International Journal of Geriatric Psychiatry

John Wiley & Sons, Ltd.;

doi: 10.1002/gps.2120pmid: N/A

In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of geriatric psychiatry. Each bibliography is divided into 9 sections: 1 Reviews; 2 General; 3 Assessment; 4 Epidemiology; 5 Therapy; 6 Care; 7 Dementia; 8 Depression; 9 Psychology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted

Tabet, Naji; Howard, Robert

doi: 10.1002/gps.2220pmid: 19226527

Objective Delirium is a very common and serious disorder with high morbidity and mortality. Despite symptomatic treatment the outcome can be poor for some especially when no underlying cause is identified. As a result, various strategies for delirium prevention have been assessed. Pharmacological agents such as antipsychotics, acetylcholinesterase inhibitors, sleep–wake cycle regulators, anti‐inflammatories and others have been advocated for a potential role in delirium prevention. The aim of this paper is to review the available evidence for their use in the prevention of delirium. Methods An electronic search was carried out using Medline, EMBASE and Cochrane for randomised controlled trials (RCTs) and other studies. The words delirium, prevention, intervention, pharmacological, prophylactic, antipsychotics, acetylcholinesterase inhibitors, sleep and anti‐inflammatories were used. References from selected papers were also searched. Results No multi‐centre RCT has been identified. Few trials and other studies have been published so far assessing the prophylactic role of antipsychotics, acetylcholinesterase inhibitors, hypnotics, melatonin, and gabapentin. As these studies tested different drugs, regimes and protocols in diverse populations no meaningful comparison can be made. Conclusion To date there is conflicting and inconsistent data regarding the efficacy of pharmacological treatment for delirium prevention. Positive reports in few of the studies justify further assessment of the potential for some pharmacological agents in the prevention of delirium. Well designed and appropriately powered RCTs are now needed. However, based on available evidence so far, no recommendation can be made to justify the routine clinical prophylactic use of any pharmacological agent in the prevention of delirium. Copyright © 2009 John Wiley & Sons, Ltd.

Hirata, Edson Shiguemi; Nakano, Eduardo Yoshio; Junior, Jony Arrais Pinto; Litvoc, Júlio; Bottino, Cássio M. C.

doi: 10.1002/gps.2224pmid: 19768699

Objectives To assess the prevalence of alcoholism in elderly living in the city of São Paulo (Brazil) and investigate associated risk factors. Methods A total of 1,563 individuals aged 60 years or older, of both genders of three districts of different socioeconomic classes (high, medium and low) in the city of São Paulo (Brazil) were interviewed. The CAGE screening test for alcoholism was applied and a structured interview was used to assess associated sociodemographic and clinical factors. The tests Mini Mental State Examination, Fuld Object Memory Evaluation, The Informant Questionnaire on Cognitive Decline in the Elderly and Bayer‐Activities of Daily Living Scale were used for cognitive and functional assessment. Results Prevalence of alcoholism was 9.1%. Multivariate regression analysis showed that alcoholism was associated with male gender, ‘mulatto’ ethnicity, smoking, and cognitive and functional impairment. In addition, the younger the individual and the lower the schooling level, the higher the risk for alcoholism. Conclusions The results obtained in this study show that alcoholism is highly frequent in the community‐dwelling elderly living in São Paulo, and that it is associated with socio‐demographic and clinical risk factors similar to those reported in the literature. This suggests that alcoholism in the elderly of a developing country shares the same basic characteristics seen in developed countries. These findings suggest that it is essential for health services and professional to be prepared to meet this demand that will significantly grow in the next years, especially in developing countries, where the rates of population aging are higher than those of developed countries. Copyright © 2009 John Wiley & Sons, Ltd.

Schellhorn, Sarah E.; Barnhill, John W.; Raiteri, Valentine; Faso, Veronica Lo; Ferrando, Stephen J.

