Covenant Winter 2014

November 25, 2014  |  By  | 

Holistic Assessment Includes an Understanding of Cognition By Benjamin Williams, PhD , C Psych The assessment of cog- nition is an invaluable aspect of a holistic multi- disciplinary assessment. While the term cogni- tion has been used very broadly to refer to mental activity, in this context, the term cognition is meant to refer to a group of skills arising out of mental activity that assist us in adapt- ing to our life circumstances. Clinicians often think of these skills with respect to various domains including: intel- lectual skills, attention and concentra- tion, learning and memory, language, and visual spatial skills. In addition, the domain of executive functioning in- cludes a host of higher-order cognitive skills that aide us in performing goal- directed behaviour and permit self- regulation. These include: planning and organization, inhibitory control, mental flexibility, concept formation, self-monitoring, etc. At a very basic level, individuals are referred for assessment because they or their leadership want a clear understanding or description of their problems and struggles. Moreover, they want some direction with respect to what can be done to address these concerns. One of the powerful elements of a holistic approach to assessment is the ability to place the particular issues with which an individual presents within the larger context of who that person is. Assessment of cognition is an essential element of this process. That is, in order to understand an individual from a holistic perspective we must know about her cognitive abilities. How effectively can this individual reason? Is he able to draw on accumulated knowledge to solve problems? What is the speed and efficiency of her mental processes? How well is this individual able to learn and recall information? Can this individual pick up concepts? Can he use planning and organisation skills effectively? In short, does cognition represent a resource for this individual or a limitation? How does cognition fit into the larger picture of the struggles that necessitated her referral in the first place? Beyond being able to describe an individual’s cognitive strengths or weaknesses it is also helpful to understand any changes in cognition with which an individual might present. In fact, assessing for cognitive changes may be at the heart of the reason for referral. When responding to a senior who has encountered deterioration in her ability to function in ministry one might well suspect that a neurodegenerative condition such as Alzheimer’s disease (AD) may be present. Neuropsychological assessment, which allows for a comprehensive description of ability across a number of cognitive domains, is one of the most sensitive instruments in detecting AD. In fact, neuropsychological assessment is able to determine the presence of mild changes in cognitive function that are associated with a higher risk of future development of AD. In other words, beyond describing cognitive strengths and weaknesses, we can determine whether there have been changes in cognition that are abnormal (i.e. beyond what would be expected with normal aging), whether there is current evidence that would suggest dementia, or whether the individual is at an increased risk of eventually developing dementia in the future. Neuropsychological assessment can also be helpful in determining whether there has been a lasting impact on one’s cognition related to any number of neurological insults. Within the context of our work at Southdown, this is particularly relevant in assessment of alcohol misuse. An assessment is not only important in naming the presence and extent of an addictive process, but also in determining any lasting effect of alcohol on one’s cognitive functioning. Finally, consideration of cognitive functioning as a part of a holistic assessment within a mental health context is important in addressing the overlap that exists between symptoms of psychiatric or psychological problems and neurological or neurocognitive disorders. For example, depression and anxiety commonly impact attention and concentration as well as one’s capacity to process information in a quick and efficient manner. Similarly individuals who have begun to encounter the cognitive and behavioural changes associated with dementia are at an increased risk of depression. Moreover, an individual with dementia might appear depressed to community or family members even though her problems are neurological in nature. Consider an elderly sister who presents with irritability, difficulty engaging in household tasks, and is found to be isolating herself from community. It may be assumed that she is experiencing late-life depression. However, this same presentation may represent the onset of dementia. Exploring and examining cognitive function can be extremely helpful in such circumstances in order to help disentangle the possible sources of an individual’s difficulties. When taking a multidisciplinary, holistic approach to assessment, the goal is not simply to identify problems and treatment alternatives. We strive to gain an understanding of the whole person. This process provides an opportunity to understand how the difficulties arose and developed within the individual, how the difficulties are impacting an individual within a number of aspects of life, what treatment would be appropriate, and what supports are needed. Assessment of one’s cognitive functioning is an essential element of this process. n _________________ How does cognition ft into the larger picture of the struggles that necessitated her referral in the frst place? _________________

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