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AIP: Acute confusional state > Clinical assessment of mental state > Flashcards

Clinical assessment of mental state Flashcards

1
Q

What are 6 types of confusion assessment tools to be aware of?

A
  1. Mini-mental state examination (MMSE)
  2. 6-item cognitive impairment test (6CIT)
  3. Confusion assessment method (CAM)
  4. GP assessment of cognition (GPCOG)
  5. Abbreviated mental test score (AMTS)
  6. 4AT
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2
Q

What is the mini mental state examination used for?

A

screening cognitive function - not suitable for making a diagnosis but can be used to indicate presence of cognitive impairment (e.g. suspected dementia or following head injury)

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3
Q

How can the score from MMSE be interpreted?

A
  • 25-30 /30 is normal
  • 21-24 mild cognitive impairment
  • 10-20 moderate
  • <10 severe
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4
Q

What are 4 disadvantages of the MMSE?

A
  1. will not detect subtle memory losses - particularly in well-educated patients
  2. in interpeting scores, allowance may have ot be made for education and ethnicity
  3. doesn’t assess long term memory (but does assess orientation, immediate memory and short term memory)
  4. Copyright holders Psychological Assessment Resources will not grant access to test in any publication without payment
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5
Q

What are 4 examples of formal screening tests to use for cognitive impairment in suspected dementia?

A
  1. Mini Mental State Examination (MMSE)
  2. 6-item Cognitive Impairment Test (6CIT)
  3. General Practitioner Assessment of Cognition (GPCOG)
  4. 7-Minute Screen (7MS)
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6
Q

What is the test which is more reliable and superior to the AMT and MMSE in detecting dementia?

A

GPCOG

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7
Q

What is the GPCOG used for?

A

screening tool for dementia

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8
Q

What does the GPCOG consist of?

A
  • 2 components:
    • cognitive assessment conducted with the patient
    • informant questionnaire (only necessary if results of cognitive section equivocal)
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9
Q

How can the result of the GPCOG test be interpreted?

A

>8 or <5 can be assumed to be cognitively intact or impairmed respectively

if patients require informant questionnaire, score of 3 or less out of 6 indicates cognitive impairment

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10
Q

What is the 6CIT and what is it used for?

A

useful dementia screening tool in primary care, consists of 6 questions

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11
Q

What are the advantages of 6CIT?

A

high sensitivity without compromising specificity, even in mild dementia

easy to translate linguistically and culturally

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12
Q

What is the main disadvantage of the 6CIT?

A

scoring and weighting of test is initially confusion (however computer models have simplified this greatly)

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13
Q

What is the AMT (Abbreviated Mental Test)?

A

quick to use screening test mainly used in general hospital (lacks validation in primary care and screening populations)

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14
Q

What are the advantages of the AMT?

A

simple to perform and score

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15
Q

What are 3 key disadvantages of the AMT?

A
  1. very limited validity data
  2. familiarity has led to numerous adaptations of questions leading to questionable validity
  3. culturally specific: questions about date of first world war, name of monarch
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16
Q

What is a better alternative to the AMT, particularly in primary care?

A

6CIT

17
Q

When should the confusion assessment method (CAM) be performed?

A

perform on all high risk patients for delirium, and performed regularly

18
Q

What are 4 points on the Confusion Assessment Method (CAM) that a patient must have to be positive for delirium?

A
  1. Acute onset and fluctuating course
  2. Inattention (e.g. 20-1 test with reduced capacity to shift attention or keep attention focused)
    • and EITHER:
  3. Disorganised thinking (disorganised or incoherent speech)
    • OR
  4. Changed level of consciousness (usually the patient is lethargic or is in a state of stupor)
19
Q

What is the 4AT screening tool used for?

A

screening for delirium

20
Q

What are 7 advantages of the 4AT (4 As Test)?

A
  1. <2 minutes
  2. no special training is required
  3. designed specifically for routine clinical practice
  4. easy and simple
  5. suitable for use by all practitioners with a basic knowledge of delirium
  6. all patients can be assessed, including those unable to speak (eg. with severe drowsiness), so no patients are ‘Unable to Assess’
  7. has built-in brief cognitive tests
21
Q

What does the 4AT consist of?

A
  1. Alertness
  2. AMT4: age, DOB, place, year
  3. Attention
  4. Acute change or fluctuating course
22
Q

What is a limitation of the 4 As Test?

A

needs further testing in populations other than >70y age group

AIP: Acute confusional state (14 decks)

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