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This paper demonstrates the effects of education on cognitive functioning which could serve as an alternative preventive method to halt or delay cognitive decline in older adults. The purpose of this proposal is to discuss and illustrate the benefits of improving cognitive ability through continuing education. As such, taking advantage of educational programmes that are already in place would not only provide mental stimulation for older adults, but would be a source for social networking, as well as technology training and physical education activities. To establish a link between cognition and education, this paper provides examples from a number of studies as well as a review of a longitudinal study on educational differences in the prevalence of dementia. The findings of this systematic review revealed a connection between cognitive decline and education after considering regions and economic status. Suggestions from these reviews imply that keeping one's mind stimulated could be influential in delaying the onset of dementia resulting in possibly extending the time older adults are independent.

Aim: To explore the experiences of residents, families and staff in the establishment of a new small-scale home model of care for people living with dementia., Background: New and innovative small-scale models of care have the potential to improve outcomes for older people, especially those with dementia, who experience high rates of cognitive impairment in traditional residential aged care homes in Australia., Design: A qualitative descriptive study., Methods: Semi-structured interviews with 14 guests, family and staff of a new small-scale dementia home named 'Kambera House' in the Australian Capital Territory were conducted between July 2021 when the home opened and August 2022. Data were analysed using reflexive thematic analysis and reported according to the COREQ guidelines., Results: Two guests with mild-to-moderate dementia, five family and seven staff members participated in the study. The data revealed high satisfaction with Kambera House, generating five themes. Falls detection technology in the home provided a sense of safety, enabling more time for person-centred care. Free, everyday technology connected the home with families as part of an overall community of care where staff were empowered to maximize choice and dignity of risk of guests living in the home. This contributed to the sense of community, rather than an institution, where the conditions of work supported the conditions of care, and were embedded in a culture of responsiveness, change and flexibility., Conclusion: Kambera House represents a successful example of a new small-scale dementia home. Technology played an important background role in improving overall safety and flexibility as part of a model of care which demonstrated positive experiences for guests and families by being responsive to their individual needs., Impacts: Small-scale homes for people with dementia offer an alternative model that may provide more individualized, person-centred care compared with the traditional institutionalized care., Patient or Public Contribution: No patient or public contribution., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Many physicians rely on sum score cognitive screening tests to evaluate patients for cognitive decline. Because the vast majority of cognitively impaired patients never receive more extensive testing, the results of these screening tests impact patients and their family members profoundly. No previous study has examined whether the metrics used by the popular Mini-Mental State Examination, Montreal Cognitive Assessment, and Saint Louis University Mental Status tests reliably identify single-domain deficits or allow clinicians to adequately track disease progression. We compare side by side the metrics used by these three tests to highlight the differences in the ways they measure domain impairments. We then contrast the sum score approach to cognitive screening with brief domain-specific tests that use extended metrics in each domain examined. Last, we suggest that moderate-to-severe domain-specific deficits on these tests should lead physicians to anticipate specific functional problems and alert family members., (© 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Introduction: Efficient healthcare planning requires reliable projections of the future increase in costs and quality-adjusted life years (QALYs) lost due to dementia., Methods: We used the microsimulation model MISCAN-Dementia to simulate life histories and dementia occurrence using population-based Rotterdam Study data and nationwide birth cohort demographics. We estimated costs and QALYs lost in the Netherlands from 2020 to 2050, incorporating literature estimates of cost and utility for patients and caregivers by dementia severity and care setting., Results: Societal costs and QALYs lost due to dementia are estimated to double between 2020 and 2050. Costs are incurred predominantly through institutional (34%), formal home (31%), and informal home care (20%). Lost QALYs are mostly due to shortened life expectancy (67%) and, to a lesser extent, quality of life with severe dementia (14%)., Discussion: To limit healthcare costs and quality of life losses due to dementia, interventions are needed that slow symptom progression and reduce care dependency., (© 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background: In the last phase of their lives, people living with dementia often indicate restlessness, anxiety or pain. Further, their care is considered inadequate, as they are, for example, sometimes overtreated for curative care or undertreated for pain management. These patients also face multiple barriers in accessing palliative care. This qualitative study explores the perception of experts about how people living with dementia in Germany are cared for at home toward the end of their lives., Methods: A total of 12 experts involved in outpatient/palliative care were recruited to constitute a purposive, heterogeneous sample. Interviews, which were structured using an interview guide, were conducted with physicians, nurses, representatives of health insurance funds, welfare associations, municipal counselling centres, scientists and coordinators of outpatient palliative care and voluntary work; the interviews were transcribed and analysed via thematic content analysis, based on Kuckartz's method., Results: The analysis of the results led to the establishment of four main categories that focused on formal care arrangements, the roles of relatives in care arrangements, the specifics of dementia, and restrictions on access to palliative care., Conclusions: Suitable end-of-life care for people living with dementia and support for their relatives require resources and the conceptualisation of specific care arrangements to help minimise potential barriers that prevent access to palliative care., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Eating, drinking and swallowing (EDS) difficulties are important to identify early. Awareness of EDS changes starts with those living with dementia or their family carers. However, little is known about early identification from the perspective of people with dementia., Aim: The aim of this study was to understand the experience of EDS by people living with dementia in their own home., Methods: Published evidence pertaining to EDS difficulties in dementia was used to inform an online semi-structured interview guide. Four people living with dementia and a third-sector Empowerment Lead were invited to become co-researchers. People living with dementia and their carers were invited to be interviewed. We enquired about their past and present experiences, and future expected changes in EDS, information needs, opinions on early problem identification, and lifestyle modifications following onset of EDS difficulty. Narrative concepts of heroes and villains in their 'stories' were identified. Responses were subjected to framework analysis informed by narrative enquiry., Results: Seven people living with dementia and five family carers were interviewed. The overarching theme was a 'missed connection' between EDS difficulty and dementia. Where EDS difficulties were identified, 'compensatory changes' and a need for 'access to information' were noted., Conclusions: The connection between potential EDS difficulties and a dementia diagnosis may not be made, even though EDS changes were recognised by people living with dementia and their family carers. This may be explained by behaviours that mask problems or allow individuals to cope or compensate. Reduced awareness may also be due to inadequate access to information and lack of specialist services. If the connection between dementia and EDS difficulty is missed it could further delay access to support services., What This Paper Adds: What is already known on the subject The prevalence of dementia is increasing and is expected to affect 9% of the population by 2040. EDS difficulties are common in people living with dementia and predispose to poorer outcomes. Better awareness of EDS changes early in the disease process of dementia or at preclinical stages can identify individuals at risk and allow for intervention prior to advanced EDS difficulties developing. What this paper adds to existing knowledge This paper reports the perspective of people living with dementia and family carers and provides insights into experiences of EDS and the challenges faced and identifies commonalities. The connection between potential EDS difficulties and dementia is missed despite various changes reported by both people living with dementia and their family carers, who tend to make compensatory lifestyle changes without support. What are the potential or actual clinical implications of this work? Lack of awareness of the connection between potential EDS difficulties and dementia may arise due to inadequate access to information to support people living with dementia and their family carers. Access to such information is needed and the quality assurance of information from reputable sources is important to people living with dementia. There is a need for greater service user awareness of signs of EDS difficulty and how to access specialist services., (© 2023 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Aim: This study aimed to verify the impact of low body mass index (BMI) on mortality in nursing home residents undergoing hemodialysis and to clarify other associated mortality risk factors., Methods: This retrospective study included patients admitted to a nursing home affiliated with Nagasaki Renal Center between April 2014 and March 2022. Medical data were collected on admission, and participants were divided into low and high BMI groups according to their median BMI values. The patients were followed up until March 2023. The association between survival and patient history was also analyzed., Results: Of the 106 patients (average age, 81.3 ± 7.9 years; male, 36.8%; median dialysis vintage, 32.5 [interquartile range (IQR), 13.8-79.3] months), 52 and 54 were classified into the low (median < 18.4 kg/m 2 ) and high (≥18.4 kg/m 2 ) BMI groups, respectively. Multivariable Cox proportional hazards analysis indicated that BMI (hazard ratio, 0.87; 95% confidence interval [CI]: 0.82-0.94; P < 0.001) was closely associated with survival. Multivariable logistic regression revealed that dementia was associated with low BMI (odds ratio: 2.89, 95% CI: 1.07-7.83, P = 0.03)., Conclusions: Low BMI was an important factor contributing to poor patient survival. Dementia was associated with low BMI. Therefore, the management of both nutrition and dementia is essential for nursing home residents undergoing hemodialysis. Geriatr Gerontol Int 2023; 23: 660-664., (© 2023 Japan Geriatrics Society.)

