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Aim: Mate wareware (dementia) presents a significant social and economic burden for Māori in Aotearoa New Zealand. Previous literature has highlighted the need to improve health literacy for Māori regarding the causes and management of mate wareware, yet there is a lack of Māori-centred educational resources. It was determined that a mobile phone application (app) could meet this need and that early consultation with Māori was required to ensure the digital solution would be culturally safe and relevant., Method: This study explored the perspectives of kaumātua (Māori elders) regarding how to cater the mate wareware mobile app to Māori. Through a qualitative approach based on Kaupapa Māori principles, two focus groups were held with 15 kaumātua. Focus group data were thematically analysed., Results: The analysis identified four themes related to the content of the proposed app and its design features. "Information about mate wareware" and "Caregiver support" were prominent themes that kaumātua prioritised for inclusion in the proposed app. To ensure uptake, kaumātua emphasised that the "Access" and "Appeal" of the proposed app should be considered., Conclusion: The findings have informed the design of the Mate Wareware app and should be considered when developing other digital health interventions for Māori., Competing Interests: Nil., (© PMA.)

Aims: Diabetes-related dementia (DRD) is a new dementia subtype associated with type 2 diabetes mellitus, first described in 2013. This study investigated data from a local New Zealand memory service to identify patients that met the criteria for DRD., Methods: Using routinely collected data from 2013-2021, we selected a sample of people with dementia, diabetes, and no CT evidence of Alzheimer's disease (AD), vascular dementia, or frontotemporal dementia. We compared their socio-demographic, clinical, and cognitive characteristics with a sample of patients with diabetes and Alzheimer's disease., Results: Forty (16%) of 249 patients with diabetes and dementia had "normal" CT scans (DRD subgroup), and 38 (15%) had AD (AD subgroup). Compared to NZ Europeans, disproportionally more Māori and Pacific Islanders (70.2%) were in the DRD subgroup. In the Pacific subgroup (n=31), the DRD subgroup had higher memory subscores than the AD subgroup (p=0.047), and the Kaplan-Meier plot suggested poorer survival (p=0.13). Māori patients with diabetes and dementia were more likely to meet all four criteria for DRD., Conclusion: We have replicated the findings of the 2013 DRD research and have demonstrated a higher risk for the DRD subtype of dementia among the Māori and Pacific Islander patients in our sample., Competing Interests: Nil., (© PMA.)

Currently, there are estimated to be 70,000 people living with dementia in Aotearoa, New Zealand (NZ). This figure is projected to more than double by 2040, but due to the more rapid growth of older age groups in non-European populations, prevalence will at least triple amongst the NZ Indian population. The impact of dementia in the NZ Indian community is currently unknown. The aim of this study was to explore the lived experiences of NZ Indians living with dementia and their caregivers. Ten caregivers (age range: 41-81) and five people living with mild dementia (age range: 65-77) were recruited from a hospital memory service and two not-for-profit community organisations in Auckland, Aotearoa, NZ. Semi-structured interviews were conducted by bilingual/bicultural researchers and transcribed for thematic analysis in the original languages. Dementia was predominantly thought of as being part of normal ageing. Getting a timely diagnosis was reported as difficult, with long waiting times. Cultural practices and religion played a large part in how both the diagnosis and ongoing care were managed. Caregivers expressed concerns about societal stigma and about managing their own health issues, but the majority also expressed a sense of duty in caring for their loved ones. Services were generally well-received, but gaps were identified in the provision of culturally appropriate services. Future health services should prioritise a timely diagnosis, and dementia care services should consider specific cultural needs to maximise uptake and benefit for Indian families living with dementia.

Little is known about the lived experience of dementia in the New Zealand Chinese community. This study aims to explore the understanding and experiences of living with dementia in Chinese New Zealanders. Participants were recruited from a memory service and a community dementia day programme. In-depth interviews were conducted by bilingual and bicultural researchers. The recorded interviews were transcribed and thematically analysed. Sixteen people living with dementia and family carers participated in this study. The first theme revealed the lack of understanding of dementia prior to diagnosis, the commonly used term of "brain shrinkage" and that dementia is associated with getting older. The second theme covered the symptoms experienced by people with dementia and how family carers found anhedonia and apathy particularly concerning. The third theme highlighted the tension between cultural obligation and carer stress. The fourth theme is about the stigma attached to dementia. Our results provide some insight into ways to improve dementia care for Chinese New Zealanders, including targeted psychoeducation in the Chinese community to improve awareness and to reduce stigma, access to person-centred interventions, and learning about strategies for healthy ageing to live well with dementia, and emotional support and psychoeducation for family carers to reduce carer stress.

