Descriptive Psychopathology: The Signs and Symptoms of ...

316 Section 3: Examination domainsTable 13.3. Guidelines for cognitive assessmentThe goal of assessment is the patient’s best performanceChoice of tasks should be based on the purpose of the assessment; one group of tests does not“fit all” patientsEach task should be administered consistently and with precise instructionsArousal and concentration should always be assessed first to determine if further assessment ispossible and will be validPeripheral neurologic and muscular–skeletal function (e.g. paresis, arthritis) determines whattasks can be donePatients with aphasia or language skills other than the language of the assessment requirespecial proceduresAsian woman for psychotic depression and Parkinson’s disease who was leftin bed for several years following a neurologist’s incorrect diagnosis of Parkinson’sdementia that was erroneously confirmed by neuropsychological testing administeredin English, her second language.The patient’s general neurologic function is also determined prior to cognitiveassessment as most bedside cognitive tests require the patient to have adequateperipheral neurologic and somatosensory functioning (e.g. visual and auditoryacuity, somatosensory acuity). For patients with compromised peripheral function,assessment is limited and requires greater reliance on behavioral cues.An assessment of arousal and concentration are also always done beforeother cognitive tests, as most cognitive functions are dependent on arousal andconcentration.Test selection is based on the purpose of the assessment. To be performed well,almost all tests require adequate function in several cognitive areas, so tests typically“overlap” in what they are assessing and provide information beyond the specificintent of the test. For example, animal naming (see below) is a timed test thatassesses fluency of ideas. It also requires a “plan” for proceeding in an efficientmanner from one group of animals to the next. However, this required executivefunctioning is not the specific target of the test but is evaluated while the patientperforms the task. A manic patient with compromised executive function might beable to haphazardly and rapidly rattle off a sufficient number of animal names to“pass” the test, but the executive function problems will be obvious.Selecting and using cognitive tests also requires working knowledge of neuropsychologicalfunctions and the relationships among functions and behavior.A discussion of these relationships is beyond this text, and so the cognitive testingpresented here is within the framework of common clinical challenges. 15