Acquired cognitive impairment in the presenium

Abstract

In a catchment area survey.43 patients with cognitive impairment acquired in the preseniumassociated with behavioural or social dysfunction,or both, were identi fied. Twelve of 18 carers were also interviewed. The patientswere mainly in their 50s,had a high prevalence of behavioural as opposed to cognitive disorder, were frequently taking psychotropic drugsand had disorders which were largely progressive.Thoseliving at home were as disabled as those living in residential settings. Carers were stressedbut uncomplaining. The findings suggest that psychiatrists,perhaps especially old age psychiatrists, have an important role in developing servicesfor this neglected group of people. Presenile dementia is a rare disorder with many causes. The annual incidence of even the com monest cause, Alzheimer's disease (AD), is only 3.5-5.6 cases per 100,000 persons aged between 40 and 64 per annum (Newens et al, 1993a). A shortfall in service provision has been suggested (ADS, 1992), but very little is known about the needs of such individuals. Psychiatrists, in both general adult and specialist elderly services, are quite often approached to manage such patients and many express reservations. This study describes a local survey of need and dependency among individuals with cognitive impairment in the presenium and of their carers. One of the aims was to examine the appropriate ness or otherwise of involvement by psychiatric services.