Geriatric Mental State Schedule Research Articles

Depression and risk of cognitive decline and Alzheimer's disease. Results of two prospective community-based studies in The Netherlands.

Depression may be associated with cognitive decline in elderly people with impaired cognition. To investigate whether depressed elderly people with normal cognition are at increased risk of cognitive decline and Alzheimer's disease. Two independent samples of older people with normal cognition were selected from the community-based Amsterdam Study of the Elderly (AMSTEL) and the Longitudinal Aging Study Amsterdam (LASA). In AMSTEL, depression was assessed by means of the Geriatric Mental State Schedule. Clinical diagnoses of incident Alzheimer's disease were made using a two-step procedure. In LASA, depression was assessed with the Center for Epidemiologic Studies Depression Scale. Cognitive decline was defined as a drop of > or = 3 on the Mini-Mental State Examination at follow-up. Both in the AMSTEL and the LASA sample, depression was associated with an increased risk of Alzheimer's disease and cognitive decline, respectively, but only in subjects with higher levels of education. In a subgroup of more highly educated elderly people, depression may be an early manifestation of Alzheimer's disease before cognitive symptoms become apparent.

Psychiatric morbidity in elderly patients admitted to non-psychiatric wards in a general/teaching hospital in Nigeria.

To determine the mental morbidity rate and types of disorders in elderly patients admitted to non-psychiatric wards of a teaching hospital in Nigeria; the ability of the non-psychiatrists to recognise the mental disorders was also assessed. All subjects aged 60 years and above who were admitted into the medical, surgical and gynaecological wards were assessed with the Self-Reporting Questionnaire, Mini Mental State Examination and the Geriatric Mental State Schedule. Diagnoses of mental disorders were made with the ICD-10 Diagnostic Criteria for Research. The patients' case records were then examined to determine the medical and any mental disorder diagnoses made by the attending physicians. The data were analysed by the SPSS/PC(+) computer package. The mental morbidity rate was 45.3% with depression being the commonest disorder, followed by organic disorders (delirium and dementia), adjustment disorder and generalised anxiety disorder. There were also cases of alcohol and drug abuse. The physicians recognised only 2.8% of the mental disorders and referred one dementia patient to the mental health team. The negative predictive value for the physicians was poor. Non-psychiatrist medical practitioners in Nigeria need adequate training in mental health to enhance their ability to recognise psychiatric disorders.

The pattern of psychiatric disorders among the aged in a selected community in Nigeria.

To describe the common mental disorders in elderly Nigerians living at home. A house-to-house survey of a rural community was conducted to identify subjects who were aged 60 years and above. The subjects were interviewed with the Self-Reporting Questionnaire (SRQ-24) and the Geriatric Mental State Schedule (GMS). Psychiatric syndromal diagnoses were made with the Clinical and Research ICD-10 manuals (ICD-10/ICD-10, DCR). The overall rate of major mental disorders was 23.1%, with depression constituting 79% of all the diagnoses. Specific dementia disorders were not found in any of the subjects (N=164), but 20.7% complained of forgetfulness. Use of tobacco (snuff), (local) alcohol, and other substances were common. No subject with any identified disorder was receiving any medical attention. The study reveals the same range of mental disorders as in studies carried out elsewhere. This suggests that if similar methodologies are used, the mental morbidity rates among the elderly in different parts of the world may be about the same. There is a need for adequate planning to accommodate the social security and mental health needs of old Nigerians.

Mental health. Cross-European mental health indicators. A dream or a reality?

Background: Life expectancy has increased in most European countries, but the value of this additional lifespan in terms of mental and physical health is unclear. To afford cross-national research into this area the Euro-REVES project was set up to promote harmonization of health expectancy calculations. One part of the project's work was to ascertain the current level of harmonization of mental health indicators. Methods: A census was conducted of studies undertaken since 1980 which included a mental health component, using a cascade approach and advertisements in European journals. Information for each study included size, age range, design (cross-sectional or longitudinal), Indicators and scales used. Responders were also asked to identify the major mental health priorities in their country. Results: To date information has been received on 60 studies from 12 European countries. Dementia and depression were consistently identified as common mental health priorities. Over half (39) of the studies were longitudinal in design, with sizes ranging from 15 to 25,000. The Mini Mental State Examination (MMSE) was included in 53% (32) of studies, with 25% (15) including the Geriatric Mental State Schedule (GMS) and 20% (12) the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) schedule. A large proportion (50%) of studies were of older people, reflecting the priority of dementia. Conclusion: This study demonstrated that harmonization of mental health indicators across Europe is more advanced than for other health indicators. Recommendations are made for further improvements in the collection of cross-European comparative information for mental health.

