The Psychogeriatric Assessment Scales

Subject Interview
Identification Information
1. Subjects name or ID: ................

_______________________________

2. Date of interview: ......................

_______________________________

3. Interviewers name or ID:..........

_______________________________

4. Sex of subject (circle): ...................................................... Male

Female

I am going to ask you some questions about your medical history and how you
are managing.
In this interview, everybody is asked the same questions, so please bear with
me if any of them seem odd or inappropriate.
Everything we discuss is confidential.
Let us begin with a few general questions.

Anthony Jorm
NH&MRC Social Psychiatry Research Unit
Australian National University
Canberra ACT 0200 Australia

Andrew Mackinnon
Mental Health Research Institute
Locked Bag No. 11
Parkville Vic 3052 Australia

Jorm & Mackinnon 1995

Subject Interview

Background Information

1.

Please spell your last name (for me). And your first name?
Correctly spelled ............................................................
Cannot give both names correctly (one minor spelling
error allowed), does not know .......................................

2.

0
1

So how old are you now?

Age in years .........................................................
Does not know ...............................................................

4.

What year were you born in?

Year ...................................................................
Does not know ...............................................................

3.

0
1

What country were you born in?

Country .........................
Does not know ...............................................................

0
1

Add boxes
If total is 1 or more, skip to the Cognitive
Impairment scale.

Subject Interview

Stroke Scale (Subject)

Have you ever had or been told that you had:

S1.

S2.

A stroke?
No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

A series of mini-strokes or transient ischaemic attacks

(or TIAs)?
No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

Have you ever:

(Include present condition in recording responses.)

S3.

S4.

S5.

Subject Interview

had a sudden weakness on one side which got better?

No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

had a sudden severe difficulty with speaking?

No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

had a sudden severe difficulty with your vision?

No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

S6.

had a sudden severe difficulty with your memory?

No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

Now calculate PAS Stroke Score (S)

Add boxes S1 to S6 .....................

Number of boxes with ? s .........

Subject Interview

If ? is not zero, score should

be pro-rated using formula:

6xS

6xS/(6-?)

(6 ?)

Depression Scale
Now Id like to ask you about how youve been feeling within yourself.

D1.

D2.

D3.

D4.

D5.

Subject Interview

In the last two weeks, have you been feeling depressed or sad
at all?
No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

Have you had trouble sleeping over the past two weeks?
No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

In the past two weeks, have you been taking anything to help
you sleep?
No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

In the last two weeks, have you been worn out or had too little
energy, even when you havent been doing a lot?
No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

In the last two weeks, have you talked or moved more slowly
than is normal for you?
No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?
5

D6.

D7.

In the last two weeks, have you had to be moving some part of
your body all the time that is, you were so restless you
couldnt sit still?
No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

In the past two weeks, how frequently have you felt lacking in
self-confidence or felt inadequate?
Never ..............................................................................
Some of the time ............................................................
Most of the time .............................................................
All of the time ................................................................
Does not know ...............................................................

0
0
1
1
?

Now Id like to ask you about your thinking.

D8.

D9.

D10.

Subject Interview

In the last two weeks, has your thinking been much slower
than usual?
No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

In the last two weeks, have you had trouble concentrating?

No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

In the last two weeks, do your thoughts seem to get mixed up

so that you cannot get them sorted out?
No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

D11.

In the last two weeks, have you had difficulty

making decisions?
No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

As they get older, some people find their thoughts turning to death
more than earlier in life.

D12.

In the last two weeks, have you felt as if you wanted to die?
No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

Now calculate PAS Depression Score (D)

Add boxes D1 to D12 ..................

Number of boxes with ? s .........

Subject Interview

If ? is not zero, score should

be pro-rated using formula:

12 x D

12xD/(12-?)

(12 ?)

Cognitive Impairment Scale

Now let me ask you a few questions to check your concentration and
your memory. Most of them will be easy.
I am going to name three objects. After I have said them I want you to
repeat them. Remember what they are, because I am going to ask you
to name them again in a few minutes.
Apple

Table

Penny

Could you repeat the three items for me?

Repeat objects until all three are learned. Stop after five
unsuccessful attempts.

