Assessment of Cognitive Function

Question 1

Things to consider when diagnosing a problem with cognitive function

Answer 1

Have they sustained a brain injury
Do they have a neurological condition
Are they in PTA (post traumatic amnesia)

Question 2

Things to consider in prognosis of a problem with cognitive function

Answer 2

Do the cognitive impairments pose risk to the patient or others
Are there likely to be further medical concerns
Are there concerns about driving
Will there be concerns with returning to work
Could these impairments impact on home
Will the patients cognition improve

Question 3

Things to consider in treatment of a problem with cognitive function

Answer 3

Would the patient benefit from rehabilitation
What abilities remain intact – could these be used to compensate for cognitive difficulties
Is family intervention required
Does the patient need OT input for ADLS, does this need to be neuro-specific
Does the patient require supervision/care
Would they benefit from follow up - Psychiatry, Neuropsychology, Social work, OT, Neurology

Question 4

Main areas of cognitive functioning

Answer 4

Sustained attention 
Response inhibition 
Speed of information processing 
Cognitive flexibility and control 
Multiple simultaneous attention 
Working memory 
Category formation 
Pattern recognition

Question 5

What is post-traumatic amnesia?

Answer 5

Amnesia occurring in the period of recovery following traumatic brain injury

Question 6

What does post-traumatic amnesia cause?

Answer 6

Causes disorientation where the patient is unable to locate themselves in time and place, and anterograde amnesia where the patient has an inability to remember new events/experiences which occurred after the brain injury

Question 7

Aims of bedside testing of cognitive functioning

Answer 7

To raise the possibility of cognitive impairments which may need further assessment/onward referral and may impact treatment or consent - observation, clinical interview, screening assessment

Question 8

Important features of clinical interview in bedside testing of cognitive functioning

Answer 8

Memory 
Language 
Processing speed 
Attention/concentration 
Executive functioning 
Personality 
Insight 
Visual-spatial

Question 9

Screening assessments for bedside testing of cognitive functioning

Answer 9

Hodges
Addenbrook’s cognitive examination III
MMSE (may not be subtle enough)

Question 10

Management options for those with cognitive impairment

Answer 10

Quantifying and monitoring change 
Pre and post-surgical assessments 
Impact of medication on cognition 
Rehab potential 
Behavioural management 
Cognitive rehabilitation 
Support and education including for families 
Advice on returning to work/education 
Advice on care requirements