Geriatric Dynamic Loewenstein Occupational Therapy Cognitive Assessment

Authors: Katz, N., Erez, A.B.N., & Averbuch, S. 

Year of Publication: 2011 (original LOTCA 1996)

Publisher: Maddok

Type of Assessments: 

• Standardized

• Norm-referenced

• Performance-based

Cost: $420.00

How to Access: https://www.hospeq.com 

Age: Geriatrics (70+)*

Diagnoses: Alzheimer's, Progressive Dementia, Stroke, TBI, CVA, Non-specific populations at risk of cognitive decline

Setting: Acute care & rehab, outpatient neuro-rehab, SNFs, memory care units, home health, inpatient rehab

Areas Assessed:

• Orientation

• Awareness

• Visual Perception

• Spatial Perception

• Praxis

• Visuomotor Construction

• Thinking Operations

• Memory* (additional domain that is not present in adult version)

Time: 45 mins - 1.5 hrs (depends on mediation needed) - can be administered in more than one session if needed.

Group/Individual: Individual 

Subtests: 24 subtests within 8 cognitive areas  

Instructions: At the beginning of the session, the examiner should tell the client: "In our meeting, I'll ask you questions and also ask you to do things. Some of them are easy, and others are more difficult. Please answer or do what you know. If you have difficulties, I will help you."

• Should only offer help as it falls within the means of mediation and not during the initial structured phase.

• Read instructions exactly as they are written in the manual to abide by standardized processes

• Administration notes are recorded - prompts required, attention, length of time required, & trial and error

• Structured (Static) Phase:

  • Performance should be observed and scored without prompting or assistance

• Dynamic (Mediated) Phase:

  • On tasks that the client presents difficulty with during the static phase will be redone through mediation where a graded cueing system is utilized to include general encouragement and focusing attention.

  • The amount of mediation needed is required as well as the client's responsiveness

• This will be repeated through all eight subtests

• Tasks are adapted to reduce demands of hearing, vision and motor skills

• Tasks are adjusted or simplified (i.e. using larger images or reduced complexity)

Materials: 

• Battery kit

• Manual

• Test booklet

• CD with computerized scoring

• 5 paper score sheets

• Card set 

• Photo book

• 8.5 x 11" sheet of paper

• 3-5/8 x 6-1/2" envelope

• Comb 

• Safety scissors

• Small jar with 5 pegs

• Blue shape set - 1 circle, 1 square, 2 triangles, peg board, 10 pegs,

• No.2 pencil/pen

• Orange 1 x 1 x 1" 2, block

• Blue 1 x 1 x 1" block

• Yellow 1 x 1 x 1" block

• Green 1 x 1 x 1" 3 block

• 9-piece butterfly puzzle

• Toothbrush

• Sequencing card set

• Handkerchief

• Candle

• Salt shaker

• Coin

• Large button

• Ring

• Blank key

• Playing card with large print

User Qualifications: Ability to make sound clinical judgments

How to Score: Each of the seven cognitive domains is assessed through structured subtests. 

• Each subtest has a predetermined scoring system (usually from 1 to 4 or 1 to 5) which reflects the person’s baseline performance without cues

  • 1 = Severe impairment or cannot perform

  • 2 = Moderate difficulty

  • 3 = Mild difficulty

  • 4 = Normal or independent performance

• After the initial attempt (structured score), the examiner provides graded cues or mediation to assess the client's learning potential and cognitive modifiability

  • The mediation is scored based on how much assistance was needed:

    • Minimal → Moderate → Maximal

  • Or coded from 1 (low responsiveness) to 5 (high responsiveness)

• No total scores are identified

Score Indications: Higher structured scores indicate greater cognitive ability and performance. Dynamic scores indicate the level of assistance needed to complete tasks, with lower scores indicating minimal assistance while higher scores indicate maximal assistance needed. Areas of strengths & limitations are identified.

Reliability: 

• Interrater: High - r=0.98

• Internal Consistency: High - Cronbach's = .683-.846 (except for Memory = .260)

Validity: 

• Criterion: r =.68-.78

• Construct: showed significant differences between groups of healthy elderly adults and stroke & dementia patients and accounted for age-related decline in cognitive function

Responsiveness:

• Large effect size for visual perception & spatial perception in acute stroke patients

• Moderate effect size was found in praxis, visuomotor construction, & thinking subtasks in acute stroke patients 

Strengths:

• Modifications for elderly client's accounts for age-related cognitive decline and sensorimotor difficulties

• The dynamic portion of the assessment can be helpful in the development of cognitive remediation interventions for the plan of care

• Static & dynamic scores provide a holistic view of what a person can do now and how much they can improve with guidance

• Covers multiple cognitive domains to be applicable to many conditions that experience cognitive deficits

• Accounts for age-related changes in elderly, more at-risk populations for cognitive deficits

• Norms are based on older adults specifically to fall more appropriately with dementia & age-related decline*

Weaknesses:

• Time-consuming which can be daunting and frustrating for clients with cognitive deficits - but requires less time than the adult version

• Not applicable to children and adolescents

• Very costly

• Low internal consistency on the memory subscale

• Asher, I. E. (2014). Asher’s occupational therapy assessment tools: An annotated index (4th ed.). AOTA Press.

• Katz, N., Averbuch, S., & Bar-Haim Erez, A. (2011). Dynamic Loewenstein Occupational Therapy Cognitive Assessment–Geriatric (DLOTCA–G). Pequannock, NJ: Maddak Inc.

• Katz, N., Averbuch, S., & Bar-Haim Erez, A. (2012). Dynamic Loewenstein Occupational Therapy Cognitive Assessment-Geriatric Version (DLOTCA-G): Assessing change in cognitive performance. American Journal of Occupational Therapy, 66 (3), 311–319. http://dx.doi.org/10.5014/ajot.2012.002485 

• Shirley Ryan Ability Lab. (2024, January 14). Dynamic Lowenstein occupational therapy cognitive assessment. https://www.sralab.org/rehabilitation-measures/dynamic-lowenstein-occupational-therapy-cognitive-assessment 

• DLOTCA-G. (n.d.). Maxi Aids. Retrieved May 6, 2025, from https://www.maxiaids.com/product/dlotca-g