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.

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.

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.

The article addressed LACLS' ability to predict medication management through the use of MARS (Medication adherence Rating Scale. All participants reported that did not use medication aids despite evidence of impaired cognition. A strong, positive correlation was found between medication adherence and LACLS for participants that access mental health services in the community. This investigation has provided the first empirical evidence indicating that the LACLS may have utility as a screening instrument for capacity to manage medication adherence among this population. However, the findings are preliminary and should continue to be assessed by future studies to determine the specificity, sensitivity and cut off score for medication adherence.

The study examined two assessments, one an occupation based assessment (AMPS) and body function assessment (LACL). 30 clients who recently experienced a stroke took both assessments at home. Two groups of participants were formed, one group took the AMPS first and the other group took the LACLS first. Subjects were allowed to choose tasks that were known to them from the AMPS. Data was analyzed to assess the ability for the AMPS and LACLS to predict independence with ADLs and subsequently IADLs. The results confirmed the hypothesis of this study: a moderate positive correlation was found between the LACL and both the motor and the process scales of the AMPS, suggesting that although correlations between the tests were found, they do not fully examine the same concepts. The results also indicated moderate positive correlation between the LACL and the AMPS, yet there were discrepancies between the two tools in the determination of independence in instrumental activities of daily living (IADL). Clients who were found to be independent by one assessment were found to be dependent by the other. The authors suggest the use of these tools in conjuction with observation of ADLs and IADLs to predict independence levels. The authors also identified areas of each tool that was assessed in conjunction with predicting levels of independence with focus directed at judgement and comprehension to predict functional performance as supported by previous literature (Fong, Chan, and Au, 2001).

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.

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.

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.

Abstract in English only, continued investigation for full article in English. Summary: Results MCI is best detected with a MOCA cut off point of 24/25 (80-81% specificity and sensitivity) MCI is best detected with a MMSE cut off 27/28 (66% sensitivity and 73% specificity ) MoCA test better meets the criteria for screening tests for the detection of MCI among patients over 60 years of age than MMSE.

In the ED and some acute care settings therapy services are based off of self-report measures in interviews with physicians. Correlation analyses were conducted to examine the relationships between the self-reported and performance-based measures of functional ability. Patients reported higher functional ability than observed by using the performance-based measures. This indicates that the two methods provide different information about functional ability. Previous research demonstrates a discrepancy between self-report measures and functional measures of functional tasks ADLs, functional mobility and IADLs. It is suggested both measures are utilized to appropriate a plan of care

The results of this current research support the SMAF as a suitable assessment for use with older adults with moderate construct validity and responsiveness and a clear minimal detectable change of five, being defined. The SMAF focuses on activity limitation experienced in everyday activities, mobility, mental functions and communication. Any limitations in activities/ abilities are then considered in reference to available resources to determine if any handicap exists. Another assessment that may be suitable for use with older adults, especially as an outcome measure in community populations of older people, is the AMPS with moderate evidence for construct validity and responsiveness to change. Assessments were often found to have been modified to suit the needs of the clinical environment or to shorten the tool, but the actual modifications were poorly reported in the papers.Once the assessment is modified, the assessment can no longer be assumed to hold equivalent measurement properties to the original. The lack of information regarding the assessment tools measurement properties signals the need for further research including validation in older populations.

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.

Population-based studies have shown that subtle functional changes can precede a dementia diagnosis by 10 to 12 years. Simple models adjusted for age and education showed that older adults with higher baseline ECog total scores, reflecting greater functional limitations, were at a greater risk of developing MCI at follow-up. Results of this study are consistent with the growing body of literature that demonstrates that subjective concerns regarding functional changes can be associated with biological markers of Alzheimer's disease and related disorders, including greater amyloid burden greater brain atrophy, and greater risk of incident dementia. Deficits in everyday memory and executive function domains were the strongest predictors of diagnostic conversion to MCI.

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.

Current objective IADL assessments are lengthy and expensive, limiting their use in clinical and research settings. Medication and finance management are key IADL domains shown to be sensitive to dementia and critical to maintaining independent living. This article investigated the of use of a screening tool BEAM, brief everyday activities measure to assess IADLs like money management and medication management. As predicted, lower accuracy and longer time to complete the BEAM were both associated with worse executive functions, attention, and processing speed. The article concluded that the BEAM is an accurate screening tool that can be administered in a brief (less than 15 minutes) with limited supplies supporting its use in the clinical setting.

An article in health promotion international sought to determine the effects of various interventions to promote mental health and decrease depressive symptoms in older adults. There were a total of 44 trials were utilized for a meta-analysis to determine effectiveness. The article concludes social activities were statistically significant at improving mental health compared to physical activity, skill training, and reminiscence. The article's most important conclusion states that a longer duration of intervention may increase the effectiveness to reduce depressive symptoms and increase quality of life. The results demonstrated statistically significant improvement for all intervention lasting longer than 3 months.

https://academic.oup.com/heapro/article/26/suppl_1/i85/687327/Psychosocial-interventions-for-the-promotion-of

As OT's we will be required to work with numerous team members for a collective and collaborative interdisciplinary team. This research utilized interviews in addition to a systematic review. Ten characteristics underpinning effective interdisciplinary team work were identified: positive leadership and management attributes; communication strategies and structures; personal rewards, training and development; appropriate resources and procedures; appropriate skill mix; supportive team climate; individual characteristics that support interdisciplinary team work; clarity of vision; quality and outcomes of care; and respecting and understanding roles. As occupational therapists our roles overlap with other professions and the role of the OT department may vary from each setting. It is essential these skills are developed in order for OT's to meaningfully contribute to patient care.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662612/

To aim of this study was to determine the cost-effective and clinically effective nature of an OT and PT program for adults with mild to moderate Parkinson's Disease (PD). Participants with limitations in ADLs were randomized between PT, OT and no therapy. The evaluative measures were the Nottingham Extended Activities of Daily Living Scale, Parkinson Disease Questionnaire, and the EuroQol-5D. Of the 762 participants there were small differences in favor of therapy with the PD Questionaire and the EuroQuol-5D, however the median treatment time was 4 visits of 58 minutes over 8 weeks. Therefore, it is not cost effective to prescribe a low-dose therapy regime for this population. As an OT practitioner informed of studies such as these it is important to assess when it is the proper time to begin and terminate services for a patient. Does the research support your intervention or treatment and to what degree?

file:///Users/jenniferburwell/Downloads/noi150094.pdf