doi: 10.1002/gps.2221pmid: 19326400

Objective The authors examine changes in psychiatric referral patterns for geriatric inpatients since last reported in the United States, more than 20 years ago, and compare geriatric psychiatric referrals to those of a non‐geriatric cohort. Method Retrospective study comparing psychiatric diagnosis, treatment and aftercare of younger (ages 18–60 years, n = 474) and older (>60 years, n = 487) patients seen in psychiatric consultation in a large, urban, university‐based tertiary care hospital setting. Results Compared to previous reports in the literature, this cohort contains a notably higher percentage of the ‘old‐old’ (>80 years), reflecting the general aging of those who are hospitalized. Compared to younger patients, geriatric inpatients were more commonly referred for psychiatric consultation, but overall rates of referral remain low (<4%). Geriatric patients were diagnosed with dementia and delirium more frequently; with substance dependence less frequently; and were just as likely to be diagnosed with depression. Geriatric patients were also more likely to receive atypical antipsychotic medications and less likely to receive benzodiazepines than younger patients. In patients diagnosed with depression, psychiatric follow‐up is more likely relegated to outpatient geriatricians and nursing homes. Conclusions Consulting psychiatrists frequently encounter geriatric patients and, given patterns of diagnosis and aftercare, should play a major role in medical staff education and in development of enhanced in‐hospital and aftercare services, including psychiatric liaison. Copyright © 2009 John Wiley & Sons, Ltd.

Mathis, Alexandre; Schunck, Thérèse; Erb, Gilles; Namer, Izzie Jacques; Luthringer, Rémy

doi: 10.1002/gps.2222pmid: 19418476

Objective The effects of aging on the inhibitory function are largely described in the neuroimaging literature but little data is available on the beginning of this age‐related impairment. Methods In this study, we described the cortical activation of middle‐aged (mean age ± standard error to the mean, 51.7 ± 3.1) subjects compared to young (26.8 ± 3.4) and elderly subjects (62.8 ± 3) while they performed a color‐matched Stroop task during functional magnetic resonance imaging. The task consisted in identifying the printing color of a word regardless of its meaning. Three conditions were defined depending on the meaning of this word; neutral (no meaning), congruent (color name matching the printing color), incongruent (color name mismatching the printing color), with interference effect in the latter. Results Middle‐aged subjects were as slow as elderly compared to young for all conditions and both were less accurate than young subjects during interference condition. Elderly showed an activity more bilateral and greater in the parietal lobule, the dorsolateral and ventrolateral prefrontal cortex (DLPFC, VLPFC) during both congruent and incongruent conditions compared to young. Middle‐aged showed an intermediary level of activity between those of elderly and young subjects in the left DLPFC, VLPFC and parietal lobule only during incongruent condition. Conclusion These results suggested that the age‐related impairment of the inhibitory process could already occur around the age of 50 years and consist in an increase of the activity in the left prefrontal and parietal cortex before increasing more and becoming bilateral around the age of 60 years. Copyright © 2009 John Wiley & Sons, Ltd.

Gustavsson, Anders; Van Der Putt, Rohan; Jönsson, Linus; McShane, Rupert

doi: 10.1002/gps.2223pmid: 19639600

Objective To assess the cost effectiveness of cholinesterase inhibitor (ChEI) treatment in patients with Alzheimer's disease (AD) and Dementia with Lewy bodies (DLB). Method We used 4‐month open label follow‐up data from routine memory clinic patients. There were 852 patients with AD and 112 with DLB. We applied three predictive models to estimate clinical and economic outcomes at five years, comparing AD and DLB patients with hypothetical untreated controls. Results The mean improvement in MMSE in 852 AD patients was 0.57 (SD 3.4) at 4 months, and in the subgroup with baseline MMSE of 10–20 (moderate) was 1.6 (SD 3.7). Overall, the 112 DLB patients improved by 1.4 (SD 3.7). DLB patients with an MMSE 10–20 improved by 3.1 (SD 4.5) points. These efficacy data were input into the SHTAC, microsimulation and Markov models and produced estimated costs per QALY gained (CQG) for all AD of £194,066, £67,904 and £123,935 respectively. In comparison, the CQGs for all DLB were £46,794, £2,706 and £35,922. For the moderate subgroups only the SHTAC and microsimulation models were applicable. These gave CQG estimates for moderate AD of £39,664 and cost saving respectively. For moderate DLB, both estimates were cost saving. Conclusion The cost per QALY gained of cholinesterase treatment of all patients with DLB (including those with MMSE outside the 10–20 range) is comparable to that of patients with moderate AD, and is probably cost saving. Copyright © 2009 John Wiley & Sons, Ltd.

