A comparison between three psychogeriatric rating scales

This study compares a new psychogeriatric rating scale, the Organic Brain Syndrome (OBS) scale, which is a combined observation and interview scale, with two other scales. Twenty-eight elderly demented patients took part in the study. The OBS scale was compared to the Gottfries, Bråne and Steen (GBS) scale, the Mini Mental State Examination (MMSE) scale and a global rating. The correlations between OBS, GBS and MMSE were high, showing that the concurrent validity is good. The ratings of the OBS scale were independent of the patient's physical disabilities as measured by Katz's index, ie the discriminant validity was good. The analyses show similarities and differences between the clinical dimensions described in the rating scales. The OBS scale contributes unique clinical information and is a valid instrument for assessment of dementia symptoms.     

Disturbed behaviour in dementia sufferers: A comparison of three nursing home settings

In order to determine whether a specialist psychogeriatric nursing home was fulfilling its intended role of caring for the most behaviourally disturbed dementia sufferers, 24 of its demented residents were compared with 28 demented individuals discharged from a psychiatric unit to ordinary nursing homes and 30 mobile dementia sufferers in nursing home wards of a geriatric centre. Those in the psychogeriatric nursing home showed more disturbed behaviours than those in the other two settings. Scores on the Rating Scale for Aggressive Behaviour in the Elderly were compared with degree of cognitive impairment for the first time in the literature and showed no correlation with degree of cognitive impairment for the first time in the literature and showed no correlation with congnitive performance.     

Comparison of rating scales for the diagnosis of dementia in adults with Down's syndrome

Making a diagnosis of dementia, particularly in its early stages, in a person with intellectual disability can be difficult. Some neuropsychological tests which were originally devised for the diagnosis of dementia in the non-intellectually disabled population have been modified for use in people with intellectual disability. Observer-rated scales have also been used for making a diagnosis of dementia in people with intellectual disability. Within the context of a genetic study, the rates of diagnosis of dementia according to different criteria, namely the clinician's diagnosis (ICD-10), the Dementia Questionnaire for Persons with Mental Retardation (DMR), the Dementia Scale for Down Syndrome (DSDS) and the Mini Mental State Examination (MMSE), were compared among 62 adults with Down's syndrome (26 demented and 36 non-demented adults according to the clinician's diagnosis). A comparison between the clinician's diagnosis and the diagnosis according to DMR criteria showed specificity and sensitivity at the 0.92 level for both categories. Similarly, a comparison between the clinician's diagnosis and the diagnosis according to the DSDS criteria showed a specificity of 0.89 and a sensitivity of 0.85. A good positive correlation was also shown between the scores of the DSDS and the DMR (Pearson's r = + 0.868, P 0.001). A similar positive correlation was found between the overall DSDS score and the scores in the main subcategories of the DMR. An MMSE could be performed in only 34 (55%) out of the 62 subjects with Down's syndrome. Out of the 30 subjects who had an MMSE score of less than 24 (the usual cut-off for the diagnosis of possible dementia), 23 (77%) did not have a diagnosis of dementia according to any criteria. It seems that the observer-rated scales, rather than the direct neuropsychological tests, are more useful for the diagnosis of dementia in people with an intellectual disability.     

老年痴呆患者徘徊行为临床研究

目的：探讨老年痴呆徘徊行为的发生及相关因素。方法：符合美国精神障碍诊断与统计手册第4版阿尔茨海默病(AD)与血管性痴呆(VD)诊断标准的痴呆患者68例,采用Algase徘徊量表(RAWS)评定徘徊行为的表现及严重程度。结果：老年痴呆者徘徊行为发生率为50．0％,RAWS各因子分中以空间定向障碍为主要表现形式,不同痴呆严重程度之间徘徊行为的发生率及RAWS评分差异显著,不同痴呆类型其徘徊行为的发生率也有明显差异;RAWS评分与简易精神状态检查量表(MMSE)总分存在显著负相关。结论：徘徊行为在老年痴呆患者中普遍存在,与认知功能障碍和痴呆的严重程度有明显关系,对于医疗、护理及社区照顾,防止患者走失、摔倒受伤具有重要现实意义。     

Increased response of serum prolactin to metoclopramide in senile dementia of Alzheimer type

The investigation studied the effect of intravenous administration of a dopamine blocking agent (metoclopramide) on serum prolactin levels in patients with senile dementia of Alzheimer type (SDAT) and in non-demented elderly controls. The response to metoclopramide was greater in the demented patients than in the controls, suggesting that dementia is associated with dysfunction in the tubero-infundibular pathway which controls prolactin secretion. This finding adds to the evidence that dopaminergic systems may be affected in dementia, in the absence of clinical evidence of extrapyramidal disorder.     

