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Background: People with intellectual disability experience a higher prevalence of dementia, at an earlier age, than the general population. The aim of this review was to establish the psychological interventions and outcomes for individuals with intellectual disability and dementia. Methods: A search of eight electronic databases and reference lists of all included articles was conducted using PRISMA guidelines. Data were synthesized using an integrative method. Results: Initial searching produced 2,331 papers. Twenty-one studies met the inclusion criteria. Interventions were deductively categorized into behavioural, systemic and therapeutic. All studies reported positive findings for individuals and for the systems which support them, but limited by methodological issues and neglect of the direct experience and impact on individuals themselves. Conclusions: The findings are discussed in relation to the wider literature and evidence base. Future research should aim to adopt methodologically robust designs that are inclusive of the individual experience of people with intellectual disability.

A set of common-acting iron-responsive 5'untranslated region (5'UTR) motifs can fold into RNA stem loops that appear significant to the biology of cognitive declines of Parkinson's disease dementia (PDD), Lewy body dementia (LDD), and Alzheimer's disease (AD). Neurodegenerative diseases exhibit perturbations of iron homeostasis in defined brain subregions over characteristic time intervals of progression. While misfolding of Aß from the amyloid-precursor-protein (APP), alpha-synuclein, prion protein (PrP) each cause neuropathic protein inclusions in the brain subregions, iron-responsive-like element (IRE-like) RNA stem-loops reside in their transcripts. APP and asyn have a role in iron transport while gene duplications elevate the expression of their products to cause rare familial cases of AD and PDD. Of note, IRE-like sequences are responsive to excesses of brain iron in a potential feedback loop to accelerate neuronal ferroptosis and cognitive declines as well as amyloidosis. This pathogenic feedback is consistent with the translational control of the iron storage protein ferritin. We discuss how the IRE-like RNA motifs in the 5'UTRs of APP, alpha-synuclein and PrP mRNAs represent uniquely folded drug targets for therapies to prevent perturbed iron homeostasis that accelerates AD, PD, PD dementia (PDD) and Lewy body dementia, thus preventing cognitive deficits. Inhibition of alpha-synuclein translation is an option to block manganese toxicity associated with early childhood cognitive problems and manganism while Pb toxicity is epigenetically associated with attention deficit and later-stage AD. Pathologies of heavy metal toxicity centered on an embargo of iron export may be treated with activators of APP and ferritin and inhibitors of alpha-synuclein translation.

Parkinson's disease (PD) is characterized clinically by progressive motor dysfunction; overt parkinsonism is often preceded by prodromal symptoms including disturbances in the sleep-wake cycle. Up to 80% of patients with PD also develop dementia. In humans, there are three major apolipoprotein E isoforms: E2, E3, and E4. Increased rate of dementia in PD may be associated with E4 isoform. To better understand prodromal changes associated with E4, we exposed young (3-5 mo) male and female mice expressing E3 or E4 via targeted replacement to a subchronic dosage of the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). We hypothesized that E4 mice would be more susceptible to MPTP-related behavioral and cognitive changes. MPTP-treated E4 mice explored novel objects longer than genotype-matched saline-treated mice. In contrast, saline-treated E3 mice preferentially explored the novel object whereas MPTP-treated E3 mice did not and showed impaired object recognition. MPTP treatment altered swim speed of E4, but not E3, mice in the water maze compared to controls. Thus, E4 carriage may influence the preclinical symptoms associated with PD. Increased efforts are warranted to study early time points in this disease model.

Purpose: Corpus analyses of spontaneous language fragments of varying length provide useful insights in the language change caused by brain damage, such as caused by some forms of dementia. Sample size is an important experimental parameter to consider when designing spontaneous language analyses studies. Sample length influences the confidence levels of analyses. Machine learning approaches often favor to use as much language as available, whereas language evaluation in a clinical setting is often based on truncated samples to minimize annotation labor and to limit any discomfort for participants. This article investigates, using Bayesian estimation of machine learned models, what the ideal text length should be to minimize model uncertainty. Method: We use the Stanford parser to extract linguistic variables and train a statistic model to distinguish samples by speakers with no brain damage from samples by speakers with probable Alzheimer's disease. We compare the results to previously published models that used CLAN for linguistic analysis. Results: The uncertainty around six individual variables and its relation to sample length are reported. The same model with linguistic variables that is used in all three experiments can predict group membership better than a model without them. One variable (concept density) is more informative when measured using the Stanford tools than when measured using CLAN. Conclusion: For our corpus of German speech, the optimal sample length is found to be around 700 words long. Longer samples do not provide more information.

