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Benbow, S. M.; Marriott, A.; Morley, M.; Walsh, S.
doi: 10.1002/gps.930080903pmid: N/A
Family therapy techniques have, until recently, had little impact on the development of old age psychiatry and the services provided. The literature on family therapy in relation to people with dementia and their families is reviewed and illustrated with results from a study of families coping with dementia who attended the York House Family Clinic. Similar therapeutic techniques were used with families coping with dementia as with those coping with other mental illnesses in later life, but some differences were found in the areas of discussion during sessions. Families coping with dementia were seen for fewer sessions, but more family members were present per session and sons and daughters‐in‐law were more likely to attend. The literature and various hypotheses which might explain these differences are presented and discussed. Further work in this area is needed, but our findings suggest that family therapy can be useful in work with dementia sufferes and their families, and can be offered within an old age psychiatry service.
Etzersdorfer, Elmar; Fischer, Peter
doi: 10.1002/gps.930080904pmid: N/A
In most countries men and women have the highest suicide rates in age groups over 60 years. We investigated suicide rates for the elderly in Austria, a country with one of the highest suicide rates in the world, for the period 1980–1991, using data from the Federal Statistical Division. Suicide rates remained stable over the last decade at a very high level. The mean rate for men was 85.2, for women 28.6/100 000. In men and women rates rise with age. The mean rate of men rises from 51.2 (60–64 years) to 117.3/100 000 (over 85 years); in women there is an increase from 21.4 (60–64 years) to 32.8/100 000 (over 85 years). We did not confirm findings in other countries, where suicide rates have increased in recent years.
Williams, S. W.; Byrne, E. J.; Stokes, P.
doi: 10.1002/gps.930080905pmid: N/A
Single case studies may provide useful information and generate hypotheses for later testing in group studies. The effect of anti‐Parkinsonian medication is reported in five individual cases of diffuse Lewy body disease. The problems caused by the variability in congnitive function and psychiatric symptoms in these cases are outlined together with suggested strategies for future research.
Haupt, Martin; Kurz, Alexander
doi: 10.1002/gps.930080906pmid: N/A
Sixty‐six outpatients with mild to moderate dementia in Alzheimer's disease at baseline were examined twice with an interval of 12 months. Twenty‐two of these patients who were admitted to a nursing home within this period were compared to a group of 44 patients who remained living at home with respect to demographic data, cognitive and physical dysfunction, behavioural changes in daily living and the burden of caregivers. Stepwise discriminant function analysis revealed that older age, global cognitive decline, incontinence, aggression, depression, and the caregiver's wish to leave the care to someone else were predictors for nursing home placement ithin 1‐year follow‐up and correctly classified 82% of the cases. The study indicates that factors predicting nursing home placement in Alzheimer patients are complex, including demographic characteristics, level of cognitive and physical functioning, behavioural abnormalities in daily living, as well as burden of the caregiver, and are consistent with predictors of institutionalization found in healthy elderly individuals.
Brooker, D. J. R.; Sturmey, P.; Gatherer, A. J. H.; Summerbell, C.
doi: 10.1002/gps.930080907pmid: N/A
Preliminary data on the Behavioural Assessment Scale of Later Life (BASOLL) (Brooker and Nissenbaum, 1986) are described. The BASOLL is based upon Zarit's Memory and Behavioural Problem Checklist (MBPC; Zarit et al., 1980) and the Blessed Dementia Scale (BDS; Blessed et al., 1968). The BASOLL was administered to a sample of 177 psychogeriatric patients over a period of 2 years during regular clinical practice in outpatient, day patient and inpatient settings. A factor analysis revealed three factors which were named self‐care behaviour, memory and orientation, and challenging behaviour. The similarity with factors derived from Zarit's MBPC is discussed. Summative scales derived from the factor analysis of the BASOLL were internally consistent. Data on test‐retest and interrater reliability are presented which suggest that the scales are reliable. The scales included in the BASOLL were all able to distinguish between patients in day hospital, respite care and continuing care settings. Thus the scales can be said to have good criterion validity for these settings. The clinical development and utility of the BASOLL is discussed.
doi: 10.1002/gps.930080908pmid: N/A
The progression of cognitive and motor functions in Alzheimer's disease (AD) patients and healthy aged individuals was studied. For the healthy aged, the progress was negligible during a 2‐year period. In the AD patients, there was a marked progression in all cognitive tests, but only a slight progression in the finger motor tests. Progression rate varied substantially across functions; the most rapid progression was seen in psychomotor speed, whereas the slowest was seen in episodic memory. The onset of decline was estimated to have occurred first in episodic memory, then in psychomotor speed, semantic memory, and visuospatial functions; finally and most recently, decline was estimated to have occurred in primary memory. The overall data pattern suggests that the onset as well as the rate of progression varies across cognitive functions, and that there may be a time‐ordered sequence of decline of neuropsychological functions in AD that parallels the trajectory of neuropathological changes in this disease.
Charlesworth, Georgina M.; Hymas, Nigel; Wischik, Claude M.; Hodges, John R.; Sahakian, Barbara J.
doi: 10.1002/gps.930080909pmid: N/A
This is a report of a clinical case presentation from the Neuropsychiatry Conference held at Fulbourn Hospital, Cambridge on March 13, 1992. The conference, chaired by Dr Nigel Hymas, was asked to comment on the diagnosis of a case first referred during September 1990. A 60‐year‐old man with no previous history of psychiatric illness presented with persecutory ideation, delusions and hallucinations in the absence of cognitive impairment. At the time, the initial tentative psychiatric diagnosis was one of late paraphrenia, but it later became clear that the patient was dementing. Were the paraphrenia and dementia related? If so, how? What was the nature of the dementing illness? Could life‐long personality abnormalities have been the earliest expression of cerebral abnormalities predisposing him to his current illness? Incompatible evidence from clinical features, functional brain scanning and comprehensive neuropsychological testing demonstrates the inadequacy of current diagnostic criteria.
Kelvin, Raphael; O'Brien, John; Dening, Tom
doi: 10.1002/gps.930080910pmid: N/A
An elderly woman presented with a severe depressive disorder and moderate cognitive impairment. She had a dyskinesia of the rabbit syndrome type, but in contrast to previous reports she had not previously been treated with neuroleptics. We believe this to be unique in the literature. Further, we speculate about the possible association of the rabbit syndrome and senile dementia of Lewy body type.
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