Clinicians are increasingly faced with the problem of interpreting subtle, early cognitive symptoms. Enhanced awareness of Alzheimer's disease (AD) and available treatments has led to a growing demand for early assessment. Although it is known that a proportion of individuals with mild cognitive impairment will progress to dementia in following years, our ability to identify these individuals and predict individual cognitive trajectories is limited. The emergence of disease-modifying treatments would make these problems more acute. In this review, the potential role of magnetic resonance imaging (MRI) in aiding the clinician in early diagnosis of AD will be considered. The changes in grey matter structure that accompany ‘normal’ ageing will be described briefly, before moving on to studies that have attempted to distinguish the onset of disease from this background of structural change. Volumetric methods range from measurements of single key structures, such as the hippocampus, to methods based on computational neuroanatomy, which evaluate subtle structural alterations across the whole brain simultaneously. Computational methods are rapidly evolving and already perform as well as radiologists in distinguishing AD from normal ageing at an individual level. This article aims to provide a practical knowledge of how and why these methods work, point out the main advantages and disadvantages and sketch out outstanding issues and possible future directions.

Loneliness and social isolation are two core concepts regarding social relationships in human life that are particularly relevant in old age. This article focuses on the prevalence of loneliness in a community sample of 1266 autonomous people aged 50 or more and on the structural circumstances (demographic social network and general health condition) that could better contribute to its experience. The prevalence of loneliness was 16.3% (n = 206) and a small number of people presented low social network (7%). Predictors of loneliness (explaining 29% of variance) were being widowed, perceiving own health as poor or very poor, and having psychological distress and cognitive impairment. The authors emphasize the importance of psychological distress as a predictor of loneliness and the need for social and psychological interventions to prevent its consequences in morbidity and mortality.

The world's older population is projected to rise to some two billion people in the next 50 years. The health of older adults deteriorates with increasing age and creates greater demand for healthcare resources. Prevalence of the metabolic syndrome in older adults is causing concern due to its interplay between type 2 diabetes, obesity and associated morbidity and mortality. This call to action discusses comorbidities associated with type 2 diabetes and obesity in the older population and its impact on patients. We cover several topics to consider when designing prevention and treatment strategies for older adults and areas for improvement in our care of this special population are discussed. We know that dietary, exercise and weight-loss interventions are effective. However, these strategies require effort by both patient and physician. If all parties responsible in patient care take action, a change in lifestyle can lead to longer, healthier lives in older adults.

Prion diseases are rare degenerative disorders of the nervous system caused by abnormal accumulation and/or metabolism of prion proteins. They are invariably fatal. Creutzfeldt-Jakob disease (CJD) is the most common human prion disease and the sporadic form accounts for 85% of cases, whilst about 15% are genetic and 1% is iatrogenic. Variant CJD (vCJD) was mostly seen in the UK and France and mainly affected young people. Sporadic CJD (sCJD) occurs throughout the world with mean age of onset in the seventh decade. It typically presents with rapidly declining cognition that may get confused with other forms of dementia. Thus identification of sCJD in older people depends on a judicious awareness of the clinical features. Here we present a clinical, pathological, therapeutic and diagnostic review of sCJD.

Falls have a significant impact upon independent living ability in older people, with fall-related fractures one of the leading predictors of having to move into assisted living facilities. The loss of independence associated with a severe fall is often accompanied by a decline in physical, social, emotional and economic well-being. Rehabilitation programmes to restore functional ability following a fall have a greater chance of success if they adopt a multi-disciplinary approach and, if appropriate, are conducted in the patient's own home. Additional multi-component interventions that improve confidence and reduce the risk of subsequent falls may confer benefits by assisting individuals independently to perform activities of daily living.

The number of people aged 65 years or more is increasing worldwide. Alcohol use disorders (AUD) are a common condition in the older population, and this combined with the changing age demographic in the population means that AUD in this population is a significant public health concern. AUD has a major impact upon the physical, psychological and social health of the older population. There is evidence that older people do benefit from interventions to reduce alcohol consumption as much as, if not more than, younger populations. There is evidence that AUD in the older population often goes undetected and the potential for beneficial behavioural health change is not realized.

Delirium is a distressing but preventable condition associated with increased morbidity and mortality, and significant financial costs. Most research on delirium has focused on high-risk patients in hospitals. Another group also at high risk are residents in care homes for older people. This report reviews the literature on the occurrence, aetiology, outcomes, prevention and treatment of delirium in long-term care. Delirium appears to be common in this setting, with a median point prevalence estimate of 14.2% in studies comparable to the UK. However, there is a paucity of high-quality studies, likely to reflect the difficulty in conducting research in this population and the particular challenges of investigating delirium. Addressing delirium successfully in care homes presents an opportunity to improve care standards and to reduce inequalities in health and social care. Well-designed prospective cohort studies and robust evaluations of interventions to prevent and treat delirium are needed.