bluuebunny/crossref_metadata_2025 huggingface dataset:
Loss of immunoreactivity for glial fibrillary acidic protein (GFAP) in astrocytes as a marker for profound tissue damage in substantia nigra and basal cortical areas after status epilepticus induced by pilocarpine in rat
Authors: Schmidt‐Kastner Rainald , Ingvar Martin
Published: December 2004

Status epilepticus induced by pilocarpine in rats induces massive tissue damage comprising neurons and astrocytes (incomplete infarction) in substantia nigra pars reticulata (SNR) and in basal cortical areas (BCTX). Immunohistochemistry with a polyclonal antiserum and a monoclonal antibody to GFAP were used here to study the astroglial damage in these regions. Control sections showed a strong labeling for glial fibrillary acidic protein (GFAP) for both antibodies in SNR and BCTX. At 1 day after induction of seizures, labeling with the polyclonal antibodies showed diffuse increase within the lesioned areas and enhanced staining of astrocytes at the border zones. However, staining with the monoclonal antibody was abolished. At 3 days, labeling with both the polyclonal antiserum and the monoclonal antibody was severely reduced within the damaged regions. Reactive astrocytes in the surround of the infarct showed enhanced labeling with both antibodies. This combination of enhanced labeling with polyclonal antibodies and decreased labeling with the specific monoclonal antibody for GFAP can be taken as indicator for acute glial cell damage in seizures and related experimental conditions.
Developmental changes in the number, size, and orientation of GFAP‐positive cells in the CA1 region of rat hippocampus
Authors: Nixdorf‐Bergweiler Barbara E. , Albrecht Dorothea , Heinemann Uwe
Published: December 2004

Changes in extracellular potassium concentration as measured with ion‐selective microelectrodes revealed abnormally large accumulations in the hippocampus during postnatal development. While rises in [K+]o during stimulation of the Schaffer collaterals were limited to about 12 mM in adult animals, identical stimulations elicited rises to levels as large as 18 mM in juveniles. Since astrocytes are believed to play an important role in K+ homeostasis, we studied the postnatal development of astrocytes in the CA1 region of rat hippocampus in four age groups using a polyclonal antibody against glial fibrillary acidic protein (GFAP). The main proliferation of GFAP‐positive cells (GFAPpc) occurred in all laminae between postnatal days 8 and 16. The number of GFAP‐positive astrocytes per unit area was reached in stratum lacunosum‐moleculare and stratum oriens at about 2 weeks and in stratum radiatum at about 3 weeks of age. During further development—at the age of 24 days—the orientation of individual astrocytes in stratum radiatum became polar with an orientation almost perpendicular to stratum pyramidale. This was revealed by an analysis based on determination of the quotients between the angular orientation of the processes of single individual GFAP‐positive cells. When the crossing points of all glial processes over vertical and horizontal grid lines were determined and respective quotients evaluated, the same development towards a perpendicular orientation of astrocytes was noted in stratum radiatum. The same approach revealed a transient orientation parallel to the fissure in stratum lacunosum‐moleculare around day 24. Camera lucida drawings of GFAPpc in stratum radiatum revealed that astrocytes became larger during the first three postnatal weeks, followed by a reduction of various parameters (e.g., cell extension, branching pattern) until adulthood. The observed developmental changes of astroglial cells may contribute to the known delayed maturation of potassium regulation in rat hippocampus.
Blood monocytes and spleen macrophages differentiate into microglia‐like cells on monolayers of astrocytes: Membrane currents
Authors: Schmidtmayer Johann , Jacobsen Christian , Miksch Gundula , Sievers Jobst
Published: December 2004

Microglia, the resident macrophages of the central nervous system (CNS), can be distinguished from most other cells of the myelomonocytic lineage by a distinct pattern of memberane currents. In the accompanying paper we have shown that the characteristic morphological feature of microglia, ramification, develops both in microglia and other myelomonocytic cells when they are cocultured with astrocytes. We therefore propose that the electrophysiological properties of microglia also develop under the influence of astrocytes, and moreover, that these properties can also be induced in other cells of the myelomonocytic lineage. Microglia cultured on poly‐d‐lysine or on a monolayer of fibroblasts possess an inwardly rectifying K+ ‐current only, which is of composite nature. In single‐channel recordings two types of K+ ‐channels are found: (i) a non‐inactivating channel with a conductance of 43pS, and (ii) an inactivating channel with 32pS. Microglia cultured on a monolayer of astrocytes additionally develop an outward K+ ‐current and a Na+ ‐current. The electric parameters of activation and inactivation of the microglial Na+ ‐current are identical to those of the neuronal Na+ ‐current. Monocytes from peripheral blood and macrophages from spleen exhibit no inward currents. However, when these cells are cocultured with astrocytes they develop microglia‐like membrane currents, including the inward and outward K+ ‐rectifyer and the Na+ ‐current. By contrast, on fibroblasts they retain their macrophage current profile. The expression of the microglia‐like membrane currents in the monounclear phagocytes is induced by a diffusible factor released from the astrocytes into the culture medium, since monocytes and microglia develop the mature microglial current profile, when cultured in astrocyte conditioned medium. These findings show that the current profile of microglia develops only, when they are in association with astrocytes, and that it is induced in myelomonocytic cells from blood and spleen when these also are associated with astrocytes. These findings add to the growing body of evidence that microglia are derived from the myelmonocytic lineage and indicate that the astrocytes are involved in regulating their morphological and functional properties.
Differences in the disposition and toxicity of 1‐methyl‐4‐phenylpyridinium in cultured rat and mouse astrocytes
Authors: Tsai May J. , Lee Eminy H. Y.
Published: December 2004

