Transcranial direct current stimulation (tDCS) has been proposed to affect long-term synaptic plasticity through LTP and LTD, thereby improving cognitive ability. In pathology, the amyloid deposits in AD disrupts the balance between long-term potentiation (LTP) and long-term depression (LTD) of neuronal cells and synaptic plasticity. An increasing number of studies have been concluded a positive therapeutic effect on cognition in AD. In brain stimulation, dorsolateral prefrontal cortex (DLPFC) was associated with improvements in memory enhancement, language, processing speed, global cognitive symptoms, and apathy over a period of treatment. Theoretically, the aftereffect of tDCS would need to be re-stimulated by tDCS to maintain its delayed plastic response benefits. In this pilot study, we investigate the maintenance effects of continuing tDCS at three different times, weekly, every two weeks, and every four weeks, for 12 weeks.

Twenty-eight AD participants aged 55-90 years were enrolled (mean age 72.7, 77.3, and 76.2 in the three groups - maintained weekly (7 cases), biweekly (9 cases) and every 4 weeks (12 cases)). The anodal electrode was placed over the left dorsal lateral prefrontal cortex and the cathodal electrode was placed over the right supraorbital area. In each active session, we applied a current intensity of 2 mA and an electrode size of 25 cm2 for 30 min. All subjects received a series of neuropsychological assessments including CDR, MMSE, CASI and WCST at (1) baseline, (2) post-10sessions of tDCS (in 2weeks), and (3) post-maintenance phase (total of 12 weeks). Chi-square tests, Wilcoxon signed rank tests and Mann-Whitney U tests were used to assess differences in participant demographic characteristics and to compare differences in test scores between groups.

After 10 sessions of tDCS stimulations, the total CASI scores in the 1-week group improved significantly from baseline to 2 weeks. However, there are no significant difference in MMSE, CASI or WCST between baseline and after maintain phase stimulations in each group.

Although tDCS has a positive effect in AD, it is recommended to prolong the number of tDCS stimulations, such as 20 sessions in 4 weeks.

Despite the advantages of Virtual Reality (VR), the increase in anxiety caused by motion sickness makes it difficult to apply to patients with depression and anxiety. We studied correlation between skin conductance and anxiety in VR.

We conducted a clinical study of 81 healthy volunteers with high stress, which was defined as a score of 20 or more on the Perceived Stress Scale-10 (PSS-10). We used STAI-X-1 to measure anxiety, and Galvanic Skin Response to measure skin conductance. This study used an open, randomized, crossover design. The videos consisted of two types, less dizzying video (G1) and more dizzying video (G3). We divided into two groups with exposure order, G1 after watching G3 (Order 1), and G3 after watching G1 (Order 2).

Anxiety significantly decreased in the Order 2 group (p < 0.035), whereas there was no significant change in anxiety in the Order 1 group. In both groups, skin conductance significantly increased after exposure to dizzying video. The skin conductance of the Order 1 group mean (SD) was 1.61 (1.07) (p < 0.0001), and the Order 2 group was 0.92 (0.90) (p < 0.0001). There was no significant difference between two groups (p = 0.077).

It is possible to reduce skin conductance and anxiety by viewing less dizzying VR video first and then viewing more dizzying video later.

Around 95% of Chinese with dementia in Australia and China reside at home and are cared for by family members. The World Health Organization (WHO) iSupport program has been translated into simplified and traditional Chinese and culturally adapted to the Chinese populations in Australia, Mainland China, Taiwan, Hong Kong and Macau. The objective of this study was to explore family caregivers’ experience in a 6-month randomized controlled trial of a facilitator-enabled iSupport intervention program that includes the utilization of the online iSupport and peer support activities.

A qualitative descriptive design was applied to address the study objective. Caregivers’ interactions with peers and program facilitators in monthly online meetings were audio-recorded and transcribed verbatim for data analysis. Facilitators were required to document their support for caregivers in their monthly portfolios and submit for data analysis. Thematic analysis was used to analyse data collected from online caregiver meetings and facilitator portfolios.

