Wisdom enhancement and life skills to augment CBT outcomes for depression in later life: a series of N-of-1 trials.

BACKGROUND: It has been suggested that cognitive behavioural therapy for older adults be augmented with age-appropriate methods to enhance outcomes for depression treatment. AIMS: This study investigated whether a CBT wisdom enhancement timeline technique for older adults reduced depression, as well as increase self-compassion and self-assessed wisdom. METHOD: An N-of-1 series trial with non-concurrent multiple-baseline AB design was conducted. Older adults experiencing depression, recruited from mental health service waiting lists, were randomly assigned to baseline conditions. Participants received five individual sessions of the examined intervention, offering a structured way of utilising one's life experiences to evolve the psychological resource of wisdom within a cognitive behavioural framework, in order to improve mood. Participants completed idiographic daily measures and self-report standardised measures of depression, anxiety, self-compassion and wisdom during baseline and intervention phases, and at 1 month follow-up. RESULTS: Six participants competed the study and were subject to standardised and single-case data analyses. Four participants were deemed responders with reliable changes in depression post-intervention with idiographic changes coinciding with intervention onset. Two participants saw clinically significant changes in depression scores at follow-up. One responder saw significant changes in measures of self-compassion and self-assessed wisdom. CONCLUSIONS: The examined technique shows promise as an effective technique for reducing depression in older adults. There is insufficient evidence to implicate wisdom and/or self-compassion as significant mechanisms of change. Clinical and theoretical implications are discussed.

Characteristics and effectiveness of cognitive behavioral therapy for older adults living in residential care: a systematic review.

OBJECTIVES: Cognitive behavioral therapy (CBT) for depression and anxiety for older adults living in residential aged care facilities (RACFs) needs to accommodate the care needs of residents and the circumstances of RACFs. This systematic review examines the delivery and content characteristics of these interventions, in relation to participant satisfaction, staff appraisal, uptake rate, attrition rate, and treatment effectiveness. Such a review could provide important information for the development of future CBT-based interventions. METHOD: Studies that examined the application of CBT for depression or anxiety in RACFs were identified by systematically searching a number of relevant databases. Reference lists of all included studies were examined, and citation searches on the Web of Science were conducted. Two independent reviewers were involved in screening articles and in extracting data and assessing methodological quality of the selected studies. RESULTS: Across the 18 studies included in this review, the most common therapeutic strategy was pleasant activities scheduling. Studies varied on treatment duration (2-24 weeks), number of sessions (6-24), and length of sessions (10-120 min). Residents and staff members were satisfied with the CBT interventions. The average uptake rate was 72.9%. The average attrition rate was 19.9%. Statistically significant results were reported in 8 of the 12 randomized controlled trials (RCTs). In these eight RCTs, CBT was characterized by psychoeducation, behavioral activation, and problem-solving techniques; further, the therapists in six of these studies had training in psychology. CONCLUSION: CBT interventions for depression and anxiety are acceptable to RACF residents and judged positively by staff members. Effective studies differed from non-effective studies on content and training characteristics, but not on other delivery features.

Development of a short form of the Attitudes to Ageing Questionnaire (AAQ).

OBJECTIVES: The original 24-item Attitudes to Aging Questionnaire (AAQ) is well established as a measure of attitudes to aging, comprising domains of psychosocial loss (PL), physical change (PC), and psychological growth (PG). This paper presents a new 12-item short form Attitudes to Aging Questionnaire (AAQ-SF). METHODS: The original field trial data used to develop the 24-item AAQ (AAQ-24) were used to compare 6-item, 9-item, and 12-item versions of AAQ-SF (sample 1, n = 2487) and to test the discriminative validity of the selected 12-item AAQ-SF (sample 2, n = 2488). Data from a separate study reporting on the AAQ-24 (sample 3, n = 792) verified the analyses. RESULTS: The 12-item AAQ-SF reported adequate internal consistency in both sample 1 (PL α = .72, PC α = .72, and PG α = .62) and sample 3 (PL α = .68, PC α = .73, and PG α = .61). The AAQ-SF functioned consistently with the profile of the AAQ-24 in that subscales in both formats of this measure discriminate between respondents on key parameters such as depression, subjective health status, and overall quality of life in sample 2. Sample 3 also demonstrated the AAQ-SF can detect the differences in attitudes toward aging between individuals experiencing anxiety and depression and those without psychological symptoms. Confirmatory factor analysis confirmed that the structure of the AAQ-SF mirrors that of the original 24-item AAQ. CONCLUSIONS: The AAQ-SF is a robust measure of attitudes toward aging, which can reduce respondent burden when used within longer questionnaire batteries or longitudinal research. Copyright © 2017 John Wiley & Sons, Ltd.

