Lee Hyer

Apathy in Dementia: Relations with Depression, Functional Competence, and Quality of Life

This study set out to clarify the association of apathy and depression in dementia as well as apathys association with basic (ADLs) and instrumental (IADLs) activities of daily living and quality of life. 68 outpatients with mild dementia were assessed on apathy, depression, global cognition, traditional ADLs/IADLs, complex daily living activities requiring intact executive functioning (DAD: Disability Assessment for Dementia Scale), and quality of life. The sample was stratified into high and low global cognition groups and compared. While no relationship was found between scores on apathy and depression in the high cognition group, there was a significant relationship between apathy and depression in the low cognition group. Further, high and low cognition groups differed in the relationship between apathy and ability to perform basic and complex activities of daily living. Specifically, in the high cognition group, increased apathy was correlated with diminished ability to perform traditional IADLs as well as those activities requiring intact executive functioning (i.e., DAD). In the low cognition group, increased apathy was associated with poor performance on traditional ADLs and IADLs, but was not related to performance on independent daily activities demanding good executive functioning. Finally, increased apathy was significantly associated with worse quality of life, but this held for the high cognition group only, suggesting that dementia patients with better cognition have insight into their deficits and, perhaps, experience poor quality of life as a result.

The interaction of posttraumatic stress disorder and depression among older combat veterans

The question whether depression is related to trauma as part of posttraumatic stress disorder (PTSD) itself or whether it represents autonomous symptoms occurring separately (from PTSD) has not been answered. We addressed two issues: (a) What is the relationship between PTSD and depression as measured by continuous measures on outcomes? and (b) By removing depression components from the PTSD diagnosis, what is the impact on standard outcomes? Older veterans from World War II or Korea were interviewed and given self-report measures on PTSD and depression. The CAPS-1 and the MMPI-D were used as the continuous measures for PTSD and depression. The outcome measures were health status, overall adjustment, social support, and physiological status. Results showed that depression influenced health status and social support: PTSD did not contribute to the equation. The CAPS-1 also was further divided into CAPS-PTSD and CAPS-D (depression) based on item content. For adjustment and health status, PTSD asserted a greater influence; for social support and heart rate, depression was the greater influence. Discussion addressed the fact that depression is an important consideration in the expression of PTSD.

Depression: Psychological Referrals in Nursing Homes

Studies in nursing homes have consistently shown the presence of mental health disorders. We assessed 300 nursing home residents (referred for psychological testing) to provide preliminary data on referral patterns, assess the cognitive and affective patterns of residents with different diagnoses, and present psychometric data on depression measures, including the Beck Depression Scale (BDI) (as a bivariate index) and the Mood Scale (a shortened version of the Geriatric Depression Scale). Results show that the referrals involved a compromised group of residents, both cognitively and affectively. Despite obvious mean differences, a MANOVA revealed that Major Depressive Disorder did not differ significantly from the Adjustment Disorder and Dementia groups on the bivariate BDI and Mood Scale; the dementia group was lower than the depression and adjustment groups on the MMSE. Patterns on depression inventories also identified a correct classification score of 4 on the BDI (89%) and 3 on the Mood Scale (79%). Discussion endorsed use of the bivariate BDI and addressed depression in these facilities.

Cognitive testing battery: Differences among groups with dementia, Huntington's Disease, and controls

This study evaluated a new test for dementia, the Cognitive Testing Battery, used for over six years in outpatient clinics for aging-related disorders. This battery was developed to be brief, easy to administer, and to provide useful feedback as a cognitive profile for clinicians, patients, and caregivers. 489 participants were tested during a 5-yr. period. Multidisicplinary teams diagnosed these patients with dementia, depression, or Huntingtons Disease. A control group was also included. Groups were then compared on the 10 key subscales that subserve dementia populations. Analysis showed there were significant differences among the groups on all measures and that selected scales differentiated the groups. The total score maximally differentiated the groups, and the dementia group was most different from the other groups.

Psychological Problems at Late Life: Holistic Care with Treatment Modules

This chapter presents a typical case for later-life patients. This particular man is best seen as one with multiple problems and needs. He has depression, anxiety, cognitive issues, somatic/sleep problems, as well as life adjustment concerns. He needs a coordinator who can assist him in his psychological, social, health, and practical problems/needs. This entails a holistic view of his situation and a considered approach to his plight. The answer then is not in a Diagnostic and Statistical Manual (DSM) diagnosis, not just in a medication for psychiatric care, and not in a private therapy session. It is in holistic care and case based on empirically supported therapies and social realities, as well as general health. This is not easily done.

PTSD-Older Adults

In general, the data of the past two decades do not suggest that older adults are at greater risk than younger adults for negative psychosocial outcome following exposure to natural disasters. There is simply insufficient evidence to conclude that disaster causes more negative psychosocial consequences in older adults. Empirically supported therapies that apply to younger groups have applicability to older groups as well. These involve exposure and assimilation techniques within the context of a supportive and collaborative therapeutic relationship. In this way memories are modified or transformed. Often, factors related specifically to aging, mourning for losses, giving meaning to experiences, reestablishing self-coherence and self-continuity, achieve ego integration, and culture and social support are integrated also.