VALIDATION OF THE HOSPITAL ANXIETY AND DEPRESSION SCALE AS A MEASURE OF SEVERITY OF GERIATRIC DEPRESSION

The purpose of this study was to evaluate the Hospital Anxiety and Depression Scale (HAD) as a measure of severity of geriatric depression. One hundred and one elderly patients with DSM-III-R non-psychotic non-bipolar major depression were rated by the interviewing psychiatrist on the Hamilton Rating Scale for Depression (HRSD) and the Montgomery–Asberg Depression Rating Scale (MADRS) at index assessment and at the completion of treatment. In a blind fashion, patients completed the HAD at the same time points. At initial assessment, correlations between the depression subscale of the HAD (HAD-D) and the HRSD and MADRS were 0.51 (p<0.001) and 0.54 (p<0.001) respectively, and at final assessment the correlations were 0.73 (<0.001) and 0.79 (p<0.001) respectively. The HAD-D was also sensitive to change in the severity of depression (r_s=0.58,p<0.001). These correlations were not of sufficient magnitude for the HAD-D to be used as an alternative to the HRSD or MADRS. However, in certain circumstances, the HAD-D may be a useful adjunct to these observer-rated scales.     

THE RELIABILITY AND VALIDITY OF THE COLLATERAL SOURCE VERSION OF THE GERIATRIC DEPRESSION RATING SCALE ADMINISTERED BY TELEPHONE

Objective. To prospectively evaluate the reliability and validity of the Collateral Source Geriatric Depression Scale (CS-GDS) administered by telephone (T-CS-GDS) in patients undergoing outpatient comprehensive geriatric assessment. Subjects. Eighty-three geriatric patients evaluated in a 1-year period at the outpatient Geriatric Assessment Center of the University of Nebraska Medical Center. Methods. The 30-item CS-GDS was completed by the collateral source of all patients on three occasions: by telephone several days before their assessment, face-to-face during their assessment visit and several days later, again by phone. During their assessment, all patients were evaluated by one of three geriatric psychiatrists who were blinded to CS-GDS results. The test–retest reliability of the T-CS-GDS was measured by comparing the results of the two phone interviews. The construct validity of the T-CS-GDS was estimated by comparing the results of the initial T-CS-GDS with the CS-GDS obtained during the comprehensive assessment. The criterion validity of the T-CS-GDS was estimated by comparing the results of the T-CS-GDS with the clinical diagnosis of depression assigned by the psychiatrists. Results. The individual items of the initial T-CS-GDS showed substantial concordance with the second T-CS-GDS (kappa range 0.41–0.8, mean=0.61) and with the assessment GDS (kappa range 0.33–0.85, mean=0.61). Twelve items showed evidence of bias when comparing the two T-CS-GDSs and four items when comparing the initial T-CS-GDS with the CS-GDS done during the assessment. The mean number of symptomatic responses was not significantly different for the T-CS-GDS vs assessment administration but did decline slightly when comparing the two T-CS-GDSs. ROC curve analysis showed good agreement between the clinical diagnosis and the T-CS-GDS. Conclusion. The CS-GDS appears to maintain its reliability and validity when administered via telephone and thus may be useful for a variety of epidemiologic and clinical purposes. © 1997 by John Wiley & Sons, Ltd.     

