bluuebunny/crossref_metadata_2025 huggingface dataset:
Visual hallucinosis in non‐delusional elderly
Authors: Beck Jennifer , Harris M. Jackuelyn
Published: December 2004

The goal of this article was to review the literature on visual hallucinations (VH) and, more specifically, the association of visual perceptual disorders with age, specific pathologies that are etiologically related to the VH, the anatomical location of the pathology, and the relation of the characteristics of the VH to the pathology and location of the lesions and, in addition, the importance of insight in the differential diagnosis of the VH. A total of 45 articles, representing 117 cases dating from 1940 to 1991, were reviewed. This review, although relying on information provided retrospectively, includes cases of VH from all disciplines and attempts to identify characteristics associated with this disorder. Our review does show an increased frequency of VH in the elderly, with almost 50% of the case reports in the past 50 years occurring in patients in their seventh and eighth decades. There was a large differential diagnosis of VH and there may be multifactorial causality. Eye pathology was the most frequent association with VH in patients over age 60 in our review, with cataracts accounting for over half of the cases reported within this group. Our review confirms that VH can occur as a result of a lesion anywhere within the visual perceptual system—from the lens to the association cortex.
The detection and prevalence of iron deficiency in long‐stay psychogeriatric patients
Authors: Treloar Adrian J. , White Daniel P. , Crook Martin A. , Philpot Michael P.
Published: December 2004

The prevalence and clinical diagnosis of iron deficiency was studied in 55 long‐stay psychogeriatric patients. Iron deficiency was found in 29% of the sample and there was a trend for iron deficiency to be more common among patients with functional as opposed to organic psychiatric conditions. There were no clinical signs that could reliably detect iron deficiency and neither serum ferritin nor iron saturation studies detected more than 63% of iron‐deficient patients. The importance and cost of detecting iron deficiency is discussed together with the need for attention to patients' dietary intake and physical state.
Audit of the use of the mental health act in a psychogeriatric hospital
Authors: Feehan C. J.
Published: December 2004

The question of detaining elderly mentally ill patients against their wishes raises many ethically difficult questions. The author conducted a survey of the extent and purpose of the use of the Mental Health Act (1983) in a particular psychogeriatric hospital, focusing on the circumstances in which it was used, how often patients or relatives appealed against its use and the outcome of the appeal. The author found that the Mental Health Act was used in only 5% of patients, and Section 5(2) was used only once. This stands in marked contrast to the use of Section 5(2) in adult general psychiatry, where one survey found it to be used in 7.2% of patients (pourgourides et al., 1992). The powers of the Mental Health Act in the population the author studied were most frequently evoked to detain and treat patients who were suffering from self‐neglect secondary to their mental illness rather than to prevent them from wandering and coming to harm. It would appear that in this population, the Mental Health Act is used to facilitate admission for assessment and treatment; once admitted, patients can successfully be managed without the need for further recourse to the Mental Health Act. Very few patients or relatives appealed against their detention, and in no case was the appeal successful.
Does anyone know what medication the patient should be taking?
Authors: Anderson David N. , Prunty Nora , Partridge Malcolm , Sexton John
Published: December 2004

Fifty consecutive psychogeriatric clinic attenders were studied to establish the ability of doctors and patient/carers to give an accurate medication history at clinic appointments. Patient/carers were unable to give accurate accounts of prescribed medication in 62% of cases, the clinic doctor in 62% and the general practitioner in 67%. The implications of this failure to convey information related to current medications and methods of improving this situation are discussed.
A postal survey of the quality of long‐term institutional care
Authors: Challiner Yvonne , Watson Rachel , Julious Steven , Philp Ian
Published: December 2004

There is increasing interest in measuring and regulating the quality of long‐term institutional care for elderly people during an era of change in the funding and provision of such care. We report the development and use of a postal questionnaire intended as a cheap, reliable and valid method for quality evaluation. The 18‐item questionnaire was derived from a set of standards for quality of long‐term care originally selected by patients and staff as appropriate for this purpose. The questionnaire was sent to a random sample of private residential homes and to all other voluntary, local authority and health service establishments providing long‐term care in one health district. There was a 94% response rate. Follow‐up in‐depth studies in a stratified random sample of establishments were undertaken. Reliability of the questionnaire was acceptable (intrarater, r= 0.88; interrater, r=0.73). There were significant differences in quality scores between sectors (p< 0.001) and a positive correlation between quality score and physical independence of residents, as measured by the Barthel Index (r= 0.48). The postal questionnaire, able to detect differences within and between the different sectors of care provision, has potential for setting national and local sectoral norms for quality of care. It could be used as a screening tool for individual establishments and inspectorate bodies prior to more detailed internal or external audit.
Neuropsychological tests as discriminators between dementia of alzheimer type and frontotemporal dementia
Authors: Elfgren Christina , Brun Arne , Gustafson Lars , Johanson Aki , Minthon Lennart , Passant Ulla , Risberg Jarl
Published: December 2004