Life course influences of physical and cognitive function and personality on attitudes to aging in the Lothian Birth Cohort 1936.

ABSTRACT Background: Reports of attitudes to aging from older people themselves are scarce. Which life course factors predict differences in these attitudes is unknown. Methods: We investigated life course influences on attitudes to aging in healthy, community-dwelling people in the UK. Participants in the Lothian Birth Cohort 1936 completed a self-report questionnaire (Attitudes to Aging Questionnaire, AAQ) at around age 75 (n = 792, 51.4% male). Demographic, social, physical, cognitive, and personality/mood predictors were assessed, around age 70. Cognitive ability data were available at age 11. Results: Generally positive attitudes were reported in all three domains: low Psychosocial Loss, high Physical Change, and high Psychological Growth. Hierarchical multiple regression found that demographic, cognitive, and physical variables each explained a relatively small proportion of the variance in attitudes to aging, with the addition of personality/mood variables contributing most significantly. Predictors of attitudes to Psychosocial Loss were high neuroticism; low extraversion, openness, agreeableness, and conscientiousness; high anxiety and depression; and more physical disability. Predictors of attitudes to Physical Change were: high extraversion, openness, agreeableness, and conscientiousness; female sex; social class; and less physical disability. Personality predictors of attitudes to Psychological Growth were similar. In contrast, less affluent environment, living alone, lower vocabulary scores, and slower walking speed predicted more positive attitudes in this domain. Conclusions: Older people's attitudes to aging are generally positive. The main predictors of attitude are personality traits. Influencing social circumstances, physical well-being, or mood may result in more positive attitudes. Alternatively, interventions to influence attitudes may have a positive impact on associated physical and affective changes.

A brief version of the Attitudes to Ageing Questionnaire for older Chinese adults: development and psychometric evaluation.

BACKGROUND: Positive attitudes toward aging are considered essential for achieving psychological well-being in later life. However, there is currently a lack of a concise and comprehensive measurement tool specifically designed to assess attitudes toward aging among the elderly population in China. To address this gap, the present study aimed to develop a brief version of the Attitudes to Ageing Questionnaire tailored to older Chinese individuals and evaluate its psychometric properties. METHODS: Initially, a sample of community-dwelling older adults (Sample 1: n = 442, aged 60-88) was utilized to establish a new scale format. Subsequently, two convenience samples (Sample 2: n = 311, aged 60-90; Sample 3: n = 164, aged 60-89) were employed to evaluate the psychometric properties of this scale, including factor structure, internal consistency, test-retest reliability, convergent validity, and discriminant validity. RESULTS: We selected 12 items from the original questionnaire to create the brief scale. The brief scale maintained the three-factor structure of the full-format version, encompassing psychosocial loss, physical change, and psychological growth, and demonstrated adequate psychometric properties. CONCLUSIONS: This development process shortens the administration time of the questionnaire while avoiding excessive loss of information. The newly developed scale serves as a reliable and valid assessment tool for measuring attitudes toward aging among older Chinese individuals and is well-suited for implementation in large-scale surveys that utilize an extensive array of questionnaires. This tool can be applied to assessing the effectiveness of interventions aimed at eliminating ageism.

Clinical issues in the treatment of anxiety and depression in older adults with Parkinson's disease.

A significant proportion of persons affected by Parkinson's disease (PD) are over age 65 years. Mental health issues are often less a focus of treatment in this population than physical manifestations of the illness. Anxiety or depression alone, as well as comorbid depression and anxiety, are underrecognized in patients with PD and are associated with deleterious effects on physical and interpersonal functioning, negatively impacting quality of life and well-being. We offer a brief overview of salient clinical points with respect to assessment and treatment approaches to enhance efficacy of the treatment of mental health symptoms in older adults with PD. Cognitive behavior therapy involves the patient learning to overcome behavioral avoidance associated with anxiety and challenge unhelpful negative cognitions. It is suggested that cognitive behavior therapy is an effective approach to treatment of anxiety and depression in PD and should be offered as a treatment to patients.

Computerised cognitive behavioural therapy for depression and anxiety with older people: a pilot study to examine patient acceptability and treatment outcome.

