Neurosyphilis can present with psychiatric symptoms. The late form can occur in old age with psychosis, paranoid delusions, affective disorders or cognitive impairment. Here we present a case of neurosyphilis in an elderly woman who, over six months, progressively manifested personality changes and paranoid delusions which were initially suspected as Alzheimer's disease. Psychotic symptoms showed a good response to antibiotic treatment. We conclude that neurosyphilis is a relevant differential diagnosis in patients developing severe psychiatric symptoms in old age. As a causal antibiotic treatment is possible this infectious disease should be considered seriously in gerontopsychiatric patients.

Background: Male sexual dysfunction is a significant international public health issue affecting both middle-aged and older adults. To date, however, no studies have compared age differences in psychiatric issues, frequency of sexual activity and treatment recommendations between older and middle-aged male military Veterans seeking treatment for erectile dysfunction (ED) in the U.S.A.

Methods: Data were collected between 1982 and 2003 at the Palo Alto Veterans Affairs Andrology Clinic. The 1,250 participants, aged 22 to 87 years (median = 63), completed a semi-structured interview. Using multiple linear regressions, we examined age differences in five domains: medical and endocrine risk factors; psychiatric and psychosocial risk factors; frequency of sexual behaviors; self-reported and objectively measured erectile function; and treatment recommendations.

Results: Compared with middle-aged adults, older adults were more likely to present for ED treatment with medical risk factors and were more often recommended a vacuum pump treatment. Middle-aged male Veterans were more likely to experience psychiatric risk factors for ED and were more sexually active than older Veterans. Despite greater objective erectile ability in middle-aged adults, there were no age differences in maximum self-reported erectile functioning.

Conclusions: These results provide some evidence of age-related characteristics and treatment needs of male patients seeking treatment for sexual dysfunction. We encourage health care professionals working with adults across the lifespan to consider ways to individualize psychoeducation and brief psychotherapy for the treatment of ED to the specific needs of the patient, which may vary between middle-aged and older cohorts of patients.

There is considerable evidence that pro-cholinergic agents can cause depressed mood. However, there are also published case reports of a rare association between cholinesterase inhibitors and mood elevation in patients with pre-existing major functional psychiatric disorders, or organic disorders other than dementia. This report adds to the literature by describing a case of mood elevation in a patient without pre-existing psychiatric disorder.

A 78-year-old female with a nine-year history of depression was hospitalized due to worsening depression and symptoms associated with Parkinson's disease (PD). Her motor abilities improved on levodopa and the depression improved after a trial of bupropion, following unsuccessful treatment with other antidepressants. We found four reports on successful treatment of depression in PD with bupropion. However, no controlled double-blind studies have been conducted so clinicians should be cautious when administering bupropion in depression in PD.

Background: This study aimed to investigate the risk factors associated with post-traumatic stress disorder (PTSD) symptoms in a mid- and old-age population who experienced Typhoon Morakot in Taiwan.

Methods: One hundred and twenty people, who were mostly Taiwanese aboriginal people aged 55 years and above, were invited to participate in this study. PTSD symptoms were assessed using the PTSD Symptom Scale (PSS-I). Information regarding demographic characteristics, relocation, personal injury, family death, property damage, and self-perceived health was collected.

Results: 29.2% of study participants presented significant PTSD symptomatology during the previous month. Development of PTSD symptomatology after the disaster was significantly associated with being female (OR 3.63, 95% CI = 1.11–11.88), experiencing relocation (OR 5.64, 95% CI = 1.60–19.88), and having poorer self-perceived health (OR 4.24, 95% CI = 1.53–11.78) after controlling for age, education, personal injury, family death, and property damage. Further, by adding depression into the analysis, we found the risk factors were being female (OR 4.66, 95% CI = 1.16–18.80), experiencing relocation (OR 27.91, 95% CI = 3.74–229.80), family death (OR 67.62, 95% CI = 2.85–1063.68), and poorer self-perceived health (OR 28.69, 95% CI = 4.52–182.06).

