Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease

Article Abstract:

The most common cause of dementia (mental impairment) among the 1.5 million patients in nursing homes in the United States is Alzheimer's disease. The dementia of Alzheimer's disease is considered untreatable, but these patients often have associated treatable conditions such as depression. This study was undertaken to evaluate the extent to which treatable conditions occurred before, and contributed to, institutionalization. Previous studies have been done to find factors that predict institutionalization, but none have assessed patients before they were admitted to nursing homes. If treatable conditions are predicting factors for institutionalization, then treating these conditions might prevent or delay unnecessary placements. Psychiatrists examined and interviewed 210 possible or probable Alzheimer's outpatients and their caregivers at six-month intervals between 1984 and 1987. When 25 (12 percent) of the patients had been admitted to nursing homes, the researchers matched them to 25 noninstitutionalized patients to compare data. The institutionalized group had not been ill longer than the control group, but they did score higher on the Hamilton depression scale, the Brief Psychiatric Rating Scale, and the behavior disorder, activities of daily living, and orientation subscales of the Psychogeriatric Dependency Rating Scales on their last examination before being placed. There were no significant differences on any measure of cognition (mental processing) between the two groups. These results show that potentially treatable psychiatric symptoms such as depression and agitation are among the predictors for nursing home placement, and suggest that psychiatric intervention and treatment may prevent or delay placement. The results of this study agree with earlier studies which have found behavioral, not cognitive, disorders to be the greatest risk factor for institutionalization among Alzheimer's patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Risk factors, Nursing homes, Nursing home care, Institutional care, Hospital admission and discharge

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The influence of major depression on clinical and psychometric assessment of senile dementia of the Alzheimer type

Article Abstract:

The clinical diagnosis of Alzheimer's disease, a type of dementia, is often highly accurate in otherwise healthy patients. However, major depression is common in the aged, and this diagnosis may confound the results of assessments for dementia. The present study evaluated results of standard clinical and psychometric measures of dementia in four groups of elderly patients. The groups consisted of 8 patients with depression alone, 7 patients with depression and mild dementia, 41 nondepressed patients with very mild dementia, 66 patients with mild dementia alone, and 83 age-matched healthy controls. Data were collected during a 90-minute interview during which clinical assessments were made, and during a two-hour psychometric test battery. The 8 patients with depression alone performed as well as the 83 control subjects on clinical measures, but their performance on psychometric tests was most similar to the nondepressed group with very mild dementia. The performance of the 66 nondepressed subjects with mild dementia and the 7 patients with depression and mild dementia was similar. Psychometric testing was unable to distinguish depressed patients from those with very mild dementia. The groups performed about equally, however, on clinical measures. The results indicate that psychiatric evaluation for depression should be performed before interpreting the results of psychometric tests for mild senile dementia of the Alzheimer type. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Depression in old age, Geriatric depression

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Psychopathology of very mild dementia of the Alzheimer type

Article Abstract:

One of the primary symptoms of Alzheimer's disease is dementia, an impairment of abstract thinking, judgment, functional ability and memory. The difficulties in diagnosing and delineating the stages of the disorder have limited the characterization of mood swings, personality changes, and psychotic symptoms related to the condition. The Clinical Dementia Rating scale divides the illness into one of five categories of dementia: absent, questionable, mild, moderate or severe. Changes in personality that occur as the disease progresses were examined and the characteristics for different stages were identified. A control group of 83 individuals was compared with two other groups that were classified as having questionable dementia (41 patients) or mild dementia (68 patients). Results indicated the affective and behavioral changes in patients with very mild dementia were similar to those in patients with mild dementia. Psychotic symptoms were rare in the very mild stage and usually did not occur until the mild stage but they were common in the moderate state of disease. Delusion, misidentification, and hallucination were almost never observed until the onset of the moderate stage of Alzheimer's disease. A better understanding of the nature and normal progression of this illness will be helpful in devising and evaluating new treatments. Also, the study of psychiatric symptoms may assist in understanding the underlying functional anatomy involved.

Research, Presenile dementia

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