cognition assessment practical

MoCA

• what is this assessment? The Montreal Cognitive Assessment (MoCA) is a standardized cognitive screening tool designed to detect mild cognitive impairment in approximately 10–15 minutes.

  It assesses multiple cognitive domains:

  • Visuospatial/executive function (e.g., trail-making, cube copy, clock drawing)

  • Naming

  • Memory (delayed recall)

  • Attention (digit span, vigilance, serial subtraction)

  • Language (sentence repetition, fluency)

  • Abstraction (similarities)

  • Orientation (time and place)

• what kind of client is ideal for this assessment? Clients who may benefit from the MoCA are those you suspect have mild cognitive impairment (MCI) or early cognitive changes that may not be detected by simpler screens like the Mini-Mental State Exam. Older adults with memory complaints or family concerns about forgetfulness.

• Clients with neurological conditions (e.g., stroke, traumatic brain injury, Parkinson’s disease, multiple sclerosis).

• Individuals recovering from concussion, hypoxia, or COVID-related cognitive changes.

• Clients with psychiatric conditions (e.g., depression, schizophrenia) that may affect cognition.

• rationale as to why the client would benefit from this assessment? The MoCA provides a quick, sensitive screening tool to detect mild cognitive deficits that could impact a client’s ability to perform activities of daily living (ADLs), instrumental ADLs, work, or leisure tasks.

  Rationale highlights:

  • Early detection allows OTs to tailor interventions for cognitive retraining or compensatory strategies.

  • It identifies specific domains of impairment (e.g., attention, executive function, memory, visuospatial skills) that are directly linked to occupational performance.

  • Helps the OT determine if further neuropsychological testing or medical referral is needed.

• what do the results/scores mean and what are the implications for OT with the client? Scoring:

  • Maximum score: 30 points

  • 26 and above = normal cognition

  • Below 26 may indicate mild cognitive impairment or early dementia A lower MoCA score suggests cognitive deficits in one or more domains.

  • Scores guide the OT in identifying functional implications—for example, difficulty with memory may affect medication management, or decreased executive function may affect cooking or financial management.

  OT Implications:

  • Use results to inform the OT plan of care—decide whether to emphasize restorative cognitive exercises, environmental modifications, or compensatory strategies.

  • Collaborate with the healthcare team for further evaluation or safety planning (e.g., driving, independent living).

  • Monitor progress—MoCA can be re-administered periodically to track changes.

  • Educate client and caregivers about cognitive strengths and weaknesses to promote independence and safety.

Menu Task

• what is this assessment? The Menu Task is a performance-based, standardized occupational therapy assessment that uses a restaurant menu and realistic scenarios to evaluate cognitive functioning in a meaningful context.

  Task example:
  The client is given a menu and asked to plan a meal for themselves (and sometimes for others) within certain parameters (e.g., dietary restrictions, time limits, or budget).

  It assesses:

  • Attention and working memory

  • Sequencing and organization

  • Problem-solving and decision-making

  • Abstract thinking and reasoning

  • Numerical reasoning and budgeting skills

  • Comprehension and reading skills

  The OT observes how the client approaches the task, error patterns, time taken, and need for cues or assistance.

• what kind of client is ideal for this assessment? Clients who would benefit from the Menu Task are those who demonstrate difficulty with everyday decision-making, problem-solving, attention, or sequencing, particularly in functional contexts.

  Examples:

  • Adults or older adults with stroke, traumatic brain injury (TBI), dementia, or mild cognitive impairment.

  • Clients with psychiatric conditions (e.g., schizophrenia, depression) that affect executive functioning.

  • Individuals recovering from neurological illnesses (e.g., MS, brain tumor, encephalopathy).

  • Clients who appear to function well in structured settings but struggle with real-life cognitive demands.

• rationale as to why the client would benefit from this assessment? The Menu Task assesses functional cognition—how a person uses cognitive processes (like attention, planning, and problem-solving) to perform real-world instrumental activities of daily living (IADLs).

  Rationale highlights:

  • It provides ecologically valid information about a person’s ability to use cognitive skills in daily occupations.

