bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased response of serum prolactin to metoclopramide in senile dementia of Alzheimer type
Authors: House Allan , Jones Jo
Published: December 2004

The investigation studied the effect of intravenous administration of a dopamine blocking agent (metoclopramide) on serum prolactin levels in patients with senile dementia of Alzheimer type (SDAT) and in non‐demented elderly controls. The response to metoclopramide was greater in the demented patients than in the controls, suggesting that dementia is associated with dysfunction in the tubero‐infundibular pathway which controls prolactin secretion. This finding adds to the evidence that dopaminergic systems may be affected in dementia, in the absence of clinical evidence of extrapyramidal disorder.
The elderly in long‐term care: 2 — an estimate of misplacement using objective criteria
Authors: Kirk S. , Compton S. A. , Devaney N. , Donnelly C. M. , McGuigan M.
Published: December 2004

Eight hundred and seventy‐one permanent residents in residential homes (Part III), EMI homes, geriatric hospitals and psychogeriatric wards were examined over a two‐week period and their cognitive and behavioural functions recorded using a reliable and valid questionnaire (CAPE Survey). Objective criteria for placement in each of these four types of unit were selected in advance of the study, using easily available Government and professional guidelines. The residents' data were then analysed to see if they were appropriately placed. A considerable degree of misplacement was found to occur in all types of unit and reasons for this are discussed.
The distribution of services to demented elderly people living in the community
Authors: O'Connor D. W. , Pollitt P. A. , Brook C. P. B. , Reiss B. B.
Published: December 2004

One hundred and sixty demented, community‐resident elderly people were identified by means of a community survey. Subjects who lived alone received home helps and meals‐on‐wheels more often than those who lived with supporters but there were no differences between the two groups with respect to district nursing or day care. Services increased in line with the degree of mental infirmity and nearly all moderately and severely demented people who lived alone were known to at least one service. We suggest that the home help and meals‐on‐wheels services, as presently constituted, may have limited applicability to dependent old people who live with able‐bodied supporters. If services are to provide effective assistance, they may need to adapt their provision to the actual needs of elderly people and their relatives.
Lithium in the elderly: A review with special focus on the use of intraerythrocyte (RBC) levels in detecting serious impending neurotoxicity
Authors: Foster Jeffrey R. , Silver Michael , Boksay Istvan J. E.
Published: December 2004

The elderly are at high risk to develop neurotoxicity in the course of lithium therapy. This is especially true for patients with neurologic or cognitive impairments. This may occur even when lithium treatment is modified to include lower doses and lower target blood levels. The literature is reviewed concerning current uses of lithium in older patients. The rationale for expecting that red blood cell (RBC) lithium levels could have predictive value in the early detection of impending serious neurotoxicity is discussed. There appears to be a critical value for RBC lithium in the region of 0.6 mEq/ 1 that is ominous as a harbinger of impending toxicity. This critical concentration may be considerably lower for patients with dementia.
Environments for the dementing
Authors: Benjamin Lisa C. , Spector John
Published: December 2004

The Multiphasic Environmental Assessment Procedure (MEAP; Moos and Lemke, 1984) was used to assess a British sample of specialized envionments for the dementing and elderly. Results supported the utility of the MEAP as a measurement tool. Shortcomings in the planning for such environments were identified, for example in the provision of adequate safety, prosthetic and orientational aids, and some assumptions about care priorities were challenged, such as the cruciality of ‘integration’ and the necessity for proximity to community facilities of units for the dementing. Comparisons with American normative data were made, with the most consistent finding being a more satisfactory provision of physical environment features in the American sample.
The relationship of staff, resident and environmental characteristics to stress experienced by staff caring for the dementing
Authors: Benjamin Lisa C. , Spector John
Published: December 2004

In a study linked to the examination of the ‘MEAP’ as a measure of environments for the dementing, a procedure for measuring stress in the carers of the dementing was designed and administered to staff caring for the dementing in three different facilities. Stress was attributed primarily to staff, resident, or environmental characteristics. Events were identified to which care staff of the dementing attributed their stress, and variables including types of staff training and experience, levels of dementia in residents and staff levels were discussed as possible contributors to the perception of events as stressful.
Fluency of speech and self‐awareness of memory deficit in alzheimer's disease
Authors: Loebel J. Pierre , Dager Stephen R. , Berg Glenda , Hyde Thomas S.
Published: December 2004

Although gradual global progression is one of the cardinal features of primary degenerative dementia of the Alzheimer type, clinical observation of patients suggested that there is some variability in the degree and rapidity of decline of different symptoms of this illness. In particular, it appeared that language fluency and self‐awareness of memory problems did not decline simultaneously. This study was designed to test the hypothesis that an inverse relationship exists between self‐awareness and fluency in patients with Alzheimer's disease. Thirty‐two patients suffering from Alzheimer's disease were divided into two groups on the grounds of presence or absence of self‐awareness of memory handicaps. These patients were also assessed in regard to fluency using a three‐point scale devised for this purpose. A significant inverse association was found between self‐awareness and fluency. This appeared to be a specific relationship, unrelated to global indicators of function including Mini‐Mental Status Evaluation, Aphasia Screening Test scores or demographic features. Possible implications of this with reference to intracerebral localization issues in mild‐moderate Alzheimer's disease are discussed.
Functional impairment and behavioural disturibances in vocally disruptive patients in psychogeriatric wards compared with controls
Authors: Hallberg Ingalill R. , Norberg Astrid , Erikson Sture
Published: December 2004

