- Email: [email protected]
LIVING WELL WITH DEMENTIA: A SYSTEMATIC REVIEW
Poster Presentations: Wednesday, July 19, 2017 P4-560
SUPPLEMENTAL RETINAL CAROTENOIDS ENHANCE MEMORY IN HEALTHY INDIVIDUALS WITH LOW LEVELS OF MACULAR PIGMENT IN A RANDOMIZED, DOUBLE BLIND, PLACEBO-CONTROLLED CLINICAL TRIAL
Rebecca Power1, Robert Coen2, Stephen Beatty1, Riona Mulcahy3, Rachel Moran1, Jim Stack1, Alan Howard4, John Nolan1, 1Nutrition Research Centre Ireland, Waterford, Ireland; 2Mercer’s Institute for Successful Ageing, St. James’s Hospital, Dublin, Ireland; 3Age-Related Care Unit, University Hospital Waterford, Waterford, Ireland; 4Howard Foundation, Cambridge, United Kingdom. Contact e-mail: [email protected] Background: There is a biologically plausible rationale whereby the di-
etary carotenoids that accumulate in the central retina (macula), where they are collectively referred to as macular pigment (MP) and which consist of lutein (L), zeaxanthin (Z) and meso-zeaxanthin (MZ), support the maintenance of cognition. This study investigated the impact of supplemental L, Z and MZ on memory, executive function and verbal fluency among healthy individuals with low MP levels. Methods: Subjects (n ¼ 91) consumed a daily formulation of 10mg L, 10mg MZ and 2mg Z (active group; n ¼ 45, 49% male, 44.38611.57 years) or placebo (n ¼ 46; 54.3% male, 46.43613.21 years) for a period of 12-months. Cognitive performance was evaluated using methods designed to test learning, immediate and delayed memory, (verbal recognition memory task; paired associated learning [PAL] task), executive function (attention switching task) and verbal fluency (phonemic and semantic). MP was measured by dual-wavelength autofluorescence, and serum carotenoid concentrations of L, Z and MZ were quantified by high performance liquid chromatography. Results:Individuals in the active intervention group exhibited significant improvements in memory over the course of the study period when compared to the placebo group (baseline/exit overall PAL scores of 18.9164.96/20.7764.57 and 21.2663.52/20.3264.57, for active and placebo groups, respectively [rANOVA, p ¼ 0.009]; PAL errors of 6.7867.10 and 4.1963.82 at baseline, and of 3.1764.52 and 4.4864.49 at exit visit, for the active intervention and placebo groups, respectively [rANOVA, p ¼ 0.017]); furthermore, the observed reduction in the number of errors made in the PAL task amongst those in the intervention group was positively and significantly related to observed increases in MP volume (p ¼ 0.005) and observed increases in serum concentrations of L (p ¼ 0.009). Conclusions: The results of this randomized, double blind, placebo-controlled clinical trial demonstrate a memoryenhancing effect of supplementation with all three retinal carotenoids (in a MZ:L:Z ratio of [mg] 10:10:2) in healthy subjects with low MP at baseline. The potential impact of these findings for intellectual performance throughout life, and for risk of cognitive decline in later life, warrants further investigation.
