Showing papers in "International Journal of Geriatric Psychiatry in 1996"
Journal Article•
TL;DR: In this paper, the authors examined brain tissue from normal (control) patients and patients with depression and dementia for activities of various cholinergic components, and these related to the degree of senile plaque formation and extent of intellectual impairment.
Abstract: Necropsy brain tissue from normal (control) patients and patients with depression and dementia was examined for activities of various cholinergic components, and these related to the degree of senile plaque formation and extent of intellectual impairment. Choline acetyltransferase and acetylcholinesterase activities decreased significantly as the mean plaque count rose, and in depressed and demented subjects the reduction in choline acetyltransferase activity correlated with the extent of intellectual impairment as measured by a memory information test; muscarinic cholinergic receptor binding activity remained unchanged with increasing senile plaque formation but butyrylcholinesterase activity increased. The results suggest a close relation between changes in the cholinergic system and Alzheimer's dementia, but the precise role of the system in this disease remains to be elucidated.
1,896 citations
269 citations
TL;DR: The Geriatric Depression Scale short form appears to be a useful, valid screening instrument in this population of geriatric affective disorders patients.
Abstract: The validity of the Geriatric Depression Scale (GDS) short form was assessed in a geriatric affective disorders outpatient clinic (N = 116). The GDS was highly correlated with the Montgomery Asberg Depression Rating Scale (MADRS), and with optimal cutoff scores of 5/6, demonstrated a sensitivity of 85% and a specificity of 74.0%. The GDS appears to be a useful, valid screening instrument in this population.
179 citations
TL;DR: Of three plants with reputed memory enhancing properties, extracts of sage (Salvia officinalis) inhibited the brain enzyme in a concentration dependant manner, indicating that the active plant constituent(s) may be an as yet unidentified compound(s).
Abstract: We investigated plants reputed in herbal encyclopedias to enhance memory or alleviate mental disorder for cholinergic activities since this transmitter system has been implicated in memory and dementia. Crude extracts were applied to human brain homogenates to determine whether any inhibit acetylcholinesterase. Of three plants with reputed memory enhancing properties (rosemary, sage and balm), extracts of sage (Salvia officinalis) inhibited the brain enzyme in a concentration dependant manner. 50% enzyme inhibition was obtained at a concentration of 0.07 μg essential oil per ml and 1.5 mg fresh herb per ml. None of the known and commercially available chemical constituents of sage oil so far tested (borneol, caffeic acid, camphor, cineol or thujone) inhibited the enzyme, indicating that the active plant constituent(s) may be an as yet unidentified compound(s). In parallel studies, plants with insecticide or vermifuge (antihelminthic) properties, which frequently depend on cholinergic activities, were examined for cholinergic receptor interactions. Crude alcoholic extracts of wormwood, balm and angelica displaced nicotine binding to the nicotinic receptor in a concentration dependant manner, with IC50 values ranging from 3–15 mg/ml. Components of these plants may be relevant in relation to dementia therapy since there is a loss of nicotinic receptors in Alzheimer's disease and related disorders and stimulation of the nicotinic receptor leads to increased receptor numbers.
154 citations
TL;DR: These results suggest that while generalized anxiety should be placed below depression in a diagnostic hierarchy, phobic disorder does not fit with this diagnostic model.
Abstract: This community study of the anxiety disorders in people aged 65 and over finds a relatively high prevalence of anxiety disorders (15%), with phobic disorders being the most prevalent subclassification (12%). While generalized anxiety was usually seen with other psychiatric syndromes, phobic disorder was usually observed in the absence of either depression or anxiety. These results suggest that while generalized anxiety should be placed below depression in a diagnostic hierarchy, phobic disorder does not fit with this diagnostic model.
146 citations
TL;DR: It is suggested that the associations between psychosocial risk factors and dementia are due to the effects of stress, but other interpretations are also possible.
