International Journal of Geriatric Psychiatry

We aimed to validate an improved revision (the ACE‐R) which incorporates five sub‐domain scores (orientation/attention, memory, verbal fluency, language and visuo‐spatial).

Standard tests for evaluating dementia screening tests were applied. A total of 241 subjects participated in this study (Alzheimer's disease = 67, frontotemporal dementia = 55, dementia of Lewy Bodies = 20; mild cognitive impairment–MCI = 36; controls = 63).

Reliability of the ACE‐R was very good (alpha coefficient = 0.8). Correlation with the Clinical Dementia Scale was significant (r = −0.321, p < 0.001). Two cut‐offs were defined (88: sensitivity = 0.94, specificity = 0.89; 82: sensitivity = 0.84, specificity = 1.0). Likelihood ratios of dementia were generated for scores between 88 and 82: at a cut‐off of 82 the likelihood of dementia is 100:1. A comparison of individual age and education matched groups of MCI, AD and controls placed the MCI group performance between controls and AD and revealed MCI patients to be impaired in areas other than memory (attention/orientation, verbal fluency and language).

The ACE‐R accomplishes standards of a valid dementia screening test, sensitive to early cognitive dysfunction. Copyright © 2006 John Wiley & Sons, Ltd.

This study aimed to examine the association of loneliness and social isolation on cognition over a 3‐year follow‐up period in middle‐ and older‐aged adults.

Data from a Spanish nationally representative sample were analyzed (n = 1691; aged 50 years or older). Loneliness, social isolation, and cognition (immediate recall, delayed recall, verbal fluency, forward digit span, backward digit span, and a composite cognitive score) were assessed both at baseline and at follow‐up. Adjusted generalized estimating equations models were performed.

Loneliness was significantly associated with lower scores in the composite cognitive score, immediate and delayed recall, verbal fluency, and backward digit span (B = −0.14 to B = −3.16; P < .05) and with a more rapid decline from baseline to follow‐up in two out of six cognitive tests. Higher social isolation was associated with lower scores in the composite cognitive score, verbal fluency, and forward digit span (B = −0.06 to B = −0.85; P < .05). The effect of loneliness and social isolation on cognition remained significant after the exclusion of individuals with depression.

Both loneliness and social isolation are associated with decreased cognitive function over a 3‐year follow‐up period. The development of interventions that include the enhancement of social participation and the maintenance of emotionally supportive relationships might contribute to cognitive decline prevention and risk reduction.

No recent attempt has been made to synthesise information on mortality and dementia despite the theoretical and practical interest in the topic. Our objective was to estimate the influence on mortality of cognitive impairment and dementia.

Data sources were Medline, Embase, personal files and colleagues' records. Studies were considered if they included a majority of persons aged 65 and over at baseline either drawn from a total community sample or drawn from a random sample from the community. Samples from health care facilities were excluded. The search located 68 community studies. Effect sizes were extracted from the studies and if they were not included in the published studies, effect sizes were calculated where possible: this was possible for 23 studies of cognitive impairment and 32 of dementia. No attempt was made to contact authors for missing data.

For the studies of cognitive impairment Fisher's method (a vote counting method), gave a p‐value (from eight studies) of 0.00001. For studies of dementia, age‐adjusted confidence intervals (CI) were pooled (odds ratio (OR) 2.63 with 95% CI 2.17 to 3.21 from six studies).

Levels of cognitive impairment commonly found in community studies give rise to an increased risk of mortality, and this appears to be true even for quite mild levels of impairment. The analysis confirms the increased risk of mortality for dementia, but reveals a dearth of information on the causes of the excess mortality and on possible effect modification by age, dementia subtype or other variables. Copyright © 2001 John Wiley & Sons, Ltd.

People with dementia often move into care homes as their needs become too complex or expensive for them to remain in their own homes. Little is known about how well their needs are met within care homes.

The aim of this study was to identify the unmet needs of people with dementia in care and the characteristics associated with high levels of needs. Two hundred and thirty‐eight people with dementia were recruited from residential care homes nationally. Needs were identified using the Camberwell Assessment of Needs for the Elderly (CANE).

Residents with dementia had a mean of 4.4 (SD 2.6) unmet and 12.1 (SD 2.6) met needs. Environmental and physical health needs were usually met. However, sensory or physical disability (including mobility problems and incontinence) needs, mental health needs, and social needs, such as company and daytime activities, were often unmet. Unmet needs were associated with psychological problems, such as anxiety and depression, but not with severity of dementia or level of dependency.

