1

DRAFT Promotional Copy for NNSDODRAFT Promotional Copy for NNSDO

Cognitive / Mental Status Assessment of Older Adults

2

ObjectivesObjectives

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 StatisticsCognitive Impairment Statistics

4 to 5 million older adults experience cognitive impairment

Dementia in the community5% of 65 – 75 years old25 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 apparentUnrecognized delirium or cognitive deficits in

30 – 40% of emergency department older adults

5

The value of cognitive screeningThe 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 AssessmentMental 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 assessmentCognitive 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 Components of Mental Status AssessmentAssessment

Alertness / Level of Consciousness Attention Comprehension Construction Emotional Status Higher Memory Function

9

Components of Mental Status Components of Mental Status AssessmentAssessment

Insight

Intelligence

Judgment

Memory

Orientation to time, place, and person

10

Components of Mental Status Components of Mental Status AssessmentAssessment

Perception

Physical appearance

Psychomotor behavior

Speech and language

Thinking

11

Folstein Mini-Mental Status Folstein Mini-Mental Status Examination (MMSE)Examination (MMSE)

Orientation

Registration

Attention and Calculation

Recall

Language

Purpose: quantify cognitive ability; measure change over time; identify presence of organic disease

MMSE Try This Assessment Series available on Hartford Institute website at www.hartfordign.org

12

Folstein Mini-Mental Status Folstein Mini-Mental Status Examination (MMSE)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 Yesavage Geriatric Depression Scale (GDS)Scale (GDS)

Purpose: screen for depression Scale:

0 = no depression>5 = refer for follow up diagnosis30 = very depressed

GDS Try This Assessment Series available on Hartford Institute website at www.hartfordign.org

14

Geriatric Depression Scale MOOD SCALE (Short form)Geriatric Depression Scale MOOD SCALE (Short form)Choose the best answer for how you have felt over the past week:

1. Are you basically satisfied with your life? YES / NO

2. Have you dropped many of your activities and interests? YES / NO

3. Do you feel that your life is empty? YES / NO

4. Do you often get bored? YES / NO

5. Are you in good spirits most of the time? YES / NO

6. Are you afraid that something bad is going to happen to you? YES / NO

7. Do you feel happy most of the time? YES / NO

8. Do you often feel helpless? YES / NO

9. 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

15

Yesavage Geriatric Depression Yesavage Geriatric Depression Scale (GDS)Scale (GDS)

StrengthsSelf-rated, yes/noNo training requiredEffective screen for MINOR depressionUsed for physically healthy and

physically ill, and cognitively impaired with MMSE >15.

16

Yesavage Geriatric Depression Yesavage Geriatric Depression Scale (GDS)Scale (GDS)

LimitationsCannot be used if client cannot self-

report such as those with severe depression and / or psychosis

Questionable reliability with MMSE <15Cannot discriminate between clinical

diagnostic categories and changes over time

17

Cornell Scale for Depression in Cornell Scale for Depression in Dementia (CSDD)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

Strength Able to assess for depression in clients

with Advanced dementia

Limitations Requires clinician Not self-administered Takes longer

Cornell Scale for Depression in Cornell Scale for Depression in Dementia (CSDD) Dementia (CSDD)

(Tool available for viewing online at http://www.aafp.org/afp/20020915/1001.html)

19

SummarySummary 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?QUESTIONS?