Five main themes were identified from data. First, caregivers were able to follow the group learning goal to complete their monthly learning activities using the online iSupport. They were also capable of selecting additional learning units from iSupport to meet their individual learning needs. Second, caregivers perceived that iSupport enabled them to change their responses to changed behaviours their care recipients had by which they reduced the sources of stressor in their daily care. Third, caregivers were willing and felt safe to share their stressors and seek help from peers and facilitators in group meetings. Fourth, caregivers demonstrated their enthusiasm to help their peers reduce their stressors and social isolation by searching and sharing various electronic resources via Wechat or Whatsapp platform throughout the trial. In addition, facilitators were able to assess caregivers’ learning needs and link them with relevant care services and resources accordingly.

Facilitator-enabled iSupport intervention in our study demonstrated advantages of engaging caregivers in learning iSupport, applying knowledge into daily care activities, sharing experiences with and supporting other caregivers.

Explore end-user evaluations and feedback focused on lifestyle change in a large-scale multidomain online intervention targeting modifiable risk factors for dementia.

Online survey and semi-structured interviews at conclusion of the Maintain Your Brain (MYB) randomized controlled trial. Participants were 55-77 years of age at baseline, and had engaged in assessments, brain training, nutrition and physical activity, and mental health modules over three years. Of 5,260 participants invited, 2,386 completed online surveys and 1,589 of these respondents provided free text comments. Nearly 250 survey respondents agreed to be contacted for additional interviews; 70 of these were invited, 40 interviewed. Survey respondents and interview completers endorsed whether they had made lifestyle changes because of MYB participation and whether they would continue healthy lifestyle changes going forward. Interview participants endorsed whether they thought similar programs can be useful in delaying or preventing dementia, whether their views regarding this type of program had changed over time, answered open-ended follow-up questions and provided additional feedback. Data were summarized using descriptive statistics and explored using multiple qualitative methods.

Of survey respondents, 90.5% endorsed intention to continue a healthier lifestyle; 63.2% endorsed that lifestyle changes had occurred. Interview participants thought similar programs could be useful in delaying or preventing dementia, but some were unsure. Trial participation had not changed many individuals’ views about online lifestyle programs. Survey free-text and interview comments indicated diversity in pre-intervention knowledge, lifestyle and health-related behavior. Many respondents reported improved knowledge and awareness, some detailed relevant and continued lifestyle change. Those who were already well informed and/or leading healthy lifestyles explained that trial participation had confirmed their existing practices. Trial characteristics, personal characteristics, social relationships and significant events impacted whether respondents had made and/or continued changes. More flexible, adaptive individually tailored goals and timely feedback were requested to better support change.

Surveyed participants who engaged in the 3-year MYB online multidomain dementia risk reduction program reported lifestyle changes and intention to continue having a healthier lifestyle. Older adults in this study suggested that similar online programs need to provide flexible, individualized guidance and feedback to support lifestyle change.

This systematic review and meta-analysis aimed to (1) assess the effectiveness of psychological therapies for depression in older people living in long-term care (LTC) settings, and (2) investigate differences in effectiveness between types of psychological treatments.

We included randomised controlled trials (RCTs) with participants aged 65 years and older. Participants were required to present with (a) major depressive disorder (MDD) or (b) symptoms of depression based on a score over a cut-point on a validated depression measure. The study setting was LTC facilities, including nursing homes, assisted-living facilities, and residential aged care facilities, where some level of day-to-day care was provided by staff employed in the facility. Treatments were grouped and classified as cognitive-behavioural therapy, behaviour therapy, or reminiscence therapy.

The literature review identified 19 studies for the qualitative synthesis: 18 were included in a meta-analysis. Results indicated a benefit for psychological treatments on depressive symptoms at end-of-intervention (standardized mean difference (SMD) -1.04, 95% CI -1.49 to -0.58; 18 trials, 644 participants), and at a medium-term follow-up (SMD -0.43, 95% CI -0.81 to -0.06; 8 RCTs, 355 participants), but not in the longer-term (SMD -0.16, 95% CI -0.58 to 0.27; 2 RCTs, 92 participants). There was no difference in outcomes between therapy types.