Species difference in the susceptibility to 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine (MPTP) was investigated in cultured rat and mouse astrocytes, where 1‐methyl‐4‐phenylpyridinium (MPP+), the toxic mediator of MPTP, is formed. Type A monoamine oxidase (MAO) predominated in both rat and mouse astrocytes, while its activity was slightly higher in mouse cells compared to rat cells; MAO‐B activity, on the other hand, was significantly lower in mouse astrocytes than in rat astrocytes. Because both types of MAO have been reported to make similar contributions to MPP+ production in astrocytes, their total activity was examined and results indicated that there was no significant difference between these two species. In additon, MPP± caused a dose dependent loss of cell viability as judged by the amount of lactate dehydrogenase released into the incubation medium. The toxicity of MPP± on astrocytes started to be seen after a 2 day incubation period. Mouse astrocytes were more vulnerable to MPP± than rat astrocytes. The threshhold values for MPP± toxicity in mouse and rat cultures were 10 ±M and 70 ±M, respectively. After addition of [3H] MPP± to the medium, intracellular [3H] MPP± was found to increase in both cultures. Mouse astrocytes accumulated more MPP± than rat astrocytes (150 pmol/mg protein vs. 65 pmol/mg protein). When astrocytes were allowed to accumulate [3H] MPP± and then incubated in fresh medium medium not containing [3H] MPP±, intracellular levels of [3H] MPP± in both cells rapidly declined (110 pmol/protein in mouse vs. 40 pmol/mg protein in rat of MPP± been released). These results indicated that (1) MPP± could cross the plasma membrane of astrocytes despite of its charged chemical structure, (2) mouse astrocytes had a higher capacity for MPP± accumulation (approximately 2‐fold), as well as release (approximately 2.7‐fold), than rat astrocytes, and (3) mouse astrocytes were more vulnerable to MPP± than rat astrocytes.
On the existence of a cartilage‐like proteoglycan and link proteins in the central nervous system
Authors: Asher Richard A. , Scheibe Renate J. , Keiser Harold D. , Bignami Amico
Published: December 2004

Monoclonal antibodies (mAbs) against the major constituents of cartilage extracellular matrix, aggrecan and link protein, were screened by indirect immunofluorescence on frozen sections of bovine spinal cord. Antibodies against aggrecan and link protein gave rise to very similar perineuronal labeling in spinal cord gray matter. Aggrecan and link protein reactivities were seen in other regions of the central nervous system (CNS), although their distributions were not always coincident. Pretreatment of the tissue section with Streptomyces hyaluronidase, which is hyaluronate‐specific, led to the loss of both reactivities. On Western blots, anti‐aggrecan mAbs reacted with a large chondroitin sulfate proteoglycan. The chondroitinase‐treated CNS proteoglycan co‐migrated with the chondroitinase‐ and keratanase‐treated cartilage proteoglycan. In CNS tissue homogenates, the addition of Streptomyces hyaluronidase brought about the release of the proteoglycan from the tissue. Anti‐link protein mAbs were reactive with two species in the bovine CNS, the mobilities of which were very similar to those of the cartilage link proteins. The release of these species from the tissue required hyaluronidase. A rabbit antiserum against aggrecan was used to identify a similar proteoglycan in the rat CNS. In spinal cord‐derived cell cultures, the labeled material was associated with astrocytes. An aggrecan cDNA hybridized to a 9.5 kb mRNA in the rat CNS. We conclude that the perineuronal matrix consists, in part, of a hyaluronate‐bound aggrecan‐like proteoglycan and link proteins, and that the former is produced by astrocytes. © 1995 Wiley‐Liss, Inc.
Mitochondrial constituents of corpora amylacea and autofluorescent astrocytic inclusions in senescent human brain
Authors: Schipper Hyman M. , Cissé Soriba
Published: December 2004

