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As life expectancy increases in India, the number of people living with dementia will also rise. Yet little is known about how people in India cope with dementia, how relationships and identities change through illness and loss.

In Fragile Brains Kathleen Taylor looks at the genetic and lifestyle factors currently linked to the development of dementia, focusing on important new research on how the immune system operates in the brain.

Dementia presents immense challenges - both for individuals as well as for society as a whole. More than 35 million people all over the world currently live with dementia, a number that is expected to double by 2050. This also has implications for architecture and urban planning because dementia often affects people's sense of orientation and their ability to perceive space. How can homes, apartments, public buildings, outdoor spaces, neighbourhoods and cities, as well as environments and infrastructure, be designed to meet the needs of people with dementia as well as those of their caregivers? And can a consideration of the problems of dementia lead to a better understanding of space that can improve architecture and the built environment for us all? This book addresses these and other questions in a series of professional essays that examine the specific requirements for different disciplines. In addition, international case study projects illustrate the breadth of current actual solutions. The book is intended as a guide for all those involved in the design and planning process - architects, interior designers, engineers, town planners, local authorities and clients - and as a reader for the users themselves: for people with dementia, their family and friends, and all those in their social environment.

Dementia is the most common type of neurodegenerative disorder. Non-Alzheimer's and Atypical Dementia concentrates on each form of dementia individually, considering symptoms, diagnosis and treatment * Focuses on non-Atypical Dementia  * Multidisciplinary approach to diagnosis and management * Allows development of management and care plan strategies * Practical approach including case studies * Written by a world-renowned editorial team

ObjectiveTo determine optimal test cut-offs for diagnosis of dementia and MCI using the mini-Addenbrooke’s Cognitive Examination (MACE) and compare these with index study cut-offs (Dement Geriatr Cogn Disord 2015;39:1–11), and to calculate MACE predictive values across a range of disease prevalences.ResultsOf 755 patients (F:M = 352:403, 47% female; median age 60 years), 114 received criterion diagnosis of dementia and 222 MCI. For diagnosis of dementia, optimal MACE cut-off determined by maximal Youden index was ≤20/30 (sensitivity 0.91, specificity 0.71) and by maximal correct classification accuracy was ≤14/30 (sensitivity 0.59, specificity 0.92). For MCI diagnosis, optimal MACE cut-off determined by maximal Youden index was ≤24/30 (sensitivity 0.90, specificity 0.57) and ≤19/30 (sensitivity 0.47, specificity 0.88) by maximal correct classification accuracy. These MACE cut-offs differed from the index study (≤25/30 high sensitivity, ≤21/30 high specificity). NPV was high (≥0.9) at all prevalences of dementia and MCI examined (range 0.05–0.4) suggesting normal MACE score effectively rules out dementia and MCI.ConclusionsIn this large dataset, optimal MACE cut-offs for dementia and MCI differed from the index study reflecting the different casemix of the studies. Revision of MACE cut-offs in may be required in clinical practice to maximise test discriminative utility.

ObjectiveTo analyse data from two previously published individual studies and two meta-analyses of the Ascertain Dementia 8 (AD8) cognitive screening instrument to calculate the recently described ‘likelihood to be diagnosed or misdiagnosed’ (LDM) metric, the ratio of ‘number needed to misdiagnose’ (NNM = 1/Inaccuracy) to either ‘number needed to diagnose’ (NND = 1/Youden index) or ‘number needed to predict’ (NNP = 1/predictive summary index).ResultsRaw data (true positives and negatives, false positives and negatives) were extracted and LDM values for the diagnosis of dementia were calculated. For the individual studies (n=212, 67 respectively) LDM values were all <1, favouring misdiagnosis, whereas for the meta-analyses (n=3278, 3694 respectively) all LDM values were >1, favouring diagnosis. This discrepancy may be explained by the poor specificity of AD8 in the individual studies, lower than in any other study included in the meta-analyses, giving very high values for NND and NNP and lower values of NNM than in the meta-analytic data. This may relate to differences in casemix between the various studies.ConclusionLDM is an easily calculated and potentially useful test metric. LDM values derived from meta-analytic data may differ from those of individual test accuracy studies.

The Forgetful Friends Chorus based in Manassas, Virginia, rehearse twice a month and travel to local senior living facilities to perform.