A SPANISH VERSION OF THE GERIATRIC DEPRESSION SCALE IN MEXICAN-AMERICAN ELDERS

Objective. The purpose of this study was to establish the sensitivity of a Spanish translation of the 15-item Geriatric Depression Scale (GDS-S) in a sample of 41 elderly Mexican-American psychiatric patients with a diagnosis of depressive disorders. Method. Utilizing the reverse translation technique and bilingual Mexican-American psychiatrists as evaluators, patients with DSM-III-R diagnoses of affective disorder who were sequential admissions to an inpatient psychiatric unit were enrolled in the study. The GDS-S was administered by trained interviewers within 2–4 weeks of admission to 28 patients with major depressive disorder (MDD) and 13 patients with other depressive disorders (ODD). No other screening instruments for depressive symptoms were used. Results. Using the original cut-scores of GDS, the sensitivity was 39% in patients with MDD and 77% in patients with ODD. When a revised cut-score of 4 and above was identified as reflective of depressive symptoms, the sensitivity improved to 75% for patients with MDD and 85% for patients with ODD. Because there were no true negatives, specificity was not determined. Conclusions. The GDS-S may have limited value in screening community-resident Mexican-American elders for depressive symptoms unless they have significant medical problems which limit their function and are associated with a dysthymic disorder. Screening instruments for depression which include neurovegetative or somatic items may be a better choice in this population. © 1997 by John Wiley & Sons, Ltd.     

AGE AND SEX DIFFERENCES IN NEUROBEHAVIORAL PERFORMANCE: A STUDY OF PORTUGUESE ELEMENTARY SCHOOL CHILDREN

In this study normative data were obtained on measures of IQ, visual/motor, motor and memory functions among Portuguese elementary school children. Subjects were 228 females and 275 males, 8.0 to 11.9 years of age, in grades 2 through 4, who participated in a dental study. Performance on all tests improved with increasing age. Females performed better in rote verbal learning, psychomotor speed, and speed of information processing. Males had higher scores on tests of visual learning, visual memory, and fine motor speed and coordination. Nonverbal IQ had a significant impact on all tests except motor speed and coordination. Results represent an initial attempt to evaluate Portuguese children in educational and medical settings.     

FACTOR STRUCTURE OF THE HAMILTON RATING SCALE FOR DEPRESSION IN A COHORT OF COMMUNITY-DWELLING ELDERLY

We examined the factor structure of the 17-item Hamilton Rating Scale for Depression (HRS-D) in 206 community-dwelling elderly patients. Using principal components analysis and quartimax rotation, a four-factor structure involving all 17 items and accounting for 57.7% of the variance was derived. The factors represented the following dimensions of depressive symptomatology and illness: depressed affect, vegetative symptoms, anxiety, and agitation/insight. This factor structure reflects the presentation of depressive symptomatology and depressive illness in this population. Findings suggest that the HRS-D can be used for clinical assessment of depressive symptomatology along major dimensions of depressive illness in community-dwelling elderly. © 1997 John Wiley & Sons, Ltd.     

A COMPARISON OF THE CLOCK DRAWING TEST AND THE PFEIFFER SHORT PORTABLE MENTAL STATUS QUESTIONNAIRE IN A GEROPSYCHIATRY CLINIC

Wolf-Klein and colleagues' clock drawing test (CDT) performance was compared with Pfeiffer's Short Portable Mental Status Questionnaire (Pfeiffer) scores in 145 outpatient geropsychiatry patients. Although normal CDT results were almost always associated with normal Pfeiffer scores, 21% of Pfeiffer normal individuals drew abnormal clocks. Age, but not gender or education, was significantly associated with this finding. Almost all the Pfeiffer normal subjects who drew abnormal clocks were diagnosed with primary psychiatric disorders (85%) or neurologically based organic mood and anxiety disorders (12%); only one (3%) had dementia. We suggest the discrepant performance between the CDT and Pfeiffer may result from psychiatric illness. Contributing to this may be CDT sensitivity to executive skills dysfunction. This dyscontrol can occur in patients with dementia and other neurological disorders, but also presents in some primary mental disorders. Older age may heighten this impairment. In a typical geropsychiatry clinic, the CDT will not have high specificity for Alzheimer's disease as reported by Wolf-Klein and her colleagues. This results from the presence of many patients with primary psychopathology, some of whom will draw abnormal clocks, and a limited number with dementia—particularly Alzheimer's disease. Abnormal CDT results of geropsychiatry outpatients must therefore be interpreted carefully. Additional conclusions regarding the study results are discussed. © 1997 John Wiley & Sons, Ltd.     

