Background: The Rivermead Behavioural Memory Test (RBMT) assesses everyday memory by means of tasks which mimic daily challenges. The objective was to examine the validity of the Brazilian version of the RBMT to detect cognitive decline.

Methods: 195 older adults were diagnosed as normal controls (NC) or with mild cognitive impairment (MCI) or Alzheimer's disease (AD) by a multidisciplinary team, after participants completed clinical and neuropsychological protocols.

Results: Cronbach's α was high for the total sample for the RBMT profile (PS) and screening scores (SS) (PS = 0.91, SS = 0.87) and for the AD group (PS = 0.84, SS = 0.85), and moderate for the MCI (PS = 0.62, SS = 0.55) and NC (PS = 0.62, SS = 0.60) groups. RBMT total scores, Appointment, Pictures, Immediate and Delayed Story, Immediate and Delayed Route, Delayed Message and Date contributed to differentiate NC from MCI. ROC curve analyses indicated high accuracy to differentiate NC from AD patients, and, moderate accuracy to differentiate NC from MCI.

Conclusions: The Brazilian version of the RBMT seems to be an appropriate instrument to identify memory decline in Brazilian older adults.

Social isolation is an important determinant of elderly suicides (Shah and De, 1998). If elderly people have telephones then social isolation can be reduced as they can contact friends and relatives and vice versa. Also, the elderly can use the telephone to seek help from telephone helplines, general practitioners, social workers, psychiatric services and friends and relatives. Additionally, general practitioners, social workers, psychiatric services and friends and relatives can contact elderly people to check on them and support them. However, a major criticism of such interventions is that those determined to kill themselves are unlikely to use a helpline. There are several studies looking at the relationship between suicide and telephone help lines. These studies showed evidence that the helpline reduced suicidality during the course of the telephone consultation or immediately afterwards and reduced the number of re-attempted suicides (De Leo et al., 1995; Mishara and Daigle, 1997; Vaiva et al., 2006; Gould et al., 2007). A study of elderly participants reported an association between lower suicide rates and availability of a telephone help and telephone check service (De Leo et al., 1995). This service provided elderly people with home assistance by allowing them to call for help and to receive weekly assessments of needs and emotional support. However, there are only a limited number of studies in this area. Therefore, a cross-national study examining the relationship between elderly suicide rates and the prevalence of societal use of telephone was undertaken.

Background: The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales.

Methods: A pilot questionnaire study examined the experience of consultants in Old Age Psychiatry in the early implementation of the MCA pertaining to local policy and training in the application of the MCA, the assessment of decision-making capacity, the determination of best interests, and the use of the least restrictive option and restraint.

Results: Fifty-two (27%) of the 196 consultants in Old Age Psychiatry returned useable questionnaires. Seventy-five percent of them reported that local training on the application of the MCA was available, but less than 50% reported that training was mandatory. The vast majority of assessments of decision-making capacity were conducted by consultants in Old Age Psychiatry. Almost all of them reported using the four-fold specific test of decision-making capacity (DMC) described in the MCA. Restraint was reported to be rarely used.

Conclusions: Consultants in Old Age Psychiatry generally reported using the criteria for the assessment of DMC, the determination of best interests and restraint described in the MCA. The findings highlight concern about the workload of clinicians in implementing the MCA and this requires careful monitoring. Consideration should be given to statutory provision of training in the application of the MCA by all healthcare and social care providers for all their healthcare and social care staff.

Behavioral changes and cognitive decline are the core clinical manifestations in the behavioral variant of frontotemporal dementia (bv-FTD). The behavioral changes may include characteristic stereotypic movements. These movements, although without clear purpose, are not involuntary. Involuntary movements are usually not seen in FTD.

Two patients with involuntary choreoathetoid movements but otherwise presenting a bv-FTD-phenotype were referred and Huntington's disease (HD) was suspected. The diagnoses of bv-FTD were made after comprehensive assessment and exclusion of other diagnoses, including HD and Huntington's disease-like (HDL) phenotypes. Although a definite diagnosis will require neuropathological confirmation, we conclude that a HDL phenotype may be part of the clinical spectrum of the bv-FTD phenotype.

We describe an 81-year old female patient who was seen at our outpatient clinic with a history of falls. The clinical diagnosis was concurrent with depressive symptoms, but an arachnoid cyst turned out to be the cause of her problems. The patient recovered completely after surgery.

We report on the treatment of a patient suffering from dementia with Lewy bodies who initially presented with severe neurological and psychopathological symptoms. After treating the patient with levodopa and clozapine, these symptoms remitted.

Background: Anxiety has a high prevalence among individuals with dementia, and it has a significant negative impact on their functioning; yet intervention studies are lacking. We developed Peaceful Mind, a cognitive-behavioral intervention for persons with dementia. In this paper, we describe the intervention and results of an open trial evaluating the feasibility and utility of the intervention and assessment procedures.

