Ranchos Los Amigos Levels of Cognitive Function

Question 1

I. No Response

Answer 1

pt appears in a deep sleep, completely unresponsive to any stimuli

Question 2

II. Generalized Response

Answer 2

pt reacts inconsistently/ non-purposefully to simuli in non-specific manner
responses are limited & often the same, regardless of stim, may be physiologic changes/ gross body movements/ vocalization

Question 3

III. Localized Response

Answer 3

pt reacts specifically but inconsistently to stim
Responses are directly related to type of stim
May follow simple commands (close eyes, squeeze hand) in inconsistent, delayed manner

Question 4

IV. Confused-Agitated

Answer 4

pt in heightened state of activity- behavior is bizarre/non-purposeful relative to environment
pt doesn’t discriminate b/w people & objects- unable to cooperate directly w/ Tx efforts
Verbalizations= incoherent/inappropriate to environment, confabulation may be present (production of fabricated, distorted/ misinterpreted memories about oneself/the world, without conscious intention to deceive)
Gross attention to environment is brief, selective attention = non-existant, no short or long term recall

Question 5

V. Confused-Inappropriate

Answer 5

Pt can respond to simple commands consistently- increased complexity/lack of structure elicits non-purposeful, random/ fragmented responses
Demonstrates gross attention to environment but highly distractible, lacks ability to focus on specific task
W/ structure, may converse on social automatic level for short periods- verbalization = inappropriate/ confabulatory
Memory severely impaired- shows inappropriate use of objects, may perform previously learned tasks but cannot learn new info

Question 6

VI. Confused-Appropriate

Answer 6

Pt shows goal-directed behavior but is dependent on external input/ direction
Follows simple instructions consistently, shows carry-over of relearned tasks (self-care)
Responses may be incorrect due to memory problems but are appropriate to situation
Past memories show more depth and detail than recent memory

Question 7

VII. Automatic-Appropriate

Answer 7

Pt appears appropriate and oriented w/in hospital/home settings
Goes through daily routine automatically, but robot-like
Minimal-no confusion, has shallow recall of activities, shows carry-over for new learning @ decreased rate
W/structure, able to initiate social/recreational activities, judgement remains impaired

Question 8

VIII. Purposeful-Appropriate

Answer 8

Pt recalls/integrates past & recent events, is aware of/responsive to environment
Shows carry-over of new learning, no supervision needed once activities are learned
May show decreased ability due to premorbid abilities/abstract reasoning/ tolerance for stress/ judgement in emergencies