Cognitive assessment: A challenge for occupational therapists in Brazil

Conti, Juliana

doi:10.1590/1980-57642016dn11-020004

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 11 (2) • Apr-Jun 2017 • https://doi.org/10.1590/1980-57642016dn11-020004 copy

Cognitive assessment: A challenge for occupational therapists in Brazil

AVALIAÇÃO COGNITIVA: UM DESAFIO PARA OS TERAPEUTAS OCUPACIONAIS NO BRASIL

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Cognitive impairment is a common dysfunction after neurological injury. Cognitive assessment tools can help the therapist understand how impairments are affecting functional status and quality of life.

Objective:

The aim of the study was to identify instruments for cognitive assessment that Occupational Therapists (OT) can use in clinical practice.

Methods:

The instruments published in English and Portuguese between 1999 and 2016 were systematically reviewed.

Results:

The search identified 17 specific instruments for OT not validated in Brazilian Portuguese, 10 non-specific instruments for OT not validated in Brazilian Portuguese, and 25 instruments validated for Portuguese, only one of which was specific for OT (Lowenstein Occupational Therapy Cognitive Assessment).

Conclusion:

There are few assessment cognitive tools validated for use in the Brazilian culture and language. The majority of the instruments appear not to be validated for use by OT in clinical practice.

Key words:
cognitive impairment; occupational therapy; assessment; cognitive assessment

