Cognitive Assessment Flashcards
What is Dementia?
Dementia - an umbrella term for a variety of diseases that create irreversible changes in the brain, including:
○ Alzheimer’s disease (associated with protein plaques and tangles);
○ Vascular dementia (associated with strokes)
○ Mixed dementias (any combination of dementias, most commonly Alzheimer’s and vascular)
○ Dementia with Lewy body disease
○ Frontotemporal dementia
○ Dementias associated with Creutzfeldt-Jakob disease, Parkinson’s disease, and Huntington’s disease.
What are Normal cognitive changes associated with aging?
○ Process becomes slower
○ May take longer to learn new information
○ Slightly decreased short-term memory (recent)
○ Long-term memory (remote) and the ability to make decisions remain intact
What are Abnormal cognitive changes associated with aging?
- Memory loss of recent or remote events
○ Memory loss (whether recent or remote) is not sufficient enough to diagnose Dementia.
○ There must be a loss of memory coupled with an impact on the patient’s activities of daily living (ADLs), or instrumental activities of daily living (IADLs)
□ ADL’s include: Bathing, Ambulation, Toileting, Transfers, Eating, Dressing
□ IADLs include: Shopping, Cooking/Cleaning, Using telephone or Transportation, Managing Money and Medications - Disoriented of confused thoughts
- Repetition of ideas
- Impaired judgement/insight
- Personality changes
What is Delirium?
Delirium: a complex neuropsychiatric syndrome marked by an acute onset, fluctuating course, altered level of consciousness, inattention, and disorganized thinking.
- described as an acute condition, usually lasting for 1-7 days, although it can persist for days or weeks .
What is Dementia?
Dementia: a brain disorder characterized by impaired cognitive functioning that can affect learning and memory, mood and behaviour, as well as the ability to conduct daily activities and high level functions such as management of other chronic conditions.
- develops gradually and is progressive, but its manifestation and course can vary considerably, depending on the disease
What is Depression?
Depression: a spectrum of mood disorders characterized by a sustained disturbance in emotional, cognitive, behavioural, and/or somatic regulation that is associated with both significant functional impairment in daily living and often loss of one’s capacity for pleasure and enjoyment (anhedonia).
- Depression can be chronic, persistent, or recurrent or it can be a reaction to events that are common in the lives of older adults, such as developing an illness, experiencing cognitive decline, losing a loved one, or being admitted to hospital or long-term care.
Features of Delirium
Onset
- Acute
Course
- Short, fluctuating, and worse at night
Duration
- Typically, short (hours -< 1 month)
- Can be persistent
Alertness
- Lethargic or Hyper-alert
Fluctuates
Attention
- Inattention, Unfocused, Distracted, Fluctuates
Orientation
- May be impaired
- Fluctuates in severity
Memory
- Recent memory impaired
Thinking
- Disorganized, Disconnected , Tangential, Rambling, Incoherent
Perception
- Acute onset hallucinations, delusions, or illusions common
Features of Dementia
Onset
- Chronic, progressive decline
Course
- Long, progressive, stable loss over time
Duration
- Chronic (months-years)
Alertness
- Normal until late stage
Attention
- Generally normal
- May decline w/ disease progression
Orientation
- Increasing impairment overtime
Memory
- Recent memory impaired
- Remote memory is increasingly impaired with progression of disease
Thinking
- Difficulty with abstract thinking
- Poor judgement
Perception
- May be longstanding (ie, dementia w/ Lewy bodies) or can occur at late stage of illness (ie. Alzheimer’s)
Features of Depression
Onset
- Variable; may appear abruptly or coincide with life changes
Course
- Diurnal effects; Typically worse in morning
Duartion
- Signs and symptoms are present for at least 2 weeks, but may persists
Alertness - Normal
Attention
- Minimal impairment - Distractible
- Poor concentration
Orientation
- Selectively Intact
- Answers “I don’t know”
Memory
- Selective or patchy impairment, “islands” of intact memory
Thinking
- Intact: themes of hopelessness, helplessness, and guilt; rumination
Perception
- Rarely impaired; hallucinations absent except in severe cases (psychosis)
Who should be Screened For Cognitive Impairment?
○ Age > 80 (25% have dementia)
○ After treatment for delirium, depression (red flag)
○ After a Stroke (30% develop a dementia at 3months post Stroke)
○ Changes in function, behavior, mood
○ New difficulties with driving/near misses
What is the Mini Mental State Exam (MMSE)?
- 1 of the first cognitive screening tools practitioners used
- 30-point questionnaire used to assess cognition.
- Used to screen for dementia. - Tests various functions, including arithmetic, memory and orientation.
includes 5 components:
1) Orientation
2) Registration (name 3 objects)
3) Attention and Calculation
4) Recall
5) Language
- Any score over 27/30 - normal
- 20-26 -mild dementia
- 10-19 - moderate dementia
- Below 10- severe dementia
What is the Mini-Cog?
- can help care providers identify possible cognitive impairment in older patients in as little as 3 minutes at the bedside.
- simple to use and can help determine when more in-depth cognitive evaluation is needed.
Step 1: Say 3 words and ask patient to repeat them back
Step 2: Ask them to draw a clock
Step 3: Ask the person to recall the 3 words states in step 1
What is the MoCA?
- MoCA—also known as Montreal Cognitive Assessment or The MoCA Test is a highly sensitive tool for early detection of mild cognitive impairment (MCI) in 2000.
- MoCA is widely used as a scale in academic and non-academic research.
- The sensitivity of MoCA for detecting MCI is 90%, compared to 18% for the MMSE.
