Abstract
406 - Spanish validation of the Revised Memory and Behavior Problems Checklist- Nursing Homes (RMBPC-NH)
- Gema Perez-Rojo, Javier López, Cristina Velasco, Cristina Noriega, José Ángel Martínez-Huertas, Isabel Carretero, Patricia López Frutos, Leyre Galarraga
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- Published online by Cambridge University Press:
- 04 November 2020, p. 122
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Introduction
The behavior problems in residents may affect professionals’ performance at work, quality of work life, and even their health. Thus, it is important to have instruments that allow to estimate their prevalence. The objective of this study was to validate the Revised Memory and Behavior Problems Checklist-Nursing Homes (RMBPC-NH; Allen et al., 2003) in a Spanish population. Specifically, it was tested the factor structure of the RMBPC-NH proposed by Wagner et al. (1995). Moreover, the relevance of the different types of problems for the working performance, at the level of individuals and institutions, was explored.
MethodIn the present study, a total of 200 professionals participated.
ResultsA Confirmatory Factor Analysis was conducted using WLSMV estimator in Mplus 7. Results showed a good fit to the data for the four-factor model (?2(813) = 1733.73, p<.001, CFI = .90, TIL = .90, RMSEA = .08). Thus, it can be concluded that the original factor structure proposed by Wagner et al. (1995) and replicated by Allen et al. (2003) can also be applied to Spanish staff nursing homes. The reliability of the scale was adequate (α from .86 to .93). Moreover, different descriptive and correlational results showed that both the factor scores of the Spanish adaptation of the RMBPC-NH and the importance of each type of problem were associated to different variable related.
DiscussionAfter analyzing the factor structure, reliability and validity of the adaptation of the RMBPC-NH scale for Spanish staff nursing homes it has found that it has good psychometric properties, so it could be a useful tool for this population.
This work was funded by the Spanish Ministry of Economy and Competitiveness (grant number PSI2016-79803-R).
407 - The Baycrest Quick-Response Caregiver Tool: The Role for a New Tool for Caregivers of Persons with Dementia
- Ken Schwartz, Robert Madan, Anna Berall, Marsha Natadiria, Anna Santiago
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- Published online by Cambridge University Press:
- 04 November 2020, p. 123
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Background:
Responsive behaviours in dementia are associated with poor outcomes for the person with dementia (PWD) and caregiver burnout. Family caregivers need a variety of tools to manage responsive behaviours. The Baycrest Quick-Response Caregiver Tool was developed to provide caregivers with a tool that can be used in real time. In this study, the feasibility, impact, and effectiveness of this new tool were studied in family caregivers and health care providers (HCP) using quantitative and qualitative measures.
Methods:Family caregivers were recruited and were asked to complete a pre-survey before being sent the link to the educational tool. One month after the telephone survey, caregivers were sent an online post-survey to gather their feedback on the tool and the impact of the tool on caregiver well -being. Healthcare providers were also recruited and reviewed the tool through an online feedback survey. The feasibility, impact, and effectiveness of the tool were assessed using quantitative and qualitative measures.
Results:Caregivers had a moderate degree of and reported a high level of competence - these scores were maintained throughout the study. Caregivers reported that tool positively impacted their compassion towards the person with dementia (PWD), and that their interactions with improved. 100% of HCP who completed the feedback survey would recommend the tool to other HCP and to caregivers of PWD. The caregivers and HCP provided specific suggestions for improvement.
Conclusions:The Baycrest Quick-Response Caregiver Tool was found to be feasible and helpful. It provides caregivers and HCP with an additional approach for responsive behaviours.
408 - PREDICTING CAREGIVER HEALTH AND RELATIONSHIP SATISFACTION: THE IMPORTANCE OF DEMENTIA PATIENT SOCIOEMOTIONAL FUNCTIONING
- Marcela C. Otero, Casey L. Brown, Robert W. Levenson
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- Published online by Cambridge University Press:
- 04 November 2020, p. 126
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Dementia caregiving is associated with a variety of negative outcomes including poor caregiver mental and physical health and low relationship satisfaction. Prior research has linked these negative caregiver outcomes to patients’ cognitive and psychiatric symptoms. However, few studies have examined the link between patients’ socioemotional functioning and caregiver outcomes. We examined how patients’ socioemotional functioning was related to caregiver marital satisfaction, physical health, and psychopathology in a sample of 103 caregivers of dementia patients (with a wide range of diagnoses). Measures included: (a) patient socioemotional functioning (Caregiver Assessment of Socioemotional Functioning), (b) patient cognitive functioning (Mini-Mental State Exam), (c) patient psychiatric symptomatology (Neuropsychiatric Inventory), (d) caregiver marital satisfaction (Locke-Wallace Marital Adjustment Test), (e) caregiver physical health (Medical Outcomes Study Health Survey), and (f) caregiver psychopathology (Symptom Checklist-90 -Revised). Results indicated that poor patient socioemotional functioning predicted lower levels of caregiver marital satisfaction (beta= −.45, p < .001) and physical health (beta= −.25, p < .05), and greater caregiver psychopathology (beta= .41, p < .001), above and beyond patient cognitive functioning and psychiatric symptoms. These findings suggest that low levels of socioemotional functioning in patients make important and unique contributions to negative caregiver outcomes.
