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We review the personality construct and its disorders according to the categorical and dimensional approaches, and the present understanding of dementia and its risk factors. This study shows a relationship between pre-morbid personality and risk of developing dementia. Data with speculative character, and indirect proofs from studies on life style, habits and pathological behaviors are reported. Categorical and dimensional parameters of personality are studied respectively by cluster analysis of the DSM classification, and by two contributive instruments: the Cloninger's temperament and character inventory (TCI) with seven dimensions, and the Costa and McCrae's NEO personality inventory (NEO PI) with five factors. Risk of dementia is higher in patients with the DSM C personality cluster, and, by order of severity, the dependent, avoidant and obsessive types of personality. According to the TCI, these three personality types have a high score on the dimension "harm avoidance", which increases the risk of dementia. With the five factor model investigated by the NEO PI, the risk of dementia is increased by low levels of extraversion, openness, agreeableness and conscienciousness, and high level of neuroticism. Biological correlations are mixed up with these two personality models, which have coherent correlations between their respective dimensions. High levels of neuroticism and harm avoidance are associated with low serotonin activity, deficient neuroplasticity, cortisol abnormalities and greater deleterious impact according to the type of stressing situations. Cortisol levels regulation differs according to the type of personality and cortisol axis dysregulation could play a key part in dementia occurrence. Detecting vulnerable personalities should lead to recommendations for dementia prevention.

Ethnopsychiatry is defined as an approach aimed to understand the ethnic and cultural dimensions of mental illnesses. The triple interest of cross-cultural approach in psychiatry in the elderly is highlighted by a review of the literature and five clinical vignettes. The first interest is to help the diagnosis of mental disorders in aged immigrants. The second is to take into account the ethnopsychogeriatric specificities by the sanitary and social systems. The third involves some aspects of psychiatry in the elderly in Sub-Saharan Africa. With aging, the immigrant has to reinvent, successfully or not, new rationalizations of his/her presence. Moreover, he/she often presents a premature physical over-deterioration linked to difficult existing conditions. Caring for the elderly from an ethnopsychiatric approach supposes firstly, to grant him correct life and physical health conditions; secondly, training of professionals to consider their specific cultural dimensions and at last, adapting the care and help services. Ethnopsychiatry or cultural psychiatry in the elderly must take into account the social and cultural representations of the diseases. Presently, depression among the elderly is common in Africa and dementia is not rare.

The dismemberment of the concept of neurosis, particularly of hysteria, in the current classifications (DSM-III and following, ICD-10) has led the authors to consider the concept of somatisation and the various situations included in it. Somatic disorders as the manifestation of a mental disorder, often of a depressive or anxious nature, bring back to the forefront both hysteria and its semiological forms under the global term "somatoform disorders", and in parallel with new pathologies, somatic symptoms as specific behaviors associated with the representation of a morbid condition from the point of view of an inhabitual physical perception. The expression of the psychic apparatus into the body, and its various clinical manifestations, has no direct specificity in the elderly. However, it is both frequent, and frequently misunderstood, thus requiring particular vigilance from the physician when confronted with physical complaints among elderly patients in whom the link between the body and the psychic apparatus takes on a particular role with the approach of death and the bereavement process that it requires. A structural approach, and search for event-driven factors and psychodynamic elements should be the key points of the clinician's approach.

GPcog is a screening tool for dementia in the aged. It consists of nine cognitive items and six items assessing the daily living instrumental activities by an informal carer. This study was aimed to assess the reliability of the French version of the GPcog in a psychogeriatric population. Two hundred and eighty inpatients from a short-term psychogeriatric ward, with or without dementia, were examined. Scores on GPcog, MMSE and on a five-word memory test for screening dementia were compared to the final diagnosis of dementia. The mean age of subjects was 77.8+/-7.0 years for males (n=116), and of 80.3+/-6.6 years for females (n=164). One hundred eighty two patients had dementia, mainly of Alzheimer's type, and 98 had psychiatric disorders but were non demented. GPcog sensitivity for the diagnosis of dementia was 96%, specificity 62%, positive predictive value 83% and negative predictive value 90%. GPcog is an accurate and well-accepted instrument for dementia screening in primary care. French results were similar to those obtained with the English version. It can be easily used by non-specialized carers.

Diagnosis of post traumatic stress disorder (PTSD) requires a past history of psychic traumatism and characteristic psychotraumatic symptoms like re-experiencing of the traumatic event, avoidance of stimuli associated with the traumatic event and increased arousal. In the elderly, PTSD prevalence rate is about 0.9% after 60 years of age. Clinical features are almost identical to those observed in younger patients. However there are various types of PTSD: PTSD de novo, occurring after exposure to extreme trauma in old age; chronic PTSD when symptoms persist since the time of the trauma; delayed-onset PTSD when patients exhibit signs of the disorder decades after the trauma; complex PTSD, generated by exposure to repeated traumatisms in early development, who could be linked up to changes in personality in older exposed to repeated traumatisms. Pharmacological and psychotherapic interventions used in younger populations can be applied for treatment to older adults, when taking into account the pharmacodynamic and psychic changes associated with aging.