The aim of this study was to examine whether cognitive test performance alone could distinguish patients with dementia of Alzheimer type (DAT) from those with frontotemporal dementia (FTD). Scores from three neuropsychological tests were used as discriminating variables in 28 cases with postmortem verified diagnoses. The selected tests measured verbal ability, visuospatial ability and verbal memory. Eighty‐nine per cent of the sample was correctly classified by discriminant analysis. Evaluating the ability of the obtained discriminant function to differentiate between groups of DAT and FTD in a new, clinically diagnosed sample of 38 cases yielded an overall success rate of 84%. The results suggest that cognitive tests may be helpful for differential diagnosis in the context of a neuropsychiatric examination.
Suicidal behaviour in the elderly
Authors: Draper Brain
Published: December 2004

In a retrospective study of 69 elderly (65 years and over) cases of attempted suicide (deliberate self‐harm) referred for psychiatric assessment in southern Sydney, 81% of took overdoses, 64% involving benzodiazepines. Depressive illness was present in 87% of cases, alcohol/substance abuse in 32%, organic syndromes in 29% and personality dysfunction in 26%. Multiple psychosocial, psychological, medical and psychiatric risk factors for suicide were identified. ‘Major’ functional psychiatric disorders (41%) were found predominantly in females and were associated with higher levels of suicidal intent, psychosis and fewer chronic physical illnesses. ‘Minor’ functional disorders (30%) were associated with lower degrees of suicidal intent, personality dysfunction and higher numbers of psychosocial stressors. Organic brain syndromes were associated with males over 75 years, chronic physical illness, and were often comorbid with depression. These findings indicate that there are several patterns of suicidal behaviour in the elderly that require further prospective research.
Psychiatric symptoms as predictors of mortality in continuing care geriatric inpatients
Authors: Shah Ajit , Phongsathorn Virach , George Collette , Bielawsk Celia , Katona Cornelius
Published: December 2004

All patients (N = 74) in continuing care geriatric beds in a London health district were screened for psychiatric morbidity and physical dependency in 1990. The sample was followed up 1 year after screening, forty‐four percent were dead at follow‐up. The relationship between individual psychiatric symptoms and mortality is reported. Using these associations, two scales to predict mortality were constructed and their usefulness is discussed.
Families and dementia
Authors: Huckle P. L.
Published: December 2004

Carers of elderly people with dementia are under considerable stress coping with the burdens of caring. This review looks at carers' stress and the psychological interventions available to help them. These include group therapy, behavioural approaches, psychoeducational techniques, family therapy and potentially more cost‐effective approaches such as the provision of telephone helplines for carers.
Is ect safe in patients with cerebrovascular disease?
Authors: Blackburn Patricia Anna , Decalmer Peter
Published: December 2004

A 70‐year‐old man with a history of peripheral vascular disease was treated initially with antidepressants, then bilateral electroconvulsive therapy (ECT) for a depressive illness. Apart from an episode of delirium following ECT he recovered fully. Four years later he relapsed. Low‐dose antidepressants caused disorientation and oversedation, as did ECT. Shortly afterwards he developed a multi‐infarct state with Parkinsonian symptoms, transient schaemic attacks (TIAs) and cerebrovascular attacks (CVAs). His cognitive deficits implicated pathology in the frontal and subcortical areas of the brain. Postmortem examination confirmed widespread atherosclerotic disease, also cerebrovascular disease. The haemodynamic and cerebral effects of ECT are condidered in the context of vascular disease. It is postulated that ECT given to such patients might cause permanent impairment of cognitive function through ischaemia of an already compromised cerebral circulation. Suggestions are outlined regarding a policy for a more comprehensive assessment of patients with atherosclerotic disease. Deficiencies of ECT procedures are highlighted.
A longitudinal study of age‐associated memory impairment
Authors: Snowdon John , Lane Fred
Published: December 2004

An 8‐year longitudinal study of elderly people has provided data concerning age‐associated impairment (AAMI). In 1985 a random sample of 146 persons aged 65 years or more, living in their own homes, were assessed using the Guild Memory Test the Mini–Mental State Examination (MMSE) and other ratings. After excluding 21% of the sample because they scored less than 24 on the MMSE, and another 34% who fulfilled other exclusion criteria, some 48% of the remainder (22% of the total sample) clearly fulfilled NIMH criteria for AAMI and a further 36% (16% of the total sample) were recorded as forgetful. The NIMH criteria are appropriate for certain research purposes but not in assessing prevalence of memory disorders. Follow–up interviews were conducted after 2, 4, 6 and 8 years. The mortality rate and development of dementia among those fulfilling criteria for AAMI appeared similar to the other non‐demented groups of subjects; the mortality rate of those with MMSE scores below 24 was significantly higher. Guild test results at 2‐yearly intervals showed considerable changes; half of those scoring least well who were retested showed improvement.
Cognitive rating scales: A comparison of the mini‐mental state examination and the middlesex elderly assessment of mental state
Authors: Husband Hilary J. , Tarbuck A. F.
Published: December 2004

