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Background:Dementia involves a progressive decline in many functional areas. Policy and practice guidelines should cover the entire course of the disease from early detection to the end-of-life. The present study aimed to evaluate the contents of national dementia strategies with a focus on palliative care content.Methods:We employed qualitative content analyses. Sixteen national dementia strategies from 14 countries were reviewed. Using open coding, the contents were compared to the domains and recommendations of the palliative care in dementia white paper of the European Association for Palliative Care (EAPC).Results:Although palliative care was not explicitly referred to in eight of the 14 countries and only to a limited extent in three countries, a number of domains from the EAPC white paper were well represented, including “person-centered care, communication, and shared decision making”; “continuity of care”; and “family care and involvement.” Three countries that referred to palliative care did so explicitly, with two domains being well represented: “education of the health care team”; and “societal and ethical issues.” The strategies all lacked reference to the domain of “prognostication and timely recognition of dying” and to spiritual caregiving.Conclusions:National dementia strategies cover part of the recent definition of palliative care in dementia, although they do not frequently label these references as “palliative care.” In view of the growing numbers of people dying with dementia, preparation for the last phase of life should be added to national strategies.

Since 2014, the year in which International Psychogeriatrics celebrated 25 years of existence, International Psychogeriatrics has featured a “paper of the month” (POM) category. Chosen by the editorial team which ranks available new International Psychogeriatrics manuscripts from the categories “original research articles” and “reviews,” a POM is identified representing high scientific quality and clinical relevance. Each POM is accompanied by a short commentary highlighting its findings and relevance. For the year 2016 this resulted in twelve papers of the month of which nine were original research articles and three were systematic reviews or meta-analyses.

It was well beyond my expectations when I heard from Professor Ames that our meta-analysis paper (Han et al., 2000) was among the top-cited papers in International Psychogeriatrics. As an expression of my gratitude to the editor for the invitation and to the audience of this paper, I would like to offer this informal discussion on the background of the paper and extend a few ideas that were not conveyed fully at the time, due either to insufficient knowledge or unavailability of relevant data or methodologies.

The majority of people with dementia develop behavioral and psychological symptoms of dementia (BPSD) at some point during their illness (Jeste et al., 2008). These symptoms, which are especially common among care home residents, are frequently distressing for the patients who experience them (Gilley et al., 2006; Jeste et al., 2008) and problematic for their professional and/or family caregivers. The starting point for our paper “Quality of life for people with dementia living in residential and nursing home care: the impact of performance on activities of daily living, behavioral and psychological symptoms, language skills, and psychotropic drugs” (Ballard et al., 2001) was to try and understand the impact of BPSD, function and language skills on quality of life in care home residents with dementia. Although there were frequent statements in previous work referring to the capacity of psychiatric and behavioral symptoms to reduce quality of life, we had been unable to identify any empirical evidence to support this clinical impression in a thorough literature review. The parallel validation of Dementia Care Mapping (DCM), predominantly a practice development tool, as an observational measure of well-being/quality of life (Kitwood and Bredin, 1997; Fossey et al., 2002) provided an excellent opportunity to examine this issue in a care home setting. The study focused on 209 people with dementia living in residential and nursing home care in north-east England in the U.K., who received a detailed assessment of BPSD, function and cognition. A DCM evaluation was completed for 112 of these individuals, providing a detailed observational measure of well-being, activities and social withdrawal as indices of quality of life over a six-hour daytime period. To our surprise, there was actually no association between well-being, social withdrawal or activities and BPSD. In contrast, there was a significant association between antipsychotic medication and reduced well-being, social withdrawal and activities respectively, even after controlling for the severity of behavioral disturbance. Using an arbitrary definition of “ill-being”, defined as a well-being score of less than zero, 5% of people not taking antipsychotics, 10% of people taking atypical antipsychotics and 22% of people taking typical antipsychotics were defined as having ill-being. Lower levels of functional ability were also associated with significantly lower well-being, less activities and more social withdrawal. At first this latter finding appears to be contrary to one of the central principles of DCM – namely, that the assessment should be independent of dementia severity. Although high levels of well-being and engagement are possible for people with severe dementia, this probably requires higher staff numbers and a workforce with more specialized skills in order to achieve this.

In 2014, International Psychogeriatrics (IPG) for the first time introduced a “paper of the month” category as part of the 25th year's milestone celebrations. Papers of the month were chosen through an internal selection process by the IPG editorial team. Each month, the seven editors ranked suitable accepted papers from the categories “original research articles” and “reviews” according to scientific quality and clinical relevance. Each paper of the month was accompanied by a brief commentary written by one of the IPG editors, one of the reviewers for the paper, or an international expert on the specific topic of the paper. From the 12 papers of the month, an IPG paper of the year was selected after a ranking process involving three independent expert reviewers.

