International Journal of Geriatric Psychiatry

John Wiley & Sons, Ltd.;

doi: 10.1002/gps.2119pmid: 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

Iliffe, Steve; Robinson, Louise; Brayne, Carol; Goodman, Claire; Rait, Greta; Manthorpe, Jill; Ashley, Peter

doi: 10.1002/gps.2204pmid: 19226529

Objectives To write a narrative review of the roles of primary care practitioners in caring for people with dementia in the community. Methods The systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006, Cochrane Reviews were identified, and other publications found by consultation with experts. Results The insidious and very variable development of dementia syndromes makes recognition of the syndrome problematic in primary care. Dementia is probably under‐diagnosed and under treated with an estimated 50% of primary care patients over 65 not diagnosed by their primary care physicians. This problem of under‐diagnosis is probably not due to lack of diagnostic skills, but rather to the interaction of case‐complexity, pressure on time and the negative effects of reimbursement systems. Primary care physicians often over‐estimate the prevalence of dementia syndromes, but in some countries may also overestimate the prevalence of vascular dementia compared with Alzheimer's disease. Diagnosis is a step‐wise process which can be aided by use of a cognitive function test, of which there are a number suitable for primary care use. Evidence based practice protocols can enhance detection rates in primary care, and there is growing evidence that communication skills in talking to people with dementia about dementia can be improved. Nevertheless there are multiple obstacles to bringing recognition forward in time, both in public awareness and professional understanding of the early changes in dementia. Conclusions There is insufficient evidence of benefit to justify population screening in primary care but earlier recognition of people with dementia syndrome is possible within primary care. The diagnosis of dementia is a shared responsibility between generalist and specialist disciplines. Primary care physicians should explore patients' ideas and concerns around their symptoms prior to referral and tentatively discuss possible diagnoses. Once the diagnosis has been confirmed, the primary care physician should provide both practical and emotional support to allow the patient and their family to come to terms with living with dementia, and refer them for additional psychosocial support if required. Copyright © 2009 John Wiley & Sons, Ltd.

Lonie, Jane A.; Tierney, Kevin M.; Ebmeier, Klaus P.

doi: 10.1002/gps.2208pmid: 19226524

Objective Patients with mild cognitive impairment account for a significant number of referrals to old age psychiatry services and specialist memory clinics. The cognitive evaluation of such patients is commonly restricted to brief dementia screens, with no consideration to their suitability for assessing MCI. Here, we review the utility of such cognitive screens for MCI and provide an overview of validated instruments. Methods We identified papers published after Petersen and colleagues 1999 MCI criteria (Petersen et al., 1999) and examining face‐to‐face cognitive screening for MCI from publication databases using combinations of the search terms ‘mild cognitive impairment’ and ‘cognitive screening’. We also combined the former search with the names of 39 screening tests recently identified in a relevant review (Cullen et al., 2007). Results Fifteen cognitive screening instruments were identified, 11 cover a restricted range of cognitive domains. High sensitivity and specificity for MCI relative to healthy controls were reported for two comprehensive and two noncomprehensive screening instruments, adequate test‐retest and inter‐rater reliability for only one of these. With the exception of three studies, sample sizes were universally small (i.e. n ≤ 100), and prognostic values were reported for only two of the identified 15 screening measures. Sensitivities of the full domain measures were universally high, but information about their specificity against psychiatric and non‐progressive neurological conditions and predictive validity is lacking. Conclusion Several cognitive screening instruments afford the clinician the ability to detect MCI, early AD, and in some cases non‐AD dementia, but they cannot currently be used to make reliable inferences about the course and eventual outcome of MCI. Copyright © 2009 John Wiley & Sons, Ltd.

Mainio, Arja; Karvonen, Kaisa; Hakko, Helinä; Särkioja, Terttu; Räsänen, Pirkko

doi: 10.1002/gps.2194pmid: 19127521

Objective We studied the prevalence of hospital‐treated Parkinson's disease (PD) among suicide victims and the profile of these persons, taking into account suicide attempts, timing of depression and comorbid somatic diseases. Methods The database of this study consisted of suicide victims aged 50 years of age or older (n = 555) during a fourteen‐year period in the province of Oulu in Northern Finland. Results Hospital‐treated Parkinson's disease occurred in 1.6% of the subjects, indicating a rather low prevalence of suicide in this group of patients. The persons with PD had attempted suicide earlier in 44% of the cases, while the corresponding percentage for other victims in older age was 9.9% (p = 0.009 Fischer exact test). Conclusions Based on the case characteristics of our study the profile of PD person who completed suicide was as follows: male subject with recently diagnosed disease, living in rural area, having multiple physical illnesses, and having attempted suicide earlier. Psychiatric consultation is thus highly recommended for the PD patients with this disease profile. Copyright © 2009 John Wiley & Sons, Ltd.

