Martin Burkart

Internal and external validity of the WHO Well-Being Scale in the elderly general population.

The objectives of this study were (i) to evaluate the validity of the WHO Well‐Being Scale in elderly subjects and (ii) to assess the influence of demographic variables on subjective quality of life. A sample of 254 elderly subjects completed the 22‐item WHO Well‐Being Scale. The scale had an adequate internal and external validity. However, the short 10‐item and 5‐item versions were equally valid. Low scores indicating decreased well‐being were related to the presence of a psychiatric disorder or, independently, to poor living conditions. The Well‐Being Scale and their short versions would appear to be useful instruments for identifying subjects with reduced subjective quality of life.

Amygdala-Hippocampal Atrophy and Memory Performance in Dementia of Alzheimer Type

The aim of the present study was to examine the involvement of brain structures, especially the amygdala-hippocampal complex, in dementia of Alzheimer type (DAT), and to assess the relation of amygdala-hippocampal atrophy with memory dysfunction. 14 patients with DAT and 10 healthy age-matched controls were examined with different neuropsychologic tests including the UCLA-Auditory Verbal Learning Test. MRI was performed with a conventional 1.5-tesla scanner. Atrophy was found in many brain structures of demented subjects in comparison with healthy age-matched controls. The volumes of amygdala-hippocampal complexes and of the temporal lobes of demented subjects were more reduced than the total brain volume and other structures. Memory dysfunction was highly correlated with atrophy of the amygdala-hippocampal complexes and of the temporal lobes. Consequently, DAT seems to affect the amygdala-hippocampal complex and their related function (i.e. memory) more than other cerebral structures, but cerebral degeneration in DAT is not restricted to these structures.

Selection biases during recruitment of patients and relatives for a family study in the elderly

The aim of the present study was to examine selection effects during recruitment of patients, controls and relatives for a family study in the elderly. The primary sample consisted of 368 in-patients (aged above 60 years) admitted in the years 1992 and 1993. One-hundred and eighty-four subjects (50%) suffering from dementia of Alzheimer type or major depression fulfilled the diagnostic inclusion criteria. Finally, 100 subjects participated in the family study. Demographic data of participants, ineligible subjects, uncooperative candidates, and control subjects from the general population was examined. Demographic parameters, reasons for refusal of personal interviews, and family history information were compared in first-degree relatives of participants and of 40 control subjects. According to demographic data, participants were representative for the whole sample of demented or depressed patients, and were comparable with the control sample. Demographic parameters of relatives were also equivalent in both groups. Rates of psychiatric disorders were equal in interviewed and unavailable relatives of patients (18.0% and 18.8%, respectively). However, interviewed relatives of controls had significantly fewer psychiatric disorders than unavailable relatives (7.8% vs 20%). This selection effect indicates the need for family history information on unavailable relatives in family studies on geriatric patients. Equivalence of demographic data alone was not a sufficient indicator of sample comparability. A second hospitalized comparison group might serve to increase the validity of conclusions resulting from comparative family studies.

Demenzscreening im klinischen Alltag Eine vergleichende Analyse von MMSE, SIDAM und ADAS

