Recently articles have appeared suggesting that in transgenic mice, vaccination with small parts of beta-amyloid can produce antibodies that prevent formation of amyloid plaques in the young and banishment in older mice. (Mice do not have tangles.) Because vaccines have eliminated or mitigated the effect of smallpox, polio, tuberculosis, and other dread diseases, such news is electrifying. However, disbelief is not long suspended when certain facts are presented. First, the role of plaques and tangles is moot. Second, there are reckoned to be at least 55 kinds of dementia, with Alzheimer's disease (AD) having a major but decreasing proportion as new types are recognized. (Thus some would argue that Lewy body disease constitutes as much as 20% of all dementias.) Third, AD is not well diagnosed in life, being a postmortem diagnosis. Finally, we now recognize that there is a considerable overlap between AD and vascular dementia in terms of etiobgy and presentation. So just what are we vaccinating against? Beyond that of course is the mixed bag of variables involved in AD. Think of age, gender, race, intelligence, education, aluminum, oxidants, cholinesterase, and vascular risk factors. These are but a few.

The Canadian Study of Health and Aging (CSHA) is one of the largest epidemiologic studies of dementia conducted to date, with over 100 papers published or in press. The first (prevalence) phase data collection began in 1991, and the second (incidence) phase was completed in 1996. Publication of first and second phase data began in 1994 and 1998, respectively. The CSHA has contributed not only to our understanding of dementia, but also more broadly to the population health of elderly people. However, for those unfamiliar with the CSHA, gaining an understanding of the study's design and results has been difficult, due to the study's scope and complexity and necessarily brief descriptions of study methods in journal articles. Now, given the widespread availability of the data to the public at large and the research community, a comprehensive description of the study methods and data sets is desirable as a guide for potential users.

As the populations of the developed world continue to age, the number of people who develop Alzheimer's disease (AD) or other forms of dementia is set to rise. In the United States, for example, the prevalence of AD is projected to quadruple over the next 50 years (Brookmeyer & Gray, 2000). The search for factors that might help to prevent or treat these conditions has therefore assumed a particular relevance.

I would like to introduce the man who needs no introduction. David Ames has kindly agreed to be our new Deputy Editor. Until very recently, as we all know, he has brilliantly edited the Bulletin and has been our most competent Book Editor.

Choices abound while we await that pharmacogenetic fix that will save each one of us from all that is our individual and collective fate, contingent of course upon panopticon surveillance of our genetic susceptibilities and environmental triggers. The past decade has offered hope to those families facing the impenetrable shroud characterizing cognitive decline and dementia. Sufferers and their physicians have a growing compendium of pharmaceutical therapeutic interventions to attempt to stave off the usual, if not necessarily mindful, course of illness progression. In January 2001, the acetylcholinesterase inhibitors donepezil, rivastigmine, and galantamine were made available in the National Health Service in the United Kingdom, and some are on the formulary of five provinces in Canada. Those provincial pharmacare programs still refusing to provide these therapies free to the elderly cite lack of evidence of efficacy, following Cochrane guidelines based upon systematic review of the best evidence available using randomized controlled trials. Advocates for public funding of the pharmaceutical agents, on the other hand, cite a narratively rich, heart felt host of behavioral and affective symptoms stabilized or boosted by these drugs. And so, the two solitudes are drawn between science and humanity, between the cold guardians of the public purse and the caring humanitarians.

Will AN-1792, the “vaccine against Alzheimer's,” gain the same significance for the aging human brain as the year 1792 for history? Recent reports look promising. Will old-age psychiatrists and geriatricians, whose pharmacotherapeutic activities against dementia were traditionally compared to using aspirin against brain tumors, now have to downsize their business? This may well happen. Will society have to cope with costly cohorts of the wise very old, who will then be able to enjoy intellectually rich lives and cunningly claim their rights? An answer would go beyond the available evidence.

This year has been an extremely busy one for the Editorial Office in Cambridge, UK. The relocation from the US to the UK was an upheaval for the Journal. It involved the familiarization of new staff with new roles, the development of protocols appropriate to the UK setting, and the establishment of friendly and effective working communications between the offices on both sides of the Atlantic. It took some months for the new Editorial Office to get up to speed. We thank our IPA colleagues, authors, and reviewers for their support during this transitional period.

