Construct Validity of a Geriatric Version of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) Battery

Effectiveness of virtual reality-based neuropsychological interventions in improving cognitive functioning in patients with mild cognitive impairment: A systematic review and meta-analysis

Objective: Increased prevalence of mild cognitive impairment (MCI) has led to a need for new neuropsychological intervention tools in this population. This meta-analysis aimed to learn about the efficacy of virtual reality (VR)-based neuropsychological interventions in improving cognitive functioning in patients with MCI. Method: This review followed the recommendations of the PRISMA statement, and it was registered in PROSPERO. The studies examined were collected from the PsycINFO, Web of Science, Pubmed/MEDLINE, Embase, Scopus, and Cochrane Library databases. Results: The systematic search yielded 258 articles, of which 13 randomized controlled trials were selected. VR-based neuropsychological interventions had moderate effects on global cognition (g = 0.30; 95% CI = 0.05, 0.56; p = 0.02), small effects on attention (g = 0.27; 95% CI = 0.04, 0.49; p = 0.02), and large effects on executive function (g = 0.60; 95% CI = 0.38, 0.81; p < 0.0001), but non-significant effects on working memory, episodic memory, language, or visuoconstruction. When the length of the intervention was considered, VR-based interventions of 15 or more hours had moderate effects on working memory (g = 0.55; 95% CI = 0.11, 0.99; p = 0.01), and large effects on language (g = 0.60; 95% CI = 0.01, 1.20; p = 0.05) and visuoconstruction (g = 1.13; 95% CI = 0.58, 1.67; p < 0.0001). Conclusions: Results suggest that VR-based interventions are beneficial for improving cognitive functioning in patients with MCI, and allow us to make recommendations that could have implications for clinical decision-making in this population.

Minimal Clinically Important Difference of the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G) in People With Dementia

IMPORTANCE

The Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G) can provide multifaceted and comprehensive measures of cognitive function with reduced literacy demands; however, its minimal clinically important difference (MCID) has not been determined for interpreting the change scores.

OBJECTIVE

To establish the LOTCA-G MCID for people with dementia.

DESIGN

Psychometric field study.

SETTING

Data were collected in communities.

PARTICIPANTS

Forty-nine participants with mild to moderate dementia who were enrolled in previous research investigating the effects of cognitive stimulation-related interventions with equivalent training hours.

OUTCOMES AND MEASURES

The Mini-Mental State Examination and LOTCA-G were used to assess cognitive function before and after the interventions. The anchor-based and distribution-based approaches were used to estimate the LOTCA-G MCID.

RESULTS

Using the anchor-based method, we defined 16 participants as the improvement group, with a mean change score of 5.75 points (the first MCID estimate). The second MCID estimate was 6.23 points, which we calculated from the 49 participants by using the distribution-based method with the medium effect size.

CONCLUSIONS AND RELEVANCE

Current results suggest that a LOTCA-G change score greater than 5.75 points should be considered as meaningful change for people with dementia. It is important to consider the LOTCA-G MCID as one of the indexes for determining the success of interventions in people with dementia.

WHAT THIS ARTICLE ADDS

This study is the first to report the LOTCA-G MCID for dementia. Establishing an MCID for standardized cognitive assessment tools for the aging population can be used to support evidence-based practice in rehabilitation clinics.

Relationship between Basic Neurological Cognition and Social Cognition among Allen Cognitive Disability Levels of Acquired Brain Injury

(1) Background: There are various cognitive, perceptual, and social problems associated with acquired brain injury (ABI). The Allen cognitive impairment level indicates the degree of cognitive function required for everyday activities. Until recently, there have been no studies on the relationship between basic neurological cognition and social cognitive function according to the Allen cognitive level (ACL). The aim of this study is to identify the relationship between basic neurological and social cognition among Allen cognitive disability levels of ABI. (2) Methods: Thirty-four patients with ABI were identified. Cartoon Intention Inference Task (CIIT), Social Behavior Sequence Task (SBST), Korean version Mimi-Mental Status Examination (K-MMSE), and Lowenstein Occupational Therapy Cognitive Assessment (LOTCA)-tests were administered to examine the differences in neurological and social cognitive functions according to each participant's Allen Cognitive Level Screening (ACLS). (3) Results: There were significant differences between K-MMSE, LOTCA, CIIT and SBST results among Allen cognitive levels (p < 0.05). There was a linear correlation between K-MMSE (r = 0.778, p < 0.01), LOTCA-total score (r = 0.627, p < 0.01), LOTCA-orientation (r = 0.470, p = 0.01), LOTCA-thinking operation (r = 0.341, p < 0.05), CIIT (r = 0.817, p < 0.05), and SBST (r = 0.376, p < 0.05) and ACL. Stepwise multivariate regression showed that the subscales affecting the ACLS score were SBST (β = 0.239, p = 0.000) and K-MMSE (β = 0.068, p = 0.001). The explanatory power of this regression equation, R², was 0.767. (4) Conclusions: A significant difference was found in neurological and social cognitive function according to the ACL level of the ABI patient. In addition, there was a linear correlation between the ACLS scores of the ABI patients and the underlying neurological cognitive function and social cognition. The higher the overall functional cognitive level (i.e., the group with higher ACLS scores), and the lower the degree of help required in daily life, the higher both the neurological cognition level and social cognitive level were determined to be.

