Background:Malnutrition and dehydration in residential aged care (nursing homes) are problematic worldwide, particularly for residents with dementia. However, conducting research to improve residents' nutritional health can be challenging. Aims:This paper describes challenges, facilitators and recommendations following an intervention to enhance nutrition and hydration care. Methods:Meaningful Engagement in Nutritional Understanding (MENU; 2018-2021) was a participatory nutrition support intervention initiated in two Tasmanian care homes. Mixed methods evaluation explored nutrition and hydration status, knowledge and care practices with residents with dementia, staff and family; and the challenges to, and facilitators of, project implementation. Results:This study found nutrition and hydration to be problematic. However, despite multiple challenges, a participatory approach may help engage stakeholders and encourage action in this area. Challenges included resident recruitment, care home and staff engagement, and external factors. Facilitators included Nutrition Champions, the participatory research approach, and tailored resources and education. Conclusions:The study has implications for conducting more effective nutrition research in residential aged care, particularly with people with dementia, nursing and other care staff, to better understand their experiences and enhance care practices. Nursing staff are key to effective participatory research in residential aged care and to ensuring residents' optimal nutrition and hydration.

Objectives This study compared discussion board involvement between family carers and non-carers in the Understanding Dementia Massive Open Online Course (UD-MOOC). Methods A mixed methods observational cohort study of family carers and non-carers was undertaken over the February-April 2020 UD-MOOC. Discussion board engagement was measured as number of posts and replies and examined longitudinally using mixed models. Discussion topics were explored through structural topic models (STM). Subsequently, thematic analysis of STM derived-topic exemplars was conducted to contextualise these discussions. Results Family carers were (n = 2320) found to post (p < 0.001) and reply (p = 0.029) significantly more often than non-carers (n = 2392). Of the 32-STM derived-topics, meaningful activities (mean Delta = 0.007, 95% CrI [0.005-0.100]), personal stories of diagnosis (mean Delta = 0.007, 95% CrI [0.005-0.009]), and family history of dementia (mean Delta = 0.006, 95% CrI [0.004-0.008]) were discussed significantly more frequently by family carers compared to non-carers. Conclusion These results may reflect underlying motivational differences and circumstantial relevance. Perhaps the greater engagement by family carers is related to a sense of having inadequate relevant offline social resources, where engagement in the UD-MOOC discussion boards may serve as means to share experiences with others.

To ensure the well-being, quality of life and quality of care of people living with dementia, carers need to have the necessary communication knowledge and skills to respond appropriately to a person's changing abilities and needs. Understanding carers' communication experiences and needs in the context of dementia care is an important step in enabling effective education and support for carers. This study aimed to investigate communication challenges faced by carers and their coping strategies, influencing factors, and communication education and training needs. The sample involved 258 carers enrolled in an online dementia care program, and data were collected using a 16-item questionnaire. Descriptive statistics and non-parametric inferential statistics, including Chi-square, Mann-Whitney U, Kruskal-Wallis and Spearman's rho, were used to analyse the data. The participants reported experiencing a range of challenges in communicating with people living with dementia and employing various strategies in addressing these challenges, either independently or with the support of others. Improvements in a number of factors would be beneficial for carers, including more time for caring, more care and social support, as well as enhanced skills in communicating with people living with dementia. A large majority of the participants indicated their need for education or training in communication knowledge and skills, and those with higher learning needs were likely to be younger, care workers and other health professionals, and those with less care experience. Recommendations are made for future research and efforts to maximise effective education and support for carers of people living with dementia.

