Professional knowledge about Alzheimer's disease (AD) is essential in order to provide appropriate care for those suffering from this progressive and fatal condition. The optimizing of service provision to these patients and their families should also involve mental health professionals including clinical psychologists. In the present study, members of the Norwegian Psychological Association working in clinical practice were invited to participate in a web-based survey measuring knowledge about AD and related disorders. Questions regarding age, gender, accreditation as clinical specialist, age group of typical patients, and experience with patients suffering from dementia were asked in addition to the administration of the Alzheimer's Disease Knowledge Scale (ADKS). ADKS consists of 30 true/false items covering risk factors, assessment and diagnosis, symptoms, course, life impact, care giving, and treatment and management. A total of 956 clinical psychologists participated, yielding a response rate of 50.9%. The average mean performance score on the ADKS was 24.10 (SD = 2.5, range 15-30). Kuder-Richardson coefficient of reliability on the ADKS was 0.98. Multiple regression analysis showed that being indirectly exposed to dementia in older family members through their own patients, together with a self-reported knowledge of one's performance on the ADKS, significantly explained high scores on the ADKS. With reservations based on study limitations, it is concluded that the knowledge of AD in Norwegian clinical psychologists is fairly good. An obvious challenge is how to strengthen this knowledge both in our professional training programs in psychology as well as among those working in applied clinical settings.
To explore whether prevalence, survival, and incidence of dementia have changed from 1987-1994 to 2001-2008 in Stockholm, Sweden.
This study is based on 2 cross-sectional surveys of people aged 75 years or over conducted in central Stockholm: the Kungsholmen Project (KP) (1987-1989, n = 1,700) and the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) (2001-2004, n = 1,575). In both surveys we diagnosed dementia according to DSM-III-R criteria, following the identical diagnostic procedure. Death certificates were used to determine survival status of KP participants as of December 1994 and SNAC-K participants as of June 2008. We used logistic and Cox models to compare prevalence and survival, controlling for major confounders. We inferred incidence of dementia according to its relationship with prevalence and survival.
At baseline, 225 subjects in KP and 298 in SNAC-K were diagnosed with dementia. The age- and sex-standardized prevalence of dementia was 17.5% (12.8% in men; 19.2% in women) in KP and 17.9% (10.8% in men; 20.5% in women) in SNAC-K. The adjusted odds ratio of dementia in SNAC-K vs KP was 1.17 (95% confidence interval 0.95-1.46). The multiadjusted hazard ratio of death in SNAC-K vs KP was 0.71 (0.57-0.88) in subjects with dementia, 0.68 (0.59-0.79) in those without dementia, and 0.66 (0.59-0.74) in all participants.
Prevalence of dementia was stable from the late 1980s to the early 2000s in central Stockholm, Sweden, whereas survival of patients with dementia increased. These results suggest that incidence of dementia may have decreased during this period.
Comment In: Neurology. 2013 May 14;80(20):1824-523596078
A community survey and subsequent clinical assessment of 192 Cree aged 65 years and over registered in two Reserves in Northern Manitoba identified only one case of probable Alzheimer's disease among eight cases of dementia, giving a prevalence of 0.5% for Alzheimer's disease and 4.2% for all dementias. This contrasted with an age-adjusted prevalence of 3.5% for Alzheimer's disease and 4.2% for all dementias in an age-stratified sample of 241 English-speaking residents of Winnipeg. Although it was not so for all dementias, the difference between the groups for prevalence of Alzheimer's disease was highly significant (p
The incidences of senile dementia of Alzheimer type (SDAT) and multi-infarction dementia (MID) were studied in a total Swedish population, the Lundby project. The study is prospective and covers a 25-year period. The incidence rates per year of contracting SDAT or MID and the probability in each 10-year age interval of contracting dementia in the elderly were calculated, as well as the cumulative risk up to a certain age. The lifetime risk of contracting SDAT was for men 25.5% and for women 31.9%. The corresponding figures for MID were 29.8 and 25.1%.
Cross-sectional and longitudinal analyses were used to compare age-related changes in adaptive functioning in institutionalized adults with and without Down syndrome. Cross-sectional analysis showed significant differences related to level of functioning but not to age or etiology of disability. Longitudinal analysis showed a pattern of decline in self-help and communication skills in several individuals with Down syndrome older than 40. The case of an adult with Down syndrome with confirmed Alzheimer pathology at postmortem was presented. Results were discussed in relation to aging and the likelihood of Alzheimer-like changes in individuals with Down syndrome.
