There is a need for methodologically similar and uniform studies of BPSD across countries and ethnic groups in a given country using appropriately validated instruments. It is suggested that a consensus should be reached by researchers on the best instrument(s) to be developed in languages other than English for use in these settings and, in turn, these instruments should be developed using appropriate methodology. This could allow identification of the genetic and environmental aetiology of BPSD and the influence of gene-environment interaction.

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Is there a need to study behavioral and psychological signs and symptoms of dementia across cultures? Behavioral and psychological symptoms of dementia (BPSD) include disorders of behavior, mood, thought content and perception (Foli and Shah, 2000). They cause distress to patients, relatives and carers, result in institutional care and long-term hospitalization, and lead to physical restraint and overmedication.Traditionally, BPSD have been poorly studied for several reasons (Fairburn and Hope, 1988): 1) the importance attached to cognition in the diagnosis of dementia; 2) the assumption that BPSD are secondary to cognitive and personality changes in dementia; 3) the difficulty with accurately defining BPSD; and, 4) the paucity of standardized instruments to measure BPSD. This latter reason is further amplified in developing countries and for ethnic minority groups in developed countries, because instruments measuring BPSD have only recently emerged in languages other than English.Population-based cross-cultural epidemiological studies of dementia have largely concentrated on cognitive impairment and neglected BPSD. Most singlecountry studies of BPSD are from developed countries (Foli and Shah, 2000). However, studies are emerging from developing countries including Hong Kong (Lam et al

This delightful book is one among the Clinical Practice Series dedicated to Linda K. Hay. It gives a comprehensive account of agitation in dementia. All the chapters have been written by experts in the field and they give an in-depth account of agitation in dementia. Behavioural and psychological symptoms of dementia (BPSD) include disorders of personality, behaviour, perception, thought content and mood. They cause distress to patients, relatives and carers. This book contains 16 chapters and covers all aspects of agitation in dementia, namely definition and theoretical conceptualization, epidemiology, neurochemistry, use of behavioural scales, differential diagnosis of agitation, clinical assessment, management and legal and ethical issues. The text is detailed and reflects wide experience. The style is clear, concise and readable. All the authors have unity of style and content. They have defined the subject well but have strayed into problem behaviours where the reader is likely to lose focus on the subject. They have elegantly described different models and conceptual frameworks for the cause of problem behaviour. The two dimensional model for agitated behaviour is worth mentioning. It not only gives a good understanding of the behaviour but will also help readers to translate the various interventions described by the authors into clinical practice. The chapter on epidemiology gives a good overview of agitation in various settings, in different types of dementias and in different demographic groups. The authors also propose a Neurobiological model for the basis of agitation in dementia in a simplistic fashion. The rapid advances in Neurobiology of Alzheimer's disease have been touched upon; however, the book does not touch upon cross-cultural aspects of agitation in dementia. This book with be helpful to a variety of professionals such as geriatric psychiatrists, geriatricians, general practioners, nurses, psychologists and house officers. M. DALVI Academic Specialist Registrar in Psychiatry

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