The major mental disorders in the aged are associated with a few notable pathologic syndromes. Excellent, brief, standardized instruments have been available for several years for the assessment of all the major pathologic syndromes with the exception of cognitive impairment. I n recent years, clinical instruments for the assessment of cognitive decline in Alzheimer's disease, and in other geriatric pathologies with cognitive concomitants, have been deueloped.The rationale, validation, and utilitarian aspects of these clinical assessments, and their relationship to mental status and psychometric measures of cognitive dysfunction, are discussed. The relationship between these clinical assessments of cognitive pathology and the phenomenology of the disease processes that they are designed to measure are explored with particular reference to our recently acquired and rapidly expanding knowledge of Alzheimer's disease and other dementing or pseudodementing disorders of the senium.

Intracranial pressure (ICP) was recorded by epidural transducer and cisterna magna catheter, and regional cerebral blood flow (rCBF) using the intraarterial Xenon 133-technique were measured in baboons with normal and during increased ICP provoked by an inflatable balloon positioned subdurally. Arterial blood pressure was altered by controlled infusion of Sodium-nitroprusside (SNP), Nitroglycerine (NG) or Trimetaphan (TMP) with the aim of reducing blood pressure by about 20%. During exflated balloon SNP provoked an increase of ICP which was more prominent than with NG and TMP. During increased ICP (due to inflation of the balloon) again SNP led to a higher further increase of ICP than both NG and TMP. rCBF rose during the state of normal ICP when SNP was infused. This was not observed with infusion of NG or TMP. When ICP was increased again by inflation of the balloon all 3 substances reduced rCBF, indicating damage to the autoregulation. CO2-reactivity as measured by induced hyperventilation with reduction of arterial CO2-tension was affected by all 3 substances thus indicating impairment of vasoconstriction during increase of ICP and simultaneous decrease of blood pressure. However, this impairment of physiological vasoconstriction was more prominent with SNP than with NG and TMP. The results indicate that all 3 substances should be used with care to reduce blood pressure during surgery or under intensive care condition, particularly in patients with increased ICP.

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