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D W Kay

Publications and source records attributed to D W Kay.

At least 19 recordsLinked to original sources
PubMed1992

Methodological problems with diagnosis of dementia in community surveys: the choice of items to study higher functions.

The 'global' character of dementia distinguishes it from other organic syndromes but in community surveys memory impairment is the predominant early symptom and the aphasia, apraxia and agnosia triad characteristic of dementia of Alzheimer type disease (DAT) may be hard to demonstrate. Both the Mini-Mental State (MMS) and CAMDEX contain appropriate items but information about how elderly persons in general perform on these tests is limited. This paper examines the relative difficulty of the items in a general practice sample and compares their sensitivity and specificity taking AGECAT organic diagnosis as criterion.

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PubMed1991

The diagnosis of dementia in the elderly. A comparison of CAMCOG (the cognitive section of CAMDEX), the AGECAT program, DSM-III, the Mini-Mental State Examination and some short rating scales.

The performance of CAMCOG, the cognitive section of the CAMDEX, is compared in a non-random sample of 222 elderly people with diagnoses based on AGECAT and on DSM-III criteria, and with the MMSE and some short rating scales. With a cut-off point of 69/70 and AGECAT organic syndrome as the criterion, the sensitivity of CAMCOG was 97% and the specificity 91%. However, 21% of DSM-III diagnoses of dementia scored above this cut-off; these were mostly mild cases. The correlation between CAMCOG and MMSE scores was 0.87, and the advantage of CAMCOG may be more apparent in longitudinal studies. Multivariate analyses showed that CAMCOG scores are affected by age, sociocultural factors and hearing and visual deficits in addition to dementia, but not by depression. There was a suggestion that individual subsections are differentially affected.

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PubMed1990

Prevalence rates of dementia in an ageing population: are low rates due to the use of insensitive instruments?

The varying prevalence rates of dementia reported in elderly populations may be partly due to the use of different diagnostic measures. In a recent study in which diagnosis was based on the CAPE, a 12-item questionnaire, the prevalence rate for severe cognitive impairment for the age group 75 years or over was lower than previously reported. In the present study, the performance of the CAPE was examined in an elderly general-practice sample with a higher than usual risk of dementia. The study diagnosis was based on a combination of the diagnosis made by the computer program AGECAT and a clinical diagnosis made by the interviewing psychiatrist. Forty-five per cent of patients with definite or probable dementia, as defined, and 100% of those with possible dementia had scores above the cut-point on the CAPE. The sensitivity of the CAPE was low compared with that of other rating scales. It is concluded that the low reported rate with the CAPE is probably due to only the more severe cases being identified. For comparative purposes it is important to know the level of dementia that the instruments used are detecting.

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PubMed1989

Genetics, Alzheimer's disease and senile dementia.

Genetic factors in the aetiology of Alzheimer's disease (AD), are now being intensively investigated. The homogeneity of AD is under investigation. There are a few large kindreds with early onset of AD in whom transmission appears to be typically autosomal dominant, and 65% or more of the remaining cases at any age may have genetic aetiology. Both multifactorial and autosomal dominant inheritance with age-dependent expression have been proposed, but the late onset and death of unaffected relatives from competing causes make it difficult to choose between them. Lifetime risk gives the best estimate of incidence in family studies, but clinical and pathological criteria are not clear enough for confident diagnosis of AD in late old age. A role for external factors is indicated by twin studies, and the role of aluminium is currently under investigation. Molecular genetics promises to resolve many questions. The clinicians' role will be to provide well documented families for interdisciplinary research and to help in clarifying diagnosis in late old age.

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PubMed1988

The Geriatric Mental State (GMS) used in the community: replication studies of the computerized diagnosis AGECAT.

Three studies are reported using the Geriatric Mental State in one of its community forms on a total of 647 subjects aged over 65 and living in their own homes. The concordance between the computer diagnosis AGECAT and psychiatrists' diagnosis is at least as good in these replication samples as in the original studies (Copeland et al. 1986). AGECAT has been shown to be useful for epidemiological surveys and as a diagnostic guide for non-medical interviewers.

Diagnosis, Computer-Assisted↗
PubMed1988

Educational level differences on the Mini-Mental State: the role of test bias.

Less educated elderly people are commonly found to perform more poorly on the Mini-Mental State Examination (MMSE). This educational level difference has been attributed by some research workers to test bias. To assess whether the MMSE is biased against the poorly educated, its validity was assessed separately in the more- and less-educated members of a community sample. No evidence was found to indicate that the test is a biased measure of cognitive impairment.

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PubMed1987

Diagnoses of dementia and depression: a latent trait analysis of their performance.

Four diagnostic systems for dementia and depression are compared on a community sample of 274 subjects. They are: DSM-III, Gurland's system, AGECAT and a clinician's ratings. These are compared, not in the usual terms of prevalence rates and cross-tabulations of diagnostic categories, but by examining the performance of each system in terms of hypothetical, continuously distributed traits underlying the symptoms of dementia and depression, as in the latent trait model described by Duncan-Jones et al. (1986). Each diagnosis is characterized by the level of severity (threshold) at which it operates, and its accuracy. Evidence is given to support a dimensional view of dementia.

