International Journal of Geriatric Psychiatry

Published by Wiley
Online ISSN: 1099-1166
Print ISSN: 0885-6230
Making an early diagnosis of Alzheimer's Disease (AD) is becoming increasingly important. The Clinical Dementia Rating scale (CDR), a semi-structured interview with patient and caregiver, is a global rating scale designed for use in staging dementia. The primary objective of our study was to examine the evolution of AD in individuals with very mild AD (CDR 0.5) across a 2-year follow up. A cohort of AD patients (n=682) living in the community were followed during 2 years in 16 centres of the French AD network. Each subject underwent extensive medical examination including the MMSE and CDR every 6 months. Two hundred and thirty-three AD patients were rated CDR 0.5 at baseline (mean MMSE score: 23.15+/-2.57). They were younger and reported an average duration of symptoms of approximately 0.8 years less than patients with CDR >or= 1.During the 2-year follow-up, none of the AD CDR 0.5 subjects improved; 65% of them showed an increase in the CDR score. The rate of cognitive decline was similar between the AD CDR 0.5 and CDR >or= 1 groups. The ADL decline was more significant in patients with CDR >or= 1 at inclusion. It is certainly possible to identify AD at a very early stage focusing on intra individual change in cognitive and functional impairment. Criteria with a high sensitivity and specificity for detecting AD at an early stage will help to further develop effective pharmacological and behavioural interventions for delaying the onset and progression of the disease.
Mental health service utilization among Canadians with a mental disorder (within the past 12 months) by age group
This paper examined the 12-month rate of mental disorders and subsequent service use among Canadian seniors aged 65-79 and 80 and over and adults aged 20-49 and 50-64. This is a secondary analysis of data [n = 33,695] of the population-based Canadian Community Health survey, Cycle 1.2 (CCHS 1.2). Major Depressive Episodes (MDEs), specific Anxiety Disorders (AD) and Alcohol Abuse/Dependence rates were assessed. The 12-month rates for the two senior groups aged 65-79 and 80+ for MDEs, ADs, and Substance Dependence (SD) are 1.7% and 1.6%; 1.4% and 0.8%; and 0.1% and 0.0%, respectively. Seniors aged 65-79 and 80+ had significantly lower rates than adults aged 20-49 and 50-64 for all mental disorders and SD. Among the total sample, seniors aged 65-79 and 80+ had significantly lower utilization rates than adults aged 20-49 and 50-64 for all three provider categories (GP only, GP and Other Health Professional, Any Other Health Professional but GP). Females aged 65-79 and 80+ were less likely to have reported service use for mental health reasons as opposed to those females aged 20-49 and 50-64. Males aged 65-79 and 80+ were more likely to have reported having used mental health services in the past 12 months as opposed to males aged 20-49 and 50-64. The presence of common mental disorders is lower in seniors as compared to younger adults. Age and gender influence mental health service utilization rates. Copyright © 2010 John Wiley & Sons, Ltd.
To examine the relationship between the ApoE epsilon4 allele and cognitive impairment 13 months after stroke. One hundred four stroke rehabilitation patients were cognitively tested on average 18 days after hospital admission and again 13 months later with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The following potential risk factors for post-stroke cognitive impairment (defined by a RBANS total index score below 77.5 points) at 13 months follow-up were analyzed in bivariate and logistic regression analyses: ApoE-genotype, socio-demographic variables, pre-stroke cognitive reduction (The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)), vascular factors, lesion characteristics, and neurological impairment (The National Institute of Health Stroke Scale (NIHSS)). Differences in general cognitive performance (pre-stroke, baseline, and follow-up) across patients with different ApoE-genotypes were analyzed, and lastly differences between epsilon4-carriers and non-carriers for changes in performance in various cognitive domains over the 13 months period were examined. Significant risk factors for cognitive impairment at 13 months were ApoE epsilon4, pre-stroke cognitive reduction (IQCODE 3.44+), previous stroke, and neurological impairment (NIHSS Total Score >5). A significant dose-dependent effect of the ApoE-genotype in relation to overall post-stroke cognitive functioning was found at baseline and follow-up, but not pre-stroke. The epsilon4 carriers showed a significant decline in tests related to verbal learning and memory compared to the non-carriers. The ApoE epsilon4-allele constitutes an independent risk factor for cognitive impairment at 13 months post-stroke, and is associated with progression of cognitive decline in tasks related to verbal learning and memory.
The purpose of this study was to investigate the psychological symptoms experienced by recently widowed older men. It was hypothesized that conjugal bereavement in this group would be characterized by a mixture of depression, anxiety and loneliness. Double cohort study. Suburban community population of Brisbane, Australia. Consecutive widowers (65+ years; N = 57) identified from official death records. Married men (65+ years; N = 57) identified from the electoral roll. Widowers interviewed at 6 weeks, 6 months and 13 months post-bereavement. Married men interviewed at similar intervals. Bereavement Phenomenology Questionnaire (BPQ), a 22-item self-report measure employing a four-point response scale to rate the frequency of phenomena over the previous fortnight. Zung Self-rating Depression Scale (SDS). State component of the Spielberger State/Trait Anxiety Inventory (STAI). Revised UCLA Loneliness Scale (ULS). 28-item General Health Questionnaire (GHQ). Widowers reported more state anxiety and general psychological distress, but not more depression or loneliness, than matched married men over the first 13 months post-bereavement. Widowers also reported more sleep disturbance and thoughts of death and suicide than married men. Level of state anxiety was strongly correlated with intensity of grief, but not with age, income, education, occupational prestige, cognitive function, duration of wife's final illness or expectedness of wife's death. The main hypothesis was not supported, as anxiety symptoms were the predominant clinical feature of recent conjugal bereavement among older men. The nature of these anxiety symptoms requires further investigation in recently widowed older persons.
