cambridge city over 75 cohort survey 5 year 13 (1999 ...€¦ · web viewcamdex. interview...

CODING: Patient does not know or won’t answer 8 or 88 Not asked/not applicable 9 or 99

Hughes Hall Project for Later Life

CAMDEXINTERVIEW SCHEDULE

1. Patient Survey Number [ ]Name: __________ Address: __________ Hospital Number: __________ Date of Admission: __________ Referred by: __________ 2. Date of Interview [ / / ]3. Interview code [ ]4. Study Site 1. Cambridge

2. Indianapolis3. Other

[ ]

5. Patient Source 1.Psychiatric Inpatient2.Geriatric Inpatient3.Outpatien4.Nursing Home(or part III)5.Referredby G.P6.Community7.Other

[ ]

Specify other:6 Date of Birth?

[ / / ]

7 Age at Interview? [ ]8. Sex? 1. Male

2. Female[ ]

9. Marital Status - current 1. Single 2. Married 3. Divorced4. Separated5. Widowed

[ ]

10. Main occupation.

Code in office.

[ ]

1


CAMDEX

Independent assessment by medical or nursing attendant

Where appropriate, interviewer should complete this page by questioning a doctor or nurse who is familiar with the patient’s condition.

Name of Staff Member: __________ Position: __________ Nursing ………… 0

Medical…………..1[ ]

Date: __________11. Clinical estimate of severity of dementia –G.P.

How would you rate the patient in terms of severity of dementia?

0. None1. Minimal2. Mild3. Moderate4. Severe

[ ]

12. Clinical estimate of severity of dementia –D.N

How would you rate the patient in terms of severity of depression?

1. None2. Minimal3. Mild4. Moderate5. Severe

[ ]

COMMETS made by referring source to be recorded by interviewer.

2


CAMDEX

SECTION A – INTERVIEW TO BE CONDUCTED WITH PATIENT/SUBJECT

INSTRUCTINS TO INTERVIER

Each question should be asked as written, although additional probing may sometimes be necessary to clarify inadequate answers. Space is provided on a separate sheet at the end of this section for any additional comments.

Questions are organised into headed sections. The sub-headings are a means of focusing the attention of examiner to a change in theme. A slight pause may be appropriate.

NOTE THAT SUB-HEADINGS ARE NOT INTENDED TO RELATE TO SPECIFIC DIAGNOSTIC ENTITIES, as they may be relevant to several diagnoses. For example, paranoid features do not relate exclusively to a paranoid state or paranoid psychosis; they will often be present in delirious states and affective psychoses. Similarly, positive responses to questions about depressed mood will often be given by subjects who do not suffer from a primary depressive illness.

ALL ITEMS MUST BE CODED.


PART I – QUESTIONS RELATING TO PRESENT STATE

Record time of commencement of interview with patient [ ] [ ]

13. What is your name? 0. Error 1. No error

[ ]

14. What is your Date of Birth?

0. Error 1. No error

[ ]

15. What was your age last birthday? 0. Error 1. No error

[ ]

If one year out and appears to be referring to age next birthday this may be clarified by questioning

SKIP TO COGNITIVE STATE EXAMINATION IF ANY TWO OF THE ABOVE QUESTIONS SHOW ERROR – INTERVIEWER TO USE OWN JUDGEMENT HERE.

3


16. How old were you when you left school? Years…………………. [ ]

17. Did you have any education or training after school (attending a university or technical school, or any other further education, e.g. nursing)

How many years?

Years………………….00. None

[ ]

18. What are your present living arrangements? 0. Long term hospital1. In residential home2. In sheltered accom3. With spouse in independent

accommodation4. With relative/friend in

independent accom5. Alone and independently

[ ]

CEREBROVASCULAR FUNCTION

Now I would like to ask you some questions about your health and any problems with it.19. Do you often have headaches (any kind)? 0. No or rarely

1. > once per week[ ]

20. Do you often feel dizzy? 0. No or rarely1. > once per week

[ ]

21. Do you have a tendency to fall? 0. No or rarely1. Once a month

[ ]

22. Have you ever had weakness, or difficulty with speech, memory or vision which got better?

0. No1. Yes

[ ]

SLEEP23. Do you have difficulty in falling asleep? 0. No

1. Yes[ ]

24. Are you restless or wakeful during the night? 0. No1. Yes

[ ]

25. Has your sleep pattern changed so that you wake early in the morning and seem unable to fall asleep again?

0. No1. Yes

[ ]

4


DEPRESSED MOOD

26. Have you lost your appetite? 0.No1.Yes

[ ]

27. Have you lost a lot of weight in the last six months? 0.No1.Yes

[ ]

28. Do you often feel less confident (or able) than before to cope with what you have to do?

0.No1.Yes

[ ]

29. Do you find it more difficult to make decisions than you used to?

0.No1.Yes

[ ]

30. Have your lost pleasure or interest in doing things you usually cared about or enjoyed?

0.No1.Yes

[ ]

31. Do you find you have lost energy and it is harder to get things done?

0.No1.Yes

[ ]

32. Have you preferred to be more on your own recently? 0.No1.Yes

[ ]

33. Do you find it more difficult to concentrate than is normal for you?

0.No1.Yes

[ ]

34. Do you find you talk more slowly than normal for you? 0.No1.Yes

[ ]

35. Are there times when you thoughts come much more slowly than usual?

0.No1.Yes

[ ]

36. Do you feel sad or depressed or miserable? 0.No1.Occasionally2.Frequently

[ ]

If not depressed omit questions 37-43 and code 999 or 9

37. How long have you felt like this Duration in Months

[ ]

38. Is there any reason why you have become depressed?Specify if yes

0.No1.Yes

[ ]

39. Is this different from your usual feeling of sadness? 0.No1.Yes

[ ]

40. When you are feeling depressed can anything cheer you up?

0.No1.Yes

[ ]

5


41. Is there any particular time of day when this is worse? 0.No1.Yes (if morning)

[ ]

42. Are other people largely to blame for your unhappiness? 0.No1.Yes

[ ]

43. Do you feel guilty or sinful or bad about some of the things you did or mistakes you made in the past?

0.No1.Yes

[ ]

44. How do you feel about your future? 0.Neutral/Optimistic1.Pessimistic

[ ]

45. Do you sometimes feel that life is not worth living?

If not omit next question and code 9

0.No1.Yes

[ ]

46. Have you felt so low that you thought of ending it all? (committing suicide)

0.No1.Yes

[ ]

WORRY/ANXIETY

47. Do you feel more tense and worry more than usual about little things?

0.No1.Yes

[ ]

48. Have you felt more irritable lately? 0.No1.Yes

[ ]

49. Have there been times lately when you were very anxious or frightened?

0.No1.Yes

[ ]

50. Have there been times lately when felt anxious and physically unwell, for example when your heart pounded or you felt shakey or sweaty?

0.No1.Yes

[ ]

51. Are there any special situations which make you anxious, e.g. leaving home alone, going into shops or crowds?

Specify

0.No1.Yes

[ ]

52. Have you had attacks of fear or panic when you felt you would collapse or lose control of yourself?

0.No1.Yes

[ ]

If no positive responses under this heading (Q. 47-52) omit next question and code 999

53. How long have you experienced this? Duration in months [ ]

6


EVERYDAY ACTIVITIES

Now I would like to ask how well you manage with some ordinary everyday activities.

