Biomedical subjects

A F Jorm

Publications and source records attributed to A F Jorm.

At least 127 records · Page 7Linked to original sources

PubMed1994

Interaction between genetic and environmental risk factors for Alzheimer's disease: a reanalysis of case-control studies.

To study the interaction among genetic and environmental risk factors, a reanalysis of case-control studies of Alzheimer's disease (AD) was conducted based on the original data of all studies carried out to January 1, 1990. Seven studies were included in the present analysis, comprising a total of 814 AD patients and 894 control subjects. When comparing those with a positive and negative family history of dementia, similar odds ratio were found for late maternal age [1.7; 95% confidence interval (0.6-4.8) vs. 2.0 (1.1-3.5)], head trauma [1.7 (0.7-4.2) vs. 1.9 (1.1-3.2)], and history of depression [2.0 (0.2-19.8) vs. 2.1 (0.8-1.7)]. This suggests a model in which these risk factors increase the risk for AD independent of family history of dementia. Among those with a positive family history of dementia, the odds ratios for family history of Down's syndrome [4.2 (0.9-20.0)] and of Parkinson's disease [3.3 (0.4-28.2)] tended to be higher than among those with a negative family history of dementia [2.6 (0.8-8.5) and 2.4 (0.8-7.0), respectively]. However, for both disorders the difference in odds ratio was not statistically significant. For history of cigarette smoking, there was no association to AD for those with no first degree relatives with dementia and an inverse relation with AD for those with a positive family history. Although in all analyses, family history of dementia remained significantly associated with AD in the absence of other factors, the odds ratio associated with family history of dementia tended to be lower for those with a positive smoking history, particularly for those with two or more affected relatives. These findings suggest that smoking may interact specifically with a genetically determined process.

Aged↗

PubMed1994

A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation.

Data from four studies were used to assess the psychometric properties of the 26 IQCODE items. The items were assessed in terms of item-total correlations, test-retest reliabilities, correlations with indicators of current cognitive functioning and correlations with indicators of premorbid cognitive functioning. These data were used to develop a 16-item short form. The short form was cross-validated in a new sample using dementia/delirium diagnosis as the validity standard. It was found to perform as well as the long form.

Aged↗

PubMed1994

Do mental health surveys disturb? Further evidence.

In a community survey of 873 persons aged 70 years or over, focusing on dementia, cognitive decline, depression, and current life circumstances, we included an enquiry into the emotional impact of the interview. A large majority reported at the end of the interview that it had no adverse effect on their emotional state. About 4% reported that it made them distressed, 1% that it depressed them, and 2% that it had intruded on their privacy. By contrast, 52% said it had made them feel good about themselves. Distress seemed to be largely related to performing poorly on cognitive tests. There is no information on the duration of these effects in the period following the interview. It is recommended that respondents in community surveys, including the elderly, be informed that they can decline to answer any question, and that interviewers be trained in how to respond to the few who will be distressed by the experience.

Aged↗

PubMed1994

Complaints of cognitive decline in the elderly: a comparison of reports by subjects and informants in a community survey.

In a community survey, subjects and their informants were asked the same questions about memory and intellectual decline in the subjects. Subjects and informants both commonly reported cognitive decline, although in most cases the decline was not seen as interfering with daily life. However, when responses from subjects and informants were cross-tabulated, agreement was found to be poor. For subjects, reports of cognitive decline were correlated with anxiety and depression symptoms and with trait neuroticism. Subjects' reports were uncorrelated with age and only weakly correlated with cognitive test performance, indicating little validity. By contrast, informants' reports were correlated with the subjects' cognitive test performance and age, but also with the informants' own anxiety and depression symptoms. Although informants' reports have validity, they may also be contaminated by the informants' affective state.

Aged↗

PubMed1994

A survey of dementia in the Canberra population: experience with ICD-10 and DSM-III-R criteria.

