Memory disorder residential facilities typically house people with later stage dementing disorders who cannot be managed in less restrictive settings. The frequency of behavioral dyscontrol tends to increase as the dementia worsen. A certain percentage of such individuals will have aggressive behaviors, which may result in patient on patient or patient on staff aggressive acting-out that can have problematic or even catastrophic outcomes. When this occurs, the incident may become the focus of legal action taken against the facility and/or the care providers. The parties to the litigation may seek the consultation and assistance of a geriatric mental health expert.

Wang et al. analyze Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment accuracy as screening tests for detecting dementia associated with Alzheimer's disease (AD). Such tests are at the center of controversy regarding recognition and treatment of AD. The continued widespread use of tools such as MMSE (1975) underscores the failure of advancing cognitive screening and assessment, which has hampered the development and evaluation of AD treatments. It is time to employ readily available, efficient computerized measures for population/mass screening, clinical assessment of dementia progression, and accurate determination of approaches for prevention and treatment of AD and related conditions.

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Ten years ago, the University of Chicago Department of Psychiatry and Behavioral Neuroscience established a geriatric forensic psychiatry rotation for 4th-year psychiatry residents as one option in a required experience in forensic psychiatry. The rotation's primary emphasis was to learn about cases of testamentary capacity and undue influence. The program was supervised by a senior faculty member, an experienced clinician who was board-certified in Geriatric Psychiatry. Results: Over the past decade, three of the 11 residents have pursued career paths in forensic psychiatry, while another has become a geriatric psychiatrist. More than half of the respondents have pursued geriatric and/or forensic work following their graduations, and all believe that what they learned in the rotation applied to their general practice work. All 11 indicated that the rotation increased their interest in and understanding of forensic work. Ten "strongly agreed" that the geriatric forensic psychiatry rotation was a valuable learning experience; one "agreed." On average, trainees worked on 4.64 forensic cases over the course of the rotation and attended 2-3 trials or depositions. Over the last 3 years of the program, all three of the participating residents have chosen to complete a forensic fellowship following the rotation. Conclusion: Residents affirm that a geriatric forensic psychiatry rotation is a valuable learning experience, one that has utility after their graduation. The University of Chicago Department of Psychiatry and Behavioral Neuroscience is committed to continuing this rotation as an important part of their forensic experience in resident education and to encourage more interest in the area of geriatric psychiatry.

Diversity and Inclusivity: Achieving Excellence in Geriatric Mental Health–this is the perfect description of what AAGP has epitomized over the past yrs and is positioned to continue its creative leadership role for the next 40 yrs. My presentation to celebrate AAGP's 40th birthday will be divided into 3 parts: Our development, accomplishments & problems:Since AAGP was established, what have been the major accomplishments in our field?How can we explain our successes?What problems have we faced?How have they impacted our work and our directions?To what extent have we overcome them? A futuristic view of geriatric psychiatry:We are now a middle-aged organization.We have gone through significant growth spurts, & also have endured setbacks.Newer organizations have assumed roles that once were exclusively ours. We must ask ourselves:Is AAGP still relevant?If so, we are what are our unique contributions, organization's future projects & goals? How can we best integrate our training, knowledge and experience into the evolving directions of society?What will clinical, research and teaching in geriatric psychiatry look like in forty years?How can we best prepare for the future?I will conclude with hypotheses on the activities of geriatric psychiatrists at the time of AAGP's 80th birthday. Bio: Dr. Finkel is currently a Clinical Profeesor of Psychiatry at the University of Chicago Medical School. Previously, he was a Professor of Psychiatry at Northwestern University Medical School with Secondary Professorial appointments in the Departments of Neurology and Internal Medicine. As the Founder of AAGP, co-Founder of the American Psychiatric Association's Council on Aging as well as the International Psychogeriatric Association.I have been privileged to witness and contribute to the birth, growth and development of our field. Our members have shared many successes, experienced many problems, and, nevertheless, are poised to participate in an exciting and worthwhile future. A praciticing clinician and teacher of geriatric psychiatry for fifty years, he continues to be active in his field, innovating in a range of areas, including Behavior and Psychological Symptoms of Dementia, the use of telephone technology for caregivers, testmanetary capacity and undue influence issues, the use of computers for memory training, agitation in nursing homes, and capitation for dually eligibel elderly.

