bluuebunny/crossref_metadata_2025 huggingface dataset:
The changing pattern of referrals for psychogeriatric consultation in the general hospital: An eight‐year study
Authors: Anderson David N. , Philpott Robin M.
Published: December 2004

An eight‐year retrospective evaluation of referrals to a psychogeriatric consultation service demonstrated a highly significant linear increase of total referrals with a selective change of case mix that included more depressions and fewer cases of acute confusion or referrals with no psychiatric disorder. This did not occur with referrals from general practice, where case mix remained stable though total referrals also increased. It is suggested that this selective change relates to an educational influence of the specialist consultation service operating within the hospital and represents a desirable change of referral behaviour. The degree of psychiatric morbidity on general hospital wards far exceeds the capacity of a consultationservice whose primary objective must be education to enable non‐psychiatrists to detect and manage the majority of these disorders without recourse to specialist referral. Research that will further define the elements of the educational process that have greatest impactis needed and offers a new research direction for liaison psychiatry of old age.
Stress, role and training in carers of the elderly
Authors: Benjamin Lisa C.
Published: December 2004

The measurement of stressful event frequencies among different long‐stay settings within a hospital for the elderly showed that staff with higher‐ranking roles, regardless of their training, experienced certain stressful events more frequently than other staff members. Stressful event frequencies for a unit with only untrained care staff did not differ from frequencies for wards of trained nurses.
Recurrent herpes zoster encephalitis: A case report
Authors: Medcalf Pippa , Windsor Angus
Published: December 2004

An 89‐year‐old lady presented with severe right‐sided ophthalmic herpes zoster infection and secondary bacterial infection. Two weeks after admission she became very unwell with confusion and drowsiness and later developed bilateral upgoing plantar reflexes. An EEG was highly suggestive of herpes encephalitis and she made a good recovery with acyclovir. Neuropsychological tests showed pathological signs of impaired left temporal lobe function. After a further three weeks she again developed symptoms and signs of herpes zoster encephalitis and a repeat CT scan showed a right internal capsule infarct had developed. Encephalitis after herpes zoster infection is a rare complication but possibly underreported due to difficulties in diagnosis.
Gender dysphoria in old age: A single case study
Authors: Hodgkiss Andrew , Denman Chess , Watson James Patrick
Published: December 2004

The case of a man presenting with thoughts about having breasts and subsequently requesting sex reassignment at 65 years of age is reported. Details of intensive idiographic investigation are described. The psychopathological status of requests for sex reassignment at this age is discussed.
Major depression in hospitalized medically ill older men: Documentation, management, and outcome
Authors: Koenig Harold G. , Goli Veeraindar , Shelp Frank , Kudler Harold S. , Cohen Harvey J. , Blazer Dan G.
Published: December 2004

Fifty‐three hospitalized elderly men with medical illness were diagnosed with major depressive disorder and followed up for a mean of 2.3 months. Documentation and management of the depression by medical housestaff during the followup period were examined. There was no note of depression in the medical records of 44% of depressed patients, and depression was on the active problem list of only 32%. Followup and management plans for the depression after discharge were documented in 29%. No form of treatment was prescribed for 44% of depressed patients. Outcomes were determined by psychiatric evaluation at the end of the followup period. Of the 33 patients still alive and evaluated at followup, 64% had persistent depression, 18% improved, and 18% were in complete remission. No baseline patient sociodemographic or health characteristic, including severity of depression, was significantly related to improvement. Likewise, neither extent of documentation nor treatment implemented by housestaff was a significant predictor of outcome. We conclude that serious clinical depression in medically ill older patients may persist for a considerable period after hospital discharge and neither detection nor current management strategies appear to have a major impact on outcome.
Violence and psychogeriatric inpatients
Authors: Shah A. K.
Published: December 2004

The characteristics of all the patients admitted to an acute psychogeriatric admission ward over a 24‐month period were examined. The patients who had been responsible for acts of violence on the ward were compared with those who had not. Violent patients were likely to be younger, not to be depressed, to have dementia, and to be discharged to a more dependent setting, particularly a long‐stay psychogeriatric ward. The implication of this for adequate provision of psychiatric and social services is discussed. Levels of violence were low with only a small number of patients exhibiting violent behaviour.
Language assessment in a memory clinic
Authors: Stevens Susan J. , Pitt Brice M. N. , Nicholl Claire G. , Fletcher Astrid E. , Palmer Alison J.
Published: December 2004

The article discusses the potential of three assessments of language function in the diagnosis of early dementia. Seventy patients (mean age 68.0 yr) attending a memory clinic were assessed using three language tests: the Boston Naming Test, a semantic, and a phonemic word fluency measure. Results of these assessments were compared with those of clinical diagnosis including the Mini‐Mental State Examination. The patients were classified by probable diagnosis as (i) dementia (N=23), (ii) minimal cognitive impairment (N=18) and (iii) other, mainly depression (N=29). Of the 23 patients in the dementia group, 18 (78.%) had a deficit on the Boston Naming Test, while only 11 (47.8%) were classified as demented on the Mini‐Mental State Examination using a cut point of <24. Nine of the 18 patients (50%) with minimal cognitive impairment had a deficit using the Boston Naming Test, while one did using the Mini‐Mental State Examination. Factors such as age, sex and language of origin, which may have influence on language performance, are discussed. Age did not affect performance, but sex and language of origin did appear to. It is concluded that there is evidence for the inclusion of certain semantic language tests in any assessment of early dementia.
Consumption of psychotropic drugs in elderly persons registered at the home nursing centre in Bergen, Norway
Authors: Nygaard Harald A.
Published: December 2004

