Suicidal thoughts and dementia

Arch. Gerontol. Geriatr. suppl. 6 (1998) 33-38 0167-4943/98/$19.00 0 1998 Elsevier Science Ireland Ltd. All right reserved SUICIDAL

THOUGHTS

M. BELLINI, 1st Chair of

0.

AND

Psychiatry,

Viale

University of

F.

University Pepoli,

of

Internal

I-401 38 Bologna,

P. FORTlb,

Psychiatry,

Behavior,

partment

DEMENTIA

DE RONCHla,

of Clinical

Suicidal

33

and

of Bologna

5,

Bologna,

Medicine,

MAIOLlb

I-40123

Viale

S.

and

Bologna;

Pepoli,

Policlinico

G.

5,

RAVACiLIAb

Center a2nd

for

the

Chair

l-40123

of

Bologna;

Orsola-Malpighi,

Via

Study Clinical

and

bDe-

Massarenti,

9,

Italy

SUMMARY Starting from a previous investigation on the diagnosis of dementia based on the guidelines of the American Psychiatric Association in the oldest old patients, the present work focuses on the suicidal thoughts expressed as the MontgomeryAsberg depression rating scale (MADRS), item 10 score in the two subgroups of 18 demented and 16 non-demented subjects aged 91-104 years. We have not found any differences regarding depression or suicidal thoughts between the two subgroups. Our results are discussed and support the trends of recent literature, accessed through the Medline database. Keywords : oldest-olds, risk factors

dementia,

DSM-I I I-R

criteria

for

dementia,

suicidal

ideas,

INTRODUCTION It aged

is well

known

subjects

suicide

incidence

higher

rates

Norway,

age

and

Referring

to

or older

people

(70.4

% of the

general

Bellini,

characterized

a recent change high

75,

in

increase

with

the

which

males. in

is

proportion

exclusion

prevalent

According of

to

the

in

the

to

Platt

(1988),

age,

with

notably

countries

Finland

and

data

of the

of

death

completed even

certificates

suicides

though

processed

are

this

committed

age group

by by

Bellini

65-year-old

accounts

for

only

14

risk

followed

by and

(1986)

loss,

have

by

of

other

race,

elderly

people

is depression

psychopathological

personality

that

male

serious

conditions

disorders.

highlighted

white

depression,

factor

high

gender,

physical

Among suicide widowed

disease

such

other risk

(Ferrari

alcohol

authors,

groups

condition, or

as

and Osgood

of the experience

untreatable

pain,

aged of some

of status. As

1956;

of

8 males),

dementia

are

Europe

third

suicide

1994), McIntosh

a phenomenon

population.

major

and

in

1982-1993

one

dependence,

is

particularly

Scotland.

in Italy

The

suicide

1990),

rates

after

Poland

(1996),

that

(Faria,

regards

incidence Sendbuehler

suicidal of

organic and

behavior

and

syndromes Goldstein,

earlier

dementia. among

1977).

elderly

On the

reports

pointed

attempters contrary,

out

(O’Neal more

recently,

et

to a al., the

34 phenomenon the

past

has

been

10 years

poorly

on the

outlined

suicidal

in relevant

studies.

behavior

of

the

in the

elderly,

We collected

demented

data

elderly,

from

summarized

below. Suicide vere

is linked

depression

deris

(1987).

from

Kim

early

their

have

got

I II et al.

Burke

et al.

problems,

suggest

47 % of

recent pressed

the

over

were

Lyness and

et al.

over,

with

dementia

was

suicide was

(1992)

8.4

about

72.4

syndrome,

%. Therefore,

a higher

physical

rate

illnesses

late-onset

of

depressive behavior

nostic

criteria

of dementia.

Ades

and

chiatric havior,

with

mented

include

aged

prevention Our

often

(Butler are survey

planned

role

of

making

third

(VD).

Consequently, But

take

among

the

is a section in a sample

reported the

important of a larger

of go-year-old

in

has

and

of dementia, dementia

health

problems

subjects.

to

literature

rate

patients. and

of

Psy-

suicidal

be-

suicidal

actions.

following

AD and

is found such

in

10 %

the

de-

as the

pri-

and

suicide

of the elderly.

on dementia Our

and

use of diag-

alcoholism

investigation or older

the

dementia,

setting

depression,

a depressive

a prevalence

alcohol-related

mental

depression

different

psychiatric

In a different

dementia,

bipolar

related

impulsive

from

no

losses

of

depression

cause

of

involved

and

suicide

risk

alcohol-related

in excess.

