Pub Date : 2020-10-01DOI: 10.1093/med/9780198807292.003.0029
D. Marchment, D. Chan
Mild cognitive impairment (MCI) is a descriptive term that in essence refers to the presence of cognitive impairment out of keeping with normal ageing but of insufficient severity to constitute dementia. Debate continues as to whether MCI represents a discrete syndrome, a transitional state, or a prodrome for a variety of neurodegenerative diseases: it is at present considered to be heterogeneous both in terms of clinical presentation and aetiology. This chapter outlines how the concept of MCI has evolved to its current form and summarizes its diagnostic criteria, epidemiology, prognosis, underlying aetiologies, and pathophysiology. It briefly covers related phenomena such as subjective cognitive decline and mild behavioural impairment. It explores the role of biomarkers and neuroimaging in investigating MCI in clinical and research settings and finally concludes with a proposed clinician’s approach to the diagnosis and management of MCI.
{"title":"Mild cognitive impairment","authors":"D. Marchment, D. Chan","doi":"10.1093/med/9780198807292.003.0029","DOIUrl":"https://doi.org/10.1093/med/9780198807292.003.0029","url":null,"abstract":"Mild cognitive impairment (MCI) is a descriptive term that in essence refers to the presence of cognitive impairment out of keeping with normal ageing but of insufficient severity to constitute dementia. Debate continues as to whether MCI represents a discrete syndrome, a transitional state, or a prodrome for a variety of neurodegenerative diseases: it is at present considered to be heterogeneous both in terms of clinical presentation and aetiology. This chapter outlines how the concept of MCI has evolved to its current form and summarizes its diagnostic criteria, epidemiology, prognosis, underlying aetiologies, and pathophysiology. It briefly covers related phenomena such as subjective cognitive decline and mild behavioural impairment. It explores the role of biomarkers and neuroimaging in investigating MCI in clinical and research settings and finally concludes with a proposed clinician’s approach to the diagnosis and management of MCI.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123808271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/MED/9780198807292.003.0024
F. Thompson, Elena A. Baker-Glenn
Liaison psychiatry is a sub-specialty of psychiatry that specializes in the interface between physical and mental health, and involves treating patients who are attending general hospitals. This chapter provides an overview of the development of old age liaison psychiatry with consideration of the commissioning and funding of services. It discusses the importance of liaison psychiatry services being integrated within the general hospital team. It outlines different models of liaison psychiatry and provides examples of different services in the UK. It describes common conditions seen within older adult liaison psychiatry and considers screening tools and outcomes. Finally, it covers other aspects of the role of liaison psychiatry, such as teaching, training, governance and accreditation of services and considers interfaces with other services and the future of liaison psychiatry.
{"title":"Liaison old age psychiatry","authors":"F. Thompson, Elena A. Baker-Glenn","doi":"10.1093/MED/9780198807292.003.0024","DOIUrl":"https://doi.org/10.1093/MED/9780198807292.003.0024","url":null,"abstract":"Liaison psychiatry is a sub-specialty of psychiatry that specializes in the interface between physical and mental health, and involves treating patients who are attending general hospitals. This chapter provides an overview of the development of old age liaison psychiatry with consideration of the commissioning and funding of services. It discusses the importance of liaison psychiatry services being integrated within the general hospital team. It outlines different models of liaison psychiatry and provides examples of different services in the UK. It describes common conditions seen within older adult liaison psychiatry and considers screening tools and outcomes. Finally, it covers other aspects of the role of liaison psychiatry, such as teaching, training, governance and accreditation of services and considers interfaces with other services and the future of liaison psychiatry.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130761628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780198807292.003.0016
P. Wilkinson, K. Laidlaw
This introductory chapter provides a summary of the range of psychological treatments used with older people, and the main clinical applications of each treatment. It reviews possible barriers to uptake of psychological treatment by older people and how these barriers may be overcome. It provides an overview of the range of efficacious psychological treatments for older people with consideration of indication, access, and adaptation, and then discusses different modes of delivering treatment, including collaborative care models. It then reviews the modification of psychological treatments for working with people experiencing cognitive impairment and it briefly covers the approaches to working in dementia care.
{"title":"Psychological treatments","authors":"P. Wilkinson, K. Laidlaw","doi":"10.1093/med/9780198807292.003.0016","DOIUrl":"https://doi.org/10.1093/med/9780198807292.003.0016","url":null,"abstract":"This introductory chapter provides a summary of the range of psychological treatments used with older people, and the main clinical applications of each treatment. It reviews possible barriers to uptake of psychological treatment by older people and how these barriers may be overcome. It provides an overview of the range of efficacious psychological treatments for older people with consideration of indication, access, and adaptation, and then discusses different modes of delivering treatment, including collaborative care models. It then reviews the modification of psychological treatments for working with people experiencing cognitive impairment and it briefly covers the approaches to working in dementia care.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125685880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780199644957.003.0055
J. Hughes, C. Baldwin
This chapter is about ethics, i.e. about right or wrong decisions and good or bad judgments in clinical practice. It starts by reflecting on the extent to which all clinical decisions are, at one and the same time, ethical decisions. This is reflected in the idea of values-based practice. It outlines the major moral theories and a range of approaches to ethical issues. These theories and approaches have to be put into practice and it is not always clear how this should be done. The notion of patterns of practice, which will be described, may be helpful. There is a great variety of ethical issues that emerge in old age psychiatry, in particular in connection with dementia. The notion of patterns of practice is used, with the help of fictional vignettes, to discuss and understand such issues.
