bluuebunny/crossref_metadata_2025 huggingface dataset:
The Prevalence of White-Matter Lesions on Computed Tomography of the Brain in Demented and Nondemented 85-Year-Olds
Authors: Skoog Ingmar , Palmertz Bo , Andreasson Lars-Arne
Published: March 2014

The prevalence of white-matter lesions on computed tomography was studied in a representative sample of 85-year-olds living in Gothenburg, Sweden. The study included a psychiatric examination, interview of a close informant, neuropsychological examination, physical examination, comprehensive laboratory tests, electrocardiogram, chest x-ray, computed tomography scan of the head, and cerebrospinal fluid analysis. The diagnoses of dementia and other mental disorders were made according to DSM-III-R criteria. The prevalence of white-matter lesions in demented subjects was 68.9%, and in nondemented, 33.8%. Their prevalence was not increased in any mental disorder other than dementia. All severities of dementia and the subtypes, Alzheimer's disease, vascular dementia, and other types of dementia, had a significantly higher prevalence of white-matter lesions than did nondemented subjects. The risk for dementia, but not its severity, increased with the severity of these lesions. A stepwise logistic regression analysis showed that both white-matter lesions and infarcts on computed tomography contributed independently to dementia.

White-matter changes may be a contributing cause of dementia in the oldest old, or may represent a disease entity of its own. They are important to recognize since they may be potentially preventable, or even treatable.
Retirement Planning by Black Psychiatrists
Authors: Baker F. M.
Published: March 2014

Fifty-three percent of active members of the Black Psychiatrists of America responded to a mailed survey that assessed retirement planning issues. Sixty-five percent of respondents were male, 61% were married, 71% had children, and 83% owned their own homes. Thirty-nine percent owned property in another state. The major anticipated reason for retirement was “a full life, and being ready for a change of pace.” A financial planner was used by 48% of the sample, and retirement seminars were attended by over 50% of the respondents. The majority of the sample were involved in the practice of adult psychiatry in multiple settings, including private practice settings, academic practice, mental health center practice, and state hospital practice. Eleven percent of respondents were retired.
Prevalence of Personality Disorders in Two Geropsychiatric Inpatient Units
Authors: Molinari Victor , Ames Ashley , Essa Mohsain
Published: March 2014

One hundred males from a Veterans Affairs geropsychiatric inpatient ward, and 100 females from a geropsychiatric inpatient ward of a private hospital completed the Structured Interview for Disorders of Personality-Revised (SIDP-R). Chart reviews provided information including age, years of education, marital status, race, as well as Axis I and Axis II psychiatric diagnoses. Data from a young adult sample, drawn from an initial SIDP-R validation study, were used for comparison. Results indicate a 56.5% rate of personality disorders (PD) for older patients. Significantly more elderly men than elderly women were diagnosed with PD by psychiatric evaluation, and elderly men were also more likely to be diagnosed with paranoid, avoidant, and multiple PD using the SIDP-R. Psychiatrists gave far fewer Axis II diagnoses than were yielded by the SIDP-R, particularly with females. There were no significant differences in total PD rates between aged and young subjects, but older adults with PD were diagnosed less frequently with multiple PD. Older adults were also less likely to be diagnosed with the “Dramatic” cluster PD, and more likely to be diagnosed with the “Odd” cluster PD. The level of depression was related to both clinical and SIDP-R diagnoses.
Association of Antidepressants and Other Medications with Mortality in the Residential-Care Elderly
Authors: Katz Ira R. , Parmelee Patricia A. , Beaston-Wimmer Patricia , Smith Buster D.
Published: March 2014

To explore the extent to which treatment of depression affects survival, we evaluated the association between use of antidepressant medications and death rates among the residents of a large residential-care facility for the elderly using a retrospective record-review study (N=624). One year survival, among those taking antidepressants (10.9%), was 11.8% compared to 11.1% among the remainder of the population. A second study followed a group of 32 patients in the same institution who had participated in a therapeutic trial of nortriptyline treatment for major depression. Patients who experienced adverse medical events during treatment exhibited significantly increased mortality; among treatment completers, there was no significant relationship between mortality and therapeutic response. These findings suggest that the inability to tolerate treatment with an antidepressant can be considered a manifestation of physiologic frailty and increased vulnerability to mortality from disease. The previously reported decrease in survival among residential-care patients with major depression is not paralleled by a similar effect in those taking antidepressants. This may reflect selection factors with respect to the ability to tolerate antidepressants, rather an effect of treatment.
Treatment of Depression in Advanced Alzheimer's Disease Using Sertraline
Authors: Volicer Ladislav , Rheaume Yvette , Cyr Dale
Published: March 2014

Effects of sertraline on the affect and food refusal of patients with advanced dementia of the Alzheimer type (DAT) are reported. Out of 10 patients with depressed affect, sertraline improved affect in eight. Six of these patients were also refusing food, and sertraline diminished food refusal in five of them. A case report of a patient who had a dramatic improvement in response to sertraline treatment is presented.
Fluoxetine-Induced Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Geriatric Case Report and a Review of the Literature
Authors: Druckenbrod Richard , Mulsant Benoit H.
Published: March 2014

