Let me begin with a declaration of disinterest. The esteemed editor of International Psychogeriatrics commissioned this article after reading my letter to Another Journal (Philpot, 2003) in which I called for a moratorium on all clock-drawing test (CDT) research. It seemed to me that an awful lot of effort was being put into a fairly trivial issue and that researchers' time might be better spent. That much effort is being expended cannot be denied. Using the search words ‘clock drawing’, MEDLINE currently lists 177 publications, 91 since the turn of the century. The first reference to this specific form of drawing test comes in 1983 (Goodglass and Kaplan), and the first paper on validation is that of Shulman et al. (1986).

The Luigi Amaducci memorial award was instituted to commemorate the distinguished Florentine neurologist, Luigi Amaducci, who was still at the forefront of research on Alzheimer's disease at the time of his premature death. It honors a living researcher whose work in neuroscience has contributed to notable advances which have led to greater understanding of therapeutics or diagnostic criteria for neurodegenerative disorders. The award is possible because of an unrestricted grant from Novartis Pharma and is awarded every two years.

Senile dementia was the third most common admission diagnosis for New York psychiatric hospitals at the start of the twentieth century and the distinction between vascular and senile dementia was understood by psychiatrists even then. The term Alzheimer's disease (AD) was originally introduced to distinguish a pre-senile dementia from the common general paresis, but Alzheimer raised the possibility that pre-senile AD might not be distinguishable in clinical or histological terms from senile dementia. By the late 1970s it had become clear that the most common disorder producing dementia in elderly people was clinically and pathologically identical to pre-senile AD. AD is malignant, reducing remaining life expectancy by almost half and raising the risk of death over five years threefold (cancer raises it fourfold). Synapse loss associated with beta amyloid oligomers is a strong determinant of cognitive decline in patients with AD. Tau-containing neurofibrillary tangles usefully track disease severity. Unmodifiable risk factors include mutations in three genes which affect the production or metabolism of beta amyloid, the risk factor gene for Apolipoprotein $\epsilon$4 and female gender. The overriding risk factor is age, the prevalence of AD doubling with every five years of age until 90. Low education, head injury and low folate levels are examples of potentially modifiable risk factors. Since a delay of onset of five years would halve the number of patients with the disease, clinical trials for such putative protective factors as estrogens, folic acid, vitamin E, statins, and NSAIDs have begun. Cognitive and leisure activity may be protective against the development of AD but any protective function can only be confirmed by clinical trials.

Background and aims: The IQCODE is widely used as a screening test for dementia, particularly where the subject is unable to undergo direct cognitive testing or for screening in populations with low levels of education and literacy. This review draws together research on the psychometric properties and validity of the IQCODE.

Method: A systematic search of the literature was carried out using three databases.

Results: The review shows that the questionnaire has high reliability and measures a single general factor of cognitive decline. It validly reflects past cognitive decline, performs at least as well at screening as conventional cognitive screening tests, predicts incident dementia, and correlates with a wide range of cognitive tests. A particular strength is that the IQCODE is relatively unaffected by education and pre-morbid ability or by proficiency in the culture's dominant language. The disadvantage of the IQCODE is that it is affected by informant characteristics such as depression and anxiety in the informant and the quality of the relationship between the informant and the subject.

Conclusions: Because the IQCODE provides information complementary to brief cognitive tests, harnessing them together can improve screening accuracy.

Background: Several reports have indicated that the Behavioral and Psychological Symptoms of Dementia (BPSD) are associated with increased burden of care, carer depression and increased rates of institutionalization of patients. The present study aims to review the association between these variables in cross-sectional as well as longitudinal studies.

Methods: Systematic review and meta-analysis of all available information published in English between January 1990 and December 2001 was made. Case-reports, case-series and studies with 20 or fewer subjects were excluded from the analyses.

Results: Thirty articles are included in the review of cross-sectional data and 12 in the systematic review of longitudinal data. Pooled correlation coefficients were generated for the relationship between BPSD and caregiver burden (rpooled=0.57; 95% CI=0.52 to 0.62), caregiver psychological distress (rpooled=0.41; 95% CI=0.32 to 0.49) and caregiver depression (rpooled=0.30; 95% CI=0.21 to 0.39), suggesting that these concepts have a moderately strong association. Multivariate data, on the whole, further supported the notion that BPSD are a predictor of burden of care and of psychological distress and depression. Limited longitudinal data made clarifying the temporal relationahip between BPSD and the psychological sequelae of care (PSC) difficult. The limited data pertaining to the relationship between BPSD and institutionalization suggest that caregiver variables may be more important in predicting institutionalization than BPSD. Methodological issues and limitations associated with this type of investigation were also considered.

Conclusion: The results of this review support, but do not conclusively establish, the association between BPSD and PSC. We propose that the concept of burden of care be abandoned in favor of more clinically relevant outcomes such as caregiver depression.

