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Mortality from dementia in a community-dwelling Brazilian population
- Authors:
- NITRINI Ricardo, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.247-253.
- Publisher:
- Wiley
The influence of dementia on mortality has not yet been reported for a Latin American country. The aim was to evaluate the influence of dementia on mortality of a community-dwelling elderly population in Brazil, and to verify the extent to which the diagnosis of dementia is reported on death certificates. A cohort of 1,656 individuals, aged 65 and over, was screened for dementia at their domiciles, in 1997. The same population was re-evaluated in 2000, and information on deaths was obtained from relatives and from the municipal obituary service. Kaplan-Meier curves were used for the survival analysis, and the mortality risk ratio (MMR) was calculated using Cox proportional hazards models. We obtained data from 1,393 subjects, corresponding to 84.1% of the target population. The number of deaths was 58 (51.3%) among the patients with dementia and 163 (12.7%) among those without dementia in 1997 (p < 0.0001). Dementia and Alzheimer's disease (AD) decreased survival, with hazards ratios of 5.16 [95% Confidence Interval (CI): 3.74-7.12] for dementia and 4.76 (95% CI: 3.16-7.18) for AD. The Cox proportional hazards model identified dementia (MMR = 3.92, 95% CI: 2.80-5.48) as the most significant predictor of death, followed by age, history of stroke, complaints of visual impairment and heart failure and by severe arterial hypertension in the baseline evaluation. Dementia and/or AD were mentioned in only 12.5% of the death certificates of individuals with dementia. Dementia causes a significant decrease in survival, and the diagnosis of dementia is rarely reported on death certificates in Brazil.
The prevention, diagnosis and management of delirium in older people: national guidelines
- Authors:
- BRITISH GERIATRICS SOCIETY, ROYAL COLLEGE OF PHYSICIANS
- Publisher:
- Royal College of Physicians
- Publication year:
- 2006
- Pagination:
- 18p.
- Place of publication:
- London
Delirium (acute confusional state) is a common condition in the elderly, affecting up to 30% of all older patients admitted to hospital. The hospital environment often precipitates or exacerbates episodes of delirium. Patients who develop delirium have high mortality, institutionalisation and complication rates and have longer lengths of stay than non-delirious patients. Delirium is often not recognised by clinicians and is often poorly managed. Recent evidence, however, demonstrates that improved understanding of delirium among health professionals and improved attention to the environment around at-risk patients can both prevent the onset of delirium and curtail episodes that do arise. The aim of these guidelines is to provide healthcare professionals with a practical approach to the identification, prevention and management of delirium. While developed primarily with a view to hospital care, the principles within the guidelines are also highly relevant to intermediate and community care settings. The appropriate management of older people at risk of delirium or who develop delirium will greatly enhance the quality of life for individuals and will be cost effective for the NHS in terms of resources required for the management of delirium and patients' length of stay.
The CIDI as an instrument for diagnosing depression in older Turkish and Moroccan labour migrants: an exploratory study into equivalence
- Authors:
- SMITS Carolien H. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.436-445.
- Publisher:
- Wiley
The number of elderly migrants from Turkey and Morocco in Western Europe will increase sharply in the coming decades. Many of these migrants seem to have mental health problems. As mental health care programs are based on DSM criteria, there is a need for diagnostic instruments with good psychometric properties. This exploratory study examines the presence of construct bias, method bias and item bias in the Composite International Diagnostic Interview (CIDI) Basis Life time version 2.1 in elderly Turkish and Moroccan men and women. From a community based health survey four groups of migrants aged 55-74 were selected for semi-structured interviews including the CIDI depression section. Data included interview transcriptions and observations of 11 respondents in each group (Turkish men, Turkish women, Moroccan men, and Moroccan women). The data were analysed using qualitative techniques. Construct bias, method bias and item bias of the CIDI was found in all groups. The poor match between the CIDI on the one hand and the taboo on mental health problems and the poor level of education of the respondents can partly explain this bias. The use of the CIDI in elderly migrants of Moroccan and Turkish descent is problematic, due to the presence of construct, method and item bias.
The Center for Epidemiologic Studies Depression Scale in older Chinese: thresholds for long and short forms
- Authors:
- CHENG Sheung-Tak, CHAN Alfred C. M.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.465-470.
