Mini Mental State

Vision for Transformation Strengths: The SHSIP describes a holistic transformation plan and ensures connections between various plan components. The State’s Plan seeks to reward health care providers for better care, smarter spending, and healthier people through higher quality, instead of quantity of services by utilizing valuebased purchasing across public and private payers. The SHSIP provides a well-detailed description of the proposed value-based models of care through the Patient-Centered Medical Home (PCMH) model, resulting in the statewide implementation of Accountable Health Communities (AHCs). The SHSIP outlines a long-term vision of building and expanding the PCMH model into a Community Centered Health Homes (CCHHs) model, which will focus on prevention and collaboration with other communitybased organizations. Another strength identified is the amount of existing PCMHs operating within the State. The SHSIP provides a course of action to assist non-PCMH practices to become nationally certified, as well as, goals for a single, statewide PCMH model to be used by all providers and payers within the state. The implementation of the AHCs will be key in addressing social determinants of health within various communities and seems to align well with the PCMH goals. This focus on population and community health will enable the State to make a broader impact and support the long-term goal of moving towards a CCHH model. The focus on the improvement of clinical, behavioral, and oral health care within the urban, rural, and frontier communities is well aligned and consistent with the SIM goals and the overall Triple Aim initiative. Figure 18: Driver Diagram clearly shows how the State plans to achieve the Triple Aim by 2020.

Department of health & human services

Caring for a family member with dementia is generally regarded as a chronically stressful process, with potentially negative physical health consequences. However, no quantitative analysis has been conducted on this literature. The authors combined the results of 23 studies to compare the physical health of caregivers with demographically similar noncaregivers. When examined across 11 health categories, caregivers exhibited a slightly greater risk for health problems than did noncaregivers. However, sex and the health category assessed moderated this relationship. Stronger relationships occurred with stress hormones, antibodies, and global reported health. The authors argue that a theoretical model is needed that relates caregiver stressors to illness and proffers moderating roles for vulnerabilities and resources and mediating roles for psychosocial distress and health behaviors.

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Is caregiving hazardous to one's physical health? A meta-analysis.

Depression in the elderly

/pdf/practice-guideline-for-the-treatment-of-patients-with-major-ofberaz3o1.pdf

PRACTICE GUIDELINE FOR THE Treatment of Patients With Major Depressive Disorder

Objective. The clock-drawing test has achieved widespread clinical use in recent years as a cognitive screening instrument and a significant amount of literature relates to its psychometric properties and clinical utility. This review aims to synthesize the available evidence and assess the value of this screening test according to well-defined criteria.

Design. A Medline and Psycho-info literature search of all languages was done from 1983 to 1998 including manual cross-referencing of bibliographies. A brief summary of all original scoring systems is provided as well as a review of replication studies. Psychometric data including correlations with other cognitive tests were recorded. Qualitative aspects of the test are also described.

Results. Among published studies, the mean sensitivity (85%) and specificity (85%) of the clock-drawing test are impressive. Correlations with the Mini-Mental State Examination and other cognitive tests was high, generally greater than r = 0.5. High levels of inter-rater and test–re-test reliability and positive predictive value are recorded and despite significant variability in the scoring systems, all report similar psychometric properties. The clock test also shows a sensitivity to cognitive change with good predictive validity.

Conclusions. The clock-drawing test meets defined criteria for a cognitive screening instrument. It taps into a wide range of cognitive abilities including executive functions, is quick and easy to administer and score with excellent acceptability by subjects. Together with informant reports, the clock-drawing test is complementary to the widely used and validated Mini-Mental State Examination and should provide a significant advance in the early detection of dementia and in monitoring cognitive change. A simple scoring system with emphasis on the qualitative aspects of clock-drawing should maximize its utility. Copyright © 2000 John Wiley & Sons, Ltd.

Clock-drawing: is it the ideal cognitive screening test?

The clock -drawing test was used in a longitudinal study of 183 dementing individuals and their caregivers. Clock-drawing performance was measured by a simple standardized score which correlated significantly with other measures of cognitive function. Clock performance showed high individual consistency of performance as well as a significant deterioration from the initial level of performance to that obtained at 1-year follow-up. Dementing individuals who had experienced a significantly greater decline in clock-drawing performance at 1-year follow-up were more likely to have caregivers who had already decided to institutionalize them. This suggests that the caregiver's decision to institutionalize was based in part on the perception of a rapid decline in their dependant's cognitive function. Thus, rate of change in cognitive function may prove to be as important a variable as the level of deterioration. The clock-drwing test appears to be a useful adjunct in the assessment and monitoring of the progressive dementias in the community.

Clock‐drawing and dementia in the community: A longitudinal study

This study compares the ‘clock-drawing test’ to two standardized cognitive screens in an elderly population. A newly developed hierarchical classification of errors in clock-drawing correlated well with the severity of scores on both cognitive and screens and also demonstrated acceptable standards for sensitivity and specificity. Clock-drawing appears to be a practical test which can be useful for clinicians as a screen for cognitive impairment in old age and possibly as a marker of change in cognitive status.

The challenge of time: Clock-drawing and cognitive function in the elderly

Introduction 1. Normative study 2. Dementia and related disorders 3. Well elderly in senior's residence 4. Focal brain damage

Clock Drawing: A Neuropsychological Analysis

Objective

To review the recent literature on cognitive screening with a focus on brief screening methods in primary care as well as geriatric services.



Design

The Medline search engine was utilized using the keyword search terms ‘cognitive screening’, ‘cognitive assessment’, and ‘dementia screening’ limiting articles to those published in English since 1998.



Results

679 abstracts were retrieved. Articles focusing on attitudes toward cognitive screening, current screening practices, promising new instruments and more recent updates contributing significant information on established instruments were retrieved and incorporated into this review. Reference lists were reviewed for relevant contributing articles. Instruments recommended from previous reviews of cognitive screening and those identified in surveys as most frequently used in primary care and geriatric settings were emphasized in this review.



Conclusions

Dementia remains under-diagnosed in the elderly population. Despite significant limitations, the Mini Mental State Exam remains the most frequently used cognitive screening instrument. Its best value in the community and primary care appears to be for the purpose of ruling out a diagnosis of dementia. Instruments such as the Mini-Cog, Memory Impairment Screen (MIS), and the General Practitioner Assessment of Cognition (GPCOG) have consistently been recognized for utility in primary care. The clock drawing test (CDT) and newer instruments such as the Montreal Cognitive Assessment (MoCA) and the Rowland Universal Dementia Assessment Scale (RUDAS) are gaining credibility due to improvements in sensitivity, addressing frontal/executive functioning, and decreasing susceptibility to cultural and educational biases. Copyright © 2009 John Wiley & Sons, Ltd.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/gps.2306

Kenneth I. Shulman

Papers

Clock-drawing: is it the ideal cognitive screening test?

Clock‐drawing and dementia in the community: A longitudinal study

The challenge of time: Clock-drawing and cognitive function in the elderly

Clock Drawing: A Neuropsychological Analysis

Brief cognitive screening instruments: an update