409 - Trends in Involvement, Perceived Role, Role Overload and Self-efficacy of Family Carers of People with Dementia in Care Homes
- Marleen Prins, Bernadette Willemse, Marlous Tuithof, Henriëtte van der Roest, Anne Margriet Pot
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- Published online by Cambridge University Press:
- 04 November 2020, p. 125
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Introduction
The quality of long-term care provided to people with dementia (PwD) in care homes can be improved by implementing person-centered care. Family carers of PwD living in care homes are an important part of person-centered care. However, they often experience high levels of burden, even when a family member with dementia lives in a care home. This study examines trends in the involvement of family carers and their perceived role, role overload and self-efficacy.
MethodsData from the Living Arrangements for People with Dementia study, a cross-sectional monitoring study that evaluates developments in care for PwD in care homes in the Netherlands, with four measurement cycles between 2008-2017 was used. Data from the three most current measurement cycles were used, with respectively 144, 47 and 49 participating care homes and 888, 392 and 401 participating family carers. Family involvement was measured by the number of hours per week that family carers visited the PwD and the type of activities they undertook. Perceived caregiving role was measured with the Family Perceptions of Caregiving Role instrument. We used the Self-Perceived Pressure by Informal Care to measure role overload and a 37-item questionnaire was used to measure self-efficacy. We investigated the changes over time (e.g., measurement cycles) of these measures.
ResultsThe number of hours that family carers visited the PwD did not change over time. However, there was a trend towards an increase in the variety of activities they undertook. Their perceived caregiving role did not change over time. Self-efficacy of family carers increased over time and they reported more feelings of role overload.
ConclusionsDuring the past decade, there has been an increasing trend towards family carers doing more diverse activities with PwD in carer homes. Family carers did feel more competent in their caring role, although their feelings of role overload also increased. Continuing attention is therefore needed for the psychological well-being of family carers after a person with dementia moves to a care home.
410 - Dementia-related Psychosis Symptoms and Impact from the Patient and Care Partner (Caregiver) Perspective: an Observational, Prospective Study to Describe the Patient Experience
- Teresa Brandt, Theresa Frangiosa, Virginia Biggar, Angela Taylor, Bill Keller, Vic Abler
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- 04 November 2020, p. 126
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Background:
This study aimed to describe the person-centered experience of symptoms and impact of dementia-related psychosis (DRP) from a patient and care partner (CP) perspective.
Methods:This observational, non-interventional, prospective study collected patient experience data to understand the impact of DRP in persons with various dementia subtypes. Qualitative interviews were conducted with persons or their CP who have a clinical diagnosis of all-cause dementia with psychotic symptoms, recruited through physician referrals. The quantitative online survey was completed by persons with self-reported DRP or their CP recruited by advocacy groups: UsAgainstAlzheimer’s and the Lewy Body Dementia Association. CP burden was beyond the scope of this study.
Results:Sixteen individuals (1 patient, 15 CP) participated in the qualitative interview. The most commonly reported symptoms of DRP were visual hallucinations (88%), auditory hallucinations (69%), and persecutory delusions (56%). Participants described an impact of DRP on activities of daily living (75%), sleep (63%), family life (56%), and safety concerns (56%).
The quantitative portion was completed by 212 participants (26 patients, 186 CP). DRP symptoms most frequently reported by patients were visual hallucinations (89%), auditory hallucinations (54%), and distortion of senses (54%); those reported by CP were paranoid delusions (76%), visual hallucinations (75%), and lack of trust for loved ones (52%). For patients with recent visual hallucinations, 61% of patients and 70% of CP reported experiencing this symptom on a weekly basis. When asked to rank the impact on the patient’s life, patients reported that visual hallucinations were the most impactful symptom whereas CP reported paranoid delusions/false beliefs as most impactful, followed by visual hallucinations. Difficulty differentiating what is real from what is not real, increased anxiety, and effects on personal relationships were the most common types of impacts reported by both patients and CP. Most patients (>40%) were not receiving medications for DRP.
Conclusions:Persons with DRP experience hallucinations and delusions that have a substantial impact on their lives. Here, patient experience data demonstrate that there is a need for treatments to reduce the symptoms and impacts of DRP.
Study Sponsored By: ACADIA Pharmaceuticals Inc.
DisclosuresTF is a consultant with Frangiosa & Associates, LLC.
VB and AT have no relevant financial relationships to disclose.
TB, BK, and VA are employees of and may hold stock and/or stock options with ACADIA Pharmaceuticals Inc.
