Assessing Abilities and Capacities: Cognition PDF

Assessing Abilities and Capacities: Cognition Part 2 OT 211 Dr. Qussai Obiedat  COGNITIVE ASSESSMENTS A cognitive assessment should incorporate: Patient/ family self- report Measures of specific cognitive domai...

Assessing Abilities and Capacities: Cognition Part 2 OT 211 Dr. Qussai Obiedat  COGNITIVE ASSESSMENTS A cognitive assessment should incorporate: Patient/ family self- report Measures of specific cognitive domains or processes Observations of functional performance Occupational therapists may conduct part or all of the assessments, depending on setting. 2  SELF-REPORT MEASURES Consist of standardized interviews and questionnaires that the patient rates their performance in various aspects of cognitive functioning. Keep in mind that individuals with impaired self-awareness may minimize problems on self-reports. Discrepancies between the patient’s self-report and that of significant others may be used as indicators of inaccurate perceptions of competency. 3  SELECTED MEASURES INVOLVING SELF-REPORT Self-Awareness of Deficits Interview (SADI) Tool designed to obtain both qualitative and quantitative data on status of self-awareness. The patient is asked about self-awareness of deficits, self-awareness of functional limitations because of deficits, and ability to set realistic goals. A therapist familiar with the patient’s level of functioning assigns a score in each realm (0–3, with 0 representing full awareness) Time to Administer: 10 minutes 4  SELECTED MEASURES INVOLVING SELF-REPORT Behavioral Rating Inventory of Executive Function-Adult version (BRIEF-A) A standardized self-report and informant report questionnaire that measures an adult’s appraisal of his or her executive functioning in everyday life. It measures the following domains: inhibit, self-monitor, plan and organize, initiate, task monitor, emotional control, working memory, and organization of materials. Composed of 75 items with composite scores falling into two broad indexes: 1. Behavioral regulation 2. Metacognition. An overall summary score results in a global executive composite. Higher values reflect greater difficulty experienced by the individual. Time to Administer: 35 minutes 5  MEASURES OF FUNCTIONAL COGNITIVE PERFORMANCE Three Themes: Dynamic Assessment: clinician uses cues and feedback to understand how to elicit patient’s best performance (i.e., Dynamic Interactional Assessment (DIA)) Any test can become dynamic through manipulation of task and environment variables and offering strategies and cues Informal Observation: enables therapist to make hypotheses about cognitive strengths and weakness and identify domains warranting further evaluation Performance-Based Assessment: patient performance of a task that simulates an everyday activity 6  PERFORMANCE-BASED MEASURES Assessment of executive abilities depends on adequate task complexity, novelty, and challenge – can/how does the patient perform complex tasks? Typically require problem solving, managing distractions, and incorporating multi-tasking Designed to have relevance to real-world contexts Examples: Executive Function Performance Tests, Multiple Errands Test 7 SELECTED MEASURES OF FUNCTIONAL COGNITIVE PERFORMANCE Observed Tasks of Daily Living–Revised (OTDL-R): An assessment of everyday problem solving in which the patient performs nine tasks related to medication use, telephone use, and financial management. Time to Administer: 25–30 minutes Arnadottir OT-ADL Neurobehavioral Evaluation (A-ONE): There are two parts to the instrument: Part 1 involves observing ADL performance and completing the (1) Functional Independence Scale and (2) Neurobehavioral Specific Impairment Subscale. Part 2 is optional, enabling the clinician to cross-link the neurobehavioral impairment to the most likely lesion site. Time to Administer: 25 minutes 8 SELECTED MEASURES OF FUNCTIONAL COGNITIVE PERFORMANCE Executive Function Performance Test (EFPT) A standardized top-down performance-based measure of executive functioning. The EFPT examines the execution of four basic tasks associated with self-maintenance: 1. Simple cooking 2. Telephone use 3. Medication management 4. Bill paying The EFPT uses an ordinal scoring system that highlights individuals’ ability levels through measurement of the cues provided