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Neuropsychiatric Syndromes in Dementia and MCI: Where are We Heading?
S278
Symposia S2-01: Innovations in Nonpharmacological Interventions to Support Well-Being in Mild Cognitive Impairment and Dementia
MONDAY, JULY 18, 2011 PLENARY PL-02 PL-02-01
NEUROPSYCHIATRIC SYNDROMES IN DEMENTIA AND MCI: WHERE ARE WE HEADING?
search and identifying promising treatments. Challenges ahead include improving our understanding of effective treatments, testing treatments on different populations of family caregivers, and making treatment more widely available. PL-02-03
Constantine Lyketsos, Johns Hopkins Medicine, Baltimore, Md., United States. Background: Neuropsychiatric syndromes (NPS) are nearly universal in patients with dementia, and are now recognized as being common in the dementia prodromes, especially MCI, where they are associated with notably increased risk of transition to dementia. Their serious adverse impact on patients and caregivers is widely recognized which has made them a major focus of treatment in clinical and research settings. Methods: Review of epidemiologic and clinical data. Results: This presentation will overview the epidemiology of NPS and discuss their measurement and classification, emphasizing the need for new ways to classify and treat NPS, through the use of biomarkers and based on evolving knowledge of pathogenesis looking to clues in neuropathology, genetics, and brain imaging. Brief mention will be made of a recently (2010) constituted Professional Interest Area (PIA) of ISTAART that is attempting to bring about paradigm change in this area. The study and treatment of these symptoms in the context of MCI will then be discussed as this may offer the best opportunity to understand pathogenesis and an opportunity to reduce dementia risk by developing treatments targeting these NPS at the MCI stage.
PL-02-02
REDUCING STRESS AND BURDEN OF FAMILY CAREGIVERS: EMPIRICAL FINDINGS AND NEW DIRECTIONS
Steven Zarit, Penn State University, University Park, Pe., United States. Background: Increasing evidence indicates that a variety of treatments to lower the burden on stress on family caregivers of persons with Alzheimer’s disease and other dementias offer meaningful relief. Although many past studies did not show promising results, efficacy was often compromised by methodological and implementation problems. New research approaches are overcoming these problems and offering more effective treatment strategies that make the management of burden and stress a realistic goal for family caregivers. Drawing on the empirical literature, I will identify features of successful treatments and suggest the challenges ahead for improving interventions and their dissemination. Methods: Controlled trials of treatment for caregivers will be reviewed, with a focus on efficacy of treatments, procedures used by effective interventions, and methodological issues critical to caregiver intervention research. Results: Empirically-validated interventions for family caregivers share several common features in content and process. Content usually includes: information about the disease and resources for managing it, improving understanding and coping with behavioral stressors, increasing family support, and increasing use of formal help. Process features of successful interventions include: collaborative goal setting, the use of a therapeutic change model, active psychological processes for learning and implementing new coping methods, multidimensional and flexible treatment approaches, and providing an adequate dosage of treatment. Findings show both immediate benefits, but more strikingly indicate continued positive effects over time, compared to caregivers in control groups. Future research needs to develop better approaches for systematic tailoring of interventions in order to address the heterogeneity among caregivers in exposure to stressors and in their responses. Tailoring needs to address both goals of treatment as well as which treatment modules are delivered. Research is needed to identify the effectiveness of specific modules to address risk factors and of various combinations of treatment modules. Early intervention and longer term follow up are keys for determining the potential benefits of treatment. Conclusions: There has been considerable progress in development of effective research strategies for caregiver treatment re-
SEING WHAT ALOIS ALZHEIMER COULDN’T SEE: THE UTILITY OF NEUROIMAGING IN TRACKING THE PROGRESSION OF ALZHEIMER’S DISEASE AND THE CHRONOLOGY OF EVENTS