411 - Implementing the STrAtegies for RelaTives (START) intervention in Portugal – preliminary findings
- Fatima Urzal, Ana Quintão, Catarina Santos, Nuno Moura, Ana Banazol, Rui Martins, Penny Rapaport, Sarah Amador, Gill Livingston, Manuel Gonçalves-Pereira
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- Published online by Cambridge University Press:
- 04 November 2020, p. 127
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Introduction
As in other countries, Portuguese family caregivers have unmet needs regarding information and distress. START (STrAtegies for RelaTives) is a manual-based coping intervention for families of people with dementia, including coping strategies and stress-management components, by Livingston and colleagues (https://www.ucl.ac.uk/psychiatry/research/mental-health-older-people/projects/start). In the UK, START has been clinically effective, immediately and continuing even after 6-years, without increasing costs. Clinical training and supervision ensures treatment fidelity. In Portugal, these kind of interventions are less available and, when provided, are mostly supportive and fail to address coping strategies. Paradoxically, recruitment may also prove challenging.
ObjectivesWe describe the development of the Portuguese translation of START, incorporating guidance from the UK team, and a pilot study of delivery to family caregivers of people with dementia. We will also discuss the challenges of recruiting participants and delivering the intervention.
MethodWe translated the START intervention and recruited family caregivers from neurology and psychiatry outpatients, in a central hospital in Lisbon. Our baseline assessment included the Hospital Anxiety and Depression Scale and the Zarit Burden Interview. The pilot is still ongoing at time of submitting, so we focus on recruitment, baseline assessments and process issues.
ResultsDuring a three-month period, we recruited six caregivers. Five were primary caregivers (spouses or adult children) who had been caring for their relatives for 2 up to 10 years. Two caregivers met the international cutoff for clinically relevant affective disorder . The most frequent motivators for taking part were learning to communicate with their relatives and increasing knowledge to build community resources. Overall, the subjective impression of the therapist in charge is that the intervention seems acceptable and promising.
Discussion/ConclusionsThis pilot study will eventually lead to an improved version of the Portuguese version of the START manual. So far, the intervention seems appropriate for selected caregivers in Portugal. However, response to striking unmet needs, particularly basic home support, may need to precede interventions like START. We look forward to concluding the intervention study and analyzing the implementation challenges, as a basis to inform a wider-scale trial.
412 - An Affect Education Model for Caregivers: Managing Behavioural and Psychological Symptoms of Dementia
- Ken Schwartz, Robert Madan, Rosalind Sham, Sandra Gardner
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- 04 November 2020, p. 128
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Introduction:
Providing care for people with behavioural and psychological symptoms of dementia is stressful as these individuals are commonly labelled as aggressive or resistant to care. Few studies have evaluated the impact of providing support to professional caregivers working in long-term care. Our mixed methods pilot study evaluated the impact of the innovative Affect Education Model among health care providers from two Toronto nursing homes.
Methods:The two-person centred Affect Educational Model through the use of seven questions that encourage self-reflection teaches that problematic behaviours are co-constructed between individuals with BPSD and caregivers. Study procedures included recruiting nursing staff and personal support workers and teaching them the model in five weekly 30-minute group sessions. Qualitative measures in the form of focus groups were obtained. Quantitative measures were obtained through the use of five questionnaires.
Results:Qualitative findings from focus groups identified four themes: facilitators and barriers perceived in current care delivery, the impact of the model experience on staff care delivery, reflections on being taught the model, and future model implementation. Quantitative results were also collected and discussed.
Conclusions:The use of both pharmacologic and nonpharmacologic treatment of individuals with BPSD may be greatly enhanced by an interpersonal two-person Affect Education Model that emphasizes the importance of calming down and self-reflection. Future directions include expanding the model to family caregivers through the use of multimedia resources.
413 - Telehealth in Multiethnic Caregiver Support Group: Transition from Telephone to Video in the Age of COVID-19
- Maria Loizos, Shehan Chin, Mari Umpierre, Mary Sano
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- Published online by Cambridge University Press:
- 04 November 2020, p. 129
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Background:
Caregivers of persons with Alzheimer’s Disease and Other Dementias are a population in need of support as they are vulnerable to emotional, physical, and mental exhaustion associated with caregiver burnout. While CDC guidelines state that social distancing is the greatest protective factor, it can already exacerbate feelings of isolation and stress. Technology offers the opportunity to maximize socialization and access to healthcare; however, research shows that digital platforms are most underutilized by older and lower socioeconomic patients.
Objective:This report describes the transition of a weekly caregiver support group from telephone to video conferencing to improve connectedness during a period of social isolation.
Method:In 2020, the caregiver support group met weekly over the phone. At each session, there were increased discussions of moving the telephone support group to a video platform. A focused discussion about technology platforms was held to gain an understanding of caregiver attitudes and thoughts regarding technology in which caregivers worried that a video platform would be intrusive and invasive. In June 2020, unreliable phone service resulted in the group transitioning to video.
