BACKGROUND:Increasing numbers of people require evaluation for possible dementia. However, research on the accuracy of informant questionnaires in primary care remains limited. METHODS:This study assessed the diagnostic accuracy of IQCODE, AD8, and GPCOGi based on the informant's relationship to the patient. We recruited 240 participants from 21 general practices in South West England. The reference standard for a diagnosis of dementia was made by a specialist clinician using ICD-10 criteria. A threshold of greater than 3.3 on IQCODE, greater or equal to 2 on AD8 and less than 5 on the informant component of GPCOG was used to indicate an abnormal test. RESULTS:Of 238 participants with informant data, 131 had dementia, 60 had CIND, and 47 had normal cognition. Median informant age was 70 years (IQR 60 years to 78 years). 71% of informants were female and 56% were spouses. On all three questionnaires, compared to spouses, adult descendants tended to score participants more cognitively impaired, whereas friends scored participants less cognitively impaired. However, there was little evidence of difference by informant type once fully adjusted. Sensitivity by informant type ranged from 91 to 100% for IQCODE, 94-100% for AD8 and 99% to100% for GPCOGi. There was no significant difference in sensitivity by informant type. Specificity by informant type ranged from 25 to 79% for IQCODE, 13-75% for AD8 and 17-38% for GPCOGi. Adult descendants tended to have the lowest specificity at 25% (95% CI 10-47%) for IQCODE, 13% (95% CI 3-32%) for AD8 and 17% (95% CI 5-37%) for GPCOGi. Friends tended to have the highest specificity at 79% (95% CI 49-95%) for IQCODE, 75% (95% CI 48-93%) for AD8 and 38% (95% CI 15-64%) for GPCOGi. CONCLUSIONS:An informant of any relationship type, using IQCODE, AD8 or GPCOGi may be useful for ruling out dementia but not for ruling it in. We found no evidence of difference between spouse or adult descendants but friends performed significantly better overall on IQCODE and AD8.

BACKGROUND:Many health systems are interested in increasing the number of uncomplicated and typical dementia diagnoses that are made in primary care, but the comparative accuracy of tests is unknown. OBJECTIVE:Calculate diagnostic accuracy of brief cognitive tests in primary care. METHODS:We did a diagnostic test accuracy study in general practice, in people over 70 years who had consulted their GP with cognitive symptoms but had no prior diagnosis of dementia. The reference standard was specialist assessment, adjudicated for difficult cases, according to ICD-10. We assessed 16 index tests at a research clinic, and additionally analyzed referring GPs clinical judgement. RESULTS:240 participants had a median age of 80 years, of whom 126 were men and 132 had dementia. Sensitivity of individual tests at the recommended thresholds ranged from 56% for GP judgement (specificity 89%) to 100% for MoCA (specificity 16%). Specificity of individual tests ranged from 4% for Sniffin' sticks (sensitivity 100%) to 91% for Timed Up and Go (sensitivity 23%). The 95% centile of test duration in people with dementia ranged from 3 minutes for 6CIT and Time and Change, to 16 minutes for MoCA. Combining tests with GP judgement increased test specificity and decreased sensitivity: e.g., MoCA with GP Judgement had specificity 87% and sensitivity 55%. CONCLUSIONS:Using GP judgement to inform selection of tests was an efficient strategy. Using IQCODE in people who GPs judge as having dementia and 6CIT in people who GPs judge as having no dementia, would be a time-efficient and accurate diagnostic assessment.The original protocol for the study is available at https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-016-0475-2.

Objectives To understand associations between the subjective experience of cognitive decline and objective cognition. This subjective experience is often conceptualised as an early step towards neurodegeneration, but this has not been scrutinised at the population level. An alternative explanation is poor meta-cognition, the extreme of which is seen in functional cognitive disorder (FCD).Design Prospective cohort (Caerphilly Prospective Study).Setting Population-based, South Wales, UK.Participants This men-only study began in 1979; 1225 men participated at an average age of 73 in 2002–2004, including assessments of simple subjective cognitive decline (sSCD, defined as a subjective report of worsening memory or concentration). Dementia outcomes were followed up to 2012–2014. Data on non-completers was additionally obtained from death certificates and local health records.Primary and secondary outcome measures The primary outcome measure was incident dementia over 10 years. Secondary outcome measures included prospective change in objective cognition and cross-sectional cognitive internal inconsistency (the existence of a cognitive ability at some times, and its absence at other times, with no intervening explanatory factors except for focus of attention).Results sSCD was common (30%) and only weakly associated with prior objective cognitive decline (sensitivity 36% (95% CI 30 to 42) and specificity 72% (95% CI 68 to 75)). Independent predictors of sSCD were older age, poor sleep quality and higher trait anxiety. Those with sSCD did not have excess cognitive internal inconsistency, but results suggested a mild attentional deficit. sSCD did not predict objective cognitive change (linear regression coefficient −0.01 (95% CI −0.13 to 0.15)) nor dementia (odds ratio 1.35 (0.61 to 2.99)) 10 years later.Conclusions sSCD is weakly associated with prior objective cognitive decline and does not predict future cognition. Prior sleep difficulties and anxiety were the most robust predictors of sSCD. sSCD in the absence of objective decline appears to be a highly prevalent example of poor meta-cognition (ie, poor self-awareness of cognitive performance), which could be a driver for later FCD.

