Adverse effects of medical and psychiatric workup in six demented geriatric patients

Observed behaviors of patients with probable Alzheimer's disease who are hospitalized for diagnostic tests

This study examines observed behaviors of hospitalized patients with probable Alzheimer's disease (AD) undergoing invasive diagnostic procedures. Data was obtained from nursing documentation in the medical records of 30 patients, 10 in each stage of AD (i.e., mild, moderate, severe). In general, analysis of the data revealed that changes in behavior occurred immediately prior to, during, and following these procedures. Specifically, the moderately impaired patients showed the most significant curve over the 5-day observation period, while patients in the mildly impaired group showed a high peak of behavioral change on the test day. The severely impaired group of patients had a higher sustained level of activity throughout the 5-day period. Routine assessment of the patients' usual behaviors, care-givers' knowledge of the stage of disease, and awareness of the potential impact that diagnostics may have on cognitively impaired patients could help care providers decide what interventions most likely would lead to successful outcomes.

Assessing dementia. Part I: Difficulties, definitions and differential diagnosis

Despite the pressures of an increasingly ageing population and an ever increasing scientific knowledge, the clinical characteristics of dementia remain poorly defined. This relative lack of clarity in clinical understanding has led to diverse diagnostic problems, including those of mistaken diagnosis as well as over- and under-diagnosis in different settings. This paper focuses on the syndromal and aetiological diagnosis of dementia by outlining current clinical definitions, considering differential diagnosis in detail and reviewing characteristics of common dementing disorders. The past emphasis on a search for treatable causes, the reliance on laboratory investigations and the concept of subcortical dementia are all questioned. Aspects of evaluation that are stressed include the value of brief objective cognitive testing, a knowledge of normal age-related cognitive changes, flexible criteria for Alzheimer's disease and a comprehensive individualised evaluation of the person. Broader assessment issues will be dealt with in a second paper.

Reversible intellectual impairment: an internist's perspective

A review of the relevant literature was stimulated by recent publications urging extensive laboratory assessment of elderly patients presenting with intellectual impairment. Published data regarding reversible causes of impairment are limited and exist only for hospitalized patients, with rare exceptions. The frequencies of azotemia, hyponatremia, volume depletion, hypoglycemia, cardiac arrhythmia, cerebrovascular disease, sensory impairment, hypercarbia, congestive heart failure, infections, subdural hematoma, and chemical intoxications as causes of the intellectual impairment are entirely unknown. It is reported that 8 per cent of patients hospitalized for dementia are depressed; alcoholism is causative in 8 to 13 per cent of patients with mental impairment; normal pressure hydrocephalus is reported in 7 to 12 per cent. The frequency of the latter conditions in outpatients is not known. While estimates exist for the frequencies of hypothyroidism, hyperparathyroidism, neurosyphilis, and vitamin B12 and folate deficiencies among the elderly, no prevalence data exist for these disorders among the intellectually impaired.