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In Austria, gerontopsychology is seen as a subdiscipline of clinical psychology which was influenced by many additional disciplines such as developmental psychology, health psychology, geriatrics, and gerontosociology. Gerontopsychology is gaining in importance in the light of recent epidemiological developments. The Gerontopsychology Working Group of the Austrian Psychological Association has taken up the initiative and developed a specialized curriculum. Its content as well as other recent initiatives are described in this contribution.

Die Wirksamkeit nicht-pharmakologischer (psychosozialer) Behandlungsmethoden konnten in wissenschaftlichen Untersuchungen gezeigt werden. Methoden der Angehörigenunterstützung können frühzeitige Institutionalisierung verhindern. Förderprogramme für Personen mit Demenz können helfen, Fähigkeiten länger zu erhalten und die Leistungsfähigkeit zu optimieren sowie die Lebensqualität trotz chronischem Verlauf der Krankheit zu erhalten. Flächendeckende Behandlungsstrukturen, welche spezialisiert sind, komplexe nicht-pharmakologische Behandlungen sowohl für Angehörige als auch für Betroffene anzubieten, sind noch selten. Der Vorteil derart spezialisierter Einrichtungen ist es, dass sie Angebote zur Verfügung stellen, die niederschwellig angelegt sind und somit eine frühzeitige Erkennung der Krankheit ermöglichen. Gleichzeitig bieten sie ideale Umgebungen für wissenschaftliche Studien und für die Entwicklung dringend benötigter Praxiskonzepte. Die M.A.S Alzheimerhilfe hat eine Behandlungsstruktur entwickelt, welche psychosoziale Unterstützung sowohl für den Betroffenen als auch für den Angehörigen bietet. Ergebnisse einer ersten Strukturanalyse werden präsentiert.

Zusammenfassung:Pflegende Angehörige von Personen mit Demenz sind ungeheuren täglichen Belastungen ausgesetzt, die Jahre und Jahrzehnte andauern können. Pflegende Angehörige haben ein erhöhtes Risiko zur Entwicklung depressiver und körperlicher Symptomatik, sowie ein erhöhtes Mortalitätsrisiko im Vergleich zu Personen, die keine Pflege durchführen. Diese Menschen brauchen dringend Entlastung. Dringend benötigt wird auch das entsprechende Wissen und die emotionale Unterstützung, die es möglich macht, dass pflegende Angehörige diese Lebensperiode gesund erleben können. Die österreichische M. A. S Alzheimerhilfe führt seit dem Jahr 2000 ein zweiwöchiges Therapie- und Förderungsprogramm für Personen mit Demenz und ihre pflegenden Angehörigen durch. Betroffene werden von einem multiprofessionellen Team betreut, stadiengerecht gefördert und aktiviert. Die Angehörigen erhalten die Möglichkeit, an einem umfassenden Schulungs- und Beratungsangebot teilzunehmen. Ein wichtiger Bestandteil des Programms ist ein anregendes Freizeitprogramm für Angehörige und Betroffene. In der vorliegenden Untersuchung wurde die Wirksamkeit dieser komplexen Intervention in Bezug auf den Belastungsgrad und die depressive Stimmung der pflegenden Angehörigen überprüft. Untersucht wurden 104 Angehörige vor und nach der Intervention. Die statistische Analyse ergab eine signifikante Reduktion der depressiven Stimmung und der direkt durch die Krankheitssymptomatik bedingten Belastungen. Dieses Programm hat sich sehr bewährt und wird von Angehörigen und Betroffenen sehr positiv aufgenommen.

