Cognitive Assessment

Question 1

Why is the confused patient challenging

Answer 1

Live alone
Lack of information - difficult to illicit a history may not be an accurate history 
Need a collateral history if possible
Cognitive impairment present 
Assess dementia and delirium
Complex comorbidities 

What does this lead to
Misdiagnoses
Serious constraints on a proper evaluation and assessment
Requires team work

Question 2

Types of cognitive impairment

Answer 2

Dementia
Delirium
Depression - pseudo dementia
Mild cognitive impairment

Question 3

What is important that you do

Answer 3

Comprehensive geriatric assessment

Question 4

How to approach an intellectual failure

Answer 4

Which ? Dementia, delirium or mild cog impairment

Question 5

How does delirium present

Answer 5

Forgetful not usual self
Acuteness of symptoms is key
Affect on everyday function
Acute neuropsychiatric condition
Affects attention alertness and cognition
Complication post surgery
Inc mortality and risk of institutionalisation

Question 6

When to suspect delirium

Answer 6

Inc age
Frail
Pre existing cog impairment
Post surgery

Question 7

Define arousal

Answer 7

Magnitude of response to a perceived stimuli

Question 8

Define cognitions

Answer 8

The mental process of thinking and knowing , including aspects such as awareness, perception, memory, language, reasoning and deciding

Question 9

Define consciousness

Answer 9

Alertness plus awareness

Ability to respond to the external environment and self perception

Question 10

Define attention

Answer 10

Ability to focus the mind, and sustain focus, on an environmental stimulus, ides or series of connected ideas

Question 11

Define awareness

Answer 11

Self perception or inward sensibility

Question 12

Define alertness

Answer 12

Ability to respond to external stimuli

Question 13

Diagnostic criteria for delirium DSM-IV

Answer 13

Disturbance of attention or arousal
A change in cognition that develops over a short period of time
Tendency to fluctuate during the course of the day with disturbance in the sleep wake cycle
Evidence from history, examination, or investigations that the delirium is a direct consequence of a general medical condition, drug withdrawal or intoxication.

Question 14

Screening tools for delirium

Answer 14

CAM - confusion assessment method - widely used, relies on understanding of inattention and needs training to do it

SQiD single question in delirium
Do you think (name) has been more confused lately

4AT test
Test alertness, attention, AMT 4 and acute history
Freely available no inattention necessary

Question 15

Causes of delirium

Answer 15

P pain
I infection
N nutrition
C constipation
H hydration
M metabolic/medication
E environment/ electrolyte imbalance

Question 16

What is dementia

Answer 16

Chronic syndrome
Global impairment not just memory
Affects everyday function

Question 17

Causes of dementia

Answer 17

Alzheimer’s 
Vascular dementia
Less body dementia
Fronto temporal Demetria
Posterior cortical atrophy

Question 18

Screening tools for dementia

Answer 18

MMSE
MOCA
6-CIT
ACEIII

Hospital AMTS
<7 dementia
Simple to do
Culture specific