Search

We describe a 78-year old male patient with Parkinsonrsquo;s disease and without a past psychiatric history, who had hallucinations and a very particular form of a delusional misidentification syndrome. His belief that he was not at home and that his home was on a different location, even in another country, is a form of 'reduplicative paramnesia'. This delusion is seen more often in association with neurodegenerative disease, for example in Parkinsonrsquo;s disease. We describe the characteristics of this delusion, provide possible explanations and delineate several therapeutic options.

In old age, cognitive functions decline in comparison to performance earlier in life. Subjective memory complaints often cause anxiety. Patient and informant history taking, along with simple additional cognitive tests are usually sufficient to reassure patients or to initiate further diagnostic work-up. Differential diagnoses include depression, delirium, other psychiatric or neurological disorders, metabolic causes, intoxications or side effects of drugs. Physical examination and laboratory tests generally have limited added value. Main reasons for referral are a suspected treatable cause for cognitive decline (e.g. delirium), focal neurological deficit (e.g. stroke), suspected dementia under the age of 65-70 years, additional complex somatic or psychiatric disorders or further work-up in non-native speaking people.

Many older adults who live at home face memory problems, which creates challenges for their participation in society. This may lead to social isolation and a lower wellbeing. In this qualitative study, we studied the physical and social participation of seven older adults with memory problems who live at home, to identify obstacles and coping strategies. Different research methods were adopted: 1) walking interviews, 2) travel diaries, and 3) in-depth interviews. Physical and social participation take place independently and in the immediate living environment. Participants experience several obstacles, which are highly impacted by the mode of transportation that they use: walking versus cycling. The results provide new insights on the strategies that participants develop to continue to participate. Fixed routes help them navigate, orientate and anticipate to traffic situations. Participating in activities for a short period of time is a strategy to make social participation less demanding. It is not the duration, but the experience of the activity that is important. The article concludes that older adults with memory problems exercise control in shaping their activities according to their personal needs, possibilities and surroundings. It is important that they are not only supported in avoiding risks, but also in developing suitable coping strategies.Veel thuiswonende ouderen krijgen te maken met geheugenproblemen, wat hun deelname aan de maatschappij bemoeilijkt. Dit kan leiden tot sociale isolatie en een lager welbevinden. In dit kwalitatieve onderzoek zijn de ervaringen met fysieke en sociale participatie van zeven thuiswonende ouderen met geheugenproblemen onderzocht om belemmeringen en copingstrategieën te achterhalen. Er zijn verschillende onderzoeksmethoden gebruikt: 1) wandelinterviews, 2) activiteiten logboeken en 3) diepte-interviews. Fysieke en sociale participatie van de deelnemers vindt voornamelijk zelfstandig plaats in de directe woonomgeving. Zij ervaren daarbij verschillende belemmeringen, die sterk worden beïnvloed door de vervoerswijze die ze gebruiken: lopen versus fietsen. De resultaten geven vernieuwende inzichten in de strategieën die de deelnemers ontwikkelen om te blijven participeren. Het gebruiken van vaste routes helpt bij navigeren, oriënteren en anticiperen op verkeerssituaties. Korter meedoen aan sociale activiteiten is een strategie die sociale participatie minder belastend maakt. Niet de duur, maar de ervaring is van belang. De conclusie van het artikel is dat ouderen met geheugenproblemen controle uitoefenen over het vormgeven van hun activiteiten, passend bij hun persoonlijke behoeften, mogelijkheden en woonomgeving. Het is daarom belangrijk dat ouderen met geheugenproblemen niet alleen worden ondersteund in het vermijden van risico’s, maar ook in het ontwikkelen van passende copingstrategieën.

A recent survey shows a steady growth in the number of memory clinics in the Netherlands over the last two decades. It appears there is considerable variation in both the organization of care and the type of diagnostic work-up that is provided. Over time, the memory clinic population has also changed; 22% of patients present with subjective memory complaints, a three-fold increase. Although the current dementia guidelines leave much room for individualized diagnostic trajectories, the results suggest a lack of consensus on the indication for the different diagnostic tests. More insight is needed in the causes of variation, before discussing to what extent this variation is acceptable or perhaps even desirable considering the widely differing patient populations. In the meantime, patients and carers deserve a more prominent role in the diagnostic process, to ensure that the quest for a timely diagnosis will go hand in hand with appropriate use of memory clinics.

