Search

Background: Several authors pointed out that in the next decades dementia will affect a considerably increasing number of the elderly. The question was raised if life-expectancy was projected to conservative, resulting in revisions with higher life-expectancy and larger numbers of the oldest population. The present paper analyses the influence of such revisions on the future numbers of dementia sufferers in Austria., Subjects and Methods: For this purpose we used meta-analyses of epidemiological studies and the population projections for the period until 2050 of the Austrian Bureau of Statistics as well as of the United Nations Population Division of the year 2001 as well of the year 2005., Results: Using the extrapolations of the Austrian Bureau of Statistics of the year 1999 as well as of the United Nations Population Division of the year 2001, the number of dementia cases in Austria in the year 2050 will rise to about 233 thousands. According to the four years later performed extrapolations of the United Nations Population Division of the year 2005, dementia cases in Austria will raise to about 262 thousands in the year 2050., Conclusions: In the next decades, the number of persons suffering from dementia will rise considerably. Increasing life-expectancy will result in markedly higher numbers of persons with dementia than estimated from earlier population projections. Nevertheless, this is the first analysis of future dementia cases based on projections from two different dates, but using the same source. We must conclude that the dramatically increasing number of dementia cases requires comprehensive planning of the health and social care system.

The Austrian Alzheimer Society developed evidence-based guidelines based on a systematic literature search and criteria-guided assessment with subsequent transparent determination of grades of clinical recommendation. The authors evaluated currently available therapeutic approaches for the most common forms of dementia and focused on diagnosis and pharmacological intervention, taking into consideration the situation in Austria. The purpose of these guidelines is the rational and cost-effective use of diagnostic and therapeutic measures in dementing illnesses. Users are physicians and all other providers of care for patients with dementia in Austria.

Objective: The purpose of the present study was to assess the needs of dementia patients using the German language version of the Camberwell Assessment of Need for the Elderly (CANE) and to investigate the internal consistency of German language., Methods: A sample of 45 dementia patients was investigated using the German CANE. Data were collected from family caregivers., Results: Most dementia patients showed a multitude of problems. In most cases, support was provided more frequently from informal caregivers than from social or medical services. Internal consistency ranged between 0.797 and 0.900 (Cronbach's Alpha)., Conclusions: The high frequency of problems indicates the importance of long-term planning of services for dementia patients. The internal consistency of the German CANE was sufficiently high.

Objective: The objective of this study was to compare the prevalence of dementia using different diagnostic systems, and to investigate the influence of the different diagnostic components (memory impairment, personality changes, definition of other intellectual functions) on the prevalence., Methods: A general population sample of 1,019 elderly living in Gothenburg, Sweden was investigated by using the Comprehensive Psychopathological Rating Scale as well as specific assessments relevant for dementia diagnoses. Diagnoses were given according to the 9th and 10th version of the International Classification of Diseases (ICD-9, ICD-10) as well as the 3rd revised and 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R, DSM-IV). Further, "historical" criteria for dementia were applied as had been used in older studies., Results: DSM-IV dementia occurred most frequently (9.6%), followed by dementia according to "historical" criteria (7.4%), DSM-III-R (6.3%), ICD-10 (3.1%), and ICD-9 (1.2%). The kappa values for the agreement between the diagnostic systems were between 0.166 and 0.810. The requirement of both long-term and short-term memory impairment in DSM-III-R and personality changes in ICD-10 explained most of the differences. When these requirements were held constant, DSM-III-R, DSM-IV, ICD-10 and "historical" criteria identified predominantly the same persons as demented (kappa: 0.810-1.000)., Conclusion: Prevalence of dementia varied widely depending on diagnostic classification system used. For DSM-III-R, DSM-IV, ICD-10, and "historical" criteria, the definitions of personality changes and combinations of memory impairment lead to differing prevalence rates, whereas the definitions of other intellectual functions have little impact.