Abstract: The role of psychosocial risk factors in the development of late onset, severe dementia was examined in a longitudinal prospective study of a representative sample followed from 70 to 79 years of age. Subjects with any signs of dementia at the age of 70 were excluded. Eighteen risk factors occurring before the age of 70 were studied, five from childhood and youth, five from adult age and eight from the age of 65-70. Thirty-eight subjects developed dementia, and they were compared to the other 326 subjects. Death of a parent before the age of 16, previous arduous manual work, physical illness in the spouse after the age of 65 and serious illness in a child after the age of 65 made independent contributions to the prediction of dementia. There was a dose-response relationship : in subjects without exposure 3% developed dementia, in subjects with exposure to one or two risk factors 8% developed dementia, and in subjects with exposure to three of more risk factors 20% developed dementia. The association with psychosocial risk factors was similar in the aetiological subgroups Alzheimer's disease and vascular dementia. There was no association with education or alcohol abuse. We suggest that the associations between psychosocial risk factors and dementia are due to the effects of stress, but other interpretations are also possible. The results should be regarded as preliminary until confirmed by others.
115 citations
TL;DR: It is concluded that older people may be more at risk for experiencing post‐traumatic stress reactions despite having fewer disaster‐related experiences and they may also underutilize support services following a disaster.
Abstract: The psychosocial effects of an earthquake which occurred in Newcastle, Australia in 1989 are the focus of the Quake Impact Study, a four-phase community survey conducted over 2 years. Comparisons were made between adults aged less than 65 years (N= 2371) and those aged 65 years and older (N = 636). Results revealed that older subjects reported fewer threat and disruption experiences and used fewer general and disaster-related support services. However, older subjects reported higher overall levels of post-traumatic stress symptoms on the Impact of Event Scale (IES) compared with younger subjects. On both the IES and a general measure of morbidity (General Health Questionnaire: GHQ-12) the effects of earthquake exposure were more marked among the elderly. Within the older group, subjects who had high levels of post-traumatic stress symptoms (IES > 25, N = 117) were more likely to be female, report higher levels of exposure and use behavioural and avoidance coping styles. Although psychological distress declined with time, post-traumatic stress symptoms remained higher for the high exposure group throughout the study. We conclude that older people may be more at risk for experiencing post-traumatic stress reactions despite having fewer disaster-related experiences. They may also underutilize support services following a disaster. Older women in particular and people with an avoidance coping style appear to be most vulnerable.
111 citations
TL;DR: It is concluded that CT is an effective intervention for depression in older people and recommends strategies for further research to enable more accurate targeting of therapy.
Abstract: The applicability for older patients of cognitive (CT) and cognitive-behavioural (CBT) therapies for depression, now well established for clinical populations aged less than 65 years, was reviewed. Eighteen English language articles published to the end of 1994 were located using Medline, Psychlit and key reference searches. Outcome data from seven studies indicate that CT is clearly more effective than no therapy or placebo, through prediction of success remains uncertain. Several variables may influence outcome. Outcome in younger and older depressives with CT was comparable. Adaptation of cognitive-behavioural techniques for older depressives is described. While these may enhance CT's efficacy with older people, they as yet lack empirical evidence. The review, though limited, concludes that CT is an effective intervention for depression in older people and recommends strategies for further research to enable more accurate targeting of therapy.
103 citations
TL;DR: The various roles GPs and the primary care team could play in diagnosis and ongoing management and the legitimate anxieties and difficulties faced in fulfilling these roles are described.
Abstract: General practitioners (GPs) and the primary care team are uniquely situated to play a central role both in the diagnosis and ongoing care of dementia. Anecdotal reports and empirical work suggest that GPs face several challenges in fulfilling this role. This paper describes the various roles GPs and the primary care team could play in diagnosis and ongoing management. It then discusses the legitimate anxieties and difficulties faced in fulfilling these roles. The paper concludes with suggestions for how GPs and the primary care team might be supported to maximize their role in dementia diagnosis and management.
