Applicants are sought for the position of Editor-in-Chief of International Psychogeriatrics, the prestigious academic journal (2007 impact factor – 2.207) owned by the International Psychogeriatric Association (IPA) and currently published six times per year by Cambridge University Press (CUP). The appointment will be for four years (January 2011 to January 2015) and the successful applicant will be eligible for re-appointment for a second four-year term (2015–2019) as determined by the IPA Board of Directors. Applicants are sought now, so that the successful candidate can be appointed as Editor-in-Chief elect at IPA's September 2009 Board of Directors (BOD) meeting. The intent is to ensure a smooth transition and enable the editor-elect to work closely with the current editor, Professor David Ames, to master the duties prior to assuming the position.

Traditionally, the prevalence of illicit and problematic drug use in the elderly was thought to be very low (Abrams and Alexopoulos, 1988; Rosenberg, 1995; Crome and Day, 1999; Simoni-Wastila and Yang, 2006). Indeed, in the most recent British Crime Survey respondents over the age of 59 years were not asked about illicit drug use because previous surveys indicated that less than 1% of those aged 60 years and over had taken illicit drugs in their lifetime (personal communication, Home Office Direct Communications Unit, 2007). The vast majority of epidemiological studies of illicit drug use and problematic use in the elderly are from the U.S.A., although studies from other countries are emerging. These epidemiological studies have either been population-based or of convenience samples.

Background: Alcohol problems in the elderly are common and frequently undetected, and therefore a potential target for a screening program.

Method: Using Medline, Psychinfo and reference lists from relevant publications, articles were identified testing pen-and-paper screens in the primary care population aged over 60 years.

Results: Using standard definitions of alcohol problems, conventional screens adapted for use in the elderly have performances similar to screens in the younger primary care population. However, it can be argued that special screens perform better for the elderly.

Conclusions: The Alcohol Use Disorders Identification Test is a useful screen for detecting harmful and hazardous drinking in the elderly while the CAGE is valuable when screening for dependence. In the future, the Alcohol-Related Problems Survey, a computer-based screen, may prove to be superior if practical implementation problems can be overcome.

Background: Previous studies have reported an association between executive dysfunction and the ability to perform activities of daily living (ADL)s among older adults. This study aims to examine the association between executive functions and functional status in a cross-section of older adults with varying degrees of cognitive impairment.

Methods: 89 individuals (mean age 73.8 years) were recruited at a memory clinic in São Paulo, Brazil. Subjects underwent evaluation, and were allocated into three diagnostic groups according to cognitive status: normal controls (NC, n = 32), mild cognitive impairment (MCI, n = 31) and mild Alzheimer's disease (AD, n = 26). Executive functions were assessed with the 25-item Executive Interview (EXIT25), and functional status was measured with the Direct Assessment of Functional Status test (DAFS-R).

Results: Significantly different total DAFS-R scores were observed across the three diagnostic groups. Patients with AD performed significantly worse in EXIT25 compared with subjects without dementia, and no significant differences were detected between NC and MCI patients. We found a robust negative correlation between the DAFS-R and the EXIT25 scores (r =–0.872, p < 0.001). Linear regression analyses suggested a significant influence of the EXIT-25 and the CAMCOG on the DAFS-R scores.

Conclusion: Executive dysfunction and decline in general measures of cognitive functioning are associated with a lower ability to undertake instrumental ADLs. MCI patients showed worse functional status than NC subjects. MCI patients may show subtle changes in functional status that may only be captured by objective measures of ADLs.

Background: Our study investigated the readability of printed material about dementia that is offered to patients and caregivers.

Methods: Comparisons of various brochures (at least three standard pages in length) on dementia and related disorders were made using automated measuring by the SMOG readability index grade.

Results: 118 brochures were assessed (25 in English, 93 in German), for which the mean readability was found to be high school/college level as measured by the SMOG readability index (grade 13.6 ± 1.8). No differences in readability were observed between materials produced by pharmaceutical companies and other sources. Furthermore, recently published brochures were not more readable than older ones. Shorter brochures, English brochures and those containing medical facts were easier to read than longer ones, those written in German or brochures primarily addressing psychosocial care/social issues. The sentence length was above the 20 word recommendation in 25% of the brochures. The average font size of the brochure texts was small (mean font size 11.1 ± 1.6 point) with only 25% of brochures having a font size of 12 or more, as recommended.

