Assessment of Cognitive Functioning

Question 1

What is PTA?

Post traumatic amnesia

Answer 1

Period of recovery following brain injury

Disorientation (unable to locate themselves in time and place)

Antero-grade amnesia (unable to remember new events/experiences occurred after brain injury)

Question 2

Why should cognitive function be assessed?

Answer 2

Can aid the delivery of medical treatment

Can help make a diagnosis

Allows a judgement about capacity to be made

Assessment of risk of the patient

Allows ideas regarding driving ability, working ability, home living standards to be explored

Question 3

What is the purpose of a bedside assessment?

Answer 3

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

Question 4

What is covered in a clinical interview regarding cognitive function?

Answer 4

Memory

Language (word finding, errors (semantic/phonetic), poor understanding, inappropriate answers, reading and writing errors

Processing speed, slowed down, not following conversation

Attention/Concentration

Excecutive Functioning - stuck on ideas/tasks, difficulty making decisions

Personality - behavioural changes, disinhibition, loss of interest/motivation

Insight

Visual Spatial - route finding, spatial orientation, fine motor tasks

Question 5

What are the screening assessments for cognitive impairment?

Answer 5

Hodges

NOT MMSE - severe memory impairments can still pass, not subtle enough

Addenbrooke’s Cognitive Examination - 111 (ACE 111)

MOCA

Question 6

What are the 5 domains which the Adenbrooke’s Cognitive Examination assesses?

Answer 6

1. attention/orientation
2. memory
3. language
4. verbal fluency
5. visuospatial skills

Also includes the MMSE

Question 7

What is included in the MMSE?

Answer 7

Examines functions including registration (repeating named prompts), attention and calculation, recall, language, ability to follow simple commands and orientation

Serial seven’s is counting down from 100 in sevens

Question 8

What is important to consider when performing a cognitive function examination?

Answer 8

Patients language might not have english as their first language

Eyesight or hearing may be impaired

Patient may be fatigued

Patient may be confused or delerious

Patient may be influenced by the likes of privacy, noise and disturbances

Patient may be anxious

Patient may not be motivated or have good attention

Question 9

What is the management for those with cognitive impiarment?

Answer 9

Monitoring change in the patient

Impact of medication on cognition

Rehabilitation (cognitive)

Behavioural management

Support and education (for famiies)

Advice on return to work / education

Advice on care requirements

Question 10

If taking a history for a patient with cognitive impairment, what are key areas to pick up on?

Answer 10

The event or condition which is associated with the cognitive defecits

Past medical history

Psychiatric history

Developmental (attention defecit disorder, autism spectrum disorder, learning difficulties)

Family (medical, neurological, psychiatric)

Adverse events

Something current that could be impacting on cognition (infection, substances?)

Question 11

What are important questions to ask about presenting problems?

Answer 11

How they have changed over the course of time

Onset

Exacerbating/Alleviating factors

What they think it is

The impact on work or hobbies daily living?

Legal involvement?

Coping?