Organic Brain Syndrome Scale Research Articles

Treatment of cobalamin deficiency in dementia, evaluated clinically and with cerebral blood flow measurements.

We investigated the relation between cobalamin deficiency, clinical changes and brain function in dementia patients. On admittance to the clinic, 24 patients had cobalamin deficiency, and dementia with additional symptoms of delirium. During cobalamin supplementation, the patients underwent repeated regional cerebral blood flow (rCBF) studies, psychiatric evaluations, and in some cases assessment with MMSE and the Organic Brain Syndrome scale. Fifteen patients who showed mild to moderate dementia improved clinically, and also showed a concomitant increase in their general CBF after treatment. In contrast, 9 patients who were severely demented showed no obvious clinical improvement, and no general blood flow change, although some regional flow increases were seen in sensory motor areas. We conclude that symptoms which probably indicated superimposed delirium such as clouding of consciousness, disorientation and clinical fluctuation, responded to the vitamin B12 supplementation, while the underlying dementia condition remained basically unchanged. The clinical improvement was also mirrored in general and focal rCBF changes.

Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly.

A prevalence study of psychiatric symptoms was performed in parts of a hospital catchment area in Mid-Sweden. In total 717 patients, aged 75 years and above, who were receiving care in an emergency hospital, three nursing homes, five old people's homes and two home medical care districts were included. All patients were examined using the OBS-scale (Organic Brain Syndrome Scale). Anxiety (51%), psychomotor slowing (45%), delirium (44%), depressed mood (41%), irritability (40%) and dementia (33%) were the most prevalent psychiatric symptoms or diagnoses in the sample but there were wide differences between the four care settings. The present study shows that the prevalence of dementia, delirium and psychiatric symptoms is high in all types of care settings for the elderly. It also demonstrates the need for psychiatric medical and nursing competence in all types of care for the elderly.

Cognitive impairment and social distress as different pathways to depression in the elderly: a cross‐sectional study

Background. This study investigates the recent suggestion that some putative aetiological factors for depression, such as cerebral deterioration and social distress, may act differentially in the aetiology of depression in old age. Method. In a cross-sectional study, a community sample of 654 elderly subjects were interviewed with Short-CARE to assess the prevalence of depression and cognitive impairment. Information was collected for a variety of potential risk factors for depression such as exposure to social support deficit, threatening life events, impairment, disability and handicap. Results. The prevalence of depression was 17% and that of a broad concept of cognitive impairment 23.9%. This analysis found associations between depression and exposure to social support deficits and threatening life events in the year prior to interview. These associations were considerably stronger for those subjects with no cognitive impairment than for those with cognitive impairment. We also found a progressive lowering in the strength of these associations the higher the chance of cognitive impairment measured as a longitudinal variable using both the Dementia Diagnostic Scale (DDS) and the Organic Brain Syndrome Scale (OBS) included in Short-CARE. Conclusions. The results of this theory-driven analysis lend some support to the notion of at least two differential pathways to depression in the elderly, one via social distress factors and another mediated by cerebral deterioration clinically expressed as cognitive impairment. © 1997 John Wiley & Sons, Ltd.

Cognitive impairment and social distress as different pathways to depression in the elderly: a cross-sectional study.

This study investigates the recent suggestion that some putative aetiological factors for depression, such as cerebral deterioration and social distress, may act differentially in the aetiology of depression in old age. In a cross-sectional study, a community sample of 654 elderly subjects were interviewed with Short-CARE to assess the prevalence of depression and cognitive impairment. Information was collected for a variety of potential risk factors for depression such as exposure to social support deficit, threatening life events, impairment, disability and handicap. The prevalence of depression was 17% and that of a broad concept of cognitive impairment 23.9%. This analysis found associations between depression and exposure to social support deficits and threatening life events in the year prior to interview. These associations were considerably stronger for those subjects with no cognitive impairment than for those with cognitive impairment. We also found a progressive lowering in the strength of these associations the higher the chance of cognitive impairment measured as a longitudinal variable using both the Dementia Diagnostic Scale (DDS) and the Organic Brain Syndrome Scale (OBS) included in Short-CARE. The results of this theory-driven analysis lend some support to the notion of at least two differential pathways to depression in the elderly, one via social distress factors and another mediated by cerebral deterioration clinically expressed as cognitive impairment.

Concurrent validity of a telephone-administered version of the Gospel Oak instrument (including the SHORT-CARE).

The aim of the study was to establish the concurrent validity of a telephone-administered version of the survey measures utilized in the Gospel Oak studies, the core of which was the SHORT-CARE. Comparisons were made between data obtained by administering the interview in its conventional, face-to-face form with those generated by conducting it by telephone. A UK teaching hospital. Elderly subjects of both sexes, recruited from geriatric and psychogeriatric day hospitals. The Depression Diagnostic Scale, Dementia Diagnostic Scale and Organic Brain Syndrome scale (all taken from the SHORT-CARE) and the London Handicap Scale. For depressive symptomatology, cognitive impairment, subjective memory impairment and handicap, intraclass correlations were 0.86, 0.89, 0.83 and 0.70, respectively. The kappa coefficient for agreement on case-level diagnosis of pervasive depression was 0.79. These results indicate that the instrument is broadly reliable when administered by telephone.

