bluuebunny/crossref_metadata_2025_split huggingface dataset:
The diagnosis and management of senile dementia in general practice: A study of 301 general practitioners in the montpellier region
Authors: Ledésert Bernard , Ritchie Karen 
Published: December 2004

AbstractWhile in most western countries the early diagnosis and community management of dementing disorders in the elderly is very much the responsibility of the general practitioner, a number of studies suggest general practitioners to be poorly prepared for such a task. In a postal questionnaire of 301 general practitioners in the Montpellier region of France, wide variations were found in clinical practice. Of particular concern was failure to use standardized instruments in the diagnosis of cognitive deficits and the high prescription rate of inappropriate laboratory and neurological examinations. The results of the study suggest areas in which general practice procedures may be altered to reduce false positive diagnoses.
Correlation between hospital anxiety depression (HAD) scale and other measures of anxiety and depression in geriatric inpatients
Authors: Wattis John Philip , Davies Keren Nicola , Burn Wendy Katherine , McKenzie Fiona Ross , Brothwell Judith Ann 
Published: December 2004

AbstractNinety‐four patients on geriatric wards were examined as part of a study of prevalence of psychiatric disorders in elderly inpatients. A good correlation was found between depression measured on the HAD and on the Montgomery–Asberg scale. Lower, but still highly significant correlations were found between anxiety measured on the HAD and on the brief anxiety scale (BRAS), between anxiety on the self‐rating anxiety scale (SRAS) and the BRAS, and between anxiety on the HAD and the SRAS.
Misdiagnosis in dementia: Comparisons of diagnostic error rate and range of hospital investigation according to medical speciality
Authors: Ryan D. H. 
Published: December 2004

AbstractClinical diagnosis was reassessed via case note audit in 146 (73%) patients with a main diagnosis of dementia randomly selected from computer‐linked general and psychiatric hospital morbidity records of dementia patients admitted to Scottish hospitals in the Lothian region between 1968 and 1987. Twenty‐three cases (16%) failed to meet DSM‐III‐R criteria on case note review. There was no significant difference in the case ascertainment rate of psychiatrists, physicians and geriatricians. Cerebrovascular accidents, depression and acute confusional states were the main differential diagnoses in failed cases (75%). The range and cost of hospital investigation in dementia was noted and varied according to specialty with significant differences between specialties in the use of specific tests, secondary investigations and postmortem examination. Diagnostic error rate and use of secondary investigations were contrasted for the periods 1968‐84 and 1985‐87, but there was no evidence of significant change.
Predictors of increased mortality in elderly depressed patients
Authors: Burvill Peter W. , Hall Wayne D. 
Published: December 2004

AbstractFive‐year standardized mortality rates for a cohort of elderly depressed patients in Perth, Western Australia, were greater than expected (M = 2.047, F = 1.658). These results were very similar to the 4‐year rates in a London study (Murphy et al., 1988), as were the causes of death. There was a significantly greater chance of being alive at the end of 5 years if, on entry to the study, the patients were: female, less than 75 years of age, had no impairment of mobility, had a diagnosis of major depression with melancholia and psychosis, and had a good recovery from the depressive illness at the end of 12 months. Impairment of mobility was the best physical status indicator of subsequent mortality. Two measures of patient's self‐assessment of physical status were as good predictors of mortality as a physician assessment of health, other than impairment of mobility.
Depression in older medical inpatients
Authors: Fenton Fred R. , Cole Martin G. , Engelsmann Frank , Mansouri Iradj 
Published: December 2004

