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Despite increasing dementia prevalence among minority ethnic populations in the UK, culturally appropriate post-diagnostic support remains limited. South Asian ethnic groups face distinct barriers in accessing care, including a lack of tailored arts, heritage, and cultural interventions that could support engagement, wellbeing, and social connection. This study explored how people living with dementia from South Asian ethnic groups and their carers in an ethnically diverse part of London, experience dementia services and perceive the potential value of creative health and culturally rooted approaches. Ten qualitative interviews were conducted with 22 participants (10 people living with dementia and 12 carers) of South Asian heritage, in 2024. Participants were recruited via community dementia services and included inpatients and outpatients aged 65-85, and carers aged 35-80. Interviews (40-90 min) explored experiences of dementia care, service access, and the role of arts, heritage, and cultural interventions. Reflexive thematic analysis was used to generate themes. Five key themes were identified: (1) Cultural Disconnect in Dementia Services; (2) Underuse of Cultural and Creative Resources; (3) Relational Continuity and Trust in Home-Based Dementia Services; (4) Gaps in Information and Dementia Healthcare System Navigation; and (5) Intersectional Barriers to Dementia Care Access. Participants described trusted relationships with home-based dementia teams, but strain in navigating wider care systems. Carers-particularly women-reported emotional exhaustion and limited capacity to engage with arts-based or cultural activities. Participants preferred culturally familiar, faith-sensitive, and home-delivered creative interventions. Dementia care for ethnically diverse groups must address the intersecting pressures of structural inequality, cultural identity, and caregiving. Co-produced, home-based arts and heritage interventions - embedded within trusted dementia care relationships - show promise in improving culturally relevant support. Embedding intersectionality and creativity in post-diagnostic dementia services can improve access, equity, and quality of life for both those with dementia and their carers.
Music engages brain regions involved in perceptual, socio-emotional and cognitive functions that may be relatively preserved in individuals with Alzheimer's disease but seem affected early in behavioural variant frontotemporal dementia. The effects of music in dementia are often assessed through observational studies, leaving the neurophysiological underpinnings of music processing in these dementia types unclear. Improved understanding of these mechanisms is relevant because the effectiveness of music therapy may depend on dementia types. In this study we investigated whether patients with behavioural variant frontotemporal dementia and Alzheimer's disease differ in music processing compared with healthy controls. We studied 60 participants (n = 35 female; aged 52-81), including 13 patients with behavioural variant frontotemporal dementia, 22 patients Alzheimer's disease, and 25 healthy controls. We designed a novel functional MRI paradigm based on passive listening to self-selected favourite music and experimenter-selected unfamiliar musical pieces using a sparse-sampling design. Activation patterns of favourite music listening (favourite > silence), unfamiliar music listening (unfamiliar > silence), and favourite music more than unfamiliar music (favourite > unfamiliar) were determined for each participant. Next, we compared activation patterns across groups for each contrast. Finally, associations between activation patterns and disease severity were investigated in behavioural variant frontotemporal dementia and Alzheimer's disease separately. The patient groups exhibited typical neuropsychological, socio-emotional and structural anatomical changes associated with Alzheimer's disease and behavioural variant frontotemporal dementia. Patients with behavioural variant frontotemporal dementia showed overall less activation during favourite music listening compared with Alzheimer's disease and healthy controls. When contrasting favourite and unfamiliar music, we found that patients with behavioural variant frontotemporal dementia showed reduced activation in the supplementary motor area, a region that has previously been implicated as an important region for semantic musical memory. Increased connectivity of the auditory cortices was observed in behavioural variant frontotemporal dementia compared with controls, potentially indicating network immaturity. Only patients with Alzheimer's disease exhibited activation in the caudate nucleus during unfamiliar music, a region associated with musical reward processing. Disease severity in Alzheimer's disease and behavioural variant frontotemporal dementia were associated with distinct patterns of functional activation. Our results confirm and expand the observation that music is processed differently in patients with behavioural variant frontotemporal dementia and Alzheimer's disease. The reduced activation in the supplementary motor area may explain altered music processing in behavioural variant frontotemporal dementia. These differences in music processing could have clinical implications in the selection of music therapy.
