International Journal of Geriatric Psychiatry via MedWorm.com

Retrospective evaluation of revised criteria for the diagnosis of Alzheimer's disease using a cohort with post-mortem diagnosis

International Journal of Geriatric Psychiatry — Tue, 09 Mar 2010 00:00:00 +0100

The criteria currently used to diagnose Alzheimer's disease (AD) require the presence of dementia, i.e. cognitive impairment sufficient to affect normal social and/or occupational function. Dubois et al. (Dubois et al., ) have recently proposed a set of revised criteria that may aid the diagnosis of the earlier stages of AD, and do not require the presence of dementia. We aimed to evaluate the new predementia-AD criteria through their retrospective application to the OPTIMA cohort with post-mortem (PM) confirmed diagnoses.The criteria were evaluated for sensitivity and specificity using cognitive, neuroimaging and cerebrospinal fluid data and clinical information for exclusion criteria. Limitations in choice of cognitive test, use of CT scans rather than MRI and missing CSFs affected the o...

Emotional support, negative interaction and DSM IV lifetime disorders among older African Americans: findings from the national survey of American life (NSAL)

International Journal of Geriatric Psychiatry — Tue, 16 Feb 2010 00:00:00 +0100

This study investigated the relationship between emotional support and negative interaction on lifetime prevalence of mood and anxiety disorders among older African Americans.The analyses utilized the National Survey of American Life.Logistic regression and negative binomial regression analyses were used to examine the effect of emotional support and negative interaction with family members on the prevalence of lifetime DSM-IV mood and anxiety disorders.Data from 786 African Americans aged 55 years and older were used.The DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to assess mental disorders. Three dependent variables were investigated: the prevalence of lifetime mood disorders, the prevalence of lifetime anxiety.Multivariate analysis found t...

A pilot randomized controlled trial of sleep therapy in Parkinson's disease: effect on patients and caregivers

International Journal of Geriatric Psychiatry — Mon, 15 Feb 2010 00:00:00 +0100

By means of a controlled trial, to investigate the efficacy, tolerability and feasibility of a multi-component sleep therapy intervention versus basic sleep hygiene education in PD patients with sleep disturbances and their live-in carers.Patient-carer dyads were randomised to either of the two interventions. Quantitative measures of sleep, psychiatric and overall functioning were administered at baseline and two weeks after the intervention to patients and carers.Sleep disturbances in the PD patients improved significantly in both the groups. Between group comparisons in both carers and patients revealed no significant differences on any outcome measures. The intervention was found to be well tolerated, feasible and could easily be translated into the clinical setting.This pilot study mak...

Impact of ambient bright light on agitation in dementia

International Journal of Geriatric Psychiatry — Wed, 27 Jan 2010 00:00:00 +0100

To evaluate the effect of ambient bright light therapy (BLT) on agitation among institutionalized persons with dementia.High intensity, low glare ambient lighting was installed in activity and dining areas of a state psychiatric hospital unit in North Carolina and a dementia-specific residential care facility in Oregon. The study employed a cluster-unit crossover design involving four ambient lighting conditions: AM bright light, PM bright light, All Day bright light, and Standard light. Sixty-six older persons with dementia participated. Outcome measures included direct observation by research personnel and completion by staff caregivers of the 14-item, short form of the Cohen-Mansfield Agitation Inventory (CMAI).Analyses of observational data revealed that for participants with mild/mode...

Suicide in later life: public health and practitioner perspectives

International Journal of Geriatric Psychiatry — Tue, 26 Jan 2010 00:00:00 +0100

Suicide in later life is a public health concern. Given the need for practical guidance and policy implementation, this paper aims to provide a critical interpretive synthesis approach to prioritize the likely relevance of publications and the contribution that they make to understanding of the problem.A selective review of the English language literature focusing on the epidemiology of suicide among older people was conducted; the search strategy built on that of a previous review. Papers were selected for their ability to shed light on the potential for prevention and practice from public health perspectives.Whilst the majority of older people who commit suicide have major depression, suicide seems to be due to a combination of personality factors and co-morbidities, including chronic pa...

