Medicine JournalFeeds

Net costs of dementia in Sweden – An Incidence Based 10 Year Simulation Study.

Int J Geriatr Psychiatry. 2012 Feb 1;

Authors: Sköldunger A, Wimo A, Johnell K

Abstract

BACKGROUND: Aging of the population results in increasing number people suffering from dementia, and this will have a great impact on costs for the society. Because of the long duration of dementia disorders, it is difficult to collect empirical data for the whole survival period of incident cases. Therefore, modeling approaches are frequently used. The purpose of this study was to describe the costs of an incident dementia cohort with progression modeling. METHODS: Epidemiological data indicated that the incidence of dementia in Sweden was 24,000 people in 2005. Thus, incident cases were run in a Markov model for 10 cycles of 1 year each. Severity state specific costs were used and defined by Clinical Dementia Rating scale. RESULTS: Total cost for the cohort was 27.24 billion Swedish Krona (SEK). The mean cost per person and year was 269,558 SEK. Total cost for long-term institutional care was 21 billion SEK during the modeled period. CONCLUSION: Cost of long-term institutional care is the major cost driver, even in mild dementia. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22298311 [PubMed - as supplied by publisher]

Semantic memory and language dysfunction in early Alzheimer’s disease: a review.

Int J Geriatr Psychiatry. 2012 Feb 1;

Authors: Verma M, Howard RJ

Abstract

BACKGROUND: Language impairment in Alzheimer’s disease occurs early, and language function deteriorates with progression of the illness to cause significant disability. This review focuses on language dysfunction in Alzheimer’s disease and the contribution of semantic memory impairment. METHODS: Electronic publication databases were searched for literature relevant to the review. Additionally, individual references were examined to elicit further studies not found by online search. RESULTS: Language impairment in Alzheimer’s disease initially affects verbal fluency and naming before breakdown in other facets. Naming and fluency require integrity of semantic concepts, and dysfunction may be a marker of primary semantic memory impairment rather than overall cognitive decline. Research suggests the presence of semantic loss several years prior to diagnosis. Imaging studies indicate an altered connectivity state with respect to language networks, and this is associated with potential semantic failure. This state may also be present in individuals with established risk factors for Alzheimer’s disease. Compensatory recruitment of alternative cortical areas to supplement language function appears to occur and may be a target for future intervention. CONCLUSIONS: Identifying and classifying the nature and degree of language impairment more closely could aid in developing targeted therapies. Treatments already established in other aphasic states, such as post-stroke, may be especially relevant. The nature of these and the protective nature of cognitive reserve are potential therapeutic avenues. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22298328 [PubMed - as supplied by publisher]

An exploration of nursing home managers’ knowledge of and attitudes towards the management of pain in residents with dementia.

Int J Geriatr Psychiatry. 2012 Jan 30;

Authors: Barry HE, Parsons C, Passmore AP, Hughes CM

Abstract

BACKGROUND: The aims of this study were to explore the knowledge, attitudes and beliefs that nursing home managers hold with regard to the assessment and management of pain in residents with dementia and to determine how these may be affected by the demographic characteristics of the respondents. METHODS: A questionnaire comprising six sections was mailed, on two occasions during March and April 2010, to 244 nursing home managers in Northern Ireland (representing 96% of the nursing homes in Northern Ireland). RESULTS: The response rate was 39%. Nearly all respondents (96%) provided care to residents with dementia, yet only 60% of managers claimed to use pain treatment guidelines within their nursing home. Respondents demonstrated good knowledge about pain in residents with dementia and acknowledged the difficulties surrounding accurate pain assessment. Nursing home managers were uncertain about how to manage pain in residents with dementia, demonstrating similar concerns about the use of opioid analgesics to those reported in previous studies about pain in older people. Managers who had received recent training (p = 0.044) were less likely to have concerns about the use of opioid analgesia than those who had not received training. Respondents’ beliefs about painkillers were largely ambivalent and were influenced by the country in which they had received their nursing education. CONCLUSIONS: The study has revealed that accurate pain assessment, training of nursing staff and a standardised approach to pain management (the use of pain management guidelines) within nursing homes all have a significant part to play in the successful management of pain in residents with dementia. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22290520 [PubMed - as supplied by publisher]

Music interventions against agitated behaviour in elderly persons with dementia: a cost-effective perspective.

