bluuebunny/crossref_metadata_2025 huggingface dataset:
Wind erosion of blanket peat during a short period of surface desiccation (North Pennines, Northern England)
Authors: Foulds Simon A. , Warburton Jeff
Published: September 2006

Strong winds are a characteristic feature of UK upland areas. Despite this, understanding of aeolian processes in upland environments of the UK is limited. This paper presents direct measurements and observations of blanket peat erosion by wind action during a two week period of desiccation in the North Pennines, Northern England. A circular configuration of mass flux sediment samplers was used to collect peat eroded by wind action from 16 cardinal compass directions. Meteorological conditions (wind speed, wind direction, precipitation and temperature) were recorded by an automatic weather station set up adjacent to the site. Surface desiccation led to peat crust erosion and dust deflation. During short (≤1 hour) periods of precipitation, wind‐driven rainfall also caused erosion. Typically, dust flux rates were up to two orders of magnitude lower than recorded during periods of sustained wet weather. Measurements demonstrate the hitherto unreported rapid switch in process regime between wind‐driven rainfall and dry blow deflation in blanket peat environments. Dry blow processes of blanket peat erosion may become more important in UK upland areas if climate change promotes more frequent surface desiccation. Copyright © 2006 John Wiley & Sons, Ltd.
The visualization of turbulence data using a wavelet‐based method
Authors: Keylock C. J.
Published: September 2006

This technical communication presents some MATLAB® routines for visualizing the structure in turbulent signals based on a standard conditional averaging and thresholding approach. Up to three velocity components may be analysed and the resulting output highlights the time at which important flow events occur as well as the frequency levels that contribute the greatest energy to this particular event. The latter information is derived from a wavelet decomposition of the signal and may assist in providing a process‐based explanation of observed flow features. Copyright © 2006 John Wiley & Sons, Ltd.
Forecasting volatility
Authors: Gospodinov Nikolay , Gavala Athanasia , Jiang Deming
Published: September 2006

In this paper, we investigate the time series properties of S&P 100 volatility and the forecasting performance of different volatility models. We consider several nonparametric and parametric volatility measures, such as implied, realized and model‐based volatility, and show that these volatility processes exhibit an extremely slow mean‐reverting behavior and possible long memory. For this reason, we explicitly model the near‐unit root behavior of volatility and construct median unbiased forecasts by approximating the finite‐sample forecast distribution using bootstrap methods. Furthermore, we produce prediction intervals for the next‐period implied volatility that provide important information about the uncertainty surrounding the point forecasts. Finally, we apply intercept corrections to forecasts from misspecified models which dramatically improve the accuracy of the volatility forecasts.  Copyright © 2006 John Wiley & Sons, Ltd.
Performance evaluation of the New Connecticut Leading Employment Index using lead profiles and BVAR models
Authors: Banerji Anirvan , Dua Pami , Miller Stephen M.
Published: September 2006

The leading and coincident employment indexes for the state of Connecticut developed following the recession of the early 1990s fell short of expectations. This paper performs two tasks. First, it describes the process of revising the Connecticut Coincident and Leading Employment Indexes. Second, it analyzes the statistical properties and performance of the new indexes by comparing the lead profiles of the new and old indexes as well as their out‐of‐sample forecasting performance, using the Bayesian Vector Autoregressive (BVAR) method. The new coincident index shows improved performance in dating employment cycle chronologies. The lead profile test demonstrates that superiority in a rigorous, non‐parametric statistic fashion. The mixed evidence on the BVAR forecasting experiments illustrates that leading indexes properly predict cycle turning points and do not necessarily provide accurate forecasts except at turning points, a view that our results support.  Copyright © 2006 John Wiley & Sons, Ltd.
Forecasting the conditional covariance matrix of a portfolio under long‐run temporal dependence
Authors: Ñíguez Trino‐Manuel , Rubia Antonio
Published: September 2006

Long‐range persistence in volatility is widely modelled and forecast in terms of the so‐called fractional integrated models. These models are mostly applied in the univariate framework, since the extension to the multivariate context of assets portfolios, while relevant, is not straightforward. We discuss and apply a procedure which is able to forecast the multivariate volatility of a portfolio including assets with long memory. The main advantage of this model is that it is feasible enough to be applied on large‐scale portfolios, solving the problem of dealing with extremely complex likelihood functions which typically arises in this context. An application of this procedure to a portfolio of five daily exchange rate series shows that the out‐of‐sample forecasts for the multivariate volatility are improved under several loss functions when the long‐range dependence property of the portfolio assets is explicitly accounted for.  Copyright © 2006 John Wiley & Sons, Ltd.
Analysis of genetic abnormalities provides insights into genetic evolution of hyperdiploid myeloma
Authors: Chng Wee J. , Ketterling Rhett P. , Fonseca Rafael
Published: September 2006

