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The question of disclosure of dem entia diagnosis has become of greater signi® cance in recent years, probably in part due to people presenting at earlier stages of the disorder and the necessity for patients to be able to consent to drug treatments for Alzheimer's disease and greater public awareness of the condition. This paper describes the effects on three people of learning their diagnosis, and a psychological intervention used with them. The methodological problems of research in this area are discussed, and the related question of what types of intervention may be useful to maintain self-esteem , social functioning and cognitive abilities following diagnosis.

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Aims and methodRetrospective information on advice and information received post-diagnosis was obtained from 40 carers of younger people with dementia, using a semi-structured interview.ResultsTwelve carers received services from old age psychiatry, the remaining 28 from predominantly adult psychiatry or neurology. Those in receipt of old age services reported greater adequacy of diagnostic information, higher levels of advice giving and more frequent referral to social services.Clinical implicationsWhile old age services were more successful on the parameters examined, the gradually emergent nature of the diagnosis may be a crucial factor in the lack of information and advice received by the comparison group.

SUMMARYThe MEAMS (Middlesex Elderly Assessment of Mental State) is a relatively new scale specifically developed to detect intellectual impairment secondary to organic brain dysfunction in the elderly. In this study the MEAMS was compared with the MMSE (Mini-Mental State Examination), a widely known and commonly used brief cognitive rating scale, in a group of 60 elderly acute psychiatric inpatients. Scores on both scales were highly correlated. However, the MEAMS was shown to be more sensitive in the detection of mild cognitive impairment, and was more sensitive to the presence of focal brain lesions than the MMSE. In the second part of the study, a further 25 inpatients were assessed using both scales by six junior and staff-grade doctors, who then rated the scales according to various criteria. Despite taking slightly longer to administer, the MEAMS was rated superior overall by the medical staff. It is suggested that the MEAMS is a sensitive instrument acceptable to both patients and staff, and is suitable for routine use in an old age psychiatric setting.KEY woms-Cognitive impairment, cognitive assessment, rating scales.