1992a,b), most

easier

60 years

diagnosis

had

alcoholism

frequent

independently

alcohol

et al.,

most

aged

to the

involve

comorbid

deaging

attempts.

DSM-III-R

or 17 % in elderly

particularly

the in

a reaction

trends

that

displayed

5 % of

suicidal

and

de-

75-SC-,

attempters

high

probably

remark

patients and

in

major the

constructs

major

suicide

different

is the

alcoholics.

care

The

elderly

inpatients

attempts,

a particularly

and over,

alcohol

dementia

elderly

sion,

an

elderly

from

39 % of

depression)

both

with

frequent

impulsive

comorbid of

associated

suffer

primary

pa-

Reynolds

admissions,

depressive

The

(AD)

1988).

psychiatric

demented and

and

particularly

65-74-, of

the

intents

suicide

dementia

(1994)

65 years

alcoholism

vascular

mary

Lejoyeux

aged

complications

Elderly of

and

the

percent

diagnosis

and

illness.

suicidal

elderly

% with

prior

aging,

of

168 psychiatric

most

of

about

14 % in the

4.8

are first

attempters.

primary

suicide

Moreover,

investigated suicide

The

depression

Nine

suicidal

% (including

attempters.

of

8 % of

attempters.

25 % of

treatment late-in-life

disorder

dementia

Hershey,

(15 % of the

including

by simplified

Alzheimer’s

seCod-

depression

mood

and

thirds

85-year-olds).

suicide

characterized

two

deny

(Kim and

dementia

can

20 % of

the

that

behavior

recent

while

through (1987),

to differentiate

patients

long-term

from

indirectly, to Gerner

is difficult

Depression

found

fourth

it

depression

investigating

one

assaultive

that

suicide,

mainly According

depressed

moderate

(1988)

and

(1988).

memory

Therefore,

pression and

Hershey as elderly

can prevent

aged.

abuseldependence.

at least

(1995)

dementia the

and

dementia,

emphasize tients

to dementia

or alcohol

and

present

depresaim is to

35 examine ted

the

to

question

possibly

in the

of suicidal

facilitate

the

thoughts former

and

and

dementia,

suicidal

the

latter

behavior

being

suspec-

in general,

especially

elderly.

PATIENTS

AND

In

the

dementia

and

considered cruited

METHODS

present the

study,

a sample

of

in long-stay

med consent self,

its Each

subject

(organic possible

risk

approved

life

family

living

the

investigate

in

after

by

Ethical

the

Further

between We have

or

before,

a relative

explanation

re-

gave

of

the

infor-

study

it-

Committee. interview

assessing (age,

previous

information

relationship oldest-olds.

in 1905 or

They

a full

sociodemographics

education,

the the

born

or at home.

study

habits),

among

Bologna,

a semi-structured

context,

factors.

to

thoughts

facilities

received

diseases, the

tions,

subjects

entering being

aim was

of suicidal

elderly

before

protocol

our

occurrence

and

was

also

medical

gender,

history

living

main

occupational

collected

by

condistatus),

other

possible

sources. Because use

of

of

strict

as possible the

the

nic

status.

evidence

disease;

cluding

(ii) count,

ment

of chronic

Cambridge 1986, state

the

mixed

of scale

VD,

(MMSE,

et al.,

a score

drugs neurological

of

(BEHAVE-AD, daily

1975)

Reisberg

living

(Katz

to differentiate

5 indicating

the

AD,

phospha-

electrophoresis,

AD and

from

for

steroids). battery

1987),

1963); VD,

Roth

the

behavioral

mini

a score 5 or

1984)

was by

two

independently psychiatrists.

diagnosed Each

according proband

was

to given

the

et

menin

the

of

over

index

ischemic 6 indi-

6 indicating

DSM-III-R the

:

pathology

Hachinski

of

were included

(CAMDEX, 1968),

a score

treat-

examination

et al.,

et al.,

in-

alkaline

and

et al.,

1975),

et al.,

chrovolume,

examination

Blessed

(i)

other

parameters

neuropsychological

elderly

(BDS,

Folstein

scale

under

the

adopted:

medication

and

on

corpuscular

protein

prescribed

the

as much

dementia. Dementia

(APA,

disorders

aged,

and

laboratory mean

anti-inflammatory The

were

endocrine

serum

evaluation

the

treatments

tryglicerides,

(iii)

sediment);

dementia

criteria

several

and

mental

(Hachinski

of

cholesterol

misdiagnosis.

rating

exclusion neoplastic.

