Driving the growing interest in psychogeriatrics is its growing knowledge base. This knowledge base has been both product and impetus of an ever-expanding number of research studies. Moreover, psychogeriatric knowledge is catalyzing the proliferation of scientific journal articles and professional textbooks, as well as influencing significant changes in curricula and training programs. International Psychogeriatrics is itself a response to rapidly accruing knowledge in this area.

Welcome to International Psychogeriatrics. It is with pride, excitement, and a sense of challenge that we launch this first issue of our new journal. Why this new journal? The impetus and the credit go to the field—specifically to the growing community of researchers, teachers, and clinicians around the globe who are interested in and contribute to psychogeriatric knowledge. This truly is the historic moment in the fields of gerontology and geriatrics, a period marked by the coming together of societal concern and scientific curiosity about issues of aging and the problems of the elderly. It is a moment not confined to any one nation, nor to any one continent; that is what makes it all the more important and exciting. It is in this context that this new journal, international in scope, is being launched.

The prevalence of depression among nursing home residents was estimated by screening a group of residents selected from a random sample on the basis of cognitive status; it ranged from 18–20% for major depression to 27–44% for other dysphoric states. Though individual patients were observed to change over a 6-month period, depression as assessed with the Geriatric Depression Scale was, in general, persistent. Major depression was clinically confirmed in 8 of 10 patients identified at screening. It was characterized by medical disorders that complicated diagnosis and treatment, and by increased mortality relative to the rest of the population.

A prospective follow-up of depressed elderly patients is described. The subjects, 91 men and 173 women aged 60 years or over, were diagnosed as depressed in an epidemiological study using the DSM-III criteria. One hundred ninety-nine patients suffered from dysthymic disorder. The mean duration of the follow-up was 14.9 ± 4.3 months. Outcome was not associated with sex and was good in 41% of the cases. In men, poor outcome was associated with low social participation, low frequency of visiting contacts, and poor insight into the depressive disorder. In women, poor outcome was associated with multiple depressive symptoms, depression diagnosed previous to this study, not living alone, low social participation, low self-perceived health, diurnal variation of symptoms, and the occurrence of initial insomnia, loss of libido, and hypochondriacal and compulsive symptoms. Many similarities were found in factors associated with outcome between all depressed patients and the patients whose depression was diagnosed during our epidemiological study.

Seventy-eight nondemented elderly depressed patients underwent an extensive battery of cognitive tess both before and after seven weeks of treatment with nortriptyline, phenelzine, or placebo. Clinical and cognitive evaluations of the patients were under double-blind conditions. Response to treatment did not appear to significantly affect cognitive capacity; neither did treatment with an active substance as compared to placebo. In addition, the baseline level of cognitive functioning did not appear related to whether a patient responded to treatment. The authors conclude that under optimal conditions neither antidepressant produces measurable changes in the cognitive capacity of nondemented elderly patients.

Drugs with a short elimination half-life should display fewer side effects than longer acting drugs in the treatment of sleep disturbances due to their smaller tendency to accumulate, especially in the elderly. This hypothesis could be confirmed in a double blind study of zopiclone versus flurazepam.

The Hasegawa Dementia Scale is well established in Japan as a screening tool for dementia in older people. A study was done on elderly Chinese to determine whether or not the scale was similarly effective. Results confirm the validity and reliability of the Hasegawa Dementia Scale.

In this review article, we describe the historical background of gerontopsychiatry in Japan and elucidate research studies on dementia. To date, 19 relatively large-scale epidemiological investigations on dementia have been conducted in the community. These results suggest that approximately 4–5% of the population over age 65 has dementia. Multi-infarct dementia is more prevalent than the Alzheimer's type dementia. Three hypotheses for this finding are suggested. Finally, we propose a theoretical model correlating the relationship between degree of cognitive dysfunction and caregiver's stress.