Dementia is an important public health problem as it is one of the most common diseases in the elderly and a major cause of disability and mortality. This review on dementia is restricted to European Union countries where the overwhelming majority of studies have been undertaken, and will also refer to the EURODEM publications which may be considered to be the principal European reference point in this area. In subjects aged over 65, crude prevalence rates for dementia varied between 5.9% and 9.4%. We discuss the major problems limiting the use of these estimations, limits which may differ according to the area of application, be it etiological research or care provision.

Objective: While the importance of non-cognitive symptoms of dementia is increasingly recognized there exist nearly no studies investigating the frequency of these symptoms among general hospital inpatients and nursing home residents., Method: The sample consisted of elderly persons admitted to medical hospital departments (N = 372) and nursing homes (N = 249) in Austria. Study participants were investigated by research psychiatrists using the Clinical Interview Schedule., Results: Of all patients with dementia, in medical departments 28 % and in nursing homes 38 % had marked or severe non-cognitive symptoms. Using multivariate regression procedures non-cognitive symptoms turned out to be significant predictors for nursing home referral, for a prolonged duration of hospital stay, and for impaired self-care., Conclusions: Non-cognitive symptoms of dementia occur frequently and have several negative consequences. Since such non-cognitive symptoms might be treatable, they should receive sufficient attention from the staff.

Background: Large randomized controlled trials have shown that risperidone reduces the frequency and severity of behavioral and psychological symptoms of dementia (BPSD) in patients with dementia. Since such trials are obliged to use very strict inclusion and exclusion criteria, their information about the efficacy is limited by the criteria used. Thus, the aim of the present study was to investigate the efficacy of risperidone on BPSD in a sample of patients routinely treated by their primary care physicians., Methods: A total of 938 elderly patients in Austria suffering from BPSD and routinely treated by their primary care physicians were included in this open-label prospective study. Patients received a flexible dose of risperidone, starting with 0.5 mg daily, for at least 6 weeks. Questionnaires were filled in before the start and after 6 weeks of treatment., Results: Before starting treatment with risperidone, BPSD were severe in 36.6% of the patients, moderate in 49.3%, and mild in 14.1%. The overall efficacy of risperidone was judged as "excellent" by the general practitioners and caregivers in about half the patients. The treatment was judged as "not satisfactory" in only a very small proportion (3.3% and 4.3%, respectively). According to the physicians' judgement, the tolerability of risperidone was "excellent" in 81.5% of the patients and "satisfactory" in 17.8%. The tolerability was "not satisfactory" in only 0.7% and only 7.4% of the patients reported any adverse event., Discussion: Overall, the results of this survey indicate that risperidone is both efficacious and well tolerated for the treatment of elderly primary care patients with BPSD.

Background: Since most studies concerning the frequency of non-cognitive symptoms of dementia are based on samples of psychiatric services, the results of these studies may be influenced by their selection procedure. For this reason, we investigated the frequency of non-cognitive dementia symptoms based on an epidemiological nursing home study., Methods: The sample consisted of 249 nursing home residents in Austria who were interviewed with the Clinical Interview Schedule within 2 weeks after admission (T1) and again 6 months later (T2). For the analyses of the non-cognitive symptoms among the demented, only manifest clinical abnormalities observed during the interview were included. Further, mobility and impaired self-care were assessed., Results: At admission, dementia was found in 63.9% of the sample. At T1, 38%, and at T2, 36.1% of the demented suffered from any non-cognitive symptoms. Flattened or incongruous affect, suspiciousness or aggressiveness, and anxiety were found most frequently. Multiple regression analyses showed that non-cognitive symptoms increase the risk for impaired self-care., Discussion: Despite the fact that the frequency of several non-cognitive symptoms found in our survey is lower than reported from studies based on psychiatric samples, a high proportion of the demented in nursing homes suffer from such symptoms. Non-cognitive symptoms of dementia increase the risk for an impaired self-care, which supports the assumption that they raise the costs of caring.

