Memory Service Research Articles

Are we adequately reviewing confusion inducing drugs in patients referred to the memory assessment service?

AimsThe aim of this quality improvement evaluation project is to establish the standard of current practice in relation to reviewing confusion inducing drugs (CIDs) at the time of referral, as it has been hypothesised that these medications contribute to short term cognitive impairment. This is essential in order to establish the validity of the diagnostic processes of dementia syndrome in the memory assessment services.BackgroundIt has long been established that anti-cholinergic medications (ACMs) have contributed to short-term cognitive impairment in patients taking them. This is compounded with the fact that these medications may be continued without review, for longer than was originally intended. The impact of polypharmacy, subsequent anti-cholinergic burden, and the overlapping presence of delirium, may call into question the validity of a diagnosis of dementia in patients who have not been correctly vetted during the course of their assessment. This quality improvement evaluation aims to assess whether patients’ medications are being reviewed before diagnosing a memory disorder. This is in accordance with guidance set out by the NG97 NICE guidelines, The Royal College of Psychiatrists Memory Service National Accreditation Programme (MSNAP), and the National Institute on Ageing and Alzheimer's Association (NIA-AA).MethodAll new referrals to the memory assessment service during July and August 2019 were systematically reviewed and data extracted from the memory referral document and entries on RIO from first point of contact. The following data were recorded: patient ID, GPCOG/6CIT score, final diagnosis, CID prescriptions and CID review.ResultThe results were collated using a data-set of 216 patients (136 females and 80 males,) of which the mean age was 79 years. It was noted that 36% of patients had not had any sort of cognitive assessment before referral, which identifies an area for improvement. However the most substantial finding was that only 10 patients (5%) had a CID prescription review documented in the RIO notes.ConclusionOur data suggest that in our memory assessment service, only a small proportion of patients are having a documented review of their CIDs prior to diagnosis of dementia. In order to improve this and thus improve compliance with guidelines from the Royal College of Psychiatrists MSNAP and the NIA-AA, measures will be taken to issue each dementia support worker and nurse with a CID prescription review card, which will list those medications to consider and flag for review.

Quality improvement project: delirium awareness and training in coventry memory services

AimsBy way of Quality Improvement, this project aims to identify awareness levels, deliver a brief training and thus increasing the confidence of Memory Assessment Clinicians in detecting delirium.BackgroundPeople with dementia are at greater risk of delirium, and the acute confusion associated with delirium may be mistaken as part of their dementia. Despite having an estimated prevalence in care homes of 14.2% in the UK, delirium is under-recognised. Memory Assessment Clinicians may have low confidence in identifying and have low awareness of delirium despite being tasked with a triage and diagnostic role in dementia assessment. NICE has recently updated the guidelines on Delirium in March 2019 with recommendations on prevention and treatment of Delirium.MethodWe delivered a survey pertaining: (a)Awareness of Delirium NICE Guidelines(b)Confidence in spotting DeliriumWe used convenience sample of Memory Assessment Clinicians in Coventry. Overall, this survey was uptake by 17 clinicians. The pre training survey was done in early October 2019 and the post training survey was done shortly after the training, at the end of October 2019.A brief training comprising NICE Guidelines and using Confusion Assessment Method (CAM) was delivered. The survey is repeated post training and differences in result of level of confidence is done to measure changes. The survey assessed knowledge, beliefs, practices and confidence level regarding delirium detection.ResultPre training:17 clinicians took part in the survey. 59% was aware that there is a delirium NICE guidelines. 12% felt strongly agree, 41% agree and 47% felt neutral in their confidence of detecting delirium.Post training:10 clinicians took part in the survey. 50% felt strongly agree and 50% agree that they are confident in detecting delirium.Overall, the mean difference is 2 and the p value is 0.92034. we used Mann- Whitney Test to measure the difference in pre and post training which showed not significant at p < 0.05.Participants felt that the training was useful and relevant to practice.ConclusionThis study showed our clinicians have a good basic knowledge in detecting delirium. As a result of this study, we have created ‘Delirium checklist’ and Confusion Assessment Method (CAM) to be used during duty work. We also feel that the majority of delirium cases referred to us comes from the community base, thus our next step of the project will be to involve educational work with the community care home.

