Abstract
318 - Does one size fit all? Evaluating individual temporal associations between affect and cognitive function in older adults using a single-subject design
- Alieke Tieks, Marij Zuidersma, Richard Oude Voshaar
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- 04 November 2020, p. 76
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Introduction
Depression and cognitive impairments often co-occur in older adults and account for a high disease burden. Insight into how affect and cognitive function influence one another on a daily basis could be helpful in the diagnostic process and treatment decisions for individual patients. However, little is known about the daily associations between affect and cognitive function in older adults and it is unknown whether these associations differ per person. Therefore, the objective of this study was to get insight into the temporal associations between affect and cognitive function within individual older adults.
Materials & MethodsFor this single-subject study eight older adults with depression and cognitive impairments filled in electronic diaries for 63 consecutive days in their home environment. The diaries included a questionnaire evaluating positive affect (PA), negative affect (NA) and a computerized cognitive test battery assessing working memory reaction time (WMRT) and visual learning accuracy (VLA). Time-series analyses using Vector Autoregressive (VAR) modelling were conducted for each individual separately. Granger causality tests were used to determine the temporal direction of the individual associations. Cumulative Orthogonalized Impulse Response Function (COIRF) analyses were performed in order to determine the cumulative effect size over a 10-day period. The contemporaneous associations were derived from the correlation between the residuals in the VAR model.
ResultsFor one out of eight participants higher NA was associated with better WMRT the next day (cumulative effect size=0.345; p=0.005). For another participant higher NA and lower PA were associated with worse WMRT at the same time (r=-0.369; p=0.003 and r=0.352; p=0.005, respectively). For a third participant better VLA was associated with lower NA (cumulative effect size=-0.569; p<0.001) and higher PA the next day (cumulative effect size=0.223; p=0.001). The other five participants showed no contemporaneous or lagged association between affect and cognitive function.
ConclusionFor the majority of individuals we found no contemporaneous or temporal association between affect and cognitive functioning. For the others, the associations differed in direction, sign and size. This highlights heterogeneity even in a small and relatively homogeneous sample. Future studies should evaluate how individual data can be used in personalizing diagnoses and treatments.
319 - Challenges in the diagnosis and treatment of dementia in schizophrenic patients: on the behalf of a clinical case
- Carolina Ribeiro Machado, Bárbara Almeida, Cristina Fragoeiro, Margarida Passos
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- 04 November 2020, p. 77
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Studies have been showing that schizophrenia is significantly associated with the risk of all-cause dementia. The neurobiological mechanisms underlying this association are not clarified, as well as, the role of antipsychotics mediating the risk of dementia.
The main aim of this work is, through the presentation of a clinical case, to show the evolution from symptoms of schizophrenia to dementia. The second aim is to present the challenges in the diagnosis and management of dementia in schizophrenic patients.
Along with the description of the clinical case we present a brief summary of a Pubmed search with the Mesh terms “schizophrenia” and “risk” and “dementia”. We selected clinical trials and review articles published in the last 5 years. From a total of 132 articles, we selected those who matched better our aims.
The patient is a 66-year-old man with a diagnosis of schizophrenia since the age of 40. In 2017 he began to develop episodes of temporal and spatial disorientation, followed by difficulties in naming and eventually functional impairment for daily activities. The initial mini mental test quoted 26/30, halving in less than two years.
The lumbar puncture revealed a Tau/Amyloid beta42 ratio compatible with Alzheimer dementia. Since language was clearly the first domain affected, it was diagnosed a logopenic variant of Alzheimer dementia.
We associated to the antipsychotic treatment galantamine 10mg and then raised it to 16mg. The loss of language was progressive, and the patient started to show psychomotor slowing and abnormal gait. We reduced paliperidone from 75mg/ml 50mg/ml but after two years of functional deterioration and apathy we eventually stopped the antipsychotic.
In the last six months the patient has been stable with galantamine 16mg, memantine 20mg, although dependent for daily activities.
Whether schizophrenia independently increases dementia incidence, or whether this correlation is confounded by traditional dementia predispositions (cerebrovascular disease, substance abuse and others) is unclear as studies have shown inconsistent results. On the other side, the cumulative use of antipsychotics for schizophrenia patients was related to cognitive decline in an observational follow-up study.
Further studies should explore whether treating schizophrenia is a potentially modifiable risk factor for dementia.
320 - Barriers to Deprescribing in Older Adults with Dementia
- Mariana Duarte-Mangas, Gonçalo A. Santos, Beatriz Jorge, Catarina Pedro Fernandes
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- 04 November 2020, p. 78
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Individuals with dementia usually have multiple chronic illnesses, most of whom are medicated with five or more medications. However, as dementia progresses and the goal of care moves from prolonging life to optimizing quality of life, the risk of taking certain medications may outweigh its benefit. Therefore, it is necessary to reassess the medication over time.