Corpora amylacea (CA) are cytoplasmic inclusions that accumulate in human brain in the course of normal aging, and to an even greater extent, in Alzheimer's disease and other neurodegenerative conditions. In senescent and Alzheimer‐diseased human brains, astrocytes in limbic and periventricular regions exhibit red autofluorescent inclusions, homologous to Gomori‐positive astrocyte granules previously described in the brains of aging rodents and other vertebrates. We have shown that Gomori inclusions in situ and in culture are derived from autophagocytosed mitochondria exhibiting iron‐mediated peroxidase activity. In the human brain, the autofluorescent inclusions share many properties with CA. Both types of inclusion progressively accumulate in periventricular regions with advancing age, are largely astrocytic in origin, and contain various heat shock proteins and ubiquitin. Using histochemistry in conjunction with confocal microscopy, we demonstrated that both CA and the red autofluorescent granules exhibit non‐enzymatic peroxidase activity and an affinity for CAH and PAS. The only major divergent histochemical feature between the Gomori‐positive astrocyte granules and CA is the presence of orange‐red autofluorescence in the former and the absence of endogenous fluorescence in the latter. On the basis of numerous shared topographic and histochemical features, we hypothesized that CA are largely derived from autofluorescent (Gomori‐positive) astrocyte granules which reside in periventricular regions of the senescent CNS. Immunofluorescent labeling and laser scanning confocal microscopy demonstrated consistent colocalization of the mitochondrial proteins, sulfite oxidase, and heat shock protein 60, to both CA and the autofluorescent astroglial inclusions. In addition, both CA and the autofluorescent astrocyte granules exhibit staining for DNA which colocalizes to mitochondrial antigens and therefore likely represents mitochondrial nucleic acid in dual‐labeled preparations. These observations suggest that a) Gomori‐positive astrocyte granules in human brain are homologous to those described in rodents, b) Gomori‐positive granules may be structural precursors of CA in senescent human brain, and c) in the aging human brain, degenerate mitochondria within periventricular astrocytes give rise to autofluorescent cytoplasmic granules and corpora amylacea. © 1995 Wiley‐Liss, Inc.
Forced to be free
Authors: Midwinter Eric
Published: December 2004

Dr Eric Midwinter MA, became Director of the Centre for Policy on Ageing in September 1980. In the field of ageing he is particularly associated with education and leisure opportunities, income maintenance and the political and cultural dimension of older age. He is General Secretary of the University of the Third Age National Committee, and is author of ‘Age is Opportunity: education and older people’ and ‘Mutual Aid Universities’, as well as ‘The wage of retirement: the case for a new pensions policy’.

Social historian, educationist, consumer champion, author and broadcaster, his previous career was principally in the community education field and the public service consumer movement, and he is at present Chairman of the London Regional Passengers Committee.
Dementia psychiatric symptoms and immobility: A one‐year follow‐up
Authors: Ballinger Brian R. , McHarg Anne M. , MacLennan William J. , Ogston Simon
Published: December 2004

One hundred elderly patients investigated for a cross‐sectional relationship between dementia and limited mobility were reviewed a year later. Forty patients had died during this time. While there was a strong relationship between poor mobility and mortality, there was little between psychiatric function or symptoms and mortality. There was also a considerable decline in physical function over the year, but little association between original mental function and this. Finally, there was a decline in cognitive function. There was no increase in the frequency of other psychiatric symptoms, but different patients were affected by particular symptoms initially and one year later.
Cost implications of depression in older adults
Authors: Gottlieb Gary L.
Published: December 2004

The economic effects of mental disorder on individuals and their families and on society have received little scientific attention. Late life depression imposes substantial disability and it affects all spheres of function. Therefore, the development of rational health policy regarding this disorder requires prospective evaluation of related costs and the determination of the value of proposed interventions. A vigorous review and analysis of the existing literature provides a framework for synthesis of an aggressive research agenda which emphasizes four major areas: (1) Improved diagnostic rigour; (2) Integration of economic and epidemiologic methods; (3) Microscopic studies of individual and family costs; (4) Interventional benefit/cost analysis.
CSF monoamine metabolites in dementia of the Alzheimer type and controls: Evidence for lower levels of homovanillic acid and 5‐hydroxyindoleacetic acid in patients
Authors: Westenberg Herman G. M. , Verhoeven Wim M. A.
Published: December 2004

The monoamine metabolites 5‐hydroxyindoleacetic acid (5‐HIAA) and homovanillic acid (HVA) in lumbar cerebrospinal fluid (CSF) were measured in 15 patients with dementia of the Alzheimer type (DAT) and 48 controls by means of a sensitive liquid chromotagraphic method. Relative to a large group of control subjects, the mean CSF 5‐HIAA and HVA levels in patients with DAT appeared to be significantly lower. This finding appeared to be sex‐related, in that the decrease in CSF monoamine metabolite levels could be attributed predominantly to male patients. A statistically significant relationship was found between 5‐HIAA and HVA in both patients and controls. Linear regression analysis revealed a statistically significant positive relationship between age and CSF HVA in female controls only. No relationship was found between 5‐HIAA and age either in patients or in controls. It is concluded that CSF 5‐HIAA and HVA levels are decreased in male patients with DAT, probably signalling a sex‐related change in serotonin and probably dopamine functioning in the central nervous system.
Lithium augmentation in the treatment of refractory depression in old age
Authors: Finch E. J. L. , Katona C. L. E.
Published: December 2004

A retrospective study of treatment and outcome is described in 59 consecutive referrals to a catchment psychogeriatric service meeting ICD9 criteria for manic depressive illness or depressive neurosis. Of 22 who failed to respond to tricyclic antidepressants, nine (of whom four had also failed to respond to ECT) were treated by lithium augmentation. Systematic comparisons between lithium‐treated subjects, tricyclic responders and others failing to respond to tricyclics revealed no significant demographic differences. Lithium augmentation was successful in 6/9 subjects. Two ‘lithium failures’ were treated with tranylcypromine to good effect. At follow‐up (median six months, range 3–20 months) 7/9 subjects in the lithium‐treated group were well. This was similar to the follow‐up status in tricyclic responders and significantly better than outcome in the other tricyclic non‐responders. Lithium augmentation appears to be a relatively well‐tolerated treatment manoeuvre in refractory depression in old age, with treatment response similar to that reported in younger subjects, and may be of particular use where ECT has failed.
Social support networks and formal support as factors influencing the psychological adjustment of spouse caregivers of dementia sufferers
Authors: Morris Lorna W. , Morris Robin G. , Britton Peter G.
Published: December 2004