Aneuploidy is ubiquitous in human cancer and is seen as whole chromosome gains and losses, unbalanced translocations and inversions, duplications, deletions and loss of heterozygosity. Within this complexity, some subgroups of aneuploid tumors emerge as distinct biological and clinical entities. Hyperdiploid myeloma (H‐MM), characterized by hyperdiploid chromosome numbers because of nonrandom trisomies, is one such example. We undertook a comprehensive survey of the karyotypes of a large number of H‐MM (n = 469) to describe fully genomic instability in these tumors, to dissect pathways of genetic evolution, and identify distinct subgroups based on their genetic changes. While selective pressure apparently favors the emergence of clones with gains of chromosomes 3, 5, 7, 9, 11, 15, 19, and 21, a background of ongoing genomic instability results in gains of other chromosomes, albeit at a much lower prevalence. A deduced temporal analysis of these karyotypes indicates that selected gains are early events. Other events occurring later in the course of the disease include secondary chromosome translocations and monosomies. The development of these genetic aberrations is thus highly ordered and undoubtedly of biological relevance. Within this framework, we propose a model of genetic evolution in H‐MM. © 2006 Wiley‐Liss, Inc.
Recognizing and engaging depressed Chinese Americans in treatment in a primary care setting
Authors: Yeung Albert , Yu Shu‐Ching , Fung Freddy , Vorono Sienna , Fava Maurizio
Published: September 2006

Objectives

To examine the effectiveness of depression screening and the Engagement Interview Protocol (EIP) in identifying and engaging in treatment depressed Chinese Americans in a primary care setting.

Methods

Chinese American patients who attended a primary care clinic between 15 September, 2004 and 14 September, 2005 were screened for depression using the Chinese Bilingual version of the Patient Health Questionnaire (CB‐PHQ‐9). Patients who screened positive (CB‐PHQ‐9 ≥ 15) were evaluated using the EIP to establish psychiatric diagnosis and to engage patients in treatment.

Results

Three thousand eight hundred and twelve patients completed the CB‐PHQ‐9, of which 113 (3.2%) screened positive for MDD. Among those screening positive, six (5.3%) had been receiving psychiatric treatment for depression, 57 (50%) declined to receive a psychiatric interview or were unable to be contacted, and 50 (44%) agreed to be interviewed with the EIP. Out of the 50 patients interviewed, 44 (88%) had their MDD diagnosis confirmed; among them, 41 (93%) agreed to receive treatment for depression and three (7%) declined intervention.

Conclusions

Under‐recognition and under‐treatment of depressed Chinese Americans in primary care settings continue to be prevalent. Recognition of depression can be enhanced by using the brief CB‐PHQ‐9 to screen for depression. Half of the Chinese Americans who screened positive for MDD declined evaluation by a mental health professional. Most of the depressed Chinese Americans who were evaluated agreed to receive treatment. Enhanced cultural sensitivity with the use of the EIP in psychiatric assessment may have contributed to the success in engaging depressed Chinese Americans in treatment. Copyright © 2006 John Wiley & Sons, Ltd.
Risk factors for neuropsychiatric symptoms in dementia: the Cache County Study
Authors: Steinberg M. , Corcoran C. , Tschanz J.T. , Huber C. , Welsh‐Bohmer K. , Norton M.C. , Zandi P. , Breitner J.C.S. , Steffens D.C. , Lyketsos C.G.
Published: September 2006

Objective

To investigate the probability of individual neuropsychiatric symptoms in dementia patients as a function of eight risk factors.

Methods

In the Cache County Study, we administered the Neuropsychiatric Inventory (NPI) to 328 dementia patients at baseline. Approximately 18 months later, we re‐administered the NPI to 184 participants available for follow‐up. Generalized estimating equation methods were used to model the probability of individual neuropsychiatric symptoms as a function of: gender, age, education, dementia type and severity, APOE status, time of observation, and general medical health.

Results

Women showed increased tendency toward anxiety, [odds ratio (OR) 2.22, 95% confidence interval (CI) 1.31–3.76] and delusions (OR 2.15, CI 1.22–3.78), but older persons of both sexes showed less tendency toward anxiety. Dementia severity increased the tendency toward hallucinations and agitation (OR 2.42, CI 1.81–3.23) and decreased risk of depression. Positive APOE ε4 status increased the tendency toward aberrant motor behavior (OR 1.84, CI 1.05–3.22). Among dementia diagnoses, those with Alzheimer's disease showed decreased tendency toward agitation (OR 0.58, CI 0.35–0.95), depression (OR 0.56, CI 0.33–0.96) and disinhibition (OR 0.46, CI 0.24–0.88). Later time of observation increased risk of aberrant motor behavior and delusions, and more serious medical comorbidity increased risk of, agitation, irritability, disinhibition, and aberrant motor behavior.

Conclusions

Gender, age, dementia severity, APOE ε4, dementia diagnosis, time of observation, and general medical health appear to influence the occurrence of individual neuropsychiatric symptoms. Copyright © 2006 John Wiley & Sons, Ltd.
Abnormal neurotransmitter metabolite levels in Alzheimer patients with a delirium
Authors: van der Cammen Tischa J.M. , Tiemeier Henning , Engelhart Marianne J. , Fekkes Durk
Published: September 2006

Background

Delirium is a complex neuropsychiatric syndrome with an acute onset and fluctuating course. Several studies have suggested the presence of disturbed cholinergic, dopaminergic and serotonergic pathways in delirium as well as in Alzheimer's disease. Abnormal concentrations of amino acids and of neurotransmitter metabolites have been found in plasma, platelets and cerebrospinal fluid of AD patients, and in plasma and CSF of patients with a delirium. The aim of this study was to investigate amino acid and neurotransmitter metabolite levels in plasma of AD patients with a concurrent delirium.

