of 26
8/12/2019 Cognitive Assessment 2
1/26
8/12/2019 Cognitive Assessment 2
2/26
Table of Content
Purpose Elements
Conclusion
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
3/26
Why do you carry out cognitive assessmentin psychiatric patients?
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
4/26
Purpose
Diagnosis
e.g. Alzheimers disease
Complication / Part of illness
e.g. Schizophrenia
e.g. Encephalopathy
e.g. Psychotropics
Prognosis / Monitoring
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
5/26
8/12/2019 Cognitive Assessment 2
6/26
Qualitative change of
consciousness
Delirium Fluctuation of consciousness Confusion: description of the patients self-
experience or the doctors observation
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
7/26
Orientation
Time
Place
Person
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
8/26
Orientation
Capacity of a person to gauge accurately time,space and person in his current setting.
Orientation in time is labile and quite readilydisturbed by rapt concentration, strong emotion
or organic brain factors.
Orientation in space is disturbed later in thedisease process than time. Disorientation in time
and place are evidence of an organic mental state.
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
9/26
Orientation
In disorientation of person, the patient failsto remember his own name.
How about asking if he could recognize anurse?
It occurs at a very late stage of organic
deterioration.
Delusion of mis-orientation
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
10/26
Attention
Concentration
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
11/26
Attention &
Concentration Attention: objective observation of anotherperson, object or event
Concentration: attention sustained forsome duration of time
Lack of attention denotes an inability tofocus on an object in a purposeful way anddisturbance of concentration is an inability
to retain this attention.
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
12/26
Bedside Testing
Orientation and attention
Alertness: level of wakefulness and
reactivity
Orientation: Time/Place/Person
Attention/Concentration: Serialsubtraction of 7s; Months of yearbackwards; Days of week backwards; digit
span forwards and backwards.
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
13/26
Memory
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
14/26
Bedside Testing
Memory Immediate Recall
Recent Memory
Remote memory
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
15/26
Bedside Testing
Calculation
ability to manipulate numbers mentally
simple addition, subtraction ormultiplication questions may be used.
problems of money and change are oftenhelpful with limited educationalbackground.
Not the same as serial 7.
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
16/26
Bedside Testing
Fund of knowledge must be tailored to the unique
circumstances and educational level of
the individual
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
17/26
Concrete Thinking
Abnormal process of thinking inschizophrenia and organic states may result
in a literalness of expression and
understanding.
Abstractions and symbols are interpreted
superficially without tact, finesse of anyawareness of nuance.
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
18/26
Bedside Testing
Abstract Reasoning
described the ability to mentally shift back andforth between general concepts and specificexamples.
of all the frequent used ways to test abstractreasoning, asking proverb interpretation is
probably the least useful.
alternative is to ask for the similarity between 2or more objects, which really mean asking towhat conceptual abstraction do both belong.
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
19/26
Bedside Testing
Insight describes patients capacity to recognize
and understand their own symptoms and
illness.
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
20/26
Bedside Testing
Judgement
can the person recognize prevailing social
norms of behavior and comply? and will this person be able to cooperate
with medical evaluation and treatment?
least descriptive and most inferential must often draw from information in the
history to supplement mental status
findingSunday, April 21, 13
8/12/2019 Cognitive Assessment 2
21/26
Bedside Testing
Posing hypothetical situation: the presumedcorrect response to such senarios is often
obvious and the answer may be very
different from the patients actual behavior.
Moreover such questions often miss thecomplexity of variables shaping behaviorand are simplistic in assuming a single
correct response.
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
22/26
Disturbance of
ud ement A judgement is a thought which express a
view of reality
To assess whether it is disturbed or not,one needs to measure it against objective
fact.
Is not made solely on the basis of thatparticular belief or argument, but on taking
the whole of the persons behavior and
opinions into account.Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
23/26
Judgement
A mans claims to be a figure of royaltypersecuted by the Marxists could, in fact, be
true. But the opinion of his judgement wasdisturbed would be confirmed if he had
suddenly become convinced about his
royalty when a psychiatric nurse had
commented to him about the tattoos on
his arm.
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
24/26
Judgement
Delusions are a disturbance of judgement.
Judgement in other areas of life apart fromthe delusion can be preserved.
Sunday, April 21, 13
8/12/2019 Cognitive Assessment 2
25/26
8/12/2019 Cognitive Assessment 2
26/26
Thank you