International Journal of Geriatric Psychiatry

Dello Buono, Marirosa; Busato, Renata; Mazzetto, Manuela; Paccagnella, Bruno; Aleotti, Federica; Zanetti, Orazio; Bianchetti, Angelo; Trabucchi, Marco; De Leo, Diego

doi: 10.1002/(SICI)1099-1166(199911)14:11<915::AID-GPS36>3.0.CO;2-Hpmid: N/A

Objective This study measures and compares use of and satisfaction with medical and social services in addition to subjectively perceived needs of family supporters of patients with probable or possible Alzheimer's disease (AD) and family supporters of non‐demented elderly people. Differences in judgement of services within the subpopulation of families of AD patients are also assessed by gender and burden level. Methods The main family supporters of 60 community‐dwelling elderly (aged over 65) with Alzheimer's disease and of 60 age‐ and sex‐matched controls were tested with a detailed questionnaire on use and satisfaction with services, any unmet needs and kinds of intervention perceived to be helpful. Results Supporters of elderly people with AD were significantly more involved in providing care than supporters of non‐demented people. Judgement on the health, social relations and financial status of their families was significantly worse in AD supporters than in supporters of non‐demented elderly people. Although the former made more use of available health and social services than the control population, they did appear to make little use of such services, not only because of lack of information but also for logistic reasons or because they would prefer a service with more specifically trained operators or more tailored intervention. AD family supporters would like to receive more information and support from their general practitioner, which confirms the importance of this figure in management of this pathology. They were less satisfied with the care provided than the control population, particularly those with a moderate–high burden. Irrespective of burden level, they also expressed a need for financial and psychological support and adequate intervention schemes, especially within the home. These should be provided by specially trained personnel and be tailored to specifically manage the individual patient's problems, especially in relation to behavioural disorders. This would help alleviate caregiver burden and allow patients to continue to be managed at home. Copyright © 1999 John Wiley & Sons, Ltd.

Salib, Emad; Sharp, Nicola

doi: 10.1002/(SICI)1099-1166(199911)14:11<925::AID-GPS37>3.0.CO;2-Bpmid: 10556863

Background There is currently no literature on the relationship between weather parameters and admissions of organic brain syndromes such as dementias. In this present study we aimed to examine the effect of weather parameters such as relative humidity, sunshine hours, diurnal variations in temperature and rainfall on dementia admissions in North Cheshire. Method Daily number of hospital admissions of dementias and other diagnoses in North Cheshire was analysed in relation to meteorological data, which were measured at the nearest meterological office to the study population. Results The study found no evidence of any statistically significant association between weather parameters and dementia admissions. There was a weak, lagged inverse relationship between dementia admissions and relative humidity and a positive association with diurnal variations in temperature within a week of admission. However, neither finding achieved statistical significance. Conclusion The study is the first in currently available literature on the subject and may therefore provide a base reference for future studies. The interesting observation relating to relative humidity and diurnal variations in temperature is unexpected and may suggest further research. Copyright © 1999 John Wiley & Sons, Ltd.

Brooke, Patrick; Bullock, Roger

doi: 10.1002/(SICI)1099-1166(199911)14:11<936::AID-GPS39>3.0.CO;2-1pmid: N/A

Objective To validate the 6 Item Cognitive Impairment Test (6CIT) against the Mini‐Mental State Exam (MMSE) with a view to usage as a screening tool. Design Three groups with varying levels of dementia were tested using the MMSE, 6CIT and Global Deterioration Scale (GDS). Setting Testing was carried out within Wiltshire, both in the community and outpatients. Subjects Patients were selected from a hospital database of dementia patients and were stratified into two groups according to GDS; a control group was also tested. Results Two hundred and eighty‐seven patients were tested: 135 controls (GDS 1–2), 70 with mild dementia (GDS 3–5) and 82 with more severe dementia (GDS 6–7). The 6CIT and MMSE were found to correlate well, r2=−0.911 (p<0.01), when all groups were analysed. Correlation falls to r2=−0.754 (p<0.01) in the mild dementia group. In the GDS 3–5 group, the MMSE has a sensitivity and specificity of 51.43% and 100% respectively (cutoff 23/24). The 6CIT gives a sensitivity and specificity of 78.57% and 100% (cutoff 7/8). Conclusion The 6CIT is a brief and simple test of cognition, which correlates well with the MMSE but outperforms it in milder dementia. The MMSE is of little value as a screening test for dementia. Copyright © 1999 John Wiley & Sons, Ltd.

