bluuebunny/crossref_metadata_2025 huggingface dataset:
Alzheimer's disease in the old and the young
Authors: Han Luke , Birkett D. Peter
Published: December 2004

This study concerns differences between Alzheimer's disease in the old and the young. Literature differentiating Alzheimer's disease from ‘senile dementia’ is reviewed. Two groups of mental hospital patients with Alzheimer brain changes at autopsy are compared. They comprised the 17 oldest and 17 youngest of the 56 ptients with definite Alzheimer changes in a series of 212 consecutive autopsies. The younger group had been first hospitalized at later ages than the older group, and were more likely to have been demented at admission. The older group had mostly been diagnosed as schizophrenic (mainly paranoid) on admission. Neuropathologically the younger group showed more severe Alzheimer changes of all kinds. The changes in the older group tended to be limited to the hippocampus, whereas in the younger group they showed extension into the frontal and occipital cortex and were also found in subcortical gray matter. Lipofuscin was more abundant in the older group, so that a discrepancy between very severe Alzheimer changes and less abundant lipofuscin characterizes the younger cases.
Clock‐drawing and dementia in the community: A longitudinal study
Authors: Shulman Kenneth I. , Pushkar Gold Dolores , Cohen Carole A. , Zucchero Carla A.
Published: December 2004

The clock ‐drawing test was used in a longitudinal study of 183 dementing individuals and their caregivers. Clock‐drawing performance was measured by a simple standardized score which correlated significantly with other measures of cognitive function. Clock performance showed high individual consistency of performance as well as a significant deterioration from the initial level of performance to that obtained at 1‐year follow‐up. Dementing individuals who had experienced a significantly greater decline in clock‐drawing performance at 1‐year follow‐up were more likely to have caregivers who had already decided to institutionalize them. This suggests that the caregiver's decision to institutionalize was based in part on the perception of a rapid decline in their dependant's cognitive function. Thus, rate of change in cognitive function may prove to be as important a variable as the level of deterioration. The clock‐drwing test appears to be a useful adjunct in the assessment and monitoring of the progressive dementias in the community.
Demographic and clinical features of patients attending a memory clinic
Authors: Almeida Osvaldo P. , Hill Katie , Howard Robert , O'brien John , Levy Raymond
Published: December 2004

Basic demographic and clinical features of the first 418 patients assessed at the Maudsley Memory Clinic are reported. Alzheimer's disease was the most frequent diagnosis (57%), followed by a group of patients complaining of memory problems but with no obvious neuropsychiatric diagnosis (24%). The latter were more likely to be younger unmarried self‐referred women living alone and with a frequent family history of dementia. The routine use of extensive laboratory investigations in memory clinics is not recommended, considering the meagre number of subjects suffering from reversible conditions identified in our clinic. The Maudsley Memory Clinic has proved to be a popular centre for the assessment and diagnosis of patients with memory complaints and has provided a useful source of subjects for research into memory‐associated disorders. The role of memory clinics in the new financial climate in the National Health Service remains to be determined.
Sexual problems associated with dementia: Part 1. Problems and their consequences
Authors: Haddad Peter M. , Benbow Susan M.
Published: December 2004

Sexual problems associated with dementia fall into four groups: problems involving an established partner, problems involving a new partner, problems occurring independent of a sexual partner (sexual acting out, inappropriate sexual talk, false sexual allegations) and sexual abuse. The whole area has received little attention despite the major consequences for patients, partners and carers.
Cases of mild dementia in the community: Improving efficacy of case finding by concurrent use of pairs of screening tests
Authors: Hooijer C. , Jonker C. , Lindeboom J.
Published: December 2004

In a previous study, combinations of two short screening tests for dementia appeared to have clear advantages over the use of one test both for the efficacy of case detection and for the comparability of studies. In the present study these results were replicated using different sampling rules for the first and second phases of the screening procedure. Preferences for specific test combinations are discussed.
The prevalence of dementia in a sample of elderly norwegians
Authors: Engedal Knut , Haugen Per Kristian
Published: December 2004

A total of 1029 elderly persons aged 75 years and above, selected at random from two different samples, were examined to estimate the prevalence rate of dementia in the elderly. Of these, 334 were living at home, 518 in nursing homes, and 177 in homes for the aged. Dementia was diagnosed according to DSM‐III. The estimated prevalence rate for the total population aged 75 years and over was 16.3%, slightly higher in women (16.5%) than in men (15.8%). Nearly half (7.8%) lived in institutions, mainly in nursing homes. In the sample living at home, the prevalence rate was 10.5%, in the nursing homes 71.6%, and in the homes for the aged 22.6%. In subjects living in nursing homes, the prevalence rate was significantly higher in women, 77.8%, then in men, 54.1%.
Depression in elderly physically ill inpatients: A 12‐month prospective study
Authors: Evans Mavis E.
Published: December 2004