Patients undergoing or about to undergo electroconvulsive therapy (ECT) are often afraid they will experience negative cognitive side-effects.To answer questions that patients and referring clinicians often ask about cognitive problems that can result from ECT.To discuss, on the basis of clinical perception and literature, the cognitive problems resulting from ECT.The cognitive problems resulting from ect are threefold: short-term postictal confusion (immediately after the treatment), anterograde amnesia and retrograde amnesia. A patient affected by anterograde amnesia, is temporarily less able to remember what he or she has experienced over a period of three months after treatment. The brain of a patient with retrograde amnesia is unable to retrieve or remember information or procedures 'saved' before the treatment took place. More specifically the patient with retrograde amnesia has three main types of problems: semantic memory problems (relating to facts), episodic memory problems (no longer able to retrieve memories concerning non-personal events), and procedural memory problems (no longer able to operate various devices). It is difficult to predict which patients will experience cognitive problems as a result from ect and to what extent. However, the problems are not intensified by maintenance treatment. Factual and autobiographical memory problems following ect-induced retrograde amnesia seems to have a more permanent character. According to the Dutch guidelines for ECT, cognitive side-effects need to be monitored. If patients are monitored before and after ect, they can be given a more targeted psycho-education and eventually a more targeted training course.We conclude that in clinical practice increasing attention is being given to ECT-related cognitive side-effects. Clearly, however, more consideration needs to be given to inter-individual variability. Cognitive monitoring is advisable because the course of the side-effects of ect must be followed and evaluated.

With the advancement of diagnostic tests, the call for an ever-earlier diagnosis of people with memory problems is becoming louder. Diagnostic tests for people with mild cognitive impairment are in fact prognostic tests, complicating the application and interpretation of test results. There is currently insufficient evidence on the incremental diagnostic (or prognostic) value of specific diagnostic tests including MRI, CSF and PET scanning in representative memory clinic populations. Labelling large groups of people who may never develop dementia as having prodromal Alzheimer's disease may be more harmful than a postponed nosological diagnosis in those with mild cognitive impairment. The current Dutch practice guideline on dementia, with a reticent attitude towards the use of diagnostic tests in patients with cognitive impairment, is appropriate and scientifically sound.

From the age of about 60, many people begin to experience difficulties with tasks that require the use of prospective memory and begin to have trouble finding words and names. Worried that these symptoms may be indicative of the onset of Alzheimer's disease, many of them fill in online self-tests or consult their family doctor. In the vast majority of cases, symptoms like these indicate completely natural age-related forgetfulness. Physicians should encourage a socially active lifestyle to slow down further decline. In cases of mild cognitive impairment (MCI), the physician should be aware of patients who deny or trivialise memory problems, especially if these problems have repercussions for performance in professions such as that of airline pilots or medical practitioners. In the absence of formal annual performance checks, ageing physicians should keep a close watch on themselves and on their colleagues.

A 38-year-old woman was admitted in a psychiatric hospital because of memory disorders. Dry beriberi and Korsakoff's syndrome, as a late neuropsychiatric manifestation of Wernicke's encephalopathy, were established. The beriberi symptoms decreased slowly, but the patient's memory impairments persisted. These clinical features were caused by a thiamine deficiency. Gastric bypass surgery is associated with an increased risk of thiamine deficiency. Excessive alcohol consumption and poor compliance with vitamin deficiency treatment both contributed to the rapid onset of these disorders. The case we describe demonstrates how important it is that patients who have undergone bariatric surgery are prescribed the correct vitamin supplements and that the treatment is continued for an appropriate period of time; this treatment is particularly important in the case of patients who are also suffering from an comorbid alcohol-related disorder.

Statins are among the most commonly prescribed drugs in the Western world. Hence, one would expect their safety and side effect profile to be firmly established. However, this assumption may be false. In a recent analysis, acute memory loss appeared to be significantly associated with the use of lipid-lowering drugs, of which statins are the most important subgroup. However troubling these findings may be, the study could still not exclude the possibility of the findings having been confounded by detection bias. Thus, decades after their introduction, uncertainties regarding side effects may still surround massively prescribed drugs, highlighting the need for care and caution on prescription of even the most commonly used drugs.