P4-561
MEDITERRANEAN DIET ADHERENCE IS ASSOCIATED WITH ATTENUATED CORTICAL THINNING IN AN AUSTRALIAN STUDY OF AGEING
Samantha L. Gardener1,2, Stephanie R. Rainey-Smith1,2, Kaikai Shen3,4, Pierrick Bourgeat5, Kevin Taddei1,2, David Ames6,7, Colin L. Masters8, Christopher C. Rowe9, Olivier Salvado5, Ralph N. Martins2,10,11, 1Edith Cowan University, Perth, Australia; 2Australian Alzheimer’s Research Foundation, Perth, Australia; 3McCusker Alzheimer’s Research Foundation, Perth, Australia; 4CSIRO Health and Biosecurity, Perth, Australia; 5CSIRO, Brisbane, Australia; 6The University of Melbourne,
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Melbourne, Australia; 7National Ageing Research Institute, Melbourne, Australia; 8The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; 9Austin Health, Melbourne, Australia; 10Macquarie University, Sydney, Australia; 11Edith Cowan University, Joondalup, Australia. Contact e-mail: [email protected] Background: Cortical thinning occurs with advancing age, with global thinning apparent by middle age. Specifically in Alzheimer’s disease (AD), there is a distinct pattern of thinning of the cortical ribbon. While there is no cure or effective treatment currently available for AD, early intervention prevention programs hold considerable promise. Following particular dietary patterns represents one potential intervention strategy accessible to all, with adherence to healthy dietary patterns, such as the Mediterranean Diet (MeDi), proposed to be associated with improved brain health; however, the relationship of MeDi adherence to cortical thinning has not been thoroughly characterised. Methods: Cognitively normal participants of the Australian Imaging, Biomarkers and Lifestyle study (n¼269; mean age 71.74 6 7.0; 43% male), completed the Cancer Council of Victoria food frequency questionnaire at baseline, from which a MeDi score was computed, and underwent MRI at baseline, and at least one other timepoint over a six year period, to determine cortical thickness. Linear mixed models assessed baseline cortical thickness and trajectories of cortical thinning dependent on MeDi adherence. All models included age, gender, body mass index, years of education, APOE 34 allele carrier status and energy intake, with p-values false discovery rate adjusted. Results: Cross-sectional analysis showed cortical thickness at baseline did not differ depending on MeDi adherence. However, longitudinally, higher MeDi score was associated with less decline in cortical thickness both globally and for multiple regions of interest (ROI): these ROI included frontal, occipital, parietal and temporal lobe structures (p<0.05; Cohen’s f ranging from 0.18 to 0.34). Conclusions:Attenuated cortical thinning seen in those with higher MeDi adherence suggests this diet may exert a protective effect with regards to cortical integrity. These findings are in agreement with our published work whereby MeDi adherence was associated with less cognitive decline over time. The results of the current study may inform the development of non-pharmacological interventions for maintaining cortical thickness and thereby reducing the risk of cognitive impairment and AD.
P4-562
LIVING WELL WITH DEMENTIA: A SYSTEMATIC REVIEW
Anthony Martyr1, Sharon M. Nelis1, Catherine Quinn1, Yu-Tzu Wu1, Ruth A. Lamont1, Catherine Henderson2, Rachel Clarke3, John Vincent Hindle4, Ian R. Jones5, Robin G. Morris6, Jennifer M. Rusted3, Jeanette M. Thom7, Christina R. Victor8, Linda Clare1, 1University of Exeter, Exeter, United Kingdom; 2London School of Economics, London, United Kingdom; 3University of Sussex, Brighton, United Kingdom; 4 Bangor University, Bangor, United Kingdom; 5Cardiff University, Cardiff, United Kingdom; 6King’s College London, Institute of Psychiatry, London, United Kingdom; 7University of New South Wales, Sydney, Australia; 8Brunel University, London, United Kingdom. Contact e-mail: [email protected] Background: Current policy emphasises the importance of living well
with dementia, but there has been no synthesis of the factors related to quality of life (QoL), subjective well-being or life satisfaction in people with dementia. We aimed to examine the available evidence in a systematic review and meta-analysis. Methods: We searched Pubmed, CINAHL, Web of Science, PsycNET, AgeInfo, Zetoc, Social Care Online, and OpenGrey to January 7th 2016 for studies investigating
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Poster Presentations: Wednesday, July 19, 2017
factors associated with QoL, well-being and life satisfaction in dementia. Articles had to provide quantitative data and include 75% people with dementia of any type or severity. Results from intervention studies were excluded. Correlational estimated effect size was employed. Results: We included 213 individual studies reported in 307 articles that reported QoL (N¼205), well-being (N¼5) and life satisfaction (N¼3) outcomes. Meta-analysis was possible for 198 QoL studies taken from 272 articles. Separate analyses were conducted for each method of assessing QoL: self-rating by the person with dementia, informant rating by a family carer or health care professional, and proxy rating by a family carer or health care professional. A further analysis focused on factors associated with differences between parallel self- and informant ratings. Longitudinal studies were examined separately to identify baseline predictors at follow-up. Demographic and disease characteristics were largely unrelated to QoL. Many factors were significantly associated but effect sizes were often small or negligible, with only a few moderate associations. Factors reflecting relationships, social engagement and functional ability were associated with better QoL. Factors indicative of poorer physical and mental health were associated with poorer QoL, as were factors indicative of poorer carer well-being. Longitudinal evidence about predictors of QoL was limited. There was considerable between-study heterogeneity. Conclusions: Efforts to improve QoL could focus on supporting relationships, social engagement and everyday functioning, addressing poor physical and mental health, and ensuring high-quality care. However, longitudinal evidence is needed to clarify causal relationships and identify ways of maintaining or improving QoL over time. The pattern of numerous predominantly small associations with QoL suggests a need to reconsider approaches to understanding and assessing living well with dementia.