The objective of this work was to explore the barriers to optimising prescribing and deprescribing (withdrawing) of medications and the benefits of this procedure. Optimizing pharmacological treatment for people with dementia usually requires the prescription of inappropriate drugs and the initiation of other drugs. Several obstacles to the optimization of treatment have been identified in elderly people with multiple morbidities, related to the doctor, the health system, the patient and the caregiver, including: inadequate guidelines, incomplete medical history, prevention of negative consequences and established beliefs in the benefits and harms medication. Desprescribing older people with dementia is made even more difficult by the decrease in decision-making capacity, difficulties in understanding and communicating, increased involvement of caregivers and difficulties in setting goals.
321 - Association between quality of life and anxiety, depression, and comorbid anxiety and depression in people with dementia in nursing homes: A 12-month follow-up study
- Alka R. Goyal, Sverre Bergh, Knut Engedal, Marit Kirkevold, Øyvind Kirkevold
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- 04 November 2020, p. 79
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Background:
Anxiety and depression are highly prevalent among people with dementia (PWD), and has many negative outcomes, such as increased behavioral problems, decreased ability to live independently, and increased risk of nursing home placement, which may affect the person’s quality of life (QoL). Many cross-sectional studies have investigated factors associated with QoL in PWD in nursing homes, but few longitudinal studies have investigated how anxiety and depression affect the course of QoL of PWD in nursing homes. This study aimed to explore the association between QoL and anxiety, depression, and comorbid anxiety and depression in PWD in nursing homes at a 12-month follow-up.
Methods:In all, 298 PWD ≥ 65 years old from 17 Norwegian nursing homes were assessed with Norwegian version of the Rating Anxiety in Dementia scale (RAID-N). Anxiety was defined as RAID-N score ≥ 12. QoL was assessed by Quality of Life in Late-Stage Dementia (QUALID) scale. Depression was assessed by the Cornell scale of depression in dementia (CSDD), defined as CSDD score ≥ 10. The assessments were made at baseline and after a mean follow-up period of 350 days (SD 12.3). A growth mixture model revealed two distinct trajectories of QUALID scores. Participants’ characteristics and related risk factors associated to QUALID score trajectories were analyzed by logistic regression models.
Results:In trajectory group 1 (206 participants), a lower proportion of participants had anxiety, and a more stable and better QoL, compared to trajectory group 2 (92 participants) with a higher proportion of participants with anxiety and poorer QoL at a 12-month follow-up. Participants with comorbid anxiety and depression had the worst QoL than the participants with only anxiety or only depression. Adjusted multivariate logistic regression analysis revealed that more severe impairment in activities of daily living, presence of anxiety, depression, agitation, and use of antipsychotics at baseline, were associated with belonging to the trajectory group with poor QoL.
Conclusion:It is important among nursing home personnel to increase awareness of and skills in identifying anxiety and depression, and to initiate adequate management to enhance Qol of PWD in nursing homes.
Note: The material was published in September 11, 2018 in Plos one.
322 - Heterogeneity in dynamic change of cognitive function among Chinese elderly: A growth mixture model
- Peiyuan Qiu, Weihong Kuang, Yan Cai, Yang Wan
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- 04 November 2020, p. 80
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Objectives:
Our aim is to use the growth mixture model (GMM) to distinguish different trajectories of cognitive change in Chinese geriatric population and identify risk factors for cognitive decline in each subpopulation.
Methods:We obtained data from the Chinese Longitudinal Health Longevity Survey, using the Chinese Mini-Mental State Examination (C-MMSE) as a proxy for cognitive function. We applied the GMM to identify heterogeneous subpopulations and potential risk factors.
Results:Our sample included 2850 older adults, 1387 (48.7%) male and 1463 (51.3%) female with age range of 62 to 108 (average of 72.3). Using GMM and best fit statistics, we identified two distinct subgroups in respect to their longitudinal cognitive function: cognitively stable (91.4%) group with 0.42 C-MMSE points decline per 3 years, and cognitively declining (8.6%) group with 4.76 C-MMSE points decline per 3 years. Of note, vision impairment and hearing impairment had the highest associations with cognitive decline, with stronger association found in the cognitively declining group than the cognitively stable group. Cognitive activities were protective in both groups. Diabetes was associated with cognitive decline in cognitive declining group. Physical activities, social activities and intake of fresh vegetables, fruits, and fish products were protective in cognitive stable group.
Conclusions:Using GMM, we identified heterogeneity in trajectories of cognitive change in Chinese elders. Moreover, we found risk factors specific to each subgroup, which should be considered in future studies.
323 - I’d prefer to stay at home but I don’t have a choice’: Irish social workers’ experiences of decision-making in care planning with older people with dementia
- John P. Brennan
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- 04 November 2020, p. 81
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This paper is based on a collaborative research study undertaken by the Irish Association of Social Workers, Age Action Ireland, The Alzheimer Society of Ireland and the School of Social policy, Social Work and Social Justice, University College Dublin. The study explored the experiences and views of social workers working with older people, including people with dementia. The purpose of the study was to investigate how the health and social care system in Ireland was responding to the care needs, required supports and preferences of older people. This paper will mainly focus on reported experiences related to older people with dementia in decision-making about their care.
