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H F Diesfeldt

Publications and source records attributed to H F Diesfeldt.

At least 19 recordsLinked to original sources
PubMed2003

[Recall of the prime minister for the assessment of mental status].

A number of cognitive screening tests assess knowledge of the head of state or current prime minister. It is supposed that correct recall is a valid indicator of cognitive functioning. A consecutive sample of 259 visitors of a psychogeriatric day care center were rated for knowledge of the prime minister's name. Recall of his name was not dependent on level of education. The mean score on an independent screening test was significantly higher for those who knew the prime minister's name than for those who failed to answer the question. More men than women correctly answered the question, regardless of education level, living arrangements (living with someone versus being single and living alone), age and cognitive score. Using item response theory and Mokken scale analysis it was found that a short screening test containing the prime minister item constituted a scale of medium scalability (Loevinger's scalability coefficient H:0.50). Scores on the screening test correlated significantly with two independent measures of episodic and semantic memory. Deletion or addition of the prime minister item did not influence the degree of association between screening test and memory test scores. It is advisable to ask for the name of the prime minister in screening for cognitive impairment. Passing or failing the prime minister item correlates with intact or impaired retrieval of current information.

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PubMed1998

[Selective use of the Eight-Word subtest in psychogeriatrics].

Performance on the Amsterdam Dementia Screening Test (ADS) and the Expanded Mental Control Test (EMCT) was examined in a consecutive sample of 204 attendants of a psychogeriatric day care department. The ADS has six subtests: picture recognition, orientation, drawing alternating sequences, category fluency, copying geometric figures, and free recall with immediate yes-no recognition of eight words. As was determined by logistic regression analysis, attentional control (EMCT), category fluency and picture recognition scores were significant predictors of verbal free recall. Recognition memory for pictures and a short orientation questionnaire (month, year, place) predicted word recognition performance. In 97% of the subjects with poor scores on EMCT and category fluency, an equally poor free recall performance was found. In those cases the incremental diagnostic value of the free recall test is doubtful. Since word recall and word recognition were conceptually related to working memory and episodic memory respectively, the two components of the verbal learning test allow detection of differential impairments of these memory systems.

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PubMed1997

[A depression inventory for psychogeriatric patients].

An interview-based assessment tool was developed to evaluate the mood of cognitively impaired psychogeriatric patients. The rating scale consists of simple questions around 15 items, presented to the patient as printed single words that are in content related to DSM-III-criteria for depression. Using these items a structured interview was conducted with a consecutive sample of 197 psychogeriatric day care attendants (mean age 77.4 years; 91.4% carrying a diagnosis of dementia). Reliability (Cronbach's alpha) over the 15 items was 0.82. A principal component analysis and Varimax rotation revealed a structure of four factors, explaining 56% of the variance and representing zest for life (7 items), nonspecific somatic complaints (3), social contacts and appetite (4), and specific complaints about insomnia (1). Cronbach's alpha of 0.78 indicated that the 7 items of the first component were a reliable subscale. Confirmatory factor analysis confirmed a model of relative independence between emotional and cognitive variables. The psychometric features and reliability of the depression inventory support its utility for the assessment of positive and negative feelings in cognitively impaired elderly subjects.

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PubMed1996

[Screening tests for dementia: agreement between CST14 and ADS3 is incomplete (Cognitive Screening Test and Amsterdam Dementia Test)].

The agreement between two screening tests for the detection of dementia was tested by comparing a 14-item orientation questionnaire (Cognitive Screening Test or CST14) and the short version of the Amsterdam Dementia Screening Test (ADS3: Visual Memory, Orientation and Fluency. All 106 consecutive patients (71% female) of a psychogeriatric day care center were tested in two sessions. Their mean age was 77,7 (range 52-89). Taking the advised cutting-scores into account, we found consistent results for 74% of the patients (95%-confidence interval: 65%-82%): 60 patients were positive for dementia on both tests, and 18 were negative. For 28 patients the results were inconsistent, in that more patients scored in the impaired range for ADS3 than for CST14.

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PubMed1996

[Content analysis of the Cognitive Screening Test (CST14)].