The availability and increasing popularity of direct-to-consumer genetic testing for the presence of an APOE4 allelle led the Alzheimer's Foundation of America Medical, Scientific and Memory Screening Advisory Board to identify three critical areas for attention: 1) ensure consumer understanding of test results; 2) address and limit potential negative consequences of acquiring this information; and 3) support linking results with positive health behaviors, including potential clinical trial participation. Improving access to appropriate sources of genetic counseling as part of the testing process is critical and requires action from clinicians and the genetic testing industry. Standardizing information and resources across the industry should start now, with the input of consumers and experts in genetic risk and health information disclosure. Direct-to-consumer testing companies and clinicians should assist consumers by facilitating consultation with genetic counselors and facilitating pursuit of accurate information about testing.

ObjectivesTo report experience with a large, nation-wide public memory screening program.DesignDescriptive study of community-dwelling elderly adults.SettingLocal community sites (48 sites agreed to provide data) throughout the United States participating in National Memory Screening Day in November 2010.ParticipantsOf 4,369 reported participants, 3,064 had complete data records and are included in this report.MeasurementsParticipants completed a questionnaire that included basic demographic information and a question about subjective memory concerns. Each site selected one of seven validated cognitive screening tests: Mini-Cog, General Practitioner assessment of Cognition, Memory Impairment Screen, Kokmen Short Test of Mental Status, Mini-Mental State Examination, Montreal Cognitive Assessment, Saint Louis University Mental Status Examination.ResultsOverall, 11.7% failed one of the seven screening tests. As expected, failure rates were higher in older and less-educated participants (P's<.05). Subjective memory concerns were associated with a 40% greater failure rate for persons of similar age and education but no memory concerns (odds ratio=1.4, 95% confidence interval=1.07-1.78), although only 11.9% of those who reported memory concerns (75% of all participants) had detectible memory problems.ConclusionScreening for cognitive impairment in community settings yielded results consistent with expected effects of age and education. The event attracted a large proportion of individuals with memory concerns; 88.1% were told that they did not have memory problems detectible with the tests used. Further studies are needed to assess how participants respond to and use screening information, whether this information ultimately influences decision-making or outcomes, and whether memory screening programs outside healthcare settings have public health value.

This is a case filed against an insurance agent and against an insurance company for selling several insurance policies and annuities to a 79 year old widow, including some which would not start paying out for many years (e.g., when she would be in her 90's). An appointed guardian brought the lawsuit several years later after the woman was diagnosed with dementia, in an attempt to recover the monies paid for the policies, plus substantial sums claimed for punitive damages and for RICO conspiracy claims. The case alleges that the agent should have known she was cognitively impaired and that the insurance company targeted elderly infirmed people to buy policies.

BACKGROUND:With the aging of the population there will be a substantial transfer of wealth in the next 25 years. The presence of delirium can complicate the evaluation of an older person's testamentary capacity and susceptibility to undue influence but has not been well examined in the existing literature. METHODS:A subcommittee of the IPA Task Force on Testamentary Capacity and Undue Influence undertook to review how to assess prospectively and retrospectively testamentary capacity and susceptibility to undue influence in patients with delirium. RESULTS:The subcommittee identified questions that should be asked in cases where someone changes their will or estate plan towards the end of their life in the presence of delirium. These questions include: was there consistency in the patient's wishes over time? Were these wishes expressed during a "lucid interval" when the person was less confused? Were the patient's wishes clearly expressed in response to open-ended questions? Is there clear documentation of the patient's mental status at the time of the discussion? CONCLUSIONS:This review with some case examples provides guidance on how to consider the question of testamentary capacity or susceptibility to undue influence in someone undergoing an episode of delirium.

