Dementia: the International Journal of Social Research and Practice, 12(5), 2013, pp.606-618.
Publisher:
Sage
Surveys were distributed to all 335 Edinburgh GPs to investigate their attitudes and expectations regarding the sharing of care between primary and secondary care for people with dementia. The response rate was 79.7%. Two-thirds of GPs were sure of their role and a similar number felt that care was appropriately shared. The latter opinion was not associated with individual GP factors...
(Edited publisher abstract)
Surveys were distributed to all 335 Edinburgh GPs to investigate their attitudes and expectations regarding the sharing of care between primary and secondary care for people with dementia. The response rate was 79.7%. Two-thirds of GPs were sure of their role and a similar number felt that care was appropriately shared. The latter opinion was not associated with individual GP factors, such as gender or length of time since qualification, or local levels of deprivation. However, there was a significant association with sector consultant psychiatrist and with the proportion of the practice list diagnosed with dementia. It is concluded that the relationship between GP and specialist could be a key target to improve shared care and early diagnosis of dementia.
(Edited publisher abstract)
Subject terms:
general practitioners, primary care, dementia, psychiatry;
International Journal of Geriatric Psychiatry, 22(12), December 2007, pp.1267-1268.
Publisher:
Wiley
AIDS dementia complex is one of the specific infectious dementias, which is rarely seen in senescent (>75 years of age) subjects. Hashimoto encephalopathy has been described as the cause of several neurological and psychiatric syndromes including dementia. The proposed pathophysiological mechanism is an autoimmune reaction to shared, thyroid gland and CNS epitopes with subsequent cerebral...
AIDS dementia complex is one of the specific infectious dementias, which is rarely seen in senescent (>75 years of age) subjects. Hashimoto encephalopathy has been described as the cause of several neurological and psychiatric syndromes including dementia. The proposed pathophysiological mechanism is an autoimmune reaction to shared, thyroid gland and CNS epitopes with subsequent cerebral dysfunction. The authors report the first case of a patient who fulfils both, the criteria for AIDS dementia complex and Hashimoto encephalopathy, yet being unresponsive to steroid therapy. Diagnostic and therapeutic implications are discussed.
International Journal of Geriatric Psychiatry, 22(9), September 2007, pp.896-901.
Publisher:
Wiley
...assessment. Significant differences were found between the EO-AD and LO-AD groups in terms of NPI total score (EO-AD: 10.3 ± 10.9, LO-AD: 17.8 ± 17.0, p = 0.004) and number of patients who experienced each NPI subscale score (delusion; EO-AD: 13.0%, LO-AD: 50.6%, p < 0.001). There were no differences in cognitive functions or dementia severity between two groups. In EO-AD, behavioural and psychological
When comparing with early-onset Alzheimer's disease (EO-AD) and late-onset Alzheimer's disease (LO-AD), some symptomatological differences in clinical features can be seen between them. Rapid progression, more severe language problems or visuospatial dysfunction occur more often in EO-AD patients. However, there have been very few reports about the differences in behavioural and psychological symptoms between these two groups. The aim of this study was to demonstrate the differences in behavioural symptoms between EO-AD and LO-AD groups. Three hundred and seven consecutive outpatients with AD were put into an EO-AD group (46 patients) or a LO-AD group (261 patients). Comprehensive assessment batteries, including the Neuropsychiatric Inventory (NPI), were administered at the first medical assessment. Significant differences were found between the EO-AD and LO-AD groups in terms of NPI total score (EO-AD: 10.3 ± 10.9, LO-AD: 17.8 ± 17.0, p = 0.004) and number of patients who experienced each NPI subscale score (delusion; EO-AD: 13.0%, LO-AD: 50.6%, p < 0.001). There were no differences in cognitive functions or dementia severity between two groups. In EO-AD, behavioural and psychological symptoms are relatively fewer than LO-AD at the first medical assessment.
Subject terms:
psychiatry, Alzheimers disease, dementia, diagnosis, early intervention;
International Journal of Geriatric Psychiatry, 22(9), September 2007, pp.843-849.
