摘要:

AbstractDelirium in the elderly attracts sporadic attention in the literature yet constitutes a major challenge to health services, complicating many illnesses and procedures in elderly patients, associated with high rates of mortality, cutting across disciplinary boundaries and posing theoretical difficulties for the organic/functional distinction that pervades medicine. In this review the importance of delirium in the elderly is emphasized, drawing attention to the suffering caused to the patient and the excess mortality. Problems of nomenclature (why use one word when three will do?) are discussed, the conclusion being that the oldest term is probably the best, provided that the concept of a ‘syndrome’ is preserved. Difficulties in research assessment are identified, and aetiology and the relationship of the delirium syndrome to dementia syndromes are discussed. Deficiencies in past approaches to management are identified and a definition of delirium is suggested. Finally, a proposal for a research programme is outli

ISSN:0885-6230    

DOI:10.1002/gps.930040603

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractWith advancing age, postoperative confusion is an increasingly important problem. Its aetiology is complex and multifactorial and includes surgical factors, anaesthetic factors, preexisting medical, psychiatric or psychological problems and postoperative complications. It often prolongs hospital stay and although mental function recovers in the majority of cases, it may be followed by permanent mental impairment. Postoperative confusion may interfere with the management of the original surgical problem and it occurs in a setting where interest and expertise in its management are low. There is scope for improved recognition, treatment and prevention of postoperative confusion. More work needs to be done to evaluate the effect of surgery and anaesthesia on mental function, especially in the very elderly.

ISSN:0885-6230    

DOI:10.1002/gps.930040604

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractDepression and depressive symptoms are reported to occur frequently in patients with Alzheimer's disease; however, familial and psychobiological contributions associated with depression in Alzheimer patients are poorly understood. In this study, we compared family history of depression and alcoholism in 44 patients with probable Alzheimer's disease and 38 aged‐matched cognitively intact controls. Results from comparison showed no overall difference between the occurrence of depression in first‐degree relatives of Alzheimer patients compared to first‐degree relatives of controls. There was, however, significantly lower incidence of alcoholism in relatives of Alzheimer patients, particularly male relatives (p<0.05). This finding suggests that family history and depression alone may not fully explain the high rate of depression in Alzheimer patients and that other factors including neurochemical changes in the brains of Alzheimer patients should be consi

ISSN:0885-6230    

DOI:10.1002/gps.930040605

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe effect of supplements of vitamins B‐1, B‐2, niacin, B‐6 and C has been assessed in a randomized double‐blind trial in 15 hospitalized elderly patients suffering from senile dementia. Supplementation did not prevent an increase in either cognitive impairment or behavioural disturbance. However, it did result in weight gain over a six‐week period. Hospitalized demented patients generally suffer significant weight loss, which increases with the duration of hospitalization. Vitamin supplementation may therefore protect against physical deterioration and the development of

ISSN:0885-6230    

DOI:10.1002/gps.930040606

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractOne hundred and sixty demented, community‐resident elderly people were identified by means of a community survey. Subjects who lived alone received home helps and meals‐on‐wheels more often than those who lived with supporters but there were no differences between the two groups with respect to district nursing or day care. Services increased in line with the degree of mental infirmity and nearly all moderately and severely demented people who lived alone were known to at least one service. We suggest that the home help and meals‐on‐wheels services, as presently constituted, may have limited applicability to dependent old people who live with able‐bodied supporters. If services are to provide effective assistance, they may need to adapt their provision to the actual needs of elderly people and thei

ISSN:0885-6230    

DOI:10.1002/gps.930040607

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractAs the pathological changes in Alzheimer dementia include degeneration of cholinergic neurones, several strategies have been used to enhance the activity of remaining cholinergic neurones, including the administration of anticholinesterases. Other drugs which have been claimed to have a beneficial effect on cognitive impairment in the aged and in various diseases include dihydroergotoxine (the most widely used in clinical practice), bufluomedil, piracetam and centrophenoxine. These drugs, and the many other compounds which have been investigated, have a wide variety of actions. However, drugs which improve the function of neuronal populations affected by pathogenic mechanisms can only be palliative. Future strategies for drug treatments will be directed towards reducing the adverse effects of the ageing process (which may include an increased susceptibility to a range of diseases) and neutralizing the pathogenic mechanisms related to genetic factors, infections, toxins, trauma, anoxia and diet. One mechanism which may operate in ageing and in some pathological changes is the production of ‘free radicals’, which can cause cellular damage. Prophylactic administration of drugs with antioxidant activity can reduce adverse effects of this process in animal models, and such treatments may also protect the brain from the effects of anoxia and other pathogenic mechanisms. Other drugs with therapeutic potential include antagonists of the excitatory effects of glutamate and aspart

ISSN:0885-6230    

DOI:10.1002/gps.930040608

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractFifty‐two elderly patients with dementia were examined in respect to 23 clinical variables including all 13 items of the Hachinski ischaemic score. A CT scan and EEG were also caried out. A three‐dimensional model was developed by a technique of multivariate analysis to demonstrate the relationship between symptoms. The characteristics of groups classified by the Hachinksi score were also examined during the course of a longitudinal study. For the atherosclerotic group it was found possible to extract symptoms which reflected the result of stroke and also to extract symptoms which reflected diminished cerebral blood flow. Symptoms characteristic of senile dementia of the Alzheimer type (senile dementia) classified by the Hachinski score were extracted from the distribution of symptoms in the model. During the course of a longitudinal follow‐up subjects classified by the Hachinski score as ‘mixed type dementia’ showed a high frequency of stroke and it is suggested that mixed types can be characterized as

ISSN:0885-6230    

DOI:10.1002/gps.930040609

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractTwo hundred and forty‐three consultant psychiatrists providing a service to old people were asked about teaching activities. Over half engaged in undergraduate teaching, covering all medical schools in the UK. Medical students they taught had a mean of six days' clinical attachment and 3.4 hours' lectures in old age psychiatry. There were fewer academic chairs as a proportion of total consultant posts in old age psychiatry than in psychiatry generally. Over 80% of respondents taught medical postgraduates and non‐medical groups. Compared with previous studies, there had been increases in undergraduate and postgraduate teaching (particularly with respect to general practice and geriatric trainees) and in teaching to nurses and social services personnel. Consultants with five or more sessions in old age psychiatry reported more involvement in undergraduate and non‐medical tea

ISSN:0885-6230    

DOI:10.1002/gps.930040610

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0885-6230    

DOI:10.1002/gps.930040602

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY