Week 4 - Day 4 - Addenbrookes Cognitive Assessment, Frontal Assessment Battery, Cognitive domains and Executive functioning Flashcards
Cognition refers to the mental processes involved in making sense of the world and the use of that information to guide behaviour. It includes the ability to perceive and react, process and understand, store and retrieve information, make decisions and produce appropriate responses. It is not a unitary concept and is made up of multiple cognitive domains. What are the main causes of cognitive dysfunction?
Neurodegenerative - Alzheimers, frontotemporal dementia Neurological conditions - eg epilepsy Vascular - eg vascular dementia, stroke, TIAs Structural - brain tumours Trauma - brain injury Inflammatory - MS, SLE Many more
It is important to screen for cognitive dysfunction if the patient presents with often unreliable history or appears cognitively impaired A good cognitive screen is quick, easily accessible, reliable and valid , sensitive and specific and covers all the cognitive domains What are the cognitive domains? (there are 5)
Memory Language Executive functioning Attention Visuospatial awareness
There are multiple different tests that look for congitive impairment ie
- MOCA (Montreal cognitive assessment)
- Addenbrookes (ACE-III), Mini-ACE
- FAB
What are the cut-offs for MOCA?
It is scored out of 30
- Score of >27 rules out dementia
- Score of <24 supports dementia
- A score of 20 to 24 suggests mild dementia
- 13 to 20 suggests moderate dementia
- < 12 indicates severe dementia.
What is the test that examines our memory, language, attention, verbal fluency and visuospatial awareness?
This would be addenbrookes cognitive examination 3 (ACE-III)
How long does it usually take to perform the full addenbrookes examination? What is the shorter version of the addenbrookes examination that only takes 5 minutes to perfrom?
The ACE-III takes around 15 minutes to perform The Mini-ACE (M-ACE) is a shorter version of the ACE-III, and it was developed for use in settings where administration of the full ACE-III is not practical - only takes about 5 minutes to perform
Memory is the ability to recall information: involves multiple brain regions (including temporal lobes & hippocampus). Many different types of memory - verbal, visual, immediate, recall and recognition, semantic etc What is semantic memory?
This is the ability to recall information that we have accumulated throughout our lives - general world knowledge
It is not possible to assess all memory abilities using a cognitive screen. What types of memory does the ACE-III assess? What are the cognitive areas that the ACE III assesses again?
ACE III - only assesses verbal and semantic memory ACE III - assesses memory, language, attention, visuospatial awareness and verbal fluency
When should somebody not be screened for cognitive dysfunction? What age group do you have to be for a ACE-III examination?
Do not screen for cognitive dysfunction if the patient has a GCS of <13, the patient is intoxicated, psychotic, post-traumatic amnesia Have to be 50 years of age and above to have an ACE-III
What are the ACE-III cut-offs for cognitive impairment? What is the test out of to begin with? the test looks for cognitive impairment in patients above 50 - mainly dementia but can also find other causes
ACE III is scored out of 100 A score of 89-100 requires no further assessment A score of 82-88 is borderline cognitive impairment and should be referred to a specialist A score of below 82 indicates cognitive impairment and should be referred to a specialist
The mini-ACE is scored out of 30 What are the cut offs indicating borderline and cognitive impairment for this test?
Mini-ACE Borderline cognitive impairment - this would be 21-25 scoring A score of less than 21 is cognitive impairment in this test
What is a range of skills which allow a person to establish new ways of thinking and behaviour patterns; and to introspect known as? What is introscpection?
EXECUTIVE FUNCTIONING is the range of skills which allow a person to establish new ways of thinking and behaviour patterns and to introspect Introscption is the act of examining ones own thoughts or feelings
Which lobe of the brain is associated with executive functioning?
Associated with frontal love regions
Describe the different executive functions that are under control by the frontal lobe? These are the headings under which the executive function regions are: Cognitive function Energisation Behaviour and emotional regulation Mea-congition
Cognitive function: * This is planning and organisation - problem solving, attention and goal setting Energisation * This is the ability to initiate and sustain a response Behaviour and emotional regulation * Impulse control and social awareness Meta-cognition * Controls empathy, humour self-awareness and reflection
What does executive dysfunction look like?
Severe inattention Inability to follow goals that are set Showing a lack of apathy (interest or enthusiasm) Deficits of inhibitory control in behaviour, humour, impulses Changes in personality - eg lack of concern for others Deficits of inhibitory control - hyperactivity, impulsive behaviour, disinhibition, hyper-sexuality, over-eating and argumentative behaviour.
Brief clinical interview/observation helpful prior to administering screen: Reported difficulties e.g. poor decision making, distractible, fixated on certain topics, reduced empathy, aggression, socially inappropriate, less able to do things alone e.g. Travel. Insight/awareness of difficulties; information from relative useful. What is the screening test used to assess the basic cognitive functions for executive dysfunction?
This would be the frontal assessment battery (FAB)
