During the past 30 years, the growth of geriatric psychiatry services has been dramatic. Indeed, the majority of developed countries can boast of an impressive range of hospital-based, community-based, and long-term-care programs (Reifler & Cohen, 1998). For the most part, these services are traditional clinical services: The client (or caretaker) identifies a problem and the mental health professional offers comprehensive assessment and treatment.

Previous reports on the activities of essential endogenous antioxidants such as superoxide dismutase, catalase, and glutathione in dementia patients have not included a simultaneous quantitative assessment of dietary antioxidant intake. This is important because the reported differences in endogenous antioxidant levels among dementia patients may have reflected variations in the total antioxidants' intake. In this study we measured the levels of antioxidant vitamins A, C, and E in the diet of 81 dementia patients and controls at the same time as assessing blood levels of three endogenous antioxidants. Results showed a significant decrease in the intake of vitamins C (p < .001) and E (p < .01) in patients with severe Alzheimer's disease (AD) when compared to controls. Patients with mild/moderate AD differed from controls only in the intake of vitamin C (p < .01). The blood levels of catalase but not superoxide dismutase and glutathione were significantly decreased in the patients with severe AD when compared to controls (p < .01), patients with mild/moderate AD (p < .01), and patients with dementia with Lewy bodies (p < .05). The blood catalase levels of dementia patients, as a whole, were significantly and positively associated with the intake of vitamins A (p < .05), C (p < .01), and E (p < .05). The results indicated that dietary intake of vitamins A, C, and E may influence blood levels of catalase possibly through their antioxidant effects on free radicals. The data underscore the importance of concurrent quantitative assessment of nutritional intake when measuring endogenous antioxidant activities and support a role for antioxidant supplementation in the treatment of dementia disorders.

Background: Decline in physical functional ability is an intrinsic component of the dementia syndrome. Reductions in muscle mass and strength represent a major factor in the loss of functional ability. Although resistance exercise has been studied as a method for maintaining/recovering function in populations of frail older adults, people with dementia have been systematically excluded because of uncertainty about the reliability of outcome measurements. Objective: The purpose of this study was to determine the test-retest reliability of a battery of established performance-based measures of strength and function among subjects with dementia. Setting: A hospital-affiliated adult day-care facility. Subjects: Twelve of 28 older subjects with dementia of various etiologies were available for two assessments prior to implementation of a resistance-exercise intervention. Methods: Subjects underwent an assessment of lower extremity strength and physical function consisting of two recorded trials of bilateral isometric strength of the knee extensor, hip flexor, and dorsiflexor muscles, as well as hand grip strength; repeated chair stands, evaluation of usual- and maximal safe-gait speed over a 6-m course, and the Timed-Up-and-Go Test. The entire assessment was repeated approximately 1 week later. An average of the trials for each measurement was computed for each of the two assessment periods, and intraclass correlation coefficients (ICCs) for these paired measurements were estimated using STATA. Results: ICCs ranged from .56 for left iliopsoas to .77 for left dorsiflexors among the strength measures whereas measures of function ranged from .80 for number of steps in usual gait to .95 for time of fast gait. Conclusions: Performance-based measures of strength and function can be reliably assessed in older people with dementia, although measures of function appear to be more reliable than measures of strength.

Ninety-one mid- to late-stage dementia patients residing in nursing homes, along with their staff caregivers, participated in a study designed to assess whether training caregivers in sensitivity to nonverbal communication could enhance mood and reduce symptoms in patients and improve psychological well-being in caregivers. Patients and staff at three nursing homes comprised three groups that were randomly assigned to either a non-verbal sensitivity group, a behavioral placebo group that received instruction in the cognitive and behavioral aspects of dementia, and a wait-list control. Training consisted of 10 one-hour sessions taught by a clinical psychologist using prepared materials. Patient measures, which were taken at baseline and at 4 three-week intervals, included patient symptomatology (depression, agitation, behavioral symptoms), as reported by the staff caregivers, and positive and negative facial expressions of emotion elicited during a face-to-face interview and coded by trained research staff. Results indicated that positive affect increased sharply during the first 6 weeks after intervention in the nonverbal group, with the placebo and wait-list controls showing no change. There was also a decline in negative affect across time for all groups. Effects with respect to patient symptomatology did not reach significance. Caregivers in both training groups showed a decline in symptomatology, whereas the wait-list control group did not.

Background: We aimed to assess why carers seek participation for their relatives in clinical trials of Alzheimer's disease (AD) medications, and to assess carer impressions of the value of trial participation. Method: A retrospective questionnaire was sent to 31 carers of participants in clinical trials for AD conducted at the Mental Health Research Institute and the National Aging Research Institute between January 1997 and December 1999. Results: Twenty-five questionnaires (81%) were returned, completed to an extent to permit analysis. Helping a relative feel better, contributing to medical science, and hoping for a cure were the main reasons for trial participation. In general, carers found the regular consultation with research staff supportive and would recommend trial participation to others. Conclusion: A greater understanding of the motivations of carers may aid the recruitment and retention of participants in clinical trials.

