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The applicability and the inter-rater reliability of the Comprehensive Psychopathological Rating Scale in an elderly clinical population
- Authors:
- VAN DER LAAN Niels Chr, SCHIMMEL Aletta, HEEREN Thea J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.35-40.
- Publisher:
- Wiley
Psychopathological rating scales are developed and tested on a relatively young population. Their applicability and psychometric performance in the elderly (aged above 60-65 years) are mostly unknown. It is unknown how factors related to ageing or mild cognitive dysfunction influence the applicability and the reliability of these scales. We tested the applicability and the inter-rater reliability of the Dutch version of the Comprehensive Psychopathological Rating Scale (CPRS) on an elderly (age > 60 years) inpatient population. The applicability and reliability (expressed by differently weighted Kappa coefficients) of the CPRS was assessed by investigating 62 consecutively referred patients in a ward for elderly patients with acute psychiatric problems that were primarily functional in nature. The results are compared with those found in a younger population. The applicability and reliability of the CPRS on the elderly can be categorised as sufficient to good and is comparable with results for a younger population. We did not find any specific factors influencing the practicality, or the reliability of the CPRS when applied to an elderly group of people with a mild cognitive dysfunction. The CPRS does not loose its clinical relevance with age, as the applicability and the reliability of the CPRS is not influenced by ageing or mild cognitive dysfunction. The CPRS can detect a broad range of symptoms and due to its psychometric properties it is a useful instrument for measuring an elderly or young population.
EEG and the Test for the Early Detection of Dementia with Discrimination from Depression (TE4D): a validation study
- Authors:
- BIRKMEYERJurgen, GRASS-KAPANKE Brigitte, IHL Ralf
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(8), August 2004, pp.748-753.
- Publisher:
- Wiley
The Test for the Early Detection of Dementia with Discrimination from Depression (TE4D) was developed as a screening instrument for mild dementia. We investigated the convergent validity of the TE4D to EEG and other psychometric tests in patients suffering from dementia and depression. In 47 patients suffering from Alzheimer's disease (ICD-10 F.00) and 16 patients with affective disorders (F30-F39) the tests TE4D, ADAS-cog, SKT, BCRS, MMSE were performed and an EEG recorded. Group differences were compared by t-tests and a regression analysis was calculated. The inter-test-correlations varied between rs = 0.77 and rs = 0.91. Significant differences between the diagnostic groups were found for all tests as well as for the frequency bands and . For the qEEG, significant positive correlations were found between TE4D (Dementia subscore) and the mean frequency (r = 0.47), the peak frequency (r = 0.42), the frequency bands (r = 0.59) and (r = 0.56) as well as negative correlations in the frequency bands (r = -0.23) and (r = -0.42). The mean frequency and the activity in the frequency bands , 2, and contributed to the regression equation. The correlation between regression equation and the TE4D was rs = 0.87. The other tests also correlated with the TE4D: ADAS rs = -0.75, MMST rs = 0.82, SKT rs = -0.74, BCRS rs = -0.83. The TE4D showed convergent validity with the EEG parameters. Both the TE4D-score and the EEG-alterations correlated significantly with the degree of severity of Alzheimer's disease. This result underlines the assumption that the TE4D will be a useful instrument for the diagnostic process in dementia.
Psychosocial correlates of late-onset psychosis: life experiences, cognitive schemas, and attitudes to ageing
- Authors:
- GIBLIN Sharon, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(7), July 2004, pp.611-623.
- Publisher:
- Wiley
Psychosis with first onset after the age of 60, and arising in the absence of dementia or primary affective disorder, is thought to affect 2-4% of older people, and as many as half will not respond fully to medication. This study represents a preliminary attempt to explore a number of possible psychosocial correlates of late-onset psychosis with potential relevance for a cognitive-behavioural formulation and for the development of psychosocial interventions for this group. The nature and extent of adverse early life experiences, presence of maladaptive cognitive schemas, and morale in relation to ageing were compared for older people with a diagnosis of late-onset psychosis (LOP; n = 14) or late-onset depression (DEP; n = 13) and healthy older volunteers (HEV; n = 18) in a cross-sectional design. Both LOP and DEP groups reported significantly higher levels of adverse life experiences than the HEV group, with between-group differences in the types of experiences described. The LOP group scored significantly higher than the HEV group on four out of five schema domains, and significantly higher than the DEP group on two domains, other-directedness and over-vigilance/inhibition. The LOP group had significantly lower overall morale in relation to ageing than the HEV group, reflecting significantly higher levels of lonely-dissatisfaction. Life experiences, cognitive schemas and attitudes to ageing are important psychosocial correlates of LOP. These findings contribute to an understanding of the emotional world of individuals who develop psychosis in later life and may have implications for developing more effective intervention approaches.
Syndromes of behavioural and psychological symptoms in mild Alzheimer's disease
- Authors:
- MORAN Maria, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(4), April 2004, pp.359-364.
