Faculty Bibliography

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.

Geriatricians are increasingly encountering older adults expressing suicidal wishes in the absence of overt mental illness. This is expected to grow as life expectancy increases. This article describes the case of an older adult who expressed the wish to end his life in the absence of a diagnosable mental illness. Although he had chronic medical illnesses, he was not terminally ill. The complex subject of rational suicide in elderly adults is approached from a clinician's perspective. Issues of ageism, gerontophobia, and changing perspectives on death are highlighted. The experience of being a Baby Boomer and its influence on rational suicide is reviewed. Finally, clinical topics such as aging, frailty, dependence on younger and healthier individuals, and the older adult's need for a sense of control are explored.

After Alzheimer's disease, Lewy body dementia (LBD) is the most prevalent progressive dementia of the many cognitive disorders wreaking unspeakable havoc on millions of lives. LBD is characterized by the presence of Lewy bodies, which are abnormal aggregates of a protein called alpha-synuclein, and are found in regions of the brain that regulate behavior, memory, movement, and personality. Many of the symptoms of Alzheimer's, Parkinson's, and LBD overlap, but LBD is more difficult to diagnose. Underdiagnosis is just part of the reason why LBD is unknown to the public and many health-care providers, and why funding for research lags far behind that for almost every other cognitive disorder.