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Biomedical subjects

C Brayne

Publications and source records attributed to C Brayne.

At least 73 records · Page 4Linked to original sources
PubMed1997

Attitudes toward death: a community study of octoagenarians and nonagenarians.

Attitudes to death were explored in 125 community residents aged 81 and older. Those people who thought about dying had less frequent contact with their interview informant; those who thought about death more frequently showed less severe cognitive impairment, a greater severity of depressive symptoms, and were more likely to be unmarried and were more commonly reported to be depressed by their interview informant. Worries about dying showed no association with sociodemographic or clinical variables. The commonest category of response from spontaneous comments was concerning the circumstances of dying. The results are discussed in light of other research findings, and emphasize the influence of low mood and social factors on death attitudes. This may have implications for closer examination of such attitudes in the assessment of depression and suicidal risk as well as in the care of the dying.

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PubMed1997

Cognitive impairment: a challenge for community care. A comparison of the domiciliary service receipt of cognitively impaired and equally dependent physically impaired elderly women.

OBJECTIVES: to compare the domiciliary service receipt of cognitively impaired and equally dependent physically impaired elderly women prior to the passing of the UK Community Care Act. METHODS: secondary analysis of a population survey conducted in 1986 in the city of Cambridge. The analysis used data on 1585 women aged 75 and over living in the community. The effect of type of impairment on the receipt of domiciliary services (meals-on-wheels, home help and community nursing) is measured using a multivariate model which allows for adjustment for dependency level and other potential confounding factors. RESULTS: the odds of an elderly woman getting help from any of the domiciliary services whilst not being significantly affected by cognitive impairment (odds ratio 0.7, 95% CI 0.5-1.2) are increased by physical impairment (odds ratio 1.8, 95% CI 1.2-2.5). Similar results were found for the home help service. The differences were exaggerated in the case of the community nursing service, whilst receipt of meals-on-wheels was similar for women of with all types of impairment. CONCLUSIONS: in the late 1980s, cognitively impaired elderly women received less help from the domiciliary services than equally dependent physically frail women who lived in similar household circumstances. The development of specialist services appropriate to the needs of cognitively impaired elderly people presents a challenge to community care policy, especially since this group are at high risk of institutionalization.

Activities of Daily Living↗
PubMed1997

Suicidal thinking in community residents over eighty.

OBJECTIVE MAIN OBJECTIVE: to study the relationship between suicidal thinking and both cognitive impairment and depression. DESIGN: Random sample selected for interview, all of whom were a cohort in a pre-existing epidemiological study of dementia. SETTING: Community residents. PATIENTS AND OTHER PARTICIPANTS: Participants aged over 81. Study excluded the following: moved out of area/died/ too frail/severe communication difficulties/refused interview, refusal by GP/family/carers, 300 names selected at random from database. 170 eligible participants approached: 31 refused, 125 interviewed, 125 informants approached for interview; 118 interviewed. MAIN OUTCOME MEASURES: CAMDEX, 15-item Geriatric Depression Scale (GDS), and Scale for Suicidal Ideation (SSI) (including informant versions of latter 2 scales). RESULTS: 9 people showed suicidal thinking, all women: 6 had clinical evidence of cardiovascular/cerebrovascular disease. Those with suicidal thinking showed higher CAMDEX depression scores, weaker strength of the wish to go on living, higher rates of expressing wish to die and higher rates of depressive illness and mixed DAT/multi-infarct dementia as primary psychiatric diagnoses. No significant associations between suicidal thinking and GDS scores, Alzheimer-type dementia alone, awareness of memory difficulties or severity of dementia. CONCLUSIONS: Results show association between suicidal thinking and both depression and mixed DAT/multi-infarct dementia, but do not support an association between suicidal thinking and awareness of memory problems/severity of dementia. Given the methodological limitations, the significance of the results should be viewed with caution. Further exploration of the role of cerebrovascular disease in depressive disorder is suggested.

Activities of Daily Living↗
PubMed1997

Local population differences and the needs of people with cognitive impairment.