{"title":"Ethics and old age psychiatry","authors":"J. Hughes, C. Baldwin","doi":"10.1093/med/9780199644957.003.0055","DOIUrl":"https://doi.org/10.1093/med/9780199644957.003.0055","url":null,"abstract":"This chapter is about ethics, i.e. about right or wrong decisions and good or bad judgments in clinical practice. It starts by reflecting on the extent to which all clinical decisions are, at one and the same time, ethical decisions. This is reflected in the idea of values-based practice. It outlines the major moral theories and a range of approaches to ethical issues. These theories and approaches have to be put into practice and it is not always clear how this should be done. The notion of patterns of practice, which will be described, may be helpful. There is a great variety of ethical issues that emerge in old age psychiatry, in particular in connection with dementia. The notion of patterns of practice is used, with the help of fictional vignettes, to discuss and understand such issues.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114998224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/MED/9780198807292.003.0044
J. Gosling
In a personal narrative of maternal love and loss, trauma and strength, the author in her sixties makes an inward journey to touch the untold depths of love and pain that run through her as a constant stream. … I permit myself now to live in the house of the mothers and I call it mine. I think increasingly about all of our lives, about their deaths, about time passing and my own death ahead of me … I find myself both war correspondent and war casualty, and surely war criminal also … I do not fear death. It is legacy from my mothers, that death in itself brings only release. It is living that hurts … With insight comes compassion and reconciliation for the author, the women and the wounds. The loving strength of mothers and daughters overcomes the pain they inflict on one another. Scars remain but they are intelligent and wise. Is healing rooted within this understanding?
{"title":"Personal experience","authors":"J. Gosling","doi":"10.1093/MED/9780198807292.003.0044","DOIUrl":"https://doi.org/10.1093/MED/9780198807292.003.0044","url":null,"abstract":"In a personal narrative of maternal love and loss, trauma and strength, the author in her sixties makes an inward journey to touch the untold depths of love and pain that run through her as a constant stream.\u0000 … I permit myself now to live in the house of the mothers and I call it mine. I think increasingly about all of our lives, about their deaths, about time passing and my own death ahead of me … I find myself both war correspondent and war casualty, and surely war criminal also … I do not fear death. It is legacy from my mothers, that death in itself brings only release. It is living that hurts …\u0000 With insight comes compassion and reconciliation for the author, the women and the wounds. The loving strength of mothers and daughters overcomes the pain they inflict on one another. Scars remain but they are intelligent and wise. Is healing rooted within this understanding?","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123005184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780198807292.003.0026
T. Dening, A. Milne
The care home sector has changed significantly in recent years: the vast majority of care homes are now in the independent sector, funding of care is complex, with greater reliance on self-funders to ensure profitability, and regulation has shifted to a more targeted model. In terms of the care home population, as most people are admitted at a late stage of their illness trajectory, many have comorbid conditions and multiple needs. Frailty is a dominant issue, often combined with dementia and other problems, e.g. sensory impairment and incontinence. The dimensions of a positive care home culture include a well-managed transition into the home, a commitment to person-centred care, and a well-trained and supported workforce. Over the last few years there has been a growing interest in care homes as major providers of care to some of the UK’s most vulnerable citizens; this includes welcome attention to research.
{"title":"Care homes for older people","authors":"T. Dening, A. Milne","doi":"10.1093/med/9780198807292.003.0026","DOIUrl":"https://doi.org/10.1093/med/9780198807292.003.0026","url":null,"abstract":"The care home sector has changed significantly in recent years: the vast majority of care homes are now in the independent sector, funding of care is complex, with greater reliance on self-funders to ensure profitability, and regulation has shifted to a more targeted model. In terms of the care home population, as most people are admitted at a late stage of their illness trajectory, many have comorbid conditions and multiple needs. Frailty is a dominant issue, often combined with dementia and other problems, e.g. sensory impairment and incontinence. The dimensions of a positive care home culture include a well-managed transition into the home, a commitment to person-centred care, and a well-trained and supported workforce. Over the last few years there has been a growing interest in care homes as major providers of care to some of the UK’s most vulnerable citizens; this includes welcome attention to research.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126312547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/MED/9780198807292.003.0038
D. Et
The majority of chapters in this book demonstrate clinical aspects of various aspects of old age psychiatry. These accounts tend to focus only on the viewpoints of the healthcare professionals involved in the investigation, diagnosis, and management of the condition. This chapter is different, and provides a first-person account of an anonymous author and his experience of having episodes of depression. The author describes the course of the condition at various times in his life and the various ways in which it has affected him at various stages. This chapter also describes his experiences of treatment and contact with professionals.
