Felix A. Silverstone

Screening for Alzheimer's Disease by Clock Drawing

The fear of Alzheimers disease for both patients and families is growing along with the increasing evidence of the disease itself. This study (N = 312) of the validity of the clock drawing test in screening patients with probable Alzheimers disease was conducted in an active outpatient geriatric clinic. Clock drawings by patients with normal mental status or depression were essentially normal. Alzheimers patients were unable to complete a normal clock and demonstrated five characteristically abnormal patterns. As a test for Alzheimers disease, clock drawing had a sensitivity of 86.7% and a specificity of 92.7%. There was correct identification in 97.2% of normals. These findings indicate that the clock drawing test, an easily administered, low cost screening tool, can be useful to health care professionals in characterizing cognitive loss in a general geriatric clinic population.

Are Alzheimer Patients Healthier

At an active outpatient geriatric program the gerontological team observed that Alzheimer patients appear to have fewer physical ailments than other elderly patients. To test this hypothesis, we reviewed a sample of 348 clinic patients. One hundred forty‐three had a normal mental status; 75 had Alzheimers disease as defined by DSM‐III criteria; 139 had an abnormal mental status attributed to other etilogies. The number of diagnoses was compiled in each of the three groups. The average number of diagnoses in the nondemented group was 5.0 in males, 5.4 in females. In the non‐Alzheimer abnormal mental status group, the average number was 5.5 in males, 4.6 in females. In contrast, the number of diagnoses in the Alzheimer group was 2.9 in males and 2.8 in females (P < 0.0001). Cardiovascular diseases, hypertension, and cerebrovascular accidents were less frequent in the Alzheimer population. This study suggests that Alzheimer patients are physically healthier than non‐Alzheimer elderly patients.

Mechanisms of Unexplained Anemia in the Nursing Home

Objectives: To characterize anemia in elderly nursing home residents.

Autopsy Proven Pulmonary Embolism Among the Institutionalized Elderly

The presentation of pulmonary embolism is variable in the elderly as in any age group. Common symptoms such as chest pain, dyspnea, and hemoptysis may be absent. Furthermore, precursors such as phlebitis, malignancy, and recent surgery often may be absent as well. Our intent was to examine the occurrence in a long‐term care institution of pulmonary embolism at autopsy and the extent of missed antemortem diagnosis of this condition, and to compare patients with and without pulmonary embolism by chart and autopsy review. The incidence of pulmonary embolism in our study of elderly patients during a six‐year period in a teaching nursing home was 12.8%. Although our series is small, consisting of 47 autopsies, our results are in accord with reports from other patient sites. Few autopsies are performed on nursing home patients and even fewer have been studied with regard to the occurrence and characteristics of pulmonary embolism in this population. The diagnosis remains difficult and uncertain, especially so in the elderly, because of the variability of presentation and association, the lesser pursuit of aggressive or invasive diagnostic methods, and the paucity of postmortem documentation.

Psychiatric profile of the noncompliant geriatric patient in the community.

A pharmacist collected data in an active geriatric outpatient program on 140 patients admitted consecutively over a 1-year period. Compliance was monitored by patient statement, pill counting, and daily written record-keeping of all medications with the help of a pocket diary provided in the program. Weekly pharmacist counseling sessions were then initiated for all patients. After four compliance sessions, two subgroups of patients were identified: 120 compliant patients and 20 patients showing persistent 50% noncompliance. Patients were interviewed by a psychiatrist to develop a profile of the noncompliant patient. This profile may be useful in identifying other noncompliant geriatric patients. Early recognition of this special group of patients in need of directed counseling may help reduce medical misjudgment in prescribing for the frail elderly population.

Brief Screening Tests versus Clinical Staging in Senile Dementia of the Alzheimer Type

To the Editor:-We applaud Dr. Davis and her colleagues in their effort to review “Brief Screening Tests versus Clinical Staging in Senile Dementia of the Alzheimer Type.”’ Recent data on the high prevalence of Alzheimer’s disease in the community clearly support the need for periodic mental status assessments on every geriatric patient.* However, we are surprised that the authors did not include the Clock Drawing Test in their comprehensive compendium. This test is performed by presenting the patient with a 4-inch circle on a sheet of paper and the instruction to “draw a clock.” The resulting clock drawing is compared with 10 standard patterns that permit categorization with regard to Alzheimer‘s disease. Though the Clock Drawing Test is limited to a screening process, we have found it to be quite sensitive and specific to Alzheimer‘s disease.3 It is most definitely a brief, inexpensive, and convenient test; its simplicity and ease of application make it invaluable not only for the health care professionals administering it, but also for accompanying family members witnessing the procedure.