54. Have you had difficulty recently looking after your money matters so that you need help?

0.No1.Yes

[ ]

55. Do you have difficulty with household tasks such as making yourself a cup of tea?

0.No1.Yes2.Impossible

[ ]

56. Do you have difficulty controlling your bladder? 0.No1.Occasionally wets2.Frequently wets

[ ]

57. IN OPINION OF INTERVIEWER IS FAILURE DUE TO PHYSICAL IMPEDIMENT, (e.g. STROKE, SEVERE RHEUMATOID ARTHRITIS etc.) AS DISTINCT FROM COGNITIVE IMPAIRMENT? IF NO IMPAIRMENT SCORE 9

0.Not physical1.Partly physical2.Entirely physical

[ ]

MEMORY

58. Do you have any difficulty with your memory? 0.No1.Yes

[ ]

59. Do you forget where you have left things more than you used to?

0.No1.Yes

[ ]

60. Do you forget the names of close friends or relatives?

0.No1.Yes

[ ]

61. Have you ever been in your own neighbourhood and forgotten your way?

0.No1.Yes

[ ]

If no difficulty with memory omit next 3 questions and code 999 or 9 below

62. When did this difficulty begin? Duration in months [ ]

63. Did it come on suddenly? 0.Gradual1.Sudden

[ ]

64. Has it become better or worse since it started? 0.Better1.Worse2.Remained same

[ ]

7


GENERAL MENTAL FUNCTIONING

65. Do you tend to think and talk about the past more than recent events?

0.No1.Yes

[ ]

66. When speaking, do you have difficulty finding the word you want, or do you sometimes say the wrong word?

0.No1.Yes

[ ]

If no difficulty (Q. 65 and 66) omit next question and code 999.

67. How long have you experienced this? Duration in Months [ ]

PARANOID/PSYCHOTIC FEATURES

68. Do you ever have the experience of hearing things that other people do not?

0.No1.Yes

[ ]

(establish presence or absence of hallucinations)

Indicate duration in months [ ]

69. Do you ever have the experience of seeing things that other people do not?

0.No1.Yes

[ ]

(establish presence or absence of hallucinations)


70. Do you ever believe that people are watching you, or spying on you, or plotting against you?

0.No1.Yes

[ ]


71. Do you ever feel that special messages are being sent to you on the T.V., radio, etc.?

0.No1.Yes

[ ]


72. Have you any peculiar feelings with regard to your body?

0.No1.Yes

[ ]

(establish presence or absence of nihilistic delusions)

[ ]

73. Record in months duration of earliest symptomIf no difficulty code … 999

Duration in Months [ ]

8


PART II – QUESTIONS RELATING TO PAST HISTORY

Now I would like to ask you some questions about your health in the past.74. Have you ever had a heart attack? 0.No

1.One2.Two3. >2

[ ]

75. Have you ever suffered from high blood pressure? 0.No1.Yes

[ ]

76. Have you ever had a stroke? 0.No1.One2.Two3. >2

[ ]

77. Have you ever had a serious head injury and been unconscious after it? At what age?

0.No1.Before 302.30 - 653.After 65

[ ]

78. Have you ever had fits – at what age? 0.No1.Before 302.30 - 653.After 65

[ ]

I would like to ask you about your smoking and drinking habits.79. Have you ever been a heavy smoker, say 20 or more a day

for a year or more?0.No1.Yes

[ ]

80. Did you ever think you were a heavy drinker? 0.No1.Yes

[ ]

81. Have you ever drunk as much as 5 pints of beer daily over a two week period?(or 10 units of wine or spirits)

1 unit = 10 gm alcoholApprox. = half-pint beer/wine glass of wine/nip of spirit

0.No1.Yes

[ ]

82. Did drinking ever cause you any problems such as losing jobs, or with driving?

0.No1.Yes

[ ]

83. Have you ever taken pills or drugs that you could not do without, for instance barbiturates to help you sleep, or purple hearts (amphetamine) to help you cope?

0.No1.Tranquillisers2.Hypnotics3.Barbiturates4.Stimulants5.OthersSpecify others:

[ ]

9


84. Do you consider yourself a nervous person?

Record answer:

0.No1.Yes

[ ]

85. Have you ever had emotional or nervous illness requiring treatment?

Record number of episodes(Record any relevant information)

0.No1.2.3.4.5.6.7.

[ ]

Were you hospitalised?

If so: Where When

(Notes to be obtained)

0.No1.Yes

[ ]

10


PART III – QUESTIONS RELATING TO FAMILY HISTORY

Now I would like to ask you some questions about your family.86. How many sons did you have?

(Living or dead)NUMBER00. None

[ ]

87. How many daughters did you have?(Living or dead)

NUMBER00. None

[ ]

88. How many brothers did you have?(Living or dead)

NUMBER00. None

[ ]

89. How many sisters did you have?(Living or dead)

NUMBER00. None

[ ]

90. What position in the family are you?(NB Coding – eldest..01, second..02, etc)

position [ ]

For the following, record best estimate91. Is your mother still alive – if so how old is

she?AGE000. Not alive

[ ]

92. (If not alive) About how old was your mother when she die

AGE000. Still alive

[ ]

93. Is your father still alive – if so how old is he?

AGE000. Not alive

[ ]

94. (If not alive) About how old was your father when she die

AGE000. Still alive

[ ]

RECORD IN THE APPROPRIATE BRACKETS THE NUMBER OF AFFECTED RELATIVES

Have any of your relatives (by blood) had special difficulty with memory or got every confused, and had to go into a home because they could not look after themselves on account of it?95. Female relatives – Mother, Sister ( ),

Daughter ( )NUMBER00. None

[ ]

96. Male relatives – Father, Brother ( ), Son ( ) NUMBER00. None

[ ]

Did any of your relatives have a heart attack (or die suddenly and unexpectedly)?97. Female relatives – Mother, Sister ( ),


[ ]


[ ]

11


Have any of your relatives had a stroke or sudden weakness or speech difficulty?99. Female relatives – Mother, Sister ( ), Daughter ( ) NUMBER

00. None[ ]


[ ]

Have any of your relatives had high blood pressure?101. Female relatives – Mother, Sister ( ), Daughter ( ) NUMBER

00. None[ ]


[ ]

Have you or any of your family had diabetes?103. Female relatives – Mother, Sister ( ), Daughter ( ) NUMBER

00. None[ ]


[ ]

105. Proband (subject) 0.No1.Yes

[ ]

Have you or any of your family had Parkinson’s disease, i.e. marked tremor or stiffness?106. Female relatives – Mother, Sister ( ), Daughter ( ) NUMBER

00. None[ ]


[ ]


[ ]

Does anyone in the family have a child with mental handicap or Down’s Syndrome? (explain if necessary)109. Female relatives – Mother, Sister ( ), Daughter ( ) NUMBER

00. None[ ]


[ ]


[ ]

12


Have you or anyone in the family had leukaemia?112. Female relatives – Mother, Sister ( ), Daughter ( ) NUMBER

00. None[ ]


[ ]


[ ]

Have you or anyone in the family had cancer?115. Female relatives – Mother, Sister ( ), Daughter

( )NUMBER00. None

[ ]


[ ]


[ ]

(Note type) Type Cancer___________________

Have any of your relatives had emotional or nervous illness requiring treatment?118. Female relatives – Mother, Sister ( ), Daughter ( ) NUMBER

00. None[ ]


[ ]

Specify type of nervous illness Type Nervous illness___________________

13


COGNITIVE EXAMINATION Before commencing, make sure you have the following items:

2 BookletPencil and WristwatchEnvelopeCoins – 5p, 10pSheet of paper with drawings to be copied.

Cookie Theft PictureTape recorder with cassetteOnly where speech to be recorded for psycholinguistic analysis (See Q 145)

This section contains all 19 items of the Mini Mental State Examination of Folstein et al (1975). Some, but not all of these items are used in scoring the more comprehensive Cambridge Cognitive Examination (CAMCOG). A list of the items comprising each of these examinations is set out in Appendix A.