A community survey of 1045 persons aged 70 years and over was conducted to identify cases of dementia in the cities of Canberra and Queanbeyan. Cases were identified using the Canberra Interview for the Elderly, administered by lay interviewers. When diagnostic criteria were rigidly applied, the point prevalence of dementia in the combined sample of community and institutional residents was considerably lower by ICD-10 than by DSM-III-R. Both criteria showed a similar rise in prevalence with age, and no gender difference. Agreement between the two systems had a kappa of only 0.48. 'Probable' cases by either criteria were identified solely from respondent-provided information in order to include persons for whom no informant was available. The point prevalence of such 'probable' cases was more similar for the two systems, and the kappa coefficient of agreement rose to 0.80. Analysis of the various components required for a diagnosis of dementia showed that the prevalence of all increased with age. Components involving cognitive assessment were correlated with education, but other components were not. The results of the study point to important differences between ICD-10 and DSM-III-R diagnoses of dementia.

Aged↗

PubMed1994

A latent trait analysis of an inventory designed to detect symptoms of anxiety and depression using an elderly community sample.

An 18-item inventory designed by Goldberg et al. (1987) to detect symptoms of anxiety and depression was administered to an elderly general population sample. Latent trait analysis was used to assess the dimensionality of the inventory and the location and discriminatory ability of the symptoms. The items showed different patterns of discrimination in this group compared to the sample of general practice attenders on which the inventory was developed. Overall, the items did define two correlated dimensions of anxiety and depression. In addition, a third dimension of sleep disturbance was detected. Both individual scales and the total symptom scores were sensitive and relatively specific detectors of depressive disorders assessed according to ICD-10 and DSM-III-R criteria. The retention of sleep items on their original scales did not affect the sensitivity of the scales to detect depressive disorders. A two-step administration procedure suggested for use in the administration of the scales was investigated but found to be sensitive to differences between the current sample and the sample on which the inventory was developed. This symptom inventory can be recommended for use in epidemiological investigations as a brief, valid and acceptable method of detecting elevated levels of anxiety and depression in elderly persons.

Aged↗

PubMed1994

Age differences and interindividual variation in cognition in community-dwelling elderly.

The cognitive test performance of 897 community-dwelling elderly Ss, aged 70 years and over, was examined for age trends and interindividual variation. Data were subjected to factor analysis, and 3 factors emerged (Crystallized Intelligence, Fluid Intelligence, and Memory). Over the age span sampled, Crystallized Intelligence, Fluid Intelligence, and Memory all decreased with the decrease being greatest for Fluid Intelligence and least for Crystallized Intelligence. Interindividual variation increased for Fluid Intelligence and Memory, but not for Crystallized Intelligence. These findings give support to the view that crystallized intelligence is lower in the very old and that there is a greater degree of variability in test performance with advancing age.

Activities of Daily Living↗

PubMed1994

The relationship between health and cognitive functioning in a sample of elderly people in the community.

The association between health status and cognitive performance was examined in a sample of 708 community dwelling elderly people aged 70 years or over. Cognitive performance declined significantly across the age groups 70-74, 75-79, 80-84, and 85-89 years on the Mini-Mental State Examination and on measures of fluid intelligence and memory, but not on measures of crystallized intelligence. Health status declined significantly across age for five of 49 past and current medical conditions, for measures of Activities of Daily Living (ADL) and for systolic blood pressure, but did not decline significantly for global self-ratings of health, diastolic blood pressure or reports of smoking. Weak but significant correlations between health and cognitive performance were found for self-reported global ratings of health and for self-reports of some physical symptoms but not for diastolic or systolic blood pressure, or for many other physical conditions. Both self- and informant-based ratings of ADL correlated with cognitive performance. Age differences remained after cognitive performance was adjusted for health variables such as ADL, self-ratings of health and current health problems. It is concluded that, at the population level, lower levels of cognitive performance in community-dwelling elderly subjects are not strongly mediated by ill health.

Activities of Daily Living↗

PubMed1994

Association of age, sex, cognitive dysfunction, and disability with major depressive symptoms in an elderly sample.