Methods: Peaceful Mind is implemented over a period of three months in the participant's home with involvement of a caregiver or “collateral.” Dyads are followed for an additional three months via telephone. An assortment of simplified skills is offered, including self-awareness, breathing, behavioral activation, calming thoughts, and sleep skills.

Results: Nine participants were enrolled, eight completed the three-month assessment, and seven completed the six-month assessment. Overall, participants and collaterals were satisfied with the intervention and reported that they benefited in terms of anxiety, depression, and collateral distress.

Conclusions: A randomized controlled trial would help determine whether this promising new treatment has a statistically significant impact on anxiety in this population.

The authors regret an error they made in the Results section of the Abstract. The sentence beginning “MANCOVAS indicated that securely attached individuals score higher than fearfully attached indivduals” should read: “MANCOVAS indicated that securely attached individuals score lower than fearfully attached indivduals.”

We read with great interest the review by Nitrini et al. on the prevalence of dementia in Latin America recently published in International Psychogeriatrics (Nitrini et al., 2009). Accurate up-to-date figures are essential for policy-making and planning, therefore the review is very welcome. With unfortunate timing, the 10/66 Dementia Research Group's population-based surveys on the prevalence of dementia were published in the Lancet (Llibre Rodriguez et al., 2008a; 2008b) shortly after this review was submitted to International Psychogeriatrics. The 10/66 surveys included seven sites in five Latin American countries: Peru, Cuba, Dominican Republic, Mexico and Venezuela. The studies were all one-phase catchment area surveys, with samples of 2944 in Cuba and between 1904 and 2011 in other countries, giving a total sample size of 10,794. We present in Table 1 the prevalence of dementia according to our cross-culturally validated 10/66 diagnosis and according to DSM-IV criteria, in each of the Latin American sites, using the same age group stratification as per Nitrini's review. We also present the pooled estimates for each age group. The 10/66 estimates are in general more homogenous than those presented in the review, but similar to the overall pooled estimate. DSM-IV prevalence is lower. We have attributed this discrepancy to an under-reporting of cognitive decline and social/occupational impairment by relatives, particularly in rural and least developed regions (Llibre Rodriguez et al., 2008b). We have shown that, at least for Cuba, the 10/66 Dementia Diagnosis agreed better than the DSM-IV with a clinician gold standard diagnosis, as a high proportion of Clinical Dementia Rating mild and moderate cases were missed by DSM-IV (Prince et al., 2008).

Completed suicides have been shown to be associated with smoking cigarettes in cohort studies of mainly female registered nurses in the U.S.A. (Hemenway et al., 1993), both sexes in the Finnish general population (Tanskanen et al., 2000), male army recruits in the U.S.A. (Miller et al., 2000a), males in the U.S. general population (Davey Smith et al., 1992), army recruits in Sweden (Hemmingsson and Kriebel, 2003), males aged 40–69 years in the general population in Japan (Iwasaki et al., 2005), and the elderly in a retirement community in the U.S.A. (Ross et al., 1990). Also, a Swiss case-control study of army recruits reported similar findings (Angst and Clayton, 1998). Additionally, positive correlation between prevalence rates of smoking and both general population (Shah and Bhandarkar, 2008) and elderly (Shah, 2008) male suicide rates has been observed in large cross-national ecological studies. This relationship between completed suicides and smoking was “dose-dependent” (Hemenway et al., 1993; Tanskanen et al., 2000; Miller et al., 2000a; Davey Smith et al., 1992; Hemmingsson and Kriebel, 2003; Iwasaki et al., 2005). Moreover, this relationship was maintained in some studies after controlling for confounding variables including demographic characteristics, socioeconomic characteristics, levels of alcohol consumption, psychiatric symptoms and physical health (Tanskanen et al., 2000; Miller et al., 2000a), but disappeared in other studies (Hemmingsson and Kriebel, 2003; Shah, 2008; Shah and Bhandarkar, 2008).

Background: Dementia with Lewy bodies (DLB) accounts for 15–20% of the millions of people worldwide with dementia. Accurate diagnosis is essential to avoid harm and optimize clinical management. There is therefore an urgent need to identify reliable biomarkers.

Methods: Mass spectrometry was used to determine the specificity of antibody α-synuclein (211) for α-synuclein. Using gel electrophoresis we measured protein levels detected by α-synuclein specific antibodies in the cerebrospinal fluid (CSF) of DLB patients and compared them to age matched controls.

Results: A 24 kDa band was detected using α-synuclein specific antibodies which was significantly reduced in the CSF of DLB patients compared to age matched controls (p < 0.05). Further analysis confirmed that even DLB patients with mild dementia showed significant reductions in this protein in comparison to controls.

Conclusions: The current study emphasizes the necessity for further studies of CSF α-synuclein as a biomarker of DLB and extends our previous knowledge by establishing a potential relationship between α-synuclein and the severity of cognitive impairment. The identification of this 24 kDa protein is the next important step in these studies.

