Alzheimer's disease pathology accumulates years before the onset of clinical symptoms and has been termed ‘preclinical dementia’. Biomarkers have been developed to detect this pathology – namely, brain amyloid deposition and markers of neurodegeneration. In this article we describe these biomarkers and review the evidence for their clinical use in predicting risk both in the cognitively ‘normal’ and in those who already have established cognitive decline. We also discuss the limitations and ethical considerations of these tests and consider whether we should start incorporating Alzheimer's disease biomarkers into clinical practice. We find that, because many cognitively healthy people will have Alzheimer's pathology, and it is not clear whether this does help predict future risk of Alzheimer's disease, diagnosing preclinical dementia carries numerous ethical implications and is currently not being advocated outside research settings.

The provision of mental health teaching and training to staff in the care home sector by a dedicated educational team was established in Bridgend in 2003. A multiprofessional old age liaison psychiatry team was created in 2009 specifically to link closely with the teaching staff, further building on previous work on referral coordination and a single point of access. This article describes the application of barrier analysis to deliver both this new service and mental health education to the care home sector. Imaginative uses of information technology and multimedia to support the efforts of all staff are described, as are some pitfalls and hazards to avoid. The most effective elements of these developments are discussed, using barrier analysis as the explanatory model, with an emphasis on aspects that could be adopted more widely.

As we doctors are beginning to understand more and more about dementia, the public has become increasingly aware of the condition and in turn this has been reflected in the arts. This article discusses four books whose main focus is the experience of dementia, each written from an entirely different perspective: a novel giving a first-person account of dementia by the Dutch writer J. Bernlef; a biography of the famous novelist Iris Murdoch by her husband John Bayley; Linda Grant's account of her mother's multi-infarct dementia (which also describes Jewish migration to the UK two generations ago); and Michael Igniateff's autobiographical novel Scar Tissue. Such accounts, offering insights into how patients and carers feel, cannot but help make us better doctors.