- Email: [email protected]
Amyloid burden in early-onset versus late-onset Alzheimer's disease: Comparison of two extremes
P228
Symposia: S2-02: Phenotypical Heterogeneity In Alzheimer’s Disease
with brain structure will be reviewed. Sensitivity to the earliest manifestations of diseases causing dementia will be emphasized. Issues of age, education, and race/ethnicity adjustment of test scores will be addressed, and limitations of one-time assessments for making complex clinical decisions will be discussed. Conclusions: Effective measurement for any population begins with careful item development and empirically guided selection so that the test is relevant to the population and measurement goals. Modern psychometric methods coupled with well-designed data collection provide a quantitative foundation for effective measurement in diverse older groups including older Hispanics. SYMPOSIA: S2-02 PHENOTYPICAL HETEROGENEITY IN ALZHEIMER’S DISEASE S2-02-01
UNDERSTANDING (ENDO)PHENOTYPICAL HETEROGENEITY: THE ROLE OF AGE AND APOE
Wiesje Van der Flier, Philip Scheltens, VU University Medical Center, Amsterdam, Netherlands. Background: It is increasingly recognized that AD is a heterogeneous disorder. Age-at-onset and APOE genotype influence cognitive phenotype, but it is unclear by which mechanisms they exert their effect. Different aspects of neuropathology, i.e. more upstream as reflected by amyloid-PET, or more downstream as reflected by EEG connectivity or volumetric MRI may serve as endophenotypes, providing clues for the variability in pathways leading to the clinical syndrome of AD. We investigated differences according to age-at-onset and APOE genotype with respect to PET, EEG connectivity, and MRI. Methods: An overview is given of how age-at-onset and APOE genotype impact different aspects of manifestation of the disease. Measures for Alzheimer pathology include Pittsburgh compound-B (PIB) PET for amyloid burden, FDG PET for glucose metabolism, electroencephalogram (EEG)-based phase lag index as measure of functional connectivity, and voxel-based morphometry as measure of neurodegeneration. Results: Comparing younger and older patients, we found a different distribution of both amyloid burden and glucose metabolism, with more prominent PIB binding and less FDG uptake in the parietal cortex of younger patients. Functional connectivity as measured using the phase lag index on EEG was reduced in AD patients compared to controls, with the largest reduction in younger AD patients. Furthermore, we observed that compared to age-matched controls, younger patients had more widespread gray matter loss than older patients. In a direct comparison, younger patients showed more tissue loss than older patients in the precuneus. These differences are in agreement with the clinical presentation of younger AD patients, which is often characterized by prominent impairment in visuospatial functions, executive functions, and/or language. The effect of APOE genotype on these measures was independent of age-at-onset, and included increased frontal PIB binding in APOE negative patients and decreased parietal glucose metabolism in APOE positive patients, while we were not able to show an effect on pattern of atrophy. Conclusions: Age-at-onset seems to influence the pathway leading to clinical AD at all levels of the cascade of events. Former studies suggested that the effects were largely expressed downstream, but we now showed a subtle upstream effect on the distribution of amyloid. S2-02-02
NEUROPATHOLOGICAL EVIDENCE OF HETEROGENEITY
Dennis Dickson, Mayo Clinic, Jacksonville, Florida, United States. Background: Neurofibrillary tangles (NFT) and senile plaques are defining lesions of the neuropathology of Alzheimer’s disease (AD). NFT have a stereotypic distribution that is the basis of Braak NFT staging of AD. Medial temporal lobe structures (e.g., hippocampus) are vulnerable early, and this correlates with conversion of at-risk individuals to AD and with clinical progression of AD. It is also the substrate for amnestic symptoms of AD; however, non-amnestic presentations of AD are recognized, and these cases often do not fit the Braak staging scheme. Methods: We systematically addressed heterogeneity in AD with a classification scheme based upon NFT counts in cortex and hippocampus with thioflavin S fluorescent microscopy
