Regulatory reforms, together with large patient pools and increasing numbers of well-trained clinicians, have facilitated the development of clinical trials in Asia. Current regulatory and ethical issues are discussed.

Invited commentary for International Psychogeriatrics on Tieges Z, Stíobhairt A, Scott K, Suchorab K, Weir A, Parks S, Shenkin S and MacLullich A. Development of a smartphone application for the objective detection of attentional deficits in delirium. International Psychogeriatrics. 2015 Mar 6:1–12.

The review by Bird and colleagues (2016), published in this issue of International Psychogeriatrics, is notable for jointly examining the effect of dementia care interventions on both staff and resident quality outcomes. This is an important contribution to improving dementia care because it recognizes the dynamic and dyadic relationship between residents and their caregivers in residential settings. While evidence exists on the dyadic effect of family caregiver intervention on dementia patient outcomes (Gitlin and Hodgson, 2015), less attention has been given to formal caregivers in institutional settings (Dellefield et al., 2015).

Clinical and neuropathological examinations have shown that Alzheimer's disease is not a single entity. An early onset form with predominant parietal symptoms (type I) can be differentiated from a late onset form with mainly general cognitive symptoms and only mild parietal symptoms (type II). In CSF of patients with Alzheimer's disease type I there are signs of reduced blood-CSF barrier function and the metabolites of serotonin and dopamine are reduced in early stages, while in patients with type II there is often a diminished blood-CSF barrier function and in later stages there are reduced monoamine metabolites. Studies of membrane lipids of the brain have shown that myelin lipids are reduced in type II while gangliosides are markedly reduced in type I. Based on this finding a method has been developed for the assay of gangliosides in CSF. An increase of ganglioside GM1 seems to be a hallmark for Alzheimer's disease, type I.

Barriers to behavioral research are multifactorial. They include attitudinal, conceptual, financial, and administrative factors. In general, behavioral research and clinical research have received less support than basic science research (Marshall, 1994). The traditional emphasis has been on funding of basic research with the expectation that clinical research can be pursued without specific financial support. Although this might have been possible in the past, the increasingly tight control of clinicians' time and the need for cost-effective healthcare delivery have rendered this approach obsolete. Advances in clinically applicable information will require the type of research funding usually reserved for basic science endeavors.

Alzheimer's disease and other dementing disorders have been reported in most ethnic groups living in the United States. Although the presence of these disorders in different U.S. ethnic groups is well documented, the characteristics of dementing disorders, such as the presence of behavioral disturbances, in these groups remains unexplored.