OBJECTIVE: The study objective was to determine the acceptability and treatment outcome of using Beating the Blues (BTB) with older people (6 + years). Specific aims included identifying the treatment uptake and drop-out rate, and describing the role of basic demographics in therapy uptake. METHOD: Fifty-eight participants, experiencing symptoms of depression, were given a free choice of receiving treatment as usual (TAU) plus BTB (TAU + BTB) or TAU alone. All participants completed demographic questionnaires and a range of outcome measures at baseline, 2 months after baseline (end of treatment) and 3 months after baseline (follow-up). RESULTS: Thirty-three participants (56.9%) opted to receive BTB and reported having more experience and confidence using a computer than those who declined BTB. Twenty-four participants (72.7%) went on to complete all eight BTB sessions. Statistical analysis found significant differences between the two treatment groups, with the TAU + BTB group showing greater improvements in their symptoms of depression and anxiety than the TAU group by the end of treatment and at follow-up. Furthermore, the TAU+ BTB group had a significantly higher percentage of participants who met criteria for clinically significant improvement in their symptoms of depression by the end of treatment and at follow-up. CONCLUSION: Although further research is required, including a randomised controlled trial, the results of this initial pilot study provide evidence that BTB may offer an acceptable and effective treatment option for older people.

A deficit in psychotherapeutic care for older people with depression and anxiety.

In this article, the current state of evidence for psychological therapy for depression and anxiety in later life is briefly reviewed and a number of deficits in psychotherapeutic care are outlined and discussed. Deficits are identified as important in preventing older people from accessing the range and types of psychological interventions that would potentially enhance quality of life. In the main, researchers have overlooked anxiety and, relatively speaking, focused more on late life depression even though this occurs less frequently than anxiety disorders and anxiety symptoms. Similarly, psychotherapists have not given due consideration to the global demographic change in lifespan, with the implications of this unprecedented and profound event for psychotherapists rarely discussed. With the current cohort of older people living beyond the expected lifespans of previous generations, most research in psychotherapy with older people recruits from the younger-old age group (60-74 years). As such it is not known how well existing models of psychotherapy will fit this new cohort of older people. This paper briefly reviews these issues.

Validation of the Caregiver Guilt Questionnaire (CGQ) in a sample of British dementia caregivers.

BACKGROUND: Depression is well documented as a key outcome variable for dementia caregivers; however, guilt has been under-researched, which may be in part due to the lack of an appropriate measure. The Caregiver Guilt Questionnaire (CGQ) was originally developed and piloted with a Spanish population but has not yet been tested in an English-speaking population. METHODS: A cross-sectional postal survey was undertaken with a sample of 221 dementia caregivers in the UK, as part of a larger study of dementia caregiver outcome measures. RESULTS: The five-factor structure identified for the CGQ in the Spanish sample was replicated in this study. The five factors, "guilt about doing wrong by the care recipient," "guilt about failing to meet the challenges of caregiving," 'guilt over experience of negative emotions in relation to caregiving," "guilt about self-care," and "guilt about neglecting other relatives" accounted for 60% of the variance. Internal consistencies for the whole scale and factors were acceptable, and convergent validity was established with the Zarit Burden Interview guilt factor. A higher score on the CGQ was associated with a higher score on the Center for Epidemiological Studies Depression scale (CES-D) and a new cut-off score of 22 was established, which predicted a clinical score on the CES-D with 80.0% sensitivity and 61.5% specificity. CONCLUSIONS: The replication of the five-factor structure suggests that these are relevant themes within the feelings of guilt to both Hispanic and British dementia caregivers. The CGQ has been demonstrated to be a valid measure for use with British dementia caregivers and is likely to be of use in clinical and research settings.

Reliability and validity of the Attitudes to Ageing Questionnaire (AAQ) in older people in Spain.

BACKGROUND: As ageing is a personal experience, an attitude to ageing questionnaire is essential for capturing the most realistic appraisal of this important stage of life. Our aim was to study the psychometric properties of the Attitudes to Ageing Questionnaire (AAQ) in a sample of Spanish older people. METHODS: A total of 242 participants aged 60 years and older were recruited from community centers, primary care centers, and family associations for the mentally ill and dementia. In addition to the AAQ, participants provided information on demographics, self-perception of health, comorbidity, health status (SF-12), depressive symptoms (GDS-30), and quality of life (WHOQOL-BREF and WHOQOL-OLD). Analysis was performed using standard psychometric techniques with SPSS v15.0. RESULTS: No floor and ceiling effects were found, and missing data were low. The internal consistency measured by Cronbach's alpha for AAQ subscales were 0.59, 0.70, and 0.73. Exploratory Factor Analysis produced a three-factors solution accounting for 34% of the variance. A priori expected associations were found between some AAQ subscales with WHOQOL-BREF domains, with WHOQOL-OLD, SF-12, and the GDS-30 indicating good construct validity. In general, AAQ subscales differentiated between participants with lower and higher levels of education, and between a priori defined groups of older people (non-depressed vs. depressed; those with higher vs. lower physical comorbidities, and non-carers vs. carers). CONCLUSIONS: The Spanish version of the AAQ questionnaire showed acceptable psychometric properties in a convenience sample of Spanish older people. It is a useful measure of attitude for use with older people in social and clinical services.

