bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial expressions in severely demented patients—a stimulus–response study of four patients with dementia of the Alzheimer type
Authors: Asplund Kenneth , Norberg Astrid , Adolfsson Rolf , Waxman Howard M.
Published: December 2004

The ability to exhibit facial expressions was studied in four patients with severe dementia of the Alzheimer type (SDAT), by means of the Facial Action Coding System (FACS) and physiological responses (heart rate, respiration, skin temperature) under pleasant and unpleasant stimulus conditions. Complex facial expressions that could be interpreted as expressions of emotions were not seen. An increase in the number of facial movements and changes in the physiological responses were seen most markedly under the unpleasant stimulus condition. The patients' reactions during the assumed pleasant stimulus conditions indicated comfort. Different reactions were obtained among the patients. The importance of developing further methods to identify and interpret facial movements in nurse‐patient relationships is emphasized.
The ageing of the third world: tackling the problems of community surveys. Part I: Brazil–a young country grows old
Authors: Veras Renato P. , Murphy Elaine
Published: December 2004

Population ageing is now a phenomenon not only of developed countries but increasingly also of developing Third World countries. In this article (Part I) Brazilian statistics are presented to illustrate the process of demographic transition in a developing country. The characteristics of the elderly population in terms of age, sex, marital status, urban/rural distribution and literacy are analysed in the light of recent changes.
Quantitative CT scan analysis in senile dementia of the Alzheimer type: I. Computerized planimetry of cerebrospinal fluid areas
Authors: Förstl Hans , Burns Alistair , Jacoby Robin , Eagger Sarah , Levy Raymond
Published: December 2004

Sixty patients with senile dementia of the Alzheimer type (DAT) and 30 age and sex‐matched healthy controls were examined by cranial computed tomography (CT). We undertook this study to evaluate a simple and unbiased quantitative method for the estimation of ventricular and subarachnoid spaces by measuring areas of defined Hounsfield units (HUs) in four symmetric quadrants: left and right anterior, left and right posterior. The DAT patients showed a significant enlargement of all ventricles and all measured subarachnoid spaces (p< 0.001). These effects were not related to the age but to the diagnosis. They correlated with the duration of disease and partly with the degree of global cognitive impairment. Seventy‐eight per cent of the patients and controls could be classified correctly by means of the planimetric measurements.
Relationship between alcohol intake, age of onset and duration of Alzheimer's disease: A pilot survey of 84 autopsy‐confirmed cases
Authors: Bidaut‐Russell Michelle , Grossberg George T.
Published: December 2004

Little is known about the drinking habits of individuals who develop Alzheimer's disease. A pilot survey of 84 autopsy‐confirmed Alzheimer cases was carried out to explore a possible role of alcohol consumption in the onset and duration of Alzheimer's disease. Information on the drinking habits of deceased patients for a 15‐year period prior to the onset of the disease was obtained from a surrogate respondent (next of kin) and from the patients' medical records. Alzheimer patients' drinking patterns were comparable to those of the general population. Patients with a history of alcohol abuse did not develop Alzeimer's disease at an earlier age than abstainers or occasional, light or moderate drinkers. Although not statistically significant, duration of survival in Alzheimer's disease was a few years shorter in patients with a history of alcohol abuse.
Computer‐assisted CT measurements in late paraphrenics with and without Schneiderian first‐rank symptoms: A preliminary report
Authors: Howard R. J. , Förstl H. , Almeida O. , Burns A. , Levy R.
Published: December 2004

Computer‐assisted measurements were made on the computed tomography (CT) scans of 14 patients meeting ICD‐9 diagnostic criteria for late paraphrenia, seven of whom had exhibited one or more first‐rank symptoms during their illness. When the CT scans of all 14 late paraphrenics were compared with those of an age‐matched healthy control group, there were no significant differences with regard to planimetric measurements of brain and ventricle areas. Comparison of the scans of late paraphrenics with first‐rank symptoms and those without them demonstrated that late paraphrenics without first‐rank symptoms had a greater degree of cerebral atrophy, which was significantly so for the left frontal lobe. The findings support the observation that late paraphrenia is a heterogeneous condition which is comprised of a group with first‐rank symptoms who probably represent late‐onset schizophrenia and a group without first‐rank symptoms who have structural brain abnormalities and a presumed organic substrate for their symptoms that is impossible to exclude through clinical evaluation.
Sociodemographic change and the elderly population of England and Wales
Authors: Grundy Emily M. D.
Published: December 2004