The MEAMS (Middlesex Elderly Assessment of Mental State) is a relatively new scale specifically developed to detect intellectual impairment secondary to organic brain dysfunction in the elderly. In this study the MEAMS was compared with the MMSE (Mini‐Mental State Examination), a widely known and commonly used brief cognitive rating scale, in a group of 60 elderly acute psychiatric inpatients. Scores on both scales were highly correlated. However, the MEAMS was shown to be more sensitive in the detection of mild cognitive impairment, and was more sensitive to the presence of focal brain lesions than the MMSE. In the second part of the study, a further 25 inpatients were assessed using both scales by six junior and staff‐grade doctors, who then rated the scales according to various criteria. Despite taking slightly longer to administer, the MEAMS was rated superior overall by the medical staff. It is suggested that the MEAMS is a sensitive instrument acceptable to both patients and staff, and is suitable for routine use in an old age psychiatric setting.
The Telephone Interview for Cognitive Status (TICS): Reliability and validity in a stroke sample
Authors: Desmond David W. , Tatemichi Thomas K. , Hanzawa Leslie
Published: December 2004

The Telephone Interview for Cognitive Status (TICS) is an 11‐item screening test (maximum score=41 points) that was developed for the assessment of cognitive function in patients with Alzheimer's disease who are unwilling or unable to be examined in person. To investigate the 1‐month test‐retest reliablility and validity of the TICS in a stroke sample, we administered it twice by telephone to 36 stroke patients (age = 72.3 ± 8.9; education = 9.7 ± 4.7) and 36 stroke‐free non‐demented control subjects (age = 71.8 ± 6.8; education = 13.1 ± 4.1). Dementia was diagnosed in six stroke patients based on neuropsychological and functional examinations performed during an outpatient visit and the Mini‐Mental State Examination (MMSE) was also given. Multiple regression analyses determined that stroke status was significantly related to performance on the TICS (β= −0.26, p = 0.006), while adjusting for demographic variables. Among stroke patients, test‐retest reliability was excellent (r = 0.90, p < 0.001) and performance was significantly correlated with MMSE score (r = 0.86, p <0.001). A TICS cutoff score <25 best distinguished between demented and non‐demented patients; sensitivity (1.00) and specificity (0.83) were excellent and comparable to the sensitivity (0.83) and specificity (0.87) of the MMSE, with dementia defined as a score <24/30. We conclude that the TICS is a reliable mental status test that can provide accurate information regarding cognitive function in stroke patients who cannot be assessed in person.
French recommendations for clinical drug trials in cognitive disorders of the elderly
Authors: Michel Bernard , Sambuc Roland , Scotto Jean‐Claude
Published: December 2004

A consensus conference on the topic of clinical drug trials in cognitive disorders of the elderly was held in Marseille on January 28–29, 1993. At the end of this conference, several recommendations were made. Drugs used in trials must be chosen according to solid neurobiological evidence. Clinical trials profoundly alter the relations between the doctor, the patient and his family and this aspect must be taken into account. Clinical trials should be designed to obtain meaningful and useful data in the domains of pharmacology and epidemiology. Patient selection criteria must be defined with strict attention to the nosology of syndromes causing cognitive disorders in the elderly. Objective evaluation tests able to detect subtle drug effects must be carefully chosen according to the requirements of each trial. Whenever possible, laboratory tests should be used in addition to clinical data. The ethical implications of clinical trials in demented patients require special adaptation to satisfy legal requirements.
Outcome of admission to an acute psychiatric facility for older people: A pluralistic evaluation
Authors: Wattis John P. , Butler Alan , Martin Carol , Sumner Ted
Published: December 2004

In this pilot study we sought to find brief, usable, reliable and valid measures of outcome from a variety of viewpoints for older adults admitted to hospital with depression or dementia. We examined patients', carers', primary nurses', consultants' and general practitioners' perceptions of outcome using a variety of measures. For the depressed patients we used nurse‐rated change on the Montgomery Asberg Depression Rating Scale (MADRS) as the main outcome measure. Adequate data for analysis were collected on 24 depressed and 16 demented patients. In the depressed group there was a highly significant improvement on the MADRS. Factor analysis of the scales used produced four factors. The MADRS and the depression subscale of the Hospital Anxiety Depression (HAD‐D) were strongly weighted on the first factor, the GPs' linear analogue scale on the second, the Selfcare‐D (and the HAD‐D) on the third and the anxiety subscale of the HAD (HAD‐A) on the fourth. The HAD, which is brief and easy to use, and the GPs' linear analogue are suggested for further evaluation as routine outcome measures for depressed elderly people. For demented patients carers' rating of resolution of perceived problems is tentatively suggested for further investigation.
A trial of buspirone for the control of disruptive behaviors in community‐dwelling patients with dementia
Authors: Levy Mark A. , Burgio Louis D. , Sweet Robert , Bonino Paula , Janosky Janine , Perel James
Published: December 2004

