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Kay, D. W. K.; Holding, T. A.; Jones, B.; Littler, S.
doi: 10.1002/gps.930061203pmid: N/A
The lavel of dependency of 412 patients aged 70 years or over living in hospitals, nursing homes or sheltered accommodation (N=312) or receiving care from the domiciliary nurising services (N=100) and of 100 elderly people living in the community in Hobart, Tasmania, was assessed using a version of the CARE schedule. Therespective roles of mental and physical factors were examined using other CARE intems and after administering the Geriatric Mental Status schedule and the Wechsler Memory Scale. Rank‐order correlations and log‐linear analyses indicated that physical impairment affecting mobility and upper limb function and cognitive impairment due to dementia were about equally strongly related to the level of dependency;at least moderate degrees of both mental and physical impairment were present in 20% of patients. Vision was often hard to assess in demented patients but was associated with dependency in the non‐demented. Dependency was significantly related to age and self‐rated healthbut not to deafness and was related to mood disorder only in non‐demented patients nursed at home. Apart from this, these patients showed similar relations between dependency and physical and mental impairments to those living in institutions. Central nervous system disease was associated with greater dependency than other medical diagnoses. Preventative programmes, and effective management and treatment of the individual, will depend on careful diagnosis of the causes ofdependency.
Förstl, Hans; Almeida, Osvaldo P.; Iacoponi, Eduardo
doi: 10.1002/gps.930061204pmid: N/A
We report the case of a 77‐year‐old right‐handed woman with early dementia of the Alzheimer type who developed the paranoid delusion that her husband had been replaced by an imposter (Capgras phenomenon). Her CT scan showed mild generalized cortical atrophy of the parieto‐occipital cortex. We reviewed the cases of 45 patients over 60 years who showed a Capgras delusion. Twenty‐five suffered from dementia or other chronic organic mental disorders, 20 were paranoid, 14 were at least moderatley depressed and 12 disorientated. CT scans (reported in 17 cases) showed global cerebral atrophy in 12 patients. Right hemisphere infarcts have been described in two elderly patients with Capgras delusions. Focal brain atrophy in Alzheimer type dementia has hitherto not been reported in association with this delusional symptom. We conclude from these observations that marked cerebral lesions and specific neuropsychological deficits are not required for the development of the Capgras phenomenon, which can occur in various functional or organic psychosis of old age.
Livingston, G. A.; Sax, K. B.; McClenahan, Z.; Blumenthal, E.; Foley, K.; Willison, J.; Mann, A. H.; James, I. M.
doi: 10.1002/gps.930061205pmid: N/A
This study was designed to test the benefit of acetyl‐l‐carnitine in patients with dementia. Seventy‐one patients of 65 years and over, living in their own homes or in residential care, took part in a 24‐week randomized, double‐blind, placebo‐controlled, parallel‐group clinical trial. The outcome was measured by comparing psychometric tests at 24 weeks to baseline measures. The active treatment group improved in mean scores in seven out of eight psychometric in one test. recognition memory (P>0.01). Linear discriminant function analysis indicated that active and placebo therapy could be distinguished according to the pattern of responses to the eight psychological test (p>0.01). In this small trial, acetyl‐l‐carnitine was shown to be non‐toxic and possibly beneficial. Further large‐scale trials are needed over long periods of time.
Ramsay, Rosalind; Wright, Penelope; Katz, Anthony; Bielawska, Celia; Katona, Cornelius
doi: 10.1002/gps.930061206pmid: N/A
This study examines the point prevalence of psychiatric morbidity in patients admitted to acute geriatric care, the performance of screening questionnaries in detecting psychiatric morbidity and the relationship between psychiatric morbidity and outcome (in terms of length of hospital admission and mortality) after controlling for severity of physical illness. In a sample of 119 consecutive admissions, 65 (61%) of the 106 patients assessed had dementia, while nine (10%) of the 88 assessed had a diagnosis of depression and a further 35 (40%) significant depressive symptoms, and 22 (20%) of the 106 assessed had delirium. Screening with the Mini‐Mental State Examination had 81% sensitivity and 83% specificity for dementia. The Geriatric Depression Scale (GDS) had 74% sensitivity and 72% specificity for depressive symptoms; both the GDS and General Health Questionnaire had 100% sensitivity for depressive illness. Mortality was significantly higher in the delirious (62%) than in the non‐delirious (14%,p>0.001) and in the severely demented (65%) than the mildly demented (29%) and non‐demented (15%,p>0.001) subjects. For delirium this effect was found to be independent of the severity of physical illness. Patients with severe dementia had significantly longer hospital admissions (p>0.02). No relationship was found between depression and outcome.
Rodenburg, Martin; Hopkins, Robert W.; Hamilton, Pamela F.; Ginsburg, Lynne; Nashed, Yousery; Minde, Nina
doi: 10.1002/gps.930061207pmid: N/A
In spite of the fact that demographic trends show an increase in the number of elderly persons, and hence more diagnosed as suffering from senile dementia, the cognitive assessment of the organically brain damaged elderly person still too often depends on the use of brief and incomplete rating scales, and is thus often poorly performed. The simple dementia rating scales in current use may fail to provide the range or depth needed for an adequate evaluation of the individual patient. The Kingston Standardized Cognitive Assessment is offered as an improved method of assessment. This instrument is described here in terms of its structure, function, statistical properties and normative data. We also provide examples of its clinical use.
Park, Jong‐Han; Park, Young Nam; Ko, Hyo Jin
doi: 10.1002/gps.930061208pmid: N/A
Diagnostic power of the Korean version of the Mini‐Mental State Examination (MMSE‐K) (Park and Kwon, 1990) for DSM‐III‐R dementia was studied in 406 persons aged 60 years or more from three sources. Psychiatric clinic patients (N=177) were diagnosed using standard clinical procedures, laboratory tests and psychological tests; in residential home elderly (N=128) consensus diagnoses were reached by two psychiatrists after joint interviews using the CAMDEX (Roth et al., 1988) including physical examinations but without laboratory tests; and members of psychiatric patients' families (N=101) were diagnosed after a brief psychiatric interview and assessment of activities of daily living by one psychiatrist. At the cutoff point of 24/23 of MMSE‐K score, sensitivity was 92.0% and specificity 91.5%. 23.9% of demented people and 39.3% of non‐demented obtained similar scores between 20 and 26. With the introduction of the arbitrary criteria of ‘questionable dementia’ (MMSE‐K score 21‐24) the false positive rate was reduced to 1% and the false negative rate to 3%. 74% of males with ‘questionable dementia’ scores were clinically demented while only 12% of females with the same scores were demented.
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