A 12‐month prospective study of a randomly selected group of acute geriatric medical inpatients was carried out. Twenty‐three of the original sample of 72 were diagnosed as cases of depression on entry into the study and commenced on treatment with fluoxetine 20 mg mane. Follow‐up at 3 months showed a significantly increased death rate in the depressed group (p < 0.05) which was reversed in those surviving to 12 months, this trend to a lower mortality not reaching significance. Two patients did not continue their antidepressants after leaving hospital and remained depressed at 3‐month follow‐up. The effect of treatment versus no treatment was significant (p < 0.03). The incidence of depression in the psychologically well group was 14% over the 12‐month period, understandably high when seen in the context of their continuing physical problems. None of the treated depressed group relapsed during the study period.
Deliberate self‐harm in the elderly: A survey of one London Borough
Authors: Nowers Mike
Published: December 2004

This article details the results of a retrospective case note study on deliberate self‐harm in the elderly in the London Borough of Tower Hamlets. There were 56 females and 32 males included in the study. The ages of the patients ranged from 65 to 90. Fifty‐seven per cent of the sample had a depressive illness, most commonly found in the younger females and the older males. Over 50% of the sample had evidence of multiple health problems, particularly heart disease and arthritis. Over 90% of cases used self‐poisoning as the means of self‐harm. Sixty‐one per cent used benzodiazepines and 25% salicylates. Over 30% used multiple drug combinations. Thirty‐eight per cent of the sample had evidence of previous self‐harm, 17% had repeated self‐harm within a year and 6% were dead through suicide. Although the characteristics of the patients bore some resemblance to those identified in the literature as being risk factors for self‐harm among younger patients, they bore a much closer resemblance to known risk factors for suicide. This may have ramifications for further research into the prevention of suicide.
Sexual problems associated with dementia: Part 2. Aetiology, assessment and treatment
Authors: Haddad Peter M. , Benbow Susan M.
Published: December 2004

Physical, psychological and social factors need to be considered in the aetiology and treatment of sexual problems in people with dementing illnesses. Treatment may raise ethical dilemmas and involve value judgements. Assessment within a multidisciplinary framework is therefore recommended.
Performance of the Italian version of the mini‐mental state examination in day hospital geriatric medical patients
Authors: Turrina Cesare , Dewey Mike E. , Siani Roberta , Saviotti Francesco , Marchione Nicoletta , Siciliani Orazio
Published: December 2004

The criterion validity of the Italian version of the Mini‐Mental State Examination was tested in a group (114) of elderly medically ill day patients. Specificity was rather disappointing (66.3%) at the conventional threshold (23/24), as well as positive predictive value (32.7%). A lower threshold (21/22) offered the best compromise between sensitivity (93.8%) and specificity (80.6%). ROC analysis evidenced a good overall performance of MMSE (area under the curve 0.938). In those subjects not affected by dementia, age, low education and depressive illness had a significant effect on MMSE scores.
Blood flow velocity waveform in the common carotid artery in advanced age and clinical outcome—A 1‐year follow‐up
Authors: Nagatomo Itsugi , Nomaguchi Mitsuo , Matsumoto Kei
Published: December 2004

We investigated the common carotid arterial blood blow in 70 patients of advanced age (80 and older) in a nursing home using an ultrasonic quantitative blood flow measurement system. Systolic and end‐diastolic velocities were obtained from the waveform, and using these two velocities, subjects were classified into three groups according to increasing severity. We then determined mortality rates and changes in the modified Stockton Geriatric Rating Scale (SGRS) over a 1‐year period. The mortality of group 1 was significantly lower than that of group 3. The groups with more severely impaired carotid blood flow also demonstrated as groups change in the sequence 1→2→3a worsening on some subscales of the modified SGRS over the year. These results suggest that carotid arterial blood flow velocity waveform can serve to predict some aspects of clinical outcome in very old age.
Assessments of productivity of psychogeriatric day care
Authors: Wimo A. , Ineichen B. , Mattson B. , Kallioinen M.
Published: December 2004

Although psychogeriatric day care has been established since the 1950s, few studies have focused on its productivity. In this study, nine assessments of productivity are presented and tested on 74 patients in psychogeriatric day care in Sundsvall, Sweden. The participation quotient was 68%, the capacity quotient 76%, and the registration quotient 112%. The mean attendance was 1.6 visits a week and the average turnover was 31% during 6 months. Six patients out of 74 (8.1%) were institutionalized at the end of the 6‐month period and the mortality was 1.4% (1/74) during 6 months. The misjudgement quotient was 12.2% for the 6‐month period. The patients' refusal to attend DC was the most frequent reason for discharge.
Paranoid disorders in the elderly
Authors: Grief Cindy , Eastwood Robin M.
Published: December 2004

Assigning paranoid diagnoses in the geriatric population can be a challenging endeavour. A survey was undertaken of selected ICD‐9 diagnoses in different hospital settings. Almost 50% of the diagnoses were associated with combative/paranoid behaviour; yet, only 12% received ‘paranoid’ diagnoses. This article addresses the problems of case definition for paranoid states in the elderly.
The treatment of diffuse lewy body disease: A pilot study
Authors: Williams S. W. , Byrne E. J. , Stokes P.
Published: December 2004

