The medical charts of 188 Alzheimer patients and a comparison group of 80 nondemented patients matched for age and sex were retrospectively reviewed for history of psychiatric morbidity. The Alzheimer patients were more likely to have had a psychiatric illness earlier in life (chi 2 = 8.5238, df = 1, P less than .001) with unipolar depression and paranoid disorder being the two most frequent psychiatric disorders. Possible explanations for these findings include underreporting, facility bias, functional psychiatric features as prodromal states of Alzheimer's disease, and vulnerability to psychiatric morbidity in those who go on to develop Alzheimer's disease. The likelihood of each of these explanations is discussed.

Suicide rates are highest in males over age 74 years. There are regional differences in elderly suicide rates and the factors that influence them. Longitudinal and cross-sectional risk factors differ, and there are gender differences in the risk factors. For both elderly males and females, suicide rates appear to be influenced by social factors in the population as a whole, not just in the elderly population. Male and female employment patterns are associated with elderly male suicide rates, even though the latter are not in the labour force. For suicide in elderly women the important factors are population education, income, and migration levels.

No abstract

Dementia and depression both affect the ability to function. There is little information on how these two disorders affect the abilities of Alzheimer disease (AD) patients to perform instrumental activities of daily living (IADLs). We explored this at the Clinic for Alzheimer''s Disease and Related Disorders at the University Hospital, UBC Site in Vancouver, Canada. Using the DSM IIIR and NINCDS-ADRDA criteria, we identified patients who met the criteria for AD and subdivided them into depressed and nondepressed based on the presence of major depression. These groups were then compared on their abilities in functional abilities and Minimental State Examination scores (MMSE). The sample consists of 14 depressed and 88 nondepressed AD patients. They did not significantly differ in age, social and occupational functioning, home and hobbies, personal care and measures of instrumental activities of daily living. The depressed group had symptoms for shorter periods of time (t = 3.52, d.f. = 36.52, p = 0.001) and higher MMSE scores (t = 2.63, d.f. = 100, p = 0.01). The two groups were further subdivided into two groups each based on ability to perform an IADL. MMSE scores differed significantly among the four resultant groups for all IADLs. There was no interaction between depression and ability to perform any of the IADLs. We conclude that the effect of dementia on IADLs was too dominant for depression to exert any further effect. The effect of depression often observed in the physically disabled may not be duplicated in the demented because of the different natures of the disabilities.