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Underdiagnosis of dementia in primary care: variations in the observed prevalence and comparisons to the expected prevalence
- Authors:
- CONNOLLY Amanda, et al
- Journal article citation:
- Aging and Mental Health, 15(8), November 2011, pp.978-984.
- Publisher:
- Taylor and Francis
Diagnosis of dementia is an important step for access to care, but many patients remain undiagnosed. This study explored the difference between observed and estimated prevalence of dementia in general practices in England. Six Primary Care Trusts (PCTs) provided data on all 351 general practices in their area in terms of number of doctors, patient list size, number of patients over 65, socio-economic status of practices and number of patients on dementia registers. The prevalence of dementia amongst patients over 65 years was 3.0%, 54.5% lower than the prevalence observed in studies in the UK. For an average size general practice, with 5269 patients, approximately 27 patients with dementia may remain undiagnosed. The observed prevalence of dementia was significantly lower among practices run by one GP compared to multiple GPs, and in more affluent areas. Just under a half of the expected numbers of patients with dementia were recognised in GP dementia registers. The under-diagnosis of dementia varies with practice characteristics, socio-economic deprivation and between PCTs.
Personality changes in Alzheimer's disease: a systematic review
- Authors:
- WAHLIN Tarja-Brita Robins, BYRNE Gerald J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(10), October 2011, pp.1019-1029.
- Publisher:
- Wiley
People with Alzheimer's disease (AD) commonly exhibit changes in personality that sometimes precedes other early clinical manifestations such as cognitive impairment and mood changes. Early identification of personality change might therefore assist with diagnosis of AD. The objective of this paper is to provide a systematic review of the literature to examine the nature and extent of change in personality in people with AD. Systematic searches of 5 databases to November 2009 were undertaken to identify studies of informant-rated personality traits in AD patients. Nine studies that mapped changes in traits from the 5-factor model of personality (neuroticism, extraversion, openness, agreeableness and conscientiousness) were selected for analysis. The change in each of these 5 traits was calculated as the mean difference in score before and after the diagnosis of AD. The findings showed a mean increase in neuroticism of 10–20 T scores, a decrease of the same magnitude in extraversion, consistently reduced openness and agreeableness, and a marked decrease in conscientiousness of about 20–30 T scores. These changes were systematic and consistent. The article concludes that conscientiousness and neuroticism are the personality traits that exhibit the most change in dementia, and that these traits might therefore be useful early markers of dementia.
World Alzheimer report 2011: the benefits of early diagnosis and intervention: executive summary
- Authors:
- PRINCE Martin, BRYCE Renata, FERRI Cleusa
- Publisher:
- Alzheimer's Disease International
- Publication year:
- 2011
- Pagination:
- 32p.
- Place of publication:
- London
This report shows that there are interventions that are effective in the early stages of dementia, some of which may be more effective when started earlier, and that there is a strong economic argument in favour of earlier diagnosis and timely intervention. Based on a quantitative research review, key finding suggest that dementia diagnosis provides access to a pathway of evidence-based treatment, care and support across the disease course. The impact of a dementia diagnosis depends greatly upon how it is made and imparted. Earlier diagnosis allows people with dementia to plan ahead while they still have the capacity to make important decisions about their future care. In addition, they and their families can receive timely practical information, advice and support. Only through receiving a diagnosis can they get access to available drug and non-drug therapies that may improve their cognition and enhance their quality of life. And, they can, if they choose, participate in research for the benefit of future generations. Finally, Available evidence suggests that governments should ‘spend to save’ – in other words, invest now to save in the future. Economic models suggest that the costs associated with an earlier dementia diagnosis are more than offset by the cost savings from the benefits of anti-dementia drugs and caregiver interventions.
World Alzheimer report 2011: the benefits of early diagnosis and intervention
- Authors:
- PRINCE Martin, BRYCE Renata, FERRI Cleusa
- Publisher:
- Alzheimer's Disease International
- Publication year:
- 2011
- Pagination:
- 68p.
- Place of publication:
- London
This report shows that there are interventions that are effective in the early stages of dementia, some of which may be more effective when started earlier, and that there is a strong economic argument in favour of earlier diagnosis and timely intervention. Based on a quantitative research review, key finding suggest that dementia diagnosis provides access to a pathway of evidence-based treatment, care and support across the disease course. The impact of a dementia diagnosis depends greatly upon how it is made and imparted. Earlier diagnosis allows people with dementia to plan ahead while they still have the capacity to make important decisions about their future care. In addition, they and their families can receive timely practical information, advice and support. Only through receiving a diagnosis can they get access to available drug and non-drug therapies that may improve their cognition and enhance their quality of life. And, they can, if they choose, participate in research for the benefit of future generations. Finally, Available evidence suggests that governments should ‘spend to save’ – in other words, invest now to save in the future. Economic models suggest that the costs associated with an earlier dementia diagnosis are more than offset by the cost savings from the benefits of anti-dementia drugs and caregiver interventions.
