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Biomedical subjects

Knut Engedal

Publications and source records attributed to Knut Engedal.

At least 19 recordsLinked to original sources
PubMed2007

The relative stress scale, a useful instrument to identify various aspects of carer burden in dementia?

OBJECTIVE: To identify carer and patient characteristics associated with various aspects of burden of care. METHOD: The burden on 196 carers, each caring for one patient with dementia, was rated by means of the Relative Stress Scale (RSS). Patients were assessed with the Mini Mental State Examination (MMSE), the Disability Assessment for Dementia (DAD) and the Neuropsychiatric Inventory (NPI). RESULTS: Factor analysis of the RSS resulted in three subgroups: 'emotional distress', 'social distress' and 'negative feelings'. The total NPI score contributed to the explanation of the RSS total score and the three RSS subgroup scores with an explanatory power of 37% for total RSS, 34% for emotional distress, 27% for social distress and 20% for negative feelings. In multiple regression analysis, total NPI, DAD%, the carer being a wife and the hours spent caring per week, contributed to the explanation of total RSS with an explanatory power of 48%. Total NPI, the carer being a female and the hours spent caring, explained 38% of the variance in 'emotional distress'. Total NPI, the DAD%-score, contact with the patient on a daily basis and the hours spent caring, explained 'social distress' (49%). 'Negative feelings' were associated with total NPI, younger patients and the carer being a wife (27%). CONCLUSIONS: The RSS offers an opportunity to differentiate between different patterns of distress. This facilitates the creation of tailored intervention to reduce the strain of caring.

Aged↗
PubMed2007

High score on the Relative Stress Scale, a marker of possible psychiatric disorder in family carers of patients with dementia.

OBJECTIVE: To compare the scores on the Relative Stress Scale (RSS) with those on the General Health Questionnaire (GHQ) and the Geriatric Depression Scale (GDS), and to establish a cut-off score for RSS in order to distinguish carers with symptoms of psychiatric disorders from those without. METHODS: One hundred and ninety-four carers of 194 patients suffering from dementia according to ICD-10 were included in the study. Burden of care was assessed by the 15-items RSS, and psychiatric symptoms by means of the GHQ-30 and the 30-items GDS. A case score above 5 on GHQ and above 13 on GDS were used to define carers with probable psychiatric morbidity. Sensitivity (SS), specificity (SP), accuracy and likelihood ratio for a positive test (LR+) were calculated for different cut-points of the RSS. RESULTS: Fifty-six percent of the carers had a GHQ score above 5, and 22% had a GDS score above 13. A two-step cluster analysis using 192 of the 194 carers, identified three groups of carers; a low risk group for psychiatric morbidity (LRG), 82 carers with GHQ < or = 5 and GDS < or = 13; a medium risk group (MRG), 69 carers with GHQ > 5 and GDS < or = 13; and a high-risk group (HRG), 40 carers with GHQ > 5 and GDS > 13. The optimal RSS cut-off to distinguish between the LRG and the others was > 23 (SS 0.72, SP 0.82, accuracy 0.76, LR + 4.0), whereas the optimal cut-off to separate the HRG from the others was >30 (SS 0.74, SP 0.87, accuracy 0.84, LR + 5.7). CONCLUSION: The RSS is a useful instrument to stratify carers according to their risk of psychiatric morbidity.

Aged↗
PubMed2007

Seven minute screen performance in a normal elderly sample.

BACKGROUND AND OBJECTIVE: The Seven Minute Screen (7MS) is a brief cognitive case-finding instrument for dementia. The test is composed of four subtests that assess performance with regard to orientation, memory, visuospatial ability and language. The objective of this study was to describe 7MS performance in a normal sample of people aged 65 years and older. METHOD: The subjects were 66 Norwegian community-dwellers who met selection criteria modified from the Mayo Older American Normative Studies standard. Mean age was 73.2 years, age range was 65-93 years, and mean Mini-Mental State Examination score was 29.06, range 26-30. RESULTS: Analysis of the 7MS subtests revealed relatively modest influence of age, education and gender on test performance. The composite 7MS performance scores were associated with education. Normal performance was expressed as means, standard deviations and percentile values for the age groups 65-74 years and 75 + years. CONCLUSION: 7MS performance is described for a normal sample. These data have the potential to increase the clinicians' ability to interpret 7MS test results.