ZusammenfassungFür ein Demenzscreening im klinischen Alltag sind kurze, sensitive und spezifische Tests erforderlich. Hierfür stehen einige standardisierter Verfahren zur Verfügung. In der vorliegenden Arbeit wurde der Zusammenhang von Testumfang und diagnostischer Güte an 3 beispielhaften Demenzscreeninginstrumenten untersucht. Die Mini-Mental-State-Untersuchung (MMSE), das Strukturierte Interview für die Diagnose einer Demenz vom Alzheimer-Typ, der Multiinfarktdemenz und Demenzen anderer Ätiologie nach ICD-10 und DSM-III-R (SIDAM) und die Alzheimer’s Disease Assessment Scale (ADAS) wurden bei 71 Patienten mit Demenz vom Alzheimer-Typ und 73 nichtdementen Kontrollprobanden durchgeführt. Eine ROC-Analyse zeigte, daß weder SIDAM noch ADAS besser zwischen dementen Patienten und nichtdementen Kontrollprobanden unterschieden, als der MMSE-Testwert. Dies galt auch für Patienten mit leichter Demenz. Auch bei der Abgrenzung verschiedener Schweregrade der Demenz waren die umfangreicheren Instrumente dem Kurztest MMSE nicht überlegen. Für den klinischen Alltag stellt die MMSE wegen ihrer Kürze das geeignetste Screeninginstrument dar.SummaryDementia-screening in clinical routine requires short, sensitive and specific tools. A number of standardized instruments are available for this purpose. The present study analysed the relationship between size of three examplary dementia-screening tests and their diagnostic accuracy.The Mini-Mental-State-Examination (MMSE), the Structured Interview for the Diagnosis of Dementia of the Alzheimer-type, Multiinfarct Dementia and Dementias of other Aetiologies according to ICD-10 and DSM-III-R (SIDAM) and the Alzheimer’s Disease Assessment Scale (ADAS) were applied to 71 patients with dementia of the Alzheimer-type and 73 non-demented controls.A ROC-analysis revealed that neighter SIDAM nor ADAS differentiated better between demented and non-demented probands than the MMSE. This was also true for patients with mild dementia. In dementia staging the more comprehensive instruments did not surpass the MMSE, too.Due to it’s brevity, the MMSE is the preferential screening-instrument for clinical routine.

Validity of the family history method in relatives of gerontopsychiatric patients

It was the aim of the present study to evaluate the validity of the family history method in relatives of a sample of elderly subjects. A total of 201 relatives of patients and 89 relatives of control subjects were interviewed directly using the Composite International Diagnostic Interview and the Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, Multi-infarct Dementia and Dementias of other Etiology. At least one relevant other could provide family history information on a respective subject. Family history information for psychiatric disorders including dementia (DSM-III-R) was neither accurate, nor sensitive (10 to 40%), but highly specific (> 95%). The sensitivity of the family history for dementia and depression increased in relation to the severity of the disorder. Relatives of patients were better informants than relatives of controls (at least for the presence of any psychiatric disorder). The use of several informants only slightly improved the sensitivity of the family history, without reducing the specificity to a significant extent. The combination of different sources of information may serve to reduce information biases. The evaluation of possible biases in future family studies is required to draw adequate conclusions from differences in familial loads.

Serial Position Effects in Dementia of the Alzheimer Type

Background: The aim of the present study was to analyse serial position effects for immediate and delayed free recall in patients with dementia of the Alzheimer type and controls. Experiment 1: 44 patients with dementia of the Alzheimer-type and 24 non-demented controls were asked for immediate and delayed free recall of 12 schematic drawings of common objects presented at the rate of 10 s/picture. Steep primacy effects were obtained at all delays in controls. By contrast, primacy effects were significantly impaired in patients with dementia at all delays of recall. Small immediate and delayed recall recency effects were found in both, patients and controls. Experiment 2: 19 patients with dementia of the Alzheimer type and 21 controls were asked for immediate and delayed free picture recall with presentation rates of 10, 5 and 1 s/picture. Again, primacy effects were significantly impaired in demented patients versus controls. With shorter presentation times, immediate recall recency effects were more pronounced than with longer presentation times, and no delayed recall recency effects were found. Conclusions: Primacy effect is impaired for immediate and delayed recall in dementia of the Alzheimer type. By contrast, immediate recall recency effect and possibly also long-term recency effect are preserved. The loss of the primacy effect contributes to the impairment of episodic memory in dementia of the Alzheimer type. Therefore further research is warranted into pharmacological and psychological interventions that might re-establish the primacy effect. Possibly, the orientation of demented patients might be improved by psychological techniques that rely on long-term recency effect.

