ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The North Manhattan Aging Project registry, using both Reporting and Survey Components, identifies dementia cases among Latino, African-American, and non-Latino white sociocultural groups (9,349 persons 65 years of age or older) in contiguous census tracts. During a 2-year prevalence period of the reporting component, 1,592 persons were reported to the Registry and screened with five widely used brief cognitive measures; 844 were evaluated in a “clinical core,” and 452 met research criteria for dementia, covering all subtypes, according to DSM-III-R criteria. Thirteen different case definitions for dementia were applied to the sociocultural groups at three levels of educational achievement, examining for associations with rates of dementia cases and controlling for age. The following findings were robust across case definitions: sociocultural membership was not associated, but lower education was associated, with increased rates of recorded dementia; however, the patterns of the association with education varied across sociocultural groups.

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The authors present the conclusions of a workshop devoted to the challenges to clinical research in the changing environment of managed care and health care reform. They identify problems and concerns with current conditions and discuss promising opportunities for new approaches to research.

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A retrospective chart review was conducted of 20 older patients treated with clozapine, who were hospitalized for treatment of severe behavioral disruption secondary to psychotic symptoms. The average daily dose of clozapine was 208 mg for an average of 22 hospital days. Follow-up was 12 months after hospital discharge. All patients had significant behavioral improvement; there was modest reduction in psychotic symptoms (hallucinations and delusions). Clozapine was discontinued in two patients who developed respiratory symptoms. One patient developed seizures. Three of 18 patients developed leukopenia during the posthospital period, two at 6 weeks after beginning clozapine and one within 10 weeks. Clozapine was then discontinued and white blood cell count returned to normal. These retrospective observations suggest that clozapine is possibly useful in controlling behavioral disruption in older patients. Older patients may be at greater risk for developing leukopenia because of their higher blood levels of clozapine and possibly norclozapine.

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Neuropsychological test batteries alone are often unable to differentiate very mild dementia from both normal aging and mild dementia of the Alzheimer type (DAT). The authors hypothesized that some of the difficulties of neuropsychological tests in the identification of very mild dementia could be overcome by the inclusion of additional levels of assessment (activities of daily living, psychopathology, and subjective complaints). Three groups (very mild dementia, mild-to-moderate DAT, and healthy control subjects) of community-dwelling older persons were assessed on cognitive and noncognitive variables. Results indicated that noncognitive variables improved prediction of group assignment. For accurate identification of all patients with very mild dementia, in addition to neuropsychological variables, subjective complaints of impaired orientation and disturbances of apperception were necessary and sufficient.

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Thirty-nine psychiatric patients age 50 and older with diagnoses of depression participated in a study of the reliability of screening instruments in the identification of depression. All patients had a diagnosis of affective disorder confirmed by a SCID interview. Forty-nine percent of the depressed patients were black, 51% were 70–92 years old, 77% were women, and 51% were widowed. When the Center for Epidemiologic Studies-Depression Scale (CES-D) was administered to these depressed patients, its sensitivity in black patients was 71% and in white patients was 85%. The sensitivity of the Geriatric Depression Scale (GDS) was 53% in black patients and 65% in white patients. The CES-D was significantly better than the GDS in the identification of depressive symptoms in this sample. These data suggest that the CES-D and the GDS may not be equally effective in identifying depression among older American black and white patients. Further studies with larger samples of SCID-diagnosed, depressed, older black and white patients are needed to confirm these findings.

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This study applies the concept of “negative symptoms,” previously used in schizophrenia, to dementia of the Alzheimer type (DAT) and examines the relationship of negative symptoms to cognitive deficits and depression. The negative symptom subscale of the Positive and Negative Symptom Scale (PANSS-N), the Hamilton Depression Scale (Ham-D), and the Mini-Mental State Examination (MMSE) were administered to 26 patients with DAT and to 13 normal control subjects. The mean PANSS-N score in DAT patients was significantly higher than in control subjects. DAT patients demonstrated significant correlation between negative symptoms and cognitive deficits. Ham-D scores did not significantly correlate with MMSE or PANSS-N scores. These results indicate that negative symptoms are prevalent in DAT and do not result from depression.

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Two commonly used geriatric depression rating scales are the Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CS). The GDS is a self-rating scale used to identify depressed older adults, whereas the CS is used to assess severity of depression based on a clinical interview. Because the scales may thus be complementary, their use was examined in 182 patients undergoing an outpatient geriatric assessment. Geriatric psychiatrists, blind to the results of the GDS, completed the CS and assigned clinical diagnoses. Both scales distinguished depressed from nondepressed individuals by means of ROC-generated cutoff scores relative to a clinical diagnosis of depression. The scores on the depression scales were not affected by cognitive status as measured by the Mini-Mental State Examination. The mean GDS scores did not vary by geriatric psychiatrist. The mean CS scores, however, did significantly differ across psychiatrists despite the fact that the psychiatrists were not blind to patients' clinical diagnosis.

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Anticipation of regret for choosing the wrong option may directly affect physicians' choice of treatment. As part of a pilot survey of physician practices for agitated dementia patients, we asked geriatric psychiatrists, primary care physicians, and neurologists to estimate the degree of anticipated regret that they might experience in response to a series of brief case vignettes describing typical treatments and outcomes for agitated dementia patients. Eight written vignettes described physician action (ordering vs. not ordering), type of intervention (haloperidol vs. physical restraints), and outcome of the intervention (adverse patient outcome vs. adverse staff outcome). Regret was measured by using a five-point Likert scale. A full factorial regression model found that “not ordering” actions were associated with more regret than “ordering” actions, regardless of specialty, intervention, or outcome. Also, geriatric psychiatrists, compared with the other physician groups, expressed the least regret for ordering (and the most for not ordering) haloperidol.

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The authors analyzed data from 42 inpatients age 55 or older with major depression. Ten patients had psychotic depression, and 32 had nonpsychotic depression. There were no significant differences between the two groups in mean age at onset of depression, proportion of patients with previous episodes of depression, frequency of suicidal ideation, or number of family members with serious psychiatric illnesses. Patients with psychotic depression had greater severity of depression and more severe overall psychopathology at admission than the non-psychotic group. Neuroleptics were used in a majority of the psychotic patients but in none of the nonpsychotic patients, whereas antidepressant use was similar. By the time of discharge, the two groups did not differ in severity of symptoms.

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID