The MacNeill-Lichtenberg Decision Tree: a unique method of triaging mental health problems in older medical rehabilitation patients.
OBJECTIVE
Evaluation of the utility of a "decision tree" that identifies potential mental health problems in older medical patients and guides decision making for referrals.


METHODS
Measures of utility including sensitivity, specificity, and predictive power were examined. Independent t tests and nonparametric statistics were used to evaluate group differences where appropriate.


METHODS
The stroke and geriatric unit of a freestanding urban medical rehabilitation hospital.


METHODS
In study 1,173 older, consecutively admitted medical rehabilitation patients completed all cognitive measures. In study 2, a separate sample of 313 older adults completed the Geriatric Depression Scale during admission.


METHODS
The MacNeill-Lichtenberg Decision Tree (MLDT) was compared with the Mini-Mental State Exam (MMSE), the Mattis Dementia Rating Scale, and the 30-item Geriatric Depression Scale.


RESULTS
Study 1: The decision tree accurately triaged 87% of mental health problems and allowed for deferral of 41% of cases, for whom further assessment was unnecessary. The MLDT was superior to the MMSE, with higher sensitivity and a lower failure rate. Study 2: The emotional status component of the MLDT was useful in triaging cases for depression evaluation.


CONCLUSIONS
The MLDT was useful in prioritizing cases with regard to mental health problems (eg, dementia, depression) and making quick referral decisions. The MLDT is a unique instrument that not only evaluates cognitive status, but also considers psychosocial factors and emotional status in older adults.
MacNeill
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SE
Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA.
Lichtenberg
P A
PA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003663:Decision Trees; D003704:Dementia / Q000145:classification / Q000534:rehabilitation; D003866:Depressive Disorder / Q000145:classification / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000534:rehabilitation*; D008609:Mental Status Schedule; D008875:Middle Aged; D012047:Rehabilitation Centers; D000071939:Stroke Rehabilitation; D014218:Triage