bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevalence of depression in an acute geriatric medical assessment unit
Authors: O'Riordan Thomas G. , Hayes James P. , Shelley Rory , O'Neill Desmond , Walsh J. Bernard , Coakley Davis
Published: December 2004

One hundred and eleven patients admitted to an acute medical geriatric assessment unit were screened for depression using the Geriatric Depression Scale questionnaire. All patients with high scores were further assessed by a consultant psychiatrist in a semistructured interview. Of the patients screened, 23.4% had depression of a clinically significant degree and 13.5% were judged to need specific antidepressant medication. 10.8% of the population had depressive illness superimposed on organic brain disease.
A comparison of ‘specialized’ and ‘non‐specialized’ psychiatric services for old people in the united kingdom
Authors: Wattis John Philip
Published: December 2004

Using data derived from a recent survey of psychiatric services for old people in the UK, services provided by ‘specialized’ consultants (committing 5/11 or more of their working week to old people) were compared with those provided by ‘non‐specialized’ consultants (working less than 5/11 with old people). The measures used included total referrals, provision of personnel, provision and location of facilities, teaching activities and research interests. Because of the way in which they were selected, non‐specialized respondents were a relatively small and probably enthusiastic proportion of all non‐specialized general psychiatrists providing services for old people. Despite this, clear differences emerged in favour of the specialized services on most measures. Future routine statistics in psychiatry should identify ‘specialized’ consultants if they are to be meaningful.
Age, manic psychopathology and treatment response
Authors: Young Robert C. , Falk James R.
Published: December 2004

The authors describe relationships between age and ratings of signs and symptoms in 40 manic inpatients. Soon after admission, some psychopathologic features were less prominent in older patients. In older patients, after two weeks of treatment with lithium and neuroleptics, there was greater residual total psychopathology, higher ratings of some clinical features, and less change in total psychopathology and some clinical features. Older patients were hospitalized longer. Ageing may alter manic psychopathology and treatment response. The authors emphasize the need for prospective studies that include geriatric patients.
The effect of design of residential homes in creating dependency among confused elderly residents: A study of elderly demented residents and their ability to find their way around homes for the elderly
Authors: Netten Ann
Published: December 2004

A study of 13 homes for elderly people examining the effect of the environment on demented residents looked into the complexity of the design from the residents' point of view. Two principal tools were used in this investigation: ‘route diagrams’, which describe a resident's use of the home, and a measure devised to indicate each resident's ability to find her way around the home. These are described and the relationship between them explored. From this the following tentative conclusions are drawn:

The variables that influence a resident's ability to find her way around differ between group and communally designed homes.

It would appear that group homes provide a more favourable design, especially in the case of physically frail demented elderly people.

In group homes, the level of lighting is an important aid to a demented person in finding her way around.

In communal homes, residents seem most able to find their way around homes that have been adapted from older premises.

In both types of home, ‘meaningful decision points’ can be seen as aids to a resident finding her way around.
Integrity‐promoting care of demented nursing home patients: Psychological and biochemical changes
Authors: Bråne Görel , Karlsson Ingvar , Kihlgren Mona , Norberg Astrid
Published: December 2004

The effects of integrity‐promoting care in a nursing home with demented patients were studied. In one ward the staff were given special training. The results showed that the treatment induced a reduction of distractability, confusion, anxiety and depressed mood, and improvement in motor performance. At the same time the cerebrospinal fluid concentrations of somatostatin increased.
Social work and people with dementia: Putting principles into practice
Authors: Polden Esther Rachel
Published: December 2004

The Kantian principle of ‘respect for persons’ has traditionally held a central place in social work theory and practice. It is argued here, however, that the language of ‘respect for persons’ falls short of giving a full account of the complex nature of social work intervention in relation to elderly persons who have dementia, and so ultimately of having practical application. An alternative framework based on the theory of consent is proposed. The aim is to put into practice the principle that all persons have the right to make decisions about their own lives no matter how disabled they may be. This involves assessing the competence of individuals to give informed consent. There is also the need to offer alternative strategies to assist persons who, because of the severity of their dementia, are not deemed competent to make a particular decision. Three options are considered: justified paternalism, consent by proxy and ‘citizen advocacy’. But a fourth option is preferred in what Paul Ramsey, in his book The Patient as Person: Explorations in Medical Ethics (see Faulder, 1985), has termed ‘constructive consent’, where the decision to give consent is based on the knowledge that the individual concerned would certainly have consented if competent to do so. In this way, the language of consent gives shape and content to Immanuel Kant's formulation of ‘respect for persons’, providing a theoretical and practical framework which promotes morally and professionally proper practice.
The additional benefit of extending an antidepressant trial past seven weeks in the depressed elderly
Authors: Georgotas Anastasios , McCue Robert E.
Published: December 2004

