Memory Problems: Assessment

Question 1

what are the three different types of human memory?

Answer 1

sensory memory (<1 sec)
short-term memory (<1 min)
long term memory (lifetime)

Question 2

what are the different types of long term memory?

Answer 2

explicit memory (conscious)

• episodic (events, experiences)
• semantic (facts, concepts)

implicit memory (unconscious)
- procedural (skills, tasks)

Question 3

what is anterograde amnesia?

Answer 3

difficulty in acquiring new material and remembering events since the onset of the illness or injury

Question 4

what is retrograde amnesia?

Answer 4

difficulty in remembering information prior to the onset of the illness or injury

Question 5

what are the typical reports of memory problems?

Answer 5

forgetting a message
losing track of conversation
forgetting to do things
inability to navigate in familiar places
increased misplacing of things
struggling to remember names

Question 6

give an example of the difference between normal age related forgetfulness, mild cognitive impairment and dementia?

Answer 6

NARF - sometimes misplaces keys, eyeglasses etc

MCI - frequently misplaces items

dementia - forgets what item is used for and puts it in inappropriate place

Question 7

what are useful questions to ask the patient in a dementia history?

Answer 7

has memory problem affected day to day life?
any problems in kitchen?
can you still use remote control, washing machine, microwave etc?
do you follow the news?
have you ever got lost or disorientated? Do you drive?
can you still enjoy golf / bridge / bingo?

Question 8

what 5 things are assessed during cognitive screening?

Answer 8

memory 
attention and concentration
executive functioning 
visuo-spatial functioning 
language

Question 9

what is the test used for rapid assessment for delirium and is aimed at detecting moderate-severe cognitive impairment?

Answer 9

4AT

Question 10

what 4 things does the 4AT assess?

Answer 10

alertness (normal/mild sleepiness/clearly abnormal)
AMT-4 (age, DOB, place, current year)
attention (months backwards)
acute or fluctuating course

Question 11

what other cognitive assessments other than 4AT can be used?

Answer 11

MMSE - suspected cognitive impairment, used in diagnosis of dementia

addenbrookes - bridges gap between MMSE and neuropsychological assessments (15 mins)

Question 12

how is the MMSE scored?

Answer 12

out of 30

- cut off >27/30 versus <24/30

Question 13

what does MMSE assess?

Answer 13

screening test which assesses orientation, memory, visuospatial and language

Question 14

what are the advantages of the MMSE?

Answer 14

quick
different languages
only blank paper and pen needed
memorisable

Question 15

what are the disadvantages of the MMSE?

Answer 15

not adjusted for age
poor examination of executive functioning
poor in severe impairment due to “floor effect”
poor in high premorbid functioning
may not indicate problems in early stages
significant focus on verbal functioning to exclusion of non-verbal skills

Question 16

what bedside tests can be used to assess memory?

Answer 16

GPCOG
6CIT (orientation, memory and corroborative history)
clock drawing test

Question 17

what test is a rapid screening instrument for mild cognitive dysfunction which assesses multiple cognitive domains?

Answer 17

montreal cognitive assessment (MoCA)

Question 18

what are the cut off scores for addenbrookes?

Answer 18

normal = 88/100

abnormal = 82/100

Question 19

why is it important that a neuropsychological evaluation is carried out?

Answer 19

important in determining whether individual has experienced abnormal intellectual or behavioural decline and whether that decline is related to underlying disease of CNS

should be used in diagnosis of dementia, especially in those where dementia not clinically obvious

*undertaken within psychological therapy services

Question 20

what are the purposes of a neuropsychological assessment?

Answer 20

identify areas of deficits and preserved functioning
aid with diagnosis
provide info regarding prognosis
obtain a baseline assessment
to inform and facilitate interventions and strategies
to monitor change in cognitive functioning
to evaluate effectiveness of interventions
to provide indicators regarding rate of recovery