A 67-year-old woman comes to the office due to difficulty concentrating. She reports repeatedly reading the same page of material due to an inability to focus. She also describes memory problems, stating that it "takes a while to remember another person's name." The patient's medical history is significant for hypertension and type 2 diabetes mellitus. These are well controlled through diet, exercise, and oral medications. She lives alone and describes her mood as "good." Blood pressure is 127/67 mm Hg and pulse is 65/min. The physician decides to administer a brief cognitive test to assess her difficulty in concentrating. Which of the following elements of cognitive testing would best assess for impaired attention and concentration in this patient?

Question

A 67-year-old woman comes to the office due to difficulty concentrating.  She reports repeatedly reading the same page of material due to an inability to focus.  She also describes memory problems, stating that it "takes a while to remember another person's name."  The patient's medical history is significant for hypertension and type 2 diabetes mellitus.  These are well controlled through diet, exercise, and oral medications.  She lives alone and describes her mood as "good."  Blood pressure is 127/67 mm Hg and pulse is 65/min.  The physician decides to administer a brief cognitive test to assess her difficulty in concentrating.  Which of the following elements of cognitive testing would best assess for impaired attention and concentration in this patient?

Quizplus · Accepted Answer

11ec160b_362e_f0ce_9249_e98ab3140663_MD0001_00 There are several quick clinical tests to assess attention and concentration in situations where they may be impaired (eg, dementia, delirium, head injury, depression). These include counting down from 100 by intervals of 3 or 7, reciting the months of the year in reverse order, or spelling "world" backwards. Asking a patient to recite the months of the year backwards is often helpful if the patient has a low educational level or is hesitant to perform a task involving math or spelling. Attention and concentration are tested in the Montreal Cognitive Assessment (MoCA), a widely used screening tool for cognitive impairment. The MoCA also measures time/place orientation, executive function, language, visual-spatial ability, and memory registration and recall. Results must be interpreted with consideration of the patient's education level and existing language, motor, and visual impairments. In order to make a diagnosis of dementia, the patient must demonstrate impairment in ≥1 cognitive domains (eg, memory, language, executive function) during testing as well as functional impairment in activities of daily living (eg, bathing, shopping, cooking). (Choice A) Comprehension is tested by asking the patient to follow a multistep command. This usually involves relatively brief tasks such as taking a piece of paper from the examiner, folding it in half, and placing it on the floor. Due to the brevity of these actions, attention and concentration may not be tested effectively. (Choice B) Memory registration and recall are assessed by asking the patient to repeat aloud the names of 3 unrelated objects and then asking him/her to recall them several minutes later. This would not test attention and concentration effectively, as these are better assessed by tasks requiring prolonged, continuous thinking. (Choice D) Remote memory is tested by asking patients about the details of significant life events (eg, birth, graduation, marriage dates). (Choice E) The writing domain of language can be tested by asking the patient to write a sentence containing at least one noun and verb. Oral fluency can be assessed by listening to the patient's spontaneous speech. Educational objective: Quick clinical tests to assess attention and concentration include counting down from 100 by intervals of 3 or 7, reciting the months of the year in reverse order, and spelling "world" backwards. __________ References: Evaluating attention in delirium: a comparison of bedside tests of attention. (http://www.ncbi.nlm.nih.gov/pubmed/26419620)

A 67-Year-Old Woman Comes to the Office Due to Difficulty