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The 6 and 12 month outcomes of older medical inpatients who recover from delirium
- Authors:
- COLE Martin G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(3), March 2008, pp.301-307.
- Publisher:
- Wiley
The aim was to compare the 6 and 12 month outcomes of patients who recovered from delirium by 8 weeks with those who did not have an index episode. Older medical inpatients were assessed for delirium using the Confusion Assessment Method. All patients with delirium and a sample of patients without delirium were enrolled. Recovery from delirium at 8 weeks was determined using the Delirium Index and an algorithm based on DSM-III-R criteria. The primary composite outcome was cognitive or functional decline, institutional residence or death at 6 and 12 months. The authors fitted two logistic regression models to predict outcome odds ratio (OR) of delirium-recovered vs no delirium groups, adjusting for co-morbidity, severity of physical illness and demographic variables. In secondary analyses, each component of the primary outcome was examined separately. Of 361 patients enrolled, 59 died, 33 withdrew and one was lost to follow-up before 8 weeks. Of 268 patients assessed at 8 weeks, 115 and 95 were in delirium-recovered and no delirium groups, respectively. The 6 month OR for the primary composite outcome was 0.89 (95% CI 0.46, 1.70); the 12 month OR was 1.5 (95% CI 0.77, 2.90). Secondary analyses revealed a clinically important increase in mortality at 6 and 12 months. Among patients who survived, there were no significant differences in cognition, function or institutional status between delirium-recovered and no delirium groups at 6 and 12 months. If replicated, these findings have potentially important implications for clinical practice and research.
Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disorders
- Authors:
- JONES Danielle, et al
- Journal article citation:
- Aging and Mental Health, 20(5), 2016, pp.500-509.
- Publisher:
- Taylor and Francis
Objectives: In the UK dementia is under-diagnosed, there is limited access to specialist memory clinics, and many of the patients referred to such clinics are ultimately found to have functional (non-progressive) memory disorders (FMD), rather than a neurodegenerative disorder. Government initiatives on ‘timely diagnosis’ aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve the screening and diagnostic process by analysing communication between clinicians and patients during initial specialist clinic visits. Establishing differential conversational profiles could help the timely differential diagnosis of memory complaints. Method: This study is based on video- and audio recordings of 25 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used to explore recurrent communicative practices associated with each diagnostic group. Results: Two discrete conversational profiles began to emerge, to help differentiate between patients with dementia and functional memory complaints, based on (1) whether the patient is able to answer questions about personal information; (2) whether they can display working memory in interaction; (3) whether they are able to respond to compound questions; (4) the time taken to respond to questions; and (5) the level of detail they offer when providing an account of their memory failure experiences. Conclusion: The distinctive conversational profiles observed in patients with functional memory complaints on the one hand and neurodegenerative memory conditions on the other suggest that conversational profiling can support the differential diagnosis of functional and neurodegenerative memory disorders. (Publisher abstract)
The role of patient personality in the identification of depression in older primary care patients
- Authors:
- McCRAY Laura W., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(11), November 2007, pp.1095-1100.
- Publisher:
- Wiley
The aim was to evaluate whether personality factors significantly contribute to the identification of depression in older primary care patients, even after controlling for depressive symptoms. The authors examined the association between personality factors and the identification of depression among 318 older adults who participated in the Spectrum study. High neuroticism (unadjusted Odds Ratio (OR) 2.36, 95% Confidence Interval (CI) [1.42, 3.93]) and low extraversion (adjusted OR 2.24, CI [1.26, 4.00]) were associated with physician identification of depression. Persons with high conscientiousness were less likely to be identified as depressed by the doctor (adjusted OR 0.45, CI [0.22, 0.91]). Personality factors influence the identification of depression among older persons in primary care over and above the relationship of depressive symptoms with physician identification. Knowledge of personality may influence the diagnosis and treatment of depression in primary care.