Data collection included a mixed method approach, that is, (i) an on-line survey of social workers across Ireland reporting on their open caseload over a period of one month (N = 38)) and (ii) semi-structured telephone interviews with social workers (N = 21).
The Quantitative data was analysed using SPSS statistical software to produce descriptive and bivariate results. For the qualitative data an iterative data reduction process was used.
Findings echoed that of other Irish research demonstrating (i) that the preference of older people is to remain living at home and receiving care in this setting as needed, and (ii) that this preference is not being realized. The study further highlighted variations in participation levels of people with dementia in the decision-making process, the barriers to participation and the place of family relationships in the decision-making process. The study made recommendations as to how to address these issues. The findings will also be considered within the context of social justice for older people.
324 - Twelve-month progress of online intervention to prevent cognitive decline: Maintain Your Brain
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- 04 November 2020, p. 82
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Authors:
Henry Brodaty, Megan Heffernan, Gavin Andrews, Kaarin Anstey, Maria Fiatarone Singh, Louisa Jorm, Nicola Lautenschlager, Anthony Maeder, John McNeill, Perminder Sachdev, Michael Valenzuela, Maintain Your Brain Collaborative Team.
Abstract:In the absence of disease modifying interventions for Alzheimer’s disease (AD) and other dementias there is an increased interest in dementia prevention. An issue for population-based lifestyle preventative approaches is scalability. An internet-based multicomponent Maintain Your Brain (MYB) randomised trial is currently underway.
Invitations to participate in Maintain Your Brain were emailed or mailed to people aged 55-77 years from the 45 and Up study, a population-based cohort study of one in ten people aged 45 years and older (n = 267,000). To be enrolled into the study participants were required to have risk factors that made them eligible for at least one of the available modules. Modules were designed to address physical inactivity and health risks associated with inactivity (Physical Activity), adherence to a Mediterranean-type diet and health risks associated with poor nutrition (Nutrition), cognitive activity (Brain Training) and mental wellbeing (Peace of Mind).
During recruitment 96,418 invitations were sent and 14,064 (14%) provided consent. Of those who completed baseline over 90% were eligible for at least two modules of the intervention. Overall, 6,236 (44%) were enrolled resulting in an overall recruitment rate of 6%, or 50% of those eligible at screening. The final sample was 64% female with a mean age of 64.9yrs (SD = 5.8, range 55-77 yrs) and mean years of education of 12.9yrs (SD = 3.0, range 2-22 yrs).
Recruitment rates in MYB were comparable to other clinical trials targeting older people and who included online recruitment strategies. This is promising for the willingness of participants to engage with trials that use online rather than traditional in-person methods. Although the baseline withdrawal number (3%) remained stable after randomisation (4%), a further 25% of participants did not attempt any activities. These rates continued at the annual assessments when 4% withdrew, 31% completed no follow-up activities, 14% partially completed and 55% completed all.
Online lifestyle interventions have capacity to reach broad segments of the 55-77 year old population, the majority of whom may benefit from support activities shown to be effective in reducing risk of cognitive decline and ultimately delay onset of dementia. The challenge with this new approach is encouraging continued engagement with the program over time.
325 - Relationship quality in dementia: Preliminary longitudinal analyses of the EU-JPND Actifcare cohort study
- Maria J. Marques, Bob Woods, Eva Y.L. Tan, Marjolein de Vugt, Frans Verhey, Manuel Gonçalves-Pereira
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- 04 November 2020, p. 83
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INTRODUCTION
Relationship quality (RQ) in dyads of persons with dementia and their family carers is important both as a clinical outcome and as a determinant of health and quality of life. In previous work we studied RQ using baseline data of a large-scale European longitudinal study on timely access to and use of community formal services in dementia (EU-JPND Acticare). We concluded that neuropsychiatric symptoms and carer stress contributed to discrepancies in RQ ratings within the dyad, which were less favourable when reported by family carers. This and other associations (e.g. between carer-rated RQ and sense of coherence) were cautiously interpreted, in the context of a cross-sectional analysis.
OBJECTIVESTo analyse how carer-reported RQ varies over time and to examine its most important influencing factors.
METHODSWe present preliminary longitudinal analyses from the Actifcare cohort study of 451 community-dwelling persons with dementia and their primary carers in eight European countries (12-month follow-up). Comprehensive assessments included the Positive Affect Index (PAI) to assess RQ, persons with dementia’s neuropsychiatric symptoms, persons with dementia and carers’ unmet needs, carers’ anxiety and depression, social support, sense of coherence and stress.
RESULTSCarers’ mean PAI scores decreased over the 12 -month period. The person with dementia neuropsychiatric symptoms and unmet needs, and carers’ perceived social support were significant predictors of carers’ RQ change.
