Assessment of Cognitive Function Flashcards
Why does cognitive function need to be considered?
- Diagnosis
- Prognosis
- Treatment
What needs to be considered in the 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
What is the clinical presentation of post traumatic amnesia?
- Disorientation: unable to locate themselves in time and place
- Antero-grate amnesia: inability to remember new events/experiences occurred after brain injury
How does diagnosis influence care?
- 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?
How does the diagnosis influence treatment?
- 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?
What is the purpose of a 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
What is the frontal lobe responsible for?
- Executive function
- Thinking
- Planing
- Organising
- Problem solving
- Emotions
- Behavioural control
- Personality
What is the function of the motor cortex?
Movement
What is the function of the sensory cortex?
Sensation
What is the function o the temporal lobe?
- Memory
- Understanding
- Language
What are the functions of the parietal lobe?
- Perception
- Making sense of the world
- Arithmetic
- Spelling
What is the function of the occipital lobe?
Vision
What do you investigate in a clinical interview?
- Memory
- Language
- Processing speed
- Attention/concentration
- Executive functioning
- Personality
- Insight
- Visual spatial
How do you investigate memory function in the clinical interview?
New learning in daily life e.g. Where they are, reason for admission, conversations, T.V programmes, personal history
How do you investigate language function in the clinical interview?
Word finding, errors (semantic/phonetic), poor understanding, inappropriate answers, reading/writing errors
How do you investigate processing speed in the clinical interview?
Slowed down, not following conversation, long response times
How do you investigate attention/concentration in the clinical interview?
Difficulties focusing, losing track in conversation, reading
How do you investigate executive function in the clinical interview?
Stuck on ideas/tasks, difficulty making decisions
How do you investigate personality in the clinical interview?
Behaviour changes, disinhibition, loss of interest/motivation
How do you investigate visual spatial in the clinical interview?
Route finding, spatial orientation, fine motor tasks
List seven assessment considerations
- 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
What is the role of clinical neuropsychologists?
The impact of injury/disease on the individual’s cognition, emotion and behaviour.
What are potential diagnoses?
- Organic v psychological
- Cognitive presentations of neurological disorders
- Differentiation between types of dementia/disorders
What is the prognosis of different conditions dependent on?
- Assessment of capacity
- Advice on support required
- Predicting likely change in neurological disorder
- Medico-legal
What are different treatment options?
- 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 do you need to ask in the 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 impacting on cognition (infection, psychiatric, substances)?
What are two formal assessments to test function?
- Orientation (PTA)
* Pre-Morbid IQ
One month on from impairment of cognitive function describe the progress of the patient
- Returned to work
- Difficulty remembering routes
- Short tempered at home
- No memory of the two weeks following the assault
Nine month on from impairment of cognitive function describe the progress of the patient
- No cognitive deficits on assessment by Clinical Neuropsychology
- Reduced motivation at home and work
- Less patient/easily frustrated
- Same symptoms on year on