Single case studies may provide useful information and generate hypotheses for later testing in group studies. The effect of anti‐Parkinsonian medication is reported in five individual cases of diffuse Lewy body disease. The problems caused by the variability in congnitive function and psychiatric symptoms in these cases are outlined together with suggested strategies for future research.
The rabbit syndrome: Occurrence in a neuroleptic naive patient
Authors: Kelvin Raphael , O'Brien John , Dening Tom
Published: December 2004

An elderly woman presented with a severe depressive disorder and moderate cognitive impairment. She had a dyskinesia of the rabbit syndrome type, but in contrast to previous reports she had not previously been treated with neuroleptics. We believe this to be unique in the literature. Further, we speculate about the possible association of the rabbit syndrome and senile dementia of Lewy body type.
Medical outcome of psychosocial intervention in demented patients: One‐year clinical follow‐up after relocation into group living units
Authors: Annerstedt Lena , Gustafson Lars , Nilsson Karin
Published: December 2004

Care of demented elderly in group living units is developing rapidly in Sweden. Group living (GL) offers a secure, small‐size, homelike physical setting and an individualized, psychosocial and integrity‐promoting therapy. Twentyeight patients suffering from dementia of Alzheimer type (DAT) or/and vascular dementias (VD) were evaluated before relocation from traditional long‐term care institutions (TI) into GL units and followed up 6 and 12 months later by psychogeriatric ratings, regional cerebral blood flow measurements, somatic investigations and registration of pharmacological treatment. The patients relocated into GL were compared to a matched sample of 28 patients permanently cared for in TI. GL patients showed less dyspraxia, dysphasia and less prominent symptoms of depression and anxiety after both 6 and 12 months compared to the control group. Restlessness diminished among GL patients while the patient group in TI got more restless. Neuroleptic treatment was found to be used significantly more often among the TI patients during the whole study and anxiolytic‐hypnotic treatment after 6 months. No difference was observed in antidepressive treatment. The results show that psychosocial stimulation and therapy offered in GL care has positive effects on emotional symptoms and performance compared to care in TI. These clinical changes abate later in the study as a consequence of the underlying organic disease. The major benefit of GL was slightly different between the diagnostic groups: for VD patients improvement of practical abilities, for AD patients abated agitation and restlessness.
Dementia, awareness and depression
Authors: Verhey Frans R. J. , Rozendaal Nico , Ponds Rudolf W. H. M. , Jolles Jellemer
Published: December 2004

We examined 170 outpatients, 103 with Alzheimer's disease, 43 with vascular dementia and 24 with various other causes, in order to investigate whether or not depressive symptoms were more likely to occur in dementia patients who had some degree of awareness of their cognitive deterioration. Awareness was rated on a four‐point scale that assessed discrepancies between the patient's and the caregiver's history. The level of awareness was significantly related to the severity of dementia but not to depression or to the score on Hamilton's depression scale. However, the score from the item “psychic anxiety” showed a weak but significant correlation with the level of awareness of one's deficits. It is concluded that intact awareness of deterioration was not clearly related to the development of depression or depressive symptoms in dementia.
Continuity and discontinuity in Dementia
Authors: Dening Tom
Published: December 2004

Recent evidence from epidemiological studies has been used to suggest that dementia represents the extreme of a continuous distribution of normal ageing, rather than being a qualitatively distinct disease entity. In contrast, clinicians, who are asked to advise about individual cases, assign patients to diagnostic groups, thereby using a categorical model of dementia. This article argues that both approaches are models, and therefore neither is ‘correct’. Each model has its strengths and limitations, and the choice of which model to apply should depend on which is more appropriate to the issues under consideration. Clinicians do not need to be apologetic about using dementia as a category as long as they are aware of the limitations of this approach.
HPA axis function in depression and dementia: A review
Authors: O'Brien John T. , Ames David , Schweitzer Isaac
Published: December 2004

This article reviews recent advances in the understanding of hypothalamic‐pituitary‐adrenal (HPA) dysfunction in depression and dementia. Although the dexamethasone suppression test (DST) has proved disappointing as a diagnostic test, more recent tests of HPA axis function have not yet been adequately investigated in this regard. There is mounting evidence from both animal and human studies that a complex interrelationship exists between mood, age, cognitive function, brain structure and HPA axis dysfunction. To explore this relationship further, studies combining clinical, neuroimaging and neuroendocrine investigation are required.
Onset of seizures as a poor indicator of longevity in people with down syndrome and dementia
Authors: Prasher V. P. , Corbett J. A.
Published: December 2004

An association between Down syndrome and dementia of Alzheimer type is well established. This study demonstrates that late onset seizures in people with Down syndrome are a strong indicator of a dementing process. Further, late onset seizures in people with Down syndrome may be used as a prognostic indicator, indicating life expectancy of less than a further 2 years, probable death within 3 years and death almost invariably within 5 years of onset.
Cognitive impairment in the elderly medically ill: How often is it missed?
Authors: Ardern Mark , Mayou Richard , Feldman Eleanor , Hawton Keith
Published: December 2004

