Most people living with dementia do so at home, comprising approximately 30 million people globally. Despite extensive research on psychotropic medication use in long-term care settings, there has been little comparative research looking at psychotropic use in people living with dementia at home.

The study aim was to systematically review the literature to identify factors associated with psychotropic medication use in people living with dementia at home.

The PROSPERO-registered review was conducted using PRISMA guidelines. A comprehensive search of four databases (2010 to 2020) was undertaken for the systematic review to identify empirical studies. A combination of MESH search terms for dementia, community-dwelling, and psychotropic medications were used. Suitable data were subject to meta-analysis using Comprehensive Meta-Analysis to calculate raw data to event rates and pooled, adjusted event rates for different modifier sub-analyses. Thematic analysis was utilised to synthesise emergent factors and a meta-analysis undertaken on suitable data.

The search identified 619 articles of which 39 met inclusion/exclusion criteria. Use of psychotropics ranged from 18.7% for anxiolytic/hypnotics, to 26.9% for antipsychotics and 33.1% for antidepressants. Thematic analysis suggested that psychotropic prescribing was associated with a range of patient and environmental factors, including, but not limited to: (i) age (<75yr; >90yr); (ii) gender (being male); (iii) more advanced functional decline; and (iv) living alone. There was a conspicuous absence of data pertaining to carer and prescriber factors. Significant associations were identified in the meta-analysis between psychotropic use and respite in full-time care or hospitalisation as well as co-morbid psychiatric illness.

The reasons for psychotropic prescribing in this population remain poorly understood. Significant associations and knowledge gaps identified here generate opportunities for further research and development of targeted interventions to improve care and meeting the needs of this population group. This includes cautionary trigger questions for prescribers including: What am I treating? Who am I treating? How will I measure response? How can I ensure that psychotropics initiated in respite/hospital are used short-term only?

We aimed to study the relationship between glutathione (GSH), a key molecule of the anti-oxidant defense system in the blood, and glutathione reductase (GR), which reduces oxidized GSSG to GSH and maintains redox balance, with the prevalence of Alzheimer’s dementia and cognitive decline.

20 with normal cognition and 20 with Alzheimer's dementia who completed the 3rd f/u clinical evaluation over 6 years were selected by matching age and gender. Plasma glutathione (GSH) and glutathione reductase (GR) concentrations were independent variables. Clinical diagnosis and neurocognitive test scores were used as dependent variables indicating cognitive status.

The higher the GR, the greater the possibility of normal cognition rather than Alzheimer's dementia. Also, the higher the GR, the higher the neurocognitive score. However, this association was not significant in GSH in any way. After 6 years, the conversion rate from normal cognition to cognitive impairment was significantly higher in the lower 50th percentile of the GR group than in the upper 50th percentile.

According to the result of this study, the higher the GR, the lower the prevalence of Alzheimer's dementia and incidence of cognitive impairment, and the higher the cognitive outcome. Therefore, GR can be regarded as a protective biomarker for Alzheimer’s dementia and cognitive decline.

There is an urgent need for clinical blood biomarkers which can rule in/out neurological disorders early in those with psychiatric symptoms, personality or behavioural changes and/or functional decline together with cognitive symptoms. The neuronal axonal protein neurofilament light (NfL) is released from damaged neuronal axons and can be measured in in blood and cerebrospinal fluid (CSF). We have undertaken a series of studies aimed at examining the clinical utility of blood and CSF NfL in assisting with the distinction between psychiatric and neurodegenerative / neurological disorders.

Since 2016 we have measured blood and CSF NfL levels across multiple psychiatric and neurological populations recruited through Neuropsychiatry, Royal Melbourne Hospital and our collaborators (national and international). We have described our findings in a series of published studies. Data from our ongoing work, in larger cohorts and diagnostic groups, will be presented. The diagnostic groups include people with psychiatric disorders (schizophrenia, bipolar disorder, depression, functional neurological disorders), neurodegenerative disorders (Alzheimer’s disease, frontotemporal dementia, Huntington’s disease, Niemann-Pick Type C) and neurological disorders (e.g., epilepsy).

