Background

Cognition is the process by which our sensory input is transformed, reduced, elaborated, stored, recorded, and used. It is our capacity to take in, organize, assimilate, and integrate new information with previous experience. Cognition allows us to adapt to environmental demands by using previously acquired information to plan and structure behavior to attain our goals. This chapter discusses how you the occupational therapist can make cognition assessments and design interventions.

In the Domain and Process and Physical Dysfunction Lecture, you learned about different cognition aspects. We discussed awareness, attention, memory, and executive function. The assessments that we talk about here are MoCA and Medi-Cog, which will help you tease out deficits in these different cognitive areas. Then, you will have an opportunity to practice designing interventions for individuals with different cognitive deficits.

Cognition

This video discusses how to screen and treat clients with cognitive deficits.

Video is licensed under CC BY 4.0.

Cognition Video Transcript

Cognitive Screenings Tips

The role of cognitive screenings is to gain a better understanding of your client’s cognitive strengths and deficits. We will practice two cognitive screenings: the Montreal Cognitive Assessment (MoCA) and the Medi-Cog. Also, you’ll find more functional cognitive assessments at https://multicontext.net/treatment-and-assessment-links-2 .

• MoCA
  • MoCA is a screening tool designed to detect mild cognitive impairment.
  • This screening tool uses 16 items that assess different cognitive domains: visuo-spatial, executive function, naming, memory, attention, language, abstraction and orientation.
  • Scores range from 0-30. Scores lower than 26 indicate cognitive impairment concerns.
  • https://www.mocatest.org/
• Medi-Cog is a two-part brief cognition, literacy, and pillbox-skills assessment.
  • Medi-Cog is a screening tool designed to measure functional cognition.
  • This screening tool uses a three-item recall, a clock drawing, and a medication transfer screening.
  • There are 10 possible points in Medi-Cog. A score of 7 or lower indicates cognitive impairment concerns.
  • https://www.pharmacy.umaryland.edu/media/SOP/medmanagementumarylandedu/MediCogPresentation.pdf

Cognitive Interventions Tips

Once a cognitive deficit is observed, the occupational therapy practitioner can treat with components, skills, and strategies

• Components—Attempts to improve memory, attention and/or executive function.
  • Caution: There is limited evidence that treating components improves occupational performance.
  • Example: Use memory games to treat components, such as Spot It.
• Skills—Improve performance on a specific skill that requires cognition.
  • Example: Practice performing medication management repeatedly until the client can perform it successfully.
• Strategies—Teach strategies that can be applied across a wide variety of tasks.
  • Example: Teach the Goal-Plan-Do-Check problem solving strategy.

Resources

• Functional Cognition and OT: Our Time to Shine by Renee Leuschke, OTR/L
• Multicontext by Joan Toglia, Ph.D, OTR/L, FAOTA