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What are you looking for in a global
observation?
Demeanor or emotion Appearance Facial expression, voice, and body language Source of pain or dysfunction Compare with what patient says TERM 2
Observation is done by
who?
DEFINITION 2 Observation done by a skilled observer (You!) is OBJECTIVE data (sOap) Be objective in your observations observation is done and recorded first as the findings may shape the remainder of the exam your professional judgement will determine if and how much test is necessary TERM 3
Terminology for Mental Status
DEFINITION 3 Arousal Attention Cognition Executive Function Mental Status Testing TERM 4
Arousal
DEFINITION 4 alertness level of consciousness spans from awake to coma TERM 5
Attention
DEFINITION 5 Behavioral or cognitive process of selectively concentrating on one object or stimulus
Cognition
Awareness, reasoning, judgment, intuition, and memory The process through which knowledge is acquired TERM 7
Executive Function
DEFINITION 7 Specific cognitive skills Planning, manipulating, self-monitoring, problem solving, abstract thinking Cause and effect TERM 8
Mental Status Testing
DEFINITION 8 Part of a neurological exam used to assess cognitive function TERM 9
Levels of Consciousness
DEFINITION 9 Alert Lethargic Obtunded Stuporous Comatose TERM 10
Alert
DEFINITION 10 awake and attentive
Selective Attention
Ability to focus on just one source of information & not others Blue TERM 17
Divided Attention
DEFINITION 17 Ability to divide attention between 2 or more tasks (Dual Task) Walking while talking TERM 18
Sustained Attention
DEFINITION 18 Ability to maintain attention over time Vigilance, concentration TERM 19
Switching Attention
DEFINITION 19 Ability to alternate focus between 2 tasks/ sources Lecture and PPT slides TERM 20
Why can't we text and drive?
DEFINITION 20 cannot do two visual spatial activities at the same time
What is the rationale for testing attention and
cognition?
Legal/ethical aspects of patient care Screening for medical disease (you may be the first one to see effects of new problem) Differentiating normal aging and pathology Motor control/ motor learning Determine need for referral for additional testing and/or providers TERM 22
Components of the Legal/Ethical aspects of
patient care?
DEFINITION 22 CAN THE PATIENT: Provide informed consent Follow directions Understand safety guidelines Participate in the plan of care Collaborate in goal setting and plan of care TERM 23
Stages of Impairment in Pathological
aging
DEFINITION 23 Normal -- slowed processing speed, forgets details, no ADL loss Depression -- clear onset, past history of life crisis, inconsistent Mild Cognitive impairment -- subtle noticeable change in memory, no loss of judgement or reasoning, no loss of ADL Dementia -- subtle decreased interest, increased confusion at night, forgets all experience, executive fxn loss Delirium -- fast onset, impaired orientation, ANS signs, altered sleep/wake TERM 24
Motor control and movement results from the
interaction of what?
DEFINITION 24
- Task activities/skills
- Environment objects surface surrounding
- Individual action perception cognition -- deficits in cognition/attention impact motor control TERM 25
Two types of motor learning distributed in the
CNS?
DEFINITION 25
- Explicit learning Facts/ rules of movement
- Implicit learning Unconscious learning from practice Demonstrate and then someone copies
Which test measures when someone is
"asleep"?
Glasgow Coma Scale High inter-rater reliability Scoring: 8 Severe brain injury9-12 Moderate brain injury13- Mild brain injury TERM 32
What test measures someone who is
"awake"?
DEFINITION 32 LEVEL OF AROUSAL RANCHO LOS AMIGOS (RLA) LEVELS OF COGNITIVE FUNCTION Descriptive scale of cognitive and behavioral recovery Does NOT address specific cognitive deficits such as calculation or reasoning Reliable & valid measure of cognitive and behavioral function TERM 33
How do you grade a patient's level of arousal?
DEFINITION 33 Grade patient on what you see RIGHT NOW and not tomorrow or yesterday or in 20 min. TERM 34
Example of Divided Attention
DEFINITION 34 Observe performance of # of sit to stands performed in 30 seconds while simultaneously subtracting from 100 by 7's Can do significantly less sit/stands while trying to count TERM 35
Signs of Cognitive Impairment
DEFINITION 35 Memory loss observed by others Motor impersistence (cant keep eyes shut) Confusion with slight change in environment Word finding, perseveration, illogical thought Calculation (ex: cant balance checkbook, calculate change) one of first signs Unkempt appearance, restless, inattentive really early sign Change/exaggeration behavior Irritable or euphoric Getting lost, or found wandering
What is the difference between old age of the
brain and Alzheimer's Disease?
In alzheimer's disease you wouldn't forget where your keys are as you would in old age but instead would forget what key are forputting shoes in fridge instead of cabinetforget names of people they see on a daily basis or people who are important to them TERM 37
Two types of test for Cognition?
DEFINITION 37 Montreal Cognitive Assessment (MoCA) Addenbrooke Cognitive Exam -- Revised (ACE-R) Mini Mental Status Exam (MMSE) TERM 38
Montreal Cognitive Assessment (MoCA)
DEFINITION 38 Quick -- ~10 min Mild cognitive dysfunction Better focus on executive functioning (problem-solving, cause-effect) Cut off < 26, 90% sensitivity for Moderate Cognitive Impairment(MCI) and 100% for Alzheimers TERM 39
Addenbrooke Cognitive Exam -- Revised (ACE-
R)
DEFINITION 39 Quick --- ~15 min More items than MoCA Sensitive for MCI TERM 40
Mini Mental Status Exam (MMSE)
DEFINITION 40 Proprietary someone owns it and you have to pay and use it Screening tool only -- Very limited, Cannot determine etiology Is not diagnostic Cut score 24 -- Indicates need for more detailed exam