It is important that the interviewer speaks slowly and clearly. If person appears not to have heard or understood, repeat question (unless item specifically prohibits repetition).

DO NOT CORRECT IF WRONG ANSWER GIVEN

Make a note of any unusual responses including extra memory items recalled.

CODING: This section differs from other sections of the CAMDEX in that patients who do not know, refuse to answer or give a silly answer are given a score of 0 (not 8) which is equivalent to giving an incorrect answer. Where a score of 9 or 99 is given indicate why question was not asked.

I am going to ask you some questions now which have to do with your memory and concentration. Some of them may seem rather easy but we need to ask everyone the same questions.ORIENTATION - Time 120. What day of the week is it? 0. Incorrect

1. Correct [ ]

121. What is the date to-day?Day

0. Incorrect 1. Correct

[ ]

122. Month 0. Incorrect 1. Correct

[ ]

123. Year 0. Incorrect 1. Correct

[ ]

14


124. What is the season? 0. Incorrect 1. Correct

[ ]

Allow flexibility when season changes, i.e.: March = winter/spring June = spring/summerSeptember = summer/autumn December = autumn/winter

Place 125. Can you tell me where we are now. For

instance what county are we in?0. Incorrect 1. Correct

[ ]

126. What is the name of this city? 0. Incorrect 1. Correct

[ ]

127. What are two main streets nearby (or near your home)?


[ ]

128. What floor of the building are we on? 0. Incorrect 1. Correct

[ ]

129. What is the name of this place? (or What is this address? if person tested in home.)


[ ]

LANGUAGE Comprehension (motor response) Should the patient not complete the full sequence then the whole instruction may be repeated to ensure that it has been heard and understood. Prompting and coaching stage by stage is not allowed. I am going to ask you to carry out some actions, so please listen carefully. 130. Please nod your head. 0. Incorrect

1. Correct [ ]

131. Touch your right ear with your left hand. 0. Incorrect 1. Correct

[ ]

132. Before you look at the ceiling look at the floor.


[ ]

133. Tap each shoulder twice with two fingers keeping your eyes shut.


[ ]

15


Comprehension (verbal response) I am going to ask you some questions and would like you to answer yes or no. 134. Is this place a hotel? 0. Incorrect

1. Correct [ ]

135. Are villages larger than towns? 0. Incorrect 1. Correct

[ ]

136. Was there wireless/radio in this country before television was invented?


[ ]

Expression – Naming Turn on the tape recorder – only where speech record is required for psycholinguistic analysis (See Q. 145)In 137 – 138 we are looking for accurate naming; descriptions of function or approximate answers are not acceptable. Tick each item correctly named and enter number correct under TOTAL.

137 SHOW PENCIL What is this called? PencilSHOW WRISTWATCH What is this called? Watch Total [ ]

138. I am going to show you some objects. Please tell me the name of each one.SHOW PICTURES IN BOOKLET

Shoe, sandalTypewriter ScalesSuitcase, portmanteau Barometer Table lamp, lamp

Total [ ]

16


139. Name as many different animals as you can think of? You will have one minute to

do this. Only if subject asks for clarification, explain that animals include birds, insects, humans, etc.

If subject gets stuck, encourage them with Can you think of any more?

RECORD NUMBER CORRECT IN ONE MINUTE.Repetitions not to be counted.

List all items

Note Recode:

Number correct

0 = 01-4 = 15-9 = 2

10-14 = 315-19 = 420-24 = 5

25+ = 6

[ ]

Expression – Definitions140. What do you do with a hammer? 0.

1. (Any correct use) [ ]

141. Where do people usually go to buy medicine?

0. Shop (if unable to specify) 1. Chemist

[ ]

(In 142 -143 a concrete definition scores 1 and an abstract definition scores 2. examples are given beside each score) 142. What is a bridge? 0. …………

1. Cross the bridge 2. Goes across a river etc

[ ]

143. What is an opinion? 0. 1. A good opinion of someone 2. A person's ideas about something

[ ]

Expression - Repetition Only one presentation allowed so it is essential that you read the phrase clearly and slowly, enunciating all the “S” s.I am going to say something and I would like you to repeat it after me.144. No ifs, ands or buts. 0. Incorrect

1. Correct [ ]

17


Turn off tape recorder MEMORY -(Recall) 146. Can you tell me what were the objects in the coloured

pictures I showed you a little while ago?

(Either description or names acceptable)(Tick each item answered correctly and enter number correct under Total)


Total[ ]

Recognition Show multiple – choice pictures in booklet. 147. Which of these did I show you before?

(Tick each item answered correctly and enter number correct under Total)


Total[ ]

Retrieval of remote information Now I am going to ask you some questions about the past. 148. Can you tell me when the First World War began?

Within 1 year0. Incorrect 1. correct

[ ]

18


149. Can you tell me when the Second World War began?Within 1 year


[ ]

150. Who was the leader of the Germans in the Second World War?


[ ]

151. Who was the leader of the Russians at that time? 0. Incorrect 1. Correct

[ ]

152. What was Mae West famous for? 0. Incorrect 1. Correct

[ ]

153. Who was the famous flyer whose son was kidnapped? 0. Incorrect 1. Correct

[ ]

Retrieval of recent information 154. What is the name of the present King or Queen? 0. Incorrect

1. Correct [ ]

155. Who will follow her? 0. Incorrect 1. Correct

[ ]

156. What is the name of the Prime Minister? 0. Incorrect 1. Correct

[ ]

157. What has been in the news in the past week or two? 0. Incorrect 1. Correct

[ ]

Registration I am going to name 3 objects. After I have finished saying all three, I would like you to repeat them. Remember what they are because I am going to ask you to name them again in a few minutes. 158 Name three objects taking 1 second to say each.

Apple, Table, Penny

(Tick items which are correct on the first attempt and enter number correct under Total

Apple……Table……Penny……

Total [ ]

If any errors or omissions are made on the first attempt, repeat all the names until respondent learns all three (maximum of five repeats). Record number of repeats. (Record 0 if all correct on first attempt)

Number of repeats

Record x if unable to remember after 5 repeats.

[ ]

19


ATTENTION/CONCENTRATION 159. Now I would like you to count backwards from 20.

Cross out as you go along.

19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5, 4, 3, 2, 1.

0. Two or more errors

1. One error 2. Correct

[ ]

160. Now I would like you to take 7 away from 100. Now take 7 away from the number you get. Now keep subtracting 7 until I tell you to stop.

Record answers. Score 1 point each time the difference is 7 even if a previous answer was incorrect.

. Subject's answer

. 93

. 86

. 79

. 72

. 65

Total[ ]

MEMORY - recall 161. What were the three objects I asked you to repeat a little

while ago?(Tick each items answered correctly and enter number correct under total)

Apple……Table……Penny……

Total [ ]

LANGUAGE - Reading comprehension Show commands in booklet Read this page and then do what it says. 162. Close your eyes. 0. Incorrect

1. Correct [ ]

163. If you are older than 50 put your hands behind your head.


[ ]

It is not necessary for respondent to read aloud. Code 1 only if action is carried out correctly. If respondent reads instruction but fails to carry out action, say Now do what it says. PRAXIS - Copying and Drawing Record responses on sheet provided. 164. Copy this design (Pentagon)

Each pentagon should have 5 sides and 5 clear corners and the overlap should form a diamond.


