Week 2 Preliminary Handout - OT Evaluation for Cognitive Dysfunction.pdf

OT-EAD311 A.Y. 2024-2025 OT EVALUATION FOR COGNITIVE DYSFUNCTION COGNITION The mental process of understanding, acquiring, and knowing information. Cognitive abilities are conceptualized in a hierarchy. COGNITIVE ABILITIES A...

OT-EAD311 A.Y. 2024-2025 OT EVALUATION FOR COGNITIVE DYSFUNCTION COGNITION The mental process of understanding, acquiring, and knowing information. Cognitive abilities are conceptualized in a hierarchy. COGNITIVE ABILITIES Arousal The cognitive ability to be responsive to stimuli The cognitive ability to understand oneself and one’s surroundings and Orientation circumstances (i.e., person, place, time, date) Attention The cognitive ability to direct mental processes toward information The cognitive ability to quickly and accurately decode elements of information into Processing meaningful terms The mental storage of information and the processes involved in the acquisition, Memory retention, and retrieval of that information Cognitive skills required for high-level thinking. Executive functions use gained Executive functions information to initiate, plan, problem solve, organize, categorize, sequence, judge, reason, and conceptualize actions for successful daily function. The cognitive ability to know one’s own capacities, skills, limitations, and level of function; used to determine, monitor, and adjust actions and behaviors to improve Self-awareness daily functions; makes it possible for people of or mental representations and concepts of themselves to regulate their own behavior. TYPES OF ATTENTION Focused attention The cognitive ability to be responsive to stimuli (also Arousal) Selective attention The cognitive ability to maintain focus on one stimulus despite distractions Sustained attention The cognitive ability to maintain focus over time (also Vigilance) Alternating attention The cognitive ability to shift focus from one task to another Divided attention The cognitive ability to attend to two or more stimuli simultaneously TYPES OF MEMORY Working memory The cognitive ability to use information that is currently held “in mind” Episodic memory Recall of information that is related to time Procedural memory Recall of how to perform tasks Semantic/declarative Recall of word-based information (e.g., knowledge about the meanings of words, memory objects, and events) Prospective memory Recall of information for upcoming events (e.g., appointments) Topographical memory Recall of a spatial representation or physical layout Retrograde memory Recall of information obtained prior to an injury (e.g., word finding, ability to recognize (also Remote memory) people, semantic/declarative knowledge) Anterograde memory Recall of information obtained after an injury Page 1 of 4  EXECUTIVE FUNCTIONS Planning Developing a proposal for doing or achieving something Problem solving The process of working through an issue to find a solution Organization The act or process of putting the different parts of something in a certain order Judgment The ability to make considered decisions or come to sensible conclusions Self-regulation Control of one’s behavior, such as inhibition and initiation of responses Flexibility The ability to change ideas or to compromise Categorization The ability to sort objects or ideas according to common attributes Sequencing Placing items or performing tasks in the order in which they should happen Abstract reasoning The ability to understand subjects on a complex level A thought process or method used to generate creative ideas by exploring many Divergent thinking possible solutions Conceptualization The ability to invent or formulate an idea CATEGORIES FOR SELF-AWARENESS Sensorimotor Cognitive Psychosocial COGNITIVE IMPAIRMENT & AGE-RELATED COGNITIVE CHANGES When cognition is impaired, occupational dysfunction can occur in any area of daily function. The effect of aging on cognitive abilities is influenced by personal and environmental factors: genetic makeup, lifestyle choices, health status, and the external environments. Research studies indicate that elders experience: o a slowing in information processing and psychomotor speed, o Deficits in tasks requiring abstraction, set-shifting, and divided attention, o And declines in fluid intelligence. Studies also indicate that factors such as physical illness, chronic conditions, depression, neurological damage, medication side effects, drug interactions, and the effects of surgery and anesthesia may also cause carrying degrees of cognitive impairment. Impairment of cognitive function is known to affect treatment and rehabilitation outcomes for elders and increases their likelihood of institutionalization. THE PROCESS OF COGNITIVE ASSESSMENT Can be categorized as either top down or bottom up, but most OTs will integrate the two approaches to assess the occupational performance of the client while attempting to discover the specific underlying cognitive deficits that may be causing difficulty with task completion. Assessments in both top-down and bottom-up categories may be either non-standardized or standardized. Page 2 of 4 EXAMPLES OF STANDARDIZED ASSESSMENTS FOR COGNITIVE FUNCTION The Montreal Cognitive Assessment (MoCA) 30-question test Takes 10-12 minutes to complete Screening tool developed to measure mild cognitive impairment (MCI) Screens attention, concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking calculations, and orientation Best used as a screening tool Therapists should be cautious in determining MCI based only on the MoCA as an evaluation tool Available in Philippine/Filipino version Scoring: Score Interpretation 26-30 Normal 25 or less (+) cognitive impairment Executive Function Performance Test (EFPT) Standardized top-down performance-based measure of executive functioning Examines the execution of four basic tasks associated with self-maintenance: simple cooking, telephone use, bill paying, and medication management Serves three (3) purposes: o To determine which executive functions are impaired o To determine an individual’s capacity for independent functioning o To determine the amount of assistance necessary for task completion Takes approx. 30-35 minutes to administer Cueing system is standardized and relates to the degree of cognitive impairment Awareness Questionnaire (AQ) A measure of impaired self-awareness after TBI; may also be appropriate for use with persons with other types of acquired brain injury Takes approximately 20-30 minutes to administer Consists of thee (3) forms: Patient Form and Family/SO Form (17 items), Clinician Form (18 items) Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA) A battery consisting of 28 subtests in 7 cognitive areas: orientation, awareness, visual perception, spatial perception, praxis, visuomotor construction and thinking operations Designed to assess cognitive performance of adults ages 18-69 years Goals of the assessment: o To identify the abilities and disabilities of the individual subjects in the different areas o To measure leaning potential and recognize thinking strategies through the use of dynamic assessment o To identify the level of awareness of the subject to his condition and cognitive disabilities Page 3 of 4 References: Barney, K. F., & Perkinson, M. A. (Eds.). (2016). Occupational therapy with aging adults: Promoting quality of life through collaborative practice. Elsevier. Baum, C.M. & Wolf, T.J. (2013). Executive Function Performance Test Manual. Washington University School of Missouri. Dirette, D. P., & Gutman, S. A. (Eds.). (2021). Occupational therapy for physical dysfunction (Eighth edition). Wolters Kluwer. Katz, N. et al. (2011). DLOTCA Dynamic Loewenstein Occupational Therapy Cognitive Assessment for Adults Manual. Maddak. Lohman, H. L., Byers-Connon, S., & Padilla, R. L. (2019). Occupational therapy with elders: Strategies for the COTA (4th ed). Elsevier Mosby. Sherer, M. (2004). The Awareness Questionnaire. The Center for Outcome Measurement in Brain Injury. http://www.tbims.org/combi/aq Page 4 of 4