... together these differing perspectives on MCI for the first time. This volume provides a comprehensive resource for clinicians, researchers, and students involved in the study, diagnosis, treatment, and rehabilitation of people with MCI. Clinical investigators initially defined mild cognitive impairment (MCI) as a transitional condition between normal aging and the early stages of Alzheimer’s disease
Mild Cognitive Impairment (MCI) has been identified as an important clinical transition between normal aging and the early stages of Alzheimer's disease (AD). Since treatments for AD are most likely to be most effective early in the course of the disease, MCI has become a topic of great importance and has been investigated in different populations of interest in many countries. This book brings together these differing perspectives on MCI for the first time. This volume provides a comprehensive resource for clinicians, researchers, and students involved in the study, diagnosis, treatment, and rehabilitation of people with MCI. Clinical investigators initially defined mild cognitive impairment (MCI) as a transitional condition between normal aging and the early stages of Alzheimer’s disease (AD). Because the prevalence of AD increases with age and very large numbers of older adults are affected worldwide, these clinicians saw a pressing need to identify AD as early as possible. It is at this very early stage in the disease course that treatments to slow the progress and control symptoms are likely to be most effective. Since the first introduction of MCI, research interest has grown exponentially, and the utility of the concept has been investigated from a variety of perspectives in different populations of interest (e.g., clinical samples, volunteers, population-based screening) in many different countries. Much variability in findings has resulted. Although it has been acknowledged that the differences observed between samples may be ‘legitimate variations’, there has been no attempt to understand what it is we have learned about MCI (i.e., common features and differences) from each of these perspectives.This book brings together information about MCI in different populations from around the world. Mild Cognitive Impairment will be an important resource for any clinician, researcher, or student involved in the study, detection, treatment, and rehabilitation of people with MCI.
Health and Social Care in the Community, 16(6), December 2008, pp.565-572.
Publisher:
Wiley
This paper reports on a qualitative study designed to examine (i) possible explanations for difficulties young Australian women (under 40 years) encountered in the process of gaining a diagnosis of premature menopause and (ii) to address issues underpinning this aspect of menopause. Drawing on hermeneutic phenomenology, face-to-face interviews were carried out with 35 women who consented to share experienced, described feelings, and reasons that led to a diagnosis of menopause. This paper suggests that the age of the women and the non-specific symptoms experienced by them contributed significantly to the delay and uncertainty surrounding the experience of being diagnosed with premature menopause. There was uncertainty of the origin of symptoms, which led the women to feel as though they were 'going
This paper reports on a qualitative study designed to examine (i) possible explanations for difficulties young Australian women (under 40 years) encountered in the process of gaining a diagnosis of premature menopause and (ii) to address issues underpinning this aspect of menopause. Drawing on hermeneutic phenomenology, face-to-face interviews were carried out with 35 women who consented to share their experiences of 'being diagnosed' with premature menopause. The participants responded to an advertisement in a newspaper article, a radio announcement or through a menopause support centre. This research reports that the process of finding an explanation for the physical and emotional symptoms the women were experiencing was very complex. The findings varied regarding the psychological and physical symptoms experienced, described feelings, and reasons that led to a diagnosis of menopause. This paper suggests that the age of the women and the non-specific symptoms experienced by them contributed significantly to the delay and uncertainty surrounding the experience of being diagnosed with premature menopause. There was uncertainty of the origin of symptoms, which led the women to feel as though they were 'going insane' or that it was 'all in their heads'. This frequently led to symptoms of menopause being attributed (by health professionals) to a psychiatric basis and menopause being overlooked for varying lengths of time.
International Journal of Geriatric Psychiatry, 34(2), 2019, pp.249-257.
