The term “Psychogeriatrics” is a misnomer. It also happens to be the name of this journal. How do we deal with this? As expected, with difficulty, because we're dealing with title recognition, which is marketing issue.

Few pieces of American legislation evoke as many raised eyebrows and quizzical looks in non-Americans as does the Omnibus Budget Reconciliation Act of 1987 (OBRA-87). Incorporated into this legislation is the Nursing Home Reform Act, which contains guidelines for establishing a better environment and better care for nursing home residents. Certainly, some of the provisions focusing on nutrition, improved staff education, and the collection and evaluation of data have resulted in improved care, but the provision that regulates the prescription of psychotropic medications has received mixed reviews.

The St. George Hospital Memory Disorders Clinic Occupational Therapy Assessment Scale (OTAS) is a performance-based assessment of activities of daily living (ADL) administered in the home environment to monitor function among patients with early cognitive decline. Of the 30 items investigated, 19 items that measured “higher” functional domains were found to be useful in discriminating between subjects. Psychometrically, these 19 items had high internal consistency (coefficientalpha = .89) and high interrater reliability (kappa coefficient range: 71–1.0), and correlated well with other measures of higher function (Lawton's instrumental activities of daily living scale: r = .75; Nottingham extended ADL scale: r = .67). However, unlike these latter measures, the OTAS also correlated well with the Mini-Mental State Examination (r = .73), indicating that OTAS is a valid instrument that should be sensitive to functional problems among patients in the early stages of cognitive impairment.

Psychometric characteristics of the Alzheimer's Disease Assessment Scale (ADAS) were examined on the basis of data from 440 patients with dementia of the Alzheimer type that were collected before treatment in a multicenter clinical drug trial. Coefficients of internal consistency of above .80 for the cognitive (ADAS-Cog) and the noncognitive section (ADAS-Noncog) indicated a high degree of homogeneity of item contents within the two assessment domains. Test-retest reliability was estimated to be .93, .98, and .96 for ADAS-Cog, ADAS-Noncog, and the total score (ADAS-Total), respectively. Reliably detectable individual changes, which were derived from the reliability estimates, were 7,3, and 8 points for ADAS-Cog, ADAS-Noncog, and ADAS-Total, in that order. Factor analysis and correlations with MMSE, SKT, and NOSGER scores support the validity of the ADAS-Cog and ADAS-Noncog scores with regard to the cognitive and the noncognitive assessment domains. The ADAS summary scores, almost all of the cognitive items, and some of the noncognitive items discriminated significantly between stages of severity of dementia, as classified independently by MMSE and SKT scores.

Many of the psychometric instruments employed in dementia research are adapted versions of tests developed in countries different from those in which they are applied. The validity of these instruments has been established in their countries of origin; however, there is little information available regarding their validity when transferred to other cultures. The SKT, a short cognitive performance test for the assessment of memory and attention deficits developed and validated in Germany, was administered in research centers in Chile, Greece, Russia, and England. SKT raw scores were factor analyzed with regard to a prespecified target structure, i.e., the factor solution found for a large German reference sample. The cross-cultural stability of the test was assessed using a statistical method that combined the perfect congruent weights approach and the bootstrapping technique. This procedure allowed for testing the similarity between factorial solutions obtained for the different centers. Results clearly indicate the factorial stability of the SKT in the countries participating in the study.

As part of a multicenter project to study noncognitive behavioral disturbances in dementia, the authors developed a comprehensive caregiver-rated questionnaire for these behaviors. The authors determined the reliability of caregiver ratings and compared caregiver ratings with clinician ratings using standard instruments. Caregivers showed good test/retest reliability for ratings of all types of patient behavioral disturbance. Caregiver interrater reliability was highest for depression and lowest for psychosis. The correlation between caregiver reports and professional assessments was highest for agitation, intermediate for psychosis, and lowest for depression. The match between caregiver and clinician assessments of patient behaviors appears to vary significantly by the type of behavior assessed.

In order to determine the factors associated with good and poor 1-year prognosis of demented patients, the caretakers of 100 home-based patients attending a specialist memory clinic were inteviewed. After the follow-up, 71% continued to live at home. Mild dementia, independence in activities of daily living, fair independence in functions of instumental activities of daily living, and lack of depression were clear signs for a good prognosis. Some patients with severe dementia and poor functional capacity continued to live at home. Continuing home care was also more likely if memory impairment, as opposed to functional problems, was expressed as the main concern. The proportion of caretakers mentioning memory decline as the main problem decreased during 1 year from 38% to 9% and the proportion mentioning functional problems increased from 48% to 64% among those continuing in home care. Memory disturbances are the first to appear and cause problems, but only functional decline threatens living at home.

Using magnetic resonance imaging-based planimetry, we measured cortical and cerebral (cortical and ventricular) atrophy in 26 patients with Alzheimer's disease (AD) (age, 72.2 ± 7.0) according to NINCDS-ADRDA criteria and 22 control subjects (age, 71.5 ± 5.4). AD patients exhibited greater cerebral atrophy (p < .05) than control subjects. Cerebral atrophy was significantly correlated with age (r = .72, p < .0005) in healthy volunteers but not in AD patients. In AD patients, age of onset was negatively correlated with the estimated rate of disease-attributed cerebral degeneration ([observed atrophy - atrophy in normal aging calculated from the regression equation derived from the control group]/[duration of illness]) (r = −.54, p < .005). Multiple regression with interaction analysis demonstrated that age, age of onset, and their interaction successfully explained cerebral (R2 = .51, p < .05) and cortical (R2 = .64, p < .05) atrophy in patients with probable AD. Age of onset may be a strong predictor of the rate of cerebral degeneration in AD, and our results suggest that controlling age and the age of onset is essential in the quantitative study of AD.

The purpose of this pilot study was to evaluate the usefulness of the Assessment of Motor and Process Skills (AMPS) as an outcome measure of instrumental activities of daily living (IADL) in pharmacologic studies of people with Alzheimer's disease. The AMPS simultaneously measures motor and process skills and their effect on the ability of the person to perform familiar IADL tasks. We administered the AMPS to 11 Alzheimer inpatients in a 31/2-month, double-blind, placebo-controlled, crossover study of fluoxetine and selegiline administered as single agents and in combination with physostigmine. Results indicated that there was a significant difference in IADL ability among study conditions for process skills, but not for motor skills, thereby suggesting that the AMPS is useful as a sensitive outcome measure of IADL ability in drug trials with this population.

Folie à deux is a rare, interesting disorder involving delusional beliefs shared by two persons. We report three cases of elderly couples referred to our service during an 18-month period with this disorder, and discuss the salient clinical features and the possible risk factors for folie à deux in the elderly.

Attitudes to death were explored in 125 community residents aged 81 and older. Those people who thought about dying had less frequent contact with their interview informant; those who thought about death more frequently showed less severe cognitive impairment, a greater severity of depressive symptoms, and were more likely to be unmarried and were more commonly reported to be depressed by their interview informant. Worries about dying showed no association with sociodemographic or clinical variables. The commonest category of response from spontaneous comments was concerning the circumstances of dying. The results are discussed in light of other research findings, and emphasize the influence of low mood and social factors on death attitudes. This may have implications for closer examination of such attitudes in the assessment of depression and suicidal risk as well as in the care of the dying.