P4-563
TOWARDS A CARING ENVIRONMENT FOR SERVICE USERS WITH DEMENTIA IN GERIATRIC HEALTH SERVICES FACILITIES AND THEIR FAMILY MEMBERS
Takeo Yonemura, IMS Group, Meiri-kai, Geriatric Healthcare Facility, Sagamihara Royal Care Center, Kanagawa, Japan. Contact e-mail: [email protected] Background: What geriatric health services facilities need to do during a phase of community living is to actively promote “home-based rehabilitation after discharge,” that is, an approach to improving the performance of activities of daily living (ADL) for residents discharged homes. A questionnaire survey was conducted to examine factors related to discharge home in our facility among residents discharged homes and long-term residents. This study reports on the socalled “Dream Plan” which was carried out on long-term residents. Methods: The study was conducted among 136 participants with dementia (52 residents discharged home and 84 long-term residents) between January 2016 March 2017. 1) Functional status of participants was evaluated using functional independence measure (FIM) on admission to our facility and at 3 months after rehabilitation interventions. Data was analyzed by Stata/SE14.0. 2) Floor staff members suggested asking our service users and their family members “what dreams do you want to achieve?” and bringing their dreams into reality. Results: 1) FIM gain after rehabilitation was compared between residents discharged homes and long-term residents with dementia. Mann-Whitney U test was used for statistical analysis. In the following FIM items: toilet behavior; transfers; locomotion; social
interaction; and problem solving, FIM gain was significantly higher in residents discharged homes when compared to long-term residents (p<0.0001). 2) Service users, their family members, and staff members came together and attempted not to give up hope for those who have a problem with discharge home due to a decrease in the ability of family caregivers. Accordingly, we made it possible to shape the dreams of service users as well as their family members and derived job satisfaction from both “Dream Plan.” Conclusions: 1) In the case of residents with higher FIM scores, improvement in locomotion and transfer abilities helped reduce care burden, which resulted in smooth acceptance into a family and facilitated smoother discharge home. 2) The residents who cannot be discharged, it seems that setting a new goal helps them to spend the rest of their lives actively in facilities.
P4-564
A SYSTEMATIC REVIEW OF THE MANAGEMENT OF MEDICINES BY PEOPLE LIVING WITH DEMENTIA IN THEIR OWN HOMES AND THEIR FAMILY CARERS: ISSUES FACED AND STRATEGIES ADOPTED
Taniya Sharmeen and Rosemary Lim, University of Reading, Reading, United Kingdom. Contact e-mail: [email protected] Background: Medication management for people living with de-
mentia (PLWD) is a complex extensive concept. Currently, there is limited understanding of how PLWD manage their own medicines in their own homes and the practical challenges faced, and the role and challenges faced by family carers who support them. We conducted a systematic review to identify issues faced by PLWD and their family carers in relation to all aspects of medicines management and coping strategies developed by PLWD and family carers to address or mitigate the impact of these issues. Methods: We searched twelve general databases and four systematic review databases using comprehensive combinations of search terms (time period from January 1986 to July 2016). We included articles that reviewed or investigated issues relating to medicines management among PWLD living in their own home; the role of family carers in medication management; PLWD, family carers and/or health care provider’s views or feelings towards medication use and management, associated issues and solutions. Relevant articles were quality assessed using established frameworks. Data from articles were thematically analysed through extensive and iterative discussions. Results: 19 articles were included in this study; 13 empirical studies (used a combination of qualitative, qualitative and mixed methods) and six reviews. We identified four major domains describing the issues faced by PLWD and their family carers in relation to medicine management: cognitive factors; medication factors; social and cultural factors; knowledge/educational and communication factors. Limited strategies were employed by PLWD to manage medicines and included accepting help, medicine-taking aids and memory strategies. Family carers played a crucial compensating role in managing medicines such as developing proactive strategies. Conclusions: PLWD and family carers encounter a range of internal and external issues when managing medicines and had developed some strategies to manage these issues. However, the effectiveness of these strategies in managing medicines is unclear. There was a distinct lack of involvement of PLWD as participants in the included articles. Family/informal carers or healthcare professionals acted as proxies. Future studies should actively involve PLWD so that high quality care that focuses on real patient needs are developed and provided.
