Subject(s)
Financing, Government , Long-Term Care/economics , State Medicine/economics , Demography , Financing, Personal , Hospitalization/economics , Long-Term Care/organization & administration , Long-Term Care/standards , Models, Organizational , Quality of Health Care , State Medicine/organization & administration , United KingdomABSTRACT
The results of the cardiovascular, neurological and neuropsychological examination of a series of patients admitted to the St. George's dementia investigation bed and who later came to postmortem are compared in relation to their pathological diagnosis. Individual clinical signs were not found to differentiate between cases of dementia with vascular versus those with Alzheimer's disease pathology, although multivariate analysis suggested that there was a pattern of signs associated with cerebrovascular disease. A vascularity index was constructed from these signs; it achieved a useful level of discrimination between vascular and nonvascular causes of dementia.
Subject(s)
Alzheimer Disease/diagnosis , Dementia, Vascular/diagnosis , Neuropsychological Tests , Aged , Aged, 80 and over , Alzheimer Disease/pathology , Alzheimer Disease/psychology , Brain/pathology , Dementia, Vascular/pathology , Dementia, Vascular/psychology , Diagnosis, Differential , Female , Humans , London , Male , Neurologic ExaminationABSTRACT
Sixty-four elderly patients who had been admitted to the St. George's Hospital Alzheimer's disease evaluation project during 1981-1989 were followed up to postmortem examination. Comparison between clinical diagnoses and neuropathological diagnoses indicated positive predictive values for the antemortem diagnoses of 50-67%. Existing clinical criteria may not be accurate enough to permit firm antemortem diagnosis of older people for either research or clinical purposes.
Subject(s)
Alzheimer Disease/diagnosis , Dementia, Multi-Infarct/diagnosis , Hospitalization , Aged , Aged, 80 and over , Alzheimer Disease/epidemiology , Alzheimer Disease/pathology , Brain/pathology , Cross-Sectional Studies , Dementia, Multi-Infarct/epidemiology , Dementia, Multi-Infarct/pathology , Diagnosis, Differential , England/epidemiology , Female , Humans , Incidence , Male , Neuropsychological TestsSubject(s)
Antidepressive Agents/therapeutic use , Depressive Disorder/drug therapy , Fluvoxamine/therapeutic use , Serotonin Antagonists/therapeutic use , Aged , Aged, 80 and over , Antidepressive Agents/adverse effects , Depressive Disorder/psychology , Dothiepin/adverse effects , Dothiepin/therapeutic use , Fluvoxamine/adverse effects , Humans , Imipramine/adverse effects , Imipramine/therapeutic use , Mianserin/adverse effects , Mianserin/therapeutic use , Middle Aged , Serotonin Antagonists/adverse effectsABSTRACT
The efficacy and tolerability of the selective 5-HT reuptake inhibitor fluvoxamine were compared with the tricyclic dothiepin in 52 elderly (age greater than 64 years) hospital patients in a multi-centre double-blind randomised trial. Patients met DSM-III criteria for 'major depressive episode' and scored greater than 29 on the Montgomery Asberg Depression Rating Scale (MADRS) after a one-week placebo baseline. Active treatment was for six weeks. The dosage of both drugs was 50 mg nocte for three days, 100 mg nocte for the remainder of the first week, thereafter increasing to a maximum of 200 mg/day according to response/tolerance. MADRS scores improved by 63.5% with fluvoxamine and 60.0% with dothiepin; there were no significant differences between treatments at any assessment. Nausea, dizziness, headache, somnolence and constipation in both groups, plus dry mouth and asthenia in the dothiepin group were more frequent than single reports. Two patients in each group discontinued treatment owing to unwanted effects. There were no clinically significant changes in haematological, biochemical or cardiovascular parameters.
Subject(s)
Depression/drug therapy , Dothiepin/therapeutic use , Fluvoxamine/therapeutic use , Aged , Aged, 80 and over , Dothiepin/adverse effects , Double-Blind Method , Female , Fluvoxamine/adverse effects , Humans , MaleSubject(s)
Aged, 80 and over/psychology , Aged , Decision Making , Female , Humans , Male , Sex , Sexual BehaviorABSTRACT
To find out whether the diagnosis of dementia agreed with findings at necropsy a detailed assessment of 27 elderly patients (mean age 82 (range 70-94] presenting with dementia was conducted at a combined department of geriatric medicine and psychiatry for the elderly. On the basis of the results the cause of the dementia was diagnosed clinically. Neuropathological examinations were performed after death. The clinical diagnosis made during life was not supported by the findings at necropsy in 11 cases. Alzheimer's disease was overdiagnosed in life (13 cases, of which only six were confirmed at necropsy). Although the clinical investigation was limited by availability of resources, neither cranial computed tomography nor the Hachinski score helped to distinguish between multi-infarct dementia and Alzheimer's disease in this age group. This study confirms the value of neuropathological studies in the precise diagnosis of dementia.