Int J Geriatr Psychiatry. 2012 Mar;27(3):327

Authors: Bellelli G, Raglio A, Trabucchi M

PMID: 22278988 [PubMed - in process]

Response to the letter by Dr. Bellelli, Raglio and Trabucchi’s article “Music intervention against agitated behavior in elderly persons with dementia: a cost-effective perspective”.

Int J Geriatr Psychiatry. 2012 Mar;27(3):328

Authors: Chou KR

PMID: 22278989 [PubMed - in process]

Assessment of cognitive fluctuation in dementia: a systematic review of the literature.

Int J Geriatr Psychiatry. 2012 Jan 25;

Authors: Lee DR, Taylor JP, Thomas AJ

Abstract

OBJECTIVE: Cognitive fluctuations (CF) are defined as spontaneous alterations in cognition, attention and arousal. They are a recognised feature of the dementias, especially dementia with Lewy bodies (DLB) and Parkinson’s disease dementia. However, the accurate identification and assessment of CF presents a major clinical difficulty, with the operationalisation of the term ‘cognitive fluctuation’ remaining elusive, despite several attempts to identify, quantify and assess the phenomenon. No published reviews of CF in dementia exist despite this being an important clinical phenomenon and a core diagnostic feature of DLB. METHODS: We systematically explored the literature and measures available for the definition, assessment and quantification of CF in the dementias. RESULTS: We identified only three psychometric measures, which have been developed for the identification and assessment of CF, and these have not been adequately tested as yet for reliability and validity. DISCUSSION AND CONCLUSIONS: We conclude that further research is warranted into the assessment of CF, and this is timely given the increasing recognition of the clinical importance of CF as a dementia symptom, particularly in the Lewy body dementias. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22278997 [PubMed - as supplied by publisher]

Association of attentional shift and reversal learning to functional deficits in geriatric depression.

Int J Geriatr Psychiatry. 2012 Jan 24;

Authors: Potter GG, McQuoid DR, Payne ME, Taylor WD, Steffens DC

Abstract

OBJECTIVE: The objective of this study is to examine the association between self-reported functional disability in depressed older adults and two types of executive function processes, attentional set shifting and reversal learning. METHODS: Participants (N = 89) were aged 60 or over and enrolled in a naturalistic treatment study of major depressive disorder. Participants provided information on self-reported function in instrumental activities of daily living (IADL) and completed the Intra-Extra Dimensional Set Shift test (IED) from the Cambridge Neuropsychological Testing Automated Battery, which assesses intra-dimensional attentional shifts, extra-dimensional attentional shifts, and reversal learning. Participants were categorized by the presence or absence of IADL difficulties and compared on IED performance using bivariable and multivariable tests. RESULTS: Participants who reported IADL difficulties had more errors in extra-dimensional attentional shifting and reversal learning, but intra-dimensional shift errors were not associated with IADLs. Only extra-dimensional shift errors were significant in multivariable models that controlled for age, sex, and depression severity. CONCLUSIONS: Attentional shifting across categories (i.e., extra-dimensional) was most strongly associated with increased IADL difficulties among depressed older adults, which make interventions to improve flexible problem solving a potential target for reducing instrumental disability in this population. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22271429 [PubMed - as supplied by publisher]

The prevalence of depressive symptoms among the older in China: a meta-analysis.

Int J Geriatr Psychiatry. 2012 Jan 17;

Authors: Zhang L, Xu Y, Nie H, Zhang Y, Wu Y

Abstract

BACKGROUND: This study aims to find the status and prevalence of depressive symptoms among the population aged 60 years and above in China. METHODS: We conducted a meta-analysis of cross-sectional studies in older population. Epidemiological studies on depressive symptoms published in Chinese journals were identified manually and online by using the Chinese Biological Medical Literature Database, Chongqing VIP database for Chinese Technical Periodicals, and Chinese National Knowledge Infrastructure database. Studies published in English journals were identified using Medlars Online. RESULTS: A total of 32 eligible studies were included in this review. The analysis showed that the pooled prevalence (with 95% confidence interval) of depressive symptoms for the seniors in China was 22.7% (confidence interval: 19.4-26.4%). The prevalence of depressive symptoms among the older was a little higher in women (24.2%) than in men (19.4%), in rural (29.2%) than urban (20.5%) areas, and in western (30.5%) than eastern (19.5%) areas. In addition, the prevalence of depressive symptoms decreased with increasing levels of education. However, it did not increase gradually with age. CONCLUSIONS: The prevalence of depressive symptoms among the older in China was a little high, and it was varied by gender, age, area, and education level. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22252938 [PubMed - as supplied by publisher]

Suicidal thoughts and behaviors in older adults in rural China: a preliminary study.

