Background: This scoping review investigates the effectiveness of mindfulness meditation in alleviating sleep disturbances among individuals with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). With the rising prevalence of dementia and its profound impact on cognitive function and quality of life, this review aims to synthesize existing research and identify gaps in the literature. Methods: We systematically searched six electronic databases (CINAHL, Embase, Medline, PsycINFO, PubMed, and Scopus) from 2004 to 2024, yielding 462 potentially relevant articles. Screening was conducted using ASReview, an AI ranking tool, which facilitated the selection of studies. Ultimately, seven studies that met our stringent eligibility criteria were included in the review. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines for reporting. Results: Our findings indicate that mindfulness meditation significantly improves sleep quality, reduces insomnia severity, and enhances overall well-being in this at-risk population. Notably, interventions that combine structured, face-to-face sessions with at-home practice emerged as the most effective. Conclusions: Despite these positive outcomes, methodological limitations, including small sample sizes and reliance on self-reported measures, underscore the need for more rigorous long-term studies. This review highlights the potential of mindfulness meditation as a low-cost, scalable intervention to improve sleep and cognitive health in older adults, paving the way for future research and clinical applications.

Black people are twice as likely to experience stroke, more likely to have a stroke younger and have poorer outcomes than White people. Clinical factors and socio-economic status account for only half of the increased risk, suggesting systemic and structural factors are also involved. Lived experience of Black people living with stroke (BPLS) in England is under-researched. Candidacy Theory describes how people access health services, how perceptions of eligibility and suitability are socially constructed, and how this can perpetuate disadvantage. By applying Candidacy Theory to the findings of our qualitative study on the experiences of BPLS in accessing and navigating health services, we identified some key drivers of current inequalities and ways of addressing them. Our study aimed to gain greater understanding of how BPLS in England engage with and experience healthcare services. We applied Candidacy Theory to gain insight into experiences of and inequalities faced by this community and implications for service provision. 20 semi-structured interviews were conducted with adults living with stroke, identifying as African, Caribbean or of mixed heritage. Purposeful sampling included men and women with a broad range of ages and ethnicities, recruited via community and national organisation gatekeepers. Interviews were analysed using Reflexive Thematic Analysis and mapped onto the Candidacy Theory framework. Findings highlighted the plethora of barriers facing BLPS in accessing services, including lack of knowledge of stroke risk or symptoms, and not being believed or listened to by healthcare professionals. While navigating services, participants encountered misalignment with their cultural and age-specific needs. Offers of services were sometimes rejected due to distrust of medical treatment, stigma associated with mental health support, lack of representation, and previous negative experiences, such as microaggression, stereotyping and racism. Participants suggested that trust-building with healthcare professionals could be impeded by historic negative experiences, further exacerbated where there is poor awareness and communication. BPLS face particular disadvantages and barriers in reducing their stroke risk and accessing health services post-stroke. To address these, a holistic, systemic approach is needed, to develop inclusive and “culturally safe” services, build trust and improve accessibility of services.

The Living Well with Dementia (LivDem) group intervention aims to support people to adjust following a diagnosis of dementia and is delivered across the UK and abroad. However, LivDem was designed for older people with dementia and may not address the needs of younger adults. This study aimed to identify the perspectives of LivDem facilitators on adapting the LivDem course for younger adults. Data was collected as part of an online facilitator survey and included questions requiring either ordinal or free-text responses. Responses from fifteen facilitators were analysed using descriptive statistics and Reflexive Thematic Analysis. The former indicated that participants believed that LivDem could be beneficial for younger adults and were in favour of it being adapted. Qualitative analysis generated two main themes, the first of which (‘The domino effect’: Unique Challenges for Younger Adults) had two subthemes: ‘Life and opportunities stripped away’ and ‘Impacting on everyone’. Theme 2, ‘Good to be with peers’: The Importance of Age-Appropriate Support, also had two subthemes: Groups ‘full of old people’ and Groups ‘specifically for younger people’. These findings reinforce the argument for creating age-appropriate services for people with young-onset dementia and will inform an adapted version of LivDem that provides age-appropriate support.

