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The article explores the validity of the LACLS-5 (Allen's cognitive level screen) to assess and distinguish adults living in the community with mild cognitive impairment (MCI) and mild dementia. Individuals with mild dementia scored less on all clinical measures than cognitively normal (CN) individuals, however individuals with MCI scored intermediately compared to CN adults. LACLS-5 was able to adequately discriminate between CN and dementia and between MCI and dementia but was unable to reliably distinguish between CN and MCI. Despite these results of tool's inability to distinguish between CN and MCI, LACLS-5 was found to be a significantly effective tool to assess functional cognition.

The MoCA screen is commonly used for individuals with Parkinson's Disease. The current study is a follow up from an original study. Thus, the aim of this pilot study was to develop an initial version of a new scoring procedure for the MoCA which considers the subtests' power to detect cognitive symptoms in PD, and to test whether it improves the ability to discriminate PD patients without cognitive impairment from patients with MCI and PD dementia. Screening procedures have high value as a time-economic, easy to use tool for a first step in detecting cognitive impairment in clinical practice, but will unlikely outweigh the reliability and validity of a neuropsychological test battery. The sensitivity of the MoCA increased from 68.8% to 81.3% while maintaining a specificity of 75% when using the weighted measurements. This means that more cognitively impaired subjects were detected in both patient groups. Since the sensitiviy increased it greater serves the purpose of a screen, to identify patients with cognitive impairments. The authors suggest this algorithm of weighting subtests may be applicable to patients with PD and other populations as historically some subtests of the MoCA have been too simple for non-demented patients.

Functional near-infrared spectroscopy (fNIRS) was used to record brain activation during cognitive testing in older individuals living in residential care communities. Using fNIRS, brain signals were recorded during a series of computerized cognitive tests, including a Symbol Digit Coding test (SDC), Stroop Test (ST), and Shifting Attention Test (SAT). An association between advanced age and increased activation in the right middle frontal region was observed during the incongruent ST. Although none of the participants had clinical dementia based on the short portable mental status questionnaire, the group performance was slightly below age-normed values on these cognitive tests. These results demonstrate the capability for obtaining functional neuroimaging measures in residential settings, which ultimately may aid in prognosis and care related to dementia in older adults. If families are educated to look for signs for family members that have dementia they are easily able to discuss long term planning and prevent adverse events due to impaired cognition.

No participants had cognitive impairment at preoperative baseline (Mini-Mental State Examination score >27). Differences in resting-state functional connectivity (RSFC) and global cognitive change relationships were assessed using a voxel-wise intrinsic connectivity method, controlling for demographic factors and pre- and perioperative cerebral white matter disease volume. Clinicians have long known that some older adults develop postoperative cognitive dysfunction (POCD) after anesthesia and surgery, yet the neurobiological correlates of POCD are not well defined. The current results suggest that altered RSFC in specific DMN regions is positively correlated with global cognitive change 6 weeks after cardiac surgery, suggesting that DMN activity and connectivity could be important diagnostic markers of POCD or intervention targets for potential POCD treatment efforts.

The MoCA also measures a wider range of abilities including executive functions, a higher level cognitive ability required for the implementation of goal-directed behavior and the process of creating and fulfilling a plan. For these reasons, the MoCA was chosen as the comparator assessment of cognition in this study. The cut off score for the MoCA has widely been research and inconclusive. The original cut off score was 26/30 for normal cognition, however many argue the score is too low. This study suggests a computerized battery (CBS- Cambridge Brain Sciences Battery) for patients scoring 23-26, that have a borderline cognitive impairment in order to classify them as impaired or unimpaired. Five tasks from the original 12 of the CBS were chosen to assess aspects of short-term memory, attention, reasoning, and planning. Results: Only two of the tasks were able to distinguish between impaired and unimpaired. Utilizing these tasks in conjunction with the MoCA provides more information regarding testers that fall in the "borderline" category 23-26. The older adults were accepting of the electronic technology.

The article describes the development and validation of a short form for the Brief Cognitive Assessment tool, BCAT-SF. The article compares the psychometric properties with the short form versus the original. The items represented in the short form represent cognitive domains such as contextual memory, executive functioning, and attention. As a result the BCAT-SF differentiated between mild cognitive impairment and dementia with a sensitivity of .9 and specificity of .8. It was also able to predict IADL and ADL. While the study determined subjects with a score of 16 or below are likely to have dementia it did not establish a cut off score to distinguish MCI from non impaired participants. This is the next step for the researchers in validating the BCAT-SF for a quick, 5 minute or less cognitive screen with functional measures.