Conclusions: Written patient information and educational material of more than three standard pages is often published at unsuitably high readability levels using small fonts. Information material about dementia should be designed and tested prior to distribution among patients and caregivers. Future studies should address material shorter than three pages and material for younger caregivers.

Background: The aim of this study is to investigate the diagnostic value of perfusion 99mTc-exametazime single photon emission computed tomography (SPECT) in the diagnosis of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) in comparison with dopaminergic 123I-2β-carbomethoxy-3β-(4-iodophenyl)-n-(3-fluoropropyl) nortropane (FP-CIT) SPECT imaging.

Methods: Subjects underwent 99mTc-exametazime scanning (39 controls, 36 AD, 30 DLB) and 123I-FP-CIT scanning (33 controls, 33 AD, 28 DLB). For each scan, five raters performed visual assessments blind to clinical diagnosis on selected transverse 99mTc-exametazime images in standard stereotactic space. Diagnostic accuracy of 99mTc-exametazime was compared to 123I-FP-CIT results for the clinically relevant subgroups AD and DLB using receiver operating characteristic (ROC) curve analysis.

Results: Inter-rater agreement for categorizing uptake was “moderate” (mean κ = 0.53) for 99mTc-exametazime and “excellent” (mean κ = 0.88) for 123I-FP-CIT. For AD and DLB, consensus rating matched clinical diagnosis in 56% of cases using 99mTc-exametazime and 84% using 123I-FP-CIT. In distinguishing AD from DLB, ROC analysis revealed superior diagnostic accuracy with 123I-FP-CIT (ROC curve area 0.83, sensitivity 78.6%, specificity 87.9%) compared to occipital 99mTc-exametazime (ROC curve area 0.64, sensitivity 64.3%, specificity 63.6%) p = 0.03.

Conclusion: Diagnostic accuracy was superior with 123I-FP-CIT compared to 99mTc-exametazime in the differentiation of DLB from AD.

Background: Despite widespread use of second-generation cholinesterase inhibitors (CHEIs) for the symptomatic treatment of Alzheimer's disease (AD), little is known about possible long-term effects in different functional domains. This study seeks to assess change in activities of daily living (ADLs) over two years in AD patients treated with CHEIs matched to untreated patients in the same longitudinal cohort study.

Methods: This study is based on the two-year prospective cohort study at the Memory Clinic in Sunnybrook Health Sciences Centre, University of Toronto. Probable AD patients (N = 130: untreated = 65, treated = 65) underwent standardized neuropsychological assessments including the Disability Assessment for Dementia Scale (DAD), at baseline, one-year and two-year follow-up. Groups received a careful evaluation of comorbid illnesses, concomitant medication use, and vascular risk factors.

Results: At baseline, there were no significant differences in demographics and characteristics. Treated patients showed less decline in overall function and in instrumental and basic ADLs. Furthermore, less decline was seen in the overall scores for initiation and planning over two years with moderate to large effect sizes.

Conclusion: These findings have clinical relevance since functional ability has been increasingly recognized as a key outcome variable in AD treatment. It is also of note that the subscores reflecting executive functioning appear to drive these beneficial differences.

Background: Previous assessments of informal care time have tended to consider only the amount of time spent with the patient by the primary informal caregiver; however, in many cases, more than one person is providing care for the patient. We assess total informal care time of people caring for patients with dementia, and estimate the bias that can arise if consideration is not made of the time spent by all participating informal caregivers.

Method: We used an extended version of the questions on informal care time from the Resource Utilization in Dementia (RUD) instrument. Caregivers were asked to state the number of days and the number of hours on a typical day they had assisted the patient in activities of daily living (ADL), instrumental ADL (IADL), and supervision during the last four weeks. Multivariate regression analyses were conducted to identify factors that could account for the amount of informal care time.

Results: 357 informal caregivers took part. Values were missing from only 4.5% of all interviews. On average, the primary informal caregiver cared for the patient 1.5, 2.1 and 1.9 hours per day in ADL, IADL and supervision respectively. Fifty-seven percent of all patients had more than one informal caregiver. Total informal care time was underestimated by about 14% if the time of caregivers other than the primary caregiver was not taken into account. The informal care time was significantly higher if the caregiver was the patient's partner and the patient's health status was lower.

Conclusion: Our results show that most previous studies probably underestimated costs of informal care because the time of informal caregivers other than the primary caregiver was not considered.