INTRODUCTION: Variations in local population age structure have attracted less attention than national population ageing. As moderate and severe cognitive impairment is a major cause of need for long-term care, population-based estimates of the numbers and characteristics of this group were calculated, to explore the effects of local differences. METHOD: The UK Office of Population Census and Surveys (OPCS) study of disability in adults (N > 14000) was reanalysed. A group with moderate or severe cognitive impairments was identified and age-specific estimators of sociodemographic characteristics, household types, disabilities and service use were combined with population estimates for district health authorities in England and Wales. RESULTS: The proportion of the 65 plus population who are 85 plus varies from 8% to 15% across districts, equivalent to national population projections for 1986 and 2031 respectively. The estimated prevalence of the study group varies from 53 to 70 per 1000 population aged 65 plus, with 34-48% of cases aged 85 plus. Curiously, the proportion with severe disabilities varies little across districts. If national norms applied, local rates of institutionalization would vary from 18 to 27 per 1000 aged 65 plus. CONCLUSION: Local differences in population age structure age large compared to national changes over decades. Local differences have substantial effects on overall prevalence and on the proportion of the cognitively impaired who would be institutionalized if national patterns applied. Service design should be influenced by these complex variations, with estimates modified by local surveys.

Activities of Daily Living↗
PubMed1996

The relationship between clinical dementia and neuropathological staging (Braak) in a very elderly community sample.

The neuropathological staging model proposed by Braak and Braak (1991) implies that the evolution of neurofibrillary pathology follows a predictable sequence and can be ordered in a regular regional hierarchy. A total of 42 cases of an elderly population sample, which had been prospectively clinically assessed, were examined. Clinical diagnosis was made according to the CAMDEX criteria, and the sample reported here did not include cases were vascular dementia according to the criteria proposed by Chui et al. (1991). The neuropathological staging procedure was applied as originally proposed by Braak and Braak (1991). In addition, in all cortical laminae and regions which are essential for the staging model neurofibrillary tangles were quantified. Demented cases had significantly more areas involved and more advanced neuropathological stages. Cases with stages 1-3 tended to be non-demented, and cases with stages 4-6 tended to be demented. However, there was a considerable degree of overlap and no clear-cut threshold could be established. This brings into question the diagnostic value of the staging model.

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PubMed1996

The tRNA(Gln) 4336 mitochondrial DNA variant is not a high penetrance mutation which predisposes to dementia before the age of 75 years.

The genetic factors that predispose to Alzheimer's disease (AD) are heterogeneous. Two recent reports have suggested that a mitochondrial DNA mutation within the tRNAGln gene, located at position 4336, may be a risk factor for AD, as it was found in 10/256 (3.9%) cases with AD confirmed by necropsy. Although low prevalences of this mutation were detected in non-demented subjects in both of these studies, the controls were not carefully matched with the AD cases. We have investigated the frequency of this mutation in two community based elderly cohorts in Cambridgeshire, who have participated in longitudinal studies of cognitive function. The 4336 mitochondrial mutation was detected in 8/ 443 people examined. These people were found to be non-demented at ages 74, 81, 84, 86, 89, 90, 91, and 102 years, in contrast to the previously described cases whose onset of dementia occurred between 60 and 76 years (mean 68). Accordingly, we believe that this mitochondrial variant is not a high penetrance mutation which predisposes to dementia before the age of 76 years.

Age of Onset↗
PubMed1995

The prevalence of depression in a cohort of the very elderly.

In a community study of 1173 very elderly (> or = 77 years) subjects, a screening interview was followed by a CAMDEX diagnostic interview in a subsample of 461. The estimated prevalence of DSM-III-R major depressive disorder in the community sampled was 2.4% (95% CI 0.9%, 4.0%). Using CAMDEX criteria, the prevalence of depressive illness was 3.0% (95% CI 0.7%, 5.3%). 10% of those who had a diagnostic interview were rated as having depressive symptoms of mild or moderate severity. Of these, approximately 1/3 met diagnostic criteria for major depressive disorder. The significance of these findings and the possible need for wider criteria for depression in the elderly are discussed.

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PubMed1995

Cognitive decline in an elderly population--a two wave study of change.

A sample of 1111 survivors from a population aged 75 years and over completed the Mini-Mental State Examination (MMSE) twice, separated by 28 months on average. There was a mean decline of 1.3 points in MMSE score. With increasing age, mean drop in score also increased. The proportion at each age identified as newly cognitively impaired according to any standard cut-point on MMSE rose markedly. Mean decline was greater in women than men even after adjustment for age. Cognitive change on the MMSE was approximately unimodally and normally distributed. This distribution was a marked contrast to the distribution of MMSE scores themselves, which was skewed due to truncation of scores at the maximum. The decline was not due to the inclusion of individuals with physical impairment. These findings indicate that cognitive decline, like dementia, becomes increasingly common with advancing age, and suggest that dementia may be regarded as one extreme of the continuum of cognitive decline.

