Ove Dehlin

Comparison of six depression rating scales in geriatric stroke patients.

We compared three self-rating scales (the Geriatric Depression Scale, the Zung Scale, and the Center for Epidemiologic Studies Depression Scale) with three examiner-rating scales (the Hamilton Rating Scale, the Comprehensive Psychopathological Rating Scale-Depression, and the Cornell Scale), to see which was best for 40 elderly (mean age 80 years) stroke patients, 17 of whom were depressed according to clinical examination. External validity and concurrent validity were good for all except the Cornell Scale. Reliability (internal consistency) showed that some items were not significantly correlated, which might be explained by our selection of the patients. The Geriatric Depression Scale, the Zung Scale, and the Comprehensive Psychopathological Rating Scale-Depression had the highest sensitivity, and the Zung Scale had the highest positive predictive value (93%). With regard to internal consistency, sensitivity, and predictive value, the best self-rating scales were the Geriatric Depression and the Zung scales and the best examiner-rating scale was the Comprehensive Psychopathological Rating Scale-Depression.

The clock-drawing test

The clock-drawing test is used for screening forcognitive impairment and dementia and as a measureof spatial dysfunction and neglect. It was originallyused to assess visuo-constructive abilities but we knowthat abnormal clock drawing occurs in other cognitiveimpairments. Doing the test requires verbal under-standing, memory and spatially coded knowledge inaddition to constructive skills [1]. Education, age andmood can influence the test results, with subjects oflow education, advanced age and depression perform-ing more poorly [2 - 4].

Social Relationships and Health as Predictors of Life Satisfaction in Advanced Old Age: Results from a Swedish Longitudinal Study

This longitudinal study examines the relationship between family and friend social support, health, and life satisfaction for a single cohort of eighty-year-old persons living in Lund, Sweden. Results indicate that participants who remained in the study are healthier and score higher on life satisfaction when compared with those who either drop-out or die prior to age eighty-three. Even though well-integrated with family and friends, the number of friends decreases significantly from eighty to eighty-three years; those who reported no close friends nearly doubled from eighty to eighty-three years. However, for those with close friends, contact with friends increases with age. In contrast to previous research, a correlational analysis indicates that neither child nor friend support is related to life satisfaction at either eighty or eighty-three years. However, health measures and satisfaction with sibling contact are related to total life satisfaction at age eighty-three only. These findings indicate the multidimensionality of both social support and life satisfaction for the old-old.

Insomnia in an 80‐year‐old population: Relationship to medical, psychological and social factors

In this study, insomnia in 80‐year‐olds was related to medical, psychological and social factors. The data were based on examinations every year in people aged between 80 and 89 years. Of 333 people living in the city of Lund and born in 1908, 67% participated. Increased severity of insomnia was significantly associated with use of diuretics, other cardiovascular drugs, hypnotics and laxatives, and with nervousness, difficulty relaxing, anorexia, nausea, constipation, backache, feeling cold, sweating, loss of weight, dizziness, depression, general fatigue, exhaustion, angina pectoris, cardiac insufficiency, worsened objective and subjective health, presence of negative T‐waves on ECG, anxiety, total life satisfaction, neuroticism, disbelief in a just world, feeling lonely and lower survival rates. Thus insomnia has widespread associations with different aspects of life in 80‐year‐olds.

Neglect in elderly stroke patients: A comparison of five tests

Abstract  Neglect is a disabling state in stroke patients. Five tests for visuo‐spatial neglect, star cancellation, line crossing, line bisection, draw a clock and copy a cross, were compared in 57 elderly patients. Sensitivity and intercorrelations between the tests were determined. Patients with neglect were studied as regards their activities of daily living, motor activity and cognition. Left‐hemisphere neglect in patients with right‐hemisphere lesions was more severe than right‐sided neglect in patients with left‐sided lesions in the star cancellation test. Sensitivity of the tests was moderate for star cancellation, line bisection and draw a clock, and low for line crossing and copy a cross. Significant correlations existed between the tests and cognitive and functional ability. Intercorrelations between the tests were moderate. Neglect patients showed a slower recovery after 6 and 12 months. Draw a clock and copy a cross displayed no sensitivity for neglect in patients with hemianopia, which may be due to the fact that these tests also evaluate constructional apraxia. The cancellation tests were influenced by hemianopia and there is evidence that hemianopia exacerbates neglect. This study shows that a battery of neglect tests is required to diagnose the neglect syndrome.