GLIAL BUNDLES IN SPINAL NERVE ROOTS: A FORM OF ISOMORPHIC GLIOSIS AT THE JUNCTION OF THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM

A morphologic study of the spinal nerve roots was undertaken in three cases of Werdnig-Hoffmann disease to investigate the phenomenon of glial bundle formation. The glial elements extended along the ventral roots as discrete cylindrical bundles comprising a large number of parallel astrocytic processes and sparsely scattered cell bodies all enclosed by a basal lamina. The bundles tapered off at a variable distance from the root exit zones. The early stage of glial bundle formation was characterized by the protrusion of astrocytes into the neurilemmal tubes containing degenerated myelinated axons. It was concluded that axonal degeneration, evoking a glial reaction, was the initial event in this process. Subsequently, the reactive astrocytes from the vicinity of the root exit zones enter the neurilemmal tubes previously occupied by myelinated axons and migrated into the domain of the peripheral nervous system in an orderly fashion. Thus glial bundle formation might be considered a special form of isomorphic gliosis occurring in Werdnig-Hoffmann disease and also in several other conditions all sharing a common feature, namely, degeneration of axons within the spinal nerve roots.     

THE EFFECT OF OXYGEN ADMINISTRATION ON VISUOSPATIAL COGNITIVE PERFORMANCE: TIME COURSE DATA ANALYSIS OF fMRI

This study investigated the effects of 30% oxygen administration on visuospatial cognitive ability using time course data analysis of fMRI. A visuospatial task was presented while brain images were scanned by a 3T MRI system. The results showed that there was an improvement in performance and also increased BOLD intensity in the parietal lobe in the higher oxygen condition. There was positive relation between behavior performance and BOLD intensity in the right parietal lobe. This result supports the conclusion that the increase in the cognitive processing ability due to highly concentrated oxygen can be explained by the increase in the BOLD intensity.     

MICROSCOPIC ANALYSIS OF THE DIFFERENT REGIONS OF THREE ALZHEIMER BRAINS AGED 93, 94, AND 104 YEARS OLD

The brains of three Alzheimer patients aged 93, 94, and 104 years old were analyzed. Although cell death was apparent in different cortices, the prefrontal cortex and the Broca's appeared to be hit hardest. The different CA areas of the hippocampal formation all displayed equivalent degrees of cell death but the entorhinal areas showed the most severe degree of cell degeneration. Both apoptosis and necrosis were observed in the different cerebral regions of these very old patients, as expected.     

THE PSYCHOGERIATRIC ASSESSMENT SCALES (PAS): FURTHER DATA ON PSYCHOMETRIC PROPERTIES AND VALIDITY FROM A LONGITUDINAL STUDY OF THE ELDERLY

The PAS is a standardized interview which assesses the changes seen in dementia and depression using a set of scales. There are three scales derived from an interview with the subject (cognitive impairment, depression, stroke) and three from an interview with an informant (cognitive decline, behaviour change, stroke). The aim was to provide data on the psychometric properties and validity of the PAS. The scales were originally developed using data from the first wave of a longitudinal study of the elderly. Reported here are further data on the PAS from the second wave of the same study, carried out 3½ years later. The setting was a community survey carried out in the Australian city of Canberra. Seven hundred and nine elderly persons, with a mean age of 80 years, and 641 informants participated. Besides the PAS, participants were administered several other scales: the Mini-Mental State Examination, the Informant Questionnaire on Cognitive Decline in the Elderly, the National Adult Reading Test and the Goldberg anxiety and depression scales. Diagnoses of dementia and depression were made with the Canberra Interview for the Elderly, from which the PAS is derived. Confirmatory factor analysis replicated the five-factor model which underpins the PAS. The PAS was found to correlate with the other scales having similar content and showed correspondence with diagnoses of dementia and depression derived from the Canberra Interview for the Elderly. Longitudinal data supported the validity of the cognitive decline scale as a measure of change. Overall, the results support the original psychometric and validity research on the PAS. © 1997 by John Wiley & Sons, Ltd.     

