READING TEST 84

READING SUB-TEST : PART A

 Look at the four texts, A-D, in the separate Text Booklet.
 For each question, 1-20, look through the texts, A-D, to find the relevant
information.
 Write your answers on the spaces provided in this Question Paper.
 Answer all the questions within the 15-minute time limit.
 Your answers should be correctly spelt.

PART A -TEXT BOOKLET – EVALUATING COGNITIVE FUNCTION

Text A
Terminology
Cognitive difficulties

Cognitive changes are normal for almost all people as they age, and
assessment should focus on differentiating the normal changes of
ageing from abnormal cognitive functioning. While concerns about
memory are common in older patients, when patients complain of
memory problems, they could be referring to difficulties in a number of
possible cognitive domains. Although learning and memory is often the
most salient of these domains, the problems could also be in:
 attention (ability to sustain or shift focus),
 language (naming, producing words, comprehension, grammar or
syntax),
 perceptual and motor skills (construction, visual perception),
 executive function (decision making, mental flexibility), or
 social cognition.
It is thus often more appropriate to refer to cognitive rather than memory
complaints or deficits.
Text B

Pharmacological treatments
There are currently no evidence-based recommendations on medications
to treat mild cognitive impairment (MCI). If dementia is suspected then
specialist referral is recommended for confirmation of the diagnosis. If
Alzheimer’s disease is confirmed then pharmacological treatment can be
considered (e.g. acetylcholinesterase inhibitors such as donepezil,
galantamine or rivastigmine).
A psychiatric or psychogeriatric referral should be considered for:
 patients who do not respond to first- or second-line treatment
 patients with atypical mental health presentations
 patients with significant psychiatric histories, including complicated
depression and/or anxiety or comorbid severe mental illnesses such
as schizophrenia and bipolar affective disorder.
Follow up
If the diagnosis remains unclear after a detailed assessment then provide
general advice and watchfully wait. All patients should have a cognitive
review with a screening instrument every 12 months, or sooner if
deterioration is detected by the patient or their family.
Risk factors for progression of MCI to dementia include older age, less
education, stroke, diabetes and hypertension. Patients who are younger,
more educated with higher baseline cognitive function and no amnesia
symptoms are more likely to revert from MCI to normal cognition. Even after
10 years, between 40 and 70% of patients with MCI may not have developed
dementia

Text C
 Examples of skills Warning signs and questions
Domain

Short-term
Learning and recall memory Have you noticed that you have
Semantic and
been talking to someone and
autobiographical
soon after forget the
Long-term
conversation?
memory Implicit
Have you had difficulty
learning
remembering the names of
people you have just met?
Have you had trouble keeping
track of dates and
appointments?
Have you had any difficulty
remembering events from your
past?
Have you had difficulty doing
activities previously thought as
automatic, like driving or
typing?
[To informant] Has he or she
been repeating him or herself
lately?

Object naming
Language Have you noticed any word-
Word finding
finding difficulties?
Receptive
[To informant] Has he or she had
language
more difficulty understanding
you lately?

Planning
Executive function Have you had more difficulty
Decision making
managing your finances lately?
Working memory
[To informant] Have you noticed
Flexibility
difficulties with his or her
capacity to plan activities or
make decisions?

Perceptual motor function Visual Have you had trouble using day-
perception to-day objects, such as phone or
Perceptual- cutlery?
motor Co- Have there been new driving
 ordination difficulties such as staying in the
lane?

Complex attention Sustained Are you having difficulty following

attention what’s
Selective going on around you?
attention [To informant] Have you noticed
that he or she is more easily
distracted?

Social Cognition Recognition of [To informant] Has he or

emotions she been behaving
Appropriateness inappropriately in social
of behaviour to situations?
social norms Is he or she able to recognise
social cues? Is she or she able
to motivate him or herself?

Text D
Dementia, now also referred to as ‘major neurocognitive disorder’ in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is defined
by the presence of substantial cognitive decline from a previous level of
functioning to the degree that the individual’s ability to live independently is
compromised owing to the cognitive deficits. Dementia is a syndrome with
many possible causes, with Alzheimer’s disease being the most common in
older people. It is generally of gradual onset with a chronic course, although
there are exceptions. Dementia must be distinguished from delirium (acute
confusional state), which by definition is of acute or recent onset and
associated with loss of awareness of surroundings, a global disturbance in
cognition, changes in perception and the sleep- wake cycle, and other
features.

PART A -QUESTIONS

Questions 1-7
For each of the questions, 1-7, decide which text (A, B, C or D) the
information comes from. You may use any letter more than once