Service evaluation for services for younger people with dementia in east locality of north Wales

AimsTo evaluate Young-onset dementia (YOD) services in terms of referral, its appropriateness, time to diagnosis and other criteria as per protocol that we have adapted.MethodCase notes of those under 65 referred to Memory service for cognitive assessment between July 2017 and June 2018 were retrospectively reviewed to look at the time to diagnosis, appropriate referrals, post-diagnostic support, etc.ResultCompared to the previous evaluation, the number of patients referred to had increased from 47–48/ year earlier to 63/year. Only 1/3 were appropriate referral over the 10-year period whereas between 2017 and 2018 more than half were appropriate referrals. More than half of them were seen within 12 weeks of referral (35/63 available). Only 132/252 were diagnosed as having some form of dementia in the previous evaluation which was about 13 cases of YOD a year. In contrast, in our new evaluation 19 patients were diagnosed with some form of dementia. Inappropriate referrals had reduced by more than 50%. Appropriateness and timely referral had improved in this time frame.ConclusionDementia is considered ‘young onset’ when it affects people under 65 years of age. It is also referred to as ‘early onset’ or ‘working age’ dementia. However, this is an arbitrary age distinction that is becoming less relevant as increasingly services are realigned to focus on the person and the impact of the condition, not the age. Teaching sessions to educate primary & secondary care clinicians on appropriateness and timely referrals have helped in improving the care for patients with YOD. Services need to be developed further to be able to diagnose & support those with YOD. Repeat evaluations every year would help to inform improvement in quality & appropriateness of referrals.

Diagnostic Accuracy of 10/66 Dementia Protocol in Fijian-Indian Elders Living in New Zealand.

The 10/66 dementia protocol was developed as a language and culture-fair instrument to estimate the prevalence of dementia in non-English speaking communities. The aim of this study was to validate the 10/66 dementia protocol in elders of Indian ethnicity born in the Fiji Islands (Fijian-Indian) living in New Zealand. To our knowledge, this is the first time a dementia diagnostic tool has been evaluated in the Fijian-Indian population in New Zealand. We translated and adapted the 10/66 dementia protocol for use in in Fijian-Indian people. Individuals (age ≥ 65) who self-identified as Fijian-Indian and had either been assessed for dementia at a local memory service (13 cases, eight controls) or had participated in a concurrent dementia prevalence feasibility study (eight controls) participated. The sensitivity, specificity, positive predictive value, and Youden’s index were obtained by comparing the 10/66 diagnosis and its sub-components against the clinical diagnosis (reference standard). The 10/66 diagnosis had a sensitivity of 92.3% (95% CI 70.3–99.5), specificity of 93.8% (95% CI 75.3–99.6), positive predictive value of 92.3% (95% CI 70.3–99.5), and negative predictive value of 93.8% (95% CI 75.3–99.6). The study results show that the Fijian-Indian 10/66 dementia protocol has adequate discriminatory abilities to diagnose dementia in our sample. This instrument would be suitable for future dementia population-based studies in the Fijian-Indian population living in Aotearoa/New Zealand or the Fiji-Islands.

Digital housekeeping: Living with data

The availability and affordability of memory and other services formats to store digital material has proliferated over the past 15 years. Making, sharing and storing digital material is now a mundane practice that is part of a broader ecology of living with different kinds of data. This article examines routines of managing networked technologies in the home: digital housekeeping through three core practices of sharing and storing everyday data. The first, what we will call tidying, involves the everyday routines of cleaning up the mess of data through practices such as syncing material ‘in the cloud’, creating inboxes and manually moving digital data such as pictures and videos to ‘folders’. The second set of practices comprises more periodic, but deeper forms of sorting, spring cleaning. During digital spring cleaning, the focus is upon decluttering digital data by disposing, editing and other forms of curation whereby digital materials can be ‘located’ when desired in the future. The final set of practices, moving house, consists of the shift or relocation of digital data from one device or service to another. Depending upon the age and functioning of the device or service, this often involves changes in format to render digital data useful into the future, the realisation of lost data, as well as an additional assessment of the value of moving such digital material. Through fine-grained attention to the ways in which households live with digital materials, this article considers the engagement with and consequence of everyday data in our lives.

