ABSTRACT
Traditional published norms for neuropsychological tests that do not consider demographic effects can lead to spuriously high false positive rates among low-educated elderly individuals. This problem may be compounded when trying to identify dementia in psychogeriatric patients whose cognitive functioning is also compromised by psychiatric illness. This study investigated the clinical utility of low education neuropsychological test norms to discriminate amongst demented and nondemented psychogeriatric inpatients and healthy community elderly with limited education. Results indicated that the Mattis Dementia Rating Scale (MDRS), the Fuld Object Memory Evaluation (FOME), the Mini-Mental State Examination (MMSE), and a Clock drawing task had high discriminability in differentiating the three groups. Application of demographically corrected norms has important implications for diagnosis and treatment planning, especially when neuropsychological status is complicated by psychiatric illness.
Subject(s)
Alzheimer Disease/diagnosis , Educational Status , Neuropsychological Tests/statistics & numerical data , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Diagnosis, Differential , Female , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Mental Status Schedule/statistics & numerical data , Middle Aged , Psychometrics , Reproducibility of ResultsABSTRACT
The present longitudinal prospective study compared results from the Geriatric Depression Scale with those from the Hamilton Depression Rating Scale for 30 dementia patients. The criterion measure was presence of depression as indicated by the psychiatric diagnosis. The psychiatrist and physician's assistant made the Hamilton ratings while the psychology staff administered the Geriatric Depression Scale. The two measures were statistically unrelated from Times 1 and 2 (rs = .26 and .41). Eleven (37%) patients were depressed and nine received antidepressant medications. Sensitivity ratings were 82% and 9%, respectively, and specificity ratings were 88% and 92%, respectively. Possible explanations for the success of the Geriatric Depression Scale and lack of success of the Hamilton ratings in detecting depression in this population are discussed.
Subject(s)
Alzheimer Disease/diagnosis , Depressive Disorder/diagnosis , Hospitalization , Personality Inventory/statistics & numerical data , Aged , Alzheimer Disease/psychology , Cross-Sectional Studies , Depressive Disorder/psychology , Female , Geriatric Assessment , Humans , Intermediate Care Facilities , Longitudinal Studies , Male , PsychometricsABSTRACT
There is evidence from the clinical and experimental literature that the elderly may be more susceptible to the anticholinergic side effects associated with antidepressant drugs. Fifty-four elderly depressed subjects participated: 27 were taking antidepressants and 27 were unmedicated controls matched for severity of depression, age, and education. The medicated subjects showed a mild, but statistically significant, deficit on a set of six measures of memory performance. However, it was unclear whether this deficit was related to anticholinergic activity. It appears that, while antidepressant medications may not be benign in terms of memory functioning in the elderly, the memory difficulties are mild and are not similar to those of Alzheimer's patients. Thus, differential diagnosis of depression and dementia should not be greatly complicated by antidepressant medication.
Subject(s)
Antidepressive Agents/adverse effects , Arousal/drug effects , Dementia/drug therapy , Depressive Disorder/drug therapy , Mental Recall/drug effects , Neuropsychological Tests , Aged , Antidepressive Agents/therapeutic use , Brain/drug effects , Dementia/psychology , Depressive Disorder/psychology , Dose-Response Relationship, Drug , Humans , Psychometrics , Receptors, Cholinergic/drug effects , Substance-Related Disorders/psychology , Wechsler ScalesABSTRACT
Conventional dichotic listening techniques can unquestionably be used for nominal (left vs. right) categorization of ear or hemispheric differences. These techniques cannot, however, be used for ordinal comparisons of the size of ear advantages among different subjects or different tasks if the measure of the size of the lateral asymmetry is confounded with effects of varying overall performance, attentional bias, or choice of laterality index. A psychophysical procedure is described which is designed to avoid these confounds by measuring discrimination ability, in decibels, as the interaural intensity difference (IID) required for a specific accuracy. Results from two experiments with right-handed subjects showed an average right-ear advantage of about 3 db for phoneme discrimination and an average left-ear advantage of the same size for intonation discrimination.
