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Biomedical subjects

A F Jorm

Publications and source records attributed to A F Jorm.

At least 109 records · Page 6Linked to original sources
PubMed1997

Beliefs about the helpfulness of interventions for mental disorders: a comparison of general practitioners, psychiatrists and clinical psychologists.

OBJECTIVE: The aim of this study was to assess health professionals' beliefs about the helpfulness of a broad range of possible interventions for mental disorders. METHOD: The study involved a postal survey of 872 general practitioners (GPs), 1128 psychiatrists and 454 clinical psychologists. These health practitioners were presented with a vignette describing either a person with schizophrenia or one with depression. The vignettes were taken from an earlier survey of the general public. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions. RESULTS: Two-thirds or more of each profession agreed that the person with schizophrenia would be helped by GPs, psychiatrists, clinical psychologists, antipsychotic agents and admission to a psychiatric ward. Similarly, two-thirds agreed that the person with depression would be helped by GPs, psychiatrists, clinical psychologists, antidepressants, counselling and cognitive-behavioural therapy. However, there were also areas of disagreement. Psychiatrists were less likely than GPs and clinical psychologists to rate psychological and lifestyle interventions as helpful, while clinical psychologists were less likely to rate specifically medical interventions as helpful. Younger members of the professional groups and female members (who also tended to be younger) tended to rate a wider range of interventions for each disorder as likely to be helpful. CONCLUSIONS: Despite areas of broad agreement about treatment, health practitioners were more likely to endorse the interventions associated with their own profession. However, younger members of each profession tended take a broader view. If these age differences represent a cohort effect, health professionals may in the future show greater acceptance of the helpfulness of interventions offered outside their profession. These conclusions are limited by the methodology of the survey, which involved a questionnaire designed for the public rather than professionals.

Adult↗
PubMed1997

Evidence that therapy works in clinically representative conditions.

This article reports a secondary analysis of past therapy outcome meta-analysis. Fifteen meta-analysis provided effect sizes from 56 studies in previous reviews that met 1 of 3 increasingly stringent levels of criteria for clinical representativeness. The effect sizes were synthesized and compared with results from the original meta-analyses. Effect sizes from more clinically representative studies are the same size at all 3 criteria levels as in past meta-analyses. Almost no studies exist that meet the most stringent level of criteria. Results are interpreted cautiously because of controversy about what criteria best capture the notion of clinical representativeness, because so few experiments have tested therapy in clinical conditions, and because other models for exploring the generalizability of therapy outcome research to clinical conditions might yield different results.

Humans↗
PubMed1997

Methods of screening for dementia: a meta-analysis of studies comparing an informant questionnaire with a brief cognitive test.

A meta-analysis was performed on 10 studies that directly compared an informant questionnaire with a brief cognitive test at screening for dementia. The effectiveness (effect size) of the screening tests used in each study was measured using the standardized difference between the means of the demented and control samples. The informant questionnaires were found to have a weighted mean effectiveness of 1.74 [95% confidence interval (CI): 1.39-2.09], whereas for the cognitive tests, the mean was 1.48 (95% CI: 1.23-1.73). These means translate into sensitivities and specificites of 0.86 and 0.80 for informant questionnaires, compared with 0.79 and 0.80 for brief cognitive tests. The effectiveness of the informant questionnaires was found to differ significantly from study to study, but the reason for this variation is not clear. It was concluded that informant questionnaires are as effective as brief cognitive tests at screening for dementia and deserve to be used more extensively.

Aged↗
PubMed1997

Aspirin, anti-inflammatory drugs and risk of dementia.

OBJECTIVE: To test the hypothesis that aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) may prevent dementia or cognitive impairment. DESIGN: A two-wave longitudinal study over 3.6 years. SETTING: A community survey of elderly persons living in Canberra, Australia. PARTICIPANTS: There were 1045 elderly persons aged 70 at the start of the study; cognitive assessment was obtained at both waves on 588. MAIN OUTCOME MEASURES: Cognitive functioning was measured using the Mini-Mental State Examination, an episodic memory test, a test of mental speed and the National Adult Reading Test. Dementia was assessed using the Canberra Interview for the Elderly. RESULTS: On cross-sectional data, those who had been taking NSAIDs or aspirin performed no better on the cognitive tests after account had been taken of other confounding variables. There was no interaction with apolipoprotein E genotype. On longitudinal data, no difference was found between NSAID or aspirin users and controls, either in cognitive decline or incidence of dementia. CONCLUSIONS: The results do not support the hypothesis that aspirin or NSAIDs have a protective effect, but it remains possible that various sources of measurement error may have attenuated an effect of clinical significance from either type of drug. Conclusive evidence can be obtained only by a prospective trial.

