Psychogeriatrics and psychogeriatric research have been particularly slow to take hold in developing countries. In part this is because the elderly constitute relatively small proportions of those countries' populations, and are thus of low priority for specialized services. A recent report in Science (Miller, 2006) addresses mental health needs in developing countries worldwide but does not include old-age mental disorders other than dementia. Similarly, an article from Brazil (Garcez-Leme et al., 2005), in another international journal, provides an overview of that country's resources and needs in geriatrics, but neglects to mention mental disorders or mental health professionals. Yet, these countries are aging faster than the industrialized world and have fewer resources with which to care for their mentally ill elderly. High-quality, locally acquired information will be essential for planning appropriate mental health services.

Background: The object of this study was to develop an Iranian version of the General Health Questionnaire-28 (GHQ-28) for use with elderly subjects.

Methods: The GHQ-28 Farsi version was evaluated for face validity among 204 elderly subjects aged 59 years or older, chosen randomly from residents of Tehran. The Composite International Diagnostic Interview (CIDI) was used to establish a gold standard diagnosis of mental disorders.

Results: The GHQ-28 was an internally consistent measure. Cronbach's α, split-half coefficients and test-retest reliability were 0.9, 0.89 and 0.58 respectively. Four factors were extracted using factor analysis: “depression,” “psychosocial activity,” “anxiety,” and “somatic.” Using receiver operating curve (ROC) analysis, the optimum cutoff score for the GHQ-28 in this group was 19/20 (sensitivity 0.83, specificity 0.76). Using a loading of 0.6 or greater, a short form of the instrument (GHQ-15) (α = 0.9) was derived and correlated well with the longer form of the scale (r = 0.97). Using ROC analysis, the optimum cutoff score was 10/11 (sensitivity 0.83, specificity 0.69).

Conclusions: The short and long forms of the GHQ-28 are suitable screening instruments for elderly Iranian residents, particularly those living in urban areas.

Background: There has been increasing interest in the measurement of quality of life in cross-sectional investigations and in the assessment of intervention outcomes in elderly adults. Several instruments used in this measurement have not yet been adequately tested.

Objective: To describe the psychometric properties of the World Health Organization's Quality of Life Instrument–Short Version (WHOQOL-BREF) in a sample of Brazilian elderly.

Method: A total of 424 elderly adults selected through convenience sampling completed the instruments WHOQOL-BREF, the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS) and a sociodemographic data form. Discriminant validity, concurrent validity, criterion validity and internal consistency were analyzed.

Results: The sample comprised predominantly women (64.2%), community-dwelling subjects (84.4%) and subjects who consider themselves healthy (67.5%). All domains in the instrument showed the ability to discriminate levels of depressive symptoms and hopelessness, as well as different perceptions of health status. The correlation coefficients among the domains and the BDI and BHS scores were statistically significant. The reliability coefficients present scores ranging from 0.614 to 0.925.

Conclusion: The WHOQOL-BREF instrument shows suitable psychometric performance in a sample of Brazilian older adults, becoming a useful alternative in the measurement of quality of life in this population.

Background: Diagnosis of mild cognitive impairment (MCI) and its subtypes requires a detailed diagnostic assessment and so may be missed at routine primary-care appointments, since the ordinary dementia screening tests lack sensitivity owing to ceiling effects, especially in highly educated subjects.

Methods: The study was undertaken using a cross-sectional assessment of 112 elderly subjects (mean age 67.96 ± 5.77 years, and mean education level of 12.8 ± 5.7 years) with a semi-structured interview and a neuropsychological battery.

Results: MCI patients did not differ from controls on total MMSE scores (p = 0.212). Nevertheless, MCI patients showed worse performance than controls on the verbal memory task (p = 0.012), and “drawing a pentagon” (p = 0.03). Amnestic MCI patients performed worse only on the “three-word recall” task (p = 0.013); non-amnestic MCI patients performed worse on the “three-stage command” task (p = 0.001); and multiple-domain MCI patients performed worse on the “drawing a pentagon” task (p = 0.001) and had a trend toward performing poorly on the ‘three word recall’ task (p = 0.06).