A National Memory Clinic Survey to Assess Provision for People from Diverse Ethnic Backgrounds in England and Wales.

English national guidelines regarding dementia assessment and management recommend consideration of cultural and linguistic diversity when assessing people with cognitive complaints. To date there has been no assessment of adherence to these guidelines. We aimed to assess whether current services provided in memory assessment services (MAS) adhere to national policy, in their approach to the assessment and management of individuals with memory problems from minority ethnic backgrounds. We sent a survey to 213 memory services in England and Wales. Twenty MAS from seven regions responded to the survey. We found that 80% (16) provided translated resources, 70% (14) used cognitive assessment tools that are culturally sensitive and appropriate, and 65% (13) showed good use of sufficiently skilled and knowledgeable interpreters. Communication barriers, particularly language, were raised as a potential obstacle to diagnosing minority ethnic patients. Memory clinics appear to reflect national policy for the assessment and management of memory problems in minority ethnic patients. However, only a minority of services responded and they may be more engaged in considering these populations. We need wider knowledge of practice to explore how guidelines support healthcare professional’s assessment of patients from minority ethnic groups in memory service diagnostic procedures.

Predictors of Aged Residential Care Placement in Patients Newly Diagnosed with Dementia at a New Zealand Memory Service

Background: Aged residential care (ARC) is a significant cost of dementia care. However, little is known about the predictors of ARC placement in New Zealand (NZ), which is important for service planning and funding. The aim of this study was to investigate the sociodemographic and clinical characteristics that predict future ARC placement among people who received a new diagnosis of dementia at a NZ memory service. Methods: Routinely collected baseline sociodemographic and clinical data in a memory service from 14/06/13 and 14/12/19 were linked with administrative LTC admission data up to 24/1/2020. Survival analysis was carried out using multivariate Cox regression models to determine significant risk factors and their association with ARC placement. Results: A total of 657 NZ European, Māori and Pacific Islander patients were included in the analyses. There were significant differences by ethnicity including age, living situation, comorbidity and ARC placement. Adjusted analyses showed that risk of ARC placement was increased by older age (HR 1.02 per year, 95%CI:1.00–1.05), moderate dementia (HR 1.45, 95%CI:1.05–1.99), severe dementia (HR 2.25, 95%CI:1.33–3.81), and antipsychotics (HR 1.55, 95%CI:1.04–2.32); while risk was reduced in Māori (HR 0.35, 95%CI:0.18–0.68) and Pacific Islanders (HR 0.32, 95%CI:0.20–0.51). Conclusions: Despite having more severe dementia and higher comorbidity, Māori and Pacific Islanders had reduced risks of ARC placement. There is an urgent need to better understand dementia care issues and to ensure culturally safe and responsive dementia services are accessible by Māori and Pacific Islanders living in the community.

Community Visioning for Innovation in Integrated Dementia Care: Stakeholder Focus Group Outcomes.

It is estimated that 5.4 million Americans have some form of dementia and these numbers are expected to rise in the coming decades, leading to an unprecedented demand for memory care housing and services. In searching for innovative options to create more autonomy and better quality of life in dementia care settings, repurposing existing structures, in particular vacant urban malls, may be 1 option for the large sites needed for the European model of dementia villages. These settings may become sustainable Dementia Friendly City Centers (DFCC), because in the case of enclosed mall construction, the internal infrastructure is in place for lighting, HVAC, with varied spatial configuration of public spaces. This paper describes the community engagement research being conducted by a research team at a Midwestern university, laying groundwork for the DFCC model for centralized dementia programs, services, and attached housing. Using graphics and plans for the DFCC model using an 800 000 ft2 closed mall site, focus groups were conducted with family caregivers of individuals with dementia and long-term care residents to gather their input and response to the model. The participants identified both opportunities and barriers in using an adaptive reuse of a large site for an innovative integrated dementia care model and through the cross-case analysis of the focus group findings, 5 themes were identified which include: community education and acceptance; amenities and activities; maintaining family connections; resident adaptation and staffing.

