The need to train more health workers, and particularly mental health workers, in the care of older adults, has been highlighted by a variety of disciplines including psychiatry (Jeste et al., 1999), psychology (Knight et al., 1995), social work (Rosen et al., 2002) and nursing (Hirst et al., 1996). This rise in attention paid to geriatric health care is partly driven by demographics. Over the next 50 years, the global population of people aged 60 years and over is expected to triple to 2 billion by 2050 (U.N. Department of Economic and Social Affairs, Population Division, 2007). This same UN report states that the expected number of centenarians is set to increase globally by a factor of 20. Worldwide, the demographic trends in aging suggest that the number of people in the world aged 65 years and over will surpass the number aged 5 years or less in approximately 2017 (UN Department of Economic and Social Affairs, Population Division, 2005). The issues concerning who will care for older adults are faced by a growing number of nations throughout the world.

Taylor et al. (2014) raise an important issue concerning the detection of alcohol problems in older adults. The authors identify a number of age-related factors playing a role in the detection of alcohol problems, such as stigma, the concept of alcohol use disorder diagnoses and their standardized assessment, and drinking levels. They list a comprehensive review of tools for assessing alcohol problems among older adults, including laboratory tests, questionnaires, and interviews.

With now over 50 million people worldwide with dementia (Prince et al., 2013), there are almost certainly well over 100 million people with cognitive concerns and many of these will attend their health professional keen to know what is going on. We need those without intensive training in this field to be more confident and correct in their diagnosis when such a concerned person turns up. Many simple diagnostic tests have been proposed and some assessed – these include the walk and talk (divided attention) test (those who stop when asked a question while walking may be cognitively impaired) (Lamoth et al., 2011), the clock drawing test (Brodaty and Moore, 1997), the “handbag” sign (those clutching their personal possessions are more likely to be cognitively impaired) and the “hippopotamus sign” (calling the rhinoceros, in those tests that include this, a hippopotamus). Simple screening tests have been extensively validated and are important to the clinician in formulating a diagnosis (Lorentz et al., 2002). The “head-turning” and the “attended with/alone” signs are frequently observed, and many clinicians assessing such individuals would be well aware of them and probably even unknowingly factor them into their diagnosis. In this issue, Pinar Soysal and colleagues (Soysal et al., 2017) have evaluated these signs and, in those older people attending with cognitive concerns, found they had quite good diagnostic value. They were not very specific but showed good sensitivity and negative predictive value. Indeed, at the recent Alzheimer's Association International Conference in London there were several posters evaluating “soft but simple” signs although not all performed as expected – one group found gait actually sped up in those with cognitive impairment that were asked a question.

The challenge facing researchers today is to develop a systematic approach to defining and studying behavioral disturbances of dementia. At present, behavioral symptoms of dementia are inconsistently and imprecisely defined. Further complicating the study of behavioral problems is the lack of standardized rating tools and the difficulty of obtaining accurate data, both from the patient and the caregiver. To provide a focus for researchers, the author outlines several areas that deserve consideration in future discussions of behavioral symptoms in patients with dementia.

Behavioral and psychological symptoms in dementia (BPSD) are an important aspect of the disorder that are now receiving more attention. The design of the trials in vascular dementia needs to account for these features. The specific area of BPSD in vascular dementia, their assessment, and relationship to the design of trials are considered in this article.

Seeking to explain the difference in the frequency of hallucinations between Afro-Caribbean and White patients with dementia, Dr. Holmes stated that genetic differences are the most obvious explanation. The frequency of the polymorphisms is increased among Afro-Caribbeans, which is reflected in the incidence of schizophrenia in this population. Dr. Holmes also mentioned that serotonin receptor polymorphisms affect binding capacity to the sites, and are instrumental in forming visual hallucinations. He speculated that researchers will find that the different frequencies of behavioral and psychological symptoms of dementia (BPSD) in different countries will be largely accounted for by genetic variation in a number of polymorphisms. However, he emphasized the importance of using the same methodology so that results can be compared across countries and cultures. Dr. Cohen agreed that researchers should be investigating potential genetic differences. How the genetic traits are linked to neuropsychiatric symptoms is an interesting question, and requires a great deal more research.

Following on from the hypothesis of a role for the ApoE ε4 and ε2 alleles as risk and protective factors, respectively, for late-onset Alzheimer's disease (AD) came inevitable questions regarding other psychiatric conditions of late onset including depressive illness and schizophrenia. Is ApoE ε4 a risk factor in these diseases and do carriers have an earlier age of onset? Does ApoE ε2 have a protective role, with carriers of this allele having a later age of onset?