William J. Burke

The nature of psychotic symptoms in senile dementia of the Alzheimer type.

The Alzheimer Disease Research Center at Washington Universitys medical school has gathered a large sample of subjects with senile dementia of the Alzheimer type (SDAT) who are free of other potentially complicating medical, neurologic and psychiatric disorders. Using this homogeneous population, we have characterized psychotic symptoms associated with SDAT. Three groups of symptoms occur commonly: paranoid delusions, misidentification syndromes, and hallucinations. The nature and frequency of these syndromes are discussed. (J Geriatr Psychiatry Neurol 1988;1:16-20).

The Reliability and Validity of the Geriatric Depression Rating Scale Administered by Telephone

OBJECTIVE: To evaluate prospectively the reliability and validity of the Geriatric Depression Scale administered by telephone (T‐GDS) in patients undergoing outpatient comprehensive geriatric assessment.

Symptoms Of “depression” In Dementia Of The Alzheimer Type

The frequency of symptoms of depression (Feighner criteria) was evaluated in subjects with dementia of the Alzheimer type (DAT) and matched controls enrolled in a longitudinal natural history study of DAT. Despite enrollment criteria which excluded subjects with affective disorders, the collateral sources of subjects with DAT described these subjects as having significantly more “depressive” symptoms than controls without dementia at entry, and at 15− and 34-month follow-up. The collateral sources of the subjects with DAT reported that these demented individuals experienced significantly greater loss of interest, decreased energy, difficulty in thinking and concentrating, and psychomotor agitation or retardation then did the control group. The subjects with DAT reported fewer symptoms than did their collateral sources, but like their collateral sources, they did not report a global elevation of all Feighner symptoms, but rather related significantly greater difficulty in thinking and concentrating than the controls and a tendency toward loss of interest and psychomotor changes. No subject became clinically depressed.The results suggest a significant overlap between the symptoms of dementia and depression. The frequency with which the above symptoms occur in DAT confounds the use of Feighner and, by extension, DSM-III criteria in diagnosing depression in cognitively impaired individuals with DAT.

The Safety of ECT in Geriatric Psychiatry

Electroconvulsive therapy (ECT) is often described as an effective and safe treatment of depression in the elderly. However, we have previously reported that there may be increased morbidity in this population, particularly in the very old. This paper extends this work to a second, larger sample of 136 subjects of whom 40 are over 60 years of age. We have again found that while ECT is efficacious, complications increase with age (r = .26; P ≤ .003), occurring in 35% of the elderly as opposed to 18% of the younger group. This increased rate of complications appears to be accounted for by problems in the very old; six of eight subjects over 75 years of age had some untoward event. Common complications in the elderly included severe confusion, falls, and cardiorespiratory problems. Complications in the whole sample were related to health status (r = .22; P ≤ .008) which in turn correlated with age (r = .50; P ≤ .0001). Those taking a greater total number of medications and a greater number of cardiovascular medications had significantly more complications during ECT. There was no relationship between either complications and outcome or complications and the number or laterality of treatments.

Electroconvulsive therapy and the elderly

Abstract The efficacy and safety of electroconvulsive therapy (ECT) in the elderly was examined by review of the charts of all patients age 60 and over receiving ECT over a nine-month period (n = 30). Eighty-three percent of all patients improved; ninety-two percent of those with major affective disorder or schizoaffective disorder improved. One-third of the patients experienced an adverse event during the course of ECT; these events were concentrated in the oldest patients in the sample (P ≤ 0.001). ECT was found to be efficacious but should be used with caution, particularly in those over the age of 75 years with cardiovascular disease.

Improvement of Debilitating Tardive Dyskinesia with Risperidone

This case vignette illustrates dramatic improvement of tardive dyskinesia (TD) in an elderly female with a long history of neuroleptic exposure, following treatment with low-dose risperidone. The TD continued to be in remission at 1-year follow-up. This observation calls for well-designed randomized studies to evaluate the efficacy of risperidone in treating TD.

Aldehyde dehydrogenase variation enhances effect of pesticides associated with Parkinson diseaseAuthor Response

In their article on aldehyde dehydrogenase variation and effect on pesticides associated with Parkinson disease (PD), the conclusions of Fitzmaurice et al.1 are based on the findings that 3,4-dihydroxyphenylacetaldehyde (DOPAL) is toxic to dopamine neurons. They stated: “We previously …

ASSOCIATION OF ANOSMIA WITH AUTONOMIC FAILURE IN PARKINSON DISEASE

Goldstein et al.1 report a link between anosmia and autonomic failure resulting in orthostatic hypotension and cardiac sympathetic denervation in Parkinson disease (PD). They postulate that the common factor explaining these disparate PD symptoms is the loss of noradrenergic (NA) neurons in the brain and periphery.1 Others have also …