100 citations
TL;DR: In this paper, the authors examined the association of the IQCODE with clinical diagnosis of dementia, a battery of neuropsychological and psychological tests, CT scan findings and psychosocial characteristics of informants.
Abstract: The validity of the long and short forms of the IQCODE was studied in a group of 144 elderly ex-servicemen whose wives served as informants. The study examined the association of the IQCODE with clinical diagnosis of dementia, a battery of neuropsychological and psychological tests, CT scan findings and psychosocial characteristics of informants. For comparison, the validity of the Mini-Mental State Examination was also examined using the same standards. The IQCODE was found to perform as well as the Mini-Mental as a screening test for dementia. Unlike the Mini-Mental, it was not influenced by premorbid intelligence or education. However, it was influenced by other non-cognitive factors : the affective state and personality of the subject, the affective state of the informant and the quality of the relationship between the subject and the informant. The short and long forms of the IQCODE were highly correlated and had equal validity.
98 citations
TL;DR: In this paper, the interrater reliability of the Behavior Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), a psychiatric rating scale designed for the evaluation of behavioral disturbances in dementia patients, was studied in both English-speaking US patients and a French-speaking elderly patient population from France.
Abstract: The interrater reliability of the Behavior Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), a psychiatric rating scale especially designed for the evaluation of behavioral disturbances in dementia patients, was studied in both English-speaking US patients and a French-speaking elderly patient population from France. Additionally, the quantitative relationship between severity of Alzheimer's disease (AD) and mean scores on each of the BEHAVE-AD categories and mean total BEHAVE-AD score was determined in a separate study of 140 patients diagnosed as having probable AD. In both reliability studies significant correlations were obtained for all BEHAVE-AD symptom category scores and for mean total BEHAVE-AD scores. Analysis of BEHAVE-AD scores as a function of disease severity demonstrated a non-linear relationship between severity of behavioral symptoms and the global and cognitive advance of AD. Moreover, score analysis of the BEHAVE-AD indicates that these behavioral disturbances become most severe in the moderate and moderately severe stages of the illness. The results of these studies provide support for the reliability of the BEHAVE-AD. Additionally, the BEHAVE-AD provides basic knowledge about the nature and severity of the behavioral symptoms in AD. The latter information may be useful for the development of appropriate and effective psychopharmacologic intervention strategies for these difficult to manage behaviors. Furthermore, these results have implications for the methodology of pharmacologic trials of putative cognitive-enhancer compounds in AD.
TL;DR: The GDS15 and the GDS10 may be utilized in screening for depression among continuing care geriatric inpatients, but would require prospective evaluation among acutely ill geriatricInpatients.
Abstract: The performances of shorter versions of the Geriatric Depression scale (GDS) are examined. A cutoff of 4/5 gives the best sensitivity (80%) and specificity (77%) for the 15-item version (GDSI 5). A cutoff of 3/4 gives the best sensitivity (75%) and specificity (77%) for the 10-item version (GDS10). A cutoff of 0/1 gives the best sensitivity (85%) and specificity (60%) for the 4-item version (GDS4). Similar cutoff values, specificities and sensitivities were demonstrated in the dementia subsample for GDSI5 and GDS10. The GDS4 had poor sensitivity and specificity in the dementia subsample. The GDS15 and the GDS10 may be utilized in screening for depression among continuing care geriatric inpatients, but would require prospective evaluation among acutely ill geriatric inpatients.
TL;DR: There has been inadequate examination of psychosocial precipitants, motivations and psychopathology and the manner in which these factors interact and the possibilities of the psychological trait of hopelessness and the biological trait of low central serotonergic activity being linked with suicide attempts in the elderly require further research.