Rivastigmine displays dose-dependent efficacy on cognition in patients with Alzheimer's disease (AD), as measured by the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog). Subanalysis of the OPTIMA (OPtimising Transdermal Exelon In Mild-to-moderate Alzheimer's disease) study aimed to define ADAS-cog domains by factor analysis of individual items. Efficacy of 13.3 mg/24 h versus 9.5 mg/24 h rivastigmine patch on individual items and newly derived domains was assessed. OPTIMA was a 48-week, double-blind (DB) study in patients with mild-to-moderate AD. Patients meeting pre-defined decline criteria during open-label treatment with 9.5 mg/24 h patch were randomized in the DB phase to 13.3 mg/24 h (n = 280) or 9.5 mg/24 h (n = 287) patch. ADAS-cog change from baseline was a co-primary outcome measure. Factor analysis categorized ADAS-cog items into newly derived domains. Change from DB-baseline was calculated for domains and individual items. Numerically, less decline was displayed with 13.3 mg/24 h versus 9.5 mg/24 h patch in the total ADAS-cog score at all time points (significant at Week 24, p = 0.027). Factor analysis identified two domains: memory and language. Significantly, less decline was observed on the memory domain with 13.3 mg/24 h versus 9.5 mg/24 h patch at Weeks 12, 24, and 48 (p < 0.05; observed cases). Three items (following commands, orientation, and word recognition) displayed numerically less decline with 13.3 mg/24 h versus 9.5 mg/24 h patch at all time points. No significant between-group differences were observed on the language domain. Results suggest that the greater cognitive efficacy of 13.3 mg/24 h versus 9.5 mg/24 h rivastigmine patch is driven primarily by effects on memory, particularly in the areas of following commands, orientation, and word recognition. Copyright © 2014 John Wiley & Sons, Ltd.
Comparison of caregiver assessment data for patients with and without an acute hospitalisation (n ¼ 134)
Causes of acute hospitalizations Behavioural disorders 52% Fractures 19% Discharge (breakdown in caregiver network) 11% Falls not causing fractures 6% Anorexia 3% Other causes (Swallowing disorders, Hypotension, 9% Epilepsy, Stroke, Deep venous thrombosis, Acute hepatitis, Gastric ulcer, Acute glaucoma . . . ) Table 2. Comparison of patient data at baseline for patients with and without an acute hospitalisation (n ¼ 134)
To evaluate the frequency of and determine predictive factors for acute hospitalization in a prospective study of patients with Alzheimer's disease (AD). A one year prospective study. 134 patients recruited from the memory clinic in Toulouse University Hospital, with AD diagnosed using the NINCDS-ADRDA criteria. A comprehensive geriatric and neuropsychological assessment was conducted 6 monthly. Among the 134 patients included in this study, at one year follow up, 32 patients had at least one acute hospitalization. Patient-related variables predictive of acute hospitalization in the univariate analysis were: level of education, ADL-bathing, ADL-toileting, ADL-feeding, total ADL score, IADL A scale (daily upkeep), history of falls, and level of behavioural disorder as measured by the Cohen scale. In the multivariate regression model, two variables were associated with acute hospitalization: dependency for ADL-bathing [Odds Ratio (OR) = 5.65, 95% Confidence Intervals (CI): 2.3-14.4] and low level of education. The results of this study demonstrate that acute hospitalization is frequent in AD patients resulting in considerable cost implications. Interventions that support patients and their cares to manage their loss of ADL may be a practical approach to reducing the need for acute hospital admissions.
Cognitive screening instruments are either too long for routine clinical use or not sensitive to distinguish mild cognitive impairment (MCI) from normal cognition (NC) or dementia. To evaluate the sensitivity and specificity of the AB Cognitive Screen (ABCS) and its subtests with a view to improving its ability to differentiate between dementia, MCI and NC. The influence of age and education on sensitivity and specificity is also examined. Cross-sectional study. Participants with dementia and MCI were recruited from those presenting to four specialty geriatric clinics in southern Ontario. Participants with NC were recruited from the family and friends of patients. A comprehensive geriatric assessment was done including ABCS, SMMSE and 15 point Geriatric Depression Scale. Analysis of variance and receiver operating characteristic (ROC) curves compared test scores. SMMSE scores were also analysed for comparison purposes. Three hundred and two participants had dementia, 166 had MCI and 174 had NC. ABCS total scores were significantly different between NC and MCI (mean difference 7.1, 1.8-12.5 CI, p = 0.000) while SMMSE scores were not (mean difference 0.5, -0.7-1.7, p < 0.628). Of individual ABCS subtests, verbal fluency and delayed recall were most sensitive to differences between NC and MCI. ROC curve analysis, which presents sensitivity and specificity, showed verbal fluency was better than delayed recall in distinguishing between NC and MCI, among participants 75 years of age or older. The AB Cognitive Screen (ABCS) can be administered in 3-5 min. The SMMSE and ABCS total and subtests significantly distinguished between dementia and MCI or NC. Verbal fluency and delayed recall were best at distinguishing between MCI and NC. The analysis illustrates how each subtest contributes to the sensitivity of the ABCS and suggests ways that sensitivity might be improved.