Background: Early identification of dementia is crucial for prompt intervention for high-risk individuals in the general population. External validation studies on prognostic models for dementia have highlighted the need for updated models. The use of machine learning in dementia prediction is in its infancy and may improve predictive performance. The current study aimed to explore the difference in performance of machine learning algorithms compared to traditional statistical techniques, such as logistic and Cox regression, for prediction of all-cause dementia. Our secondary aim was to assess the feasibility of only using clinically accessible predictors rather than MRI predictors., Methods: Data are from 4,793 participants in the population-based AGES-Reykjavik Study without dementia or mild cognitive impairment at baseline (mean age: 76 years, % female: 59%). Cognitive, biometric, and MRI assessments (total: 59 variables) were collected at baseline, with follow-up of incident dementia diagnoses for a maximum of 12 years. Machine learning algorithms included elastic net regression, random forest, support vector machine, and elastic net Cox regression. Traditional statistical methods for comparison were logistic and Cox regression. Model 1 was fit using all variables and model 2 was after feature selection using the Boruta package. A third model explored performance when leaving out neuroimaging markers (clinically accessible model). Ten-fold cross-validation, repeated ten times, was implemented during training. Upsampling was used to account for imbalanced data. Tuning parameters were optimized for recalibration automatically using the caret package in R., Results: 19% of participants developed all-cause dementia. Machine learning algorithms were comparable in performance to logistic regression in all three models. However, a slight added performance was observed in the elastic net Cox regression in the third model (c = 0.78, 95% CI: 0.78-0.78) compared to the traditional Cox regression (c = 0.75, 95% CI: 0.74-0.77)., Conclusions: Supervised machine learning only showed added benefit when using survival techniques. Removing MRI markers did not significantly worsen our model's performance. Further, we presented the use of a nomogram using machine learning methods, showing transportability for the use of machine learning models in clinical practice. External validation is needed to assess the use of this model in other populations. Identifying high-risk individuals will amplify prevention efforts and selection for clinical trials., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Sanfilippo syndrome (MPS III) is an autosomal recessive inherited disorder causing dementia in children, following an essentially normal early developmental period. First symptoms typically include delayed language development, hyperactivity and/or insomnia from 2 years of age, followed by unremitting and overt loss of previously acquired skills. There are no approved treatments, and the median age of death is 18 years. Treatments under clinical trial demonstrate therapeutic benefit when applied pre-symptomatically in children diagnosed early through known familial inheritance risk. Newborn screening for Sanfilippo syndrome would enable pre-symptomatic diagnosis and optimal therapeutic benefit, however, many fold more patients with Sanfilippo syndrome are expected to be identified in the population than present with childhood dementia. Therefore, the capacity to stratify which Sanfilippo infants will need treatment in toddlerhood is necessary. While diagnostic methods have been developed, and continue to be refined, currently there are no tools or laboratory-based biomarkers available to provide pre-symptomatic prognosis. There is also a lack of progression and neurocognitive response-to-treatment biomarkers; disease stage and rate of progression are currently determined by age at symptom onset, loss of cerebral grey matter volume by magnetic resonance imaging and developmental quotient score for age. Robust blood-based biomarkers are an urgent unmet need. In this review, we discuss the development of biomarker assays for Sanfilippo based on the neuropathological pathways known to change leading into symptom onset and progression, and their performance as biomarkers in other neurodegenerative diseases. We propose that neural-derived exosomes extracted from blood may provide an ideal liquid biopsy to detect reductions in synaptic protein availability, and mitochondrial function. Furthermore, given the prominent role of neuroinflammation in symptom expression, glial fibrillary acidic protein detection in plasma/serum, alongside measurement of active brain atrophy by neurofilament light chain, warrant increased investigation for prognostic, progression and neurocognitive response-to-treatment biomarker potential in Sanfilippo syndrome and potentially other childhood dementias., (© 2023 The Authors. Journal of Neurochemistry published by John Wiley & Sons Ltd on behalf of International Society for Neurochemistry.)