(Murray et al, Lancet Neurol 2011). Results: We identified subsets of early onset AD with short disease duration and sparse NFT in the hippocampus (hippocampal sparing AD) and late onset AD with long disease duration and many NFT in medial temporal lobe (limbic predominant AD). The former, often had atypical clinical presentations, including frontal dementia and progressive aphasia. The latter had slowly progressive amnestic dementia that could be mistaken for hippocampal sclerosis of the elderly, which is increasingly recognized as a late life amnestic syndrome. In over half of AD cases, limbic pathology is associated with TDP-43 or a-synuclein deposition in the amygdala. These cases tend to have more severe clinical symptoms, but no distinctive clinical syndrome has been identified for AD with amygdala predominant TDP-43 or a-synuclein deposition. Cerebrovascular pathology also contributes to clinical heterogeneity in AD. One particular form, cerebral amyloid angiopathy (CAA), is pathogenically linked to fundamental processes that cause AD, yet CAA is not present in all AD cases and in only a subset is it associated with overt clinical signs, often due to diffuse white matter pathology or cortical microhemorrhages. Conclusions: Recognition of heterogeneity of AD is important in clinical studies, since some cases will not be recognized as having AD and in other cases, the non-AD aspects of the disease process (including cerebrovascular lesions, as well as TDP-43 and a-synuclein deposition) may obscure response to future disease modifying therapies targeted at the fundamental AD lesions, senile plaques and NFT. S2-02-03
METRICS OF BRAIN NETWORK BREAKDOWN IN VARIANT SYNDROMES OF ALZHEIMER’S DISEASE
Jason Warren, University College London, London, United Kingdom. Background: Atypical phenotypes of Alzheimer’s disease (AD) are of considerable clinical and neurobiological interest. Clinically, such variant syndromes present major challenges for diagnosis and disease monitoring. Neurobiologically, they illustrate the problem of phenotypic diversity underpinned by a common histopathological substrate. This problem is particularly acute given current interest in identifying signatures of tissue pathology in AD and other neurodegenerative diseases and recent proposals that neurodegenerative brain damage reflects a coherent profile of neural network disintegration. Methods: Here I review the most important variant AD phenotypes and their neuroanatomical associations, focusing on the syndromes of posterior cortical atrophy and logopenic progressive aphasia and metrics that can capture distributed change at the level of large-scale brain networks. Results: The major AD phenotypes show separable but overlapping network-level signatures. The balance of evidence suggests a core profile of network involvement linked to AD pathology: this profile is importantly modulated by incompletely understood genetic and phenotypic modifiers, including factors that remain to be identified. Conclusions: Variant AD syndromes can be reconciled with the emerging network paradigm of neurodegenerative disease, with important clinical and neurobiological implications in the era of disease-modification trials. S2-02-04
AMYLOID BURDEN IN EARLY-ONSET VERSUS LATE-ONSET ALZHEIMER’S DISEASE: COMPARISON OF TWO EXTREMES
Hanna Cho, Sang Won Seo, Jung-Hyun Kim, Young Noh, Geon Ha Kim, Ji Soo Shin, Duk L. Na, Samsung Medical Center, Seoul, South Korea. Background: Patients with early-onset Alzheimer’s disease (EOAD) show more rapid progression, more generalized cognitive deficits and greater cortical atrophy and hypometabolism compared to patients with late-onset Alzheimer’s disease (LOAD) at a similar disease stage. The purpose of this study was to compare the distribution and burden of fibrillar amyloid-ß between EOAD and LOAD in the two extremes classification. Methods: We evaluated 68 patients with AD (61 with PiB-positive (PiB+) and 7 with PiBnegative (PiB-)) who underwent brain MRI, Pittsburg compound-B (PiB) PET and detailed neuropsychological tests. Sixty-one patients with PiB+ AD were divided according to the age at onset: Seventeen patients belonged to EOAD group (age onset <60 years); 24 patients to LOAD group (onset age 70 years); the remaining is 20 patients (60 years onset age < 70
Symposia: S2-03: Developments In Psychosocial Intervention Research (Social-Behavioral Track) years). This study analyzed between the two extremes (PiB+ EOAD vs LOAD group). Group differences in tracer uptake were assessed on a voxel-wise basis using statistical parametric mapping, and by comparing mean values in regions of interest. Results: EOAD group showed significantly increased [11C]-labeled PiB uptake throughout bilateral basal ganglia, bilateral thalamus, left lateral temporal cortex and left occipital cortex on voxel-wise and region of interest comparisons (P<0.05). Conclusions: Our findings demonstrated that EOAD group has greater amyloid burden than LOAD group and there are consistent with postmortem pathologic studies. SYMPOSIA: S2-03 DEVELOPMENTS IN PSYCHOSOCIAL INTERVENTION RESEARCH (SOCIAL-BEHAVIORAL TRACK) S2-03-01
RESEARCHERS AND FRONTOTEMPORAL DEMENTIA CAREGIVERS: PARTNERING FOR BRAIN DONATION