In a frail, elderly, depressed patient, hyponatremia can present a difficult diagnostic and management challenge. We report the case of a severely depressed 83-year-old woman presenting with severe hyponatremia, eventually attributed to a syndrome of inappropriate, antidiuretic hormone (SIADH) secretion induced by fluoxetine. This case is discussed in the context of the multiple potential causes of hyponatremia in an elderly depressed patient, with a focus on fluoxetine-induced SIADH, as reported in 9 other published cases.
Pharmacotherapy of Cognitive Impairment in Alzheimer's Disease: A Review
Authors: Patel Shirish V.
Published: March 2014

Experimental pharmacotherapy of cognitive impairment in Alzheimer's disease has seen a recent proliferation of drug trials involving a wide variety of drugs. Many of the earlier studies focused on cholinergic agents. However, subsequent advances in basic and biological sciences have broadened the scope of therapeutic strategies beyond the neurotransmitter approaches to include neurotrophic, metabolic-enhancing, membrane-modifying, and antitoxic agents, and have also provided rationale for developing antiamyloid and anti-infective therapies. For the clinician, it has not been easy to keep abreast of these developments. In this article, I present an overview of the cognition-enhancing drugs that have been used in the past, of those currently under investigation, and of new drugs and strategies that are likely to receive attention in the next few years.
Depressive Symptoms in Alzheimer's Disease and Multi-infarct Dementia
Authors: Reichman William E. , Coyne Andrew C.
Published: March 2014

We examined the prevalence of major depression, depressed mood/anhedonia, and subjective and neurovegetative symptoms of depression that were unaccompanied by depressed mood/anhedonia in patients with clinically-diagnosed Alzheimer's disease (AD) and multi-infarct dementia (MID). The specificity of subjective and neurovegetative depressive symptoms for depressed mood in dementia was examined, as was the impact on depression of clinical variables such as family history, patient age, and dementia severity. Subjects were 105 outpatients who met DSM-III-R criteria for AD (n = 67) or MID (n = 38). Depressed mood/anhedonia was frequently noted in both the AD (40.3%) and MID (34.2%) groups. One or more depressive symptoms, not accompanied by depressed mood/anhedonia, were also common in AD and MID (49.3% and 36.8%, respectively). Major depression was relatively uncommon in AD (10.5%) but was noted more frequently in MID (29.0%). Among AD patients, neurovegetative symptoms of depression were not any more common in patients with depressed mood/anhedonia than in those without depressed mood/anhedonia. Subjective symptoms of depression were also not significantly associated with depressed mood/anhedonia. The study highlights the importance of viewing major depression, depressed mood-anhedonia, and other depressive symptoms (subjective and neurovegetative) as separate entities in AD and MID.
Clomipramine Treatment of Paraphilias in Elderly Demented Patients
Authors: Leo Raphael J. , Kim Kye Y.
Published: March 2014

Sexually inappropriate conduct often accompanies the disinhibition associated with dementia and neuropsychologic deficits. Management of these behaviors is problematic and time consuming. We report two cases in which paraphilias responded to treatment with clomipramine. This effect was not due to the sexual side effects of the drug (e.g., decreased ability to sustain an erection or orgasm). Careful monitoring of the elderly patient is required during treatment with clomipramine, particularly with regard to orthostasis, the increased risk of falls, and worsened confusion secondary to the potential risks of anticholinergic delirium and toxicity.
Memory Deficits in a Demented Patient with Probable Corticobasal Degeneration
Authors: Beatty William W. , Scott James G. , Wilson Don A. , Prince John R. , Williamson David J.
Published: March 2014

Anterograde and retrograde amnesia in a patient with probable corticobasal degeneration (pCBD) and dementia were studied in a university medical center setting. The patient with pCBD and four comparison patients of comparable global mental status (Mini-Mental State Exam) who met NINCDS-ADRDA criteria for Alzheimer's disease (AD) were included. Standard neuropsychological tests of naming, intelligence, achievement, verbal fluency, anterograde and remote verbal and visuospatial memory, and motor skill learning were given. The pCBD patient exhibited a progressive asymmetric akinetic-rigid syndrome, which was unresponsive to Sinemet. His initially mild, intellectual deficits consisted of apraxia, slowed speech, and word-finding and memory difficulties. Over a 2-year period, a dementia syndrome developed, which involved more-serious deficits in praxis and naming, as well as impairments in spelling, calculation, verbal fluency, IQ, anterograde verbal and visuospatial memory, and motor skill learning. When tested by recall methods, the pCBD patient exhibited marked deficits on several tests of remote memory; however, on recognition testing, he performed normally on the Famous Faces Test and on a test of geographical knowledge, which measures remote visuospatial memory. By contrast, the four AD patients, who showed equivalent naming difficulties, less-severe fluency deficits, and normal motor skill learning, showed severe impairments in recalling and recognizing the names of famous people from photographs. A magnetic resonance imaging (MRI) scan of the pCBD patient showed marked frontal and parietal lobe atrophy and central atrophy, with ventriculomegaly that was greater on the left side of the brain. The temporal lobes were relatively spared, and the amygdalae, hippocampi, and temporal horns were of normal size. The striking integrity of the pCBD patient's remote recognition memory can probably be accounted for by the absence of atrophy of medial temporal lobe structures, especially the hippocampus, which undergo degenerative changes early in the course of AD. Alternatively, differences in the extent of damage to the temporoparietal cortices may explain the remote-memory differences between the pCBD and the AD patients.
The Older Adult Health and Mood Questionnaire: A Measure of Geriatric Depressive Disorder
Authors: Kemp Bryan J. , Adams Brad M.
Published: March 2014

