Louis University Mental Status Exam Research Articles

Engagement in Meaningful Activities Among Residents with Dementia in Assisted Living

AbstractBackgroundEngagement in meaningful activities is beneficial for the physical and psychological well‐being of persons with Alzheimer’s disease or related dementia (ADRD). Meaningful activities are a critical dimension of person‐centered care, although challenges exist in providing them for persons with ADRD in long‐term care settings. The purpose of this study was to describe engagement in meaningful activities among residents with ADRD in assisted living.MethodThis study included baseline data collected from the first cohort of the randomized controlled trial, Meaningful Activities for Managing Behavioral Symptoms of Distress (MAC‐4‐BSD). Assisted living residents were eligible if they were ≥55 years old, live in a participating setting, and screen positive for dementia based on the Saint Louis University Mental Status exam (SLUMS) and AD8 Dementia Screening Interview. Residents were excluded if they were enrolled in hospice, admitted for short term respite, or had a significant neurological condition not related to ADRD. Residents’ engagement in meaningful activities was evaluated based on the Engagement in Meaningful Activities Survey (EMAS). Descriptive statistics were used to summarize sample characteristics and describe engagement in meaningful activities.ResultA total of 38 residents from 3 assisted living communities were included in the sample. Most participants were female (71%), White (82%), and mean age was 81 years old (SD = 7.9). Average score on the SLUMS was 4.5 (SD = 4.9). The EMAS mean score was 43.57 (SD = 10.9) with a range of 25 to 60. Participation was endorsed most frequently for activities that give them pleasure (60.7%) and a sense of satisfaction (64.3%). Participation was endorsed least frequently for activities that help other people (35.7%), contribute to feeling competent (42.9%), and have the right amount of challenge (42.8%).ConclusionFindings from this study offer preliminary insights into residents’ engagement in meaningful activities in assisted living and suggest there is limited participation in activities that help others, help with feeling competent, and have the right challenge level for those with ADRD. Although limited by small sample size, this study highlights the need for increasing engagement in meaningful volunteer activities to help others which recent research demonstrates could positively impact physical and cognitive health outcomes.

Differences in Medication Use by Gender and Race in Hospitalized Persons Living with Dementia.

The purpose of this study was to describe differences in treatment of White versus Black older adults, males versus females, and those living at home, assisted living, or nursing home communities with regard to the use of psychotropic, pain, and cardiovascular medications. Baseline data from the first 352 participants in the study, implementation of Function-Focused Care for Acute Care Using the Evidence Integration Triangle, were used. Data included age, gender, race, comorbidities, admission diagnosis, and living location prior to hospitalization, the Saint Louis University Mental Status exam, the modified Charlson Comorbidity Index, the Pain Assessment in Advanced Dementia scale, the Confusion Assessment Method, and medications prescribed. Generalized linear mixed model analyses were done, controlling for race or gender (depending on which comparison analysis was being done), age, cognitive status, hospital, delirium, and comorbidities. Medication use was significantly higher for White older adults, compared to Black older adults, for antidepressants, anxiolytics, non-opioid pain medications, and opioids and lower for antihypertensives. Females received more anxiolytics than their male counterparts. There were differences in medication use by living location with regard to non-opioid pain medication, antipsychotics, statins, and anticoagulants. The findings provide some current information about differences in medication use across groups of individuals and can help guide future research and hypothesis testing for approaches to minimizing these differences in treatment.