We report the results of a pilot study examining the dose–response of buspirone for the treatment of agitated and disruptive behaviors in dementia patients. Patients were identified by physician referral, chart review and caregiver response to newspaper adverisements. All subjects met NINCDS–ADRDA criteria for probable Alzheimer's disease. Twenty subjects were entered into the study, 12 completed the protocol. After a washout period, all subjects received 1 week of placebo followed by approximately 2 weeks each of buspirone 15 mg, 30 mg, 45mg and 60 mg daily. The primary outcome measure was the total score on Reisberg's Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE–AD), which was administered at baseline, the end of the placebo phase and at the end of each dosage interval. Significant improvement in the mean score was seen at a daily dosage of 30mg (p< 0.05 vs placebo). Significant improvement was also seen on the delusion, aggression and anxiety subscales of the BEHAVE‐AD. Few side‐effects were noted. These data suggest that the optimal starting dosage of buspirone for the treatment of behavioral pathology in dementia patients is 30mg daily. Individual patients may have their best response at dosages ranging from 15 to 60 mg daily. Confirmation of these findings requires a double‐blind, placebo‐controlled clinical trail.
Cognitive functioning in elderly depressed patients with and without psychosis
Authors: Kunik Mark E. , Champagne Laura , Harper Robert G. , Chacko Ranjit C.
Published: December 2004

Cognitive deficits occurring with major depression in the elderly are well recognized. However, cognitive differences in depressed patients with and without psychotic features have received little attention. Of 14 consecutively referred elderly patients with major depression, the eight patients with psychotic features had significantly more cognitive deficits on neuropsychological tests than the six patients with major depression without psychotic features. The differences in performance IQ were most remarkable, but the differences extended to verbal IQ subtests, word fluency and memory.
Staff activity patterns in a community mental health team for older people
Authors: von Abendorff Richard , Challis David , Netten Ann
Published: December 2004

The study used a diary‐based approach to examine the distribution of time of different professional staff in two community mental health teams for the elderly. It was possible to discriminate between two broad groups of staff, defined as core workers and extended role members of the teams based upon the range of responsibilities and patterns of time use. The latter group consisted of clinicians and psychologists. About three‐quarters of staff time was spent in client‐related activities, although there were differences between core and extended workers, the latter undertaking more service‐related activities. The similarity of patterns of time use by core workers and other community‐based workers is noted and the distinction between key workers and care managers is considered.
Vasomotor reactivity in dementia of alzheimer type
Authors: Heun R. , Knappertz V. A. , Krämer And G.
Published: December 2004

The objective of this study was to examine the cerebral blood flow and the vasomotor function of CO2‐responsive intracerebral vessels in Alzheimer's disease. Patients met DSM‐III‐R criteria for dementia of Alzheimer type and had neither symptoms nor signs of cardiovascular or cerebrovascular disease. Blood flow velocities in both middle cerebral arteries (MCA) were recorded using transcranial Doppler sonography during hypercapnia, normocapnia and hypocapnia. Several psychometric tests were performed. Patients' age, disease duration and severity of dementia did not correlate with vasomotor reactivity. Exploratory analysis revealed that mean flow velocities under hypercapnia correlated with severity of dementia and with patient's age. This suggests that the disease process does not influence the autoregulative function of small resistance vessels as assessed by CO2 challenge. However, the excess reduction of the highest flow velocities measured during maximal CO2 stimulation indicates that the number of small capillaries are diminished, or alternatively that the diameters of these capillaries are reduced in Alzheimer's disease.
CT study in senile dementia of Alzheimer type
Authors: Ueyama Kenichi , Fukuzako Hiroshi , Fukuzako Tsuyoshi , Hokazono Yoshirou , Takeuchi Kouzou , Hashiguchi Tomo , Takigawa Morikuni , Yamanaka Takao , Matsumoto Kei
Published: December 2004

We evaluated 14 patients with senile dementia of Alzheimer type (SDAT) and 15 age‐matched normal elderly controls using psychological test and computed tomography scans. The low‐density rate (LDR) was used as an index of brain atrophy. SDAT patients had significantly higher scores on the Hasegawa Dementia Scale (p< 0.01) and significantly lower scores on the Bender Gestalt Test (p<0.01) than control subjects. The LDRs of the left and right hemispheres were significantly higher in the SDAT group than in the control group in all three slices investigated (p<0.05/6 = 0.0083). In SDAT patients, significant diagnosis by hemisphere interaction was observed in one slice (p<0.05), with higher LDR on the left than on the right (p<0.05/6 = 0.0083). Our findings suggest that cortical atrophy is predominant on the left side in patients with SDAT.
Rapid cycling bipolar disorder in a case of Binswanger's disease
Authors: El‐Shazly M.
Published: December 2004

The case of a middle‐aged woman, who presented with a 2‐year history of rapid cycling manic depressive illness, is described. As neuropsychological deficits emerged, the swings of mood subsided and her condition evolved into generalized anxiety with emotional lability. CT scan showed diffuse white matter changes in both cerebral hemispheres.
Changes in behaviour before and after nursing home admission
Authors: Morriss Richard K. , Rovner Barry W. , German Pearl S.
Published: December 2004

