Abstract
337 - Pseudodementia, pseudopseudodementia and pseudodepression
- H Brodaty, M Connors
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- 04 November 2020, p. 96
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While most older people who develop problems with their memory and thinking that are severe enough to impair their ability to function in everyday life typically, are found to have Alzheimer’s disease or other neurodegenerative diseases, some have an undiagnosed and treatable psychiatric disorder masquerading as dementia. These conditions including depression can affect memory and thinking and, when severe, create a clinical picture similar to dementia. This phenomenon, known as “pseudodementia”, is encountered in clinical practice. It is important to identify because it may be reversible with appropriate treatment.
There is controversy about what the longer-term prognosis is for people diagnosed with pseudodementia. This has implications for how to manage patients, what advice to give to patients and their family, and how to conceptualise the disorder. Some studies found that people with pseudodementia eventually develop organic dementia, so called pseudo-pseudodementia. To address this, we conducted a systematic review of studies that had been conducted on pseudodementia and which followed up patients over time.
Eighteen studies followed patients from several weeks to 18 years. Overall, patients with pseudodementia were at greater risk of later developing organic dementia. Importantly, not all patients did; many patients remained stable or improved, albeit some still impaired by their psychiatric disorder. Our review showed possible treatment benefits and differences with age; patients diagnosed with pseudodementia at a younger age had better outcomes.
Finally, people with apathy (which is the commonest behavioural symptom in dementia) can be misdiagnosed as having depression, so called pseudo-depression and then often treated for the wrong condition. Patients with apathy do not respond to antidepressants.
Receiving the correct clinical diagnoses are crucial to patients receiving the correct treatment for their condition. A missed diagnosis of a potentially reversible depressive pseudodementia can have tragic consequence for the patient and family.
Recent research has neglected the study of pseudodementia. Our findings reveal a clear need for better diagnostic skills, further research with modern investigative tools, such as neuroimaging and genetic sequencing, and clinical trials to better understand underlying mechanisms and determine effective treatment strategies.
338 - Risk factors for moderate cognitive impairment and dementia in the Kazakh and Kyrgyz populations (preliminary results)
- Saule T. Turuspekova, B. Demesinova, Z. Rayimzhanov, R. Nurzhanova, L. Bespalova, I. Murkamilov, A. Arykova
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- 04 November 2020, pp. 97-98
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The current demographic situation in Kazakhstan and Kyrgyzstan is associated with pronounced processes of population aging. Today, about two million elderly people live in Kazakhstan, which makes up more than 10% of the population, which crosses a seven percent threshold for determining the “aging” country in the world.
For Kyrgyzstan, an increase in the proportion of the elderly is a new phenomenon. At the beginning of 2016, there were 965,385 people over 50 in Kyrgyzstan, which is 16% of the total population, of whom 60 and over are 7.06%. According to the average version of the forecast, the relative number of people 60 years and older will almost triple by 2050. (M. B. Denisenko, 2011, Report of a statistical study, 2017) The aging of the population is the most significant social problem of the XXI st century and is associated with the development of cognitive impairment and dementia. Moderate cognitive impairment, according to several authors are an intermediate stage between normal aging and dementia (Brodaty H., 2013, Peterson, 2009).
The cause of cognitive disorders in old age can be a number of diseases, including neurodegenerative. According to projections, it is expected that neurodegenerative diseases will surpass cancer as the leading cause of death by 2040 (Walter U., 2013). The Global prevalence pattern of dementia depends on several factors, from life expectancy to the health status, last but not least from the particular environment.
Purpose of the study. To study the prevalence of cognitive impairment and the main risk factors for their occurrence among people over 60 in the Kazakh and Kyrgyz populations.
Materials and methods.The screening was attended by 300 respondents (150 Kazakhs and 150 Kyrgyz) aged 60 to 90 years (average age 65.6). The material was collected using the Questionnaire for the Champ Clinic and the MOCA test (cut-off point <26) based on the city polyclinics of Almaty and Bishkek.
Results:moderate cognitive impairment was detected - 39.9%, mild cognitive impairment - 33.4%, normal cognitive function - 26.7% in Kazakhs. In the Kyrgyz population, a moderate cognitive impairment was identified - 48.3%; pronounced cognitive impairment - 15.4%, dementia - 8.2%. Expected risk factors for cognitive impairment: 1) in Kazakhs, arterial hypertension - 86.89%, cardiac ischemia, angina pectoris - 70.21%, pathology of the thyroid gland and pancreas (diabetes, hyperthyroidism and hypothyroidism) - 29.50%, atherosclerotic vascular diseases - 29.9%, brain injury - 18.22%, education level - 4.24%, depression - 0.6%, respectively. 2) in Kyrgyz: arterial hypertension - 49%, cardiac ischemia, angina pectoris - 13%, pathology of the thyroid gland and pancreas (diabetes, hyperthyroidism and hypothyroidism) - 21%, low level of education - 11%, Bad habits of smoking and alcohol - 25 %, 20%, respectively.
Conclusions:The transformation of the demographic burden can have important implications for the social security system.We have an urgent need to continue screening the population to identify the main risk factors for moderate cognitive impairment in individuals in the Kazakh and Kyrgyz populations.
