Cognitive Assessment

Question 1

What is the purpose of cognitive examination and assessment

Answer 1

Separate patients in whom a firm clinical diagnosis can be made from those who require further and more detailed investigation

Question 2

Describe the approach to assessment

Answer 2

Symptom-oriented -> localisation of pathology -> clinical diagnosis

Question 3

How is history taking important to create a picture of functioning

Answer 3

Ability to respond to conversational cues. Importance of reliable informant

Question 4

What do we look for when taking a history

Answer 4

Onset and time course of deterioration, deficits observed, disparities between accounts, family history and risk factors, level of alertness, patient background: level of education, employment, relationships

Question 5

Describe the Addenbrooke’s cognitive exam (ACE-R)

Answer 5

Brief cognitive screening tool. Includes items covered in the MMSE, more sensitive and specific, 5 subdomains: orientation/ attention, memory, verbal fluency, language, visuo-spatial

Question 6

What parts of the brain are used in attention and orientation

Answer 6

Precuneus and inferior parietal lobe active in all 3 domains of attentional orienting. Medial prefrontal cortex mostly active for person and time. Temporal lobe activity for time and person, strong left lateralisation for time.

Question 7

What assessed attention

Answer 7

Serial subtraction and backward spelling

Question 8

Describe assessing memory

Answer 8

Memory complaints provide a good starting point. Analyse by dividing memory into separate domains: episodic, reterograde, anterograde

Question 9

Describe working memory

Answer 9

Lapses in concentration and attention, deficits common in ageing as well as with depression and anxiety. Dorsolateral prefrontal cortex important in working memory and attention

Question 10

Describe semantic memory

Answer 10

Anterior temporal lobe key neural substrate. Resides in multiple cortical areas related to various types of knowledge ‘bound’ by anterioir temporal lobe ‘hub’

Question 11

Describe the visuo-spatial ability

Answer 11

Dorsal and ventral visual pathways

Question 12

Describe the dorsal or “where” stream

Answer 12

Spatial processing from occipital lobe to temporal lobe via parietal lobe- location, movement, spatial transformations, spatial relations

Question 13

Describe the ventral or “what” stream

Answer 13

Object processing from occipital lobe to frontal lobe via temporal lobe- colour, texture, pictorial detail, shape, size

Question 14

Describe constructional apraxia

Answer 14

Characterised by an inability or difficulty to assemble or draw objects. May be caused by lesions in the parietal lobe following stroke or may serve as an indicator Alzheimer’s disease. Right parietal damage leads to neglect syndrome- patients neglect left half of space

Question 15

What type of memory is most likely affected following hippocampal damage

Answer 15

Episodic

Question 16

A 58 year-old male presents with his partner who reports that she has noticed a number of changes in the patient over the past few months. His movements have become stiffer and more rigid, he tends to be less steady and has fallen over a couple of times. At certain times of the day he tends to fluctuate between periods of alertness and confusion quite rapidly. He recently claimed that he could see his mother in their bedroom. His mother passed away 5 years ago, who was previously diagnosed with dementia. What is the most likely diagnosis given the patient’s presenting symptoms and history?

Answer 16

Dementia with Lewy bodies

Question 17

What factors influence cognitive ageing

Answer 17

Genes – early vs. late onset? Level of education. Aversive life experiences. Can high level of education mask early signs of pathology? General cognitive ability and intelligence related to how we age?

Question 18

What is cognitive reserve

Answer 18

Resilience to disease-related changes and ability to maintain function (different to brain reserve. Individuals matches for clinical severity as identified b assessment of cognitive function and daily living may have higher level of underlying pathology

Question 19

What is the formula for Z score

Answer 19

z= (x-u)/SD
x= test score
u= mean
SD= standard deviation