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The prevalence and phenomenology of psychotic symptoms in dementia sufferers
- Authors:
- BALLARD C.G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 10(6), June 1995, pp.477-485.
- Publisher:
- Wiley
One hundred patients referred to old age psychiatry services in the West Midlands and 25 patients referred to a memory clinic in Bristol with mild to moderate dementia were assessed using the GMS/HAS schedule together with a detailed inventory to assess their psychotic symptoms. On careful evaluation one patient did not have dementia. Eighty-three of the other 124 patients (66%) had a least one psychotic symptom. The frequencies of individual psychotic symptoms are described in the text.
VITA: subtypes of mild cognitive impairment in a community-based cohort at the age of 75 years
- Authors:
- JUNGWIRTH S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.452-458.
- Publisher:
- Wiley
Mild cognitive impairment (MCI) is defined to diagnose prodromal dementia and prodromal Alzheimer dementia, in particular. The main aim of this study is to identify subtypes of MCI in comparison to the frequency of Petersen's MCI-amnestic in an elderly age-cohort. The study is based on the cross sectional data from the Vienna-Transdanube-Aging (VITA) study. The data refer to the age cohort of 592 individuals at age 75 to 76 years who completed extensive neuropsychological examination. Dementia was present in 15 subjects (2.5%, CI: 1.4-4.1). 141 subjects (23.8%, CI: 20.4-27.5) of the entire age cohort 75 (n = 592) showed cognitive impairment without dementia concerning one or more cognitive functions (1.5 SD paradigm). These subjects were assigned to three subtypes of MCI: Selective Memory Impairment: n = 22 (3.7%, CI: 2.3-5.6), Memory Impairment+Non-Memory Impairment: n = 31 (5.2%, CI: 3.6-7.4) and Non-Memory Impairment: n = 88 (14.9%, CI: 12.1-18.0). The frequency of MCI-amnestic, the so-called prestage of AD according to Petersen, was very low (0.5%, CI: 0.1-1.5) compared to the estimated incidence rates of AD at this age. Established criteria of MCI could be modified in order to include a higher percentage of high-risk subjects for later developing Alzheimer dementia.
Attachment behaviours and parent fixation in people with dementia: the role of cognitive functioning and pre-morbid attachment style
- Authors:
- BROWNE C. J., SHOLSBERG E.
- Journal article citation:
- Aging and Mental Health, 9(2), March 2005, pp.153-161.
- Publisher:
- Taylor and Francis
This study replicates and extends exploratory research into the occurrence of attachment behaviours and parent fixation amongst people with dementia. Relationships between cognitive functioning, pre-morbid attachment style, attachment behaviours and parent fixation were examined. Fifty-three people with dementia, living in residential or nursing homes, completed the Standardised Mini-Mental State Examination and were interviewed about their parents. A family member or friend rated pre-morbid attachment style and care staff made observations of attachment behaviour. Results indicated that parent fixation occurred more often in participants with lower levels of cognitive functioning. Parent fixation was not related to pre-morbid attachment style. The occurrence of overt attachment behaviour was inconsistently associated with both high and low levels of cognitive functioning, at different times of the day. Participants with an avoidant attachment style exhibited more overt attachment behaviour than participants with a secure attachment style. Findings are interpreted in terms of attachment theory and the clinical and research implications of the study are discussed.
Neuropsychological characteristics of mild vascular cognitive impairment and dementia after stroke
- Authors:
- STEPHENS S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1053-1057.
