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.

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 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.

It is a privilege to announce on behalf of IPA the 7th Biannual IPA Research Awards in Psychogeriatrics. These awards are given for the best-submitted results of original, previously unpublished, research conducted in the field of psychogeriatrics. For the 2001 award competition, 35 submissions were received. These submissions came from 15 countries on five continents. Clearly, the review task is both rigorous and demanding, and I would like to commend the other referees who generously gave of their time and expertise for this competition. The referees were: Manfred Bergener from Germany; Henry Brodaty from Australia; Alistair Burns from England (UK); Vijay Chandra from India; Helen Fung-kum Chiu from Hong Kong; Edmund Chiu from Australia; Michael Davidson from Israel; Robin Eastwood from England (UK); Timo Erkinjuntti from Finland; Sanford Finkel from the United States; Mario Fioravanti from Italy; George Grossberg from the United States; Brian Lawlor from Ireland; Joao Carlos Barbosa Machado from Brazil; Burton Reifler from the United States; Karen Ritchie from France; Joel Sadavoy from Canada; and Michael Zaudig from Germany, in addition to myself, who also served as Chair of the IPA Research Awards Committee.

Background: Psychotic symptoms in subjects with Alzheimer disease (AD+psychosis, AD+P) are a marker for a distinct phenotype characterized by more rapid cognitive and functional decline and a liability to aggressive behaviors. We recently found that AD subjects homozygous for long alleles (l) of an insertion/deletion polymorphism in the promoter region of the serotonin transporter (5-HTTPR) had elevated rates of aggressive behavior. Objective: To examine whether the 5-HTTPR ll genotype confers an increased risk of AD+P, and of the combined AD+P/aggressive phenotype. Methods: The 5-HTTPR genotype was determined in 332 subjects diagnosed with possible or probable AD. All subjects received structured psychiatric assessments and were categorized with regard to their history of aggressive behaviors and psychotic symptoms. Results: Consistent with other reports, AD+P was associated with a significant increased risk for aggressive behavior. AD+P and aggression were both significantly associated with 5-HTTPR ll genotype and with an increased l allele frequency. Subjects with the combined behavioral phenotype (AD+P and aggressive behavior) had the highest rate of ll genotype and highest l allele frequency. Conclusion: The 5-HTTPR l allele appears to confer risk for the combined AD+P/aggressive phenotype. Confirmation of this association in a similar behaviorally well-characterized independent sample is needed.

Introduction. The aim of the study was to investigate whether the preclinical stage of Alzheimer's disease (AD) can be diagnosed in a clinical setting. To this end we investigated whether subjects with preclinical AD could be differentiated from subjects with nonprogressive mild cognitive impairment and from subjects with very mild AD-type dementia. Methods. Twenty-three subjects with preclinical AD, 44 subjects with nonprogressive mild cognitive impairment, and 25 subjects with very mild AD-type dementia were selected from a memory clinic population. Variables that were used to differentiate the groups were demographic variables, the Mini-Mental State Examination score, performance on cognitive tests, measures of functional impairment, and measures of noncognitive symptomatology. Results. Age and the scores for the delayed recall task could best discriminate between subjects with preclinical AD and subjects with nonprogressive mild cognitive impairment. The overall accuracy was 87% The score on the Global Deterioration Scale and a measure of intelligence could best discriminate between subjects with preclinical AD and subjects with very mild AD-type dementia. The overall accuracy was 85% Conclusions. Subjects with preclinical AD can be distinguished from subjects with nonprogressive mild cognitive impairment and from subjects with very mild AD-type dementia. This means that preclinical AD is a diagnostic entity for which clinical criteria should be developed.

Objective: Until now, prospective studies of aging have begun with 50- to 60-year olds, not adolescents. Premature deaths, childhood variables, and alcohol abuse have been often ignored. So has positive aging. As people live longer, gerontology needs to understand the determinants of health as well as illness in the later years. Method: The present study follows a cohort of adolescent boys (332 inner-city youths) for 60 years or until death. Complete physical exams were obtained every 5 years and psychosocial data every 2 years. Predictor variables assessed prior to age 50 include six variables reflecting uncontrollable factors—parental social class, environmental strengths, number of family problems, major depression, ancestral longevity, and premorbid physical health at age 50—and six variables reflecting (at least some) personal control: alcohol abuse, smoking, marital stability, body mass index, coping mechanisms, and education. The four outcome variables chosen to assess healthy aging at 70 reflected both “mind” and “body”. They included objectively assessed variables (death and/or disability prior to 70, and objectives mental health) and two subjectively assessed variables (perceived instrumental activities of daily living and life enjoyment). Results: Multivariate analysis suggested that positive aging at 70 could be predicted by variables assessed prior to age 50. More hopeful still, if the six variables under some personal control were controlled, depression was the only uncontrollable variable that affected the quality of subjective and objective aging. Conclusions: First, we may have greater personal control over our biopsychosocial health after retirement than previously recognized. Second, in this cohort, psychiatric rather than sociological predictors appeared more important.