Background: Forwards citation searching is a valuable method for finding relevant studies in reviews where concepts are not clearly defined. Scopus and Web of Science can both be used for forwards citation searching but there is little evidence comparing the resources for this purpose. Method: 104 source records relevant to a scoping review of implementation and dissemination strategies in dementia care were checked for inclusion on Web of Science and Scopus. The number of citing references was recorded. Where citing references appeared unique to one of the resources, they were checked for inclusion on the other resource to assess the performance of citation links. Results: 1397 citing references were returned by Scopus and 1010 were returned by Web of Science. For the unique citing references returned by Web of Science (n = 52), 36 were subsequently found to be on Scopus but had failed to be picked up as citing a source record. Of the unique citing references returned by Scopus (n = 355), 83 were found to be on Web of Science but had failed to be picked up as citing a source record. 26 additional relevant records were identified for the review by forwards citation searching. All were found on Scopus; six would have been missed by searching Web of Science alone. Conclusion: Citation searching using Scopus alone would have found all additional relevant studies for the review. Both Scopus and Web of Science failed to return all citing references from the source records, even where they were present on the database, indicating poor links between citations.

Purpose: In this study, we sought to identify critical linguistic markers that can differentiate sentence processing of individuals with mild cognitive impairment (MCI) from the sentence processing of normal-aging populations by manipulating sentences' linguistic complexity. We investigated whether passive sentences, as linguistically complex structures, can serve as linguistic markers that can contribute to diagnoses that distinguish MCI from normal aging. Method: In total, 52 participants, including 26 adults with amnestic MCI and 26 cognitively unimpaired adults, participated in the study. All participants were native speakers of Korean. We administered the two subsets of active and passive conditions using a sentence-picture paradigm with semantically reversible sentences to both groups. Results: A mixed-effects model using PROC NLMIXED demonstrated that the MCI group exhibited differentially greater difficulty in processing passive than active sentences compared to the normal-aging group. A logistic regression fitted with the PROC LOGISTIC model identified the sum of the passive sentences, with age and education effects as the best models to distinguish individuals with MCI from the normal-aging group. Conclusion: Sentence comprehension deficits emerged in the MCI stage when the syntactic complexity was increased. Furthermore, a passive structure was the best predictor for efficiently distinguishing the MCI group from the normal-aging group. These results are clinically and theoretically important, given that linguistic complexity can serve as a critical behavioral marker in the detection of early symptoms associated with linguistic-cognitive decline.

Equating of psychometric scales and tests is frequently required and conducted in educational, behavioral, and clinical research. Construct comparability or equivalence between measuring instruments is a necessary condition for making decisions about linking and equating resulting scores. This article is concerned with a widely applicable method for examining if two scales or tests cannot be equated. A latent variable modeling method is discussed that can be used to evaluate whether the tests or parts thereof measure latent constructs that are distinct from each other. The approach can be routinely used before an equating procedure is undertaken, in order to assess whether equating could be meaningfully carried out to begin with. The procedure is readily applicable in empirical research using popular software. The method is illustrated with data from dementia screening test batteries administered as part of two studies designed to evaluate a wide range of biomarkers throughout the process of normal aging to dementia or Alzheimer's disease.

Background: Acquired brain injury (ABI), such as Parkinson's disease, dementia or stroke, can result in communication difficulties that lead to an impoverished ability to connect meaningfully with others. Choral singing is a complex task that uses multiple brain regions which are also responsible for language and communication skills. The potential therapeutic effects of group singing on communication-related outcomes across ABI aetiologies have not been systematically reviewed. Aims: To examine whether participation in group singing over multiple sessions improves speech, voice, language and/or communication skills in individuals with ABI-related communication disorders. Methods & Procedures: A database search was undertaken according to the PRISMA guidelines. Search terms included: stroke OR Parkinson* OR dementia OR 'acquired brain injury' AND choir OR choral OR singing OR sing OR 'choral sing*' OR group adj3 singing OR community adj3 singing AND speech OR language OR communication. Main Contribution: A total of 11 studies were included. Nine were quantitative, including one randomized and one non-randomized control trial, and two were mixed method. Nine studies were scored as level IV (uncontrolled) on the American Academy of Neurology (AAN) Classification of Evidence Matrix and two as level III (e.g., lack of blinded assessors). Eight examined speech and voice skills in Parkinson's disease, two functional communication skills in post-stroke aphasia and one communication between individuals with dementia and a significant other. One level III control trials provided evidence for a therapeutic effect of group singing on communication in individuals with Parkinson's disease. Conclusions & Implications: Currently, there is only one study providing support for using group singing to improve speech and voice skills in people with Parkinson's disease, and no studies of adequate quality indicating positive effects on language and functional communication abilities in ABI. Further research using more rigorous experimental designs is required to determine whether group singing can influence communication skills in ABI.