Aged↗
PubMed2007

The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes.

BACKGROUND: Psychiatric and behavioural symptoms in dementia are associated with a range of negative outcomes, including institutional placement and the widespread use of psychotropic drugs in spite of limited evidence for their efficacy. AIMS: To determine the prevalence of psychiatric and behavioural symptoms and the pattern of psychotropic drug prescription in patients with various degrees of dementia. METHODS: A sample of 1,163 non-selected nursing home patients were assessed by means of the Neuropsychiatric Inventory, the Clinical Dementia Rating scale and Lawton's activities of daily living scale. In addition, information was collected from the patients' records. RESULTS: Dementia was found in 81% of the patients and 72% of them had clinically significant psychiatric and behavioural symptoms. The frequencies of symptoms increased with the severity of the dementia. Psychotropic medication was being prescribed to 75% of patients with dementia. There was a significant relationship between the type of drug and the symptom for which it had been dispensed. CONCLUSION: Psychiatric and behavioural symptoms are frequent in nursing homes and the rate increases with the progression of the dementia. Systematic programmes are needed for disseminating skills and providing guidance regarding the evaluation and treatment of these symptoms in nursing homes.

Aged↗
PubMed2006

[Public social health services to demented persons living at home in Norway].

BACKGROUND: About 50% of the 65,000 elderly with dementia in Norway live in their own homes, and are cared for by their families and social and health care personnel in the municipalities. According to governmental documents, the provision of help to demented patients should be predictable, continuous, individually tailored, and carried out by few helpers. The purpose of this study was to examine public social and health services provided to demented patients living at home. MATERIAL AND METHODS: Provision of public care to 460 patients from 24 municipalities, was recorded for seven consecutive days. The average patient age was 82 years (SD 7.1), 74% were women. Degree of dementia was assessed with the Clinical Dementia Rating scale (CDR). Functional status and need of help was assessed with the Rapid Disability Rating Scale-2 (RDRS 2). RESULTS AND INTERPRETATION: . Of the 460 patients, 54% had received a diagnosis by a physician. On average, 8 (SD 4) different people helped for 5.4 ( SD: 6.3) hours a week. Help was most frequently given to; take medicines, prepare food, carry out personal Activity of Daily Living (ADL) and to clean the house. Some did not receive enough help and a few received too much. Patients with a dementia diagnosis did not receive more help than those without. The results indicate that Norwegian municipalities provide a substantial amount of health services, but fail to tailor plans according to individual needs.

Activities of Daily Living↗
PubMed2006

Emotional symptoms in acute ischemic stroke.

BACKGROUND: Anxiety and depressive symptoms encountered in acute stroke influence the patients' neurological outcome and the psychosocial burden of family members. These emotional changes may be caused by the patients' brain damage per se or by psychological reactions. The aims of the present study were to assess the prevalence of anxiety and depressive symptoms in the acute stage of ischemic stroke, and to identify the factors associated with such problems. METHODS: Anxiety and depressive symptoms were evaluated in 178 patients with acute ischemic stroke using the Hospital Anxiety and Depression Scale (HADS) between day 3 and 7 after admittance to the stroke unit. Factors associated with anxiety and depressive symptoms were identified using logistic regression analyses. RESULTS: 26.4% of the patients suffered from anxiety symptoms, 14.0% from depressive symptoms and 7.9% from both. Anxiety symptoms were associated with single marital state (OR 2.53, 95% CI 1.18-5.41) and a low Mini Mental State Examination (MMSE) score (< 26 points) (OR 0.53, 95% CI 0.31-0.87) whereas depressive symptoms were related to a low Barthel Activities of Daily Living index (BI) (score < 90 points) (OR 0.37, 95% CI 0.15-0.88). CONCLUSION: The present study indicates that anxiety symptoms are more frequent than depressive symptoms in the acute stage of ischemic stroke. It is important to focus on both anxiety and depressive symptoms throughout the rehabilitation phase in order to ease the patients' personal anguish and improve neurological outcome after stroke.

