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Advances in clinical dementia research have made it possible to diagnose prodromal stages of various dementia syndromes. We present here the concept of mild cognitive impairment (MCI) as the most widely used concept for this stage of dementia processes. Necessary diagnostic procedures for MCI are presented, including clinical, neuropsychological and laboratory methods. Particularly in Alzheimer's disease it seems possible to diagnose a prodromal stage by using biomarkers and brain imaging, i.e. before the clinical dementia syndrome of the Alzheimer's type is present. When diagnosing dementia diseases in the stage of a clinical dementia syndrome, irreversible neuropathological processes are advanced. For this reason we should aim for the clinical detection of dementia disorders in the stage of mild cognitive impairment. This will lead to research on how to slow or even halt the progression of prodromal dementia.

Cognitive disorders have become a major topic not only in the scientific community but also among clinicians. Cognitive disorders are of special importance in schizophrenic patients. The present paper gives a survey over the basic definitions and the extent of these disturbances in schizophrenic patients, the main etiopathogenetic hypotheses and the development over time as well as treatment options with special regard to psychopharmacological treatment options.

Assessment of the educational level is important to prevent false neuropsychological diagnostic decisions. In the German-speaking countries some instruments for this assessment already exist, but there are problems involved in the practical application. There still is no reading test, which is a common standard in international neuropsychological test batteries. The lector investigates how subjects read rare German words or foreign words used in German-speaking countries. Words were selected which are pronounced differently from German pronunciation rules. A subject who does not know the word will pronounce it false, i.e., according to the German pronunciation rule. Norms (percentiles), estimation of reliability, and first data about validity were calculated from three samples with a total of 503 subjects. On the basis of the data presented, the Lector Test can be used as a control variable in research with groups as well as in neuropsychological diagnostics.

Therapeutic interventions for dementia are crucially dependent on the early diagnosis of the case. The question is, how an early diagnosis on the symptom-, the syndrome- and the disease level can be accomplished. The data from epidemiological and clinical studies are described. On the symptom level a disorder of episodic memory, language and visuo-spatial functions have to be assessed in contrast to normal ageing effects and premorbid low cognitive functioning. Simple, clinically practical tests are described like an 10-word learning-test with encoding fascilitation, the semantic fluency (animals) and the clock drawing test. At the syndrome level the dementia syndrome of Alzheimer type has to be differentiated from other dementia syndromes, the senile amnestic syndrome and the delirium syndrome. At the disease level, the attempt to identify clinically the etiological entity is at most not possible with reasonable reliability in senile dementia cases. An improvement of the early diagnosis by prospective longitudinal investigations of the cases seems to be possible in the future.

Three short, respectively promising self-rating scales used for the assessment of emotional states, especially depression, were examined: a visual analogue scale with only five items, a short version of the so-called "adjectives list" and a differentiated scale for recording current emotions, possible susceptibility to them and the ability to express them. We checked statistical parameters of item analysis, reliability, validity and time course measurement. This study was carried out with depressive inpatients (n = 35) at the time of admission and 4 weeks later in beginning remission. All three scales proved to be reliable (Cronbach-alpha between 0.48 and 0.97) and partially very valid instruments (concurrent validity between 0.04 and 0.87). In order to improve the documentation of a beginning response to therapeutic efforts, separate recordings of depressive subsyndromes such as "impetus" or "positive emotionality" seem to be quite promising approaches.

The relation of age associated changes of cognitive functions to those of dementia diseases is not well investigated for very old age. Because aging as well as dementia diseases are associated with cognitive deficits, this leads to differential diagnostic problems in very old age. Relevant with respect to this differentiation are on the one hand the concepts of cognitive ageing, the dementia syndrome and dementia diseases, and on the other hand empirical findings with respect to 1. the neuropsychological crossectional pattern, 2. the premorbid intelligence or adult intelligence level, 3. the speed of decline. ad 1. The speed of cognitive processes shows a considerable reduction in normal aging. However, the reduction of learning and orientation as well as pronounced word-finding problems seem to be characteristic of the development of a dementia syndrome. ad 2. The importance of the level of adult intelligence is demonstrated by the possibility that a very old person with low adult intelligence level is diagnosed as demented without suffering from one of the dementia diseases. In the opposite case of a slowly progressive dementia disease in a person with a superior level of adult intelligence a diagnosis of dementia according the standard criteria can be given only in an advanced stage of the disease. ad 3. The importance of the speed of decline of cognitive performance for the diagnosis of dementia is discussed (e.g. < 1 point of the MMSE vs > 3 MMSE points per year). An optimization of the time course criterion (change-sensitive tests and an empirically determined cut-off) could improve the early dementia diagnosis, which relies up to now mostly on crossectional features. The more precise assessment of the deterioration speed would be an opportunity to investigate the factors or processes which determine the deterioration speed, knowledge of which in turn would be a starting point for development of therapy.

In the Berlin Aging Study (BASE) an age and gender stratified sample of 516 persons aged 70 to over 100 was assessed by means of the semi-structured GMS-A interview, the CES-D-self-rating scale and the Hamiltion-Depression-observer-rating scale. Prevalence rates were 4.8% for Major Depression, 9.1% for all DSM III-R specified depressive disorders and 26.9% of subthreshold depression was included. There was no increase in prevalence rates with age but an increase in scores on the self rating CES-D. The prevalence rates for DSM III-R specified depression in females was 10.3% and almost double that of men (5.6%). Depressed persons do not show significant cognitive impairment as measured with the MMSE in comparison to controls. As compared to the total sample higher prevalence rates of overall depression were seen in persons with multimorbidity (36.8%) and lower rates in married persons. 13.2% of the elderly talked about feeling tired with life, 7.9% had thoughts about death and 1.2% reported suicidal ideation, which was closely linked to depressive disorders. In 44% of depressed cases undertreatment was observed. Only 6% got Antidepressants but 40% benzodiazepines.

The frequency of dementia in very old subjects, the risk factors and the consequences of the disease were investigated in the Berlin Aging Study in an age- and gender-stratified design (ages 70-103 years, n = 516). Psychiatrists diagnosed a dementia syndrome according to DSM-III-R, applying the GMS-A and HAS interviews. The dementia frequency steeply increases until the 90-94 year group, but there is no further exponential increase for the 95+ group--instead for men the data show a plateau of dementia prevalence. Low education level turned out to be a risk factor, which explains the gender effect in a logistic regression analysis. The apolipoprotein E4 genotype was confirmed as a risk factor--however, only for the older subjects (85+). Dementia was a major reason for institutionalization. The 2-year mortality was no higher in dementia than for age-matched non-demented controls. The results gave a detailed picture of dementia in the very old. This is a prerequisite for planning facilities for psychiatric diagnostics and therapy as well as nursing care.

The severity of the depressive and apathy syndrome, which are factoranalytically derived from the AMDP-system is reported for 428 patients with a monopolar depression. The data are compared with the results from 79 patients with a bipolar depression, 192 with a neurotic depression and 89 with a depressive reaction. The percentile scores can be used for the evaluation of the severity of a depressive and apathy syndrome in comparison to a reference sample.

The performance of schizophrenic patients in a task which requires a sequence of saccades guided by visuospatial cues is reported. A previous study recording eye movements determined a highly increased number of fixations necessary for this task in acute schizophrenic patients compared with normal controls. The performance of normal control subjects of different age groups and the correlation between the performance in the tracking task and the results of a clinical psychological test battery are described. Schizophrenic patients in a partly remitted state and in a remitted or mildly chronic state performed this task worse than matched control subjects; this was particularly indicated by the time score. The relation to the lifetime dosage of neuroleptic medication is considered.