- Email: [email protected]
A competency-based training program improves caregivers’ competence and dementia patients’ behavioral problem
P898
Developing Topics
common in persons with dementia and appears to progress as disease stage worsens. Sleep efficiency is relatively poor in persons with dementia and also appears to deteriorate as disease stage worsens. Although mechanisms underlying these associations are not yet clear, healthy sleep appears to play an important role in maintaining brain health with age, and may play a key role in Alzheimer’s disease prevention.
(MCI). In this pilot study, the instructors met every week in order to adapt the intervention according to the challenges met during each session. Results: Based on our comprehensive literature review, clinical studies measuring the efficacy of MBI in elders at risk for AD must include larger samples and use randomized/ controlled designs, with long-term outcome assessment. Moreover, the use of validated and structured interventions (such as the Mindfulness-based stress reduction program) is recommended. As regards the pilot experiment, it yielded adaptations of the program to elders at risk for AD in the following ways. The psychoeducative content of the intervention was made more concrete using Acceptance and Commitment Therapy strategies. Also, commitment to the program was fostered by explaining clearly during the first session how the program is thought to lead to memory improvements and by making weekly phone calls to the participants, in order to improve adherence and sustain motivation. The pilot study also revealed that it is recommended to exclude participants intending to miss one of the first four sessions of the intervention. Conclusion: These recommendations should help demonstrating the benefits of MBI and support clinicians who intend to administrate MBI to individuals at risk for developing AD.
P4-295
RACIAL DIFFERENCES IN PROGRAM EVALUATION OF A LIFESTYLE PHYSICAL ACTIVITY RANDOMIZED CLINICAL TRIAL
Fawn A. Cothran1, Carol J. Farran1, Olimpia Paun1, Lisa L. Barnes2, 1Rush University College of Nursing, Chicago, IL, USA; 2Rush University, Chicago, IL, USA. Contact e-mail: [email protected] Fig. 1. Wake After Sleep Onset (WASO) by CDR
P4-293
WITHDRAWN
P4-294
RELEVANCE AND APPLICATION OF MINDFULNESS-BASED INTERVENTIONS FOR OLDER ADULTS AT RISK FOR DEVELOPING ALZHEIMER’S DISEASE
Eddy Larouche1,2, Anne-Marie Chouinard1,2, Carol Hudon1,2, Sonia Goulet1,2, 1Universite Laval, Quebec, QC, Canada; 2Institut Universitaire en Sante Mentale de Quebec, Quebec, QC, Canada. Contact e-mail: [email protected] Background: In the last decade, pharmacological research has failed finding novel treatments for Alzheimer’s disease (AD). This situation has stimulated the development of non-pharmacological approaches. However, several non-pharmacological interventions (e.g., cognitive training) do not target the diversity of symptoms that can be observed in the pre-dementia or dementia stage of AD. Approaches being more holistic, such as Mindfulness-Based Interventions (MBI), may show great potential to prevent or slow down cognitive decline in older adults at risk for AD. This presentation aims at formulating recommendations to overcome the limitations of previous studies on MBI in the context of AD and at presenting adaptations drawn from a pilot experiment. Methods: The recommendations are based on a comprehensive literature review of studies using interventions similar to MBI (Larouche et al., 2015). They are also based on a pilot study carried out with 11 elders presenting Subjective cognitive decline (SCD) or Mild cognitive impairment
Background: The purpose of this secondary analysis was to compare program evaluation data between African American and Caucasian caregivers of persons with Alzheimer’s disease or a related dementia who completed a lifestyle physical activity randomized clinical trial. Methods: Family caregivers of person’s with dementia (56 African American, 138 Caucasian) were randomly assigned to a 12month physical activity intervention (EPAI) or a control condition (CSBI). Upon completion of the intervention, (n¼114) caregivers completed an 11-item Program Evaluation Questionnaire using Likert responses (0-3, ‘not at all’ to ‘very much’), and three open-ended questions to determine what was most helpful, least helpful, and suggestions for improvements. Descriptive analyses examined quantitative data. Qualitative data were analyzed using content analysis, where data were analyzed line-by-line to identify key words and themes. Frequency of themes was determined. Results: Across intervention groups significant racial differences revealed African American caregivers evaluated both interventions more favorably than Caucasian caregivers (p¼0.02). Five major qualitative themes emerged: Support, Resources, Responsibility, Adjusting, and Time. Conclusions: Findings suggest that African Americans had more positive evaluations and fewer suggestions for changes. These results may be helpful in developing culturally tailored interventions for future research.
