55
• tht HOW DEMENTIA COMPLICATES THE CARE OF OTHER DISORDERS Touro University November 8, 2013
• tht
HOW DEMENTIA COMPLICATES THE CARE OF OTHER DISORDERS Touro University November 8, 2013
Steven E. Rubin, MD
ADULT & GERIATRIC PSYCHIATRY FORENSIC CONSULTATION CLINICAL, CONTINUING and COMMUNITY EDUCATION
AUTUMN LEAVES AGING, WITH and WITHOUT
DEMENTIA
DEMENTIA: A MUSICAL?
ALZHEIMER’S TOP TEN CAUSES
The below training materials were supported by grant number UB4HP19205 between
2010 and 2015 from the Health Resources and Services Administration (HRSA), an
operating division of the U.S. Department of Health and Human Services (DHHS). The
contents are solely the responsibility of the authors and do not necessarily represent the
official views of HRSA, DHHS, or the Nevada Geriatric Education Consortium partners. The
Nevada Geriatric Education Consortium partners included: University of Nevada School of
Medicine, University of Nevada, Las Vegas, Touro University Nevada and Desert Meadows
AHEC. Please note that Continuing Education Credit is not available for these educational
resources.
DISCLOSE AND DISCLAIM
No financial vestments or conflict of interests
Medications discussed may be “Off-label” and referred to either by brand or generic names.
THE BRAIN
IS LIKE A TREE
HOW DEMENTIA COMPLICATES
CARE OF OTHER
DISORDERS
MEDICARE ANNUAL WELLNESS VISIT
The AWV,
Stages of Dementia, and Treatment Plans
QUANTITY
QUALITY
QUALITY
. ....cnc.
.
QUICK REFERENCE INFORMATION:
The ABCs of Providing the Annual Wellness Visit
MedleaCOYt!Batl Mnutl V'l.f&lk'!HsVISit (I#NJ PIO'kll119 P n_,t<l Pfto\<fnllon Pian SeMoN (PPP$).TneA'M/ hCIIIOeS 8Hea!ttl Rls'c ASMUneftl(HRA).A bMf $'Jtm\afY cf lfletnirimum elementt
inct.ded in the HRA is below.Addiic.'ltheCe.nleqfor DiNa.Control andPr9119n$:>n (CO¢) publlsiMICJ"AFtafOt Pelient.C..red Ht<tlRlst Atleumenlt: PfO\I\:IIng Heal:h PfomoliOtl afld
OIMUe ventiOft 5efllilO Mediea!e B&.tlefidlrles.'This framework irQidoos Mctbnt about tilt' Nttory o1HAM. detlning the HRAMel18t le tor •• \IM, HRA tJM 811d foll<wt..l4) inteiWI.,_tOn&
thet t'ridence &1J9018MlC8ll fl'lfueftce hNIIh behavicn, aJCI 8$UOGW.od 101 ol HRAquostlon..FOf mof'l i'labout HRAt,¥1111 hi'P:Jiwww.cde(!OI!pOIICWOI)!hlhrafFtel'l'leWOrkfOrttRA...e!0t1tl'le lr'II&IMl
Yov muflPI'O'Y\041.Of provlcl& aftd reeer. all CO'I'IpOtlenbef tM A'IN priOt 1o st.tln'ting 1dMn tot theAYN.Mocfa,. tht A.WV fol ten riiiJs..tlonnolonger InfirM t 2 monlhe of ltlelf l'irft P rl B COI4ttge Pttio<l ._.... 4WI<Jtd ttft doctmarntII»twoaeetiOtr. lf'e intexplaineslements inctlded inthe firM AWl/ a bontfi"ciary receive-.end tho Moond P:•ins ttw elemtMt indl.ldtd kl el$UbMQuonl AWls.
Pif,e"fiOOt!N/JJINis 8 &epeIC.Ml"itCe ffOm &be lrtllal Pte\lenliYe Phyaical Examinaion(IPPE, Po known h thoo "Welcomek1Mccllcare Prwcnttve \11sir),
Elements of the F1RST AWV Providi ag PPPS
A< tJ t mt 111 "• u 1 \IH tll"'o"-'
, , ,, ){11'110'
C HtatthRttk A•••wn.nt C<ll&els seJ.riii)Otted il'lformstiotl known eolle benef.dlry;
Can t>e achinil&eredby N bendclaty or hea!IJ'I PfO{essionot befole.or uportGf, 11\t!AYNencow!IOf;
TOliN no n»re non 20 * to• to;61'14
At a mhtdclreues tM totopiea: Detnogftlphiedata, Sei OfhHIIhe&eM,
P&)'dloaoclel ri!b, BeMvlorat rilb, AaMiiel oldatyiMng (AOU), and
ln51rumeMat A.DU.
