Cognitive Assessment

Question 1

Components of cognitive exam

Answer 1

Memory:
Conscious level
Registration
Orientation
Attention and Concentration
Delayed recall

Executive:
Verbal fluency/ Similarities and Differences
Luria's 3 step (fist-edge-palm)
Copy a drawing
Follow instruction
Visuospatial: Draw cube/clock

In OSCE: focus on identifying deficits related to predominant cognitive problem first then screen other domains using 1-2 tests
“I’m going to test your memory. Some questions easy and some will be hard. Don’t worry and try your best to answer”

Question 2

Consciousness and Orientation

Answer 2

Conscious
- alert, drowsy, confused, coma

Orientation (guess if don’t know, no need to correct them)

• time (very sensitive in delirium)
• place
• person

Question 3

Attention

Answer 3

Ascending digit span
Serial subtraction test (serial 7s)

More complex tests: stroop test, trail making, dichotic listening

Question 4

Learning and memory

Answer 4

Registration (short term memory; limited capacity of 1 min) - list of 3 words, tell them to repeat and rmb for later
and 
Recall (5 minutes later - recent long term memory)

Both testing episodic memory - fx of medial temporal structures

Question 5

Language

Answer 5

Observe for coherent and relevant speech
Physical qualities of speech
Determine comprehensive and expressive skills e.g. give a sentence/instruction to fold paper, verbal fluency

Question 6

Executive function and judgement

Answer 6

Category/Verbal fluency (1 minute e.g. animals); Similarities and differences
Complex motor sequence

Other tests: trail making, stroop test, card sorting test

Question 7

Visuospatial motor skills

Answer 7

Clock-drawing/cube drawing
- look an symmetry, numbering
Copying geometric figures
Praxis - complex motor sequence (Luria’s 3 step; do both hands)

Question 8

Other extended neurocognitive examinations - frontal lobe and temporal lobe

Answer 8

Frontal

• disinhibition, impulsivity
• primitive reflexes e.g. sucking, rooting, grasp
• echopraxia (copying movements), utilisation behaviour
• personality changes

Temporal

• receptive dysphasia
• naming deficits
• amnesia

Question 9

Other extended neurocognitive examinations - parietal lobe and occipital lobe

Answer 9

Parietal

• astereognosis (visuospatial)
• left-right discrimination
• finger agnosia
• sensory inattention

Occipital

• scotoma (blind spots)
• visual field defects
• visual agnosia