PRIMER: Profiling Interrupts using Electromagnetic Side-Channel for Embedded Devices

Recent proliferation of CPS and IoT devices has led to an increasing demand for analyzing performance and timing of event-driven computational activity, especially interrupts and exceptions. However, these devices typically lack hardware resources, power, and system-software infrastructure for profiling/monitoring such events. Even when feasible, the profiling/monitoring activity itself can perturb the performance and timing of the timing-sensitive activity to be analyzed, therefore producing misleading results. Thus, we present PRIMER, a novel approach for profiling interrupts. PRIMER leverages existing unintentional (side-channel) electromagnetic emanations of the profiled/monitored device to identify its asynchronous execution (e.g., interrupt handlers). PRIMER leaves the monitored system (and its behavior) completely unchanged, requires no system resources or support, and introduces neither overheads nor perturbation in the monitored system. We validate PRIMER by analyzing signals that correspond to five different types of interrupts on an IoT device (ARM Cortex-M), achieving 99.5% accuracy (with no false positives), and on an MSP430 microcontroller-based device with even better accuracy. We also demonstrate the effectiveness of PRIMER in analyzing page faults and network interrupts when executing real-world applications on a more sophisticated embedded device (ARM Cortex-A8), and show that the results provided by PRIMER can provide useful insights about an application's interaction with the system's virtual memory and network-oriented services.

FogQSYM: An Industry 4.0 Analytical Model for Fog Applications

Industry 4.0 refers to the fourth evolution of technology development, which strives to connect people to various industries in terms of achieving their expected outcomes efficiently. However, resource management in an Industry 4.0 network is very complex and challenging. To manage and provide suitable resources to each service, we propose a FogQSYM (Fog–-Queuing system) model; it is an analytical model for Fog Applications that helps divide the application into several layers, then enables the sharing of the resources in an effective way according to the availability of memory, bandwidth, and network services. It follows the Markovian queuing model that helps identify the service rates of the devices, the availability of the system, and the number of jobs in the Industry 4.0 systems, which helps applications process data with a reasonable response time. An experiment is conducted using a Cloud Analyst simulator with multiple segments of datacenters in a fog application, which shows that the model helps efficiently provide the arrival resources to the appropriate services with a low response time. After implementing the proposed model with different sizes of fog services in Industry 4.0 applications, FogQSYM provides a lower response time than the existing optimized response time model. It should also be noted that the average response time increases when the arrival rate increases.

Adaptive MRAM Write and Read with MTJ Variation Monitor

Temperature and wafer-level process variations significantly degrade operation efficiency of Spin-transfer torque random access memory (STT-MRAM) and magnetoelectric random access memory (MeRAM), where the write and read reliability issues are exacerbated by the variations. We propose adaptive write and read schemes for highly efficient STT-MRAM and MeRAM programming and sensing that optimally selects write and read pulses to overcome process and temperature variation. With adaptive write, the write latency of STT-MRAM and MeRAM cache are reduced by up to 17 and 59 percent respectively, and application run time is improved by up to 41 percent. With adaptive read, the sensing margin is dramatically improved by 1.4X while maintaining read disturbance correctable by error-correcting-code (ECC) correction. To further mitigate read disturbance impact on memory system, additional adaptive read scheme can dynamically lower read voltage according to the proposed monitor result. It can extend memory service time by haft to one year, and reduce read disturbance induced memory failure by 59 to 84 percent. To better support these schemes, we also propose, design, and evaluate low-cost MTJ-based variation monitor, which precisely senses process and temperature variation. The monitor is over 10X faster, 5X more energy-efficient, and 20X smaller compared with conventional thermal monitors of similar accuracy.

Adaptive Reuse of Distressed Malls for Dementia-Friendly City Centers: Outcomes From Community Focus Groups

It is estimated that 5.4 million Americans have some form of dementia and these numbers are expected to rise in the coming decades, leading to an unprecedented demand for memory care housing and services. In searching for innovative options to create more autonomy and better quality of life in dementia care settings, repurposing existing structures, in particular vacant urban malls, may be one option for the large sites needed for the European model of dementia villages. These settings may become sustainable Dementia Friendly City Centers (DFCC), because in the case of enclosed mall construction, the internal infrastructure is in place for lighting, HVAC, with varied spatial configuration of public spaces. This presentation describes the community engagement research being conducted by a research team at a Midwestern university, laying groundwork for the DFCC model for centralized dementia programs, services and attached housing. Focus group outcomes from four disciplines (caregiver, physician, designer, community development) detailed four principle themes including : community revitalization, building sustainability, urban regreening and the nurturing of innovation to further a culture of dementia care which is inclusive, progressive and convergent with the needs of an aging. The DFCC model can be seen as one opportunity to make life better not only for those with needs associated with dementia now, but also for ourselves in the future, therefore educating and updating future stakeholders about the value of this model of care will be critical in transforming current hurdles into future opportunities.