Unlabelled: Caregivers of demented outpatients can have a weak health, are often old and alone, and the burden of care can generate precariousness., Objectives: This survey tends to determine the parameters influencing the caregiver's Quality of Life (QoL) and precariousness, and to measure their consequences., Methods: A scale measuring caregivers' QoL and a scale measuring precariousness, developed from data of previous PIXEL studies were used. Each scale is a 20-item questionnaire. The results were related to the socio-demographic data of both patients and their principal caregivers, and to the patients' medical and therapeutic data., Results: 1.410 patients diagnosed with dementia who lived at home with their principal caregivers were included in this survey. The caregivers' QoL was correlated to the carers' precariousness. Females caregivers had poorer QoL and more precariousness than men. Caregivers' QoL and precariousness were favourably influenced by specific dementia treatment. Frail caregivers had a poor QoL and an important precariousness. They were often sick and had to deal with nutritional difficulties with the demented patient. They were less satisfied with their care ability and their relationships with their patients., Discussion: Caregivers' QoL and precariousness are related and both express their distress. The specific treatment of dementia is beneficial for both of them. Presumably, this benefit would be increased by supportive care of carer and patient.

Personality disorders have been implicated in the occurrence of depression in the elderly. The main purpose of this study was to assess the role of personality disorders in depression of the elderly and to distinguish between early and late onset depression. The study included 48 subjects over 65 years of age from a department of psychiatry, who suffered from a major depressive episode according to the criteria of the DSM-III-R, without bipolar characteristics. The patients were examined at two different times. At the first interview, depression was assessed by the mini-GDS and the CES-D scales, and a cognitive disorder was ruled out by the Mini-Mental State Examination. The patients were then classified in two groups according to the time of the first occurrence of depression, before (early onset depression) or after (late onset depression) 65 years of age. A second evaluation was performed after the cure of the depression. The patients' personality was then assessed using the International Personality Disorder Examination, in its VKP French-translated version, which evaluates personality disorders as defined by the criteria of the DSM-III-R and the ICD-10. The frequency of personality disorders was higher in patients with early-onset depression rather than in those with late onset depression. The most frequent personality disorder was avoiding personality (Cluster C) according to categorical as well as dimensional assessment. "Dependant personality" (Cluster C) was also quite often associated with early-onset depression. However this results should be confirmed by a larger study.

Extensive research has been achieved on the old age depression during the last decades. Specific clinical features and management have been reported. Indirect clinical and behavioural indicators, and even biological ones should be considered for the detection of depression. Cognitive assessment must be promoted in standard practice to differentiate depression from incipient dementia, but also in depression occurring in long stay care, vascular depression and in the depression-executive dysfunction syndrome. Distinction between recurrent depressive episode and late-onset depression has to be clarified. Therapeutic strategies have to be reconsidered in duration, according to the trend toward chronicity of late life depression. They remain based on the use of pluri-aminergic antidepressants. Depressive disorder in the elderly is associated with hippocampus dysfunction, but other biological variables should be taken into account according to a dynamic stress-vulnerability model.

Etiopathogeny of dementia is presently considered as multidimensional, involving genetic, biological and psychological factors. This study was aimed to find out if life events and personality are risk factors for dementia and varied according to the type of dementia. 54 subjects meeting the DSM IV criteria for dementia were included and compared to 54 cognitively controls. 25 patients had dementia of Alzheimer type, 17 frontotemporal dementia and 12 vascular dementia. Data collection was performed using various questionnaires filled in by the patients and caregivers: questionnaire EVVIE for life events, the French version of the personality traits (VKP) for the assessment of personality, a questionnaire for diagnosing alexithymia (EFEA), the mini-geriatric depression scale for depression, and the Neuropsychiatric Inventory for behavioural disorders. Cognitive function was assessed by the Mini Mental State Examination, and the Global Deterioration Scale. Significant differences were found between people suffering from dementia and controls for the frequency and impact of several life events occurred during childhood, marital or professional life. Some qualitative but no quantitative differences in life events experienced were found between patients with different types of dementia. People suffering from dementia had significant personality traits higher than controls such as passivity, avoidance, obsessive features and alexithymia. However, no difference was found in personality traits between subjects with the different types of dementia. These results suggest that psychosocial cumulative stress and personality could constitute a risk factor for dementia, which could be mediated by a dysregulation in the HPA axis.