Sociodemographic characteristics in later life are associated with differentials in both health status and the need for health and other services. An understanding of how sociodemographic changes affect both ageing individuals and the elderly population is therefore important for health care planning. Three aspects of this issue are considered. Changes in the demographic composition of the elderly population, including projected increases in the number of very old people and in the ratio of men to women, are discussed in the first section. The second section based on longitudinal data, concerns sociodemographic differentials in age‐related household changes, and shows that, for example, both housing tenure and density of the local elderly population seem to be associated with differentials in the probability of moving into an institution. In the third section possible influences on the supply of informal support are considered. At the moment there is no evidence that working women or the divorced are less likely than others to live with an elderly parent (including an elderly parent they care for), but further work in this area is needed.
Assessing the environmental quality of long‐stay wards for the confused elderly
Authors: Bowie Peter , Mountain Gail , Clayden David
Published: December 2004

This article describes the requirements for a system of evaluating the quality of the environment on long‐stay wards for elderly demented patients. For the purposes of the study, environment is defined as the physical and social conditions on the ward. A review of available measures of environmental quality is provided. The creation of six rating scales to assess environmental quality is described including tests of their reliability and validity. Problems encountered during the development of the rating scales are discussed.
Obsessive compulsive disorder arising in a 75‐year‐old woman
Authors: Bajulaiye Rotimi , Addonizio Gerard
Published: December 2004

Presented is the case of a 75‐year‐old woman with obsessive compulsive disorder with an unusual age of onset at age 72 years. The patient was resistant to various treatments, but responded to lithium augmentation of fluoxetine.
Short report: Effect of premorbid intelligence on the Mini‐Mental State and IQCODE
Authors: Christensen Helen , Jorm Anthony F.
Published: December 2004

Two groups of elderly men were tested on the Mini‐Mental State Examination (MMSE), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the National Adult Reading Test (NART). The first group consisted of eminent academics and scientists and the second of retired blue‐collar workers. The high education group scored better on the MMSE, but not on the IQCODE. The MMSE was found to correlate with the NART, but the IQCODE did not. These results indicate that the IQCODE, unlike the MMSE, is unaffected by premorbid ability and education.
Elderly Chinese‐ and Caucasian‐Americans compared on measures of psychic distress, somatic complaints and social competence
Authors: Raskin Allen , Chien Ching‐Piao , Lin Keh‐Ming
Published: December 2004

Elderly Chinese‐Americans residing in the community were compared to a sample of elderly community resident Caucasian‐Americans on tests that measured psychological and somatic complaints, mood states and ability to perform activities of daily living. Contrary to expectations based on prior results, the Chinese‐Americans did not admit to more somatic distress or somatic symptoms than their Caucasian‐American counterparts. Rather, they reported less somatic as well psychic distress than the Caucasian‐Americans with few exceptions such as greater concern about memory loss. Chinese‐Americans showed greater moderation in expression of emotions and feelings than the Caucasian‐Americans. Chinese‐American women, however, rated themselves as less proficient in the performance of activities of daily living such as use of public transportation, handling of finances and caring for household chores than the Chinese‐American men and Caucasian‐American men and women.
‘Negative symptoms’, health, depression, and level of functioning among nursing home residents
Authors: Meeks Suzanne , Gibson Lori L. , Walker Kathy P.
Published: December 2004

A six‐month longitudinal design was used to assess the relations among functinal ability, medically disabling conditions, cognitive function, depression, and negative psychiatric symptoms in a nursing home sample. Seventy intermediate and skilled care residents were interviewed, with 51 completing the six‐month follow‐up. Negative symptoms were found to be related approximately equally to physical disability, boredom, and depression, but were not strongly predicted by any study variables. The most stable relationship observed was that between negative symptoms and functioning in the realm of activities of daily living (ADL). Negative symptoms predicted change in ADL functioning across the six‐month period of the study. The findings have possible implications for predicting mortality and focusing interventions on what appears to be a general decline syndrome in nursing home elderly.
Is there a desolation effect after dementia? A comparative study of mortality rates in spouses of dementia patients following admission and bereavement
Authors: Ryan D. H.
Published: December 2004

Mortality rates following patient admission and patient death were measured in the surviving spouses of a sample of dementia patients admitted to a psychogeriatric unit between 1971 and 1986. The vital status of 85% of spouses was confirmed, and the ratio of observed to expected deaths (SMR) was calculated using regional and national mortality statistics.

Spouse mortality following first admission to hospital was significantly lower than expected (p < 0.006), and spouse deaths following bereavement were significantly fewer than expected (p < 0.026). When male and female spouse mortality rates were compared, no significant differences were found, but there was a trend towards lower mortality in female spouses.

