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.

The Canadian Study of Health and Aging collected data focusing on the epidemiology of dementia, using interviews and questionnaires, clinical and neuropsychological examinations, physical measurements and blood collection, and access to public records such as death certificates, from people 65 and over in community (N = 9,008) institutional settings (N = 1,255). The study produced 12 data sets, including community health interviews, clinical and neuropsychological assessements, risk factor questionnaires, and caregiver interviews. This report describes the data collection and processing procedures, summarizes the content of each data set, and outlines the information collected in sufficient detail to permit its suitability for secondary analyses to be scrutinized.

Background: Aggressive behavior among geriatric psychiatry inpatients spontaneously declines during serial measurements over time with rating scales. Method: Evidence for decline in aggressive behavior, over a 6-week period, on a continuing-care geriatric psychiatry ward was examined with the Staff Observation Aggression Scale (SOAS) and the Rating Scale for Aggressive Behavior in the Elderly (RAGE). Results: The RAGE and all its subitems did not spontaneously decline. The total number of aggressive incidents on the SOAS, the SOAS total score, and the subitem scores, except for the SOAS results subitem, spontaneously declined after Week 4 and became established by Week 5. Conclusion: A “run in” period of at least 4 weeks may be needed in intervention studies using the SOAS to reduce contamination by spontaneous decline.

Dementia is a major public health problem in the United States and the world, requiring the expenditure of enormous economic and human resources. Dementia is common in the elderly, and, as the size of the aged population increases, the number of dementia victims will rise. Many dementias are fatal, producing the gradual erosion of intellectual abilities and eventual death of the patient. Demands made on family members and caregivers of dementia patients are extraordinary and often result in their emotional and financial exhaustion. Although basic science efforts are devoted to finding a cure for Alzheimer's disease (AD) and other dementing illnesses, there is an urgent need for research that has immediate applicability to the 4 million current dementia patients.

Aggressive behavior among the elderly is a neglected area of research. An 18-week prospective study of aggressive behavior on a continuing-care psychogeriatric ward provided data to examine the relationship between two aggression scales (SOAS and RAGE). There was a strong and significant correlation between the SOAS and RAGE scales for the total and the subscale scores. Both these scales appear useful in measuring aggressive behavior among continuing-care psychogeriatric inpatients. Also, the nursing staff can be trained to complete these scales effectively.

Community mental healthcare in rural and remote areas of Greece is mostly delivered by generic Community Mental Health Teams (CMHTs), namely the Mobile Mental Health Units (MMHUs). In Epirus, north-west Greece, one of the poorest regions in Europe, the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T) has been established in 2007 and provides services to a population grossly estimated at 100,000 per size of the catchment area in remote and mostly mountainous rural areas. The establishment of the MMHU I-T and its contribution to the care of patients with psychosis has been described elsewhere (Peritogiannis et al., 2011).

With current projections indicating that the number of persons with dementia will continue to rise in the near future (Alzheimer Disease International, 2018), dementia is now recognized as a public health priority worldwide. Despite the great efforts and budgets invested; as of yet, no cure or highly effective treatments for dementia are available. Thus, the development of care practices to improve the wellbeing and quality of life of persons with dementia and their caregivers have become primary aims in the management of the condition (Ortega et al., 2018).

In 150 older stroke patients (>75) without dementia, the proportion of people meeting different criteria for early cognitive impairment varied from 17% to 23% depending upon the individual criteria used. Given this large disparity, prospective studies to clarify the utility of different criteria as a predictor of subsequent dementia are a priority.

Lithium intoxication is known to induce cognitive deficits along with motor and behavioral changes, even in association with normal serum levels. However, cases with comprehensive neuropsychological assessment of the deficits are rare. In our patient, we initially found severe cognitive deficits, including apraxia and visuo-constructive problems, and temporo-parietal FDG–PET hypometabolism. Neuropsychological and imaging findings were highly suggestive of Alzheimer's disease. However, lithium intoxication was suspected to account for these findings because of a Parkinson's syndrome, despite serum levels being in the upper therapeutic range. This was confirmed as cessation of lithium medication not only let the Parkinson's syndrome disappear, but also lead to dramatic improvements with respect to cognition.

Impressive developments in the biomarker diagnosis of Alzheimer's disease (AD and pre-symptomatic states, using cerebrospinal fluid (CSF), positron emission tomography (PET), magnetic resonance imaging (MRI), and proteomics, have been at the forefront of research in the last decade. With the publication of the criteria of Dubois et al. (2007) and the revised National Institute on Aging and Alzheimer's Association (NIA–AA) criteria for the diagnosis of AD (Jack et al., 2011), this has further ignited the interest and enthusiasm for researchers and clinicians in the field. In some of the major conferences on dementia in recent years, the topic of the biomarker-driven diagnosis of AD has dominated the research agenda. But many questions arise as to how this research will translate into practice. Here, we would like to put forward our arguments against a biomarker-driven diagnosis of AD, and we would caution that very early diagnosis of AD may not result in better care of the subjects.

A 79-year-old female with type 2 diabetes and mild cognitive impairment (Clinical Dementia Rating score of 0.5) was supported with medication with regard to the daily requirements using a medication reminder device. Use of this device not only improved her medication adherence, hemoglobin A1c level, and self-confidence but also reduced caregiver's burden. For elderly patients with such diseases, loading the device with medication, providing advance notice before mechanical reminders for a short period after the device's activation, monitoring unused medication, and adjusting the timing of reminders according to users’ daily routine, seemed to facilitate daily use of the device.

Background: The objectives of this study were to characterize the psychiatric comorbidity of a group of older subacute inpatients and then determine whether their psychiatric comorbidity affected measures of rehabilitation outcomes.

Methods: Eighty-eight older subacute inpatients were recruited for this prospective study. Psychiatric comorbidity was defined according to a participants' performance on four inventory scales: the Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), Brief Psychiatric Rating Scale and Health of the Nation Outcome Scale 65+. Rehabilitation outcome referred to the participants' length of stay and their performance at discharge on the EuroQol-5D health-related quality of life questionnaire and Barthel index.

Results: 68% of the participants scored in the clinical range on at least one of the four scales assessing psychiatric comorbidity at admission, with 51% in the clinical range for GDS and 32% for the GAI. The decrease in scores by the time of discharge was significant for all four scales. Linear regression analyses pointed to a trend for depressive symptoms at admission to be an influential but nonsignificant predictor of rehabilitation outcome. An interesting association was found between the length of the previous acute admission and the GDS score on admission to the subacute unit.

Conclusion: A high prevalence of psychological symptoms was identified upon admission, with a significant decrease by the time of discharge. These factors did not significantly predict the selected measures of rehabilitation outcome. Opportunities for future longitudinal research on the prevalence and impact of psychiatric comorbidities on patient outcomes are considered.

This article is a review of the literature on the elderly with a learning disability, focusing on demographic data, functional abilities, mental health, physical health, and service use. This particular population is increasing and will have high health and social care needs. They share with their non-learning-disabled peers the problems of aging, namely the age-related infirmities of dementia, sensory impairment, urinary incontinence, and poor mobility. They develop psychiatric disorders that remain unrecognized and untreated. Some are cared for by aging parents who also may be frail with serious health problems. Further research is required on the quality of life, successful indicators of aging, and guidance on the type of service that will meet the needs of this group.