The regular use of psychotropic drugs in all patients aged 70 yr and over who were registered at the home nursing centre was studied. 27.4% of the patients used psychotropic drugs, 11.9% used antipsychotics, 14.6% anxiolytics and hypnotics/sedatives and 6% antidepressants. The use of antipsychotics was increased in mentally impaired patients and in wandering, restless aggressive persons, but declined with increasing age. Anxiolytics and hypnotics/sedatives and antidepressants were more frequently used by apathetic/passive/anxious patients. The dosage of antipsychotics declined with age. The doses are usually in line with general suggestions. Drugs in which the efficacy is judged by the patients themselves seem to be taken in higher doses than drugs in which the efficacy is determined by the physician.
Cognitive improvement following benzodiazepine discontinuation in elderly nursing home residents
Authors: Salzman Carl , Fisher Janina , Nobel Kenneth , Glassman Randy , Wolfson Abbie , Kelley Margaret
Published: December 2004

In a controlled study, benzodiazepine treatment was gradually discontinued from a group of elderly nursing home residents. In comparison with similar residents who continued on benzodiazepines, measures of memory and cognitive functioning showed significant improvement following discontinuance. There was no associated increase in anxiety, agitation, or sleeplessness. These data are consistent with previous observations suggesting that benzodiazepines impair cognitive function in the elderly and further indicate that such impairment is reversible upon benzodiazepine discontinuance.
Serum levels of tacrine in relation to clinical response in Alzheimer's disease
Authors: Eagger Sarah , Levy Raymond
Published: December 2004

The relationship between the serum concentrations of tacrine (tetrahydroaminoacridine), two of its metabolites and age, sex and therapeutic effect was examined. The improvement in two measures of cognitive function previously reported to show significant changes with the drug (MMSE and AMTS) correlated with blood levels to a modest but significant degree. Age was associated with higher levels of the drug and of its metabolites but there were no differences between males and females on any of the variables examined. The dose required to achieve adequate levels and therapeutic change is estimated to be at least 125 mg of tacrine hydrochloride or 100 mg of the active base. It is suggested that the full therapeutic value of the drug cannot be estimated at doses much below this and that this might explain some of the discrepant results reported in the literature.
The quantification of the relative effects of age and NART‐predicted IQ on cognitive function in healthy old people
Authors: Starr John M. , Whalley Lawrence J. , Inch Susan , Shering P. Anne
Published: December 2004

The cognitive function of 598 healthy old people aged 70 years or over resident in the community was measured by Mini‐Mental State Examination (MMSE) and National Adult Reading Test (NART). The 598 subjects, who were asymptomatic and on no medication, showed no significant correlation between age and NART‐predicted intelligence quotient (NARTIQ), but there were significant correlations between both age and MMSE score and NARTIQ and MMSE score. These cross‐sectional data suggest that the rate of decline of cognitive function may be significantly greater in subjects with lower NARTIQs; however, longitudinal data are required to test this hypothesis. The provision of normative data from a substantial number of community‐resident old people should assist later studies designed to detect the precise effects of cerebral pathology or systemic disease on cognitive function in old people.
Learning processes in dementia
Authors: Wertheimer J. , Boula J. G. , Brull J. , Gut A. M. , Pierrehumbert B. , Rufini J. , Zinder M. , Brechbühl D. , El Nadi A. , Mouflin A. , Montangéro J.
Published: December 2004

In its broadest sense, learning is a form of adaptation which continues throughout life; a process through which individuals are able to provide adequate responses. Dementia, however, generates a process of unlearning as well as an alteration of the capability to acquire new knowledge. Among the classical theories of learning, genetic psychology seems to be the one that is best suited to provide an understanding of how demented patients use their altered intellectual tools in an effort to master the reality of a world that escapes them. From this perspective, the observations of these patients permit a distinction of five classes of spontaneous activities. Moreover, this theory is helpful in understanding the patient's movements in space, no longer represented internally as a global entity. In occupational therapy workshops, the analysis of the tasks proposed to patients reveal two types of learning, one in which the repetition of the elementary actions is the only causal link with the construction of the object, the other in which a causal sequence of several stages of activity is necessary to reach this goal. Furthermore, within the framework of this theory, it is possible to identify the support necessary to carry out the objectives, in spite of the memory deficits. The social interaction between two patients jointly solving the same task seems to favour learning. Thus, learning remains possible, inasmuch as the channels still open are detected and the ways to use them are defined.
The role of two major cholinergic systems in memory acquistion and retention in the eight‐arm radial maze
Authors: Yamasaki Ritsu , Yamashita Motoshi , Taguchi Koshiro , Okada Michiyuki , Ikeda Hisao
Published: December 2004

