Domiciliary and day care services: Why do people with dementia refuse?

Objective: To explore the reasons given for refusal of day services, and to examine the relationship between willingness to accept day services and clinical variables.

Method: Fifty people with dementia who lived alone and had refused day services were interviewed.

Results: The most common reasons for reluctance to attend day services were the belief that they did not need day services, that they liked being on their own, and the belief that they would not enjoy it. People who persistently refused day services tended to have additional worries about meeting new people, losing their independence and being institutionalised. Fifty-four per cent of people with dementia who lived alone and had refused day services scored six or more on the Cornell Scale for Depression in Dementia, suggesting possible presence of major depression.

Conclusion: In patients with dementia who live alone and refuse day services, their misconceptions about day services and possibility of undiagnosed depression need further exploration.     

Care home design for people with dementia: What do people with dementia and their family carers value?

Objectives: To report on the views of people with dementia who live in care homes and their family carers on aspects of design that are important to them, and discuss these in relation to developing physical care environments that respond to the wishes of people with dementia and their family carers.

Method: Six focus groups were held: two in Northern Ireland and four in Scotland. A total of 40 people participated in the focus groups. Twenty nine people were with dementia (24 female and five male), and 11 were family carers (10 female and one male).

Results: Carers discussed the features of a building they took into account when selecting a care home, and discussed this in relation to ‘bricks and mortar versus people’. Key themes reported by people with dementia and their family carers included how the space in the environment is used, for example, what happens in the building and the presence or absence of certain design features. Outside space and wayfinding aids were identified as positive features of the home, along with a general lack of concern about ensuite provision.

Conclusion: The results demonstrate the complexity of building design as it must provide living space acceptable to people with dementia living there and family members who visit, as well as provide a workable environment for staff. The findings highlight areas that should be considered by care home teams involved in the build of a new home or the redevelopment of an existing care home.     

Elderly people with alcohol-related problems: where do they go?

OBJECTIVE: To investigate how elderly people with alcohol-related problems present to medical services and examine their further management in terms of rehabilitation. DESIGN: Retrospective case-note study. SETTING: South Manchester. PATIENTS: 176 patients aged 60 and over admitted between January 1992 and April 1996 with ICD9 diagnoses of alcohol dependence or alcohol abuse. MEASURES: Medical notes of subjects aged 60 and over with an ICD9 diagnosis of alcohol dependence or abuse were reviewed. Admission episodes by age group and specialty, reason for presentation and follow-up arrangement record were noted. Frequency and specialty of admission were noted for all patients aged 20-95 with the above diagnoses for the above period from PAS (Patient Administration System). RESULTS: One hundred and seventy-six elderly patients (representing 244 episodes) were admitted with a diagnosis of alcohol dependence or abuse. Twenty-nine% of the admissions were to psychiatric services and 71% were to medicine or surgery. Of the 125 admissions where medical records were available, 50% were due to falls. Only 15% were referred on for rehabilitation. In contrast, 1441 patients (2524 episodes) aged 20-59 were admitted over the same period. Seventy-eight% were admitted to a psychiatric ward and 22% to non-psychiatric facilities. CONCLUSION: Alcohol-related problems in the elderly might present as physical problems. Most of these presented as falls and only a small proportion were referred on for rehabilitation.     

Pediatric stroke: what do we know and what do we need to know?

Stroke is a heterogeneous disorder and an important cause of mortality and chronic morbidity in children. Estimates of international incidence rates for childhood stroke have varied widely. Arterial ischemic stroke is reported to be more common than hemorrhagic stroke in children. The clinical presentation of stroke in children differs according to the child's age and stroke type and location. Several risk factors for ischemic and hemorrhagic stroke in children have been reported and include cardiac disorders, blood disorders, vasculopathies, viral infections, and arteriovenous malformations. Current treatment recommendations for stroke in children are based on small nonrandomized trials, adult stroke studies, case series, or consensus or individual expert opinion. Over half of children with stroke will develop lifelong cognitive or motor disability, and up to a third will have a recurrent stroke. International studies have provided important information on stroke in children, but major gaps in our knowledge of the disorder still exist. Currently, there is a need for prospective cohort studies in diverse populations, which utilize a consensus pediatric stroke classification system and a standard evaluation of risk factors and outcome, so that treatment and prevention strategies can be developed.     

