The Cognitive Domain involves understanding our patients' ability to understand and process their overall health. Cognitive impairment may lead to barriers in medical management, increase falls, and higher risk social living conditions.
The following tests may be used to evaluate a patient's cognition
Mini-cog: The Mini-cog is a brief instrument to screen for cognitive impairment.
- Since it can be completed quite quickly, it is convenient to use on the wards or clinic
1. Ask the patient to remember 3 words
2. Ask them to draw a clock including the numbers. Place hands of clock at "10 minutes past 11"
3. Ask the patient to repeat 3 words
MoCA: The Montreal Cognitive Assessment is an instrument that is now more widely used. It is more sensitive in assessing different cognitive domains, particularly visual-spatial and executive domains.
- The MoCA is available in different languages and versions
Changes in cognition can be viewed on a spectrum from normal age decline to dementia:
Age Related Cognitive Decline (ACRD): As we age, our cognitive function in speed and processing naturally declines. However, in normal age decline, individuals score normally on cognitive tests and are still able to perform their daily functions independently
Mild Cognitive Impairment (MCI): These individuals are still able to perform their daily functions, but score lower than normal on cognitive testing
Dementia: These individuals have mild to severe cognitive impairment to the point that it impairs daily functions
Delirium: Primarily an acute change in attention. There are 3 types of delirium: Hyperactue, hypoacute and mixed. It is usually caused by a medical condition and can be reversed