#5742 MID-ARM CIRCUMFERENCE AS A CORRELATE TO DIFFERENT: ASPECT NEUROCOGNITIVE IMPAIRMENT IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Malnutrition is associated with poor cognitive function (CI) in Hemodialysis (HD) patients. Both have multiple ways of assessment scaled from simple bedside screening tests to more sophisticated time- and cost-consuming measures. This work aims to define the best nutritive assessment measure that correlates to the degree of CI. Method A cross-sectional study was carried out on 116 patients in 4 different HD units from Delta Nile, Egypt. The nutritional status was examined after the dialysis session in euvolemic patients using (1) anthropometric measurements, including body mass index (BMI), mid-arm circumference (MAC), skin fold thickness (SFT), and mid-arm muscle circumference (MAMC); (2) bioelectrical impedance analysis for assessment of skeletal muscle mass (SMM), skeletal muscle index (SMI), free fat mass (FFM), body fat mass (BFM), and total body water (TBW); (3) Hand grip strength was used to assess muscle power. The assessment of cognition was made using (1) a mini-mental state examination (MMSE) for orientation, registration, attention, recall, language, and copying; (2) Saint Louis University Mental Status Exam (SLUMS) for early CI and executive functioning; (3) Arabic version of Penn Web-Based Computerized Neurocognitive Battery (WebCNP) for those who scored no CI in the previous two tests. Results The results of MMSE and SLUMS tests showed that 34.5% of our cohort (n = 40) had no CI, 34.5% (n = 40) had mild to moderate degrees of CI, and 31% (n = 36) had a severe form of CI. Comparing the nutritional assessment parameters between the categories of cognitive scores revealed that there were no significant differences except in significantly lower median values of MAC (P 0.01), SMI in bioelectrical impedance analysis (P0.01), and hand grip strength (P 0.002) in severe CI group than the normal to patients without CI. In correlation statistics, MAC and hand grip strength were negatively correlated to the degree of CI (r = -0.3, P 0.006 and r = -0.26, P 0.009, respectively). MAC was the only parameter correlated with attention, emotional recognition, and differentiation functioning in the forty patients with no CI who underwent computerized neurocognitive assessment. The highest reported positive correlations reported were between the MAC and response time of both emotion recognition (r = 0.57, P <0.001) and differentiation (r = 0.55, P <0.001). Conclusion Of the different parameters of nutritional state assessment, MAC, the simple bedside measurement, was the best correlate with the degree of cognitive impairment in HD patients, even in its mild primitive forms.

0096 Short sleep duration and poor sleep quality associated with elevated serum NfL and mild cognitive impairment in older Veterans

Abstract Introduction Ten percent of adults aged ≥ 65 and 50% of adults ≥ 85 years exhibit cognitive impairment. In addition, 50% of older adults experience poor sleep quality. Veterans are more vulnerable to sleep disturbances and potential cognitive impairment as long-term consequences of on-duty responsibilities, co-morbidities, and conditions such as post-traumatic stress disorder. Previous studies demonstrated a relationship between sleep and cognitive impairment through impaired glymphatic function and neurodegeneration. Biomarkers such as neurofilament light (NfL) are elevated in neurodegeneration and dementia. Here, we sought to investigate NfL levels in cognitive-intact older Veterans exhibiting poor sleep quality. Methods A cross-sectional study with eighteen Veterans aged 65-86 without a clinical diagnosis of dementia. Self-reported sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), while time in bed (TIB), and total sleep time (TST) were retrieved from Fitbit Charge. Cognitive function was evaluated with the St. Louis University Mental Status Exam (VA-SLUMS). We used an automated multiplex immunoassay system to identify dementia biomarkers using an enzyme-linked lectin assay. T-tests, one-way or two-way ANOVAs with Tukey’s post-hoc (with or without repeated measures) were used for the analysis. Results Participants were classified as good sleepers (PSQI>5) and poor sleepers (PSQI< 5). Poor sleepers spent less TIB (Fitbit 5.3h vs. 7.7h, p =0.001) and slept fewer hours (Fitbit 4.7h vs. 7.2h, p =0.001) when compared to good sleepers. Additionally, poor sleepers exhibited mild cognitive impairment (VA SLUMS 26.9, p, =0.01). Lastly, poor sleepers exhibited higher serum NfL (mean 66.7, p=0.04). Conclusion Poor sleep quality was associated with short sleep duration, mild cognitive impairment, and higher serum levels of NfL in older Veterans without a dementia diagnosis. Results may contribute to the early identification of dementia and sleep-centered treatment guidance. Further studies with more extensive and diverse samples are warranted before clinical recommendations. Support (if any) Carleara Weiss, Ph.D., MS, RN. 1K99AG079117-01 (PI), National Institute on Aging.

Undiagnosed Cognitive Impairment and Impact on Instrumental Activities of Daily Living Among People With HIV Infection in Primary Care.