Publisher:
Wiley
Objectives: The prevalence of generalized anxiety disorder (GAD) is supposed to decrease with age. Reasons suggested include that emotional control increases and that anxiety and worry are expressed differently in older adults. The aim of this study was to examine how the expression of anxiety and worry changes with age and how this influences diagnoses in current classification systems. Method: Semistructured psychiatric examinations were performed in population‐based samples of 70‐ (n = 562), 75‐ (n = 770), 79/80‐ (n = 603), and 85‐year‐olds (n = 433). Individuals with dementia were excluded. GAD was diagnosed according to DSM‐5 (DSM5 GAD) and ICD‐10 (ICD10 GAD) criteria. Individual symptoms were assessed according to severity and frequency. Functioning was measured with Global Assessment of Functioning (GAF). Results: The prevalence of clinical anxiety, autonomic arousal, muscle tension, and irritability decreased with age, while that of worry and fatigue increased. Concentration difficulties and sleep disturbances remained stable. The prevalence of ICD10 GAD tended to decrease, while that of DSM5 GAD did not change with age. Core symptoms and diagnoses of GAD were related to lower GAF scores. However, in those with autonomic arousal and ICD10 GAD, GAF scores increased with age. Conclusions: The prevalence of ICD10 GAD tended to decrease with increasing age while the prevalence of DSM5 GAD remained stable. This difference was partly due to a decreased frequency of severe anxiety and autonomic arousal symptoms, and that worries increased, suggesting changes in the expression of GAD with increasing age.
(Publisher abstract)
Objectives: The prevalence of generalized anxiety disorder (GAD) is supposed to decrease with age. Reasons suggested include that emotional control increases and that anxiety and worry are expressed differently in older adults. The aim of this study was to examine how the expression of anxiety and worry changes with age and how this influences diagnoses in current classification systems. Method: Semistructured psychiatric examinations were performed in population‐based samples of 70‐ (n = 562), 75‐ (n = 770), 79/80‐ (n = 603), and 85‐year‐olds (n = 433). Individuals with dementia were excluded. GAD was diagnosed according to DSM‐5 (DSM5 GAD) and ICD‐10 (ICD10 GAD) criteria. Individual symptoms were assessed according to severity and frequency. Functioning was measured with Global Assessment of Functioning (GAF). Results: The prevalence of clinical anxiety, autonomic arousal, muscle tension, and irritability decreased with age, while that of worry and fatigue increased. Concentration difficulties and sleep disturbances remained stable. The prevalence of ICD10 GAD tended to decrease, while that of DSM5 GAD did not change with age. Core symptoms and diagnoses of GAD were related to lower GAF scores. However, in those with autonomic arousal and ICD10 GAD, GAF scores increased with age. Conclusions: The prevalence of ICD10 GAD tended to decrease with increasing age while the prevalence of DSM5 GAD remained stable. This difference was partly due to a decreased frequency of severe anxiety and autonomic arousal symptoms, and that worries increased, suggesting changes in the expression of GAD with increasing age.
(Publisher abstract)
International Journal of Geriatric Psychiatry, 29(6), 2014, pp.569-576.
Publisher:
Wiley
Background: Dementia with Lewy bodies is one of the most prevalent dementia diagnoses. However, differential diagnosis between dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia can still be very difficult given the overlap in neuropathology, clinical presentation, cognitive, and neuroanatomical changes.
Method: A literature review of dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia was conducted using PubMed.
Results and Implications: Accurate diagnosis of dementia with Lewy bodies is crucial in order to more accurately predict the progression of the disease and negative side effects from pharmacological treatment. The differences and similarities between dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia are highlighted in order to aid clinicians in differential diagnosis.
(Publisher abstract)
Background: Dementia with Lewy bodies is one of the most prevalent dementia diagnoses. However, differential diagnosis between dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia can still be very difficult given the overlap in neuropathology, clinical presentation, cognitive, and neuroanatomical changes.
Method: A literature review of dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia was conducted using PubMed.
Results and Implications: Accurate diagnosis of dementia with Lewy bodies is crucial in order to more accurately predict the progression of the disease and negative side effects from pharmacological treatment. The differences and similarities between dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia are highlighted in order to aid clinicians in differential diagnosis.
(Publisher abstract)
Subject terms:
diagnosis, dementia, ageing, older people, literature reviews;
Aging and Mental Health, 12(6), November 2008, pp.800-806.