Transient global amnesia is a recognised phenomenon in adults. However in children it is rarely described. It is characterised by a sudden loss of memory in an otherwise healthy patient. What is striking is that other cognitive functions and neurological examination are normal.A 9-year-old boy presented at the paediatric ward with acute onset retrograde and anterograde amnesia. He had no history of headache or other (neurological) symptoms. There were no known emotional or physical stressors. A general physical and neurological examination showed no abnormalities. The boy was hospitalised for observation overnight. The next day he was fully recovered.Transient global amnesia may occur in childhood. Since patients recover spontaneously, watchful waiting is justified.

Binge drinking by adolescents and young adults is on the increase and is having serious medical and social consequences. Over the last ten years more and more research has been done into the neurocognitive effects of binge drinking and into the possibility that these effects are gender-specific. However, so far, findings have been inconsistent.To collect evidence for the negative impact of binge drinking on the neurocognitive functioning of adolescents and young adults and to find out whether binge drinking has a more serious effect on neurocognition in females than in males.We searched the literature using PubMed and Web of Science.Nineteen studies satisfied our selection criteria. Eleven studies examined the binge/gender interaction.There is considerable evidence that binge drinking does have a negative effect on neurocognition in adolescents and young adults, particularly with regard to executive functioning and memory. Females seem to be more susceptible than males to deficits in spatial working memory and impulse control.

Two women aged 50 and 64 years, respectively, and one man aged 43 years, were treated with cyclic etidronic acid for osteoporosis. After some months/years they developed mood, concentration and memory problems. The complaints diminished within several weeks after withdrawal of the drugs, and reappeared after rechallenge. Two of these patients had similar complaints during the use of another bisphosphonate (pamidronic acid and alendronic acid, respectively). Bisphosphonates are used increasingly frequently for the treatment of osteoporosis. Generally, these drugs are well tolerated. The most frequently reported adverse events are gastrointestinal complaints and oesophageal ulcers. Psychiatric complaints also appear to be a rare side effect.

Camphor is a toxic hydrocarbon, found in numerous over-the-counter medicinal products and chemist-shop items. The consequences of camphor poisoning depend on the dose, and severe poisoning can result in death. Ingestion of camphor can cause seizures, apnoea, renal insufficiency, raised hepatic enzyme levels, and vomiting resulting in chemical pneumonitis due to aspiration.We present the case of a 34-year-old female patient from the Dominican Republic who was brought into our accident and emergency department following the ingestion of camphor mothballs for persisting headaches. She was unconscious (Glasgow coma score: 3) and had severe acidosis (pH 6.59), respiratory insufficiency, electrolyte imbalance and raised hepatic enzyme and amylase levels. She was admitted to the intensive care unit and recovered quickly. Five days later, she was transferred to a general ward, where it became apparent that she was suffering from severe memory loss. After eight days she was discharged in good clinical condition, although she still suffered some memory loss.Many every-day products contain camphor. Poisoning can lead to an acute clinical picture, and immediate intensive care department treatment is obligatory. As there is no antidote available, supportive care is the only available option when poisoning occurs.

In this case-report we present two patients who were referred to the memory clinic. In both cases there is doubt about the earlier diagnosis. During the physical examination choreatic movements were observed. After repeating diagnostic tests, both patients were diagnosed with Huntington's disease. The dementia with this disease is often preceded by psychiatric symptoms, which makes it quite difficult to diagnose, especially in an early stage of the disease. That is why it is essential that, in case of even the slightest doubt or confronted with new insights, geriatricians should see patients again in the memory clinic and repeat nosologic diagnosis.

This paper provides a brief review of the developments in neurobiological research of posttraumatic stress disorder (ptsd), particularly into the link between the disorder and the central and peripheral stress-regulating processes. ptsd is an impairment of neuronal circuits and stress-regulating systems in the brain, where a critical note is played by limbic structures such as the hippocampus, the amygdala and the medial prefrontal cortex. In patients with ptsd the 'behaviour' of these neuronal circuits and systems is chronically disturbed. Characteristic symptoms are increased stress reactivity, reduction of declarative memory performance, high emotionality in response to trauma-related stimuli and over-representation of traumatic memory, all of which can be described as chronic dysregulated processes. Because of improvements in research designs and stratification of research populations, the specificity of research findings has improved and the developmental trajectories of specific ptsd parameters have been described more clearly. One of the most promising developments in the field of research designs is the current shift away from cross-sectional research designs to 'true prospective' research designs.