[ ]

20


165. Copy this design (Spiral)Three connected loops are required in the correct orientation.


[ ]

166. Copy this design (3-D house)Requires windows, door chimney in correct position and 3-D represented.


[ ]

167. Draw a large clock and put the numbers in.When respondent has done this say Now set the hands to 10 past 11

a) Circle b) All numbers in correct position c) Correct time

Total [ ]

Writing - Spontaneous 168. Write a complete sentence on this sheet of paper. 0. Incorrect

1. Correct [ ]

Ask patient what he/she has written and record here.

(Spelling and grammar are not important. The sentence must have a subject (real or implied) and a verb. ``Help!'' ``Go away'' are acceptable.) PRAXIS - Ideational Read full statement and then hand over the paper used above. Make a point of handing to subjects midline.169. I am going to give you a piece of paper. When I do,

take the paper in your right hand. Fold the paper in half with both hands, and put the paper down on your lap.

Right handFoldsOn lap

Total[ ]

Do not repeat instructions or coach.

(Score a move as correct only if it takes place in the correct sequence. Tick each correct move and enter number correct under Total.) 170. Put the paper in the envelope and seal the envelope. 0. Incorrect

1. Correct [ ]

21


Writing to dictation 171. Write this name and address on the

envelopeMr John Brown 42 West Street Bedford

0. Incorrect 1. Poor but acceptable 2. Correct

[ ]

Spelling and neatness are not important. Criterion is whether letter is likely to reach exact destination, e.g. Jon Brwn is acceptable; 24, and Burford are incorrect.

Then say: Please try to remember this name and address as I shall be asking you about them later on.

If patient is unable to write, say the address slowly, twice and ask her/him to remember it.

PRAXIS - Ideomotor 172. Show me how you wave goodbye. 0. Incorrect

1. Correct [ ]

In 173 and 174 we are looking for a correct mime. Score 1 (concrete response) if patient uses fingers to represent object. 173. Show me how you would cut with scissors. 0. Incorrect

1. Concrete response 2. Correct mime

[ ]

174. Show me how you would brush your teeth with a toothbrush.

0. Incorrect 1. Concrete response 2. Correct mime

[ ]

PERCEPTION - Tactile 175. I am going to place a coin into your hand and

I want you to tell me what it is without looking at it.

PLACE COINS ONE AT A TIME IN THE SUBJECT'S HAND PALM DOWN. (5p,10p)

(Tick each item correct and enter number correct under Total)

5p(or 1 shilling)10p (or 2 shillings)

Total[ ]

CALCULATIONMental calculation is required. Paper and pencil are not allowed176. Now let the patient see the coins.

How much money does that make?0. Incorrect 1. correct (15p/3 shillings)

[ ]

22


177. If somebody gave you this amount (15p or 3 shillings) as change from £ 1, how much did you spend?

0. Incorrect 1. correct(85p/17 shillings)

[ ]

MEMORY - Recall 178. What was the name and address you

wrote on the envelope a short time ago?

(Tick each item answered correct and enter number correct under Total)

John Brown42West Street Bedford

Total[ ]

ABSTRACT THINKING In this question we are looking for the capacity to think abstractly. Abstract answers score 2, concrete answers score 1. Examples are given beside each score.I am going to name two things and I'd like you to tell me in what way they are alike. For example, a dog and a monkey are alike because they are both animals.

179. In what way are an apple and a banana alike?

0. round, have calories 1. food, grow, have peel 2. fruit

[ ]

Record Answer

For this question ONLY if score is less than 2 say, ``They are also alike because they are both fruit.''

180. In what way are a shirt and a dress alike?

0. have buttons 1. to wear, made of cloth, keep you warm 2. clothing, garments

[ ]

Record Answer

181. In what way are a table and chair alike? 0. wooden, have 4 legs 1. household objects used for meals 2. furniture

[ ]

Record answer

182. In what way are a plant and an animal alike? 0. useful to man, carry germs 1. grow, need feed, natural 2. living things

[ ]

Record Answer

23


VISUAL PERCEPTION - Famous People SHOW PICTURES IN BOOKLET183 Who is this?

Score as correct if picture is recognised. Correct name is not required, but record any answer which does not correspond exactly to the examples given.

Queen Pope, Archbishop

Total[ ]

Object Constancy SHOW PICTURES IN BOOKLET184. These are pictures of objects taken from

unusual angles. Can you tell me what they are?

(Tick each item answered correctly and enter number correct under Total. Criterion is whether the object is recognised not that it be named correctly.)

Spectacles Shoe Purse, Suitcase Cup and Saucer Telephone Pipe

Total[ ]

Recognition of Person/function 185. Can you tell me who this is, or what he/she

does? (indicate any 2 available, e.g. Cleaner, Doctor, Nurse, Patient, Relative)(if none available score 9)


[ ]

PASSAGE OF TIME 186. Without looking at your watch, tell me what

the time is now?(Error of up to 30 min. allowed)


[ ]

187. Without looking at your watch, can you tell me how long you think we have been talking together?

Record finishing time___________________

Time in mins [ ]

Actual time taken by interview in mins ___________________(check against start time on p.4)

Total score:

24


SECTION C – INTERVIEWER OBSERVATIONS

TO BE RECORDED AT THE END OF THE INTERVIEW – CODE YES ONLY IF MARKEDLY PRERSENT.

188. Self neglect 0.No1.Yes

[ ]

189. Uncooperative behaviour 0.No1.Yes

[ ]

190. Suspiciousness – reluctant to answer 0.No1.Yes

[ ]

191. Hostile or irritable e.g. angry response 0.No1.Yes

[ ]

192. Silly or bizarre behaviour 0.No1.Yes

[ ]

193. Slow and underactive e.g. sits abnormally still, delay in response to questions

0.No1.Yes

[ ]

194. Restless e.g. fidgeting, pacing, unnecessary movements 0.No1.Yes

[ ]

195. Anxiety and Fear – appears frightened, worried or somatically tense out of proportion to situation

0.No1.Yes

[ ]

196. Depressed mood – looks sad, mournful, tearful, voice low or gloomy

0.No1.Yes

[ ]

197. Lability of mood – rapidly change from sad to happy, friendly to irritable

0.No1.Yes

[ ]

198. Flat affect – lack of spontaneous emotion or emotional response to interviewer. Monotonous voice and lack of gestures.

0.No1.Yes

[ ]

199. Hallucinating – behaves as it hears voices, or sees visions, or admits to doing so

0.No1.Yes

[ ]

200. Speech very rapid and difficult to follow 0.No1.Yes

[ ]

25


201. Speech very slow. Pauses between the words. 0.No1.Yes

[ ]

202. Speech restricted in quantity, e.g. answers to questions only, no unnecessary words used.

0.No1.Yes

[ ]

203. Speech rambling or incoherent, irrelevant answers to questions

0.No1.Yes

[ ]

204. Speech slurred 0.No1.Yes

[ ]

205. Perseveration 0.No1.Yes

[ ]

206. Lack of insight into present disability 0.No1.Yes

[ ]

207. Drowsiness 0.No1.Yes

[ ]

208. Peculiar use of terms e.g. Neologisms 0.No1.Yes

[ ]

209. Speaks to self 0.No1.Yes

[ ]

210. Impaired ability to focus, sustain and shift attention 0.No1.Yes

[ ]

211. Impaired judgement of situations and / or persons 0.No1.Yes

[ ]

212. Hypochondriacal pre-occupations with somatic discomfort 0.No1.Yes

[ ]

26


SECTION D – PHYSICAL EXAMINATION

213. Systolic Blood Pressure [ ]

214. Diastolic Blood Pressure [ ]

215. Tendon reflexes 0.Normal1.Abnormal

[ ]