Objective: To investigate Vietnamese community pharmacists' knowledge and attitudes towards dementia., Methods: 1066 community pharmacists in eight provinces/centrally-governed cities were recruited using a non-probability convenience sampling technique. Their dementia knowledge was measured using a set of 14 questions developed through a literature review. The Approaches to Dementia Questionnaire was used to assess pharmacists' attitudes towards dementia. Cronbach's alpha was 0.88 for the overall questionnaire (0.70 for the knowledge part and 0.81 for the attitude part)., Results: Participants were mostly female (74.2%), 20-39 years old (79.1%), and had work experience in pharmacies of less than 10 years (77.0%). Medicines for dementia were available in only 40 community pharmacies (3.8%), including galantamine (3.0%) and donepezil (0.8%). Pharmacists' average knowledge and attitude scores were 8.03 ± 2.61 and 64.81 ± 7.34, respectively. There were considerable differences in pharmacists' knowledge and attitudes between rural and urban areas and among eight provinces (p < 0.001). Higher knowledge and attitude scores were found among those with higher education levels and longer work experience (p < 0.001). Using reliable sources to seek information on dementia, such as books and scientific articles, also helped pharmacists to have better knowledge and more positive attitudes (p < 0.001). There was a positive relationship between knowledge and attitude scores (r = 0.326, p < 0.001)., Conclusion: Community pharmacists demonstrated moderate levels of knowledge and attitudes towards dementia. Their knowledge about the symptoms of dementia was inadequate. Educational interventions and training programs are urgently needed to enhance their dementia knowledge and attitudes., (© 2023 John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: Much research has been conducted on the relationship between recovery orientation and people diagnosed with mental illnesses such as schizophrenia and mood disorders. A recovery-oriented approach by mental health professionals can reduce hospital stays and medical costs for people diagnosed with mental illness. There are similarities and differences between recovery-oriented approaches for individuals diagnosed with dementia and those diagnosed with mental illness. This reflects the characteristics of irreversible dementia. Although dementia courses at recovery colleges are increasing, dementia recovery is in its infancy and course content varies. The core of the recovery framework for individuals diagnosed with dementia is 'Continue to be me'. Recovery-oriented approaches and programmes have been developed by mental health workers for older adults, including those with dementia, but there are no outcome measures that reflect the characteristics of dementia care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We developed a scale to assess nurses' recovery orientation in dementia care, which has been found to be reliable, and although some validity issues remain, it is the first scale to objectively assess recovery orientation in dementia care. The emphasis is on helping people diagnosed with dementia maintain their identity, which is not adequately covered by existing measures of recovery. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The ability to objectively assess recovery orientation in dementia care allows us to identify areas of inadequacy. It can be used to reduce variation in the content of recovery college courses and as an indicator for evaluating training in recovery-oriented approaches to dementia care., Abstract: INTRODUCTION: Programmes regarding recovery-oriented approaches for older people, including those with dementia, have been developed, but there are no clear indicators, and the process is still in its infancy., Purpose: We developed a scale to assess nurses' recovery orientation in dementia care., Methods: A draft of a 28-item scale was developed based on interviews with 10 nurses, skilled in dementia care with a Japanese mental health perspective, and a literature review. A self-administered questionnaire was developed for nurses working in a dementia ward, and an exploratory factor analysis was conducted. A confirmatory factor analysis was conducted to test for convergent and discriminant validity. The Recovery Attitude Questionnaire was used to examine criterion-related validity., Results: An exploratory factor analysis produced a 19-item scale and identified five factors (KMO value: 0.854). The Cronbach's alpha for the overall scale was .856, with each subfactor showing a range of .742-.792, validating its reliability., Discussion: The results of confirmatory factor analysis supported the five-factor construct. Reliability was verified, but some issues remained in convergent and discriminant validity., Implications for Practice: This scale can be used to objectively assess nurses' recovery orientation in dementia care and as a measure of training in recovery-oriented approaches., (© 2023 John Wiley & Sons Ltd.)

