- Email: [email protected]
Challenges for the detection of dementia in culturally, racially and ethnically diverse populations
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Plenary: PL-02: Challenges for The Detection of Dementia In Culturally, Racially and Ethnically Diverse Populations
at baseline, and 2, 4, and 8 year follow-up. In an ancillary project, sleep complaints were assessed at baseline by a face-to-face standardized interview with a sleep questionnaire. We analyzed data on 4894 non-demented subjects: 1) with complete sleep questionnaires; 2) having a Mini Mental Status Examination (MMSE) score 24 points at baseline; 3) with at least one follow up and no missing covariate data. Incident cognitive decline was defined as a 4-point reduction in MMSE score during follow-up. Logistic regression models were adjusted for sociodemographic, behavioral, physical and mental health variables, prescribed sleep medication and APOE genotype. Results: EDS, reported by 17.9% of subjects, independently increased the risk of cognitive decline (OR ¼ 1.26, 95% CI ¼ 1.02-1.56) while difficulty in maintaining sleep (63.5% of subjects) was negatively associated (OR ¼ 0.81 95% CI ¼ 0.68-0.96, respectively). The three others components of insomnia (poor sleep quality, 12.4% ;difficulty in initiating sleep, 33.8% ; early morning awakening, 35.7%) were not significantly associated with decline on the MMSE. Conclusions: Our results show that EDS may be associated independently with the risk of cognitive decline in the elderly population. These results suggest that EDS may be considered as an early unspecific neurological predictor of incident cognitive decline and that sleep complaint should be adequately evaluated in older persons. F2-03-04
CIRCADIAN PATTERNS OF BETA-AMYLOID IN HUMAN CEREBROSPINAL FLUID AND PLASMA
Yafei Huang, Randall Bateman, Washington University School of Medicine, St. Louis, Missouri, United States. Background: The amyloid hypothesis predicts that increased production or decreased clearance of amyloid-beta (Ab) leads to amyloidosis, which ultimately culminates in Alzheimer’s disease (AD). Changes in amyloid proteins, such as decreased cerebrospinal fluid (CSF) Ab42 have been recognized as a biomarker for AD. However, the dynamics of Ab concentrations over time are not well understood. Methods: Hourly CSF and plasma samples were obtained over a 36-hour study period in three groups of human volunteers: a dementia group with amyloid deposition, an age-matched control group, and a younger control group. We investigated dynamic patterns of Ab peptides (Ab40 and Ab42 in CSF and plasma using bead-based Luminex XMAP assays), and Amyloid Precursor Protein (APP) (APP-^I6 and APP-b in CSF using ELISA assays). We then analyzed the effects of aging and amyloidosis on circadian patterns and correlations between CSF and plasma Ab peptides. Results: Circadian patterns were observed in CSF and plasma Ab, with decreased amplitudes with aging. Further, CSF APP also demonstrated a circadian pattern. No significant correlations were found between plasma and CSF Ab levels on an hourly or individual basis. We also found that CSF APP^I6, APPb, Ab40, and Ab42 are highly positively correlated in all participants without amyloidosis. However, in participants with amyloidosis, there is no correlation of Ab42 to the other APP metabolites, suggesting that normal physiologic regulation of CSF Ab42 is impaired in the presence of amyloidosis. Conclusions: This study suggests amyloid proteins in both central and peripheral compartments are dynamic, and regulated in a circadian pattern that is part of the normal dynamic physiologic control of Ab concentrations. Regulatory mechanisms of these proteins may be altered with aging and amyloidosis. The lack of correlation of plasma and CSF Ab levels suggest plasma Ab concentrations can not be used for surrogates of central Ab concentrations. These findings support an active circadian regulation of Ab and may provide insight into the pathophysiological changes in AD. PLENARY: PL-02 CHALLENGES FOR THE DETECTION OF DEMENTIA IN CULTURALLY, RACIALLY AND ETHNICALLY DIVERSE POPULATIONS PL-02-01
IMPROVING QUALITY OF LIFE FOR PEOPLE WITH DEMENTIA IN THE COMMUNITY
Linda Teri, University of Washington, Seattle, Washington, United States. Behavioral problems are prevalent among persons with AD and significantly impair their health, well-being, and quality of life; our ability to provide