D E l'lmtnt of t"- benefkialy's1Mdkl6/lamlf)'lllslofy N CI01IM:t andd0Qimon41ho
Pest modai.,:w:t .UJVhWoty, .x nosa,._ 1.._., MIYt...atef;IN,"'iurilrt.and ......,..,.: Ute of Of ro10lcalcinIlUP........,I». t\dl.di'lgc:elcium end•fi'Mis;and
"""1$h the btl1ffid11)1'a PiiiritlttalilYtn<1 dlld"t91.1. .....tl\all:may bt he>f'tCIQ!yorpl.ce the
ReoMw of the beneflcWy'a pottfllfat r1•k r.ctOt* br
·- atinc:re M d .
_ mry te»ct tom*fOil•.vahtte eereenlng or 818ndatdked que,Stiot'lnaifel dKigned fOf this purpos.a tn6
D U.atty title tcrett ii'IQI instrument tot pe1SO!'dlloithout a c Mront t1i119ontotls wti:rii'IOfiMih protessionflYl
<'tf)fNaiOn. lndi'Cin,g cu,.._ftlor l)lat•.ll*"lll'lett wtt .e'ect tom variOus ..,.bble•etlder«<lze6 scteH ing '"*'dest;ned for !tis putpOM ond iatdby no.lional prolsslionll
C .. olu. "ll.lnctlontl MlellntydII HI U•dhct cbM!'W'aiSct'l 01'll'f beneldety.Of tlly a» actHnlr$ Illor asetet'*'Q queS'tiOmail'e,WhiCh the rwatll'l
.
....ThiAMAdte$no!OllndIMC!Ic:iMOtd.,_.fNidica1IIMOIJ, TIIIAMA""""'" no-
depmtiOn or other mood dlaotdei'S mediCal enlteUotls.
lied byneiJor'tattnedlatlotV*f'lltarJGntto
HerWttQ
••aa..••mlflil'l'lm,hfOiowinO tOfllel: ·
. hlpeirmenl, '
Hill)' to lly peliotmADl••
F•rtsk,an<l HomeMfety,
ICN 90 706 January 2012 CPT.vy 2tt i Atloei81ion.M,.,.Itwwtd.CPTit aW ofl"-AII'IetbtiMed.ceiiiModellon. "-RSIMARSRewl*niAW/IO tU•"- *·'_._..f..,.l,llllt.. I8CIOrt«'WS//f• e tocrn •• O'JIIIIIMA.nl'lOIPettoiCPT,a : -.eAMAitftOtrec:orntner < i'tllheil.
lOtII-01not«M''I8htcc tlet$11\
'*"" .,. ""'*"""nt
[ lcnu n tJ oftlle •·t RT AWV PJ'Ovidine.l'J»J>s (wn(.)
D An .s...-nont OOUin lhe fOiowlng rneoasutemeontl:
• HelgM. weiO'It,boltymass incJ&x (or waistCrc!.WIIfoi"CC''Qt,lf •wopriattl.1nd blood p,.. .ure;snd • OCher IOU!Il'le tnNtiXernetlts •Clt!emecl apptOpriiiiO, blsod on modlclt and famlty tistoly,
Q &albll.,.,_nt of a ltll of CUrNnlprcwldtt't MdIUPPier8
C O.btellofl of ...y C<JQI"'tll'lt ln'lf)lf,....,l tMl the bonefkllaty my Nve
AUoOh thebonofic:ill)'t c:og,.._ f.anction by di!'9Ct ol»ervablotl.tMitl '*tconstleralbn Of obt.,...d t,.WlfoJ Of patient reports
•nd conoorns f1CMd by flm'ly metrbrlf'S, ltltncft. Cllrtlakers.or others.
Col '\'-rllH'IIIt i\IH '''''HII'lll" IJ Ettabtlhi'Hlltof 8wl1tt.1tc,.tnifiSI attl8dll!t tor ttM
beneflcUry,1\ICh .. I dltdl:lflt f04' thl next 6 -10yNrs,
•••ppropllat•
C E&Uiblshnlolnl cl•Ill Olfind c;ottetitlonl for
wt.ltnt' oe prtmwy,••co, o.t,t.rtt.ry r=«,.....dOt fuor lh1blntlc;llry
C Funfthit'ISI Of ptt'lontllud fiN•rt 8dvlce to the benellolery
and1 *lft't, 11epproptlale,to I'INithldueatiol"' or port Mfve COUI'IIeling MI"'IC81
Basewtitl8'1IO'!Hni1g Khodule Of O:
RfiCOJTmend lltionJ '-om lhoU.St.IC$ Prtwrrtlva Serv1oM Tlltlt F ce (U$PSlF) and theAdvlwyCOtm'll!ee onlf'M'IUI"'IU!iOn
Pnc:tioh (ACIP),
• The benefie:illl)'lhea11h staiUt lnd SO"etr*l!h!Aofy, and'
• Afe-ar:f)t'Of:ltlnprevl!t'lliwl seMc::u C C Wf11d byModlt&r., lndl.klelh'e .