339 - A psychological profile of near-centenarians and centenarians with and without dementia from the Sydney Centenarian Study
- Adrian Cheng, Yvonne Leung, John Crawford, Fleur Harrison, Perminder Sachdev, Henry Brodaty
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- 04 November 2020, p. 99
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Background:
Studying those who have achieved exceptional longevity can provide a model of successful ageing, however current research remains limited. Previous work on centenarians has primarily focused on depression and anxiety; life satisfaction remains understudied.
Objectives:To compare the psychological profile of near-centenarians (95-99) and centenarians (100+) with and without dementia. To compare the psychological distress and life satisfaction in near-centenarians and centenarians without dementia with younger age groups. To identify the risk and protective factors of psychological distress and life satisfaction in near-centenarians and centenarians without dementia.
Methods:The Sydney Centenarian Study (SCS) collected data from 343 participants aged 95 years and older, of whom 119 had dementia. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10). Life satisfaction was measured using the Satisfaction with Life Scale (SWLS). Persons aged 70-90 years from the Sydney Memory and Ageing Study (MAS) were used as a cross-sectional comparison group, for which dementia was an exclusion. Multiple linear regressions were undertaken to investigate the predictors for psychological distress and life satisfaction in SCS.
Findings:There was no significant difference in K10 or SWLS score between SCS participants with and without dementia. SCS participants without dementia reported significantly higher levels of psychological distress (15.3, 13.4, t=3.869, p<0.001) and life satisfaction (6.0, 5.6, t=5.835, p<0.001) compared to cognitively intact younger age groups in MAS. In SCS, a greater number of psychotropic medications and less contact with friends and family were associated with higher psychological distress. Higher scores on the Mini -Mental State Examination and greater contact with friends and family were associated with higher life satisfaction.
Conclusions:Psychological health was similar in near-centenarians and centenarians whether or not they had dementia. Although near-centenarians and centenarians without dementia demonstrated higher levels of psychological distress in the past 4 weeks than younger age groups, their satisfaction with life was higher. Social support and cognition may be protective factors against poor psychological health and promote greater life satisfaction. Factors identified as associated with psychological distress and life satisfaction may be targets for interventions to maintain good psychological health in this vulnerable population.
340 - VISUAL HALLUCINATIONS SECONDARY TO ROPINIROLE: CASE REPORT
- A.M. Carvalheiro, Joana Maia
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- 04 November 2020, p. 100
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Objectives:
Using as a starting point a clinical case, the authors performed a literature review to clarify the relationship between visual hallucinations and treatment with ropinirole.
Methods:Analysis of the patient's clinical process and brief review of the latest available literature on the subject, published in PubMed/Medline databases.
Results:Female patient, 89 years old, without psychiatric illness, brought to the emergency room by visual hallucinations, in the past 3 days “I see red, blue and green spots and roses on your sweater and a lot of flowers on that lady's blouse”sic. She recognised them as unreal (pseudo hallucinations) “no, nothing is there. It's from my eyes. I am fine of the head”sic. She has a personal history of glaucoma for decades, and restless legs syndrome for about 1 year, medicated with ropinirole. Adherence to therapeutic has been explored and it was found that she has been increasing, progressively and by its own initiative, the dose of ropinirole. She claims to be currently taking two pills of 8 mg twice daily (the recommended daily dose is 24 mg).
Conclusions:Studies indicate that the incidence of hallucinations during the treatment of RLS with ropinirole is less than 1%, which can be justified by its high affinity for D3 receivers compared to D2 receivers. However, it is also known that the over-stimulation of dopamine receptors (by overdose or rapid titration) can cause hallucinations, which may have been the cause of the patient's clinical condition. This clinical case also allows to alert for the importance of excluding organic causes in the diagnosis of visual hallucinations.
341 - Exploring the feasibility and acceptability of a Comprehensive Resilience-building psychosocial intervention (CREST) for people with dementia in the community: a non-randomised feasibility study
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- 04 November 2020, p. 101
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Presenting Author: Priscilla Doyle, MA
Organisation: National University of Ireland Galway, Galway city, Galway, Ireland
Co-Authors:
Name: Niamh Gallagher
Degrees: B.A (International), M.A Health Promotion
Organisation: National University of Ireland Galway, Galway city, Galway, Ireland
Name: Siobhán Smyth
Degrees: RPN, PhD
Organisation: National University of Ireland Galway, Galway city, Galway, Ireland
Name: Dympna Casey
Degrees: RGN, BA, MA, Phd
Organisation: National University of Ireland Galway, Galway city, Galway, Ireland
Background:A dementia diagnosis can prevent people from participating in society, leading to a further decline in cognitive, social and physical health. However, it may be possible for people with dementia to continue to live meaningful lives and continue to participate actively in society if a supportive psychosocial environment exists. This feasibility study seeks to create such an environment by determining the feasibility of conducting a multifaceted complex resilience-building psychosocial intervention for people with dementia and their caregivers living in the community.
