Increasing numbers of people in absolute terms, and even more so in relative terms, are reaching an age in which psychogeriatric illness, as well as geriatric illness, frequently is manifested. This unprecedented increase in average individual lifespan is due largely to advancement in life standards of the population as a whole, the enormous improvement in hygiene, and the progress made by preventive and curative medicine in controlling acute and fatal disease, in addition to advancements in available treatments of chronic disease in old people.

Computer-analyzed EEG data and mental functions of the healthy aged (28 survivors and 20 nonsurvivors) were followed for nine years in a study of their relationship with age and longevity. The study revealed that decrease in fast waves occurred from early senescence. The slowing of EEG, the increase in theta waves, and the decrease in alpha frequency became obvious in late senescence, after the late 70s or beyond 80 years. The amount of alpha waves was maintained until the early 80s. The decline of mental functions occurred with the slowing of EEG in late senescence. The slowing of EEG and the lowered scores of psychometrics were closely related to the longevity of life, comparing the survivors and nonsurvivors in retrospect.

The authors reanalyzed previously published data from a prospectively randomized, placebo-controlled, double-blind phase-III study of 130 inpatients with dementia syndrome. The patients in the study had been diagnosed as having suffered from organic brain syndrome (ICD 290), which is the core syndrome of dementia (so-called dementia syndrome) for at least two years. They were treated with piracetam for three months at a dose level of 4,800 mg/d.

These data were reexamined in order both to survey the extent of drugrelated improvement and response rates when assessed at different levels and to investigate the comparability of efficacy in subgroups suffering from either senile dementia of the Alzheimer type or multi-infarct dementia. Three scales were used for the assessment of efficacy. They were the CGI, or Clinical Global Impression, completed by the physicians; the SCAG, or Sandoz Clinical Assessment Geriatric, used by clinical psychologists; and the BGP, or Beurteilungsskala f$uUr Geriatrische Patienten (Evaluation Scale for Geriatric Patients), employed by the nursing staff. The Syndrom-Kurztest (SKT) and Benton tests served to measure performance.

The items and subscores of the SCAG and the SKT were highly intercorrelated at baseline, forming a common factor fairly independent of the information gained by BGP. This suggests that merely using different kinds of information-gathering methods, i.e., clinical scales and performance tests, completed by different groups of observers, does not automatically result in nonredundant comprehensive information.

Benzodiazepine hypnotic medications are widely prescribed for elderly patients, but there is a paucity of information available concerning the resudual cognitive and psychomotor (the morning-after) effects of these drugs. We compared two commonly used hypnotics—temazepam and triazolam—in a double-blind, placebo-controlled, single-dose study with community-dwelling healthy elderly with a DSM-III-R diagnosis of primary insomnia. Fortyfive subjects over the age of 65 (mean age 72.23, SD = 4.44) qualified for the study. Subjects were randomly assigned to one of five treatment groups (placebo, triazolam 0.125 mg., triazolam 0.25 mg., temazepam 15 mg., and temazepam 30 mg.). Neuropsychological testing was completed at baseline and 12–14 hours after the dosing.

Patients were evaluated with a variety of tests that measured attention, concentration, motor speed, immediate memory, and learning of new information. Separate repeated measured analyses of variance were performed to assess the significant changes among the five treatment groups. We found improved performance or no change in all the measures for all medication groups except for impairment of performance on a serial learning task for both high-dose medication groups. The significance of these results and the need for further research in elderly insomniacs is discussed.

Diagnosis of dementia needs to be complemented by precise determination of disease severity across the broad spectrum of disease progression. The Mini-Mental State Exam (MMS), the Activities-of-Daily-Living assessment (ADL) and the Clinical Dementia Rating scale (CDR) were modified for direct comparability and administred to 112 outpatients and 45 nursing home residents with a range of dementia severity from mild to profound. The scales showed the highest correlations for the probable Alzheimer's disease patient group (62) (Global Assessment of Dementia; GAD vs. ADL: r = 0.91; Extended Mini-Mental Assessment; EMA vs. GAD: r = 0.91; ADL vs. EMA: r = 0.86). For these patients, scores on the individual scales tended to be similar. Disparity among the three scores for individual cases was associated with the presence of comorbidities. The high correlations and correspondence among these scales demonstrate their reliability, validity, and utility in the assessment of dementia severity. The use of an average of these measures, with their increased precision, may give a more accurate indication of dementia severity over a broader range of impairment.

One hundred and sixty-eight elderly subjects in a geriatric hospital and the adjoining nursing home were examined in a study of relationships among the items of Hasegawa's dementia scale. A three-dimensional model using multivariate analysis demonstrated the relationships among items. The results led to the identification of six clinical groups determined by the presence of stroke and the score on the dementia scale. Nonstroke subjects of middle intellectual level had disturbances of memory and orientation. This group fell into two categories during the course of a five-year follow-up study: severe dementia and intellectual deterioration. Retrospective multivariate analysis results suggested that features characteristic of the severe intellectual deterioration group were earlier disturbances of orientation and distant memory. This statistical method used only objective clinical data in order to avoid subjective and, often, baised judgements.