• My tMfllal heell'l COfldllloM «llt'tf 8UCh rf&k feCIOtlot ('.IOnciti:)ns ldonW!Iod l!f'OU!ilh 1n IPPE, .ncl
. • A Itt d ov.IOMend flefr ·NU endbetleJta..
ln®det re;errals to prog,.m,aimed at Commu -bnedlle lnle'YIAionl to reduct hMI!h •ltklltldptOn'IO(ie 18fo(l'lltlltld wellneu,
'Nelghtloll. PI'Tytic;lldW!y, l
O!:IIQOO....SOCHI.eiOI\.
Filii pt YC nlion.ancl NWilion.
Elcmen tsofSUlJSEQUENT AWV§ Providi ng PPPS
A t 1.)1 HH l I'll\ II n1UIh I'H\ ll I 1 H.\ Il l " I{II'I I ll'\:
C UpQW of ""llh rlllt..,uwnent Cc.lectl sel-r1Q0111ed lnforrNIJtn ktlown tot'le bt:ne1k:la1Y. Can bOacfminisllll«< by 1MbtlltlicitY or hulthprolttalcnll belol"', Of 81pert d,bA'IN
Tlt t'l()tnofa "''"20 m'nu..,to:and
Ata•dd"''"''"- A>li:Ming tollb: Oemogrspfllc hta.
8e""-tSO$$I'flfltlt ot lleolh.u.ws, Psycha.ociat risb. Bei!IWiorll risQ.,
AOla., alld IM1n.menlolADL.s.
At •mlnn.nn, upcii!ID •nd ctowmert the fo
Patmdcat and tufVIC81hisloy,t.::blngw:th il........,.,tmptalttays,OJI8fltlo W.. alefg!es, lfiUflet., 8fld walrr'l«'lta;
Uae Of or uretomedicat:ttls1t1d suppltmel lll, holudlngc:.lc*;.frl•nd;.-d Meclk:8f Wensrn lhe bonolcilw('tpltelntland ll'rJ aiblings n dlllttrel\ lndudingdi10t11Cf 1t1tt mey be '*'<!itaryor p1eoe the beaefidlry81 inCJNMd rist.
,
Practitioner Compliance Best Health Care Provision
Realistic, enjoyable, lucrative (enough)
*EFFICIENCY *KNOWLEDGE
(information applied sensibly)
Comprehension Capacity
Treatment Compliance
ACQUIRE INFORMATION
Subjective Hx Collateral Info
Physical/Mental Exam Standardized Cognitive Tests
Labs and Radiology
P fent N·- UJl IDX s:tJ;b[ bQIP:illllll)tl
o.to ,_ 0
-
asoo Date ...,., Date
1) •> 2) 5)
3) 6)
Ph-fticianllRIIFliliGitta mY g,twent!x HI
Name/ Specialty Nome/ SpeOolty
1) •> 2) S)
Lil& IDX tlltrvin &Q m.tSIIWkl:o. K·ll!X2[food.
Allergy Reaction
Lias IDX ID:aliatloa &bls xaw wamstx SID i!!Sfus:li!JS12lti'[""Jt.-.cowaler. Name Svength 0\re<tion Pre=obe<l by
Do you drink alcohol?................D No 0 Yes If )"1$ how much?
Are othe<s <oocemed about your drinking' 0 No D Yes
Diet OBaal nced DVegetarian ODiabetic OLow salt OLow fat OLow carb OOther:
Educatioo:0 High school 0 College 0 Some College 0 Trade school 0 Other.
Do you do some form of regul<!r e'""'Cise every day? 0 No DYes
I(how much?
Maritll Status: 0 Married 0Single 0DMlrced 0Widowed O O!hfr Occupation:
List OYet)<lne in your household including pet<:
Do you wror seatbctts? ....-----·----···-----····· --·-·0 No DYes
Have you ever smoked 0< lobacco? ··---·--·ONo DYes I{how much?
Ver.Ll_070711
Matylancl
·------------- ___
5).
PnmaryCare Phystctans
Medicare Annual Wellness Visit
Questionnaire
------------------ --- --W-I--- -----IJit$1
iiOOii
te of Birth:
CYY
Homt AddtHS: ------mfilt
rti;Tn------
Gend<r. 0 FerNie 0 Male
HSSom#:t - __-- - - _
.<PFIUNI< --.-
c.tll'tlono:
Nmof IGn({or tmtrgtncyj: -------------------- ------------------------
Namt of Spo<lst:--------------.,--------------
D•y Phone:
Referredby: _ _ _ _
Insurance: Name ----- -------- -------- ---- Phone II
Policyt -- ---- -- -- -- -- ---- -
Lilt; •py CU!Df)t mtdkal probltmt or conditionJ.