Method:Ten participants with dementia and their primary caregivers living in the community were recruited and received the CREST intervention. The intervention provided (a) a 7-week cognitive stimulation programme (CST) followed by an 8-week physical exercise programme for people with dementia and (b) a 6-week educational programme for caregivers. Members of the wider community were invited to a dementia awareness programme and GP practices to a dementia-training workshop. Trained professionals delivered all intervention components. Outcomes assessed the feasibility and acceptability of all study processes such as: recruitment; intervention content and delivery; and data collection methods.
Results:Recruiting participants was difficult, with local community organisations/groups proving more successful than GP practices. Preliminary results indicate that participants (people with dementia and carers) enjoyed the content of the CREST intervention, that the delivery method and timing worked well and overall found the programme beneficial. Carers reported that the educational programme provided them with valuable information which was accessible and easy to understand. However, the group activities and learning from each other was identified as crucial to their enjoyment and learning. The people with dementia likewise enjoyed the CST and exercise components, some reporting that the CST enhanced their concentration and that exercising with an exercise buddy was more sociable and enjoyable.
Conclusion:The evidence from participants indicates that CREST is feasible and acceptable to carers and people with dementia in the community.
342 - The Dementia Early Stage Cognitive Aids New Trial (DESCANT) intervention: Goal Attainment Scaling
- Helen Chester, Rebecca Beresford, Paul Clarkson, Charlotte Entwistle, Vincent Gillan, Jane Hughes, Martin Orrell, Rosa Pitts, Ian Russell, Eileen Symonds, David Challis
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- 04 November 2020, p. 102
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The DESCANT (Dementia Early Stage Cognitive Aids New Trial) intervention provided a personalised care package to improve the cognitive abilities, function and well -being of people with early-stage dementia and their carers by providing a range of memory aids, with training and support for use. This presentation will explore findings from a goal attainment scaling exercise undertaken within a multi-site pragmatic randomised trial, part of a NIHR-funded research programme ‘Effective Home Support in Dementia Care: Components, Impacts and Costs of Tertiary Prevention.’
The aim was to describe the Goal Attainment Scaling (GAS) approach developed; investigate the types of goals identified by people with dementia and their carers and subsequent attainment; and explore the role of Dementia Support Practitioners (DSPs) in the process. This GAS exercise was designed by researchers, a clinical psychologist, a clinician and a DSP. Goal setting and attainment were conducted with the person with dementia and their carer and recorded by DSPs. Data were obtained from 117 intervention records and semi-structured interviews with five DSPs delivering the intervention across seven NHS Trusts in England and Wales. The GAS exercise was conducted as planned with goals and extent of involvement in the exercise tailored to individual participants and engagement was high. Demographic characteristics from the trial baseline dataset were analysed. Measures were created from intervention records to permit quantification and descriptive analysis. Interviews were professionally transcribed and subject to thematic analysis to identify salient themes.
A total of 293 goals were identified across the 117 participants. From these 17 goal types were distinguished across six domains: self -care; household tasks; daily occupation; orientation; communication; and well-being and safety. A measure of goal attainment appropriate to both the client group and a modest intervention was obtained. On average participants had evidenced some improvement regarding goals set. Qualitative findings suggested overall DSPs were positive about their experience of goal setting. Although several challenges were identified, if these were overcome, measuring goal attainment was generally viewed as straightforward. GAS can be used in the context of a psychosocial intervention for people with early-stage dementia to identify and measure attainment of personalised care goals.
343 - Best Practice Guidance on Human Interaction with Technology in Dementia – Recommendations from the INDUCT Network
- Rose-Marie Dröes, Yvette Vermeer, Sébastien Libert, Sophie Gaber, Sarah Wallcook, Harleen Rai, Aline Cavalcanti Barroso, Joeke van Santen, Floriana Mangiaracina, Kim Beentjes, Sara Bartels, Hannah Christie, Rose Miranda, Annelien van Dael, Kate Shiells, Ángel C. Pinto Bruno, Angie Alejandra Diaz, Lieve Van den Block, Lara Pivodic, Louise Nygard, Manuel Franco Martin, Paul Higgs, Iva Holmerova, Camilla Malinowsky, Franka Meiland, Henriëtte van der Roest, Justine Schneider, Annemieke van Straten, Frans Verhey, Marjolein de Vugt, Martin Orrell
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- 04 November 2020, p. 103
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The Interdisciplinary Network for Dementia Using Current Technology, INDUCT, is a Marie Sklodowska Curie funded International Training Network that aims to develop a multi-disciplinary, inter-sectorial educational research framework for Europe to improve technology and care for people with dementia, and to provide the evidence to show how technology can improve the lives of people with dementia. Within INDUCT (2016-2020) 15 Early Stage Researchers worked on projects in the areas of Technology to support every day life; technology to promote meaningful activities; and health care technology.
Three transversal objectives were adopted by INDUCT: 1) To determine the practical, cognitive and social factors needed to make technology more useable for people with dementia; 2) To evaluate the effectiveness of specific contemporary technology; and 3) To trace facilitators and barriers for implementation of technology in dementia care.