Background: With the aging of the population there will be a substantial transfer of wealth in the next 25 years. The presence of delirium can complicate the evaluation of an older person’s testamentary capacity and susceptibility to undue influence but has not been well examined in the existing literature. Methods: A subcommittee of the IPA Task Force on Testamentary Capacity and Undue Influence undertook to review how to assess prospectively and retrospectively testamentary capacity and susceptibility to undue influence in patients with delirium. Results: The subcommittee identified questions that should be asked in cases where someone changes their will or estate plan towards the end of their life in the presence of delirium. These questions include: was there consistency in the patient’s wishes over time? Were these wishes expressed during a “lucid interval” when the person was less confused? Were the patient’s wishes clearly expressed in response to open-ended questions? Is there clear documentation of the patient’s mental status at the time of the discussion? Conclusions: This review with some case examples provides guidance on how to consider the question of testamentary capacity or susceptibility to undue influence in someone undergoing an episode of delirium.

Gene D. Cohen, M.D., Ph.D., the founding Editor-in-Chief of the American Journal of Geriatric Psychiatry (AJGP) passed away on November 7, 2009, at the young age of 65 years. Gene was a trail blazer, a visionary leader, and a pioneer in the field of geriatric psychiatry for more than 30 years. As a researcher, educator, clinician, administrator, and advocate older people, he worked for better understanding of the biopsychosocial processes of aging and helped to shift the emphasis in gerontological research from the problems of people as they age to the potential they can realize. Gene was one of the founders of geriatric psychiatry in the United States and shared his in-depth knowledge of the phenomena occurring in the brain as we age and their effects on cognitive and psychosocial development.In 1978, Gene and a small group of other leaders in the field met to form the first national group on geriatric psychiatry, creating the American Association for Geriatric Psychiatry, now 2,000 members strong. In 1992, plans were made to start a new journal for this organization. There was unanimity among the leaders that the best person to head this important venture would be Gene. His personal stature and inspiring leadership led to the AJGP being listed in MEDLINE in 1996, and its growth has never stopped ever since. When Gene stepped down from the editorship in 2001, the journal had become an internationally known publication in geriatric psychiatry.Gene's interest in research on aging went farther back into his early life. As a high school student, he won the first prize at the Massachusetts Institute of Technology/Massachusetts State High School Science Fair in 1961. The title of his project was aging and oceanography—a comparative analysis of the relationship of age to growth in fish to assess ecological conditions and a new method to assess age in fish. He graduated from the Harvard College and the Georgetown University School of Medicine and obtained a doctorate in Gerontology from the Union Institute.Gene began his professional career during the Vietnam War, which coincided with the emergence and expansion of geriatric psychiatry as a field of inquiry in the United States. Gene proposed the idea for a federally funded national center on aging and mental health in 1974. A year later, the National Institute of Mental Health's center on aging, the first such federal center in the world, was born. Fittingly, Gene was chosen to serve as the first chief of this new center, which was the forerunner of National Institute of Mental Health geriatrics research branch. In 1988, Gene moved to the National Institute on Aging, becoming its deputy director and later its acting director. During his National Institutes of Health tenure, Gene took a firm stance that biological, psychological, and social issues all needed financial support to conduct research. Thus, he laid the foundation for National Institutes of Health programs that now enable us to be engaged in federally funded research activities on mental disorders of late life.After leaving the federal government, Gene became the first director of the center on aging, health, and humanities, established in 1994 at George Washington University, where he was a professor of health care sciences and psychiatry and behavioral sciences (http://www.gwumc.edu/cahh/about/cohen.htm). He was also involved with the National Center for Creative Aging, dedicated to fostering an understanding of the relationship between creative expression and quality of life in older people. Gene also launched a public education program on aging called societal education about aging for change. He cofounded the Creativity Discovery Corps to help identify and preserve the creative accomplishments and rich histories of underrecognized talented older adults. He coordinated the Department of Health and Human Services' planning and programs on Alzheimer disease. He was the principal investigator of a 25-year longitudinal study of ill older adults, with problems from depression to dementia, living independently in the community, and conducted extensive longitudinal research on both healthy older adults and those residing in nursing homes.Gene devoted much of the last decade and a half of his life to exploring the relationship between aging and creativity. He was the project director for the National Endowment for the Arts' sponsored study that assessed the impact on older people of cultural programs provided by professional artists. Gene championed the idea that people past retirement age, whom he considered “keepers of the culture,” have untapped stores of creativity and intellectually rigorous skills in their later years. Gene once again led this newly emerging dynamic field of creativity and aging. His professional interests were also reflected in his personal life and hobbies. As a blooming game inventor after the age of 50 years, Gene showed through his own work that exceptional creativity was possible in later life. It is even more remarkable that Gene was as productive as he was despite having a serious physical illness for the last decade and a half of his life.Gene invented and copyrighted a number of games to stimulate and exercise the brains of elderly people, most of which were geared to an intergenerational audience. These Intergenerational Board Games received recognition in national and international media as well as juried game and art shows. They