Although scientific research is generally and appropriately initiated by individuals, there are limitations and inefficiencies inherent in studies done by individuals alone. Collaboration is the concept of our time. As an example, both the medical community and lay public recognize the urgent need for an effective antidementia drug. Sound clinical trials will require subjects sufficiently numerous for investigation, and a multicentered collaborative study approach, extending even to international collaborative clinical trials.

In the diagnosis, treatment, and care of dementia patients in the senile stage, comprehensive evaluation of ability in daily life and mental function is needed. Using a simple behavioral rating scale for the mental states (NM scale) and activities of daily living (N-ADL) of the elderly, we evaluated 250 elderly subjects. According to the NM scale, the scores for subjects in whom the severity was clinically diagnosed were as follows: normal, 50–48; borderline, 47–43; mild dementia, 42–31; moderate dementia, 30–17; and severe dementia, 16–0. Screening for dementia and determining its severity were readily accomplished using the NM scale, and basic activities in the daily life of the elderly could be evaluated effectively using the N-ADL. There was a significant correlation (r=0.863) between the Hasegawa dementia scale and the NM scale (p<0.001), a significant correlation (r=−0.947) between intellectual function scores of the GBS scale and the NM scale, and a significant correlation (r=0.944) between motor function score of the GBS scale and the N-ADL score. Evaluations of daily life activities can be made not only by psychiatrists and clinical psychologists, but by nonspecialists as well, because they are based on data obtained by observation of daily life behaviors; thus, assessment is appropriate both in clinical settings and in places of living.

The purpose of this paper was to use the Wechsler Adult Intelligence Scale (WAIS) to further define the nature of the underlying factors of the Mini-Mental State Examination (MMSE) as proposed by Tinklenberg et al. (1990). The MMSE was administered to 51 patients once every 6 months for at least one year; the WAIS was administered only at the beginning of the study. Stepwise regression analyses yielded these results: for the Following Commands factor, the best correlate was the Comprehension subtest; for the Language Repetition factor, the best correlate was the Picture Arrangement subtest; and for the Language Expression factor, the best correlates were the Digit Symbol and Object Assembly subtests. These relations help clarify the correlates of decline of AD patients on the MMSE.

The Center for Epidemiological Studies Depression scale (CES-D) was administered in Swedish to two representative samples, one aged 84 to 90 (mean = 87), the second aged 29 to 95 (mean = 61). There were both linear and quadratic differences with age: the oldest individuals were highest on depressive symptoms, but younger adults were higher than middle-aged. Dimensions or subscales identified by previous studies were generally replicated, including a sadness and depressed mood factor, a psychomotor retardation and loss of energy factor, and a well-being factor (on which items are reverse-scored to indicate depression). The findings support cross-national use of the CES-D to assess self-reported symptoms of depression in adults and older adults.

The purpose of this study was to establish whether physical health and cognitive function in married long-term patients or in their spouses determines why some patients are cared for in home care while others reside in nursing homes. Out of 38 married couples with a sick spouse cared for in a nursing home, 23 couples were studied; out of 34 couples with a sick spouse cared for in home care, 22 patients and 25 spouses were studied. The results showed no significant differences in physical health score either between the two groups of patients, or between the two groups of spouses. Both home-care patients and nursing home patients had low cognitive function scores, but nursing home patients had significantly lower scores. A multivariate analysis showed that physical health and cognitive function explained only 20% of patients' residence. Between the two groups of spouses there was no difference in cognitive function score. The conclusion is that physical health status and cognitive function explain only to a small extent why married long-term care patients are cared for in nursing homes or in home care.

An extensive new caring program—including the introduction of Individual Care Plans and changes in ward organization, caring techniques, and caring philosophy—was introduced at two psychogeriatric wards with severely demented patients. The hypotheses were that the patients (n=31) would improve in psychosocial capacity and orientation and the staff work load would decline in contrast to two other wards with a similar clientele (n=31). After ten months the milieu was more “homelike,” routines were more flexible, and the staff communicated more with the patients. However, the hypotheses were not proven. All patients in both groups deteriorated in ADL capacity, orientation, and behavior. The patients in the program wards became significantly more restless and disoriented and ate less than the patients in the contrast wards. The conclusion is that, despite optimal care, a humanistic approach, and support from staff, the progression of dementia symptoms is inevitable.

A cross-sectional study of 60 men aged 65–80 was carried out to test the impact of the aging process on sexual hormones (testoterone, FSH, LH, prolactin), sexual activity, and the relations between them. Blood samples for hormone assays were taken between 8–9 A.M. in the primary care clinic at which the participants were registered. Data on sexual activity (coitus), sexual desire (libido), marital status, and age were obtained from the respondents by means of a structured interview. No relationship was found between testosterone (T) or prolactin (PL) and sexual activity. Nevertheless, a statistically significant relationship between FSH and LH versus age, and an inverse relationship between sexual activity and age were found. Hypogonadism (T level less than 3ng/ml) with normal levels of FSH and LH was observed in 11 respondents.

Pick's disease is a rare cause of dementia frequently misdiagnosed as Alzheimer's disease. Because patients with Pick's disease often present with psychiatric symptoms, the psychiatric aspects of this disorder are reviewed, as well as the pathology and epidemiology of the disease. Two case reports illustrate many of the clinical features of PD. A detailed examination of the psychiatric aspects of the disorder is followed by an elucidation of the many clinical differences between Pick's disease and Alzheimer's disease.

Elderly residents of rural areas are at significant risk for mental health problems, yet have less access to mental health services. Thus, most mental health problems among rural elderly remain either undiagnosed or untreated. We describe two models of mental health outreach programs to rural elderly in Iowa and Virginia, serving demographically, culturally, and epidemiologically different populations in geographically and economically dissimilar regions. Programs are compared on the basis of initiation, community partnerships, target population, target region, clinical disciplines involved, coordinating discipline, referral sources, operational model, initial home assessment, care planning, sustainability, cost, patient demographics, and primary and secondary diagnoses. Outreach programs are argued to be effective models of delivering services to geographically and/or socially isolated elderly populations. The experiences of our programs, though limited to rural populations, may be of relevance to any outreach program attempting to serve elderly presenting with or at risk for mental health problems.

Nursing homes, or verpleeghuizen, play an important role in the health care system in the Netherlands. These multifunctional institutions provide clinical and ambulatory (day hospital) care for somatic and psychogeriatric elderly with multiple pathology, disabilities, and handicaps. Quantitative data on morbidity, admission, and discharge of (psychogeriatric) nursing home patients are presented. The data on the nursing home institutions—number of residents, costs, and staff ratios—are placed in the context of the whole health care system. A new trend is to organize nursing home care in homes for the aged via substitution projects and dependences.