Cognitive impairment + MMSE

Question 1

three key features of cognitive impairment

Answer 1

loss of higher brain function, loss of functional independence, signs of physical brain disease

Question 2

What to look for in higher brain function

Answer 2

Look for change of higher brain functions
changes in behavior
does patient have identify changes?
does family/others see a change?

Question 3

key features of loss of functional indepndence?

Answer 3

loss of skills ($ management, phone numbers, driving)
significant indicator for dementia
often need witness to provide info
w/ no significant functional decline, this could be mild cognitive impairment

Question 4

signs of physical brain disease

Answer 4

Cognitive changes, loss of function and/or focal neurological deficits or CNS hyperactivity

imaging based on abnormalities of brain

Question 5

Primary concerns with signs of physical brain diseasd (4d)

Answer 5

destructive of tissue (space occupying lesions)
Depression
Drugs
Delirium

Question 6

what is the score cut off for the MMSE?

Answer 6

below 24 indicatives dementia or cognitive deficit

Question 7

what score is of concern in the 6-item congitive impairment test (6CIT)?

Answer 7

> 7 is abnormal

Question 8

____% of people over the age of 65 experience memory loss

Answer 8

40

Question 9

What is age-associated memory impairment?

Answer 9

]Memory loss with no medical reason (associated with senescence)

Question 10

Which of the following are associated with Alzheimers? Which are associated with Senescence?

1. Poor judgement and decision making
2. Forgetting which day it is and remembering later
3. Difficulty having a conversation
4. Inability to manage a budget
5. Losing things from time to time

Answer 10

1. A
2. S
3. A
4. A
5. S

Question 11

One of the key distinctions between Alzheimer’s and senescence is that while both involve memory problems, Alzheimer’s involves changes in _______________

Answer 11

Personality (eg. not being able to carry out conversation, complete ADLs, loss of sense of day/time/place)

Question 12

Which 6 signs should prompt you to do a mental status exam?

Answer 12

1. Loss of cognitive function (complaint from patient/informant)
2. Difficulty getting details (taking history)
3. Significant change in behaviour
4. Un-kept appearance or loss of weight
5. New-onset depression/anxiety/psychosis
6. Confusion w/o an obvious cause

Question 13

What is the most significant indicator of dementia?

Answer 13

Loss of functional independence (eg. inability to feed themselves, difficulty navigating society, difficulty with ADLs)

Question 14

What tool can be used to measure a loss of functional independence?

Answer 14

Functional Independence Measure (FIM)

Question 15

A patient with a decline in cognition and normal functional skill can be described as having ________________________________

Answer 15

Mild cognitive impairment (MCI)

Question 16

DDX for patients with focal cognitive deficits developing in under 3 months

Answer 16

4 D’s (NOT dementia):

1. Destruction of tissue (eg. space-occupying lesion)
2. Depression (mental disorder)
3. Drugs
4. Delirium

Question 17

When administering a comprehensive mental status exam, you should take detailed notes on which 4 characteristics?

Answer 17

1. Thought formation
2. Content of thoughts (negative/positve, hallicinations)
3. Patient affect
4. Behaviours/symptoms (demeanor, appropriateness of action)

Question 18

True or false: the MSE can be used to make a diagnosis of dementia

Answer 18

False - screening tool, not diagnostic

Question 19

Which 3 components of cognition are assessed with the Mini-Cognitive Test?

Answer 19

1. Short term memory
Eg. I want you to remember 3 words. Repeat them so I know you have heard me
o Banana
o Sunrise
o Chair

2. Registration:
   Eg. Draw a clock face and put the numbers in the right place. Set the hands to10 past 5.
3. Recall:
   Eg. What were the 3 words I asked you to remember?

Question 20

How is the Mini-Cog scored?

Answer 20

3 recalled words = negative for cog impairment
1-2 recalled words + normal clock = negative
1-2 recalled words + abnormal clock = positive
0 recalled words = positive

Question 21

What is the impromptu testing method?

Answer 21

Put 3-5 common objects on the desk and ask patient to name and remember them, then put them out of sight.

Ask patient to draw large clock face and put all numbers ina nd set hands to 10 past 5

Ask patient to recall objects

(very similar to mini-cog)

Question 22

What is the 6-item cognitive impairment test? What is an abnormal score?

Answer 22

Series of 6 questions to test cognition:

Abnormal = >7