The main recommendations resulting from the research projects are integrated in a web-based digital Best Practice Guidance on Human Interaction with Technology in Dementia which will be presented at the congress. The recommendations are meant to be helpful for different target groups, i.e. people with dementia, their formal and informal carers, policy makers, designers and researchers, who can easily select the for them relevant recommendations in the Best Practice Guidance by means of a selection tool. The main aim of the Best Practice Guidance is to improve the development, usage and implementation of technology for people with dementia in the three mentioned technology areas.
This Best Practice Guidance is the result of the intensive collaborative partnership of INDUCT with academic and non-academic partners as well as the involvement of representatives of the different target groups throughout the INDUCT project.
Acknowledgements: The research presented was carried out within the Marie Sklodowska Curie International Training Network (ITN) action, H2020-MSCA-ITN-2015, grant agreement number 676265.
344 - Study protocol for a feasibility RCT of Club Connect, a healthy brain ageing cognitive training program for older adults with depression
- Claudia Woolf, Leanne Kaplan, Sharon L Naismith, David Burke, Louisa Margaret Norrie, Loren Mowszowski
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- 04 November 2020, p. 104
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Background:
Current treatments for Major Depression are only moderately effective. In fact, 20-30% do not achieve full recovery despite multiple interventions. Interestingly, while it is well recognised that cognitive impairment is associated with Major Depression, available treatments do not address cognitive impairment. In this regard, cognitive training (CT) represents a promising intervention, however CT is not typically offered in public health settings.
Aim:To evaluate the feasibility of a blinded, randomised controlled trial of group-based CT in a hospital sample of older adults with clinically significant depressive symptoms or history of a major depressive episode within the last five years, and in doing so, to adapt and translate research findings to the clinical setting.
Methods:40 older adults, aged at least 65 years, with depression or a history of depression, and without dementia were randomly allocated to Club Connect, a 10-week group-based healthy brain ageing CT program, or a waitlist, treatment-as-usual control group. Baseline assessment including review by a psychogeriatrician and a brief neuropsychological assessment was completed within a fortnight of the intervention starting, and follow-up assessment was completed within a fortnight of the intervention ceasing. Primary outcomes included feasibility of trial design, tolerability of the intervention, and acceptability of random allocation and data collection procedures (as perceived by both participants and clinicians). We also examined the most sensitive clinical outcomes and measurement tools to inform larger scale trials.
Significance:The current health, social and economic costs of late-life depression, especially in those with concomitant cognitive impairment, renders the holistic treatment of depression in older adults a public health priority. CT represents an efficacious therapeutic intervention in this regard, however, there appears to be a paucity of CT programs being offered in public health settings. This trial represents the first step in addressing the ‘implementation gap’ that exists between care that is known to be effective and care that is delivered. We must recognise the need to evaluate not only health outcomes, but also to perform formative evaluations that assess the extent to which implementation is effective in order to optimise intervention benefits, to prolong sustainability, and to promote dissemination of findings.
346 - Canadian Guidelines on Opioid and Benzodiazepine Use Disorders in Older Adults
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- 04 November 2020, p. 107
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The United Nations 20171 report on World Population Aging predicts that the number of persons over age 60 years will reach nearly 2.1 billion by the year 2050, representing 22% of the overall population. Despite this predicted demographic surge there is a vast lack of awareness of substance use disorders (SUDs) in older adults, a phenomenon that has been called “an invisible epidemic” by the Royal College of Psychiatrists2. Older adults, principally baby boomers, face the highest risk for SUDs3, but often go underrecognized, undertreated and underrepresented in clinical trials.
Vaccarino et al in 20184 has put out a Call to Action to better serve the unmet needs of this population. There is an urgent need for raising awareness and improving education regarding SUDs, especially among older adults. There is also a great need for better training of health care professionals to improve their skills, knowledge, and attitudes towards treating SUDs in older adults. Policy and decision makers regarding health care delivery systems need to be better informed to make wiser decisions in order to improve access and availability of age-specific SUD treatments in older adults. To this end, The Canadian Coalition for Seniors’ Mental Health (CCSMH)5, with a grant from the Substance Use and Addictions Program (SUAP) of Health Canada, has recently created and published an introductory paper6 and a set of four guidelines on the prevention, assessment, and treatment of alcohol7, benzodiazepine8, cannabis9, and opioid10 use disorders among older adults.
This is Part 1 of a two-part presentation of CCSMH’s SUD guidelines highlighting the opioid and benzodiazepine use disorders in older adults; Part 2, second presentation, will highlight guidelines related to alcohol and cannabis use disorder in older adults.
347 - Canadian Guidelines on Alcohol & Cannabis Use Disorders Substance Use Disorders in Older Adults
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- 04 November 2020, p. 109
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The United Nations 20171 report on World Population Aging predicts that the number of persons over age 60 years will reach nearly 2.1 billion by the year 2050, representing 22% of the overall population. Despite this predicted demographic surge there is a vast lack of awareness of substance use disorders (SUDs) in older adults, a phenomenon that has been called “an invisible epidemic” by the Royal College of Psychiatrists2. Older adults, principally baby boomers, face the highest risk for SUDs3, but often go underrecognized, undertreated and underrepresented in clinical trials.