Thinking outside of the Box: Medical Provider Perspectives on Adaptive Reuse of Closed Mall Sites for Mixed-Use Dementia Programs and Services

The double societal hit of dementia and infectious disease outbreaks like the COVID-19 pandemic have raised a convergence of concerns for the future of care settings for people living with dementia. It is estimated that 5.4 million Americans have some form of dementia and these numbers are expected to rise in the coming decades, leading to an unprecedented demand for memory care housing and services. In searching for innovative options to create more autonomy and better quality of life in dementia care settings, repurposing existing structures, in particular vacant urban malls, may be one option for the large sites needed for the European model of dementia villages. These settings may become sustainable Dementia Friendly City Centers, because with enclosed mall construction, the internal infrastructure is in place for lighting and HVAC, with varied spatial configuration of public spaces. This paper describes the community-based focus group research with medical providers who addressed designs for adaptive reuse of an existing closed mall case study site. Focus group outcomes included discussions on four central themes about the adaptive reuse including: applicability of the concept, spectrum of programs, economic feasibility and onsite medical care.

Current memory service professional practice surrounding assistive technology in England: What do memory service professionals need in order to provide information on, and support access to, assistive technology for people living with dementia?

AbstractBackgroundAssistive Technology (AT) has the potential to support people with dementia to remain independently at home for longer. Unfortunately, to date AT is not fully integrated into Dementia care. A recent European position paper(2) called for better education and training of stakeholders and a central information source in order to successfully deploy AT. Key stakeholders involved in deployment of AT in England are Memory Service (MS) professionals who are the first professionals to give information to people with dementia after diagnosis. This study aims to explore current MS practice surrounding AT.MethodTwo surveys were designed and piloted with MS professionals in England. One survey targeted MS managers/lead clinicians to explore MS characteristics and the other looked an individual professionals practice. Questions included fixed and open‐ended responses. They were distributed by the Royal College of Psychiatrists and the National Institute for Health Research to more than 117 MS. Quantitative data was analysed using descriptive statistics and qualitative data using thematic analysis.Result665 professionals completed a survey. Professionals lack key resources to provide information and support access to AT; only 7% have access to a protocol and 12% to a demonstrator site, 31% receive training, and 38% have a named professional responsible for AT. Professionals are positive about AT and view AT as a solution to a problem. However, they describe assessing risk, were risk was viewed negatively. Professionals were aware of a range of AT available but concerns were raised about potential knowledge gaps and challenges of keeping abreast with technological advances. Information and access pathways were tailored to the individual resulting in no one pathway to AT.ConclusionOverall, professionals provided an insight into current practice and challenges of giving information and supporting people with dementia to access AT. They also suggested ways to improve the current provision and thus deployment of AT.1. Meiland F, Innes A, Mountain G, Robinson L, van der Roest H, García‐Casal JA, et al. Technologies to support community‐dwelling persons with dementia: a position paper on issues regarding development, usability, effectiveness and cost‐effectiveness, deployment, and ethics. JMIR Rehabilitation and Assistive Technologies. 2017;4(1).

The status of current clinical practice in diagnosis of young onset dementia in England: Findings from The Angela Project

AbstractBackgroundThe presentation of dementia in young people is complex and challenging, often resulting in delays in receiving a confirmed diagnosis and appropriate support. A recent Delphi consensus has derived minimum and gold standards for the diagnostic workup that international expert clinicians consider best practice. This presentation will review the results of a large case note audit that assessed compliance with these standards in current UK clinical practice.Method403 patient records of young people who received a diagnosis of dementia in the last 5 years were audited according to our minimum and gold standards. Records were obtained from memory services within eight different National Health Service locations from across England.ResultWe found significant differences between the sites in meeting the standards, though all sites had median scores that were below 50% compliance for both the minimum and gold standard. This suggests that current UK assessments fail to reach an acceptable standard.ConclusionFurther consultation with clinicians and young people with dementia is necessary to understand local impediments to meeting an acceptable standard and to identify interventions that can lead to improvement.