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PubMed1987

Psychiatric morbidity in Hobart's dependent aged.

Psychiatric morbidity in the dependent aged was studied in the elderly population of Hobart's nursing homes and long-stay hospitals. Only patients with home addresses in Hobart and who were admitted for the first time aged 70 years or over were included. Three hundred and twelve persons were interviewed with a standard interview, and an informant was interviewed when appropriate. The medical records were searched for diagnoses and drug treatments. Physical disability was rated on an ad hoc scale. Comparisons were made of the prevalence of dementia, depression and anxiety in different types of unit, and between these and two domiciliary samples, one of which received domiciliary nursing services (n = 100) and the other not (n = 100). The differential use of institutions by men and women, and a possible sex difference in the prevalence of dementia is discussed.

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PubMed1986

Social support, dementia and depression among the elderly living in the Hobart community.

In a community sample of the elderly (N = 274) in Hobart, Tasmania, cases of dementia and depression were ascertained by the Canberra Geriatric Mental State and the Mini Mental State Examination. Social relationships and support were examined by means of the Interview Schedule for Social Interaction. The elderly had fewer social relationships than younger adults, but were more content with what they did have. Elderly women had more affectional ties than elderly men. The presence of offspring in the same town increased the number of close ties and of social relationships, but was more important for men than for women. Persons with cognitive impairment or an established dementia reported that they had less social interaction than they would like. Depressed subjects reported having markedly less social interaction than the mentally healthy elderly, but did not complain that it was too little. This study provides a systematic description of the social environment of the elderly, both in mental health and in states of depression or impaired cognition.

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PubMed1986

The elderly who live alone: their mental health and social relationships.

In a community survey of the elderly in Hobart, persons who lived alone were compared to those who lived with others. Those who lived alone were more often widows and had had more education. They had markedly fewer close relationships but as much other social interaction. They reported that their personal networks were as adequate as other elderly persons, yet they experienced much more loneliness. They had no higher a prevalence of depressive disorders or dementia on DSM-III criteria, but they did have a higher frequency of neurotic depression and some depressive symptoms, of which loneliness was one. Contrary to what might intuitively be expected, the elderly who live along may not be a group at increased risk for formal psychiatric morbidity. Instead, they may have a moderate excess of dysphoric symptoms.

Activities of Daily Living↗
PubMed1985

Dementia and depression among the elderly living in the Hobart community: the effect of the diagnostic criteria on the prevalence rates.

A survey was made of 274 non-institutionalized persons aged 70 and over living in Hobart. The prevalence of dementia and of depression was measured by interviewing subjects using a modified version of the Geriatric Mental State Schedule (GMS) (Copeland et al. 1976) and the Mini Mental State Examination (MMSE) (Folstein et al. 1975). Rates of morbidity were derived from different diagnostic procedures. These were: diagnoses made by a psychiatrist (A.S.H.) directly from the interview schedules and audiotapes, and rated as mild, moderate or severe; the criteria laid down in DSM-III, converted into algorithms describing 3 degrees of severity; and the algorithms for pervasive dementia and depression proposed by Gurland et al. (1983), and from these authors' rational scales. In addition, the relation between scales for dementia and for depression and the diagnosed categories was examined. Some problems in applying these methods to aged persons in the community are discussed. It is concluded that more detailed specification of criteria is desirable if the comparative epidemiology of dementia and depression in old age is to advance.

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PubMed1978

Psychiatric illness in the elderly. A comparison of GP records and survey findings.

The GP records of 200 elderly people living at home were scrutinized and estimation made of physical and psychiatric disability. These estimations were compared with those made independently by a psychiatrist interviewing the subjects at home. There was a reasonable agreement between the two assessments of functional disorder and between the two assessments of physical disabilities. Whereas the survey psychiatrist's diagnoses of mental disorder correlated positively with the presence of physical illness, this did not hold for those considered to have evidence of psychiatric illness using GP records alone. The duration of a positive psychiatric history obtained from GP records was consistent with a discrimination between late onset (recent) and chronic neurosis.

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PubMed1977

Cognitive function and length of survival in elderly subjects living at home.

177 people aged 65 or over, chosen at random from larger representative samples of elderly people living at home in Newcastle upon Tyne, were given the Weschler Adult Intelligence Scale (WAIS) or a shortened form of it, and followed up for 7 years or till death. Discriminated function analysis showed that the power of the test score to predict death occurring within 2 years was not explained away by its correlations with age, sex, social class or physical disability. Exclusion of clinically diagnosed chronic brain syndromes reduced but did not abolish the relationship found to exist between test score and outcome. The ascertainment of impaired cognitive functioning has important applications in the assessment of prognosis and in the planning of care of elderly people.

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