!),
Group I
n----------
· ·----------- -------------- -------
4)---------------------- 5)
6)
·------------ 1 ·-------------------- lll•---------------------
.1---------------------
Chitdbopd II! Dft"'
2·,)----------
U!naan
3),
5)·--------------
·--------------- 6)•-------------- Chronic
!),
Loot fyo{<;Nucomolum:
3),
·-------------- ,,, ___
2), _ •>·------ Dote
1),_ _
5)· - - -
Ve<. l.l_070711
«W------------------------------ Dolo of INrth: --- -- -- -
ROUTN I E JASKS: PINgjnctjgztr If""" do ordo pot nud http pcrfpanloq Ibm coutiac tgsb
1) Feeding yourself DNo DYes If yes,wllo helps?r __
2) Getting from bed to chair DNo DYes If yeo, who helps?
3) Getting to the toilet DNo DYes Ifwho helps?
4) Getting dres<ed DNo OYes Ifwhohelps?
5) Bathing ()( showering DNo OYes If yes. whohelps?
6) Walking across the room
(includesusing tane or walker] ONo DYes If YI!S. who helps?
7) Using tho telej)hone ONo DYes If yes. wllo helps1
8) Taking your medicines ONo OYes If yes. wllo helps?
9) Pr-ring meals ONo OYes If yes. who IM!psl
10)Monoging money
(likekl<lping trac:kof_.,..orPl)ing bils) ONo OYos If yes. who holps?
U) Modately strenuoushouseworlc such as doing thelaundry ONo OY« IIyes. who helps?
12) Shopping for penonaJ items lki e toiletries
or medicines ONo OYes If yeo, who helps!
1.3) Shopp;ng for groceries
14) Driving
ONo DYes
ONo DYes
Ifwllo helps?
If yes, wllo helps1
15) Climbing •Hight of stairs ONo DYes If yes, wllo helps!
P\Nst list 10¥ btalth FMOb!tMliDd 'MifMof dtftb jf tPPinHe
living1 Deceosed Age Medical Problems
Father
Mother
8rother(s)
Sister(s)
Mother'sf"'het
Mocher's mother --- ---------
Fathe<'sfathet
Father"s mo-ther
Vor, U..0707U
m·-------------
eftaM rttOrd thc.lmt WW WPM hpd the fW'=iPJL H you 4e 1!9( t ppw ltgw blqnk.
fiepB {mot)-·---····--·--·--·------·- Hearing Exam, ..................... ...... - - - Flu vaccine (shot)....... ................................... _
Pneumonia wcclne (shot) .......................____
Tetnos ...mettn'--- - -
Zo<Uvax{shot) - - -- - - - Abdom.Aortic Aneuoysm Screening....
Bone Density $Can ......................... .............. Colono«:Oj))l............... ,_ _,.................
Diabetesf Management Training_
Hemocult......................................... __
Upid Panel ...---- -------------
Nulritionol Tl>on>py - -- Pap Smear_..............._. ,
Pel vic Exam......................................
Prostate Exam----·-···-··-·-···- - - - -
PSATest
d Mn·-----------.- ----Rectal Exam
Eye Glaucoma Exam·-
Glucose...... ...................-................... _
Smoking Cessation..._, , _ -----
HEARING: Ch«Jr NO,Yfi. 01' SOHE TI MES for oodt qutStion
1)Do you find it difficult to follow a convet1ation in•
noisy restaurant 0( crowded room?.................--·-----·--·-···-............. .--0 No o Yes 0 Sometimes
2) Do yow sometimes fee.l that pie are mumbling or not
speaking d<otly? -----------·-·--·---------------0 No 0 Yes 0 SomEtimes
J)Do you - difficulty folloMng <ialogue in the theat«1--0 No 0Yes 0SomEtimes
4) Do you sometimes find it diff'IC1lto undOtStand a speaker at
a public meeting or (efigious s...vlce? .................................................................0 No 0Yes 0 Sometimes
S) Doyou find yourwlf asking peoplespeak up or repeat tllemselves? _o No oYes o SomEtimes
6) Do you find meft'svoiceseasier tounde<Stand than_,..,·,? --- 0 No O Yos OSometifi'IH
·n Do you eq>et oo a <iffiaJity ...-ncr"9soft or whi_...:t spe«t?_o No oYes oSom<!Umes
8) Do you som<timos hdaifficulty undef'SiiOnding >peed>
on the telephoner............................................................................. ... .........................0 No 0Yes 0 Sometimes
9) Does a hearing problem cause you to feel embarrused when
meeting new people? 0 No 0 Yes 0Som<!Umes
10) Doyou feel handicapped by • hearing problern?..................................... o No oYH oSometimes
11) Does a hearing problem cause you to visit friends. relatives.
or neighbors less often than you would like? ................-.........................0 No 0Yes 0 Sometimes
U) Do you ""perlenco ringing ex nol5<5 in yoor oMS? ... ............... ..............0 No 0Yts 0 Sometimes
U) Do you hoor better with one ear than the Olher? ,_, ,_,oNo 0 Yes 0Som<!Umes
14) Have you had any significant noise exposure during woc1c,
recreation,0( military sei'Vice? ................ ...................................... ... ..............0 No 0Yes 0 Sometimes
1S) Have a ny of your rela{tbi y birth) had a hearing loss? .......................0 No 0 Y« 0 Sometimes
Vflf , 1.1..070711
Yes Nn 6. C..n you get places out of
walking distance without help? Por example. can you travel alone by bus. taxi.or drive your owncar?