Cognitive reserve and mortality in dementia: the role of cognition, functional ability and depression.

This study examined whether dementia patients with greater cognitive reserve had increased mortality rates, and whether this association was different across strata of cognition, functional ability and depression. In the community-based Amsterdam Study of the Elderly, 261 non-institutionalized dementia patients, identified using the Geriatric Mental State Schedule (GMS), were followed for an average of 55.5 months after which mortality data were obtained. Cognitive reserve was indicated by years of education and pre-morbid intelligence (measured using the Dutch Adult Reading Test). Cognition, functional ability and depression were indicated by Mini-Mental State scores, ADL and IADL measurements and GMS depressive syndrome, respectively. During the follow-up 146 persons (55.9%) died. Cox regression analyses showed that more highly educated dementia patients had higher mortality rates, only if they had low MMSE scores or if they had a concurrent depression. Pre-morbid intelligence was associated with a higher mortality rate, independent of cognition, but this association was much stronger among patients with depression. The positive association between education or intelligence and mortality was not modified by functional disabilities. The results suggest that dementia patients with greater cognitive reserve have increased mortality rates, only if the disease has progressed to such an extent that clinical symptoms are more severe. In this respect, the reserve hypothesis needs a modification. Depression in dementia patients with greater cognitive reserve may reflect a subgroup of patients with poor prognosis.

Behavioural management in nursing and residential homes: a randomised controlled trial

As more and more elderly people are being cared for in residential and nursing homes, how best can their psychiatric needs be met? We report on evaluation of a behavioural intervention by an old-age psychiatry hospital outreach team. This randomised controlled trial of a training and education intervention over 6 months was done in south Manchester, UK. 12 matched nursing and residential homes were randomised to the control or intervention group and within each, the staff selected 10 residents whose behavioural problems made them difficult to care for. Care staff in the intervention homes attended seminars from the hospital outreach team and received weekly visits from a psychiatric nurse to assist in developing care planning skills. The main outcome measures were cognitive impairment and depression, behavioural disturbance, and functional ability, assessed by the geriatric mental state schedule, Crichton Royal behaviour rating scale, and Barthel index, respectively. Residents in the intervention group had significantly improved scores for depression (before-and-after change difference -0.5 [95% CI -0.8 to -0.1]) and for cognitive impairment (-0.7 [-1.1 to -0.2]) but not for behaviour rating or Barthel index. Elderly residents can benefit from improved quality of care achieved by training from a hospital outreach team.

Mental health of the elderly Chinese population in Singapore.

A study of 804 elderly Chinese in Singapore was conducted to assess physical health, mental health and social support. The questionnaire was derived from the Older American Resources and Services and the Geriatric Mental State Schedule. The results showed that the majority of elderly people in the survey (94%) were able to live independently, only 9.3% had mental disorders and 78% of the sample had good social resources meaning that relationships were good and family care was available.

An informant interview for the diagnosis of dementia and depression in older adults (IDD-GMS).

There has been no instrument developed for the differential diagnosis of psychiatric conditions using an informant. The present study describes the development and validation of an informant interview for the diagnosis of dementia and depression in older adults (IDD-GMS). The IDD-GMs, as its name indicates, is based upon the well-established Geriatric Mental State Schedule (GMS). Thirty older adults with psychiatric illnesses were identified. An informant/career was interviewed using the IDD-GMS. Questions from the GMS were altered to reflect the informant nature of interview. Validity was compared to ICD-10 diagnoses. Interrater reliability was determined. Using a hierarchical diagnostic system, receiver operating characteristics demonstrated one optimal cutpoint for sensitivity, > 13 for dementia and > 16 for depression, and one for specificity, > 13 for dementia and > 10 for depression. The validity and reliability of the IDD-GMS falls within acceptable limits and indicates that the IDD-GMS can be used as a diagnostic instrument for dementia and depression. The IDD-GMS represents the first informant interview to achieve this.