Patients with Mild Cognitive Impairment (MCI) run a higher risk for the development of a dementia. A disturbed awareness of deficits is a symptom of dementia and could be a predictor for the development of dementia in the assessment in the early stages of dementia. This awareness can be assessed by means of the discrepancy between the assessment of memory problems by patient and partner. In this study, the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-N) was used to assess the level of awareness. The results show that the discrepancy score (the difference between the IQCODE-Nscore of the patient and the IQCODE-Nscore of the partner) was significantly higher for the 61 MCI-patients when compared to the 40 healthy elderly (p = 0,01). This suggests a diminished awareness in MCI-patients. Analysis of the range of the MCI-group shows that this is true for 60% of the patients. Patients with a disturbed awareness score significantly lower on the MMSE (p0,01) than patients with an intact awareness.

Memory Clinics (MC's) are multidisciplinary teams involved with early diagnosis and treatment of people with dementia. In order to attain more insight into the development of this kind of services in The Netherlands, we compared the data of two inventories, one of 1998 and the other of 2004.The number of MC's increased from 12 to 40. The number of referrals per service has also increased. Dementia was the most important syndromal diagnosis. The focus is less exclusively on academic centres. An growing number of MC's has structural collaborations with local service providers for mental health. Differences among MC's exist with regard to the number of referrals per week, the intensity and duration of the diagnostic procedures and the proportion of people without dementia. There is much interest among MC's to participate in a national network for harmonisation and quality control.MC's are an increasing part of standard care for people with early dementia and other cognitive disorders.

Memory loss and lack of concentration are symptoms that frequently occur in patients who have undergone a surgical procedure. Although cognitive function can be assessed using neuropsychological tests, diagnosing postoperative cognitive decline (POCD) reliably appears to be difficult. Therefore, the true incidence of POCD is unknown. Severe POCD, which is apparent even without neuropsychological testing, is predominantly reported after cardiac and hip-replacement surgery. In these cases, POCD probably reflects micro embolic brain injury. Apart from the nature of the surgical procedure, advanced age is the most important risk factor for POCD. The anaesthetic technique used is not a determinant: the risks of POCD occurring appear to be similar following both general and local anaesthesia.

The development of memory clinics in the Netherlands. - Memory clinics (MCs) are multidisciplinary teams involved in the early diagnosis and treatment of people with dementia. Between 1998 and 2004 the number of MCs in the Netherlands increased from 13 to 40. This type of clinic is increasingly becoming part of standard care for people with early dementia and other cognitive disorders. A growing number ofMCs are collaborating structurally with local mental health care service providers. This is a positive development, in which hospital-based diagnosis and treatment are increasingly being integrated with long-term care to reach patient centred disease management.

In order to identify persons who are at risk for dementia in an early phase, two classification trees were developed. Data were used from the Longitudinal Aging Study Amsterdam (LASA). The prevalence of dementia in the whole sample was 4.0%. In the first tree age seemed to be the strongest predictor, with an increased risk for persons older than 75. In this group the positive predictive value reached a maximum of 33.3% when the persons had memory complaints and a score on the Mini Mental State Examination (MMSE)24. In a second classification tree, age was excluded as a predictor because of high association with the other potential predictors. In this tree functional limitations seemed the strongest predictor. In the group of persons with at least one functional limitations, the positive predictive value reached a maximum of 28.8% when the persons had memory complaints and a score24 on the MMSE. In persons without memory complaints, persons with cardiovascular diseases or diabetes were at increased risk of dementia. Further research is necessary before these classification trees can be implemented in general health care.

Episodic memory is the conscious recollection of personal experiences. In clinical practice several episodic memory tests are used, but their validity as measures of an episodic memory construct is not clear. The sensitivity and specificity of variables hypothesized to represent a distinct psychological construct is established by a pattern of convergent and discriminant validity. Confirmatory factor analysis was used to analyse the correlations between four episodic memory tests: a standardized orientation questionnaire, free recall, and two delayed recognition memory tests. The episodic memory construct was contrasted with an executive functioning construct, measured by three variables: two tasks of semantic word fluency and the Expanded Mental Control Test. The measures were taken from 813 consecutive visitors of a psychogeriatric day care centre. As a set the four indicators of episodic memory provided reliable measurement of the construct. The same was true for the three measures of the executive functioning construct. However, the strong correlation (0.89) between the two constructs implies a lack of discriminant validity and suggests that processes of executive control contribute to the successful performance on episodic memory tasks.