Thirty‐three elderly depressed patients who had not responded to either phenelzine or nortriptyline after seven weeks of treatment were given an additional two weeks of treatment. Nearly half of these patients responded during this grace period and the overall response rate increased from 54.0% to 70.0%. Patients on phenelzine did particularly well with the extended trial. The authors conclude that for elderly patients, an antidepressant trial of at least two months may be necessary for optimal response.
Visual hallucinations as the presenting symptom of dementia — A variant of the charles bonnet syndrome?
Authors: Beats Barbara
Published: December 2004

The presentation of functional symptoms with related behaviour disturbance in elderly patients may deflect the attention of clinicians from an underlying cognitive impairment. The objectives of the case presentation below are to demonstrate the relatively independent course of different symptoms within the natural history of a dementing disorder, and to look also at how they might have arisen: is there a single organic aetiology, or a more complex interplay between perceptual disturbance and the release of past experience? The intention is to discuss diagnostic issues and also to address the most appropriate investigation and management.
Completed suicide in psychogeriatric inpatients
Authors: Modestin Jiří
Published: December 2004

In a larger sample of psychiatric inpatient suicides a proportion of 15% of psychogeriatric patients was identified corresponding exactly to the proportion of psychogeriatric patients in the control group. Among inpatient suicides, the patients of older age groups are not over‐represented. Comparing 22 psychogeriatric inpatient suicides with 21 psychogeriatric inpatient controls a few significant differences emerged pointing to a longer, more severe and more incapacitating course of the suicides' illness. Psychogeriatric inpatient suicides were also compared with 127 younger inpatient suicides. Psychogeriatric suicides represent a cohort of patients who fall ill at a substantially later age, otherwise suffering from comparable mental illnesses of similar characteristics.
The geriatric mental state schedule administered with the aid of a microcomputer: A pilot study
Authors: Jones Jeffrey Royle , McWilliam Christopher
Published: December 2004

A version of the Geriatric Mental State Schedule developed for the microcomputer is described and compared to the usual paper version of the questionnaire. The advantages and disadvantages of the two techniques are discussed. A feasibility study of the microcomputer‐administered questionnaire is described. A shortened version of the Geriatric Mental State Schedule (version A) is administered to a number of geriatric patients attending psychogeriatric day hospitals. The study compares the microcomputer‐administered with the pencil‐and‐paper questionnaire. Two raters administer the questionnaire using the two techniques to a group of patients and the reliability is evaluated by comparing the correlation coefficients for the scores obtained on the questionnaire, as well as by evaluating Cohen's kappa statistic. The correlation results show that there is significant positive correlation between the paper and the microcomputer‐administered questionnaire. However, the kappa values comparing diagnoses obtained with the AGECAT program are not high and reasons for this are discussed. Further developments of the system, including an authoring program (QUESTLAN) for such questionnaires and the use of portable microcomputers in the community, are discussed.
Interiors: Architecture in the lives of people with dementia
Authors: Keen Justin
Published: December 2004

Most elderly people, including the majority of those with dementia, live in their own homes, but a significant minority live in residential homes, nursing homes and hospitals. While a great deal of research has been carried out into the experiences of residents and staff in these latter environments, it is not at all clear what contribution the design of these environments makes to their lives. The physical environment is often treated as a confounding variable in evaluations; and theoretical frameworks are frequently too general in nature to suggest what role design might play. Moreover, these frameworks typically do not acknowledge the phenomenon of architectural determinism, even though it has important consequences for research designs. Alternative approaches, which attempt to be more specific in dealing with design, and which are not deterministic, are discussed. The practical importance of key concepts such as privacy and home is also highlighted.
Does sundowning occur in residents of an Alzheimer's unit?
Authors: Cohen‐Mansfield Jiska , Watson Valerie , Meade William , Gordon Marjorie , Leatherman Jodi , Emor Charles
Published: December 2004

Eight agitated residents from an Alzheimer's unit of a 500‐bed skilled nursing home facility were observed over a period of two months. A behavior‐mapping instrument yielded information about agitated behaviors, and the physical and social environment in which they occurred. Trained observers rated each resident's behavior for three minutes of each hour of the 24‐hour day. The agitated behaviors which occurred most frequently were: making strange noises (babble, cry, scream, inappropriate laughter), constant requests for attention (repeat words, ask questions, ask for help), and repetitious mannerisms. The amount and types of agitated behaviors varied greatly across subjects and time. Some of the subjects exhibited behaviors with uniformly high frequencies during all their waking hours. While two of the eight residents appeared to manifest a sundown syndrome, four residents manifested agitation significantly more frequently during the morning hours, and the data of two residents did not show any clear pattern. These results suggest the need for reevaluation of the concept of sundown syndrome in agitated nursing home residents.
Family history of depression and alcoholism in Alzheimer patients and age‐matched controls
Authors: Lawlor Brian A. , Sunderland Trey , Mellow Alan M. , Hill James L. , Newhouse Paul A. , Murphy Dennis L.
Published: December 2004

