Intro to Cognitive Evaluation

Question 1

what tests and measures can we use to test mental status/cognitive function?

Answer 1

• consciousness
• orientation
• attention/concentration
• memory
• executive function

Question 2

why should cognitive function always be the first thing we test for?

Answer 2

shows you if the pt will be able to follow directions for other tests

Question 3

full consciousness

Answer 3

alert, aware, responsive, awake

Question 4

lethargy

Answer 4

• awake, but not alert
• slow and zombie-like
• do not want pt to be less than this for eval

Question 5

obtundation

Answer 5

• asleep but easy to arouse
• resting their eyes
• hard time staying engaged

Question 6

stupor

Answer 6

-difficult to arouse, may need to use noxious stimuli

Question 7

coma

Answer 7

unconscious, cannot arouse

Question 8

define orientation

Answer 8

knowing who you are and where you are

Question 9

what 4 things are involved in assessing orientation?

Answer 9

• person (name, DOB, where from)
• place (hospital, city, state)
• time (month and year)
• situation (“can you tell me why you’re here?”)

Question 10

what is sustained attention, and how do we test it?

Answer 10

• sustain and focus attention over a duration of time

- test: cancellation test

Question 11

what is selective attention, and how do we test it?

Answer 11

• ability to screen and process relevant sensory info about the task and environment while screening out irrelevant info
• test: stroop test

Question 12

what is divided attention, and how do we test it?

Answer 12

• ability to perform 2 tasks simultaneously

- test: walkie-talkie test

Question 13

what is alternating attention?

Answer 13

attention flexibility

Question 14

define memory

Answer 14

the capacity to store knowledge, experiences, and perceptions for recall and recognition

Question 15

declarative (explicit) memory

Answer 15

conscious recollection of facts and events

Question 16

non-declarative (procedural, implicit) memory

Answer 16

recall of movements/movement schema without conscious recollections

Question 17

immediate recall

Answer 17

after short interval of time (seconds to minutes)

Question 18

short-term memory

Answer 18

• minutes to hours/days

- recent working memory

Question 19

long-term memory

Answer 19

• months to years

- remote memory

Question 20

define executive function

Answer 20

capacity to engage successfully in independent, purposeful, self-directed behavior

Question 21

volition/planning

Answer 21

goal planning and task initiation

Question 22

problem solving/reasoning

Answer 22

abstract thinking, flexibility

Question 23

insight/awareness

Answer 23

poor judgement

Question 24

social pragmatics

Answer 24

inappropriate behavior

Question 25

self-regulation/purposeful action

Answer 25

initiate, maintain, switch, and stop tasks

Question 26

logic and abstract thinking

Answer 26

- logic = making sense of things | - abstract thinking = being able to picture something without it right in front of you

Question 27

why might we want to test logic and abstract thinking?

Answer 27

- safety | - finding new ways to do things

Question 28

grading system for somatosensory exam

Answer 28

5/5: normal 1-4/5: impaired 0/5: absent

Question 29

how do we test dermatomes in a somatosensory exam?

Answer 29

- light touch - 2-point discrimination - hot/cold - sharp/dull

Question 30

where can we test vibration in the UE?

Answer 30

- thumb DIP - styloid process of ulna - lateral/medial epicondyles - olecranon process - acromion process

Question 31

where can we test vibration in the LE?

Answer 31

- big toe DIP - medial/lateral malleolus - fibular head - greater trochanter - ASIS

Question 32

what is important when testing proprioception/kinesthesia?

Answer 32

- keep movements small - little contact - your hand should not touch muscles being stretched

Question 33

how to test graphestesia

Answer 33

- make sure pt's hand has light touch first | - draw a letter on the pt's hand with your finger and see if they can tell you what letter it is

Question 34

how to test stereognosis

Answer 34

- place an object in the pt's hand and see if they can tell you what it is without looking - object must be small enough to fit in the palm - if they don't know what it is, could indicate a problem with their association cortex