Many people are concerned about a loss of cognitive function. Our intellectual functioning is a composite of activity from different parts of the brain and includes both visual and verbal memory, spatial orientation, sequencing and problem solving. There is also a strong link with attention which is affected in ADD, motivation and control of emotion.

Assessment of a person with possible cognitive problems requires a thorough history and physical examination. We use screening tools to identify obvious deficits. I usually arrange blood tests to look for physical factors that may be impeding functioning together with detailed imaging. If there remain uncertainty, I may refer for formal neuropsychometric testing. We recognise that mood and anxiety may affect our cognitive function and will address this if appropriate.

After a head injury many people experience a post concussive syndrome with a combination of headache, fatigue, dizziness and mood and impaired cognitive function. Fortunately, once we exclude significant structural brain damage this usually recovers in time with appropriate support.

Fatigue may be both physical and cognitive and is a sensation of being tired or exhausted. Pathological fatigue occurs with limited exertion and affects one’s daily functioning. When investigating fatigue I exclude medical issues or deficiencies that may affect function. I investigate for any possible neurological causes. The next step is to work with therapy colleagues and if necessary employers to provide appropriate support for recovery.