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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Attempts to determine the underlying causes of falls have come to conflicting conclusions, partly because subject groups studied have not been representative of all elderly people. Two hundred and three randomly selected people of 75 years and over, living at home, were visited and questioned about falls experienced in the previous 12 months, and about factors that might be related to falling. Eighty-six subjects (42.4%) had suffered one or more falls during this time, and of fallers, 49 (59.3%) were injured, 9 of them seriously. Women were slightly more likely to have had falls and were more likely to have suffered injury, but no increase in frequency of falls with age was demonstrated. Only a minority of fallers (43.0%) sought medical attention following their fall. Falls outside the home accounted for 39.5% of falls and these were more likely to be due to simple trips or slips. Analysis of the factors related to falls showed a considerable overlap between fallers and non-fallers. Fallers had significantly greater dependency and cognitive impairment, more physical symptoms, and higher scores for anxiety and depression, but there was no association with postural hypotension, neurological abnormalities, or measurements relating to nutritional state. The factors found to be significant on discriminant analysis were combined to determine a "fall risk score". This type of easily calculated score might be of use to medical and paramedical personnel for assessing the risk of falling among the elderly living at home.
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PMID:Prevalence, characteristics and factors associated with falls among the elderly living at home. 176 90

The purpose of this study was to identify associations between the use of commonly taken medications and groups of medications and the risk of falls in elderly people living in the community. A stratified random sample of 1358 persons aged 65 years and over was selected from the 15,000 members of an educational organization for functionally independent, community-dwelling elderly people in St Louis, Missouri. Twenty-seven per cent of subjects reported at least one fall in the past year and 8% reported two or more falls. After adjusting for potential confounders (including age, sex, relevant medical conditions, health status, cognitive impairment, use of alcohol, depression and use of other medications), the following medications were found to be important risk factors for multiple falls: diazepam [odds ratio (OR): 3.7, 95% confidence interval (CI): 1.5-9.3], diltiazem (OR: 1.8, 95% CI: 0.8-4.1), diuretics (OR: 1.8, 95% CI: 1.2-2.8) and laxatives (OR: 2.1, 95% CI: 1.0-4.5). We conclude that caution is needed before prescribing diuretics and psychotropics, especially diazepam, for elderly people. The safety of diltiazem in this age group should be assessed further.
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PMID:Medications and multiple falls in elderly people: the St Louis OASIS study. 177 97

Interrelations between depression (Geriatric Depression Scale) and cognitive impairment (Blessed test) were examined among 201 nursing home and congregate apartment residents in a 2-year, 3-wave study. In structural equations models that controlled autocorrelations and within-occasion correlated residuals, introducing paths from depression to subsequent cognitive status significantly reduced unexplained variance, whereas paths from cognitive status to subsequent depression did not. Subsidiary analyses indicated that the relation of depression to subsequent cognitive status was strongest among persons with borderline (vs. impaired or intact) cognitive status, but only for the first time interval. Discussion addresses explanations for obtained results and implications for monitoring and treating depression among elderly long-term care residents.
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PMID:Depression and cognitive change among institutionalized aged. 177 37

Five operational methods for clinical diagnosis of mild dementia were compared to find out their diagnostic concordance when applied to a single group of seventy-five subjects. The clinical validity of the diagnoses was assessed in terms of their capacity to predict continued cognitive deterioration over three years after diagnosis and their capacity to reject the diagnostic influence of 'non-dementia' factors (that is, the cognitive consequences of depression, poor intellect, limited education and non-neurological physical illness). By all criteria of clinical validity the diagnostic methods for mild dementia performed poorly. Kappas measuring agreement between methods averaged only 0.15 and up to 57% of diagnostic deviance was explained by 'non-dementia' factors. Prediction of continued deterioration was poor, with a false positive rate which was too high for the diagnoses to be clinically usable. By no criterion of validity did the diagnostic methods exceed the performance of a clinician's judgement of the presence of pathological cognitive impairment or diagnosis by a cutpoint on the Mini-Mental State Examination.
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PMID:The validity of the diagnosis of mild dementia. 178 Apr 5

Potentially reversible dementia is reviewed with reference to diagnosis, causes and outcome. Many disorders which cause cognitive impairment, such as drug toxicity and depression, fail to meet diagnostic criteria for dementia. These tend to have the best prognosis. Studies of the neuropsychiatric syndromes associated with disorders causing potentially reversible dementias suggest that dementia is an infrequent outcome and when it does occur, few cases recover. Factors predictive of improvement are short duration of symptoms and mild degree of cognitive impairment, usually subcortical in type. It is suggested that potentially reversible cognitive impairment would be a more accurate term as many cases are due to delirium and depression. While cases of well established dementia do not require extensive investigation, all cases should have a thorough clinical assessment as in many instances dual pathology exists and all require psychosocial management.
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PMID:Potentially reversible dementia: a review. 164 31