The results give no support to the theory that hospital admission often follows a breakdown in the health of a caring spouse. Previous studies have shown an increase in mortality following conjugal bereavement, but the spouses of dementia patients were relative survivors and outlived their married and widowed counterparts in the general population. The possible relationships between dementia, anticipatory grief, and the impact of bereavement on the health of the surviving spouse are discussed.
The geriatric depression scale: Rater‐administered or self‐administered?
Authors: O'Neill Desmond , Rice Iris , Blake Patricia , Walsh J. B. , Coakley Davis
Published: December 2004

A need exists for a simple screening instrument for depression in the elderly which may be applicable in mild to moderate dementia. The GDS is a simple 30‐item instrument whose role in screening for depression in dementia is controversial. This may relate to problems with its use as a self‐administered questionnaire with unclear guidelines as to which subjects may be aided by the rater. We assessed the GDS as a staff‐administered and a self‐administered instrument in 100 elderly medical patients. There was a significant difference between the mean scores for each mode of presentation. This may account in part for the discrepancies between published studies on the GDS in dementia. In the absence of strict guidelines for the original mixed mode of application, the GDS should be considered as a staff‐administered questionnaire exclusively.
Primary degenerative dementia of the Alzheimer type in twins: Initial findings from the Maudsley Hospital Twin Register
Authors: Karlinsky Harry , Macdonald Alison M. , Berg Joseph M.
Published: December 2004

In detailed published accounts to date of 40 twin pairs one or both of whom were said to have Alzheimer's disease (AD), 16 of 35 monozygotic (MZ) pairs were described as concordant for the disease and the remaining 19 pairs as discordant, while of the five pairs of dizygotic (DZ) twins two pairs were designated as concordant. However, these data have emerged almost exclusively from selective case reports and volunteer samples, resulting in an over‐representation of MZ twins that complicates the overall interpretation of the data. In an effort to reduce such ascertainment bias, we screened for diagnoses consistent with AD in the Maudsley Hospital Twin Register, which consists of twins registered at the Bethlem Royal and the Maudsley Hospitals (London, UK) since 1948. Seven twins were identified who met criteria for primary degenerative dementia of the Alzheimer type. Available details of their affected status as well as of the status of their co‐twins are presented and discussed.
Neuropsychological differentiation of Alzheimer's disease from vascular dementia
Authors: Barr Amy , Benedict Ralph , Tune Larry , Brandt Jason
Published: December 2004

The purpose of this study was to determine whether cognitive test performances alone could distinguish patients with probable Alzheimer's disease from those with probable vascular dementia. Sixty‐eight outpatients with clinical diagnoses of either Alzheimer's disease or vascular dementia were administered a brief battery of neuropsychological tests. Scores from the Boston Naming Test and the Hopkins Verbal Learning Test were identified as most discriminating of the groups. Seventy‐seven per cent of the sample was correctly classified by a stepwise discriminant function analysis. Results of this study indicate that selected neuropsychological tests have moderate concurrent utility in the differential diagnosis of dementia.
Geriatric care on a ward without nurses
Authors: Benjamin Lisa C. , Spector John
Published: December 2004

The Multiphasic Environmental Assessment Procedure (MEAP; Moos and Lemke, 1984) was used to assess three long‐stay settings within a geriatric hospital, one of which is a non‐nursing unit committed to the philosophy of residents viewing the setting as their own home. Findings suggest positive outcomes for residents on the nonnursing unit, and support the view that types of care fostering independence and personal responsibility of elderly residents in their setting may be associated with increased mental functioning and activity. The lack of trained nursing staff had no detrimental effect on any measure of resident life, and some specific caring practices on the unit may be interpreted as having a positive outcome for residents.
Clinical diagnosis of presenile Alzheimer's disease: A novel approach
Authors: McGonigal Gerard , Thomas Brenda , McQuade Cecilia , Whalley Lawrence J.
Published: December 2004

A national retrospective survey of hospital records was used to select those patients with presenile dementia who had undergone neuropathological examination. The National Institute of Neurological and Communicative Disorders and the Alzheimer's Disease and Related Disorders Association (NINCDS–ADRDA) clinical criteria for probable Alzheimer's disease and a Hachinski score were applied to each record before the neuropathological diagnosis was known. A discriminant analysis, which entered the criteria as variables, was performed. The diagnostic accuracy of the clinical criteria was compared before and after discriminant analysis. One thousand six hundred and seventy‐one records were scrutinised of which 61 patients had undergone neuropathological examination. NINCDS–ADRDA criteria had a diagnostic accuracy of 72% (specificity 88%, sensitivity 61%) compared to 77% (specificity 80%, sensitivity 75%) after analysis. NINCDS–ADRDA criteria together with the Hachinski score had an accuracy of 72% (specificity 61%, sensitivity 88%) compared to 83.6% (specificity 76%, sensitivity 89%) after analysis. Variables of highest discriminating value were the Hachinski score, presence of coexistent neurological disease and presence of coexistent systemic disease. The results highlight limitations of current clinical criteria used to diagnose Alzheimer's disease and suggest that substantial improvements are possible.
Short screening tests for dementia in the elderly population. II. The combined use of more than one test
Authors: Hooijer C. , Dinkgreve M. , Jonker C. , Kay D. W. K.
Published: December 2004