In 2014, the International Psychogeriatric Association (IPA) celebrated the fact that IPA's flagship scientific journalInternational Psychogeriatrics(IPG) has matured, attaining 25 years of existence since its foundation in 1989. The IPG editorial team introduced several new features in the 2014 issues to celebrate this significant quarter century milestone. One of them was the new “paper of the month” category. Following an internal selection process amongst the editorial team, who ranked available accepted papers focusing on their scientific quality and clinical relevance each month, one paper was selected as paper of the month from the categories “original research articles” and “reviews”. This resulted in 12 papers of the month, of which eight were original research articles and four were reviews or meta-analyses. Each paper of the month was accompanied by a short commentary highlighting its importance, written either by an editorial team member, one of the reviewers of the paper, or an external international expert on the topic of the paper. The editorial team aimed to highlight various psychogeriatric topics, so there are papers covering the wide spectrum of cognitive impairment, from risk factors such a hippocampal atrophy (Ferrariniet al., 2014) and traumatic brain injury (Gilbertet al., 2014), via transition between diagnostic categories on the cognitive continuum (Elliset al., 2014) to variations in symptom expression (Rockwoodet al., 2014) and apathy (Theleritiset al., 2014) to exercise interventions for people with Alzheimer's disease (AD) (Farinaet al., 2014) or antipsychotic use for patients with dementia living in residential care (Kleijeret al., 2014). Other papers reported on topics relevant to the aging process in general, such as neuroplasticity (Valkanovaet al., 2014), loneliness (Yanet al., 2014) or attitudes to aging (Shenkinet al., 2014). Other psychogeriatric topics covered were delirium (Ritchieet al., 2014) and geriatric depression (Steffenset al., 2014). In the international spirit of IPA, authors of the 12 papers come from Australia, Canada China, Greece, Germany, Italy, Mexico, the Netherlands, Switzerland, the UK, and the USA. From those 12 papers an IPG paper of the year 2014 was selected with the help of three independent reviewers: Dr Doh Kwan Kim from South Korea, Dr Gill Livingston from the UK, and Dr Daniel Weintraub from the USA. Our three reviewers ranked all 12 papers of the month independently from each other and the highest ranked paper overall was “The association of traumatic brain injury with rate of progression of cognitive and functional impairment in a population-based cohort of Alzheimer's disease: the Cache County Dementia Progression Study” by Mac Gilbert, Christine Snyder, Chris Corcoran, Maria C. Norton, Constantine G. Lyketsos, and JoAnn T. Tschanz. The reviewers emphasized that traumatic brain injury (TBI) is recognized as an important risk factor for AD which needs more research, and that the study by Gilbertet al.contributes important new knowledge to the area with the specific strength of reporting long-term follow up. In this context, we refer to the excellent commentary on the paper of the year by Dr David Sharp (Sharp, 2014), which was published alongside the paper of the year when it was paper of the month in the October 2014 issue.

The behavioral and psychological symptoms of dementia (BPSD) are common and serious problems that affect the quality of life of the patients who experience such symptoms as well as their caregivers (Matsui et al., 2006). BPSD present a major challenge in the medical management of cognitively impaired patients. Our paper entitled “Behavioral disorders and caregivers’ reaction in Taiwanese patients with Alzheimer's disease” (hereafter referred to as the “paper”) (Fuh et al., 2001) has been cited widely, reflecting the importance of these clinical issues and the growing international interest in studies of BPSD.

While working as a staff development coordinator in a long-term care facility during the mid to late 1980s I witnessed agitation in persons with dementia (PWD) and the negative effects that these behaviors had on both the caregiver and the care recipient. Published research findings validated the widespread prevalence of this problem. Management strategies at the time focused primarily on chemical and physical restraints which, in and of themselves, were fraught with adverse effects. Shortly thereafter I enrolled in graduate school where I focused my efforts on exploring this problem with a clear understanding that there was a need for alternative interventions that were relatively inexpensive and could be readily and easily implemented by trained staff. These efforts eventually led to the development of individualized music as an intervention for the management of agitation in PWD. Individualized music is defined as music that has been integrated into the person's life and is based on personal preference (Gerdner, 1992). Extensive clinical experience along with findings from a pilot study (Gerdner, 1992) served as the foundation for the development of intervention guidelines (Gerdner, 1996) and a mid-range theory of individualized music intervention for agitation (IMIA) (Gerdner, 1997). The publication of the original pilot study (Gerdner and Swanson, 1993) generated a considerable amount of interest resulting in further efforts toward testing the effects of individualized music for the management of agitation in PWD (Casby and Holm, 1994; Cohen-Mansfield and Werner, 1997; Devereaux, 1997; Thomas et al., 1997; Clark et al., 1998). The strengths and limitations of these studies were used to design a more rigorous methodology using a larger sample for the purpose of testing the propositions of IMIA and the effects of individualized music when compared to classical “relaxation” music on the frequency of agitation in PWD. The findings of this study were published in International Psychogeriatrics (Gerdner, 2000). As of January 2009, this article has been cited in 91 scholarly publications and was the impetus for additional studies conducted in the U.S.A., Sweden, Japan and Taiwan. These efforts have resulted in an expanding body of research to support the use of this intervention for the management of agitation (Ragneskog et al., 2001; Janelli et al., 2002; Suzuki et al. 2004; Sung et al., 2006; 2008; Park, 2008).

