The relationship between pre-operative anxiety and post-operative delirium.

Forty five elderly patients undergoing total hip replacements were assessed one day before and two days after surgery in order to explore the relationship between pre-operative anxiety and post-operative delirium. Anxiety was measured by the State-Trait Anxiety Inventory and delirium was measured by a decrease in various measures of cognitive functioning. No relationship was found and this is discussed in the light of two theories which would have predicted one. Other secondary findings are reported and discussed.

Diagnosing dementia: do we get it right?

To find out whether the diagnosis of dementia agreed with findings at necropsy a detailed assessment of 27 elderly patients (mean age 82 (range 70-94] presenting with dementia was conducted at a combined department of geriatric medicine and psychiatry for the elderly. On the basis of the results the cause of the dementia was diagnosed clinically. Neuropathological examinations were performed after death. The clinical diagnosis made during life was not supported by the findings at necropsy in 11 cases. Alzheimer's disease was overdiagnosed in life (13 cases, of which only six were confirmed at necropsy). Although the clinical investigation was limited by availability of resources, neither cranial computed tomography nor the Hachinski score helped to distinguish between multi-infarct dementia and Alzheimer's disease in this age group. This study confirms the value of neuropathological studies in the precise diagnosis of dementia.

Alcoholism in the general hospital.

To assess the prevalence of alcoholism among people admitted to hospital 303 patients completed a drinking questionnaire. A total of 59 (19.5%) were found to have a drinking problem, which constituted a sixfold greater prevalence than recorded in a community survey using the same technique. The drinkers were mostly men and tended to be younger than the non-drinkers and to smoke more heavily, live in more crowded conditions, and be of lower social class. Significantly more of the drinkers had at least one parent who was an alcoholic. The results confirm that hospital inpatients comprise a larger proportion of alcoholics than found in the general population. Hence medical staff should be alert to such patients, so that treatment may be initiated at an early stage of social decompensation.

Attitudes to psychiatry in the general hospital.

A survey of consultant attitudes to psychiatry in six general hospitals is presented and compared with reported findings in general practitioners and medical students.Psychological factors were accepted as important in a variety of medical conditions. Different specialties differed little in their attitudes to neurotic patients and to psychiatrists, younger consultants tending to be more critical. Consultants had a lower level of neuroticism than the general population and medical students, and physicians were less extraverted than surgeons; these personality factors were not related to expressed attitudes.The results suggest that other specialties accept the role of psychiatry, and its integration into the general hospital is not likely to meet with antagonism.

Anti-cholinergic drugs and memory: the effects of benzhexol on memory in a group of geriatric patients.

A double blind trial on the effects of 2 mg of benzhexol on memory was performed on thirteen elderly subjects without cognitive impairment. The tests given 90 minutes after the drug or placebo involved learning a list of ten words, a paired-associate learning task, learning a short story and a test of digit span. Subjects were asked to recall the word list one minute after an interfering task, and 6 items from the story directly. Digit span involved immediate recall and the paired learning was measured by the number of trials necessary to learn. All tests were significantly impaired by the benzhexol except for digit span. This suggests that muscarinic blocking drugs should be avoided in the elderly, as they mimic the memory deficits found in senile dementia of Alzheimer type.

Aneuploidy in cultured human lymphocytes: I. Age and sex differences.

The chromosomes of the lymphocytes of 208 subjects have been analysed in order to determine the relationship between age, sex and aneuploidy. The subjects consisted of 111 females and 34 males all over 65 years and 31 females and 32 males aged between 18 and 32 years. The degree of hypodiploidy (chromosome loss) differs significantly between the elderly and young subjects of each sex and between the aged males and females. Hyperdiploidy differs significantly only between the old and the young females. Giemsa banding shows that, in elderly females, increased hypodiploidy is especially due to the loss of an X-chromosome. The possible mechanisms accounting for these results are discussed.

Aneuploidy in cultured human lymphocytes: II. A comparison between senescence and dementia.

A study has been made of aneuploidy in the cultured lymphocytes of senile dements (46 females and 8 males), arteriosclerotic dements (10 females and 8 males) and normal geriatric controls (55 females and 18 males). Contrary to previous reports of senile dements having a higher degree of hypodiploidy (chromosome loss) than age-matched controls, there were no significant differences between any of the diagnostic groups. The association between individual subjects' age and hypodiploidy is positive, though not significant, with a high degree of individual variation. The reasons for the discrepancies between this and previous studies are discussed as are possible future lines of research in this field.