7.Can you shop for grocorles or clothes without helo?
8.Can you prepare your own meals?
9.CiUl you do your own housework wlthout belo?
10.CiUl you handle you r own monev without helo7
11. Do you need help eating. bathing.dressing.or getting around your home?
I Name: Date: Date of Birth:
A Checkllst for Your Medicare Wellness Annual Visit
Pieo< compleu thlschocklist before ,,.,"9your doctor or nurse.Your otUW•rs will help you roceive the best
health core possible.
1. During the past 4 WCfks how much have you beenbothered by emotional problems suchas feeling arudous, deplnitable.sad or downhearted illld blue?
Not at all
Slighdy
Moderately
Quil2.bit
E><tremely
2. During the past 4 weeks has your physical and emotional health limited your social act1vldes with family friends.neighbors or grou ps?
S During tbe past 4wCfks.what was the harden physical activity you could do forat least 2
minuteS? Veryheary He-avy· ·· 1· .·_.
Moderate
Light
Very light
Not at all
Slightly
Moderately
Quite a bit
Extremely
3.During the past 4 wteb bow much bodHy pain have you aenerally had?
No palo
Very mUd pain
Mild pain
Moderatepain
Severe pain
4. During the past 4 weeh was someone available to help you If you needed and wanted
htlp? For example. if you felt vtry nervous,
lonely or blue,aot sick and had to stay in bed. needed someone to talk to, needed help with dally chores,or needed help just taking care of yourself.
Ye., as much as I wanted
Yes, quite a bit
Yes. some
Yes,alitde
No, not at all
12.D!Jring the pa:g '\ Wms bow would you
rate yohuealth In sc?eral? .· El<cellent i
Verygood
Good. fair
Poor
13. How have things been going for yo"du ring
the p;!$14 weeks? Very well · could hardly be better
Pretty good Good and bad parts aboutequal
Pretty bad
Very bad· could hardly be worse
1
p.m------------------- --- -------------
Please write your answer in the spaceprovided.
O...ofllloth: __
lJ litdc interest or pleasure in doing things.
2) fe<ling down. d<!pressed,or hoptless
Key:
O·Not at aU 1·1doys 2·Mor•thon hal/ !h.doys 3·Nfotly -rydoy
Pl. .se check the awropriat•answer.
1) Ateyou afradi of fall ng?
2) Have you fallen in the past year?
3) I,f.y,e_s,.c.i.rc,le the circumstances surrounding the fall.
Tripped CMr something
Llghtheodedn& orpolpitotions prior to
Lo.ss of contelousnw
Injured
Needed to SH o doaot
Able to get vp on own
O No D Yes
DNo D Yes
Do you have o n OirectiYelling will)? 0 No 0 Yes N es:
Authorized S:'!jnature:- -- - ------ - ----- - - --- - - -Date:- - --- -
Reviewed by. Date: -- - -
Standardized Cognitive Testing
ALZHEIMER'S ASSOCIATION --- - - - - -- -
Si symproais present -- ·lilt ---,
1----- lrlonnant a.a-lable 10C0'1(wm
Follow updum+g subscqu..,.AWV
•
BrioiU$0$$111tnt(o) lriggel$ concerns:Patient Mini-Cog <3GI'OlG <5!5-a score is indewmlnate wi11>oUI informant) or MIS<4 or lnlonnant Shon IOCOOE >3.38 or AD8>2 or GPCOG informant seora'Nith patientscore <8
• No one tool is recognized as1he best brief assessment to detannine if e full dementia eveluallcn is
ll88ded.Some providers repeat patient assessment wid> an al temate tool!e.g • SlUMS.or MoCAJ to confirm initial findings before referralorinitiation of f\111 dementia evaluation.
ADI•Eigh·t ilffn Informant Interview Ill Differentiate Aging and Dementia; AWV •Annual Wellness 1/isi't GPCOG•Gcnctal Proctilioner Assessment of Cognition: HRAHeelthRisk As>essment MIS • Mernocy Impairment Screen; MMSEMjni Mental Starus Exam:MoCA •Montreal Cognitive Assessment SLUMS =StLouis University MentalSllltusExam; Sholl IQCODE •Sltort lnfOONitt Questionnaire on Cognitive Decline in the Elderly
Ccrdoll C8.8ol>ons.Boo.:staniM.ChodOsh J.Reuben D. Ve<Pse J.et al.Almeunel's Assotoat1011 for opennionefiziqj lhe detection of a>gnilive impairment during 111t Medicare An"""l Wellness VISit on a prlmal'f care ..tting. Ab!!eimen llM>er>t.2012.1n pnu.