AGGRESSIVE BEHAVIOUR IN THE CHINESE ELDERLY—VALIDATION OF THE CHINESE VERSION OF THE RATING SCALE FOR AGGRESSIVE BEHAVIOUR IN THE ELDERLY (RAGE) IN HOSPITAL AND NURSING HOME SETTINGS

Objective. The objective is to examine the validity of the Chinese version of the Rating Scale for Aggressive Behaviour in the Elderly (RAGE) in Hong Kong. Design. A cross-sectional study comparing the pattern of aggressive behaviour among residents of different elderly institutions. Setting. A nursing home and a psychogeriatric inpatient unit. Patients. Psychogeriatric inpatients and nursing home residents. Thirty subjects participated in the validation study of the Chinese version of the RAGE (CRAGE). Eighty-eight subjects were assessed by the CRAGE for pattern of aggressive behaviour. Measures. The CRAGE and the Chinese version of the Mini-Mental State Examination (CMMSE). Results. The CRAGE showed satisfactory validity and reliability measures. Aggressive episodes were found in 57% of the subjects, mostly mild in nature. No significant difference was found in the CRAGE total scores in different institutions and across diagnoses. Hospital and schizophrenic patients had significantly higher ratings in overall aggressiveness. Demented subjects had higher CRAGE ratings with CMMSE scores from 11 to 15. Conclusions. CRAGE is a valid instrument for use in the Chinese elderly. Although there is no significant difference in total aggressive episodes among different elderly institutions, chronic psychiatric patients were more frequently regarded as aggressive.     

The DTES – Drug Taking Evaluation Scale: A SIMPLE SCALE FOR THE EVALUATION OF DRUG TAKING BEHAVIOUR

This paper describes a clinically based scale elaborated for the evaluation of drug taking behaviour. The scale is a composite scale that includes subscales for drug taking behaviour, social functioning, social identity and belonging and mental health. The scale is used in different evaluation projects from surveys to treatment research, and the experiences as well as reliability testing are described. Finally, the paper contains a manual for the use of the scale.     

PSYCHIATRIC DISTURBANCES AND THE USE OF PSYCHOTROPIC DRUGS IN A POPULATION OF NONAGENARIANS

The present study examined the prevalence of dementia, anxiety syndromes, depression, psychotic symptoms, sleep disturbance and the use of psychotropic drugs in a population of 330 nonagenarians. Subjects underwent an extensive medical examination, and information on sociodemographic characteristics, mental health, physical health and psychotropic drug use was collected. The prevalence of dementia in the study sample was 46.7% according to DSM-III-R criteria. Demented persons had more often psychotic symptoms (11.7% versus 3.4%) and anxiety syndromes (5.2% versus 1.1%) than non-demented. Depression was equally prevalent in both the demented and non-demented (8.4% versus 7.4%), whereas sleep disturbance was a more common complaint in non-demented persons. Half of the study sample (49.7%) used some sort of psychotropic drug, with the most common being hypnotics and the least common being antidepressants. However, the rate of specific treatment was low, especially for depression, indicating the need for more knowledge concerning the recognition of depression in the very elderly. © 1997 John Wiley & Sons, Ltd.     