Anxiety is a common but underdetected or underdiagnosed symptom in dementia, affecting quality of life and care outcomes. Clinical trials are essential for informing effective management, yet the use of patient-reported outcome measures (PROMs) in dementia trials remains unclear. This review examined how validated PROMs are used to assess anxiety in dementia trials, including measurement tools, methods, demographic representation and evidence gaps. A systematic review was conducted following PRISMA and Cochrane Handbook guidance, with protocol registration on PROSPERO (CRD42025649920). Randomised controlled trials published between January 2015 and February 2025 were included if they assessed anxiety in mild to moderate dementia using validated PROMs within pharmacological or non-pharmacological interventions. Searches were conducted across MEDLINE, Embase, PsycINFO, Cochrane Library and ClinicalTrials.gov, supplemented by citation tracking. Two reviewers independently undertook study selection, data extraction and risk of bias assessment. Due to heterogeneity, findings were narratively synthesised. Of 2328 records screened, 29 trials (n = 5697) met inclusion criteria. While 93.1% used validated anxiety measurement tools, only 44.4% employed PROMs, most frequently the Hospital Anxiety and Depression Scale, mainly in non-pharmacological trials. Women and individuals of White ethnicity were overrepresented, and no studies examined PROM effectiveness by sex and ethnicity. Most trials showed moderate to high risk of bias, and evidence was confined to high-income countries. Anxiety outcomes in dementia trials remain largely proxy-reported. Existing anxiety PROMs are generic and unvalidated for dementia populations. There is a critical need for dementia-specific, culturally sensitive anxiety PROMs, improved demographic reporting and integration of anxiety assessment within dementia core outcome sets. Feedback from research participants in dementia studies, who reported experiencing anxiety, motivated this systematic review. Patient and public involvement was examined across all included studies. The lack of validated dementia-specific anxiety PROMs identified in this review highlights a broader gap in co-produced outcome development within dementia research. These findings emphasise the need for meaningful involvement of people living with dementia and care partners in the development, validation and cultural adaptation of anxiety PROMs to ensure that trial outcomes are relevant, acceptable and representative.
Identifying reliable predictors for dementia remains a critical unmet need. Light exposure plays a crucial role in regulating circadian rhythms, which influence cognitive function. However, the association between light exposure and dementia risk remains unclear. This study examined the associations of daytime and nighttime light exposure with dementia risk. A total of 87 577 dementia-free participants (mean age: 62.36 years; 56.98% female) were included. Daytime and nighttime light exposures were measured using 7-day free-living wrist-worn accelerometry. Incident dementia was identified from primary care, hospital inpatient admissions and death registry data. Cox proportional hazards models assessed associations, and mediation analyses evaluated circadian rest-activity rhythms (CRARs), brain structures and vitamin D as potential mediators. Over a median follow-up of 8.1 years, 741 participants developed dementia. Daytime light exposure above 1000 lux was associated with reduced dementia risk (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.71-0.99, p = 0.039). Longer exposure to brighter light (e.g., ≥ 0.70 h at ≥ 5000 lux; HR 0.83, p = 0.036) was associated with a further reduction in risk. In exploratory analyses, CRARs and brain structures mediated up to 33% of the association. Protective associations were stronger in those with high levels of nighttime light exposure, an evening chronotype or apolipoprotein E (APOE) ε4 carrier status, with a risk reduction of up to 41%. Furthermore, < 0.70 h per day of bright daytime light (≥ 5000 lux) outperformed six established dementia predictors (e.g., obesity, alcohol consumption, traumatic brain injury and so on). Nighttime light showed no significant association with dementia risk. High levels of daytime light exposure were significantly associated with lower dementia risk. Further research should explore its role in dementia screening and inform the development of light-based interventions.
