BEHAVIOURAL NEUROLOGY ASSESSMENT Short Form BEHAVIOURAL NEUROLOGY PROGRAM BAYCREST CENTRE FOR GERIATRIC CARE TORONTO, ONTARIO Copyright 2002; Sultan Darvesh, Larry Leach Sandra Black, Edith Kaplan, and Morris Freedman.. June, 2002 NAME: AGE: GENDER: HANDEDNESS: EDUCATION: DATE:
LEVEL OF CONSCIOUSNESS check one: 2 Alert Drowsy PHYSICAL APPEARANCE Hygiene Dress Motor behaviour Appropriate Inappropriate EMOTIONAL STATE (describe) Affect Mood Delusions Hallucinations Insight Judgement
3 ATTENTION AND CONCENTRATION SERIAL SUBTRACTIONS Directions: The patient is to do serial subtractions. Record responses verbatim. Circle the errors. Instructions: "Begin at 100 and take away (subtract) 7 (3) and keep taking away 7 from the next number until I say stop". Responses Score Serial 7 s 100 93 86 79 72 65 58 51 (100-7) 44 37 30 23 16 9 2 /2 Serial 3 s 100 97 94 91 88 85 82 79 (100-3) 76 73 70 67 64 61 58 /2 For each correct subtraction, give credit as long as the difference between two successive subtractions is correct. Score: 2 points: If the entire sequence is correct 2 points: For serial 3's if not given because serial 7 s were done correctly. 1 point: If there is one error 0 points: If there are two or more errors. MONTHS BACKWARDS Instructions: Say to the patient: "I want you to tell me the months backwards. Start with December and go all the way back to January. Dec Nov Oct Sep Aug Jul Jun May Apr Mar Feb Jan Score /2 Score: 2 points: If the entire sequence is correct. 1 point: If there is only one error. 0 points: If there are 2 or more errors
4 MEMORY ORIENTATION Directions: Ask the patient about all the items given in the table. Record answers verbatim. Instructions: Say to the patient: "What is the...?" or "Who is the...?" Year Month Day Date Place Prime Minister (President) Premier (Governor) RESPONSE Score Total Score /7 Score: 1 point: Each correct response Maximum score: 7 points
5 VERBAL RECALL Directions: Give the patient the 3 words below. The patient should repeat them for immediate recall. Do not give the semantic cues for immediate recall. Give up to 5 trials for patient to learn to repeat all 3 words. Score only the response on the first trial. Then ask the patient to recall them after 5 minutes. If the patient is unable to recall the words, give the semantic cues. If the patient is unable to recall after the semantic cues, give the recognition items. Instructions: Say to the patient: "I am going to say 3 words. I want you to repeat them after I finish". After the patient has repeated them twice say to the patient, "I will ask you for the three words again later on". Recall: CAT APPLE TABLE Semantic Cue Condition Response animal fruit furniture Immediate Score 5 Minutes Recognition 1. Cow 2. Cat 3. Bear 1. Apricot 2. Banana 3. Apple 1. Table 2. Chair 3. Sofa Total Score: 3 points: Each correct item. 2 points: If the item is correct after a semantic cue. 1 point: If the item is correct after recognition. Maximum score: 9 points (at each time interval)
LANGUAGE 6 SPONTANEOUS SPEECH (Not scored) Directions: Listen to the patient give an answer to an open-ended question. (e.g., What kind of work did you do? or What happened to you?). Listen for fluency of speech. Interrupted, agrammatic, effortful speech would be non-fluent speech. Record whether there was normal effort or increased effort in speech production. Record if there were any paraphasic errors. An example of a phonemic paraphasic error is "clable" for "table". An example of a semantic paraphasic error is "table" for "chair". Record if the patient has empty speech, circumlocutory speech or word-finding difficulties. Record if patient has normalk articulation. Record if the patient has normal intonation of voice (prosody). Phrase length fluent non-fluent Effort normal increased Phonemic paraphasia no yes Semantic paraphasia no yes Empty speech no yes Circumlocutory speech no yes Word-finding difficulties no yes Articulation normal impaired Prosody normal impaired
NAMING 7 Directions: Show the patient the items given in the table, one at a time. The patient is to name each of the items. Instructions: Say to the patient: "What is this?" Item Response Score Watch Shirt Collar Glasses Frame Lens Shoe Heel Pen Thumb Total Score /10 Score: 1 point: Each correct item. Maximum score: 10 points
8 VISUOSPATIAL FUNCTION CLOCK DRAWING Instructions: Turn to the next page and say to the patient: "Draw a clock, put in the numbers and set the hands at 10 after 11." Score: Contour: 1 point: Contour is closed or within 1/8 inch or 3 mm of closure and is not too small to contain all numbers 1 point: Contour is circular with the ratio of the shortest to the longest diameter no greater that 1:1.5 Numbers: 1 point: Numbers 1 to 12 are all present without additional numbers 1 point: Numbers are represented by either Arabic numerals alone or by Roman numerals alone by not by a combination of both 1 point: Numbers are in the correct order 1 point: Paper not rotated 1 point: Numbers are approximately in the correct position. 1 point: All numbers are within the clock contour Hands: 1 point: Two and only two hands are present (allow three hands if the patient spontaneously or on cue clearly indicates one hand is a second hand) 1 point: Hour target number indicated in some manner 1 point: Minute target number indicated in some manner (e.g., a hand, or a mark of some sort) 1 point: Hands in correct proportion (i.e. minute hand longer than hour) 1 point: No superfluous markings on the clock face 1 point: Hands overlap or join within ½ inch (12mm) Centre: 1 point: Centre drawn or inferred Maximum score: 15 points Modified from Clock Drawing: A Neuropsychological Analysis by Morris Freedman, Larry Leach, Edith Kaplan, Gordon Winocur, Kenneth I Shulman, and Dean Delis. Copyright 1994 by Oxford University Press, Inc. Used by permission of Oxford University Press, Inc.