Little is known about the prevalence of undiagnosed cognitive impairment and its impact on instrumental activities of daily living (IADL) among people with HIV (PWH) in primary care. PWH were recruited from an integrated health care setting in the United States. PWH were eligible for recruitment if they were ≥50 years old, taking antiretroviral therapy (ie, ≥1 antiretroviral therapy [ART] prescription fill in the past year), and had no clinical diagnosis of dementia. Participants completed a cognitive screen (St. Louis University Mental Status exam) and a questionnaire on IADL (modified Lawton-Brody). Study participants (n = 47) were mostly male (85.1%), 51.1% White, 25.5% Black, 17.0% Hispanic, and the average age (SD) was 59.7 (7.0) years. Overall, 27 (57.5%) participants were categorized as cognitively normal, 17 (36.2%) as having mild cognitive impairment, and 3 (6.4%) as having possible dementia. Of the 20 participants with mild cognitive impairment or possible dementia, 85.0% were men, the average age (SD) was 60.4 (7.1) years; 45.0% were White, 40.0% were Black, 10.0% were Hispanic, and 30.0% reported difficulty with at least 1 IADL. Most (66.7%) attributed difficulty with IADL primarily (33.3%) or in part (33.3%) to cognitive problems. Undiagnosed cognitive impairment is frequent among ART-treated PWH, with possible elevated risk among Black PWH, and may be accompanied by difficulty with IADL. Efforts are needed to optimize identification of factors contributing to cognitive and IADL difficulties among ART-treated PWH in primary care.

Occupational and Physical Therapy Rehabilitation Strategies for COVID-19 Related Guillain-Barré Syndrome: A Case Report

<h3>Research Objectives</h3> To describe the occupational and physical therapy strategies used to rehabilitate COVID-19 related Guillain-Barré Syndrome (GBS). <h3>Design</h3> Single patient retrospective case report. <h3>Setting</h3> Long-term acute care hospital located in Wallingford, Connecticut, USA. <h3>Participants</h3> A 61 year old male admitted for physical and occupational therapy rehabilitation following intravenous immunoglobulin treatment for COVID-19 related GBS. The patient gave his written approval for the creation of this case report. <h3>Interventions</h3> Individual occupational and physical therapy sessions, occupational and physical therapy co-treatment sessions, and targeted group therapy sessions focused on leg, arm, and fine motor coordination exercises. <h3>Main Outcome Measures</h3> Manual muscle testing, range-of-motion, grip-strength, Activity Measure for Post-Acute Care, and St. Louis University Mental Status Exam. <h3>Results</h3> Despite the unforeseen complication of a distal right fibula fracture, the patient was successfully discharged directly home 56 days after LTACH admission. The patient discharged with clinically improved ambulation, strength, self-care, and cognition. <h3>Conclusions</h3> This unique case highlights the complex and significant rehabilitation needs a patient may require to regain independence after a diagnosis of COVID-19 associated GBS. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose.

The SLU‐AMSAD, a short screening tool for diagnosing depression in dementia patients

AbstractBackgroundThe prevalence of depression in people with Alzheimer’s disease is estimated to be nearly 50%, accounting for a significant amount of additional caregiver burden1. With the COVID‐19 crisis, depression in dementia patients, especially those living in long term care facilities, has increased. The Cornell Scale for Depression in Dementia (CSDD) is the gold standard for assessing depression in dementia patients, but is lengthy, taking nearly 20 minutes to administer3. The SLU AMSAD is a previously validated depression tool which consists of 5‐items and takes less than 2 minutes to administer3. The objective of this study was to compare this short tool with the lengthier gold standard, the CSDD, to diagnose depression in cognitively impaired patients.Method44 patients, 65years and older were enrolled in the study from an out‐patient clinic setting. A St. Louis University Mental Status Exam (SLUMS) score of less than 25 was used to include the eligible patients. All enrolled subjects were administered the SLUMS, SLU AMSAD and the CSDD. The SLUMS score was used to classify the patients as having mild, moderate and severe dementiaResultThe preliminary data set analyzed data for N=44 cases of which 54.5% were female and 88.6% Caucasian with a mean age of 79.9. The average SLUMS score was 14.3 (6.5). For the total sample, area under the curve (AUC), sensitivity, and specificity values exceeded 0.82, with a maximum sensitivity of 0.92 and specificity of 0.84 (for an optimal cut‐off score of 4/5).ConclusionThe SLU AMSAD had a very strong correlation with the CSDD as shown by the above results in this preliminary data sample of 44 patients. We intend to continue with the study and gather a total sample of 105 patients to add stronger statistical power to the study.

