Explore the vast range of titles available.

Quality of life (QoL) is recognized as an essential end point in the disease management of chronic conditions such as HIV with calls to include good QoL as a ‘fourth 90’ in the 90-90-90 testing and treatment targets introduced by World Health Organization in 2016. Cognitive impairments impact a broad spectrum of experiences and are a common issue effecting people living with HIV (PLWH). Despite this, few studies have examined QoL in PLWH who also have a cognitive disorder. This study aimed to synthesize and describe what is known about QoL in those living with HIV-associated neurocognitive disorders (HAND). A scoping review of peer-reviewed literature was conducted to identify how QoL has been investigated and measured in PLWH with HAND, and how PLWH with HAND report and describe their QoL. We searched PsychInfo, Medline, Scopus, and Web of Science along with hand-searching reference lists from relevant studies found. Included studies were those published in English after 1 st January 2003 which included PLWH with cognitive impairment not due to other pre-existing conditions. Fifteen articles met criteria for inclusion. Two studies measured QoL as a primary aim, with others including QoL assessment as part of a broader battery of outcomes. The MOS-HIV and SF-36 were the most commonly used measures of overall QoL, with findings generally suggestive of poorer overall QoL in PLWH with HAND, compared to PLWH without cognitive impairment. Studies which examined dimensions of QoL focused exclusively on functionality, level of independence, and psychological QoL domains. There is a considerable dearth of research examining QoL in PLWH with HAND. The initiatives which advocate for healthy aging and improved QoL in PLWH must be extended to include and understand the experiences those also living with cognitive impairment. Research is needed to understand the broad experiential impacts of living with these two complex, chronic conditions, to ensure interventions are meaningful to patients and potential benefits are not missed.

End-of-life-care is often poor in individuals with dementia. Advanced care planning (ACP) has the potential to improve end-of-life care in dementia. Commonly ACP is completed in the last six months of life but in dementia there may be problems with this as decision-making capacity and ability to communicate necessarily decrease as the disease progresses. Choosing the right time to discuss ACP with people with dementia may be challenging given the duration of the illness may be up to nine years. To explore the acceptability of discussing ACP with people with memory problems and mild dementia shortly after diagnosis. In-depth interviews were conducted with 12 patients and eight carers who had participated in ACP discussions and six staff members from a memory clinic and a community mental health team who had either conducted or attended the discussions for training purposes. Patients and carers found ACP a positive intervention that helped them think about the future, enabled people with dementia to make their wishes known, and resulted in their feeling relieved and less worried about the future. The importance of sharing the ACP documentation between health service providers was highlighted. This qualitative evaluation of ACP in early dementia has encouragingly positive results which support the wider application of the intervention in memory services and community mental health teams. Strategies are suggested to support the implementation of ACP further in clinical practice.

There has been a shift in focus of international dementia policies from improving diagnostic rates to enhancing the post-diagnostic support provided to people with dementia and their carers. There is, however, little agreement over what constitutes good post-diagnostic support. This study aimed to identify the components of post-diagnostic dementia support. We adopted a qualitative design using interviews, focus groups and observation to explore the perspectives of key stakeholders on the content of post-diagnostic dementia support. Purposive sampling was used to identify sites in England and Wales recognised as delivering good practice. Participants included 17 people with dementia, 31 carers, 68 service managers or funders, and 78 frontline staff. Interviews and focus groups were audio recorded and transcribed for analysis. Forty-eight sessions of observation were completed and recorded in fieldnotes. Components were identified through an inductive, thematic approach and cross-checked against national guidelines and existing frameworks; they were subsequently critically reviewed by a range of experts and our mixed stakeholder panel. Twenty distinct components of post-diagnostic support were identified, related to five themes: timely identification and management of needs; understanding and managing dementia; emotional and psychological wellbeing; practical support; and integrating support. The first and last of these were cross-cutting themes facilitating the delivery of a unique constellation of components of post-diagnostic support to each individual living with dementia or dyad at a particular time. Our work offers an empirically based framework to inform the development and delivery of holistic, integrated and continuous dementia care from diagnosis to end of life. It highlights the relevance of many components to both people living with dementia and their carers. Since the framework was developed in England and Wales, further research is needed to explore the relevance of our components to other sectors, countries and care systems.