Four patients, two women aged 29 and 52 and two men aged 46 and 25, respectively, consulted a neurologist for attention and memory disorders. Further investigation revealed that the symptoms were caused by metachromatic leucodystrophy, Graves' disease, Huntington's disease, and a psychological background, respectively. The first patient became dependent in 1.5 years, the second recovered after treatment, the third was independent with slowly progressive symptoms after 1 year, and the fourth was advised to consult a psychologist. Disorders of attention and memory in relatively young people deserve a detailed evaluation at the very first visit, involving the elaboration of an initially extensive differential diagnosis. Too early a separation between a psychic and an organic pathogenesis should be avoided. Indications for the presence of a neurological condition include: consultation at the initiative of others, a relatively brief duration of symptoms without a clear provoking factor, the absence of a psychiatric history or life event, cognitive dysfunction in several areas, abnormal behaviour and an incriminating family history.

Memory problems are the most common cognitive deficits in dementia. In order to help these patients with their everyday activities and to increase their quality of life, a number of memory aids have been developed. This paper focuses on the efficacy and the applicability of three different types of external memory aids. The findings suggest that environmental adjustment is an easy and low-priced method. It is beneficial even for patients in the most severe stages of dementia, since only a limited amount of training is necessary. The non-electronic aids are also relatively cheap and easy to learn. The electronic aids are more expensive and, at this point, only a few studies have investigated the efficacy of this memory aid on the memory problems of patients with dementia. However, most published studies only investigated small samples. Hence, the current results should be interpreted with caution.

Two women aged 50 and 64 years, respectively, and one man aged 43 years, were treated with cyclic etidronic acid for osteoporosis. After some months/years they developed mood, concentration and memory problems. The complaints diminished within several weeks after withdrawal of the drugs, and reappeared after rechallenge. Two of these patients had similar complaints during the use of another bisphosphonate (pamidronic acid and alendronic acid, respectively). Bisphosphonates are used increasingly frequently for the treatment of osteoporosis. Generally, these drugs are well tolerated. The most frequently reported adverse events are gastrointestinal complaints and oesophageal ulcers. Psychiatric complaints also appear to be a rare side effect.

Two women aged 50 and 64 years, respectively, and one man aged 43 years, were treated with cyclic etidronic acid for osteoporosis. After some months/years they developed mood, concentration and memory problems. The complaints diminished within several weeks after withdrawal of the drugs, and reappeared after rechallenge. Two of these patients had similar complaints during the use of another bisphosphonate (pamidronic acid and alendronic acid, respectively). Bisphosphonates are used increasingly frequently for the treatment of osteoporosis. Generally, these drugs are well tolerated. The most frequently reported adverse events are gastrointestinal complaints and oesophageal ulcers. Psychiatric complaints also appear to be a rare side effect.

Does memory strategy training improve the quantity and quality of reported strategy use of normal older adults (N = 111, mean age 63 years, range 46-85 years) in daily life? Three strategy training conditions, remembering names (N = 26), intentions (N = 20) and verbal information (N = 20) and an educational training (N = 23) were compared to a test-retest control group (N = 22). Strategy use was assessed with a Strategy Frequency Questionnaire (investigating the reported frequency of strategy use on five scales: encoding, retrieval, general, external and no strategies) and a Memory Situations Questionnaire (investigating the preference of strategies in specific situations). Three months after training, the frequency of strategy use as assessed by the scale scores had not increased more in the strategy training conditions than in the control condition. No demographic or psychological characteristics were identified that could predict which individuals were most likely to change their strategy use. When strategies were analyzed separately, only after names training a specific effect was demonstrated, indicating that subjects more frequently used the strategy for remembering names (association) at follow-up. With regard to changes in the strategies used in specific situations, subjects in the names and intention training conditions reported an increase in the use of the trained strategies on names and prospective situations respectively. Moreover, there was some evidence of a generalization of training to strategies that were not directly dealt with during training. The control group showed that repeated practice with memory tests may result in changes in strategy use in specific situations, which are not always for the better, how-ever.