In the present report, the effects of combining two or more of four short screening tests for dementia in the elderly population were studied using GMS‐AGECAT organic levels as the criterion. Both the combined cut‐off scores and the summed test scores appeared to have clear advantages over the use of one test for the efficacy of case detection and for the comparability of studies. Costs and benefits of this procedure are discussed. In population‐based studies the addition of another screening test to the MMSE is recommended.
The effects of tacrine on regional cerebral blood flow in Alzheimer's disease
Authors: O'Brien John T. , Syed Ghulam M. S. , Levy Raymond
Published: December 2004

Regional cerebral blood flow (rCBF) was studied in nine patients with Alzheimer's disease before and after treatment with tacrine. A small but significant improvement in cognitive functioning on the drug was not accompanied by significant changes in rCBF for the group as a whole. However, when the analysis was repeated excluding the only patient who showed no clinical response to the drug a significant increase in rCBF was seen to the right posterior temporal area. This preliminary study shows that some caution is necessary when interpreting studies of rCBF as changes in cognitive functioning may not always be accompanied by parallel changes in rCBF. Separate analysis of drug responders and non‐responders may be a fruitful area for further research.
Neuroimaging and the differential diagnosis of early dementia: Quantitative CT scan analysis in patients attending a memory clinic
Authors: Spanó A. , Förstl H. , Almeida O. P. , Levy R.
Published: December 2004

Seventy‐eight consecutive patients who attended a ‘memory clinic’ underwent a standardized clinical examination including extensive laboratory tests and cranial computed tomography (CT). This brief report evaluates the contribution of quantitative CT scan analysis to the differential diagnosis of early dementia syndromes. Vascular changes were readily identified in 13 patients with a clinical history and findings compatible with vascular dementia. Enlargement of the anterior and Sylvian fissures and of the third and lateral ventricles was significantly more severe in a group of 29 patients diagnosed as Alzheimer's disease than in 36 ‘memory complainers’ with milder cognitive impairment or in 10 age‐matched non‐demented controls. Quantitative CT scan analysis alone permitted a correct diagnositc distinction between ‘memory complainers’ and patients with Alzheimer's disease in 83% of the cases, but led to an only modest improvement of the correct discrimination achieved by cognitive testing. Our results indicate that CT scans may aid the differentiation of ealry dementing conditions.
Late life psychosis
Authors: Lacro Jonathan P. , Harris M. Jackuelyn , Jeste Dilip V.
Published: December 2004

Psychoses in late life are serious psychiatric disorders. They include schizophrenia (both late onset schizophrenic patients and the more prevalent early onset schizophrenic patients living into middle and old age), delusional disorder, psychosis in patients with dementia, psychosis in patients with depression, and miscellaneous psychoses. This article reviews some of the more recent and interesting findings in late life psychoses. A need for further research is stressed.
Clinical psychopharmacology research in geriatrics: An agenda for research
Authors: Schneider Lon S. , Martinez Rick A. , Lebowitz Barry D.
Published: December 2004

The two main areas of geriatric clinical psychopharmacology research, depression and dementia, are reviewed. The issues for depression research include pharmacokinetics in the geriatric population and the relationship to efficacy and side‐effects; the treatment of the medically ill and the very old; and maintenance and continuation treatments. In particular, the recommendations from the recently convened NIH Consensus Development Conference for the Diagnosis and Treatment of Depression in Late Life are discussed. The issues in dementia research include effective treatment of behavioral symptoms as well as severe and mild cognitive impairment; the development of better cholinesterase inhibitors; the application of other drugs; and the use of appropriate clinical trials methodology.
Prevalence and recognition rates of psychiatric disorder in the elderly clients of a community care service
Authors: Banerjee Sube
Published: December 2004

One hundred and sixty‐nine people over the age of 65 receiving home care services in Lewisham were interviewed using the Geriatric Mental State (A) (GMS(A)) and diagnostic output was obtained using AGECAT. The prevalence of psychiatric disorder in this group is reported and is compared with that found in community surveys which have used the GMS/AGECAT package. Of note is the 26.0% prevalence rate of cases of depression. The prevalence rate of AGECAT ‘depressive psychosis’ was found to be 13.6%, which was significantly higher than expected. Measures of agreement between AGECAT diagnostic cases and assessments made by home care staff are presented—‘kappa’ values and negative predictive values are higher for organic cases than for cases of depression. These ‘recognition’ rates are compared with reported recognition rates of psychiatric disorder in the elderly by health care professionals. Suggestions for further research are made so that the stated aims of the White Paper Caring for People can be achieved.
Cognitive screening of nursing home residents: Factor structure of the modified mini‐mental state (3MS) examination
Authors: Abraham Ivo L. , Manning Carol A. , Boyd Mary R. , Neese Jane B. , Newman Maureen C. , Plowfield Lisa Ann , Reel Sally J.
Published: December 2004