800 212 3900 I alz org alzhc•mcra's »ooal •on
'
ABSTRACTIO -- --
DEl).YfOR £ (;.ll
rf== l ? MONTREALCOGNITIVE ASSESSMENT (MOCA) Eclucotlon : oouotbi<th:
Version 7.1Original V:..:e;;.r.:;s.:;1on;;;;.. -
VI SUOSPATII\l DECUT I VE
w .JFJ.. ® <D..·····® -
llo9ln
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LANGUAGE
I N
.. .
_14 8
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SLUMS Examination Quest ions about lhis assessment tool? E·mJII aajnr@lly cdy
Nls p-ati-eG-t a-!-en-?-------------------
Le-ve-l o-f e-d-uc-at-io-n ----------------------
_fl
_f l
_fl
0 I.Wbat til)' oftbe •nek Is It?_
0 2.Wbat is tbt ynr? - '-
0
:·S-::; S. ._.. -;;
.... - .
_13
_13
_fS
_f2
J.Wbahtateare e>la'£!-- cs: ·::a ..:;::--- '"'•'''d - 4.Pl<a>e rtm<tDber tbeoe liVe obJetts.lwiD oskyou Wht t t)'art bter.
Apple Pen TIC Bouse Car
S. You have $100 and you go to tbe store and buy a doua appltt for S3 and a tricycle ror 520.
0 How mucb dkl you spead!
Uo"·muth do you ave left?
6.Pkue n.ame as many aolm:als as you-o in one mi.nute.
CD 0-4animals 0S-9animals 8 t0-14animals CHS+animoh
0
7.Wbat were the five obje<:ts I tiked you to rtmembtr? I point for eoeh one correct . 8.1 tam ROinlto a.ive you a series ofnumben and I would like you to cive them to me baciM·anls.
For uamplt,if! uy 42,you would say 24.
CD 87 0 649 0 8537 9. This is a clock race.Pluse put iD the boar marken and tbt time at
to o'clock. ttn mi.outa tlt\'tn
8 Hour marlcenoi<Ay
_f2 0 to.;.::.::•:• xln•••niall& DL D 0 W\l<h of the a ben fiplftis lugest!
11. J am coin& to teU you a story.Please tit:tm taref•llb' bea.ute afterwards. I'm going to ask you
ome questions about iL
Jill wu a very su=ssful stockbroker.She made a lot of money on lhes10ek market. She theG met Jack.a devastlltingly handsome man.She manied him and hod three chlldren. They lived inChlcago. She then stopped work and $14yed at home to bring up her children. When they were teenagers, she werll bllck to work. She and Jack Lived happily ever af\er.
@ '\Vbat WIJ tbc fc•ale's name? @ \Vbat work did sbe do?
_18 @ 'Wbeo did tbt ao back to work? 8\Vbat llate did she live in?
TOTALSCORE
I'V"'- Department of
\!t) Veterans Affairs
BJca Saloo&.&'DucAno:-r 17-30
21-16
1-lO
•Mild Ncurocoanitivc Diaotder
Normal MNCD' Deaa tio
LasniA. IIJca Sal.ooL EJK;cmos lS-Jt 20-24
1-19
SH TltiQ. N '1'\imosa. nOllbna11.HM P«Yy Ill, tnd JE Morley. Tbe Saint LoW Unlvm.IOO Mc:Dtal Slab:at(SLUMS) ElwniMtioo for Of:1ecrine Mild Coanffive
lmpairmcm Mel Dcmcnt.la b morte s!th'Cilharl Ole M:inl.Men31SmusoExuninalion (MMS£)·A piiOIII!.Kty. I am Ooriatri
MENTAL and
COGNITIVE STATUS EXAM
TO VALIDATE YOUR MEDICAL KNOWLEDGE
APPLY YOUR FIVE SENSES
Perform MSE Simultaneous to Review of Systems and Physical
Exam
Observe or test re: Appearance
Behavior Thought process/content
FTT Imminence/eventuality
Ask or assess re: Anxiety, depression, anger SI, HI, PI (et al alterations)
Memory/Executive Functions Capacity to thrive
Biopsychosocial risks for depression and suicide
are increased
The Diagnosis is in the History
Screen Top 10 Causes
1. Cardiovascular 2. Pulmonary
3. Sleep 4. ETOH
5. RX
6. PO 7. TBI
8. Biology and Genetics 9. Iatrogenic
10. SOYA
HOW DEMENTIA COMPLICATES THE CARE OF OTHER DISORDERS
Co-Morbidities Complacity
Treatment Complexity
Caregiver Burden
The AWV assists the diagnosis
of the Dementia and stage,
and thus the Treatment
·.