One hundred and sixty‐three patients over 65 years of age admitted to the acute medical wards of a district teaching hospital were studied for prevalence and type of cognitive impairment. Findings from research assessments, where possible using a cognitive rating scale, were compared with detection of impairment by medical and nursing staff involved in patients' clinical management. 30.7% of patients were judged by us to show definite or probable cognitive impairment, a figure substantially higher than that detected by hospital staff. Outcomes in terms of death, duration of admission and discharge location were related to the presence or absence of cognitive impairment and whether impairment was due to delirium, dementia or a mixed syndrome. The low rate of detection of cognitive impairment is discussed, and suggestions made to improve detection in acute elderly medical inpatients.
The eugeria study of cognitive ageing: Who are the ‘normal’ elderly?
Authors: Ritchie Karen , Ledésert Bernard , Touchon Jacques
Published: December 2004

A cross‐sectional study of the cognitive performance of 575 normal elderly persons suggests considerable heterogeneity at each age level. While a number of cognitive functions (articulation, reading, semantic matching, comprehension of syntax and implicit memory) showed no difference with age, explicit memory, and other linguistic and visuospatial capacities, were significantly poorer, especially over 80 years. Within this normal population an ‘unstable’ subgroup showing significant deterioration in everyday performance according to an informant questionnaire was found to differ significantly on cognitive testing from elderly persons who had remained stable over this period. The ‘unstable’ group was also found to have a higher prevalence of depressive symptomatology and depressive illness. The question is raised as to whether ‘instability’ over time may be a very early indicator of subclinical pathology. The importance of taking such a group into account in the interpretation of studies of cognitive functioning and senile dementia is also discussed.
Neuroleptics in the treatment of psychosis in late life: A rational approach
Authors: Mulsant Benoit H. , Gershon Samuel
Published: December 2004

Scientifically assessing the therapeutic benefits of neuroleptics in the treatment of psychoses occurring in late life would require answering two related questions: to what extent are dopaminergic mechanisms at the core of these disorders, and to what extent is the dopaminergic blockade of neuroleptics essential to their beneficial effects? Given the dearth of relevant scientific data, the use of neuroleptics in the treatment of late life psychoses remains justified mostly by extrapolations from data obtained in younger patients and by results of empirical trials in older patients. Based on a careful examination of these data, this article reviews the nosology of the late life psychotic disorders and proposes a rational approach to the use of neuroleptics in their treatment. Suggestions for future research are made.
Outcome of depression in demented and non‐demented elderly: Observations from a three‐year follow‐up in a community‐based study
Authors: Forsell Y. , Jorm A. F. , Winblad B.
Published: December 2004

In the Kungsholmen project, a longitudinal study of a total population, samples of non‐demented and demented elderly persons with a depressive disorder were followed over 3 years. Of 668 persons who received a full medical examination, 62 were found to have a depressive disorder. Of these, 28 were demented and 34 non‐demented. Two‐thirds of the 62 had not been previously recognized as having a depressive disorder. There was no difference in this regard between the demented and non‐demented samples. After 3 years, only two out of 20 non‐demented cases had recovered from their depressive disorder. This is in contrast to the demented cases, where only one of 11 were still depressed. These results indicate the need for greater attention to the recognition and management of depressive disorders in the elderly.
Risk factors among incident cases of dementia in a representative british sample
Authors: Morgan Kevin , Lilley Jeanette M.
Published: December 2004

In a 4‐year follow up of 1042 elderly people (aged 65+) randomly sampled from the community, levels of dementia were assessed using a two‐phase case‐finding procedure (screening followed by clinical interview) among survivors, with additional information provided by death certificates, hospital case notes or postal questionnaires. Overall, 42 cases were clinically identified. In a case‐control analysis matching for age, sex and premorbid cognitive status, risk estimates were obtained for nine self‐reported factors: heart trouble; headaches; giddiness; falls; current smoking; past smoking; left handedness; insomnia; and the use of sedative‐hypnotic drugs to promote sleep. While none of these factors was associated with a significantly increased risk, the power of these case‐control comparisons was limited by sample size.
Falls among community‐dwelling psychogeriatric patients
Authors: Asada Takashi , Kariya Tetsuhiko , Kitajima Eiji , Kakuma Tatsuyuki , Yoshioka Mitsuru
Published: December 2004

