Cognition as the fifth vital sign: Integrating neuropsychological assessment and neuroimaging in modern neurology practice

Background: Cognitive symptoms are among the most common reasons patients seek neurological care, yet cognition is often assessed inconsistently in routine clinical practice. As neurological disorders increasingly affect aging populations worldwide, early identification of cognitive dysfunction has become critical for diagnosis, treatment planning, and patient safety. Advances in computerized cognitive screening and multimodal neuroimaging—including structural MRI, diffusion tensor imaging (DTI), and functional MRI (fMRI)—offer new opportunities to integrate cognitive phenotyping with brain network characterization in everyday neurology practice.
Objective: This presentation reviews current strategies for incorporating structured cognitive assessment into neurology clinics and highlights the complementary role of neuroimaging in evaluating cognitive dysfunction across neurological conditions.
Methods: We review contemporary literature and emerging clinical models integrating brief cognitive screening tools, comprehensive neuropsychological evaluation, and multimodal neuroimaging approaches. Particular emphasis is placed on the clinical utility of computerized cognitive screening platforms, structural MRI markers of neurodegeneration and cerebrovascular disease, diffusion tensor imaging measures of white matter integrity, and functional MRI for mapping language, memory, and executive networks.
Results: Integrating cognitive assessment with neuroimaging enhances diagnostic precision and clinical decision-making across a wide range of neurological conditions. Brief cognitive screening tools can function as efficient triage mechanisms within neurology clinics, identifying patients who may benefit from comprehensive neuropsychological evaluation or targeted neuroimaging. Multimodal imaging provides additional insight into neural network dysfunction in disorders such as neurodegenerative disease, vascular cognitive impairment, epilepsy, brain tumors, traumatic brain injury, and post-viral syndromes including long COVID. Advanced neuroimaging techniques also play an increasingly important role in pre-surgical brain mapping and treatment planning.
Conclusion: Cognition should be considered a “fifth vital sign” in neurological care. Integrating standardized cognitive assessment with advanced neuroimaging allows clinicians to move beyond symptombased diagnosis toward network-based understanding of neurological disease. Adoption of scalable cognitive screening workflows and multimodal imaging strategies has the potential to improve diagnostic accuracy, guide treatment planning, and ultimately enhance patient outcomes in modern neurology practice.

Keywords: Cognitive assessment, neuropsychology, neuroimaging, functional MRI, diffusion tensor imaging, cognitive screening, neurology practice