C1.

I am going to give you a piece of paper. Would you please

write any complete sentence on that piece of paper for me?
If sentence is illegible, ask Could you read it for me?,
and copy sentence onto sheet.
Sentence should have a subject and a verb, and
make sense.
Spelling and grammatical errors are acceptable.
Correct............................................................................
Incorrect or refusal .........................................................
Not asked (e.g. sensory or motor impairment) ..............

C2.

Subject Interview

0
1
?

Now what were the three objects I asked you to remember?

Score 0 for each object remembered, 1 if an error is
made because object is not mentioned or subject
refuses. Order of recall is not important.
Apple ..............................................................................
Object not mentioned or subject refuses ........................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

Table ...............................................................................
Object not mentioned or subject refuses ........................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

Penny..............................................................................
Object not mentioned or subject refuses ........................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

Please listen carefully to the following name and address, then

repeat it:
John Brown, 42 West Street, Kensington.
Repeat address until learned. Stop after five unsuccessful
attempts.
Please go on remembering this name and address and I will ask you
about it later.

C3.

I am now going to say the names of some people who were

famous and I would like you to tell me who they were or why
they were famous in the past.
Score 0 for each person correctly identified, 1 if
answer is incorrect or subject refuses.

C4.

Subject Interview

Charlie Chaplin .............................................................

(actor, comedian, film star, comic)
Incorrectly identified or refused.....................................
Not asked (e.g. sensory or motor impairment) ..............

Joseph Stalin ..................................................................

(Soviet, Russian, WWII leader, Communist leader)
Incorrectly identified or refused.....................................
Not asked (e.g. sensory or motor impairment) ..............

Captain Cook .................................................................

(explorer, sailor, navigator, discoverer)
Incorrectly identified or refused.....................................
Not asked (e.g. sensory or motor impairment) ..............

Adolf Hitler ....................................................................

(German, Nazi, WWII leader)
Incorrectly identified or refused.....................................
Not asked (e.g. sensory or motor impairment) ..............

New Years day falls on what date?

First of January/first day of new year ............................
A wrong date, does not know, refusal ............................
Not asked .......................................................................

1
?

1
?

1
?

1
?

0
1
?

C5.

What is the name and address I asked you to remember a

short time ago?
Score 0 for each component remembered, 1 if a
component is not mentioned or subject refuses.
Order of recall is not important.

C6.

John ................................................................................
Component not mentioned or subject refuses ................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

Brown .............................................................................
Component not mentioned or subject refuses ................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

42....................................................................................
Component not mentioned or subject refuses ................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

West Street .....................................................................

Component not mentioned or subject refuses ................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

Kensington .....................................................................
Component not mentioned or subject refuses ................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

Here is a drawing. Please make a copy of it here.

Hand subject the paper with 2 five-sided figures
and point to the space underneath it.
Correct if 2 five-sided figures intersect to make a
four-sided figure.
Correct............................................................................
Incorrect or refusal .........................................................
Not asked (e.g. sensory or motor impairment) ..............

Subject Interview

0
1
?

10

C7.

Read aloud the words on this page and then do what it says.
Hand subject the sheet with the words
close your eyes.
Correct (subject closes eyes) ..........................................
Incorrect or refusal .........................................................
Not asked (e.g. sensory or motor impairment) ..............

C8.

0
1
?

Now, read aloud the words on this page and then do what it says.
Hand subject the sheet with the words
cough hard.
Correct (subject coughs) ................................................
Incorrect or refusal .........................................................
Not asked (e.g. sensory or motor impairment) ..............

C9.

0
1
?

Tell me what objects you see in this picture?

Hand the four-object sheet to the subject.
Score 0 for each object identified, 1 if an object is
not mentioned or subject refuses. Order of
identification is not important.
Teapot, kettle ..................................................................
Object not mentioned or subject refuses ........................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

Telephone (whole object, not just dial) ..........................

Object not mentioned or subject refuses ........................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

Scissors ..........................................................................
Object not mentioned or subject refuses ........................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

Fork ................................................................................
Object not mentioned or subject refuses ........................
Not asked (e.g. sensory or motor impairment) ..............

