Background: A growing body of literature suggests that caregiving burden is associated with impaired immune system functioning, which may contribute to elevated morbidity and mortality risk among dementia caregivers. However, potential mechanisms linking these relationships are not well understood. The purpose of this study was to investigate whether stress-related experience of depressive symptoms and reductions in personal mastery were related to alterations in ß2-adrenergic receptor sensitivity.

Methods: Spousal Alzheimer's caregivers (N = 106) completed measures assessing the extent to which they felt overloaded by their caregiving responsibilities, experienced depressive symptoms, and believed their life circumstances were under their control. We hypothesized that caregivers reporting elevated stress would report increased depressive symptoms and reduced mastery, which in turn would be associated with reduced ß2- adrenergic receptor sensitivity on peripheral blood mononuclear cells (PBMC), as assessed by in vitro isoproterenol stimulation.

Results: Regression analyses indicated that overload was negatively associated with mastery (β = −0.36, p = 0.001) and receptor sensitivity (β = −0.24, p = 0.030), whereas mastery was positively associated with receptor sensitivity (β = 0.29, p = 0.005). Finally, the relationship between overload and receptor sensitivity diminshed upon simultaneous entry of mastery. Sobel's test confirmed that mastery significantly mediated some of the relationship between overload and receptor sensitivity (z = −2.02, p = 0.044).

Conclusions: These results suggest that a reduced sense of mastery may help explain the association between caregiving burden and reduced immune cell ß2-receptor sensitivity.

It is estimated that 24 million people currently have dementia and that two-thirds of them live in developing countries. However, most of the assessment instruments for dementia have originated in developed countries. This paper explores the relevance of outcome measures in clinical trials of dementia drugs in different cultural groups, particularly in developing countries. The challenges of assessing treatment benefits in dementia in such groups include linguistic and cultural diversity, as well as high illiteracy rates, lack of human resources and the time constraints in assessment of patients. This paper also highlights methodological issues in cross-cultural research of cognitive assessment. Improvement in neuropsychiatric outcomes may be of particular importance to people in non-Western cultures. Functional outcomes and global outcomes are potentially useful outcome measures, but more studies are required in various countries. The use of biological markers such as neuroimaging and cerebrospinal fluid studies may not be practical in developing countries due to their costs and acceptability respectively. More work is also needed in the area of quality of life measures in various countries.

Background: A fall experienced by an elderly person is of special note because it appears to hold a reciprocal causal association with the fear of falling. This study attempts to determine the temporal relationship between the fear of falling and falling among community-dwelling elderly.

Methods: Data on falls experienced during the previous three years were obtained from 732 community-dwelling elderly people. Participants were also asked to provide detailed information about their most recent fall, including the date, time of day, place, circumstances, consequences of the fall, fear of falling, and activity limitations due to fear of falling.

Results: Those who had fallen within the past six months had over four times greater odds of a fear of falling and approximately five times greater odds of activity restriction, compared with those who had not fallen. The association decreased linearly over time, and became nonsignificant for those who had not fallen during the past 25–36 months.

Conclusions: The experience of a fall is strongly associated with an increased fear of falling, and the association appears to persist for at least two years. An elderly person who has experienced a fall requires continuous attention to prevent the development of fear as another problem, together with early intervention to counter the fear of falling.

Background: Studies indicate that diet may be related to the occurrence of brain lesions. The cross-sectional association between food intake and brain lesion volumes in late-life depression was examined in a cohort of elderly individuals with current or prior depression.

Methods: Food intake was assessed in 54 elderly vascular depression subjects (vascular depression defined by presence of hyperintensities on brain MRI) using a Block 1998 food frequency questionnaire. Food and kilocalorie intake were determined. Brain lesion volumes were calculated from MRI. Subjects were aged 60 or over and were participants in a longitudinal study of major depression. All subjects received psychiatric assessment and treatment, and medical comorbidity assessments.

Results: High-fat dairy and whole grains were significantly positively correlated with brain lesion volume, while other food groups were not significantly associated with lesion volume. In multivariable analyses, controlling for age, sex, hypertension, diabetes and total kilocalories, the positive association with lesion volume remained significant for both high-fat dairy and whole grains.

Conclusions: High fat dairy and whole grain consumption may be associated with brain lesions in elderly subjects with depression.