effective care; and the life of their caregivers. Despite this, effective pharmacological treatments are of questionable utility. Indeed, experts and guidelines from various professional associations agree that medications are “the last resort” and nonpharmacological strategies should be implemented first. This keynote will provide an overview on the state-of-the-science for nonpharmacological treatment of persons with AD and their caregivers. Despite major advances in recent years, the rate of knowledge acquisition and dissemination is seriously hindered by ever dwindling funds on both national and international levels. Recent findings from the Seattle Protocols, a series of systematic randomized controlled clinical trials designed to reduce behavioral problems in persons with Alzheimer’s disease via education, support and skill-training of their caregivers, will be discussed. The goal of these studies is to establish conceptually sound and clinically relevant treatment approaches and to evaluate their effectiveness along the diverse continuum of environments in which older adults reside and receive care (e.g., private homes, retirement communities, assisted-living residences, adult family homes, and skilled nursing facilities). Translated in over a dozen languages, employed in countries around the world, and states across the U.S., it is hoped that these programs offer a solid platform for advancing our knowledge of how best to improve the care of those suffering from Alzheimer’s Disease and helping those dedicated to providing that care. PL-02-02
CHALLENGES FOR THE DETECTION OF DEMENTIA IN CULTURALLY, RACIALLY AND ETHNICALLY DIVERSE POPULATIONS
Jennifer Manly1, Adam Brickman2, M. Maria Glymour3, Karen Siedlecki4, Beyon Miloyan5, Richard Mayeux1, Nicole Schupf1, 1Columbia University Medical Center, New York, New York, United States; 2Columbia University, New York, New York, United States; 3Harvard School of Public Health, Boston, Massachusetts, United States; 4Fordham University, New York, New York, United States; 5California State University Northridge, Northridge, California, United States. Background: Studies have shown a higher prevalence and incidence of Alzheimer’s Disease (AD) among African Americans and Latinos than non-Hispanic Whites. Early and accurate detection of cognitive impairment in diverse populations is therefore of tremendous significance as the search for neuropsychological, imaging, and genetic markers of early dementia intensifies. This plenary will discuss challenges and present potential solutions and recommendations for addressing key gaps in knowledge about dementia among ethnically diverse groups. Methods: The accuracy of early detection of dementia among ethnically diverse older adults was investigated among large cohorts of African American, Latino, and White participants in longitudinal research studies of risks for cognitive impairment and AD. Neuropsychological measures of memory, executive function, language, visuospatial skill, and attention were administered, and the basis for their use across groups was established using tests of measurement invariance. Measures of acculturation and language proficiency were employed among US-born and immigrant groups. Childhood educational experience was assessed using measures of quality of schooling, achievement, and literacy level. Structural MRI of the brain was completed in order to characterize level of cerebrovascular disease burden, and markers of hyperinsulinemia, inflammation, and cardiovascular health were collected, as was APOE E4 allele status. Results: A common factor structure captured most of the variability in neuropsychological test scores and was invariant across language, ethnic group, and diagnostic group. Educational experience, including quality of schooling, setting and location of school, achievement, and reading level were very powerful predictors of cognitive decline and accounting for these variables improved specificity of neuropsychological measures for detection of cognitive impairment. African Americans and Latinos had a higher burden of cerebrovascular and cardiovascular disease, and the role of these factors as mediators of the relationship between educational experience and cognition was examined. Conclusions: There are many challenges for the accurate and early detection of cognitive impairment among ethnically diverse groups, but recent research suggests that a lifecourse
Oral Sessions: O2-01: Social-Behavioral and Care Research and Practice: Cognitive Training and Physical Exercise Interventions approach, taking into account the educational and health experiences of diverse people can help to identify early and accurate markers of cognitive decline and dementia.