The study investigated the relationship between social and formal support in promoting the psychological adjustment of spouse caregivers of dementia sufferers. It was found that the quality of social support was negatively correlated with the degree of perceived strain and the level of depression. This result suggests that social support reduces the caregiver's strain or depression. In contrast, formal support was positively correlated with strain, but not with depression, indicating that in the present sample, increased formal support may be reactive to strain in the caregiver. The implications of the findings for the community care of dementia sufferers are discussed.
Positron emission tomography in dementia: A clinical review
Authors: Burns Alistair , Tune Larry , Steele Cynthia , Folstein Marshal
Published: December 2004

Positron emission tomography (PET) is a technique which enables direct measurement of cerebral metabolism to be made. The procedure has exciting possibilities for the investigation of brain metabolism but there are limitations and problem which need to be overcome. A review is presented of the current state of knowledge of PET in relation to dementia, the techniques used, the practicalities of performing a scan and the limitations involved.
Alcohol use and abuse in the elderly: Findings from the liverpool longitudinal study of continuing health in the community
Authors: Saunders Paul A. , Copeland John R. M. , Dewey Michael E. , Davidson Ian A. , McWilliam Christopher , Sharma V. K. , Sullivan Caroline , Voruganti L. N. P.
Published: December 2004

Problem drinking and patterns of alcohol consumption are examined as part of a follow‐up study of 1070 elderly subjects randomly selected from Liverpool general practitioner lists. Using a community version of the Geriatric Mental State Examination, the prevalence of current drinking problems was found to be 9.4/1000 subjects aged 65 and over. At follow‐up three years later, one‐third were drinking moderately and a similar proportion whose health had seriously deteriorated were abstinent. Detailed examination of drinking patterns reveals a decline with age in the number of subjects drinking regularly. This decline is accompanied by a trend towards reduction in alcohol consumption with age which is less marked for women. Nearly one‐fifth of both males and females who are drinking regularly are exceeding recommended sensible limits of alcohol consumption.
Psychogeriatric consultation within a geriatric hospital: A six–year experience
Authors: De Leo Diego , Baiocchi Antonella , Cipollone Bruno , Pavan Luigi , Beltrame Paolo
Published: December 2004

This article describes a six‐year experience of psychiatric consultation in Padua Geriatric Hospital (Italy). Motivation for the request for psychiatric treatment, diagnosis, recommended treatment and compliance with it by the geriatric medical staff are reported. The authors stress the radical change in the activities of the consultants since the establishment in 1986 of a new psychogeriatric unit, probably still the only such unit in formal existence in Italy. The service offered by the team thus underwent considerable innovation, leading to substantial modifications in treatment and, especially, to a reduction in the duration of hospital stay of patients admitted to the psychogeriatric unit.
The prevalence of psychiatric illness among continuing‐care patients under the care of departments of geriatric medicine
Authors: Bond John , Atkinson Ann , Gregson Barbara A.
Published: December 2004

Between 1983 and 1987, 568 patients in three centres, who were under the care of consultant physicians with a special interest in elderly people, were referred to a randomized controlled trial as part of the evaluation of the three experimental NHS nursing homes. All patients referred to the trial were defined by the referring consultant as ‘long‐stay’ or ‘continuing‐care’ patients. The mental state of patients was assessed as part of the baseline assessments undertaken at entry to the trial. Two methods of assessment were used. First, the presence of organic psychiatric disorders and of affective disorders and psychoneuroses was assessed using the Survey Psychiatric Assessment Schedule. Second, the presence of ‘confusion’ was estimated using the the modified Crichton Royal Behavioural Rating Scale. The prevalence of organic psychiatric conditions was found to be 72% and of affective disorders and psychoneuroses 40%. This substantial proportion of people with psychiatric illness has major implications for the training of both medical and nursing staff working in non‐psychiatric hospitals.
Changes in erythrocyte ouabain binding with age in down's syndrome and in controls
Authors: Naylor G. J. , Shepherd B. , Findlay D. , Young S. , McRae D.
Published: December 2004

Ouabain binding was estimated in erythrocytes from 31 patients with trisomy 21 and 32 matched mentally handicapped controls. The ouabain binding of the control group decreased significantly with age, as expected, but this change did not occur in the Down's syndrome group. However, the ouabain binding of the younger (less than 40 years) Down's group was significantly lower than that of the younger controls and simply remained low in the older group.
The impact of reminiscence groups in two different settings
Authors: Head Donna Marie , Portnoy Sara , Woods Robert T
Published: December 2004