In spite of the great impact of senile dementia of the Alzheimer type (SDAT) on society, far too little is known about its epidemiology. In this study of a total, normal population from a geographically delimited area in Sweden, Lundby, 2612 persons were examined in 1957 by one psychiatrist (Hagnell). In 1972 the same population was reexamined irrespective of domicile. The incidence and risk of contracting SDAT during the 15 years were calculated. No cases of SDAT were diagnosed before the age of 60 years. The lifetime risk was for men 25.7% and for women 26.2%. When only the very severely impaired were taken into account, the figures were 14.5% in men and 14.6% in women.
OBJECTIVE: To examine preclinical depressive symptoms 3 years before the diagnosis of AD. METHODS: The authors compared incident AD patients and nondemented individuals in terms of baseline mood- and motivation-related symptoms of depression, and assessed whether depressive symptoms in preclinical AD are related to self-perceived memory problems. Participants came from a population-based longitudinal study on aging and dementia in Stockholm, Sweden. The sample consisted of 222 persons older than 74 years who were followed for a 3-year interval. Thirty-four individuals had developed AD at follow-up, whereas 188 remained nondemented. Dementia diagnosis was made according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised. Depressive symptoms were assessed by the Comprehensive Psychopathological Rating Scale. RESULTS: The incident AD patients had more depressive symptoms than the nondemented persons at baseline. There was a dominance of motivation-related symptoms of depression (e.g., lack of interest, loss of energy, concentration difficulties) in preclinical AD. This association remained when adjusting for subjective memory complaints. CONCLUSIONS: Depressive symptoms are elevated preclinically in AD, and this elevation is not merely a by-product of self-perceived cognitive difficulties. Thus, depressive symptoms may be part of the preclinical phase in AD.
The Kungsholmen Project is a study on elderly people living in a parish of Stockholm, Sweden. The study uses a longitudinal approach with the principal purpose of determining the natural history of Alzheimer's disease and other dementias. The study population consists of all 2,368 inhabitants of the Kungsholmen area in Stockholm, aged 75 years and above in October, 1987. The study design consists of three phases. Phase I consists of a screening test used in order to identify the 'possible' dementia cases; phase II is a complete clinical examination carried out in order to reach a final diagnosis of dementia; in phase III the whole population is reexamined in order to ascertain new cases of dementia. DSM-IIIR criteria for dementia and different types of dementia are used. The final diagnosis is based on a consensus using two preliminary diagnoses, made separately by different physicians.
BACKGROUND: Studies in mixed-aged populations show differences between the predictors of a relapse and those of a long-term course of depression, supporting the hypothesis about similar differences among the aged. AIM: The aim was to identify the factors predicting or related to a relapse of depression among the Finnish elderly having recovered from depression during treatment. MATERIAL AND METHODS: The population consisted of 70 depressed (DSM-III criteria) elderly (60 yr-) Finns having recovered from depression during treatment as determined 15 months after baseline. By the 4-year follow-up after the recovery, 20 patients had relapsed and 50 persons were non-depressed. RESULTS: The logistic regression model showed major depression and psychomotor retardation to be independent predictors. Relapses were not related to stressors in life or physical illnesses occurring during the follow-up. CONCLUSIONS: Major depressive elderly patients have a high risk for relapses without the occurrence of the stressors or physical illnesses. In clinical practice, major depressive elderly patients should be followed up in order to detect and treat potential relapses as early as possible. Cooperation between psychiatrists and general practitioners is needed in the follow-up. Theoretically, the results suggest the assumption of a biochemical aetiology of major depression.
Neuropsychiatric symptoms (NPS), such as depression, apathy, agitation, and psychotic symptoms are common in mild cognitive impairment (MCI) and dementia in Alzheimer's disease (AD). Subgroups of NPS have been reported. Yet the relationship of NPS and their subgroups to different stages of cognitive impairment is unclear. Most previous studies are based on small sample sizes and show conflicting results. We sought to examine the frequency of NPS and their subgroups in MCI and different stages of dementia in AD.
This was a cross-sectional study using data from a Norwegian national registry of memory clinics. From a total sample of 4,571 patients, we included those with MCI or AD (MCI 817, mild AD 883, moderate-severe AD 441). To compare variables across groups ANOVA or ? 2-test was applied. We used factor analysis of Neuropsychiatric Inventory Questionnaire (NPI-Q) items to identify subgroups of NPS.
The frequency of any NPS was 87.2% (AD 91.2%, MCI 79.5%; p