A retrospective study of the behavioural and psychological symptoms of mid and late phase Alzheimer's disease.

AIM: To document the behavioural and psychological symptoms in patients with a diagnosis of established Alzheimer's disease (AD) for at least 3 years. METHODS: Patients with a > or =3 year history of AD (NINCDS/ADRDA) were recruited from old age psychiatrist and elderly care memory clinics. Information regarding duration of symptoms and non-cognitive symptomatology was obtained during interview with a carer or next-of-kin who had contact with the patient at least 3 times a week and for at least 3 years. MMSE, FAST and NPI including caregiver distress, were used to assess cognition, function and behavioural/psychological disturbance respectively. With each non-cognitive symptom the carer was asked to estimate its onset. RESULTS: The mean age of patients was 77 years and duration of illness 87 months. Mean MMSE was 8/30 and FAST score 6d. Of the psychological symptoms occurring at any stage, depression (56%), delusions (55%) and anxiety (52%) were most common, with hallucinations, elation and disinhibition occurring less frequently. In general, behavioural changes were more common with apathy occurring in 88% of patients, motor behaviour in 70%, aggression in 66%, irritability and appetite changes in 60% and sleep disturbance in 54%. All symptoms except apathy became less common when the carer was asked if they were still present in the last month. Mean onset of psychological symptoms was 47 months. Mean onset of behavioural symptoms was 48 months. Behavioural disturbance seemed to cause more care-giver distress than psychological change. CONCLUSION: The results show behavioural and psychological symptoms in AD are common and distressing for carers. They appear to require a consistent period of neurodegeneration in order to emerge.

Drugs for dementia: the first year. An audit of prescribing practice.

In March 1998 the Department of Health and Social Services issued prescribing guidelines for the use of drugs for dementia. A criterion based audit of 202 consecutive cases was undertaken over one year which showed that the prescribing guidelines in general were being followed. A small number of patients, 3, were prescribed the drugs outside the guidelines and most failures, 10, were due to poor recording of data in the clinical record. Despite the recommendation of the DHSS no agreed shared care protocols have been implemented but this does not seem to have affected access to these drugs. As a result of this audit changes have been made with regard to documentation of patient assessments and suggestions made to review Clinical Resource Efficiency Support Team (CREST) guidelines.

Elder abuse in people with dementia in Northern Ireland: Prevalence and predictors in cases referred to a psychiatry of old age service.

OBJECTIVE: To establish the prevalence of elder abuse in community-dwelling patients with dementia and to test the hypothesis that there is no difference in carer and patient characteristics between the abused and non-abused populations. DESIGN: A cohort of consecutive referrals was formed and subdivided by the presence or absence of abuse and the two groups compared. SETTING: A rural psychiatry of old age service in N. Ireland. SUBJECTS: Each case had been newly referred, was 65 years old or over, lived at home, had an identifiable carer and met DSMIII-R criteria for a diagnosis of dementia. There were 49 such cases; 38 carers agreed to be interviewed. MAIN OUTCOME MEASURES: The General Health Questionnaire 28, the Gilleard Pre-Morbid Relationship Rating Scale and Gilleard's Problem Checklist were administered to the carer and the information/orientation sub scale of the Clifton Assessment Procedure for the Elderly used to measure cognitive impairment in the patient. RESULTS: Abuse was elicited in 14 (37%) cases; four (10.5%) of physical and 13 (34%) of verbal abuse. No cases of abuse by neglect were detected. A poor premorbid relationship, verbal or physical abuse by the dependant, problem behaviours in the dependant, the carer's level of anxiety and a perception of not receiving help were significantly associated with abuse. Alcohol consumption of the carer, physical dependence, severity of cognitive impairment or financial or social circumstances were not associated with elder abuse. CONCLUSIONS: Elder abuse is associated with aspects of the patient/carer relationship and should be regarded as a significant problem in patients with dementia referred to an old age service.

A profile of residents of old people's homes.

This paper describes the characteristics of the 450 residents of all statutory residential homes for the elderly within five local government districts in Northern Ireland. The residents are described in terms of demographic detail, prevalence of dementia and prevalence of problem behaviour. Results are comparable with those of other studies. There are more females, fewer are married and more are over the age of 75 years than would be predicted from the general population. Roughly half scored within the dementia range, with 56% of those over 85 years being demented. More than 33% had some degree of incontinence, 9% were immobile and 10% were physically aggressive at least once a week. Five percent were wanderers and nearly all residents required help with bathing.

Mortality rates of patients admitted to a psychogeriatric assessment unit.

Admission of elderly people to a geriatric hospital may carry an increased risk of death. In this study 355 admissions of 243 elderly persons with dementia to a purpose built psychogeriatric unit were studied and the mortality rate found to be 8.2%, which is less than that reported elsewhere. Admission for the purpose of respite (holiday) relief is a safe procedure and should not be discouraged.

Rates of admission to six Northern Ireland psychiatric hospitals of patients with primary alcohol-related diagnoses.

The rate of admissions to psychiatric hospitals of patients with primary alcohol-related diagnoses (PARD) has increased from 1971 to 1983 and they now account for 19.7% of all admissions. There is a wide variation in admission rates between hospitals, and the use of the Mental Health (NI) Act 1961 to admit these patients formally varies up to twelvefold.