1. DRAFT Promotional Copy for NNSDO 1 Cognitive / Mental Status Assessment of Older Adults

2. 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. 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. 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. 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. 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. 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. 8 Components of Mental Status Assessment Alertness / Level of Consciousness Attention Comprehension Construction Emotional Status Higher Memory Function

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

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

11. 11 Folstein Mini-Mental Status 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. 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. 13 Yesavage Geriatric Depression Scale (GDS) Purpose: screen for depression Scale:  0 = no depression  >5 = refer for follow up diagnosis  30 = very depressed GDS Try This Assessment Series available on Hartford Institute website at www.hartfordign.org

14. 14 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. 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. 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. 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. 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 Dementia (CSDD) Cornell Scale for Depression in Dementia (CSDD) (Tool available for viewing online at http://www.aafp.org/afp/20020915/1001.html)

19. 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. 20 Web sites www.minimental.com/MSRS/htm http://www.medafile.com/mmses.htm http://arcc.stanford.edu/videos.html

21. 21 QUESTIONS?