Abstract
Dementing disorders are found most commonly in the elderly. However, the approaches derived from the diagnosis and management of these patients exemplify principles which can equally well be applied to the management of psychiatric disorders in younger patients. These principles include the process of syndromic diagnosis, the need for multi-dimensional assessment, the recognition of the interaction of biological and psycho-social factors in the etiology and treatment of psychiatric symptoms and the crucial role of the family in the management of patients with dementia. In this paper these principles are discussed.
Similar content being viewed by others
REFERENCES
Swearer JM: Behavioral disturbances in dementia, in Handbook of Dementing Illnesses, Edited by Morris JC. New York, Marcel Dekker, Inc., 1994.
Rocca WA, Amaducci LA, Schoenberg BS: Epidemiology of clinically diagnosed Alzheimer's disease. Annals of Neurology 19:415-424, 1986.
Jorm AF, Korten AE, Henderson AS: The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatrica Scandinavica 76:465-479, 1987.
Evans DA, Funkenstein HH, Albert MS, et al: Prevalence of Alzheimer's disease in a community population of older persons. Higher than previously reported. Journal of the American Medical Association 262:2551-2556, 1989.
Henderson AS: The risk factors for Alzheimer's disease: a review and a hypothesis. Acta Psychiatrica Scandinavica 78:257-275, 1988.
Class CA, Unverzagt FW, Gao SJ, et al: Psychiatric disorders in African-American nursing home residents. The American Journal of Psychiatry 153:677-681, 1996.
Ernst RL and Hay JW: The US economic and social costs of Alzheimer's disease revisited. American Journal of Public Health 84:1261-1264, 1996.
Osuntokun BO, Hendrie HC, Ogunniyi AO, et al: Cross Cultural Studies in Alzheimer's Disease. Ethnicity & Disease 2(4):352-357, Fall 1992.
Lowenthal MF, Berkman P, Buehler JA, et al: Aging and Mental Disorder in San Francisco. San Francisco, Jossey-Bass, 1967.
Wechsler D: WMS-R: Wechsler Memory Scale-Revised Manual. San Antonio, The Psychological Corporation, 1987.
Kral VA: Senescent forgetfulness: Benign and malignant. Canadian Medical Association Journal 86(6):257-260, 1962.
Petersen RC, Smith GE, Ivnik RJ, et al: Apolipoprotein E status as a predictor of the development of Alzheimer's disease in memory-impaired individuals. The Journal of the American Medical Association 273(16): 1274-1278, 1995.
Blazer D, Bachar JR, Hughes DC: Major depression with melancholia: a comparison of middle aged and elderly adults. Journal of the American Geriatrics Society 35:927-932, 1987.
Hendrie HC and Crossett JHW: An overview of depression in the elderly. Psychiatric Annals 20(2):65-70, 1990.
Thomas RI, Cameron DJ, Fahs MC, et al: A prospective study of delirium and prolonged hospital stay. Archives of General Psychiatry 45:937-940, 1988.
Francis J, Martin D, Kapoor WN: A prospective study of delirium in hospitalized elderly. Journal of the American Medical Association 263:1097-1101, 1990.
Mach JR Jr., Dysken MW, Kuskowski M, et al: Serum anticholinergic activity in hospitalized older persons with delirium: a preliminary study. Journal of the American Geriatric Society 43:491-495, 1995.
Callahan CM, Hendrie HC, Tierney WM: Documentation and evaluation of cognitive impairment in elderly primary care patients. Annals of Internal Medicine 122(6):422-429, 1995.
Callahan CM, Hendrie HC, Dittus RS, et al: Depression in late life: the use of clinical characteristics to focus screening efforts. Journal of Gerontology 49(1):M9-M14, 1994.
West L, Maxwell DS, Noble EP, et al: Alcoholism. Annals of Internal Medicine 100:405-416, 1984.
Bowden SC: Separating cognitive impairment in neurologically asymptomatic alcoholism from Wernicke-Korsakoff syndrome: is the neuropsychological distinction justified? Psychological Bulletin 107:355-366, 1990.
Saunders R, Copeland JRH, Dewey ME, et al: Heavy drinking as a risk factor for depression and dementia in elderly men. British Journal of Psychiatry 159:213-216, 1991.