Vaccarino et al in 20184 has put out a Call to Action to better serve the unmet needs of this population. There is an urgent need for raising awareness and improving education regarding SUDs, especially among older adults. There is also a great need for better training of health care professionals to improve their skills, knowledge, and attitudes towards treating SUDs in older adults. Policy and decision makers regarding health care delivery systems need to be better informed to make wiser decisions in order to improve access and availability of age-specific SUD treatments in older adults. To this end, The Canadian Coalition for Seniors’ Mental Health (CCSMH)5, with a grant from the Substance Use and Addictions Program (SUAP) of Health Canada, has recently created and published an introductory paper 6 and a set of four guidelines on the prevention, assessment, and treatment of alcohol7, benzodiazepine8, cannabis9, and opioid10 use disorders among older adults.
This is Part 2 of a two-part presentation of CCSMH’s SUD guidelines highlighting the alcohol and cannabis use disorders in older adults; the second presentation will highlight benzodiazepines and opioid use disorder in older adults.
348 - Increased White Matter Hyperintensity and Brain Resting-state fMRI Topology Changes in Suicide Attempters of Late-life Depression
- Chemin Lin, Chih-Mao Huang, Ho-Ling Anthony Liu, Changwei W. Wu, Cheng Hong Toh, Yun-Fang Tsai, Tatia Mei-Chun Lee, Shwu-Hua Lee
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- 04 November 2020, pp. 111-112
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Supported by (1) medical research grants CMRPG3C0041/42 from Chang Gung Memorial Hospital and NRRPG2H0031 from Ministry of Science and Technology, Taiwan to Chemin Lin (2) NMRPG3G6031/32 from Ministry of Science and Technology, Taiwan to Shwu-Hua, Lee (3) the KKHo International Charitable Foundation to Tatia Lee.
Introduction:Suicide rate tends to peak in old age, and major depression is the most salient risk factor for late-life suicide. However, few studies have focused on the neuroscientific facet of suicide in the context of late-life depression (LLD).
Methods:We recruited 114 participants of LLD (28 with history of suicide attempt and 86 without) and 47 elderly controls. They received MRI scanning and behavioral assessment. White matter hyperintensity (WMH) was quantified by an automated segmentation algorithm and graph theoretical analysis was applied to resting-state fMRI. We used ANCOVA to compare group difference in WMH loading and multivariate generalized linear model to compare global and local topological parameters in fMRI signals, controlling for demographics. Partial correlation was conducted between imaging parameters and behavioral data in group of suicide attempters.
Results:We found significant higher WMH in suicide attempters than those of LLD without suicide attempts and elderly controls (F =7.091; p = 0.001). Suicide attempters also had increased betweenness centrality (BC) in right superior occipital gyrus (SOG) (Bonferroni corrected), right precuneus (False positive corrected) and right superior temporal gyrus (uncorrected) and decreased BC in left hippocampus (uncorrected). In suicide attempters, higher BC in right SOG correlated with higher WMH, higher depression severity, higher illness awareness and insight, and lower cognitive function (digit backward), while higher BC in right precuneus correlated with higher decrease awareness and insight and higher cognitive function (digit backward).
Conclusion:Resonating with the vascular hypothesis in LLD, higher WMH was found in those having history of suicide attempts. However, the re-organized brain topology changes are related with divergent cognitive function and convergent heightened disease insight.
349 - Cognitive-Behavioral Therapy for Caregiving Relatives of People with Dementia: Three-Year Follow-Up of a Randomized Controlled Trial
- Mareike C. Sittler, Nils F. Töpfer, Franziska Meichsner, Christina Theurer, Gabriele Wilz
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- 04 November 2020, p. 113
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Background:
Even if cognitive-behavioral therapy (CBT) for caregiving relatives of people with dementia (PwD) has been found to be effective across various outcome measures, investigations into the long-term effects of these interventions remain scarce. Therefore, the purpose of the present study was the evaluation of a CBT intervention for caregiving relatives of PwD three years after intervention onset.
Method:273 caregivers were randomly assigned to receive the intervention (IG) or usual care (CG). IG participants received over 6 month twelve 50-min sessions of individual CBT by trained psychotherapists. Symptoms of depression (CES-D), physical health symptoms (GBB-24), challenging behavior (BEHAVE-AD), quality of life (WHOQOL-BREF), utilization of psychosocial resources (RES), burden of care, coping with the care situation, and emotional well-being (visual analogue scales) were assessed three years after baseline. Data were analyzed using generalized ANCOVA.
Results:164 participants (IG: n = 83, CG: n = 81; 60% of the baseline sample) participated in the three-year follow-up. Based on changes in the caregiving situation at three-year follow-up, we divided the sample into three subgroups: “still caring at home” (n = 52), “nursing home placement of the care recipient” (n = 29), “bereaved caregivers” (n = 83). Positive effects were found in the subgroup of caregivers “still caring at home” (on burden of care, coping with challenging behavior, social relationships QoL-domain) and “bereaved caregivers” (on overall QoL and physical health QoL-domain) compared to the CG. However, IG participants who decided for “nursing home placement of the care recipient” had poorer outcomes on a few measures (overall QoL, psychological health, emotional well-being, utilization of resources related to well-being).