Apolipoprotein E phenotype is not related to late-life depression in a population-based sample.

Apolipoprotein E (ApoE) allele frequencies were examined in a population-based sample (n = 475: age range 65-84 years: Amsterdam Study of the Elderly). The relation of ApoE epsilon 4 with dementia and with various types of late-life depression was studied. Depression was measured with the Geriatric Mental State schedule. Dementia was diagnosed by DSM-III-R criteria. It was expected that ApoE epsilon 4 allele frequencies would be elevated not only in Alzheimer's disease and dementia in general, but also in first episode, late-life depression accompanied by subtle cognitive impairment (possibly organic depression). However, the results indicated that epsilon 4 allele frequency is related to (family history of) dementia and cognitive impairment, but not to possibly organic depression. The main predictor of late-life depression is an episode of psychiatric problems before the age of 65 years.

Subjective memory complaints in the elderly: depressive symptoms and future dementia.

Population studies indicate that subjective memory complaints by elderly people are correlated with cognitive performance. These complaints have some predictive power regarding the development of dementia. The present study attempted to replicate this finding, and investigated which variables determine subjective memory complaints. Participants in the Amsterdam Study of the Elderly (n = 2114; 65-84 years of age), who were not demented and had a normal MMSE score (> 23) at baseline, were re-examined after four years. Subjective complaints were measured using a previously developed scale. Dementia and depression were measured using the Geriatric Mental State Schedule (GMS). Premorbid intelligence was measured by the Dutch Adult Reading Test (DART). Memory complaints at baseline contributed a small but significant amount of diagnostic information with respect to the prediction of future dementia. Depressive symptoms at baseline had no predictive value when these memory complaints were accounted for. Subjective memory complaints were associated with depression, baseline MMSE score, and premorbid intelligence. Subjective memory complaints are not just secondary to depression, but in part reflect realistic self-observations of cognitive decline.

Experience with a Swedish version of the Geriatric Depression Scale in primary care centres.

The purpose of this study was to use a Swedish version of the Geriatric Depression Scale (GDS-20) for diagnosis of depression in the elderly in primary care. Elderly consecutive patients visiting two primary care centres (> or = 65 years of age; N = 1189) were rated by educated nurses using the GDS-20. All elderly patients attending two primary care centres in an urban-based community in the south of Sweden. Of the 1189 patients interviewed, 1002 were rated using the GDS-20. The GDS-20, and in 26 patients also the Geriatric Mental State Schedule--Depression Scale (GMSS-DS). Of 1002 rated patients, 93 had scores of 5 or above on the GDS-20. Further analysis showed that 158 (13.3%) suffered from affective disorders. Depression in the elderly is underdiagnosed in primary care centres. A screening instrument such as the GDS-20 is of value in identifying the patients.

Experience with a Swedish version of the Geriatric Depression Scale in primary care centres

Objective. The purpose of this study was to use a Swedish version of the Geriatric Depression Scale (GDS-20) for diagnosis of depression in the elderly in primary care. Design. Elderly consecutive patients visiting two primary care centres (⩾65 years of age; N = 1189) were rated by educated nurses using the GDS-20. Setting. All elderly patients attending two primary care centres in an urban-based community in the south of Sweden. Patients. Of the 1189 patients interviewed, 1002 were rated using the GDS-20. Measures. The GDS-20, and in 26 patients also the Geriatric Mental State Schedule—Depression Scale (GMSS-DS). Results. Of 1002 rated patients, 93 had scores of 5 or above on the GDS-20. Further analysis showed that 158 (13.3%) suffered from affective disorders. Conclusion. Depression in the elderly is underdiagnosed in primary care centres. A screening instrument such as the GDS-20 is of value in identifying the patients. © 1997 John Wiley & Sons, Ltd.

