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Psychotic symptoms arise commonly in the context of behavioural and psychological symptoms of dementia (BPSD) in the elderly. While non-pharmacological interventions are preferable to manage such symptoms, antipsychotic medications are frequently used. This is largely unlicensed and associated with significant risks, particularly in dementia (1).
Objectives
To examine antipsychotic prescribing practices in SJH.
Methods
On 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified. Demographic and medical data were collected from medical and electronic notes and medication kardexes.
Results
Complete data were available for 53 of 59 identified cases. The cohort had a mean age of 80 (range 65–99) and 62% were male. Seventy-four percent (n = 39) had documented cognitive impairment or dementia. Fifty-eight percent (n = 31) were newly prescribed an antipsychotic following admission. The commonest indications for antipsychotics were: delirium (53%) and BPSD (25%). Haloperidol (56%), quetiapine (19%) and risperidone (8%) were prescribed most frequently. Non-pharmacological interventions were documented in 50% however in many cases it is not clear what these interventions were. Antipsychotic use was discussed with patients and/or next of kin in less than 25% of cases. Adverse effects were noted in 6/36 (17%) with equal incidence of falls, EPSEs and ECG changes.
Conclusion
Positive and negative aspects of current antipsychotic prescribing practices are highlighted. Antipsychotics were prescribed for a small number of patients for appropriate indications. However, there was poor consideration of non-pharmacological interventions and a lack of consultation with the patient/NOK. This may reflect, in part, inadequate medical documentation. A guideline needs to specifically address these areas of concern to improve safety and promote best practice.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Type 2 diabetes (T2DM) has a multifactorial aetiology, and wide-ranging potential health complications, including brain health associations.
Objectives
A number of diabetes risk factors and complications have a strong evidence base. This study will address ambiguity in the literature regarding others.
Aims
Results will inform development of a questionnaire for use among the public and individuals with diabetes, assessing knowledge of diabetes and brain health associations and the role of modifiable risk factors. Aiming to ultimately inform effective preventative strategies for both dementia and depression.
Methods
A systematic literature review preceded this two-round modified Delphi study. Respondents rated their agreement with risk factors for T2DM, and potential complications of diabetes on an e-questionnaire.
Results
Of 46 international experts invited to participate in round-one; 14 responded (30.4%). Thirteen respondents (92.9%) completed round-two questionnaire. Consensus was pre-defined as 70% or more agreement between respondents on questionnaire items. On completion, 11/18 risk factor items for T2DM met consensus criteria however ‘depression’ did not. Of diabetes complication items, 13/16 met consensus criteria (see Table 1).
Conclusions
Study results indicate that international experts consider a number of brain health complications to be associated with diabetes. Results will be incorporated in a diabetes and brain health knowledge questionnaire for use among vulnerable populations.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The existence of a frontotemporal dementia phenocopy (phFTD) syndrome remains controversial. Opinions differ on whether the phenocopy presentation represents the neuropsychological manifestation of a mid-life decompensation in vulnerable pre-morbid personalities or an indolent prodrome of behavioral-variant FTD (bvFTD). Literature on this topic is sparse and clinicians and patients have little guidance around prognosis and management.
Objectives
To describe the demographic, neuropsychological and biomarker profiles of a case series of phFTD patients, attending the memory clinic and review relevant literature.
Methods
Retrospective review of all cases diagnosed with phFTD.
Results
Eleven cases were identified (male = 9, female = 2). Mean age 55.8 years. Subjective complaints comprised memory and language difficulties. Collateral reports described apathy, aggression, impulsivity, disinhibition, hyperorality. Function was relatively preserved though motivation or supervision for higher-level tasks was sometimes required. All had non-neurodegenerative MRI and PET scans. Neuropsychological test (NPT) findings predominantly showed executive dysfunction and fluency impairment. A total of 3/11 had non-amnestic memory impairment. Follow-up imaging and NPT were invariably unchanged; 1/11 had a pre-morbid psychiatric diagnosis; 5/11 had unusual personality traits pre-morbidly. Major psychosocial stressors were documented in 7/11. Management consisted of psychosocial interventions to support function and interpersonal relationships.
Conclusions
The literature describes the phFTD syndrome as predominantly affecting males though we include 2 females who meet the criteria. In keeping with our findings, personality traits and psychosocial stressors may be more common in phFTD than bvFTD. More severe symptoms, memory impairment at presentation and C9ORF72 gene mutation may predict eventual progression. Those who do not progress have minimal long-term functional impairment though behavioral symptoms persist.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Evidence from the literature suggests that group mindfulness interventions result in improved quality of life, less depressive symptoms and improved subjective sleep quality among patients with memory problems [1].
Objectives
To design and pilot a brief mindfulness intervention for Memory Clinic attendees.
Aims
To develop a non-pharmacological low-resource intervention for Memory Clinic attendees.
Methods
An introduction to mindfulness pack, designed by author CD, includes a booklet introducing the concept of mindfulness, instructions for meditation exercises with an accompanying CD. Memory clinic attendees diagnosed with subjective memory complaints or mild cognitive impairment were invited to take part. Participants completed standardised questionnaires pre- and post-intervention, which examined subjective memory, depression and anxiety symptoms, subjective sleep quality, worry and mindfulness levels. Qualitative information was also gathered.
Results
Of twenty-four participants (66.6% female, mean age 60.8 years), 14 (58.3%) completed the 6-week study. There was no statistical difference in anxiety and depressive symptoms, quality of life, sleep quality and worry levels pre- and post-intervention among participants. However, 100% of participants found the mindfulness intervention beneficial, with 64.3% (n = 9) reporting a subjective improvement in both memory and concentration.
Conclusions
In this small pilot study, a brief self-guided mindfulness intervention was found to be acceptable to a heterogenous group of Memory Clinic attendees.
Disclosure of interest
The authors have not supplied their declaration of competing interest.