Assessment of Cognitive Functioning Flashcards
What is clinical neurophychology?
The applied science concerning with the behaviour expression of brain dysfunction
Why do you need to consider cognitive functioning for diagnosis?
- Does it help you make a diagnosis
- Such as neurological condition or brain injury
- Do the cognitive impairments pose risk to the patent or others
- Questions about capacity
- Adherence, vulnerability
- Disinhibited, impulsive
- Does it help you plan care
- Concerns about driving
- Concerns about returning to work
- Impact on home
- Will the patients cognition improve
- Does it help deliver medical treatment
- Such as awareness of PTA (post traumatic amnesia), adaptations
Why do you need to consider cognitive functioning for treatment?
- Medical treatment informed by an appreciation of cognition
- Conversations informed by an awareness of their cognition
- Simplify, reduce, added time, visual aids/written infro
- What abilities remain in tact, could these be used to compensate for cognitive difficulties
- Wold the patient benefit from rehabilitation
- Is family intervention required
- Does the patient need OT input for dailty living
- Does the patient need supervision/care requirements
- Would they benefit from follow up
What is the purpose of a bedside assessment?
Purpose is the raise the possibility of cognitive impairments which may need further assessment/onward referral and may impact treatment/consent
How is a bedside assessment done?
How this is done:
- Observation
- Clinical interview (patient and relative)
- Screening assessments
- Cannot use MMSE as although it is widely used there are copyright issues, insensitive to mild impairment or focal deficit and lack of executive assessments
- Addenobrooke’s cognitive examination – III (ACE-III)
- Sensitivity to mild impairment, differentiation between organic brain disease (dementias), executive assessment
- Includes language, memory, executive functioning, visuospatial/perceptual
- Takes 15 minutes
- MOCA
- 10 min screening tool, freely available, better sensitivity and specificity than MMSE
Why can MMSE not be used as a screening assessment?
Copyright issues
Is MMSE or MOCA better?
MOCA, 10 min screening tool, freely available, better sensitivity and specificity than MMSE
What are some things that must be considered before assessing a patient?
- Environmental factors
- Privacy, noise, disturbances
- Physical factors
- Confusion/delirium, PTA, fatigue, illness/infection
- Psychological
- Anxiety/mood, effort/confidence
- Accessibility
- Language, eyesight/hearing, disability
- Pre-morbid factor
- Pre-morbid functioning, education, occupation, prior injuries/TBI, lifestyle factors
What are some treatments that result from neuropsychological referals?
- Quantifying and monitoring change
- Pre and post surgery assessments (tumour, epilepsy)
- Impact of medication on cognition
- Rehab potential
- Behavioural management
- Cognitive rehabilitation
- Support and education including families
- Advice on return to work/education
- Advice on care requirements
What are aspects of the presenting problem that are important for assessment of cognitive function?
- Problem list
- Coarse
- Improvements/deterioration, fluctuations
- Acute or gradual onset
- Factors that impact on them
- Times worse or better
- What they think it is
- Impact on
- Work, hobbies, ADLs
- Any ongoing legal involvement
- Coping
What formal assessments can be done to assess cognitive functioning?
- Orientation (PTA)
- Pre-morbid IQ
What is the frontal lobe responsible for?
What is the motor cortex responsible for?
Movement
What is the sensory cortex responsible for?
Sensations
What is the parietal lobe responsible for?
What is the occipital lobe responsible for?
Vision
What is the temporal lobe responsible for?