Specific psychological and behavioral symptoms of depression in patients with dementia

International Journal of Geriatric Psychiatry — Tue, 26 Jan 2010 00:00:00 +0100

This study aimed to characterize the psychological and behavioral manifestations of depression in patients with dementia.We recruited patients with dementia from several nursing homes in the Limousin region of France. Depression was as diagnosed by the Cornell Scale for Depression in Dementia (CSDD) with a cut-off of 7, and BPSD were assessed using the Neuropsychiatric Inventory (NPI).Of 319 patients with dementia, 42.9% (n = 137) were depressed and 75.9% (n = 242) had BPSD. All BPSD were significantly (p < 0.0001) more prevalent among depressed patients, but no significant differences were observed according to sex and age. The NPI showed that the most common additional symptoms in depressed patients were agitation (43.2%), anxiety (42.3%) and irritability (40.1%). Four NPI-based factors ...

Memory complaints and increased rates of brain atrophy: risk factors for mild cognitive impairment and Alzheimer's disease

International Journal of Geriatric Psychiatry — Tue, 19 Jan 2010 00:00:00 +0100

To determine rates of cerebral atrophy in individuals with symptoms of memory loss but no objective cognitive impairment (SNCI) and their association with future cognitive decline.Thirty-two SNCI subjects, 16 with mild cognitive impairment (MCI) and 27 control subjects had clinical assessment and magnetic resonance imaging at baseline and 1 year later. Rates of whole brain atrophy (WBA), hippocampal atrophy (HA) and ventricular enlargement (VE) were measured. Our outcome was clinical diagnosis at 2 years after entry into the study.The MCI group had greater rates of WBA, HA and VE than both controls and SNCI subjects. As a group SNCI subjects did not have significantly greater rates of atrophy than the controls. However, SNCI subjects who progressed to MCI or dementia had increased rates of...

Does age at onset have clinical significance in older adults with bipolar disorder?

International Journal of Geriatric Psychiatry — Sat, 16 Jan 2010 00:00:00 +0100

While age at onset may be useful in explaining some of the heterogeneity of bipolar disorder (BD) in large, mixed age groups, investigations to date have found few meaningful clinical differences between early versus late age at onset in older adults with BD.Data were collected from sixty-one subjects aged 60 years and older, mean (SD) age 67.6 (7.0), with BD I (75%) and II (25%). Subjects were grouped by early ( (Source: International Journal of Geriatric Psychiatry)

The physical environment influences neuropsychiatric symptoms and other outcomes in assisted living residents

International Journal of Geriatric Psychiatry — Fri, 15 Jan 2010 00:00:00 +0100

Although the number of elderly residents living in assisted living (AL) facilities is rising, few studies have examined the AL physical environment and its impact on resident well-being. We sought to quantify the relationship of AL physical environment with resident outcomes including neuropsychiatric symptoms (NPS), quality of life (QOL), and fall risk, and to compare the effects for demented and non-demented residents.Prospective cohort study of a stratified random sample of 326 AL residents living in 21 AL facilities. Measures included the Therapeutic Environmental Screening Scale for Nursing Homes and Residential Care (TESS-NH/RC) to rate facilities and in-person assessment of residents for diagnosis (and assessment of treatment) of dementia, ratings on standardized clinical, cognitive...

Cognitive Stimulation Therapy (CST): effects on different areas of cognitive function for people with dementia

International Journal of Geriatric Psychiatry — Wed, 13 Jan 2010 00:00:00 +0100

This study looks at the subscales of the ADAS-Cog (memory and new learning, praxis and language) and compares the outcome of CST with a treatment as usual control group.There was a significant difference between treatment and control groups in total ADAS-Cog score (p = 0.01) and in the language subscale (p = 0.01). There were no significant changes in memory and orientation or praxis.CST appears to have particular effects in promoting language function, which is likely to lead to generalised benefits. This may be through generating opinions and creating new semantic links through categorisation. Future research might use more sensitive psychometric tests to assess these effects in more depth. Copyright © 2010 John Wiley & Sons, Ltd. (Source: International Journal of Geriatric Psychiatry)

Executive deficits and regional brain metabolism in Alzheimer's disease

International Journal of Geriatric Psychiatry — Tue, 12 Jan 2010 00:00:00 +0100

This study examined regional brain hypometabolism associated with executive dysfunction in patients with AD.Forty-one patients with probable AD underwent [18F] fluorodeoxyglucose positron emission tomography (FDG-PET) imaging at rest. Neuropsychological measures of executive control included the Conceptualization (Conc) and Initiation/Perseveration (I/P) subscales of the Mattis Dementia Rating Scale (DRS), the Wechsler Adult Intelligence Scale (WAIS) Similarities subtest, the Tower test, and the Ruff Figural Fluency test (Ruff). Voxel-based analyses were conducted using statistical parametric mapping (SPM2) to measure the correlation between regional cerebral metabolism and executive measures. Correlations independent of global cognitive impairment were identified by including Mini-Mental ...