To assess the effects of a range of chronic systemic and neurological disorders on three life quality indicators: disability, depressive symptoms and life satisfaction. As part of the Sydney Older Persons Study, a community survey was carried out with 434 non-demented people aged 75 or over living in Sydney, Australia. Subjects were given a medical examination covering the following disorders: heart disease, chronic lung disease, bone and joint disease, stroke, visual loss, peripheral vascular disease, obesity, other systemic diseases, gait ataxia, gait slowing (including Parkinsonism) and cognitive impairement short of dementia. They were also assessed on a clinician-rated disability scale and given self-report depression and life satisfaction scales. Gait slowing affected all three indicators of life quality. Heart disease and chronic lung disease affected disability and depressive symptoms, but not life satisfaction. These associations were present when the effects of age, sex, education and all other disorders were controlled in multiple regression analyses. However, when disability was also controlled, none of the physical disorders predicted life satisfaction and only heart disease continued to predict depressive symptoms. Of the physical disorders considered in the study, gait slowing, heart disease and chronic lung disease had the greatest impact on life quality. These disorders affect depressive symptoms and life satisfaction largely because they increase disability.
Several social, demographic and physical factors have been shown to be associated with depression in later life, but results have been inconsistent. We aimed to assess factors associated with depression in old age, using data from the MRC trial of assessment and management of older people in the community. Analysis of cross-sectional data. Depression was measured with a threshold of <6/6+ on the GDS-15. Independent associations with social, demographic, physical and social network variables were assessed by logistic regression. In a fully adjusted analysis, odds ratios (OR) for depression were greater in older people, (adjusted OR for those aged 80-84 years = 1.1, 85-90 years = 1.5 and 90+ years = 1.8), those in rented (OR:1.3) or sheltered/residential accommodation (OR:1.5), and those widowed, divorced or separated (OR:1.2). Life events, (OR:1.4), smoking (OR:1.6), having two or more physical illnesses (OR:1.6) or no confiding relationship (OR:3.4) were also significantly associated with depression. Higher alcohol consumption was not predictive. Female sex and living alone were associated with depression in a crude analysis, but not after full adjustment for confounding. The importance of these results lies in the large size and representative nature of the sample. In contrast to some previous reports, increasing age was associated with increasing risk of depression, but sex, living alone and alcohol were not associated. Social isolation was more important than living alone per se. Other associations largely concurred with previous work.
The 15-item Geriatric Depression Scale (GDS-15) is recommended for screening older people, but there are no large epidemiological studies using this instrument in the UK. We describe the age and sex distribution of GDS-15 scores in the largest ever UK sample of people aged 75 and over. We used cross-sectional data from the MRC Trial of the Assessment and Management of Older People in the Community. The GDS-15 was offered to a representative sample of UK people aged 75 and over. Proportions of people attaining thresholds on the GDS-15 were calculated by age group and sex. Crude Odds ratios (ORs) for the effect of age and sex were calculated and the sex/age adjusted ORs estimated using logistic regression for surveys, at three GDS-15 thresholds. Of 21 241 (71.2%; 95% Confidence intervals (CI): 67.9-74.3) eligible people, 15 126 received the assessment including the GDS-15. Of these, 14 545 (96.2%; 94.7-97.2) completed > or =13 GDS-15 answers and were included in the study. Scores showed a marked right skew, with a median of 2 (interquartile range: 1-3; range: 0-14). 34.6% (95% CI: 32.1-37.3) people scored > or =3, 8.0% (6.9-9.2) scored > or =6 and 3.1% (2.5-3.7) scored > or =8. Women were significantly more likely to score above all three thresholds than men, as were older participants. Depression may be common in later life. The data provide a national picture of the numbers of older people who will score positively for depression in health screens which include the GDS-15, as recommended by the Royal College of General Practitioners.
Objective Depression might be a prodromal stage of dementia. Many factors contribute to the etiology of depression and dementia, being inflammation one of those. The present work measured and analyzed immune molecules involved in the innate immunity on cluster of differentiation 14 (CD14+) monocytes trying to investigate any relationship among late-onset depression (LOD) and Alzheimer's disease (AD). Methods Immune molecules were evaluated in monocytes of AD, LOD patients, and controls using flow cytometry. ResultsInterestingly, interleukin 1 beta (IL-1) expressing CD14+ monocytes were increased in AD patients compared with controls. LOD presented intermediate frequency of CD14+ monocytes expressing IL-1 between controls and AD patients. Conclusion Results suggest that an increased frequency of CD14+ monocytes expressing IL-1 level could be a stage marker related to the pathophysiology of dementia process between normal aging and AD. Copyright (c) 2013 John Wiley & Sons, Ltd.
