The mental status examination of the older psychiatric patients is central to the diagnostic work up. Many aspects of this examination can be assessed during the history taking interview. Appearance may be affected by the older patients psychiatric symptoms, cognitive status, patient with dementia may not be able to match clothes or even put on clothes and environment.

Affect and mood usually can be assessed by observing the patient during the interview. Affect is the feeling tone that accompanies the Patients cognitive output. Affect may fluctuate during the interview; however, the older person is more likely to have a constriction of affect. Mood, the state that underlies overt affect and is sustained over time, is usually apparent by the end of the interview. For example the effect of a depressed older adult may not reach the degree of dysphoria seen in younger persons, yet the depressed mood is usually sustained and discernible from beginning to end.

Psychomotor activity may be agitated or retarded. Psychomotor retardation or underactivity is characteristic of major depression and severe schizophrenic form symptoms, as well as of some variants of primary degenerative dementia. Psychiatrically impaired older persons except some who advanced dementia are more likely to show hyperactivity or agitation. Those who are depressed will appear uneasy move their hands frequently, and have difficulty remaining seated through the interview.

Patients with mild to moderate dementia, especially those with vascular dementia, will be easily distracted, rise from a seated position and or walk around the room or even out of the room. Pacing is often observed when the older adults is admitted to a hospital ward. Agitation usually can be distinguished from anxiety the agitated individual does not complain of a sense of impending doom or dread. In patients with psychomotor dysfunction, movement generally relives the immediate discomfort, although it does not correct the underlying disturbance. Occasionally, the older adult with motor retardation may actually be experiencing a disturbance in consciousness and may even reach an almost stupors state. The patient may not be easily aroused but when aroused he or she will respond by grimacing or withdrawal.

Regards
John George
Journal of Aging Science