13th Congress of the International Psychogeriatric Association and recent expansion of research into psychogeriatrics

In recent times, there has been a rapid increase in both the elderly population and the physical problems related to aging. Thus, the importance of mental issues in the elderly has increased. The 13th Congress of the International Psychogeriatric Association (IPA 2007 OSAKA SILVER) was held in Osaka on 14–18 October 2007.1 The IPA was established in 1982 to manage the psychiatric problems of a senile population, including dementia, depression, delirium etc., all of which have become major issues in various countries. The Japanese Psychogeriatric Society was established in 1986 in cooperation with the IPA. It was significant that the Congress was held in Japan in the year marking the 25th anniversary of the foundation of the IPA because the most rapid advances in an aging society have occurred here. The main theme of the Congress was ‘Active Aging: Wisdom for Body, Mind, and Spirit’ and the contributions included key note lectures (four speakers), eight plenary lectures (23 speakers), 34 symposia (141 speakers), free communications (115 presenters), and 565 poster presentations. There were approximately 2900 participants from 52 countries, enabling fruitful discussion and exchange in the fields of scientific research, medical approaches, nursing care, welfare, and family support related to mental disorders in the elderly. One of the goals of the Congress was to encourage a multidisciplinary approach to the care of the elderly with mental disoders and this position enabled experts from many fields to meet, to understand clinical problems from different aspects as a result of indepth discussion, and to achieve further progresses in each domain. Twenty-five years have passed since the establishment of the IPA. Reviewing the past 25 years, there have been changes in social situations and many fields of medical science have been developed. The aging society is one of the most important issues worldwide; in response, in Japan we have seen the start of long-term care insurance and legal guardianship systems. Aging-related disorders, especially mental disorders, are being studied much more than at any time before. For example, the pathological mechanisms of Alzheimer's disease are under intense investigation and definitive therapies, including immunotherapy and secretase inhibitors, have been tried. In addition to studies into Alzheimer's disease, there has been progress made in studies of Lewy body disease and frontotemporal dementia. To confirm the increased number of studies regarding mental problems in the elderly compared with other medical research, we surveyed the number of publications related to psychogeriatrics in the literature using the PubMed site (http://www.ncbi.nlm.nih.gov/sites/entrez), which was developed by National Center for Biotechnology Information at the National Library of Medicine in US. The terms ‘dementia’, ‘dementia care’, ‘Alzheimer’, ‘Alzheimer/tau’, and ‘Alzheimer/amyloid’ were selected as terms related to mental disorders in the elderly. In addition, the terms ‘Hypertension’ and ‘Osteoporosis’ were selected as terms related to physical disorders in the elderly. ‘Diabetes’, ‘Cancer’, ‘Infection’, ‘Heart disease’, and ‘Hepatitis’ were selected as general terms related to physical health. These terms were surveyed from 1990 to 2006 and the number of publications including each term was determined for each year (Table 1). To understand the chronological changes in the number of publications for each term, numbers were normalized using the number of publications in 1990 for each term as 100%; data were converted to a line graph and are shown in Fig. 1. Generally, the number of publications for all terms increased from 1990 to 2006, suggesting an increase in the total number of publications and journals registered with PubMed. Comparing numbers of publications over the period 1990–2006 for individual terms, most publications related to ‘Cancer’ (1 076 969), probably because cancer is one of the most important causes of death. The second and third highest rates of publication were for ‘Infection’ (498 632) and ‘Heart disease’ (356 389), respectively. Both of these are also important health issues that may result in death. The number of publications on ‘Dementia ‘ (70 231), ‘Hypertension’ (146 527), and ‘Osteoporosis’ (29 580), which are related to aging, was relatively less than that for terms directly related to causes of death; however, the increase in the number of publications containing terms related to aging was greater than that for the other terms. The ratios of publication numbers related to aging in 2006 are 221% (‘Dementia’), 175% (‘Hypertension’), and 384% (‘Osteoporosis’), whereas the ratios of publications for the other terms are 186% (‘Cancer’), 193% (‘Infection’), and 183% (‘Heart-Disease’). These data suggest that issues related to causes of death are investigated and reported on in large numbers, but there has been a more rapid increase in the number of studies and publications regarding issues related to aging, especially ‘Dementia’ and ‘Osteoporosis’, over these 17 years. Among studies of dementia, the total number of publications related to ‘dementia care’ was 8,211, giving a publication ratio in 2006 of 352%, suggesting the importance of non-pharmacological approaches to the treatment of dementia. Individual themes on basic dementia research were surveyed and the total numbers of publications related to ‘Alzheimer/tau’ and ‘Alzheimer/amyloid’ was determined to be 3686 (publication ratio in 2006; 822%) and 13 522 (publication ratio in 2006; 774%), respectively, indicating that there was more basic research into β-amyloid than tau probably because of a strong interest in the amyloid hypothesis as the main causative pathway of Alzheimer's disease. Tau2 and β-amyloid3 were found to be major components of neurofibrillary tangles in 1986 and senile plaques in 1984, respectively, and this may have contributed to the rapid increase in the number of publications on both terms. In addition, interest into ‘amyloid’ and ‘tau’ has increased because of the finding of mutations in the APP (amyloid precursor protein) gene in familial Alzheimer's disease in 19914 and mutations of the tau gene in FTDP-17 (Frontotemporal dementia with Parkinsonism linked to chromosome 17) in 1998.5 Percentage increase in the number of annual publications on medical themes. The number of publications for each theme in 1990 was taken as 100%. As discussed above, investigations into psychogeriatrics have expanded rapidly. On the basis of findings from genetic studies, as well as from basic research, we may be able to develop definitive therapies for some individual brain diseases within the next decade. As for the best solutions for elderly patients, comprehensive approaches that include both pharmacological and non-pharmacological treatment are suggested. As organizers of the IPA 2007 OSAKA SILVER, we dearly hope the Congress proved helpful to those people who want to advance these approaches.