- Email: [email protected]
Ageing, epidemiologic transitions, and dementia in fourth world Aboriginal Australia
e12
Abstracts / Alzheimer’s & Dementia 5 (2009) e10–e17
Methods: The plasma of 332 patients who had undergone neuropsychological testing before and 3 and 12 months after CABG surgery was analyzed for Ab42 and Ab40. Patients were classified as having pre-existing cognitive impairment (PreCI) if cognitive function was decreased in two or more tests compared with a healthy control group, and postoperative cognitive dysfunction (POCD) was defined as a decline in two or more tests compared with the group mean baseline score. Results: PreCI was present in 117 patients (35.2%) and POCD in 40 (12%) at 3 months and 41 (13%) at 12 months after surgery. Both plasma Ab42 and Ab40 levels assessed before the CABG surgery were significantly decreased in patients who later had POCD at 3 months. Conclusions: Decreased preoperative plasma levels of Ab42 and Ab40 in patients who exhibit POCD at 3 months suggest that POCD at this time might share a common pathology with MCI/AD. This process might be exacerbated by anesthesia.
9
MAKING SENSE OF DEMENTIA: UNDERSTANDING AMONG INDIGENOUS AUSTRALIANS
G. Garveya, D. Simmondsa, V. Clementsa, P. O’Rourkea, K. Sullivanb, D. Gormanc, V. Curnowd, S. Wiseb, E. Beattieb, aQueensland Institute of Medical Research, Brisbane, QLD, Australia; bQueensland University of Technology, Brisbane, QLD, Australia; cUniversity of Southern Queensland, Toowoomba, QLD, Australia; dAlzheimer’s Australia, Cairns, QLD, Australia Background: Dementia is a growing health and social concern for all Australians. There have been very few studies that have investigated the general public’s awareness of dementia. A few of these have been conducted in Australia, and a small number have been conducted in diverse cultural groups. Given the recently reported high prevalence rates of dementia in some indigenous communities, this study was conducted to gain an understanding of the perceptions, understanding, and awareness of dementia among Indigenous Australians. Methods: With data from a cross-sectional study of 174 Indigenous Australians who attended a Sports and Cultural Festival in Brisbane, Queensland, Australia in November 2008, we investigated the participants’ responses to a modified Alzheimer’s Disease Knowledge Test (20 multiple choice questions) and open-ended questions on their understanding of Alzheimer’s disease and dementia. Results: Indigenous Australians understand Alzheimer’s disease to be synonymous with dementia. The number of correct responses to the questionnaire indicated a lack of knowledge of Alzheimer’s disease among Indigenous Australians, more so on the biomedical questions about dementia. There was no significant difference for geographical location (residence), education, or sex. However, age was found to be highly significant because younger participants were likely to have only some or no knowledge of Alzheimer’s disease. Conclusions: To enable Indigenous people and communities to recognize the signs of dementia and to seek professional assistance early, there needs to be greater public awareness of this condition among these communities. Culturally appropriate Alzheimer’s disease health promotion strategies need to be developed, particularly for young Indigenous adults.
ing medical, biologic, sociologic, and psychological domains. In addition, the prevalence of psychosocial problems/stressors is not known. The aim of the study was to examine a range of positive and negative psychosocial factors in older urban-dwelling Indigenous people and to assess the impact on daily functioning. Methods: This study is a substudy of the National Health and Medical Research Council funded study (#510347) known as the Koori Growing Old Well Study, which is examining the prevalence and burden of dementia in six urban Aboriginal communities. Results: Quantitative and qualitative methods will be used. A total of 65 subjects and carers will be recruited by using a dementia prevalence rate in Indigenous communities. The qualitative component will be ethnographic semistructured in-depth interviews. This component is embedded within an interpretive paradigm, which implies discovering what Aboriginal people think and feel about the dementia needs and barriers for culturally appropriate care and services. Conclusions: Outcomes will provide a profile for future health care planning and for clinical care, community services, and workforce planning needs for (majority) urban Aboriginal communities.
