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BURKE, WILLIAM J.; RANGWANI, SUNIL; ROCCAFORTE, WILLIAM H.; WENGEL, STEVEN P.; CONLEY, DEBORAH M.; POTTER, JANE F.
doi: 10.1002/(SICI)1099-1166(199703)12:3<288::AID-GPS474>3.0.CO;2-1pmid: N/A
Objective. To prospectively evaluate the reliability and validity of the Collateral Source Geriatric Depression Scale (CS‐GDS) administered by telephone (T‐CS‐GDS) in patients undergoing outpatient comprehensive geriatric assessment. Subjects. Eighty‐three geriatric patients evaluated in a 1‐year period at the outpatient Geriatric Assessment Center of the University of Nebraska Medical Center. Methods. The 30‐item CS‐GDS was completed by the collateral source of all patients on three occasions: by telephone several days before their assessment, face‐to‐face during their assessment visit and several days later, again by phone. During their assessment, all patients were evaluated by one of three geriatric psychiatrists who were blinded to CS‐GDS results. The test–retest reliability of the T‐CS‐GDS was measured by comparing the results of the two phone interviews. The construct validity of the T‐CS‐GDS was estimated by comparing the results of the initial T‐CS‐GDS with the CS‐GDS obtained during the comprehensive assessment. The criterion validity of the T‐CS‐GDS was estimated by comparing the results of the T‐CS‐GDS with the clinical diagnosis of depression assigned by the psychiatrists. Results. The individual items of the initial T‐CS‐GDS showed substantial concordance with the second T‐CS‐GDS (kappa range 0.41–0.8, mean=0.61) and with the assessment GDS (kappa range 0.33–0.85, mean=0.61). Twelve items showed evidence of bias when comparing the two T‐CS‐GDSs and four items when comparing the initial T‐CS‐GDS with the CS‐GDS done during the assessment. The mean number of symptomatic responses was not significantly different for the T‐CS‐GDS vs assessment administration but did decline slightly when comparing the two T‐CS‐GDSs. ROC curve analysis showed good agreement between the clinical diagnosis and the T‐CS‐GDS. Conclusion. The CS‐GDS appears to maintain its reliability and validity when administered via telephone and thus may be useful for a variety of epidemiologic and clinical purposes. © 1997 by John Wiley & Sons, Ltd.
doi: 10.1002/(SICI)1099-1166(199703)12:3<295::AID-GPS476>3.0.CO;2-3pmid: N/A
Objectives. To study the association between Alzheimer's disease and smoking history. Design. An unmatched case‐control study. Setting. Psychogeriatric unit serving an elderly population of Warrington. Period. 2 years 1991–1993. Subjects. 198 cases of Alzheimer's disease (ADRDA–NINCDS diagnostic criteria) were compared to two selected control groups (164 other dementias and 176 non‐dementing group) with respect to their smoking history. Main outcome measure. Relative risk (odds ratio) of Alzheimer's disease. Results. The odds ratio for Alzheimer's disease in patients who smoked was 0.68 (95% CI 0.47–0.98). The negative association was statistically significant only in male patients, OR 0.45 95% CI (0.23–0.87), p<0.05. The inverse association was also only significant in patients with family history of dementia, OR 0.34 95% CI (0.12–0.92), p<0.05. Conclusion. The study supports previous findings of an inverse relationship between smoking and Alzheimer's disease. This, however, does not suggest that smoking is used as a preventive measure for Alzheimer's disease. © 1997 by John Wiley & Sons, Ltd.
DRACH, LUTZ M.; STEINMETZ, HANS E. E.; WACH, STEFANIE; BOHL, JÜRGEN
doi: 10.1002/(SICI)1099-1166(199703)12:3<301::AID-GPS482>3.0.CO;2-Wpmid: N/A
Objective. Dementia with Lewy bodies (DLB) is under‐recognized in Germany. No data on the number of patients suffering from this condition in Germany are available at present. We were interested in the proportion of DLB in the postmortems of demented inpatients in the care of a psychogeriatric service. Design. In a retrospective study we examined consecutive postmortems of inpatients who died in one mental hospital. Setting. A suburban and rural old age psychiatry service in Germany. Patients. 103 consecutive postmortems had been performed from 9/1987 to 6/1995. Fifty‐nine (57.3%) of all cases warranted the clinical diagnosis of dementia (DSM‐III‐R). Measures. The causes of dementia were examined histologically. Lewy bodies (LBs) were detected with ubiquitin immunohistochemistry. Results. DLB was the third most frequent cause of dementia (13.6% of demented), after dementia of Alzheimer's type (DAT) (35.6%) and mixed DAT and vascular dementia (15.3%), but ahead of ‘pure’ vascular dementia (MID). The DLB group showed a male preponderance compared with the DAT, MID and mixed group of our series. The DLB patients died younger than the DAT patients. The differences, however, were not statistically significant. All DLB cases showed neurofibrillary and amyloid pathology sufficient to warrant an additional diagnosis of DAT. Cases with ‘pure’ LB pathology had not been detected in our series. Conclusions. Our results indicate that by using appropriate methods, ie ubiquitin immunohistochemistry, a considerable number of DLB cases can be detected in postmortems of demented patients from German mental hospitals. © 1997 by John Wiley & Sons, Ltd.