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PubMed1995

Predictors of hospital contact by very elderly people: a pilot study from a cohort of people aged 75 years and over.

We wished to test the hypothesis that elderly people with impaired cognitive function were heavier users of both outpatient and inpatient hospital services. In a retrospective cohort study, 144 elderly people aged 75-97 years (50 men and 94 women) identified from a prevalence survey of dementia were traced over an average period of 4 years. They were categorized into three groups: cognitively impaired, physically frail and physically healthy. Elderly people with impaired cognitive function had fewer contacts with outpatient services (p = 0.0003) but did not differ in inpatient service use from subjects with normal cognitive function. Cognitively impaired people who lived alone had longer hospital stays (p = 0.002) and a higher admission rate to geriatric wards (p = 0,009). Negative self-rated health was an important factor predicting more contacts for men with inpatient services and geriatric outpatient services (both p = 0.002). Use of surgical outpatient services was associated with use of surgical inpatient services by the physically healthy group only (p = 0.0003). After adjusting for age, sex and physical health, cognitively impaired subjects were nearly twice as likely to die within four years as the other two groups (RR = 1.89).

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PubMed1995

CAMCOG--a concise neuropsychological test to assist dementia diagnosis: socio-demographic determinants in an elderly population sample.

The CAMCOG, which forms part of the CAMDEX interview (Roth et al., 1986, 1988), is a brief neuropsychological battery designed to assess the range of cognitive functions required for a diagnosis of dementia, and to detect mild degrees of cognitive impairment. It was administered to a population sample of 418 elderly people (aged 77 and above) in their place of residence. The data show that in contrast to the Mini-Mental State Examination, total CAMCOG scores are well distributed and there is no ceiling effect. Examination of the association between CAMCOG scores and socio-demographic variables (age, sex, education and social class) shows that each exerts a significant, and independent, effect upon performance. CAMCOG also includes a number of subscale which assess individual areas of cognitive function. Of the eight major subscales (orientation, language, memory, attention, praxis, calculation, abstract thinking, perception), age was significantly related to all but attention; sex with attention, praxis, calculation and perception; education with language and abstract thinking; and social class with language and perception. In all these analyses, the results were adjusted for the effects of the other socio-demographic variables using analysis of variance. However, education and social class are highly correlated variables and when the association with education is examined without adjusting for social class, attention and praxis are also found to be significantly related to education. Caution must therefore be taken when using the CAMCOG (or any other cognitive test) as a screening test for dementia, using a single, predetermined cutpoint. In general, the combination of brevity and breadth of the CAMCOG, along with its distributional properties, makes it an attractive neuropsychological test for use in the community or the clinic.

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PubMed1995

Epidemiology of vascular dementia.

Vascular dementia (VaD) is the second commonest dementia after Alzheimer's disease (AD). Epidemiological studies of this condition suffer from many shortcomings related to definition of the disease, diagnostic criteria and assessment of subjects. The prevalence of VaD increases linearly with age and varies greatly from country to country, ranging from 1.2 to 4.2% of people over 65 years old, even after adjustment for age and sex. The incidence of VaD is more homogeneous than prevalence and is estimated at 6-12 cases per 1,000 persons over 70 years per year. The mean duration of the disease is around 5 years and survival is less than for the general population and for AD. The major risk factors for VaD appear to be hypertension, diabetes, heart disease and stroke. Although some of these risk factors are modifiable, there is no study on efficacy of prevention of VaD.

Age Factors↗
PubMed1995

Incidence of clinically diagnosed subtypes of dementia in an elderly population. Cambridge Project for Later Life.