Discussion:It is impressive that CBT for caregiving relatives yielded positive effects in caregivers still caring at home and bereaved caregivers investigating long-term effects three years after baseline. Many challenges arise over the course of the different caregiving trajectories with changes in the caregiving situation being probably particularly influential. We will provide some ideas on how effects could be further sustained and discuss the need for further investigating the impact of changes in the caregiving situation.
350 - Support group for depressed elderly in the outpatient – challenges in the Asian context
- Lay Ling Tan, Yong Lock Ong, Joy PP Lim
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- 04 November 2020, p. 114
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Introduction:
With Singapore’s ageing population, it was anticipated that the increasing number depressed elderly would make recurrent and expensive demands on old age services. There were evidence-based studies that demonstrated the benefits of group therapy in older people with depression, anxiety, low self-esteem and maladaptive behaviour. Aside from being cost effective, group therapy can be more helpful than individual therapy when social support and learning about interpersonal difficulties are objectives of treatment. This paper described the process of setting up and running an outpatient support group for depressed elderly in the psychiatric setting and highlighted the challenges encountered.
Methodology:English-speaking subjects > 65 years old with a diagnosis of depressive disorder (ICD-10) with no significant cognitive impairment were recruited. Participants attended a weekly closed group for 12 consecutive weeks with each session lasting 75 minutes. Participants continued with their treatments offered by their psychiatrists. The content of the discussion was determined by the group members. Discussion notes were taken by the facilitators after each session. Depression and well-being rating scales were used to assess depression severity at baseline and at the end of 12 weeks.
Results:The response for the study was poor with reluctance to participate in group treatment despite attempts made by the department to encourage participation. 8 participants were eventually enrolled with 3 dropouts. Attendance was disrupted due to sickness, medical appointments, hospitalizations and grandparenting duties. There was a trend of improvement in the evaluation scores of the participants. The main themes identified were (1) ageing and health concerns; (2) reminiscence of the past; (3) regrets and burdens; (4) strategies to defeat depression. Group dynamics observed included universality of painful experiences, mirroring of common experiences during Japanese occupation and strong pairing of the same gender. There were no re-admissions or suicide attempts during the study period.
Conclusions:The lack of response to group work amongst the elderly was consistently observed in this study. This contrasted with the popularity of such interventions in non-Asian settings. Further research would help to elucidate the cultural reluctance in sharing psychological problems amongst the elderly within a psychiatric setting.
351 - Success rate of various countermeasures against behavioral psychological symptoms of dementia based on the accumulation of real-world experience
- Hiroaki Kazui, Shunsuke Sato, Kenji Yoshiyama, Hideki Kanemoto
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- 04 November 2020, p. 115
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Background and Objective:
Appropriate countermeasures that can alleviate behavioral psychological symptoms of dementia (BPSD) are proposed. However, the effectiveness of these countermeasures has not been fully verified. Conversely, the caregivers of patients with dementia encounter BPSD every day and adopt some kind of measures against that particular BPSD.
Methods:We collected data regarding “whether or not a certain measure against a particular BPSD alleviates the symptom (care experience)” from all over Japan using Dementia Chienowa Net, which is a website we developed in 2016. We also collected patient’s data, such as sex, primary disease, and nursing care level, which is an indicator of dementia severity in the Long-term Care Insurance System of Japan.
Results:In this study we analyzed 2003 care experiences (M/F:808/1192). In terms of primary disease, there were 1113 cases (55.6%) of Alzheimer’s dementia (AD), 236 cases (11.8%) of dementia with Lewy bodies (DLB), 217 cases (10.8%) of frontotemporal lobar degeneration (FTLD), and 118 cases (5.9%) of vascular dementia (VaD). Among AD patients living at home with nursing care level 1, care experiences related to forgetfulness were the most common at 43%, denial/rejection was 14%, and restless behavior was 9%. For nursing care level 2, forgetfulness was 38%, restless behavior was 15%, and denial/rejection was 9%. For nursing care level 3, restless behavior was most common at 30%, forgetfulness was 17%, and denial/rejection was 16%. Success rates were calculated; for “forgetting to take medicine,” the success rate of “use of medicine box” was 40%. The success rate of “use of medicine calendar” was 60.8%, and the success rate of “someone handing over the medicine” was 92.3%. For “poor fire management,” the success rate of “changing to equipment that is less likely to cause hazards” was 71.4%.
Conclusions:The frequency of DLB and FTLD in care experiences on Dementia Chienowa Net was more than the frequency of the diseases in Japan. The percentage of BPSD categories troubling patients’ families differed depending on the severity of the dementia. The success rate of some common countermeasures against BPSD frequently encountered in daily life was embodied numerically.
