Interpretation of Cognitive Tests Workshop for BGS Trainees Conference 6th February 2016 Dr Vicki Osman-Hicks, Consultant in Old Age Psychiatry victoria.osman-hicks@southernhealth.nhs.uk

BGS Traine

es w

eeke

nd 20

16

Plan for Workshop • Checking level of experience/confidence • Principles for interpretation of tests • Refresher on different cognitive functions • Different cognitive tests and when to use each one. • Cognitive Tests in context of a community/OPD assessment for

suspected dementia • Cognitive Tests in different conditions • Round up and questions

BGS Traine

es w

eeke

nd 20

16

Checking level of experience High level of experience

Highly confident

BGS Traine

es w

eeke

nd 20

16

Shared Tips vs What’s hard?

BGS Traine

es w

eeke

nd 20

16

Principles for Interpreting Cognitive Tests • Caution with screening tests

• Why Assess now- it is timely and appropriate?

• Assessment: Cognitive test only as part of full ‘memory clinic style’ assessment (history +mental state + collateral history+ risk assessment + bloods+ physical examination +neuroimaging*). • On it’s own means nothing. Patient not the score.

• Assessment for What- Dementia vs MCI? Alz vs. FTD? • Link the history taking with the appropriate cognitive tests

• Pre-morbid abilities: 1st Language, IQ, Reading/Writing/Age Left

School.

• Disabilities: Sight/Hearing/ Tremor/Weakness

BGS Traine

es w

eeke

nd 20

16

Cognitive Function: Memory

Memory Distributed Function

STM Registration of a name and address/immediate recall.

LTM

Explicit (Declarative)

Testable at bedside

Episodic Personally experienced

Semantic Vocab, Concepts, World

Knowledge

Implicit (Procedural)

Not testable at bedside

Motor Skills e.g. Driving/Golf

Priming Previous exposure improves

future performance

Classical Conditioning

Pavlov’s Dogs

BGS Traine

es w

eeke

nd 20

16

Cognitive Function: Attention and Executive Function

Responsivity Or Alertness

Sustained Attention

Divided Attention (more

than 1 task at once)

Selective Attention (focus on 1, suppress

another stimuli) Personality, Social Behaviour, Affect, Theory

of Mind, Motivation

Problem Solving, Sequencing and

Planning

Abstract Thinking

Set Shifting

Initiation and

Decision Making

Inhibitory Control

BGS Traine

es w

eeke

nd 20

16

Different Cognitive Tests MMSE ACE-III MOCA 6-CIT

Screening/ Staging for Dementia

Assessment for MCI and Dementia

Assessment for MCI not dementia

Screening for Dementia in Primary Care

Cut off 24/30 87% Sensitive 82% Specific Sensitivity depends on care setting. Cut off 27/30 in highly educated.

Cut Off 88/100 100% Sensitive 96% Specific 82/100 93% Sensitive 100% Specific for Dementia

Cut off 26/30 94% Sensitive 80% Specific

8+/28 Abnormal 79% Sensitive 100% Specific Culturally unbiased.

Takes 5-10 mins Takes 16 mins Takes 10 mins Takes <5 mins

Validated in: GP and Secondary Care

Validated in memory clinic, psych & neuro.

Validated in memory clinics,

Validated in Memory Clinics

Copyrighted ACE 3 Online 6CIT Online BGS Trai

nees

wee

kend

2016

Exercise: Cognitive Tests • You will be given a number of cognitive tests. In pairs: 1. Name the cognitive deficits on the test and rate the severity, if indeed it is dementia. 2. Link the one depression scale with the most likely MMSE. 3. Link the one ‘back of an MMSE’ with the most likely MMSE. 4. Think about the differential diagnosis for each one. 5. Finally describe the most likely history/mental state for your preferred diagnosis for each cognitive test?

BGS Traine

es w

eeke

nd 20

16

Exercise: Your Service • Design a flow chart of how you would manage a good quality

assessment of dementia including interpretation of cognitive tests in your clinic/service/future consultant job/ward?

BGS Traine

es w

eeke

nd 20

16

Round Up & Key Learning Points • Caution with screening tests

• Why Assess now- it is timely and appropriate?

• Assessment: Cognitive test only as part of full ‘memory clinic style’ assessment (history +mental state + collateral history+ risk assessment + bloods+ physical examination +neuroimaging*). • On it’s own means nothing. Patient not the score.

• Assessment for What- Dementia vs MCI? Alz vs. FTD? • Link the history taking with the appropriate cognitive tests

• Think about how you design your service to interpret them

well. BGS Traine

es w

eeke

nd 20

16

Further Reading • MOCA (how to do) You Tube MOCA • Stroop Test You Tube Stroop • ACE 3 Training (Free) ACE Training Online • Review of Brief

Cognitive Tests Velayudham L et al 2014

BGS Traine

es w

eeke

nd 20

16