Assessment of Cognitive Functioning

Question 1

What is clinical neurophychology?

Answer 1

The applied science concerning with the behaviour expression of brain dysfunction

Question 2

Why do you need to consider cognitive functioning for diagnosis?

Answer 2

• 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

Question 3

Why do you need to consider cognitive functioning for treatment?

Answer 3

• 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

Question 4

What is the purpose of a bedside assessment?

Answer 4

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

Question 5

How is a bedside assessment done?

Answer 5

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

Question 6

Why can MMSE not be used as a screening assessment?

Answer 6

Copyright issues

Question 7

Is MMSE or MOCA better?

Answer 7

MOCA, 10 min screening tool, freely available, better sensitivity and specificity than MMSE

Question 8

What are some things that must be considered before assessing a patient?

Answer 8

• 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

Question 9

What are some treatments that result from neuropsychological referals?

Answer 9

• 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

Question 10

What are aspects of the presenting problem that are important for assessment of cognitive function?

Answer 10

• 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

Question 11

What formal assessments can be done to assess cognitive functioning?

Answer 11

• Orientation (PTA)
• Pre-morbid IQ

Question 12

What is the frontal lobe responsible for?

Answer 12

Question 13

What is the motor cortex responsible for?

Answer 13

Movement

Question 14

What is the sensory cortex responsible for?

Answer 14

Sensations

Question 15

What is the parietal lobe responsible for?

Answer 15

Question 16

What is the occipital lobe responsible for?

Answer 16

Vision

Question 17

What is the temporal lobe responsible for?

Answer 17

Question 18

What does a clinical interview/formal assessment look at?

Answer 18

Memory

Language

Processing speed

Attention/concentration

Executive functioning

Personality

Insight

VIsual spatial