Publisher:
Taylor and Francis
Depression in later life has potential grave implications and contributes to heavy emotional, medical, and economic burdens. Therefore, it is not surprising that identifying depression and its symptoms in later life has remained a sustained concern for professionals who treat older patients. Despite this concern, the current diagnostic gold standard may not identify depression symptoms equally well in older and younger adults. The objective of this analysis is to determine whether older and younger adults with equivalent levels of latent depression are equally likely to endorse particular DSM diagnostic symptoms. DSM depression data were analysed using Item Response Theory (IRT)-based differential item functioning analyses. The data came from 1808 older adults (age 65-98 years) and 3,734 younger adults (age 18-34 years) who participated in the National Epidemiological Survey on Alcoholism and Related Conditions in the United States. The analyses confirmed the hypothesis. The DSM items identify depression differently in younger and older adults. Specifically, results showed that older adults were more likely to endorse somatic items and less likely to endorse cognitive and suicide items than their younger counterparts with equivalent levels of depression. Conclusion: These findings provide evidence that the DSM depression items work differently across age groups when controlling for latent depression. It is important to consider, however, that these findings are limited by the sampling methodology and the particular protocol implemented.
Depression in later life has potential grave implications and contributes to heavy emotional, medical, and economic burdens. Therefore, it is not surprising that identifying depression and its symptoms in later life has remained a sustained concern for professionals who treat older patients. Despite this concern, the current diagnostic gold standard may not identify depression symptoms equally well in older and younger adults. The objective of this analysis is to determine whether older and younger adults with equivalent levels of latent depression are equally likely to endorse particular DSM diagnostic symptoms. DSM depression data were analysed using Item Response Theory (IRT)-based differential item functioning analyses. The data came from 1808 older adults (age 65-98 years) and 3,734 younger adults (age 18-34 years) who participated in the National Epidemiological Survey on Alcoholism and Related Conditions in the United States. The analyses confirmed the hypothesis. The DSM items identify depression differently in younger and older adults. Specifically, results showed that older adults were more likely to endorse somatic items and less likely to endorse cognitive and suicide items than their younger counterparts with equivalent levels of depression. Conclusion: These findings provide evidence that the DSM depression items work differently across age groups when controlling for latent depression. It is important to consider, however, that these findings are limited by the sampling methodology and the particular protocol implemented.
Dementia: the International Journal of Social Research and Practice, 15(5), 2016, pp.1246-1259.
Publisher:
Sage
Mild cognitive impairment is a heterogeneous clinical state whereby assessed cognitive changes over time may progress to dementia, remain stable or revert to back to normal. This study aimed to identify, through discourse analysis, how people with a diagnosis of mild cognitive impairment used language in order to reveal the societal views and shared meanings of the diagnosis, and the positions
(Publisher abstract)
Mild cognitive impairment is a heterogeneous clinical state whereby assessed cognitive changes over time may progress to dementia, remain stable or revert to back to normal. This study aimed to identify, through discourse analysis, how people with a diagnosis of mild cognitive impairment used language in order to reveal the societal views and shared meanings of the diagnosis, and the positions taken by people. Seven people with mild cognitive impairment were interviewed, and three discourses emerged during analysis. One of the discourses revealed was ‘Not Knowing’ about mild cognitive impairment. Furthermore, in the absence of a coherent discourse related to mild cognitive impairment, participants went on to position themselves between two more familiar discourse; ‘Knowing’ about ageing and dying and ‘Not Wanting to Know’ about dementia. Clinicians must consider how information is presented to people about mild cognitive impairment, including where mild cognitive impairment is positioned in respect to normal ageing and dementia.
(Publisher abstract)
Subject terms:
ageing, dementia, cognitive impairment, diagnosis, older people, communication, information sharing;
Dementia is the collective name for as set of mood changes, confusion and increasing difficulty with everyday tasks.. This four part series provides an overview of dementia and it's treatment, from its causes a pathophysiology to diagnosis and the nurse's role in its management. This, first article reviews the main forms of dementia and how research is shedding new light on the differences
(Publisher abstract)
Dementia is the collective name for as set of mood changes, confusion and increasing difficulty with everyday tasks.. This four part series provides an overview of dementia and it's treatment, from its causes a pathophysiology to diagnosis and the nurse's role in its management. This, first article reviews the main forms of dementia and how research is shedding new light on the differences between dementia and normal ageing.