Depression and depressive symptoms are reported to occur frequently in patients with Alzheimer's disease; however, familial and psychobiological contributions associated with depression in Alzheimer patients are poorly understood. In this study, we compared family history of depression and alcoholism in 44 patients with probable Alzheimer's disease and 38 aged‐matched cognitively intact controls. Results from comparison showed no overall difference between the occurrence of depression in first‐degree relatives of Alzheimer patients compared to first‐degree relatives of controls. There was, however, significantly lower incidence of alcoholism in relatives of Alzheimer patients, particularly male relatives (p<0.05). This finding suggests that family history and depression alone may not fully explain the high rate of depression in Alzheimer patients and that other factors including neurochemical changes in the brains of Alzheimer patients should be considered.
Classification of clinical symptoms of dementia in the elderly
Authors: Kawai Makoto J. , Miyamoto Mari , Miyamoto Kimio
Published: December 2004

Fifty‐two elderly patients with dementia were examined in respect to 23 clinical variables including all 13 items of the Hachinski ischaemic score. A CT scan and EEG were also caried out. A three‐dimensional model was developed by a technique of multivariate analysis to demonstrate the relationship between symptoms. The characteristics of groups classified by the Hachinksi score were also examined during the course of a longitudinal study. For the atherosclerotic group it was found possible to extract symptoms which reflected the result of stroke and also to extract symptoms which reflected diminished cerebral blood flow. Symptoms characteristic of senile dementia of the Alzheimer type (senile dementia) classified by the Hachinski score were extracted from the distribution of symptoms in the model. During the course of a longitudinal follow‐up subjects classified by the Hachinski score as ‘mixed type dementia’ showed a high frequency of stroke and it is suggested that mixed types can be characterized as vascular.
Old age psychiatrists in the united kingdom —their educational role
Authors: Wattis J. P.
Published: December 2004

Two hundred and forty‐three consultant psychiatrists providing a service to old people were asked about teaching activities. Over half engaged in undergraduate teaching, covering all medical schools in the UK. Medical students they taught had a mean of six days' clinical attachment and 3.4 hours' lectures in old age psychiatry. There were fewer academic chairs as a proportion of total consultant posts in old age psychiatry than in psychiatry generally. Over 80% of respondents taught medical postgraduates and non‐medical groups. Compared with previous studies, there had been increases in undergraduate and postgraduate teaching (particularly with respect to general practice and geriatric trainees) and in teaching to nurses and social services personnel. Consultants with five or more sessions in old age psychiatry reported more involvement in undergraduate and non‐medical teaching.
The potential use of adjunctive intraerythrocyte (RBC) lithium levels in detecting serious impending neurotoxicity in the elderly: Two case reports
Authors: Foster Jeffrey R. , Silver Michael , Boksay Istvan J. E.
Published: December 2004

The lithium literature indicates that geriatric psychiatric patients are particularly at risk for developing serious neurotoxic side‐effects. There is currently no reliable method for predicting which patients are at heightened risk for this adverse development. There is evidence that the adjunctive monitoring of intra‐erythrocyte (RBC) lithium levels may offer early indications that such toxicity is impending. Applications of such measurements are shown in two case reports which offer preliminary support for the value of RBC levels.
Outcome of depression in a geriatric medical day hospital following psychiatric consulation
Authors: Agbayewa M. Oluwafemi
Published: December 2004

A two‐year review of a psychiatric clinic within a geriatric medical day hospital was undertaken to obtain: (a) the prevalence of major depression in that clinic and (b) outcome at 6–12 months postintervention. The clinic provided only consultative service to primary caregivers. Thirty‐seven per cent of the 78 referrals to this clinic, ie 15% of all day hospital attenders, had a DSM‐III diagnosis of major depression; the depressed group had more widows. Outcome of depression at six months and 12 months was better than or comparable to recent reports despite the low‐contact psychiatric involvement. Cognitive scores and severity of depression had no effect on outcome in this group. More setting‐specific prevalence and outcome studies are recommended for a better understanding of depression in the elderly.
Dementia and depression in elderly persons: Agecat compared with dsm III and pervasive illness
Authors: Copeland John R. M. , Dewey Michael E. , Griffiths‐Jones Hazel M.
Published: December 2004

The computer diagnosis AGECAT applied to data from the Geriatric Mental State is shown to agree closely with cases of dementia and depression selected by the ‘pervasive illness’ (Gurland et al., 1983) and DSM III methods (American Psychiatric Association, 1980). AGECAT selects more borderline cases of depression than either of the other two methods, but also designates two levels of mild or subcases for both depression and dementia.
The distinction between depression and dementia in the very old
Authors: Ames David , Dolan Ray , Mann Anthony
Published: December 2004

