ISSN:0885-6230    

DOI:10.1002/gps.930090802

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractWeight loss is commonly observed in patients with Alzheimer's disease and is an accepted symptom of the clinical diagnostic criteria in current use. It is, however, unclear as to whether disease or dietetic factors are responsible for the causation of weight loss. Difficulty also arises due to variability in clinical diagnostic criteria used in defining Alzheimer's disease and clinical heterogeneity with respect to weight loss. This review examines the evidence available for weight loss in Alzheimer's disease and the possible explanations for this.

ISSN:0885-6230    

DOI:10.1002/gps.930090803

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractWe examined factor structures of the 30‐item Geriatric Depression Scale in a sample of depressed nursing home residents at various levels of cognitive functioning (N=917; observation‐to‐variable ratio 30.6:1). Using principal components analysis and orthogonal varimax rotation, a six‐factor structure involving 26 of the 30 items was derived. This solution, which explained 55.1% of the variance, consisted of the following factors: life dissatisfaction, dysphoria, hopelessness/decreased self‐attitude, rumination/anxiety, social withdrawal/decreased motivation and decreased cognition. This factor solution shows that a screening test for depression like the GDS may be able to make stable and independent distinctions between various dimensions associated with depressed mood in nursing home residents. The factors derived map well onto commonly recognized dimensions of depressed mood in frail older adults residing in long‐term care facilities. The proposed six‐factor solution offers a stable, intuitively sound and statistically supported framework for differentiation of depressive screening data into independent dimensions. This, in turn, offers opportunities for clinical differentiation in both practice and research efforts

ISSN:0885-6230    

DOI:10.1002/gps.930090804

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThere is increasing interest in measuring and regulating the quality of long‐term institutional care for elderly people during an era of change in the funding and provision of such care. We report the development and use of a postal questionnaire intended as a cheap, reliable and valid method for quality evaluation. The 18‐item questionnaire was derived from a set of standards for quality of long‐term care originally selected by patients and staff as appropriate for this purpose. The questionnaire was sent to a random sample of private residential homes and to all other voluntary, local authority and health service establishments providing long‐term care in one health district. There was a 94% response rate. Follow‐up in‐depth studies in a stratified random sample of establishments were undertaken. Reliability of the questionnaire was acceptable (intrarater, r= 0.88; interrater, r=0.73). There were significant differences in quality scores between sectors (p<0.001) and a positive correlation between quality score and physical independence of residents, as measured by the Barthel Index (r= 0.48). The postal questionnaire, able to detect differences within and between the different sectors of care provision, has potential for setting national and local sectoral norms for quality of care. It could be used as a screening tool for individual establishments and inspectorate bodies prior to more detailed internal or ext

ISSN:0885-6230    

DOI:10.1002/gps.930090805

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractPhysically ill elderly patients (N= 236) in a geriatric and a general hospital were interviewed with the Geriatric Mental State (GMS) schedule. Psychiatric diagnoses made by the computer programme ‘AGECAT’ were compared with those made by a psychiatrist who applied DSM‐III‐R diagnostic criteria to the GMS data. Overall kappa for all diagnostic groups was 0.78. Agreement was excellent for organic diagnoses and good for depression. GMS‐AGECAT can be used with confidence to detect common psychiatric disorders in physically ill elderly general and geriatric hospital

ISSN:0885-6230    

DOI:10.1002/gps.930090806

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe aim of this study was to examine whether cognitive test performance alone could distinguish patients with dementia of Alzheimer type (DAT) from those with frontotemporal dementia (FTD). Scores from three neuropsychological tests were used as discriminating variables in 28 cases with postmortem verified diagnoses. The selected tests measured verbal ability, visuospatial ability and verbal memory. Eighty‐nine per cent of the sample was correctly classified by discriminant analysis. Evaluating the ability of the obtained discriminant function to differentiate between groups of DAT and FTD in a new, clinically diagnosed sample of 38 cases yielded an overall success rate of 84%. The results suggest that cognitive tests may be helpful for differential diagnosis in the context of a neuropsychiatric examinatio

