Cognitive Assessment and Development of Cognitive Assessment test for Older People: A challenge

Cognitive assessment of older people is still a challenge, because of multiple morbidities with advancing age in them.  The older people are compromised with sensory organs, physical activities and fatigability leads to non-response  or discontinuation of the test.   Therefore, before going to assess in detail, older person should screen for cognitive impairment.  Many cognitive screening tests are available but they are having some bias.  MMSE (Mini Mental State Examination) is the most widely used cognitive screening test but it also has education, language and culture bias.  The test is translated, adapted and modified in many languages beside these limitations.  Standardized MMSE, Modified MMSE, HMSE (Hindi Mental State Examination), HCST (Hindi Cognitive Screening Test) are few names of this modified test.  All authors made some modifications as per their sociocultural background to eliminate the education, language and culture bias. 

But, we are yet too far in developing universally used cognitive screening test like Rorschach Psychodiagnostics. Montreal Cognitive Assessment and SLUMS (Saint Luis Mental State Examination) are two cognitive assessment tools which are sensitive and specific for detecting mild cognitive impairment (MCI) also.  Many researchers are trying to adapt, translate and modify these tests as per their social and cultural background.  But developing culture fair norm is still a challenge.

I wish to share an experience in the assessment of immediate memory of a 85 years old inpatient of the Department of Geriatric Mental Health, KGMU, Lucknow, UP, India.  The three items of PGI Memory Scale are arranged in increasing difficulty level.  The first and second sentences were having three and four segments of a sentence however, third sentence has 5 segments.  The patient could not repeat the first two sentences but, he could repeat last sentence which has 5 segments in a sentence.   This was surprising to me. After analysing this response i found that the last sentence was very close to his daily routine work and rest two were not.   So he could easily repeat the last sentence which was much difficult than the rest two.  

Thus, before developing, adapting and modifying of a test for older people we should consider all factors mentioned above.  And Yes!  Older people are treasure of our life so, we should make an extra effort to ease them at the time of assessment in a dignified manner.  Respect them, pat on him/her, motivate and encourage them to be with you in spite of failure in response. Although, it is a still challenge to assess their cognitive functions without bias.

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Does education affects cognitive functions in older people?

It is reported in scientific literature that more educated persons have more cognitive reserve in comparison to less educated person.  It may be because more educated persons think more, plan more, act more and ready to learn more in their life.  These cognitive stimulating activities stimulate brain cells and they remain active to give their best at even in old age.

Predictors of Healthy and Unhealthy Aging in North Indian Older Adults with Reference to Mental Health

Rakesh Kumar Tripathi, S. C. Tiwari, Aditya Kumar

Reference: Tiwari, S.C., Tripathi, R.K., Kumar A. Predictors of healthy and unhealthy aging in north Indian Older adults with reference to mental health awarded as IAGMH / INTAS award-2010 at  3^rd place in 6^th Annual National Conference of IAGMH held on 4^th-5^th Sep. 2010, Mumbai.  Indian Journal of Geriatric Mental Health, Vol. 7 (1); 24-35; 2011.

Introduction: Scientific reports regarding specific socio–demographic and personal characteristics of individuals with ‘healthy’ and ‘unhealthy’ (with mental health problems) aging in their life time are inconclusive. Present study attempts to address these issues. Methods: Sample consisted of 1368 subjects aged 55 years and above giving informed consent, drawn from urban localities of Lucknow, India. Subjects were initially assessed for their socio-demographic and personal history along with their physical and neurological condition.  After screening through Mini Mental Status Examination and Survey Psychiatric Assessment Schedule for ‘cognitive’ and ‘neuropsychiatric disorders’, subjects were assessed in detail on Cambridge Mental Disorder of the Elderly Examination- Revised for ‘cognitive disorders’(C.D.) and Schedule for Clinical Assessment in Neuropsychiatry for ‘neuropsychiatric disorders other than cognitive disorders’(N.P.). Subjects were categorized into N.P.(n=258), C.D.(n= 148), ‘Sub-syndromal mental health problems’(n= 91) and ‘Normal aging’(n=871) groups. Older adults were subdivided into two major groups - Pre-elderly group(55-59years) and Elderly group(60 years and above).   Comparison among the above groups was done on socio-demographic and personal variables. Results:  Unmarried male, aged less than 60 years with higher education, employed, financially independent, living in joint family, belonging to reserved caste categories, having better perception of health, highly satisfied with their quality of life, involved in group activities and health check up as per need and those without any significant life events were found to be ageing significantly healthy in comparison to unhealthy aging subjects.  Conclusions: Identified predictors of healthy and unhealthy aging can be intervened to promote healthy aging.

The Findings are based on an ICMR, New Delhi funded research project.  The published paper is available on www.ijgmh.com