Cognitive Function Tests

Cognitive Function Tests
Tests for cognition

Basic things to do ?
•Should not be the first thing to do while evaluating a patient
• Basic history taking, brief conversation- may give you idea
about patient’s intelligence
• Make a note of education level of the patient
•Make the patient at ease
• Do not try to show or make the patient feel that he or she is
in a test situation
• Failure means ?? Nothing as far as diagnosis is concerned, as
far as management is concerned- can improve
• Explain to the patient- test may appear silly, but we can still
carry on
Tests for cognition
Aim ?
• To get the best out of the patient and not to get worst out
of the patient and also make him feel that he is not able
to perform
What to do ?
• Give positive reinforcement/encouragement whereever
possible
• Avoid negative feedback
Tests for cognition
•Level of consciousness • Language
•Orientation • Executive functions
•Attention & Concentration • Planning
•Memory • Coordination
•Abstraction • Naming
•Comprehension
•Calculation
•Intelligence
•Calculation
•Judgment Follow the sequence
•Insight
Consciousness
What is consciousness ?
• Consciousness is a multifaceted concept that has two
dimensions:
– Arousal, or wakefulness (i.e., level of consciousness) and
– Awareness (i.e., content of consciousness)
Basics
• One needs to be awake in order to be aware (rapid eye
movement (REM) sleep and lucid dreaming being notorious
exceptions)
Consciousness
Consciousness
Consciousness
Consciousness
Consciousness
Consciousness
Quantitative lowering of Qualitative change of
consciousness consciousness
• Normal (alert, vigilant, • Delirium
lucid) • Fluctuations
• Clouding • Confusion
• Drowsiness
• Stupor
• Coma
• Death
Consciousness
Consciousness
Consciousness
Consciousness
Orientation (Recent memory)
What is orientation?
• Capacity of an individual to gauge accurately time, place and
person in his current setting
• Orientation to time and place- actually measures of recent
memory as they test the patient’s ability to learn these
continually changing facts
• If a patient is not fully oriented, this alone suggests a
significant recent memory deficit
• When consciousness is disturbed it tends to affect these three
aspects in that order
• Time-Place-Person (orientation to self is lost at the last)
Time Place Person