Introduction The Living Well with Dementia (LivDem) intervention is an eight-week, group based post-diagnostic course for people living with dementia that aims to facilitate adjustment to the diagnosis. We set out to establish the views of course facilitators in two areas: first, the benefits of LivDem for participants, their families and for facilitators; and second whether carers can be more actively involved in the course. Method An online survey was distributed to health and social care workers in the UK and overseas who were delivering the LivDem course. The survey explored LivDem facilitators’ opinions about the benefits of LivDem and whether families could be involved more actively in the course. Results Twenty-eight facilitators completed the survey, with an average course completion rate of 2.43. One participant worked in Italy and another in Ireland, with the remainder working in the UK. All respondents agreed that LivDem was of benefit to participants with dementia (e.g. by enabling them to talk more openly about their dementia) and that it also strengthened participants’ relationships with their partner. Many facilitators also felt that they had learnt new skills that they used outside the course. While respondents largely agreed that carers should be more actively involved there were strong concerns that this should not impact on participants’ ability to express themselves within sessions. Discussion This study is consistent with research elsewhere suggesting that attending the LivDem course facilitates a greater ability to talk openly about dementia. The more active involvement of carers in LivDem needs to be balanced against risks that people with dementia may be inhibited from discussing their dementia. Accordingly, the study team have begun to explore ways to deliver LivDem directly to family units.

Introduction: Despite the psychological challenges that dementia creates, comparatively little attention has been paid to how individuals or families can be helped to adjust to dementia. One of the few interventions to do this is the Living well with Dementia (LivDem) post-diagnostic course. LivDem focuses on supporting individuals to talk more openly about their dementia. However, while family supporters attend preliminary and follow up sessions, their role is limited and finding a way for them to be more actively involved might enhance the impact of the intervention and make it more flexible. We therefore set out to explore how the current LivDem intervention could be adapted for couples and families. Method: We completed eleven semi-structured interviews and focus groups with four groups of stakeholders: people living with dementia and their families: LivDem facilitators; researchers in this area; and psychotherapists with experience of working with couples or families living with dementia. Interviews were transcribed and analysed using reflexive thematic analysis. Results: Four main themes were generated: "Hear the impact on everybody"; People who are "ready to do that"; "It's such a fine line"; and "You deal with it in your family". Participants emphasised that the intervention needs to be delivered by willing and skilled facilitators to people who are ready to talk in their family context; and this intervention needs to be embedded within connected services. Conclusions: Stakeholders felt that it would be possible to adapt the LivDem model for couples and families so long as a number of conditions were met. An adapted family or couple version of LivDem has the potential to facilitate improved adaptation to dementia and to be incorporated into dementia pathways and delivered with the NHS and the voluntary sector. Further research is needed to establish the feasibility of such an intervention.

Objectives Nostalgic memories are more social than other forms of autobiographical recall, often refer to atypical events, express more positive affect and reflect life as meaningful. Recalling a nostalgic (compared to ordinary) memory increases self-esteem, self-growth, meaning in life and social connectedness for people living with dementia. We set two objectives: to work with people living with dementia to develop an intervention based on nostalgia, and to assess whether couples could engage in nostalgic conversations. Method Our research fell into three phases. Initially, we consulted with people living with dementia and with carers to identify the parameters for a nostalgic intervention. From this, we drafted a workbook that contained triggers for nostalgic conversations, which we then took back to the public contributors for refinement. Finally, we trialled the workbook over 5 weeks with six couples, each of which included a person living with dementia. We assessed pre- and post-intervention self-esteem, self-growth, meaning in life and social connectedness for participants with dementia and social connectedness for carers. We then calculated Reliable Change Index scores and established levels of clinically significant change. We also interviewed couples at the end of the intervention to explore its implementation and acceptability. Results All six couples could identify nostalgic memories, with five couples successfully integrating the nostalgic conversations into their day-to-day lives. A sixth couple found it difficult to engage fully with the intervention, but still considered it useful. All six couples manifested a reliable change in at least one outcome, with one couple showing reliable change across three outcomes. Conclusion The psychological benefits of nostalgia have been robustly demonstrated in laboratory-based studies. This co-production of an intervention that sets nostalgic recall into the context of a conversation has clinical potential but requires further investigation through a larger study.

Although dementia may affect the reliability of autobiographical memories, the psychological properties of nostalgic memories may be preserved. We compared the content of nostalgic (n = 36) and ordinary (n = 31) narratives of 67 participants living with dementia. Narratives were rated according to their self-oriented, social, and existential properties, as well as their affective content. Social properties and affective content were assessed using a linguistic word count procedure. Compared to the ordinary narratives described in the control condition, nostalgic narratives described a typical events, expressed more positive affect, and had more expressions of self-esteem and self-continuity. They were also rated higher on companionship, connectedness and the closeness of relationships, and reflected life as being meaningful. Despite their cognitive impairment, people living with dementia experience nostalgia in similar ways to cognitively healthy adults, with their nostalgic narratives containing self-oriented, social, and existential properties.

