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Background: The presence of apathy is associated with less favourable outcomes in dementia, including more rapid functional and cognitive decline, greater disease severity and increased mortality. We aimed to explore and gain an understanding into how people with dementia experience apathy, and consequently suggest effective interventions to help them and their carers. Method: 12 participants (6 dyads of 6 people with dementia and their family carers) were recruited from memory cafés, social groups, seminars and Patient and Public Involvement (PPI) meetings. People with dementia and their carers were interviewed separately and simultaneously. Quantitative data was collected using the following validated scales: Apathy Evaluation Scale (AES), short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Montreal Cognitive Assessment (MOCA), Cornell Scale for Depression in Dementia (CSSD) and Hospital Anxiety and Depression (HAD). The interviews were semi‐structured, focusing on the subjective interpretation of apathy and impact on behaviour, habits, hobbies, relationships, mood and activities of daily living. Interviews were recorded and transcribed and analysed using interpretative phenomenological analysis (IPA) which generated codes and patterns, which were collated into themes. Result: The participants with dementia had mild to moderate degrees of cognitive impairment, with a range between 9‐22 (out of 30) on the MOCA. They reported moderate levels of apathy on the AES. Four superordinate themes were identified, three of which highlighted the challenging aspects of apathy: "Losing one's sense of self"; "Feeling like a burden" and "Hindered by invisible obstacles". One theme: ''What keeps me going", described the positive aspects of the individuals' efforts to overcome apathy and remain connected with the world and people around them. Conclusion: This study is the first to illustrate and conceptualise the subjective experience of apathy in dementia, portraying it as a more complex and active phenomenon than the traditional view of apathy being simply negative and hopeless. Our study reveals a struggle against cognitive difficulties, fear of failure and invisible obstacles, with individuals desperate to remain connected, and appreciative of their carers' efforts to help them. Apathy and its effects warrant more attention from clinicians, researchers and others involved in dementia care. [ABSTRACT FROM AUTHOR]