Aims: Dementia is an important health concern for Māori and therefore it is essential to explore the extent and impact of dementia in this community. The 10/66 dementia protocol, a widely used research tool for measuring the prevalence of dementia, was developed to minimise cultural and educational bias in comparisons of dementia prevalence across different countries and/or cultures. The aims of this study are to (i) adapt the 10/66 dementia protocol for use in research within the Māori community and (ii) test the diagnostic accuracy of the adapted (ie, Māori-friendly) 10/66 dementia protocol against the reference standard of a clinical diagnosis of dementia (or no dementia)., Method: The sample included Māori aged 65 and over who had been assessed at a local memory service. Ten dementia cases and 10 controls were included. The sample was further enriched by the inclusion of 6 controls from a concurrent dementia-prevalence feasibility study in the local community. The Māori-friendly 10/66 dementia protocol was measured against the reference standard. Sensitivity, specificity, positive and negative predictive values and Youden's Index were calculated., Results: The Māori-friendly 10/66 dementia protocol had a sensitivity of 90.0% (95% CI 62.8-99.4), specificity of 93.8% (95% CI 75.3-99.6), positive predictive value of 90.0% (95% CI 62.8-99.4), negative predictive value of 93.8% (95% CI 75.3-99.6) and Youden's Index of 0.83., Conclusions: Our study results provide preliminary evidence that the Māori-friendly 10/66 dementia protocol has adequate discriminatory abilities for the diagnosis of dementia. Our study also demonstrates that the Māori-friendly 10/66 dementia protocol has the potential to be used in a dementia-population-based study for Māori in Aotearoa New Zealand., Competing Interests: Nil.

Introduction: Aotearoa/New Zealand (NZ) is officially recognised as a bicultural country composed of Māori and non-Māori. Recent estimations have projected a threefold increase in dementia prevalence in NZ by 2050, with the greatest increase in non-NZ-Europeans. The NZ government will need to develop policies and plan services to meet the demands of the rapid rise in dementia cases. However, to date, there are no national data on dementia prevalence and overseas data are used to estimate the NZ dementia statistics. The overall aim of the Living with Dementia in Aotearoa study was to prepare the groundwork for a large full-scale NZ dementia prevalence study., Methods and Analysis: The study has two phases. In phase I, we will adapt and translate the 10/66 dementia assessment protocol to be administered in Māori, Samoan, Tongan and Fijian-Indian elders. The diagnostic accuracy of the adapted 10/66 protocol will be tested in older people from these ethnic backgrounds who were assessed for dementia at a local memory service. In phase II, we will address the feasibility issues of conducting a population-based prevalence study by applying the adapted 10/66 protocol in South Auckland and will include NZ-European, Māori, Samoan, Tongan, Chinese and Fijian-Indian participants. The feasibility issues to be explored are as follows: (1) how do we sample to ensure we get accurate community representation? (2) how do we prepare a workforce to conduct the fieldwork and develop quality control? (3) how do we raise awareness of the study in the community to maximise recruitment? (4) how do we conduct door knocking to maximise recruitment? (5) how do we retain those we have recruited to remain in the study? (6) what is the acceptability of study recruitment and the 10/66 assessment process in different ethnic groups?, Ethics and Dissemination: The validity and feasibility studies were approved by the New Zealand Northern A Health and Disability Ethics Committee (numbers 17NTA234 and 18NTA176, respectively). The findings will be disseminated through peer-reviewed academic journals, national and international conferences, and public events. Data will be available on reasonable request from the corresponding author., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The 10/66 dementia protocol was developed as a language and culture-fair instrument to estimate the prevalence of dementia in non-English speaking communities. The aim of this study was to validate the 10/66 dementia protocol in elders of Indian ethnicity born in the Fiji Islands (Fijian-Indian) living in New Zealand. To our knowledge, this is the first time a dementia diagnostic tool has been evaluated in the Fijian-Indian population in New Zealand. We translated and adapted the 10/66 dementia protocol for use in in Fijian-Indian people. Individuals (age ≥ 65) who self-identified as Fijian-Indian and had either been assessed for dementia at a local memory service (13 cases, eight controls) or had participated in a concurrent dementia prevalence feasibility study (eight controls) participated. The sensitivity, specificity, positive predictive value, and Youden's index were obtained by comparing the 10/66 diagnosis and its sub-components against the clinical diagnosis (reference standard). The 10/66 diagnosis had a sensitivity of 92.3% (95% CI 70.3-99.5), specificity of 93.8% (95% CI 75.3-99.6), positive predictive value of 92.3% (95% CI 70.3-99.5), and negative predictive value of 93.8% (95% CI 75.3-99.6). The study results show that the Fijian-Indian 10/66 dementia protocol has adequate discriminatory abilities to diagnose dementia in our sample. This instrument would be suitable for future dementia population-based studies in the Fijian-Indian population living in Aotearoa/New Zealand or the Fiji-Islands.