Adult↗
PubMed2006

The quality of care in Norwegian nursing homes.

BACKGROUND: Promoting the quality of life is an importing aim of the long-term care for the elderly, and the quality of life is related to quality of care (QoC). This way the QoC in nursing homes, and its correlates, is an interesting subject. AIM: To describe to what degree Norwegian nursing homes provide services in line with the core areas of the 'regulation of care' and whether patient or ward characteristics are associated with the QoC. METHODS AND MATERIAL: Cross-sectional study where data were collected in structured interview of the nursing staff in 251 wards regarding 1926 patients. RESULTS: Most of the patients receive good basic care in Norwegian nursing homes, but taking part in leisure activities and having the opportunity to go out for a walk are more often neglected. Acceptable QoC had a strongly negative association with patient characteristics such as low function in mental capacity, low function in activities of daily living and aggressive behaviour. In most of the measured areas of QoC, ward characteristics, such as type of ward, size of ward and staffing ratio, do have an influence on QoC.

Activities of Daily Living↗
PubMed2006

Antihypertensive medication is associated with less cognitive impairment in the very old with apolipoprotein-E epsilon4 allele.

BACKGROUND AND OBJECTIVES: High and low blood pressure and apolipoprotein (Apo)-E epsilon4 alleles have been shown to be associated with dementia of the Alzheimer's type. The aim of this study was to examine the relationship between Apo-E epsilon4 allele status and the effect of antihypertensive treatment on cognitive performance in persons > or =80 years of age. METHODS: A sample of 258 individuals 80-102 years of age was studied. Associations between the Mini-Mental State Examination (MMSE) score and treatment with antihypertensive medication, blood pressure, Apo-E polymorphism, sex, age and education were assessed. Patients treated with antihypertensive drugs typically used two to ten different medications. RESULTS: Individuals with no Apo-E epsilon4 alleles who were not treated with antihypertensive medications had a significantly higher diastolic blood pressure than other participants in the study but no cognitive deficits. Participants who had at least one Apo-E epsilon4 allele who were not treated with antihypertensive medications scored significantly lower on the MMSE compared with other participants in the study. CONCLUSIONS: Individuals with an Apo-E epsilon4 allele who were not treated with antihypertensive medication showed the poorest cognitive performance. This could suggest that individuals with the Apo-E epsilon4 allele may benefit cognitively from treatment with antihypertensive drugs.

Aged, 80 and over↗
PubMed2005

[Assessment of dementia and use of anti-dementia drugs in nursing homes].

BACKGROUND: About 75% of nursing homes patients in Norway suffer from dementia, though only half of them have a dementia diagnosis. No consensus exists on how or when to do an assessment for dementia in the nursing home. MATERIAL AND METHODS: The paper is based on a search on Medline and personal experience in the field. RESULTS AND INTERPRETATION: Dementia assessment in nursing homes should be done in a co-operation between a physician, a nurse and an occupational therapist. The physician should carry out a Mini-Mental State Examination and a clock test, a physical and mental examination, an assessment of depressive symptomatology, and see to it that the thyroid function is measured. A CT scan of the brain should be done in cases with short duration of dementia symptomatology. A nurse and an occupational therapist should interview a family member and assess the patient's functioning by means of the Informant questionnaire on cognitive decline in the elderly and the Clinical dementia rating scale, or a similar assessment tool. Memantine could be a treatment for some patients with moderate to severe degrees of dementia, while acetylcholinesterase inhibitors could be useful for some patients with mild to moderate degrees of dementia of the Alzheimer type. Anti-dementia drug therapy must be individualised.

Alzheimer Disease↗
PubMed2005

Plasma total homocysteine and memory in the elderly: the Hordaland Homocysteine Study.