Background: Vaccine hesitancy is a risk to global health and has become particularly salient considering the COVID‐19 pandemic. To date, no studies have investigated COVID‐19 vaccination behaviour in people with young‐onset dementia (YOD) and their carers. This study aimed to fill this gap. Method: 26 participants with YOD and 24 carers for a person with YOD (i.e., aged <65 years) from the UK were enrolled. Participants filled out a self‐administered online questionnaire including demographic data, history of COVID‐19, and adulthood vaccination. Following this, participants attended a one‐to‐one semi‐structured interview focused on their experiences and thoughts on COVID‐19 vaccines and the vaccination process. Result: The mean age of participants with YOD was 42.2 (range 26‐60), 88.5% were male, and 96.2% self‐identified as Black. The mean age of carers was 31.7 (range 19‐54 years), 70.8% were male, and 79.2% self‐identified as Black. In total, more than 30 reasons for acceptance and hesitation were identified. Willing to protect themselves, loved ones, and the community were identified as important reason to accept the vaccination by both groups. Recommendations from family members or healthcare professionals and wanting to go back to normal life were two of the most commonly repeated acceptance reason for people with YOD. Meanwhile, two of the most frequently mentioned acceptance reasons in carer groups were believing vaccination is the right thing to do and knowing the severity of COVID‐19. Several causes of vaccine hesitancy were mentioned by both groups, including fear of vaccine side effects and hearing negative news about the vaccination. In addition, people with YOD, but not carers, also identified fear of needles and suspicion that vaccination would exacerbate dementia as important causes of vaccine hesitancy. Important difficulties experienced in the vaccination process included long queues for vaccination, remote vaccine centre locations, and needing to be accompanied to the hospital for each dose. Conclusion: Participants delayed or refused COVID‐19 vaccination largely due to resolvable reasons such as a lack of time, issues around queuing, inaccurate information about vaccines, or previous negative experiences. Future research should explore the factors of COVID‐19 vaccination behaviour in women and in other ethnic groups. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's Disease (AD) is a neurodegenerative disease which is characterized by cognitive and functional impairment, and defined by triad of Amyloid status, Tau pathology, and Neuroimaging marker of neurodegeneration or neuronal injury. An early diagnosis of AD can be challenging and it can be detected earlier in brain functional imaging than brain structural imaging. Method: We develop a pipeline for synthesizing FDG‐PET/MRI from source MRI‐T1‐Weighted (MRI‐T1W) images based on denoising diffusion mechanism [1]. The pipeline includes a forward pass which encodes the source MRI‐T1WI images to gaussian noise space, and a backward pass which generates the corresponding FDG‐PET from the derived noises with repeated denoising steps. Furthermore, to validate the effectiveness of the synthesized FDG‐PET images, we also develop multiple types of classifiers and the experiments for both single input of MRI‐T1WI and joint input of MRI‐T1WI and synthesized FDG‐PET. Result: The experiments are performed on 1036 of FDG‐PET/MRI pairs (286,474, 276 for Cognitive Normal, Mild Cognitive Impaiement and Alzheimer's Disease each) are obtained from ADNI [2] datasets and display the promising results with low Mean Absolute Error (MAE) and high Structural Similarity Index Measure (SSIM) for the two stage diffusion denoising based FDG‐PET synthesis pipeline. The results for the additional classification experiments also show that in most cases the joint input enhances the classifiers' performance in accuracy and F1‐score. The results also indicate that the synthesized FDG‐PET images are not only visually similar to the ground truth images, but also improve the performance of machine learning based AD diagnosis. Conclusion: This work provides support for the notion that machine learning‐derived image analysis may be a useful approach to improving the diagnosis of AD. Reference: [1] Ho, J., Jain, A., & Abbeel, P. (2020). Denoising diffusion probabilistic models. Advances in Neural Information Processing Systems, 33, 6840‐6851. [2] Petersen, R., Aisen, P. S., Beckett, L. A., Donohue, M. C., Gamst, A. C., Harvey, D. J., ... & Toga, A. W. (2010). Alzheimer's disease neuroimaging initiative (ADNI). Neurology, 74(3), 201‐209. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of ageing patients in forensic psychiatric settings is increasing. However, limited research has reported around this population. The aim of this scoping review is to synthesise the current evidence around ageing forensic psychiatric patients.Methods: The literature was searched through four databases and Google searches. The identified outputs were screened for suitability and assessed for quality. Quantitative data were extracted and analysed on SPSS; qualitative data were extracted and analysed onto NVivo.Results: Seven studies were included in the review. Quantitative results reported around demographics, service contact, offending patterns, mental, and physical health of ageing patients. Qualitative findings focused on age-friendliness of services, staff-patient rapport, activities, security issues, and discharge planning.Conclusions: Ageing forensic psychiatric patients present with complex and unique needs in relation to treatment, activities, mental, physical, and support. Further research looking at individual patients' needs is paramount to inform policy development and good practice in this area. [ABSTRACT FROM AUTHOR]

