Old Age Flashcards
How do you test dominant parietal lobe dysfunction?
- Finger agnosia
- L-R finger disorientation
- Dysgraphia - draw a sentence
- Dyscalculia - 100 - 7
How do you test non-dominant parietal lobe dysfunction?
- Dressing apraxia
- Constructional apraxia - intersecting pentagons + cube
- Visuospatial neglect - draw a clock
- Anosognosia - if they have a physical injury/defect are they aware of it
- Topographical disorientation - do they get lost/confused in new places
How do you test bilateral parietal lobe dysfunction?
Astereoagnosia - can they identify a coin in the hand/item
Agraphagnosia - can they tell letters scrawled on their hand
How do you test visual aspects of parietal love dysfunction?
Prosopagnogsia - face on a bank note
Visual fields - lower quadrant homonomous hemianopia
What memory tests make up a temporal lobe exam?
Memory
- Registration: address
Short term memory:
What did you have for breakfast?
How did you get here today?
Long term memory:
Name of primary school?
Where did you grow up?
Semantic memory:
- First UK prime minister?
- Can you think of any famous landmarks?
FINALLY –> Recall address above
What language tests make up a temporal lobe exam?
Repeat phrase - no ifs ands or buts
Alexia: Ask the patient to read a sentence: “Close your eyes”
Agraphia: Write a sentence
What visual recognition tests make up the temporal lobe exam?
Naming objects of increasing difficulty (watch/buckle and pen/nib)
Prosopagnosia - recognises the faces on a bank note
Name some visual function tests for temporal lobe?
Visual fields - upper quadrant homonymous hemianopia
Clock face - test for neglect: clock face with numbers and time to show 10 past 5
Outline the temporal lobe exam?
Memory - registration, short term memory, long term memory, recall
Language - repeat phrase, read a phrase and do actions, write a sentence
Visual recognition - name objects of increasing difficulty, prosopagnosia (name face on a bank note)
Visual function - visual fields
Extras - assess for epileptic phenomenon, assess for psychosis, draw a clock showing 10 past 5 (neglect)
What is the structure of the frontal lobe exam?
- Questions
- Abstraction tests
- Frontal release signs
What questions will be asked to start the frontal lobe exam?
a) Have you noticed a change in your sense of smell?
b) Have your family/friends reported a change in your personality, specifically are you becoming more impulsive?
What abstraction tests make up the frontal lobe exam?
Proverb interpretation
- What does a stitch in nine saves time mean?
Cognitive estimates
- How many camels are there in Denmark?
- How tall is a double decker bus
Similarities
- What are the similarities between a coat and a dress
- What are the similarities between a watch and a ruler
Verbal fluency:
- How many words can the person name beginning with the letter S in 1 minutes
Luria’s three step sequence:
- 5 x repeated without verbal cues - the patient then repeats
Go-no-go test:
- When I tap once you tap twice - test that
- When I tap twice you tap once - test that
- Test both together
- Change rules when I tap once you tap once, when I tap twice you don’t tap - test that
Key search:
- Imagine this piece of paper is a field, you have lost your keys in the field
- Please draw how you will search for the key
What frontal release signs are tested in the frontal lobe exam?
Grasp reflex - lightly touch palm to see if the patient grasps
Pamomental reflex - strokes the thenar eminence and looks for contraction of the contralateral mentalis muscle
Pouting - asks patient to close eyes, touches lips firmly with spatula - does the patient pout?
Outline a cognitive exam (MMSE)?
ORARLP
Orientation:
- Macro - Micro (time and place)
Remembering:
- Registration –> Repeat three words and learn them - 1 point for each “lemon, tree, car”
- What is the name of the current prime minister? Score 1
What was the name of the US president who was assassinated in the 1960s? Score 1
Attention:
- Serial 7s
Recall:
- 3 items
Language (NIPES)
- Name two objects (pen and nib)
- Say phrase (no Ifs ands or buts)
- 3 stage command - Place index finger of your right hand on your nose then your left ear
- Read and obey a command (close your Eyes)
- Write a Sentences
Additional:
- Name as many words as you can beginning with F. You cannot use names of people or places, and you have one minute. Maximum score 3 (<3 score 0, 3–5 score 1, 6–9 score 2, and 9+ score 3)
- Repeat these words: caterpillar, eccentricity, statistician, unintelligible. Score 2
Construction:
- Intersecting pentagons
Outline the cognitive history points?
