Georgina Charlesworth

In July 2026, Richard (Rik) Cheston retired from his post as Professor of Dementia Research at the University of the West of England (UWE), Bristol. In this article we look back with appreciation on his contributions to PSIGE/FPOP and at a body of psychological research and practice that has made, and continues to make, profound differences to the lives of people with dementia. We hear from former students and colleagues and look forward to Rik’s ongoing influence through the expanding LivDem programme.

Background: Sleep disturbances are common and distressing for people with dementia and their family carers and can lead to carers having interrupted sleep, low mood and care breakdown. Medication can have harmful side effects and is generally ineffective. Non-pharmacological interventions should be first-line treatments, yet until now there have not been effective treatments. Objectives: To establish whether Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS START), a multicomponent intervention, reduced sleep disturbance in people with dementia living at home at 8 months compared with National Health Service treatment (treatment as usual). Design and methods: We conducted a two-arm, multicentre, parallel-arm, superiority randomised controlled trial with masked outcome assessment. Participants were randomised (1 : 1 ratio) to DREAMS START intervention plus treatment as usual or treatment as usual alone. Analyses were intention to treat. We conducted a mixed-method process evaluation with additional substudies: one exploring how United Kingdom-based South Asians experience sleep disturbance and dementia, and one exploring the interaction of sleep, dementia and long-term conditions. Settings and participants: We recruited dyads of people with dementia and sleep disturbance living at home and family carers from 12 National Health Service trusts and the Join Dementia Research service in England. Interventions: DREAMS START is a six-session, multicomponent, manualised intervention delivered to family carers of people with dementia who implement strategies to improve their relatives’ sleep. It is delivered face to face or remotely by non-clinically trained graduates weekly or fortnightly and incorporates information about sleep and dementia, promotes de-arousal at night, adaptive stimulus control (e.g. bedtime routine maintenance), daytime behavioural activation, increasing access to light, improving carer sleep and making a tailored action plan. Main outcome measures: The primary outcome was sleep disturbance measured using the Sleep Disorders Inventory at 8 months. Results: Between February 2021 and March 2023, 377 dyads were randomly assigned, 189 to treatment as usual and 188 to DREAMS START plus treatment as usual. Mean age of participants with dementia was 79.4 years (standard deviation 9.0), and 206 (55%) were women. Mean Sleep Disorders Inventory score at 8 months was lower in the intervention versus treatment-as-usual arm [15.16 (standard deviation 12.77), n = 159, vs. 20.34 (16.67), n = 163]; adjusted difference in means [−4.70 (95% confidence interval −7.65 to −1.74); p = 0.002]. Seventeen (9%) people with dementia in the intervention and 17 (9%) in the control arm died during the trial; deaths were unrelated to the intervention. The mean incremental difference in health and care costs incorporating wider costs was £116 less per dyad (95% confidence interval −£5769 to £5536) for DREAMS START compared to treatment as usual. There was a 78% probability that DREAMS START is cost-effective compared to treatment as usual at a £20,000 decision threshold with no significant difference in quality of life. Conclusion: DREAMS START plus treatment as usual is clinically effective in reducing sleep disturbance in people living at home with dementia at 8 months, demonstrating sustained effectiveness beyond intervention delivery. DREAMS START is likely to be cost-effective, and delivery by non-clinically trained graduates increases potential for National Health Service implementation at scale. Limitations: We relied upon family carers’ proxy and self-reported outcomes, with intervention participants potentially more invested and optimistic, increasing risk of bias. Additionally, based on our feasibility randomised controlled trial, we did not include actigraphy or another direct measure of sleep and activity. Future work: Studies should explore the longer-term effect of DREAMS START (we are following up participants at 2 years), and there should be an implementation study considering delivery and scaling up DREAMS START in real-world healthcare settings. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR128761.

Translation of evidence about dementia risk and its reduction into effective, equitable public health policy is a major challenge. To address this challenge, the National Institute for Health and Care Research Policy Research Unit in Dementia and Neurodegeneration at Queen Mary University of London (DeNPRU-QM) convened a multidisciplinary panel of 40 experts from across England, with diverse lived, academic, clinical, policy and advocacy experience, at various career stages, and of diverse gender and ethnicity, to develop actionable policy recommendations for dementia risk reduction. Through a 2-day in-person workshop and a subsequent three-round modified Delphi survey, the panel evaluated and refined statements on dementia prevention. The panel achieved consensus on 56 recommendations in four domains: public health messaging, individual-level interventions, population-level interventions and research commissioning. A key priority across all domains was the need to consider and address health inequalities so that prevention efforts do not exacerbate existing disparities. Our recommendations provide policymakers with a robust foundation for designing and implementing an evidence-based dementia prevention strategy in England and provide guidance that can inform approaches in other countries and contexts. By prioritizing clear communication, targeted intervention and sustained research investment, the recommendations can help to address structural inequities and advance dementia risk reduction. Ongoing cross-sector advocacy will be crucial in driving policy adoption and implementation.

Background: Symptoms of anxiety and depression are common in people affected by dementia (people with dementia and family carers). There are many reviews of psychological interventions to reduce stress and distress in people with dementia and family carers, but little cross‐fertilisation with the evidence base underpinning NHS Talking Therapies for anxiety and depression (TTad). Objectives: To review the psychological intervention literature for people with dementia and their family carers through the lens of TTad, thus providing a bridge between the two literatures. Methods: We undertook a rapid scoping review of meta‐analyses of TTad‐recommended therapies used with people with dementia and family carers, including cognitive‐behavioural therapies (CBT), behavioural activation, problem‐solving, counselling for depression and mindfulness‐based cognitive therapy. Results: All meta‐analytic reviews of cognitive and behavioural therapies (nine with family carers and a Cochrane review with people with dementia) demonstrated the effectiveness of behavioural activation and CBT‐informed interventions in reducing symptoms of depression. Anxiety was less frequently studied, with no positive findings found for people with dementia. Psychoeducation was the most effective approach for anxiety reduction in carers. Evidence from meta‐analyses of mindfulness‐based interventions (MBIs) for carers showed reduced symptoms of both depression and anxiety. Conclusions: There are ontological and methodological differences in the literatures underpinning TTad and psychological interventions for people affected by dementia. To improve access to TTad for people with dementia and family carers, changes are required to research methodologies, TTad data collection and approaches to service delivery.