PSYCHIATRY EDUCATION FORUM ACADEMY'S

HOW TO EVALUATE SIX

NEUROCOGNITIVE DOMAINS
FOR DEMENTIA SUBTYPES?

DR. HARVINDER SINGH

NEUROCOGNITIVE
DOMAINS
01 COMPLEX ATTENTION
02 EXECUTIVE FUNCTION
03 LEARNING & MEMORY
04 LANGUAGE
03 PERCEPTUAL-MOTOR
04 SOCIAL COGNITION
(1) COMPLEX ATTENTION VASCULAR

DEMENTIA

SUSTAINED ATTENTION:
not able to maintain attention over time.
DIVIDED ATTENTION:
difficulty holding new information: new address or phone
number difficulty attending to two tasks at the same time.

HOW TO ASSESS: HOW TO ASSESS:

ask to tap on the desk each time a specific number/alphabet ask to tap rapidly while learning a story being read.
is heard, and over a period of time.

PROCESSING SPEED:
SELECTIVE ATTENTION:
normal tasks/thinking takes longer than previously unless simplified
difficulty maintaining attention with multiple background to one or a few.
stimuli (TV, radio, conversations) or competing events. need more double-checking or begins to find errors in routine tasks.

HOW TO ASSESS: HOW TO ASSESS:

read both alphabets and numbers and ask the patient to check the time to match symbols with letter.
only count alphabets. check the speed in answering serial 3 or counting during tasks.
(1) COMPLEX ATTENTION VASCULAR

DEMENTIA

ADDENBROOKE’S COGNITIVE EXAMINATION – ACE-III

(2) EXECUTIVE FUNCTION
MILD: MAJOR:
Difficulty multitasking or getting fatigued Relying on others for iADLs.
from extra emotional efforts.
Difficulty resuming tasks if interrupted.
Difficulty with large social gatherings.
PLANNING
HOW TO ASSESS: CLOCK DRAWING
Draw a clock with all the numbers and pointers marking a
particular time.
INHIBITORY CONTROL
HOW TO ASSESS: STROOP TEST: consists of 3 conditions:
In the first condition: the subject must say, as quickly as
possible, the names of the colors that are arranged on a
card.
In the second condition: the subject must say the names
of the colors that the words “all”, “today”, etc. are printed
in.
In the third condition, the participant has to name the
colors that the words “yellow”, “red”, etc. are printed in.
VASCULAR
DEMENTIA
WORKING MEMORY
HOW TO ASSESS: Digits Forward and Backward subtests
In the Digits Forward subtest, the participant must repeat the
numbers dictated by the examiner in the same order. In the Digits
Backward subtest, the patient must repeat the same numbers in
reverse order.
COGNITIVE FLEXIBILITY
HOW TO ASSESS: (A) TRAIL MAKING TEST
Connect 13 numbers and 12 letters alternately and as quickly as
possible.
HOW TO ASSESS: (B) WISCONSIN CARD SORTING TEST
The test consists of cards that need to be classified according to
color, shape or number categories.
Dement Neuropsychol. 2015 Apr-Jun; 9(2): 149–155.
(2) EXECUTIVE FUNCTION
CLOCK DRAWING TASK

Age and Ageing 1998; 27: 399-403

(2) EXECUTIVE FUNCTION
STROOP TEST:
(PART 1)

ROW 1

ROW 2

ROW 3
(2) EXECUTIVE FUNCTION
TRAIL MAKING TEST:
(2) EXECUTIVE FUNCTION
WISCONSIN CARD SORTING TEST:
(3) MEMORY & LEARNING
MILD:
ALZHEIMER'S

DISEASE
Difficult recalling recent events
Relying on list-making or calendar
Re-reading book to keep track of characters
Losing track of bills, if paid recently or not. RELATIVELY SPARED IN FTD
MAJOR:
Repeating self in conversation (often in the same conversation)
Difficulty keeping track of short-list (shopping or planning a day) RECENT MEMORY
Frequent reminders are needed to orient to the task at hand

IMMEDIATE MEMORY HOW TO ASSESS: SLUMS STORY TELLING EXERCISE

HOW TO ASSESS: SLUMS five-word repeat
ask to repeat a list of words or digits.
SEMANTIC/LONG TERM MEMORY
1. FREE RECALL: recall as many words, diagrams, or elements of
the story as possible.
2. CUED RECALL: help recall by providing cues. ex: "Name all the
children from the story".
3. RECOGNITION MEMORY: by asking about specific items. ex:
"was apple on the list?"

this is the memory of facts: knowledge learned over many

AUTOBIOGRAPHICAL MEMORY
experiences
HOW TO ASSESS: NAMING ANIMALS IN MOCA HOW TO ASSESS: memory of personal events or people from past
names of the animals, their features, and how objects are first time learning a car
related to one another. social security number
(3) MEMORY & LEARNING
IMMEDIATE MEMORY
HOW TO ASSESS:
ask to repeat a list of words or digits.