This study aimed at identifying patterns or clusters of functional impairment and behavioural disturbances in vocally disruptive patients compared with controls. Identified vocally disruptive patients (37) from psychogeriatric wards (264 patients) were included and compared with controls (37) matched for sex and wards. Assessment of the degree of orientation and functional performance (physical and psychosocial) was made using a newly developed rating scale, Organic Brain Syndrome Scale, consisting of two subscales, a 16‐item scale measuring orientation and a 39‐item scale measuring functional performance. Principal component analysis was applied reducing the first subscale into three factors (orientation to time, person, past and present events) and the other subscale into seven factors (functional performance and orientation in the ward, fluctuations in mental state and emotional disturbances, speech performance and psychomotor slowing, mobility, hostility, presence of delusions and hallucinations, sensitivity and euphoric state). Discriminant analysis revealed that vocally disruptive behaviour related significantly to physical dependence and disorientation in the ward, confusional reactions, delusions, hallucinations and a more preserved speech performance compared with controls. Suggestions have been made that vocally disruptive behaviour develops when environmental factors such as sensory deprivation interact with the effects of the brain damage.
Quantification of physical illness in psychiatric research in the elderly
Authors: Burvill Peter W. , Mowry Bryan , Hall Wayne D.
Published: December 2004

This article outlines a simple coding matrix for recording physical illness in a compact form suitable for computerization in research. It allows the recording of physical illness in a number of different ways: the particular organ system(s) involved; whether the illness is acute or chronic; the severity of illness; and the severity of interference with daily living. The application of the scheme is shown in a cohort of depressed elderly patients in hospital. Also included were three self‐assessment scales of physical illness and an OARS Physical Health Rating. It was concluded that the simplest and most parsimonious approach to assessing global physical illness for psychiatric research purposes on the elderly would be to (a) measure the number of body system affected by acute and chronic physical illness, and (b) ask each patient to assess his/her own physical health by one appropriate question.
The guy's/age concern survey: Physical health and psychiatric disorder in an urban elderly community
Authors: Lindesay James
Published: December 2004

The associations between physical health problems and cognitive impairment, depression, generalized anxiety and phobic disorders are described in a random community sample of 890 elderly people. 28.4% of the total sample reported one or more serious physical health problems, and increased rates of health problems were associated with cognitive impairment, depression, generalized anxiety and agoraphobia. Particular psychiatric disorders were associated with distinct patterns of specific physical health problems. Self‐reports of physical health problems were associated with worry about physical health, but this did not account for the association between physical health problems and depression and agoraphobia.
A sequential double‐blind controlled study of moclobemide and mianserin in elderly depressed patients
Authors: Tiller John , Maguire Kay , Davies Brian
Published: December 2004

Moclobemide was compared with mianserin in a double‐blind controlled study in elderly depressed patients. Sequential analysis of 11 pairs of patients found no significant difference between the drugs at the week 8 analysis. Unpaired comparison of the 26 patients completing four weeks' treatment also showed no significant difference between the two drugs. Both drugs significantly reduced Hamilton and Carroll depression rating scroes. A separate analysis of the 20 patients completing eight weeks' treatment showed that both drugs produced significant decreases in Hamilton and Carroll depression ratings with no significant difference between the two drugs for depression scores at either week 4 or 8. Side‐effects were minimal, with the most severe emergent side‐effects for moclobemide being sleep disturbance, blurred vision and dry mouth.
Hypothesis linking plasticity, vulnerability and nerve growth factor to basal forebrain cholinergic neurons
Authors: Perry Elaine K.
Published: December 2004

The hypothesis is advanced that two striking features of basal forebrain cholinergic neurons (BFCN)—their role in memory and their vulnerability in disease—are related to their dependence on nerve growth factor (NGF). Numerous studies, involving retrograde transport, receptor localization and responses to exogenous growth factor, have demonstrated a relatively selective association of NGF with these neurons in adult brain. The role of BFCN innervating cortical areas such as the hippocampus (and other cortical areas) in memory is widely supported by the results of surgical or pharmacological manipulation in experimental animals. Neuronal degeneration, indicated by decreased cortical cholinergic activity and/or subcortical cell loss, is also evident in a wide variety of cerebral disorders involving memory loss and dementia (Alzheimer's and Parkinson's disease, subacute sclerosing panencephalitis, Lewy body dementia and olivopontocerebellar atrophy are some examples) and to a lesser extent in normal ageing itself, in which memory is particularly vulnerable. Evidence is provided to support the idea that activity‐dependent uptake of NGF underlies both the memory function of BFCN and their susceptibility to disease. It is suggested that therapeutic strategies in dementia may need to be directed towards stimulation (pharmacological or physiological) of surviving BFCN.
The nature of wandering in dementia: A community‐based study
Authors: Hope R. A. , Fairburn Christopher G.
Published: December 2004

