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The Cognitive Performance Test (CPT) is a standardized occupational therapy assessment that examines cognitive integration with functioning in an instrumental activities of daily living context. Conventional cognitive measures provide diagnostic utility but do not fully address the functional implications. Ninety-one veterans diagnosed with cognitive impairment were evaluated. We compared the predictive value of the CPT with the Large Allen Cognitive Level Screen (LACLS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (M°CA) for the need to retire from driving versus ability to pass an on-road exam. Measures were also analyzed by diagnostic classification. CPT correctly classified a mild versus major neurocognitive disorder, whereas MMSE, M°CA, and LACLS did not differentiate the groups. A CPT cutoff score of <4.7/5.6 showed 89% sensitivity for failing the road exam and 75% specificity for ability to pass. CPT discriminated functional level in neurocognitive disorders and had better predictive value for fitness to drive compared with conventional cognitive measures.
There is a growing interest in performance-based assessments that offer both clinical utility and ecological validity for predicting levels of competency required in everyday tasks (Burgess et al., 2006; Dickerson, Reistetter, Davis, & Monahan, 2011; Hartman-Maeir, Katz, & Baum, 2009; Moore, Palmer, Patterson, & Jeste, 2007; Schaber et al., 2013). Ecological validity refers to whether the findings in a controlled environment (i.e., the clinic) can be generalized to the real world. The goal of occupational therapy evaluation is predictive validity for real-world functioning with an emphasis on the ability to measure change in functioning over time. Functional cognition is a relatively new concept that links the two constructs of function and cognition in the performance of daily life. Older adults often show a decline in their performance of instrumental activities of daily living (IADLs), and impairment in IADLs can predict the onset of future dementia (Péres et al., 2008; Sikkes et al., 2011).
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) subsumes dementia under the new category of neurocognitive disorders (NCDs). Neurocognitive disorders are further divided into major and mild NCDs, according to the degree of functional impairment. Dementia is classified as a major NCD with the diagnostic criteria that cognitive deficits interfere with independence in everyday activities and, at a minimum,...