The role of the nucleus basalis magnocellularis (NBM) and the medial septum (MS) in postoperative memory acquisition and postoperative memory retention was assessed in the eight‐arm radial maze task (Olton). NBM lesions and MS lesion significantly decreased choline acetyltransferase (CAT) activity in the innervated areas. Animals with MS lesion, but not NBM lesions, showed significant impairment of memory acquisition. NBM lesions induced a unique strategic pattern, but the development of strategic pattern with training was comparable to the sham‐injected group. Animals with MS lesion did not develop strategic pattern with training. NBM and MS lesions did not influence either memory retention or developed strategic pattern. These results suggest that (1) MS contributes to the radial maze task; (2) the two systems have qualitatively different contributions in the radial maze task; (3) the two systems do not contribute to memory retention; (4) the two major cholinergic systems have different functions in the pathophysiology of Alzheimer's disease.
The response of elderly community residents to request for brain donation: An interim report
Authors: Beardsall Lynn , Barkley Claire , O'Sullivan Angela
Published: December 2004

Normal neurohistology of the elderly brain is largely unstudied and unknown. Normal brains are essential as controls for postmortem investigations in longitudinal, prospective studies which aim to document and clarify the natural history of Alzheimer's disease. Ethically, consent should be sought from these subjects and their relatives at the beginning of such studies. This article reports the responses of normal and demented elderly community residents to request for brain donation. Eighty‐five per cent of the normal control group and 83% of incident cases of dementia signed declarations of intent for postmortem. During the first year of brain collection, 24 of 33 donated brains have been successfully collected at postmortem. The responses and attitudes of the subjects and their relatives and the value of obtaining such consent are discussed.
An observational study of two long‐stay psychogeriatric wards
Authors: Ward Tony , Murphy Elaine , Procter Andrew , Weinman John
Published: December 2004

Patients on two long‐stay psychogeriatric wards were observed using a schedule derived from transcription of videotape filmed on the wards. Data were also collected using the Clifton Assessment Procedures for the Elderly Behaviour Rating Scale (CAPEBRS), the Brighton Clinic Adaptive Behaviour Scale (BCABS) and psychiatric ratings. The observational procedure proved highly reliable but there was little evidence of association with other measures. Items related to disturbed behaviour on the CAPEBRS and the BCABS aggression subscale proved unreliable and it is suggested that this may be due to the overall low levels of activity. The implication for future research are discussed.
Lewy bodies in psychiatric patients
Authors: Birkett D. Peter , Desouky Abdellatif , Han Luke , Kaufman Mavis
Published: December 2004

This investigation concerns the mental changes associated with Lewy bodies. Lewy bodies are inclusion bodies found in nerve cells and are characteristic of idiopathic Parkinson's disease. It has also been suggested that they may occur as a normal ageing change. Previous literature concerning the psychiatric symptoms of Lewy body disease is reviewed. Dementia and parkinsonism‐associated depression have been previously recognized. For this study the psychiatric histories of two groups of autopsied mental hospital patients were compared; one group with Lewy bodies, and one group without Lewy bodies. There were 212 autopsies. Of these, 15 had Lewy bodies and 197 did not. Clinical and neuropathological descriptions of those with Lewy bodies are given. Findings are also presented in tabulated form, and the groups are compared statistically. Clinical diagnosis of Parkinson's disease and admission with a paranoid diagnosis were the findings most associated with Lewy bodies. It is suggested that paranoia may sometimes be an early symptom of Lewy body disease. The problem of patients with psychosis who subsequently develop idiopathic Parkinson's disease is discussed. Such patients could be misidentified and mistreated because of being diagnosed as drug‐induced parkinsonism.
Wechsler intelligence scale profiles in Alzheimer type dementia and healthy ageing
Authors: Christensen Helen , Mackinnon Andrew
Published: December 2004

Meta‐analytic techniques were used to integrate the Wechsler Adult Intelligence (WAIS) scores of healthy elderly subjects and Alzheimer type dementia patients from 21 studies. Although age‐scaled scores for demented subjects were lower than those of healthy elderly subjects for all subtests, the profiles for both groups were essentially parallel, with no subtest having significantly poorer scores than the others for the dementia patients. The pattern confirms other findings that verbal tests do not ‘hold’ to a greater degree than performance tests in dementia.
The St George's dementia investigation bed: A study of factors influencing the agreement between clinical and pathological diagnosis
Authors: Gilleard C. J. , Kellett J. M. , Millard P. H. , Wilkins P. , Honavar M. , Lantos P. L.
Published: December 2004

