Mild cognitive impairment (MCI) is a clinical condition conceptualized as a stage between normal cognition and dementia. To diagnose it requires subjective cognitive impairment, evidence of cognitive impairment on cognitive testing but no abnormality in a person's functioning and no evidence of dementia (American Psychiatric Association, 2013). There has been growing interest in the condition over the past two decades or so because people with MCI are much more likely than people with no cognitive impairment to progress to dementia (Roberts et al., 2013). However, a significant percentage of people with MCI will not progress to dementia and some will revert to having normal cognition. Rates of progression and reversion to normal cognition vary widely in different studies (Manly et al., 2008). People with MCI experience worry about their symptoms and this is partly alleviated by receiving a diagnosis of MCI and being reassured they do not have dementia (Gomersall et al., 2017). The benefits of diagnosis also include gaining a greater understanding of their symptoms and accessing clinical support but a significant amount of uncertainty remains with regards to the risk of progression and recipients of the diagnosis remain frustrated at the lack of treatments for MCI (Gomersall et al., 2017). There has been much interest in improving the prediction of progression to dementia from MCI but to date, the best predictors of progression remain structured clinical and functional assessments, with some additional benefit from measures of cortical volume/thickness from brain imaging (Korolev et al., 2016). As yet, however, there are no interventions that can prevent (Kane et al., 2017) or treat (Cooper et al., 2013) MCI so it seems set to remain an important clinical entity for the foreseeable future.

We recruited eight general practice (GP) practices for a pilot cluster randomized controlled trial (RCT) of a digital versatile disc/leaflet encouraging South Asian people to seek timely help for memory problems. Primary outcomes were feasibility (proportion of patients expressing interest, consenting) and acceptability. Seventy-eight of one hundred and two (76%) potential participants consented; 76/78 (97%) were followed-up. Thirty-seven of forty-one (90%) receiving the intervention rated this acceptable. Only 17/41 (41%) accessed it; they appeared then to be more likely to seek timely help. The intervention was acceptable and feasible but a full-scale RCT would be very expensive. It may be proportionate to make this intervention available without a full-scale RCT.

Background: Mild cognitive impairment (MCI) may represent a transitional stage between normal functioning and dementia. Following the initial criteria developed by Petersen et al. in 1999, which focused on memory deficit in the context of otherwise normal cognition and general functioning, the concept has evolved with the introduction of subtypes of MCI and improved understanding of etiology. Our aim was to investigate current practice as well as familiarity with and attitudes toward the concept of MCI amongst UK old age psychiatrists.

Method: We sent an anonymized postal survey to all clinicians on the Royal College of Psychiatrists Old Age Psychiatry register. Questions covered attitudes toward the concept of MCI in addition to diagnostic criteria and assessment tools used.

Results: The response rate was 39% (453 of 1,154 questionnaires returned completed). The majority of respondents were consultants (83%) and 91% diagnosed MCI. Only 4.4% of the respondents thought that the concept of MCI was not useful and 79% of them required a memory complaint from either the patient or an informant for a diagnosis, but the majority did not have a specific cut-off on cognitive testing. Eighty-two percent reported that they required no or minimal impairment in activities of daily living for a diagnosis of MCI. The two most frequently used tools for assessment were the Mini-Mental State Examination and the Addenbrooke's Cognitive Examination–Revised.

Conclusions: Our survey shows that in the United Kingdom, the term MCI has become part of everyday clinical practice in psychiatry, suggesting that clinicians find it a useful term to conceptualize the transitional stage between normal aging and dementia. However, there is variability in diagnostic practice.

Background: People with dementia report lower quality of life, but we know little about what interventions might improve it.

Methods: We systematically reviewed 20 randomized controlled trials reporting the effectiveness of non-pharmacological interventions in improving quality of life or well-being of people with dementia meeting predetermined criteria. We rated study validity with a checklist. We contacted authors for additional data. We calculated standardized mean differences (SMD) and, for studies reporting similar interventions, pooled standardized effect sizes (SES).

Results: Pooled analyses found that family carer coping strategy-based interventions (four studies, which did not individually achieve significance; n = 420; SES 0.24 (range 0.03–0.45)) and combined patient activity and family carer coping interventions (two studies, not individually significant; n = 191; SES 0.84 (range 0.54–1.14)) might improve quality of life. In one high-quality study, a care management system improved quality of life of people with dementia living at home. Group Cognitive Stimulation Therapy (GCST) improved quality of life of people with dementia in care homes.

Conclusion: Preliminary evidence indicated that coping strategy-based family carer therapy with or without a patient activity intervention improved quality of life of people with dementia living at home. GCST was the only effective intervention in a higher quality trial for those in care homes, but we did not find such evidence in the community. Few studies explored whether effects continued after the intervention stopped. Future research should explore the longer-term impact of interventions on, and devise strategies to increase, life quality of people with dementia living in care homes or at home without a family carer.

Background: Western policy initiatives prioritize early diagnosis of dementia, but minority ethnic (ME) people currently present later to dementia specialist care than their indigenous counterparts. In order to allow the development of rational interventions, we completed this first study to explore the link between attitudes to help-seeking for dementia and the help-seeking pathway in the ME and indigenous population.

Methods: We purposively recruited a maximum variation sample comprising 18 family carers of people with dementia from the major UK ethnic groups. We used semi-structured interviews to determine the barriers to and facilitators of help-seeking, and the pathways to diagnosis. Two researchers independently coded interviews and recruitment continued until theoretical saturation was reached.

Results: ME carers, in contrast to the indigenous population, tended to delay help-seeking until they could no longer cope or until others commented on the problems. They often thought that families should look after their own elders and a diagnosis alone was purposeless. This appeared to relate to beliefs about the etiology of cognitive impairment, negative beliefs about psychiatry and their sense of familial responsibility.

Conclusions: ME carer beliefs were an important barrier to early diagnosis. Further work should explore whether an intervention can modify these attitudes, so that families understand that a diagnosis may allow planning and avoidance of crises; rather than signifying a failure in duty, disloyalty, or relinquishing of the caring role. Further research should focus on developing interventions to tackle barriers to help-seeking in ethnic minorities so that healthcare access can be equitable for all.

Background: Older people are commonly admitted to the acute hospital and increasing numbers will have dementia. In this study we systematically reviewed the prevalence, associations and outcomes of dementia in older people in the general hospital, to examine the range of diagnostic tools used and highlight gaps in the literature.

Methods: We searched the English language literature using Embase, PsychInfo and Medline. Studies were included if they used validated criteria for diagnosing dementia, involved subjects over the age of 55 years and were set in the general hospital.

Results: Fourteen papers were identified. Prevalence estimates for dementia in studies with robust methodology were 12.9–63.0%. Less than a third of studies screened for delirium or depression and therefore some subjects may have been misclassified as having dementia. The data were highly heterogeneous and prevalence estimates varied widely, influenced by study setting and demographic features of the cohorts. Patients with dementia in the acute hospital are older, require more hours of nursing care, have longer hospital stays, and are more at risk of delayed discharge and functional decline during admission.

Conclusions: When planning liaison services, the setting and demographic features of the population need to be taken into account. Most study cohorts were recruited from medical wards. More work is required on the prevalence of dementia in surgical and other specialties. A wider range of associations (particularly medical and psychiatric comorbidity) and outcomes should be studied so that care can be improved.