Overinclusive thought and loosening of associations are not unique to schizophrenia and are produced in Alzheimer's dementia.

INTRODUCTION: Bleuler's concept of loosening of associations which he believed epitomised psychotic thinking can manifest as overinclusion (merging of semantic categories) on semantic categorisation tasks. Overinclusion is explained by excessive activation within the semantic memory network to subordinate features with low associative strength. Therefore patients with degradation of subordinate semantic knowledge (e.g., with Alzheimer's Dementia-AD) should not produce overinclusion errors. METHODS: 22 people with schizophrenia and 26 people with AD (nonpsychotic, semantic memory impairment) were compared on a semantic categorisation test, the Category Generation Test (CGT). The CGT involves free-sorting 45 cards of pictured objects from five taxonomic groups (e.g., animals). Overinclusion and underinclusion (subdivision of categories) errors were recorded and the strategies used in generating these abnormal categories were explored qualitatively. RESULTS: Two-thirds of both groups generated abnormal categories, including frequent overinclusions. Using a semantic probes test, abnormal categorisations could not be attributed to knowledge degradation as this appeared preserved. Qualitatively, the two groups differed in their sorting strategies. CONCLUSIONS: Loosening of associations is found in nonpsychotic people, who have semantic memory impairments (e.g., AD), using semantic knowledge tasks. However there may be different explanations; atypical semantic categorisation in schizophrenia appears to result from attention to thematic rather than feature-based associations.

Spontaneous retrieval deficits in amnestic mild cognitive impairment: A case of focal event-based prospective memory.

OBJECTIVE: Research on early cognitive markers of Alzheimer's disease is primarily focused on retrospective recall (of word lists, pairs of items, stories) and executive functions. However, research shows that people with amnestic mild cognitive impairment (aMCI), who are at a higher risk of developing the disease than healthy controls, are particularly impaired in remembering to do things in the future or prospective memory (PM). The aim of this study was to establish which type of event-based PM is particularly disrupted in aMCI, focal PM, based on spontaneous retrieval, or nonfocal PM that relies on strategic monitoring processes. METHOD: Thirty-eight aMCI individuals and 46 age- and education-matched healthy older adults identified the profession of each famous face presented (ongoing task) and, additionally, responded to certain professions (focal PM condition), or to certain physical features of a person presented (nonfocal PM). Only 4 aMCI individuals could not remember PM instructions at the end of the session, and were excluded from analyses. RESULTS: In comparison with healthy controls, participants with aMCI were significantly impaired in the focal PM task, but not on the nonfocal task. In both groups, monitoring indices were significantly higher in the nonfocal than focal PM condition. CONCLUSIONS: The results fully replicate and extend initial findings of Chi et al. (2014) and McDaniel, Shelton, Breneiser, Moynan, and Balota (2011), showing substantial spontaneous retrieval deficits in PM performance of aMCI individuals. Possible brain mechanisms involved in this deficit are discussed and a novel hypothesis of more generic spontaneous retrieval deficits in aMCI is proposed. (PsycINFO Database Record

Carers' diaries in dementia: Is there a role in clinical practice?

INTRODUCTION: Carers' diaries have been used in very few instances in dementia to assist with gathering information about persons with dementia in the community. The main aim of this study was to compare problems identified using diaries kept by family carers for a week with carers' oral recollection of problems. METHOD: Carers were randomly allocated into two groups, diary and control groups. In the diary group, carers received a diary and instructions on how to complete it for 7 days. RESULTS: A total of 78 carers completed the study. The frequency of problems identified in the carers diaries was greater than in the carers' narrative accounts at day 1 and day 8. The most common problems were behavioral and cognitive problems. DISCUSSION: Carers' diaries may complement the assessment of dementia as they can provide more information on the problems faced by the persons with dementia.

A protocol for a systematic review of research on managing behavioural and psychological symptoms in dementia for community-dwelling older people: evidence mapping and syntheses.

BACKGROUND: Non-cognitive behavioural and psychological symptoms of dementia affect up to 90% of people with dementia during the disease course and result in distress, increased carer burden, high service utilization and unwanted moves to care homes. Research has focused on long-term settings and has not considered people with dementia living at home and at different stages of the disease trajectory. Our aim is to review systematically the evidence concerning non-pharmacological strategies to minimise behavioural and psychological symptoms in community-dwelling older people with dementia. METHODS/DESIGN: Our approach is a two-stage co-design: a systematic mapping of the broad evidence around behavioural and psychological symptoms followed by an in-depth systematic review of studies of non-pharmacological interventions for behavioural and psychological symptoms from the perspective of their impact on community-dwelling older people with dementia and their carers. The review will include published literature involving a wide range of electronic databases using sensitive and comprehensive searches and lateral searching including checking citations.We will produce a descriptive map of the studies by design and by the focus of interventions and apply further inclusion criteria, developed in conjunction with lay experts, to select studies for an in-depth systematic review that will include independent quality assessment and detailed data extraction by two reviewers.The review process will be integrated with stakeholder meetings and a multidisciplinary expert advisory group to guide the review parameters and shape the research questions on the management of behavioural and psychological symptoms in people with dementia. Because studies are likely to be diverse in methodology and interventions, we will conduct a narrative synthesis of the in-depth systematic review. If appropriate, we will pool studies in a meta-analysis. We will explore review findings at both stages through focus groups and interviews with service providers, practitioners, people with dementia and carers. DISCUSSION: This integrated review in collaboration with key stakeholders will synthesise research evidence to identify appropriate interventions for effective management of behavioural and psychological symptoms that supports people with dementia living at home and their carers, and which reflects their priorities. It will make recommendations for research and practice. STUDY REGISTRATION: PROSPERO registration number: CRD42013004344.

