- Email: [email protected]
MIND-BODY RCTs TO IMPROVE COGNITIVE FUNCTION IN OLDER ADULTS: CONTRIBUTIONS TO POSITIVE AND NEGATIVE RESULTS
P594
P1-415
Poster Presentations: Sunday, July 24, 2016
SLEEP QUALITY IS ASSOCIATED WITH FUNCTIONAL CONNECTIVITY OF MEDIAL PREFRONTAL CORTEX IN HEALTHY MIDDLEAGED ADULTS
Zhuang Song1, Michael Scullin2, Denise C. Park1, 1University of Texas at Dallas, Dallas, TX, USA; 2Baylor University, Waco, TX, USA. Contact e-mail: [email protected] Background: Sleep may play an important role in aging and Alzheimer’s disease (AD). Medial prefrontal cortex (mPFC) is important for slow wave sleep and memory consolidation but also vulnerable to early amyloid deposition. We hypothesized that poor sleep quality, as early as middle age, could affect functional connectivity of mPFC in cognitively normal adults. Methods: Cognitively normal middle-age adults (aged 40-59, MMSE¼2630, N¼17) were enrolled from the Dallas Lifespan Brain Study. We assessed sleep quality with the global score of the Pittsburgh Sleep Quality Index (PSQI). Whole brain resting-state fMRI data were acquired and preprocessed with standard procedures. Seedbased functional connectivity of bilateral mPFC was measured in the whole brain using Pearson’s correlation of the entire time series. General linear modeling was used to assess the relationship between sleep quality and the mPFC connectivity, for which age was controlled (false discovery correction for clusters, p<0.05). Results: As expected, poor sleep quality was related to the mPFC connectivity. Specifically we found decreased connectivity between mPFC and a cluster region in bilateral orbitofrontal cortex (7974.75 mm3). Additionally, poor sleep quality was associated with greater mPFC connectivity to cluster regions in bilateral supplementary motor area (6131.13 mm3), left superior frontal cortex (4930.63 mm3), and bilateral precuneus (3558.63 mm3). A further confirmation of the reported effects was provided by a post-hoc analysis that the mPFC connectivity to all the four cluster regions was significantly associated with the sleep quality score (R2>0.46; p<0.005), when age was controlled. The sleep quality score was not associated with any cognitive measures (p>0.25). Conclusions: Poor sleep quality in cognitively normal middleaged adults was associated with decreased intrinsic functional connectivity of mPFC to the orbitofrontal cortex, and with increased connectivity to supplementary motor, superior frontal, and precuneus. All of these frontal regions as well as the precuneus are important memory structures. Connectivity differences related to poor sleep quality in middle-aged could be an early link between sleep disturbance and AD-related neuropathology later in life. Further studies are need to confirm these findings.
P1-416
MIND-BODY RCTS TO IMPROVE COGNITIVE FUNCTION IN OLDER ADULTS: CONTRIBUTIONS TO POSITIVE AND NEGATIVE RESULTS
Barry Oken, Oregon Health & Science University, Portland, OR, USA. Contact e-mail: [email protected] Background: Psychological stress is common in the population and
there is evidence that it contributes to age-related cognitive decline and dementia. Mind-body medicine interventions are one approach to modify this risk factor and relevant studies have produced mixed results. Methods: Three already published studies by the presenter and one recently completed unpublished study were reviewed to understand variability in outcomes: 1) 135 50-85 year old healthy adults randomized to 6 months of weekly yoga or education class or wait-list control; 2) 31 dementia caregivers aged 45-85 years
old randomized to 2 months of weekly mindfulness meditation, education or respite-only control; 3) 40 65-85 year olds randomized to receive a pill (participants deceptively told it was an active drug being evaluated but was actually methylcellulose) or not to improve their cognitive function, and; 4) 134 at least mildly stressed 5085 year olds randomized to 2 months of weekly one-on-one mindfulness meditation with home practice or wait-list control Results: There is a consistent improvement in self-rated mental health measures across the studies with greater improvements in those with worse mental health at baseline. Cognitive function was only improved in those with very high levels of stress (caregivers) and in those where expectancy was experimentally manipulated to maximize it (placebo effect study). Conclusions: Future mindbody trials targeting cognitive function in older adults will need to refine the target population and the assessment of cognitive function. Adapting the mind-body intervention to be most suitable for the older population is also critical. P1-417
ADVANCED CARE PLANNING IN PATIENTS WITH NEUROCOGNITIVE IMPAIRMENT: STARTING THE CONVERSATION EARLY TO RESPECT THEIR CHOICES LATER
Nathaniel A. Chin, Robert J. Przybelski, University of Wisconsin, Madison, WI, USA. Contact e-mail: [email protected] Background: Alzheimer’s disease is an invariably fatal condition.