Methods

In a case‐control study of patients suffering from Alzheimer's disease (AD) with concurrent delirium, we investigated the contribution of delirium to some biochemical parameters in blood.

We compared plasma amino acid and neurotransmitter metabolite levels of 17 delirious AD patients with those of 17 age‐ and gender‐matched non‐delirious AD patients and 29 age‐ and gender‐matched controls.

Results

Homovanillic acid (HVA) and 5‐hydroxyindoleacetic acid (5‐HIAA) levels were higher in delirious AD patients than in controls, but only HVA concentrations were higher in delirious AD patients than in non‐delirious AD patients.

Conclusions

Our findings suggest that central dopaminergic and serotonergic turnover are increased in AD patients with delirium and that the high dopaminergic turnover might reflect the consequences of delirium. Copyright © 2006 John Wiley & Sons, Ltd.
A normative study of the Trail Making Test in Korean elders
Authors: Seo Eun Hyun , Lee Dong Young , Kim Ki Woong , Lee Jung Hie , Jhoo Jin Hyeong , Youn Jong Choul , Choo IL Han , Ha Jin , Woo Jong Inn
Published: September 2006

Objective

The purpose of this study was to explore the effects of age, education and gender on the performance of the Trail Making Test (TMT) and provide normative information in Korean elders.

Methods

The TMT was administered to 997 community‐dwelling volunteers aged 60–90. People with serious neurological, medical and psychiatric disorders, including dementia, were excluded.

Results

Education and age had significant effects on both parts of the TMT. Gender also had an effect on part A of the TMT (Trail A). Based on these results, the norms of Trail A stratified by age (four overlapping tables), education (four strata) and gender, and the norms of part B of TMT (Trail B) stratified by age (four overlapping tables) and education (three strata).

Conclusions

Age and educational level had a considerable influence on both Trail A and B. Our normative information on the Trail A will be useful in the elders with poor educational attainment and can be utilized for cross‐cultural comparison of the Trail A performance. The fact that a large number of elders fail to complete Trail B indicates a limited applicability of Trail B in elderly population, particularly with poor educational background. Copyright © 2006 John Wiley & Sons, Ltd.
Correlates of caregiver burden for Korean elders according to cognitive and functional status
Authors: Kim Sung‐Wan , Kim Jae‐Min , Stewart Robert , Bae Kyung‐Lyul , Yang Su‐Jin , Shin Il‐Seon , Shin Hee‐Young , Yoon Jin‐Sang
Published: September 2006

Background

Caregiver strain was investigated in a community sample of Korean elders with cohabiting caregivers, and factors associated with this were compared between groups classified by cognitive and functional impairment.

Methods

The study sample consisted of 484 elders and their cohabiting caregivers resident in Kwangju, South Korea. Caregiver burden was measured by the Zarit Burden Interview. Data on the elders' socio‐demographics (age, gender, education, and religion) and clinical characteristics (cognitive function (MMSE), activities of daily living (IADL), depressive symptoms, alcoholism, and physical illness), and caregivers' socio‐demographic characteristics (age, gender, education, relation to elders, and current employment) and caregiving environments (living area, alternative caregiver, number of rooms, monthly income, and social network) were gathered. Participants were classified into those with (n = 61) or without cognitive impairment. The second group was classified into those with (n = 68) or without (n = 355) functional impairment.

Results

Caregiver strain was significantly associated with cognitive impairment. In the group without cognitive impairment, caregiver strain was significantly associated with participant characteristics (IADL impairment, and symptoms of depression and alcoholism). In those with cognitive impairment, caregiver strain was associated with both participant status (depressive symptoms and IADL impairment) and caregiver characteristics (a child caregiver, lower social support, and urban environment).

Conclusions

Individual mental and physical health characteristics predict caregiver strain regardless of cognitive impairment. Caregiver characteristics are most important in the presence of cognitive impairment. Copyright © 2006 John Wiley & Sons, Ltd.
Delirium subtype identification and the validation of the Delirium Rating Scale—Revised‐98 (Dutch version) in hospitalized elderly patients
Authors: de Rooij Sophia E. , van Munster Barbara C. , Korevaar Johanna C. , Casteelen Gerty , Schuurmans Marieke J. , van der Mast Roos C. , Levi Marcel
Published: September 2006

Background

Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. The Dutch version of the Delirium Rating Scale—Revised‐98 (DRS‐R‐98) appears to be a reliable method to classify delirium. The aim of this study was to determine the validity and reliability of the DRS‐R‐98 and to study clinical subtypes of delirium using the DRS‐R‐98.

Methods

Patients received the Dutch version of the DRS‐R‐98, the Mini‐Mental State Examination, the Confusion Assessment Method, and a clinical diagnosis of delirium according to DSM‐IV criteria, and their relatives the Informant Questionnaire Cognitive Decline in the Elderly.