  • It helps OTs determine the level of cognitive assistance or supervision required for safe community living.

  • It bridges the gap between traditional paper-pencil tests (like MoCA) and functional performance.

  • Supports treatment planning for real-world skill building, safety training, or compensatory strategy use.

• what do the results/scores mean and what are the implications for OT with the client? Interpretation:

  • Performance is analyzed based on accuracy, efficiency, organization, and insight.

  • Difficulty following directions, maintaining attention, or planning logically may indicate executive dysfunction or reduced functional cognition.

  • The level of cueing required helps determine the client’s functional independence and need for support.

  OT Implications:

  • Results inform the OT’s clinical reasoning about how cognitive deficits impact IADLs like cooking, shopping, or community participation.

  • Guides goal setting — for example, improving planning skills for meal preparation or budgeting.

  • Informs intervention design (restorative vs. compensatory vs. environmental adaptation).

  • Provides education to family/caregivers about supervision needs and strategies to promote independence.

Weekly Calendar Planning Activity

• what is this assessment? The Weekly Calendar Planning Activity (WCPA) is a standardized, performance-based cognitive assessment that measures executive functioning and functional cognition through a real-world simulation.

  Task:

  • The client is given a list of appointments (with specific rules and time conflicts) and asked to enter them into a weekly calendar while following specific instructions (e.g., “Do not schedule anything on Tuesday afternoons,” “Avoid overlapping appointments,” etc.).

  • The Short Level 2 version uses a smaller set of appointments and is designed to take approximately 10–15 minutes, making it ideal for clinical or lab settings.

  It assesses:

  • Planning and organization

  • Working memory

  • Attention and task switching

  • Problem-solving and error awareness

  • Inhibition and strategy use

  • Adherence to rules and time management

• what kind of client is ideal for this assessment? Clients who would benefit from the WCPA are those who have executive functioning deficits or difficulties organizing, planning, or managing time in daily life.

  Examples:

  • Adults or adolescents with traumatic brain injury (TBI), stroke, multiple sclerosis, concussion, or mild cognitive impairment.

  • Clients with psychiatric or neurodevelopmental conditions (e.g., ADHD, schizophrenia, depression) that affect organization or attention.

  • Individuals who appear cognitively intact on simple screening tests but struggle with complex, real-world tasks.

• rationale as to why the client would benefit from this assessment?  The WCPA helps the occupational therapist understand how a client’s cognitive skills—such as working memory, planning, problem-solving, and self-monitoring—affect their ability to complete functional tasks that mirror everyday demands.

  Rationale highlights:

  • It evaluates functional cognition—how well clients apply executive functioning to real-world activities (like managing appointments or schedules).

  • Provides insight into strategies used and cueing needs during task performance.

  • Helps the OT determine if the client can live independently, manage work or school demands, or requires cognitive supports.

  • It directly aligns with OT’s focus on occupational performance and participation in daily routines. 

• what do the results/scores mean and what are the implications for OT with the client? Interpretation:

  • The OT evaluates accuracy (correctly scheduled appointments), efficiency (time taken), rule adherence, strategy use, and awareness of errors.

  • Clients who make multiple scheduling errors, ignore rules, or use no strategies may have executive dysfunction or difficulty generalizing cognitive skills to daily life.

  OT Implications:

  • Results provide a functional profile of cognitive strengths and weaknesses related to everyday scheduling, multitasking, and time management.

  • Informs treatment planning — for example:

    • Training in external strategies (e.g., planners, reminders).

    • Cognitive remediation for attention, organization, or working memory.

    • Compensatory approaches for independent living, work, or school tasks.

  • Helps justify recommendations for supervision level, return to work/school decisions, or further cognitive rehabilitation.

  • Facilitates client-centered goal setting and education about how cognitive deficits impact real-life occupations.

Rivermead Behavioral Memory Test - Active Recall

• what is this assessment? The Rivermead Behavioral Memory Test (RBMT) is a standardized, performance-based assessment developed by occupational therapists and neuropsychologists to measure everyday memory abilities.