OBJECTIVES:To assess evidence regarding the effects of interventions aimed at improving dementia literacy for different groups of non-health-professionals.METHODS:A systematic search for relevant interventions was conducted using a range of online databases (e.g. CINAHL, Embase, Medline, ProQuest, and PsycINFO) and hand-searching of reference lists. Eligible interventions were identified based on predefined inclusion/exclusion criteria and methodological quality criteria. Meta analyses were performed using a random-effects model.RESULTS:The final review included 14 interventions, which were either randomised controlled trials or non-randomised controlled trials. The interventions had varied contents, approaches, settings, and outcome measures. Evidence of improved dementia literacy in various aspects was found, and the intervention effects were strongest on knowledge of dementia.DISCUSSION:There is evidence for the positive impact of dementia literacy interventions on different groups of non-health-professionals. Best practices in intervention contents, approaches, and outcome measures should be examined to guide future interventions.

Background People with young onset dementia (YOD) have unique needs and experiences, requiring care and support that is timely, appropriate and accessible. This relies on health professionals possessing sufficient knowledge about YOD. This study aims to establish a consensus among YOD experts about the information that is essential for health professionals to know about YOD. Methods An international Delphi study was conducted using an online survey platform with a panel of experts ( n = 19) on YOD. In round 1 the panel individually responded to open-ended questions about key facts that are essential for health professionals to understand about YOD. In rounds 2 and 3, the panel individually rated the collated responses in terms of their importance in addition to selected items from the Dementia Knowledge Assessment Scale. The consensus level reached for each statement was calculated using the median, interquartile range and percentage of panel members who rated the statement at the highest level of importance. Results The panel of experts were mostly current or retired clinicians (57%, n = 16). Their roles included neurologist, psychiatrist and neuropsychiatrist, psychologist, neuropsychologist and geropsychologist, physician, social worker and nurse practitioner. The remaining respondents had backgrounds in academia, advocacy, or other areas such as law, administration, homecare or were unemployed. The panel reached a high to very high consensus on 42 (72%) statements that they considered to be important for health professionals to know when providing care and services to people with YOD and their support persons. Importantly the panel agreed that health professionals should be aware that people with YOD require age-appropriate care programs and accommodation options that take a whole-family approach. In terms of identifying YOD, the panel agreed that it was important for health professionals to know that YOD is aetiologically diverse, distinct from a mental illness, and has a combination of genetic and non-genetic contributing factors. The panel highlighted the importance of health professionals understanding the need for specialised, multidisciplinary services both in terms of diagnosing YOD and in providing ongoing support. The panel also agreed that health professionals be aware of the importance of psychosocial support and non-pharmacological interventions to manage neuropsychiatric symptoms. Conclusions The expert panel identified information that they deem essential for health professionals to know about YOD. There was agreement across all thematic categories, indicating the importance of broad professional knowledge related to YOD identification, diagnosis, treatment, and ongoing care. The findings of this study are not only applicable to the delivery of support and care services for people with YOD and their support persons, but also to inform the design of educational resources for health professionals who are not experts in YOD.

Most massive open online courses (MOOCs) are offered in English, including those offered by non-English speaking universities. The study investigated an identified English language dementia MOOC’s accessibility and effectiveness in improving the dementia knowledge of non-native English speaker participants. A total of 6,389 enrolees (age range 18–82 years; 88.4% female) from 67 countries was included in analyses. Dementia knowledge was measured by the Dementia Knowledge Assessment Scale (DKAS) before and after the MOOC completion. Rates of completion were also compared. Native English speakers (n = 5,320) were older, more likely to be female, less likely to be employed, and had lower educational attainment than non-native English speakers (n = 1025). Native English speakers were also more likely to care for or have cared for a family member or friend living with dementia than were non-native English speakers. Native English speakers had a significantly higher DKAS score both pre- (M = 33.0, SD = 9.3) and post-MOOC (M = 44.2, SD = 5.5) than did non-native English speakers (M = 31.7, SD = 9.1; and M = 40.7, SD = 7.7 for pre- and post-MOOC, respectively). Non-native English speakers with low pre-MOOC dementia knowledge scores gained significantly less dementia knowledge following course completion than did native English speakers (p <.001, adjusted for age and education). There was no significant difference between the two groups in their likelihood of completing the MOOC. Our findings suggest that non-native English speakers are motivated and able to complete the MOOC at similar rates to native English speakers, but the MOOC is a more effective educational intervention for native English speakers with low dementia knowledge.

