Cognitive Function Test

Cognitive Functions Test

  I.         Consciousness

The intensity of stimulation needed to arouse the patient should be indicated to demonstrate the level of alertness,
Grade the level of consciousness of the pt.: Conscious/Confuse/Somnolence/Clouded level of conscious /Delirious/Stuporous/Comatose.

   II.         Orientation:

a.     Time (test by asking the time, date, day, month, year, season, and the time spent in hospital)?

-       What day is it today?

-       What is the date today?

-       Which month is it now?

-       Which year is this year?

-       What is the current season?

b.     Place (test by asking the present location, building, city, and country)?

-       Where are we now?

-       Which city are we in?

-       Which country are we in?

c.     Person (test by asking the patient whether he can identify people around him and their role in that setting)?

-       Who am I?

-       Ask about People around nurses, helpers, ward boys.

-       His relatives/friends around.

 III.         Attention: digit span test
(Ask the patient to repeat digits forwards and backwards, one at a time (for example, patient may be able to repeat 5 digits forward and 3 digits backwards); Forward Span is 7+/- 2 (5-9), Backward span is 5+/- 2 (3-7)

-       Repeat this number after me, 642138

-       Repeat this number backwards, 908

 IV.         Concentration: Sustained attention Serial 7 test

a.     Ask to subtract serial sevens from hundred (100-7 test), or serial threes from twenty (20-3 test).

b.     If the patient is unable to do it, ask the patient to enumerate the names of the months (or days of the week) in the reverse order

-       Can you please subtract 100-7? (93, 86, 79, 72, 65)

-       Can you please list the name of the days of the week backwards?

   V.         Memory

a.     Immediate Retention and Recall The same test for attention

b.     Recent Memory/ short term memory

1.     Ask how did the patient come to the room/hospital?

2.     What he ate for dinner the day before or for breakfast the same morning.

What did you have for breakfast today?

3.     Registration and recall for 3 different items

Registration for immediate memory Recall after 15 min for recent memory

Give the pt. 3 items to be memorized and ask it to be recalled 15 minutes later or at the end of the interview

c. Remote Memory / long term memory

Ask for the date and place of marriage, name and birthdays of children, any other relevant questions from the person’s past. Note any amnesia (anterograde/ retro grade), or confabulation, if present.

  VI.         Intelligence

Keep in mind the patient’s educational and social background, his experiences and interests.

-       who is the president of the country?

-       what is the capital of the country?

-       what are the general events going recently?

VII.         Abstract thinking

Test by:

a.     Proverb Testing: The meaning of simple proverbs (usually three, from the patient language or culture) should be asked.

Ex. don’t judge book by it cover"

b.     Similarities: between familiar objects should be asked.

Ex. What is the similarity between a table and a chair? (banana/orange; dog/lion; eye/ear)

VIII.         Judgment

a. Situational judgment

It is the ability to assess a situation correctly and act appropriately within that situation.
Test judgement is assessed by asking the patient what he would do in certain test situations, such as

- What would you do if you saw a house on fire?
- What would you do if you saw a man lying on the road?

b. Overall judgment/ personal judgment

Assessed through the full history that you took from the pt. Judgment is rated as Good/Intact/Normal or Poor/ Impaired/Abnormal.