P4-296
A COMPETENCY-BASED TRAINING PROGRAM IMPROVES CAREGIVERS’ COMPETENCE AND DEMENTIA PATIENTS’ BEHAVIORAL PROBLEM
Huei-Ling Huang1, Yea-Ing L. Shyu2, Wen-Chuin Hsu3, 1Chang Gung University of Science and Technology, Taoyuan, Taiwan; 2Chang Gung
Developing Topics University, Taoyuan, Taiwan; 3Chang Gung Memorial Hospital, Taoyuan, Taiwan. Contact e-mail: [email protected] Background: The purpose of this study was to develop a competency-based train-the-trainer model of curriculum for dementia educator as well as to implement a interventional study to examine the effectiveness of this dementia educator training model for elders with dementia and their family caregivers in Taiwan. Methods: A randomized clinical trial was conducted. The interventional group received one year of health education and evaluation at a health education clinic, including patient and family assessment, problem identification, handling of dementia behavioral problems as well as other care and health issues. Telephone consultation and home visit were provided according to individual needs. The control group received only regular service at the clinic. Setting: The Neurology clinics of two hospitals in northern Taiwan. Elders with dementia and their family caregivers (N¼248) lived in the communities of northern Taiwan and were randomly assigned to the interventional group (n¼124) or control group (n¼124). Behavioral problems of elders with dementia were assessed by the Chinese version of the Cohen-Mansfield Agitation Inventory, community form. Family caregivers’ outcomes were measured by the Agitation Management Self-efficacy Scale and the Preparedness and Competence Scales. These instruments were administered before the program and 1 months, and 3 months afterward. The difference in outcomes change between the interventional and the control group, and within 3 months following the baseline were examined using the generalized estimating equations (GEE) method. Results: The results of this study showed that family caregivers who received the health education program can effectively decreased the behavioral problem of elders with dementia, and improve the caregiver’ self-efficacy, competence and preparedness for managing behavioral problem. Conclusions: The clinic is the most convenient venue to provide accessible health education. Training for dementia healthcare educators is necessary and should start immediately. This study brought up a training course for healthcare educators based on competency. It is expected to cultivate dementia healthcare educators with practical competence, and will serve as a base for future dementia educator training model in Taiwan.
P4-297
FEASIBILITY, RELIABILITY, AND VALIDITY OF A SMARTPHONE-BASED APPLICATION OF THE MMSE (MMSE-A) FOR THE ASSESSMENT OF COGNITIVE FUNCTION IN THE ELDERLY
Kenta Shigemori, Kanako Okamoto, Kansai University of Welfare, Kashiwara, Japan. Contact e-mail: [email protected] Project Description: While considerable knowledge has been gained through the use of established cognitive assessment tools, there is a considerable interest and need for the development of a battery of reliable and validated assessment tools that provide real-time and remote analysis of cognitive function in the elderly. Smartphones appear to be an obvious choice for the development of these “next-generation” assessment tools for geriatric research, although to date no studies have reported on the use of smartphone-based applications for the study of cognition in the elderly. The Mini-mental state examination (MMSE) is a brief cognitive screening tool with high sensitivity and specificity for detecting mild dementia. The primary focus of the current study was to assess the feasibility, reliability, and validity of a smartphone-based application for the
P899
assessment of MMSE the elderly. A total of 28 non-demented elderly individuals were administered a newly developed smartphone application-based MMSE (MMSE-A). Validity of this novel MMSE-A was assessed by correlating performance on the MMSEA with scores on widely accepted assessments of MMSE. Scores on the MMSE-A were significantly correlated with MMSE (r ¼ 0.730, p<0.0001). Test re-test reliability was observed to be significant (r ¼ 0.922; p ¼<0.0001). Together, these data are the first to demonstrate the feasibility, reliability, and validity of using a smartphone-based application for the purpose of assessing cognitive function in the elderly. The importance of these findings for the establishment of application -based assessment batteries of MMSE in the elderly is discussed. P4-298