Accurate diagnosis in life of the underlying pathology in the dementias of old age remains difficult despite improvements in the specification of diagnostic criteria. The present study sought to determine the influence of age, comprehensiveness of investigations, severity of dementia and length of delay between investigation and autopsy on the level of clinicopathological diagnostic accuracy achieved. We were unable to identify any single factor which significantly enhanced or impaired overall diagnostic accuracy.
A behavioral microanalysis of the effects of haloperidol and oxazepam in demented psychogeriatric inpatients
Authors: Burgio Louis D. , Reynolds Charles F. , Janosky Janine E. , Perel James , Thornton Joe E. , Hohman Mary Jane
Published: December 2004

Twenty‐one inpatients on a psychogeriatric unit were assigned randomly to a haloperidol or oxazepam treatment group. Drug effects were assessed with three psychiatric rating scales and direct behavioral observation. The behavioral microanalysis employed two separate systems of observation: aberrant behaviors were assessed by recording the frequency of behaviors per hour, and the activities assessment (eg social interaction, sleeping) sampled each resident's behaviors during two 10‐min intervals per day. Results showed no differences between drug groups on any of the assessments, except for engagement in activities from the activities assessment. A modest non‐significant decrease in symptoms was noted on all psychiatric assessments. The behavioral observations showed very low pretreatment levels of aberrant behaviors. Non‐significant post‐treatment decreases were observed for disruptive vocalizations, paranoid verbalization, and non‐compliance; rates of physical aggression and psychomotor agitation increased somewhat. The potential role of behavioral microanalysis in nursing homes is discussed in light of new HCFA guidelines.
Differentiation between organic and functional psychiatric illness in the elderly: An evaluation of four cognitive tests
Authors: Orrell Martin , Howard Robert , Payne Andrew , Bergmann Klaus , Woods Robert , Everitt Brian S. , Levy Raymond
Published: December 2004

One hundred and sixty‐four patients admitted to a psychogeriatric unit were given a combination of four different cognitive tests: the Mini Mental State Examination (MMSE), the Abbreviated Mental Test Score, The Felix Post Unit Score and the compilation of tests recommended by the MRC Alzheimer's Disease Workshop. The tests were compared with respect to their ability to sort accurately cases of dementia and depression, and the effects of age and education on test score and misclassification rate with diagnosis controlled for. The MMSE had a very high misclassification rate for the poorly educated and depressed group. The logistical discriminant functional analysis selected only eight items as the best discriminators between organic/ functional or dementia/depression groups. Only one of these eight was not either a memory or orientation test. The value of simply adding up tests of different aspects of cognitive function in dementia assessment or screening is questioned.
The possessions owned by long‐stay psychogeriatric patients
Authors: Mountain Gail , Bowie Peter
Published: December 2004

A survey of patients' property and clothing was carried out on 11 long‐stay wards for the elderly confused in one health district. The results revealed a significant variance across the wards for both possessions and clothing. The potential effects on patient ownership of patient sex, physical dependency, availability of storage facilities, ward relocation and the practices of the staff are discussed.
Psychiatric morbidity among people aged 85+ in 1987. A follow‐up study at two and a half years: Associations with changes in psychiatric morbidity
Authors: Bowling Ann , Farquhar Morag , Grundy Emily , Formby Juliet
Published: December 2004

This article reports findings from a longitudinal survey of very elderly people living at home in London. The research aimed to identify social, psychological and physical characteristics associated with positive ageing and successful survival in the community in later life and its converse—negative ageing—as well as the associated policy implications. Associations with psychiatric morbidity, measured using the General Health Questionnaire, among sample members without cognitive impairment between the baseline interviews in 1987 and at follow‐up, two and a half years later in 1990, are reported. Twenty‐five per cent of survivors scored over the threshold of the GHQ in 1987 and 30% scored over the threshold in 1990. Half of those with a score over the threshold in 1990 also scored over the threshold in 1987. Hierarchical regression (using residualized change analysis) was used to estimate the effects of the independent variables on changes in psychiatric morbidity. The most significant predictor of psychiatric morbidity (GHQ score) in 1990 was baseline GHQ score, followed by health and functional status scores. Health and functional status were also the strongest predictors of baseline (1987) GHQ scores. The uniqueness of the study lies in the collection of follow‐up data on a sample of very elderly people, given that most surveys are corss‐sectional and contain too few people aged 85+ to merit separate analysis. It contributes to the small body of literature on outcome of depression. The lack of consistent associations with recovery from psychiatric morbidity in the literature enhances the importance of studies aiming to identify factors associated with different outcomes.
Psychotic symptoms in Alzheimer's disease
Authors: Jabeen Sabiha , McKeith Ian G. , Fairbairn Andrew F. , Perry Robert H. , Ferrier I. Nicol
Published: December 2004

The case notes of 37 patients with neuropathologically confirmed Alzheimer's disease were studied for non‐cognitive psychiatric features occurring during the course of the illness. Four (11%) exhibited delusions, five (14%) had visual hallucinations and one (3%) had auditory hallucinations. Two (6%) developed a misidentification syndrome, five (14%) developed non‐delusional paranoid thinking and six (16%) had significant depressive symptoms with two (5%) developing major depression. Possible explanations for the wide variation in reported rates of psychotic symptoms in Alzheimer's disease in the literature are discussed.
A psychogeriatric community outreach service: Description and evaluation
Authors: Seidel G. , Smith C. , Hafner R. J. , Holme G.
Published: December 2004

