Should dementia patients be informed about their diagnosis?

Current government policy encourages service users to be involved as equal members of the interprofessional care team. This goal is compromised in the care of people with dementia if they are not informed of their diagnosis. This paper looks at recent research both for and against disclosure, and argues in favour of breaking the news in a supportive way.     

Depressive symptoms in advanced cancer. Part 2. Depression over time; the role of the palliative care professional

OBJECTIVE: To survey changes in depressive symptoms over time in patients with advanced cancer using the Mood Evaluation Questionnaire (MEQ), and explore how effective Palliative Care Professionals (PCPs) are at assessing this. METHOD: Forty-five advanced cancer patients were followed monthly for up to six interviews (108 interviews in total). Selected clinical variables were recorded. RESULTS: At first interview, 26 (58%) patients were depressed using MEQ, seven (16%) severely. Attrition rates were high, with 28, 13, nine, seven and six patients available for subsequent interviews. A > 12-point increase in MEQ over sequential interviews was associated with reduced survival (Hazard ratio 3.2, CI 1.2-8.4). PCPs recognized depressed mood, but underdiagnosed severe depression in 9% of patients (CI 3-16%, P = 0.002). A past history of depression was a strong indicator of current depressed mood on the MEQ. CONCLUSION: Change in depressive symptoms over time is related to mortality in this patient cohort, patients with marked deterioration in mood dying earlier. PCPs usually recognize patients' depression but underestimate the severity of depressed mood.     

The cerebellum and olfaction in the aging brain: a functional magnetic resonance imaging study

The present study investigated activation of distinct cerebellar regions as a result of olfactory stimulation in healthy young and elderly adults using functional magnetic resonance imaging (fMRI). Ten young and 10 elderly adults were imaged using a 1.5-TMR scanner. The odorant amyl acetate was delivered in 12-s on, 40-s off cycles. Throughout the scan participants responded with a button press at first detection of each stimulus interval followed by a second button press upon odorant extinction. Images were processed with AFNI software. Elderly participants showed significantly decreased cerebellar activation in both the superior semilunar lobule (Crus I) and the inferior semilunar lobule (Crus II), two of three previously identified regions of interest for odor processing, compared to young adults. Interestingly, both groups showed similar levels of activation in the third region of interest, the posterior quadrangular lobule (VI), although the elderly showed more variability than the young did. Previous research identifying this area to be involved in attention may reflect the possibility that elderly adults engaged in olfactory tasks may show more variability than young participants in the degree of attentional demands needed for these tasks as a result of decreased olfactory abilities.     

Predictive validity and reliability of adult hearing screening techniques

The purpose of this study was to evaluate and compare the efficacy of hearing screening tools to identify hearing loss in the older adult population. The test-retest reliability of both the AuDX DPOAE hand-held screener and subjective otoscopic ratings of percent earwax accumulation were evaluated. Additionally, the predictive validity was investigated for five hearing screening tools: the DPOAE hand-held screener, pure-tone screening, screening otoscopy, self-assessment of communication, and case history screening. The research was conducted through typical community hearing screenings on normal-hearing and hearing-impaired volunteer subjects. The screening subjects included 67 adults aged 49 to 89 years. Of those, 44 returned for a full audiologic evaluation. Key findings include: (1) Pure-tone screening had predictive validity for actual hearing loss in the older adult population when a 25 dB HL fence is used; (2) Screening otoscopy ratings were highly reliable across time and raters; (3) Self-assessment scores did not predict compliance with referral recommendations; (4)The AuDX DPOAE hand-held screener proved to be reliable in the overall pass/refer outcome, but lacked predictive validity for actual hearing loss in older adults.