This study set out to investigate whether there were disparities in service provision for people from Black, Asian and Minority Ethnic (BAME) communities compared to White British (WB) communities within a primary care led dementia service in the UK. Data were extracted from 30 cases from three BAME (African-Caribbean, South Asian and Chinese) communities who had been referred to a dementia service between April 2016 and December 2017. We then extracted data from 30 WB cases matched for gender, age (within 5 years) and General Practitioner surgery. We compared service provision for both samples around assessment, diagnosis and post-diagnostic support. The primary source of information in the BAME sample was less likely to be recorded as being the main carer and more likely to be an adult child. Cases from both samples were equally likely to have a CT scan. People from BAME communities were less likely to receive a cognitive assessment, and when they did they scored at a lower level. There was no difference between samples for the diagnoses that cases received, but BAME cases were more likely to be assessed as being low rather than medium or high risk. While cases from both samples were equally likely to receive medication, BAME cases were more likely to be seen by a psychiatrist. Significantly more people from the WB sample were recorded as using or being offered more than one form of community support. This study of a primary care-based dementia service suggests that while many areas of service provision showed no evidence of inequality, important differences remain including the time at which people present for assessment and the range of post-diagnostic services which are discussed. Further research is required to establish the likely causes of these disparities.

Dementia represents a more immediate threat for older than for younger adults. Consequently, different strategies may be used to defend the self against the threat of dementia. We hypothesised that older (compared to younger) adults are more likely to manifest mnemic neglect (in which information that is threatening to the self is selectively forgotten) to reduce distress for dementia-related information.Fifty-nine participants aged under 50 and 44 participants aged over 50 recalled 24 dementia-related statements that were either high or low in negativity. Participants were randomised to recall statements that referred either to themselves or another person. High-negativity, self-referent statements had the most substantial threat potential. The recall of older (but not younger) participants for high-negativity (vs. low-negativity) dementia-related statements was impaired when these statements referred to the self rather than to another person. These results indicate that older adults evince mnemic neglect in response to self-threatening information about dementia.

Dementia represents a substantial threat to the self. However, to date, there is no reliable way to measure how threatened people feel by dementia. This article reports on two online studies. In Study 1, 248 participants rated statements about dementia according to their threat to well-being. In Study 2, 99 participants (all students at the University of the West of England) completed the emerging scale (the Threat of Dementia Scale or ToDS). We validated this by examining its associations with conceptually related measures, including the revised Fraboni Scale of Ageism and the Fear of Alzheimer’s Disease Scale. Study 1 yielded 13 statements that were highly intercorrelated and comprised a single factor. In Study 2, the ToDS demonstrated good construct validity and acceptable test–retest reliability. Higher levels of distancing predicted lower scores on the ToDS. The ToDS is a reliable and valid instrument that is the first statistically validated method of examining the extent to which dementia threatens well-being.

Objective Thought suppression may not work effectively when people have a cognitive impairment. This study tests whether participants with dementia showed lessened or enhanced recall and recognition of dementia-related words compared with a control population. Methods Fifty participants living with dementia with mild levels of cognitive impairment and a control group of 52 participants without a diagnosis of dementia took part. A list of 12 words, composed of six dementia-related and six neutral words matched for frequency and length, was read out on four occasions, with the word order being varied for each presentation. Recognition was also assessed. Results There was an interaction between word-type and participant group at both recall and recognition. While control participants recalled more neutral than dementia-related words, there was no difference for dementia participants. However, dementia participants recognised a significantly higher proportion of the dementia-related words, while there was no difference in word-type recognition for control participants. Conclusions This study adapts a social psychological paradigm to explore whether an important psychological mechanism for reducing distress can be affected by cognitive impairment. Our findings suggest that for people living with dementia, thought suppression may be either ineffective in reducing conscious awareness of distal threats or operate in an ironic fashion. While threatening proximal material may be repressed from awareness, distal threats may return into implicit awareness. This casts new light on research and has clinical implications.

BACKGROUNDStudies with non-clinical populations show that nostalgia increases psychological resources, such as self-esteem and social connectedness.OBJECTIVESOur objectives were to find out if the benefits of nostalgia in non-clinical populations generalize to people with dementia and if nostalgia facilitates recall of dementia-related information.METHODSAll three experiments recruited participants with mild or moderate levels of dementia. Experiment 1 tested whether nostalgia (compared to control) enhances psychological resources among 27 participants. Experiment 2 used music to induce nostalgia (compared to control) in 29 participants. Experiment 3 compared recall for self-referent dementia statements among 50 participants randomized to either a nostalgia or control condition. Findings across experiments were synthesized with integrative data analysis.RESULTSNostalgia (compared to control) significantly increased self-reported social connectedness, meaning in life, self-continuity, optimism, self-esteem, and positive (but not negative) affect (Experiments 1-3). Compared to controls, nostalgic participants also recalled significantly more self-referent dementia-related information (Experiment 3).CONCLUSIONThis series of experiments extends social psychological research with non-clinical populations into dementia care, providing evidence that nostalgia significantly enhances psychological resources. The finding that nostalgia increased recall of self-referent statements about dementia suggests that this emotion lends participants the fortitude to face the threat posed by their illness. The finding has potentially important clinical implications both for the development of reminiscence therapy and for facilitating adjustment to a diagnosis of dementia.