OBJECTIVES:To investigate dementia knowledge within a rural Australian general public cohort and understand demographic predictors of knowledge in this population.DESIGN:A cross-sectional study comprising quantitative surveys.SETTING:321 participants were recruited from the Tasmanian general public (February-September 2017).PARTICIPANTS:28% of participants were from remote or outer regional postcodes; the remainder were from inner regional areas. The median age was 46 years; 35% were male. 30% had participated in prior dementia education, 29% had worked with people living with dementia, and 23% had no identified personal experience of people living with dementia.INTERVENTIONS:No interventions were conducted as part of this study.MAIN OUTCOME MEASURES:Dementia knowledge was assessed using the Dementia Knowledge Assessment Scale. Demographic variables were also collected.RESULTS:Mean dementia knowledge was moderate and participants scored highest on the care considerations subscale. Those with personal experience with a person living with dementia scored significantly higher on all subscales, and overall, than those without. Dementia education, general education, and previous work, care or close relationship with people living with dementia were all significant predictors in a regression model explaining nearly a third of the variance in overall dementia knowledge.CONCLUSION:While personal experience of dementia improves knowledge of the condition, dementia education is the most important predictor. Deficits identified in knowledge of risk factors, and incomplete knowledge about aspects important to quality care, suggest a need for further education for the general public, particularly in the light of the rising prevalence of dementia in ageing rural populations.

Objectives: The Consumer Access, Appraisal, and Application of Services and Information for Dementia (CAAASI-Dem) was developed to examine individuals' self-assessed confidence in their ability to access, appraise and use dementia services and information. The CAAASI-Dem is the only tool to date to measure this crucial component of dementia literacy. This study was designed to validate its structural validity. Method: Data was collected from 3277 participants enrolled in an on-line dementia course. The five-factor structure of the CAAASI-Dem, which was derived from a previous exploratory factor analysis, was evaluated using confirmatory factor analysis. Internal reliability, convergent and divergent validity, and known-groups validity were assessed. Results: The five-factor model demonstrated good fit with the observed data with the removal of 2 items and movement of 1 item across the factors. The resultant 24-item five-factor CAAASI-Dem showed very good sub-scale internal reliability and satisfactory convergent and divergent validity. There was good discrimination between groups of participants with different levels of care experience. Conclusion: The results provided evidence for the 24-item CAAASI-Dem as a valid and reliable five-dimensional scale. Limitations of the study are discussed, and recommendations are made for future research and practice.

Background The ability to locate, navigate and use dementia services and information, either for oneself or in providing care for others, is an essential component of dementia literacy. Despite dementia literacy being understood to be inadequate in many settings, no validated instrument exists to measure these elements. Here we describe the development and preliminary validation of the Consumer Access, Appraisal and Application of Services and Information for Dementia (CAAASI-Dem) tool. Methods Items were adapted from existing health literacy tools and guided by discussion posts in the Understanding Dementia Massive Open Online Course (UDMOOC). Following expert review and respondent debriefing, a modified CAAASI-Dem was administered to UDMOOC participants online. On the basis of descriptive statistics, inter-item and item total correlations and qualitative feedback, this was further refined and administered online to a second cohort of UDMOOC participants. Exploratory factor analysis identified underlying factor structure. Items were retained if they had significant factor loadings on one factor only. Each factor required at least three items with significant factor loadings. Internal consistency of factors in the final model was evaluated using Cronbach’s alpha coefficients. Results From a pool of 70 initial items with either a 5-point Likert scale (Not at all confident – Extremely confident; or Strongly agree – Strongly disagree) or a binary scale (Yes – No), 65 items were retained in CAAASI-Dem-V1. Statistical and qualitative analysis of 1412 responses led to a further 34 items being removed and 11 revised to improve clarity. The 31 item CAAASI-Dem-V2 tool was subsequently administered to 3146 participants, one item was removed due to redundancy and EFA resulted in the removal of an additional 4 items and determination of a five factor structure: Evaluation and engagement; Readiness; Social supports; Specific dementia services ; and Practical aspects . Conclusions The five factors and 26 constituent items in CAAASI-Dem align with functional, critical, and communicative aspects of dementia health literacy from the perspective of the carer. As a screening tool for people living with dementia and their carers, CAAASI-Dem potentially provides a means to determine support needs and may be a key component of the dementia literacy assessment toolbox.