- Publisher:
- Wiley
Behavioural and psychological symptoms of dementia (BPSD) are common in Alzheimer's disease (AD), and are associated with significant distress for patient and carer. Certain behavioural and psychological symptoms have been associated with each other, leading to the suggestion that differences in symptom patterns among patients with AD may represent different syndromes within AD. The purpose of this study is to see if patients with AD could be meaningfully classified into syndromes, based on the relationships between their BPSD. The sample was recruited through a memory clinic. Two hundred and forty first visit patients with a diagnosis of very mild to mild AD were included. BPSD were assessed using the BEHAVE-AD. Latent class analysis was used to assess for different classes or groups of patients within the sample, based on their behavioural and psychological symptoms. Three classes were identified; Class 1 with a low prevalence of behavioural and psychological symptoms; Class 2 an anxiety/depressive symptom class and Class 3 an aggressive symptom class. The three classes (or groups) of patients obtained by LCA in this sample may be explained by a latent, as yet, unidentified factor. Further research is required to determine if these classes are stable over time, and to identify possible latent variables.
The Middelheim Frontality Score: a behavioural assessment scale that discriminates frontotemporal dementia from Alzheimer's disease
- Author:
- DE DEYN Peter Paul
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.70-79.
- Publisher:
- Wiley
Despite striking neuropsychological and behavioural differences between Alzheimer's disease (AD) and frontotemporal dementia (FTD), clinical diagnostic criteria failed to discriminate FTD from AD patients. We therefore developed the Middelheim Frontality Score (MFS), a disease-long clinical and behavioural assessment tool that measures frontal lobe features, and set up this prospective study in clinically diagnosed AD and FTD patients to assess discriminatory power and intra- and inter-rater variability. Patients with probable AD (n = 400) and FTD (n = 62) were included. The MFS was obtained by summating the scores obtained in a standardized fashion on ten items yielding a total maximal score of 10. Information was obtained through an interview of the patient and her/his caregiver, clinical files and behavioural observation. Comparing mean total MFS scores, FTD patients (6.3 ± 1.8) had significantly higher scores than AD patients (3.1 ± 1.8) (p < 0.001). Distribution of scores on individual MFS items was significantly different between both disease groups (2 = 76.2; p < 0.001). A moderately positive and highly significant correlation was shown between the total MFS score and diagnosis FTD (r = 0.478; p < 0.0001). Applying a total MFS score of 5 as discriminatory cut-off, a specificity of 89.0% and a sensitivity of 88.7% were achieved. Intra- and inter-rater variability was calculated in a different study population by means of retest correlation, revealing moderate to strong positive correlations of high statistical significance. The MFS is a clinical and behavioural assessment scale that measures frontal lobe features and that was shown to reliably discriminate FTD from AD patients.
Selective memory impairment on an adapted Mini-Mental State Examination increases risk of future dementia
- Authors:
- GLAZARIN J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(12), December 2004, pp.1173-1180.
- Publisher:
- Wiley
The aim was to determine whether selective memory impairment (SMI) on an adapted Mini-Mental State Examination (aMMSE) test increases risk of future dementia in a population-based survey of central Spain. SMI is a strong predictor of dementia in the elderly. However, most approaches have used extensive memory batteries, which are not always suitable for screening purposes. The basal cohort consisted of 2982 poorly educated individuals aged 65 or over. Dementia, stroke and parkinsonism cases were previously excluded. At entry, participants received a structured interview including an aMMSE. Two groups were created according to basal cognitive performance, namely: (1) aMMSE > 23 and no word remembered on the aMMSE delayed-recall task (SMI group); and (2) aMMSE > 23 and at least one word remembered on the delayed-recall task (control group). In a three-year follow-up wave, conversion rate to dementia was calculated and logistic regression was performed. Of a total of 2507 subjects who completed the two evaluations, 280 qualified for SMI at entry. In the SMI group, 25 subjects (8.9%) developed dementia vs 26 subjects (1.2%) in the control group. Taking the two groups together, and once demographic and medical variables had been controlled, a low delayed-recall score increased dementia conversion rate (OR 0.47, 95% CI 0.34-0.64). Alzheimer's disease was the main cause of dementia (79.8%). Memory impairment is a risk factor for future dementia in the neurologically-healthy elderly. This can be observed in a subgroup of subjects with SMI defined on the aMMSE delayed-recall subscore. Some other measurements should be added to the SMI construct to improve its predictive validity.
Adaptation of the ACE for a Malayalam speaking population in southern India
- Authors:
- MATHURNANTH P. S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(12), December 2004, pp.1188-1194.