Objective: More understanding is needed about the emotional experiences of dementia from the perspective of the individual. This understanding can then inform the provision of health care to meet individual needs. This systematic review aimed to present all available descriptions of emotional distress and explanations for emotional distress experienced by individuals with dementia, articulated personally and by others.Methods: A systematic mixed-method review identified literature that was screened and quality appraised. Data were analysed quantitatively and qualitatively using corpus-based methods and meta-ethnography.Results: The 121 included studies showed that individuals with dementia have expressed emotional distress comprehensibly. Family, professional caregivers, clinicians, and academic writers have also observed and described extreme emotional experiences. Feeling fearful and lonely were predominant and show the importance of anxiety in dementia. Explanations for emotional distress included threats to universal, human needs for identity, belonging, hope, and predictability.Conclusions: The variable and personal emotional experiences of individuals with dementia are well described and should not continue to be overlooked. Limitations, future research, and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: The existing literature on ageing prisoners tends to focus on such aspects as diagnosis and physical ill-health. In contrast, the experience of imprisonment from the perspective of ageing prisoners has received less attention. Grounded in a Good Lives Model theoretical framework, we reviewed and meta-synthesised literature around their experience of life in prison, its impact on their wellbeing and how prison services are currently addressing their complex needs. We further identify potential areas of improvement.Methods: 1. Systematic search on Assia, PsycInfo, MedLine, Embase, Web of Science, Google and Gov.uk. 2. Extraction and categorisation of data on NVivo. 3. Development of themes through thematic analysis and meta-synthesis. 4. Identification of potential areas of improvement.Results: We selected 25 studies for our review, of which 13 were from the USA, seven from the UK, two from Australia and one each from Ireland, Switzerland and Israel. We identified three themes: The hardship of imprisonment, addressing health and social care needs, and the route out of prison.Conclusions: Ageing prisoners have unique and complex health and social care needs which, to varying degree across different countries, are mostly unmet. Promising initiatives to address their needs are emerging, but, at present time, the overall experience of incarceration for the ageing prisoner is quite poor, given the inconsistent physical, emotional and social care support offered from prison intake to release and beyond. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to establish the feasibility and initial effectiveness of training and support intervention for care staff to improve pain management in people with dementia living in care homes (PAIN-Dem).Methods: PAIN-Dem training was delivered to care staff from three care homes in South London, followed by intervention support and resources to encourage improved pain management by staff over 4 weeks. Feasibility was assessed through fidelity to intervention materials and qualitative approaches. Focus group discussions with staff explored the use of the PAIN-Dem intervention, and interviews were held with six residents and family carers. Pain was assessed in all residents at baseline, 3 and 4 weeks, and goal attainment scaling was assessed at 4 weeks.Results: Delivery of training was a key driver for success and feasibility of the PAIN-Dem intervention. Improvements in pain management behaviour and staff confidence were seen in homes where training was delivered in a care home setting across the care team with good manager buy-in. Family involvement in pain management was highlighted as an area for improvement. Goal attainment in residents was significantly improved across the cohort, although no significant change in pain was seen.Conclusions: This study shows good initial feasibility of the PAIN-Dem intervention and provides valuable insight into training and support paradigms that deliver successful learning and behaviour change. There is a need for a larger trial of PAIN-Dem to establish its impact on resident pain and quantifiable staff behaviour measures. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The authors reflects on the editorial by S. Traverso and G. B. Traverso entitled "Revolutionary reform in psychiatric care in Italy: the abolition of forensic mental hospitals." They discuss the potential implications of the reform in the closure of forensic mental hospitals in Italy, the role of the Residential Units for the Execution of Security Measures (REMS) in psychiatric care, and the success of the psychiatric care reform in the country.

Objective: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. We examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients.Methods: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial. A total of 295 community-dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine.Results: Continuing donepezil for 52 weeks was more cost-effective than discontinuation, considering cognition, activities of daily living and health-related quality of life. Starting memantine was more cost-effective than donepezil discontinuation. Donepezil-memantine combined is not more cost-effective than donepezil alone.Conclusions: Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To study the stability and emergence of a range of behavioural and psychological symptoms (BPS), their association with mortality and the effect of covariates on these transitions in a population-based study of cognitively impaired older people with a long follow-up period and large sample size, with a particular focus on apathy.Methods: Data were from a population-based, longitudinal cohort study of ageing. Interviews were conducted at 0, 2, 6, 8 and 10 years with 3626 participants aged 65+. The persistence of 11 BPS and their association with mortality in those with cognitive impairment (MMSE 25 or below) was investigated using multi-state models, allowing us to take into account estimations of the probability of transitions that occurred in the time between interviews.Results: Most BPS were persistent. Apathy was one of the most stable symptoms; in those with apathy, the probability of still having apathy after 1 year is 62%. Apathy, sleep problems, depression, irritability and wandering were most likely to develop. BPS are associated with mortality; in those with apathy, mortality is 3.1 times more likely than in those without apathy. Low cognitive function and dementia were associated with emergence of new symptoms.Conclusions: This population-based, multi-centre study with a follow-up period of 10 years showed that BPS are associated with mortality and most symptoms are persistent. Apathy was characterised by a high prevalence, a high persistence and a strong association with mortality, and has a negative impact on disability, management of other disease and caregiver burden. [ABSTRACT FROM AUTHOR]

