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Differentiation of semantic dementia and Alzheimer's disease using the Addenbrooke's Cognitive Examination (ACE)
- Authors:
- DAVIES R. Rhys, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(4), April 2008, pp.370-375.
- Publisher:
- Wiley
The Addenbrooke's Cognitive Examination (ACE) is a simple diagnostic tool bridging the gap between the very brief Mini Mental State Exam (MMSE) and much longer test batteries used by neuropsychologists which has proven extremely popular internationally. This study aimed to assess the ability of the ACE to differentiate semantic dementia (SD) from Alzheimer's disease (AD). The ACE was administered to three groups: SD patients (n = 40) and two separate groups of AD patients (n = 40 in each), matched for overall ACE or MMSE score. Significant differences were found between SD and both AD groups for the ACE sub-scores of naming, reading and orientation in time. Discriminant analysis (SD versus AD) led to the formulation of a semantic index (naming plus reading minus scores for serial-7s, orientation in time and drawing). Application of the semantic index to the patient data found values of less than zero to be predictive of SD rather than AD with 88% sensitivity and 90% specificity. Validation analysis in an independent sample of 24 SD and AD patients proved even more favourable. The overall ACE score is known to be a sensitive, and specific, indicator of early neurodegenerative dementia; this study shows that the ACE can also be used to detect SD through application of the semantic index.
Development of a Korean version of the behavior rating scale for dementia (BRSD-K)
- Authors:
- YOUN Jong Chui, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(7), July 2008, pp.677-684.
- Publisher:
- Wiley
The purpose of this study was to develop a Korean version of the behaviour rating scale for dementia (BRSD-K) for evaluating behavioural and psychological symptoms of dementia. The BRSD-K was administered to the informants of 268 subjects with dementia. Internal, inter-rater and test-retest reliabilities were tested. To evaluate construct validity, exploratory factor analysis was performed. To evaluate concurrent validity, Pearson correlation coefficients between BRSD-K scores and the corresponding scores of the Korean version of the neuropsychiatric inventory (NPI-K) were calculated. BRSD-K demonstrated substantially high levels of reliabilities. Factor analysis identified seven factors: depressive symptoms, irritability/aggression, psychotic symptoms, behavioural dysregulations, sleep disturbance, inertia and appetite. Correlations between BRSD-K and corresponding NPI-K scores were statistically significant. BRSD-K was found to be a reliable and valid instrument for evaluating behavioural and psychological symptoms of dementia.
Reliability and validity of a short form of the Severe Impairment Battery in Korean Alzheimer's disease patients
- Authors:
- AHN Inn-Sook, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(7), July 2007, pp.682-687.
- Publisher:
- Wiley
The objective of this study was to evaluate the reliability and validity of a short form of the Severe Impairment Battery (SIB) for a Korean population. Eighty-four Alzheimer's disease patients with Clinical Dementia Rating (CDR) stages 2 (n = 32) or 3 (n = 52) and scores of less than 15 on the Korean version-Mini Mental State Examination (K-MMSE) participated in this study. Seventeen of the patients were men and 67 were women, and the mean age was 75 (SD = 10.4). Cronbach's coefficient alpha of the shortened SIB (SIB-S) was 0.93, and the item-total correlation was significant. Test-retest correlation for the total SIB-S score and subscale scores was significant, with the exception of the orienting to name subscale. Construct validity was confirmed by evaluating the correlation between the SIB-S and the SIB, K-MMSE, CDR, and S-ADL; Spearman correlation coefficients were 0.96, 0.88, -0.67, and -0.63, respectively, which were found to be significant. The difference in the total SIB-S score and its subscale scores between the CDR 2 and CDR 3 groups was significant, except for the orienting to name subscale. More severely demented patients also showed a wide range of the SIB-S score. Finally, the diagnostic accuracy of the SIB-S was high in the differentiation of the CDR 2 and 3 patients. The sensitivity and specificity of the SIB-S were 91% and 80%, respectively, when the cut-off score was 32.5. The results indicate that the SIB-S is a reliable and valid instrument for evaluating patients with severe dementia in the Korean population.
Changes in the expression of worries, anxiety, and generalized anxiety disorder with increasing age: a population study of 70 to 85‐year‐olds
- Authors:
- NILSSON Johanna E., et al
- Journal article citation:
- 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)
Preliminary validation of an online DSM-based mental health referral inventory
- Authors:
- EPSTEIN Robert, MUZZATTI Laura
- Journal article citation:
- Journal of Technology in Human Services, 29(4), October 2011, pp.284-295.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The authors report the preliminary evaluation of a brief online inventory, the Epstein Mental Health Inventory (EMHI), designed to identify people with possible mental health problems needing referral to qualified professionals for further evaluation of symptoms that might be diagnosable under DSM guidelines. It is not designed to diagnose. The authors believe that this is a much needed corrective for the “hundreds of unscientific tests that are used now by millions of people to self-diagnose mental health problems”. The inventory was found to be a valid and reliable measuring instrument based on analysis of data obtained from 3,403 subjects (90% from the USA and Canada, mean age 34.2 years, 61% female). The 54-item checklist looks for 18 common problems identified in the DSM-IV and takes from 5 to 10 minutes to complete. Test scores proved to be good predictors of a variety of self-reported criterion measures, including happiness, personal and professional success, history of hospitalisation, history of therapy, current participation in therapy, employment, and level of education. Females were found to have slightly more mental health problems than males, but no differences in scores were found by race or ethnicity.
