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Prevalence of major and minor depression in elderly persons with mild cognitive impairment - MADRS factor analysis
- Authors:
- GABRYELEWICZ T., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(12), December 2004, pp.1168-1172.
- Publisher:
- Wiley
The aim of the study was to detect the prevalence of depressive syndromes and symptoms in the sample of elderly persons with Mild Cognitive Impairment (MCI), and to analyse Montgomery-Asberg Depression Rating (MADRS) item scores. The subjects of the study were 102 consecutive out-patients with MCI. All subjects were assessed by an experienced psychiatrist and MADRS was applied. Major and minor depressive episodes were defined according to DSM-IV criteria. Factor analysis was used to analyse baseline MADRS item scores. Three patient groups emerged according to the depressive symptoms distribution and severity scores basis: those with major depression constituted 19.6% (n = 20), with minor depression 26.5% (n = 27), and with very few depressive symptoms 53.9% (n = 55). Three interpretable MADRS factors were identified, using the factor analysis with Varimax rotation: the first consisting of apparent and reported sadness, inability to feel, pessimistic thoughts, the second consisting of inner tension, reduced sleep, reduced appetite, suicidal thoughts, and the third with concentration difficulties and lassitude. It was concluded that both major and minor depression is common in MCI. Three MADRS factors were identified and labelled as anhedonia-pessimism, anxiety-vegetative, and cognitive-inhibition.
Telephone word-list recall tested in the rural aging and memory study: two parallel versions for the TICS-M
- Authors:
- HOGERVORST Eva, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(9), September 2004, pp.875-880.
- Publisher:
- Wiley
Parallel versions of memory tasks are useful in clinical and research settings to reduce practice effects engendered by multiple administrations. We aimed to investigate the usefulness of three parallel versions of ten-item word list recall tasks administered by telephone. A population based telephone survey of middle-aged and elderly residents of Bradley County, Arkansas was carried out as part of the Rural Aging and Memory Study (RAMS). Participants in the study were 1845 persons aged 40 to 95 years. Word lists included that used in the telephone interview of cognitive status (TICS) as a criterion standard and two newly developed lists. The mean age of participants was 61.05 (SD 12.44) years; 39.5% were over age 65. 78% of the participants had completed high school, 66% were women and 21% were African-American. There was no difference in demographic characteristics between groups receiving different word list versions, and performances on the three versions were equivalent for both immediate (mean 4.22, SD 1.53) and delayed (mean 2.35 SD 1.75) recall trials. The total memory score (immediate+delayed recall) was negatively associated with older age (beta = -0.41, 95%CI=-0.11 to -0.04), lower education (beta = 0.24, 95%CI = 0.36 to 0.51), male gender (beta = -0.18, 95%CI = -1.39 to -0.90) and African-American race (beta = -0.15, 95%CI = -1.41 to -0.82). The two RAMS word recall lists and the TICS word recall list can be used interchangeably in telephone assessment of memory of middle-aged and elderly persons. This finding is important for future studies where parallel versions of a word-list memory task are needed. (250 words).
A longitudinal study of Alzheimer's disease: rates of cognitive and functional decline
- Authors:
- SUH Guk-Hee, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(9), September 2004, pp.817-824.
- Publisher:
- Wiley
The aim was to measure rates of decline in cognition and function in patients with Alzheimer's disease (AD) and to investigate their accelerating risk factors in Korea. This study presents longitudinal data on a community-based sample of 107 patients with AD, followed at 6 months and 12 months. The cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Mini Mental State Examination (MMSE) and the Disability Assessment for Dementia Scale (DAD) were given. Mixed model analyses were conducted using the following independent variables: times of repeated assessment (0, 6 or 12 months), severity of dementia assessed by the Functional Assessment Staging (FAST) and individual indicators as covariates. Average annual rates of decline in the MMSE, the ADAS-cog and the DAD were 2.3, 11.4 and 15.1 points, respectively. Neither gender, duration of formal education, nor duration of AD since onset was significant predictors of cognitive and functional decline. Patterns of functional decline in total DAD, instrumental ADLs, planning and organization and performance subscale are linear as MMSE score declines, while those of the basic ADLs and the initiation are curvilinear. This naturalistic observational study measured rates of cognitive and functional decline in AD, and can provide reference data for further longitudinal studies or clinical trials. Further study will be necessary to determine whether linear or curvilinear pattern in functional decline is due to progression of AD itself or statistical artifact.