ORAL SESSIONS: O2-01 SOCIAL-BEHAVIORAL AND CARE RESEARCH AND PRACTICE: COGNITIVE TRAINING AND PHYSICAL EXERCISE INTERVENTIONS O2-01-01
KNOWLEDGE-TRANSFER FOLLOWING COGNITIVE INTERVENTION FOR AMNESTIC MILD COGNITIVE IMPAIRMENT
Glynda Kinsella1, David Ames2, Elsdon Storey3, Ben Ong1, Kerryn Pike1, Elizabeth Mullaly4, Elizabeth Rand4, Linda Clare5, Michael Saling6, Samuel Parsons1, 1La Trobe University, Melbourne, Australia; 2National Ageing Research Institute Melbourne, Parkville, Australia; 3Monash University, Melbourne, Australia; 4Caulfield Hospital, Melbourne, Australia; 5Bangor University, Bangor, United Kingdom; 6University of Melbourne, Melbourne, Australia. Background: Many people with amnestic mild cognitive impairment (aMCI) seek guidance about how best to manage everyday memory challenges. Building upon positive pilot study results, we investigated response to a six-week cognitive-behavioural intervention for aMCI. The program (the LaTCH Memory Group Program) focuses on providing knowledge about memory strategies and how to use such strategies in everyday activities. It is based on the expectation that people experiencing memory difficulties need assistance in learning and implementing effective compensatory strategies in everyday situations. This offers an alternative approach to ‘brain training’ or practice on memory tasks. Methods: In a randomised controlled trial, 220 older adults, either diagnosed with aMCI or agematched healthy older adults (HOA), were randomly allocated to early or late intervention. Over three years, we trained allied health professionals to deliver the intervention which was provided through 40 memory groups at locations throughout Melbourne and regional centres in Victoria, Australia. Results: Following intervention, both HOA and aMCI groups (i) improved knowledge about memory strategies and when to use them (d ¼ 0.50); (ii) improved contentment and self-efficacy about memory ability (d ¼ 1.22); (iii) improved self-report of everyday memory ability, (d ¼ 0.54), e.g. remembering to return a missed telephone call; (iv) improved achievement of personal memory goals, (d ¼ 0.28), e.g., learning people’s names in a yoga class. Nevertheless, these significant changes were not reflected in performance on neuropsychological tests of memory. A further benefit was that family members, accompanying relatives with aMCI, significantly improved their memory strategy knowledge (d ¼ 1.23). Conclusions: The ability of participants (HOA and aMCI) to achieve self-determined memory-based goals after intervention was the most critical outcome of the study as it opens up opportunity for people to engage in more life activities and more socialising, adding to the cycle of improving mental health. Reasons for the discrepancy between improved memory strategy knowledge, personal memory goal achievement and lack of change on neuropsychological test performance will be discussed.
O2-01-02
SELF-EFFICACY FOR COGNITIVE REMEDIATION IN ALZHEIMER’S DISEASE
Jimmy Choi1, Joanna Fiszdon2, 1Columbia University, New York, New York, United States; 2Yale University School of Medicine, West Haven, Connecticut, United States. Background: Cognitive remediation (CR) for Alzheimer’s disease (AD) is becoming more readily available to the geriatric population in an attempt to curb the insidious decline in cognitive and functional performance. Patients with dementing pathology, however, may have difficulty adhering to these cognitive treatments due to denial of memory deficits, lack of motivation and apathy, or a sense of hopelessness which may be primarily due to illness or secondary to geriatric depression. For
P235
this reason, remediation techniques which incorporate motivational strategies to enhance treatment engagement and self efficacy may provide greater benefits than standard remediation training. Methods: Sixtynine outpatients diagnosed with mild to moderate Alzheimer’s disease were randomly assigned to 3 months of (1) computer-based memory training (MT), or (2) Cognitive Vitality Training (CVT), the same memory training but contextualized in a milieu specifically designed to increase adherence to treatment by reducing the sense of hopelessness, enhancing motivation, and empowering patients to be actively involved in treatment. Assessments of cognitive function, quality of life, neuropsychiatric symptoms, activities of daily living, treatment adherence, motivation, and perceptions of self efficacy were conducted at intake, 2, 4, and 6 months. Results: Patients in CVT showed greater resistance to memory decline compared to MT at 6 months. Patients and caregivers in CVT both reported better quality of life and less overall depressive symptoms throughout the intervention. Interestingly, perceptions of self-efficacy for treatment predicted cognitive outcome, even after variance attributable to group assignment, baseline memory ability, overall dementia symptoms, and depressive symptoms were accounted for. Conclusions: This suggest that while patients recently diagnosed with AD (and their caregivers) experience a tremendous loss of control in their lives, therapies which strive to re-introduce elements of control and self-efficacy through intrinsic motivation may offer psychological as well as neuropsychological benefits. Applying these findings to a more preventive approach in the prodromal stages of dementia (mild cognitive impairment) will also be discussed. O2-01-03
TRAINING THE BRAIN: CAN COGNITIVE TRAINING ALTER THE GLOBAL EFFECTS OF ALZHEIMER’S DISEASE?