Background: This study was designed to determine the effectiveness of a psychosocial intervention for family caregivers in delaying nursing home placement of individuals with dementia.

Methods: The participants comprised 153 family caregivers of persons with dementia who underwent intervention and 155 family caregivers who did not. The intervention consisted of five weekly counselling sessions and a three-month conversation group. All patients with dementia underwent a standardized assessment of cognitive and functional ability. The degree of burden and the subjective health of family caregivers were assessed. Participation continued until the patient moved to a nursing home or died, or until five years of living at home had passed.

Results: There were significant delays (6 months) in nursing home placement, and a longer time at home for persons with dementia with adult children as caregivers in the intervention group compared to the control group at follow-up (p = 0.004). A greater delay of institutionalization was found where intervention-group caregivers were daughters (p = 0.028). The proportional hazards regression showed factors associated with nursing home placement to be the family caregiver's influence on intervention (OR = 1.55, p = 0.019), caregiver gender (OR = 0.66, p = 0.033) and the patient's severity of dementia (OR = 1.45, p = 0.002).

Conclusion: Family caregiver intervention for adult children was significantly associated with prolonged time to nursing home placement.

Background: Too little is currently known about the prevalence of and risk factors for depression and carer strain among informal carers of community-dwelling elderly mentally ill. This study seeks to assess the prevalence of depression, using the Geriatric Depression Scale-15 (GDS-15), the degree of carer burden/strain, and their risk factors among the primary informal carers of patients referred to our community-based old age psychiatry service.

Methods: A cross-sectional study design was used, with the subjects comprising 100 primary informal carers of patients who live at home and were referred to our service. The main carer measures were the GDS-15 and an adapted version of Gilleard's Strain Scale. Patients were assessed the Clifton Assessment Procedure for the Elderly–Survey version, the GDS-15 and the Mini-mental State Examination.

Results: Depression was found in 21% of the carers (a score of 5 or more on the GDS-15). The more problem behaviors identified and the greater the functional impairment of the patient, the higher the strain score deciles and the more likely the carer was to be depressed. Spouses were associated with lower carer strain scores. Patient diagnoses did not affect carer depression or carer strain.

Conclusion: We found high levels of depression in the primary carers of community-dwelling patients attending an old age psychiatric service. The patients' behavior and their cognitive and functional ability conferred greater risk of carer depression or strain than their diagnosis. These risk factors may help identify carers at risk of strain and depression.

Background: Fluctuating hormone levels are known to influence a woman's mood and well-being. This study aimed to determine whether lifetime hormonal markers are associated with late-life depression symptoms among elderly community-dwelling women.

Method: Detailed reproductive histories of 1013 women aged 65 years and over were obtained using questionnaires, and depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale. Multivariate logistic regression models were generated to determine whether any lifetime endogenous or exogenous hormonal factors were associated with late-life depression.

Results: The prevalence of depressive symptoms was 17%. Age at menopause was associated with depressive symptoms, but only among women with a lower education level. For these women, an earlier age at menopause increased their risk of late-life depression (linear effect, OR = 0.95, 95%CI: 0.91–0.99). The odds of late-life depression were also increased for women who were past (OR = 1.6, 95%CI: 1.1–2.5), but were not current users. On the other hand, long-term oral contraceptive use (≥10 years) was protective against depression (OR = 0.3, 95%CI: 0.1–0.9). These associations remained significant even after extensive adjustment for a range of potential confounding factors, including sociodemographic factors, mental and physical incapacities, antidepressant use and past depression. The other factors examined – including age at first menses, parity, age at childbirth and surgical menopause – were not associated with late-life depressive symptoms.

Conclusions: Lifetime hormonal factors that are significantly associated with depression symptoms in later life have been identified. Further work is needed to determine how potential hormonal interventions could be used in the treatment of late-life depression in certain subgroups of women.

Background: Inadequate recognition of depression in old age in primary care and the consequences for individuals are now well reported, but little research has been undertaken on its impact on healthcare costs. It is not known whether these costs (i) differ between GP-recognized and -unrecognized depressed individuals, and (ii) differ between these groups and non-depressed individuals.

Methods: 451 primary care patients aged 75+ were interviewed face-to-face regarding depressive symptoms (Geriatric Depression Scale), chronic medical illness (Chronic Disease Score), resource utilization and healthcare costs (questionnaire of service utilization and costs). A general practitioner (GP) questionnaire was used to measure GPs' recognition of depression. Resource utilization was valued in monetary terms using 2004/2005 prices.