Fu, Brenda Yan; Ma, Suk Ling; Tang, Nelson Leung Sang; Tam, Cindy Woon Chi; Lui, Victor Wing Cheong; Chiu, Helen Fung Kum; Lam, Linda Chiu Wa

doi: 10.1002/gps.2196pmid: 19212968

Objectives We previously found that the polymorphisms of cholesterol 24‐hydroxylase (CYP46A1) gene were associated with the risk of Alzheimer's disease (AD) in Chinese. However, its effect in predicting progression of cognitive decline remains unknown. Methods Two hundred and eighty‐one Chinese subjects (121 cognitively intact, 101 with mild cognitive impairment and 59 with mildly dementia) were followed‐up with a mean (SD) duration of 25.22(5.74) months. Association between the CYP46A1 gene polymorphisms and 2‐year cognitive deterioration were evaluated. Results At follow‐up, 225(80.0%) subjects were reassessed. Sixty‐three subjects were diagnosed as AD, 68 were MCI and 94 were cognitively intact. Among them, 158 had improved or remained stable while 67 deteriorated. The ‘deteriorated’ group was older than ‘improved or stable’ group (t‐test, t = −2.87, p < 0.001). IVS2‐150 polymorphism was associated with a higher risk of cognitive deterioration. Subjects with T allele were more likely to deteriorate compared with those without T allele (Pearson χ2 = 8.98, df 2, p = 0.011). IVS3‐128 CC genotype was higher in ‘improved or stable’ group (Likelihood Ratio = 6.55, df 2, p = 0.038), suggesting a protective role for this allele. The two other polymorphisms, IVS1‐192 and IVS4‐122, did not show any significant association with cognitive function. Conclusion CYP46A1 gene may act to modulate the course of cognitive deterioration in late life. Copyright © 2009 John Wiley & Sons, Ltd.

Kerr, Enda; Craig, David; McGuinness, Bernadette; Dynan, Kevin B.; Fogarty, Damian; Johnston, Janet A.; Passmore, A. Peter

doi: 10.1002/gps.2197pmid: 19194887

Objectives Renal disease is increasingly regarded as an independent risk factor for vascular disease which in itself is believed to influence risk of AD. Alterations in amyloid homeostasis via reduced renal clearance of peripheral beta‐amyloid (A|*beta*|) may represent another potential role for variation in renal function leading to increased risk of AD. We sought to examine estimates of glomerular filtration rate in AD and control groups. Methods AD patients were randomly recruited from the Memory Clinic of the Belfast City Hospital (n = 83). Genomic DNA was extracted from peripheral leucocytes and was genotyped for Apolipoprotein E using standard methods. Using creatinine values, age and gender, estimated Glomerular Filtration Rates (eGFR) were calculated using the isotope dilution mass spectrometry (IDMS)‐traceable Modification of Diet in Renal Disease (MDRD) Study equation (using the United Kingdom National External Quality Assessment Scheme (UKNEQAS) correction factor). IDMS eGFR values were then compared between AD and control groups. Results Significant baseline differences in age, diastolic blood pressure, education level attained and APOE |*epsilon*|4 carriage were noted between cases and controls. The AD group had a significantly lower eGFR versus controls (69 vs 77 ml/min) which persisted after adjustment for possible confounders (p = 0.045). Conclusions This case‐control analysis suggests that using a relatively accurate estimate of renal function, patients with AD have greater renal impairment than cognitively normal controls. This may reflect impaired renal clearance of peripheral A|*beta*| or be a marker of shared vascular processes altering cerebral and renal functioning. Copyright © 2009 John Wiley & Sons, Ltd.

van der Steen, Jenny T.; Helton, Margaret R.; Ribbe, Miel W.

doi: 10.1002/gps.2198pmid: 19156757

Objective To explore how physicians treating nursing home residents with dementia and pneumonia in the Netherlands consider prognosis in their treatment decision. Methods Survey study with data collected between July 2006 and March 2008. Physicians (n = 69) from 54 nursing homes in the Netherlands completed a questionnaire on symptoms, treatment, and prognosis for their next dementia patient newly diagnosed with pneumonia. They were also asked a general question regarding withholding antibiotic treatment and prognosis. Outcome was assessed at least two months afterwards. Two‐week mortality risk if treated with antibiotics was calculated with a validated prognostic score. Results The patients not treated with antibiotics had high (92%) actual 2‐week mortality while only 12% of patients treated with antibiotics died. Physicians believed that mortality risk was high in the untreated group and would have been only slightly lower if treated with antibiotics (mean estimated risk 73%), which was higher than predicted from the risk score (42%). In general, three‐quarters of physicians considered withholding antibiotics appropriate for mortality risks between 75% and 90%. Conclusions Prognosis is an important consideration when Dutch nursing home physicians make antibiotic treatment decisions for patients with dementia and pneumonia. This suggests they prefer not to treat with antibiotics when to do so is probably futile. Physicians in other countries may hold different views on futility, which should be addressed in larger, cross‐national comparative studies. Copyright © 2009 John Wiley & Sons, Ltd.