Conclusion: Nearly 30% of the elderly people studied who experienced Typhoon Morakot developed significant PTSD symptomatology. The risk factors for PTSD symptoms were female gender, poorer self-perceived health, relocation, family death, and depression. The elderly people who were relocated by governmental programs were more likely to develop PTSD symptomatology after experiencing trauma. Resettlement and rehabilitation programs after a disaster need to be more concerned with their psychological effects on victims.

Background: The aging population in prison is growing rapidly in the United Kingdom. This trend is also found in other countries worldwide. As this population increases prison authorities will need to adjust the custody process to accommodate increasing mental and physical frailty.

Methods: This study examined the prevalence of psychiatric disorders and physical disorders, including dementia, in prisoners aged 50 years and over from four prisons in and around Staffordshire to see whether detection and treatment rates have improved over the past decade during which there has been a dramatic increase in the number of older prisoners. Subjects were assessed using the Geriatric Mental State Examination, the Mini-Mental State Examination and Short Form 12 and their prison records.

Results: Sixty prisoners (50%) had a diagnosable mental disorder, with depression being most common, and 15 (12%) prisoners had signs of cognitive impairment. Only 18% of those with a psychiatric diagnosis were prescribed medication from the appropriate class. Physical problems were also common in this population with an average self-report of 2.26 problems per prisoner.

Conclusions: Mental disorders in older prisoners are common, but despite recent training initiatives they often go undetected and untreated. Prisoners themselves accurately self-report mental disorder, but the best way of detecting dementia in the prison population remains unclear. The psychological and physical health of this prison population was poorer than that of their community-based peers.

Visual hallucinations are well recognized in individuals with low vision and intact cognition (Charles Bonnet syndrome) (Teunisse et al., 1996). Visual hallucinations also occur in those with early manifestations of dementia with Lewy bodies (McKeith et al., 2005) and Parkinson's disease dementia (Williams and Lees, 2005). Typically, visual hallucinations in these conditions are complex recurrent hallucinations of people and animals and frequently reported as being unpleasant (Mosimann et al., 2006). Individuals with visual hallucinations are often reluctant to disclose details of their symptoms (Menon, 2005), but may instead report non-specific visual difficulties to their family physician or optometrist, resulting in referral to an eye clinic. Failure to elicit the presence of visual hallucinations may lead to inappropriate treatment of age-related ocular comorbidity, such as early cataract.

In cross-sectional studies, skull circumference and leg length are often inversely associated with dementia prevalence (Prince et al., in press). Skull circumference and leg length are thought to remain stable across the adult life course, but the associations might yet be explained by reverse causality. Weight loss in dementia could lead to loss of subcutaneous scalp fat. Osteoporosis mainly affects trunk proportions (loss of disc space, vertebral fractures and kyphosis), but limited knee extension could also lead to apparent reductions in leg length. No previous studies have assessed changes in these measurements over time in older people with and without dementia. Only two cohort studies have examined the effect of skull circumference (Borenstein et al., 2001) and knee height (Huang et al., 2008) on incident dementia. Even in cohort studies differential mortality can lead to bias.

There is little in the literature on auditory hallucinations in the deaf, although the phenomenon is obviously genuine. Bearing this in mind there is hardly anything on non-verbal hallucinations, let alone musical ones.

In general medicine, falls among older adults and the consequences of such falls have been the focus of a plethora of empirical and scholarly research efforts. This is for good reason since falls are the leading cause of accidental death in older adults and are a major cause of morbidity and mortality (Currie, 2006). It is estimated that between a third and a half of adults aged over 65 years fall each year (Lim et al., 2001). The cost to healthcare systems is significant; for example, in the U.S.A. non-fatal falls cost between $16 billion and $19 billion per annum (Stevens et al., 2006). Despite advances in general medicine, there is a relative dearth of empirical data on the incidence of falls in older adults.

