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We investigated whether people with dementia or low memory/orientation reported more help misaligned with needs – more unmet need and/or more unrequired help – than other people with similar levels of functional limitation, and examined associations with quality of life. From pooled English Longitudinal Study of Ageing data from waves 6, 7, and 8, we identified community-dwelling people aged 50+ with: dementia (n= 405); low memory/orientation but no dementia (n= 4520); and intact memory/orientation (n= 10,264). Unmet need (not receiving help for the functional limitation) and unrequired help (receipt of help without the respective functional limitation) were used as outcomes in two-part regressions. Quality of life (CASP-19) was used as a continuous outcome in a linear regression. Functional limitation and its interaction with cognitive status and socio-demographic factors were included in the models. Those with dementia or low memory/orientation but few functional limitations reported more unmet needs and unrequired help than their counterparts with intact memory/orientation. At high levels of limitations, the needs of those with dementia or lower memory/orientation were met more often and the receipt of unrequired help was similar compared to those with intact memory/orientation. Unmet need and unrequired help were associated with poorer quality of life. Unmet need and unrequired help were particular challenges for those with poorer cognition and potentially at early stages of dementia; they were associated with lower quality of life. Our results highlight the importance of good-quality timely diagnosis, identification of needs, and person-centred assessment to help improve quality of life. [ABSTRACT FROM AUTHOR]

We tested for differences in the prevalence of autism spectrum conditions (ASC) in school-aged children in three geographical regions in the Netherlands. Schools were asked to provide the number of children enrolled, the number having a clinical diagnosis of ASC and/or two control neurodevelopmental conditions. Prevalence was evaluated by negative binomial regression and adjustments were made for non-response and size of the schools. The prevalence estimates of ASC in Eindhoven was 229 per 10,000, significantly higher than in Haarlem (84 per 10,000) and Utrecht (57 per 10,000), whilst the prevalence for the control conditions were similar in all regions. Phase two is planned to validate school-reported cases using standardized diagnostic methods and to explore the possible causes for these differences.

The potential protective role of education for dementia is an area of major interest. Almost all older people have some pathology in their brain at death but have not necessarily died with dementia. We have explored these two observations in large population-based cohort studies (Epidemiological Clinicopathological Studies in Europe; EClipSE) in an investigation of the relationships of brain pathology at death, clinical dementia and time in education, testing the hypothesis that greater exposure to education reduces the risk of dementia. EClipSE has harmonized longitudinal clinical data and neuropathology from three longstanding population-based studies that included post-mortem brain donation. These three studies started between 1985 and 1991. Number of years of education during earlier life was recorded at baseline. Incident dementia was detected through follow-up interviews, complemented by retrospective informant interviews, death certificate data and linked health/social records (dependent on study) after death. Dementia-related neuropathologies were assessed in each study in a comparable manner based on the Consortium to Establish a Registry for Alzheimer's Disease protocol. Eight hundred and seventy-two brain donors were included, of whom 56% were demented at death. Longer years in education were associated with decreased dementia risk and greater brain weight but had no relationship to neurodegenerative or vascular pathologies. The associations between neuropathological variables and clinical dementia differed according to the "dose" of education such that more education reduced dementia risk largely independently of severity of pathology. More education did not protect individuals from developing neurodegenerative and vascular neuropathology by the time they died but it did appear to mitigate the impact of pathology on the clinical expression of dementia before death. The findings suggest that an understanding of the mechanisms leading to functional protection in the presence of pathology may be of considerable value to society.

The Childhood Autism Spectrum Test (CAST) (formally known as the Childhood Asperger Screening Test) identifies autism spectrum conditions by measuring social and communication skills. The present study explored the sex distribution of scores. The CAST was distributed to 11,635 children aged 4-9 years in Cambridgeshire primary schools (UK). 3,370 (29%) were returned. The median score was significantly higher in boys (median test, P less than 0.001) (Boys, median = 5 (IQR: 3,8); girls, median = 4 (IQR: 2,6)). There was a predominance of boys (n = 81 (79.4%) over girls (n = 21 (20.6%)) amongst those scoring greater than or equal to 15. Exclusion of children with ASC did not significantly affect the results. We conclude that different profiles of social and communication skills in boys and girls must be taken into account when measuring these skills in the general population.

We report a major revision of the CHecklist for Autism in Toddlers (CHAT). This "quantitative" CHAT (Q-CHAT) contains 25 items, scored on a 5 point scale (0-4). The Q-CHAT was completed by parents of n = 779 unselected toddlers (mean age 21 months) and n = 160 toddlers and preschoolers (mean age 44 months) with an Autism Spectrum Condition (ASC). The ASC group (mean (SD) = 51.8 (14.3)) scored higher on the Q-CHAT than controls (26.7 (7.8)). Boys in the control group (27.5 (7.8)) scored higher than girls (25.8 (7.7)). The intraclass correlation for test-retest reliability was 0.82 (n = 330). The distribution in the control group was close to normal. Full examination of the clinical validity of the Q-CHAT and test properties is underway.