Thirty‐four elderly residents of local authority homes (mean age 83) with depressive symptoms, some with a primary clinical diagnosis of dementia, others with a primary clinical diagnosis of depression, were further investigated and followed up in order to determine the validity of these diagnostic groupings. The two clinical diagnostic subgroups could not be distinguished by neuroradiological appearance on computed tomography and while those with dementia generally performed worse on psychometric testing, there was no statistically significant overall difference in the psychometric scores between the groups. Prognosis for those subjects with depressive symptoms was poor. There were no differences in outcome between those with a primary diagnosis of depression and those with a primary diagnosis of dementia, with only five subjects showing evidence of improvement in depressive symptomatology at one‐and two year follow‐up. These data question the validity and clinical usefulness of a strict categorical distinction between depression and dementia in the very old.
Mania in old age: A First Prospective Study
Authors: Broadhead Jeremy , Jacoby Robin
Published: December 2004

In a first prospective study of manic illness in old age, 35 manic patients over the age of 60 were compared with 35 patients below the age of 40 on clinical and cognitive measures. CT scan comparisons were made between the elderly patients and age‐matched healthy controls. Contrary to previously accepted teaching, the elderly were effectively clinically indistinguishable from the younger patients, except that the latter experienced more severe illnesses. CT and cognitive results, however, in the elderly group showed evidence of changes which support the view that cerebral organic factors play an important role in the genesis of affective disorder in old age.
Blunted affect, blunted lives? negative symptoms, ADL functioning, and mental health among older adults
Authors: Meeks Suzanne , Walker James S.
Published: December 2004

With the growing numbers of elderly chronically mentally ill individuals, there is increasing need for evaluation of assessment procedures relevant to this population. The assessment of negative symptoms among older patients may be especially problematic if expression of affect, poverty of speech, and social withdrawal are affected by normal ageing processes. The present study was intended to establish normative levels of negative symptoms for older adults. A sample of 127 elderly community residents was compared to smaller samples of elderly schizophrenics, nursing home residents without psychiatric disorder, and young schizophrenics, using the Scale for the Assessment of Negative Symptoms. The results support the validity of this scale for elderly individuals. Negative symptoms appeared rarely among community‐residing elders without psychiatric histories, so that a low cutting score on the scale identifies symptoms for this age group. For all groups negative symptoms were significantly related to competence in activities of daily living and ratings of mental health. Findings support the importance of assessing negative symptoms among the elderly chronically mentally ill. Further research is recommended to explore the relationship between asymptomatic levels of negative symptoms and functioning among non‐psychiatric elders.
‘How to do it’—obtaining consent for autopsy in Alzheimer's disease
Authors: Burns Alistair , Reith Margaret , Jacoby Robin , Levy Raymond
Published: December 2004

Postmortem examination of the brain is essential for the diagnosis of Alzheimer's disease. In the context of a study on the natural history of the condition, the authors describe their experience in obtaining consent for this procedure. Three‐quarters of relatives agreed to postmortem examination. This was the same whether they were asked before or at the time of death. The difficulties encountered in obtaining postmortems are discussed and practical suggestions made about the best way of acquiring relatives' full cooperation.
Tetrahydroaminoacridine in Alzheimer's disease
Authors: Davies B. , Andrewes D. , Stargatt R. , Ames D. , Tuckwell V. , Davis S.
Published: December 2004

Tetrahydroaminoacridine (THA), a centrally acting anticholinesterase, was used in a two‐month, double‐blind, placebo‐controlled crossover trial to treat 10 patients meeting DSM‐III‐R criteria for dementia of the Alzheimer type. Eight patients continued to take THA for a further three months. Nausea was a frequent side‐effect. Five patients developed abnormal liver function tests; liver biopsies showed evidence of liver cell necrosis in three patients, a granulomatous reaction in one, and one recovered after reduction of THA dosage. During the trail, patients as a group showed a significantly better performance on one of 10 memory tests when taking THA as compared to placebo. One patient showed a marked clinical improvement, six showed some improvement, and three patients showed no improvement with the active treatment. The group of eight patients who completed a further three months of THA treatment showed a significant deterioration on two psychological test scores.
Orofacial dyskinesia and senile dementia of the Alzheimer type
Authors: O'Keane V. , Dinan Timothy G.
Published: December 2004

Seventy‐eight patients between the ages of 65 and 91 years with a diagnosis of semile dementia of the Alzheimer type were included in this study. They were assessed for the presence of abnormal movements using the Abnormal Involuntary Movement Scale and their cognitive functioning was assessed using the Mini Mental Test. Seventy‐nine per cent of the patients had evidence of orofacial dyskinesia. Those patients with abnormal movements had greater degrees of cognitive impairment than those without. Orofacial movements were more common than similar movements of the extremities or trunk. Individuals with abnormal movements also tended to have higher levels of paranoid ideation.
Presence of parieto‐temporal symptomatology distinguishes early and late onset Alzheimer's disease
Authors: Blennow Kaj , Wallin Anders , Gottfries Carl‐Gerhard
Published: December 2004