more

in

to exclude

pharmacological

hemoglobin,

(including

in activities

or

rate,

Blessed

disease

independence cating

disorders

examination

Alzheimer score

glucose,

to discourage

the

or

disease

in order

aminotransferases,

neuropsychological

al.,

following

one

glucose, alanine

(protein,

performed

the

of

and

conditions

inflammatory,

ion

urea,

disability

is mandatory

of medical

sedimentation and

Detailed

of

criteria

Thus,

alterat

aspartate

urinanalysis

frequency

of infective,

erythrocyte

leucocyte tase,

high selection

influence

psychiatric

clinical

tal

the

health

criteria

Montgomery-As-

36 berg

depression

Data

rating

collected

RESULTS

were

AND

subjects

aged

homes of

or

91-104

summarizes the

made

mean

age,

and

Significant years

of

item

scores

(Table

of

(Montgomery

SPSSlPC

and

+ software

Asberg,

1979).

(Norusis,

1994).

of

them

for

for

the

distribution, persons. between

Moreover, total

in

while

gender

the

two

no

in

1996

The were and

subgroups

was

the

physical

two

1997,

DSM-III-R

their

diagnosis Table

occupational

only

found

subgroups

by

significant

conat

non-demented.

education,

statistically

good

- January

Bologna.

16 ones

discriminating

score,

recruited

March

elderly

18 subjects,

difference

were

period

non-demented

education. and

males)

the

status

in

age

and

in the

differences

I

MADRS

were

found

II).

Table

I

SOCIODEMOCRAPHIC

CHARACTERISTICS

Parameters

(%)

M F

Age (mean + SD) Years of sciiooling Occupation distrib. (90) Housewife Physical worker Intellectual worker Notes: Occupation The age-difference whereas the years Finally, the

relation

diagnosis

crude

OR

has

not

found

In

conclusion,

findings possible

to to

point

subjects

POOL

Non-demented

subjects

16 56.3 43.7 98.1 + 3.2 4.3 T 1.8

22.2 66.7 11 .l

18.8 62.5 18.8

suicidal

be

of the

out suicidal

that

was

p = ns,

95

from

calculated in

ideation

% Cl,

to

the

odds

ratios, versus

by

itself

among

the

physically

not

score)

to

relevant

risk

of

rates be

sample

terms

item-10

odds

of

the

ol-

depressive

thoughts

oldest-old increase

considered

healthy

of

score).

suicidal

non-demented

incidence must

item-10 the

our in

MADRS the

period in life. (p < 0.05) , (p < 0.01)

1.29.

difference

(as

suicide

MADRS

calculating

persons,

significant

demented

the

by

0.92

thoughts

age-specific dementia

(as

studied

non-demented

any

suicidal

different

though

thoughts

dementia

displayed

and

Referring

STUDY

18 44.4 55.6 95.1 + 3.4 8.0 7 5.2

demented

symptomatology

not

of of

= 1.09;

Differentiating dest-olds

THE

was classified on the basis held for the longest of the two groups was marginally significant of schooling were longer in the demented group

the

DSM-III-R

ratios:

OF

Demented

Number Sex distribution

of

too

means

over

facilities

was

demented

(7

years,

long-stay

dementia

(MADRS), by

CONCLUSIONS

Thirty-four ditions,

scale

analyzed

oldest

subjects.

in as

was

proportion a risk

olds.

factor This

is

37 Table

II

THE

MEAN

SCORES

OF THE

1 2 3 4 5 6 7 8 9 10 MADRS

total

score

Notes:

None

of the

more

by the those

presence

other sical

by

the

of possible

non-demented

Concerning

the

compared

with

suicide

1.59 1.59 1.51 1.21 1.80 0.85 2.02 1.29 0.29 0.29 6.84

lack

are

+ T 7 7 T 7 + ir T T r

0.87 1.02 0.86 1.15 1.24 1.25 1.15 1.15 0.77 0.00 5.14

significant.

abuse

symptoms

subjects

in our not

demented

significantly

patients different

and from

group. criteria

literature, risk

0.69 0.88 0.75 1.56 1.06 1.31 1.44 0.56 0.25 0.00 8.50

of alcohol

depressive

involve

Non-demented

differences

control

diagnostic

may occasionally noteworthy

+ + 7 T T T T T T T T

between-group

highlighted

[+ SD)

subjects

0.83 0.83 1.08 1.00 1.17 3.00 2.42 0.75 0.08 0.08 11.25

of the

Therefore, mentia

TEST

Demented

I terns

even

MADRS

suicidal factors

of our

dementia,

results tendencies,

as depression

our

support mainly

methods the

are

hypothesis

indirectly

or alcoholism

and

reliable. that

de-

through

or serious

phy-

diseases.

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