[7] Assessment of an Older Patient Flashcards
What can be tried to overcome hearing impairment when assessing an older patient?
- Ensure appropriate environment
- Ensure hearing aids in
- Speak slowly and clearly
- Try writing
What can be tried to overcome vision impairment when assessing an older patient?
- Ensure appropriate environment
- Ensure have glasses
What is cognition?
The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.
What does cognition involve?
Dynamic organisation of thoughts and sensations, so that what is perceived is given meaning
What part of the brain are intellectual processes a function of?
The cerebral cortex
What might indicate a persons level of cognitive function?
Action and behaviour
What may an assessment of cognitive function form part of?
The general assessment and clerking conducted on admission to hospital
What standardised tests of cognitive function are there?
- Abbreviated mental test (AMT)
- MMSE
What is in the AMT?
10 questions that evaluate attention, memory, and orientation
When is the AMT recommended for use?
For use in the first instance when a patient appears muddled or confused
What is the MMSE?
A screening tool to determine the cognitive function aspect of a mental state assessment in older adults specifically
Why was the MMSE developed?
To provide a standardised quantitative test of cognitive aspects of mental function
What are the areas of cognitive function to be tested?
- Orientation
- Attention
- Registration
- Immediate recall
- Short term recall
- Language
- Ability to follow simple and written commands
Is MMSE a diagnostic tool?
No
What is the result of MMSE not being a diagnostic tool?
It is not equivalent to a neurological examination or formal mental status testing
What does the MMSE not test?
- Personality
- Mood
- Behaviour
- Function
What is the MMSE scored out of?
30
How does the MMSE compare to the AMT in terms of things tested?
Tests same things, but adds constructional skill test, language, and provides greater teal
How are the questions in the MMSE divided?
Has 2 sections and 19 questions
What does the first section of the MMSE cover?
Orientation, memory, and attention
What is the maximum score of the first section of the MMSE?
21
What does the second section of the MMSE cover?
Ability to name and follow written and veritable commands requiring written responses
What is the cut off score for dementia in MMSE?
23/30 (in a person with at least 8 years of education)
How can MMSE be helpful in the ongoing management of dementia?
Measure progression of cognitive decline
What is the Adenbrooke’s Cognitive Examination (ACE-R)?
A brief cognitive test that assesses 5 cognitive domains
What cognitive domains does the ACE-R test?
- Attention/orientation
- Memory
- Verbal fluency
- Language
- Visuospatial abilities
What is the total score of the ACE-R?
100
What does a higher score in the ACE-R indicate?
Better cognitive functioning
How long does administration of the ACE-R take?
Approx 15 mins
What was the Montreal Cognitive Assessment (MOCA) designed to be?
A rapid screening instrument for mild cognitive dysfunction
How long does it take to administered the MOCA?
10 mins
What cognitive domains does the MOCA test?
- Attention and concentration
- Executive functions
- Memory
- Language
- Visuoconstructional skills
- Conceptual thinking
- Calculations
- Orientiation
What is the maximum score on the MOCA?
30
What score is considered normal on the MOCA?
26+