The utility of the Visual Analogue Scale for the assessment of depressive mood in cognitively impaired patients
- Authors:
- KERTZMAN Semion, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(8), August 2004, pp.789-796.
- Publisher:
- Wiley
Early detection of depression in elderly demented patients may assist in adequate treatment. The aim of this study was to evaluate the utility of Visual Analogue Scale for depression among demented and mild cognitively impaired elderly patients. 157 Patients, aged from 65 to 92 years, in a memory clinic were divided into two groups according to scores on the Mini Mental State Examination (MMSE): Demented group (62 patients) with MMSE scores from 16 to 23, and Mild Cognitively Impaired group (MCI-95 patients) with MMSE scores from 24 to 29. Subjects were diagnosed for depression according to DSM-IV criteria, using Hamilton Depression Rating Scale (HDRS) and a comprehensive clinical evaluation. All were administered a Visual Analogue Scale (VAS) for depression. In the demented group, 25 subjects were diagnosed as depressive. In the MCI group, 46 subjects were diagnosed as depressive. Mean VAS scores for the demented and MCI groups were similar, both for depressive and non-depressive patients. Correlations between VAS scores with HDRS scores and with the clinical diagnosis were high, although somewhat lower for the demented group. Analyzing data with ROC curve technique yielded significantly different ROC curves. Optimal cutoff point for the demented group was VAS value of 60, and 50 for the MCI group. VAS seems to be a useful tool for evaluation of depression among cognitively impaired patients. Severity of cognitive decline in the elderly may influence the cutoff points on VAS for detecting depression. Further large-scale studies are needed to substantiate our observation.
Smell identification test as an indicator for cognitive impairment in Alzheimer's disease
- Authors:
- SUZYKI Y., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(8), August 2004, pp.727-733.
- Publisher:
- Wiley
The aim of the present study was to assess olfactory dysfunction in patients with Alzheimer's disease (AD) and to compare utility of the olfactory tests as possible clinical markers. Two olfactory identification tests (The Cross-Cultural Smell Identification Test [CC-SIT] and the Picture-based Smell Identification Test [P-SIT]) and the Mini Mental State Examination (MMSE) were administered to patients with AD and age-matched controls. Apolipoprotein E (Apo E) genotypes of patients with AD were identified. Patients with AD had significantly lower olfactory identification scores than age-matched non-demented elderly subjects in both olfactory assessments. In the AD group, the coefficient of correlation between the MMSE scores and the P-SIT scores was higher than that between the MMSE scores and the CC-SIT scores. Receiver operating curve (ROC) analyses for both tests indicated that the P-SIT discriminated AD patients from controls more reliably than did the CC-SIT. Within AD patients, those who were carrying one or two ApoE 4 alleles had a higher coefficient of correlation between the MMSE scores and the P-SIT scores than patients without the ApoE 4 allele. The results suggest that a short and simple non-lexical olfactory identification test can be useful as a clinical marker of AD appropriate for Japanese elderly 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.
A failure of Pop-Out in visual search tasks in dementia with Lewy Bodies as compared to Alzheimer's and Parkinson's disease
- Authors:
- CORMACK Francesca, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(8), August 2004, pp.763-772.