The Childhood Asperger Syndrome Test (CAST) is a 37-item parental self-completion questionnaire designed to screen for high-functioning autism spectrum conditions in epidemiological research. The CAST has previously demonstrated good accuracy for use as a screening test, with high sensitivity in studies with primary school aged children in mainstream schools. This study aimed to investigate test-retest reliability of the CAST in a high scoring sample. To this end, 73 parents filled in the second CAST (CAST-2) within approximately 2 months of the first administration of the CAST (CAST-1). Agreement above and below the cut-point of 15 was investigated. The kappa statistic for agreement (less than 15 versus greater than or equal to 15) was 0.41. It was found that 70 percent (95% CI: 58, 80) of children did not move across the cut-point of 15. The correlation between the two test scores was 0.67 (Spearman's rho). The CAST shows moderate test-retest reliability in a high scoring sample, further evidence that it is a relatively robust screening tool for epidemiological research. (Contains 4 tables, 2 figures and 2 notes.)

This review examines the evidence for screening for autism spectrum disorders in the general population and the information needed to inform screening policy. The UK National Screening Committee criteria are taken as the framework. These criteria cover the condition, the screening test, the treatment and the screening programme as a whole. With respect to the condition, reasons for variation in prevalence estimates for autism spectrum disorders need to be resolved and there are few longitudinal studies to describe the natural history of autism spectrum disorders that include data on children identified at an early age. There is no screening test suitable for use in a population setting that has been fully validated. There is insufficient evidence regarding the effectiveness of interventions. This review supports the current policy position of the National Screening Committee, that on the basis of existing evidence, screening for autism spectrum disorders cannot be recommended. (Contains 3 tables and 1 figure.)

The Childhood Asperger Syndrome Test (CAST) is a 37-item parental self-completion questionnaire to screen for autism spectrum conditions in research. Good test accuracy was demonstrated in studies with primary school aged children in mainstream schools. The aim of this study was to investigate the test-retest reliability of the CAST. Parents of 1000 children in years 1-6 in five mainstream primary schools in Cambridgeshire received the CAST. A second identical questionnaire was posted to respondents after approximately 2 weeks. Both mailings generated 136 responses. Agreement above and below a screening cut-point of 15 was investigated. The kappa statistic for agreement (less than 15 versus greater than or equal to 15) was 0.70, and 97 percent (95 percent CI: 93-99 percent) of children did not move across the cut-point of 15. The correlation between the two test scores was 0.83 (Spearman's rho). The CAST has shown good test-retest reliability, and now requires further investigation in a high-scoring sample. (Contains 5 tables, 2 figures, and 1 note.)

We have used multiple sources to identify a population-representative cohort of newly diagnosed patients with parkinsonism and Parkinson's disease in the UK over a 2-year period. All patients have been invited to participate in a detailed clinical assessment either at home or in an outpatient clinic. These assessments have been used to refine clinical diagnoses of parkinsonism using established criteria, and describe some of the phenotypic variability of Parkinson's disease at the time of diagnosis. The crude incidence of Parkinson's disease was 13.6/10[superscript 5yr-1] [confidence interval (CI) 11.8-15.6 and of parkinsonism was 20.9/10[superscript 5yr-1] (CI 18.7-23.3). Age-standardized to the 1991 European population, the incidence figures become 10.8/10[superscript 5yr-1] (CI 9.4-12.4) for Parkinson's disease and 16.6/10[superscript 5yr-1](CI 14.8-18.6) for parkinsonism. Thirty-six per cent of the Parkinson's disease patients had evidence of cognitive impairment based on their performance in the Mini-Mental State Examination, a pattern recognition task, and the Tower of London task. The pattern of cognitive deficits seen among these patients using these and further cognitive tasks suggests that sub-groups of patients based on cognitive ability might be identifiable even in the early stages of disease, which may reflect regional differences in the underlying neuropathological processes.

Sex differences in social and communication behaviours related to autism spectrum conditions (ASC) have been investigated mainly in Western populations. Little research has been done in Chinese populations. This study explored sex differences related to ASC characteristics by examining differences in item responses and score distributions in relation to a screening instrument, the Childhood Autism Spectrum Test (CAST), used with Chinese children. A Mandarin Chinese version of the CAST (M-CAST) was distributed to 737 children aged 6-11 years in mainstream schools in Beijing. Questionnaires from 682 (93 %) children were available for analysis. The median score for boys was higher than for girls [boys, median = 8 (IQR 6, 11); girls, median = 7 (IQR 4, 9); p < 0.001]. There were differences in the proportions of boys and girls across all three score groups ([less than or equal to]11, 12-14, ≥15) with more boys being found in the higher score groups (p = 0.035). This finding provides evidence that boys and girls have different social and communication development profiles, consistent with previous findings in Western cultures. These results suggest that sex differences related to ASC are consistent across cultures. Keywords Autism * Social behaviours * Communication * Sex differences * China, Introduction Autism spectrum conditions (ASC) are neurodevelopmental disorders and are characterised by impairments in social interaction and communication, alongside the presence of repetitive and stereotyped behaviours, narrow interests and activities [...]