Diabetes Prevalence and Risk Factors in Patients With Chronic Mental Illness on Second-Generation Antipsychotics

The rates of obesity and type 2 diabetes (T2D) are much higher in patients with chronic mental illness compared to the general population1. Second-generation antipsychotic medications (SGA) are clearly contributory to these adverse metabolic phenotypes2. Thus, annual monitoring of fasting plasma glucose (FPG) levels is recommended to screen for T2D in patients on SGA3. Of note, FPG, and also HbA1c, have poor sensitivities in detecting T2D early, with nearly 50% of cases being missed using either of the above tests when compared to oral Glucose Tolerance Testing (oGTT,4). We thus screened patients with schizophrenia, schizoaffective or bipolar disorder on SGA per oGTT. We hypothesized that we would identify more patients with T2D per oGTT compared to FPG or HbA1c testing alone. To identify risk factors for T2D, we also assessed BMI, waist/hip ratio, blood pressure, dietary habits (UKDDQ = UK Diabetes and Diet Questionnaire), physical activity records (3d pedometer records), measures of psychopathology, cognition (PHQ-9 = Patient Health Questionnaire, SLUMS = Saint Louis University Mental Status exam) as well as HOMA IR (Homeostatic Model Assessment of Insulin Resistance), Matsuda index and lipid profile. Data were analyzed using SPSS, comparing normal and prediabetic patients to patients with T2D (per oGTT criteria). Thus far, we screened 22 patients per oGTT and newly identified 5 patients with T2D (23%), only one patient had T2D per HbA1c criterion, 4 were identified per elevated FPG, 3 patients had elevated 2h plasma glucose levels. Patients with T2D had significantly lower Matsuda indices (p<0.0001); trends towards higher HOMA IR and waist/hip ratios were observed in diabetic compared to non-diabetic patients (p=0.08). Patients with T2D tended to be heavier, had worse dietary habits (higher UKDDQ scores), and surprisingly were less depressed (lower PHQ-9 scores) than non-diabetic patients (p<0.25). In conclusion, oGTT is more sensitive in identifying patients with T2D early compared to FPG or HbA1c alone. Matsuda indices, HOMA IR and waist/hip ratios may serve as additional markers to distinguish non-diabetic from diabetic patients. Since metabolic syndrome and diabetes are all risk factors for an increased cardiovascular mortality in patients with chronic mental illness, identifying and treating T2D early and aggressively should be primary goals of care in this high-risk patient population.

Examining Satisfaction With Assisted Living Among Residents With and Without Dementia

Understanding residents’ satisfaction with assisted living (AL) is essential for creating supportive environments that are focused on residents’ needs and preferences. Nearly half of AL residents experience some level of cognitive impairment, although limited research has examined residents’ satisfaction with AL particularly among those with cognitive impairment. The purpose of this study was to compare satisfaction with AL between residents with and without dementia. Baseline data from the Dissemination and Implementation of Function Focused Care in AL study was used in this analysis. A total of 481 AL residents were included in the sample. Measures included demographic information, Saint Louis University Mental Status Exam (SLUMS), and the Resident Satisfaction Index. Controlling for age, gender, and comorbidities, multivariate analyses of variance was performed to consider the impact of cognitive status on residents’ satisfaction with health care services, physical environment, relationships with staff, and social activities. The majority of participants were female (71%), White (97%), mean age was 89 years old (SD=7.43), and mean SLUMS score was 15.90 (SD=4.74). On average, residents were highly satisfied with AL reporting a mean score of 19.17 (SD=3.15). There were no significant differences in residents’ satisfaction scores (p>.05) between residents with dementia and without dementia across all subdomains of satisfaction: health care services, physical environment, relationships with staff, and social activities. There may have been some bias in results due to social desirability. Further research should explore additional aspects of residents’ satisfaction with staff such as whether or not person-centered care is provided.

COGNITIVE STIMULATION THERAPY FOR INDIVIDUALS WITH MEMORY LOSS

Cognitive Stimulation Therapy (CST) is a non-pharmacological approach for individuals with mild to moderate dementia. It is one of the age friendly community activities of the GWEP to engage older adults with memory challenges. We explored the impact of caregiver-assisted CST (CA-CST) on participants’ overall memory, mood, and retention in the groups. We also investigated the impact of this CST format on the overall well-being of dementia caregivers. Four CST groups (N=28) entered the CA-CST groups meeting once per week for 14 weeks in a university setting. 61 % of participants who completed the group (n=17) showed a .5 point improvement on the Saint Louis University Mental Status Exam (SLUMS), a 2-point decrease on the Cornell Scale for Depression in Dementia (p<.01), and 1.5 point increase in overall caregiver well-being. Continued psychosocial interventions for dementia are needed not just in university settings, but healthcare organizations and other age-friendly settings.