The structure and function of a small psychogeriatric community outreach team is outlined, together with the results of intervention in 100 consecutive cases. Patients in residential or nursing home care were rated for level of behavioural disturbance at entry to the study and after three months. Patients with dementia and psychotic disorders showed clinically and statistically significant improvement, whereas the improvement of patients with major depression was not statistically significant. The usefulness of the outreach service was evaluated independently by carers and by referring agents. Eighty per cent of carers and 87% of referring agents rated the service as useful or very useful. It was concluded that a small outreach team (comprising the equivalent of only six full‐time staff) is an effective and acceptable supplement to the overall care of psychogeriatric patients.
Affective behaviour and success of EMI community home placement
Authors: Wood Kenneth A. , Cooper Jean , Richardson Kim , Forbes Alasdair
Published: December 2004

Cognitively impaired or mentally ill older individuals placed in community accommodation specifically for the elderly mentally infirm (EMI) may not always be viewed as successfully placed by residence staff. This sometimes necessitates a move to alternative care. This article examines several factors that may influence care staff views about current success of residents' placement and finds that affective behavioural factors correlate more strongly with this than either cognitive function as measured by Mini Mental State or behaviour reflected in Crichton Rating Scale scores.
Prescribing residential respite care for dementia—effects, side‐effects, indications and dosage
Authors: Brodaty Henry , Gresham Meredith
Published: December 2004

Recent momentum for increased provision of residential respite services for people with dementia is not supported by empirical data. Yet the literature is replete with anecdotal reports indicating the efficacy of residential respite. This discrepancy may have resulted from methodological flaws in the research, lack of awareness by consumers and health professionals and great diversity in the reasons for, and among the recipients of, respite. The prescription of respite care will need to be more specific and rigorous—matching the correct dose of respite care to the needs of recipients and caregivers—for future research to demonstrate its efficacy.
Zuclopenthixol and thioridazine in the treatment of aggressive, elderly patients: A double‐blind, controlled, multicentre study
Authors: Harenko A. , Alanen I. , Elovaara S. , Ginström S. , Hagert U. , Savijärvi M. , Yli‐kerttula A. , Elgen K.
Published: December 2004

A four‐week double‐blind study of zuclopenthixol and thioridazine in 64 elderly patients presenting with hostility or restlessness has been carried out in five Finnish mental hospitals. The ages of the patients in the two groups ranged from 64 to 97 years. The initial daily dose was 2–6 mg zuclopenthixol or 20–60 mg thioridazine. In week 4 the mean daily dose was 6.8 mg zuclopenthixol and 62 mg thioridazine. AFter one week of treatment the severity of illness was reduced significantly in the zuclopenthixol group and in both groups after two and four weeks. The key symptom hostility showed significant improvement in both treatment groups after only one week of treatment. The other key symptom restlessness was also significantly improved in both groups. The only significant difference between the groups was a better effect on sleep disturbance with zuclopenthixol. Few side‐effects were recorded in either group, and no serious effects on cardiovascular function were found. The study indicates that both zuclopenthixol and thioridazine are effective drugs in the treatment of elderly patients with symptoms such as hostility, aggressiveness and restlessness.
Concepts of mild memory impairment in the elderly and their relationship to dementia—a review
Authors: Dawe Bridget , Procter Andrew , Philpot Michael
Published: December 2004

The concept enshrined by Kral (1962) in the term ‘benign senescent forgetfulness’ is reviewed together with a number of other diagnostic terms synonymous with mild memory impairment. Data from epidemiological studies which employ them are presented and the relationship between ‘normal’ ageing, subjective memory complaints and dementia is discussed. Mild memory impairment in late life is associated with an increased risk of developing dementia but it is difficult from present studies to quantify this.
Do subjective memory complaints precede dementia? A three‐year follow‐up of patients with supposed ‘benign senescent forgetfulness’
Authors: O'Brien John T. , Beats Barbara , Hill Katie , Howard Robert , Sahakian Barbara , Levy Raymond
Published: December 2004

A three‐year follow‐up study is reported of people presenting to a hospital memory clinic with ‘benign senescent forgetfulness’.All were complaining of forgetfulness for which no organic or psychiatric cause could be found. Sixty‐four out of the 68 patients initially seen were traced, of whom three had died. Six (8.8%) were found to have become demented, a slightly higher proportion than would be expected given the age of the population. No particular clinical features were found that predicted the subsequent development of dementia. Cognitive performance of remaining non‐demented subjects showed a significant but relatively modest decline, probably related to the effects of normal ageing. It is concluded that memory complaint must be taken seriously in the elderly and may sometimes indicate early dementia despite normal scores on simple screening tests. However, a finding of normality after careful assessment is reassuringly correct in the majority of cases.
Reliability and validity of the Cohen–Mansfield agitation inventory in institutionalized elderly
Authors: Finkel Sanford I. , Lyons John S. , Anderson Rachel L.
Published: December 2004

