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Does education moderate neuropsychological impairment in late-life depression?
- Authors:
- BHALLA Rishi K., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.413-417.
- Publisher:
- Wiley
The increased resistance of better-educated individuals to the cognitive effects of neuropathology has been conceptualized as reflecting brain reserve. This study examined whether educational level influences the degree of neuropsychological impairment associated with late-life depression. The neuropsychological performances of 115 older depressed patients and of 44 comparison subjects of similar age and education were compared as a function of educational level. While depressed patients performed worse than comparison subjects on all the measures, the severity of this impairment (with respect to comparison subjects) did not differ with the educational level of the patients. Brain reserve, as indexed by the patients' level of education, does not mitigate the cognitive decrements associated with late-life depression.
Does arm length indicate cognitive and functional reserve?
- Authors:
- JEONG Seul-Ki, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.406-412.
- Publisher:
- Wiley
This study aimed to examine whether arm length and height were associated with cognitive and functional abilities. Screening interviews were conducted in 235 community dwelling individuals aged 65 and over. The assessment scales included the Korean version of modified Mini-Mental State Examination (K-mMMSE) for cognition, and the Korean Instrumental Activities of Daily Living (K-IADL) for functional ability. All the participants were examined clinically and a diagnosis of dementia was ascertained. Anthropometric measurements included total arm span and height. Both arm length and height correlated significantly with the cognitive and functional scales. In the multivariate regression models, their associations were significant, independent of age, sex, education, and other variables. Shorter arm length was also significantly associated with dementia; while, height lost significance after an adjustment for the potential confounders. Arm length and height could indicate cognitive and functional ability. Arm length, which was known to be less prone to degenerative processes, might be more stable as an indicator for cognitive and functional reserve capacity than height.
Comparison of suicide in people aged 65-74 and 75+ by gender in England and Wales and the major Western countries 1979-1999
- Authors:
- PRICHARD Colin, HANSEN Lars
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.17-25.
- Publisher:
- Wiley
The factors most strongly associated with suicide are age and gender - more men than women, and, more people over 65 kill themselves. As a number of Governments have targets to reduce suicide levels we compare elderly suicide rates over a 20-year period in England and Wales. And the major Western countries focusing upon age and gender. Male GSPR: 65-74 suicide ratios fell significantly in six countries and in three for the 75+. Female GSPR: 65-74 suicide ratios fell in every country except Spain. Proportionately, there were more suicides in the over 65s in countries with an extended family tradition, Spain, Italy, Germany, France and Japan, than in the five secular countries. England and Wales male 65-74 suicide fell significantly more than Canada, France, Germany, Italy, Japan, Spain, Netherlands and the USA, and did significantly better than the other countries for all female senior citizen suicides. Suicide of the over-65s has improved in seven countries, especially in England and Wales, who had the greatest proportional reduction, which reflects well upon the psycho-geriatric and community services. However, in all countries, male 65-74 rates did not match the female out so extra efforts are needed to improve male rates.
Is vascular depression a distinct sub-type of depressive disorder?: a review of causal evidence
- Author:
- BALDWIN Robert C.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.1-11.
- Publisher:
- Wiley
A literature review with discussion of findings in the light of recently suggested guidelines for the development of new psychiatric disorders. There is considerable evidence linking depression in later life with vascular brain disease but the interaction is bi-directional. Depression and vascular disease could be mediated by factors other than traditional vascular risk factors. There is increasing interest in mechanisms such as inflammatory processes which may mediate both depression and vascular disease. Vascular depression provides a useful framework with which to remind the clinician of important interactions between depression and vascular disease but conceptually it may be too restrictive.
Forgetful but not forgotten: assessment and aspects of treatment of people with dementia by a specialist old age psychiatry service
- Author:
- ROYAL COLLEGE OF PSYCHIATRISTS
- Publisher:
- Royal College of Psychiatrists
- Publication year:
- 2005
- Pagination:
- 94p., bibliog.
- Place of publication:
- London
The report represents a consensus statement from an Expert Working Group of the Faculty of the Psychiatry of Old Age, and has been produced in collaboration with the Alzheimer's Society and with representation from primary care. It describes good practice, with particular attention focused on working with primary care and with carers. In preparing the report, the Working Group has used systematic summaries of published evidence.
Prevalence of depression in older patients consulting their general practitioner in the Netherlands
- Authors:
- LICHT-STRUNK Els, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(11), November 2005, pp.1013-1019.
