Several recent autopsy studies suggest that senile dementia of Lewy body type (SDLT) may be the second most common neuropathologic cause of dementia in the elderly, accounting for 7 to 30% of all cases. Operational criteria for the antemortem clinical diagnosis of SDLT have already been proposed by our group. The performance of these is now examined by randomizing the case notes from a new series of SDLT, Alzheimer, and multi-infarct dementia patients for psychiatric assessment by four raters of varying clinical experience and blind to pathologic diagnosis. Using the SDLT criteria, the two most experienced raters agreed in 94% of cases (kappa = 0.87), with the least experienced rater agreeing in 78% (kappa = 0.50). Diagnostic specificity for SDLT was uniformly high (90.0 to 97.0%), with a mean sensitivity of detection of 74%, and was greater by the experienced (90.0%) than the least experienced (55%) clinician. The antemortem identification of SDLT patients can therefore be achieved with a high degree of diagnostic specificity using such operationalized criteria, although there remains a minority of patients who present with either "typical" Alzheimer-type symptoms or with paranoid or delusional symptoms in the absence of substantial cognitive impairment. Sensitivity to neuroleptics may be a useful diagnostic pointer in these patients.

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Forty-four subjects with a history of a major recurrent affective disorder in remission and who were either on no medication or taking a single dose of psychotropic medication were conscripted together with matched controls. The fluorescent indicator fura 2 was used to measure intracellular calcium in platelets and estimations were made of total serum and ionised calcium as well as of whole blood serotonin. Intracellular calcium was measured in the resting state as well as after stimulation with thrombin, platelet activating factor and serotonin. No significant differences were found between the 17 subjects with a diagnosis of bipolar disorder or the 27 subjects with recurrent unipolar depression and their matched controls. Intracellular calcium measures were significantly higher in the lithium treated group after stimulation with 5HT, whereas the subjects taking tricyclic antidepressants did not differ significantly from their controls on any measure. Serum calcium was found to be significantly higher in those subjects taking lithium. These findings suggest that the measurement of intracellular calcium is not a useful trait marker in affective disorders. Lithium appears to enhance the 5HT induced rise of intracellular calcium.

SUMMARYData were collected on inpatients admitted to one psychogeriatric unit in the Newcastle upon Tyne area, in the first 6 months of 1985, 1988 and 1991-a period which saw substantial reductions in the number of long-term elderly care bed numbers in the statutory sector. Admissions to the unit increased by almost 50% over the 6 years while mean length of stay decreased from 12.4 to 9.4 weeks. Between 1988 and 1991 discharges into private sector care increased considerably with no evidence that this group differed in any way from those patients discharged into statutory care in terms of level of dependency or presence of behavioural problems. Patients with high dependency needs or behaviour problems which were difficult to manage tended to stay in hospital for much longer periods, possibly indicating a shortfall of suitable long-stay facilities for this patient group.

Background: Depressed subjects and euthymic controls demonstrate differences in cognitive processing and brain electrophysiology. Contingent negative variation (CNV) and postimperative negative variation (PINV) was used to investigate the relationship between cognition and cortical event related potentials. Method: Electrophysiological responses and memory of different personality trait adjectives were measured in 15 patients with major depressive disorder and 15 euthymic controls. The words were presented acoustically to elicit event-related potentials. The subjects were asked to indicate whether the words were self-referential. Responses were measured separately for self referential and non-self referential, neutral, positively and negatively toned words. Results: Depressed patients chose more negative and fewer positive words as self-referential, though no significant differences between groups in CNV magnitude for any of the words were found. Persistence of cortical negativity after the motor response (PINV) was significantly (P < 0.02) greater in patients for all non-self-referential words, and reaction times were significantly longer for all words. Recall of positive words and recognition of all words were significantly impaired in patients. Conclusions: Both electrophysiological measures and memory tests found differences between depressed patients and controls, suggesting that the PINV wave may be a useful electrophysiological probe to clarify the neurophysiological basis of cognitive processes.