Retrogenesis is the process by which degenerative mechanisms reverse the order of acquisition in normal development. Alzheimer's disease (AD) and related conditions in the senium have long been noted to resemble “a return to childhood.” Previously, we noted that the functional stages of AD precisely and remarkably recapitulated the acquisition of the same functional landmarks in normal human development. Subsequent work indicated that this developmental recapitulation also applied to the cognitive and related symptoms in AD. Remarkably, further investigations revealed that the same neurologic “infantile” reflexes, which mark the emergence from infancy in normal development, are equally robust indicators of corresponding stages in AD. Neuropathologic and biomolecular mechanisms for these retrogenic processes are now evident. For example, the pattern of myelin loss in AD appears to mirror the pattern of myelin acquisition in normal development. Also, recent findings indicate that mitogenic factors become reactivated in AD, and, consequently, the most actively “growing” brain regions are the most vulnerable. Because of this robust retrogenic process, the stages of AD can be translated into corresponding developmental ages (DAs). These DAs can account for the overall management and care needs of AD patients. A science of AD management can be formulated on the basis of the DA of the Alzheimer's patient, taking into consideration differences of AD from normal development as well as homologies.

Increased international collaboration in clinical trials has created a need for scale translations and cross-culturally valid instruments. The use of scales that have been poorly translated and of translations that have not been validated can lead to erroneous results. Accordingly, the quality of studies using nonvalidated translations of scales from different cultural regions should be questioned. Scale translation is important, and it is surprising that little attention has been paid to the methodology of translating measurements and scales into other languages and validating them for different cultures, especially in psychiatric and geriatric research.

Behavioral and psychological symptoms of dementia (BPSD; Finkel et al., 1998) are receiving increased attention in the medical and scientific literature. These symptoms are a principal cause of distress and disability among patients with dementia and their caregivers. Numerous therapeutic studies examining the treatment of these symptoms are being conducted.

The Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) was specifically designed to assess behavioral and psychological symptoms of dementia (BPSD) that would be remediable to both psychologic and pharmacologic intervention. Furthermore, the BEHAVE-AD was designed to assess categories of symptoms that would respond in a cohesive (syndrome) manner in dementia patients, independently of effects of interventions on cognition and functioning. Current data indicate that the BEHAVE-AD does indeed assess a cohesive, cognition- and function independent syndrome in AD and in related dementias that is responsive to psychologic and appropriate pharmacologic intervention. Evidence is also increasing for differential responsiveness of this BPSD syndrome to select pharmacologic agents compared with nonspecific psychologic (placebo) intervention. This article reviews the evidence for this BPSD syndrome in dementia patients, as assessed with the BEHAVE-AD.

Background: General relationships between dotage and infancy and childhood have been acknowledged for more than two millennia. Recent findings indicate precise relationships between functional, praxic, and feeding changes in the course of the degenerative dementia of Alzheimer's disease (AD) and inverse corresponding developmental sequences. Similar inverse relationships between AD and human development can be described for cognition and language skills; for physiologic measures of electroencephalographic activity, brain glucose metabolism, and developmental neurologic reflex changes; and for the neuropathologic and neuroanatomic progression of these processes. In AD, these processes may be termed “retrogenesis.” The relevance of the retrogenesis model for AD management is explored. Method: The functional stages of AD can be translated into developmental age equivalents that can be utilized to explicate observed changes in the disease. Results: The retrogenesis-based developmental age model can usefully inform an understanding of the general care needs, emotional and behavioral changes, and activity needs of the AD patient. This model must be amended by necessary caveats regarding physical differences, variations in age-associated pathology, differences in social and societal reactions, and differences in background between AD patients and their developmental age “peers.” Conclusions: Knowledge of retrogenesis and the developmental age of the AD patients can form a nidus for the development of a nascent science of disease management. Such a science must ultimately incorporate not only appropriate caveats but also relevant universal human needs, such as those for dignity, love, and movement.