Background: Dementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia, working alongside clinical services. Navigator services have been implemented but the service offered vary without a consistent overview provided. The aim of this narrative systematic review was to describe and compare existing service formats, and to synthesise evidence regarding their implementation and impacts., Methods: The review was registered on PROSPERO [CRD42021292518]. Three electronic databases were searched and included studies reported on a DCN service, defined as a service in which non-clinically trained workers provide personalised advice and support to people with dementia and/or carers in the community. Two independent reviewers screened abstracts and titles and read through full papers for inclusion. Risk of bias was assessed using the Standard Quality Assessment QualSyst., Results: We included 14 papers reporting on six studies. All services were US-based and only varied by integration and training provided. Studies reported different degrees of impact on service utilisation and on symptoms and mental well-being of people with dementia and their carers, with too little evidence to draw substantial/meaningful conclusions and studies employing different outcome measures. One study evidenced greater impacts on people with more advanced dementia compared to earlier stages., Conclusions: DCN services have the potential to effectively provide non-clinical support to people with dementia and carers from the point of diagnosis. Further research from countries other than the USA, focusing on the impact on social care and social support service access and utilisation, and utilising similar established outcome measures are required., (© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

Aim: To describe a study protocol for a survey study in German nursing homes that (1) plans to enhance a typology of care units (2) and investigates the association between different care unit types and the provision of dementia-specific interventions based on a stratified randomized sample., Background: Many nursing homes in Germany provide Dementia Special Care Units. Existing definitions often do no justice to the complexity of their context. In this study, we define context as structural and organizational variables. It is necessary to define an empirical based set of indicators to characterize care units with respect to dementia care., Design: Observational survey study with a cross-sectional design., Methods: We will use a stratified random nationwide sample of 160 German nursing homes. Stratification variables are federal state and the existence of a Dementia Special Care Unit. The sampling frame from which the participating nursing homes are selected is a list with the total population of German nursing homes (n = 11.658). Data will be gathered on the level of the nursing homes and one of their care units via computer-assisted telephone interviews with a standardized questionnaire. The distribution of the assessed variables (contextual characteristics) will be described in absolute and relative frequencies for the whole sample in the first step in order to describe dementia-specific care structures. In the second step, factor analysis of mixed data (FAMD) with hierarchical clustering (HC) will be applied to analyze relationships between variables. The study was ethically approved in October 2018., Discussion: The typology can be used in future studies to define the context of care units in nursing homes. This may improve the interpretation of findings from future studies that investigated interventions in nursing homes., Impact: The typology will visualize and describe the complexity of contextual characteristics of several care units., (© 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Alzheimer's disease (AD) is characterized by high heterogeneity in disease manifestation, progression and risk factors. High phenotypic variability is currently regarded as one of the largest hurdles in early diagnosis and in the design of clinical trials; there is therefore great interest in identifying factors driving variability that can be used for patient stratification. In addition to genetic and lifestyle factors, the individual's sex and gender are emerging as crucial drivers of phenotypic variability. Evidence exists on sex and gender differences in the rate of cognitive deterioration and brain atrophy, and in the effect of risk factors as well as in the patterns of diagnostic biomarkers. Such evidence might be of high relevance and requires attention in clinical practice and clinical trials. However, sex and gender differences are currently seldom appreciated; importantly, consideration of sex and gender differences is not currently a focus in the design and analysis of clinical trials for AD. The objective of this position paper is (i) to provide an overview of known sex and gender differences that might have implications for clinical practice, (ii) to identify the most important knowledge gaps in the field (with a special regard to clinical trials) and (iii) to provide conclusions for future studies. This scientific statement is endorsed by the European Academy of Neurology. [ABSTRACT FROM AUTHOR]

