bluuebunny/crossref_metadata_2025 huggingface dataset:
Age‐specific prevalence, thyroid dysfunction and depressive symptomatology in adults with down syndrome and dementia
Authors: Prasher V. P.
Published: December 2004

Two hundred and one adults with Down syndrome (DS) were investigated for differing aspects of clinical dementia. Age‐specific prevalence rates of 9.4% for age range 40–49 years, 36.1% for 50–59 years and 54.5% for 60–69 years were found. Findings associated with increasing severity of dementia were gait deterioration, onset of urinary incontinence, increased muscle tone and onset of seizures. No association was found between thyroid dysfunction or thyroid autoimmunity and dementia. However, depressive symptomatology of depressed mood, weight loss and reduced appetite were associated with dementia. These findings investigating Alzheimer's disease (AD) in adults with DS support findings reported for the non‐learning disability population of an association between age, depressive symptomatology and AD but no association between thyroid dysfunction and AD.
A group therapy programme for depressed and anxious elderly inpatients
Authors: Moffatt Fiona , Mohr Caroline , Ames David
Published: December 2004

Concurrent symptoms of depression and anxiety are common in elderly people in psychogeriatric units. A group therapy programme is one potentially useful strategy to complement existing modes of treatment. This report describes such a programme.
A prospective study in three psychogeriatric day hospitals using administrative interventions to improve non‐attendance
Authors: Wright Barry D. , Lunt Bridget , Harris Stephen J. , Wallace Daphne
Published: December 2004

The article reports a survey and a subsequent prospective intervention study. The survey was conducted in two psychogeriatric day hospitals to establish the extent of day‐by‐day non‐attendance. In 1991, 23% of allocated places were not taken up and the reasons for 98% of these episodes are reported. Little attention has been paid to non‐attendance rates in the literature. Their importance is discussed. The prospective intervention study was then conducted using information from the survey year. Administrative interventions, which sought to raise the awareness of patient non‐attendance within the multidisciplinary team, were put into place in the two day hospitals. Non‐attendance rates in a third day hospital, where no intervention was made, were used for comparative purposes. After a second year, non‐attendance in the day hospital with no interventions had fallen by 3%. The other two had each reduced non‐attendance rates by 18%. These reductions have clinical relevance, representing 380 patient days over the whole year in the two day hospitals.
Do general practitioners and old age psychiatrists differ in their attitudes to dementia?
Authors: Wolff Linda E. , Woods Jonothan P. , Reid Jean
Published: December 2004

Research suggests dementia is still underdiagnosed and referral to specialists occurs late and often in crisis, despite increasing evidence that sufferers and carers want early intervention and advice. A questionnaire designed to survey attitudes to dementia was completed by 35 consultants in old age psychiatry across Scotland and a representative sample of 35 general practitioners in Glasgow. The results indicated that general practitioners' and psychiatrists' attitudes to dementia differed significantly in several aspects. The majority of general practitioners felt that they had little to offer dementia patients, that early referral was unhelpful, that easier access to long‐term beds was needed and that the problem was mainly social. In contrast, the majority of consultants supported early referral and diagnosis, strongly felt help could be offered, saw dementia as having both medical and social aspects and were divided regarding ease of admission for continuing care. These differences and possible implications for the delivery of optimum care are discussed.
Alzheimer patients know their date of birth but not their age: A study on disorientation
Authors: Cossa Federico M. , Sala Sergio Della , Spinnler Hans
Published: December 2004

Two experiments on orientation abilities were carried out to investigate whether differences in orientation performances are attributable to the nature of the information to be retrieved, ie to the necessity or not of its continuous updating. In the first experiment, a sample of 112 patients with „probable”︁ Alzheimer's disease (AD/pts) and 112 healthy controls were administered a 14‐item orientation inquiry. AD/pts were most impaired on items which required updating. This finding is interpreted in the light of the different attentional demands made by the two categories of items, namely variant and invariant, and the diminished attentional resources in AD/pts. In the second experiment, the same orientation inquiry was administered to 20 healthy young controls in a dual‐task design. The secondary task called for a continuous attention demanding reaction time. Results indicate that the items which required updating placed the greatest attentional demands. These findings lend support to the hypothesis raised to account for the outcome of the first experiment.
Phenomenologic subtypes in dementia and previous psychiatric hospitalization
Authors: Heinik Jeremia , Berkman Pinhas
Published: December 2004

