Assessment of Cognitive Functioning

Question 1

State the reasons why cognitive function should be assessed.

Answer 1

Helps you to make a diagnosis.

Assess the risks posed by the cognitive impairments to the patient or others;

• Capacity
• Adherence, vulnerability
• Disinhibited, impulsive

Helps you to plan care;

• Concerns about driving
• Returning to work
• Impact on home life
• Can cognition be improved?

Helps you to deliver medical treatment.

Question 2

Name the main areas of cognitive functioning.

Answer 2

Frontal lobe;

• Executive functions: thinking, planning, organising
• Emotion, behaviour, personality

Motor and sensory cortices.

Parietal lobe;

• Perception
• Arithmetic, spelling

Occipital lobe;
- Vision

Temporal lobe;

• Memory
• Understanding language

Question 3

Describe approaches to bedside testing of cognitive functioning.

Answer 3

• Observation
• Clinical interview (patient and relative)
• Screening assessments

Question 4

State the purpose of bedside assessment of cognitive functioning.

Answer 4

To raise the possibility of cognitive impairments, which may need further assessment/onward referral and may impact consent/treatment.

Question 5

Identify management options in those with cognitive impairment.

Answer 5

• Rehab potential
• Behavioural management
• Cognitive rehabilitation
• Support and education
• Advice of returning to life/work

Question 6

Describe the screening assessments used in the diagnosis of cognitive functioning and their pros and cons.

Answer 6

NOT MMSE!

• Widely used but
• Copyrighted
• Insensitive to mild impairment/focal deficit

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

• Sensitive to mild impairment
• Differentiates between organic brain disease (dementias)

MOCA

• 10 min screening tool
• Freely available
• Better sensitivity and specificity than MMSE

Question 7

Describe the confounding factors present when assessing an cognitively impaired patient.

Answer 7

Environmental;

• Privacy
• Noise
• Disturbances

Physical;

• Delirium
• Fatigue
• Illness

Psychological;

• Anxiety/mood
• Confidence

Accessibility;

• Language
• Eyesight/hearing
• Disability

Pre-morbid;

• Education
• Occupation
• Prior injuries
• Lifestyle

Question 8

Describe the confounding factors present when assessing a cognitively impaired patient.

Answer 8

Environmental;

• Privacy
• Noise
• Disturbances

Physical;

• Delirium
• Fatigue
• Illness

Psychological;

• Anxiety/mood
• Confidence

Accessibility;

• Language
• Eyesight/hearing
• Disability

Pre-morbid;

• Education
• Occupation
• Prior injuries
• Lifestyle