Intro to Cognitive Assessments: Part 1

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.

Choosing an Assessment

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.

"Quick" Assessments or Screeners

Mini Mental State Exam (MMSE)- I appreciate many of the basic components of the Mini Mental however I find that it misses many other aspects and is, as was meant to be, a basic screener. Research has shown that in comparison to the MoCA it is not as sensitive to mild cognitive deficits. Mild cognitive deficits may not be as significant to a long term patient, but make a huge difference to someone returning home.

Montreal Cognitive Assessment (MoCA)- This quick assessment provides information on many specific areas of cognition. Some of which, such as picture naming, are not assessed by the Mini Mental or the SLUMS. In addition the way in which it tests short term memory provides additional information into the persons memory skill. However it too lacks in regards to some language aspects. 

Saint Luis University Mental State (SLUMS)- This quick assessment provides many specific areas of cognition that are not covered by the mini mental. I do appreciate the following directions and the story recall portions which are not present on the Mini Mental or MoCA. It however doesn't touch on some of the major features seen in the MoCA.

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.

In Part 2

"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)

In Part 3

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

Please comment your agreements, disagreements and any other thoughts or questions below. 

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