The Psychogeriatric Dependency Rating Scale (PGDRS) behavior subscale was completed for 431 residents of eight nursing homes at three time points: the weeks preceding nursing home admission, 2 weeks and 2 months after nursing home admission. The mean PGDRS behaviour subscale score significantly decreased from before admission to 2 weeks after admission but returned to preadmission levels at 2 months after admission (p < 0.01). There were significant temporary decreases after admission in the prevalence of interfering behaviour, difficulty understanding, self‐destructive behaviour, persecutory ideas and hallucinations. A decrease in behaviour problems after admission was associated with admission because of disruptive behaviour, possible Alzheimer's disease and expecting to live permanently in the nursing home. An increase in behaviour problems was associated with admission because of disruptive behaviour, dementia with stroke, delirium, being uneasy with other residents, unoccupied by activities, incontinence and physical dependence.
Falls and fractures in nursing home patients receiveing psychotropic drugs
Authors: Cooper James W.
Published: December 2004

Falls in 44 matched control patients (average age 87.1) were statistically compared to 38 patients (average age 85.3) who received scheduled or as needed (prn) single‐agent psychotropics over a 6‐month period. Prospective assessments of psychotropic drug therapy were made on a monthly basis, and data on falls and fractures were retrospectively gathered. Both scheduled and prn single‐agent usage of benzodiazepine (BZ) hypnotics, and scheduled usage of BZ anxiolytics and thioridazine increased the incidence and episodes of falls over the frequency of falls found in the control group. Fractures were more prevalent in the treatment group over the 6‐month period, but half the falls in the control group resulted in fractures. Longer‐acting BZs, both prn and scheduled, resulted in a greater rate of falls than the shorter‐acting BZs, but even the shorter‐acting (SA) BZs given on a scheduled basis more often than three times a week had a greater rate of falls than the control group. When not more than 3 SABZ doses per week were given, no falls were noted for the follow‐up 6‐month period. It appears that most single psychotropics, except the SABZs given no more often than three times a week, haloperidol and desipramine, increase the risk of falls and fractures in a very old frail nursing home population.
Depressive symptoms in african american medical patients
Authors: Baker F. M. , Parker Donna A. , Wiley Cynthia , Velli Susan A. , Johnson Janice T.
Published: December 2004

The objective of the study was to determine the prevalence of depressive symptoms in African American medical clinic patients age 50 and older and to describe the presentation of depressive symptoms in this sample. Consecutive, consenting, African American patients age 50 and older in active treatment at a University Hospital medical clinic were screened for the presence of depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES‐D). Thirty‐two per cent of the 66 patients comprising the sample had scores of 16 or higher on the CES‐D. Based upon a clinical interview using the DSM‐III‐R checklist, 11% (seven patients) had affective disorders and were referred for psychiatric evaluation. Although 33% (N = 22) of the sample reported that they had 8 years or less of formal education, 62% (N = 41) were found to have a current reading level of seventh grade or less. These data demonstrate that the levels of depressive symptoms among medically ill, African American medical clinic patients with two or more medical illnesses are higher than reported for medical clinic samples composed of white Americans or of mixed racial subjects. Unless current reading levels are assesse, functional illiteracy and the patient's inability to provide informed consent based upon reading material may be missed.
A therapeutic group in the community for the elderly with functional psychiatric illnesses
Authors: Procter Elizabeth Ann , Alwar Lutchmee
Published: December 2004

We describe a closed therapeutic group run in a community setting for the elderly with functional psychiatric illnesses. The aim of the group was to promote mental health and self‐confidence and to reduce psychiatric morbidity. A directive approach was taken and members were encouraged to seek solutions to their problems. Outcome was good on both objective and subjective measures. Difficulties in running the group are discussed. Finally, it is suggested that such groups may be an effective means both of improving mental health and of utilizing limited health service resources, and warrant further research.
Discharge patterns from a psychogeriatric inpatient unit
Authors: Domken Mark , Bothwell Robert , McKeith Ian
Published: December 2004

Data were collected on inpatients admitted to one psychogeriatric unit in the Newcastle upon Tyne area, in the first 6 months of 1985, 1988 and 1991—a period which saw substantial reductions in the number of long‐term elderly care bed numbers in the statutory sector. Admissions to the unit increased by almost 50% over the 6 years while mean length of stay decreased from 12.4 to 9.4 weeks. Between 1988 and 1991 discharges into private sector care increased considerably with no evidence that this group differed in any way from those patients discharged into statutory care in terms of level of dependency or presence of behavioural problems. Patients with high dependency needs or behaviour problems which were difficult to manage tended to stay in hospital for much longer periods, possibly indicating a shortfall of suitable long‐stay facilities for this patient group.
Delirium during the course of clinically diagnosed Alzheimer's disease
Authors: Baker F. M. , Wiley Cynthia , Kokmen Emre , Chandra Vijav , Schoenberg Bruce S.
Published: December 2004

A retrospective chart review was completed on the 122 cases of CDAD for the period of 1965–1970 identified from a longitudinal study of dementia at the Mayo Clinic. A psychiatrist assigned DSM‐III‐R diagnoses based upon the longitudinal description of symptoms detailed in the medical records of the Mayo Clinic hospitals, nursing home visit records and state hospital records.

