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