11
B. Dowa, B. Haralambousa, C. Hemptona, S. Huntb, D. Callejac, aNational Ageing Research Institute, Parkville, VIC, Australia; bMonash University, Clayton, VIC, Australia; cDepartment of Human Services, Melbourne, VIC, Australia Background: Memory Lane Cafe´s are a service for people with dementia and their family carers or friends, run by Alzheimer’s Australia Vic. They aim to promote social connectedness and prevent isolation. Many people living with dementia and their carers experience social isolation. An evaluation of the Cafe´s was commissioned by the Victorian Department of Human Services and undertaken by the National Ageing Research Institute. The objective was to provide information about Cafe´s including the service model, client demographics, impact and outcomes, entry, referral and exit patterns, service gaps, and possible future development. Methods: The evaluation included (1) focus groups with Cafe´ clients, (2) a survey of Cafe´ clients, (3) consultation with staff, and (4) interviews with key stakeholders. Results: Clients and staff were highly satisfied with the service. Valued components included the following: Integration with other services offered by Alzheimer’s Australia Vic; Opportunity for people with dementia to attend a social activity with family carers or friends; and Environment in which behaviors associated with dementia are accepted. Main shortcomings of the service were the following: Lack of access for people who had not completed ‘‘Living with Memory Loss’’ (point of entry); and Under-representation of people from Aboriginal and Torres Strait Islander and culturally and linguistically diverse backgrounds. Conclusions: The service provides a highly valued opportunity for people with dementia, their family carers, or friends to interact with others in similar situations and share their experiences. The evaluation recommended that the service be further developed to meet the needs of a wider group of clients.
12 10
IDENTIFYING CULTURAL RISKS AND RESILIENCE IN DEMENTIA CARE IN URBAN ABORIGINAL COMMUNITIES
W. Hampshirea,b, G. Broea,c, Pulver L. Jacksona, aUniversity of New South Wales, Sydney, NSW, Australia; bSouthern Cross University, Coffs Harbour, NSW, Australia; cPrince of Wales Hospital, Sydney, NSW, Australia Background: Health from an Aboriginal perspective incorporates a wholeof-life outlook that not only focuses on the social, emotional, and cultural well-being of the individual but of the entire community. We know that family structure in Aboriginal culture holds ultimate respect and honor, with the strong relationship between family and kinship being the center of Aboriginal well-being. However, little is known about the psychosocial aspects of Aboriginal aging in comparison to non-Aboriginal populations, in which there is immense Australian and international literature on aging encompass-
EVALUATION OF ALZHEIMER’S AUSTRALIA VIC MEMORY LANE CAFES
AGEING, EPIDEMIOLOGIC TRANSITIONS, AND DEMENTIA IN FOURTH WORLD ABORIGINAL AUSTRALIA
Pulver L. Jacksona, G. A. Broeb, aUniversity of New South Wales, Sydney, NSW, Australia; bPrince of Wales Medical Research Institute, Sydney, NSW, Australia Background: Australian Aboriginal people have high mid-life mortality rates from systemic diseases and a 17-year life expectancy gap compared with the general Australian population. Remote Aboriginal Australians in the Kimberley Region have recently been shown to have the highest recorded rates of dementia in the world literature. We reviewed epidemiologic transitions in Aboriginal and non-Indigenous Australians to examine why urban Aboriginal people, who form the large majority, have high systemic disease rates, with the hypothesis that they also have high dementia prevalence rates. Methods: We conducted a major literature review of Aboriginal aging,
Abstracts / Alzheimer’s & Dementia 5 (2009) e10–e17 cognition, and dementia. We are currently undertaking a National Health and Medical Research Council funded study involving w700 urban Aboriginal people aged 45 and older, examining dementia prevalence, social and biologic determinants of health, and dementia risk factors. Results: Aboriginal fertility is falling, survival is increasing, and absolute numbers of older people are rising as a result of recent improvements in Aboriginal health. This is occurring 50 years after the classic/Western epidemiologic transition to delayed chronic systemic diseases. A combination of persistent socioeconomic and educational disadvantages in childhood/early life and high chronic/vascular disease rates in mid-life is likely to accelerate the epidemiologic transition to neurodegenerative diseases as Aboriginal people age. Conclusions: Reducing the gap in Aboriginal health and life expectancy requires multiple interventions across the life cycle; particularly those aimed at parenting, growing young minds, improving opportunities for education and job training, and building human capital in Aboriginal people. This is in addition to the provision of equity in health, housing, and human rights.
13
WHAT ROLE SHOULD WEBSITES PLAY IN DEMENTIA CARE IN HOSPITALS?
