bluuebunny/crossref_metadata_2025_split huggingface dataset:
A postal survey of the quality of long‐term institutional care
Authors: Challiner Yvonne , Watson Rachel , Julious Steven , Philp Ian 
Published: December 2004

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

AbstractWe describe a closed therapeutic group run in a community setting for the elderly with functional psychiatric illnesses. The aim of the group was to promote mental health and self‐confidence and to reduce psychiatric morbidity. A directive approach was taken and members were encouraged to seek solutions to their problems. Outcome was good on both objective and subjective measures. Difficulties in running the group are discussed. Finally, it is suggested that such groups may be an effective means both of improving mental health and of utilizing limited health service resources, and warrant further research.