Importance: When in-person rehabilitation is not feasible, interventions delivered in remote telephone-based sessions may be an option. Objective: To determine whether telephone-based reality orientation therapy (T–ROT) can improve cognition, mood, and neuropsychiatric symptoms among patients with major neurocognitive disorders (NCDs) who are forced to isolate and also whether T–ROT can relieve the burden of distress among their caregivers. Design: Nonrandomized interventional comparison study. Setting: Individual telephone calls between practitioners and patients and their caregivers. Participants: Twenty-seven patients (14 in the experimental group, 13 in the control group) with a major NCD and their primary caregivers. Intervention: Ten T–ROT sessions and a pretest–posttest neuropsychological evaluation over 4 wk. Outcomes and Measures: Outcomes measured included cognitive and behavioral symptoms of patients with major NCDs and correlations between changes in patient clinical condition and caregiver stress. Primary outcome measures were two measures of depressive symptoms, the Neuropsychiatric Inventory Questionnaire and the Telephone Mini-Mental State Examination, administered at baseline and program discharge. Results: T–ROT significantly outperformed nontreatment on all measures of depression, behavior, cognition, and caregiver burden. Conclusions and Relevance: T–ROT combined with emotional support appears to be an effective intervention for monitoring and managing the behavioral symptoms of patients with major NCDs who are forced to isolate. What This Article Adds: Occupational therapy practitioners can use T–ROT or similar procedures not only during a pandemic but also when it is not possible to treat patients in person at a hospital or at home. Telephone-based treatment may also represent a good practice to be integrated into traditional rehabilitation programs.

The Cognitive Performance Test (CPT) is a standardized occupational therapy assessment that examines cognitive integration with functioning in an instrumental activities of daily living context. Conventional cognitive measures provide diagnostic utility but do not fully address the functional implications. Ninety-one veterans diagnosed with cognitive impairment were evaluated. We compared the predictive value of the CPT with the Large Allen Cognitive Level Screen (LACLS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) for the need to retire from driving versus ability to pass an on-road exam. Measures were also analyzed by diagnostic classification. CPT correctly classified a mild versus major neurocognitive disorder, whereas MMSE, MoCA, and LACLS did not differentiate the groups. A CPT cutoff score of <4.7/5.6 showed 89% sensitivity for failing the road exam and 75% specificity for ability to pass. CPT discriminated functional level in neurocognitive disorders and had better predictive value for fitness to drive compared with conventional cognitive measures.