Background: The merit of using baseline cognitive assessments in mid-life to help interpret cross-sectional cognitive tests scores in later life is uncertain. Objective: Evaluate how accuracy for diagnosing dementia is enhanced by comparing cross-sectional results to a midlife measure. Methods: Cohort study of 2,512 men with repeated measures of Mini-Mental State Examination (MMSE) over approximately 10 years. Index test MMSE at threshold of 24 indicating normal, as a cross-sectional measure and in combination with decline in MMSE score from mid-life. Reference standard consensus clinical diagnosis of dementia by two clinicians according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Results: 1,150 men participated at phase 4 of whom 75 had dementia. A cross-sectional MMSE alone produced a sensitivity of 60% (50% to 70%) and specificity 95% (94% to 97%) with a threshold of >= 24 points indicating normal. For lower-scoring men in late life, with cross sectional scores of < 22, combining cross-sectional AND a three-point or more decline over time had a sensitivity of 52% (39% to 64%) and specificity 99% (99% to 100%). For higher-scoring men in later life, with cross sectional scores < 26 combining cross-sectional OR decline of at least three points had a sensitivity of 98% (92% to 100%) and specificity 38% (32% to 44%). Conclusion: It may be helpful in practice to formally evaluate cognition in mid-life as a baseline to compare with if problems develop in future, as this may enhance diagnostic accuracy and classification of people in later life.

Background: Care homes are an increasingly important sector of care. Care home residents are particularly vulnerable to infections and are often prescribed antibiotics, driving antibiotic resistance. Probiotics may be a cheap and safe way to reduce antibiotic use. Efficacy and possible mechanisms of action are yet to be rigorously evaluated in this group. Objective: The objective was to evaluate efficacy and explore mechanisms of action of a daily oral probiotic combination in reducing antibiotic use and infections in care home residents. Design: This was a multicentre, parallel, individually randomised, placebo-controlled, double-blind trial, with qualitative evaluation and mechanistic studies. Setting: A total of 310 care home residents were randomised from 23 UK care homes (from December 2016 to May 2018). Participants: The participants were care home residents aged ≥ 65 years who were willing and able to give informed consent or, if they lacked capacity to consent, had a consultee to advise about participation on their behalf. Intervention: A daily capsule containing an oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 (n = 155) or matched placebo (n = 155) for up to 1 year. Main outcome measures: The primary outcome was cumulative systemic antibiotic administration days for all-cause infections. Secondary outcomes included incidence and duration of infections, antibiotic-associated diarrhoea, quality of life, hospitalisations and the detection of resistant Enterobacterales cultured from stool samples (not exclusively). Methods: Participants were randomised (1 : 1) to receive capsules containing probiotic or matched placebo. Minimisation was implemented for recruiting care home and care home resident sex. Care home residents were followed up for 12 months with a review by a research nurse at 3 months and at 6–12 months post randomisation. Care home residents, consultees, care home staff and all members of the trial team, including assessors and statisticians, were blinded to group allocation. Results: Care home residents who were randomised to probiotic had a mean 12.9 cumulative systemic antibiotic administration days (standard error 1.49 days) (n = 152) and care home residents randomised to placebo had a mean 12.0 cumulative systemic antibiotic administration days (standard error 1.50 days) (n = 153) (adjusted incidence rate ratio = 1.13, 95% confidence interval 0.79 to 1.63; p = 0.495). There was no evidence of any beneficial effects on incidence and duration of infections, antibiotic-associated diarrhoea, quality of life, hospitalisations, the detection of resistant Enterobacterales cultured from stool samples or other secondary outcomes. There was no evidence that this probiotic combination improved blood immune cell numbers, subtypes or responses to seasonal influenza vaccination. Conclusions: Care home residents did not benefit from daily consumption of a combination of the probiotics Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 to reduce antibiotic consumption. Limitations: Limitations included the following: truncated follow-up of some participants; higher than expected probiotics in stool samples at baseline; fewer events than expected meant that study power may have been lower than anticipated; standard infection-related definitions were not used; and findings are not necessarily generalisable because effects may be strain specific and could vary according to patient population. Future work: Future work could involve further rigorous efficacy, mechanisms and effectiveness trials of other probiotics in other population groups and settings regarding antibiotic use and susceptibility to and recovery from infections, in which potential harms should be carefully studied. Trial registration: Current Controlled Trials ISRCTN16392920. Funding: This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and NIHR partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.