Many patients, however, die outside of their homes with aggressive, non-terminal care including CPR and feeding tubes. Furthermore, patients with Alzheimer’s disease are less likely to have advanced directives (AD) on admission and undergo fewer goals of care discussions, likely resulting in this undesirable care. Advanced care planning (ACP) should therefore start early in the management process. Methods: Chart analysis was conducted of all University of Wisconsin Geriatrics memory clinic initial consultation visits from 9/1/15-11/1/15. Documentation was reviewed for neurocognitive impairment diagnosis, presence of AD before and after clinic visits, and ACP discussion. Data was analyzed to determine percentages of patients presenting to clinic with ADs on file, filing of the ADs after clinic, and discussing ACP during visit. When possible, subsequent brief interviews were conducted with some patients and families regarding barriers to completing ADs and scheduling ACP meetings. Results: There were 101 new Memory Clinic consultations from 9/1/15-11/1/15. 82.2% of patients were diagnosed with neurocognitive impairment. 33.7% of patients diagnosed with neurocognitive impairment had an AD prior to clinic. 9.1% of patients diagnosed with neurocognitive impairment without an AD on file obtained one after leaving the clinic. Three percent of total patients presenting to the Memory Clinic without an AD eventually obtained one. The Memory Clinic discussed ACP with 17.8% of all patients. The most common perceived barriers to obtaining an AD included lack of understanding the forms, lack of time in clinic to fill out forms, and believing they already had one completed at home. Conclusions: Despite evidence for the importance of AD and ACP in patients with dementia, a gap continues to exist in the initiation and implementation of these processes by front line care providers. As this study illustrates, even in a multidisciplinary university-based memory clinic, it has been difficult to both address ADs and facilitate the ACP process. Based on these results, the Memory Clinic has prepared three simple and efficient interventions that will be implemented to improve ACP rates.
P1-415
Poster Presentations: Sunday, July 24, 2016
SLEEP QUALITY IS ASSOCIATED WITH FUNCTIONAL CONNECTIVITY OF MEDIAL PREFRONTAL CORTEX IN HEALTHY MIDDLEAGED ADULTS
Zhuang Song1, Michael Scullin2, Denise C. Park1, 1University of Texas at Dallas, Dallas, TX, USA; 2Baylor University, Waco, TX, USA. Contact e-mail: [email protected] Background: Sleep may play an important role in aging and Alzheimer’s disease (AD). Medial prefrontal cortex (mPFC) is important for slow wave sleep and memory consolidation but also vulnerable to early amyloid deposition. We hypothesized that poor sleep quality, as early as middle age, could affect functional connectivity of mPFC in cognitively normal adults. Methods: Cognitively normal middle-age adults (aged 40-59, MMSE¼2630, N¼17) were enrolled from the Dallas Lifespan Brain Study. We assessed sleep quality with the global score of the Pittsburgh Sleep Quality Index (PSQI). Whole brain resting-state fMRI data were acquired and preprocessed with standard procedures. Seedbased functional connectivity of bilateral mPFC was measured in the whole brain using Pearson’s correlation of the entire time series. General linear modeling was used to assess the relationship between sleep quality and the mPFC connectivity, for which age was controlled (false discovery correction for clusters, p<0.05). Results: As expected, poor sleep quality was related to the mPFC connectivity. Specifically we found decreased connectivity between mPFC and a cluster region in bilateral orbitofrontal cortex (7974.75 mm3). Additionally, poor sleep quality was associated with greater mPFC connectivity to cluster regions in bilateral supplementary motor area (6131.13 mm3), left superior frontal cortex (4930.63 mm3), and bilateral precuneus (3558.63 mm3). A further confirmation of the reported effects was provided by a post-hoc analysis that the mPFC connectivity to all the four cluster regions was significantly associated with the sleep quality score (R2>0.46; p<0.005), when age was controlled. The sleep quality score was not associated with any cognitive measures (p>0.25). Conclusions: Poor sleep quality in cognitively normal middleaged adults was associated with decreased intrinsic functional connectivity of mPFC to the orbitofrontal cortex, and with increased connectivity to supplementary motor, superior frontal, and precuneus. All of these frontal regions as well as the precuneus are important memory structures. Connectivity differences related to poor sleep quality in middle-aged could be an early link between sleep disturbance and AD-related neuropathology later in life. Further studies are need to confirm these findings.
