Chapter 8 Evaluating Cognition

Hierarchy of Cognitive Processing

1) Self awareness and insight 2) Executive functions, reasoning, concept formation, and problem solving 3) Foundational Cognitive Processes (Arousal, Orientation, Attention, Memory)

1st step in evaluating cognition

Administration of a screening measure to broadly assess mental functions that underscore a client's cognitive performance

Mental functions

Higher-level cognitive (executive function - judgment, concept formation, metacognition, cognitive flexibility, insight), attention (awareness, sustained, selective, & divided), memory (short-term, long-term, & working), perception (discrimination of sensations, multisensory processing, sensory memory, spatial, & temporal relationships), thought (recognition, categorization, generalization, awareness of reality, logical/coherent thought, & appropriate thought content), mental functions of sequencing complex movement (execution of learned movement patterns), emotional (coping and behavioral regulation), experience of self and time (body image, self-concept, self-esteem)

Higher-order cognitive function

Individuals with problems in what exhibit impaired judgment, impulsivity, and lack self-awareness

attention

Most basic relies on the integrity of what

top-down approach

The OT observes a client to determine the difficulties he/she is experiencing in their occupations & use standardized assessments to discern the nature of a client's occupational performance difficulties. The OT hypothesizes that the client's difficulties are related to cognitive dysfunction & decide that it is necessary to assess specific mental functions.

Self-awareness

a component of metacognition; the conscious knowledge of one's cognitive processes and practice of thinking about one's thinking

Focused attention

a person's ability to attend briefly and respond to stimuli; the most basic for attention; the earliest to recover following a neurological insult (i.e., TBI)

Cognitive performance skills (OTPF)

are described as "actions or behaviors a client uses to plan and manage the performance of an activity."

Episodic memory

autographical memory of information about contextually specific personal events that a person has experienced; a simple occurrence during the day, descriptions of tasks from home or work, or an event that has occurred

Mental functions

cognitive performance skills are underscored by client factors (affective, cognitive, and perceptual components)

Self-awareness

cognitive processes that are used to monitor quality of performance and lead to self-correction of errors and self-regulating behaviors

attention

complex neurological function involving interactions among the prefrontal cortex, ventral brain stem, temporal lobe, and posterior cortex; used interchangeably with vigilance, alertness, & effort

Global mental functions

consciousness (level of arousal, level of consciousness), orientation (to person, place, time, self, & others), temperament and personality (emotional stability), energy and drive (motivation, impulse control, and appetite)

Prospective memory

denotes the recall required to carry out future activities such as keeping appointments and taking medication

Semantic memory

describes a person's knowledge of basic facts, rules for language (including linguistic skills), and world knowledge.

The Blessing Rating Scale

designed for individuals with dementia, older screen of cognitive function

Montreal Cognitive Assessment (MoCA) and St. Louis Mental Status Exam (SLUMS)

designed to screen for mild cognitive impairment, including cognitive changes in function in the early stage of dementia

Working memory

dynamic memory; involves the manipulation of information for short-term shortage is vital to everyday functioning; encoded "chunks of meaningful information"

Evaluation of self-awareness

explains a lack of responsiveness to feedback, poor insight, problems with initiating tasks, planning, and an inability to self-monitor or regulate behavior and emotions

Declarative memory

explicit memory; semantic and episodic memory; defines the retrieval of learned information, including both events and facts; encompasses the memory of specific events, time, and place

working memory

integral in storing selected information and is important in the process of attention

Executive cognitive processes

involve initiating goal-directed behavior, problem-solving, decision making, complex cognitive manipulations and sequence of actions, and generating strategies to test hypotheses

Cognition

is the global term used to refer to mental processes that involve acquiring information, using acquired and existing knowledge to reason, problem-solve, and plan goal-directed purposeful actions

Short-term memory

limited sensory information that is encoded and stored, information recently used in cognitive processes, & can be information recently recalled from long-term memory

Intact attention

means a person can attend to both the salient cues and stimuli in the environment and his/her internal thoughts that are also relevant to his/her current occupational performance

Mini-Mental State Examination (MMSE)

most commonly used cognitive screening measure regarded as the gold standard of cognitive screens (identified moderate to severe dementia)

Divided attention

multitasking; managing multiple simultaneous stimuli/tasks at the same time; a person attends to more than one task at the same time; most sophisticated cognitive process in the hierarchy of attention

Long-term memory

permanent (long-term) storage of information, infinite; declarative, episodic, nondeclarative

Attention

refers to the cognitive process when an individual selectively focuses or concentrates on one aspect of the environment or stimuli, while being able to ignore other stimuli or aspects of the environment.

bottom-up approach (basic memory and attention to higher executive function (judgment & problem solving))

restorative and remedial approaches to interventions associated with impaired cognitive performance

Concentration

the ability to focus on a task that requires higher-level cognitive skills involving encoding information in one's working memory

Selective attention

the ability to manage competing stimuli and focus on the most salient information for the task; a person needs to focus and select relevant information, while ignoring other irrelevant or distracting information

Alternating attention

the ability to shift attention back and forth among various stimuli; a person can move between cognitive demands/tasks

Cognitive impairments

the different levels of what have been considered clinically significant, and the need to discern the nature, severity, and progression of cognitive impairments is viewed as important

Arousal

the most fundamental mental process (level of cognition) and a precursor to attention; refers to a person's alertness and responsiveness to environmental sensory stimuli; measures used to evaluate altered levels of consciousness are the Rancho Levels of Cognitive Functioning and the Glasgow Coma Scale

Test of Everyday Attention

the most value in measures of attention that have ecological validity (better predict occupational performance in everyday activities)

Nondeclarative memory

the process of knowing how to perform a skill or task that has been previously acquired, as well as the memory used when learning new skills; implicit memory (the information stored that is not consciously recalled but used to perform tasks that are habitual)

Cognitive Performance Test or Executive Function Performance Test

top-down approach to cognition use occupation based tests to evaluate cognitive performance skills and high-level mental functions (executive functions)

Sustained attention

vigilance; the capacity to attend over time to a task measured by the length of time that a person spends on task; involves holding and manipulating information in the working memory