Psychiatric features in dementia may reflect the coexistence of a previous „functional”︁ mental disorder and dementia. To test this hypothesis we used the national Psychiatric Case Register (PCR) as a data source and (a) compared PCR data between phenomenologic subtypes of dementia patients with and without history of psychiatric hospitalization; (b) investigated in what way past psychiatric diagnoses relate to present dementia phenomenology. A small but significant portion of senile (31%) and arteriosclerotic (23%) dementia sufferers did have a documented history of psychiatric hospitalization. No significant or consistent differences concerning PCR demographic, clinical and clinical‐administrative variables studied were found when dementia patients of each subtype, with and without previous psychiatric hospitalizations, were compared. However, phenomenologic subtypes with delusions and depression in senile and arteriosclerotic patients were significantly associated with previous psychiatric „functional”︁ diagnoses of a similar phenomenology. We suggest that, at least in a subgroup of senile and arteriosclerotic dementia patients, the psychiatric subtypes of delusions and depression might reflect the coexistence of two separate mental illnesses.
A randomized, placebo‐controlled trial of thiothixene in agitated, demented nursing home patients'
Authors: Finkel Sanford I. , Lyons John S. , Anderson Rachel L. , Sherrell Kathleen , Davis John , Cohen‐Mansfield Jiska , Schwartz Allen , Gandy James , Schneider Lon
Published: December 2004

The therapeutic efficacy of thiothixene in the treatment of behaviorally agitated dementia nursing home patients was studied in a double‐blind, randomized, placebo‐controlled clinical trial. Thirty‐three subjects were randomized for thiothixene (dose range: 0.25–18 mg) or placebo treatment over an 11‐week period, followed by a 6‐week crossover period to assess for return of symptoms in the group crossed over to placebo and further improvement in the group crossed over to thiothixene. Thiothixene was significantly more effective than placebo in the reduction of agitation at the end of 11 weeks of treatment. Symptoms tended to return after discontinuation. There were no significant changes in the Mini‐Mental State Examination (MMSE) or Activities of Daily Living (ADLs) and no significant differences in side‐effects. Two placebo‐treated patients died, and two patients died after being crossed over from thiothixene to placebo. The results suggest the efficacy of low doses of thiothixene for well‐defined agitation in specifically selected demented nursing home patients.
Apolipoprotein e genotype and late paraphrenia
Authors: Howard Robert , Dennehey John , Lovestone Simon , Birkett Joseph , Sham Pak , Powell John , Castle David , Murray Robin , Levy Raymond
Published: December 2004

Patients with late paraphrenia or late onset schizophrenia frequently have associated cognitive impairment which may in some cases progress to a recognized dementia. The frequency of the apoE ϵ4 allele is high in individuals who develop Alzheimer's disease. Twenty‐three patients with late paraphrenia were genotyped for ApoE. The frequency of the ϵ4 allele was comparable with that found in a large group of centenarians, but lower than previously reported from populations of normal controls and Alzheimer's disease patients. Two out of three male patients tested had the rare ϵ2/ϵ2 genotype, which was not found in any of the females.
Physical morbidity in a group of patients referred to a psychogeriatric unit; A 6‐month prospective study
Authors: Perry David W. , Milner Eric , Krishnan V. H. R.
Published: December 2004

In a 6‐month prospective study of all admissions (N = 72) to an old age psychiatric unit, 34% (N = 24) were found to have significant physical illnesses at the time of admission. Sixty‐two per cent of the conditions were detected by a combination of clinical methods and simple tests alone. There was no significant difference in terms of age, sex, marital status or a past history of psychiatric treatment between those who were initially diagnosed as physically ill and those who were physically well at the time of admission. Higher levels of morbidity were found in those with an organic psychiatric diagnosis compared to those with a functional psychiatric diagnosis, although this did not reach a statistically significant level. It is suggested that simple tests can be carried out in the community by family doctors.
The referral, investigation and diagnosis of presenile dementia: Two services compared
Authors: Allen Harry , Baldwin Bob
Published: December 2004

The case notes of 28 patients with presenile dementia presenting to a neurology service were compared with 26 who had presented to a specialist old age psychiatric department (OAPD). Referrals to the former were mainly from hospital doctors for diagnostic purposes. General practitioners referred more often to the OAPD and the patients were older. The reasons were more heterogeneous, but oriented to aspects of practical management of behavioural disturbance. Patients referred to the OAPD were inadequately investigated. It is concluded that specialist old age psychiatric services in Britain have a role in the management of patients with presenile dementia but that diagnosis should be undertaken by neurologists.
Evaluation of a geriatric assessment unit
Authors: Gerritsen J. C. , van Ende P. C. Der , Wolffensperger E. W. , Boom R. Ch.
Published: December 2004

Psychogeriatric patients are a very vulnerable group among the elderly. A relative large proportion is institutionalized. In addition, many studies point to the heavy burden on the informal carers of psychogeriatric patients, frequently leading to depression. Geriatric expertise in primary care, however, is limited. To complement this expertise, an experiment was conducted involving a geriatric assessment unit in a nursing home. An evaluation study was carried out including 96 patients, 89 of whom were looked after by informal carers. Data were collected from the unit and two ‘external controls’, both the GP and the informal carer, were interviewed before and 3 months after the intervention. The results show that, in a majority of cases, a new psychiatric or somatic diagnosis could be arrived at. Advice was given on drugs and physiotherapy and the monitoring of behaviour. The impact of the behavioural problems of patients was diminished after the intervention according to the informal carers. Moreover, the sense of competence of the informal carers was enhanced. The health status of the informal carers and the social support they received remained the same. Furthermore, comparison with other datasets supported the assumption of early detection.
Religion and older men in prison
Authors: Koenig Harold G.
Published: December 2004