400 - Effects of Computerized Cognitive Training with an Elderly Community Sample
- M Pires, A Antunes, C Gameiro, C Pombo
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- 04 November 2020, p. 116
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Community-focused programs that promote active and healthy aging can help preserve cognitive capacities, prevent or reverse cognitive deficits. Computer-based cognitive training (CCT) is a promising non-pharmacological, cost -effective and accessible intervention to face the effects of age-related cognitive decline. Previous studies proved CCT to have equal or better efficacy compared to traditional interventions. This comparative multifactorial study aims to test the efficacy of a CCT in a non-randomized community sample of 74 older adults: G1-CCT Experimental group (n=43) (Mean age M=72.21, SD=12.65) and G2- Paper-Pencil Control group (n=31; M=77.94, SD=10.51). Pensioners (97.3%), mostly women (83.8 %) with basic education (51.4%) and without dementia diagnosis, completed a cognitive training program of 17 or 34 group sessions (twice a week). G2 undertook a classic cognitive paper-pencil stimuli tasks. G1, performed, additionally, individual CCT with COGWEB® in a multimodal format (intensive training of attention, calculation, memory, gnosis, praxis, executive functions). Both groups completed Portuguese versions of Mini -Mental State Examination (MMSE),Montreal Cognitive Assessment (MOCA); Geriatric Depressive Scale (GDS); Mini Dependence Assessment (MDA); WHOOQL 5 and Social Support Satisfaction Scale (ESSS) before and after participating in the program. Both groups reported better post-test scores on basic cognitive functions (MMSE, MOCA), Depression symptoms (GDS-30), subjective well-being and quality of life (WHOOQL-5). G1 presented higher MOCA and lower GDS scores before and after CCT, although, group differences become less expressive when interaction effects are considered. Results are in line with findings from past studies, CCT supported by the new technologies, is as a relevant cost-effective therapeutic tool for health professionals working with older adults. Particularly for preventive purposes of neuro-cognitive disorders.
401 - The Costs of Agitation: A Literature Review
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- 04 November 2020, p. 117
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PRESENTING AUTHOR:
Mary Michael, Vice President, Patient Advocacy and Stakeholder Management, Otsuka America Pharmaceutical, Inc.
OBJECTIVE:To evaluate the extent to which the cost of both treated and untreated agitation in Alzheimer’s disease has been studied in order to inform future research and development of predictive models of the cost of untreated agitation in Alzheimer’s disease.
BACKGROUND:There is inadequate understanding of the costs of agitation in Alzheimer’s disease in the scientific and academic literature. Agitation in Alzheimer’s disease contributes to negative social and financial outcomes for people with the condition, their care partners, and health systems. When left untreated, the impact of these outcomes is exacerbated, yet the scale of this impact is unknown. This gap in the literature both reflects and perpetuates the broader under-recognition of agitation as a serious unmet need in the Alzheimer’s community. Conversely, a better understanding of the costs can help elevate agitation within the global Alzheimer’s dialogue.
METHODS:We used MEDLINE, PubMed, PsychINFO the Cochrane Library and Google Scholar databases to identify relevant articles published between 2000 until May 2020. We also reviewed reliable literature published outside of these databases. Keywords utilized in the search include agitation in Alzheimer’s, neuropsychiatric symptoms of Alzheimer’s, cost of informal and formal care, Medicare and Medicaid costs, economic costs associated to delirium, among others. Only articles in English were included. Inclusion and exclusion criteria were determined by study design, data source and population studied, number of cases included in analysis, source of health service use or cost data, statistical methods and agitation in Alzheimer’s attributable and/or incremental costs.
RESULTS:Results will describe the breadth and depth to which costs of treated and untreated agitation in Alzheimer’s have been examined, indicating data and statistical methodology used.
CONCLUSIONS:This literature review serves as the basis for understanding global costs of agitation in Alzheimer’s disease. From our analysis, we recommend that further cost modeling activities be conducted. We also urge the greater community to use these findings to elevate agitation to the top of the Alzheimer’s agenda.
402 - Cognitive reserve and linguistic skills in Spanish older adults with Alzheimer’s disease
- Cristina G. Dumitrache, Laura Rubio, Nuria Calet, José Andrés González, Ian C. Simpson
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- 04 November 2020, p. 118
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Background:
Cognitive reserve, or the extent to which brain can cope with damage, is associated with extended healthy aging and with slow age-related cognitive decline, as well as a lower number of dementia-associated clinical cognitive signs. Thus, understanding how cognitive reserve might affect different cognitive abilities is important. This study aims at investigating the associations between cognitive reserve and linguistic abilities in a group of Spanish older adults with Alzheimer’s disease.
Method:The sample comprised 25 older adults with a clinical diagnostic of AD with mild to moderate dementia, and 25 controls who were residing in care homes from the province of Granada and with ages between 52 and 92 years old (M= 83.40, SD= 7.18). The Mini Mental State Examination (MMSE), the Global Deterioration Scale, the Cognitive Reserve Questionnaire, and the Short Form of the Boston Naming Test for Individuals with Aphasia were used to collect data. Correlations and regression analysis were performed.
Results:Results showed that cognitive reserve positively and significantly correlated with naming and with phonological fluency but not with semantic fluency word or sentence repetitions or with the global cognitive functioning and the severity of cognitive impairment. The regression analysis showed that cognitive reserve explained 24.7% of the variance in spontaneous naming (F=3.764, p=.039). On the contrary cognitive reserve did not predict verbal fluency.
Conclusions:People with higher cognitive reserve score obtained higher scores in phonological fluency and in spontaneous naming and in naming after a semantic clue. Thus, cognitive reserve is linked with better linguistic abilities in AD patients and therefore it should be considered when designing speech therapy interventions for these patients.