A prospective pilot study compared the Neurobehavioral Cognituve Status Examination (NCSE) to the Folstein Mini-Mental State Examination (MMSE) to determine the usefulness of the NCSE as a cognitive screen in a geriatric inpatient population. All patients directly admitted to the geriatric evaluation and treatment unit (GETU) of a university teaching hospital over a two-and-a-half-month period were eligible for the study, in which 42% participated, Within 72 hours of admission, patients were given the MMSE and the NCSE in a nonrandom order by a trained psychologist and a structured interview by a psychiatrist. The ability of the NCSE to detect global cognitive impairment was compared to the MMSE and psychiatrist's assessment. Differences in sensitivity were examined by discordant pair analysis. The psychiatrist's determination of the presence of cognitive impairment was used as the criterion standard. Comparison of the MMSE and NCSE, respectively, revealed the following: sensitivity 83% versus 100%; specificity 78% versus 11%; positive predictive value 83% versus 43%; and negative predictive value 78% versus 100%. Seven patients who were cognitively impaired by the NCSE were not impaired by the MMSE (p < 0.05 by discordant pair analysis). The time of administration for the two tests was significantly shorter for the MMSE (14.75 ± 5.7 minutes) than for the NCSE (38.9 ± 12.9 minutes). The NCSE was found to be more sensitive than the MMSE in detecting cognitive impairment among geriatric inpatients, but its specificity and positive predictive values were lower. Beyond this pilot study, additional work examining the utility of the NCSE in other geriatric settings and for different purpose (e.g., as part of comprehensive assessment) needs to be performed.

A nutritional study of 100 patients enrolled in an active geriatric outpatient teaching program was conducted to document the clinical impression of weight loss in Alzheimer's disease. All new patients were asked to complete a questionnaire on nutrition. Patients were evaluated by a geriatrician, then categorized using DSM-III and NINCDS-ADRDA criteria. There were 34 Alzheimer patients and 60 nondemented patients with an average weight of 56.2 kgs and 66.1 kgs, respectively (p < .002). Of the Alzheimer group, 44% reported weight loss in the past five years compared with 37% of the nondemented group, despite a concomitant increase in food intake in 35% versus 7%, respectively. On a one-year follow-up, 92% of Alzheimer patients lost weight, whereas 57% of the nondemented patients actually gained weight. The increase in reported food intake, with a significant concomitant weight loss, raises some challenging questions as to the existence of a hypermetabolic state in Alzheimer's disease.

Chronic cerevrovascular disturbances of the aged are characterized by a decline of attention. When these patients undergo pharmacological treatment, it is very difficult to distinguish between a direct benefit and/or a secondary effect on memory resulting from attention improvement. In our study we have proposed and evaluated a new method for identifying the different components of therapeutic efficacy on memory and attention in chronic cerebrovascular patients. This method is based on the use of the Randt Memory Test, traditional scores of memory efficiency (Acquisition, Recall, and a combined index), and the RMT three-factor scores derived from a structural model of memory functioning. The three scores have been called Encoding and Organization, Cognitive Efficiency, and Attention Efficiency. Participants were 96 selected chronic cerebrovascular patients treated in a double-blind study for 12 weeks with dihydroergocristine versus placebo. While changes in both acquisition and recall scores were related to the treatment, only changes of the Encoding and Organization factor scores were systematically related to therapy. Changes in Attention Efficiency were positively related to therapy only in proportion to the degree of cerebrovascular impairment.

A large percentage of older adults must endure at least one chronic medical illness. Clinically significant depression and anxiety are common among these patients. Specific psychotherapy approaches as well as adaptations required to address the unique issues of this population have not been delineated in the literature. We outline a cognitive-behavioral therapy approach and discuss five treatment issues we have found to be important for this population. These issues include: (1) resolving practical barriers to participation; (2) accepting depression as a separate and reversible problem; (3) limiting excess disability; (4) counteracting the loss of important social roles and autonomy; and (5) challenging the perception of being a “burden.” A case study of a chronic obstructive pulmonary disease (COPD) patient with depression is presented and recommendations for future research are suggested.

The authors present an overview of research questions related to psychopathology in elderly patients. Specific research questions in the areas of organic mental disorders, affective disorders, personality disorders, anxiety disorders, psychotic disorders, and substance abuse are presented. Clinical investigators are encouraged to pursue some of these specific questions in order to facilitate diagnosis and to develop specific effective treatment strategies for psychopathology in older patients.