BACKGROUND: In developed countries, most dementia appears to be due to Alzheimer's disease and vascular dementia. We report rates for incidence of subtypes of dementia based on clinical diagnosis. METHOD: This study was a 2.4-year (s.d. 2.6 months) follow-up of a cohort aged 75 years and over, seen initially in a prevalence study of dementia. A screening interview in 1173 survivors was followed in a subsample of 461 respondents by a diagnostic interview 1.8 months after screening (s.d. 1.5 months). This comprised a standardised interview with respondent and informant, with venepuncture where possible. Clinical diagnoses of subtypes were made by specified criteria. RESULTS: The incidence of Alzheimer's disease of mild and greater severity was 2.7/1000 person-years at risk (1.6-4.4); in men 1.5 (0.8-2.7) and in women 3.3 (1.8-5.9). The incidence of vascular dementia was 1.2/100 person-years at risk (0.7-1.9); in men 1.1 (0.4-2.8) and in women 1.2 (0.7-2.0). Alzheimer's disease, but not vascular dementia, showed a marked increase with age, particularly in women. Rates for minimal dementia of different subtypes showed similar age and sex effects, but were much higher for Alzheimer's disease than vascular dementia. CONCLUSIONS: The striking rise in incidence rates of dementia in the very old appear to be due to Alzheimer's disease, while rates for vascular dementia remain relatively constant. These trends are particularly marked for minimal dementia, but emphasise the importance of Alzheimer's disease in the community as a cause of cognitive decline of all degrees.

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PubMed1994

Incidence of dementia in a population older than 75 years in the United Kingdom.

BACKGROUND: Incidence studies have been relatively neglected in psychiatric epidemiology. They are particularly important for dementia, since prevalence rates are affected by length of survival, which itself falls with increasing age and presence of dementia. METHODS: Two-wave community study of 1195 elderly subjects aged older than 75 years, restudied 2.4 years after a community prevalence study. A two-stage method was used, comprising the Mini-Mental State Examination followed in a stratified sample by the Cambridge Examination for Mental Disorders of the Elderly (CAM-DEX) interview. Incidence rates were based on person-years at risk. RESULTS: Annual incidence rates for dementia were 2.3% for subjects initially aged 75 to 79 years, 4.6% for ages 80 to 84 years, and 8.5% for ages 85 to 89 years, approximately doubling every 5 years. Rates did not differ significantly by sex, educational level, or social class. Twice as many additional individuals received a diagnosis of minimal dementia not reaching case threshold. CONCLUSIONS: The findings show high rates of new onset dementia, increasing markedly with age, and suggest rapid acceleration of one or more processes that is common in advanced age.

Age Distribution↗
PubMed1993

Clinicopathological studies of the dementias from an epidemiological viewpoint.

Studies which examine patients with and without dementia during life and then examine brain tissue after death are extremely difficult to conduct. There are now several such studies published, representing a major contribution to the understanding of the pathologies of the dementias. These studies were not designed to represent population samples and, from an epidemiological viewpoint, they are flawed because none are population-based and none represent the full range of function observed during life. It is therefore important to examine the available studies for their contributions and biases.

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PubMed1992

A longitudinal study in progress: a five-year follow-up of women aged 70-79 years living in a rural community.

The study in progress is a 5-year follow-up of an epidemiological investigation of the indices of dementia in women aged 70-79. From the original sample of 365 women approximately 78 had died at 5 years. Of those remaining all are being reapproached for the purpose of reassessment using the same tools as the original study and informants of both surviving and decreased participants are likewise being contacted. Observations will be made with respect to cognitive change over time.

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PubMed1992

The Cambridge Project for Later Life: design and preliminary results.

The Cambridge Project for Later Life is the follow-up at 2.4 years of the Hughes Hall Project for Later Life, a prevalence study of dementia in Cambridge city in which 40% of the population aged 75 and over were screened for dementia. In the follow-up, 1,173 people were screened a second time, and using Mini-Mental Scale Examination scores were selected for a more intensive interview with CAMDEX. This was followed by detailed neuropsychological testing and magnetic resonance imaging in a smaller proportion of individuals.

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PubMed1992

Methodological issues in screening for dementia.

Screening for dementia in populations presents particular difficulties for researchers. In the absence of gold standards for diagnosis, the methods used must be determined by the purposes of the study. In two-stage epidemiological study the screening wave and the diagnostic instrument should be considered together in relation to a third proxy gold standard such as progression of the disorder to moderate and greater severity and neuropathological diagnosis. This provides a measure of the predictive performance of the original screening method and its diagnostic phase. To reduce the variance of estimates of prevalence and incidence it is suggested that the screening interview be a subset of the diagnostic interview.

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