Objective/AimsDoes Subjective Cognitive Decline (SCD) indicate susceptibility to Functional Cognitive Disorder (FCD) more often than it indicates neurodegeneration? Prior research has focused on clinical populations where FCD is increasingly identified, but associations could differ at the community level. A clinical diagnosis of FCD requires cognitive symptoms, internal inconsistency, the absence of another explanatory disorder, and significant impairment; but we know little about its aetiology and prevalence. Cognitive internal inconsistency has not been systematically studied.Methods1,143 men were followed in the Caerphilly Prospective Study. Their subjective experience of cognitive change at average age 73 years was compared to their previous rate of objective cognitive change (using the Cambridge Cognition Examination). Logistic regression models examined potential predictors of SCD (measured in the preceding decade) including sociodemographic factors, vascular risk markers (ischaemic heart disease, vascular medications, smoking history), alcohol exposure, sleep problems, depression, anxiety trait, and objective cognition. We also looked for markers of cognitive internal inconsistency (delayed recall proportionately better than immediate recall, using the Rivermead Behavioural Memory Test). Finally, subjective and objective cognition at average age 73 were used to predict change in objective cognition nine years later.ResultsSCD was common (30%), and only weakly related to prior objective cognitive decline (sensitivity 36% [95% CI 30-42], specificity 72% [95% CI 68-75]). Longitudinal independent predictors of SCD were older age, poor sleep quality and higher trait anxiety: rate of decline in objective cognition did not independently predict subsequent SCD (adjusted OR 1.18 [95% CI 0.72 1.95]). Those with SCD (compared to those without) had mildly worse scores on immediate recall, but their delayed recall was in proportion to their immediate recall, i.e., there was no evidence of cognitive internal inconsistency. SCD did not predict future objective cognitive change (p=0.84). Important limitations include the male-only sample and the possibility of survivor bias.ConclusionsSCD is common, but is only weakly associated with prior objective cognitive decline, is not predicted by vascular risk markers (aside from age), and does not predict future objective cognitive decline. The high community prevalence of SCD is instead driven partly via sleep difficulties and anxiety. Our results suggest those with SCD may have a mild deficit in attentional processes but relatively intact memory for the items they do encode. Subjectively experiencing cognitive decline in the absence of an objective decline appears to be a highly prevalent example of poor meta-cognition, which could be a driver to later FCD.

Introduction: A timely diagnosis of dementia is crucial for initiating andmaintaining support for people living with dementia. Thecoronavirus disease (COVID) pandemic temporarily haltedMemory Clinics, where this is organised, and rate of dementia diagnosis has fallen. Despite increasing use of alternatives to face-to-face (F2F) consultations in other departments, it is unclear whether this is feasible within the traditional Memory Clinic model. Aims: Themain aim of this service improvement project performed during the pandemic was to explore feasibility of telephone (TC) and videoconference (VC) Memory Clinic consultations. Methods: Consecutive patients on the Memory Clinic waiting list were telephoned and offered an initial appointment by VC or TC. Data extracted included: age, internet-enabled device ownership, reason for and choice of Memory Clinic assessment. We noted Montreal Cognitive Assessment-Blind (TC) and Addenbrooke's Cognitive Examination-III (VC via Attend Anywhere) scores, and feasibility of consultation. Results: Out of 100 patients, 12 had a home assessment, moved away, been hospitalised, or died. 45, 21 and 6 preferred F2F, VC and TC assessments respectively. 16 were not contactable and offered a F2F appointment. The main reason for preferring F2F was non-ownership, or inability to use an internet-enabled device (80%). VC and TC preference reasons were unwillingness to come to hospital (59%), and convenience (41%). Attendance rate was 100% for VC and TC, but 77% for F2F. Feasibility (successful consultations) was seen in 90% (VC) and 67% (TC) patients. Conclusion: For able and willing patients, remote Memory Consultations can be both feasible and beneficial. This has implications for future planning in dementia services.

