Assessment of presenting symptoms.

Abstract

The major mental disorders in the aged are associated with a few notable pathologic syndromes. Excellent, brief, standardized instruments have been available for several years for the assessment of all the major pathologic syndromes with the exception of cognitive impairment. I n recent years, clinical instruments for the assessment of cognitive decline in Alzheimer's disease, and in other geriatric pathologies with cognitive concomitants, have been deueloped.The rationale, validation, and utilitarian aspects of these clinical assessments, and their relationship to mental status and psychometric measures of cognitive dysfunction, are discussed. The relationship between these clinical assessments of cognitive pathology and the phenomenology of the disease processes that they are designed to measure are explored with particular reference to our recently acquired and rapidly expanding knowledge of Alzheimer's disease and other dementing or pseudodementing disorders of the senium.

Memory disorder and subjective time estimation

“…This disability results in the clinical observation of disorientation to place and time (Daniel, 1988;Daniel & Crovitz, 1982;Kahn, 1986;Reisberg et al, 1986). The amnesic person often cannot recall the name of the current setting, such as the hospital, or recent events, such as meals or visits from the family.…”

Primary or depressive dementia: Clinical features

“…According to Wells, it is the discrepancies in the appearance of these difficulties which could prove most diagnostic. In a prospective study, Reisberg et al (1986) found that, by and large, AD patients might be expected to choose the proper clothing to wear (eg pyjamas at night) before losing the ability to put it on properly). Not infrequently, those with depressive dementia will show inconsistencies such as incontinence while still being able to dial the telephone.…”

“…Only depressives who scored in the 'normal range' of the Mini-Mental State Examination (MMSE) were selected however while none of the A D patients were in mild stages. Other evidence instead shows that, in many patients with early AD, complaints of specific memory failures are the presenting grievance and are congruent with their spouse's evaluation of their predicament (Reisberg et al, 1986). Conversely, elderly depressives tend to exhibit a high degree of complaining overall.…”

“…Recent research using standardized new learning tasks (eg story recall) now suggests depressives do not encode as much as healthy controls, and sometimes not much better than mild AD patients, but will retain as well as controls the little they managed to register (Kopelman, 1987). Though some surveys list distractibility as a feature of AD (Thal, 1988;Wells, 1979), others show it to be mostly characteristic of later stages (Reisberg et al, 1986). Psychometric studies comparing attentional performance (eg digit span) in the two groups report inconsistent findings (eg Hart et al, 1987;Mazzucchi et al, 1987) but it is now recognized that psychometric attention is not a unitary construct and that different tasks are sensitive to different aspects (Freedman et at., 1991).…”

Cognitive training in the rural elderly: A randomized trial to evaluate the efficacy and accessibility of a new approach.

“…Commonality among the indexes is near perfect (r = 97) (Reisberg, Ferris, & Borenstein, 1987). The rating scale characterizes the degree of impairment, from normal to very severe, on five global axes (concentration, short term/long term memory, orientation, and self-care).…”