Week 7: Cognitive Assessment

Question 1

Normal cognitive changes

Answer 1

Processes become slower

May take longer to learn new information

Slightly decreased short-term memory (recent)

Long-term memory (remote), and the ability to make decisions remain intact

Question 2

Atypical Cognitive Changes

Answer 2

Memory loss of short-term/recent events

Disorientation, confused thoughts

Repetition of ideas

Tangentiality (digress from original topic)

Executive thought processing

Impaired judgement

Lack of insight

Changes in personality

Dementia (many different types and causes)

Question 3

Elderly: common reasons for cognitive change

Answer 3

3Ds: Delirium, Dementia, Depression

Question 4

Depression

Answer 4

Causes: loss or threat of loss of atonomy and independence
Isolation
Friends passing away
Feeling lack of usefulness

risks
Can be reversible, yet frequently misinterpreted as irreversible dementia which affects course of treatment

Contributes to physical/social limitations

Complicates the treatment of other health conditions

Reduces overall well-being & QOL

Increases risk for suicide*

Question 5

dementia

Answer 5

*progressive deterioration

Dementia refers to a large class of disorders characterized by the progressive deterioration of thinking ability and memory as the brain becomes damaged, with no change in consciousness.

must have change in functioning in addition to memory impairment for diagnosis

Question 6

Delerium

Answer 6

acute (rapid onset) of confusion, reversible/treatable, change in level of conciousness
Behavioural issues

Not based in reality

Not sure what is going on

Causes: medication, changes in routine, environment, acute illness, infections (respiratory, UTI)

Dangerous: can lead to death

Question 7

ADLs: Activities of daily living

Answer 7

Basic living needs
Eating

Drinking

Toileting

Transfers

Bathing

Question 8

IADLs: Instrumental activities of daily living

Answer 8

require organizing, sequencing and planning
Shopping

Cleaning

Managing money and medications

Using telephone

Question 9

Delirium screening tools

Answer 9

Confusion Assessment Method Instrument (CAM)

I WATCH DEATH (Infections, Withdrawal, Acute metabolic, Toxins, drugs, CNS pathology, Hypoxia, Deficiencies, Endocrine, Acute vascular, Trauma, Heavy metals)

Question 10

dementia screening tools

Answer 10

Mini Mental State Examination (MMSE) or Folstein; Mini-Cog Dementia Screen

Clock Drawing Test (CDT)

Functional Dementia Scale (p. 358)

Montreal Cognitive Assessment (MoCA)

RUDAS

Question 11

depression screening tools

Answer 11

Cornell Scale for Depression

Geriatric Depression Scale (GDS)

SIG E CAPS (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide), (DSM-5 Criteria)

Assessment of Suicide Risk in the Older Adult

Question 12

types of dementia

Answer 12

mixed (alzheimer’s + vascular)

alzheimer’s disease

Lewy Body Dementia

Parkinson’s Disease

Fronto/temporal Dementia ie. Picks disease

Question 13

when to screen for cognitive impairment

Answer 13

Age over 80 (25% have dementia)

After treatment for delirium, depression (red flag)

After a CVA (30% develop a dementia at 3 months post CVA) (Stroke)

Changes in function, behaviour, mood (Usually brought up by families because)They forgot that they forgot

New difficulties with driving/near misses

Question 14

Components of a Cognitive Assessment

Answer 14

Review past medical and surgical history (include family history, head injury)

Review ADLs and IADLs

Review medications – could anything be contributing to cog decline?

Review recent lab results – any other causes for cognitive decline?

Review recent imaging reports if available - CT head, MRI head, Carotid Doppler

Cognitive Screening

Physical exam (advanced)

Corroborative history if possible

Question 15

History – cognitive assessment

Answer 15

Onset? –sudden, gradual

Course of decline? – quick, slow, step-wise

Mood or behaviour changes?

Any history of confusion?

Features of psychosis? – hallucinations, delusions, paranoia

Any signs or symptoms of other illnesses?

Past medical/surgical history, family history, allergies, current medications?

Any recent falls?

History of head injury? Seizures?

Any new medications?

What is their current level of function? ADLs, IAD’s

Question 16

Mini Mental State Exam (MMSE) or ‘Folstein’ test

Answer 16

30-point questionnaire used to assess cognition

used to screen for dementia

tests various functions, including arithmetic, memory and orientation.

• Any score over 27 (out of 30) is normal
• 20-26 indicates mild dementia
• 10-19 moderate dementia; and below 10 severe dementia

Question 17

The Rowland Universal Dementia Scale (RUDAS)

Answer 17

The RUDAS was designed to minimize the effects of level of education, cultural background and language

Question 18

Risks to dementia patients

Answer 18

nutrition 
hygeine 
medications
falls
fire
wandering/exposure
behavioural changes
targeted scams 
abuse 
driving

Question 19

dementia patients driving

Answer 19

People with mild dementia have 8x increased risk of having an accident

Everyone with dementia should be asked if they drive

In Ontario, MDs and NPs are OBLIGATED to report to MTO if anyone has any condition that “may make it dangerous for someone to continue driving”

Driving capacity depends on cognition, function, physical abilities, medical conditions, medications/ETOH, behaviour and driving record

Question 20

Caregiver Stress

Answer 20

Watching the deterioration of a loved one is devastating and exhausting