Reaction time (RT) in Vascular Cognitive Impairment (VCI) is particularly slowed when assessed using tests of executive function, however, these tests do not reveal the integrity of specific functional subcomponents of information processing related to RT that are affected by VCI, thus limiting understanding of behavioural change, symptoms and disease progression. Pathological changes in white matter can be ‘silent’, on routine neuroimaging, and not all clinical tests may be sensitive to such effects, highlighting the importance of using of a wider range of tests than may be used at present. The Multi-Item Localization (MILO) task is used to characterise the performance of mild/moderate VCI and is designed to explore the temporal context of visual search, in addition to measuring overall completion time, it provides a profile of serial reaction time (SRT) patterns across all items in a sequence. MILO assesses how well participants plan ahead during search, and whether items that have already been located can be effectively ignored (i.e., inhibited) identifying deficits in inhibitory control during search. Participant groups: VCI patients (n =26); cognitively healthy (CH) older adult control group (n=23); young adults (n=26). The MILO iPad app consisted of the digit sequence 1-8, presented as red/white pool balls. Participants were required to tap each ball in consecutive order, quickly and accurately. In the Vanish condition, items were removed from the screen following the response. In the Remain condition, items were unaffected when touched and the set size were the same throughout a trial. Participants completed two blocks of 20 correct trials, one block of Vanish trials followed by one block of Remain trials. The performance of VCI participants was characterised by overall slowing, increased error rates, and crucially, a compromised ability to use inhibitory tagging. Performance was compromised when items remained visible and have already been responded to, resulting in detrimental slowing of processing. The MILO task could be a useful tool for identifying non-age-related changes in behaviour with patient populations, and clearly hints at a specific inhibitory deficit in VCI.

AimsSleep disorders are highly prevalent with growing evidence that sleep problems may predict cognitive decline and dementia. A previous analysis of the Caerphilly Prospective Study (CaPS), a cohort of middle-aged men, found that daytime sleepiness predicted vascular dementia and cognitive impairment. We have re-examined this hypothesis with additional events based on further follow-up. The study aimed to examine the role of different sleep problems in predicting cognitive impairment not dementia (CIND) and dementia. Our hypothesis was that sleep problems in mid-life would predict CIND and dementia in later life.MethodCaPS is a population cohort of men born between 1920 and 1935 and resident in Caerphilly in South Wales, first seen between 1979–1983. Cognitive tests and a sleep questionnaire were introduced at Phase III (men aged 55–69 years). The questionnaire asked about daytime dysfunction, hypnotic use, insomnia, napping, nocturnal limb movements, sleep apnoea, sleep duration, sleep latency and snoring.At Phase V (men aged 68–82 years), poor performance on the Cambridge Cognition Exam (CAMCOG) was used to select men for detailed clinical assessment. Subjects were classified as having normal cognition, CIND or dementia. Cognitive disorders were sub-classified as vascular or non-vascular. At Phase VII (men aged 78–92 years), new cases were identified and survivors with existing diagnoses were reassessed.We initially conducted separate logistic regressions for vascular and non-vascular cognitive outcomes with the individual sleep measures, but where there was no evidence of heterogeneity, we combined these outcomes to enhance power. We also ran ordered logistic regression models to test for association of our sleep measures with CIND and dementia from any cause, with no cognitive problems as the reference group. All models were adjusted for potential confounders such as age and lifestyle variables.ResultThere were 256 cases of CIND, 155 dementia and 118 vascular cognitive disorders. 889 had normal cognition. Nocturnal limb movements strongly predicted vascular cognitive disorders (OR 2.59, 95% CI 1.34–4.98, p = 0.004). Poor sleep duration, defined as less than 6 or more than 8 hours, predicted all-cause CIND and all-cause dementia (OR 1.62, 95% CI 1.01–2.61, p = 0.045). The other sleep measures showed weak associations consistent with chance.ConclusionWe have provided further evidence that sleep problems predict cognitive decline, justifying the growing interest in sleep as a potentially modifiable risk factor for dementia. Future evidence is required from intervention studies that attempt to improve sleep parameters.