Wandering in dementia causes major difficulties for both patients and their carers. The term ‘wandering’ however, is vague and has no specific meaning. The behaviour of 29 patients in the community with dementia who had been classed as ‘wanderers’ was studied. The subjects were assessed using a semistructured interview with a carer. The findings show that the term ‘wandering’ covers a wide range of distinct behavioural abnormalities. A descriptive typology of wandering is proposed and the rates of each type are given. It is suggested that five fundamental components underlie the various types of wandering.
Zuclopenthixol dihydrochloride in the management of behavioural disorders in elderly demented patients: A dose‐ranging study
Authors: Venkateswarlu Tamirisa , Staley Christopher John , Neal Charles David
Published: December 2004

Restlessness, aggressiveness and agitation in elderly people with dementia sometimes requires treatment with drugs. Often patients cannot be calmed by soothing measures alone, and neuroleptics in low dosages are frequently used. This open dose ranging study was proposed to determine the optimum dosage of oral zuclopenthixol for patients with dementia and behavioural problems. Twenty hospital inpatients entered the study of whom 14 were established on a therapeutic dosage (the lowest dose providing maximum clinical benefit without the emergence of unwanted symptoms) and maintained for four weeks. Eleven of the 14 patients who were established on a therapeutic dosage received either 2 or 4mg bd. Patients' symptoms were shown to have significantly improved during the study.
Mental and physical capacity and consumption of neuroleptic drugs in residents of nursing homes
Authors: Nygaard H. A. , Bakke K. J. , Breivik K. , Brudvik E.
Published: December 2004

The mental and physical capacity of all persons living permanently in a nursing home in Bergen were estimated and their neuroleptic drug consumption and duration of stay were registered. Fifty‐one per cent were severely and 14% moderately mentally impaired. Eighty‐seven per cent demanded more extensive nursing care. Physical dependence was significantly associated with mental decline, but not with age. 32.6% received regularly neuroleptic medication, which was most common among restless and wandering residents. Dosage fell with increasing age and decreasing ability to perform personal hygiene.
The case identification of dementia in the community: A comparison of methods
Authors: Brayne Carol , Calloway Paul
Published: December 2004

Few studies have compared methods of case identification in dementia in detail. In this epidemiological study of cognitive function and dementia, scales and clinical diagnoses were compared in 365 women aged between 70 and 79. The women were interviewed using CAMDEX (Cambridge Examination for Mental Disorders of the Elderly), which includes established and new scales of cognitive function and behaviour. In addition, the information/orientation subscale of the Clifton Assessment Procedure for the Elderly was recorded. The proportions of the population identified by various recommended cutpoints for these scales were calculated. Sensitivities and specificities for these were compared, using CAMDEX clinical diagnosis as the standard. Large differences were found in these according to both the cutpoint set and the level of dementia examined. Each subject was rated by her own general practitioner and a random 10% of the sample was seen using the Geriatric Mental State Examination in addition to CAMDEX. The different diagnoses were compared and considerable variation found.
A community‐based study of aggressive behaviour in dementia
Authors: Ware Christopher J. G. , Fairburn Christopher G. , Hope R. A.
Published: December 2004

Aggressive behaviour is a serious care problem for families looking after patients with dementia. The aim of this study was to investigate, in a community sample of patients with dementia, the nature of aggressive behaviour and the settings in which it occurred. Thirty‐seven subjects known to be aggressive were studied. The results show that the acts of aggression can be usefully classified on the basis of the circumstances in which they occur. It is argued that such a classification is likely to be of more value in understanding aetiology than is a classification based on the nature of the acts themselves.
Mortality in relation to dementia, depression and social integration in an elderly community sample
Authors: Jorm A. F. , Henderson A. S. , Kay D. W. K. , Jacomb P. A.
Published: December 2004

In a community sample of 274 persons aged 70 + years in 1982‐83, measures of depression, dementia and social integration made at that time were examined in relation to mortality in the following five years. The probability of death was increased in those diagnosed as having a dementia or a depressive disorder. The association between depression and mortality suggests that there may in such cases be a physical illness accompanied by a drop in mood. Alternatively, the symptoms of depression could also be symptoms of serious medical illness. Other symptoms, typical only of depression, did not predict mortality. There was no association between mortality and social integration, a finding which is contrary to previous observations.
Incidence of depression in a medical long‐term care facility: Findings from a restricted sample of new admissions
Authors: Foster Jeffrey R. , Cataldo Janine K. , Boksay Istvan J. E.
Published: December 2004

The prevalence rate of depression in medical long‐term care facilities is high but varies over a large range. One source of variation may be differences in the underlying incidence rates. A cohort of 104 new admissions was followed for one year and showed and incidence rate of approximately 14%. This rate is comparable to the only other published study and suggests that incidence rates may be more uniform than expected from the range of prevalence reports.
Group living, an alternative for dementia patients. A cost analysis
Authors: Wimo Anders , Wallin Jan Olov , Lundgren Kjerstin , Rönnbäck Eva , Asplund Kenneth , Mattsson Bengt , Krakau Ingvar
Published: December 2004

The increasing number of patients with dementia requires new forms of care management. Group living (GL) is an alternative, and two units were established in Sundsvall, Sweden, in 1984. The patients in GL used institutional care to a significantly lower extent (nursing homes, emergency hospital care, psychiatric care) after admission to GL (p < 0.001). The costs for the Municipality and the County Council changed from £49 to £42/day (p=0.21) and patient during the first six‐month period in GL compared to the six‐month period prior to GL. If the costs for GL are compared to the costs for nursing home care (£68/day), GL is significantly cheaper (p < 0.05).
The impact of a new community mental health team on an inner city psychogeriatric service
Authors: Coles R. J. , Von Abendorff R. , Herzberg J. L.
Published: December 2004

The introduction of a multidisciplinary mental health team for the elderly, providing comprehensive assessment and support for elderly people with mental health problems in an area of inner London, has represented a major change in the way in which psychogeriatric referrals are dealt with locally. The new service replaced a traditional hospital‐based system with a consultant making domiciliary visits. Characteristics of 109 referrals to the consultantbased service over six months are compared to 193 referrals over a similar period following the introduction of the team. Demographic patterns in both groups were similar, as were diagnoses made, with the exception of acute organic confusional states of which a slightly larger proportion were seen under the old service. More detailed assessment of cases and more input both to cases and their carers were possible with a community team. The implications of a community team based service for psychogeriatrics are discussed.
Psychological autopsy of an elderly suicide
Authors: Alexopoulos George S.
Published: December 2004

The case of an elderly woman who committed suicide is presented. Clinical and sociological concepts and empirical findings are discussed in the context of this case. Depression, substance abuse, cognitive dysfunction, exacerbation of preexisting personality disturbance, and medical illness and disability appear to contribute to geriatric suicide in older people. Relocation to a nursing home, while often necessary, has significant emotional value and may function as a precipitant to suicidal behaviour.
Patterns of hearing loss and psychiatric morbidity in elderly patients attending a hearing clinic
Authors: Kalayam Balu , Alexopoulos George S. , Merrell Hal B. , Young Robert C. , Shindledecker Richard
Published: December 2004

This study examines the relationship between hearing loss and psychiatric diagnosis in a geriatric population attending a hearing clinic. Major depression was the most frequent psychiatric disorder and was diagnosed in 30% of subjects. A sensorineural type hearing loss was diagnosed in 85% of the depressed subjects. More hearing loss was seen in subjects with onset of depression after age 55 years, in comparison to geriatric patients with depression onset before age 55 years, subjects with other psychiatric disorders and subjects without a psychiatric diagnosis (p <0.001). The audiogram and speech audiometry suggest involvement of auditory nerve and central auditory pathways in late onset depression.
Subcortical symptoms predominate in vascular dementia
Authors: Wallin Anders , Blennow Kaj , Gottfries Carl‐Gerhard
Published: December 2004

Thirty‐one patients with the clinical diagnosis of vascualar dementia were examined with regard to symptoms reflecting disturbances in various brain regions. Frontal, parietal, subcortical and non‐regional symptom complexes were used to characterize each patient. Frontal (77%) and subcortical (68%) symptoms were the most common clinical patterns. Using an overall evaluation, subcortical symptomatology was the most prominent clinical picture (45%) Extrapyramidal symptoms, an important aspect of the subcortical symptom complex, were associated with histories of hypertension (p<0.05) and low levels of 5‐hydroxyindoleacetic acid (p<0.05) in the spinal fluid. This study suggests that subcortical, and possibly also frontal, symptoms are typical and perhaps underestimated manifestations of vascular dementia and that they may reflect important pathogenetic pathways in this disorder.
Paranoid features in the elderly with dementia
Authors: Ballard C. G. , Chithiramohan R. N. , Bannister C. , Handy S. , Todd N.
Published: December 2004

Ninety‐two consecutive psychogeriatric day hospital referrals were assessed using the Camdex schedule. Sixty‐six of the patients had a first‐degree relative visiting more often than once per week and the data from the patient and informant sections of these schedules were analysed to assess the prevalence of paranoid features. Overall, 36.4% fulfilled the modified criteria for paranoid disorder. Significantly more patients with Alzheimer's disease fulfulled these criteria than did those with vascular dementia, and paranoid features were most common in patients with dementia of moderate severity.
Which elderly depressives will respond to ECT?
Authors: Morris Paul D.
Published: December 2004