Mild cognitive impairment in Parkinson's disease (PD-MCI) has been suggested to be a predictor for the development of PD dementia (PDD). This study explored the incidence and possible neuropsychological domain differences between PD patients with PD-MCI and without cognitive impairment (normal cognitive function with PD), on the basis of the Movement Disorders Task Force Guidelines for PD-MCI. At baseline (T1), 4 years (T2) and 6 years (T3), 166 patients with PD were administered global neuropsychological assessments. At 16 years, case note and neuropsychological assessment review was employed to calculate the number of patients who had progressed to PDD. At baseline, 68 patients were classified as normal cognitive function with PD, 18 with PD-MCI and 80 with PDD. At T2, 12 of the PD-MCI cohort at T1 had progressed to PDD, and there were 15 incident cases of PD-MCI. At T3, nine PD-MCI cases at T2 had progressed to PDD. There were 10 incident cases of PD-MCI at T3. The incidence of progression from PD-MCI to PDD was 98.0 per 1000 person-years, with an annual conversion rate to PDD of 11%. Neuropsychological predictors for conversion from PD-MCI to PDD were semantic language, praxis (figure drawing/copying) and visuospatial deficits. At 16 years, 91% of the PD-MCI cohort had progressed to PDD. Mild cognitive impairment in Parkinson's disease is an important predictor for the progression to PDD. This investigation also confirmed that if PD patients live long enough, they will develop cognitive impairment or dementia. Early detection of cognitive impairment in these individuals is possible with existing standardised global cognitive assessments, which include semantic language assessment. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
The objective of this study is to examine the prediction of mortality, over 16 years, by the domains and domain elements underlying generic measures of quality of life (QoL). The method used was an analysis of mortality in an older (65 + years) representative sample (N = 2130) of a multicultural community in North Manhattan. Five conventional QoL domains were measured by in-home, rater-administered, and computer-assisted questionnaire: depressed mood, pain, self-perceived health, and function and social relationships. Some domain scales that qualitatively express distress, such as depressed mood and widespread pain, significantly predicted lower mortality (were protective) and felt isolation trended in that direction, whereas domains indicating quantitative limitations such as impairment of functioning in daily tasks, stair climbing, as well as social disengagements and lack of support network significantly predicted higher mortality. Domain elements also mattered; contrary to their domain predictions, increased mortality was predicted by the domain elements of somatic symptoms of depression. Self-perceived poor health reflected the predictive (higher mortality) direction of the limitations cluster. The internal complexity of QoL is underscored by differential impacts of domains and elements on mortality. Clinical implications include setting distress domains as important clinical goals, whereas strengthening limiting domains could result in lengthening life and secondarily relieving distress. The relative weighting of these goals could be derived from patient preferences and clinical efficacy. Fundamental implications lie in the interaction between the person's qualitative evaluations of choices and the quantitative building of desired choices for a better QoL. Copyright © 2013 John Wiley & Sons, Ltd.
Indications for serotonergic medications in the treatment of behavioral disorders associated with Alzheimer's disease (AD) remain to be established. Sertraline (100 mg OD) was evaluated in a double-blind, randomized, placebo-controlled cross-over study in 22 nondepressed patients with severe probable AD and significant behavioral disturbance. Each subject was given a fenfluramine challenge to evaluate central serotonergic tone. Eight of 21 (38%) completers responded to sertraline. Drug responsive behaviors included aggression/agitation, irritability and aberrant motor behavior. Low aggression, female gender and large prolactin increase were associated with a better response. There was a trend for decreased aggression during sertraline versus placebo (p = 0.08). Aggression, gender and serotonergic function were associated with sertraline response. Larger randomized controlled trials are needed to clarify the profile of responders.
Previous studies have indicated that not all subjects who meet the CAMDEX criteria of 'minimal dementia' progress to dementia. In the present study, predictors of outcome in minimally demented subjects were tested. Forty-five subjects with minimal dementia who were participating in a population-based study were followed-up for on average 2.3 years. Variables tested as predictors of outcome were age, the apolipoprotein E (APOE) genotype, and the baseline scores on the MMSE, CAMCOG memory subscale, and fluency. Depression at baseline was tested as a predictor of reversible minimal dementia. At follow-up, minimal dementia turned out to be reversible in 11 subjects (24%), and persistent in ten subjects (22%). Twenty-four subjects (53%) had become demented. Predictors of outcome in multivariate analyses were age, score on the CAMCOG memory subscale, and the APOE genotype. Depression was not associated with reversible minimal dementia. Subjects who meet the CAMDEX criteria of minimal dementia form a heterogenous group with respect to clinical outcome. Age, the score on the CAMCOG memory subscale, and the APOE genotype can improve predictive accuracy in these subjects.
To construct a (18)F-FDG PET normative database of Japanese healthy elderly subjects and to apply it to demented and mild cognitive impairment (MCI) patients. Seventy-seven Japanese normal volunteers from 41 to 84 years of age (36 males and 41 females) who underwent clinical, neuropsychological, and MRI examinations were selected. In these subjects, (18)F-FDG PET/CT scans were performed, (18)F-FDG PET images were analyzed using the 3D-SSP program, and a normative database for cerebral glucose metabolism was constructed. Then, (18)F-FDG PET images from 14 demented and MCI patients were evaluated based on the normative database. The 77 healthy elderly subjects were divided into three groups according to their age. In these subjects, the difference in glucose metabolism between males and females was minimal in contrast, glucose metabolism showed a weak reciprocal correlation with aging in several cerebral regions. The 3D-SSP images of 14 demented and MCI patients based on the age-matched (18)F-FDG PET normative database showed decreased patterns of glucose metabolism similar to those of previous studies on dementia diseases and MCI. An age-matched normative database can be applied to the evaluation of single subjects, and the application of a mixed database of males and females is viable. Normative databases are useful for detecting dementia diseases and their MCI.
The prevalence of depression in acutely medically ill elderly inpatients is high. Depression in the elderly is associated with increased mortality. The association between mortality at 18-month follow-up and depression, depressive symptoms and demographic variables at the outset in a cohort of acutely medically ill elderly inpatients was examined. The mortality at 18-month follow-up was 47%. Depression, depressive symptoms and demographic variables were not associated with mortality. An important explanation of this absence of association between mortality and depression may be an artifact due to patient selection designed to resemble normal clinical practice.
