Clock Drawing Test

Definition: A technique used in clinical neuropsychological examinations whereby the test taker draws the face of a clock, usually indicating a particular time that is then evaluated for distortions that may be symptomatic of dementia or other neurological or psychiatric conditions[footnoteRef:2]. [2: http://highered.mcgraw-hill.com/sites/0073129097/student_view0/glossary.html]

What for: The clock has been proposed as a quick screening test for cognitive dysfunction secondary to dementia, delirium, or a range of neurological and psychiatric illnesses[footnoteRef:3]. The CDT is used to quickly assess visuospatial and praxis abilities, and may determine the presence of both attention and executive dysfunctions.[footnoteRef:4] [3: http://www.neurosurvival.ca/ClinicalAssistant/scales/clock_drawing_test.htm#whydo] [4: http://strokengine.ca/assess/module_cdt_intro-en.html]

How to: The CDT was administered by asking patients to first draw the face of the clock and then to place the hands to indicate 10 minutes past 10 oclockScore: The clock was scored from 04. The scoring system awards one point for drawing a closed circle, one point for placing numbers in the correct position, one point for including all 12 correct numbers, and one point for placing hands in the correct positions. [footnoteRef:5] [5: The Clock Drawing Test: Diagnostic, Functional, and Neuroimaging Correlates in Older Medically Ill AdultsJulia B. Samton, M.D.; Stephen J. Ferrando, M.D.; Pina Sanelli, M.D.; Sassan Karimi, M.D.; Valentine Raiteri, M.D.; John W. Barnhill, M.D.]

[footnoteRef:6] [6: http://www.jabfm.org/content/16/5/423/F3.large.jpg]

MMSE

Definition: The Mini-Mental State Examination (MMSE) is psychometric screening assessment of cognitive functioning.What for: screen patients for cognitive impairment, track changes in cognitive functioning over time, and oftentimes to assess the effects of therapeutic agents on cognitive function.[footnoteRef:7] [7: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587038/]

How to: [footnoteRef:8] [8: www.framinghamheartstudy.org/share/.../mm1_8s_protocol.pdf]

CategoryPossible pointsDescription

Orientation to time5From broadest to most narrow. Orientation to time has been correlated with future decline.

Orientation to place5From broadest to most narrow. This is sometimes narrowed down to streetsand sometimes to floor.

Registration3Repeating named prompts

Attention and calculation5Serial sevens, or spelling "world" backwards.It has been suggested that serial sevens may be more appropriate in a population where English is not the first language.

Recall3Registration recall

Language2Naming a pencil and a watch

Repetition1Speaking back a phrase

Complex commands6Varies. Can involve drawing figure shown.

Score: Subjects whose education levels are 7tb grade or lower, a score on the MMSE of 22 or below Subjects whose education attainment level is 8th grade or some high school (but not a graduate of), a score on the MMSE of 24 or below Subjects whose education attainment level is high school graduate, a score on the MMSE of 25 or below Subjects whose education attainment level is some college or higher, a score on the MMSE of 26 or below. ADLDefinition: An activity of daily living (ADL) evaluation is an assessment of an individual's physical and sometimes mental skills.[footnoteRef:9] [9: Activities of Daily Living Evaluation."Encyclopedia of Nursing & Allied Health. ed. Kristine Krapp. Gale Group, Inc., 2002. eNotes.com. 2006.]

Activities of Daily Living (ADLs) are a defined set of activities necessary for normal self-care. The activities are movement in bed, transfers, locomotion, dressing, personal hygiene, and feeding.[footnoteRef:10] [10: www.vrb.gov.au/pubs/garp-chapter16.pdf]

Movement in bed. means sitting in, rising from, and moving around in, bed; Transfers. means moving from one seat to another, changing position from sitting to standing, and transferring to and from the toilet and bed; Locomotion. means walking on the level, on gentle slopes and down stairs; Dressing. means putting on socks, stockings, and shoes, as well as clothing the upper and lower trunk; Personal hygiene. means grooming, and washing of face, trunk, extremities and perineum; Feeding. means eating and drinking, but not the preparation of food.What for: ADL evaluations help practitioners determine how independent patients are and what skills they can accomplish on their own, as well as to gauge how independent each individual can become after intervention by a health professional. The goal of practitioners performing ADL evaluations is to help patients become as independent as possible, using appropriate adaptations if needed.How to:

Assess each activity and sum it up.Score: Other impairment rating:

IADLDefinition: Instrumental activities of daily living refer to skills beyond basic self care.What for: evaluate how individuals function within their homes, workplaces, and social environments. Instrumental ADLs may include typical domestic tasks, such as driving, cleaning, cooking, and shopping, as well as other less physically demanding tasks such as operating electronic appliances and handling budgets. In the work environment, an ADL evaluation assesses the qualities necessary to perform a job, such as strength, endurance, manual dexterity, andpain management.

Score: The patient receives a score of 1 for each item labeled A H if his or her competence is rated at some minimal level or higher. Add the total points circled for A H. The total score may range from 0 8. A lower score indicates a higher level of dependence.Sarah Qurrotun Aini 130110110021 F4 case 5

How to:[footnoteRef:11] [11: www.healthcare.uiowa.edu/igec/tools/function/lawtonbrody.pdf]

Aphasia[footnoteRef:12] [12: http://www.asha.org/public/speech/disorders/aphasia.htm]

Some people with aphasia have trouble using words and sentences (expressive aphasia). Some have problems understanding others (receptive aphasia). Others with aphasia struggle with both using words and understanding (global aphasia).

Aphasia may be mild or severe. The severity of communication difficulties depends on the amount and location of the damage to the brain.

A Person With Mild Aphasia may be able to carry on normal conversations in many settings may have trouble understanding language when it is long and/or complex may have trouble finding the words (calledanomia) to express an idea or explain himself/herself-this is like having a word "on the tip of your tongue"

A Person With Severe Aphasia may not understand anything that is said to him/her may say little or nothing at all may make approximations of common phrases, such as "yes," "no," "hi," and "thanks"

Characteristics of Expressive Aphasia Speaks only in single words (e.g., names of objects) Speaks in short, fragmented phrases Omits smaller words like "the," "of," and "and" (so message sounds like a telegram) Puts words in wrong order Switches sounds and/or words (e.g., bed is called table or dishwasher a "wish dasher") Makes up words (e.g., jargon) Strings together nonsense words and real words fluently but makes no sense

Characteristics of Receptive Aphasia Requires extra time to understand spoken messages (e.g., like translating a foreign language) Finds if very hard to follow fast speech (e.g., radio or television news) Misinterprets subtleties of language-takes the literal meaning of figurative speech (e.g., "it's raining cats and dogs") Is frustrating for the person with aphasia and for the listenercan lead to communication breakdown Very often, a person with aphasia has both expressive and receptive difficulties to varying degrees.