Depressive disorders are a common problem in late life, requiring consistent and reliable screening by clinicians. Such screening should be based upon the most recent criteria available to facilitate diagnostic and nosologic agreement. This study presents a new screening instrument for geriatric depressive disorders based upon DSM-III-R criteria and the known differences in the display of depression that occur among older persons. The Older Adult Health and Mood Questionnaire (OAHMQ) is a 22-item questionnaire with sound psychometric properties and high validity. Its validation included comparisons with diagnostic assessments by geriatrically-trained psychiatrists and psychologists, and factor analysis. Using a three-part division of “normal,” “clinically significant depressive symptoms,” and “probable major depression,” its sensitivity is .80 and its specificity is .87 for major depression, and .92 and .87, respectively, for any depressive disorder. Separate scoring of affective symptoms versus other symptoms of depression (i.e., physiologic, cognitive, or behavioral) can be useful for diagnostic and research purposes.
Mental Status Testing in the Elderly Nursing Home Population
Authors: Nadler Jodi D. , Relkin Norman R. , Cohen Melanie S. , Hodder Richard A. , Reingold Jacob , Plum Fred
Published: March 2014

The clinical utility of selected brief cognitive screening instruments in detecting dementia in an elderly nursing home population was examined. One hundred twenty nursing home residents (mean age 87.9) were administered the Mini-Mental State Exam (MMSE) and the Modified Mini-Mental State Exam (3MS). The majority of the subjects (75%) were also administered the Dementia Rating Scale (DRS). Both clinically diagnosed demented (n=57) and non-demented (n=63) subjects participated in the study. Dementia was diagnosed in accordance with DSM-III-R criteria by physicians specializing in geriatric medicine. Using standard cutoffs for impairment, the 3MS, MMSE, and DRS achieved high sensitivity (82% to 100%) but low specificity (33% to 52%) in the detection of dementia among nursing home residents. Positive predictive values ranged from 52% to 61%, and negative predictive values from 77% to 100%. Higher age, lower education, and history of depression were significantly associated with misclassification of non-demented elderly subjects. Receiver Operating Characteristic (ROC) curve analyses revealed optimal classification of dementia with cutoff values of 74 for the 3MS, 22 for the MMSE, and 110 for the DRS. The results suggest that the 3MS, MMSE, and DRS do not differ significantly with respect to classification accuracy of dementia in a nursing home population. Elderly individuals of advanced age (i.e., the oldest-old) with lower education and a history of depression appear at particular risk for dementia misclassification with these instruments. Revised cutoff values for impairment should be employed when these instruments are applied to elderly residents of nursing homes and the oldest-old.
Differentiation of the Dementias of Alzheimer's and Parkinson's Disease with the Dementia Rating Scale
Authors: Paolo Anthony M. , Tröster Alexander I. , Glatt Sander L. , Hubble Jean P. , Koller William C.
Published: March 2014

The Mattis Dementia Rating Scale (DRS) was used to distinguish between 50 dementia of the Alzheimer's type (DAT) and 50 Parkinson's disease (PD) subjects matched for age, education, and DRS total score. Despite a similar level of overall cognitive impairment, the DAT group earned significantly lower scores than did the PD group on the Memory subscale, while the PD group displayed lower scores than did the DAT subjects on the Construction subscale. A jackknifed, stepwise, linear discriminant function using the five DRS subscales revealed that the Memory, Construction, and Initiation subtests significantly distinguished the groups. These results suggest qualitative differences in the dementias of DAT and PD patients and reveal that such differences can emerge on brief mental status examinations.
Geographically Overlapping Alzheimer's Disease Registries: Comparisons and Implications
Authors: Barnhart Ross L. , van Belle Gerald , Edland Steven D. , Kukull Walter , Borson Soo , Raskind Murray , Teri Linda , McLean Pam , Larson Eric
Published: March 2014

In the medical and epidemiologic literature, a registry denotes a data base in which registrants share some common characteristic such as disease category. One criticism of registries is that they frequently collect subjects in a haphazard fashion and, hence, are “nonrepresentative of the population purportedly being represented.” In this report, we compare two registries: an incident-based Alzheimer's Disease Patient Registry (ADPR) recruiting subjects for epidemiologic studies from a large health maintenance organization; and an Alzheimer's Disease Research Center (ADRC) registry recruiting subjects for phenomenologic, biologic, and pharmacologic studies. While these registries share personnel, overlap geographically, and use similar diagnostic procedures, they differ substantially in their missions and resulting recruitment strategies. We compared these registries with respect to demographic characteristics and cognitive features at subject entry. Subjects enrolled in the incident-based registry are older and report shorter time between symptom onset and recruitment. They are less demented and mirror the general population demographically more closely than do subjects in the other registry. The ADRC registry contains a much greater proportion of subjects with higher educational attainment.
Behavioral Disturbance in Dementia
Authors: Lloyd Chris , Hafner R. Julian , Holme Gwili
Published: March 2014