Family caregivers play a critical role in dietary care and the nutritional status of people with dementia. The aim of this study was to investigate the effects of a family care-based dementia dietary educational program (DDEP) on family caregivers' nutritional knowledge, healthy eating behavior and nutritional status of people with dementia. A total of 57 pairs of participants completed this longitudinal experimental study. Group A received routine care. Group B received the DDEP. Three outcomes were measured at pretest (T1), posttest (T2) and follow-up test (T3). Generalized estimating equations and regression were used to analyze the data. The scores of the caregivers' nutritional knowledge significantly increased after receiving the DDEP in group B, and this increase was better than in group A. The posttest and follow-up test scores of healthy eating behavior were significantly higher than the pretest scores in both groups. The scores of nutritional status in group B increased from the pretest to the follow-up test, although there was no significant difference between the two groups. Some demographic factors played significant roles in the caregivers' nutritional knowledge and healthy eating behavior. In sum, the DDEP improved the caregivers' nutritional knowledge and healthy eating behavior for dementia. The demographic factors of family caregivers should be considered when providing nutritional information to enhance the nutritional status of people with dementia. The DHPDEP should be incorporated into the in-service education and training courses for nurses or dietitians who work with people with dementia.

We developed online training modules focused on Alzheimer's disease and related dementias (ADRD) designed to improve best care practices in long-term care settings, such as nursing homes, as a part of a federal grant focused on improving geriatric education for interprofessional (collaboration among different professions providing patient care) team members working in primary care settings. Faculty and clinicians with ADRD-expertise created and implemented an online asynchronous "ADRD Best Care Practices in Long-Term Care" program that includes audio-visual recorded presentations, a threaded case study, and supplemental information. Prior to enrolling in the course, participants complete a demographic survey and a modified 15-item version of the Alzheimer's Disease Knowledge Scale. After completing the modules, participants complete a satisfaction survey and the ADKS. A total of 94 participants completed both the pre- and post-surveys. Satisfaction evaluation data showed that the majority of participants reported that the information presented was very clear (74.5%), was useful for their work (88.3%), and would improve the care that they provide to their geriatric patients (93.6%). Out of 15 possible.

Objectives: Certain heart conditions and diseases are common in Down syndrome (DS; trisomy 21), but their role in early onset dementia that is prevalent in older adults with DS has not been evaluated. To address this knowledge gap, we conducted a study of risk factors for low neurocognitive/behavioral scores obtained with a published dementia test battery (DTB). Participants were adults with DS living in New York (N = 29; average age 46 years). We asked three questions. (1) Does having any type of heart disease affect the association between DTB scores and chronological age? (2) Does thyroid status affect the association between heart disease and DTB scores? (3) Are the E4 or E2 alleles of apolipoprotein E (APOE) associated with DTB scores or with heart disease? Method: The study was retrospective, pilot, and exploratory. It involved analysis of information in a database previously established for the study of aging in DS. Participants had moderate intellectual disability on average. Information for each person included: gender, age, a single DTB score obtained by combining results from individual subscales of the DTB, the presence or absence of heart disease, thyroid status (treated hypothyroidism or normal), and APOE genotype. Trends were visualized by inspection of graphs and contingency tables. Statistical methods used to evaluate associations included Pearson correlation analysis, Fisher's exact tests (2-tailed), and odds ratio analysis. P values were interpreted at the 95% confidence level without Bonferroni correction. P values >0.05<0.1 were considered trends. Results: The negative correlation between DTB scores and age was significant in those with heart disease but not in those without. Heart disease was significantly associated with DTB scores >1 SD below the sample mean; there was a strong association between heart disease and low DTB scores in those with treated hypothyroidism but not in those with normal thyroid status. The APOE genotype was weakly associated with heart disease (E4, predisposing; E2, protective) in males. Conclusions: On the basis of the potentially important findings from the present study, large prospective studies are warranted to confirm and extend the observations. In these, particular heart conditions or diseases and other medical comorbidities in individuals should be documented.

This article considers two examples of life story performance: the first autobiographical work about the author's recovery from stroke, and the second the life-story production Re-Live Theatre's "Memoria" about dementia. It explores how performing life stories facilitates connection between performers with transformed cognitive capacities and their audiences, and posits that life-story performance offers a unique way to affect relations between performers and their audiences through an experience of 'felt resonance'. The article argues that felt resonance in performance matters: it leads to possibilities of transformative connections within and between bodies, as well as the systems that they are part of.

This study aims to establish an understanding of (a) health-care professionals' knowledge and attitudes; and (b) tools used to assess sexuality in older people living with/(out) dementia and those identified as lesbian, gay, bisexual, trans, or intersex (LGBTI) individuals. An integrative review of the literature, as registered on the PROSPERO international Prospective Register of Systematic Reviews (CRD42019129589), was conducted. A comprehensive and systematic literature search was performed for the period between 2009 to 2019 across eight electronic databases: CINAHL, PubMed, MEDLINE, Web of Science, Cochrane library, Embase, PsycINFO, and Scopus, together with a manual search of reference lists. Screening of titles, abstracts, and full texts of eligible studies plus quality appraisal (using the Mixed Methods Appraisal Tool) were independently conducted by two reviewers with disagreements resolved via discussion with a third reviewer. Nineteen articles were reviewed with three themes identified from the synthesis: 1) varying knowledge and attitudes amongst health-care professionals; 2) needs for professional development opportunities and support from workplace and 3) lack of recent validated tools to assess knowledge and attitudes. Health-care professionals' knowledge and attitudes toward sexuality in older people living with/(out) dementia and those identified as LGBTI individuals are varying. Sexuality education and professional development training are needed to enhance their knowledge and attitudes and build skills in order to manage sexuality concerns. Current assessment tools are inadequate, highlighting the need for an appropriate assessment tool to be developed.

