A systematic review of 34 articles was conducted to answer the following clinical questions posed by Joette Jindra, the Director of Rehabilitation, at ManorCare of Tacoma: “Which cognitive screen, out of the four we are currently using, most accurately measures a patient's functional cognitive performance?” and “How well do cognitive tools and measures predict a client’s discharge setting from a skilled nursing facility (SNF)?”. Results indicate the Montreal Cognitive Assessment (MoCA) to be the most clinically useful tool for detecting mild cognitive impairment (MCI) as it demonstrated the greatest sensitivity across studies and diagnoses. The evidence did not support the use of the Mini Mental State Examination (MMSE) as it has low sensitivity to detect MCI across diagnoses. There is limited psychometric data available regarding the St. Louis University Mental Status Exam (SLUMS) and Allen Cognitive Level Screen (ACLS). Additionally, the research suggests a relationship between clients’ cognitive functioning and their discharge location. It is recommended that ManorCare change their cognitive screening protocols, requiring all patients to be screened using the MoCA as opposed to the MMSE, SLUMS, or ACLS based on the available evidence. This will ensure client safety and detection of mild to severe cognitive impairment when present. New research pertaining to the SLUMS and ACLS should be monitored as this may affect the current recommendation.

To translate knowledge and support the implementation of evidence-based practice, a 30 minute in-service was delivered during which the research process and findings were presented to a team of 15 rehabilitation professionals. Additionally, an informational MoCA resource packet was provided and discussed. Pre- and post- in-service surveys were conducted to determine the impact of the in-service presentation. Analysis of survey responses indicated the in-service and informational resource packet to be effective knowledge translation activities. It is recommended that a follow-up implementation study be conducted by graduate students at the University of Puget Sound to determine the extent that policy changes are adopted by ManorCare and to develop a chart review research project to examine the connection between patient MoCA scores and discharge settings.

Publication Place

Tacoma, Washington


University of Puget Sound

Project Chairperson

Sue Doyle, PhD, OTR/L, CFE

Project Chairperson

Publication Date



Capstone Project





Degree Program

Occupational Therapy

Degree Level

Master of Science


Occupational Therapy


University of Puget Sound

T11_Backinskaya-page1.pdf (234 kB)
Capstone Approval