Tool	Categories	Administration time (approximate)
Arnadottir OT-ADL Neurobehavioural Evaluation (A-ONE).³⁰30 Poulin V, Korner-Bitenski N, Dawson DR. Stroke-specific executive function assessment: a literature review of performance-based tools. Aus J Occup Ther. 2013;60:3-19. Divided in two sub-scales	Therapist observes the neurobehavioral of the person performing the Activities of Daily Living	25 minutes
Assessment of Motor and Process Skills³¹31 Árnadóttir G. The Árnadóttir OT-ADL Neurobehavioral Evaluation (A-ONE): Concurrent validity. Paper presented at the IVth European Congress of Ergotherapy, Ostend, Belgium; 1992.	Therapist observes motor and process skills during the performance of ADLExecutive function	Depends on patient's ability and on task chosen.
Activity of Daily Living Profile³²32 Fisher AG, and Bray Jones K. Assessment of motor and process skills. Vol. 1: Development, standardization, and administration manual (seventh ed.). Fort Collins, CO: Three Star Press: 2010. http://www.ampsintl.com/AMPS/documents/Vol%201%207th%20Ed.%20Chapters%201-4.pdfAccess in 04/10/2015 http://www.ampsintl.com/AMPS/documents/V...	Performance on Activities of Daily Living and Instrumental Activities of Daily LivingAssess the executive dysfunctions to perform these tasks	More than one therapy session. Depends on patient's ability.
Chessington OT Neurological Assessment Battery (COTNAB)³³33 Mandy Stanley M, Buttfield J, Bowden S, Williams C. Chessington Occupational Therapy Neurological Assessment Battery: Comparison of performance of people aged 50-65 years with people aged 66 years and over. Aust Occup Ther J. 1995;42(2):55-65.^,³⁴34 Tyerman R, Tyerman A, Howard P, Hadfield C. The Chessington Occupational Therapy Neurological Assessment Battery: introductory manual; 1986.	Visual functions, ability to follow instructions, sensory motor ability, constructional ability	More than 60 minutes.
Cognitive Assessment of Minnesota (CAM)¹⁷17 Baum CM, Connor LT, Morrison T, Hahn M, Dromerick AW, Edwards DF. Reliability, validity, and clinical utility of the Executive Function Performance Test: a measure of executive function in a sample of people with stroke. Am J Occup Ther. 2008;62 (4):446-455.	Memory, attention, orientation, simple math skills, simple money skills, executive function, visuospatial, skills	40 minutes
Cognitive Competency Test (CCT)³⁵35 Wang P, Ennis K, Copland S. Cognitive Competency Test manual. Mount Sinai Hospital, Toronto, ON; 1992.	Cognitive skills to perform Activities of Daily Living	30-40 minutes
Cognitive Performance Test³⁶36 Burns T, Mortimer JA, Merchak P. Cognitive Performance Test: a new approach to functional assessment in Alzheimer's disease. J Geriatr Psychiatry Neurol. 1994;7(1):46-54.	Level of cuing and demonstration required	60 minutes
Contextual Memory Test³⁷37 Toglia JP. Contextual Memory Test. San Antonio, TX: Therapy Skill Builders;1993. https://health.utah.edu/occupational-recreational-therapies/docs/evaluations-reviews/cmt.pdfAccess in 04/10/2015 https://health.utah.edu/occupational-rec...	Memory	10-20 minutes
Executive Function Performance Test¹⁸18 Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98.	Executive Functions	40 minutes
Execution of a Cooking Task³⁸38 Chevignard M, Pillon B, Pradat-Diehl P, Taillefer C, Rousseau S, Le Bras C, et al. An ecological approach to planning dysfunction: script execution. Cortex. 2000;36:649-69.	Prepare two recipes: baking a cake and making an omeletAssess the executive dysfunctions to perform these tasks	60 minutes
Independent Living Scales (ILS)³⁸38 Chevignard M, Pillon B, Pradat-Diehl P, Taillefer C, Rousseau S, Le Bras C, et al. An ecological approach to planning dysfunction: script execution. Cortex. 2000;36:649-69.	Memory, orientation, simple money skills, managing home and transportation	45 minutes
Kitchen Task Assessment (part of EFPT)³⁹39 Loeb PA. Independent Living Scales Manual. San Antonio, TX: The Psychological Corporation; 1996.	Executive Functions	20-40 minutes
Ontario Society of Occupational Therapist Perceptual Assessment⁴⁰40 Baum C, Edwards DF. Cognitive Performance in Senile Dementia of the Alzheimer's Type: The Kitchen Task Assessment. Am J Occup Ther 1993;47(5):431-6.	Sensation, gnosis, praxis, scanning, body awareness, spatial relation	50-60 minutes
Rivermead Perceptual Assessment Battery (RPAB)¹⁶16 Rustad RA, DeGroot TL, Jungkunz ML, Freeberg KS, Borowick LG, Wanttie AM. The Cognitive Assessment of Minnesota. Therapy Skill Builders: San Antonio, TX. 1993.	Picture matching, object matching, size recognition, missing article,sequencing-pictures, right/left copying words, color matching, right/left copying shapes, figure-ground, animal halves, body-image	50-60 minutes
The Complex Task Performance Assessment⁴¹41 Boys M, Fisher P, Holzberg C, Reid DW. The OSOT Perceptual Evaluation: a research perspective. Am J Occup Ther. 1988; 42(2):92-8.	Executive Functions	30-40 minutes
The Naturalistic Action Test (NAT)⁴²42 Wolf TJ, Morrison T, Matheson L. Initial development of a work-related assessment of dysexecutive syndrome: The Complex Task Performance Assessment. Work 2008;31(2):221-8.	Assess errors during execution of daily routine activitiesExecutive Functions	45-90 minutes
Virtual Action Planning Supermarket (VAP-S)¹⁹19 Josman N, Kizony R, Hof E, Goldenberg K, Weiss PL, Klinger E. Using the virtual action planning-supermarket for evaluating executive functions in people with stroke. J Stroke Cereb Dis. 2014;23(5):879-887.	Simulates real supermarketExecutive Functions	Depends on patient's ability