DISCUSSION AND CONCLUSIONWe analysed carer-reported RQ variation over time and predictors in a large European sample of persons with dementia and their family carers. As expected, RQ decreased over the oneyear follow-up period as the disease progressed. Its main predictors in this sample (neuropsychiatric symptoms and the person’s unmet needs, together with carers’ social support) can all influence the impact that caregiving has on the carer and on how time and energy-consuming caregiving is. The role of increased clinical symptoms (also affecting communication difficulties), together with carers’ exhaustion, must be equated. Overall, these results may help us to tailor interventions addressing RQ and potentially improve dementia outcomes.
326 - Present-mindedness in adaptation to living with young onset dementia
- Charlotte Berry, Jan Oyebode, Carol Martin
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- 04 November 2020, p. 84
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Introduction:
Research into the experiences of those with a diagnosis of young onset dementia is extremely limited and the research that does exist tends to be loss orientated.
Aim:This paper will focus on a doctoral study which aimed to explore the full spectrum of lived experience of those with young onset dementia, whilst considering the unique impact of diagnosis at a younger age and the possibility of personal growth.
Methods:Five individuals took part in semi-structured interviews within which they were invited to bring along artefacts that helped them to share their experiences. Transcribed interviews were analysed using Interpretative Phenomenological Analysis and superordinate and subordinate themes were identified.
Findings:Four superordinate themes emerged: ‘Fear’, ‘Anger’, ‘Sadness’, ‘Contentment’ with thirteen subordinate themes. The findings indicated that participants experienced feelings of fear and vulnerability in response to their diagnosis. Participants felt angry that they did not have a voice, not enough was being done for those with dementia and they were being stereotyped. Participants spoke of a depressive state of mind in which they grieved for their past self, experienced isolation and loneliness, and feelings of hopelessness and despair. Finally, participants spoke of a sense of contentment in relation to a preserved self, a sense of living alongside their dementia and a desire to live in the present; making the most of the here and now.
Conclusions:The findings highlight the transitory nature of participants’ experiences as a result of multiple and repeated challenges to psychological equanimity. It suggested that these experiences could best be understood using lenses of lifespan development, bereavement and grief. The findings suggest that approaches to dementia care that focus on developing present-mindedness, acceptance and compassion may be particularly helpful.
327 - The Course and Predictors of Quality of Life in Nursing Home Residents with Young-onset Dementia
- Lihui Pu, Christian Bakker, Britt Appelhof, Jeannette C.L. Van Duinen-van den Ijssel, Sandra A. Zwijsen, Steven Teerenstra, Martin Smalbrugge, Frans R.J. Verhey, Marjolein E. de Vugt, Sytse U. Zuidema, Raymond T.C.M. Koopmans
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- 04 November 2020, pp. 85-86
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Background:
People with young-onset dementia (YOD) living in nursing homes may experience poor quality of life (QoL) due to advanced dementia, high prevalence of neuropsychiatric symptoms and psychotropic drug use. However, the course of QoL in institutionalized people with YOD and factors that predict this course are unclear. This knowledge could help health professionals identify appropriate interventions to improve QoL in YOD.
Objective:To explore the course of QoL in institutionalized people with YOD and resident-related predictors of that course.
Methods:Secondary analyses were conducted with longitudinal data from the Behavior and Evolution in Young-ONset Dementia (BEYOND)-II study. A total of 278 people with YOD were recruited from 13 YOD special care units in the Netherlands. QoL was measured by the proxy assessment of Quality of Life in Dementia (QUALIDEM) questionnaire at four assessments over 18 months. Independent variables included age, gender, dementia subtype, length of stay, dementia severity, neuropsychiatric symptoms and psychotropic drug use at baseline. Multilevel modeling adjusted for correlation within nursing homes and residents was used to determine the course and predictors of QoL.
Results:The total QUALIDEM score (range: 0–111) decreased over 18 months with a statistically significant decline of 0.73 points per six months. A significant increase of QoL over time was seen in the subscales “Care relationship”, “Positive self-image”, and “Feeling at home”. However, a significant decline was observed in the subscales “Positive affect”, “Social relations”, and “Something to do”. Residents’ course of QoL was positively associated with the baseline scores of the QoL, age and longer duration of stay; however, being male, having advanced dementia, Alzheimer’s disease and high rates of neuropsychiatric symptoms at baseline were negatively associated with the course of QoL
Conclusion:Longitudinal changes in QoL in residents with YOD were small over 18 months and QUALIDEM subscales showed multidirectional changes. The largest QoL decline in the subscale “Positive affect” suggests that interventions should be targeted to improve positive emotions, in particular for male residents with neuropsychiatric symptoms and advanced dementia.
328 - Depression as a disorder of accelerated ageing
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- 04 November 2020, p. 87
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Presenting author:
Prof.dr. Richard C. Oude Voshaar, University of Groningen, The Netherlands (r.c.oude.voshaar@umcg.nl)
Co-author:Prof.dr. Ivan Aprahamian, Faculty of Medicine of Jundiaí, Brazil (ivan.aprahamian@gmail.com)
Depressive disorder has been conceptualised as a disorder of accelerated ageing. Furthermore, meta - analyses have shown that depression associated with excess mortality, although most studies can be criticised for insufficient confounder control. These characteristics of depression resemble the characteristics of biomedical frailty. Biomedical frailty can be assessed with the frailty index (FI) based on the deficit accumulation model. This model postulates that the proportion of at least 30 ageing-related health deficits reflects biological age on top of chronological age. The characteristics of the FI are independent of the specific health deficits included, as long as health deficits from different physiological systems are included. The FI is the most accurate frailty model for predicting mortality, the ultimate outcome of increasing frailty states. Because of its continuous nature, the FI is sensitive to change which enables us to study trajectories of frailty.