(Publisher abstract)
Subject terms:
dementia, ageing, diagnosis, older people, behaviour, cognitive impairment, long term conditions;
International Journal of Geriatric Psychiatry, 31(7), 2016, pp.755-764.
Publisher:
Wiley
Objective: Even though the prevalence of mental disorders and social problems is high among elderly patients, it is difficult to detect these in a primary (home) care setting. Goal was the development and preliminary validation of a short observation list to detect six problem areas: anxiety, depression, cognition, suspicion, loneliness, and somatisation.
Methods: A draft list of indicators identified from a short review of the literature and the opinions of 22 experts was evaluated by general practitioners (GPs) and home care organisations for feasibility. It was then used by GPs and home care personnel to observe patients, who also completed validated tests for psychological disorders (General Health Questionnaire 12 item version (GHQ-12)), depression (Geriatric Depression Scale 15-item version (GDS-15)), anxiety and suspicion (Symptom Checklist-90 (SCL-90)), loneliness (University of California, Los Angeles (UCLA)), somatisation (Illness Attitude Scale (IAS)), and cognition (Mini-Mental State Examination (MMSE)).
Results: GPs and home care personnel observed 180 patients (mean age 78.4 years; 66% female) and evaluated the draft list during a regular visit. Cronbach's α was 0.87 for the draft list and ≥0.80 for the draft problem areas (loneliness and suspicion excepted). Principal component analysis identified six components (cognition, depression + loneliness, somatisation, anxiety + suspicion, depression (other signs), and an ambiguous component). Convergent validity was shown for the indicators list as a whole (using the GHQ-12), and the subscales of depression, anxiety, loneliness, cognition, and somatisation. Using pre-set agreed criteria, the list was reduced to 14 final indicators divided over five problem areas.
Conclusion: The Observation List for mental disorders and social Problems (OLP) proved to be preliminarily valid, reliable, and feasible for use in primary and home care settings.
(Publisher abstract)
Objective: Even though the prevalence of mental disorders and social problems is high among elderly patients, it is difficult to detect these in a primary (home) care setting. Goal was the development and preliminary validation of a short observation list to detect six problem areas: anxiety, depression, cognition, suspicion, loneliness, and somatisation.
Methods: A draft list of indicators identified from a short review of the literature and the opinions of 22 experts was evaluated by general practitioners (GPs) and home care organisations for feasibility. It was then used by GPs and home care personnel to observe patients, who also completed validated tests for psychological disorders (General Health Questionnaire 12 item version (GHQ-12)), depression (Geriatric Depression Scale 15-item version (GDS-15)), anxiety and suspicion (Symptom Checklist-90 (SCL-90)), loneliness (University of California, Los Angeles (UCLA)), somatisation (Illness Attitude Scale (IAS)), and cognition (Mini-Mental State Examination (MMSE)).
Results: GPs and home care personnel observed 180 patients (mean age 78.4 years; 66% female) and evaluated the draft list during a regular visit. Cronbach's α was 0.87 for the draft list and ≥0.80 for the draft problem areas (loneliness and suspicion excepted). Principal component analysis identified six components (cognition, depression + loneliness, somatisation, anxiety + suspicion, depression (other signs), and an ambiguous component). Convergent validity was shown for the indicators list as a whole (using the GHQ-12), and the subscales of depression, anxiety, loneliness, cognition, and somatisation. Using pre-set agreed criteria, the list was reduced to 14 final indicators divided over five problem areas.
Conclusion: The Observation List for mental disorders and social Problems (OLP) proved to be preliminarily valid, reliable, and feasible for use in primary and home care settings.
(Publisher abstract)
Subject terms:
mental health problems, diagnosis, primary care, social problems, older people, ageing, home care;
Dementia: the International Journal of Social Research and Practice, 12(1), 2013, pp.137-151.