0
1
?

That brings us to the end of the interview. Thank you very much for
your time.

Subject Interview

11

Now calculate PAS Cognitive Impairment

Score (C)

Add response boxes for C1 to C9 ...

Number of boxes with ? s .........

If ? is not zero, score should

be pro-rated using formula:
21xC/(21-?)

Subject Interview

?
21 x C
(21 ?)

12

Close your eyes

Cough hard

The Psychogeriatric Assessment Scales

Informant Interview
Identification Information
1. Subjects name or ID: ................

_______________________________

2. Date of interview: ......................

_______________________________

3. Interviewers name or ID: ..........

_______________________________

4. Sex of informant (circle): ................................................. Male

Female

I am going to ask you some questions about the medical history of SUBJECT
and how s/he is managing.
In this interview, everybody is asked the same questions, so please bear with
me if any of them seem odd or inappropriate.
Everything we discuss is confidential.
Let us begin with a few general questions.

Anthony Jorm
NH&MRC Social Psychiatry Research Unit
Australian National University
Canberra ACT 0200 Australia

Andrew Mackinnon
Mental Health Research Institute
Locked Bag No. 11
Parkville Vic 3052 Australia

Jorm & Mackinnon 1995

Informant Interview

Background Information
1.

What is your relationship to SUBJECT?

Spouse ............................................................................
Sibling ............................................................................
Sister/brother in-law .......................................................
Daughter/son ..................................................................
Daughter/son in law .......................................................
Friend .............................................................................
Nurse/professional carer (other than above) ..................
Other ..............................................................................

2.

1
2
3
4
5
6
7
8

How long have you known SUBJECT?

Length of time in years ..................................................

3.

How often do you see SUBJECT?

Lives with subject ..........................................................
Daily ...............................................................................
More than once a week or weekly .................................
Less than once a week....................................................
Does not know ...............................................................

4.

1
2
3
4
?

How old is SUBJECT?

Age in years ...................................................................

5.

How old was SUBJECT when s/he left school?

Age in years ...................................................................
Does not know ...............................................................

Did s/he have any particular

problems learning to read or write?
No..................................
Yes .................................
Does not know ..............

0
1
?

If subject was
less than 12
when s/he left
school, ask:

Informant Interview

Stroke Scale (Informant)

Has s/he ever had or been told that s/he had:

IS1.

IS2.

A stroke?
No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

A series of mini-strokes or transient ischaemic attacks

(or TIAs)?
No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

Has s/he ever:

(Include present condition in recording responses.)

IS3.

IS4.

IS5.

Informant Interview

had a sudden weakness on one side which got better?

No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

had a sudden severe difficulty with speaking?

No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

had a sudden severe difficulty with her/his vision?

No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

IS6.

had a sudden severe difficulty with her/his memory?

No ...................................................................................
Yes ..................................................................................
Does not know ...............................................................

0
1
?

Now calculate PAS (Informant) Stroke

Score (IS)

IS

Add boxes IS1 to IS6 ...................

Number of boxes with ? s ..........

If ? is not zero, score should

be pro-rated using formula:
6xIS/(6-?)

Informant Interview

?
6 x IS
(6 ?)

IS

Cognitive Decline Scale

I would now like to ask you about some specific situations and
whether SUBJECTs memory has become any worse in these areas
compared to earlier in life.

CD1. Has s/he recently had any difficulty finding her/his way
around familiar places when alone? (Where s/he lives, the
neighbourhood and shops, the homes of close friends
and relatives?)
No difficulty, or doesnt think so ...................................
Moderate or occasional difficulty ..................................
Severe, persistent, frequent difficulty ............................
Bedridden, immobile......................................................
Does not know ...............................................................

0
1
1
1
?

CD2. Does SUBJECT have more trouble remembering things that

have happened recently?
No, not much worse .......................................................
A bit worse .....................................................................
Yes, a lot worse ..............................................................
Does not know ...............................................................

0
1
1
?

CD3. Is SUBJECT worse at remembering where belongings

are kept?
No, not much worse .......................................................
A bit worse .....................................................................
Yes, a lot worse ..............................................................
Does not know ...............................................................