Memory impairment in a 63-year-old man was the most prominent expression of partial epileptic seizures from the temporal lobe, probably resulting from a head injury. Treatment with antiepileptic drugs resulted in complete recovery. This case illustrates that epilepsy should be considered in the differential diagnosis in elderly patients with an isolated memory disorder. The diagnosis is made by clinical methods and may be confirmed by electroencephalography.

The influence of health-related incidents on memory test performance and subjective memory ratings was assessed in a) a group of healthy older adults recruited via the register of population (group 1: N = 117, mean age 62 years, range 46-89) and b) a group of healthy older subjects having memory complaints and applying for memory training (group 2: N = 111, mean age 63 years, range 45-85). The study tries to cross-validate a previous study, where the presence and frequency of health-related incidents were related to cognitive performance. The presence of 9 categories of health-related incidents (consultation of a neurologist, systemic diseases, repeated mild concussions, repeated anaesthesia, use of psychotropic medication, alcohol use, other neurotoxic factors, such as exposure to organic solvents, psychiatric disorders, birth complications or developmental problems) was assessed in a semi-structured interview. Memory performance was assessed with a battery covering different aspects of memory. Memory self-ratings were assessed with questionnaires asking for frequencies of memory failures and a general judgement of memory capacity. Health-related incidents occurred in about half of both subject groups and were not related to age or other demographic characteristics. In both subject groups, the presence, nor the number of health-related incidents was related to memory performance or memory complaints and there was no interaction with age. The results are not in agreement with the notion that health-related indices explain age differences in cognitive performance.

The frequency and preference of memory strategies were investigated in a group of independently living older adults (N = 111, 45-85 year) who were interested in memory training because of subjective and objective memory problems. Mokken scale analysis identified, besides the use of 'no strategy', four strategy scales, viz. encoding, retrieval, general, and external strategies. These five scales allowed for a differentiated analysis of strategy use. Frequency judgments showed that external strategies were used most frequently, followed by retrieval strategies. Encoding strategies were used least often. Reports on the preference of strategies in specific situations showed that subjects reported to use specific strategies in the majority of situations, although here too external strategies were used most generally. Strategy reports were more related to psychological variables (mental speed, primary memory ability, need for cognition and memory complaints) than to demographic characteristics (age, educational level and sex). The explained variances, however, were low which suggests substantial individual differences in use and preference of memory strategies.

In this study, a memory training program for remembering names was developed. It was assumed that names are remembered better if they have meaning. The effect of training is compared with two control conditions a) a placebo training, aimed at reducing worries about forgetfulness by giving information about memory and aging and b) a retest control group. Participants were healthy persons over 43 years old (M = 70 years) having subjective memory complaints and objective memory problems. The effect of training is evaluated with tasks for remembering names. Because the learned memory strategy can be applied to these tasks, these are called target memory tests. Other evaluation measures concerned remembering verbal information and intentions. These are called control memory tests, because the memory strategy learned cannot be applied directly. In accordance with the expectations, performance in the placebo training group (n = 10) did not improve more than in the retest control group (n = 11). The names training group (n = 13) improved more than both control groups on tests for remembering names. This improvement was maintained for at least three months after training. As expected, the improvement in performance on the target memory tests did not generalize to the control tasks, because of the specificity of the learned strategies.

A 40-year-old conductor was admitted because of increasing drowsiness and confusion. Two years before admission he had had a first seizure. One year before admission he had a generalized convulsive status epilepticus; the following months he was less able to concentrate. A second status epilepticus was followed by transient weakness of his left arm and a depressed level of consciousness for several weeks. After awakening, he had delusions, and his wife found him demented. In the following months his confusion and drowsiness gradually deteriorated. He had previously had gonorrhoea, an episode of fever and exanthema, and was found to have oligospermia as cause of his infertility. On examination he was disoriented, and he had dysarthria. His left pupil was smaller, but both pupils reacted normally. There was left hemianopia and cerebellar ataxia. CT and MR showed large ventricles and periventricular diffuse lesions in the white matter. CSF examination revealed leucocytosis and increased protein content. Further examination were focussed on serological evidence of syphilis, and finally neurosyphilis was diagnosed. After treatment with penicillin, the patient started to recover.