Thirty‐one patients with early onset Alzheimer's disease (EAD) and 44 with late onset Alzheimer's disease (LAD) were examined with regard to symptoms reflecting disturbances in various brain regions, ie frontal, parietal and subcortical symptoms. Clinical vascular factors were recorded. The albumin ratio (CSF albumin/serum albumin) was used as a measure of the blood‐brain barrier (BBB) function. Parietal symptoms were more common in EAD than in LAD, both among mildly demented patients (60% in EAD, 10% in LAD; p<0.01) and among moderately demented patients (93% in EAD, 58% in LAD; p<0.01). Among moderately and severely demented patients, predominance parietal symptoms was more common in EAD (93%) than in LAD (26%) (p<0.01). Patients with predominant parietal symptoms had significantly lower age at onset, absence of concomitant diseases, and normal BBB function, and we suggest that they constitute the classical AD group. A symptom profile without parietal predominance was found to be associated with higher age at onset, presence of clinical vascular factors and impaired BBB function, suggesting that age‐related and/or vascular factors may influence the symptomatology in this group.
Neuroleptic malignant syndrome—an unrecognized problem in elderly patients with psychiatric illness?
Authors: Nicklason Frank N. , Finucane Paul M. , John Pathy M. S. , Sutton David A.
Published: December 2004

Until recently, neuroleptic malignant syndrome (NMS) was considered to be most unusual in elderly patients. During a two‐year period, we encountered five patients with the syndrome among some 13000 admissions to our acute geriatric assessment beds. As there have been few other reports of the syndrome in elderly patints, we believe that many cases go unrecognized. All of our patients had existing neurological and/or psychiatric illness which tended to mask the clinical features and in some cases this may have contributed to a delay in making a diagnosis. A delayed diagnosis in NMS can have serious consequences, as early recognition with appropriate intervention offers the best prospect of reducing the high mortality rate.
Myxoedema madness: A case report
Authors: Pearce Mary‐Jane , Walbridge David Gerrard
Published: December 2004

A case of psychosis in an elderly lady with hypothyroidism is described. The literature is reviewed with reference to the clinical diagnosis of myxoedema madness and the importance of its early detection.
The measurement of incapacity in the severely demented elderly: The validation of a behavioural assessment scale
Authors: Ritchie Karen , Ledesert Bernard
Published: December 2004

The development and validation of a scale for the assessment of intellectual functioning and adaptive behaviour in the severely dementing elderly (ECA) is described. This scale consists of items relating to the ‘survival roles’ proposed by the World Health Organization (physical independence, mobility, social integration, and language, occupation and orientation) and may be completed by non‐professional observers. The scale has highly acceptable interrater and internal reliability and is able to differentiate different levels of dementia. Moreover, ECA is able to describe the wide individual variation in individual functioning which is evident to the clinician but cannot be appreciated by standard cognitive tests, which have a ‘floor effect’ in severely demented populations. ECA scores correlate highly with both the Mini‐Mental State Examination and Psychometric assessment of agnosia, visual retention, verbal fluency, object naming and receptive language. A linear regression model is used to demonstrate the independence of ECA scores from age, education, associated pathology and perceptual handicap. The potential usefulness of the scale for both clinical and epidemiological studies is discussed.
The kingston dementia rating scale
Authors: Pelletier Frederick L. , Hopkins Robert W. , Hamilton Pamela F.
Published: December 2004

A dementia rating scale for use with psychogeriatric patients, published initially by Lawson et al. (1977), has been subjected to a number of revisions and is now presented as the Kingston Dementia Rating Scale (KDRS). Item content has been modified, and the administration and scoring instructions have been elaborated. Psychometric studies supporting the reliability and validity of the KDRS are reported, and normative data obtained from a sample of 237 psychogeriatric patients are summarized and presented.
Issues in the assessment of outcome in depressive illness in the elderly
Authors: Burvill Peter W. , Stampfer Hans G. , Hall Wayne D.
Published: December 2004

Different approaches to assessment of outcome of psychiatric illness generally are critically appraised. The article examines research design, outcome criteria and statistical analysis, including newer statistical approaches. Measurement of outcome is complex and a more detailed and sophisticated approach needs to be adopted than in the past. Some of the special problems associated with outcome studies of depressive illness in the elderly are discussed. Specific recommendations are suggested for future outcome studies of depression in the elderly. Such studies should be prospective, recruit a wide range of patient severity and make greater use of newer statistical analyses, eg survival analysis and proportional hazards model. Outcome criteria should be precisely defined, measured using standardized instruments and be comprehensive (clinical, physical health, psychosocial, etc.). Attention should be given to inter‐episode symptomatology.
A follow‐up study of elderly depressives and Alzheimer‐type dementia—relationship with DST status
Authors: Ferrier Nicol , Lister E. Susan , Riordan Denise M. , Scott Jan L. , Lett Debbie J. , Leake Alan , McKeith Ian G.
Published: December 2004

