Journal of Geriatric Psychiatry and Neurology

Delirium is a common poststroke complication, but its prevalence and effect in rehabilitation settings is unknown. We retrospectively assessed the prevalence of delirium in elderly patients undergoing poststroke rehabilitation and its association with short-term outcomes.

All patients (aged ≥65 years) admitted to the Department of Rehabilitation between November 2007 and October 2011 after a recent stroke were screened for delirium. Delirium was diagnosed using the confusion assessment method. Multiple logistic regressions were used to evaluate the association between delirium, institutionalization, and inhospital death, while multiple linear regressions were used for the association between delirium and functional recovery, defined in 3 different ways which include (1) measuring the relative functional gain of the Barthel index (BI-RFG); (2) the change in Barthel index (BI) walking subscore from admission to discharge; and (3) the change in Tinetti score from admission to discharge.

In all, 58 (33%) patients of the total 176 patients were consecutively admitted to our department with delirium. After adjustment for potential confounders, poststroke delirium (PSD) was an independent predictor of institutionalization (odds ratio [OR] = 7.23; 95% confidence interval [CI] = 4.79 to 10.91; P ≤ .0003) and inhospital death (OR = 4.26; 95% CI = 1.15 to 15.81; P = .03); PSD was not a predictor of functional recovery at discharge, neither using the BI-RFG (P = .96) nor using the change from admission to discharge of both the BI walking subscore (P = .57) and the Tinetti score (P = .61) as outcome measures.

In elderly patients undergoing poststroke rehabilitation, delirium is an independent predictor of institutionalization and inhospital death, but it does not affect functional recovery.

To characterize the prevalence of functional limitations among older adults with cognitive impairment without dementia (CIND).

Secondary data analysis was performed using the Aging, Demographics, and Memory Study data set. A total of 856 individuals aged ≥ 71 years were assigned to 3 diagnostic cognitive categories. A questionnaire was completed by a proxy informant regarding functional limitations for 744 of the 856 respondents.

Of the 744 patients, 263 (13.9%) had dementia, 201 (21.3%) had CIND, and 280 (64.8%) had normal cognition. Informants reported ≥1 instrumental activities of daily living (ADLs) limitation in 45% of the patients with CIND compared to 13% of the patients with normal cognition and 85% of the patients with dementia (P < .001). The ADL impairments among individuals with CIND were primarily attributed to physical health problems (n = 41; 40%).

Many individuals with CIND have impairment in a range of complex and basic daily activities, largely due to physical health problems.

Several studies have identified certain caregiver factors that can produce variability in their assessments of the capacities of patients with Alzheimer disease (AD).

To identify the caregiver variables associated with variability in their ratings of patients’ capacities.

Consecutive sample of 221 outpatients with AD and their family caregivers. The capacities evaluated by caregivers were the degree of functional disability, using the Disability Assessment for Dementia (DAD); psychological and behavioral symptoms, via the Neuropsychiatric Inventory (NPI); anosognosia, with the Anosognosia Questionnaire-Dementia (AQ-D); and quality of life, using the Quality of Life in AD (QOL-AD). The relationship between these measures and caregiver’s gender, burden, depression, and health was analyzed by means of a bivariate analysis, calculating the effect size (Cohen d) and subsequently by a regression analysis, calculating the contribution coefficient (CC).

The greatest variability in caregiver assessments was observed in relation to patients with early-stage dementia, where caregiver’s burden was the main factor associated with a more negative evaluation (d = 1.02-1.25). Depression in the caregiver was associated with less variability and only in the assessments of patients with moderate dementia (d = 0.38-0.69). In the regression analysis, caregiver factors were associated with greater variance in scores on the NPI (CC = 37.4%) and QOL-AD (CC = 27.2%), and lower variance in AQ-D (CC = 21.6%) and DAD (CC = 10.3%) scores.

Caregiver’s burden and depression were associated with more negative assessments of patients’ psychological and behavioral symptoms and quality of life.

In previous studies among patients with Parkinson disease (PD) who were administered the Apathy Evaluation Scale (AES), between 12% and 51% evidenced clinically significant apathy. Although apathy is a risk factor for dementia, its causes and clinical correlates have not been adequately studied. In particular, side of onset of disease, though a likely predictor of apathy and dementia, has not been thoroughly investigated.

A total of 30 mid-stage patients with PD and 35 community-dwelling elderly control patients (CPs) were administered the AES (self version) along with a battery of cognitive and neuropsychiatric assessments. Persons close to patients with PD and CPs completed the AES—other (informant) version about the patient or CP. Multiple linear regression analysis examined predictors of apathy severity after controlling for mood, levodopa dosage equivalents (LDEs), gender, age, and disease severity (Hoehn–Yahr [H-Y] stage).

Patients with right-onset disease more frequently exhibited apathy and evidenced significantly higher total AES scores than left-onset patients with PD or CPs (P < .03). Of all the patients, 42% with right-onset PD versus 11.1% of the patients with left-onset PD exhibited clinically significant levels of apathy. There were no differences for self versus informant scores for right-onset patients with PD. The AES scores were not correlated with depression, stress, anxiety, LDEs, gender, age, and H-Y stage. There were no gender differences for any AES variables.

Clinically significant levels of apathy are much more likely to occur in patients with right-onset disease. These patients may be at greater risk of PD-related dementia.

Parkinson’s disease (PD) is frequently complicated by co-occurring psychiatric problems such as depression and anxiety that negatively affect the course and management of the illness. Yet, in most cases, these psychiatric comorbidities are neither recognized nor treated to remission. The primary purpose of this study was to identify and describe barriers to mental health care utilization for people with PD. Secondary objectives included the assessment of attitudes and preferences regarding the need for mental health services in the PD community and the acceptability of telehealth interventions as a method for improving access and quality of care.

A total of 769 people with PD completed an anonymous cross-sectional questionnaire assessing barriers to mental health care utilization in this medical population. Respondents were drawn from a national sample.

Commonly endorsed barriers to mental health care utilization in PD reflect the patients’ incomplete understanding of mental health problems, access issues, and illness-specific concerns, as well as the inadequate screening and detection of psychiatric complications by medical providers and the need for more effective treatments in this medical population. Several demographic, medical, and psychiatric variables also influenced the likelihood of accessing mental health care. Interest in telehealth approaches to mental health treatment was high and, in several instances, correlated with perceived barriers to mental health care utilization.

People with PD may encounter a multitude of barriers that impede their pursuit of mental health care. Clinical implications are discussed and further research is needed to replicate and extend these findings.