Nation, Daniel A.; Katzen, Heather L.; Papapetropoulos, Spyridon; Scanlon, Blake K.; Levin, Bonnie E.

doi: 10.1002/gps.2199pmid: 19212967

Objective It is estimated that 40% of patients with Parkinson's disease (PD) are clinically depressed, however, little is known about the frequency and associated features of subthreshold depression in PD. The current study sought to determine the prevalence of subthreshold depression (sD) and to further characterize the associated features in a sample of 111 nondemented patients with moderate to severe PD. Methods Patients were classified into the following groups: diagnostic depression (DD), subthreshold depression (sD), or nondepressed (ND) by applying the Diagnostic and Statistical Manual, 4th edn criteria for depression and previously reported criteria for sD to items from the Beck Depression Inventory, 2nd edn. These groups were compared on clinical and demographic variables. The symptom profile of the sD group is also described. Results Fifty participants (45.0%) were classified as ND, 32 (28.8%) as sD, and 29 (26.1%) as DD. Patients with sD were younger (∼5 yrs) than nondepressed patients, but did not differ in disease stage or any other demographic variables. Patients with sD tended to endorse mood symptoms that overlap with PD, including fatigue, sleep difficulties, appetite dysfunction, and concentration difficulties. These symptoms were also endorsed with high frequency by the other groups. Conclusions These findings suggest that sD is not uncommon in PD and may be more prevalent among younger patients. The finding that sD patients report mood symptoms that overlap with the PD symptomatology suggests that these two entities share common features and may be difficult to disentangle. Copyright © 2009 John Wiley & Sons, Ltd.

Bishara, Delia; Taylor, David; Howard, Robert J.; Abdel‐Tawab, Rauja

doi: 10.1002/gps.2200pmid: 19156700

Background The management of Behavioural and Psychological Symptoms of Dementia (BPSD) has been the subject of considerable debate over the last few years in view of the poor evidence base for pharmacological agents and concerns about their safety. Objectives This study sought to obtain expert opinion on the management of BPSD and to investigate current prescribing practices in the UK. Method A total of 166 expert opinion surveys were emailed to UK consultants in Old Age Psychiatry asking them to rate the appropriateness of psychotropics in different aspects of BPSD. A service evaluation was also carried out in 8 UK centres to investigate prescribing patterns. Results Overall, 59 consultants returned completed questionnaires, a response rate of 35%. Results revealed that experts rated quetiapine as the most appropriate agent for all BPSD followed by acetylcholinesterase inhibitors for psychotic symptoms, benzodiazepines for agitation or aggression and trazodone for behavioural symptoms such as disinhibition. The service evaluations showed that benzodiazepines were most frequently prescribed for BPSD. Conclusions Although quetiapine was judged by experts to be the most appropriate agent for BPSD, it appears that in clinical practice benzodiazepines are most often used to manage these symptoms. Evidence from both studies show wide inconsistencies in prescribing trends. Copyright © 2009 John Wiley & Sons, Ltd.

Chung, Man Cheung; McKee, Kevin J.; Austin, Chris; Barkby, Helen; Brown, Hayley; Cash, Sophie; Ellingford, Jenny; Hanger, Liz; Pais, Tara

doi: 10.1002/gps.2201pmid: 19145576

Background Posttraumatic Stress Disorder (PTSD) is a debilitating psychological condition, never studied in relation to falls in older people. This study determines the prevalence and correlates of PTSD in older people post‐fall. Method A prospective survey study, with baseline data collected by interview in hospital post‐fall and by postal self‐completion at 12 and 24 weeks post‐baseline. A convenience sample of 196 people (≥ 65 years) were serially recruited, 87.9% of those eligible. Information collected at baseline included falls‐related data, activity problems, fear of falling, PTSD symptoms, anxiety and depression, and at follow‐up PTSD symptoms, anxiety and depression, the receipt of rehabilitation and further falls. Results In hospital, of 40 participants whose fall had occurred over 1 month previously 35% had full acute PTSD and 17.5% had partial acute PTSD. At follow‐up full or partial chronic PTSD was found in 26.1% of participants at first follow‐up, and in 27.4% of participants at second follow‐up. Older age, pre‐fall activity problems, fear of falling, and anxiety assessed at baseline were associated (p < 0.05) with follow‐up PTSD diagnosis, as were anxiety and depression assessed concurrently. Conclusion PTSD occurs in a substantial minority of older people post‐fall. No pattern emerged of factors predictive of PTSD, although the association between fear of falling and PTSD suggests some patients thought to have fear of falling may be manifesting PTSD, and require identification to enable therapeutic intervention. Copyright © 2009 John Wiley & Sons, Ltd.