HOW THEY MEASURE UP: RATING SCALES IN GERIATRIC PSYCHIATRY: Session 110

Abstract

Clinical assessment in geriatric psychiatry is complex. It involves detection of subtle signs, separation of psychiatric symptoms from co-occurring medical and neurological manifestations, and work with families. Rating scales are a useful complement to clinical skills in ensuring all relevant questions have been asked, objectively detecting the presence or absence of an illness, quantifying its severity, as well as tracking response to treatment, and the course of an illness over time. This presentation will touch upon multiple available rating scales, with focus on the ones which will be of use to the busy clinician. The first section of the presentation will be a discussion on rating scales for depression, namely the Geriatric Depression Rating Scale (GDS), the Cornell Scale for Depression in Dementia (CSDD), the Hamilton Depression Scale (HDS), and the Montgomery Asberg Depression Rating Scale (MADRS). In the next section, we will describe an overview of the various types of assessment scales for dementia, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), St. Louis University Mental Status Exam (SLUMS), Alzheimer's Disease Assessment Scale – Cognitive sub-scale (ADAS-cog), and the Modified Mini-Mental State Examination (3-MS). The third section of the presentation will constitute a discussion of rating scales to detect neuropsychiatric disturbances, such as the Neuropsychiatry Inventory (NPI), the Neurobehavioral Rating Scale (NBRS), and the Cohen Mansfield Agitation Inventory (CMAI). The final section will be a discussion of common rating scales used in assessing anxiety such as the Geriatric Anxiety Inventory (GAI) and the Geriatric Anxiety Scale (GAS). This section will also explore caregiver burden scales, with focus on the Zarit Caregiver Burden Interview. Every sub-section of the presentation will provide an overview of the literature and comparison in terms of clinical utility, practicality, and psychometric properties. Since primary care physicians provide majority of the medical care for the elderly, screening tools for primary care that can be incorporated in a busy clinical practice will also be discussed.