Although increasing interest has been focused on falling in the elderly, little is known about the incidence and consequence of falls in psychogeriatric outpatients. We conducted a 1‐year prospective study of falling in 102 community‐dwelling elderly patients with psychiatric morbidity (mean age: 70 years) and 100 mentally intact elderly patients (controls, mean age: 74 years). The subject group comprised 79 patients with depression, 14 with dementia and nine with combined disease based on DSM‐III‐R criteria. Overall, 216 falls in the subject group and 54 in the controls were reported. At the end of the study, recurrent fallers aged 75 years and older showed significant physical deterioration. Multiple logistic regression analysis of selected medical and demographic variables indicated that the most influential variable regarding falling of the subjects was severity of depression rated using the Hamilton scale. Unexpectedly, the analysis revealed that the use of antidepressants was associated with a lower likelihood of falling. On the basis of the two variables, 75% of all respondents were correctly classified as fallers or non‐fallers.
Autopsy services for old age psychiatrists in England and Wales: A survey of consumer satisfaction
Authors: Benbow Emyr W. , Benbow Susan M. , Reid Helen
Published: December 2004

Anecdotal evidence suggests that some old age psychiatrists are dissatisfied and disillusioned with their local autopsy services, and so we carried out a postal survey to assess the extent of the problem. Our most striking finding was that over a quarter of old age psychiatrists are, indeed, dissatisfied with the way other organ systems were examined. This dissatisfaction is very strongly associated with services where autopsies on psychogeriatric patients are carried out by general histopathologists, especially where there is no established facility for the brain to be preserved and subsequently examined by a neuropathologist. The main complaint about neuropathologists was that reports sometimes took an unacceptable length of time to be returned to the clinician. The solution to the difficulties experienced by old age psychiatrists would be a closer association with their local neuropathology services, but whether neuropathologists are in a position to increase their workloads remains to be determined.
Evaluation of early dementia by a trained nurse
Authors: Seymour Jeremy , Saunders Peter , Wattis John P. , Daly Lynn
Published: December 2004

Patients tend to get referred to psychogeriatricians late in the course of a dementing illness, often when a crisis has occurred and carers can no longer cope. Earlier referral is disirable, but generates extra work for the psychogeriatrician. Nurse screening may overcome this. In this study a nurse, trained in the administration of the CAMDEX structured interview and supervised by a psychogeriatrician, performed a diagnostic assessment on patients with early cognitive impairment referred from primary care. This initial phase of the study sought to validate the nurse's assessment, and found that in 33 patients with possible early cognitive impairment, there was good broad agreement between the nurse's diagnosis and a psychogeriatrician's diagnosis supported by standardized rating scales. Nurse screening may be a cost‐effective means for a secondary care psychogeriatric service to provide support to general practitioners, form a case register of patients with early dementia, and follow these patients through as their dementia progresses.
The service experiences of people with presenile dementia: A study of carers in one London Borough
Authors: Sperlinger David , Furst Maria
Published: December 2004

Fifteen carers of people with presenile dementia in the London Borough of Sutton were interviewed about their experiences of the services that had been provided to them. The carers were generally satisfied once they had been referred for specialist help and they would have liked more support and information around the time of diagnosis. When asked about what additional services were required, carers were particularly concerned about the lack of appropriate day care for their relative. Carers whose relative had been admitted to long‐term care reported finding the process of admission distressing. High levels of stress were found among all the carers. The importance of providing emotional support to this group of carers is emphasized.
Evaluating the effects of brief day hospital closure
Authors: Rolleston Margaret , Ball Christopher
Published: December 2004

The wellbeing of attenders of an old age psychiatry day hospital and their carers was assessed as the unit closed over a 2‐week period. Decline in the wellbeing of carers and attenders was seen with a regression to preclosure levels. The results suggest the importance of the day hospital to the patients and their carers. The problems of evaluation at short notice are discussed.
A pilot placebo‐controlled study of trazodone and buspirone in alzheimer's disease
Authors: Lawlor Brian A. , Radcliffe Jeanne , Molchan Susan E. , Martinez Rick A. , Hill James L. , Sunderland Trey
Published: December 2004

The pharmacological management of behavioural symptoms in Alzheimer's disease is limited by the dearth of effective agents in this area. The purpose of this study was to determine whether trazodone or buspirone are helpful in the treatment of behavioural disturbance in AD. Ten patients meeting NINCDS criteria for AD with behavioural complications were administered trazodone (up to 50 mg tid), buspirone (10 mg tid), and placeboin a 12‐week double‐blind, crossover design. Outcome measures were the Brief Psychiatric Rating Scale (BPRS), the Dementia Mood Assessment Scale (DMAS), and the Buschke Selective Reminding Task. The data were analysed by ANOVA. Compared to placebo, trazodone produced a small but significant reduction in BPRS and DMAS scores (p<0.05), indicating improvement in behaviour but no change in cognitive measures. In contrast, buspirone has no significant effect on either behavioural or cognitive measures compared to placebo. The results of this pilot study suggest a beneficial role for trazodone, but not buspirone, in the treatment of behavioural disturbance in AD. Further studies using a wider range of doses of trazodone in more behaviourally disturbed AD patients should now be initiated in an attempt to replicate and expand on this preliminary finding.
The mental health problems of elderly people living on London's streets
Authors: Crane Maureen
Published: December 2004

