No abstract

The authors investigated sources of disagreement on the Geriatric Depression Scale (GDS) between patients and their collateral sources (CSs). There were 198 subjects with possible or probable Alzheimer's disease (DAT) and 64 cognitively intact subjects evaluated at an outpatient geriatric assessment center. The 30-item GDS was completed by the patient and the CS version of the GDS by the CS. A sizable discrepancy was found in the reporting of depressive symptoms by the subjects vs. the CSs. Multiple-regression analyses revealed that both level of insight and level of physical illness in the subjects with DAT significantly influenced the discrepancy. An increased sense of burden in the CSs was associated with a larger symptom gap in both DAT and control subjects. CSs consistently perceived more depressive symptoms than subjects, especially subjects with DAT who had no insight into their cognitive impairment.

There has been a growing interest in understanding issues surrounding alcohol use in late life. Information about the relationship of alcohol use to behavioral problems in older persons living in the community is particularly limited. This study used information obtained from an outpatient geriatric assessment clinic to study this relationship and the effects of these behaviors on caregivers. Data on alcohol use, problem behaviors, and caregiver burden were collected prospectively in consecutive patients undergoing geriatric assessment primarily for cognitive problems over a 3-year period. All patients were evaluated by a multidisciplinary team, which included a geriatric psychiatrist. The evaluation screened for current and/or past alcohol use through interviews with the patient and a collateral source. The collateral source also completed the Neuropsychiatric Inventory and the Family Burden Scale. Subjects were classified into 2 groups: those with a current or past alcohol problem and those with no alcohol problem. A total of 349 patients were evaluated, with 17.8% being designated as having a current or past alcohol problem. This subgroup represented 35% of the men and 9% of the women from the study population. Approximately half of the subgroup was actively drinking alcohol. Patients with a history of problem alcohol use, regardless of current use and cognitive status, exhibited more behavioral disturbances including agitation, irritability, and disinhibition. Their caregivers reported significantly higher caregiver distress. Current or past alcohol problem use was frequent in this population of frail, older adults undergoing geriatric assessment. Regardless of current alcohol use, these patients displayed more behavioral disturbances than those without a history of problem drinking, and their caregivers experienced significantly more burden. A history of problem drinking appears to be a significant marker for behavioral disturbances in late life and merits further study.