Test name
Use
Length (min)
Features
Montreal cognitive assessment (MoCA)
Cognitive screen
10
Normed on geriatric population, multiple forms, free to use
St. Louis University Mental Status Exam (SLUMS)
Cognitive screen
7
Normed on geriatric population, free to use
Cognitive status exam (Cognistat)
Cognitive screen
15–20
Normed on geriatric population, includes brief screen for judgment, must purchase from publisher
Geriatric depression scale (GDS)
Depression screen
3–10
Created for geriatric population; brief (five items), short (15 items), and long (30 items) versions; free online forms and free downloadable phone app
Cornell scale for depression in dementia (CSDD)
Depression in dementia screen
30
Screen for patient and semi-structured interview with caregiver
Geriatric anxiety scale (GAS)
Anxiety screen
10–15
Created for geriatric population; available free online; follows DSM-IV criteria
CAGE
Alcohol screen
<5
Brief screen for problematic drinking; all ages; free to use
Confusion assessment method (CAM)
Delirium screen
5
Designed for detection of delirium, wide use on geriatric population, free to use
Differential diagnosis —depression, dementia, and delirium
Table 21.2 offers distinguishing characteristics of common geriatric syndromes. Differentiating between these conditions is vital in offering the most appropriate treatments. Several common causes of dementia are listed in Table 21.3. Consult with a specialist in geriatric mental health and medicine if needed. See also separate chapters in this book on delirium (Rudolph and Budd), dementias (Stiers and Strung), and depression (Schechter and Bentley).
Table 21.2
Differential diagnosis in geriatric patients
Delirium | Depression | Dementia | |
|---|---|---|---|
Onset | Acute | Gradual or episodic, may be exacerbated by admission to hospital | Varies depending on cause; can be gradual (Alzheimer’s) or sudden (stroke) |
Features in rehabilitation setting | Inattentiveness, fluctuations, disorganized thought, hypo- and/or hyperactive, may have visual hallucinations | Low mood, loss of interest, lack of positive emotions, suicidal ideation, lack motivation for rehab, subjective complaints about cognition | Difficulty with memory, change in behavior, impairment in language, lacking awareness of deficits or nursing safety precautions |
Contributions | Dehydration, metabolic, medication toxicity, septic, encephalopathy, malnutrition, dysregulated labs | Organic (vascular health, stroke, Parkinson’s, etc.) or psychosocial (physical limitations, life transitions, etc.) | Varies depending on the cause of the impairment |
Treatments | Improve sensory input, lab work, address underlying medical condition | Supportive psychotherapy, refer to outpatient when discharged | Consult geriatric specialists, manage problematic behaviors in rehab setting |
Rehabilitation resources | Physician, psychiatrist, neurologist, psychologist, nurse | Psychologist, psychiatrist, clinical social worker, licensed mental health provider, recreation therapist, psychiatric nurse | Psychologist, neurologist, psychiatrist, geriatrician, nurse |
Table 21.3
Common causes of dementia
Cause of dementia | Average age of onset | Early features |
|---|---|---|
Alzheimer’s disease | 65 and older | Insidious onset, progressive nature, impaired immediate recall, learning, and short-term memory early in the process, followed by language, executive functioning, and visuospatial abilities |
Vascular | 70 and older | Varies according to cause of impairment (i.e., stroke, microvascular ischemic changes, vascular risk factors), deficits may be focal or diffuse, impairment in executive functioning, may have an abrupt onset, diagnosis is also supported by neuroimaging |
Lewy bodies | 70 and older | Hallucinations (often detailed visual hallucinations), delusions, fluctuations in cognition, parkinsonism, progressive nature, REM sleep behavior disorder |
Frontotemporal | 50–60 | Changes in personality, executive functioning, disinhibition, language impairment, and social functioning; various subtypes (i.e., behavior, language, etc.) |
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Delirium
Delirium is a common and costly problem among older patients in medical settings . Episodes of delirium are known to increase length of stay, increase morbidity and mortality, and decrease the likelihood of returning home after rehab. About 25 % of geriatric patients on medical wards will develop delirium [7].
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Signs and symptoms . Delirium is acute brain failure characterized by sudden onset of confusion, disorganized thinking, fluctuation throughout the day, inability to pay attention, and altered alertness.
Subtypes
○ Hyperactive (25 %): predominant agitation and confusionRelated posts:
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