The Cornell Scale for Depression in Dementia (CSDD) was specifically developed to assess signs and symptoms of major depression in patients with dementia. Because some of these patients may give unreliable reports, the CSDD uses a comprehensive interviewing approach that derives information from the patient and the informant. Information is elicited through two semi-structured interviews; an interview with an informant and an interview with the patient. Based on these interviews, the interviewer can score the CSDD by assigning a preliminary score to each item of the scale on the basis of the informant's report in the "Informant" column. The next step is for the rater to interview the patient using the Cornell scale items as a guide. The interviews focus on depressive symptoms and signs occurring during the week preceding the interview. Many of the items during the patient interview can be filled after direct observation of the patient. If there are discrepancies in ratings generated from the informant and the patient interviews, the rater should re-interview both the informant and the patient to resolve the discrepancies. The final ratings of the CSDD items represent the rater's clinical impression rather than the responses of the informant or the patient. The CSDD takes approximately 20 minutes to administer. Each item is rated for severity on a scale of 0-2 (0=absent, 1=mild or intermittent, 2=severe). The item scores are added. Scores above 10 indicate a probable major depression. Scores above 18 indicate a definite major depression. Scores below 6 as a rule are associated with absence of significant depressive symptoms. INTERVIEW WITH THE INFORMANT Who qualifies as an Informant? Informants should know and have frequent contact with the patient. Reliable informants can include nursing staff for patients in the hospital and nursing homes or a family member for outpatients.

A "response window" technique is described and used to reliably demonstrate unconscious activation of meaning by subliminal (visually masked) words. Visually masked prime words were shown to influence judged meaning of following target words. This priming-effect marker was used to identify two additional markers of unconscious semantic activation: (i) the activation is very short-lived (the target word must occur within about 100 milliseconds of the subliminal prime); and (ii) unlike supraliminal prime-target pairs, a subliminal pair leaves no memory trace that can be observed in response to the next prime-target pair. Thus, unconscious semantic activation is shown to be a readily reproducible phenomenon but also very limited in the duration of its effect.

The Cornell Scale for Depression in Dementia (CSDD) was specifically developed to assess signs and symptoms of major depression in patients with dementia. Because some of these patients may give unreliable reports, the CSDD uses a comprehensive interviewing approach that derives information from the patient and the informant. Information is elicited through two semi-structured interviews; an interview with an informant and an interview with the patient. Based on these interviews, the interviewer can score the CSDD by assigning a preliminary score to each item of the scale on the basis of the informant's report in the "Informant" column. The next step is for the rater to interview the patient using the Cornell scale items as a guide. The interviews focus on depressive symptoms and signs occurring during the week preceding the interview. Many of the items during the patient interview can be filled after direct observation of the patient. If there are discrepancies in ratings generated from the informant and the patient interviews, the rater should re-interview both the informant and the patient to resolve the discrepancies. The final ratings of the CSDD items represent the rater's clinical impression rather than the responses of the informant or the patient. The CSDD takes approximately 20 minutes to administer. Each item is rated for severity on a scale of 0-2 (0=absent, 1=mild or intermittent, 2=severe). The item scores are added. Scores above 10 indicate a probable major depression. Scores above 18 indicate a definite major depression. Scores below 6 as a rule are associated with absence of significant depressive symptoms. INTERVIEW WITH THE INFORMANT Who qualifies as an Informant? Informants should know and have frequent contact with the patient. Reliable informants can include nursing staff for patients in the hospital and nursing homes or a family member for outpatients.

In unconscious semantic priming, an unidentifiable visually masked word (the prime) facilitates semantic classification of a following visible related word (the target). Three experiments reported here provide evidence that masked primes are analyzed mainly at the level of word parts, not whole-word meaning. In Experiment 1, masked nonword primes composed of subword fragments of earlier-viewed targets functioned as effective evaluative primes. (For example, after repeated classification of the targets angel and warm, the nonword anrm acted as an evaluatively positive masked prime.) Experiment 2 showed that this part-word processing was potent enough to oppose analysis at the whole-word level. Thus, smile functioned as an evaluatively negative (!) masked prime after repeated classification of smut and bile. Experiment 3 found no priming when masked word primes contained no parts of earlier targets. These results suggest that robust unconscious priming (a) is driven by analysis of part-word information and (b) requires previous classification of visible targets that contain the fragments later serving as primes. Contrary to a widely held view, analysis of subliminal primes appears not to function at the level of analysis of complete words.

The prevalence of depressive disorders among nursing home residents is high; depression recognition is relatively low, with only 37%-45% of cases diagnosed by psychiatrists recognized as depressed by staff. A structured Depression Recognition Scale increased the rates of recognition (sensitivity of staff ratings) to 47%-55%, demonstrating the utility of the scale in increasing awareness of symptomatology.

Importance Persistent pain is highly prevalent, costly, and frequently disabling in later life. Objective To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. Evidence Acquisition Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. Findings Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended–emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician. Conclusions and Relevance Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.

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Elderly individuals living in the community who experience clinically significant depressive symptoms and/or cognitive impairment may be at risk for the development of self-neglect and may become candidates for intervention.