lecture 5: assessment of cognition

Question 1

Piaget’s theory: cognitive development

Answer 1

• birth - adulthood
• uses experience to move from stage to stage
• thinking becomes more sophisticated and complex

Question 2

cognitive development’s importance to nursing (providing care)

Answer 2

• helps us understand “normal” and “abnormal” development
• must change approach, based on their cognitive ability

Question 3

Normal cognitive changes with aging

Answer 3

• ability to process and learn new info becomes slower
• slightly decreased short term memory, long term memory remains
• ability to make decisions remains

Question 4

atypical/abnormal changes with aging

Answer 4

• memory loss of short-term events
• disoriented, confused thoughts
• tangentiality (thoughts/speech all over the place)
• dementia

Question 5

Elderly common reasons for cognitive change: 3Ds

Answer 5

1. Depression
2. Delirium
3. Dementia
   - similar symptoms
   - different reasons of occurrence, different treatments

Question 6

Depression

Answer 6

• can be reversible
• limits physical/social interactions, detrimental to mental health

Question 7

Delirium

Answer 7

• sudden state of confusion
• can be reversible
• symptom of something else that’s wrong (dehydration, malnutrition, medication, change in environment)
• # 1 cause is bladder infections

Question 8

Dementia

Answer 8

• large class of disorders caused by progressive deterioration of thinking ability & memory
• irreversible
• must have memory impairment and change in function for a dementia diagnosis

Question 9

Dementia: ADLs vs. IADLs

Answer 9

IADL’s: instrumental activities of daily living
- first to change
- ex. shopping, cooking/cleaning, using telephone

ADL’s: activities of daily living
- last to change
- ex. bathing, eating, dressing

Question 10

When to screen for cognitive impairment

Answer 10

• age over 80
• after treatment for delirium, depression (sign)
• after cardio-vascular event
• changes in function, behaviour, mood

Question 11

components of a cognitive assessment

Answer 11

• review past medical and surgical history
• review ADL’s and IADL’s
• recent imaging reports (can’t rely on them for diagnosis)
• perform cognitive screening/tests
• perform physical exam

Question 12

dealing with a decreased cognition patient

Answer 12

• slow down
• sit in front of them, be clear & present
• simplicity
• don’t argue, redirect attention

Question 13

types of cognitive assessment tests

Answer 13

• MMSE or Folstein test: used to screen for dementia, invalidates educational, language, and cultural factors
• ‘mini-cog’: request drawing of a clock at specific time
• MOCA: minimizes effects of education level, cultural background, language
• RUDAS: also minimizes effects of education level, cultural background, language

Question 14

Dementia and Driving

Answer 14

• everyone with dementia should be asked if they drive
• in Ontario, MDs and NPs are obligated to report if anyone has a condition making it dangerous for someone to continue driving

Question 15

caregivers

Answer 15

• causes change in roles and relationships
• the happier the caregiver, the safer the patient is in their own home
• advocating for caregivers and caregiver burnouts is important