Cognitive Assessment in Occupational Therapy

Occupational therapist performs a cognitive exam using a tablet. Photographer/Getty Images

Cognitive assessment can be the most emotional part of an occupational therapy evaluation. More so than testing strength and joint movement, looking into cognition hits us closer to our core identity.

Many of the conditions that occupational therapists work with on a regular basis, including multiple sclerosis, stroke, Parkinson’s, traumatic brain injuries and acute infections, can impact the ability to process, store, and retrieve information.

This makes cognitive assessment a critical part of occupational therapy evaluations.

This article gives you an overview of what to expect from the cognitive assessment process and hopefully empowers you to make the most of this portion of occupational therapy.

Why Assess Cognition?

Occupational therapists assist clients in participating in daily activities when the ability to do so is compromised. The first step in the occupational therapy process is an evaluation, and this almost always includes assessment of cognition. Below are several reasons occupational therapists include this type of assessment in their evaluation.

Assess the client’s ability to participate in occupational therapy

One of the most basic components of occupational therapy assessment is whether the client will benefit from occupational therapy treatment and what type of treatment would be beneficial.

Client participation is key to many types of occupational therapy treatment.

If a patient is disoriented or has difficulty learning new things, there are some types of treatment they would not benefit from.

Provide a baseline for cognitive interventions

Cognition is under an occupational therapist’s scope of practice to address in treatment. This type of treatment is known as cognitive rehabilitation.

Initial assessment of cognition provides a baseline to help track whether cognitive rehabilitation treatments are successful.

Inform how instruction should be structured

Occupational therapists are educated in different ways to give feedback and reinforce new learning. Understanding what cognitive level the client is at helps them know how to structure their client education so that it will have the most impact.

Begin planning for discharge

Planning for discharge from occupational therapy begins from day one and often involves anticipating how much assistance the client will need with daily activities. Understanding the client’s ability to make safe decisions about their self-care is a key to determining how much assistance they will need.

What Components of Cognition Are Typically Assessed?

Depending on the client’s unique situation, the cognitive assessment may range from a simple screen of basic brain functions to an in-depth analysis of more complex processes. Here are some of the components of cognition that your therapist may look at:


Orientation is whether the patient is aware of who they are, where they are, what circumstance they are there under, and a general sense of time. Orientation is typically one of the first baselines established.


Attention is the ability to focus on and process select information in your environment. There are different types of attention that may be assessed including selective attention, sustained attention, divided attention. Here is an overview of the brain functions involved in attention.


Memory is the complex task of encoding, storing, and retrieving information. Memory assessment is typically roughly divided into short term and long term memory.

Executive Functions

Executive functions are the medical industry’s shorthand for describing the complex mental tasks of planning, problem-solving, self-monitoring, self-awareness. These are important for occupational therapists to assess, as they are necessary to performing everyday tasks.

Types of Assessments

Occupational therapists use two basic categories of cognitive assessments: standardized and informal/nonstandardized. Each has merit when properly employed. A therapist may use a combination of both of these types of assessment, for example, informal assessments are often used as a screen and standardized assessments to further explore a suspected area of impairment.

Standardized Assessments

Standardized assessments have set protocols for how they are administered. This makes it possible to study how valid they are at assessing cognition. The results are typically easier to communicate to a health team as they have a set terminology that team members are familiar with.

Historically, many of the standardized assessments have been pencil and paper based, but the trend is toward performance-based assessment as these may be more representative of the difficulties that the client may be having. 

The downside of standardized assessments is that they can be cumbersome to perform and in some cases may give too much data. For example, it would be an unethical use of a therapist’s time to perform an in-depth assessment of divided attention on every patient in a hospital setting.

Informal Assessments

Non-standardized assessments rely on therapist observation and assessment. These have the downside of being subjective, and unable to be studied for their accuracy. However, they can play a useful role in the assessment process.

These assessments can often be done quickly. For example, they may be as simple as asking a client if they know the date or observing whether they know how to sequence a task. For many therapists, this makes for a handy screening tool and may provide indicators of whether a more in-depth standardized screen is merited. These can also be useful when the patient may be unable to perform or tolerate standardized assessments.

