Cog-Log Syllabus

The Cog-Log does not require any materials, so it is very easy to administer. The patient must be able to follow verbal instructions and communicate at a basic level. One of the items requires modest visual acuity. The Cog-Log can take up to 15 minutes to complete for a confused patient who requires correcting and prompting, but a patient who performs well can complete the screening in 5 minutes. The items of the Cog-Log include the three most difficult items from the O-Log (name of facility, date, and time of day), as well as items requiring concentration, memory, and executive skills. These are areas that are maximally affected in most cases of severe TBI. Two items assess immediate and delayed recall for a short address (e.g., Sally Jones, 23 North Boulevard, Seattle) using the scale developed by Katzman, et al. as a model. Patients are also asked to count backwards from 20, recite the months in reverse order, and estimate when 30 seconds has passed. Two motor tasks involving hand gestures – a movement sequence (fist-edge-palm praxis) and a response inhibition task (go/no-go) – are also included.

Experience with both the O-Log and Cog-Log suggests that administration of the Cog-Log is very difficult and of minimal value for patients scoring less than 15 on the O-Log. The typical procedure at Spain Rehabilitation Center is to begin administering the O-Log upon admission of a patient and add the Cog-Log when the O-Log score reaches 15. The O-Log is discontinued and the Cog-Log administered alone when an O-Log score of 25 or greater has been achieved for 2 administrations in a row. The Cog-Log can be administered each day of the week, if desired. At Spain Rehabilitation Center the Cog-Log is typically administered 3 times a week during morning rounds (between 7:00 and 8:00 a.m.).

Each of the 10 items of the Cog-Log is scored from 0 to 3. The 3 orientation items (name of facility, date, and time of day) are scored in the same manner as on the O-Log. A spontaneous correct response receives 3 points, a correct response after cueing receives 2 points, a correct response when given multiple choices is given 1 point, while a score of zero is reserved for those still unable to provide a correct response after being given multiple choices. Instructions and scoring for the other items of the Cog-Log are as follows:

Repeat an address:
Instructions—I am going to read a name and address to you. When I finish I would like you to repeat the name and address back to me. This is not a person that you know. This is a check on your memory. There is a different name and address for each day of the week (see below). After the first response, say I am going to read you that name and address again. After the second response, say One more time, and repeat the address again, followed by the third response.
Scoring—3 points for correct repetition of the address 3 times; 2 points for correct repetition two times; 1 point for correct repetition once; 0 points for no correct repetition in three attempts.

Counting backwards from 20 to 1:
Instructions—I would like you to count backward from 20 to 1 (if the patient seems confused, it is acceptable to demonstrate by saying 20, 19, 18, and so forth).
Scoring—3 points when done without error (time is not a factor); 2 points if there is one error that is not self-corrected (a number is omitted or out of sequence, or a cue is required for the patient to continue); 1 point if there are two errors that are not self-corrected; 0 points if there are 3 or more errors.

Reciting the months of the year in reverse order:
Instructions—Please say the months of the year in reverse order beginning with December (if the patient seems confused, it is acceptable to demonstrate by saying December, November, and so forth).
Scoring—3 points when done without error (time is not a factor); 2 points if there is one error that is not self-corrected (a month is omitted or out of sequence, or a cue is required for the patient to continue); 1 point if there are two errors that are not self-corrected; 0 points if there are 3 or more errors.

Estimating the passage of 30 seconds:
Instructions—I would like you to estimate when 30 seconds has passed. That is half a minute. I will say “Go” and you are to say “Stop” when 30 seconds have passed. After saying “Go” remind the patient by saying, Tell me when 30 seconds have passed.
Scoring—3 points for an estimate of 25 to 35 seconds; 2 points for an estimate of 20-24 seconds or 36-40 seconds; 1 point for an estimate between 15 and 19 seconds or 41 and 45 seconds; 0 points for an estimate between 1 and 14 seconds or if there is no response by 45 seconds.

Completing a motor sequence of fist-edge-palm with the hand:
Instructions—Please watch what I do with my hand. Notice the sequence of movements, beginning with this one. Hold your hand in the position of a fist for 2 seconds, transition to your hand being extended and vertical for 2 seconds, and then transition to the hand being extended with the palm downward for 2 seconds. I’m going to do that again, so watch carefully. Demonstrate the hand motions again. Now you try that. After the patient demonstrates the motion, say Please do it again in the same sequence I showed you.
Scoring—3 points for successful demonstration of the action accurately and in sequence 3 times; 2 points for 2 correct demonstrations; 1 point for 1 correct demonstration; 0 points for no accurate demonstrations in three attempts.

Raising the forefinger to “red” and doing nothing to “green” (go/no-go):
Instructions—When I say the word “red” I want you to raise your finger like this (demonstrate). Then you can put it back down (demonstrate). When I say “green” don’t do anything (demonstrate by holding your fist in a closed position). Some patients requiring repeated prompting to put a finger down once it is raised. This is not an error, but is worthy of noticing as an example of perseveration. Give the instruction in the following order: red, green, red, red, green, green.
Scoring—3 points for a correct response to each stimulus presented 3 times; 2 points for correct response on 4 or 5 of the stimulus presentations; 1 point for a correct response to 2 or 3 stimulus presentations; 0 points for 1 or 0 stimulus presentations.

Address recall:
Instructions—Do you remember the name and address I read to you earlier? I want you to recall that information now. If the person is unable to generate any accurate recall a prompt is given, which is the full name of the person in the address.
Scoring—3 points for accurate recall of the full name and address; 2 points for partial recall, such as the name, street address, or city, even if accompanied by inaccurate information; 1 point if accurate recall of the street address or city is prompted by the examiner providing the person’s name; 0 points if there is no accurate recall even after the prompt.
The following addresses are used for each day of the week:
Monday—John Brown, 42 Market Street, Chicago
Tuesday—Tim Smith, 84 Center Ave., Cleveland
Wednesday—Sally Jones, 23 North Blvd., Seattle
Thursday—Bill Jackson, 16 Maple Court, Houston
Friday—Judy Wilson, 75 Ocean Ave., Baltimore
Saturday—Bob Taylor, 37 Main Street, Los Angeles
Sunday—Susan Anderson, 58 River Road, Atlanta