Objective With a prevalence that varies between 20% and 65%, poststroke depression (PSD) is a frequent sequel of stroke. The aim of this study was to determine incidence and risk factors for PSD 18months after stroke. Methods As part of the Middelheim Interdisciplinary Stroke Study, patients were followed up for 18months in this prospective and longitudinal epidemiological study. Clinically significant signs and symptoms of PSD were quantified by means of the Cornell Scale for Depression (CSD) and the Montgomery and angstrom sberg Depression Rating Scale. Activities, including social activities, were measured with the Stroke Impact Scale (SIS). Relational problems since stroke onset were defined by a questionnaire. ResultsData analysis was performed on 125 patients who completed follow-up assessments. Depression (CSD score 8) was diagnosed in 28% of the patients. Patients with PSD were more dependent for activities of daily living and displayed more physical and cognitive impairment than patients without PSD. The risk to become depressed decreased with 5% when the patient's activities increased with one unit on the SIS (odds ratio (OR)=0.95; 95% confidence interval (CI)=0.93-0.97). Patients with persistent relational problems since stroke onset had approximately four and a half times greater risk of becoming depressed than patients without (OR=4.48; 95%CI=1.17-16.87). Conclusions Multiple regression models indicated that the most determining features for developing PSD at 18months poststroke include reduced activity and relationship problems due to stroke. Further studies on risk factors for PSD are essential, including psychosocial aspects, given its negative impact on rehabilitation and quality of life. Copyright (c) 2013 John Wiley & Sons, Ltd.
Dopamine D2/3 receptor positron emission tomography tracers have guided antipsychotic prescribing in young people with schizophrenia by establishing a 'therapeutic window' of striatal D2/3 receptor occupancy. Older people, particularly those with dementia, are highly susceptible to motor side effects and may benefit from the appropriate application of imaging techniques. The study aimed to adapt [(18) F]fallypride imaging for use in occupancy studies in Alzheimer's disease (AD) and to investigate whether data acquisition could be made more tolerable by piloting the protocol in a small sample. Six participants with AD (three men; 85.0 ± 5.6 years old; MMSE = 16.0 ± 2.4) were recruited prior to commencing amisulpride for the treatment of psychosis and associated agitation. [(18) F]fallypride binding potential (BPND ) was determined using an interrupted scanning protocol at baseline (n = 6) and after 27.0 ± 6.1 days of amisulpride (25-50 mg) treatment (n = 4). D2/3 occupancy was calculated by percentage reduction in BPND between scanning sessions. Image data were re-analysed after reducing individual sampling times to 20 min. The protocol was tolerated well, apart from the final (40 min) session of the post-treatment scan in one participant. Higher occupancies were achieved in the striatum (caudate 47-70%, putamen 31-58%) and thalamus (54-76%) than in the inferior temporal gyrus (27-43%). There was high agreement between occupancy values derived using longer and shorter sampling times (mean absolute difference 6.1% in the inferior temporal gyrus; <2% all other regions). The protocol is feasible for use in AD and represents the first step towards establishing dose-occupancy relationships across older clinical populations. Copyright © 2014 John Wiley & Sons, Ltd.
The use of neuropsychological assessment beyond diagnosis is related partly to the extent to which it can indicate everyday function. This study investigates whether the associations between neuropsychological functioning, activities of daily living (ADL) and instrumental activities of daily living (IADL) change over an 18- to 24-month follow-up, exploring whether these change with dementia progression. Thirty-four patients with probable Alzheimer's disease were assessed at baseline and again after between 18 and 24 months. Neuropsychological function was assessed using the revised Cambridge Cognitive Examination, which includes in it the Mini mental state examination and an executive functions scale. ADL and IADL were also measured, together with background neuropsychiatric features by using the Neuropsychiatric Inventory. Pearson correlations between the measures of daily functioning and cognitive abilities and neuropsychiatric symptoms showed that initially neuropsychological test results tended to correlate with IADL rather than ADL measures. Neuropsychiatric symptoms were not correlated whether IADL or ADL. At follow-up, none of the neuropsychological function measures correlated with IADL or ADL, but neuropsychiatric symptoms were correlated with IADL. At baseline, neuropsychological function is associated with IADL but not ADL. At follow-up, the association between neuropsychological function and IADL diminishes, and associations between neuropsychiatric disturbances and IADL emerge.
The purpose of this study was to clarify the concordance of diagnostic abilities and interobserver agreement between (18) F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and brain perfusion single photon-emission computed tomography (SPECT) in patients with Alzheimer's disease (AD) who were diagnosed according to the research criteria of the National Institute of Aging-Alzheimer's Association Workshop. Fifty-five patients with "AD and mild cognitive impairment (MCI)" (n = 40) and "non-AD" (n = 15) were evaluated with (18) F-FDG PET and (99m) Tc-ethyl cysteinate dimer (ECD) SPECT during an 8-week period. Three radiologists independently graded the regional uptake in the frontal, temporal, parietal, and occipital lobes as well as the precuneus/posterior cingulate cortex in both images. Kappa values were used to determine the interobserver reliability regarding regional uptake. The regions with better interobserver reliability between (18) F-FDG PET and (99m) Tc-ECD SPECT were the frontal, parietal, and temporal lobes. The (99m) Tc-ECD SPECT agreement in the occipital lobes was not significant. The frontal, temporal, and parietal lobes showed good correlations between (18) F-FDG PET and (99m) Tc-ECD SPECT in the degree of uptake, but the occipital lobe and precuneus/posterior cingulate cortex did not show good correlations. The diagnostic accuracy rates of "AD and MCI" ranged from 60% to 70% in both of the techniques. The degree of uptake on (18) F-FDG PET and (99m) Tc-ECD SPECT showed significant correlations in the frontal, temporal, and parietal lobes. The diagnostic abilities of (18) F-FDG PET and (99m) Tc-ECD SPECT for "AD and MCI," when diagnosed according to the National Institute of Aging-Alzheimer's Association Workshop criteria, were nearly identical. Copyright © 2014 John Wiley & Sons, Ltd.