Reminiscence groups are being increasingly used as a ‘therapeutic’ activity with elderly people suffering from dementia. A report on two separate reminiscence groups carried out in two different day centres is presented. The settings are described along with the aims, methods and content of the two groups. The study compared the effect of reminiscence with the effect of alternative group activities on elderly people's interaction in the two separate settings using an observational methodology. The interaction pattern of a staff member in each centre was also observed. The impact of the reminiscence groups in the two day centres was quite different, illustrating the need for careful definition of environmental factors in evaluating such approaches. Where there was previously little interaction during an alternative group activity, reminiscence produced a dramatic change in the behaviour of the staff member and elderly people observed. In an initially ‘richer’ environment, reminiscence did not effect a change in either staff or elderly people. Ways in which reminiscence may best be used with elderly people with dementia are discussed, and the extension of observation to include more qualitative aspects of interaction is recommended.
Measures of ageing in senile dementia of Alzheimer type and in controls
Authors: Shepherd Beryl , Naylor Graham J. , Smith Anne H. W. , McHarg Ann , Harper Margaret
Published: December 2004

Patients suffering from senile dementia of Alzheimer type, elderly patients suffering from functional psychiatric illness and younger functionally ill patients were tested using a battery of ageing measures. Although the younger group was clearly different from the older groups, there was no statistically significant difference in measures of ageing between the demented and non‐demented elderly groups.
Dexamphetamine may reduce hyperactivity in dementia—a case study using direct observation
Authors: Hope R. A. , Patel Vikram , Series Hugh
Published: December 2004

Excessive motor activity (hyperactivity) often causes management problems in people with dementia. We report a 63‐year‐old woman with a clinical diagnosis of Alzheimer's disease whose hyperactivity dramatically improved when she was given dexamphetamine. The improvement was maintained after the amphetamine was stopped. Assessment included the use of standardized direct observation.
Subclinical dementia. Relation to cognition, personality and psychopathology: A nine‐year prospective study
Authors: Persson Göran , Berg Stig , Nilsson Lars , Svanborg Alvar
Published: December 2004

In 1971/72 a representative sample of 70‐year‐olds was studied by means of psychological tests and personality inventories. Subjects showing evidence of dementia were excluded. Those who developed severe dementia between the ages of 70 and 79 were compared with those who did not. At 70, males subsequently developing dementia scored lower on a test of reasoning and on a test of perceptual speed, and needed more time to complete their tests than did the other males. At the same age, females subsequently developing dementia were slow on some of the tests, scored lower on a personality dimension pertaining to available resources of mental energy and scored higher on a personality dimension pertaining to a need to keep other people at a distance than did the other females. A logistic regression analysis demonstrated that the time taken to complete some of the cognitive tests and the personality dimension pertaining to mental energy independently predicted the development of severe dementia. There were no differences with regard to psychiatric diagnoses. The question whether these findings might be interpreted as early manifestations of dementia or as predisposing factors is as yet unanswered.
A comparison of care in private nursing homes, geriatric and psychogeriatric hospitals
Authors: Philp Ian , Mutch William J. , Ballinger Brian R. , Boyd Louis
Published: December 2004

There is considerable debate about who should provide long‐term institutional care for the elderly.

We describe and compare care in three private nursing homes, 12 long‐term geriatric and 10 psychogeriatric hospital wards which service a Scottish city using measures of patient dependency, patient morale, regime, environment and staff morale.

There was overlap of phsyical dependency between geriatric and psychogeriatric wards but lower dependency in nursing homes. There was a high prevalence of cognitive impairment in all sectors (<80%) limiting the use of patient self‐report measures, but nursing home patients were more satisfied with staff than geriatric patients (p < 0.05).

Nursing home staff had greater job satisfaction than geriatric (p <0.01) or psychogeriatric (p < 0.05) staff.

There were large variations between homes and between wards in measures of regime and environment, with overlap of most measures between the three settings, suggesting that where care is provided is less important than how it is shaped at the level of individual homes and wards.
Neuroticism may be associated with history of depression in the elderly
Authors: Abrams Robert C. , Young Robert C. , Alexopoulos George S. , Holt Jonathan H.
Published: December 2004

The relationships between geriatric depression and various personality traits have never been fully clarified, and their clinical significance is uncertain. Depression in geriatric patients may differ from the disorder found in younger individuals, and may also have distinctive personality antecedents or consequences. In this study 16 elderly subjects who had recovered from depression and 14 elderly control completed the Eysenck Personality Inventory (EPI) and the Personality Disorder Examination (PDE). On the EPI, neuroticism subscale scores were significantly higher for patients than controls, while mean extraversion scores were not significantly different. On the PDE, recovered depressives had higher dimensional scores than controls in each DSM‐III‐R personality disorder except antisocial. Neuroticism scores correlated significantly with PDE dimensional scores for all but two of the DSM‐III‐R personality disorders, while extraversion scores correlated significantly with only two PDE categories. Together, these findings suggest that neuroticism and criteria for most DSM‐III‐R personality disorders may be associated with history of depression in a geriatric population.
The cognitive efficiency profile: Description and validation in patients with Alzheimer's disease
Authors: De Rotrou Jocelyne , Forette Francoise , Hervy Marie Pierre , Tortrat Daniele , Fermanian Jacques , Boudou Marie‐Renee , Boller Francois
Published: December 2004

The rigorous diagnosis of dementia, especially in the early stages, requires clinical observation and neuropsychological tests. This article shows how a short strategy‐oriented neuropsychological battery, the Cognitive Efficiency Profile (CEP), can contribute to the early diagnosis of Alheimer's disease.