Fifty-seven subjects with moderate to severe dementia (49 with Alzheimer's disease) were rated twice, 8 weeks apart, using the Mini-Mental State Examination (MMSE), the Blessed Information-Memory-Concentration Test (BIMC), and the Stockton Geriatric Rating Scale (SGRC). Only three subjects lived at home; the rest were in long-stay hospital beds or nursing homes. For 29 subjects, the first rating coincided with their referral to a comprehensive geriatric psychiatry service. The main hypothesis, that the level of behavioral disturbance would correlate positively with the level of cognitive impairment, was strongly confirmed. This finding may reflect the severity of dementia in the study sample. The correlations between MMSE and BIMC scores were .87 at entry and .92 at exit, suggesting that the two measures were broadly equivalent, although both had marked floor effects. Test-retest reliability was high for all three measures. Overall, medication was of limited effectiveness in managing severe behavioral disturbance, highlighting the need for introducing effective behavioral programs.
Reliability of the Blessed Telephone Information-Memory-Concentration Test
Authors: Kawas Claudia , Karagiozis Helen , Resau Lisa , Corrada Maria , Brookmeyer Ronald
Published: March 2014

In-person cognitive evaluations can be costly and labor intensive in geographically widespread populations. Reliable telephone instruments that screen for cognitive status would greatly facilitate epidemiologic and other longitudinal studies. We evaluated the reliability of the Blessed Information-Memory-Concentration (IMC) test when administered by telephone. Eighty-four subjects with a wide range of cognitive abilities were administered the Blessed IMC twice over a 3-week interval. Forty-nine of the subjects were administered the test both by telephone and in-person, and 35 of the subjects were tested twice by telephone. Spearman's rank correlation was used to compare scores of the different administrations (.96; P < .001) and to examine test-retest reliability (.96; P < .001). The Blessed Telephone IMC (TIMC) test exhibits excellent reliability both when compared to in-person administration as-well as in test-retest results. The Blessed TIMC appears to be a practical instrument for population and longitudinal studies when in-person assessment is not feasible.
Usefulness of the SF-36 Health Survey in Measuring Health Outcomes in the Depressed Elderly
Authors: Beusterien Kathleen M. , Steinwald Bruce , Ware John E.
Published: March 2014

Longitudinal data from a clinical trial were analyzed to evaluate the usefulness of the SF-36 Health Survey in estimating the impact of depression and changes in severity over time on the functional health and well-being of 532 patients, 60 to 86 years of age, who met DSM-III-R criteria for major depressive disorder. The Hamilton Depression Rating Scale, the Clinician's Global Impression of Severity and Improvement, and the Geriatric Depression Scale were used to define clinical severity and changes in severity over a 6-week period. Answers to SF-36 questions tended to be complete and to satisfy assumptions underlying methods of scale construction and scoring. As hypothesized, the SF-36 Mental Health Scale and Mental Component Summary measure, shown in previous studies to be most valid in measuring differences in mental health, exhibited the strongest associations with severity of depression in cross-sectional analyses and were most responsive to changes in severity in longitudinal comparisons. We conclude that the SF-36 Health Survey is useful for estimating the burden of depression and in monitoring changes in functional health and well-being over time among the depressed elderly.
Longitudinal Changes in Cognitive Functioning in Adult Day Care Participants
Authors: Cohen-Mansfield Jiska , Gruber-Baldini Ann L. , Culpepper William J. , Werner Perla
Published: March 2014

This study examines longitudinal changes in cognitive functioning over the course of 2 years in participants of adult day care programs. Cognitive measures included the Brief Cognitive Rating Scale (BCRS) and the Mini-Mental State Examination (MMSE). Longitudinal data were available for five measurement points over 2 years for 82 participants (22 males and 60 females). Overall, results from this study suggest that there were significant cognitive declines on BCRS and MMSE, even after only 1 or 2 years in the study. The rates of impairment over the 2 years for BCRS and MMSE were highly correlated. Within each measure, the individual rates of decline were very heterogenous and were influenced by the presence, type, and prognosis of dementia. Participants with multi-infarct dementia had greater cognitive decline than did those with other types of dementias. Initial cognitive functioning and physician's prognosis of dementia trajectory were also significant predictors of change over time. Results suggest a floor effect in the BCRS.
Cardinal Features of Cognitive Dysfunction in Alzheimer's Disease: A Factor-Analytic Study of the Alzheimer's Disease Assessment Scale
Authors: Talwalker Sheela , Overall John E. , Srirama Mandyam K. , Gracon Stephen I.
Published: March 2014