Physical complications for elderly inpatients with senile dementia in the Imaise Branch of Ichinomiya City Hospital

Background: In the present study, we investigated the physical complications of elderly patients with senile dementia in the Department of Psychogeriatrics, Imaise Branch, Ichinomiya City Hospital. Methods: Physical complications that occurred in our ward in the 12 months from April 2007 to March 2008 were recorded. Our ward has 50 beds and, over the 12 months, the average occupation rate was approximately 90%. We subdivided physical complications into two categories: (i) serious emergencies occurring in the ward with a possible high risk of mortality within a few days (e.g. pneumonia and upper airway obstruction); and (ii) life‐threatening complications arising in the ward that required diagnosis and treatment by specialists from other medical departments (e.g. bone fracture and cancer). Results: Serious emergencies with a high risk of mortality occurred 56 times. Six patients died. Life‐threatening complications requiring diagnosis and treatment by specialists from other departments occurred 44 times. Both categories of physical complications in occurred at a high rate, with various types of diseases recorded. Conclusions: The present study confirms the high frequency of physical complications that require treatment in facilities for patients with senile dementia. It is necessary to diagnose and treat these various physical complications and to cooperate with specialists from other medical departments.     

The GBS scale in multi-infarct dementia and senile dementia of Alzheimer type

The GBS profile was assessed for 39 patients with multi-infarct dementia (MID) and 34 patients with senile dementia of Alzheimer type (SDAT). The MID patients fulfilled the DSM-III criteria for multi-infarct dementia and had a score of 7 points or more on the Hachinski Ischemic Scale (HIS) and a score of 4 points or less on the Gustafson/Nilsson Alzheimer Scale (GNAS). The SDAT patients fulfilled DSM-III criteria for primary degenerative dementia and had a score of 5 points or more on the GNAS and a score of 6 points or less on the HIS. The total GBS score, the GBS subscale and relative subscale scores for intellectual functioning were significantly higher in patients with SDAT as compared with patients with MID. However, these subscale scores were considerably dispersed and nearly totally overlapping between patients with MID and SDAT, which implicates that the discriminative value is minimal. The validity between the GBS versus HIS and between the GBS versus GNAS was divergent, suggesting that the GBS scale has its own unique validity. In conclusion, the study does not support the hypothesis that the GBS profile may be of diagnostic value in clinical differentiation between multi-infarct dementia (MID) and senile dementia of Alzheimer type (SDAT).     

Prioritizing problem features in Korean patients with senile dementia for implementation of monitoring technologies

The purpose of this study was to investigate the central problem features of Korean patients with senile dementia and to prioritize the features according to risk to the patient with a view to the implementation of remote monitoring technologies. Twenty central problem features were extracted using factorial analysis. The frequency of violent language and confabulation, gathering, and repetition was significantly greater in female than in male patients with senile dementia. All central features, with the exception of abnormal sexual behavior and audiovisual deficits, differed in frequency between the normal elderly and the senile dementia patients and between patients with dementias of different severity. Judgment disorder was the greatest differentiating factor between the normal elderly and the patients with senile dementia. For dementia severity, memory disorder was the greatest differentiating factor of severe versus mild dementia. When risk to the patient was analyzed, problems of perception were identified as the problem features of highest priority.     

Evaluation of three aggression/agitation behaviour rating scales for use on an acute admission and assessment psychogeriatric ward

Background. In recent years many instruments measuring aggressive and agitated behaviours among the elderly in a variety of settings have emerged. Individual instruments have only occasionally been compared with each other. Method. Some psychometric properties of three aggression/agitation scales on an acute assessment and admission psychogeriatric ward were examined. The correlation between the Rating Scale for Aggressive Behaviour in the Elderly (RAGE), the Cohen-Mansfield Agitation Inventory (CMAI) and the Brief Agitation Rating Scale (BARS) and their internal consistencies and test–retest and interrater reliabilites were measured. Results. The RAGE was strongly correlated with the CMAI (rho=+0.73) and the BARS (rho=+0.72). The CMAI was strongly correlated with the CMAI (rho=+0·84). The internal consistency, as measured by Cronbach's alpha, was greater than 0·8 on all three scales. The test–retest and interrater reliability correlations were 0·75 or greater for all three scales (except the BARS interrater reliability correlation of 0·6). Conclusions. All three scales have good psychometric properties for use in acute admission and assessment psychogeriatric wards. © 1998 John Wiley & Sons, Ltd.     