Recent research has confirmed that ECT is an effective treatment for elderly patients with severe depressive illnesses, but not without some hazard in its administration. The currently available prognostic indicators for ECT have been developed in adults under 65 years old. In this study, the Newcastle ECT prediction scale, the presence of delusions and a scale developed in an elderly population are used to predict response to ECT in a group of 30 elderly depressives. Only the latter is shown to predict responses to ECT. The significance of these findings is discussed.
Assessment of kendrick cognitive tests for the elderly
Authors: Rai G. S. , Phongsathorn V. , Scott L. C.
Published: December 2004

The Kendrick cognitive tests for the elderly were administered to 42 elderly patients with SDAT, 32 normal elderly, 10 patients with depression and 20 elderly patients with multi‐infract dementia. The scores on KDCT and KOLT revealed significant differences between those who had dementia and those who had non‐dementing illness. However, initial test patterns for KOLT and KDCT and test‐retest patterns revealed some overlap. For diagnosis of dementia, if one uses the test‐retest patterns assigned by Kendrick to the various diagnostic categories, the tests have a specificity of 100% and a sensitivity of only 39% thus suggesting that they are of limited value in predicting the presence or absence of dementia in an individual.
The diagnosis of dementia—I clinical and pathological criteria: A review of the literature
Authors: Jane Byrne E. , Smith C. W. , Arie T.
Published: December 2004

Pathology has been viewed as the gold standard for the diagnosis of dementia. Critical appraisal of the literature suggests that the criteria for pathological diagnosis of Alzheimer's disease vary widely, and that the relative frequency of the various aetiological causes of the dementia syndrome cannot yet be firmly established.
Occult subcortical magnetic resonance findings in elderly depressives
Authors: Churchill Cynthia M. , Priolo Christine V. , Nemeroff Charles B. , Krishnan K. Ranga R. , Breitner John C. S.
Published: December 2004

Hyperintense signal areas (HSA) on T2‐weighted brain magnetic resonance imaging (MRI) may reflect subtle cerebrovascular insufficiency and are common in elderly depressives. We hypothesized that these HSAs may indicate a vascular etiology for depression in late life, and that patients with late‐onset major depression (MDD) would therfore more often show HSAs than comparably aged recurrent depressives. We reviewed the brain MRI findings of a consecutive series of inpatients aged 50 or over who were treated for MDD during an 18‐month period. Patients with Parkinson's or other brain diseases predisposing to depression were not considered.

Twenty‐seven (82%) of 33 patients with depression first apparent in late life and nine (64%) of 14 patients with earlier‐onset recurrent depression showed HSAs. This difference did not reach statistical significance. It was not attributable to the older mean age of the late‐onset group.

These rates are in accord with an 86% rate reported in a series of patients referred for ECT (Coffey et al., 1988). They are much higher than the 20–30% figure for comparably aged normals (Bradley, 1984; Kirkpatrick and Hayman, 1987). HSAs were common in this series of elderly depressed inpatients, regardless of age of onset of illness.
Palatability of liquid major tranquillizers
Authors: Gibson P. , Mountjoy C. Q. , Sutcliffe R. L. G.
Published: December 2004

Those with mental disorder in later life may reject medication for various reasons. In the case of liquid medication this may be due not to mental disturbance or swallowing difficulty but to unpalatability of the medication. Thirty volunteers blind‐tasted four major tranquillizer liquid medications and a palcebo.

Not one of the active preparations was thought to be pleasant, each being associated with bad immediate or delayed taste.

Undesirable taste may be a valid cause for rejection by patients of any age. As liquid medication is prescribed more frequently for elderly than for younger patients, palatability should be considered.
A case of late‐onset rapid cycling affective disorder
Authors: Lovestone Simon
Published: December 2004

A case of late‐onset bipolar rapid cycling affective disorder of classical cycle length is presented. The aetiology and management of the disorder is discussed. The case adds to other evidence that the symptoms of affective disorder in old age are similar to those in younger patients.
A comparison of clinical, psychometric and behavioural memory tests: Findings from a community study of the early detection of dementia
Authors: Beardsall Lynn , Huppert Felicia A.
Published: December 2004

Diagnostic criteria for dementia require assessment of the ability to learn new information. Ideally, this assessment should be brief and sensitive to early impairment. We present comparative data on a variety of memory tests administered to a population sample of elderly community residents who are being studied longitudinally. Of the three classes of memory tests, clinical, psychometric and everyday tests, discriminant function analysis indicated that, overall, the best discrimination between demented and non‐demented individuals was achieved by some everyday tests: recalling a news item, retracing a route, and recalling a name after learning a name‐photograph association. However, of the 11 tests examined in total, two were identified which together discriminated almost as efficiently as all 11 measures combined. These were recalling a name and recalling six objects. By comparison, the principal memory item in the Mini Mental State Examination, the recall of three words, produced poor discrimination. The two simple measures which provided good discrimination in this population sample may therefore be recommended to assess the ability to learn new information, where the aim of the assessment is the diagnosis of dementia.
The validity of memory complaints by elderly persons
Authors: Christensen Helen
Published: December 2004

