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K Engedal

Publications and source records attributed to K Engedal.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Geriatric psychiatry--a specialty within psychiatry].

The aim of this article is to describe the prevalence of mental disorders in the elderly and how the psychiatric services for these patients ought to be organized in Norway. Geriatric psychiatry is a special branch of psychiatry. Its areas of concern are the assessment and treatment of mental disorders which frequently occur in the elderly. The most prevalent psychiatric disorders are depression and dementia. Functional psychosis and anxiety disorders are less prevalent, but nevertheless disorders causing great concern. Psychiatric morbidity frequently coexists with physical illness. An elderly patient suffering from a mental disorder often has a combination of psychological, social and physical needs. The resources allocated to psychiatric services for old people are scarce. Efforts should be made to establish a special unit for geriatric psychiatry in every county in Norway. Each unit should serve approximately 150-200,000 inhabitants, and should consist of both an in-patients' and an out-patients' clinic. It is recommended that there should be 1 to 1.5 beds per 1000 elderly aged 65 years and over.

Aged↗
PubMed1997

The role of heredity in late-onset Alzheimer disease and vascular dementia. A twin study.

BACKGROUND: This study compares the relative importance of heredity and environment in the development of Alzheimer disease and vascular dementia. The relationship between apolipoprotein E and dementia is also tested. METHODS: A total of 23,000 cognitively impaired subjects from Norwegian institutions for the elderly were identified, and their files were checked against the records of 26,000 twin pairs from the Norwegian Twin Register. A sample of 72 twin pairs was selected and thoroughly investigated clinically. The mean age of the sample was 80 years. RESULTS: The pairwise concordance rate for Alzheimer disease was 78% (7/9) among monozygotic and 39% (9/23) among dizygotic twin pairs. The probandwise concordance rate was 83% (10/12) among monozygotic and 46% (12/26) among dizygotic twin pairs. There was no significant difference in the rate of apolipoprotein E epsilon 4 allele between twin pairs concordant and discordant for Alzheimer disease. By using tetrachoric correlations, the estimated heritability was approximately 0.6. Environmental factors shared by cotwins seemed to explain most of the remaining variance. In vascular dementia, there was no significant difference in pairwise concordance rates among monozygotic (1/6 [17%]) and dizygotic (4/16 [25%]) twin pairs or in probandwise concordance rates among monozygotic (2/7 [29%]) and dizygotic (5/17 [29%]) twin pairs. CONCLUSION: Heredity is the major causal factor in late onset Alzheimer disease, whereas environmental factors dominate in vascular dementia.

Age Factors↗
PubMed1997

Interobserver variation in the interpretation of breast imaging. Comparison of mammography, ultrasonography, and both combined in the interpretation of palpable noncalcified breast masses.

PURPOSE: To analyze interobserver agreement in the interpretation of palpable noncalcified breast masses by means of mammography, ultrasonography, and a combination of both methods. MATERIAL AND METHODS: Mammograms and ultrasonograms of 100 benign breast masses and 100 malignant ones in 200 patients were retrospectively analyzed by 4 radiologists with experience in both imaging modalities. The images were analyzed independently and without knowledge of the final diagnosis. The analysis was performed in 3 sessions and used a 5-point rating scale for probability of malignancy. The interobserver variation was analyzed by means of observed agreement, kappa, and weighted kappa statistics based on the 5-point rating scale and a 3-level scale of the collapsed 5-point scale. The chi-square statistic was used for testing the equality of the kappa values. RESULTS: The overall kappa value on the 3-level scale was 0.48 (range 0.37-0.61) for ultrasonography, 0.58 (range 0.52-0.66) for mammography, and 0.71 (range 0.63-0.79) for the combined reading. The kappa values were statistically different for ultrasonography but did not differ significantly for the mammographic and combined readings. The combined reading showed higher kappa values than mammography alone, and the improvement was statistically significant for 3 of the 6 pairs of comparison. CONCLUSION: Radiologists differ substantially in their interpretations of mammograms and breast ultrasonograms. Agreement was highest in the combined reading, intermediate in mammography, and lowest in ultrasonography.

Breast Neoplasms↗
PubMed1996

Mental impairment and driving licences for elderly people--a survey among Norwegian general practitioners.

OBJECTIVE: Study how GPs assess mental function when a health certificate for elderly drivers has to be issued. DESIGN: Postal questionnaire survey. SETTING: Nationwide survey. SUBJECTS: Random sample of 532 Norwegian general practitioners, response rate 54%. MAIN OUTCOME MEASURES: Open and closed questions. RESULTS: Various types of examinations and assessments are carried out in this context. More than 50% always assess mental function. Only 22% use formal mental tests, mostly when in doubt. The assessment of elderly patients for a health certificate for driving is regarded by many as a difficult problem. CONCLUSION: There is a lack of uniformity in issuing a health certificate to elderly drivers, a low use of formal cognitive testing, and problems facing GPs in this context. More concrete guidelines and a formal second-line system would facilitate an objective assessment and could also alleviate the burden on the doctor.

