Computerized diagnosis from a standardized history schedule: A preliminary communication about the organic section of the HAS–AGECAT system

This article presents the results of the application of a computerized diagnostic method (HAS–AGECAT) to a standardized psychiatric History and Aetiology Schedule (HAS) designed for use with older people. In a community sample from Zaragoza good agreement (kappa = 0.76) was obtained between HAS–AGECAT and the interviewing psychiatrist. The discrepant cases are discussed in detail.     

An informant interview for the diagnosis of dementia and depression in older adults (IDD-GMS)

Background. There has been no instrument developed for the differential diagnosis of psychiatric conditions using an informant. The present study describes the development and validation of an informant interview for the diagnosis of dementia and depression in older adults (IDD-GMS). The IDD-GMS, as its name indicates, is based upon the well-established Geriatric Mental State Schedule (GMS). Method. Thirty older adults with psychiatric illnesses were identified. An informant/carer was interviewed using the IDD-GMS. Questions from the GMS were altered to reflect the informant nature of the interview. Validity was compared to ICD-10 diagnoses. Interrater reliability was determined. Results. Using a hierarchical diagnostic system, receiver operating characteristics demonstrated one optimal cutpoint for sensitivity, >13 for dementia and >16 for depression, and one for specificity, >13 for dementia and >10 for depression. Conclusion. The validity and reliability of the IDD-GMS falls within acceptable limits and indicates that the IDD-GMS can be used as a diagnostic instrument for dementia and depression. The IDD-GMS represents the first informant interview to achieve this. © 1998 John Wiley & Sons, Ltd.     

The modified CAMDEX informant interview is a valid and reliable tool for use in the diagnosis of dementia in adults with Down's syndrome

Background Dementia because of Alzheimer's disease (AD) commonly affects older adults with Down's syndrome (DS). Methods are needed, with established concurrent and predictive validity, to facilitate the diagnostic assessment of dementia, when it is complicated by pre‐existing intellectual disabilities (ID). We report on the reliability and validity of a modified version of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) informant interview, for use when assessing people with DS suspected as having dementia. Methods As part of a previous epidemiological study of older people with DS, the CAMDEX informant interview was used to determine the prevalence of dementia. The 74 people with DS included at that time (Time 1) had also completed the Cambridge Cognitive Examination (CAMCOG), the neuropsychological assessment from the CAMDEX schedule. Fifty‐six were assessed again 6 years later (Time 2). Based on the CAMDEX informant interview, nine of the 74 at Time 1, and 11 of the 56 at Time 2, were found to meet clinical criteria for AD. Forty‐one scored above floor on the CAMCOG at Time 1 and were included in the analysis of cognitive decline. Concurrent validity was established by comparing diagnosis at Time 2 with independent evidence of objective decline on cognitive tasks since Time 1. Predictive validity was established by examining how accurately diagnosis at Time 1 predicted both cognitive decline and future diagnosis. Inter‐rater reliability was determined by comparing the level of agreement between two raters. Results CAMDEX‐based diagnosis of AD was shown to be consistent with objectively observed cognitive decline (good concurrent validity) and to be a good predictor of future diagnosis. Although numbers are small, some support is also provided for the accuracy with which diagnosis predicts cognitive decline. Inter‐rater reliability was good with Kappa > 0.8 for 91% of items and > 0.6 for all items. Conclusions The use of the modified CAMDEX informant interview enables the structured collection of diagnostic information, so that a valid and a reliable diagnosis of dementia can be made in those with pre‐existing ID, using established diagnostic criteria.     