Bit-mapped multicomponent CNV complex and reaction time (RT) were recorded and measured in 24 presenile patients with initial symptoms of very mild to moderately severe primary mental deterioration without depression, and in 10 age-matched controls. All patients underwent CT and MRI examinations, EEG spectral analysis and a battery of psychometric test. Significant group differences were obtained for measures of some post-S1 ERP and CNV components, particularly of the post-S1 N1b, P300 and early and late pre-S2 CNV. P300 with increased latency, no significant CNV activity, very prolonged RTs, EEG slowing down and diffuse brain atrophy were observed in the majority of patients with probable presenile Alzheimer's dementia. These results suggest that CNV/RT and EEG activity changes similar to those observed in our patients may constitute a valuable clue for the study of brain dysfunction in the early stage of presenile idiopathic cognitive impairment.
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PMID:Effect of physiological and pathological aging processes on topographic bit-mapped cognitive evoked potentials in presenile subjects. 180 55

A survey of patients aged 75 years and over registered with general practitioners in north and north west London was carried out by trained interviewers to investigate cognitive impairment. A random sample of 239 patients was selected for the more detailed home assessment. General practitioners had seen nearly two thirds (65.3%) of their patients aged 75 years and over in the three months prior to the study, the majority of these consultations (82.1%) being initiated by the patient and occurring at the surgery. Half of the patients lived alone (50.2%), nearly one in three had no living siblings (31.9%), a similar proportion had no living children (29.5%), and contact with neighbours and relatives was relatively infrequent. One in five elderly patients had evidence of depression (22.0%) although this appeared to be severe in only two cases, and 36 participants (15.1%) had scores on the mini-mental state examination suggesting cognitive impairment. General practitioners underdiagnosed both dementia and depression. The population contained a small group of people who consumed alcohol on a daily basis (10.5%). This study showed that an annual assessment of elderly people as required by the new general practitioners' contract would yield much new evidence of depression and dementia and assist in the identification of heavy drinkers. Up to 30% of patients aged 75 years and over are likely to require further assessment on the basis of screening tests for depression and cognitive impairment, although it remains unclear to what extent identification of these patients will lead to improvements in outcome for them or their carers.
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PMID:Assessment of elderly people in general practice. 1. Social circumstances and mental state. 174 72

Evaluation of the change in performance on the Blessed Memory Information Concentration Test over a one-year period was used as a probe for the prevalence of reversible cognitive disorders among patients living in a residential care facility. Of 157 patients with cognitive impairment at the initial assessment, 10 (6.4%) improved by 6 points or more, 19 (12.1%) improved by 5 points or more, and 15 (9.6%) had a reduction in the number of errors by 33% or more. Thus, using improvement over time as an indicator, we estimate that 6% to 12% of the elderly patients in our sample had a reversible component to their cognitive impairment at the initial assessment. Retrospective review of medical records identified (one or more) possible causes for impairment at baseline in each of the ten patients who showed the greatest improvement: adverse drug effects in seven patients, depression in two, and metabolic encephalopathies in three.
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PMID:Toxic and metabolic encephalopathies in long-term care patients. 181 86

Because there are no direct biological markers for the substances implicated in indoor air exposure, it is impossible to directly measure if an individual or group of individuals has been exposed to a potentially neurotoxic substance in the workplace. Behavioral changes may be the earliest and only manifestation of central nervous system (CNS) effects and are often too subtle to be revealed by routine physical or neurological examination. Neuropsychological techniques are sensitive to subtle behavioral/cognitive changes that can result from exposure to neurotoxins. These techniques consist of oral and written tests that are administered by a trained examiner on a one-to-one basis. In general, a wide variety of cognitive domains are evaluated. The typical battery generally includes assessing orientation, attention, intelligence, language, visual memory, verbal memory, perception, visuoconstruction, simple motor speed, psychomotor speed, and mood. As with most assessment techniques, the neuropsychological methods have limitations. One major drawback is the availability of appropriate norms that are used to compare the results of a specific individual. Because these tasks are greatly affected by age, intelligence, and in some instances sex, the availability of appropriate norms is mandatory to determine if the CNS has been effected. Although neuropsychological tests are sensitive to the presence of CNS involvement, they are not specific. Patterns of performance seen with specific instances of neurotoxic exposure may also be seen with a number of other diseases of the CNS such as dementia, cerebrovascular disease, hydrocephalus, or normal aging. In addition, neuropsychiatric symptoms such as anxiety and/or depression are often manifested as cognitive difficulties that will mimic the cognitive dysfunction seen with toxicity of the CNS.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Neuropsychological assessment for detecting adverse effects of volatile organic compounds on the central nervous system. 182 86

Advanced age among the elderly has been hypothesized to be a risk factor for depression, yet extant data do not uniformly support this hypothesis. The paucity of sufficiently large and representative samples of both the young-old and old-old and the failure to control for critical variables known to confound the association between advanced age and depression have prevented testing this hypothesis. The Duke EPESE (Establishment of a Population for Epidemiologic Studies of the Elderly) assessed 3,998 community-dwelling elders (65+) for depressive symptoms using a modified version of the CES-D and relevant control variables. Depressive symptoms were associated in bivariate analysis with increased age, being female, lower income, physical disability, cognitive impairment, and social support. In a multiple regression analysis, the association of age and depressive symptoms reversed when the above confounding variables were simultaneously controlled. The oldest old suffered fewer depressive symptoms when factors associated with both increased age and depressive symptoms were taken into account. Because many of these factors can be prevented (such as decreased income, physical disability, and social support), the uncontrolled association between age and depressive symptoms can potentially be modified.
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PMID:The association of age and depression among the elderly: an epidemiologic exploration. 183 26


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