Thirty patients (25%) were found to have an episode of delirium (EOD) during their course of CDAD which occurred during inpatient admissions. Single EODs were found to occur within 2 years of the onset of CDAD, and multiple EODs within 3 years of the onset of CDAD. A psychiatric consultation was requested in only 14% of the sample (N = 17); 88% of these patients received diagnoses involving primary degenerative dementia of the Alzheimer's type, late onset. Psychopharmacology was the major management strategy (82% of patients with an EOD received medication) with the resolution of symptoms within 48 hours. At discharge, only two patients (7%) failed to completely clear the increased degree of confusion. Implications of these findings for the management of patients with CDAD and the management of EOD with the knowledge of the 1990s are discussed.
Disorganized sleep–wake schedule associated with neuroendocrine abnormalities in dementia. A clinical study
Authors: Björkstén Karin Sparring , Basun Hans , Wetterberg Lennart
Published: December 2004

Demented patients were investigated by blood sampling at 10 occasions during a 24‐hour period. Serum levels of melatonin and cortisol were determined. One patient with probable vascular dementia had a severely disorganized sleep‐wake schedule and showed disturbed patterns of serum melatonin and cortisol. After withdrawal of alprenolol, substitution of a vitamin B12 deficiency and cataract surgery, the patient regained normal sleep habits and a normal circadian pattern of serum cortisol and melatonin. A patient with frontal lobe dementia and a disorganized sleep‐wake schedule showed a disturbed melatonin rhythm, unexpected cortisol peaks and a disability to suppress melatonin by light. Two Alzheimer patients with regular sleep habits had normal circadian patterns of serum melatonin and cortisol.
Augmentation strategies in geriatric depression
Authors: Flint Alastair J.
Published: December 2004

Approximately 30–40% of elderly patients with major depression have inadequate response to an initial therapeutic trial of antidepressant medication. In these cases augmentation of the antidepressant has been recommended as one way of improving the rate of response. This article reviews the literature on augmentation strategies in treatment‐resistant geriatric depression. Successful augmentation with lithium, triiodothyronine, stimulants, carbamazepine, valproate and a tricyclic–serotonin reuptake inhibitor combination have been described. However, there have been no controlled trials and, with the exception of two open prospective studies of lithium potentiation, the literature consists entirely of case reports and retrospective case series. As a result, it is difficult to draw conclusions about the efficacy of these strategies in late life, especially since treatment failures seldom get reported. Side‐effects may limit the usefulness of some augmentation regimens in old age—up to 25% of patients treated with lithium or carbamazepine discontinued these medications because of adverse events. There is a need for controlled studies to better determine the clinical utility of augmentation strategies in physically well depressed elderly, as well as those with depression complicating medical illness, dementia and other neurological disorders.
Autopsy services for old age psychiatrists in england and wales: Can neuropathologists help?
Authors: Benbow Emyr W. , Reid Helen , Benbow Susan M.
Published: December 2004

We have previously shown that many old age psychiatrists are dissatisfied with their local autopsy services. Their most common complaint was the poor quality of central nervous system examinations carried out by general histopathologists, and so we sought to determine whether neuropathologists could carry out more autopsies on old age psychiatry patients. A postal questionnaire was used, and responses indicate that neuropathologists carry out an average of 8.8 autopsies on old age psychiatry patients each year, out of a mean total of 42.2 neuropathological autopsies, and examine an average of 28.3 other brains from old age psychiatry patients, out of a mean total of 109.3 cases. In general, respondents found autopsies on psychiatric and neurological patients much more interesting than autopsies on neurosurgical and forensic cases, but did not rate psychiatric autopsies as more important than any other kind of case. Most neuropathologists would wish to examine more brains from old age psychiatry patients, but would require more pathologists, more technicians or more resources before doing so. Old age psychiatrists who wish to obtain a better autopsy service may need to take the initiative.
The cognitive drug research computerized assessment system in the evaluation of early dementia‐is speed of the essence?
Authors: Nicholl Claire G. , Lynch Sean , Kelly Cornelius A. , White Linda , Simpson Pauline M. , Wesnes Keith A. , Pitt Brice M. N.
Published: December 2004

The cognitive drug research computerized assessment system (COGDRAS) was evaluated in 98 unselected Hammer‐smith Hospital Memory Clinic patients (mean age 64.9, range 28‐83 years). They were divided into five groups (worried well, depressed, demented, minimally cognitively impaired and other brain disorders) on clinical assessment, Mini Mental State Examination (MMSE) and Cambridge Cognitive Examination (CAMCOG) scores. All but one patient completed the computer package, confirming its acceptability. The results of the COGDRAS in the five groups were analysed blind to diagnosis. The performance of the demented group was significantly impaired in comparison with the worried well group, showing that the COGDRAS is valid in mild dementia (mean MMSE 21.5, mean CAMCOG 73.9). The depressed group tended to perform slightly less well than the worried well, and the ‘other’ group showed a wide range of scores consistent with its diversity. The minimally impaired had scores intermediate between the demented and worried well, but an interesting speed/accuracy tradeoff was seen‐patients appeared to maintain accuracy by taking longer to perform tasks. The heterogeneity of the minimally impaired group and the role of the measurement of task completion time in the diagnosis of early dementia are discussed.
Carer‐rated personality changes associated with senile dementia
Authors: Williams Rhoda , Briggs Roger , Coleman Peter
Published: December 2004

