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Background: We investigated the association between atrial fibrillation (AF) and dementia, and its subtypes (vascular‐VaD, Alzheimer, mixed and rare dementia), and identified predictors for dementia in AF patients. Methods: The analysis was based on 183,610 patients with new‐onset AF and 367,220 non‐AF controls in the United Kingdom between 1998 and 2016, identified in three prospectively collected, linked electronic health records sources. Time‐to‐event (dementia or subtypes) analyses were performed using Cox proportional hazards and weighted Cox. Sub‐analyses performed: including & censoring stroke and age (median used as cut‐off). Results: Over a median follow‐up of 2.67 years (IQR.65–6.02) for AF patients and 5.84 years for non‐AF patients (IQR 2.26–11.80), incidence of dementia in the AF cohort was 2.65 per 100 person‐years, compared to 2.02 in the non‐AF cohort. After adjustment, a significant association was observed between AF and all‐cause dementia (HR = 1.38, 95% CI: 1.31–1.45), driven by a strong association with VaD (HR = 1.55, 95% CI: 1.41–1.70). AF was also associated with mixed dementia (HR = 1.26, 95% CI: 1.01–1.56), but we could not confirm an association with Alzheimer (HR = 1.05, 95% CI:.94–1.16) and rare dementia forms (HR = 1.19, 95% CI:.90–1.56). Ischemic stroke (HR = 1.40, 95% CI: 1.26–1.56), subarachnoid haemorrhage (HR = 2.08, 95% CI: 1.47–2.96), intracerebral haemorrhage (HR = 1.95, 95% CI: 1.54–2.48) and diabetes (HR = 1.32, 95% CI: 1.24–1.41) were identified as the strongest predictors of dementia in AF patients. Conclusions: AF patients have an increased risk of dementia, independent of stroke, with highest risk of VaD. Management and prevention of the identified risk factors could be crucial to reduce the increasing burden of dementia. [ABSTRACT FROM AUTHOR]

This article presents research that explored the ways that systemic and family therapists might approach the support of families living with dementia. A constructivist grounded theory methodology was used to interpret interviews with four systemic family therapists working in the United Kingdom. All participants had professional and/or lived experience of dementia. Transcript analysis and theoretical sampling led to the development of five categories, each related to different aspects of considering systemic therapy in a dementia context. These categories were further developed into a 'systemically informed dementia orienteering' conceptual framework, which is presented in this paper as a learning resource. Findings are related to existing literature, and recommendations for future research are made. [ABSTRACT FROM AUTHOR]

Background and objectives: People with dementia have been affected in unique ways during the COVID-19 pandemic. It is not known whether the impact of the pandemic has changed with time or with the changes in social restrictions. This study explored how experiences of coping with the effects of the pandemic in the UK changed over time. Research design and methods: We conducted semi-structured interviews with people with dementia living in the community in England and Wales who had taken part in a qualitative interview at an earlier stage of the pandemic. We applied framework analysis to identify themes and compared these with interviewees' previous accounts. Findings: Nine people aged between 51 and 89 years were interviewed; four were female and five had early onset dementia. We identified three themes: 1. Navigating a changing world: Living with coronavirus; 2. A 'downward spiral': Managing advancing dementia; and 3. Availability, accessibility, and suitability of support. Findings reflect participants' ongoing caution about re-emerging from social restrictions to resume valued activities, and how this led to coping behaviours to minimise the impact on wellbeing in the absence of formal support and services. Discussion and implications: Despite easing of restrictions across the UK, the negative impact of the coronavirus pandemic on people with dementia continues. Whilst individuals and services have adapted to some of the challenges, there is now an opportunity to rebuild support networks and services to ensure people with dementia are suitably advised, supported and socially engaged to allow them to live as well as possible. [ABSTRACT FROM AUTHOR]