were the subject of three featured lectures that he was asked to give by the Smithsonian Institution. A Public Broadcasting Service (PBS) film was developed on his book, The Creative Age. One of the intergenerational games Gene created was Word Wars III (WW III), a combination of chess and Scrabble. It was named the best party game of 1994–1995 by fun and games magazine. Gene used to quip that “Since I hold the patent on WW III, it is now illegal for any person or country to declare WW III.” He also patented his adaptation of the centuries-old game of cribbage for people with visual or other physical disabilities.Gene authored more than 150 publications in the field of aging, including three books, The brain in human aging, The creative age: awakening human potential in the second half of life, and The mature mind: the positive power of the aging brain. The latter two books encouraged older people and their families to engage in creative activities, arguing that science has shown that such activities lead people to longer healthier lives. He also edited several textbooks.In addition to his many intellectual contributions, Gene was a moving force in the formation and building up of many other organizational structures and publication outlets that have become critical components in the mental health and aging field. Gene was the president of the Gerontological Society of America. His other positions included chairman of the council on aging of American Psychological Association. He was also the first Editor-in-Chief of International Psychogeriatrics, the official journal of the International Psychogeriatric Association.Gene received numerous honors and awards, including the Kent Award from the Gerontological Society of America, the Jack Weinberg memorial award for geriatric psychiatry from American Psychological Association, and Blair L. Sadler International Healing Arts Competition Award, First place (Participatory Arts Category), through the Society for the Arts in Health Care. During his tenure at the National Institutes of Health, he received the Public Health Service distinguished service medal (the highest honor of the Public Health Service). He was also recognized in Best Doctors in America.Gene was instrumental in bringing information about aging to the public. He was interviewed on Nightline, the MacNeil/Lehrer Show, CBS Nightly News, NBC Nightly News, The Today Show, Good Morning America, the CBS Early Show, and in a series of public service messages with comedian George Burns (the latter was awarded a public service gold medal media award).An important part of Gene's life was his family, which included his wife, two children, and four grandchildren. Additionally, he had a large global family of friends and colleagues. Gene's professional career was dedicated to the field of aging and geriatrics long before the field was established in the United States. In the beginning, Gene was the critical leader who provided leadership and direction in geriatric psychiatry. When he arrived, there was only one specialty program in geriatric psychiatry and when he left there were dozens. Whenever he reached a point where the growth curve was slowing a little, he found a new direction that took him and others to a different level. Thus, he reached out to the broader issues of health and aging and then beyond that to the aging of the entire population.Gene was thrilled to see the continued growth and development of the AJGP even after he left the Editor's position. A journal that started in 1993 as a quarterly with 60 submissions a year is now a monthly with over 300 submissions a year, with more than 50% of them coming from outside the United States, and with an impact factor exceeding 4.00, making it the highest impact journal in geriatrics. The best tribute to Gene's memory will be our commitment to rapid progress in the field of geriatric psychiatry from clinical, research, educational, and health care perspectives. Gene deserves nothing less. Gene D. Cohen, M.D., Ph.D., the founding Editor-in-Chief of the American Journal of Geriatric Psychiatry (AJGP) passed away on November 7, 2009, at the young age of 65 years. Gene was a trail blazer, a visionary leader, and a pioneer in the field of geriatric psychiatry for more than 30 years. As a researcher, educator, clinician, administrator, and advocate older people, he worked for better understanding of the biopsychosocial processes of aging and helped to shift the emphasis in gerontological research from the problems of people as they age to the potential they can realize. Gene was one of the founders of geriatric psychiatry in the United States and shared his in-depth knowledge of the phenomena occurring in the brain as we age and their effects on cognitive and psychosocial development. In 1978, Gene and a small group of other leaders in the field met to form the first national group on geriatric psychiatry, creating the American Association for Geriatric Psychiatry, now 2,000 members strong. In 1992, plans were made to start a new journal for this organization. There was unanimity among the leaders that the best person to head this important venture would be Gene. His personal stature and inspiring leadership led to the AJGP being listed in MEDLINE in 1996, and its growth has never stopped ever since. When Gene stepped down from the editorship in 2001, the journal had become an internationally known publication in geriatric psychiatry. Gene's interest in research on aging went farther back into his early life. As a high school student, he won the first prize at the Massachusetts Institute of Technology/Massachusetts State High School Science Fair in 1961. The title of his project was aging and oceanography—a comparative analysis of the relationship of age to growth in fish to assess ecological conditions and a new method to assess age in fish. He graduated from the Harvard College and the Georgetown University School of Medicine and obtained a doctorate in Gerontology from the Union Institute. Gene began his professional career during the Vietnam War, which coincided with the emergence and expansion of geriatric psychiatry as a field of inquiry in the United States. Gene proposed the idea for a federally funded national center on aging and mental health in 1974. A year later, the National Institute of Mental Health's center on aging, the first such federal center in the world, was born. Fittingly, Gene was chosen to serve as the first chief of this new center, which was the forerunner of National Institute of Mental Health geriatrics research branch. In 1988, Gene moved to the National Institute on Aging, becoming its deputy director and later its acting director. During his National