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Objectives: this study aims to explore how patient safety in community dementia services is understood by caregivers, and healthcare professionals., Methods: cross-sectional analysis of guided one-to-one interviews with 10 caregivers, and 10 healthcare professionals., Results: caregivers and healthcare professionals identified a range of issues including medication errors, mis-communication between professionals, unclear service pathways and the effects of stress on caregivers' behaviour. Caregivers and professionals differed in their attitudes to balancing safety with patient autonomy and who is responsible for managing safety., Conclusions: this article helps to define the nature of safety issues in the context of community care for people with dementia. In contrast to hospital medicine, where the ideal treatment world is safe with all risks managed or minimised, in dementia some risks are actively taken in the interests of promoting autonomy. Caregivers' views differ from those of health professionals but both parties see potential for collaborative working to manage risk in this context, balancing the promotion of autonomy with the minimisation of potential harm., (© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com)

Most people with mild dementia can continue to drive, but dementia is progressive and many patients and clinicians will be faced with questions about driving safety in the course of their illness. Determining when this happens is a complex decision, with risks of personal and public safety needing to be weighed against individual patient benefits of driving in terms of autonomy, independence and well-being. Decisions need to make reference to cognitive abilities, as well as other factors including physical comorbidity, vision, mobility, insight and history of driving errors and accidents. Deciding to stop driving, or being required to stop driving is often difficult for patients to accept and can be a particularly problematic consequence of a dementia diagnosis. Legal frameworks help in decision-making but may not provide sufficient detail to advise individual patients. We review the current guidelines and evidence relating to driving and dementia to help clinicians answer questions about driving safety and to consider the full range of assessment tools available., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Associations between dementia and impairments in hearing, vision, olfaction and (to a lesser degree) taste have been identified. Hearing impairment has been shown to precede cognitive decline, but it is not clear if the hearing loss is an early marker of dementia or a modifiable risk factor. Olfactory impairment is seen in many neurodegenerative conditions, but it has been shown that those with dementia have particular difficulties with the recognition and identification of odours rather than the detection, suggesting a link to impairment of higher cognitive function. Olfactory impairment has been shown to be predictive of conversion from mild cognitive impairment to Alzheimer's disease with 85.2% sensitivity. As cognitive function deteriorates, the world is experienced at a sensory level, with reduced ability to integrate the sensory experiences to understand the context. Thus, people with dementia are very sensitive to sensory experiences and their environment needs to be managed carefully to make it understandable, comfortable, and (if possible) therapeutic. Light can be used to stabilise the circadian rhythm, which may be disturbed in dementia. Music therapy, aromatherapy, massage and multisensory stimulation are recommended by NICE for the management of behavioural and psychological symptoms of dementia (BPSD), although the mechanisms behind such interventions are poorly understood and evidence is limited. Sensory considerations are likely to play a greater role in dementia care in the future, with the development of purpose-built dementia care facilities and the focus on non-pharmacological management strategies for BPSD., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Mild cognitive impairment (MCI) is a term used to describe cognitive impairment in one or more cognitive domains that is greater than any expected age-related changes, but not of the magnitude to warrant a diagnosis of dementia. This review considers how early cognitive decline is diagnosed, focusing on the use of neuropsychological tests and neuroimaging, as well as the differential diagnosis. Potential treatments, including secondary prevention, post-diagnostic support and self-help are discussed. Finally, medico-legal matters such as driving, lasting power of attorney and employment are outlined. [ABSTRACT FROM AUTHOR]

Antipsychotic medications are widely prescribed in elderly populations for a range of psychiatric symptoms. Evidence for their efficacy in this population is limited, and such individuals are at increased risk of numerous side-effects, including stroke and death, particularly in those with dementia. There appears to be a mismatch between the current evidence base and what is occurring in clinical practice, especially in the use of antipsychotics to treat delirium and behavioural and psychological disturbance in dementia. We advise caution in the prescription of antipsychotics in older people and seeking specialist advice. [ABSTRACT FROM AUTHOR]