216. Plantar reflex 0.Normal1.Extensor L2.Extensor R

[ ]

217. Hemiparesis – marked weakness of supper or lower or both limbs of one side

0.None1.Left2.Right3.Both

[ ]

218. Gait abnormal e.g. wide based

Specify other, e.g. small step, untidy

0.Normal1.Wide based2.Other

[ ]

219. Mobility – record if he/she needs an artificial aid such as a frame or stick, or needs help of another person

0.Normal1.Needs aid2.With person

[ ]

220. Deafness – record if he/she can hear without examiner raising voice, or if unable to hear with voice raised.

0.Normal1.Needs aid2.Unable hear

[ ]

221. Visual defects – record if unable to see materials or instructions in booklet.

0.No difficulty1.Sees with difficulty2.Cannot see

[ ]

222. Tremor – (score 1= mild if tremor present but causes no difficulty with dressing or eating, or gait).

0.None1.Mild2.Severe

[ ]

223. Physical difficulty interfering with manual task e.g. unable to hold pen to write

0.No1.Yes

[ ]

224. Abnormal eye movements e.g. nystagmus 0.No1.Yes

[ ]

225. Shortness of breath at rest? 0.No1.Yes

[ ]

27


SECTION E – TEST RESULT if available

Results226. Blood count 0.Normal

1.Abnormal[ ]

227. B12 or Folate 0.Normal1.Abnormal

[ ]

228. T3, T4, TSH 0.Normal1.Abnormal

[ ]

229. Urea and Electrolytes 0.Normal1.Abnormal

[ ]

230. Skull X-Ray 0.Normal1.Abnormal

[ ]

231. Liver Function Tests 0.Normal1.Abnormal

[ ]

232. CT Scan 0.Normal1.Abnormal

[ ]

233. VDRL, etc 0.Normal1.Abnormal

[ ]

234. In opinion of interviewer, have specific causes of dementia been excluded by the history, physical examination and laboratory test.

0.Yes1.No

[ ]

28


SECTION F – LIST OF CURRENT MEDICATIONS

Approx. Period Taken1.

____________________________________________________________________2.

____________________________________________________________________3.

____________________________________________________________________4.

____________________________________________________________________5.

____________________________________________________________________6.

____________________________________________________________________7.

____________________________________________________________________8.

____________________________________________________________________9.

____________________________________________________________________10.

____________________________________________________________________

29


SECTION G – ADDITIONAL INFORMATION (Optional)

Observations, remarks concerning patient etc. made at time of interview.

Comment briefly on appearance and demeanour; accommodation and pointers to impaired function; response to interviewer and interview; impression of “mental sharpness”; factors other than dementia which contribute to low score; abnormalities or mental state; general performance on testing; reasons for arriving at particular diagnosis and reasons for rejecting alternative diagnoses.

30


SECTION H – INTERVIEW WITH INFORMANT

Interview to be conducted with a relative, friend or carer concerned with patient who may or may not be living with them.

Questions are organised into headed sections. It may be necessary at the questioner’s discretion to introduce each section – for example, “sometimes people loss skills needed for everyday life” with the section on Daily Activities.

Introduction to informant

I am going to ask some questions relating to changes in behaviour and character of …... they donot always appear in late life and may not be relevant to him/her. But we ask these of everybody because the replies might prove valuable in helping people who do have difficulties.

Informant’s name: __________ Address: __________ Date of Interview [ / / ]235. How was interview conducted? 1.Face to face

2.Telephone[ ]

236. Relationship of informant to patient: 1. Spouse2. Sibling3. In-law(sister/brother)4.Son/daughter5.In-law(son/daughter)6.Friend7.Caretaker/warden8.Other

[ ]

237. How often do you see him/her? 1.Lives with2.Daily3.More than 1/week4.1 or <1/week

[ ]

31


PART 1 – ITEMS CONCERNED WITH HISTORY OF PRESENT DIFFICULTY(All questions to be asked)

PERSONALITY238. Have you noticed any changes in his/her

personality, such as the way he/she behaves socially?

TYPE OF CHANGES MAY BE NOTED HERE

0.No1.Yes

[ ]

239. Has there been any noticeable exaggeration in his/her normal character?

0.No1.Yes

[ ]

240. Has he/she become more changeable in mood? 0.No1.Yes

[ ]

241. Has he/she become more irritable or angry? 0.No1.Yes

[ ]

242. Does he/she show less concern for others? 0.No1.Yes

[ ]

243. Does he/she get involved in difficult or embarrassing situations in public because of his/her behaviour?

0.No1.Yes

[ ]

244. Has she/he become more stubborn or perhaps a little awkward?

0.No1.Yes

[ ]

If no personality changes omit next 2 questions and code 999 or 9 below245. How long have these changes been present? Duration in months [ ]

246. Have these changes developed gradually or did they come on suddenly?

0.Gradual1.Sudden

[ ]

MEMORY247. Does he/she have more difficulty remembering

short lists of items e.g. shopping?0.No difficulty1.Slight difficulty2.Great difficulty

[ ]

32


248. Does he/she have difficulty remembering when he/she last saw you, or what happened the day before?

0.No difficulty1.Slight difficulty2.Great difficulty

[ ]

249. Does he/she have difficulty knowing where he/she is, or discriminating between different types of people, such as doctors, visitors, relatives?


[ ]

250. Does he/she have difficulty finding the way about the home (or ward) e.g. finding the toilet?


[ ]

251. Does he/she have difficulty finding the way around the neighbourhood e.g. to the shops or post office near home?


[ ]

If no memory problem omit next 2 questions and code 999 or 9 below252. How long have these changes been present? Duration in months [ ]


0.Gradual1.Sudden

[ ]

GENERAL MENTAL FUNCTIONING254. Has there been a more general decline in his/her

mental functioning?0.No1.Yes

[ ]

255. Does he/she tend to talk about what happened long ago rather than in the present?

0.No1.Sometimes2.Often

[ ]

256. When speaking, does he/she have difficulty finding the right word or use wrong words?

0.No1.Yes

[ ]

257. Does he/she seem to find it more difficult to make decisions lately?

0.No1.Yes

[ ]

258. Is there a loss of any special skill or hobby he/she could manage before?

0.No1.Yes

[ ]

259. Does his/her thinking seem muddled? 0.No1.Yes

[ ]

33


If no mental deterioration omit next 3 questions and code 999 or 9 below260. How long have these changes been

present?Duration in months [ ]


0.Gradual1.Sudden

[ ]

262. Has this difficulty developed in steps and stages?

0.No1.Yes

[ ]

EVERYDAY ACTIVITIES263. Does he/she have any difficulty

performing common household chores, e.g. can he/she make a cup of tea?


[ ]

264. Does he/she have more difficulty managing small amounts of money?


[ ]

265. Does he/she have difficulty feeding him/herself?

0.No difficulty2.Eats with a spoon4.Eats solid biscuits6.Has to be fed

[ ]

266. Does he/she have difficulty dressing? 0.No difficulty2.needs help with buttons4.Wrong sequence, often forgets items6.Unable to dress self

[ ]

267. Does he/she wet or soil him/herself? 0.No 2.Wets occasionally4.Wets often6.Doubly incontinent

[ ]

If none of the above present, omit next 2 questions and code 999 or 9 below268. How long has this difficulty been

present?Duration in months [ ]


0.Gradual1.Sudden

[ ]

34


CLOUDING/DELIRIUM270. Has there been a sudden worsening towards

mental confusion in recent weeks or months, which has continued to the present time?

