PubMed Health⌕ Search

Biomedical subjects

T Hope

Publications and source records attributed to T Hope.

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

Behaviour changes in dementia. 2: Are there behavioural syndromes?

OBJECTIVE: To establish whether robust behavioural 'syndromes' can be identified from among the widely heterogeneous behavioural changes which occur in dementia. DESIGN: Longitudinal, prospective study with follow-up at 4 and 8 months. SETTING: Community settings in Oxfordshire, UK. PARTICIPANTS: 97 elderly people with a diagnosis of Alzheimer's disease or vascular dementia (in many cases confirmed by postmortem examination) and who were living at home with a carer. MEASURES: Each subject's behaviour was assessed in detail at each interview using the Present Behavioural Examination to assess subject's behaviour over the preceding 4 weeks. Seventeen key behaviour items which were both common and clinically important were selected for further analysis. RESULTS: Three syndromes were identified: (a) overactivity (walking more, walking aimlessly, trailing the carer or checking where the carer was); (b) aggressive behaviour (physical aggression, aggressive resistance, verbal aggression); (c) psychosis (anxiety, persecutory ideas and hallucinations). The same syndromes were found using data collected at three different time points and by using a variety of statistical techniques, confirming their robustness. CONCLUSIONS: Overactivity, aggressive behaviour and psychosis form three distinct behavioural syndromes in dementia.

Aged↗
PubMed1997

Hyperphagia in dementia: 1. The use of an objective and reliable method for measuring hyperphagia in people with dementia.

Up to one third of dementia sufferers eat an increased quantity of food, compared with their premorbid intake, at some stage during the dementia. A proportion of these eat extraordinarily large quantities if food intake is not restricted. In order to investigate this phenomenon in detail, a reliable and standardized method of quantifying the degree of hyperphagia is required. We report the development of such a method. Twenty-six people with dementia, who were reported by their carers to be hyperphagic, were compared with 14 matched non-hyperphagic controls with dementia and 14 matched normal elderly. Subjects were offered two standardized meals, under specified conditions, ad libitum. One meal consisted of a single food, the other of a mixture of foods. The total energy intake provided a reliable measure of the degree of hyperphagia. The single food meal was more reliable but the mixed meal was a more sensitive measure of the hyperphagia.

Aged↗
PubMed1997

Hyperphagia in dementia: 2. Food choices and their macronutrient contents in hyperphagia, dementia and ageing.

Up to one third of dementia sufferers eat an increased quantity of food compared with their premorbid intake, at some stage during the dementia. In addition, over half of people with dementia are reported, by their carers, to show a marked change in food choice, particularly an increased liking for sweet food. The macronutrient content of foods chosen and the ratio of sweet to savoury foods were investigated experimentally using a standardized mixed meal. Three subject groups were studied: 17 people with dementia who were reported by their carers to overeat and who ate excessively under experimental conditions; 14 people with dementia who ate a normal amount; and, normal, non-demented controls (18 under 50 years old and 14 over 50 years old). The results showed that the normal elderly people chose a lower proportion of high-protein food than the young. The proportion of protein eaten was lower in people with dementia than in age-matched controls and was even lower in the hyperphagic dementia group. The proportion of sweet food eaten was higher in people with dementia and even higher in people with dementia who were hyperphagic. Various mechanisms to account for the results are discussed.

Adult↗
PubMed1997

Cognitive impairment in medical inpatients. I: Screening for dementia--is history better than mental state?

BACKGROUND: evaluation of the short version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the Abbreviated Mental Test (AMT) as screening tools for dementia in medical inpatients. METHODS: 201 patients over 65 were assessed. Assessment included administration of the AMT, a delirium screening instrument and a brief psychiatric interview. Relatives were interviewed and the IQCODE administered. Diagnostic and Statistical Manual (DSM) IIIR diagnoses of various causes of cognitive impairment were made. Sensitivity and specificity values of the screening tests for a DSM IIIR diagnosis of dementia were calculated. RESULTS: our study suggests that the IQCODE is more accurate than the AMT as a screening instrument for dementia. Using a cut-off point of > 3.44, sensitivity and specificity of the IQCODE for diagnosing dementia were 100 and 86% respectively. Equivalent values for the AMT (cut-off point < 8) were 96 and 73%. It was possible to use the IQCODE in eight of the 10 patients unable to complete the AMT. CONCLUSION: using both the IQCODE and a brief cognitive function test when screening for dementia in medical inpatients will maximize the number of patients who can be screened.

Aged↗
PubMed1997

Cognitive impairment in medical inpatients. II: Do physicians miss cognitive impairment?

AIM: to study the recognition of cognitive impairment in elderly medical inpatients by medical staff. METHODS: 201 patients over 65 were assessed by administration of standard cognitive screening tests and an interview with relatives. We made Diagnostic and Statistical Manual (DSM) IIIR diagnoses of various causes of cognitive impairment and clinical diagnoses for those patients not fulfilling DSM IIIR criteria. Medical notes were scrutinized for any mention of cognitive impairment. RESULTS: 46% of the patients found to be cognitively impaired by the researcher had no record of cognitive impairment in the medical notes. However, 14 out of 15 of the patients with DSM IIIR delirium, and 22 out of the 26 patients with DSM IIIR dementia, were identified as cognitively impaired by the physicians. This suggests that the physicians were detecting the vast majority of patients with clinically significant cognitive impairment.

Aged↗
PubMed1997

Ethics and the GMC core curriculum: a survey of resources in UK medical schools.

