[Verse 1]
Margaret is eighty-two, a widow in the autumn of her days,
Her daughter called the clinic saying mother seems a little dazed,
She stumbled in the hallway last October, bruised her wrist,
And now she frets at twilight over memories she fears she's missed,
We pull the intake folder, sharpen pencils, clear the desk,
Four instruments await us — let us name them, for the test:
The GDS-15 for sorrow, fifteen questions, yes or no,
The GAI for anxious rumination, twenty items in a row
[Chorus]
GDS, GAI, MoCA, MAST-G — four keys on a baroque harpsichord,
Fifteen, twenty, thirty, twenty-four — each threshold must be scored,
Depression, dread, cognition, alcohol — four domains to explore,
Administer with caution, know the ceiling, know the floor,
GDS, GAI, MoCA, MAST-G — four keys, four keys, four keys of the accord
[Verse 2]
The MoCA clocks and cubes and trails and animals on a page,
Twenty-six the cutoff — below signals cognitive stage,
But Margaret wore her glasses and she'd barely slept the night before,
Low education shaves a point — the manual keeps the score,
The MAST-G asks of alcohol in language plain and old,
Twenty-four-item screen designed for silver, not for gold —
She scores a three on GDS, anxiety GAI shows ten,
MoCA twenty-four, MAST-G clean — now we integrate again
[Chorus]
GDS, GAI, MoCA, MAST-G — four keys on a baroque harpsichord,
Fifteen, twenty, thirty, twenty-four — each threshold must be scored,
Depression, dread, cognition, alcohol — four domains to explore,
Administer with caution, know the ceiling, know the floor,
GDS, GAI, MoCA, MAST-G — four keys, four keys, four keys of the accord
[Verse 3]
Now the formulation weaves the threads into a tapestry,
Predisposing: lifelong worry, trait neuroticism, family history,
Precipitating: widowhood, the fall, the shaken sense of ground,
Perpetuating: hypervigilance to stumbling, checking every sound,
Protective: prior coping, faith community, a sharp sardonic wit,
The biopsychosocial braid — no single strand will fit,
Her mild memory complaints reflect the anxious hoarding of attention,
Not dementia but the cortisol of dread and apprehension
[Bridge]
Every instrument has borders — the GDS skips somatic cues,
GAI norms are thin in oldest-old, so weight the item queues,
MoCA misses subcortical drift when cutoffs stay the same,
MAST-G self-report can undercount the bottles without shame,
Hold the number lightly — let the narrative speak louder,
The score confirms a hypothesis, the clinician digs the powder
[Chorus]
GDS, GAI, MoCA, MAST-G — four keys on a baroque harpsichord,
Fifteen, twenty, thirty, twenty-four — each threshold must be scored,
Depression, dread, cognition, alcohol — four domains to explore,
Administer with caution, know the ceiling, know the floor,
GDS, GAI, MoCA, MAST-G — four keys, four keys, four keys of the accord