Bedside cognitive assessment Flashcards
Learning objectives
-To understand why cognitive assessment is important
-To understand how cognitive assessment is performed
-To appreciate the different cognitive domains
Cognitive screening measures
MMSE
ACE-III
MoCA
- Mini-Mental State Examination
- Addenbrooke’s Cognitive Examination
- Montreal Cognitive Assessment
Measures
MMSE
Folstein et al. 1970
Measures
- Orientation
- Registration
- Attention and calculation
- Recall
- Language
Cut off 24/30
Evaluation
MoCA
Nasreddine et al. 1996
The MoCA has better senstivity for detecting MCI compared to the MMSE
What are the three general clincial questions that need to be answered?
- What is the diagnosis?
- What is the prognosis?
- What is the management?
Measures
MoCA
Nasreddine et al. 1996
Measures
- Visuospatial
- Executive function
- Naming
- Memory
- Attention
- Language
- Abstraction
- Delayed recall
- Orientation
Cut-off 26/30 (MCI)
Other tests
AMTS
6CIT
Mini-cog
- Abbreviated mental state score
- 6-item cognitive impairment test
- Mini-cog
What are the two main elements of cognitive assessment?
- Cognitive screening
- Formal neuropsychological assessment
DSM Criteria
What are the cognitive domains?
- Memory
- Attention
- Language
- Learning
- Executive functions
- Perceptual-motor
- Social cognition
Different types of attention
What can attention be subdivied into?
(3)
- Divided attention
- Selective attention
- Sustained attention
How might attention be tested on cognitive screening measures?
- Spelling WORLD backwards
- Serial 7s (counting backwards from 100 in 7s)
How might attention be tested on neuropsychological testing?
- Wisconsin card sorting test
- Brixton spatial anticipation test
Which asepcts of memory might be tested with cognitive screening/ neuropsychological assessment?
- semantic memory
- episodic memory
- immedate and delayed recall
- working memory
- visual memory
Define
Episodic memory
This is a type of long term memory of autobiographical information and every day events and experiences. Linked to anterograde and retrograde memory or amnesia.
Define
Semantic memory
This is the memory for factual information e.g. capitals, meanings of words etc.
How might episodic memory be tested on cognitive screening measures?
Consider measures of anterograde and retrograde memory
Anterograde
- recent news events
- immediate and delayed recall of a name and address (ACE-III and mini ACE)
Retrograde
- past news events
How might episodic memory be tested on neuropsychological assessment?
Consider measures of anterograde and retrograde memory
Anterograde
- story recall
- worldlist learning
- rey-complex figure
- figure recall from WMS
Retrograde
- autobiographical memory review
How might semantic memory be tested on cognitive screening?
You might ask the inidividual…
- Name the oject being pointed at
- Define ‘x’
- “Is there a source of illumination in the room?”
How might semantic memory be tested on neuropsychological assessment?
- Vocabulary and similarities (WAIS)
- Graded naming (naming objects with increasing difficulty)
- Phonemic fluency (same letter)
- Semantic fluency (words from the same category e.g. animals)
- Pyramids and palm trees
Learning objectives CHECK
What are cognitive assessments for?
Cognitive assessments help us to diagnose deficits, measure the severity and and progression of cogntiive impairment and guide management (and research).
Learning objectives CHECK
How are cognitive assessments done?
We
- Take a history from the patient and a knowledgeable informant
- Complete cognitive screening during history taking and the initial clinical assessment
- Refer the patient for further neuropsychological testing
- Interpret findings within the patients’ context
Which cognitive domains can be assessed?
- Memory
- Attention
- Language
- Learning
- Visuspatial and contructional skills
- Social cognition
- Executive functions
Don’t forget we can test specific aspects of each domain!