In three patients, referred to a memory clinic because of memory impairment, three different types of memory dysfunction were observed: a deficit in encoding of new episodic memories, a relatively pure loss of semantic memory and an impairment in retrieval of stored information. These patients were diagnosed as suffering from Alzheimer's disease, semantic dementia and frontotemporal dementia respectively. The diagnosis was essential in determining the individual management strategy.

Previous research revealed that many elderly people are worried about their memory and are afraid of falling victim to dementia. An information brochure was developed in 1991 for this target group. After reading the brochure, 63% of all respondents who were worried about dementia beforehand (n = 307), said that their anxiety had decreased or disappeared. Approximately 3% of the total group of 400 respondents became more worried. A cognitive test battery was used to determine whether people's increased or decreased anxiety was justifiable. This test battery gave an indication of the severity of cognitive problems. A sample of 104 people was tested. Thirty subjects achieved a low test score and sixteen of them were inappropriately reassured by the brochure. Approximately 64% of fifty-four subjects who performed well on cognitive test and were worried about dementia beforehand, were rightly reassured, but the other 36% were (still) unnecessarily worried. The occurrence of dementia in a close relative covaried with worries about possible dementia in people with good test results. In conclusion, it appeared that an information brochure about normal forgetfulness and dementia may reduce the anxiety for dementia.

Many elderly people complain about their memory or are afraid to become demented. Research shows that in most cases this worry is unsubstantiated. Anxiety and uncertainty are primarily caused by a lack of proper information about the differences between normal forgetfulness and dementia. In order to be able to effectively inform the general public, more insight and a better understanding are needed about level of knowledge, needs and characteristics of the target group. For this reason, a survey was carried out among 500 elderly people who ordered an information brochure on memory and dementia. Approximately 32% of the respondents worry very much about their forgetfulness and 57% worry somewhat. Among other things, respondents ascribe their memory complaints to bad concentration (61%), stress and tension (45%) and the medication they use (30%). Almost 22% indicate that they worry a lot about possible dementia and 47% worry somewhat about dementia. The main predictors for respondents' concern about dementia are the extent to which people are hindered by their forgetfulness in daily life and the fact that someone in the near family has or has had dementia. Of all respondents who worry about their memory, 26% consulted their general practitioner to discuss their complaints. Important reasons for not seeking help despite being worried, are that many subjects do not want to bother their general practitioner (48%) and feel that they are not taken seriously by their social environment (27%).

After a general overview of the many forms, aims and methods of memory courses, especially in the Netherlands, a strategy-oriented memory course for healthy elderly in a residential home is evaluated. The participants (N = 18) were compared with control subjects from the same home of comparable age, level of education and memory performance. Significant effects of the course could be demonstrated on subjective measures of memory but not on objective and 'ecologically valid' memory tests. Although one could consider subjectively experienced memory improvement as a very satisfactory result of memory courses, the authors state that adjustments to achieve objectively demonstrable progress are both necessary and possible.

To determine whether psychiatric conditions other than depression are relevant in elder patients with memory disturbances.430 consecutive outpatients (242 males, 188 females; mean age 61.7 years) who visited the Maastricht Memory Clinic were examined, according to a standardised diagnostic procedure, including somatic, neurological, psychiatric and neuropsychological examination. Psychiatric disorders were diagnosed according to DSM-III(-R) criteria.Of 152 patients with dementia, 34 had a secondary depressive syndrome, 19 another secondary psychiatric disorder. Of the 37 patients with a psycho-organic disorder other than dementia, 16 had an organic mood disorder. Of the other 241 patients, 152 had 159 primary psychiatric diagnoses: mood disorders in 100 cases and other psychiatric disorders in 59 cases, especially adjustment disorders, anxiety disorders and personality disorders. Together, only 60% percent of all primary or secondary psychiatric disorders were mood disorders. Various ways in which organic substrate, cognitive problems and psychopathology can be interrelated are discussed.Although affective disorders were the most frequent psychiatric disorders, several other psychiatric conditions were related to memory disturbances as well. Psychiatric assessment in patients with memory complaints should not be restricted to the diagnosis of depressive symptoms.

