Accurate clinical staging of dementia in older subjects has not previously been achieved despite the use of such methods as psychometric testing, behavioural rating, and various combinations of simpler psychometric and behavioural evaluations. The Clinical Dementia Rating (CRD), a global rating device, was developed for a prospective study of mild senile dementia--Alzheimer type (SDAT). Reliability, validity, and correlational data are discussed. The CRD was found to distinguish unambiguously among older subjects with a wide range of cognitive function, from healthy to severely impaired.

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In response to the crisis of 2008 and deep recession that followed, the UK government assigned key importance to the need to 'spatially rebalance' the economy, to reduce its dependence on London and the South East by 'powering up' northern cities. This paper argues that the UK's problem of spatial economic imbalance is in fact a long-standing one, the very persistence of which raises key issues for our theories of regional development and policy. It argues that neither the new spatial economics, with its obsession with agglomeration, nor regional studies, with its plethora of concepts and paradigms but lack of integration and synthesis, offers a particularly convincing basis for devising policies capable of redressing the spatial imbalance in the UK's economic landscape.EXTRACTO En réponse à la crise de 2008 et au marasme économique qui a suivi, le gouvernement du R-U a attaché une importance capitale à la nécessité de 'rééquilibrer spatialement' l'économie, de réduire sa dépendance à l'égard de Londres et du Sud-Est en rendant les grandes villes situées dans le nord du pays des 'forces motrices'. Ce présent article affirme que le problème du déséquilibre économique spatial au R-U est en fait un problème de longue date, dont la persistence même soulève des questions clés en ce qui concerne les théories d'aménagement du terriotire et de politique régionale. On affirme que ni la nouvelle économie spatiale, qui est obsédée par la notion d'agglomération, ni les études régionales, fortes de leur multitude de notions et de paradigmes, mais faisant défaut d'intégration et de synthèse, ne fournissent de base particulièrement convaincante pour l'élaboration des politiques susceptibles de rééquilibrer le territoire économique au R-U.RÉSUMÉ En respuesta a la crisis de 2008 seguido por una profunda recesión, el Gobierno británico consideró que era sumamente importante 'reequilibrar espacialmente' la economía fortaleciendo las ciudades del norte del país con la finalidad de reducir la dependencia de Londres y la región sudeste. En este artículo se argumenta que el problema británico del desequilibrio económico espacial viene de largo y su persistencia plantea cuestiones fundamentales para nuestras teorías de desarrollo y política regionales. Se sostiene que ni las nuevas economías espaciales, con su obsesión por la aglomeración, ni los estudios regionales, con su plétora de conceptos y paradigmas, pero sin integración ni síntesis, ofrecen una base especialmente convincente para

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SUMMARY Clinical investigations of senile dementia of the Alzheimer type require establishment of explicit clinical diagnostic criteria before histological confirmation is possible. Criteria for selection of mildly impaired subjects with senile dementia of Alzheimer type, free of other major disease, are proposed. Problems of recruitment of this select population for a longitudinal study are discussed. A study population with matched healthy control subjects has been enrolled and described. Short term follow-up has provided preliminary support for the diagnostic criteria.The most frequent cause of dementia in persons over age 65 is senile dementia of the Alzheimer type (SDAT), multi-infarct dementia being much less common.`-Increased awareness has led investigators to focus on SDAT and to search for means of identifying subjects in the less advanced stages, before the illness is complicated by effects of chronic debility and/or institutionalisation.Establishing presumptive diagnostic criteria without resorting to histologic study of the brain is an essential goal of clinical investigation. The importance of this goal is underscored by the difficulties inherent in distinguishing among the many disorders leading to brain failure3`and by the dearth of valid information on aetiology, natural history, pathophysiology, and therapy of SDAT. Concurrent needs include a reliable means of quantifying the degree of dementia9 and a comparison of the effects of healthy aging with those of SDAT. The Dementia Study Group of Washington University has met frequently for several years to discuss and investigate topics related to dementia.`0-17 The needs listed above led to the group to establish explicit clinical diagnostic criteria for SDAT and to initiate a longitudinal study of mild cases and healthy aging. In this paper is Address for reprint requests: L Berg, MD.,