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Flashcards in Assessment of Cognitive Function Deck (29)
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1
Q

Why do we consider cognitive function?

A
  • Diagnosis
  • Prognosis
  • Treatment
2
Q

Why do we consider cognitive function in diagnosis?

A
  • Have they sustained a brain injury?
  • Do they have a neurological condition?
  • Are they in PTA?
3
Q

What is post traumatic amnesia?

A

Period of recovery following traumatic brain injury.

4
Q

Disorientation

A

Unable to locate themselves in time and place

5
Q

Antero-grade amnesia

A

Inability to remember new events/experiences occurred after brain injury

6
Q

Why do we consider cognitive function in diagnosis/prognosis?

A
  • Delivery of medical treatment
  • Make a diagnosis
  • Are there questions about capacity
  • Do the cognitive impairments pose risk to the patient or others
  • Plan care
  • Concerns about driving
  • Concerns about employment
  • Impact on home life
  • Will the patients cognition improve?
7
Q

Why do we consider cognitive function in treatment?

A

-Medical treatment informed by an appreciation of cognition.
-Conversations informed by an awareness of their cognition.
-What abilities remain intact – could these be used to compensate for cognitive difficulties?
-Would the patient benefit from rehabilitation?
-Is family intervention required?
Does the patient need OT input for ADLs? -Does this need to be neuro-specific?
-Does the patient need supervision/care requirement?
-Would they benefit from follow up? Psychiatry, Neuropsychology, Social Work, OT, Neurology?

8
Q

What is the purpose of bedside assessment?

A

To raise the possibility of cognitive impairments which may need further assessment/onward referral and may impact treatment/consent.

9
Q

How is a bedside assessment carried out?

A
  • Observation
  • Clinical Interview (patient & relative)
  • Screening Assessments
10
Q

How is memory assessed in clinical interview?

A

New learning in daily life e.g. Where they are, reason for admission, conversations, T.V programmes, personal history.

11
Q

What is assessed during clinical interview?

A
  • Memory
  • Language
  • Processing speed
  • Attention/Concentration
  • executive functioning
  • Personality
  • Insight
  • Visual spatial
12
Q

How is language assessed in clinical interview?

A

Word finding, errors (semantic/phonetic), poor understanding, inappropriate answers, reading/writing errors

13
Q

How is processing speed assessed in clinical interview?

A

Slowed down, not following conversation, long response times

14
Q

How is attention/concentration assessed in clinical interview?

A

Difficulties focusing, losing track in conversation, reading

15
Q

How is executive functioning assessed in clinical interview?

A

Stuck on ideas/tasks, difficulty making decisions

16
Q

How is personality assessed in clinical interview?

A

Behaviour changes, disinhibition, loss of interest/motivation

17
Q

How is visual spatial components assess in clinical interview?

A

Route finding, spatial orientation, fine motor tasks

18
Q

What screening assessments are used?

A
  • Hodges
  • ACE-III
  • MOCA
19
Q

What does the Hodges’ assessment include?

A
  • 20 minutes

- Covers clinical interview, observations and basic screening assessments

20
Q

Why is the MMSE not used?

A
  • Copyright issues
  • No EF assessments
  • Severe memory impairments can still pass
  • Not subtle enough
21
Q

What does the ACE-III include?

A
  • 15mins
  • Includes: language, memory, executive functioning, visuospatial/perceptual
  • More sensitive
22
Q

What considerations must be accounted for before assessing someone?

A
  • Language – impaired? English first language?
  • Eyesight/Hearing
  • Fatigue – best time to assess
  • Confusion/delirium
  • Environmental factors – privacy, noise, disturbances
  • Anxiety
  • Observation/Clinical judgement – e.g. Poor memory scores due to reduced motivation/fatigue/attention
23
Q

Clinical neurophysiology

A
  • Clinical Neuropsychologists focus on the impact of injury/disease on the individual’s cognition, emotion and behaviour.
  • The applied science concerned with the behavioural expression of brain dysfunction
24
Q

Why are people commonly referred for assessment for a diagnosis?

A
  • Organic v psychological
  • Cognitive presentations of neurological disorders
  • Differentiation between types of dementia/disorders
25
Q

Why are people commonly referred for assessment for prognosis?

A
  • Assessment of capacity
  • Advice on support required
  • Predicting likely change in neurological disorder
  • Medico-legal
26
Q

Why are people commonly referred for assessment for treatment?

A
  • Quantifying and monitoring change
  • Pre & Post surgery assessments (tumour, epilepsy)
  • Impact of medication of cognition
  • Rehab potential
  • Behavioural management
  • Cognitive rehabilitation
  • Support and education incl. Families
  • Advice on return to work/education
  • Advice on care requirements
27
Q

What is important when taking a history?

A

Medical history

  • Event or condition associated with cognitive deficits
  • Past medical history
  • Psychiatric history
  • Developmental (ADD, ASD, LD)
  • Family (medical, neurological, psychiatric)
  • Adverse events
  • Anything current that could be impacting on cognition (infection, psychiatric, substances)?
28
Q

What should you discuss with regards to the presenting complaint?

A
  • Problem list
  • Course – improvements/deterioration, fluctuations
  • Acute or gradual onset
  • Factors that impact on them – times worse/better
  • What they think it is
  • Impact on: work, hobbies, ADLs
  • Any ongoing legal involvement
  • Coping
29
Q

What formal assessment is there?

A
  • Orientation (PTA)

- Pre-morbid IQ