Objective: Aging societies will bring an increase in the number of long-term care patients with mental-physical multimorbidity (MPM). This paper aimed to describe the natural course of ...neuropsychiatric symptoms (NPS) in patients with MPM in the first 8 months after admission to a geronto-psychiatric nursing home (GP-NH) unit.
Methods: Longitudinal cohort study among 63 patients with MPM no dementia living in 17 GP-NH units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, and brief neuropsychological testing, among which our primary outcome measure the Neuropsychiatric Inventory (NPI). Descriptive and bivariate analyses were conducted.
Results: Our study showed a significant increase of the NPI total score (from 25.3 to 29.3, p = 0.045), and the total scores of a NPI hyperactivity cluster (from 9.7 to 11.8, p = 0.039), and a NPI mood/apathy cluster (from 7.7 to 10.1, p = 0.008). Just over 95% had any clinically relevant symptom at baseline and/or six months later, of which irritability was the most prevalent and persistent symptom and the symptom with the highest incidence. Hyperactivity was the most prevalent and persistent symptom cluster. Also, depression had a high persistence.
Conclusions: Our results indicate the omnipresence of NPS of which most were found to be persistent. Therefore, we recommend to explore opportunities to reduce NPS in NH patients with MPM, such as creating a therapeutic milieu, educating the staff, and evaluating patient's psychotropic drug use.
Spontaneous cerebral emboli (SCE) are frequent in Alzheimer's disease (AD) and vascular dementia (VaD). We investigated the effect of SCE on the rates of cognitive and functional decline in AD and ...VaD. Methods One hundred thirty-two patients with dementia (74 AD, National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association NINCDS/ADRDA criteria; 58 VaD, National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences NINDS/AIREN criteria) underwent 1-hour transcranial Doppler for detection of SCE (mean SD age 75.5 (7.4) years; 46% female). Neuropsychological tests (Mini-Mental State Examination MMSE, Alzheimer's Disease Assessment Scale-Cognitive subscale ADAS-Cog, and Neuropsychiatric Inventory NPI) and assessment of activities of daily living (Interview for Deterioration in Daily Living Activities in Dementia IDDD) were performed initially and 6 months later. SCE positive (SCE+ve, n = 47) and SCE negative (SCE-ve, n = 85) patients were compared using repeated measures analyses of variance (ANOVAs) adjusted for age, gender, and cardiovascular risk factors. Results SCE+ve patients with dementia, both AD and VaD, suffered a more rapid decline in cognitive functioning over 6 months (ADAS-cog, mean increase 7.1 for SCE+ve compared with 3.3 for SCE-ve, p = .006) and activities of daily living (IDDD, mean increase 24.4 for SCE+ve compared with 10.8 for SCE-ve, p = .014). Conclusions Asymptomatic SCE are associated with an accelerated cognitive and functional decline in dementia. SCE may be a potentially treatable cause of disease progression in dementia.
Previous research suggests that depression is a risk factor for stroke. However, the reliability of much research is limited by the lack of documentation on the presence of preexistent cardiovascular ...disease and by the use of limited measures of depression or stroke.
To test the hypotheses that (1) clinically relevant depressive symptoms are an independent risk factor of incident stroke in cardiac and noncardiac patients and (2) more chronic and severe depressive symptoms are associated with incident stroke.
A cohort of elderly Dutch people (aged > or = 55 years) was followed up for 9 years in the Longitudinal Aging Study Amsterdam (baseline measurements were taken in 1992 or 1993, and the study concluded in 2001 or 2002, respectively).
General community.
Randomly selected population-based sample (N = 2965) without a history of stroke.
The study end point was a first stroke (nonfatal or fatal). Depression was measured using the National Institute of Mental Health Diagnostic Interview Schedule and the Center for Epidemiological Studies-Depression Scale. Multivariate Cox proportional hazards regression analyses of stroke incidence were performed. The association of the chronicity and severity of depressive symptoms was studied in extended models with time-dependent variables.
The sample's mean (SD) age was 70.5 (8.7) years, 52.1% were women, and the mean (SD) follow-up was 7.7 (3.1) years. Inclusion of an interaction between cardiac disease and clinically relevant depressive symptoms improved the model for stroke (P = .03). In participants with preexistent cardiac disease, but not in participants without cardiac disease, clinically relevant depressive symptoms at baseline (hazard ratio HR, 2.18; 95% confidence interval CI, 1.17-4.09) and the severity (range, 0-60; HR, 1.08; 95% CI, 1.02-1.13) and chronicity (HR, 3.51; 95% CI, 1.13-10.93) of symptoms during follow-up were associated with stroke.
Preexistent cardiac disease moderates the association between depressive symptoms and incident stroke. In cardiac patients, baseline depressive symptoms and both the severity and chronicity of symptoms during follow-up are associated with incident stroke.
Background Self-rated general health has been associated with worse outcome after a myocardial infarction (MI). Previously, however, concurrent depression or anxiety were not taken into account. ...Objective To evaluate the impact of physical health-complaints post-MI on cardiac prognosis adjusting for cardiac disease severity, depression and anxiety. Methods The somatic subscale of the Health Complaints Scale (HCS) was administered to 424 MI-patients at 3 and 12 months post-MI. Types and trajectories of health-complaints were identified with latent-transition-analysis (LTA). The prognostic impact of HCS-sum-score at 3 months, and of types and trajectories of health-complaints on combined endpoints (new cardiac events and mortality) was evaluated with Cox-regression. Adjustments were made for age, sex, education-level, living alone, history of MI, left ventricular ejection fraction, depressive symptoms and generalized anxiety disorder. Results 189 (44.9%) MI-patients had a cardiac event or died during a mean follow-up of 5.7 (3.1) years. In the fully adjusted model HCS-sum-score predicted outcome (HR=1.02 95%CI: 1.00-1.05). LTA distinguished 5 groups at 3 and 12 months characterized by 1) no/minimal complaints, 2) cardiac complaints, 3) lack of energy, 4) sleep-problems, and 5) mixed health-complaints, resulting in 25 transition-classes. Patients with cardiac and energy complaints at 3 months (HRcardiac =1.55 1.15-2.10; HRenergy =1.351.00-1.81)) and those with new or persistent cardiac, energy and mixed complaints over time had a worse prognosis (HRcardiac =1.55 1.11- 2.16, HRmixed =1.71 1.19- 2.47, HRenergy =1.51 1.09-2.08). Conclusions Physical health-complaints are predictors of cardiac outcome independent from cardiac disease, depression and anxiety. Type and trajectories of health-complaints may have additional prognostic significance.
Although a clear definition of pseudologia fantastica cannot be found in the literature, there is consensus that this condition differs quantitatively and qualitatively from 'normal lying'. We ...discuss recognition of pseudologia fantastica based on 2 patients who presented with suicidal ideations at the casualty department following a traumatic event. Early recognition is important in order to break the pattern of lying, to restrict the use of medical resources and, finally, to act in accordance with the general principle of 'primum-non-nocere'. Although a psychiatric diagnostic workup might be worthwhile, it remains difficult to engage these patients for psychiatric treatment.
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