A clinician should not rely entirely upon a caregiver's report regarding behavioral pathology when planning a treatment strategy. Direct observational evaluation instruments as well as caregiver-based assessments are necessary. A new scale for the empirical (observational) evaluation of behavioral symptoms in Alzheimer's disease (AD) and related dementias, the Empirical Behavioral Pathology in Alzheimer's Disease Rating Scale (E-BEHAVEAD) was developed. Interrater reliability of this new assessment instrument was examined. Additionally, the relationship between the observed occurrence of behavioral symptomatology on this new rating instrument was compared with the occurrence using a similarly designed, caregiver-based instrument. The interrater reliability study consisted of two raters who simultaneously evaluated 20 dementia patients. The comparative study employed a cross-sectional design (N = 49). Individuals were evaluated in an outpatient clinic setting. The study population consisted of cognitively normal individuals and dementia patients. Evaluations included the new, observationally based behavioral assessment (the E-BEHAVE-AD), a caregiver-based behavioral assessment (the Behavioral Pathology in Alzheimer's Disease Rating Scale; BEHAVE-AD), a clinical global measure (the Global Deterioration Scale), and a mental status assessment (the Mini-Mental State Examination). The interrater reliability study revealed an intraclass correlation coefficient of .97 (p < .01) for total scores on the new E-BEHAVE-AD rating scale. The correlation coefficient for the amount of agreement on the presence of symptoms in six symptomatic categories between caregiver-based information about the patient's behavioral pathology assessed on the BEHAVE-AD and the clinician's observations assessed with the new E-BEHAVE-AD rating instrument was .51 (p < .01). The New E-BEHAVE-AD rating instrument showed excellent interrater reliability. Furthermore, there was a statistically significant relationship between clinician observation of the occurrence of behavioral pathology assessed using the E-BEHAVE-AD and caregive-reported pathology assessed with the BEHAVE-AD. However the magnitude of the correlation between these measures indicated that the majority of variance was independent and nonoverlapping. Consequently, these data support theoretical models suggesting that the assessment of behavioral pathology in dementia might ideally encompass both direct observational and caregiver-report approaches, using measures such as the E-BEHAVE-AD as well as measures such as the BEHAVE-AD.

Two reliability studies were performed on a recently developed cognitive assessment battery for severe dementia. The method, the Modified Ordinal Scales of Psychological Development (M-OSPD), is based on the Piagetian developmental model of sensorimotor functions. Procedures have been adapted from this test battery, which was originally applied to infants and small children, for the assessment of remaining cognitive capacity in severe dementia. Two independent interrater reliability studies were conducted. In these studies, two different raters simulataneously evaluated patients with severe dementia. One interrater reliability study was performed in a nursing home setting (Study 1), and the other reliability study consisted of a sample of community-residing patients (Study 2). The Global Deterioration Scale and the Mini-Mental State Examination were used to assess dementia severity. Study 1 (N = 22) resulted in an intraclass correlation coefficient (ICC) of .99 (p < .01) for the M-OSPD total score. Study 2(N = 19) resulted in an ICC of .96 (p < .01) for the M-OSPD total score. The M-OSPD proved to be a reliable instrument in these studies. This cognitive assessment measure can provide meaningful information regarding the cognitive abilities of late-stage dementia patients. Until recently, these late-stage dementia patients had been considered untestable in studies that utilized conventional psychometric and mental status evaluation measures.

To address the issue of mild, moderate, and severe Alzheimer's disease (AD), it is necessary to initially establish some agreement on terminology. In recent decades, these terms have frequently been defined using screening instrument scores with measures such as the Mini-Menal State Examination (MMSE). There are many problems with this approach, perhaps the most salient of which is that it has contributed to the total and tragic neglect of patients with severe AD. An alternative approach to the classification of AD severity is staging. This approach has advanced to the point where moderately severe and severe AD can be described in detail. Procedures for describing this previously neglected latter portion of AD have recently been extensively validated. Staging is also uniquely useful at the other end of the severity spectrum, in differentiating early aging brain/behavior changes, incipient AD, and mild AD. Temporally, with staging procedures, it is possible to track the course of AD approximately three times more accurately than with the MMSE. The net result of the advances in AD delineation is that issues such as prophylaxis, modification of course, treatment of behavioral distrubances, loss of ambulation, progressive rigidity, and the development of contractures in AD patients can now be addressed in a scientifically meaningful way that will hopefully bestow much benefit in AD patients and those who care for them.