AWARENESS PROBLEMS IN PEOPLE WITH MILD COGNITIVE IMPAIRMENT AND MILD DEMENTIA
Yi-Chen Chiu1, Ting Huan Chang2, Wen Chuin Hsu3, 1Chang Gung University and Healthy Aging Research Center, Taoyuan, Taiwan; 2Chung Shan Medical University, Taichung, Taiwan; 3Chang Gung Memorial Hospital and Dementia Center, Linkou, Taiwan. Contact e-mail: [email protected] Background: Taiwan has more than one million persons with cognitive impairment (PWCIs), accounting for 4.5% of the total elderly population in Taiwan. Recent estimates suggest 15-24% of PWCIs have impaired awareness. 85% of them live in the community and are cared for by family members. The nature of unawareness is not yet fully understood. However, in view of its potential importance for adaptation to living with cognitive impairment, this is a key area for research. The purpose of this study: 1. to develop the Everyday Memory Questionnaire (EMQ) to measure self awareness on daily functioning for community-dwelling PWCIs. Methods: A combination of a focus group approach to develop the item pool of the EMQ and a survey to test the psychometric properties of the EMQ were applied. Results: Three focus groups (n ¼ 32, older adults, patients with MCI) were conducted and five themes were found: wayfinding difficulty in familiar environment, wayfinding difficulty in unfamiliar environments, daily memory, confusions in social conversations, missing procedures in daily life. The total item number was 30 of the EMQ. The Chronbach’s alpha value for the EMQ was 0.91 (n ¼ 198). The ICC value of inter-rater reliability on 4 PWCIs was 0.99. Confirmatory Factory Analysis was performed to test the structure of EMQ. Criteria for deleting items: factor loading < 0.45. We found a five-factor solution for the EMQ which consisted of 18 items. Conclusions: This study shows that the newly developed EMQ (patient version) has good psychometric properties to measure self-awareness in PWCIs.
P4-299
IMPACT OF EXPERT DATA REVIEW AND CENTRALIZED SCORING ON TEST-RETEST RELIABILITY OF THE ADAS-COG
Alexandra S. Atkins1, Ioan Stroescu1, Vicki Davis1, Tiffany Williamson1, Kelley Boyd1, Lyn Harper Mozley2, Tiffini Voss2, Kerry Budd-McMahon2, Richard S. E. Keefe1,3, 1NeuroCog Trials, Durham, NC, USA; 2Merck & Co, Kenilworth, NJ, USA; 3Duke University Medical Center, Durham, NC, USA. Contact e-mail: [email protected] Background: The Alzheimer’s Disease Assessment Scale - cognitive subscale (ADAS-cog) is the primary neurocognitive outcome measure in many clinical trials for mild-moderate Alzheimer’s disease (AD). Despite wide use, variations in administration and scoring
Developing Topics
common in persons with dementia and appears to progress as disease stage worsens. Sleep efficiency is relatively poor in persons with dementia and also appears to deteriorate as disease stage worsens. Although mechanisms underlying these associations are not yet clear, healthy sleep appears to play an important role in maintaining brain health with age, and may play a key role in Alzheimer’s disease prevention.
(MCI). In this pilot study, the instructors met every week in order to adapt the intervention according to the challenges met during each session. Results: Based on our comprehensive literature review, clinical studies measuring the efficacy of MBI in elders at risk for AD must include larger samples and use randomized/ controlled designs, with long-term outcome assessment. Moreover, the use of validated and structured interventions (such as the Mindfulness-based stress reduction program) is recommended. As regards the pilot experiment, it yielded adaptations of the program to elders at risk for AD in the following ways. The psychoeducative content of the intervention was made more concrete using Acceptance and Commitment Therapy strategies. Also, commitment to the program was fostered by explaining clearly during the first session how the program is thought to lead to memory improvements and by making weekly phone calls to the participants, in order to improve adherence and sustain motivation. The pilot study also revealed that it is recommended to exclude participants intending to miss one of the first four sessions of the intervention. Conclusion: These recommendations should help demonstrating the benefits of MBI and support clinicians who intend to administrate MBI to individuals at risk for developing AD.