Common Cognitive Assessments

Within the category of standardized assessments is a large array of options, each developed with a specific purpose in mind, for example, to a provide a quick screen, to look at a specific area of cognition, or to help assess a particular age group or diagnosis.

Below are some common examples. Many institutions will have a go-to cognitive assessment as the consistency makes it easier to communicate between team members.

  • Addenbrooke’s Cognitive Examination Revised 
  • Allen’s Cognitive Level Screen (ACLS)
  • Cambridge Prospective Memory Test
  • Cognitive Assessment of Minnesota
  • Cognitive Performance Test
  • Dementia Questionnaire for People with Learning Disabilities
  • Implicit Memory Test
  • Lowenstein Occupational Therapy Cognitive Assessment
  • Middlesex Elderly Assessment of Mental State
  • Mini Mental State Exam
  • Rivermead Behavioral Memory Test
  • Scales of Cognitive Ability for Traumatic Brain Injury
  • Severe Impairment Battery
  • St. Louis University Mental Status Exam
  • Test of Everyday Attention
  • Test of Orientation for Rehabilitation Patients
  • The Dynamic Occupational Therapy Cognitive Assessment for Children
  • Working Memory Test Battery for Children

Getting the Most Out of Your Loved One’s Assessment

Your involvement in the occupational therapy process is critical to its success. The partnership with your OT always works best when you are informed and make decisions in partnership. Never be afraid to ask questions or to advocate for the best care. Here are some examples of ways you can be involved in the cognitive assessment process:

Make sure the whole treatment team is involved

While occupational therapists may be the point person in evaluating and treating cognition, the area is not exclusive to the profession. Cognition is also within the scope of practice of physical therapist as it interplays so closely with language and communication. Physical therapists and social workers will benefit from updates of cognitive changes that influence their work and discharge planning. Overseeing all of the treatment should be an MD.

If there is miscommunication between the treatment team, requesting a team meeting is always a good first step to getting everyone on the same page.

Ask to see the results

In almost all cases, you have the right to see your documentation from therapy. As cognition is such a sensitive treatment area, I would advocate for receiving copies of your therapy notes and requesting a discharge summary when treatment comes to a close.

Learn more about the particular assessment being used

You should be able to perform a simple Google search to learn more about the particular standardized assessment being used. This should reveal the basics about each assessment and what it is testing. You may also be able to read journal abstracts about studies that have been done related to the assessment. At a minimum, assessments should have been studied for whether they are reliable and valid.

The scoring on your particular assessment may also be linked to additional outcomes. For example, if the score on Mini-Mental State Exam and the St. Louis University Mental Status Exam indicates dementia this can signal stronger likelihood over a 7.5-year span that the client will need the 24-hour care provided by an institution.

Discuss how the results link to function

Gathering concrete information is very important in the evaluation process but it is important to always link that information back to functional challenges associated and possible gains. For example, if your processing speed is slow, how does that affect your day-to-day life? How much would it need to improve to enable you to participate in a meaningful daily activity, such as driving?

Linking assessment and treatment to the impact on your daily life is the bread and butter of occupational therapy. If your OT has not clearly communicated the goals she is formulating and working for, do not hesitate to ask.


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Cruz-Oliver DM, Malmstrom TK, Allen CM, Tumosa N, Morley JE. The veterans affairs Saint Louis University mental status exam (slums exam) and the mini-mental status exam as predictors of mortality and institutionalization. The journal of nutrition and aging. 2012;16(7):636-641.

Douglas A, Liu L, Warren S, Hopper T. Cognitive assessments for older adults: Which ones are used by Canadian therapists and why. The Canadian Journal of Occupational Therapy. 2007;74(5):370-381.

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Katz N, Golstand S, Bar-Ilan RT, Parush S. The Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch): A New Instrument for Assessing Learning Potential. American Journal of Occupational Therapy. 2007;61(1):41-52.

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