OBJECTIVE: Previous studies have yielded conflicting results regarding the association of age, sex, and cognitive deficit with depression in the elderly. However, there is agreement about a relationship between depressive symptoms and disability. The authors previously conducted a factor analysis of the symptoms of major depression in elderly subjects and found that the symptoms clustered into factors of mood disturbance and motivation disturbance. The aim of the present study was to replicate these findings in a larger population sample and relate some of the variables possibly associated with depression to these two factors. METHOD: A population sample of 1,304 persons aged 75 years or older registered in a parish of Stockholm were examined by physicians to determine DSM-III-R depressive symptoms and disability in activities of daily living. The Mini-Mental State examination was also performed. RESULTS: Factor analysis showed factors of mood and motivation symptoms, and these were related differently to the associated variables. When the other associated variables were controlled for, age was unrelated to both types of symptoms. Women had more mood disturbance, but men had slightly more motivation disturbance. As cognitive function declined, mood disturbance first increased, then decreased. Motivation symptoms increased sharply with decreasing cognitive function. A relationship was found between increasing disability and both the mood and motivation symptoms. CONCLUSIONS: In the elderly, symptoms of depression involve either mood or motivation disturbance and the two types of symptoms are associated with different variables.

Activities of Daily Living↗

PubMed1993

The disabled elderly living in the community: care received from family and formal services.

OBJECTIVES: Based on a community sample, to assess the reasons disabled elderly people need care, the type of formal services they receive, the characteristics of their carers and the degree of psychological morbidity in these carers. DESIGN AND SETTING: A community survey of people aged 70 or more years living in Canberra or Queanbeyan. Survey participants were asked to nominate informants, who were interviewed about the subjects' state of health. The informants provided information on need for care, services received and the role of carers. Informants also reported on their own health, including symptoms of anxiety and depression. RESULTS: Elderly people needed care because of physical disability more often than behavioural disability. Those with physical disability received more formal services and more help from health professionals than those with behavioural disability. Contact with general practitioners was high for both disabled and non-disabled subjects. Carers of the physically disabled had raised levels of anxiety and symptoms of depression, and poorer self-rated health, but carers of the behaviourally disabled did not. Wives, daughters and husbands made up the biggest categories of carers and around two-thirds of carers were women. CONCLUSION: Family carers play an important role in maintaining disabled elderly people in the community and this role is often stressful. Formal services have to be aimed as much at the needs of the carers as at the disabled people themselves.

Activities of Daily Living↗

PubMed1993

Differential diagnosis in dementia. Principal components analysis of clinical data from a population survey.

OBJECTIVE: To reduce all the clinical data, collected from an unselected group of subjects, to a small set of factors and to see how these factors correspond to standard clinical diagnosis of dementing disorders. DESIGN: Population survey. SETTING: General community: elderly older than 74 years, from an area in Stockholm, Sweden. SUBJECTS: Population-based sample including (1) all the screened positive subjects using the Mini-Mental State examination; and (2) a random sample of the screened negative subjects, matched by age and sex. A clinical examination and an informant interview were carried out. Cases were identified using Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition diagnostic criteria for Alzheimer's disease (AD) and other dementias. MAIN OUTCOME MEASURE: Independently from the clinical diagnosis, a principal components factor analysis was carried out to investigate groupings among the clinical data (factors). Factor scores, calculated as a weighted sum of the symptom variables and converted to a standard score form. RESULTS: Four major factors were found: cognitive impairment, cerebrovascular disease, disturbed behavior, and depressive symptoms. The comparison of these factors with the clinical diagnoses showed that (1) the cognitive impairment factor discriminated demented cases from nondemented; (2) the cerebrovascular disease factor discriminated vascular dementia from AD cases and nondemented; (3) the disturbed behavior factor discriminated AD cases from vascular dementia cases and nondemented, indicating behavioral changes characteristic of AD. CONCLUSIONS: This finding, if replicated, would have implications for the construction of diagnostic criteria for AD.