Background: As the economic impact of dementia on health and social care increases, governments require disease-specific epidemiological data that will help inform spending and policy decisions. The aim of this study is to examine predictors of mortality in dementia in consecutive referrals to a New Zealand (NZ) memory service that includes Māori, Pacific Islander, and NZ European patients., Methods: Date of birth, sex, ethnicity, living situation, cognitive function, dementia subtype, dementia severity, physical comorbidity, and medication data were collected from electronic health records. The resulting data set was linked to administrative data on mortality and last hospital contact dates to allow time-dependent survival analyses., Results: The risk of death in people with dementia was increased by age (adjusted HR per year 1.08, 95%CI:1.05-1.12) and lower cognitive score at baseline (adjusted HR for severe impairment:2.54, 95% CI:1.25-5.16), and was reduced by cholinesterase inhibitors (adjusted HR:0.54, 95% CI:0.34-0.88). Compared to NZ Europeans (HR:1.19, 95% CI:0.63-2.25), antipsychotics increased the risk of death three-fold in Māori (adjusted HR:3.62, 95% CI:0.79-16.7) and Pacific Islanders (adjusted HR:2.54, 95%CI:1.10-5.85)., Conclusions: Further research is required to elucidate the mechanisms underlying the survival rates in Māori and Pacific Islanders living with dementia in NZ,and their increased risk of death if antipsychotics are used., (© 2020 John Wiley & Sons Ltd.)

Objective: Ethnicity may affect presentation to clinical services in people with dementia; however, no studies have examined this in Māori or Pacific peoples in New Zealand (NZ). Our objective was to examine the routinely collected clinical data from a memory assessment service in South Auckland to examine the presentation of dementia in the major NZ ethnic groups., Methods: A total of 360 patients presenting to a memory service with a new diagnosis of dementia were included in this study. Demographic data (age, sex, and ethnicity) and dementia sub-type and severity were analyzed., Results: There were 142 NZ European (mean age: 79.2, SD 7.4), 43 Māori (mean age: 70.2, SD 7.6), 126 Pacific (mean age: 74.3, SD 7.6), and 49 other ethnicities (mean age: 78.0, SD 8.5) presenting with a new diagnosis of dementia. After adjustment for gender and dementia subtype, Māori and Pacific patients were 8.5 and 5.3 years younger than NZ European patients (P < 0.0001). Pacific peoples tended to present with more advanced dementia (OR = 1.63, 95% CI: 0.98-2.70, P = 0.06) after adjustment for age and gender. There was little difference in the subtypes of dementia between ethnic groups., Conclusions: Māori and Pacific peoples with dementia presented to an NZ memory service at a younger age than NZ Europeans, and Pacific peoples presented with more advanced dementia. A population-based epidemiological study is critical to determine whether Māori and Pacific peoples have indeed a higher risk of developing dementia at a younger age., (Copyright © 2018 John Wiley & Sons, Ltd.)