Conclusion: The analysis of MMSE subtest scores, in addition to MMSE total scores, may increase the sensitivity of the MMSE test in screening for MCI and its subtypes.

Background: The aim of the study was to determine the correlation and agreement between the Mini-mental State Examination (MMSE) and Clock Drawing Test (CDT), administered and scored using Shulman's method (2000), in elderly Brazilian adults with very low levels of formal education.

Methods: CDT and MMSE tests, performed by a sample of 1118 elderly subjects from a population-based cohort, were evaluated. Spearman's correlation coefficient was calculated for the total sample and according to gender, age and schooling level. Agreement was assessed using receiver operating characteristic (ROC) analysis.

Results: CDTs with high scores had high corresponding MMSE scores whereas CDTs with low scores had a wide range of corresponding MMSE scores. Correlation was moderate (ρ = 0.64) and no difference was found according to gender, age or schooling level. For CDT cut-off 3/4, the best MMSE cut-off was 27/28 and agreement between tests was 75.1%.

Conclusions: Correlation between tests was moderate. Subjects who performed well on the CDT could be expected to obtain high MMSE scores. Although one test does not substitute for the other, the CDT may be more practical in developing countries where resources are limited and low education is common in the elderly, as well as in situations where time for assessment or screening is limited. Moreover, the CDT may be sensitive to cognitive domains not assessed by the MMSE.

Background: Different interview schedules and diagnostic criteria for dementia have contributed to differing incidence and prevalence rates.

Aim: This study aimed to examine the effect of different diagnostic criteria on the prevalence of dementia in the community.

Methods: Some 1000 subjects (> 65 years) were recruited in Kaniyambadi Block, Vellore, India, using a one-stage assessment procedure.

Results: The prevalence of dementia by Diagnostic and Statistical Manual IV standard, the Community Screening instrument for Dementia DF Score, the education adjusted 10/66 Dementia Research Group criteria, and the Geriatric Mental State was 0.8%, 6.2%, 10.6%, 63.2% respectively.

Conclusion: Differences in information, interview schedules, diagnostic criteria and settings contribute to variation in identification of people with dementia. Minor variations in criteria have a significant impact on diagnosis. The assessment of the clinical state is influenced by education, level of baseline function, impairment in current functioning, life style and demands on the person, tolerance of impairment and expectation by relatives and by differences between patients attending hospitals and those living in the community. The variation in rates demands a debate on the criteria for dementia in the community in general and for less literate populations in particular.

Background: This is a community-based longitudinal epidemiological comparative study of elderly African Americans in Indianapolis and elderly Yoruba in Ibadan, Nigeria.

Method: A two-stage study was designed in which community-based individuals were first screened using the Community Screening Interview for Dementia. The second stage was a full clinical assessment, which included use of the Geriatric Depression Scale, of a smaller sub-sample of individuals selected on the basis of their performance in the screening interview. Prevalence of depression was estimated using sampling weights according to the sampling stratification scheme for clinical assessment.

Results: Some 2627 individuals were evaluated at the first stage in Indianapolis and 2806 in Ibadan. All were aged 69 years and over. Of these, 451 (17.2%) underwent clinical assessment in Indianapolis, while 605 (21.6%) were assessed in Ibadan. The prevalence estimates of both mild and severe depression were similar for the two sites (p = 0.1273 and p = 0.7093): 12.3% (mild depression) and 2.2% (severe depression) in Indianapolis and 19.8% and 1.6% respectively in Ibadan. Some differences were identified in association with demographic characteristics; for example, Ibadan men had a significantly higher prevalence of mild depression than Indianapolis men (p < 0.0001). Poor cognitive performance was associated with significantly higher rates of depression in Yoruba (p = 0.0039).

Conclusion: Prevalence of depression was similar for elderly African Americans and Yoruba despite considerable socioeconomic and cultural differences between these populations.

