It is now generally agreed that healthy individuals are characterized by cognitive decline during the later decades of adult life. The acquisition of new information becomes less efficient, which, coupled with a diminished retention of this information for later use, results in substantially poorer memory performance. The ability to plan new activities, solve problems and make complex decisions, as well as cognitive flexibility is noticeably diminished. In addition, attentional processes appear to be invariably poorer in old subjects than in young subjects (for review). While it is quite clearly established that elderly subjects (i.e. after 65 years of age) show a deterioration of cognitive functioning, there is also evidence that this deterioration may start in middle age (40 years). There is large individual variance in age groups; for instance, some old individuals perform on many neurocognitive tests as well as young individuals do. Rowe and Kahn proposed in their influential article to discern between successful aging and usual aging. Successful aging would be due to the effect of chronological age, whereas additional factors would be responsible for usual aging. An important point is the nature of the borderland between usual cognitive aging and pathological conditions such as dementia. Various health-related factors are thought to be important in this respect. They may be a determinant for the transition between successful aging to normal aging and into the borderland with dementia. The Brain & Behavior Research Institute in Maastricht investigates the determinants of successful and pathological aging in a number of related and multidisciplinary projects. This paper describes some major findings of this research programme and gives a theory on the interaction of vulnerability factors and protective factors in their effect on cognitive aging.

Cognitive dysfunctions in old individuals can be a precursor of dementia. The Maastricht Aging Study (MAAS) was designed to characterize the usual and pathological aging of cognitive function. The study involves a group of 1,900 initially healthy individuals who will be followed-upfor a period of 12 years with respect to health characteristics and neurocognitive status. For this purpose a sample was drawn from a patient register of collaborating family practices, stratified for age (range 24 to 81 years), sex and general ability level. Rationale and design of MAAS are discussed and also some findings from the cross-sectional baseline measurement: general aspects of memory and attention, cognitive functioning after brain trauma and general anesthesia, physical condition (fitness, morbidity and vascular risk factors) as predictor of cognitive function, and finally cognitive complaints and metamemory.

Between 25 and 30% of the victims of a whiplash injury have complaints after one year. This condition is referred to as late whiplash syndrome. This syndrome is characterized by pain of the neck, headache, forgetfulness, poor concentration, mental fatigue, and affective symptoms. The causes of the persistent symptoms are unknown. In all, the evidence that late-whiplash syndrome is a neurological disorder is flimsy. Current opinion holds that the acute basis is the painful injury of the neck. In the months following the accident, pain is the substrate on which psychological and social factors may act. Emotional symptoms such as lability of affect and disturbed mood, or posttraumatic stress disorders are common after whiplash. Although there is definitely a place for psychiatrists and psychologists in the treatment of late whiplash syndrome, these professionals are not involved in late whiplash disorder as much as they should be. Brief psychological treatment has proven to significantly reduce the severity and duration of symptoms. Optimal management must cover the treatment of pain, depression, anxiety, and fatigue; adequate psycho-education, stressing the good long-term outcome; and education of patients and relatives on possible cognitive symptoms.

Dementia and Amyotrophic Lateral Sclerosis

The case-histories of two patients are presented with Amyo-trofic Lateral Sclerosis and dementia (ALS-D), followed by a discussion of recent literature on this topic. This condition can be considered as the interface between non-Alzheimer frontal lobe dementia and amyotrophic lateral sclerosis. The nosological classification of the ALS-D complex has not been established yet.

Who was andré Jolles? born in den helder in 1874; raised in amsterdam; in his youth a significant player in the literary Movement of the Nineties (Beweging van Negentig), whose organ was the Dutch cultural weekly De Kroniek; a close friend of Aby M. Warburg's and Johan Huizinga's—Jolles studied art history at Freiburg beginning in 1902 and then taught art history in Berlin, archaeology and cultural history in occupied Ghent during World War I, and Netherlandic and comparative literature at Leipzig from 1919 until shortly before his death, in 1946. A man of extraordinary intellectual range—his publications include essays on early Florentine painting, a dissertation on the aesthetics of Vitruvius, a habilitation thesis on Egyptian-Mycenaean ceremonial vessels, literary letters on ancient Greek art, and essays in German and Dutch on folklore, theater, dance, Boccaccio, Dante, Goethe, Zola, Ibsen, Strindberg, and Provençal and Renaissance Italian poetry—he was also an amateur playwright and an outspoken champion of modern trends in dramatic art and stage design. To his friends, he could be something of an intellectual midwife, helping Warburg to formulate what would become a signature notion, the “pathos formula,” and Huizinga to conceive The Waning of the Middle Ages (1919). Jolles's chief work, the one for which he is best known, is Einfache Formen (1930; “Simple Forms”), a collection of lectures he had delivered in German at Leipzig in 1927-28 and revised.

Long-term supplementation with folic acid may improve cognitive performance in older individuals. The relationship between folate status and cognitive performance might be mediated by changes in methylation capacity, as methylation reactions are important for normal functioning of the brain. Although aberrant DNA methylation has been implicated in neurodevelopmental disorders, the relationship between DNA methylation status and non-pathological cognitive functioning in human subjects has not yet been investigated. The present study investigated the associations between global DNA methylation and key domains of cognitive functioning in healthy older adults. Global DNA methylation, defined as the percentage of methylated cytosine to total cytosine, was measured in leucocytes by liquid chromatography–MS/MS, in 215 men and women, aged 50–70 years, who participated in the Folic Acid and Carotid Intima-Media Thickness (FACIT) study (clinical trial registration number NCT00110604). Cognitive performance was assessed by means of the Visual Verbal Word Learning Task, the Stroop Colour-Word Interference Test, the Concept Shifting Test, the Letter–Digit Substitution Test and the Verbal Fluency Test. Using hierarchical linear regression analyses adjusted for age, sex, level of education, alcohol consumption, smoking status, physical activity, erythrocyte folate concentration and 5,10-methylenetetrahydrofolate reductase 677 C → T genotype, we found that global DNA methylation was not related to cognitive performance on any of the domains measured. The present study results do not support the hypothesis that global DNA methylation, as measured in leucocytes, might be associated with cognitive functioning in healthy older individuals.