William Tippett, Mireille Rizkalla, University of Northern British Columbia, Prince George, British Columbia, Canada. Background: There is a growing need for novel behavioural interventions such as cognitive training that can benefit clinically vulnerable populations, such as people living with Alzheimer’s disease (AD). Specifically, the potential for neural plasticity, which is the ability of the brain to adapt to changes at a cellular and molecular level, may still be present after trauma or neurodegeneration, particularly in the early stages of a disease. Consequently, there is great interest in the potential for neurologically compromised individuals, such as AD patients, to adapt to new challenges through neural plasticity and altered brain chemistry. Cognitive training (CT) for AD patients is a relatively new area of research however; recent evidence suggests that techniques such as CT may be effective way in stabilising and even enhancing cognition in mild AD1, perhaps through neuronal plasticity. Methods: Six participants diagnosed with probable or possible AD participated in a 14-week program consisting of twice-weekly on-site sessions of 2 hours each. Training tasks included: a visuomotor activity (Pac-man game playing), visuoconstructive procedures (e.g. Block design, 3-D puzzle construction), and a navigation task (finding on-site location using a map). Each participant also completed twice-weekly in-home sessions of 1 hour each, consisting primarily of visuospatial tasks (e.g. mazes and similar paper and pencil tasks).Neuropsychological testing occurred at 2 time points: baseline (pre-training) and follow-up (post-training). Completion of our neuropsychological test battery required approximately 100 min. This battery was selected to index all major cognitive domains, and to have a sufficient range of difficulty, i.e. floor and ceiling effects. The Neuropsychiatric Inventory2 and the Disability Assessment for Dementia3 were also scored to assess functional behaviour and activities of daily living (ADLs). Results: Participants demonstrated improvement upon post-training neuropsychological evaluation, compared to pre-training. Importantly, for some patients the pre-training to post-training improvement in scores was from the impaired range to within normal limits. In addition, patients also demonstrated significant positive changes on a number of the training procedures. Conclusions: Providing regular and challenging cognitive training tasks for AD patients can lead to positive improvements in cognitive and functional performances.
Plenary: PL-02: Challenges for The Detection of Dementia In Culturally, Racially and Ethnically Diverse Populations
at baseline, and 2, 4, and 8 year follow-up. In an ancillary project, sleep complaints were assessed at baseline by a face-to-face standardized interview with a sleep questionnaire. We analyzed data on 4894 non-demented subjects: 1) with complete sleep questionnaires; 2) having a Mini Mental Status Examination (MMSE) score 24 points at baseline; 3) with at least one follow up and no missing covariate data. Incident cognitive decline was defined as a 4-point reduction in MMSE score during follow-up. Logistic regression models were adjusted for sociodemographic, behavioral, physical and mental health variables, prescribed sleep medication and APOE genotype. Results: EDS, reported by 17.9% of subjects, independently increased the risk of cognitive decline (OR ¼ 1.26, 95% CI ¼ 1.02-1.56) while difficulty in maintaining sleep (63.5% of subjects) was negatively associated (OR ¼ 0.81 95% CI ¼ 0.68-0.96, respectively). The three others components of insomnia (poor sleep quality, 12.4% ;difficulty in initiating sleep, 33.8% ; early morning awakening, 35.7%) were not significantly associated with decline on the MMSE. Conclusions: Our results show that EDS may be associated independently with the risk of cognitive decline in the elderly population. These results suggest that EDS may be considered as an early unspecific neurological predictor of incident cognitive decline and that sleep complaint should be adequately evaluated in older persons. F2-03-04
CIRCADIAN PATTERNS OF BETA-AMYLOID IN HUMAN CEREBROSPINAL FLUID AND PLASMA
