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Block 3 > Assessment Of Cognitive Functioning > Flashcards

Assessment Of Cognitive Functioning Flashcards

1
Q

Why is it important to assess cognition?

A
  1. > 1/4 of medical inpatients have dementia
  2. 15-25% of medical inpatients have delirium
  3. Relevant to assessment of capacity/Mental Capacity Act (MCA)/Deprivation of Liberty Safeguards (DoLS)
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2
Q

What is cognition?

A

Of, relating to, or involving conscious mental activities such as thinking, understanding, learning and remembering (Webster dictionary) but its difficult to say and there are many different definitions

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3
Q

What are the different areas of cognition?

A
  1. MEMORY
  2. Reading
  3. Praxis
  4. ATTENTION/CONCENTRATION
  5. Calculation
  6. VISUOSPATIAL
  7. LANGUAGE
  8. EXECUTIVE FUNCTIONING
  9. Writing
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4
Q

What are the different types of memory?

A

Short-term:
- Working: immediate recall of small amounts of verbal/visual material

Long-term memory:

  • Anterograde: acquisition of new info
  • Retrograde: recall of previously learnt info
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5
Q

What is explicit and implicit memory?

A

Explicit: episode and semantic
Implicit: procedural

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6
Q

Is orientation an area of cognition?

A

No, it is not itself a separate area of cognition

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7
Q

How many items can you keep in your working/short-term memory and for how long?

A

7 items +/- 2 for about 30 seconds - can be improved by chunking the information into parts BUT new info will replace this

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8
Q

What is attention?

A

Ability to initiate it and persist with it i.e. concentration so includes:

  • Persistence
  • Vigilance
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9
Q

What are the different types of language?

A

Aphasia/dysphasia:

  • Receptive vs expressive
  • Language vs speech (dysphagia vs dysarthria)
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10
Q

What is dyspraxia?

A

Inability to carry out complex motor actions despite intact motor/sensory, coordination, comprehension and co-operation

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11
Q

What is executive functioning?

A

‘Higher order cognitive functioning’ involving the frontal lobe which is involved in executive, behaviour and personality inc. adaptation, abstraction, mental flexibility, problem-solving, planning, initiation, sequencing, judgement and goal-setting e.g. planning to go on holiday

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12
Q

What patients should be cognitively assessed?

A

ALL but degree will vary depending on presentation - can be screen through observation so cognitive assessments do not necessarily mean the use of assessment schedules

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13
Q

When should you carry out formal cognitive bedside testing?

A

If history of screening indicates poor memory, head injury or reduced attention at interview

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14
Q

Many cognitive tests are not ___.

A

Pure (i.e. cognitive aspects are not tested in isolation)

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15
Q

How do you assess working memory?

A
  1. Observation but not easily assessed
  2. Bedside testing:
    - Digit span forwards (7)/backwards (5)
    - Immediate recall of 10 item list/7 item name and addresses
    (NOT 3 items like in MMSE)
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16
Q

How do you assess anterograde memory?

A
  1. Observation: forgetful of content of conversation and repetitive
  2. Bedside testing:
    - Delayed recall of 10 item list/7 item name and address
    - Delayed recall of 3 items
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17
Q

How do you assess retrograde memory?

A
  1. Observation: incoherent history and forgetting past events
  2. Bedside testing:
    - Dates of wars
    - Recall of prime ministers/presidents/monarchs
    - Recall of personal info (need informant to confirm)
18
Q

How do you assess attention/concentration?

A
  1. Observation: ability to establish/maintain conversation and distractibility
  2. Bedside testing:
    - Orientation in time/place (also memory)
    - Serial subtraction e.g. 100-7, 20-3/spelling backwards e.g. WORLD (check they can spell it forward 1st)
    - Days of week or months of year backwards
19
Q

How can you assess language through observation?

A
  • Able to express fluently and appropriately
  • Wordfinding difficulties (semantic dysphasia)
  • Able to understand questions/instructions
20
Q

How can you assess language through bedside testing?

A
  • Naming objects + parts e.g. watch, strap, winder, pen, nib, naming of pictures
  • Repetition of complex words e.g. Statistician, Hippopotamus or Constitutional
  • Repetition of complex sentences e.g. “No ifs, ands or buts”
  • Comprehension e.g. 3 stage command, pen-watch-keys test
21
Q

How do you assess executive functioning by bedside testing?

A
  • Verbal fluency e.g. 1 min - animals, supermarket, FAC
  • Abstraction: proverb interpretation (e.g. people in glass houses), similarities/differences (apple/banana, coat/dress) or cognitive estimates (Camels in Holland/How fast horse gallops)
  • Set shifting e.g. alternating sequence test, Luria, trail-making test
  • Response inhibition e.g. go-no go test
22
Q

How do you assess executive functioning by observation?

A

Not easily assessed

23
Q

What is the alternating sequence test?

A

Draw out a shape pattern and ask patient to continue it

24
Q

What is the trail-making test?

A

Connect letters and numbers

25
Q

What is the Luria test?

A

Moving fists and hands in a certain sequence repeatedly

26
Q

What is the go-no go test?

A

Give instructions to patient e.g. tell patient to bang hand against desk with 1 knock and not move hand with 2 knocks

27
Q

How do you assess visuospatial functioning?

A
  1. Observation: position on chair and bumping into furniture (if severely impaired)
  2. Bedside testing: draw 2 intersecting pentagons (tend to struggle with intersection), cube or clock drawing (draw face, numbers and sets hand to 10 past 5)
28
Q

How can you assess reading?

A
  • Read aloud complex works (pint, tomb, dough) or a sentence

- Follow written instructions e.g. close your eyes

29
Q

How do you assess writing?

A

Write a simple sentence

30
Q

How do you assess calculation?

A
  • Addition
  • Subtraction
  • Multiplication
  • Division
31
Q

How do you calculate praxis?

A

Mime a common action e.g. cleaning teeth

32
Q

What is a quick method of assessing that a patients cognition is grossly intact?

A

Orientation to time, place and person

33
Q

What is the MMSE?

A

Simple quick screen with wide breadth but it is not comprehensive, not covering executive or memory particularly well so if a problem is shown the patient needs further testing

34
Q

What is the ACE-R?

A

More comprehensive test that takes approximately 30 minutes utilised for people shown to have a cognitive deficit

35
Q

What is the DemTect test?

A

Brief and simple test for early cognitive changes detecting minor problems but not for moderate problems as they will just be scoring 0

36
Q

What is the MoCA?

A

Longer test that is more widespread in use but also good for early cognitive changes

37
Q

What is the CAMCOG?

A

Comprehensive test that is usually carried out by an OT

38
Q

What are the different types of brief GP cognitive tests?

A

6-CIT
AMT
GPCOG

39
Q

What other specialities will use specialised versions of cognitive assessments?

A

Neuropsychology
SALT
Psychology
CAMHS

40
Q

What are the pros and cons of assessment schedules?

A

Pros: standardised, validated and transferable

Cons: don’t cover all areas fully, some require training

41
Q

If you use an assessment schedule, what should you be aware of?

A

Shortcomings
Fill in deficits
Supplement depending on findings

Block 3 (40 decks)

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