10-18

19-24

25-34

35-44

45-54

55-64

65+

No Age

3

4

10

1

4

3

0

1

Birth Sex:

Gender Identity:

Percent or Average (+/- SD)

SLEEP:

Number of Hours

6-8 hours

65.38%

8-10 hours

15.38%

<6 hours

11.54%

>10 hours

7.69%

FATIGUE:

(1=not tired at all to 5=extremely tired)

2.04 (0.71)

PAIN:

(1=no pain at all to 5=worst pain ever)

1.20 (0.49)

ANXIETY:

(1=no anxiety to 5=extremely anxious)

1.68 (0.73)

MOOD:

(1=sad, depressed to 10=awesome, great)

7.80 (1.77)

Functional Cognitive Skill

Description

Percent or Average (+/- SD)

1.Temporal Awareness – To Time of Day

Time of day of assessment – morning, afternoon or evening.

Time of day correct:

88% yes (0.33)

2. Memory - Immediate- Verbal

Remember a five-item grocery list.

Version A (46.15% norm sample) Grocery items immediately recalled: Number of trials to recall all 5 words:

Version B (30.77% norm sample) Grocery items immediately recalled: Number of trials to recall all 5 words:

Version C (23.08% norm sample) Grocery items immediately recalled: Number of trials to recall all 5 words:

4.5/5 (0.52)

1.5 (0.5)

4.8/5 (0.46)

1.38 (0.48)

4.7/5 (0.82)

1.2 (0.4)

3.Numerical Problem Solving

Solve eight math questions without using paper or calculator (two addition, two subtraction, two multiplication, two division).

Version A (61.54% norm sample)

Number Correct:

Time to Complete:

Required repetition of questions: Number of repetitions:

Version B (23.08% norm sample)

Number Correct:

Time to Complete:

Required repetition of questions: Number of repetitions:

Version C (11.54% norm sample)

Number Correct:

Time to Complete:

Required repetition of questions: Number of repetitions:

7.7/8 (0.48)

47.5s (20.38)

25% yes (0.43)

1 (0)

7.2/8 (1.17)

64.5s (35.98)

16.67% yes (0.37)

1 (0)

7.3/8 (1.15)

53.7s (15.17)

33.33% yes (0.47)

1 (0)

Functional Cognitive Skill

Description

Percent or Average (+/- SD)

Version D (3.85% norm sample)

Number Correct:

8/8 (0)

Time to Complete:

51.0s (0)

Required repetition of questions:

0% yes (0)

Number of repetitions:

0 (0)

4.Simple Instructions

Follow short, three step instructions to complete in order.

Version A (65.38% norm sample)

Number Correct: In Order: Impulsive Start:

3/3 (0)

100% yes (0)

100% no (0)

Version B (34.62% norm sample)

Number Correct: In Order: Impulsive Start:

2.9/3 (0.33)

88.89% yes (0.33)

100% no (0)

5.Judgement for Safety

Identified in a given scenario what the worst was that could happen (foresight) and what to do if it does (insight).

Version A (57.69% norm sample)

Situation 1

Identified worst that can happen:

100% yes (0)

Identified what to do if worst happens:

1.3/2 (0.49)

Situation 2 

Identified worst that can happen:

100% yes (0)

Identified what to do if worst happens:

1.4/2 (0.51)

Responses demonstrated reasonable judgement for

safety?

93.33% yes (0.25)

Version B (42.31% norm sample)

Situation 1

Identified worst that can happen:

100% yes (0)

Identified what to do if worst happens:

1.5/2 (0.52)

Situation 2 

Identified worst that can happen:

100% yes (0)

Identified what to do if worst happens:

1.7/2 (0.48)

Responses demonstrated reasonable judgement for

safety?

81.82% yes (0.39)

Functional Cognitive Skill

Description

Percent or Average (+/- SD)

6.Comprehension

Explain the point of a story, its sarcasm/humour, and meaning of an idiom.

Understood situation and humor: Understood sarcasm: Understood idiom:

Required repetition of parts of the story:

96.15% yes (0.19)

100% yes (0)

96.15% yes (0.19)

100% no (0)

7.Memory - Delayed - Verbal

Remember the five items that were on their grocery list after a delay.

Version A (46.15% norm sample)

Grocery items recalled after delay:

Version B (30.77% norm sample)

Grocery items recalled after delay:

Version C (23.08% norm sample)

Grocery items recalled after delay:

4.3/5 (.89)

4.3/5 (1.49)

4.5/5 (0.55)

8.Decision Making

Able to identify a problem or issue and discuss options and considerations/factors in making the decision.

Version A (69.23% norm sample)

Identified the problem/issue:

Cueing Required:

Identified at least three options:

Cueing Required:

Provided at least three logical considerations or factors on how to make the decision:

Cueing Required:

During this activity, client demonstrated: Tangential thinking:

Impulsivity:

Concrete thinking:

Version B (30.77% norm sample)

Identified the problem/issue:

Cueing Required:

Identified at least three options:

Cueing Required:

Provided at least three logical considerations or factors on how to make the decision:

Cueing Required:

94.44% yes (0.24)

83.33% no (0.37)

100% yes (0)

94.44% no (0.23)

88.89% yes (0.32)

66.67% no (0.47)

7.69% yes

0% yes

92.31% yes

100% yes (0)

42.86% no (0.49)

75% yes (0.46)

50% no (0.5)

75% yes (0.46)

37.5% no (0.48)

Functional Cognitive Skill

Description

Percent or Average (+/- SD)

During this activity, client demonstrated:

Tangential thinking:

16.67% yes

Impulsivity:

0% yes

Concrete thinking:

83.33% yes

9.Abstract Thinking

- Understanding the Big Picture

Identified the lesson of a short story.

