Merrill F. Elias - Böcker

It has been estimated that there are at least 2,500,000 adults, 10% of the population above age 65, who are currently in need of some sort of mental health services (Kramer, Taube, and Redick, 1973). Other estimates are even higher (e. g. , Pfeiffer, 1977). It is expected that this number will increase as the number of older adults increases over the next 40 years. Probably less than 400 clinical psychologists are now provid­ ing services to this age group. The number of elderly patients actually seen by these psychologists is very, very small. One national survey found that of 353 psychologists who reported that they had older clients, only 495 individuals were seen for psycho­ logical testing and 1423 for psychotherapy in the one month just prior to the response (Dye, in press). Assuming that the same in­ dividuals were not seen for both testing and therapy within the one month period--a questionable assumption--approximately . 08% of the at least two-and-one-half million older adults in need of psychological services are now being supplied with these services in some form or another. Thus, the need for increased involvement of clinical psychology with the aged is undeniable. However, few resources currently exist which will serve to increase the number of clinical psychologists trained to meet this need. Probably less than 100 clinical psychologists living today have received any kind of formal graduate training in the clinical psychology of the aging (Storandt, 1977).

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States and most westernized nations. Both CVDs and their risk factors confer substantial risk for stroke and dementia, but are also associated with more subtle changes in brain structure and function and cognitive performance prior to such devastating clinical outcomes. It has been suggested that there exists a continuum of brain abnormalities and cognitive difficulties associated with increasingly severe manifestations of cardiovascular risk factors and diseases that precede vascular cognitive impairment and may ultimately culminate in stroke or dementia.This second edition examines the relations of a host of behavioral and biomedical risk factors, in addition to subclinical and clinical CVDs, to brain and cognitive function. Associations with dementia and pre-dementia cognitive performance are reported, described, and discussed with a focus on underlying brain mechanisms. Future research agendas are suggested, and clinical implications are considered. The volume is a resource for professionals and students in neuropsychology, behavioral medicine, neurology, cardiology, cardiovascular and behavioral epidemiology, gerontology, geriatric medicine, nursing, adult developmental psychology, and for other physicians and health care professionals who work with patients with, or at risk for, CVDs.