Brian Cooper

Incidence and relative risk of dementia in an urban elderly population: Findings of a prospective field study.

To ascertain the frequency and distribution of new cases of dementing illness in the elderly population of Mannheim (population 308,000), a survey sample of community residents of > 65 years of age was re-examined after an interval of 7-8 years, and a sample of elderly persons in long-stay care after 5-6 years. The estimated annual incidence rate for all forms of dementia, after correction for ageing of the samples, was 15.4 per 1000 persons aged > 65, made up of dementia of Alzheimer type (8.9 per 1000), vascular dementia (4.4 per 1000) and other forms (2.1 per 1000). Apart from the expected association with age > 65 years, the most powerful predictors of onset of a dementing illness were residence in long-stay care and the presence of minor cognitive deficits at the initial examination, each of which was associated with a highly significant increase in risk. In addition, a number of socio-demographic characteristics (marital status, occupational history and quality of present living accommodation) was found to be predictive, though analysis of larger samples or pooled research data would be necessary to establish their importance in this respect. The findings suggest that identification of mild cognitive impairment on screening could prove helpful in assessing risk for dementia from two to three years before the condition becomes clinically apparent.

Life events and the onset of neurotic illness: an investigation in general practice.

New cases of neurotic illness identified during one month by each in turn of eight general practitioners in a London borough were investigated by means of standardized clinical and social interviews. When compared with a matched control group of consulting patients, the index group was found to have experienced significantly more life events during the three months before the onset of illness. Events particularly associated with neurotic illness were unexpected crises and failure to achieve various life goals. The distribution of events suggested that serious, threatening events have an important aetiological role; minor events appear to play a small contributory part which may become critical when the morbid risk is already high. The problems of method involved in this type of investigation are discussed.

Population screening and the early detection of dementing disorders in old age: a review

The scope for the early detection of dementing disorders in the elderly by means of screening techniques is reviewed in the light of the basic principles of early disease detection. It is concluded that, while there is an increasingly urgent need for the development and application of psychogeriatric screening methods as a step towards preventive action, such methods are still at an early experimental stage. Prescriptive screening programmes are contra-indicated at present. The most immediate requirement is for evaluative research, which should be planned to take account both of the properties of the screening instruments and of the health-care and social settings in which these are to be applied. No major progress in this field can be expected unless it proves possible to integrate methods of early case-detection, and of systematic surveillance of the at-risk elderly, into the work of primary medical and social services.

Early development and progression of dementing illness in the elderly: a general-practice based study.

In a study carried out in 21 general practices in Mannheim, Germany, a stratified random sample (N = 507) of patients over the age of 65 years was drawn from the total of nearly 4000 who were medically documented. Eighty per cent of the sample were examined, using the Hierarchic Dementia Scale to test cognitive functioning and the CAMDEX criteria to assess global clinical severity. Repeat assessment after a mean interval of 27 months showed that all new cases of clinical dementia had arisen in persons with mild deficits initially and represented one-fifth of this group. The first-assessment ratings of cognitive function proved to be strongly predictive of risks for age-corrected mortality, admission to long-term care and dependency at follow-up, as well as of further progressive cognitive decline.

Single spies and battalions : the clinical epidemiology of mental disorders

Clinical epidemiology, a term that has been variously defined, is used here to refer to a discipline which, commencing with examination and diagnosis of the individual patient who presents in medical practice, proceeds to study the occurrence of similar, possibly connected cases in the local community, and in so doing may provide hypotheses for population-based studies of disease and its risk factors. While the relevance of this discipline to the modern practice of clinical psychiatry remains largely unexplored, its importance in the search for causes of mental disorder is attested by many instances, both historical and more recent, in which the spread or clustering of psychiatric syndromes in populations could be related to nutritional deficiency, infectious disease, the presence of environmental neurotoxins, the social communication of psychopathology or the transmission of abnormal, harmful behaviour patterns within family groups. Observations made in clinical practice have repeatedly served as the starting point for epidemiological investigation of mental disorders, while conversely epidemiological findings have influenced clinical thinking about their classification, diagnosis, prognosis and morbid risk. A review of the relevant literature underlines the need for a keener awareness of environmental risk factors and a fundamentally epidemiological frame of reference in trying to grapple with the aetiological problems of mental disorder.

Dementia care needs in an area population: case register data and morbidity survey estimates.

Objective. To compare case register data on the frequency and distribution of known dementia cases in a metropolitan area population with expected total numbers computed from a national disability survey.

AGEING AND SENILITY: A MAJOR PROBLEM OF PSYCHIATRY. AUBREY LEWIS, JOURNAL OF MENTAL SCIENCE (1946), 92: 150–170: INTRODUCTION AND COMMENTARY

The contribution of Sir Aubrey Lewis (1900–1975) to the field of old age psychiatry is recognized by the presentation of his 1946 paper in the Journal of Mental Science.