THE EYES OF ANENCEPHALIC BABIES: A MORPHOLOGICAL AND IMMUNOHISTOCHEMICAL EVALUATION

This study studied the eyes of three anencephalic stillborns to evaluate whether brain degeneration affected eye development and/or survival. The study encompassed histology, scanning electronmicroscopy, and immunocytochemistry. The corneae were otherwise normal except for the presence of blood vessels in the stroma and the posterior surface of the cornea demonstrated wrinkles. Synaechia was present and the lens had occasional vacuolated cells. The retinae had normal layers in most regions except the center where fibroblasts infiltration was observed. The optic nerve was atypical and composed of aggregates of disoriented fibroblasts and disoriented nerve fibers. Anti-cleaved caspase 3 immunocytochemistry revealed only few positive dying cells in the visual cell layer. Antineurofilament 200 reactions demonstrated positive ganglion cells even in the anencephalic eyes. The choroids in anencephaly had more VEGF positive sites, indicating vascularization in both control and anencephalic eyes. If the brains degenerate before retinal maturation, then such degenerations may not have an effect on subsequent retinal development except for the degeneration of the nerve fiber layer. If the brains degenerate after retinal maturation, then the survival of the retinae does not appear to rely on its linkage with the brain at birth, again apart from the degeneration of nerve fibers.     

A COMPARISON OF OLDER LONGSTAY PSYCHIATRIC AND LEARNING DISABILITY INPATIENTS USING THE HEALTH OF THE NATION OUTCOME SCALES

Objective. With increasing longevity, the number of elderly patients with psychiatric or learning disabilities is likely to increase. The degree of overlap of symptoms and needs of these two groups of patients, which may allow for their care within the same service, was examined. Design. Twenty-six longstay, elderly (>65 years) psychiatric patients resident in psychogeriatric wards of a psychiatric hospital were compared with 23 longstay, elderly patients and 40 longstay patients aged 50–65 years, both resident in the wards of a specialist hospital for learning disabilities. The instrument used was the Health of the Nation Outcome Scales (HoNOS). Result. On the HoNOS, the elderly psychiatric patients scored significantly higher for problems with mood, relationships and occupation/activities. There were no significant differences for any of the scales rated between the 50–65 and >65 years old patients with learning disabilities. Conclusion. The similarities between the three groups of patients would suggest that for some patients the same services may be utilized. This could reduce the cost of the care in the community and entail more economical use of the facilities and staff. The HoNOS proved to be a concise and simple instrument, which could become a useful tool in monitoring the outcome of healthcare in longstay patients. © 1997 John Wiley & Sons, Ltd.     

A BEHAVIORAL AND HISTOLOGICAL STUDY OF THE EFFECTS OF LONG-TERM EXPOSURE OF ADULT RATS TO ALUMINUM

Aluminum (Al) has been etiologically and epidemiologically related to several neurologic conditions, including Alzheimer's disease (AD). The effects of Al long-term exposure were investigated to describe the associated behavioral and brain modifications. Adult rats were intraperitoneally injected three times a week for 6 months with ecological doses of Al gluconate (0.85 mg/kg). The Al overload was confirmed by the significantly increased level of Al in serum. We assessed fear conditioning, spatial memory and emotional reactivity by shuttle-box task, Morris water maze, and open-field, respectively. The performance of the experimental animals at the shuttle-box task was significantly lower (p <. 01) compared to that of control. The experimental animals had impaired spatial memory, with lower and more fluctuant performance at Morris water maze. The noxious-driven behavior of the experimental animals was also altered, with significantly lower activity scores (p <. 05), and high emotionality scores (p <. 01) at the open-field. We recovered and processed the brain for aluminum and amyloid deposits. The brains of experimental animals, studied by optical microscopy, displayed a massive cellular depletion in the hippocampal formation, particularly, the CAl field, and also in the temporal and parietal cortex. We observed numerous ghost-like neurons with cytoplasmic and nuclear vacuolations, and with Al deposits. The hippocampus contained extracellular accumulations of Al and amyloid surrounded by nuclei of degenerating cells, which we interpreted as neuritic plaques. The cerebrovasculature was distorted, with a significant thickening of the wall of capillaries, associated with amyloid deposits. These behavioral and neuropathological modifications associated with long-term exposure to Al are reminiscent of those observed in AD.­­