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Cognition & Decision Making
We rely on our cognition to help us make reasonable decisions every day. When your cognitive functioning is optimal, you might not even notice that you are using cognitive skills. For example, many people experience a sense of “flow” when driving and do not actively need to remind themselves to pay attention to their lane or remember what a red light means. However, if you experience cognitive challenges, driving could be an extremely overwhelming task. You may miss your exit because you were thinking about what to eat for lunch or run a stop sign because you reasoned you might be late for work.
The truth is, we all experience times when our cognition is not at its best but this does not mean that we are not capable of making sound decisions. To be considered capable of decision making, we need to be able to understand the information pertaining to a decision, as well as the outcomes of that decision. A cognitive assessment can indicate whether someone truly has this ability.
Changes in Cognition
Our cognition can be positively impacted by both experience and education. Alternatively, our cognition can be negatively impacted by conditions or injury, including traumatic brain injury, stroke, Parkinson’s disease, Multiple Sclerosis, the general progression of aging, and developmental disability. Some changes in cognition are permanent and will require permanent changes to your environment or your occupations to ensure your safety. Some cognitive changes can also be mediated through practice and skill development. To determine what course of action will best meet your needs, a cognitive assessment may be administered.
The Purpose of a Cognitive Assessment
Like any assessment, a cognitive assessment provides an array of important information, including:
- Understanding what parts of cognition you specifically experience challenges with. For example, some people may have significant challenges with memory, but are efficient in solving problems or using reasoning.
- A functional cognitive assessment (which your occupational therapist will likely administer) can indicate how your cognition impacts your everyday life and specific tasks you complete day-to-day.
- Scores of your cognitive assessment can act as a baseline from which you can measure cognitive changes over time.
- The results from your cognitive assessment will help inform your occupational therapist’s plan of care, including whether to focus on building cognitive skill or compensating for cognitive challenges.
- Cognitive assessments can also inform legal decisions, including your capacity to make informed decisions independently. While assessing capacity is a multifactorial process, a cognitive assessment can play an important role in determining your ability to understand and appreciate financial, legal, healthcare and accommodation decisions.
What to Expect from a Cognitive Assessment
Cognitive assessments can look very different depending on the challenges you experience and the information your therapist is seeking. Many cognitive assessments will involve sitting down with your therapist to complete a pencil-and-paper assessment. These assessments commonly ask you to complete tasks which test your memory, motor planning and control, attention, judgement and use of language. These types of test will produce a numbered score which your therapist will share with you and explain how your scores compare to other people of similar ages, levels of education or conditions.
Other cognitive assessments are functional, meaning that, rather than writing down your answers, you will show or explain how you complete a task. Again, these tests are beneficial in assessing your memory, attention, language and problem-solving skills, as well as how cognitive challenges impact your day-to-day life. Again, this type of assessment will also result in a score which your therapist can share and explain to you in order to inform both therapeutic and legal decisions.
CONTRIBUTED BY: Lauren Macartney, Occupational Therapist, MScOT