Functional Cognition: Distinct From Fluid and Crystallized Cognition?

IMPORTANCE: Functional cognition is emerging as a professional priority for occupational therapy practice. It is important to understand how it relates to other established cognitive constructs, so that occupational therapists can demonstrate their unique contributions. OBJECTIVE: To examine whether functional cognition is a construct that is distinct from crystallized and fluid cognitive abilities. DESIGN: Secondary analysis of data collected from a cross-sectional study. SETTING: Community. PARTICIPANTS: Adults with spinal cord injury, traumatic brain injury, or stroke (N = 493). OUTCOMES AND MEASURES: The National Institutes of Health Toolbox Cognition Battery and the Executive Function Performance Test. RESULTS: We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to investigate the factor structure of cognition. EFA identified three factors representing crystallized, fluid, and functional cognition. CFA revealed a second-order model in which the three cognitive constructs contribute hierarchically to a general cognitive factor. CONCLUSIONS AND RELEVANCE: This study provides important and timely evidence for establishing functional cognition as a unique construct that is distinct from executive function as well as from fluid and crystallized cognition. Functional cognition is central to performance in daily activities, and its use will ensure that occupational therapy services support continued recovery and community reintegration. What This Article Adds: This study supports occupational therapy professionals in establishing the profession's role in evaluating and treating deficits of functional cognition to support patients' return to desired occupations in the family, workplace, and community.