Ageism is a problem in aging societies. Clinical psychologists and undergraduate psychology students have shown negative attitudes toward older adults. However, no specific measure against ageist myths in the psychotherapeutic context is available. This study aims to develop and present the psychometric properties of the Ageist Myths about Psychotherapy Questionnaire (AMPQ). These issues were examined by surveying 222 psychology graduates at higher education institutions about their attitudes and behaviors concerning psychotherapy with older adults, negative stereotypes toward aging, and attitudes toward dementia. Using principal components analysis, 10 items were retained and one factor was obtained with an acceptable reliability index. Significant associations were found between the AMPQ and negative stereotypes toward aging, and attitudes toward dementia. Results revealed that universities and colleges with psychology programs have an ageist bias. Implications for college formation in aging, and older adults with mental health problems, are discussed and presented.

Background: There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well-being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia-related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. Aims: To establish the current practices of SLTs managing dementia-related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. Methods & Procedures: An anonymous, cross-sectional web-based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open-ended questions were analysed using conventional content analysis. Outcomes & Results: A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self-rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. Conclusions & Implications: The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents' views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well-being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential.

Providing educational interventions to informal dementia caregivers has been shown to have numerous positive outcomes including improving general well-being and quality of life as well as reducing depression, anxiety, and caregiver stress. The purpose of this study is the development, delivery, and evaluation of caregiver conferences to educate informal dementia caregivers about dementia and caregiving. We provided eight half-day conferences for informal caregivers to educate them about Alzheimer's disease and related dementias (ADRD) and make them aware of community and state resources. Demographic and program evaluation surveys including an assessment of Alzheimer's disease knowledge were administered to participants. A total of 563 community-based caregivers attended the conferences. Participants tended to be female, White, and well-educated. Evaluation surveys showed high levels of satisfaction with the training. Paired t-tests showed no significant differences in AD knowledge prior to and following the training. Although there were no statistically significant improvements in participant ADRD knowledge, participant reported satisfaction levels with the conferences were high with the agreement that their educational needs were met and that the information that they learned will help improve the care they provide to the individual(s) with ADRD.

Introduction: Having a diagnosis of Down syndrome (DS) is associated with intellectual disability (ID), pervasive developmental disorders and Alzheimer's dementia (AD). The association between these conditions has not been well evaluated. This paper looks to examine the current evidence pertaining to the relationship between dementia in people with DS and severity of ID and the presence of pervasive developmental disorders. Methods: A scoping review using PRISMA guidance was undertaken. Medline, Cochrane database, NHS evidence, Trial registers and Open Grey were searched in December 2018 and an updated search was completed in July 2020. Three search strategies were used to retrieve articles relating to DS, dementia, pervasive developmental disorders (including autism, autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD)) and severity of ID. Studies were included if they met the pre-defined inclusion criteria of investigating an association between autism/ASD, ADHD, or severity of ID and the development of dementia in people with DS. Studies were excluded if they did not include primary data, if the population included non-Down causes of ID, or if no specific outcome measure related to comorbid autism/ASD, ADHD, or severity of ID and dementia in people with a diagnosis of DS were reported. There were no exclusions related to study design. Papers were assessed for quality using the Mixed Methods Appraisal Tool (MMAT). Results: The search identified 15 papers, publishing results from 12 studies, relating to severity of ID, DS and dementia. No papers were identified relating to pervasive developmental disorders, DS and dementia. There is limited evidence on how severity of ID impacts on the presentation, diagnosis, management or prognosis of dementia in people with DS. However, no evidence was found on comorbid pervasive developmental disorders, DS and dementia. Conclusion: This paper has identified multiple areas for future research. There is an urgent need for longitudinal studies into the presentation, development and progression of dementia in people with DS ensuring the severity of ID and comorbid pervasive developmental conditions are captured regularly to understand their influence on the dementia etiology and outcome.

It is well documented that engagement in arts and cultural activities contributes to improving and maintaining the health and well-being of older people. Despite this, many health and social care professionals do not recognize or accept arts and cultural activities as relevant to their care remit. To address this, a team of 17 individuals comprising older service users, and staff from a range of health and social care, arts, and museum and archive services in North East England worked collaboratively to design and develop the Museum Health and Social Care Service (MHSCS). MHSCS is a resource and training package that reinforces the care and clinical benefits of arts and cultural activities to older people's health and wellbeing, aimed at supporting health and social care professionals to acknowledge and use these activities as integral to care delivery.

