- Email: [email protected]
Researchers and frontotemporal dementia caregivers: Partnering for brain donation
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
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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
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