On the title page, the authors' affiliations need to be reversed. The first author is affiliated to the Gerontology Department at the School of Arts, Sciences and Humanities (EACH), University of São Paulo, and the remaining authors are affiliated to the Psychogeriatric Unit, Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo.

We report a case of a 63-year-old man who experienced his first manic episode, and then, one year later, experienced a second episode which was associated with a significant loss of brain parenchyma. Two computed tomography (CT) brain scans were performed at each manic episode to observe brain structure. Significant loss of brain parenchyma was shown using CT scans. A Mini-mental State Examination (MMSE) score of 29 was observed after the first manic episode and a score of 23 was obtained after the second manic episode. This case report supports the idea that an increased risk of developing dementia exists in patients with major affective disorders.

Falls are the commonest cause of trauma in older adults and are of particular concern in hospital settings (Ojo et al., 2009). Osteoporotic fractures occurring as a consequence of falls are a leading cause of morbidity and mortality in this population (Stubbs et al., 2009). Older adult psychiatric long-stay patients are at elevated risk of osteoporosis, with one recent study confirming this link by demonstrating that over half had osteoporosis (58%) with just under one-third having ostetopenia (32%) (Stubbs et al., 2009). The incidence of falls is known to be higher in psychiatric settings, and this is particularly so in older adult settings (Blair and Gruman, 2006). Risk factors predisposing older adult psychiatric patients to falls include chronic illness, high rates of cognitive disturbance, psychotropic medication use and behavioral manifestations, and in particular agitation and wandering, two factors which are both strongly associated with falls (Blair and Gruman, 2006). Clearly, older adult psychiatric patients are at an elevated risk of falls (Blair and Gruman, 2006). Even if a patient has not fallen prior to hospitalization, the mere presence of being admitted immediately increases their subsequent falls risk (Blair and Gruman, 2006).

Some patients with dementia with Lewy bodies (DLB) exhibit persistent disturbing psychiatric symptoms or challenging behavior despite treatment with cholinesterase inhibitors. Such patients pose one of the more difficult clinical management problems faced in psychogeriatrics. Neuroleptics are quite rightly avoided whenever possible and the cautious “start low/go slow” maxim, which most clinicians apply when neuroleptics have to be used, often turns into a chronic “stay low/get no (response)” situation. Memantine has recently been reported to produce cognitive and global benefits but without any significant improvement in psychiatric symptoms (Aarsland et al., 2009) and there are no other specific treatment recommendations for this clinical scenario.

Background: Delirium exemplifies the interface between medicine and psychiatry. The mainstay of treatment of delirium are the antipsychotic drugs. These are efficacious and safe for the treatment of delirium. In the last decade the use of second generation antipsychotics has been advocated at the expense of the classical drugs, particularly haloperidol. We thus aimed to compare the outcome of delirium treatment in a large, university-affiliated general hospital.

Methods: We used retrospective medical charts analysis over a one-year period. Those included were all patients who had been admitted to an acute internal medicine ward for delirium or who had developed delirium during their hospital stay.

Results: 191 patients' records were analysed. Mean age for the group was 78.8 ± 1.1 years. There were 108 males (56.5%) and 83 (43.5%) female patients. The most frequent co-morbid psychiatric diagnosis was that of dementia (106; 56%). The most common physical conditions were: cardiovascular (75 patients) and sepsis (24 patients). Patients suffering from delirium were mostly treated with an antipsychotic: 147 (77%) were treated either with risperidone (73 patients) or classical antipsychotics (74 patients). The most frequently used classical antipsychotic was haloperidol (59/74). Mean risperidone dose was 1.7 ± 0.4 mg/daily. Mean haloperidol dose was 7.8 ± 1.9 mg/daily. Mean duration of antipsychotic treatment was 3.8 days for the classical antipsychotics group and 2.6 for the risperidone group (p = 0.04). In the untreated group, mean delirium episodes lasted 5.6 days – significantly longer than that of either treated groups, p = 0.02.

Mean hospital stay (days) for the group was 12.8 ± 1.4. In the risperidone treated group the mean stay was 10.8 days while in the classical antipsychotics group it was 13.5 and in the untreated group it was 15.5 (p = 0.008). Fourteen patients (7.3%) died during the delirium episode: 10 untreated, 3 treated by classical antipsychotics and 1 risperidone treated (p = 0.04). The majority of patients (65%) were discharged to the community.

Conclusions: The present study adds to the growing body of evidence favoring risperidone as the drug of choice for the treatment of delirium. However, due to the limitations inherent in a retrospective analysis, prospective large-scale trials are needed to support this recommendation.

Papers submitted to International Psychogeriatrics undergo peer review, with each manuscript being assessed by two or more reviewers possessing expertise relevant to the paper's topic. The advice of reviewers is often highly valuable to authors working to strengthen papers through revision, and their recommendations are central to the process of determining what is published in International Psychogeriatrics.