Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are the two most common types of degenerative dementia. It has been questioned whether they are totally separate conditions, or whether they are in fact both part of a spectrum of a more general neurodegenerative disease. Fluctuating cognition and parkinsonism are key features of DLB, but atypical in AD which is characterized by progressive amnesia, aphasia, agnosia and apraxia. Neuropsychiatric disturbances also seem to be more common in DLB. The main neuropathological features of DLB are Lewy bodies, and in AD are senile plaques and neurofibrillary tangles, though some overlap has been found. A key finding of neuroimaging studies is that there is relative preservation of brain volume in DLB patients compared with AD patients, particularly of temporal lobe structures. There are also profound reductions in striatal dopamine transport in DLB, demonstrated by single photon emission computerized tomography (SPECT) imaging. Whilst there are some distinct differences between AD and DLB, further research is needed to greater define the distinctions between these two conditions.

Obesity is a worldwide problem with increasing prevalence and incidence in both developed and developing countries. In older adults, excess weight is associated with a higher prevalence of cardiovascular disease, metabolic disease, several important cancers, and numerous other medical conditions. Obesity has also been associated with increased functional limitations, disability, and poorer quality of life. Additionally, obesity has been independently associated with all-cause mortality. The obesity epidemic has important social and economic implications, representing an important source of increased public health care costs. The aim of this review is to report the epidemiology of obesity worldwide, and the implications of obesity on disability and chronic diseases in older adults.

Cerebral infarction, as the result of atheroma in large blood vessels, was one of the first explanations for dementia in older people. However, this was a relatively uncommon finding in those presenting with dementia and it was soon realized that subcortical infarctions due to non-atheromatous changes in small blood vessel walls were more important factors in cognitive decline. Furthermore, small vessel disease (SVD) producing lacunar infarcts (LI) and white matter changes increased dementia severity in individuals with only moderate Alzheimer's disease (AD) pathology. Magnetic resonance imaging (MRI) found subcortical (lacunar) ‘silent infarcts’ and white matter changes were surrogate markers for SVD and increased significantly the likelihood of developing dementia. Detailed histopathological studies of SVD showed it was in fact a range of pathologies, but the aetiology of the most common type (arteriosclerosis/lipohyalinosis) is difficult to explain. Theories to explain SVD include effects of hypertension, a leaky blood–brain barrier (BBB), amyloid accumulation, microbleeds, venous changes and endothelial inflammation. Endothelial expressed inflammatory molecules could represent potential biomarkers of SVD. Many of the risk factors associated with SVD are also present in AD, such as diabetes, systemic hypertension and ageing; all of these can target the endothelium with the potential to initiate SVD, resulting in ischaemic changes and neurodegeneration, including AD pathology.

China has an increasing ageing population. Depression, as one of the most common problems in older people, is a concern that merits attention. This paper reviewed published studies of the prevalence of depression and its related factors in older people in China. Seventeen papers were identified by searching the following electronic databases: Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Whilst prevalence varied across studies, health status, social support, financial status, living arrangements and some demographic factors were consistently related to older people's depression. Further well-designed studies are needed to explore depression in older people in China to identify more culture-specific contributors to maximize well-being.

Frailty is common in older age, and is associated with important adverse health outcomes, including increased risk of disability and long-term care admission.

This study aims to evaluate whether home-based exercise interventions improve outcomes for frail older people.

We searched systematically for randomized controlled trials (RCTs) and cluster RCTs, with literature searching to February 2010.

All trials that evaluated home-based exercise interventions for frail older people were eligible. Primary outcomes were mobility, quality of life and daily living activities. Secondary outcomes included long-term care admission and hospitalization.

Six RCTs involving 987 participants met the inclusion criteria. Four trials were considered of high quality. One high-quality trial reported improved disability in those with moderate but not severe frailty. Meta-analysis of long-term care admission rates identified a trend towards reduced risk. Inconsistent effects on other primary and secondary outcomes were reported in the other studies.

There is preliminary evidence that home-based exercise interventions may improve disability in older people with moderate, but not severe, frailty. There is considerable uncertainty regarding effects on important outcomes including quality of life and long-term care admission. Home-based exercises are a potentially simple, safe and widely applicable intervention to prevent dependency decline for frail older people.

The psychosocial characteristics of older heroin-dependent patients (defined as 45 years and over) attending a specialist addiction clinic in Stoke on Trent, UK were studied using retrospective record analysis of the case notes of the 20 oldest heroin-dependent patients. This study draws attention to the multiple psychosocial problems facing ageing heroin addicts. On average, patients were 48 years old, had first been exposed to heroin at age 29, 85% were injectors and the majority were polydrug users. In 20% a major life event had preceded first use of heroin. Nineteen were male, 17 were single, only 10% were employed, while just 10% did not have a criminal history. Depression, self-harm and memory disturbance were frequently reported. Retention in treatment was a feature, with consequent improvements including reduction in criminality and injecting behaviour. However, there is little specific guidance on treatment, training or policy for this group in the UK.