Key messages * Poor cognitive performance has been associated with increased mortality in several studies of elderly people, but the underlying mechanisms are unclear * In this prospective study of 921 elderly people cognitive impairment was a strong predictor of death from ischaemic stroke * Low vitamin C intake and low plasma ascorbate concentrations were also important risk factors for death from stroke * Cognitive performance was poorest in people with the lowest vitamin C status * A high vitamin C intake may protect against both cognitive impairment and cerebrovascular disease showed that intake of the antioxidant vitamin C was a strong predictor of subsequent death from stroke.8 This finding, together with the known link between atherosclerosis and cognitive impairment, suggests that subclinical deficiency of vitamin C may be a determinant rather than a consequence of impaired cognitive function in elderly people.Declining cognitive function and cerebrovascular disease are both common in old people. The results of this study tend to support the view that a considerable proportion of cognitive decline in the elderly population is vascular in origin. They also suggest that a high vitamin C intake, perhaps by an antiatherogenic mechanism, protects against both cognitive impairment and cerebrovascular disease. This may have important implications for prevention.

Psychological health of caregivers of people with dementia is a major public concern. This study sought to determine the relationship between caregiver burden, psychological distress, frailty and functional dependency of a relative with advanced dementia. Persons with dementia and their caregivers (102 dyads) participated in this Portuguese community based cross-sectional study. Data were collected using the Clinical Dementia Rating Scale, a sociodemographic questionnaire, the Zarit Burden Interview, the Brief Symptoms Inventory and the Edmonton Frail Scale. Alzheimer's disease was the most common type of dementia among the recipients of care, who showed moderate (42.2%) to severe (52.9%) dementia. Among them 35.3% exhibited moderate and 45.1% severe frailty. Family caregivers reported moderate (76.5%) to severe burden (18.6%). Psychological distress was very high among family caregivers. Results show that people with dementia exhibited moderate (35.3%) or severe frailty (45.1%) and that a severe frailty was found in people with moderate dementia. A one-way ANOVA was conducted between the Global Severity Index and some sociodemographic variables. ANOVA reached p < .01 for employment status of the caregiver, assistance and professional support, and psychiatric history; and p = 0.01 for caregiver age and years of caregiving. Although caregivers reported benefit from the supportive approach offered by the multidisciplinary home care team, high levels of distress and associated burden were found, which might decrease their capacity to care for the person with dementia and their own health and well-being.

CBT alone and TAU alone produced significant reductions in depressive symptoms at the end of treatment and at 6 months follow-up. CBT on its own is shown to be an effective treatment procedure for mild to moderate late life depression and has utility as a treatment alternative for older people who cannot or will not tolerate physical treatment approaches for depression.

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Existing levels of dementia diagnosis are 58%. This study finds an additional 31.8% of residents without a diagnosis of dementia who score within the range of possible dementia, giving a ceiling of 89.8%. It appears that underdiagnosis of dementia exists within this 31.8% group.