Cognitive screen and exam Flashcards
what is cognition?
ability to sort, retrieve, and manipulate information
ability to pay attention, recall, use language, and learn
what are examples of executive functions?
plan, manipulate information, recognize errors, problem solve, abstract thinking
which lobe deals with executive functioning?
frontal
Your patient just worked with OT requiring long periods of sustained attention. What is your concern with seeing them for PT right after?
decreased cognitive performance due to fatigue and stress from sustained attention
why is assessing cognition important? 3
part of neurologic screen
developing intervention strategies
part of building prognosis/discharge plan
what do your assessment findings from a cognitive screen tell you?
if there is a cognitive impairment that could affect physical performance
appropriateness of goals
appropriateness of discharge plans/living situation – fall risk?
need for referral
patients with dementia are ______ more likely to fall
why?
5x
decreased insight to deficits
decreased problem solving
poor functional mobility
decreased self care ability
can a PT diagnose a pt with dementia based on assessment findings?
no - medical diagnosis
consult with MD
what is a serial numbers bedside exam and what are you looking for?
patient instructed to count down from 100 by 7s or 3s
looking for patients processing and difficulty with task
what is the animal fluency bedside exam and what are you evaluating?
name as many animals as you can in one minute without repeating
evaluate for:
- immediate recall (5-8 animals named)
- long term recall (digs for more animals to reach goal of 12-18 animals)
what is the clock drawing bedside exam and what are you watching for?
ask pt to draw clock w/ numbers and hands to the time you choose
watch placement, processing and spatial awareness
what is the sentence inhibition bedside exam?
what lobe does it assess?
first, have pt correctly complete the sentence. second, have the pt intentionally say the wrong word to complete the sentence
frontal lobe
what is the reasoning bedside exam?
how do you score it?
ask pt to explain what is meant by a common phrase
score
0 - no relevance
1 - literal
2 - understands phrase in the abstract
what is the retention/recall bedside test?
give pt a list of words to remember
retention - have them repeat them to you
recall - ask them to repeat the words at a later time during your eval
which outcome measure should be used if cognitive deficits are suspected and patient is an adult with undiagnosed cognitive impairment?
mini-mental state examination (MMSE) or Montreal Cognitive Assessment (MOCA)
what is the most commonly used clinical tool for assessing cognition?
Mini mental
what is the bias with the mini mental?
bias when assessing non-English speakers by consistently providing lower scores to those who are non-white
a score of <26/30 on the MOCA suggests ________ is present
vascular dementia
the St. Louis University Mental Status Examination (SLUMS) is indicated for ?
lower-level cognitive patients
which outcome measure is more sensitive/accurate for detecting MCI and dementia?
SLUMS
a score of ____/30 on the SLUMS demonstrates cognitive deficit
<25
which cognitive outcome measure requires cost to use?
which requires the least amount of time?
MMSE
MMSE
are we able to document a diagnosis of dementia?
no - therapeutic diagnosis of cognitive impairment
put exam score in objective portion, interpret result in assessment
what do we focus our interventions on for cognitively impaired patients?
mobility and strength limitations
minimize fall risk factors
emphasis on procedural learning
cognitive exercises to promote quality of life
manage behavior barriers
what is procedural learning?
patient’s can learn even if they can’t remember due to habit development and doing rather than hearing
- they may not even remember learning the skill
how do you maximize procedural learning?
blocked practice - repeat same exercise many times then move on
practice by doing in actual context and limit verbal cues/instructions
true or false. resistance training and aerobic exercise has substantial benefits in older adults’ cognition, attention and memory
true
what are pre/postdiction exercises?
predictions:
- how long do you think it will take you to complete this task?
- how many reps do you think you can do?
postdictions:
- reflection ; how did you do?
cognitive exercises:
what is retention testing?
instruct pt they need to remember the instructions or words after a set interval of time
what is the spaced retrieval technique?
increasing the interval over time improves ability to recall
cognitive exercises:
what is the generation effect?
them making instructions will improve retention
allow pts the chance to figure out the solution themselves, all them to fail safely
cognitive exercises:
what is visual imagery?
mental practice/walkthrough
have pt explain to caregiver how to perform a task
cognitive exercises:
what is “use it”
use your brain
- ex: crossword, word search, interaction with others
behavioral disturbances are first seen in _______ stage of dementia
middle (second)
what are some examples of behaviors associated with Alzheimer’s?
yelling, hitting, kicking, wandering, suspicion, paranoia, agitation, hoarding
what are strategies for PT to manage behavior associated with dementia?
avoid confrontation, anticipate their needs
modify the environment
provide routine exercise
look for and reduce triggers
maintaining functionality and ADLs
what are things that need to be considered when building your patient a discharge plan?
build a plan that works for the pt and their family
where to send them (home vs SNF)
safety when alone
assistive devices needed?
why is identifying a cognitive impairment/fall risk important?
non-fatal falls can start a person down a vicious healthcare spiral