This systematic review demonstrated positive impacts of psychological therapies on symptoms of depression in older people living in LTC, both immediately after therapy and in the medium term, but longer-term impacts were not demonstrated.

Social health (SH) markers, including marital status, contact frequency, network size, and social support, have been linked with increased cognitive capability. However, the underlying mechanisms remain poorly understood. We aim to investigate whether depression symptoms and inflammatory biomarkers mediate associations between SH and cognitive outcomes.

We used data from waves 1-9 of the English Longitudinal Study of Ageing, involving 7,136 participants aged 50 or older at baseline. First, we examined associations between SH (wave 1) and depression and inflammatory biomarkers (C-reactive protein (CRP) and fibrinogen) (wave 2) using linear regression models. Second, we tested associations between a) SH and b) depression and inflammation with subsequent standardised verbal fluency and memory in wave 3 and change between waves 3-9, indexed using slopes derived from multilevel models. We adjusted for age, sex, socio-economic position, cardiovascular disease, basic and instrumental activities of daily living, health behaviours, and baseline depression symptoms and cognition. We will also conduct causal mediation analysis.

All SH markers, except contact frequency, were associated with lower subsequent depression, but not inflammatory biomarkers. Greater contact frequency (e.g. once-twice a week vs <once per year: β=0.18 [0.01, 0.36]) and less negative support (β=0.02 [0.00, 0.03]) were associated with higher verbal fluency. Larger network size (>6 people vs none: β=0.007SD/year [0.001, 0.012]), less negative (β=0.001SD/year [0.001, 0.002]) and more positive support (β=0.001SD/year [0.000, 0.001]) were linked with slower memory decline, and more positive support predicted slower verbal fluency decline (β=0.001SD/year [0.000, 0.001]). Depression symptoms were associated with lower memory and verbal fluency, and faster memory decline (β=-0.001SD/year [-0.001, -0.000]) and verbal fluency (β=-0.001SD/year [-0.001, -0.000]). CRP was associated with lower verbal fluency (β=-0.02 [-0.04, 0.00]), whereas fibrinogen was linked with faster memory decline (β=-0.001SD/year [-0.003, -0.000]).

Depression symptoms and SH showed associations with subsequent cognitive capability and change. SH was linked with lower depression, but not inflammatory biomarkers. Findings highlight the potential for depression to underpin associations between SH and cognition, a pathway which we will test using causal mediation analysis. We will also examine whether findings replicate in the Swedish National Study of Aging and Care in Kungsholmen.

Social connection is important for health, quality of life and care in long-term care (LTC) homes. However, research on how to improve social connection in LTC has been limited by lack of consensus on best approaches to measurement.

We will present a systematic review of measures of social connection developed for use in LTC residents, which aims to identify all existing measures and evaluate their measurement properties including structural validity, internal consistency, reliability and construct validity.

We are following Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic review methods. We searched multiple bibliographic databases from inception to November 2021 for studies that were conducted in LTC resident populations, quantified any aspect(s) of social connection, and reported at least one psychometric property for the measure(s) of social connection. We conducted a second targeted search in April 2022 based on our list of identified measures, supplemented with a list of measures used in previous research in this population. We are currently evaluating the measurement properties reported for each identified measure in accordance with COSMIN guidelines.

We have identified 68 studies reporting on 35 measures used to assess multiple aspects of social connection in LTC homes. The majority (n=25) were measures of quality of life, wellbeing or life satisfaction, which included a social connection subdomain, whilst only 10 measures specifically target social connection. From our pooled evaluation of 20 measures to date, we have found that 20% (n=4) have sufficient evidence of structural validity, 15% (n=3) have sufficient internal consistency, 25% (n=5) have sufficient reliability, and 15% (n=3) have sufficient construct validity.

