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Cognitive Disorders: Assessment and Testing – Psychiatry | Lecturio - YouTube
Channel: Lecturio Medical
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I want to walk you now through a quick test for cognitive disorders,
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so cognitive disorders result primarily from primary or secondary abnormalities
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of the central nervous system. They can affect memory and orientation, attention and judgment.
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The mini mental status exam is used to test cognitive function.
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Now this is a great screening tool and it's one that should actually be included
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in any mental status exam that you do for the patient. It's quick, it's short, it's easy
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and again it's a screening tool and it will tell you whether or not
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you need to dig a little bit deeper into determining if there is in fact a cognitive problem.
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But because errors in cognition can come with all kinds of psychiatric disorders
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even general medical conditions, consider things like depression and psychosis,
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sometimes poor memory and concentration can be features of these illnesses.
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That’s why it's really important to get some baseline MMSE on every patient you encounter.
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Now, the mini mental status exam, it is also called a Folstein, it's scored out of 30 points
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and really anyone following below a 26 probably has some problems that need
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a little digger deeping into figuring out what’s going on there with their cognition.
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So there are a lot of things that you can test for and again this is scored out of 30 points.
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Here’s a chart that helps to summarize a little bit about what you're looking for.
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Things like orientation for the patient, do they know what the month and year is?
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Do they know where they are? That it's a hospital, what floor they're on
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or whether it's an outpatient clinic? What city they’re in, etc.
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So you're really gonna score them there based on their orientation.
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You're gonna want them to name 3 objects and register them,
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meaning repeat them right back to you. You wanna be able to test for their attention
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by giving them some calculations or spelling quiz. Now before you do this step,
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it's really important that you know the educational level of your patient
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so that you can tailor the exam to meet them where they're at.
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You wanna know about their recall so you ask them to repeat the 3 words
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they had registered 5 minutes previously. And then you're gonna score patients
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by asking them to name simple objects like a pen and a clock. Ask them to repeat
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a sentence after you and give them a 3-step command to follow.
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So other things that you're gonna do is see how well they can complete tasks.
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Tell them to close their eyes, have them write a sentence, and have them copy a design
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which should be 3-dimensional and something that they're able to construct without problem.
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So you’ll score all of these and in summary, the mini mental status exam
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is testing all kinds of things, orientation, alertness, patient’s language skills,
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you're testing their executive functioning, their recall, their memory.
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You may also, as part of this exam, throw in some obstructions to see how well they can
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join objects together. Do they know that an apple and an orange are similar
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because they're fruits? That’s a good example of an abstract thinker
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or somebody who’s more concrete is gonna say, well, they are both round,
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which is not so good of an answer.
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So I wanna tell you about two other quick tests that you can do in terms of checking cognition.
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So sometimes these come up on exams and on the words so they're worth noting.
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Now when you're suspecting a cognitive disorder in a patient, let’s say you've screened them
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with the mini mental status exam, they didn’t do so well. So you wanna take a one step further
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or maybe give them a MoCA, the Montreal Cognitive Assessment. This is a brief screening tool,
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only takes about 10 minutes to deliver and it really tests a variety of things.
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It can test… compared with the MMSE, it tests things that are a little more sensitive
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to the detection of a mild cognitive impairment. Okay, so there’s a wider range of domains here
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that you are looking at, including memory and language, attention, also visuospatial things,
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and executive functions. For example, the MoCA includes little quizzes like drawing a clock,
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telling it to say a certain time and includes a trail making sequence.
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They test how quickly a person can name words starting with the certain letter within a minute,
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so it just a little bit more challenging than the MMSE and a little bit more new ones.
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There's also a test called the mini-cog and this is a clock drawing test and also a test of recall.
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And this can be really important and a really quick way to assess whether or not
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somebody is having some cognitive trouble. The clock drawing test is a great way to really see
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if people are able to connect the sequence of ideas and strategize and do something
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in a goal-oriented task driven way. And then with a recall of three words,
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you can really quickly just see how somebody’s memory is based of,
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of whether they can recall all three words easily or if it's a struggle to even come up with one.
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So the advantages of the mini-cog again are the high sensitivity for predicting dementia,
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the short testing time because it really takes only a couple of minutes
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compared to the mini mental status exam or MoCA which may take about 7-10 minutes each.
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And there is a little bit of diagnostic value that’s limited in the mini-cog
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because it's so short but it's a good way to just clue you in and as to whether or not
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there might be a serious cognition problem that you need to dig deeper for.
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So you're familiar now with the few quick screening tools, I’d say for your exam
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the ones to remember is the mini mental status exam and note that this is important
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to do not only in patients who may have cognitive trouble
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but really you should include it as part of your mental status exam for all patients.
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