Cognitive Assessments Used in Occupational Therapy Explained: A Comprehensive Guide for 2026

When someone you care about experiences cognitive changes—whether from stroke, brain injury, dementia, or developmental delays—the uncertainty can feel overwhelming. Questions flood in: Can they still manage daily tasks safely? Will they regain independence? What support do they truly need? This is where cognitive assessments used in occupational therapy become invaluable tools, transforming uncertainty into actionable understanding and hope into measurable progress.

Unlike standard medical tests that focus solely on diagnosis, occupational therapy cognitive assessments evaluate how thinking, memory, and problem-solving abilities impact real-world functioning. They answer the questions that matter most: Can your loved one prepare meals safely? Manage medications independently? Return to work or school? Navigate community settings confidently?

Understanding these assessments empowers you to advocate effectively, make informed decisions, and access appropriate support—particularly through programmes like the NDIS across Queensland, Victoria, New South Wales, and Tasmania.

What Are Cognitive Assessments in Occupational Therapy and Why Do They Matter?

Cognitive assessments used in occupational therapy are specialized evaluation tools that measure an individual’s thinking, learning, memory, problem-solving abilities, and participation in daily occupations. Rather than simply identifying what’s wrong with the brain, these assessments reveal how cognitive changes affect everyday life—from getting dressed independently to managing household finances.

Cognition encompasses both elementary skills (arousal, alertness, orientation) and higher-order abilities (insight, judgement, problem-solving). When cognitive function changes due to injury, illness, or developmental conditions, even familiar tasks can become challenging or unsafe.

Occupational therapy cognitive assessments serve multiple critical purposes that directly impact quality of life:

Establishing Meaningful Baselines: These assessments document current performance in processing speed, memory, safety awareness, judgement, and problem-solving. This baseline becomes essential for measuring progress and determining when someone has improved enough to resume valued activities.

Informing Individualised Treatment Plans: By identifying specific cognitive strengths and weaknesses, occupational therapists design targeted interventions. Rather than generic exercises, therapy addresses the precise skills needed for independence—whether that’s remembering medication schedules or sequencing steps to prepare breakfast.

Determining Safety and Independence: A comprehensive assessment reveals whether someone can live independently, what modifications might help, and what level of support they require. This information proves vital for families making difficult decisions about care arrangements.

Facilitating Team Communication: Assessment results provide a common language for physicians, neuropsychologists, educators, disability support coordinators, and family members. Everyone works from the same understanding of the person’s abilities and needs.

According to the American Occupational Therapy Association, cognitive impairments have a significant relationship to healthcare resource use, length of hospital stay, and long-term outcomes—making early, accurate assessment critical for optimising recovery trajectories.

Which Cognitive Assessment Tools Do Occupational Therapists Use Most Commonly?

A comprehensive global study of 323 occupational therapists revealed interesting patterns in assessment selection. The most frequently used standardised cognitive assessments in occupational therapy include:

Assessment Tool	Usage Rate	Primary Purpose	Administration Time
Canadian Occupational Performance Measure (COPM)	56.7%	Client-centred goal identification across self-care, productivity, leisure	30-40 minutes
Mini-Mental State Examination (MMSE)	54.2%	Cognitive screening across orientation, memory, attention, language	5-10 minutes
Montreal Cognitive Assessment (MoCA)	45.5%	Cognitive screening with superior sensitivity for mild impairments	10-15 minutes
Clinical Observation (non-standardised)	38.4%	Real-world functional performance assessment	Varies
Functional Independence Measure (FIM)	34.1%	Level of assistance required for daily activities	30-45 minutes
Barthel Index	31.6%	Independence in basic self-care tasks	15-20 minutes
Clock Drawing Test	30.3%	Visuospatial and executive function screening	2-5 minutes

The Canadian Occupational Performance Measure (COPM) dominates occupational therapy practice because it aligns perfectly with the profession’s client-centred philosophy. Rather than the therapist deciding what matters, the COPM empowers individuals to identify their priority areas for improvement. This assessment asks people to rate both their performance and satisfaction across activities they personally value—making goals immediately relevant and motivating.

The Montreal Cognitive Assessment (MoCA) has gained preference over the older MMSE because research demonstrates its superior sensitivity in detecting cognitive deficits, particularly in visuospatial and executive function, attention, and recall. The MoCA proves especially valuable for individuals who’ve experienced stroke or transient ischaemic attack, detecting impairments the MMSE might miss. However, administering the MoCA requires proper training and certification, which influences its adoption in some practice settings.

Functional Independence Measure (FIM) holds particular value for occupational therapists because it includes a cognitive subscale alongside physical function measures. This assessment quantifies the level of assistance someone requires for basic daily activities, providing concrete evidence for funding applications and support planning. Interestingly, FIM usage reaches 53.8% in Asia-Pacific regions compared with 31.9% elsewhere, reflecting different healthcare and documentation priorities across regions.