P1-416
MIND-BODY RCTS TO IMPROVE COGNITIVE FUNCTION IN OLDER ADULTS: CONTRIBUTIONS TO POSITIVE AND NEGATIVE RESULTS
Barry Oken, Oregon Health & Science University, Portland, OR, USA. Contact e-mail: [email protected] Background: Psychological stress is common in the population and
there is evidence that it contributes to age-related cognitive decline and dementia. Mind-body medicine interventions are one approach to modify this risk factor and relevant studies have produced mixed results. Methods: Three already published studies by the presenter and one recently completed unpublished study were reviewed to understand variability in outcomes: 1) 135 50-85 year old healthy adults randomized to 6 months of weekly yoga or education class or wait-list control; 2) 31 dementia caregivers aged 45-85 years
old randomized to 2 months of weekly mindfulness meditation, education or respite-only control; 3) 40 65-85 year olds randomized to receive a pill (participants deceptively told it was an active drug being evaluated but was actually methylcellulose) or not to improve their cognitive function, and; 4) 134 at least mildly stressed 5085 year olds randomized to 2 months of weekly one-on-one mindfulness meditation with home practice or wait-list control Results: There is a consistent improvement in self-rated mental health measures across the studies with greater improvements in those with worse mental health at baseline. Cognitive function was only improved in those with very high levels of stress (caregivers) and in those where expectancy was experimentally manipulated to maximize it (placebo effect study). Conclusions: Future mindbody trials targeting cognitive function in older adults will need to refine the target population and the assessment of cognitive function. Adapting the mind-body intervention to be most suitable for the older population is also critical. P1-417
ADVANCED CARE PLANNING IN PATIENTS WITH NEUROCOGNITIVE IMPAIRMENT: STARTING THE CONVERSATION EARLY TO RESPECT THEIR CHOICES LATER
Nathaniel A. Chin, Robert J. Przybelski, University of Wisconsin, Madison, WI, USA. Contact e-mail: [email protected] Background: Alzheimer’s disease is an invariably fatal condition.
Many patients, however, die outside of their homes with aggressive, non-terminal care including CPR and feeding tubes. Furthermore, patients with Alzheimer’s disease are less likely to have advanced directives (AD) on admission and undergo fewer goals of care discussions, likely resulting in this undesirable care. Advanced care planning (ACP) should therefore start early in the management process. Methods: Chart analysis was conducted of all University of Wisconsin Geriatrics memory clinic initial consultation visits from 9/1/15-11/1/15. Documentation was reviewed for neurocognitive impairment diagnosis, presence of AD before and after clinic visits, and ACP discussion. Data was analyzed to determine percentages of patients presenting to clinic with ADs on file, filing of the ADs after clinic, and discussing ACP during visit. When possible, subsequent brief interviews were conducted with some patients and families regarding barriers to completing ADs and scheduling ACP meetings. Results: There were 101 new Memory Clinic consultations from 9/1/15-11/1/15. 82.2% of patients were diagnosed with neurocognitive impairment. 33.7% of patients diagnosed with neurocognitive impairment had an AD prior to clinic. 9.1% of patients diagnosed with neurocognitive impairment without an AD on file obtained one after leaving the clinic. Three percent of total patients presenting to the Memory Clinic without an AD eventually obtained one. The Memory Clinic discussed ACP with 17.8% of all patients. The most common perceived barriers to obtaining an AD included lack of understanding the forms, lack of time in clinic to fill out forms, and believing they already had one completed at home. Conclusions: Despite evidence for the importance of AD and ACP in patients with dementia, a gap continues to exist in the initiation and implementation of these processes by front line care providers. As this study illustrates, even in a multidisciplinary university-based memory clinic, it has been difficult to both address ADs and facilitate the ACP process. Based on these results, the Memory Clinic has prepared three simple and efficient interventions that will be implemented to improve ACP rates.