AbstractThis cross‐sectional survey conducted in a university‐affiliated community hospital determines the point prevalence rates and identifies demographic, social and clinical correlates of major depressive episode (MDE) among men and women aged 65–74, 75–84, and 85 and older. Items from the Diagnostic Interview Schedule were used to diagnose major depressive episode (MDE); the Depression Status Inventory and the Depression Diagnostic Scale were used to measure its severity. Among 215 newly admitted medical inpatients, 100 men and 115 women who were at most mildly cognitively impaired, the point prevalence rates of MDE were: similar in the three age groups, 28%, 28% and 24% respectively; over twice as high among women as among men aged 65–74 and 75–84; virtually identical among men and women aged 85 and older. The intensity of the MDEs detected was on average mild. Clinically meaningful statistical associations were observed between certain psychological and clinical correlates and MDE. The psychological correlates were absence of meaning in life and premorbid personality. The clinical correlates were impaired ability to perform routine daily activities relating to self‐care and previous consultation or treatment for an emotional problem. We contrast our results with those of similar surveys, and identify the clinical and research directions we believe that this and similar work should take.
Personality changes in normal and cognitively impaired elderly: Informant reports in a community sample
Authors: Jacomb Patricia , Jorm Anthony , Christensen Helen , Mackinnon Andrew , Henderson Scott , Scott Ruth , Korten Ailsa 
Published: December 2004

AbstractPersonality changes are included in the DSM‐III‐R and ICD‐10 criteria for diagnosis of dementia. However, until quite recently, dementia research has emphasized cognitive decline, with little interest being shown in personality change. Recent studies looking at personality changes in dementia have usually used small clinical samples. In the study reported here, such changes have been assessed in a community sample of persons over 70 years. Information was obtained from a close relative or friend. A single dimension of personality change was found. There was a moderate but significant correlation between personality change and cognitive change. Reports of personality change were also correlated to neurotic symptoms in the informant. Personality change was unrelated to the gender of the informant, the relationship of the informant to their relative or whether they lived with their relative. Also, there was no association between personality change and the elderly subject's age, gender or level of education. Through logistic regression, the neurotic symptom score of the informant was found to be the best predictor of reported personality change. This suggests that caution may be needed in interpreting information about personality change obtained from informants.
Late onset problem drinking in older adults
Authors: Atkinson Roland M. 
Published: December 2004

AbstractAfter the first descriptions of late onset alcoholism in the early 1970s, no systematic attention followed for more than a decade. In the past 10 years, however, that has changed, and this report seeks to summarize recently acquired knowledge about late onset problem drinking, including the author's own work on this phenomenon. The incidence of new alcoholism cases does decline with age but remains appreciable into the late sixties. Samples of ageing alcoholics in treatment show that as many as ¼ to ⅔ of cases had onset after age 60. Risk factors for late onset alcoholism include female gender, higher socioeconomic status and (in some but not all studies) life stressors, but neither psychiatric comorbidity nor positive family history of alcoholism appears to contribute in a majority of cases. Compared to longstanding alcoholics, late onset cases tend to be milder and more circumscribed, and they may also fluctuate more, with an apparently high likelihood of spontaneous remission, at least over the short term. These characteristics have implications for the use of brief and informal interventions to prevent and reduce late onset problem drinking, but also suggest caution in interpreting the response of late onset cases to treatment in uncontrolled studies. Present knowledge of late onset alcoholism is fragmentary; more systematic clinical research on its characteristics and treatment is needed.
Affective disorders related to spect patterns in alzheimer's disease: A study of emotionalism
Authors: Lebert Florence , Pasquier Florence , Steinling Marc , Petit Henri 
Published: December 2004

AbstractMood disorder in dementia of the Alzheimer type (DAT) is heterogeneous in presentation. A typical feature is emotionalism, defined by Allman (1991) as 'a heightened tendency to cry (or rarely laugh) such that crying occurs more frequently, more easily, more vigorously, or in circumstances that previously would have been out of character'. Given the evidence for the involvement of cerebral laterality in the control of emotion, we investigated the relationship between emotionalism and 99mTc‐HMPAO–SPECT patterns in 14 DAT patients. Right/left frontolateral asymmetry was significantly greater in the eight emotionalism‐positive patients than in the six emotionalism‐negative patients.
Evaluating decisions in mental capacity assessments
Authors: Silberfeld Michel 
Published: December 2004