Beyond these common tools, occupational therapists employ numerous specialised assessments depending on the client’s specific needs and clinical presentation.

How Do Occupational Therapists Choose Between Different Assessment Approaches?

Cognitive assessments used in occupational therapy fall into two fundamental approaches, each offering distinct insights into functional ability.

Bottom-Up Approach: Measuring Specific Cognitive Components

The bottom-up approach examines cognition through the lens of individual cognitive components—memory, attention, information processing, and executive functions. These assessments identify which specific cognitive “building blocks” are impaired.

Examples include:

• Trail Making Test: Measures processing speed and cognitive flexibility by connecting numbered dots (Part A) then alternating between numbers and letters (Part B)
• Wisconsin Card Sorting Test: Assesses executive functioning and the ability to shift strategies when rules change
• Rivermead Behavioural Memory Test: Evaluates gross memory impairment and predicts everyday memory problems in people with acquired brain injury
• Stroop Colour and Word Test: Measures attention, processing speed, and the ability to inhibit automatic responses

Bottom-up assessments provide precise data about which cognitive systems are affected. However, they typically occur in clinical settings using abstract tasks that may not directly reflect real-world functioning.

Top-Down Approach: Evaluating Functional Performance

The top-down approach considers how cognition enables individuals to successfully engage in meaningful daily occupations—self-care, household management, work, leisure, and community participation. This involves observing actual task performance in natural environments.

Examples include:

• Kitchen Task Assessment (KTA): Client prepares a simple meal while the therapist observes sequencing, safety awareness, and problem-solving
• Executive Function Performance Test (EFPT): Evaluates executive skills through everyday tasks like preparing oatmeal, paying bills, taking medications, and using the telephone
• Performance Assessment of Self-Care Skills (PASS): Comprehensively assesses independence across functional mobility, personal care, and cognitive activities
• Kettle Test: Client prepares two cups of hot beverage with different ingredients, revealing functional cognitive capacity through a familiar task

Occupational therapists particularly excel at measuring functional cognition—assessing how cognitive abilities translate into everyday task performance. This specialisation makes occupational therapy assessment uniquely valuable for determining what support someone genuinely needs at home, work, school, or in community settings.

Research demonstrates that factors influencing assessment selection include availability at the workplace (79.6%), familiarity with the tool (65.9%), client-centred nature (61.0%), known reliability and validity (57.0%), and quick administration time (54.2%). Interestingly, experienced occupational therapists (10+ years practice) rely more on assessments with specific occupational therapy frameworks and demonstrated psychometric properties, whilst being less influenced by curriculum learning or speed of administration.

What Specialised Cognitive Assessments Address Specific Conditions and Populations?

Different conditions and life stages require tailored assessment approaches that match the individual’s circumstances and the questions needing answers.

Stroke and Acquired Brain Injury

Following stroke or traumatic brain injury, cognitive changes can be subtle yet significantly impact safety and independence. Specialised assessments for this population include:

The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) provides an in-depth profile of cognitive flexibility and strategy development, offering more detailed information than brief screening tools. Unlike assessments that generate a single numerical score, LOTCA creates a comprehensive cognitive profile that may prove a stronger predictor of functional outcomes.

The Confusion Assessment Method for the ICU (CAM-ICU) specifically assesses and monitors delirium in intensive care settings—critical because ICU delirium associates with increased mortality, longer hospital stays, elevated healthcare costs, and long-term cognitive impairment. Early identification allows prompt intervention.

Dementia and Older Adults

As Australia’s population ages, cognitive assessments for older adults have become increasingly important:

The Saint Louis University Mental Status (SLUMS) Examination incorporates clock drawing, animal naming, figure differentiation, orientation, memory, attention, and executive function tasks to detect mild cognitive impairment and dementia. Administration takes approximately 15 minutes, and free access versions exist, making it practical for diverse practice settings.

The LOTCA-G (geriatric version) features enlarged items to reduce difficulties related to visual or motor coordination issues common in older adults, whilst maintaining the comprehensive cognitive profiling that makes LOTCA valuable.

The Short-Blessed Test quickly screens for early cognitive changes related to Alzheimer’s disease or other dementias in older adults, with scores ranging from normal cognition through questionable impairment to impairment consistent with dementia.

Paediatric Populations

Children present unique assessment challenges because cognitive abilities develop continuously and expected performance varies dramatically by age:

The Bayley Scales of Infant and Toddler Development (Bayley 4) assesses children from one month to 42 months across five domains: cognition, language, motor skills, social-emotional development, and adaptive behaviour. This comprehensive tool identifies developmental delays early when intervention proves most effective.