The objective of the present lecture is 1) to show that depressive disorder associated with accelerated biological ageing as indexed by the frailty index, 2) that depressive disorder is a risk factor for excess mortality, and 3) to show that this latter explanation is largely explain by biomedical frailty.
The Netherlands Study of Depression in Older persons (NESDO) is a clinical cohort of 378 depressed patients according to DSM-IV criteria and 132 non-depressed controls who have been followed up for six-year. The data of this cohort study enabled us to construct a frailty index based on 41 non-depression related health deficits. Linear mixed models showed that the frailty index had a significantly steeper increase over six years among depressed patients compared to their non-depressed counterparts.
Subsequently, we constructed a frailty index based on 64 health deficits in the LifeLines cohort study, a three-generation population-based study including 167,000 persons. In this population-based cohort, we replicated our finding that the presence of a depressive disorder according to DSM-IV criteria, but also anxiety disorders, were associated with an accelerated increase of the frailty index over a 5-year follow-up. Furthermore, Cox-regression showed that the presence of a depressive disorder or any anxiety disorder was also associated with excess mortality over a 10-year follow-up. These effects remained significant when adjusted for socio-demographic characteristics, lifestyle variables and multimorbidity, but disappeared when adjusted for the frailty index.
We conclude that depressive disorder can indeed be conceptualised as a disorder of accelerated biological ageing, as indexed by the frailty index. Moreover, biomedical frailty may be an explanatory factor for excess mortality found to be associated with affective disorders. Therefore, biomedical frailty seems a promising marker for risk stratification in geriatric psychiatry.
329 - A psychological needs-based intervention to reduce depression in newly admitted nursing home residents
- Tanya E. Davison, Marita P. McCabe, Lucy Busija, Annette Graham
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- 04 November 2020, p. 88
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Background:
Depression is common in nursing homes, with newly admitted residents at a particularly high risk. Current prevention and treatment approaches have failed to impact on the high rates of depression and new approaches are required. We have developed a novel intervention that addresses individual psychological needs in newly admitted residents, which is implemented in collaboration with residents and facility staff. The Program to Enhance Adjustment to Residential Living (PEARL) is a 5-session intervention based on Self-Determination Theory that aims to tailor care to enhance residents’ autonomy, competence and relations.
Methods:A cluster randomised controlled trial was conducted to determine the effectiveness of PEARL in reducing depression in newly admitted nursing home residents, compared to a treatment as usual control condition. A total of 216 residents with normal cognition or mild-moderate cognitive impairment, living in 42 nursing homes in Melbourne, Australia, participated in the study. The sample included 76 men and 140 women, aged 62-99 years (M = 85.5, SD = 7.3). The primary outcome was level of depressive symptoms, assessed using the Cornell Scale for Depression in Dementia at baseline and at 8, 16 (primary endpoint), and 31 weeks follow-up. Multi-level modelling, accounting for within-facility clustering and repeated assessments, was used to determine the effectiveness of the intervention, employing an intention-to-treat approach.
Results:At 16-weeks, fewer symptoms of depression were observed among those in the intervention group (M = 7.0, SD = 5.6) than in the control group (M = 8.6, SD = 6.5). Multi-level modelling of unadjusted data showed a significant condition (intervention, control) by time (T1, T2, T3) interaction (p = .021), indicating that the PEARL intervention led to a reduction in the occurrence of depressive symptoms. The treatment effect was maintained at 31 weeks follow-up (p = .004).
Discussion:This study provides evidence that an intervention designed to address newly admitted residents’ individual psychological needs reduced symptoms of depression in subsequent months. This brief, simple intervention may be suitable for broad implementation across long-term care settings. However, future research to determine if the intervention can be implemented by trained facility staff in situ is warranted.
330 - Depression and Anxiety among Older people in Central Africa: Results of the EPIDEMCA population-based study
- Maëlenn Guerchet, Antoine Gbessemehlan, Caroline Adou, Jean-Pierre Clément, Bébène Ndamba-Bandzouzi, Pascal Mbelesso, Dismand Houinato, Pierre-Marie Preux
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- Published online by Cambridge University Press:
- 04 November 2020, p. 89
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Introduction:
Depression and anxiety are two very common psychiatric disorders in late-life. They are markers of poor quality of life and are strongly associated with death among older people. Yet, few studies on these comorbidities have been conducted in the African population. This study aims to present the epidemiology of depression and anxiety among older people in Central Africa.