• Time-Place-Person (orientation to self is lost at the last)
Place
Location What is the name of this place ?
What kind of place are we in now ?
Which floor did you come to today ?
City location What city are we now?
State? Country?
Address What is your home address?
Orientation to person
• Identify/Recognise/Name the people around
• Able to name self/tell the age
Name What is your name?
Age How old are you?
Date of birth When is your birthday(day, month, year)
Orientation to person
• Sequentially ask questions
• Paraphrase when necessary to ensure clarity
• If the patient fails these items, tell the patient correct answers &
have him/her repeat them; several minutes later, have the
patient recall the answers
• Failure at this level verifies poor new learning ability & predicts
deficient performance on any subsequent memory tasks
[Strub & Black, 2003]
How to go about ?
• Avoid test situation
• Many of the issues related to orientation can be covered while
evaluating the Identification data, history taking
• Specific questions to be asked casually
Interpretation
• Normal people usually perform perfectly
• Sometimes exact date, less commonly day of the week missed
[Simpson et al, 1986]
• Correlates with education level; normal college students, if they
do not know the date or day, usually miss by only 1 day,
whereas normal without high school education may miss by 2 or
3 days
• Normal uneducated people(7.7%)- incorrectly identify month
Natelson et al, 1979
How to describe ?
Oriented to time, place and person
Not Oriented to time, place and person
Not Oriented to time and place but oriented to person
Attention
What is attention?
• Attention is the patient’s ability to attend to a specific stimulus
without being distracted by extraneous internal or
environmental stimuli
Attention
What are the different aspects of attention?: SIMS
• Focused attention: The capacity to highlight important stimuli
while suppressing awareness of competing distractions
• Sustained attention/ vigilance: The capacity to maintain
attentional activity over a prolonged period
• The term "vigilance," however, has been used interchangeably
with both "sustained attention" (focusing on one stimulus over
an extended period of time) and also with the more common
concept of "watchfulness" or "alertness”
• Vigilance in the sense of alertness refers to a more basic arousal
process in which the awake patient can respond to any stimulus
appearing in the environment
Attention
What are the different aspects of attention?: SIMS
• Divided attention: The ability to respond to more than one
task at a time, including taking account of the multiple
attempts within a complex task
• Alternating attention: Ability to shift attentional focus from
task to task
• Attentional capacity: The extent of the processing ability
inherent in the attentional system. It is often considered to
be a part of the working memory
Attention
• Attention underlies performance in virtually all other areas
of functioning and should always be considered as a
potential contributor to impairment on any tests that require
sustained concentration and vigilance or rapid integration of
new information
[CTP-9]
Inattention
• The concept of inattention (distractibility) is applied to two
distinct clinical situations
1. When the patient is clinically inattentive or is unable to
sustain sufficient attention to succeed in the simple tests of
attention
2. When the patient has specific unilateral inattention
(neglect) to stimuli on the side of the body opposite a brain
lesion
How to test Attention/Conc.
Which tests can be used to assess attention?
Digit repetition
• Digit forward
• Digit backward
• Digit span requires patients to repeat increasingly longer
strings of digits as a way of assessing ability to process
relatively simple information, while digit span backwards
reflects more complex simultaneous processing and cognitive
manipulation demands or working memory
[CTP-9]
1) Digit Repetition
How should the test be done?
• Check the level of hearing
• Check the common number which patient uses- phone
number, vehicle number, house no, date of birth etc
• Give example, separately for Digit forward and Digit
backwards
• While giving examples give examples up to 3 digits to clarify
the sequence (specifically for making the patient
understand the sequence of digit backwards)
• At times may use, pen and paper to show what you want
the patient to
1) Digit Repetition