Background: There is no previous information about economic costs of Alzheimer's disease (AD) in South America. The objective of this study was to evaluate the costs of AD in Argentina.

Methods: Eighty community-dwelling patients, 20 institutionalized AD patients and their respective primary caregivers, and 25 healthy elderly subjects participated in this study. The cognitive and neuropsychiatric impairments and severity of dementia were assessed with the Mini-mental State Examination, Neuropsychiatric Inventory and Clinical Dementia Rating, respectively. A structured interview about health and health-care resources used during the past 3 months was administered to family caregivers. The time devoted by carers to looking after the patients and the caregiver burden (Zarit's Burden Interview) were recorded.

Results: The annual direct costs of the disease increased with cognitive deterioration from US$3420.40 in mild to US$9657.60 in severe AD, and with institutionalization (US$3189.20 outpatient vs. US$14 447.68 institutionalized). Most direct costs were paid for by the family.

Conclusions: With the projected increase in the number of persons at risk for developing AD in emerging countries, the family cost of the disease will be significant. Dementia costs should be a matter of analysis when health policies are being designed in developing countries.

Objective: The aim of this study is to evaluate the validity and the utility of the Japanese version of the WHO-Five Well-Being Index (WHO-5-J) in the context of detecting suicidal ideation in elderly community residents.

Methods: A sample of 696 subjects aged 70 years or over who completed a set of questionnaires was examined.

Results: Cronbach's α was 0.87 and Loevinger's coefficient was 0.64. The total score was significantly correlated with the number of cohabitants, the number of physical illnesses, physical functioning, instrumental activities of daily living, and depressive symptoms. Subjects with suicidal ideation had significantly lower scores on the WHO-5-J. The receiver-operating characteristic curve analysis indicated that the scale significantly discriminated the subjects with suicidal ideation. When combined with the assessment of a lack of perceived social support (PSS), a standard cut-off criterion of “a total score ≤ 12 or answering 0 or 1 to any of the five items” more appropriately identified elderly subjects with suicidal ideation: sensitivity = 87%, specificity = 75%, negative predictive value = 99%, and positive predictive value = 10%.

Conclusions: In combination with PSS, the scale has predictive utility to detect suicidal ideation in elderly community residents.

Background and objectives: Endothelial function plays a key role in determining the clinical manifestations of atherosclerosis. Recent reports have shown that healthy elderly subjects with higher trait anxiety tend to have heightened risks of atherosclerotic lesions and cardiovascular disease. The present study was intended to examine whether an association exists between trait anxiety and endothelial function in healthy young and elderly subjects.

Methods: This study examined 26 young male and 30 elderly male subjects using brachial artery flow-mediated dilation (FMD) – a non-invasive ultrasound method – to evaluate endothelial function by measuring the dilation responses of vascular smooth muscle to the nitric oxide produced by endothelial cells following hyperemia.

Results: A significant negative correlation was observed between the State and Trait Anxiety Inventory (STAI)-trait score as a parameter of anxiety and the percentage change of FMD (%FMD) in the elderly subjects, but not in the young subjects. The elderly subjects showed significantly lower %FMD than the young subjects.

Conclusion: These results suggest the possibility that trait anxiety is a predisposing risk factor for cardiovascular damage that might, over a long period, induce atherosclerotic lesions.

Objective: To determine and compare the prevalence and risk factors of elder abuse in elderly population in two different districts in Izmir, Turkey.

Methods: This cross-sectional study involved 497 subjects selected by cluster sampling.

Results: The prevalence of physical and financial abuse among the elderly in the district of low socioeconomic status was 1.5% and 2.5%, respectively, while among the elderly in the district of high socioeconomic status, it was 2% and 0.3%, respectively. However, the prevalence of elder neglect in the two districts was 27.4% and 11.2%, respectively. Prevalence of neglect was associated with infrequent contact with relatives, little or no income, and fewer years of education among the elderly in the low socioeconomic district. In the high socioeconomic district, neglect was associated with fewer years in education, poor health status and having chronic status.

Conclusion: The prevalence of abuse among the elderly living in the two different districts was low. However, nearly one-fifth of elderly people were exposed to neglect.

Background: Both anxiety disorders and subclinical anxiety symptoms are related to poorer health and functioning in later life. Because worry is an important component of anxiety, the accurate measurement of worry is crucial to studying the etiology, prevention and treatment of anxiety disorders. Assessment of the trait worry has emerged as the most widely used strategy to establish the presence and extent of pathological worry. However, the Penn State Worry Questionnaire (PSWQ), the most widely used measure of the trait worry, has not been validated cross-culturally in groups outside of the U.S.A.