How should a group living unit for demented elderly be designed to decrease psychiatric symptoms?

The main objectives were to study relationships between the design of group living (GL) units and psychiatric symptoms in demented patients before, 6 months after, and 1 year after admission to GL units. The study population comprised 105 demented elderly (83 +/- 6 years), 37% with dementia of Alzheimer's type and 58% with vascular dementia. The patients were relocated by the municipal care planning team after clinical examination. An observational scale (the Organic Brain Syndrome scale) was used to assess confusional symptoms and disorientation. The physical environment was assessed by an architect using the Therapeutic Environment Screening Scale, which evaluates general design, space, lighting, noise, communication area, floor plan, and related factors. Less than 15% of the patients had no signs of dyspraxia, hallucinosis, dysphasia, or depression at admission, whereas 66% or more reported lack of vitality, aggressiveness, or restlessness. Fourteen out of 18 units had a corridor-like design (group A), one unit an L-shaped design (group B), and the others a square or H-shaped design (group C). Patients living in the B unit had less disorientation than the others at the 6-month follow-up. After 1 year, the patients in the A units had more dyspraxia, lack of vitality, and disorientation of identity. The communication areas in the units were negatively associated with "disorientation for recent memory" and "lack of vitality," adjusted for type of dementia (r = -0.13 to -0.16). The size of the activity area, indoor public rooms in square meters, was not correlated to confusional reactions and disorientation. In conclusion, a GL unit design that facilitates perception without reducing the communication area is to be preferred.

Correlation between clinical characteristics and cerebrospinal fluid neuropeptide Y levels in dementia of the Alzheimer type and frontotemporal dementia.

Neuropeptide Y (NPY) has been shown to be involved in the control of several neuroendocrine functions. Moreover, in animal models, NPY produces behavioral effects that are similar to those induced by anxiolytics. We studied NPY-like immunoreactivity (NPY-LI) in cerebrospinal fluid (CSF) in two primary degenerative dementias, Alzheimer disease (AD, n = 34) and frontotemporal dementia (FTD, n = 22) and correlated the CSF NPY-LI levels with clinical characteristics, as rated with the Organic Brain Syndrome scale. There were significant correlations between NPY-LI and such clinical items as suspiciousness, anxiousness, restlessness-agitation, and irritability in both AD and FTD. AD patients, but not FTD patients, showed a significant negative correlation between NPY-LI and duration of the disease. Thus, the study found significant correlations between CSF NPY-LI and emotional symptoms and behavior in organic dementia.

A comparison between three psychogeriatric rating scales

AbstractThis study compares a new psychogeriatric rating scale, the Organic Brain Syndrome (OBS) scale, which is a combined observation and interview scale, with two other scales. Twenty‐eight elderly demented patients took part in the study. The OBS scale was compared to the Gottfries, Bråne and Steen (GBS) scale, the Mini Mental State Examination (MMSE) scale and a global rating. The correlations between OBS, GBS and MMSE were high, showing that the concurrent validity is good. The ratings of the OBS scale were independent of the patient's physical disabilities as measured by Katz's index, ie the discriminant validity was good. The analyses show similarities and differences between the clinical dimensions described in the rating scales. The OBS scale contributes unique clinical information and is a valid instrument for assessment of dementia symptoms.

Jim who? Recall of national leaders by elderly people in three countries

AbstractThe Organic Brain Syndrome scale (OBS) of the Brief Assessment Scale (BAS) was administered to 1202 elderly subjects in London, Mannheim, Sydney and Melbourne. Subjects' knowledge of current and last national leaders was assessed, and two methods of scoring the OBS were compared. Taking into account the degree of cognitive impairment found using seven items of the OBS were compared. Taking into account the degree of cognitive impairment found using seven items of the OBS other than the national leader item, knowledge of current leader was much more consistent across countries than was knowledge of last leader. When subjects were allocated an error point for failing to know either current or last leader, dementia prevalence measured by the OBS was consistently 5–6% less than that found when they were allocated an error point for failing to know both leaders. Future studies using the BAS should publish prevalence data for both scoring methods in order to permit comparison between studies.

A memory clinic at a geriatric hospital: rationale, routine and results from the first 100 patients.