Although adult personality traits have been shown to be stable with age, a recent study in the USA showed changes in a group of elderly people with memory disorders, as perceived by caregivers. The aim of this study was to replicate these findings in individuals suffering from senile dementia and to examine interactions with other emotional and physical stresses experienced by the carer. Thirty‐six subjects caring for an elderly person with dementia were visited twice in their own homes to assess the problems they had and how they were coping with them. NEO Personality Inventories were used to identify perceived personality changes. Individuals with senile dementia were regarded as becoming more neurotic, less extravert and less conscientious. These personality changes had more effect on carer morale than the physical burden of caring.
Citalopram‐lithium combination treatment of elderly depressed patients: A pilot study
Authors: Uehlinger Claude , Nil Rico , Amey Marlyse , Baumann Pierre , Dufour Henri
Published: December 2004

Fourteen elderly depressive patients (age 67‐88 yr), phenotyped with dextromethorphan and mephenytoin before and during the trial, were treated for 4 weeks with citalopram (final dose 20‐30 mg/day, except one patient 60 mg/day). The clinical state of the patients was recorded weekly using the Hamilton Depression Rating Scale, the CGI (psychopathology) scale, the VAS and the UKU scale for side‐effects. As assessed by the Hamilton Depression Rating Scale, nine patients improved by more than 50% and continued with their citalopram treatment. The treatment of the five non‐responders was then continued for another 2 weeks by addition of lithium (target plasma levels 0.4‐0.8 mmol/l) to the ongoing citalopram medication. After 1 week, one patient had to be withdrawn for non‐response, three were responders, while the fifth patient was a responder only after 2 weeks of lithium addition. Due to side‐effects, the lithium dose had to be decreased in one patient who had responded to the combination therapy. Plasma levels of citalopram were within 145‐459 nmol/l after 4 weeks of citalopram treatment. All patients were extensive metabolizers of dextromethorphan, and all but possibly one also of mephenytoin. After 4 weeks of citalopram, there was a highly significant correlation between the ratios of S/R‐mephenytoin in urine and citalopram/desmethylcitalopram in plasma, which suggests a common mechanism in the metabolism of these drugs. The preliminary finding that a citalopram‐Li combination therapy may be useful in elderly depressive patients resistant to citalopram alone needs to be replicated by a controlled double‐blind study.
The fragmentation of rest/activity cycles in Alzheimer's disease
Authors: Ghali Laura , Hopkins Robert W. , Rindlisbacher Peter
Published: December 2004

Clinicans caring for Alzheimer patients have observed that many have disruption in nocturnal sleep patterns. Despite their obvious clinical importance, little research has been conducted to investigate abnormal activity patterns in these patients. In this study, diurnal rest/activity patterns were examined using an electronic monitor with a movement sensor. Eighteen patients diagnosed with Alzheimer's disease were monitored for 48 consecutive hours each. Subject variables such as age, estiamted duration of illness and cognitive ratings were compared for degree of association with the movement data. Analyses indicated that an estimate of the duration of illness was superior to other variables in predicting the degree of change in activity rhythms. Specifically, the longer patients had suffered from Alzheimer's disease, the more disrupted their rest/activity patterns were. Patients who were in the late stages of Alzheimer's disease were less active and rested for longer than those in the earlier stages. In addition, circadian rhythmicity was reduced in the activity patterns of these patients. The present study confirms the findings of Hopkins and Rindlisbacher (1992) indicating that rest/activity patterns are dramatically altered as a result of Alzheimer's disease.
Success and failure in five case studies: Used of cued recall to ameliorate behaviour problems in senile dementia
Authors: Bird Michael , Alexopoulos Paula , Adamowicz Joanna
Published: December 2004

Four patients suffering dementing illnesses and presenting management difficulties were taught the association between either a cue and a behaviour, or a cue and information affecting behaviour. On subsequently encountering the cue in the environment, targeted problem behaviour. On subsequently encourtering the cue in the environment, targeted problem behaviours diminished to manageable levels, were modified, or ceased. Problemes were: obsessive demands, inappropriate urinating and intrusive aggressive behaviour. The technique failed with a fifth patient, who shouted constantly. Theoretical and clinical aspects of the interventions and the teaching method (repeated retrieval trials) are discussed.
Social factors and psychiatric admission for senile dementia
Authors: Orrell Martin , Bebbington Paul
Published: December 2004