Yafei Huang, Randall Bateman, Washington University School of Medicine, St. Louis, Missouri, United States. Background: The amyloid hypothesis predicts that increased production or decreased clearance of amyloid-beta (Ab) leads to amyloidosis, which ultimately culminates in Alzheimer’s disease (AD). Changes in amyloid proteins, such as decreased cerebrospinal fluid (CSF) Ab42 have been recognized as a biomarker for AD. However, the dynamics of Ab concentrations over time are not well understood. Methods: Hourly CSF and plasma samples were obtained over a 36-hour study period in three groups of human volunteers: a dementia group with amyloid deposition, an age-matched control group, and a younger control group. We investigated dynamic patterns of Ab peptides (Ab40 and Ab42 in CSF and plasma using bead-based Luminex XMAP assays), and Amyloid Precursor Protein (APP) (APP-^I6 and APP-b in CSF using ELISA assays). We then analyzed the effects of aging and amyloidosis on circadian patterns and correlations between CSF and plasma Ab peptides. Results: Circadian patterns were observed in CSF and plasma Ab, with decreased amplitudes with aging. Further, CSF APP also demonstrated a circadian pattern. No significant correlations were found between plasma and CSF Ab levels on an hourly or individual basis. We also found that CSF APP^I6, APPb, Ab40, and Ab42 are highly positively correlated in all participants without amyloidosis. However, in participants with amyloidosis, there is no correlation of Ab42 to the other APP metabolites, suggesting that normal physiologic regulation of CSF Ab42 is impaired in the presence of amyloidosis. Conclusions: This study suggests amyloid proteins in both central and peripheral compartments are dynamic, and regulated in a circadian pattern that is part of the normal dynamic physiologic control of Ab concentrations. Regulatory mechanisms of these proteins may be altered with aging and amyloidosis. The lack of correlation of plasma and CSF Ab levels suggest plasma Ab concentrations can not be used for surrogates of central Ab concentrations. These findings support an active circadian regulation of Ab and may provide insight into the pathophysiological changes in AD. PLENARY: PL-02 CHALLENGES FOR THE DETECTION OF DEMENTIA IN CULTURALLY, RACIALLY AND ETHNICALLY DIVERSE POPULATIONS PL-02-01
IMPROVING QUALITY OF LIFE FOR PEOPLE WITH DEMENTIA IN THE COMMUNITY
Linda Teri, University of Washington, Seattle, Washington, United States. Behavioral problems are prevalent among persons with AD and significantly impair their health, well-being, and quality of life; our ability to provide
effective care; and the life of their caregivers. Despite this, effective pharmacological treatments are of questionable utility. Indeed, experts and guidelines from various professional associations agree that medications are “the last resort” and nonpharmacological strategies should be implemented first. This keynote will provide an overview on the state-of-the-science for nonpharmacological treatment of persons with AD and their caregivers. Despite major advances in recent years, the rate of knowledge acquisition and dissemination is seriously hindered by ever dwindling funds on both national and international levels. Recent findings from the Seattle Protocols, a series of systematic randomized controlled clinical trials designed to reduce behavioral problems in persons with Alzheimer’s disease via education, support and skill-training of their caregivers, will be discussed. The goal of these studies is to establish conceptually sound and clinically relevant treatment approaches and to evaluate their effectiveness along the diverse continuum of environments in which older adults reside and receive care (e.g., private homes, retirement communities, assisted-living residences, adult family homes, and skilled nursing facilities). Translated in over a dozen languages, employed in countries around the world, and states across the U.S., it is hoped that these programs offer a solid platform for advancing our knowledge of how best to improve the care of those suffering from Alzheimer’s Disease and helping those dedicated to providing that care. PL-02-02
CHALLENGES FOR THE DETECTION OF DEMENTIA IN CULTURALLY, RACIALLY AND ETHNICALLY DIVERSE POPULATIONS
Jennifer Manly1, Adam Brickman2, M. Maria Glymour3, Karen Siedlecki4, Beyon Miloyan5, Richard Mayeux1, Nicole Schupf1, 1Columbia University Medical Center, New York, New York, United States; 2Columbia University, New York, New York, United States; 3Harvard School of Public Health, Boston, Massachusetts, United States; 4Fordham University, New York, New York, United States; 5California State University Northridge, Northridge, California, United States. Background: Studies have shown a higher prevalence and incidence of Alzheimer’s Disease (AD) among African Americans and Latinos than non-Hispanic Whites. Early and accurate detection of cognitive impairment in diverse populations is therefore of tremendous significance as the search for neuropsychological, imaging, and genetic markers of early dementia intensifies. This plenary will discuss challenges and present potential solutions and recommendations for addressing key gaps in knowledge about dementia among ethnically diverse groups. Methods: The accuracy of early detection of dementia among ethnically diverse older adults was investigated among large cohorts of African American, Latino, and