- Publisher:
- Wiley
Data of The West Friesland Study were used. Five thousand, six hundred and eight-six GP attendees of 55 years and older filled in the Geriatric Depression Scale - 15 items as a screening instrument for depression (response 62%). Of those screened positive on the GDS-15, 846 (77.5%) were interviewed using the Primary Care Evaluation of Mental Disorders (PRIME-MD). A random sample of 102 patients scoring below the threshold of the GDS-15 was interviewed to estimate the proportion of false negatives. Major depression was prevalent in 13.7% and minor depression in 10.2% of the patients. Depressed patients were older, more often female and lived more often in urban districts. Patients with major depression were younger and more often female than those with a minor depression. Only 22.9% of the patients with a major depression were treated with antidepressants. Depression in older GP attendees is a very common health problem. Further research should focus on identifying those groups of patients with high risk of persistence of depression. This could help to focus the limited resources available in general practice to those patients in whom treatment is most urgently needed.
Major depression as a risk factor for early institutionalization of dementia patients living in the community
- Authors:
- DORENLOT Pascale, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.471-478.
- Publisher:
- Wiley
Although depression is known to be frequently associated with dementia, it is nonetheless under-diagnosed and under-treated among this patient population. Its effect on outcome for dementia patients is thought to be substantial, because depression appears to induce higher than normal rates of disability as well as supplementary cognitive decline. The aim of this study was to measure the impact of major depression on the institutionalization rate of community-dwelling dementia patients. Three-hundred forty-eight consecutive dementia outpatients of a geriatric clinic (mean age: 81 years, 69.8% women, 65.5% dementia of Alzheimer's type, mean baseline MMSE score: 20.5), followed between 1997 and 2002 (mean follow-up: 20.5 months). Twenty-five percent of the patients met the criteria of major depression at baseline, and only 30.3% of these received antidepressant medication. Major depression at baseline was independently associated with nursing home admission within one year of the baseline assessment. Antidepressant medication tended to protect against this outcome, but not to a statistically significant extent. Major depression at baseline is an independent risk factor for early institutionalization of dementia sufferers. Early institutionalization is defined in this study as nursing home placement within a year of diagnosis with dementia at our specialized outpatient center. The study highlights the need for better management of depression among dementia outpatients. Further investigation is needed to evaluate the protective effect of antidepressant medication (and/or non-pharmacological therapies) on the institutionalization rate.
A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia
- Authors:
- PRRELL Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.446-451.
- Publisher:
- Wiley
A recent randomised controlled trial on Cognitive Stimulation Therapy (CST) identified the need to evaluate its more long-term benefits for people with dementia. This study evaluates the effectiveness of a weekly maintenance CST programme for people with dementia in residential care. Thirty-five people with dementia were included, following on from a seven-week twice-weekly study of CST. The maintenance CST sessions ran in two residential homes using a once a week programme of CST over an additional 16 weeks. Two control homes did not receive the maintenance intervention. Using repeated measures ANOVAS, there was a continuous, significant improvement in cognitive function (MMSE) for those receiving MCST (CST+maintenance CST sessions) as compared to CST alone or no treatment (p = 0.012). There were no effects on quality of life, behaviour or communication following maintenance sessions. The initial cognitive improvements following CST were only sustained at follow-up when followed by the programme of maintenance CST sessions. The cognitive benefits of CST can be maintained by weekly sessions for around 6 months. A large-scale, multi-centre maintenance CST trial is required to clarify potential longer-term benefits of maintenance CST for dementia.
The clinical psychiatry of late life in Britain from 1950 to 1970: an overview
- Author:
- HILTON Claire
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.423-428.
- Publisher:
- Wiley
The psychiatry of old age in Britain can be traced back to the 1940s. Provision of services for mentally ill older people, however, did not become widespread until the 1970s. Survey of archive sources, published work, and oral history interviews relating to the development of services for mentally ill older people in Britain between 1950 and 1970. Despite considerable progress in research leading to a firm academic foundation for the specialty of old age psychiatry, there was relatively little progress made in the coordinated development of services from 1950 to 1970. A new generation of old age psychiatrists began to take service delivery issues forward at the very end of the 1960s and into the 1970s.
Clinical trials of potential antidepressants: to what extent are the elderly represented: a review
- Authors:
- GIRON Maria Stella T., FASTBOM Johan, WINBLAD Bengt
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.201-217.
- Publisher:
- Wiley
There is widespread use of antidepressants in the elderly population. The principle of treatment of depression, however, is derived mostly from studies employing young adults and healthy elderly. This article reviews the literature on the extent to which the elderly are represented in clinical trials of potential antidepressants. The maximum age of inclusion for most clinical trials was 65 years. The highest age reported for depressed subjects was 90 years. There was no clear consensus on who were considered to be elderly; clinical trials conducted on the elderly included subjects who were 50, 55, or 60 years and over. Pharmacological studies on healthy subjects were most often done on young adults, age range 18 to 65 years. The period of study was relatively shorter for clinical trials done on elderly subjects. There was however, no difference in the exclusion or inclusion criteria between studies done in young and elderly subjects. Elderly subjects aged 75 years and over were clearly underrepresented in the clinical trials of potential antidepressants. For drugs that are used by the elderly, in its pivotal studies for registration, the inclusion of at least 25% of subjects aged 75 years and over is recommended.