Assessing mild cognitive impairment among older African Americans

International Journal of Geriatric Psychiatry — Tue, 12 Jan 2010 00:00:00 +0100

This study demonstrates that impairment in a non-memory domain may be an early indicator of cognitive impairment, particularly among African Americans. Copyright © 2010 John Wiley & Sons, Ltd. (Source: International Journal of Geriatric Psychiatry)

Occurrence of depression and its correlates in early onset dementia patients

International Journal of Geriatric Psychiatry — Tue, 12 Jan 2010 00:00:00 +0100

We wanted to investigate the occurrence of depression in early onset dementia (EOD) patients and which characteristics were associated with depressive symptoms.We included 221 patients who were diagnosed with dementia before the age of 65. Depression in these patients was measured by the Montgomery Asberg depression scale (MADRS). Measurements of cognition, behavioural and psychological symptoms and activities of daily life were along with hypothyroidism, diabetes and stroke included in the analysis. History of depression, current psychiatric co-morbidity and usage of antidepressants were recorded.Mean age of patients was 58.6 years (SD = 5.2); 50.6% were women. Of them 123 patients (55.6%) had a mild degree of depression (MADRS total score 7-19), 21 patients (9.5%) had a moderate degree o...

Anxiety and its correlates among older adults accessing aging services

International Journal of Geriatric Psychiatry — Tue, 12 Jan 2010 00:00:00 +0100

To assess the characteristics of anxiety in aging services network (ASN) clients.Interviews were conducted as part of an academic-community partnership for studying the mental health needs of community-dwelling older adults. Participants consisted of ASN clients in Monroe County, NY, that were aged 60 years and older and received an in-home assessment for care management services. The Goldberg Anxiety Scale screened for anxiety symptoms, and instruments covering the domains of associated mental health, physical health and disability, social support, negative life events, and other areas relevant to delivery of aging services were administered.Of 378 subjects enrolled, 27% had clinically significant levels of anxiety. In bivariate analyses anxiety was associated with having a current major ...

Validation study of a French version of the modified telephone interview for cognitive status (F-TICS-m) in elderly women

International Journal of Geriatric Psychiatry — Thu, 07 Jan 2010 00:00:00 +0100

To evaluate the performance of a French version of the modified Telephone Interview for Cognitive Status (F-TICS-m) in identifying cognitive decline among elderly women.All women aged 72-86 participating in the 'Etude Epidémiologique auprès de Femmes de l'Education Nationale' (E3N) cohort and living in or near Paris constituted the target population of the validation study. Volunteer women (n = 120) underwent both a 20-min telephone interview and a face-to-face neuropsychological examination at an interval of few days (median interval: 10 days). The telephone interview included F-TICS-m, as well as a recall of key elements of a short story, arithmetic/verbal problems and two verbal fluency tests. Neuropsychological examination consisted of a standardized battery of cognitive tests (inclu...

Prevalence of mental disorders and service utilization in seniors: results from the Canadian community health survey cycle 1.2.

International Journal of Geriatric Psychiatry — Wed, 06 Jan 2010 00:00:00 +0100

This paper examined the 12-month rate of mental disorders and subsequent service use among Canadian seniors aged 65-79 and 80 and over and adults aged 20-49 and 50-64.This is a secondary analysis of data [n = 33 695] of the population-based Canadian Community Health survey, Cycle 1.2 (CCHS 1.2). Major Depressive Episodes (MDEs), specific Anxiety Disorders (AD) and Alcohol Abuse/Dependence rates were assessed.The 12-month rates for the two senior groups aged 65-79 and 80+ for MDEs, ADs, and Substance Dependence (SD) are 1.7% and 1.6%; 1.4% and 0.8%; and 0.1% and 0.0%, respectively. Seniors aged 65-79 and 80+ had significantly lower rates than adults aged 20-49 and 50-64 for all mental disorders and SD. Among the total sample, seniors aged 65-79 and 80+ had significantly lower utilization ra...