Method:A cross-sectional population-based study was carried out in Republic of Congo (ROC) and Central African Republic (CAR) between 2011 - 2012 among older people aged ? 65 years (EPIDEMCA study). Data were collected using a standardized questionnaire and participants underwent a brief physical examination. Depression and anxiety symptoms were ascertained using a community version of the Geriatric Mental State (GMS-B3) and the Automated Geriatric Examination for Computer Assisted Taxonomy diagnostic system (AGECAT), probable cases were defined as having a GMS-AGECAT level of 3 or more. Logistic regression models were used to investigate the association between potential risk factors collected and each symptom.
Results:Overall 2002 participants were included in the EPIDEMCA study (500 in Brazzaville and 529 in Gamboma in ROC, 500 in Bangui and 473 in Nola (473) in CAR). Median age of the participants was 72 years [interquartile range: 68 – 78 years] and females were mostly represented (61.8%). Prevalence was 38.1% (95% Confidence Interval: 35.9% - 40.2%) for depression, 7.7% (95% CI: 6.5% - 8.9%) for anxiety and 5.7% (95% CI: 4.6% - 6.7%) for the co-occurrence of both disorders. For all three outcomes, prevalence was significantly higher among females and in rural areas. Only depression increased with age. Preliminary analyses showed that female sex, living in a rural area, and living without a partner were associated with the three outcomes (Odds Ratios from 1.59 to 3.27; p<0.01). In-depth results regarding correlates of depression, anxiety and the co-occurrence of both will be presented.
Conclusion:The prevalence of depression and anxiety was high among Central African older people. Evidence on the epidemiology of these common psychiatric symptoms are of importance for care management and also emphasize the need to maintain and/or strengthen social support around older people in the region.
331 - Global cognition modified the relationship between Anemia and Depression in old age: longitudinal analysis from The IMIAS Study
- Tamer Ahmed, Helen-Maria Vasiliadis
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- 04 November 2020, p. 90
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Running head:
role of global cognition in the association between Anemia and depression.
Background:We examined the longitudinal relationships between hemoglobin concentrations or Anemia and depression and whether baseline cognitive function modifies these longitudinal relationships over 4 years of follow-up.
Methods:A total of 1608 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). The study outcome was depression, defined by a score of 16 or over in the Center for Epidemiologic Studies Depression Scale (CES-D). Longitudinal associations over four years follow-up were examined using generalized estimating equations. Models reported were either unadjusted and adjusted for research sites, alcohol drinking status, body mass index, chronic conditions, activities of daily life disabilities, and polypharmacy.
Results:Longuitinal relationships suggested an evidence of multiplicative interaction by baseline global cognition in which 1g/dL increase in hemoglobin concentrations there was a significant reduction in the risk of depression with a stronger effect among participants with good cognitive function (Odds Ratio (OR)=0.85, 95% CI: 0.78-0.92) compared to those with poor cognition (OR=0.89, 95% CI: 0.80-0.97). Anemia and poor cognition at baseline were associated with an increased risk of depression over four years of follow-up (OR=5.80, 95% CI: 1.84-18.23). Global cognition was also an effect modifier of the longitudinal association between the severity of Anemia and depression.
Conclusion:In international samples of older adults, hemoglobin concentrations, as well as the severity of Anemia, were independent risk factors for depression, and these associations differed by global cognitive function.
332 - Electroconvulsive therapy in older adults with major depression was not associated with cognitive decline during a 15-year follow-up
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- 04 November 2020, p. 91
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AUTHORS:
Kerstin Johansson, Karolina Thömkvist, Ingmar Skoog and Sacuiu SF* (*presenter)
OBJECTIVE:To determine the effects of electroconvulsive therapy (ECT) in major depression in relation to the development of dementia during long-term follow-up.
METHOD:In an observational clinical prospective study of consecutive patients 70 years and older diagnosed with major depression at baseline 2000-2004 (n=1090), who were free of dementia and received antidepressant treatment, with or without ECT, we sought to determine if cognitive decline (mild cognitive impairment and dementia) during 15 -year follow-up was associated with receiving ECT at baseline. The control group was selected among the participants in the Gothenburg H70 Birth Cohort Studies matched by age group and sex 1:1.
RESULTS:Among patients with affective syndromes 7% received ECT. During follow-up, 157 patients were diagnosed with dementia, equal proportions among those who received ECT (14.5%) and those who did not receive ECT (14.5%). The relation between ECT and cognitive decline remained non-significant irrespective antidepressive medication or presence of mild cognitive impairment at baseline.
CONCLUSION:Preliminary results indicate that ECT was not associated with the development of cognitive decline in the long-term in a hospital-based cohort of 70+ year-olds. The results remain to verify against controls from a representative community sample.