The Dynamic Occupational Therapy Cognitive Assessment specifically targets children with learning difficulties, evaluating cognitive abilities within functional contexts relevant to childhood occupations.

Under the NDIS Early Childhood Approach, children under seven years may access occupational therapy support without requiring formal diagnosis, recognising that early intervention during critical developmental periods optimises outcomes.

Executive Function Impairments

Executive functions—planning, organisation, initiation, cognitive flexibility, and self-monitoring—prove essential for independence yet can be devastatingly impaired by various conditions:

The Behavioural Assessment of Dysexecutive Syndrome (BADS) uses everyday tasks to assess real-world executive functioning difficulties that standard cognitive tests might miss. Tasks simulate practical challenges like planning routes, searching for lost keys, and managing time.

The Executive Function Performance Test (EFPT) evaluates executive skills through activities of daily living, indicating capacity for independent functioning and the specific assistance needed. This shorter assessment typically requires about one hour but yields invaluable insights into whether someone can safely manage essential tasks independently.

How Do Cognitive Assessments Connect to NDIS Funding and Support Planning?

For individuals with cognitive impairments across Queensland, Victoria, New South Wales, and Tasmania, the National Disability Insurance Scheme (NDIS) provides crucial funding for occupational therapy services. Understanding how cognitive assessments connect to NDIS access and support proves essential for maximising available resources.

NDIS Eligibility for Cognitive Impairment

Individuals with cognitive impairment qualify for NDIS support when they meet three criteria:

Age Requirements: Under 65 years at the time of access request

Residence Requirements: Australian citizen, permanent resident, or protected Special Category Visa holder residing in Australia

Disability Requirements: Permanent disability significantly affecting participation in daily living, school, work, or social situations, where the person cannot participate effectively without assistive technology, equipment, home modifications, or assistance from others

Cognitive impairments from various sources—acquired brain injury, stroke, intellectual disability, dementia, neurodevelopmental conditions—may meet these criteria when they permanently and substantially impact functional capacity.

Occupational Therapy Assessment Within NDIS Framework

Occupational therapy services fall under “Improved Daily Living” within Capacity Building supports, focusing on building participants’ skills and independence. NDIS-funded occupational therapy assessments include:

• Functional Capacity Evaluations (FCE): Comprehensive 6-8 hour assessments (sometimes across multiple sessions) thoroughly evaluating ability to manage essential daily activities including mobility, self-care, social participation, and task management
• Home Safety Assessments: Identifying environmental modifications that enable safer, more independent functioning
• Assistive Technology Assessments: Determining equipment and technology needs that compensate for cognitive impairments
• Complex Care Evaluations: For participants with multiple, complex support needs
• Supported Independent Living (SIL) Assessments: Evaluating support requirements for shared living arrangements
• Specialist Disability Accommodation (SDA) Assessments: Determining housing design features needed to support independence

When NDIS Funds Cognitive Assessments

Whilst the NDIS generally doesn’t fund diagnostic assessments (considered health system responsibility), important exceptions exist:

Assessments to Inform Support Needs: When cognitive assessment information directly shapes the participant’s NDIS plan, tailoring supports to specific functional limitations, the NDIS may fund the assessment as “reasonable and necessary”

No Alternative Funding Available: When Medicare, private health insurance, or public health services cannot provide the required assessment, NDIS may fund it on a case-by-case basis

Early Childhood Approach: Children under seven years can access early intervention supports without formal diagnosis, with assessments focusing on functional impact and support needs rather than diagnostic labels

NDIS-recognised standardised assessment tools specifically mentioned in documentation include the Assessment of Motor and Process Skills (AMPS), Canadian Occupational Performance Measure (COPM), and Functional Independence Measure (FIM)—all tools that clearly link cognitive abilities to everyday functioning and support requirements.

Functional Capacity Assessments in NDIS Context

Functional Capacity Assessments become particularly relevant during several circumstances:

• Change of Circumstances: When significant health changes, living situation changes, or other major life events occur
• Ongoing Eligibility Evaluation: Periodic reviews of whether disability remains permanent and significantly impacts participation
• Insufficient Current Plan: When current NDIS supports prove inadequate for meeting reasonable and necessary needs
• Initial Access Request: Supporting the application for NDIS access with comprehensive functional information
• Plan Review or Reassessment: Informing plan renewals with current functional capacity data

These comprehensive assessments typically document cognitive abilities across multiple domains, safety awareness, capacity for independent living, and specific support needs—providing the evidence base for NDIS funding decisions.

What Benefits Does Home-Based Cognitive Assessment Offer?

mobile occupational therapy services delivering cognitive assessments in home and community environments offer distinct advantages over clinic-based testing, particularly relevant for services operating across Brisbane, North Lakes, Sydney, Melbourne, the Gold Coast, and the Sunshine Coast.