Homebound older adults are at high risk for depression and anxiety. Systematic screening may increase identification of these difficulties and facilitate service usage. The purpose of this study was to investigate the factor structure, internal consistency, and concurrent validity of the Brief Symptom Inventory-18 (BSI-18) for use as a screening instrument for depression and anxiety with homebound older adults and to examine if the BSI-18 could be shortened further and exhibit comparable psychometric properties. A sample of 142 older adults receiving in-home aging services completed interviews that included the BSI-18 and the depression and anxiety modules of the structured clinical interview for DSM-IV. Confirmatory factor analysis showed that the theorized three-factor, second-order model of the BSI-18 fit the data well (S-B X(2) = 136.17; p = 0.36). The depression and anxiety subscales exhibited high internal consistency (alpha > 0.81), whereas the somatic subscale exhibited lower internal consistency (alpha = 0.69). Receiver operator curve (ROC) analyses suggest that the BSI-18 depression and anxiety subscales were able to predict those with DSM-IV diagnoses (Depression AUC = 0.89 p < 0.001; Anxiety AUC = 0.80, p < 0.001). The ROC results suggested adapting a cut score of T = 50 to achieve optimal sensitivity and specificity. The short three-item depression scale exhibited comparable psychometric properties to the full scale, while the three-item somatic and anxiety scales exhibited lower internal consistency and sensitivity. These findings provide initial evidence that the BSI-18 is valid for use with homebound older adults.
The mortality pattern of individuals with impaired verbal memory (IVM) has not yet been well described. We sought to describe the risk of all-causes, as well as specific causes of death associated with IVM. We used the data of 4151 nationally representative adults ≥60 years old who participated in the third National Health and Nutrition Examination Survey, 1988-1994, and completed one non-contextual (i.e., word list memory) and one contextual delayed-recall tests (i.e., short story recall). The participants were passively followed up through 31 December 2006. We determined the hazard ratio of death from all-causes and specific cause through Cox proportional hazard regression. Severe and moderate IVM were present in 268 (6.5%) and 495 (11.9%) participants at baseline survey, and 2550 deaths occurred by the end of 18-year follow-up (median = 12 years). The medians of survival time adjusted for all-causes death were 6.17(95%CI: 5.50, 6.92), 9.50 (8.92, 10.25), and 13.17 (12.75, 13.58) years, respectively for the individuals with severe, moderate, and no IVM. Severe IVM was significantly associated with death from cardio-cerebral vascular diseases [hazard ratio = 1.70, 95%CI = (1.36-2.12)], stroke [2.60 (1.69-3.99)], and Alzheimer's disease [3.50 (1.40-8.76)]. The shortened survival time of the participants with IVM was mainly driven by the deaths of cerebral-cardiovascular diseases, which accounted for almost half of all deaths. The predictability of memory scores to early cerebral-cardiovascular deaths demonstrated that central challenge among individuals with cognitive impairment was cardiovascular diseases management. Copyright © 2014 John Wiley & Sons, Ltd.
Sensory impairment and depression are common in old age and the relation between depression and vision as well as hearing impairment have been established. However, few studies have directly compared their effects and examined the impact of dual sensory loss. The purpose of this study is to compare impacts of self-reported hearing and vision loss as well as the effect of double sensory impairment on depression. This article analyzes cross-sectional data collected from a representative community sample of 2,003 Chinese elderly people aged 60 or above in Hong Kong. Respondents were interviewed in a face-to-face format and data including vision and hearing impairment, socio-demographic variables, health indicators, family support, and depression were obtained. Logistic regression analyses revealed that visual impairment was significantly related to depression even after age, gender, marital status, education, self-reported health status, the presence of 11 diseases, functional limitation and family support were controlled but hearing loss was not. Hearing impairment did not add to the likelihood of depression where visual impairment was already present. The impact of visual impairment on psychological well-being among elderly Chinese is more robust than hearing loss. Therefore, aged care service practitioners must take this risk factor into consideration in their preventive intervention and treatment for psychological well-being.