P4-295
RACIAL DIFFERENCES IN PROGRAM EVALUATION OF A LIFESTYLE PHYSICAL ACTIVITY RANDOMIZED CLINICAL TRIAL
Fawn A. Cothran1, Carol J. Farran1, Olimpia Paun1, Lisa L. Barnes2, 1Rush University College of Nursing, Chicago, IL, USA; 2Rush University, Chicago, IL, USA. Contact e-mail: [email protected] Fig. 1. Wake After Sleep Onset (WASO) by CDR
P4-293
WITHDRAWN
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RELEVANCE AND APPLICATION OF MINDFULNESS-BASED INTERVENTIONS FOR OLDER ADULTS AT RISK FOR DEVELOPING ALZHEIMER’S DISEASE
Eddy Larouche1,2, Anne-Marie Chouinard1,2, Carol Hudon1,2, Sonia Goulet1,2, 1Universite Laval, Quebec, QC, Canada; 2Institut Universitaire en Sante Mentale de Quebec, Quebec, QC, Canada. Contact e-mail: [email protected] Background: In the last decade, pharmacological research has failed finding novel treatments for Alzheimer’s disease (AD). This situation has stimulated the development of non-pharmacological approaches. However, several non-pharmacological interventions (e.g., cognitive training) do not target the diversity of symptoms that can be observed in the pre-dementia or dementia stage of AD. Approaches being more holistic, such as Mindfulness-Based Interventions (MBI), may show great potential to prevent or slow down cognitive decline in older adults at risk for AD. This presentation aims at formulating recommendations to overcome the limitations of previous studies on MBI in the context of AD and at presenting adaptations drawn from a pilot experiment. Methods: The recommendations are based on a comprehensive literature review of studies using interventions similar to MBI (Larouche et al., 2015). They are also based on a pilot study carried out with 11 elders presenting Subjective cognitive decline (SCD) or Mild cognitive impairment
Background: The purpose of this secondary analysis was to compare program evaluation data between African American and Caucasian caregivers of persons with Alzheimer’s disease or a related dementia who completed a lifestyle physical activity randomized clinical trial. Methods: Family caregivers of person’s with dementia (56 African American, 138 Caucasian) were randomly assigned to a 12month physical activity intervention (EPAI) or a control condition (CSBI). Upon completion of the intervention, (n¼114) caregivers completed an 11-item Program Evaluation Questionnaire using Likert responses (0-3, ‘not at all’ to ‘very much’), and three open-ended questions to determine what was most helpful, least helpful, and suggestions for improvements. Descriptive analyses examined quantitative data. Qualitative data were analyzed using content analysis, where data were analyzed line-by-line to identify key words and themes. Frequency of themes was determined. Results: Across intervention groups significant racial differences revealed African American caregivers evaluated both interventions more favorably than Caucasian caregivers (p¼0.02). Five major qualitative themes emerged: Support, Resources, Responsibility, Adjusting, and Time. Conclusions: Findings suggest that African Americans had more positive evaluations and fewer suggestions for changes. These results may be helpful in developing culturally tailored interventions for future research.
P4-296
A COMPETENCY-BASED TRAINING PROGRAM IMPROVES CAREGIVERS’ COMPETENCE AND DEMENTIA PATIENTS’ BEHAVIORAL PROBLEM
Huei-Ling Huang1, Yea-Ing L. Shyu2, Wen-Chuin Hsu3, 1Chang Gung University of Science and Technology, Taoyuan, Taiwan; 2Chang Gung
Developing Topics University, Taoyuan, Taiwan; 3Chang Gung Memorial Hospital, Taoyuan, Taiwan. Contact e-mail: [email protected] Background: The purpose of this study was to develop a competency-based train-the-trainer model of curriculum for dementia educator as well as to implement a interventional study to examine the effectiveness of this dementia educator training model for elders with dementia and their family caregivers in Taiwan. Methods: A randomized clinical trial was conducted. The interventional group received one year of health education and evaluation at a health education clinic, including patient and family assessment, problem identification, handling of dementia behavioral problems as well as other care and health issues. Telephone consultation and home visit were provided according to individual needs. The control group received only regular service at the clinic. Setting: The Neurology clinics of two hospitals in northern Taiwan. Elders with dementia and their family caregivers (N¼248) lived in the communities of northern Taiwan and were randomly assigned to the interventional group (n¼124) or control group (n¼124). Behavioral problems of elders with dementia were assessed by the Chinese version of the Cohen-Mansfield Agitation Inventory, community form. Family caregivers’ outcomes were measured by the Agitation Management Self-efficacy Scale and the Preparedness and Competence Scales. These instruments were administered before the program and 1 months, and 3 months afterward. The difference in outcomes change between the interventional and the control group, and within 3 months following the baseline were examined using the generalized estimating equations (GEE) method. Results: The results of this study showed that family caregivers who received the health education program can effectively decreased the behavioral problem of elders with dementia, and improve the caregiver’ self-efficacy, competence and preparedness for managing behavioral problem. Conclusions: The clinic is the most convenient venue to provide accessible health education. Training for dementia healthcare educators is necessary and should start immediately. This study brought up a training course for healthcare educators based on competency. It is expected to cultivate dementia healthcare educators with practical competence, and will serve as a base for future dementia educator training model in Taiwan.