Results

The DRS‐R‐98 validation cohort (n = 65) consisted of 23 patients with delirium, 22 patients with dementia, and 20 non‐psychiatric comparison patients. For the delirium subtype study, a second cohort comprising 54 delirious patients was investigated. Median DRS‐R‐98 scores significantly distinguished delirium from dementia and no psychiatric disorder. Inter‐rater reliability (intra‐class correlation 0.97) and internal consistency (Crohnbach's alpha 0.94) were high. Positive scores of DRS‐R‐98 item 4 (affect liability) and item 7 (motor agitation) predicted the presence of non‐hypoactive delirium, with a specificity of 89% and a sensitivity of 57%.

Conclusion

The results show that the Dutch version of the DRS‐R‐98 is a valid and reliable measure of delirium severity and distinguishes patients with delirium from patients with dementia and comparison patients. Furthermore, the DRS‐R‐98 is able to exclude hypoactive delirium. Copyright © 2006 John Wiley & Sons, Ltd.
Comparison of three rating scales as outcome measures for treatment trials of depression in Alzheimer disease: findings from DIADS
Authors: Mayer Lawrence S. , Bay R. Curt , Politis Antonios , Steinberg Martin , Steele Cynthia , Baker Alva S. , Rabins Peter V. , Lyketsos Constantine G.
Published: September 2006

Context

Major depression affects about 25% of patients with Alzheimer's disease (AD) and has serious adverse consequences for patients as well as caregivers. Studies of treatments for depression in AD, like most treatment studies, depend on the ability of the scales used to measure outcome to detect a difference between the effects of treatment and control, particularly in trials conducted over waves.

Objective

To compare the ability of three depression scales, and some of their subscales, to detect the difference in the effects of drug (treatment) and placebo (control).

Design

Comparison of three scales of depression in terms of percent variance explained as indicated by the adjusted or partial eta‐squared for the effect of drug versus placebo, controlling for baseline depression, in a randomized, placebo‐controlled, parallel, 12‐week, clinical trial of sertraline for the treatment of depression with AD.

Setting

University outpatient clinic.

Participants

Forty‐four patients with probable Alzheimer's disease and Major Depressive Episode.

Outcome measures

The Cornell Scale for Depression in Dementia (CSDD), the Hamilton Depression Rating Scale (HDRS), and the Neuropsychiatric‐Inventory Mood Domains (NPI‐M).

Results

Examination of the treatment effects as indicated by the partial eta‐squared's for each scale at each wave, revealed a slight, but not significant, advantage for the use of the CSDD over the HDRS, and a significant advantage for the use of either of these over the NPI‐M. Treatment effects, as reflected in the partial eta‐squared's computed for the subscales at each wave, were significant for all four subscales, and were largest for the CSDD ‘mood’ subscale although they were not significantly greater than for the other subscales.

Conclusions

The CSDD, and particularly its mood subscale, appears to be more sensitive than the HDRS, it's subscales or the NPI‐M, for comparing drug to placebo in treating major depression in AD patients. Treatment effects as reflected in the partial eta‐squared's were largest on the CSDD mood subscale and increased over time. The pattern for the other subscales was non‐monotonic over waves and resembled the pattern for the entire scale. Perhaps combining the CSDD two subscales obscures the treatment effects for the separate subscales. Copyright © 2006 John Wiley & Sons, Ltd.
The contribution of neuropsychiatric symptoms to the cost of dementia care
Authors: Herrmann Nathan , Lanctôt Krista L. , Sambrook Robert , Lesnikova Nadia , Hébert Réjean , McCracken Peter , Robillard Alain , Nguyen Elizabeth
Published: September 2006

Objective

To estimate the contribution of behavioral and psychological symptoms of dementia (BPSD) to the costs of care.

Method

A one‐year prospective study of resource utilization recorded monthly by 500 caregivers of community dwelling patients with dementia. The effect of behavior on total, direct and indirect costs of care was examined.

Results

The total cost of care was $1,298 per month and there was a significant independent relationship between costs and BPSD. The incremental cost of a one point increase in Neuropsychiatric Inventory score was $30 per month (95% CI: $19–$41).

Conclusion

BPSD contribute significantly to the overall costs of dementia care. Interventions targeted at BPSD may help to reduce the staggering societal costs of this illness. Copyright © 2006 John Wiley & Sons, Ltd.
Demonstration of cognitive decline in Parkinson's disease using the Cambridge Cognitive Assessment (Revised) (CAMCOG‐R)
Authors: Athey Richard J. , Walker Richard W.
Published: September 2006

Background

Cognitive impairment is well recognised in Parkinson's Disease (PD) but few studies have examined cognitive decline over time in such subjects. Standard clinical assessments of cognitive function, such as the MMSE, do not measure all cognitive domains and often have a ceiling effect. CAMCOG‐R provides a more comprehensive cognitive assessment allowing several different domains of cognition to be compared. It also features the ability to test ‘executive function’. CAMCOG‐R has only been reported on one previous occasion in PD subjects and this is the first study to report a follow‐up CAMCOG‐R to assess cognitive decline.

Methods

In a previously published study CAMCOG‐R was administered to a prevalent community‐based population of 94 subjects with PD with a MMSE of 25 or above. In this subsequent study 85 of the subjects (two declined and seven were deceased) underwent a follow‐up CAMCOG‐R after a mean delay of 13.1 months.

