SynopsisThe Mini-Mental State Examination was administered to 1865 general-practice patients aged 75 years and over. Even when demented cases were removed from analysis, respondents with relatively little education, together with those in social classes Ill-manual and below, were significantly more likely to score below the cut-off point used in North American community surveys to denote ‘cognitive impairment’. Education and social class influenced scores on all sections within the MMSE with the exception of registration. Sex influenced scores on tests of calculation and spelling backwards but had no effect on total scores. These findings emphasize the importance of investigating low scorers in more detail before making a diagnosis of dementia.
The supporters of 120 demented elderly people completed rating scales of the frequency and severity of the problems they faced, the amount of strain they experienced and their psychological well-being. Problems and strain increased with the degree of dementia. Problems relating to physical dependency, forgetfulness and inertia were relatively common, while disturbed behaviours were relatively uncommon. Physical dependency and disturbed behaviour were less well tolerated than forgetfulness and inertia, but all problem categories were positively associated with measures of strain. Wives reported more problems and strain than husbands, and co-resident children were under greater strain than children who lived independently.
Objective-To test whether early diagnosis and practical help reduce the number of elderly people with dementia admitted to institutions.Design-Controlled trial of effect of help from a multidisciplinary team on admission rates of people with dementia.Setting-Seven general practices in Cambridge. Subjects-2889 subjects aged 75 and over, of whom 159 were identified as having dementia with a two stage community survey. Eighty six subjects were referred for extra help ifthey or their supporters wished. The other 73 subjects had access to the usual services and served as controls.Intervention-Subjects and families in the action group were offered a wide range of help, including financial benefits, physical aids, home helps, respite admissions, practical advice, and psychiatric assessments.Main outcome measure-Permanent admission to long term care within two years after diagnosis.Results-Early intervention did not affect admission rates in subjects who lived with supporters.
We report here on the coexistence of dementia and depression in a community population aged 75 years and older. Complete information about mood and cognition was available for 286 cognitively intact subjects selected for assessment because of their low scores on the Mini-Mental State. and for 158 mildly and moderately demented subjects. Severely demented subjects, who were incapable of providing information, were excluded. Five percent (8/158) of demented subjects also fulfilled criteria for major depressive disorder Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) compared with 9% (27/286) of cognitively intact subjects. No substantial differences existed in the symptoms reported by demented depressives andnondemented depressives, but subjects who suffered from both disorders were so markedly apathetic that their depression might easily have been overlooked had specific enquiries not beenmade. Depression was particularly associated with dementia secondary to multi-infarct and Parkinson's disease. When reviewed one year later, 2 of the 18 surviving depressed, nondemented subjects showed evidence of dementia. Both presented unusual diagnostic difficulties, however, and no evidence emerged that large numbers of elderly people will be misclassified in community surveys that include a mental state examination, cognitive testing, and an informant interview.
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