sport, see the Zürich 2008 meeting publication.
  • A detailed discussion of the medical use of the Cogstate CCAT in concussion management, see the Cogstate Medical Guide to the CCAT.

  
   

Contact Us

Haven't found the answer to your question? Please feel free to utilize the information below to contact us:

Phone

877-399-2966 (US and Canada)

01-800-681-9273 (Mexico)

Email

customerservice@cogstate.com

Live Chat

Address

2100 Stewart Avenue
Suite 201
Wausau, WI 54401