Cognitive screen and exam Flashcards

1
Q

what is cognition?

A

ability to sort, retrieve, and manipulate information
ability to pay attention, recall, use language, and learn

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2
Q

what are examples of executive functions?

A

plan, manipulate information, recognize errors, problem solve, abstract thinking

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3
Q

which lobe deals with executive functioning?

A

frontal

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4
Q

Your patient just worked with OT requiring long periods of sustained attention. What is your concern with seeing them for PT right after?

A

decreased cognitive performance due to fatigue and stress from sustained attention

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5
Q

why is assessing cognition important? 3

A

part of neurologic screen
developing intervention strategies
part of building prognosis/discharge plan

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6
Q

what do your assessment findings from a cognitive screen tell you?

A

if there is a cognitive impairment that could affect physical performance
appropriateness of goals
appropriateness of discharge plans/living situation – fall risk?
need for referral

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7
Q

patients with dementia are ______ more likely to fall
why?

A

5x
decreased insight to deficits
decreased problem solving
poor functional mobility
decreased self care ability

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8
Q

can a PT diagnose a pt with dementia based on assessment findings?

A

no - medical diagnosis
consult with MD

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9
Q

what is a serial numbers bedside exam and what are you looking for?

A

patient instructed to count down from 100 by 7s or 3s
looking for patients processing and difficulty with task

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10
Q

what is the animal fluency bedside exam and what are you evaluating?

A

name as many animals as you can in one minute without repeating
evaluate for:
- immediate recall (5-8 animals named)
- long term recall (digs for more animals to reach goal of 12-18 animals)

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11
Q

what is the clock drawing bedside exam and what are you watching for?

A

ask pt to draw clock w/ numbers and hands to the time you choose

watch placement, processing and spatial awareness

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12
Q

what is the sentence inhibition bedside exam?
what lobe does it assess?

A

first, have pt correctly complete the sentence. second, have the pt intentionally say the wrong word to complete the sentence

frontal lobe

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13
Q

what is the reasoning bedside exam?
how do you score it?

A

ask pt to explain what is meant by a common phrase
score
0 - no relevance
1 - literal
2 - understands phrase in the abstract

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14
Q

what is the retention/recall bedside test?

A

give pt a list of words to remember
retention - have them repeat them to you
recall - ask them to repeat the words at a later time during your eval

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15
Q

which outcome measure should be used if cognitive deficits are suspected and patient is an adult with undiagnosed cognitive impairment?

A

mini-mental state examination (MMSE) or Montreal Cognitive Assessment (MOCA)

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16
Q

what is the most commonly used clinical tool for assessing cognition?

A

Mini mental

17
Q

what is the bias with the mini mental?

A

bias when assessing non-English speakers by consistently providing lower scores to those who are non-white

18
Q

a score of <26/30 on the MOCA suggests ________ is present

A

vascular dementia

19
Q

the St. Louis University Mental Status Examination (SLUMS) is indicated for ?

A

lower-level cognitive patients

20
Q

which outcome measure is more sensitive/accurate for detecting MCI and dementia?

A

SLUMS

21
Q

a score of ____/30 on the SLUMS demonstrates cognitive deficit

A

<25

22
Q

which cognitive outcome measure requires cost to use?
which requires the least amount of time?

A

MMSE
MMSE

23
Q

are we able to document a diagnosis of dementia?

A

no - therapeutic diagnosis of cognitive impairment
put exam score in objective portion, interpret result in assessment

24
Q

what do we focus our interventions on for cognitively impaired patients?

A

mobility and strength limitations
minimize fall risk factors
emphasis on procedural learning
cognitive exercises to promote quality of life
manage behavior barriers

25
Q

what is procedural learning?

A

patient’s can learn even if they can’t remember due to habit development and doing rather than hearing
- they may not even remember learning the skill

26
Q

how do you maximize procedural learning?

A

blocked practice - repeat same exercise many times then move on
practice by doing in actual context and limit verbal cues/instructions

27
Q

true or false. resistance training and aerobic exercise has substantial benefits in older adults’ cognition, attention and memory

A

true

28
Q

what are pre/postdiction exercises?

A

predictions:
- how long do you think it will take you to complete this task?
- how many reps do you think you can do?

postdictions:
- reflection ; how did you do?

29
Q

cognitive exercises:
what is retention testing?

A

instruct pt they need to remember the instructions or words after a set interval of time

30
Q

what is the spaced retrieval technique?

A

increasing the interval over time improves ability to recall

31
Q

cognitive exercises:
what is the generation effect?

A

them making instructions will improve retention

allow pts the chance to figure out the solution themselves, all them to fail safely

32
Q

cognitive exercises:
what is visual imagery?

A

mental practice/walkthrough
have pt explain to caregiver how to perform a task

33
Q

cognitive exercises:
what is “use it”

A

use your brain
- ex: crossword, word search, interaction with others

34
Q

behavioral disturbances are first seen in _______ stage of dementia

A

middle (second)

35
Q

what are some examples of behaviors associated with Alzheimer’s?

A

yelling, hitting, kicking, wandering, suspicion, paranoia, agitation, hoarding

36
Q

what are strategies for PT to manage behavior associated with dementia?

A

avoid confrontation, anticipate their needs
modify the environment
provide routine exercise
look for and reduce triggers
maintaining functionality and ADLs

37
Q

what are things that need to be considered when building your patient a discharge plan?

A

build a plan that works for the pt and their family
where to send them (home vs SNF)
safety when alone
assistive devices needed?

38
Q

why is identifying a cognitive impairment/fall risk important?

A

non-fatal falls can start a person down a vicious healthcare spiral