Carers' knowledge of dementia, their coping strategies and morbidity

The main hypothesis was that carers of dementia sufferers who have a higher level of knowledge on the subject of dementia have lower rates of physical and psychological morbidity. We also wanted to examine whether a carer's level of knowledge bears any relation to their attributional style and coping mechanisms. Informal carers, caring for patients who fulfilled the CAMDEX criteria for mild or moderate dementia, were approached to participate in the study. Old age psychiatry services in the West Midlands and Bristol. Informal carers, caring for relatives with dementia. Trained researchers administered the Geriatric Mental State Schedule, the Dementia Knowledge Questionnaire, the Pennebaker Inventory of Limbic-Languidness (an inventory of common physical symptoms) and the Carer Stress Scale. More knowledgeable carers experienced significantly lower levels of depression but also higher rates of anxiety. Carers' level of knowledge on the subject of dementia showed no association with their physical health. More knowledgeable carers were more likely to have 'reduced expectations' of their dependants' abilities and make 'positive comparisons'; they were also more likely to feel competent and confident as carergivers. The findings support the main hypothesis when considering carers' rates of depression but not when considering rates of anxiety or physical ill-health.

Psychiatric disorders in elderly from the Indian sub-continent living in Bradford

In our community study of the prevalence of psychiatric disorders among elderly South Asian immigrants from the Indian sub-continent (India, Pakistan and Bangladesh) living in Bradford (UK), we found depression in 20%, dementia in 4% and anxiety neurosis in 4%. Subjects were interviewed at their place of residence by a consultant psychiatrist familiar with their culture and language. The Hindi translation of the community version of the Geriatric Mental State schedule (GMS-A) was also administered. Psychiatrist's ICD-9 diagnosis was compared with GMS-AGECAT computerized diagnosis. We found low-level agreement in dementia cases (kappa 0.33) whereas the agreement in subjects with depression was high (kappa 0.81). In many subjects GMS-A made a diagnosis of dementia not diagnosed as cases by the psychiatrist, who had the benefit of additional history information from carers in this population from a different culture and educational background. These findings are discussed along with suggestions and present limitations of GMS-A in the diagnosis of dementia in cross-cultural research. Larger studies are needed in this population (a) to find out prevalence rates in countries of origin and (b) to investigate the author's (KB) observation of low rates of Alzheimer's type dementia in this population, which may have aetiological significance.

EATING DISORDERS IN DEMENTIA

To examine the prevalence and associations of altered eating patterns in dementia sufferers. Prospective cohort study. Psychiatric services and a memory clinic. 124 patients with DSM-III-R dementia. The Geriatric Mental State Schedule, the History and Aetiology Schedule, the Cornell Depression Scale and the CAMCOG. Additional standardized questions were asked about eating patterns in the month prior to the study. Information concerning eating patterns was obtained from 105 of the 124 patients: 21% had increased food consumption, 22.1% had decreased food consumption, 2.9% tried to eat inedible substances, 11.4% had an increased preference for sweet things, 7.6% became more fussy about their food choices and 4.8% became less fussy. Decreased food consumption was significantly associated with less severe cognitive impairment and was related to RDC major depression in some patients. An increased preference for sweet things showed an association with a diagnosis of Alzheimer's disease. Increased food consumption was probably heterogeneous. Neither increased food consumption nor an increased preference for sweet foods was associated with the severity of cognitive impairment. Altered eating patterns are common in dementia sufferers.

EATING DISORDERS IN DEMENTIA

Objectives. To examine the prevalence and associations of altered eating patterns in dementia sufferers. Design. Prospective cohort study. Setting. Psychiatric services and a memory clinic. Sample. 124 patients with DSM-III-R dementia. Measures. The Geriatric Mental State Schedule, the History and Aetiology Schedule, the Cornell Depression Scale and the CAMCOG. Additional standardized questions were asked about eating patterns in the month prior to the study. Results. Information concerning eating patterns was obtained from 105 of the 124 patients: 21% had increased food consumption, 22.1% had decreased food consumption, 2.9% tried to eat inedible substances, 11.4% had an increased preference for sweet things, 7.6% became more fussy about their food choices and 4.8% became less fussy. Decreased food consumption was significantly associated with less severe cognitive impairment and was related to RDC major depression in some patients. An increased preference for sweet things showed an association with a diagnosis of Alzheimer's disease. Increased food consumption was probably heterogeneous. Neither increased food consumption nor an increased preference for sweet foods was associated with the severity of cognitive impairment. Conclusion. Altered eating patterns are common in dementia sufferers. © 1997 John Wiley & Sons, Ltd.