Zuidema, Sytse U.; de Jonghe, Jos F. M.; Verhey, Frans R. J.; Koopmans, Raymond T. C. M.

doi: 10.1002/gps.2225pmid: 19280678

Introduction The aim of the study was to assess the influence of dementia severity and gender on neuropsychiatric symptoms in demented nursing home patients. Methods Neuropsychiatric symptoms were assessed in a large sample of 1319 Dutch nursing home patients using the Cohen‐Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory–Nursing Home version (NPI‐NH). The influence of gender and severity of cognitive decline, assessed with the Global Deterioration Scale (GDS), was investigated using logistic regression analysis and subsequently corrected for possible confounders, such as age, duration of institutionalization and psychoactive medication use. Results While physically aggressive behaviour was more common in patients with very severe cognitive deterioration (GDS stage 7), disinhibition, irritability, physically non‐aggressive and verbally agitated behaviour were more common in patients in GDS stage 5 or 6. Physically aggressive behaviour was more common in men, whereas female patients demonstrated more verbally agitated behaviour. With respect to other neuropsychiatric symptoms, delusions and depression were also more common in patients in GDS stage 5 and 6, while prevalences of anxiety and apathy further increased in severely demented patients (GDS stage 7). Apathy was more prevalent in male patients, while depression and anxiety were more common in females. Conclusion In nursing home patients, neuropsychiatric symptoms were associated with the severity of dementia, with most symptoms occurring in patients showing (moderately) severe cognitive decline. Only physical aggression, anxiety and apathy were more common in patients with very severe cognitive decline. Dementia severity and gender were important predictors of neuropsychiatric symptoms in this patient cohort. Copyright © 2009 John Wiley & Sons, Ltd.

Keaton, Daniel; Lamkin, Nathan; Cassidy, Kristin A.; Meyer, William J.; Ignacio, Rosalinda V.; Aulakh, Lakyntiew; Blow, Frederic C.; Sajatovic, Martha

doi: 10.1002/gps.2227pmid: 19274637

Objectives Herbal and nutritional compounds (HNC) are widely used among geriatric populations with depression, however little data exists on HNC use in older populations with bipolar disorder. The goal of this study was to evaluate orally‐ ingested HNC use in individuals with bipolar disorder and with major depression. Methods This was a cross‐sectional analysis of self‐reported factual knowledge of HNC, individual perspective on efficacy and safety of HNC, patterns of HNC use, and discussion of HNC with health care providers in 50 older adults with bipolar disorder and 50 older adults with major depression. Results In this sample, approximately 30% of older individuals with depression or bipolar disorder used orally‐ ingested HNC. Over 40% of older adults believed that HNC is FDA‐regulated and 14‐20% preferred to take HNC compared to physician‐prescribed psychotropic medications. Use of HNC was more common among older adults with bipolar disorder (44%) compared to older adults with major depression (16%, p = 0.003). The majority of older adults with mood disorders (64%) had not discussed use of HNC with their treating physicians. Conclusion Orally ingested HNC was used by nearly one in three older adults with mood disorders, and was more common among those with bipolar disorder compared to those with major depression. Most individuals did not discuss HNC use with their physicians. Clinicians need to assess for HNC use, particularly with respect to potential drug‐drug interactions. Copyright © 2009 John Wiley & Sons, Ltd.

Dierckx, E.; Engelborghs, S.; De Raedt, R.; Van Buggenhout, M.; De Deyn, P. P.; Verté, D.; Ponjaert‐Kristoffersen, I.

doi: 10.1002/gps.2228pmid: 19280679

Objective This study was set up to investigate whether neuropsychological tests are able to predict conversion to AD among Mild Cognitive Impairment (MCI) patients. Methods At baseline the cognitive part of the Cambridge Examination for Mental Disorders of the Elderly (CAMCOG), the Mini Mental Status Examination (MMSE), the Geriatric Depression Scale (GDS), a Dutch variation of Rey's Auditory Verbal Learning Test, the Memory Impairment Screen plus (MISplus) and the Visual Association Test (VAT) were administered to 40 patients diagnosed with MCI. After 18 months, MCI‐patients were reassessed and a follow‐up diagnosis was established. Of those who were seen for follow‐up (n = 31), seven fulfilled (NINCDS‐ADRDA) criteria of probable AD, while 24 did not convert. Results A binary logistic regression analysis showed that the MISplus contributed most to the prediction of conversion (OR = 0.28, 95% CI 0.099–0.790). With a cut‐off of 2 out of 6, a positive predictive value of 71.5%, a negative predictive value of 91.5% and an overall diagnostic accuracy of 87.0% were achieved. Conclusions This prospective, longitudinal study shows that a score of 0 or 1 out of 6 on the MISplus may be a good indicator of future (within 18 months) progression to AD among MCI‐patients. Copyright © 2009 John Wiley & Sons, Ltd.

Brega, Angela G.; Reynolds, Ann; Bennett, Rachael E.; Leehey, Maureen A.; Bounds, Lanee S.; Cogswell, Jennifer B.; Hagerman, Randi J.; Hagerman, Paul J.; Grigsby, Jim

doi: 10.1002/gps.2231pmid: 19404994