Background: The identification of effective dementia prevention strategies is a major public health priority, due to the enormous and growing societal cost of this condition. Consumption of a Mediterranean diet (MedDiet) has been proposed to reduce dementia risk. However, current evidence is inconclusive and is typically derived from small cohorts with limited dementia cases. Additionally, few studies have explored the interaction between diet and genetic risk of dementia. Methods: We used Cox proportional hazard regression models to explore the associations between MedDiet adherence, defined using two different scores (Mediterranean Diet Adherence Screener [MEDAS] continuous and Mediterranean diet Pyramid [PYRAMID] scores), and incident all-cause dementia risk in 60,298 participants from UK Biobank, followed for an average 9.1 years. The interaction between diet and polygenic risk for dementia was also tested. Results: Higher MedDiet adherence was associated with lower dementia risk (MEDAS continuous: HR = 0.77, 95% CI = 0.65–0.91; PYRAMID: HR = 0.86, 95% CI = 0.73–1.02 for highest versus lowest tertiles). There was no significant interaction between MedDiet adherence defined by the MEDAS continuous and PYRAMID scores and polygenic risk for dementia. Conclusions: Higher adherence to a MedDiet was associated with lower dementia risk, independent of genetic risk, underlining the importance of diet in dementia prevention interventions. [ABSTRACT FROM AUTHOR]

The APOE -ε4 allele is known to predispose to amyloid deposition and consequently is strongly associated with Alzheimer's disease (AD) risk. There is debate as to whether the APOE gene accounts for all genetic variation of the APOE locus. Another question which remains is whether APOE -ε4 carriers have other genetic factors influencing the progression of amyloid positive individuals to AD. We conducted a genome-wide association study in a sample of 5,390 APOE -ε4 homozygous (ε4ε4) individuals (288 cases and 5102 controls) aged 65 or over in the UK Biobank. We found no significant associations of SNPs in the APOE locus with AD in the sample of ε4ε4 individuals. However, we identified a novel genome-wide significant locus associated to AD, mapping to DAB1 (rs112437613, OR = 2.28, CI = 1.73–3.01, p = 5.4 × 10−9). This identification of DAB1 led us to investigate other components of the DAB1-RELN pathway for association. Analysis of the DAB1-RELN pathway indicated that the pathway itself was associated with AD, therefore suggesting an epistatic interaction between the APOE locus and the DAB1-RELN pathway. [ABSTRACT FROM AUTHOR]

Background: A diagnosis of dementia presents individuals with both social and psychological challenges but research on self-stigma in dementia has been largely confined to qualitative approaches due to a lack of robust outcome measures that assess change. The Stigma Impact Scale (SIS) is the most commonly used measure of self-stigma in dementia but its suitability as a tool to assess change in a UK population is unclear. Thus, the aim of this study was to identify, adapt and evaluate the acceptability and preliminary psychometric properties of self-stigma measures for people with dementia for use as measures of change.Method: A 4-step sequential design of identifying, selecting, adapting and testing psychometric measures as follows: 1) identification of stigma outcome measures through reviewing anti-stigma intervention literature, 2) selection of candidate measures through quality assessment (Terwee criteria) and expert consultation, 3) adaptation for UK dementia population (Stewart and colleagues Modification Framework) 4) testing of adapted measures in people living with dementia (N=40) to establish acceptability and preliminary reproducibility (test retest), criterion (concurrent with SIS) and construct (negative convergence with Rosenberg self-esteem scale) validity.Results: Seven measures were identified from the review, but most were poor quality (Terwee range: 0-4). Three measures were selected for modification: Stigma Stress Scale; Secrecy subscale of the Stigma Coping Orientation Scale; Disclosure Related Distress Scale. Internal consistency and test-retest reliability were acceptable (.866≤α≤ .938; ICC .721-.774), except for the Stigma Stress Scale (α= .643) for which the component subscales (perceived harm, ability to cope) had stronger psychometric properties. Concurrent validity with the SIS was not established (r<.7) although there were significant correlations between total SIS and perceived harm (r=.587) and between internalized shame and secrecy (r=.488). Relationships with self-esteem were in the hypothesized direction for all scales and subscales indicating convergent validity.Conclusion: Stigma scales from mental health are not readily adapted for use with people with dementia. However there is preliminary evidence for the acceptability, reliability and validity of measures of perceived harm, secrecy and stigma impact. Further conceptual and psychometric development is required. [ABSTRACT FROM AUTHOR]

