Assessment of Cognitive Function Flashcards
Why do we consider cognitive function?
- Diagnosis
- Prognosis
- Treatment
Why do we consider cognitive function in diagnosis?
- Have they sustained a brain injury?
- Do they have a neurological condition?
- Are they in PTA?
What is post traumatic amnesia?
Period of recovery following traumatic brain injury.
Disorientation
Unable to locate themselves in time and place
Antero-grade amnesia
Inability to remember new events/experiences occurred after brain injury
Why do we consider cognitive function in diagnosis/prognosis?
- Delivery of medical treatment
- Make a diagnosis
- Are there questions about capacity
- Do the cognitive impairments pose risk to the patient or others
- Plan care
- Concerns about driving
- Concerns about employment
- Impact on home life
- Will the patients cognition improve?
Why do we consider cognitive function in treatment?
-Medical treatment informed by an appreciation of cognition.
-Conversations informed by an awareness of their cognition.
-What abilities remain intact – could these be used to compensate for cognitive difficulties?
-Would the patient benefit from rehabilitation?
-Is family intervention required?
Does the patient need OT input for ADLs? -Does this need to be neuro-specific?
-Does the patient need supervision/care requirement?
-Would they benefit from follow up? Psychiatry, Neuropsychology, Social Work, OT, Neurology?
What is the purpose of bedside assessment?
To raise the possibility of cognitive impairments which may need further assessment/onward referral and may impact treatment/consent.
How is a bedside assessment carried out?
- Observation
- Clinical Interview (patient & relative)
- Screening Assessments
How is memory assessed in clinical interview?
New learning in daily life e.g. Where they are, reason for admission, conversations, T.V programmes, personal history.
What is assessed during clinical interview?
- Memory
- Language
- Processing speed
- Attention/Concentration
- executive functioning
- Personality
- Insight
- Visual spatial
How is language assessed in clinical interview?
Word finding, errors (semantic/phonetic), poor understanding, inappropriate answers, reading/writing errors
How is processing speed assessed in clinical interview?
Slowed down, not following conversation, long response times
How is attention/concentration assessed in clinical interview?
Difficulties focusing, losing track in conversation, reading
How is executive functioning assessed in clinical interview?
Stuck on ideas/tasks, difficulty making decisions
How is personality assessed in clinical interview?
Behaviour changes, disinhibition, loss of interest/motivation
How is visual spatial components assess in clinical interview?
Route finding, spatial orientation, fine motor tasks
What screening assessments are used?
- Hodges
- ACE-III
- MOCA
What does the Hodges’ assessment include?
- 20 minutes
- Covers clinical interview, observations and basic screening assessments
Why is the MMSE not used?
- Copyright issues
- No EF assessments
- Severe memory impairments can still pass
- Not subtle enough
What does the ACE-III include?
- 15mins
- Includes: language, memory, executive functioning, visuospatial/perceptual
- More sensitive
What considerations must be accounted for before assessing someone?
- Language – impaired? English first language?
- Eyesight/Hearing
- Fatigue – best time to assess
- Confusion/delirium
- Environmental factors – privacy, noise, disturbances
- Anxiety
- Observation/Clinical judgement – e.g. Poor memory scores due to reduced motivation/fatigue/attention
Clinical neurophysiology
- Clinical Neuropsychologists focus on the impact of injury/disease on the individual’s cognition, emotion and behaviour.
- The applied science concerned with the behavioural expression of brain dysfunction
Why are people commonly referred for assessment for a diagnosis?
- Organic v psychological
- Cognitive presentations of neurological disorders
- Differentiation between types of dementia/disorders
Why are people commonly referred for assessment for prognosis?
- Assessment of capacity
- Advice on support required
- Predicting likely change in neurological disorder
- Medico-legal
Why are people commonly referred for assessment for treatment?
- Quantifying and monitoring change
- Pre & Post surgery assessments (tumour, epilepsy)
- Impact of medication of cognition
- Rehab potential
- Behavioural management
- Cognitive rehabilitation
- Support and education incl. Families
- Advice on return to work/education
- Advice on care requirements
What is important when taking a history?
Medical history
- Event or condition associated with cognitive deficits
- Past medical history
- Psychiatric history
- Developmental (ADD, ASD, LD)
- Family (medical, neurological, psychiatric)
- Adverse events
- Anything current that could be impacting on cognition (infection, psychiatric, substances)?
What should you discuss with regards to the presenting complaint?
- Problem list
- Course – improvements/deterioration, fluctuations
- Acute or gradual onset
- Factors that impact on them – times worse/better
- What they think it is
- Impact on: work, hobbies, ADLs
- Any ongoing legal involvement
- Coping
What formal assessment is there?
- Orientation (PTA)
- Pre-morbid IQ