Dopamine in neurotoxicity and neuroprotection: what do D2 receptors have to do with it?

Accurate control of dopamine levels and/or the resulting dopamine-receptor interaction is essential for brain function. Indeed, several human neurological and psychiatric disorders are characterized by dysfunctions of the dopaminergic system. Dopamine has been reported to exert either protective or toxic effects on neurons, yet it is unclear whether these effects are receptor-dependent and, if so, which dopamine receptor could be involved. The D(2) dopamine receptor occupies a privileged position because its signalling might be neuroprotective in human diseases, such as Parkinson's disease, ischaemia and epilepsy. Unravelling the role of D(2) receptors in neuronal death and survival might be central to understanding the mechanisms that underlie several neuropathologies.     

Atypical presentation of Prader-Willi syndrome with cerebral venous thrombosis: association or fortuity?

A newborn female born at term was admitted at 28 hours for seizures and generalized hypotonia. Cerebral ultrasound showed a right temporal echogenic lesion confirmed on MRI and thought to be secondary to thrombosis of the vein of Labbé. The EEG showed epileptic discharges over the right temporal region. Extensive thrombotic studies revealed a transiently decreased PTT consistent with a prothrombotic state. The hypotonia did not resolve after the acute phase as expected, raising the possibility of another underlying cause. Because of a peculiar phenotype with almond-shaped eyes and bitemporal depression, Prader-Willi syndrome (PWS) was suspected. Methylation analysis confirmed PWS, FISH analysis excluded a deletion in 15q11-q13, maternal uniparental disomy (UPD) was confirmed. To our knowledge, this is the first report of the association of a neonatal venous thrombosis and a PW Syndrome.     

Do people with schizophrenia comprehend what they read?

Although people with schizophrenia appear to be able to read aloud, their reading comprehension has been little tested. This study asks, Do people with schizophrenia have deficits in reading comprehension compared with well controls and, if so, what are the type and severity of those deficits? The reading comprehension of 30 people with chronic schizophrenia was compared with a group of 30 people without a psychiatric diagnosis. The groups were matched for sex and age and had similar intelligence scores. The Reading Comprehension Battery for Aphasia (RCBA) was used to obtain a profile of reading comprehension skills, and intelligence was estimated using the National Adult Reading Test. Schizophrenia subjects took significantly longer to complete the RCBA and obtained significantly poorer scores than did controls on the RCBA total and on all but one RCBA subtest. Although these findings could have serious implications for the presentation of written material such as consent and information forms, further research is needed to determine how these deficits impact on functional reading and whether or not they can be addressed.     

Pictures and their colors: what do children remember?

Theories regarding children's reliability as witnesses suggest that children are more likely to confuse memories from different sources especially when the sources are highly similar. To investigate the developmental aspects of source retrieval, we measured brain electrical activity from children and adults while they retrieved content and source information. Similar brain responses among the age groups were found when participants were asked to retrieve content information. However, retrieval of source information improved with age and was accompanied by different patterns of brain potentials. The results implicate immaturity of frontal lobe structures in children's difficulty in retrieving source information.     

Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences?