D. Liea, S. Austinb, aPrincess Alexandra Hospital, Woolloongabba, QLD, Australia; bUniversity of Queensland, Woolloongabba, QLD, Australia Background: In 2003–2004 more than 70,000 people with a principal or additional diagnosis of dementia were admitted to Australian hospitals. This comprised more than a million bed-days or 6.9% of total days. With demographic aging, the prevalence of associated behavioral and psychological sequelae will rise in the acute care setting. Associated issues include falls management, restraint reduction, misuse of medication, and delirium detection/prevention. The Streaming Technology as an Adjunct to Dementia Interventions (STEADI) Project investigates the utility of a multimedia website housed on a metropolitan teaching hospital intranet and its impact on staff knowledge and attitudes. The site includes text files and short vignettes about management of behaviors of concern. To date, the use of information and communication technology in hospital dementia care has been rarely reported. Methods: A website was established and located on the hospital intranet. The website includes multimedia files about Behavioural and Psychological Symptoms of Dementia (BPSD) management. Log file analysis evaluated frequency and pattern of usage. Results: More than three fourths of usage was between 11 PM and 7 AM, with implications for the use of web-based materials, potential audience, and educational strategies. Average time on the website per session was 4.0 minutes. Understanding and diagnosis of dementia was the most popular page viewed. Conclusions: Early evidence indicates the website is in use and has been incorporated into existing work processes, eg, inductions and orientations. Our observations support the interdependence of education and information and communications technology (ICT) in healthcare. Further research is needed to establish the effectiveness of ICT in dementia care. 14
AMYLOID-b AND ITS RELEVANCE TO THE DETECTION OF ALZHEIMER’S DISEASE IN BLOOD PLASMA: FINDINGS FROM THE FIRST PHASE OF THE AUSTRALIAN IMAGING, BIOMARKER AND LIFESTYLE (AIBL) FLAGSHIP STUDY OF AGING
J. Luia, Q. Lid, K. De Ruycka,c, V. Guptaa, K. Taddeia,b,c, J. Fostera,b,c, T. Taddeia,b,c, B. Browna,b,c, V. Warda,b,c, M. Rodriguesa,b,c, M. Rimajovaa,b,c, K. Ellisd,f, C. Rowef, V. Villemagnef, P. Hudsone, C. Mastersd,f, D. Amesd,f, R. Martinsa,b,c, aEdith Cowan University, Perth, WA, Australia; bHollywood Private Hospital, Perth, WA, Australia; cThe McCusker Foundation for Alzheimer’s Disease Research, Perth, WA, Australia; dUniversity of Melbourne, Melbourne, VIC, Australia; eCSIRO Health Flagship, Melbourne, VIC, Australia; fAustin Health, Melbourne, VIC, Australia Background: With research in preventative medicine and early treatment gaining fast momentum, the importance of detection, in particular early
e13
detection of Alzheimer’s disease (AD), is now prevalent. On top of the growing list of known biomarkers of AD is amyloid-b (Ab), which has long been known as central to the pathology of AD. Blood products have recently been used as a source to detect AD but have resulted in inconclusive results. Contributing factors to conflicting results might be due to the low participant numbers in the studies and/or differences in technical procedures. We present results from the first phase of the Australian Imaging, Biomarker and Lifestyle (AIBL) Flagship Study of Ageing, which addresses the issue of low sample number and technical variations. Methods: Blood plasma samples of more than 1,000 participants across two cities in Australia were collected and analyzed for the levels of the two isoforms Ab1-40 and Ab1-42 by using the INNO-BIA Ab detection kits as well as a standard sandwich enzymelinked immunosorbent assay (ELISA). Neuropsychological assessment data of the participants were correlated against the levels of Ab isoforms. Results: It was found that a commercial assay resulted in different outcomes in the levels of the plasma Ab isoform compared with a standard double sandwich ELISA assay. Moreover, the ranges of plasma Ab concentrations between the neuropsychological categories were largely overlapped. Conclusions: Technical differences in assays affect the final outcome of Ab measurements. A single time point measurement of Ab on its own would not be suitable as a diagnostic for AD. 15
EVALUATION OF ADHERENCE TO DEMENTIA RISK REDUCTION IN EVERYDAY PRACTICE: A LITERATURE REVIEW