COMORBIDITY OF DEPRESSION IN THE ELDERLY?AN EPIDEMIOLOGICAL STUDY IN A CHINESE COMMUNITY

This is an epidemiological study on the comorbidity of depression in a random sample of 1062 elderly Chinese aged 65 and over in Singapore, using the Geriatric Mental State (GMS) schedule and the data analysed by the computerized diagnostic program AGECAT. The overall prevalence of current (30-day) depression was estimated to be 6.0% (males 5.9%, females 6.1%). There were comorbid psychiatric disorders, predominantly anxiety, in 45.3% of depressed elderly. Using DSM-III-R criteria, the prevalence of major depression was 5.2% and dysthymia 0.2%, with comorbid psychiatric disorders, mainly generalized anxiety disorder, in 40% of major depression. The risk factor profile of the elderly with pure and comorbid depression showed significant differences. A past history of depression and lower level of education were risk factors for comorbid depression-but there was no significant difference between the two groups in sex, age, marital status or living arrangement.

Screening for depression: Clinical validation of geriatricians? diagnosis, The Brief Assessment Schedule Depression Cards and the 5-item version of the Symptom Check List among non-demented geriatric inpatients

In this study, two screening instruments for depression and geriatricians' diagnosis were compared against the Geriatric Mental State Schedule (GMS), a standardized semi-structured psychiatric interview. The Brief Assessment Schedule Depression Cards (BASDEC) achieved 91% sensitivity and 85% specificity using a cutoff score of 7. Its receiver operating characteristics (ROC) had an area under the curve (AUC) of 0.88, with 95% confidence intervals of 0.78 and 0.98. The 5-item version of the Symptom Check List (SCL-5) achieved 77% sensitivity and 74% specificity using a cutoff score of 10. Its AUC was 0.77, with 95% confidence intervals of 0.63 and 0.90. The p-value of the statistical difference between the two AUCs was 0.0554. The geriatricians' diagnosis had a kappa agreement coefficient of 0.39, sensitivity of 55% and specificity of 96%. They missed 45% of depressed patients. Routine screening with BASDEC would considerably improve the detection of depression. Even among those patients who did not appear depressed to the geriatricians, BASDEC would detect one case in every 10 patients.

Prevalence of Dementia in the Community: a Rural‐Urban Comparison from Madras, India

Two studies to estimate the prevalenlce of dementia, one in a rural and the other in an urban area, were conducted in Madras in South India. Seven hundred and fifty people aged 60 years and over, selected using the cluster sampling technique, constituted the rural sample. The urban sample comprised 1,300 people 65 years and over, selected using the multistage stratified random sampling technique. Both samples were interviewed using the Geriatric Mental State schedule (GMS). The prevalence of dementia was 3.5% in the rural and 2.7% in the urban setting and increased exponentially with age. Rural prevalence estimates were higher than the urban. Though gender differences were negligible in the rural setting, dementia rates were significantly higher among urban males in contrast to urban females. The paper compares the findings of the two studies and discusses their implications for India's growing elderly population in the context of age, literacy and gender.

A follow up study of depression in the carers of dementia sufferers.

Caring for people with dementia is stressful,1 and depression occurs in 30-50% of carers.2 Few data are available, however, about the course of depression or variables associated with the length of episodes, such as age, closeness of relationship, and non-cognitive symptoms among patients. We followed up a group of carers over a year to assess the length and determinants of depression. We recruited 124 patients with dementia as defined by DSMIIIR from consecutive referrals to psychiatric services in Birmingham (99) and a memory clinic in Bristol (25); 90% of those approached agreed to participate. One hundred and nine had informal carers, of whom 85 were followed up for one year. Carers were interviewed initially and every month with the geriatric mental state schedule and the …