The home care workforce provides essential support for older people with dementia to live a life of fulfillment. " Enabling Choices," an evidence-informed conversation tool, aims to negotiate risk around everyday activities between home care workers, people with dementia and their informal carers. This paper describes tool conversion into electronic format and preparation for implementation throughout a large Australian health and aged care service provider, utilizing the Implementation Framework for Aged Care (IFAC). Using codesign principles, the tool was converted from paper-based to electronic format involving frontline, operational and Information Management Services staff, and people with dementia/carers. Focus groups and interviews identified tool acceptability, feasibility, and appropriateness. For implementation preparation, the wider socio-cultural-political context was mapped, and key questions of the IFAC addressed. Environment, workflow, and training requirements were determined, and strategies for behavior change ascertained. Numerous opportunities and challenges exist for the widespread upscale of an evidence-informed tool into practice. [ABSTRACT FROM AUTHOR]

Background: Word retrieval skills change across the lifespan. Permanent alterations in the form of decreased accuracy or increased response time can be a consequence of both normal ageing processes or the presence of acquired and neurodegenerative disorders (e.g., aphasia and dementia). Despite the extensive literature exploring the neuroanatomical underpinnings of word retrieval, psycholinguistic, biolinguistic and theoretical explanations, and the vast amount of evidence from primary and secondary language disorders, the best approach to consistently capture these changes is yet to be discovered. Aims: The goal of this paper is to determine which method(s) stand(s) as the most suitable candidate(s) to provide an accurate picture of word retrieval in the oral production of different groups of adult speakers, including cases of healthy ageing, preclinical Alzheimer's disease (AD), mild cognitive impairment (MCI), aphasia and dementia. Methods & Procedures: Using an integrative review of recent peer-reviewed journal articles, we provide an overview of the different behavioural methods traditionally used to measure oral naming skills in research-oriented and clinical protocols and discuss their main advantages and limitations. Main Contribution: Most existing studies are based on the results of people with diagnosed language disorders. Despite the growing interest, the reliability of the majority of the tasks to detect subtle changes associated with healthy ageing, MCI and preclinical AD are yet to be demonstrated, and the delicate balance between informativeness and efficiency (especially in terms of administration time and variable control) in experimental protocols is yet to be achieved. In this article we propose the pursuit of an integrative overarching methodology to characterize all naming deficits (from anecdotal to permanent) and all adult populations (from healthy to pathological ageing). Conclusions & Implications: A combination of spontaneous speech data and results from structured tasks stands as the best approach to capture changes in word retrieval skills of adult speakers with and without observable deficits. This review can guide future reflections on the necessary prerequisites of purpose-oriented, sensitive and reliable protocols for the detection of incipient word retrieval problems, thus contributing to the early diagnosis and the design of personalized multicomponent treatments.

Despite the increasing policy focus on integrated dementia care in the UK, little is known about the opportunities and challenges encountered by practitioners charged with implementing these policies on the ground. We undertook an extensive, mixed-methods analysis of how a contemporary multidisciplinary dementia pathway in the UK was experienced and negotiated by service providers. Our pragmatic mixed methods design incorporated three types of research interaction with practitioners: (a) Semi-structured interviews (n = 31) and focus group discussions (n = 4), (b) Practitioner 'shadowing' observations (n = 19), and (c) Service attendance and performance metrics reviews (n = 8). Through an abductive analysis of practitioner narratives and practice observations, we evidenced how inter-practitioner prejudices, restrictive and competitive commissioning frameworks, barriers to effective data sharing and other resource constraints, all challenged integrative dementia care and led to unintended consequences such as practice overlap and failure to identify and respond to people's needs. In order to more successfully realise integrated dementia pathways, we propose innovative commissioning frameworks which purposefully seek to diffuse power imbalances, encourage inter-provider respect and understanding, and determine clear lines of responsibility., (© 2020 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

Background: This study aims to clarify the association between marital status and dementia in Japan, adjusting for socioeconomic, lifestyle, and lifestyle-related disease factors., Methods: Data from the Japanese Toyama Dementia Survey were used. Individuals aged ≥65 years living in Toyama Prefecture were randomly selected, and 1171 participants were analysed, with a sampling rate of 0.5%. The participants' marital status, socioeconomic status, lifestyle factors, and lifestyle-related diseases were assessed. The odds ratio (OR) of marital status for each lifestyle factor and medical histories were calculated by logistic regression analysis. The OR of marital status for dementia was also calculated by logistic regression analysis., Results: The prevalence of dementia was 7.4% for married, and 20.6% for non-married participants. Non-married participants showed a higher prevalence of a history of stroke than married participants. The age- and sex-adjusted OR of marital status for dementia was 1.99 (95% confidence interval (CI) 1.24-3.18) for non-married compared with married participants. Following variable adjustments, the OR for dementia was higher for non-married participants (adjusted OR 1.71; 95% CI 1.03-2.85)., Conclusions: Non-marital status was an independent risk factor for dementia in Japan even after adjusting for socioeconomic, lifestyle, and lifestyle-related disease factors. Non-married people were more likely to have dementia because of their history of stroke., (© 2021 Japanese Psychogeriatric Society.)