The course of mild dementia in a birth cohort

The mental health of a birth cohort has been followed until the age of 87 years. The cohort consists of all Icelanders born during a period of three years. Only three probands were lost in the follow up period from 61 to 87 years. The diagnoses were made by two methods: an indirect method based mainly on information provided by general practitioners, and the computerized diagnosis AGECAT. Many cases diagnosed as mild dementia by the indirect method had no or very few cognitive symptoms when the AGECAT was applied. The diagnosis of mild dementia is associated with high mortality. Almost 30% of cases of mild dementia diagnosed by the indirect method before the age of 75 years have no symptoms of dementia at the age of 81 years and more than 10% continue to have mild symptoms. Similar results are found at the age of 87 years. Atherosclerotic disorders are present in 48.6% of cases of mild dementia and 58.6% of severe dementia in contrast to only 25–30% of probands with a effective disorder or without psychiatric diagnosis.     

The epidemiology of dementia: GMS-AGECAT studies of prevalence and incidence,including studies in progress

Summary The paper reviews the main studies using the AGECAT computerised diagnostic system for the diagnosis of dementia in community studies of prevalence and incidence. It is suggested that variations in reported rates may be due to the use of unstandardised methods, and the paper reviews the oldest established standardised interview: the Geriatric Mental State. The AGECAT system is outlined, and the studies of its diagnostic validity indicated. Arguments are presented against the inclusion of cognitive tests in such instruments, and for the critical evaluation of the concepts of mild dementia. The use of AGECAT in the US/UK Diagnostic Project, and in the Liverpool study of Continuing Health in the Community is described. In addition, preliminary information is given on the Liverpool ALPHA study, the MRC UK multi-centre study, studies organised by the Pan American Health Organisation (Argentina, Chile, Cuba), the Eurodem concerted action (based in Rotterdam) and the WHO multi-site studies. Individual studies in Spain and Portugal are also discussed.     

Respondent and informant accounts of psychiatric symptoms in a sample of patients with learning disability

This paper investigates differences in the nature and frequency of psychiatric symptoms reported by patients with learning disability and by key informants. The study involved psychiatric assessment of 100 patients with learning disabilities and key informants using the Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS-ADD), a semi-structured psychiatric interview developed specifically for people who have a learning disability. There was considerable disagreement between respondent and informant interviews; only 40.7% of cases were detected by both interviews. Respondents were more likely to report on autonomic symptoms and certain psychotic phenomena. Other anxiety and depression symptoms were more frequently reported by infcrnnants. The results indicate that it is crucial for sensitive case detection to complete both interviews where possible. If the respondent cannot be interviewed, panic disorder or phobias may be particularly difficult to detect.     

Diagnosing dementia in a developing nation: an evaluation of the GMS-AGECAT algorithm in an older Korean population

BACKGROUND: Numbers of older people are increasing rapidly in many developing nations and there is a pressing need for epidemiological studies of psychiatric morbidity, particularly dementia. Valid methods for case identification are an important first step. The Geriatric Mental State (GMS) is a widely used diagnostic instrument but has received little formal evaluation in developing nations. The objective of this study was to investigate the screening properties of GMS organic disorder with respect to clinically diagnosed dementia in an older Korean population, about half of whom have received no formal education. METHODS: 746 people aged 65+ in Kwangju, South Korea who were participants in a community survey of psychiatic morbidity, completed a GMS interview (with diagnoses assigned through the AGECAT computerised algorithm) and, independently, received a clinical assessment for dementia. RESULTS: GMS organic disorder was diagnosed in 262 participants (35%) and DSM-IV dementia in 110 (15%). Increased age, female gender and lower education independently predicted disagreement between the two diagnoses. In these groups, GMS sensitivity to a clinical diagnosis of dementia remained high but specificity was markedly reduced. CONCLUSIONS: Dementia may be overestimated in developing nations if the GMS-AGECAT diagnosis of organic disorder is used alone. The validity of other diagnoses, such as affective disorder, may also be affected if the hierarchical diagnostic algorithm is used (i.e. where the diagnosis of organic disorder affects the likelihood of other diagnoses).     