Individuals with intellectual disabilities (ID) are at an increased risk of developing dementia. Early detection is essential for providing appropriate support, yet identifying dementia-related changes is challenging due to pre-existing cognitive impairments. Informant-based adapted tools have been developed to support dementia screening in individuals with ID. Among those, the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) aims to assess behavioural and functional changes related to dementia. This study aimed to examine the associations between the DSQIID total scores, cognitive performance and demographic characteristics of adults with ID. This cross-sectional study included 322 individuals with ID (n Down syndrome [DS] = 55; n non-DS ID = 267). Behavioural and functional changes were assessed using the DSQIID, whereas cognitive functioning was measured with the Test for Severe Impairment (TSI), Brief Praxis Test (BPT) and a semantic verbal fluency task. Negative binomial regression analyses were conducted to explore associations between DSQIID total scores and selected demographic and cognitive variables. Age was significantly associated with behavioural dementia-related changes, as assessed by the DSQIID, whereas ID severity was not associated. Results further showed that participants with DS had significantly higher scores on the DSQIID compared to participants with ID without DS. Higher DSQIID scores were significantly associated with higher semantic verbal fluency performance. Our findings suggest that caregivers may more readily detect behavioural and functional changes in adults with ID who exhibit relatively good verbal capacities. This study underscores the elevated risk of dementia in adults with DS and highlights the importance of supporting caregivers in recognizing early signs of dementia in adults with ID who exhibit lower verbal capacities. The findings underscore the importance of monitoring behavioural, functional and cognitive changes over time. Further research is needed to explore the associations between reported dementia-related changes and the severity of ID.
Background: Hearing loss is a well-established modifiable risk factor for dementia at the individual level, but less is known about whether hearing loss prevalence aligns with dementia prevalence at the country level across diverse socioeconomic and demographic contexts. This study examined sex-stratified country-level associations between hearing loss prevalence and dementia prevalence, while avoiding causal interpretation of ecological associations. Methods: Country-level sex-specific prevalence estimates for hearing loss and dementia prevalence were obtained from the Global Burden of Disease data resources. Analyses were conducted separately for females and males and included descriptive sample summaries, Pearson and Spearman correlations, principal component analysis, partial correlations used as sequential robustness checks, and theory-informed multivariable linear regression. Variables were log10-transformed for the primary analyses. Models adjusted for economic development, urbanisation, the Henneberg Index, and sex-specific life expectancy at age 60. Formal sex comparison was evaluated using coefficient-comparison testing of the hearing-loss effect from comparable adjusted models. Results: The global bivariate association between hearing loss prevalence and dementia prevalence was strong in females (Pearson r = 0.827; Spearman rho = 0.845; p < 0.001) and males (Pearson r = 0.848; Spearman rho = 0.855; p < 0.001). Principal component analyses indicated that hearing loss prevalence clustered with socioeconomic and demographic indicators in both sexes, explaining more than 70% of total variance. In multivariable regression models, adding hearing loss increased explanatory power in females (R2 from 0.661 to 0.827) and males (R2 from 0.674 to 0.811). A formal coefficient-comparison test did not indicate a statistically meaningful difference between the female and male hearing-loss coefficients in the fully adjusted models (z = 0.82; p = 0.41). Conclusions: Hearing loss prevalence is strongly associated with dementia prevalence at the country level in both females and males after adjustment for macro-level socioeconomic and demographic covariates. The findings support the population-level relevance of hearing health for dementia surveillance and prevention, while indicating broad convergence rather than clear sex-based divergence in the hearing loss-dementia association.
Growth/differentiation factor-15 (GDF15) is a secreted cytokine strongly associated with dementia risk. However, the extent to which GDF15 represents a biomarker and driver of dementia risk remains unclear. Across multiple cohorts, we demonstrated that plasma GDF15 is associated with greater dementia risk over 15- to 25-year follow-up periods when measured in midlife, with stronger associations observed for vascular, compared to Alzheimer's disease (AD), dementia. Two-sample Mendelian randomization supported plasma GDF15's mechanistic role in AD and related dementias, while cohort studies linked it to cerebral small vessel disease, neurodegeneration, phosphorylated tau, and a cerebrospinal fluid proteomic signature indicative of neuroimmune activation. Exposure of cultured myeloid cells to recombinant GDF15 altered biological pathways that we subsequently demonstrated are predictive of dementia risk, including interferon/antiviral responses. These findings support circulating GDF15's role as an early biomarker-particularly for vascular dementia and neuroinflammation-and identify the mechanisms by which it may drive dementia risk.
