Ten pre-senile Alzheimer's patients, 11 patients with Korsakoff's psychosis and 11 age- and pre-morbid intelligence-matched controls were given a test of Inspection Time, which estimates the efficiency of visual encoding or iconic memory. Alzheimer's patients had impaired Inspection Time while the Korsakoff group performed very similarly to the controls. Inspection Time performance correlated significantly with psychometric tests of cognitive ability and with clinical tests of cognitive ability (Mini Mental State Examination and Cambridge Mental Disorders of the Elderly Examination). The early stage of information processing measured by the Inspection Time procedure appears to be damaged by the Alzheimer's disease process, and to impose a rate-limiting effect on a wide variety of mental tests.

Psychometric performance was studied on two occasions in 18 chronic haemodialysis patients. Nine patients treated with rHuEpo performed a battery of psychometric tests before treatment, haemoglobin [mean (SD)] 5.8 (0.6) g/dl and after partial correction of anaemia, haemoglobin 9.3 (1.28) g/dl. The same battery of psychometric tests was administered on two occasions to nine patients (haemoglobin 7.3 (1.2) g/dl) matched with the treatment group for age, educational status and social class, who did not receive rHuEpo. In the rHuEpo-treated group, IQ, measured by the Wechsler Adult Intelligence Scale-Revised, improved by a mean of 8.7 points (P less than 0.01), while in the control group an improvement by a mean of 2.5 points was not significant. Comparison between the groups of the change in IQ score was significant (P = 0.04). There was no change in the mean scores obtained in either group for the other psychometric tests administered including the Paced Auditory Serial Addition Test, Rey auditory verbal learning, and Borkowski verbal fluency test. These results indicate that anaemia makes a reversible contribution to uraemic cognitive dysfunction.

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In the longer term, however, midwives have to face a more important question. Do they want their profession to be regulated by disciplinary procedures designed primarily for nurses? Midwives are practitioners in their own right. Doctors are not governed by firm rules, and the General Medical Council recognises the importance of individual judgment in clinical matters. Though the midwives' rules should remain, at least for the time being, the midwives' disciplinary system should be seen to recognise how delicate the interpretation of these rules may be. The high court, which hears appeals against UKCC decisions, should not be the forum in which midwives regulate themselves. A separate disciplinary system for midwives that recognises their status as practitioners may be the best way to avoid further damaging public disputes.

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