General cognitive function and specific language and memory processing abilities were compared in dementia of the Alzheimer type (DAT), depressed and normal control subjects. Several tests clearly differentiated between DAT and depressed subjects including a verbal fluency task, several components of a word memory test, an IQ deterioration index, and the Mini-Mental State Examination. The inability of DAT subjects to take advantage of semantic cues in both the verbal fluency and in the memory test contrasted with the performance of depressed and normal subjects, who were able to benefit from semantic cues. Depressed patients displayed deficits compared with normal controls on the more effortful verbal fluency task but not on the memory test. Tasks that are least effortful, rely on semantic associations, and require declarative memory are most likely to discriminate between DAT and depression.

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Participation of relatives to provide clinical information on psychiatric patients is frequently under-utilized resulting in valuable data being bypassed. In an attempt to formalise the gathering of data from relatives we used the Geriatric Evaluation by Relatives Rating Instrument (GERRI), a 49-statement questionnaire in which the relative rates the patient's behaviour in terms of frequency of occurrence, The information obtained from relatives was then compared with that obtained from other forms of patient-assessment—the London Psychogeriatric Rating Scale completed by nursing staff, the Minimental State Screening Test and the Visual Analogue Scale for Depression completed by the patient, and the Activities of Daily Living Instrument completed by the occupational therapist. These instruments were chosen as being valid and reliable procedures with which to compare the GERRI. Subjects were 100 patients aged 65 yr. and over who were admitted consecutively to a psychogeriatric unit in a large psychiatric hospital. Significant correlations between relatives' assessment of cognitive and social function and those completed by the patients and other staff were noted. The relatives' assessment of the patients' mood, however, did not correlate with the patients' self-assessment of mood, suggesting that depression in the elderly may be “masked.”

SUMMARYThe authors present the results of routine CT head scans done on 80 consecutively admitted elderly psychiatric patients. Many patients had abnormal scans but in few cases were the results of major clinical importance. Patients in whom the clinical history suggests a recent change in behaviour or personality, or whose findings on physical examination have recently altered, represent a select group for whom CT scans should be considered.