AbstractOne hundred and eleven capacity assessments are described where three criteria to assess the ability to make decisions were investigated. These were ability to identify options, the ability to understand the consequences of decisions and the ability to implement decisions. The effectiveness of these criteria in differentiating capable/incapable patients supports the idea of decision‐making capacity or decision‐specific capacity. The criteria applied, nevertheless, are not sufficient in all cases to determine capacity.
Caring for an elderly person: Presictors of burden in dementia care
Authors: Grafström Margareta , Fratiglioni Laura , Winblad Bengt 
Published: December 2004

AbstractIn a population‐based study, the burden of caring for an elderly relative was investigated. In this article the nature of burden, reported by the relatives of the elderly, is described according to Pearlin's conceptual model. Background factors and context as a well as primary stressors were analysed. The close relatives were interviewed with a structured burden questionnaire. Among the background variables, gender of the caregiver was strongly associated with a heavy burden. Behaviour disturbances also emerged as a predictive factor of burden. Analysis of the primary stressors indicated that in the mild phase of dementia, long duration of the disease and decreased ADL capacity cause greater burden for the caregiver.
Psychological distress among workers caring for the elderly
Authors: Macpherson Robertson , Eastley Rebecca J. , Richards Hayley , Mian Ihsan Haq 
Published: December 2004

AbstractThe GHQ‐30 was used to assess psychological disturbance among staff working in four long‐stay wards, four homes for the elderly mentally infirm, four elderly persons' homes and four private nursing homes. Rates of disturbance were consistent across all 16 units. Rates of CGHQ caseness were low, compared with published findings from a representative UK community sample. A strong relationship was demonstrated between staff psychological disturbance and aggression from residents over the last week. Disturbed staff were more likely to perceive a lack of support at work, and to report 'shouting back' at aggressive residents. No relationship was found between rates of disturbance and a range of demographic and work‐related factors. Implications for service provision and future research are discussed.
Consumption of psychotropic drugs in nursing home residents: A prospective study in patients permanently admitted to a nursing home
Authors: Nygaard H. A. , Brudvik E. , Juvik O. B. , Pedersen W. E. , Rotevatn T. S. , Vollset Å. 
Published: December 2004

AbstractIn a prospective study, the routine handling of psychotropic drugs in five nursing homes in Bergen, Norway, was examined in patients who were admitted to a permanent stay. A follow‐up was performed after 3 months. Of the 83 patients who were admitted 64% consumed psychotropic drugs, at follow‐up 68%. Both at admittance and after 3 months one‐third of the residents were treated with antipsychotics. For antipsychotics alone evident changes were observed during the observation time. The consumers were more liable to be demented, restless and wandering. The study confirms the high number of residents using psychotropic drugs. It is concluded that 'overprescription' seems to be a general way of treating disruptive behaviour and not confined to nursing homes.
Disturbed behaviour in dementia sufferers: A comparison of three nursing home settings
Authors: Martin Christopher , McKenzie Stephen , Ames David 
Published: December 2004

AbstractIn order to determine whether a specialist psychogeriatric nursing home was fulfilling its intended role of caring for the most behaviourally disturbed dementia sufferers, 24 of its demented residents were compared with 28 demented individuals discharged from a psychiatric unit to ordinary nursing homes and 30 mobile dementia sufferers in nursing home wards of a geriatric centre. Those in the psychogeriatric nursing home showed more disturbed behaviours than those in the other two settings. Scores on the Rating Scale for Aggressive Behaviour in the Elderly were compared with degree of cognitive impairment for the first time in the literature and showed no correlation with degree of cognitive impairment for the first time in the literature and showed no correlation with congnitive performance.
Charles bonnet syndrome plus: Complex visual hallucinations of charles bonnet syndrome type in late paraphrenia
Authors: Howard Robert , Levy Raymond 
Published: December 2004