Aged↗
PubMed1996

A comparison of alternative methods of screening for dementia in clinical settings.

OBJECTIVE: To compare 3 approaches to screening for dementia: cognitive testing, informant report, and neurovisual assessment in a clinical environment. SETTING: A university hospital in Geneva, Switzerland. PATIENTS: Subjects were 76 patients admitted to the Geriatric Hospital or outpatients assessed at the Memory Clinic of the Hospitals of the University of Geneva School of Medicine in Geneva, Switzerland. Thirty-three met criteria for dementia and 11 for depression based on the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. MAIN OUTCOME MEASURES: Performance in French-language versions of the Mini-Mental State Examination, the Informant Questionnaire on Cognitive Decline in the Elderly, and the Clinical Antisaccadic Eye Movement Test. RESULTS: All tests significantly discriminated cases of dementia from noncases. The receiver operator characteristic analysis demonstrated that the Mini-Mental State Examination and the Informant Questionnaire on Cognitive Decline in the Elderly were more efficient screening measures for dementia than the Antisaccadic Eye Movement Test in this setting. Unlike the Mini-Mental State Examination, the Informant Questionnaire on Cognitive Decline in the Elderly was unrelated to patients' educational attainment or premorbid intelligence. The previously reported strong relationship between the Mini-Mental State Examination and the Antisaccadic Eye Movement Test was not replicated in these patients. CONCLUSIONS: Both cognitive testing and informant report are efficient methods of screening for dementia in clinical settings. Factors such as sensorimotor disability or informant availability may dictate the viability of each approach in individual application. The performance of the Antisaccadic Eye Movement Test precludes recommending its use as a screen for dementia without further research into its performance.

Aged↗
PubMed1996

Activity levels and cognitive functioning in an elderly community sample.

The influence of self-reported and informant-reported activity levels on Crystallized Intelligence, Fluid Intelligence, Memory and the Mini-Mental State Examination was investigated in a sample of 858 community-dwelling elderly subjects. Both self-reported and informant-reported activity levels explained variance beyond that accounted for by sex, sensory functioning, activities of daily living, medical conditions, current health problems and education. Age accounted for additional variance once activity and the other contextual variables were entered. Interaction effects indicated that inactivity was associated with poorer performance on fluid intelligence in older rather than younger elderly subjects and that inactivity was predictive of poor crystallized intelligence at younger ages. Higher informant-rated activity levels moderated the effects of education, so that higher activity offset effects associated with low education on memory tasks. The mount of variance explained by activity levels was modest.

Activities of Daily Living↗
PubMed1996

Are malnutrition and stress risk factors for accelerated cognitive decline? A prisoner of war study.

We set out to test the hypothesis that severe malnutrition and stress experienced by prisoners of war (POWs) are associated with cognitive deficits later in life. We assessed 101 former Australian POWs of the Japanese and 108 veteran control subjects using a battery of neuropsychological tests, a depression scale, a clinical examination for dementia, and CT. We divided the POWs into high weight loss (>35%) and low weight loss groups (<35%). We found no significant differences in cognitive performance between the POWs and control subjects or between high and low weight loss groups on any of the tests or in the prevalence of dementia. Scores on the depression scale showed that the former POWs had more depressive symptoms than the control subjects a decade previous, but the difference had diminished over time. This study does not support the hypothesis that malnutrition is a risk factor for accelerated cognitive decline nor the theory that severe stress can lead to hippocampal neuronal loss and cognitive deficits. Cognitive deficits in earlier studies of former POWs may have been associated with concurrent depression.

Aged↗
PubMed1996

Informant ratings of cognitive decline of elderly people: relationship to longitudinal change on cognitive tests.

Formal assessment of cognitive decline with cognitive tests can be difficult, requiring either two measurement points or a comparison of 'hold' with 'don't hold' tests. Informant-based assessment provides an alternative approach because informants can adopt a longitudinal perspective and directly rate cognitive change. A study was carried out to assess the validity of informant ratings collected by means of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). A community sample of 500 subjects aged 74 or over underwent four cognitive tests on two occasions 3 1/2 years apart. On the second occasion, informants filled out the IQCODE. Subjects rated as having moderate or severe decline were found to have greater change on the cognitive tests. These findings support the validity of informant ratings of cognitive decline.