Our initial pilot study (n=129) found that CSF NfL was a promising biomarker in differentiating psychiatric from neurological disorders. In our larger follow up larger study (n=498) which included more diagnostic groups CSF NfL levels exhibited high accuracy (91%), sensitivity (92%), and specificity (87%) in differentiating psychiatric from neurological disorders, and distinguished behavioural variant frontotemporal dementia from frontal lobe syndrome phenocopies/mimics, with high accuracy. We have found that NfL is not elevated in people with treatment resistant schizophrenia compared to controls and is elevated in people with Niemann-Pick Type C compared to people with psychiatric disorders and controls. Further (unpublished) data has shown that these findings are replicated with plasma NfL levels across 400 further psychiatric, neurological and control participants.

NfL is a highly promising biomarker which differentiates psychiatric from neurological disorders with high sensitivity and specificity. The translation of NfL levels into standard clinical practice could substantially improve the clinical diagnostic process in people with complex neuropsychiatric and cognitive disorders.

Ageing and dementia affect many aspects of life, including intimate relationships, sex and sexual expression. Older people, including those living with dementia, can have sexual relationships and form new ones. Their sexual and physical health, quality of life, and psychological well-being can be improved by respecting their intimacy and sexuality expression preferences. However, due to ageism and stigma, healthcare professionals often ignore the sexual feelings and needs of those with dementia living in long-term care. Discussions with stakeholders and literature show limited attention paid to understanding the sexual preferences of people living with dementia in health and social care. In 2020, the Intimacy and Sexuality Expression Preference (ISEP) tool was developed for use in long-term care to gather information on intimate and sexual expression preferences of older people, including those living with dementia, to assist in care provision. The ISEP tool was trialled in a Queensland, Australia, nursing home with 14 older residents. This presentation will share insight into the use of the ISEP tool and how it informs the development of ‘ISEP: A Practical User Guide’. This guide provides information on how to (a) use the ISEP tool for assessment; (b) interpret and integrate findings into care (i.e., identify a potential course of action); and (c) evaluate outcomes. Illustrative examples will be included. It will inform how preferences for the expression of sexuality can be practically addressed to improve care practices and care outcomes (i.e., satisfaction and quality of life) for people with dementia.

Treatment of idiopathic normal-pressure hydrocephalus (iNPH) requires collaboration between dementia specialists and neurosurgeons. The role of dementia specialists is to differentiate patients with iNPH from patients with other dementia diseases and to determine if other dementia diseases are comorbid with iNPH. We conducted a nationwide hospital-based questionnaire survey on iNPH in medical centers for dementia (MCDs).

We developed a questionnaire to assess how physicians in MCDs evaluate and treat patients with cognitive impairment due to suspected iNPH and the difficulties these physicians experience in the evaluation and treatment of patients. The questionnaire was sent to all 456 MCDs in Japan.

Questionnaires from 279 MCDs were returned to us (response rate: 61.2%). Patients underwent cognitive tests, evaluation of the triad symptoms of iNPH, and morphological neuroimaging examinations in 96.8, 77.8, and 98.2% of the MCDs, respectively. Patients with suspected iNPH were referred to other hospitals (e.g., hospitals with neurosurgery departments) from 78.9% of MCDs, and cerebrospinal fluid (CSF) tap test was performed in 44 MCDs (15.8%). iNPH guidelines (iNPHGLs) and disproportionately enlarged subarachnoid space hydrocephalus (DESH), a specific morphological finding, were used and known in 39.4% and 38% of MCDs, respectively. Logistic regression analysis with “Refer the patient to other hospitals (e.g., hospitals with neurosurgery departments) when iNPH is suspected.” as the response variable and (a) using the iNPHGLs, (b) knowledge of DESH, (c) confidence regarding DESH, (d) difficulty with performing brain magnetic resonance imaging, (e) knowledge of the methods of CSF tap test, (f) absence of physician who can perform lumbar puncture, and (g) experience of being told by neurosurgeons that referred patients are not indicated for shunt surgery as explanatory variables revealed that the last two factors were significant predictors of patient referral from MCDs to other hospitals.