This article reports the findings of a 3-year epidemiological survey for dementia in an urban community-resident population in Mumbai (Bombay), India, wherein the prevalence of all types of dementia was determined. Method: The study was conducted in three stages. Stage 1: From a potential pool of 30,000 subjects aged 40 years or more, 24,488 (male = 11,875; female = 12,613) persons completed self-report or interviewer-rated protocols based on the Sandoz Clinical Assessment Geriatric Scale, but 5,512 (18.37%) persons refused to participate. Scores on the protocol had a possible range from 0 through 34. Stage 2: Persons with a score +2SD above the mean were selected in this stage where the persons were screened for cognitive functioning using a modified and translated version of the Mini-Mental State Examination. Individuals who scored below the 5th percentile were included in Stage 3 and underwent a detailed neurological, psychiatric, and neuropsychological evaluation as well as hematological, radiological, electrocardiographic, and electroencephalographic investigations. Diagnoses were made jointly by a neurologist, psychiatrist, and psychologist using the DSM-IV diagnostic criteria. Subjects were also rated on the Clinical Dementia Rating (CDR) scale and assessed for activities of daily living. Results: One hundred five subjects with dementia (CDR ≥ 0.5) were identified in this population of 24,488 persons. The prevalence rate for dementia in those aged 40 years and more was 0.43% and for persons aged 65 and above was 2.44%. Seventy-eight individuals had a CDR of ≥ 1 yielding an overall prevalence rate of 0.32%, and a prevalence rate of 1.81% for those aged 65 years and older. The overall prevalence rate for Alzheimer's disease (AD) in the population was 0.25%, and 1.5% for those aged 65 years and above. AD (n = 62;65%) was the most common cause of dementia followed by vascular dementia (n = 23;22%). There were more women (n = 38) than men (n = 24) in the AD group. Increasing age was associated with a higher prevalence of the dementia syndrome in general as well as AD specifically. Conclusion: In the population surveyed, the prevalence of AD and other dementias is less than that reported from developed countries but similar to results of other studies in India. Prevalence of the dementia syndrome increased with age and was not related to gender. AD was the most common dementia and the prevalence was higher in women than in men. Results are discussed with respect to shorter life expectancy, relocation of affected persons, and differences in the risk factors as compared to developed countries.

The objective of this study was to analyze the relationship of the apolipoprotein E (apoE) ε4 and ε2 alleles to learning and memory performances in the nondemented oldest old. Forty-six nondemented persons aged 85 years or over from a randomly selected group of 128 subjects in Vantaa, Finland, were studied. ApoE genotyping was performed using the minisequencing technique. A structured clinical examination and interview were carried out. The test variables studied were learning and memory scores (from the Fuld Object-Memory Evaluation), verbal fluency, and conceptualization (the Similarities subtest of the WAIS-R). We compared apoE-ε4 carriers to noncarriers and apoE-ε2 carriers to noncarrirs. No statistically significant differences were found in any of the test variables. The results failed to confirm the hypotheses that poor cognitive performance is associated with the apoE-ε4 allele and good performance with the apoE-ε2 allele in the oldest old. This suggests that the apoE alleles do not have a detectable relationship to learning and memory in nondemented very elderly people.

Butyrylcholinesterase (BuChE) is expressed in brain structures involved in cognition, but the effect of selective BuChE inhibitors on human cognitive function is unknown. We report a patient whose cognitive function deteriorated following a reduction and improved following reinstitution of ethopropazine, a selective BuChE inhibitor. We suggest that, because neurons expressing BuChE may be involved in cognition, there is merit to further evaluation of selective BuChE inhibitors in treating cognitive dysfunction.

Nicotinic receptor loss has been implicated in the pathogenesis of Alzheimer's disease. The present study investigated the effects of chronic low-dose transdermal nicotine in a cohort of nondemented, healthy volunteers (mean age 63 years). The majority of subjects (85%) had a first-degree relation with dementia. Subjects were tested using a before, during, and after design on a battery of tests known to be sensitive to early cognitive decline. A mixed pattern of results was seen, with significant changes occurring with verbal learning, object learning, delayed recall, and word retrieval. Nicotine had no effect on measures of concentration or psychomotor speed. The effects were most noticeable in subjects at the lower end of baseline test performance on the tasks used. The results are discussed with reference to the relationship between strategic nicotinic receptor loss and measurable psychometric change. The potential therapeutic role of nicotinic agonists in preclinical “at risk” individuals is supported by the results of this study.

Objective: To describe a population-based, multifaceted shared-care intervention for late-life depression in residential care as a new model of geriatric practice, to outline its development and implementation, and to describe the lessons learned during the implementation process. Setting: A large continuing-care retirement community in Sydney, Australia, providing three levels of care (independent living units, assisted-living complexes, and nursing homes). Participants:) The intervention was implemented for the entire non-nursing home population (residents in independent and assisted living: N = 1,466) of the facility and their health care providers. Of the 1,036 residents who were eligible and agreed to be interviewed, 281 (27.1%) were classified as depressed according to the Geriatric Depression Scale. Intervention Description: The intervention included: (a) multidisciplinary collaboration between primary care physicians, facility health care providers, and the local psychogeriatric service; (b) trainning for primary care physicians and other facility health care providers about detecting and managing depression; and (c) depression-related health education/promotion programs for residents. Conclusions: The intervention was widely accepted by residents and their health care providers, and was sustained and enhanced by the facility after the completion of the study. It is possible to implement and sustain a multifaceted shared-care intervention for late-life depression in a residential care facility where local psychogeriatric services are scarce, staff-to-resident ratios are low, and the needs of depressed to residents are substantial.