The reliability and validity of the Cohen–Mansfield Agitation Inventory (CMAI) were studied in residents of a long‐term care facility. The CMAI demonstrated high internal consistency, but only marginally adequate interrater reliability. Correlations with the Behavioral Syndromes Scale for Dementia (BSSD) and the Behavioral Pathology in Alzheimer's Disease (Behave—AD) provide support for the contention that the CMAI is valid measure of agitation with nursing home residents.
Psychiatric disorders among elderly patients attending a geriatric medical day hospital: Prevalence according to clinical diagnosis (DSM‐III‐R) and agecat
Authors: Turrina Cesare , Siciliani Orazio , Dewey Mike E. , Fazzari Giuseppe C. , Copeland John R. M.
Published: December 2004

One hundred and fourteen elderly medically ill day patients were interviewed in order to assess the prevalance of DSM‐III‐R main psychiatric disorders. Dementia affected 14.0% of the subjects, major depression 20.3%, dysthymic disorder 4.4%, atypical depression 13.2%, other disorders 3.6%. Overall, 60.5% of the patients had a psychiatric disorder. The computerized case designation (AGECAT) showed an acceptable concordance with clinical diagnoses (kappa value for dementia 0.59, for depression 0.58). Some issues related to the high prevalence of major depression are discussed.
Psychiatric morbidity and outcome in elderly patients undergoing emergency hip surgery: A one‐year follow‐up study
Authors: Shamash K. , O'Connell K. , Lowy M. , Katona C. L. E.
Published: December 2004

Fifty consecutive elderly patients undergoing emergency hip surgry were assessed shortly after operation and again one year later. Depressive symptoms, cognitive impairment, global physical ill‐health and activity of daily living (ADL) function were assessed and their predictive effect on outcome investigated. Mortality was predicted by the presence of both depression and dementia as well as by physical ill‐health. The effect of depression on mortality was independent of concurrent physical illness. Mortality was particularly high in subjects with both depression and dementia. Length of hospital stay was predicted by increased age and the presence of dementia. Psychiatric evaluation may thus be relevant to the postoperative management of elderly patients undergoing emergency hip surgery.
Psychiatric morbidity among continuing care geriatric inpatients
Authors: Shah Ajit , Phongsathorn Virach , George Collette , Bielawska Celia , Katona Cornelius
Published: December 2004

This study examines the point prevalence of psychiatric morbidity among continuing care geriatric inpatients and the performance of screening questionnaires in detecting such morbidity. From a sample of 74 patients it was possible to carry out complete dementia ratings in 53 patients and depression ratings in 52 patients. Eighty‐three per cent of the patients assessed had dementia and 48% had significant depressive symptoms. Screening for dementia with the Mini Mental State Examination (MMSE) had 100% sensitivity and 78% specificity. The Geriatric Depression Scale (GDS) had 80% sensitivity and 64% specificity at the conventional cutoff of 10/11. Receiver operating characteristics curve analysis suggested that a 12/13 cutoff gave the best sensitivity (75%) and specificity (73%) values for depressive symptoms. Among patients with dementia a cutoff score of 12/13 on the GDS also gave optimal sensitivity, specificity and positive predictive values. The GDS revealed good test–retest stability in the whole sample (tau = +0.55, p < 0.001) and the demented subgroup (tau = +0.52, p < 0.001).
The evaluation of long‐term care for the dementing elderly: A comparative study of hospital and collective non‐medical care in France
Authors: Ritchie K. , Colvez A. , Ankri J. , Ledesert B. , Gardent H. , Fontaine A.
Published: December 2004

Despite growing interest in the nature and mechanisms of senile dementia, there has been surprisingly little research on long‐term care provision for persons with irreversible cognitive decline. The present study describes a model for the evaluation of long‐term care facilities for the dementing elderly and its application in France to a comparative study of traditional long‐stay hospitals and non‐medical communal care. Results suggest that persons in communal care are less dependent, report less depressive symptomatology, are more mobile, engage in verbal communication more frequently and have fewer language difficulties than persons in hospital care, although no differences are found between the two groups in terms of dementia severity. Both family and professional caregivers were found to be more satisfied with communal care. A follow‐up study suggests that some of these differences might, however, be due to differences in the populations at admission. The results are discussed in terms of appropriate care allocation for persons with senile dementia.
Concurrent validity of critical flicker fusion in patients with primary degenerative dementia of the Alzheimer type
Authors: Curran Stephen , Wattis John P. , Hindmarch Ian
Published: December 2004

The concurrent validity of critical flicker fusion threshold (CFFT) and flicker threshold measurement was examined in 23 female and three male patients with primary degenerative dementia of the Alzheimer type (PDDAT). Patients had a mean age of 81.7 ± 6.05 years (range 67–89). Diagnosis of PDDAT was based on the DSM‐III‐R classification. Both the CFFT and flicker thresholds were found to be highly and significantly correlated with standardized clinical assessment (Global Deterioration Scale), cognitive function (Abbreviated Mental Test) and psychomotor performance (Choice Reaction Time). The implications of these two measures for clinical trial research and the longitudinal assessment of patients with Alzheimer's disease are discussed.
The impact on carers of behavioural difficulties in dementia: A pilot study on management
Authors: Hinchliffe A. C. , Hyman Inge , Blizard Bob , Livingston Gill
Published: December 2004