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.
Depression in older adults
- Authors:
- RODDA Joanne, WALKER Zuzana, CARTER Janet
- Journal article citation:
- British Journal of General Practice, 1.10.11, 2011, pp.683-687.
- Publisher:
- Royal College of General Practitioners
This clinical review draws on recent systematic reviews, meta-analyses, and randomised controlled trials to provide an overview of current approaches to the diagnosis and management of patients who develop late life depression. It covers older people at risk, the diagnosis of depression in older adults, how late life depression is managed, and drug and psychological therapies.
The transition from cognitive impairment to dementia: older people's experiences
- Authors:
- MANTHORPE Jill, et al
- Publisher:
- National Institute for Health Research
- Publication year:
- 2011
- Pagination:
- 119p.
- Place of publication:
- London
The aim of this study was to understand the experiences, expectations and service needs of the person who is becoming the person with dementia, from the perspectives of the older person and their supporter or carer. Separate interviews were carried out with 27 people with memory problems as well as 26 key supporters and carers, regarding their perceptions of expectations, experiences and perceptions of the process of assessment and diagnosis. The interviews were transcribed and analysed to generate themes and codes. Few of the participants experienced the system of memory assessment as patient-centred. Instead, they felt that they were kept waiting for long periods of time without knowing what was going on, and sometimes experienced tests and assessments as distressing in settings that could be alarming. Five transitions in the experience of the participants were identified: ‘internalising dialogue’; ‘confirming positions’; ‘seeking expert advice’; ‘being tested’; and ‘seeking understanding’. The findings suggest that transition is not a linear process. Professionals would be better able to provide tailored support to individuals and their carers at this uncertain time if they are informed of the ‘journey’ from the insights of those who have undertaken it. Recommendations are providing relating to: national issues; issues for commissioners and practitioners; and research questions.
Case report: an unusual case of post-stroke psychosis in a 71-year-old lady with a learning disability
- Authors:
- LEEDS Lesley, SRINIVASAN Janaki
- Journal article citation:
- British Journal of Learning Disabilities, 39(4), December 2011, pp.292-294.
- Publisher:
- Wiley
Stroke is a major health concern, and can lead to psychiatric problems, and people with a learning disability are just as likely as people in the general population to be at risk of cerebrovascular disease, due to the presence of undetected or undertreated vascular risk factors. However, it is often difficult to tell whether someone with a learning disability has had a stroke, especially if they seem well. When people with a learning disability are presenting with additional cognitive impairment, it is important to consider a range of conditions that may account for this. Stroke is a major cause of cognitive impairment in older people, affecting at least one-third of stroke survivors. However, post-stroke psychosis is rare following stroke, and, as can be seen from the case of ‘May’, a 71 year-old lady with a learning disability, individuals can make a good recovery with appropriate assessment and intervention. The article concludes that it is important that a diagnosis of dementia is given only after all other potentially treatable conditions have been excluded, and there is deterioration in condition that defies other explanations.
Depression in Alzheimer's disease: specificity of depressive symptoms using three different clinical criteria
- Authors:
- ENGEDAL Knut, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(9), September 2011, pp.944-951.
- Publisher:
- Wiley
It is not clear whether symptoms of depression in Alzheimer's disease patients differ from those seen in other elderly depressed patients. This study aimed to examine the usefulness of the specific criteria for depression in Alzheimer's disease which have been developed, the Provisional Diagnostic Criteria for Depression in Alzheimer's Disease (PDC-dAD), compared to other existing depression criteria. The study used 112 patients with Alzheimer's disease recruited from 2 hospitals of geriatric psychiatry in Norway. The patients were interviewed by a psychiatrist who diagnosed depression according to a range of scales, and were assessed by trained nurses who also interviewed their caregivers. The researchers found that the most prominent and significant symptoms of depression in patients with Alzheimer's disease are the same symptoms that are considered the core symptoms of depression in older people who do not suffer from dementia. They report that using the PDC-dAD, more patients received a diagnosis of depression than when using other existing depression criteria, and discuss the results and their implications.
The needs of people with learning disabilities who develop dementia: a literature review
- Author:
- LLEWELLYN Penny
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 10(2), May 2011, pp.235-247.
- Publisher:
- Sage
The longevity of people with learning disabilities is rising, and they are increasingly developing age related conditions including dementia. When this occurs, their medical and social needs pose many challenges for services. A literature review was undertaken of articles published between 1996 and 2006. Data were collected relating to the needs of people with learning disabilities and dementia, their carers and their peers. Findings revealed that the primary medical need was for timely and accurate diagnosis. There were a multitude of diagnostic tools, and advice was available as to which are most suitable for different client groups. The needs of carers are intertwined with those of people with learning disabilities and dementia and meeting their needs for education, training and increased staff numbers, has proved beneficial. Although multiple services were responsible for the needs of this client group, there was an agreement that learning disability services should be central to social care service provision.