Comprehension
Capacity
Burden of Treatment Compliance
0...00-
0..IMtlllf am,.arm.nt1«itrMI'IIt8
Ol.fld
PaMnt NiMt'le: ----- - - - - - - --
PSVCHOLOClCAL & CUNICAL eVALUATION
1. PlfYSICAL AND MeNTAL CONDITIONS
------- -------------- -- ------------
M--HM!tw.
e.c.nom
Fiir Over.a M.,.....H. ll\ will B B Oodino
k lli'llgMing FKtora.Ate ! '.ere tNligllin; feolln C•·e.. twlll'tlg.ot apMCh1, bnlwment, «c.) thai CMIM 11110•rrnc.pae t -.d lnd OOI..IId ir'l"'ppi'CMMIII'M.
QI'Uii$Md W c:es? 0V• ONo 0
c;. C.U...........,. otCIIJMS Ofmental l'npelm'lel"'t bMn ev1l.llled •ncl
- O vo• 0 No o u-
0. Lftt..»a ilctliona. - - ----- - --- - - --- - -----
£
·..
-0Vot 0N o 0= '"""""" 1II'WMntoontrol&llb..w9th 1Mdlctltlon1
<Mran Pl'lyU:alMelllh will B
2.COGNITIVE FUNCTIONING Falr o.cr..
t• ......,AdMit)o....., _..( l!!'*...shmowlkilla) t,et.oe cf rmotnt: 0 Nan• OMi'lcl OModerl• 0,.. 0Notl'llal.
2. Wottcklo"*' .
',
(llli:Md""' \Wo
tW.I.II..0...1. ..,"*-"-
oCM r thOtt liM: period ::h
.oldo2l..t.M.
IInftlh:S)
3. ShorLt tanortJr-.ctenit.I'I,"'M_MIfY and Ln mirl
ot.J
".tl
"ii
'ty tooo
encocllo Mote
o.*'IInlllrilw
o....-. 4. L.ont.tw..m.".'*."',''f.Y,(r_em.mboer fn..f.o.f.m..a. tioof'l to..m..N os r)
o-. o...-. S. llndo..-lnf r._..,.-o';CXJIII)IthondWIIMJIIOI<on.OI O.al )
Level 01lmp irment: 0 Nona 0UilrJ 0 .,0 SeYet. 0Net t¥111.
L r lillriiJulee-: MilIn WCitdt,Wl'i*!g, lfgns;lrdcaChoicM)
oflmt 0 HOI,. 0Mild 0MCIOtftert 0S 0Not tvtf.
OM <
0- 0S.V...
on,.......
0 No Wlpa'n'nett or mil n
.......... o ..... o- o-.,. o-. o.......
.....,..._. ...,., o -· o- o-os.- a.........
8
0
· ------- ------ ------ ------ --- 1. A l......,. iN tic t o ,_......... oM- os -.. o........ I. VtrbllR.-oning (.ciOn'!part two c:hok:eland to ._.. )
.......,_ 0 Nono 0- 0Not.,.,,
a. bJic..u..C...i. ;fu (pllnboib..f.l..t.b. .no. c.t...+. 'IoO.I .n.W. Mo.sii.S-4oc o; ......... )
31... E-MO.-..l.l.O.l,N0lANL A!HO-'P-SYC"HIA'T9RIC ,UNC-TIO-N.IHG -) 0 NOno 0Mid 0-. 0Sew" 0 Not. .ll. d itnpllhntlnll vNn o ,.....,.dellypoJ'(I'KIII'09ie mediC::IOcJM,.
l. Hd Ndon•(..-.inQ, hNN!g.INMiing11111'1;CNC ere no1 )or O.lus10M (...nme wsp:iclou$1'14!11; believlrlg IJ!i1g51hal _.nc:C WI IQIIIMt tt•$0n or )
0No OI mftd ""'*'on ps med'ICIIIofiS.
'· Anxle..ty....
' W '(Jtt J. I0
a,t,1tC
Oiu"rd
) 0.._,,. 0Sevoro a........
0NoWlpa"""«t or mN impelrrnett ¥tfleo on, larlclailyc mtdic:aliol'l$..
4.(...-yh9'mood., . ;' ..... et*VY)
IA¥el of impelln*'ll: 0 Non. 0MilO I:] - CJ QNot evtll,
0No IITC)81rmer:t 01ll'likwl "'lln p$J(fdl_,lrl8dlcldions.
s. o., t e M M ood caecs 01 1n1111o1e moocJ
o..-._ .....,""'"""""'........._..,..,....,....,.-... s. lf'l•lt.tr.t.(.l.tl.l.lt.y b ec g eoilnM6 anod
helltl01Nonc:omfl('l.811o::1:11CthiiiiiP)
0No01mildIwttenon rwgWrt!IMy pt)'CI'IOtropie medic:don$,
7, -..il(ed!rlglllli:boulCCJI'WdllmGNCIOP i iOMfA
o.........
L.ewf di'npollirmwlt 0 None 0Mild 0Mo0er11 0s. Cl Nolct'lll.