Institutes of Health tenure, Gene took a firm stance that biological, psychological, and social issues all needed financial support to conduct research. Thus, he laid the foundation for National Institutes of Health programs that now enable us to be engaged in federally funded research activities on mental disorders of late life. After leaving the federal government, Gene became the first director of the center on aging, health, and humanities, established in 1994 at George Washington University, where he was a professor of health care sciences and psychiatry and behavioral sciences (http://www.gwumc.edu/cahh/about/cohen.htm). He was also involved with the National Center for Creative Aging, dedicated to fostering an understanding of the relationship between creative expression and quality of life in older people. Gene also launched a public education program on aging called societal education about aging for change. He cofounded the Creativity Discovery Corps to help identify and preserve the creative accomplishments and rich histories of underrecognized talented older adults. He coordinated the Department of Health and Human Services' planning and programs on Alzheimer disease. He was the principal investigator of a 25-year longitudinal study of ill older adults, with problems from depression to dementia, living independently in the community, and conducted extensive longitudinal research on both healthy older adults and those residing in nursing homes. Gene devoted much of the last decade and a half of his life to exploring the relationship between aging and creativity. He was the project director for the National Endowment for the Arts' sponsored study that assessed the impact on older people of cultural programs provided by professional artists. Gene championed the idea that people past retirement age, whom he considered “keepers of the culture,” have untapped stores of creativity and intellectually rigorous skills in their later years. Gene once again led this newly emerging dynamic field of creativity and aging. His professional interests were also reflected in his personal life and hobbies. As a blooming game inventor after the age of 50 years, Gene showed through his own work that exceptional creativity was possible in later life. It is even more remarkable that Gene was as productive as he was despite having a serious physical illness for the last decade and a half of his life. Gene invented and copyrighted a number of games to stimulate and exercise the brains of elderly people, most of which were geared to an intergenerational audience. These Intergenerational Board Games received recognition in national and international media as well as juried game and art shows. They were the subject of three featured lectures that he was asked to give by the Smithsonian Institution. A Public Broadcasting Service (PBS) film was developed on his book, The Creative Age. One of the intergenerational games Gene created was Word Wars III (WW III), a combination of chess and Scrabble. It was named the best party game of 1994–1995 by fun and games magazine. Gene used to quip that “Since I hold the patent on WW III, it is now illegal for any person or country to declare WW III.” He also patented his adaptation of the centuries-old game of cribbage for people with visual or other physical disabilities. Gene authored more than 150 publications in the field of aging, including three books, The brain in human aging, The creative age: awakening human potential in the second half of life, and The mature mind: the positive power of the aging brain. The latter two books encouraged older people and their families to engage in creative activities, arguing that science has shown that such activities lead people to longer healthier lives. He also edited several textbooks. In addition to his many intellectual contributions, Gene was a moving force in the formation and building up of many other organizational structures and publication outlets that have become critical components in the mental health and aging field. Gene was the president of the Gerontological Society of America. His other positions included chairman of the council on aging of American Psychological Association. He was also the first Editor-in-Chief of International Psychogeriatrics, the official journal of the International Psychogeriatric Association. Gene received numerous honors and awards, including the Kent Award from the Gerontological Society of America, the Jack Weinberg memorial award for geriatric psychiatry from American Psychological Association, and Blair L. Sadler International Healing Arts Competition Award, First place (Participatory Arts Category), through the Society for the Arts in Health Care. During his tenure at the National Institutes of Health, he received the Public Health Service distinguished service medal (the highest honor of the Public Health Service). He was also recognized in Best Doctors in America. Gene was instrumental in bringing information about aging to the public. He was interviewed on Nightline, the MacNeil/Lehrer Show, CBS Nightly News, NBC Nightly News, The Today Show, Good Morning America, the CBS Early Show, and in a series of public service messages with comedian George Burns (the latter was awarded a public service gold medal media award). An important part of Gene's life was his family, which included his wife, two children, and four grandchildren. Additionally, he had a large global family of friends and colleagues. Gene's professional career was dedicated to the field of aging and geriatrics long before the field was established in the United States. In the beginning, Gene was the critical leader who provided leadership and direction in geriatric psychiatry. When he arrived, there was only one specialty program in geriatric psychiatry and when he left there were dozens. Whenever he reached a point where the growth curve was slowing a little, he found a new direction that took him and others to a different level. Thus, he reached out to the broader issues of health and aging and then beyond that to the aging of the entire population. Gene was thrilled to see the continued growth and development of the AJGP even after he left the Editor's position. A journal that started in 1993 as a quarterly with 60 submissions a year is now a monthly with over 300 submissions a year, with more than 50% of them coming from outside the United States, and with an impact factor exceeding 4.00, making it the highest impact journal in geriatrics. The best tribute to Gene's memory will be our commitment to rapid progress in the field of geriatric psychiatry from clinical, research, educational, and health care perspectives. Gene deserves nothing less.