Factor analysis methodology applied to Alzheimer's Disease Assessment Scale (ADAS) subtest profiles for patients in two large-scale clinical trials of the antidementia drug tacrine yielded three oblique factors interpreted as dysfunctions in memory, language, and praxis. The factor structures confirmed reliable assessment of primary dimensions of cognitive impairment in Alzheimer's disease that the original authors of the ADAS proposed to measure and that correspond well to that of the only previously reported factor analysis of the ADAS-COG. The presence of a strong general factor, supported by stable correlations among the oblique primary factors, justifies the recommendation to continue reliance on the ADAS-COG total score as a primary outcome measure in clinical trials, whereas the factor scores are recommended for evaluation of differential treatment effects on more specific aspects of the general cognitive decline. The stability of correlations across time appears to satisfy a primary requirement for application of repeated measures ANOVA to ADAS-COG total score and factor scores in longitudinal clinical trials.
Association of Serum Cholesterol and Triglyceride Levels with Agitation and Cognitive Function in a Geropsychiatry Unit
Authors: Orengo Claudia A. , Kunik Mark E. , Molinari Victor A. , Teasdale Thomas A. , Workman Richard H. , Yudofsky Stuart C.
Published: March 2014

Several studies have reported an association between aggression and cholesterol levels. The purpose of this study was to investigate the relationship of serum cholesterol and triglyceride levels with aggression and cognitive function in elderly inpatients. One hundred ten patients consecutively admitted to the Geriatric Psychiatry inpatient unit at Houston's Veterans Affairs Hospital received comprehensive evaluations by a multidisciplinary team. Fasting serum cholesterol and triglyceride levels were obtained within 3 days of admission. In addition, two geriatric psychiatrists administered the Mini-Mental State Examination (MMSE) and the Cohen-Mansfield Agitation Inventory (CMAI). Correlation coefficients were calculated between lipid levels, CMAI total and subscale scores, and MMSE scores. Multiple linear-regression analyses were done to further investigate the relation between lipid concentrations and various confounders. We found no significant correlation between serum triglyceride levels and MMSE, CMAI total, and CMAI factor scores. In addition, we found a significant positive correlation between serum cholesterol levels and physical nonaggressive behavior, and a significant negative correlation between serum cholesterol levels and MMSE scores. We found no relationship between aggressive behavior and serum cholesterol or triglyceride levels. However, an association between high cholesterol levels and agitation exists, which may be mediated by the association between high cholesterol levels and impaired cognition.
Effects of Passive Body Heating on the Sleep of Older Female Insomniacs
Authors: Dorsey Cynthia M. , Lukas Scott E. , Teicher Martin H. , Harper David , Winkelman John W. , Cunningham Steven L. , Satlin Andrew
Published: March 2014

The purpose of this study was to evaluate passive body heating (PBH) as a treatment for insomnia in older adults. Polysomnographic recordings of older adults routinely show an increase in sleep fragmentation and a substantial decrease in slow-wave sleep (SWS) consistent with complaints of “lighter” more disturbed sleep. An increase in body temperature in young adults early in the evening by way of PBH has been shown to produce an increase in SWS in the early part of the sleep period. In a crossover design, nine female insomniacs (aged 60–72 yr) participated in two consecutive nights of PBH, involving hot (40–40.5°C) and luke-warm (37.5–38.5°C) baths 1.5 hours before bedtime. Significant improvement in sleep continuity and a trend toward an increase in SWS occurred after hot baths. Results of subjective measures showed that subjects experienced significantly “deeper” and more restful sleep after hot baths. In addition, hot baths resulted in a significant delay of temperature nadir in comparison to baseline nights.
Chronic Subdural Hematoma in the Elderly: A Case Report
Authors: Elie Michel , Primeau Francois , Cole Martin G.
Published: March 2014

A previously healthy 82-year-old male presented with depressive and paranoid symptoms of 3 months' duration. Physical examination and cognitive functions were normal. Poor response to treatment and continuing weight loss lead to medical investigations that ultimately showed a large, left frontoparietal, chronic subdural hematoma. Following drainage, the patient showed some improvement in paranoid features but still required pharmacologic treatment for depression. The psychiatric features of chronic subdural hematoma as well as the management of this neurologic condition in the elderly patient are reviewed and discussed.
Risk of Mortality and Institutionalization in Demented Patients with Delusions
Authors: Magni Eugenio , Binetti Giuliano , Bianchetti Angelo , Trabucchi Marco
Published: March 2014

Delusions are a common symptom during the course of dementia. Despite their clinical relevance, however, it is still unclear whether they are of prognostic value. This longitudinal study involving, at baseline, 99 demented Alzheimer disease (AD) and multi-infarct dementia (MID) patients, investigates the risk of mortality and institutionalization at 2 years after discharge from a dementia unit in patients with and without delusions at baseline. Results indicate that the presence of delusions is a significant predictor of future institutionalization (odds ratio 3.6, confidence interval 1.3-9.6), even when confounding factors such as age, educational level, and severity of cognitive and functional impairment are statistically controlled. No significant impact on survival was found.
Screening African-American Elderly for the Presence of Depressive Symptoms: A Preliminary Investigation
Authors: Baker F. M. , Okwumabua Jebose , Philipose Vilmala , Wong Steve
Published: March 2014