Prevalence and management of behavioural and psychiatric symptoms on a continuing care unit for patients with dementia.

OBJECTIVES: With the increasing concerns over the safety of some pharmacological interventions or lack of sufficient evidence of effectiveness in managing neuropsychiatric symptoms in dementia, there is a constant need to review how such patients are managed. This study looks at the prevalence and management of behavioural and psychiatric symptoms amongst patients with dementia in a National Health Service (NHS) continuing care unit. METHOD: In this study, a survey of all 50 patients admitted to a longstay NHS-funded dementia care unit was carried out. The socio-demographic details along with severity of dementia, neuropsychiatric symptoms, and medication were obtained on all the patients. FINDINGS: All 50 patients were prescribed some form of medication for either physical and/or mental health reasons. Only five (10%) patients were not prescribed any form of psychotropic medication. A lack of non-pharmacological treatment options for the treatment of neuropsychiatric symptoms was evident in the unit with only one occupational therapist available. CONCLUSION: Effective management of severe behavioural and psychiatric symptoms in dementia is challenging even in a NHS continuing care dementia unit due to the absence of clear benefit from pharmacological interventions and lack of resources for optimum non-pharmacological interventions.

High specificity of the medical symptom validity test in patients with very severe memory impairment.

Failure on effort tests usually implies insufficient effort to produce valid cognitive test scores. However, many people with very severe cognitive impairment, such as dementia patients, will produce failing scores on nearly all effort tests. In such patients, effort tests have low specificity. The Medical Symptom Validity Test (MSVT) and the nonverbal MSVT (NV-MSVT) were designed to address this problem. They produce profiles of scores across multiple subtests to facilitate discrimination between low scores from people trying to feign impairment and low scores attributable to severe impairment. To study the specificity of the MSVT and NV-MSVT in people with very severe memory impairment, we tested (a) 10 institutionalized patients with dementia and (b) 10 volunteers who were asked to simulate memory impairment. It was hypothesized that the "possible dementia profile" would be found significantly more often in the dementia patients than in the simulators. The MSVT and the NV-MSVT both displayed 100% specificity in the dementia group, while retaining a combined sensitivity of 80% to suboptimal effort in the simulator group.

An observational study of the needs and quality of life amongst patients in the treatment of Alzheimer's dementia with cholinesterase inhibitors.

Alzheimer's dementia is one of the most commost mental health disorders associated with aging. In its earlier stages sufferers live independently but gradually rely increasingly on loved ones or formal carers for support as the illness progresses. Its treatment involves both medical and social care. This study assesses the impact of outpatients' care and cholinesterase inhibitors in patients being treated for Alzheimer's dementia. The needs and quality of life of patients attending an outpatients dementia care service were assessed using the Camberwell Assessment of Need for the Elderly (CANE) and Quality of Life in Alzheimer's Disease: Patient and Caregiver report. Other tools used were the Problems Checklist and Carer Strain, the Minimental State Examination (MMSE) and a proforma to obtain sociodemographic details. All patients who had informal care were assessed using the questionnaires. 104 patients were seen of whom 34 were new and 70 were follow-up patients. 43 patients lived alone while the rest lived with their spouses or other relatives such as children. There was reduction in the number of CANE unmet needs and increased combined Quality of Life in Alzheimer's Dementia scores in the first three months amongst the newly referred patients. The findings suggest that outpatients' dementia care and prescribing of cholinesterase inhibitors helped to meet the needs of patients and improve patients' quality of life in first three months.

Don't seize the day hospital! Recent research on the effectiveness of day hospitals for older people with mental health problems.

BACKGROUND: Day hospital (DH) care remains a core component of mental health services for older people. However, there has been an ongoing debate about the effectiveness and value for money of DHs in comparison to day centres (DC). AIM: The aim was to review the recent research on the effectiveness of day hospitals for older people with mental health problems. METHOD: A systematic search of relevant research literature over the last decade using the major electronic healthcare databases examining the quality and effectiveness of mental health DHs for older people. RESULTS: In the last decade the evidence for the effectiveness of DHs has continued to increase, but still lags behind research on DHs in general adult psychiatry and geriatric medicine. The review found that DHs appear effective at assessing and meeting needs and that a systematic approach to evaluating quality can be used to improve services. CONCLUSION: Recent research supports the effectiveness of day hospitals, but further studies are needed in order to provide a more robust evidence base.

Knowledge of ECT among staff of a mental health service.

Electroconvulsive therapy (ECT) is frequently projected as a controversial treatment to the general public. In England and Wales, user groups have reported an insufficient provision of information on which to base a decision regarding consent to ECT. In view of these findings, a study was carried out to assess the knowledge of ECT among mental health staff in a general hospital setting, as they are frequently the source of information for patients and caregivers. All staff in the mental health unit were invited to complete a semistructured questionnaire that consisted of questions about ECT including their knowledge of the laws about informed consent. Seventy-five staff members, representing about two thirds of the staff population, returned the questionnaires. Seventy of them responded that they knew the indications for ECT, of which the most frequently quoted were depression, mania, and schizophrenia. Only 24 (36.9%) staff members knew of the guidance with respect to informed consent and ECT. The finding in this study led to a revision of the local ECT training program for patients, caregivers, and staff. A review of the impact of the changes made will take place in the future. The Royal College of Psychiatrists itself has decided to implement changes by setting up a commission to assess and accredit various ECT units in England and Wales.