Publisher:
Wiley
Psychiatric and behavioural symptoms in dementia are associated with a range of negative outcomes, including institutional placement and the widespread use of psychotropic drugs in spite of limited evidence for their efficacy. The aim was to determine the prevalence of psychiatric and behavioural symptoms and the pattern of psychotropic drug prescription in patients with various degrees...
Psychiatric and behavioural symptoms in dementia are associated with a range of negative outcomes, including institutional placement and the widespread use of psychotropic drugs in spite of limited evidence for their efficacy. The aim was to determine the prevalence of psychiatric and behavioural symptoms and the pattern of psychotropic drug prescription in patients with various degrees of dementia. A sample of 1,163 non-selected nursing home patients were assessed by means of the Neuropsychiatric Inventory, the Clinical Dementia Rating scale and Lawton's activities of daily living scale. In addition, information was collected from the patients' records. Dementia was found in 81% of the patients and 72% of them had clinically significant psychiatric and behavioural symptoms. The frequencies of symptoms increased with the severity of the dementia. Psychotropic medication was being prescribed to 75% of patients with dementia. There was a significant relationship between the type of drug and the symptom for which it had been dispensed. Psychiatric and behavioural symptoms are frequent in nursing homes and the rate increases with the progression of the dementia. Systematic programmes are needed for disseminating skills and providing guidance regarding the evaluation and treatment of these symptoms in nursing homes.
Subject terms:
mental health problems, nursing homes, older people, psychiatry, dementia;
International Journal of Geriatric Psychiatry, 21(10), October 2006, pp.972-976.
Publisher:
Wiley
The objective was to estimate the contribution of behavioural and psychological symptoms of dementia (BPSD) to the costs of care. A one-year prospective study of resource utilization recorded monthly by 500 caregivers of community dwelling patients with dementia. The effect of behaviour on total, direct and indirect costs of care was examined. The total cost of care was $1,298 per month...
The objective was to estimate the contribution of behavioural and psychological symptoms of dementia (BPSD) to the costs of care. A one-year prospective study of resource utilization recorded monthly by 500 caregivers of community dwelling patients with dementia. The effect of behaviour on total, direct and indirect costs of care was examined. The total cost of care was $1,298 per month and there was a significant independent relationship between costs and BPSD. The incremental cost of a one point increase in Neuropsychiatric Inventory score was $30 per month (95% CI: $19-$41). BPSD contribute significantly to the overall costs of dementia care. Interventions targeted at BPSD may help to reduce the staggering societal costs of this illness.
Subject terms:
psychiatry, cost effectiveness, dementia, diagnosis, health care;
The report represents a consensus statement from an Expert Working Group of the Faculty of the Psychiatry of Old Age, and has been produced in collaboration with the Alzheimer's Society and with representation from primary care. It describes good practice, with particular attention focused on working with primary care and with carers. In preparing the report, the Working Group has used systematic summaries of published evidence.
The report represents a consensus statement from an Expert Working Group of the Faculty of the Psychiatry of Old Age, and has been produced in collaboration with the Alzheimer's Society and with representation from primary care. It describes good practice, with particular attention focused on working with primary care and with carers. In preparing the report, the Working Group has used systematic summaries of published evidence.
Subject terms:
medical treatment, older people, psychiatry, assessment, dementia;
International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.446-451.
Publisher:
Wiley
A recent randomised controlled trial on Cognitive Stimulation Therapy (CST) identified the need to evaluate its more long-term benefits for people with dementia. This study evaluates the effectiveness of a weekly maintenance CST programme for people with dementia in residential care. Thirty-five people with dementia were included, following on from a seven-week twice-weekly study of CST...
A recent randomised controlled trial on Cognitive Stimulation Therapy (CST) identified the need to evaluate its more long-term benefits for people with dementia. This study evaluates the effectiveness of a weekly maintenance CST programme for people with dementia in residential care. Thirty-five people with dementia were included, following on from a seven-week twice-weekly study of CST. The maintenance CST sessions ran in two residential homes using a once a week programme of CST over an additional 16 weeks. Two control homes did not receive the maintenance intervention. Using repeated measures ANOVAS, there was a continuous, significant improvement in cognitive function (MMSE) for those receiving MCST (CST+maintenance CST sessions) as compared to CST alone or no treatment (p = 0.012). There were no effects on quality of life, behaviour or communication following maintenance sessions. The initial cognitive improvements following CST were only sustained at follow-up when followed by the programme of maintenance CST sessions. The cognitive benefits of CST can be maintained by weekly sessions for around 6 months. A large-scale, multi-centre maintenance CST trial is required to clarify potential longer-term benefits of maintenance CST for dementia.