Many measures have been used to assess social connection in LTC settings, but few are specifically designed for this purpose and they often have insufficient evidence for psychometric properties. This review will provide detailed evidence of the quality of these measures to enable future researchers to prioritise higher quality tools and will inform our development of a new person-centred social connection measurement tool for LTC residents in the Social Connection in Long-Term Care Home Residents (SONNET) study.

Health disparities between communities with greater and lesser advantages are a global concern. In the USA, self-identified race as African American (AA) is consistently associated with mild cognitive impairment (MCI) and dementia, compared to Americans of European descent. In a prospective population-based study, we sought to confirm this association and investigate potential explanatory factors.

The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) and Seniors Project 15104 (SP15104) studies recruited adults aged 65+ years from a group of small towns of lower socioeconomic status in the US. MYHAT recruited by age-stratified random sampling from the voter registration list for all towns; SP15104 recruited by intensive community engagement from three towns with populations that are 60% AA. Based on the Clinical Dementia Rating (CDR), MCI was defined as CDR=0.5 and dementia as CDR > 1. Using Cox proportional hazard models, we modeled time to incident CDR > 0.5 from baseline as a function of race (AA vs. all other), other demographics, and several other covariates at baseline.

The sample of 2120 individuals was 8% AA, and 62% female, with median age of 73y, and median educational level of partial college. During follow up of up to 14.5 years, 499 participants developed new-onset MCI/dementia (CDR >0.5). Cox models revealed that being AA was significantly associated with incident CDR > 0.5 (HR=1.45. 95% CI:1.01,2.10). Inclusion of age, sex, and education in the model increased the HR for race to 1.63 (1.1, 2.3). Adding number of regularly taken prescription drugs (reflecting overall morbidity), depression symptoms, preceding year alcohol consumption, and number of visits to emergency or urgent care together reduced the HR to 1.4 (0.96, 2.0), no longer statistically significant

In this population-based cohort study, self-identified African Americans had an about 40% elevated risk of developing MCI/dementia. Adjusting for demographics, the significant association between race and incident MCI/dementia was attenuated by variables reflecting depression, greater general morbidity, and lesser access to regular health services. These variables possibly reflect downstream effects of historic discrimination, but couldstill be modifiable risk factors for MCI/dementia. Addressing them could potentially mitigate ethno-racial disparities in cognitive impairment.

To explore barriers towards mental health services for older adults with symptoms of depression and/or anxiety in a low-resource community in Lima, Peru. We explored these barriers from the perspective of older adults and health providers.

We conducted an interview-based qualitative study. The first set of interviews was carried out between October 2018 and February 2019, and the second, between January 2022 and September 2022. In the first sample, we interviewed 38 older adults ≥60 years with symptoms of depression (Patient Health Questionnaire-9 ≥ 10), anxiety (Beck Anxiety Inventory ≥ 16), or those who had previous experience using formal mental health care irrespective of current symptoms. In the second sample, we included 20 health providers (8 psychologists, 2 general practitioners, 2 nurses, 4 psychiatrists, 4 social workers). We used an inductive thematic data analysis.

We identified two main barriers: stigma towards mental health conditions and care, and ageism. Stigma and ageism interacted with each other and exacerbated other barriers to mental health services. Stigma led to negative labels for people with mental health conditions and shame among older adults to disclose their feelings to health providers. Looking at the health system, health care facilities were described as not being age friendly. Additionally, aside from psychologists and psychiatrists, most providers mentioned little previous training in mental health care, but even less about the nuances of treating mental health challenges in old age. Among older adults, other important barriers were the accumulated mistrust towards health professionals and lack of knowledge about existing services and how they work. Importantly, older adults mentioned competing priorities, for example, not having time to seek care because they needed to work to obtain food. Other barriers included hidden costs incurred for transportation to health centers or to obtain medications. For older adults with diminished physical mobility, lack of accompaniment to attend health appointments was another important barrier.

Community-based mental health interventions towards older adults need to address ageism and mental health stigma to improve access to care. Furthermore, training for health providers must be improved and expanded to prioritize older adult mental health care.