The 15-item Geriatric Depression Scale (GDS-15) is a widely used screening instrument for depressive symptoms in the elderly, but its ability to detect alterations in depressive symptoms over time has not been established. To assess the change of the GDS-15 score after a major negative life event. Within the Leiden 85-plus Study, we prospectively followed a population-based cohort of 599 subjects from 85 years onwards. The GDS-15 was applied annually to participants with a Mini-Mental State Examination (MMSE) score above 18 points. The change in GDS-15 score of 32 subjects who had lost their partner during follow-up was compared with a control group of 32 subjects who had not lost their partner, matched for age, sex, and initial GDS-15 score. At baseline, 241 subjects lived together with a partner. During a mean follow-up of 3.2 years, 55 participants (23%) lost their partner. Of those, 32 subjects completed the GDS-15 before and after the loss of their partner. All subjects reported the bereavement to be a major negative life event. The mean increase of the GDS-15 score after the death of a partner was 1.2 points (paired t-test, p = 0.013). This was significantly higher than the mean change of -0.06 points in the matched control group (independent t-test, p = 0.032), and independent of sex, level of education, pre-bereavement GDS-15 score, and time period since the loss of a partner. This study shows that the GDS-15 detects change in depressive symptoms after loss of a partner, a negative life event that is the most important risk factor for depression in the elderly. Therefore, it may be concluded that the GDS-15 has the ability to measure longitudinal alterations in depressive symptomatology.
The psychiatry of old age in Britain can be traced back to the 1940s. Provision of services for mentally ill older people, however, did not become widespread until the 1970s. Survey of archive sources, published work, and oral history interviews relating to the development of services for mentally ill older people in Britain between 1950 and 1970. Despite considerable progress in research leading to a firm academic foundation for the specialty of old age psychiatry, there was relatively little progress made in the coordinated development of services from 1950 to 1970. A new generation of old age psychiatrists began to take service delivery issues forward at the very end of the 1960s and into the 1970s.
To create a record of the development of old age psychiatry in Britain, as seen through the eyes of some of the people who participated in building it, from the earliest days until it was officially recognised as a specialty by the Department of Health in 1989. Group reminiscences and discussions in the format of a witness seminar which was audio-recorded and transcribed. Witnesses also provided written biographical information. The annotated full record created at the seminar is available on line. This paper reflecting themes, lessons and highlights has been derived from it. Early old age psychiatrists often encountered opposition and incredulity from other health care professionals and managers. However, their experiences were demonstrating just how much could be achieved in improving the lives of older mentally ill people. They conveyed their enthusiasm for their work in both clinical and university settings. Clinical creativity, support when working in relative professional isolation, and dealing with opposition benefited from both the development of the Group for the Psychiatry of Old Age at the Royal College of Psychiatrists and from close links with geriatric medicine.
Suicides of the elderly (persons aged 65 and older) make up a large proportion of total suicides. Since suicide rates of the elderly are highest in western populations, addressing them as a risk group in prevention plans has been recommended. In order to assess possible approaches to prevention strategies, this study examines high-risk groups of the elderly. We examined official statistics on suicides that occurred in Austria between 1970-2004 (18,101 Suicides of the elderly). We analyzed time trends and differences in suicide methods as well as in age groups and both genders of the elderly. Three major high-risk groups were identified: elderly male suicides by firearms; elderly female suicides by poisoning, which occur more often with increasing age; and suicides of both genders by jumping from heights. Besides conducting treatment of psychiatric disorders of the elderly, restricting the means to commit suicide may help to prevent it among the elderly. Such specific prevention strategies should be implemented in national suicide prevention plans for the high-risk groups identified in this study.
ObjectThe aim is to describe the development of the scientific literature on dementia.Methods We present a quantitative, bibliometric study of the literature on dementia, based on Medline, covering 36 years (1974-2009). Two samples of references to dementia papers were retrieved: The main sample based on the MeSH term Dementia holds more than 88 500 references. We have compared the annual additions of references on dementia with the addition to total Medline. Changes of ‘the Dementia to Medline ratio’ (%) give the best information on the development.ResultsPublications on dementia increased 5.6 times faster than Medline. Most of this relative acceleration took place during 1980-1997, when the references on dementia increased from 0.17 to 0.78%. During the recent 12 years, the publications on dementia have been keeping pace with Medline and have stabilized around 0.8%.Conclusions We have shown a large increase of the literature on dementia, relative both to the development of all medical research and to all psychiatric research. The bibliometric approach may be questioned as quantitative methods treat articles as being of equal value, what is not true. If, for example, during a certain period, the research output is ‘inflated’ by a great number of repetitive papers, the quantitative method will give an unfair picture of the development. Our relative method, however, will give relevant results as, at each point of time, the proportion of ‘valuable research’ ought to be about the same in the dementia group as in total Medline.
In order to study secular changes in personality factors neuroticism and extroversion, representative population samples of non-demented 75-year-olds underwent psychiatric examinations in 1976–1977 (total n = 223, 138 women, 85 men) and 2005–2006 (total n = 556, 322 women and 234 men). Eysenck Personality Inventory was used at both occasions. Demographic factors (educational level, marital status, having children) were registered. Seventy-five-year-olds examined in 2005–2006 had higher values on extroversion and lower values on the Lie scale compared with those examined in 1976–1977. Neuroticism did not differ between the two birth cohorts. Neuroticism scores were higher in women than in men both in 1976–1977 and 2005–2006, and Lie score was higher in women than in men in 2005–2006. Our findings suggest that present cohorts of 75-year-olds are more extroverted and less prone to respond in a socially desirable manner than those born three decades earlier. Neuroticism levels remained unchanged, suggesting this trait may be less influenced by environmental factors than the other traits studied. Copyright
The factors most strongly associated with suicide are age and gender--more men than women, and, more people over 65 kill themselves. As a number of Governments have targets to reduce suicide levels we compare elderly suicide rates over a 20-year period in England and Wales. And the major Western countries focusing upon age and gender. WHO mortality data were used to calculate three-year average General Population Suicide Rates (GPSR) for 1979-1981 to 1997-1999 and rates of people aged 65-74 and 75+ suicide by gender to provide ratios of change and a statistical comparison of England and Wales and the Major Western countries over the period. Male GSPR: '65-74' suicide ratios fell significantly in six countries and in three for the '75+'. Female GSPR: '65-74' suicide ratios fell in every country except Spain. Proportionately, there were more suicides in the over 65s in countries with an 'extended family' tradition, Spain, Italy, Germany, France and Japan, than in the five 'secular' countries. England and Wales male '65-74' suicide fell significantly more than Canada, France, Germany, Italy, Japan, Spain, Netherlands and the USA, and did significantly better than the other countries for all female senior citizen suicides. Suicide of the over-65s has improved in seven countries, especially in England and Wales, who had the greatest proportional reduction, which reflects well upon the psycho-geriatric and community services. However, in all countries, male 65-74 rates did not match the female out so extra efforts are needed to improve male rates.