Mental health services and residential home staff need to be aware that many needs remain unmet and much can be done to improve the quality of life of the residents with dementia. Copyright © 2005 John Wiley & Sons, Ltd.

Alzheimer's disease and related syndromes have heavy social and human consequences for the patient and his family. Beyond the neuropsychiatric effects of specific therapies for dementia, one of today's challenges is the quality of life for both patients and their informal caregivers.

This survey tends to determine parameters influencing caregivers' quality of life, and its possible link with patients' quality of life.

A scale measuring caregivers' quality of life, developed from data from previous PIXEL studies was used. It is a questionnaire composed of 20 items. The scale was related to the socio‐demographic data of both patients and their main caregivers, to the ADRQL scale (Alzheimer Disease Related Quality Life) of Rabins for the QoL of dementia patients, to the patients medical and therapeutic data, specially a neuropsychological inventory: Folstein's cognition test, Cornell's depression scale, the fast battery of frontal assessment, Katz's dependence index, Cummings' neuropsychiatric inventory for behavioral and psychological symptoms of dementia and to a physician evaluation of caregiver's depression.

One hundred patients diagnosed with dementia who live at home with their principal caregivers were recruited for this survey. Patients were 80.2 ± 6.8 years old and caregivers were 65.7 ± 12.8 years old. The caregivers' quality of life was correlated to the quality of life of the patients they cared for, the importance of behavioral disorders, and the duration of dementia evolution. Women caregivers had a worse quality of life and were more depressive than men.

Caregivers' and patients' quality of life are related and both share a community of distress. Copyright © 2005 John Wiley & Sons, Ltd.

Behavioural disturbances are a common and distressing aspect of Alzheimer's disease (AD). This pooled analysis evaluated the specific benefits of memantine on behavioural disturbances in patients with moderate to severe AD.

Data were pooled from six 24/28‐week, randomised, placebo‐controlled, double‐blind studies. Of the 2,311 patients included in these studies, 1,826 patients with moderate to severe AD (MMSE <20) were included in this analysis, corresponding to the extended indication for memantine in Europe. In this subgroup, 959 patients received memantine 20 mg/day and 867 received placebo. Behavioural symptoms were rated using the Neuropsychiatric Inventory (NPI) total and single‐item scores at weeks 12 and 24/28.

At weeks 12 and 24/28, ITT analysis demonstrated that memantine treatment produced statistically significant benefits over placebo treatment in NPI total score (p = 0.001 and p = 0.008), and in NPI single items: delusions (p = 0.007 week 12, p = 0.001 week 24/28), hallucinations (p = 0.037 week 12), agitation/aggression (p = 0.001 week 12, p = 0.001 week 24/28), and irritability/lability (p = 0.005 week 24/28), LOCF population. Analysis of the patients without symptoms at baseline indicated reduced emergence of agitation/aggression (p = 0.002), delusions (p = 0.047), and disinhibition (p = 0.011), at week 12, and of agitation/aggression (p = 0.002), irritability/lability (p = 0.004), and night‐time behaviour (p = 0.050) at week 24/28 in those receiving memantine. OC analyses yielded similar results.

The data suggest that memantine is effective in treating and preventing the behavioural symptoms of moderate to severe AD. Specific persistent benefits were observed on the symptoms of delusions and agitation/aggression, which are known to be associated with rapid disease progression, increased caregiver burden, early institutionalisation, and increased costs of care. Copyright © 2007 John Wiley & Sons, Ltd.

The purpose of this study was to explore the structure of the Zarit Burden Interview (ZBI) for informal caregivers of patients suffering from AD or related disorders, and to examine the relations of the dimensions found with functional disabilities and other patient health indicators.

152 dyads of community‐dwelling older adults with dementia and their primary caregivers were analysed.

Caregiver burden was measured by the 22‐item ZBI. Caregivers' and care recipients' characteristics were collected with the MDS (Minimum Data Set) of the RAI (Resident Assessment Instrument) Home Care instrument. Data on dementia (diagnosis, severity, MMSE) were also obtained. Burden data were analysed by principal component analysis (PCA) with varimax rotation. Relationships between scores on PCA factors and care recipients' health indicators were studied with inferential statisti cal tests.

Three dimensions of burden were found: effect on the social and personal life of caregivers, psychological burden and feelings of guilt. Some health variables were linked to these dimensions. Spouses and children perceived burden differently. Spouse caregivers emphasized the deterioration of their personal and social life. Children, less involved in daily care, were more prone to feel guilt that they were not doing enough for their parent. Copyright © 2005 John Wiley & Sons, Ltd.