Sufficient differential or comorbid diagnosis using CSF tap test was performed in a few MCDs. Medical care for patients with iNPH in MCDs may be improved by having dementia specialists perform CSF tap tests and share the eligibility criteria for shunt surgery with neurosurgeons.

Falls is the leading cause of injury, and injury-related cognitive decline and death for older adults. Weight loss and malnutrition contribute to the risk of falls through increased frailty, visual and cognitive impairment, and predicts both the severity and recovery time of falls. Psychological and social factors such as isolation, loneliness, cognitive impairment, anxiety and depression are significantly associated with falls and weight loss for older adults. Reminiscence therapy is a psychological intervention that can improve anxiety, mood disorders, cognition and isolation; however, it is not yet known the impact that reminiscence therapy has on the incidence of falls and weight loss. This abstract will present the existing research on reminiscence therapy for the prevention of falls and weight loss, describe a group reminiscence therapy protocol to target these risk factors, and outline preliminary findings from a small pilot trial group therapy program conducted in February, 2023.

Data on pre and post incidence of falls and weight loss collected from eHealth records for: 1) 3 months prior to the group, and 2) the 9-week duration of the group will be discussed. Group participants will complete a pre and post Depression Anxiety Stress Scale (DASS21) and provide feedback on the therapy protocol.

This presentation will discuss the suitability of a group reminiscence therapy protocol to reduce psychological and social risk factors associated with falls and weight loss for older adults in residential aged care.

The group population of older adults has suffered the highest number of deaths and impact on health associated with the COVID-19 pandemic. Many older adults can perceive this pandemic as a traumatic experience. However, many older adults may have also experienced positive changes, defined as post-traumatic growth (PTG). Several factors may enhance or hinder this possibility of development.

This study aimed to analyze if the effects of COVID-19 affection (direct and indirect), anxiety and depression on PTG would be mediated by the protective variables life purpose and resilience.

359 older adults over 60 years old completed a web-based survey during the COVID-19 pandemic including sociodemographic data, direct/indirect affectation by COVID-19, anxiety, depression, resilience, life purpose and PTG.

63.2% of the participants were women and 58.2% were married. 89.1% had been infected by COVID-19, 1.7% had been hospitalized, 15.6% had lost a loved one and 17.2% have had a relative hospitalized because of COVID-19. Women (M = 56.77; SD = 18.00) showed higher levels of PTG than men (M = 52.41; SD = 17.84) (t = -2.19; p < .05). Differences in the outcome variables based on direct or indirect COVID-19 affection were not found. The path analysis showed that the effect of COVID-19 symptoms on PTG was mainly mediated by life purpose, and anxiety to a lesser extent. We also confirmed two indirect effects: (1) the negative effect of depression on PTG through resilience and life purpose assessed simultaneously; (2) the positive effect of resilience on PTG through life purpose. Results showed an excellent model fit to this model (χ² = 3.759; χ²/gl = 5; p = .585; GFI = .997; CFI = .999; RMSEA = .001).

The identification of protective and vulnerability variables is essential to protect older adults from mental disorders. This study highlights the need for developing interventions that aim to increase PTG by promoting life purpose and resilience.

The recognition of dementia as a multifactorial disorder encourages the exploration of potentially modifiable risk factors. Social health might play a role in cognitive decline and dementia. The Social Health And REserve in the Dementia patient journey (SHARED) project aims to unravel the interplay between social health and biological and psychological factors on the trajectory from cognitive healthy. A multi-method approach is used, including the development of a conceptual framework for social health and its application in epidemiological and qualitative studies. Epidemiological studies in the SHARED project reveal potentially modifiable social health characteristics or markers associated with cognitive decline, dementia and mortality. This may shape new avenues for future interventions to prevent or delay cognitive decline and dementia and to enhance living well with dementia.