403 - Verbal fluency and spontaneous conversation in institutionalized older adults with and without cognitive impairment
- Cristina G. Dumitrache, Laura Rubio, Nuria Calet, José Andrés González, Ian C. Simpson
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- 04 November 2020, p. 119
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Background:
Several neurodegenerative conditions negatively impact linguistics skills. Despite this, many studies carried out with these kinds of patients either only include participants with initial stages of cognitive impairment either do not contemplate linguistic skills, or they do assess language in clinical or experimental settings. Due to it this study aims at investigating verbal fluency and spontaneous conversation abilities in a group of institutionalized Spanish older adults with and without cognitive impairment.
Method:The sample comprised 50 older adults who were residing in care homes from the province of Granada and with ages between 52 and 92 years old (M= 83.40, SD= 7.18). The Mini Mental State Examination (MMSE), the Global Deterioration Scale, and the Short Form of the Boston Naming Test for Individuals with Aphasia were used to collect data. In order to analyze the differences in verbal fluency and in spontaneous conversation between participants ANOVA analysis were performed.
Results:Results showed that people without cognitive impairment or with initial stages of Parkinson’s’ disease showed a higher complexity in their spontaneous conversation and obtained higher scores in verbal fluency when compared with patients with Alzheimer’s disease, and with people with cognitive impairment but without a clinical diagnose. No significant differences were found between participants in word or sentence repetitions tasks.
Conclusions:Language impairment in people with cognitive impairment has dramatic consequences, affecting people’s communication and social interaction, their identity and autonomy thus language skills should be assessed in institutionalized older adults with cognitive impairment and interventions should be designed to maintain their linguistic abilities.
404 - Effect of Psychoeducation Modul on the Administration of Psychotropic Drugs for Patients with Behavioral and Psychological Symptoms of Dementia at the RS Dr. H. Marzoeki Mahdi Bogor on Caregivers
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- 04 November 2020, p. 120
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Name : Yuniar Pukuk Kesuma
Study program : Psychiatry, Specialist II Geriatric Psychiatry
Counsellor : Dr.dr. Martina Wiwie S. Nasrun, Sp.KJ(K)
Background:Dementia is a clinical syndrome characterized by a decline in cognitive abilities and memory deficits globally. About 90% of patients experience behavioral and psychological symptoms. The use of psychotropic drugs is influenced by the patient symptoms, burden of the caregiver, and the habit of health workers.
Objective:To determine the effect of psychoeducation modules to caregivers to increase knowledge, decrease of psychotropic drugs, reduce symptoms and burden of caregivers.
Methods:There are 2 steps of studies. The first was a qualitative study to create psychoeducation module and the second was to conduct a pre-experimental study (one group pretest-posttest study). Psychoeducation is given in 2 consecutive weeks.
Results:Fourty caregivers of dementia patients aged 41.3 (± 9.72) years. The psychoeducation modules is associated with decreasing symptoms and the use of psychotropic drugs, increasing knowledge and decreasing the burden of caregivers. At the end, 23% of patients were able to stop using psychotropic drugs and 62% of patients reduced their dose and/or the amount of psychotropic drugs.
Conclusion:The psychoeducation modules to caregivers is associated with a decrease of patient symptoms and the use of psychotropic drugs. Psychoeducation also increases the knowledge of the caregiver and decreases the burden of the caregiver so that this psychoeducation module can be an additional therapy for patients with dementia.
405 - Music Therapy in the management of dementia
- Catarina Pedro, Beatriz Jorge, Mariana Duarte
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- 04 November 2020, p. 121
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Introduction:
Dementia has become a worldwide concern. According to the World Health Organization, there are 50 million individuals suffering from dementia across the world and approximately 20 million new cases are diagnosed each year. The efficacy of medications in controlling agitation and psychotic symptoms is modest and may cause serious adverse effects, outlining the urge for new treatment methods for patients with dementia. Music therapy (MT) is a nonpharmacologic strategy that is used in patients with early-to-late stages of dementia with promising results.
Objectives:The aim of this presentation is to evaluate the benefits of music therapy in cognitive functioning and neuropsychiatric symptoms in patients diagnosed with dementia. We also summarize the current knowledge about this topic.
Methods:A non-systematic review of the literature was performed on PubMed, PsycINFO and Web of science using selected keywords.
Results:MT sustains its benefit because musical memory regions in the brain are relatively spared compared to cognitive function. “Musical memories” can, thus, be stored longer than non-musical memories, allowing to recall associated life events and emotions. Systematic reviews suggest that MT seem to have a positive effect on symptoms such as depression, anxiety and behavioral problems while the findings concerning agitation/aggression are inconsistent. No large differences were found between studies using live or recorded music although the latter reported more of a consistently positive impact on behavioral and psychological outcomes. The studies using live music, however, reported specific benefits to relationships and interactions.
Conclusions:The majority of the studies have methodological limitations, making it difficult to offer firm conclusions. Despite this, there were positive results on aspects of quality of life, cognitive function, behavioral, psychological, physiological and communication outcomes.