Results: Thirty-eight (60%) of the 63 depressed patients were not identified by the GPs. From a societal perspective, mean annual healthcare costs were €5,582 for unrecognized depressed and €4,722 for recognized depressed patients with no significant difference. Healthcare costs of recognized and unrecognized depressed exceeded the healthcare costs of non-depressed patients (€3,648) by 23% and 35% respectively (p < 0.05).

Conclusion: Although mean annual healthcare costs for GP-unrecognized depressed patients exceed the costs of GP-recognized depressed patients in absolute numbers, differences were not found to be statistically significant. Both groups differ from non-depressed individuals regarding their healthcare costs. Results encourage further research into the effect of recognition on healthcare costs of depression in large-scale studies.

Background: Elderly suicide rates may be influenced by mental health service provision.

Methods: A cross-national study examining the hypothesis that the relationship between elderly suicide rates and markers of mental health service provision would be curvilinear (inverted-U shaped curve) and fit the quadratic equation y = a + bx − cx2 (where y is the elderly suicide rate, x is a marker for mental health service provision, and a, b and c are constants) was undertaken by utilizing data from the World Health Organization.

Results: The relationship between the logarithm of suicide rates in both sexes in both the elderly age-bands and the percentage of the total health budget spent on mental health, the total number of psychiatric beds per 10,000 population and the total number of psychiatrists per 10,000 population were curvilinear (inverted U-shaped curve) and fitted the quadratic equation y = a + bx − cx2 with statistical significance.

Conclusions: The direction of the causal relationship could be examined in longitudinal studies, after further improvement in levels of mental health service provision, in individual countries segregated by low and high levels of existing mental health service provision.

Background: Despite the increase in the proportion of older people in the population, little is known about factors that facilitate the development of specialist mental health services for older people.

Methods: The relationship between the presence of specialist mental health programs for older people and elderly population size, proportion of older people in the population, gross national domestic product (GDP), and various parameters of health funding, mental health funding and mental health service provision was examined in an ecological study using data from the World Health Organization.

Results: The presence of specialist mental health programs for older people was significantly associated with higher GDP, higher expenditure on healthcare and mental healthcare, the presence of a national mental health policy and a national mental health program, the availability of mental health care in primary care and the community, and higher density of psychiatric beds, psychiatrists, psychiatric nurses, psychologists and social workers.

Conclusion: The challenge will be to persuade policy-makers in low and medium income countries, where the increase in the elderly population is most rapid, to develop specialist mental health services for older people.

Background: In elderly schizophrenia patients remission is difficult to determine due to long disease duration, exposure to differing treatments, long-standing side-effects, non-adherence, cognitive decline and physical comorbidity.

Method: Retrospective chart reviews were undertaken of 48 elderly (60+ years) schizophrenia patients admitted to a university-affiliated tertiary psychiatric center in 2006. These patients were experiencing an exacerbation of symptoms at admission. Remission criteria used were those of the American Psychiatric Association's “Remission in Schizophrenia Working Group”, and clinical status and improvement were quantified using the Clinical Global Impression scale (CGI).

Results: Of 25 patients treated with long-acting risperidone (LAR), 19 (76%) continued uninterrupted treatment for 6 months or longer. In six patients treatment was discontinued due to insufficient response. The clinical severity ratings with the CGI of all patients were in the range 5–7 prior to treatment. Following six months of LAR treatment, mean dose 36.0 mg/2 weeks (range: 25–50), 18 patients were rated as “improved” or “very much improved” on the CGI-global improvement item scale. In 15/25 patients (60%) symptomatic remission was achieved.

Conclusion: LAR may be effective in achieving remission among elderly schizophrenia patients. Tolerability was high and adherence rates improved. However, the results must be treated with caution owing to the inherent bias in this retrospective analysis.

Background: This study examines the psychometric properties of the Chinese version of the Activities of Daily Living Questionnaire (ADLQ-CV) in a sample of older Hong Kong Chinese adults with dementia.

Method: The ADLQ-CV was administered to primary family caregivers of 125 community-dwelling individuals with dementia. Assessments were then made of the scale's reliability, validity and factor structure.

