Depression in Late Life, Third Edition,
p417
by Dan Blazer Reviewed by David Ames (Australia)
The Experience of Alzheimer’s Disease. Life Through a Tangled Veil,
p418
by Steven R. Sabat Reviewed by Don Williams (United Kingdom)
Early-Onset Dementia: A Multidisciplinary Approach,
p419
by John Hodges (Ed.) Reviewed by David Ames (Australia)
Clinical Guidelines in Old Age Psychiatry,
p420
by Alistair Burns, Tom Dening, and Brian Lawlor Reviewed by David Ames (Australia)
Treating Alcohol and Drug Abuse in the Elderly,
p421
by Anne M. Gurnack, Roland Atkinson, and Nancy J. Osgood (Eds.) Reviewed by Kathryn A. Hall (Australia)
Narrative Gerontology: Theory, Research, and Practice,
p423
by Gary Kenyon, Phillip Clark, and Brian de Vries (Eds.) Reviewed by Sirkka-Liisa Kivelä (Finland)
Geriatric Consultation Liaison Psychiatry,
p424
by Pamela Melding and Brian Draper Reviewed by Richard Yeatman (Australia)
Drug Discovery and Development for Alzheimer’s Disease, 2000,
p425
by Howard M. Fillit and Alan W. O’Connell (Eds.) Reviewed by Michael Woodward (Australia)
Communication Skills for Working With Elders (2nd Ed.),
p426
by Barbara Bender Dreher Reviewed by Lucy Smith (Australia)
Assessing and Treating Late-Life Depression: A Case Book and
Resource Guide, p427
by Michele J. Karel, Suzann Ogland-Hand, and Margaret Gatz Reviewed by Robert C. Baldwin (United Kingdom)
Annual Review of Gerontology and Geriatrics, Vol. 21,
p428
by Vincent J. Cristofalo, Richard Adelman, and K. Warner Schaie (Eds.) Reviewed by Colin L. Masters (Australia)
Psychiatry in the Elderly (3rd Ed.),
p429
by Robin Jacoby and Catherine Oppenheimer (Eds.) Reviewed by Daniel O’Connor (Australia)
Research Into Depressive Disorder in Later Life: Who Is Doing What? A Literature Search From 1998-2001
Robert C. Baldwin
ABSTRACT. Aims and Background: The International Psychogeriatric Association (IPA) aims
to improve the mental health care of older people globally. With regard to depression, a number
of key publications over the past decade have highlighted areas of progress and areas
requiring further research. In order to help clarify what progress has been made, the author
conducted a literature review of original research subsequent to three recent major reviews.
Method: A literature search of four databases over the period 1998–October 2001. Publications
with an abstract in English were studied to ascertain number of relevant publications;
type of research methodology; topics; and where the research originated. Results: A total of
1,002 publications meeting predefined criteria were located. Fifty-nine percent were crosssectional
studies; less than 10% were randomized controlled studies. The most common
themes were depression with comorbidity and etiology, accounting for almost half the
papers, with stroke and Parkinson’s disease the most frequently researched comorbid medical
disorders, although interest in Alzheimer’s disease, heart disease, hip fracture, and
chronic lung disease appears to be increasing. There were comparatively few studies of psychological
and psychosocial interventions. A quarter of the publications concerned major
depressive disorder. There were striking variations in the origin of publications with two
regions, North America and Northern Europe, accounting for two thirds of all publications
but only 13.7% of the world’s population aged 65 and over. Conclusions: Progress is being
made but it might occur more rapidly and with greater scope with more international and
cross-center collaboration.
