UNIT 2: COMPREHENSIVE GERIATRIC ASSESSMENT 2.3 COGNITIVE ASSESSMENT

It is estimated that the prevalence of dementia is around 1% of the population over 65 years, which doubles every 5 years and reaching 30-50% from age 85.

For the assessment of mental and social capacity in the elderly, it is necessary assess cognitive impairment (dementia), behavioral disorders associated with cognitive impairment, affective capacity and also assess and take into account the variables implied by the fragility of these.

Higher mental functions in the elderly may be affected by changes of the aging, among these, mild cognitive deficits may evolve into dementia, so it is important to make early detection for early treatment. (Masaro EJ, 2006).

These changes can be serious when they appear:

- Severe disturbances of memory and orientation

- Inability to maintain a coherent conversation

- Obvious behavioral disorders

- Serious difficulties in self-care

- Frequent incontinence

Cognitive impairment is any deficit of higher mental functions (language, reasoning, calculation, memory, praxis, gnosis, etc.). The most common is memory loss. This type of disorder can be caused by multiple causes, so the cognitive impairment is classified as a geriatric syndrome, which must be evaluated to determine the components of it and thus make the diagnosis of dementia. (SK Inouye, 2007).

To evaluate the cognitive sphere is necessary that the clinical interview as secondary prevention, is questioned about the complaint, onset form, evaluation of symptoms, guidance, complaints, memory impairment, problems in recognizing family and friends, language, capacity for abstraction, behavioral disorders, agitation, sleep-wake rhythm, wandering, etc.

On the other hand, cognitive impairment has important implications for the functionality of the patient and family and social level. Are important implications for quality of life, both in the patient and in his primary caregiver. It is essential to assessing for signs of overload. That can be done in the clinical interview or directed by the use of scales.

How to conduct a screening, the test that stand out for its convenience and simplicity are:

- Pfeiffer Questionnaire (Short Portable Mental Status questionarie)

- Mini Mental State Examination of Folstein (MMSE)

- Wolf Mini cognitive examination (MEC)

- Clock Test

Another scale is the scale of Zarit caregiver burden, which is part of the social assessment.

The Mini Mental State Examination (MMSE) is useful as a screening tool for cognitive impairment and can be used as an initial test (SIGN, 2006). It takes place in less than 10 minutes and identifies memory disorders in early and cognitive impairment. (Pezzotti P, 2008). Furthermore, the result of the MMSE should be controlled for age and education of the subjects, (according to years of schooling of the patient). It has a sensitivity of 90% and a specificity of 75% for detecting cognitive impairment (Haubois G, 2011).

So with a score over 24 points on the MMSE test and a clinical history consistent with the decline in functional status and previous cognitive assessment recommended by a specialist, Neurologist or Geriatrician. (Folstein MF, 1975).

In order to make a diagnosis of cognitive impairment, it is necessary that the patient is not enrolled with delirium, metabolic disorders or comorbidity that could alter their sensory perception or alertness. It is also advisable to rule out secondary causes of cognitive decline and timely treatment in each case. Given that influence: psychotropic drugs, depression, hypo and hyperthyroidism, vitamin B12, folic acid, brain tumor, subdural hematoma, etc.. (Geldmacher, 2004)

In practice, adults mayors who have mild or moderate cognitive impairment in addition to medical treatment, are recommended to be valued by the social care team to integrate maintenance activities or improvement of cognitive functions in sessions or workshops for mental stimulation, that can be group or individual.

REFERENCES:

·         - Treaty for geriatric residents. Spanish Society of Geriatrics and Gerontology. [Home Site] [accessed May 18, 2012] Available at: http://www.segg.es/tratadogeriatria/main.html

·         - Clinical Practice Guideline: Assessment Comprehensive Geriatric Gerontological Ambulatory Elderly. Mexico: Ministry of Health, 2011. Available at: http://sgm.issste.gob.mx/medica/medica_documentacion/guias_autorizadas/Geriatr%C3%ADa/IMSS-491-11-valoraci%C3%B3n%20geronto-geriatrica/IMSS-491-11-GER%20Valoraci%C3%B3n%20geronto%20geriatrica.pdf