Background People with intellectual disabilities are a marginalized group whose health experiences and outcomes are poor. Lack of skill and knowledge in the healthcare workforce is a contributing factor. In England, there is a new legislative requirement for mandatory intellectual disability training to be given to the existing healthcare workforce, including doctors. There is a lack of evidence about effective models of educational delivery of such training in medical schools. We undertook a scoping review to assess the range of intellectual disabilities educational interventions and their effectiveness. Methods We included any study from 1980 onwards which reported an educational intervention on intellectual disability, or intellectual disability and autism, for medical students from any year group. Databases searched included PUBMED, ERIC, Scopus and Web of Science as well as searches of grey literature and hand searching two journals (Medical Education and Journal of Learning Disabilities). 2,020 records were extracted, with 1,992 excluded from initial screening, and a further 12 excluded from full-text review, leaving 16 studies for inclusion. Data was extracted, quality assessed, and findings collated using narrative analysis. Results We found a variety of intervention types: classroom-based teaching, simulation, placement, home visits, and panel discussions. There was substantial variation in content. Most studies involved lived experience input. Across studies, interventions had different learning outcomes which made it difficult to assess effectiveness. Overall study quality was poor, with high use of non-validated measures, making further assessment of effectiveness problematic. Conclusions There is a need for more consistency in intervention design, and higher quality evaluation of teaching in this area. Our review has drawn attention to the variety in teaching on this topic area and further research should focus on updating this review as curriculum changes are implemented over time.

We aimed to examine regional differences in the relationship between core clinical features assessed using the Improving the DIAgnosis and Management Of Neurodegenerative Dementias of Lewy body type in the NHS (DIAMOND-Lewy) dementia with Lewy bodies (DLB) Assessment Toolkit and memory service diagnoses of Lewy body dementia (LBD). Secondary analysis of a multicentre observational study. Memory clinics in three sites across England (North East, London and South East) from July 2019 to March 2023. 935 individuals with a new memory service diagnosis of dementia enrolled in the DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers (DETERMIND) programme. Core clinical features of DLB were assessed using the DLB Assessment Toolkit. The relationship between core clinical features and memory service diagnosis of LBD was examined using Bayesian probit models. There were higher rates of LBD diagnosis from memory services in the cohort in North East England compared with the London and South East centres (11% vs 4%; risk ratio (RR)=1.72 (1.35-2.08)) and evidence of a regional moderating effect on the relationship between clinical features and LBD diagnosis (RR=1.73 (1.26-2.40)).All core clinical features of DLB were associated with LBD diagnosis in North East England, whereas visual hallucinations were the most influential diagnostic feature in London and the South East (RR=3.18 (2.29-4.02)). Regional differences in LBD diagnosis in UK memory services appear to reflect different rates of recognition of specific LBD clinical features. Routinely using a standardised DLB Assessment Toolkit and improving awareness of non-hallucination features in LBD could help to address this disparity.

Background: Experiencing agitation can be particularly distressing for people with dementia and their caregivers. Using technologies to detect agitation can help monitor and intervene when agitation occurs, potentially reducing overall care and support needs. This systematic review aims to explore the implementation outcomes related to the use of agitation detection technologies in people with dementia. By adopting a taxonomy of implementation outcomes, this review seeks to provide insights valuable for the real-world adoption of such technologies for people with dementia. Methods: Searches were conducted in the following databases: SCOPUS, PubMed, PsychINFO, IEEEXplore, and CINAHL Plus. Included studies were required to have implemented, evaluated, or validated technology with the intention to detect agitation in people with dementia in real-time. Results: On 14 May 2024, 1697 records were identified, and 19 were included in the review. The median sample size was 10, and around two-thirds of the records (n = 12, 63%) used ‘multimodal’ technologies for detecting agitation. Over half of the records (n = 10, 53%) were reporting from two studies. Across technologies, there was evidence of acceptability and feasibility, though there was a general absence of primary data related to implementation outcomes. There were, however, a number of technical issues and limitations that affected the fidelity and appropriateness of the technology, albeit not unique to people with dementia. Conclusions: There is a need for more empirical data on this topic to maximise uptake and adoption. Future research needs to ensure that the voice of the person with dementia is integrated within the evaluation process.

Background A current issue in workforce planning is ensuring healthcare professionals are both competent and willing to work with older adults with complex needs. This includes dementia care, which is widely recognised as a priority. Yet research suggests that working with older people is unattractive to undergraduate healthcare students. Methods The aim of this systematic review and narrative synthesis is to explore the factors related to healthcare (medical and nursing) student preferences’ for working with older people and people with dementia. Searches were conducted in five databases: MEDLINE, PsycINFO, CINHAL, BNI, ERIC. Screening, data extraction and quality appraisal were conducted by two independent reviewers. A narrative, data-based convergent synthesis was conducted. Results One thousand twenty-four papers were screened (139 full texts) and 62 papers were included for a narrative synthesis. Factors were grouped into seven categories; student characteristics, experiences of students, course characteristics, career characteristics, patient characteristics, work characteristics and the theory of planned behaviour. Conclusion Health educators should review their role in cultivating student interest in working with older adults, with consideration of student preparation and the perceived value of this work. There is a lack of evidence about the career preferences of students in relation to dementia, and this warrants further research.

