Social worker estimations of life span in terminal cancer patients

The objective of this study was to evaluate the accuracy of the social worker estimation (SWE) of the length of survival of patients who were seen at the end stage of their terminal illness, in home-based palliative care treatment. Estimates were filled out on a form every 2 weeks during the time of the visits until the patient's discharge or death. The wording used by the social worker was the 'average survival period'. Survival was measured from the time of each survival prognostication until death from any cause. Both SWE and actual survival were categorized into 12 weeks. Then, 29 estimates were analyzed using the SPSS statistical software package. The mean and median actual survivals of the total cohort were 6.5 and 5.1 weeks, respectively. The minimum and maximum weeks of actual survival were 0.1 and 23.1, respectively. The mean and median differences between SWE and actual survival were 2.1 and 1.6 weeks, respectively (range: 18.7, minimum and maximum differences of -7.3 and 11.4 weeks, respectively). The Pearson correlation coefficient between actual survival and SWE was 0.827 (P<0.001). Overall, 59% (17/29) were correctly assigned by social worker to the correct survival categories. Our study suggests that the oncology social worker can be a valuable resource for information about the patient's prognosis of life span.     

Correlation between the CAMCOG, the MMSE, and three clock drawing tests in a specialized outpatient psychogeriatric service

Our objective was to assess the correlation between (1) the Cambridge Cognitive Examination (CAMCOG) (including the Mini-Mental State Examination [MMSE]) score and three clock drawing tests (CDT) and (2) the three CDTs independently, in a specialized outpatient psychogeriatric service. One hundred and fourteen subjects completed a comprehensive evaluation and were allocated to one of the following groups: dementia of the Alzheimer's type (DAT) in 52; vascular dementia (VD) in 36; non-dementia (ND; Mood or Anxiety Disorders) in 26. When the entire sample of patients is considered, all three CDTs used were highly and significantly correlated to the MMSE score, the CAMCOG score, and to each other. In this patient population, these cognitive tests may be interchangeable for providing an initial objective measure of cognitive function. However, when the same correlations were studied in the separate diagnostic groups, in the dementia group (DAT and VD) even though the high correlations between the various CDTs themselves did not change, the correlations between the MMSE score, the CAMCOG score and the CDTs decreased, more evidently in the VD group. This trend became even more conspicuous in the ND group, where some of the above mentioned correlations became non-significant. We hypothesize that in a real clinical situation the clinician initially assumes the role of cognitive "evaluator" (in terms of the total sample) followed by the role of cognitive "monitor" (in relation to specific diagnostic groups). In the first instance, CDTs, the MMSE, and the CAMCOG might be considered interchangeable as an initial objective measure of cognitive dysfunction, while in the second role, different CDTs might be diversely used, presumably supplemented by other cognitive tests and clinical methods.     

Intentions of first-degree relatives of patients with Alzheimer's disease to seek a cognitive status examination

AIMS: The aim of the present study was to examine the factors influencing intentions to seek a cognitive status evaluation among first-degree relatives of persons with Alzheimer's disease. METHODS: Phone interviews were conducted with 93 first-degree relatives of persons with Alzheimer's disease, recruited from a large memory clinic. MEASURES: Intentions to seek a cognitive status examination were examined by asking participants to rate their willingness to seek a cognitive status examination during the next year and during the next five years. Independent variables included participants' and patients' characteristics, caregiving characteristics, knowledge about AD, worries about memory problems, and perceptions of the benefits and barriers of seeking a cognitive status examination. RESULTS: Overall, first-degree relatives reported only moderate intentions to seek a cognitive status examination. Their willingness to seek an examination was related to the characteristics of the first-degree relative (income and subjective memory), the characteristics of the patients (behavioral problems), the caregiving characteristics (primary caregiver), and to the perceptions of barriers associated with the examination. CONCLUSIONS: These findings stress the complexity of the decision-making process confronting first-degree relatives regarding their intentions to seek a cognitive status examination, and suggest the need to provide information to reach an informed decision.     

Are the clock-drawing test and the MMSE combined interchangeable with CAMCOG as a dementia evaluation instrument in a specialized outpatient setting?

This study examines whether the Clock-Drawing Test (CDT) combined with the Mini-Mental State Examination (MMSE) is interchangeable with the more detailed and lengthy Cambridge Cognitive Examination (CAMCOG) as a dementia evaluation instrument in a specialized psychogeriatric outpatient setting: 114 outpatients (88 with dementia, 26 with depressive and anxiety disorders) were included. Each subject underwent a comprehensive evaluation in which the CAMCOG (MMSE included) was administered. DSM-IV diagnoses were independently established. CAMCOG-derived clock drawings were blindly scored according to Freedman's method. The authors found that a combination of CDT and MMSE enhanced the psychometric properties of the above scales approximating them to CAMCOG's. They conclude that CDT in combination with the MMSE is valid for differentiation of dementia sufferers from nondemented psychiatric controls in a specialistic setting and might replace CAMCOG. However, the generalizability of these findings (a wider range of diagnoses, primary care settings) still needs to be verified.     

Accuracy of recall memory in elderly patients in response to telephone support calls

During the Gulf War, 93 elderly patients (mean age 74 years) received telephone-based support calls from a hospital-based home care facility. Accuracy of memory recall of these telephone support calls was assessed 6 weeks after the termination of the war by means of a postal questionnaire. The relative accuracy of the recall memory of these patients or their caregivers to the telephone calls received exhibited a sensitivity of 75%, a specificity of 78%, a positive predictive value of 60% and a negative predictive value of 88%. Patients who had received four calls demonstrated better memory recall than those receiving less than four. Thus, relying upon patient's memory alone may be insufficient for evaluating survey data in the elderly. In addition, we found that only patients who correctly remembered receiving four individual telephone support calls tended to exhibit a decrease in the anxiety level. This study emphasizes the importance of repeated interventional telephone calls as a method of increasing recall accuracy and decreasing anxiety in aged patients.     

Psychiatric hospitalization of senile,presenile and arteriosclerotic dementia patients in israel: A psychiatric case register study

Most dementia patients in Israel are cared for by non-psychiatric services. Psychiatric hospitals are generally reluctant to admit behaviourally disturbed dementia patients, unless it is for appropriate psychiatric reasons and for a transient period of time. We used national Psychiatric Case Register (PCR) data to examine the implementation of these criteria in a sample of 711 dementia patients (senile and arteriosclerotic). Results suggest that: (a) in about a third of senile patients and in nearly half of arteriosclerotics no primarily treatable, psychiatric symptoma-tology was diagnosed; (b)most admissions were not on a psychiatric emergency basis; (c)inpatient stay of dementia patients was longer than the average psychiatric admission. These patients were usually transferred to a non psychiatric facility or to a general hospital, or died in the psychiatric hospital. We conclude that the subject of psychiatric hospitalization of dementia patients in Israel needs substantial revision.     

Examining the reliability and validity of the Hebrew version of the Mini Mental State Examination

The Mini Mental State Examination is used worldwide for the screening and diagnosis of dementia. The aim of the present study was to examine the reliability and validity of the Hebrew version of the Mini Mental State Examination. The Hebrew version of the Mini Mental State Examination was administered to 36 demented and 19 non-demented elderly persons. Test-retest reliability scores were calculated as exact agreement rates, and ranged from good to excellent for all the items. Strong convergent validity, as measured by the correlation between the MMSE and the CAM-COG (r = 0.94), was found. Good predictive value was observed as over three-quarters of the participants were correctly classified as demented or non-demented. The Hebrew version of the MMSE was found to be a useful and valid instrument for the determination of dementia in the elderly population.