On April 1st, 2003, at its meeting in Geneva, the Board of Directors (BOD) of the International Psychogeriatric Association (IPA) voted to create the post of Editor Emeritus of International Psychogeriatrics. A few minutes later the BOD voted to appoint former Editor-in-Chief Robin Eastwood to the post.

In the past decade, pharmacological, behavioral, educational, and environmental interventions for individuals with dementia have addressed a variety of goals: improving cognitive status, delaying the onset of symptoms, reducing behavioral problems such as depression and agitation, and maximizing activities of daily living. It is important not only to ameliorate symptoms but also to evaluate the extent to which an intervention improves the quality of life (QOL) of the person being treated (Logsdon et al., 2002).

Effective management depends on good communication. This is as relevant in health care as it is in industry, or in governing a nation, or when putting battle plans into effect, or in household management. It is important for people to understand each other's statements. Messages need to be clear and unambiguous.

Alzheimer's disease (AD) is the most common neurodegenerative disease. There has been a rapid increase in the knowledge of epidemiology, genetics, risk factors, and underlying neuropathological mechanisms, but still there is no cure for AD. Recent promising studies with functional imaging using positron emission tomography (PET) and magnetic resonance imaging reveal that disease processes can be detected when very early subjective symptoms of AD are manifest. Recently the PET ligand PIB was reported to bind in vivo to β-amyloid in the brains of AD patients. Also cerebrospinal fluid markers including tau, phosphotau, and Aβ 1–42 are probably important early biological markers that will provide an early diagnosis of AD. An obvious impairment in central cholinergic transmitter function and its close relation to cognitive function led to the development of the acetylcholinesterase inhibitors that now are used as symptomatic therapy. A drug interfering with the glutaminergic brain transmitter system, the NMDA antagonist memantine, has recently been approved for the treatment of patients with severe AD. In order to stop or reverse disease progression, different AD treatment strategies are of great interest. Epidemiological studies support the hypothesis that long-term treatment with estrogen, antioxidants, anti-inflammatory drugs, and cholesterol-lowering agents could protect against the development of AD. Treatment with these drugs in manifest AD has been less promising. The use of nerve growth factors was limited by severe side effects. Much evidence supports the key role of β-amyloid in the pathogenesis of AD. Compounds such as amyloid β-sheet breakers, cholesterol-lowering drugs, estrogen, nicotine, zinc and copper chelators, inhibitors of β- and γ-secretases, and immunization to reduce the amyloid burden in transgenic mice over-expressing β-amyloid all have their advocates. The latter exciting strategy turned out to cause meningoencephalitis in 6% of AD patients so treated. One patient from the trial has died showing less β-amyloid burden in brain than expected and patients with serum β-amyloid plaque reactive antibodies had less cognitive decline after 1 year than AD patients without antibodies. There is a great optimism for early diagnosis and effective treatment of AD in the future.

Background: Older Puerto Ricans belong to two rapidly growing demographic groups known to have high rates of depression: the aging and Hispanic populations. Studies of depression in Puerto Ricans have primarily focused on the impact of demographic factors and health. This study expands previous research, examining the relationships between depression and social stressors, social support, and religiosity, for Puerto Rican primary care patients aged 50 and older. Patients: Participants included 303 Puerto Ricans from six primary care clinics in a northeastern city. Methods: Patients completed in-person interview in Spanish. The Composite International Diagnostic Interview indicated depressive disorders meeting DSM-IV criteria. Bivariate and multivariate relationships between depression and demographics, health, social stress and support, and religiosity were explored. Results: One fifth of participants met DSM-IV criteria for major depression or dysthymia. Participants with the lowest income, more recent migration, and poor subjective health were significantly more likely to be depressed. In addition, rates of depression increased steeply for patients caring for grandchildren and those with personal or family legal problems. Seeing few relatives each month and needing more instrumental, emotional, or financial support were also related to higher rates of depression. Unexpectedly, low objective illness severity correlated with increased depression, whereas religiosity and religious participation had no relationship to depression. Conclusions: The findings presented here indicate the potential for social stressors and inadequate supports to substantially increase the risk of depression in older Puerto Ricans in primary care settings. Further studies should explore incorporating these social risk factors into improved prevention, clinical detection, and culturally sensitive treatment of older depressed Puerto Ricans.

The increasing numbers of Asian and other immigrants in the United States have resulted in greater demands for research methodology sensitive to cross-cultural issues. A regional probability sample (n = 407) of Asian elderly immigrants of different nationalities (Chinese, Korean, Indian, Filipino, Vietnamese, or Japanese) residing in New York City was used to examine the reliability of the Geriatric Depression Scale (GDS). Using the 30-item GDS, about 40% of this representative sample of Asian elderly immigrants was considered to be depressed, indicating higher depression rates than in the previous studies of other Asian elderly samples in the US and in Asia. Results also showed that the 30-item GDS and 15-item GDS Short Forms were reliable measures to assess depression in community-dwelling Asian immigrant elders. Data strongly suggest that Asian elderly immigrants in the US are at risk of depression, indicating a need for the design of culturally sensitive mental health programs.