BLIXEN, CAROL E.; McDOUGALL, GRAHAM J.; SUEN, LEE‐JEN
doi: 10.1002/(SICI)1099-1166(199703)12:3<307::AID-GPS475>3.0.CO;2-6pmid: 9152713
Recent evidence indicates persons 60 years and over experience significant alcohol and substance abuse problems. Since a combination of alcoholism and depression is likely to increase the relative rsk of suicide, it is important to examine the prevalence of dual diagnosis in older adults. The purpose of this study is to examine the prevalence and correlates of dual diagnosis in older psychiatric inpatient populations and compare our results with findings from studies of younger hospitalized dually diagnosed patients. A retrospective chart audit was performed on 101 elders who were discharged from three psychiatric hospitals. Clinical variables that were examined included length of hospital stay, psychiatric and medical diagnoses, medications and history of suicidal ideation or intent. The leading psychiatric disorder diagnosis for our sample of hospitalized psychiatric elders was depression. Over one‐third (37.6%) had a substance abuse disorder in addition to a psychiatric disorder, and almost three‐fourths (71%) of this ‘dual diagnosis’ group abused alcohol and 29% abused both alcohol and other substances. In addition, significantly more elders in the ‘dual diagnosis’ group (17.7%) than in the group with only a mental disorder diagnosis (3.3%) made a suicide attempt prior to admission to the hospital. Because affective disorders in conjunction with alcohol abuse are the most frequently found disorders in completed suicides, our findings have important relevance for the advocating of routine use of diagnostic assessment and screening for both substance abuse and mental disorders in this population. © 1997 by John Wiley & Sons, Ltd.
GRAHAM, CANDIDA; BALLARD, CLIVE; SAAD, KARIM
doi: 10.1002/(SICI)1099-1166(199703)12:3<314::AID-GPS487>3.0.CO;2-7pmid: N/A
Objectives. To compare patients fulfilling clinical criteria for Lewy body dementia with those meeting clinical criteria for Alzheimer's disease. Design. Prospective cohort study. Setting. Psychiatric services and a memory clinic. Sample. 124 patients with DSM‐III‐R dementia. Measures. The assessment included the GMS/HAS/SDS package, the CAMCOG, the Cornell Depression scale and the Burns Symptom Checklist. Dementia was diagnosed according to DSM‐III‐R, NINCDS ADRDA, McKeith, Byrne, Hachinski and HAS AGECAT criteria. Results. Patients meeting McKeith et al. criteria for senile dementia of Lewy body type were significantly more likely to have clouding of consciousness, significant Parkinsonian symptoms and less severely impaired recent memory than patients with NINCDS ADRDA Alzheimer's disease. Each of these variables also distinguished patients meeting Byrne et al.'s criteria for dementia with Lewy bodies from those with a diagnosis of Alzheimer's disease. Conclusions. It is suggested that one set of criteria could encompass those overlapping groups of patients. Work is needed to further develop the diagnostic criteria for Lewy body dementia. © 1997 by John Wiley & Sons, Ltd.
LAWLOR, BRIAN A.; AISEN, PAUL S.; GREEN, CYNTHIA; FINE, ELIZABETH; SCHMEIDLER, JAMES
doi: 10.1002/(SICI)1099-1166(199703)12:3<319::AID-GPS488>3.0.CO;2-Qpmid: 9152715
Objective. The purpose of this study was to examine the behavioural and cognitive effects of selegiline in a group of moderately behaviourally disturbed AD patients. Design. This was a 14‐week randomized double‐blind placebo‐controlled study of selegiline (10 mg) and placebo. Setting. An outpatient clinic in an urban‐based tertiary referral centre in the USA. Patients. Twenty‐five outpatients meeting NINCDS criteria for probable Alzheimer's disease with associated behavioural disturbance. Measures. The Brief Psychiatric Rating Scale (BPRS), the Dementia Mood Assessment Scale (DMAS) and the Alzheimer Disease Assessment Scale (Cognitive) (ADAS‐COG). Results. In the primary analysis, improvement on the BPRS and DMAS scores with selegeline treatment did not reach statistical significance. A secondary analysis using a parallel design showed a significant benefit of drug treatment on BPRS scores with a trend towards improvement on the DMAS. Among the 10 subjects who could be tested, there was a significant improvement in cognitive function on the ADAS‐COG with selegiline compared to placebo. Conclusions. Short‐term selegiline treatment produced an improvement in behaviour and had a significant effect on cognition in a subset of testable patients. © 1997 by John Wiley & Sons, Ltd.
