MIAH Toolkit Mini-Tutorial: Page 3


			The initial four tool kits (Memory Loss, Urinary Incontinence, Depression, and Falls) were developed for the Practicing Physician Education in Geriatrics project supported by a grant from the John A. Hartford Foundation through the American Geriatrics Society. The MIAH is providing continued support for the ongoing development of new tool kits. The tool kits are intended to help physicians better understand the common 'Geriatric Syndromes' and contain educational materials, suggested guidelines, forms and tools for evaluation, diagnosis and treatment.


	During the physical examination, the physician looks for evidence of other diseases that might cause or contribute to memory loss. The documentation format allows quick indication of normal examination findings.

Mini-Tutorial Step 3: Initial Visit continued

steps:

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Section Descriptions:

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steps:

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Folstein Mini-mental State Examination:
A valid, widely used measure of cognitive function. Staff can perform and indicate findings in the boxes listed. The norm (expected score) differs slightly by age and education; for example, the norm for a 70 year old high school graduate is 28; and 80 year old with the same education is 26. The instrument may work less well in highly and poorly educated individuals. Low scores (less than 22) are reasonably specific for dementia. High scores do not exclude dementia, particularly in bright, well educated individuals.

Support Documentation:

Download Norm Chart

Geriatric Depression Scale Short Form:
This instrument is a useful screening tool for depression (ref). Scores of 5 or more are considered suspicious for depression. Chronically ill individuals may have false positives related to the burden of physical symptoms.

Hachinski Scale for Vascular Dementia:
The Hachinski scale collects and scores risk factors for vascular dementia elicited during the history and physical. It is rated by the physician after the history and physical are complete. Scores of 4 or higher are considered suspicious for a vascular etiology of a dementing illness. The first column items count two points each, and the second column items count one.