333 - The advantages of a double threshold MoCA (Montreal Cognitive Assessment) for triaging patients to a memory clinic
- Géraud Dautzenberg, Jeroen Lijmer, Aartjan T.F. Beekman
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- 04 November 2020, p. 92
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The MoCA was developed as a screening tool for mild cognitive impairment (MCI) and mild dementia (MD) and validated in different settings. At the original suggested cutoff of <26, with 30 being flawless, it has a high sensitivity for detecting MCI and MD. The specificity is argued in clinical practice. Its high sensitivity makes it a good screener for identifying most MD-patients, however, for selecting those in need of a scarce neuropsychological assessment (NPA), the moderate specificity gives too many false positives. It is repeatedly suggested to lower the cut-off to <21, resulting in higher specificity for identifying MD. But lowering the cut-off, increasing the false negatives, will not decrease the number of classification errors. One needs to triage with a cut-off that finds all patients at high risk of MD without referring too many who are not (yet) in need of a NPA. A difficulty is who to consider at risk, as definitions for illnesses (e.g. MD) do not always define health at the same time and thereby create subthreshold disorders. As MCI is a state of subthreshold dementia -of which 40% worsens 40% stabilizes 20% recovers, therefore justifying its own policy -it is essential to differentiate it from MD and no-cognitive impairment (NoCI). Double thresholds are a solution by using one threshold for health and one for illness. Especially where classifications create subthreshold disorders, regardless of whether these are disorders in their own right or are merely (minor) forms of major disorders. A double threshold MoCA gives the best accuracy and raises the opportunity to differentiate the clinical and subclinical states to their appropriate domain and hence their appropriate policy. Next to these clinical aspects, shown in our study, a double threshold also reduces random classification errors. By applying an uncertainty interval -most errors appear from 21 to 26- the PPV and NPV improves and becomes less dependent of the prevalence. Two thresholds, with <21 selecting patients for NPA and ?26 for clearing patients, gives the best results and achieves two aims at once. It also identifies most MCI (21<26) who’s intermediate state justifies active monitoring.
334 - Diagnostic complexities of the differential diagnosis between biomedical frailty and depression
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- 04 November 2020, p. 93
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Presenting author:
Prof.dr. Richard C. Oude Voshaar, University of Groningen, The Netherlands (r.c.oude.voshaar@umcg.nl)
Co-authors:Miss Astrid Lugtenburg, GGZ Drenthe Mental Health Institute, Assen, The Netherlands (astridlugtenburg@gmail.com)
Miss Marij Zuidersma, University of Groningen, The Netherlands (m.a.zuidersma@umcg.nl)
The Netherlands Study of Depression in Older persons (NESDO) is a clinical cohort study including 378 older persons suffering from a depressive disorder and a comparison group of 132 never depressed older persons. Within NESDO cohort, we examined the impact of the Fried Frailty Phenotype and its criteria on the two-year course of late-life depression.
With respect to the prognosis of depression, frail-depressed older patients had a significantly higher level of depressive symptoms over the course of two-years and were less often in remission at the two-year follow-up. Paradoxically, the improvement of the severity of depressive symptoms were larger in frail-depressed compared to non-frail-depressed patients. This raises the question whether the remaining symptoms should be considered as residual depressive symptoms (in need of psychiatric treatment) or physical frailty (in need of geriatric rehabilitation).
To address this latter issue, we have searched for data-driven depressive subgroups by conducting a latent profile analysis on the subscales of the Inventory of Depressive Symptomatology Self Report (IDS-SR), cognitive performance (processing speed, interference, working and verbal memory) and physical frailty (gait speed, handgrip strength). Half of the depressed patients were suffering from a pure depressive disorder (consisting of two subgroups being either mildly or severely depressed), whereas the other half of the sample consisted of three different subgroups of frail-depressed patients, namely a subgroup suffering from amnestic depression, a subgroup of physically dominated frail-depressed patients and finally a subgroup of cognitively dominated frail-depressed subgroup. The three frail -depressed subgroups had differential outcomes with respect to depressive symptom severity, course of frailty parameters and mortality.
345 - 7 Critical factors for safely supporting dementia patients in mental health crisis in community
- Sabarigirivasan Muthukrishnan, Kate Hydon, Lucy Young, Cristie Howells
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- 04 November 2020, pp. 105-106
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Background:
Best practice in dementia care is support in the home. Yet, crisis is common and can result in hospital admission. Home-treatment of crisis is an alternative to hospital admission that can have better outcomes and is the preference of people living with dementia.
Purpose:To report an investigation of the management of crisis for people with dementia living at home and managed by a Home Treatment Crisis Team.
Objective:To identify critical factors for successful resolution of crisis and avoidance of hospital admission
Methods:The research was mixed-methods case study design. It was an in depth investigation of what happens during crisis in people with dementia and how it is managed by a home treatment crisis team to resolution and outcome at six weeks and six months. Methods were observation of the management of crisis in the home setting for 15 people with dementia (max 3 per person, total 41 observations), interviews with people with dementia (n=5), carers (n=13), and 14 professionals (range 1 to 6 per person, total 29), a focus group with professionals (n=9) and extraction from medical records of demographics and medical history.
The analysis focused on the identification of key treatments, behaviours, education and context important for home treatment to prevent hospital admission.
Findings:The study recruited 15 of the 88 accepted referrals to the service for management of a crisis in a person with dementia.