BACKGROUND:Challenges to wills on the basis of lack of testamentary capacity and/or undue influence are likely to increase over the next generation. Since contemporaneous assessment of testamentary capacity can be a powerful influence on the outcome of such challenges, there will be an associated increase in requests for expert assessment of testamentary capacity. There is a need to provide such potential experts with the knowledge and guidelines necessary to conduct assessments that will be helpful to the judicial system. METHODS:A subcommittee of the International Psychogeriatric Association (IPA) task force on "Testamentary Capacity and Undue Influence" was formed to establish guidelines for contemporaneous assessment of testamentary capacity. RESULTS:The task-specific criteria for testamentary capacity as outlined by Lord Chief Justice Cockburn in the well-known Banks v. Goodfellow case are described. Additional issues are identified for probing and documentation. This is designed to determine whether the testator can formulate a coherent, rational testamentary plan that connects his/her beliefs, values and relationships with the proposed disposition of assets. Rules of engagement by the expert assessor are defined as well as an approach to the clinical examination for testamentary capacity resulting in a clear and relevant report. CONCLUSION:Guidelines for experts who are asked to provide a contemporaneous opinion on testamentary capacity should help to inform disputes resulting from challenges to wills. A consistent clinical approach will help the courts to make their determinations.

OBJECTIVE:This study evaluated the effectiveness of a technology-based psychoeducational intervention for family caregivers of dementia patients. An additional objective was to determine if the intervention could be implemented by a community-based social service agency.METHODS:Forty-six caregivers were randomly assigned to either a technology-based intervention or an information-only control condition.RESULTS:Caregivers assigned to the intervention condition reported a significant decrease in burden postintervention and those who evidenced high depression at baseline experienced a significant decline in depression.CONCLUSION:This study provides evidence that technology offers a cost-effective and practical method for delivering interventions to caregivers.