A double‐blind comparison of alaproclate and placebo in the treatment of patients with senile dementia

ABSTRACT– A double‐blind parallel comparison of alaproclate and placebo was carried out in patients suffering from senile dementia of primary degenerative type, or multiinfarction dementia. Both groups consisted of 20 patients each, valid for efficacy evaluation. The patients received either alaproclate 200 mg twice daily or placebo according to a randomized procedure. The study started with a placebo washout period of 2 weeks followed by a 4‐week period of active treatment or placebo and a finishing 2‐week placebo washout period. The efficacy was evaluated with a dementia rating scale by Gottfries, Brane and Steen (GBS), selected items from the Comprehensive Psychopathological Rating Scale (CPRS), a rating scale for dementia adapted for nurses, and by clinical global evaluations. No difference in efficacy between the two treatments was observed with the exception of the intellectual factor of the GBS scale, where a statistically significant improvement was detected in the alaproclate group compared with the placebo group. There were no serious adverse symptoms.

Incidence and risk factors for depression and anxiety disorders: results from a 34-year longitudinal Swedish cohort study.

This study is based on a total cohort (N = 192) of people born in 1902 and 1903 and living in southern Sweden. Subjects were assessed at baseline when 67 years of age and on eight further occasions over 34 years or until death. The participation rate in the nine examinations ranged from 78–100%. Interviews, psychological tests, and medical examinations were used as well as information on medical diagnoses from primary health care records and hospital records. The cumulative probability for the development of clinical depression during the follow-up was 8% and for anxiety 6%. The incidence rate for depression and for anxiety was highest during the period 67–81 years. Persons with poor financial status were more likely to be diagnosed with depression but no significant risk factor for anxiety was found. Only 14% developed depression and anxiety during the follow-up period, females more often than men. The strongest risk factors for the development of depression were perceived economic problems.

Plasma homocysteine in 80-year-olds Relationships to medical, psychological and social variables.

Plasma homocysteine concentrations in a group of 80-year-old persons were related to symptoms and signs. Plasma homocysteine concentrations higher than 15 micromol/l were associated with lower total life satisfaction (P<0.01), mood (P<0.05), zest for life (P<0.05), lower scores for reasoning (P<0.05), spatial ability (P<0.05), memory recognition (P<0.05), and subjective health (P<0.01). In an instrument comprising of 30 symptoms, plasma homocysteine concentrations higher than 15 micromol/l were associated with impaired concentration (P<0.05), restlessness (P<0.05), feeling cold (P<0.05), loss of weight (P<0.05), and feeling depressed (P<0.01). The above data indicate that plasma homocysteine values over 15 micromol/l could be relevant markers for clinical intervention.

Depression in stroke patients with left and right hemisphere lesions. A study in geriatric rehabilitation in-patients

To analyze possible differences in depression rate and symptomatology in stroke patients with left and right hemisphere lesions, ninety- three patients in geriatric rehabilitation wards with a mean age of 76 years were studied. A clinical psychiatric examination was used together with two depression rating scales. Depression prevalence was 46%, and there was no difference between left and right hemisphere lesions. Mean depression scores in the two rating scales showed no significant difference regarding location of lesions. It is concluded that in this elderly, moderately handicapped, stroke population there was no significant difference in depression rate between patients with left and right hemisphere lesions. (Aging Clin. Exp. Res. 6: 49- 56, 1994)

Zopiclone to Geriatric Patients

Zopiclone was given for 14 nights to 68 geriatric patients (mean age 81 years) with sleep problems. The patients were randomly allocated to four treatment groups: 3.75 mg, 5.0, 7.5, or 10.0 mg of zopi