We examined the relation between plasma total homocysteine (tHcy), folate, vitamin B12, and episodic memory in elderly community-dwelling subjects. A population-based study was conducted in 1992 and 1993, and subjects were re-investigated after 6 years. Plasma analytes were determined on both occasions. At follow-up, memory performance, using the Kendrick Object Learning Test, was investigated in 2,189 subjects (age, 65-67 years at baseline). Subjects with memory deficit (test score, < 25) had higher tHcy and lower folate at follow-up compared with those without memory deficit: 12.6 (95% confidence interval [CI], 12.1, 13.1) versus 11.5 (95% CI, 11.3, 11.6) micromol/L (p < 0.001) for tHcy, and 6.7 (95% CI, 6.2, 7.1) versus 7.6 (95% CI, 7.5, 7.8) nmol/L (p < 0.001) for folate. The risk of memory deficit increased according to quintiles of tHcy both at baseline and at follow-up. A decline in tHcy, or an increase in folate, over a 6-year period was associated with a higher memory test score; and vice versa. These findings indicate that increased plasma tHcy is an independent risk factor for memory deficit both cross-sectionally and prospectively, and that a "favorable" change in folate or tHcy concentrations over time is associated with better memory performance.

Aged↗
PubMed2005

The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients.

BACKGROUND: In geriatric psychiatry assessment scales are often used in clinical praxis in the diagnostic work-up of mental disorders. AIM: To assess whether the state part of the STAI is useful as a case-finding instrument of mental disorders. MATERIALS AND METHOD: Data came from 70 non demented geriatric in-patients in stable clinical condition. Mean age was 83.3 years (range 64-96), and 74.3% were women. The 20-item STAI state instrument was used to measure current anxiety symptoms. Without knowledge of the score on STAI state a psychiatrist examined all patients and set diagnosis according to DSM-IV-TR criteria, but hierarchical rules were not used. Sensitivity, specificity, Likelihood ratio and accuracy were calculated for different cut-points of the mean sumscore on the STAI state. RESULTS: 15.7% of the participants suffered from a mental disorder: GAD = 1, mixed anxiety-depression = 5, depression = 1, dysthymic = 1, adjustment disorder (mixed anxiety-depression) = 1, and personality disorder = 1. The mean STAI sumscore in this group was 56.3 compared with 39.2 in the 59 patients without any psychiatric diagnosis. The optimal cut-off score on the STAI mean sumscore corresponding to the highest accuracy of 0.87 was 55/54 with sensitivity 0.82, specificity 0.88, and LR + 6.8. CONCLUSION: The STAI state scale is a useful instrument for detecting a variety of mental disorders in older people. Further studies should be carried out in different populations.

Aged↗
PubMed2005

The association between depression, anxiety, and cognitive function in the elderly general population--the Hordaland Health Study.

OBJECTIVES: To examine the association between depression and/or anxiety and cognitive function in the elderly general population. SUBJECTS: Non-demented participants from the general population (n = 1,930) aged 72-74 years. METHODS: Symptoms and caseness of depression and anxiety disorder were assessed using the Hospital Anxiety and Depression Scale (HADS). Cognitive function was assessed by the Digit Symbol Test (modified version), the Kendrick Object Learning Test, and the 'S'-task from the Controlled Oral Word Association Test. RESULTS: There was a significant association between depression and reduced cognitive function. The inverse association between anxiety and reduced cognitive performance was explained by adjustment for co-morbid depression. The inverse association between depressive symptoms and cognitive function was found to be close to linear, and was also present in the sub-clinical symptom range. Males were more affected cognitively by depressive symptoms than females. CONCLUSION: The inverse association between depression and cognitive function is not only a finding restricted to severely ill patient samples, but it can also be found in the elderly general population.

Aged↗
PubMed2005

Medicosocial care for persons suffering from Alzheimer's disease and related disorders.