Effects of Educational Attainment and Occupational Status on Cognitive
and Functional Decline in Persons With Alzheimer-Type Dementia Thomas Fritsch, McKee J. McClendon, Kathleen A. Smyth, and Paula K. Ogrocki
ABSTRACT. Researchers have suggested that educational attainment and occupational status
—indicators of cognitive and/or neurologic “reserve”—can help persons compensate for
clinical manifestations of Alzheimer’s disease (AD), such as the rates of cognitive and functional
decline. The effects of educational attainment on rates of decline could be “direct”
(independent of occupational status), “indirect” (working through occupational status), or
both. We used multilevel analysis for repeated measures to study the effects of educational
attainment and occupational status on rates of decline in cognition (Mini-Mental State Examination,
MMSE) and function (Cleveland Scale for Activities of Daily Living). Subjects included
persons with “probable” or “possible” AD, drawn from our Alzheimer’s Disease Research
Center registry (N = 482 in the analysis of cognitive decline, and N = 450 in the analysis of
functional decline). When controlling for year of birth, gender, ethnicity, and duration of illness,
we found that there was an inverse relationship between number of years of education
and rate of decline in MMSE, but effects of occupational status were not significant. This
implies a “direct” effect of education on decline in MMSE, but no “indirect” effect through
occupational status. Neither educational attainment nor occupational status affected rate of
decline in functional ability. We conclude that education slows the rate of cognitive decline
in persons with AD, but not through its impact on occupational status. Thus, the protective
effects of reserve may be established early in life, before people enter the workforce.
Regional Brain Atrophy in Patients With Mild Alzheimer’s Disease
and Delusions Cristina Geroldi, Lorena Bresciani, Orazio Zanetti, and Giovanni B. Frisoni
ABSTRACT. Background and Objective: The pathophysiology and the neurobiology of the
behavioral disturbances in Alzheimer’s disease (AD) are far from understood. The aim of the
study was to assess whether delusional AD patients have a specific pattern of regional brain
atrophy. Methods: The setting of the study was the outpatient facility of a memory clinic. Subjects
were 41 AD patients with mild dementia severity (Mini-Mental State Exam score of 22 ±
3, range 18 to 27). Delusions were assessed with the pertinent subscale of the UCLA Neuropsychiatric
Inventory (NPI). Nondelusional (n = 22) AD and delusional (n = 19) AD were
defined on the basis of absence (NPI delusions subscale = 0) or presence (NPI delusions subscale
= 1 or higher) of delusions. Thirteen (68%) of the delusional patients had isolated theft
delusions, and 6 (32%) had theft associated with another paranoid delusion (of jealousy or
persecution). None of the patients had misidentifications or other delusions of nonparanoid
content. Temporal lobe and frontal lobe atrophy were assessed with linear measures (radial
width of the temporal horn, rWTH, and frontal index, FI) taken from computed tomographic
films. Temporal and frontal asymmetries were computed as right/left ratio of the rWTH and
FI. Results: AD patients without delusions had symmetrical enlargement of both temporal (8.1
± 3.9 vs. 8.5 ± 4.5) and frontal horns (35.8 ± 4.8 vs. 35.9 ± 4.6). On the contrary, AD with delusions
showed temporal horns larger to the right (9.1 ± 3.3 vs. 7.7 ± 3.1, p = .06) and the frontal
horn to the left (35.7 ± 4.3 vs. 37.5 ± 4.2, p = .02). This different pattern was confirmed with a
gender-adjusted repeated measures analysis of variance model (interaction term between
asymmetry and group: F1,38 = 5.5, p = .03). Discussion: AD patients with delusions are characterized
by a specific pattern of frontal and temporal asymmetry of brain atrophy, whereas
nondelusional patients are symmetric. Because the asymmetry pattern of the delusional
patients is similar to the physiological pattern of asymmetry of individuals without dementia,
the data indicate that the absence of theft delusions in the mild stage of AD rather than their
presence is associated with an abnormal asymmetry pattern.
An Evaluation of Needs in Elderly Continuing-Care Settings
Mark D. Martin, Geraldine A. Hancock, Barbora Richardson, Peter Simmons,
Cornelius Katona, Eleanor Mullan, and Martin Orrell
ABSTRACT. This study examined the utility of the TELE, a telephone assessment for dementia,
in a sample of 269 individuals that was not selected on the basis of previous dementia
diagnosis. Thus, the conditions of the study reflect the actual situation in which a screening
instrument might be employed. Scores on TELE were compared to dementia diagnoses.
