Cognitive screen and exam

Question 1

what is cognition?

Answer 1

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

Question 2

what are examples of executive functions?

Answer 2

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

Question 3

which lobe deals with executive functioning?

Answer 3

frontal

Question 4

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

Answer 4

decreased cognitive performance due to fatigue and stress from sustained attention

Question 5

why is assessing cognition important? 3

Answer 5

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

Question 6

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

Answer 6

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

Question 7

patients with dementia are ______ more likely to fall
why?

Answer 7

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

Question 8

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

Answer 8

no - medical diagnosis
consult with MD

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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)

Question 11

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

Answer 11

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

watch placement, processing and spatial awareness

Question 12

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

Answer 12

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

frontal lobe

Question 13

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

Answer 13

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

Question 14

what is the retention/recall bedside test?

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

Mini mental

Question 17

what is the bias with the mini mental?

Answer 17

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

Question 18

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

Answer 18

vascular dementia

Question 19

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

Answer 19

lower-level cognitive patients

Question 20

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

Answer 20

SLUMS

Question 21

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

Answer 21

<25

Question 22

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

Answer 22

MMSE
MMSE

Question 23

are we able to document a diagnosis of dementia?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

what is procedural learning?

Answer 25

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

Question 26

how do you maximize procedural learning?

Answer 26

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

Question 27

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

Answer 27

true

Question 28

what are pre/postdiction exercises?

Answer 28

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?

Question 29

cognitive exercises:
what is retention testing?

Answer 29

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

Question 30

what is the spaced retrieval technique?

Answer 30

increasing the interval over time improves ability to recall

Question 31

cognitive exercises:
what is the generation effect?

Answer 31

them making instructions will improve retention

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

Question 32

cognitive exercises:
what is visual imagery?

Answer 32

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

Question 33

cognitive exercises:
what is “use it”

Answer 33

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

Question 34

behavioral disturbances are first seen in _______ stage of dementia

Answer 34

middle (second)

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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

Question 37

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

Answer 37

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

Question 38

why is identifying a cognitive impairment/fall risk important?

Answer 38

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