The CEP was given to 56 subjects who had been independently diagnosed as being cognitively unimpaired (N = 16), as having probable AD with mild dementia (N = 32) or as having “borderline” deterioration (N = 8). One‐year follow‐up showed that all the latter patients developed unequivocal dementia. There was a clear‐cut separation in the test results between the controls and the probable AD cases when the scores were corrected for age and education. There was some overlap between the borderline cases and the probable AD patients but, in all cases, the corrected scores fell below those of normal controls.

The usefulness of the CEP rests on the fact that it assesses the efficiency or the failure of strategies applied to a number of abilities related to cognitive efficiency. Coupled with clinical data, a good or a poor performance on the CEP strongly corroborates the diagnosis of normal cognitive functioning or of dementia in the elderly.
Does a mirror deter wandering in demented older people?
Authors: Mayer Robert , Darby Stuart J.
Published: December 2004

The management of wandering behaviour in the confused older person raises a dilemma concerning the contravention of basic human rights and the maintenance of individual safety, balancing an acceptable risk while ensuring the duty to care. In general, where restraint is used, a less restrictive method is to be preferred over one which is more so. Observations on a psychogeriatric ward of nine habitual wanderers compared the rate of successful exit door contact (touching, opening or exiting) over a two‐week period under three experimental conditions. These included the use of a full‐length mirror, placed in front of the door, the mirror reversed, and neither. A reduction in successful exit door rates from 76.2% to 35.7% (p <0.02) was noted with the mirror in use, compared with no mirror. The possible mechanism for the putative effect is discussed.
Diazepam in depressive stupor: A case report
Authors: Shah A. K. , Cope H.
Published: December 2004

With the aid of a case report the efficacy of intravenous diazepam in depressive stupor for diagnostic and therapeutic purposes is described. This may enable use of conventional drug treatment and postpone or avoid use of electroconvulsive therapy.
Psychogeriatric day care outcome: A five‐year follow‐up
Authors: Diesfeldt Han
Published: December 2004

All 224 consecutive new patients who were admitted in 1982 through 1985 to the day care department of a skilled‐care psychogeriatric nursing home were followed longitudinally until death. Dementia was diagnosed in 95.1% of the 133 women and 91 men. Their mean age at admission was 78.7 years (SD = 7.4). Every 12 months after their initial attendance the patients' status was recorded and coded as living in the community, institutionalized or dead. At one year after initial attendance 99 (44.2%) patients still resided in the community, 94 (42.0%) were admitted to a nursing home or (psychiatric) hospital and 31 (13.8%) had died. At five years only nine (4.0%) patients resided in the community, 65 (29.0%) were in long‐term institutional care and 150 (67.0%) had died. Age, gender, socioeconomic status or living alone did not contribute to first‐year outcome, but severity of cognitive impairment was associated with an increased risk of becoming institutionalized. Using logistic regression analysis, a model of three variables, living at home, needing help from caregiving children, and high ratings of dependency, assigned 61.4% of 176 subjects correctly as institutionalized versus residing in the community.
Elderly survivors of the Lockerbie air disaster
Authors: Livingston Hilary M. , Livingston Martin G. , Brooks D. Neil , McKinlay William W.
Published: December 2004

Thirty‐one elderly people were examined in Lockerbie and compared with 24 younger survivors of the disaster which took place in December 1988. Examination took place within one year of the disaster, but was timed to avoid the anniversary period. All subjects were in Lockerbie at the time the aeroplane exploded in mid‐air. Examinations were conducted for purposes of medico‐legal assessment. The elderly had similar responses to the younger disaster victims, the majority of whom met DSM‐III‐R criteria for PTSD. The elderly, however, had a very high incidence of coexisting major depression, unlike the younger population. Loss or injury to friends and the witnessing of human remains was positively correlated with a diagnosis of post‐traumatic stress disorder in the elderly but not in the younger subjects. Neither material nor personal loss, nor the witnessing of human remains, was associated with a diagnosis of depression in the elderly, although significant material loss was associated with depression in the younger patients.
Antipsychotic drugs in continuing care: A 2‐year follow‐up audit
Authors: Connelly Peter J.
Published: December 2004

The use of antipsychotic drugs was examined in a geriatric psychiatry continuing care unit using the same procedures as in 1990 in the same unit. The main change in practice between the 2 years was the increased use of high‐potency preparations in 1992, though in low dosage. The group on regular antipsychotics (RA) were less dependent and more disturbed than the group on no psychotropic medication (NM) but the severity of behaviour problems had fallen considerably in the RA group. Although those on high‐potency (HP) preparations were most disturbed than those on low‐potency (LP) drugs, this was partly a result of the policy of giving HP drugs to those who had responded inadequately to LP preparations. 31.5% of the population studied were on RA (37.5% in 1990) and 53% on NM (46% in 1990). Factors influencing the prescription and withdrawal of antipsychotic drugs in demented patients are discussed, and the need to develop clearer guidelines for the drug treatment of behaviour disturbance associated with dementia is identified.
The course of mild dementia in a birth cohort
Authors: Magnússon Hallgrímur , Helgason Tómas
Published: December 2004

The mental health of a birth cohort has been followed until the age of 87 years. The cohort consists of all Icelanders born during a period of three years. Only three probands were lost in the follow up period from 61 to 87 years.

