During an epidemiological survey conducted in Tokyo in 1988 by the Department of Psychiatry, Tokyo Metropolitan Institute of Gerontology, I met two demented elderly women in the course of interviewing city residents.

This study examined the relationship between subjective memory complaints and performance on tests of memory by relatives of patients with probable Alzheimer's disease (AD) and by older adults without a family history of dementia. Relatives of AD patients did not differ significantly from controls either in level of complaint or in performance on neuropsychological tests. However, among relatives of patients with early-onset AD, significant correlations were found between performance on memory tests and self-rated changes in everyday memory. These findings raise the possibility that relatives who have entered the age range in which their parents or siblings developed dementia symptoms are monitoring their memory performance more diligently than relatives of patients whose illness began at much later ages or persons who have no close relatives with AD.

The effects of training on two memory and two attention tasks were investigated in 24 healthy elderly and 23 young subjects. Two training periods, each consisting of four sessions, were performed, and the effects of training were assessed during two test sessions 1 week thereafter. Significant age-related effects at the pretraining test session were found for reaction times to a simple visual stimulus, retrieval time of information from long-term storage, and the speed of focusing attention. In both age groups, performance of the first two tasks was significantly improved by training; however, the age-related effect remained significant after training. In the focused attention task, the age difference at baseline disappeared after training due to an opposite learning trend in young and elderly subjects. Thus, the cognitive performance of elderly subjects could be trained to a large extent. Significant age differences, however, could be decreased only if the test performance of young subjects did not improve.

Memory can be assessed with either explicit or implicit tasks. Implicit memory tasks, in contrast with explicit tasks, do not refer to conscious recollection of a previous learning experience. Implicit memory is revealed by a change in task performance that can be attributed to previous learning. Amnesic patients perform poorly on explicit memory tasks, but exhibit normal performance on implicit tasks. Recently, researchers have studied the implicit memory performance of patients with Alzheimer's disease. This article aims to give an overview of the performance of Alzheimer patients on four tasks of implicit memory. Compared with normal elderly controls, patients with Alzheimer's disease seem to demonstrate impaired performance on conceptual, but not on perceptual, implicit memory tasks. This dissociation could yield important information about the neurologic systems subserving implicit memory processes. Some suggestions for future research into the implicit memory of Alzheimer patients are given.

Cognitive and neuropsychological tests are often employed to help describe the functioning of patients with multi-infarct dementia (MID) or patients with dementia of the Alzheimer's type (DAT). In this study, the Halstead-Reitan Neuropsychological Battery (HRNB), Wechsler Adult Intelligence Scale-Revised (WAIS-R), and Wechsler Memory Scale (WMS) were completed by 20 MID patients and 62 patients with DAT. Total scores on these measures did not differentiate DAT and MID patients. Contrary to clinical observations, cognitive tasks assessing social judgment did not differentiate between the groups. However, MID patients demonstrated greater variability in test scores. Compared with DAT patients, the MID patients demonstrated better preserved memory as shown on the WMS in comparison to the WAIS-R IQ.

Previous efforts to define the case mix of psychiatric inpatients have generally relied on the use of psychiatric diagnosis, and have had little success elucidating the relationship between clinical outcome and resource utilization. The Severity of Psychiatric Illness (SPI) rating scale, a reliable chart-based system using nine clinical rating dimensions, has been developed by one of the authors for use in studying the case mix of psychiatric inpatients. This report is the first describing this scale. For a sample of 244 psychogeriatric patients, all but one of the dimensions were significantly correlated with at least one of the five baseline clinical assessments, and all but one of the SPI items were correlated with outcome assessment. Four dimensions of the SPI were related to clinical outcomes. The SPI also predicted length of stay (predicting 23% of the variance for patients discharged to their homes). This study provides strong evidence for the construct and predictive validity of the SPI among older adult psychiatric inpatients.

Mini-Mental State Exam (MMSE) scores for 247 community-dwelling, well-functioning individuals in their 60s (n = 88), in their 80s (n = 92), and 100 or older (n = 67) were compared to examine overall and component MMSE differences. The concomitant influences of visual or literacy deficits, gender, education, race, income, and activities of daily living on MMSE performance were analyzed. Mean MMSE scores of 27.8, 27.1, and 24.8, respectively, for the three cohorts were significantly different, even when all concomitant variables were controlled. After the concomitant variables were controlled, results indicated that there were no age group differences on five MMSE items: naming, repeating, listening and obeying, reading and obeying, and writing sentences. Participants with visual or literacy deficits scored 1.5 points lower than other partimcipants, and displayed performance deficits in four items form the Read & Write MMSE division: naming, reading and obeying, writing sentences, and praxis. Education and gender were significant covariates for total and divisional MMSE scores.

Thirty-seven subjects, 15 with a clinical diagnosis of Alzheimer's disease and 22 normal controls, participated in a study of the accuracy of telephone screening in identifying potential dementia cases. The telephone protocol and scoring algorithm resulted in 100% sensitivity and 91% specificity. The findings suggest that a brief telephone interview can serve as an efficient screening device to locate dementia cases in the context of a large-scale community-based investigation.

This is a comparative study of the prevalence of dementia among elderly Chinese and Malay persons living in the community in Singapore. The subjects, aged 65 years and over, were all living in public housing estates. Two hundred elderly Chinese and 149 elderly Malay persons were interviewed. They were first screened for any cognitive deficit with the Elderly Cognitive Assessment Questionnaire (ECAQ). All those who scored 5 or fewer points on the ECAQ were then assessed with the Geriatric Mental State schedule.

The results showed an overall dementia prevalence of 4.0% among the Malay elderly and 2.5% among the Chinese elderly. The rate of dementia of the Alzheimer's type was 1.8% for Chinese women and 1.5% for Malay women; for multi-infarct dementia the rate for Malay women was 4.4% and for Chinese women 0.9%. For Chinese and Malay men, the prevalence of Alzheimer's disease and multi-infarct dementia was quite similar (1.1% and 1.2%).

Two hundred participants (mean age = 80 years) from five senior day-care centers were included in a study of agitation. Staff members at the centers and participants' relatives rated the frequency with which participants displayed agitated behaviors, via an expanded version of the Cohen-Mansfield Agitation Inventory. The most frequent behaviors noted were general restlessness, repetitious sentences, verbal interruptions, and pacing. A three-factor solution for staff members' ratings included (a) physically nonaggressive behaviors, including general restlessness and pacing; (b) verbally agitated behaviors, including complaining and constant requests for attention; and (c) aggressive verbal behaviors, including cursing and temper outbursts. A three-factor solution for relatives' ratings included (a) physically nonaggressive behaviors, including general restlessness and pacing; (b) verbally agitated behaviors, including constant requests for attention and related interruptions; and (c) aggressive behaviors, including cursing, grabbing, kicking, and pushing. The syndromes of both models showed similarity to the factors found in a nursing home population, although differences were also apparent.

Because of the growing number of elderly people, the incidence of dementia is increasing. The disease represents a heavy burden for patients and their relatives and has growing social and financial implications. Unforunately, research and therapeutic progress is slowed by mehodological differences in the assessment of dementia and a therapeutic nihilism toward antidementia drugs. However, the limited efficacy of some antidementia drugs should not obscure the fact that a definite placebo-verum difference has been proved for other drugs and that the combination of these drugs with other therapeutic methods, like cognitive training, does bring positive results. Their use also seems meaningful in terms of economics.