Direct observations of 24 highly agitated, cognitively impaired nursing home residents were performed during each hour of the 24-hour day for 2–3 months. Results showed that agitated behaviors (in particular, strange noises, requests for attention, repetitious mannerisms, picking at things, strange movements, and pacing) were manifested at very high frequencies. The data also showed that daytime agitation was positively related to nighttime agitation. Patterns of agitation were specific to each resident, an important finding for future research and intervention.

Late-life depression and dementia of the Alzheimer's type both have profound, although different, effects on electroencephalographic (EEG) sleep patterns. Thus, while depression is associated with REM sleep disinhibition and extreme sleep fragmentation (e.g., sleep onset REM periods and early morning awakenings), Alzheimer's disease is associated with deficits in the production of phasic activity during sleep (e.g., rapid eye movements and K-complexes) and with increased rates of sleep-disordered breathing. These differences have been shown to be reliable in large numbers of patients during the past five years and appear to extend to differences in sleep between depressive pseudodementia and dementia with secondary depression. Preliminary data also suggest that pretreatment sleep onset REM periods may be associated with enhanced vulnerability to recurrent depression. In summary, sleep physiological measures provide useful diagnostic and prognostic indexes in late-life neuropsychiatric disorders.

The effect of oral clonidine challenge on cortisol secretion was evaluated in seven patients with primary degenerative dementia and in seven patients with major depression. Postclonidine cortisol levels were decreased in all depressed patients and in demented patients with hypercortisolemia at baseline. Demented patients with normal cortisol levels at baseline developed increased post-clonidine cortisol levels. These preliminary findings suggest differences in noradrenergic regulation of cortisol secretion among patients with primary degenerative dementia.

Functional brain imaging using computer-analyzed electroencephalography was performed in 40 subjects: 15 with mild-to-moderate dementia of the Alzheimer's type (DAT), 13 with mild-to-moderate multi-infarct dementia (MID), and 12 age-matched controls. We examined three different parameters of brain electrical activity in these subjects: absolute slow-wave power, proportional power in all frequency bands, and ratios of high-frequency/low-frequency electrical activity (so-called “spectral ratios”). Spectral ratios were significantly more powerful in discriminating among groups than the other measures. Functional images using spectral ratios revealed that subjects with DAT have a characteristic left temporo-parietal defect which clearly distinguished them from subjects with MID and from control subjects. The severity of dementia was best assessed by examining absolute slow-wave power, which had the strongest linear correlation with mental status testing. Serial images from one subject with DAT over 3 years demonstrate both quantitative and qualitative shifts in slow-wave activity in the course of DAT. The study suggests that functional imaging may be more useful than either simple EEG or computer-analyzed EEG in assessing and diagnosing patients with suspected dementia.

A pharmacist collected data in an active geriatric outpatient program on 140 patients admitted consecutively over a 1-year period. Compliance was monitored by patient statement, pill counting, and daily written record-keeping of all medications with the help of a pocket diary provided in the program. Weekly pharmacist counseling sessions were then initiated for all patients. After four compliance sessions, two subgroups of patients were identified: 120 compliant patients and 20 patients showing persistent 50% noncompliance. Patients were interviewed by a psychiatrist to develop a profile of the noncompliant patient. This profile may be useful in identifying other noncompliant geriatric patients. Early recognition of this special group of patients in need of directed counseling may help reduce medical misjudgment in prescribing for the frail elderly population.

Chronically ill and healthy persons are compared as to social roles, dominant concerns, and in coping with stress. The comparison is based on a longitudinal analysis of data which was collected in the Bonn Longitudinal Study of Aging (BOLSA). The empirical analysis indicates that both groups show great success in mastering life situations and in coping with challenges and restrictions. This competence persists over the eight measurement points. The empirical analysis also makes clear that chronically ill patients often cope actively with stress, that they are able to accept restrictions and to look simultaneously for new possibilities in life. Social contacts have a predominant position in coping with chronic disease. Intrafamilial and extrafamilial contacts are important and helpful for chronically ill patients. As the longitudinal analysis reveals, coping with challenges and demands of life is influenced by the individual life-style. The analysis points to the aging process as a process of growth and of new potentials. This applies not only to persons who are in good health, but to chronically ill persons as well.