The factorial structure of the CST14 was analysed and its relationship with several tests of cognitive function examined. Participants were 106 consecutive attendants of a psychogeriatric day care centre (75 women, 31 men). Their mean age was 77.7 (SD = 6.4). Factor analysis of CST14-scores revealed four principal components accounting for 66% of the explanatory variance. The factors reflected knowledge of current and last queen, orientation to date, day, age and time of day, date of birth, and home address. A stepwise regression model including measures of episodic recall, episodic recognition, confrontation naming and category fluency explained 55% of the variance in CST-scores. No explanatory variance was left for measures of visual and visuospatial perception (thematic apperception and clock reading). Dissociations between items of the CST may reveal individual profiles of impaired and relatively intact cognitive functions, such as preserved episodic memory (orientation to date) in aphasic patients.

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PubMed1994

[Care burden in nursing homes: uni- or multidimensional?].

The objective of this study was to determine the concurrent validity of a new rating scale for dependence of elderly people in residential homes (EBISZ). Care dependence was assessed by 5 items of ADL (dressing, bathing, using toilet, eating, getting around inside) and 5 items on special care (e.g., because of pressure scores), annoying behaviour, wandering, and language and memory impairment. Subjects were 212 elderly residents (mean age 84 years, sd = 6.3). The Pearson correlation between the new rating scale and a 12-item ADL-scale was 0.88. A multiple regression analysis with ADL, cognitive impairments, mood and behaviour problems, and social activities as independent variables, revealed that 2 variables (ADL and cognition) explained 83% of the variance in EBISZ. The new rating scale was relatively insensitive to problems of mood and social behaviour. The EBISZ missed more than 50% of the residents who needed special care because of depression or lack of social contacts. Dependence is a multidimensional concept. Its assessment should include ADL, mood, and social behaviour measures.

Activities of Daily Living↗
PubMed1993

[Determinants of dying and of nursing home admission in residents of a home for the aged].

Between 1987 and 1991 the full cohort of 155 residents (115 females and 40 males) of a home for the elderly was followed in order to establish yearly outcomes in terms of nursing home placement and mortality. Ages ranged from 68 to 97 with a mean (and SD) of 83.0 (5.5) years. After 4 years 68 residents had died without being admitted to a nursing home (43.9%), 15 were discharged to a skilled care nursing home for psychogeriatric patients (9.7%), and 8 to a skilled care facility for physically handicapped patients (5.2%). Baseline data included: age, gender, living circumstances, length of stay and BOP-behaviour ratings. The BOP is a Dutch rating scale derived from the Stockton Geriatric Rating Scale. It appeared from this study that the prognosis of the number of inmates who were at risk of death of nursing home admission could be made with greater precision if behaviour ratings were taken into account.

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PubMed1993

[Care requirements and psychosocial care problems in nursing homes].

Residential homes were initially conceptualized to offer relatively independent elderly people room and board, rather than the nursing, medical, and rehabilitative care provided in nursing homes. Yet in the Netherlands an increasing number of frail elderly people are cared for in residential homes. By means of standardized rating scales data were collected in 1991 on the ability to perform 12 activities of daily living (ADL), cognitive disabilities, frequency of mood and behavioural problems, and social activities of all 1045 residents of 12 homes. The mean age of the 842 women (80.6%) and 203 men (19.4%) in this sample was 84.9 years (SD = 6.1). Using cutoff points that indicated the presence of serious impairment, we found that 11.9% of the residents were severely disabled in ADL. Severe cognitive impairments were detected in 10.2%, mood and behavioural problems in 13.7% and lack of social contacts in 11.6%. Multivariate cluster analysis revealed five patterns of care requirements, ranging from slight assistance (61.4%) to continuous skilled nursing care (4.9%). Residents are not homogeneous in their care requirements: 12.1% were found in a cluster that indicated a selective need of social contacts, 11.6% clustered together because of mood disorders, and 10.0% was found to have serious problems in three areas (ADL, cognition and social activity), except mood. This study suggests that about 15% of the elderly in residential homes need intensive and round-the-clock (psychogeriatric) nursing care. We conclude that residential homes have become a major component of the Dutch health care system for frail elderly patients.

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PubMed1991

Impaired phonological reading in primary degenerative dementia.

