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Journal ArticleDOI

A Psychometric Study of Senility

01 Jul 1943-British Journal of Psychiatry (The Royal College of Psychiatrists)-Vol. 89, pp 363-373
TL;DR: It is shown that tests for senility should be short, especially those with oral questions, because of straying attention, impaired comprehension, and short retention, andPerseveration is greatly increased in senescence; it can be brought out merely by having a succession of short, varied items.
Abstract: A tentative battery of 25 short tests for the measurement of senescence is described ( cf. Table I). The scale is the result of the application of nearly 80 tests to senile patients in three London hospitals. It was administered in full to 38 patients in all, and the present findings refer to a group of 20 less seriously demented ones, with an age range of 68 to 83. The tests are classified into three groups according to the degree of difficulty experienced by the seniles (Table II). The divisions were made on the basis of a number of criteria which emerged during the working up of the results, and are only pointers to the kind of functions involved. Briefly, the most difficult tests were those in which subjects were required to break away from old mental habits and adapt to unfamiliar situations, tests of recent memory (logical), of judgment, planning, and reasoning, or embodying difficult or lengthy instructions. Less difficulty was found with such tests as rote memory, fluency of associations, simple arithmetic, and vocabulary. Performance seemed to be least affected on tests of visual recognition, old mental habits, and simple motor tasks. It is shown that tests for senility should be short, especially those with oral questions, because of straying attention, impaired comprehension, and short retention. Perseveration is greatly increased in senescence; it can be brought out merely by having a succession of short, varied items. There is a loss of steadiness and speed on the motor side. The disturbing effect of tests with a time element on the slower acting senile is noted. The present mental status of the patients is estimated on eleven tests which are scored on the (outmoded) mental age method (Table I): the average of these is between M.A. 10 and 11. This figure is compared with previous reports on the decline of intelligence. An estimate of the former mental status of each patient is made by means of efficiency quotients on part of the “Bellevue” scale. These relate each score to the average level for the peak age-group of 20 to 24 years (Table III). The use of the vocabulary score as an index of former level is discussed. A comparison of score variation within individuals with variation between individuals shows a ratio of the former to the latter of approximately 85 per cent. Variability of scores within individuals increases with age inside the patient group, also with lower intelligence. A shortened version of the scale, which takes about 40 minutes, is indicated (Table I).
Citations
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Journal ArticleDOI
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.

76,181 citations

01 Jan 2002
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Abstract: EXAMINATION of the mental state is essential in evaluating psychiatric patients.1 Many investigators have added quantitative assessment of cognitive performance to the standard examination, and have documented reliability and validity of the several “clinical tests of the sensorium”.2*3 The available batteries are lengthy. For example, WITHERS and HINTON’S test includes 33 questions and requires about 30 min to administer and score. The standard WAIS requires even more time. However, elderly patients, particularly those with delirium or dementia syndromes, cooperate well only for short periods.4 Therefore, we devised a simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely. It is “mini” because it concentrates only on the cognitive aspects of mental functions, and excludes questions concerning mood, abnormal mental experiences and the form of thinking. But within the cognitive realm it is thorough. We have documented the validity and reliability of the MMS when given to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment “pseudodementia”5T6), mania, schizophrenia, personality disorders, and in 63 normal subjects.

70,887 citations

Journal ArticleDOI
TL;DR: The object is that of obtaining more detailed knowledge of the nature of the intellectual changes so as to be able to construct a test battery which can be presumed to be a suitable instrument also for studying the presence of intellectual disturbances some time after the termination of a series of electroshock treatments and possibly in other clinical investigations as well.
Abstract: The purpose of the present investigations is that of studying the intellectual changes produced by electroconvulsive therapy (E.C.T. j , especially the memory disturbances, with the use of psychological tests on the same day as the treatment is given, but after the most acute effects have cleared up. The object is that of obtaining more detailed knowledge of the nature of the intellectual changes so as to be able to construct a test battery which can be presumed to be a suitable instrument also for studying the presence of intellectual disturbances some time after the termination of a series of electroshock treatments and possibly in other clinical investigations as well.

132 citations

Journal ArticleDOI
TL;DR: The history of cognitive screening tests, the numerous excellent tests that are currently available and ready for use, and directions and methods that will lead to progressively better evaluations are examined.
Abstract: Dementia and its most common cause, Alzheimer’s disease, affect memory and occur predominantly in the elderly. Dementia has become increasingly prevalent in the world as health has improved and life expectancy has increased. However, the fields of clinical care have not responded adequately to develop diagnostic tools and treatments for this rapidly increasing group of conditions. While scientists search for cures for the numerous causes of dementia, improvement of diagnostic measures are needed now and should begin with screening elderly populations for memory difficulties and other cognitive problems. This review examines the history of cognitive screening tests, the numerous excellent tests that are currently available and ready for use, and directions and methods that will lead to progressively better evaluations.

71 citations


Cites background from "A Psychometric Study of Senility"

  • ...• Reversing items [29] • Related tests – Say the months in reverse order [29,32] – Naming of animals in 1 min [29] – TRAILS A,B [93] – count backward from 20 to 1 [32,33] – Days of week backwards, in addition to 7’s [162]...