Tool	Categories	Administration time (approximate)
The Behavioral Inattention Test (BIT)⁴³43 Schwartz MF, Segal M, Veramonti T, Ferraro M, Buxbaum JL. The Naturalistic Action Test: A standardized assessment for everyday action impairment. Neuropsychol Rehab. 2002;12(4):311-39.	Unilateral neglect in everyday tasks	40 minutes
Cognitive Abilities Screening Instrument (CASI)⁴⁴44 Wilson HA, Cockhurn J, Halligan PW. Behavioural Inattention Test Manual. Fareham. Hants. England. Thames Valley Test Co. and Los Angeles. Western Psychological Services; 1987.	Attention, concentration, memory, language, visual skills, abstraction and judgment	15-20 minutes
Middlesex Elderly Assessment of Mental State (MEAMS)⁴⁵45 Teng EL, Hasegawa K, Homma A, Imai Y, Larson E, Graves A, et al. The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr. 1994; 6:45-58.	Orientation, new learning, memory, language, simple math's skills, visuo-spatial skills, perception and motor perseveration	10 minutes
Motor Free Visual Perceptual Test (MVPT) Version 1 or 3⁴⁶46 Shiel A and Wilson BA. Performance of stroke patients on the Middlesex Elderly Assessment of Mental State. Clin Rehabil. 1992. 6 (4).^,⁴⁷47 Colarusso RP, Hammill DD. Motor-free visual perception test. Novato CA: Academic Therapy Publications; 1972.	Discrimination, figure-ground, visual memory, visuospatial functions, visual closure	20-30 minutes
Severe Impairment Battery (SIB)⁴⁹49 Saxton J, Kastango KB, Hugonot-Diener L, Boller F, Verny M, Sarles CE, et al. Development of a short form of the Severe Impairment Battery. Am J Geriatr Psychiatry. 2005;13(11):999-1005.	Memory, language, orientation, visuospatial, praxis, social interaction	20-30 minutes
Test of Everyday Attention (TEA)⁵⁰50 Robertson IH, Ward T, Ridgeway V, and Nimmo-Smith I. The structure of normal human attention: The Test of Everyday Attention. J Int Neuropsychol Soc. 1996;2 (6):525-34.	Attention, executive function, visuospatial functions, auditory and visual demands	45-60 minutes
Note: For OT it is necessary to obtain a Thames Valley Test Company endorsed license during one-day course²⁹29 Thames Valley Test Company. Catalogue. 2004. http://www.blessing-cathay.com/sub/ps/pdf/S1-TVTC%20with%20price.pdfAccess in 04/10/2015. http://www.blessing-cathay.com/sub/ps/pd...
The Multiple Errands Test (MET)⁵⁰50 Robertson IH, Ward T, Ridgeway V, and Nimmo-Smith I. The structure of normal human attention: The Test of Everyday Attention. J Int Neuropsychol Soc. 1996;2 (6):525-34.	Executive Functions	40 minutes
Wessex Head Injury Matrix (WHIM)⁵¹51 Shiel A, Horn SA, Wilson BA, Watson MJ, Campbell MJ, McLellan DL. The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury. Clin Rehabil. 2000;(14):408-16.	Assess and monitor recovery of cognitive function after severe head injury	10-15 minutes
Westmead Post Traumatic Amnesia Scale²⁷27 Engelhardt E, Tocquer C, André C, Moreira DM, and Okamoto IH, Sá Cavalcanti JL. Demência vascular. Critérios diagnósticos e exames complementares. Dement Neuropsychol. 2001;5(Suppl 1):49-77.	Orientation, memory, ability to learn, language, attention	10-15 minutes
Virtual Multiple Errands test⁵²52 Rand D, Rukan SBA, Weiss PL, Katz N. Validation of the Virtual MET as an assessment tool for executive functions. Neuropsychol Rehabil. 2009;19(4):583-602.	Executive Functions	Depends on patient's ability

