Menu Task

Last Updated

January 25, 2023

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Purpose

The Menu Task is a brief performance-based screening assessment to identify clients with functional cognitive deficits. It was designed to be used in acute or post-acute settings to determine those at risk for functional cognitive deficits limiting instrumental activities of daily living performance necessary for independent community living.

Link to Instrument

https://kinesiology.education.wisc.edu/research/dorothy-edwards-research/the-menu-task/

Acronym MT

Area of Assessment

Cognition

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

CDE Status

Not a CDE—last search performed 8/1/2023.

Older Adults and Geriatric Care

Examiner provides the participant with a written list of rules about making meal selections on a sample menu for breakfast, lunch and dinner. The participant must make their selections while adhering to the set of rules. The participant must also follow a set of behavioral rules as indicated on the instructions as well (e.g. not speaking to the examiner during the test).
The instrument is timed, however time to complete the task does not affect scoring.
While not scored, the participant is asked to rate how they anticipate and to rate their performance before and after the task. They are also asked if they made any errors and, if so, to identify what errors they made.
Total score is based on 12 items (7 for client task error and 5 for client initiation and inhibition errors). The scale for scoring is a nominal scale with 1 = performance score and 0 = error score.
Item scores are summed.
Scores range from 0-12.

Number of Items

There are 7 items for client to complete on the assessment. The remaining 5 items are rated by the examiner based on the client’s initiation and inhibition during the task. The total score is based on 12 items.

Menu Task Menu
Menu Task Client Instruction Sheet
Menu Task Scoring Sheet
Pen/Pencil
Stop Watch (optional)

Less than 5 minutes

Required Training

No Training

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Lisa A. Lowenthal, OTR/L, Columbia University (Master of Occupational Therapy student) and Anna Norweg, PhD, MA, OTR, Columbia University (Faculty mentor)

ICF Domain

Activity

Measurement Domain

Cognition

Professional Association Recommendation

None found—last search performed 8/1/2023.

Considerations

Authors are currently examining the need for age or education scoring adjustments and may institute new scoring guidelines in the future.

Cut-Off Scores

Community Dwelling Adults 55+ & Hospitalized Elective Orthopedic Surgery Patients [Adults 55+]: (Edwards et al., 2019; community dwelling adults, n = 130; Mean Age (SD) = 73.56 (11.21) years; hospitalized elective orthopedic surgery patients, n = 60; Mean Age (SD) = 65.21 (6.79) years)

ROC analysis supported a cutoff score between 5.5 and 6.5.
A cutoff score of 6 or less was determined as indicating cognitive impairment with sensitivity .80 and specificity of .65.

Community Dwelling Adults 55+: (Marks et al., 2021a; n = 197; Mean Age (SD) = 70.46 (8.26) years)

With a cutoff score of 8, the AUC for the MT indicated an accuracy of .77 (95% CI, 0.70-0.84; p < .001) for identifying cognitive impairment.

Community Dwelling Adults 55+: (Marks et al., 2021b; n = 277; Mean Age (SD) = 69.73 (8.21) years)

Using the Weekly Calendar Planning Activity (WCPA) as the reference standard and MT cutoff score of 8, the sensitivity (95% CI) was .66 % (0.53, 0.78) and specificity (95% CI) was .75 (0.69, 0.81).
There were 44% true positives, 89% true negatives, 56% false positives and 11% false negatives.

Community Dwelling Adults 55+: (Al-Heizan et al., 2022; n = 287; Mean Age (SD) = 69.72 (8.81) years)

The AUC for the MT was .80 with a cutoff score of 8 for identifying a functional cognitive impairment.
Sensitivity was 0.89 and specificity was 0.58.
There were 31 observed true positives, 142 true negatives, 103 false positives and 4 false negatives. The positive predictive value = 0.23; negative predictive value = 0.97.

Interrater/Intrarater Reliability

Community Dwelling Adults 55+ & Hospitalized Elective Orthopedic Surgery Patients [Adults 55+]: (Edwards et al., 2019)

Excellent interrater reliability (ICC = 1)

Internal Consistency

Community Dwelling Adults 55+ & Hospitalized Elective Orthopedic Surgery Patients [Adults 55+]: (Edwards et al., 2019)

Adequate internal consistency (Cronbach’s alpha = .70)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Community Dwelling Adults 55+: (Al-Heizan et al., 2022; Bivariate Correlation Coefficients between the Menu Task and the Weekly Calendar Planning Activity (WCPA) Scores, n = 280)

Adequate correlation with the WCPA accuracy (r = .55, p < .01)
Adequate correlation with the WCPA appointments entered (r = .30, p < .01)
Poor correlation with the WCPA total time (r = -.05)
Adequate correlation with the WCPA rules (r = .36, p < .01)
Adequate correlation with the WCPA efficiency (r = -.42, p < .01)

Community Dwelling Adults 55+ & Hospitalized Elective Orthopedic Surgery Patients [Adults 55+]: (Edwards et al., 2019)

Adequate correlation with the Montreal Cognitive Assessment (r = .56, p < .001)
Adequate correlation with the Trail Making Test B (r = -.54, p < .001)
Adequate correlation with the Brief Interview for Mental Status (r = .34, p < .001)
Adequate correlation with the Trail Making Test A (r = -.35, p < .01)

Community Dwelling Adults 55+: (Al-Heizan et al., 2020; n = 114; Mean Age (SD) = 69 (9.85) years; Pearson correlation coefficients between study measures)

Adequate correlation with the Montreal Cognitive Assessment (r = .53, p < .01)
Adequate correlation with the Trail Making Test B (r = -.43, p < .01)
Adequate correlation with the Trail Making Test A (r = -.34, p < .01)
Poor correlation with the Brief Interview for Mental Status (r = .21, p < .05)

Community Dwelling Adults 55+: (Marks et al., 2021a)

Adequate correlation with total scores on the Brief Interview for Mental Status (r = .37)

Bibliography

Al-Heizan, M. O., Giles, G. M., Wolf, T. J., & Edwards, D. F. (2020). The construct validity of a new screening measure of functional cognitive ability: The menu task. Neuropsychological Rehabilitation, 30(5), 961–972. https://doi.org/10.1080/09602011.2018.1531767

Al-Heizan, M. O., Marks, T. S., Giles, G. M., & Edwards, D. F. (2022). Further validation of the Menu Task: Functional cognition screening for older adults. OTJR: Occupation, Participation and Health, 42(4), 286–294. https://doi.org/10.1177/15394492221110546

Edwards, D. F., Wolf, T. J., Marks, T., Alter, S., Larkin, V., Padesky, B. L., Spiers, M., Al-Heizan, M. O., & Giles, G. M. (2019). Reliability and validity of a functional cognition screening tool to identify the need for occupational therapy. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 73(2), 7302205050p1-7302205050p10. https://doi.org/10.5014/ajot.2019.028753

Marks, T. S., Giles, G. M., Al-Heizan, M. O., & Edwards, D. F. (2021a). How well does the Brief Interview for Mental Status identify risk for cognition mediated functional impairment in a community sample? Archives of Rehabilitation Research and Clinical Translation, 3(1), 100102. https://doi.org/10.1016/j.arrct.2021.100102

Marks, T. S., Giles, G. M., Al-Heizan, M. O., & Edwards, D. F. (2021b). Screening to assessment pathways in evaluating functional cognition in older adults. OTJR: Occupation, Participation and Health, 41(4), 275–284. https://doi.org/10.1177/15394492211021851