Do health factors affect memory performance in old age?

OBJECTIVES: The aim of this study was to examine the effect of health factors on memory performance in a population-based sample of 679 older people (mean age=69.2 years). METHODS: Both subjective and objective indices of health were used as predictor variables. Memory performance was measured with an immediate recall test and a delayed recall test. RESULTS: Some of the objective health indices were correlated with performance on the memory tasks, but regression analysis showed that they hardly had a unique effect on memory performance. CONCLUSION: Health factors have only a weak relationship with memory performance in older adults.     

Does integration really make a difference? A comparison of old age psychiatry services in England and Northern Ireland

OBJECTIVE: This paper seeks to address whether integrated structures are associated with more integrated forms of service. Northern Ireland has one of the most structurally integrated and comprehensive models of health and personal social services in Europe. Social and health services are jointly administered and this arrangement should, in theory, promote collaborative working and interdisciplinary arrangements. DESIGN: The study employed a cross-sectional survey of consultants in old age psychiatry in England and Northern Ireland. Potential respondents were sourced from the UK Royal College of Psychiatrists membership list and locally collected information. MEASURES: A self-administered postal questionnaire. Along with general service arrangements, the domains measured reflect core policy issues for older people's services. Under particular scrutiny in this study were the degree of integration of health and social service provision, as well as inter-professional team working. RESULTS: The integrated health and social care services in Northern Ireland do appear to provide more integrated patterns of working, primarily in managerial arrangements and in the location of staff. There was no evidence of the impact of integration on practice in areas such as: assessment, referral and medical screening. The factors found to be associated with greater integration of health and social care in the prediction model fell into three categories: provision of specialist services; provision of outreach activities; and shared policies by which the whole team worked. CONCLUSIONS: Health and personal social services in Northern Ireland have a distinct advantage over their counterparts in comparable areas of England. The results indicate that integrated structures in old age psychiatry services are associated more with integrated management systems and less with integrated practice-related activities. Further research is required on the effectiveness and cost effectiveness of integrating services in general. It is important that future intervention studies systematically measure the component parts, nature and extent of integration and their individual and joint contribution to the effectiveness and efficacy of services.     

How do Individuals with Autism Plan Their Movements?

Two experiments investigated how persons with and without autism plan manual aiming movements when advance information is direct and when strategic planning is required. In Experiment 1 advance information about hand, direction, and/or movement amplitude was manipulated. Reaction times suggested both groups adopted a hierarchical pattern of movement planning. In Experiment 2, participants performed aiming movements to one of two targets that were the same or different size. Participants without autism varied the starting location in anticipation of specific target stimuli whereas participants with autism consistently selected the midpoint. Overall, individuals with autism used advance information to plan their movements when this information was direct. However, their performance became stereotyped when strategies were self-generated.     

How do officially organized services meet the needs of elderly caregivers and their spouses with Alzheimer's disease?

The caregiving situation among caregivers and their spouses with Alzheimer's disease, the support and services received, the unmet needs, and the caregivers' satisfaction with the services are examined. The study included a survey of a random sample of 1943 caregivers of persons with Alzheimer's disease in Finland. Mean age of the caregivers was 78.2 years, and 35% had poor subjective health. Disabilities and behavioral symptoms were common among the spouses with Alzheimer's disease. The services most often offered were financial support (36%), technical devices (33%), physiotherapy (32%), and respite care in nursing homes (31%). Most often needed services were physiotherapy for the spouse with dementia (56%), financial support (50%), house-cleaning (41%), and home respite (40%). Only 39% of the caregivers were satisfied with the services, and 69% felt they did not have any influence on what services were offered. It was concluded that official services poorly meet the needs of these caregivers.     

How do patients with neglect see a horizontal line?

Abstract. Twelve patients with left unilateral spatial neglect were examined with a newly devised coloured line bisection task. They were presented with a horizontal line printed in blue on one side and in red on the other side; the proportions of the blue and red segments were varied. Immediately after placement of the subjective midpoint, the line was concealed and the patients were asked to name the colours of the right and left ends. Five patients who identified the left-end colour almost correctly had no visual field defect, while the other seven whose colour naming was impaired on the left side had left visual field defect. The rightward bisection errors were similarly distributed in the fair and poor colour-naming patients except for two patients from the latter group. The lesions of the fair colour-naming patients spared the lingual and fusiform gyri, which are known to be engaged in colour processing. Patients with neglect whose visual field is preserved may neglect the leftward extension of a line but not the colour in the neglected space. The poor colournaming patients frequently failed to name the left-end colour that appeared to the left of their subjective midpoint, which indicates that they hardly searched leftward beyond that point. In such trials, they reported that the left end had the same colour as the right end. The results suggest that in patients with neglect and left visual field defect, both the leftward extent and the colour of a line may be represented on the basis of the information from the attended right segment.     

Is depression more prevalent in old age?

OBJECTIVE: To examine the prevalence of depression in old age and to review cross-age studies that reported age-related differences in prevalence. METHOD: Reports of studies that included data on the prevalence of depression in old age were reviewed, and conclusions from review articles were considered. RESULTS: Findings have been inconsistent, but majority opinion holds that depression (especially 'subsyndromal') is common in old age. There may be two peaks in the prevalence rate of major depression, one in late old age and the other in middle age or earlier. CONCLUSIONS: The allocation of health care resources should not be determined by survey findings concerning the prevalence of major depression and dysthymia.     

How do seizures stop?

Although often overshadowed by factors influencing seizure initiation, seizure termination is a critical step in the return to the interictal state. Understanding the mechanisms contributing to seizure termination could potentially identify novel targets for anticonvulsant drug development and may also highlight the pathophysiological processes contributing to seizure initiation. In this article, we review known physiological mechanisms contributing to seizure termination and discuss additional mechanisms that are likely to be relevant even though specific data are not yet available. This review is organized according to successively increasing "size scales"-from membranes to synapses to networks to circuits. We first discuss mechanisms of seizure termination acting at the shortest distances and affecting the excitable membranes of neurons in the seizure onset zone. Next we consider the contributions of ensembles of neurons and glia interacting at intermediate distances within the region of the seizure onset zone. Lastly, we consider the contribution of brain nuclei, such as the substantia nigra pars reticulata (SNR), that are capable of modulating seizures and exert their influence over the seizure onset zone (and neighboring areas) from a relatively great-in neuroanatomical terms-distance. It is our hope that the attention to the mechanisms contributing to seizure termination will stimulate novel avenues of epilepsy research and will contribute to improved patient care.     

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.