Ga€el Chetelat, HE Universite de Caen, GIP Cyceron, CHU C^ote de Nacre France, Caen, France. Background: Improving our knowledge on the rate at which the brain shrinks, metabolism declines and ß-amyloid deposition accumulates over the course of Alzheimer’s disease (AD) provides essential tools to monitor the effects of new therapeutics. Moreover, the sequence of events and causal relationships between the different alterations is one of the most pressing questions in current AD research, as we need to identify the appropriate target for future therapeutic developments, i.e. the initial causal event. For these reasons, it is crucial to further our knowledge on the progression of AD-related pathological processes. Methods: The presentation will address the role of neuroimaging in identifying the main structural and functional brain alterations over the course of Alzheimer’s disease, with an emphasis on their progression and chronology. Results: The first part of the presentation will give an overview on where the pathology starts and how it progresses from longitudinal neuroimaging studies including structural and functional MRI, FDG-PET, and amyloid neuroimaging. The second part will tend to be more interpretative, first presenting the main models proposed for the sequence of alterations over the course of the disease. The different strategies used to test these models and more generally to address the question of chronology and causal relationships will then be introduced, and the few results obtained to date as first attempts to answer to this pressing question will be presented. Conclusions: Multimodal longitudinal neuroimaging explorations have been possible, then accessible, and are now available for analyses. There is no clear-cut response as regard to the chronology of events for now, but there are exciting avenues for the future as some pieces of the puzzle start to fit together. MONDAY, JULY 18, 2011 SYMPOSIA S2-01 INNOVATIONS IN NONPHARMACOLOGICAL INTERVENTIONS TO SUPPORT WELL-BEING IN MILD COGNITIVE IMPAIRMENT AND DEMENTIA S2-01-01
MEMORY MANAGEMENT IN MILD COGNITIVE IMPAIRMENT
Glynda Kinsella1, Ben Ong1, Kerryn Pike1, David Ames2, Elsdon Storey3, Samuel Parsons1, Elizabeth Mullaly4, Michael Saling2, Linda Clare5, 1 LaTrobe University, Melbourne, Victoria; 2Melbourne University, Parkville, Australia; 3Monash University, Melbourne, Australia; 4Caulfield Hospital, Melbourne, Australia; 5Bangor University, Bangor, United Kingdom. Background: Many people in the early stages of a dementia are seeking guidance about how best to manage memory challenges in everyday life. In evaluating cognitive interventions for older adults with increasing memory difficulties there is a need to use outcome measures that index memory performance in everyday activities. Many everyday activities rely on prospective memory, or remembering to perform intended actions, and prospective memory can provide a useful approach to measurement of everyday memory competence. Methods: We will report on our work in evaluating response to interventions for prospective memory impairments in mild cognitive impairment, including preliminary findings from our recently completed randomised controlled trial of cognitive intervention (six-week memory group) for 120 healthy older adults and 100
Symposia S2-01: Innovations in Nonpharmacological Interventions to Support Well-Being in Mild Cognitive Impairment and Dementia
MONDAY, JULY 18, 2011 PLENARY PL-02 PL-02-01
NEUROPSYCHIATRIC SYNDROMES IN DEMENTIA AND MCI: WHERE ARE WE HEADING?
search and identifying promising treatments. Challenges ahead include improving our understanding of effective treatments, testing treatments on different populations of family caregivers, and making treatment more widely available. PL-02-03
Constantine Lyketsos, Johns Hopkins Medicine, Baltimore, Md., United States. Background: Neuropsychiatric syndromes (NPS) are nearly universal in patients with dementia, and are now recognized as being common in the dementia prodromes, especially MCI, where they are associated with notably increased risk of transition to dementia. Their serious adverse impact on patients and caregivers is widely recognized which has made them a major focus of treatment in clinical and research settings. Methods: Review of epidemiologic and clinical data. Results: This presentation will overview the epidemiology of NPS and discuss their measurement and classification, emphasizing the need for new ways to classify and treat NPS, through the use of biomarkers and based on evolving knowledge of pathogenesis looking to clues in neuropathology, genetics, and brain imaging. Brief mention will be made of a recently (2010) constituted Professional Interest Area (PIA) of ISTAART that is attempting to bring about paradigm change in this area. The study and treatment of these symptoms in the context of MCI will then be discussed as this may offer the best opportunity to understand pathogenesis and an opportunity to reduce dementia risk by developing treatments targeting these NPS at the MCI stage.