{"title":"The experience of depression","authors":"D. Et","doi":"10.1093/MED/9780198807292.003.0038","DOIUrl":"https://doi.org/10.1093/MED/9780198807292.003.0038","url":null,"abstract":"The majority of chapters in this book demonstrate clinical aspects of various aspects of old age psychiatry. These accounts tend to focus only on the viewpoints of the healthcare professionals involved in the investigation, diagnosis, and management of the condition. This chapter is different, and provides a first-person account of an anonymous author and his experience of having episodes of depression. The author describes the course of the condition at various times in his life and the various ways in which it has affected him at various stages. This chapter also describes his experiences of treatment and contact with professionals.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128626879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/MED/9780198807292.003.0006
A. Vergallo, H. Hampel, R. Bun, S. Lista
Reflecting the neuropathological hallmarks of Alzheimer’s disease (AD), cerebrospinal fluid (CSF) concentrations of Aβ1-42, t-tau, and p-tau and positive amyloid positron emission tomography (PET) imaging are considered core biomarkers for AD. Unfortunately, their use for screening is limited by their invasive nature (CSF biomarkers) or high cost (PET imaging). Among the biologic specimens that may be scrutinized for identifying novel AD biomarkers, circulating blood is a convenient source for sampling. The dynamic range of high-throughput technological platforms, coupled with advances in bioinformatics, holds the promise that proteomics will be a significant contributor to the field of blood-based AD biomarkers. Here, the chapter summarizes the blood-based biomarker platforms applied to the investigation of AD and reviews recent achievements in plasma/serum proteomics related to AD. These findings set the stage for the implementation of systems biology in the context of the evolving precision medicine paradigm for AD.
{"title":"Biomarkers for Alzheimer’s disease","authors":"A. Vergallo, H. Hampel, R. Bun, S. Lista","doi":"10.1093/MED/9780198807292.003.0006","DOIUrl":"https://doi.org/10.1093/MED/9780198807292.003.0006","url":null,"abstract":"Reflecting the neuropathological hallmarks of Alzheimer’s disease (AD), cerebrospinal fluid (CSF) concentrations of Aβ1-42, t-tau, and p-tau and positive amyloid positron emission tomography (PET) imaging are considered core biomarkers for AD. Unfortunately, their use for screening is limited by their invasive nature (CSF biomarkers) or high cost (PET imaging). Among the biologic specimens that may be scrutinized for identifying novel AD biomarkers, circulating blood is a convenient source for sampling. The dynamic range of high-throughput technological platforms, coupled with advances in bioinformatics, holds the promise that proteomics will be a significant contributor to the field of blood-based AD biomarkers. Here, the chapter summarizes the blood-based biomarker platforms applied to the investigation of AD and reviews recent achievements in plasma/serum proteomics related to AD. These findings set the stage for the implementation of systems biology in the context of the evolving precision medicine paradigm for AD.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121990213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1007/978-1-349-07780-9_2
R. Harwood, R. Cowan
{"title":"Physical assessment","authors":"R. Harwood, R. Cowan","doi":"10.1007/978-1-349-07780-9_2","DOIUrl":"https://doi.org/10.1007/978-1-349-07780-9_2","url":null,"abstract":"","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"215 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123065595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780198807292.003.0012
S. Suri, Vyara Valkanova, V. Heise, C. Sexton, Klaus P. Ebmeier
Neuroimaging provides a way of examining the structure and function of the brain in life. This chapter gives an up-to-date summary of the methods employed in research and clinic, what is involved for the patient in taking part in imaging, and both current clinical applications as well as those about to enter general old age psychiatry practice. Magnetic resonance imaging and imaging with ionizing radiation, such as X-ray computed tomography (CT), single photon emission computed tomography (SPECT), and positron emission tomography (PET), are covered. Additionally, it provides a short summary of the applications and potential of electro- and magnetophysiological techniques. It summarizes the current and potential use of neuroimaging methods in diagnosis, prognosis, understanding illness mechanisms, and the brain mechanisms that confer resilience against the brain diseases of old age.
{"title":"Neuroimaging","authors":"S. Suri, Vyara Valkanova, V. Heise, C. Sexton, Klaus P. Ebmeier","doi":"10.1093/med/9780198807292.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780198807292.003.0012","url":null,"abstract":"Neuroimaging provides a way of examining the structure and function of the brain in life. This chapter gives an up-to-date summary of the methods employed in research and clinic, what is involved for the patient in taking part in imaging, and both current clinical applications as well as those about to enter general old age psychiatry practice. Magnetic resonance imaging and imaging with ionizing radiation, such as X-ray computed tomography (CT), single photon emission computed tomography (SPECT), and positron emission tomography (PET), are covered. Additionally, it provides a short summary of the applications and potential of electro- and magnetophysiological techniques. It summarizes the current and potential use of neuroimaging methods in diagnosis, prognosis, understanding illness mechanisms, and the brain mechanisms that confer resilience against the brain diseases of old age.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134293418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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