AbstractEighteen of a series of 101 late paraphrenic patients experienced complex, prolonged and repetitive visual hallucinations that resemble the characteristic experiences of individuals with the Charles Bonnet syndrome. The Charles Bonnet syndrome itself is a rare and heterogeneous disorder and the appearance of Charles Bonnet syndrome‐like hallucinations in association with functional psychoses in the elderly has been hitherto largely unrecognized. Cases were predominantly female (reflecting the overall sex ratio described in late paraphrenia), 50% had accompanying auditory hallucinations, 42% were visually impaired and only one patient had insight into the hallucinatory nature of the experiences. Late paraphrenics who experienced these phenomena had significantly lower scores on the MMSE than those who did not. The hallucinations disappeared in 53% of the patients who were treated with antipsychotic medication. Eight of the patients underwent MR brain imaging and in four of these structural abnormalities of the midbrain were found.
The use of risperidone, an atypical neuroleptic, in lewy body disease
Authors: Lee Heidi , Cooney John M. , Lawlor Brian A. 
Published: December 2004

AbstractA case of senile dementia of Lewy body type (SDLBT) who developed severe and incapacitating extrapyramidal side‐effects (EPSE) following treatment with typical neuroleptics, but responded to and tolerated the new atypical neuroleptic risperidone, is described. The potential benefits of atypical neuroleptics for elderly dementia patients with concurrent psychotic and behavioural symptoms are discussed.
Should general practitioners refer more of their elderly depressed patients to psychiatric services?
Authors: Jenkins D. , Macdonald A. 
Published: December 2004

AbstractAs part of a prevalence and recognition study of 336 elderly attenders at GP surgeries, 65 with high depression scores (who had not been referred for specialist psychiatric services) were randomly allocated either to 9 months' treatment by a multidisciplinary community psychogeriatric team or to continued management by their GP. At follow‐up, elderly men treated by the team had done better than those cared for by their GP, but this was not statistically significant. There was no difference in outcome for elderly women, nor for the group as a whole. It is suggested that while larger studies are awaited, elderly depressed men might profitably be referred to specialist services more often than at present.
Breaking the bad news: What do psychiatrists tell patients with dementia about their illness?
Authors: Rice Karl , Warner Nick 
Published: December 2004

AbstractConsultants in old age psychiatry were sent a questionnaire concerning their practice in informing dementia patients and their carers about the diagnosis and prognosis. The results showed a wide variation in practice. Carers almost invariably were told of the diagnosis. Patients with severe dementia were almost never told. There was more of a tendency to tell moderately affected sufferers but for patients with mild dementia practice was variable. There was a significant difference between all categories of dementia and the carer category for both diagnosis and prognosis giving. Informing patients of diagnosis differed from informing of prognosis only in the mild dementia category, with the tendency to give diagnosis more frequently than prognosis. Carers were also given diagnosis more frequently than prognosis. The article discusses some of the issues involved in giving information on diagnosis and prognosis to patients with dementia.
The impact of cognitive decline and workload on the costs of dementia care
Authors: Wimo Anders , Krakau Ingvar , Mattsson Bengt , Nelvig Anders 
Published: December 2004

AbstractCosts of dementia care and its relation to cognitive capacity, activities of daily living (ADL) and behavioural disturbances were studied in a prospective, non‐randomized concurrent control study. The participants consisted of 173 demented patients who at inclusion were cared for in four caring alternatives: 45 in home care, 55 in day care (DC), 49 in group living (GL) and 24 institutionalized patients in Sundsvall, an industrial city in northern Sweden. The use of institutional care and costs were constant for the GL patients, independently of cognitive capacity, ADL capacity and behavioural disturbances, while institutional care and costs of the home care patients and the DC patients increased when cognitive capacity and the ADL capacity deteriorated and behavioural disturbances increased. The main conclusion is that care in GL seems to be a caring alternative in which institutionalization figures and costs are independent of measurements of the degree of dementia. The costs for the municipality and the county council regarding the DC group were lower than GL, particularly in relation to impaired cognitive function. In the sensitivity analysis, however, where ‘hotel costs’ and the value of the families' informal work were included, the costs of the DC and the home care group increased considerably.
Consultation‐liaison psychiatry: A comparison of two service models for geriatric patients
Authors: Swanwick Gregory R. J. , Lee Heidi , Clare Anthony W. , Lawlor Brian A. 
Published: December 2004