0 No IIT\pllin'ntntotmitd impeltmet!t when on ily
4. RJSK OF HARM AND LEVELOF IUPERVISION NEEDED
A. Mow MWN t. t1•1t o1Mtmto...,or DNont 0MiliCI 0 Ds.vore 0 No •ilk wt en on131/delly psyctiOtJ'OJ*;.medlce
,. - lllooll'"lt: o- o- o-"" a.._ Ho ri5ll.wtw.n on rt rldlly P•meclicaiiOna.
c. · NMdilcl. tnyour
l.oc:bd trdlity 0 2"-'hr auporoAtlon 0 Som•· 0 No IIJpe!'Vitlon Noorimlled ..nen on Qa'rdcb.,.
1
...,.._now
C... . i$ -. . . .I.M n o (A I)I.'oloncl-
-
_7
......._ ___ _
S. EVERYDAY FUNCTIONINO
§ § §§ "Pr"tp'"e";.'.".'m-
nl.t..M..._d.-.lntoc.r:.el.du.e_cqfuinoegM.".t".rl."ti.'O".f."t.'·.O..'o.s.o.iro. -ro._,
F1ntndal (H' cl611arlimltt)
-wthhold medlcll OMaa'IC
§ § MIMgeand Ul8c:Ncb.wiflcnw,
-..x-,.Jrwat
er.tr.o aCIDI'OWC!l.....•...-.,--• •ven•t en-lli01 t l 01 .... hi""'- tMioft,cotrdon, Ul"'dut lnfiiHOOt
Admit Mlf to hNIItt JKIKty
MeM or cNI'IOtandiNcf:M
CorUclMJpltll Otitll
cttmom
ofi.a.:nd C
,.•..•m•u•nl,y u..
Mtintlin..t.an6 Mn lfltltlr o.tv•oruMIIU!I"ie .....W'ldCl)nlf t'.. . cfloic:ealbout /lwottJ .,.,io••....,,.,.._,.ucf'\ .. ww:1 obtln emerglf'IC'f "'-
S. CAPACITY AHOATTENDANCEAT HIAIUNGS
A. d..l>..c.u.m...m.&..,.D.IoIQe&.l,'lt_vefthiot ca.P"4("ity"'._, ooov.. o...lnd •UOJOt
.- a. Yotinre- Ooet pMient ""'*=- toundetltand andvow
klrmsMI10¥<*? Q Y8f 0 No QlJnotfUIII'I
e. - .._._ .. ov.. Q No o....... 0. OWI'IIng 01 pwn:;Nslng a tr Mttn. WOIAdl)reMtlt a Nk or lneiiO Mlf 01 II plllllft
._.,.k)CJwnOt llirNm\1 C]YM QNo 0
E. a1 t.Mr1nt roprclllng vu-rdllnehlp.
o._............ 0Pltllnt WOIM nottht r•Mon for lhndanct 8t the *MoMel COI.IId not
l """""'
-· "*"""
Petl.n&Millme:_ _ _ _ _
c:ol(fl)uce10 lhtP
·t
.O
....t
..s.
wou&d· -:o ·men......
F. A$JOllb- lt olillbclrney. -- olh,...Csdf#ll l»a6.....,._..JW
- ?-[JYoo 0Mo
0Patient haS rcnentd a.n.
-O -o ,....b ···,... would tll topilbld't.
0Pa&rc WOUid ftOt (:iOIT;pllihln6tnt t'IMd ror a:m.v 111oon.
o.R
.tspo
-nM
.Cfpru.nt: --- -- ----------
-
0?alieni•taplbte ctlncSeprtnder..ty atJO does notaOIJidln.
0PMnllsC PCJ tot «k'llmlr.mtl \llt96
,._ 10;,ke miiCIIcMions INl/ot ast.iMW!ee wl:t'l medie.tl and lnlnd(.iJtnl'!Qd guel'df:wlelllporene
0PWt! ctMOt t.oe l'lly trnd reQ\Jim aQ!Atdaf\ fOr all tneOieal tw'ld1\Nnoill cttdsloot (fu ill'! ).
0MICI toro-dia:wlipwWi pofitnl WCIUid bt .,HIItttrl:nti"MM healt\.
0 PaMnlhM,.._.-ctlhlt be IOCIOhtc: •
OAT£0 INo _ ..,.., 20_.
Fonn must be signedby 1physlclen1icen11d topractlce In Nevada. a physldan employed by tilt Votorans Admlni5tntlon.or1poychlllrist or peycllo
liunMcllo pqc:tlce In -
•
----------- ------ ------ ------ A soc:lal worker or ca..manager m•y aulat In cOmpletion of this fotm. but
cannot cornplellt1M fonn t11o a Qnot>nol phyololan, .-yc >llttlot or poychologisl
DAtto bl_ Otr(of 20_
Bio-Psycho-Social: The Individual in his/her Environment
Communicate: Pt, caregivers, extenders, ancillary
Resource Realities
< 10 RXs (6?)
