Diagnosis and assessment of the older patient

Despite the enormous medical and psychiatric importance of mental illness among the elderly, clinicians generally are not trained in the phenomenology and presentation of the major mental disorders that occur primarily in this age group. The authors describe the presenting symptoms and course of four conditions--senescent forgetfulness, primary degenerative dementia (considered as the confusional phase and dementia phase), geriatric depression, and multi-infarct dementia--with emphasis on differential diagnosis. The clinical examination of the patient is the most important feature of any diagnostic and assessment program; because of the wide prevalence and in many ways unique aspects of mental illness among the elderly, all but the smallest psychiatric programs should have at least one clinician who specializes in assessment of geriatric problems.