Assessment of cognitive functioning

Question 1

Why do we need to consider cognitive functioning? (3)

Answer 1

diagnosis
prognosis
treatment

Question 2

What is PTA?

Answer 2

Post-traumatic amnesia - Period of recovery following traumatic brain injury.

injured person is disoriented - unable to locate themselves in time and place

has antero-grade amnesia - inability to remember new events/experiences occurred after brain injury

Question 3

What concerns may you have when planning care for a patient with cognitive impairment? (4)

Answer 3

Are there concerns about driving?

Will there be concerns with returning to work?

Could these impairments impact on home?

Will the patients cognition improve?

Question 4

What concerns may you have about the risk a patient with cognitive impairment may pose to themselves or others (3)

Answer 4

Are there questions about capacity

Adherence, vulnerability

Disinhibited, impulsive

Question 5

A patient’s cognitive functioning may help you with the diagnosis. It could be… (give 2 examples)

Answer 5

neurological condition

brain injury

Question 6

How do you treat a patient taking into consideration their level of cognitive functioning? (4)

Answer 6

Medical treatment informed by an appreciation of cognition.

Conversations informed by an awareness of their cognition ie simplify them, reduce, added time, visual aids/written info

Acknowledge what abilities remain intact – could these be used to compensate for cognitive difficulties?

Would the patient benefit from rehabilitation?
- 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 and in which specialty - Psychiatry, Neuropsychology, Social Work, OT, Neurology?

Question 7

How can bedside assessment of a patient be carried out? (3)

Answer 7

observation

clinical interview (patient and relative)

screening assessments

Question 8

What is MOCA?

Answer 8

Montreal Cognitive Assessment

10 min screening tool, freely available, better sensitivity and specificity than MMSE

Tests things like attention, memory, language and delayed recall

Question 9

What is Addenbrooke’s Cognitive Examination- III (ACE-III)

Answer 9

takes 15 mins - includes language, memory, exectuive functioning, visuospatial/perceptual

Sensitivity to mild impairment, differentiation between organic brain disease (dementias), executive assessment

Question 10

Name 3 screening assessments used

Answer 10

MOCA

MMSE

Addenbrooke’s cognitive examination

Question 11

What is MMSE

Answer 11

Mini mental state examination

widely used, however, there are copyright issues, it’s insensitive to mild impairment or focal deficit and there is a lack of executive assessments

Question 12

Which factors need to be considered when assessing cognitive functioning? (5)

Answer 12

Environmental
Physical
Psychological
Accessibility
Pre-morbid factors

Question 13

3 examples of environmental factors?

Answer 13

privacy
noise
disturbances

Question 14

4 examples of physical factors

Answer 14

Confusion/delirium

PTA

fatigue

illness/infection

Question 15

2 psychological examples

Answer 15

anxiety/mood

effort/confidence

Question 16

3 accessibility examples

Answer 16

language
eyesight/hearing
disability

Question 17

5 examples of pre-morbid factors

Answer 17

Pre-morbid functioning
Education
Occupation
prior injuries/TBI
lifestyle factors

Question 18

What is organic brain disease?

Answer 18

is a syndrome or disorder of mental function - due to illnesses that are not psychiatric in nature - organic (physiologic) rather than psychological

Question 19

Examples of organic brain disorders

Answer 19

Alcoholism
Alzheimer's disease
Attention Deficit/hyperactivity disorder
Autism
Concussion
Encephalitis
Epilepsy
Fetal alcohol syndrome

Question 20

What does a doctor do to decide the prognosis for a patient (4)

Answer 20

Assessment of capacity

Advice on support required

Predicting likely change in neurological disorder

Medico-legal considerations

Question 21

Possible treatment/management options (9)

Answer 21

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 22

Main areas of cognitive functioning (7)

Answer 22

Memory 
Language
Processing speed
Insight
Personality
Executive functioning - control of behaviours
Attention/concentration