Memory complaint and objective test performance were assessed in 20 elderly ‘memory complainers’, 11 elderly controls, 14 young students, and 19 mildly‐to‐moderately demented patients using an everyday memory questionnaire and clinical memory tasks. Consistent with earlier studies, memory complainers as a group reported more failures of everyday memory but did not differ from the controls on the clinical memory tasks. However, on further analysis, memory complaint and poor test performance were positively associated; first, in those elderly subjects who considered their memory impairment to be both worse than their peers' and recently acquired; and secondly, in individuals whose level of memory performance was lower than that expected on the basis of their ‘premorbid intelligence’. The latter finding indicates that a legitimate basis for memory complaint is more often present in complainers than non‐complainers.
The assessment of orientation in dementia: Item content versus item format
Authors: Hopkins R. W. , Rindlisbacher P.
Published: December 2004

Orientation assessments with regard to time, place and person tend to show a typical pattern of deterioration in progressive dementias. Some clinicians have established hierarchies of orientation based on these observed paterns. There are discrepancies in the order of these hierarchies, due perhaps to differences in the phrasing of questions asked of patients. It is possible to vary the difficulty of items by changing the question format and evidence is cited to show that format differences may be especially pertinent to demented populations. In two large samples of psychogeriatric subject frequencies of incorrect responses for individual orientation items were calculated along with probabilities of success based on chance responding. Results show that although the traditional contentbased hierarchy was observed, simple probabilities of success could also account for the observed frequencies of incorrect responding.
Reliability of flicker threshold measurement in patients with primary degenerative dementia of the Alzheimer's type (PDDAT)
Authors: Curran S. , Wattis J. P. , Hindmarch I.
Published: December 2004

The test‐retest and split‐half reliability of flicker threshold measurement was determined in 23 female and three male patients with primary degenerative dementia of the Alzheimer's type (PDDAT). Patients had a mean age of 81.7 ± 6.05 years (range 67–89). Diagnosis of PDDAT was based on DSM‐IIIR criteria. The psychophysical method of limits was used to determine the flicker threshold and was the average of four separate measurements. The split‐half reliability was found to be 0.97 and the test‐retest reliability 0.941 (both p < 0.0001). The measurement of flicker thresholds is a quick, easy and reliable technique in patients with PDDAT. Future work will also need to examine the validity and pharmacosensitivity of the measure if it is to be used to assess potentially therapeutic agents for the management of the underlying disease process.
Binswanger on Binswanger's disease
Authors: Forstl Hans , Howard Robert , Levy Raymond
Published: December 2004

In 1894 Otto Binswanger described a disease of the hemispheric white matter which he called encephalitis subcorticalis chronica progressiva'. He examined eight patients who had shown a slow but relentless cognitive decay that began in middle or old age and lead to severe dementia, characterized in the early stages by a disturbance of association of cortical sensory and motor areas, by aphasia, hemiamblyopia, hemianopia, hemiparesis and a loss of the sense of pressure, position and touch. At postmortem the patients showed white matter atrophy most pronounced in the temporal and occipital lobes. Binswanger proposed that this subcortical fibre loss was due to cerebral arteriosclerosis, which was almost invariably demonstrated. “Binswangers” disease' has gained topical importance following the introduction of sensitive imaging techniques which have led to the frequent detection of white matter disease during life. This full account of his original observations may contribute to the clarification of contemporary terminological issues.
Life satisfaction and associations with social network and support variables in three samples of elderly people
Authors: Bowling Ann , Farquhar Morag , Browne Peter
Published: December 2004

Research evidence concerning the contributions of social networks and support to the subjective wellbeing (ie life satisfaction) of older persons is not consistent. This article reports the results of an investigation of social network type and health status and their effects on life satisfaction in relation to 1415 elderly people from three independent but comparable surveys: two in City and Hackney, London (urban area) and one in Braintree, Essex (semi‐rural area). The percentages of the total variation in overall life satisfaction which was explained by the model ranged from 22% to 33% between samples. The most variation was explained among the sampleaged 85+ living in inner London. Although most of the variance remains unexplained, healthstatus was a more powerful predictor of life satisfaction among respondents living in City and Hackney, but not those living in Braintree.
Psychiatric morbidity as predictor of mortality for residents of local authority homes for the elderly
Authors: Ashby Deborah , Ames David , West Christopher R. , MacDonald Alastair , Graham Nori , Mann Anthony H.
Published: December 2004

The residents of 12 local authority homes for the elderly run by one London borough were screened for depression and dementia in 1982 and again in 1985/6. Both samples were followed up 8–16 months after screening. In both groups, 23% were dead at follow–up and a small percentage (2% in the first sample, 5% in the second) had moved to hospitals. The mortality was approximately twice that expected for the general population of the same ages and was associated with male sex, young age, high organic brain syndrome score, high depression score, and the expression of a wish to die when screened. The majority of deaths were certified as due to chest infection or cardiovascular disease. The term “dementia” appered on only 18 of 99 death certificates, although 58 of these 99 residents had been classed as demented when screened. This study provides further evidence of the malign prognosis of depressive and cognitive disorder among residents of these homes.
Three‐year follow‐up study of nursing home residents using rating scales in Japan
Authors: Nagatomo Itsugi , Nomaguchi Mitsuo , Fukuzako Hiroshi , Matsumoto Kei
Published: December 2004

