Ordering OT Cognitive Screens: Basic Considerations
***Reported history of cognitive or functional impairment in ADL or IADLs***
Screening is a process for evaluating the possible presence of a particular
problem/impairment, not severity.
MOCA is screen for the “presence” of Mild Cognitive Impairment in 55-85 year old population.
Normal score is 26/30 with an education cut off of +1 point for those with grade 12-13 or lower.
Usually IADL impairments: $, meds, driving, meals, etc.
MMSE is a screen for possible Dementia- appropriate for someone who might be having or reported
to be having difficulty completing their ADLs. Age and education cut offs used at VJH. Also included
usually is the Clock Draw, a quick screen for executive function and Visual-spatial ability.
Capacity to make decisions: Neither a MOCA nor MMSE adequately evaluates a person’s ability to make
decisions. Both the MMSE and MOCA only screen for presence only of Dementia or MCI. Capacity is
multifactorial and entails a great deal of Executive function which the above screens do not adequately
screen. Your OT can assist in determining which screens to use and their potential impact on functional
performance of ADL and IADLs to aide in discharge planning.
Other considerations:
Cog screens should never delay a discharge: just request an Outpatient referral for cog assessment and
OT will see within 1-2weeks for the assessment and fax results to the family Dr.
Not to be requested to complete Interai-LTC assessment, or baseline info, requested by family: OT will
assess appropriateness based on function.
Priority Intervention Guidelines (priority 2) consider OT workload and current hospital capacity issues
Concurrent screening, monitoring for cog change: Not appropriate for acute care
Has an existing Dx of MCI or Dementia. Cog screen not appropriate, screens only for presence of
dementia or MCI, not severity.
Psychiatry will not see unless a cog screen is completed. OT will screen only IF there is a functional
impairment.
