[Alzheimer's disease and milieu therapy]. / La maladie d'Alzheimer et sa thérapie par le milieu.

Frequency of dementia increases quickly with age. Such syndromes touch 2-3% of people between 65 to 69 of age, but 20-30% of the people after 85 of age. To treat the patients, early diagnosis is very important. Therapeutic measures taking in account the environment, the pharmacotherapy and prevention of malnutrition is of growing importance.

[Wellbeing, health and autonomy in old age: the Basal IDA Study (Interdisciplinary Aging Study)]. / Wohlbefinden, Gesundheit und Autonomie im Alter: Die Basler IDA-Studie (Interdisziplinäre Altersstudie).

Current research on successful aging reflects a multicriteria approach, although a consensus on the interrelationship between different factors has not yet been achieved. The longitudinal-sequential study presented here aims at identifying psychological, biological and sociobiographical predictors of well-being, health and autonomy in old age and their interdependency. The concern of this study is thus a multidisciplinary approach including psychology, psychiatry, geriatrics and sports sciences. The ongoing study is described and first findings are reported. Four hundred and forty-two people, aged 65 to 94, were tested twice (1993 and 1995). Since this project is a pursuit of a medical longitudinal study (Basler-Studie), bio-medical parameters from former status measurements (1960, 1965, 1971, 1985, 1990) are available and taken into account for comparison with the newly collected data from 1993 and 1995. The tests included both a medical examination and cognitive and personality measurements. The medical test battery included: clinical and anthropometrical data, bio-chemical data as well as the medical history, health behaviour, complaints and subjective health. The psychological assessment included psychological well-being, health-related control beliefs, causal attribution, religiosity, etc. For memory assessment a computerized test was used which allows to test 1) perceptual error-scanning, 2) naming speed, and memory resources in terms of 3) capacity, 4) explicit and 5) implicit components. It therefore integrates direct (free recall, recognition) and indirect memory tests (perceptual identification: clarification), that were used previously in different experimental and quasi-experimental studies to investigate memory performance over the life-span. Furthermore, the following three experimental interventions are performed: memory and reattribution training, physical training and psychoanalytical group therapy. First descriptive results are presented concerning age-correlated changes in biological and medical parameters, health behavior, cognitive performances and psychological well-being and functional autonomy. The results show the strongest age effects in the cognitive variables (with the exception of priming). Beside age effects in speed variables and episodic memory we also find an age-correlated decline in semantic memory. Psychological well-being however, is not affected by age.

[Gerontopsychiatry--psychiatry for the aged]. / Gerontopsychiatrie--Alterspsychiatrie.

The multimorbidity is increasing with high age. The number of elderly and especially of the very old is going to increase in the next decades. This leads to a necessity to introduce more profound undergraduate and postgraduate training for those who are likely to work with and care for the elderly. The following article describes in detail the most important psychiatric disturbances in the old age, their etiology--as far as we know it--, clinical picture and treatment possibilities.

[The importance of psychotropic drugs for gerontology]. / Die Bedeutung der Psychopharmaka für die Gerontologie.

Psychopharmacotherapy in the aged with psychiatric problems must always be considered within the framework of an overall therapeutic concept. In the elderly, psychotropic drugs are prescribed for the same sort of symptoms as those observed in young adults. The multimorbidity often observed in old age can lead to a polypragmatic approach with associated possible interactions between the various drugs, and possible potentiation of known side effects. The side effects are frequently misunderstood and additional drugs prescribed, or doses increased, sometimes with development of confusion that might lead to unnecessary hospitalization. An accurate diagnosis, selection of the smallest possible dosage, and prescription only when the indication has been clearly established, should be our guidelines when prescribing such drugs in the elderly.

[Group therapy with elderly patients with dementia]. / Gruppenarbeit mit dementen Betagten.

In the work with the demented hospitalised elderly, mostly suffering from senile dementia of Alzheimer's type, we introduced group therapy. As known from the literature the group setting and the group leader must undergo important changes in the work with the demented elderly in comparison to the therapeutical work with the nondemented elderly. Our experiences, different evaluations attempts and the limitations of this therapeutical approach will be discussed.

Group therapy with demented elderly.

In the work with the demented hospitalised elderly, mostly suffering from senile dementia of Alzheimer's type, we introduced group therapy. As known from the literature the group setting and the group leader must undergo important changes in the work with the demented elderly in comparison to the therapeutical work with the nondemented elderly. Our experiences, different evaluations attempts and the limitations of this therapeutical approach will be discussed.

[The memory clinic]. / Die Memory-Klinik.

The aim of the Memory Clinic, in operation at Basel since 1986, is the early detection of dementing disorders in ambulatory elderly patients. Special emphasis is put on the differential diagnosis and detection of reversible mental disorders such as depression. Treatment comprises medical, psychological and social measures. For suitable patients, drug treatment with investigational compounds is offered. Memory training programs and therapeutic groups for patients with coexisting affective disorders as well as groups for relatives are held. By these means the Memory Clinic attempts to improve the situation of elderly patients with cognitive disturbances and to maintain them longer in the community. Experience with the first 180 patients is reported.

[Clinical aspects of benzodiazepines]. / Klinik der Benzodiazepine.

The wide therapeutic spectrum of benzodiazepines is well known. This is due to its neuropharmacological, e.g. anxiolytic, sedative-hypnotic, muscle relaxing and anticonvulsant effects. The existence of an antidepressive effect could not be proven up till now. The anxiolytic and the hypnotic effects are considered as the most important events. But it has to be pointed out that the pharmacotherapy of anxiety is only one of the therapeutic approaches towards the problem. A way how to deal with anxiety and other problems could be well discussed and supported in Balint-groups, which are widely offered especially for those, who have not been trained in psychotherapy. Unfortunately a misuse of benzodiazepines is still widely existing. Especially after longer treatment the patients often become addicted to the drugs. Therefore we suggest a thorough consideration of these side effects before any long term treatment with benzodiazepines is decided.