Congitive Assessment: Geriatrics Flashcards
What happens to the nervous system as we age?
- Decreased number of neurons and increase in size and number of neurological cells
- Decline in nerves and nerve fibers
- Atrophy of the brain and increase in cranial dead space
How to screen for a mental status change?
Perform mini mental status examination
What are some of the components of a mini entail status?
- State of consciousness
- General appearance and behavior
- Orientation
- Memory
- Executive function control
What are the 3 basic components of memory that are tested during the mini mental status examination?
- Immediate recall
*New memory (name objects and have them recall) - Recent memory
*recalling 3 objects after a few minutes - Remote memory
*give details of early life
How to evaluate cognitive function?
- Orientation
*time, place, person, situation - Attention and concentration
*Serial 7, Spell word backwards - Memory
What are ways to test higher cognitive functions?
- Copy diagrams/constructional ability
- Similarities between objects
What is executive function?
Involves the planning, sequencing, and execution of goal-directed activities
*balancing a check book, following a recipe
*Critical to the ability to perform instrumental activities of daily living
How to screen for executive dysfunction?
- Clock-drawing
*Mini-cog
What is the scoring for the mini mental state examination?
24-30: Normal range
20-23: mild cognitive impairment
10-19: Middle-stage/ moderate Alzheimer’s
0-9: Late-stage/severe Alzheimer’s disease
When is a Mini-cog used?
When there is suspicion of cognitive impairment, conduct
1. Three-item recall with
2. Clock drawing
*If the patient fails then continue with standardized instrument
What dos the Mini-Cog specifically test for?
- Memory (3 item recall)
- Executive function (clock drawing)
If a patient cannot remember any words from the three item recall what are they classified as?
Impaired
If a patient can remember 1-2 words from the three item recall, what happens next?
Clock drawing
*Abnormal=Impaired
*Normal=Not impaired
What are the 5 elements for decision making capacity?
- Ability to express a choice
- Understanding relevant information and risk and benefits of planned therapy
- Comprehension of the problem and its consequences
- Ability to reason
- Consistency of choice
How can cognitive impairment be categorized?
- Acute disorders associated with acute illness, drugs, and environmental factors
*delirium - More slowly progressive impairment of cognitive function
*dementia - Impaired cognitive function associated with affective disorders
what happens during age-related cognitive decline?
- Slowed thinking and reaction time
- Mild recent memory loss
- Symptoms are sporadic and do not affect function
What is Mild Cognitive Impairment?
- Impairment in memory, executive function, attention, and language
- Preserved independence in functional abilities
*deficit is not the result of neurological,psychiatric or other medical disorders
What is Delirium?
- Acute or subacute alteration in mental status
- Can persist for days or weeks
- Reversible
What are some key features of delirium?
- Disturbance of consciousness and attention and awareness
- Symptoms develop over short period of time
*hours to days - There is a fluctuation of symptoms and signs
What is a patient presentation of delirium?
- Difficulty sustaining attention to external and internal stimuli
- Fragmented or disordered stream of thought
- Sensory misperceptions
- Neurological signs are uncommon in delirium
How to assess for delirium
3 minute CAM (confusion assessment method)
1. Acute onset and fluctuating course
2. Inattention
AND EITHER
3. Disorganized thinking OR
4. Altered level of consciousness
What are some ways that delirium can be diagnosed?
Intracranial:
1. Infection
2. Seizures
3. Stroke
Extracranial
1. MI
2. CHF
3. Withdrawal
4. giant cell arteritis
Can a laboratory test diagnose delirium?
No
*only a diagnosis of exclusion
Only CAM can diagnose delirium
What is a treatment for Delirium?
Antipsychotics
*Haloperidol