Education and Decision-Making in Patients and Caregivers Considering Left Ventricular Assist Devices

Purpose Left ventricular assist device (LVAD) is a mainstay of therapy in end-stage heart failure, but presents a challenge in decision-making to patients and caregivers. The aim of this study is to assess patient education and understanding of LVAD therapy. Methods Consecutive candidates for LVAD therapy were enrolled for this study. Patients were excluded if they were unable to participate in baseline testing. Prior to LVAD implant, health literacy was assessed by Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) testing, a word-recognition test of 11 items. Cognitive function was assessed by St. Louis University Mental Status Exam (SLUMS), a brief oral and written exam. LVAD knowledge was assessed by a validated 20-item score. Results 21 patients were enrolled. The median age was 59 years and 62% of the patients were male. Most patients were institution naive, and only 47% had a documented prior advanced heart failure (HF) clinic visit. The majority of patients were on IV inotropes (85.7%) at the time of evaluation and many had indwelling aortic balloon pumps (42.9%). The median time to assessment following formal LVAD education was 1 day. 31% of patients had low health literacy based on REALM-R testing. Median SLUMS scores were in range of mild neurocognitive disorder (22.5; IQR 21, 25) (Fig. 1A). Baseline knowledge check demonstrated a low median score (45/100; IQR 35, 50) (Fig. 1B), and no patient reached a score of >70 (previously described average). Conclusion The majority of referrals for LVAD at our institution are late referrals of critically ill patients. Health literacy and cognitive scores are low in our patient population resulting in low knowledge check scores, despite systematic LVAD education. Patient specific LVAD education should address each patient's individual needs.

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

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.

A randomized control trial to establish the feasibility and safety of rapamycin treatment in an older human cohort: Immunological, physical performance, and cognitive effects

Inhibition of the mechanistic target of rapamycin (mTOR) pathway by rapamycin (RAPA), an FDA-approved immunosuppressive drug used as a clinical therapy to prevent solid organ allograft rejection, enhances longevity in mice. Importantly, RAPA was efficacious even when initiated in relatively old animals, suggesting that mTOR inhibition could potentially slow the progression of aging-associated pathologies in older humans (Harrison et al., 2009; Miller et al., 2011). However, the safety and tolerability of RAPA in older human subjects have not yet been demonstrated. Towards this end, we undertook a placebo-controlled pilot study in 25 generally healthy older adults (aged 70–95 years); subjects were randomized to receive either 1 mg RAPA or placebo daily. Although three subjects withdrew, 11 RAPA and 14 controls completed at least 8 weeks of treatment and were included in the analysis. We monitored for changes that would indicate detrimental effects of RAPA treatment on metabolism, including both standard clinical laboratory assays (CBC, CMP, HbA1c) and oral glucose tolerance tests (OGTTs). We also monitored parameters typically associated with aging that could potentially be modified by RAPA; these included cognitive function which was assessed by three different tools: Executive Interview-25 (EXIT25); Saint Louis University Mental Status Exam (SLUMS); and Texas Assessment of Processing Speed (TAPS). In addition, physical performance was measured by handgrip strength and 40-foot timed walks. Lastly, changes in general parameters of healthy immune aging, including serum pro-inflammatory cytokine levels and blood cell subsets, were assessed. Five subjects reported potential adverse side effects; in the RAPA group, these were limited to facial rash (1 subject), stomatitis (1 subject) and gastrointestinal issues (2 subjects) whereas placebo treated subjects only reported stomatitis (1 subject). Although no other adverse events were reported, statistically significant decrements in several erythrocyte parameters including hemoglobin (HgB) and hematocrit (Hct) as well as in red blood cell count (RBC), red blood cell distribution width (RDW), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) were observed in the RAPA-treatment group. None of these changes manifested clinically significant effects during the short duration of this study. Similarly, no changes were noted in any other clinical laboratory, cognitive, physical performance, or self-perceived health status measure over the study period. Immune parameters were largely unchanged as well, possibly due to the advanced ages of the cohort (70–93 years; mean age 80.5). RAPA-associated increases in a myeloid cell subset and in TREGS were detected, but changes in most other PBMC cell subsets were not statistically significant. Importantly, the OGTTs revealed no RAPA-induced change in blood glucose concentration, insulin secretion, and insulin sensitivity. Thus, based on the results of our pilot study, it appears that short-term RAPA treatment can be used safely in older persons who are otherwise healthy; a trial with a larger sample size and longer treatment duration is warranted.