Relationships of Cognitive Performance and Daily Function of Clients following Right Hemisphere Stroke: Predictive and Ecological Validity of the LOTCA Battery

The purpose of this study was to determine the relationship of cognitive performance, as measured by the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery, to daily function in patients following right hemisphere stroke. Furthermore, to explore the predictive power of cognitive performance using the LOTCA at the first rehabilitative stage after stroke to long-term functional outcomes. The method was a longitudinal research design at 3 points in time: admission to rehabilitation; discharge from the rehabilitation hospital; and at follow-up, six months after discharge, which in some cases reached one year post onset. Subjects were 40 consecutive patient admissions to a rehabilitation hospital. All patients were right-handed adults with a CT-proven, first, single, right hemispheric stroke. Based on their total cutoff score in the Behavioral Inattention Test (BIT) for unilateral spatial neglect, patients were divided into 2 subgroups: 19 with neglect and 21 without neglect. Instruments included the LOTCA, the Functional Independence Measure (FIM), the Rabideau Kitchen Evaluation and Phone use. Results showed that right hemispheric stroke patients with unilateral spatial neglect performed at a lower level than patients without neglect on all measures of cognitive skills, as well as daily functional tasks as measured by the FIM and kitchen tasks. Differences were significant in all testing periods. Relationships between cognitive and functional measures showed that visuomotor organization and thinking operations correlated at moderate to high levels in both subgroups. The predictive results from admission to follow-up suggest that unilateral spatial neglect is the major predictor of activities of daily living (ADL) and instrumental activities of daily living (IADL) task performance, however cognitive skills, especially the more complex integrated visuomotor and thinking skills, were significantly related to functional outcomes in the non-neglect group. Thus, they are crucial in the assessment of stroke patients. The predictive and ecological validity of the LOTCA battery was supported.

Cognitive and Language Function in Aphasic Patients Assessed With the Korean Version of Mini-Mental Status Examination

Objective

To assess the clinical usefulness of the relatively short instrument, the Korean version of the Mini-Mental State Examination (MMSE-K), for testing the association between cognition and language function in subacute post-stroke aphasia patients.

Methods

Medical charts of 111 post-stroke patients (65 men; age 69.6±10.0 years; 124.6±80.6 days post-onset) were reviewed retrospectively. All patients were assessed longitudinally for aphasia using the validated Korean version of the Western Aphasia Battery (K-WAB) and for cognition using the MMSE-K. Patients were categorized and analyzed according to 3 aphasia-severity clusters.

Results

All subscales of the K-WAB showed significant improvement in follow-up assessments in all groups (p<0.05 or p<0.01). Only the scores of orientation, language function, and total score of MMSE-K showed significant improvement in all groups (p<0.01). The more severely impaired group showed stronger Pearson correlation coefficients between cognition and language function. Additionally, comparisons between correlation coefficients showed that the association of improvement in orientation with that of fluency and AQ% (aphasia quotient %) was significant in the more severely impaired group.

Conclusion

Among subacute post-stroke aphasic patients, patients with more severe aphasia showed greater impairments to cognitive function; in addition, recovery of orientation may be related to recovery of language function.

Effect of the recreational life review program on patients with dementia in an outpatient clinic: a preliminary study

The purpose of this study is to investigate the effect of the Life Review Program-Taiwan (LRP-TW) on outpatients with mild to moderate dementia. Ten individuals were selected through purposive sampling and tested using a single group pretest-posttest design. The Mini-Mental State Examination (MMSE), the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G) and the Geriatric Depression Scale-Short Form (GDS-SF) were used as outcome measures. The total scores and three subtests of the LOTCA-G revealed significant differences after the intervention. Affective function remained stable through the experiment. The LRP-TW may offer a clinical intervention program for supporting cognitive and mental performance in individuals with dementia.

Dynamic Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (DLOTCA–G): Assessing Change in Cognitive Performance

OBJECTIVE. We studied the internal consistency reliability and construct validity of the new Dynamic Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (DLOTCA–G), a dynamic version of the Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (LOTCA–G), and examined the properties of the mediation system.

METHOD. Participants included 61 clients hospitalized after stroke in three rehabilitation centers (mean age = 77.6 yr, standard deviation [SD] = 6.2) and 52 healthy control participants (mean age = 77.8 yr, SD = 6.4). All participants were assessed with the DLOTCA–G.

RESULTS. Internal consistency reliability showed moderate to high α coefficient levels in all domains (αs = .68–.85) except the Memory domain (α = .26). Both groups benefitted from mediation, but the stroke clients needed more concrete levels of mediation (Levels 3–5).

CONCLUSION. The addition of mediation to the LOTCA–G is effective in providing insights into clients’ cognitive status and learning potential. Our findings are similar to the results of the validation study for the DLOTCA for adults and support the use and benefits of the dynamic version.