Objective A wide range of behavioural and psychological symptoms (BPSD) are common in dementia, and it has been suggested that groups of correlated symptoms should be studied together. Here, we describe the groups of BPSD that have been identified in the literature and how they have been used to study associations, burden, treatment and underlying biology. Methods The literature database PubMed was searched for articles that identified clusters or factors of BPSD or used previously defined symptom groups. Results Sixty-two studies were included. Generally, the following symptom groups were suggested: affective symptoms, including depression and anxiety; psychosis, including delusions and hallucinations; hyperactivity, including irritability and aggression; and euphoria. Symptoms that did not show consistent results include apathy, eating disturbances, night-time behaviour disturbances, disinhibition and aberrant motor behaviour. Symptom groups differed in their associations, treatment and biology. Conclusions Studies investigating symptom groups show relatively consistent results. Studying symptom groups allows similar symptoms to be studied together, which might strengthen results and may point to differences in their aetiology and treatment. However, a large amount of the individual variability of the symptoms could not be explained by the factors, and authors should carefully address their research question and hypotheses to decide if symptoms should be studied in groups or individually. Clinicians need to consider each symptom in its own right and also to be aware of the interrelations between them when assessing patients and developing strategies for treatment. © 2013 The Authors. International Journal of Geriatric Psychiatry by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Reliable and valid measurement of behavioural and psychological symptoms of dementia (BPSD) is important for research and clinical practice. Here we provide an overview of the different instruments and discuss issues involved in the choice of the most appropriate instrument to measure BPSD in research. A list of BPSD instruments was generated. For each instrument Pubmed and SCOPUS were searched for articles that reported on their use or quality. Eighty-three instruments that are used to measure BPSD were identified. Instruments differ in length and detail, whether the interview is with participants, informants or by observation, the target sample and the time frames for use. Reliability and validity is generally good, but reported in few independent samples. When choosing a BPSD instrument for research the research question should be carefully scrutinised and the symptoms of interest, population, quality, detail, time frame and practical issues should be considered. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Although less likely to be reported in clinical trials than expressions of the statistical significance of differences in outcomes, whether or not a treatment has delivered a specified minimum clinically important difference (MCID) is also relevant to patients and their caregivers and doctors. Many dementia treatment randomised controlled trials (RCTs) have not reported MCIDs and, where they have been done, observed differences have not reached these. Methods: As part of the development of the Statistical Analysis Plan for the DOMINO trial, investigators met to consider expert opinion- and distribution-based values for the MCID and triangulated these to provide appropriate values for three outcome measures, the Standardised Mini-mental State Examination (sMMSE), Bristol Activities of Daily Living Scale (BADLS) and Neuropsychiatric Inventory (NPI). Only standard deviations (SD) were presented to investigators who remained blind to treatment allocation. Results: Adoption of values for MCIDs based upon 0.4 of the SD of the change in score from baseline on the sMMSE, BADLS and NPI in the first 127 participants to complete DOMINO yielded MCIDs of 1.4 points for sMMSE, 3.5 for BADLS and 8.0 for NPI. Conclusions: Reference to MCIDs is important for the full interpretation of the results of dementia trials and those conducting such trials should be open about the way in which they have determined and chosen their values for the MCIDs. [ABSTRACT FROM AUTHOR]