• Use the written sequence for your self and avoid generation
of sequence extempore
• Do not use the same sequences
1) Digit Repetition
• Tell the patient I am going to say some simple numbers
• Listen carefully and when I am finished, repeat the numbers said by me
in the same sequence
• Present the digits in a normal tone of voice at a rate of one digit per
second
• Take care not to group digits either in pairs (e.g., 2-6, 5-9) or in
sequences that could serve as an aid to repetition (e.g., in telephone
number form, 376- 8439)
• Numbers should be presented randomly (non-sequential) without
natural sequences (e.g., not 2-4-6-8)
• Begin with a two-number sequence, and continue until the patient fails
to repeat all the numbers correctly
1) Digit Repetition
When to stop
• At least 2 failures on the same sequence
• Go up to the longest series
Normal digit span
• The average adult patient of average intelligence can
accurately repeat 7±2 (5-9) digits without difficulty
• In a non retarded patient without obvious aphasia, inability
to repeat more than five digits indicates defective attention
• Digit backwards: 5 ±2 (3-7)
• Alternatives- WORLD
Concentration
What is concentration ?
• Sustained attention (concentration) is the ability to maintain
attention to a specific stimulus over an extended period
Factors shown to interfere with attention
1. The intensity and frequency of the stimulus
2. Environmental stressors (e.g., noise, temperature,
complexity of the environment)
3. Emotional factors (e.g., anxiety or depression)
4. Lower IQ
Concentration
Which tests can be used to assess concentration?
1. ‘A’ random letter test
2. Serial sevens subtraction test
Concentration
"A" Random Letter Test
• It consists of a series of random letters among which a target
letter appears with greater-than-random frequency
• The patient is required to indicate whenever the target letter is
spoken by the examiner
DIRECTIONS:
• Tell the patient: “I am going to read you a long series of letters
• Whenever you hear the letter 'A,' indicate by tapping the desk/
raising your finger, blinking your eyes, nodding the head
• Read the following letter list in a normal tone at a rate of one
letter per second
Concentration
Concentration
Scoring
• Currently, only preliminary standardized norms exist for this test
• The average person should complete the task without error (x = 0.2);
• A sample of randomly selected brain-damaged patients made an
average of 10 error
• Common organic errors are
1. Failure to indicate when the target letter has been presented (omission
error);
2. Indication made when a non target letter has been presented
(commission error); and
3. Failure to stop tapping with the presentation of subsequent non target
letters (perseveration error)
Concentration
Serial Sevens Subtraction Test
It is counting backward from 100 by 7s: 100, 93, 86, …
Results of studies of performance by normal people suggest that
errors on this test may be influenced by
• Intellectual capability, education, calculating ability, or
socioeconomic status, rather than indicating a pathologic
process
• Excellent performance indicates adequate attention or mental
control, but failure may reflect any of a number of problems,
inattention being but one
• In general, this test has proved of limited validity
Concentration
• 100-7 (time, mistakes) -150 sec
• 40-3 (time, mistakes)-90 sec
• 20-1 (time, mistakes)-30 sec
Illiterate person
• Reverse days of the week
• Reverse months of the year
Concentration
• How to do it- make sure patient has understood the test
• Keep on subtracting till you reach zero or a number from which 7
can not be subtracted
• Give example of a different number series, lets say, 80-6, 100-5
• If patient has done 100-7 than no need to go ahead with 40-3 or
20-1
Memory
• A disturbance in memory: most common cognitive complaint of
patients with organically based behavioral syndromes
• Almost all patients with dementia show memory problems
early in the course of disease
• Various neurologic diseases results in different types of
memory disturbance (e.g., severe memory deficit in relative
isolation in Korsakoff's syndrome, memory difficulty
compounded by inattention and agitation in confusional states,
impaired recent memory associated with general cognitive
dysfunction in dementia)
Memory
Terminology
• Memory is a general term for mental process that allows the
individual to store information for later recall