Background: A psychosocial dementia care programme for challenging behaviour (DEMBASE ® ) was developed in collaboration with a Swedish BPSD-registry team for in-home care services use in Japan. The programme consisted of a web-based tool for the continued assessment of challenging behaviours and interdisciplinary discussion meetings. Effectiveness of the adapted programme was verified through a cluster-randomised controlled trial. The Tokyo Metropolitan Government provided municipal funding to introduce the programme into daily practice beginning in April 2018., Objectives: To investigate both facilitators and barriers associated with programme implementation., Design: A secondary analysis of qualitative and quantitative data., Settings: Data were collected in naturalistic long-term care settings from April 2018 to March 2019., Participants: A total of 138 professionals and 157 people with dementia participated in the programme., Methods: Challenging behaviour in persons with dementia was assessed by professionals using a total Neuropsychiatric Inventory score. Data on expected facilitators and barriers were extracted for qualitative analysis from a debriefing meeting between professionals., Results: Of the 157 persons with dementia, 81 (51.6%) received follow-up behavioural evaluations by March 2019. The average level of challenging behaviour was significantly reduced for 81 persons from baseline to their most recent follow-up evaluations. Facilitators included 'programme available for care managers', 'visualised feedback on professionals' work', 'affordable for providers and professionals' and 'media coverage'. Barriers included 'professionals from different organisations', 'unpaid work', 'operation requirement for municipalities' and 'conflict with daily benefit-oriented framework'., Conclusions: A follow-up evaluation was not fully achieved. Further strategies to address barriers may include the development of a benefit-rewarding scheme for interdisciplinary discussion meetings, an e-learning system capable of substituting training course portions and a cross-municipality training course., (© 2020 Nordic College of Caring Science.)

Background: This study aims to elucidate the impact of financial incentives on the motivation to participate in dementia prevention activities and to provide support to people with dementia., Methods: An online survey was completed by 1500 men and women, aged 60 or above, from the general community in Japan. When responding to questions regarding motivation for participating in dementia prevention activities and providing support to people with dementia, respondents were randomly assigned different incentive conditions. Two incentive options were used for dementia prevention activities (no incentives, and a small number of reward points). Three incentive options were used for support activities (no incentives, a small cash reward, or an in-kind time reward that allowed respondents or their family members to use similar services at a later time (time credits))., Results: Financial incentives decreased motivation for participating in dementia prevention activities, while time credits significantly increased motivation to participate in providing support to people with dementia for going out of their home, when receiving a cash reward was compared with receiving no reward. No significant differences by incentive were found for participating in daily living support for those with dementia or for providing support at a dementia café where people with dementia and their families interact., Conclusions: The adverse influence of financial incentives on motivation to participate in dementia prevention suggested that financial incentives may reduce intrinsic motivation for dementia prevention activities. The positive effects of time credits in providing support to people with dementia in going out suggested that time credits might be effective for some support activities for people with dementia. Different incentive measures should be considered to raise awareness of dementia prevention and dementia support activities., (© 2021 Japanese Psychogeriatric Society.)

Objectives: Identification of inappropriate medications in people living with severe dementia is a complex task which has the potential to reduce avoidable adverse events and increase quality of life. This scoping review (i) identifies published tools intended to aid deprescribing in people living with severe dementia and (ii) describes evaluations of their usefulness in clinical practice., Methods: A scoping review was undertaken, with Medline, Medline in Process, EMBASE, Cochrane Library, CINAHL, Scopus and Web of Science databases, from inception to April 2023, identifying tools for deprescribing in severe dementia. A tool was considered as any resource for deprescribing, including clinical study, scientific publication, health guideline, website, algorithm, model or framework. Two reviewers assessed the eligibility of articles through abstract and full text review. Data extracted from included studies were summarized through narrative synthesis., Results: Twelve studies were identified from 18,633 articles screened. Tools were categorized into three groups: deprescribing interventions (n = 2), consensus-based deprescribing criteria (n = 5), and medication-specific recommendations (n = 5). Six studies developed tools using expert opinion and ten tools were tested in people living with severe dementia. Only one of the four studies that evaluated patient outcomes (cognitive change and adverse events) identified clear clinical benefit from medication withdrawal., Conclusions: Clinical application of current deprescribing tools is limited due to the lack of evidence-based research on the clinical effects of individual medication deprescribing in people with severe dementia. Further research on patient outcomes, including cognitive change and adverse events, will help clarify the role of these tools in clinical care., (© 2023 John Wiley & Sons Ltd.)

Objectives: This study aimed to investigate the mediating effects of quality of the caregiving relationship and other carer and person with dementia variables in predicting carer resilience over time., Method: Carers of people with mild and moderate dementia in community settings completed baseline (n = 176 dyads) and six-month follow-up assessments (n = 139 dyads). Causal mediation analysis was conducted using Pearson Correlation and Structural Equation Modelling (SEM) to examine longitudinal predictors of carer resilience, and the effect of several mediating person with dementia, and carer factors on carer resilience over time., Results: At 6-month follow-up, higher levels of carer resilience were longitudinally correlated with higher ratings of perceived relationship quality by people with dementia (r = 0.53 p ≤ 0.01), and lower levels of emotional distress symptoms by carer's (r = -0.59 p ≤ 0.01). Mediation analyses showed that people with dementia perspectives of the quality of the caregiving relationship mediated the relationship between carer distress specific to neuropsychiatric symptoms (β = -0.32, p ≤ 0.001) and carer resilience (β = 0.53, p ≤ 0.001) over time. The final SEM provided a good fit for the data (X 2  = 0.12, p = 0.72, CFI = 1.00, NFI = 0.99, and Root Mean Square Error of Approximation = 0.001)., Conclusion: Higher ratings of perceived relationship quality by people with dementia, and lower levels of carer emotional distress predicted higher carer resilience at follow-up. People with dementia perspectives of the quality of the caregiving relationship mediated the relationship between carer distress specific to neuropsychiatric symptoms and carer resilience over time. Our findings indicate that interventions aimed at strengthening the caregiving relationship might have a protective long-term effect for carer resilience in dementia caregiving., (© 2023 University College London. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

