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There is a need in South Africa to understand the status of available care and support to strengthen responses to dementia. This study provides a situational analysis of the current provisions of health, care and support for older persons, people living with dementia and their families in South Africa. It is a first step towards describing the landscape of needs and services available, and provides an evidence base to inform priority-setting for strengthening responses to dementia in South Africa. This situational analysis was conducted in three phases: (1) a desk review guided by a comprehensive topic guide which includes the WHO’s Global Dementia Observatory indicators; (2) multi-sectoral stakeholder interviews to verify the secondary sources used in the desk review, and to identify gaps and opportunities in policy and service provisions; and (3) a SWOT-analysis examining the strengths, weaknesses, opportunities and threats in current care and support provisions in South Africa. Our findings highlight the gaps and opportunities with current service provision and show how structural factors create barriers to diagnosis, support, and care. There is an urgent need for intersectoral policy responses to support and strengthen current health, social care, and long-term support systems so that people living with dementia and their families can live and age well. This paper forms part of a larger study on strengthening responses to dementia (The STRIDE project).

Background A core element of the Strengthening Responses to Dementia in Developing Countries (STRiDE) programme was to generate novel data on the prevalence, cost and impact of dementia in low- and middle-income countries, to build better health policy. Indonesia and South Africa are two middle-income countries in need of such data. Aims To present the STRiDE methodology and generate estimates of dementia prevalence in Indonesia and South Africa. Method We conducted community-based, single-phase, cross-sectional studies in Indonesia and South Africa, randomly sampling participants aged 65 years or older in each country. Dementia prevalence rates for each country were generated by using the 10/66 short schedule and applying its diagnostic algorithm. Weighted estimates were calculated with national sociodemographic data. Results Data were collected between September and December 2021 in 2110 people in Indonesia and 408 people in South Africa. The adjusted weighted dementia prevalence was 27.9% (95% CI 25.2-28.9) in Indonesia and 12.5% (95% CI 9.5-16.0) in South Africa. Our results indicate that there could be >4.2 million people in Indonesia and >450 000 people in South Africa who have dementia. Only five participants (0.2%) in Indonesia and two (0.5%) in South Africa had been previously diagnosed with dementia. Conclusions Despite prevalence estimates being high, formal diagnosis rates of dementia were very low across both countries (

Introduction: Numerous studies have previously estimated the dementia prevalence in India. However, as these estimates use different methodologies and sampling strategies, generating definitive prevalence estimates can be difficult. Methods: A Delphi process involving eight clinical and academic experts provided prevalence estimates of dementia within India, split by sex and age. The experts were also asked to estimate the number of people potentially living at different stages of the condition. A priori criteria were used to ascertain the point in which consensus was achieved. Results: Our consensus estimates generated a dementia prevalence of 2.8% (95% CI = 1.9 to 3.6) for those aged 60 years and above in India. Consensus was achieved across age and sex prevalence estimates, with the exception of one (females aged 60-64). Our experts estimated that 42.9% of people living with dementia in India had a mild severity. Conclusions: The findings indicate that there could be approximately 3.9 million people living with dementia in India, of which 1.7 million could be living with dementia of mild severity. Such estimates can better help researchers and policy makers to estimate the true cost and impact of dementia in India and can inform resource allocation decisions.

Supplemental Material for Estimating the number of people living with dementia at different stages of the condition in India: A Delphi process by Nicolas Farina, Jayeeta Rajagopalan, Suvarna Alladi, Aliaa Ibnidris, Cleusa P Ferri, Martin Knapp, Adelina Comas-Herrera in Dementia

Supplemental Material for Understanding, experiences and attitudes of dementia in India: A qualitative study by Saadiya Hurzuk, Nicolas Farina, Meera Pattabiraman, R Narendhar, Suvarna Alladi, Jayeeta Rajagopalan, Adelina Comas-Herrera, Priya Treesa Thomas and Sara Evans-Lacko in Dementia

