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Biomedical subjects

Clive Ballard

Publications and source records attributed to Clive Ballard.

44 records · Page 3Linked to original sources
PubMed2002

Can psychiatric liaison reduce neuroleptic use and reduce health service utilization for dementia patients residing in care facilities.

BACKGROUND: The quality of care and overuse of neuroleptic medication in care environments are major issues in the care of elderly people with dementia. METHOD: The quality of care (Dementia Care Mapping), the severity of Behavioural and Psychological Symptoms (BPSD--Neuropsychiatric Inventory), expressive language skills (Sheffield Acquired Language Disorder scale), service utilization and use of neuroleptic drugs was compared over 9 months between six care facilities receiving a psychiatric liaison service and three facilities receiving the usual clinical support, using a single blind design. RESULTS: There was a significant reduction in neuroleptic usage in the facilities receiving the liaison service (McNemar test p<0.0001), but not amongst those receiving standard clinical support (McNemar test p=0.07). There were also significantly less GP contacts (t=3.9 p=0.0001) for residents in the facilities receiving the liaison service, and a three fold reduction in psychiatric in-patient bed usage (Bed days per person 0.6 vs. 1.5). Residents in care facilities receiving the liaison service experienced significantly less deterioration in expressive language skills (t=2.2 p=0.03), but there were no significant differences in BPSD or wellbeing. CONCLUSION: A resource efficient psychiatric liaison service can reduce neuroleptic drug use and reduce some aspects of health service utilization; but a more extensive intervention is probably required to improve the overall quality of care.

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PubMed2002

Dementia Care Mapping as a research tool for measuring quality of life in care settings: psychometric properties.

BACKGROUND: There are a paucity of validated measures focusing on quality of life for people with dementia in care facilities. METHOD: The current study evaluated the internal consistency of Dementia Care Mapping (DCM) in a group of 123 people with dementia residing in care facilities and further evaluated the test retest reliability and concurrent validity of key DCM constructs in an additional group of 54 residents. RESULTS: The results show good internal consistency. Well-ill being score was significantly correlated with an informant rated quality of life measure (r = 0.73, p < 0.0001) and showed good test retest reliability (r = 0.55, p < 0.0001). An abbreviated assessment period focusing on the hour before lunch showed significant correlation with the total assessment period (well-ill being score r = 0.5, p = 0.02). CONCLUSION: The current study indicates that DCM is a valid tool for the longitudinal evaluation of quality of life in people with dementia in care settings and that some abbreviation of the method may facilitate its use more widely.

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PubMed2002

A positive association between 5HT re-uptake binding sites and depression in dementia with Lewy bodies.

BACKGROUND: Depression is a common and distressing problem in the context of dementia, and is significantly more common in Dementia with Lewy bodies (DLB) than in Alzheimer's disease. The neurochemical basis for depression in DLB has not been investigated. AIM: To investigate the association between depression and 5HT transporter re-uptake binding in DLB patients. METHOD: A representative cohort of dementia patients received annual assessments, which included a standardised evaluation of depression until death. At post-mortem, (3H) cyanoimipramine autoradiography was used to quantify 5HT transporter re-uptake sites in the hippocampus and adjacent temporal cortex (Brodmann Area-BA 36, and 20); and parietal neocortex (BA 7a). RESULTS: Twenty-one cases were evaluated neurochemically, of whom seven had experienced a major depressive disorder. Major depression was associated with a significant preservation of 5HT transporter re-uptake sites in the parietal neocortex compared with non-affected cases (BA 7a area 1 t = 3.3, P = 0.004; BA 7a area 3 t = 3.8, P = 0.001). CONCLUSION: This preliminary report is important in challenging some of the assumptions about cortical monoamine functioning in depressed dementia.

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PubMed2002

Cognitive decline in a prospectively studied group of stroke survivors, with a particular emphasis on the >75's.

BACKGROUND: Although cognitive decline is frequent after stroke, there has been very little work focussing upon older age groups, in whom the majority of strokes occur. OBJECTIVE: To determine whether cognitive decline is more common in older (>75) compared to younger (<75) stroke survivors. METHOD: A cohort of 360 stroke survivors of all ages from a stroke register in Newcastle, UK, were assessed prospectively at 3 time points over 1 year with a standardized battery. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. RESULTS: The overall one year prevalence of dementia was 23%, but rose from 7% in the under 65's to 53% in over 85's. People over 75 were significantly more likely to have dementia (Odds Ratio 8.9, 95% Confidence Intervals 4.1-19.1). CONCLUSION: The striking age related increase in the prevalence of dementia has important implications for service planning and clinical management.

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PubMed2002

Neuropsychological deficits in older stroke patients.

This paper examines the frequency of CIND, the profile of early cognitive deficits in stroke patients, the differences in the profile of cognitive impairment in people with CIND and those with vascular dementia, and the MRI associations of CIND in older stroke patients.

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PubMed2002

Neurocardiovascular instability in cognitive impairment and dementia.

Neurocardiovascular instability (NCVI, neurally mediated disorders causing hypotension with or without bradycardia) represents abnormal neural control of the cardiovascular system and presents as dizziness, syncope, or falls. The mechanisms underpinning NCVI are incompletely understood. The three most common disorders are carotid sinus syndrome (CSS), orthostatic hypotension (OH), and vasovagal syndrome (VVS): CSS, cardioinhibition > 3 s and/or vasodepressor response > or = 50 mmHg drop in systolic pressure during carotid sinus stimulation; OH: fall in systolic blood pressure > 20 mmHg during standing; VVS: cardioinhibition > 3 s and/or vasodepressor response > 50 mmHg during prolonged head-up tilting. In fallers with cognitive impairment or dementia, the prevalence of NCVI is 70%. Multifactorial interventions, including treatment of NCVI, significantly reduce falls and syncope. The predominant components of NCVI in fallers with cognitive impairment and dementia are CSS and OH. In Lewy body and Alzheimer's dementia, the prevalence of NCVI is up to 60%, again predominantly CSS and OH. The prevalence of cardioinhibitory carotid sinus hypersensitivity is particularly high in Lewy body dementia-41% compared with 12% in Alzheimer's disease and 3% in case controls. In addition, patients with Lewy body dementia have greater heart rate slowing (>2 s) and falls in systolic blood pressure (>20 mmHg) than those with Alzheimer's disease or controls during carotid sinus stimulation. The extent of deep white matter hyperintensities on MRI correlates with systolic fall during carotid sinus stimulation (R = 0.58; p < 0.005), suggesting a possible causal association between bradyarrhythmia-induced hypotension and microvascular pathology. NCVI is common in patients with dementia and may be a reversible cause of falls and syncope. Repeated hypotensive episodes may exaggerate cognitive decline in these patients.

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