A recent post on a speech therapy related Facebook group asked for advice regarding selection of assessment tools and creation of goals for cognitive development in the elderly/SNF setting especially with those who have dementia.

Cognitve Assessment in itself is a very large topic so I, in an effort to help, will address it in three parts: 1) Intro & "Quick" Cognitive Assessments; 2) "Full" Cognitive Assessments; 3) Considerations for dementia: Verbal & Non-verball assessment. If you have not already, please read my first post on Cognitive Rehabilitation. Hopefully the initial information will be enough to get anyone off to a good start and wanting more.

Depending on the functioning level of the patient, their areas of stimulability and the sort of targets you would like to create for them, your assessment type/method will vary. For example if you are targeting specific cognitive skills verses overall functional tasks you will want different information. In addition if the patient is extremely hard of hearing or in a later stage of dementia an assessment requiring good understanding/use of language is not ideal. Finally we must also consider completing a timely assessment. Especially with the new speech evaluation CPT codes put into effect January 1, 2014. Thus Part 1 starts by looking at the common "Quick" assessments and some basic considerations.

There could be some debate as to whether the above tools can be used as assessments or if they are simply screeners. They do however provide a score and a range of normal to assess a persons performance and as a whole are utilized across the speech therapy profession. 

I personally have combined the top elements from all three "quick assessments" to create a more comprehensive tool that resembles the Cognitive Linguistic Quick test, my personal favorite standardized cognitive assessment. This, of course, has not been compared against the other screening tools or standardized assessments so does not have a standardized score of it's own. It does however obtain a MoCA score and provide a much more complete view of the residents abilities.

"Full" Cognitive Assessments
-Cognitive-Linguistic Quick Test (CLQT)
-Functional Linguistic Communication Inventory (FLCI)
-Arizona Battery of Communication Disorders of Dementia (ABCD)
-Ross Information processing Assessment (RIPA-G)
-Allen Cognitive Levels (ACL)

Considerations for individuals for individuals with dementia. 
-"What we CAN'T do will never determine our success as long as what we CAN do always guides our goals."
-Verbal & non-verbal assessment
-Non standardized assessment

Cognitive evaluation and treatment, as a field, is highly lacking. This is especially true for the population with dementia. This is predominantly due to the fact that it has only been recently that we have discovered that cognitive degeneration can be slowed and cognitive aspects such as IQ are not actually set in stone as we once thought. This significantly changes things not only for those working with cognitive rehabilitation, but also in the school systems. 

IQ is frequently used as THE reference point when determining eligibility for services in schools. If we now know that IQ can be increased, then where does that leave our use of it as a reference point? We can no longer base our "expected language abilities" on a number range that we now know we can increase. Even greater what are the implications for cognitive HABILITATION of youth where before we only targeted REhabilitation of a damage brain? This is just another avenue of exploration for the speech-language pathologist which I have no doubt will creep into my writings on cognition as I go along.

As I'm sure you're all aware, what we as professionals know most is how much we DON'T know about the brain and how to mend it. I know I personally have felt very lost and confused in regards to what I am actually assessing and what the results of these cogntive-linguistic assessments really mean for my treatment. Many times I take maximal approach to cognitive treatment because that's the only way to get to what ever else might be wrong. 

There is a fundamental lack of knowledge in this area that is just starting to be filled in. This being said, it seems odd to me that there are a number of cognitive-linguistic materials available. Worksheets to do, things to memorize and minimal to no direction to using them. What's more is that the number of materials seems even more odd compared to the minimal number of assessments which in turn have little, if any, instruction or correlation to treatment. This occurs in a time when we are finding cognitive re/habilitation has great potential AND when payer sources and tightening down on billable services. These factors contribute the overwhelming need for greater dialogue and research about the field.

Thus with lack of information and the necessity to provide the highest quality service to those serviced by Innovative Therapy Solutions I personally have turned a large portion of my professional focus towards behavior, cognition, habilitation, rehabilitation and learning. It is my hope this pursuit and interest will prove useful to you along the way.