ABSTRACT
Delirium is commonly encountered in elderly patients in general hospitals. Most patients with delirium respond well within 12 days of commencement of treatment with haloperidol. A significant number of patients, however, does not improve. Three elderly male patients aged 85, 79 and 81 respectively suffering from prolonged delirium and unresponsive to haloperidol or atypical anti-psychotic drugs, responded well within days to treatment with rivastigmine--a cholinesterase-inhibitor. It was very well tolerated. In The Netherlands cholinesterase inhibitors are registered for the symptomatic treatment of Alzheimer's disease. There is some evidence, both from animal and human experiments, that cholinergic deficiency plays a role in certain types of delirium. Therefore treatment of delirium with a cholinesterase-inhibitor seems logical. Controlled studies are needed to evaluate the effects of these types of drugs in patients with prolonged delirium.
Subject(s)
Carbamates/therapeutic use , Cholinesterase Inhibitors/therapeutic use , Delirium/drug therapy , Phenylcarbamates , Aged , Aged, 80 and over , Antipsychotic Agents/therapeutic use , Haloperidol/therapeutic use , Hospitalization , Humans , Male , Rivastigmine , Treatment OutcomeABSTRACT
UNLABELLED: The Neuropsychiatric Inventory is a clinical instrument for assessing behavioral and psychological symptoms in dementia. It is based on an interview with the primary caregiver. A brief questionnaire form of the NPI was developed, intended for use in routine clinical practice (NPI-Q). This study evaluates the validity of the NPI-Q Dutch form. The NPI-Q was compared to other questionnaires, i.e. the Revised Memory and Behavioural Problems Checklist (RMBPC), the short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-N), the 15 items Geriatric Depression Scale (GDS-15) and the Cognitive Screening Test (CST-20). A data set was used of geriatric outpatients who were referred for neuropsychological assessment (n = 29). Correlations between the NPI-Q and RMBPC Depression- and Disinhibition subscales were relatively high. No relationship was found between the NPI-Q and the RMBPC Memory related behavioral changes subscale, or between the NPI-Q and the IQCODE-N and the CST-20. Informant ratings on the NPI-Q depression-item were related with patient ratings on the GDS-15, especially when patients were relatively mildly cognitive impaired. Caregiver distress was strongly associated with NPI-Q symptom assessment. IN CONCLUSION: our preliminary results support validity of the NPI-Q Dutch form. It is a practical rating scale for assessing neuropsychiatric symptoms in dementia and associated caregiver distress.
Subject(s)
Caregivers/psychology , Dementia/diagnosis , Neuropsychological Tests , Surveys and Questionnaires/standards , Aged , Aged, 80 and over , Dementia/psychology , Female , Humans , Male , Middle Aged , Netherlands , Psychometrics , Reproducibility of ResultsABSTRACT
Nakao and Axelrod (1976) and van Noorden (1975) showed that the threshold for discriminating an anisochronous duple rhythm (a series of clicks with a temporal offset on every other one) from an isochronous rhythm (no offset) is poorer when the clicks are presented alternately to the two ears than when they are presented to the same ears. Van Noorden reported that the difference between the thresholds in the alternating and nonalternating conditions varied with the tempo of the sequence. Nakao and Axelrod found invariance of this threshold difference with sequence speed. According to our quantification of temporal processing of interaural sequences, the latter result should be expected. We carried out five psychophysical experiments to establish interaural and monaural discrimination between isochronous and anisochronous rhythms. Across experiments, base time intervals of 60-720 msec were spanned. The main result was that we replicated the poorer discrimination for interaural sequences. This deterioration in discrimination was the same for all sequence speeds. It was also the case that the thresholds were almost constant up to a sound repetition rate of about 3 per second, but increased linearly with slower rates. This result supports evidence in the literature that temporal processing of sequences faster than about 3-4 sounds per second differs from temporal processing of slower sequences.