PL-02-02
REDUCING STRESS AND BURDEN OF FAMILY CAREGIVERS: EMPIRICAL FINDINGS AND NEW DIRECTIONS
Steven Zarit, Penn State University, University Park, Pe., United States. Background: Increasing evidence indicates that a variety of treatments to lower the burden on stress on family caregivers of persons with Alzheimer’s disease and other dementias offer meaningful relief. Although many past studies did not show promising results, efficacy was often compromised by methodological and implementation problems. New research approaches are overcoming these problems and offering more effective treatment strategies that make the management of burden and stress a realistic goal for family caregivers. Drawing on the empirical literature, I will identify features of successful treatments and suggest the challenges ahead for improving interventions and their dissemination. Methods: Controlled trials of treatment for caregivers will be reviewed, with a focus on efficacy of treatments, procedures used by effective interventions, and methodological issues critical to caregiver intervention research. Results: Empirically-validated interventions for family caregivers share several common features in content and process. Content usually includes: information about the disease and resources for managing it, improving understanding and coping with behavioral stressors, increasing family support, and increasing use of formal help. Process features of successful interventions include: collaborative goal setting, the use of a therapeutic change model, active psychological processes for learning and implementing new coping methods, multidimensional and flexible treatment approaches, and providing an adequate dosage of treatment. Findings show both immediate benefits, but more strikingly indicate continued positive effects over time, compared to caregivers in control groups. Future research needs to develop better approaches for systematic tailoring of interventions in order to address the heterogeneity among caregivers in exposure to stressors and in their responses. Tailoring needs to address both goals of treatment as well as which treatment modules are delivered. Research is needed to identify the effectiveness of specific modules to address risk factors and of various combinations of treatment modules. Early intervention and longer term follow up are keys for determining the potential benefits of treatment. Conclusions: There has been considerable progress in development of effective research strategies for caregiver treatment re-
SEING WHAT ALOIS ALZHEIMER COULDN’T SEE: THE UTILITY OF NEUROIMAGING IN TRACKING THE PROGRESSION OF ALZHEIMER’S DISEASE AND THE CHRONOLOGY OF EVENTS
Ga€el Chetelat, HE Universite de Caen, GIP Cyceron, CHU C^ote de Nacre France, Caen, France. Background: Improving our knowledge on the rate at which the brain shrinks, metabolism declines and ß-amyloid deposition accumulates over the course of Alzheimer’s disease (AD) provides essential tools to monitor the effects of new therapeutics. Moreover, the sequence of events and causal relationships between the different alterations is one of the most pressing questions in current AD research, as we need to identify the appropriate target for future therapeutic developments, i.e. the initial causal event. For these reasons, it is crucial to further our knowledge on the progression of AD-related pathological processes. Methods: The presentation will address the role of neuroimaging in identifying the main structural and functional brain alterations over the course of Alzheimer’s disease, with an emphasis on their progression and chronology. Results: The first part of the presentation will give an overview on where the pathology starts and how it progresses from longitudinal neuroimaging studies including structural and functional MRI, FDG-PET, and amyloid neuroimaging. The second part will tend to be more interpretative, first presenting the main models proposed for the sequence of alterations over the course of the disease. The different strategies used to test these models and more generally to address the question of chronology and causal relationships will then be introduced, and the few results obtained to date as first attempts to answer to this pressing question will be presented. Conclusions: Multimodal longitudinal neuroimaging explorations have been possible, then accessible, and are now available for analyses. There is no clear-cut response as regard to the chronology of events for now, but there are exciting avenues for the future as some pieces of the puzzle start to fit together. MONDAY, JULY 18, 2011 SYMPOSIA S2-01 INNOVATIONS IN NONPHARMACOLOGICAL INTERVENTIONS TO SUPPORT WELL-BEING IN MILD COGNITIVE IMPAIRMENT AND DEMENTIA S2-01-01
MEMORY MANAGEMENT IN MILD COGNITIVE IMPAIRMENT
Glynda Kinsella1, Ben Ong1, Kerryn Pike1, David Ames2, Elsdon Storey3, Samuel Parsons1, Elizabeth Mullaly4, Michael Saling2, Linda Clare5, 1 LaTrobe University, Melbourne, Victoria; 2Melbourne University, Parkville, Australia; 3Monash University, Melbourne, Australia; 4Caulfield Hospital, Melbourne, Australia; 5Bangor University, Bangor, United Kingdom. Background: Many people in the early stages of a dementia are seeking guidance about how best to manage memory challenges in everyday life. In evaluating cognitive interventions for older adults with increasing memory difficulties there is a need to use outcome measures that index memory performance in everyday activities. Many everyday activities rely on prospective memory, or remembering to perform intended actions, and prospective memory can provide a useful approach to measurement of everyday memory competence. Methods: We will report on our work in evaluating response to interventions for prospective memory impairments in mild cognitive impairment, including preliminary findings from our recently completed randomised controlled trial of cognitive intervention (six-week memory group) for 120 healthy older adults and 100