Several authors have pointed out that in the next few decades dementia will affect a considerably increasing number of the elderly. To our knowledge there exist no calculations of the number of demented persons for the whole European region. We made calculations on the number of dementia cases for the period 2000-2050 based on the population projections of the United Nations. For this purpose, we used the results of several meta-analyses of epidemiological studies. The number of prevalent dementia cases in the year 2000 was 7.1 million. Within the next 50 years, this number will rise to about 16.2 million dementia sufferers. The number of new dementia cases per year will increase from about 1.9 million in the year 2000 to about 4.1 million in the year 2050. Contrarily, the working-age population will considerably decrease during the next 50 years. In the year 2000, 7.1 million dementia cases faced 493 million persons in working-age. This equals a ratio of 69.4 persons in working-age per one demented person. Until the year 2050, this ratio will decrease to only 21.1. Thus, the financial and emotional burden placed by dementia on the working-age population will markedly rise.

Objective: To our knowledge, there are no studies investigating the non-cognitive symptoms of patients with dementia such as depression, agitation, or delusions among general hospital inpatients. The aim of this study was to investigate the frequency of such non-cognitive symptoms among medical inpatients and to analyze their impact on the length of hospital stay and on admission to nursing homes., Method: The sample consisted of 372 elderly inpatients admitted to four internal medical departments (i.e., not including psychiatric wards) in Austria. Patients were investigated by research psychiatrists using the Clinical Interview Schedule. For the analyses of the non-cognitive symptomatology, only marked and severe symptoms were included. To identify predictors for the length of hospital stay and for nursing home placement, multivariate regression procedures were used., Results: Of all inpatients, 27.4% met criteria for dementia according to DSM-III-R. Of those with dementia, 27.8% had marked or severe non-cognitive symptoms. A diagnosis of dementia markedly increased the risk for nursing home referral and prolonged the duration of inpatient treatment. Among the demented, both, cognitive and non-cognitive symptoms turned out to be significant predictors for nursing home placement and for prolonged duration of acute hospital stay, even when controlling for other independent variables., Conclusions: Non-cognitive symptoms occur frequently among medical inpatients with dementia and considerably increase both the duration of inpatient treatment and the risk of nursing home placement. Since such non-cognitive symptoms are treatable, they should receive attention from the hospital staff.

Because of the increasing life expectancy it is generally assumed that the number of demented individuals will steeply rise in the next decades. Dementia is a main reason for requiring extensive nursing care. Therefore, estimations of the future number of demented subjects in Austria are necessary for planning appropriate services. Since the age structure of the Austrian population has already changed during the last decades, the development of the number of demented individuals during the last five decades is compared with the estimations for the next five decades. These estimations are based on the population projections for Austria and on all available international meta-analyses of prevalence and incidence surveys. Estimations of the number of people suffering from dementia and of those developing dementia within one year are presented for the period between 1951 and 2050. In 1951, the number of dementia sufferers was 35,500; by 2050 this number will increase to 233,800. At present, 90,500 elderly people with dementia live in Austria. Thus, in the next decades, the number of people suffering from dementia will rise more steeply than the in the past. If the projected life expectancy leads to a prolonged duration of illness the number of dementia sufferers will be markedly higher. On the other hand, the working force will decrease in the next decades. Therefore, while in 1951 there were 120 employable persons per demented person, in 2050 there will be only 17 employable persons per demented person. Extensive planning of the future care of demented people is an urgent necessity.

