Vulnerable patients going to court: a psychiatrist's guide to special measures.

There have been significant changes to how vulnerable people are treated in the court system, including the introduction of special measures to support people both as witness and as accused. This paper summarises the use of special measures and their application to people with mental health diagnoses or cognitive impairment.

Associations Between Original and a Reduced Frontal Systems Behavior Scale (FrSBe), Cognition, and Activities of Daily Living in a Large Neurologic Sample.

A recent confirmatory factor analysis (CFA) on the Frontal Systems Behavior Scale (FrSBe) indicated that the basic structure of the FrSBe subscales held after removal of 8 weak items. In a replication of previous studies using the original FrSBe, the present study explored associations between a reduced version of the FrSBe, cognition, and activities of daily living (ADLs) in a large mixed outpatient neurologic sample. Consistent with previous findings with the original FrSBe, significant associations existed between reduced FrSBe scores and the Mattis Dementia Rating Scale-Second Edition.

Feasibility of use of probabilistic reversal learning and serial reaction time tasks in clinical trials of Parkinson's disease.

Introduction: The aim of this study was to investigate the feasibility of using two computer-administered neuropsychological tasks in a clinical trial involving participants with Parkinson's disease without dementia. The tasks, probabilistic reversal learning (PRL) and serial reaction time (SRT), target dorsolateral prefrontal cortex (SRT) and ventral striatal-orbitofrontal (PRL) functioning respectively.

Methods: Participants were 53 adults with idiopathic Parkinson's disease who completed both the SRT and PRL tasks at baseline in a clinical trial.

Utility of the cognitive difficulties scale and association with objective test performance.

Subjective memory complaints (SMCs) are commonly noted in memory disorder clinic patients. The present study sought to examine the presence of SMCs on the Cognitive Difficulties Scale (CDS) in older adults and to examine the relationship between CDS scores and current cognitive ability. Participants were 50 adults diagnosed with possible/probable Alzheimer's disease (AD), 100 with amnestic mild cognitive impairment (MCI) and 84 cognitively healthy controls (HCs).

The contribution of apathy and increased learning trials to risky decision-making in Parkinson's disease.

Impairments in executive functioning are commonly found in Parkinson's disease (PD); however, the research into risky decision making has been mixed. The present study sought to investigate three potential hypotheses: difficulty learning the task probabilities, levodopa equivalent dose (LED), and the presence of apathy. Twenty-four individuals with idiopathic PD and 13 healthy controls completed the Frontal Systems Behavior Scale to assess current apathy, the Iowa Gambling Task, and the Balloon Analog Risk Task (BART).

Confirmatory factor analysis of the Frontal Systems Behavior Scale (FrSBe).

The Frontal Systems Behavior Scale (FrSBe) is a 46-item questionnaire that measures behaviors associated with frontal subcortical deficits (apathy, disinhibition, and executive dysfunction) in adult neurologic populations. Based on findings from a previous exploratory factor analysis on the scale, the current study used confirmatory factor analysis to explore and potentially improve on the measurement model fit of current FrSBe scores. Model fit indices and reliabilities (measured using internal consistency reliability) were compared in the original and in several alternative models.

The ethics of using placebo medication in a non-capacitous patient.

Background: The use of placebo has long been controversial. Whilst evidence accumulates regarding it's beneficial and safe effects, ethical issues around the eroding of patient autonomy and accusations of deception stop most doctors prescribing inert placebo substances.

Case Study: This paper presents a case of a non-capacitous patient who was prescribed placebo medication, as a 'best interest' decision under the Mental Capacity Act 2005.

Use of the telephone-administered Minnesota Cognitive Acuity Screen to detect mild cognitive impairment.

This study determined the sensitivity and specificity of the telephone-administered Minnesota Cognitive Acuity Screen (MCAS) to distinguish mild cognitive impairment (MCI) from healthy controls (HCs) and from Alzheimer's disease (AD). A total of 100 individuals with MCI, 50 individuals with possible/probable AD, and 50 HCs were screened to exclude medical and psychiatric conditions affecting cognition. In-office evaluation included neuropsychological testing, neurologic examination, and neurodiagnostic work-up.