To tell or not to tell: comparison of older patients' reaction to their diagnosis of dementia and depression
- Authors:
- JHA Arun, TABET Naji, ORRELL Martin
- Journal article citation:
- International Journal of Geriatric Psychiatry, 16(9), September 2001, pp.879-885.
- Publisher:
- Wiley
This study investigates the reaction of elderly patients to the disclosure of their diagnosis of dementia compared with depression. Elderly patients suffering from dementia and depression were asked to complete a questionnaire about the diagnosis and other aspects of their clinical summary sent to them by post. Demographic data included age, gender, marital status and occupation; degree of dementia or depression was established by administering the mini-mental state examination and the geriatric depression scale, respectively. Results showed most depressed and dementia patients liked the idea of reading their diagnosis but one quarter of dementia cases felt upset. Within the dementia group, the majority of patients with mild or severe dementia welcomed the idea of knowing their diagnosis; and 13 (100%) of the patients with vascular dementia wished to know (compared with 68% cases with Alzheimer's disease). Among dementia patients who also happened to be depressed, a higher proportion (60%) expressed an unfavourable view towards knowing their diagnosis, but only a minority (40%) of them were actually upset. Most older married females, especially those with depression and Alzheimer's disease, felt pessimistic afterwards. There was no significant difference between patients with dementia or depression in their wish to know their diagnosis. Patients with severe dementia, even if they felt upset, preferred to be told their diagnosis. Patients with vascular dementia tended to express a more favourable view.
Explaining the effects of symptom attribution by carers on help-seeking for individuals living with dementia
- Authors:
- FELDMAN Lisa, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 16(3), 2017, pp.375-387.
- Publisher:
- Sage
This study investigated the effects of carer attributions on help-seeking behaviour for people with dementia using interviews with 84 carers recruited through general practice. Memory loss was the most commonly reported first symptom but psychological and behavioural symptoms were also common at onset. In over a third of individuals help-seeking was delayed for a mean of 25 months (range 6–69, SD 19.3). Help-seeking between those who attributed symptoms to dementia, or to unknown causes, and those who attributed symptoms to personality, ageing, life events or other illnesses was statistically significant (p < 0.001). No statistically significant associations between help-seeking and patient or carer characteristics were found. There is a need to raise public awareness about the range of symptoms suggestive of dementia. Assumptions that age and other conditions may be the likely cause of an individual's cognitive decline needs to be challenged by practitioners. Attribution of symptoms to characteristics other than dementia delays help-seeking. (Publisher abstract)
10 questions to consider: a guide for general practitioners to assist in managing patients with dementia
- Authors:
- JACKSON Graham, HEGDE Rekha
- Publisher:
- University of Stirling. Dementia Services Development Centre
- Publication year:
- 2009
- Pagination:
- 50p., bibliog.
- Place of publication:
- Stirling
- Edition:
- 2nd ed.
This booklet sets out ten questions for general practitioners to consider to assist them in their management of the care of patients with dementia. These are: is there problem behaviour; what are the possible precipitants; what risks are posed by the current situation; does the person have dementia; are there specific reasons for the behaviour; what changes in the environment help; is the use of medication necessary; are there issues of consent; do the carers require support and training; and what other agencies might assist? A comparison of commonly used drugs and their side effects and quick reference NICE and SIGN guidelines are included. The booklet emphasises the need for a thorough assessment of each situation and the need to view the person with dementia in a holistic way.
Sharing letters with patients and their carers: problems and outcomes in elderly and dementia care
- Authors:
- TRELOAR Adrian, ADAMIS Dimitrios
- Journal article citation:
- Psychiatric Bulletin, 29(9), September 2005, pp.330-333.
- Publisher:
- Royal College of Psychiatrists
In a cross-sectional survey, this study assessed the attitudes of older patients and their carers towards receiving copies of letters about them and the effects upon outcomes of sharing letters. The opinions of consultants onletter-sharing were also studied. Few old age psychiatrists shared letters with patients or carers, and many had concerns about this practice. In contrast, letters were considered ‘very welcome’ by 87% of patients and carers who received them, and 81% of those who did not would be ‘very pleased’ to receive them. Patients and carers who had received letters had significantly better knowledge of their care plan, whom to contact and ways of making contact with services. Despite concerns expressed by psychiatrists, the findings support the sharing of letters with patients and carers of patients with dementia in old age psychiatry services.