Charness ME, Simon RP, Greenberg DA: Ethanol and the nervous system. New England Journal of Medicine 321:442-454, 1989.
Victor M and Adams RD: The alcoholic dementias, in Handbook of Clinical Neurology Series 2, Vol 46. Edited by Vinken PJ, Bruyn GW, Klawans UL. Amsterdam, Elsevier Publishing, 338-352, 1985.
Osuntokun BO, Hendrie HC, Fisher K, et al: The diagnosis of dementia associated with alcoholism: a preliminary report of a new approach. West African Medical Journal 13:160-163, 1994.
Jorm AF. Cross-national comparisons of the occurrence of Alzheimer's and vascular dementias. European Archives of Psychiatry and Clinical Neuroscience 240:218-222, 1991.
Shibayama H, Kasahara Y, Kobayashi H: Prevalence of dementia in a Japanese elderly population. Acta Psychiatrica Scandinavica 74:144-151, 1986.
Hendrie HC, Osuntokun BO, Hall KS, et al: The prevalence of Alzheimer's disease and dementia in two communities: Nigerian Arricans and African Americans. The American Journal of Psychiatry 152(10):1485-1492, October, 1995.
Ritchie K, Kildea D and Robine JM: The relationship between age and the prevalence of senile dementia: a meta-analysis of recent data. International Journal of Epidemiology 21(4):763-769, 1992.
McKhann G, Drachman D, Folstein M, et al: Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 34:939-944, 1984.
Talbot PR, Snowden JS, Lloyd JJ, et al: The contribution of single photon emission tomography to the clinical differentiation of degenerative cortical brain disorder. Journal of Neurology 242(9):579-586, 1995.
Small GW, Mazziotta JC, Collins MT, et al: Apolipoprotein E type 4 allele and cerebral glucose metabolism in relatives at risk for familial Alzheimer disease. Journal of the American Medical Association. 273(12):942-947, Mar 22–29, 1995.
Morris JC, McKeel DW Jr., Storandt M, et al: Very mild Alzheimer's disease: informant-based clinical, psychometric, and pathological distinction from normal aging. Neurology 41:469-478, 1991.
Schellenberg GD: Genetic dissection of Alzheimer disease, a heterogenous disorder. Proceedings of the National Academy of Sciences of the United States of America. 92:8552-8559, 1995.
Van Broeckhoven C: Presenilins and Alzheimer disease. Nature Genetics 11:230-232, 1995.
Saunder AM, Strittmatter WJ, Schmechel D, et al: Association of apolipoprotein E allele E4with late onset familial and sporadic Alzheimer's disease. Neurology 43:1467-1472, 1993.
Hendrie HC, Hall KS, Hui SL, et al: Apolipoprotein E genotypes and Alzheimer Disease in a community study of elderly African Americans. Annals of Neurology 37(1):118-120, January 1995.
Osuntokun BO, Sahota A, Ogunniyi AO, et al: Lack of an association between the E4allele of ApoE and Alzheimer's disease in elderly Nigerians. Annals of Neurology 38(3):463-465, September, 1995.
Anonymous: Statement on the use of Apolipoprotein E testing for Alzheimer's disease. American College of Medical Genetics/American Society of Human Genetics Working Group on ApoE and Alzheimer Disease. Journal of the American Medical Association 274:1627-1629, 1995.
Committee on Aging. Group for the Advancement of Psychiatry: Impact of Tacrine in the case of patients with Alzheimer's disease. American Journal of Geriatric Psychiatry 2(4):285-289, 1994.
Hebert R and Brayne C: Epidemiology of vascular dementia. Neuroepidemiology 14:240-257, 1995.
Hachinski V: Preventable senility: a call for action against the vascular dementias. Lancet 340:645-648, 1992.
Chui HC, Victoroff JI, Margolin D, et al: Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology 42:473-480, 1992.
Roman GC, Tatemichi TK, Erkinjuntti T, et al: Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43:250-260, 1993.
