Cognitive assessment Flashcards
1
Q
What is cognition
A
The mental action or process by which knowledge is acquired and understanding through thought, experience and the senses.
2
Q
What are the different areas of cognition?
A
- Memory:
- Working
- anterograde
- retrograde
- Reading/ writing/ calculation
- Praxis
-
Important:
- Attention/ concentration
- Visuospatial
- language
- exective functioning
- Also query orientation - not an area of cognition, but its an area of memory
3
Q
Why assess cognition?
A
- It affects a large proportion of patients, 25% of patients have dementia
- Many of them have deleruim (15-25%)
- Also relevant to asses CAPACITY and the mental capacity act
4
Q
What are the different types of memory
A
- Working memory / short term memory:
- What you are able to keep in your mind at any one time
- Immediate recall of small amounts of verbal or visual material
- can aid by chunking it
- Anterograde memory:
- acquisition of new information
- Retrograde memory:
- recall of previously learnt information
- Explicit memory -> episodic and semantic
- Implicit –> procedural (e.g. riding a bike)
5
Q
What is attention?
What are the different componenet of language?
What is praxis?
A
- Attention = ability to focus on something and iniate that focus then, vigilance, persistence / concentration (Maintain concentration on it).
- Language:
- Aphasia and dysphagia
- Receptive and expressive
- Language vs speech (speech being motor component) (dysphasia vs dysarthria).
- Aphasia and dysphagia
- Praxis:
- Dyspraxia = inabiloty to carry out complex motor actions despite an intact motor/ sensory coordination, comprehension and cooperation.
6
Q
What is exectuive functioning?
What lobe is involved?
what processes are involved?
A
- Frontal lobe = executive + behaviour + personality
- Higher order cognitive functioning
- E.g. adaptation, abstraction, mental flexibility, problem solving, planning, initiation, sequencing, judgement, goal setting
7
Q
What are some of the main principles of cognitive assessment?
What is a formal bedside assessment indicated?
what are two things to note in cognitive assessment?
A
- We should assess ALL patients –> the degree of assessment varies depending on the presentation
- It can be screened through observation
- Formal bedside teaching if the history or screening indicates it:
- for example poor memory, head injury, reduced attention at interview
- Note: that many cognitive tests are not “pure”, e.g. any test of working memory requires attention. If there are problems with language it affects all the assessment, so may not always be accurate.
- Note: that use of assessent schedules is not the same as cognitive assessment.
8
Q
Assessment of memory:
How would you assess working memory?
A
- Working memory: observationally it is not easy to assess.
- Bedside test of working memory –> Digit span forwards (7) or backwards (%)
- Immediate recall of 10 item list / 7 items
- 7 item name and address
- Do not use 3 items: not an assessment of working memory, not decent assessment amount. Reason done in MSE is only to check if the patient has heard it and for very impaired working memory.
9
Q
Assessment of memory:
How do you asses Anterograde memory?
A
- E.g. observation –> forgetful of conversation, are they repetitive?
- Bedside teaching:
- Delayed recall of 10 item list/ 7 item name and address
- delayed recall of 3 items
10
Q
How do you assess retrograde memory?
A
- Observation: incoherent history? Forgetting past events?
- Bedside teaching:
- dates of wars (Starting to lose relevance)
- Recall of prime ministers/ presidents/ monarchs
- Recall of personal information –> need informant
11
Q
How can you assess attention or concentration?
A
- Observation: during consultation, ability to establish and maintain conversation and distractability
- Bedside testing: orientation in time and place (also memory)
- Serial subtraction –> eg 100- 7, 20 -3 / Spelling backwards e.g. WORLD
- days of the week or months of the year backwards
12
Q
How can you assess language?
A
- Observation:
- able to fluently and appropriately
- wordfinding difficulties (semantic dysphagia)
- Able to understand questions or instructions
- Bedside teaching:
- Naming objects and parts, e.g .watch, strap, pen, nib, or naming of pictures
- Comprehension testing: 3 stage command (but also requires memory).
- Comprehension testing: better test is the pen- watch- keys test (look at the pen then the keys, then pen again.)
- Repetition of complex sentences –> No ifs, ands or buts’.
- Repetition of complex words –> statistician, hippopotamus, constitutional
13
Q
How do you assess executive function?
A
- Not easily observed
- Bedside testing:
- Verbal fluency e.g in 1 min name as many animals, supermarkets
- Abstraction:
- proverb interpretation e.g. people in glass houses/ grass is always greener
- similarities and differences (Apple/ a
- cognitive estimates (How many camels are there in holland, how fast horse gallops/ how tall is a house).
- Set shifting e.g. alternating sequence test –> draw pattern and ask them to repeat it
- –> trail making test –> letters and numbers, A -1, B -2 , C-3 etc..
- Luria –> making a fist, tap hand, flatten hand, make fist again…
- Go, no go test –> when I knock once, tap on the table, if i knock twice dont tap on the table. Switch up the pattern, people who are disinhibited cant help but knock.
14
Q
How can we assess visuospatial functioning?
A
- Positioning on the chair, bumping into furniture
- Bedside teaching:
- Intersecting pentagon
- Clock drawing, with hands showing ten to two…
- cube
15
Q
How can you assess other cognitive functions:
Reading
Writing
Calculation
Praxis
A
- Reading –> read aloud complex words or a sentence
- follow written instructions e.g. close your eyes
- Writing –> write simple sentence
- Calculations –> addition/ subtraction/ multiplication/ division
- Praxis –> mime common action eg cleaning teeth