This article presents a review of studies published between 2006 and 2016 on research into multi-sensory environments (MSEs), as part of a project to develop a community-based MSE. This scoping review aimed to identify the settings MSEs are used in, rationale for implementation, equipment installed and the reported effects of the MSE upon users. The Scopus and Web of Science databases were searched for studies reporting on the applications and effects of MSEs. Thirty-three studies met the inclusion criteria and were allocated to groups based on the population they were designed for. These were mental health, intellectual and developmental disabilities, dementia, traumatic brain injuries and maternity. It was difficult to clearly determine what equipment, specific sensory experiences or patterns of implementation were most effective, due to the wide range of research designs and methodologies employed. Overall MSEs show promise through offering benefits to users with a range of disabilities or other conditions; however further studies are required to develop a stronger evidence base on the reported effects of MSEs for particular user groups. A framework has been proposed to address current inconsistencies in reporting the effectiveness of MSEs, to provide a more uniform approach.

Background: Due to dementia-related communication difficulties, speech--language pathologists (SLPs) play a significant role in supporting individuals with dementia and their caregivers. Nevertheless, SLP practitioners may not have received adequate dementia training during their undergraduate programme and skills updating post-qualification. Investigating the knowledge, attitudes and training needs of SLP students and practitioners would provide evidence on the need of enhancing training in dementia care and management at both the undergraduate level and through continuous professional development programmes. Aims: To assess the levels of dementia knowledge, attitudes and training needs of SLP students and practitioners. Methods & Procedures: A countrywide survey was conducted with undergraduate students reading for a BSc degree in communication therapy and SLPs currently in practice. Dementia knowledge and attitudes were assessed using the Alzheimer's Disease Knowledge Scale (ADKS) and the Dementia Attitude Scale (DAS). Training needs were measured using a three-point Likert scale from a list of topics related to dementia management and care. Quantitative methods were used to analyse the collected data. Outcomes & Results: A total of 49 SLP students (94.2% response rate) and 113 practitioners (57.4% response rate) completed the survey. Although SLP practitioners scored significantly better than students on the ADKS and its constructs, both cohorts showed inadequate knowledge of dementia, in particular dementia risk factors. In general, both SLP students and practitioners showed positive attitudes towards individuals with dementia, even though significant differences were observed. With respect to training needs, SLP practitioners significantly scored less compared with students denoting that, in this cohort, there was the belief that less training in dementia was required. Conclusions & Implications: Although SLPs have an important role to play in the management and care of individuals with dementia, the findings of this study indicated a shortage of in-depth knowledge in this area of practice. This continues to highlight the need of enhancing dementia training programmes through undergraduate curriculum development and continuous professional programmes for skills updating.

As the U.S. population ages, Extension's need for associated organizational readiness increases. We conducted a needs assessment with a sample of 1,028 Extension professionals in the Extension North Central Region (NCR) to identify the current scope of aging-related community needs. Health care, chronic disease prevention and management, housing, and transportation emerged from qualitative analysis as top aging-related needs. A rankorder analysis identified finances, healthy aging, and aging-friendly communities as chief community concerns. Additionally, the NCR Extension professionals indicated the importance of resources and programs and need for community capacity building related to aging issues, regardless of their programming area and/or responsibilities.

Aim: The research sought to enhance professional understanding of the violence perpetrated by some people with an intellectual disability. Background: The violent behaviour exhibited by some people with intellectual disabilities remains poorly understood, particularly with regard to a clear and informative definition. Design: A qualitative study investigated the views and perceptions of professionals working directly with people with an intellectual disability in different settings. Methods: Twenty-two semi-structured interviews were undertaken with professionals from a variety of backgrounds, and four themes were generated through data analysis. Findings: Themes produced comprised the degree of intellectual disability, impulsivity, intentionality and unpredictability. Findings indicated tension between understanding violence as purposeful and explaining it in relation to the intellectual disability and/or additional conditions. Conclusion: Intellectual disability is central to understanding the impact of the other three themes, though there is a professional reluctance to use such knowledge as evidence to inform practice.

The introduction of Massive Open Online Courses (MOOCs) as a vehicle for education delivery presents opportunities and challenges. In the context of the Wicking Dementia Research and Education Centre (Wicking Centre), the driver to develop a MOOC was the promise of addressing the international deficit in evidence-based dementia education, as well as the lack of research into international perspectives on dementia. The Wicking Centre's activity integrates research and education, framed by the concept of "quality of life across the trajectory of dementia." With dementia emerging as the public health issue of the 21st century, lack of dementia education at multiple levels, professional and non-professional, is of increasing concern. The disruptive character of MOOCs, with associated risks and uncertainties, warranted the application of a research-oriented project management approach to development. This included investing resources in gathering and analysing data to underpin each phase of decision-making. We used a design-based research approach incorporating the concept of "life-cycle of an e-learning design" (Phillips et al. 2012). Data collection and analysis focused on three dynamically interacting components: 1) expertise in dementia knowledge and dementia education; 2) a cohort-centric approach to design and delivery, and 3) models and designs for MOOCs currently promoted, discussed and reported in the higher education discipline. Laurillard's Conversational Framework, relating types of learning, teaching-learning activities and the digital technologies that support them (2012), informed the selection of digital technology elements for massive-scale engagement of our identified cohort. The paper describes the initial design process and the outcomes of the limited release pilot that informed the first full offering of the MOOC.

