Assessment of Cognitive Functioning Flashcards
What is clinical neuropsychology?
“The applied science concerned with the behavioural expression of brain dysfunction”
Clinical Neuropsychologists focus on the impact of injury/disease on the individual’s cognition, emotion and behaviour
Why do we need to consider cognitive functioning?
Diagnosis
Prognosis
Treatment
How do you determine diagnosis/prognosis when assessing cognative function?
Does it help you make a diagnosis – e.g. Neurological condition or Brain Injury
Do the cognitive impairments pose risk to the patient or others - Adherence, vulnerability, Disinhibited, impulsive
Does it help you plan care:
Are there concerns about driving?
Will there be concerns with returning to work?
Could these impairments impact on home?
Will the patients cognition improve?
Does it help deliver medical treatment – e.g. Awareness of PTA, adaptations
What is post traumatic amnesia?
a state of confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is disoriented and unable to remember events that occur after the injury
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
What is the treatment of someone with altered cognative function?
Medical treatment informed by an appreciation of cognition
Conversations informed by an awareness of their cognition - Simplify, reduce, added time, visual aids /written info
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 daily living? 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?
How and what is a bedside assessment of aptient?
Purpose: to raise the possibility of cognitive impairments which may need further assessment/onward referral and may impact treatment/consent
How?
Observation
Clinical Interview (patient & relative)
Screening Assessments
What are some screening assessments?
No to MMSE - Widely used, however: Copyright issues, insensitive to mild impairment or focal deficit, lack of executive assessments
Addenbrooke’s Cognitive Examination- III (ACE-III) - Sensitivity to mild impairment, differentiation between organic brain disease (dementias), executive assessment (best one to do)
MOCA - 10 min screening tool, freely available, better sensitivity and specificity than MMSE
What is ACE - III?
15mins
Includes: language, memory, executive functioning, visuospatial/perceptual
More sensitive
The Addenbrooke’s Cognitive Examination-III (ACE-III) is a brief cognitive test that assesses five cognitive domains: attention, memory, verbal fluency, language and visuospatial abilities. The total score is 100 with higher scores indicating better cognitive functioning. Administration of the ACE-III takes, on average, 15 minutes and scoring takes about 5 minutes
What is involved in the diagnosis of common neuropsychology referrals?
Organic v psychological - Impairment vs anxiety, low mood, personality, interpersonal factors
Cognitive presentations of neurological disorders – see if it a progressive decline or if they are stable
Impairment/rate of decline in MS, stroke, huntingtons, parkinsons
Differentiation between types of dementia/disorders - Cortical vs subcortical subtypes
What is involved in the prognosis of common neuropsychology referrals?
Assessment of capacity
Insight into impact of management/understand risk
Remember information and apply to complex/abstract decisions (e.g. finance and welfare)
Advice on support required
Predicting likely change in neurological disorder
Medico-legal (e.g. ability to perform as previously)
What is the treatment of common referrals?
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 some information to consider before formal assessment?
Acute/transient effect on cognition - post-traumatic amnesia, infection, toxicity, substance use
What kind of information are we looking for?
-Formulation/not test results
- Confounding/influencing factors/differential diagnosis
What is the patients normal - pre-morbid IQ, mood, behaviours
What is formulation
pulling together all different information to see how it fits together?
What are some assessment considerations (confounding/influencing factors)?
Environmental Factors – privacy, noise, disturbances
Physical Factors – Confusion/delirium, PTA, Fatigue, Illness/infection
Psychological – Anxiety/Mood, Effort/Confidence
Accessibility – Language, Eyesight/Hearing, Disability
Pre-morbid Factor – Pre-morbid functioning, Education, Occupation, prior injuries/TBI, lifestyle factors
When someone present with a problem, what information is important to get?
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
When doing a Clinical Interview/Formal Assessment, what different domains of cognition are important to test?
