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Cognitive Impairment Mental Status Evaluation Hints

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Cognitive Impairment Mental Status Evaluation Hints

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    1. Cognitive Impairment & Mental Status Evaluation Hints Ted Johnson, M.D., M.P.H. Director, Atlanta Site Birmingham/Atlanta Geriatric Research Education and Clinical Center

    3. Purpose of Evaluation for Cognitive Impairment Identify disease Offer treatment Cholinesterase inhibitors (mild-to-moderate) Donepezil, Galantamine, Rivastigmine NMDA Receptor Antagonists (mod-to-severe) Memantine Managing co-morbidities Advanced planning and expectations

    4. Prevalence of Dementia: Age and Setting

    5. Missed Dementia Williamson et al (British) 1964 87% of dementia unknown to GP Ross et al (Hawaii) 1997 60% of dementia in men not recognized by family Snowdon (Nuns) 1997 22% of caregivers failed to recognize dementia Sternberg et al (CSHA) 2000: 64% missed by caregivers and physician

    6. Dementia criteria (DSM-IV) Short-term memory (learning skills) and long term memory impairment plus Functional decline plus Work and social activity impairments plus Normal consciousness plus One or more impairments in abstract thinking, problem solving or judgment; personality disturbance; aphasia, apraxia, agnosia, constructional abilities, or calculations

    7. Delirium and Depression Distinguishing criteria of delirium: Sudden onset of deficits; Waxing and waning cognitive impairment; Alteration in consciousness Dysphoria Anhedonia Guilt/ Self-reproach Fatigability Impaired concentration and cognition Appetite disturbance Sleep disturbance Suicidal thoughts, risk Agitation or retardation

    8. Single Test in Cognitive Screening- Orientation

    9. Single Test in Cognitive Screening- Serial 7s

    10. Clock Drawing Test Instructions: Draw a clock, put all the details in and show that it is 10 minutes after 11. Normal Correct spacing, numbering, rotation Almost normal Missing number, inappropriate spacing Abnormal Perseveration, counterclockwise rotation, irrelevant patterns

    11. Single Test in Cognitive Screening- Clock Draw

    12. Summary of Instruments Folstein Mini-Mental State Examination Mini-Cog Montreal Cognitive Assessment Individual Elements Clock drawing Time orientation Serial 7 subtractions

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