Version A (50% norm sample)

Understood main lesson:

Required repetition of parts of the story:

100% yes (0)

100% no (0)

Version B (50% norm sample)

Understood main lesson:

Required repetition of parts of the story:

84.62% (0.38)

84.62% (0.36)

10,Prioritizing

Determine which of two activities at a certain time of day is more important to do first.

Identified correct priority:

2.8/3 (0.43)

11.Temporal Awareness – to Time Passed

Time elapsed since start of assessment.

Time Elapsed Within 5 minutes: Time Elapsed Within 10 minutes:

Time Elapsed Outside of 10 minutes:

84.62% (0.49)

11.54% (0.49)

3.85% (0.49)

12.Functional Math

Calculate amount of change to expect back when paying for an order with a $20 or $10 bill.

Version A (69.23% norm sample)

Number Correct:

2/2 (0)

Version B (30.77% norm sample)

Number Correct:

2/2 (0)

13.Abstract

Sorted 18 everyday items into five categories.

Thinking - To Categories

Version A (65.38% norm sample)

Number items categorized correctly:

18/18 (0)

Version B (19.23% norm sample)

Number items categorized correctly:

17.2/18 (1.3)

Functional Cognitive Skill

Description

Percent or Average (+/- SD)

Version C (7.69% norm sample)

Number items categorized correctly:

18/18 (0)

Version D (7.69% norm sample)

Number items categorized correctly:

18/18 (0)

14.Complex Instructions

Remember multi-step directions to get from the hotel lobby to their hotel room.

Version A (73.08% norm sample)

Number of steps in the directions recalled: Recalled in correct order?

6.6./8 (1.42)

94.74% yes (0.23)

Version B (26.92% norm sample)

Number of steps in the directions recalled: Recalled in correct order?

6/8 (2.08)

71.43% yes (0.49)

15.Memory - Prospective - Verbal

Remember to put on their calendar an appointment from voicemail earlier in assessment.

Recalled the need to put appointment on calendar:

100% yes (0)

Version A (65.38% norm sample)

Number of details recalled:

2.8/3 (0.39)

Version B (34.62% norm sample)

Number of details recalled:

2.8/3 (0.67)

16.Abstract Thinking - Themes

Identified the common theme to six words presented one at a time as soon as they knew.

First Round

Number of Clues Read: (where after 1 clue = 5; after 6 =0) Number of Incorrect Guesses:

Correct response:

3.4/5 (0.86)

95% = 0 incorrect (0.22)

100% yes (0)

Second Round

Number of Clues Read: (where after 1 clue = 5; after 6 =0) Number of Incorrect Guesses:

Correct response:

2.4/5 (1.08)

75% = 0 incorrect (0.62)

96.15% yes (0.20)

17.Mental Flexibility

Name as many items in a category as they can in 60 seconds.

21.08 (4.82)

0.6 (1.2)

First Round

Number of Correct Items: Number of Errors:

Functional Cognitive Skill

Description

Percent or Average (+/- SD)

Second Round

Number of Correct Items: Number of Errors:

11.61 (3.87)

0.65 (0.91)

Able to think of more than 10 items for first round and more than 6 items for second round without more than a couple of errors for each category:

96.15% yes (0.39)

18.Memory -

Remember the details of a short lecture on a topic.

Immediate - Verbal - Complex, Novel

Version A (73.08% norm sample)

Number of details immediately recalled:

13.6/23 (3.83)

Version B (26.92% norm sample)

Number of details immediately recalled:

12/23 (3.06)

19.Memory - Prospective - Verbal - Cued

Remember to say a certain phrase when they hear the health provider say a certain phrase.

Client remembered to say correct phrase:

96.15% yes (0.20)

20.Attention

Client able to attend and focus on the assessment process without getting distracted.

Health Provider Response:

92.3% yes (0.27)

21.Communication

Client’s ability to communicate during the assessment

negatively impacted overall performance.

Health Provider Response:

96.15% no (0.20)

22.Memory - Immediate - Overall

Immediate memory challenges negatively impacted overall performance.

Health Provider Response:

96.15% no (0.20)

23.Impulsivity

Impulsivity negatively impacted overall performance.

Health Provider Response:

100% no (0)

24.Information Processing Speed:

Slower processing speed negatively impacted overall performance.

Health Provider Response:

96.15% no (0.20)

Functional Cognitive Skill

Description

Percent or Average (+/- SD)

25.Mood Fluctuations

Mood fluctuations observed over the course of the assessment.

Health Provider Response:

96.15% no (0.20)

26.Endurance:

Decreased endurance observed over the course of the assessment.

Health Provider Response:

92.31% no (0.27)

Average Number of Challenges (+/- SD)

Average Number of Potential Challenges (+/- SD)

0.44 (0.58)

1.07 (1.45)