Results

The initial, and follow‐up mean total CAMCOG‐R scores were 88.65/104 and 84.75/104 respectively, demonstrating a significant decline (p < 0.05). Significant cognitive decline (p < 0.05) was also seen across every CAMCOG‐R cognitive domain and in the executive function scores.

Conclusions

A wide range of cognitive ability was again demonstrated using CAMCOG‐R in this PD population. The decline of 3.9 CAMCOG‐R points over the 13‐month period compares to other previous studies showing an annual decline of 1.6 CAMCOG points in normal elderly individuals and 12 CAMCOG points annually in those with established dementia. This study suggests that CAMCOG‐R is a useful and appropriate tool for use in follow‐up cognitive screening in PD subjects. Copyright © 2006 John Wiley & Sons, Ltd.
Relationship between periventricular and deep white matter lesions and depressive symptoms in older people. The LADIS Study
Authors: Krishnan Mani S , O'Brien John T , Firbank Michael J , Pantoni Leonardo , Carlucci Giovanna , Erkinjuntti Timo , Wallin Anders , Wahlund Lars‐Olof , Scheltens Philip , van Straaten Elisabeth C.W. , Inzitari Domenico
Published: September 2006

Background

Both types of cerebral white matter hyperintensities, periventricular (PVL) and deep white matter lesions (DWML) have been previously associated with the development of depression in older subjects. However, it remains controversial as to whether PVL, DWML, or both are most strongly associated with depression and this was the aim of the current study.

Methods

In a pan‐European multicentre study of 626 older subjects, we examined the relationship between PVL and DWML, depressive symptoms (GDS quintile), cognitive status (MMSE), hypertension and history of stroke.

Results

In univariate analysis we found that depressive symptoms as assessed by GDS were associated with both types of white matter lesions (Spearman rho = 0.12 p = 0.002 for DWML and rho = 0.09 p = 0.01 for PVL). Using ordinal logistic regression analysis the total DWML score (p = 0.041), rather than PVL (p = 0.9) was found to predict GDS scores.

Conclusions

DWML, but not PVL, were most strongly associated with depressive symptoms in this sample. As DWML (unlike PVL) are associated with vascular ischaemic damage, our findings are consistent with the ‘vascular depression’ hypothesis. Longitudinal studies are needed to clarify the time course of these relationships, in particular, whether modifying DWML alters the natural history of depression. Copyright © 2006 John Wiley & Sons, Ltd.
Preferences for routines in older people: associations with cognitive and psychological vulnerability
Authors: Bergua Valérie , Fabrigoule Colette , Barberger‐Gateau Pascale , Dartigues Jean‐François , Swendsen Joel , Bouisson Jean
Published: September 2006

Objectives

Although routine activities are important to normal functioning across all phases of life, their expression in older people may be associated with cognitive and psychological vulnerability.

Methods

The relationship between these variables was explored in 235 elderly French participants from the PAQUID cohort study.

Results

Cross‐sectional positive associations were found between preferences for routines, anxiety and depression levels, and cognitive complaints. General cognitive decline over a three‐year time span was also associated with a greater desire for routines at the end of this period.

Conclusions

The progressive routinization of behaviors and activities in older people is discussed as a marker of affective and cognitive vulnerability, and its understanding has potential for improving the early detection of adaptation difficulties and overall care in this population. Copyright © 2006 John Wiley & Sons, Ltd.
Dementia Care Mapping (DCM): initial validation of DCM 8 in UK field trials
Authors: Brooker Dawn J. , Surr Claire
Published: September 2006

Objectives

This paper describes DCM 8 and reports on the initial validation study of DCM 8.

Methods

Between 2001–2003, a series of international expert working groups were established to examine various aspects of DCM with the intention of revising and refining it. During 2004–2005 the revised tool (DCM 8) was piloted in seven service settings in the UK and validated against DCM 7th edition.

Results

At a group score level, WIB scores and spread of Behavioural Category Codes were very similar, suggesting that group scores are comparable between DCM 7 and 8. Interviews with mappers and focus groups with staff teams suggested that DCM 8 was preferable to DCM 7th edition because of the clarification and simplification of codes; the addition of new codes relevant to person‐centred care; and the replacement of Positive Events with a more structured recording of Personal Enhancers.

Conclusions

DCM 8 appears comparable with DCM 7th edition in terms of data produced and is well received by mappers and dementia care staff. Copyright © 2006 John Wiley & Sons, Ltd.
The association of neuroleptic sensitivity in Lewy body disease with a false positive clinical diagnosis of Creutzfeldt‐Jakob disease
Authors: Lemstra A.W. , Schoenmaker N. , Rozemuller‐Kwakkel A.J.M. , van Gool W.A.
Published: September 2006

Background

Dementia with Lewy bodies (DLB) and Creutzfeldt‐Jakob disease (CJD) share clinical features like cognitive decline, motor disturbances en psychiatric symptoms. Overlapping symptoms may cause physicians to mistake DLB for CJD.

Methods

Clinical data of 12 patients with autopsy‐confirmed DLB who had been clinically suspected to suffer from CJD were analysed to investigate possible clinical features which led to misdiagnosis.

Results

There was an association in time between administering neuroleptics and rapid clinical deterioration in 8 out of 9 patients.

