bluuebunny/crossref_metadata_2025_split huggingface dataset:
The additional benefit of extending an antidepressant trial past seven weeks in the depressed elderly
Authors: Georgotas Anastasios , McCue Robert E. 
Published: December 2004

AbstractThirty‐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

AbstractThe 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

AbstractIn 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

AbstractA 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

AbstractMost 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

AbstractEight 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

AbstractDepression 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

AbstractFifty‐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

AbstractTwo 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

AbstractThe 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

AbstractA 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

AbstractThe 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

AbstractThirty‐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

AbstractIn 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

AbstractWith 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

AbstractPostmortem 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

AbstractTetrahydroaminoacridine (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

AbstractSeventy‐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

AbstractThirty‐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

AbstractUntil 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.
The measurement of incapacity in the severely demented elderly: The validation of a behavioural assessment scale
Authors: Ritchie Karen , Ledesert Bernard 
Published: December 2004

AbstractThe 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

AbstractA 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

AbstractDifferent 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.