Predictors of care home placement in people diagnosed with dementia in a New Zealand memory service

AbstractBackgroundAs the global population ages the burden of dementia is expected to rise across all cultures around the world. Much of the social sector costs of dementia care in high income countries is due to residential care. The aim of this study is to investigate the sociodemographic and clinical characteristics that predict care home placement in people diagnosed with dementia at a New Zealand memory service.MethodThis cohort study used routinely collected clinical data gathered on referrals to the Memory Service at Middlemore Hospital in South Auckland between 2013 and 2019. Survival analysis was carried out using Cox regression models to determine significant risk factors and their associations with care home placement.ResultComparison by ethnic group showed that NZ Europeans were on average older compared to Māori and Pacific Islanders, and were more likely to be living alone. As might be expected, age, more severe cognitive impairment and living alone were independently associated with increased risk of care home placement. After adjustment for these factors, Māori and Pacific Islanders were still less likely to be placed in a care home. People diagnosed with mixed dementia were more likely to be placed in a care home than those diagnosed with other dementia subtypes. Prescription of antipsychotics was highly associated with care home placement however we were unable to establish if antipsychotics were prescribed before or after placement.ConclusionThese data will help us to understand differences in adverse outcomes in people with dementia. The ability of Māori and Pacific Islanders to continue to care for their family member with dementia needs to be examined in more detail, as the findings might empower and enable other families to postpone care home placement.

A fully automated cognitive screening tool based on assessment of speech and language

AbstractBackgroundThe dramatic recent rise in referrals to specialist memory clinics has been associated with an increased proportion of patients referred with Functional Memory Disorder (FMD), i.e. non‐progressive cognitive complaints. These referrals have exerted time and financial pressures on secondary care services, impairing their ability to deliver high‐quality care for patients with neurodegenerative cognitive disorders. We have developed a fully automated system, “CognoSpeak”, which enables risk stratification at the primary‐secondary care interface and ongoing monitoring of patients with memory concerns.MethodWe recruited 15 participants to each of four groups: Alzheimer’s disease (AD), Mild Cognitive Impairment (MCI), FMD and healthy controls. Participants responded to 12 questions posed by a computer‐presented talking head. Automatic analysis of the audio and speech data involved speaker segmentation, automatic speech recognition and machine learning classification.ResultCognoSpeak could distinguish between participants in the AD or MCI groups and those in the FMD or healthy control groups with a sensitivity of 86.7%. Patients with MCI were identified with a sensitivity of 80%.ConclusionOur fully automated system achieved levels of accuracy comparable to currently available, manually administered assessments. Greater accuracy should be achievable through further system training with a greater number of users, the inclusion of verbal fluency tasks and mood assessments. The current data supports CognoSpeak’s promise as a screening and monitoring tool for patients with MCI. Pending confirmation of these findings, it may allow clinicians to offer patients at low risk of dementia earlier reassurance and relieve pressures on specialist memory services.

Stakeholders’ views around the concept and diagnosis of mild cognitive impairment and their understanding of dementia prevention: A qualitative study

AbstractBackgroundMany people live with an awareness of mild cognitive changes and an associated dementia risk. Previous authors describe the uncertainties of this liminal state between cognitive health and dementia. The interface of this group with health services is growing, driven by early dementia diagnosis campaigns and research about the preventative potential of health promotion. This brings both preventative opportunities and risks of medicalisation, which have not previously been qualitatively explored from the perspectives of professionals, clients and their family members. We ask how services respond to people with memory concerns currently, and how future dementia prevention interventions for people with memory concerns should be structured.MethodWe conducted qualitative interviews with 18 people aged 60+ with subjective or objective memory problems, six family members, 10 health and social care professionals and 11 third sector workers. Interviews were audio‐recorded, transcribed and analysed using an inductive thematic approach. Interviews were conducted as part of the APPLE‐Tree (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline) programme, which is an international collaboration run in the UK.ResultThree main themes were identified: 1) acknowledging the liminal state, compounded by current, discordant health service responses, which medicalise memory concerns yet situate responsibilities for their management with patients and families; 2) challenges of enabling change in contexts of physical and cognitive frailty and social disengagement, and 3) building on existing values, cultures and routines to facilitate the process of implementing and maintaining behavioural and lifestyle changes.ConclusionThis study extends our understanding of the complex liminal position of people with memory concerns seeking help. Effective dementia prevention must empower individuals within challenging contexts and acknowledge their existing values. This cannot be realised within current memory service responses. Our findings further feed into a dementia prevention intervention which is currently being developed as part of the APPLE‐Tree programme.