Background: The elderly are vulnerable to illness and particularly to psychiatric illness. Many mentally ill elderly patients end up on non-psychiatric wards owing to somatization of their illnesses. Even for these patients, a psychiatric diagnosis may not be made. The literature on the elderly in Uganda is very scanty. This study aims to establish the prevalence and factors associated with psychiatric disorders among elderly patients admitted to non-psychiatric wards.

Methods: We carried out a descriptive cross-sectional study of 127 consenting elderly patients. They were administered a standardized questionnaire comprising the Self Reporting Questionnaire 25, the Mini-mental State Examination and the Structured Clinical Interview for the Diagnostic and Statistical Manual IV. Study variables included socio-demographic characteristics, physical illnesses, psychiatric disorders and the treatment given.

Results: The rate of psychiatric morbidity was 48%. The sex ratio was 1:1; however, women had a higher rate of psychiatric illness than men, 54.6% and 41.3% respectively. Being widowed or separated and having cancer were associated with SRQ > 5, p = 0.02 and p = 0.04 respectively. Depressive disorders were the most common at 25.2% and were more common in women. Increasing age was associated with dementia (p < 0.00).

Conclusion: There is a high rate of psychiatric morbidity among the elderly in Uganda. Particular attention should be given to the psychological health of elderly people admitted to general hospitals.

Background: There is no previous information about economic costs of Alzheimer's disease (AD) in South America. The objective of this study was to evaluate the costs of AD in Argentina.

Methods: Eighty community-dwelling patients, 20 institutionalized AD patients and their respective primary caregivers, and 25 healthy elderly subjects participated in this study. The cognitive and neuropsychiatric impairments and severity of dementia were assessed with the Mini-mental State Examination, Neuropsychiatric Inventory and Clinical Dementia Rating, respectively. A structured interview about health and health-care resources used during the past 3 months was administered to family caregivers. The time devoted by carers to looking after the patients and the caregiver burden (Zarit's Burden Interview) were recorded.

Results: The annual direct costs of the disease increased with cognitive deterioration from US$3420.40 in mild to US$9657.60 in severe AD, and with institutionalization (US$3189.20 outpatient vs. US$14 447.68 institutionalized). Most direct costs were paid for by the family.

Conclusions: With the projected increase in the number of persons at risk for developing AD in emerging countries, the family cost of the disease will be significant. Dementia costs should be a matter of analysis when health policies are being designed in developing countries.

Objective: To determine and compare the prevalence and risk factors of elder abuse in elderly population in two different districts in Izmir, Turkey.

Methods: This cross-sectional study involved 497 subjects selected by cluster sampling.

Results: The prevalence of physical and financial abuse among the elderly in the district of low socioeconomic status was 1.5% and 2.5%, respectively, while among the elderly in the district of high socioeconomic status, it was 2% and 0.3%, respectively. However, the prevalence of elder neglect in the two districts was 27.4% and 11.2%, respectively. Prevalence of neglect was associated with infrequent contact with relatives, little or no income, and fewer years of education among the elderly in the low socioeconomic district. In the high socioeconomic district, neglect was associated with fewer years in education, poor health status and having chronic status.

Conclusion: The prevalence of abuse among the elderly living in the two different districts was low. However, nearly one-fifth of elderly people were exposed to neglect.

Background: Impairment of deficit awareness is a clinically relevant feature of dementia affecting the maintenance of decision capacities, management and safety of patients with risk behaviors, and caregiver burden. This study assessed awareness of disease of patient/caregiver dyads and the relationship between unawareness on various domains and sociodemographic variables among elderly Brazilians with Alzheimer's disease (AD).

Methods: The dyads (n = 52), stratified by clinical severity and age groups, responded to the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD). Statistical tests were used to compare clinical and sociodemographic variables and to calculate differences in rates of discrepant responses among mild and moderate dyads and between age groups, rates of discrepant responses among the ASPIDD domains, and association between awareness and age/age at onset.