Understanding the beliefs and attitudes towards mental health problems held by Muslim communities and acceptability of Cognitive Behavioral Therapy as a treatment: systematic review and thematic synthesis.

BACKGROUND: Muslims experience the lowest recovery rate from mental health difficulties across all religious groups. The aim of this research is to understand the barriers that prevent Muslims from accessing Cognitive Behavioral Therapy (CBT) and the extent to which these may vary across country of residence. METHODS: Systematic review and thematic synthesis for quantitative, qualitative, and mixed methods studies published in English and Arabic informed by the SPIDER search tool. Methodological quality and risk of bias of included papers were critically appraised independently according to the Mixed Methods Appraisal Tool. RESULTS: A search of seven databases in the Arabic and English language yielded 3836 studies with 210 studies assessed for eligibility. Employing the Mixed Methods Appraisal Tool resulted in 14 studies included in the thematic synthesis. Seven studies adopted a qualitative methodology employing semi-structured interviews and seven were quantitative descriptive studies. CONCLUSIONS: Muslim communities experience barriers accessing Cognitive Behavioral Therapy at the level of the individual, culture, provider and management. The main barriers were experienced at the individual level which was dominated by the influence of Islam regarding the cause of mental health difficulties, which also influenced the way in which difficulties were managed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO and registration number: CRD42020192854.

A meta-analysis of CBT efficacy for depression comparing adults and older adults.

INTRODUCTION: This meta-analysis investigates CBT treatment efficacy fordepression, and compares outcomes between adults (young and middle aged) and older adults (OA). METHODOLOGY: Effect sizes (Hedges' g) were obtained from 37 peer-reviewed RCTs, 25 adult papers (participant n = 2948) and 12 OA papers (participant n = 551), and analysed with the random effects model. RESULTS: No significant difference between age groups is reported in terms of CBT efficacy for depression compared to other treatments (Qbetween (1) = 0.06, p = .89), with the overall effect favouring CBT over any other treatments (g = 0.48, 95 % CI = 0.29-0.68). The same pattern of results was found when restricting studies to those which used active control conditions (Qbetween (1) = 0.03, p = .86) or passive control conditions (Q (1) = 2.45, p = .12). DISCUSSION: No significant differences in efficacy for CBT treatment for depression are found when comparing adults and OA. CBT is as efficacious with OA as with adults.

Suitability of the WHOQOL-BREF and WHOQOL-OLD for Spanish older adults.

BACKGROUND: People are living longer and healthier than at any other time point in history. Therefore, in the last decade, international interest has focussed on the study of quality of life (QoL) in older people. Our aim was to study the psychometric properties of the generic QoL measure WHOQOL-BREF (WHOQOL, World Health Organization Quality of Life) and specific older adult module WHOQOL-OLD in a sample of 286 Spanish elderly. METHODS: Participants were 60 years and older from community centres, primary care centres, family associations and nursing homes. The following information was collected: demographics, self-perception of health, depressive symptoms (Geriatric Depression Scale, GDS-30), functional status (SF-12) and QoL (WHOQOL-BREF and WHOQOL-OLD). Analysis was performed using classic psychometric techniques with SPSS v15.0. RESULTS: We found no ceiling and floor effects, and missing data was low. The internal consistency measured by Cronbach's alpha was 0.90 for the WHOQOL-BREF total scale and 0.80 for the WHOQOL-OLD. A priori expected associations were found between WHOQOL-BREF and WHOQOL-OLD with the SF-12 and the GDS-30, indicating good construct validity. WHOQOL-BREF and WHOQOL-OLD domain scores differentiated between participants with lower and higher level of education, and between groups of older people (healthy vs. unhealthy; non-depressed vs. depressed; non-carers vs. carers and non-residents vs. residents). CONCLUSIONS: The WHOQOL-BREF and WHOQOL-OLD questionnaires demonstrate acceptable psychometric performance in a convenience sample of Spanish older people. They are valuable measures of QoL for use with older people.

