RESUMEN
The accuracy of a dementia diagnosis by specialist physicians, as verified at an autopsy, is greater than 90% in many series. Donations of brains to the Maritime Brain Tissue Bank (MBTB) by individuals who did not have expert dementia diagnoses before death led us to investigate whether clinical features could also be detected retrospectively. Informants for 36 individuals whose brains were in the MBTB (18 women, mean age = 79 years; pathologic diagnoses: 75% Alzheimer's disease [AD]; 8.4% vascular or mixed dementia) were interviewed by specialist physicians using a semistructured retrospective interview based on the Brief Cognitive Rating Scale (BCRS) (range = 1 [no impairment] to 7 [terminal dementia]). The mean duration of dementia was 8.5 +/- 12.8 years based on proxy reports, and most cases suggested severe dementia--(stage 6 [severe] or 7 [terminal])--on the retrospective BCRS (RetroBCRS) before death. A score of 4 or more on the RetroBCRS had 100% sensitivity and specificity in detecting dementia. The RetroBCRS score correlated moderately with duration (.51). In linear and logistic regression models adjusted for age and sex, RetroBCRS staging helped explain 93% of the variation in duration. The accuracy of the retrospective diagnosis of the cause of dementia, compared with autopsy, was 92%. The RetroBCRS used by an expert physician with a reliable informant is a valid method of detecting dementia and determining whether AD was present.
Asunto(s)
Demencia/diagnóstico , Evaluación Geriátrica , Entrevista Psicológica/normas , Escalas de Valoración Psiquiátrica , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Encéfalo/patología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Percepción SocialRESUMEN
We report data on the validity and responsiveness (i.e. sensitivity to change) of assessment instruments including Goal Attainment Scaling (GAS), at a single site in a multicentre trial of the experimental therapeutic agent linopirdine. Fifteen people (11 women) were evaluated. GAS yielded a mean 3.7 goals per patient (range 2-6). The mean gain in the GAS scores, 2.7 +/- 16.4, was compared to changes in the Alzheimer's Disease Assessment Scale-Cognitive Section, the Global Deterioration Scale, Clinical Global Impression and the Mini-Mental State Exam. GAS had the largest relative efficiency (0.47) when compared to the standard. GAS also had the largest effect size (0.61). The data suggest that an individualized approach may have merit as an outcome measure and as a means to better understanding treatment effects. Qualitative analysis revealed consistent goal setting in self-care, behaviour, cognition and leisure, suggesting that these areas should routinely be evaluated.
Asunto(s)
Demencia/tratamiento farmacológico , Indoles/uso terapéutico , Piridinas/uso terapéutico , Actividades Cotidianas/psicología , Anciano , Demencia/diagnóstico , Método Doble Ciego , Estudios de Factibilidad , Femenino , Humanos , Indoles/efectos adversos , Masculino , Recuerdo Mental/efectos de los fármacos , Escala del Estado Mental/estadística & datos numéricos , Pruebas Neuropsicológicas/estadística & datos numéricos , Psicometría , Piridinas/efectos adversos , Conducta Social , Resultado del TratamientoRESUMEN
Behavioral problems in nursing home residents are already common and are likely to increase in number with the "graying" of the population. Effective treatment is available, and a structured and logical approach to management is needed. Patients should be assessed to differentiate delirium from dementia, and possible precipitants of disturbed behavior should be investigated. The best treatment of dementia-related behavioral problems includes nonpharmacologic measures (eg, environmental changes) and appropriate choice, dosing, and monitoring of pharmacologic agents. Long-term success with demented patients may depend on realistic expectations.
Asunto(s)
Demencia/terapia , Pacientes Internos , Casas de Salud , Anciano , Antipsicóticos/uso terapéutico , Terapia Conductista , Benzodiazepinas/uso terapéutico , Terapia Combinada , Delirio/diagnóstico , Delirio/terapia , Demencia/diagnóstico , Humanos , Fototerapia , Restricción Física , Medio SocialRESUMEN
The practice of preventive medicine in the elderly population needs to be revitalized. A review of the existing literature of preventive medicine for recommendations for the elderly uncovers two problems: most screening studies have had few elderly subjects, and the focus has been mainly on early disease detection and prevention of mortality. Prevention of morbidity and of functional impairment should receive more emphasis.