A comparison of GMS-A/AGECAT,DSM-III-R for dementia and depression,including subthreshold depression (SD)--results from the Berlin Aging Study (BASE)

BACKGROUND: Empirical evaluation of the agreement between different diagnostic approaches is crucial for the understanding of epidemiological results in geriatric psychiatry. OBJECTIVES: In this paper, we analyse differences between widely used diagnostic approaches of dementia and depression and offer evidence that diagnostic thresholds vary substantially on quantitative dimensions, but that conceptual and other differences between approaches must also been taken into account. METHODS: In an epidemiological study of n = 516 persons, aged 70-103 years, we compared psychiatric diagnoses of dementia and depression obtained by GMS-A/HAS-AGECAT, DSM-III-R and clinician's diagnoses of subthreshold depression (SD). RESULTS: For depression, cumulative prevalence of clinician's diagnosis (including SD, GMS-A/HAS-AGECAT and DSM-III-R defined forms) was highest, followed by GMS-A/HAS-AGECAT-diagnosis and DSM-III-R, while for dementia DSM-III-R was followed by GMS-A/HAS-AGECAT. Overall agreement between DSM-III-R and GMS-A/HAS-AGECAT was moderate. Adapting thresholds for AGECAT resulted in slightly better diagnostic efficiency. Diagnostic disagreement was found predominantly for cases with intermediate symptom severity, supporting the hypothesis of differing thresholds between DSM-III-R and GMS-A/HAS-AGECAT, while cases with lower or higher symptom severity were similarly seen as cases or non-cases. CONCLUSION: Disagreement is not only caused by conceptual differences, but also different thresholds of diagnostic algorithms. Adaptation of threshold levels should be feasible, depending on the purpose of the analysis.     

Interpreting subject and informant reports of function in screening for dementia

A related article showed that five widely used screens for dementia predicted criterion diagnosis well with extreme scores, but misclassified many persons when screen scores were intermediate (borderzone). In this article, based on representative samples of community elders from the North Manhattan Aging Project, information on the subject's functioning was added to intermediate dementia screen scores and found to increase specificity, with sensitivity held constant. Informant reports on the subject's functioning predicted criterion diagnosis somewhat better than did the subject's self-report of functioning.     

Alcoholism by Chinese diagnostic interview schedule: a prevalence and validity study

A community survey in metropolitan Taipei (MT) and two small towns (ST) by using the Chinese modified diagnostic interview schedule (DIS-CM) revealed a significant difference in the prevalence of alcohol abuse (AA) defined by DSM-III between two study samples (MT 3.4%; ST 8.0%), but the prevalence of alcohol dependence (AD) was not different (MT 1.5%; ST 1.8%). These figures are significantly higher than that of an earlier Formosan study. Demographic data, psychiatric symptoms, medical complications and impairment of social functions were adopted as the variables to validate the nosological status of AA and AD. The results of this study substantiated that AA and AD identified by the DIS-CM were nosologically different from a non-alcoholic group. The possible reasons for an increasing prevalence of alcoholism in Taiwan Chinese were discussed. An etiological hypothesis was proposed for AA and AD on account of their differential prevalences.     

The distribution of dementia,depression and neurosis in elderly men and women in an urban community: Assessed using the GMS–AGECAT package

A computerized diagnosis, AGECAT, is applied to data from random community samples of elderly people in New York and London in order to examine the distribution of mental illness between males and females. The greater proportion of dementia in females is confirmed for all AGECAT's levels of diagnostic confidence, and for depression at all levels except one. Age- and sex-specific prevalence rates are quoted for each half decade between 65 and 90 years. Differences between the sexes on syndrome case and subcase levels of neurotic disorder do not reach statistical significance.     

