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Yes / This paper describes a study which explored the knowledge and attitudes of university students towards people living with dementia, and developed and tested a dementia awareness workshop, Dementia Detectives: University edition, designed to improve knowledge and foster positive attitudes to dementia in students. Design/methodology/approach: Dementia Detectives: University edition was launched during Dementia Awareness Week and five workshops were delivered to university students. Forty-two participants attended and completed a knowledge and attitude measure before and after the workshop, as well as rating the workshop with regards to satisfaction, relevance, understanding and whether they would recommend the workshop to friends. Findings: Students perceived living with dementia to be a negative and stigmatised experience. The workshop scored highly in terms of satisfaction, relevance and understanding and all students stated they would recommend the workshop to others. Paired t-tests found significant improvements in self-assessed dementia knowledge. Research Limitations: This was a pilot evaluation and further testing with larger samples is required. Practical implications: The workshop meets the requirements for tier 1 dementia education and training as outlined in the Dementia Core Skills and Knowledge Framework published by the Department of Health. Social implications: The workshop has the potential to increase knowledge, change attitudes, improve empathy and contribute to the development of a dementia aware workforce through undergraduate education. Originality/value: Dementia Detectives: University edition is a novel interactive method of dementia education and training.

Dementia is a public health priority and its importance is projected to increase in coming decades, particularly in low-to middle-income countries. A description of the methodological challenges of observational studies and the limitations of previous attempts to combine the published literature leads me to discuss ascertainment of dementia cases and the suitability of dementia mortality as an outcome. I report the findings of a memory clinic study where 71.5% of 502 deceased individuals with probable Alzheimer dementia had dementia correctly recorded on their death certificate, which is an improvement on similar results from two decades earlier. I review the evidence for geographical variation in dementia and discuss the implication that such variation might point towards potentially modifiable risk or protective factors for dementia. I have attempted to overcome the methodological challenges alluded to above by only examining within-study comparisons. A metaanalysis of rural-urban comparisons reveals some evidence of increased prevalence (odds ratio; 90% confidence interval (CI): 1.11; 0.79, 1.57) and incidence (1.20; 0.84, 1.71) of dementia in rural areas. These associations were stronger for Alzheimer dementia and particularly so in studies which identified early life rural residence (prevalence 2.22; 1.19, 4.16; incidence 1.64; 1.08, 2.50). Since there are no effective treatments, there is an obvious need to focus on prevention and an urgent need to improve our understanding of the aetiology of dementia in order to attempt to prevent or delay its onset. However, it is clear that prevention must begin sufficiently early in life to have an effect – intervening in later life might be too late. I describe a body of work using the Health Survey for England cohort studies examining the association between a series of risk factors and later dementiarelated death, including cardiovascular disease risk factors, psychological distress, and socioeconomic status. For example, there is a dose-response relationship between increasing psychological distress and dementia death (12-item General Health Questionnaire score 1-3 vs 0 age- and sex-adjusted hazard ratio; 95% CI: 1.44; 1.17, 1.78; score 4-12 vs 0: 1.74; 1.36, 2.22). I conclude by summarising the contribution these publications have made to the field of dementia epidemiology and by outlining ongoing and future projects building on the work presented in this thesis.

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