Late-life depression (LLD) is associated with cognitive impairment and an elevated risk of dementia, yet the influence of age at depression onset on cognitive prognosis remains unclear. Emerging evidence suggests that late-onset depression, defined as first depressive episode in later adulthood, may reflect distinct neuropathological mechanisms and predict more severe cognitive decline and greater dementia risk than early-onset depression.

This study aimed to investigate whether late-onset depression is linked to domain-specific cognitive impairment and higher risk of incident dementia among older adults with major depressive disorder.

We analysed UK Biobank data from older adults (aged ≥60 years) with primary care linkage, classifying participants into depression-free controls, early-life depression, late-life depression with early onset (LLD-EO) and late-life depression with late onset (LLD-LO). Cognitive performance across these five domains was assessed cross-sectionally at baseline using touchscreen tasks. Incident dementia was evaluated prospectively using clinical records up to 2022. Multi-level models with inverse-probability weighting and survey-adjusted mixed modelling were applied to assess group differences in cognitive function, controlling for demographic covariates, lifestyle factors and physical and mental health conditions. A Cox regression model was employed to estimate dementia risk among groups.

Among 75 064 participants aged ≥60 years, the LLD-LO group (n = 4858) showed significantly worse cognitive performance than healthy controls, particularly on fluid intelligence and visuospatial memory. The LLD-LO group performed worse than LLD-EO on fluid intelligence. During follow-up, LLD-LO was associated with a higher risk of incident dementia (hazard ratio 1.42–1.52) across all adjusted models. Deficits in fluid intelligence and visuospatial memory partially mediated the link between LLD-LO and subsequent dementia.

Late-onset depression showed more severe impairment in fluid intelligence compared with LLD-EO. Late-onset depression was associated with increased incident dementia compared with depression-free individuals.

The COVID-19 pandemic caused by the SARS-CoV-2 virus was the biggest global health emergency in the past century. The impact of the pandemic on society, and demand for health services, especially mental health services is not fully understood.

We describe the change in activity in a single UK NHS mental health trust during and following the pandemic.

We conducted a retrospective service evaluation using a population-based referral rates and clinical activity for mental health disorders in Cambridgeshire over the period 1 January 2017 to 31 December 2023. We divided the time period into pre-pandemic period, during the pandemic, and post-pandemic months. A negative binomial regression model was fitted to the monthly rates to yield incidence rate ratios. Subgroup analyses were performed by age, gender, ethnicity, and level of deprivation.

There was a steep decline in both referrals and clinical contacts during the lockdowns with a subsequent and steep increase in these measures during the immediate post-pandemic period. Increased numbers of referrals and contacts have been sustained well into the post-pandemic period.

In a single county-wide mental health service in the UK, the prolonged and sustained increase in both referrals and activity post-pandemic was not matched by equal increase in resource to meet demand. Our findings may be useful to effectively plan mental health services before, during and after any future pandemics.

Non-pharmacological interventions (NPIs) are recognised for their potential in treating dementia symptoms. However, little is known about the extent of their use. In this study, we conducted structured interviews with people with dementia and their family caregivers (n = 50), professional caregivers (n = 42) and dementia care coordinators (n = 42) on the use of 14 NPIs.

Cognitive stimulation/training, physical activity and occupational therapy were implemented by most participants, whereas neurofeedback, drama therapy and phototherapy were rarely used. Most NPIs were carried out weekly. People with dementia and their caregivers reported using significantly fewer NPIs than other participants (P < 0.001). Participants perceived effects for, on average, 90.3% (s.d. = 31.3%) of the NPIs that they used.

Providing targeted support and funding might help to increase the use of NPIs by family caregivers as well as in institutional care settings.

The covert administration of medicines is associated with multiple legal and ethical issues. We aimed to develop a natural language processing (NLP) methodology to identify instances of covert administration from electronic mental health records. We used this NLP method to pilot an audit of the use of covert administration.

We developed a method that was able to identify covert administration through free-text searching with a precision of 72%. Pilot audit results showed that 95% of patients receiving covert administration (n = 41/43) had evidence of a completed mental capacity assessment and best interests meeting. Pharmacy was contacted for information about administration for 77% of patients.

We demonstrate a simple, readily deployable NLP method that has potential wider applicability to other areas. This method also has potential to be applied via real-time health record processing to prompt and facilitate active monitoring of covert administration of medicines.

The novel South London and Maudsley Brain Health Clinic (SLaM BHC) leverages advances in remote consultations and biomarkers to provide a timely, cost-efficient and accurate diagnosis in mild cognitive impairment (MCI).

To describe the organisation, patient cohort and acceptability of the remote diagnostic and interventional procedures.

We describe the recruitment, consultation set-up, the clinical and biomarker programme, and the two online group interventions for cognitive wellbeing and lifestyle change. We evaluate the acceptability of the remote consultations, lumbar puncture, saliva genotyping, and remote cognitive and functional assessments.

We present the results of the first 68 (mean age 73, 55% female, 43% minoritised ethnicity) of 146 people who enrolled for full remote clinical, cognitive, genetic, cerebrospinal fluid and neuroimaging phenotyping. A total of 86% were very satisfied/satisfied with the remote service. In all, 67% consented to lumbar puncture, and 95% of those were very satisfied, all having no significant complications. A total of 93% found taking saliva genotyping very easy/easy, and 93% found the cognitive assessments instructions clear. In all, 98% were satisfied with the Cognitive Wellbeing Group, and 90% of goals were achieved in the Lifestyle Intervention Group.

The SLaM BHC provides a highly acceptable and safe clinical model for remote assessments and lumbar punctures in a representative, ethnically diverse population. This allows early and accurate diagnosis of Alzheimer's disease, differentiation from other MCI causes and targets modifiable risk factors. This is crucial for future disease modification, ensuring equitable access to research, and provides precise, timely and cost-efficient diagnoses in UK mental health services.