Abstract: Studies of attempted suicide (parasuicide, deliberate self-harm) in old age published between 1985 and 1994 are critically reviewed with reference to demography, suicide methods, stressors, psychiatric features and outcome. Despite methodological weaknesses, the studies consistently identified a number of factors long regarded as being associated with suicidal behaviour in old age. These include being unmarried, social isolation, impaired physical health, high suicidal intent and mental illness (particularly major depression). In contrast to earlier research, recent studies have found relationship problems to be a prominent factor. However, in the past decade there has been inadequate examination of psychosocial precipitants, motivations and psychopathology and the manner in which these factors interact. The possibilities of the psychological trait of hopelessness and the biological trait of low central serotonergic activity being linked with suicide attempts in the elderly require further research. Future studies should be prospective, longitudinal, use standardized measures, matched control groups and include evaluations of post-suicide attempt interventions, hopelessness and central serotonergic activity.
TL;DR: In this article, an investigation into the impact of caring for someone with Parkinson's disease is described, and it is found that spouses, in this case spouses, were found to have raised levels of psychological distress as indicated by a number of instruments.
Abstract: An investigation into the impact of caring for someone with Parkinson's disease is described. Informal carers, in this case spouses, were found to have raised levels of psychological distress as indicated by a number of instruments. Levels of depression in the sufferer emerged as offering the best prediction of distress in the carer, which raises the potential importance of treating depression in those with Parkinson's disease. Contrary to expectations, an index of potential social support did not predict carer distress and this may have been because the extent of social contact with others was so low as to not allow it to be a differentiating factor.
TL;DR: Estimation of median annual rates of moderate‐severe depression at each level of the pathway to psychiatric care found that only 10% of the elderly with moderate‐ severe depression were assessed or treated by a psychiatrist.
Abstract: Goldberg and Huxley describe a pathway to psychiatric care which has five levels and four filters. To explore the application of this pathway to the elderly with depression we searched the relevant literature to estimate median annual rates of moderate-severe depression at each level of the pathway. Among 27 elderly per thousand each year who had depression, 22 consulted a family physician who detected the disorder in 5.3. Of these, 2.8 were referred to psychiatric services and 1.3 were ultimately admitted to psychiatric units. Thus, only 10% of the elderly with moderate-severe depression were assessed or treated by a psychiatrist. If confirmed, these findings have implications for geriatric psychiatry services and research.
TL;DR: A review of magnetic resonance imaging (MRI) studies of white matter lesions in depression and Alzheimer's disease can be found in this paper, with depression associated with deep white matter lesion (DWML) and Alzheimer disease with periventricular lesions (PVL).
Abstract: This article reviews magnetic resonance imaging (MRI) studies of white matter lesions in depression and Alzheimer's disease. Although conflicting reports exist, many studies show that white matter lesions are more prevalent in both conditions, with depression associated with deep white matter lesions (DWML) and Alzheimer's disease with periventricular lesions (PVL). In normal ageing and depression there is some evidence that such lesions may be associated with neuropsychological dysfunction, though the relationship is less clear for Alzheimer's disease. One difficulty in drawing firm conclusions from work so far is that confounding variables, such as cerebrovascular risk factors, have now always been taken into account. Most studies have been cross-sectional so there is little information regarding the progression, prognostic significance and pathogenesis of such lesions. These issues merit examination in longitudinal studies combining serial MRI with clinical assessments of subjects who have been fully assessed for vascular risk factors.
TL;DR: Residents in five nursing homes in central Sydney were asked to take part in a study of depression and anxiety and a strong association was shown between anxiety and depression; seven of the 12 subjects were rated on the GDS as definitely depressed, compared with only 24% of the non‐anxious.
Abstract: Residents in five nursing homes in central Sydney were asked to take part in a study of depression and anxiety. One hundred and seven subjects who scored 18 or more on the Mini-Mental State Examination (MMSE) were interviewed using an anxiety questionnaire devised by Lindesay et al. (1989) as well as the Geriatric Depression Scale (GDS). Lindesay et al. found that 3.7% of elderly people in the community had generalized anxiety. Based on scores obtained on the anxiety questionnaire, 12 of the 107 (11.2%) were considered to have generalized anxiety. When subsequently these 12 were seen by a psychiatrist, the following DSM-III-R diagnoses were made: generalized anxiety disorder (3), panic disorder plus anxiety (one), mood disorder (three), schizophrenia (one), personality disorder (one) and no psychiatric disorder— realistic worries (3). As in previous studies, a strong association was shown between anxiety and depression; seven of the 12 (58%) were rated on the GDS as definitely depressed, compared with only 24% of the non-anxious. More of them were taking antidepressants. Phobic disorders were common (14% of subjects) but without causing persistent distress in most cases. Only two subjects had panic disorder.
