Cognition

Question 1

Name some cognitive impairment screening tools

Answer 1

Mini Mental State Exam
MiniCog
Trail Making Test

Question 2

Describe the MiniCog

Answer 2

Say 3 words eg Apple Penny Watch
Get the patient to remember them

Ask the patient to draw a clock and mark a time

Ask the patient to repeat the 3 words

Question 3

How do you interpret the MiniCog?

Answer 3

3 words recalled? - negative screen, no cog imp. Don’t mark clock

1-2 words - mark clock
Normal: negative screen
Abnormal: positive screen, cog imp

0 words - positive screen, don’t mark clock

Question 4

Describe the components of the Mini Mental State Exam (MMSE)

Answer 4

Orientation - time and place 
Registration - learn 3 words 
Attention and calculation - minus 7 from 100 5 times, spell WORLD backwards
Recall - repeat the 3 words 
Language 
- name 2 items
- follow 3 stage command
- follow written command (close eyes)
- write a simple sentence
- repeat 'no ifs, ands or buts'
Copying - copy linked pentagons

Question 5

What’s the Trail Making Test?

Answer 5

Draw a line between numbered/lettered dots in ascending order

Tests visual attention and task switching

Question 6

Criteria for mental capacity

Answer 6

Understand, Retain, Weigh up, Communicate
+ Known condition of the mind

Situation specific

Question 7

What’s an Advanced Statement/Directive?

Answer 7

A legal document stating patients wishes for if they lose capacity

Question 8

What is a Lasting Power of Attorney?

Answer 8

Someone appointed (while patient has capacity) to make decisions on their behalf if they lose capacity

This can be a Health and Welfare and/or Property and Finance LPoA

They cannot overrule advanced statements

Question 9

What is an Advanced Decision to Refuse Treatment? (ADRT)

Answer 9

Legal document stating what interventions/treatments the patients wishes to refuse in the future, including life-sustaining treatment.

This must be valid (signed and witnessed) and applicable (to the current situation)

Question 10

What are the key principles when considering deprivation of Liberty Safeguards?

Answer 10

Liberty should only be deprived if:
It’s in their best interest
Its in the least restrictive way possible