Tool	Categories	Administration time (approximate)
Addenbrooke's Cognitive Examination⁵⁶56 Carvalho VA and Caramelli P. Brazilian adaptation of the Addenbrooke's cognitive examination-revised (ACE-R). Dement Neuropsychol. 2014;8(1):20-5.	Memory, orientation, language, praxis, following commands	15-20 minutes
Alzheimer's Disease Assessment Scale⁵⁷57 Bertolucci PHF, Nitrini R. Proposta de uma versão brasileira para a escala ADCS-CGIC. Arq Neuropsiquiatr. 2003;61(3B):881-90.	The test is divided into two parts: cognitive assessment (memory, language, praxis and understanding commands) behavior assessment	30-45 minutes
Benton Visual Recognition Test⁵⁸58 Zanini AM, Wagner GP, Zortea M, Segabinazi JD, Salles JF, Bandeira DR, et al. Evidence of criterion validity for the Benton Visual Retention Test: comparison between older adults with and without a possible diagnosis of Alzheimer's disease. Psychol Neurosci. 2014;7(2):131-8.	Evaluates visual memory and visual perception	10-20 minutes
Brief Cognitive Screening Battery⁵⁹59 Mathuranath PS, Nestor PJ, Berrios GE, Rakowicz W, and Hodges JR. A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia. Neurology. 2000;55(11):1613-20.	Memory, attention, executive function, visuospatial function, language, simple math ´s skills	30-40 minutes
Cambridge Cognitive Examination-Revised (CAMCOG-R)⁶⁰60 Paradela EMP; Lopes CS, Lourenço RA. Adaptação para o português do Cambridge Cognitive Examination-Revised aplicado em um ambulatório público de geriatria. Cad Saúde Pública. 2009;25(12):2562-70.	Brief cognitive assessment for elderly with cognitive impairment The functions evaluated are memory, language, attention, perception, praxis and thinking	20 minutes
Cancellation task⁶¹61 Brucki SMD, Nitrini R. Cancellation task in very low educated people. Arch Clin Neuropsychol. 2008;23:139-47.^,⁶²62 Montiel JM, Capovilla AGS. Teste de Atenção por Cancelamento. Em Capovilla, AGS. and Capovilla, F.C. (Orgs.) Teoria e pesquisa em avaliação neuropsicológica São Paulo: Memnon; 2007:119-24	Visuospatial function, sustained and selective attention, psychomotor speed, visual searching and motor coordination	10-15 minutes
Clock Drawing Test⁶³63 Sunderiand T, Hill JL, Mellow AM, Lawlor BA, Gundersheimer J, Newhouse PA, et al. Clock drawing in Alzheimer's disease. A novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-9.	Visuospatial, attention and executive functions	5 minutes
Cognitive Abilities Screening Instrument - Short Form⁶⁴64 Rezende GP, Cecato J, and Martinelli JE. Cognitive Abilities Screening: Instrument-Short Form, Mini-Mental State Examination and Functional Activities Questionnaire in the illiterate elderly. Dement Neuropsychol. 2013;7(4):410-5.	Evaluates verbal fluency, orientation and recall	30 minutes
Digit Span⁶⁵65 Cunha JA. As Escalas Wechsler. Em J. A. Cunha (Org.), Psicodiagnóstico-R. Porto Alegre: Artes Médicas;1993:278-354.	This test evaluates working memory	10-15 minutes
Direct Assessment of Functional Status- revised (DAFS-R)⁶⁶66 Pereira FS, Oliveira AM, Diniz BS, Forlenza OV, and Yassuda MS. Cross-cultural adaptation, reliability and validity of the DAFS-R in a sample of Brazilian older adults. Arch Clin Neuropsychol. 2010;25(4):335-43.	Orientation, Communication, simple money skills, memory and ADL and IADL	30-40 minutes
Executive Interview (EXIT 25)⁶⁷67 Matioli NMPS, Caramelli P, Marques BD, Rocha FD, Castro MCC, Yamashita SR, et al. EXIT25 - Executive interview applied to a cognitively healthy elderly population with heterogeneous educational background. Dement Neuropsychol. 2008;2(4):305-9.	Executive function and behavior	10 minutes
Frontal Assessment Battery (FAB)⁶⁸68 Beato R, Carvalho VA, Guimarães HC, Tumas V, Souza CP, Oliveira GN, et al. Frontal assessment battery in a Brazilian sample of healthy controls: normative data. Arq Neuropsiquiatr. 2012;70(4):278-80.	Executive function	30-40 minutes
Fuld Object Memory Evaluation⁶⁹69 Avila R, Lopes MA, Nakano EY, and Bottino CMC. Normative data of Fuld Object Memory Evaluation test for brazilian elderly population. Arq Neuropsiquiatr. 2016;74(2):138-44.	Evaluates learning and memory in elderly	30 minutes
