17 Nov 2024
PSYCHOLOGICAL
TESTS- COGNITION
1
Introduction
• Cognition - Mental process of knowing and becoming aware; an ego function closely
associated with judgment.
• Psychological tests are conducted for various reasons, including:
1.Assessment of Mental Health: They help in diagnosing mental disorders by
providing objective data (American Psychiatric Association, 2013).
2.Treatment Planning: Results can guide therapists in creating personalized
treatment plans (Weiner, 2013).
3.Tracking Progress: Tests can measure changes over time, assessing the
effectiveness of interventions (Hunsley & Mash, 2007).
17 Nov 2024 2
4.Research: They contribute to understanding psychological phenomena
and the effectiveness of different therapies (Kazdin, 2003).
5.Personnel Selection: In organizational settings, tests evaluate candidate
suitability and personality traits relevant to job performance (Schmidt &
Hunter, 1998).
6.Educational Placement: They assist in identifying learning disabilities
and tailoring educational strategies (Ysseldyke & Bolt, 2007).
17 Nov 2024 3
Degenerative disorders
Alzheimer’s,vascular dementia, lewy
body disease, fronto temporal, HIV-AIDS
Different causes of Other Neurological disorders
CJD, MND,PD,MS, Tumours
cognitive impairment
Medical and psychiatric causes
Thiamine deficiency,thyroid,alcohol abuse,
medications, delirium.
Schizophrenia, Depression, Other psychotic
disorders.
17 Nov 2024 4
Types of dementia
Heavy
HIV,MS,CJD metals,
toxins
Vascular
dementia
Hungtington’
Lewy body s
dementia
disease
Alzheimer’s
dementia
Fronto- Volatile
temporal
dementia inhalants
Sedatives,
Hypnotics,
TBI anxiolytics NP
hydrocephalus
17 Nov 2024 REF-ICD-11 5
Dementia – ALZHEIMER’S
DISEASE
17 Nov 2024 6
MMSE
17 Nov 2024 7
MOCA
17 Nov 2024 8
17 Nov 2024 9
MINI -COG
• It is a brief cognitive screening tool that can be used to assess for cognitive impairment. It consists of three
components:
1.Three-word recall: The patient is asked to remember three unrelated words (e.g., apple, table, pen).
2.Clock drawing task: The patient is asked to draw a clock with the time set at 11:10.
3.Recall of the three words: The patient is asked to recall the three words they were asked to remember
earlier.
• Scoring:
• Score of 0: If the patient recalls all three words correctly and draws the clock accurately.
• Score of 1: If the patient recalls one or two words correctly and draws the clock accurately.
• Score of 2: If the patient recalls no words or draws the clock incorrectly.
• A score of 3 or 4 on the Mini-Cog is suggestive of cognitive impairment, and further evaluation may be
17 Nov 2024 10
warranted.
MINI-Cog
17 Nov 2024 11
Vascular dementia
17 Nov 2024 12
Hachinski Ischemic Score
• A tool used to differentiate between vascular dementia and Alzheimer's disease. It assesses the
likelihood of vascular factors contributing to cognitive decline.
1.Vascular Risk Factors: The score considers a patient's history of vascular risk factors, such as
hypertension, diabetes, smoking, and previous strokes or transient ischemic attacks (TIAs).
2.Abrupt Onset: It evaluates whether the cognitive decline began abruptly or gradually.
3.Fluctuating Course: The score assesses if the patient's cognitive function has fluctuated over time.
4.Somatic Symptoms: It considers the presence of somatic symptoms, such as focal neurological
deficits, gait disturbances, or urinary incontinence.
5.Emotional Blunting: The score evaluates whether the patient has experienced emotional blunting or
apathy.
17 Nov 2024 13
Hachinski ischemic scale
17 Nov 2024 14
Lewy body dementia
17 Nov 2024 15
Dementia of frontal type
17 Nov 2024 16
HIV- Dementia complex
• . The HIV-Dementia Scale (HDS), a screening tool originally created for detecting
cognitive impairment due to subcortical damage in HIV + patients, has proved to be
useful in other neurological diseases.