The dramatic explosion of scientific information, as well as the development of computerized devices in medicine, will continue to change both the diagnosis and treatment of the elderly as it changes our entire culture. There are many technological forces now combining to push the frontiers of knowledge about the brain to new levels. This article outlines these new scientific and technological frontiers in psychiatric diagnosis including: diagnostic imaging, computer EEG, and psychiatric evaluation; treatment including health-related computerized aids, computerized psychopharmacology, neuropsychiatric training for handicapped and brain-injured, and chronic care; and medical education. This article discusses some of the issues that arise due to these new developments. Computers have multiplied the kinds of questions that can be meaningfully asked. In this way, the advent of the computer has opened the minds of many researchers to new frontiers. An important question is, “What will the psychiatric ‘state of the art’ be in a technological age?” Other issues include confidentiality with new devices, use of high technology to define malpractice liability, the lack of professional standards in software, the resistance of medical profession to computers, and the increased ability to misuse statistics. Geriatric psychiatrists must take an active role in planning the future impact of high technology in our field.

This intervention study compares the effectiveness of two approaches on caregiving stress reduction. Caregivers' psychobiological symptom experience and coping were profiled over time by identifying the types of stress-related symptoms most frequently experienced. Following pretesting (and selected matching procedures) using family functioning, coping, stress and mental status instruments, random assignment of caregivers was made to one of four groups: educative/didactic, psychotherapeutic/support, placebo, or control. Patients were tested at the end of eight weekly 2-hour sessions and again at 1-, 3-, 6-, and 12-month intervals after treatment. Although both the educative and psychotherapeutic groups were effective interventions for the reduction of strain, the psychotherapeutic/support group was the most effective over time, both at posttest and at the 3-month intervals. Neither group intervention was more effective than the control groups in reducing other types of stress, including anxiety, somatization, or depression. The psychobiological symptoms experienced by caregivers peaked at crisis periods in the caregiving trajectory, or when multiple demands were made of the caregiver during any one point in time.

In 1960, we studied the health and living conditions of Hungarian centenarians and published our data in 1965 (Haranghy, 1965). In the 1960 study, 34 Hungarians were 99 years old and over; 23 were examined by a medical team.

This article touches primarily on the influence that the socioeconomic and cultural conditions in Poland have on the family structure and individual needs of the elderly. Based on several studies in the past 20 years in Poland, I will show the main direction the changes are taking in the patterns of family support (i.e., intergenerational help) for elderly people.

Aging has now become a universal phenomenon of increasing importance both in developed and developing countries. Brazil is a huge country with more than 120 million inhabitants. Those in the 60-year-old-and-over age group represent, according to the latest census (1980), 6.5% of the population (Anuário Estatístico do Brasil, 1986, 1987). Since 1900 the percentage of persons 60 years and older has doubled (3.2% in 1900 to 6.5% in 1980) and nominally has increased 13 times (from 0.6 million to 7.7 million) (Anuário Estatístico do Brasil, 1986, 1987). A child born in 1980 can expect to live 63.5 years, about 18.6 years longer than a child born in 1940 (Fundação IBGE, 1984). The major part of this increase occurred due to lower mortality rates for young adults and children.

In the United States, a process is underway that is likely to result in the establishment of subspecialty status for geriatric psychiatry by 1991. To understand this development it is important to examine it in terms of critical and catalyzing influences. It is also important to understand what the thrust of subspecialty status for geriatric psychiatry is and what it is not in the United States. Moreover, the context that has set the stage for this movement in the United States is very different from that of many other nations around the world.