Performance on MoCA subtests was compared at these MMSE cutoffs to determine profiles of early cognitive difficulties. The MoCA detected cognitive impairment not detected by the MMSE in a high proportion of participants, and this impairment was evident across various subtests. The MoCA appears to be a sensitive screening test for detection of early cognitive impairment.

This article discusses the two most used cognitive assessment tools and how they help in predicting therapy outcome measures. I did my inservice presentation on the Montreal Cognitive Assessment and the Mini-mental state exam and how the OTs at Grant can use one or the other using clinical judgement as a standardized cognitive assessment with mild TBI, stroke and other patients who present with neuro deficits. The MOCA has been proven to help in identifying mild cognitive deficits that the MMSE is unable to identify.

Cognitive impairment is under-recognized and misdiagnosed among community-dwelling older adults. At present, there is no consensus about which cognitive screening tool represents the 'gold standard.' However, one tool that shows promise is the Brief Cognitive Assessment Tool (BCAT), which was originally validated in an assisted living sample and contains a multi-level memory component (e.g. word lists and story recall items) and complex executive functions features (e.g. judgment, set-shifting, and problem-solving). 75 community dwelling adults took the assessment and the MoCA with a cut off score of <26. A cut off score for the BCAT was 45 after utilizing the results of the study to balance sensitivity and specificity at .81 and .8 respectively. In addition scores can be separated to interpret BCAT memory and executive dysfunction component scores.

The aim of this study was to explore the relationship among cognitive reserve, Executive function, and health and safety judgment among a sample of older adult inpatients of an extended medical care unit at a Veterans Health Administration (VHA) hospital. Independent Living Scales (ILS): Health and Safety subtest were used to assess judgement and safety. Executive function was measured by the Trial making test. Global function was measured by the MMSE. After controlling for global cognitive functioning, the results revealed that people with high estimated IQ performed similarly on a measure of health and safety judgment, regardless of their EF abilities. However, among individuals with low estimated IQ it appears that intact EF is critical in making appropriate health and safety decisions. Therefore, the results suggest executive functioning is critical for making appropriate health and safety decisions for patients with lower measured intellectual abilities and provide further support for the cognitive reserve model.

The aim of this study is to identify and evaluate the psychometric properties of cognitive assessments for older adults. Assessments were categorized based on length of time to assess, less than or more than 30 minutes and body function versus activity or participation. The authors reviewed evidence to determine the strength of each assessment (validity, reliability, sensitivity, specificity) and the amount of literature supporting the use of these cognitive assessments for older adults. The following assessments demonstrated the best rigor for psychometric properties for cognitive assessment with older adults: for body function(under 30 minutes): the MMSE and 3MS, for body function (over 30 minutes): the Cognistat and CASE/Pecpa, and for the activity and participation level: the AMPS.

The MoCA is a valid screening test for Mild Cognitive impairement. This study aims to establish 90% reliable change indices for the MoCA together with MMSE in cognitive healthy adults. The study demonstrated RCI for the MoCA and MMSE in a 3 year time period that can be used for the estimation of cognitive decline or improvement in clinical settings.

This link can provide a lot of relevant information on Allen's Cognitive levels. I went to it a lot when putting together my presentation for my second rotation. Being out in the field it is nice to use an assessment that comes with an entire system basically. ACL are backed up by years of research and is something we should keep in mind. I think one of my weak points is challenging cognitive patients with appropriate activities. ACL can really help close the gap to get good fit activities for your cognitively impaired patients.

The BCAT's utility for identifying dementia versus mild cognitive impairment was excellent, with a sensitivity of .99, a specificity of .77, and an area under the receiver-operatingcharacteristic (ROC) curve of .95. Executive control, contextual memory, and attentional capacity items were the best predictors of diagnostic category and of instrumental activities of daily living. From a clinical standpoint, it is recommended a BCAT cut score of 37/38 for differentiating between persons with dementia and those with MCI. This means that patients who have scores of 37 and below are likely to have dementia. This research utilized a population residing in assisted living facilities. Future studies should address a cut off for mild cognitive impairment and non-impaired and community dwelling adults.

In every scientific profession, practice is constantly evolving in response to new knowledge. However, new knowledge presents challenges for all practitioners, not only in terms of how to stay up-to-date but also in terms of how to deliver the best quality practice. Another issue with the use of brief cognitive assessments is the use of specialized assessments based on the diagnosis typically presents. All presentations are different and therefore this reduces the effectiveness of a screen and attempts to act as a tool to diagnose. There is call in Australia for brief cognitive assessment with supported validity, reliability, sensitivity and specificity to better screen and address deficits. This same call has been made by AOTA.