Making a Difference: A Study of Cognitive Stimulation Therapy for Persons with Dementia

ABSTRACTAffecting nearly 5.4 million older adults in the United States and 35.6 million individuals worldwide, dementia is one of the greatest public health crises of our time. As a result, helping professionals, clients, and care partners seek effective and affordable treatment. Developed in the United Kingdom by Spector and colleagues, Cognitive Stimulation Therapy (CST) is a non-pharmacologic psychosocial group intervention for persons with dementia. To expand upon and fill the gaps within existing research, the authors developed a descriptive study to assess the impact of CST on cognition, quality of life, and depression, among six CST groups (n = 40). A paired sample t-test was run among pre- and post-test measures. There was a statistically significant difference in Saint Louis University Mental Status Exam (SLUMS) scores after CST (t = 2.80, p = 0.008). There was also a statistically significant difference in Cornell Scale for Depression in Dementia scores (t = −3.36, p = 0.002). There was no statistically significant difference in Quality of Life scores.

Development of a brief validated geriatric depression screening tool: the SLU "AM SAD".

Combining five commonly observed symptoms of late-life depression to develop a short depression screening tool with similar sensitivity and specificity asthe conventional, more time-consuming tools. We developed the St. Louis University AM SAD (Appetite, Mood, Sleep, Activity, and thoughts of Death) questionnaire. The frequency of each symptom in the prior 2 weeks is quantified as 0, 1, or 2. Patients 65 years or older from our clinics were administered the AM SAD, the Geriatric Depression Scale (GDS-15), the Montgomery-Asberg Depression Rating Scale (MADRS), and the St. Louis University Mental Status Exam (SLUMS). 100 patients were selected. AMSAD correlation with GDS was 0.72 and MADRS 0.80. AM SAD yielded a sensitivity and specificity of 79% and 62% against diagnosis of depression; of 88% and 62% with GDS-15; and 92% and 71% with MADRS. The AM SAD can be reliably used as a short depression screening tool in patients with a SLUMS score of 20 or higher.

The Veterans Affairs Saint Louis University mental status exam (SLUMS exam) and the Mini-mental status exam as predictors of mortality and institutionalization.

To evaluate predictive validity of cognitive dysfunction of the Saint Louis University mental status (SLUMS) exam or mini-mental state exam (MMSE) for institutionalization and mortality after 7.5-years. Longitudinal study. Geriatric Research, Education and Clinical Center Veterans Affairs Hospital St. Louis, MO. Patients (N=705) were screened for cognitive dysfunction in 2003 using the SLUMS exam and MMSE, and mortality and institutionalization up to 7.5-years later were evaluated as outcome measures. The associations between outcome measures and MMSE and SLUMS exam total scores, and cognitive status were examined using Kaplan-Meier curves and Cox proportional-hazards regression. Five hundred thirty-three charts were reviewed, 176/533(33%) patients had died and 31/526 (6%) were institutionalized during 7.5-year follow-up period. All subjects were male with a mean age of 75 years and most had high school education or greater (71%). MMSE dementia, SLUMS dementia (ps<.001) and MCI (p<.05) groups had significantly lower survival rates than normal cognition group in the Kaplan-Meier curves. Scores classified as dementia on SLUMS (HR=2.4, 95% CI 1.6-3.7; p <.001) or MMSE (HR=2.3, 95% CI 1.5-3.6; p <.001) both predicted mortality and, also, institutionalization (SLUMS: HR=3.5, 95% CI 1.3-9.1; p <.01; MMSE: HR=3.8, 95% CI 1.6-9.0; p <.001) after adjustment for covariates. Unadjusted SLUMS exam MCI predicted morality (HR=1.5, 95% CI 1.1-2.2; p <.019) but not institutionalization. The SLUMS exam and MMSE both predict mortality and institutionalization for male patients screened as positive for dementia.