Post-stroke depression: the case for augmented, individually tailored cognitive behavioural therapy.

In this review, we begin by considering why post-stroke depression (PSD) is so prevalent. We then examine the current evidence base to support cognitive behavioural therapy (CBT) as a treatment approach for the condition. While there is limited evidence currently, we demonstrate that much remains to be established with regard to PSD and the efficacy of CBT. We argue there is every reason to believe CBT should be an effective treatment, but that clinicians must augment and individually tailor this approach to ensure effectiveness. We set out our rationale for a novel augmented, individually tailored CBT protocol, and describe five key components that we believe once incorporated, and tested using randomized controlled methods, should enhance treatment outcome of PSD.

Understanding the beliefs and attitudes towards mental health problems held by Muslim communities and acceptability of cognitive behavioural therapy as a treatment: systematic review and thematic synthesis protocol.

INTRODUCTION: Many barriers prevent Muslims' accessing mental health services, the aim of this systematic review is to gain an understanding regarding these barriers and consider how they vary across different Muslim communities resident in different countries. METHODS AND ANALYSIS: Systematic review of PubMed/MEDLINE, CINAHL, PsycINFO, Ovid MEDLINE, Embase and Index Islamicus databases for studies published in English in addition to the Saudi Digital Library for studies published in Arabic. The review will include quantitative, qualitative and mixed methods studies published in peer-review journals since 1980. Methodological quality and risk of bias of included papers will be critically appraised independently according to the Mixed Methods Appraisal Tool. Thematic synthesis will be used to extract outcome and analyse data from studies included in the review. ETHICS AND DISSEMINATION: There are considered to be no ethical issues. Findings will be disseminated in both English and Arabic to clinicians and researchers via journal publication and conference presentation(s). TRIAL REGISTRATION NUMBER: CRD42020192854.

Attitudes to ageing and expectations for filial piety across Chinese and British cultures: a pilot exploratory evaluation.

INTRODUCTION: Filial piety (FP) is a central theme in Asian culture and is seen as care for one's parents as part of a traditional concept of Confucianism. Older people may hold strong expectations for FP from their children. Attitudes towards the experience of ageing may be influenced by how far one perceives their expectations to be met. METHOD: A cross-sectional evaluation of expectation for FP and attitudes to ageing was undertaken in three different cultural groups--elderly Chinese immigrants living in the UK, Chinese older people living in Beijing and Scottish older people living in Scotland. RESULTS: There were significant differences between the three cultural groups on a standardized measure of attitudes to ageing on psychosocial loss, F(2, 127) = 28.20, p = 0.0005 and physical change, F(2, 127) = 67.60, p = 0.0005 domains of attitudes to ageing. With expectations for FP, the UK-born participants evidenced lower expectations than the two Chinese groups, who were very similar in their levels of expectation, F(2, 127) = 10.92, p = 0.0005. CONCLUSIONS: The study was the first of its kind to consider attitudes to ageing and expectations for FP across three cultural groups. Overall an interesting pattern of results emerged suggesting that both Chinese groups remain invested in the concept of FP, whereas the UK sample was not. In contrast, however, the Chinese immigrants and the UK participants were more similar in reporting attitudes to ageing than the Chinese participants who were more likely to endorse a loss-deficit view of ageing.

Older peoples' attitudes to mental illness.

Despite the prevalence of mental health problems in later life, older people markedly underutilize mental health services. A greater awareness of factors influencing older peoples' attitudes to mental illness may therefore improve awareness and treatment of mental disorders in this population. A mixed methodology approach was used to explore and compare older peoples' attitudes to mental illness in a sample of clinical and non-clinical participants. Results indicated that, similar to younger people, older people endorsed a range of positive and negative attitudes to mental illness. However, when attitudes to mental illness were considered within the context of ageing and experience a more complex pattern of results emerged. Although negative attitudes to mental illness were associated with negative attitudes to ageing across the entire sample, clinical participants (and those with prior experience of mental illness) reported more positive attitudes to mental illness and more negative attitudes to ageing than non-clinical participants, for whom the reverse was true. Attitudes were also differentially related to health behaviour outcomes. Results suggest that attitudes to mental illness and ageing may be linked and mediated by personal experience and capacity for psychological self-regulation in the face of age-associated adversity.