Several guidelines propose the use of cognitive stimulation (CS) in people with dementia. Multi-component CS interventions seem most effective in improving cognitive function, quality of life, and behavioral and psychological symptoms of dementia. For successful implementation, it is important to analyze CS interventions in detail in order to identify frequently used and potentially effective components. The aim of this systematic review is to identify, describe and summarise multicomponent CS interventions conducted in nursing homes aiming to improve cognitive function, quality of life, mood, and behavior of people with dementia in nursing homes.

This review is based on established methodological frameworks for systematic evidence syntheses. We conducted a database search in February 2021, using PubMed, CENTRAL, PsycINFO, ALOIS and CINAHL. Two independent reviewers assessed all search results for eligible studies and assessed studies’ methodological quality using the Cochrane Risk of Bias tool for RCTs and the Joanna Briggs Institute checklist for quasi-experimental studies. Evaluation and intervention development studies of any design examining multicomponent interventions CS were included. Components of included intervention programs were analyzed using the TIDieR and CReDECI 2 criteria following a narrative analysis.

We identified 19,992 references and included 45 publications. We observed large heterogeneity regarding intervention components, delivery, materials, mode of delivery, intervention provider, and intervention duration. Intervention components included for example reminiscence therapy, activities of daily living, cognitive exercises or reality orientation. Risk of bias was generally low. Reporting of complex interventions was frequently insufficient. No study reported patient and public involvement (PPI) at any stage of the research process.

This systematic review is the first to describe complex CS interventions conducted in nursing homes in detail. Results indicate the need for more detailed intervention description for future studies based on TIDieR and CReDECI2 guidelines to allow reliable replication of these interventions. Despite enormous research activities, many questions regarding the implementation and efficacy are still unanswered as process evaluations are lacking. In addition, reproducibility of interventions is hardly possible due to limited reporting. Future studies should use established frameworks for the development, evaluation and implementation of complex interventions and apply PPI concepts.

Research tends to focus on the issues couples face – i.e., the dyadic relationship between carers and the affected person. This study examined young onset dementia from the broader family systems approach, focusing on the impact on the entire family following a diagnosis.

Public patient involvement was utilised to explore the specific issues of relevance to people with young onset dementia. Participatory workshops with members of the Alzheimer Society of Irelands Dementia Research Advisory Team were held to develop questions for the focus group interviews. Focus group interviews involved people with young onset dementia and their family members. The sample (n = 44) included people with a formal diagnosis of young onset dementia (with various subtypes) living in the community, and their family members including children.

Analysis of the qualitative data uncovered five main themes with related sub-themes including: initial onset of dementia; personal and social impact; behavioural and psychological symptoms of dementia; age-appropriate support and the shifting family roles.

It is clear from the current data that a diagnosis of young onset dementia results in significant challenges for the entire family system. The traditional model of care, which tends to narrow the focus to the person with dementia and primary caregiver, needs to be expanded to include the entire family/caregiving system.

Delirium is a potential emergency with serious consequences. Little attention has been paid to residents of nursing homes, although they are at extreme risk for developing delirium. Health Care Professionals (HCPs) such as nurses and general practitioners are assumed to know little about delirium in nursing homes.

The German project DeliA (delirium in nursing homes) comprises three sub- studies and two reviews. The sub-studies have the following objectives: (1) to determine the prevalence of delirium and its sub-types in German nursing homes; (2) to describe and assess the quality of delirium care practices (prevention, diagnosis, therapy) of HCPs in nursing homes; and (3) to develop a Technology Enhanced Learning (TEL) to increase the delirium- specific knowledge of HCPs in nursing homes. The reviews aim to (a) summarize the prevalence of delirium reported in international studies and (b) to find out how, why and under what context education for HCPs in nursing homes works.