M. Martin-Khana, C. Traversa, D. Lieb, aUniversity of Queensland, Woolloongabba, QLD, Australia; bPrincess Alexandra Hospital, Woolloongabba, QLD, Australia Background: A comprehensive literature review of national and international research was carried out to summarize the research literature relating to outcome measures of health professional performance. Methods: The literature was methodically searched retrospectively from August 2008 to the beginning of 1998. Bibliographic databases were searched for relevant peerreviewed literature, and 24 individual websites were searched. The key terms included general practice or family practice, and outcome assessment or quality indicator. Results: The uptake of dementia risk reduction strategies by primary care practitioners could be measured in a multitude of ways by using a range of process and outcome measures at different levels, eg, individual patient versus individual practice versus whole of population level. In Australia a considerable amount of process data at the level of the individual general practitioner is available through administrative data sets (ie, Medicare) that capture data regarding the provision of medical services and pharmaceutical products. A number of existing data sources could be used, either in their current format or in a modified form, to inform the uptake of dementia risk reduction activities in primary care. These vary in terms of reliability, validity, and feasibility. It might be necessary to triangulate data from multiple sources to provide a comprehensive picture regarding the uptake and impact of these activities. Conclusions: On the basis of the research evidence, seven recommendations were made including coordinating the collection of dementia-related information with that of chronic disease data and using existing national, state, and other data sources where possible.
16
IDENTIFYING DEPRESSION IN OLDER ADULTS VIA VIDEO CONSULTATION
M. Martin-Khana, L. Flickerb, R. Woottonc, P. K. Lohb,d, H. Edwardse, G. Byrnef, P. Vargheseg, E. Bellerh, L. Graya, aUniversity of Queensland, Woolloongabba, QLD, Australia; bUniversity of Western Australia, Perth, WA, Australia; cScottish Centre for Telehealth, Aberdeen, Scotland; dRoyal Perth Hospital, Perth, WA, Australia; e Queensland University of Technology, Brisbane, QLD, Australia; f University of Queensland, Herston, QLD, Australia; gPrincess Alexandra Hospital, Woolloongabba, QLD, Australia; hUniversity of Queensland, Woolloongabba, QLD, Australia
Abstracts / Alzheimer’s & Dementia 5 (2009) e10–e17
Methods: The plasma of 332 patients who had undergone neuropsychological testing before and 3 and 12 months after CABG surgery was analyzed for Ab42 and Ab40. Patients were classified as having pre-existing cognitive impairment (PreCI) if cognitive function was decreased in two or more tests compared with a healthy control group, and postoperative cognitive dysfunction (POCD) was defined as a decline in two or more tests compared with the group mean baseline score. Results: PreCI was present in 117 patients (35.2%) and POCD in 40 (12%) at 3 months and 41 (13%) at 12 months after surgery. Both plasma Ab42 and Ab40 levels assessed before the CABG surgery were significantly decreased in patients who later had POCD at 3 months. Conclusions: Decreased preoperative plasma levels of Ab42 and Ab40 in patients who exhibit POCD at 3 months suggest that POCD at this time might share a common pathology with MCI/AD. This process might be exacerbated by anesthesia.
9
MAKING SENSE OF DEMENTIA: UNDERSTANDING AMONG INDIGENOUS AUSTRALIANS
G. Garveya, D. Simmondsa, V. Clementsa, P. O’Rourkea, K. Sullivanb, D. Gormanc, V. Curnowd, S. Wiseb, E. Beattieb, aQueensland Institute of Medical Research, Brisbane, QLD, Australia; bQueensland University of Technology, Brisbane, QLD, Australia; cUniversity of Southern Queensland, Toowoomba, QLD, Australia; dAlzheimer’s Australia, Cairns, QLD, Australia Background: Dementia is a growing health and social concern for all Australians. There have been very few studies that have investigated the general public’s awareness of dementia. A few of these have been conducted in Australia, and a small number have been conducted in diverse cultural groups. Given the recently reported high prevalence rates of dementia in some indigenous communities, this study was conducted to gain an understanding of the perceptions, understanding, and awareness of dementia among Indigenous Australians. Methods: With data from a cross-sectional study of 174 Indigenous Australians who attended a Sports and Cultural Festival in Brisbane, Queensland, Australia in November 2008, we investigated the participants’ responses to a modified Alzheimer’s Disease Knowledge Test (20 multiple choice questions) and open-ended questions on their understanding of Alzheimer’s disease and dementia. Results: Indigenous Australians understand Alzheimer’s disease to be synonymous with dementia. The number of correct responses to the questionnaire indicated a lack of knowledge of Alzheimer’s disease among Indigenous Australians, more so on the biomedical questions about dementia. There was no significant difference for geographical location (residence), education, or sex. However, age was found to be highly significant because younger participants were likely to have only some or no knowledge of Alzheimer’s disease. Conclusions: To enable Indigenous people and communities to recognize the signs of dementia and to seek professional assistance early, there needs to be greater public awareness of this condition among these communities. Culturally appropriate Alzheimer’s disease health promotion strategies need to be developed, particularly for young Indigenous adults.