Development and validation of the Brazilian version of the Attitudes to Aging Questionnaire (AAQ): An example of merging classical psychometric theory and the Rasch measurement model.

BACKGROUND: Aging has determined a demographic shift in the world, which is considered a major societal achievement, and a challenge. Aging is primarily a subjective experience, shaped by factors such as gender and culture. There is a lack of instruments to assess attitudes to aging adequately. In addition, there is no instrument developed or validated in developing region contexts, so that the particularities of ageing in these areas are not included in the measures available. This paper aims to develop and validate a reliable attitude to aging instrument by combining classical psychometric approach and Rasch analysis. METHODS: Pilot study and field trial are described in details. Statistical analysis included classic psychometric theory (EFA and CFA) and Rasch measurement model. The latter was applied to examine unidimensionality, response scale and item fit. RESULTS: Sample was composed of 424 Brazilian old adults, which was compared to an international sample (n = 5238). The final instrument shows excellent psychometric performance (discriminant validity, confirmatory factor analysis and Rasch fit statistics). Rasch analysis indicated that modifications in the response scale and item deletions improved the initial solution derived from the classic approach. CONCLUSION: The combination of classic and modern psychometric theories in a complementary way is fruitful for development and validation of instruments. The construction of a reliable Brazilian Attitudes to Aging Questionnaire is important for assessing cultural specificities of aging in a transcultural perspective and can be applied in international cross-cultural investigations running less risk of cultural bias.

Impact of major depression and subsyndromal symptoms on quality of life and attitudes toward aging in an international sample of older adults.

PURPOSE: The impact of major depression on quality of life (QOL) and aging experiences in older adults has been reported. Studies have demonstrated that the clinical diagnosis of major depression is the strongest predictor for QOL. We postulate that some findings are biased because of the use of inadequate instruments. Although subsyndromal depression is more prevalent than major depression, there are no reports on its impact on QOL or attitudes toward aging. In the present study we aim at assessing the association of major and subsyndromal depression on QOL and attitudes toward aging in a large international sample. DESIGN AND METHODS: Our cross-sectional study assessed 4,316 respondents in 20 countries from five continents. The study used the World Health Organization Quality of Life (WHOQOL) Assessment for Older Adults, known as the WHOQOL-OLD; the brief version of the WHOQOL instrument, known as the WHOQOL-BREF; and the Attitudes to Ageing Questionnaire. Statistical analyses involved hierarchical multiple regression, as well as comparison of means. RESULTS: Even relatively minor levels of depression are associated with a significant decrease in all QOL domains and with a pattern of negative attitudes toward aging (overall WHOQOL-OLD R(2) change =.421). QOL and attitudes toward aging scores are lower as depression intensity is increased, even in subsyndromal levels (overall WHOQOL-OLD mean scores of 95.7 vs 86.4, p <.001). This phenomenon happens not only for clinically depressed individuals but also for subsyndromic individuals. IMPLICATIONS: Present findings suggest that classifying a respondent as nondepressed is not sufficient and is still not informative about his or her QOL and attitudes toward aging status.

Systematic Review Investigating Multi-disciplinary Team Approaches to Screening and Early Diagnosis of Dementia in Primary Care - What are the Positive and Negative Effects and Who Should Deliver It?

BACKGROUND: Primary care services frequently provide the initial contact between people with dementia and health service providers. Early diagnosis and screening programmes have been suggested as a possible strategy to improve the identification of such individuals and treatment and planning health and social care support. OBJECTIVE: To determine what early diagnostic and screening programmes have been adopted in primary care practice, to explore who should deliver these and to determine the possible positive and negative effects of an early diagnostic and screening programme for people with dementia in primary care. METHODS: A systematic review of the literature was undertaken using published and unpublished research databases. All papers answering our research objectives were included. A narrative analysis of the literature was undertaken, with the CASP tools used appropriately to assess study quality. RESULTS: Thirty-three papers were identified of moderate to high quality. The limited therapeutic options for those diagnosed with dementia means that even if such a programme was instigated, the clinical value remains questionable. Furthermore, accuracy of the diagnosis remains difficult to assess due to poor evidence and this raises questions regarding whether people could be over- or under-diagnosed. Given the negative social and psychological consequences of such a diagnosis, this could be devastating for individuals. CONCLUSION: Early diagnostic and screening programmes have not been widely adopted into primary care. Until there is rigorous evidence assessing the clinical and cost-effectiveness of such programmes, there remains insufficient evidence to support the adoption of these programmes in practice.