CHRISTENSEN, H.; KORTEN, A. E.; JORM, A. F.; HENDERSON, A. S.; JACOMB, P. A.; RODGERS, B.; MACKINNON, A. J.
doi: 10.1002/(SICI)1099-1166(199703)12:3<323::AID-GPS492>3.0.CO;2-Npmid: 9152716
The association between education and cognitive change was investigated in a large community sample of elderly people followed up after 3.6 years. Lower education was predictive of decline on the Mini‐Mental State Examination (MMSE) and on tests of language and knowledge, but not on tests of cognitive speed, memory or reaction time. The effects of education were not attenuated when adjusted for health, disability or activity level. The findings suggest that education slows the rate of decline on crystallized intelligence, but not other cognitive abilities. Education may compensate for neurodegenerative changes rather than protect against them. © 1997 by John Wiley & Sons, Ltd.
COEN, ROBERT F.; SWANWICK, GREGORY R. J.; O'BOYLE, CIARAN A.; COAKLEY, DAVIS
doi: 10.1002/(SICI)1099-1166(199703)12:3<331::AID-GPS495>3.0.CO;2-Jpmid: N/A
Objective. To investigate predictors of carer burden in Alzheimer's disease (AD). Design. Two cohorts were formed, one comprising AD patients, the other comprising their primary carers. The relationship of patient and carer variables to carer burden was investigated. Setting. An urban hospital memory clinic. Participants. A convenience sample of 50 patients meeting NINCDS–ADRDA for probable AD, age range 60–87, and their primary carers, age range 31–84. Measures. The Cambridge Cognitive Examination (CAMCOG), the Mini‐Mental State Examination (MMSE), the Baumgarten et al. Dementia Behaviour Disturbance Scale, the Blessed–Roth Dementia Scale, the Personal Self‐Maintenance Scale, the Zarit Burden Interview and the Vaux et al. Social Support Appraisals (SS‐A) and Social Support Behaviours (SS‐B) Scales. Results. Daughters were particularly prone to burden. Neither patient cognitive nor functional status predicted burden. Behaviour disturbance in particular, and informal support were significant, but independent, predictors of carer burden. Conclusions. In this study increased carer burden was related independently to increased levels of patient behaviour disturbance and decreased levels of informal social support. This may have relevance to appropriate interventions for carers. As the study was based on a convenience sample of memory clinic attenders, replication in less highly selected samples is desirable. © 1997 by John Wiley & Sons, Ltd.
RAO, RAHUL; DENING, TOM; BRAYNE, CAROL; HUPPERT, FELICIA A.
doi: 10.1002/(SICI)1099-1166(199703)12:3<337::AID-GPS498>3.0.CO;2-Tpmid: N/A
Objective. Main objective: to study the relationship between suicidal thinking and both cognitive impairment and depression. Design. Random sample selected for interview, all of whom were a cohort in a pre‐existing epidemiological study of dementia. Setting. Community residents. Patients and other participants. Participants aged over 81. Study excluded the following: moved out of area/died/too frail/severe communication difficulties/refused interview, refusal by GP/family/carers. 300 names selected at random from database. 170 eligible participants approached; 31 refused, 125 interviewed. 125 informants approached for interview; 118 interviewed. Main outcome measures. CAMDEX, 15‐item Geriatric Depression Scale (GDS), and Scale for Suicidal Ideation (SSI) (including informant versions of latter 2 scales). Results. 9 people showed suicidal thinking, all women; 6 had clinical evidence of cardiovascular/cerebrovascular disease. Those with suicidal thinking showed higher CAMDEX depression scores, weaker strength of the wish to go on living, higher rates of expressing wish to die and higher rates of depressive illness and mixed DAT/multi‐infarct dementia as primary psychiatric diagnoses. No significant associations between suicidal thinking and GDS scores, Alzheimer‐type dementia alone, awareness of memory difficulties or severity of dementia. Conclusions. Results show association between suicidal thinking and both depression and mixed DAT/multi‐infarct dementia, but do not support an association between suicidal thinking and awareness of memory problems/severity of dementia. Given the methodological limitations, the significance of the results should be viewed with caution. Further exploration of the role of cerebrovascular disease in depressive disorder is suggested. © 1997 by John Wiley & Sons, Ltd.
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