White participants in longitudinal research studies of risks for cognitive impairment and AD. Neuropsychological measures of memory, executive function, language, visuospatial skill, and attention were administered, and the basis for their use across groups was established using tests of measurement invariance. Measures of acculturation and language proficiency were employed among US-born and immigrant groups. Childhood educational experience was assessed using measures of quality of schooling, achievement, and literacy level. Structural MRI of the brain was completed in order to characterize level of cerebrovascular disease burden, and markers of hyperinsulinemia, inflammation, and cardiovascular health were collected, as was APOE E4 allele status. Results: A common factor structure captured most of the variability in neuropsychological test scores and was invariant across language, ethnic group, and diagnostic group. Educational experience, including quality of schooling, setting and location of school, achievement, and reading level were very powerful predictors of cognitive decline and accounting for these variables improved specificity of neuropsychological measures for detection of cognitive impairment. African Americans and Latinos had a higher burden of cerebrovascular and cardiovascular disease, and the role of these factors as mediators of the relationship between educational experience and cognition was examined. Conclusions: There are many challenges for the accurate and early detection of cognitive impairment among ethnically diverse groups, but recent research suggests that a lifecourse
Oral Sessions: O2-01: Social-Behavioral and Care Research and Practice: Cognitive Training and Physical Exercise Interventions approach, taking into account the educational and health experiences of diverse people can help to identify early and accurate markers of cognitive decline and dementia.
ORAL SESSIONS: O2-01 SOCIAL-BEHAVIORAL AND CARE RESEARCH AND PRACTICE: COGNITIVE TRAINING AND PHYSICAL EXERCISE INTERVENTIONS O2-01-01
KNOWLEDGE-TRANSFER FOLLOWING COGNITIVE INTERVENTION FOR AMNESTIC MILD COGNITIVE IMPAIRMENT
Glynda Kinsella1, David Ames2, Elsdon Storey3, Ben Ong1, Kerryn Pike1, Elizabeth Mullaly4, Elizabeth Rand4, Linda Clare5, Michael Saling6, Samuel Parsons1, 1La Trobe University, Melbourne, Australia; 2National Ageing Research Institute Melbourne, Parkville, Australia; 3Monash University, Melbourne, Australia; 4Caulfield Hospital, Melbourne, Australia; 5Bangor University, Bangor, United Kingdom; 6University of Melbourne, Melbourne, Australia. Background: Many people with amnestic mild cognitive impairment (aMCI) seek guidance about how best to manage everyday memory challenges. Building upon positive pilot study results, we investigated response to a six-week cognitive-behavioural intervention for aMCI. The program (the LaTCH Memory Group Program) focuses on providing knowledge about memory strategies and how to use such strategies in everyday activities. It is based on the expectation that people experiencing memory difficulties need assistance in learning and implementing effective compensatory strategies in everyday situations. This offers an alternative approach to ‘brain training’ or practice on memory tasks. Methods: In a randomised controlled trial, 220 older adults, either diagnosed with aMCI or agematched healthy older adults (HOA), were randomly allocated to early or late intervention. Over three years, we trained allied health professionals to deliver the intervention which was provided through 40 memory groups at locations throughout Melbourne and regional centres in Victoria, Australia. Results: Following intervention, both HOA and aMCI groups (i) improved knowledge about memory strategies and when to use them (d ¼ 0.50); (ii) improved contentment and self-efficacy about memory ability (d ¼ 1.22); (iii) improved self-report of everyday memory ability, (d ¼ 0.54), e.g. remembering to return a missed telephone call; (iv) improved achievement of personal memory goals, (d ¼ 0.28), e.g., learning people’s names in a yoga class. Nevertheless, these significant changes were not reflected in performance on neuropsychological tests of memory. A further benefit was that family members, accompanying relatives with aMCI, significantly improved their memory strategy knowledge (d ¼ 1.23). Conclusions: The ability of participants (HOA and aMCI) to achieve self-determined memory-based goals after intervention was the most critical outcome of the study as it opens up opportunity for people to engage in more life activities and more socialising, adding to the cycle of improving mental health. Reasons for the discrepancy between improved memory strategy knowledge, personal memory goal achievement and lack of change on neuropsychological test performance will be discussed.