0
1
1
?

CD4. Does s/he have more trouble recalling conversations a few

days later?
No, not much worse .......................................................
A bit worse .....................................................................
Yes, a lot worse ..............................................................
Does not know ...............................................................

0
1
1
?

Informant Interview

CD5. Does s/he have more trouble remembering appointments and

social arrangements?
No, not much worse .......................................................
A bit worse .....................................................................
Yes, a lot worse ..............................................................
Does not know ...............................................................

0
1
1
?

CD6. Does s/he have more trouble recognising the faces of family
and close friends even though s/he has reasonably good vision?
No, not much worse .......................................................
A bit worse .....................................................................
Yes, a lot worse ..............................................................
Does not know ...............................................................

0
1
1
?

CD7. Does s/he need help to handle her/his money and financial
affairs (banking, paying bills, deciding how and where to
spend money, or how to invest)?
No, no difficulty .............................................................
Yes, but manages day-to-day purchases .........................
Yes, cannot manage finances or handle money..............
Has never handled finances except for
day-to-day purchases ...................................................
Does not know ...............................................................

0
1
1
0
?

CD8. Has SUBJECT had more trouble concentrating recently?

No ...................................................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

CD9. Recently have her/his thoughts seemed more mixed up so that

s/he cannot get them sorted out?
No more than usual ........................................................
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

Informant Interview

CD10. Recently, has SUBJECT had more difficulty

making decisions?
No more than usual (includes makes no decisions) .......
Depends on situation ......................................................
Yes ..................................................................................
Does not know ...............................................................

0
0
1
?

Now calculate the PAS Cognitive Decline (CD)

Score

CD

Add boxes CD1 to CD10 .............

Number of boxes with ? s ..........

If ? is not zero, score should

be pro-rated using formula:
10xCD/(10-?)

Informant Interview

?
10 x CD
(10 ?)

CD

Behaviour Change Scale

Here are some more questions concerning SUBJECTs behaviour.

B1.

Is SUBJECT lacking in initiative?

No ...................................................................................
Yes

B2.

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Is SUBJECT demanding and attention seeking?

No ...................................................................................

Yes

B3.

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Is s/he overly emotional?

No ...................................................................................

Yes

B4.

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Does s/he like mixing with others?

Yes ..................................................................................

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

No

Informant Interview

B5.

Is s/he apathetic and withdrawn?

No ...................................................................................

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Is s/he irritable?
No ...................................................................................

Yes

B6.

Yes

B7.

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Is s/he a person whos easy to get on with?

Yes ..................................................................................

No

B8.

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Is s/he impatient and always wanting things right away?

No ...................................................................................

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Yes

Informant Interview

B9.

Is s/he suspicious of others?

No ...................................................................................

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Is s/he inflexible so that s/he wont change her/his ways even

when its necessary?
No ...................................................................................

Yes

B10.

Yes

B11.

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Is s/he cantankerous?
No ...................................................................................

Yes

B12.

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Is s/he particularly sad in mood or depressed?

No ...................................................................................

Yes

Informant Interview

Is this a change from earlier?

No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

10

B13.

Does s/he keep her/himself looking reasonably clean and

respectable without having to be reminded?
Yes ..................................................................................
Only
sometimes
No, needs
constant care

B14.

Is this a recent change from what

s/he was like earlier in life?
No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Does s/he tend to act without considering other

peoples feelings?
No, or only rarely ...........................................................

Sometimes
Most of the
time

B15.

Has s/he always been like this?

No, is worse now...........
Yes .................................
Does not know ..............

1
0
?

Does not know ...............................................................

Does s/he behave on social occassions or in public in a way

which can make people embarrassed or upset?
Never, or only rarely ......................................................

Is this a recent change from what

s/he was like earlier in life?
No..................................
Yes .................................
Does not know ..............

0
1
?

Does not know ...............................................................

Occasionally
Very often

That brings us to the end of the interview. Thank you very much for
your time.

Informant Interview

11

Now calculate the PAS Behaviour Change (B)

Score

Add boxes B1 to B15 ..................

Number of boxes with ? s ..........

If ? is not zero, score should

be pro-rated using formula:
15xB/(15-?)