There are inconsistent research findings regarding the prevalence of mental illness in homeless individuals of all ages. Most studies, both in Britain and in America, have concentrated on homeless persons in hostels or shelters. A few American works have examined individuals sleeping on the streets but this is a neglected area of research in Britain. Very few studies have examined the prevalence of mental illness in elderly homeless persons. This article reports findings from a recent investigation of the mental health problems of elderly homeless people who were sleeping on the streets in central London. Through observation and interviews it appeared that a high proportion of these individuals had mental health problems. Whereas nearly half of the elderly men appeared to be depressed, the majority of women either portrayed thought disturbances or were identified as having severe memory problems.
Behavior assessment of older adults: A review of factor analytic studies and a proposed model
Authors: Sturmey Peter
Published: December 2004

Factor analytic studies of behavior checklists used with elderly clients are reviewed. An analysis of the kinds of items contained in the measures and the kinds of populations studied is presented. Preliminary evidence was found for the robustness of three factors, here named adaptive behavior, extrapersonal maladaptive behavior, and memory and orientation. On the basis of this, a model of behavior in the elderly is proposed. Implications for future research and the design of behavior checklists are discussed.
Protection from clinical depression in medical long‐term care facilities: Evidence for psychologic adaptation in cognitively intact patients
Authors: Foster Jeffrey R. , Cataldo Janine K.
Published: December 2004

A recent study in a medical long‐term care facility (LTCF) population demonstrated evidence of psychologic adaptation in a predominantly demented population. We have also reported evidence of such adaptation which lowered the risk of depression in an LTCF sample. The present study extends the adaptational variables for depression compares areas of agreement between the dementia and depression studies, reviews the adaptational construct, and suggests clinical applications targeted to primary prevention of depression in this setting.
Autopsy services for old age psychiatrists in england and wales: Benefits and problems
Authors: Benbow Emyr W. , Benbow Susan M.
Published: December 2004

We sought to determine the views of old age psychiatrists about the quality, benefits and drawbacks of their autopsy services, so a postal questionnaire was circulated to all individuals identified by the Royal College of Psychiatrists as providing old age psychiatry services in England and Wales. We found that many old age psychiatrists are aware of the potential benefits of autopsies, but many receive a service which is of poor quality. Some have difficulty in organizing hospital autopsies, and many found coroners' autopsies unhelpful, with the brain being ignored or examined only superficially. Poor descriptions of neuropathology are associated with autopsies carried out by general histopathologists, whereas neuropathologists are criticized for delayed reports. Better services might be provided if neuropathologists could be more closely involved, if only in the examination of brains removed by other pathologists.
Admission laboratory testing in elderly psychiatric patients without organic mental syndromes: Should it be routine?
Authors: Harms Herman H. , Hermans Peter
Published: December 2004

The clinical benefit of and admission screening battery of laboratory tests, electrocardiogram, electroencephalogram and chest X‐ray was evaluated in a group of 227 elderly psychiatric patients without clinical evidence of dementia or other organic mental illness. Important contributions from the screening battery to clinical management were obtained only from measurement of blood glucose and thyroid function, and possibly also of red blood cell status, urinalysis and prostatic specific antigen. Given the very limited benefit of extensive screening batteries reported in the literature for psychiatric patients in general, and described in this study for elderly psychiatric patients without organic mental disorder, we suggest that such batteries should only be used in high(er) risk groups, which remain to be defined.
The structure of wandering in dementia
Authors: Hope Tony , Tilling Kathleen M. , Gedling Kathy , Keene Janet M. , Cooper Sandra D. , Fairburn Christopher G.
Published: December 2004

‘Wandering’ is one of the most troublesome of behavioural problems in dementia. The term ‘wandering’ covers many different types of behaviour. We examined the hypothesis that the different types of wandering behaviour seen in dementia from a scale using data collected on 83 elderly subjects suffering from either Alzheimer's disease or multiinfarct dementia. We reject the scaling hypothesis. Our data suggest that there are three main categories of wandering behaviour, and that one of these categories is usefully divided into four subcategories.
Support networks and dementia
Authors: Wenger G. Clare
Published: December 2004

Based on data from a sample of 4500+ people aged 65+ living in the community (ie not in residential care) in Liverpool, this article presents data on the availability of kin and levels of contact with family, friends neighbours and community groups, and compares the distribution of support network types of those identified as cases of dementia with non‐cases. It is shown that dementia sufferers are more likely to live with others and to have more contact with family members and less contact with friends, neighbours and community groups than non‐sufferers. It is also shown that the distribution of network type is distinctively different for cases and non‐cases and it is suggested that this reflects the greater ability of some types of network to support continued community residence in the face of the onset of dementia.
The validity of a caregiver‐rated brief behavior symptom rating scale (BSRS) for use in the cognitively impaired
Authors: Rabins Peter V.
Published: December 2004

