Test battery for the diagnosis of dementia in individuals with intellectual disability. Working Group for the Establishment of Criteria for the Diagnosis of Dementia in Individuals with Intellectual Disability.

A working battery of tests for the diagnosis of dementia, which is applicable to most adults with intellectual disability, is proposed by an international Working Group. The battery, reflecting contemporary research and practice findings, includes scales for informant report of functioning and tests for direct assessment. The Working Group recommends the international use of the battery both as part of ongoing and new longitudinal research, and in clinical practice. The widespread use of a common battery will enhance communication and collaborative opportunities among researchers and clinicians at various sites, and will help to standardize diagnostic protocols and research findings. The collaborative evaluation of such a battery will address one of the greatest challenges in the field, that of differentiating change associated with ageing from that associated with dementia.

Assessment of orientation: relationship between informant report and direct measures.

Although informant reports of everyday functioning are often used in dementia assessments, the actual correspondence between such indirect reports of functioning and actual performance has not been examined. Orientation results on the Dementia Questionnaire for Mentally Retarded Persons were compared to those obtained in direct assessment of orientation of 138 adults with mental retardation. Fair to good agreement was found between informant report and direct assessment. However, for some orientation items, nonverbal IQ, cause of mental retardation, and age affected the level of agreement. Thus, both informant report and direct measures of orientation are necessary in dementia assessments, and further work is needed on informant scale validation.

Dementia in adults with Down syndrome: diagnostic challenges.

Although dementia associated with Down syndrome is often presumed to be progressive and irreversible, variations in disease course have been described. In addition, prevalence rates have varied widely among studies. This interim report is a description of the status of 70 adults with Down syndrome who are being followed for signs of dementia. Of the 70, 12 met all criteria for dementia, 40 met subsets of criteria, and 18 met no criteria. Information is provided on instruments used, rationale for choice and revision of instruments as well as criteria used to identify dementia and changes in the status of the participants. The results suggest that extreme care is needed when diagnosing dementia in adults with Down syndrome, for both clinical and research purposes.

Diagnosis of dementia in individuals with intellectual disability.

The foremost impediment to progress in the understanding and treatment of dementia in adults with intellectual disability is the lack of standardized criteria and diagnostic procedures. Standardized criteria for the diagnosis of dementia in individuals with intellectual disability are proposed, and their application is discussed. In addition, procedures for determining whether or not criteria are met in individual cases are outlined. It is the intention of the authors, who were participants of an International Colloquium on Alzheimer Disease and Mental Retardation, that these criteria be appropriate for use by both clinicians and researchers. Their use will improve communication among clinicians and researchers, and will allow researchers to test hypotheses concerning discrepancies in findings among research groups (e.g. dementia prevalence ranges and age of onset).

Stability of diagnosis in schizophrenia.

OBJECTIVE: The authors investigated factors associated with change in diagnosis from schizophrenia to other disorders and from other disorders to schizophrenia, as well as the time elapsed before diagnostic change. METHODS: Using a longitudinal study design, they examined data collected over a 7-year period at an urban acute care psychiatric hospital. The subjects were 936 inpatients who had been hospitalized at least four times during the study period. Changes to and from a diagnosis of schizophrenia over the 7 years were investigated in relation to demographic variables, socioeconomic factors, and clinical features. RESULTS: Fifty-six (21.9%) of the 256 subjects with a diagnosis of schizophrenia at the beginning of the study received a different diagnosis during a subsequent hospitalization. Females and subjects of Hispanic origin were more likely to undergo a diagnostic change from schizophrenia. Two hundred twenty-three (32.8%) of the 680 subjects who initially had a diagnosis other than schizophrenia were later diagnosed with schizophrenia. Males and African Americans had significantly higher rates of change to a diagnosis of schizophrenia than females and other ethnic groups. In addition, socio-economic factors and clinical features were associated with a change in diagnosis from another disorder to schizophrenia. CONCLUSIONS: The diagnosis of schizophrenia, in current practice, is not static. Patients' characteristics interact with longitudinal clinical changes to produce shifts in diagnosis. Longitudinal follow-up is necessary to validate diagnoses.

Aging in adults with Down syndrome: report from a longitudinal study.

Changes in functioning related to aging were examined in 34 adults (14 females, 20 males) with Down syndrome who were 22 to 56 years of age. Changes in functioning over 3 to 4 years were examined, with age, IQ at entry into the study, and gender considered. Neither effects of age at entry nor change over time were significant, suggesting that changes related to aging in adults with Down syndrome were minimal. In contrast, IQ at entry had a significant effect on all performances, suggesting that any examination of aging must consider intellectual level. Results do not support the idea that adults with Down syndrome show rapid age-related declines in functioning apart from the occurrence of a progressive dementia such as Alzheimer's disease.

Depression and memory impairment: a meta-analysis of the association, its pattern, and specificity.

The existing evidence paints an unclear picture of whether an association exists between depression and memory impairment. The purpose of this investigation was to determine whether depression is associated with memory impairment, whether moderator variables determine the extent of this association, and whether any obtained association is unique to depression. Meta-analytic techniques were used to synthesize data from 99 studies on recall and 48 studies on recognition in clinically depressed and nondepressed samples. Associations between memory impairment and other psychiatric disorders (e.g., schizophrenia, dementia) were also examined. A significant, stable association between depression and memory impairment was revealed. Further analyses indicated, however, that it is likely that depression is linked to particular aspects of memory, the linkage is found in particular subsets of depressed individuals, and memory impairment is not unique to depression.

Triazolam and ethanol effects on human matching-to-sample performance vary as a function of pattern size and discriminability.

The effects of placebo, triazolam (2.0, 4.0 and 8.0 micrograms/kg) and ethanol (0.25, 0.5, 1.0 g/kg) on perceptual-motor performance were examined using a visual pattern matching-to-sample procedure in which pattern size and comparison stimulus discriminability were systematically varied. Baseline response rates and accuracy increased as the discriminability of the comparison stimuli increased. At the highest dose, both drugs decreased response accuracy. This disruption of accuracy was attenuated by increasing the discriminability of non-matching stimuli. Triazolam produced dose-related decreases in response rate while ethanol produced only slight decreases at the highest baseline rates of responding. Thus, triazolam produced response rate slowing at relatively lower doses than ethanol.

Depression and the onset of dementia in adults with mental retardation.

The relation between dementia and depression in 61 adults with Down syndrome or 43 adults with mental retardation due to other causes was examined. Age-matched participants, ranging in age from 20 to 60 years, received a neuropsychological battery to assess declines in functioning and caregiver report measures to assess adaptive behavior and depression. Eight adults with Down syndrome had both depression and declines in functioning. No adults with mental retardation due to other causes had declines. Greater severity of depression was related to lower MA, poorer memory, and lower adaptive functioning in adults with Down syndrome only. Results suggest that dementia and depression are associated in Down syndrome but not in mental retardation due to other causes.