Cognitive Dysfunction Flashcards
What are the five main key physical impairments?
Gait, (cognition, vision, perception), speech, swallowing and nutrition
What is cognition?
This is the set of all mental abilities and processes related to knowledge, attention, memory and working memory, judgement and evaluation, reasoning and computation, problem solving and decision making, comprehension and production of language.
NB
-Sensory input goes to Primary sensory cortices
-Next where is it???-this goes to the association cortex in the parietal lobe, when is it???- this goes to the association cortex in the temporal lobe. DORSAL= WHERE
VENTRAL= WHAT
-Then salience occurs in the limbic structure (connections formed)
-Then a strategy is generated in the prefrontal cortex
-and action is taken via the basal ganglia, cerebellum, motor cortex and parietal cortex.
What is agnosia?
This is the inability to process sensory information, in the absence of sensory impairment or memory loss, e.g. inability to recognise sounds, shapes, objects, smells and people
What is anosognosia?
This is a lack of insight into/recognition of impairment.
What are short term consequences of hemi neglect?
Bumping into things, under use of affected limb, poor sitting posture and shoulder subluxation.
If you have a stroke or a TIA, how long are you barred for driving?
AUTOMATICALLY barred for one month
If you have visual field neglect, when can you drive?
If you have 160 degrees lateral field with 30 degrees up and down and no central defect
What is apraxia?
This is disorder of motor planning, this is when the patient is unable to perform tasks when asked, despite understanding the request. This is NOT caused by incoordination, sensory loss or failure to comprehend commands.
What are the four types of apraxia?
Ideomotor, conceptual, constructional, gait apraxia.
What is ideomotor apraxia?
This is when you can explain how to perform an action, can perform the action automatically (i.e. pick up the phone when it rings) BUT you cannot mine how to perform the action.
What is conceptual (ideational) apraxia?
This iix the inability to conceptualise a task and unable to complete multistep actions, they have incorrect sequencing of tasks and they use tools incorrectly.
Eg, not knowing how to put on your coat, boil the kettle etc
What is constructional apraxia?
This is the inability to draw figures
What is gait apraxia?
There is NORMAL power and coordination BUT unable to sequence movements as part of a gait cycle- difficulty initiating, stooped posture, short shuffling steps, difficulty picking up feet off the floor, freezing, poor postural control and righting reflexes, but when tested on bed, NORMAL POWER AND COORDINATION, not like cog wheeling in parkinsons.
What are the consequences of apraxias?
There is limitation of functional abilities (meal prep, washing, dressing), mobility is impaired (falls, posture control etc, stairs), and difficult rehab- impaired task sequencing, unable to plan an execute tasks
How do you test language in cognition tests?
Object naming, sentence repitition
How do you test memory in cognitive tests?
Orienttion, recall (immediate and delayed) and biographical.
How do you test executive function in cognitive tests?
Trail making, abstraction, name as many as you can in 1 min….
How do you test attention in cognitive tests?
Repeat digit sequence, copying complex figures, sentence repetition, serial 7 subtraction
So the counting backwards in the AMTS is testing??
Attention
What is sentence repetition testing?
Language
What is clock and cube drawing testing?
Visuospation function
What is verbal abstraction and trail making testing?
Executive function
How do you test capacity?
Can they understand, retain, weigh up and communicate back their decision?
When is the mental capacity act 2005 not appropriate to use?
If it is a high-impact decision, e.g. withdrawing life-sustaining treatment, if there is conflict within the family, complex cases where there is borderline/fluctuating capacity or if there is communication impairment.
What is DOLS?
This is when a person with a transient mental disorder can be temporarily deprived of some of their liberty, e.g. if they are agitated or confused and attempting to leave the ward, you can use mittens for example to facilitate NG feeding.
What restrictions may happen in DOLS?
Detaining person on medical ward, restricting the person’s movements, restricting their freedom (mittens, sedative medication), stipulating who they may or may not associate with (visiting rights), specifying where the person is to live (long term care etc).
What three principles must be applied to restrictions in DOLS?
They should be proportionate to the anticipated harm, the least restrictive to the patients rights, reviewed regularly and relaxed or rescinded if necessary.
NB
Mental capacity act is TIME and DECISION specific
What is extinction (neglect)?
This is when a stimulus is presented on each side INDIVIDUALLY and it is DETECTED, but when the stimulus is present on both sides simultaneously, ONLY the right side is detected. This is EXTINCTION
Don’t forget
If a patient has hemiparesis, epilepsy, neglect, visual field defect THEY ARE BARRED FROM DRIVING and must contact the DVLA, you must tell them not to drive and to do this.
What is autonomic dysreflexia?
This occurs in patients with spinal injuries due to a defect in their modulatory response, for example the sympathetic nervous system when its activated may usually be modulated by the parasympathetic system, however in patients with spinal cord injuries the response is unmodulated and the patients bp goes really high. The body can cause a bradycardia in response.
Tx for autonomic dysreflexia?
So tx- treat underlying infection/cause, give sublingual GTN spray, nifedipine.