Given considerable variation in diagnostic and therapeutic practice, there is a need for national guidance on the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and diagnostic terminology in mild cognitive impairment (MCI). MCI is a heterogenous clinical syndrome reflecting a change in cognitive function and deficits on neuropsychological testing but relatively intact activities of daily living. MCI is a risk state for further cognitive and functional decline with 5–15% of people developing dementia per year. However, ~50% remain stable at 5 years and in a minority, symptoms resolve over time. There is considerable debate about whether MCI is a useful clinical diagnosis, or whether the use of the term prevents proper inquiry (by history, examination and investigations) into underlying causes of cognitive symptoms, which can include prodromal neurodegenerative disease, other physical or psychiatric illness, or combinations thereof. Cognitive testing, neuroimaging and fluid biomarkers can improve the sensitivity and specificity of aetiological diagnosis, with growing evidence that these may also help guide prognosis. Diagnostic criteria allow for a diagnosis of Alzheimer's disease to be made where MCI is accompanied by appropriate biomarker changes, but in practice, such biomarkers are not available in routine clinical practice in the UK. This would change if disease-modifying therapies became available and required a definitive diagnosis but would present major challenges to the National Health Service and similar health systems. Significantly increased investment would be required in training, infrastructure and provision of fluid biomarkers and neuroimaging. Statistical techniques combining markers may provide greater sensitivity and specificity than any single disease marker but their practical usefulness will depend on large-scale studies to ensure ecological validity and that multiple measures, e.g. both cognitive tests and biomarkers, are widely available for clinical use. To perform such large studies, we must increase research participation amongst those with MCI. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to develop and explore feasibility of SettleIN, a staff-led programme about healthy adjustment for people with dementia following care home placement. The main foci were intervention feasibility and the impact of the programme on resident quality of life and mood. Method: A manualised intervention developed through consultation with 47 experts was trialled using a mixed-method design. Thirteen new residents with dementia and 24 staff were recruited from six UK care homes. Outcomes were measured at baseline, intervention completion and four-week follow-up. Analysis of staff interviews and field notes is reported. Results: Most experts deemed SettleIN to be well structured, comprehensive and appropriate. However, uptake of SettleIN was low. When implemented, staff emphasised integration ease and staff benefits, but that SettleIN may not be universally suitable. High attrition, most commonly due to death and hospitalisation, and partial results from only four participants meant that there was a lack of support for the positive outcomes. Feasibility problems included a lack of staff time and dependency on families for some components. Conclusion: SettleIN is acceptable to a wide range of stakeholders though does not appear to be feasible in its current form and improvements are recommended. A second pilot phase is required, which will address the reasons for the high attrition rate in this study and amend the methodology accordingly. This is an important work, as a manualised and standardised approach to healthy adjustment in care is unique and could have huge clinical significance if effective. [ABSTRACT FROM AUTHOR]

Background: With increasing numbers of people in the UK living with dementia, the provision of good quality person-centred care that meets the often complex needs of this population is required. Given the majority of people with dementia live in the community, significant care and support will be provided by primary care services. This means the primary care workforce needs appropriate education to ensure they have the right knowledge, skills and attitudes to meet these care needs. However, little is understood about the most successful approaches to dementia education in this setting. Methods: An in-depth case study was undertaken in a single primary care organisation with the aim of exploring the impact of a person-centred dementia educational programme, and identify barriers and facilitators to implementation. Data was gathered from a wide range of sources and analysed using Kirkpatrick's evaluative framework. Results: Initially, staff learners struggled to incorporate the 'whole-person' approach to dementia care, but gained knowledge and confidence through self-directed learning. They reacted positively to the training and appreciated opportunities to learn from peers in other services. They identified improvements in communication and prescribing practices, despite difficulties implementing changes during busy periods. Resultant impact for service users included more timely routine appointments, and positive satisfaction ratings from patients and families. Conclusions: The findings indicate the perceived value of person-centred dementia education for primary care. Further recommendations for provision in this service setting include tailored programmes designed collaboratively with clinical service providers, and bringing together an interdisciplinary mix of learners to enhance knowledge exchange. [ABSTRACT FROM AUTHOR]