Background: The ageing of people with intellectual disabilities, involving consequences like dementia, creates a need for methods to support care staff. One promising method is Dementia Care Mapping (DCM). This study examined the effect of DCM on job satisfaction and care skills of ID-care staff. Methods: We performed a quasi-experimental study in 23 group homes for older people with intellectual disabilities in the Netherlands. Among staff, we assessed job satisfaction and care skills as primary outcomes and work experience measures as secondary outcomes (N = 227). Results: Dementia Care Mapping achieved no significantly better effect than care as usual (CAU) for primary outcomes on job satisfaction (MWSS-HC) and working skills (P-CAT). Effect sizes varied from -0.18 to -0.66. We also found no differences for any of the secondary outcomes. Conclusion: Dementia Care Mapping does not increase job satisfaction and care skills of staff caring for older people with intellectual disabilities. This result differs from previous findings and deserves further study.

The burden of dementia in China is expected to increase dramatically. This study aimed to estimate the potential impact of early parental death on cognitive functioning in late life and whether education is a possible mechanism underlying this association. Data were derived from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey. The final sample consisted of 10,953 Chinese older adults aged 80 to 105 years. Logistic regression models were used to estimate the impact of early parental death and education on the odds of severe cognitive impairment in older men and women. Results showed that experiencing the death of a mother at or before 16 years of age significantly increased the risk of severe cognitive impairment in older men (but not women), independent of demographic, socioeconomic, and physical health conditions. This association did not persist over a 3-year follow-up period and was not mediated by education. These findings provide further evidence that childhood trauma is associated with adverse adult health outcomes, in this case the death of a mother in early life and cognitive impairment in late life. Potential mechanisms that may link early parental death to worse cognitive functioning over the life course were discussed.

Executive function (EF) decline is a consistent early sign of Alzheimer's disease (AD) among adults with Down syndrome (DS), which means that baseline measures of EF for individuals with DS are vital to allow detection of meaningful decline. We developed a framework to extract measures of three core components of EF (memory updating, inhibitory, and temporal components) within one task. Increases in memory load, inhibitory load, and temporal demands led to significant increases in reaction times and significant decreases in accuracy among 18 adults with DS and 18 typically developing matched individuals; thus, the expected effects of all three manipulations were detected. Good test-retest reliability indicated that this framework has the potential to provide a simple, baseline EF measure for individuals with DS.

The International Summit on Intellectual Disability and Dementia covered a range of issues related to dementia and intellectual disability, including the dearth of personal reflections of persons with intellectual disability affected by dementia. This article reflects on this deficiency and explores some of the personal perspectives gleaned from the literature, from the Summit attendees and from the experiences of persons with intellectual disability recorded or scribed in advance of the two-day Summit meeting. Systemic recommendations included reinforcing the value of the involvement of persons with intellectual disability in (a) research alongside removing barriers to inclusion posed by institutional/ethics review boards, (b) planning groups that establish supports for dementia and (c) peer support. Practice recommendations included (a) valuing personal perspectives in decision-making, (b) enabling peer-to-peer support models, (c) supporting choice in community-dwelling arrangements and (d) broadening availability of materials for persons with intellectual disability that would promote understanding of dementia.

Longitudinal studies have steadily grown in popularity across the educational and behavioral sciences, particularly with the increased availability of technological devices that allow the easy collection of repeated measures on multiple dimensions of substantive relevance. This article discusses a procedure that can be used to evaluate population differences in within-person (intraindividual) variability in such longitudinal investigations. The method is based on an application of the latent variable modeling methodology within a two-level modeling framework. The approach is used to obtain point and interval estimates of the differences in within-person variance and in the strength of correlative effects of repeated measures between normal and very mildly demented persons in a longitudinal study of a diagnostic cognitive test assessing verbal episodic memory.

Background: The increased life expectancy of people with intellectual disability intensifies the need for age-specific support. Research on effects of support strategies on quality of life (QoL) of these people remains scattered. Methods: A systematic search of peer-reviewed publications since 1995 was performed, with participants having intellectual disability and being aged =50 years. Studies include experimental, observational and exploratory designs, analysing links between support strategies and QoL outcomes. The present authors adopted a narrative approach. Results: The present authors found 73 articles, assessed their quality, thematically categorized interventions into 12 themes, and listed them with their stated relationships to QoL. Conclusions: The studies indicated the importance of funding, provision and organization of services/personnel, education, and cooperation among different support systems. The provision of good housing or activities, support when these provisions change, provision of (mental) health care, dementia care and end-of-life care, life story work, future planning and support for (I)ADLs are crucial.

