An attempt at prevention of obesity in infancy.

A study of The Prudent Diet in early infancy was undertaken in a test group of 80 infants as an attempt to prevent overweight in a private practice setting. This group was compared with another group of 50 infants born in 1964 who were fed the standard infant diet then in use. Although an incidence of 34.1% overweight was present in the comparison group as compared with 25% in the diet group at age 3 months, by age 3 years the comparison still showed a 25.5% prevalence of overweight as compared with the study group with a significantly lower incidence of only 1.28%. These results require confirmation from other investigators, as well as long-term follow-up observation of patients before one could consider recommending such a diet for widespread use.

Early diagnosis and management of Alzheimer's disease.

It is only recently that Alzheimer's disease has become recognized as a major public health concern. Not only those diagnosed with Alzheimer's disease are impacted by the disease; the emotional toll exacted on caregivers is enormous, and the financial costs incurred by the United States are staggering. Early diagnosis of Alzheimer's disease can prevent costly and inappropriate treatment and permits earlier treatment of symptoms. There have been several recent pharmacologic advances in the treatment of Alzheimer's disease, including the development of acetylcholinesterase inhibitors. For any intervention to prove successful, however, early and accurate diagnosis and effective disease management are crucial.

Delusions and behavioral disturbances in cognitively impaired elderly persons.

OBJECTIVE: To compare cognitive function and the prevalence of selected behavioral problems in delusional and non-delusional dementia patients. DESIGN: Retrospective medical record review. SETTING: An outpatient geriatric assessment center. PARTICIPANTS: 114 consecutive patients with dementia. MAIN OUTCOME MEASURES: Delusions as recorded in a consultation report. RESULTS: Delusions were described in 25.5% of patients. A variety of behavioral disturbances were more common in delusional than non-delusional patients, including agitation, angry or hostile outbursts, urinary incontinence, wandering or pacing, and insomnia. While cognitive function as measured by the MMSE was similar in delusional and non-delusional patients (18.9 +/- 3.8 and 19.2 +/- 5.9, respectively), there was a statistically borderline tendency for delusions to occur more often in patients in the mid-range of cognitive impairment (17 less than or equal to MMSE less than or equal to 23) compared with patients with greater or lesser degrees of cognitive impairment (32% vs 17% respectively). CONCLUSION: Delusions in dementia are associated with a variety of behavioral problems. Further studies are needed to clarify the role of delusions in the development of disruptive behaviors in dementing illness.

Reversible anorexia and rapid weight loss associated with neuroleptic administration in Alzheimer's disease.

Weight loss and malnutrition despite adequate dietary intake has been reported to be part of the clinical course in advanced dementia of the Alzheimer type. We present a case of reversible weight loss associated with neuroleptic use in a patient with Alzheimer's disease and discuss a possible pathophysiological basis for the weight loss.

Reevaluating the work of a community mental health center: the care of chronic patients.

Traditional forms of data-gathering have tended to underrepresent the care that community mental health centers provide to the more chronic, or seriously ill, patients. Using an alternative data-gathering method based on accumulated direct patient contacts, the authors illustrate how traditional data sets based on discharged patients and active patients yield very different views of the types of patients served and intensity of services received. Only by examining resource utilization among patients in both data sets were the authors able to show their center's extensive commitment to more chronic patients.

Preadmission screening of Medicare patients. The clinical impact of reimbursement disapproval.

The clinical impact of a statewide Medicare preadmission certification program was assessed with a retrospective survey of Connecticut physicians. In a three-month period, only 100 (0.37%) of 28,450 Medicare admission requests were disapproved for reimbursement. Following disapproval, 22 patients were admitted immediately, 44 received outpatient care, and eight additional outpatients were not evaluated or treated. The remaining 26 patients subsequently were admitted with preadmission approval due to changed clinical condition or failed outpatient plan. Although some patients had minor problems that their physicians believed would have been avoided by immediate admission, no severe morbidity resulted from admission delay. Many physicians expressed concern about preadmission certification program-related patient anxiety and inconvenience. Although this limited survey provides preliminary evidence that preadmission certification programs can be implemented without major deleterious short-term medical effects, continued monitoring of physicians and patients involved in disapproved admissions is necessary to evaluate potential medical and psychosocial problems.

Clarifying confusion: the confusion assessment method. A new method for detection of delirium.

OBJECTIVE: To develop and validate a new standardized confusion assessment method (CAM) that enables nonpsychiatric clinicians to detect delirium quickly in high-risk settings. DESIGN: Prospective validation study. SETTING: Conducted in general medicine wards and in an outpatient geriatric assessment center at Yale University (site 1) and in general medicine wards at the University of Chicago (site 2). PATIENTS: The study included 56 subjects, ranging in age from 65 to 98 years. At site 1, 10 patients with and 20 without delirium participated; at site 2, 16 patients with and 10 without delirium participated. MEASUREMENTS AND MAIN RESULTS: An expert panel developed the CAM through a consensus building process. The CAM instrument, which can be completed in less than 5 minutes, consists of nine operationalized criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). An a priori hypothesis was established for the diagnostic value of four criteria: acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness. The CAM algorithm for diagnosis of delirium required the presence of both the first and the second criteria and of either the third or the fourth criterion. At both sites, the diagnoses made by the CAM were concurrently validated against the diagnoses made by psychiatrists. At sites 1 and 2 values for sensitivity were 100% and 94%, respectively; values for specificity were 95% and 90%; values for positive predictive accuracy were 91% and 94%; and values for negative predictive accuracy were 100% and 90%. The CAM algorithm had the highest predictive accuracy for all possible combinations of the nine features of delirium. The CAM was shown to have convergent agreement with four other mental status tests, including the Mini-Mental State Examination. The interobserver reliability of the CAM was high (kappa = 0.81 - 1.0). CONCLUSIONS: The CAM is sensitive, specific, reliable, and easy to use for identification of delirium.