IPA Bulletin 

Where Are They Now?

RESEARCH AWARD WAS IMPORTANT STIMULUS FOR WORK ON NON-COGNITIVE FEATURES OF DEMENTIA

ALISTAIR BURNS
Second Place, 1989 IPA Research Awards in Psychogeriatrics

[Editor’s note: This article is another in our series, “Where Are They Now?” by former IPA Research Award winners and IPA Research Scholars, who will share with us what they are doing and describe some of the ways in which IPA recogni-tion has influenced their careers. From 1989 to 1999 the IPA Research Awards were sponsored and supported by Bayer AG. The IPA Research Scholar Program was sponsored and supported by Pfizer Central Research, Pfizer Inc] I won joint Second Place in the 1989 IPA/Bayer Research Awards in Psychogeriatarics for a paper on Psychiatric Symptoms and Behavioral Disturbances in Dementia (Burns et al., 1990a). I had started a Medical Research Council-funded project grant with Raymond Levy and Robin Jacoby three years earlier, and the work consisted of the preliminary findings in the first samples of patients. Essentially, we validated the Crichton Royal Behaviour Rating Scale and showed that behavioral disturbances were related to changes in mortality over time. It emphasized that the so-called “non-cognitive features” of dementia were not a homogeneous group of symptoms.

I can’t remember now why I put in for the prize, or who put me up to it, but it must have been Raymond Levy. I was as surprised as anyone to get second prize; that is, I was surprised to get a prize at all, rather than surprised I didn’t get first prize! The Fourth Congress, in Tokyo in 1989, still holds a particular affection for me. We went on to publish four papers, which appeared in the British Journal of Psychiatry (Burns et al., 1990bcde). The acceptance of these papers was an important stimulus in pur-suing the description of the non-cognitive features of dementia, and I remember being particularly encouraged by Barry Reisberg, in whose field the subject lay. I naïvely worried about publishing the preliminary findings and was concerned about “salami publication,” but was greatly reassured by the consoling words of my supervisors, Robin Jacoby and Raymond Levy.

In 1992 I was appointed to the Foundation Chair of Old Age Psychiatry in the University of Manchester. This was helped by having been awarded a Wellcome Trust University Award, a senior fellowship from the charity designed to encourage researchers to take on an academic post. The early days in Manchester were spent trying to get funding to continue the work - a venture that was successful after one failed attempt to get money to replicate the Institute of Psychiatry care services, in which the original observa-tions had been made. It is interesting to consider how things have developed since then.

The project was a joint initiative between old age psychiatry and clinical psychology (Nick Tarrier) and was funded by the Wellcome Trust to look at the effects of non-cognitive features (now called Behavioral and Psychological Symptoms of Dementia (BPSD) on carers. Our findings replicated others, in that we demonstrated that BPSD was a cause for stress in carers (Donaldson et al. 1997, 1998). This begged for an intervention trial, which was funded by the Alzheimer’s Society in the UK (previously the Alzheimer’s Disease Society). Further work has been carried out in a sponsored trial (by Pfizer International) looking at the effects of an intervention package in patients taking donepezil hydrochloride (in conjunction with Mary Mittleman, New York, and Henry Brodaty, Sydney). Links with clinical psychology prompted a parallel study examining the benefits of a structured intervention to reduce behavioral isturbances in elderly residents in nursing and residential care (Proctor et al., 1999). That led to the idea that a pharmacist in homes could reduce the number of medications prescribed (Furniss et al., 1999).

The recognition of the work carried out in these early studies allowed the authors an entry ticket to the IPA initiative on BPSD. This initiative has been extremely successful both in raising the profile of the issues as well as potentially changing regulatory bodies’ view of the specificity of BPSD as a clinical syndrome with dementia.

A lesser known fact is that I was a named prize winner in the 1997 Research Award, won by Stephen Simpson, Robert Baldwin, and Alan Jackson for work on vascular changes in resistant depression in later life. Again, this gave confidence and much needed respectability to an arm of research and led on to funded projects. In summary, the IPA Research Award helped me gain the confidence that the research area in which I was involved was useful and ger-mane to the field in general. It led to newer but related research areas and gave me an opportunity for which I am grateful to Bayer AG (who supported the prize), to the then-officers of IPA, and to the anonymous referees who read the 1989 proposal.

References

Burns, A., Jacoby, R, & Levy, R. (1990a.) Behavioral Abnormalities and Psychiatric Symptoms in Alzheimer’s Disease: Preliminary Findings. International Psychogeriatrics, 2, (1) 25-36.

Burns, A., Jacoby, R. & Levy, R. (1990b). Psychiatric Phenomena in Alzheimer’s Disease I: Disorders of Thought Content. British Journal of Psychiatry, 157, 72-76

Burns, A. Jacoby, R. & Levy, R. (1990c). Psychiatric Phenomena in Alzheimer’s Disease II: Disorders of Perception. British Journal of Psychiatry, 157, 76-81

Burns, A., Jacoby, R. & Levy, R. (1990d). Psychiatric Phenomena in Alzheimer’s Disease. III: Disorders of Mood. British Journal of Psychiatry, 157, 81-86

Burns, A., Jacoby, R. & Levy, R. (1990e). Psychiatric Phenomena in Alzheimer’s Disease IV: Disorders of Behaviour. British Journal of Psychiatry, 157, 86-94

Donaldson, C., Tarrier, N. & Burns, A. (1997). The impact of the symptoms of dementia on Caregivers. British Journal of Psychiatry, 170, 62-68

Donaldson, C., Tarrier, N. & Burns, A. (1998). Determinants of Carer Stress in Alzheimer’s Disease. International Journal of Geriatric Psychiatry, 13, 248-256

Furniss, L., Burns, A., Cook, J., Craig, S. & Scobie, S. (in press) The effect of a pharmacist in nursing and residential homes. British Journal of Psychiatry

Proctor, R., Burns, A., Stratton Powell, H., Tarrier, N., Faragher, B., Richardson, G., Davies, L. & South, B. (1999). Behavioural management in nursing and residential homes: a randomised controlled trial The Lancet, 354, 26-29

Alistair Burns, MD, FRCP, FRCPsych, is Professor of Old Age Psychiatry, University of Manchester, Withington Hospital, West Didsbury, Manchester M20 8LR, England UK tel: 44+161 291 4355, fax: 44+161 445 5305, e-mail: a_burns@fs1.with.man.ac.uk. A member of IPA’s Board of Directors since 1992, he currently is President-Elect of the organization.

Reprinted from IPA Bulletin, Volume 17, Number 2