The objective of the study was to examine the religious characteristics and background of inmates age 50 or over confined to a federal correctional institution. Ninety‐six of 106 eligible inmates (91%) consented and received complete evaluations. Forensic, demographic and health data were collected on all inmates, including detailed information on religious affiliation, background, belief, public and private activities, experience, intrinsic religiosity and religious coping. Over 80% of inmates were currently affiliated with a denomination different from the one in which they were raised, with a net movement from conservative Protestant to mainline traditions. Contrary to expectation, religious characteristics of older inmates were not greatly different from those of non‐incarcerated older adults. There was weak support for a relationship between religiousness and positive forensic factors (first prison term, fewer disciplinary actions). Religion was reported by 32% of inmates to be the most important factor that enabled them to cope. Inmates' intrinsic religiosity and perceived importance of religion to their primary caretaker (person who raised them) were both inversely related to depressive symptoms. This study suggests that religious background, belief, activities, experience and intrinsic religiosity are important factors to the adjustment and behavior of older prisoners.
The prevalence of depression in the carers of dementia sufferers
Authors: Coope Bernie , Ballard Clive , Saad Karim , Patel Abdul , Bentham Peter , Bannister Carol , Graham Candida , Wilcock Gordon
Published: December 2004

The survey aims to evaluate psychiatric morbidity in the carers of dementia sufferers using a semi‐structured psychiatric interview. The case notes of consecutive referrals to four psychiatric services for the elderly in the West Midlands and a memory clinic service in Bristol were reviewed. All referrals who fulfilled the CAMDEX criteria for mild or moderate dementia and had a carer in contact at least once a week were contacted. Participants were assessed using a detailed package which included a Geriatric Mental State Schedule for the carers. More than 90% of those contacted agreed to participate. Altogether 125 patients with dementia were assessed of whom 109 had family members of friends as the main carer. Thirty‐one (28.4%) of the carers had a case level of depression and three (2.75%) had a case level of anxiety. In addition, 36 (33.2%) carers had subcase levels of morbidity. First‐degree relatives showed a trend to be more likely to suffer from depression than friends or more distant relatives. The prevalence of depression was similar among carers in the two different service settings. There was good agreement between AGECAT and RDC diagnosis of depression.
Problem drinking among residents of a VA nursing home
Authors: Joseph Carol L. , Atkinson Roland M. , Ganzini Linda
Published: December 2004

The authors conducted a retrospective study of problem drinking among persons admitted to a Veterans Affairs Nursing Home Care Unit (VA NHCU). Lifetime problem drinking was prevalent in 36% of admissions, two‐thirds of whom had active alcohol problems. Problem drinkers were younger and less often currently married than NHCU residents without alcohol problems. Forty‐seven per cent of persons with active alcohol problems returned to independent living. The results suggest that VA NHCUs may be an important transition between hospital and home for elderly patients with alcohol problems, affording an opportunity for identification and intervention.
The effect of primary care nurse intervention upon older people screened as depressed
Authors: Blanchard M. R. , Waterreus A. , Mann A. H.
Published: December 2004

Ninety‐six older people were identified as probably suffering from pervasive depression by screening a household‐enumerated population in Gospel Oak Ward, Inner London. They were further assessed by means of the GMS‐AGECAT, and then randomly allocated to either the intervention of community nurse management or normal, local general practitioner care. There were difficulties in implementing recommended changes in the intervention group, in particular the introduction of antidepressant medication and attendance at day centre facilities. Despite these difficulties, an independent assessment 3 months later performed by an interviewer blind to intervention status found that the nurse‐intervened group showed improved depression scores compared to controls. This effect seemed to be greater among the long‐standing cases and was not associated with time spent or number of visits to the subject by the nurse. This community‐based intervention study indicates that depression in older people can be helped by active interventions coordinated and implemented at the level of primary care.
Prevalence and incidence of dementia in the oldest old: A longitudinal study of a population‐based sample of 84–90‐year‐olds in sweden
Authors: Johansson Boo , Zarit Steven H.
Published: December 2004

Prevalence and incidence rates of dementia, and the relationship between these rates and mortality, were explored in a longitudinal population‐based study of individuals aged 84–90 at baseline living in the municipality of Jönköping, Sweden. The subjects were reexamined twice at 2‐year intervals using DSM‐III‐R criteria for dementia. The prevalence rate of dementia at time 1 through 3 was: 31% (N=97/312), 40% (N=82/206) and 42% (N=52/123), respectively, which reflects a 4‐years overall increase of age in the sample. The 2‐year incidence was 19.8% from the first to the second wave and 14.9% in the interval between the second and third wave. Of the non‐demented at baseline, 22% (N=48/218) had developed dementia within 4 years. A twofold increased mortality risk was found in demented subjects. The present investigation confirms a high prevalence and incidence of dementia in the oldest old. The substantially increased risk of mortality in demented old olds, however, counterbalances the high incidence rates, keeping prevalence lower than otherwise would be the case.
A survey of memory clinics in the british isles
Authors: Wright Neil , Lindesay James
Published: December 2004