17 Nov 2024 17
Interpretation:
•This is the sum of the
scores on items 1-3. The
maximum possible
score is 12 points. A
patient with a score of
≤10 should be
evaluated further for
possible dementia.
17 Nov 2024 18
Wisconsin card sorting test
■ The material consists of 64 cards, each containing from one to four geometrical fi gures.
■ These consist of any one of four shapes (triangles, stars, crosses and circles) in any one of
four colours.
■ Four stimulus cards are set out before the subject who must sort the remainder beneath
them.
■ His task is to discover by trial and error whether he is required to sort according to colour,
form or number, the clue being the examiner’s remark of ‘right’ or ‘wrong’ after each
response is made.
■ In administering the test the subject is required to sort first of all by colour, all other
responses being called wrong; then when he has achieved 10 consecutive correct responses
to colour, the required sorting principle shifts without warning to form.
■ Later it shifts to number, then back again to colour, and so on. The test thus combines the
requirement for shifting frames of reference with a need for empirical discovery of
categories. A total score can be obtained, also scores for perseverative and non-
perseverative types of errors
17 Nov 2024 19
17 Nov 2024 20
Bender gestalt test
• The Bender Visual-Motor Gestalt Test is a psychological assessment used to evaluate visual-motor
functioning and identify potential developmental or neurological issues. It involves replicating
geometric designs, which helps assess cognitive and perceptual skills. (1)
How to Apply:
1.Materials: You'll need a copy of the BGT stimulus cards and a blank sheet of paper for the
examinee.
2.Instructions: Provide clear instructions to the examinee, such as: "I want you to copy these
figures onto your paper exactly as you see them. Take your time and do your best."
3.Presentation: Present the stimulus cards one at a time, allowing the examinee to copy each
figure before moving on to the next.
4.Observation:
17 Nov 2024 Observe the examinee's approach to the task, including their speed, accuracy, and 21
any unusual behaviors.
• Scoring:
• The BGT is scored based on the accuracy and quality of the copied figures. There are various
scoring systems, but common criteria include:
• Rotations: Whether the figures are rotated or distorted.
• Perseverations: If the examinee continues to repeat a previous figure.
• Distortions: Whether the figures are misshapen or incomplete.
• Oversimplifications: If the figures are overly simplified or reduced to basic shapes.
• The scoring system you use will determine the specific criteria and the assigned points for
each error.
17 Nov 2024 22
• Uses:
• The BGT is often used to:
• Assess brain damage or dysfunction in various neurological conditions, such as
stroke, dementia, or traumatic brain injury.
• Evaluate perceptual and motor skills in children and adults.
• Identify learning disabilities or visual-motor deficits.
• Aid in the diagnosis of mental health disorders, such as schizophrenia or autism.
17 Nov 2024 23
Delirium
• The fifth edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) defines delirium in the following
manner: Foremost a disturbance of awareness and attention.
17 Nov 2024 24
17 Nov 2024 25
• Diagnostic Approach Clinicians should be aware that delirium may signal serious
underlying conditions like myocardial infarction, infections, or respiratory failure. A
comprehensive medication review is vital, as even long-term medications can
contribute to delirium. Formal cognitive assessments, such as the Confusion
Assessment Method (CAM), should be conducted. CAM effectively identifies delirium
with high sensitivity and specificity.
• Laboratory and Imaging Studies Extensive laboratory testing is usually
unnecessary unless the cause of delirium is unclear. Basic tests should assess
electrolytes, glucose, and complete blood counts. A chest X-ray may be warranted
17 Nov 2024
to rule out pneumonia, while ECGs can detect cardiac issues. For patients with fever 26
and delirium, CSF examination is typically not needed unless CNS infections are
• Electroencephalography (EEG) and Neuroimaging EEG can help
differentiate delirium from psychiatric disorders, though it has notable
false-negative and false-positive rates. Neuroimaging should be reserved
for patients with focal neurologic signs, history of trauma, or unexplained
acute mental status changes. Routine neuroimaging is low-yield unless
atypical symptoms are present.