The Canadian Study of Health and Aging is a multicenter, population-based cohort study of dementia with a sample of 10,263 participants aged 65 or over. Field work began in 1991, and a follow-up study was undertaken in 1996–97. The present article describes the origins and objectives of the study, provides an overview of its design, organization, and data collection methods, and offers a brief summary of the main results.

The Canadian Study of Health and Aging drew representative samples of people aged 65 or over from the community and institutions across Canada. The sample was designed to provide regional and national prevalence estimates for dementia by age and sex. Thirty-six sampling areas were used in a stratified cluster design with optimal allocation; sampling weights were developed to provide population estimates. The sample included 9,008 people aged 65 or over from the community, and 1,255 from institutions. This report describes the sampling procedures, the methods used to recruit people to the study and participation rates, the characteristics of the resulting sample, and the way in which sample weights should be used.

Antioxidants, such as vitamins C and E, have been proposed for the treatment of dementia disorders. Although other vitamins and trace elements may also have antioxidant-enhancing activities, it is not known whether the overall antioxidant status in dementia patients is associated with the intake level of these vitamins and trace elements. In this study, we assessed the levels of vitamins and trace elements in the diet of patients with Alzheimer's disease (AD), vascular dementia (VaD), and dementia with Lewy bodies (DLB) and a group of carers, along with blood levels of total antioxidant capacity (TAC). Results show that the dietary intake was decreased for most measured vitamins and trace elements in severe AD, but not in other dementia groups. In addition, we found no significant difference in the levels of TAC between any of the dementia groups. There was, however, a significant correlation between intake of vitamin B1, vitamin B12, zinc, and selenium and blood levels of TAC in the VaD group, but not in the AD and DLB groups. Furthermore, no association was observed in any of the dementia groups between zinc and copper intake and Cu/Zn superoxide dismutase activity, or between dietary selenium intake and glutathione peroxidase activity. The activities of these two endogenous antioxidant enzymes do not seem to be influenced by intake levels of relevant substances. The data indicate that the influence of dietary vitamins and metal ions on the overall antioxidant status is limited to VaD patients only. Clinical trials are needed to ascertain the value of antioxidant supplementation in VaD patients.

Existing data on case management (CM) time were analyzed to investigate the impact of agitation and dementia-related behavior problems on the use of CM time by older clients (N = 242) in a Medicaid waiver-funded home and community-based services program. Among clients with dementia (n = 73), regression analysis revealed that having problem behaviors resulted in increased use of CM time. Among clients with behavior problems, those with greater functional ability consumed greater CM time. Content analysis revealed that most CM activity focused on service coordination rather than on direct attempts to manage problem behaviors. Implications for CM programs include the need to consider case mix when allocating caseload size and provision of specific training on interventions to address behavior problems.

The 10/66 Dementia Research Group (2000a) has drawn attention to the uneven distribution of research evidence worldwide; although two thirds (66%) of all persons with dementia live in developing countries, 10% or less of population-based research has been conducted in those regions. The study by Vas and colleagues on dementia in Mumbai, India, published in this issue of International Psychogeriatrics is therefore most welcome. Dementia has a very low profile in most developing countries. Families often view it as a normal part of aging, and few seek help despite experiencing significant strain (Pate1 & Prince, 2001; Shaji et al., in press). Unsurprisingly therefore it is accorded a low priority by policymakers in the developing world, and there is little sign of attention being given to the development of more responsive health care or social welfare services. Population-based research, well disseminated, can play an important role in increasing awareness at all levels of society.

Objective: This article analyzes the natural history of wandering behavior throughout the course of dementia. Design: Prospective, 10-year, longitudinal study of wandering behavior in dementia, with autopsy follow-up. Setting: Participants with dementia, living at home with a carer. All lived in Oxfordshire, UK. Participants: Eighty-six people with dementia who were living at home with a carer and who were able to walk unaided at entry to study. Measures: At 4-monthly intervals, the carers were interviewed using the Present Behavioural Examination to assess wandering behavior were distinguished. Results: Changes in wandering behavior were not generally related to gender, age, or time since onset of dementia. Onset of different types of wandering behavior showed some relationship with cognitive state. Various forms of increased walking first appeared during moderate dementia, each type typically persisting for 1 to 2 years. Late dementia was characterized by decreased walking and immobility. Conclusions: Wandering behavior in dementia can cause great problems for carers. There are different causes for such changes, some of which are related to cognitive ability, for example increased confusion results in ineffectual “pottering” and getting lost. Increased walking at night corresponds with disruption of diurnal rhythm.