This survey describes the characteristics and activities of 20 memory clinics currently operating in the United Kingdom and Eire. There was broad agreement with regard to aims, objectives and general operating characteristics, but the clinics varied considerably in the number of patients assessed over a given period and in the proportion of cases diagnosed with dementia (15–98%) and Alzheimer's disease (9–80%) in the year prior to the survey.
Characteristics of nursing home patients who receive medications with the potential for addiction on a regular and long‐term basis: A retrospective pilot study
Authors: Solomon Kenneth , Shackson James B. , Brown Barbara W.
Published: December 2004

Benzodiazepines are among the most commonly prescribed drugs in nursing homes. Other potentially addictive drugs, including other sedative/hypnotics and oral narcotics, are also prescribed quite frequently. These drugs are not always prescribed for appropriate clinical indications, may be prescribed for extended periods of time and may cause significant side‐effects. Among the concerns about the regular use of these medications is their potential for abuse and dependence. In this study, we examined the records of 253 consecutive psychiatric consultations in nursing homes. All consultations were performed by the senior author. At the time of consultation, one‐third of the subjects were receiving a potentially addictive drug on a regular, and usually daily basis. We compared the group receiving these drugs and the group not receiving these drugs on several variables, including psychiatric and family histories, psychopharmacologic treatments, personal and family addiction histories, psychiatric diagnoses and clinical symptoms. This article presents the results of this study. There were 84 patients in the addictive drug use group and 167 patients in the addictive drug non‐use group. We found that regular use of these drugs was associated with several variables. These included the possibility of a biologic vulnerability to addiction, the presence and severity of the psychiatric disorder(s) of the patients, and the third was the presence of major depression or depressive symptoms. The implications of these data are reviewed. In addition, methodologic and diagnostic issues are discussed. The implications for clinical practice and future research in this area are also discussed.
The relationship between extrapyramidal signs and cognitive function in patients with moderate to severe Alzheimer's disease
Authors: Richards Marcus , McLoughlin Declan , Levy Raymond
Published: December 2004

We studied the association between extrapyramidal signs (EPS) and neuropsychological performance in 137 patients with moderate to severe Alzheimer's disease (AD) residing in a geographically defined area of inner London, UK. The presence of EPS in AD was associated with a distinct neuropsychological profile, suggestive of the additive effect of frontostriatal degeneration. Yet, there was no significant difference in functional capacity between patients with and without EPS. These findings support the hypothesis that EPS represent a parallel independent pathology superimposed over the classical features of AD, rather than providing a marker for global AD severity.
What is a significant score change on the mini‐mental state examination?
Authors: Schmand Ben , Lindeboom Jaap , Launer Lenore , Dinkgreve Marc , Hooijer Chris , Jonker Cees
Published: December 2004

The distribution of change scores of the Mini‐Mental State Examination (MMSE) was assessed in healthy aged subjects after an interval of 1 year. As part of the Amsterdam Study of the Elderly, which is a community survey on ageing and cognitive decline (N = 4051; age range 65–84), a subsample of subjects (N = 247) was studied twice. Participants with dementia, other psychiatric disorders or physical disease which might interfere with cognitive testing were excluded. Test‐retest reliability was 0.55 in this group. The distribution of change scores ranged from −9 to +5. From this result the following clinical rule‐of‐thumb was derived. In an individual patient, and in the absence of other indications of a dementing process, a deterioration in MMSE score must be greater than five points after 1 year to be suspect for a genuine cognitive decline.
A UK national survey of the management of depression by geriatricians and old age psychiatrists
Authors: Orrell Martin W. , Baldwin Bob , Collins Elizabeth , Katona Cornelius
Published: December 2004

A national postal questionnaire on the management of depression in the elderly was completed by 89 geriatricians and 72 old age psychiatrists. Significant differences were noted in intended choice of antidepressant drugs (using case vignettes), knowledge of antidepressant drugs and knowledge of psychological treatments. Geriatricians were more likely to suggest dose ranges which were subtherapeutic and were not confident in prescribing newer antidepressants. Very few doctors had overtly negative attitudes towards ageing and depression. However, a need for more training was clearly identified, particularly for geriatricians and for older doctors of both groups. Doctors who were confident about their own abilities tended to also have a more positive approach to therapy and regarded depression as less difficult to treat. Older doctors, geriatricians and those who felt they needed more training in how to treat depression were more likely to use low doses or discontinue treatment too soon after recovery. The results suggest a need for training which focuses on these areas.
Depressive symptoms in the very elderly—their prevalence and significance
Authors: Girling Deborah M. , Huppert Felicia A. , Brayne Carol , Paykel Eugene S. , Gill Caroline , Mathewson Diane
Published: December 2004