Conceptualisation of mild cognitive impairment: a review
- Authors:
- DAVIS Heather S., ROCKWOOD Kenneth
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(4), April 2004, pp.313-319.
- Publisher:
- Wiley
Several factors have prompted renewed interest in the concept of declines in cognitive function that occur in association with aging, in particular the area between normal cognition and dementia. We review the changing conceptualization of what has come to be known as mild cognitive impairment (MCI) in an effort to identify recent developments and highlight areas of controversy. Standard MEDLINE search for relevant English-language publications on mild cognitive impairment and its associated terms, supplemented by hand searches of pertinent reference lists. Many conditions cause cognitive impairment which does not meet current criteria for dementia. Within this heterogenous group, termed Cognitive Impairment, No Dementia (CIND), there are disorders associated with an increased risk of progression to dementia. Still, the conceptualization of these latter disorders remains in flux, with variability around assumptions about aging, the relationship between impairment and disease, and how concomitant functional impairment is classified. Amongst patients with MCI, especially its amnestic form, many will progress to Alzheimer's disease (AD). In contrast with clinic-based studies, where progression is more uniform, population-based studies suggest that the MCI classification is unstable in that context. In addition to Amnestic Mild Cognitive Impairment (AMCI), other syndromes exist and can progress to dementia. For example, an identifiable group with vascular cognitive impairment without dementia shows a higher risk of progression to vascular dementia, Alzheimer's disease and mixed dementia. Recent attempts to profile patients at an increased risk of dementia suggest that this can be done in skilled hands, especially in people whose symptoms prompt them to seek medical attention. Whether these people actually have early AD remains to be determined. The more narrowly defined MCI profiles need to be understood in a population context of CIND.
Sharing a diagnosis of dementia: learning from the patient perspective
- Authors:
- WILKINSON H., MILNE A.J.
- Journal article citation:
- Aging and Mental Health, 7(4), July 2003, pp.300-307.
- Publisher:
- Taylor and Francis
Sharing a diagnosis of dementia is a key focus of debate and research in the field of dementia care. The pivotal role of the GP in the early identification and subsequent management of dementia has long been recognized and whilst diagnostic practice is improving, the knowledge gained from research exploring the patient perspective is insufficiently absorbed. This paper presents the evidence from the two perspectives of the diagnostic relationship: the views of GPs around giving a diagnosis and the views of patients on receiving one. The authors draw upon their own projects—as well as wider research—in suggesting ways that diagnostic practice can be improved by taking account of the patient perspective. The learning can be distilled around the dimensions of the process, approach and nature of disclosure with evidence particularly challenging the ‘myths’ held by many GPs around the value of early diagnosis. Whilst much work still needs to be done to incorporate the patient perspective in dementia care, there is clear evidence that patient oriented research has much to offer the development of disclosure practice in primary care to the benefit of patients, their families and GPs.
Which factors influence cognitive decline in older adults suffering from dementing disorders?
- Authors:
- SCHAUFELE Martina, BICKEL Horst, WEYERER Siegfreid
- Journal article citation:
- International Journal of Geriatric Psychiatry, 17(11), November 2002, pp.1055-1063.
- Publisher:
- Wiley
Although extensive research has been done on dementing disorders in recent decades, their natural course and prognosis are not yet well understood. The aim of our study was to assess cognitive decline in a representative sample of demented elderly and to analyse the predictive value of a broad spectrum of sociodemographic, neurological and clinical variables. It was found that there are some prognostic indicators that can help to establish the prognosis for dementia patients. The best indicator for both - the rate of cognitive decline and the probability of survival - is the severity of dementia