The validity of a 12‐item brief behavioral symptom rating scale for use in the cognitively impaired was studied using nurse clinician ratings for criterion validity and the Brief Psychiatric Rating Scale and Behavioral Scale of the Psychogeriatric Dependency Rating Scale for convergent validity. The scale is designed to be filled out by care providers and to meet the needs for a brief scale focused on behavioral symptoms.
Cognitive stimulation of patients with dementia: Preliminary results
Authors: Breuil Véronique , De Rotrou Jocelyne , Forette Françoise , Tortrat Daniele , Ganansia‐Ganem Annie , Frambourt Anne , Moulin Florence , Boller Fraņcois
Published: December 2004

We present the first results of a cognitive stimulation programme for patients with dementia. Fifty‐six subjects entered a study involving two parallel, randomized groups. Assessment was blind for the main criteria (neuropsychological tests). Twenty‐nine patients were stimulated and were compared to 27 non‐stimulated patients. The stimulated group attended 10 stimulation sessions over 5 weeks. Each group was assessed on the first and seventh week. Following stimulation, there was significant improvement of Mini‐Mental State (MMS) scores (p < 0.01) and increased performance for the Word List Memory Test (one‐tailed p = 0.09) in the Consortium to establish a Registry for Alzheimer's Disease (CERAD) battery. Verbal fluency remained unchanged. Stimulation tended to improve items of an additional battery (one‐tailed p < 0.01). The composite sum of test scores showed a significant difference in favour of the stimulated group. These results were positively correlated with the initial MMS scores and negatively with education. The Activities of Daily Living (ADL) scale did not show a significant change. We concluded that global stimulation of cognitive functions improves certain parameters among demented outpatients.
Physical dependency and dementia in nhs continuing care wards and contracted nhs beds in voluntary nursing homes
Authors: Shah Ajit , Phongsathorn Virach , George Collette , Bielawska Celia , Katona Cornelius
Published: December 2004

All patients in hospital based and voluntary nursing home based National Health Service (NHS) continuing care geriatric beds in one London Health District were screened for psychiatric morbidity and physical dependency. They were followed‐up at one year. Patients in hospital based continuing care beds had more severe dementia and physical dependency and higher mortality rates than those in voluntary nursing home based NHS continuing care beds. The implications of these findings are discussed in the light of governmental policy to encourage growth of private and voluntary sector nursing homes.
Comparison of clinical state, retrospective informant interview and the neuropathologic diagnosis of alzheimer's disease
Authors: Thomas L. D. , Gonzales M. F. , Chamberlain A. , Beyreuther K. , Masters C. L. , Flicker L.
Published: December 2004

This study compared clinical diagnosis of dementia derived from medical records and a retrospective version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) against the criterion of neuropathology. Subjects comprised 50 consecutive patients who died in a geriatric hospital in Melbourne and underwent necropsy. All informants were seen within 3.5 years of death. Discordance between clinical and pathological diagnosis occurred in seven (14%) cases. The IQCODE scores for the group with a clinical diagnosis of Alzheimer's disease (mean ± SD) were 4.28 ± 0.78 and were significantly different from the non‐demented group, 3.39 ± 0.51, p < 0.001. Similarly, IQCODE scores were significantly different between the groups with and without a pathologic diagnosis of Alzheimer's disease, 4.21 ± 0.70 and 3.51 ± 0.79 respectively, p < 0.01. Using immunohistochemical techniques instead of conventional methods to make a diagnosis of Alzheimer's disease, there were significant differences in IQCODE scores between the Alzheimer's group, 4.13 ± 0.83, and the group with normal neuropathology, 3.45 ± 0.54, p < 0.01. These data support the conclusion that when used retrospectively, the IQCODE is a valid screening test for dementia using neuropathological diagnosis as the criterion.
The sixth congress of the international psychogeriatric association, 5–10 September 1993, Berlin
Authors: Treloar Adrian , Philpot Micheal
Published: December 2004

‘All around the globe the hearts of psychogeriatricians are beating synchronously as they strive together to further the cause of old age psychiatry in an academic world without frontiers.’ (Paraphrasing Dr Sanford Finkel, President of the IPA).
White matter hyperintensities in healthy older adults: A longitudinal study
Authors: Wohl Marcy A. , Mehringer C. Mark , Lesser Ira M. , Boone Kyle B. , Miller Bruce L.
Published: December 2004

A 3‐year longitudinal study was conducted using magnetic resonance imaging (MRI) to determine the progression of white matter hyperintensities (WMH) and ventricle‐to‐brain ratio (VBR) in 16 healthy older adults. We found that, as a group, the subjects' WMH showed little progression over a 3‐year period, but their VBR significantly increased during that same period of time. This increase occurred in healthy older adults who did not develop serious medical problems during the course of the 3‐year study. In two of the subjects, with the largest increases in both WMH and VBR, there was a change in their health status.
The mental health of older people in rio de janeiro
Authors: Veras Renato P. , Murphy Elaine
Published: December 2004