Background: Agitation is common in people with dementia and negatively affects the quality of life of both people with dementia and carers. Non-drug patient-centred care is the first-line treatment, but there is a need for other treatment when this care is not effective. Current evidence is sparse on safer and effective alternatives to antipsychotics. We assessed the efficacy and safety of mirtazapine, an antidepressant prescribed for agitation in dementia. Methods: This parallel-group, double-blind, placebo-controlled trial—the Study of Mirtazapine for Agitated Behaviours in Dementia trial (SYMBAD)—was done in 26 UK centres. Participants had probable or possible Alzheimer's disease, agitation unresponsive to non-drug treatment, and a Cohen-Mansfield Agitation Inventory (CMAI) score of 45 or more. They were randomly assigned (1:1) to receive either mirtazapine (titrated to 45 mg) or placebo. The primary outcome was reduction in CMAI score at 12 weeks. This trial is registered with ClinicalTrials.gov, NCT03031184, and ISRCTN17411897. Findings: Between Jan 26, 2017, and March 6, 2020, 204 participants were recruited and randomised. Mean CMAI scores at 12 weeks were not significantly different between participants receiving mirtazapine and participants receiving placebo (adjusted mean difference –1·74, 95% CI –7·17 to 3·69; p=0·53). The number of controls with adverse events (65 [64%] of 102 controls) was similar to that in the mirtazapine group (67 [66%] of 102 participants receiving mirtazapine). However, there were more deaths in the mirtazapine group (n=7) by week 16 than in the control group (n=1), with post-hoc analysis suggesting this difference was of marginal statistical significance (p=0·065). Interpretation: This trial found no benefit of mirtazapine compared with placebo, and we observed a potentially higher mortality with use of mirtazapine. The data from this study do not support using mirtazapine as a treatment for agitation in dementia. Funding: UK National Institute for Health Research Health Technology Assessment Programme.

A protocol paper for a mapping review of the barriers and facilitators to a dementia diagnosis.

A protocol paper for a desk review in local care home information available online. Background information, aims and methodology are described.

Protocol for a systematic review to answer the question:How do intergenerational interventions for dementia affect attitudes, views and beliefs about dementia in participants and the wider community?

Supplemental Material, sj-pdf-1-dem-10.1177_14713012211014800 for Perceptions and experiences of dementia and its care in rural Kenya by Christine W Musyimi, David M Ndetei, Sara Evans-Lacko, Déborah Oliveira, Elizabeth Mutunga and Nicolas Farina in Dementia

This document is meant to provide an overview of research studies that has utilised various iterations of the DEMQOL instrument (e.g. DEMQOL, DEMQOL-Proxy, DEMQOL-CH or C-DEMQOL). The hope is that this document can provide an insight in when and how these measures have been used in the past.

Supplemental material, Supplementary_Information_Files for Quality of Life and Well-being of Carers of People With Dementia: Are There Differences Between Working and Nonworking Carers? Results From the IDEAL Program by Rachel Clarke, Nicolas Farina, Henglien Lisa Chen and Jennifer M. Rusted in Journal of Applied Gerontology

Supplemental material, Appendix_A for Measuring adolescent attitudes towards dementia: The revalidation and refinement of the A-ADS by Nicolas Farina, Alys W Griffiths, Laura J Hughes and Sahdia Parveen in Journal of Health Psychology

Background\ud models projecting future disease burden have focussed on one or two diseases. Little is known on how risk factors of younger cohorts will play out in the future burden of multi-morbidity (two or more concurrent long-term conditions).\ud \ud Design\ud a dynamic microsimulation model, the Population Ageing and Care Simulation (PACSim) model, simulates the characteristics (sociodemographic factors, health behaviours, chronic diseases and geriatric conditions) of individuals over the period 2014–2040.\ud \ud Population\ud about 303,589 individuals aged 35 years and over (a 1% random sample of the 2014 England population) created from Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II.\ud \ud Main outcome measures\ud the prevalence of, numbers with, and years lived with, chronic diseases, geriatric conditions and multi-morbidity.\ud \ud Results\ud between 2015 and 2035, multi-morbidity prevalence is estimated to increase, the proportion with 4+ diseases almost doubling (2015:9.8%; 2035:17.0%) and two-thirds of those with 4+ diseases will have mental ill-health (dementia, depression, cognitive impairment no dementia). Multi-morbidity prevalence in incoming cohorts aged 65–74 years will rise (2015:45.7%; 2035:52.8%). Life expectancy gains (men 3.6 years, women: 2.9 years) will be spent mostly with 4+ diseases (men: 2.4 years, 65.9%; women: 2.5 years, 85.2%), resulting from increased prevalence of rather than longer survival with multi-morbidity.\ud \ud Conclusions\ud our findings indicate that over the next 20 years there will be an expansion of morbidity, particularly complex multi-morbidity (4+ diseases). We advocate for a new focus on prevention of, and appropriate and efficient service provision for those with, complex multi-morbidity.

