Differences in cognitive status between healthy, psychiatrically ill, and diffusely brain-damaged elderly subjects

It has recently been pointed out by several authors that the psychometric assessment of the elderly patient has largely been geared to, or preoccupied with, the solution of diagnostic problems, measuring deterioration or discovering early dementia (Post, 1966; Inglis, 1962). Therefore, it appears that little attention has been paid to the use of psychometric tests in the broad area of prognosis. Often the psychiatric diagnosis of an elderly patient is quite clear, and in these circumstances it would be valuable to be able to discern reliable and significant changes in the cognitive status of such patients. For example, it may well prove quite significant, prognostically, to measure the rate of change in cognition of an elderly person suffering from a progressive cerebral disease. The rate of decline could be a prognostic indicator for the future disposal of the patient or for impending death. A variety of studies have shown that scores on measures of physical and cognitive abilities can predict death or discharge from hospital (Cosin et al., 1957; Inglis, 1959; Kleemeier, 1961; Kral, 1963). In the case of patients suffering from depressive “pseudo-dementia” (Post, 1965) it will probably be valuable to know if their cognitive status reflects changes in their clinical status. But probably the most important aspect of the psychometric assessment of the geriatric patient will be found to lie in measuring changes in function which may be the sequelae of treatment affecting brain function in general, i.e. anti-depressant preparations and electroconvulsive therapy.