Environments need to be designed such that they support successful orientation for older adults and those with dementia who often experience marked difficulties in their orientation abilities. To better understand how environments can compensate for decreasing orientation skills, voice should be given directly to those experiencing dementia to describe how they find their way and to understand their design preferences. This study explored the navigational experiences and design preferences of older adults with memory difficulties living in a retirement development. In-depth semi-structured interviews with 13 older adults experiencing memory difficulties were conducted. All participants were residents of one retirement development in the United Kingdom. Questions began broadly, for example, to describe their experiences of navigating in their living environment, before discussing any specific navigation difficulties in detail. Thematic analysis identified three main themes: highlighting environmental design that causes disorientation, strategies to overcome disorientation, and residents’ suggestions to improve the design. The design suggestions were particularly informative, heavily focusing on the importance of having memorable and meaningful spaces which were favoured more than signage as an orientation aid. The findings demonstrate the need to consider environmental design to support orientation for those with memory difficulties. Of particular importance is the use of meaningful and relevant landmarks as orientation aids which can additionally stimulate conversation and increase wellbeing. Given the range of suggestions in dementia-friendly design guidelines aimed to support orientation, it is crucial to speak directly to those living in different environments to learn how they find their way around and what design works in their environment. [ABSTRACT FROM AUTHOR]

This article provides an overview of relevant factors in dementia care. The number of people experiencing dementia is increasing and dementia is at the forefront of health policy. The evidence base for person-centred approaches and interventions in dementia is expanding and nurses are central to implementing these across care settings. This is a challenging time for dementia care and nursing has a major role in leading and developing these changes in practice. The article discusses the Positive Approaches to Care (PAC) philosophy as a training approach in caring for people with dementia. [ABSTRACT FROM AUTHOR]

Air pollution may cause inflammatory and oxidative stress damage to the brain, leading to neurodegenerative disease. The association between air pollution and dementia, and modification by apolipoprotein E genotype 4 (APOE -ε4) has yet to be fully investigated. To examine associations of air pollution with three types of incident dementias (Alzheimer's disease (AD), frontotemporal dementia (FTD), and vascular dementia (VAD)), and their potential modification by APOE -ε4 genotype. The UK Biobank enrolled >500,000 participants (2006–2010) with ongoing follow-up. We used annual averages of air pollution (PM 2.5 , PM 10 , PM 2.5-10 , PM 2.5absorbance , NO 2 , NO X) for 2010 scaled to interquartile ranges (IQR). We included individuals aged ≥60 years, with no dementia diagnosis prior to January 1, 2010. Time to incident dementia and follow-up time were reported from baseline (January 01, 2010) to last censor event (death, last hospitalization, or loss to follow-up). Cox proportional hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated to estimate the association of air pollutants and incident dementia, and modification of these associations by APOE -ε4. Our sample included 187,194 individuals (including N = 680 AD, N = 377 VAD, N = 63 FTD) with a mean follow-up of 7.04 years. We observed consistent associations of PM 2.5 with greater risk of all-cause dementia (HR = 1.17, 95% CI: 1.10, 1.24) and AD (HR = 1.17, 95% CI: 1.06, 1.29). NO 2 was also associated with greater risk of any incident dementia (HR = 1.18, 95% CI: 1.10, 1.25), AD (HR = 1.15, 95% CI: 1.04, 1.28) and VAD (HR = 1.18, 95% CI: 1.03, 1.35). APOE -ε4 did not modify the association between any air pollutants and dementia. PM 2.5 and NO 2 levels were associated with several types of dementia, and these associations were not modified by APOE -ε4. Findings from the UK Biobank support and extend to other epidemiological evidence for the potential association of air pollutants with detrimental brain health during aging. • Examined air pollution and dementia incidence over 10 years in the UK Biobank. • PM2.5, NO2, and NOX, was associated with higher incidence of dementia. • APOE -ε4 did not modify the association of air pollution with dementia. [ABSTRACT FROM AUTHOR]

A significant number of people experience pain and cognitive impairment toward the end of life. Assessment of their pain becomes more complex as their cognitive abilities diminish and they lose their ability to express themselves and understand their experience of pain. The rate and pattern of cognitive decline differs between individuals, which makes it difficult to take a standardised approach to pain assessment. Based on a review of the literature, this article describes the development of a pain assessment toolkit consisting of guidelines and a selection of self-report and behavioural assessment tools to support health professionals in tailoring their assessment to meet the needs of an individual with cognitive impairment. [ABSTRACT FROM AUTHOR]