This study investigated the psychosocial and physical factors preceding psychiatric admission in 70 elderly patients suffering from senile dementia by comparing them with two control groups, 50 dementia sufferers in the community and 50 fit elderly people matched for age and sex. There was no overall excess of current physical ill‐health or disability in the dementia sufferers. Moreover, the dementia sufferers had more social contacts and better support from relatives and services than the fit elderly group. However, the dementia patients who lived with a carer had significantly more negative communication than those dementia controls living with carers. Negative communication may increase the risk of admission but may be attenuated by day centre support.
Social participation and cognitive functioning in older adults
Authors: Maria Carolien Hendrika Smits , van Rijsselt René Johannes Theresia , Jonker Cees , Deeg Dorly Joan Hardy
Published: December 2004

The association between aspects of social participation and components of cognitive functioning and the ability of these aspects to predict cognitive performance was studied in an age and gender stratified sample of 116 individuals aged 55‐89 years in the Netherlands. Measures of social participation included questionnaires on societal participation, sociocultural activities and media use. Cognitive functioning was measured by tests of fluid intelligence, processing speed, word learning and recall, and everyday memory. All aspects of social participation showed significant bivariate correlations with all components of cognitive functioning. Independent of age, gender, education and functional limitations, societal participation and sociocultural activities contributed significantly to the prediction of processing speed and of delayed recall. Tendencies of independent association were apparent between both societal participation and sociocultural activities and word learning. No aspect of social participation independently predicted fluid intelligence or everyday memory. The evidence suggests independent associations between social participation characterized by an organizational setting and high level of activity, and basic components of cognitive functioning, such as information‐processing speed and measures of learning and delayed recall. Further research needs to clarify the process underlying the causal relation between cognitive functioning and forms of participation.
The botany survey: A longitudinal study of depression and cognitive impairment in an elderly population
Authors: Snowdon John , Lane Fred
Published: December 2004

An 8‐year‐long longitudinal study of elderly people in Botany (Sydney) has provided data on the prevalence, incidence and outcome of cognitive impairment and depression in this population. In 1985, a random sample of 146 persons aged 65 years or more, living in their own homes, were assessed using the Brief Assessment Schedule, depression ratings and cognitive tests. Follow‐up interviews were conducted after 2, 4, 6 and 8 years. Data from separate hostel and nursing home studies were used when estimating prevalence rates. The estimated prevalence and annual incidence of definite dementia in Botany were, respectively, 14% (3.5% severe) and 2.5%. Among elderly people living at home the prevalence of definite dementia was 11%; 23% of our community sample suffered dementia during the 8 years. The prevalence and minimum annual incidence of depressive disorders were, respectively, 12.5% and 2.0%. Among those living at home the prevalence was 12.3%. Dementia was associated with a high mortality rate, but the apparently increased mortality of depressed subjects did not reach significance, probably because numbers were relatively small; a high proportion of the deceased had comorbid cognitive impairment. Some depressions eventually remitted.
A hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in india
Authors: Ganguli Mary , Ratcliff Graham , Chandra Vijay , Sharma Sujatha , Gilby Joanne , Pandav Rajesh , Belle Steven , Ryan Christopher , Baker Carol , Seaberg Eric , Dekosky Steven
Published: December 2004

The Indo‐US Cross‐National Dementia Epidemiology Study seeks to compare two rural populations, in the US and India: the Monongahela Valley, a rural community of relatively low socioeconomic status in southwestern Pennsylvania (USA), and Ballabgarh, a rural community near New Delhi in North India. Of Particular interest is the fact that the Ballabgarh elderly population is exclusively Hindi‐speaking, has little or no education and is largely illiterate, rendering its cognitive screening a particular challenge. In this article we report methods and preliminary data on the development of a Hindi cognitive screening instrument suitable for the Ballabgarh elderly population. We use as an example our Hindi adaptation of the Mini‐Mental State Examination (MMSE), a widely used global cognitive screening scale. Systematic, item‐by‐item, empirically based test development has shown that effective modifications can be made to existing tests that require reading and writing; and that culturally sensitive modifications can be made to render the test meaningful and relevant while still tapping the appropriate cognitive domains. Certain cognitive functions, particularly orientation to time, remain difficult to test adequately in this type of population. In Ballabgarh, as in the Monongahela Valley, educated individuals obtain higher test scores. Implications for dementia screening are discussed, including those relevant to the hypothesis that low education predisposes to dementia.
Antidepressant therapeutic effect of mianserin‐induced generalized tonic‐clonic seizure in an elderly patient
Authors: Rosenthal Michal , Schwartz Sima , Shapira Edy , Mester Roberto
Published: December 2004

Generalized tonic‐clinic seizures may appear as a side‐effect of all antidepressant drugs, including mianserin. We present here a case of an 83‐year‐old woman whose major depressive episode (superimposed on mild dementia) completely resolved following a generalized tonic‐clonic seizure. The improvement, which was maintained for 3 months, may be attributable to the drug‐induced single convulsion. It would be of interest to know whether other psychiatrists have had similar experiences concerning an immediate antidepressant effect to a single tonic‐clonic seizure (drug‐induced or provoked by electroconvulsive therapy). If a subgroup of patients responsive to single generalized tonic‐clonic seizure were to exist (especially among elderly patients), it would allow them to receive a minimal number of electroconvulsive therapy (ECT) sessions, decreasing the probability of the appearance of ECT side‐effects.