The diagnoses were made by two methods: an indirect method based mainly on information provided by general practitioners, and the computerized diagnosis AGECAT.

Many cases diagnosed as mild dementia by the indirect method had no or very few cognitive symptoms when the AGECAT was applied.

The diagnosis of mild dementia is associated with high mortality. Almost 30% of cases of mild dementia diagnosed by the indirect method before the age of 75 years have no symptoms of dementia at the age of 81 years and more than 10% continue to have mild symptoms. Similar results are found at the age of 87 years.

Atherosclerotic disorders are present in 48.6% of cases of mild dementia and 58.6% of severe dementia in contrast to only 25–30% of probands with a effective disorder or without psychiatric diagnosis.
Syphilis, neither dead nor buried—A survey of psychogeriatric inpatients
Authors: Cleare Anthony James , Jacoby Robin , Tovey Stuart John , Bergmann Klaus
Published: December 2004

Over a 5‐year period, 3.8% of 423 psychogeriatric inpatients who were tested for syphilis had positive serology. Eight out of 14 received treatment, in contrast to previous suggestions that treatment was rarely instigated. Screening and adequate investigation of this population remain important, and we believe that serology should be carried out routinely in organic cases.
Family therapy and dementia: Review and clinical experience
Authors: Benbow S. M. , Marriott A. , Morley M. , Walsh S.
Published: December 2004

Family therapy techniques have, until recently, had little impact on the development of old age psychiatry and the services provided. The literature on family therapy in relation to people with dementia and their families is reviewed and illustrated with results from a study of families coping with dementia who attended the York House Family Clinic. Similar therapeutic techniques were used with families coping with dementia as with those coping with other mental illnesses in later life, but some differences were found in the areas of discussion during sessions. Families coping with dementia were seen for fewer sessions, but more family members were present per session and sons and daughters‐in‐law were more likely to attend. The literature and various hypotheses which might explain these differences are presented and discussed. Further work in this area is needed, but our findings suggest that family therapy can be useful in work with dementia sufferes and their families, and can be offered within an old age psychiatry service.
Using direct observation to record the behaviour of long‐stay patients with dementia
Authors: Bowie Peter , Mountain Gail
Published: December 2004

This article describes the development of a direct observation system for the assessment of the behaviour of elderly demented long‐stay patients. The technique of recording behaviour in real time has high face validity, and in conjunction with portable computers was found to be very reliable. The technique was used to assess the behaviour of patients during their waking day on seven wards. The findings suggest that almost two‐thirds of the day is spent doing nothing, with aimless or disruptive behaviours also accounting for a significant period of the day. Only a small proportion of the day was spent in self‐care or social behaviours.
One‐year follow‐up of continuation convulsive therapy prescribed for depressed elderly patients
Authors: Mirchandani Indu C. , Abrams Robert C. , Young Robert C. , Alexopoulos George S.
Published: December 2004

Nine elderly patients with major depression were followed for outcome of continuation ECT. All nine patients had poor response to pharmacotherapy of the index episode, favorable response to acute treatment with ECT and, to varying degrees, previous failure of prophylactic pharmacotherapy. Four of the nine patients complied with continuation ECT as recommended for periods of 9 months to 1 year; these patients remained essentially well during the follow‐up period, while the five who stopped the treatment prematurely fared poorly (one died, one required chronic hospitalization and three where rehospitalized acutely). These findings suggest the need for controlled studies of continuation ECT in geriatric depression.
Does education protect against cognitive impairment? A comparison of the elderly in two australian cities
Authors: Jorm A. F. , Henderson A. S. , Scott R. , Korten A. E. , Christen H. , Mackinnon A. J. , Kay D. W. K.
Published: December 2004

Cognitive impairment was assessed using the Mini‐Mental State Examination in commuity surveys of the elderly in Canberra and Hobart. Mean scores on the Mini‐Mental were higher in Canberra than in Hobart and the prevalence of cognitive impairment was lower. This difference was found to be attributable to the higher level of education in the Canberra elderly. When education was statistically controlled, the difference between the cities disappeared. These findings may have implications for future cohorts of the elderly, which will have a higher level of education than the present‐day elderly. It is argued that the prevalence of congnitive impairment could drop in the future.
Cognitive assessment in alzheimer's disease: What does the camcog assess?
Authors: Greifenhagen A. , Kurz A. , Wiseman M. , Haupt M. , Zimmer R.
Published: December 2004

The CAMDEX (Cambridge Mental Disorders of the Elderly Examination) is a widely used instrument for the diagnosis of dementia. It contains a cognitive section (CAMCOG) which consists of 60 items grouped into eight a priori subscales (orientation, language, memory, praxis, attention, abstract thinking, perception and calculation). A principal component analysis was performed on CAMCOG data from 191 patients with probable Alzheimer's disease (mild to moderate dementia). The analysis identified four factors which were interpreted clinically as representing language/praxis, visuoconstructive abilities, remote memory and short‐term memory. These factors differed in number and in composition from the a priori subscales postulated by the developers of the instrument. The results of the principal component analysis of empirical CAMCOG data demonstrate an overlap and potentiation of different cognitive deficits in AD.
The Lockerbie disaster: A 3‐Year follow‐up of elderly victims
Authors: Livingston Hilary M. , Livingston Martin G. , Fell Sheila
Published: December 2004

