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Veras, Renato P.; Murphy, Elaine
doi: 10.1002/gps.930060903pmid: N/A
Population ageing is now a phenomenon not only of developed countries but increasingly also of developing Third World countries. In this article (Part I) Brazilian statistics are presented to illustrate the process of demographic transition in a developing country. The characteristics of the elderly population in terms of age, sex, marital status, urban/rural distribution and literacy are analysed in the light of recent changes.
Veras, Renato P.; Murphy, Elaine
doi: 10.1002/gps.930060904pmid: N/A
This article (Part II) introduces a joint project being carried out at the Institute of Social Medicine, Rio de Janeiro, and the United Medical and Dental Schools, Guy's Hospital, London, concerning the epidemiology of the elderly population of Rio de Janeiro. The methodology used and the stages of the community survey are presented. The sampling methods and the steps of the enumerator process are detailed, and the design on the reliability and validity study of mental health is also presented. The main purpose of this article is to present the methodological approach.
Phanthumchinda, Kammant; Jitapunkul, Sutthichai; Sitthi‐amron, Chitr; Bunnag, Srichitra C.; Ebrahim, Shah
doi: 10.1002/gps.930060905pmid: N/A
A randomly selected sample of 500 subjects over 60 years old and their relatives were studied using standardized methods for assessment of cognitive impairment. The prevalence of DSM‐III‐R dementia was 1.8% (95% confidence intervals 0.6‐3%), and the majority of cases had a probable diagnosis of Alzheimer's disease. The sensitivity and specificity of the field survey version of the Mini‐Mental State Examination (MMSE) for a diagnosis of dementia using a threshold of 21 were 100% and 53% respectively. This was associated with a positive predictive value of dementia, given a low score, of only 3%. A high prevalence of low MMSE scores was found: 23% of men and 50% of women had scores below 21, and there were strong relationship between low scores and age. Strong associations between low MMSE scores and no education were found, and weaker associations with female sex, deafness and poor sight. The MMSE is markedly affected by educational level, which together with its low positive predictive value for dementia in this population makes it a poor screening of research tool. A Behaviour Rating Scale score had a higher specificity leading to fewer false positives, but only achieved a sensitivity of 67%. In populations with low levels of education it is recommended that behavioural disabilities scales should be developed as a means of screening for dementia syndromes.
Turrina, Cesare; Perdona, Giampietro; Bianchi, Lucian; Cordioli, Luciano; Burti, Lorenzo; Micciolo, Rocco; Copeland, John R. M.
doi: 10.1002/gps.930060906pmid: N/A
The Italian version of the Geriatric Mental State Examination (GMS) was tested for interrater agreement (interobserver). Thirty geriatric patients form psychiatry, neurology and general medical facilities were interviewed by four raters. The mean values of kappa and phi for the analysable items were 0.80 and 0.81. ‘Organic’ and ‘functional’ items produced very similar coeffcient values.
Krull, Alice J.; Press, Gary; Dupont, Renee; Harris, M. Jackuelyn; Jeste, Dilip V.
doi: 10.1002/gps.930060907pmid: N/A
In this article we review the published studies on brain imaging in late‐life psychoses, and present data from our study of magnetic resonance (MR) imaging of the brain in late‐onset schizophrenia (LOS). MR images were obtained in 11 patients with late‐onset schizophrenia (LOS), nine patients with probable Alzheimer's disease (AD), and nine normal controls comparable in age, gender, and education. Two of the LOS patients were excluded from further analysis due to the presence of diagnosable organic pathology (i.e. Alzheimer's disease and presence of a subaracnoid cyst). The MR images were subjectively rated for both degree of ventricular enlargement (VE) and degree of abnormal white matter hyperintensities (WHM) by an experienced, board certified neuroradiologist in a blind manner. No significant differences were found among the groups on degree of abnormal WHM. MR images of AD patients had a significantly greater degree of VE than normal controls, with LOS patients being intermediate. Our data, for LOS and have evidence of non‐specific abnormalities in brain morphology on MR imaging, yet do not have clinical or MR imaging evidence of a specific organic etiology for psychosis.
doi: 10.1002/gps.930060908pmid: N/A
The effects of ageing and concurrent psychotropic durgs on demethylation degree of tertiary tricyclic antidepressants (TCAs) were studied in 340 psychiatric inpatients with depression. They were treated daily with routine therapeutic doses of doxepin (177±59 mg, mean ± SD) or amitriptyline (154±47 mg). The numbers of blood samples analysed gas chromatographically for serum concentrations of tertiary TCAs and their secondary amine metabolites were 340 for doxepin and 192 for amitriptyline. The patients were divided into three age groups: >35, 35‐65 and <65 years old. Serum concentrations of doxepin and amitriptyline were increased significantly or showed a trend towards an increase with advancing age, but the concentrations of secondary amine, TCAs did not increase at all in the elderly. The ratio of secondary/secondary + tertiary amine TCAs was generally decreased with ageing. Concurrent neuroleptics, but not benzodiazepines, frequently increased the percentage fraction of secondary amine TCAs. We conclude that the altered demethylation ratio of tertiary amine TCAs, conceivably favouring the altered profile of drug action, should be considered when serum TCA concentrations are monitored in the eldrly and with concurrent neuroleptic therapy.
Connelly, Peter J.; Jamieson, Fiona E.
doi: 10.1002/gps.930060909pmid: N/A
Cognitive assessment schedules for the elderly are often complex, cumbersome or highly dependent on memory function. Performance on visuoconstructive tests, which are often easily undertaken, is not dependent on ‘dominance’ of either hemisphere. Unfortunately, such tests often have complex objective and subjective scoring criteria, making standardization difficult. We have designed a structured diagram and scoring system which proved simple to administer and score and performance on which correlated well with intellectual function on the CAPE, while, unlike the Gibson Spiral Maze (GSM), those without dementia tended not to make any mistakes. Scoring on the GSM was also affected by age and the presence of parietal signs to a greater extent than the OAP, suggesting that the GSM may overestimate cognitive impairment in the population for which it was designed. Some possible uses for the OAP as a new test in the assessment of the elderly are discussed.
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