ARTICLEThis article is an update to the overview in Advances by Douglas et al (2004). We summarise the most well-researched psychosocial approaches for dementia by focusing on those with goodquality evidence, and acknowledge some of the newer and less-researched interventions listed in Box 1.The recurrent theme throughout the literature regarding the efficacy of non-pharmacological interventions for dementia is the need for more robust evidence. Reasons for this include that research funding is largely targeted at biomedical approaches and that study designs are not always a good fit for the outcomes measured. Kitwood (1997) proposed that a person-centred approach should be the bedrock for supporting people with dementia. The essential tenet is that personhood remains throughout the experience of dementia and it is the caregiver's responsibility to ensure that it is maintained. Person-centred practice recognises the underlying needs of the individual, often expressed through behaviour. The paradigm shift from 'managing' behavioural and psychological symptoms of dementia (BPSD) towards improving well-being, engagement and quality of life represents a significant change. These goals are more hopeful, leaving therapeutic nihilism in the past. Reducing antipsychotic prescribing (Banerjee 2009) presents another opportunity to exploit these approaches. A review of 26 non-pharmacological intervention categories concluded that non-pharmacological therapies are useful, versatile and potentially cost-effective in improving outcomes and quality of life (Olazarán 2010); however, they necessitate staff time, raising issues regarding priorities and risk (Lawrence 2012).The essential component is the belief that distress and behaviour are expressions of unmet need -all behaviour having meaning -and are a response to the challenges dementia presents (Kitwood 1997). The key appears to be formulation or behavioural analysis (Moniz-Cook 2012) to understand the behaviour and its function for each person. is not yet robust enough to clearly suggest which interventions are most suited for which environment. However, from our literature review there appears to be reason to use music therapy, aromatherapy, life story work, animal-assisted therapy and post-diagnosis/carer support work. We focus on both the traditional outcome measures of behavioural and psychological symptoms of dementia (BPSD) and the more difficult to measure, but equally important, person-centred outcomes of non-pharmacological interventions, as their properties are distinctly different from those of pharmacological agents. LEARNING OBJECTIVES•• Be aware of the range of psychosocial interventions.•• Have a better understanding of the possible outcomes from given interventions.•• Be aware of the paradigm shift from managing BPSD to a person-centred approach that focuses on the patient's well-being and quality of life. DECLARATION OF INTERESTNone.BOX 1 Psychosocial approaches for dementia that are in use but research is ongoing

SummaryAggression is common in older people with mental illness, with 15–43% of community referrals to old age psychiatry services and 44–65% of older people with Alzheimer's disease living in the community exhibiting such behaviour. In psychiatric in-patient units, assaults on staff are most common on wards for elderly people with organic mental illness. There is little high-quality research into the management of aggressive behaviour in dementia. We consider the available literature, which has shown certain behavioural measures and different classes of medication to be of benefit. We discuss factors associated with violence in elderly people with mental illness and potential management options.

SUMMARYClozapine is one of the most effective drugs available to psychiatrists for treating psychosis. It is currently licensed for use in treatment-resistant schizophrenia and psychosis in Parkinson's disease, but its use in old age psychiatry is very uncommon. With the ageing population, and the increased incidence of psychosis in older patients, it is important to consider whether this is a drug that is not being used to its full advantage.LEARNING OBJECTIVES•Appreciate the differences in titration and monitoring of clozapine in older adults, compared with working-age adults•Consider the efficacy of clozapine in older people and its impact on mortality•Understand the side-effect profile of clozapine in older adultsDECLARATION OF INTERESTNone.

SummaryThere is currently a huge variation in clinical practice as to whether patients being assessed for dementia undergo neuroimaging investigations. With an ageing population it is likely that there will be greater pressures on psychogeriatric services, so accurate assessment, diagnosis and prompt treatment will be required. This article will examine the evidence for the use of different neuroimaging techniques in the diagnosis of mild cognitive impairment and dementia.

SummaryThis article gives an overview of the profile of Alzheimer's disease, its pathophysiology and recent developments in technology that enable better understanding of the mechanism of disease. The diagnostic criteria and role of biomarkers proposed are explained. The new subgroups described are outlined in table form for easy reference. Subtypes of mild cognitive impairment (MCI) are reviewed and the conversion of amnestic MCI to Alzheimer's disease is considered. The implications and change to current clinical practice form the basis of the conclusion of the article.