Purpose: Various directional hypotheses for the observed links between aging, hearing, and cognition have been proposed: (a) cognitive load on perception hypothesis, (b) information degradation hypothesis, (c) sensory deprivation hypothesis, and (d) common cause hypothesis. Supporting evidence for all 4 hypotheses has been reported. No studies have modeled the corresponding 4 causal pathways into 1 single model, which would be required to evidence that multiple directional hypotheses apply. The aim of the current study was to tease out which pathways apply for 5 different cognitive measures. Method: Data from 1,029 respondents of the Longitudinal Aging Study Amsterdam were used spanning a maximum follow-up of 7 years (3 measurements). Speech-in-noise recognition ability (digit triplet speech-in-noise test) was included as a measure of auditory function. Cognitive measures included global cognitive functioning, fluid intelligence, information processing speed, and verbal memory (immediate recall and retention). Bivariate dual change score modeling was used to model the causal pathways between hearing, cognition, and baseline age. Results: For information processing speed, global cognitive functioning, fluid intelligence, and memory-immediate recall, all pathways except for the sensory deprivation pathway were supported. For memory-retention, only the common cause and the sensory deprivation pathways were supported. Conclusions: Causal pathways corresponding to all 4 hypotheses were supported. Support for the common cause hypothesis, the information degradation hypothesis, and the cognitive load on perception hypotheses was found for 4 of 5 cognitive measures. This was unexpected in some cases (e.g., support for the information degradation pathway for cognitive measures that do not rely on auditory stimuli). The sensory deprivation pathway that emerged for memory-retention might point toward processes related to early stages of dementia. In summary, the results show that the links between decline in auditory function, cognition, and aging are complex and most likely are captured by pathways belonging to various directional hypotheses.

Purpose: Evidence exists that changes in language performance may be an early indicator of mild cognitive impairment (MCI), often a harbinger of dementing disease. The purpose of this study was the evaluation of language performance in individuals at risk for MCI by virtue of age and self-concern and its relation to performance on tests of memory, visuospatial function, and mental status. Method: Eighty-three individuals 55 years or older were administered the Arizona Battery for Communication Disorders of Dementia (Bayles & Tomoeda, 1993), a standardized battery with normative data from 86 healthy older adults (HOAs) and 86 individuals with Alzheimer's dementia, the most common dementing disease. A performance criterion of 1-1.5 "SD"s below the mean of HOAs defined MCI, as recommended in the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition." We hypothesized that (a) the majority of at-risk participants would score 1 "SD" or more below the mean of HOAs on 1 or more subtests and (b) language performance tests would present a greater challenge than memory, mental status, and visuospatial construction tests. Results: Both hypotheses were confirmed. Sixty-two participants (74.6%) met the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition," criteria on at least 1 subtest. Moreover, language subtests were those most likely to elicit a performance 1 SD or more below the mean of HOAs. Conclusions: Language performance deficits can appear early before impairment in episodic memory, visuospatial construction ability, or mental status in individuals at risk for MCI. Speech-language pathologists are uniquely qualified to identify subtle changes in language, and standardized language tests with normative data should be used when testing for MCI.

Purpose: This research study aims to evaluate the effectiveness of a psychoeducation group, which is founded on an Eastern approach to health care, in improving the quality of life of Chinese people with mild cognitive impairment (PwMCI). Method: In a randomized controlled trial (RCT), 40 Chinese PwMCI were randomly assigned to either a 10-session psychoeducation group or the control group. Results: A paired sample t test indicated that the treatment group (n = 18) showed significant improvement in their World Health Organization Quality of Life Measure (WHOQOL) score, while the control group (n = 22) did not. Moreover, an independent t test showed that the treatment group was more effective than the control group to improve their WHOQOL score. A reduction in the depressive symptoms was related to the improvement in WHOQOL score. Conclusions: This RCT provides evidence to support the feasibility and effectiveness of psychoeducation groups for improving the overall quality of life of PwMCI.

We examine the syntactic structures exhibited by persons with dementia in conversation. Traditionally, research on the linguistic abilities of persons with dementia is either observational (reports kept by caregivers) or experimental (e.g. based on comprehension tasks), and the focus is not on the syntactic competence of the speaker. We combine insights from corpus-based syntactic analysis with methods from interactional approaches. Our close syntactic analysis of the talk of 20 persons diagnosed with dementia and their non-impaired co-participants document both grammatical accuracy and the range of linguistic complexity produced as compared to patterns reported in studies of non-impaired speakers. We note the selection of complex grammatical structures (i.e. verbal arguments) is largely a consequence of the interaction rather than evidence of linguistic decrement. We report on the most pertinent of these interactional influences. Our findings support strategies that promote complex linguistic and interactional talk with persons diagnosed with dementia. We believe that these strategies will help increase the interactional opportunities that are lacking as reported by and about persons residing in an assisted living facility (Brooker 2011).

This short essay uses James Thompson's aesthetics of care to examine 'Memory in Two Voices', a multi-vocal poetry performance about dementia by long-time lesbian partners Chris Morrissey and Bridget Coll. Noting how Chris and Bridget's years-long tenure in the Queer Imaging and Riting Kollective for Elders, an arts and performance group based in Vancouver, Canada, gave the women the emotional and artistic resources to respond to Bridget's dementia diagnosis, I suggest that an aesthetics of care can be beneficial in long-term arts and performance groups for seniors and older adults.