AbstractIn general hospitals the psychiatric morbidity in the old and frail is at least 40%. Two models for the provision of a psychiatric service to hospitalized geriatric patients were evaluated in order to identify which model most effectively fulfilled the aims of liaison psychiatry. At present, consultation type services predominate and there is some concern that an active liaison service could increase the referral rate of cases more appropriately dealt with by physicians. In this study an active liaison model was not associated with a marked increase in the referral rate, and when compared to a service with an emphasis on consultation, there was a higher degree of diagnostic accuracy by referring doctors in the liaison type model.
Does admission to a hospital geriatric psychiatry programme improve benzodiazepine and other drug use?
Authors: Williams David , Chiu Edmond , Harvey Ken 
Published: December 2004

AbstractSeventy‐five consecutive patients admitted to a hospital geriatric psychiatry unit had their medication reviewed on admission and at discharge. Use of benzodiazepines declined significantly from 40% to 20% of patients, but use of other therapeutic groups showed no significant change. The number of patients taking drug combinations with potentially adverse side‐effects decreased significantly between admission (21) and discharge (7). The use of relatively contraindicated drugs also declined. Drug utilization review is a valuable technique for drawing attention to potential problems of prescribing for elderly people.
The prognosis of demented patients — one‐year follow‐up study of a population sample
Authors: Juva Kati , Sulkava Raimo , Erkinjuntti Timo , Mäkelä Matti , Valvanne Jaakko , Tilvis Reijo 
Published: December 2004

AbstractFunctional decline and mortality after 1‐year follow‐up of 93 demented elderly subjects from a random population sample (N =795) were studied in Helsinki, Finland. Seventeen (18%) of the demented patients died as compared to only 5% of the non‐demented subjects. The age‐adjusted risk ratio for 1‐year mortality of demented patients was 3.2 (95% confidence interval 1.8–5.6). Forty‐four per cent (26/59) of the surviving patients who were not bedridden and incontinent at the very beginning of the study suffered further impairment in the following functions: institutionalization (6/21), losing the ability to walk (5/57) or beginning of incontinence (17/30). Sixteen (21%) surviving subjects were already bedbound, incontinent and institutionalized at the beginning of the study. Age, sex or the degree of dementia did not correlate to mortality or functional decline. The number of patients who were institutionalized during the follow‐up was small. The appearance of incontinence and other recorded risk factors (age, degree of dementia or motility) did not seem to predispose to institutionalization. Subjective factors, such as caretaker's burden, probably have a great influence on the ending of home care.
The validity of the judgement of general practitioners on dementia
Authors: Wind Annet W. , Van Staveren Gerrit , Schellevis Francois G. , Jonker Cees , van Eijk Jacques Th. M. 
Published: December 2004

AbstractThis study focused on two aspects of the validity of the judgement of general practitioners (GPs) on dementia: criterion and construct validity. The Cambridge Mental Disorder of the Elderly Examination (CAMDEX) was used as the gold standard to assess the specificity and sensitivity of the GP judgement. Construct validity was studied by comparing patient characteristics that were hypothesized to predict the GP judgement by predictive variables from our data, using logistic regression analysis. In addition, the patient characteristics that predicted a ‘falsel positive’ or ‘falsel negative’ GP judgement were determined. Thirty‐six GPs participated in the study, as well as 475 community‐dwelling patients. The overall agreement between CAMDEX diagnosis and GP judgement was 72%. The sensitivity and speciticity of the GP judgement in making the distinction between ‘normal cognitive functioning + minimall dementia’ versus ‘mild + moderate + severel dementia’ were 52% and 94% respectively. Patient characteristics that predicted the GP judgement on dementia were: age, sex, cognitive functioning, IADL functioning (Instrumental Activities of Daily Living) and memory complaints. All these characteristics, except sex, were hypothesized to do so. Patient characteristics predicting a ‘falsel positive’ or a ‘falsel negative’ GP judgement were cognitive and IADL functioning. Both groups of patients (‘overldiagnosed’ and‘ missed’ by the GP) belong to the in‐between group with some impaired functioning. The finding that impaired IADL functioning is so important in the GP's judgement reflects the significance of dementia diagnosis in general practice: a starting point for adequate care.