Mary Austrom, Indiana Alzheimer Disease Center, Indianapolis, Indiana, United States. Background: Behavioral and psychological symptoms of dementia (BPSD) represent a major challenge in the care of older adults with Alzheimer disease. These symptoms, which include a broad range of distressing behaviors and psychological reactions, affect the health and quality of life of both the person with dementia and the caregiver. More than 90% of persons with dementia will experience BPSD at some point during the course of their illness. BPSD may occur at any stage of the disease. Older adults with mild cognitive impairment also experience clinically significant behavioral and psychological symptoms. Leaving patients’ behavioral and psychological symptoms untreated has been associated with earlier nursing home placement, poor management of co-morbid conditions, excess health care costs and increased risk of caregiver depression and stress-related medical problems. Methods: Our group has been using and testing non-pharmacological protocols and interventions in a variety of settings as a means to improve outcomes for both persons with AD and their caregivers. We have successfully demonstrated the effectiveness of these interventions in primary care settings (PREVENT study) and are now using them in our specialty memory care clinic for seniors (Healthy Aging Brain Center [HABC]) and our primary care-based outreach program for seniors (Aging Brain Care Medical Home); are testing them in the home setting with persons with mild to moderate disease (Alzheimer’s Disease Multiple Intervention Trial [ADMIT study]) and have also adapted them for use with caregivers and persons with late stage dementia still living at home (Indiana version of Palliative Excellence in Alzheimer Care Efforts [IN-PEACE study]). In addition, we are also pilot-testing an on-line videoconference support group for caregivers (Support and Attention for Families of Elders through Technology [SAFE-T study]). Results: This session will present our work to date with our non-pharmacological interventions in these studies. Conclusions: Several successful models of non-pharmacological interventions exist and continue to be tested and used in a variety of settings. The successful implementation of these interventions has been shown to alleviate caregiver burden, improve both caregiver and patient outcomes, and reduce excess health care costs.
S2-03-02
USING TECHNOLOGY IN DESIGNING CLINICAL TRIALS TO INVESTIGATE THE EFFICACY OF ENHANCED SOCIAL ENGAGEMENT IN MCI
Hiroko Dodge, Jeffrey Kaye, Oregon Health & Science University, Portland, Oregon, United States. Background: Past epidemiological studies have demonstrated that larger social networks or more frequent social interactions could have potential protective effects on the incidence of AD. Psychological studies suggest that the task of conversation is highly cognitively stimulating: Conversations require attention, working memory and the organization and control of thought (executive functions), as well as social cognition to understand
P229
others’ intentions and feelings. Despite the accumulating evidence that increasing social interaction could be a potentially promising intervention tool to improve cognitive and emotional well-being of the elderly, only a few randomized controlled prevention studies using social interaction have been conducted. We developed a randomized controlled behavioral clinical trial to examine whether conversation-based cognitive stimulation has a positive effect on general and domain-specific cognitive functions among older adults with normal cognition or mild cognitive impairment (MCI). Daily face-to-face communications are being conducted through the use of personal computers, webcams, and user-friendly interactive Internet conducted programs to allow participants to be more socially engage while staying at home. Methods: The trial protocol was developed forming an inter-disciplinary team of neurologists, neuropsychologists, social psychologists, linguistic scientists, engineers and statisticians. Pilot studies were conducted to develop user-friendly technology interfaces. Results: A standardized conversational interview protocol was developed. Word counts spoken by the interviewer vs. participants during the trial session were monitored using an automated spoken language detection algorithm. A user-friendly Internet communication program using touch-screens and webcams was developed. To monitor daily conversations which might occur outside of the Internet-based conversations, algorithms for automatically extracting spoken language markers were developed, refined, and implemented into a wearable, voice activated digital recorder. To assess the generalizability of subsequent findings, we conducted mass mail-in surveys among community dwelling elderly, assessing demographic characteristics, life style factors and willingness of participating in trials which use technologies and the proposed prevention trial. Conclusions: The results obtained from this pilot study will be used for dose/duration determination in larger prevention studies that examine conversation-based cognitive stimulation as a potential intervention for cognitive decline and incident AD. The technology could improve the feasibility and cost-effective execution of social interaction based preventions.