Methods: We tested the psychometric properties and measurement invariance of an 8 item abbreviated version of the PSWQ (PSWQ-A) in American (N = 206) and Spanish (N = 137) older adult samples.

Results: Internal consistency was high and analyses supported a unidimensional solution in both samples. Measurement invariance was tested using confirmatory factor analysis (CFA) and Rasch models. Results of the CFA suggest that measurement invariance between the samples can be assumed for women but not for men. Rasch modeling results by gender suggested that three items have different endorsability levels in the two samples, suggesting that certain items may more closely represent the construct of the trait worry in American and Spanish older adults.

Conclusions: Overall, the PSWQ-A appears appropriate for cross-cultural use, although deletion of one item (item 6) may improve the psychometric properties of the scale across different populations.

Background: At present, our understanding of the risk markers associated with panic disorder among older, community dwelling older adults is limited. To address this gap, we examined the prevalence, risk markers, and comorbidity of panic disorder defined using DSM-IV criteria among older adults.

Method: Using data drawn from a large, nationally representative sample of Canadians, we estimated lifetime and 12-month prevalence of panic disorder, and examined demographic predictors and patterns of comorbidity of current panic disorder in adults aged 55 years and older (n = 12,792).

Results: The 12-month and lifetime prevalence estimates of panic disorder in this sample were 0.82% and 2.45% respectively, and one-fifth of these cases reported a first onset after the age of 55 years. In multivariate models, the risk of panic disorder decreased with older age and was significantly lower among widowed respondents. Physical limitations in daily activities as well as the presence of other psychiatric disorders (major depression, and social phobia) were also significantly associated with panic disorder in this sample.

Conclusions: Consistent with previous research on panic disorder, the prevalence of the disorder decreased with age among older adults. Potential explanations for the age effect and the clinical implications of the mental health comorbidities with panic disorder are discussed.

Dementia is defined as global cognitive impairment that interferes with func-tion; however, function has been less well measured than cognition in anti-dementia drug trials. In the modern era of anti-dementia clinical trials, measurement of function has improved by differentiating between the aspects of function that have been impaired – for example, impaired initiative versus ineffective performance, as is evaluated by the Disability Assessment for Dementia. Obstacles remain, including how best to distinguish the concepts of functional impairment and disability, how broad to make the range of functional impairment (e.g. whether it should include impaired performance of hobbies, or withdrawal from leisure activities) to individualize assessment, and to distinguish cognitive from non-cognitive causes of impaired function. Even though it appears that improved function is commonly related to improved executive function, and that the latter, more than other aspects of improved cognition, is the effect most prized by patients, families and physicians, functional assessment measures are often less sensitive to change than other outcome measures. How best to improve sensitivity to change of functional measurements is controversial, but it is necessary to do so in order to evaluate the full effects of treatment.

Background: The 12-item Clock Reading Test (CRT) allows a fine-graded assessment of clock-reading ability. It has a strong focus on visuo-spatial processing and requires no executive processing. This study evaluated the reliability, validity, sensitivity and specificity of the CRT for the diagnosis of dementia and visuo-spatial dysfunction.

Methods: The CRT, the Clock Drawing Test (CDT) and other tests were applied to groups of 200 subjects with dementia, 105 subjects with mild cognitive impairment (MCI), 20 subjects with focal parietal lesions and 64 elderly control subjects.

Results: The CRT was found to be reliable and sensitive for the detection of cognitive impairment in parietal lesions, Alzheimer-, mixed- and Lewy Body dementia. Normal subjects and patients with MCI, frontotemporal dementia or cerebral small vessel disease showed little or no impairment.

Conclusion: CRT and CDT are clock-processing tests with different demand profiles. They can supplement each other in the neuropsychological diagnosis of dementia and visuo-spatial dysfunction.

Background: Implementation of the Long-term Care Insurance Law of 1988 in Israel has made it possible to provide services to frail elderly people in the community. This study compares two specific services that are offered to elderly people as part of the law: (1) help offered to elderly people by homecare workers, and (2) help offered in day-care centers.

Methods: The study sought to analyze the impact of the two social service approaches on the self-esteem of the care seekers, and included 300 elderly women (150 of whom received services at home and 150 at day-care centers).

