Cognitive Assessment Flashcards
Why is assessing cognition important?
>25% of medical inpatients have dementia
15-25% of medical inpatients have delirium
Relevant to the assessment of capacity / Mental Capacity Act / DoLS
What is cognition?
The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses
What is executive functioning?
Frontal lobe = executive + behaviour + personality
“higher order cognitive functioning”
Adaptation, abstraction, mental flexibility, problem-solving, planning, initiation, sequencing, judgement, goal-setting
How do you assess memory?
Working Memory
Observation: not easily assessed
Bedside Testing:
Digit span forwards (7) / backwards (5)
Immediate recall of 10 item list / 7 item name and address
N.b. not 3 items e.g. apple, table, penny
Anterograde memory
Observation: forgetful of content of conversation, repetitive
Bedside Testing:
Delayed recall of 10 item list / 7 item name and address
Delayed recall of 3 items
Retrograde memory
Observation: incoherent history, forgetting past events
Bedside Testing:
Dates of wars
Recall of Prime Ministers / Presidents / Monarchs
Recall of personal information (need informant)
How do you assess attention/concentration?
Observation:
Ability to establish and maintain conversation and distractibility
Bedside Testing:
Orientation in time / place (also memory)
Serial subtraction eg 100-7, 20-3 /Spelling backwards eg WORLD
Days of week or months of year backwards
How do you assess language?
Observation:
Able to express fluently and appropriately
Wordfinding difficulties (semantic dysphasia)
Able to understand questions / instructions
Bedside Testing:
Naming objects and parts eg watch, strap, winder, pen, nib, naming of pictures
Repetition of complex words eg Statistician, Hippopotamus, Constitutional
Repetition of complex sentences eg “No ifs, ands or buts”
Comprehension eg 3 stage command, pen-watch-keys test
How do you assess executive functioning?
Observation: Not easily assessed
Bedside testing:
Verbal fluency e.g. 1 min - animals, supermarket, FAS
Abstraction
proverb interpretation eg People in glass houses
similarities / differences (apple / banana, coat/ dress, table / chair, poem / statue, praise / punishment)
cognitive estimates (Camels in Holland / How fast horse gallops)
Set shifting eg alternating sequence test, Luria, trail-making test
Response inhibition eg go-no go test
How do you assess visuospatial functioning?
Observation:
Positioning on chair, bumping into furniture
Bedside Testing:
Intersecting pentagons
Cube
Clock drawing - ask to draw clock face, put in numbers and set hands to ten past five
How do you assess reading, writing, calculation and praxis?
Reading
Read aloud complex words (pint, tomb, dough) or a sentence
Follow written instructions eg “close your eyes”
Writing
Write a simple sentence
Calculation
Addition, subtraction, multiplication, division
Praxis
Mime a common action eg cleaning teeth
Name some assessment schedules
Orientation to time place person – to ensure grossly intact
MMSE – simple screen, wide breadth, not comprehensive (executive)
ACE-R – more comprehensive, approx 30mins
DemTect – brief, simple, for early cognitive changes
MoCA – good for early cognitive changes but longer
CAMCOG – comprehensive. Usually OT
6-CIT, AMT, GPCOG – v brief screens e.g. GPs
Neuropsychology, specialised assessments by SLT, psychology, CAMHS
What are the advantages and disadvantages of assessment schedules?
Advantages - Standardised, validated, transferable
Disadvantages - Don’t cover all areas fully
Some require training
n.b. copyright
You do not need to use an assessment schedule, and can choose to assess each area as above but if you chose to use an assessment schedule, you should be aware of shortcomings, fill in deficits, and supplement depending on findings.