Dementia affects millions globally and presents diverse challenges shaped by personal, social and environmental factors. People living in under-served rural, coastal and deprived communities often face additional barriers to diagnosis, care and support, limiting person-centred approaches. These inequalities can negatively impact quality of life, social inclusion and health outcomes. Whilst dementia experiences have been widely studied, the influence of geographical context remains underexplored. Understanding this is essential to improving equitable, person-centred care across diverse settings. MEDLINE, PsycInfo, Cochrane Library and Web of Science were searched from inception in February 2025 for qualitative studies on people's experiences of living with dementia in rural, coastal or deprived areas. The review was not limited by country or date. Data were coded and thematically synthesised using NVivo. Seventy-three full texts were screened using Rayyan and 15 studies were included in the review. Thirteen studies were based in rural areas and two in deprived areas. No included studies were set in coastal areas. Four analytical themes were developed: navigating stigma, privacy and disclosure, navigating fragmented healthcare systems and services, lack of appropriate and accessible services and positive experiences of managing dementia. Key barriers to managing dementia included limited service availability, unsuitable support, stigma and logistical challenges. Findings underscored the need for person-centred, context-sensitive care that considers geographic, social and cultural factors. Future research should further explore diverse under-served settings to inform equitable dementia care particularly in deprived and coastal areas.
Dementia develops from a complex interplay of genetic and environmental factors, and nearly half of dementia globally are attributable to modifiable risk factors, including nutrition. We aim to examine the relationship between nutritional status and dementia risk factor burden, as quantified by the context-specific CAIDE score, for its applicability in India. This community-based cross-sectional study involved middle-aged and older-adults residing in Telangana, India. The Indian-specific CAIDE score was calculated using the variables: age, gender, education, BMI, physical activity, systolic blood pressure, and total cholesterol. Dietary intake and blood vitamin levels were estimated and correlated with the dementia risk factor burden. Among 556 study participants (mean age: 63 years), 39% had a predicted risk of dementia (≥9 CAIDE score). The risk was higher in rural areas (60% vs 27%) and in females (55% vs 45%). Vitamin B2 deficiency was most prevalent (64%), followed by vitamin D (42%), B6 (34%), active B12 (17%), B9 (8%), and B1 (3%). The prevalence of deficiencies in vitamin D, B2, B6, and B9 was significantly higher in the high-risk group (HRG) than in the low-risk group (LRG). Dietary diversity was lower in the HRG than in the LRG. Saturated fat intake was higher, whereas unsaturated fat intake was lower in HRG than in LRG. Vitamin deficiencies (D, B2, B6, B9, B12) were significantly higher among rural participants than among urban participants. This study applies a context-specific CAIDE score for dementia risk assessment in adults from India and reports its association with nutritional markers. This work was supported by grants from the Department of Biotechnology (BT/PR36689/PFN/20/1524/2020) and the Indian Council of Medical Research, Government of India.
Person-centeredness is instrumental to quality dementia care but is inconsistently defined and descriptions often reflect higher-income and Eurocentric perspectives. This paper addressed these limitations by surveying 39 member associations of Alzheimer's Disease International regarding the global quality of dementia care, challenges and successes in providing person-centered dementia care, and definitions of person-centered dementia care in their countries. The economically and geographically diverse respondents described a common lack of both quality and person-centered dementia care and identified associated barriers. Results suggest that identifying shared perspectives is necessary to further the person-centeredness of dementia care, and should reflect five core tenets: individualize care, support and acknowledge caregivers, empower the individual, cultivate respectful relationships, and address dimensions of wellness.