ing medical, biologic, sociologic, and psychological domains. In addition, the prevalence of psychosocial problems/stressors is not known. The aim of the study was to examine a range of positive and negative psychosocial factors in older urban-dwelling Indigenous people and to assess the impact on daily functioning. Methods: This study is a substudy of the National Health and Medical Research Council funded study (#510347) known as the Koori Growing Old Well Study, which is examining the prevalence and burden of dementia in six urban Aboriginal communities. Results: Quantitative and qualitative methods will be used. A total of 65 subjects and carers will be recruited by using a dementia prevalence rate in Indigenous communities. The qualitative component will be ethnographic semistructured in-depth interviews. This component is embedded within an interpretive paradigm, which implies discovering what Aboriginal people think and feel about the dementia needs and barriers for culturally appropriate care and services. Conclusions: Outcomes will provide a profile for future health care planning and for clinical care, community services, and workforce planning needs for (majority) urban Aboriginal communities.
11
B. Dowa, B. Haralambousa, C. Hemptona, S. Huntb, D. Callejac, aNational Ageing Research Institute, Parkville, VIC, Australia; bMonash University, Clayton, VIC, Australia; cDepartment of Human Services, Melbourne, VIC, Australia Background: Memory Lane Cafe´s are a service for people with dementia and their family carers or friends, run by Alzheimer’s Australia Vic. They aim to promote social connectedness and prevent isolation. Many people living with dementia and their carers experience social isolation. An evaluation of the Cafe´s was commissioned by the Victorian Department of Human Services and undertaken by the National Ageing Research Institute. The objective was to provide information about Cafe´s including the service model, client demographics, impact and outcomes, entry, referral and exit patterns, service gaps, and possible future development. Methods: The evaluation included (1) focus groups with Cafe´ clients, (2) a survey of Cafe´ clients, (3) consultation with staff, and (4) interviews with key stakeholders. Results: Clients and staff were highly satisfied with the service. Valued components included the following: Integration with other services offered by Alzheimer’s Australia Vic; Opportunity for people with dementia to attend a social activity with family carers or friends; and Environment in which behaviors associated with dementia are accepted. Main shortcomings of the service were the following: Lack of access for people who had not completed ‘‘Living with Memory Loss’’ (point of entry); and Under-representation of people from Aboriginal and Torres Strait Islander and culturally and linguistically diverse backgrounds. Conclusions: The service provides a highly valued opportunity for people with dementia, their family carers, or friends to interact with others in similar situations and share their experiences. The evaluation recommended that the service be further developed to meet the needs of a wider group of clients.