OBJECTIVE:Traditional mental status and psychometric assessments bottom out in the late stages of Alzheimer disease (AD). A method adapted from cognitive testing in infants, the Ordinal Scales of Psychological Development was modified (M‐OSPD) and applied to a severely demented population. The concurrent validity of this method was tested in comparison with Functional Assessment Staging (FAST). Internal consistency as a measure for reliability was also determined.

Staging methodologies are an essential tool in the assessment of disease severity in progressive dementing illness. Several different instruments have been developed for this purpose. One of the most widely used methodologies is the Global Deterioration Scale/Functional Assessment Staging (GDS/FAST) system. This system has been studied extensively and proven to be reliable and valid for staging dementia in Alzheimer's disease (AD) in diverse settings. One of the major advantages of this system is that it spans, demarcates, and describes the entire course of normal aging and progressive AD until the final substages of the disease process. Other advantages include: (a) greatly enhanced ability to track the longitudinal course of AD, (b) improved clinicopathologic observations of AD interrelationships, and (c) enhanced diagnostic, differential diagnostic, and prognostic information. This article presents a brief overview of the GDS/FAST staging system.

Behavioral symptoms of dementia are stressful not only for patients but also for their caregivers. These symptoms include delusions, hallucinations, activity disturbances, aggressiveness, sleep disturbances, affective disturbances, and anxieties and phobias. Despite the burden of coping with behavioral problems, little information is available about effective treatments for behavioral symptoms in Alzheimer's disease and related dementing disorders.

Before the development of the Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) rating scale in 1987 by Reisberg and colleagues and its predecessor scale, the Symptoms of Psychosis in Alzheimer's Disease (SPAD) rating scale, in 1985 by Reisberg and Ferris, other scales were available for measuring behavioral disturbances and psychiatric disorders in patients with Alzheimer's disease. However, these scales generally mixed together cognitive disturbances with behavioral symptoms and sometimes included functional impairments as well. These predecessor scales also were not specifically designed to assess the types of behavioral problems seen in Alzheimer's disease. If a scale did address behavioral disturbances of dementia, it tended to be seriously underspecified in terms of the nature of behavioral disturbances.

Behavioral disturbances in dementia are some of the most burdensome features with which the caregivers must cope. These symptoms are particularly important because they are likely to be responsive to both pharmacological and nonpharmacological intervention strategies. Before the 1980s, rating scales for patients suffering from dementia did not separate cognitive features from noncognitive behavioral symptoms. This was a major problem because the evolution and course of behavioral symptoms in dementias, such as Alzheimer's disease, is different from the evolution and course of cognitive and cognition-related symptomatology. Before appropriate rating scales could be developed for the assessment of behavioral disturbances in dementia, the specific nature of these disturbances had to be described in the medical literature. Publications in the late 1980s described the specific behavioral diturbances occurring in dementia patients in detail for the first time. The rating scales that have been developed from these studies are as reliable as cognitive assessment measures. Instruments are now available that are based on information provided by the caregiver or that are based on observation of the patient made by the clinician. Construct validity, reliability, and the differences in methodology of these scales are compared in this overview. Using these scales will enable clinicians to assess pharmacological and nonpharmacological intervention strategies for behavioral symptoms in dementia with enhanced sensitivity.

We investigated the reliability, using a telephone interview procedure, of cognitive, functional, and behavioral scales in an elderly population with normal aging and dementia. Two clinicians performed the assessments: one performed the assessments in a telephone interview format and the other conducted the assessments at the clinic. The telephone interview always preceded the clinic evaluation (2-30 days apart), and both clinicians were blind to any previous evaluations of the patient. The intraclass correlation coefficients between the telephone interview and the ratings obtained by a different clinician on the clinic evaluation varied between 0.92 and 0.98 (P's≤ .001) for comprehensive test scores. These results indicate that a telephone interview format, although not a substitute for a face-to-face diagnostic evaluation, is a reliable procedure for obtaining the assessment modalities studied. These findings are particularly important in aged and dementia research populations where personal contact may not always be feasible.