A community sample of 1173 very elderly people (aged over 77) was interviewed by trained lay interviewers using a structured interview, including questions relating to emotional and physical health and social circumstances and the Mini‐Mental State Examination. Depressive symptoms such as loss of energy and feelings of tension and irritability were found frequently. High scores for depressive symptoms were associated with female sex, poor subjective physical health, loneliness and use of statutory services. Depressive symptom score was not found to be associated with age. Although only 6% of the sample described feeling depressed most of the time, 21% of respondents admitted that they sometimes felt that life was not worth living.
Autopsy diagnoses of Alzheimer disease: Independent reviews and clinical implications
Authors: Jarvik Lissy F. , Matsuyama Steven S. , Chui Helena , Scheibel Arnold B. , Vinters Harry V.
Published: December 2004

At present, the neuropathologic examination is universally regarded as essential for the final diagnosis of Alzheimer disease (AD). However, there is absence of agreement on what areas to examine, what stains to use, which lesions to report, and how to interpret other neuropathologic findings. In this study, we describe the results of reviewing the neuropathologic findings in probands from a family study of AD who had received a clinical diagnosis of ‘probable AD’ (N = 33). A neuropathologic diagnosis of AD was received for 88% of the probands, a proportion entirely in agreement with that reported in the literature. An independent review of the autopsy reports found variability in whether the neuropathologic diagnosis was based on the presence of plaques or tangles or both. Further, when a subset of histologic slides was reviewed by two researchers working in the field of AD, there were substantial diagnostic discrepancies. These findings indicate the need for standardized protocols, but suggest that even they have limitations. These limitations are of particular concern when estimating vulnerability to AD of first‐degree relatives. Thus, while neuropathologic examination continues to provide invaluable information about the causes of dementia, it cannot be regarded as a gold standard for diagnosis of individual cases.
Needs assessment in old age psychiatry—a need for standardization
Authors: Hamid Walid Abdul , Howard Robert , Silverman Marisa
Published: December 2004

Need assessment is an important component in planning, prioritizing and evaluating care provision. Old age psychiatry is an expanding community‐based speciality. It is important for community mental health services to be need‐led (McCrone and Strathdee, 1994), since this ensures better targeting of the limited resources. The available needs assessment instruments are either those problem‐oriented methods that have limited applicability in health service planning or methods that are too complicated and cumbersome to be used in the community. Some of these instruments have been standardized on adult general psychiatry patients and might not be appropriate for old age psychiatry services. There is thus an opportunity for the development of a needs assessment method that is standardized on old age psychiatry patients and measures need for the range of interventions offered by old age psychiatry services.
Anxiety and quality of life in residents of a special nursing home
Authors: Nagatomo Itsugi , Nomaguchi Mitsuo , Takigawa Morikuni
Published: December 2004

Forty residents of a special nursing home in Japan were categorized as low or high anxiety according to the State–Trait Anxiety Inventory. Using a Japanese version of the Self‐Rating Depression Scale by Zung (SDS) and the Quality of Life (QOL) rating scale designed by Iida et al. (QOL scale), we compared the QOL and depressive states of the two groups. Although scores in all categories of the modified Stockton Geriatric Rating Scale (a behavioural rating scale) of the two groups, as rated by a skilled nursing staff, did not differ significantly, scores in all categories of the QOL scale and the SDS were significantly higher in the group with high anxiety. Such higher scores indicated a greater impairment. Our results suggest that the QOL in residents with high anxiety was lower than in those with low anxiety, and the QOL of residents of special nursing homes could not be measured by a behavioural rating scale.
Nurses' job satisfaction and the quality of care received by patients in psychogeriatric wards
Authors: Robertson Alex , Gilloran Alan , McGlew Tom , McKee Kevin , McKinley Andrew , Wight Daniel
Published: December 2004

The methodology and part of the results of an in‐depth observational study of four psychogeriatric hospitals are described, focusing on the quality of care received by patients and how this was affected by the level of job satisfaction among nurses. In all four hospitals two wards were selected for intensive study over a period of 4–5 months each. Quality of care was studied through standardized recording of staff's feeding, toileting and bathing of a stratified sample of patients. The findings point to a very strong relationship between job satisfaction and quality of patient care. Staff and patients in high‐satisfaction (HS) wards proved more likely to initiate a conversation or other interaction. HS staff also offered patients more choice, independence, personal attention, supervision, information and privacy, and were more likely to converse with patients during feeding, toileting and bathing. Toileting and bathing appeared especially sensitive to these effects. Despite these differences, HS staff took no longer to feed, toilet or bathe their patients. These relationships are suggested to be mainly attributable to management practices, particularly at ward level, which influence both job satisfaction and quality of patient care.
Glucose metabolic rate and progression of illness in Alzheimer's disease
Authors: Siegel Benjamin V. , Buchsbaum Monte S. , Starr Arnold , Mohs Richard C. , Neto Dirceu C.
Published: December 2004