Results: The findings showed that the self-esteem of elderly women receiving services in a day-care center was higher than that of elderly women receiving the same services at home.

Conclusions: The study shows that the provision of services in a social context is important in giving elderly people proper attention which increases their self-esteem, self-evaluation and sense of mastery.

Background: The aim of the study was to determine the amount of trauma impact, post-traumatic stress symptoms and current psychopathological distress in a sample of former German children of World War II.

Methods: 93 participants were recruited through the local press, and assessed using the modified Post-traumatic Diagnostic Scale (PDS) and the Symptom Checklist (SCL-90-R).

Results: Subjects reported a high qualitative and quantitative degree of trauma exposure. 13.8% reported PTSD-related symptoms after the war, and 10.8% reported current symptoms. PTSD symptoms after World War II were significantly correlated with current psychopathological distress.

Conclusions: In line with other studies, our data document a high degree of trauma exposure during warchildhood. In comparison with other studies on PTSD in warchildren, there is a persisting high prevalence of war-associated PTSD symptoms in this sample. Despite some methodological limitations, our data underline the urgent need for further studies on the ageing group of former children of World War II.

Background: Spanish-language screening tests that are sensitive to the early cognitive changes of Alzheimer's disease (AD) are needed. Persons known to be at 50% risk for young-onset AD due to presenilin-1 (PSEN1) mutations provide the opportunity to assess which measures on the Mini-mental State Examination (MMSE) are most sensitive to these early changes.

Methods: We performed genetic and Spanish-language cognitive testing on 50 Mexican persons without dementia at risk for inheriting PSEN1 mutations. We then compared the performance on sub-items of the MMSE between PSEN1 mutation carriers (MCs) and non-carriers (NCs) using t-tests and Fisher's exact tests. Exploratory multiple logistic regression analyses were also performed.

Results: Twenty-nine persons were MCs and 21 NCs. NCs tended to achieve higher levels of education (p = 0.039) than did MCs. MCs tended to perform more poorly when spelling “MUNDO” backwards and on Orientation, particularly regarding the date. In multiple regression analyses the ability of backwards spelling to predict PSEN1 mutation status was reduced when education was included as an independent variable.

Conclusion: Subjects in the earliest stage of PSEN1-related AD showed deficits on orientation to date and in divided attention when spelling backwards. It is unclear if educational level should be considered an associated feature or a con-founding variable in this population although it should be taken into account when considering performance on the MMSE task of divided attention. The relative lack of deficits on delayed recall of three words probably represents the insensitivity of this measure in early AD. This study supports the utility of autosomal dominant AD as a model of the more common sporadic form of the disorder.

Background: Impairment of deficit awareness is a clinically relevant feature of dementia affecting the maintenance of decision capacities, management and safety of patients with risk behaviors, and caregiver burden. This study assessed awareness of disease of patient/caregiver dyads and the relationship between unawareness on various domains and sociodemographic variables among elderly Brazilians with Alzheimer's disease (AD).

Methods: The dyads (n = 52), stratified by clinical severity and age groups, responded to the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD). Statistical tests were used to compare clinical and sociodemographic variables and to calculate differences in rates of discrepant responses among mild and moderate dyads and between age groups, rates of discrepant responses among the ASPIDD domains, and association between awareness and age/age at onset.

Results: Awareness of deficits did not differ significantly among mild patients, whereas moderate patients showed impaired recognition on all domains. Older moderate dyads showed more discrepant responses, as compared to younger dyads at both severity stages. Mild patients could associate the disease with the cognitive deficits and recognized impairments on other domains. There was no significant relation of awareness with age at onset.

Conclusion: Mild AD patients could associate the disease process with the presence of cognitive deficits, and also the changes in the emotional response with difficulties in social, family, and affective relations. Moderate AD patients were less aware of the symptoms and did not attribute them to the disease.

Background: Anxiety symptoms and anxiety disorders are highly prevalent among elderly people, although infrequently the subject of systematic research in this age group. One important limitation is the lack of a widely accepted instrument to measure dimensional anxiety in both normal old people and old people with mental health problems seen in various settings. Accordingly, we developed and tested of a short scale to measure anxiety in older people.