Observing Cognition in Natural Context

When cognitive assessments occur in someone’s actual home environment, occupational therapists observe real-world functioning rather than artificial clinic performance. This matters because cognitive abilities often manifest differently in familiar versus unfamiliar settings.

A person might successfully complete memory tasks in a structured clinic environment but struggle to remember essential steps when preparing breakfast in their own kitchen. Alternatively, someone might use compensatory strategies at home—calendar systems, medication organisers, environmental cues—that enable better functioning than clinic testing would predict. Home-based assessment captures these contextual factors that dramatically influence actual independence and safety.

Identifying Environmental Barriers and Enablers

Conducting cognitive assessments at home allows simultaneous evaluation of the physical environment. Occupational therapists identify:

• Safety Hazards: Unlocked doors someone with impaired judgement might wander through, stove controls someone with memory difficulties might leave on, cluttered pathways creating fall risks for someone with impaired safety awareness
• Environmental Supports: Existing modifications or natural features that compensate for cognitive limitations
• Modification Opportunities: Simple changes that could significantly enhance independence and safety—labels on cupboards, colour-coded medication systems, simplified kitchen organisation

This holistic perspective proves impossible in clinic settings yet proves essential for practical intervention planning.

Enhancing Family Understanding and Involvement

When family members observe occupational therapy assessment in the home environment, they gain invaluable insights into their loved one’s actual abilities and limitations. This shared understanding:

• Reduces family conflict arising from differing perceptions of capability
• Enables families to provide appropriately supportive assistance—neither over-helping nor under-supporting
• Facilitates family learning about effective strategies and modifications
• Builds realistic expectations about recovery trajectories and support needs

For ageing parents, adult children witnessing assessment firsthand often better accept difficult decisions about driving cessation, living arrangements, or financial management support.

Reducing Barriers to Assessment Access

Mobile services eliminate transportation barriers that prevent many people from accessing clinic-based assessment. For individuals with:

• Mobility Limitations: Physical disabilities making travel difficult or impossible
• Cognitive Impairments: Difficulty navigating unfamiliar routes or managing transport logistics independently
• Geographic Isolation: Living in rural or regional areas distant from major assessment centres
• Multiple Responsibilities: Caring responsibilities or other commitments making clinic attendance challenging

Home-based assessment removes these barriers whilst simultaneously providing richer, more ecologically valid information about functional cognition.

Telehealth Assessment Options

For some aspects of cognitive assessment, telehealth delivery proves increasingly viable. Secure video platforms enable:

• Initial information gathering and screening
• Specific cognitive tests administered via iPad or paper assessments visible to camera
• Feedback and recommendations delivery
• Remote coaching for family members and caregivers
• Ongoing monitoring and support between in-person visits

Telehealth assessment particularly benefits individuals in very remote areas of Queensland, Victoria, New South Wales, and Tasmania, extending specialist occupational therapy cognitive assessment to populations previously lacking access.

Moving Forward: Transforming Assessment Results Into Meaningful Support

Cognitive assessments used in occupational therapy serve as starting points rather than endpoints. The true value emerges when assessment results transform into individualised intervention plans that enhance independence, safety, and quality of life.

Following comprehensive cognitive assessment, occupational therapists work collaboratively with individuals, families, and support teams to:

Establish Measurable, Meaningful Goals: Rather than vague aims like “improve memory,” goals become specific and functional—”independently manage morning medication routine using compensatory strategies” or “safely prepare simple meals with environmental modifications.”

Develop Targeted Interventions: Therapy addresses the precise cognitive skills most affecting valued activities, whether that’s training in memory strategies, environmental modification to reduce cognitive load, or assistive technology to compensate for impairments.

Implement Compensatory Strategies: When cognitive abilities cannot be restored, occupational therapists excel at developing workarounds—external memory aids, simplified routines, environmental modifications—that enable someone to achieve their goals despite persistent impairments.

Monitor Progress and Adapt: Periodic reassessment tracks improvement, identifies emerging challenges, and allows intervention adjustment. This ongoing process ensures therapy remains relevant as needs evolve.

Facilitate Transitions: Assessment results inform safe discharge planning, return to work or school planning, driving evaluations, and care transition decisions.

The Australian Occupational Therapy Competency Standards explicitly require that occupational therapists “perform appropriate information gathering and assessment when identifying a client’s status and functioning, strengths, occupational performance and goals” whilst using “effective collaborative, multidisciplinary approaches for decision-making.”

This professional obligation ensures that cognitive assessments remain firmly centred on the questions that genuinely matter: What can this person do? What support do they need? How can we maximise their independence and participation in the activities they value?