Clinical evaluation of dementia.

The diagnosis of dementia is a clinical one that can only be made with the rigorous use of clearly defined diagnostic criteria in an interview setting. The diagnosis cannot be made by laboratory tests or imaging techniques alone. In the elderly, a number of other psychiatric syndromes must be distinguished from dementia, including delirium, psychosis, depression, and mania. Sometimes it is not possible to make this distinction with confidence. Most dementias are caused by Alzheimer's disease or multi-infarct dementia, and the probable etiologic diagnosis can be made fairly quickly. However, a number of etiologies are possible, and some patients require extensive study. Some uncertainty is usual in the diagnosis of the living patient because routine brain biopsy is not feasible. Geropsychiatric and neurologic consultants can be helpful in selected cases.

Prospective study of tardive dyskinesia incidence in the elderly.

OBJECTIVES: To investigate the incidence of tardive dyskinesia in elderly individuals beginning treatment with antipsychotic drugs and to identify risk factors for the development of tardive dyskinesia in the elderly. DESIGN: A cohort of previously neuroleptic-naive patients was identified at the time of initiation of antipsychotic drug treatment. Patients were evaluated at baseline and followed up at 3-month intervals for periods ranging from 3 to 119 weeks. SETTING: Subjects were recruited from the psychiatric and geriatric medical services of two medical centers, a geriatric institute, and three nursing homes in the metropolitan area of New York City, NY. PATIENTS: Two hundred fifteen individuals older than 55 years have entered the study thus far. Preliminary data are presented for 160 patients who were followed up for at least 1 month. Their age range was 57 to 99 years (mean, 77 years). Seventy-two percent were women and 87% were white. Sixty-seven percent of patients had a diagnosis of organic mental syndrome and 42% had a psychiatric diagnosis. INTERVENTIONS: A naturalistic, longitudinal, repeated assessment paradigm was employed. Assessments included abnormal involuntary movements, extrapyramidal signs, psychiatric symptoms, and medical and drug treatment histories. MAIN OUTCOME MEASURE: The incidence of tardive dyskinesia was determined using a standardized rating instrument and survival analysis. RESULTS: The incidence of neuroleptic-induced dyskinesia was 31% (95% confidence interval, 20%, 42%) after 43 weeks of cumulative neuroleptic treatment. Psychiatric (as opposed to organic) diagnosis and presence of extrapyramidal signs early in treatment were associated with increased tardive dyskinesia vulnerability.