Dementia is an important cause of disability in the elderly. There is evidence that cognitive impairment in dementia is on a continuum with cognitive impairment in the non-demented elderly. In order to investigate this possibility, we need detailed knowledge about the population distribution of cognitive function and change in cognitive function. The aim of this study is to describe the change in different domains of cognitive function over 4 years in a population-based sample of non-demented elderly people, and to investigate the effect of sociodemographic variables and baseline cognitive function on change in each of the cognitive domains. Respondents from two group general practice lists (n =503) were interviewed using the Cambridge Cognitive Examination (CAMCOG) at the incidence wave of the Cambridge City Over-75 Cohort Study and after a mean time period of 3.9 years. One hundred and thirty five of 212 non-demented subjects seen at follow-up completed the CAMCOG at both interviews. The annual rate of change in total CAMCOG score was -1.6 points per year (p <0.001). There was statistically significant decline in all of the CAMCOG subscales. Greater decline in the Memory subscale was associated with less education (p =0.03). Greater decline in the Attention/Calculation subscale was associated with manual social class (p =0.05). Greater decline in the Perception subscale was associated with older age (p =0.03). Decline in specific cognitive domains may indicate a reversible phase of cognitive impairment and deserves further investigation. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In recent years there has been interest in risk of cognitive impairment and dementia in populations of African origin. Little is known about this risk in older African Caribbean residents in the UK. One difficulty is lack of consensus over an adequate cognitive test battery for this community. Forty-five African Caribbean and 45 age and gender matched white community residents were recruited by household enumeration of an inner London electoral ward. These participants were administered the MMSE during a screening interview. Where possible, this was followed up by tests from the CERAD and CAMCOG neuropsychological batteries, a medical examination, and a structured interview with an informant. Based on these data, a psychiatrist blind to ethnicity independently rated 86 of these participants (41 of the African Caribbeans, all 45 of the whites) as cognitively normal, cognitively impaired, or demented. Of 41 African Caribbeans, 18 (44%) were rated as cognitively normal, 9 (22%) were rated as cognitively impaired, and 14 (34%) were rated as demented. Of the 45 whites, 39 (87%) were rated as cognitively normal, 4 (9%) were rated as cognitively impaired, and 2 (4%) were rated as demented. African Caribbeans scored significantly lower than whites in most cognitive test scores, which was not accounted for by their lower educational and occupational attainment, or their higher frequency of cardiovascular risk factors. African Caribbean elders in the UK appear to be at high risk of cognitive impairment and dementia. However, the influence of potential confounding factors such as socio-economic position and ill-health, and the effect of cultural test bias, cannot be ruled out. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives . To examine, using the published literature and local service experience, the contributions that carers can make to the development and evaluation of specialist mental health services for the elderly. Methods . MEDLINE search for relevant papers about carers and the elderly, especially with mental disorders; review of recent experience of service planning, implementation and evaluation in the Cambridge area. Results . Increased emphasis on the role of carers in recent literature, extending into acknowledgement of the carer perspective in official publications; few papers on the role of carers specifically in evaluating services, with only one study looking solely at an old age psychiatry service. Conclusions . There is considerable scope for involving carers in the development and evaluation of services, though there are also some potential concerns, not least that carers and users may have different perspectives. These issues are discussed, along with possible future developments, such as the need for a standardized assessment of carer satisfaction. Copyright © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective. Main objective: to study the relationship between suicidal thinking and both cognitive impairment and depression. Design. Random sample selected for interview, all of whom were a cohort in a pre-existing epidemiological study of dementia. Setting. Community residents. Patients and other participants. Participants aged over 81. Study excluded the following: moved out of area/died/too frail/severe communication difficulties/refused interview, refusal by GP/family/carers. 300 names selected at random from database. 170 eligible participants approached; 31 refused, 125 interviewed. 125 informants approached for interview; 118 interviewed. Main outcome measures. CAMDEX, 15-item Geriatric Depression Scale (GDS), and Scale for Suicidal Ideation (SSI) (including informant versions of latter 2 scales). Results. 9 people showed suicidal thinking, all women; 6 had clinical evidence of cardiovascular/cerebrovascular disease. Those with suicidal thinking showed higher CAMDEX depression scores, weaker strength of the wish to go on living, higher rates of expressing wish to die and higher rates of depressive illness and mixed DAT/multi-infarct dementia as primary psychiatric diagnoses. No significant associations between suicidal thinking and GDS scores, Alzheimer-type dementia alone, awareness of memory difficulties or severity of dementia. Conclusions. Results show association between suicidal thinking and both depression and mixed DAT/multi-infarct dementia, but do not support an association between suicidal thinking and awareness of memory problems/severity of dementia. Given the methodological limitations, the significance of the results should be viewed with caution. Further exploration of the role of cerebrovascular disease in depressive disorder is suggested. © 1997 by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A questionnaire regarding the teaching of old age psychiatry was sent to psychiatrists at teaching hospitals in England. A 53% response was received. Old age psychiatry is usually taught within general psychiatry, though there is frequent collaboration with geriatric medicine. Large numbers of students provide a challenge to this small speciality. More resources including time for teaching appear to be needed. Old age psychiatrists were keen to convey their enthusiasm and highlight the positive aspects of working with the elderly. [ABSTRACT FROM AUTHOR]

This article is based on the examination of seven old age psychiatry services in England in 1991, and it addresses the main issues in the organization of community-oriented clinical services for elderly people with mental disorders. The current practice of old age psychiatry places much emphasis, but there were marked differences in emphasis. The most controversial issue was whether all patients should initially be seen by a psychiatrist or whether assessments by non-medical professional were acceptable. Several areas of recent development in old age psychiatry are also discussed. [ABSTRACT FROM AUTHOR]