'Dis-identifications from dominant models of subject-formation can be productive and creative' (Braidotti 2013, 167). This problematises applied theatre practices informed by received understandings of dementia, and their implications for memory and identity. "Forgotten Futures"(2017) and "Never-Ending Story" (2016-ongoing) refuse those understandings, emphasising future-focused, relational well-being for people living with dementia.

Walking by those living with dementia is often pathologically labelled 'wandering', an act lacking a clear purpose or destination. Walking in this context is not widely understood or valued, except as physical exercise. Drawing on walking performances by other artists and the author's own arts-based research, during which she walked outdoors and in care homes with people living with dementia, this article explores the role that the performance and conceptualisation of walking by artists can play in challenging and reimagining walking undertaken by people living with dementia.

This paper reports on a mixed methods project entitled "Playful Engagement" aimed at improving the quality of life (QoL) of individuals living with dementia through engagement with two relational clowns. Analysis of the quantitative data was unable to identify QoL improvements, whilst the qualitative data revealed positive affective outcomes within individual visits. In light of these outcomes, literature focused on the perceptions of QoL by individuals living with dementia was employed to generate an alternate reading. This alternate reading suggests that while the visits may not have improved the participants' overall quality of life, they nevertheless generated 'quality moments of life' characterised by connectedness, relationships, agency and happiness.

A reflection on the process that led to the development of dementia friendly theatre performances at Leeds Playhouse (formerly West Yorkshire Playhouse) including the vital involvement of people living with dementia as creative consultants. This article outlines the inspiration behind such performances, the steps required to make the necessary adaptations and enhancements identified by people living with dementia, and the potential for theatres to value and validate the voices of people with dementia through continued cultural engagement.

This article explores the practices of three young artist/facilitators, illustrating how they use their own age identity to develop expertise in working with older people in residential care homes. A research process of reflective dialogues reveals that they respond to the arts and drama-based workshop practices at creative ageing organisation Equal Arts with a growing value of their youthfulness. A self-defined 'unsettled' nature facilitates their work with older people, some with dementia who also share an 'unsettled' identity. The young practitioners are able to operate positively through relationships with older people, as well as re-view and re-new their own identity as artist/facilitators.

The autobiographical shows "The Waiting Room" (by John Mann and Morris Panych), and "Sonic Elder" (by Vancouver's The Chop Theatre), both featured performers with dementia or marked age-related memory loss who performed rock music live on stage. These professional Canadian productions used a dramaturgical approach ("dramaturgy of assistance") that foregrounded relational and embodied selfhoods, thus highlighting the performers' musicality and relationships. While "The Waiting Room" partially sought to mask the performer's need for support to maintain a slick, commercial aesthetic, "Sonic Elder"'s approach was more transparent about exposing memory challenges, and to a greater extent disrupted traditional loss-based dementia narratives.

"Dementia's Journey" explores the year-long process of a playwright working with a charity and its partners in writing a play focussing on experiences of dementia in a South Asian community, and how the need to tell an emotionally engaging and resonant story is balanced with the requirement to raise awareness of the issues involved. It explores the demands and challenges of using a cast of older volunteers, and asks if using volunteers adds to the authenticity and resonance of the play's message, or if the artistic and aesthetic standards of a performance are more important.

Through this paper, I consider how we might be aesthetically and relationally accountable in creating research-informed theatre through the conceptual frame of an aesthetic of relationality, and in-depth considerations of the theoretical notions embodiment, imagination and foolishness (as vulnerability-bravery). Through the example of "Cracked: new light on dementia," of which I am the playwright and director, I consider the ways artist-researchers foolishly and imaginatively engage in exploration from the starting point their own bodies, as socially, culturally and historically situated. I additionally extend these considerations towards a vision for how we might engage with persons with dementia beyond the tragic.

Currently there is a lack of understanding of dementia by the general public in Taiwan, and more importantly, those who care for dementia suffers. The aim of the current Educational Programme (EP) was to help the participants increase their knowledge of dementia, and thus to strengthen their caring skills for dealing with the Older Adults with Dementia (OAwD). The programme involved 282 participants and took 15 months to complete. All those participated were non-professional, private carers who looked after their family members that suffer from dementia. It was demonstrated that such a programme was greatly beneficial to participants in gaining knowledge about dementia, learning more caring skills, and other valuable information included in the educational programme curriculum. It was evident that after completion of the programme, the participants became more aware of the available community resources and more likely to access those additional support. All participants showed strong interest in repeating the educational programme to further enhance their caring skills.

Art therapy appears to be well positioned to assist people with dementia in improving their psychological well-being and quality of life because of its ability to address neuropsychiatric symptoms and to circumvent declining cognitive and verbal capacities. However, despite increased interest in nonpharmacological approaches to the care of people with Alzheimer's disease and dementia, art therapy research in this area is still greatly needed. Neurologically informed art therapy offers the potential to overcome historical limitations in the direction of evidence-based practice.