Methods: We generated a large number of potential items de novo and by reference to existing anxiety scales, and then reduced the number of items to 60 through consultation with a reference group consisting of psychologists, psychiatrists and normal elderly people. We then tested the psychometric properties of these 60 items in 452 normal old people and 46 patients attending a psychogeriatric service. We were able to reduce the number of items to 20. We chose a 1-week perspective and a dichotomous response scale.

Results: Cronbach's α for the 20-item Geriatric Anxiety Inventory (GAI) was 0.91 among normal elderly people and 0.93 in the psychogeriatric sample. Concurrent validity with a variety of other measures was demonstrated in both the normal sample and the psychogeriatric sample. Inter-rater and test–retest reliability were found to be excellent. Receiver operating characteristic analysis indicated a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in the psychogeriatric sample, with 83% of patients correctly classified with a specificity of 84% and a sensitivity of 75%.

Conclusions: The GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people. It has sound psychometric properties. Initial clinical testing indicates that it is able to discriminate between those with and without any anxiety disorder and between those with and without DSM-IV GAD.

The pervasive scarcity of resources relative to the demands upon them makes it necessary for decision makers to think carefully about choices. Evidence from economics can help to inform such choices, particularly as it relates to costs, outcomes, the efficiency with which resources are used, the distribution of benefits and burdens across different individuals and budgets, and the processes by which care and treatment are delivered. However, there is still insufficient economic evidence to inform the full range of decisions to be taken in the dementia field; indeed the accumulated volume of evidence remains very modest. The measurement of cost is often too narrow, and there is some disagreement about whether and how to include the costs (direct or indirect) incurred by caregivers. The conceptualization of outcomes for certain purposes has generated argument, especially when attempts are made to introduce generic measures that apply across many clinical areas. It has not always been demonstrated that such measures have any validity in the dementia field. Other comparatively neglected areas have been research on equity and the processes by which care is delivered. Finally, the paper looks at economic barriers to implementation of evidence-based interventions, and the policy levers that might prove influential.

Background: Research on young psychiatric patients suggests that a significant proportion experience trauma and, in some cases, post-traumatic stress disorder (PTSD) as a result of hospitalization. This paper focuses on the evidence of trauma and PTSD associated with admission to an aged psychiatry ward.

Methods: Fifty former patients from three Melbourne hospitals were interviewed in their own homes, using a semi-structured, open-ended questionnaire.

Results: Thirty-four percent of participants reported having felt frightened, unsafe, powerless, and undermined at some time during their hospital stay. In 24% of cases these experiences could be described as “traumatic.” None met criteria for PTSD.

Conclusion: Most of the distressing experiences reported had been re-evaluated in the light of recovery or the passage of time. Nevertheless, finding ways to reduce the occurrence of such potentially traumatic experiences is clearly desirable. The evidence from this study suggests that providing opportunities for patients with depression to spend time apart from disturbed and disruptive patients would be helpful in this regard.

Background: Vascular risk factors are blamed as being involved in the pathogenesis of cognitive dysfunction in the elderly. Alzheimer's disease or vascular-type dementia could be part of a metabolic syndrome. The aim of this study was to evaluate whether there is any relation between insulin resistance and cognitive status of the elderly regarding normal, mild cognitive impairment (MCI), Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia.

Methods: 267 elderly patients admitted to an outpatient geriatrics clinic were evaluated medically and cognitively in this study. The patients were diagnosed using ARDRA and DSM-IV criteria for AD; NINDS-AIREN and DSM-IV criteria for VaD; and Petersen criteria for MCI. Insulin resistance was calculated using both the homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) formulas.

Results: The mean values of HOMA and QUICKI scores were 2.79 (SD ± 3.56) and 0.346 (SD ± 0.036) for the normal group, 2.81 (SD ± 3.06) and 0.354 (SD ± 0.047) for AD group, 2.20 (SD ± 1.82) and 0.360 (SD ± 0.048) for VaD group, 2.87 (SD ± 1.81) and 0.339 (SD ± 0.038) for mixed dementia group, 2.79 (SD ± 2.81) and 0,349 (SD ± 0.042) for MCI group, respectively. There were no statistically significant differences between HOMA and QUICKI scores of all the groups.

Conclusion: This is the first study of the possible relation between insulin resistance and cognitive function in people categorized according to five forms of cognitive status. Unfortunately the results do not allow generalizations. Further prospective cohort studies that follow a normal cognitive group and MCI patients with and without insulin resistance are necessary.