Addressing inequalities between mental and physical healthcare in older adult healthcare is imperative for safe patient care. This evaluation of services at The Harbour mental health hospital, Blackpool, UK gives insight into parity of esteem and prompts investigation into the clinical decisions of doctors working in older adult mental healthcare.

This review of available longitudinal structural imaging and immunological findings in first-onset schizophrenia, bipolar disorder, attention-deficit hyperactivity disorder (ADHD) and autism suggests that different patterns of synaptic pruning lead to various phenotypes. Proposals for future research strategies to try to replicate these findings are suggested, potential biomarkers to assist in diagnosis and determining the optimum duration of maintenance treatment are considered and ideas of potential immunotherapy augmentation are outlined.

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.