Results:The caregiver group consisted of 5 active members, 2 African American, 2 Asian, and 1 Caucasian. Initial problems included connectivity issues, needing to switch to multiple devices, and assistance with troubleshooting and utilizing the platform. However, caregivers reported feeling that the transition to video was the most natural next step and assisted with reducing feelings of isolation, anxiety, and fear they reported as a result of social distancing due to COVID-19. Caregivers reported feeling connected and because they knew each other so intimately, no longer felt video was intrusive.
Conclusions:For older populations who are not familiar with technology, it is important to take steps before beginning a new platform service. This allows for a natural progression to unfamiliar technology. The video platform provided an opportunity for caregivers to be together while apart, which is important for mental health and decreasing caregiver burden.
414 - Rise in the number of geriatric patients attending psychiatric emergency services in a tertiary hospital during the COVID-19 lockdown period
- Migita M. D’cruz, Thomas G. Issac, Gargi Mondal, Naga VSS Gorthi, Shiva Shankar Reddy Mukku, Adesh Agarwal, Subhashini Rangarajan, Namrata Jagatap, Preeti Sinha, P.T. Sivakumar, Mathew Varghese
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- 04 November 2020, p. 130
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Introduction: Older adults are at disproportionate risk of serious disease and mortality due to the novel coronavirus (COVID-19) pandemic. Further, the global response to the lockdown has rendered older adults particularly vulnerable to loneliness and social isolation due to the physical distancing and shelter in place mandate. We hypothesized that both these factors would lead to an increase in geriatric mental health problems during the COVID-19 pandemic.
Material and Methods: We undertook a clinical audit of all geriatric patients (above 60 years of age) attending the psychiatry emergency services at a tertiary care hospital. This audit was conducted over a period of 52 days dating from the cessation of non-essential services at the hospital as part of the national response to the COVID-19 pandemic (lockdown).
We used descriptive statistics to summarize the number, age, sex, presenting complaint and diagnoses of our patients. We further compared the average number of geriatric patients attending the psychiatry emergency services in the hospital during the lockdown to that of geriatric patients attending the same in the year before the lockdown.
Results: A total of 112 geriatric patients attended the psychiatry emergency services during the lockdown period. Of these, 62 were male and 50 female. The average number of geriatric patients attending the emergency services daily during this period (μ1 2.15) was significantly higher (z 5.36, p ≤ 0.01) than the average number of patients attending the emergency services in the year preceding the lockdown (μ2 1.34).
The most common presenting complaint was agitation in the preceding weeks. The most common diagnoses were late onset schizophrenia spectrum disorders followed by affective disorders and major neurocognitive disorders.
Discussion: The COVID-19 pandemic and the global response to the same constitute life events for older adults. They may contribute to biological, psychological and social risk factors for mental health problems in older adults during this period. The increase in geriatric patients attending our emergency services, despite an increase in restrictions on mobility which act as barriers in the pathway to care, is worrying. Under stimulation in older adults during this period may contribute to an increase in agitation.
415 - Evaluation of an e-learning aiming to improve person-centered attitude in healthcare professionals working with people with dementia
- Claudia van der Velden, Marleen Prins, Henriëtte van der Roest
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- Published online by Cambridge University Press:
- 04 November 2020, p. 131
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Introduction Healthcare professionals working with people with dementia (PwD) have increasingly been moving away from task-oriented models of healthcare towards a more person-centered care (PCC) model. Several studies have showed positive results of PCC on the quality of life of PwD. Also, it shows positive effects on self -esteem and work satisfaction of healthcare professionals. An effective way to educate professionals in PCC and improve their knowledge and person-centered attitude is by using online learning tools.
We developed an e-learning in co-creation with end users focusing on well-being and (changing) behavior of PwD. The interactive e-learning supports healthcare professionals in developing a person-centered attitude, by using practical videos and exercises.
Methods In the current pilot study, the e-learning is evaluated. To date, 33 healthcare professionals working in Dutch care homes from different care organizations participated in the study and completed the e-learning. In addition, they filled in online questionnaires before and after completing the e-learning. The questionnaires include the Approach to Dementia Questionnaire, Dementia Knowledge, Person Centered Care, Sense of Competence in Dementia Care Questionnaire. Post-measurement also included questions about satisfaction with the e-learning and user-friendliness.
Results The final participants are currently completing their post-measurement questionnaires and final results are expected in September 2019. Preliminary data-analysis shows promising results. Positive effects on knowledge about dementia, person-centered attitude and sense of competence are expected. Also, user-friendliness, especially the flexibility of the e-learning (being able to follow the e-learning at home or at work and being able to stop and continue at any time) and the practice-oriented videos are positively evaluated.
Conclusion Preliminary results of this pilot study suggest that the e-learning might contribute to developing a more person-centered attitude in healthcare professionals and indicate that participants have positive experiences with the e-learning module.
