Distinguishing between depression and dementia in the elderly: A review of neuropsychological findings

Distinguishing between cognitive deficits seen in depression and progressive dementing, diseases is complex and often difficult clinically. We review recent neuropsychological studies comparing normal elderly individuals, depressed patients, and patients with progressive dementias. Findings from these studies suggest that the distinction between depression and dementia is fairly straightforward and facilitated by neuropsychological evaluation. Data from neuroimaging studies of depressed elderly are reviewed and integrated with the neuropsychological findings. A descriptive scheme for categorizing elderly patients is proposed. It is suggested that the label "pseudodementia" be discarded in favor of more thorough description of cognitive deficits associated with various clinical presentations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30936/1/0000606.pd

Could versus should: A reply to Sammons

Sammons (1994) believes that our critique of organized psychology's efforts to gain limited prescriptive privileges (Adams & Bieliauskas, 1994) is comprised of pseudo-problems (e.g., the noncurative nature of psychopharmacology) or issues that can readily be handled (e.g., malpractice exposure). We disagree and attempt herein to inject some reality into the picture of the bright new world of psychologists armed with prescription pads. Most importantly, the seemingly vanished distinction between what could be done politically or legislatively and what should be done for the profession and the public good is redrawn.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44852/1/10880_2005_Article_BF01989622.pd

Self‐Reported Health and Safety Awareness Improves Prediction of Level of Care Needs in Veterans Discharged From a Postacute Unit

ObjectivesTo evaluate the differential value of a self‐reported health and safety awareness measure relative to other medical, psychosocial, and cognitive factors in predicting level of care (LOC) needs after hospital discharge.DesignRetrospective medical record review.SettingCommunity living center postacute care (CLC‐PAC) unit at a Veterans Affairs hospital.ParticipantsA total of 175 veterans admitted to the Veterans Affairs hospital or directly to the CLC‐PAC from home.MethodsCognitive status was assessed with the Mini‐Mental State Examination, Digit Span Backward subtest, Trail Making Test (Part B), and Hopkins Verbal Learning Test‐Revised. Self‐report of health and safety awareness was measured with the Independent Living Scales Health and Safety (ILS‐HS) subscale. Additional demographic and admission‐related variables were coded, along with medical comorbidity, with the Charlson Comorbidity Index and depression using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision Depression Checklist.Main Outcome MeasurementsIncreased level of care was collected from social work and occupational therapy notes and defined as increased assistance with activities of daily living or nursing home placement comparing prehospitalization with CLC‐PAC discharge.ResultsA total of 19% (n = 34) of residents required increased LOC on CLC‐PAC discharge. The ILS‐HS was a significant predictor of increased LOC above and beyond age and Mini Mental Status Examination score; for each standard deviation decrease in ILS‐HS, there was an increased likelihood of greater LOC (odds ratio 0. 54, 95% confidence interval 0.35‐0.83). Other neuropsychological tests (memory, executive functioning) did not significantly improve the model.ConclusionsThe inclusion of the ILS‐HS to a standard cognitive screen (Mini Mental Status Examination) can improve prediction of increased LOC. Although select aspects of memory and executive functioning independently contribute to increased LOC prediction, the ILS‐HS likely measures a unique aspect of cognitive functioning that may be specific to discharge planning needs in CLC‐PAC residents.Level of EvidenceIIPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146814/1/pmr21122.pd

The Sensitivity and Psychometric Properties of a Brief Computer-Based Cognitive Screening Battery in a Depression Clinic

At present, there is poor accuracy in assessing cognitive and vegetative symptoms in depression using clinician or self-rated measures, suggesting the need for development of standardized tasks to assess these functions. The current study assessed the psychometric properties and diagnostic specificity of a brief neuropsychological screening battery designed to assess core signs of depression; psychomotor retardation, attention and executive functioning difficulties, and impaired emotion perception within an outpatient psychiatry setting. Three hundred eighty-four patients with mood disorders and 77 healthy volunteers participated. A large percentage of patients met diagnostic criteria for Major Depressive Disorder alone (49%) or with another comorbid psychiatric disorder (24%). A brief, 25-min battery of computer-based tests was administered to control participants and patients measuring the constructs of inhibitory control, attention, visual perception, and both executive and visual processing speed. The patient groups performed significantly worse than the control group regardless of diagnosis on visual perception and attention accuracy and processing speed factors. Surprisingly, the anxiety disorder group performed better than several other psychiatric disorder groups in inhibitory control accuracy. Developing valid and reliable measures of cognitive signs in mood disorders creates excellent opportunities for tracking cognitive status prior to initiation of treatment, and allows for reliable retest following treatment

Streamlining screening of emotional function in Veterans with traumatic brain injury