Reviews the book, "Elder Abuse: Selected Papers from the Prague World Congress on Family Violence" edited by E. Podnieks, J.I. Kosberg, and A. Lowenstein (2005). The 'Prague Papers', as this collection has become known, consists of ten contributions on various aspects of elder abuse by international experts. The papers cover topics from the prevention of financial abuse and recognition of elder abuse in faith communities, international variations in the definition and reliable detection of elder abuse, to the vulnerability of older women. The reader will find plenty of new developments presented here, although the studies reported are relatively modest and have not had access to larger-scale research resources. Papers of special interest call for greater awareness of abuse of grandparents by grandchildren. However, given examples of threats, defiance and sometimes serious acts of violence, it leaves little doubt that, as vulnerable children need protection, so do vulnerable adults need the same opportunities for frank disclosure, support and protection from harm. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Senile dementia was the third most common admission diagnosis for New York psychiatric hospitals at the start of the twentieth century and the distinction between vascular and senile dementia was understood by psychiatrists even then. The term Alzheimer's disease (AD) was originally introduced to distinguish a pre-senile dementia from the common general paresis, but Alzheimer raised the possibility that pre-senile AD might not be distinguishable in clinical or histological terms from senile dementia. By the late 1970s it had become clear that the most common disorder producing dementia in elderly people was clinically and pathologically identical to pre-senile AD. AD is malignant, reducing remaining life expectancy by almost half and raising the risk of death over five years threefold (cancer raises it fourfold). Synapse loss associated with beta amyloid oligomers is a strong determinant of cognitive decline in patients with AD. Tau-containing neurofibrillary tangles usefully track disease severity. Unmodifiable risk factors include mutations in three genes which affect the production or metabolism of beta amyloid, the risk factor gene for Apolipoprotein [see symol in text]4 and female gender. The overriding risk factor is age, the prevalence of AD doubling with every five years of age until 90. Low education, head injury and low folate levels are examples of potentially modifiable risk factors. Since a delay of onset of five years would halve the number of patients with the disease, clinical trials for such putative protective factors as estrogens, folic acid, vitamin E, statins, and NSAIDs have begun. Cognitive and leisure activity may be protective against the development of AD but any protective function can only be confirmed by clinical trials.

Eleven authors, 29 patients and an open-label design would not generally be regarded as strong predictors of a publication's citation success, so this one (Grace et al ., 2001) probably needs some explaining. I was advised early in my prospective publishing career always to look for “a gap in the market” and in 2001 this short paper probably filled a significant gap in clinical knowledge. It was almost a decade since the first reports had appeared about dementia with Lewy bodies (DLB) being a relatively common cause of dementia in older people, and by 2001 the first iteration of the consensus criteria for DLB diagnosis was starting to be widely used. Clinicians were therefore becoming more confident about recognizing DLB in their clinics, realized that cholinesterase inhibitors (ChEIs) were often useful in symptom control, and wanted to know more about their effects in the longer term. This short paper gave them some useful evidence to support their practice. The lead author, Janet Grace, who was working as my clinical lecturer, had for a couple of years been following up a group of DLB patients whom she had originally entered in an earlier placebo controlled study (McKeith et al ., 2000) and was interested in charting their progress with the ready help of U.K. colleagues in Essex, Manchester, Southampton and Nottingham. Although the 21 patients who remained on treatment did show some evidence of disease progression after two years, neither their Mini-mental State Examination (MMSE) scores nor their Neuropsychiatric Inventory (NPI) scores were significantly worse than at baseline. And reassuringly their parkinsonism had not worsened, which was a common concern at that time.

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.

I would like to thank the editor of International Psychogeriatrics for the opportunity to comment on this article (Unutzer et al., 2000). The work leading to this paper was undertaken early in my career and has become the foundation for a decade of research focused on improving the care of older adults with depression.

We were delighted, but surprised, by the publication success of our first pilot trial on the efficacy of repetitive transcranial magnetic stimulation (rTMS) to treat late life depression (LLD) (Manes et al ., 2001). This preliminary study had major limitations – for example, the small sample size and the use of both a non-therapeutic dose of rTMS and a defective method of sham stimulation. However, it addressed an important clinical problem for which we still do not have a satisfactory solution: how do we treat LLD that has been resistant to the usual therapeutic approaches in a safe and efficient way?