Louis, Beverley; Harwood, Daniel; Hope, Tony; Jacoby, Robin

doi: 10.1002/(SICI)1099-1166(199911)14:11<941::AID-GPS44>3.0.CO;2-Hpmid: N/A

Objective To determine whether elderly medical inpatients without dementia who score >3.31 on the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) are at an increased risk of developing dementia. Design/participants Twenty‐nine patients with an IQCODE score of >3.31 without dementia and 29 age‐ and sex‐matched controls, from an original sample of 201 medical inpatients over 65, were examined 17–24 months after initial assessment. Setting Interviews took place in patients' homes, but all subjects had been recruited while medical inpatients in a general hospital 17–24 months previously. Measures The IQCODE and clinical interview to make DSM‐III‐R diagnosis of dementia. Results Ten of the study group and one control had developed dementia since the original assessment. Conclusions Non‐demented elderly medical inpatients with an admission IQCODE score of >3.31 are more likely to develop dementia than those with an IQCODE score of <3.31. The IQCODE is a sensitive tool for detecting early dementia. Copyright © 1999 John Wiley & Sons, Ltd.

Schäufele, Martina; Bickel, Horst; Weyerer, Siegfried

doi: 10.1002/(SICI)1099-1166(199911)14:11<946::AID-GPS45>3.0.CO;2-9pmid: 10556866

Objectives To evaluate a wide range of sociodemographic, neurological and clinical variables as to whether they predict mortality in a representative sample of demented elderly. Design A three‐stage community survey was conducted, based on a total of 3721 elderly patients whose cognitive status was assessed by their general practitioners (stage I). A stratified random sample of patients underwent a standardized research interview, including cognitive testing and the assessment of mental status, physical illness, sensory impairment and motor disability (stage II). After a mean interval of 28 months, all patients were recontacted. For deceased patients a close reference person was interviewed and the exact date of death was recorded (stage III). The influence of the predictor variables on mortality was determined by using the Cox proportional hazards model. Subjects A stratified random sample of 117 patients in primary care (mean age 82 years) suffering from mild, moderate or severe dementia (Alzheimer type, vascular or mixed dementia). Materials Hierarchical Dementia Scale (HDS), a modified version of the Hamilton Depression Scale, other clinical rating scales and CAMDEX criteria for clinical diagnosis and a degree of severity of dementia. Results Fifty‐three of the 117 demented patients had died during the follow‐up interval. The mortality risk increased steeply with the degree of severity of dementia. By controlling for this variable, only age and motor disability contributed significantly to the prediction of mortality, whereas gender, social class, type of dementia, extrapyramidal signs and other clinical features showed no or only a weak effect on the outcome. Conclusion The remaining life expectancy of the demented elderly depends primarily on the severity of the dementia, the patients' age and their general physical health. The influence of other clinical features which often have been hypothesized as indicators of specific subgroups of dementia was mainly due to their relationship to the disease severity. Copyright © 1999 John Wiley & Sons, Ltd.

