The virtual reality research group at the University of East London has its origins in basic neuroscience research on environmental influences on recovery of function from brain damage. Here we describe our work since incorporating within our research the use of virtual environments (VEs) in brain damage rehabilitation. We have focused on three issues relating to the development of VEs for people with impaired brain function: "usability," the value of active interaction (as opposed to passive observation), and the nature of transfer of training from virtual to real environments. Our studies, which have encompassed vascular, traumatic, degenerative, and developmental brain damage, suggest that VEs have great potential in brain damage rehabilitation.

In the UK there has been a shift over the last decade towards the setting of targets by commissioning or regulatory bodies so that health services provide improved levels of care. For mental health services this has occurred in three phases: phase one related to simple key performance indicators (for example collection of patients' diagnostic codes); phase two placed greater emphasis on more meaningful clinical outcome data; the third and most recent phase placed prominence on patient‐focused data collection. We report the development and preliminary findings of a piloting of a patient‐related outcome measure (PROM) and patient‐related experience measure (PREM) created specifically for older adult mental health services in Central and North West London NHS Foundation Trust. PROMs/PREMs are in keeping with an increased focus on patients' experience of health care, the provision of quality services and various key policies such as the recent government white paper Equity and Excellence: Liberating the NHS.

Background: The CHARIOT PRO Main study is a prospective, non-interventional study evaluating cognitive trajectories in participants at the preclinical stage of Alzheimer’s disease (AD) classified by risk levels for developing mild cognitive impairment due to AD (MCI-AD). Objectives: The study aimed to characterize factors and markers influencing cognitive and functional progression among individuals at-risk for developing MCI-AD, and examine data for more precise predictors of cognitive change, particularly in relation to APOE ε4 subgroup. Design: This single-site study was conducted at the Imperial College London (ICL) in the United Kingdom. Participants 60 to 85 years of age were classified as high, medium (amnestic or non-amnestic) or low risk for developing MCI-AD based on RBANS z-scores. A series of clinical outcome assessments (COAs) on factors influencing baseline cognitive changes were collected in each of the instrument categories of cognition, lifestyle exposure, mood, and sleep. Data collection was planned to occur every 6 months for 48 months, however the median follow-up time was 18.1 months due to early termination of study by the sponsor. Results: 987 participants were screened, among them 690 participants were actively followed-up post baseline, of whom 165 (23.9%) were APOE ε4 carriers; with at least one copy of the allele. The mean age was 68.73 years, 94.6% were white, 57.4% were female, and 34.8% had a Family History of Dementia with a somewhat larger percentage in the APOE ε4 carrier group (42.4%) compared to the non-carrier group (32.4%). Over half of the participants were married and 53% had a Bachelor’s or higher degree. Most frequently, safety events typical for this population consisted of upper respiratory tract infection (10.4%), falls (5.2%), hypertension (3.5%) and back pain (3.0%). Conclusion (clinical relevance): AD-related measures collected during the CHARIOT PRO Main study will allow identification and evaluation of AD risk factors and markers associated with cognitive performance from the pre-clinical stage. Evaluating the psycho-biological characteristics of these pre-symptomatic individuals in relation to their natural neurocognitive trajectories will enhance current understanding on determinants of the initial signs of cognitive changes linked to AD.

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The article shows how Southwark and Salford have attempted to bring alive government guidance by developing a mental health resource for those working at the intersection with integrated mainstream care. Although a local context receptive to partnership working was important, connecting collaborative theory with practice was crucial to the successful development of this resource.

PurposeDespite older adult community mental health team (CMHT) workers inevitably encountering service users with alcohol use disorders (AUDs), they have a limited evidence base for working with this group. This paper aims to argue against a wholesale transfer of knowledge and practices from working age adults with dual diagnosis to the older age group.Design/methodology/approachThe paper aims to address the scant attention given to the needs of older service users with a dual diagnosis by detailing the progress of four older adult service users with AUDs in a CMHT.FindingsThis case study series illuminates some of the clinical and professional dilemmas and challenges encountered when working with this group. Suggestions of how to respond to some of these challenges are provided by focussing on aspects of identification, assessment and treatment.Originality/valueThis paper provides a catalyst to further discussion, debate and publications on the issue of older people misusing alcohol by presenting and reflecting on the issues raised by four practice vignettes.

The imminent payment‐by‐results system for mental health in England means that Trusts need to reorganise delivery of care taking into account the new care pathway clusters. In this article, Dr Whelan and colleagues discuss the potential dilemmas and problems faced by the introduction of this system based on their own experience, with a particular focus on old age services. Copyright © 2011 Wiley Interface Ltd

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