Conclusion

It is suggested that the neuroleptic sensitivity in LBD fuelled the misdiagnosis of CJD in the presented series. Diagnostic confusion between CJD and DLB may have important clinical consequences and may lead to treatment restrictions. Copyright © 2006 John Wiley & Sons, Ltd.
Nutrient intake and psychological health in an elderly Chinese population
Authors: Woo J. , Lynn H. , Lau W. Y. , Leung J. , Lau E. , Wong S. Y. S. , Kwok T.
Published: September 2006

Background

Associations between nutrition and cognitive impairment, and nutrition and depression, have been observed. Elderly people are at risk of under nutrition, and also have higher prevalence of cognitive impairment and depression.

Objective

To examine the relationship between nutrient intake and psychological health in the elderly, adjusting for confounding factors.

Subjects

Three thousand nine hundred and ninety‐ninemen and women aged 65 years and over living in the community, with approximately equal numbers in three age groups: 65–69, 70–74, 75+ years.

Methods

Dietary intake was assessed using a 7‐day food frequency questionnaire. Cognitive function was assessed by the cognitive part of the Community Screening Instrument for Dementia (CSID). Depression was assessed using the Geriatric Depression Scale (GDS). Information was also collected for confounding factors: demographics, educational level, socioeconomic status, medical history, smoking, alcohol intake, and physical activity. Logistic regression analyses were carried out to examine associations between lifestyle and dietary variables, and CSID and GDS, controlling for confounders.

Results

Both CSID and GDS scores were associated with co‐morbidity, demographic and socioeconomic factors. Few associations between lifestyle factors and CSID score were observed. Dietary factors inversely associated with GDS score include total fat intake, vitamins A, B2, B3, C, fibre, and vegetables. In terms of nutrient density, iron and isoflavone intake were additional factors.

Conclusion

Association exists between intake of various nutrients and psychological health independent of other confounding factors in the elderly population. A follow‐up study of this cohort or interventional studies are needed to elucidate cause effect relationship. Copyright © 2006 John Wiley & Sons, Ltd.
Elderly suicide attempters: characteristics and outcome
Authors: Lebret Stéphane , Perret‐Vaille Estelle , Mulliez Aurélien , Gerbaud Laurent , Jalenques Isabelle
Published: September 2006

Purpose

We made a descriptive survey to assess the outcome of elderly patients discharged from a hospital psychiatric service after a suicide attempt (rates of overall mortality and repeat attempts), to identify the factors that had a significant impact on their survival and to determine patient characteristics.

Methods

Fifty‐nine suicide attempters over 60 years of age admitted to hospital between 1993 and 2000 were included in the study. Their outcome was assessed by questioning their attending physicians over the telephone. We traced 51 of the 59 patients; 8 were lost to follow‐up. Statistical analysis (Log Rank tests, Cox model) was computed to determine which factors altered the overall survival and the survival without further attempt.

The patients sociodemographic, medical and psychiatric characteristics were recorded from hospital patient files.

Results

Elderly suicide attempters showed an increased mortality from suicide and natural causes and the risk of a repeat attempt increased in female patients with memory disorders. The factors altering survival were advanced age, pre‐existing physical disability, several co‐existing physical illnesses, severe physical consequences of the suicide attempt, history of psychiatric illness other than depression, memory disorders and one previous suicide attempt.

The elderly suicide attempter was most likely to be a widowed woman suffering from social isolation, loneliness and depression.

Conclusion

Elderly suicide attempters remained both physically and mentally vulnerable after their attempt. A repeat act represents a turning point in personal life progression which it is essential to detect. Copyright © 2006 John Wiley & Sons, Ltd.
Factors related to hospitalization in elderly manic patients with early and late‐onset bipolar disorder
Authors: Lehmann Susan W. , Rabins Peter V.
Published: September 2006

Objective

To identify factors contributing to relapse and hospitalization in elderly patients with bipolar disorder.

Method

Retrospective chart review surveyed consecutive patients over age 65 admitted to the Johns Hopkins Hospital for a manic episode over a five year period (n = 73). Factors precipitating index admission were compared in patients with early‐onset bipolar disorder (age 45, n = 35).

Results

The distribution of ages of onset of bipolar disorder was most consistent with a bimodal pattern with a cut‐point at age 45. Early‐onset patients were more likely to have been aggressive and threatening prior to admission (p = 0.014) compared to late‐onset patients and were more likely to have been brought to the emergency room on emergency petition for evaluation (p = 0.028). Early‐onset patients were also more likely to have been non‐adherent with prescribed psychiatric medication (p = 0.032).

Conclusions

Relapse and rehospitalization were common among elderly manic patients with early‐onset and late‐onset bipolar disorder. Strategies which improve medication adherence are needed to help prevent recurring hospitalization. Copyright © 2006 John Wiley & Sons, Ltd.
Drug prescription in mild cognitive impairment: the physicians' perspective in Italy
Authors: Frisoni Giovanni B. , Canu Elisa , Geroldi Cristina , Zanetti Orazio , Zacchi Valeria
Published: September 2006

Objectives

Today there are no data on the type of drugs prescribed to MCI patients nor the prevalence of their prescription. The aim of this study was to describe which drugs were prescribed in 2004 for cognitive and non cognitive disturbances of patients with MCI in a sizable group of Italian expert centers for the diagnosis and treatment of Alzheimer's disease.