• The memory process consists of 3 stages:
• In first stage, information is received and registered by a particular
sensory modality (e.g., touch, auditory or visual) and is held
temporarily in short term memory (working memory)
• The second stage, consists of storing and retaining the information in
a more permanent form (long term memory)
 This is enhanced by repetition or by association with other
information that is usually an active process requiring effort through
practice and rehearsal
 Some information is stored passively throughout our lives and is
called incidental memory because it is acquired effortlessly
Memory
Terminology
• The final stage, is the recall or retrieval of the stored
information
 It is an active process of mobilizing stored information on
request or as needed so called declarative memory
Memory
Memory
Memory
Memory
Memory
Memory
Memory
Memory
Memory
Assessment
• Clinically memory is divided into 3 types, based on the time
span between stimulus presentation and memory retrieval
– Immediate
– Recent
– Remote
Memory
Registration/Immediate memory/ recall: is used to recall a
memory trace after an interval of a few seconds/ few minutes,
as in the repetition of a series of digits
Recent memory:
• Is the patient’s capacity to remember current, day-to-day
events (e.g., the current date, the doctor`s name, breakfast
or recent new events)
• It is the ability to learn new material and to retrieve that
material after an interval of minutes, hours, or days
Remote memory : recall of facts or events that occurred years
previously (e.g., names of teachers and old school friends, birth
dates, and historic facts)
Memory
Amnesia
• General term used for defect in memory function (e.g.,
Korsakoff`s syndrome or posttraumatic amnesia
• Anterograde amnesia: the inability to learn new material
after a brain insult
Amnesia in both cases can vary from few seconds
• Retrograde amnesia: the inability to remember events that
to several years
occurred before the brain insult
• Psychogenic amnesia: in which the patient block a period of
time from memory
• Do not demonstrate a recent memory deficit
• Can learn items during the amnestic period
Memory
Assessment of Memory
• Each aspect of the memory should be assessed in detail
• Patient`s commonly perform at different levels on various memory
tests depending upon the nature of disorder
• The accurate assessment of memory requires that any question
asked by the examiner be verifiable from a source other than the
patient
• Personal information concerning the patient`s social history,
lifestyle, vocation etc. should be verified by the patient`s family or
friends
• Historic facts (e.g., ‘when was World War 2” or “who was the Prime
Minister before Mr Vajpayee?”)
• The most sensitive and valid tests of recent memory are those that
require the patient to learn new material and recall it over time
Memory
• Equip yourself with all the test material
Immediate recall (short term memory):
• Tested by digit repetition
• It is useful as a general screening test for brain dysfunction
• The m/c cause of failure on short term memory tasks is probably
inattention
Orientation (Recent memory):
• The patient’s orientation with respect to
 Person (who he or she is )
 Time (date)
 And place (where he or she is)
Orientation to time and place are actually measures of recent memory,
as they test the patient`s ability to learn these continually changing facts
Memory
Directions
• Tell the patient “I am going to tell you 3 words that I would like
you to remember. In a few minutes I will ask you to recall these
words”
• To ensure that patient has heard, understood and initially
retained the 3 words
• Older patients may require several trials to learn the words
accurately
• To eliminate possible mental rehearsal, interference should be
used between presentation and recall of words
• After 5 minutes ask the patient to recall the 3 words
Memory
• 3 items to be given to the patient- should not rhyme, should
not be able to use in one sentence, should not be present in
the vicinity/field of vision
• 3 items to be given from different categories
• Words to be told slowly, @ 1per second
• Immediate recall- repetition/registration
• Recall at 1 minute, 5 minutes
Memory
Test items
1. brown 1. fun 1. grape
2. Honesty 2. carrot 2. stocking
3. Tulip 3. ankle 3. happiness
4. Eyedropper 4. loyalty 4. toothbrush
• Normal patients <60 years recall 2 or 3 words over 10 minutes