Aged↗

PubMed1993

Predicting dementia from the Mini-Mental State Examination in an elderly population: the role of education.

Our study aimed to assess whether education affects the positive predictive value of the MMSE when it is used as a screening test for dementia. The MMSE has been consistently found to correlate with education and, at the same time, education is regarded by some researchers as being of potential etiological significance for dementia. In the present study, results on the MMSE from a community-based study in Sweden were compared with two standards: the clinical diagnosis of dementia and the Katz index of daily living activities. For both these comparisons, education did not substantially change the predictive ability of the MMSE. Our data, when compared with previous studies, show that the influence of education on the predictive ability of the MMSE varies in different populations. We conclude that differential MMSE cut-off points for different educational levels or adjustment techniques for education are not universally applicable.

Aged↗

PubMed1993

The prevalence of depressive disorders and the distribution of depressive symptoms in later life: a survey using Draft ICD-10 and DSM-III-R.

The point prevalence of depressive disorders was estimated in a sample of persons aged 70 years and over, which included both those living in the community and those in institutional settings. Lay interviewers administered the Canberra Interview for the Elderly to the subjects and their informants. The point prevalence of depressive episodes as defined by the Draft ICD-10 diagnostic criteria was 3.3%. The rate for DSM-III-R major depressive disorder was 1.0%. The latter prevalence rate is similar to those reported elsewhere for the elderly. Evidence is accumulating that older persons may indeed have low rates for depressive disorders at the formal case level. Possible reasons for this finding are offered. A scale for depressive symptoms, based exclusively on those specified in Draft ICD-10 and DSM-III-R, showed that the elderly do experience many depressive symptoms. Contrary to expectation, these did not increase with age. The number of depressive symptoms was correlated with neuroticism, poor physical health, disability and a history of previous depression. Attention now needs to be directed to the clinical significance of depressive symptoms below the case level in elderly persons.

Age of Onset↗

PubMed1993

Assessing the risk of Alzheimer's disease in first-degree relatives of Alzheimer's disease cases.

Family history of Alzheimer's disease (AD) was investigated using a telephone reinterview of 99 cases and 116 controls selected from a case-control study of 170 matched pairs. It was found that the family history method used in the initial interview was satisfactory in identifying first-degree relatives and assessing their ages of birth and death, but the number of first-degree relatives suffering from AD was probably under-estimated. Family history of AD was confirmed as a risk factor for AD. Higher estimates of cumulative incidence were obtained among case relatives than among control relatives. No evidence was found to support the hypothesis that a familial form of AD is more common in those with earlier onset AD (before age 75) in those who display early, prominent features of aphasia or apraxia, or that an AD gene may be sex-linked. The curves for cumulative incidence showed no tendency to reach an asymptote, as is implied by the theory that some forms of AD are due to the action of an autosomal dominant gene. Estimates of lifetime risk by age 90 were within the range found by other investigators. Much larger samples of the very old are needed to obtain estimates of total lifetime risk with smaller standard errors.

Age of Onset↗

PubMed1993

Memory complaints of elderly people in a population survey: variation according to dementia stage and depression.

OBJECTIVE: To study the relationship between subjective memory complaints, cognitive functioning, and clinical diagnosis of dementia. DESIGN: Cross-sectional, total-population survey. MEASUREMENTS: A two-phase study was done. All 2368 were screened by Mini-Mental State Examination (MMSE). Then the 314 who screened positive and a sample of 354 who screened negative were examined clinically (by examining the subject and interviewing an informant) for DMS-III-R criteria for dementia, Clinical Dementia Rating (CDR) scale for severity of dementia and the presence of memory complaints or depressed mood. SETTING: An area in Stockholm, Sweden. PARTICIPANTS: All inhabitants of the area (2368) born in 1912 or before, living at home or in institutions. RESULTS: A greater percentage of informants reported marked memory impairment than did the subjects themselves. Neither the informants' nor the subject' reports differed according to the type of dementia, but they differed clearly according to the stage of dementia. Informants reported memory impairment more frequently as dementia severity increased, while the subjects' complaints of marked memory impairment were most common in mild-moderate dementia. Furthermore, non-demented subjects with marked complaints performed more poorly on the MMSE. Subjects with depressed mood were also more likely to complain about their memory, both in the demented and non-demented groups. CONCLUSION: Our data show the validity of the informants' reports about the subjects' memory deficits. Moreover, the study confirmed the clinical impression that the patient's own complaints should not be ignored, as subjects in the mild stage of dementia often have some insight into their own memory deficit. However, depressed individuals may underestimate their own memory, and individuals with moderate-severe dementia may overestimate theirs.