Measure of quality of life for Taiwanese persons with early to moderate dementia and related factors

BACKGROUND: This study validates the Chinese Dementia-Quality of Life instrument (DQoL) in patients with early to moderate stages of Alzheimer's disease (AD) (Clinical Dementia Rating Scale, CDR=0.5, 1, and 2; MMSE >or= 12). METHODS: A cross-sectional design was used involving 98 participants (27 controls, 35 patients with questionable dementia (QD), and 36 patients with mild to moderate AD) and 51 paired family caregivers (FCs) (20 FCs of QD patients, 31 FCs of AD patients). FCs were recruited to evaluate patients' DQoL using the parallel form. Internal consistency, construct validity and concurrent validity of the DQoL were examined. RESULTS: The findings indicated that the Chinese DQoL instrument has stable internal consistency but only moderate validity when used in early to moderate AD participants with MMSE greater than, or equal to 12. The DQoL and Self-esteem subscales were significantly different across the three dementia severity groups. The values of internal consistency of the DQoL and its five subscales were high for the ratings of both the patients and the FCs. The interscale correlations for the DQoL were almost all significant for patients' and FCs' ratings. Agreement of the DQoL and its subscales for patients and FCs was significant. However, two inconsistencies were found in the results of the factor analysis and the prior conceptualization of patients' DQoL, the subscales of Self-esteem and Negative Affect. Global cognitive impairment and self-care problems significantly correlated with the patients' DQoL, while the patients' depressive symptoms and self-care problems significantly correlated with the FCs' DQoL. CONCLUSIONS: The Chinese DQoL reported by early to moderate AD patients has good reliability, but moderate validity because the patients' depressive symptoms did not correlate with their DQoL and the major subscales. Both patients' and FCs' ratings on DQoL are important in research and treatment decision making.     

Cognitive Impairment Questionnaire (CIMP‐QUEST): reported topographic symptoms in MCI and dementia

Åstrand R, Rolstad S, Wallin A. Cognitive Impairment Questionnaire (CIMP‐QUEST): reported topographic symptoms in MCI and dementia.
Acta Neurol Scand: 2010: 121: 384–391.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – The Cognitive Impairment Questionnaire (CIMP‐QUEST) is an instrument based on information obtained by key informants to identify symptoms of dementia and dementia‐like disorders. The questionnaire consists of three subscales reflecting impairment in parietal‐temporal (PT), frontal (F) and subcortical (SC) brain regions. The questionnaire includes a memory scale and lists non‐cognitive symptoms. The reliability and validity of the questionnaire were examined in 131 patients with mild cognitive impairment (MCI) or mild dementia at a university‐based memory unit. Methods/Results – Cronbach alpha for all subscales was calculated at r = 0.90. Factor analysis supported the tri‐dimensionality of CIMP‐QUEST’s brain region‐oriented construct. Test–retest reliability for a subgroup of cognitively stable MCI‐patients (n = 25) was found to be r = 0.83 (P = 0.0005). The correlation between the score on the cognitive subscales (PT + F + M) and Informant Questionnaire on Cognitive Decline in the Elderly was r = 0.83 (P = 0.0005, n = 123). The memory subscale correlated significantly with episodic memory tests, the PT subscale with visuospatial and language‐oriented tests, and the SC and F subscales with tests of attention, psychomotor tempo and executive function. Conclusions – CIMP‐QUEST has high reliability and validity, and provides information about cognitive impairment and brain region‐oriented symptomatology in patients with MCI and mild dementia.     