416 - Risk of Mortality Associated with Antipsychotics in Alzheimer's Disease
- Liliana P. Ferreira, Núria Santos, Nuno Fernandes, Carla Ferreira
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- 04 November 2020, p. 132
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Objectives: Alzheimer's disease (AD) is the most common cause of dementia and it is associated with increased mortality. The use of antipsychotics is common among the elderly, especially in those with dementia. Evidence suggests an increased risk of mortality associated with antipsychotic use. Despite the short-term benefit of antipsychotic treatment to reduce the behavioral and psychological symptoms of dementia, it increases the risk of mortality in patients with AD. Our aim is to discuss the findings from the literature about risk of mortality associated with the use of antipsychotics in AD.
Methods: We searched Internet databases indexed at MEDLINE using following MeSH terms: "Antipsychotic Agents" AND "Alzheimer Disease" OR "Dementia" AND "Mortality" and selected articles published in the last 5 years.
Results: Antipsychotics are widely used in the pharmacological treatment of agitation and aggression in elderly patients with AD, but their benefit is limited. Serious adverse events associated with antipsychotics include increased risk of death. The risk of mortality is associated with both typical and atypical antipsychotics. Antipsychotic polypharmacy is associated with a higher mortality risk than monotherapy and should be avoided. The mortality risk increases after the first few days of treatment, gradually reducing but continues to increase after two years of treatment. Haloperidol is associated with a higher mortality risk and quetiapine with a lower risk than risperidone.
Conclusions: If the use of antipsychotics is considered necessary, the lowest effective dose should be chosen and the duration should be limited because the mortality risk remains high with long-term use. The risk / benefit should be considered when choosing the antipsychotic. Further studies on the efficacy and risk of adverse events with antipsychotics are needed for a better choice of treatment and adequate monitoring with risk reduction.
417 - Olfactory signatures in models of aging and Alzheimer’s disease and the effect of social isolation: A translational neuroscience approach in times of coronavirus pandemic (COVID-19)
- Daniela Marín-Pardo, Lydia Gimenez-Llort
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- Published online by Cambridge University Press:
- 04 November 2020, p. 133
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Sensory systems ensure the ability to perceive and recognize the world. Therefore, the temporal course and the severity of their involution through the aging process can be critical. In the elderly, sensory impairments significantly increase their risk of biological, psychological and social impoverishment. Olfactory loss, known to happen in bacterial and viral infections and considered an early biomarker in Alzheimer’s and Parkinson’s diseases neurodegenerative processes, has been reported also as an early indicator of current infection by SARS-CoV-2. At the translational level, in the present work, we have studied olfactory ethograms in normal and advanced AD-related pathological aging using wildtype and the 3xTg-AD mice, a genetic model of Alzheimer’s disease that presents AD-cognitive dysfunction but also a conspicuous BPSD-like phenotype. An olfactory paradigm, involving the equivalent to one day food deprivation, was used to investigate in middle-aged males and females with normal and AD-pathological aging the ethological patterns shown in the olfactory inspection of a new cage with beddings and the posterior detection, finding and consumption of food pellets hidden in this new anxiogenic environment. Males with normal and pathological aging were equally delayed in their first contact with food pellets, while in female sex this latency was dependent on the genotype (longer in 3xTg-AD mice, shorter in those with normal aging). Once the animals had inspected the arena, the latencies to smell, find and eat the food pellets were found progressively increased in males with normal aging, but consecutively developed in 3xTg-AD mice. In contrast, both groups of females exhibited longer delays as compared to males, and the temporal pattern of their ethogram to smell-find-eat the food was faster. In 3xTg-AD males, social isolation (naturally occurring due to death of counterparts) emphasized these olfactory patterns, which were independent of the punctual loss of weight of this paradigm. The results show that this paradigm provides distinct contextual, sex and genotype olfactory ethogram signatures useful to investigate olfactory function in normal and AD-pathological aging. Also, that isolation has an impact enhancing the changes in the olfactory signature here described, for the first time, in the 3xTg-AD mice model of Alzheimer’s disease.
418 - Digging signatures modeling anxiety and OCD disorders in very old age and end-of-life Alzheimer’s disease and the effect of social isolation: A translational neuroscience approach in times of coronavirus pandemic (COVID-19)
- Gimenez-Llort L, Alveal-Mellado L
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- 04 November 2020, p. 134
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The severity of the current scenarios in this pandemic will leave important psychological traces. In fact, the first clinical reports available already refer to increased incidence of depression and anxiety disorders such as obsessive-compulsive disorder (OCD) and post-traumatic stress disorder. At the translational level, modelling of such neuropsychiatric alterations in animal models relays in neuroethological perspectives since response to fearful situations and traumatic events, critical for survival and adaptation to the environment, are strongly preserved in phylogeny. In the wild, mice dig as a ‘defensive behavior’ which is considered to reflect the anxiety state of animals. In the laboratory, mice dig vigorously in deep bedding to bury food pellets or small objects they may find. Thus this behavior, initially used to screen anxiolytic activity was later proposed to better model meaningless repetitive and perseverative behaviors characteristic of OCD or autism spectrum disorders. In the present work, we have studied the digging ethograms in normal and advanced AD-related pathological aging using wildtype and the 3xTg-AD mice, a genetic model of Alzheimer’s disease that presents AD-cognitive dysfunction but also a conspicuous BPSD-like phenotype. We also studied the effects of isolation in this respect, using very old (18 month-old) 3xTg-AD mice that survived to their cage mates, as mortality rates in this animal model are high after 13 months of age. Two digging paradigms, involving different anxiogenic and contextual situations were used to investigate the digging patterns in these very old males with normal and AD-pathological aging, as well as the effects of isolation. The temporal course and intensity of this behavior was found increased in those 3xTg-AD mice that had lost their ‘room partner’ and lived isolated. However, when they were tested under neophobia conditions, incidence of this behavior was smaller and the pattern of digging was disrupted. The results show that this combined paradigm unveils distinct features of digging signatures that can be useful to provide an animal model for these perseverative behaviors and their interplay with anxiety states, which represent an important part of BPSD or can now emerge as a result of the enhancement of obsessive-convulsive behaviors by social-isolation.
