Cognitive Log

Last Updated

November 28, 2012

Purpose

The Cog-Log measures general cognitive abilities in a cursory way, designed to be used as a companion to the Orientation-Log (O-Log).

Link to Instrument

Instrument Details

Acronym Cog-Log

Cost

Free

Diagnosis/Conditions

Brain Injury Recovery

Brain Injury

The Cog-Log includes the 3 most difficult orientation items from the O-Log, and 7 additional items that test other cognitive abililty:
1) (O-Log) Name of facility
2) (O-Log) Date
3) (O-Log) Time of day
4) Repeat an address
5) Counting backwards from 20 to 1
6) Reciting the months of the year in reverse order
7) Estimating the passage of 30 seconds
8) Repeat a motor sequence (fist-edge-palm)
9) Raising finger to “red” and do nothing to “green”
10) Address recall
Each item is scored from 0 to 3 based on specific criteria per item with score of 3 if the spontaneous response is correct; 2 if a correct response requires cueing; 1 if a correct response requires multiple choice; 0 if a correct response is not obtained. Total score ranges from 0 to 30.
Administration instructions are described on the COMBI website (see link above).

Number of Items

Stopwatch
Scoresheet includes a graph where serial assessments can be plotted for visual analysis

10 minutes

5-10 minutes depending on patient's performance

Required Training

No Training

Instrument Reviewers

Initially reviewed by Karen McCulloch, PT, PhD, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 6/2012.

ICF Domain

Body Structure
Body Function

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

HR	Highly Recommend
R	Recommend
*LS / UR*	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations based on level of care in which the assessment is taken:

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

Recommendations for use based on ambulatory status after brain injury:

	Completely Independent	Mildly dependant	Moderately Dependant	Severely Dependant
TBI EDGE	N/A	N/A	N/A	N/A

Recommendations for entry-level physical therapy education and use in research:

Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
TBI EDGE	No	No	Yes	Not reported

Considerations

Developers are clear that they do not intend the Cog-Log to replace or substitute for neuropsychological testing or other cognitive performance scales, suggesting the Cog-Log is a simple tool that can easily be used bedside to track progression of orientation and cognitive improvements. The test can be done without writing, which is sometimes a problem for other cognitive tests.

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Standard Error of Measurement (SEM)

Aquired Brain Injury: (Alderson and Novack, 2003; n=82 patients with brain injury and 82 controls matched for age, education and gender; total sample included 150 patients with ABI, 80% moderate to severe, mean age 45(18.7) years)

SEM no more than .10 for single item scores, which range from 0 to 3
SEM for the total score of .53 (ranges 0 to 30).

Cut-Off Scores

Acquired Brain Injury: (Alderson & Novack, 2003)

A cut-off score of 25 correctly classified 88.4% in the appropriate group (brain injury vs. controls)

Normative Data

Healthy controls: (Alderson & Novack, 2003; n=83 young adults, mean age 22.73 (5.82) years without ABI)

Mean =28 (2) with mean individual item scores > 2.4

Interrater/Intrarater Reliability

Acquired brain injury: (Alderson & Novack, 2003; subset of 19 patients with 75 observations)

Adequate to excellent inter-rater reliability with Spearman’s rho coefficients ranging from .749 (go/no-go task) to 1.0 (time estimation)

Internal Consistency

Acquired Brain Injury: (Alderson & Novack, 2003)

Excellent internal consistency (Chronbach’s alpha= .778)

Criterion Validity (Predictive/Concurrent)

Criterion validity:

Aquired Brain Injury: (Penna et al, 2007; n=45 patients with moderate to severe ABI in inpatient rehabilitation; mean age=39.7(18.5) years)

Cog-Log correlates significantly with the MiniMentalStateExam r=.75, and with the O-Log r=.65

Predictive validity:

Traumatic Brain Injury: (Lee et al, 2004; n=50 patients with TBI, mean age 35.2(14.9) years)

Lowest Cog-Log scores during acute rehab for patients with moderate to severe TBI predicted cognitive outcome at one year post-injury for:
- Attention (delta r2=.10)
- Executive function (delta r2=.11)
- Visuomotor/spatial function (delta r2=.16)

Construct Validity

Construct Validity:

Acquired Brain Injury: (Alderson & Novack, 2003)

Cog-Log scores significantly associated with neuropsych measures of verbal and working memory, and executive function (p=.004-<.001)

Content Validity

Traumatic brain injury:

Factor analysis demonstrated loading on a single factor with eigenvalue 3.48, which authors attributed to complex working memory and long term recall. (Alderson & Novack, 2003)

Face Validity

Acquired Brain Injury: (Alderson and Novack, 2003)

Items of the Cog-Log are very similar to those described by Katzman et al, 1983, validated as a short cognitive test for older adults.

Floor/Ceiling Effects

Acquired Brain Injury: (Alderson and Novack, 2003)

Not specifically studied, but developers suggest it is best not to use Cog-Log unless O-Log score is 15 or greater (possible floor effect with Cog-Log if individual is too confused)
If O-Log score is between 15 and 25, use the O-Log and Cog-Log together
Once O-Log score is 25 or greater for 2 test administrations, the Cog-Log can be used by itself
The use of cuing and multiple choice responses is cited as a benefit to reduce floor effects, since partial credit is possible for responses based on cuing

Bibliography

Alderson, A. L. and Novack, T. A. (2003). "Reliable serial measurement of cognitive processes in rehabilitation: the Cognitive Log." Arch Phys Med Rehabil 84(5): 668-672. Find it on PubMed

Katzman, R., Brown, T., et al. (1983). "Validation of a short Orientation-Memory-Concentration Test of cognitive impairment." Am J Psychiatry 140(6): 734-739. Find it on PubMed

Lee, D., LoGalbo, A. P., et al. (2004). "Prediction of Cognitive Abilities 1 Year Following Traumatic Brain Injury From Inpatient Rehabilitation Cognitive Screening." Rehabilitation Psychology 49(2): 167.

Penna, S. and Novack, T. A. (2007). "Further validation of the Orientation and Cognitive Logs: their relationship to the Mini-Mental State Examination." Arch Phys Med Rehabil 88(10): 1360-1361. Find it on PubMed