Int J Geriatr Psychiatry. 2012 Jan 17;

Authors: Chiu HF, Dai J, Xiang YT, Chan SS, Leung T, Yu X, Hou ZJ, Ungvari GS, Caine ED

Abstract

BACKGROUND: One purpose of this study was to examine the feasibility of conducting epidemiological survey on suicidal thoughts and behaviors (hereafter “suicidal thoughts/behaviors”; i.e., any suicidal ideation, serious ideation, planning, and attempts) among older adults in rural China. Another purpose was to investigate among older people in rural China the prevalence of suicidal thoughts/behaviors, as well as their sociodemographic and clinical correlates. METHODS: A randomly selected sample of 263 subjects, 50 years or older, was recruited in a remote rural area of Southwestern China (Mianyang Region, Sichuan Province) and interviewed using structured instruments. Basic sociodemographic and clinical data were collected. RESULTS: There was no refusal among approached subjects, and subjects were willing to answer questions on suicidal thoughts/behaviors. The lifetime prevalence of suicidal ideation, serious ideation, planning, and attempt was 28.9% (23.4%-34.4%), 19.7% (14.9%-24.6%), 11.4% (7.5%-15.3%), and 5.3% (2.6%-8.1%), respectively. The corresponding 12-month prevalence was 8.8% (5.3%-12.2%), 5.3% (2.6%-8.1%), 2.7% (0.7%-4.6%), and 0%, respectively. The 2-week prevalence was 3.4% (1.2%-5.6%), 2.3% (0.5%-4.1%), 2.3% (0.5%-4.1%), and 0%, respectively. Correlates of suicidal thoughts/behaviors of this group are similar to findings from other community studies, such as female gender, unmarried status, major medical conditions, insomnia, financial difficulties and lower education, depressive symptoms, recent stressful life events, greater life dissatisfaction. CONCLUSIONS: Our findings suggest that larger scale epidemiological survey of suicidal thoughts/behaviors on older adults in rural China would be feasible. Suicidal thoughts/behaviors are common among older people in rural China, as seen in this preliminary study, which points to the need for further larger scale investigations. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22252964 [PubMed - as supplied by publisher]

Mortality and causes of death in older patients with schizophrenia.

Int J Geriatr Psychiatry. 2012 Jan 17;

Authors: Talaslahti T, Alanen HM, Hakko H, Isohanni M, Häkkinen U, Leinonen E

Abstract

OBJECTIVE: The aim of this study was to evaluate mortality and causes of death in older patients with schizophrenia in comparison with the general population. The mortality of patients experiencing relapse was also compared with those in remission. METHODS: The study sample consists of patients (n = 9461) over 65 years by the first of January 1999, with schizophrenia or schizoaffective disorder (ICD-8, ICD-9: 295, ICD-10: F20, F25) as the main register diagnosis during the period 1969-1998. The sample was collected from nationwide registers in Finland and followed up between 1999 and 2008. RESULTS: Overall Standard Mortality Ratio (SMR) of the older schizophrenia patients was 2.69 [95% confidence interval, 2.62-2.76]. For natural causes of death, overall SMR was 2.58 (2.51-2.65; n = 5301), and for unnatural causes of death, it was 11.04 (9.75-12.47; n = 262). The most common causes of death matched those in the general population. Of patients who died during follow-up, 31% (1709/5596) had at least one psychiatric hospitalization within 5 years before follow-up. The SMR for this group was higher (3.92; 3.73-4.11) than in those patients (2.37; 2.29-2.44) with no such treatment during that time. CONCLUSION: All-cause mortality of older patients with schizophrenia was almost threefold that of general population. They died for similar reasons to the general population; however, deaths for unnatural causes were especially common (accidents and suicides). Those patients still experiencing relapses in older age have an increased risk of death compared with those with schizophrenia in remission. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22252980 [PubMed - as supplied by publisher]