In patients with moderate or severe Alzheimer's disease receiving donepezil, those assigned to continue donepezil had less cognitive decline than did those assigned to discontinue donepezil. The combination of donepezil and memantine did not confer benefits over donepezil alone. Most studies evaluating cholinesterase inhibitors for the treatment of Alzheimer's disease have focused on patients with mild-to-moderate disease. Despite questions about the methods used in the trials 1 and about the clinical significance of reported benefits, 1 , 2 guidelines advocate treatment with a cholinesterase inhibitor, although some recommend discontinuation when Alzheimer's disease becomes severe. 3 Evidence of the efficacy of memantine has been shown primarily in patients with moderate or severe Alzheimer's disease. 4 The findings of a study showing that combination therapy with memantine and a cholinesterase inhibitor was more effective than treatment with a cholinesterase inhibitor alone 5 have not been replicated. 6 Results . . .

Background Over the last decade there has been a recognition of the need for better dementia education for undergraduate healthcare professionals. Time for Dementia is an innovative educational programme in the UK whereby students learn about the condition directly from a two-year longitudinal contact with a person living with dementia and their families. There is evidence that such programmes have positive outcomes for students in terms of improved attitudes and knowledge, however, students’ evaluations of these programmes are scarce. Objectives To understand the satisfaction of the students taking part in Time for Dementia and their perceptions of the programme. Methods A cross-sectional survey, with Likert responses, was completed to assess overall levels of satisfaction for students enrolled in Time for Dementia. 1,225 students consented and completed the satisfaction survey at five universities in England. Factors that might predict satisfaction were explored using multiple regression analysis. A qualitative framework thematic analysis explored the best aspects of the programme and possible improvements, as recorded by student responses to open text questions. Results 78% of students agreed or strongly agreed that Time for Dementia had increased their knowledge of psychosocial issues, and 69% enjoyed the programme. The multiple regression analysis found satisfaction was statistically significantly higher for students who completed more visits; took part after the onset of the COVID-19 pandemic; were of Black or Asian ethnicities (compared to White British/European); and were relatively older. The themes related to the best aspects of the programme were that Time for Dementia provides relational learning, understanding the impact of dementia on family and thinking psychosocially. Improvements include preferred programme structure, the need for clarity of expectations and addressing barriers to learning. Conclusions This study supports the value of Time for Dementia as assessed by students. Key considerations to ensure satisfaction include the fidelity of programme experience and clear expectations.

Possible dementia is usually identified in primary care by general practitioners (GPs) who refer to specialists for diagnosis. Only two-thirds of dementia cases are currently recorded in primary care, so increasing the proportion of cases diagnosed is a strategic priority for the UK and internationally. Variables in the primary care record may indicate risk of developing dementia, and could be combined in a predictive model to help find patients who are missing a diagnosis. We conducted a meta-analysis to identify clinical entities with potential for use in such a predictive model for dementia in primary care. We conducted a systematic search in PubMed, Web of Science and primary care database bibliographies. We included cohort or case-control studies which used routinely collected primary care data, to measure the association between any clinical entity and dementia. Meta-analyses were performed to pool odds ratios. A sensitivity analysis assessed the impact of non-independence of cases between studies. From a sift of 3836 papers, 20 studies, all European, were eligible for inclusion, comprising >1 million patients. 75 clinical entities were assessed as risk factors for all cause dementia, Alzheimer's (AD) and Vascular dementia (VaD). Data included were unexpectedly heterogeneous, and assumptions were made about definitions of clinical entities and timing as these were not all well described. Meta-analysis showed that neuropsychiatric symptoms including depression, anxiety, and seizures, cognitive symptoms, and history of stroke, were positively associated with dementia. Cardiovascular risk factors such as hypertension, heart disease, dyslipidaemia and diabetes were positively associated with VaD and negatively with AD. Sensitivity analyses showed similar results. These findings are of potential value in guiding feature selection for a risk prediction tool for dementia in primary care. Limitations include findings being UK-focussed. Further predictive entities ascertainable from primary care data, such as changes in consulting patterns, were absent from the literature and should also be explored in future studies.