Written records have been describing extreme states of emotions since ancient Greece (Angst and Marneros, 2001), but Aretaeus of Cappadocia (which is geographically located in modern Turkey) was probably the first to outline the close relationship between depression and mania nearly 2000 years ago: “I think that melancholia is the beginning and a part of mania. . . The development of mania is really a worsening of the disease rather than a change into another disease. . . In most of them the sadness became better after various lengths of time and changed into happiness; the patients then developed a mania” (Angst and Marneros, 2001). Limited progress in our understanding of these extreme states of affect occurred until the mid-1800s, when both German and French physicians suggested that the change from melancholia to mania was not only “usual,” but that the continuous cycle between depression, mania, and disease free intervals were the key features of a mental disorder. Jean Pierre Falret named the disorder “folie circulaire” (1851), while Jules Baillarger called it “folie a double-form” (1854).

This brief editorial is written at the beginning of a new calendar year and it is typical for this time to ponder what changes the new year will bring. One exciting change for International Psychogeriatrics (IPG) is the introduction of a new category of paper, the Brief Report.

Changes in cognition are known to follow anesthesia and surgery in older individuals (Evered et al., 2011). Although survival per se was the prime outcome in the 19th and early 20th centuries for invasive procedures, a link was none-the-less observed with adverse cognitive outcomes as far back as 1887 (Savage, 1887). Historical reports of “insanity” or “weak mindedness” after anesthesia appeared within 40 years of the first anesthetic having been administered and anecdotal and retrospective reports have implicated anesthesia ever since. However, it was not until the 1970s that these observations received any sound scientific evaluation, when clinicians became aware of cognitive changes following cardiac surgery. It was assumed that the cardiopulmonary bypass (heart lung machine) must have been the main culprit because it was this factor which so greatly distinguished cardiac surgery from non-cardiac surgery (Shaw et al., 1987). This long held belief entered surgical folklore and was the basis for many publications endeavoring to identify particular aspects of the heart lung machine responsible for this cognitive decline.

No breakthrough has been made in dementia research to find a cure in the last century (Selkoe, 2012), but a great deal of progress has been made in the description of pathology. The damage caused by this multifaceted “disease” has been described in terms of its physical, neuropsychological, and social manifestations at an individual level but also its societal impact at large, often in financial terms.

With the number of older drivers projected to increase by up to 70% over the next 20 years, preventing injury resulting from crashes involving older drivers is a significant concern for both policy-makers and clinicians. While the total number of fatal crashes per annum has steadily decreased since 2005 in Australia, the rate of fatalities has demonstrated an upward trend since 2010 in drivers aged 65 years and above (8.5 per 100,000), such that it is now on par with the fatality rate in drivers aged 17–25 years (8.0 per 100,000) (Austroads, 2015). Similar statistics are reported for the United States (NHTSA, 2012), implying there is a need for better identification of those older drivers who are unsafe and implementation of strategies that can enhance mobility while maximizing road safety.

Approximately 39 million older adults (age >65) were evaluated for traumatic brain injury (TBI) in United States emergency departments during the 2-year period from 2009 to 2010, representing a 61% increase in estimates from prior years (Albrecht et al., 2015a). Across the lifespan, an estimated 5.3 million Americans are living with a TBI-related disability (Centers for Disease Control and Prevention (CDC), 2003). With improved recognition and management, more individuals experiencing TBI are surviving to die of other causes later in life (Flanagan et al., 2005). Taken together, these statistics highlight two important populations: those who are “aging with a TBI” and “incident TBI in the aged.”

A variety of forces have shifted the conceptualization of elder abuse over time to where it is almost unrecognizable when compared to its original conceptualization. The field has adopted or embraced whatever social problem is in vogue in an attempt to elevate elder abuse to a recognizable social problem that to date has eluded the field. This paper traces the various influences on the shifting conceptualizations of elder abuse and how those conceptualizations have shaped society's response. The paper concludes by suggesting that multiple conceptualizations can and must co-exist, a framework which is consistent with the multidisciplinary team approach becoming prevalent in the field.

