Chapter 2: Examine Cognitive Function

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Chapter 2: Examine Cognitive Function
2015-03-08 18:54:40
Cognitive Function Exam
NPTE: Chapter 2
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  1. Components of a Cognitive Function Exam
    • Memory
    • Attention
    • Emotional Responses/Barriers
    • Higher-Level Cognitive Abilities¬†
    • Mini-Mental State Examination (MMSE)
    • Cognitive Scale: Rancho Los Amigos Levels of Cognitive Function (LOCF)
  2. Memory Exam
    • Immediate recall: name 3 items previously presented after a brief interval (i.e. 5min)
    • Recent memory (short-term): recall recent events (what did you have for breakfast?)
    • Remote memory (long-term): recall of past events (where were you born? where did you grow up?)
  3. Attention Exam
    • Length of attention span: digit span retention test (ability to recall 7 numbers in order presented)
    • Ability to attend to task without redirection (sustained attention): determine time on task, frequency of redirection
    • Ability to shift attention from one task to another (divided attention): assess ability of dual task control
    • Perseveration (mental inertia): getting stuck on a task
    • Ability to stay on task in presence of detractors (focused attention): assess impact of environmental vs internal detractors
    • Ability to follow commands: 1 or 2 step, multilevel commands
  4. Emotional Responses/Behaviors Exam
    • Safety, judgment: impulsivity and lack of inhibition
    • Affect, mood: irritability, agitation, depression, and withdrawal
    • Frustration tolerance
    • Self-centeredness (egocentricity)
    • Insight into disability
    • Ability to follow rules of social conduct
    • Ability to tolerate criticism
  5. Higher-Level Cognitive Abilitites
    • Judgement
    • Problem solving
    • Abstract reasoning
    • Fund of general knowledge (current events, ability to learn new info, generalize learning to new situations)
    • Calculation: serial 7 test (count backward rom 100 by 7's)
    • Sequencing: ability to order components of cognitive or functional task -- assess if cueing is necessary, frequency of cues
  6. Mini-Mental State Examination (MMSE): Definition and Components
    • Brief screening test for cognitive dysfunction
    • Includes screening items for:
    • Orientation
    • Registration
    • Attention and calculation
    • Recall and language
  7. Mini-Mental State Exam (MMSE): Scoring
    • Max score = 30
    • 21-24: mild cognitive impairment
    • 16-20: moderate impairment
    • <15: severe impairment
  8. Rancho Los Amigos Levels of Cognitive Function (LOCF)
    • Assesses cognitive recovery from TBI
    • Includes 8 levels of behavior:
    • No response (I)
    • Decreased response levels (II and III)
    • Confused levels (IV, V, and VI)
    • Appropriate (automatic, purposeful) levels (VII and VIII)
    • Delineates emerging behaviors
    • Pts may plateau at any level