Suicide by drowning increases with age but its rates vary between countries and among communities. Drowning suicide rates in some of the available studies may have been over reported or under reported because of misclassification. This study presents data on the time trends, age/sex mortality rates from death by drowning in the elderly in England and Wales between 1979 and 2001. All coroners' verdicts in death by drowning; suicide, deaths undetermined whether accidentally or purposely inflicted were examined. Counts of suicide due to drowning and submersion [ICD 9 codes; E954] and undetermined injury deaths [E984] (WHO, 1977), reported in England and Wales between 1979 and 2001 were obtained from National Statistics (ONS). There has been a gradual reduction in suicide by drowning in men and women by more than a third the observed count in 1979 (p < 0.01). However, this decline was less evident in the elderly particularly those over the age of 75. Elderly drownings appear to attract more verdicts of suicide compared to younger age groups (Odds Ratio 4.3 95% CI 2.3-8.3). Women, particularly elderly, are more likely to have a suicide verdict returned in drowning compared to men (Odds Ratio 1.5 95% CI 1.1-1.6). The high rate of open verdicts in elderly drowning over the study period and compared to any other method of fatal self harm in England and Wales confirms the difficulties in reaching a firm conclusion in drowning death. Therefore combining suicide and all undetermined deaths in drowning as a matter of course, in nationally collected statistics, may result in grossly exaggerated rates and misleading trends in suicidal drowning. Suicide by drowning is probably not amenable to prevention and although the elderly are often thought to benefit more from suicide prevention than younger adults, the study findings seem to suggest that this is not likely to be the case in drowning.
Some major changes have occurred in the care of older people in institutions providing geriatric care from a few decades ago to today. How these changes regarding organization, diagnosis and pharmacological treatment, have affected the mental health of the population in general remains unclear. The prevalence of symptoms of mental health in two comparable cross-sectional surveys from 1982 and 2000 were studied. The study population consisted of all the people aged 65 years or older living in geriatric care units in the county of Västerbotten, in northern Sweden. Multivariate regression was used to correct for the effect of change in demographic structure. Six out of 14 symptoms showed a significant decrease, correcting for demographical changes. These were, expressed as descriptions of behaviours, Sad (OR 0.72), Crying (OR 0.67), Fearful (OR 0.73), Disturbed and restless (OR 0.84), Lacking initiative (OR 0.67) and Does not cooperate (OR 0.67).Two symptoms showed a significant increase, Overactive/manic (OR 1.44) and Hallucinates visually (OR 1.27). The use of antidepressants had increased from 6.3% 1982 to 39.9% 2000. The use of minor tranquillizers had increased from 13.2% to 39.2% and the prevalence of antipsychotic use had decreased from 25.1% to 20.5%. This article clearly shows that the prevalence of several important symptoms and behaviours in a geriatric care population have decreased over the course of eighteen years, correcting for demographical changes. This might at least partly be accounted for by today's more widespread use of antidepressants and benzodiazepines.
Elderly people commit suicide more often than people under the age of 65. An elevated risk is also attached to depression and other axis I psychiatric disorders. However, little is known about the preferred suicide method, effect of primary psychiatric diagnosis, and length of time between discharge from psychiatric hospitalization and suicide. The lack of information is most apparent in the oldest old (individuals over 75 years). On the basis of forensic examinations, data on suicide rates were separately examined for the 50-64, 65-74 and over 75 year-olds (Total n=564) with regard to suicide method, history of psychiatric hospitalization and primary diagnoses gathered from the Finnish Hospital Discharge Register. Study population consisted of all suicides committed between 1988 and 2003 in the province of Oulu in Northern Finland. Of the oldest old, females had more frequent hospitalizations than males in connection with psychiatric disorders (61% vs 23%), of which depression was the most common (39% vs 14%). In this age group, 42% committed suicide within 3 months after being discharged from hospital and 83% used a violent method. Both elderly males and females were less often under the influence of alcohol, but used more often violent methods than middle-aged persons. Suicide rates within the first 3 months following discharge from hospital in the 65-74 and the over 75 year olds were substantial and should influence post-hospitalization treatment strategies. To reduce the risk of suicides in elderly patients discharged from hospital, close post-hospitalization supervision combined with proper psychoactive medication and psychotherapy, are possible interventions.
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. 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. 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). 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.
Top-cited authors
Robert Arnold
  • Southern New Hampshire University
George S Alexopoulos
  • Cornell University
Carol Brayne
  • University of Cambridge
Gill Livingston
  • University College London
Marjolein E de Vugt
  • Maastricht University