Cognitive Assessment for Clinicians by John R Hodges

Author:John R Hodges
Language: eng
Format: mobi
Publisher: Oxford University Press
Published: 2007-08-16T03:00:00+00:00

Chapter 5

Testing Cognitive Function at the Bedside

The general schema followed is that already outlined in Chapters 1 and 3. The first part of the examination should assess distributed cognitive functions; deficits in these indicate damage to particular brain systems, but not to focal areas of one hemisphere. The second part of the assessment should deal with more localized functions, divided into those associated with the dominant (i.e. the left side, in right-handers) and non-dominant hemispheres.

The Addenbrooke’s Cognitive Examination (ACE), which has now been revised (ACE-R), is described in Chapter 7. The ACE-R takes approximately 15 min to complete and can be regarded as a basic screening instrument that is particularly useful in an outpatient setting. It was developed principally to aid in the detection and monitoring of dementia syndromes and is less valuable in the diagnosis of delirium or other cognitive disorders. Specific shortcomings and pitfalls are discussed below, and in the context of the illustrative cases in Chapter 8.

Cognitive assessment should always follow history taking, because invaluable information is gained from the patient and informant, which guides the examination. For instance, even minor degrees of aphasia should be apparent from history taking, and will lead the examiner to assess language function thoroughly.

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