Seventy‐three elderly patients (38 with Alzheimer‐type dementia (ATD) and 35 with major depressive disorder) were followed up 2–5 years after an index admission during which a dexamethasone suppression test (DST) had been performed. Clinical state, cognitive function, neurological status and repeat DST were assessed where possible. The death rate was high in both groups (greater in the ATD group) but was not influenced by original DST status. Original DST status did not predict on survival time, development of physical illness or admission rate in either group, but DST non‐suppression in the depressed group was associated with significant cognitive decline and abnormal neurological features. Possible mechanisms of the association are discussed.
Cognitive complaint and test performance in elderly patients suffering depression or dementia
Authors: Feehan Michael , Knight Robert G. , Partridge Fiona M.
Published: December 2004

Ten depressed elderly patients were compared with 20 age‐matched normal controls on measures of memory, perceptual organization, and speed of letter cancellation. Only on the letter cancellation task were there significant differences between groups. In contrast, 10 elderly patients with primary degenerative dementia (Alzheimer's type) performed more poorly than 10 age‐matched normal controls on all the cognitive tests employed. Depressed patients rated their level of dysfunction in performing everyday tasks as more severe than the controls; however, the demented patients rated their degree of deficit as significantly less severe than the normal controls. The relationship between patient's subjective ratings of their cognitive difficulties and their results on neuropsychological tests is discussed. The present data suggest that determining subjective complaint may be important when assessing geriatric patients.
Information reliability in dementia sufferers
Authors: Ballard C. G. , Chithiramohan R. N. , Handy S. , Bannister C. , Davis R. , Todd N. B.
Published: December 2004

The level of agreement between 58 patients suffering with dementia and their first‐degree relatives was assessed for various types of information using questions directly comparable between the patient and informant section of the Camdex schedule. The overall agreement was 76% but this fell considerably when specifically comparing answers for which the relatives' responses were positive. This indicates that the main form of error displayed was an under‐reporting of information by patients suffering with dementia. These findings pose important questions for clinical practice and research work. There is a need for further work to more precisely elicit the pattern of error and to investigate ways of improving information reliability.
Old age psychiatrists' views on the use of ECT
Authors: Benbow Susan Mary
Published: December 2004

Two hundred and five practising old age psychiatrists completed a questionnaire regarding their opinions and use of electroconvulsive therapy (ECT). Details of the psychiatrists and their jobs were recorded, their opinions were sought on ECT and they were asked their views regarding physical problems in association with treatment, as well as the treatment procedure they employed. The majority of respondents reported that they would consider using ECT for appropriate patients, but opinion diverged concerning who this might be. Agreement was greatest regarding when ECT would never be appropriate. Depressive psychosis was the condition where ECT was felt most often to be useful. Most respondents used bilateral ECT, and most commonly administered it twice weekly. There was broad agreement over when ECT might be the treatment of choice and whether certain psychotropic drugs should be discontinued during treatment. All respondents regarded physical examination as routinely necessary prior to treatment, but opinion diverged regarding other investigations. Similarly, views diverged regarding which physical conditions might constitute absolute or partial contraindications to ECT. ECT is regarded as useful by most old age psychiatrists, and age itself is not a contraindication to treatment.
Mixed organic mood disorder following cholera, tetanus and typhoid immunization—a case report
Authors: Malizia Andrea L. , Ridley‐Siegert Drew
Published: December 2004

A case of organic mood disorder following multiple immunization is reported. The evidence for a possible association with cholera immunization is presented.
Short‐term cognitive fluctuation in multi‐infarct dementia and dementia of the Alzheimer type
Authors: Taylor Robert , Gilleard Chris J. , McGuire Ralph J.
Published: December 2004

Short‐term fluctuation in cognitive functioning was assessed in 13 subjects with presumed multi‐infarct dementia (MID) and 16 subjects with presumed dementia of the Alzheimer type (DAT) by administering a short battery of cognitive tests to subjects on three occasions over a period of approximately two weeks. The mean amount of fluctuation was small in both groups and was not generally greater in MID than in DAT subjects. Fluctuation therefore does not seem to be a universal characteristic of MID. No serious doubt is cast on the reliability of cognitive assessments made on a single occasion in either condition.
Epidemiology and diagnosis of alcoholism in the elderly (a review)
Authors: Caracci Giovanni , Miller Norman S.
Published: December 2004

The authors review the research on alcoholism in the elderly. There is evidence that prevalence studies underestimate its extent. Geriatric alcoholism often eludes detection as diagnostic criteria generally used for the adult may not apply to the elderly population. Issues pertaining to clinical features, classification and pattern of use are discussed.
Changes in survival in demented hospital inpatients 1957–1987
Authors: Wood Eric , Whitfield Elizabeth , Christie Alexander
Published: December 2004