Dementia with Lewy bodies (DLB) is a common cause of the dementia syndrome. Symptomatic treatment of the fluctuating cognition, visual hallucinations, and sleep distrubance that characterize this condition is challenging; neuroleptics are relatively contraindicated. We describe eight patients fulfilling the consensus diagnostic criteria for probable DLB who were treated with rivastigmine. Clinical features rated were: cognition by the Modified Mini-Mental State Examination (3MS); and behavioral and psychiatric symptoms by the Neuropsychiatric Inventory (NPI). Additional information was obtained from family and nursing reports. Seven patients showed resolution or improvement in cognition and neuropsychiatric symptoms as demonstrated by improvement in their 3MS and NPI scores. They also became more independent in mobility and activities of daily living, and the majority returned to live in their own home. Of the seven patients with sleep disruption, six improved. One case had no improvement in his symptomatology and the rivastigmine was stopped. Outcomes in this case series suggest that rivastigmine is well tolerated in clinical practice.

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.

Objective: To compare the utility of temporal lobe magnetic resonance imaging (MRI) and single-photon emission tomography (SPET) scanning in discriminating between subjects with Alzheimer's disease (AD) and age-matched controls. Methods: Thirty subjects with NINCDS-ADRDA AD (23 probable AD, 5 possible AD, 2 definite AD) and 22 age- and sex-matched controls underwent T1-weighted coronal MRI scanning (0.3 T) and technetium 99m-HMPAOSPET scanning. MRI scans were analyzed using a digitizer system with volumes of hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, and whole cerebral cortex calculated. From SPET scans, regional cerebral blood flow (rCBF) was assessed in anterior and posterior frontal, parietal, occipital, and mesial temporal cortex using a region of interest analysis with the cerebellum as a reference area. Results: Using MRI, the areas that best separated groups were left hippocampal and left amygdala volume, resulting in correct classification (patient vs. control) in 79% of cases (sensitivity 77%, specificity 82%). Exactly the same proportion of subjects were correctly classified by SPET, with the most discriminating rCBF changes being left parietal and right posterio frontal. Combining information from both scans improved the proportion of correctly classified subjects in a discriminant function to 90% (sensitivity 93%, specificity 86%, only 2AD and 3 controls misclassified). All AD subjects had abnormalities on MRI and/or SPET (sensitivity for combined examinations 100%), while abnormalities on both MRI and SPET had a positive predictive value of 100% for dementia (including the detection of one control subject who later had dementia). Significant correlations between MRI and SPET measures were seen in control subjects but not in patients. Conclusion: Both 0.3 T MRI and single rotating gamma camera SPET were equally useful in separating AD subjects from age-matched controls, although the combination of both significantly enhanced discrimination. In particular, all AD subjects had abnormalities on either MRI or SPET and both techniques may have an important role in assisting with clinical diagnosis, though replication in other centers and examination of differentiation of AD from other causes of dementia need to be examined.

Few instruments are available with which to measure behavioral and psychological signs and symptoms in Hispanic patients with dementia. Therefore, the aim of the current study was to develop and evaluate a 17-item scale adapted from the Revised Memory and Behavior Problems Checklist. This measure, the Behavior Problems Checklist-Spanish (BPC-S), assesses caregiver-reported symptoms of depression and disruption in patients with dementia. The sample for this study comprised 27 Spanish-speaking Hispanic patients and their family caregivers evaluated at a university-affiliated memory disorders center. All patients met diagnostic criteria for possible or probable Alzheimer's disease as set forth by the National Institute of Neurological and Communicative Diseases and Stroke--Alzheimer's Disease and Related Disorders Association. Satisfactory convergent validity, discriminant validity, and internal consistency reliability were demonstrated for the Depression and Disruption subscales of the BPC-S. Both of these neuropsychiatric distrubances were related to heightened levels of caregiver burden. The results of this preliminary study suggest the BPC-S is a brief, psychometrically sound caregiver-report instrument to assess symptoms of mood disturbance and behavioral disruption in Hispanic patients with dementia. This instrument may have utility for both clinical and research purposes.