Epidemiology Old Age

Transcription

1 Epidemiology Old Age Chris Gale Otago Regional Psychiatry Training Programme March 2011

2 Criteria Validity of a Psychiatric Diagnosis (see Sachdev, 1999). (1) shared genetic risk factors ; (2) familiality ; (3) shared specific environmental risk factors ; (4) shared neural substrates ; (5) shared biomarkers; (6) shared temperamental antecedents; (7) shared abnormalities in cognitive or emotional processing; (8) symptom similarity ; (9) high rates of co-morbidity among disorders ; (10) course of illness ; (11) treatment response

3 Boxplots of distribution of total DRS-R98 scores for diagnostic groups. J Neurol Neurosurg Psychiatry 2010;81: doi: /jnnp

4 Boxplots of distribution of scores on the Cognitive Test for Delirium (CTD) spatial span item forwards (SSF) and backwards (SSB) for diagnostic groups. J Neurol Neurosurg Psychiatry 2010;81: doi: /jnn p

5 The American Journal of Geriatric Psychiatry15.12 (Dec 2007):

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7 On the dementias. The dementias occur in a context. The rate of comorbidity is very high. Between dementias Between dementia and: Disability Substance Abuse Physical Disorders Mood disorders. Surveys are very poor tools for elucidating differential diagnoses.

8 Overall pattern of cognitive function by neuropsychological domain for some neurocognitive and other psychiatric disorders. The abscissa gives the mean effect size for each domain in the group, indicating impairment. AD, Alzheimers disease; FTD, frontotemporal dementia; PD+D, Parkinsons disease with dementia; MDD, major depressive disorder; Schiz, schizophrenia; OCD, obsessive? compulsive disorder; Verbal, verbal intelligence; Performance, non-verbal intelligence (adapted from Zakzanis et al. 1999).

9 Independance (ADL) and prevalence of Dementia. Dementias (percent) Major Mental Disorder (percent) 0: No difficulty Complete cares required From Stineman, J Am Geriatr Soc Mar 1. (ahead of print) doi: /j x

10 Patterns of association between activity of daily living stage across different type(s) of mental and physical chronic health conditions. A multinomial logistic regression addressed condition type as the history of cardiopulmonary disorders (heart attack, myocardial infarction, angina pectoris, other heart disease, bronchitis, emphysema, or asthma), stroke, osteoporosis, diabetes mellitus, arthritis, hypertension, cancer, major mental illness (schizophrenia, paranoid disorder, bipolar disorder, or major depression), or serious dementia (need for proxy because of poor memory or Alzheimer's disease). The reference category in each condition comparison was absence of the condition or other types of conditions. Each plotted association was adjusted for age, sex, and race and for all other conditions. Points indicate relative risk ratios, and vertical lines represent 95% confidence intervals. Steinman, 2011, op.cit.

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12 Prevalence psychosis old age J Geriatr Psychiatry Neurol March 2011 vol. 24 no

13 Severity & Type dementia and psychosis J Geriatr Psychiatry Neurol March 2011 vol. 24 no

14 Anxiety and Mood middle age and older age.

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16 References. Mariani E, Monastero R, Mecocci P. Mild cognitive impairment: a systematic review. J Alzheimers Dis Aug;12(1):23-35 Östling S Gustafson D Blennow K Börjesson-Hanson A Waern M. Psychotic Symptoms in a Population-Based Sample of 85-Year-Old Individuals With Dementia. J Geriatr Psychiatry Neurol March : 3-8, first published on July 2, 2010 doi: / Sachdev P, Andrews G, Hobbs MJ, Sunderland M, Anderson TM. Neurocognitive disorders: cluster 1 of the proposed meta-structure for DSM-V and ICD-11. Psychol Med Dec;39(12): Stineman MG, Xie D, Pan Q, Kurichi JE, Saliba D, Streim J. Activity of Daily Living Staging, Chronic Health Conditions, and Perceived Lack of Home Accessibility Features for Elderly People Living in the Community. J Am Geriatr Soc Mar 1. doi: /j x. Trollor JN, Anderson TM, Sachdev PS, Brodaty H, Andrews G. Age shall not weary them: mental health in the middle-aged and the elderly. Aust N Z J Psychiatry Jul;41(7):581-9.