- Publisher:
- Wiley
Post-stroke cognitive impairment is frequent, with characteristic impairments of attentional and executive performance. The study aims to determine whether the profile and severity of impairment in vascular Cognitive Impairment No Dementia (vascular CIND) is intermediate between that seen in stroke patients without significant cognitive impairment and patients with post-stroke dementia and thus to establish if the potential value of vascular CIND is a useful concept for predicting further cognitive decline and dementia in stroke patients. Stroke patients (n = 381) > 75 were recruited from representative hospital-based stroke registers in Tyneside and Wearside, UK. Sixty six age matched controls were also recruited. A detailed battery of neuropsychological assessments was completed 3 months post stroke. Deficits of attention (z = 5.7; p < 0.0001) and executive function (z = 5.9; p < 0.0001) were seen even in stroke patients without vascular CIND, compared to controls. However, stroke patients with CIND were significantly more impaired again on tests of executive function (z = 10.3; p < 0.0001) compared to those not meeting CIND criteria; and also had greater impairments of memory (z = 10.4; p < 0.0001) and language expression (z = 10.1; p < 0.0001). A similar overall profile of deficits was evident in the CIND and the dementia group, but specific deficits were significantly more pronounced in those with dementia, particularly in orientation (z = 7.2; p < 0.0001) and memory (z = 5.8; p < 0.0001). The current study indicates that attentional and executive impairments are frequent in stroke patients, but deficits of memory, orientation and language are more indicative of CIND and dementia. Further longitudinal studies are required to clarify the relationship between specific lesions and the progression of specific cognitive deficits in post-stroke patients.
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).
Syndromes of behavioural and psychological symptoms in mild Alzheimer's disease
- Authors:
- MORAN Maria, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(4), April 2004, pp.359-364.
- Publisher:
- Wiley
Behavioural and psychological symptoms of dementia (BPSD) are common in Alzheimer's disease (AD), and are associated with significant distress for patient and carer. Certain behavioural and psychological symptoms have been associated with each other, leading to the suggestion that differences in symptom patterns among patients with AD may represent different syndromes within AD. The purpose of this study is to see if patients with AD could be meaningfully classified into syndromes, based on the relationships between their BPSD. The sample was recruited through a memory clinic. Two hundred and forty first visit patients with a diagnosis of very mild to mild AD were included. BPSD were assessed using the BEHAVE-AD. Latent class analysis was used to assess for different classes or groups of patients within the sample, based on their behavioural and psychological symptoms. Three classes were identified; Class 1 with a low prevalence of behavioural and psychological symptoms; Class 2 an anxiety/depressive symptom class and Class 3 an aggressive symptom class. The three classes (or groups) of patients obtained by LCA in this sample may be explained by a latent, as yet, unidentified factor. Further research is required to determine if these classes are stable over time, and to identify possible latent variables.
Validity and reliability of the newly translated Hellenic Neuropsychiatric Inventory (H-NPI) applied to Greek outpatients with Alzheimer's disease: a study of disturbing behaviours among referrals to a memory clinic
- Authors:
- POLITIS Antonis, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(3), March 2004, pp.203-208.
- Publisher:
- Wiley
No rating scales of the neuropsychiatric symptoms of patients with dementia and Alzheimer's disease (AD) have previously been developed or translated. The aim was to develop a Hellenic translation of the Neuropsychiatric Inventory (NPI), to evaluate it's reliability and validity, and to compare NPI results in Greek patients referred to a neuropsychiatry clinic for either of two reasons: disturbing behaviours evoking embarrassment and disturbing behaviours evoking fear in the caregiver. The Hellenic translations of the NPI, Brief Psychiatric Rating Scale (BPRS), and Emotional Distress Scale (EDS) were compared in evaluating 29 consecutive referrals of patients with AD. The Hellenic NPI (H-NPI) demonstrated a high degree of internal consistency reliability, and of concurrent validity when compared to the BPRS or the EDS. Patients referred for behaviours evoking embarrassment presented with higher scores on NPI ratings of apathy. However, patients referred for behaviours evoking fear presented with higher scores on NPI ratings of aggression and irritability. These results indicate that the H-NPI is a reliable instrument, able to detect differences in clinically referred groups of AD patients.
Cognitive and functional neuroimaging correlate for anosognosia in Mild Cognitive Impairment and Alzheimer's disease
- Authors:
- VOGEL Asmu, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.238-246.