S2-03-03
INTERVENTIONS TO PROMOTE WELL-BEING FOR PEOPLE WITH DEMENTIA AND THEIR FAMILY CAREGIVERS
Laura Gitlin, Johns Hopkins University, Baltimore, Maryland, United States. Background: Families are the primary providers of daily care for people with dementia worldwide. A growing body of evidence is emerging from robust randomized trials showing that psychosocial and environmental interventions (Nonpharmacological) promote well-being of people with dementia and family caregivers. Nevertheless, few families have access to these interventions and their use in real world contexts are limited. This presentation provides a broad overview of promising interventions and highlights next steps in their integration in practice/service settings. Methods: Systematic reviews, meta-analyses and Cochrane reports over the past 15 years are reviewed to identify promising psycho-social-environmental (nonpharmacological) interventions enhancing patient/family caregiver well-being. Considered are randomized trials conducted in various practice settings including home, nursing home/assisted living, community (adult day) and primary care settings. Also considered are proven programs that are integrated into practice settings and sustained. Results: Findings suggest varied multi-component tailored interventions benefit patients and reduce neuropsychiatric behaviors, minimize functional dependence, improve quality of life, and address depression, and disengagement; and for caregivers, interventions decrease depression, burden and upset, and enhance mastery, skills and wellbeing. Limitations include lack of interventions for: different disease stages and etiologies, common clinical concerns (fall risk, physical health, comorbidities), those living alone, and diverse caregivers with multiple care demands and financial strain. Few programs are integrated/sustained in practice settings. Components similar across interventions (problem-solving, communication training) could form a standard for dementia care. Conclusions: We continue to need rigorous research to test interventions that address a range of concerns, issues and challenges in
Symposia: S2-02: Phenotypical Heterogeneity In Alzheimer’s Disease
with brain structure will be reviewed. Sensitivity to the earliest manifestations of diseases causing dementia will be emphasized. Issues of age, education, and race/ethnicity adjustment of test scores will be addressed, and limitations of one-time assessments for making complex clinical decisions will be discussed. Conclusions: Effective measurement for any population begins with careful item development and empirically guided selection so that the test is relevant to the population and measurement goals. Modern psychometric methods coupled with well-designed data collection provide a quantitative foundation for effective measurement in diverse older groups including older Hispanics. SYMPOSIA: S2-02 PHENOTYPICAL HETEROGENEITY IN ALZHEIMER’S DISEASE S2-02-01
UNDERSTANDING (ENDO)PHENOTYPICAL HETEROGENEITY: THE ROLE OF AGE AND APOE
Wiesje Van der Flier, Philip Scheltens, VU University Medical Center, Amsterdam, Netherlands. Background: It is increasingly recognized that AD is a heterogeneous disorder. Age-at-onset and APOE genotype influence cognitive phenotype, but it is unclear by which mechanisms they exert their effect. Different aspects of neuropathology, i.e. more upstream as reflected by amyloid-PET, or more downstream as reflected by EEG connectivity or volumetric MRI may serve as endophenotypes, providing clues for the variability in pathways leading to the clinical syndrome of AD. We investigated differences according to age-at-onset and APOE genotype with respect to PET, EEG connectivity, and MRI. Methods: An overview is given of how age-at-onset and APOE genotype impact different aspects of manifestation of the disease. Measures for Alzheimer pathology include Pittsburgh compound-B (PIB) PET for amyloid burden, FDG PET for glucose metabolism, electroencephalogram (EEG)-based phase lag index as measure of functional connectivity, and voxel-based morphometry as measure of neurodegeneration. Results: Comparing younger and older patients, we found a different distribution of both amyloid burden and glucose metabolism, with more prominent PIB binding and less FDG uptake in the parietal cortex of younger patients. Functional connectivity as measured using the phase lag index on EEG was reduced in AD patients compared to controls, with the largest reduction in younger AD patients. Furthermore, we observed that compared to age-matched controls, younger patients had more widespread gray matter loss than older patients. In a direct