17 Nov 2024 27
CAMS- ICU
• The CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) is a validated
tool used to assess for delirium in critically ill patients. It consists of four criteria:
1.Features of Inattention: The patient is unable to focus attention or is easily distracted.
2.Disorganized Thinking: The patient's speech is incoherent or rambling.
3.Altered Level of Consciousness: The patient is lethargic or agitated.
4.Fluctuating Mental Status: The patient's mental status fluctuates throughout the day.
Scoring:
• Score of 0: If none of the four criteria are present.
• Score of 1: If one of the four criteria is present.
• Score of 2: If two or more of the four criteria are present.
• A score of 2 on the CAM-ICU is indicative of delirium.
17 Nov 2024 28
CAMS -ICU
17 Nov 2024 29
Memorial Delirium Rating Scale (MDRS)
ITEM 1- ITEM 2- ITEM 3-short ITEM 4- ITEM ITEM 6-
reduced disorientati term impaired 5Reduced Disorganis
awareness on memory imp digit span ability to ed
maintain and
shift
thinking
attention
How Rate the patient’s current
awareness of and
Rate current state by
asking the following 10
Rate current state by
using repetition and
Rate current
performance by
As indicated during
the interview by
As indicated during
the interview by
to interaction with the
environment (interviewer,
orientation items: date,
month,
delayed recall of 3
words (patient must
asking subjects to
repeat 3, 4, then 5
questions
needing to be
rambling, irrelevant,
or incoherent
test other people/objects in day, year, season, floor, immediately repeat and digits rephrased and/or speech, or by
the room; for example, name of hospital, city, recall words 5 min later forward and then 3, repeated because tangential,
ask state, and country. after an interviewing task. then 4 backwards; patient’s attention circumstantial, or
patients to describe their Use continue to the next wanders, patient faulty reasoning.
surroundings). alternate sets of 3 words step only if patient loses track,
Ask patient a
for successive evaluations succeeds at the patient is distracted
somewhat complex
[e.g., apple, table, previous one. by outside stimuli or
tomorrow, sky, cigar, over-absorbed in a
question (e.g.,
justice task “Describe your
current medical
condition.”
0 None None None None None None
1 Mild Mild Mild Mild Mild Mild
2
17 Nov 2024 Mod Mod Mod Mod Mod Mod 30
17 Nov 2024 31
PIOTROWSKI’S SIGNS
17 Nov 2024 32
• Key Points
• Fluctuating symptoms and caretaker history are critical for diagnosis.
• Daily evaluations are essential for identifying hypoactive delirium.
• Use CAM for formal cognitive assessment.
• Limit lab tests to electrolytes, glucose, and CBC; consider imaging based on
clinical findings.
• Reserve EEG and neuroimaging for specific cases; routine use is often unnecessary.
17 Nov 2024 33
What to expect?
• Hachinski ischemic score
• AIDS-dementia complex
• Assessment of delirium
17 Nov 2024 34
References
• Bender, L. (1938). A Visual-Motor Gestalt Test for Children. American Journal of
Orthopsychiatry, 8(3), 512-517.
• Kopp, U. (2009). The Bender Gestalt Test: A Comprehensive Review. Psychological
Assessment, 21(1), 1-26.
• Kaplan, E., & Sadock, B. J. (2017). Kaplan & Sadock's Comprehensive Textbook of Psychiatry
(10th ed.). Wolters Kluwer. ]
• https://www.hiv.uw.edu/page/mental-health-screening/ihds
• Hachinski, V. C., Lassen, N. A., & Rowan, J. O. (1975). Cerebral blood flow and dementia.
Neurology, 25(7), 672-677.
• Borson, S., Scanlan, J. M., & Chadeayne, L. (2000). The Mini-Cog: A brief screening
instrument for cognitive impairment. Journal of the American Geriatrics Society, 48(9),
1221-1224.
17 Nov 2024 35
17 Nov 2024
THANK YOU
36