Potentially harmful practices: using the DSM with people of color
- Authors:
- BARRERA Irán, JORDAN Catheleen
- Journal article citation:
- Social Work in Mental Health, 9(1-6), 2011, pp.272-286.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The Diagnostic Statistical Manual of Mental Disorders (DSM) was designed to classify mental disorders and not necessarily to understand them. The manual is especially bereft in its ability to understand the impact of cultural influences on mental disorders. The aim of this article is to create practitioner awareness of the potential for harm when using the DSM as the only tool when diagnosing minority clients with a mental illness. Issues addressed include diagnosing, accuracy, cultural information, revision process, clinical judgment, training, and empirical evidence. A brief discussion of what social workers can do to enhance diagnosing is given, as well as looking at the DSM-5. Finally, a brief summary and recommendations for practitioners, schools of social work, and researchers are provided.
Depression symptom ratings in geriatric patients with bipolar mania
- Authors:
- SAJATOVIC Martha, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(11), November 2011, pp.1201-1208.
- Publisher:
- Wiley
There appears to be a paucity of information about standardised ratings of depressive symptoms in geriatric bipolar mania. Baseline data was obtained from the first 100 patients enrolled in a 9-week, randomised, double-blind RCT comparing treatment with lithium or valproate in patients aged 60 years and older with Type I bipolar mania or hypomania. Six academic medical centres in the US enrolled inpatients and outpatients with a total Young Mania Rating Scale (YMRS) score of 18 or greater. Depressive symptoms were evaluated with the Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS). The criterion for at least moderate bipolar depressive symptoms was the European College of Neuropsychopharmacology (ECNP) Consensus Meeting definition of HAM-D 17 total score more than 20. Eleven percent of patients had mixed symptoms defined by depression scale severity according to ECNP criteria. Overall, total scores on the two depression scales were highly correlated. Total YMRS scores of this mixed symptom group were similar to the remainder of the sample. The authors conclude that moderate to severe depressive symptoms occur in about one in ten bipolar manic elders. They recommend further studies to more fully evaluate symptom profiles, clinical correlates, and treatments for bipolar older adults with combined manic and depressive symptoms.
Assessments for attention-deficit hyperactivity disorder: use of objective measurements
- Authors:
- VOGT Carsten, SHAMELI Amirreza
- Journal article citation:
- Psychiatrist (The), 35(10), October 2011, pp.380-383.
- Publisher:
- Royal College of Psychiatrists
... differentiating between ADHD and other conditions where symptoms overlap with ADHD. Objective measurements reduce the risk of unidentified ADHD as measured by subsequent rates of revised diagnosis over a 12-month period. It is concluded that introducing objective measurements into the clinical assessment of ADHD provides an increased robustness of the clinical diagnosis strengthening clinical decisions
Test Your Memory test: diagnostic utility in a memory clinic population
- Authors:
- HANCOCK P., LARNER A. J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(9), September 2011, pp.976-980.
- Publisher:
- Wiley
... referred to 2 memory clinics in England over a 23 month period. The article describes the methodology, analysis and results. The test proved easy to use and acceptable to patients, being completed in about 5 to 10 minutes with little supervision required. The authors report that it was found useful in the differential diagnosis of dementia from non-dementia cases. They conclude that the Test Your Memory (Edited publisher abstract)
The utility of PAINAD in assessing pain in a UK population with severe dementia
- Authors:
- JORDAN Alice, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(2), February 2011, pp.118-126.
- Publisher:
- Wiley
Identifying pain in those with severe dementia is challenging and as a result it tends to be under-recognised and under-treated in these patients. This study investigated the effectiveness of a pain assessment tool (PAINAD) for identifying and managing pain in dementia patients. The tool comprises five items: breathing, negative vocalisation, facial expression, body language and consolability. Seventy-nine residents with advanced dementia living at a nursing home in the North of England took part. A total of 39 patients scored above the cutofff (two) on PAINAD. A management plan was designed for those thought to be in pain. Those considered not to be in pain, formed the false positive group. Both groups were reassessed at 1 and 3 months. Of the 39, only 13 were assessed as being in pain. For the 26 thought not to be in pain, their behaviour had a psychosocial explanation, often to do with a lack of understanding of what was happening to them. The sensitivity of PAINAD was 92%. A significant decrease was demonstrated in the PAINAD scores of those who received a pain intervention. It is concluded that PAINAD is a sensitive tool for detecting pain in people with advanced dementia and can be used to assess pain management strategies. However the false positive rate is high, often detecting psychosocial distress rather than pain.