Objectives: Emergency department (ED) attendance is common among people with dementia and associated with poor health outcomes. Literature suggests a link between access to community care and the ED, but we know little about the mechanisms behind this link. This study aimed to explore experiences of accessing community and emergency care among people affected by dementia., Methods: Informed by critical realism, semi-structured online and telephone interviews were conducted with people with dementia and family caregivers, with and without experience of using the ED. Participants were recruited from across the United Kingdom using purposive sampling with maximum variation. A mostly experiential reflexive thematic analysis approach was used, applying the candidacy model of access to deepen interpretation., Results: Two dyad and 33 individual interviews were conducted with 10 people with dementia, 11 current caregivers and 16 bereaved caregivers (men = 11, 70-89 years = 18, white ethnicity = 32). Three themes are reported: (1) Navigating a 'push system', (2) ED as the 'last resort', and (3) Taking dementia 'seriously'. Themes describe a discrepancy between the configuration of services and the needs of people affected by dementia, who resort to the ED in the absence of accessible alternatives. Underlying this discrepancy is a lack of systemic prioritisation of dementia and wider societal stigma., Conclusion: Although a last resort, ED attendance is frequently the path of least resistance for people with dementia who encounter multiple barriers for timely, responsive access to community health and social care. Greater systemic prioritisation of dementia as a life-limiting condition may help to reduce reliance on the ED through essential development of post-diagnostic care, from diagnosis to the end of life., (© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

The 2020 Lancet issue identified social isolation as one of 12 modifiable risk factors for dementia and revealed that enhanced social connections and social support can effectively reduce the incidence of social isolation. During the COVID-19 pandemic, technology attracted an increasing amount of attention, and it is necessary to synthesize ideas from existing evidence. First, we explored how people with dementia experienced changes in social connection and social support due to tablet/app use. Second, we explored the attitudes of people with dementia towards tablets and mobile applications. Third, we explored the feasibility of using tablets and mobile applications to enhance social connection and social support among people with dementia. We systematically searched the PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, WanFang, and VIP databases. Two reviewers independently screened the titles and abstracts of studies, extracted the data and performed critical appraisals of each included study. The data synthesis was conducted using thematic analysis. A total of nine studies were included. Eight studies used mobile applications via tablets, and one study collected textual data from Twitter for analysis. Four themes were synthesized: (1) change from the perspective of caregivers; (2) growth of nonsingle aspects; (3) emotional feeling of belonging; and (4) feasibility of using digital technology. Tablet- and mobile application-based interventions can enhance both online and offline social connections and provide multiple types of social support among people with dementia. People with dementia have positive attitudes towards tablets and mobile applications. Overall, it is feasible for people with dementia to use technology., (© 2023 John Wiley & Sons Australia, Ltd.)