In 2014, International Psychogeriatrics (IPG) for the first time introduced a “paper of the month” category as part of the 25th year's milestone celebrations. Papers of the month were chosen through an internal selection process by the IPG editorial team. Each month, the seven editors ranked suitable accepted papers from the categories “original research articles” and “reviews” according to scientific quality and clinical relevance. Each paper of the month was accompanied by a brief commentary written by one of the IPG editors, one of the reviewers for the paper, or an international expert on the specific topic of the paper. From the 12 papers of the month, an IPG paper of the year was selected after a ranking process involving three independent expert reviewers.

Medical associations globally have had to come to grips with new realities in the 21st century. Knowledge transmission has undergone a revolution. Universities, learned colleges, and professional organizations are no longer the custodians of information. New journals spring up weekly and the challenges for most professionals is deciding what not to read. Professional meetings used to be how we meet like-minded associates; now face-to-face conferences are just one of many options to interact with colleagues. Tighter rules regarding relations between industry and healthcare practitioners have resulted in decreased sponsorships, less profitable conferences, and reduced funding generally.

We have arrived at an exciting juncture in dementia research: the second major pathological hallmark of Alzheimer's disease (AD)–tau–can now be seen for the first time in the living human brain. The major proteinopathies in AD include amyloid-β plaques and neurofibrillary tangles (NFTs) made of hyperphosphorylated paired helical filament (PHF) tau. Since its advent more than a decade ago, amyloid PET imaging has revolutionized the field of dementia research, enabling more confident diagnosis of the likely pathology in patients with a variety of clinical dementia syndromes, paving the way for the identification of people with preclinical or prodromal AD pathology, and serving as a minimally invasive molecular readout in clinical trials of putative disease-modifying interventions. Now that we are on the brink of a second revolution in molecular imaging in dementia, it is worth considering the likely potential impact of this development on the field.

Delirium is defined as a neurocognitive disorder characterized by sudden onset, fluctuating course, and disturbances in level of consciousness, attention, orientation, memory, thought, perception, and behavior (American Psychiatric Association, 2013). It occurs in hyperactive, hypoactive, or mixed forms in up to 50% of older hospital patients (Inouye et al., 2014) and 70% of older long-term care residents (McCusker et al., 2011), many with pre-existing dementia (Fick et al., 2002).

Delirium is common and is commonly misdiagnosed, chiefly in being missed (Bhat and Rockwood, 2007). The consequences of misdiagnosis are often severe and wide ranging, affecting patients, caregivers, health professionals, and hospitals (Inouye et al., 2014). Many an older hospitalized person with delirium is trapped in the interface between psychiatry and the rest of medicine, and can too easily be caught in the tendentious battles between treating teams. Both researchers and policymakers have sought to improve this unacceptable state of affairs (Young et al., 2010; Tieges et al., 2015).

The review by Bird and colleagues (2016), published in this issue of International Psychogeriatrics, is notable for jointly examining the effect of dementia care interventions on both staff and resident quality outcomes. This is an important contribution to improving dementia care because it recognizes the dynamic and dyadic relationship between residents and their caregivers in residential settings. While evidence exists on the dyadic effect of family caregiver intervention on dementia patient outcomes (Gitlin and Hodgson, 2015), less attention has been given to formal caregivers in institutional settings (Dellefield et al., 2015).

In light of the growing burden of dementia, continued research into risk factors and potential contributors to disease development is essential. Clearly established risk factors can not only inform our understanding of disease pathophysiology and treatments but also identify potential preventive strategies. While age and the ApoE4 allele have consistently been shown to increase risk of developing dementia (Kukull et al., 2002), other risk factors have been less studied or have had inconsistent findings. The study by Booker and colleagues (Booker et al., 2016) re-examines proposed late-life medical risk factors for incident dementia in a large population-based case-control study. This important contribution is best interpreted in the context of existing research.

Natural disasters by their very nature occur suddenly and have the potential to cause great harm at an individual, family, community, and societal level. They occur frequently, and with the escalation in extreme events related to climate change, the frequency, and severity of natural disasters will only increase (Intergovernmental Panel on Climate Change (IPCC), 2014). Globally, a growing number of people are being exposed to natural disaster; however, the vulnerability to exposure is not equally shared. Those who are socially, physically, economically, culturally, politically, institutionally, or otherwise disadvantaged are especially vulnerable to experiencing natural disaster.