Cognitive history:
- Time course - sudden impairment and progression
- 1st symptom that present (most symptoms start focal then become generalised)
- Memory
–> Working memory (hold things in their head)
–> Anterograde memory (can they encode new information e.g. diary appointment)
–>Retrograde (semantic i.e. facts or episodic i.e. memories)
–> Procedural) - Orientatation
- Language
–> Struggle with unusual words
–> Choosing a more general term rather than a specific time, superordinate substitution
–> reading/writing - Attention
–> Concentrate on TV, book or conversation
–> Can they plan
Behaviour:
–> Personality
–> Disinhibition/impulsivity
Depression
–> Apathy/anhedonia
Psychosis
–> Paranoid delusions in Alzh
–> Visual hallucinations in LBD
Background info for cognitive assessment
- PMH
- Substance misuse
- Medications (anti-cholinergic)
- PPH
- SH: co-inhabitants
- Personal Hx - premorbid IQ/occupation
- FHx of Dementia and Neurological history
What are the main risks in dementia?
Wandering
Stairs
Driving
Self-neglect
Inadvertent overdoses
Finances
Fires
Floods
What is the outline of the frontal lobe test?
PAVL Go Key Reflex
Smell
Personality - self, others, acted in a way out of character
Abstraction:
- Too many cooks spoil the broth vs. a stitch in time saves nine
- How many Camels in Denmark
- Two objects in common (give example apple & banana, then ask train & bicycle, watch and ruler)
Verbal fluency:
- F, A, S
- 12 in a minute
Luria
Go-no-go test (set-shifting)
- Tap 1 you tap 2
- Tap 2 you tap 1
- Combine
- Tap 1 you tap 1
- Tap 2 you don’t tap
Key
Primitive reflexes
- Grasp
- Pout
- Palmomental reflex
How do we test dominant (left) temporal lobe
Language
- Receptive aphasia - repeat words from conversation `no ifs and or buts”
- Verbal retention –> John Smith, West Register Street, Luton, Bedfordshire –> repeat x 3
- Alexia –> read a couple of sentences
- Agraphia –> write a couple of sentences
- Anomia –> start easy then increase in difficulty (pen, bottle, watch, nib)
- Check verbal retention
How do you test non-dominant temporal lobe?
Non-verbal retention –> draw two cubes, get them to copy it
Visuospatial function:
- Hemisomatoagnosia - are all four limbs of your body working well?
- Prospagnosia - any difficulty recognising faces? (Benton Facial Recognition Test) // Recognise Queen’s face on a bank note
- Getting lost?
Musical recognition - do you recognise tunes?
Test non-verbal retention
Draw a clockface to assess for neglect
What tests check for bilateral temporal lobe?
Semantic memory
- Who is the current PM?
- Big river running inside London?
- Which American president got assassinated?
Autobiographical memory
- What did you have for breakfast?
- How did you get here?
- Where were you born?
- What was your first school?
Visual field
- Contralateral upper quadrantopia
Ever had a fit? Ever lost consciousness?
Strange beliefs?
Outline the dominant parietal lobe exam?
Receptive dysphaisa
Gerstmann’s syndrome:
- Acalculia: 4+7?
- Agraphia: write a sentence
- R-L disorientation: touch R ear w/ L hand
- Finger agnosia: show me your R index finger
Ideomotor apraxia: brush teeth or comb hair
Astereognosia: Pts eye closed - put object in their palm, what is it?
Agraphagnosia: w/eyes closed, trace H or W on patient palm and ask them what it is
How is non-dominant parietal lobe assessed?
Topographical disorientation: do they get confused or lost in new places?
Constructional apraxia: intersecting pentagons
Dressing apraxia
Anosagnosia: ask patient if they have a deficit are they aware
Neglect: Wiggle L finger, R finger then both fingers, get patient to point to the moving one
How is bilateral parietal lobes assessed?
Visual fields
Prosopagnosia