Immunological factors in senile dementia.

Sixty-four patients suffering from senile dementia were compared with 71 age-matched controls suffering from functional psychiatric illness, in terms of their chromosome complement, tuberculin and dinitrochlorobenzene response and total immunoglobulin levels. No significant differences emerged between these groups except for slightly reduced levels of immunoglobulin G in the dement sample. We conclude that senile dementia as a whole is not related to a defect in immunological function.

Information leading to accurate diagnosis in the elderly.

Psychiatric diagnosis in the elderly has been examined in order to extract the information which leads to later modification of the diagnosis. Initial diagnoses of neuroses and toxic states were least stable, 14 out of 29 changing to a different category. Information from relatives and further interviews contributed most to the modification of the initial diagnosis, though affective and neurotic syndromes were particularly susceptible to change resulting from conceptual differences, and dementia to change consequent on physical examination. It is concluded that an adequate initial interview of a patient and his next of kin will achieve a diagnosis which is correct in its major category on 95 per cent of occasions.

Trials of lithium, chlorpromazine and amitriptyline in schizoaffective patients.

Two drug trials in schizoaffective patients are reported. Nineteen "schizomanic" patients were treated for one month, on a double blind basis, with chlorpromazine or lithium and 41 "schizodepressive" patients with amitriptyline, chlorpromazine or both. In the schizodepressive patients there was a trend to a better response to chlorpromazine, but drug response generally was poor, only 20 per cent of patients recovering within the month. In the schizomanic patients lithium seemed as effective as chlorpromazine, which supports the view that these patients were suffering from a variant of mania.

Beta blockade in lithium tremor.

Practolol, propranolol, and placebo have been tested on an objective test of lithium induced tremor. Both beta-blocking agents produced significantly more tremor than the placebo. It is argued that lithium induced tremor is closer to essential than to physiological tremor.

The St. George's dementia bed investigation study: a comparison of clinical and pathological diagnosis.

Sixty-four elderly patients who had been admitted to the St. George's Hospital Alzheimer's disease evaluation project during 1981-1989 were followed up to postmortem examination. Comparison between clinical diagnoses and neuropathological diagnoses indicated positive predictive values for the antemortem diagnoses of 50-67%. Existing clinical criteria may not be accurate enough to permit firm antemortem diagnosis of older people for either research or clinical purposes.

A double-blind, randomised comparison of fluvoxamine with dothiepin in the treatment of depression in elderly patients.

The efficacy and tolerability of the selective 5-HT reuptake inhibitor fluvoxamine were compared with the tricyclic dothiepin in 52 elderly (age greater than 64 years) hospital patients in a multi-centre double-blind randomised trial. Patients met DSM-III criteria for 'major depressive episode' and scored greater than 29 on the Montgomery Asberg Depression Rating Scale (MADRS) after a one-week placebo baseline. Active treatment was for six weeks. The dosage of both drugs was 50 mg nocte for three days, 100 mg nocte for the remainder of the first week, thereafter increasing to a maximum of 200 mg/day according to response/tolerance. MADRS scores improved by 63.5% with fluvoxamine and 60.0% with dothiepin; there were no significant differences between treatments at any assessment. Nausea, dizziness, headache, somnolence and constipation in both groups, plus dry mouth and asthenia in the dothiepin group were more frequent than single reports. Two patients in each group discontinued treatment owing to unwanted effects. There were no clinically significant changes in haematological, biochemical or cardiovascular parameters.

The St. George's dementia bed investigation study: cardiovascular, neurological and neuropsychological correlates.

The results of the cardiovascular, neurological and neuropsychological examination of a series of patients admitted to the St. George's dementia investigation bed and who later came to postmortem are compared in relation to their pathological diagnosis. Individual clinical signs were not found to differentiate between cases of dementia with vascular versus those with Alzheimer's disease pathology, although multivariate analysis suggested that there was a pattern of signs associated with cerebrovascular disease. A vascularity index was constructed from these signs; it achieved a useful level of discrimination between vascular and nonvascular causes of dementia.