Aged↗
PubMed1995

Apolipoprotein E allele epsilon 4, dementia, and cognitive decline in a population sample.

From clinically based series it has been proposed that, in homozygotes for the apolipoprotein E epsilon 4 (apoE epsilon 4) allele, Alzheimer's disease is almost inevitable by the age of 80. A population sample of persons aged 70 years and over was interviewed in 1990-91 to ascertain the presence of dementia or cognitive impairment. The sample was reinterviewed in 1994, when the apoE genotype was also determined. Prevalence data for the 638 persons who completed the second examination revealed a linear association between having an apoE epsilon 4 allele and both dementia and cognitive impairment (for heterozygotes, odds ratio for dementia 1.89, 95% confidence interval 1.04-3.44 and for homozygotes OR 3.58, 95% CI 1.08-11.82; both adjusted for age). However, even in subjects homozygous for epsilon 4 the estimated prevalence of dementia by age 90 was only about 50%. Persons with one or two epsilon 4 alleles were more likely to have a family history of dementia than those with none. This study confirms in a population sample that the epsilon 4 allele is a risk factor for dementia, but refutes the suggestion that homozygosity for the epsilon 4 allele is sufficient for the development of Alzheimer's disease: persons with either one or two epsilon 4 alleles may reach late old age without cognitive impairment.

Aged↗
PubMed1995

Insomnia in the elderly: its prevalence and correlates in the general population.

OBJECTIVE: To estimate the prevalence of persistent insomnia and its correlates in samples of people living in the community and in institutional settings. METHODS: Respondents were interviewed in their place of residence by trained interviewers using the Canberra Interview for the Elderly, a structured psychiatric examination. RESULTS: Information about sleeping habits was obtained from 874 community and 59 institutional residents. Insomnia was persistent in 16% of the community-dwelling population and 12% of the institutional residents, with 15% and 40%, respectively, regularly taking a hypnotic. Of those without insomnia, 10% in the community but over a third in institutions were using a hypnotic. Insomnia was associated with depression, pain and poor physical health. CONCLUSIONS: Persistent insomnia in the elderly, as in other age groups, is strongly associated with depressed mood, as well as with physical disease. Because of this, insomnia should not be dismissed as a normal part of ageing, and therefore ignored as a significant symptom. Continued surveillance is needed in general practice, geriatric services and nursing homes of the routine use of hypnotics by the elderly.

Activities of Daily Living↗
PubMed1995

The epidemiology of depressive states in the elderly: implications for recognition, intervention and prevention.

The evidence is reviewed on factors that might affect the onset of new depressive symptoms (destabilization) or loss of depressive symptoms (restitution) in the elderly. These factors are grouped into three broad categories: health-related factors (physical ill health, disability, and dementia and cognitive impairment); social factors (living in a nursing home, social support, bereavement, caring for a disabled person); and personal vulnerability factors (level of depressive symptoms at previous time points, history of depression, personality). The possible implications for preventing destabilization, aiding restitution and identifying high-risk groups are considered. Many of the factors are not easily modifiable, but there is potential for intervention with the physically ill and care givers. The physically ill may also merit routine screening. As in younger age groups, the greatest and most difficult challenge is to modify personal vulnerability.

Aged↗
PubMed1995

ICD-10 mild cognitive disorder: epidemiological evidence on its validity.

Criteria for the diagnosis of ICD-10 Mild Cognitive Disorder (MCD) were applied to a sample of 897 community dwelling elderly participants. Criterion A (the presence of a physical disorder) was met by 44%, Criterion B (report of a cognitive disorder) by 17%, Criterion C (an abnormality in quantified cognitive assessments) by 60%, and Criterion D (exclusion on basis of dementia and other conditions) by 74%. A total of 36 cases (4%) met all four criteria. Correlations between Criteria A and B, and B and C were weak (r = 0.18), and the correlation between Criteria A and C was almost zero (r = 0.02). This suggests that no syndrome exists. Membership of MCD was predicted by a report that memory or intelligence interfered with daily life but not by performance on cognitive tests or by a report of physical illness. Cases of MCD had higher anxiety, depression and neuroticism scores than normal elderly, but did not differ substantially on tests of cognitive functioning. These findings call into question the validity of the ICD-10 diagnosis of MCD.

Activities of Daily Living↗
PubMed1995

The Psychogeriatric Assessment Scales: a multi-dimensional alternative to categorical diagnoses of dementia and depression in the elderly.