SUPPLEMENTAL RETINAL CAROTENOIDS ENHANCE MEMORY IN HEALTHY INDIVIDUALS WITH LOW LEVELS OF MACULAR PIGMENT IN A RANDOMIZED, DOUBLE BLIND, PLACEBO-CONTROLLED CLINICAL TRIAL
Rebecca Power1, Robert Coen2, Stephen Beatty1, Riona Mulcahy3, Rachel Moran1, Jim Stack1, Alan Howard4, John Nolan1, 1Nutrition Research Centre Ireland, Waterford, Ireland; 2Mercer’s Institute for Successful Ageing, St. James’s Hospital, Dublin, Ireland; 3Age-Related Care Unit, University Hospital Waterford, Waterford, Ireland; 4Howard Foundation, Cambridge, United Kingdom. Contact e-mail: [email protected] Background: There is a biologically plausible rationale whereby the di-
etary carotenoids that accumulate in the central retina (macula), where they are collectively referred to as macular pigment (MP) and which consist of lutein (L), zeaxanthin (Z) and meso-zeaxanthin (MZ), support the maintenance of cognition. This study investigated the impact of supplemental L, Z and MZ on memory, executive function and verbal fluency among healthy individuals with low MP levels. Methods: Subjects (n ¼ 91) consumed a daily formulation of 10mg L, 10mg MZ and 2mg Z (active group; n ¼ 45, 49% male, 44.38611.57 years) or placebo (n ¼ 46; 54.3% male, 46.43613.21 years) for a period of 12-months. Cognitive performance was evaluated using methods designed to test learning, immediate and delayed memory, (verbal recognition memory task; paired associated learning [PAL] task), executive function (attention switching task) and verbal fluency (phonemic and semantic). MP was measured by dual-wavelength autofluorescence, and serum carotenoid concentrations of L, Z and MZ were quantified by high performance liquid chromatography. Results:Individuals in the active intervention group exhibited significant improvements in memory over the course of the study period when compared to the placebo group (baseline/exit overall PAL scores of 18.9164.96/20.7764.57 and 21.2663.52/20.3264.57, for active and placebo groups, respectively [rANOVA, p ¼ 0.009]; PAL errors of 6.7867.10 and 4.1963.82 at baseline, and of 3.1764.52 and 4.4864.49 at exit visit, for the active intervention and placebo groups, respectively [rANOVA, p ¼ 0.017]); furthermore, the observed reduction in the number of errors made in the PAL task amongst those in the intervention group was positively and significantly related to observed increases in MP volume (p ¼ 0.005) and observed increases in serum concentrations of L (p ¼ 0.009). Conclusions: The results of this randomized, double blind, placebo-controlled clinical trial demonstrate a memoryenhancing effect of supplementation with all three retinal carotenoids (in a MZ:L:Z ratio of [mg] 10:10:2) in healthy subjects with low MP at baseline. The potential impact of these findings for intellectual performance throughout life, and for risk of cognitive decline in later life, warrants further investigation.
P4-561
MEDITERRANEAN DIET ADHERENCE IS ASSOCIATED WITH ATTENUATED CORTICAL THINNING IN AN AUSTRALIAN STUDY OF AGEING
Samantha L. Gardener1,2, Stephanie R. Rainey-Smith1,2, Kaikai Shen3,4, Pierrick Bourgeat5, Kevin Taddei1,2, David Ames6,7, Colin L. Masters8, Christopher C. Rowe9, Olivier Salvado5, Ralph N. Martins2,10,11, 1Edith Cowan University, Perth, Australia; 2Australian Alzheimer’s Research Foundation, Perth, Australia; 3McCusker Alzheimer’s Research Foundation, Perth, Australia; 4CSIRO Health and Biosecurity, Perth, Australia; 5CSIRO, Brisbane, Australia; 6The University of Melbourne,
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Melbourne, Australia; 7National Ageing Research Institute, Melbourne, Australia; 8The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; 9Austin Health, Melbourne, Australia; 10Macquarie University, Sydney, Australia; 11Edith Cowan University, Joondalup, Australia. Contact e-mail: [email protected] Background: Cortical thinning occurs with advancing age, with global thinning apparent by middle age. Specifically in Alzheimer’s disease (AD), there is a distinct pattern of thinning of the cortical ribbon. While there is no cure or effective treatment currently available for AD, early intervention prevention programs hold considerable promise. Following particular dietary patterns represents one potential intervention strategy accessible to all, with adherence to healthy dietary patterns, such as the Mediterranean Diet (MeDi), proposed to be associated with improved brain health; however, the relationship of MeDi adherence to cortical thinning has not been thoroughly characterised. Methods: Cognitively normal participants of the Australian Imaging, Biomarkers and Lifestyle study (n¼269; mean age 71.74 6 7.0; 43% male), completed