delay
• Low score of 2 out of 4 must be taken into account
Memory
Directions:
• If the patient fails in registration, tell the patient the correct
answers and have him or her repeat them, several minutes
later, have the patient recall the answers
• Failure at this level verifies poor new learning ability and
predicts deficient performance on any subsequent memory
tasks
Memory
Recent memory
• Ask things related to day to day activities, to be verified
– What did you have in the lunch
– Who all came to meet you
– When did you go for the test
• Ask about current affairs (if patient is following the same)
– Who won the match
– What happened to such and such person yesterday
Memory
Remote memory
• To evaluate patient’s ability to recall personal and historic
events
• Personal events must be verifiable by a reliable source other
than the patient
• Recall on historic information must be interpreted in light of
patient’s premorbid intelligence, education and social
experience
Memory
Remote memory
Personal information
Where were you born?
School information Where did you go to school?
When did you attend school?
Where is your school located?
Vocation history What do you do for work?
Where have you worked?
When did you work at those places?
Memory
Remote memory
Family information
What is your wife`s (children`s) name?
How old is your wife (children)?
• Personal information items are completed with equal accuracy
by both normal patients and patients with mild , non specific
brain damage
• Impaired performance is pathologic
Memory
Remote memory
Historic facts
• Ask patient to name four people who have been president
during the patient`s lifetime
• Normal patient will accomplish and failed by patient`s with
early Alzheimer`s disease
General Fund of Knowledge
General fund of knowledge
• Provides reasonable estimates of patient’s store of knowledge
• Continue to ask questions until the test is completed or until
the patient has failed 3 successive questions
•Questions
Examiner may repeat the question but should
Acceptable not paraphrase
answers
How
ormany
spellweeks are in a year?
or explain 52
words that are unfamiliar to the patient
Why do people have lungs ? To transfer oxygen from air to
blood; to breathe
What is the capital of India? Delhi
Where is Taj Mahal ? Agra
Who was the first PM?
Who is the president of India ?
Who was the first female president of India?
• “refer to the historically accumulated and culturally developed
bodies of knowledge and skills essential for household or
individual functioning and well-being”
Interpretation
• Answer must either be exact or very closely approximate the
acceptable response
• Educational background plays an important role
• Less adequate performance indicates an impaired fund of
knowledge, reduced intelligence, limited social and educational
experience, or significant dementia
• More adequate performance suggests above average
intelligence and education
Calculation
Types of calculations:
•Addition, Subtraction, Multiplication & Division
•Verbal, Written
•Simple, complex
•Sequence (correct sequence)
–Simple written
–Simple verbal
–Complex written
–Complex verbal
Calculation
It include
• Rote tables (e.g., addition, subtraction, and multiplication)
Verbal rote examples
• Read each example in clear voice and record the patient`s
response
• Addition 4+6=10
7+9=16
• Subtraction 8 - 5 =3
17 - 9=8
• Multiplication 2 x 8= 16
9 x 7= 63
• Division 9 /3 = 3
56/8 = 7
Calculation
Verbal complex examples
• Allow only 20 seconds for response
• Addition 14 +17 = 31
• Subtraction 43 -38 = 5
• Multiplication 21 x 5 = 16
• Division 128/8 = 16
Written complex examples
• Failure to complete with in 30 seconds should be noted
• Addition 108 +79
• Subtraction 605 -86
• Multiplication 108 x 36
• Division 559 / 43
Abstraction
• What is abstraction?
Abstraction
• What is abstraction?
• Abstract reasoning is the ability to shift back and forth between
general concepts and specific examples
• Having the patient identify similarities between like objects or
concepts (apple and pear, bus and airplane, or a poem and a
painting) as well as interpreting proverbs can be useful in
assessing one’s ability to abstract
• Cultural and educational factors and limitations should be kept
in mind when assessing ability to abstract. Occasionally, the
inability to abstract or the idiosyncratic manner of grouping
items can be dramatic
[CTP-9]
Abstraction
• Difficulty in thinking abstractly is a relatively common
consequence of brain injury
• Verbal and Non-verbal tests
• Verbal abstraction ability is the Wechsler Similarities Subtest
– The task is to identify how two objects are alike
– Proverb interpretation is another way to assess ability to think abstractly
• Nonverbal tests of abstraction include sorting tests:
– Wisconsin Card Sorting Test - test of problem solving and ability to
develop and test hypotheses
– Stroop Test - test of cognitive flexibility
– Category test
Abstraction
Similarities testing
• The patient must explain the basic similarity between two
overtly different objects or situations
• It involves analysis of relationships, formation of verbal
concepts and logical thinking
Abstraction
How to do similarities testing ?
• Give example, table and chair, suggest the possible answers
• Make sure that patient has understood that he need to tell
similarities and not the dissimilarities
• Concrete, Function, Class/Category
– Apple, Orange
– Apple, Banana
– Car, Aero plane
– Horse, apple
– Poem, Novel
– Desk, Bookcase
Abstraction
Interpretation of similarities testing ?
• Scoring depends on whether the subject mentions a similarity,
even a concrete one, and not a difference
• An answer based on a difference shows the subject’s inability to
create a link between these two elements
• Scoring is then based on the abstractness of the answer
“How are a poem and a statue alike?”