We examined factor structures of the Modified Mini‐Mental State Examination in a sample of nursing home residents (N=892; observation‐to‐variable ratio 59.5:1). Using principal components analysis and orthogonal equamax rotation, a five‐factor structure was derived. This solution, which explained 58.9% of the variance, consisted of the following factors: psychomotor skills, memory, identification and association, orientation, and concentration and calculation. This factor solution shows that, notwithstanding previous claims to the contrary, cognitive screening tests may be able to make stable and independent distinctions between psychomotor and perceptual‐organizational processes. The factors derived map well onto commonly recognized dimensions of neurocognitive ability. The proposed five‐factor solution offers a stable, intuitively sound, and statistically supported framework for differentiation of cognitive screening data into independent dimensions.
Factors related to coping with physical and instrumental activities of daily living among people born in 1904–1923
Authors: Laukkanen P. , Kauppinen M. , Era P. , Heikkinen E.
Published: December 2004

Functional ability is affected by a number of different factors, including biological ageing, illness, and living environment. This study was concerned with the connections of functional ability with mood and cognitive capacity in elderly individuals. It forms part of a cross‐sectional study which was carried out in 1988, involving two random samples of 800 non‐institutionalized persons born in 1904–1913 and 1914–1923. Functional ability tests included 18 questions; eight concerned coping with physical activities of daily living (PADL) and 10 instrumental activities of daily living (IADL). Depressive symptoms and cognitive capacity were examined by tests. In addition, there was a set of questions concerning health status and socioeconomic situation. Regression models (LISREL) were used to identify factors associated with PADL and IADL activities. In the younger age group, 68% of the men and 65% of the women had no difficulty in coping with PADL activities. The figures for the older group were 58% and 37%, respectively. Difficulties were reported more frequently with IADL activities. In the older age group 17% of the men and 10% of the women coped with no difficulty. In all activities difficulties tended to increase with age, and more so among women than men. The explanatory factors that emerged from the regression models as most significant were the number of chronic illnesses, the number of depressive symptoms and cognitive capacity.
Stress on relative caregivers of dementia sufferers, and predictors of the breakdown of community care
Authors: Jerrom Bill , Mian Ihsan , Rukanyake Nemal G. , Prothero David
Published: December 2004

The stress upon the principal relative caregivers of a series of dementia sufferers attending an assessment day hospital was studied. The main variables influencing stress levels were the caregiver's own health self‐rating and a measure of behaviour and mood disturbance in the patient. Predictors of the breakdown of community care over a 1‐year follow‐up period were studied. At 12 months caregiver's ‘caseness’ on the GHQ was a highly significant predictor. Clinical work with dementia sufferers in the community should include an assessment of the health and psychological status of the caregiver. Future research should focus upon evaluating specifically targeted interventions aimed at reducing stress in caregivers.
Response of visual hallucinations to blindfolding
Authors: Naik Prakash , Jones Rob
Published: December 2004

A 65‐year‐old lady presented with distressing persistent nocturnal visual hallucinations. These occurred in clear consciousness and remitted in association with blindfolding therapy.
Determinants of disability in alzheimer's disease
Authors: Zanetti Orazio , Bianchetti Angelo , Frisoni Giovanni B. , Rozzini Renzo , Trabucchi Marco
Published: December 2004

The aim of the study is to evaluate risk factors of disability in a population of 64 patients affected by Alzheimer's disease. The subjects were consecutively recruited at the day hospital service of an Alzheimer's dementia care unit. The associations between activities of daily living and age, cognitive status, affective status, cognitive symptoms duration and number of diseases were evaluated within a multidimensional assessment programme. Cognitive performance, as detected by the Mini‐Mental Status Examination, was the main independent predictor of disability; other independent predictors of disability were age and cognitive disease duration. Number of diseases—physical and mental–and self‐rated depression scores were not independently associated with disability. It is concluded that, in a population of Alzheimer's patients, cognitive impairment has a high impact on the aetiology of disability, but other variables such as age and disease duration should be taken into account. It is also suggested that cognitive performance is the most important indicator of performance in activities of daily living.
Comment. ‘I don’t feel old': The significance of the search for meaning in later life
Authors: Thompson Paul
Published: December 2004

A critique of the study of ageing by social scientists is provided in this article, on the basis of the comparative neglect of life history studies across the whole lifespan. It points to the skewed nature of studies reported in the literature. As a corrective, results from a UK life history based study are presented. It focuses on work, leisure, grandparenting, and intimate relationships between adults, leading to conclusions about the factors determining later life experiences and self‐perceptions of the meaning of old age.
Suicide in the elderly in Austria
Authors: Etzersdorfer Elmar , Fischer Peter
Published: December 2004