Adult↗
PubMed1996

Geriatric work-up in the Nordic countries. The Nordic approach to comprehensive geriatric assessment.

A group established by the Nordic professors of geriatrics has developed a position document presenting a shared and updated review of geriatric work-up as a way of comprehensive geriatric assessment in the Nordic countries. The main intention is that the document will serve as support and help for the clinician concerned with hospital based geriatric medicine. It may also be useful for quality control and teaching. Not least, it may be useful for health professionals other than geriatricians. To some extent, the position of geriatric medicine in the Nordic countries varies between the countries. However, the background for developing a Nordic version of geriatric work-up is shared attitudes and principally the same organization of the health care system, and collaboration within geriatrics for many years. Several trials on comprehensive geriatric assessment and management performed in different settings have shown favourable outcomes. Results from controlled Nordic trials are compiled and summaries of meta-analyses are presented. The concept of Nordic geriatric work-up is based on a model defining health and disease in old age as dimensions of pathology, impairments, functional limitations, and disability, all being modified by extra- and intraindividual factors. Handicap is defined as the disability gap. Different health professionals have varying responsibilities in the geriatric team-work, but all should be dedicated to establish common goals. The geriatric work-up is presented with success factors and barriers, stating important differences between multidisciplinary and interdisciplinary processes. Checklists and assessment scales may be very useful when performing a geriatric work-up, but they should be used with caution. Specific scales covering different functional areas of the geriatric patient are recommended for clinical practice. Such scales must be valid, reliable, acceptable to the patient, responsive to change, and should be in an appropriate format, as well as easy to administer. Prior to the use among geriatric teams in the Nordic countries the scales should be translated into all the Nordic languages, and the translated versions should ideally have been subjected to validity and reliability testing. However, so far no scale meets these demands regarding all the five Nordic languages.

Aged↗
PubMed1995

The set test as a diagnostic tool in elderly outpatients with suspected dementia.

The set test was validated in 138 outpatients (mean age 74 years, 65% women) against a global clinical assessment using the DSM-III-R criteria for dementia. The test proved to have low sensitivity even at cutpoints close to a full score, and 12 of 72 patients diagnosed with dementia had a full score. We were unable to confirm the hypothesis that the set test can distinguish between vascular and Alzheimer's type of dementia. Used in its original form, the set test does not seem to be an appropriate diagnostic tool in the setting of a memory clinic.

Aged↗
PubMed1995

A low, 'normal' score on the Mini-Mental State Examination predicts development of dementia after three years.

OBJECTIVES: To study whether a low, "normal" sumscore (i.e., 24 or higher) on the Mini-Mental Status Examination (MMSE) near the cutpoint usually employed for identifying persons with cognitive impairment predicts later development of dementia. DESIGN: A prospective study of a random sample of nondemented persons aged 75 years and older, according to DSM-III criteria, with follow-ups after 3 and 6 years. PARTICIPANTS: The subjects were 215 persons living at home, mean age 81 years, 81% women. Their mean MMSE sumscore at the start of the study (T0) was 27.9 (range 24-30). MAIN RESULTS: A low MMSE sumscore at T0 was identified as a statistically strongly significant predictor of dementia after 3 years (P < .001), when more than 40% of those with a sumscore of 24 or 25 at T0 had become demented. A similar, although weaker and statistically nonsignificant, trend was observed for the risk after 6 years in relation to MMSE scoring at baseline. CONCLUSION: Persons with a sumscore of 24 or 25 and classified as not suffering from dementia according to the DSM-III criteria are at high risk of developing dementia within 3 years.

Activities of Daily Living↗
PubMed1994

[Delirium (acute confusion) among elderly patients after admission to a medical department].

Delirium is a common mental disorder among the elderly. In this study we examined the prevalence of delirium among patients older than 75 years of age who had been admitted to an acute medical ward. 14 of 58 patients (24%) received a diagnosis of delirium. For these patients we recorded in all 58 factors possibly associated with its occurrence, four on average per patient. Drugs, cerebrovascular disease, and congestive heart failure were the most common factors. The large number of possibly contributing factors precludes a definite conclusion regarding precipitating factors. Mini-Mental State Examination, which is a commonly used screening-instrument for detecting cognitive impairment, was of minor value in detecting delirium.

Acute Disease↗
PubMed1992

The Mini-Mental State Examination: identifying the most efficient variables for detecting cognitive impairment in the elderly.