TL;DR: One hundred and fifty‐eight consecutive patients attending a university memory clinic were assessed using a variety of standardized instruments, and three main categories of anxiety symptoms were evident—anxiety related to depression, anxietyrelated to psychosis and anxiety related to interpersonal situations.
Abstract: One hundred and fifty-eight consecutive patients attending a university memory clinic were assessed using a variety of standardized instruments. Dementia was diagnosed according to DSM-III-R criteria. One hundred and nine patients had DSM-III-R dementia, of whom 22% had subjective anxiety, 11% experienced autonomic anxiety, 38% experienced tension, 13% experienced situational anxiety and 1.8% had panic attacks. Thirty-two (29.4%) had one or more anxiety symptoms. None of the cognitive or demographic variables were significantly associated with the presence of anxiety symptoms. Three main categories of anxiety symptoms were evident-anxiety related to depression, anxiety related to psychosis and anxiety related to interpersonal situations.
TL;DR: There is a need for specialized multidisciplinary services for this group of patients, both diagnostic and supportive for presenile dementia, in Liverpool.
Abstract: The clinical characteristics and the level of service use were studied in a cohort of 200 patients referred for the investigation of presenile dementia, having had the onset of symptoms before the age of 65. The most common diagnoses given were Alzheimer's disease, vascular dementia and depressive pseudodementia. The level of psychiatric morbidity was high, depression insomnia, anxiety and aggression being the most common symptoms. As regards rate of service use, 22% of the Liverpool patients were in residential care after 1 year of follow-up, in contrast to 8% initially. We conclude that there is a need for specialized multidisciplinary services for this group of patients, both diagnostic and supportive.
TL;DR: A worsening in the quality of relationship between the caregiver and patient, being a spouse, shorter length of caregiving, poor caregiver self‐rated health, greater physical disability and behaviour/mood disturbance in the patient were found to be risk factors for burden.
Abstract: This cross-sectional study examined 99 elderly coresident stroke and dementia caregivers who had been in the caregiving role for at least 6 months, to identify risk factors for subjective burden and psychological morbidity. A worsening in the quality of relationship between the caregiver and patient, being a spouse, shorter length of caregiving, poor caregiver self-rated health, greater physical disability and behaviour/mood disturbance in the patient were found to be risk factors for burden. For psychological morbidity, risk factors also included behaviour/mood disturbance as well as female gender and low participation in life activities. These results demonstrate the multifactorial nature of caregiver stress in the elderly.
TL;DR: The results from the follow-up data presented in this article show that the most significant predictor of changes in life satisfaction at followup was baseline life satisfaction, while followup health and functional status, social network structure and activities explained the remainder of the explained variance.
Abstract: Life satisfaction, measured using Neugarten's Life Satisfaction Scale, was examined in three samples of elderly people in London and Essex at baseline and at follow-up 2½–3 years later. The analyses reported here relate to changes in life satisfaction. The previously reported baseline analyses showed that poor health and functional ability were the strongest predictors of baseline life satisfaction. The results from the follow-up data presented here show that the most significant predictor of changes in life satisfaction at follow-up was baseline life satisfaction. While follow-up health and functional status, social network structure and activities explained the remainder of the explained variance, this was very little. The results are consistent with previous analyses of associations with changes in psychiatric morbidity (mainly depression) and highlight the importance of initiating early rehabilitation programmes.
TL;DR: The study concludes that several factors may predict mortality in the elderly, especially in persons of 75 years and over, and the most consistent predictors of death in elderly persons are dementia, depression and poor social integration.