Thirty‐eight patients with mild to moderate Alzheimer's disease (AD) underwent a neuropsychological test battery and 18‐fluoro‐2‐deoxyglucose (FDG) positron emission tomography (PET) before beginning and at the end of a randomized double‐blind study of an experimental treatment. Twelve of the patients took placebo. In the placebo patients, Mini‐Mental State (MMS) score decreased and cortical metabolism increased significantly over the 6‐month course of the study. Correlations of metabolism with neuropsychological performance were stable over time in the placebo group. Cortical metabolism correlated significantly with performance on the Blessed Information Subtest and the MMS and showed trend correlations with performance on the WAIS Digit Symbol and Word Fluency. Patients with high relative occipital metabolism tended to do poorly on word fluency. Low baseline relative metabolism in right frontal cortex and high baseline relative metabolism in left parietal and temporal cortices and in right occipital cortex predicted more 6‐month deterioration on the World Fluency Test, suggesting that frontal metabolic deficits may precede neuropsychological deficits. Correlations of 6‐month change in MMS, Blessed and Digit Symbol performance with initial glucose metabolism were not significant.
Discriminating power of the hachinski ischaemic score in a geriatric population with mild dementia
Authors: Swanwick Gregory R. J. , Coen Robert F. , Lawlor Brian A. , O'Mahony Denis , Walsh J. Bernard , Coakley Davis
Published: December 2004

The Hachinski Ischaemic Score (HIS) is used to clinically discriminate multi‐infarct dementia (MID) and primary degenerative dementia (PDD). The present study aims to evaluate the discriminating power of the individual HIS items in a geriatric population with mild dementia. The 13 HIS items were studied in 93 demented subjects with no evidence of infarction, a single cortical infarct or multiple cortical infarcts on CT brain scan. The item ‘hypertension’ was a poor discriminator between PDD and MID in this elderly population; however, the remaining unambiguous items ‘abrupt onset’, ‘neurological sings’, ‘neurological symptoms’, ‘history of stroke’ and ‘atherosclerosis’ were useful discriminators. We found that five of the least discriminating items diverged from the aspects of MID that they were originally intended to address and were, therefore, particularly ambiguous. In order to improve the discriminating power of these items and the HIS as a whole, we recommend dividing the 13 items into four categories, ‘evidence of delirium’, ‘evidence of focal deficits’, ‘evidence of vascular pathology’ and ‘abrupt onset’, to minimize any problems with interpretation of the more ambiguous items.
A comparison of clock and pentagon drawing in Alzheimer's disease
Authors: Bourke John , Castleden C. Mark , Stephen Ronnie , Dennis Michael
Published: December 2004

Clock drawing is described as a novel, easily administered bedside measure of cognitive function. We examined from 77 ambulant elderly persons meeting NINCDS criteria for Alzheimer's disease their drawings of clock faces and overlapping pentagons. Interrater reliability for two previously published scoring scales for clocks and a devised ordinal scale for overlapping pentagons was high. There was moderate correlation with their total scores on the CAMCOG and Mini Mental State Exam (MMSE). However, a considerable number of patients scored within the normal range on all three drawing scales. A third (23/77) on clock drawing demonstrated their only abnormality at setting the time to 10 to 11 instead of the requested 10 past 11. For the clock drawing test to be used as a rapid screening instrument for Alzheimer's disease in the community an accurately drawn clock face must include the correct position of the hands. The pentagon test either alone or in combination did not enhance the accuracy of the clock test.
Abuse of patients with dementia by carers — out of sight but not out of mind
Authors: Cooney Colm , Howard Robert
Published: December 2004

Elderly people with dementia living with a carer are at significantly higher risk of abuse than the general population over 65. This review looks at the limitations of the research to date and discusses risk factors in both carers and patients that predispose them to abuse. Management strategies are discussed with reference to the growing research base.
Giving up driving in Alzheimer's disease—an integrative therapeutic approach
Authors: Bahro Marcel , Silber Earle , Box Paulette , Sunderland Trey
Published: December 2004

For patients with Alzheimer's disease (AD), a recommendation to stop operating a motor vehicle can be a serious event complicated by a loss of self‐esteem and personal dignity. Patients are often reluctant to give up an activity so essential, both practically and symbolically, to independent living. We describe here a patient with moderately progressed AD who lacked insight of his need to cease driving. Through an integrative treatment approach, combining behavioral and psychodynamic modalities, we helped him to formulate effective ways of coping with his loss of access to independent transportation. We favor a psychotherapeutic strategy that combines behavioral and managerial measures with dynamic patient interaction, thereby developing the patient's insight of the need to give up driving while fostering his sense of autonomy.
Dementia known to mental health services: First findings of a case register for a defined elderly population
Authors: Holmes Clive , Cooper Brian , Levy Raymond
Published: December 2004

