Use of the Allen’s Cognitive Test for Identifying Dementia

There are numerous ways to measure cognitive factors. The Allen Cognitive Test is an internationally accepted tool, a simple and at the same time powerful. It helps understand a person’s level of cognitive function and thus provides opportunities for making his or her best abilities function properly. For several decades, occupational therapists have been widely using it as a standardized initial procedure when dealing, primarily, with patients with dementia.

The Allen Cognitive Level Test assesses a person’s ability to function independently, which includes not only performing basic skills in everyday life, but also taking decisions and learning something new. The whole idea is to determine and improve the so-called adaptive functioning of people with dementia.

The first version of this cognitive test was proposed in 1985 by the team headed by Claudia K. Allen, and there have been several modifications since then.

Unlike many other tests designed to assess cognition, the Allen Cognitive Test does not imply asking questions or doing a paper test. A person is to carry out some sewing tasks using a special tool (the ACLS that stands for the Allen Cognitive Level Screen) which consists of a piece of leather punched along the edges, a large needle and a leather string one side of which is light and the other is dark.

The tasks are of different levels of complexity:

  • making running stitches;
  • making whipstitches;
  • error correcting;
  • making cordovan stitches.

They should be fulfilled in this very order, which means from the simplest to the most complex one, each time requiring a higher level of understanding

In the first two cases, before asking the client to make several of those stitches, the person who conducts the cognitive test shows how to perform them.

Apart from the fact that whipstitches are more complicated, the person who undergoes the testing should avoid twisting the string and keep it with the light side faced up.

Then the test administrator makes several stitches, one of them incorrectly (the so-called cross-in-the-back error). The client is to identify the error and fix it. Then he or she is supposed to identify the twisted lace and fix it as well.

What concerns the cordovan stitch, the process of its making is not demonstrated. The client is to look at the completed stitch and to copy it.

A 25-point scale is used for scoring. While scoring, the test administrator takes into account the complexity of the task and the quality of its performance.

Allen Cognitive Levels and Dementia

The results of the test are assessed on the basis of the cognitive levels, also developed by Claudia K. Allen. The scale from zero to six refers to different abilities and, accordingly, lists specific care and supervision needed in daily life. The results of the Allen Cognitive Level Screen cannot be lower than 3.0 as long as people participate in it. The highest score in the ACLS is 5.8, not 6, because this cognitive test does not assess in full whether people can plan for the future or not.

People who reach this score can function well when living on their own. They may need some education on such issues as the prevention of injuries, positioning of the body, etc., especially as they are still capable of learning something new.

Persons with dementia who obtain less than 5.8 need assistance the range of which varies greatly. It may be weekly help with just a few activities, periodic help about the house or round-the-clock home care (levels 3.0-3.8, for example).

The peculiarity of the Allen Cognitive Test is that it focuses not on memory and communication skills but on the following issues:

  • identifying cognitive impairments characteristic of various types of dementia;
  • assessing a person’s ability to function;
  • determining how much help he or she needs;
  • giving practical advice on how to assist such people so as to maximize their cognitive and performance abilities.

Research shows that results of the ACLS are quite reliable and measure well with the actual level of people’s daily performance.

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