Heart rate variability (HRV), a quantitative measure of mainly parasympathetic activity, has been applied in evaluating many types of psychiatric and neurological disorders, including dementia (or neurocognitive disorders). However, although dementia patients often showed significantly lower HRV (various indices) than healthy controls, and different types of dementia had distinct HRV features, the results were not identical across studies. We designed a systematic review and meta-analysis for incorporating data from different studies.

We gathered studies comparing HRV in patients with dementia and in healthy controls. HRV was analysed in several ways: parasympathetic function in hierarchical order (main analysis); total variability; comparison of HRV between different subtypes of dementia; specific indices of HRV; HRV reactivity.

In initial search, we found 3425 relevant articles; 24 studies with a total of 1107 dementia patients and 1017 control participants finally entered the meta-analysis. The dementia patients had a significantly lower resting HRV for parasympathetic function (Hedges’g=−0.3596, p=0.0002) and total variability (Hedges’g=−0.3059, p=0.0002) than the controls. For diagnostic subgroup analysis relative to the controls, HRV was significantly lower in mild cognitive impairment (MCI) patients (Hedges’g=−0.3060) and in patients with dementia with Lewy bodies (DLB) (Hedges’g=−1.4154, p<0.0001). Relative to patients with Alzheimer’s disease, HRV in patients with DLB was significantly lower (Hedges’g=−1.5465, p=0.0381). Meta-regression revealed that gender proportion was significantly associated with effect size.

Our results support that dementia (especially DLB and MCI) patients to have lower parasympathetic activity than health people. The influence of gender on the results should be carefully interpreted.

Agitation is a common neuropsychiatric symptom in patients with Alzheimer’s dementia, resulting in significant burden to patients and caregivers. This study was conducted to better understand caregiver perspectives on the frequency and severity of agitation behaviors, captured by the Cohen-Mansfield Agitation Inventory, and to assess what constitutes a meaningful change in these behaviors.

This was a qualitative, non-interventional, descriptive study conducted in the United States. Semi-structured 1:1 interviews were completed with non- professional caregivers of patients with Alzheimer’s disease (AD) (i.e., family caregivers providing unpaid, informal care) who met the following inclusion criteria: ≥21 years old; caring for an individual with clinically confirmed AD; noticed agitation behaviors including emotional distress, excessive movements, verbal aggression, physical aggression; spent ≥4 days a week for ≥2 hours with the person with AD; and willing to participate in the virtual interview in English. Interview transcripts were analyzed thematically through detailed line-by-line inductive and deductive coding approaches using the ATLAS.ti software.

Thirty caregivers participated. Participants’ mean age was 64 (±13) years. Most participants were Caucasian/white (77%), non-Hispanic or Latinx (97%), and female (70%). Approximately half were providing care to their spouse (53%), and the remainder for a parent or parent-in-law. Several key themes on what constitutes ‘meaningful change’ emerged. All caregivers tied a meaningful change in agitation behaviors to a change in behavior frequency (becoming less frequent or stopping entirely). Beyond frequency, themes describing meaningful change included: change in behavior intensity; apparent intent to disturb or cause harm to self or others; potential to cause serious harm; amount of harm caused; more “normal” behavior; shorter episode duration; and less worry, frustration, or isolation. Additionally, a shift from verbally aggressive behavior to physically aggressive behavior was considered an escalation in agitation severity and meaningful worsening. Thus, unique to physical aggression, a meaningful change was described as a de-escalation to verbal aggression.

Caregivers report several themes on what constitutes meaningful improvement or worsening of agitation behaviors in individuals with AD. A change in the frequency of agitation behaviors was consistently reported by caregivers as important, with decreased frequency perceived as a meaningful improvement.

People with dementia can live full and meaningful lives after diagnosis, but still many people with dementia and their family care partners are dissatisfied with the process of getting a diagnosis and may also receive limited, if any, post-diagnostic support. The international COGNISANCE project aims to improve the communication of dementia diagnosis and post-diagnostic support. It is a 3-year project supported by the EU Joint Program for Neurodegenerative Disease Research (JPND), with partners in Australia (lead), Canada, Netherlands, UK, and Poland.