Computerized maze navigation and on-road performance by drivers with dementia.

This study examined the ability of computerized maze test performance to predict the road test performance of cognitively impaired and normal older drivers. The authors examined 133 older drivers, including 65 with probable Alzheimer disease, 23 with possible Alzheimer disease, and 45 control subjects without cognitive impairment. Subjects completed 5 computerized maze tasks employing a touch screen and pointer as well as a battery of standard neuropsychological tests.

Boston naming performance distinguishes between Lewy body and Alzheimer's dementias.

Although naming impairment is common among persons with dementia, little is known about how specific error types on naming tasks may differ between dementias. Recent research has suggested that persons with dementia with Lewy bodies (DLB) have more visuospatial/visuoperceptual dysfunction than those with Alzheimer's disease (AD), which may impact their ability to correctly perceive and name objects. Our retrospective study evaluated the presence and frequency of error types among patients with DLB and AD on the Boston Naming Test (BNT).

The Frontal Systems Behavior Scale discriminates frontotemporal dementia from Alzheimer's disease.

Frontotemporal dementia (FTD) is characterized by pronounced changes in affect, self-regulation, and social conduct. These behaviors can predate significant cognitive changes and can be the most disabling aspect of FTD, yet there are few scales designed to assess such changes. The Frontal Systems Behavior Scale (FrSBe) is a 46-item behavior rating scale that is intended to measure behavior associated with damage to the frontal systems of the brain, with subscales measuring Apathy, Disinhibition, and Executive Dysfunction.

Factor structure of patient and caregiver ratings on the dementia quality of life instrument.

Preliminary evidence suggests that quality of life reports from patients diagnosed with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) are as reliable and valid as data provided by caregivers. To date, no studies compared the factor structure of data provided by caregivers and patients. Factor analyses are important to conduct because they are an indicator of validity.

A comparison of fatigue measures in Parkinson's disease.

Fatigue is a common problem in Parkinson's disease (PD). The Parkinson's Fatigue Scale (PFS) designed for measurement of fatigue in PD has not been validated in the US. The objective of this study was to validate the PFS by comparing it to the Fatigue Severity Scale (FSS).

Insight and cognitive impairment: effects on quality-of-life reports from mild cognitive impairment and Alzheimer's disease patients.

This study follows previous work to determine the effect of patient insight and cognitive impairment on the reliability and validity of self-reported quality of life (QOL) from patients diagnosed with Alzheimer's disease (AD) and mild cognitive impairment (MCI). AD and MCI patients (N = 68) and their caregivers participated. Patients with impaired insight provided QOL ratings that were less reliable than those provided by patients with better insight.

Deep brain stimulation surgery for Parkinson's disease: the role of neuropsychological assessment.

Neuropsychological assessment has two primary roles in the DBS process. First, assessment of cognitive and emotional functioning ensures that only appropriate candidates undergo this surgical procedure. Patients with dementia, cognitive performance suggestive of an additional neuropathological process, or significant psychiatric impairments should not undergo DBS.

The management of behavioural and psychiatric symptoms in delirium.

Delirium is a common and usually reversible syndrome occurring during a period of physical illness. It is most common in children and the elderly. The primary treatment of delirium focuses on the underlying cause, but behavioural and psychiatric symptoms are sometimes of sufficient severity to treat.

Neuropsychological deficits associated with driving performance in Parkinson's and Alzheimer's disease.

Neuropsychological and motor deficits in Parkinson's disease that may contribute to driving impairment were examined in a cohort study comparing patients with Parkinson's disease (PD) to patients with Alzheimer's disease (AD) and to healthy elderly controls. Nondemented individuals with Parkinson's disease [Hoehn & Yahr (H&Y) stage I-III], patients with Alzheimer's disease [Clinical Demetia Rating scale (CDR) range 0-1], and elderly controls, who were actively driving, completed a neuropsychological battery and a standardized road test administered by a professional driving instructor. On-road driving ability was rated on number of driving errors and a global rating of safe, marginal, or unsafe.

