Cognitive impairment and depression in older patients labelled as "vague", "poor historians" or "poorly motivated"

Purpose: Geriatricians often teach that older people labelled "poor historians", "poorly motivated" or "vague" may have underlying conditions such as cognitive impairment and depression. The aim of this study was to examine the accuracy of this contention. Patients and methods: The use of the phrases "poor historians", "poorly motivated" or "vague" by qualified health-care staff regarding older patients was noted prospectively for 1113 patients aged 65 or more seen by a single consultant geriatrician over a 6-month period. All patients were screened for depression using the question "are you depressed?" and for cognitive impairment using the Folstein Mini-Mental State Examination or the Abbreviated Mental Test followed by more detailed evaluation. Results: Description of a patient as "vague" or as a "poor historian" was associated with a positive screening test for cognitive impairment (positive likelihood ratio [LR] 3.4 [2.3-4.9]) and with a final diagnosis of dementia, delirium or both (positive LR 3.1 [2.1-4.4]). Description of a patient as "poorly motivated" predicted a positive screening test for depression (positive LR 11.8 [4.9-19.9]) and a final diagnosis of depression (positive LR 14.0 [5.8-35.0]). Conclusions: Older patients described as "poor historians", "poorly motivated" or "vague" often have underlying cognitive impairment or depression. Education is required to ensure that that this is recognised by health care professionals.