  The Immediate Recall Story Subtest is one of its components, assessing the client’s ability to recall information immediately after hearing a short story.

  Procedure:

  • The therapist reads a short, meaningful story aloud.

  • The client is asked to recall as much of the story as possible immediately after hearing it (immediate recall).

  • Later, delayed recall may also be tested (after a short interval).

  • The story includes specific key ideas or units (often 21–25 items) scored for accuracy and completeness.

  Cognitive domains assessed:

  • Immediate verbal memory

  • Attention and auditory processing

  • Working memory and encoding

  • Comprehension and organization of information

• what kind of client is ideal for this assessment? Clients who would benefit from the RBMT Immediate Recall Story Subtest are those who demonstrate memory difficulties affecting daily functioning. This includes individuals who struggle with remembering conversations, events, or new information.

  Examples:

  • Adults with traumatic brain injury (TBI), stroke, or hypoxic brain injury

  • Clients with mild cognitive impairment (MCI) or early dementia

  • Individuals with neurological or psychiatric conditions affecting memory (e.g., depression, multiple sclerosis, Parkinson’s disease)

  • Clients recovering from concussion or encephalitis who report forgetfulness or confusion in daily routines

• rationale as to why the client would benefit from this assessment? The Immediate Recall Story Subtest assesses a client’s immediate verbal memory and attention using a realistic, meaningful story. Because it mimics real-life situations (like remembering instructions or conversations), it provides functionally relevant information for occupational therapy.

  Rationale highlights:

  • Helps identify how memory deficits impact daily tasks such as following directions, recalling appointments, or remembering safety instructions.

  • Provides a functional measure of everyday memory, rather than abstract recall.

  • Informs treatment planning focused on compensatory memory strategies or cognitive retraining.

  • Allows the OT to observe attention span, processing speed, and recall style (e.g., verbatim vs. gist memory).

• what do the results/scores mean and what are the implications for OT with the client? Interpretation:

  • A higher score indicates effective immediate recall and attention.

  • A lower score suggests difficulty encoding and recalling new verbal information, which can impact daily functioning.

  • Comparison between immediate and delayed recall provides insight into storage vs. retrieval deficits.

  OT Implications:

  • Results help identify specific memory deficits affecting occupational performance (e.g., forgetting safety steps, appointments, or instructions).

  • Guides intervention planning, such as:

    • Memory strategy training (e.g., chunking, repetition, association).

    • External memory aids (e.g., notebooks, phone reminders, visual cues).

    • Environmental modifications to support recall.

  • Assists in determining readiness for return to work, school, or independent living.

  • Provides objective data for progress monitoring and caregiver education.

Behavioral Assessment of the Dysexecutive Syndrome (The Key Search Test)

• what is this assessment? The Key Search Subtest is one of its six core subtests. It uses a realistic analogy — searching for lost keys in a field — to assess the client’s ability to plan, monitor, and evaluate an efficient search strategy.

  Procedure:

  • The client is shown a drawing of a large rectangular “field” and asked to draw a path showing how they would search for their lost keys.

  • They must demonstrate an organized, logical, and complete search pattern to maximize the chance of finding the keys.

  • The OT scores the performance based on strategy effectiveness, thoroughness, and systematic coverage.

  Cognitive domains assessed:

  • Planning and organization

  • Problem-solving

  • Self-monitoring and inhibition

  • Abstract reasoning and flexibility

  • Awareness of strategy and self-evaluation

• what kind of client is ideal for this assessment? Clients who would benefit from the Key Search Subtest are those who demonstrate executive functioning difficulties that affect their ability to plan, organize, or problem-solve in everyday life.

  Examples:

  • Adults or adolescents with traumatic brain injury (TBI), stroke, or frontal lobe damage

  • Clients with neurodegenerative disorders such as Parkinson’s disease or dementia

  • Individuals with psychiatric conditions (e.g., schizophrenia, bipolar disorder) affecting executive control

  • Clients with ADHD, post-COVID cognitive issues, or mild cognitive impairment who struggle with goal-directed behavior

• rationale as to why the client would benefit from this assessment? The Key Search Subtest provides insight into a client’s executive functions — especially planning, organization, reasoning, and self-monitoring — all of which are essential for independent daily functioning.