0.No1.Yes

[ ]

If yes or uncertain ASK next 4 questions. If no, code 999 or 9 below271. Are there episodes lasting days or weeks

when his/her thinking seems quite clear and then becomes muddled?

0.No1.Yes

[ ]

272. Are there brief episodes during 24 hours when he/she seems much worse and then times when quite clear?

0.No1.Yes

[ ]

273. Is the confusion worse towards dusk or the evening?

0.No1.Yes

[ ]

274. How long have these changes been present?

Duration in months [ ]

DEPRESSED MOOD275. Is there a loss of interest or enjoyment in

things in general?0.No1.Yes

[ ]

276. Has he/she been inclined to blame herself or feel unreasonably guilty?

0.No1.Yes

[ ]

277. Do you think he/she is depressed? 0.No1.Yes

[ ]

If no depression, omit next 2 questions and code 999 or 9 below278. How long has this difficulty been present? Duration in months [ ]


0.Gradual1.Sudden

[ ]

SLEEP280. Does he/she have difficulty in getting to

sleep?0.No1.Yes

[ ]

281. Is he/she restless or wakeful during the night?

0.No1.Yes

[ ]

35


282. Does he/she wake early in the morning and seem unable to fall asleep again?

0.No1.Yes

[ ]

283. Does he/she tend to get up and wander at night, or any other time?

0.No1.Yes

[ ]

If no difficulties omit next 2 questions and code 999 or 9 below284. How long has this difficulty been present? Duration in months [ ]


0.Gradual1.Sudden

[ ]

PARANOID FEATURES286. Has he/she complained of being unjustly

persecuted or spied on by others?0.No1.Yes

[ ]

287. Has he/she been troubled by voices or visions not experienced by others?

0.No1.Yes

[ ]

CEREBROVASCULAR PROBLEMS

If yes to any of the following questions establish how long since first occurrence (in months)288. Has he/she ever passed out and then had a

brief weakness or difficulty with speech, memory or vision?

0.No1.Yes

[ ]

289. Does he/she have a tendency to fall? 0.No1.Yes

[ ]

290. Has he/she ever had a stroke? 0.No1.Yes

[ ]

If any answer is positive – record time (in months) since onset of first symptom. If all answer are no, code 999291. How long ago did this first occur? Duration in months [ ]

36


GENERAL SUMMARY

This question is aimed at identifying immobility associated with advanced Alzheimer’s disease, clouded states or severe depression or changes in gait not due to definable neurological illness.

292. Does he/she have trouble getting about since the above difficulties?

0.No 1.Some difficulty2.Great difficulty

[ ]

If no problem has been established anywhere in this section, code 9 above and 999 below. Other wise say:

You have indicated some changes in Mr./Mrs __________________ can you tell me,

What was the first change you noticed in your relative’s behaviour?

RECORD ANSWER IN FULL

293. How long ago was that? Duration in months [ ]

294. When in your judgement was your relative’s mental ability last quite normal?

Duration in months [ ]

37


QUESTIONS PERTAINING TO HIS/HER PAST HEALTH

Now I would like to ask you some questions about other aspects of his/her health in the past.295. Has he/she ever had high blood pressure? 0.No

1.Yes[ ]

296. Has he/she ever had a heart attack? 0.No1.Yes2.More than one

[ ]

297. Has he/she ever been diagnosed diabetic? 0.No1.Yes

[ ]

298. Has he/she ever been diagnosed Parkinson’s disease?

0.No1.Yes

[ ]

299. Has he/she had a mentally handicapped child or one with Down’s Syndrome?

0.No1.Yes

[ ]

300. Has he/she ever had a cancer? 0.No1.Yes

[ ]

301. Has he/she ever been unconscious after a serious head injury? At what age?

0.No1.Before 302.30 - 653.After 65

[ ]

302. Has he/she ever had fits – at what age? 0.No1.Before 302.30 - 653.After 65

[ ]

303. Has he/she ever been a heavy smoker, say 20 or more a day for a year or more?

0.No1.Yes

[ ]

304. Did you ever think he/she was a heavy drinker? 0.No1.Yes

[ ]

305. Has he/she ever drunk as much as 5 pints of beer daily over a two week period?(or 10 units of wine or spirits)

1 unit = 10 gm alcoholApprox. = half-pint beer/wine glass of wine/nip of spirit

0.No1.Yes

[ ]

306. Did drinking ever cause him/her any problems such as losing jobs, or with driving?

0.No1.Yes

[ ]

38


307. Has he/she ever taken pills or drugs that he/she could not do without, for instance barbiturates to help you sleep, or purple hearts (amphetamine) to help he/she cope?

0.No1.Tranquillisers2.Hypnotics3.Barbiturates4.Stimulants5.OthersSpecify others:

[ ]

308. Has he/she ever been a nervous person?

Record answer:

0.No1.Yes

[ ]

309. Has he/she ever had emotional or nervous illness requiring treatment?

Record number of illnesses

0.None1.One2.Two3.Three4.four5.Five6.Six or more

[ ]

310. Was he/she hospitalised?

Where When

0.No1.Yes

[ ]

39


PART II – QUESTIONS PERTAINING TO FAMILY HISTORY AND PAST HISTORY

Now I would like to ask you about other members of his/her family.311. How many children does he/she have?

(Living or dead)NUMBER00. None

[ ]

312. How many brothers does he/she have?(Living or dead)

NUMBER00. None

[ ]

313. How many sisters does he/she have?(Living or dead)

NUMBER00. None

[ ]

314. What position was he/she in his/her family?(NB Coding – eldest..01, second..02, etc)

position [ ]

315. About how old was his/her mother when she died (approx.)?

AGE00. Not alive

[ ]

316. How old was your relative when his/her mother died?

AGE [ ]

317. About how old was his/her father when he died (approx.)?

AGE00. Still alive

[ ]

Did any of his/her relatives have trouble with memory or getting every confused, and have to go into a home to be looked after?318. Female relatives – Mother, Sister ( ),


[ ]

319. Male relatives – Father, Brother ( ), Son ( )

NUMBER00. None

[ ]

Have any of his/her family had Parkinson’s disease, i.e. marked tremor or stiffness?320. Female relatives – Mother, Sister ( ),


[ ]

321. Male relatives – Father, Brother ( ), Son ( )

NUMBER00. None

[ ]

40


Has anyone in the family had a child with mental handicap or Down’s Syndrome (explain if necessary)?322. Female relatives – Mother, Sister ( ), Daughter ( ) NUMBER

00. None[ ]


[ ]

Has anyone in his/her family had leukaemia?324. Female relatives – Mother, Sister ( ), Daughter ( ) NUMBER

00. None[ ]


[ ]

Has anyone in his/her family had a heart attack?326. Female relatives – Mother, Sister ( ), Daughter ( ) NUMBER

00. None[ ]


[ ]

Have any of his/her relatives had a stroke or sudden weakness or speech difficulty?328. Female relatives – Mother, Sister ( ), Daughter (

)NUMBER00. None

[ ]


[ ]

Has anyone in his/her relatives had high blood pressure diagnosed?330. Female relatives – Mother, Sister ( ), Daughter (

)NUMBER00. None

[ ]


[ ]

Has anyone in his/her family had a nervous or emotional illness requiring treatment?332. Female relatives – Mother, Sister ( ), Daughter

( )NUMBER00. None

[ ]


[ ]

41


SECTION I

ADDITIONAL INFORMATION FROM INFORMANT

Expand on any aspects of history which have bearing on diagnosis. Comment briefly on changes noticed by informant; difficulties caused by patient; relationship between patient and informant; amount of support provided by informant and others.