One hundred and nine nursing home residents were examined by the modified Stockton Geriatric Rating Scale (modified SGRS) and the Hasegawa Dementia Rating Scale in April 1987. Twenty‐eight residents died during the three‐year period. The 64 survivors remaining at the nursing home were reexamined in April 1990 and were divided into two groups according to whether they had been admitted to hospital or not during the follow‐up period. Physical ability as measured by the modified SGRS and the Hasegawa Dementia Rating Scale had deteriorated in both groups, and communication failure and apathy on the modified SGRS were aggravated in the admitted group. It is considered that not only the physical care of all nursing home residents but also the psychogeriatric care of residents with severe physical impairment is necessary.
Further evidence of preserved memory function in Alzheimer's disease
Authors: Scott L. C. , Wright G. K. , Rai G. S. , Exton‐Smith A. N. , Gardiner J. M.
Published: December 2004

Memory performance of elderly patients in the early stages of Alzheimer's disease (DAT) was compared with that of elderly control subjects. In explicit tests of recognition memory, which involve conscious recollection, the DAT patients were grossly impaired. In implicit tests of anagram solution and wordstem completion, which do not require conscious recollection, the DAT patients were not impaired. These findings further support the idea that a separate memory system, episodic memory, underlies conscious recollection, that it is this system which is most commonly damaged in amnesia, and that memory systems not involving conscious recollection may be spared in the early stages of Alzheimer's disease.
The ageing of the third world: tackling the problems of community surveys. Part II: A community survey of the elderly population in rio de janeiro: a methodological approach
Authors: Veras Renato P. , Murphy Elaine
Published: December 2004

This article (Part II) introduces a joint project being carried out at the Institute of Social Medicine, Rio de Janeiro, and the United Medical and Dental Schools, Guy's Hospital, London, concerning the epidemiology of the elderly population of Rio de Janeiro. The methodology used and the stages of the community survey are presented. The sampling methods and the steps of the enumerator process are detailed, and the design on the reliability and validity study of mental health is also presented. The main purpose of this article is to present the methodological approach.
Prevalence of dementia in an urban slum population in thailand: Validity of screening methods
Authors: Phanthumchinda Kammant , Jitapunkul Sutthichai , Sitthi‐amron Chitr , Bunnag Srichitra C. , Ebrahim Shah
Published: December 2004

A randomly selected sample of 500 subjects over 60 years old and their relatives were studied using standardized methods for assessment of cognitive impairment. The prevalence of DSM‐III‐R dementia was 1.8% (95% confidence intervals 0.6‐3%), and the majority of cases had a probable diagnosis of Alzheimer's disease. The sensitivity and specificity of the field survey version of the Mini‐Mental State Examination (MMSE) for a diagnosis of dementia using a threshold of 21 were 100% and 53% respectively. This was associated with a positive predictive value of dementia, given a low score, of only 3%. A high prevalence of low MMSE scores was found: 23% of men and 50% of women had scores below 21, and there were strong relationship between low scores and age. Strong associations between low MMSE scores and no education were found, and weaker associations with female sex, deafness and poor sight. The MMSE is markedly affected by educational level, which together with its low positive predictive value for dementia in this population makes it a poor screening of research tool. A Behaviour Rating Scale score had a higher specificity leading to fewer false positives, but only achieved a sensitivity of 67%. In populations with low levels of education it is recommended that behavioural disabilities scales should be developed as a means of screening for dementia syndromes.
Brain imaging in late‐onset schizophrenia and related psychoses
Authors: Krull Alice J. , Press Gary , Dupont Renee , Harris M. Jackuelyn , Jeste Dilip V.
Published: December 2004

In this article we review the published studies on brain imaging in late‐life psychoses, and present data from our study of magnetic resonance (MR) imaging of the brain in late‐onset schizophrenia (LOS). MR images were obtained in 11 patients with late‐onset schizophrenia (LOS), nine patients with probable Alzheimer's disease (AD), and nine normal controls comparable in age, gender, and education. Two of the LOS patients were excluded from further analysis due to the presence of diagnosable organic pathology (i.e. Alzheimer's disease and presence of a subaracnoid cyst). The MR images were subjectively rated for both degree of ventricular enlargement (VE) and degree of abnormal white matter hyperintensities (WHM) by an experienced, board certified neuroradiologist in a blind manner. No significant differences were found among the groups on degree of abnormal WHM. MR images of AD patients had a significantly greater degree of VE than normal controls, with LOS patients being intermediate. Our data, for LOS and have evidence of non‐specific abnormalities in brain morphology on MR imaging, yet do not have clinical or MR imaging evidence of a specific organic etiology for psychosis.
Influence of ageing and concurrent psychotropic drugs on dementhylation of tertiary tricyclic antidepressants
Authors: Leinonen Esa , Ylitalo Pauli
Published: December 2004