This case study reports the profile of preserved and impaired capacities in a left-handed patient suffering from primary degenerative dementia of unknown aetiology. She was remarkable because her relatively preserved object naming and semantic categorization abilities contrasted with severe deficits in speech fluency, oral reading, inability to execute spoken and written commands, and severely impaired auditory-verbal short-term memory. Her reading disorder could be characterized as a disturbance of assembled phonology. She had great difficulty reading pronounceable nonwords, but she could correctly read irregular words. She showed effects of word imageability or concreteness (more than word frequency). She also showed effects of part-of-speech, where nouns and adjectives were read more easily than inflected verbs. She had difficulty reading function words. The syntactic category effects could be proven (by hierarchical log-linear analysis) not to be an artefact of imageability differences between verbs, adjectives and nouns. In reading aloud she made visual and morphological errors, but no semantic errors. This interesting pattern of preserved semantic information and disrupted phonological processing is unusual in dementia and contrasts with the severe dysnomia of patients with surface dyslexia who are able to read by the indirect, assembly-of-phonology route and show better reading of nonwords than irregular words. Her reading by a direct visual-semantic route appeared to be associated with relatively intact object naming, concrete word reading, and irregular word reading. This selective impairment of phonological reading in the context of partly preserved semantic abilities was interpreted as confirmation of the dissociability of language functions in primary degenerative dementia.

Dementia↗
PubMed1991

[Faces get names--cognitive training for psychogeriatric patients for remembering names and faces].

By systematic training, 14 psychogeriatric patients (aged 70 to 95 years and admitted to day care because of dementia) were taught the first names of 8 members of staff of the day care center. Treatment duration was one month, twice weekly. The therapist introduced the names by a step-by-step approach, beginning with two name-face combinations, and adding one new name (and photograph of that person's face) every next training session. Treatment consisted of a combination of several cognitive strategies: organisation and directed attention, rehearsal, first letter cueing and vanishing cue techniques, and paired-associate learning based on rhymes, pictures and visual imagery. Patients were assigned at random to a treatment and a control group (waiting list condition). Patients in the control group received their training after the waiting period of one month. Using this pretest-posttest-control-group design, we were able to objectively evaluate treatment effects. Treatment caused a significant enhancement of knowledge of staff members names. Gains achieved using this program persisted over at least one month, as could be demonstrated by a follow-up evaluation.

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PubMed1990

Recognition memory for words and faces in primary degenerative dementia of the Alzheimer type and normal old age.

The suitability of Warrington's Recognition Memory Test (RMT) for discriminating between patients with dementia of the Alzheimer type and nondemented elderly subjects was tested in a study with 44 patients (aged 59 to 94) and 45 normal elderly (aged 69 to 92). The patients showed a significant memory deficit, both in Recognition Memory for Words (RMW) and Recognition Memory for Faces (RMF), even when the scores were corrected for verbal intelligence score (WAIS Vocabulary) or a measure of visuoperceptual ability (Raven's Coloured Progressive Matrices, CPM). Word-face discrepancy scores did not differentiate between dementia and normal old age. At the 95%-specificity level, the sensitivity of RMW and RMF for the detection of memory impairment in dementia was 81% and 100% for subjects below 80, and, less satisfactory, 59% and 76% for subjects of 80 years or older. Correlational analysis showed that the patients' RMW and RMF scores were moderately correlated (r = .40). The significant correlation (r = .45) between CPM and RMF suggests that visuoperceptual deficits are involved in deficient face recognition.

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PubMed1990

[Detection of memory impairment using a recognition test for words and faces].

Fifty-two patients (mean age 78.3; sd: 5.5; range 70-94) who were admitted to psychogeriatric day care because of memory problems and other cognitive deficits were tested with the Dutch form of Warrington's Recognition Memory Test (RMT). Forty-five mentally normal elderly (mean age 79.5; sd: 5.7; range 69-92) were also tested in order to establish the sensitivity and specificity of the test for the detection of memory impairment. Mentally normal subjects were mainly recruited from homes for the aged and were rated by the staff as free from any symptoms of dementia or other psychiatric disease. Using cut-off scores at the 98%-specificity level, the sensitivity of the RMT was 54% for the verbal part (Recognition Memory for Words, RMW) and 73% for the non-verbal part (Recognition Memory for Faces, RMF). Selection of cut-off scores with high sensitivity (96%) resulted in specificities of 62% and 71% for RMW and RMF, respectively. The RMF appears to be a more valid test for the detection of memory impairment than the RMW. Selection of cut-off scores is contingent on knowledge of the pretest or prior probability of memory impairment. A cut-off score with high sensitivity is recommended if impairment is strongly suspected, whereas high specificity is needed to verify the presence of impairments for which there is little clinical evidence.

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PubMed1990

[Changes in functional status of patients at initial admission to a psychogeriatric nursing home and at point-prevalence rate].

