Cogni&ve assessment workshop. Dr. Roger Ho Consultant Psychiatrist and Assistant Professor Department of Psychological Medicine NUHS

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June Lamb
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1 Cogni&ve assessment workshop Dr. Roger Ho Consultant Psychiatrist and Assistant Professor Department of Psychological Medicine NUHS

2 Objec&ve of this lecture To prepare medical students to have full competency in cogni&ve assessment in view of the aging popula&on. See one, do one under supervision and do one on your own when you become a doctor. For MMSE and frontal lobe assessment, the teacher will be SP and student will be the assessor. Introduc&on of MOCA (Montreal Cogni&ve Assessment). Demonstra&on of temporal and parietal lobe assessment.

3 Conduct a MMSE

4 Do not do MMSE in the OSCE exam unless there is a very clear instruc9on to do part of the MMSE (e.g. Assess a@en9on)] MMSE is more relevant for your future prac9ce Orienta9on (Time): Time, day, day of the month, month, year (5) Orienta9on (Place): Ward #, floor, Name of hospital, nearest MRT, Singapore (5) Short term memory: Registra&on of 3 objects (3) A@en9on: Serial 7 or serial 3 (5) Short term memory: Recall of 3 objects (3) Recogni9on: Naming of 2 objects (Agnosia) (2) Language: Wri&ng a complete sentence (1) Following a wriwen command (1) Repea&ng a sentence, no ifs and or buts (aphasia) (1) Visual- spa9al skill: Drawing a double pentagon (1) Motor sequence: 3 stages command (3) Total = 30 points

5 How to do serial 7 correctly? Serial 7s: Administra&on: The examiner gives the following instruc&on: Now, I will ask you to count by subtrac4ng seven from 100, and then, keep subtrac4ng seven from your answer un4l I tell you to stop. Give this instruc&on twice if necessary. If the par&cipant successfully makes four or five correct subtrac&ons. Count each correct subtrac&on of 7 beginning at 100. Each subtrac&on is evaluated independently; that is, if the par&cipant responds with an incorrect number but con&nues to correctly subtract 7 from it, give a point for each correct subtrac&on. For example, a par&cipant may respond where the 92 is incorrect, but all subsequent numbers are subtracted correctly. This is one error and the item would be given a score of 4.

6 Conduct a frontal lobe assessment

7 Frontal lobe assessment Cogni&ve es&ma&on Verbal fluency Judgment Abstract thinking Luria hand test Alterna&ng sequence

8 Conduct a MOCA assessment hwp://

Rey- Osterrieth Complex Figure The Rey- Osterrieth Complex Figure Test (ROCF) is a neuropsychological assessment in which examinees are asked to reproduce a complicated line drawing, first by copying

12 Rey- Osterrieth Complex Figure The Rey- Osterrieth Complex Figure Test (ROCF) is a neuropsychological assessment in which examinees are asked to reproduce a complicated line drawing, first by copying and then from memory. Many different cogni&ve abili&es are needed for a correct performance, and the test therefore permits the evalua&on of different func&ons, such as visuospa&al abili&es, memory, awen&on, planning, and working memory ( execu&ve func&ons). First proposed by Swiss psychologist André Rey in 1941 and further standardized by Paul- Alexandre Osterrieth in 1944, it is frequently used to further elucidate any secondary effect of brain injury in neurological pa&ents, to test for the presence of demen&a, or to study the degree of cogni&ve development in children.

13 Assessing parietal lobe func&on

14 Assessment of unilateral parietal lobe func&on Dominant parietal lobe func&on: Broca s or Wernicke s dysphasia (from conversa&on) Ideomotor apraxia Gerstmann s syndrome: Finger agnosia Dyscalculia Right- lep orienta&on Agraphia (cannot write a sentence) Asterognosia: Place a coin or key in the palm of pa&ent s hand. Agraphagnosia: Write a lewer on pa&ent s hand, H or W. Non- dominant parietal lobe func&on: Neglect (draw a clock face) Asomatognosia (cannot recognize physical impairment) Construc&onal apraxia Topographical disorienta&on: get lost in a place.

15 Assess bilateral parietal lobe func&on Test visual field to look for lower homonymous quadrantanopia.

16 Assessing temporal lobe func&on

17 Assessing unilateral temporal lobe func&on Dominant temporal lobe Wernicke dysphasia (no ifs, and or buts) Agraphia (Can pa&ent write a couple of sentences?) Alexia (Can pa&ent read a couple of sentences?) Remember and recall an address (3 to 5 minutes later) Non- dominant temporal lobe Anomia (name of items) Hemiasomatopagnosia (neglect one side of the body in a person with hemiplegia )

18 Assessing bilateral temporal lobe Assessing short- term memory: Where did you have lunch today? How did you get to NUH today? func&on Assessing long- term memory: What happened to JF Kennedy? Can you tell me why the twin towers fell in New York? Remote personal memory: Can you tell me your date of birth? What is the name of your primary school? Assess visual field look for upper homonymous quadrantanopia Did you have a fit before? Can you tell me more about your fit? Explore psycho&c experience. Test for prosopagnosia.

20 Test on seman&c memory (1)

21 Test on seman&c memory (2)

The Brief Cogni-ve Assessment Tool (BCAT): A New Test Emphasizing Contextual Memory and Execu<ve Func<ons

The Brief Cogni-ve Assessment Tool (BCAT): A New Test Emphasizing Contextual Memory and Execu