The 2-factor solution shows that, notwithstanding previous claims to the contrary, the MMSE can make stable and independent distinctions between psychomotor and perceptual-organizational processes. However, this solution is statistically and conceptually limited and, therefore, of limited clinical and scientific relevance. The 4-factor solution of the MMSE maps well onto commonly recognized dimensions of neurocognitive ability. It offers a stable, intuitively sound, and statistically supported framework for clinical differentiation of cognitive screening data into independent clinical dimensions of neurocognitive functioning. Thus, it offers clinicians and researchers a 4-dimensional framework for interpreting data obtained by means of the MMSE. Studies with other populations of cognitively impaired and intact elderly are recommended to validate and extend the present findings.

The prevalence of mental disorders in rural primary care office practice is as high as in urban office practice.

SUMMARYWe examined factor structures of the 30-item Geriatric Depression Scale in a sample of depressed nursing home residents at various levels of cognitive functioning ( N = 9 17; observation-to-variable ratio 30.6: 1). Using principal components analysis and orthogonal varimax rotation, a six-factor structure involving 26 of the 30 items was derived. This solution, which explained 55.1% of the variance, consisted of the following factors: life dissatisfaction, dysphoria, hopelessness/decreased self-attitude, ruminationlanxiety, social withdrawalidecreased motivation and decreased cognition. This factor solution shows that a screening test for depression like the GDS may be able to make stable and independent distinctions between various dimensions associated with depressed mood in nursing home residents. The factors derived map well onto commonly recognized dimensions of depressed mood in frail older adults residing in long-term care facilities. The proposed six-factor solution offers a stable, intuitively sound and statistically supported framework for differentiation of depressive screening data into independent dimensions. This, in turn, offers opportunities for clinical differentiation in both practice and research efforts using the GDS.