Stephen Curran

Critical flicker fusion threshold: a potentially useful measure for the early detection of Alzheimer's disease.

Critical Flicker Fusion Threshold (CFFT) is a psychophysical threshold and, in psychological terms, it is regarded as a measure of information processing capacity. CFFT has previously been shown to be a valid and reliable measure in young healthy volunteers and it also has a long history of use as a psychopharmacological measure in this group. Furthermore, the test satisfies many of the requirements of an ‘ideal’ measure for monitoring change, especially in a psychopharmacological context. Despite this, CFFT has been neglected as a research tool in elderly and Alzheimers disease (AD) populations and was therefore investigated further in this regard. CFFT in community‐based healthy elderly subjects was normally distributed, but CFFT and ascending and descending thresholds were not significantly correlated with age. The difference between ascending and descending thresholds was, however, significantly correlated with age and this relationship appeared to be due almost entirely to a change in the descending threshold. In addition, descending thresholds were found to be significantly greater than ascending thresholds in healthy elderly subjects. In contrast, patients with AD were found to have significantly lower CFFT and descending scores compared with healthy elderly subjects. Interestingly, descending thresholds were significantly lower than ascending thresholds in the patient group, a feature that may be a characteristic of AD. Mean CFFT and ascending and descending thresholds were found to have a high test–retest, split‐half and inter‐rater reliability, in addition to being significantly correlated with a number of psychometric measures, clinical scales and neuropsychological instruments commonly used to assess patients with AD. CFFT is a quick and simple measure to administer and patients had no difficulty completing the test. Because the measure is a psychophysical threshold, it is free from educational and cultural bias and there are no floor or ceiling effects. From the results of this work, CFFT appears to be a useful research tool in AD. It may be a suitable measure for monitoring cognitive change over time, either in community studies of AD or a clinical trial context, but further work is required. The technique might also contribute to the early detection of AD. This application would be particularly important because it would enable effective pharmacotherapies to be started early during the course of the illness before neuronal damage is too advanced and this would have significant benefits for patients. Copyright

Use of donepezil for the treatment of mild-moderate Alzheimer's disease: an audit of the assessment and treatment of patients in routine clinical practice.

There have been a number of randomised, placebo‐controlled trials of donepezil in the treatment of mild – moderate Alzheimers disease and these report significant benefits for a proportion of patients. Little is known about the use of donepezil in routine clinical practice. The aims of this study were to examine the use of donepezil in routine clinical practice and to identify some of the practical and resource implications associated with treatment. A number of areas were examined against published guidelines including assessment, diagnosis, initiation of treatment, monitoring and discontinuation of treatment. This was a retrospective case note study involving patients with mild – moderate Alzheimers disease over a one‐year period. One hundred and seventeen patients were commenced on donepezil and 93 successfully completed three months of treatment. Of these, 47% demonstrated an improvement in cognition, activities of daily living or carer observation (or a combination). Compliance with accepted guidelines with respect to assessment, diagnosis and monitoring requires a standardised approach that has both clinical and resource implications. Copyright

The impact of location on satisfaction with dementia services amongst people with dementia and their informal carers: a comparative evaluation of a community-based and a clinic-based memory service

BACKGROUND The development of effective medication for the treatment of Alzheimers disease led to an expansion in the use of memory clinics ther clinic-based services for the delivery and monitoring of the drugs. In contrast, there is an increased emphasis on providing home and community based service delivery for a range of illnesses including dementia. METHODS This paper reports the findings of an evaluation study comparing a clinic-based and a community service. A convenience sample of 10 service users and carer dyads took part in in-depth qualitative interviews. Service users were diagnosed with mild to moderate dementia of Alzheimers type. Interviews were recorded, transcribed and subsequently analyzed using template analysis. RESULTS Service users and carers were satisfied with both services, with determinants of satisfaction differing between the two services. Issues relating to the location and spatial design of services, comfort, familiarity, communication with staff, and ease of use are highlighted as important determinants of satisfaction amongst service users and their carers. CONCLUSION This study has implications for person-centred care practices in service delivery and for the future design of mental health services for people with dementia.

Practical management of dementia : a multi-professional approach

Dementia in the new millennium. Epidemiology of dementia. Diagnosis and classification. Early detection of dementia. The role of the clinical psychologist in the assessment, diagnosis and treatment of patients with dementia. The role of the physician for the elderly in the assessment, diagnosis and treatment of patients with dementia. The general practitioners perspective. The role of the nurse in the assessment, diagnosis and management of patients with dementia. Dementia: an occupational therapists perspective. Social aspects of the assessment and treatment of dementia. Towards practical service delivery for younger people with dementia. Understanding behavioural change in dementia. Legal aspects of management. Spiritual aspects of dementia. Comprehensive and integrated mental health services for people with dementia. The role of service users and carers in helping to develop and improve services for people with dementia.