Introduction Dementia increases malnutrition risk. Malnutrition rates for people living with dementia in residential aged care are high world-wide, often 50% or over. Malnutrition increases ill health and decreases quality of life. This presentation outlines the collaborative development of action plans to improve care for people with dementia in residential aged care in an Australian study: Meaningful Engagement in Nutritional Understanding (MENU). Methods The MENU participatory, whole-of-organisation intervention study involves residents, family members and staff collaboratively selecting and implementing customised and best-evidence nutrition care strategies for people living with dementia. Baseline mixed methods data were collected from two participating aged care homes (October 2018 - January 2019). Nutrition knowledge, attitudes and organisational practices were measured via a survey (49 staff & family members), qualitative data from workshops (47 staff, residents & family members), and nutritional screening and ethnographic observations (18 residents living with dementia). Data were analysed using descriptive and thematic approaches and shared with staff, residents and family members at workshops, along with education on best-evidence nutritional care to assist in identification of key intervention areas. Nutrition Champions at each home guided the chosen intervention strategies. Results Staff nutrition knowledge was moderate (mean score 6/11 on the survey), with a third having undertaken nutrition education. Observations suggested areas for improvement focused on strategies to increase hydration, maintaining adequate snacks between meals, and enhancing the mealtime environment – including staff and residents eating together and decreasing noise levels in dining rooms. Workshop attendance was challenging as attending to work activities was prioritised over participating in educational research. Despite this, workshop participants, Nutrition Champions, and researchers successfully worked together to consider the data and develop and implement a customised action plan for each care home. Conclusions Early findings show the positive impact of customised and evidence-based nutritional care for people with dementia in residential care, supported by tailored nutrition education. Implementing the adaptable and transferable MENU model assisted staff to focus on what worked best for the residents in their care and in their unique setting. This may enhance staff capacity to practice best evidence care, reduce nutrition-related ill health and optimise quality of life for people with dementia in residential aged care.

Walsh (2020) underscores how dementia leads to a cognitive transformative experience, which can result in a change in preferences, values, and beliefs. This transformation supports placing greater decisive moral weight on current preferences of people living with dementia than what is solely indicated in their advance directives. We agree with Walsh (2020) that people with dementia can undergo a substantial cognitive transformative experience, as with the case of a vegetarian and former animal rights activist suddenly deciding to start eating meat (Banks and Nøhr 2013). Complicating this picture however is the reality that cognitive dysfunction is a primary feature of dementia, which can influence a person’s ability to consent. Although certain people with dementia-associated cognitive dysfunction can have impaired ability to consent, many are still capable of consenting to medical research participation, as indicated by scores on a comprehensive capacity assessment test (Palmer et al. 2017). Most work on informed consent and dementia focuses on the clinically defined changes in cognition or on the cognitive transformative experience that people living with dementia could undergo, as highlighted by Walsh (2020). However, dementia is more than just a disorder of cognition; people living with dementia function in various social environments; and their decisions exist in a context. Focusing solely on cognition or cognitive transformative experiences risks downplaying other factors that caregivers, medical personnel, and researchers must consider. Such factors are critical in honoring the capacity of someone living with dementia to express preferences or wishes, and in providing an environment that fosters opportunities for autonomous decision-making.