Objective: This study examined the association between the Apolipoprotein-E ε4 allele (APOE ε4) and age of disease onset in a bi-ethnic sample of community dwelling Alzheimer's disease (AD) patients.

Design: Cross-sectional study of AD patients evaluated at a University-affiliated outpatient memory disorders clinic.

Subjects: A clinic-based cohort of white non-Hispanic (WNH; n=601) and white Hispanic (WH; n=359) patients diagnosed with possible or probable AD according to NINCDS-ADRDA diagnostic criteria.

Measures: Global cognitive functioning of the subjects was evaluated using the Mini-mental State Exam. The age of onset of AD was calculated from the patient's current age minus the reported duration of disease obtained from a knowledgeable family member.

Results: A significant relationship was discovered between APOE ε4 and age of onset for WNH, with lower ages of onset among patients carrying the ε4/ε4 and ε3˜/ε4 genotypes in relation to patients with the ε3/ε3 genotype. The results revealed a more modest effect for APOE genotype in the WH cohort, with a lower age of onset witnessed among ε4 positive patients (ε2/ε4, ε3/ε4 and ε4/ε4 genotypes) in comparison to ε4 negative patients (ε2/ε2, ε2/ε3 and ε3/ε3 genotypes).

Conclusion: The association between the ε4 allele and earlier age of onset was more pronounced in WNH compared to WH patients, suggesting the impact of APOE polymorphism on clinical phenotype may be different for distinct ethnic groups in the U.S.

Background: We investigated the longitudinal relationship between body mass index (BMI), a major vascular risk factor, and white matter lesions (WMLs) in older women.

Methods: Twenty-seven Swedish women were followed from age 70 to 88. Measurements of BMI, and systolic and diastolic blood pressures were conducted at 70, 75, 79, 85, and 88 years. WMLs were measured using computerized tomography at age 85 and 88 (85/88).

Results: Women with any WMLs at age 85/88 had higher BMI at age 70 (p=0.003) and 75 (p=0.006), compared to women without WMLs. Increasing severity of WMLs was related to BMI at age 70 (p<0.001), 75 (p<0.001), 79 (p=0.017), and 85 (p=0.025). After consideration of other vascular factors, BMI at age 70, 75, and 79 was most significantly related to WML at 85/88. Every 1.0 kg/m2 increase in BMI at age 70 increased risk of WMLs twofold.

Conclusions: Overweight and obesity may be important contributors to the presence of WMLs in the elderly.

Background/Objective: There were few studies identifying the natural unfolding of behavioural and psychological symptoms of dementia (BPSD) in the course of Alzheimer's disease (AD) progression in antipsychotic-naïve AD patients. This study aims to examine the specific nature of the association between BPSD in AD and the global severity of illness measured by Global Deterioration Scale(GDS) in antipsychotic-naïve AD patients in Korea.

Methods: A total of 562 antipsychotics-naïve AD patients were recruited from four different groups [a geriatric mental hospital (n=145), a semi-hospitalized dementia institution (n=120), a dementia clinic (n=114) and community-dwelling dementia patients (n=183)]. BPSD exhibited by AD patients were measured using the 25-item Korean version of the BEHAVE-AD.

Results: Ninety-two percent (n=517) of AD patients had at least one BPSD, while 56% (n=315) had 4 or more BPSD. Specific kinds of behavioral disturbance peak at the stages of moderate AD (GDS stage 5) or moderately severe AD (GDS stage 6). AD patients left at home without any treatment had higher frequency of BPSD than did other groups seeking treatment, although all of them were antipsychotic-naïve.

Conclusion: BPSD potentially remediable to treatment were highly frequent in Korean AD patients. Health policies to meet the unmet needs of elderly Koreans are urgently needed, especially for AD patients at home without treatment.

Objective: To compare the clinical, demographic, social and service utilization characteristics of elderly Poles with indigenous elders.

Setting: A geriatric psychiatry service in an urban area.

Methods: All newly referred patients to a West London geriatric psychiatry service were studied. The uptake of service and clinical, demographic, social and service utilization characteristics of elderly Poles and indigenous elders were compared after extracting information from case-notes.

Results: Twelve percent of all referrals were of Polish origin. This figure is considerably higher than 4% of all community-dwelling elderly being of Polish origin in Ealing. There were no differences in clinical, demographic, social and service utilization characteristics between Polish and indigenous patients with a few exceptions. Elderly Poles were more likely to be married (p<0.005) and indigenous elders were more likely to be single (p<0.05). Elderly Poles were more likely to be advised to take out power of attorney (p<0.014). Elderly Poles were less fluent in English (p<0.0005).

Conclusions: Newly referred elderly Poles accessed and utilized the geriatric psychiatry service resources and social services at least as equitably as indigenous elders.