Lithuania, like many European countries, is facing the problem of ageing population. The ageing society is accompanied by an increase in the prevalence of the disorders that are characteristic for old age. This article presents an overview of the current situation with respect to care of patients with dementia in Lithuania. Calculations based on epidemiological studies in other countries reveal that at least 31,000 persons may be suffering from dementia in Lithuania, with 6407 new cases occurring each year. Management of persons with dementia is mainly conducted by psychiatrists and neurologists with a few geriatricians. Mental health centers with interdisciplinary teams assure medical treatment, primary diagnosis of dementia, family consultations, managing of social and psychological problems and visits to homes when needed. Institutional services and home help services for persons with dementia are scarce and underdeveloped. Our future priorities in developing care for people with dementia are to improve the timely diagnosis and comprehensive management of dementia with the establishment of a continuity of high quality social services with special emphasis on home help and the support of family members.

Age Factors↗
PubMed2005

Cognitive impairment is associated with poor oral health in individuals in long-term care.

PURPOSE: The aim of this work was to study oral hygiene and cognition in patients in long-term care. MATERIALS AND METHODS: A representative sample of individuals in long-term care aged 67 years and above, from all 19 countries of Norway, was selected for the study. Trained local dental teams examined 1910 individuals--1358 from institutions and 552 living at home. Oral hygiene was assessed by means of a combined plaque and mucosal score (MPS), and cognition by means of a short version of Mini-Mental State Examination (MMSE-12). RESULTS: Mean age was 84.2 years and the age range was 67-106 years. Over 70% were cognitively impaired. Cognitive impairment increased with age and was more prevalent in institutionalised individuals compared to those living at home. Poor oral status was more prevalent among individuals with cognitive impairment. CONCLUSION: The results of this study indicate that a large proportion of individuals in long-term care in Norway show cognitive impairment. A high proportion of these has a poor oral status. Thus, they carry a high risk of developing dental caries. Obviously, there is a demand for careful and close surveillance of oral hygiene and oral health in individuals in long-term care, and especially of those cognitively impaired.

Age Factors↗
PubMed2004

Concealment of drugs in food and beverages in nursing homes: cross sectional study.

OBJECTIVE: To examine the practice of concealing drugs in patients' foodstuff in nursing homes. DESIGN: Cross sectional study with data collected by structured interview. SETTING: All five health regions in Norway. PARTICIPANTS: Professional carers of 1362 patients in 160 regular nursing home units and 564 patients in 90 special care units for people with dementia. MAIN OUTCOME MEASURES: Frequency of concealment of drugs; who decided to conceal the drugs; how this practice was documented in the patients' records; and what types of drugs were given this way. RESULTS: 11% of the patients in regular nursing home units and 17% of the patients in special care units for people with dementia received drugs mixed in their food or beverages at least once during seven days. In 95% of cases, drugs were routinely mixed in the food or beverages. The practice was documented in patients' records in 40% (96/241) of cases. The covert administration of drugs was more often documented when the physician took the decision to hide the drugs in the patient's foodstuff (57%; 27/47) than when the person who made the decision was unknown or not recorded (23%; 7/30). Patients who got drugs covertly more often received antiepileptics, antipsychotics, and anxiolytics compared with patients who were given their drugs openly. CONCLUSIONS: The covert administration of drugs is common in Norwegian nursing homes. Routines for such practice are arbitrary, and the practice is poorly documented in the patients' records.

Aged↗
PubMed2004

[Vascular dementia--an ill-defined concept].

BACKGROUND: Vascular dementia is defined as dementia caused by cerebrovascular disease and is seen as the most common cause of dementia after Alzheimer's disease. In our opinion, vascular dementia is an ill-defined term; this proposition is discussed in this article. MATERIAL AND METHODS: The concept of vascular dementia is discussed based on the literature and our own clinical experience. RESULTS: The prevalence of vascular dementia varies markedly across different studies and several clinical diagnostic criteria are used. There has been an ongoing debate as to which radiological changes are associated with vascular dementia; we question the use of neuropathological changes as a diagnostic gold standard. Several studies have shown similarities between dementia of the Alzheimer type and vascular dementia regarding risk factors and symptomatology. INTERPRETATION: We conclude that the concept of vascular dementia should be re-evaluated. It is important to establish valid and reliable criteria for vascular dementia, especially in the light of the therapeutic consequences.

Alzheimer Disease↗