Several authors have reported that older African-Americans with multiple medical problems and decreased activities of daily living are at an increased risk of reporting symptoms of depression. African-Americans were more likely to report symptoms of anger, irritability, denial of illness, and to spontaneously report symptoms that did not reflect a change in mood, but rather forbearance of a difficult time or somatic complaints. This paper describes the results of a study to assess the presence of depressive symptoms in older African-American community residents. Anew instrument, the Baker Belief Scale, is compared with the Center for Epidemiologic Studies-Depression Scale (CES-D) and the association of medical illnesses, social network, and level of physical function in activities of daily living (ADL). Ninety-six African-American men and women, aged 60 years or older, with equal representation from urban and rural counties in western Tennessee comprised the sample. The sample was stratified, in each of the two counties, into three age categories; 60-69, 70-79, and 80 years and older. A screening battery consisting of the Short Portable Mental Status Questionnaire, the CES-D, the Lubben Social Network Scale, and the Katz ADL were administered to the sample. Current medical illnesses were recorded with demographic data. There was a significant association between the CES-D score and the BBS score for those who screened positive for symptoms of depression. In addition there was a significant relationship between CES-D score and specific medical illnesses, social network, physical function in ADL, and residence (urban vs. rural). Residents who screened positive (N = 19) for depressive symptomatology with CES-D scores of 16 or higher exhibited a higher frequency of hypertension, arteriosclerosis, and circulatory problems than those who tested negative (N = 77). More urban residents (N = 13) than rural residents (N = 6) screened positive for symptoms of depression. Approximately 21% (N = 20) of the 96 respondents had scores of 20 or less on the Lubben Social Network Scale, suggesting a group “at risk” for social isolation.
Effects of Normal Aging on the Performance of Motor-Vehicle Operational Skills
Authors: Perryman Kent M. , Fitten L. Jaime
Published: March 2014

Operational skills involved in controlling a motor vehicle were measured in two groups of very healthy elderly drivers and a young control group to test the hypothesis that there are age-related declines in operational performance that may influence driver safety. An actual behind-the-wheel, standardized road test was employed using a motor vehicle equipped with sensors to record speed, braking activity, and lane position, as well as direction and magnitude of front-wheel and eye-movement excursions. The data from these sensors were used as dependent measures of operational performance. Older drivers made fewer steering and eye-movement excursions and drifted across the center line more frequently than the young control group. Younger drivers drove significantly faster and executed more braking applications than did their older counterparts. The motor-vehicle operational performance of older healthy drivers was related to visual-spatial attentional declines and the useful field of vision associated with the normal aging process.
Antiandrogen Treatment of Aggressivity in Men Suffering from Dementia
Authors: Amadeo Marco
Published: March 2014

Three demented patients who manifested an aggressive syndrome and motor disturbances including agitation, pacing, and restlessness received a therapeutic trial of the antiandrogen agents medroxyprogesterone acetate and luprolide acetate. Within 4 weeks of the start of the antiandrogen therapy, verbal and physical aggressivity had ceased; activity disturbances such as agitation, pacing, and restlessness were markedly reduced. One patient also manifested marked disinhibited and disruptive sexual behavior. Following treatment, that behavior also ceased. Further control studies assessing the efficacy and safety of antiandrogen agents are recommended.
A Case of Late-Onset Psychosis: Integrating Neuropsychological and SPECT Data
Authors: Cloud Blaine S. , Carew Tania Giovannetti , Rothenberg Howard , Malloy Paul , Libon David J.
Published: March 2014

We report the case of a 67-year-old woman who experienced a sudden onset of psychotic illness (i.e., prominent delusions and hallucinations) that has endured for approximately 3 years. As part of her neurobehavioral work-up, a SPECT scan revealed right frontal and left anterior temporal-lobe hypoperfusion. Serial neuropsychological evaluations obtained 2 years apart demonstrated a steady decline on tests of executive control (monitoring, allocation of attention, perseveration) and visuospatial abilities, whereas performance in other areas of cognitive functioning have remained steady and in the normal range for the patient's age. Over this same period of time, serial EEG, MRI, and neurology examinations have been within normal limits. Thus, there was little evidence with which to diagnose dementia. It is suggested that concomitant impairment in executive control, coupled with a degraded capacity to process perceptual information, can give rise to enduring psychotic behavior.
Circadian Rhythms and Psychiatric Disorders in the Elderly
Authors: Sloan Eileen P. , Flint Alastair J. , Reinish Lawrence , Shapiro Colin M.
Published: March 2014

This article reviews changes in circadian rhythms that have been reported to occur in the elderly psychiatric population. Data relating to circadian changes in normal aging are included where relevant. Information was obtained from: (1) a computerized MEDLINE search from 1975 to May 1996; (2) a review of bibliographies of papers obtained through the computerized search; and (3) texts on chronobiology. We could not locate any information relating to circadian rhythms and mania, anxiety, or paranoid disorders in old age. Disruption to the sleep/wake cycle, temperature, melatonin, and motor activity rhythms have been reported in dementia and depression, and disruption to some neuroendocrine and cardiovascular rhythms are reported in dementia. Disruption to circadian rhythmicity has implications for the management of dementia patients: for example, the sleep/wake and behavioral disturbances, and for the long-term management of mood disorders. A number of circadian markers have not been studied and several patient groups have received no research attention to date.
Visual Hallucinations in a Geriatric Psychiatry Clinic: Prevalence and Associated Diagnoses
Authors: Holroyd Suzanne
Published: March 2014

