September 1999 – Vol 1 – No. 2
This second issue of Dialogues in Clinical Neuroscience was planned and coordinated by Barry LEBOWITZ from the Adult and Geriatric Treatment and Preventive Interventions Research Branch at the National Institute of Mental Health in Bethesda, Maryland.The articles you are about to read typify the high-quality scientific information we wish to provide in this new journal. The theme of this issue—geriatric depression—has prompted us to reflect on the broader concept of cerebral aging. Because of the ongoing significant increase in life expectancy and the larger segment of the population reaching retirement age to enjoy a new period of life, drug regulatory agencies in most countries will have to consider and approve new treatments for the prevention of aging, particularly cerebral aging.
The development of drugs for cerebral aging opens up a new area of research, and with it comes the need to address specific clinical and therapeutic issues:
- Firstly, the diagnosis of normal and abnormal cerebral aging should become more precise and reliable. This means we need to better understand the phenomenology of aging and refine our qualitative and quantitative diagnostic instruments.
- Secondly, techniques for investigating the central nervous system should be perfected in order to define pertinent biological markers for the early diagnosis and therapeutic follow-up of mild disorders related to cerebral aging.
- Thirdly, clinical research protocols should be validated to assess the changes achieved by experimental treatments for the prevention of brain aging. These protocols should facilitate the discovery of innovative treatments, both for normal and abnormal cerebral aging.
These issues are all the more pressing, as the benefit of a longer life will be squandered without the cognitive and intellectual functions necessary to profit from these extra years. Increased physical longevity should not come at the expense of a pitiful intellectual decline into dotage or “second childhood.” The pharmaceutical industry is keenly aware of the human, scientific, and financial implications of this emerging market. Several companies have endeavored to develop drugs for the prevention or treatment of normal cerebral aging. Unfortunately, these initial efforts have been stymied by concerns on the part of governmental regulatory agencies about elevated costs and poor cost-benefit ratios. Cerebral aging is, in our opinion, one of the major public health issues of our time, and the increase in longevity makes it a problem we can no longer afford to ignore. One of the best means to persuade governments and public opinion that the mental health of the aging population is so important is to further develop our scientific research on this subject.
Jean-Paul MACHER, MD / Marc-Antoine CROCQ, MD
In This issue
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Barry D. Lebowitz, PhD
State of the art
Depression in late life
D. Lebowitz Barry, PhD
Posters & images in neuroscience
Relative glucose metabolic rates in the elderly depressed patient (MRI/PET)
Charles F. Reynolds III, MD
Vascular depression: a new view of late-onset depression
George S. Alexopoulos, MD; Martha L. Bruce, PhD; David Silbersweig, MD; Balu Kalayam, MD; Emily Stern, MD
Depression in late life: psychiatric-medical comorbidity
Ira R. Katz, MD, PhD
Long-term course and outcome of depression in later life
Charles F. Reynolds III, MD
Designing an intervention to prevent suicide: PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial)
Martha L. Bruce , PhD; MPH; Jane L. Pearson, PhD
Treatment of depression in late life
Lon S. Schneider, MD
Exploring the affective toxicity of commonly prescribed medications in the elderly
David W. Oslin, MD
Salience of positive and negative affect in the recognition of depression among elderly persons
Tina L. Harralson, PhD; M. Powell Lawton, PhD