ISSN:0885-6230    

DOI:10.1002/gps.930090807

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractTo study the efficacy and safety of prolonged tacrine administration, we monitored 41 patients meeting NINCDS–ADRDA criteria for probable Alzheimer's disease while taking tacrine on an open basis for a period of up to 192 weeks. Dependent variables were the Abbreviated Mental Test Score (AMTS) and aspartate transaminase levels (AST) as a measure of liver function which was tested every 2 weeks at first and at less frequent intervals thereafter, the 10‐week measure being taken as an index of long‐term liver function. Survival analysis revealed that the median time for the AMTS score to decline from its level at the open label baseline to at least one point below on two successive occasions was 91.5 weeks (range 20–190 weeks). Fifteen patients showed liver function abnormalities during tacrine administration but these abnormalities resolved following reduction of the dose in all but two patients. We conclude that tacrine may temporarily delay the progression of symptoms of Alzheimer's disease and that administration of this drug can safely be prolonged with appropriate clinical supervision. These results may help to guide the clinical use of tacrine now that this drug has been licensed in some countries and is under consideration in

ISSN:0885-6230    

DOI:10.1002/gps.930090808

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe present study was designed to determine whether oral tacrine (tetrahydraminoacridine, THA) improves the symptoms of patients with mild to moderate Alzheimer's disease. The study was a multicentre, randomized double‐blind, placebo controlled, parallel group study with individual determination of maximum tolerated dose over a period of 12 weeks. One hundred and fifty‐four patients (93 women) aged 44–92 years (mean 75) were selected as having probable Alzheimer's disease as defined by NINCDS–ADRDA workgroup classification and a Mini‐Mental State Examination score of 10 or more. Most patients were titrated to 80 mg of tacrine per day. Tacrine improved patients in clinicians‘ global ratings and the relatives’ global rating compared to placebo (p<0.05). Tacrine did not significantly improve the Mini‐Mental State Examination score, although as with other scores the trend favoured tacrine. There was a substantial variation in response among patients. Twelve patients in the tacrine and four in the placebo group were withdrawn from the study due to raised LFTs or adverse events. No serious sequelae resulted from these. One patient in the placebo group and two in the tacrine group died from causes which were considered unrelated t

ISSN:0885-6230    

DOI:10.1002/gps.930090809

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractIn a retrospective study of 69 elderly (65 years and over) cases of attempted suicide (deliberate self‐harm) referred for psychiatric assessment in southern Sydney, 81% of took overdoses, 64% involving benzodiazepines. Depressive illness was present in 87% of cases, alcohol/substance abuse in 32%, organic syndromes in 29% and personality dysfunction in 26%. Multiple psychosocial, psychological, medical and psychiatric risk factors for suicide were identified. ‘Major’ functional psychiatric disorders (41%) were found predominantly in females and were associated with higher levels of suicidal intent, psychosis and fewer chronic physical illnesses. ‘Minor’ functional disorders (30%) were associated with lower degrees of suicidal intent, personality dysfunction and higher numbers of psychosocial stressors. Organic brain syndromes were associated with males over 75 years, chronic physical illness, and were often comorbid with depression. These findings indicate that there are several patterns of suicidal behaviour in the elderly that require further prospective

ISSN:0885-6230    

DOI:10.1002/gps.930090810

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe development of and the demand for geriatric psychiatric services (GPS) have increased over the past decade. Psychopathology, autonomy, physical disorders, sociodemographics, social support and caregivers' burden have all been advanced as influencing the elderly's risk of hospitalization. These factors were examined in a 1‐year prospective study of 87 new patients consulting a catchment‐area GPS. Standardized assessments were used, including both patients' and caregivers' independent measures of patients' social network. Entry points to the study were as follows: 70.1% of patients came from an outpatient clinic and 25.3% were admitted directly to psychiatric wards. Subjects were followed up 1 year after discharge or first contact. Overall, 47.1% of the sample was admitted to a higher‐supervision setting during the 1‐year follow‐up, including 20.7% of the total sample admitted to GPS wards. Multivariate logistic regression analysis indicated different factors influencing admission according to the definition of admission. Loss of autonomy was a key factor related to both psychiatric and overall admissions. Previous admission was a predictor of psychiatric admissions only. Relatives' strain and not living with spouse were predictors of overall admissions. The results indicate that functional consequences of disease (eg loss of autonomy) and resilience of relatives are key in predicting the elderly's need for greater su

ISSN:0885-6230    

DOI:10.1002/gps.930090811

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY