Frequently Asked Questions (FAQs) from Altered Mental States in the Long Term Care Setting

1. Is altered mental state (AMS) a disease that can be treated?

   Altered mental state is not a disease. It is a symptom or syndrome and always has a cause, such as an acute or chronic medical or psychiatric condition, trauma, environmental stress, or an adverse effect of a medical intervention. Only some causes of mental alterations are readily identifiable or treatable.

2. What are some tools that may be used to assess for current signs and symptoms of AMS?

   The patient's inability to participate in assessment tests, such as the Mini-Mental State Examination (MMSE), by itself may suggest the presence of AMS, Other generally recognized specific assessment tools may be used, including the Geriatric Depression Scale, and the Cornell Scale for Depression in Dementia.

3. What patients may be at high risk for developing AMS?

   Patients at high risk for developing AMS include those who are not currently impaired but have had a recent stroke or cancer metastasis to the brain.

4. Where would the practitioner look to find clues to possible causes of AMS and disturbed behavior?

   Clues may come from reviewing the Resident Assessment Protocol (RAP) Guidelines #4 (Communication), #7 (Psychosocial Well-Being), #8 (Mood State), #9 (Behavioral Symptoms), #17 (Psychotropic Drug Set), and #18 (Physical Restraints) accompanying the Minimum Data Set (MDS).

5. Are medical work-ups appropriate for all patients with AMS?

   A work-up may not be indicated for reasons such as the following: if an individual has a terminal or end-stage condition; if the results of the work-up would not change the management course; if the individual would refuse treatment.

6. If the patient's medication regimen has been stable and has not caused adverse reactions in the past, should it be considered as a possible contributor to or cause of symptoms of AMS?

   Even it the regimen has been stable and has not caused adverse reactions in the past, it may contribute to or cause symptoms of newly developed conditions.