Methods

Eighty‐eight of the 314 contacted UVAs (28%) agreed to take part to the present study. The physicians were surveyed with a structured questionnaire assessing questions related to prescription of drug therapy based on their subjective judgement.

Results

Cholinesterase inhibitors are prescribed to 90% of patients with AD but, interestingly, to about one in four patients with MCI (27%). Gingko and nootropics are prescribed infrequently, but in MCI two to three times more often than in AD. About one in four (27%) and one in ten (9%) MCI patient are prescribed SSRIs and benzodiazepines, a proportion similar to that of AD (28% and 10%), while atypical and traditional neuroleptics are virtually never used in MCI patients. Vitamin E is prescribed to more than half of MCI (57%) and in about half as many AD patients (27%).

Conclusions

These data suggest that lacking approved or clearly effective drugs for cognitive symptoms, physicians respond with ‘analogy treatments’ and by increasing the prescription of ‘accessory drugs’. Non cognitive symptoms in MCI are managed virtually exclusively with SSRIs and benzodiazepines. Copyright © 2006 John Wiley & Sons, Ltd.
Quality of life measures for depressed and non‐depressed Chinese older people
Authors: Chan Sally Wai‐chi , Chien Wai‐tong , Thompson David R. , Chiu Helen F. K. , Lam Linda
Published: September 2006

Aim

To compare the perception of quality of life (QoL) between depressed and non‐depressed Chinese older people in Hong Kong and examined the factors that influence this perception.

Methods

A cross‐sectional study was conducted with a convenience sample of 80 older people with a diagnosis of depression and 179 non‐depressed controls.

Results

The depressed group had a lower rating in perceived QoL in all aspects than the non‐depressed group. Level of depression and functional abilities were predictors of quality of life ratings for the both groups and activities of daily living was the predictor of quality of life for the depressed group only. The study identified the subjective perception of QoL amongst depressed older people is significantly lower than that amongst non‐depressed older people. Depression affects the bio‐psychosocial status of Chinese older people. This study provides insight for healthcare professionals in planning innovative services to meet their health needs. Copyright © 2006 John Wiley & Sons, Ltd.
Doll use in care homes for people with dementia
Authors: James Ian Andrew , Mackenzie Lorna , Mukaetova‐Ladinska Elizabeta
Published: September 2006

Dolls and teddy bears were introduced into an Elderly Mentally Ill (EMI) home as part of a non‐pharmacological intervention. Thirteen residents from a population of 33 chose to use a doll and one chose a teddy bear. The impact of the toys was assessed on five domains over a 12‐week period and the findings were generally positive, which was consistent with previous observations (Mackenzie et al., in press). The investigation also attempted to determine whether staff were able to predict which residents would chose a toy. In terms of the dolls, out of the 16 residents predicted to use a doll, nine did so (56% accuracy). Despite the benefits outlined in this largely descriptive study, a number of problems were observed and some of these difficulties are outlined below. Copyright © 2006 John Wiley & Sons, Ltd.
Response inhibition and everyday memory complaints in older adult women
Authors: Potter Guy G. , Hartman Marilyn
Published: September 2006

Objective

To explore the association of executive functions to the everyday memory complaints of healthy older adults.

Methods

Ninety‐nine community‐dwelling women aged 60 and above were administered a battery that included neuropsychological tests of executive functions and memory, along with self‐report measures of everyday memory complaints, depression, and anxiety.

Results

Multivariate regression analyses revealed that a measure of response inhibition (Stroop Color‐Word) accounted for unique variance in predicting memory complaints above and beyond measures of episodic memory, depression, and anxiety. Depression, however, accounted for the largest variance in memory complaints.

Conclusions

Higher frequency of everyday memory complaints among older adults was associated with decreased response inhibition independent of episodic memory and affective state. Further research is needed to understand the interrelationships among these and other predictors of everyday memory complaints. Copyright © 2006 John Wiley & Sons, Ltd.
Differences in diagnostic subtypes among patients with late and early onset of a single depressive episode
Authors: Kessing Lars Vedel
Published: September 2006

Objective

It is unclear whether patients with late onset and patients with early onset present with different subtypes of depression. The aim of the study was to compare the prevalence of subtypes of ICD‐10 single depressive episodes for patients with late onset (age >65 years) and patient with early onset (age ≤ 65 years) in a nationwide sample of all patients discharged from psychiatric in‐ or outpatient settings.

Method

All patients who got a diagnosis of a single depressive episode in a period from 1994–2002 at the end of the first outpatient treatment or at the first discharge from psychiatric hospitalisation ever in Denmark were identified in a nationwide register.

Results

In total, 18.192 patients were given a diagnosis of a single depressive episode at the first outpatient contact and 8.396 patients were given a diagnosis of a single depressive episode at the first psychiatric hospitalisation ever. Patients with late onset were more often women, more often presented with a severe depressive episode and more often with psychosis than patients with early onset, in both inpatient and outpatient treatment settings. No differences were found between patients with late and patients with early onset in the prevalence of depression with or without melancholic symptoms–in either of the treatment settings.