Abstraction
• The more capable a subject is of abstraction, the higher he or
she will score on the Similarities Test
• Following this scoring principle, an answer such as “they are
both artworks” receives the most points (2 points); an answer
like “a representation of something” is worth 1 point, and an
answer like “the poem describes the statue” results in 0 points
Abstraction
• A review of the literature on categorization (Blaye, Bernard-Peyron, & Bonthoux,
2000; Bonthoux et al., 2004; Lautrey, 1998; Nelson, 1985) suggests that the
answer “they are both artworks” is the result of superordinate taxonomic
categorization, which consists of grouping objects or words according to their
common features at a high level of generality
• Taxonomic processing requires one to separate the category from the context in
which the elements were found
• A subject who answers “representation of something” is able to find a common
feature, but only a perceptual or visual one
• The answer, “the poem describes the statue”, results from a thematic
categorization process where, “elements are associated on the basis of spatial
or temporal contiguity […]. Most often, the thematic relation places two entities
in a causal relationship, in temporal or spatial succession, in a relation of a part
to the whole” (Blaye et al., 2000, p. 59, our translation).
• Thematic categorization refers to the notion of a schema in which the
organization of knowledge relates to familiar events or scenes from daily life
Abstraction
• According to Lautrey (1998), thematic categorization reflects
“knowledge organization in episodic memory, which is more
context-related than knowledge organization in semantic
memory” (p. 93, our translation)
• Taxonomic categorization allows more inferences about new
objects than does thematic categorization because the object
inherits the properties of the category
Abstraction
• 0 = when response reflect properties of only one member of
the pair, differences or generalizations that are not pertinent to
the item pair or failure to respond
• 2 , 1 and 0 points as follows
Abstraction
• Turnip – cauliflower
–2 points – vegetables
–1 point – food ; grow in ground; edible
–0 point – buy in the store, one is root , the other grows above
the ground
• Car – airplane
–2 points – modes of transportation
–1 point – drive them both , both have motors
–0 points – one`s in the air and one`s on the road
Abstraction
How many examples to be done ?
• At least use 2 examples
• If patient fails in one of these, then use additional one
example
Abstraction
Proverb testing
• In the Proverbs Test the subject is asked to tell the meaning of a
proverb
• For normal subjects, this request readily stimulates what Goldstein
refers to as the "abstract attitude"
• Indeed, the process of translating the concrete symbols of a proverb
into generalized concepts is almost explicitly described in one of
Goldstein's characterizations of abstraction
• In the abstract attitude, we transgress the immediately given specific
aspect or sense impression; we abstract from particular properties
• We detach ourselves from the given impression, and the individual
thing represents to us an accidental sample or representative of a
category
Abstraction
Proverb testing
• How to go about ?
• Ask the patient whether they know any proverbs ?
• If yes, ask them to say the same (make sure that you or the informant
is familiar with the same)
• Ask the meaning of the same from the patient and use the same in a
sentence
• If you do not understand the same, check from the informant
Abstraction
Proverb testing
Test items
• Don’t cry over spilled milk
• Rome wasn`t built in a day
• A drowning man will clutch at a straw
• A golden hammer can break down an iron door
• The hot coal burns ; the cold one blackens
Scoring
Examples of abstract (2 points); semi abstract (1 point);
And concrete (0 points)
Abstraction
Proverb testing
• बंदर क्या जाने अदरक का स्वाद
• दूर के ढोल सुहावने
• घर की मुर्गी दाल बराबर
• घर का भेदी लंका ढाए
• पानी में रहकर मगर से बैर
• जो गरजते हैं वो बरसते नहीं
• जितनी चादर उतने ही पैर पसारो
• सौ सुनार की, एक लोहार की
• जान है तो जहान है
• जंगल में मोर नाचा किस ने देखा?
• जिस की लाठी उस की भैंस
Abstraction
Proverb testing
• नौ सौ चूहे खाके बिल्ली हज को चली
• अन्धों में काना राजा
• नाच न जाने आंगन टेढ़ा
• लातों के भूत बातों से नहीं मानते!
• आ बैल मुझे मार
• इस हाथ दे उस हाथ ले
• ऊं ट कि मूह् मे जीरा
• उल्टा चोर कोतवाल को डांटे
• आमदनी अठन्नी और खर्चा रुपैया
• काला अक्षर भैंस बराबर
Abstraction
Proverb testing
• नौ सौ चूहे खाके बिल्ली हज को चली
• अन्धों में काना राजा
• नाच न जाने आंगन टेढ़ा
• लातों के भूत बातों से नहीं मानते!
• आ बैल मुझे मार
• इस हाथ दे उस हाथ ले
• ऊं ट कि मूह् मे जीरा
• उल्टा चोर कोतवाल को डांटे
• आमदनी अठन्नी और खर्चा रुपैया
• काला अक्षर भैंस बराबर
• अंधेरे में तीर चलाना
Abstraction
How many examples to be done ?
• At least use 2 examples
• If patient fails in one of these, then use additional
one example
Abstraction
Proverb testing
• Don’t cry over spilled milk
0 – concrete – the milk is all over the floor
- when the milk is on the floor you can`t use it
1- semi abstract - it`s gone, don`t worry about it
-don`t cry when something goes wrong
2 – abstract – once something is over don`t worry about it
-don’t be concerned about events that are beyond
control
Abstraction
Proverb testing
Interpretation
• Concrete responses are pathologic in all but the retarded or
illiterate patient
• Average person should provide abstract interpretations to at
least the first three proverbs and minimally semiabstract
responses to the remaining proverbs
• A concrete response or an absence of any abstract responses
should suggest an impairment of abstract ability
• Performance on Proverb interpretation is stable across all ages
Comprehension
What is comprehension ?
• Comprehension is the ability to understand and get meaning
from spoken and written language
