Assessing cognition in acute care
The use of specific assessment tools should supplement your findings from chart review, observations of functional ability, and any interview of the client or caregiver. However, sometimes we need additional information to create a thorough occupational profile of a client.
Yes, using assessment tools is a challenge in acute care. Therapists only have so much time and money! Here is a list of tools for cognition that are quick, easy to administer, and mostly free.
Paper-based assessment tools for cognition
MMSE. This is paper-based assessment of cognition. PRO: It is a quick-to-administer, classic tool that needs little explanation to medical staff. CON: Must have facility license to use.
SLUMS. The SLUMS distinguishes dementia and mild cognitive impairment. PRO: It is quick to administer. There are clear cut-off scores that describes a clients cognitive function. CON: Not directly related to functional ability.
MOCA. The MOCA distinguishes between dementia and mild cognitive impairment. PRO: It is quick to administer and easy to learn. CON: It is not functional.
Observation or interview-based tools for cognition
Short Blessed Test. This is a tool in interview format that looks at memory and cognition. It distinguishes between MCI and dementia. PRO: It is quick and easy to use. CON: This test does not relate to function.
O-log. A tool that allows a therapist to track a patient’s improvement in orientation over time. Originally developed for individuals with brain injury but can be used with anyone in a coma. PRO: Allows healthcare providers track orientation over time. It is easy and quick to administer. CON: Primarily for ICU.
Cog-log. A tool that allows a therapist to track a patient’s cognitive improvement over time. It was also originally developed for individuals with brain injury but can be used with anyone coming out of a coma. PRO: Allows healthcare providers to track orientation over time. It is easy and quick to administer. CON: Primarily for ICU. It does not directly relate to function.
CAM-ICU. This is an interdisciplinary assessment that determines if a patient is experiencing delirium or not. PRO: Helps determine delirium. May open the door for OTs who want to work with delirium. CON: Not directly related to function or cognitive functioning. Useful in ICU, not general acute care.
Function-based tools for cognition
Kettle Test. This tool is a great function-based cognitive assessment. The client is required to make a cup of tea with an electric kettle. The therapist makes observations about their performance. These observations help determine a client’s higher level cognitive function. PRO: The most functional cognitive assessment validated in acute care. CON: It takes more time than other assessments. It may be difficult to set-up.
Executive Function Performance Test. A thorough measure of executive function. It is broken up into sub-tests: simple cooking, telephone use, medication management, and bill payment. PRO: It gives the therapist information on cognitive impairment, capacity for independent living, and amount of assistance required for everyday tasks. CON: It is time intensive (15-45 minutes). Many therapists will separate the assessment and administer it in parts.
Kohlman Evaluation of Living Skills (4th edition). This assessment tool looks at a client’s ability to live safely in the community. PRO: In its newly updated form, it is more relevant to real-life IADLs, safety, and community living. CONS: It takes more time to complete. You may need access to a computer. It is not free.
Allen Cognitive Level Assessment. This assessment tool looks at current cognitive function: attention, problem-solving, and learning potential. It can be useful to make discharge decisions. PRO: It is quick and easy to administer. You may need training to administer and score it correctly. CON: It can be difficult to explain to other members of the team. It is not free.
Trail Making Test. This is a test of visual attention and alternating attention. The two versions together look at executive function and cognitive speed. PRO: Quick and easy to administer. CON: The results do not directly relate to function. Interpretation to function is difficult. It can be used as a quick screen to make referrals – for example, it can highlight those who may be unsafe to drive.