Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-0NON-COMPUTERIZED ASSESSMENT PROCEDURES 141Misinterpretations of scores result from several misconceptionsabout the test. The MMSE is not a complete mental statusexamination or a complete neuropsychological examination. TheMMSE does not define a clinical or pathological diagnosticcategory, such as dementia or brain tumor or organicity. The scoredoes not measure decline from a previous level unless tests arerepeated over time. The score does not tell the whole story.Individual items are useful for understanding the situation of thepatient, since they indicate whether the patient can followinstructions, read and write. Finally, the MMSE is a weak measureof competence or disability. Competence, handicap and disabilitymust be assessed by procedures designed for that purpose.REFERENCES1. Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practicalmethod for grading the cognitive state of patients for the clinician. JPsychiatr Res 1975; 12: 189–98.2. Tune L, Folstein MF. Post-operative delirium. Adv Psychosom Med1986 15: 51–68.3. Tsai L, Tsuang MT. The Mini-Mental State test and computerizedtomography. Am J Psychiat 1979; 136(4A): 436–8.4. Bondareff W, Raval J, Woo B et al. Magnetic resonance imaging andthe severity of dementia in older adults. Arch Gen Psychiatry 1990;47(1): 47–51.5. DeKosky ST, Shih WJ, Schmitt FA et al. Assessing utility of singlephoton emission computed tomography (SPECT) scan in Alzheimerdisease: correlation with cognitive severity. Alz Dis Assoc Disord1990; 4(1): 14–23.6. Koponen H, Stenback U, Mattila E et al. CSF -endorphin-likeimmunoreactivity in delirium. Biol Psychiat 1989; 25(7): 938–44.7. Martignoni E, Petraglia F, Costa A et al. Dementia of the Alzheimertype and hypothalamus–pituitary–adrenocortical factor and plasmacortisol levels. Acta Neurol Scand 1990; 8(5): 452–6.8. DeKosky ST, Scheff SW. Synapse loss in frontal cortex biopsies inAlzheimer’s disease: correlation with cognitive severity. Ann Neurol1990; 27(5): 457–84.9. Anthony JC, Leflesche L, Niaz U et al. Limits of the ‘‘Mini-MentalState’’ as a screening test for dementia and delirium among hospitalpatients. Psychol Med 1982; 12: 397–408.10. Folstein M, Anthony JC, Parhad I et al. The meaning of cognitiveimpairment in the elderly. J Am Geriat Soc 1985; 38: 228–35.11. Crum R, Anthony J, Bassett S, Folstein M. Population-based normsfor the Mini-Mental State examination by age and educational level.J Am Med Assoc 1993; 269: 2386–91.12. DePaulo JR, Folstein MF. Psychiatric disturbances in neurologicpatients: detection, recognition and hospital course. Ann Neurol1978; 4: 225–8.13. Rebok G, Brandt J, Folstein M. Longitudinal cognitive decline inpatients with Alzheimer’s disease. J Geriat Psychiat Neurol 1990; 3:91–7.14. McHugh PR, Folstein MF. Organic mental disorders. In Michels R,Cooper AM, Guze SB et al., eds. Psychiatry. Philadelphia: JBLippincott, 1988, 1–24.IQCODE: Informant InterviewsA. F. JormCentre for Mental Health Research, The Australian National University, Canberra, AustraliaIn assessing patients for dementia, informants are a valuablesource of information, complementing other sources such ascognitive testing. The strengths of informant data include:. Everyday relevance. Informants can report on how the patientis functioning in everyday cognitive tasks. Cognitive tests, bycontrast, generally involve artificial tasks removed from dailylife.. Acceptability to patients. Formal cognitive testing can bedistressing to some people because of the limitations it reveals.However, informant interviews do not directly confront thepatient’s limitations.. Longitudinal perspective. It is often useful to know how apatient is functioning compared to earlier in life. An interviewwith an informant who has known the patient for many yearscan provide this.. Ease of administration. If necessary, informant data can becollected by telephone or mail. In some research situations, ithas even been used to assess deceased subjects.. Cross-cultural portability. Informant data may have greatervalidity than cognitive testing for patients who are fromculturally different backgrounds 1 .While informant interviews are widely used in clinical practice,there is now a range of standardized informant interviews andquestionnaires available for quantifying this information. Probablythe most widely used and researched is the InformantQuestionnaire on Cognitive Decline in the Elderly (IQCODE) 2 .The IQCODE is a 26-item questionnaire that asks the informantabout cognitive changes over the previous 10 years. Items covermemory and intellectual functioning and are rated on a five-pointscale from ‘‘1. Much improved’’ to ‘‘5. Much worse’’. Originally,the IQCODE was designed as an interview but it is morecommonly used as a self-administered questionnaire. There is nowa short 16-item IQCODE which performs as well as the original.Translations of the IQCODE are available in a range oflanguages. The various versions are available on the Web athttp://www.anu.edu.au/iqcode/.Principal component analysis of the IQCODE items haveshown that it measures a general factor of cognitive decline.Validity studies have found that the IQCODE correlatesmoderately with cognitive screening tests such as the Mini-MentalState Examination (MMSE) (mean r=0.59 over seven samples).Correlations with indicators of premorbid ability, such as theNational Adult Reading Test (NART) and years of education arerepeatedly found to be near zero.A meta-analysis of seven studies directly comparing theIQCODE with the MMSE as a screening test for dementiafound that the IQCODE performed at least as well as the