The main findings are presented of a prevalence study of mental health problems (organic brain syndrome and depression) in the elderly population of Rio de Janeiro, Brazil. Three districts in the city were surveyed—Copacabana, Meier and Santa Cruz–chosen using a set of socioeconomic indicators to identify rich, middle income and poor areas. Validity and reliability studies of the survey instrument were carried out in Copacabana. Prevalence results for organic brain syndrome (OBS) were 5.95% in Copacabana, 9.84% in Meier and 29.75% in Santa Cruz, while results for depression were 22.62%, 19.67% and 35.12% respectively. The methodological problems of the survey which influence confidence in the results are discussed. Dependence and loss of autonomy in elderly people were strongly associated with organic brain syndrome and depression. The results are compared with those in the other Brazilian and international studies.
Memory performance, self‐reported memory loss and depressive symptoms in attenders at a GP‐referral and a self‐referral memory clinic
Authors: Barker Andrew , Carter Carol , Jones Roy
Published: December 2004

Reports of declining memory are common with increasing age. Sometimes these are corroborated by poor memory test performance, but often they appear to be more closely related to depressive symptomatology. As pharmacological treatments emerge for improving cognition in the elderly, understanding the aetiology of memory complaints will become increasingly important. This article compares memory performance, reports of memory loss and depressive symptoms in attenders at a GP‐referral and a self‐referral memory clinic, with age‐ and sex‐matched community controls. The GP‐referred patients were older, had lower MMSE scores and had levels of memory complaint and depression between the control and self‐referred subjects. The self‐referrers had cognitive test performance similar to community controls but complained more of memory loss, were more depressed and more frequently reported a past history of treated depression. Self‐presentation of memory complaint appears to be more closely related to affective and possibly personality factors than memory test performance.
Psychiatric hospitalization of senile, presenile and arteriosclerotic dementia patients in israel: A psychiatric case register study
Authors: Heinik Jeremia , Popper Miriam , Hes Josef Ph. , Avnon Moshe , Barak Yoram
Published: December 2004

Most dementia patients in Israel are cared for by non‐psychiatric services. Psychiatric hospitals are generally reluctant to admit behaviourally disturbed dementia patients, unless it is for appropriate psychiatric reasons and for a transient period of time. We used national Psychiatric Case Register (PCR) data to examine the implementation of these criteria in a sample of 711 dementia patients (senile and arteriosclerotic). Results suggest that: (a) in about a third of senile patients and in nearly half of arteriosclerotics no primarily treatable, psychiatric symptoma‐tology was diagnosed; (b)most admissions were not on a psychiatric emergency basis; (c)inpatient stay of dementia patients was longer than the average psychiatric admission. These patients were usually transferred to a non psychiatric facility or to a general hospital, or died in the psychiatric hospital. We conclude that the subject of psychiatric hospitalization of dementia patients in Israel needs substantial revision.
Mortality after bereavement: An analysis of mortality rates and associations with mortality 13 years after bereavement
Authors: Bowling Ann
Published: December 2004

The mortality rates of a national sample of 505 elderly people who were widowed in 1979 were analysed. Over the 13 1/4‐year period analysed, 62% of the sample had died. Although earlier analyses had indicated excess mortality in the first 6 months of bereavement for men aged 75+, there were no other significant excess mortality rates over the 13 1/4‐year period. Mortality was analysed in relation to the demographic characteristics of the whole sample and in relation to the inerview data on physical, social and psychological characteristics of the responders in 1979. Logistic regression analysis showed that age, sex and functional ability were the strongest predictors of mortality, and frequency of telephone contacts was only significant for the younger widowed.
Dementia and crime: A forensic psychiatry unit study in israel
Authors: Heinik Jeremiah , Kimhi Robert , Hes Josef Ph.
Published: December 2004

The psychiatric files of the 57 consecutive defendants aged 60+ referred by court for psychiatric examination at the Forensic Psychiatry Unit at the Y. Abarbanel Mental Health Center in the period 1982–1992 were retrospectively evaluated. The objectives were as follows: (a) to compare some assessment aspects of dementia patients with those of psychotics and personality disorders; (b) to compare how the questions of competency to stand trial, legal responsibility and competency to be sentenced were differentially approached. Of the 57 elderly patients surveyed, 17 (30%) suffered from dementia, 14 (25%) from a functional psychosis and 16 (28%) from a personality disorder. These three groups of psychiatric patients were found to be quite similar regarding the demographic and criminal variables studied. However, dementia patients occupied an intermediate position between the psychotics and personality disorders when assessment characteristics, psychiatric and legal recommendations to the court were considered.
Day hospitals: The case in favour
Authors: Howard Robert
Published: December 2004

The day hospital constitutes an integral and valued component of the old age psychiatry service provided by the majority of units in the United Kingdom. Changes in the political climate, vogues for alternative forms of care provision and a lamentable lack of hard evidence that day hospitals present the best use of resources have led to serious questioning of their future by most who have written in recent years on the subject. The issue should not be ‘day hospitals are wonderful; other systemls are not’ (or vice versa), but that the day hospital should be seen as an available option with its own particular benefits alongside other hospital‐based and community components of a good service. Advocates of day hospitals should continually review staffing mix and structure to ensure the best use of professional skills.