Gilles de la Tourette Syndrome (GTS) and obsessive-compulsive disorder (OCD) share obsessive-compulsive phenomena. The aims of this study were to compare the OC symptom distribution between GTS and OCD and to investigate whether a subdivision of these phenomena into obsessions, compulsions and 'impulsions' is useful in distinguishing GTS and OCD patients. Thirty-two GTS, 31 OCD (10 with tics, 21 without tics) and 29 control subjects were studied using the Leiden repetitive behaviors semi-structured interview to assess GTS as well as OCD-related behaviors. Each reported repetitive thought or action was evaluated on the presence of anxiety and on goal-directedness. This information was used to define whether the behavior was an obsession, compulsion, or 'impulsion'. Both the GTS and OCD study groups showed higher scores than control subjects on rating scales measuring depression, OC behavior and anxiety. In GTS, Y-BOCS severity scores and trait anxiety were lower than in the OCD groups. Furthermore, GTS patients differed from OCD patients in the distribution of symptoms. Aggressive repetitive thoughts, contamination worries and washing behaviors were reported more frequently by tic-free OCD, while mental play, echophenomena, touching and (self)-injurious behaviors were reported more frequently by GTS. OCD individuals with tics were intermediate, but closer to tic-free OCD. GTS individuals reported significantly more 'impulsions' and fewer obsessions and compulsions than OCD individuals with and without tics. Factor analysis revealed three factors accounting for 44% of the variance, resulting in an 'impulsive' factor related to GTS, a 'compulsive' factor related to OCD and an 'obsessive' factor related to tic-free OCD. In conclusion, OCD individuals reported more anxiety and goal-directedness associated with their behaviors than did GTS subjects. The distinction between obsessions, compulsions and impulsions is of importance in identifying Tourette-related vs. non-Tourette-related repetitions.     

Drawings by individuals with Williams syndrome: are people different from shapes?

Because it is unclear whether people with Williams syndrome produce drawings that are delayed or deviant, we examined these two possibilities in Draw a Person and figure copying tasks (VMI) in 28 persons with Williams syndrome, 28 with mixed etiologies, and 28 with Down syndrome. All human figures could be classified into discrete stages of drawing development, and in all groups, drawing tasks were significantly correlated with MA. Human figures from participants with Williams syndrome were no more deviant than their counterparts, nor did they show "local-global" differences. Draw a Person scores exceeded VMI scores in the Williams syndrome group, whereas the Down syndrome group showed relative strengths on both drawing tasks, and the mixed group had no profile. Developmental and phenotypic implications of findings are discussed.     

Childhood epilepsy: what is the evidence for what we think and what we do?

This article reviews the strength of the evidence that underlies the current approach to the management of childhood epilepsy. The authors reviewed published, peer-reviewed English literature accessed through PubMed and Cochrane reviews with evidence rated as Class 1 (strongest) to Class 4 (weakest). There is considerable inaccuracy in the diagnosis of seizures and epilepsy syndromes. Sound information supports the consensus that the diagnosis of epilepsy should await two unprovoked seizures. Population-based studies indicate that remission from childhood onset epilepsy occurs in at least 50% of children. It is easier to predict a good seizure outcome than a poor one. Absence of concomitant neurologic handicap and onset before about 12 years of age are the most consistent predictors of remission. Intractability is poorly defined and difficult to predict until several antiepilepsy drugs have been used and failed to control the seizures. Most epilepsy syndrome diagnoses do not yield an accurate prognosis. Social outcome appears unsatisfactory in about 50% of cases without intellectual handicap. Death is rare in childhood epilepsy. Those without severe neurologic handicaps have the same mortality as the general population. We identified only 27 published randomized trials of antiepilepsy drugs in children that compare the efficacy of antiepilepsy drugs, offer treatment of syndromes currently without successful treatment, or have negative effects. There is a pressing need for better definitions of seizures and epilepsy syndromes. The causes of poor social outcome are unclear. Intractability needs a clear definition and randomized trials comparing treatment regimes are sadly lacking.     

Physical activity and nutrition health promotion interventions: what is working for people with intellectual disabilities?

A scoping review of studies on physical activity and nutrition health promotion interventions for individuals with intellectual disabilities was conducted. Searches included MEDLINE, PsycINFO, and CINAHL databases from 1986 through July 2006. The final number included 11 articles comprising 12 studies. Generally, this review indicated some evidence for fitness and psychosocial benefits of community-based physical activity and exercise programs for adults with intellectual disabilities. When combined with a more comprehensive health behavior education program incorporating exercise and nutrition information, some evidence exists for reductions in weight.