In most countries men and women have the highest suicide rates in age groups over 60 years. We investigated suicide rates for the elderly in Austria, a country with one of the highest suicide rates in the world, for the period 1980–1991, using data from the Federal Statistical Division. Suicide rates remained stable over the last decade at a very high level. The mean rate for men was 85.2, for women 28.6/100 000. In men and women rates rise with age. The mean rate of men rises from 51.2 (60–64 years) to 117.3/100 000 (over 85 years); in women there is an increase from 21.4 (60–64 years) to 32.8/100 000 (over 85 years). We did not confirm findings in other countries, where suicide rates have increased in recent years.
Progression in alzheimer's disease: Sequencing of neuropsychological decline
Authors: Almkvist Ove , Bäckman Lars
Published: December 2004

The progression of cognitive and motor functions in Alzheimer's disease (AD) patients and healthy aged individuals was studied. For the healthy aged, the progress was negligible during a 2‐year period. In the AD patients, there was a marked progression in all cognitive tests, but only a slight progression in the finger motor tests. Progression rate varied substantially across functions; the most rapid progression was seen in psychomotor speed, whereas the slowest was seen in episodic memory. The onset of decline was estimated to have occurred first in episodic memory, then in psychomotor speed, semantic memory, and visuospatial functions; finally and most recently, decline was estimated to have occurred in primary memory. The overall data pattern suggests that the onset as well as the rate of progression varies across cognitive functions, and that there may be a time‐ordered sequence of decline of neuropsychological functions in AD that parallels the trajectory of neuropathological changes in this disease.
The quality of interactions schedule (QUIS): Development, reliability and use in the evaluation of two domus units
Authors: Dean Rachel , Proudfoot Roger , Lindesay James
Published: December 2004

The Quality of Interactions Schedule (QUIS) was developed as part of the prospective evaluation of two residential domus units for elderly people with severe mental illnesses. QUIS is an observational strategy in which social interactions between residents and care staff are coded as positive social, positive care, neutral, negative protective or negative restrictive. The interrater reliabilities of both the observational technique and the category codings were good. In the domus evaluation, QUIS demonstrated that the number and quality of interactions were significantly improved in both domuses compared to a baseline hospital ward at 3 months, 6 months and 12 months follow‐up. In particular, the number of negative interactions observed fell to almost zero in the domuses at 12 months.
Behavioural symptoms in the institutionalized elderly—relationship to dementia
Authors: Nösman Birgitta , Bucht Gösta , Eriksson Sture , Sandman P. O.
Published: December 2004

A proportion of patients in long‐term care institutions have behavioural symptoms that increase the physical and psychiatric workload of those caring for them. We performed a cross‐sectional study in order to assess the prevalence of behavioural symptoms in patients in various types of long‐stay institutions. In addition, we studied behavioural patterns to find predictors for behavioural symptoms. Prevalence and pattern of behavioural symptoms were studied in 1350 patients in the long‐stay institutions in the county of Umeå using Gottfries and Gottfries Psychogeriatric and Sandman‐Adolfsson's Multi‐Dimensional Dementia Assessment Scales. The patients were in a psychogeriatric unit, a somatic long‐stay unit, eight nursing homes and 15 homes for the aged with a total number of 1403 beds. Behavioural symptoms were found in 65% of the patients and were classified into six syndromes: escape, aggression, restlessness, wandering, regression and verbally disruptive behaviour.
Psychiatric morbidity among ‘ABLE’ residents of part III homes
Authors: Stout Ian , Wilkin David , Jolley David J.
Published: December 2004

One hundred and thirty residents of 11 Part III homes who had been in care for a year or more and had no cognitive impairment as assessed by the Crichton Royal Behavioural Rating Scale were investigated using the Clinical Interview Schedule, the 10‐question Mental Test Score and standardized schedules for aphasia and parietal lobe function. Thirty per cent showed signs of early dementia; mild to moderate neurotic symptoms were common among the remainder. Ten per cent had longstanding impairment of intellect or personality or were schizophrenic. Less than 15% warranted a diagnosis of neuritic depression or anxiety. Most of this psychopathology was regarded as ‘normal’ by senior staff. Relatively well‐preserved ‘clients’ presenting as ‘in need of care’ should receive particularly careful attention when formal assessment is reintroduced as a requirement before placement into rest homes at public expense. Those failing because of mild/moderate dementia are likely to benefit from admission while others may find life in care frustrating and depressing.
Electroconvulsive therapy in elderly patients with intracranial tumor: A case series
Authors: Holroyd Suzanne
Published: December 2004

Five cases of depressed elderly patients with intracranial tumors treated with electroconvulsive therapy (ECT) are reported. None had adverse reactions to ECT and all had a positive response. The largest tumor was 4 cm in diameter. No case had evidence of increased intracranial pressure or mass effect. Three tumors were meningiomas, the other two were an acoustic neuroma and a pituitary adenoma. Given that increased use of neuroimaging techniques may result in discovery of incidental intracranial tumors in the depressed elderly prior to ECT, this report suggests that ECT in such patients may be administered safely.
Crisis intervention in psychogeriatrics: A round‐the‐clock commitment?
Authors: Doyle Harry , Varian John
Published: December 2004