Using the best cutoff score, sensitivity was .86 and specificity was .90. Longitudinal followup
established that false positives primarily included those who subsequently developed
dementia. Telephone screening for dementia has both clinical and research applications.
One recommendation based on our experience is that longitudinal studies should include a
telephone interview component for anyone who drops out of the study, to enable characterizing
the cognitive status of dropouts.
Efficacy of Donepezil on Behavioral Symptoms in Patients With
Moderate to Severe Alzheimer’s Disease Serge Gauthier, Howard Feldman, Jane Hecker, Bruno Vellas, David Ames, Ponni Subbiah, Edward Whalen,
Birol Emir, and the Donepezil MSAD Study Investigators Group
ABSTRACT. Objective: This subanalysis of a large, double-blind, placebo-controlled trial
examined the prevalence of behavioral symptoms in moderate to severe Alzheimer’s disease
(AD), and the effect of treatment with donepezil. Methods: Two hundred ninety patients with
moderate to severe AD (standardized Mini-Mental State Examination scores 5-17) were randomized
to receive 24 weeks of once-daily doses of donepezil 5 mg/day for 28 days, and 10
mg/day thereafter per the clinician’s judgment (n = 144), or placebo (n = 146). The outcome
measure of interest was the 12-item Neuropsychiatric Inventory (NPI). Results: Baseline
demographics were similar between the treatment groups. Least squares mean (± SE) baseline
NPI 12-item total scores were 19.55 ± 1.48 and 19.30 ± 1.45, respectively. At baseline, the
most common symptoms were apathy/indifference (67%), aberrant motor behavior (53%),
depression/dysphoria (52%), anxiety (49%), and agitation/aggression (45%). NPI individual
item change from baseline scores at Week 24 using a last observation carried forward
(LOCF) analysis showed benefits with donepezil treatment compared with placebo for all
items, with significant treatment differences for depression/dysphoria, anxiety, and apathy/
indifference (p < .05). Symptoms present at baseline that improved significantly for
donepezil- compared with placebo-treated patients at Week 24 LOCF included anxiety, apathy/
indifference, and irritability/lability (p < .05). When patients who were not receiving psychoactive
medications at baseline were analyzed separately, significant improvements in
NPI 12-item total score were observed with donepezil compared with placebo at most visits and
at Week 24 LOCF (p < .05). Conclusions: Behavioral symptoms of the magnitude observed in
this moderate to severe AD population improved with donepezil.
Agitation and Aggressiveness Among the Elderly Population Living in
Nursing or Retirement Homes in France
Jean-Marie Léger, Robert Moulias, Philippe Robert, Bruno Vellas,
Paul-Henri Chapuy, Jean Claude Monfort, Babak Khoshnood,
Stéphane Bouee, Nadjib Rebah, and Daniel Gerard
ABSTRACT. The aim of this study was to describe the epidemiological features of agitation
and aggressiveness in elderly individuals living in French nursing and retirement homes in
the year 2000. Data were collected on the type, time of onset, and duration of symptoms,
medical evaluation and treatment, and medical and psychiatric comorbidities of the elderly
patients. The most frequently reported behavior was verbal aggressiveness and the least
reported behavior was physical aggressiveness. A triggering factor initiating the symptoms
of agitation or aggressiveness was reported in 61% of the cases. In 61% of the study population,
there were several morbidities reported as caused by the agitated or aggressive behavior
(anorexia, weight loss, dehydration). A specialist was consulted for nearly half of the
agitated or aggressive patients. For 55% of the patients, a new medication regimen was started
or the administration of previous medications was modified, the most frequently prescribed
drugs being antipsychotics. The results of our study and others show that agitation
and aggression have a substantial impact on the lives of the elderly population, as well as on
the lives of their family members and caretakers.
Copyright 2008 International Psychogeriatric Association
