Mental disorders and illnesses in old age are not an inescapable fate, particularly if physicians can look beyond the medical aspects of an illness to the potential interpersonal, familial, and social influences. Indeed, the different factors involved in the genesis of mental disorder intertwine to form an intricate network, from which it is very difficult to isolate single components. Moreover, the importance of the components that trigger an acute mental disorder and shape the course and diversity of the symptomatology can continue to change. The interweaving of different pathogenic factors contributes further to the diversity and ambiguity of the clinical symptomatology.

Alzheimer's disease affects an estimated 2 million elderly in the U.S. and challenges primary care physicians to assist caregivers in dealing with the daily management of these patients. To support the clinical observation of weight loss in Alzheimer patients despite adequate food intake, we reviewed the existing literature. To date, eight international studies have focused on nutrition in Alzheimer's disease and all have found weight loss. It is not clear whether this weight loss is a component of or a consequence of the disease.

These findings suggest systemic, metabolic alterations in Alzheimer's disease. They require further investigation as to their nature and as to their appropriate recognition and management to retard the deteriorating effects of chronic weight loss and malnutrition. Finally, some reports lead to speculation that nutritional strategies may improve cognitive function.

There is increasing evidence that mildly impaired patients with Alzheimer's disease (AD) may be distinguished from mildly impaired patients with multi-infarct cognitive disorder (MICD) by their degree of semantic memory impairment. However, despite these observed group differences, it is unknown whether AD and MICD patients differ in their ability to perform a broad array of functional activities required for daily living and the degree to which severity of cognitive impairment is associated with functional deficits. Using a measure assessing numerous functional domains within the clinical setting, we were able to directly compare the functional capacity of mildly impaired AD and MICD patients, as well as a more cognitively impaired AD group.

Although mildly impaired AD patients scored significantly lower on tests of semantic memory relative to their mildly impaired MICD counterparts, deficits in functional capacity were relatively equivalent. The AD group with more severe cognitive impairment scored lower on both memory and functional measures. A relatively high proportion of mildly impaired AD and MICD subjects evidenced impairment across a number of functional domains, suggesting that functional impairment may occur with relatively high frequency in these patient groups.

A double-blind randomized trial was performed involoving 162 patients with age-associated memory impairment (AAMI) selected and followed by their general practitioners. Two intervention methods—a drug and a cognitive therapy—were assessed in combination. Three randomized parallel groups of 54 patients each, aged 55 years and, over, were followed and treated for 3 months. After a placebo wash-out period of 10 days, one group received 2.4 g of piracetam, another group, 4.8g, and the third, a placebo. A total of 135 patients, 45 in each group, completed the study. Combined therapy was most effective in patients whose baseline performance on memory tests was lowest. The best results were observed with 4.8 g of piracetam, especially when training sessions began after 6 weeks of drug treatment. This result was confirmed by the global impression of the principal investigator.

In the last year, there has been increased research interest in the sensitivity and applicability of activities of daily living (ADL) scales for the detection of early behavioral dysfunction and efficacies in drug trials. At the September 1993 meeting of the Sixth Congress of the International Psychogeriatric Association (IPA) in Berlin, Germany, no fewer than three symposia and 16 papers focused on the use of ADL scales. For example, a symposium chaired by Hindmarch and Erzigkeit (1993) described an international collaborative effort to improve the sensitivity of ADL scales, and a paper by Sclan, Schmidt-Gollas, and Erzigkeit (1993) addressed the following issue: “Clinical drug trials and assessment of functional changes in cognitively impaired elderly persons: Do we need another rating scale?”

In this article a cost-comparison study of psychogeriatric outpatient and home consultations (if all outpatients are seen at home) is reported. The cost of home visits was estimated to be less than that for outpatient consultations. The results are discussed in the context of methodological difficulties and the advantages and disadvantages of home and outpatient consultations. In view of the many advantages of home-based consultations, including lower costs, it is concluded that we should be developing and evaluating services with greater emphasis on home-based consultations.

Similarities and differences in the way geriatric rehabilitation is viewed in the Federal Republic of Germany and in the United States are highlighted. The philosophy and goals of geriatric rehabilitation in both countries are basically similar. However, there are some differences, particularly in practice applications and in how the historical and social contexts of each country influence what is emphasized. This article traces the relevant knowledge components and practice application in each country and makes some comparisons. In addition, differences in how members of the geriatric team function are described, as well as the varying educational preparations of team members. Developments in both countries suggest that substantial integration of knowledge already has taken place. The continuation of this trend should bode well for the future.

In order to analyze whether the referral system and nature of care exert any effect on the characteristics of patients, subjects aged 60 or above attending three medical centers on the Hong Kong Island between August and December 1990 were studied with respect to their age, sex, and psychiatric diagnosis. Psychiatric diagnoses were made in 98% of subjects at the psychogeriatric assessment service (PAC) (predominantly chronic organic brain syndrome), in 79.6% at the university psychiatric unit (mainly acute psychiatric problems, substance abuse, and deliberate self-harm), and in 20% at the general outpatient clinic (largely sleep and anxiety-related disorders). There was overrepresentation of the very old (above 80) and underutilization of counseling service at PAC. In Hong Kong, the psychogeriatric needs of the very old and of those with minor emotional disturbances associated with aging, retirement, and bereavement deserve reassessment.

Estimates of the prevalence rates for dementia vary significantly among countries. Such variation may be explained, at least in part, by methodologic differences in studies. The disparities in prevalence rates of dementia subtypes, particularly Alzheimer's disease and multi-infarct dementia, are especially apparent in studies conducted in Eastern and Western countries. In Japan and China, the prevalence of multi-infarct dementia exceeds that of Alzheimer's disease, whereas in the West, Alzheimer's disease predominates in the vast majority of studies. Clearly, cross-cultural studies of incidence using standard methods are needed to investigate whether a true difference in risk exists, and which risk factors differentially contribute to this variation. Migrant studies of genetically homogeneous populations offer a unique opportunity to answer these questions. This article explores the value of migrant studies, their application to etiologic questions of dementia and its subtypes, and recommendations concerning how to conduct such studies.