The purpose of the study was to ascertain if comparable results could be obtained with a crisis intervention service operating during normal working hours as with a round‐the‐clock service. A follow‐up study, over a period of 3 years, was conducted on a cohort of 70 patients aged 65 years and over who were referred urgently to a Crisis Intervention Team over a 6‐month period. This team operated on a 9–5 basis. Outcome under several headings was compared with outcome in a previously reported 2‐year follow‐up study of a crisis intervention service which operated on a 24 hr basis. This group had comparable age and sex distribution, and similar proportions living alone at referral. Diagnostic groupings were similar and in both groups similar percentages of those referred were admitted (31% of 9–5 group vs 29% other). Notable differences were a greater referral rate in the 24 hr group and significantly greater numbers living in residential accommodation in the 9–5 group. Over the follow‐up period 9% of the 9–5 group were admitted vs 5% other. There was a greater use of community services by the 24 hr group. Mortality was almost identical in both groups. The finding that on many outcome criteria results were as impressive in the service operating during normal working hours as in the round‐the‐clock service has important service implications. However, caution is needed in interpreting the results due to the difficulties of comparing two geographically separate services with varied demographic differences. Suggestions for further analysis of models of service delivery are made.
Neuropsychiatric lupus erythematosus and the elderly
Authors: Dennis Michael
Published: December 2004

Recent research suggests systemic lupus erythematosus (SLE) is more common in the elderly than previously thought. Neuropsychiatric disorder occurs in the majority of patients at some time during the course of the illness. Frequently neuropsychiatric features occur early, and may precede other typical features of multisystem disease by some years. An organic brain syndrome is the most frequently encountered neuropsychiatric manifestation of SLE. It is important that cases presenting to elderly services are recognized, as organic brain disorders resulting from SLE are potentially treatable.
Tourette syndrome in the elderly
Authors: Hartman Jennifer Anne , Yuvarajan Rasiah
Published: December 2004

An 82‐year‐old housewife presented with motor and phonic tics and coprolalia. These had developed in the months following an acute confusional state associated with posterior neck pain 10 years previously. Neurological examination, including MRI scan, was otherwise normal. The index illness was presumed to be encephalitis lethargica.
Quasi‐experimental evaluation of an educational model for dementia caregivers
Authors: Brodaty Henry , Roberts Kate , Peters Karin
Published: December 2004

Dementia caregivers are known to be distressed and may be helped by psychoeducational interventions. We investigated the effectiveness of one model of intervention comprising a structured package of six sessions of training, focusing on education, stress management and problem behaviour management in a group setting. Three groups of caregivers were compared‐those who had completed (N= 33) or partially completed (N= 22) training and a control group (N= 26)‐on measures of psychological stress, burden, satisfaction with life, well‐being and knowledge. There were no significant differences in outcome between the three groups. We conclude that, with methodological qualifications, this quasi‐experimental study of one model of training was not empirically effective. Interventions for caregivers should be tailored to individual needs from a range of techniques encompassing psychological and practical strategies.
Residential care as an alternative to long‐stay hospital: A cost‐effectiveness evaluation of two pilot projects
Authors: Knapp Martin , Cambridge Paul , Beecham Jennifer , Darton Robin , Thomason Corinne , Allen Caroline
Published: December 2004

Two projects were established to help elderly people with mental health problems move from continuing care hospital wards to local authority residential care homes. The projects were part of a larger programme established in the 1980s to test new policy and practice options. Each hospital resident was interviewed and assessed prior to commencing any programme of activities designed to prepare them for resettlement in the community. Data came from hospital patients themselves, from staff and from interviewer observations. Most of the people who moved from hospital were reinterviewed and reassessed approximately 9 months after discharge. The evaluation revealed that quality of life in residential homes was certainly not inferior to hospital but was less expensive. The residential homes offered more lively and psychologically pleasing environments than hospital. Residents'levels of participation were higher according to staff, and residents had more social contacts. The quality of social contacts also appeared to improve. The two projects thus provided a cost‐effective alternative to hospital for elderly people with mental health problems.
Visual evoked potential in the diagnosis of dementia in people with down syndrome
Authors: Prasher V. P. , Krishnan V. H. R. , Blake A. , Clarke D. J. , Corbett J. A.
Published: December 2004

The diagnosis of dementia in people with Down syndrome (DS) remains controversial. In this study DS patients who had a diagnosis of clinical dementia according to modified DSM‐III‐R criteria were assessed using the flash (P2) and pattern‐reversal (P100) visual evoked potential (VEP). Abnormal VEP recordings were apparent in both demented and non‐demented subjects. None of the demented subjects had the characteristic (P2–P100 latency difference) VEP changes reported in adults in the general population suffering from dementia. The VEP is unlikely to be a useful tool in the diagnosis of dementia in people with DS.
A double‐blind, placebo controlled, multicentre study of tacrine for alzheimer's disease
Authors: Wood Philip C. , Castleden C. Mark
Published: December 2004