Results: Factor analysis yielded six factors that closely resembled the six subscales proposed in the original scale. The ADLQ-CV demonstrated excellent convergent validity with the Chinese version of the Disability Assessment for Dementia (rp = −0.92, p < 0.001). The internal consistency of the ADLQ-CV was good (Cronbach's α = 0.81). Excellent test-retest reliability (ICC = 0.998) and inter-rater reliability (ICC = 0.997) of the ADLQ-CV were obtained. The ADLQ-CV showed a significant negative association with global mental states (rp = −0.80, p < 0.001), but it did not correlate with the age or educational level of individuals with dementia.

Conclusion: The findings suggest that the ADLQ-CV is a valid and reliable instrument for evaluating the functional abilities of Hong Kong Chinese people with dementia. The brevity and simplicity of administration make ita potentially useful tool for routine assessment of functional status of people with dementia in community or hospital outpatient settings.

Background: This study aims to develop and validate a Chinese translation of the 6-item De Jong Gierveld Loneliness Scale – a widely used instrument to measure loneliness – specifically determining its psychometric properties in community-dwelling Chinese elders in Hong Kong. The relationships between loneliness and several clinical variables are also assessed.

Method: The English version was translated into Chinese. Content validity was established by group discussion and Delphi panel. The questionnaire was administered to 103 Hong Kong Chinese community-dwelling elders. Statistical analysis was performed to test the reliability and validity of the scale.

Results: The content validity was high as shown by the results of the Delphi panel. Cronbach's α of the 6-item scale was 0.76. For the inter-rater reliability of the six items, the intra-class correlation coefficients ranged from 0.98 to 1.00. The emotional loneliness subscale significantly correlated with the social loneliness subscale (ρ = 0.37; p < 0.001). In using a direct question to measure loneliness, 21 participants (20%) reported that they were lonely. The overall loneliness scale score significantly correlated with the answers on the direct question of loneliness (rpb = 0.71; p < 0.001). The overall loneliness score showed significant correlation with Cornell Scale for Depression in Dementia (ρ = 0.29; p = 0.003), current smoking status (rpb = 0.24; p = 0.014), and some objective social characteristics.

Conclusion: The Chinese version of the 6-item De Jong Gierveld Loneliness Scale is a reliable and valid measure of loneliness in Chinese elders.

Background: Tailor-made care in dementia requires an individual needs assessment. The Camberwell Assessment of Need for the Elderly (CANE) was developed to assess needs of older people with mental disorders. In this study the validity and reliability of the Dutch version of the CANE were studied among community-dwelling persons with dementia and their informal carers.

Method: Interviews were carried out with 236 people with mild to severe dementia and 322 informal carers; 69 informal carers were interviewed twice. Construct and criterion validity and test-retest reliability of the CANE were studied using data for informal carers. Construct validity was also studied for CANE ratings of people with dementia.

Results: The construct validity of the CANE was good among people with dementia and informal carers. Criterion validity could be studied for 76.9% of the CANE items, and all significant correlations were convergent. Test-retest reliability of the CANE varied from poor to very good and was best on domains where needs were explicit and problems well defined.

Conclusions: Use of the Dutch version of the CANE among community-dwelling people with dementia and their carers is supported by the study results, with the study showing acceptable construct and criterion validity and test-retest reliability of the CANE.

Mukadam et al. (2008) report cholinesterase inhibitors to be effective in treating delirium. This suggests that cholinesterase inhibitors have a broader spectrum of effect than the treatment of dementia alone. Acetylcholine itself interacts with various other neurotransmitters. Cancelli et al. (2004) report that a fall in acetylcholine levels, as occurs in dementia, could increase sensitivity to serotonin agonists. Increased sensitivity to serotonin agonists and cholinergic hypoactivity seems to trigger complex visual hallucinations. It has been reported that selective serotonin reuptake inhibitors (SSRIs) may provoke suicidality, especially in young patients. SSRIs may decrease sensitivity of serotonin agonists and raise acetylcholine levels.

The number of studies aimed at analyzing caregiving distress among carers of people with dementia has grown exponentially in recent years. The study of variables that may help reduce the impact of caregiving demands on the health of caregivers is an issue of special interest for researchers. Self-efficacy is one of these variables. Perceived self-efficacy has been described as the subjective belief that one can organize and execute courses of action to manage given situations. Higher self-efficacy expectations regarding the caregiver's own ability to handle caregiving challenges have been significantly related to lower scores on burden, anger, anxiety and depression, even after controlling for objective stressors.