In this paper, we present the findings from a study of Voices in Motion, an intergenerational community choir program involving persons living with dementia, care partners, and high school students in Victoria, British Columbia, Canada. Using the concept of social capital, we examine the role Voices in Motion plays in generating trustworthy social relationships, reducing feelings of social isolation, and improving subjective well-being among choir members. Data came from interviews with 23 dyads, each consisting of a person living with dementia and their care partner; additionally, five focus groups with 29 high school students across two Voices in Motion choirs were conducted. Choir rehearsals and concerts were also observed. The study sought to identify factors in Voices in Motion that facilitate the emergence of supportive social relationships among choir members, the way members characterize the nature of these relationships, and the benefits they see in the context of everyday life. The analysis revealed that the two choirs in the Voices in Motion program served as a source of bonding social capital for persons living with dementia, care partners, and students. Care partners and persons living with dementia spoke of a sense of togetherness that united choir members as they shared a similar journey with dementia, along with a profound joy in singing and pride at performing at well-attended concerts and advocacy events. Care partners in particular saw Voices in Motion as a source of emotional support in the context of increasing caregiving burden, while students reported gaining a deeper understanding of the everyday experiences of dementia through their involvement in Voices in Motion.
Previous studies have modelled long-term cost-effectiveness of dementia prevention but seldom within trials. APPLE-Tree (Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce) is a personalised, multi-domain, low-intensity dementia prevention intervention for adults experiencing subjective cognitive decline or mild cognitive impairment. Intervention receipt, relative to control, was associated with an adjusted mean difference of 0.06 (95%CI -0.001 to -0.128) in the Neuropsychological Test Battery (NTB). We evaluated cost-effectiveness from health- and social-care perspectives over 2 years. We recruited 746 older adults from English health and community settings and randomly assigned them (1:1) to APPLE-Tree plus usual care (UC) or UC plus written dementia prevention information. Quality-adjusted life-years (QALYs) were calculated from the EQ-5D-5L. Over 24-months, intention-to-treat analyses compared QALYs (primary) and incremental cost per NTB unit (one z-score) change (secondary). Between October 2020 and December 2022, 374 participants were randomised to intervention and 372 to control. Mean adjusted QALYs were 1.511 (intervention) and 1.520 (control), an adjusted difference of -0.010 (95%CI -0.04 to -0.022). Mean adjusted (SD) costs were £2966 (3629) and £2551 (4439), respectively. Cost per 1-point NTB change z-score was £6809. At a £30 000 threshold, the probability of cost-effective was 12% and 96% based on QALYs and cognition, respectively. Post hoc analyses indicated higher cost-effectiveness for non-White participants (incremental costs: £374; 95%CI -590.751 to -1338.515) and socioeconomically disadvantaged participants (non-homeowners), who had higher QALYs (0.106) and lower costs (-£1830), yielding a 98% probability of cost-effectiveness at a £20 000 threshold. APPLE-Tree has a high probability of being cost-effective for a 1-point NTB gain, a difference previously associated with a three-fold reduction in 5-year dementia risk. QALY-based cost-effectiveness was not observed, but post-hoc analyses suggested it may be more effective in groups with greater needs. Findings highlight the potential of targeted, lower-intensity interventions to reduce dementia risk. Longer-term follow-up is required to determine whether cost-effectiveness is realised over time.
The prevalence of dementia is currently set to rise to 1.7 million by 2040, with associated costs estimated at £90 billion. Given its substantial impact on quality of life (QoL) and the growing societal and financial burden, identifying efficient approaches to dementia support is a key policy priority. Current policy direction emphasises a shift toward community-based models of care; however, economic evidence is required to determine whether such approaches can improve outcomes while representing cost-effective use of limited healthcare resources. This study presents a cost-effectiveness analysis of the Sage House Model, a community-based dementia support intervention integrating NHS diagnostic services, third-sector provision, and local partnerships within a single hub. A preliminary cost-effectiveness analysis was conducted using a natural experimental design comparing individuals with dementia accessing the Sage House Model (n = 65) to those receiving usual care (n = 153). Health-Related Quality of Life (HRQoL) and health and social care utilisation were collected over a three-month period and valued from a health and social care perspective. Incremental costs and outcomes were estimated to assess cost-effectiveness. The Sage House Model was associated with lower incremental costs and higher incremental QALYs compared to usual care over the three-month time horizon and was likely to be cost-effective, with a 72.2% probability at a £20,000 willingness-to-pay threshold and 74.7% at £30,000 per QALY. These findings provide preliminary evidence that community-based dementia support approaches, such as the Sage House Model, may represent a promising strategy for improving outcomes alongside more efficient use of health and social care resources, and therefore warrants larger scale investigation.