Objective To create a record of the development of old age psychiatry in Britain, as seen through the eyes of some of the people who participated in building it, from the earliest days until it was officially recognised as a specialty by the Department of Health in 1989. Method Group reminiscences and discussions in the format of a witness seminar which was audio-recorded and transcribed. Witnesses also provided written biographical information. Results The annotated full record created at the seminar is available on line. This paper reflecting themes, lessons and highlights has been derived from it. Conclusions Early old age psychiatrists often encountered opposition and incredulity from other health care professionals and managers. However, their experiences were demonstrating just how much could be achieved in improving the lives of older mentally ill people. They conveyed their enthusiasm for their work in both clinical and university settings. Clinical creativity, support when working in relative professional isolation, and dealing with opposition benefited from both the development of the Group for the Psychiatry of Old Age at the Royal College of Psychiatrists and from close links with geriatric medicine. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Emerging research has found an association between post-traumatic stress disorder (PTSD) and dementia in veterans, yet little is known about the nature of this association and how it is conceptualized in the literature. The purpose of this scoping review is to understand how the relationship between PTSD and dementia in veterans is recognized and described in the peer-reviewed literature. A scoping review was conducted using Arksey and O'Malley's (International Journal of Social Research Methodology, 8, 19, 2005) framework. Articles are included if participants were veterans with a focus on PTSD and dementia. A total of six databases (CINAHL, MEDLINE, EMBASE, PsycINFO, HealthSTAR, and PubMed) were searched along with the reference lists of eligible sources in September 2018. Thematic analysis was used to summarize the data. Thirty-six studies were included in this review. Three main themes emerged from the literature: (i) symptomatic expression of PTSD and dementia; (ii) aetiology underlying the relationship between PTSD and dementia; and (iii) implications of PTSD and dementia on healthcare providers, treatment, and resources. This study highlights the ongoing need to understand mechanisms underlying the association between PTSD and dementia, the need for definition of PTSD symptoms, and to sensitize healthcare providers to the presence of PTSD when caring for veterans with dementia., (© 2019 Australian College of Mental Health Nurses Inc.)

Alzheimer's Society is the UK's leading dementia charity. We provide information and support, improve care, fund research, and create lasting change for people affected by dementia. Our New Deal on Support, which forms part of our Strategy, The New Deal on Dementia, has developed a unique approach to influencing the development of effective integrated care for people with dementia, driving improvements in access to high quality care and support that understands and meets their needs. The current situation is unacceptable and unsustainable. Our analysis shows that people with dementia and their carers have to navigate up to 20 different professionals, through NHS and social care, to get the support they need. This often results in a person with dementia, or their carer, having to tell their story twenty times, which is nineteen too many. Our new deal on support links with the integration agenda to ensure that people are diagnosed in a timely way, and that they and their carers are supported to live the lives they want. By 2022 Alzheimer's Society will be providing information and support to anyone who needs it, in the way they need it. Dementia Connect, our new multi-channel information, advice and support service will give people access to tiered advice, support and self-management services. The service supports innovation coming out of the national health and social care integration and personalisation agenda, and how we can address the continued challenges that face people affected by dementia, as well as the health and care workforce. Our wider integration influencing and engagement activity includes the publication of our 10 Point Plan 'Why integrate Dementia Care?' This tool, developed with input from people affected by dementia and supported by NHS England, is aimed at local health services and government to enable them to realise their ambitions for an efficient integrated health and social care system. Our work in this area clearly demonstrates the voluntary sector's essential role in the development and implementation of high quality, responsive care and support, identifying the opportunities for joint working to build on this further to meet the needs of people living with dementia. [ABSTRACT FROM AUTHOR]

This is a short report summarising the plenary talk by Professor Bart de Strooper, at the 2017 FENS-Kavli winter symposium. We have tried to capture some of the key points in his lecture on dementia research and we discuss his vision for the new UK Dementia Research Institute (UK DRI). In his talk, Prof. de Strooper encourages us to focus on the multicellular influence on brain dysfunction in dementia and we summarise how the UK DRI is a timely and ambitious, collaborative endevour, aiming to conquer dementia., (© 2018 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)