Transcript Module 5. Cognitive / Mental Status Assessment of the

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Cognitive / Mental
Status Assessment of
Older Adults
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Objectives

Identify the importance of mental status assessment
in older adults
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Define and identify the components of mental status
assessment
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Assess mental status using validated tool – Folstein
Mini-Mental Status Examination (MMSE)
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Assess mood using validated tool – Yesavage
Geriatric Depression Scale (GDS) and Cornell
Depression Scale (CDS) – identifying strengths and
limitations
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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
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Where are they?
80% of all medical care for dementia
occurs in (1) Doctors’ offices; (2) Hospital
settings, and (3)Nursing homes
 Outpatient settings:
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 Few
patients are screened UNLESS cognitive
impairment is apparent
 Unrecognized
delirium or cognitive deficits in
30 – 40% of emergency department older
adults
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The value of cognitive screening
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Detects noncomplaining but impaired older
adults
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Dementia delirium or cognitive deficits
almost always undiagnosed
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Patients screened ONLY when cognitive
impairment is apparent
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Mental Status Assessment
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Cognitive function decline: dementias,
delirium, and impaired thought process
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Indicators of general cognitive loss:
declining scores on tests of memory
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Mental Status Assessment screens for
changes in cognition and mood but does
not diagnose
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Cognitive assessment

Identify the presence of and monitor
the course of dementia, depression, or
delirium
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Determines readiness to learn
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Evaluates effectiveness of treatment
regimen
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Components of Mental Status
Assessment
Alertness / Level of Consciousness
 Attention
 Comprehension
 Construction
 Emotional Status
 Higher Memory Function
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Components of Mental Status
Assessment
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Insight
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Intelligence
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Judgment
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Memory
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Orientation to time, place, and person
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Components of Mental Status
Assessment
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Perception
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Physical appearance
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Psychomotor behavior
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Speech and language
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Thinking
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Folstein Mini-Mental Status
Try This
Examination (MMSE) MMSE
Assessment Series
available on Hartford
Institute website at
www.hartfordign.org

Purpose: quantify
cognitive ability;
measure change over
time; identify
presence of organic
disease
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Orientation
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Registration
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Attention and
Calculation
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Recall
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Language
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Folstein Mini-Mental Status
Examination (MMSE)
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Strengths: valid, reliable, 5 – 10 minutes, need
little training, can be administered by lay person
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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
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Yesavage Geriatric Depression
GDS Try This Assessment
Scale (GDS)
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
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Geriatric Depression Scale MOOD SCALE (Short form)
Choose the best answer for how you have felt over the past week:
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8.
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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
10. Do you feel you have more problems with memory than most? YES / NO
11. Do you think it is wonderful to be alive now? YES / NO
12. Do you feel pretty worthless the way you are now? YES / NO
13. Do you feel full of energy? YES / NO
14. Do you feel that your situation is hopeless? YES / NO
15. Do you think that most people are better off than you are? YES / NO
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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.
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Yesavage Geriatric Depression
Scale (GDS)
Limitations
Cannot be used if client cannot selfreport such as those with severe
depression and / or psychosis
Questionable reliability with MMSE <15
Cannot discriminate between clinical
diagnostic categories and changes over
time
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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 followup diagnosis.
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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
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Summary
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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.
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Web sites

www.minimental.com/MSRS/htm

http://www.medafile.com/mmses.htm

http://arcc.stanford.edu/videos.html
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QUESTIONS?
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