A systematic review of the reported prevalence of delirium in nursing homes will be conducted (a). The prevalence study (1) will assess delirium and its proposed associated factors in at least 50 nursing homes using validated measurements. Medication schedules of participating residents will be analyzed to determine potential for delirium. To describe current practice, process-oriented semi-structured guided interviews will be conducted with 30 representatives of the (nursing home) medical service and the nursing service of nursing homes (2). As a theoretical basis for the TEL, a realist review will be conducted to understand the active ingredients of educational interventions and to develop an initial program theory (b). The curriculum for the proposed TEL will be developed based on a synthesis of existing curricula and evaluated by Delphi experts for relevance, comprehensiveness, and content. A final feasibility study will assess the potential increase in knowledge about delirium among HCPs (n = 50) in nursing homes (3).

It is expected that the project and the dissemination of its findings will raise awareness among HCPs and the public about delirium in nursing homes. The developed TEL and its underlying program theory will be further tested.

Rapid societal changes occurred during the course of the 20th century. Previous literature has found an increase in depression over time for younger and middle- aged populations. Among older adults, the prevalence of major depression has been found to be stable over time, while for the milder forms, the findings are limited by the largely non-representative nature of analyzed samples. Given the dramatic secular changes in several factors linked to old-age depression, a careful examination of depressive symptom burden and prevalence of depression in representative cohorts of similarly-aged older adults separated in time is required.

We will analyze data on 2,041 older adults from the Swedish National Study on Aging and Care in Kungsholmen. Separate individuals, aged 60 and 81 years were assessed with a Comprehensive Psychopathological Rating Scale (CPRS) during detailed clinical examinations, separated in time by 15 years (2001 vs. 2016). Information on 21 depressive symptoms, is subsequently combined into diagnoses of major depression (presence of at least one core symptom [low mood and/or loss of interest], and at least five out of the nine symptoms); minor depression (presence of at least one core symptom, and two to four symptoms in total), and subsyndromal depression (presence of at least two symptoms in the absence of any other depression diagnoses). Psychosocial (loneliness, bereavement), behavioral (alcohol consumption, smoking), and functional factors (impairments in activities of daily living) are used as potential explanatory factors for any observed cohort differences in symptom burden or prevalence of depression.

For the 60-year old age-group, comparison of symptom burden and diagnostic status will be done across 739 participants assessed in 2001 and 677 people assessed in 2013. For the 81-year old age- group, comparisons will involve 236 people assessed in 2001, 194 people assessed in 2010, and 195 people assessed in 2016.

Preliminary results are expected by March, once data entry and cleaning are completed. We hypothesize that the burden of depressive symptoms and the prevalence of depression will be lower in later born cohorts and that explanatory factors may account for some of the cohort effect.

The present study aims to determine the prevalence estimates of MBI and specific MBI domains in a large sample of the general population, by degree of cognitive impairment (CI).

A representative community sample of individuals aged 55+ (n=4803) (ZARADEMP Study) was studied. MBI, and specific MBI domains, were assessed according to ISTAART-AA MBI criteria, using the Geriatric Mental State (GMS). In accordance with these criteria, clinically significant anxiety, depression, and dementia were excluded. For the standardized degree of CI Perneczky et al. ́s criteria were applied: normal (MMSE 30), questionable (MMSE 26-29), mild CI (MMSE 21-25), moderate-severe CI (MMSE <21).

The prevalence of MBI, and specifically the domain Decrease Motivation (DM), increased progressively and significantly by degree of CI, the differences being significant between all cognitive groups. After control by age and education, DM was 2- and 4.5-times more frequent in subjects with mild CI (10.6%) and moderate-severe CI (18.3%), respectively, than in cognitive normal (5.8%). Affective Dysregulation (AD) was 1.7-times more frequent in mild CI (26.4%) (vs 20.4% in normal). Impulsive Dyscontrol (ID) was 2- and 7.9-times more frequent in mild CI (8%) and moderate-severe CI (23.5%) than in cognitive normal (4.7%). And Abnormal Perception and Thoughts (APT) was 6-times more frequent in moderate-severe CI (10%) (vs 1.4% in cognitive normal).

