Mohammed T. Abou-Saleh

162 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYthe elderly. The Geriatric Mental State 1. Development andreliability. Psychol Med 1976; 6: 439–49.2. Gurland BJ, Fleiss JL, Goldberg K et al. A semi-structured clinicalinterview for the assessment of diagnosis and mental state in theelderly. The Geriatric Mental State Schedule 2. A factor analysis.Psychol Med 1976; 6: 451–9.3. Wing JK, Cooper JE, Sartorius N. The Description and Classificationof Psychiatric Symptoms: An Instruction Manual for the PSE andCatego System. London: Cambridge University Press, 1974.4. Spitzer RL, Endicott J, Fleiss JL, Cohen J. Psychiatric StatusSchedule: a technique for evaluating psychopathology andimpairment in role functioning. Arch Gen Psychiat 1970; 23: 41–55.5. McKhann G, Drachman D, Folstein M et al. Clinical diagnosis ofAlzheimer’s disease: Report of the NINCDS–ADRDA Work Groupunder the auspices of Department of Health and Human ServicesTask Force on Alzheimer’s Disease. Neurology 1984; 34: 939–44.6. Copeland JRM, Dewey ME, Griffiths-Jones HM. Computerisedpsychiatric diagnostic system and case nomenclature for elderlysubjects: GMS and AGECAT. Psychol Med 1986; 16: 89–99.7. Copeland JRM, Dewey ME, Henderson AS et al. The GeriatricMental State (GMS) used in the community. Replication studies ofthe computerised diagnosis AGECAT. Psychol Med 1988; 18: 219–23.8. Dewey ME, Copeland JRM. Computerised psychiatric diagnosis inthe elderly: AGECAT. J Microcomp Appl 1986; 9: 135–40.9. Copeland JRM, Davidson IA, Dewey ME et al. Alzheimer’s Disease,other dementias, depression and pseudodementia prevalence,incidence and three year outcome in Liverpool. Br J Psychiat 1992;161: 230–9.10. Hachinski VC, Illiff LD, Zihka E et al. Cerebral flow in dementia.Arch Neurol 1975; 32: 632–7.11. Copeland JRM, Dewey ME, Wood N et al. The range of mentalillness amongst the elderly in the community: prevalence in Liverpool.Br J Psychiat 1987; 150: 815–23.12. Saunders PA, Glover GR. Field use of portable computers inepidemiological surveys: computerised administration of the GMS–HAS–AGECAT package. In Dewey ME, Copeland JRM, HofmannA, (eds), Case-finding for Dementia in Epidemiological Studies.Liverpool: Institute of Human Ageing, 1990: 89–94.13. Copeland JRM, Dewey ME, Saunders PA. The epidemiology ofdementia: GMS–AGECAT studies of prevalence and incidence,including studies in progress. Eur Arch Psychiat Clin Neurosci 1991;240: 212–17.14. Copeland JRM, McCracken CFM, Dewey ME et al. Undifferentiateddementia, Alzheimer’s disease and vascular dementia: age- andgender-related incidence in Liverpool. Br J Psychiat 1999; 175: 433–8.15. MRC–CFAS. Cognitive function and dementia in six areas ofEngland and Wales: the distribution of MMSE and prevalence ofGMS organicity level in the MRC–CFAS. Psychol Med 1998; 28:319–35.16. Copeland JRM, Beekman ATF, Dewey ME et al. Depression inEurope. Geographical distribution among older people. Br J Psychiat1999; 174: 312–21.17. Lobo A, Launer LJ, Fratiglioni L et al. Prevalence of dementia andmajor subtypes in Europe: a collaborative study of population-basedcohorts. Neurology 2000; 54 (suppl 5): S4–9.18. Fratiglioni L, Launer LJ, Andersen K et al. Incidence of dementiaand major subtypes in Europe: a collaborative study of populationbasedcohorts. Neurology 2000; 54 (suppl 5): S10–15.CAMDEXDaniel W. O’ConnorMonash University, Melbourne, AustraliaThe Cambridge Examination for Mental Disorders of the Elderly(CAMDEX) was devised to assist clinicians and epidemiologiststo diagnose dementia, and mild dementia in particular, as reliablyand validly as possible 1 . It was developed with the following aimsin mind: it addresses all elements of current diagnostic criteria; itincorporates historical material so that persons with cognitivedeficits due to intellectual disability, sensory handicap orfunctional mental disorder are classified correctly; and itsneuropsychological battery is sensitive to mild dementia.The schedule is fully structured and incorporates: a mentalstatus examination; a comprehensive neuropsychological battery(CAMCOG); a medical and psychiatric history; a brief physicalexamination; and an interview with an informant that enquiresinto changes in memory, intellect, personality, behaviour and selfcare.Medications, laboratory investigations and imaging are allrecorded. There is a clear focus on dementia but conditions suchas delirium, anxiety, depression, bipolar disorder, delusionaldisorder and schizophrenia are considered as differential diagnoses.The respondent interview takes 30–60 minutes to complete.Informants are questioned for another 20–30 minutes, bytelephone if necessary. Diagnoses are based on all available datausing criteria virtually identical to those in ICD-10. Sincejudgement is required, interviewers should have a clinical backgroundand have received training in formulating complex data,applying diagnostic criteria and rating dementia severity.CAMDEX, which is available in English, Dutch, French,German, Italian, Spanish and Swedish versions, is practicable andacceptable and can be administered with high inter-observerreliability 1 . It includes the Mini-Mental State Examination 2 ,Hachinski Ischaemia Scale 3 and other commonly-used ratingscales. When applied in community surveys, prevalence rates ofdementia based on CAMDEX assessments are close to thosereported in other recent Western European studies 4 . CAMDEXdiagnoses are also stable over time. In a British study in whichcommunity residents rated as having mild dementia were followedfor 2 years, diagnoses were maintained for 51 of the surviving 56persons. Two were re-classified as having minimal dementia andonly three were rated as having no significant impairment, mostlyas the result of better-controlled diabetes mellitus 5,6 . CAMCOGhas been used as a stand-alone assessment package in manyclinical and community studies. Further details about itspsychometric properties can be found on the website listedbelow.An updated version of CAMDEX includes both DSM-IV andICD-10 diagnostic criteria and provides better coverage of morerecently described conditions, such as frontotemporal dementiaand dementia of the Lewy body type. A floppy disk permitscomputer-assisted administration, data entry, scoring and analysis.CAMDEX is copyright but packs including the interviewschedule, test materials and scoring sheets can be purchased inmost countries. Consult this website (http://www.iph.cam.ac.uk/camdex-r) for further updates, access to a dedicated bulletinboard, references to published reports based on CAMDEX andCAMCOG, and other relevant information.