Validity of a brazilian version of the mental status questionnaire as a screening test for dementia among elderly urban subjects. A pilot study

Validity of the Mental Status Questionnaire (MSQ) was assessed by comparing the screening scores against a standardized psychiatric evaluation, the Clinical Interview Schedule. In a pilot study patients with dementia were divided into two subgroups: Mild and moderate/severe cases. Including patients with mild dementia in the dementia group, the best balance between sensitivity and specificity fell at cutoff point 1/2. The validity coefficients were as follows: Sensitivity 80.0%, specificity 60.5% positive predictive value 10.5%, negative predictive value 98.1%, and overall misclassification rate 38.5%Including mild dementia in the non-dementia group, we observed that with six errors in the questionnaire the validity coefficients for moderate/severe dementia were: sensitivity 100.0%, specificity 94.4%, positive predictive value 16.7%, negative predictive value 100.0%, overall misclassification rate 5.5%. A discriminant analysis was run in order to select the most discriminant MSQ items for detecting dementia. Factors associated with misclassification in the questionnaire were investigated.     

城乡社区≥55岁人群、可疑痴呆和痴呆患者死亡率及生存率的研究

目的　了解社区≥ 5 5周岁人群、可疑痴呆和痴呆患者的死亡率及生存率。方法　在1997年调查成都地区城乡社区≥ 5 5周岁人群 5 35 3人中痴呆患病率的基础上 ,于 2 0 0 0年用随机整群抽样方法抽取 384 1人调查其死亡及生存情况。在 384 1人中随访到 30 5 8人 ,死亡 391人 ,外出或迁出 392人。基线调查用美国精神障碍诊断与统计手册第 3版修订本的标准诊断痴呆 ,用临床痴呆程度评定量表评定痴呆程度。结果　 (1)基线调查时被评为筛查阴性、复查正常、可疑痴呆和痴呆的患者 ,3 3年后随访时的死亡率分别为 2 9% (2 35人 )、6 2 % (85人 )、15 0 % (19例 )和 2 8 5 % (5 2例 )。其中阿尔茨海默病 (AD)、血管性痴呆 (VD)和其他类型痴呆 (OD)患者死亡率分别为 2 8 8% (40例 )、33 9% (8例 )和 19 9% (4例 )。 (2 )筛查阴性、复查正常、可疑痴呆和痴呆患者的生存率分别为90 5 %、81 8%、6 0 0 %和 37 6 % (χ2 =36 1 31,P <0 0 0 1)。从发病时起 ,AD、VD、OD的 5 0 %生存率时间分别为 7 0年、4 2年、10 3年。结论　痴呆患者死亡率高 ,可疑痴呆者次之 ,正常人最低 ;而生存率则相反。VD患者的死亡率高于AD和OD患者且存活期短。     

Neurofibrillary tangle predominant form of senile dementia of Alzheimer type: a rare subtype in very old subjects

In a consecutive autopsy series of 580 demented elderly subject, 256 with the clinical diagnosis of probable/possible Alzheimer's disease (AD), there were 10 cases aged between 80 and 99 years with moderate to severe dementia or confusional state in which neuropathological studies revealed abundant neurofibrillary tangles with predominant involvement of the allocortex (entorhinal region, subiculum, CA 1 sector of hippocampus, amygdala) but no or only very few senile plaques. Small numbers of diffuse deposits of A4 amyloid protein were present in the entorhinal cortex of 3 and in the isocortex of 5 brains, while neuritic plaques were totally absent. Only a few cases of this senile dementia with tangles only or, more correctly, neurofibrillary predominant type of AD corresponding to the limbic stage of neuritic AD pathology have been described in the literature. This rare subtype occurring in very old (over 80 years of age) subjects that does not fall within the currently used neuropathological criteria for diagnosis of AD warrants further clinico-pathological documentation.     

