Assessment of Cognitive Function

Question 1

Why does cognitive function need to be considered?

Answer 1

• Diagnosis
• Prognosis
• Treatment

Question 2

What needs to be considered in the diagnosis?

Answer 2

• Have they sustained a brain injury?
• Do they have a neurological condition?
• Are they in PTA?

Question 3

What is post traumatic amnesia?

Answer 3

Period of recovery following traumatic brain injury

Question 4

What is the clinical presentation of post traumatic amnesia?

Answer 4

• Disorientation: unable to locate themselves in time and place
• Antero-grate amnesia: inability to remember new events/experiences occurred after brain injury

Question 5

How does diagnosis influence care?

Answer 5

• Help deliver medical treatment
• Capacity?
• Does cognitive impairments pose risk to patient or others?
• Plans care:
  
  • Driving?
  • Return to work?
  • Can impairments impact on home?
  • Will cognitive function improve?

Question 6

How does the diagnosis influence treatment?

Answer 6

• What abilities remain intact - could these be used to compensate for cognitive difficulties?
• Would patient benefit from rehabilitation?
  
  • Is family intervention required?
  • OT input for ADLs? does this need to be near-specific?
  • Does patient need supervision/care?
  • Follow beneficial?
  • Psychiatry, neuropsychology, social work, OT, neurology?

Question 7

What is the purpose of a bedside assessment?

Answer 7

To raise the possibility of cognitive impairments which may need further assessment/onward referral and may impact treatment/consent.

Question 8

How is a bedside assessment carried out?

Answer 8

• Observation
• Clinical interview (patient + relative)
• Screening assessments

Question 9

What is the frontal lobe responsible for?

Answer 9

• Executive function
• Thinking
• Planing
• Organising
• Problem solving
• Emotions
• Behavioural control
• Personality

Question 10

What is the function of the motor cortex?

Answer 10

Movement

Question 11

What is the function of the sensory cortex?

Answer 11

Sensation

Question 12

What is the function o the temporal lobe?

Answer 12

• Memory
• Understanding
• Language

Question 13

What are the functions of the parietal lobe?

Answer 13

• Perception
• Making sense of the world
• Arithmetic
• Spelling

Question 14

What is the function of the occipital lobe?

Answer 14

Vision

Question 15

What do you investigate in a clinical interview?

Answer 15

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

Question 16

How do you investigate memory function in the clinical interview?

Answer 16

New learning in daily life e.g. Where they are, reason for admission, conversations, T.V programmes, personal history

Question 17

How do you investigate language function in the clinical interview?

Answer 17

Word finding, errors (semantic/phonetic), poor understanding, inappropriate answers, reading/writing errors

Question 18

How do you investigate processing speed in the clinical interview?

Answer 18

Slowed down, not following conversation, long response times

Question 19

How do you investigate attention/concentration in the clinical interview?

Answer 19

Difficulties focusing, losing track in conversation, reading

Question 20

How do you investigate executive function in the clinical interview?

Answer 20

Stuck on ideas/tasks, difficulty making decisions

Question 21

How do you investigate personality in the clinical interview?

Answer 21

Behaviour changes, disinhibition, loss of interest/motivation

Question 22

How do you investigate visual spatial in the clinical interview?

Answer 22

Route finding, spatial orientation, fine motor tasks

Question 23

List seven assessment considerations

Answer 23

• 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

Question 24

What is the role of clinical neuropsychologists?

Answer 24

The impact of injury/disease on the individual’s cognition, emotion and behaviour.

Question 25

What are potential diagnoses?

Answer 25

• Organic v psychological
• Cognitive presentations of neurological disorders
• Differentiation between types of dementia/disorders

Question 26

What is the prognosis of different conditions dependent on?

Answer 26

• Assessment of capacity
• Advice on support required
• Predicting likely change in neurological disorder
• Medico-legal

Question 27

What are different treatment options?

Answer 27

• 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

Question 28

What do you need to ask in the history?

Answer 28

• 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 impacting on cognition (infection, psychiatric, substances)?

Question 29

What are two formal assessments to test function?

Answer 29

• Orientation (PTA)

* Pre-Morbid IQ

Question 30

One month on from impairment of cognitive function describe the progress of the patient

Answer 30

• Returned to work
• Difficulty remembering routes
• Short tempered at home
• No memory of the two weeks following the assault

Question 31

Nine month on from impairment of cognitive function describe the progress of the patient

Answer 31

• No cognitive deficits on assessment by Clinical Neuropsychology
• Reduced motivation at home and work
• Less patient/easily frustrated
• Same symptoms on year on