the Cancer Council of Victoria food frequency questionnaire at baseline, from which a MeDi score was computed, and underwent MRI at baseline, and at least one other timepoint over a six year period, to determine cortical thickness. Linear mixed models assessed baseline cortical thickness and trajectories of cortical thinning dependent on MeDi adherence. All models included age, gender, body mass index, years of education, APOE 34 allele carrier status and energy intake, with p-values false discovery rate adjusted. Results: Cross-sectional analysis showed cortical thickness at baseline did not differ depending on MeDi adherence. However, longitudinally, higher MeDi score was associated with less decline in cortical thickness both globally and for multiple regions of interest (ROI): these ROI included frontal, occipital, parietal and temporal lobe structures (p<0.05; Cohen’s f ranging from 0.18 to 0.34). Conclusions:Attenuated cortical thinning seen in those with higher MeDi adherence suggests this diet may exert a protective effect with regards to cortical integrity. These findings are in agreement with our published work whereby MeDi adherence was associated with less cognitive decline over time. The results of the current study may inform the development of non-pharmacological interventions for maintaining cortical thickness and thereby reducing the risk of cognitive impairment and AD.
P4-562
LIVING WELL WITH DEMENTIA: A SYSTEMATIC REVIEW
Anthony Martyr1, Sharon M. Nelis1, Catherine Quinn1, Yu-Tzu Wu1, Ruth A. Lamont1, Catherine Henderson2, Rachel Clarke3, John Vincent Hindle4, Ian R. Jones5, Robin G. Morris6, Jennifer M. Rusted3, Jeanette M. Thom7, Christina R. Victor8, Linda Clare1, 1University of Exeter, Exeter, United Kingdom; 2London School of Economics, London, United Kingdom; 3University of Sussex, Brighton, United Kingdom; 4 Bangor University, Bangor, United Kingdom; 5Cardiff University, Cardiff, United Kingdom; 6King’s College London, Institute of Psychiatry, London, United Kingdom; 7University of New South Wales, Sydney, Australia; 8Brunel University, London, United Kingdom. Contact e-mail: [email protected] Background: Current policy emphasises the importance of living well
with dementia, but there has been no synthesis of the factors related to quality of life (QoL), subjective well-being or life satisfaction in people with dementia. We aimed to examine the available evidence in a systematic review and meta-analysis. Methods: We searched Pubmed, CINAHL, Web of Science, PsycNET, AgeInfo, Zetoc, Social Care Online, and OpenGrey to January 7th 2016 for studies investigating
P1568
Poster Presentations: Wednesday, July 19, 2017
factors associated with QoL, well-being and life satisfaction in dementia. Articles had to provide quantitative data and include 75% people with dementia of any type or severity. Results from intervention studies were excluded. Correlational estimated effect size was employed. Results: We included 213 individual studies reported in 307 articles that reported QoL (N¼205), well-being (N¼5) and life satisfaction (N¼3) outcomes. Meta-analysis was possible for 198 QoL studies taken from 272 articles. Separate analyses were conducted for each method of assessing QoL: self-rating by the person with dementia, informant rating by a family carer or health care professional, and proxy rating by a family carer or health care professional. A further analysis focused on factors associated with differences between parallel self- and informant ratings. Longitudinal studies were examined separately to identify baseline predictors at follow-up. Demographic and disease characteristics were largely unrelated to QoL. Many factors were significantly associated but effect sizes were often small or negligible, with only a few moderate associations. Factors reflecting relationships, social engagement and functional ability were associated with better QoL. Factors indicative of poorer physical and mental health were associated with poorer QoL, as were factors indicative of poorer carer well-being. Longitudinal evidence about predictors of QoL was limited. There was considerable between-study heterogeneity. Conclusions: Efforts to improve QoL could focus on supporting relationships, social engagement and everyday functioning, addressing poor physical and mental health, and ensuring high-quality care. However, longitudinal evidence is needed to clarify causal relationships and identify ways of maintaining or improving QoL over time. The pattern of numerous predominantly small associations with QoL suggests a need to reconsider approaches to understanding and assessing living well with dementia.