Introduction: Providing accessible and evidence-based education to improve the knowledge and understanding of dementia in care personnel is a key target of the Global action plan on dementia. Since 2013, the free Understanding Dementia Massive Open Online Course (UDMOOC) has delivered evidence-based education about dementia to the broadest possible cohort, amongst whom residential aged care staff are highly represented. This study investigated motivation to participate, engagement, and effectiveness of the UDMOOC as a means to meet the knowledge needs of both nurses and care assistants working in this sector. Methods: Indices of engagement over three modules (1: The Brain, 2: The Diseases, 3: The Person) were examined for 4305 participants in the UDMOOC who consented to participate in research and identified as nurses or care assistants working in residential aged care. Motivation to undertake the course was determined quantitatively by survey responses and qualitatively by structural topic modelling of responses to an open-ended question. Knowledge of dementia was assessed pre and post UDMOOC participation using the Dementia Knowledge Assessment Scale (DKAS) with a maximum possible score of 50. Results: Probability of course completion was significantly higher for nurses (0.68 +/- 0.018) than care assistants (0.64 +/- 0.015). Baseline DKAS scores were also significantly higher for nurses than care assistants (37.9 +/- 7.33 vs 33.5+/- 8.14). Lower pre UDMOOC DKAS scores were associated with reduced probability of completion of the first UDMOOC module (The Brain) and the entire course, particularly for care assistants. Both groups showed significantly improved post course DKAS scores (44.2+/- 5.03 vs 40.6+/- 7.36) across all subscales, with care assistants showing a greater magnitude of improvement. Analysis of 3587 responses revealed the predominant motivating factors for both nurses and care assistants were: to acquire new knowledge in order to deliver the best possible care; to address deficits in their existing training; and to develop new skills and deliver person-centred care. Care assistants particularly reported on the need to build on their existing practical dementia care skills in order to provide better care. Conclusion: Both care assistants and nurses in residential aged care recognise the need to address deficiencies in their training which impact on their capacity to deliver appropriate care to residents living with dementia. The UDMOOC demonstrably improves knowledge of dementia in both groups, even for those with limited initial knowledge. This free online course is an effective way to provide accessible and evidence-based information about dementia and dementia care to the care workforce.

BackgroundThe attitude of General Practitioner's (GP's) towards dementia and confidence in their clinical abilities impacts on diagnosis rates and management of the condition. The purpose of the present research is to refine and confirm the reliability and validity of the General Practitioner Attitudes and Confidence Scale for Dementia (GPACS-D) as a tool to measure confidence and attitude.MethodsA sample of 194 GP volunteers attending dementia education workshops were recruited to complete the GPACS-D before and after the workshop. Volunteer respondents comprised both GP Registrars and GP Supervisors. Analyses included Confirmatory Factor Analysis (CFA), measures of internal consistency, Pearson correlations, and a comparison of subscale scores between cohorts (T-Test for independent samples).ResultsFindings of the CFA support a 15-item, 3-factor model with four items removed due to poor performance and one item moved between factors. The resultant model exhibited good fit (x(2)=103.88; p=.105; RMSEA=.032; PCLOSE=.915; CFI=.967; TLI=960), with acceptable internal consistency. Subscales exhibited clear discriminant validity with no underlying relationships between subscales. Finally, total and subscale scores exhibited good discrimination between groups who would be expected to score differently based on experience and level of exposure to dementia.ConclusionThe 15-item, 3-subscale GPACS-D is a reliable and valid measure of GP confidence and attitudes toward dementia. The subscales clearly distinguish between groups who might be expected to score differently from each other based on their training or professional experiences. The psychometric properties of the GPACS-D support its use as a research tool.

