Computerized cognitive assessment and care plan development services are critical for newly diagnosed dementia patients to receive safe and proper care for the state of their cognitive, mental, and physical health. As an initial tool, these services can develop a baseline for care and can help determine the proper living situations for dementia patients, whether that be with in-home caregivers or in assisted living facilities. The required level of caregiver involvement can also be determined through such tools.
More often than not, these services are utilized sporadically, largely due to the lack of cognitive assessment tools available for longitudinal assessment of neurocognitive health. Furthermore, most tools only assess either cognition or function, making the practicality of longitudinal assessments of neurocognitive health challenging. As the cognitive and functional abilities of diagnosed patients change over time, the ability to complete Activities of Daily Living (ADLs) will also change, potentially resulting in new care needs. To effectively update care plans with changing needs, the ability of patients to complete complex ADLs should be regularly assessed and tracked over time.
Below, we explore commonly recommended measures to be taken for assessing several domains of care planning, the benefits of computerized cognitive assessments for care plan development, and how new neurocognitive assessment tools can improve patient care.
According to the Alzheimer’s Association, there are nine domains of care planning that should be assessed to determine care plans for dementia patients. Two of the most influential care planning domains include cognition and function. Let’s take a look into common tools used to assess these two critical domains.
The most common and widely recognized tools are the Mini-Mental State Exam (MMSE), the Montreal Cognitive Assessment (MoCA), the Mini-Cog, and the General Practitioner Assessment of Cognition (GPCOG). The Alzheimer’s Association recommends the use of the Mini-Cog, the GPCOG, and the short MoCA. All of the assessments aim to assess the presence of cognitive impairment and incorporate similar aspects, such as memory, visuospatial functioning (Clock Drawing Test), language, orientation, attention, and calculation.
These assessments are good indicators of overall cognitive function. However, they pose several challenges and limitations. From a feasibility perspective, these assessments require a caregiver or healthcare professional to administer, interpret, and report on the results, making regular assessments of cognitive function challenging while also introducing the risk of bias or human-to-human variability. However, this issue may be addressed with computerized cognitive assessment and care plan development.
These surface-level assessments rely on specific, symptom-oriented testing that may not provide the level of data granularity and specificity needed to fully understand a patient’s cognitive function to provide proper personalized care.
To assess a patient’s functional abilities, the Alzheimer’s Association recommends the use of the Katz ADL and Lawton-Brody Instrumental ADL (IADL). Both assessments aim to assess a patient’s ability to perform ADLs or tasks necessary to live independently in a community. The respective categories for the assessment of functional abilities are detailed below.
Categories for Assessment
While both assessments may not be sensitive to small, incremental, intra-individual changes, the Lawton-Brody IADL is considered to assess ADLs of higher complexity compared to the Katz ADL. However, assessing a patient's ability to complete the eight types of activities through a demonstration of each task is very time-consuming and may lead to self-reporting or surrogate reporting methods. This can yield significant inaccuracies such as the overestimation or underestimation of functional abilities.
More recently, some caregivers and healthcare professionals have turned to computerized cognitive assessments for care plan development and, in some cases, computerized functional assessments. In general, computerized assessments have several advantages, including the following:
While computerized versions of existing tools eliminate several of the challenges associated with the assessments detailed above, they still have similar limitations regarding the data granularity and specificity required to provide a comprehensive understanding of a patient’s cognitive and functional abilities to provide personalized patient care.
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