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Screening for Stroke and Cognitive Impairment Chapter 5: When is Cognitive Screening Limited?

Screening for Stroke and Cognitive Impairment Chapter 5: When is Cognitive Screening Limited?. BRIEF COGNITIVE SCREENING: WHAT IT CAN DO. • Identify those individuals who might have cognitive impairment; Indicate the need for more comprehensive cognitive evaluation;

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Screening for Stroke and Cognitive Impairment Chapter 5: When is Cognitive Screening Limited?

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  1. Screening for Stroke and Cognitive ImpairmentChapter 5: When is Cognitive Screening Limited?

  2. BRIEF COGNITIVE SCREENING:WHAT IT CAN DO • • Identify those individuals who might have cognitive impairment; • Indicate the need for more comprehensive cognitive evaluation; • Support concerns regarding the client’s safety or ability to function independently in their daily roles; • • Assist in understanding the client’s strengths and limitations9.

  3. BRIEF COGNITIVE SCREENING:WHAT IT CAN DO • Screening can indicate possible deficits in an area of cognition (the process of knowing) e.g. • Memory; • Language; • Executive functions (cognitive processes that orchestrate complex & goal-directed activities) i.e. Sequencing, Organizing, Abstracting & Planning9.

  4. COGNITIVE SCREENING:WHAT IT CAN’T DO • • Diagnose a disease; • • Be 100% predictive (false positive’s & negatives can occur); • • Test all domains of cognition; • • Evaluate judgment & reasoning; • • Test decisional capacity9.

  5. COGNITIVE SCREENING:WHAT IT CAN’T DO • Provide standardized accommodations for administration or interpretation when visual, language, or motor barriers are present; • Pro-Rate or adjust scoring based on above barriers; • • Assess for capacity i.e., the ability to understand the information relevant to a decision and the ability to appreciate the foreseeable consequences of a decision or lack of decision9.

  6. Exercising Caution • Caution must be taken in interpreting individual cognitive domains. • WHY? • Completion of test items can be affected by: • Multiple cognitive processes, so a simple label is not always reflective. • Motor deficits: e.g., patient is unable to hold a pencil due to hemiparesis. • Language issues due to aphasia. • Visual Perceptual Barriers. • Screens are not meant to identify specific domains or diagnostic patterns.

  7. Additional Screening Tools • Clinicians are encouraged to communicate with the interprofessional team about other resources and next steps in terms of additional assessments that could be provided. • The Canadian Best Practice Recommendations for Stroke Care make reference to additional assessmentsin Table 7.2B: Summary of Select Screening Tools for Assessment of Vascular Cognitive Impairment in Stroke Patients: http://strokebestpractices.ca/wp-content/uploads/2013/03/Table7.2B-EN.pdf • Other resources the clinician may refer to are: • Stroke Engine www.strokengine.ca/assess/assessmenttool-domains-en.html • Evidenced Based Review of Stroke Rehabilitation: www.ebrsr.com - http://www.ebrsr.com/uploads/Module-12_cognition.pdf

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