Results: Awareness of deficits did not differ significantly among mild patients, whereas moderate patients showed impaired recognition on all domains. Older moderate dyads showed more discrepant responses, as compared to younger dyads at both severity stages. Mild patients could associate the disease with the cognitive deficits and recognized impairments on other domains. There was no significant relation of awareness with age at onset.

Conclusion: Mild AD patients could associate the disease process with the presence of cognitive deficits, and also the changes in the emotional response with difficulties in social, family, and affective relations. Moderate AD patients were less aware of the symptoms and did not attribute them to the disease.

Background: Vascular risk factors are blamed as being involved in the pathogenesis of cognitive dysfunction in the elderly. Alzheimer's disease or vascular-type dementia could be part of a metabolic syndrome. The aim of this study was to evaluate whether there is any relation between insulin resistance and cognitive status of the elderly regarding normal, mild cognitive impairment (MCI), Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia.

Methods: 267 elderly patients admitted to an outpatient geriatrics clinic were evaluated medically and cognitively in this study. The patients were diagnosed using ARDRA and DSM-IV criteria for AD; NINDS-AIREN and DSM-IV criteria for VaD; and Petersen criteria for MCI. Insulin resistance was calculated using both the homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) formulas.

Results: The mean values of HOMA and QUICKI scores were 2.79 (SD ± 3.56) and 0.346 (SD ± 0.036) for the normal group, 2.81 (SD ± 3.06) and 0.354 (SD ± 0.047) for AD group, 2.20 (SD ± 1.82) and 0.360 (SD ± 0.048) for VaD group, 2.87 (SD ± 1.81) and 0.339 (SD ± 0.038) for mixed dementia group, 2.79 (SD ± 2.81) and 0,349 (SD ± 0.042) for MCI group, respectively. There were no statistically significant differences between HOMA and QUICKI scores of all the groups.

Conclusion: This is the first study of the possible relation between insulin resistance and cognitive function in people categorized according to five forms of cognitive status. Unfortunately the results do not allow generalizations. Further prospective cohort studies that follow a normal cognitive group and MCI patients with and without insulin resistance are necessary.

Objective: To evaluate the location and the degree of white matter damage in late-life depression using diffusion tensor imaging (DTI).

Methods: Thirty-one patients with late-life depression and 15 healthy volunteers matched for age, gender and years of education received conventional MRI (magnetic resonance imaging) and MR-diffusion tensor scanning. The fractional anisotropy (FA) values of white matter were measured respectively in frontal and temporal regions and the corpus callosum.

Results: FA values were significantly decreased in the frontal (superior and middle frontal gyrus), and temporal (right parahippocampal gyrus) regions of elderly patients with depression compared with healthy controls.

Conclusion: Microstructural changes in the frontal (superior and middle frontal gyrus) and temporal (right parahippocampal gyrus) areas are associated with late-life depression.

Background: The aim of this study is to compare the results of magnetic resonance (MR) imaging, particularly the decline in hippocampal volume, of patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) with healthy age-matched controls, to examine the reliability of hippocampal volumetry in the early diagnosis of AD and the correlation of the severity of hippocampal atrophy with the severity of cognitive decline.

Methods: Twenty-six AD, 22 MCI and 15 normal cognitive status (NCS) patients were scanned with a 3 Tesla MR scanner. Hippocampus volumes were detected manually by Osiris 4.18.

Results: Multivariate regression analysis, which was performed to adjust the covariate effects of education, age, gender, hypertension and diabetes mellitus, showed that hippocampal atrophy was correlated with AD and MCI for right hippocampus; AD, MCI and age for left hippocampus independent of other parameters. A second regression analysis revealed that MMSE was correlated with hippocampal volume.

Conclusions: Hippocampal volumetry can be used in early diagnosis of cognitive impairment, as well as grading cognitive decline.

