DEMENTIA CARE SERIES Michigan Department of Community Health THOUGHTS & SUGGESTIONS FOR CARING Caring Sheet #21: Questions about a Person’s Cognition: An Assessment Checklist By Shelly E. Weaverdyck, PhD Introduction This caring sheet lists questions a caregiver can ask to discover what a person with cognitive impairment can and can’t do with respect to cognition (i.e., the ability to think, and to understand and respond to the environment). The questions are based on very specific changes to the brain. They help explore why the person is distressed, is having trouble performing a task, or is engaging in a particular behavior. The caregiver is expected to ask these questions to her/himself or to other caregivers, but NOT to the person with cognitive impairment. The questions can be asked informally by family and other caregivers or more systematically with formal recording by professionals. (These questions are included in a more formal assessment instrument called the Cognitive Impairment Assessment Protocol or CIAP.) The questions are meant to be asked either as a general assessment or while the caregiver is helping a person with cognitive impairment perform a task. The answers to these questions can help a caregiver modify the environment, the task, or communication strategies to accommodate the person’s abilities and cognitive difficulties. When they are asked during a task, the caregiver can intervene immediately and respond to subtle changes that occur minute by minute in the person’s cognitive abilities. The questions here are organized under five major queries or steps which reflect the five cognitive phases every person (healthy or not) must go through in order to receive, organize and respond to information from the environment. (These five phases of cognitive functioning were developed and introduced by this author in 1987 and published in the sources cited at the end of the list of questions.)DEMENTIA CARE SERIES Michigan Department of Community Health THOUGHTS & SUGGESTIONS FOR CARING Caring Sheet #21 Assessment Questions: Cognition S. Weaverdyck Page 2 of 5 UNDERSTANDING A PERSON WITH COGNITIVE IMPAIRMENT Questions to Ask: The following questions about a person’s cognition are based on specific brain functions and changes. We do not need to know about the brain, however to ask the questions. The questions address five phases of cognitive processing that everyone (with or without cognitive impairment) must go through in order to respond to other people and to the environment. The five phases are sensory, perception/comprehension, executive, expressive, and motoric. Asking ourselves these questions can help us, as caregivers, assess a person’s ability to understand and respond to us and to objects and events in the environment. Answers to these questions can suggest effective intervention strategies. 1. Sensory: Can this person receive information from the environment through the five senses (see, hear, feel, taste, smell)? A. How well does this person SEE and HEAR me? • Does this person need glasses? • Are the glasses clean? • Does this person need a hearing aid? • Does the hearing aid need adjusting? B. How does this person FEEL or experience my touch? • Does this person know I am touching a particular body part? • Does the touch feel softer or harder than I think? • Does the cloth, water, or surface feel uncomfortable? • Does the temperature change suddenly or feel different than I think? 2. Comprehension/Perception: Can this person recognize and understand the information received through the senses? A. How well does this person UNDERSTAND what s/he sees and hears? • Does this person know what an object is when s/he sees it? • Does this person recognize various colors?DEMENTIA CARE SERIES Michigan Department of Community Health THOUGHTS & SUGGESTIONS FOR CARING Caring Sheet #21 Assessment Questions: Cognition S. Weaverdyck Page 3 of 5 • Can this person read and understand what s/he reads? • Can this person recognize pictures and gestures? • Does this person recognize what a word means when s/he hears it? B. How well does this person recognize WHERE an object, sound, or touch is? • Does this person notice objects in all parts of her/his visual field? • Does this person notice touch on all parts of her/his body? • Can this person see how far away an object is from her/himself? • Can this person see where objects are relative to other objects? 3. Executive: Can this person categorize, organize, and manipulate the information received? A. How well does this person recognize the IMPORTANCE of the information and use it to make decisions, solve problems, and organize plans? • How long can this person focus or pay attention to a task, to an object, or to what I am saying? • Can this person figure out what I mean even if s/he can’t hear or understand me very well? • Does this person remember what s/he sees, hears, or figures out? • Can this person compare new information with other information s/he has learned before? • How easily can this person shift from one activity to another? • How easily can this person get her/himself started on a task or a response? • Does this person know how much time has passed? • Does this person recognize her/his own abilities, needs, desires, and mistakes? 4. Expressive: Can this person’s brain tell this person’s body what to do? A. How well does this person’s brain COORDINATE the person’s body to perform a task or to express a thought? • How easily can this person produce words to speak and/or write? • Can this person sing more easily than speak?DEMENTIA CARE SERIES Michigan Department of Community Health THOUGHTS & SUGGESTIONS FOR CARING Caring Sheet #21 Assessment Questions: Cognition S. Weaverdyck Page 4 of 5 • Does this person talk or do a task more easily when it is spontaneous rather than upon request? • Does this person perform tasks more easily if s/he doesn’t think about it? • How well does this person perform a task spontaneously and upon request (e.g., move a body part, build something, draw, manipulate or move an object when eating and dressing)? 5. Motoric: Can this person’s body physically respond to the instructions from this person’s brain? A.