Background: Care management providing a high quality of life (QoL) is a crucial issue in dealing with increasing numbers of dementia patients. Although the transition from informal (home-based) care to formal (institutional) care is often a function of dementia stage, for those with early dementia there is currently no definitive evidence showing that informal or formal care provides a higher QoL, particularly where informal care is favored for local cultural reasons. This paper outlines the research protocol for a study comparing formal and informal care in Malaysia. It seeks to provide evidence regarding which is more appropriate and results in higher QoL in early dementia.

Methods: This is a quasi-experimental study design involving 224 early dementia patients from both nursing home and community settings. Participants will be assessed for cognitive severity, QoL, needs, activities of daily living, depression and social isolation/connectedness by using the Mini-Mental State Examination (MMSE), Cognitive Impairment Scale – 4 items (CIS-4), EUROPE Health Interview Survey-Quality of Life (WHO8), Assessment of Quality of Life (AQoL8), Camberwell Assessment of Need for the Elderly – Short Version (CANE-S), Barthel Index (BI), Cornell Scale for Depression (CSDD), Geriatric Depression Scale – 15 items (GDS-15), and Friendship Scale (FS) respectively.

Conclusion: This study aims to provide a better understanding of care needs in early dementia. Given population aging, the study findings will provide evidence assisting decision-making for policies aimed at reducing the burden of caregiving and preserving the QoL of dementia patients.

Lapid et al. (2010) provide a fascinating insight into the much over-looked problem of eating disorders (EDs) in older adults and highlight the fact that an ED is often not considered in our differential when assessing elderly patients.

Background: This is the first study to analyze the psychometric properties of the International Wellbeing Index (IWI), which comprises the Personal Wellbeing Index (PWI) and National Wellbeing Index (NWI), among community-dwelling older adults.

Methods: The IWI was applied to 1106 community-dwelling adults aged 60 years and over. The sample was additionally assessed using scales for comorbidity, disability, mood, general orientation to life, social support, health-related quality of life, and two questions assessing satisfaction with life as a whole and with life in Spain. The PWI and NWI were separately analyzed for acceptability, internal consistency, convergent and discriminative validity, and precision. Linear regression analyses of the PWI and the NWI were also conducted.

Results: Mean scores were 71.0 ± 13.5 for the PWI and 49.5 ± 14.4 for the NWI. No floor or ceiling effects were detected. Cronbach's α was 0.88 for the PWI and 0.92 for the NWI. Factor analysis identified two factors in the IWI, and one factor in the PWI and NWI respectively. The PWI showed a correlation of 0.50 with the “satisfaction with life as a whole” item, and the NWI showed a correlation of 0.73 with the “satisfaction with life in Spain” item. There were significant differences in scores: in the PWI, according to gender, age, social support, education and depression; and in the NWI, according to education and depression. The regression model identified psychosocial, health and functional factors as determinants of the PWI (explained variance: 46.8%).

Conclusions: The IWI displays good acceptability and is a consistent, valid and precise measure of global quality of life in older adults.

We report the case of a 69 year-old female patient who was hospitalized for Diogenes syndrome, defined by marked self-neglect, social withdrawal and excessive hoarding, leading to squalor. Somatic causes were eliminated. Her personal history showed an eight-year depressive episode followed by a 20-year hypomanic episode without remission, followed by a persistent manic episode associated with Diogenes syndrome for four years. The Diogenes syndrome was successfully treated with mood stabilizers. Mood disorders – in particular chronic mania (i.e. a manic episode lasting more than two years) – should be considered in cases of Diogenes syndrome and in current classifications.

High suicide rates are observed in elderly men, and the identification of high risk individuals is a challenging task. The Suicide Assessment Dimension (see Box 1) is intended to aid the evaluation process. We are concerned that the proposed assessment may miss some seniors in need of intensive management.