Limited information is available with respect to the association between age and the plasma phospholipid fatty acid profile. Therefore we investigated the association between plasma phospholipid fatty acid status and age after correction for sex, smoking, alcohol use, BMI and fish intake. Plasma phospholipid fatty acid composition was measured and information on fish intake and other potential covariates was collected in 234 participants of the Maastricht Aging Study. The participants were healthy individuals of both sexes with an age range between 36 and 88 years. Hierarchical linear regression analyses were applied to study the relationship between age and fatty acid concentrations. After correction for fish consumption and other relevant covariates, a significant positive relationship was observed between age of the subjects and their plasma phospholipid concentrations of DHA (22 : 6n-3, P = 0·006) and EPA (20 : 5n-3; P = 0·001). Age contributed 2·3 and 3·9 % to the amount of explained variance, respectively. The higher n-3 long-chain PUFA status at advanced age was confirmed by lower concentrations of their putative ‘shortage marker’ Osbond acid (ObA, 22 : 5n-6; P = 0·022 for the relationship with age after correction for covariates and fish intake, R2 0·022). Concentrations of linoleic acid (LA; 18 : 2n-6) were negatively associated with age (P < 0·001; R2 0·061). In conclusion, DHA and EPA concentrations appeared to be higher in older age groups, partly because of a higher fish intake and partly because of another age-associated mechanism, possibly involving the well-known competition with LA.

Evince-I is a desktop expert system for the differential diagnosis of dementia, implemented on a personal computer. It is intended to assess the effectiveness of this new technology in modeling a psychiatrist who uses international guidelines for diagnosing dementia. EVINCE-I was tested in diagnosing 19 patients with varying stages of dementia and 10 patients showing other disorders except dementia. EVINCE-I and the human expert were in perfect agreement on the diagnosis of dementia and correlated highly on the diagnosis of dementia of the Alzheimer type and multiple infarct dementia. EVINCE-I thus offers important possibilities as a tool in investigating the data and procedures used by the human expert.

Older adults experience more problems than younger people when using everyday technological devices such as personal computers, automatic teller machines and microwave ovens. Such problems may have serious consequences for the autonomy of older adults since the ability to use technology is becoming essential in everyday life. One potential cause of these difficulties is age-related decline of cognitive functions. To test the role of cognitive abilities in performing technological tasks, we designed the Technological Transfer Test (TTT). This new and ecologically valid test comprises eight technological tasks that are common in modern life (operating a CD player, a telephone, an ATM, a train-ticket vending machine, a microwave-oven, an alarm clock, a smart card charging device and a telephone voice menu). The TTT and a comprehensive battery of cognitive tests were administered to 236 healthy adults aged 64–75 years on two separate occasions. The results demonstrated that the performance time for five of the eight tasks was predicted by cognitive abilities. The exact cognitive functions affecting technological performance varied by the technological task. Among several measures and components of cognition, the speed of information processing and cognitive flexibility had the greatest predictive power. The results imply that age-related cognitive decline has a profound effect on the interaction between older adults and technological appliances.

Background. Pregnancy has often been associated with cognitive deficits, but results are equivocal and little is known about how these deficits progress with time.

Method. In the present study, the cognitive performance of 57 pregnant women was compared with that of 50 non-pregnant women matched for age and education, using a well-validated neurocognitive test battery at weeks 14, 17, 29, and 36 of pregnancy, and 32 weeks postpartum in the pregnant group and at comparable times in the non-pregnant group.

Results. Memory encoding and retrieval, as assessed with a word learning task, were significantly lower in the pregnant group than in the control group. This difference was still present at 32 weeks after delivery. The two groups did not differ in complex speed of information processing at any of the test moments; however, general speed of information processing was significantly compromised during early motherhood (week 32 postpartum).

Conclusion. Thus, memory performance is poorer during pregnancy and early motherhood, and general speed of information processing is slower during early motherhood.

Background: The results of studies of the association between awareness and clinical correlates in patients with dementia are inconclusive. The aims of this study were to investigate whether awareness changed during the course of dementia and to determine whether awareness was associated with certain behavioral symptoms. Specifically, it was hypothesized that relatively intact awareness was related to affective disorders.

Methods: One hundred and ninety-nine patients with dementia were included in a prospective 18-month follow-up study. Behavioral problems were assessed with the Neuropsychiatric Inventory and the Cornell Scale for Depression in Dementia. Awareness was assessed by means of the Guidelines for the Rating of Awareness Deficits.

Results: Cross-sectional analyses showed awareness to be positively associated with age, gender, education and socioeconomic status, and negatively associated with psychosis, apathy, and overall behavioral disorders at baseline. After 1 year, a higher level of awareness was related to depression and anxiety. The level of awareness at baseline also predicted depression and anxiety after 1 year. Awareness decreased during the study.

Conclusions: A higher level of awareness is associated with subsyndromal depression and anxiety, whereas lack of awareness is associated with psychosis and apathy. The level of awareness decreases as dementia progresses. Clinicians should be more alert to changes in awareness in patients with dementia because psychosocial support might help to prevent the development of affective symptoms.