Hypnosedatives and anxiolytics

Publisher Summary This chapter focuses on hypnosedatives and anxiolytics drugs including alprazolam, diazepam, flunitrazepam, lorazepam, midazolam, triazolam, and other drugs. In a double-blind, placebo-controlled, crossover study, 18 healthy male volunteers took a single dose of alprazolam 0.75 or 1.75 mg or placebo in randomized order. Performance on cognitive tests included immediate and delayed recall, digit symbol substitution, critical flicker fusion, and choice reaction time as well as subjective ratings. Alprazolam impaired cognitive performance and subjective sedation in a dose-dependent manner. Baclofen can reduce the symptoms of the alcohol withdrawal syndrome and has been compared with diazepam in 37 patients, who were randomized into two groups. Baclofen 30 mg/day was given orally to 18 patients and diazepam 0.5–0.75 kg/kg/day to 19 patients. The Clinical Institute Withdrawal Assessment was used to evaluate physical symptoms of alcohol withdrawal syndrome. Both baclofen and diazepam significantly reduced the score, and there were no significant differences between the two. When subscales for sweating, tremors, anxiety, and agitation were evaluated singly, baclofen and diazepam both significantly and equally reduced sweating, tremors, and anxiety. Both reduced the agitation score, although diazepam acted slightly more rapidly than baclofen.

Spiritually Competent Practice in Health Care

Features Presents a user friendly, readable and practical style Offers evidence-based approach Focuses on psychological, emotional and spiritual needs Helps practitioners to distinguish religion from spirituality and understand the relationship between them Highlights the cultural and organizational issues that must be addressed to support spiritually competent care Summary This practical guide tackles the important issues of spirituality in health care, emphasising the role of organisations in developing a culture of leadership and management that facilitates spiritual care. Spirituality is a central part of holistic care that addresses physical, mental, emotional and spiritual aspects of care in an integrated way. The chapters are written by experts in their fields, pitched at the practitioner level rather than addressing ‘spirituality’ as a purely theoretical concept. Each one describes the realities of spiritually competent practice and show how it can be taught and put into practice in a variety of areas and settings, including 　　　　　　　　 Undergraduate and Postgraduate education 　　　　　　　　 Acute healthcare settings 　　　　　　　　 Mental health 　　　　　　　　 Primary care 　　　　　　　　 End of Life Care 　　　　　　　　 Creative organisations 　　　　　　　　 Social services Ideal for practitioners, educators, trainees and managers in nursing and healthcare, the book is also relevant reading for occupational therapists, physiotherapists, social workers and psychologists.

Practical Management and Leadership for Doctors

How can you survive and thrive as a medical manager in the ever-changing world of healthcare? Practical Management and Leadership for Doctors is a hands-on introduction to developing the knowledge, skills, attitudes and behaviour required to succeed in a modern healthcare setting. Combining their own vast experience with insights from management literature, the authors reflect on key strategies and competencies for successful and enjoyable medical management and leadership. Focussing on common issues and challenges, they examine oganisational structures and strategies for productive relationship-building, goal setting and quality maintenance. The book also stresses the importance of maintaining personal well-being and balance in the face of sometimes seemingly impossible demands. Written in a punchy, engaging style that inspires and stimulates, this book will prove useful to all doctors new to formal management and leadership, including directors and clinical leads, and doctors working or preparing to work at a senior level.

The importance of spirituality in caring for patients

Key points: According to the GMC, attention to spiritual issues is expected as part of a medical assessment. 1. Spirituality is hard to define precisely but it can be understood as what gives meaning and purpose and a sense of connectedness to life. 2. Religion and spirituality overlap but are distinct and there are non-religious as well as religious approaches to spirituality. 3. Serious illness and injury may challenge patients’ spirituality and clinicians need to be sensitive to this and provide or arrange support as appropriate to meet their spiritual needs. 4. Training to address these issues is in its infancy in the UK, though nursing research has identified key competencies than can be applied to medicine, too. 5. The present challenges in the NHS mean we need to pay particular attention to organisational issues related to spirituality.

Chapter 5 - Hypnosedatives and Anxiolytics

Hypnosedatives and Anxiolytics are commonly prescribed drugs. This chapter presents an overview of adverse effects of hypnosedatives and anxiolytics published in recent years. This chapter covers some benzodiazepines (Alprazolam, Clobazam, Clonazepam, Clonazepam, Diazepam, Midazolam, and Lorazepam), benzodiazepine-like drugs (Eszopiclone, Zaleplon, Zolpidem, and Zopiclone), and Dexmedetomidine.