Cognitive stimulation by caregivers for people with dementia.

Cognitive stimulation (CS) is a psychological intervention for people with dementia aimed at maintaining cognitive functioning. CS provided by caregivers would allow long-term maintenance without greatly increasing demands on health services, but raises questions concerning treatment fidelity and acceptability, which were investigated in this study. Caregivers of home-living people with dementia were trained to provide CS activities to their relative with dementia. Recordings of intervention sessions and analysis of training manuals suggested adequate delivery of the intervention. Dyads continued with the activities after caregiver training had stopped. In addition, presentation of the activities without supervision from a health care professional had no detrimental effect on well-being in the caregiver or the person with dementia. The majority of caregivers indicated that, even though they experienced some burden from doing the activities with their relative, they themselves had also benefited from the intervention and intended to continue with some of the activities.

Cardiac monitoring for cholinesterase inhibitors: a survey.

BACKGROUND: There is no consensus on the monitoring for rare but potentially serious cardiac adverse events associated with cholinesterase inhibitor drugs in the treatment of dementia. Different protocols have been proposed, with and without ECG examination. We surveyed an urban old age psychiatry service to investigate the variables that may influence the implementation of such protocols. METHODS: Case notes of 45 consecutive patients assessed for dementia were scrutinized, to establish how many underwent an ECG or other cardiac examination prior to drug treatments. Data were collected on demographics, medical conditions and drug treatments. Patient files were searched for indications of investigations and any outcomes. RESULTS: Half of all patients treated with a cholinesterase inhibitor (11/22) had an ECG before treatment. In five cases no pulse or cardiac symptoms were recorded in the absence of an ECG. Medical history, findings on examination, seniority of the clinician, and patient cooperation all may have influenced whether patients had an ECG. In three cases treatment was not prescribed due to concerns over cardiac effects, and with five ECGs new diagnoses were made. A protocol based on pulse monitoring would only have indicated ECGs in two out of 22 cases. CONCLUSIONS: Several factors may influence decisions on cardiac monitoring. Fewer ECGs could be done if only pulse and cardiac symptoms were monitored before cholinesterase inhibitor prescription, but new cardiac diagnoses might then be missed. Protocols can be devised to incorporate both cardiac investigation and cholinesterase inhibitor monitoring.

Nithsdale Schizophrenia Surveys 23: movement disorders. 20-year review.

BACKGROUND: In the past 10 years the new atypical antipsychotic drugs have stimulated further interest in the pharmacological management of schizophrenia. The risk of movement disorders has been reported to be less with these new agents. AIMS: To examine the current prevalence of movement disorders among all people with schizophrenia in a discrete geographical area, to compare the prevalence in patients receiving and not receiving atypical antipsychotic drugs; and to compare current prevalence with prevalence over the past 20 years. METHOD: In Nithsdale, south-west Scotland, in 1999/2000, we replicated previous studies by using the Abnormal Involuntary Movements Scale, Simpson-Angus scale and Barnes Akathisia Rating Scale to measure tardive dyskinesia, parkinsonism and akathisia, respectively. Mental state was assessed by the Positive and Negative Syndrome Scale. RESULTS: In 136 patients the prevalence of probable tardive dyskinesia was 43%, of parkinsonism 35% and of akathisia 15%. Parkinsonism was present as often in those receiving atypicals as in those receiving standard oral antipsychotics. The prevalence of tardive dyskinesia has doubled over 20 years. CONCLUSIONS: Movement disorders remain significant problems for patients despite the introduction of atypical antipsychotic drugs.