Top Cognitive Exam for Older Adults

Exclusive Occupational Therapy Exam for a Full Cognitive Profile


Michelle Eliason, MS, OTR/L, C.D.S., CKTS

Why go to an occupational therapist for a cognitive evaluation?


“Occupational therapists are in a unique position to assess and treat adults and children with cognitive deficits in order to facilitate their participation in all areas of occupational performance, such as self-care, education, play, leisure, and social participation.” (1)

Occupational Therapy has extensive training in cognitive function and rehabilitation. One of the emerging practice areas of this field is geriatric wellness and aging in place, fortunately occupational therapy has many evidence-based evaluation and assessment tools to be able to aid in helping you age within the setting you desire. One of the biggest factors affecting one’s ability to age in place is cognition and memory deficits. If you believe you are experiencing memory loss, it is always a good idea to have a formal evaluation conducted to determine your baseline and/or if your perceived memory deficits are ‘average’ for your age or an additional consult is recommended.

Occupational Therapy evaluates the memory and cognition in  older adults aged 70+ for many reasons:

  • An individual is experiencing memory changes and wants to be evaluated and given treatment/education regarding how to preserve memory
  • Caregivers are concerned their loved one is experiencing signs and symptoms of dementia and need an objection third party professional opinion
  • Primary Care Physicians want to establish a cognitive baseline for records so that they can better monitor memory needs over time (whether or not their is an abnormal decline)
  • Primary Care Physicians want to prescribe a cognitive enhancement medication but would like occupational therapy treatment simultaneously to record the effectiveness of the medication through a trial period

In one comprehensive exam, occupational therapy measures SEVEN cognitive areas which specifically effect the aging generations:

  • Orientation
  • Visual
  • Short Memory Screening
  • Spatial Perceptions
  • Praxis 
  • Visuomotor Organization
  • Thinking Operations 

This examination uses the Dynamic Lowenstein Occupational Therapy Cognitive Assessment for Geriatrics (DLOTCA-G) (A 24 subtest battery assessment).

Why is the DLOTCA-G assessment better than a ‘typical’ screen or quick assessment performed during a the course of a routine doctor’s appointment?

Much like the original LOTCA-G, many assessments/screening tools performed in the course of a routine doctor’s appointment are static in nature. This means that they are used to quickly identify or quantify (put a number on) the cognitive deficit. The authors of the DLOTCA-G became aware of the nature of neurological deficits in older adults and developed a dynamic version. This means that the evaluation not only quantifies an individuals ‘hear and now’ but also “estimates their intelligence….estimates the individuals ability to learn”.  “Dynamic assessments become naturally linked to intervention, and can be used as a baseline for choosing and designing an intervention program” (1). 

Research of the LOTCA- G ( DLOTCA-G differs only be the addition of mediation tactics thereby establishing a cognitive profile AND appropriate treatment approach.)

“Results showed significant differences between healthy elderly and those with dementia in all LOTCA-G domains. Most LOTCA-G subtests differentiated between individuals with mild dementia (MMSE 20-23) and those with moderate dementia (MMSE 16-19) suggesting that the test is sensitive to levels of dementia. Also, significant moderate correlations were found between the LOTCA-G domains and MMSE score.” (1)

Michelle Eliason, MS, OTR/L, C.D.S, CKTS  is both an occupational therapist and CARES Dementia Specialist. She has been an elder care professional for 7+ years. Working in various aspects of the elder care industry has given her a generalist skill set and a broad knowledge base of elder care approaches and resources. Michelle is passionate about influencing the elder care industry advocating against nursing home negligence and elder abuse, and working with older adults to enable them to live in their own homes throughout the aging process.

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