P4-297
FEASIBILITY, RELIABILITY, AND VALIDITY OF A SMARTPHONE-BASED APPLICATION OF THE MMSE (MMSE-A) FOR THE ASSESSMENT OF COGNITIVE FUNCTION IN THE ELDERLY
Kenta Shigemori, Kanako Okamoto, Kansai University of Welfare, Kashiwara, Japan. Contact e-mail: [email protected] Project Description: While considerable knowledge has been gained through the use of established cognitive assessment tools, there is a considerable interest and need for the development of a battery of reliable and validated assessment tools that provide real-time and remote analysis of cognitive function in the elderly. Smartphones appear to be an obvious choice for the development of these “next-generation” assessment tools for geriatric research, although to date no studies have reported on the use of smartphone-based applications for the study of cognition in the elderly. The Mini-mental state examination (MMSE) is a brief cognitive screening tool with high sensitivity and specificity for detecting mild dementia. The primary focus of the current study was to assess the feasibility, reliability, and validity of a smartphone-based application for the
P899
assessment of MMSE the elderly. A total of 28 non-demented elderly individuals were administered a newly developed smartphone application-based MMSE (MMSE-A). Validity of this novel MMSE-A was assessed by correlating performance on the MMSEA with scores on widely accepted assessments of MMSE. Scores on the MMSE-A were significantly correlated with MMSE (r ¼ 0.730, p<0.0001). Test re-test reliability was observed to be significant (r ¼ 0.922; p ¼<0.0001). Together, these data are the first to demonstrate the feasibility, reliability, and validity of using a smartphone-based application for the purpose of assessing cognitive function in the elderly. The importance of these findings for the establishment of application -based assessment batteries of MMSE in the elderly is discussed. P4-298
AWARENESS PROBLEMS IN PEOPLE WITH MILD COGNITIVE IMPAIRMENT AND MILD DEMENTIA
Yi-Chen Chiu1, Ting Huan Chang2, Wen Chuin Hsu3, 1Chang Gung University and Healthy Aging Research Center, Taoyuan, Taiwan; 2Chung Shan Medical University, Taichung, Taiwan; 3Chang Gung Memorial Hospital and Dementia Center, Linkou, Taiwan. Contact e-mail: [email protected] Background: Taiwan has more than one million persons with cognitive impairment (PWCIs), accounting for 4.5% of the total elderly population in Taiwan. Recent estimates suggest 15-24% of PWCIs have impaired awareness. 85% of them live in the community and are cared for by family members. The nature of unawareness is not yet fully understood. However, in view of its potential importance for adaptation to living with cognitive impairment, this is a key area for research. The purpose of this study: 1. to develop the Everyday Memory Questionnaire (EMQ) to measure self awareness on daily functioning for community-dwelling PWCIs. Methods: A combination of a focus group approach to develop the item pool of the EMQ and a survey to test the psychometric properties of the EMQ were applied. Results: Three focus groups (n ¼ 32, older adults, patients with MCI) were conducted and five themes were found: wayfinding difficulty in familiar environment, wayfinding difficulty in unfamiliar environments, daily memory, confusions in social conversations, missing procedures in daily life. The total item number was 30 of the EMQ. The Chronbach’s alpha value for the EMQ was 0.91 (n ¼ 198). The ICC value of inter-rater reliability on 4 PWCIs was 0.99. Confirmatory Factory Analysis was performed to test the structure of EMQ. Criteria for deleting items: factor loading < 0.45. We found a five-factor solution for the EMQ which consisted of 18 items. Conclusions: This study shows that the newly developed EMQ (patient version) has good psychometric properties to measure self-awareness in PWCIs.
P4-299
IMPACT OF EXPERT DATA REVIEW AND CENTRALIZED SCORING ON TEST-RETEST RELIABILITY OF THE ADAS-COG
Alexandra S. Atkins1, Ioan Stroescu1, Vicki Davis1, Tiffany Williamson1, Kelley Boyd1, Lyn Harper Mozley2, Tiffini Voss2, Kerry Budd-McMahon2, Richard S. E. Keefe1,3, 1NeuroCog Trials, Durham, NC, USA; 2Merck & Co, Kenilworth, NJ, USA; 3Duke University Medical Center, Durham, NC, USA. Contact e-mail: [email protected] Background: The Alzheimer’s Disease Assessment Scale - cognitive subscale (ADAS-cog) is the primary neurocognitive outcome measure in many clinical trials for mild-moderate Alzheimer’s disease (AD). Despite wide use, variations in administration and scoring