Seven cohorts of demented elderly patients who died in Crichton Royal Hospital between the years 1957 and 1987 were identified and their survival time during their terminal admission noted. There was an increase in mean survival time over this period which did not appear due to changes in age or in level of disability at the time of final admission, or in willingness to treat concurrent physical illness following admission. There was some evidence that treatments available for concurrent physical illness were more effective in postponing mortality in the later cohorts. It is suggested that, over the study period, medical advances have extended the life expectancy of the general population including those who develop dementia. Within the latter subgroup, however, there is no evidence that the time of onset or rate of decline to terminal disability of dementia has changed.
Survey of long‐stay psychogeriatric bed use: Implications for future provisions
Authors: Cope Denise
Published: December 2004

Three hundred and twenty patients occupying long‐stay psychogeriatric beds were identified as compared to the Royal College of Psychiatrists' proposed number for this population of 470. Of these 7.1% were aged under 65 years, 11.3% had a diagnosis of functional illness and 75% were over 75 years. Existing guidelines for bed provision for the elderly mentally ill do not account for these numbers of under 65, functionally ill or the rapidly expanding number of over 75 year olds. Fixed guidelines for bed provision are inappropriate for this population; at present they are too high, but with the uncertainty surrounding the funding of community care they may well prove to be too low here as in other areas.
Major depressive disorder in the elderly: The relationship between age of onset and cognitive impairment
Authors: Steingart A. , Herrmann N.
Published: December 2004

In order to determine if later age of onset of depression in the elderly is associated with increased cognitive impairment, the scores on the Mini‐Mental State Examinations of 41 elderly depressed patients were correlated with the ages of onset of depression. All subjects, average age 74.7, were referred to a psychiatric day hospital for treatment of a major depressive disorder, and all scored at least 14 on the 17‐item Hamilton Depression Rating Scale. The ages of first mental health contact and symptom onset were significantly negatively correlated with Mini‐Mental State scores (p =0.021 and 0.035 respectively) after the confounding effect of age was adjusted for using partial correlations. The relation between late‐onset depression and cognitive impairment lends support to the hypothesis that late‐onset depressive disorders in the elderly may be associated with occult brain disease.
Wandering in dementia sufferers
Authors: Ballard C. G. , Mohan R. N. C. , Bannister C. , Handy S. , Patel A.
Published: December 2004

Ninety‐two patients with dementia were thoroughly assessed by domiciliary interview and a period of day hospital attendance which included the completion of Camdex and Camcog schedules. Domiciliary visit letters described getting lost outside the home as a problem in 20.6% of patients, and inside the home in 3.3% of patients. The corresponding figures obtained from interviews were 36.9% and 28.3%. According to interview data, patients with senile dementia of Alzheimer's type were more likely to get lost outside the home than those with vascular dementia and there was no correlation between the severity of cognitive impairment and the prevalence of getting lost outside the home.
Interobserver reliability of the italian version of the geriatric mental state examination
Authors: Turrina Cesare , Perdona Giampietro , Bianchi Lucian , Cordioli Luciano , Burti Lorenzo , Micciolo Rocco , Copeland John R. M.
Published: December 2004

The Italian version of the Geriatric Mental State Examination (GMS) was tested for interrater agreement (interobserver). Thirty geriatric patients form psychiatry, neurology and general medical facilities were interviewed by four raters. The mean values of kappa and phi for the analysable items were 0.80 and 0.81. ‘Organic’ and ‘functional’ items produced very similar coeffcient values.
The vascular origins of the charles bonnet syndrome: Four cases and a review of the pathogenic mechanisms
Authors: Ball Christopher J.
Published: December 2004

The definitions of the Charles Bonnet syndrome are reviewed and four cases with the CT findings of three described. The incidence and the pathogenic mechanisms are discussed in the light of these cases, which suggest that disorders of the vertebrobasilar and posterior cerebral arteries underlie the syndrome.
Non‐neuroleptic medications in the management of agitation in Alzheimer's disease and other dementia: A selective review
Authors: Schneider L. S. , Sobin P. B.
Published: December 2004

Both neuroleptic and non‐neuroleptic medications are widely used to treat symptomatic behaviors in dementia patients. There is a substantial body of literature suggestig that neuroleptics are modestly effective in treating these symptoms, but the magnitude of their effect is limited. Non‐neuroleptic medications such as anticonvulsants and antidepressants have been advocated as useful in treating certain symptoms but have not been as well studied. This article critically reviews the published evidence for the effectiveness of selected non‐neuroleptic medications in treating behavioral symptoms in elderly dementia patiens, especially those with possible Alzheimer' disease. The medications reviewed include lithium, β‐adrenergic blockers, trazodone, carbamazepine, buspirone, I‐deprenyl, and serotonin uptake blockers, reflecting the point of view that pharmacological approaches to the problem of agitation in dementia have included a variety of psychotropic medications. Most of these medications were not tried specifically with Alzheimer' disease patients, however, but in patients with various organic mental syndromes. The literature consists almost entirely of clnical series and case reports, making interpretations of the efficacy of individual medications difficult. With the singular exception of the serotonin uptake blocker citalopram, the few placebo‐controlled studies are of small sample sizes, showing at best very modest efficacy for the study medication. Despite their widespread use, there is very little published empirical evidence for the effectiveness of these novel treatments for treating behavioral symptoms in elderly dementia patients.
Quantitative CT scan analysis in senile dementia of the Alzheimer type: II. Radioattentuation of grey and white matter
Authors: Förstl Hans , Burns Aliatair , Jacoby Robin , Eagger Sarah , Levy Raymond
Published: December 2004