A group of 24 elderly persons who applied for a memory training because of memory complaints is compared with a control group of 24 healthy persons (matched for age, sex, and education). The comparison concerned several memory tests, complaints above everyday memory, depression and aspects of meta-memory. Before training, the memory training group had more complaints about everyday memory and depression compared to the control group. The training group reported more decline in memory capacity and functioning compared to their earlier days. They also reported feelings of stress and anxiety related to memory performance in daily life. Before training, the training group had more general knowledge about basic memory processes and used memory strategies more frequently. On most memory tests no differences were found. Memory complaints of elderly people may therefore not only be related to memory abilities according to tests but also to individual (negative) beliefs in memory capacity and abilities.

The department of neurology of the Academisch Medisch Centrum started an outpatient memory clinic in 1987 for patients aged 65 and older. Its specific aims are: assessment of elderly patients with memory problems, treatment where appropriate, and advice; clinical research; teaching and training. The clinic has run full-time since 1990. The approach is multidisciplinary. We describe our findings in the first 75 patients who were referred by their general practitioners because of forgetfulness or possible dementia: 72 of them had a complete investigation; 30 patients were not demented; three could be reassured because their performance was within normal limits. Four patients were depressed and they improved on therapy. Forty-two patients were demented. All had a CT scan and comprehensive blood tests but a curable cause for the dementia syndrome was never identified. This result was expected on account of the probably low frequency of 'reversible' causes and patient selection. Secondary prevention was important when a vascular component contributed to the pathogenesis of the mental deterioration (n = 6). Even when no curable condition was found, clarity about diagnosis and prognosis was important not only to the relatives but also to the general practitioner in planning the future management of the patient. Fifty-five of the 72 patients were older than 65 years which means that we do see the patients we are particularly interested in. The clinic offers facilities for clinical research. In the project 'Diagnostiek bij dementiesyndroom' (Diagnostics in dementia syndrome) we investigate the utility of ancillary investigations in relation to the outcome in demented patients.

In this explorative study, 20 demented and 20 non-demented elderly adults were tested with the Amsterdam Dementia Screening test (ADS3) and the Wechsler Memory Scale-Revised (WMS-R). Subjects were recruited from a nursing home. The ADS3 appeared to be a feasible instrument for the patient groups investigated here: 87.5% of the demented and non-demented patients were classified correctly. A combination of the ADS3 and the WMS-R led to a correct prediction of 97.5% of the individuals in the two groups investigated. Education appeared to have an effect on performance on the ADS3, whereas age and gender did not. As expected, a strong linear relationship between the ADS3 and the WMS-R was found. However, since data about reliability, validity and norms of the WMS-R are still under investigation, definite conclusions about the concurrent validity cannot be made yet.

By systematic training, 14 psychogeriatric patients (aged 70 to 95 years and admitted to day care because of dementia) were taught the first names of 8 members of staff of the day care center. Treatment duration was one month, twice weekly. The therapist introduced the names by a step-by-step approach, beginning with two name-face combinations, and adding one new name (and photograph of that person's face) every next training session. Treatment consisted of a combination of several cognitive strategies: organisation and directed attention, rehearsal, first letter cueing and vanishing cue techniques, and paired-associate learning based on rhymes, pictures and visual imagery. Patients were assigned at random to a treatment and a control group (waiting list condition). Patients in the control group received their training after the waiting period of one month. Using this pretest-posttest-control-group design, we were able to objectively evaluate treatment effects. Treatment caused a significant enhancement of knowledge of staff members names. Gains achieved using this program persisted over at least one month, as could be demonstrated by a follow-up evaluation.

Government, scientists and health care workers show an increasing interest in dementia and memory defects. It is unclear, however, whether the general public has acquired more access to the increased knowledge in this field. This is important to know because many people seem to worry about memory dysfunctions or about a possible dementia. An analysis of newspaper articles over a period of 3 years (March 1987 until March 1990) shows that the number of newspaper articles on memory has decreased. On the other hand, the average number of articles on dementia has increased from 11 per month in the first year to 25 and 28 in the second and third year. In these articles, most attention is given to research on dementia and to health care services for dementia patients. The number of articles on general aspects of dementia remained practically unchanged, although these articles in particular have an important informative function. In national newspapers, the attention for the six different themes is unequally divided. The themes 'general aspects of dementia', 'health care services' and 'research on dementia' have a relatively high impact. Finally, it appears that the same headline of an article can evoke different emotional reactions in a group of judges. Taking the results of this research into account, the authors argue that more health education activities should be directed at memory defects and dementia. Furthermore they conclude that a more systematic evaluation of these activities is necessary.