The aims and methodology of the population‐based Camberwell Dementia Case Register are described. Data collected during the first 18 months of the Register's operation have been used to check the reliability of clinical diagnosis as assessed on the one hand by standardized interview and test procedures and on the other hand from available hospital records; further, to examine the predictive validity of a ‘consensus’ diagnosis by comparison with the neuropathological findings in deceased patients. A diagnostic breakdown of 510 cases screened during this initial period is presented, and both point prevalence ratios and one‐year incidence rates for ‘declared’ cases of dementia in the Camberwell elderly population computed. Analysis of the current living situation and care status on a census day (31.10.94) revealed that 10% of the patients were occupying NHS beds, 45% in long‐stay residential care and the remaining 45% still living in private households, with varying degrees of support.
Violence among psychogeriatric inpatients with dementia
Authors: Shah Ajit
Published: December 2004

The characteristics of all patients with dementia admitted to an acute psychogeriatric admission ward over a 36‐month period were examined. Patients with dementia who had been responsible for acts of violence were compared with those with dementia who had not. Violent patients were more likely to have an ICD‐9 diagnosis of senile dementia. Levels of violence were low, with only a small number of patients exhibiting violent behaviour. The implications of these findings for evaluative studies of pharmacotherapy and staff training in aggression control techniques are discussed.
Are professional footballers at risk of developing dementia?
Authors: Spear Jon
Published: December 2004

Football is a contact sport which involves heading the ball and clash of heads, both having the potential for causing repetitive minor head injury. Much of the research on the association between football and Alzheimer's disease (AD) is flawed, but what is available suggests that footballers are more likely to have EEG abnormalities, cortical atrophy and mild neurological abnormalities than controls. It is also known that head injury may precipitate a cascade of events leading to AD pathology by increasing the expression of amyloid precursor protein and increasing amyloid deposition. It is not known if footballers have an increased risk of dementia, but it is possible that they do. Preventative action could be taken by football's governing bodies to reduce the risk of brain damage as a result of head injury and subsequent development of dementia.
Evaluating the usefulness of training in psychogeriatrics
Authors: Saarela Tuula , Kiviharju Upu
Published: December 2004

A training programme in psychogeriatrics was run for 51 primary health care doctors, nurses and social workers split into two groups for training in two formats. One group was a patient‐case group and the other a lecture group. The participants were interviewed 2–4 months after the course and the material analysed by the phenomenographic method. The main result of the training for both groups, from the trainees' point of view, was an enhanced experience of psychogeriatric work and a more creative application of preexisting professional knowledge. No differences in outcome were detected between the groups. Problems in achieving effective training and training evaluation are discussed.
The quality of long‐term care for dementia: A survey of ward environments
Authors: Mountain Gail , Bowie Peter
Published: December 2004

A survey of long‐stay wards for elderly demented patients was carried out. The quality of five aspects of ward environment was assessed, covering institutional practices, social/recreational input, reality orientation cues, ward condition and space availability. Of the 28 wards surveyed, two‐thirds achieved high quality on one aspect but only two wards had high quality on three or more aspects. In contrast, 14% of the wards obtained low‐quality scores on at least three aspects. A hospital trend was found for the variation in institutional care practices. The results have implications for staff training and for reprovision programmes.
How can we detect sick elderly excessive drinkers?
Authors: Naik P. C. , Jones R. G. , Lilley J.
Published: December 2004

The sensitivities and specificities of alcohol history, alcohol history with a specific additional question, ‘Do you drink spirits in your tea or coffee, or both’, alcohol questionnaires (SMAST and CAGE) and laboratory investigations (γGT and MCV) as indicators of excessive alcohol intake among elderly (≥ 65 years) acute medical admissions were studied and compared. Alcohol history with the specific additional question was the most sensitive indicator. Initial alcohol history had a sensitivity of 50%. Both alcohol questionnaires had a sensitivity of 0% and it is recommended that new questionnaires specifically for use in the elderly should be developed and validated. γGT was 50% sensitive with a specificity of 80%. MCV had a sensitivity of 17%. Both MCV and γGT should be used with caution as indicators in this age group. A simple alcohol history with the additional specific question is at present the best indicator of excessive alcohol intake.
End‐stae dementia in adults with down syndrome
Authors: Prasher V.
Published: December 2004

End‐stage dementia in adults with Down syndrome has not been fully investigated. Available information, 6 months prior to death, for 20 adults with Down syndrome who had died with Alzheimer's disease was reviewed. A terminal stage of severe intellectual deterioration, marked personality and mood changes, loss of sphincter control, seizure activity, immobility with hypertonia and complete loss of self‐care skills was found. These findings have important clinical and service implications.
Imaging the spatiotemporal dynamics of cognition with high‐resolution evoked potential methods
Authors: Gevins Alan , Cutillo Brian , Durousseau Don , Le Jian , Leong Harrison , Martin Nancy , Smith Michael E. , Bressler Steven , Brickett Paul , McLaughlin Judith , Barbero Nicholas , Laxer Kenneth
Published: December 2004