Sixteen day centre attenders with dementia and their carers were interviewed. The cognitive and behavioural impairments of subjects with dementia were assessed using the Mini‐Mental State and the Stockton Geriatric Behaviour Rating Scale. Carers were assessed using the GHQ(28) as a screen for psychiatric morbidity. Where psychological intervention programmes were successful in reducing behaviour identified by carers as particularly distressing, carer GHQ fell. Future studies are needed.
The Hachinski Ischaemic Score: A reevaluation
Authors: Dening T. R. , Berrios G. E.
Published: December 2004

The Hachinski Ischaemic Score (HIS) was first introduced in 1975 as a clinical scale intended to differentiate cases of dementia resulting from multiple strokes (multi‐infarct dementia) from those with primary degenerative dementias. Its conceptual basis rests on the view that vascular dementia is the result of strokes, not of general atherosclerosis or ischaemia. This article critically examines the psychometric properties of the scale. Reliability studies are singularly lacking, and studies of its validity have produced inconsistent findings. Furthermore, there has been a change of views regarding vascular dementia, which is currently seen as heterogeneous and not simply a consequence of strokes. We argue that the HIS is in fact an infarct score, that it is not a true dimensional scale, and that it has outlived its usefulness.
The ability of general practitioners to detect dementia and cognitive impairment in their elderly patients: A study in Mannheim
Authors: Cooper Brian , Bickel Horst , Schäufele Martina
Published: December 2004

The early detection and diagnosis of dementia is gaining in importance both for medical research and for individual case management. Here, a key part can be played by general practitioners, who are in contact with most of the affected old people and well placed to observe any signs of mental deterioration.

A study in Mannheim, Germany, is reported, in which all contacts with over‐65‐year‐old patients during one month were documented in each of 24 practices, and each patient's level of memory and cognitive functioning was assessed by his or her own doctor. A stratified subsample of patients in 21 of the practices was examined by the research team, using a standardized interview and test procedure.

The findings indicate a greater accuracy of case recognition than has been reported in previous studies. In screening the interview subsample, the practitioners achieved a sensitivity of 92% and a specificity of 76%, identifying most of the mild as well as the severe cases. These results emphasize the potential importance of general practice for the early detection of dementia, and suggest that more attention should now be directed towards the clinical prognosis and management of cases presenting in the primary care setting.
Primary or depressive dementia: Clinical features
Authors: desRosiers Gabriel
Published: December 2004

In 1979, Wells tabled a list of ‘major clinical features’ which he found most useful in distinguishing dementia due to organic disease from dementia occuring in the context of psychiatric conditions like depression. This article reviews recent findings on the most commonly accepted items of this list and, for several of them, concludes that the evidence is controversial. Newer aspects are then briefly considered which, when validated in longitudinal studies, may add to the clinician's range of implements during diagnostic workup.
Keeping track of a conversation: Impairments in Alzheimer's disease
Authors: Alberoni Margherita , Baddeley Alan , Sala Sergio Della , Logie Robert , Spinnler Hans
Published: December 2004

Earlier research suggests that AD patients tend to be particularly impaired in the central executive component of working memory, leading to problems in coordinating information from different sources. This suggests that they may be particularly handicapped in keeping track of conversations involving several people. This was studied in 19 AD and 19 matched control subjects. The patients were screened to minimize problems of face recognition and language comprehension and were then shown videotapes of conversations involving from two to five characters. After each tape, a statement made by one of the characters was presented and the subject required to point to the person who had made that statement. Performance was at ceiling for normals, except when the speakers had changed location, when some errors occured. AD patients showed a clear tendency for performance to deteriorate as number of speakers increased, and to show higher error rates when participants changed location. Implications are discussed for AD patients attempting to cope with everyday social situations.
Diagnosis of dementia 3—use of investigations. A survey of current consultant practice, review of the literature and implications for audit
Authors: Byrne E. J. , Smith C. W. , Arie T. , Lilley J.
Published: December 2004

The use of a screening battery of investigations in the assessment of the patient with the dementia syndrome has been recommended by many authorities. A postal survey of hospital specialists showed that the age of the patient influenced their routine use of such batteries. In patients aged < 75 years, their use of investigations closely resembled ‘recommended’ batteries; patients aged > 75 years were much less likely to have a routine screen of investigations. The use of CT scan was much less influenced by the age of the patient. A critical appraisal of the use of investigations in the patient with the dementia syndrome concludes that few of the ‘recommended’ tests will identify the cause of dementia, but will identify conditions which aggravate cognitive impairment, and that further information on the yield of tests, costs of tests, and the results of treating aggravating factors is urgently needed.
Screening for dementia—a comparison of two tests using receiver operating characteristic (ROC) analysis
Authors: Jagger Carol , Clarke Michael , Anderson Judith
Published: December 2004

