Journals Watch - Dementia, vertigo and anorexia

Too busy to catch up on the latest research? Let Dr Alison Glenesk update you on recent papers.

Predictive value of the clock-drawing test Dement Geriatr Cogn Disord 2008; 26: 351-5
The authors were looking at methods for identifying early dementia, and decided to use this rather elegant, simple test in which the patient is asked to draw a clock face and position the hands at a specified time.

Early dementia may be detected by a simple test that is more culturally fair than the MMSE

In theory, this test, which examines executive function and praxis, has advantages over the mini-mental state examination (MMSE), which is more language based and may disadvantage non-native English speakers.

It also tests memory, planning and organisational skills, and to some extent bypasses the 'advantage' those of higher educational attainment may exhibit in the MMSE.

A systematic review of the literature produced five studies, but the data could not be collated satisfactorily. They appear to show that the clock-drawing test may show a deficit before the MMSE falls to 24 - the accepted cut-off for mild dementia.

The authors feel more studies are needed.

The clock-drawing test can be performed quickly in the surgery. I think I may be keeping paper and pencil handy.

Burden of dizziness and vertigo in the community Arch Intern Med 2008; 168: 2,118-24

Like many GPs, I find patients complaining of dizziness difficult to diagnose and treat. The word means many things to many people, and history-taking can be difficult.

The authors of this German paper sampled 4,869 adults from the general population. Of these, 1,003 (22.9 per cent) admitted to a dizziness symptom in the past year. The prevalence of actual vestibular vertigo in this group was 4.8 per cent.

Vertigo more commonly resulted in consultation (70 per cent versus 54 per cent) and sick leave (41 per cent versus 15 per cent), than dizziness. However, more than half of the patients with vertigo had been given a non-vestibular diagnosis.

Vertigo also had a marked effect on quality of life scores.

The message seems to be that there is a lot of dizziness about, and it is very important to make a logical diagnosis. As usual, the clue is in the history.

Community intervention for childhood obesity Arch Dis Child 2008; 95: 921-6
Childhood obesity is becoming more prevalent. This Coventry-based project ran for 12 weeks, involving 27 children aged 7-13 from 21 families.

Facilitators were recruited from a variety of medical disciplines. They received training in delivering parenting programmes and family lifestyle advice, as well as advising on diet and exercise.

Parents and children had separate two-and-a-half-hour weekly sessions at a local leisure centre, meeting halfway through for a healthy snack. Parents were educated to be aware of what their children were eating without restricting quantity.

Of the 27 children, 18 completed the course. The attendance rate was 62 per cent. The outcome measure was change in BMI at the end of the study and at a nine-month follow-up.

BMI fell 0.18 in three months and by 0.21 at nine months, on average. Fruit and vegetable consumption and exercise participation did not change significantly.

This programme was moderately successful, but costly in terms of staff training and time. Ideally, we should be able to intervene at an earlier stage to reduce the likelihood of children becoming obese.

Depression screening in cardiovascular disease JAMA 2008; 13: 2,161-71
This study caught my eye because of the campaign in our practice to improve our depression screening rates.

The study was a systematic review that aimed to assess the potential benefits of depression screening on patients with cardiovascular disease, both from mental health and cardiovascular viewpoints.

Another objective was to assess the accuracy of depression-screening tests.

Articles were included if they compared a screening tool to a valid major depressive-disorder criterion standard, or compared depression treatment with placebo or usual care in a randomised controlled trial. Eleven and six studies were found, respectively.

Sensitivity of screening tests ranged from 39 per cent to 100 per cent. Treatment with anti-depressants or cognitive behavioural therapy gave a modest reduction in depression scores.

There was no evidence that depression treatment improved cardiovascular outcomes.

It makes me question the validity of our screening programme.

Olanzapine in the treatment of anorexia nervosa Am J Psychiatry 2008; 165: 1,281-8
The aim of this study was to assess the efficacy of the atypical antipsychotic olanzapine in promoting weight gain and reducing obsessive symptoms among adult women with anorexia nervosa.

In this small randomised, double-blind patient-controlled trial, 34 patients were randomised to receive either olanzapine (average dose 6.6mg/day) plus day hospital care or placebo plus day hospital care.

After 13 weeks, those taking the active drug showed a greater rate of increase in weight, earlier achievement of their target BMI and a greater rate of reduction in obsessive symptoms than the placebo group.

This is hardly surprising, as weight gain is often a side-effect of olanzapine in patients of normal weight. Any reliable treatment for anorexia nervosa is welcome.

The authors concede that, while the results are encouraging, larger trials are needed.

  • Dr Glenesk is a GP trainer in Aberdeen and a member of our team who review the journals

The quick study

  • Early dementia may be identified using the clock-drawing test.
  • Vertigo often has a non-vestibular diagnosis.
  • Obese children receiving community-based lifestyle and diet advice had a decrease in BMI but exercise participation did not change.
  • Depression treatment did not improve cardiovascular outcomes for patients with cardiovascular disease.
  • Olanzapine increased the rate of weight gain in patients with anorexia nervosa.

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