419 - Brain atrophy asymmetry in dementia is worsened by social isolation: A translational neuroscience approach in times of coronavirus pandemic (COVID-19)
- Muntsant-Soria A, Giménez-Llort L
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- 04 November 2020, p. 135
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The coronavirus pandemic (COVID-19) that has ravaged the entire world presents the most dramatic scenarios in the most vulnerable populations, with exacerbated focus on the elderly people, especially the most frail needing home-care or living in nursing homes. The urgency and severity of the outbreaks forces the use of segregation in restricted areas and confinement in individual rooms as desperate strategies to avoid the spreading of disease and the worse scenario of becoming a deadly trap. Residents are becoming socially isolated, lacking the social and environmental enrichment that are key rehabilitation factors against their progressive physical and/or mental deterioration. Recently, a study on gender perspective in COVID -19 found that men have more severe disease and are over twice as likely to die. It is well known that dementia is associated with increased mortality and males show worse survival than females. On the other hand, the asymmetric neurodegeneration of subcortical structures in Alzheimer’s disease (AD) has been recently demonstrated and proposed as a powerful imaging biomarker. In the present work, we studied the impact of long-term isolation in old male 3xTg-AD mice modeling advanced-stages of AD and as compared to age-matched counterparts with normal aging. A battery of behavioral tests resembling several areas in nursery homes was used. Atrophy of left and right hippocampus, cortex and cerebellum was measured. Our results are the first evidences of brain atrophy asymmetry being demonstrated in an animal model of AD, thus modeling that found in human patients. The main findings aware of a consistent impact of isolation increasing the hippocampal and cortical atrophy asymmetries. Isolated animals showed a prominent hyperactive pattern in both gross and fine-motor functions, re-structured negative valence system with the emergence of bizarre behaviors and flight copying-with-stress strategies. Overall, these results from translational neuroscience aware of the impact of isolation enhancing the neurodegenerative asymmetry and BPSD-like behaviors. They also highlight the relevance of personalized-based interventions tailored to the heterogeneous and complex clinical profile of the individuals with dementia, and to pay special attention to BPSD behaviors that may worse their caregivers’ burden in these times of coronavirus and post-COVID-19 pandemic scenario.
420 - Translational modeling of psycho-motor function in normal and pathological aging with special concerns on the effects of isolation
- Lidia Castillo-Mariqueo, Lydia Giménez-Llort
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- 04 November 2020, p. 136
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Time factor and human support are major constrains in the management of the COVID-19 pandemic and they enhance the challenges to adapt the lifestyles and intervention programs, with greater impact on the elderly people, especially those who are the most physically or cognitively frail. The restrictive confinement and the closing of the day centers has left those whose frailty requires permanent rehabilitation programs at home. In the case of Alzheimer’s disease (AD) and other dementias, non-professional home care may not be enough to cover the needs and demands of these complex disorders. On the other hand, as elder people, these patients can be particularly affected by social isolation, which can cause changes in behavior and decrease functional performance in the basic activities of daily life, worsening their BPSD and cognitive impairment. In this context, and under the gaze of normal and pathological aging, we are developing a functional model of psycho-motor evaluation that allows us to study psycho-motor function, including motor learning and memory. Its translational value relays in the modeling of tests used in clinical settings. Here we present the very first results. We have selected the gold standard C57BL/6 mice together with the triple transgenic model of AD (3xTg-AD) to apply our psycho-motor protocol. We have included a series of measurements that make possible to differentiate several dimensions of basal motor learning, and the learning associated with fragile situations. We have found common as well as distinctive features between the sample of normal and AD-pathological aging, and under the isolation scenario. Among all, we can highlight the gender factor and the level of physical activity as a protective mechanism when indicators of frailty are present. Particularly, the 3xTg-AD mice show greater deterioration in physical aspects, but they retain their motor learning capacity comparable to the controls. On the other hand, higher performance in tests of exercise tolerance and muscle strength stand out in these mice, where genotype and gender appear to be determinant factors in overall physical performance: This generates new hypotheses of underlying biological protection mechanisms in translational scenarios relevant for the rehabilitation of geriatric and AD-patients.