P4-563
TOWARDS A CARING ENVIRONMENT FOR SERVICE USERS WITH DEMENTIA IN GERIATRIC HEALTH SERVICES FACILITIES AND THEIR FAMILY MEMBERS
Takeo Yonemura, IMS Group, Meiri-kai, Geriatric Healthcare Facility, Sagamihara Royal Care Center, Kanagawa, Japan. Contact e-mail: [email protected] Background: What geriatric health services facilities need to do during a phase of community living is to actively promote “home-based rehabilitation after discharge,” that is, an approach to improving the performance of activities of daily living (ADL) for residents discharged homes. A questionnaire survey was conducted to examine factors related to discharge home in our facility among residents discharged homes and long-term residents. This study reports on the socalled “Dream Plan” which was carried out on long-term residents. Methods: The study was conducted among 136 participants with dementia (52 residents discharged home and 84 long-term residents) between January 2016 March 2017. 1) Functional status of participants was evaluated using functional independence measure (FIM) on admission to our facility and at 3 months after rehabilitation interventions. Data was analyzed by Stata/SE14.0. 2) Floor staff members suggested asking our service users and their family members “what dreams do you want to achieve?” and bringing their dreams into reality. Results: 1) FIM gain after rehabilitation was compared between residents discharged homes and long-term residents with dementia. Mann-Whitney U test was used for statistical analysis. In the following FIM items: toilet behavior; transfers; locomotion; social
interaction; and problem solving, FIM gain was significantly higher in residents discharged homes when compared to long-term residents (p<0.0001). 2) Service users, their family members, and staff members came together and attempted not to give up hope for those who have a problem with discharge home due to a decrease in the ability of family caregivers. Accordingly, we made it possible to shape the dreams of service users as well as their family members and derived job satisfaction from both “Dream Plan.” Conclusions: 1) In the case of residents with higher FIM scores, improvement in locomotion and transfer abilities helped reduce care burden, which resulted in smooth acceptance into a family and facilitated smoother discharge home. 2) The residents who cannot be discharged, it seems that setting a new goal helps them to spend the rest of their lives actively in facilities.
P4-564
A SYSTEMATIC REVIEW OF THE MANAGEMENT OF MEDICINES BY PEOPLE LIVING WITH DEMENTIA IN THEIR OWN HOMES AND THEIR FAMILY CARERS: ISSUES FACED AND STRATEGIES ADOPTED
Taniya Sharmeen and Rosemary Lim, University of Reading, Reading, United Kingdom. Contact e-mail: [email protected] Background: Medication management for people living with de-
mentia (PLWD) is a complex extensive concept. Currently, there is limited understanding of how PLWD manage their own medicines in their own homes and the practical challenges faced, and the role and challenges faced by family carers who support them. We conducted a systematic review to identify issues faced by PLWD and their family carers in relation to all aspects of medicines management and coping strategies developed by PLWD and family carers to address or mitigate the impact of these issues. Methods: We searched twelve general databases and four systematic review databases using comprehensive combinations of search terms (time period from January 1986 to July 2016). We included articles that reviewed or investigated issues relating to medicines management among PWLD living in their own home; the role of family carers in medication management; PLWD, family carers and/or health care provider’s views or feelings towards medication use and management, associated issues and solutions. Relevant articles were quality assessed using established frameworks. Data from articles were thematically analysed through extensive and iterative discussions. Results: 19 articles were included in this study; 13 empirical studies (used a combination of qualitative, qualitative and mixed methods) and six reviews. We identified four major domains describing the issues faced by PLWD and their family carers in relation to medicine management: cognitive factors; medication factors; social and cultural factors; knowledge/educational and communication factors. Limited strategies were employed by PLWD to manage medicines and included accepting help, medicine-taking aids and memory strategies. Family carers played a crucial compensating role in managing medicines such as developing proactive strategies. Conclusions: PLWD and family carers encounter a range of internal and external issues when managing medicines and had developed some strategies to manage these issues. However, the effectiveness of these strategies in managing medicines is unclear. There was a distinct lack of involvement of PLWD as participants in the included articles. Family/informal carers or healthcare professionals acted as proxies. Future studies should actively involve PLWD so that high quality care that focuses on real patient needs are developed and provided.