The natural history of dementia

This review summarizes studies on the natural history of dementia with a focus on Alzheimer's disease and vascular dementia. Understanding the course of dementia is important not only for patients, caregivers, and health professionals, but also for health policy‐makers, who have to plan for national resources needed in the management of an increasing number of dementia cases. From the available published data, the life expectancy of elderly people with dementia is shorter than that of non‐demented elderly. Reports on survival after a diagnosis of dementia vary from 3 to 12 years. The wide variation is partly due to the diagnostic criteria used in the studies and the sites where they were conducted (i.e. hospitals, clinics, or homes). There is an apparent difference in survival between Alzheimer's disease patients with onset of illness before 75 years and those after 75 years: the younger patients have a longer life expectancy. However, there are conflicting data on survival (in years) comparing male and female patients and comparing patients of different ethnicities. For vascular dementia, published papers on life expectancy vary between 3 to 5 years. Vascular dementia appears to have a poorer prognosis than Alzheimer's disease. The stages of severity of dementia were compared in a follow‐up of a sample of Alzheimer's disease patients in Singapore, and the mean duration of the mild phase (clinical dementia rating 1) was 5.6 years, the moderate phase (clinical dementia rating 2) was 3.5 years, and the severe phase (clinical dementia rating 3) was 3.2 years. At the various phases of the disease, the demand on health‐care services and economic cost are different.     

Family history of dementia: dementia with lewy bodies and dementia in Parkinson's disease

Parkinson's disease with dementia (PD-D) and dementia with Lewy bodies (DLB) may result from the same neurodegenerative process with different temporal and spatial courses. The authors report an association between DLB and family history of dementia in a comparison study between patients with a clinicopathological diagnosis of PD-D and DLB. Findings suggest that positive family history for dementia is associated with DLB with a yet unknown mechanism.     

Psychiatric diagnoses made by the agecat system in residents of local authority homes for the elderly: Outcome and diagnostic stability after four years

Eighty-six residents of 12 local authority homes for the elderly were interviewed with the Geriatric Mental State (GMS) in 1985/6 after having been classed as depressed by a screening interview. The data so gathered were analysed by the computerized diagnostic program AGECAT in order to derive psychiatric diagnoses for these residents. All were traced after four years; 61 were dead. The 25 survivors were reinterviewed and given a second AGECAT diagnosis. In 1985/6 70 of the 86 examined were ‘diagnostic cases’ of psychiatric disorder. After four years 22 of the 25 survivors were classed as diagnostic cases. AGECAT diagnoses of organic psychosis were stable over four years within this population though the majority of subjects so diagnosed died within four years. Cases of depression had a more varied prognosis, with death, continunce as cases of depression or progression to organic psychosis being the most common outcomes. Recovery from any class of AGECAT disorder was an uncommon event.     

Diagnosis and treatment of mixed dementia

Vascular dementia (VaD)--secondary to cerebrovascular disease (CVD)--has been traditionally distinguished from Alzheimer's disease (AD), which is a purely neurodegenerative form of dementia. However, CVDs such as lacunes and white matter lesions are common in patients with AD, whereas certain pathological changes of AD, including senile plaques and tangles, are observed in elderly patients with VaD. These findings indicate that mixed vascular-degenerative dementia (MD) is the most common cause of dementia in the elderly. In the treatment and prevention of dementia, the accurate diagnosis of each individual type of dementia is vital. However, recognizing the distinction between these diseases can be difficult in clinical practice. This article provides an overview of MD, including the incidence, diagnosis, and treatment. In particular, we emphasize that functional brain imaging, including perfusion single photon emission computed tomography and benzodiazepine receptor binding measurement, in combination with morphological imaging (such as magnetic resonance imaging) is useful for distinguishing AD, VaD and MD. In addition to antiplatelet medications, cholinesterase inhibitors and N-methyl-D-aspartic acid antagonists may be effective in treating MD. Moreover the vascular risk factors also should be treated appropriately. The article describes the need for further studies to develop a better understanding of MD.     

社区痴呆患者的家庭照料者心理状况研究

目的：为了社区痴呆患者的家庭照料者心理状况及相关因素，方法：采用MMSE，ADL，GDS，Be-AD和GHQ对103例社区痴呆患者的家庭照料者心理状况进行调查并分析。结果：家庭照料者的焦虑失眠症状明显，主要是痴呆患者的精神／行为问题相关，与照料者本身的年龄，文化和对痴呆知识的了解程度有关。结论：对老年痴呆的照料以及照料者的心理健康状况值得重视。