As part of a survey conducted in six general-hospital departments of internal medicine, in the neighbouring cities of Mannheim and Ludwigshafen (total pop. 470,000), 626 patients in the age range 65 to 80 years, all admitted from private addresses, were screened by means of a standardized questionnaire (Cognitive and Affective Screening of the Elderly--'CASE'). All patients whose scores indicated possible mental abnormality, together with a proportion of those having normal scores, were then examined in greater detail, using the Clinical Psychiatric Interview. Following correction, the screening results indicated a frequency of 30.2% for clinically significant psychiatric disturbance, made up of 9.1% with organic mental disorders and 21.1% with functional mental illness only. These rates are considerably higher than could be expected on the basis of a field study of the background population. One year after hospital discharge, the numbers of deaths and of admissions to long-stay care were established for the whole sample, and in addition, individually matched sub-samples of 100 mentally ill and 100 mentally normal patients were reinvestigated. A second follow-up of the matched sub-samples was undertaken after a further interval of 5.6 years on average. The results of follow-up show that 75% of the identified cases ran a chronic or recurring course, while only a small proportion proved to be transient reactions to physical illness or hospital admission. In general, the psychiatrically ill patients had a relatively unfavourable outcome, even after the effects of age, physical disability and other relevant variables had been controlled for. When compared with the matched group of mentally normal patients, they manifested a 43% excess of mortality, and an increase of 157% in the risk for having to be admitted to long-stay care.

A total of 728 patients admitted to the medical, gynaecological and surgical departments of one urban and one rural general hospital in Austria were investigated for psychiatric morbidity. Using the Clinical Interview Schedule and its case criteria, the prevalence of psychiatric morbidity was found to be highest in medical departments (38.2%), followed by surgical departments (32.5%), and lowest in gynaecological departments (20.7%). Among medical and surgical patients, dementia and substance abuse disorders were the most frequent psychiatric categories, while in gynaecological departments neurotic disorders showed the highest frequency. For the sample as a whole, single status (i.e. unmarried, widowed or divorced), lower social class and rural catchment area of the general hospital predicted a high prevalence of psychiatric morbidity in a logistic regression analysis, while complications of childbirth, pregnancy or the puerperium, and diseases of the skin or the musculoskeletal system showed a negative association with psychiatric illness. [ABSTRACT FROM AUTHOR]

A case of a 95-year-old man suffering from dementia and additional noncognitive symptoms is reported. Sleep disturbances and restlessness were treated with several psychotropics including polycyclic antidepressants and conventional neuroleptics without success. Receiving this treatment, the patient became increasingly confused and markedly aggressive. In addition, he developed marked extrapyramidal side-effects and became severely sedated during the day. Swtiching to risperidone resulted in a reduction of many of these symptoms. Finally, receiving risperidone, all non-cognitive symptoms and all side-effects completely disappeared. Further, this case shows the importance of an adequate psychopharmacologic training for non-psychiatric physicians who often treat elderly mentally ill in nursing homes and general hospitals. (Int J Psych Clin Pract 2000; 4: 249 - 251). [ABSTRACT FROM AUTHOR]

Objectives A variety of interventions are available to supportthe caregivers of dementia patients. For the purpose of service planning, we developed aninstrument to assess the needs of dementia caregivers and whether these needsare met. Another aim was to investigate aspects of reliability and validity ofthis new instrument. Methods Thedevelopment of this instrument ('Carers’ Needs Assessment for Dementia” =CNA-D) wasbased on in-depth interviews and a focus group. The combined inter-rater and test-retest reliabilitywas investigated among 45 dementia caregivers. For analyzing concurrent validity correlations of the CNA-D with the ”ZaritBurden Inventory' were used. Content validity wasinvestigated by performing a separate survey among 40 caregivers and 40 professionals. Results The CNA-D is asemi-structured research interview including 18 problem areas. For each ofthese problem areas, the CNA-D offers several possible interventions. Therelevance of the problem areas and the interventions (contentvalidity) wasconfirmed by the majority of the study participants. Significant positiveassociations were found between the total score of the 'Zarit Burden Inventory'on the one hand, and the number of problems and the number of unmet needsaccording to the CNA-D on the other hand. The agreement between the interviewerswas 'excellent” (i.e. kappa above 0.75) in 73.7% of the problem areas and in69.9% of the interventions. Conclusions These results suggest that the CNA-D is both validand reliable. The CNA-D seems to be able to comprehensively assess the needs ofdementia caregivers [ABSTRACT FROM AUTHOR]