O2-01-02
SELF-EFFICACY FOR COGNITIVE REMEDIATION IN ALZHEIMER’S DISEASE
Jimmy Choi1, Joanna Fiszdon2, 1Columbia University, New York, New York, United States; 2Yale University School of Medicine, West Haven, Connecticut, United States. Background: Cognitive remediation (CR) for Alzheimer’s disease (AD) is becoming more readily available to the geriatric population in an attempt to curb the insidious decline in cognitive and functional performance. Patients with dementing pathology, however, may have difficulty adhering to these cognitive treatments due to denial of memory deficits, lack of motivation and apathy, or a sense of hopelessness which may be primarily due to illness or secondary to geriatric depression. For
P235
this reason, remediation techniques which incorporate motivational strategies to enhance treatment engagement and self efficacy may provide greater benefits than standard remediation training. Methods: Sixtynine outpatients diagnosed with mild to moderate Alzheimer’s disease were randomly assigned to 3 months of (1) computer-based memory training (MT), or (2) Cognitive Vitality Training (CVT), the same memory training but contextualized in a milieu specifically designed to increase adherence to treatment by reducing the sense of hopelessness, enhancing motivation, and empowering patients to be actively involved in treatment. Assessments of cognitive function, quality of life, neuropsychiatric symptoms, activities of daily living, treatment adherence, motivation, and perceptions of self efficacy were conducted at intake, 2, 4, and 6 months. Results: Patients in CVT showed greater resistance to memory decline compared to MT at 6 months. Patients and caregivers in CVT both reported better quality of life and less overall depressive symptoms throughout the intervention. Interestingly, perceptions of self-efficacy for treatment predicted cognitive outcome, even after variance attributable to group assignment, baseline memory ability, overall dementia symptoms, and depressive symptoms were accounted for. Conclusions: This suggest that while patients recently diagnosed with AD (and their caregivers) experience a tremendous loss of control in their lives, therapies which strive to re-introduce elements of control and self-efficacy through intrinsic motivation may offer psychological as well as neuropsychological benefits. Applying these findings to a more preventive approach in the prodromal stages of dementia (mild cognitive impairment) will also be discussed. O2-01-03
TRAINING THE BRAIN: CAN COGNITIVE TRAINING ALTER THE GLOBAL EFFECTS OF ALZHEIMER’S DISEASE?
William Tippett, Mireille Rizkalla, University of Northern British Columbia, Prince George, British Columbia, Canada. Background: There is a growing need for novel behavioural interventions such as cognitive training that can benefit clinically vulnerable populations, such as people living with Alzheimer’s disease (AD). Specifically, the potential for neural plasticity, which is the ability of the brain to adapt to changes at a cellular and molecular level, may still be present after trauma or neurodegeneration, particularly in the early stages of a disease. Consequently, there is great interest in the potential for neurologically compromised individuals, such as AD patients, to adapt to new challenges through neural plasticity and altered brain chemistry. Cognitive training (CT) for AD patients is a relatively new area of research however; recent evidence suggests that techniques such as CT may be effective way in stabilising and even enhancing cognition in mild AD1, perhaps through neuronal plasticity. Methods: Six participants diagnosed with probable or possible AD participated in a 14-week program consisting of twice-weekly on-site sessions of 2 hours each. Training tasks included: a visuomotor activity (Pac-man game playing), visuoconstructive procedures (e.g. Block design, 3-D puzzle construction), and a navigation task (finding on-site location using a map). Each participant also completed twice-weekly in-home sessions of 1 hour each, consisting primarily of visuospatial tasks (e.g. mazes and similar paper and pencil tasks).Neuropsychological testing occurred at 2 time points: baseline (pre-training) and follow-up (post-training). Completion of our neuropsychological test battery required approximately 100 min. This battery was selected to index all major cognitive domains, and to have a sufficient range of difficulty, i.e. floor and ceiling effects. The Neuropsychiatric Inventory2 and the Disability Assessment for Dementia3 were also scored to assess functional behaviour and activities of daily living (ADLs). Results: Participants demonstrated improvement upon post-training neuropsychological evaluation, compared to pre-training. Importantly, for some patients the pre-training to post-training improvement in scores was from the impaired range to within normal limits. In addition, patients also demonstrated significant positive changes on a number of the training procedures. Conclusions: Providing regular and challenging cognitive training tasks for AD patients can lead to positive improvements in cognitive and functional performances.