12 10
IDENTIFYING CULTURAL RISKS AND RESILIENCE IN DEMENTIA CARE IN URBAN ABORIGINAL COMMUNITIES
W. Hampshirea,b, G. Broea,c, Pulver L. Jacksona, aUniversity of New South Wales, Sydney, NSW, Australia; bSouthern Cross University, Coffs Harbour, NSW, Australia; cPrince of Wales Hospital, Sydney, NSW, Australia Background: Health from an Aboriginal perspective incorporates a wholeof-life outlook that not only focuses on the social, emotional, and cultural well-being of the individual but of the entire community. We know that family structure in Aboriginal culture holds ultimate respect and honor, with the strong relationship between family and kinship being the center of Aboriginal well-being. However, little is known about the psychosocial aspects of Aboriginal aging in comparison to non-Aboriginal populations, in which there is immense Australian and international literature on aging encompass-
EVALUATION OF ALZHEIMER’S AUSTRALIA VIC MEMORY LANE CAFES
AGEING, EPIDEMIOLOGIC TRANSITIONS, AND DEMENTIA IN FOURTH WORLD ABORIGINAL AUSTRALIA
Pulver L. Jacksona, G. A. Broeb, aUniversity of New South Wales, Sydney, NSW, Australia; bPrince of Wales Medical Research Institute, Sydney, NSW, Australia Background: Australian Aboriginal people have high mid-life mortality rates from systemic diseases and a 17-year life expectancy gap compared with the general Australian population. Remote Aboriginal Australians in the Kimberley Region have recently been shown to have the highest recorded rates of dementia in the world literature. We reviewed epidemiologic transitions in Aboriginal and non-Indigenous Australians to examine why urban Aboriginal people, who form the large majority, have high systemic disease rates, with the hypothesis that they also have high dementia prevalence rates. Methods: We conducted a major literature review of Aboriginal aging,
Abstracts / Alzheimer’s & Dementia 5 (2009) e10–e17 cognition, and dementia. We are currently undertaking a National Health and Medical Research Council funded study involving w700 urban Aboriginal people aged 45 and older, examining dementia prevalence, social and biologic determinants of health, and dementia risk factors. Results: Aboriginal fertility is falling, survival is increasing, and absolute numbers of older people are rising as a result of recent improvements in Aboriginal health. This is occurring 50 years after the classic/Western epidemiologic transition to delayed chronic systemic diseases. A combination of persistent socioeconomic and educational disadvantages in childhood/early life and high chronic/vascular disease rates in mid-life is likely to accelerate the epidemiologic transition to neurodegenerative diseases as Aboriginal people age. Conclusions: Reducing the gap in Aboriginal health and life expectancy requires multiple interventions across the life cycle; particularly those aimed at parenting, growing young minds, improving opportunities for education and job training, and building human capital in Aboriginal people. This is in addition to the provision of equity in health, housing, and human rights.
13
WHAT ROLE SHOULD WEBSITES PLAY IN DEMENTIA CARE IN HOSPITALS?
D. Liea, S. Austinb, aPrincess Alexandra Hospital, Woolloongabba, QLD, Australia; bUniversity of Queensland, Woolloongabba, QLD, Australia Background: In 2003–2004 more than 70,000 people with a principal or additional diagnosis of dementia were admitted to Australian hospitals. This comprised more than a million bed-days or 6.9% of total days. With demographic aging, the prevalence of associated behavioral and psychological sequelae will rise in the acute care setting. Associated issues include falls management, restraint reduction, misuse of medication, and delirium detection/prevention. The Streaming Technology as an Adjunct to Dementia Interventions (STEADI) Project investigates the utility of a multimedia website housed on a metropolitan teaching hospital intranet and its impact on staff knowledge and attitudes. The site includes text files and short vignettes about management of behaviors of concern. To date, the use of information and communication technology in hospital dementia care has been rarely reported. Methods: A website was established and located on the hospital intranet. The website includes multimedia files about Behavioural and Psychological Symptoms of Dementia (BPSD) management. Log file analysis evaluated frequency and pattern of usage. Results: More than three fourths of usage was between 11 PM and 7 AM, with implications for the use of web-based materials, potential audience, and educational strategies. Average time on the website per session was 4.0 minutes. Understanding and diagnosis of dementia was the most popular page viewed. Conclusions: Early evidence indicates the website is in use and has been incorporated into existing work processes, eg, inductions and orientations. Our observations support the interdependence of education and information and communications technology (ICT) in healthcare. Further research is needed to establish the effectiveness of ICT in dementia care. 14