• Comprehension is comprised of a complex process involving
knowledge, experience, thinking, and teaching
• Comprehension skills are based on rich language and
experience with text from early in life. These experiences
include learning how to decode; becoming fluent in decoding
with an extensive repertoire of sight words; increasing
vocabulary to include words commonly found in texts; and
learning how to get meaning from text using comprehension
processes
Comprehension
Comprehension is the understanding and interpretation of what
is read
To be able to accurately understand written material, there is a
need to be able to
(1) decode what they read
(2) make connections between what they read and what they
already know; and
(3) think deeply about what they have read
Comprehension
How to assess ?
Telling Stories
• Ask the patient about a particular story
• Ask the patient to tell the story
• Ask the patient what is the moral of the story or what do we
learn from the story
Alternative
• Tell the story to the patient, which he may or may not be
familiar
• Ask the patient what is the moral of the story or what do we
learn from the story
Comprehension
How to assess ?
• Rabbit and Tortoise
• Thirsty Crow Story
Comprehension
Comprehension
Comprehension
Comprehension
Comprehension
Comprehension
Comprehension
Comprehension
Comprehension
Comprehension
Naming
• Ask the patient to name the 3 common objects in the
vicinity
• Show the objects and ask the patient to name them
Judgment
What is Judgment ?
• It is a complex mental process whereby a person
forms an opinion, makes a decision, or plans an
action or response after first analyzing the issue and
comparing the choices
• Types of Judgment?
– Test Judgment
– Social Judgment
Judgment
What is Judgment ?
Social Judgment:
• it includes basic knowledge of social situations, knowledge of
the socially appropriate responses in such situations and the
ability to apply the correct responses personally when faced
with an actual social situation
• Impression based on observations of others who have
witnessed the patient’s actual performance in dealing with
day to day events
Judgment
Test Judgment (situational judgment test)
• Place the patient in an actual, but experimental, situations
that require an immediate, appropriate response
• Tell the patient that she/he will be presented with a situation
and she/he has to give a response that she/he think is the most
effective in dealing with the situation
• Realistic/ hypothetical situations – may use a test, depending
on the patients profession/day to day functioning
• Tailor-made to suit the individual role requirements
– Fire story
– Letter story
Judgment
Test Judgment
Fire story:
• Suppose you are walking on the street, you see smoke and fire
coming out of the building, what would you do ?
• Suppose, you are sitting in a room, there is a fire, what would
you do ?
• Suppose, you are sitting in a room, there is a fire (big fire) in
the room, what would you do ?
Judgment
Test Judgment
Letter story:
• Suppose you are walking on the street, you see a letter lying
on the ground, what would you do ?
on the ground, you pick it up, see the letter has address of
someone in a different city, what would you do ?
someone in a different city, it has a postage stamp on it, what
would you do ?
Judgment
Test Judgment
Letter story:
someone in a different city, it has a postage stamp on it,
which is not being cancelled/utilized, what would you do ?
someone in a different city, it has a postage stamp on it,
which is not being cancelled/utilized, name of the sender is
given, who stays in your neighborhood, what would you do ?
Judgment
Test Judgment
• At the end of a busy day at work, you accidentally send an e-
mail containing an attachment with some confidential client
information to the wrong person
• What is the best solution to this
• Which of the following would be the best thing to do?
Judgment
Test Judgment
• A - Decide to leave the office and deal with any problems
tomorrow
• B - Decide to overlook your error, send the e-mail to the correct
person and leave things like that
• C - Immediately send a follow up email to the "wrong" person,
or if possible telephone them explaining your mistake. Then
send the email to the correct person
• D - Find your manager, explain what has happened to them and
let them deal with any problems
Judgment
Test Judgment
Answers to Question
• A - This is the least effective decision. In this scenario, you would have sent
the wrong person the important email, but not have sent the correct
individual the email
• B - This is not an effective decision. Although you do send the email to the
correct person, you do not rectify the error you have made, which you must
do
• C - This is the most effective decision. In this scenario you explain your
mistake to your colleague and send the email to the correct person
• D - This is not an effective decision. If the contents of your email are very
confidential then it would be a good idea to explain your mistake to your
manager. However, it is not necessary to pass this type of issue to your boss
to deal with, when you could quite easily deal with this yourself
Judgment
Test Judgment
• At the end of a busy day at work, at mid night, once you
finished preparing the handout, you accidentally send an e-
mail containing an attachment with name of the consultant
being wrongly spelled/ not mentioned to the group, what
would you do ?
• What is the best solution to this
• Which of the following would be the best thing to do?
Judgment
Judgment
Judgment

Cognitive Function Tests

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Cognitive Function Tests

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Cognitive Function Tests

Tests for cognition

Time Place Person

• Normal patients <60 years recall 2 or 3 words over 10 minutes

“How are a poem and a statue alike?”

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