9 CLOCK DRAWING
10 EXECUTIVE FUNCTION SIMILARITIES Directions: The patient is to give similarity between each of the items given in the table. Instructions: Say to the patient: "I am going to tell you two things. Tell me how these things are similar." Then give the first two items. If the patient says: "They are not similar", say to the patient: "Yes, they are similar. Please tell me how they are similar." If the answer is concrete or incorrect then say to the patient: "An orange and an apple are fruits. These are the sorts of answers I am looking for." After saying this give the patient the rest of the items sequentially. Record answers verbatim. Certain responses warrant a query to determine whether a better response can be obtained. These are noted with query in parentheses. orange-apple (if incorrect give answer on first item) salt-pepper fork-knife man-tree song-painting Response Score Total /10 Score: 2 points: For each abstract answer 1 point: For a concrete answer 0 points: For irrelevant answers or differences Maximum score: 10 points Scoring Examples Orange-apple: 2 points: Fruit 1 point: Food (query), to eat, have peels, grow on trees) 0 points: Round, same shape, different (fruits), they re not alike Salt-pepper: 2 points: Condiments, flavorings, spices 1 point: Improve taste (of food), used on food, edible 0 points: Used for the same thing (query), one s spicy the other is salty, they make you want to drink water
11 Fork-knife: Man-tree: 2 points: Utensils, eating utensils, flatware, silverware 1 point: Use them to eat (food), used to cut food 0 points: Made of metal/wood/plastic, used with food (query), both long 2 points: Living things, have life 1 point: Breathe, grow, need food, created by (part of ) nature 0 points: Found on earth (query), both have limbs Song-painting: 2 points: Works of art, artistic creations 1 point: Man made, symbolic, beautiful, tell stories, express feelings (or ideas, emotions), have meaning 0 points: Culture (query), a song is heard - a painting is seen, make you feel good
12 PROVERBS Direction: The patient is to give an abstract interpretation of the proverbs given below. If the patient has not heard the proverb before, then an attempt should still be made by the patient to give an abstract interpretation. The patient should be encouraged to give an answer. Instructions: Say to the patient: "I am going to tell you a proverb, a saying. Tell me what it means." If the answer is unclear, ask the patient for a clarification by saying: "What do you mean?" Clarification should be asked only once for each proverb. Record the answer verbatim. Proverb Response Score People who live in glass houses should not throw stones. A stitch in time saves nine Score: 2 points: For each abstract answer 1 point: For a concrete answer 0 points: For an irrelevant answer. Maximum score: 4 points Scoring Examples for Glass House 2 points: Don t criticize others for faults that you may have yourself 1 point: If you throw a stone in a glass house, you will break the glass 1 point: Don t criticize others (patient cannot explain why) 0 points: Irrelevant answer Scoring Examples for Stitch in Time 2 points: Dealing with a problem early on avoids bigger problems later. 1 point: Sewing up a small tear keeps it from getting bigger. 1 point: Solve your problems now (without explaining why) 0 points: Irrelevant answer /2 /2 Total Score /4
13 MULTIPLE LOOPS AND ALTERNATING SEQUENCE Directions: For each task, orient the page so that the word TOP is at the top. The patient should use his/her dominant hand. Multiple loops Instructions: Point to the end of the 3 multiple loops and say to the patient: "Draw the same design starting here to the end of the page." Alternating sequence Instructions: Turn to the next page. Point to the end of the alternating sequence and say: "Starting here continue with the same design until you reach the end of the page." Score: Multiple loops: 2 points: For a complete correct sequence. 1 point: For one error of omission (i.e., 3 instead of a triple loop) or commission (i.e., 4 or more loops instead of three) 0 points: For 2 or more errors of commission and/or omission. Maximum score: 2 points Alternating sequence: 2 points: For a complete correct sequence. 1 point: For 1 perseverative error. 0 points: For 2 or more perseverative errors. Maximum score: 2 points
14 TOP
15 TOP
WORD GENERATION 16 Direction: The patient is to generate as many words as he/she can in one minute starting with the letter "F". Then the patient is to generate the names of as many animals as he/she can in one minute. F words Instructions: Say to the patient: "When I tell you to start, I would like you to tell me as many words as you can think of starting with a certain letter. But do not tell me names of people or places or any word that would usually be capitalized. The other rule is that you should not give me the same word you have told me in different ways. For example, if you say "nap" do not say "naps", "napped", napping, etc." Having given the instructions say to the patient: "The letter is "F", start now." Record the responses verbatim in 15 second units Animals Instructions: Say to the patient: "Now I want you to tell me as many animals as you can think of." Record the responses verbatim in 15 second units.
17 "F" Words Animal Names 15 seconds total: 15 seconds total: 30 seconds total: 30 seconds total: 45 seconds total: 45 seconds total: 60 seconds total: 60 seconds total: Grand total: Grand total: Score: 1 point: For each word starting with the letter "F". 1 point: For each animal. Note: Maximum score is 20. If more than 20 items are generated for F words or for animals, then score as 20.