CAP Frequently Asked Questions

1. Is the CAP administered by itself or as part of a longer bedside exam?
2. Why are memory items not included in the CAP?
3. Can you give other bedside tests along with the CAP?
4. Can the CAP be given to non-TBI patients?
5. Can sleep history be obtained from patient self-report?
6. Over what time frame should sleep information be gathered?
7. What are good sources of information for rating psychotic-type symptoms? What are some commonly asked questions?
8. If a patient is perseverative (says the same thing repeatedly) during administration of cognitive tasks such as counting forward or backward, how is this scored?
9. If a patient quits responding during a cognitive task (e.g., falls asleep), how are the remaining items scored?
   

1. Is the CAP administered by itself or as part of a longer bedside exam?
The CAP can be incorporated into a lengthier bedside examination. It is often easier to complete some of the ratings including decreased daytime arousal, fluctuation, and psychotic-type symptoms when more of the patient’s behavior is sampled by the clinician.

2. Why are memory items not included in the CAP?
In the original development of the CAP, a more lengthy bedside examination was administered to patients that included assessment of many cognitive domains including memory. However, poor performance was observed on memory items across individuals who did and did not meet criteria for DSM-IV Delirium/Acute Confusion. In other words, impaired memory performance after a traumatic brain injury (TBI) did not help distinguish individuals who were acutely confused from individuals who were not acutely confused. Of note, the authors of the CAP do feel it is important to assess memory impairment after TBI.

3. Can you give other bedside tests along with the CAP?
Yes, you can give other tests in addition to the CAP in a bedside examination.

4. Can the CAP be given to non-TBI patients?
The CAP is still in an early stage of development and has only been used with acute TBI inpatients. However, the authors of the CAP believe that the CAP has potential application for assessment of acute confusion of various etiologies.

5. Can sleep history be obtained from patient self-report?
Acutely confused patients are often unreliable historians for personal information such as ongoing medical events including sleep history. Thus, sleep history is best obtained from clinicians and family members caring for the patient. Use of sleep graphs and examination of nursing and therapy notes are often helpful.

6. Over what time frame should sleep information be gathered?
Ratings of nighttime sleep should be based on the last night’s sleep, at least, and can include information from the past 2-3 days. Similarly, ratings of decreased daytime arousal should be based on at least the past 8 hours and may include information from the past 2-3 days.

7. What are good sources of information for rating psychotic-type symptoms? What are some commonly asked questions?
Information regarding psychotic-type symptoms is often gathered from the medical chart, bedside examination, family members, medical staff, nurses, and therapists treating the patient. Questions can include:

1. Does the patient talk to people who are not present in the room?
2. Does the patient report seeing someone or something that is not present?
3. Does the patient report experiencing sensations that are impossible (e.g., being given a shot when no shots were administered)?
4. What is the patient’s understanding of his/her situation? Ask the patient, “Why are you here?”