Abstract: A simple random sample of 334 persons aged 75+ years living in their own homes was initially examined in 1984/1985 and reexamined by the same physician 3 years later. The assessment included measures of mental and physical health, social integration, functional capacity, use of drugs and use of tobacco and alcohol. Mortality was recorded in the following 3 years. The mortality rate was increased among demented and depressed elderly and persons suffering from stroke or cancer. Increased mortality was also seen among subjects with hearing impairment, poor mobility and poor social integration, and in users of neuroleptics, digitalis and tobacco. A stepwise logistic regression analysis identified dementia, cancer, male sex and hearing impairments as explanatory variables for death. The study concludes that several factors may predict mortality in the elderly, especially in persons of 75 years and over. When compared with other studies, the most consistent predictors of death in elderly persons are dementia, depression and poor social integration.
TL;DR: The prevalence rate of concurrent depression and dementia among clinical samples is approximately 20% with lower rates in the community, with relatively little information available regarding patients in nursing homes.
Abstract: A large number of studies concerning depression in dementia sufferers have appeared in the literature over the last few years and have added to our knowledge considerably. The prevalence rate of concurrent depression and dementia among clinical samples is approximately 20% with lower rates in the community. There is relatively little information available regarding patients in nursing homes, which is a priority for research along with the study of milder depression. Although there have been a number of interesting developments regarding possible neurochemical associations of depression among these patients, there has been little study of psychosocial factors. The symptoms of depression are similar to those seen in patients without cognitive impairment. Concurrent depression creates considerable excess disability. More information is required about the natural course of these disorders and treatment strategies.
TL;DR: The case is made that insight and anosognosia are concepts with direct clinical relevance to Alzheimer's disease and the associated symptomatology, and implications for patient management, are emphasized.
Abstract: Increasing interest in insight and anosognosia in neuropsychiatric illness has been accompanied by growing academic study of such awareness phenomena in Alzheimer's disease This article reviews the current status of knowledge of this topic and makes the case that insight and anosognosia are concepts with direct clinical relevance to Alzheimer's disease The associated symptomatology, and implications for patient management, are emphasized Such relevance should form the basis for future research
TL;DR: A questionnaire was sent to memory disorders clinics in England, Scotland and Eire asking if they had a policy for sharing the diagnosis, how they did this and what terminology was used, and what support services were available afterwards.
Abstract: In order to understand better how much information is shared with people who are diagnosed with dementia, a questionnaire was sent to 20 memory disorders clinics in England, Scotland and Eire. We asked if they had a policy for sharing the diagnosis, how they did this and what terminology was used, and what support services were available afterwards. Our findings are reported.
TL;DR: Assessment of symptoms of stress and stressful events, as well as job satisfaction and attitudes towards the elderly and the home, in care staff in three Local Authority Social Services residential (Part III) homes for the elderly in Leicester suggested that with increasingly high levels of dementia and dependency in the residents, the homes’ structure has not sufficiently responded to the increasing demands on the staff.
Abstract: The present study assessed symptoms of stress and stressful events, as well as job satisfaction and attitudes towards the elderly and the home, in care staff in three Local Authority Social Services residential (Part III) homes for the elderly in Leicester. These homes have been reported as caring for a highly dependent group of residents (Neville et al., 1995). From the pattern of the care staff’s responses on both the Stressful Events Questionnaire and the Minnesota Satisfaction Questionnaire, it was indicated that organizational factors are identified as being as stressful as aspects of caring for the residents and managing their behaviour. Staff in these homes indicated favourable attitudes towards the elderly and towards caring for confused residents in the home. It is suggested that with increasingly high levels of dementia (82%) and dependency in the resident group, the homes’ structure in terms of staff group, training and support has not sufficiently responded to the increasing demands on the staff, which may significantly contribute to the reported high levels of stress and low job satisfaction.
TL;DR: The performance characteristics of an informant screening test for senile dementia were evaluated within a community-dwelling sample of 583 elderly persons in the Bordeaux region of France as discussed by the authors.
