ObjectivesDetection of dementia is essential for improving the lives of patients but the extent of underdetection worldwide and its causes are not known. This study aimed to quantify the prevalence of undetected dementia and to examine its correlates.Methods/setting/participantsA systematic search was conducted until October 2016 for studies reporting the proportion of undetected dementia and/or its determinants in either the community or in residential care settings worldwide. Random-effects models calculated the pooled rate of undetected dementia and subgroup analyses were conducted to identify determinants of the variation.Primary and secondary outcome measuresThe outcome measures of interest were the prevalence and determinants of undetected dementia.Results23 studies were eligible for inclusion in this review. The pooled rate of undetected dementia was 61.7% (95% CI 55.0% to 68.0%). The rate of underdetection was higher in China and India (vs Europe and North America), in the community setting (vs residential/nursing care), age of <70 years, male gender and diagnosis by general practitioner. However, it was lower in the studies using Mini-Mental State Examination (MMSE) diagnosis criteria.ConclusionsThe prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community.

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The long term effects of maternal smoking during pregnancy on the cognitive development of the child are not well understood due to conflicting findings in past research. The aim of this paper was to provide an up to date, critical review of the literature to determine whether there is evidence of a relationship between tobacco smoke exposure in utero and cognitive functioning. We systematically reviewed observational studies (dated 2000-2011) that examined associations between tobacco smoke exposure in utero due to maternal smoking and performance on cognitive, intelligence, neurodevelopmental and academic tests. Eligible studies were identified through searches of Web of Knowledge, Medline, Science Direct, Google Scholar, CINAHL, EMBASE, Zetoc and Clinicaltrials.gov databases. The review found evidence of a relationship between tobacco smoke exposure in utero and reduced academic achievement and cognitive abilities independent of other variables. Maternal smoking during pregnancy may therefore be a modifiable risk factor for reduced cognitive abilities later in the life of the child. Giving up smoking during pregnancy should be initiated as early as possible to reduce the impact on the child's cognitive development.

Recommendations should be made to the public to avoid sources of SHS and future research should investigate interactions between SHS exposure and other risk factors for delayed neurodevelopment and poor cognitive performance.

Programs that provide services for young children with special needs are now planning ways to support the child's family as well. In response to the great diversity in the way programs define and implement a family-centered approach to service delivery, researchers at the Beach Center on Families and Disability designed and tested the Family-Centered Program Rating Scale (FamPRS). In addition to being used as a component of a comprehensive program evaluation, the FamPRS may be used for program planning, staff development, and research. This article describes how the rating scale was developed, provides information about its psychometric properties, and makes recommendations for its appropriate uses.Programs that provide services for young children with special needs are undergoing great changes. Instead of working only with the child, they now plan ways to support the child's family as well, in order to maximize the benefit of services for the child and for the family. Although there is an increased awareness of the need for family-centered services, there is great diversity in the way programs define and implement such an approach to service delivery. Furthermore, as many professionals are discovering, changing to a family-centered approach often requires a major reconceptualization of early intervention (Meisels, 1992;