  Rationale highlights:

  • It evaluates how the client plans and executes a strategy to solve a real-world–like problem, rather than rote cognitive skills.

  • Helps the OT determine whether cognitive deficits are affecting functional performance in tasks such as navigating environments, organizing routines, or managing complex daily activities.

  • Results guide interventions to promote problem-solving and strategic thinking for real-life independence.

• what do the results/scores mean and what are the implications for OT with the client? Interpretation:

  • High scores indicate effective planning, organization, and self-monitoring.

  • Low scores reflect poor executive control, disorganized thinking, or difficulty anticipating outcomes.

  • Clients who use random or incomplete search patterns may demonstrate deficits in goal-directed behavior and poor awareness of task demands.

  OT Implications:

  • Results inform the OT about how executive dysfunction affects real-world activities, such as finding misplaced items, planning routes, or managing complex tasks.

  • Guides intervention planning — for example:

    • Training in problem-solving strategies and systematic approaches to tasks.

    • Use of visual checklists, routines, or external structure to improve organization.

    • Metacognitive training to enhance self-awareness and self-monitoring.

  • Provides objective data for documenting executive impairments and tracking progress.

  • Assists with safety assessments, return-to-work/school decisions, or independent living recommendations.

Cognitive Performance Test

• what is this assessment? The Cognitive Performance Test (CPT) is a standardized, performance-based assessment developed by occupational therapists to measure functional cognition—that is, how cognitive skills (attention, memory, sequencing, judgment, and problem-solving) are used during familiar daily tasks.

  Administration:

  • The CPT consists of seven standardized subtests modeled after common daily tasks:

    1. Dress

    2. Shopping

    3. Toast Preparation

    4. Phone Use

    5. Washing

    6. Travel

    7. Medication Management

  • The OT observes how the client plans, initiates, sequences, and completes each task, while noting the type and amount of assistance or cueing required.

  • Cognitive domains assessed:

    • Working memory

    • Attention

    • Sequencing and planning

    • Organization

    • Problem-solving and judgment

    • Functional use of memory strategies

• what kind of client is ideal for this assessment? Adults and older adults with dementia, Alzheimer’s disease, or mild cognitive impairment

• Clients with traumatic brain injury (TBI), stroke, or neurological conditions (e.g., Parkinson’s disease, multiple sclerosis)

• Individuals with psychiatric conditions (e.g., schizophrenia, major depression) affecting cognitive function

• Clients with developmental disabilities or cognitive decline impacting independence

• rationale as to why the client would benefit from this assessment? The CPT helps the OT determine how cognitive impairments influence the client’s real-life functional performance by assessing cognition through everyday tasks rather than abstract testing.

  Rationale highlights:

  • Provides a functional, occupation-based measure of cognition that reflects how clients think and problem-solve in daily life.

  • Identifies the client’s cognitive level and abilities using familiar activities rather than artificial testing contexts.

  • Supports treatment planning, environmental adaptation, and caregiver education based on the client’s cognitive capacity.

  • Helps determine the level of assistance or supervision needed for safe living, discharge planning, or community reintegration.

• what do the results/scores mean and what are the implications for OT with the client? Scoring:

  • The CPT is scored on a scale of 1–6 based on the client’s performance and level of assistance required:

    • 6 = Independent (no assistance)

    • 1 = Total dependence (unable to perform even with cues)

  • These scores correlate with the Allen Cognitive Levels (ACLs) to guide intervention and safety recommendations. 

  • Interpretation:

    • The client’s score reflects their functional cognitive level, which helps predict how they might perform other everyday activities.

    • Higher scores indicate independent performance, while lower scores indicate the need for greater supervision or assistance.

    • The pattern of strengths and weaknesses across subtests helps identify specific cognitive domains (e.g., planning vs. attention) that need intervention.

    OT Implications:

    • Results guide goal setting and treatment planning — e.g., focus on maintaining independence in ADLs, teaching compensatory techniques, or using adaptive equipment.