The file attached to this record is the author's final version. The Publisher's final version can be found by following the DOI link. Open access article Traditional healthcare education, delivered through a series of time-limited clinical placements, often fails to deliver an understanding of the experiences of those with long-term conditions, a growing issue for healthcare systems. Responses include longitudinal integrated clerkships and senior mentor programmes allowing students’ longer placements, continuity of contact and opportunities to learn about chronic illness and patient experience. We review their development and delivery in dementia and present the Time for Dementia (TFD) Programme, a novel 2-year interdisciplinary educational programme. Design: The study design involves a scoping review of enhanced placements in dementia for healthcare professionals in training including longitudinal integrated clerkships and senior mentor programmes and a case study of the development of TFD and its evaluation. Results: Eight enhanced programmes in dementia were identified and seven in the USA. None were compulsory and all lasted 12 months. All reported positive impact from case study designs but data quality was weak. Building on these, TFD was developed in partnership between the Alzheimer’s Society, universities and NHS and made a core part of the curriculum for medical, nursing and paramedic students. Students visit a person with dementia and their family in pairs for 2 h every 3 months for 2 years. They follow a semi-structured interaction guide focusing on experiences of illness and services and complete reflective appraisals. Conclusions: We need interprofessional undergraduate healthcare education that enables future healthcare professionals to be able to understand and manage the people with the long-term conditions who current systems often fail. TFD is designed to help address this need.

Objectives: Antidepressants are commonly used in dementia. Depression is a frequent and important co-morbidity in dementia and antidepressants are often used to treat depression and more widely. However there are questions about their utility in depression in dementia and other behavioural and psychological symptoms of dementia (BPSD). The aim of this narrative review is to summarise the evidence on whether there is therapeutic value in prescribing antidepressants to people with dementia.\ud \ud Methods: A PubMed search was performed to identify RCTs that prescribed antidepressants to people with dementia, either in the treatment of BPSD (depression, anxiety, agitation/aggression, psychosis, apathy) or for secondary outcomes (quality of life, carer burden, activities of daily living, cognition, clinical severity, adverse events).\ud \ud Results: Thirty-six RCTs were identified (participant n=3,386). A consistent finding in well-designed blinded placebo controlled trials in dementia is the lack of positive effect of antidepressants on outcomes of interest including depression. One large well-designed study has reported a significant reduction in agitation in people with dementia, but at the expense of clinically significant adverse events. Otherwise change observed in open trials is also seen in the placebo group, suggesting any effect is not attributable to the prescription of antidepressants.\ud \ud Conclusions: It is striking how few data there are on indications other than depression. We should question the use of antidepressants in dementia. Definitive trials of clinical effectiveness of specific indications such as anxiety and agitation in dementia and discontinuation of antidepressants in dementia are needed.