Functional Assessment Measure (FAM)¹¹11 Jorge LL, Marchi FG, Hara ACP, Battistella LR. Brazilian version of the Functional Assessment Measure: cross-cultural adaptation and reliability evaluation. Int J Rehab Res. 2011;34(1):89-91.^,⁷⁰70 Turner-Stokes L, Nyein, K, Turner-Stokes T, and Gatehouse C. The UK FIM+FAM: development and evaluation. Clin Rehabil. 1999;13:277-87.	Must be used in conjunction with the FIMBehavioral, orientation, emotional status, communication, swallowing and community ability	20 minutes
Functional Independence Measure (FIM)⁷⁰70 Turner-Stokes L, Nyein, K, Turner-Stokes T, and Gatehouse C. The UK FIM+FAM: development and evaluation. Clin Rehabil. 1999;13:277-87.	Memory, social interaction, functional status	20-30 minutes
Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)⁷¹71 Sanchez MAS, Lourenço RA. Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): adaptação transcultural para uso no Brasil. Cad Saúde Pública. 2009;25(7):1455-65.	This is a short questionnaire to assess cognitive decline in elderly	30 minutes
Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)¹³13 Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto I. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr. 2003;61(3B):777-81.	Orientation, perception, visuo-motor and thinking operations	30-90 minutes
Mini-Mental State Exam (MMSE)¹⁷17 Baum CM, Connor LT, Morrison T, Hahn M, Dromerick AW, Edwards DF. Reliability, validity, and clinical utility of the Executive Function Performance Test: a measure of executive function in a sample of people with stroke. Am J Occup Ther. 2008;62 (4):446-455.	Memory, orientation, language, praxis, following commands	10-15 minutes
Short Cognitive Performance Test⁷²72 Flaks MK, Forlenza OV, Pereira FS, Viola LF, and Yassuda MS. Short Cognitive Performance Test: Diagnostic Accuracy and Education Bias in Older Brazilian Adults. Arch Clin Neuropsychol. 2009;24(3):301-6.	Cognitive screening to detect memory and attention impairment	30 minutes
SIDAM Portuguese Version⁷³73 Ventura MM, Bottino CMC. Estudo de confiabilidade da versão em português de uma entrevista para o diagnóstico de Demência. Rev Ass Med Brasil 2001;47(2):110-6.	This test is divided into 4 parts: clinical history, cognition, personality and behavior and dementia etiology	30 minutes
Spatial Delayed Recognition Span Task⁷⁴74 Satler C, Belham FS, Garcia A, Tomaz C, Tavares MC. Computerized spatial delayed recognition span task: a specific tool to assess visuospatial working memory. Front Aging Neurosci. 2015;24:7:53.	This is a computerized test that evaluates visuo-spatial working memory	20-30 minutes
The Montreal Cognitive Assessment (MoCA)¹²12 Sarmento ALR. Apresentação e aplicabilidade da versão brasileira da MoCA (Montreal Cognitive Assessment) para rastreio de Comprometimento Cognitivo Leve [MD] (Presentation and applicability of the Brazilian version of the MoCA for MCI screening). Dissertação de mestrado. Escola Paulista de Medicina da Universidade Federal de São Paulo: São Paulo. 2009.^,⁷⁵75 Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53:695-9.	Language, memory, praxis, attention, orientation, executive function, abstraction and visuospatial	15-20 minutes
Token Test⁷⁶76 Moreira L, Schlottfeldt CG, Paula JJ, Daniel MT, Paiva A, Cazita V, et al. Normative study of the Token Test (short version): preliminary data for a sample of Brazilian seniors. Rev Psiq Clín. 2011;38(3):97-101.	Language is the main cognitive function evaluated in this test	20-30 minutes
Verbal Fluency⁷⁷77 Passos VMA, Giatti L, Barreto SM, Figueiredo RC, Caramelli P, Benseñor I, et al. Verbal fluency tests reliability in a Brazilian multicentric study, ELSA-Brasil. Arq Neuropsiquiatr 2011;69(5):814-6.	Language and executive functions	5 minutes
Visual Object and Space Perception Battery- VOSP⁷⁸78 Warrington EK and James M. The Visual Object and Space Perception Battery. Thames Valley Test, Bury St. Edmunds (UK); 1991. http://www.pearsonclinical.co.uk/Psychology/AdultCognitionNeuropsychologyandLanguage/AdultPerceptionandVisuomotorAbilities/VisualObjectandSpacePerceptionBattery(VOSP)/VisualObjectandSpacePerceptionBattery(VOSP).aspxAccess in 04/10/2015. http://www.pearsonclinical.co.uk/Psychol...	Visuo-perceptual and visuo-spatial functions	30 minutes

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E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Juliana Conti. Occupational Therapy Division Hospital das Clínicas/Sao Paulo University – R. Dr. Ovídio Pires de Campos, 186 – 05403-010 São Paulo SP – Brazil. E-mail: juconti@yahoo.com.br