Publisher:
Sage
One reason for the rise in the prevalence of Alzheimer's disease (AD) since the 1980s is the “new” association between the disease and aging; although this relationship remains a subject of discussion in medical and scientific spheres. Those who fight the extensive use of AD diagnosis argue that AD could be part of normal aging, or that AD diagnosis is misused for social or commercial reasons, However, those who advocate the recognition of AD as a pathological entity distinct from normal aging seem to be winning the battle. This review is based on 49 articles published in French and in English between 1995 and June 2010. Aging appears to be a concurrent diagnosis for AD, both for the lay public and for health professionals, but this confusion, which can be interpreted as a lack
One reason for the rise in the prevalence of Alzheimer's disease (AD) since the 1980s is the “new” association between the disease and aging; although this relationship remains a subject of discussion in medical and scientific spheres. Those who fight the extensive use of AD diagnosis argue that AD could be part of normal aging, or that AD diagnosis is misused for social or commercial reasons, However, those who advocate the recognition of AD as a pathological entity distinct from normal aging seem to be winning the battle. This review is based on 49 articles published in French and in English between 1995 and June 2010. Aging appears to be a concurrent diagnosis for AD, both for the lay public and for health professionals, but this confusion, which can be interpreted as a lack of medicalisation of memory loss on the conceptual level, does not necessarily constitute an obstacle to medical intervention. It is suggested that the transformation of senile dementia into AD can diminish, as well as reinforce, stigmatisation of people with AD. The authors believe that elderly people with AD are subjected to both the persisting stigmas of aging and of dementia as well as, for most of them, that of feminine cognitive incompetence.
Subject terms:
public opinion, stigma, ageing, Alzheimers disease, attitudes, diagnosis, feminist theory;
HYBELS Celia F., LANDERMAN Lawrence R., BLAZER Dan G.
Journal article citation:
International Journal of Geriatric Psychiatry, 27(6), June 2012, pp.601-611.
Publisher:
Wiley
Symptom expression was compared in middle-aged (below 60) and older (60+) depressed patients to determine whether symptom profiles differed by age. Patients diagnosed with major depression (N=664) were screened using the Center for Epidemiologic Studies Depression scale and sections of the Diagnostic Interview Schedule. They were separated into homogeneous clusters based on symptom endorsement. Older patients were less likely to endorse crying spells, sadness, feeling fearful, being bothered, or feeling life a failure but were more likely to endorse poor appetite and loss of interest in sex. Older patients were also less likely to report enjoying life, feeling as good as others, feeling worthless, wanting to die, and thinking about suicide. Profiles supported heterogeneity in symptom expression. Clusters differed by age when other demographic, clinical, health, and social variables were controlled but did not support age-specific symptom profiles. Overall, older patients had later age of onset, had fewer lifetime spells, were more likely to have received electroconvulsive therapy (ECT), and were less likely to have comorbid anxiety. Older patients also had more cognitive impairment, health conditions, and mobility limitations but had higher levels of subjective social support and had experienced fewer stressful life events. It appears that there are age differences in symptom endorsement; however the data did not support a symptom profile unique to late-life depression.
Symptom expression was compared in middle-aged (below 60) and older (60+) depressed patients to determine whether symptom profiles differed by age. Patients diagnosed with major depression (N=664) were screened using the Center for Epidemiologic Studies Depression scale and sections of the Diagnostic Interview Schedule. They were separated into homogeneous clusters based on symptom endorsement. Older patients were less likely to endorse crying spells, sadness, feeling fearful, being bothered, or feeling life a failure but were more likely to endorse poor appetite and loss of interest in sex. Older patients were also less likely to report enjoying life, feeling as good as others, feeling worthless, wanting to die, and thinking about suicide. Profiles supported heterogeneity in symptom expression. Clusters differed by age when other demographic, clinical, health, and social variables were controlled but did not support age-specific symptom profiles. Overall, older patients had later age of onset, had fewer lifetime spells, were more likely to have received electroconvulsive therapy (ECT), and were less likely to have comorbid anxiety. Older patients also had more cognitive impairment, health conditions, and mobility limitations but had higher levels of subjective social support and had experienced fewer stressful life events. It appears that there are age differences in symptom endorsement; however the data did not support a symptom profile unique to late-life depression.
Subject terms:
mental health problems, older people, adults, ageing, depression, diagnosis, emotions;