Alzheimer’s disease (AD) is a neurodegenerative disorder that results in cognitive and functional impairment. Current pharmacological treatments have limited effect on correcting cognitive deficits. However, there is a growing amount of literature to suggest that lifestyle factors, such as physical activity, may have a positive effect on cognitive function for people with AD. Through a series of four articles I have addressed methodological short-comings in the existing literature, and determined, through collection and analysis of data in a longitudinal cohort study, the impact of lifestyle factors on cognitive performance in AD.\ud \ud Article I systematically reviews previous physical activity intervention trials and their effects on cognition in an AD population. Physical activity interventions were found to have a moderately positive effect on global cognition. However, the review highlights the apparent heterogeneity between intervention trials as well as the lack of domain specific cognitive outcome measures.\ud \ud Article II focuses on the importance of sensitive measures of cognition in an AD population. Comparing people with AD and age-matched control volunteers, measures of prospective memory were shown to decline with age in the AD volunteers. Significantly, the cost of carrying a PM intention, a measure of working memory, did not exhibit an age related decline and did not differ compared to cognitively healthy controls.\ud \ud Article III explores whether habitual physical activity, is significantly associated with cognitive outcome on a composite measures of executive function. Habitual physical activity significantly accounted for variance (8%) on executive function even after controlling for covariates.\ud \ud Article IV investigates the contribution of habitual physical activity to executive function change in AD over a year. Habitual physical activity was found to be associated with executive function change.\ud \ud These articles contribute in the understanding of the association between habitual physical activity and cognitive function in an AD population.

At Volvo Cars Torslanda's paint shop there is a requirement to in a fast and effective way get an overview of the plants capacity. Therefore a capacity template was constructed as a tool for the engineers at Volvo several years ago. This template has during the years become complicated and outdated. Thus this thesis work will resort as a new capacity template, built from scratch. The new template has been built up based on requirements from Volvo and the concept of OEE (Overall Equipment Effectiveness). OEE is an effective way of measuring how well manufacturing equipment is running compared to its full potential. In the different parts that build up OEE there is also vital information that can be used in calculating the plants capacity, hence the use of OEE in the new template.To make this thesis possible the following problems had to be answered; what types of questions should the template be able to answer, what type of input is needed and how should the template be built.Prior to the building of the template a case study was conducted in which different sources were studied in order to help us solve our problems. While choosing and appointing inputs several test OEE-calculations were conducted. The structure used in building the template is based on OEE-calculations and by requests from the Volvo technicians.This report can be used as a user’s manual for the new template. Uppsatsnivå: C

Physical activity questionnaires are an important means to assess habitual physical activity. It remains unclear what questionnaires are used and whether they are appropriate for people with dementia who have impaired information recall but are also often largely sedentary. This scoping review aimed to identify and quantify the use of physical activity questionnaires within a dementia population. Eighteen studies met the inclusion criteria for this review. The majority of studies used questionnaires that were validated for use within an older adult population (e.g., Modified Baecke Questionnaire for the Elderly), though none had specifically been validated for use in people with dementia. Interestingly, just over half of studies (N= 10, 55.6%) adapted the questionnaires from the original validated version by allowing a proxy to provide input into the responses. Future research needs to robustly validate the use of proxy-report measures of physical activity in people with dementia.

OBJECTIVES:\ud Measuring physical activity is complicated particularly in people with dementia, where activity levels are low and subjective measures are susceptible to inaccurate recall. Activity monitors are increasingly being used within research, however, it is unclear how people with dementia view wearing such devices, and what aspects of the device effect wear time. The aim of the study was to evaluate the acceptability and feasibility of people with dementia wearing activity monitors.\ud \ud METHODS:\ud Twenty-six, community-dwelling, people with mild dementia were asked to wear an activity monitor (GENEactiv Original) over a one-month period. Perceptions of the device were measured using the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) 2.0, alongside qualitative interviews. Device diary and activity monitor data was used to assess compliance.\ud \ud RESULTS:\ud Participants tended to find wearing the activity monitors acceptable, with only three participants (12%) withdrawing prior to the study end date. Participants were generally satisfied with wearing the devices as measured by the QUEST (Mdn = 4.4, IQR = 1.1). Four themes were identified that influenced perceptions of wearing the device: external influences, design, routine, and perceived benefits.\ud \ud DISCUSSION:\ud Asking people with dementia to wear a wrist-worn activity monitor for prolonged periods appears to be both feasible and acceptable. Researchers need to consider the needs and preferences of the sample population prior to selecting activity monitors.