A long-term care center interdisciplinary education program for antipsychotic use in dementia: program update five years later.

Background: While antipsychotic (AP) medications are frequently used in long-term care, current evidence suggests that the risks may offset the benefits, necessitating periodic reassessment of their use. The aims of this present study were: (1) to assess rates of AP use five years after our first intervention to determine the long-term impact; and (2) to implement an updated AP reduction educational intervention program at the same center five years later in order to determine whether AP use could be further reduced.

Methods: Participants were residents with dementia receiving AP medication.

Reliability and validity of the Safety Assessment Scale for people with dementia living at home.

Background: With the recent funding changes in health care services, more seniors with dementia are cared for in their homes and the nature of their condition puts them at higher risk for accidents and injuries.

Purpose: The Safety Assessment Scale (SAS) was developed for use by community healthcare providers to evaluate and lower the risk of accidents, provide recommendations to family caregivers and enhance case management. Method.

Staging methods for the assessment of dementia: Perspectives.

Most dementias in old age are characterized by a progressive course with interindividual variability in pattern and rate of progression. Developing a system for staging such dementia poses a challenge in capturing this variability in a system that will afford comparisons among individuals and predictions of future change. Several core questions underlie the development of such systems: (1) Is there a definable order in which abilities are lost? (2) Which skills and functions should be considered essential for the staging of dementia and what is their relative weight? (3) Can the different skills be captured within one staging system? (4) How is the whole range of function captured, and are the differences between stages clearly defined? (5) Which populations can be rated with each staging system? The determination of this last question is based on understanding which other medical conditions may interfere with the course of dementia and how prior characteristics, such as education, affect ratings on specific scales for the staging of dementia.

The Hierarchic Dementia Scale: conceptualization.

The Hierarchic Dementia Scale is an instrument for measuring the severity of mental impairment based on Piagetian concepts, neuropsychological findings, and the hierarchic nature of decline in mental function. Performance of 20 specific functions such as orienting reflexes and comprehension can be rapidly pinpointed over a wide range of impairment. The scale is reliable, valid, responsive, safe, inexpensive, and easy to use.

A comparison of the cardiac safety and therapeutic efficacy of trimipramine versus doxepin in geriatric depressed patients.

Objective: To compare the cardiac safety and therapeutic efficacy of trimipramine and doxepin.

Design: A 1-week single-blind placebo period followed by a 5-week randomized double-blind parallel group clinical trial.

Setting: Psychiatric out-patient clinic of a general hospital.

The prevalence of late-onset schizophrenia in a psychogeriatric population.

Of 288 patients admitted to our psychogeriatric unit during a 4-year study, seven patients were diagnosed as having symptoms of paranoid schizophrenia (2.4% of all admissions). All the patients were women.

Predictors and consequences of aggressive behavior by community-based dementia patients.

The frequency, nature, context, and caregivers' reactions to aggressive behavior in 213 dementia patients residing in the community was studied. Aggression was reported in 57.2% of the patients and in 10.

Progress report on the Canadian Multicentre Trial of tetrahydroaminoacridine with lecithin in Alzheimer's disease.

Since the discovery of a significant depletion of acetylcholine in discrete areas of the brain of patients affected by Alzheimer's disease, attempts at symptomatic therapy have concentrated on acetylcholine supplementation, an approach that is based upon the efficacy of dopaminergic supplementation therapy for Parkinson's disease. Choline, then lecithin, used orally, failed to improve symptoms but the hypothesis that long-term choline supplementation might stabilize the course of Alzheimer's disease remains to be tested. Nerve growth factor may also offer that possibility.

Growth hormone response to apomorphine, a dopamine receptor agonist, in normal aging and in dementia of the Alzheimer type.

The growth hormone (GH) response to the dopamine (DA) receptor agonist, apomorphine HCl (Apo) (0.5 mg SC) was studied in young and elderly normal subjects as well as in patients with dementia of the Alzheimer type (DAT) and controls matched for age, gender and Quetelet index. The GH response was significantly decreased in normal elderly men (mean age 67.

Skills training with supporters of the demented.

This study examined the effects of Supporter Endurance Training (SET) on family supporters of elderly demented patients. Single case methodology was used in evaluating the outcome of providing eight supporters with eight weekly training sessions in meditative relaxation and assertiveness. Four such supporters received no special training.

Transmitter-replacement therapy in Alzheimer's disease using intracerebroventricular infusions of receptor agonists.

Neurotransmitter replacement therapy in Alzheimer's Disease is currently being attempted using bethanechol chloride (Urecholine) infused intracerebroventricularly with an Infusaid continuous infusion pump. The rationale of this therapy is based on the severe cortical pre-synaptic cholinergic deficit in the presence of relatively normal post-synaptic muscarinic receptor density. Patients are selected on the basis of strict clinical criteria at a functional stage 4 or 5 of Reisberg.

Existential issues in the management of the demented elderly patient.

Four major existential themes are explored, as they relate to the predicament of the relative supporting a demented elderly dependent at home. These issues, namely, death, isolation, freedom, and meaning are discussed with respect to their dynamic impact on the stressed supporter as well as their implications for anxiety management.

CSF acetylcholinesterase in dementia and in sequential samples of lumbar CSF.

Acetylcholinesterase (AchE) activity (nmol/ml/min) was measured in lumbar CSF from 11 patients with dementia of the Alzheimer type (DAT), 8 patients with Korsakoff psychosis and 33 patients with low back pain who were undergoing myelography (controls). There was no significant difference in enzyme activity between the three groups. There was no significant correlation between age and AchE activity.

Coping with dementia: a pilot study.

Ten supporters of demented elderly dependents were studied in order to examine their coping behavior in the context of caring for their relatives at home. Coping skills were described with respect to programs, solutions, and cognitive aspects of motivation and stress tolerance. The observations made suggested the hypothesis that tolerance of debility in a demented relative is related not only to the number and type of problems in the dependent but also to the availability and quality of coping skills in the supporter.

Alzheimer disease: lack of effect of lecithin treatment for 3 months.

Eleven outpatients with Alzheimer disease of moderate severity completed a double-blind placebo-controlled crossover trial of lecithin. Each patient received 10 gm three times daily of a placebo for 3 months. Plasma choline levels rose threefold and remained at that level throughout the lecithin administration period.

Neuropathy in tetanus.

Thirty-four cases of severe tetanus were studied. On clinical examination weakness and sensory loss compatible with peripheral neuropathy was found in 27. The pattern was usually asymmetrical, the commonest nerves affected being ulnar, median and lateral popliteal, although occasionally circumflex, musculocutaneous, femoral and facial nerves were also involved.

A psychogeriatric assessment program. V. Three-year follow-up.

In 1974, a 10-month diagnostic evaluation of 80 newly admitted psychogeriatric patients was undertaken. The diagnostic categories were functional versus organic brain disease. The present report deals with results of a follow-up evaluation three years later.

Amantadine in senile dementia: electroencephalographic and clinical effects.

Nineteen patients with senile brain disease (including 2 with parkinsonian symptoms) were treated with amantadine in an oral dosage of 200--300 mg daily. Seven showed definite clinical benefits such as increased alertness and decreased agitation, and 2 others showed slight benefits. However, in only one instance was the benefit maintained without complications.