OBJECTIVES: To study how well the scoring on each item of the MMSE relates to the sum-score when the purpose is to identify persons with cognitive impairment, and to identify an equally effective subset of MMSE items for predicting cognitive impairment. DESIGN: Retrospective survey of MMSE data for 850 elderly. SETTING: A variety of clinical settings. PARTICIPANTS: Mean age 82 years (range 54 to 99), 74% women. The subjects were of three different categories: geriatric in-patients, patients living under supervision, and elderly people living independently at home. RESULTS: Five of the binomial ("State," "Town," "Name a pencil," "Name a watch," "Read and obey") and one of the polychotomous MMSE variables ("Learn three words and repeat immediately") had low sensitivity and gave high percentages of misclassifications versus the sumscore dichotomized at the cut-point 23/24. Univariate logistic regression indicated that the three remaining polychotomous variables ("Spell backwards," "Recall three words," and "Three-stage command") can be scored binomially. Two factors were identified on factor analysis. Logistic regression analysis showed that 12 of the original 20 items predicted the sumscore dichotomized at 23/24 with only 3% misclassifications. Validation against the psychogeriatrician's diagnosis showed that this 12-items MMSE derivative performs as well as the full MMSE. CONCLUSIONS: Six of the 20 MMSE variables perform poorly regarding sensitivity and misclassifications versus the sumscore at cut-point 23/24. Two additional items did not contribute to the prediction of a low/high sumscore. The remaining 12 MMSE items can all be scored binomially and produce a sumscore which is equally as effective as the sumscore of the full MMSE when the purpose is to identify elderly patients with cognitive impairment.

Activities of Daily Living↗
PubMed1992

The patterns of motility are maintained in the human small intestine throughout the process of aging.

Intestinal disorders suggesting impaired gastrointestinal motility due to aging have been reported, but the influence of advanced age on the patterns of motility in the human small intestine is unknown. The present prospective study describes these patterns of motility in 15 healthy old subjects with a median of 84 years (range, 81-91 years). Nineteen healthy young adults served as controls. Ambulatory manometry was performed at home, with two sensors located in the proximal small intestine. Postprandial motility was induced by a standardized meal at 1800 h, and fasting motility was recorded during the subsequent night. Migrating motor complex (MMC) data were analysed by means of an expanded variance component model. Recurrent MMCs were identified during fasting in all individuals, with similar periodicity in old and young adults (p = 0.4). The propagation velocity of phase III of MMC was slower in the old subjects (6.5 +/- 0.8 cm/min versus 10.8 +/- 1.2 cm/min; p less than 0.01). Duration of postprandial motility was preserved, as were the amplitude and frequency of contractions during phase III and the postprandial state. Propagated clustered contractions were more frequently present in old subjects both after a meal (67% versus 11%; p less than 0.01) and during fasting (p less than 0.01); otherwise the patterns of motility are maintained in the human small intestine throughout the process of aging.

Aged↗
PubMed1991

[Psychiatry for the elderly--a specialty field in progress].

Services concerned specially with elderly people who are mentally ill have developed in response to changing needs and expectations in society. In Norway, more than 600 beds in psychiatric hospitals are allocated to geriatric psychiatry (gerontopsychiatry), and are served by 20 senior registars and 19 psychiatric trainees. There are hardly any outreach programmes. Most of the beds in the hospitals are occupied by long-term psychiatric patients. There is little consensus as to what type of patients these beds should primarily serve. The authors recommend that a special unit to deal with geriatric psychiatry be organized in every county in Norway. Funds should also be allocated for professorships in this field.

Aged↗
PubMed1991

Frequency and distribution of Alzheimer's disease in Europe: a collaborative study of 1980-1990 prevalence findings. The EURODEM-Prevalence Research Group.

We reanalyzed and compared current prevalence estimates of Alzheimer's disease in Europe. Studies characterized as follows qualified for comparison: dementia defined by the Diagnostic and Statistical Manual for Mental Disorders, 3rd edition, or equivalent criteria; Alzheimer's disease diagnosed by the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association or equivalent criteria; case-finding through direct individual examination; appropriate sample size; and inclusion of institutionalized persons. Of the 23 European surveys of dementia considered, six fulfilled the inclusion criteria. When age and sex were considered, there were no major geographic differences in the prevalence of Alzheimer's disease across Europe. Overall European prevalence (per 100 population) for the age groups 30 to 59, 60 to 69, 70 to 79, and 80 to 89 years was, respectively, 0.02, 0.3, 3.2, and 10.8. Prevalence increased exponentially with advancing age and, in some populations, was consistently higher in women. Prevalence remained stable over 15 years in one study.

Adult↗
PubMed1991

The prevalence of vascular dementia in Europe: facts and fragments from 1980-1990 studies. EURODEM-Prevalence Research Group.

We selected, reanalyzed, and compared data from current prevalence studies of vascular dementia in Europe. Inclusion criteria were: dementia defined by the Diagnostic and Statistical Manual for Mental Disorders, edition 3, or equivalent criteria; case finding through direct individual examination; appropriate sample size; and inclusion of institutionalized persons. Mixed dementia was combined with vascular dementia. Of the 23 surveys of dementia considered, five fulfilled the inclusion criteria. Age-specific prevalence varied more widely for men than for women; differences were greater in older ages. The prevalence increased steeply with advancing age in all countries, and was generally higher in men; it declined over 15 years in the age class of 80 to 89 years in one Swedish population. Within populations, Alzheimer's disease was generally more common than vascular dementia. Unfortunately, prevalence studies of vascular dementia are limited in Europe and worldwide, and their comparison is impeded by the lack of common diagnostic criteria.

Aged↗