The prevalence of dementia is escalating world-wide and knowledge deficits remain a barrier to community inclusiveness and quality care. The need for quality, comprehensive education has been identified as a key priority for global action plans on dementia. The Understanding Dementia Massive Open Online Course (UDMOOC) offers the potential to improve dementia knowledge globally. Completion rates for the UDMOOC (2016–2017) were on average 42% of enrolments, and 69% of participants care or have cared for people with dementia. The current study shows baseline dementia knowledge was positively related to previous learning about dementia from various types of exposure to the condition including having family members and/or working with people with the condition, and having undertaken dementia education. However, knowledge of all participant groups showed substantial improvements after completion of the UDMOOC. This was shown regardless of educational background and previous experience of dementia, and group differences after completing the UDMOOC were minimised. The UDMOOC is therefore an effective knowledge translation strategy to improve dementia knowledge for a diverse, international learner group.

Affordable and accessible evidence-based educational resources are needed to address persisting deficiencies in dementia literacy. The Wicking Dementia Research and Education Centre Understanding Dementia Massive Open Online Course (UD MOOC) was designed to meet the broad dementia educational needs of both health workers and family carers and is delivered as a free, 9 week on-line course focussed on the brain, pathophysiology, symptoms and care. This study examined the impact of the UDMOOC on dementia knowledge, a key component of dementia literacy. Dementia knowledge of participants was determined before and after completing the UD MOOC using the Dementia Knowledge Assessment Scale (DKAS 2.0). This validated, reliable scale comprises 25 items considered important in understanding dementia and associated care needs. In addition to standard demographic parameters, data was collated on participant experience of dementia, including prior exposure to dementia education, and experience obtained in the workplace and/or as a family carer. 1718 UDMOOC participants completed the DKAS 2.0 comprising a regional distribution of 81% Oceania, 8.2 % Americas, 7.2 % Europe, 2.3% Asia and less than 1% Africa. A significant improvement in dementia knowledge was evident following completion of the UDMOOC. Mean dementia knowledge score prior to undertaking the UDMOOC was 34.7 (+/- 9.12) out of a possible 50 and after undertaking the UDMOOC was 43.7 (+/-6.01). 22% achieved the target score of 46 prior to the UDMOOC while 78% achieved this target score after completing the UDMOOC. The improvements in dementia knowledge were evident in both health care worker and family carer groups irrespective of experience or educational background, suggesting the UDMOOC is an effective means of delivering dementia education to a wide cross section of participants. The UDMOOC is an effective means of improving dementia knowledge and will contribute to improving the dementia literacy of health care providers, people living with dementia, their families and the broader community globally. Given its relevance and accessibility, the UDMOOC is a valuable and widely applicable public health intervention.

Background: Advance care planning aims to ensure that care received during serious and chronic illness is consistent with the person’s values, preferences and goals. However, less than 40% of people with dementia undertake advance care planning internationally. Aim: This study aims to describe the perspectives of people with dementia and their carers on advance care planning and end-of-life care. Design: Systematic review and thematic synthesis of qualitative studies. Data sources: Electronic databases were searched from inception to July 2018. Results: From 84 studies involving 389 people with dementia and 1864 carers, five themes were identified: avoiding dehumanising treatment and care (remaining connected, delaying institutionalisation, rejecting the burdens of futile treatment); confronting emotionally difficult conversations (signifying death, unpreparedness to face impending cognitive decline, locked into a pathway); navigating existential tensions (accepting inevitable incapacity and death, fear of being responsible for cause of death, alleviating decisional responsibility); defining personal autonomy (struggling with unknown preferences, depending on carer advocacy, justifying treatments for health deteriorations); and lacking confidence in healthcare settings (distrusting clinicians’ mastery and knowledge, making uninformed choices, deprived of hospice access and support at end of life). Conclusion: People with dementia and their carers felt uncertain in making treatment decisions in the context of advance care planning and end-of-life care. Advance care planning strategies that attend to people’s uncertainty in decision-making may help to empower people with dementia and carers and strengthen person-centred care in this context.

