Screening for Delirium, Dementia and Depression in Older Adults

Nursing Best Practice GuidelineClock Drawing TestThe Clock Drawing Test (see Appendix F) assists in supporting a diagnosis of dementia or inindicating to a clinician areas of difficulty experienced by a client (NZGG, 1998). To date thereare about fifteen original scoring systems for the clock drawing test (Heinik, Solomesh, Shein &Becker, 2002). The decline in clock-drawing performance over the dementia process has beenstudied by several authors. In a study by Heinik et al. (2002), it was found that some scoringsystems may have greater sensitivity than others in monitoring progression of cognitivedeterioration. The correlation between different clock drawing tests and the variables suchas demographic, cognitive and activities of daily living is not ubiquitous and it changes withthe dementia severity.Confusion Assessment Method InstrumentDelirium and dementia can be difficult to differentiate. Although both conditions arehallmarked by global disturbance in cognition, delirium is distinguished from dementia by:disruption of consciousness and attention; clinical course; development over a short periodof time; and fluctuation through the course of the day (Costa et al., 1996). Assessment tools adoptedmust capture these essential components. One such tool is the Confusion AssessmentMethod Instrument (CAM) (see Appendix H). The CAM-ICU is another tool specificallydesigned to objectively assess the same characteristics in an intensive care unit population(Ely et al., 2001).33Cornell Scale for DepressionDepression screening in persons suspected of dementia should include information fromthe client and caregiver, as well as the nurse’s observation of symptoms. The Cornell Scalefor Depression (see Appendix J) requires an assessment interview by a clinician obtaininginformation from both the client and the informant.Geriatric Depression ScaleFollowing the clinical interview and the identification of risk factors or client symptoms, thenurse may substantiate the potential for depression with the use of a questionnaire such asthe Geriatric Depression Scale (GDS) (see Appendix K for GDS-15 and Appendix L for GDS-4).The GDS long or short form is valid and reliable for the screening and quantification ofdepression in mild-to-moderate dementia (Isella, Villa & Appollonio, 2001). The findings fromIsella, Villa and Appollonio’s study (2001) support the use of GDS-4 for the screening ofdepression and of the GDS-15 for its severity assessment.