The seven key factors key for crisis resolution were
a systems approach with embedded respect for personhood,
attention to carer needs independently of the person with dementia,
review and monitoring of the effect of medications,
awareness and promotion of potential benefits with treatment at home,
education of the health and social care workforce in dementia care,
local availability of respite and other social care services.
a dynamic and flexible working ethos and meaningful MDT working with flattened hierarchy
The Home Treatment Crisis Team created a ‘Safe Dementia Space’ for the person with dementia in crisis. In the first instance, this was immediate but temporary with on-going assessment and intervention until negotiated permanent support was in place coproduced and agreed by stakeholders to be a sustainable dementia space with acceptable risk of harm to the person with dementia or others. The approach enabled avoidance of hospital admission in more than 80% of referrals.
Conclusion:This is the first study to collect data during crisis at home for people with dementia and to investigate process and management. It reveals the Home Treatment Crisis Team created sustainable ‘Safe Dementia Space’ to enable the person with dementia to continue to live in the community during and after crisis, thus avoiding hospital admission. The identified key components of the management approach for crisis resolution are important considerations in the design and delivery of home treatment services for people with dementia in the UK and beyond.
335 - BEHÇET DISEASE PRESENTING WITH ACUTE PSYCHOSIS
- A.M. Carvalheiro, A.R. Fonseca, J. Maia
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- 04 November 2020, p. 94
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Objectives
Using as a starting point a clinical case, the authors performed a literature review to clarify the relationship between Behçet disease and acute psychosis.
MethodsAnalysis of the patient's clinical process and brief review of the latest available literature on the subject, published in PubMed/Medline databases.
ResultsMale patient, 55 years old, brought to the emergency room by fever, headache, hetero-aggressive behavior, disinhibited behavior, mood swings, euphoria, persecutory delusions and insomnia, in the last 4 days. He had no insight into his illness. There was no personal or family history of psychiatric illness and toxicological habits were irrelevant. Due to the personal history of posterior uveitis with bilateral macular edema, retinal vasculitis, genital aphthosis, papulo-vesicular lesions and recurrent bipolar aphthosis, the hypothesis of neuro-behçet was raised.
ConclusionsBehçet's disease can present with neurological involvement - neuro -behçet - and can manifest itself with several psychiatric symptoms (euphoria, lack of insight, disinhibited behavior, agitation or psychomotor retardation, persecutory delusions, obsessive thoughts, anxiety, depression, insomnia or memory changes). Fever and headache usually appear in the prodromal stage and can be signs of onset or recurrence of the disease. The prevalence of neuro-behçet ranges from 2 to 50% and usually occurs 1 to 10 years after the first symptoms of the disease. Since it appears as the first manifestation of the disease in only 3% of cases, it is difficult to diagnose. The literature suggests that symptoms are generally resistant to treatment with conventional psychotropic drugs and so it is an important cause of morbidity and mortality.”
336 - Prevalence of cognitive frailty in a sample of Portuguese community-dwelling elderly people
- P.M. Gaspar, D. Facal, O. Juncos-Rabadán
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- 04 November 2020, p. 95
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Background:
Cognitive frailty (CF) has been considered as a subtype of frailty characterized by concurrent physical frailty and potentially cognitive impairment (Kelaiditi et al., 2013). Early detection of CF is an important issue in order to implement prevention and intervention to improve quality of life in aging. The aim of this study was to explore the prevalence of cognitive frailty in a sample of Portuguese old people, living in the community, and determine its relationship with sex, age, education and comorbidity.
Method:Two hundred forty nine community-dwelling participants aged over 60 years and without dementia and other neurological and psychiatric diseases were assessed to obtain sociodemographic, functional, health, physical, cognitive and socio-affective measures. Participants were classified with/without mild cognitive impairment using the Montreal cognitive test (MoCa Test), and as physically robust, pre-frail and frail using the criteria of Fried et al. (2001). A cognitive frailty classification variable was created with six groups that were compared on sociodemographic variables and on comorbidity measured with the Charlson Index Scale (ChIS).
Results:A 20.1% of participants were classified as physically robust and cognitively normal (Group 1), a 28.5% as physically pre-frail and cognitively normal (Group 2), a 11.2% as physically frail and cognitively normal (Group 3), a 6.8% as physically robust with cognitive impairment (Group 4), a 14.9% as physically pre-frail with cognitive impairment (Group 5), and a 18.5% as physically frail with cognitive impairment (Group 6). No significant group differences were registered in the distribution by sex. Significant differences were observed between Group 6 and Group 1 and Group 2 in age [F(5, 243)=6.20, p<.01] and in education [F(5, 243)= 6.54, p<.01], being the first older and with lower education level than the two last ones. Regarding comorbidity, Group 6 had significant higher scores in the ChIS [F(5,243)=9.91, p<.01] than all the other groups
Conclusion:The study reveals that a 33.4% of the older adults and with less education level living in community suffer the two more advanced stages of cognitive frailty. Prevention and interventions measures are need to improve their quality of life.