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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