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  • ...• Prior recommendations to assess orientation to place: – Name and location of place [29] – Location [164] – “Where are we now”, “where is this place” [31] – Name of this place, address [162] – Type of place, name of hospital, ward, town [33] – Community, street [163]...

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  • ...Three Shapes [174] • General Practitioner Assessment of Cognition [114] • Six-item Screener [175] • Efficient Office-Based Assessment of Cognition [176] • Mini-Cog [177] • Rapid Dementia Screening Test [178] • Brief Alzheimer Screen [27] • Short Cognitive Evaluation Battery [71] • AB Cognitive Screen [179] • Q and E [73] • Mild Cognitive Impairment Screen [83] • Blessed Memory Test/Category Fluency [180] • Ten-item free recall with serial position effect analysis [181] (B) Brief screening questionnaires for knowledgeable informants and inventories of activities of daily living • Stockton Geriatric Rating Scale [182] • Blessed Dementia Scale [32] • Instrumental Activities of Daily Living (ADLs; note: basic ADLs assess greater impairment) [183] • Clifton Assessment Procedures for the Elderly – Behavior Rating Scale [170] • Functional Activities Questionnaire [184] • Geriatric Evaluation by Relatives Rating Instrument [185] • Record of Independent Living [186] • Informant Completed ADLs [186] • Informant Questionnaire on Cognitive Decline (IQ-CODE) [187] • Direct Assessment of Functional Status [58] • Alzheimer’s Deficit Scale [188] • Interview for Deterioration in Daily Life in Dementia [189] • Nurses’ Observation Scale for Geriatric Patients [190] • Social and Occupational Functioning Assessment Scale [191] • IADL/BADL [48] • Cognitive Performance Test [192] • DECO [193,194] • Alzheimer’s Disease Cooperative Study/ADLs [195] • MDS Cognitive Performance Scale [196] • Groningen Activity Restriction Scale [197] • Cognitive Assessment Screening Test [198] • Direct Assessment of Cognitive Abilities [57] • Disability Assessment Scale for Dementia [199] • Symptoms of Dementia Screener [200] • Observation List for early signs of Dementia [201] • General Practitioner’s Assessment of Cognition Informant Interview [114] • Sunnybrook & Women’s six-item test (304) • Financial Capacity Instrument [202] • Alzheimer’s Disease Caregiver Questionnaire [203] • ADLs Questionnaire [204] • AD8 [205] • Patient-reported outcomes in cognitive impairment [206] 9www.futuremedicine.com 10 Au tho r P ro of (C) Global impression scales • Clinical Dementia Rating Scale (CDR) [111,112]: – CDR-sum of boxes [207] – CDR-extended [48] • Global Deterioration Scale [110] • Brief Cognitive Rating Scale [113] • Functional Assessment Test [208] • Alzheimer’s Staging Scale [188] • Confusion Assessment Method [209] (D) Global synthesis/combining cognitive testing and informant report • Global Clinical Scale [48] • Milan Overall Dementia Assessment [210] • IQCODE and Mini-Mental State Examination (MMSE) [211] • IQCODE and 3MS [60] (E) Telephone screening tests • Telephone Interview for Cognitive Status [212] • Telephone-assessed Mental State [213] • TELE [214,215] • Minnesota Cognitive Acuity Screen [216] • Interactive-Voice Recognition Dementia Screen [217] • Memory Impairment Screen – telephone version [218] • MMSE – telephone version [219] • Telephone Brief Screen for Cognitive Impairment [220] • Indiana University Telephone-Based Assessment of Neuropsychological Status [221] (F) Other cognitive testing modalities • Web-Based and Computer-Based Screening Tools: • Cognitive Stability Index [158] • Neurotrax (a cognitive battery) [222] • Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (a cognitive battery) [160] • Memtrax (a 2-min memory screen useable on the internet) [161] (G) Nonspecific brief cognitive tests (useful component tests that are not appropriate for use as stand-alone exams) • Temporal Orientation [29,223] • Category Fluency (e.g., animal naming in 1 min) [29,224]: – Variant: the Set Test [225] – Category and Letter Fluency [68,74] • Clock Drawing Task [226,227] • Trail Making Tests A and B [93] • Mental Alternation Test [228] • Time & Change Test [229,230] • WORLD test [231] • Visual Association Test [86] (H) Secondary, longer screening tests & cognitive/memory assesments for those positive on preliminary tests, or if there is a concern for detecting or measuring dementia • Mattis Dementia Rating Scale [34,35,100] • Cognitive Capacity Screening Exam [232] • Extended Scale for Dementia – from Mattis [233,234,104] • Modified MMSE [50,235,236] • Alzheimer’s Disease Assessment Scale – cognitive subscale [237] • Cognitive section of CAMDEX [238] • Neurobehavioral Cognitive Status Examination (renamed Cognistat in 1995)[239] • High Sensitivity Cognitive Screen [240] • Halifax Mental Status Scale [241,242] • MMS-extended [48] • Ottawa Mental Status Exam [243] Box 4....

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  • ...Halstead summarized the literature prior to 1943 to develop his test, “In all, nearly 80 short tests or items were tried before the present scale took shape” [29]....

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  • ...Katzman R, Brown T, Fuld P et al.: Validation of a short Orientation–Memory– Concentration Test of cognitive impairment....

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