Using spaced retrieval and Montessori-based activities in improving eating ability for residents with dementia

International Journal of Geriatric Psychiatry — Wed, 06 Jan 2010 00:00:00 +0100

This study confirms the efficacy of SR and Montessori-based activities for eating difficulty and eating ability. A longitudinal study to follow the long-term effects of SR and Montessori-based activities on eating ability and nutritional status is recommended. Copyright © 2010 John Wiley & Sons, Ltd. (Source: International Journal of Geriatric Psychiatry)

Subtle deficits of attention after surgery: quantifying indicators of sub syndrome delirium

International Journal of Geriatric Psychiatry — Wed, 06 Jan 2010 00:00:00 +0100

To determine whether attentional impairments are reliable neuropsychological markers of sub syndrome delirium.A prospective cohort study with repeated assessment beginning pre-operatively and continuing through the first post-operative week. Computerized assessments of attention and the Mini-Mental State Examination were administered with one hundred patients admitted for elective orthopedic surgery, 70 years and over and free of dementia. Acute change of cognitive status was used to identify cases of sub syndrome delirium.There were significant differences of post-surgical performance between the 'no delirium' and 'sub-syndrome delirium' groups of reaction time, global cognition, accuracy and greater variability of reaction time (p < 0.041). There were significant within subject main effe...

Effects of discontinuing benzodiazepine-derivative hypnotics on postural sway and cognitive functions in the elderly

International Journal of Geriatric Psychiatry — Wed, 06 Jan 2010 00:00:00 +0100

Benzodiazepines (BZDs) have been reported to cause negative impacts on body stability and cognitive functions, which in turn could result in lethal incidents, including falls, especially in the elderly. This fact notwithstanding, no systematic trial has evaluated the feasibility and benefits of discontinuing BZD-derivative hypnotics in this population, which was addressed in this study.In this 8-week open-label study, subjects aged [ge]60 living in a nursing home who received BZD as a hypnotic were recruited. The BZD dose was tapered off over 3 weeks. The following assessments were performed 12 h post-dose at baseline and at endpoint: the Clinical Stabilometric Platform (CSP), the Critical Flicker Fusion Test (CFF), the Repeatable Battery for the Assessment of Neuropsychological Status (RB...

Broad spectrum assessment of psychopathology and adaptive functioning with the Older Adult Behavior Checklist: a validation and diagnostic discrimination study

International Journal of Geriatric Psychiatry — Wed, 06 Jan 2010 00:00:00 +0100

Self-administered by spouses and other collateral informants, the nationally normed Older Adult Behavior Checklist (OABCL) provides standardized data on diverse aspects of older adult psychopathology and adaptive functioning. We tested the validity of the Older Adult Behavior Checklist (OABCL) scale scores in terms of associations with diagnoses of dementia of the Alzheimer's type (DAT) and mood disorders (MD) and with nine measures of psychopathology, cognitive performance, and adaptive functioning.Informants completed OABCLs for 727 60-97-year-olds recruited from a memory disorders clinic, geriatric psychiatry clinic, and community-dwelling seniors. OABCL scale scores were tested for associations with DAT and MD diagnoses, as well as with scores on the Neuropsychiatric Inventory, Mini-Me...

The neuropsychological characteristics and regional cerebral blood flow of vascular cognitive impairment-no dementia

International Journal of Geriatric Psychiatry — Wed, 06 Jan 2010 00:00:00 +0100

To investigate the neuropsychological characteristics of VCI-ND and to analyze the relationship between deficit pattern and regional cerebral blood flow (rCBF) in various VCI-ND subtypes defined by cognitive features.69 subjects diagnosed with VCI-ND were recruited, then further classified into four subtypes: amnestic VCI-ND with single memory impairment (subtype I, n = 19), amnestic VCI-ND with multi-domain impairment (subtype II, n = 27), non-amnestic VCI-ND with single domain impairment (subtype III, n = 16), and non-amnestic VCI-ND with multi-domain impairment (subtype IV, n = 7) according to their cognitive profile. Xenon-CT scan was administered to 31 VCI-ND patients (11 of subtype I, 12 of subtype II and 8 of subtype III) and 10 normal controls (NC) to evaluate rCBF.The rate of diff...

