Mental Health in the Elderly

Mental Health in the Elderly

Mrs. K, the older adult who was examined is in her late '80s. Her children recently had concerns regarding her ability to remember concepts, in particular names of family members and places, and they were concerned that Mrs. K. might be in the beginning stages of Alzheimer or some other similar disease. Always an alert and creative person who enjoyed reminiscing, Mrs. K. had comparatively recently, according to her family, shown some deficiencies in her memory span. She also seemed to take much longer in reading a book, would often fall asleep in the middle, reread the episode, seemingly forgetting that she had read the story not too long before. These and similar incidents troubled the family.

Mrs. K. herself, cheerful and optimistic, attributed these incidents to old age and thought her family was unduly concerned and exaggerating matters. Nonetheless, we had Mrs. K. tested for possible dementia.

We used the Mini Mental State Examination (MMSE) test on her. The MMSE is a 30-point assessment tool commonly used for screening for, and monitoring, progression of dementia and delirium. In this case, we wanted to see whether Mrs. had dementia and, if so, how far progressed it was. The MMSE screens for level of functioning in orientation to time and place, registration and recall, attention and calculation, as well as patient's performance in terms of aspects of language function and lastly motor skills. To elaborate, orientation to time and place tests Mrs. K's recognition of and her adaptation to the historical time / date and geographical location / place that she exists in the moment (such as questioning her on the name of the present president and similar other well-known facts that exist in connection with her present time, as well as asking her where she is right now to assess her cognizance of her spatial-temporal location. Attention and calculation would measure her ability of focus and concentration as well as simple mathematical / calculation capacities (such as the sum of two digits). Registration and recall would assess Mrs. K's capacities to register stimuli of her immediate environment or statements transmitted to her as well as assessing Mrs. K's recall of facts, events, occurrences, and figures. Finally, language function would gauge Mrs. K's simple language capacities of vocabulary, speech, and simple grammar whilst motor skills would test Mrs. K's basic periproceptive abilities.

It is a brief 30-pioint-questionnaire test and takes approximately 10 minutes to administer. Its questions are simple. Such as the time and place of the test (to measure location and time aptitude), repeating lists of words, arithmetic, and to imitate a drawing of two pentagons (to test her abilities of recall and focus).

Scored out of 30, any score greater than or equal to 25 points is intact. Below this, 9 points indicates severity, 10-20 points represents a moderate situation, whilst 21-24 points indicates mild condition. In Mrs. K's case (as in terms of all patients to whom the test is administered) her educational attainment and age need to be considered.

Mrs. K's rating was low - 14 points - and although this does correlate closely with dementia, caution has to be exercised since other mental disorders can also lead to low readings on the MMSE testing. It was also taken into account that physical problems, such as deafness, fatigue, concern, inability to concentrate, inability to hear or read the instructions properly or to understand them, or perhaps a motor or visual deficit that affected writing and drawing skills may interfere with test results. As far as possible, we tried to correct for these occurrences.

What I would recommend is one or other of similar clinical tests for corroboration. The 6-item Cognitive Impairment Test (6CIT) may be an option. This instrument, also known as the Short Orientation-Memory-Concentration Test, or the Blessed Concentration-Memory-Concentration Test, is constructed from six items that test memory, calculation, and orientation, The Clock Drawing Test (CDT) or Mini-cog may be another option the latter focusing on Mrs. K's word recall. The CDT screens for visuospatial, constructional praxis and frontal / execution brain impairment whilst the General Practitioner Assessment of Cognition (GPCOG) also tests memories if recent events and orientation.

My endeavor would be to assess areas where Mrs. K. showed limitations and then to refer her for the specific test that focuses on those limitations. In this case, I would refer Mrs. K. To both the CDT and GPCOG tests in order to decide veracity of the findings of the MMSI and where we go from there. These tests when used in combination would also enable us, with greater certainty to separate mental illness and delirium from cognitive impairment.