Psychiatric hospitalization of senile,presenile and arteriosclerotic dementia patients in israel: A psychiatric case register study

Most dementia patients in Israel are cared for by non-psychiatric services. Psychiatric hospitals are generally reluctant to admit behaviourally disturbed dementia patients, unless it is for appropriate psychiatric reasons and for a transient period of time. We used national Psychiatric Case Register (PCR) data to examine the implementation of these criteria in a sample of 711 dementia patients (senile and arteriosclerotic). Results suggest that: (a) in about a third of senile patients and in nearly half of arteriosclerotics no primarily treatable, psychiatric symptoma-tology was diagnosed; (b)most admissions were not on a psychiatric emergency basis; (c)inpatient stay of dementia patients was longer than the average psychiatric admission. These patients were usually transferred to a non psychiatric facility or to a general hospital, or died in the psychiatric hospital. We conclude that the subject of psychiatric hospitalization of dementia patients in Israel needs substantial revision.     

Violence among psychogeriatric inpatients with dementia

The characteristics of all patients with dementia admitted to an acute psychogeriatric admission ward over a 36-month period were examined. Patients with dementia who had been responsible for acts of violence were compared with those with dementia who had not. Violent patients were more likely to have an ICD-9 diagnosis of senile dementia. Levels of violence were low, with only a small number of patients exhibiting violent behaviour. The implications of these findings for evaluative studies of pharmacotherapy and staff training in aggression control techniques are discussed.     

A double-blind comparison of alaproclate and placebo in the treatment of patients with senile dementia

ABSTRACT– A double-blind parallel comparison of alaproclate and placebo was carried out in patients suffering from senile dementia of primary degenerative type, or multiinfarction dementia. Both groups consisted of 20 patients each, valid for efficacy evaluation. The patients received either alaproclate 200 mg twice daily or placebo according to a randomized procedure. The study started with a placebo washout period of 2 weeks followed by a 4-week period of active treatment or placebo and a finishing 2-week placebo washout period. The efficacy was evaluated with a dementia rating scale by Gottfries, Brane and Steen (GBS), selected items from the Comprehensive Psychopathological Rating Scale (CPRS), a rating scale for dementia adapted for nurses, and by clinical global evaluations. No difference in efficacy between the two treatments was observed with the exception of the intellectual factor of the GBS scale, where a statistically significant improvement was detected in the alaproclate group compared with the placebo group. There were no serious adverse symptoms.     

利培酮与喹硫平对老年期痴呆患者体重及糖脂代谢的影响

目的探讨利培酮与喹硫平对伴精神行为症状的老年期痴呆患者（BPSD）的体重、血糖及血脂的影响。方法将60例伴精神行为症状的老年期痴呆患者分为喹硫平组及利培酮组进行治疗,于治疗前及治疗后（第4、8周末）分别测体重、空腹血糖及血脂包括胆固醇（TC）、甘油三脂（TG）、低密度脂蛋白（LDL）及高密度脂蛋白（HDL）。结果喹硫平组的体重及LDL在治疗第8周末较治疗前升高,HDL较治疗前下降,差异具有显著性（P〈0.05）。利培酮组治疗前后各数值的变化无显著差异（P〉0.05）。两组患者体重的第8周末与治疗前差值,LDL的第8周末与第4周末的差值比较有统计学意义（P〈0.05）。结论喹硫平对伴精神行为症状的痴呆患者体重、血脂的影响较利培酮明显,两者对糖代谢影响不大。     

Pattern of cerebral hypoperfusion according to the clinical staging in dementia with Lewy bodies

This study aimed to detect different patterns of cerebral hypoperfusion in DLB according to clinical staging. Thirty-three patients with DLB were recruited by clinical dementia rating (CDR) stage. Compared with control, cerebral hypoperfusion was mainly observed in the lingual gyrus, the cuneus, the occipital gyrus in CDR 0.5 group; the fusiform gyrus, the middle temporal gyrus, and the posterior cingulate in CDR 1; and the lingual gyrus, the cuneus, the hippocampus, the fusiform gyrus, and the inferior frontal gyrus in CDR 2. Our findings suggest that cerebral hypoperfusion spreads to the frontal cortex and temporal lobes as disease progresses.