Evaluation of special and traditional dementia care in nursing homes: results from a cross-sectional study in Germany

International Journal of Geriatric Psychiatry — Wed, 06 Jan 2010 00:00:00 +0100

Two-thirds of all residents in nursing homes in Germany suffer from some type of dementia. We investigated whether or not dementia patients receiving special (segregated or partially segregated) care exhibited a better quality of life than their counterparts residing in traditional nursing homes.In a cross-sectional study in 28 special dementia care facilities in the city of Hamburg (admission criterion: mobile dementia patients with behaviour problems) 594 residents were compared to a group of nursing home residents with dementia (n = 573) in 11 randomly selected nursing homes who were receiving traditional integrative care. Primary features such as cognitive and functional impairment, and behaviour problems were assessed by qualified nursing staff.Controlling for confounding variables, f...

A review comparing the safety and tolerability of memantine with the acetylcholinesterase inhibitors

International Journal of Geriatric Psychiatry — Tue, 05 Jan 2010 00:00:00 +0100

Alzheimer's disease (AD) is prevalent among elderly people, who often have comorbid conditions, and may be prescribed multiple medications. Drug safety and tolerability is paramount in maximising efficacy and optimising patient and carer quality of life, as patients are vulnerable to adverse events (AEs) and/or compliance difficulties. The two principal categories of drug used in the treatment of AD are the acetylcholinesterase inhibitors (AChEIs) and the NMDA-receptor antagonist, memantine. This paper reviews the most recent safety data for memantine in comparison with the AChEIs.Review of most recent safety/tolerability data for memantine and AChEIs, derived from meta-analyses, pooled analyses, European SPCs and EMEA publications.Memantine was found to have a favourable tolerability prof...

Subjective well-being, social support, and age-related functioning among the very old in China

International Journal of Geriatric Psychiatry — Thu, 24 Dec 2009 00:00:00 +0100

Previous research has suggested that social support and functional status influence the subjective well-being of the elderly. However, few studies have investigated whether these associations influence well-being in the very old.In this population-based, cross-sectional study, 1401 persons aged 90 years or over were located in Du Jiang Yan city, Sichuan, China. Among them 732 were willing to participate and provided data on a battery of standardized questionnaire inventories. The 23-item Philadelphia Geriatric Center Morale Scale (PGCMS) was examined as an index of subjective well-being. Functional status was assessed using the physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scales. The mini-mental state examination (MMSE) was used to measure c...

Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles

International Journal of Geriatric Psychiatry — Wed, 23 Dec 2009 00:00:00 +0100

To review evidence regarding the prevalence, causation, clinical implications, aspects of healthcare utilisation and management of depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease.A critical review of the literature (1994-2009).The prevalence of depression and anxiety is high in both chronic obstructive pulmonary disease (8-80% depression; 6-74% anxiety) and chronic heart failure (10-60% depression; 11-45% anxiety). However, methodological weaknesses and the use of a wide range of diagnostic tools make it difficult to reach a consensus on rates of prevalence. Co-morbid depression and anxiety are associated with increased mortality and healthcare utilisation and impact upon functional disability and quality of life. Despite these negative consequence...

Chronic endurance exercise training prevents aging-related cognitive decline in healthy older adults: a randomized controlled trial

International Journal of Geriatric Psychiatry — Wed, 23 Dec 2009 00:00:00 +0100

To evaluate the effects of endurance exercise training (EET) on the cognitive status of healthy community-dwelling older adults.A randomized controlled trial was conducted involving community-dwelling older adults from the town of Pianoro (northern Italy). We randomized 120 healthy subjects aged 65-74 years, both genders, to treatment (N = 60) and control (N = 60) groups. The treatment consisted of 12 months of supervised EET in a community gym, 3 h a week. All participants were assessed both at baseline and after 12 months on an intention-to-treat analysis. Cognitive status was assessed by one single test (Mini Mental State Examination, MMSE). Anthropometric indexes, routine laboratory measurements and C-reactive protein (CRP) were also assessed.The control group showed a significant decr...