Objectives . To determine the prevalence of lithium therapy in the over-65s in the Cambridge Mental Health Services catchment area, to abtain a profile of this group and to find out how well and by whom lithium treatment is being monitored. Methods. A census was carried out of patients over the age of 65 in the Cambridge Mental Health Services catchment area who were on lithium therapy on 1 February 1995. The records of these patients were examined retrospectively for demographic details, details of lithium therapy, information about lithium monitoring and risk factors associated with lithium treatment. Results. One hundred and forty-eight patients were identified representing a point prevalence of 0·27%. GPs carried out lithium monitoring for the majority of this group and 47% had not been seen by a psychiatrist in the 12 months leading up to the census date. Thirty-two per cent of the group were on thyroxine treatment or had raised TSH levels. Conclusions. The prevalence of lithium therapy in this study was greater than the prevalences reported in studies of patients of all ages. Standards of monitoring varied widely and were not always better where psychiatrists monitored the treatment, although psychiatrists were more likely than GPs to monitor renal function. There was a high rate of thyroid dysfunction in the study group. © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To monitor key processes and outcomes in joint health and social services community psychogeriatric teams, from the perspective of principal caters of people with dementia. Design: Interview with carets six months after referral of the 39 community based people with dementia. Overall 34 (87%) principal carers volunteered but 5 refused follow-up. Setting: Two rural and two urban health and social services teams. All were routine service teams, rather than run for research purposes. District had relatively large long stay inpatient facility but low independent sector provision. Main outcome measures: Measures included avoidable admissions, crises or untoward events, unmet needs, proportion of carets experiencing severe stress assessed on the General Health Questionnaire, the cater satisfaction with service elements. Also comparison of cater and keyworker assessments of carer stress. Results: The majority of patients were female and few were under 75 years old. 93% were severely or totally impaired on the Activities of Daily Living problem score. The principal carets were mostly spouses or children, 56% being female. During the six month period from referral, keyworkers considered that there were 2 avoidable admissions and crisis or untoward events in 18 cases, the largest group being accidents (7). Caters considered needs to be met in 44% of cases. Lack of patient stimulation and cater respite, together with needs for appropriate institutional care, formed the major areas of unmet need. Fifteen of 26 (58%) caters completing the General Health Questionnaire had scores indicating the probable or definite presence of psychological distress. However, keyworker assessments of cater stress showed no correlation with GHQ scores. Fourteen of 32 (43%) considered the services received as of poor or moderate quality. Accounts of problems in arranging and using services highlighted a series of issues requiring management of policy attention. Conclusions: Carer inclusion in the monitoring of joint agency teams is feasible and leads to the identification of a range of practical problems in service configuration and delivery. Keyworker assessments of caret stress may not be valid and direct measurement may be necessary. [ABSTRACT FROM AUTHOR]

Objective: To monitor key processes and outcomes in joint health and social services community psychogeriatric teams. Design: Six month follow-up of new referrals to 4 teams in Cambridge. Data collected from structured clinical assessment forms at baseline and interviews with keyworkers at follow-up. Data for groups with and without dementia were compared. Setting: Two rural and two urban teams in area with relatively large long stay inpatient facility but low independent sector provision. All were routine service teams, rather than run for research purposes. Main outcome measures: The main outcome measures were survival, institutionalisation, key worker assessments of avoidable admissions, appropriateness of placement, unmet needs, carer stress and global outcome for patient and carers. Results: Rates of referral to urban teams were double rural rates. Around forty percent of the dementia group had a social worker as assessor and keyworker. The dementia group was significantly more dependent and received more informal and formal care. After six months, only 54% of the dementia group were alive and living outside institutional care, compared to 79% in the functionally ill group. Unplanned admissions to hospitals or homes were rarely judged avoidable by key workers. Outcomes for carets were judged poor in 15% of both groups, and 13% and 11 % of carers respectively were judged to be under severe stress. Unmet needs were more common in the dementia group, and related principally to residential care and cater respite. A number of measures, including evidence of geographical inequity and identification of unmet needs, provided an important contribution to local policy development. Further work is needed on the validity of keyworker assessments of carer stress, given the findings of the cater interview sub-study. [ABSTRACT FROM AUTHOR]

The article discusses geriatric psychiatry as of April 2013, with a focus on the instruments used in measuring behavioural and psychological symptoms of dementia (BPSD). Topics include the Neuropsychiatric Inventory (NPI) questionnaire which measures BPSD, cognitive impairment assessments, and the Behavioral Pathology in Alzheimer’s Disease Scale (BEHAVE-AD).

Presents a letter to the editor on the mortality of patients with dementia following discharge from hospital.

Presents a letter to the editor on Alzheimer and Arteriosclerotic Dementia, published in the June 1992 issue of the "International Journal of Geriatric Psychiatry."

Reviews two video releases. "Dementia Does Not Discriminate" and "Dementia Ki Hai."

Presents a letter to the editor about mental disorders in elderly published in August 1, 1994 issue of "International Journal of Geriatric Psychiatry."