ObjectivesThis study examined how depression, anxiety, and sleep items from the Neurobehavioral Symptom Inventory (NSI) predict results from longer inventories.MethodThis was a retrospective review from 484, predominantly male (96.1%) Veterans, mean age 29.7 years, who underwent brief neuropsychological screening during a comprehensive, multidisciplinary evaluation for mild traumatic brain injury (TBI). Participants completed the NSI, insomnia severity index (ISI), and hospital anxiety and depression scale (HADS).Results: Overall,97.1% who endorsed “severe”/“very severe” anxiety on the NSI had significant anxiety on the HADS; 85% reporting “severe”/“very severe” depression on the NSI, had significant depression on the HADS; and 97.7% reporting “severe”/“very severe” sleep problems on the NSI, had significant sleep difficulties on the ISI.ConclusionClose correspondence between “severe”/“very severe” symptoms on the NSI and lengthier checklists suggests additional checklists may be eliminated and individuals can be referred for mental health treatment. NSI reports of “mild”/“moderate” require further screening.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144598/1/jclp22595_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144598/2/jclp22595.pd

On perhaps becoming what you had previously despised: Psychologists as prescribers of medication

The authors contend that organized psychology's efforts to gain limited prescriptive privileges may be misguided. The modification of psychology's traditional scope of practice may produce harm in the form of lessened patient regard, devaluation of nonpharmacologic elements of practice, and markedly increased exposure to claims of malpractice. The authors also decry the disingenuous use of psychopharmacologically “underserved” populations as rationales for the pursuit of prescriptive privileges. Psychology may mount a major effort to make this change without sufficient justification, in the view of the authors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44851/1/10880_2005_Article_BF01989620.pd

Perceived Need for Medical Care in the Geriatric General Medical Population: Relationship to Neuropsychological and Psychological Function

Insight is a multidimensional construct used in the psychiatric literature to refer to topics, such as awareness of symptoms of illness, awareness of consequences of illness, and perceived need for treatment. The primary aim of the present investigation was to examine both neuropsychological (i.e., executive, attention, and memory skills) and psychological contributions (i.e., depression and anxiety) to one component of insight (i.e., perceived need for medical care) among geriatric inpatients with multiple medical problems. Retrospective chart review involved analysis of data from 47 men who completed a battery of neuropsychological and psychological tests. Findings indicated that perceived need for medical care was significantly and positively related to performance on a test of executive function measuring verbal social reasoning, but not to performance on other tests of cognitive or emotional function. Theoretical and clinical implications of this result are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44858/1/10880_2005_Article_7816.pd

Changes in Mood States and Biomarkers During Peginterferon and Ribavirin Treatment of Chronic Hepatitis C

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74953/1/j.1572-0241.2008.02106.x.pd

Failed back surgeries and minnesota multiphasic personality inventory (MMPI) profiles

MMPI profiles were evaluated for 105 prospective surgical patients who had previously undergone surgery or other procedures for treatment of back pain. Patients were classified into groups having undergone zero, one, two, three, or four or more previous surgeries. While all groups demonstrated a characteristic somatogenic profile, none of the MMPI validity or clinical scales significantly differentiated the groups and there was no relationship between increased number of surgeries and MMPI scale characteristics. These results support the nonoptimistic prognostication of the somatogenic MMPI profile for surgical intervention for back pain but show no clear relationship of MMPI profile characteristics to degree of experience of previously failed surgery.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44850/1/10880_2005_Article_BF01999744.pd

A psycho-Geoinformatics approach for investigating older adults’ driving behaviours and underlying cognitive mechanisms

Introduction: Safe driving constantly challenges the driver’s ability to respond to the dynamic traffic scene under space and time constraints. It is of particular importance for older drivers to perform sufficient visual and motor actions with effective coordination due to the fact of age-related cognitive decline. However, few studies have been able to integrate drivers’ visual-motor behaviours with environmental information in a spatial-temporal context and link to the cognitive conditions of individual drivers. Little is known about the mechanisms that underpin the deterioration in visual-motor coordination of older drivers. Development: Based on a review of driving-related cognitive decline in older adults and the context of driver-vehicle-environment interactions, this paper established a conceptual framework to identify the parameters of driver’s visual and motor behaviour, and reveal the cognitive process from visual search to vehicle control in driving. The framework led to a psycho-geoinformatics approach to measure older drivers’ driving behaviours and investigate the underlying cognitive mechanisms. The proposed data collection protocol and the analysis and assessments depicted the psycho-geoinformatics approach on obtaining quantified variables and the key means of analysis, as well as outcome measures. Conclusions: Recordings of the driver and their interactions with the vehicle and environment at a detailed scale give a closer assessment of the driver’s behaviours. Using geoinformatics tools in driving behaviours assessment opens a new era of research with many possible analytical options, which do not have to rely on human observations. Instead, it receives clear indicators of the individual drivers’ interactions with the vehicle and the traffic environment. This approach should make it possible to identify lower-performing older drivers and problematic visual and motor behaviours, and the cognitive predictors of risky driving behaviours. A better targeted regulation and tailored intervention programs for older can be developed by further research