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W H Roccaforte

Publications and source records attributed to W H Roccaforte.

7 recordsLinked to original sources
PubMed1992

Validation of a telephone version of the mini-mental state examination.

OBJECTIVE: To assess the construct validity of a telephone-administered version of the Mini-Mental State Examination (MMSE). DESIGN: Validity testing by comparing a telephone version of the MMSE administered first to a face-to-face evaluation done several days later. SETTING: Outpatient geriatric assessment center. SUBJECTS: 100 of 175 consecutive referrals. MAIN OUTCOME MEASURES: MMSE and a brief neuropsychological screening test (BNPS) face-to-face and a telephone version of the MMSE as part of the Adult Lifestyles and Function Interview (ALFI-MMSE). RESULTS: Test scores of the two MMSE versions correlated strongly for all subjects (Pearson's r = 0.85, P = 0.001) and remained significant for the cognitively intact (P = 0.02) and questionably (P = 0.002), mildly (P = 0.0001), and moderately (P = 0.003) demented. Comparison of the two versions' equivalent 22 items revealed no significant difference for scores of all subjects (P = 0.07) but with a trend toward higher scores in the original version. Diminished hearing, reported either by the subject (P = 0.003) or by the collateral source (P = 0.02) was associated with lower scores on the telephone version. Five individual test items were biased by the route of test administration. Sensitivity and specificity relative to the BNPS were 67% and 100% for the ALFI-MMSE and 68% and 100% for the MMSE, respectively. CONCLUSION: The scores on the ALFI-MMSE correlated strongly with the scores of the original version given face-to-face in subjects undergoing geriatric assessment. The results indicate that the ALFI-MMSE could be a useful and economical tool to screen for cognitive impairment.

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PubMed1992

A prospective evaluation of the Geriatric Depression Scale in an outpatient geriatric assessment center.

OBJECTIVE: To prospectively evaluate the Geriatric Depression Scale (GDS) in cognitively intact and impaired patients undergoing outpatient geriatric assessment. SUBJECTS: One hundred ninety-four geriatric patients evaluated in a 1-year period. SETTING: The outpatient Geriatric Assessment Center of the University of Nebraska Medical Center. MEASUREMENTS: The 30-item GDS was completed by all patients. The patients were then evaluated by one of three geriatric psychiatrists who were blind to the GDS results. The prospective clinical diagnosis of major depression was compared to the GDS results. Patients were categorized as cognitively impaired or intact on the basis of the Mini-Mental State Examination. Data were analyzed using ROC curves. An optimal cutoff was identified which was the total score on the GDS with the highest combined sensitivity and specificity. RESULTS: ROC curve analyses showed good agreement between the clinical diagnosis and the GDS in both cognitively intact and impaired subjects. Cognitively intact, euthymic patients reported a mean of 8.4 symptoms, while cognitively impaired, euthymic patients, reported a mean of 8.7. Cognitively intact, depressed patients reported a mean of 14.7 symptoms, while cognitively impaired, depressed patients reported a mean of 15.0. CONCLUSIONS: This study provides further evidence that the GDS is as accurate a screening test for depression in cognitively impaired as in intact patients.

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PubMed1990

Use of psychostimulants for the elderly.

As the number of people over age 65 continues to grow, a clear understanding of the usefulness and limitations of psychostimulants in treating elderly persons becomes more important. The authors review the limited literature and discuss the use of psychostimulants for treating "senility," including their effects on cognition, amotivational syndromes, and depression. They conclude that early studies of "senile" patients suffered from a lack of clear diagnostic standards and did not address the issue of whether measurements of the target symptoms being assessed were reliable or valid. The authors suggest that future studies more clearly define age groups, diagnostic criteria, and scales to measure the effects of psychostimulants.

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PubMed1989

Use of the Geriatric Depression Scale in dementia of the Alzheimer type.

The Geriatric Depression Scale (GDS) has been shown to be an effective screening test for depression in selected geriatric populations. However, it has not been evaluated as a screening test for depression among elderly adults with dementia of the Alzheimer type. Over a two-year period 283 patients were seen in a geriatric assessment center and were screened for depression using the Geriatric Depression Scale. They also received a clinical psychiatric diagnosis by one of two geropsychiatrists. Patients with a Clinical Dementia Rating (CDR) of 0 (cognitively intact) (n = 70) and those with mild Alzheimer's disease (CDR of 1) (n = 72) were selected for comparison. The data were analyzed using Receiver Operating Characteristic Curves (ROCs) in order to compare the utility of the Geriatric Depression Scale in these two groups. ROC curves, which plot sensitivity against false positives, have come into increasing use as a method of examining the clinical performance of tests. The area lying beneath the curve (AUC) can be estimated and used as a quantitative measure of test performance (equivalent to the Wilcoxon rank sum). In the intact group, the Geriatric Depression Scale produced a ROC curve with an AUC of 0.85 (percent score = 1), which is significant (z = 7.28, P less than .0001). In the group composed of those with Alzheimer's disease, the Geriatric Depression Scale yielded a ROC curve with an AUC of 0.66, which was not significantly different from chance (z = 1.92, P = NS). This study provides empirical evidence that while the Geriatric Depression Scale is an accurate screening test for depression in cognitively intact geriatric populations, it does not maintain its validity in populations that contain large numbers of patients with dementia of the Alzheimer type.

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PubMedDate not supplied

Characteristics of elderly patients admitted for the first time to a psychiatric facility.

There has been little investigation of patients admitted to a psychiatric facility for the first time late in life. We therefore examined characteristics of a group of 100 consecutive patients over the age of 65, admitted for the first time to the psychiatric service of a private, university-affiliated hospital. Almost two thirds of these patients received a primary discharge diagnosis of major depression, while another one fourth received a diagnosis of dementia. Patients with dementia were significantly older and more likely to be men. The frequency of dementia climbed with each decile affecting 15% of those less than 75 years, 39% of those 75 to 84, and 47% of those over age 85. Thirty-six percent of all patients were psychotic on admission, including 28% of those with major depression and 48% of those with dementia. Visual hallucinations were significantly more common in the group with dementia. In turn, eye disease was significantly more common in those with visual hallucinations. Nine patients were admitted with a history of recent assaultive behavior. Four of these were psychotic and eight of nine were demented. Five patients had attempted suicide prior to their admission. All were diagnosed as having major depression.

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PubMedDate not supplied

The short form of the Geriatric Depression Scale: a comparison with the 30-item form.

The Geriatric Depression Scale (GDS) exists in both short and long forms. The original 30-item form of the GDS has been shown to be an effective screening test for depression in a variety of settings. However, its utility in patients with dementia of the Alzheimer type (DAT) is questionable. The short, 15-item version of the GDS was developed primarily for brevity and, in particular, for use in populations such as the medically ill or those with dementia, where the longer form might be burdensome. How well this short form works in these populations, however, is largely undetermined. In this paper, the sensitivity and specificity of the 15- and 30-item GDS are compared in a group of patients who were either cognitively intact or had mild DAT. The findings suggest that the short version of the GDS, like its longer predecessor, is an effective screening tool in the cognitively intact. However, in a population of subjects with mild DAT, it does not appear to retain its validity.

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