Cognition Testing
Old age and forgetfulness are common occurrences. With age, all body parts, including the brain, take their natural cause of deterioration. This is a situation that also sees many older people often take longer periods to learn new things. A new patient with some pre-existing conditions including osteoarthritis, hyperlipidemia, high blood pressure, diabetes mellitus, and suffered from two mini-strokes with multiple falls is coming in for testing. We shall analyze two possible tests for cognition for the patient and the possible causes of memory loss for the patient.
Two tests can be used to assess the patient’s memory – Delirium Triage Screen and Brief Confusion Assessment test (Perry et al., 2018). Delirium Triage Screen (DTS) is an initial test that is designed to rule out the delirium or to nullify the need for a formal assessment. The area that is assessed is the level of alteration of the consciousness and inattention of the patient. The test is used primarily in the emergency department of a clinical setting. The use of DTS can be used through integration in the normal nursing assessment since it is rapid (Han et al., 2013). This is because the tests are scored as either yes or no. The estimated time for completion is also less than one minute. Where the result is negative, there is no need for further tests, whereas where there is a positive result, there is a need for the application of the Brief Confusion Assessment test.
The second test is the Brief Confusion Assessment Test (b-CAM). This follows the DTS after a positive result has been attained. There are four key features of this second part of the test. The first is the acute setting in of mental status changes or fluctuating course; the second is inattention, which leads to either of two outcomes. The third feature, which is an outcome have a conscious level that is altered, and the alternative and forth feature is disorganized thinking, which has seven items. The test should take about two minutes to perform, which makes it appropriate for the primary care setting and is highly sensitive, with about 78 to 97% sensitivity when performed by a non-physician and physician, respectively. The b-CAM test is adapted for easy use in the primary care setting by being modified to be usable by non-psychiatric professionals, especially outside the intensive care unit. The test has to be conducted in in-person just as the DTS.
Various causes of memory loss exist for older patients. For the patient, a primary cause of memory loss is the transient ischemic attack (TIA). This is due to the lack of enough supply of blood for a momentary period that does not lead to permanent brain damage but may lead to disturbance in memory retention. This is a direct cause of memory loss.
There is the possibility of indirect causes of memory loss in the patient. The patient has a history of high blood pressure and diabetes mellitus. There is an increased risk of patients who have these two conditions occurring simultaneously having episodes of memory loss. High levels of blood glucose in the blood are linked with an increase in the damage to peripheral nerves in the brain and body. The silent damage caused by diabetes to the capillaries in the brain can also lead to brain atrophy leading to increased but slow memory loss (ADRC, 2020).
Hyperlipidemia is a condition characterized by high cholesterol levels in the blood. Cholesterol is a vital part in the normal functioning of the brain. This makes it a vital part in the metabolism and other brain processes. The alteration of the cholesterol levels in the brain can lead to peripheral pathology. Statins found in cholesterol are important for the brain functioning and are responsible for improving memory. A reduction in this can lead to a steady loss of the brain capacity to learn, store, and retrieve necessary information (Schreurs, 2010).
In conclusion, two main tests that can be used for the cognitive determination of memory include Delirium Triage Screen and Brief Confusion Assessment tests. The two are linked are complementary of each other. A negative result in the DTS test negates the use of the b-CAM test. A positive result triggers the use of b-CAM. Both tests are adequate for use in the presented case setting as they give rapid results and can be performed by non-psychiatric professionals. For the patient, there are three potential causes of memory loss. They include the occurrence of mini-stroke, the existence of high blood pressure and diabetes mellitus concurrently, and the hyperlipidemia condition.
References
ADRC (Alzheimer Disease Research Center). (2020). Diabetes, Pre-Diabetes, and Memory Loss. Retrieved from http://adrc.usc.edu/diabetes-pre-diabetes-and-memory-loss/
Han, J. H., Wilson, A., Vasilevskis, E. E., Shintani, A., Schnelle, J. F., Dittus, R. S., Graves, A. J., Storrow, A. B., Shuster, J., Ely, E. W. (2013). Diagnosing Delirium in Older Emergency Department Patients: Validity and Reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method. Annals of Emergency Medicine. 62(5): 457-465
Perry, W., Lacritz, L., Roebuck-Spencer, T., Silver, C., Denney, R. L., Meyers, J., McConnel, C. E., Pliskin, N., Adler, D., Alban, C., Bondi, M., Braun, M., Cagigas, X., Daven, M., Drozdick, L., Foster, N. L., Hwang, U., Ivey, L., Iverson, G., Kramer, J., … Golden, T. (2018). Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients. Innovation in Aging, 2(2), igy025. https://doi.org/10.1093/geroni/igy025
Schreurs, B. G. (2010). The Effects of Cholesterol on Learning and Memory. Neuroscience & Behavioral Reviews, 34(8): 1366-1379