The present study was designed to determine whether oral tacrine (tetrahydraminoacridine, THA) improves the symptoms of patients with mild to moderate Alzheimer's disease. The study was a multicentre, randomized double‐blind, placebo controlled, parallel group study with individual determination of maximum tolerated dose over a period of 12 weeks. One hundred and fifty‐four patients (93 women) aged 44–92 years (mean 75) were selected as having probable Alzheimer's disease as defined by NINCDS–ADRDA workgroup classification and a Mini‐Mental State Examination score of 10 or more. Most patients were titrated to 80 mg of tacrine per day. Tacrine improved patients in clinicians‘ global ratings and the relatives’ global rating compared to placebo (p < 0.05). Tacrine did not significantly improve the Mini‐Mental State Examination score, although as with other scores the trend favoured tacrine. There was a substantial variation in response among patients. Twelve patients in the tacrine and four in the placebo group were withdrawn from the study due to raised LFTs or adverse events. No serious sequelae resulted from these. One patient in the placebo group and two in the tacrine group died from causes which were considered unrelated to the treatment.
Factors related to admission of new patients consulting geriatric psychiatric services in montreal
Authors: Lesage Alain D. , Charron Maryse , Punti Rosita , Murphy Carole , Dorvil Henri , Charbonneau Manon , Carpentier Normand
Published: December 2004

The development of and the demand for geriatric psychiatric services (GPS) have increased over the past decade. Psychopathology, autonomy, physical disorders, sociodemographics, social support and caregivers' burden have all been advanced as influencing the elderly's risk of hospitalization. These factors were examined in a 1‐year prospective study of 87 new patients consulting a catchment‐area GPS. Standardized assessments were used, including both patients' and caregivers' independent measures of patients' social network. Entry points to the study were as follows: 70.1% of patients came from an outpatient clinic and 25.3% were admitted directly to psychiatric wards. Subjects were followed up 1 year after discharge or first contact. Overall, 47.1% of the sample was admitted to a higher‐supervision setting during the 1‐year follow‐up, including 20.7% of the total sample admitted to GPS wards. Multivariate logistic regression analysis indicated different factors influencing admission according to the definition of admission. Loss of autonomy was a key factor related to both psychiatric and overall admissions. Previous admission was a predictor of psychiatric admissions only. Relatives' strain and not living with spouse were predictors of overall admissions. The results indicate that functional consequences of disease (eg loss of autonomy) and resilience of relatives are key in predicting the elderly's need for greater supervision.
Erotomania in the elderly
Authors: Chlu Helen F. K.
Published: December 2004

The case notes of 349 Chinese patients of a psychogeriatric unit in Hong Kong were studied retrospectively and only one case of DSM‐111‐R erotomania was diagnosed. This was a 76‐year‐old widow with a delusion that a male cotenant in the old age home was in love with her. She improved after treatment with neuroleptics and the delusions subsided in 3 months. This case shows that the course of erotomania is not necessarily a chronic one and that culture may influence the expression of the disorder.
Impact of ‘open access’ to specialist services—the case of community psychogeriatrics
Authors: Macdonald A. , Goddard C. , Poynton A.
Published: December 2004

To compare patients referred via traditional, medical sources with those referred under an ‘open access’ policy to a community‐based multidisciplinary psychogeriatric service, we studied 1477 first referrals to the service over 58 months. General practitioners referred 45% of all patients, but 53% of all with delirium and 49% of all with depressive syndromes. Social workers referred 20% of all patients, but only 10% of all with depression; they referred 38% of all with alcohol problems and 34% of all with paranoid disorders. Ten per cent of those referred by social workers and 12% of those referred by general practitioners had no psychiatric disorder. Had the service been confined to patients referred from traditional (ie medical) sources, 463 patients with a psychiatric diagnosis would have had to await referral via these sources. There was no evidence that more inappropriate referrals are produced by ‘open access’ to this psychogeriatric service; the assessment of depression by social workers and delirium by general practitioners merits further study.
Ability of the mini‐mental state examination to discriminate diagnostic entities in a psychogeriatric population
Authors: Field Sarah J. , Jackson Henry J. , Hassett Anne M. , Pattison Pip
Published: December 2004

The Mini‐Mental State Examination (MMSE) is widely used in clinical practice. A standardized MMSE (SMMSE) was used to differentiate those patients with dementia or delirium from those with functional psychiatric disorders. Seventy psychogeriatric patients from Royal Park Psychiatric Hospital were interviewed. The SMMSE and the Hamilton Rating Scale for Depression (HRSD) were administered at two time points, 3 weeks apart. The study found that the SMMSE did differentiate those with dementia or delirium from those with functional psychiatric disorders. However, caution should be exercised when interpreting SMMSE results in community settings.