ObjectiveWe tested whether people with dementia manifest selective forgetting for self-threatening information, the mnemic neglect effect (MNE). This selective forgetting is observed among healthy adults in the recall, but not the recognition, of self-threatening feedback. MethodsSixty-four statements about dementia were rated for their level of negativity by 280 staff and students at University of the West of England. The 12 statements rated as most negative and the 12 statements rated as least negative were then read to 62 people with dementia. Participants were randomized to 1 of 2 conditions with the statements referring either to self or to another person. High-negativity and self-referent statements had strong threat potential. Participants recalled the statements and then completed a recognition task, which consisted of the 24 previously read statements and 24 new statements. ResultsParticipants manifested the MNE: They recalled fewer high-negativity (compared with low-negativity) statements, but only when these referred to the self rather than another person. This pattern occurred independently of levels of depression or anxiety. Participants also made more self-protective intrusion errors when the statements referred to the self than another person. Participants did not differ in their recognition of statements. ConclusionThe MNE occurs among people with dementia. The selective forgetting of highly negative, self-referent statements serves to protect the self against the threat that dementia represents. Given the similarities between the MNE and the clinical phenomenon of repression, the findings may mark psychological processes that are implicated in the acceptance (or lack thereof) of a dementia diagnosis.

Hospital adverse events, such as falls, violence and aggression, security, self-harm, and suicide, are difficult to manage in older people with dementia. The purpose of the present study was to determine whether protected engagement time (PET) resulted in lower adverse events and incidents compared to comparable non-PET wards for people admitted to inpatient older people's mental health wards. Ten inpatient wards for older people were included. Five followed a PET-management pathway, while five continued usual care. All adverse events and incidents were recorded in routine hospital records over 72 weeks. Data were gathered from these records and analysed as rate per person per week to assess differences in frequency and type of adverse events between wards. A total of 4130 adverse events were recorded. In the PET wards, a mean of 0.38 adverse events occurred per person per week compared to 0.40 in non-PET wards. No statistically-significant differences were found between PET and non-PET wards for adverse events (P = 0.93), or for adverse events of any particular type (P ≥ 0.15). Therefore, there is no evidence to suggest that PET has any impact on adverse events in older people's mental health wards. Further investigation with a larger cohort is warranted, using a definitive, phase 3, clinical trial.

Hospital adverse events such as falls, violence and aggression, security, self-harm and suicide are difficult to manage in older people with dementia. The purpose of this study was to determine whether Protected Engagement Time (PET) resulted in lower adverse events and incidence compared to comparable non-PET wards for people admitted to inpatient older people’s mental health wards. Ten inpatient psychiatric units for older people were recruited. Five followed a PET management pathway, whilst five continued usual care. All adverse events and incidents were recorded in routine hospital records over 72 weeks. Data were gathered from these records and analysed as rate per person per week to assess for differences in frequency and type of adverse events between wards. 4130 adverse events were recorded. In the PET wards, a mean of 0.38 adverse events occurred per person per week compared to 0.40 in non-PET wards. No statistically significant differences were found between PET and non-PET wards for adverse events (p=0.93), nor for adverse events of any particular type (p≥0.15). Hence these is no evidence to suggest that PET had any impact of adverse events in older people’s psychiatric wards. Further investigation with a larger cohort, is warranted on this intervention through a definitive, phase three, clinical trial.

Dr Toby Smith, School of Health Sciences, University of East Anglia, Norwich, UK Dr Allan Clark, Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK Emily Dodd, Department of Health and Social Sciences, University of the West of England, Bristol, UK Mary-Ellen Khoo, Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK Sarah Heneker, Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK Dr Jane Cross, School of Health Sciences, University of East Anglia, Norwich, UK Prof Rik Cheston, Department of Health and Social Sciences, University of the West of England, Bristol, UK Prof Richard Gray, Nurse Education and Research, Hamad Medical Corporation, Doha, Qatar Prof Chris Fox, Norwich Medical School, University of East Anglia, Norwich, UK Prof Fiona Nolan, School of Health Sciences, University of Essex, Colchester, Essex, UK