Antipsychotic use in people living with dementia has been linked to serious adverse outcomes. Guidelines recommend limiting antipsychotic treatment to short-term use (<12 weeks), followed by tapering and cessation. However, antipsychotic treatment in routine practice often exceeds the recommended duration. The effect of discontinuing antipsychotics on reducing adverse outcomes in practice remains unclear. We aimed to use linked primary and secondary care data in England to investigate whether tapering or abrupt discontinuation of antipsychotics, versus continuation, affected the risk of stroke, death, fracture, delirium, and pneumonia in people living with dementia. Using UK primary care data from the Clinical Practice Research Datalink, linked with hospital and mortality data from Jan 1, 1998, to March 31, 2021, we emulated two sets of target trials, one after 12 weeks of antipsychotic treatment and another after 24 weeks of antipsychotic treatment, to compare continuing treatment versus tapering treatment and continuing treatment versus abrupt discontinuation of treatment. Patients aged 65 years and older at incident dementia diagnosis with antipsychotic treatment duration of at least 12 weeks were included. Study outcomes were incidence of fracture, stroke, hospitalisation for delirium, hospitalisation for pneumonia, and all-cause mortality within 24 months. A negative control outcome of skin conditions was included to measure potential unmeasured confounding. A clone-censor-weight approach was used with a 6-month grace period allowed for discontinuing antipsychotics. Weighted pooled logistic regression models were used to estimate 24-month absolute risk differences (ARDs). 134 549 eligible patients had a new antipsychotic treatment after dementia diagnosis, of whom 24 822 (18·4%) had a treatment period of at least 12 weeks and 16 795 (12·5%) had a treatment period of at least 24 weeks and met the eligibility criteria. The mean age was 83·57 (SD 7·07) in the 12-week trial and 83·65 (SD 7·02) in the 24-week trial; 16 725 (67·4%) of 24 822 patients were female and 8097 were male in the 12-week trial and 11 523 (68·6%) of 16 795 patients were female and 5272 were male in the 24-week trial. Compared with continuation after 12 weeks of treatment, estimated risks of delirium and fracture under the tapering strategy corresponded to 24-month ARDs of -2·46% (95% CI -4·10 to -1·27) and -2·80% (-4·14 to -1·29), respectively. Estimated risks for stroke, pneumonia, and all-cause mortality were similar between strategies. No difference in risk was observed for the negative control outcome. Similar results were found after 24 weeks of treatment and in sensitivity analyses. Irrespective of method, antipsychotic discontinuation decreased the risk of delirium and fracture. Antipsychotics can be discontinued safely when treatment duration has exceeded guideline recommendations without increasing the risk of death, stroke, or pneumonia in those living with dementia. PharmAlliance Research Clusters for Doctoral Training.
In the UK, over half a million older people rely on publicly funded social care services to support their daily living needs. It is crucial to measure the quality of these services to ensure they meet the needs of those they support. The Adult Social Care Outcomes Toolkit (ASCOT) was developed to assess social care-related quality of life (SCRQoL; Netten et al., 2012). However, many older individuals, particularly those living with dementia, face difficulties completing standard questionnaires (Aznar et al., 2021). This project aimed to enhance the accessibility of the ASCOT toolkit for older people, enabling more people to self-report their experiences of social care. We employed a co-design methodology, bringing together a working group of older adults, primarily those living with dementia, along with their carers/supporters, to adapt the ASCOT toolkit. The adaptation process involved six working group meetings. In between these meetings, three rounds of cognitive testing (Meadows, 2021) with 25 participants who had difficulties completing traditional questionnaires also took place, with findings brought back to the working group after each round, so they could further refine the toolkit in light of cognitive testing results. The final adapted version of the ASCOT toolkit differs significantly from the original. The cognitive testing results demonstrate a considerable reduction in challenges experienced by participants between testing rounds, indicating a more accessible and user-friendly tool. The findings from this project demonstrate that co-designing outcome measures with older people, particularly those living with dementia, is both feasible and impactful. This work offers a replicable model for creating inclusive, accessible tools that amplify the voices of service users. 8 older people, including those living with dementia, have co-designed the new version of the tool over 6 meetings. Further meetings took place to jointly design dissemination materials. Working group members have co-presented project findings at conferences and events, and two members have co-authored this article. PPI were involved from the funding acquisition stage of this project. Two PPI members who were not part of the working group were part of the project steering group.