    • Helps determine appropriate living environments and level of care (independent, assisted, or skilled nursing).

    • Informs caregiver training, safety recommendations, and environmental modifications to support function.

    • Supports evidence-based discharge planning and interdisciplinary collaboration with nursing, social work, and family members.

    • Allows the OT to track cognitive changes over time and measure intervention outcomes.

MoCA sample speech

“The MoCA is a quick cognitive screening that helps identify mild cognitive impairment across multiple domains such as attention, memory, and executive functioning. I would use this with a client who’s showing subtle memory or problem-solving difficulties—such as an older adult post-stroke or someone reporting forgetfulness impacting their daily routines.

The rationale is that it helps me, as an OT, understand how cognitive deficits might affect occupational performance—like managing medications or finances. Results below 26 suggest mild impairment, which would guide my intervention plan toward cognitive retraining, compensatory strategies, and caregiver education.”

Menu task sample speech

“The Menu Task is a performance-based cognitive assessment developed by occupational therapists that uses a restaurant menu to evaluate how clients use attention, planning, and problem-solving in a functional context. I’d use this with a client who has mild cognitive or executive functioning deficits after a stroke or brain injury and is having trouble organizing daily tasks or meal planning.

The rationale is that it provides a realistic measure of functional cognition — how the client actually manages complex daily decisions — which is crucial for independent living. Results showing difficulty organizing or budgeting would guide me to focus on interventions for executive functioning, compensatory strategies, and caregiver education.”

Weekly Calendar Planning sample speech

“The Weekly Calendar Planning Activity, short Level 2 version, is a standardized functional cognitive assessment that measures how clients use executive functions like planning, working memory, and problem-solving to complete a real-world scheduling task.

I’d use this with clients who have cognitive or executive function challenges—like after a brain injury, stroke, or concussion—to see how these deficits affect daily life tasks such as managing appointments or work schedules.

The rationale is that it simulates a real-world cognitive demand and helps me, as an OT, identify which cognitive skills are limiting participation and what strategies or supports are needed.

Results showing poor organization or rule adherence would lead me to focus on interventions for planning, use of external aids, and compensatory techniques to support independence.”

Rivermead sample speech

“The Rivermead Behavioral Memory Test—Immediate Recall Story Subtest is a standardized, performance-based memory assessment that evaluates how well a client can remember meaningful information right after hearing it. I’d use this with clients who have memory or attention concerns—like after a brain injury, stroke, or early dementia—to see how these difficulties impact daily tasks.

The rationale is that it provides a real-world measure of memory, similar to remembering conversations or instructions. Lower recall scores indicate difficulties with encoding or attention, which would guide my OT plan toward memory strategy training, use of external aids, and compensatory techniques to improve daily functioning.”

BADS sample speech

“The Key Search Subtest from the Behavioral Assessment of the Dysexecutive Syndrome is a standardized, performance-based assessment that evaluates a client’s executive functioning—specifically their ability to plan, organize, and problem-solve.

I would use this with a client who has had a brain injury or stroke and is showing difficulty organizing daily routines or following through on tasks.

The rationale is that this subtest simulates a real-world situation requiring strategy and self-monitoring, allowing me to see how the client approaches problem-solving in functional contexts.

Results showing a disorganized or inefficient search pattern suggest executive function deficits, guiding my OT plan to focus on teaching systematic strategies, external supports, and metacognitive skills to improve daily independence.”

cognitive performance test sample speech

“The Cognitive Performance Test is a standardized, performance-based assessment that evaluates how a client uses cognitive skills to complete everyday tasks like dressing, shopping, and medication management.

I would use this with clients who have cognitive impairments from conditions such as dementia, brain injury, or stroke to understand how these deficits impact their ability to live safely and independently.

The rationale is that it assesses cognition through meaningful, real-world activities, giving me a better understanding of functional performance rather than abstract testing.

Results indicate the level of assistance the client requires for daily tasks. If scores show decreased problem-solving or sequencing, I would focus on interventions that build routines, teach compensatory strategies, and educate caregivers to support safe participation in daily life.”