Visual hallucinations are associated with a variety of psychiatric, medical, neurologic, and ophthalmologic disorders. One hundred forty outpatients presenting to a geriatric psychiatric clinic were screened for visual hallucinations and assessed on a number of descriptive variables, medical history, ophthalmologic history, psychiatric diagnosis, and cognitive score. The data revealed that 14 patients (10%) experienced visual hallucinations. Presence of visual hallucinations was significantly associated with diagnoses of dementia or delirium, living in a nursing home, lower cognitive score, and presence of auditory hallucinations and delusions. There was no association to number of medications, age, gender, or presence of eye disease. No patient had ‘insight’ into their visual hallucinations. Despite the numerous disorders that are associated with visual hallucinations, the most common causes in a geriatric psychiatry clinic are dementia and delirium. Clinicians assessing older patients with visual hallucinations should first carefully evaluate for these disorders.
Clinical Evaluation of Global Change in Alzheimer's Disease: Identifying Consensus
Authors: Olin Jason T. , Schneider Lon S. , Doody Rachelle S. , Clark Christopher M. , Ferris Steven H. , Morris John C. , Reisberg Barry , Schmitt Frederick A.
Published: March 2014

It is important that clinicians who rate global change as part of Alzheimer's disease (AD) clinical drug trials agree on a relevant set of behaviors and information to be considered in formulating their rating. Yet, consensus among raters has been difficult to establish, and inter-rater reliability of clinical global impression of change (CGIC) ratings has been low. In preparation for the development of a new CGIC scale to be used in AD clinical trials, the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC), we surveyed clinicians at sites comprising the National Institute on Aging-sponsored ADCS participating centers to identify whether or not consensus regarding CGICs exists. Overall, respondents reported that a CGIC should include an assessment of the patient's function and mental status, a care giver interview, and a standardized set of questions, and it should take approximately 20 minutes per interview. Depending on a patient's level of impairment, raters consider different areas of behavior in formulating a CGIC rating. These findings demonstrate the considerable consensus regarding the CGIC rating process, and were integrated into the design of the ADCS-CGIC, currently in use.
Stepwise Comparative Status Analysis (STEP): A Tool for Identification of Regional Brain Syndromes in Dementia
Authors: Wallin Anders , Edman Åke , Blennow Kaj , Gottfries Carl-Gerhard , Karlsson Ingvar , Regland Björn , Sjögren Magnus
Published: March 2014

A method for clinical examination of patients with dementia, stepwise comparative status analysis (STEP), is presented. It combines psychiatric and neurologic status examination methods to identify certain common dementia symptoms by which the patient's regional brain symptom profile can be determined. Fifty status variables (items) are estimated with respect to occurrence and severity. The analysis is performed in three steps. The scores on the primary variables reflect observations of single dementia symptoms. These scores form the basis for the assessment of the ‘compound’ variables, which in turn form the basis for evaluation of the ‘complex’ variables, one of which describes the patient's regional (predominant) brain syndrome (subcortical, frontosubcortical, frontal, frontoparietal, parietal, or global). In 96 mildly and moderately demented inpatients, the global (42%) and frontosubcortical (31%) were the most common. Ninety-one percent of the patients with vascular dementia had a predominant frontal and/or subcortical symptomatology
Idiopathic Musical Hallucinations in the Elderly
Authors: Pasquini Filoteo , Cole Martin G.
Published: March 2014

The purpose of this study was to determine the phenomenology and treatment of idiopathic musical hallucinations in the elderly by reviewing all relevant case reports. A systematic literature search yielded 32 case reports that met the following four inclusion criteria: (1) published in English, French, or Italian; (2) cases aged 65 years of age or older; (3) absence of major focal neurologic disease; and (4) absence of drug toxicity. Information was subsequently abstracted from each case reported and tabulated. Idiopathic musical hallucinations in the elderly occurred predominantly in females who had a hearing impairment, one third of whom were depressed. Treatment of depressed patients with antidepressants and nondepressed patients with anticonvulsants/anxiolytics seemed to result in improvement of many cases.
Sensitivity, Specificity, and Positive Predictive Value of Technetium 99-HMPAO SPECT in Discriminating Alzheimer's Disease from other Dementias
Authors: Masterman Donna L. , Mendez Mario F. , Fairbanks Lynn A. , Cummings Jeffrey L.
Published: March 2014

Investigators have reported high sensitivity and specificity values for single photon emission computerized tomography (SPECT) when distinguishing Alzheimer's disease (AD) patients from normal elderly controls or from selected patient groups. The role of SPECT in identifying AD among unselected patients with memory complaints requires investigation. We examined 139 consecutive patients with 99Tc-HMPAO SPECT. NINCDS-ADRDA diagnoses were determined blind to SPECT results, and scans were read and classified by visual inspection blind to clinical diagnoses. Bilateral temporoparietal hypoperfusion (TP) occurred in 75% of probable, 65% of possible, and 45% of unlikely AD patients, yielding a sensitivity of 75% and a specificity of 52% when comparing probable AD versus unlikely AD groups. A positive predictive value of 78% was obtained based on a 69% prevalence of AD in our total clinic population. Patients with false-positive results included a variety of dementing illnesses; all patients with bilateral hypoperfusion had dementia. A pattern of TP on SPECT scans is seen in most patients with AD, but could be found in other dementias as well and cannot be regarded as specific to AD. Reduced TP perfusion discriminated between demented and nondemented individuals. Further strategies for SPECT interpretation that improve diagnostic specificity should be sought.
Outcome of Psychiatric Hospitalization for Very Low-Functioning Demented Patients
Authors: Bakey Ayman Abdel , Kunik Mark E. , Orengo Claudia A. , Molinari Victor A. , Workman Richard H. , Hamilton Joseph D.
Published: March 2014