AMYLOID-b AND ITS RELEVANCE TO THE DETECTION OF ALZHEIMER’S DISEASE IN BLOOD PLASMA: FINDINGS FROM THE FIRST PHASE OF THE AUSTRALIAN IMAGING, BIOMARKER AND LIFESTYLE (AIBL) FLAGSHIP STUDY OF AGING
J. Luia, Q. Lid, K. De Ruycka,c, V. Guptaa, K. Taddeia,b,c, J. Fostera,b,c, T. Taddeia,b,c, B. Browna,b,c, V. Warda,b,c, M. Rodriguesa,b,c, M. Rimajovaa,b,c, K. Ellisd,f, C. Rowef, V. Villemagnef, P. Hudsone, C. Mastersd,f, D. Amesd,f, R. Martinsa,b,c, aEdith Cowan University, Perth, WA, Australia; bHollywood Private Hospital, Perth, WA, Australia; cThe McCusker Foundation for Alzheimer’s Disease Research, Perth, WA, Australia; dUniversity of Melbourne, Melbourne, VIC, Australia; eCSIRO Health Flagship, Melbourne, VIC, Australia; fAustin Health, Melbourne, VIC, Australia Background: With research in preventative medicine and early treatment gaining fast momentum, the importance of detection, in particular early
e13
detection of Alzheimer’s disease (AD), is now prevalent. On top of the growing list of known biomarkers of AD is amyloid-b (Ab), which has long been known as central to the pathology of AD. Blood products have recently been used as a source to detect AD but have resulted in inconclusive results. Contributing factors to conflicting results might be due to the low participant numbers in the studies and/or differences in technical procedures. We present results from the first phase of the Australian Imaging, Biomarker and Lifestyle (AIBL) Flagship Study of Ageing, which addresses the issue of low sample number and technical variations. Methods: Blood plasma samples of more than 1,000 participants across two cities in Australia were collected and analyzed for the levels of the two isoforms Ab1-40 and Ab1-42 by using the INNO-BIA Ab detection kits as well as a standard sandwich enzymelinked immunosorbent assay (ELISA). Neuropsychological assessment data of the participants were correlated against the levels of Ab isoforms. Results: It was found that a commercial assay resulted in different outcomes in the levels of the plasma Ab isoform compared with a standard double sandwich ELISA assay. Moreover, the ranges of plasma Ab concentrations between the neuropsychological categories were largely overlapped. Conclusions: Technical differences in assays affect the final outcome of Ab measurements. A single time point measurement of Ab on its own would not be suitable as a diagnostic for AD. 15
EVALUATION OF ADHERENCE TO DEMENTIA RISK REDUCTION IN EVERYDAY PRACTICE: A LITERATURE REVIEW
M. Martin-Khana, C. Traversa, D. Lieb, aUniversity of Queensland, Woolloongabba, QLD, Australia; bPrincess Alexandra Hospital, Woolloongabba, QLD, Australia Background: A comprehensive literature review of national and international research was carried out to summarize the research literature relating to outcome measures of health professional performance. Methods: The literature was methodically searched retrospectively from August 2008 to the beginning of 1998. Bibliographic databases were searched for relevant peerreviewed literature, and 24 individual websites were searched. The key terms included general practice or family practice, and outcome assessment or quality indicator. Results: The uptake of dementia risk reduction strategies by primary care practitioners could be measured in a multitude of ways by using a range of process and outcome measures at different levels, eg, individual patient versus individual practice versus whole of population level. In Australia a considerable amount of process data at the level of the individual general practitioner is available through administrative data sets (ie, Medicare) that capture data regarding the provision of medical services and pharmaceutical products. A number of existing data sources could be used, either in their current format or in a modified form, to inform the uptake of dementia risk reduction activities in primary care. These vary in terms of reliability, validity, and feasibility. It might be necessary to triangulate data from multiple sources to provide a comprehensive picture regarding the uptake and impact of these activities. Conclusions: On the basis of the research evidence, seven recommendations were made including coordinating the collection of dementia-related information with that of chronic disease data and using existing national, state, and other data sources where possible.
16
IDENTIFYING DEPRESSION IN OLDER ADULTS VIA VIDEO CONSULTATION
M. Martin-Khana, L. Flickerb, R. Woottonc, P. K. Lohb,d, H. Edwardse, G. Byrnef, P. Vargheseg, E. Bellerh, L. Graya, aUniversity of Queensland, Woolloongabba, QLD, Australia; bUniversity of Western Australia, Perth, WA, Australia; cScottish Centre for Telehealth, Aberdeen, Scotland; dRoyal Perth Hospital, Perth, WA, Australia; e Queensland University of Technology, Brisbane, QLD, Australia; f University of Queensland, Herston, QLD, Australia; gPrincess Alexandra Hospital, Woolloongabba, QLD, Australia; hUniversity of Queensland, Woolloongabba, QLD, Australia