The Oxford Brain Health Centre: Embedding dementia research in clinical practice

AbstractIntroductionThe Oxford Brain Health Centre (BHC) is an ambitious and innovative joint clinical‐research service that aims to bring UK NHS memory services into the 21st century by addressing gaps between clinical practice and research advances into dementia. This NIHR‐funded partnership between Oxford Health NHS Foundation Trust and the University of Oxford will be the first psychiatry‐led service of its kind, developing the model for a specialist service that can be adopted throughout the UK health service.Methods and MaterialsThe BHC will augment current NHS memory services by providing high‐quality assessments not routinely available in clinical service, e.g. MRI rather than CT brain scans, and developing novel diagnostic tools sensitive to earlier pathological changes. Enhanced information will be fed into clinical notes, improving the quality of information available to clinicians empowered to make more confident and accurate timely diagnoses. The BHC will increase opportunities for patients and relatives to participate in research by embedding research in the clinical service, through use of clinical data for research, completion of additional research assessments, and re‐contact about future research opportunities. All research data collected at the BHC will be made openly available to the scientific community through the BHC Research Database, encouraging collaborative and transparent research. The BHC actively involves public contributors with lived experience at all stages of the development and evolution of the service.ResultsA six‐month pilot of 150 patients from a single memory clinic will launch in early 2020 to demonstrate feasibility and refine procedures, before expanding to other memory clinics. The pilot will incorporate evaluation of service‐user and clinician feedback and health economic measures.ConclusionsTo prepare the UK health system for the future of dementia treatment and ultimately prevention, the BHC will provide a translational interface, enabling new advances in diagnosis, risk reduction and treatment to be rapidly implemented in clinical practice to provide better care for patients.

Access to Health Services in Older Minority Ethnic Groups with Dementia: A Systematic Review.

BACKGROUND/OBJECTIVESWhile it is acknowledged that minority ethnic (ME) groups across international settings face barriers to accessing care for dementia, it is not clear whether ME groups access services less frequently as a result. The objective of this review is to examine whether ME groups have longer delays before accessing dementia/memory services, higher use of acute care and crisis services and lower use of routine care services based on existing literature. We also examined whether ME groups had higher dementia severity or lower cognition when presenting to memory services.DESIGNSystematic review with narrative synthesis.SETTINGNonresidential medical, psychiatric, memory, and emergency services.PARTICIPANTSTwenty studies totaling 94,431 older adults with dementia or mild cognitive impairment.MEASUREMENTSWe searched Embase, Ovid MEDLINE, Global Health, and PsycINFO from inception to November 2018 for peer‐reviewed observational studies which quantified ethnic minority differences in nonresidential health service use in people with dementia. Narrative synthesis was used to analyze findings.RESULTSTwenty studies were included, mostly from the U.S. (n = 13), as well as the UK (n = 4), Australia (n = 1), Belgium (n = 1), and the Netherlands (n = 1). There was little evidence that ME groups in any country accessed routine care at different rates than comparison groups, although studies may have been underpowered. There was strong evidence that African American/Black groups had higher use of hospital inpatient services versus U.S. comparison groups. Primary care and emergency services were less well studied. Study quality was mixed, and there was a large amount of variability in the way ethnicity and service use outcomes were ascertained and defined.CONCLUSIONThere is evidence that some ME groups, such as Black/African American groups in the U.S., may use more acute care services than comparison populations, but less evidence for differences in routine care use. Research is sparse, especially outside the U.S.