A review of rating scales for measuring behavior change due to frontal systems damage.

Objective: To perform a critical review of scales designed to measure frontal behavior change.

Background: Changes in cognition due to frontal disease or damage have been well described, but noncognitive changes in behavior are often more deleterious functionally for frontal patients.

Method: The review concentrates on five behavior rating scales: the Behavior Rating Inventory of Executive Functions (BRIEF), the Dysexecutive Questionnaire (DEX), the Frontal Behavior Inventory (FBI), the Frontal Systems Behavior Scale (FrSBe), the Iowa Rating Scales of Personality Change (IRSPC), and the Neuropsychiatric Inventory (NPI).

Validity of informant reports about AD and MCI patients' memory.

Efficient, valid, and economical methods are needed to measure memory in elderly patients who are participants in clinical trials for the prevention or treatment of dementia. Data provided by knowledgeable informants are an ideal means of assessment, but factors that may limit the validity of informant-report data are not known. This study investigated the living status, relationship type, and educational history of informants and determined the impact of these factors on the validity of informant-report data about patients (N = 62) diagnosed with Alzheimer disease or mild cognitive impairment.

Patient versus informant perspectives of Quality of Life in Mild Cognitive Impairment and Alzheimer's disease.

Background: Prior studies on Quality of Life (QOL) in Alzheimer's disease (AD) have rarely included control participants, or participants with very mild levels of cognitive impairment. Furthermore, there is little data to indicate whether or not mildly impaired patients can provide self-report QOL data or if informant reports are needed.

Objectives: This study compared QOL ratings from informants and patients with mild AD (n = 26), Mild Cognitive Impairment (MCI, n = 30), and elderly controls (n = 23).

Discrimination of dementia with lewy bodies from Alzheimer disease and Parkinson disease using the clock drawing test.

Objective: The authors' objective was to examine the ability of the Clock Drawing Test to discriminate Dementia with Lewy bodies from Alzheimer disease and Parkinson disease.

Background: Recent advances in medical treatments for dementia underscore the importance of differentiating among dementia subtypes. Clinically, Dementia with Lewy bodies can often be difficult to discriminate from Alzheimer disease and Parkinson disease because of similar and overlapping cognitive and motor features.

Association of life events and psychosocial factors with early but not late onset depression in the elderly: implications for possible differences in aetiology.

Background: Depression occurring for the first time in later life (after age 60, late onset depression (LOD)) may have a different, more organic, aetiology from early onset depression (EOD). We investigated the possible role of life events, the presence of a confidante and personality factors in the aetiology of depression in the elderly, testing the hypothesis that these factors would be associated with EOD but not LOD.

Methods: Subjects consisted of 66 elderly patients (aged over 60) with DSM-IV Major depression (30 EOD, 33 LOD; groups matched for age) and 38 age and sex matched controls.

Factor analysis of the frontal systems behavior scale (FrSBe).

The Frontal Systems Behavior Scale (FrSBe), formerly called the Frontal Lobe Personality Scale (FLOPS), is a brief behavior rating scale with demonstrated validity for the assessment of behavior disturbances associated with damage to the frontal-subcortical brain circuits. The authors report an exploratory principal factor analysis of the FrSBe-Family Version in a sample including 324 neurological patients and research participants, of which about 63% were diagnosed with neurodegenerative diseases (Huntington's, Parkinson's, and Alzheimer's diseases). The three-factor solution accounted for a modest level of variance (41%) and confirmed a factor structure consistent with the three subscales proposed on the theoretical basis of the frontal systems.

Apathy and executive dysfunction in mild cognitive impairment and Alzheimer disease.

Objective: The authors assessed and contrasted frontally mediated behavior changes in patients diagnosed with Mild Cognitive Impairment (MCI) and Alzheimer disease (AD). Apathy, executive dysfunction, and disinhibition are common in AD, but these behaviors have not been studied in MCI.

Methods: Participants were patients diagnosed with AD (n=25) or MCI (n=20).