AIMS AND OBJECTIVES:To review communication interventions that aim to improve regular care interactions between people with dementia and their carers in various settings; and to examine the impact of such interventions on both carer and care-receiver outcomes.BACKGROUND:Effective communication is imperative to ensure quality of care for people living with dementia. Due to neurodegenerative changes, people with dementia encounter ongoing and progressive difficulties in both understanding and expressing themselves. This in turn creates challenges for carers, which highlights the need for equipping them with necessary communication skills to respond to the specific communication needs of people with dementia.DESIGN:Systematic review and meta-analysis.METHOD:Medline, Embase, CINAHL, ProQuest and PsycINFO databases were searched for eligible interventions with any date of the publication. Hand searching was also conducted through reviewing the reference lists of relevant articles. The screening and selection of studies were based on the inclusion/exclusion criteria for eligibility and the methodological quality assessment checklist. Random-effects meta-analyses were conducted on comparable quantitative data. The review is reported following the PRISMA reporting guidelines.RESULTS:Seventeen studies were included in the final review, including 12 randomised controlled trials (RCTs), three nonrandomised controlled trials (NRCTs) and two controlled before-after interventions. The intervention designs, settings and outcome measures were varied. The findings suggest that the communication training had a positive impact on both carer and care-receiver outcomes, albeit to different degrees. The intervention effects were found to be strongest on carer communication skills and knowledge.CONCLUSION:There is solid evidence for the positive impact of communication training on the skills and knowledge of carers. More research is needed regarding the effects of such educational interventions on carer physio-psychological outcomes and care-receiver neuropsychiatric symptoms. It is important to establish best practices in training design, develop validated outcome measures and adopt consistent reporting approaches.RELEVANCE TO CLINICAL PRACTICE:The increasing global prevalence of people with dementia manifests across clinical and community contexts. The profound impact of dementia on communication and associated care raises the imperative for enhanced health worker and carer communication skills to meet the needs of this particular client group. The findings of this review indicate that educational interventions incorporating face-to-face and diverse instructional delivery methods in dementia communication showed positive outcomes for communication skills in all carer groups and warrant inclusion as strategies in dementia training.

There is a documented need and growing demand for evidence-based consumer-friendly education to enable more effective dementia care and wider adoption of strategies to prevent dementia. The Wicking Dementia Research and Education Centre developed the Understanding Dementia Massive Open Online Course (UD-MOOC) to increase knowledge of dementia and person-centered care practices, particularly for those providing care. The Centre's Preventing Dementia MOOC (PD-MOOC) was developed to educate people on the scientific basis of dementia risk reduction, both those interested in reducing their own risk, and those providing related services. The 9-week UD-MOOC examined how the brain is affected by diseases that cause dementia, symptoms, diagnosis, stages, management, and perspectives of those affected and caregivers. The 5-week PD-MOOC explored non-modifiable and modifiable risk factors, myths about dementia risk and causes, and barriers and enablers of health-behaviour change. MOOC completion was defined as a passing grade of 70% on 3 quizzes. To assess MOOC impact, completing participants were asked how they had applied knowledge gained and a natural-language processing algorithm was used to identify common themes. Six iterations of the UD-MOOC from 2013 to 2017 attracted a total of 119,611 enrolments, with 47,793 (40%) completing the course. Two offerings of the PD-MOOC in 2016 and 2017 attracted 27,048 enrolments and 13,778 (51%) completed. 76% of 2017 UD-MOOC and 75% of 2017 PD-MOOC feedback survey respondents agreed they had already applied the knowledge gained from the MOOC. Thematic analyses revealed UD-MOOC completers were applying a more person-centered approach to care, changing work practices, and sharing knowledge with others, and had improved understanding of dementia, and more empathy for and confidence in supporting people experiencing dementia. PD-MOOC completers specified they were increasing physical, social and cognitive activity, improving their diet, losing weight, having check-ups for vascular risk factors, more motivated to reduce their risk, and sharing knowledge with others. The large enrolments and high completion rates for Wicking's dementia MOOCs highlight the scale of demand for accessible quality dementia education. Participant feedback demonstrates that the MOOCs are improving both knowledge and practice, with potential large-scale impacts for dementia care and prevention.