Lecture 44 Assessment of Cognitive Function

Question 1

What is the purpose of bedside assessment

Answer 1

• Purpose: to raise the possibility of cognitive impairments which may need further assessment/onward referral and may impact treatment/consent.

Question 2

How is bedside assessment carried out

Answer 2

o Observation
o Clinical Interview (patient & relative)
o Screening Assessments

Question 3

Name types of screening assessments you would use during bedside assessment

Answer 3

MMSE
ACE-III
MOCA

Question 4

Describe MMSE

Answer 4

Widely used, however: insensitive to mild impairment or focal deficit, lack of executive assessments

Question 5

Describe ACE-III

Answer 5

Sensitivity to mild impairment, differentiation between organic brain disease (dementias), executive assessment
o 15mins
o Includes: language, memory, executive functioning, visuospatial/perceptual
o More sensitive

Question 6

Describe MOCA

Answer 6

10 min screening tool, freely available, better sensitivity and specificity than MMSE

Question 7

What needs to be taken into considerations during bedside assessment

Answer 7

• Environmental Factors – privacy, noise, disturbances.
• Physical Factors – Confusion/delirium, PTA, Fatigue, Illness/infection.
• Psychological – Anxiety/Mood, Effort/Confidence
• Accessibility – Language, Eyesight/Hearing, Disability
• Pre-morbid Factor – Pre-morbid functioning, Education, Occupation, prior injuries/TBI, lifestyle factors.

Question 8

Treatment and common referrals

Answer 8

• Quantifying and monitoring change
• Pre & Post surgery assessments (tumour, epilepsy)
• Impact of medication of cognition
• Rehab potential
• Behavioural management
• Cognitive rehabilitation
• Support and education incl. Families
• Advice on return to work/education
• Advice on care requirements

Question 9

What is involved in Formal assessment

Answer 9

Memory
Language
Processing speed
Attention/concentration
Executive functioning 
Personality
Insight
Visual spatial