Subject terms:
older people, psychiatry, quality of life, behaviour therapy, dementia;
International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.471-478.
Publisher:
Wiley
Although depression is known to be frequently associated with dementia, it is nonetheless under-diagnosed and under-treated among this patient population. Its effect on outcome for dementia patients is thought to be substantial, because depression appears to induce higher than normal rates of disability as well as supplementary cognitive decline. The aim of this study was to measure the impact...
Although depression is known to be frequently associated with dementia, it is nonetheless under-diagnosed and under-treated among this patient population. Its effect on outcome for dementia patients is thought to be substantial, because depression appears to induce higher than normal rates of disability as well as supplementary cognitive decline. The aim of this study was to measure the impact of major depression on the institutionalization rate of community-dwelling dementia patients. Three-hundred forty-eight consecutive dementia outpatients of a geriatric clinic (mean age: 81 years, 69.8% women, 65.5% dementia of Alzheimer's type, mean baseline MMSE score: 20.5), followed between 1997 and 2002 (mean follow-up: 20.5 months). Twenty-five percent of the patients met the criteria of major depression at baseline, and only 30.3% of these received antidepressant medication. Major depression at baseline was independently associated with nursing home admission within one year of the baseline assessment. Antidepressant medication tended to protect against this outcome, but not to a statistically significant extent. Major depression at baseline is an independent risk factor for early institutionalization of dementia sufferers. Early institutionalization is defined in this study as nursing home placement within a year of diagnosis with dementia at our specialized outpatient center. The study highlights the need for better management of depression among dementia outpatients. Further investigation is needed to evaluate the protective effect of antidepressant medication (and/or non-pharmacological therapies) on the institutionalization rate.
International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.247-253.
Publisher:
Wiley
The influence of dementia on mortality has not yet been reported for a Latin American country. The aim was to evaluate the influence of dementia on mortality of a community-dwelling elderly population in Brazil, and to verify the extent to which the diagnosis of dementia is reported on death certificates. A cohort of 1,656 individuals, aged 65 and over, was screened for dementia...
The influence of dementia on mortality has not yet been reported for a Latin American country. The aim was to evaluate the influence of dementia on mortality of a community-dwelling elderly population in Brazil, and to verify the extent to which the diagnosis of dementia is reported on death certificates. A cohort of 1,656 individuals, aged 65 and over, was screened for dementia at their domiciles, in 1997. The same population was re-evaluated in 2000, and information on deaths was obtained from relatives and from the municipal obituary service. Kaplan-Meier curves were used for the survival analysis, and the mortality risk ratio (MMR) was calculated using Cox proportional hazards models. We obtained data from 1,393 subjects, corresponding to 84.1% of the target population. The number of deaths was 58 (51.3%) among the patients with dementia and 163 (12.7%) among those without dementia in 1997 (p < 0.0001). Dementia and Alzheimer's disease (AD) decreased survival, with hazards ratios of 5.16 [95% Confidence Interval (CI): 3.74-7.12] for dementia and 4.76 (95% CI: 3.16-7.18) for AD. The Cox proportional hazards model identified dementia (MMR = 3.92, 95% CI: 2.80-5.48) as the most significant predictor of death, followed by age, history of stroke, complaints of visual impairment and heart failure and by severe arterial hypertension in the baseline evaluation. Dementia and/or AD were mentioned in only 12.5% of the death certificates of individuals with dementia. Dementia causes a significant decrease in survival, and the diagnosis of dementia is rarely reported on death certificates in Brazil.
The International Journal of Geriatric Psychiatry provides an international perspective on the of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services. This journal is indexed and abstracted selectively on Social Care Online.
The International Journal of Geriatric Psychiatry provides an international perspective on the of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services. This journal is indexed and abstracted selectively on Social Care Online.
Subject terms:
mental health problems, older people, psychiatry, carers, dementia;