We used the MILO (Multi-Item Localization) task to characterise the performance of a group of older adults diagnosed with mild to moderate vascular cognitive impairment (VCI). The MILO task is designed to explore the temporal context of visual search and in addition to measuring overall completion time, provides a profile of serial reaction time (SRT) patterns across all items in a sequence. Of particular interest here is the Vanish/Remain MILO manipulation that can identify problems with inhibitory control during search. Typically, SRT functions closely overlap, regardless of whether items Vanish or Remain visible when selected, indicating an ability to ignore previously selected targets. Based on the distributed nature of VCI-related pathology and previous visual search studies from our group, we speculated that MILO performance would be compromised in this group of participants when items remained visible after being selected relative to when they vanished. Compared to cognitively healthy, age-matched control participants, the performance of VCI participants was characterised by overall slowing, increased error rates, and crucially, a compromised ability to ignore past locations. As predicted, the Vanish versus Remain SRT functions of VCI participants significantly diverged towards the end of the sequence, which was not the case for control groups. Overall, our findings suggest that the MILO task could be a useful tool for identifying non-age-related changes in behaviour with patient populations, and more generally hints at a possible inhibitory deficit in VCI.

BACKGROUND:The study of reaction time (RT) and its intraindividual variability (IIV) in aging, cognitive impairment, and dementia typically fails to investigate the processing stages that contribute to an overall response. Applying "mental chronometry" techniques makes it possible to separately assess the role of processing components during environmental interaction.OBJECTIVE:To determine whether RT and IIV-decomposition techniques can shed light on the nature of underlying deficits in subcortical ischemic vascular cognitive impairment (VCI). Using a novel iPad task, we examined whether VCI deficits occur during both initiation and movement phases of a response, and whether they are equally reflected in both RT and IIV.METHODS:Touch cancellation RT and its IIV were measured in a group of younger adults (n = 22), cognitively healthy older adults (n = 21), and patients with VCI (n = 21) using an iPad task.RESULTS:Whereas cognitively healthy aging affected the speed (RT) of response initiation and movement but not its variability (IIV), VCI resulted in both slowed RT and increased IIV for both response phases. Furthermore, there were group differences with respect to response phase.CONCLUSION:These results indicate that IIV can be more sensitive than absolute RT in separating VCI from normal aging. Furthermore, compared to cognitively healthy aging, VCI was characterized by significant deficits in planning/initiating action as well as performing movements. Such deficits have important implications for real life actions such as driving safety, employment, and falls risk.

Behaviors which are associated with the preservation of health include nonsmoking, regular exercise, a low body weight, a healthy diet, and a low alcohol intake. Together, as a healthy lifestyle, these have been shown to be associated with marked protection against a wide range of diseases: diabetes, vascular disease, cancer, and dementia. On the other hand, the protection associated with statins and aspirin, the two most commonly used preventive drugs, is limited to vascular disease and, probably for aspirin, cancer. These are not alternative prophylactics and any two, or all three—a healthy lifestyle, a statin, and aspirin—can reasonably be taken together. Only a small proportion of the members of the community follow a healthy lifestyle. Yet a small increase in the uptake of the healthy behaviors throughout the community can be shown to have relatively large effects on the incidence of disease. There is therefore an urgent need for health promotion activities across the whole community to be greatly increased and for new challenging and encouraging strategies to be devised and tested.

ImportanceProbiotics are frequently used by residents in care homes (residential homes or nursing homes that provide residents with 24-hour support for personal care or nursing care), although the evidence on whether probiotics prevent infections and reduce antibiotic use in these settings is limited.ObjectiveTo determine whether a daily oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 compared with placebo reduces antibiotic administration in care home residents.Design, Setting, and ParticipantsPlacebo-controlled randomized clinical trial of 310 care home residents, aged 65 years and older, recruited from 23 care homes in the United Kingdom between December 2016 and May 2018, with last follow-up on October 31, 2018.InterventionsStudy participants were randomized to receive a daily capsule containing a probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 (total cell count per capsule, 1.3 × 1010 to 1.6 × 1010) (n = 155), or daily matched placebo (n = 155), for up to 1 year.Main Outcomes and MeasuresThe primary outcome was cumulative antibiotic administration days for all-cause infections measured from randomization for up to 1 year.ResultsAmong 310 randomized care home residents (mean age, 85.3 years; 66.8% women), 195 (62.9%) remained alive and completed the trial. Participant diary data (daily data including study product use, antibiotic administration, and signs of infection) were available for 98.7% randomized to the probiotic group and 97.4% randomized to placebo. Care home residents randomized to the probiotic group had a mean of 12.9 cumulative systemic antibiotic administration days (95% CI, 0 to 18.05), and residents randomized to placebo had a mean of 12.0 days (95% CI, 0 to 16.95) (absolute difference, 0.9 days [95% CI, -3.25 to 5.05]; adjusted incidence rate ratio, 1.13 [95% CI, 0.79 to 1.63]; P = .50). A total of 120 care home residents experienced 283 adverse events (150 adverse events in the probiotic group and 133 in the placebo group). Hospitalizations accounted for 94 of the events in probiotic group and 78 events in the placebo group, and deaths accounted for 33 of the events in the probiotic group and 32 of the events in the placebo group.Conclusions and RelevanceAmong care home residents in the United Kingdom, a daily dose of a probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 did not significantly reduce antibiotic administration for all-cause infections. These findings do not support the use of probiotics in this setting.Trial RegistrationISRCTN Identifier:16392920.