comparison, younger patients showed more tissue loss than older patients in the precuneus. These differences are in agreement with the clinical presentation of younger AD patients, which is often characterized by prominent impairment in visuospatial functions, executive functions, and/or language. The effect of APOE genotype on these measures was independent of age-at-onset, and included increased frontal PIB binding in APOE negative patients and decreased parietal glucose metabolism in APOE positive patients, while we were not able to show an effect on pattern of atrophy. Conclusions: Age-at-onset seems to influence the pathway leading to clinical AD at all levels of the cascade of events. Former studies suggested that the effects were largely expressed downstream, but we now showed a subtle upstream effect on the distribution of amyloid. S2-02-02
NEUROPATHOLOGICAL EVIDENCE OF HETEROGENEITY
Dennis Dickson, Mayo Clinic, Jacksonville, Florida, United States. Background: Neurofibrillary tangles (NFT) and senile plaques are defining lesions of the neuropathology of Alzheimer’s disease (AD). NFT have a stereotypic distribution that is the basis of Braak NFT staging of AD. Medial temporal lobe structures (e.g., hippocampus) are vulnerable early, and this correlates with conversion of at-risk individuals to AD and with clinical progression of AD. It is also the substrate for amnestic symptoms of AD; however, non-amnestic presentations of AD are recognized, and these cases often do not fit the Braak staging scheme. Methods: We systematically addressed heterogeneity in AD with a classification scheme based upon NFT counts in cortex and hippocampus with thioflavin S fluorescent microscopy
(Murray et al, Lancet Neurol 2011). Results: We identified subsets of early onset AD with short disease duration and sparse NFT in the hippocampus (hippocampal sparing AD) and late onset AD with long disease duration and many NFT in medial temporal lobe (limbic predominant AD). The former, often had atypical clinical presentations, including frontal dementia and progressive aphasia. The latter had slowly progressive amnestic dementia that could be mistaken for hippocampal sclerosis of the elderly, which is increasingly recognized as a late life amnestic syndrome. In over half of AD cases, limbic pathology is associated with TDP-43 or a-synuclein deposition in the amygdala. These cases tend to have more severe clinical symptoms, but no distinctive clinical syndrome has been identified for AD with amygdala predominant TDP-43 or a-synuclein deposition. Cerebrovascular pathology also contributes to clinical heterogeneity in AD. One particular form, cerebral amyloid angiopathy (CAA), is pathogenically linked to fundamental processes that cause AD, yet CAA is not present in all AD cases and in only a subset is it associated with overt clinical signs, often due to diffuse white matter pathology or cortical microhemorrhages. Conclusions: Recognition of heterogeneity of AD is important in clinical studies, since some cases will not be recognized as having AD and in other cases, the non-AD aspects of the disease process (including cerebrovascular lesions, as well as TDP-43 and a-synuclein deposition) may obscure response to future disease modifying therapies targeted at the fundamental AD lesions, senile plaques and NFT. S2-02-03
METRICS OF BRAIN NETWORK BREAKDOWN IN VARIANT SYNDROMES OF ALZHEIMER’S DISEASE
Jason Warren, University College London, London, United Kingdom. Background: Atypical phenotypes of Alzheimer’s disease (AD) are of considerable clinical and neurobiological interest. Clinically, such variant syndromes present major challenges for diagnosis and disease monitoring. Neurobiologically, they illustrate the problem of phenotypic diversity underpinned by a common histopathological substrate. This problem is particularly acute given current interest in identifying signatures of tissue pathology in AD and other neurodegenerative diseases and recent proposals that neurodegenerative brain damage reflects a coherent profile of neural network disintegration. Methods: Here I review the most important variant AD phenotypes and their neuroanatomical associations, focusing on the syndromes of posterior cortical atrophy and logopenic progressive aphasia and metrics that can capture distributed change at the level of large-scale brain networks. Results: The major AD phenotypes show separable but overlapping network-level signatures. The balance of evidence suggests a core profile of network involvement linked to AD pathology: this profile is importantly modulated by incompletely understood genetic and phenotypic modifiers, including factors that remain to be identified. Conclusions: Variant AD syndromes can be reconciled with the emerging network paradigm of neurodegenerative disease, with important clinical and neurobiological implications in the era of disease-modification trials. S2-02-04
