Failure on effort tests usually implies insufficient effort to produce valid cognitive test scores. However, many people with very severe cognitive impairment, such as dementia patients, will produce failing scores on nearly all effort tests. In such patients, effort tests have low specificity. The Medical Symptom Validity Test (MSVT) and the nonverbal MSVT (NV-MSVT) were designed to address this problem. They produce profiles of scores across multiple subtests to facilitate discrimination between low scores from people trying to feign impairment and low scores attributable to severe impairment. To study the specificity of the MSVT and NV-MSVT in people with very severe memory impairment, we tested (a) 10 institutionalized patients with dementia and (b) 10 volunteers who were asked to simulate memory impairment. It was hypothesized that the "possible dementia profile" would be found significantly more often in the dementia patients than in the simulators. The MSVT and the NV-MSVT both displayed 100% specificity in the dementia group, while retaining a combined sensitivity of 80% to suboptimal effort in the simulator group.

Background People living with dementia often develop distressing behavioural and psychological symptoms (BPSD) that can affect their quality of life and the capacity of family carers and staff providing support at home. This systematic review of qualitative studies considers the views and experiences of people living with dementia and care providers about these symptoms and what helps to reduce their impact. Methods The two-stage review involved (a) An initial mapping of the literature to understand the range of BPSD, and how it is operationalised by different groups, to develop a search strategy; (b) A search of electronic databases from January 2000 to March 2015, updated in October 2016. Included studies focused on people living in their own homes. Data extraction and thematic analysis were structured to provide a narrative synthesis of the evidence. Results We retrieved 17, 871 records and included relevant qualitative papers (n = 58) targeting community-dwelling people with dementia and family carers around the management of BPSD. Five key themes were identified: (1) Helpful interventions/support for BPSD management, (2) Barriers to support services for BPSD management, (3) Challenges around recognition/diagnosis of BPSD, (4) Difficulties in responding to aggression and other BPSD, and (5) Impact of BPSD on family carers and people living with dementia. Conclusions Family carers sometimes feel that their experiences of BPSD may not be evident to professionals until a crisis point is reached. Some helpful services exist but access to support, lack of knowledge and skills, and limited information are consistently identified as barriers to their uptake. The lack of common terminology to identify and monitor the range of BPSD that people with dementia living at home may experience means that closer attention should be paid to family carer accounts. Future research should include qualitative studies to evaluate the relevance of interventions.

The results fully replicate and extend initial findings of Chi et al. (2014) and McDaniel, Shelton, Breneiser, Moynan, and Balota (2011), showing substantial spontaneous retrieval deficits in PM performance of aMCI individuals. Possible brain mechanisms involved in this deficit are discussed and a novel hypothesis of more generic spontaneous retrieval deficits in aMCI is proposed. (PsycINFO Database Record

BackgroundNon-cognitive behavioural and psychological symptoms of dementia affect up to 90% of people with dementia during the disease course and result in distress, increased carer burden, high service utilization and unwanted moves to care homes. Research has focused on long-term settings and has not considered people with dementia living at home and at different stages of the disease trajectory. Our aim is to review systematically the evidence concerning non-pharmacological strategies to minimise behavioural and psychological symptoms in community-dwelling older people with dementia.Methods/DesignOur approach is a two-stage co-design: a systematic mapping of the broad evidence around behavioural and psychological symptoms followed by an in-depth systematic review of studies of non-pharmacological interventions for behavioural and psychological symptoms from the perspective of their impact on community-dwelling older people with dementia and their carers. The review will include published literature involving a wide range of electronic databases using sensitive and comprehensive searches and lateral searching including checking citations.We will produce a descriptive map of the studies by design and by the focus of interventions and apply further inclusion criteria, developed in conjunction with lay experts, to select studies for an in-depth systematic review that will include independent quality assessment and detailed data extraction by two reviewers.The review process will be integrated with stakeholder meetings and a multidisciplinary expert advisory group to guide the review parameters and shape the research questions on the management of behavioural and psychological symptoms in people with dementia. Because studies are likely to be diverse in methodology and interventions, we will conduct a narrative synthesis of the in-depth systematic review. If appropriate, we will pool studies in a meta-analysis. We will explore review findings at both stages through focus groups and interviews with service providers, practitioners, people with dementia and carers.DiscussionThis integrated review in collaboration with key stakeholders will synthesise research evidence to identify appropriate interventions for effective management of behavioural and psychological symptoms that supports people with dementia living at home and their carers, and which reflects their priorities. It will make recommendations for research and practice.Study registrationPROSPERO registration number: CRD42013004344