To describe the operation of a memory clinic with reference to the referral pattern, patient characteristics and psychiatric diagnoses, frequency of reversible dementias and utility of brief cognitive screening tools in the detection of dementia. All patients underwent cognitive screening tests (Mini Mental Status Examination, Abbreviated Mental Test Score, Organic Brain Syndrome Scale of the Brief Assessment Scale) and two activities of daily living instruments. Psychiatric diagnoses were made according to criteria of the Diagnostic and statistical manual, third edition revised, of the American Psychiatric Association (DSM-III-R). A large geriatric hospital. First 100 patients referred. The mean age of the patients was 75.5 years and 75 were women. Seventy-four met DSM-III-R criteria for dementia and a further 13 had other organic brain syndromes. No case of reversible dementia which recovered was encountered. The cognitive screening tools had a high correlation (r = 0.85-0.89) with one another but a much lower correlation with the activities of daily living instruments (r = 0.27-0.37). Reversible dementias are unlikely to be detected in a memory clinic at a geriatric hospital, but the assessment process may have other benefits which will need to be assessed in prospective research. The clinic population represents a unique resource for further research on dementia.

The Gospel Oak Study stage II: the diagnosis of dementia in the community

An attempt was made to assess in detail subjects screened as suffering from dementia among a North London community sample of elderly people. Forty-eight (80%) subjects were interviewed, 7 (12%) were found to have died and 5 (8%) either refused interview or were lost to follow-up. By clinicians' diagnosis of the 48 interviewed, 22 subjects (46%) had probable Alzheimer's disease, one had multi-infarct dementia, five had mixed dementia, five had secondary dementia, 10 had a dementia which could not be further classified and 5 were not demented. No subject had a reversible condition. The prevalence rate for clinical dementia was 6.1%, and for Alzheimer's disease 3.1%. According to AGECAT diagnosis the prevalence of organicity was 5.7%. The AGECAT diagnoses and psychiatrists' diagnoses were significantly associated (P less than 0.003) and AGECAT was more likely to identify as organic those subjects with dementia diagnosed by psychiatrists as Alzheimer's disease, than those not so diagnosed (P less than 0.04). A short psychometric battery, including the MMSE in two versions, was administered and its acceptability to a community sample evaluated. This detailed clinical investigation showed that the Dementia Diagnostic Scale of the Short-CARE was a specific predictor of clinical dementia or death at the time of follow-up, whereas the more inclusive Organic Brain Syndrome scale was a more satisfactory first phase screening instrument.

Functional impairment and behavioural disturibances in vocally disruptive patients in psychogeriatric wards compared with controls

AbstractThis study aimed at identifying patterns or clusters of functional impairment and behavioural disturbances in vocally disruptive patients compared with controls. Identified vocally disruptive patients (37) from psychogeriatric wards (264 patients) were included and compared with controls (37) matched for sex and wards. Assessment of the degree of orientation and functional performance (physical and psychosocial) was made using a newly developed rating scale, Organic Brain Syndrome Scale, consisting of two subscales, a 16‐item scale measuring orientation and a 39‐item scale measuring functional performance. Principal component analysis was applied reducing the first subscale into three factors (orientation to time, person, past and present events) and the other subscale into seven factors (functional performance and orientation in the ward, fluctuations in mental state and emotional disturbances, speech performance and psychomotor slowing, mobility, hostility, presence of delusions and hallucinations, sensitivity and euphoric state). Discriminant analysis revealed that vocally disruptive behaviour related significantly to physical dependence and disorientation in the ward, confusional reactions, delusions, hallucinations and a more preserved speech performance compared with controls. Suggestions have been made that vocally disruptive behaviour develops when environmental factors such as sensory deprivation interact with the effects of the brain damage.

Italian version of the organic brain syndrome and the depression scales from the CARE: evaluation of their performance in geriatric institutions.

The Organic Brain Syndrome (OBS) and the Depression (D) scales derived from the Comprehensive Assessment and Referral Evaluation (CARE) were translated into Italian and used in a survey of geriatric institutions in Milan. During the survey validity and reliability tests of the scales were conducted. Inter-rater reliability (total score weighted kappa) was highly satisfactory for both scales (0.96 for OBS and 0.83 for D scale). Reliability was assessed three times during the survey and showed good stability for both scales, with a slight but significant trend towards reduction over time for the D scale. Reliability of the D scale was significantly lower when the subjects interviewed scored highly on the OBS scale (severe cognitive impairment). Criterion validity was highly satisfactory both for the OBS scale (cut-off point 4/5: sensitivity 77%, specificity 96%, positive predictive value 91%) and the D scale (cut-off point 10/11: sensitivity 95%, specificity 92%, positive predictive value 84%). Results are discussed with special reference to longitudinal assessment of reliability, the choice of the cut-off point, and the context-dependent properties of questionnaires.

A Study on Organic Brain Syndrome in the Elderly at the Home for the Aged

The authors studied organic brain syndrome, using organic brain syndrome scale of the Diagnostic Interview Schedule for DSM-II, in the subjects of 65 males and 231 females at the homes for the aged in the Taegu and Kyong-buk areas. The authors collected the data during the period from June to August, 1986, and applied ANOVA and -test in order to compare various psychologic factors in relation to the organic brain syndrome. The results could be summarized as follows : The elderly males(15%) showed high OBS scores of 12 and over, while ninety elderly females(39%) showed the same scores. Among those psychosocial factors, age, education, birth place, occupation, religion, history before institutionalization are significantly related to the OBS scores.