42


DIAGNOSIS TO BE COMPLETED BY INTERVIEWER ON THE BASIS OF OPERATIONAL DIAGNOSTIC CRITERIA (APPENDIX D)

334. Primary Psychiatric Diagnosis of present condition to be completed at end of interview.

00.None01.SDAT02.Vascular dementia03.SDAT + vascular dementia04. Dementia secondary to other causes05. Clouded/delirious state06.Clouded/delirious state + SDAT07. Clouded/delirious state + vascular dementia08.Clouded/delirious state + other dementia09.Paranoid or paraphrenic illness10. Depressive illness11.Anxiety or phobic neurosis12.Other psychiatric disorder

SPECIFY OTHER:

[ ]

Secondary diagnosis (if present)(Use coding from previous question)

[ ]

335. Clinical estimate of severity of dementia. 0.None1.Minimal2.Mild3.Moderate4.Severe

[ ]

336. Clinical estimate of severity of depressive symptoms.(To be assessed irrespective of diagnosis)

0.None1.Minimal2.Mild3.Moderate4.Severe

[ ]

337. In interviewer’s opinion has the patient an adequate personality (free from any history of neurotic breakdown and without disabling neurotic symptoms or serious social maladjustment).

0.Adequate1.Not adequate

[ ]

43


338. Recent acute physical illness (i.e. weeks or rarely months duration).

0.No1.Yes

[ ]

Other medical diagnosis:

(List from notes:)

44


16. ACTIVITIES OF DAILY LIVING Now I'd like to ask you some questions about how you cope with day-to-day tasks.

(a) How does S manage with using a telephone i.e. looking up numbers, dialling etc?

0 Telephones independently – looks up numbers, dials etc.1 Dials a few well-known numbers only.2 Answers telephone but does not dial.3 Cannot use telephone at all.9 No telephone within easy access.

[ ]

(b) How does S manage with shopping?0 Takes care of all or nearly all shopping independently1 Shops independently for small purchases only.2 Needs to be accompanied on any shopping trip.3 Does not shop at all

[ ]

Who helps? [ ] (c) How does S manage with preparing meals?

0 Prepares all or nearly all meals independently.1 Prepares snacks only or heats up meals prepared by others.2 All meals and snacks must be prepared by others.9 Meals have always been prepared by spouse or others.

[ ]

Who helps? [ ](d) How does S manage with housework?

0 Independent apart from occasional help with heavy work.1 Performs only light daily tasks e.g. dish washing, dusting. 2 All housework must be done by others.9 Housework has always been done by spouse or other.

[ ]

Who helps? [ ]

Code: Nobody/none required .. 00 Home help ………………08Spouse …………………01 Meals on wheels ………..09Daughter ……………….02 Community nurse ………10Daughter – in – law ……03 Chiropodist ……………..11Son ……………………..04 Warden …………………12Son – in – law ………….05 Other (specify) ………… 13Other relative …………..06Friend/Neighbour ……..07

(e) How does S manage with laundry? 0 Independent apart from occasional help with heavy work. [ ]

45


1 Lauders only small items, e.g. stockings, underwear 2 All laundry must be done by others

9 Laundry has always been done by spouse or othersWho helps? [ ]

(f) How does S looking after his own finances i.e. keeping track of bills, income? 0 Independent – keeping track of bills, income1 Manages day to day spending only.2 Does not handle money at all.

[ ]

Who helps? [ ](g) How does S manage with walking?

0 Walks around town, suburb or village 1 Walks no further than one block away 2 Walks no further than gate 3 Walks only within house 4 Takes no more than a few steps

[ ]

(h) Do you use a walking stick or other aid? 0 Independent 1 Walking stick(s) 2 Frame/tripod 3 Wheelchair

4 Other person

[ ]

(i) How does S manage with bathing or showering? 0 Independent in bath, shower or sponge-wash 1 Needs help getting in or out of bath or shower 2 Can wash face and hands only 3 Needs major assistance

[ ]

Who helps? [ ]

Code: Nobody/none required .. 00 Home help ………………08Spouse …………………01 Meals on wheels ………..09Daughter ……………….02 Community nurse ………10Daughter – in – law ……03 Chiropodist ……………..11Son ……………………..04 Warden …………………12Son – in – law ………….05 Other (specify) ………… 13Other relative …………..06Friend/Neighbour ……..07

46


(j) How does S manage with reaching up to comb your hair (or shave) or down to cut your toenails?

0 Attends to grooming independently 1 Needs minor assistance, e.g. cutting toenails 2 Needs moderate assistance, e.g. shaving, brushing hair 3 Needs major assistance.

[ ]

Who helps? [ ](k) How does S manage with dressing or undressing?

0 Dresses and undresses independently 1 Needs minor assistance, e.g. tying shoelaces, buttons 2 Needs moderate assistance e.g. shoes, socks, arms in sleeves 3 Needs major assistance

[ ]

Who helps? [ ](l) How does S manage with getting to the toilet on time?

0 Always gets to the toilet on time 1 Rare (weekly at most) accidents 2 Accidents more than once a week 3 No control of bladder or bowels

[ ]

Who helps? [ ](m) How does S manage with taking medicines?

0 Responsible for taking medicines in correct dose at correct time. 1 Medication must be put out in advance by others 2 Medication must be administered by others 9 Takes no medication at present

[ ]

Who helps? [ ] (n) Do you think that he/she need more help than?

0 No 1 Yes

[ ]

Code:

Nobody/none required .. 00 Home help ………………08Spouse …………………01 Meals on wheels ………..09Daughter ……………….02 Community nurse ………10Daughter – in – law ……03 Chiropodist ……………..11Son ……………………..04 Warden …………………12Son – in – law ………….05 Other (specify) ………… 13Other relative …………..06Friend/Neighbour ………07

47


o. Is S visited by a home help, meals on wheels or community nurse?If yes: How many times did HH, MOW visit in the last week? CN in last month?

Code number of visits In last week (month for CN).None= 0

Home help Meals on wheelsCommunity nurse

[ ][ ][ ]

p. Does S attend a day centre or day hospital?

Code no=0, yes=1.

Day centre…..Day hospital…

[ ][ ]

48


PROBLEM CHECKLIST

NEVER OCCASION FREQUENT NO PROBLEM

SMALL PROBLEM

BIG PROBLEM

1. NEEDS HELP WITH DRESSING.2. DEMANDS ATTENTION.3. NEEDS HELP TO GET IN AND OUT OF CHAIR.4. USES BAD LANGUAGE5.NEEDS HELP TO GET IN AND OUT THE BED6. DISRUPTS PERSONAL AND SOCIAL LIFE.7. NEEDS HELP TO WASH8. PHYSICALLY AGGRESSIVE.9. NEEDS HELP AT MEALTIMES.10. VALGAR HABITS.11. INCONTINENT – SOILING.12. CREATE PERSONALITY CLASHES.13. FORGETS THINGS THAT HAVE HAPPENED.14. TEMPER OUTBURSTS.15. FALLS.16. RUDE TO VISITORS.

0 1 2 0 1 2

49


17. UNABLE TO MANAGE STAIRS18. NOT SAFE IF OUTSIDE THE HOUSE ALONE19. CANNOT BE LEFT ALONE FOR EVEN ONE HOUR20. WANDERS ABOUT THE HOUSE AT NIGHT.21. CARELESS ABOUT OWN APPEARANCE22. UNABLE TO WALK OUTSIDE HOUSE23. UNABLE TO HOLD A SENSIBLE CONVERSATION.24. NOISY, SHOUTING.25. INCONTINENT – WETTING.26. SHOWS NO CONCERN FOR PERSONAL HYGIENE.27. UNSTEADY ON FEET.28. ALWAYS ASKING QUESTIONS.29. UNABLE TO TAKE PART IN FAMILY CONVERSATIONS30. UNABLE TO READ NEWSPAPERS, MAGAZINES.31. SITS AROUND DOING NOTHING32. NO INTEREST IN NEWS ABOUT FAMILY OR FRIENDS33. UNABLE TO FOLLOW T.V. OR RADIO.34. UNABLE TO KEEP OCCUPIED DOING USEFUL THINGS.

