It is both an honor and a privilege to introduce the winners of the sixth biennial IPA Research Awards in Psychogeriatrics, sponsored by Bayer AG. On behalf of IPA and the entire psychogeriatric community, I want to thank Bayer for their very generous support of these awards since their inception in 1989.

The global regulatory environment strongly affects the development of effective medications to treat behavioral and psychological symptoms of dementia (BPSD) (Whitehouse, 1998b). Since its inception in 1994, the International Working Group for Harmonization of Dementia Drug Guidelines (IWG) has been working to foster dialogue on dementia drug development among academics, regulators, industry representatives, and patients and their families. In this overview, I describe the IWG's mission, people, and recent activities (Whitehouse, 1998c), and its activities concerning BPSD in several regions throughout the world.

Alzheimer's disease (AD) is an example of cortical dementia, where most of the pathological changes lie in cortical association areas and the predominant clinical features are symptomatic of cortical dysfunction. The differential diagnosis of AD is complex and is usually made in two stages: diagnosis of the dementia syndrome and diagnosis of the underlying etiology. Each of these stages is complicated by the existence of conditions that mimic dementia in presentation and by the risk of inappropriately diagnosing AD where other conditions are responsible for the dementia state. Despite the fact that the concept of dementia, in terms of a decline in cognitive function and behavioral change, has existed for many years, there is still a general lack of agreement about the components of the syndrome. This article reviews the issues surrounding the differential diagnosis of the dementia syndrome and explores the points of differentiation between AD and some similar etiologies encountered when making a differential diagnosis.

I have chosen the 30 years, 1969–1999, for this article, because this represents my psychiatric career from entry into the training scheme at the Maudsley Hospital to being current head of the old-age group at the Institute of Psychiatry. What becomes apparent, on looking back, is that the developments at this campus, which contains a psychiatric teaching hospital and a postgraduate research institute, reflect those in the UK over that time. In many areas, the lead has come from here. These activities will be reviewed and some challenges for the next decade proposed. The latter will be personal, from a researcher with an epidemiological/public health perspective.

Delirium is a recognized cause of behavioral disturbances of dementia. Yet the proportion of cases of behavioral disturbances resulting from delirium is difficult to determine. In many epidemiologic studies, delirium is excluded as a causal factor. In the few studies that describe delirium as an underlying cause of behavioral disturbances, the mechanism by which delirium is diagnosed and the extent of the diagnostic workup are rarely delineated.

Our top and middle management initially received thorough training in group theory and group management techniques for organizational reasons. In daily shift meetings, nurse aides (NAs) learn some of the techniques and approaches, translating part of them to work with patients. From the moment we started to focus on the day-care center patients as a group to be managed every minute, we found that disturbances decreased significantly (based on empiric assessment by staff).

Assessment of progress in geriatric psychiatry in Canada is a difficult task. There are no good and easily accessible measures; the process of assessment is influenced by personal values and emotions; to a large extent, progress in geriatric psychiatry defies national and even subspecialty boundaries. Difficulties notwithstanding, I have attempted a brief, dispassionate assessment that focuses on training, personnel, services, professional organizations, and research activity.