- Publisher:
- Wiley
The aim was to adapt the Addenbrooke's Cognitive Examination (ACE) as a dementia-screening tool in a community in south India, and to establish that items in the adapted version are equivalent to that in the original. The ACE was adapted into the local language, Malayalam (m-ACE), following cultural/linguistic modifications. To establish equivalence, qualitative comparisons were made (on the distribution of scores, percentage scoring at ceiling, and relative difficulty across items) between a UK sample receiving the ACE (n = 50; mean age = 67.9 ± 7.4; education 9, mean = 10.9 ± 2.5) and a community-based educationally-stratified Indian sample receiving the m-ACE: India 9 (n = 50; mean age = 67.8 ± 5.2; education 9, mean = 13.9 ± 2.7) and India 8 (n = 50; mean age = 67.1 ± 5.3; education 8, mean = 3.1 ± 2.0). Most ACE items were retained. The score distribution (mean ± 1SD), percentage at ceiling, and relative difficulties across items is comparable between the UK and the educationally equivalent India 9 groups. Language, Naming, Attention and Orientation are relatively easy ( 80% at ceiling) and Recall and Verbal fluency are relatively difficult ( 22% at ceiling). Although the percentage at ceiling were lower for the India 8 group, the order of relative difficulty was similar and the percentage scoring at floor was 10% on all except visuospatial item. The m-ACE provides a culture-fair Malayalam adaptation of the ACE with component items of equivalent difficulty.
Measuring disability in patients with neurodegenerative disease using the Yesterday Interview
- Authors:
- LOMAX Claire L., BROWN Richard G., HOWARD Robet J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1058-1064.
- Publisher:
- Wiley
The aim was to illustrate the use of time-budget methodology as a means of measuring disability within the framework of the World Health Organisation (WHO) International Classification of Functioning, Disability and Health (ICF) in a mixed group of patients with neurodegenerative disease. A semi-structured interview method (the Yesterday Interview) was used to reconstruct the preceding 24-hour period in terms of activity, social and environmental context, and subjective enjoyment. Data were collected on 40 elderly control subjects and a sample of 99 community based patients diagnosed with either Parkinson's disease without or with dementia, Alzheimer's disease, Dementia with Lewy bodies, Progressive Supranuclear Palsy or Multiple System Atrophy. All participants were seen in their own home. The results were translated hierarchically into the ICF framework of disability domains, and further into a higher level formulation based on the constructs of discretionary/obligatory activity. Disability profiles were obtained for the patient group as a whole and for the individual disorders. Restricted patterns of time-use were noted across a range of domains encompassing both obligatory and discretionary activity, and accompanied by a significant increase in passive activity such as day-time sleeping or sitting in front of the television. The data also illustrated the restrictions in both the social and environmental contexts of the patient's lives, and the diminished levels of subjective enjoyment associated with their pattern of daily time-use. With the exception of time spent on discretionary activities, these various indices were significantly associated with standard clinical measures disability. With further studies to assess reliability and validity, time-use and contextual data obtained from structured interviews may provide a useful means of measuring disability within the ICF framework in patients with degenerative neurological disease.
Conversion pseudodementia in older people: a descriptive case series
- Author:
- HEPPLE J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(10), October 2004, pp.961-967.
- Publisher:
- Wiley
This paper reports a case series of ten patients collected over a 12-year period of clinical work in old age psychiatry in the UK by the author. The core features of the syndrome are: apparent cognitive impairment, regression and increasing physical dependency beginning in late middle or early old age, without evidence for an organic dementia from investigations or from taking into account the course of the illness. The syndrome is more common in women from a higher socio-economic background with past psychiatric histories dominated by depressive symptoms. The syndrome usually progresses to the point where long term institutional care is needed although the mean survival from onset is 13 years. The author suggests that conversion pseudodementia in older people is caused by a catastrophic reaction to cumulative loss in later life in individuals who have predisposing borderline and narcissistic personality traits. Treatment using psychotherapeutic approaches may limit the progression of the syndrome if it is recognised at an early stage
Scoring clock tests for dementia screening: a comparison of two scoring methods
- Authors:
- VAN DER BURG Marjoke, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(7), July 2004, pp.685-689.
- Publisher:
- Wiley
A sample of 1199 elderly subjects was administered the clock drawing test as part of a study on aging and dementia. The clock drawings were scored using published criteria for the two scoring systems that were compared. Additionally, a selection of 103 drawings was scored by three different raters to evaluate inter-rater agreement within each of the two methods. For a selection of 473 drawings the final diagnosis on the presence or absence of dementia was known. For these drawings accuracy for the detection of dementia was compared between the two methods. The four-item scoring system (Kappa 0.76; sensitivity 0.97; specificity 0.32; PPV 0.53; NPV 0.93) was found to be a little more reliable and as accurate as the six-item scoring system (Kappa 0.67; sensitivity 0.96; specificity 0.42; PPV 0.56; NPV 0.94). Since both scoring systems showed largely similar results, primary care physicians and other health care providers should be encouraged to use the four-item scoring checklist as it is easier and requires less time than the more elaborate checklist of the six-item system.