The Psychogeriatric Assessment Scales (PAS) provide an assessment of the clinical changes seen in dementia and depression. Principal components analysis and latent trait analysis were used to develop a set of scales to summarize these clinical changes. There are three scales derived from an interview with the subject (Cognitive Impairment, Depression, Stroke) and three from an interview with an informant (Cognitive Decline, Behaviour Change, Stroke). Results are reported on the reliability and validity of these scales using data from clinical samples in Sydney and Geneva and a population sample from Canberra. The scales were found to have excellent validity when judged against clinical diagnoses of dementia and depression and could distinguish Alzheimer's from vascular dementia. Cut-off points were developed to indicate correspondence between scale scores and clinical diagnoses. Percentile rank norms were developed from the Canberra population sample. The PAS is easy to administer and score and can be used by lay interviewers after training. It is intended for application both in research and in services for the elderly.

Activities of Daily Living↗
PubMed1995

Factors associated with the wish to die in elderly people.

This study aimed to determine the prevalence of the wish to die in elderly people and investigate the factors associated with it, in particular, whether factors other than depression contribute to the wish to die. Data were obtained from an Australian epidemiological survey of people aged 70 or more. Survey participants were asked whether, in the last two weeks, they had felt that they wanted to die and, if so, if they had had such thoughts repeatedly. Three classes of possible risk factors were investigated: sociodemographic factors (age, sex, marital status), mental health (depression, cognitive impairment), and physical health (poor self-rated health, disability, pain, sensory impairment, and living in a nursing home or hostel). Only 21 of 923 elderly persons reported repeatedly having had a wish to die during the previous two weeks. Although the wish to die was associated with depression, there were several other factors also associated with it independently of depression: not being married, poor self-rated health, disability, pain, hearing impairment, visual impairment, living in a nursing home or hostel. A small minority expressed the wish to die but had a normal mood state. It was concluded that the wish to die is associated with several factors in addition to depression and may be present in individuals with few depressive symptoms. There is a need to investigate whether factors associated with the wish to die are treatable and whether this can restore the desire to live.

Aged↗
PubMed1995

Prevalence and correlates of depression in a population of nonagenarians.

BACKGROUND: Clinicians see many more nonagenarian patients now and there is a need for epidemiological data relating to this group. The aim of the present study was to investigate the prevalence of depressive symptoms and syndromes in this age group. METHOD: The DSM-IV and the ICD-10 criteria for depression were used and correlated with physical health, disability in daily life, gender, use of drugs, social circumstances and cognitive dysfunction. Data were derived from 329 persons aged 90 and over, registered in a parish of Stockholm, who had been extensively examined by physicians and nurses. RESULTS/CONCLUSIONS: The prevalence of Major Depressive Episode as defined in DSM-IV was 7.9%; and of mild, moderate and severe Depressive Episode (combined); as defined in ICD-10 9.1%. No gender difference was found. Disability in daily life and the use of psychotropic drugs were found to correlate with depressive symptoms and syndromes.

Activities of Daily Living↗
PubMed1994

Efficacy of tacrine and lecithin in mild to moderate Alzheimer's disease: double blind trial.

OBJECTIVE: To assess the efficacy of tacrine and lecithin in treating Alzheimer's disease over nine months. DESIGN: Double blind randomised controlled trial. SETTING: Outpatients clinic of university department of geriatric medicine. SUBJECTS: 53 subjects (26 women, 27 men) with probable Alzheimer's disease. 41 completed the dose finding phase and were randomised to treatment. 32 (14 tacrine, 18 placebo) completed nine months' treatment. INTERVENTIONS: Lecithin and tacrine or lecithin and placebo for 36 weeks. MAIN OUTCOME MEASURES: Scores on neuropsychological tests sensitive to deficits in the cholinergic system; mini-mental state score; behaviour change; mood; functional state; and stress in carers. RESULTS: The tacrine and placebo groups were similar except that the tacrine group had a longer duration of disease (mean 5.4 v 2.5 years in placebo group; P = 0.003). Only 17 of the 32 patients could tolerate the maximum dose of tacrine (100 mg). No significant difference was found between the groups for any of the tests after nine months' treatment except for the digit backwards test, which is insensitive to cholinergic deficit. Analysis of subjects taking the maximum dose of tacrine and of subjects with mild dementia also found no differences. CONCLUSIONS: Tacrine produces no clinically relevant improvement over 36 weeks at the doses tolerated by these patients.

Activities of Daily Living↗