by the clinician. Time to Administer: 60 minutes 9 SELECTED MEASURES OF FUNCTIONAL COGNITIVE PERFORMANCE The Multiple Errands Test (MET) A naturalistic performance-based measure of executive functioning deficits. The MET is set up much like a scavenger hunt. Participants are given a task list (typically 12 tasks); tasks with rules (typically 9 rules); and a map of the test environment. Participants are told to begin the test and to complete the test as they wish. Patients are successful only with careful planning with test goals and rules in mind. Time to Administer: 60 minutes 10  MEASURES OF SPECIFIC COGNITIVE DOMAINS AND PROCESSES Assess specific cognitive capacities and abilities but are unable to provide information and what specific areas may be impaired. Selected Tools for Assessing Cognitive Capacities and Abilities: Galveston Orientation and Amnesia Test (GOAT): A widely used measure of orientation to person, place, time, and memory for events preceding and following injury. Ten questions with weighted error points deducted from a total of 100 points. Time to Administer: 10–15 minutes Test of Everyday Attention (TEA): Test of sustained, selective, and divided attention based on eight ecologically plausible subtests such as: Map and telephone search (selective attention) Elevator counting and lottery (sustained attention) Telephone dual task (divided attention) Time to Administer: 45–60 minutes 11  SELECTED COGNITIVE SCREENS AND MICROBATTERIES Mini-Mental State Examination (MMSE) Screening tool involving a therapist-administered interview composed of 11 questions related to orientation, attention, learning, calculation, abstraction, information, construction, and delayed recall. Scores of 0–30, with scores of 24 or below suggestive of possible cognitive disorder Time to Administer: 5–10 minutes 12  SELECTED COGNITIVE SCREENS AND MICROBATTERIES The Montreal Cognitive Assessment (MoCA): A screening tool developed to measure mild cognitive impairment. The MoCA screens attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. The MoCA has been validated on a range of patients, including those with stroke, Parkinson’s disease, and dementia. However, it can be used on any patient experiencing memory difficulties who scores within the normal ranges on the MMSE Time to Administer: 10–15 minutes 13  SELECTED COGNITIVE SCREENS AND MICROBATTERIES Loewenstein Occupational Therapy Cognitive Assessment (LOTCA): Microbattery consisting of 20 subtests in four areas: Orientation, Perception, Visuomotor operations, and Thinking operations. Time to Administer: 30–45 minutes Cognistat (Neurobehavioral Cognitive Status Examination): Microbattery comprised of 10 subtests in the areas of orientation*, attention, comprehension*, repetition*, naming*, construction, memory, calculation, similarities, and judgment. Time to Administer: 20–25 minutes 14  INTERPRETING RESULTS OF PERFORMANCE Consider neurobiological, affective, sociocultural, task and environment Neurobiological Crystallized intelligence (well-practiced, overlearned skills) maintained or strengthened in 8th decade of life Fluid intelligence (reasoning and problem solving) slowly declines at 6th decade of life Decline in visual-perceptual function alter inputs to memory process Dehydration and anemia Medications 15  INTERPRETING RESULTS OF PERFORMANCE Affective High anxiety → attend to threat-related stimuli, use limited-capacity working memory for worry, self-concern, and other task-irrelevant distractions Depression → show passive disengagement with the environment, attentional focus on internal concerns, negative recall bias, memory deficits have secondary effect on executive processes Transient mental distractions → pain and fatigue provide irrelevant inputs that interfere with memory trace formation and diminish function of working memory 16  INTERPRETING RESULTS OF PERFORMANCE Sociocultural Information processing differences between cultures (objects and object attributes vs. field, background, context) Influence on self-awareness Performance on cognitive tests shaped by years of education 17  INTERPRETING RESULTS OF PERFORMANCE Task & Environment Familiarity of task Environment similarity Contextual cues enhance recall of similar tasks Stimulus-arousal properties of the environment Lighting and noise 18 Thank You! 19