Aim: To describe the biopsychosocial characteristics of a series of Pacific men living in South Auckland with a history of boxing presenting with early onset dementia. We discuss the history of boxing in Pacific people and the possibility of increased risk of early onset dementia in New Zealand Pacific men compared to their European counterparts., Method: We reviewed the files of Pacific men with a history of amateur or professional boxing who presented to our memory and older adult mental health services with early onset dementia over a 45-month period. We gathered relevant information to construct a biopsychosocial paradigm as possible explanation of this phenomenon., Results: We identified a series of eight New Zealand Pacific men with early onset dementia and with a history of boxing. Alcohol was a contributing factor in seven of the eight cases, and vascular risk factors in five., Conclusion: Historical, cultural and socio-economic factors underpin the attraction of some Pacific men to boxing as a sport. Given that New Zealand Pacific peoples may have an earlier onset of dementia than their European counterparts, further research is required to establish whether boxing is a contributory factor. Sports physicians should advise young New Zealand Pacific boxers about the long-term risks associated with their sport., Competing Interests: Nil.

Introduction: Recent estimations have projected a threefold increase in dementia prevalence in Aotearoa New Zealand (NZ) by 2050, particularly in Maori and Pacific peoples. However, to date, there are no national data on dementia prevalence, and overseas data are used to estimate the NZ dementia statistics. The aim of this feasibility study was to prepare the groundwork for the first full-scale NZ dementia prevalence study that is representative of Māori, European, Pacific and Asian peoples living in NZ. Methods: The main feasibility issues were: (i) Sampling to ensure adequate community representation from the included ethnic groups, (ii) Preparing a workforce to conduct the fieldwork and developing quality control, (iii) Raising awareness of the study in the communities (iv) Maximizing recruitment by door-knocking, (v) Retaining those we have recruited to the study and (vi) Acceptability of study recruitment and assessment using adapted versions of the 10/66 dementia protocol in different ethnic groups living in South Auckland. Results: We found that a probability sampling strategy using NZ Census data was reasonably accurate and all ethnic groups were sampled effectively. We demonstrated that we were able to train up a multi-ethnic workforce consisting of lay interviewers who were able to administer the 10/66 dementia protocol in community settings. The response rate (224/297, 75.5%) at the door-knocking stage was good but attrition at subsequent stages was high and only 75/297 (25.2%) received the full interview. Conclusions: Our study showed that it would be feasible to conduct a population-based dementia prevalence study using the 10/66 dementia protocol in Māori, European and Asian communities living in NZ, utilizing a qualified, skilled research team representative of the families participating in the study. The study has demonstrated that for recruitment and interviewing in Pacific communities a different but culturally appropriate approach is required. [ABSTRACT FROM AUTHOR]

Context: Compared to Europeans, Māori and Pacific peoples living with dementia in the Counties Manukau District Health Board region are three times less likely to use Aged Residential Care (ARC). Objectives: The aim of this study was to investigate whether reduced ARC utilisation by Māori and Pacific peoples living with dementia is equitably compensated by an increase in Home Based Support Service (HBSS). Methods: Routinely collected sociodemographic and clinical data for people diagnosed with dementia at an NZ memory service (2013-2019) were linked with administrative ARC and HBSS invoicing data. Two-part models were used to estimate adjusted costs of HBSS utilisation or ARC placement. Findings: six hundred fifty-seven people of European, Māori and Pacific ethnicity were included in the analysis. Compared to Europeans, both unadjusted and adjusted ARC costs per person-year were significantly lower for both Māori (-NZD$3580, 95%CI: -$6890, -$140) and Pacific peoples (-NZD$3110, 95%CI: -$5590, -$540) but HBSS cost per person-year was only higher for Pacific peoples (+NZD$640, 95%CI: $100, $1180) and not Māori (+NZD$180, 95%CI: -$470, $840). There was no significant difference in the combined HBSS and ARC cost per person-year for Māori (-NZD3460, 95%CI -7200, 280) or Pacific peoples (-NZD2490 95%CI -5090, 110). Conclusions: Lower ARC utilisation amongst Māori and Pacific peoples living with dementia does not translate to an equitable increase in HBSS spend. The difference is likely to be compensated by care provided by unpaid family carers. Addressing the wider determinants of long-term care use in these populations and providing alternative culturally appropriate services must be prioritised to address this inequity in allocation of public sector resources. [ABSTRACT FROM AUTHOR]