Janet M. Lawrence

Is large-scale community memory screening feasible? Experience from a regional memory-screening day.

OBJECTIVES: To investigate whether a large‐scale memory‐screening program for community‐dwelling elders would be successful in identifying individuals with a high probability of dementia in need of further assessment that would result in the earlier diagnosis of dementia.

A Pilot Program of Improved Methods for Community-Based Screening for Dementia

The authors examined the effectiveness of a voluntary memory impairment-screening program for community-dwelling older persons, assessing three factors: appropriateness of screening instrument, reliability of complaints of cognitive difficulties, and adherence to screening recommendations. Two cognitive screening instruments, the Mini-Mental State Exam (MMSE) and the Seven-Minute Screen (7MS) were compared in 59 participants. Twenty-nine percent showed signs of impairment on the 7MS. Results suggested that the 7MS and the MMSE may have different sensitivities and specificities for the detection of early dementia. Failure on the 7MS was not predicted by cognitive or functional complaints. The study identified and addressed factors affecting compliance with screening recommendations.

Motor Activity and Antidepressant Drugs: A Proposed Approach to Categorizing Depression Syndromes and Their Animal Models

Affective disorders are characterized by disturbances in mood, cognition, and neurovegetative processes. Among the latter, dysregulation of appetite and weight, sleep, energy, and libido have received particular clinical attention. Current standard diagnostic criteria for major depression in the American Psychiatric Association Diagnostic Manual (DSM-III) accommodate neurovegetative disturbances in either direction—deficits as well as excesses—and evaluation of these features is routine in the clinical assessment of depressed patients. These dysfunctions often serve as target symptoms for psychopharmacological treatment and as quantifiable behaviors that can be used to bridge the gap between animal models and relevant clinical disorders.

Reactions to withdrawal of antidepressants, antiparkinsonian drugs, and lithium.

Abstract Withdrawal reactions to antidepressants, antiparkinsonian drugs, and lithium are rarely considered as a source of morbidity in psychiatric patients. The author reviews the somewhat limited information available for these three drug categories. Possible neurotransmitter mechanisms underlying these reactions are discussed, along with recommendations for clinical management and areas for future research.

A pilot program of community-based screening for memory impairment.

To the Editor: I am writing in regard to the recent paper by Christmas and Andersen regarding the benefits of exercise for improving the health and quality of life of older people.’ Recent epidemiological analyses supported by the National Institute on Aging (NIA) have demonstrated that regular exercise is associated with both longer life and lower rate of developing disability.’ Although older adults often know that exercise is one of the healthiest things they can do, many are reluctant to start exercising. Studies have shown that one important source of influence on older adults’ activity is their physician and, indeed, Christmas and Andersen suggest that “it is imperative that healthcare professionals educate patients about the benefits of exercise and an active lifestyle and provide clear recommendations to the individual on how to achieve this goal.” Physicians, however, do not consistently encourage their older patients to exercise. In a recent study, Damush et al. found that fewer than 50% of older adults ever receive a suggestion to exercise from their phy~ician.~ The low rates of physician counseling have been linked to a number of barriers, including limited availability of materials to aid both the patient and the phy~ician.~ Working with a panel of experts on the topic of exercise for older adults, the NIA has created patient education material to overcome this critical barrier. Exercise: A Guide from the National lnstitute on Aging tells patients which exercises to do and demonstrates how to do them safely.’ It includes endurance, strength, balance, and flexibility exercises, as well information on healthy lifestyles and tips for developing an exercise habit. A single, free copy of the 100page Guide is available by calling 1-800-222-2225. To complement the Guide, NIA has produced an exercise video, which begins with 6 minutes of health and safety tips followed by 40 minutes of balance, strength, and stretching exercises. The video and complementary Guide are available for

Methods for diagnosing Alzheimer's disease and other forms of dementia

7.00. The NIA supports the recommendations put forth by Christmas and Andersen. We encourage physicians to prescribe exercise and to go one step further by giving their older patients a tool to help them get started.