421 - Mood disorders and its relationship with cognitive impairment and dementia
- Sandra Torres, Andreia Lopes
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- Published online by Cambridge University Press:
- 04 November 2020, p. 137
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Mood disorders are common psychiatric illnesses that represent a major cause of disability worldwide. With life expectancy and the percentage of elderly people rising in many developed and undeveloped countries around the globe, cognitive impairment and dementia are gaining a societal importance. The relation between mood disorders and cognitive function is a twofold. On the one hand, cognitive deficits within mood disorders have been studied extensively, in which there seems to be a persistent neurocognitive impairment, both in acute phases and in interepisodic euthymic phases. Although results have not always been consistent, an overall pattern of specific impairments – in executive function, attention and memory - has become evident. On the other hand, recent research suggests that mood disorders, in general, may be risk factors for the development of mild cognitive impairment and dementia. In this sense, of the many models for the association of mood disorders and dementia, two are favored by several authors. One suggests that mood disorders are a risk factor for earlier clinical manifestation of dementia. The second sees mood disorders as the cause of dementing states, for instance through neuronal loss via dysregulation of the glucocorticoid cascade. In fact, there is suggestion that impairment of neuroplasticity may underlie the pathophysiology of mood disorders as such, and not only of neurocognitive impairment. In some patients, specific neurocognitive functions may be present before the onset of mood disorder and may constitute a trait factor or even an endophenotype. The aim of the present work is to, through a basic narrative review of published research on the main databases, summarize the main evidences of the association of mood disorders and dementia.
422 - Behavioral Variant Frontotemporal Dementia : an atypical case
- Filipa Gomes Tavares
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- Published online by Cambridge University Press:
- 04 November 2020, p. 138
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Objective: To present an atypical clinical case and to review the literature on frontotemporal dementia (FTD) focusing on the most frequent psychopathological findings.
Methods: Case report and a non systematic review using databases Pubmed, UpToDate, Medscape, between 2007 to 2020. Keywords: frontotemporal dementia, psychiatry, psychopathology.
Results: FTD is a neurodegenerative syndrome that appears most frequently in the fifth and sixth decades, mostly before the age of 65. Six to seven years before the diagnosis of FTD, psychiatric disorders such as major depression can appear. The behavioral variant DFT is characterized by symptoms such as disinhibition, apathy or inertia, loss of empathy, hyperorality, persevering behaviors, executive dysfunction, and it is also associated with changes in imaging exams, namely frontal and temporal cortical atrophy, which may affect one or both hemispheres. We present the case of a 66-year-old female patient, accompanied for a long time in psychiatry by conversion and dissociative symptoms, associated with histrionic personality traits. She was hospitalized for deteriorating functioning, pauted by great agitation and maladjusted behavior, alteration of thought and speech, and marked perseverance, as well as periods of space-time disorientation. Analytically, there were no changes, as well as in imaging exams such as CT and MRI. It was performed an electroencephalogram (EEG) that demonstrated diffuse cortical dysfunction.
Discussion/Conclusion: This case is atypical in the DFT pattern, regarding the age of onset and the absence of imaging findings. However, there was alterations in the EEG, which together with the symptomatic presentation point to DFT. This case exemplifies the difficulty in the management of symptoms, whose therapy is purely symptomatic and psychoeducational strategies for the family and caregivers are fundamental.
423 - Visual Hallucinations in Parkinson Disease and Dementia with Lewy Bodies: a review
- Joana Regala, Camila Nóbrega, João Reis
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- Published online by Cambridge University Press:
- 04 November 2020, p. 139
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Visual Hallucinations (VH) are a common psychiatric symptom of Parkinson’s Disease (PD) and Dementia with Lewy Bodies (DLB). According to the Perception-Attention Deficits Model, VH stem from impaired perceptual (bottom-up), including dorsal (DVS) and ventral visual streams (VVS), and attentional (top-down) processes, with a persistent Default Mode Network (DMN) activity and a dysfunctional imbalance of Dorsal (DAN) and Ventral Attentional Networks (VAN).
We review the literature on the neurobiological underpinnings of VH in DLB and PD, concerning overlapping and different mechanisms.
In DLB hallucinators, PET-scan findings of disconnection between higher and primary visual areas and dysfunctional recruitment of the VVS, corroborate other imaging and neuropathologic studies which document inferior longitudinal fasciculus damage and increased temporal lobe Lewy body (LB) pathology. The alteration of network topography is more pronounced in the DAN and DMN. The involvement of anterior cortical regions, clustering around attentional networks, is demonstrated in neuropathologic, volumetric and perfusion studies. VH severity closely correlates with anterior cingulate cortex and inferior temporal cortex hypoperfusion, structural changes in the DVS (superior parietal gyrus and precuneus) and increased diffusivity of the right thalamic projections to parieto-occipital cortices. Thalamocortical dysfunction alongside decreased cholinergic activity in reticular nucleus, which receive projections from the nucleus basalis of Meynert, seems to play a crucial role.