Objectives: To investigate what kind of changes spouse caregivers of demented patients experience after the onset of dementia (a) in the general atmosphere, happiness, and relations of marriage and (b) in the sexual side of marriage. Design: Semistructured telephone interviews of spouse caregivers of demented patients. Setting: Community-living demented patients and their spouse caregivers in eastern Finland. Participants: The spouse caregivers of 42 demented patients recruited from a previous intervention study. Measures: The questionnaire covered different areas of marriage from the time before and after the onset of dementia. Results: A statistically significant decline had occured in extent of happiness (p = .012), in equal relations (p = .001), and in patients' expressions of sexual needs (p < .001) when compared the time before and after dementia. Twenty-five (60%) of the caregivers reported that the demented patient had shown at least one negative sexual behavioral change during the course of dementia. Seven male patients (24%) had shown the behavioral symptom of constantly expressing need for making love. One in 10 caregivers had experienced positive sexual behavioral changes. In one third of the patients, the expressions of tenderness towards the caregiver had increased. Dementia did not affect significantly the general atmosphere of the marriage. Out of those still in home care, at 3 years from the onset of dementia, 19 couples (46%) continued to practice intercourse, at 5 years the number was 15 couples (41%), and at 7 years it had declined to 7 couples (28%). Conclusions: Dementing illness has a major negative impact on many dimensions of marriage. However, there are also positive changes and preserved aspects of marriage. Dementia seems to have a surprisingly little impact on whether the couple continues to have intercourse when compared with the general aging population.

Background: Volumetric magnetic resonance imaging (MRI) has been extensively studied in the last decade as a method to help with the clinical diagnosis of Alzheimer's disease (AD). In recent years, researchers have also started investigating if that technique would be useful to identify individuals with mild cognitive impairment (MCI), differentiating them from AD patients and from normal elderly controls. This research project was planned to assess the accuracy of volumetric MRI to differentiate those groups of individuals. Method: The investigation involved 39 patients with diagnosis of mild to moderate dementia in AD, according to the criteria of the NINCDS-ADRDA, DSM-III-R, and ICD-10; 21 subjects with complaints of cognitive decline without other psychiatric disorders (MCI); and 20 normal elderly controls. All the subjects were submitted to a standard protocol, including volumetric MRI evaluations. Results: The results indicated that all regions of interest measured (amygdala, hippocampus, and parahippocampal gyrus) were significantly different (p < .005) in AD patients compared to MCI subjects and controls. The left volumetric measures (amygdala, hippocampus, and parahippocampal gyrus) were also significantly different between the MCI subjects and controls (p < .05). The discriminant function analysis correctly classified 88.14% of the AD patients and controls, 81.67% of AD patients and MCI subjects, and 80.49% of the MCI subjects and controls. Conclusions: The results suggest that measures of medial temporal lobe regions are useful to identify mild to moderate AD patients and MCI subjects, separating them from normal elderly individuals.

Major advances in understanding the physiology and genetics of circadian rhythm in the past decade challenge the researcher of sleep/wake disorders in Alzheimer's disease (AD) to distinguish patient characteristics stable across the course of illness (“traits”) from characteristics that vary with stage of illness (“states”). A components-of-variance approach with a repeated measures model was used to examine the between-subjects variance over time (“trait”) vs. within-subjects (“state”) variance in 42 patients with probable AD followed, on average, over 2 years on actigraphic sleep/wake measures. Mental status scores indexed stage of illness. Actigraphic measures of sleep efficiency and circadian rhythmicity appeared predominantly “trait,” with between-individual differences accounting for over 55% of variance compared to the less than 5% of variance related to stage of cognitive impairment. We discuss how “state-trait” analyses can be helpful in identifying areas of assessment most likely to be fruitful objectives of physiologic and genetic research on sleep/wake disturbance in AD.

In this exploratory study, we compared the performance of 10 African American and 26 European American persons with early-to mid-stage Alzheimer's disease (AD) to 20 nondemented elderly (NE), using a shortened version of the Test of Problem Solving (TOPS). The TOPS measures verbal reasoning to solve everyday problems in five areas: explaining inferences, determining causes, answering negative why questions, determining solutions, and avoiding problems. Six linguistic measures were also examined: total utterances, abandoned utterances, length of utterances, maze words, questions, and total words. NE performed better than AD subjects on all but one measure of verbal reasoning ability. AD subjects also showed a trend to use more total utterances and abandoned utterances than NE. For the AD group, no ethnic differences were found for verbal reasoning or linguistic measures. The findings from this preliminary investigation suggest that, compared to European Americans, African American persons with AD demonstrate similar everyday problem solving and linguistic skills. Thus, assessments such as TOPS that examine everyday problem solving may be a useful nonbiased evaluation tool for persons with AD in these two ethnic groups.

Objective: To examine the demographic, prescription, ingestion, and psychiatric diagnostic factors that distinguished elderly from nonelderly patients treated for deliberate self-poisoning (DSP). Method: A prospective case series study of 2,667 patients presenting to a regional referral center for poisoning (Newcastle Mater Hospital, NSW, Australia), January 1991 to July 1998. The sample was stratified into two groups, 65 years or greater (n = 110) and 64 years or less (n = 2,557) at the time of index admission. The groups were compared using a forward stepwise logistic regression model. Uncontrolled comparisons were analyzed by chi-square statistic with Bonferroni-adjusted p values and controlled comparisons by odds ratio (OR) with 95% confidence interval (CI). Results: The elderly group represented 4.1% of the total. The logistic regression analysis found the elderly DSP group was more likely to have a longer length of stay (OR 5.90, CI 3.87–9.00), to have been prescribed “other” drugs (neither benzodiazepines, mood treatment drugs, nor paracetamol) before admission (OR 5.32, CI 3.34–8.48), to have been prescribed benzodiazepines (OR 3.15, CI 2.03–4.89), and to be diagnosed with major depression (OR 2.17, CI 1.41–3.36) than the younger group. The elderly group was less likely to have ingested paracetamol (OR 0.28, CI 0.14–0.54) or “other” drugs (neither benzodiazepines nor mood treatment drugs) in the DSP episode (OR 0.33, CI 0.20–0.54). Discussion: Elderly DSP patients differ in several important respects from younger patients. They have higher morbidity as a result of the DSP. Major depression plays a more important role. The strong relationship between benzodiazepine prescription and DSP in the elderly raises questions and possible prevention strategies.