Abstract: The performance characteristics of an informant screening test for senile dementia were evaluated within a community-dwelling sample of 583 elderly persons in the Bordeaux region of France Receiver operating characteristics analysis indicated that although the test performs less well within this context than within a previous case-control study, it nonetheless retains high discriminability A specificity of 90% and a sensitivity of 79% for the detection of diagnosed senile dementia were obtained with a cutoff point of 24/25 The discriminability of the test was not affected by level of education The study demonstrates the necessity of adjusting the cutoff point of dementia screening instruments according to the estimated prevalence rate of dementia in the target population The potential utility of the instrument as a method of detecting dementia by postal survey and in cross-cultural research is discussed
TL;DR: The developed cognitive impairment screening test, the Chula Mental Test (CMT), had the best combination of sensitivity and specificity for detection of dementia and may have value in other south and southeast Asian countries.
Abstract: Western instruments for assessing cognitive impairment perform badly in less developed countries, producing many false positives. This occurs because many items require literacy and a reasonable level of education. A cognitive impairment screening test for use in less developed countries with high levels of illiteracy and low educational attainment is needed. The development of such an instrument was attempted. An initial instrument was derived from a review of existing instruments, selecting those items not requiring reading and writing ability. The 36 items obtained were then used with elderly people aged 60+ years who had no evidence of psychiatric, behavioural or psychological disturbance. Subjects were drawn from rural and urban clinical settings and a random sample from a Bangkok slum. Thirteen items showed no relationship with educational attainment and were then considered by an expert panel for utility and domain of cognition covered. The revised instrument, the Chula Mental Test (CMT), was then applied to 212 residents of an old people's home in Bangkok. The validity of the CMT was tested by comparison with a neurologist's independent diagnosis of dementia. Comparisons were made with the Mini-Mental State Examination and the Abbreviated Mental Test. The CMT at its optimal threshold had the best combination of sensitivity (100%) and specificity (90%) for detection of dementia. Test-retest repeatability and internal consistency were high. Translated versions of the CMT may have value in other south and southeast Asian countries.
TL;DR: The predictive value of health, health behaviour and functional ability for the occurrence of depression in elderly Finns is described using a longitudinal design.
Abstract: The predictive value of health, health behaviour and functional ability for the occurrence of depression in elderly Finns is described using a longitudinal design. The persons determined as not being depressed (DSM-III criteria) in an epidemiological study in 1984–85 were interviewed and examined in a follow-up study in 1989–90 (N=679). The risk factors were analysed by contrasting the persons depressed in 1989–90 with those not depressed.
Of the symptoms, recurrent falling and a loss of appetite in men, and palpitation, dyspnoea at rest, tremor in the hands, nausea, dizziness, recurrent falling, apathy and feebleness, fatigue and weakness, restlessness and sight disturbances in women predicted depression. Certain depressive symptoms, such as crying spells, psychomotor agitation, irritability, self-deprecation and suicidal thoughts in men, and sadness, tachycardia, a loss of concentration, psychomotor retardation and indecisiveness in women, also predicted depression. Numerous somatic and psychosomatic symptoms and numerous depressive symptoms were risk factors for women. Old age, poor self-perceived health, dependence on outside help in negotiating stairs and dependence on outside help in washing oneself were risk factors for men. A previous episode of depression was a predictor in both sexes. Sex was not related to the risk of depression. Both in men and women, an impairment of functional abilities during the follow-up was related to depression. A decline of self-perceived health, an occurrence of a serious disease and a decrease in the amount of physical exercise among women and moving into long-term institutional care and a decline of self-perceived health during the follow-up among men were associated with a greater risk. The occurrence of genitourinary diseases in men and the occurrence of vascular, cerebrovascular, thyroid or neurological disease in women during the follow-up were related to a high risk. The results support the hypotheses of a multifactorial aetiology and a relapsing and episodic course of depression in old age.