Nielsen, Henry; Lolk, Annette; Andersen, Kjeld; Andersen, Jutta; Kragh‐Sørensen, Per

doi: 10.1002/(SICI)1099-1166(199911)14:11<957::AID-GPS43>3.0.CO;2-Bpmid: 10556867

Objective The aim of the study was to determine which cognitive functions first deteriorate in Alzheimer's disease (AD) and to identify persons who would become demented 2 years following an initial examination. Participants A total of 2452 initially non‐demented persons, aged 65–84 years and randomly drawn from the population, who were examined 2 years apart. Measures CAMCOG, the cognitive section of CAMDEX (The Cambridge Mental Disorders of the Elderly Examination). Fourteen composite measures were constructed of the 60 CAMCOG items. Results During the 2‐year period, 102 developed AD; this group had significantly lower scores on all of the 14 composite measures at baseline examination than the subjects who remained non‐demented. The incident demented were significantly older than the non‐demented, had less formal schooling, were more often unskilled and had lower verbal intellectual level. Logistic regression analyses showed that especially higher age, together with reduced recent and remote memory, low category verbal fluency and attentional deficiency, characterized incident demented 2 years before the diagnosis was made. Conclusions Cognitive changes, which develop years before the AD diagnosis, can be identified by means of CAMCOG, but this instrument does not allow identification of persons who later develop AD with sufficient precision. Copyright © 1999 John Wiley & Sons, Ltd.

Rao, Rahul; Jackson, Stephen; Howard, Robert

doi: 10.1002/(SICI)1099-1166(199911)14:11<964::AID-GPS51>3.0.CO;2-Gpmid: N/A

Objectives To determine the prevalence of primitive reflexes (frontal release signs) in elderly community residents with cerebrovascular disease and to examine their relationship with neuropsychological and mood‐related variables. Methods Three groups of 25 people over 65 with anterior circulation stroke, transient ischaemic attack (TIA) and a control group were assessed using measures of generalized cognitive impairment, frontal lobe dysfunction, frontal release signs and mood‐related variables. Predictors of cerebrovascular disease were examined further in stroke and TIA groups. Results Both stroke and TIA groups showed a higher mean score on the Frontal Release Signs Scale and a higher prevalence of most reflexes than the control group. Verbal fluency and DSM‐IV depressive disorder were independent predictors of frontal release signs. Conclusion TIAs may predispose to subtle neurological impairment, which may be mediated by frontal lobe damage. Their role in the pathogenesis of depression in later life requires further exploration. Copyright © 1999 John Wiley & Sons, Ltd.

Dubois, Bruno; McKeith, Ian; Orgogozo, Jean‐Marc; Collins, Owen; Meulien, Didier

doi: 10.1002/(SICI)1099-1166(199911)14:11<973::AID-GPS58>3.0.CO;2-Upmid: N/A

Background Metrifonate is a long‐lasting acetylcholinesterase inhibitor being developed for the symptomatic treatment of Alzheimer's disease (AD). Objectives This study compared the efficacy, tolerability and safety of two doses of metrifonate in patients with mild‐to‐moderate AD, over a 26‐week treatment period. Methods Six hundred and five patients were randomized to placebo (n=208), a 40/50 mg dose (40 or 50 mg by weight; n=200) or a 60/80 mg dose (60 or 80 mg by weight; n=197) metrifonate. Patients randomized to receive metrifonate were administered a once‐daily loading dose of 80 or 120 mg based on weight for 2 weeks, followed by the relevant maintenance dose for 24 weeks. Four main clinical domains of AD were assessed: cognition (ADAS‐cog and MMSE), psychiatric and behavioural symptoms (ADAS‐noncog and NPI), instrumental and basic activities of daily living (DAD) and global functioning (CIBIC‐plus, CIBIS‐plus and GDS). Results ADAS‐cog performance was significantly improved in the 60/80 mg and 40/50 mg dose groups, compared with placebo, in the intention‐to‐treat (ITT) population. In addition, statistically significant treatment differences were demonstrated between the 60/80 mg dose group and placebo on MMSE, ADAS‐noncog, the NPI subitems of hallucinations and apathy, DAD, CIBIC‐plus, CIBIS‐plus and the GDS. The performance of the 40/50 mg dose group was also significantly superior to placebo on the CIBIS‐plus and the NPI subitem aberrant motor behaviour. Conclusions Metrifonate significantly improved a wide range of symptoms across all four clinical domains of AD in a dose‐dependent manner, and was safe and well tolerated at both doses studied. Copyright © 1999 John Wiley & Sons, Ltd.