0 1 2 0 1 2

50


STRAIN SCALE

NEVER SOMETIMES OFTEN1.DO YOU EVER FEAR ACCIDENTS OR DANGERS CONCERNING YOUR RELATIVE E.G. FIRE,GAS FALLING OVER ETC.?2. DO YOU EVER FEEL EMBARRASSED BY YOUR RELATIVE IN ANY WAY?3. IS YOUR SLEEP EVER INTERRUPTED BY YOUR RELATIVE?4. HOW OFTEN DO YOU FEEL IT IS DIFFICULT TO COPE WITH THE SITUATION YOU ARE IN AND, IN PARTICULAR, WITH YOUR RELATIVE?5. DO YOU EVER GET DEPRESSED ABOUT THE SITUATION?6. HOW MUCH DO YOU WORRY ABOUT YOUR RELATIVE?7. HAS YOUR HOUSEHOLD ROUTINE BEEN UPSET IN CARING FOR YOUR RELATIVE?8. DO YOU FEEL FRUSTRATED WITH YOUR SITUATION?9. DO YOU GET ANY PLEASURE FROM CARING FOR YOUR RELATIVE?

2 1 0

10. DO THE PROBLEMS OF CARING PREVENT YOU GETTING AWAY ON HOLIDAY?11. HAS YOUR STANDARD OF LIVING BEEN AFFECTED BY HAVING TO CARE FOR YOUR RELATIVE?12. HAS YOU HEALTH SUFFERED FROM CARING FOR YOUR RELATIVE?13. DO YOU FIND THAT YOUR RELATIVE’S DEMANDS FOR ATTENTION GET TOO MUCH FOR YOU?

0 1 2

51


INFORMANT HEALTH INVENTORY

1. How would you rate your own health at the moment?

1. Good 2. Fair 3. Poor 4. Very poor

[ ]

2.What particular problems do you have with your health at present?

SPECIFY:3. Do you suffered from any of the following, to

the point where they interfere with your day to day activities?

Code No=0, Yes = 1.

Code “Yes” if has had symptom or difficulty in the last month?

Poor vision (with spectacles) Poor hearing (with hearing aid) Arthritis/ rheumatismBack painChest painShortness of breath Weakness in arm or legUnsteady on feet Falls

[ ][ ][ ][ ][ ][ ][ ][ ][ ]

4. Do you have a history of any of the following illnesses?

Code No=0, Yes = 1.

High blood pressureHeart troubleStrokeDiabetesCancer

[ ][ ][ ][ ][ ]

5. When did you last see a G.P about your own health?

Months [ ]

6. When were you last admitted to any hospital? Years [ ]7. Have you ever seen your G.P. or been admitted

to hospital because of any nervous (psychiatric) trouble?

0.N01.G.P.only2.Hospital

[ ]

52


IF CONSULTED G.P. OR ADMITTED TO HOSPITAL?

How long ago?

ROUND UP TO NEAREST YEAR.

IF NEVER, CODE = 99.

Years [ ]

8. Are you taking any medicines prescribed by your doctor or the hospital?

SPECIFY ALL:

CODE: NO=0, YES=1

HypnoticsMinor tranqsAntidepressantsNuroleptics

[ ][ ][ ][ ]

53


GENERAL HEALTH QUESTIONNAIRE

We would to know how you have been feeling in recent weeks. Please read the following list of questions carefully and circle the answer which applies most closely to you. We want to know how you have been feeling in yourself over the past few weeks and whether there has been any change in your feelings, not about any difficulties you might have had in the past. It is important that you try and answer all the questions.

Have you recently: 0 0 1 1A1 Been feeling perfectly well and in

good health? Better Same Worse Much worsethan usual as usual than usual than usual

A2 Been feeling in need of a good tonic? Not No more Rather more Much moreat all than usual than usual than usual

A3 Been feeling run down and out of sorts?

Not No more Rather more Much moreat all than usual than usual than usual

A4 Felt that you are ill? Not No more Rather more Much moreat all than usual than usual than usual

A5 Been getting any pains in your head? Not No more Rather more Much moreat all than usual than usual than usual

A6 Been getting a feeling of tightness or pressure in your head?


A7 Been having hot or cold spells? Not No more Rather more Much moreat all than usual than usual than usual

B1 Lost much sleep over worry? Not No more Rather more Much moreat all than usual than usual than usual

B2 Had difficulty in staying asleep once you are off?


B3 Felt constantly under strain? Not No more Rather more Much moreat all than usual than usual than usual

B4 Been getting edgy and bad-tempered? Not No more Rather more Much moreat all than usual than usual than usual

B5 Been getting scared or panicky for no good reason?


B6 Found everything getting on top of you?


B7 Been feeling nervous and strung-up all the time?


54


C1 Been managing to keep yourself busy and occupied?

More so Same Rather less Much lessthan usual as usual than usual than usual

C2 Been taking longer over the things you do?

Quicker Same Longer Much longerthan usual as usual than usual than usual

C3 Felt on the whole you were doing things well?

Better About Less well Muchthan usual the same than usual less well

C4 Been satisfied with the way you have carried out your tasks?

More About same Less satisfied Much lesssatisfied as usual than usual satisfied

C5 Felt that you are playing a useful part in things?

More so Same Less useful Much lessthan usual as usual than usual useful

C6 Felt capable of making decisions about things?

More so Same Less so Much lessthan usual as usual than usual capable

C7 Been able to enjoy your normal day-to-day activities?

More so Same Less so Much lessthan usual as usual than usual than usual

D1 Been thinking of yourself as a worthless person?


D2 Felt that life is entirely hopeless? Not No more Rather more Much moreat all than usual than usual than usual

D3 Felt that life is not worth living? Not No more Rather more Much moreat all than usual than usual than usual

D4 Though of the possibility that might make away with yourself?

Definitely I donot Has crossed Definitelynot think so my mind have

D5 Found at times you could not do anything because your nerves were too bad?


D6 Found yourself wishing you were dead and away from it all?


D7 Found that the idea of taking you own life kept coming into your mind?

Definitely I donot Has crossed Definitelynot think so my mind have

E1 Do you feel lonely? Never Occasionally Quite often Very often

55


MEDICAL HISTORY

1. MEDICAL HISTORY.

2. PSYCHIATRIC HISTORY

NO=0, YES=1

DepressionDeliriumDementiaOther psych.disorder

[ ][ ][ ][ ]

3. REFERRALS/ADMISSIONS

CODE NUMBERSREFERRAL = OP APPT ONLY.

General referralGeneral admissionPsych referralPsych admission

[ ][ ][ ][ ]

4. CURRENT MEDICATION AntidepressantsHypnoticsDaytime BZDPsNeurolepticsOther psychotropics

[ ][ ][ ][ ]

5. REFERRAL TO SOCIAL SERVICES

Code for last 2 years only.

0.Yes1.No

[ ][ ][ ][ ]

This file was typed by Emily zhao, on 2007-06-20.

56

cambridge city over 75 cohort survey 5 year 13 (1999 ...€¦ · web viewcamdex. interview...

Documents