The effects of ageing and concurrent psychotropic durgs on demethylation degree of tertiary tricyclic antidepressants (TCAs) were studied in 340 psychiatric inpatients with depression. They were treated daily with routine therapeutic doses of doxepin (177±59 mg, mean ± SD) or amitriptyline (154±47 mg). The numbers of blood samples analysed gas chromatographically for serum concentrations of tertiary TCAs and their secondary amine metabolites were 340 for doxepin and 192 for amitriptyline. The patients were divided into three age groups: >35, 35‐65 and <65 years old. Serum concentrations of doxepin and amitriptyline were increased significantly or showed a trend towards an increase with advancing age, but the concentrations of secondary amine, TCAs did not increase at all in the elderly. The ratio of secondary/secondary + tertiary amine TCAs was generally decreased with ageing. Concurrent neuroleptics, but not benzodiazepines, frequently increased the percentage fraction of secondary amine TCAs. We conclude that the altered demethylation ratio of tertiary amine TCAs, conceivably favouring the altered profile of drug action, should be considered when serum TCA concentrations are monitored in the eldrly and with concurrent neuroleptic therapy.
Objective assessment of praxis‐the oap diagram:‐simply testing for dementia
Authors: Connelly Peter J. , Jamieson Fiona E.
Published: December 2004

Cognitive assessment schedules for the elderly are often complex, cumbersome or highly dependent on memory function. Performance on visuoconstructive tests, which are often easily undertaken, is not dependent on ‘dominance’ of either hemisphere. Unfortunately, such tests often have complex objective and subjective scoring criteria, making standardization difficult. We have designed a structured diagram and scoring system which proved simple to administer and score and performance on which correlated well with intellectual function on the CAPE, while, unlike the Gibson Spiral Maze (GSM), those without dementia tended not to make any mistakes. Scoring on the GSM was also affected by age and the presence of parietal signs to a greater extent than the OAP, suggesting that the GSM may overestimate cognitive impairment in the population for which it was designed. Some possible uses for the OAP as a new test in the assessment of the elderly are discussed.
Psychotic symptoms in Alzheimer's disease
Authors: Cooper James K. , Mungas Dan , Verma Maxine , Weiler Philip G.
Published: December 2004

Memory loss is the hallmark of Alzheimer' disease. However, psychotic symptoms have also been reported. We studied the prevalence of hallucinations and delusions in 677 subjects with probable Alzheimer' disease. Data were collected in six centers and analyzed retrospectively. A two‐stage, multivariate approach was used. The overall prevalence of these psychotic symptoms was 31%. The prevalence of hallucinations was 17%, and of delusions 26%. Both were associated with emotional incontinence, insomnia and agitation as well as with advanced disease. While psychotic symptoms were more prevalent in advanced disease, nonetheless they occurred with notable frequency in early disease. Of subjects with early AD (MMSE scores between 21 and 30), 6% had hallucinations and 17% had delusions. Alzheimer' disease must be considered in the differential diagnosis of any subject over 55 presenting with these psychotic symptoms.
The prediction of stress in carers: The role of behaviour, reported self care and dementia in patients with idiopathic Parkinson's disease
Authors: Calder Sheila A. , Ebmeier Klaus P. , Stewart Lesley , Crawford John R. , Besson John A. O.
Published: December 2004

Stress scores were elicited from relatives living with Parkinsonian patients and correlated with various aspects of the patients' impairment. The (usually female) relatives looking after male patients reported higher levels of stress than husbands looking after their wives. In general, the best predictor of relatives' stress was the behavioural rating scale of the CAPE and a reported selfcare scale designed for the study. The relative contribution of Parkinsonian motor impairment and cognitive impairment to relatives' stress scores was examined. While motor impairment was still associated with relatives' stress after controlling for sex and cognitive deterioration, both dementia and cognitive impairment measured by the Mini‐Mental State Examination were not associated with relatives' stress if Parkinsonian disability was controlled for.
F. H. Lewy on Lewy bodies, parkinsonism and dementia
Authors: Föorstl Hans , Levy Raymond
Published: December 2004

F. H. Lewy (1885‐1950) recognized characteristic globoid and elongated inclusions with a surrounding halo (Lewy bodies) in the nervecells of the dorsal nucleus of the vagus and in Meynert's nucleuls basalis of patients with shaking palsy. Excerpts of his influential publications from 1912 and 1913 are translated. In 1923 he published a monograph which contains neurological, psychiatric and neuropathological data about 43 patients with Parkinsonism; 21 were demented, 10 had affective disturbances and 12 were considered as mentally normal. Alzheimer tangles and/or plaques were found in the cortices of 12 patients. Structures corresponding to Lewy bodies were described in the brains of 13 patients, but only once in the neocortex. Lewy's original work may deserve interest in view of current research on the prevalence and nature of the Lewy body and the nosological confusion caused by its rediscovery.