Cognitive impairment + MMSE Flashcards
three key features of cognitive impairment
loss of higher brain function, loss of functional independence, signs of physical brain disease
What to look for in higher brain function
Look for change of higher brain functions
changes in behavior
does patient have identify changes?
does family/others see a change?
key features of loss of functional indepndence?
loss of skills ($ management, phone numbers, driving)
significant indicator for dementia
often need witness to provide info
w/ no significant functional decline, this could be mild cognitive impairment
signs of physical brain disease
Cognitive changes, loss of function and/or focal neurological deficits or CNS hyperactivity
imaging based on abnormalities of brain
Primary concerns with signs of physical brain diseasd (4d)
destructive of tissue (space occupying lesions)
Depression
Drugs
Delirium
what is the score cut off for the MMSE?
below 24 indicatives dementia or cognitive deficit
what score is of concern in the 6-item congitive impairment test (6CIT)?
> 7 is abnormal
____% of people over the age of 65 experience memory loss
40
What is age-associated memory impairment?
]Memory loss with no medical reason (associated with senescence)
Which of the following are associated with Alzheimers? Which are associated with Senescence?
- Poor judgement and decision making
- Forgetting which day it is and remembering later
- Difficulty having a conversation
- Inability to manage a budget
- Losing things from time to time
- A
- S
- A
- A
- S
One of the key distinctions between Alzheimer’s and senescence is that while both involve memory problems, Alzheimer’s involves changes in _______________
Personality (eg. not being able to carry out conversation, complete ADLs, loss of sense of day/time/place)
Which 6 signs should prompt you to do a mental status exam?
- Loss of cognitive function (complaint from patient/informant)
- Difficulty getting details (taking history)
- Significant change in behaviour
- Un-kept appearance or loss of weight
- New-onset depression/anxiety/psychosis
- Confusion w/o an obvious cause
What is the most significant indicator of dementia?
Loss of functional independence (eg. inability to feed themselves, difficulty navigating society, difficulty with ADLs)
What tool can be used to measure a loss of functional independence?
Functional Independence Measure (FIM)
A patient with a decline in cognition and normal functional skill can be described as having ________________________________
Mild cognitive impairment (MCI)
DDX for patients with focal cognitive deficits developing in under 3 months
4 D’s (NOT dementia):
- Destruction of tissue (eg. space-occupying lesion)
- Depression (mental disorder)
- Drugs
- Delirium
When administering a comprehensive mental status exam, you should take detailed notes on which 4 characteristics?
- Thought formation
- Content of thoughts (negative/positve, hallicinations)
- Patient affect
- Behaviours/symptoms (demeanor, appropriateness of action)
True or false: the MSE can be used to make a diagnosis of dementia
False - screening tool, not diagnostic
Which 3 components of cognition are assessed with the Mini-Cognitive Test?
1. Short term memory Eg. I want you to remember 3 words. Repeat them so I know you have heard me o Banana o Sunrise o Chair
- Registration:
Eg. Draw a clock face and put the numbers in the right place. Set the hands to10 past 5. - Recall:
Eg. What were the 3 words I asked you to remember?
How is the Mini-Cog scored?
3 recalled words = negative for cog impairment
1-2 recalled words + normal clock = negative
1-2 recalled words + abnormal clock = positive
0 recalled words = positive
What is the impromptu testing method?
Put 3-5 common objects on the desk and ask patient to name and remember them, then put them out of sight.
Ask patient to draw large clock face and put all numbers ina nd set hands to 10 past 5
Ask patient to recall objects
(very similar to mini-cog)
What is the 6-item cognitive impairment test? What is an abnormal score?
Series of 6 questions to test cognition:
Abnormal = >7