AMYLOID BURDEN IN EARLY-ONSET VERSUS LATE-ONSET ALZHEIMER’S DISEASE: COMPARISON OF TWO EXTREMES
Hanna Cho, Sang Won Seo, Jung-Hyun Kim, Young Noh, Geon Ha Kim, Ji Soo Shin, Duk L. Na, Samsung Medical Center, Seoul, South Korea. Background: Patients with early-onset Alzheimer’s disease (EOAD) show more rapid progression, more generalized cognitive deficits and greater cortical atrophy and hypometabolism compared to patients with late-onset Alzheimer’s disease (LOAD) at a similar disease stage. The purpose of this study was to compare the distribution and burden of fibrillar amyloid-ß between EOAD and LOAD in the two extremes classification. Methods: We evaluated 68 patients with AD (61 with PiB-positive (PiB+) and 7 with PiBnegative (PiB-)) who underwent brain MRI, Pittsburg compound-B (PiB) PET and detailed neuropsychological tests. Sixty-one patients with PiB+ AD were divided according to the age at onset: Seventeen patients belonged to EOAD group (age onset <60 years); 24 patients to LOAD group (onset age 70 years); the remaining is 20 patients (60 years onset age < 70
Symposia: S2-03: Developments In Psychosocial Intervention Research (Social-Behavioral Track) years). This study analyzed between the two extremes (PiB+ EOAD vs LOAD group). Group differences in tracer uptake were assessed on a voxel-wise basis using statistical parametric mapping, and by comparing mean values in regions of interest. Results: EOAD group showed significantly increased [11C]-labeled PiB uptake throughout bilateral basal ganglia, bilateral thalamus, left lateral temporal cortex and left occipital cortex on voxel-wise and region of interest comparisons (P<0.05). Conclusions: Our findings demonstrated that EOAD group has greater amyloid burden than LOAD group and there are consistent with postmortem pathologic studies. SYMPOSIA: S2-03 DEVELOPMENTS IN PSYCHOSOCIAL INTERVENTION RESEARCH (SOCIAL-BEHAVIORAL TRACK) S2-03-01
RESEARCHERS AND FRONTOTEMPORAL DEMENTIA CAREGIVERS: PARTNERING FOR BRAIN DONATION
Mary Austrom, Indiana Alzheimer Disease Center, Indianapolis, Indiana, United States. Background: Behavioral and psychological symptoms of dementia (BPSD) represent a major challenge in the care of older adults with Alzheimer disease. These symptoms, which include a broad range of distressing behaviors and psychological reactions, affect the health and quality of life of both the person with dementia and the caregiver. More than 90% of persons with dementia will experience BPSD at some point during the course of their illness. BPSD may occur at any stage of the disease. Older adults with mild cognitive impairment also experience clinically significant behavioral and psychological symptoms. Leaving patients’ behavioral and psychological symptoms untreated has been associated with earlier nursing home placement, poor management of co-morbid conditions, excess health care costs and increased risk of caregiver depression and stress-related medical problems. Methods: Our group has been using and testing non-pharmacological protocols and interventions in a variety of settings as a means to improve outcomes for both persons with AD and their caregivers. We have successfully demonstrated the effectiveness of these interventions in primary care settings (PREVENT study) and are now using them in our specialty memory care clinic for seniors (Healthy Aging Brain Center [HABC]) and our primary care-based outreach program for seniors (Aging Brain Care Medical Home); are testing them in the home setting with persons with mild to moderate disease (Alzheimer’s Disease Multiple Intervention Trial [ADMIT study]) and have also adapted them for use with caregivers and persons with late stage dementia still living at home (Indiana version of Palliative Excellence in Alzheimer Care Efforts [IN-PEACE study]). In addition, we are also pilot-testing an on-line videoconference support group for caregivers (Support and Attention for Families of Elders through Technology [SAFE-T study]). Results: This session will present our work to date with our non-pharmacological interventions in these studies. Conclusions: Several successful models of non-pharmacological interventions exist and continue to be tested and used in a variety of settings. The successful implementation of these interventions has been shown to alleviate caregiver burden, improve both caregiver and patient outcomes, and reduce excess health care costs.