Awareness of carer distress in people with dementia

International Journal of Geriatric Psychiatry — Wed, 23 Dec 2009 00:00:00 +0100

This study investigated whether or not people with dementia are aware of the level of distress experienced by their carers.Two groups of participants were studied, a dementia group and a control group of people with arthritis. Each group consisted of pairs of people, the person with dementia or arthritis and the family member who acted as their main carer; 40 pairs participated in total. For both groups, the carer's psychological health was rated by the carer themselves and by the care-recipient, using the Hospital Anxiety and Depression Scale. For the dementia group, memory functioning in the person with dementia was rated by the care-recipient themselves and by the carer, using the Memory Function Scale. The ratings made by the carer and care-recipient were compared to give an indication...

Brief problem-solving treatment in primary care (pst-pc) was not more effective than placebo for elderly patients screened positive of psychological problems

International Journal of Geriatric Psychiatry — Wed, 23 Dec 2009 00:00:00 +0100

To evaluate whether screening followed by brief problem-solving treatment by primary care doctors (PST-PC) could improve health-related quality of life (HRQOL) and reduce consultation rates in the elderly.A single-blind randomized placebo controlled trial (RCT).Two government funded primary care clinics in Hong Kong.Two hundred and ninety nine Chinese patients aged 60 years or over, with positive screening scores for psychological problems by the Hospital Anxiety and Depression Scale (HADS).One hundred and forty nine subjects were randomized to receive brief PST-PC from primary care doctors (treatment) and 150 to group video-viewing (placebo). All subjects were followed up by telephone at 6, 12, 26 and 52 weeks.Changes in SF-36 HRQOL scores, HADS scores and monthly consultation rates were ...

Reliability and validity of the PHQ-9 for screening late-life depression in Chinese primary care

International Journal of Geriatric Psychiatry — Wed, 23 Dec 2009 00:00:00 +0100

The aim of this study was to examine the reliability and validation of the 9-item Patient Health Questionnaire (PHQ-9) for late-life depression in Chinese primary care.In the primary care clinics (PCCs) of Hangzhou city, we recruited 364 older patients (aged [ge] 60) for the PHQ-9 screening. Then 77 of them were further interviewed with Structured Clinical Interview for DSM Disorders (SCID) for the diagnosis of major depression in late life. Statistic strategies for the feasibility, reliability, validity, and receiver operating characteristic curve were performed.The mean administration time was 7.5 min, and the Cronbach's [alpha] was 0.91. The optimal cut-off score of PHQ-9 [ge] 9 revealed a sensitivity of 0.86, specificity of 0.77, and positive likelihood ratio of 5.73. The area under th...

Canadian Alzheimer's disease caregiver survey: baby-boomer caregivers and burden of care

International Journal of Geriatric Psychiatry — Tue, 22 Dec 2009 00:00:00 +0100

Alzheimer's disease (AD) burdens not only the person, but also the person's caregiver(s). This burden has been linked to negative health effects for caregivers. To that end, a survey of Canadian caregivers of persons with AD/other dementias was conducted to investigate the social, physical, psychological and financial impact of AD and/or dementia-related conditions on caregivers' quality of life.A web-based survey, the Canadian Alzheimer's Disease Caregiver survey, was made available through the Canadian Alzheimer's Society website and 50plus.com, an internet portal for baby boomers (BB) (people aged 50 years or older), as well as through HarrisDecima Research's e-Vox panel. A total of 398 individuals completed the survey between 15 September and 5 November 2006.Of the 398 total respondent...

Ageism in first episode psychosis

International Journal of Geriatric Psychiatry — Tue, 22 Dec 2009 00:00:00 +0100

To consider the characteristics of first episode psychosis in older adults in a county in North East England.The present study used a naturalistic design to compare individuals aged 65 years and over with those under 65, with a first episode psychosis. Data were collected on demographics, diagnosis at presentation and hospital admissions in the first year.Almost a quarter of all patients were aged 65 years or older. The older group were admitted later on after presentation, but with longer average hospital stays (p < 0.01), compared to the younger group, with no difference in the use of the Mental Health Act. Late onset schizophrenia (40-59 years) and very late onset schizophrenia-like psychosis (60 + years) formed a considerable proportion of patients.There is a substantial proportion of ...