Conclusions

Patients with a late onset first depressive episode are more often women and are clinically characterised by more severe depressions and a higher prevalence of psychosis than patients with early onset. Copyright © 2006 John Wiley & Sons, Ltd.
Defining severe dementia with the Minimum Data Set
Authors: van der Steen Jenny T. , Volicer Ladislav , Gerritsen Debby L. , Kruse Robin L. , Ribbe Miel W. , Mehr David R.
Published: September 2006

Background

Accurately defining severe dementia is important for care and prognosis, but is not explicitly included in the Minimum Data Set (MDS).

Objective

To define severe dementia using the MDS, we used data for nursing home residents with moderate to severe dementia.

Methods

Two cross‐sectional studies enrolled 175 residents; 89 residents from one US Veterans Affairs nursing home, and 86 residents from nine Dutch nursing homes. Measurements included the Cognitive Performance Scale (CPS; range: 0–6), activities of daily living (ADL) dependency, and the Bedford Alzheimer Nursing Severity‐Scale (BANS‐S; range: 7–28), a staging instrument specific for severe dementia.

Results

Half of the residents received CPS scores of 5, and their BANS‐S scores varied widely. There was fair agreement (kappa = 0.36) between severe cognitive impairment as defined by the CPS (scores 5 and 6) and the BANS‐S (score 17 or higher). Addition of an ADL dependency requirement to the CPS definition improved agreement (kappa = 0.75). The observed patterns were similar but more obvious for US residents than for Dutch residents.

Conclusion

Cognitively impaired residents comprise a heterogeneous group with a wide variety of function. Restriction with respect to ADL dependency allows for distinction between moderate and severe dementia. We propose the following MDS‐based definition of severe dementia: a CPS score of 5 or 6 with a minimum score of at least 10 points on the MDS ADL‐Short Form. Copyright © 2006 John Wiley & Sons, Ltd.
Patient versus informant reported quality of life in the earliest phases of Alzheimer's disease
Authors: Vogel Asmus , Mortensen Erik Lykke , Hasselbalch Steen G. , Andersen Birgitte B. , Waldemar Gunhild
Published: September 2006

Objectives

The study investigated if patient and informant reported Quality of Life (QoL) differed in early Alzheimer's disease (AD). In addition, we examined whether anosognosia had an impact on the agreement between patient and informant ratings of QoL and whether anosognosia, dementia severity, depression and behavioural symptoms were significantly correlated to QoL in early AD.

Methods

From a prospective research program including newly referred patients (age >60 years and MMSE ≥ 20), 48 patients with very early AD were included. QoL was assessed using the QoL‐AD and EQ‐5D scales. Anosognosia was rated on a categorical scale by an examiner. MMSE, Geriatric Depression Scale, Danish Adult Reading Test and Frontal Behavioural Inventory were also administered.

Results

On most QoL measures patients rated their QoL higher than their informants. Anosognosia was not associated with QoL but significantly with an inverse impact on the agreement between patient and informant ratings of QoL. Self‐reported QoL was significantly correlated to depression but not to age, dementia severity, behavioural symptoms or memory impairment. Informant ratings of QoL were significantly correlated to behavioural symptoms and informant ratings on the EQ‐5D Visual Analogue Scale were significantly correlated to patient reported depression.

Conclusion

Patients with early AD generally reported higher QoL than their informants. This disagreement was associated with the presence of anosognosia. Self‐reported QoL did not correlate with the MMSE score. Behavioural changes and depressive symptoms may be associated with low QoL. Copyright © 2006 John Wiley & Sons, Ltd.
Depressive symptoms in newly admitted nursing home residents
Authors: Achterberg Wilco , Pot Anne Margriet , Kerkstra Ada , Ribbe Miel
Published: September 2006

Objectives

To study the relationship between the prevalence of depressive symptoms in newly admitted nursing home residents and their previous place of residence.

Methods

In 65 nursing homes in the Netherlands trained physicians assessed 562 residents (mean age 78.5, range 28–101, 64.6% female) within 10 days after admission. Depressive symptoms were assessed with the Minimum Data Set (MDS) Depression Rating Scale (DRS), and the MDS items: ‘diagnosis of major or minor depression’, ‘change in depression’ and ‘indicators of persistent depressed, sad or anxious mood disorder present’. Previous place of residence was categorized as ‘own home’, ‘hospital’ or ‘sheltered living facility’. Adjustments were performed for demographic and health related factors measured with the MDS.

Results

The prevalence of depressive symptoms (DRS ≥ 3) for all 562 residents was 26.9%; it was higher in residents admitted from their own home (34.3%) than in residents admitted from the hospital (19.7%) (p = 0.002). Residents who were admitted from the hospital have an adjusted Odds Ratio for having many depressive symptoms of 0.54 (95% CI 0.31–0.94) compared to residents admitted from their own home. There is, after adjustment, no statistical significant difference between residents admitted from their own home, or residents admitted from a sheltered living facility.

Conclusions

Depressive symptoms are very prevalent in nursing homes. Residents who are admitted from their own home, or from a residential facility, have more depressive symptoms than residents admitted from the hospital. This may reflect different conceptualizations or different adjustment patterns for those groups. For a better understanding of the factors associated with nursing home depression, future studies in detection, prevention and management of depressive symptoms should start prior to or directly after admission, especially for those who have no prior institutional history. Copyright © 2006 John Wiley & Sons, Ltd.