OBJECTIVES: To study the resources available and resources needed for ethics teaching to medical students in UK medical schools as required by the new GMC core curriculum. DESIGN: A structured questionnaire was piloted and then circulated to deans of medical schools. SETTING: All UK medical schools. RESULTS: Eighteen out of 28 schools completed the questionnaire, the remainder either indicating that their arrangements were "under review" (4) or not responding (6). Among those responding: 1) library resources, including video and information technology were found to be fairly well developed; 2) many schools had a good supply of handouts and sample cases for teaching; 3) most had a written syllabus, and 4) two-thirds examined in the subject. However, many schools indicated that there was an urgent need for: 1) full-time teachers (most ethics teaching is still by part-time and voluntary staff); funding for books and journals, and 3) additional teaching materials (including further case vignettes, handouts and sample exam questions). CONCLUSIONS: There has been a considerable overall improvement in resources for medical ethics teaching since the time of the last national survey (The Pond Report). However, provision varies widely from medical school to medical school. The particular needs identified were for full-time teachers, library resources and teaching materials. Wider use of existing organisations concerned with medical ethics could help to meet these needs.

Curriculum↗
PubMed1997

Manchester and Oxford University Scale for the psychopathological assessment of dementia.

There is increasing awareness of the importance of psychopathological and behavioral changes in dementia and a need for a technique to measure these noncognitive features. Such a schedule should keep screening questions to a minimum, include a severity measure, exclude symptoms resulting from physical illness, be as brief as possible, and not mix domains of psychopathology. To test the reliability, sensitivity, and validity of a newly developed test, 30 carers were interviewed four times during 6 weeks. An obligatory stem question in each category was followed by supplementary questions. The interviewer recorded the presence of each symptom, its severity, when each symptom started, its duration, and whether it was still present. To detect the presence of delusions, the informant was asked about the patient's insight. Satisfactory differences in mean kappa values were demonstrated in test-retest and interrater reliability and validity compared with other techniques. This test may be useful to measure the outcome of drug trials, for correlating psychopathological and behavioral changes with autopsy findings and in epidemiological surveys.

Aged↗
PubMed1996

The Asbury draft policy on ethical use of resources.

The general practice partners invited two medical ethicists (RC and TH) to meet them to develop the document. The partners met RC and TH for one and a half hours on eight occasions over one year and met without them on eight further occasions. The entire general practice also had an all day session to discuss in detail an advanced version of the draft. The developmental process was of great value to the partnership and has led to appreciable change in individuals' views. The draft policy presented here is intended to start the ball rolling, so that proper guidelines will be developed at whatever level in the NHS is most appropriate. Comments and feedback are welcomed.

Attitude of Health Personnel↗
PubMed1996

Behavioural problems in dementia and biochemistry: clinical aspects.

Behavioural and psychiatric problems in dementia are clinically important; they are also theoretically interesting. Neurochemical factors are likely to play a causal role in some of these problems. Two approaches to investigating the biochemical basis of behavioural problems are outlined: the correlation of prospectively collected behavioural data with postmortem neurochemical measures; and the detailed analysis of behaviour allowing investigation of underlying mechanisms. These approaches are illustrated with empirical data. David Bowen's neurochemical approach to dementia provided stimulus to this work.

Animals↗
PubMed1996

Presynaptic serotonergic markers in community-acquired cases of Alzheimer's disease: correlations with depression and neuroleptic medication.

Presynaptic serotonergic markers, serotonin uptake sites, and concentrations of serotonin and 5-hydroxyindoleacetic acid were studied in the frontal and temporal cortex of 20 community-acquired cases of Alzheimer's disease and 16 controls matched for age, sex, postmortem delay, and storage. Clinical assessments, including behavioural symptoms, of the Alzheimer patients were made at 4-month intervals during life. There was significant reduction in the number of serotonin uptake sites in Alzheimer cases in temporal but not frontal cortex. There was no significant alteration in the concentrations of serotonin or 5-hydroxyindoleacetic acid in either region. Alzheimer patients who had persistent depressive symptoms during life had significantly fewer serotonin uptake sites in both cortical areas compared with Alzheimer patients without these symptoms. In addition, Alzheimer patients who were receiving chronic neuroleptic medication had significantly lower concentrations of serotonin in frontal cortex and 5-hydroxyindoleacetic acid in temporal cortex than those patients not receiving such treatment. These data suggest previous studies that reported uniform serotonergic dysfunction may have been subject to unintentional selection of behaviourally disturbed Alzheimer cases or those receiving chronic neuroleptic medication. This study also provides a basis for the treatment of behaviourally disturbed Alzheimer patients with serotonomimetics.

Age Factors↗
PubMed1996

Advance directives.

Explore the source record for details and available documents.

Advance Directives↗
PubMed1996

Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia (MOUSEPAD).

BACKGROUND: There is increasing awareness of the importance of psychopathological and behavioural changes in dementia and a need for an instrument to measure these features which achieves an appropriate compromise between brevity and breadth. We describe a newly developed 59-item instrument: the MOUSEPAD. METHOD: Reliability, sensitivity and validity were examined with 30 carers, each of whom was interviewed four times over six weeks. RESULTS: For different symptom groups, kappa ranged from 0.43 to 0.93 for test-retest reliability, from 0.56 to 1.0 for inter-rater reliability, and from 0.43 to 0.67 for the validation study. CONCLUSIONS: The scale may be useful as an outcome measure in drug trials, for correlating psychopathological and behavioural changes with post-mortem findings, and in epidemiological surveys.

Aged↗