- Publisher:
- Wiley
The pattern of neural damage in dementia with Lewy Bodies (DLB) led us to hypothesize that patients with DLB would be particularly impaired on parallel (pop-out) search tasks, relative to serial search tasks, and that this would serve to distinguish DLB from other forms of neurodegenerative disease, particularly Alzheimer's disease (AD). To explore this possibility the authors tested four groups of observers (DLB, Alzheimer's Disease, Parkinson's Disease and age-matched controls) on parallel and serial search tasks, and a choice reaction time task. The DLB participants performed in a quantitatively and qualitatively different manner to the other groups. As predicted, they were particularly impaired on the parallel search task relative to the other observer groups. This pattern of deficit may reflect damage in the occipital areas leading to deficits in figure-ground segregation, and can assist differential diagnosis of DLB from other patients groups such as AD.
A 10-item Rasch modeled memory self-efficacy scale
- Authors:
- ZELINSKI E. M., GILEWSKI M. J.
- Journal article citation:
- Aging and Mental Health, 9(4), July 2004, pp.293-306.
- Publisher:
- Taylor and Francis
A 10-item scale to measure memory self-efficacy was developed from responses to the 33-item Frequency of Forgetting scale of the Memory Functioning Questionnaire (MFQ). Responses to the MFQ from 565 participants in the 1994-1995 wave of the Long Beach Longitudinal Study were analyzed. Rasch scaling procedures were used to select items that discriminated individuals' scoring patterns and that provided non-redundant information about responses. A set of 10 items provided a scale that was reliable across items and persons. Female gender, conscientiousness score, depression score, and list recall predicted individual differences in participants' scores on the scale. Age, education, neuroticism, and text recall were also reliably correlated with scores but were suppressed by the other covariates. The shortened test is predicted by the same covariates as the long version, indicating that it has similar construct validity.
Clinical utility of computed tomography in the assessment of dementia: a memory clinic study
- Authors:
- CONFEDER Kelly A., HAWORTH Judith, WILCOCK Gordon K.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(5), May 2004, pp.414-427.
- Publisher:
- Wiley
Seeks to define the influence of computed tomography (CT) on clinical decision-making in the outpatient evaluation of dementia. A case series in which two physicians reviewed standardised data extracted from clinical records, first blind to CT results, and then with CT results. Clinical decisions made with and without the input of CT were compared. The study was based in an outpatient referral centre for the assessment of memory disorders and dementia. The study involved 146 participants who were diagnosed with dementia after their first clinic visit, had Mini Mental State Examination scores >12, were aged >65 years, and had no history of neurologic disease. CT impacted on diagnosis in an average of 12% (±2), and on treatment plan in 11% (±2) of cases. Physicians predicted a priori which cases CT may influence with an average sensitivity of 28% (±2), and specificity of 78.5% (±1.5). There was no statistically significant relationship between diagnostically uncertain cases and helpful CT scans [average 2 = 1.121 (±1.116), p = ns]. Blind to CT physicians appropriately identified cerebrovascular disease with an average sensitivity of 63% (±3), and specificity of 93.5% (±3.5). In the outpatient setting, CT may be expected to impact on diagnosis and treatment of dementia in 10% to 15% of cases. Memory clinic physicians recognise and treat cerebrovascular risk factors with reasonable sensitivity and specificity without the input of CT.
Social services and the single assessment process: early warning signs?
- Author:
- GLASBY Jon
- Journal article citation:
- Journal of Interprofessional Care, 18(2), May 2004, pp.129-139.
- Publisher:
- Taylor and Francis
Following the publication of policy documents such as the NHS Plan and the National Service Framework for Older People, health and social care agencies in the UK have been charged with devising and implementing a Single Assessment Process by April 2004. Although service users and carers are often frustrated at having to give the same information to many different professionals, this article cites research which raises significant doubts about the present capacity of social services departments to deliver on this government initiative. Based on telephone interviews with 25 local authorities, this paper describes the findings of research into the use of dependency measures in residential and nursing care. Although this research was conducted prior to the introduction of the Single Assessment Process, the study suggests that some local agencies may lack the expertise and skills to develop effective assessment tools/scales and that considerable Developmental work may be required to prepare