Subsecond temporal resolution is necessary to resolve the changes in brain activity that are associated with task‐related cognitive processes. Evoked potentials (EPs) provide the requisite millisecondrange temporal resolution, and do so with nonencumbering recordings at a reasonably low cost. These features would seem to make EPs the ideal complement to structural and functiona magnetic resonance images (MRIs) and positron emission tomography (PET). However, until recently, the utility of EPs has been limited by their poor spatial resolution. Sufficient spatial correspondence has not existed between EPs and other brain imaging modalities to determine unambiguously the relationship between a sequence of EP components and structures visualized by MRI or PET. We describe progress that has been made toward overcoming this obstacle by registering electrophysiological data with anatomical information from each subject's MRI, by improving the spatial resolution of the EP, and by using analytic methods for measuring the spatiotemporal dynamics of distributed neurocognitive processes. The use of these techniques is illustrated by reviewing several experiments in which sequences of component neural processes were measured during cognitive tasks. © 1994 Wiley‐Liss, Inc.
Spatiotemporal analysis of brain electrical fields
Authors: Tucker Don M. , Liotti Mario , Potts Geoffrey F. , Russell Gerald S. , Posner Michael I.
Published: December 2004

Psychological studies with reaction time methodology show that there is meaningful variability in the performance of cognitive operations when responses are measured in milliseconds. Temporal precision is also required to reveal the rapid neurophysiological events in cortical networks. Sampling the brain's electrical activity at the scalp surface characterizes regional brain function with millisecond temporal resolution. The problem with electroencephalographic (EEG) data is localizing the areas of the cortex that generate the observed scalp fields. Although the eventual goal will be to specify the neural generators of the EEG, we propose that an important first step for functional studies is to examine accurate, time‐dynamic maps of the brain's electrical fields at the head surface. Given an adequate spatial sampling of the surface potentials, accurate electrical studies require measures that are independent of the location of the reference sensor. The 2D Laplacian of the potential field may be used to define the local features of the scalp current flow. Because the electrical fields are dynamic, brain mapping with electrical data requires animations rather than static images. © 1994 Wiley‐Liss, Inc.
Micromapping of the human brain: Three‐dimensional imaging of immunofluorescence and dendritic morphology using dual‐channel confocal laser scanning microscopy
Authors: Belichenko Pavel V. , Dahlström Annica B.
Published: December 2004

A strategy for investigating neuronal networks at the microscopic level is described. The Lucifer Yellow microinjection technique was combined with immunofluorescence on human brain material, which was then studied in a confocal laser scanning microscope with dual‐channel scanning and equipped with an argon/krypton laser. The three‐dimensional architecture of the Lucifer Yellow‐injected neurons was investigated after transfer of the scanned frames in file format to a Silicon Graphics IRIS computer, using VoxelView software from Vital Images Inc. Microinjection of Lucifer Yellow revealed the dendritic morphology of various types of cells in different brain areas. Indirect immunofluorescence, with Texas Red as the secondary label, was used to determine the distribution of various categories of macromolecules (enzymes, receptor protein, and synaptic vesicle proteins) in the brain slices. We used single‐ as well as dual‐channel confocal laser scanning microscopy for imaging these double‐stained fluorescent specimens. Using these techniques in combination, we have created and saved three‐dimensional confocal images of detailed morphology (axons and dendrites with spines and varicosities) of individual cells, together with the localization of immunofluorescence. These three‐dimensional confocal images will be collected in a database for probable future use in human brain mapping. © 1994 Wiley‐Liss, Inc.
Assessing the significance of focal activations using their spatial extent
Authors: Friston K. J. , Worsley K. J. , Frackowiak R. S. J. , Mazziotta J. C. , Evans A. C.
Published: December 2004

Current approaches to detecting significantly activated regions of cerebral tissue use statistical parametric maps, which are thresholded to render the probability of one or more activated regions of one voxel, or larger, suitably small (e. g., 0.05). We present an approximate analysis giving the probability that one or more activated regions of a specified volume, or larger, could have occurred by chance. These results mean that detecting significant activations no longer depends on a fixed (and high) threshold, but can be effected at any (lower) threshold, in terms of the spatial extent of the activated region. The substantial improvement in sensitivity that ensues is illustrated using a power analysis and a simulated phantom activation study. © 1994 Wiley‐Liss, Inc.
A new technique for pet slice orientation and MRI‐PET coregistration
Authors: Grabowski T. J. , Damasio H. , Frank R. , Hichwa R. D. , Boles Ponto L. L. , Watkins G. L.
Published: December 2004

We report and validate a technique for magnetic resonace imaging (MRI) positron emission tomography (PET) coregistration and the optimization of PET slice orientation that enhances and complements existing techniques. The technique depends on an external fiducial system and on software that models the relationship of the PET gantry with respect to a three‐dimensional (3D) MR reconstruction of each subject's brain anatomy. The technique offers the possibility of using individual neuroanatomical information to plan PET activation studies. Estimated 3D errors average 3 mm in [15O]H2O PET activation studies. In‐plane interinjection movement averages less than 1 mm. The resulting MRI‐PET coregistration provides a basis for bringing neuroanatomical information to bear on a number of issues critical for the interpretation of functional imaging studies. © 1995 Wiley‐Liss, Inc.