- Publisher:
- Wiley
To investigate the correlation between anosognosia and behavioural symptoms, performance on executive tests, and frontal cortex regional cerebral blood flow (rCBF) in patients with amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). From a prospective Memory Clinic cohort including consecutively referred patients, age 60 years or above, and with MMSE score 20 or above, 36 patients with AD and 30 with MCI were included in this study. Anosognosia was assessed using a categorical scale and discrepancy scores between patients' and relatives' reports on a 20-item Memory Questionnaire (MQ). Behavioural symptoms were assessed with Frontal Behavioural Inventory (FBI). Executive functions were examined with a range of neuropsychological tests. Tc99m-HMPAO SPECT was obtained in an unselected sample of 55 of the 66 patients, and rCBF was analysed in six cortical frontal regions. Insight was equally impaired in the two patient groups. A significant correlation was found between impaired awareness and dementia severity (MMSE). Discrepancy-scores on the MQ were significantly correlated to scores on FBI and to rCBF in the right inferior frontal gyrus, but not to executive tests. The groups classified by the categorical ratings full, shallow and no awareness were not characterized by differences in behavioural symptoms, executive performance or frontal rCBF. Impaired awareness is associated with behavioural symptoms and may reflect functional impairment in the right inferior frontal cortex.
White matter lesions on magnetic resonance imaging and their relationship with vascular risk factors in memory clinic attenders
- Authors:
- LAZARUS R., PRETTYMAN R., CHERRYMAN G.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.274-279.
- Publisher:
- Wiley
The association between white matter lesions on magnetic resonance imaging (MRI) and the presence of vascular risk factors has been investigated in different populations, and results have varied widely. However, this relationship has not been adequately addressed in memory clinic attenders who have relatively early cognitive impairment. This study was undertaken to determine the relationship between the severity of white matter lesions and vascular risk factors in elderly subjects referred to a Memory Clinic, irrespective of their diagnoses. Patients attending the Memory Clinic had relatively early, mild cognitive impairment and differed, in this respect, from typical unselected community-based samples and from patients with established dementia. The study also investigated whether periventricular and deep white matter lesions differed in their relationship with vascular risk factors. All patients assessed in the Memory Clinic at Leicester General Hospital between April 1998 and October 2000 who had undergone an MRI scan were included in the study. They received a comprehensive clinical and cognitive assessment, a standard dementia laboratory screen and evaluation of vascular risk factors. MRI scans were reviewed by two independent raters and semi-quantitative ratings of the severity of white matter lesions were made using standardised protocols. The relationship between cerebral white matter lesions and vascular risk factor variables was examined by multiple linear regression. One hundred and seventy-seven subjects were included in the study. The mean age was 69.8 and the mean MMSE score was 23.2. Of the risk factors investigated, only age and prior cerebrovascular disease were significantly associated with severe periventricular white matter lesions; age, hypertension and diabetes were significantly associated with severe deep white matter lesions. Periventricular and deep white matter lesions are differentially influenced by vascular risk factors.
The effects of reminiscence on depressive symptoms and mood status of older institutionalized adults in Taiwan
- Author:
- WANG Jing-Yy
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.57-62.
- Publisher:
- Wiley
This study examined the effects of reminiscence on depressive symptoms and mood status of elderly people residing in long-term care facilities. A longitudinal quasi-experimental design was conducted, using two equivalent groups for pre-post test and purposive sampling. Each subject was administered pre- and post- tests at a 4 month interval, but subjects in the experimental group underwent weekly individual reminiscence therapy. Geriatric Depression Scale short form (GDS-SF) and Apparent Emotion Rating Scale (AER) were used as study instruments. Forty-eight subjects completed the study, with 25 in the experimental group and 23 in the control group. The experimental findings indicated that the experimental group demonstrated fewer depressive symptoms (p < 0.05) and better mood status (p = 0.05) on the post-test comparing to the control group. These warranted that reminiscence therapy is a recommended therapy for older people who reside in care facilities. It can provide a basis for planning geriatric care in community to promote the well being and quality of life of older people.