Harm avoidance is one of the four temperament dimensions in Cloninger's psychobiological model of personality (Cloninger et al., 1993). In this model, personality is conceptualized as having four temperament dimensions (novelty seeking, harm avoidance, reward dependence, persistence) and three character dimensions (self-directedness, cooperativeness, self-transcendence). Individuals high in harm avoidance (HA) tend to be described as “worrying and pessimistic; fearful and doubtful; shy; and fatigable.” Those with low HA scores are “relaxed and optimistic; bold and confident; outgoing; and vigorous.” HA was initially proposed as a personality trait that is independent of the state of depression. However, other reports have found HA to be positively correlated with the severity of depression (Hansenne et al., 1999; Hirano et al., 2002). Repeated within-subject measures have been used to explore the stability of HA in major depression. However, conflicting results are reported in the literature and research in HA is largely with adults (Chien and Dunner, 1996; Marijnissen et al., 2002). The aim of this study is to investigate whether the personality trait of HA is stable over a 12-month period in a group of older people with a history of depression. This is a first report on the stability of HA in an exclusive elderly sample.

Studies reported in the literature indicate a wide range of movement disorders associated with anti-epileptic treatment (Easterford et al., 2004). Valproic acid is a well-known cause of reversible neurotoxicity characterized by symptoms resembling idiopathic Parkinson's disease (PD) and cognitive impairment (Armon et al., 1996; Onofrj et al., 1998).

War is a complex, enduring trauma composed of variable forms of extreme stress, such as violence, fear of death, displacement, loss of family members, abuse and starvation (Berman, 2001). More than 90% of war victims are civilians (UNICEF, 2006). Children and women are extremely vulnerable to traumatic experiences in times of war and the risk continues even in post-war-situations (Shanks and Schull, 2000). As far as former war-children are concerned, a high prevalence of post-traumatic stress symptoms is apparent even six decades after World War II (Kuwert et al., 2006). In the 1990s, the world was shocked by reports about systematic and widespread rape in the former Yugoslavia and Rwanda (Shanks and Schull, 2000). The Lancet has published articles about wartime rape and demanded the development of clear strategies against sexual violence in conflict (Hargreaves, 2001). However, it can be concluded that sexual violence was and is common in nearly all crisis zones. One recent example was the rape and murder of a 14-year-old girl by U.S. soldiers of the 101st Airborne Division in Iraq (The Times, 2006).

The prevalence of a disorder is a function of the incidence of the disorder and the duration of the illness (which may remit spontaneously, by treatment or death). The socioeconomic status of societies may influence the incidence and duration of mental illnesses in old age by influencing life expectancy and availability of appropriate healthcare services and treatments (Suh and Shah, 2001). The relationship between a proxy measure of the socioeconomic status (per capita gross national domestic product (GDP)) and (i) the life expectancy, (ii) child mortality rates and (iii) proxy measures of the quality and quantity of available healthcare services (the proportion of GDP spent on health, per capita expenditure on health and child mortality rates) was examined. The WHO website (www.who.int/countries/en/) provided data on these variables for 191 of the 192 countries for the year 2002. The inter-correlations between all the measured variables were examined using Pearson's correlation coefficient. Because of highly significant inter-correlations between all these variables, multiple linear regression analysis, with the Enter method, was undertaken with per capita GDP as the dependent variable, and all the variables that were significantly correlated with per capita GDP on univariate analysis as the independent variables.

Elderly suicide rates have been shown to be low in countries with low socioeconomic status, including those with greater income inequality and those with reduced life expectancy (Shah et al., 2007). It is therefore possible in such countries that people at risk of suicide in old age do not reach the age of increased risk. Moreover, selective survival of those at reduced risk for suicide due to genetic or constitutional factors may further compound this trend. Furthemore, those who do survive may be at reduced risk of suicide in old age because they may be better able to tolerate extra hardship in old age due to exposure to life-long adversity (Seiden, 1981; Lindesay, 1991). For example, elderly African Americans and native Americans (Indians) have low suicide rates (McIntosh, 1984) and this has been attributed to a life-long history of socioeconomic deprivation (McIntosh, 1984). Therefore, we examined the relationship between elderly suicide rates and long-term measures of economic adversity, including the average annual growth rate and average annual change in the consumer price index over a long period.