Aged↗

PubMed1993

The Canberra Interview for the Elderly: assessment of its validity in the diagnosis of dementia and depression.

The Canberra Interview for the Elderly (CIE) has been developed as a field instrument for identifying cases of dementia and depression, according to the diagnostic criteria in both draft ICD-10 and DSM-III-R. It has been designed to be administered by lay interviewers and responses are assembled algorithmically to derive diagnoses. The validity of the CIE was assessed using a sample of 75 elderly patients attending a hospital clinic. The CIE diagnoses were compared with clinical judgements made at the time of recruitment into the study and later by 3 clinicians using the information collected by the lay interviewers. Agreement between the CIE and the clinicians' diagnoses was as great as agreement between the clinicians themselves, meeting or exceeding agreement observed for comparable instruments designed for lay administration.

Aged↗

PubMed1993

Application of DSM-III-R criteria for major depressive episode to elderly subjects with and without dementia.

OBJECTIVE: The aim of the present study was to see how DSM-III-R criteria for a major depressive episode functioned in a representative sample of elderly subjects with and without dementia. METHOD: Data were used from a population-based study of individuals 75 years old or older living in Stockholm. Subjects were screened for dementia by using the Mini-Mental State. Subjects with scores of 23 or lower as well as age- and sex-matched subjects with scores of 24 or higher were given a medical examination. Dementia was diagnosed according to DSM-III-R and staged for severity by using the Washington University Clinical Dementia Rating Scale. The Comprehensive Psychopathological Rating Scale was used to record symptoms of depression, which were then classified according to DSM-III-R criteria for a major depressive episode. Data on depressive symptoms were available for 643 individuals: 213 with and 430 without dementia. A principal component analysis was carried out on the nine symptoms from criterion. A for a major depressive episode. RESULTS: The depressive symptoms clustered into two groups: mood disturbance and motivation disturbance. The mood disturbance symptoms were most frequent in subjects with mild dementia and less frequent in those with more severe dementia; the subjects with the most severe dementia had the highest rates of motivation disturbance symptoms. CONCLUSIONS: The different manifestations of depression in elderly patients with and without dementia should be taken into account when making the diagnosis of major depression. Further research is needed on the manifestations of depressive symptoms in the elderly in order to validate the diagnostic criteria.

Aged↗

PubMed1993

Inequalities in the regional distribution of private psychiatric services provided under Medicare.

An analysis was carried out on Medicare data to find out if there are inequalities in the geographical distribution of private psychiatric services in Australia. The number of psychiatric services and persons becoming patients per 100,000 population was calculated for each federal electorate for the year 1985/86 and related to social indicators derived from the 1986 census. As a comparison, services provided by consultant physicians were analyzed as well. The data were based on the electorate of the patient rather than the electorate of the practitioner. Consultant psychiatrist services were found to be received more often in high socio-economic status electorates and those with older populations, and less often in rural areas. A similar pattern was found for consultant physician services, although the relationship with socio-economic status was not as strong. Frequent psychiatric consultations of longer duration, which are an indicator of insight psychotherapy, were more common in higher socioeconomic status electorates. A limitation of the Medicare data is that they cover only private services. To overcome this limitation, a supplementary analysis was carried out on the distribution of consultations for mental disorders using data from the National Health Survey. These data confirmed that individuals of high socio-economic status with a mental disorder are more likely to receive specialist treatment.

Adolescent↗