Evaluation of the factor structure and psychometric properties of the brief symptom inventory - 18 with homebound older adults

International Journal of Geriatric Psychiatry — Thu, 10 Dec 2009 00:00:00 +0100

Homebound older adults are at high risk for depression and anxiety. Systematic screening may increase identification of these difficulties and facilitate service usage. The purpose of this study was to investigate the factor structure, internal consistency, and concurrent validity of the Brief Symptom Inventory - 18 (BSI-18) for use as a screening instrument for depression and anxiety with homebound older adults and to examine if the BSI-18 could be shortened further and exhibit comparable psychometric properties.A sample of 142 older adults receiving in-home aging services completed interviews that included the BSI-18 and the depression and anxiety modules of the structured clinical interview for DSM-IV.Confirmatory factor analysis showed that the theorized three-factor, second-order mode...

Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults

International Journal of Geriatric Psychiatry — Wed, 09 Dec 2009 00:00:00 +0100

It has been reported that late onset depression is more frequently associated with acquired organic pathology and that patients are less likely to report a family history of depression. Differences in phenomenology according to age of onset have been described although these have not been consistently replicated. The majority of these studies have been in hospital populations. The aim of this study is to address this question in a sample of community dwelling older adults.89 subjects with GMS-AGECAT depression were identified from a sample of 1231 community dwelling adults aged 65 years and over. Subjects were analysed across a range of aetiological and phenomenological variables according to age of onset of first depressive episode.Subjects with late onset depression ([ge] 60) were signif...

The reliability of three depression rating scales in a general population of Dutch older persons

International Journal of Geriatric Psychiatry — Tue, 08 Dec 2009 00:00:00 +0100

To compare the reliability of three rating scales for assessing depressive symptoms in a community-based, non-clinically depressed older population.The study sample comprised of 302 independently living subjects aged 65 years or older. Depressive symptoms were assessed using the centre for epidemiologic studies depression scale (CES-D), the geriatric depression scale (GDS-15) and the Montgomery and Åsberg depression rating scale (MADRS) at three time points: at baseline, after 13 weeks (except the GDS-15) and after 26 weeks. Three dimensions of reliability were compared: (i) internal consistency (Cronbach's alpha), (ii) reproducibility (Spearman correlations) and (iii) the intra- and inter-rater reliability (Spearman correlations to compare the differences between correlations of subjects...

Cognitive impairment and the role of the ApoE [epsiv]4-allele after stroke - a 13 months follow-up study

International Journal of Geriatric Psychiatry — Fri, 04 Dec 2009 00:00:00 +0100

To examine the relationship between the ApoE [epsiv]4 allele and cognitive impairment 13 months after stroke.One hundred four stroke rehabilitation patients were cognitively tested on average 18 days after hospital admission and again 13 months later with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The following potential risk factors for post-stroke cognitive impairment (defined by a RBANS total index score below 77.5 points) at 13 months follow-up were analyzed in bivariate and logistic regression analyses: ApoE-genotype, socio-demographic variables, pre-stroke cognitive reduction (The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)), vascular factors, lesion characteristics, and neurological impairment (The National Institute of H...

Predictors of adherence to atypical antipsychotics (risperidone or olanzapine) in older patients with schizophrenia: an open study of 3½ years duration

International Journal of Geriatric Psychiatry — Sat, 28 Nov 2009 00:00:00 +0100

Although the evidence base for the use of antipsychotics in older people with schizophrenia is generally of low quality, it tends to support the use of atypical antipsychotics. Only limited information regarding longer term adherence to these apparently more effective drugs is available. The aim of this study was to determine predictors of adherence to risperidone or olanzapine in patients over 60.Patients receiving care from old age psychiatrists for their schizophrenia were randomised to treatment with olanzapine or risperidone and were followed for up to 3½ years. Kaplan-Meier curves were generated to assess the univariate effect of randomisation drug on long-term adherence and Cox regression adjusted for baseline variables which may have affected adherence.In total, 60.6% of the 66 pa...

Panic disorder in older adults: evidence from the national epidemiologic survey on alcohol and related conditions