Background: The association between traumatic brain injury (TBI) and dementia is controversial, and of growing importance considering the ageing demography of TBI., Objective: To review the scope and quality of the existing literature investigating the relationship between TBI and dementia., Methods: We conducted a systematic review following PRISMA guidelines. Studies that compared TBI exposure and dementia risk were included. Studies were formally assessed for quality with a validated quality-assessment tool., Results: 44 studies were included in the final analysis. 75% (n = 33) were cohort studies and data collection was predominantly retrospective (n = 30, 66.7%). 25 studies (56.8%) found a positive relationship between TBI and dementia. Clearly defined and valid measures of assessing TBI history were lacking (case-control studies-88.9%, cohort studies-52.9%). Most studies failed to justify a sample size (case-control studies-77.8%, cohort studies-91.2%), blind assessors to exposure (case-control-66.7%) or blind assessors to exposure status (cohort-3.00%). Studies that identified a relationship between TBI and dementia had a longer median follow-up time (120 months vs 48 months, p = 0.022) and were more likely to use validated TBI definitions (p = 0.01). Studies which clearly defined TBI exposure (p = 0.013) and accounted for TBI severity (p = 0.036) were also more likely to identify an association between TBI and dementia. There was no consensus method by which studies diagnosed dementia and neuropathological confirmation was only available in 15.5% of studies., Conclusions: Our review suggests a relationship between TBI and dementia, but we are unable to predict the risk of dementia for an individual following TBI. Our conclusions are limited by heterogeneity in both exposure and outcome reporting and by poor study quality. Future studies should; (a) use validated methods to define TBI, accounting for TBI severity; (b) follow consensus agreement on criteria for dementia diagnosis; and (c) undertake follow-up that is both longitudinal, to determine if there is a progressive neurodegenerative change or static post-traumatic deficit, and of sufficient duration., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objectives: Treatments that target the biological causes of dementia remain limited, making prevention critically important. Well-being-defined broadly as living in accordance with one's potential and experiencing one's life as enjoyable and satisfying-is a promising avenue for prevention. It can be targeted by large-scale, noninvasive interventions and has been linked with better cognitive health and lower dementia risk. In the current review, we begin by summarizing empirical evidence linking well-being to cognitive functioning, cognitive decline, dementia diagnosis, and dementia-related neuropathology. Then, we highlight 3 key areas for future research., Methods: We searched the literature on wellbeing, cognitive decline, and dementia, focusing on prospective and longitidinal evidence., Results: The research reviewed here provides consistent evidence for associations of well-being with cognitive decline, dementia risk, and cognitive resilience to neuropathology. However, several open questions remain regarding (1) causality and mechanism(s), (2) specificity versus generalizability of associations, and (3) timing., Discussion: To inform potential intervention efforts, the field must address complex open questions about whether, how, when, and for whom well-being influences dementia risk. The majority of existing research on well-being and cognitive health is correlational, and few studies have tested potential mechanisms that may explain those associations. Further, relatively little is known about the generalizability of associations across different aspects of well-being and for different sociocultural groups. Finally, we do not yet understand when in the life span and on what timescale well-being might influence cognitive health. We discuss challenges and opportunities for addressing each of these open questions, including concrete recommendations for research designs and use of open science practices., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Communication difficulties are common in people with dementia, and often present from an early stage. However, direct treatment options for people with dementia that positively influence their daily communication are scarce., Aims: To evaluate the potential impact and feasibility of a personalized logopaedic intervention., Methods & Procedures: A total of 40 community-dwelling persons with dementia and their caregivers were recruited. Five experienced speech and language therapists (SLTs) delivered the six-session Com-mens intervention at home. Com-mens aims to improve positive communication between people with dementia and their primary caregivers and comprises five elements: interactive history-taking, dynamic observational assessment, education about the consequences of dementia on communication, development and use of personalized communication tools, use motivational, and person-centred strategies by the SLT. We conducted a single-group mixed-methods pilot study with five measurements: baseline, directly after intervention, and at 3, 6 and 9 months follow-up. Semi-structured interviews and questionnaires for Experienced Communication in Dementia, quality of life, psychological well-being and caregiver burden were conducted. Process evaluation was performed by interviewing participants, drop-outs, SLTs and other stakeholders., Outcomes & Results: A total of 32 dyads completed the intervention. Repeated measures analyses revealed no significant changes over time. In the interviews, participants reported a positive impact on their feelings, increased communication skills and better coping with the diagnosis. Participants would recommend the intervention to others. Facilitators were timely delivery, personalized content and adequate reimbursement. Barriers were unfamiliarity with Com-mens among referrers, an overburdened caregiver or disrupted family relationships., Conclusions & Implications: This newly developed logopaedic intervention is feasible and has a perceived positive impact on both people with dementia and their caregivers, which is confirmed by a stable pattern over a period of 1 year. Future comparative studies are needed to test the effectiveness of personalized interventions in this patient population., What This Paper Adds: What is already known on the subject? SLTs are experts in the field of communication, but even though communication problems are common between people with dementia and their caregivers, there is a lack of logopaedic guidelines and materials for the direct treatment for this population. Interventions that are available either focus on (professional) caregivers only or aim to enhance cognitive functioning and do not target on joined communication. What this paper adds to the existing knowledge? A newly developed intervention called Com-mens can be provided by trained SLTs and takes an average of six 1-h sessions. The intervention is perceived to be valuable and feasible for people with dementia and their caregivers, by the participants themselves, as well as by healthcare professionals and other stakeholders. What are the potential or actual clinical implications of this work? Dissemination of this intervention will give SLTs skills, tools and materials to provide meaningful care to home-dwelling persons with dementia and their caregivers. Also, persons with dementia and their caregivers will receive education and materials that can help them increase their understanding of communication problems, enhance their communication skills and better cope with the communication problems that result from dementia. We consider the Com-mens intervention to be a valuable addition to the field of speech language therapy and dementia., (© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: Reminiscence therapy (RT) is the most common non-pharmacological treatment for dementia care. The therapy stimulates the senses to evoke memories having the potential to reduce Behavioral and Psychological Symptoms of Dementia (BPSD). Digital RT, such as web-based reminiscence therapy (WBRT), has the potential to support dementia care and reduce the caregiving burden., Aims: This study aimed to explore healthcare professionals (HCPs) perceptions of utilizing WBRT in institutionalized settings to support persons with dementia during the COVID-19 pandemic., Methods: A qualitative phenomenological descriptive study was adopted and guided by Graham's Knowledge to Action framework. Online training on the use of WBRT was conducted, followed by interviews with HCPs., Results: Four major themes were identified on the potential use of WBRT in dementia care, including usability and efficacy, impact on caregiving, capability of reducing BPSD, and. feasibility during COVID-19 social distancing., Discussion: This study recognized the potential use of WBRT to support the person with dementia during the pandemic in institutionalized settings., Conclusion: The knowledge generated from this study will guide the future application of WBRT to support dementia care in diverse healthcare settings., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)