During a period of 15 years (1973-1987) the dependency of 902 patients on first admission to a psychogeriatric nursing home has been registered by means of the Beoordelingsschaal voor Oudere Patiënten (BOP, i.e. Behavioural Rating Scale for Elderly Patients). Besides, age, sex, marital status and place of residence before admission were registered. During the research period the proportion of severely disabled patients decreased systematically. The proportion of patients directly admitted from their homes increased. Furthermore, we found an increase of the proportion of married patients. These results are compatible with a greater accessibility of the nursing home, since the availability of nursing home beds in the region has grown significantly. Though the proportion of patients who were severely disabled on first admission, decreased, the experienced burden of care for in-patients has strongly increased. Since 1973 not only the dependency of in-patients increased, but also the need for a higher quality of care. We assume that the burden of care giving has increased due to these factors, but not to changed characteristics of patients on first admission.

Activities of Daily Living↗
PubMed1989

[Visual pattern analysis and reasoning: Ravens' Coloured Progressive Matrices in old-age and very-old-age adults].

Sixty-five non-demented elderly adults, born between 1895 and 1918 (mean age +/- sd: 80.0 +/- 5.4) were tested with Raven's Coloured Progressive Matrices (CPM). Subjects were recruited from homes for the aged and were rated by the staff as free from any symptoms of dementia or other psychiatric disease. Mean number of years of education was 8.2 (range 5 to 18). CPM scores ranged from 9 to 35 with mean +/- sd of 25.9 +/- 5.9. Subjects who had received more formal education performed better on the CPM (Pearson's r: 0.49). When education was controlled for in the analysis, the correlation between age and performance was attenuated and did not reach statistical significance (Pearson's r: -0.24). Test results appeared to be specific for generations, regardless of age. Mean performance in this sample was significantly higher than less recently published norms suggest. Analysis of item content revealed that the CPM consists of three main types of problems: two of a predominantly visuospatial type (12 items of simple continuous pattern-completion and 15 concrete items showing progressive changes in one or two directions) and 9 items of an abstract reasoning type. The concrete visuospatial items appear very useful in the assessment of visuoperceptive dysfunction, as for example in visual apperceptive agnosia. The abstract matrices were very difficult for most of our elderly subjects, so that these items cannot be used to detect deviations from normal old age.

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PubMed1989

[Behavior problems at homes for the aged. An inventory of 6 homes for the aged and a comparison with various nursing homes].

An inventory of behavioural problems by means of the 'Beoordelingsschaal voor Oudere Patiënten' (BOP, Behaviour Rating Scale for Elderly Patients), was made in six residential homes. About half of the 673 residents made little social contact and showed depressive behaviour. Apathy and difficulties spending their time were found in 30% of the residents. Behaviour associated with cognitive dysfunctions was observed in 14%. Approximately 5% of the residents had very severe physical disabilities. Thus, in the residential homes we found a wide range of behavioural problems. These place high demands on the organisation and quality of the care. The BOP-scores of the subjects in the residential homes were compared with those sampled in the same period in a nursing home for patients suffering from physical disabilities (N = 152) and a psychogeriatric nursing home (N = 169). Highly significant differences between the inhabitants of the residential homes on the one hand and the nursing homes on the other, were found for the subscales dependency, social disturbance, physical disability, orientation/communication and apathy. Only depression-scores were the same in the three types of institutions. These results contradict the often-heard opinion that the problems of care and assistance in residential homes increasingly resemble those of nursing homes.

Activities of Daily Living↗
PubMed1989

[Psychometric study of the vocabulary of older and very old adults].

Sixty-five non-demented elderly adults, born between 1895 and 1918 (mean age +/- SD: 80.0 +/- 5.4) were tested with the Vocabulary Test of the 1970 Dutch revision (30-item form) of Wechsler's Adult Intelligence Scale. Subjects were recruited from homes for the aged and were rated by the staff as free from any symptoms of dementia or other psychiatric disease. Vocabulary scores ranged from 11 to 53 (maximum score would be 60) with mean +/- SD of 31.3 +/- 10.2 Subjects who had received more formal education performed better on this test (Pearson's r = 0.59). When education was controlled for in the analysis, the correlation between age and performance was attenuated and did not reach statistical significance (Pearson's r = -0.16). Data are presented for two levels of education that can be used to put clinical data in perspective. The level of difficulty of each item of the Vocabulary scale was calculated for this sample. Twelve per cent of the subjects recorded correct answers beyond the official criterion of five consecutive failures for discontinuing the test. The effect of differences in item difficulty could be minimized by using a criterion of six consecutive failures to determine the point at which the test should be discontinued.

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