S2-03-02
USING TECHNOLOGY IN DESIGNING CLINICAL TRIALS TO INVESTIGATE THE EFFICACY OF ENHANCED SOCIAL ENGAGEMENT IN MCI
Hiroko Dodge, Jeffrey Kaye, Oregon Health & Science University, Portland, Oregon, United States. Background: Past epidemiological studies have demonstrated that larger social networks or more frequent social interactions could have potential protective effects on the incidence of AD. Psychological studies suggest that the task of conversation is highly cognitively stimulating: Conversations require attention, working memory and the organization and control of thought (executive functions), as well as social cognition to understand
P229
others’ intentions and feelings. Despite the accumulating evidence that increasing social interaction could be a potentially promising intervention tool to improve cognitive and emotional well-being of the elderly, only a few randomized controlled prevention studies using social interaction have been conducted. We developed a randomized controlled behavioral clinical trial to examine whether conversation-based cognitive stimulation has a positive effect on general and domain-specific cognitive functions among older adults with normal cognition or mild cognitive impairment (MCI). Daily face-to-face communications are being conducted through the use of personal computers, webcams, and user-friendly interactive Internet conducted programs to allow participants to be more socially engage while staying at home. Methods: The trial protocol was developed forming an inter-disciplinary team of neurologists, neuropsychologists, social psychologists, linguistic scientists, engineers and statisticians. Pilot studies were conducted to develop user-friendly technology interfaces. Results: A standardized conversational interview protocol was developed. Word counts spoken by the interviewer vs. participants during the trial session were monitored using an automated spoken language detection algorithm. A user-friendly Internet communication program using touch-screens and webcams was developed. To monitor daily conversations which might occur outside of the Internet-based conversations, algorithms for automatically extracting spoken language markers were developed, refined, and implemented into a wearable, voice activated digital recorder. To assess the generalizability of subsequent findings, we conducted mass mail-in surveys among community dwelling elderly, assessing demographic characteristics, life style factors and willingness of participating in trials which use technologies and the proposed prevention trial. Conclusions: The results obtained from this pilot study will be used for dose/duration determination in larger prevention studies that examine conversation-based cognitive stimulation as a potential intervention for cognitive decline and incident AD. The technology could improve the feasibility and cost-effective execution of social interaction based preventions.
S2-03-03
INTERVENTIONS TO PROMOTE WELL-BEING FOR PEOPLE WITH DEMENTIA AND THEIR FAMILY CAREGIVERS
Laura Gitlin, Johns Hopkins University, Baltimore, Maryland, United States. Background: Families are the primary providers of daily care for people with dementia worldwide. A growing body of evidence is emerging from robust randomized trials showing that psychosocial and environmental interventions (Nonpharmacological) promote well-being of people with dementia and family caregivers. Nevertheless, few families have access to these interventions and their use in real world contexts are limited. This presentation provides a broad overview of promising interventions and highlights next steps in their integration in practice/service settings. Methods: Systematic reviews, meta-analyses and Cochrane reports over the past 15 years are reviewed to identify promising psycho-social-environmental (nonpharmacological) interventions enhancing patient/family caregiver well-being. Considered are randomized trials conducted in various practice settings including home, nursing home/assisted living, community (adult day) and primary care settings. Also considered are proven programs that are integrated into practice settings and sustained. Results: Findings suggest varied multi-component tailored interventions benefit patients and reduce neuropsychiatric behaviors, minimize functional dependence, improve quality of life, and address depression, and disengagement; and for caregivers, interventions decrease depression, burden and upset, and enhance mastery, skills and wellbeing. Limitations include lack of interventions for: different disease stages and etiologies, common clinical concerns (fall risk, physical health, comorbidities), those living alone, and diverse caregivers with multiple care demands and financial strain. Few programs are integrated/sustained in practice settings. Components similar across interventions (problem-solving, communication training) could form a standard for dementia care. Conclusions: We continue to need rigorous research to test interventions that address a range of concerns, issues and challenges in