1. Cognitive / Mental Status Assessment of Older Adults

2. Objectives • Identify the importance of mental status assessment in older adults • Define and identify the components of mental status assessment • Assess mental status using validated tool – Folstein Mini-Mental Status Examination (MMSE) • Assess mood using validated tool – Yesavage Geriatric Depression Scale (GDS) and Cornell Depression Scale (CDS) – identifying strengths and limitations

3. Cognitive Impairment Statistics • 4 to 5 million older adults experience cognitive impairment • Dementia in the community • 5% of 65 – 75 years old • 25 to 30% of ages 85+ • 60% nursing home residents

4. Where are they? • 80% of all medical care for dementia occurs in (1) Doctors’ offices; (2) Hospital settings, and (3)Nursing homes • Outpatient settings: • Few patients are screened UNLESS cognitive impairment is apparent • Unrecognized delirium or cognitive deficits in 30 – 40% of emergency department older adults

5. The value of cognitive screening • Detects noncomplaining but impaired older adults • Dementia delirium or cognitive deficits almost always undiagnosed • Patients screened ONLY when cognitive impairment is apparent

6. Mental Status Assessment • Cognitive function decline: dementias, delirium, and impaired thought process • Indicators of general cognitive loss: declining scores on tests of memory • Mental Status Assessment screens for changes in cognition and mood but does not diagnose

7. Cognitive assessment • Identify the presence of and monitor the course of dementia, depression, or delirium • Determines readiness to learn • Evaluates effectiveness of treatment regimen

8. Components of Mental Status Assessment • Alertness / Level of Consciousness • Attention • Comprehension • Construction • Emotional Status • Higher Memory Function

9. Components of Mental Status Assessment • Insight • Intelligence • Judgment • Memory • Orientation to time, place, and person

10. Components of Mental Status Assessment • Perception • Physical appearance • Psychomotor behavior • Speech and language • Thinking

11. Folstein Mini-Mental Status Examination (MMSE) MMSETry This Assessment Series available on Hartford Institute website at www.hartfordign.org • Purpose: quantify cognitive ability; measure change over time; identify presence of organic disease • Orientation • Registration • Attention and Calculation • Recall • Language

12. Folstein Mini-Mental Status Examination (MMSE) • Strengths: valid, reliable, 5 – 10 minutes, need little training, can be administered by lay person • Limitations: relies heavily on verbal response, reading and writing • Cultural, educational/racial bias, low English proficiency, advanced age • Communication and sensory disorders • Does not assess mood, insight, remote memory, perceptual disturbances

13. Yesavage Geriatric Depression Scale (GDS) GDSTry This Assessment Series available on Hartford Institute website at www.hartfordign.org • Purpose: screen for depression • Scale: • 0 = no depression • >5 = refer for follow up diagnosis • 30 = very depressed

14. Geriatric Depression Scale MOOD SCALE (Short form) Choose the best answer for how you have felt over the past week: Are you basically satisfied with your life? YES /NO Have you dropped many of your activities and interests? YES/ NO Do you feel that your life is empty? YES / NO Do you often get bored?YES/ NO Are you in good spirits most of the time? YES /NO Are you afraid that something bad is going to happen to you? YES/ NO Do you feel happy most of the time? YES /NO Do you often feel helpless? YES/ NO Do you prefer to stay at home, rather than going out and doing new things? YES/ NO Do you feel you have more problems with memory than most? YES/ NO Do you think it is wonderful to be alive now? YES / NO Do you feel pretty worthless the way you are now? YES / NO Do you feel full of energy? YES / NO Do you feel that your situation is hopeless? YES / NO Do you think that most people are better off than you are? YES / NO

15. Yesavage Geriatric Depression Scale (GDS) Strengths • Self-rated, yes/no • No training required • Effective screen for MINOR depression • Used for physically healthy and physically ill, and cognitively impaired with MMSE >15.

16. Yesavage Geriatric Depression Scale (GDS) Limitations • Cannot be used if client cannot self-report such as those with severe depression and / or psychosis • Questionable reliability with MMSE <15 • Cannot discriminate between clinical diagnostic categories and changes over time

17. Cornell Scale for Depression in Dementia (CSDD) • Purpose: screen for depression in older adults with dementia • Scoring • 0 = no depression • 2 = probable depression • 19 = severe depression • Those patients with a score of 12 or above should be referred for follow-up diagnosis.

18. Cornell Scale for Depression in Dementia (CSDD) (Tool available for viewing online at http://www.aafp.org/afp/20020915/1001.html) Strength • Able to assess for depression in clients with Advanced dementia Limitations • Requires clinician • Not self-administered • Takes longer

19. Summary • Cognitive assessment and its purposes • Components of mental status assessment • MMSE – measures change over time • GDS • >5 points = refer for follow-up interview • >10 means almost always depression • CSDD – refer for follow-up diagnosis if score of 12+ • Careful with bias: cultural, language, sensory loss when selecting tool.

20. Web sites • www.minimental.com/MSRS/htm • http://www.medafile.com/mmses.htm • http://arcc.stanford.edu/videos.html

21. QUESTIONS?