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The cortical appearance on CT scan in patients suffering from late paraphrenia was assessed compared to that of age-matched normal controls. There was no difference in overall cortical appearance between the two groups. However, a correlation existed between ventricular size and cortical size and between ventricular size and age in normal controls but this was not present in paraphrenia. The implications of these findings are discussed in relation to a possible structural abnormality in late paraphrenia.

The objective was to develop a new short-form Geriatric Depression Scale (GDS-12R) suitable for older people living in nursing and residential care settings, including those persons with significant cognitive impairment. A total of 308 newly admitted residents of 30 nursing and residential homes in northwest England were interviewed using the Geriatric Depression Scale (GDS-15), the Mini-Mental State Examination, and the Affect Balance Scale (ABS). A 12-item version of the GDS was shown to have greater internal reliability than the 15-item version, because of the context-dependent nature of the deleted items. There was close agreement between the GDS-12R items and another indicator of depressed mood (a single item from the ABS). Furthermore, moderate to high levels of cognitive impairment did not affect the performance of the new version of the scale. The GDS-12R provides researchers and clinicians with a brief, easy-to-administer depression scale that is relevant to residential and nursing home populations.

Impaired frontal lobe and/or nondominant hemisphere lesions have been described in patients with typical misidentification syndromes (e.g., Capgras' syndrome or reduplicative paramnesia) who had various underlying psychiatric or neurologic disorders. In a prospective long-term study, the authors examined computed tomography measurements of patients with senile dementia of the Alzheimer type (DAT) to determine whether the forms of misidentification they suffered might correlate with organic factors.One hundred twenty-eight consecutive DAT patients were examined by means of standardized clinical instruments (Mini-Mental State score, CAMCOG, the Benton facial recognition test, the Kendrick object learning test, CAMDEX, and the Geriatric Mental State Schedule) and computed tomography.Of the 128 patients, 40 showed symptoms of misidentification; 25 of them misidentified other people in their homes, 7 misidentified their own mirror images, and 7 misidentified television images as being real. Computer-assisted planimetric computed tomography measurements showed that patients with misidentification syndromes had significantly larger right anterior horn areas of the lateral ventricle and significantly larger left anterior brain areas than did patients without such symptoms.The authors conclude that an accentuated degeneration of the right frontal lobe (and a relative preservation of the left frontal lobe) may be associated with delusional misidentification symptoms in DAT.

During some recent research for a project in the history of psychiatry, I had the opportunity of studying the first hundred years' Annual Reports of Glasgow's Gartnavel Royal Mental Hospital dating from 1814. I was struck at how applicable some of the comments were in modern psychiatry and was interested in some of the phraseology used and ideas expressed. Some were quaint, some entertaining and surprisingly few abstruse.

Background: Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer’s disease, vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. Methods/design: In this multi-centre, single-blind randomised controlled trial, 480 people with early-stage dementia, each with a carer, will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months, followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life, self-efficacy, mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. Discussion: If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation, it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion. Trial registration: Current Controlled Trials ISRCTN21027481