Week 4 - Cognitive Impairment

Question 1

What are risk factors for cognitive impairment? (8)

Answer 1

• advanced age
• brain trauma
• disease or disorder (tumour , hypoxia, stroke)
• Environmental exposure (lead)
• Substance use disorder (decreased LOC)
• genetic diseases
• depression
• medications (sedative hypnotics, opiods)
• Fluid and electrolyte imbalance

Question 2

What are consequences of cognitive impairment? (7)

Answer 2

1. Loss of short and/or long-term memory
2. Disorientation to person, place, time, and/or situation
3. Impaired reasoning and decision-making ability
4. Impaired language skills
5. Uncontrollable or inappropriate emotions such as severe agitation and aggression
6. Impaired reasoning and decision-making ability
7. Delusions and hallucinations (perception)

Question 3

What can we do to generally manage cognition? (6)

Answer 3

• primary prevention
• secondary prevention (screening)
• collaborative interventions
• general management
• pharmacologic agents (medications)
• family and caregiver support

Question 4

What can we do as primary prevention? (5)

Answer 4

• promote healthy lifestyle
• genetic counselling
• educate HCP about latest evidence
• avoid drugs that cause cognitive impairment
• avoid head injuries

Question 5

What are some screening/assessment tools for cognition? (3)

Answer 5

• General survey
• Glasgow Coma Scale
• Mini Mental (older adult)

Question 6

What can you do in a general survey on cognition? (4 feature, 9 points)

Answer 6

1. Physical appearance
   - age, gender, LOC, skin colour, facial features
2. Body structure
   - stature, nutrition, symmetry, posture, position, body build, contour
3. Behaviour
   - facial expression, mood and affect, speech, dress, personal hygiene
4. Mobility
   - gait
   - range of motion

Question 7

How can we assess LOC? (6)

Answer 7

1. General survey - each patient contact
2. In hospital, initial contact and PRN, schedule if needed
   - A&O x 4
   - person, place, time, context
   - easily follow commands (hand grasps, quick and easy)
   - Neuor check q1H

Question 8

What are the different LOC? (5)

Answer 8

• alert
• lethargic (somnolent)
• obtunded
• stupor (semicoma)
• coma

Question 9

What occurs with alert LOC? (3)

Answer 9

• awake or readily aroused
• oriented x 4
• repsonds appropriately

Question 10

What is lethargic (somnolent) LOC? (5)

Answer 10

• drifts off to sleep when not stimulated
• looks drowsy
• aroused when name called
• thinking slow/fuzzy
• loose train of thought

Question 11

What is obtunded LOC? (5)

Answer 11

• mainly asleep, difficult to arouse
• loud shout or vigorous shake
• confused
• speaks in monosyllables
• mumbles/incoherent

Question 12

What is stupor LOC (semicoma)? (4)

Answer 12

• spontaneously unconscious
• responds only to pain or vigorous shake
• withdraws from pain
• groans, grumbles

Question 13

What is coma LOC? (2)

Answer 13

• completely unconscious
• no response to pain

Question 14

GCS chart

Answer 14

Question 15

How does one respond to painful stimuli? (3)

Answer 15

• localizes
• withdraws
• grimaces

Question 16

What is an abnormal response to stimuli? (2)

Answer 16

• abnormal posturing
  (decerebrate/decorticate)
• no response, flaccid

Question 17

What does the Mini Mental State Examination assess?

Answer 17

• if the person is safe to function in community or has needs