The authors determined the outcome of geropsychiatric hospitalization for 73 very low-functioning demented patients (GAF score < 21). General psychiatric symptoms, depression, and agitation decreased significantly, and mean GAF scores increased significantly, with no significant change in cognitive function. Psychiatric hospitalization can meaningfully improve function and quality of life even in this very impaired population. Despite these improvements many patients are discharged to more restrictive settings.
Neuromotor Changes in Alzheimer's Disease: Implications for Patient Care
Authors: Souren Liduïn E.M. , Franssen Emile H. , Reisberg Barry
Published: March 2014

As a result of the neuropathologic process of Alzheimer's disease (AD), significant changes occur in neuromotor function (e.g., paratonia and compulsive grasping). These changes become manifest in the moderately severe stage of AD, when patients begin to require ongoing assistance with activities of daily life (ADL), and they are prominent in the severe stage of AD, when patients are continuously dependent on a caregiver. Patients in these stages often display behavioral disturbances during care activities. These disturbing behaviors result not only from cognitive impairment, but also from a patient's physical inability to cooperate with the caregiver. When care management strategies take into account the characteristic physical restrictions resulting from the neuromotor changes that accompany advanced AD, the caregiving process may be significantly facilitated.
Treatment of Functional Decline in Adults with down Syndrome Using Selective Serotonin-Reuptake Inhibitor Drugs
Authors: Geldmacher David S. , Lerner Alan J. , Voci J. Mathew , Noelker Elizabeth A. , Somple Lauren C. , Whitehouse Peter J.
Published: March 2014

Alzheimer's disease (AD) is a common cause of functional decline in Down syndrome (DS) adults. Acquired cognitive deficits may be difficult to evaluate in the context of baseline impairments. Behavioral symptoms are also common and may represent the effects of depression, AD, or both. Therefore, the objective of this study was to report a clinical case series of selected adults with DS and behavioral change who responded to treatment with selective serotonin-reuptake inhibitor (SSRI) medication. Six patients, aged 23 to 63 years, 5 women and 1 man, with the clinical diagnosis of DS presented for diagnosis and treatment of functional decline in adult life. Noncognitive symptoms were prominent and included aggression, social withdrawal, and compulsive behaviors. Memory dysfunction was reported in varying degrees. Treatment with SSRI antidepressants was instituted for depressive, apathetic, and compulsive behaviors. Treated patients showed improvement in behaviors as reported by caregivers, and on objective measures, such as workplace productivity. Noncognitive symptoms are a cardinal feature of functional decline in adults with DS and may represent either depression or AD. In some patients, the symptoms respond well to SSRI agents with concomitant improvement in daily function. Treatment trials with SSRIs may, therefore, be warranted in such cases.
Rapid-Cycling Affective Disorder in the Elderly: Clinical Subtype or Specific Course of Manic-Depressive Illness?
Authors: Camus Vincent , de Mendonça Lima Carlos Augusto , Antonioli Daniel , Wertheimer Jean
Published: March 2014

Rapid cycling is a relatively unusual presentation of bipolar affective disorder in the elderly. Four cases or rapid-cycling affective disorder (RCAD) in elderly women (aged 78-86 yr) are presented. Two patients began their bipolar illness in adulthood (aged 30 and 49 yr), and rapid cycles appeared secondarily in their elderly years (82 and 76 yr). The other two began their illness immediately with rapid cycles respectively at the age of 62 and 66. Added to the nine cases of RCAD in the elderly previously reported in the literature, a meta-analysis conducted on this small sample suggests that immediate entry in rapid cycles seems more likely to be associated with a late occurrence of bipolar illness (after 60 years of age) ( P = .0035, Fisher's Exact Test, two-tailed), and that very short cycles (< 2 weeks each) are more likely to be associated with female gender ( P = .0047, Fisher's Exact Test, two-tailed). Despite the small size of the sample, these results give some arguments to the hypothesis that RCAD is not a homogeneous syndrome but could be considered as a pattern of evolution, as well as clinical subtype, of the bipolar illness.
Klüver-Bucy Syndrome in a Patient with Nasopharyngeal Carcinoma: A Late Complication of Radiation Brain Injury
Authors: Lam Linda C.W. , Chiu Helen F.K.
Published: March 2014

We report a patient with dementia and Klüver-Bucy syndrome who presented 17 years after radiotherapy for nasopharyngeal carcinoma. Computerized tomography of the brain revealed bilateral temporal lobe atrophy. The possibility of delayed effects of radiation brain injury in causing the human Klüver-Bucy syndrome is discussed.