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Assessing Cognitive Function in Nursing Homes

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The value of cognitive assessment

Cognitive assessment is a paramount need in nursing homes. Establishing an accurate picture of a resident’s cognitive functioning, along with a comprehensive neurobehavioral assessment, can develop a treatment plan and improve quality of life. Ongoing, standardized assessments help practitioners identify changes over time as well.

It is important to invest the time and expertise to evaluate newly admitted residents. “Many people who are developing dementia or already have it do not receive a diagnosis,” according to the National Institute on Aging. They add: “The failure to evaluate memory or cognitive complaints is likely to hinder treatment of underlying disease and comorbid conditions, and may present safety issues for the patient and others.”

Tools for cognitive assessment in nursing homes

Some of the common tools for cognitive assessment include:

  • Brief Interview for Mental Status (BIMS), a screening measure to assess cognition
  • Folstein Mini-Mental Status Exam (MMSE), a quick assessment tool for dementia, which assesses cognitive domains of orientation, language, memory, attention, calculation, registration, following simple commands, and visuoconstruction
  • Montreal Cognitive Assessment – Full (MOCA-full), a quick assessment measure for mild cognitive dysfunction, which assesses cognitive domains of executive functioning, visuoconstructional skills, language, attention and concentration, conceptual thinking, calculations, orientation, and memory. Other versions of the MOCA are MOCA-blind (for individuals with vision impairment), MOCA-short (an abbreviated version of the MOCA-Full), and MOCA-mini (an abbreviated version that omits executive function and drawing items).

The MOCA assessment is very focused on executive functioning. Thus, it’s quite sensitive in picking up even mild cognitive issues. Thus, when a MOCA–short score is anything less than perfect, GuideStar practitioners move directly into a MOCA-full assessment.  An advantage of the full MOCA is that it provides more assessment levels, whereas the MOCA - short provides only two.

The need for neurobehavioral evaluation

Beyond cognitive assessment alone, a comprehensive evaluation takes into account psychological and adaptive functioning, according to Psychologists in Long-Term Care. They recommend using “multiple assessment methods when possible, including reviewing records, clinical interviewing, direct behavioral observation, self-report, informant report, assessment instruments as indicated, electronic activity and sleep monitoring, and psychophysiological techniques.”

It’s important to recognize that some degree of cognitive impairment or dementia may be layered with other conditions. For example, a patient may have a co-occurring illness, a neurological condition, traumatic brain injury, or mental health condition such as depression. Behavioral problems such as agitation and aggression among nursing home patients with dementia are key concerns as well.

While Alzheimer’s disease is a common cause of dementia, it’s important to dig deeper, advises the National Institute on Aging. When cognitive impairment is identified, it’s time to rule out other causes of impairment, such as medication side effects, metabolic and/or endocrine imbalance, substance use, sleep disorder, delirium, depression or anxiety, or a different form of dementia. See our blog post for more information on co-occurring diagnoses in Alzheimer’s patients.

A basis in neurobehavioral health models helps to pin down specific diagnoses that can lead to more effective care. According to the American Psychological Association (APA), “Neuropsychological evaluation remains a critical component of differential diagnostic methods in discriminating neurodegenerative changes from normal age-related cognitive decline, cognitive difficulties that are related to psychiatric conditions or medical morbidities, and other related disorders” (APA Alzheimer’s Recommendations).

A multi-disciplinary perspective

Taking a person-centered, holistic approach to neurobehavioral care, a clinical psychologist can work with other members of the healthcare team to evaluate neurobehavioral functioning, including cognitive function. GuideStar Eldercare dedicates itself to providing compassionate and comprehensive advanced clinical care to our residents, the majority of which display neurocognitive, psychiatric, and behavioral symptoms that can fluctuate rapidly.

To effectively measure and track these symptoms and associated outcome data, GuideStar completes a basic complement of assessments for all residents to address:

  1. Cognitive measures
  2. Neuropsychiatric/behavioral measures (may be more than one, as appropriate), and
  3. A functional dementia severity rating measure.

In addition to the patient, family members and nursing staff can provide valuable information about mood, behaviors, and level of functioning.

Cognitive assessment is a cornerstone of evidence-based nursing home care. At GuideStar Eldercare, we formalize the neurobehavioral assessments for all residents under our care. Based on an accurate assessment, the practitioners develop a neuropsychiatric treatment plan. It is individualized according to each patient’s diagnoses to promote the best possible functioning, dignity, and safety of a patient.

Contact GuideStar Eldercare today to hear how we can provide qualified neurobehavioral, science-based expertise for any long-term care facility and its patients.