Effect of Presentation Rate on Word List Learning in Patients with Dementia of the Alzheimer Type

The efficacy of simple interventions for the improvement of memory performance in patients with dementia of Alzheimer type (DAT) has rarely been evaluated. Therefore, we examined the effects of presentation duration and task practice on word list learning in this sample: 19 patients with DAT and 21 control subjects (with remitted major depression) repeatedly performed modifications of a word list learning task using five different presentation durations (i.e. 1, 2, 5, 10 or 20 s/word). In agreement with previous observations, prolonged visual presentation of words significantly improved recall and recognition in demented subjects, whereas task practice did not improve memory performance. The performance in the demented sample after long presentation times (20 s/item) does not reach the level of performance of the comparison group after short presentation times (1 s/item). Consequently, it seems unlikely that memory dysfunction is caused by increased item processing times in patients with dementia. To reach comparable performance of demented and controls for intervention or activation studies, presentation times must be shortened below 1 s/item in the control sample.

IMPROVEMENT OF PICTURE RECALL BY REPETITION IN PATIENTS WITH DEMENTIA OF ALZHEIMER TYPE

The evidence for positive effects of repetition on recall performance in patients with dementia of Alzheimer type is equivocal. This may be due to the difference repetition conditions used. The aim of this study was therefore to evaluate the effects of different repetition modes on the improvement of recall performance in demented subjects. Twenty‐four patients with Alzheimer type dementia and 24 control subjects with remitted depression were included in the study. Pictures were presented repeatedly using different presentation modes at a constant total presentation time. Free recall was tested repeatedly after different periods of delay (0–8 hours). Immediate and delayed list repetition significantly improved recall performance in both groups. Within‐list repetition did not improve total recall in demented subjects. The repeated measurement design sensitively detected minor changes in recall performance. These were not observed using other measures of recall and recognition (hits, false alarms, indices of signal discrimination).

Effect of Repetition and Inspection Times on Picture Recall in Patients with Dementia of Alzheimer Type

The present study is part of a series of systematic studies intended to identify simple strategies of picture presentation to improve recall performance in demented subjects. The aims of this design were to examine the effects of elaboration by naming, 4-fold repetition and different inspection times on memory performance. 19 patients with senile dementia of Alzheimer type and 21 control subjects with remitted depression were included. Picture recall was examined using different presentation conditions on 5 consecutive days. The presentation conditions significantly influenced recall performance depending on the diagnosis and on the delay of recall. Naming of pictures did not improve later recall or recognition. In both groups repetition improved memory performance. Shorter presentation times deteriorated immediate and delayed memory performance in comparison with the control condition. Forgetting did not depend on picture inspection times in patients and control. This observation allows the use of different presentation times for further comparisons of interventions in patients and control. Even though we could provide evidence of some minor memory improvements after some interventions, i.e. prolonged inspection time and repetition, we suppose that the cognitive reserve capacity in demented subjects is limited and does not allow major memory improvements.

Psychometric Analysis of the Selective Reminding Procedure in a Sample from the General Elderly Population

The selective reminding procedure (SRP) has been proposed for the assessment of distinct aspects of episodic memory, i.e. storage to and retrieval from short-term and long-term memory, item learning and list learning, and as dementia screening tool. In the present study SRP results were analysed in 256 probands from the general elderly population. SRP scores were highly intercorrelated, and principal component analysis yielded only one single factor. The SRP scores were moderately and not differentially correlated with immediate and delayed free recall and recognition and with verbal fluency. All SRP scores discriminated nondemented probands with episodic long-term memory impairment from those without. The MMSE performed significantly better than any SRP score in detecting dementia. The theory-based assumption that the SRP allows assessment of different, independent aspects of memory could not be validated. It is suggested that the SRP is a mixed measure of semantic memory, episodic long-term and short-term memory, and working memory, and that the different SRP scores do not allow to assess different memory functions. Thus, the SRP may neither be recommended for assessment of different subfunctions of memory nor for dementia screening.