Few would argue that achieving the age of 100 years is extraordinary, but what about the quality of life at this extreme age? Is it worth it to live to 100 and beyond? The study by Araújo, Ribero, Teixeira, and Paúl (2015) in three ways provided an answer to this question substantiating and complementing recent findings about successful aging in extreme old age (Poon and Perls, 2007; Martin et al., 2015). First, the study joined other investigators in asking whether the criteria for successful aging posed by Rowe and Kahn (1997) are applicable for older adults at the end stage of a very long life. Second, the study shed light on whether objective or subjective criteria are more appropriate to gauge levels of successful aging for the oldest old (e.g. Pruchno et al., 2010; Cho et al., 2012). Finally, the study provided additional data on psychological, social, and economic resources that enhance the needed ingredients of successful aging at the century mark.

The increasing prevalence of dementia with population aging has heightened interest in understanding patterns of utilization and health expenditures in persons with dementia (PWD) among policy officials, practicing physicians, and health system. While a substantial part of this interest is concerned with the high costs of care for people diagnosed with dementia (Kelley et al., 2015), less attention has been focused on the costs and consequences of missed or delayed diagnosis in those who screen positive for dementia. The article on “Healthcare resource utilization and cost in dementia: are there differences between patients screened positive for dementia with and those without a formal diagnosis of dementia in primary care in Germany?” by Michalowsky and colleagues (Michalowsky et al., 2015) in this issue makes a particularly important contribution in this regard.

Behavioral and Psychological Symptoms of Dementia (BPSD) or neuropsychiatric symptoms occur in more or less every person with dementia at some stage during the illness. They often have a significant impact on caregiver well-being and vice versa – caregivers response to BPSD can impact on the well-being of the care recipient with dementia (Feast et al., 2016A). The relationship between caregiver and care-recipient factors when it comes to BPSD is complex and more detailed research is needed to be able to progress to more effective interventions and support.

For almost two decades, O'Brien and colleagues have investigated virtually every facet of dementia with Lewy bodies (DLB), phenomenology, treatment, and neurobiology, ranging from genetics to post-mortem and in vivo imaging studies. The latest study from this group, reported here, describes differences in regional grey matter volumes using magnetic resonance (MR) imaging and an automated segmentation analysis method in a well-characterized sample of patients with Alzheimer disease (AD), DLB, and a healthy control group (Watson et al., 2015). The study incorporated detailed psychometric assessments of cognitive and motor functions for correlation with the grey matter volumes, and age, gender and dementia severity were included as covariates in the statistical analysis. The key observations are relatively greater hippocampal volumes and lower subcortical volumes in DLB compared to AD, but it is to be noted that most of these differences in subcortical volume were demonstrated indirectly through comparisons of the disease groups with age-matched healthy control subjects. Thus, replication in studies that make direct comparisons between DLB and AD subjects, perhaps in a larger sample size, is necessary. Still, these results highlight the potential for MR imaging to provide indicators of the extent of the neurodegenerative process in DLB. Furthermore, the results underscore the importance of correcting molecular imaging data for the effects of cerebral atrophy (partial volume correction) that may further enhance the ability of these methods to reveal pathophysiological processes.

The use of psychotropic medication among persons with dementia (PWD) both in nursing home (Wetzels et al., 2011) and community settings (Maust et al., 2016) far exceeds what might be expected based on their limited evidence for benefit (Kales et al., 2015). This relatively high use persists despite years of evidence about the potential harms associated with their use in older adults generally and PWD in particular (e.g. Wang et al., 2001; Schneider et al., 2005). However, the solution to relatively high psychotropic use is not to end all psychotropic use, as there are individual patients for whom use of such medication is appropriate. For example, a policy that defines all antipsychotic use as inappropriate may simply lead to increased use of alternatives with even less evidence of benefit, as suggested by the response to antipsychotics’ black box warning in the United States (Kales et al., 2011).