The National Health Service (NHS) England Primary Care Dementia Data (PCDD) provides a comprehensive dementia registry, underpinning national policy to improve diagnosis, care, and support. This paper evaluates the PCDD in comparison with international quality dementia registries (SveDem, NorCog, ADNeT). We highlight strengths in PCDD coverage and case ascertainment, but also weaknesses in diagnostic specificity and post-diagnostic metrics. We review currently collected metrics and discuss potential data expansions, including dementia severity and NICE-approved therapy uptake, alongside new targets, such as an 18-week standard for memory assessment service referrals.
Understanding a person's life story can transform dementia care by promoting a person-centered approach. Documented life stories help staff to personalize care, but further research is needed to understand their construction and usage in care practice. The aim of this study was to explore assistant nurses' experiences of life story documentation and their practical applications in dementia care practice. Five semi-structured focus groups were conducted, and data were analyzed using qualitative content analysis. The findings consisted of five themes: "Ensuring timing and accessibility when constructing a documented life story," "Recognizing template limitations in capturing a comprehensive view of the person," "Refining life story quality and understanding through ongoing dialogues," "Building connection and support through insights from documented life stories," and "Harmonizing life histories with evolving care needs in practice." Our findings highlight the importance of a dynamic and inclusive approach to life story documentation that goes beyond rigid templates. Accessible and well-documented life stories can empower nursing staff to provide responsive and personalized care, enhancing the dignity and quality of life of people living with dementia.
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Mild cognitive impairment (MCI) is a clinical condition at the very beginning of dementia continuum whose heterogeneity prevents a precise prediction of clinical evolution. In this work, in a cohort composed of MCI, healthy controls (HC), and Alzheimer's disease (AD) patients, graph theory (GT) was combined with virtual brain modelling (TVB) to extract the information on network topology and dynamics embedded in magnetic resonance imaging data. With this approach, the analysis was extended to a multiparametric space and brought from the group to the subject-specific level. The comparison of network properties in HC, MCI, and AD revealed a profound reshaping of brain connectivity, which mainly affected the default mode, limbic, attention, and somatosensory networks. Interestingly, positivity to AD biomarkers (Aβ and τ) in MCI correlated with network topology, while a TVB parameter (i.e., recurrent excitation) correlated with reduced global cognition (MMSE score). The combination of GT and TVB parameters was superior to the individual techniques alone in providing a subject-specific phenotype of MCI sensitive to molecular biomarkers and correlated (R2 ~ 70%) with neuropsychological scores. This, in turn, could form the basis for a more precise stratification in prodromic dementia leading, in future, to a personalized prediction of evolution and therapeutic intervention.
By 2050, two-thirds of people with dementia will live in low-and-middle-income countries (LMICs). However, multimodal prevention lifestyle interventions for people at risk are being developed predominantly in higher-income countries. We systematically reviewed randomised controlled trials (RCTs) evaluating non-pharmacological interventions in individuals with mild cognitive impairment and subjective cognitive decline in LMICs. We assessed quality using the Mixed Methods Assessment Tool, meta-analysed and synthesised evidence. We included 25 RCTs from six countries (most in China, n=17), involving 1304 participants. In the 15 studies with sufficient data to meta-analyse, we found significant positive effects on cognition favouring interventions (1.49 (standardised mean difference, 95% CI 1.06 to 1.93)). There was significant publication bias. We classified interventions into exercise, multidomain and arts/creative expression. Exercise (1.67, 95% CI 1.24 to 2.11, n=8) and multidomain (1.22, 95% CI 0.22 to 2.21, n=5) had replicated evidence of effectiveness. There was insufficient data to meta-analyse the arts/creative category. We propose greater consideration and investment in the development of interventions accounting for specific LMIC contexts from the outset, so they are acceptable and used by local services. CRD42023403908.