The abilities of the Mini‐Mental State Examination (MMSE) and the Information/Orientation (IO) subtest of the CAPE assessment to detect a range of severities of dementia were compared by receiver operating characteristic (ROC) analysis. One thousand five hundred and seventy‐nine persons completed the initial screening phase and on the basis of their MMSE score, 438 completed the second stage, a full psychiatric assessment using the CAMDEX (Cambridge Mental Disorders of the Elderly Examination). The IO subtest performed significantly better than the MMSE for detection of moderate and severe dementia. However, for minimal or worse dementia the MMSE showed the best overall performance. Optimal cutpoints for detection of moderate+ dementia were found to be 18/19 (MMSE) and 8/9 (IO subtest) while for mild and more severe dementia these were 22/23 (MMSE) and 11/12 (IO subtest). For both screens the ability of the test to discriminate dementia was significantly impaired for those with physical disability, of manual social class or low educational attainment. The MMSE also performed worse with those aged 80 years and over.
The lifetime productivity of eminent Australian academics
Authors: Christensen Helen , Jacomb Patricia A.
Published: December 2004

Research productivity was examined over the careers of a sample of eminent Australian academics now aged 70–90 years. Overall number of publications increased to a peak at 50–59 years of age and then declined. However, different peaks were observed for various types of publication. Productivity increased to a peak age of 40–49 years for journal articles, 50–59 years for new books and cross‐disciplinary publications, and 60–69 years for revised and edited books, technical publications and non‐technical books. The age of peak productivity for low and high publishers coincided. These effects could be either a consequence of ageing or due to cohort effects in publication practices.
Case report: Acute confusional state secondary to a combination of fluoxetine and lithium
Authors: Shah A. K. , McCloskey O.
Published: December 2004

With the aid of case report, acute confusional state secondary to the combined use of fluoxetine and lithium is described. This is an important side‐effect of the combination and its recognition and management are discussed.
Do old age psychiatrists miss physical illnesses?
Authors: Tench David W. , Benbow Susan M. , Benbow Emyr W.
Published: December 2004

We studied the ability of old age psychiatrists to accurately diagnose physical disorders in elderly patients. A group of 24 psychogeriatric patients who died in hospital were matched for age and sex with 24 elderly patients who died under the care of other specialists in the same hospital. Postmortem findings and premortem diagnoses were compared retrospectively and the two groups showed high but similar levels of diagnostic discrepancies, despite the greater prevalence of dementia in the psychogeriatric group. The results show that old age psychiatrists are as successful as other specialists in identifying physical illnesses in their elderly patients.
Permeable walls, floors, ceilings and doors. Partition delusions in late paraphrenia
Authors: Howard Robert , Castle David , O'Brien John , Almeida Osvaldo , Levy Raymond
Published: December 2004

A partition delusion is the belief that people, objects or radiation can pass through what would normally constitute a barrier to such passage. These delusions have been reported to be common in late paraphrenia and late‐onset schizophrenia. Such partition delusions were found in 68% of 50 patients with late paraphrenia, but only in 13% of patients with schizophrenia who had grown old and in 20% of young schizophrenics. Partition delusions, often in association with persecutory beliefs, are common in late paraphrenia and we discuss some possible reasons for this.
A survey of frontal lobe dementia in a psychogeriatric day unit population
Authors: Cole Andrew J.
Published: December 2004

Nine (12%) of 78 consecutive first admissions to psychogeriatric day units fulfilled an operational definition for dementia of frontal lobe type (DFT). These cases showed many of the behavioural, neuropsychological and neurophysiological features of DFT reported in presenile subjects. They accounted for 14% of first admissions with organic brain syndromes and 37% of those showing marked apathy or disinhibition. These findings support the hypothesis that DFT is a common cause of referral to psychogeriatric services and a significant source of behavioural disturbances in such settings.
Prolactin response to withdrawal of thioridazine in dementia
Authors: McLennan J. , Findlay D. J. , Sharma J. , McEwen J. , Ballinger B. R. , Maclennan W. J. , McHarg A. M.
Published: December 2004

Thirty‐six female inpatients with a clinical diagnosis of senile dementia of the Alzheimer type were entered into a double‐blind withdrawal of their established thioridazine therapy over a four‐week period. Prolactin (PRL) levels were assayed at weeks 0, 2 and 4 in both groups. A significant reduction in PRL level over this period was seen in the placebo‐substituted group as compared with the active‐continued group. Over the same interval there was no significant change or difference between the two groups in terms of cognitive function, behaviour or physical condition. There was no correlation between PRL levels and degree of dementia or dose of thioridazine at the start of the study. This study suggests that the response to thioridazine withdrawal in senile dementia of the Alzheimer type is a reversal of pharmacological hyperprolactinaemia. The timescale and extent of this can be likened to that seen in schizophrenics and in normal volunteers. No definite evidence emerged that PRL levels might be useful as markers of disease severity or response to neuroleptic therapy.