- Publisher:
- Wiley
No study has examined the diagnostic validity of the Center for Epidemiologic Studies Depression Scale (CES-D) in the Chinese elderly. This study aims to determine appropriate cutoffs for the 20- (CESD-20) as well as a ten-item (CESD-10) version of the instrument. Data were also provided, based on simulated scoring, for the diagnostic performance of the scales when using dichotomous instead of 4-point rating scales. Three hundred and ninety eight persons aged 60 +referred for psychiatric asssessment by a physician were administered the CES-D as well as given an independent psychiatric assessment. A spectrum of depression diagnosis as the criterion was used to assess the diagnostic validity of the CES-D. The ten and the 20-item version of the CES-D, regardless of scoring method, produced essentially identical performance indices. The optimal thresholds were 12 and 22 for CESD-10 and CESD-20 respectively, and based on these thresholds, sensitivity, specificity, positive predictive value and negative predictive value were 0.76, 0.55, 0.57 and 0.74 for CESD-10, and 0.75, 0.51, 0.55 and 0.72 for CESD-20. With both ends of the rating scale collapsed to create dichotomous items, the optimal thresholds became 4 for CESD-10 and 7 for CESD-20, and the correponding performance indices were 0.67, 0.58, 0.56 and 0.69 for CESD-10, and 0.70, 0.58, 0.57 and 0.70 for CESD-20. The ten-item version can be used in lieu of the 20-item version, and a dichotomous response format would probably work as well as the original four-point format, in order to simplify administration for elderly persons
Depressive symptom quality and neuropsychological performance in dementia
- Authors:
- JANZING Joost G. E., NAARDING Paul, ELING Paul A. T. M.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.479-484.
- Publisher:
- Wiley
It is unknown to what extent depression and cognitive dysfunction are related in subjects with dementia. A limitation of earlier studies is that only general measures of depression have been studied. In a sample of 60 subjects with dementia according to DSM-III-R criteria depressive symptoms were divided into factors of mood and motivation disturbance according to a principal components analysis. Correlations were computed between the factor scores and the performance on a number of specific neuropsychological tests. As the symptom content of motivation disturbance suggests subcorticofrontal dysfunction it was hypothesized that this factor is related to impaired executive functions. 77% of the depressive symptoms contributed to the dimension of motivation disturbance and most of these symptoms occurred outside the context of a major depressive episode. Our hypothesis was supported by a significant negative correlation between motivation symptoms and semantic verbal fluency. This relationship seems to have specificity, as both the dimensions of mood symptoms and of general depressive symptoms did not correlate significantly with specific neuropsychological test scores. The division of depressive symptoms in factors of mood and motivation disturbance contributes to insight into the relationship between depression and cognitive dysfunction in dementia. An advantage of the motivation disturbance factor compared to the regular apathy scales is that it consists of depressive symptoms. Therefore, it becomes evident that apathy or impaired motivation may occur in patients with dementia both in and outside the context of a depressive syndrome.
Physical health, depression and cognitive function as correlates of disability in an older Korean population
- Authors:
- KIM Jae-Min, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(2), February 2005, pp.160-167.
- Publisher:
- Wiley
The World Health Organisation Disability Assessment Schedule II (WHODAS II) measures functioning and disability in concordance with the bio-psycho-social model of the WHO's International Classification of Functioning, Disability, and Health. Our objectives were to investigate the independent associations of physical health, depression and cognitive function with WHODAS II disability in an older Korean population. The WHODAS II was administered to a community sample of 1204 residents age 65 or over. Data on demographic characteristics (age, gender, living area, marital state, and religion), socio-economic state (education, type of accommodation, number of rooms, previous occupation, current employment, monthly income), social support, number of physical illness, depression (GMS), and cognitive function (MMSE) was gathered. A subsample (n = 746) received a clinical examination for dementia. Scores on the WHODAS II were significantly and independently associated with worse physical health, depression, and lower cognitive function. Associations with other factors were no longer apparent after adjustment for these. These associations persisted in the absence of dementia. In participants with dementia (n = 110), WHODAS II scores were principally associated with physical health and accommodation type. Level of disability, as measured by the WHODAS II, was principally associated with physical health, depression and cognitive function, rather than socio-demographic factors.
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.
Effectiveness of a clinical pathway for the diagnosis and treatment of dementia and for the education of families
- Authors:
- KAZUI Hiroaki, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(9), September 2004, pp.892-897.
- Publisher:
- Wiley
Clinical pathways (CPs) are rarely used in the treatment of dementia. We established a CP for a series of medical practices (diagnosis, treatment, establishment of a care system, and caregiver education) for patients with dementia hospitalized for a three-week period, and evaluated its usefulness. The length of hospital stay and hospital costs were compared between 23 consecutive patients with dementia hospitalized and treated using a CP and 20 controls treated by conventional medical practice without using a CP in a special ward for dementia patients. In the CP group, at the time of discharge, primary caregivers, physicians, and nurses were given a questionnaire to obtain their comments about the impression of treatment with the CP. The questionnaire survey indicated that the CP deepened the caregiver's understanding of the sequence of medical practices for the inpatient, the disorders of the inpatient, the treatment methods, and the methods for coping with the disorder. The CP was also useful for facilitating inpatient medical practice and promoting the establishment of a care system after discharge. The use of the CP significantly shortened the length of hospital stay and decreased hospital costs during hospitalization but increased the amount of work per day and made the medical staff feel that their freedom to choose medical procedures had been restricted. The CP was useful for execution of inpatient medical practices for patients with dementia.
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.