Background and Objectives: A variety of electroencephalogram (EEG) abnormalities may occur in schizophrenics who had a typical onset of the disorder in early adulthood. The purpose of this study was to investigate EEG findings in patients with late-onset schizophrenia (onset of illness between ages 40 and 60). Methods: Ten patients (one male, nine female, average age 52.8 years old) with late-onset schizophrenia underwent magnetic resonance imaging (MRI) of the brain and recording of quantitative EEG. Results: MRI results for seven of the subjects were within normal limits and the other three showed nonspecific changes. Quantitative analysis of EEG variables revealed that for eight of the subjects, absolute power and relative power for the four EEG frequency bands, overall mean frequency, mean frequency for each of the EEG frequency bands, and interhemispheric coherence values did not vary significantly from a normative database of age-matched normal subjects. Conclusions: Results obtained to some degree replicate the single previous EEG study of late-onset schizophrenia. These findings suggest that the neurophysiological etiology and mechanism of late-onset schizophrenia may differ from that of schizophrenia with a typical age of onset, and that brain abnormalities are not an inevitable accompaniment to late onset of schizophrenia.

Objective: To determine the attitudes of patients with mild dementia and their carers towards the disclosure of diagnoses of cancer and dementia and whether there are differences between these groups. To determine whether any major adverse events occurred following disclosure of diagnosis of dementia. Design: A prospective study followed by a retrospective case-note study after 1 year. Participants and Setting: Fifty patients with mild dementia and their carers were recruited from a memory clinic in Nottingham, UK, and an old-age psychiatrist, using a semistructured questionnaire, separately interviewed them. Measures: Questions related to whether patients and their carers wished to be told diagnoses of cancer and dementia; the reasons for this; whether they would want treatment and make use of predictive testing if available were included. At 1-year follow-up whether antidepressants had been prescribed and whether any catastrophic reaction had occurred following disclosure of diagnosis. Results: An overwhelming majority of patients with mild dementia wished to be informed of their diagnosis (92%); even more (98%) of the same patient sample reported wanting disclosure of a hypothetical diagnosis of cancer. A higher proportion (98%) of carers would wish to be told if they were to develop either dementia or cancer. All patients and carers would like access to treatment for dementia. A total of 88% of patients and 86% of carers would make use of a predictive test of Alzheimer's disease. Before receiving a diagnosis of mild dementia, only 28% of patients had insight that they may have dementia. Only a quarter (26%) of carers did not want the doctor to disclose the diagnosis of dementia to the patient. After 1 year, 6% of the original sample had developed a depressive illness requiring antidepressant treatment and no major incidents had occurred following disclosure of diagnosis. Conclusions: There has been a growing debate on whether patients with dementia should be informed of their diagnosis. Until recently, little was known about the views of patients themselves. This study shows that the vast majority of patients with mild dementia wish to be fully informed. Despite increasing awareness, a quarter of carers still do not wish their relative to be informed, though wish to be informed if they themselves were to develop the illness. This is significantly lower, however, than previously reported, suggesting a shift in attitudes. This study adds support to the weight of evidence that disclosure of a diagnosis of dementia does not cause depression or any irreversible harm to the patient.

Objective: To determine correlates of hoarding behavior in frail elderly persons. Methods: Information about nursing home residents (n = 408) and community-dwelling senior day-care participants (n = 177) was gathered through interviews with family and professional caregivers, medical chart review, and physician examinations, and included the following areas of assessment: hoarding behavior, demographic and health information, level of cognitive functioning, activities of daily living (ADL) performance, depressed affect, social functioning, manifestations of agitated behaviors, and previous stressful life experiences. Results: We found that 15% of the nursing home residents and 25% of the community-dwelling senior day-care participants manifested hoarding behavior at a rate of several times a week or higher. For nursing home residents, hoarding behavior was significantly related to a larger appetite, taking fewer medications, higher social functioning, comparatively less ADL impairment, and manifestations of physically nonaggressive agitated behaviors. For senior day-care participants, hoarding behavior was significantly associated with being female, a larger appetite, comparatively less gait impairment, fewer medical diagnoses, more involvement in activities, a positive diagnosis of dementia, hallucinations, the delusion of infidelity, and manifestations of three syndromes of agitated behaviors. Conclusion: While hoarding behavior in our samples presents differently from compulsive hoarding described in the literature, we obtained robust findings that show that despite differences in living conditions, the elderly persons who manifested hoarding behavior were those with relatively fewer health and functional disabilities. In addition, those who exhibited hoarding behavior also manifested agitated behaviors. We suggest that future researchers develop alternative measures of hoarding behavior so as to further clarify the phenomenon of hoarding behavior in the elderly.

Aggressive behavior in dementia often has a severe impact on the quality of life of the patient and the caregivers, and is therefore important to handle. The strategy of treatment should be broad. Nonpharmacological interventions, including environmental adjustments and supporting and training the caregivers, should always be considered. Pharmacological treatment of aggressive behavior in patients with dementia often includes the use of neuroleptics. The atypical compounds clozapine, risperidone, and olanzapine have been shown to have an effect on aggressive behavior at low dosage with limited extrapyramidal side effects. The anticonvulsants carbamazepine and sodium valproate are further alternatives. In treatment-resistant cases, buspirone or lithium may be tried, although the effect of these substances on aggressive behavior in dementia has not been well established. In the end, however, a considerable degree of aggressive behavior sometimes remains after careful treatment trials, particularly in patients with severe aggressive behavior. In addition, treatment is sometimes limited by side effects.