OBJECTIVE The objective of this study was to determine the occurrence and recognition of common sleep-related problems and their relationship to health-related quality-of-life measures in the elderly. METHOD A total of 1,503 participants with a mean age of 75.5 (+/- 6.8, range: 62-100) years from 11 primary care sites serving primarily elderly patients were interviewed. Subjects completed a five-item sleep questionnaire and the SF-12. A Physical Component Summary (PCS-12) and Mental Component Summary (MCS-12) score was calculated. A systematic medical chart review was conducted to determine whether sleep problems were identified by the healthcare providers. RESULTS A total of 68.9% of patients reported at least one sleep complaint and 40% had two or more. Participants most commonly endorsed (45%) that they had "difficulty falling asleep, staying asleep, or being able to sleep." The number and type of sleep problems endorsed was associated with both physical and mental health quality-of-life status. Excessive daytime sleepiness was the best predictor of poor mental and physical health-related quality of life. Even when all five sleep questions were endorsed, a sleep complaint was only reported in the chart 19.2% of the time. CONCLUSIONS When elicited, sleep complaints predicted the general physical and mental health-related quality-of-life status in elderly populations with comorbid medical and mental illnesses. Yet, questions regarding sleep are not an integral component of most clinical evaluations. Given the growing evidence of a relationship between sleep and health, identification of sleep disorders could lead to improved management of common age-related chronic illnesses and quality of life of elderly patients.

Background: The possibility that low-dose antipsychotic treatment is associated with increased risk of cerebrovascular events (CVEs) in elderly patients with dementia has been raised. The objective was to determine whether risperidone is associated with an increased risk of CVEs relative to other commonly considered alternative treatments.Methods: An analysis of Medicaid data from 1999 to 2002, representing approximately 8 million enrollees from multiple states, was conducted. The primary outcome was the incidence of acute inpatient admission for a CVE within 3 months following initiation of treatment with atypical antipsychotics (risperidone, olanzapine, quetiapine, or ziprasidone), haloperidol, or benzodiazepines.Results: Descriptive analyses found similar rates of incident CVEs across evaluated agents. Multivariate analyses found no differences in comparisons of risperidone with olanzapine or quetiapine. Risperidone and other antipsychotics as a group were also not associated with a higher odds ratio (OR) of incident CVE than either haloperidol or benzodiazepines. With risperidone as the reference group: olanzapine, OR = 1.05, 95% CI 0.63-1.73; quetiapine, OR = 0.66, 95% CI 0.23-1.87; haloperidol, OR = 1.91, 95% CI 1.02-3.60, benzodiazepines, OR = 1.97, 95% CI 1.30-2.98. With benzodiazepines as the reference group, the OR of incident CVE for all antipsychotics as a class was 0.49, 95% CI 0.35-0.69.Conclusions: This study found no significant difference in the incidence of CVEs between patients taking risperidone and those taking other atypical antipsychotics. Risperidone and all atypical antipsychotics were not associated with higher risk than two common treatment alternatives (haloperidol and benzodiazepines). These findings do not support the conclusion that risperidone is associated with a higher risk of CVE than other available treatment alternatives. The data also suggest that patient characteristics other than antipsychotic use are more significant predictors of CVEs. Given the relatively low rates of incident CVEs, a larger sample of patients with groups closely balanced on a wide spectrum of potential risk factors could provide a more precise assessment of risk.