The radiodensity of the total intracranial area and of the dorsomedial thalamic nuclei were significantly lower in 60 patients with moderate to severe dementia of the Alzheimer type (DAT) compared to 30 healthy age and sex‐matched controls (p<0.02). The radiodensity of the caudate nuclei was similar in the DAT and the coantrol these effects did not exhibit significant correlations with age, duration of illness or global cognitive impairment. The denstitometric parameters discriminated 78.4% of patients and controls; together with the olanimetric measurements 84.4% of the individuals were classified correctly. A potential contribution of white matter shrinkage to ‘cortical atrophy’ and the possible role of thalamic degeneration in DAT are briefly discussed.
The domus philosophy: A comparative evaluation of a new approach to residential care for the demented elderly
Authors: Lindesay James , Briggs Kate , Lawes Matthew , MacDonald Alastair , Herzberg Joe
Published: December 2004

This study reports a cross‐sectional comparison between three continuing care facilities for severely disturbed elderly demented people: two mental hospital psychogeriatric wards and a unit run according to the domus philosophy of care. The domus was characterized by greater expectations for residents' functioning, policy choice, resident control and availability of social and recreational activities. The level of staffing was higher on the domus than on the two wards. The residents on the three settings were broadly comparable with regard to age, diagnosis, length of stay, objectively assessed cognitive impairment and depression, but the domus residents were rated by the staff as less disabled in self‐care tasks, orientation and communication. Direct non‐participant observation using the Short Observation Method demonstrated significantly higher levels of activities and staff‐resident interaction on the domus compared to the hospital wards. There were no differences between the settings with regard to staff absenteeism, job turnover or psychological impairment, but the domus staff expressed higher levels of job satisfaction. These findings are discussed in the context of the limitations of study design and method.
Who should care for the frail elderly? A survey of medical and nursing staff
Authors: Victor Christina R.
Published: December 2004

Community care has been the main policy for the care of frail elderly people in Britain in the postwar period. Currently most care is provided by the informal sector, with state domiciliary services playing a residual role. In long‐term hospital beds or residential/nursing homes, institutional care is received by only a minority of elderly and has a very poor public image. One hundred and thirty‐nine medical and nursing hospital staff in an inner London health district were surveyed about (a) their knowledge of elderly people and (b) their views on the care of the frail elderly. Respondents overestimated the proportion of elderly in the general population and the proportion receiving community care services. Community care as opposed to institution care was the respondents' favoured general policy option. However, when presented with different types of frail elderly varying responses were elicted. For personal care tasks the family was seen as the most appropriate provider; state domiciliary services were seen as appropriate for house care tasks and incontinence. For severe dementia institutional provision and domiciliary services and not the family were the favoured care option. This illustrates that the frail elderly are not a homogeneous group and policies for their care must recognise the diversity of needs which this group presents.
Single photon emission tomography in Alzheimer's disease. A longitudinal study of changes in relative regional cerebral blood flow
Authors: Philpot Michael P. , Costa Durval C. , Burns Alistair , Levy Raymond , Ell Peter J.
Published: December 2004

Relative regional cerebral blood (rCBF) was measured in 10 patients fulfilling NINCDS‐ADRDA criteria for Alzheimer's disease using Tc‐99m‐HMPAO single photon emission tomography (SPET). In comparison with 11 age‐matched control subjects, relative rCBF was reduced in lateral and medial temporal areas. SPET was repeated after 12‐18 months. Relative rCBF fell significantly in the frontal and anterior and posterior parietal areas. Significant changes in left/right asymmetry were found in the frontal and posterior parietal areas suggestinga greater reduction in left hemisphere rCBF. There were few associations between relative rCBF and neuropsychological test performance.
Semiquantitative I‐123 IMP spect studies in late onset depression before and after treatment
Authors: Kumar Anand , Mozley David , Dunham Chris , Velchik Michel , Reilley John , Gottlieb Gary , Alavi Abass
Published: December 2004

Nine subjects with late onset unipolar depression were studied, before and after treatment, using I‐123 iodoamphetamine SPECT. In all nine subjects clinical improvement was associated with a significant increase (p<0.01) in cerebral/cerebellar activity ratios that correlated well with the decline in Hamilton depression scores.