BackgroundThe accuracy of General Practitioners’ (GPs’) clinical judgement for dementia is uncertain.AimInvestigate the accuracy of GPs’ clinical judgement for the diagnosis of dementia.Design and SettingDiagnostic test accuracy study, recruiting from 21 practices around Bristol.MethodThe clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia.Results240 people were recruited, with a median age of 80 years (IQR 75 to 84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12 to 36 months) and the median ACE-III score was 75 (IQR 65 to 87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI 2.9 to 15) compared to people aged ≥ 80 years (3.6, 95% CI 1.7 to 7.6), and in women (10.4, 95% CI 3.4 to 31.7) compared to men (3.2, 95% CI 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups.ConclusionA GP clinical judgement of dementia is specific, but confirmatory testing is needed for symptomatic people who GPs judge as not having dementia.How this fits inPrevious studies in this area have investigated the accuracy of GP clinical judgement as a screening test for dementia in unselected people attending a primary care clinic; or as a retrospective test based on their knowledge of their patient; or derived the accuracy of judgement from the medical records, which may not reflect the judgement of the clinician. The role of the GP in supporting a more effective route to diagnosis for people with dementia is a research priority for patients, carers and clinicians. This study shows that, in a symptomatic older adult, prospective clinical judgement may be useful for helping to confirm a diagnosis of dementia, whereas GP judgement should not by itself be used to exclude dementia.

The way that a diagnosis of dementia is delivered to patients, what information is provided and what practical advice and support is arranged has a lasting impact and deserves at least as much attention as the process of assessment and investigation. Individuals and their families require an honest yet sensitive discussion about the nature and cause of their problems, using non-technical language and tailored to their priorities and needs. This should lead on to the provision of good-quality information in an accessible format. Priorities for intervention include medication review, attention to sensory deficits, appropriate pharmacological and nonpharmacological treatment, best use of memory aids and strategies and discussion of driving eligibility, financial entitlement and legal advice. Referral onwards should be made to an appropriate individual or service to provide ongoing emotional and practical support and signposting.

To improve the characterisation and the understanding of VCI by examining reaction time (RT), the intra individual variability of RT (IIV), errors, practice, the effects of processing load (e.g. the influence of distracting information) and the effects of hesitancy in cognitively healthy (CH) ageing compared to patients with Subcortical Ischaemic VCI (SIVCI). In addition, the potential influence of the task used to measure these factors upon these results was investigated. The DSM5 requires a measure of brain processing speed to aid in the diagnosis of vascular dementia, but there is no indication of which test to use.

We studied resting-state oscillatory connectivity using magnetoencephalography in healthy young humans (N = 183) genotyped for APOE-ɛ4, the greatest genetic risk for Alzheimer’s disease (AD). Connectivity across frequencies, but most prevalent in alpha/beta, was increased in APOE-ɛ4 in a set of mostly right-hemisphere connections, including lateral parietal and precuneus regions of the Default Mode Network. Similar regions also demonstrated hyperactivity, but only in gamma (40–160 Hz). In a separate study of AD patients, hypoconnectivity was seen in an extended bilateral network that partially overlapped with the hyperconnected regions seen in young APOE-ɛ4 carriers. Using machine-learning, AD patients could be distinguished from elderly controls with reasonable sensitivity and specificity, while young APOE-e4 carriers could also be distinguished from their controls with above chance performance. These results support theories of initial hyperconnectivity driving eventual profound disconnection in AD and suggest that this is present decades before the onset of AD symptomology.