The long‐term outcome of a civilian disaster is examined in an elderly population assessed originally for medicolegal purposes. Thirty‐one elderly inhabitants of the village of Lockerbie, who had survived the Lockerbie air disaster, were assessed 1 year after the event. Nineteen of the sample were available for reexamination 2 years later. Although there was a significant reduction in the incidence of PTSD and significant improvement across a range of anxiety‐based symptoms, 15.7% of the subjects continued to fulfil diagnostic criteria (DSM‐III‐R) for PTSD. In these subjects, there was a persistence of other anxiety‐related symptoms and of major depression (DSM‐III‐R). This is the only longitudinal assessment of PTSD in elderly subjects and it shows that, as with younger subjects, PTSD tends to persist for at least 2 years after the traumatic event and, for a substantial minority, has still not remitted within 3 years of the traumatic event.
Lithium augmentation in geriatric depressed outpatients: A clinical report
Authors: Parker Karen L. , Mitmann Nicole , Shear Neil H. , Herrmann Nathan , Shulman Kenneth I. , Silver Ivan L. , Gardner David M. , Busto Usoa E.
Published: December 2004

Lithium augmentation of antidepressant therapy in elderly outpatients has not been systematically assessed. A prospective, practice‐based observational study of 44 patients comparing an antidepressant monotherapy group (N = 23) with a lithium augmentation group (N = 21) was conducted in a geriatric psychiatry, outpatient clinic. The severity of depression was evaluated with the Montgomery–Asberg Depression Rating Scale (MADRS), the DSM‐III‐R Global Assessment of Functioning (GAF), a treatment effectiveness rating (ER) and the Geriatric Depression Scale (GDS). Patient‐reported adverse events were systematically collected. The mean age for the group was 76.5 ± 6.0 years, 81.8% were female and the most common principal diagnosis was major depression (88.6%). Doxepin was the most commonly prescribed antidepressant (29.5%), followed by nortriptyline (27.2%) and phenelzine (15.9%). Patients receiving lithium augmentation were less depressed and functioning better than those in the antidepressant alone treatment group—MADRS: 8.5 ± 8.8 vs 13.9 ± 9.0 (p < 0.05); GAF: 77.9 ± 8.3 vs 68.5 ± 10.5 (p < 0.01); ER: X2 = 4.5 (p < 0.05); GDS: 4.0 ± 2.7 vs 5.9 ± 4.3 (NS). Patients in the lithium group tended to report fewer adverse events (3.7 ± 2.1 vs 5.0 ± 3.0 (NS)). Results suggest that lithium augmented patients are less depressed and report fewer adverse events than those on antidepressants alone. Lithium appears to be a safe and effective addition to antidepressant pharmacotherapy in the elderly.
Depression and dementia in geriatric inpatients: Diagnostic comparisons between psychiatrists, geriatricians and test scores
Authors: Ryan D. H. , Blackburn P. , Lawley D. , Ellis A. , Musil J. , Kendrick D. C.
Published: December 2004

A clinical and psychometric survey of depression and dementia in acute geriatric admissions (n = 50) found clinical evidence of depression and dementia in 25% and 35% of patients respectively, consistent with the results of prevalence surveys of geriatric hospital inpatients. There was a significant correlation between clinical assessment of dementia by geriatricians, and psychiatrists, and cognitive impairment using the Middlesex Elderly Assessment Memory Schedule (p < 0.01). Although an intercorrelation between clinical diagnosis of depression by geriatricians, psychiatrists and scores on the Geriatric Depression Scale (GDS) just reached significance (p < 0.05), there was no association between diagnosis of depression by geriatricians and GDS at a cutoff score of 11/30. The relationship was significant at a cutoff score of 16/30 (p < 0.02). In contrast, the associations between diagnosis of depression by psychiatrists and GDS were highly significant at both cutoff points (p < 0.002 and p < 0.001 respectively). No significant differences were found between geriatricians and psychiatrists on indications for (1) antidepressant medication, (2) referral to liaison psychiatry, or (3) referral to a community mental health team. None of the inpatients assessed were receiving antidepressant medication at the time of their discharge from hospital although depression was diagnosed in a quarter of all inpatients and geriatricians supported the use of antidepressant treatment in 40% of those cases identified. Factor analysis suggested that geriatricians were identifying a subgroup of patients as depressed who were not recognized either by psychiatrists or by psychometric testing. Patients with abnormal scores on psychometric testing were followed up after discharge and retested. There was evidence of a significant fall in GDS scores and a non‐significant trend to increased fail scores on the MEAMS test suggesting an improvement in depressive symptoms with physical recovery and further cognitive decline following discharge. The results of the present study underline the need for active liaison between geriatricians and psychiatrists to improve the recognition and treatment of concurrent psychological problems during inpatient episodes.