Breteler MM, de Groot RR, van Rommde LK, et al: Risk of dementia in patients with Parkinson's disease, epilepsy and severe head trauma: a register-based follow-up study. American Journal of Epidemiology 142(12): 1300-1305, 1995.
McKeith IG, Fairbairn AF, Bothwell RA, et al: An evaluation of the predictive validity and inter-rater reliability of clinical diagnostic criteria for senile dementia of Lewy body type. Neurology 44:872-877, 1994.
Folstein MF, Folstein SE & McHugh PR: Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12:189-198, 1975.
Blessed G, Tomlinson BE, & Roth M: The association between quantitative measures of dementia and of senile change in the cerebral grey mattery of elderly subjects. British Journal of Psychiatry 114:797-811, 1968.
Morris JC, Mohs RC, Rogers H, et al: Consortium to Establish a Registry for Alzheimer's Disease (CERAD) clinical and neuropsychological assessment of Alzheimer's disease. Psychopharmacology Bulletin 24(4):641-652, 1988.
Mattis S: DRS: Dementia Rating Scale Professional Manual. Odessa, FL, Psychological Assessment Resources, Inc., 1973.
Hughes CP, Berg L, Danziger WL, et al: A new scale for the staging of dementia. British Journal of Psychiatry 140:566-572, 1982.
Reisberg B: Functional Assessment Staging (FAST). Psychopharmacology Bulletin 24(4): 653-659, 1988.
Fillenbaum GG: Screening the elderly: A brief instrumental activities of daily living measure. Journal of the American Geriatrics Society 33(10):698-706, 1985.
Burns A: Psychiatric phenomena in dementia of the Alzheimer type. International Psychogeriatrics 4(Supp. 1):43-54, 1992.
Sultzer DL, Levin HS, Mahler ME, et al: A comparison of psychiatric symptoms in vascular dementia and Alzheimer's disease. American Journal of Psychiatry 150(12):1806-1812, 1993.
Burns A, Folstein S, Brandt J, et al: Clinical assessment of irritability, aggression, and apathy in Huntington and Alzheimer disease. Journal of Nervous & Mental Disease 178(10):20-26, 1990.
Bergener M and Finkel S (Eds.) Treating Alzheimer's and other dementias. New York, Spranger, 1995.
Zubenko GS: Biological correlates of clinical heterogeneity in primary dementia. Neuropsychopharmacology 6:77-93, 1992.
Starkstein SE, Vazquez S, Petracca G, et al: A SPECT study of delusions in Alzheimer's disease. Neurology 44:2055-2059, 1994.
Cohen-Mansfield J and Werner P: Environmental influences on agitation: An integrative summary of an observational study. American Journal of Alzheimer's Care and Related Disorders & Research 1:32-39, Jan/Feb 1995.
Cohen-Mansfield J and Billig N: Agitated behaviors in the elderly. A conceptual review. Journal of the American Geriatric Society 34:711-721, 1986.
Hinchliffe A, Hyman IL, Blizard B, et al: Behavioral complications of dementia — Can they be treated? International Journal of Geriatric Psychiatry 10:839-847, 1995.
Teri L, Rabins P, Whitehouse P, et al: Management of behavioral disturbance in Alzheimer's disease: Current knowledge and future directions. Alzheimer's Disease and Related Disorders 6:77-88, 1992.
Katz IB and Hendrie HC (Guest Editors): Psychiatric Care in the Nursing Home: Introduction. Psychiatric Annals 25(7):408, July 1995.
Fredman L, Daly MP and Lazur AM: Burden among white and black caregivers to elderly adults. Journal of Gerontology: Social Sciences 50B(2):S110-S118, 1995.
Lawton MP, Rajagopal D, Brody E, et al: The dynamics of caregiving for a demented elder among black and white families. Journal of Gerontology: Social Sciences 47:S156-S164, 1992.
Austrom MG and Hendrie HC: Quality of life: the family and Alzheimer disease. Journal of Palliative Care 8(3):56-60, 1992.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hendrie, H.C., Unverzagt, F.W. & Austrom, M.G. The Dementing Disorders. Psychiatr Q 68, 261–279 (1997). https://doi.org/10.1023/A:1025488324153
Issue Date:
DOI: https://doi.org/10.1023/A:1025488324153