Based on the experiences of people with dementia, family care partners and health care professionals, and in partnership with them, we codesigned a website that provides structured information, resources and tools tailored to empower people with dementia and their family care partners. Effects of the campaign was evaluated using the RE-AIM framework. From our collective experiences, a ‘playbook’ was produced outlining how to deliver similar campaigns in other countries. Through these activities we aimed to improve health care practitioner’s diagnostic habits and provision of support, as well as increase help seeking by people with dementia and care partners.

In this symposium, you will hear about the latest results of four workpackages of this COGNISANCE project:

1. 1. A general overview of the rationale, goals, and design of the project will be presented by the principal investigator

2. 2. Data of a qualitative study will be presented on the experiences of receiving a diagnosis, and the barriers and facilitators towards post-diagnostic support, as well as on the differences and similarities between countries.

3. 3. The development of an online actionable guide Forward with dementia (www.forwardwithdementia.org) using a person-centered approach with target audience groups. The aim of this online guide was to support decision making and to help people find their way forward from a diagnosis of dementia.

4. 4. Data will be presented of the evaluation of the implementation and perceived impact of the Forward With Dementia websites and campaign in the five participating countries

Delirium is an acute and fluctuating disorder characterized by a disturbance in attention and cognition that is commonly observed in hospitalized older adults; being present in up to 23% of patients admitted to a general medical service and as many as 85% of patients in the intensive care unit. Delirium causes complications such as increased morbidity, persistent functional decline, mortality, increased frailty and increased length of hospital stay. Nonetheless, it is often underdiagnosed, especially when it occurs in its hypoactive form. The objective of this study is to describe characteristics and factors associated with the presence of delirium in patients ≥65 years treated by the liaison psychiatric units in seven general hospitals.

This is an observational, cross-sectional, multicentre study. We obtained data from a sample of 165 patients (≥65 years) admitted to seven general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.

We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Delirium was diagnosed in 20% of the consultations. A multivariate analysis was developed with the presence of delirium as the independent variable. The nature of the underlying pathology, the presence of a previous mental disorder, functionality using the Barthel and Lawton Brody Indexes and the prescribed pharmacological treatments were used as dependent variables. Cohen’s kappa statistics were used to estimate the agreement between delirium diagnose made by psychiatrists and the diagnoses considered by the referring doctors. Low agreement was found for the presence of delirium (Kappa= 0,2341). We also explored the relationship between the presence of delirium and the mean length of stay, as well as the discharge destination of these patients.

There are still many difficulties in the diagnosis and treatment of patients with delirium. Better knowledge of the factors associated with its appearance would improve the management of these patients.

The COVID-19 situation could be considered as an uncontrollable stressful life event. It may exert an impact on their quality of life (QoL). Not only COVID related variables, sociodemographic characteristics, health and appraisal but also personal resources could have an impact on QoL.

This study aims to assess the association between QoL and sociodemographic characteristics (sex, age), levels of health (physical health, emotional distress, and psychological well-being), COVID-19 related variables (having got infected, having lost a loved person, being hospitalized or having had a loved one hospitalized), appraisal (fear of COVID-19 outbreak), personal resources (family function, resilience, acceptance and gratitude).

QoL was assessed in all participants using CASP-19. A regression model was tested. 361 older adults in Spain participated in this study. The average age was 68.44 (SD= 5.31) and 62.8% were women (N= 227) and 58.2% were married (N= 210).

The results suggest that the nature of the COVID-19 may not be as relevant for the older adults’ QoL as their levels of health, personal resources for managing COVID related and emotional status. We found that the older adults QoL increased when increased the levels of health, acceptance, gratitude, personal growth, and purpose in life and when there were lower scores in anxiety and depression. This model explained 66.4% of variance. In contrast, COVID-19 variables or appraisal did not show any association with QoL.

A better understanding of the factors associated with QoL could help health professionals to develop interventions that enhance it. Efforts to address older adults’ QoL focusing on older adults’ personal resources, perceived health and emotional status should be considered.