Our results confirm an increase of MBI prevalence across the spectrum of CI. However, each specific domain of MBI shows a different pattern of association with CI. Our results support the relevance of studying MBI domains independently.

The Min-Mental State Exam (MMSE) is the most common exam for screening and follow-up of cognitive impairment. One of 30 points is allocated to correct orientation to the weekday (“day orientation”).

The purpose of this study is to assess whether day orientation correlates with the weekday in which the exam was conducted, hypothesis being that orientation would be better on the work day immediately following the weekend (in Israel – Sundays).

All digitally recorded MMSE scores from Shalvata MHC’s were collected. The percentage of correct answers to day orientation was compared between weekdays. Differences between in/correct answers were assessed by Chi-square tests, with Cramer's V for the effect size of the correlations. Differences in total score between groups were assessed by independent t- tests with Cohen's d for effect size (p=0.05)

The cohort consisted of 2,049 MMSE taken by 1,376 patients [average age 80.3 (SD 9.3) 56.4% Female] between 2016 and 2022. Due to very few responses (n=7) on Friday and Saturday, these days were excluded from analyses. Overall, 67.8% of exams were correctly oriented to the day. Correct response rate according to the weekday yielded a significant result (X2 = 20.77, p < .001, Cramer's V = 0.104), with the largest effect difference was found on Sundays (53.4%), and then on Mondays (38.9%). The relative odds ratio (OR) for providing a correct response was found for Sunday (OR=1.55, p=.001), while for other days no significant OR was found. Patients who responded correctly showed higher final total scores in comparison with patients who did not respond correctly across all days. Similar analysis was carried out for orientation to the month, comparing between the first 5 days and last 5 days of the month, but no statistically significant difference for correct answers was found.

MMSE delivered on the first working day of the week may entail a better day orientation, and thus a higher total score. This finding may have significant implications for assessments (as in clinical trials) and thus treatment.

Mild Behavioral Impairment (MBI) is a diagnostic construct defined by the later-life emergence of persistent neuropsychiatric symptoms (for example, apathy, anxiety, depression, amongst others) displayed by older adults, with the aim to identify individuals at increasing risk of future dementia. The construct is also related to AD biomarkers including beta-amyloid, tau, and cerebral atrophy. For the assessment of MBI, researchers developed the Mild Behavioral Impairment Checklist (MBI-C) (Ismail et al., 2017) evaluating five domains: decreased motivation, affective dysregulation, impulse dyscontrol, social inappropriateness, and abnormal thought and perception.

The purpose of this symposium is to present four contributions that allow increasing our knowledge of the added value of MBI in clinical diagnosis of neurocognitive disorders.

Firstly, Dr. Maurits Johansson from Lund University (Malmö, Sweden) presents an overview of the role of MBI in the contemporary clinical diagnostic criteria for AD and some perspectives for treatment in the future.

Then, Dr. Sabela C. Mallo from the University of Santiago de Compostela (Spain) and Dr. Byron Creese from the University of Exeter (UK) will talk on methodological issues regarding the MBI-C, the underlying structure of the instrument and the impact of the self and informant ratings in the results of the questionnaire.

Dr. Martin Vyhnalek from the Faculty of Medicine of Prague (Czech Republic) will discuss the MBI profile and severity in a sample of β-amyloid positive individuals with amnestic Mild Cognitive Impairment compared to Cognitively Normal older adults.

Lastly, Dr. Camilla Elefante and Giulio Emilio Brancati from the University of Pisa (Italy) will analyze the relationships and boundaries between MBI and late-life major primary psychiatric disorders in patients who attend to psychogeriatric settings.