ADDENBROOKE’S COGNITIVE EXAMINATION – ACE-III

(3) MEMORY & LEARNING
SEMANTIC/LONG TERM MEMORY

ADDENBROOKE’S COGNITIVE EXAMINATION – ACE-III

(3) MEMORY & LEARNING
RECENT MEMORY

VAMC SLUMS
(3) MEMORY & LEARNING
RECENT MEMORY

ADDENBROOKE’S COGNITIVE EXAMINATION – ACE-III

(3) MEMORY & LEARNING
AUTOBIOGRAPHICAL MEMORY

ADDENBROOKE’S COGNITIVE EXAMINATION – ACE-III

(4) LANGUAGE FTD,

LANGUAGE VARIANT

MILD: EXPRESSIVE LANGUAGE

Word finding difficulty
Substituting general for specific terms
HOW TO ASSESS: check for fluency.
Grammatical errors: incorrect use of articles, name as many animals possible in 1 minute
verbs, prepositions

GRAMMAR & SYNTAX:

MAJOR:
Often using general terms: “that thing” “you
HOW TO ASSESS:
know what I mean”
Monitor for incorrect use of articles, prepositions, auxiliary verbs
Difficulty recalling close family or friends during naming and fluency testing.
name
Echolalia
Automatic speech (can precede mutism) RECEPTIVE LANGUAGE:
HOW TO ASSESS:
the ability to listen and follow the instructions.
(4) LANGUAGE
EXPRESSIVE LANGUAGE
(4) LANGUAGE
GRAMMAR & SYNTAX:
(4) LANGUAGE
RECEPTIVE LANGUAGE:
(5) PERCEPTUAL MOTOR
RELATIVE

SPARING IN FTD

MILD: MAJOR:
Relying on maps or others for direction. Significant difficulty with previously familiar activities
Finding self lost (when not concentrating on (driving, using tools)
tasks): at new places (for mild) and in familiar Confused at dusk or lower light levels
environment (for major)
Less precise in parking
Greater effort needed in spatial tasks PERCEPTUAL-MOTOR:
(carpentry, assembly, sewing, knitting)
HOW TO ASSESS:
inserting blocks into a board without visual cues.
VISUO-CONSTRUCTIONAL:
PRAXIS:
HOW TO ASSESS:
Clock Drawing
Copying cube (in MOCA) HOW TO ASSESS:
show me how to use the hammer
(5) PERCEPTUAL MOTOR
VISUO-CONSTRUCTIONAL:
(5) PERCEPTUAL MOTOR
VISUO-CONSTRUCTIONAL:
(5) PERCEPTUAL MOTOR
VISUO-
CONSTRUCTIONAL:
(5) PERCEPTUAL MOTOR
VISUO-CONSTRUCTIONAL:
(6) SOCIAL COGNITION
MILD:
Changes in behavior or attitudes
Difficulty recognizing social cues
Difficulty reading facial expressions
Degreased empathy
Increased extraversion or introversion
Decreased inhibitions
Apathy
RECOGNITION OF EMOTIONS:
HOW TO ASSESS:
Identifying emotions in images of faces
FTD,
behavioral variant
MAJOR:
Behavior out of acceptable social range
Showing insensitivity to political, religious or sexual topics of
conversation
Showing insensitivity to social standard of modesty of dressing
Excessive focus on topics despite groups’ disinterest or feedback
Making decisions without regard to safety (clothing not
appropriate for weather or social settings)
THEORY OF MIND:
HOW TO ASSESS:
ability to consider another person's mental state based on story
cards: "Why is the boy sad?"
(6) SOCIAL COGNITION
RECOGNITION OF EMOTIONS:

Test Battery for Measuring the

Perception and Recognition of Facial
Expressions of Emotion:

Front Psychol . 2014 May 13;5:404.

PSYCHIATRY EDUCATION FORUM ACADEMY'S

HOW TO EVALUATE SIX

NEUROCOGNITIVE DOMAINS
FOR DEMENTIA SUBTYPES?

DR. HARVINDER SINGH