BACKGROUND:The aim of this study was to assess the undertreatment of elderly mild to moderate Alzheimer's disease (AD) patients in the United States utilizing baseline data from a community-based trial that has established comparability to national survey samples on demographic characteristics.METHODS:Baseline data were used from an open-label, 12-week, postapproval study of compliance with galantamine, an AChEI and nicotinic receptor modulator, and vitamin E. A total of 2,114 patients from 406 community-based US practices in which physicians had previously treated patients with acetylcholinesterase inhibitors (AChEIs) were included in the study. This population reflects a large, ethnically diverse patient pool consistent with the demographics of the elderly population in the United States, atypical of those enrolled in most AD trials.RESULTS:The majority of patients (64.5%) were described by either themselves or their caregivers as not having received prior AChEI treatment. Positive associations were found between past AChEI treatment and longer time since diagnosis, white race, higher education, medical care by a neurologist, and older caregivers. The likelihood of having received previous AChEI treatment was higher among white patients (61.9%) than among those from other ethnic groups combined (25.8%).CONCLUSIONS:The similarity of patient demographic characteristics to the 2000 US Census figures for the population aged >65 years makes this data set a potentially powerful tool for planning public health initiatives. Findings suggest that patients with mild to moderate AD are undertreated and that specialist and nonspecialist organizations should discuss and implement ways to optimize management of this disease.

STUDY OBJECTIVES:Sleep disturbances and decline in neuropsychological performance are common in older adults. Reduced social and physical activity is likely a contributing factor for these age-related changes in sleep and cognition. We previously demonstrated that a program of structured social and physical activity, with 2 daily activity sessions, 1 in the morning and 1 in the evening for a relatively short period of 2 weeks, improved sleep and neuropsychological performance in community-dwelling older adults. The goals of this pilot study were to determine whether a single daily morning or evening activity session for 2 weeks would also improve sleep and neuropsychological function and whether these effects were dependent on the timing of the activity sessions.DESIGN:We compared the effect of morning or evening structured activity sessions in a repeated-measures crossover design. Subjective mood, neuropsychological performance tasks, and subjective and objective measures of sleep were assessed at baseline and after the intervention.SETTING:All procedures took place in the participant's residence.PARTICIPANTS:Twelve older men and women (74.6 +/- 5.5 years of age).INTERVENTIONS:Subjects participated in 14 days of structured activity sessions in the morning (9:00-10:30 am) or evening (7:00-8:30 pm). Sessions consisted of stretching, low-impact aerobics, and game playing.MEASUREMENTS AND RESULTS:Exposure to either morning or evening activity significantly improved performance on a neuropsychological test battery. Morning activity sessions increased throughput on 4 of 8 performance tasks, while evening activity sessions improved throughput on 7 of the 8 performance tasks. Subjective sleep-quality ratings, measured by the Pittsburg Sleep Quality Index, improved following activity sessions in either the morning or the evening. Objective measures of sleep did not improve when measured by actigraphy or polysomnography.CONCLUSIONS:These results suggest that short-term exposure to either morning or evening social and physical activity improves objective measures of neuropsychological performance and subjective sleep quality in the elderly. Increasing exposure to social and physical activity may be a useful intervention to improve sleep quality and daytime function in older adults.