Both DLB and demented PD hallucinators have more frontal cortical atrophy, yet greater in DLB, supporting top-down mechanisms.
Regarding PD hallucinators, findings of cortical atrophy in inferior parietal lobule, cuneus, lingual lobule, and precentral gyrus correlated with hallucination scores. However, some studies did not evidence volumetric cortical differences between hallucinators and non-hallucinators. Moreover, LB are not necessarily present in hallucinators, suggesting other neuropathologic mechanisms in the genesis of VH, namely altered neurochemical circuitry. Volume loss in pedunculopontine nucleus and right-thalamus support the hypothesis of a dysfunctional cholinergic brainstem control of the cortex. PET-scan studies discovered higher 5-HT2A receptor levels in the inferolateral temporal and prefrontal cortices. A greater nigrostriatal impairment is documented in the right-caudate of hallucinators. Therefore, VH may arise from an inability to activate DAN (in which caudate is involved) and consequent faulty visuo-perceptual processing by DMN and VAN.
424 - Using the Montreal cognitive assessment in a memory clinic setting for triaging after initial assessment
- Géraud Dautzenberg, Jeroen Lijmer, Aartjan T.F. Beekman
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- Published online by Cambridge University Press:
- 04 November 2020, p. 140
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Objectives: More and more referrals to memory clinics are expected, but diagnostic routes are already challenged. In order to be able to follow the advice to diagnose dementia more often and earlier in the process, but also to be able to handle the increasing numbers of referrals, a fast but reliable triage test is needed.
According to the Cochrane review, “the MoCA can help identify people who need specialist assessment and treatment for dementia”. It has been validated in multiple institutions and languages. However, many of these studies are designed with a case-control design using healthy, community-based individuals as controls, which can lead to spectrum bias.
Our cohort of referrals to a memory clinic with patients suspected of having cognitive disorders (mild dementia and MCI) after initial assessment in an old age psychiatric clinic, needs to be validated because different settings can give different results.
Design: our reference standard consisted of a consensus-based diagnosis according to international criteria for detecting MCI and MD, and this was compared with patients suspected of MCI/MD - but excluded from cognitive disorders (NoCI)- from the same cohort.
Results: The mean MoCA scores differ significantly between the groups: 24 in NoCI, 21 in MCI and 16.5 in MD. The AUC of MD against non-demented (MCI+NoCI) was 0.83 resulting in 90% sensitivity, 65% specificity, 50% PPV and 94% NPV at a best cut-off of <21 according the Younden index. For CI (MD+MCI) against NoCI the results were respectively 0.77AUC, 95%sens, 47%spec, 88%PPV, 68%NPV at a cut-off <26.
On an individual basis, as a box plot of DSM IV diagnoses showed, the MoCA score has limitations and clinical aspects need to be taken into account: FTD, high education to the upside; MCI including psychiatric etiology to the downside.
Conclusions: by using a cut-off score of <21, 90% of people with positive MoCA have CI, while 94% of people with negative MoCA (≥21) will not have dementia. The MoCA can significantly reduce referrals (50%) by excluding patients for further diagnostic work-up at a memory clinic, even if they are suspected of CI after initial assessment.
425 - Do seniors find sensors use for assessment and surveillance of cognitive functioning acceptable? Findings from two feasibility studies
- Iris Rawtaer, Tan Hwee Pink, Khalid Bin Abdul Jabbar, Liu Xiao, Wee Shiou Liang, Ng Tze
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- Published online by Cambridge University Press:
- 04 November 2020, p. 141
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Background Mild Cognitive Impairment is an at-risk stage for dementia and early detection has been increasingly recommended to facilitate beneficial interventions and forward planning. Changes in cognition and function can be insidious. In ageing populations, relying on relatives to detect changes is not sustainable. Moreover, resource scarcity necessitates that we innovate to find less manpower dependent methods for early detection and assessment.
Objectives In two separate feasibility studies, we set out to evaluate if sensors could be utilized to (1) detect changes in behaviour patterns in homes of community dwelling elderly* & (2) evaluate instrumental activities of daily living (iADLs) in a smart home lab setting.
Method In the first study, 59 community-dwelling seniors (aged >65 years) were observed over the course of 2 months through the use of motion sensors, smart plugs, bed sensors and activity bands. Behaviour metrics such as forgetfulness, outings and sleep were tracked. In the second study, a smart lab was equipped with similar sensors and 35 seniors were tasked to complete two iADLs (using the telephone and counting money) while being evaluated by the sensor system.
Results In both studies, we found that it was feasible and seniors found the sensors to be acceptable. Over 80% of seniors had positive feedback for the in-home system and over 95% of seniors had found the lab-based evaluation of iADLs to be acceptable.
Conclusion Sensor technology and smart homes are feasible to utilize for assessment and monitoring of cognition and function. Knowing that seniors find it acceptable is a crucial initial step. Much more needs to be done to refine the systems and the clinical information it yields.