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Assessment of Cognitive Function - Coggle Diagram
Assessment of Cognitive Function
Cognitive Assessment
Defines presence of 1 or more clinical syndromes :
3 Ds: Dementia, Delerium, depression
Epidemiology
Dementia affects 20% of over 80s
Deleium 30-50% in hospital
Depression 30-40% long term care
Diagnosis rate poor
Cognitive Complications
Presentation Complicated by
Lack of insight
Diverse features
Denial
Ascertaining information
Communications issues - deafness, dialect
Physical illness
Misinterpretation by Family / Friends
Denial / Compensation by family
Cognition
“Mental action or process of acquiring knowledge
and understanding through thought, experience
and the senses
Intellectual Functions
Attention
Formation of knowledge
Memory
Judgement
Evaluation
Reasoning
Comprehension
Production of language
Cognitive Impairment
Whena person has difficulty remembering, learning new things, concentrating or making everyday decisions
Range
Mild
Changes in functions noticed but still able to do everyday activities
Severe
Loss of comprehension, ability to communicate, unable to live independently
Syndromes of Cognitive Impairment
Types
Delirium
Learning disability
Dementia
Assessment
History and Collateral
Medication review
Mental state exam
Physical examination
Basic tests
Specialised tests
Interpret in light of person's education / employment background + Physical health (eyesight / hearing)
Management
Future planning
Timely support
Treatment
Dementia
Early Clinical Features
Forgetfullness
Short term memory loss
Appointments
Disorientation - date/day/location
Impaired task performance (apraxia)
Meal prep
Runningappliances
Hygiene tasks
Impaired language (aphasia)
Word finding issues
Impaired recognition (agnosia)
Faces
Objects
Sounds
Locations
Impaired abstract thinking
Complex issues
Logical argument
Impaired judgement (executive dysfunction)
Organising / planning
Inappropriate actions
Mood & behaviour
Irritability
Sweaning
Apathy
Loss of pleasure
Personality changes
More self centred
Over the top reactions
History Questions
Interference / intrusion by memory i terms of daily living such as
Forgetting appointments
Problems with finances
Mislaying objects
Kitchen mishaps
Subjective view of driving ability
Systems Review / Medications
Head injury / stroke
Anticholingeric medications
Antihistamine drugs (sedation)
Drugs causing orthostatic hypotension
Drugs causing EPSE - bradykinesia, gait issue
Neurological System Review
Incontinence
Limb Weakness
Disorientation
Dizziness
Garbled speech - all pointing to TIA
Seizures / absence attacks
Swallow impairments / tremor / hallucinations in absence of psychiatic hx
Social Aspects
Home environment
Cleanliness
Nutrition
Warmth
Attention to medication management
Adapted home
Bathroom
Kitchen
Stairs
Support network
Danger
Abuse / exploitation
Physical activity
Danger with driving / appliances
Collateral History
What lead to presentation to medical attention
Timeline of symptoms - duration, fluctuation, progression, when last normal
Forgetfulness - repetition
Safety - appliances