Cognitive Tests Flashcards
What is cognition?
The mental action or process of acquiring knowledge and understanding through thought, experience and the senses: relating to conscious mental activities (thinking, understanding, learning and remembrance)
What are the different areas of cognitive functioning? Which are the main ones for testing?
Memory * Language Praxis Attention/Concentration * Calculation Visuospatial * Language * Executive functioning * Writing
What are different types of memory that can be assessed? How is memory assessed?
Working (STM), Anterograde, Retrograde, Explicit
Give a random sequence of numbers and ask the patient to repeat either in order or backwards (immediate recall - STM)
Acquisition of new information (delayed recall) - anterograde memory
Can test the dates of wars/previous prime ministers/personal information to test retrograde memory
How is attention/concentration assessed?
Bedside tests: Orientation in time/place
Spell WORLD backwards or serial subtraction (100-7-7…)
Months of the year backwards
Through observation: ability to maintain conversation and distractibility
How can you assess language?
Observation: able to express fluently, word finding difficulties, able to understand questions
Bedside tests: Name surrounding objects
Repeat ‘no ifs, ands or buts’
Use 3-step command: eg fold piece of paper in half then put it on the floor
What is executive functioning? How is executive functioning assessed?
Higher order cognitive functioning (frontal lobe: executive, personality, behaviour) concerned with problem-solving, planning, initiation, judgement, goal-setting, mental flexibility
Assessment: Alternative sequencing, Draw a pattern then ask patient to repeat it, Go-no go test
How is visuospatial functioning assessed?
Observation: positioning on chair/bumping into furniture
Bedside tests: Ask patient to draw intersecting pyramids, or a cube, or a clock face and set the time to 10 past 5
What are some common assessment schedules?
MMSE is a simple screen to see whether further testing is needed
ACE-R, DemTect, MoCA more comprehensive and good for detecting early changes
CAMCOG usually used by OTs
6-CIT, AMT, GPCOG very brief screens used by GPs
What are some advantages and disadvantages of cognitive assessment schedules?
They’re universal so scores are understood by all clinicians - transferable and validated
Some schedules require training and are copyright
No schedule includes everything that should be tested, there may always be another deficit which will need to be added in to the test to be tested
Why is cognitive assessment important?
> 25% medical inpatients have dementia
15-25% have delirium
Relevant to the assessment of mental capacity, deprivation of liberty
What’s dyspraxia? How could you test?
Inability to carry out complex motor actions despite in tact motor/sensory coordination, comprehension, cooperation
Test for praxis: ask patient to mime a common action eg brushing teeth