Informant Interview

?
15 x B
(15 ?)

12

PSYCHOGERIATRIC ASSESSMENT SCALES: SUMMARY PROFILE

100

Subjects Name____________________

Informants Name____________________

Subjects Age______

Relationship to Subject_____________

Date of Subject Interview__________

Date of Informant Interview__________

3+
2

90

6+
5

11+
9 10
8

6+

8+
7
6
5

4+
3
2

4-5
3

2
6
3

Percentile
Rank in
Population

80

2
4
2
3

70
1

Median
or below

60

Stroke

0-1

Depression Cognitive
Impairment

SUBJECT SCALES

Stroke

Cognitive
Decline

Behaviour
Change

INFORMANT SCALES

SUBJECT INTERVIEW
Background

Subject Details:

Cognitive
Impairment

Depression

1.

Spell name...............

D1.

Depressed/Sad.....

2.

Year born: ..............

D2.

Trouble sleeping..

3.

Age: ........................

D3.

Sleeping pills.......

Apple, Table, Penny

C1.

Sentence..............

C2.

Apple..................
Table...................

4.

Country of birth.......
___________________ ....

Add boxes

D4.

Worn out.............

D5.

Move slowly........

AddressJohn Brown

D6.

Restless...............

C3.

D7.

Lack confidence..

Penny..................

Stalin...................
If total is 1 or more, skip
to Cognitive Impairment.

Cook....................
D8.

Thinking slow.....

D9.

Concentration......

Hitler...................

D10. Mixed up.............

Stroke

C4.

New Year............

C5.

John.....................
Brown.................

D11. Decisions.............
S1.

Chaplin................

42........................

Stroke...................
D12. Want to die..........

S2.

West St................

Mini-stroke/TIA...

Kensington..........
S3.
S4.
S5.
S6.

Side weakness......
Speech difficulty..

Add boxes

12 D
(12 ?)

C6.

Copy figure.........

D'

C7.

Close eyes...........

C8.

Cough hard.........

C9.

Teapot.................

Vision difficulty...

Question Scoring

Memory difficulty

Add boxes
6S
(6 ?)

For symptoms, generally

score:
absence=0, present=1.

S'

For test items, generally:

incorrect=1, correct=0.
To administer the PAS
you must be familiar
with the specific scoring
instructions for each
item.

Telephone...........
Scissors...............
Fork.....................
Add boxes

21 C
(21 ?)

C'

This form should only be used in conjunction with the Psychogeriatric Assessment Scales Interview

INFORMANT INTERVIEW
Background

Subject Details:

Behaviour
Change

Cognitive Decline

1.

Relation to subject...

CD1. Familiar places....

B1.

Lacks initiative....

2.

Time known: ..........

CD2. Recent events......

B2.

Demanding..........

3.

How often seen.......

CD3. Belongings..........

B3.

Emotional............

4.

Subjects age:

CD4. Conversations......

B4.

Mixing.................

5.

Schooling age:

CD5. Appointments......

B5.

Apathetic.............

CD6. Family faces........

B6.

Irritable................

CD7. Money/finances...

B7.

Easy going...........

CD8. Concentration......

B8.

Impatient.............

CD9. Thoughts mixed..

B9.

Suspicious...........

CD10. Decision making.

B10. Inflexible.............

..

Learning problems..

Stroke
IS1. Stroke...................
IS2. Mini-stroke/TIA...

Add boxes
10 CD
(10 ?)

IS3. Side weakness......

CD

B11. Cantankerous.......
B12. Sad in mood........

CD'

IS4. Speech difficulty..

B13. Keeps clean.........

IS5. Vision difficulty...

B14. Inconsiderate.......

Question Scoring

IS6. Memory difficulty

Add boxes
6 IS
(6 ?)

IS
IS'

B15. Embarrassing.......

For symptoms, generally

score:
absence=0, present=1

Add boxes

For test items, generally:

incorrect=1, correct=0.

15 B
(15 ?)

B'

To administer the PAS

you must be familiar
with the specific scoring
instructions for each
item.

This form should only be used in conjunction with the Psychogeriatric Assessment Scales Interview