- Email: [email protected]
Specialization evolution of group homes for dementia-related care of adults with intellectual disabilities
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Podium Presentations: Tuesday, July 21, 2015
to have their memory evaluated, actual screening behaviors were more likely to occur in individuals with high self-efficacy for discussing memory problems, perceived accessibility to dementia services, already present preventive health behaviors, and a social support system. These constructs can be used to develop interventions to evaluate and improve cognitive health in African Americans. O3-08-04
INNOVATIVE HEALTH CARE MODELS FOR PERSONS WITH DEMENTIA: A COMPARISON OF OUR GERMAN AND AMERICAN EXPERIENCES
Jochen Rene Thyrian1, Michael A. LaMantia2, Cathy A. Alder2, Mary Guerriero Austrom2, Verena Leve3, Tilly Eichler4, Wolfgang Hoffmann4,5, Malaz M. Boustani6, Horst Christian Vollmar3, 1 German Center for Neurodegenerative Diseases, Greifswald, Germany; 2 IU Center for Aging Research, Indianapolis, IN, USA; 3Institute of General Practice, University of D€ usseldorf, D€usseldorf, Germany; 4DZNE, Greifswald, Germany; 5University Medicine Greifswald, Greifswald, Germany; 6Indiana University Center for Health Innovation and Implementation Science, Indianapolis, IN, USA. Contact e-mail: rene. [email protected]
about caregivers’ awareness and perceptions of these technologies. To address this question, we compare German and American caregivers’ awareness of and attitudes toward existing technologies, with a more detailed discussion of five emerging technologies. In-depth qualitative interviews were conducted with over 100 German and 34 US caregivers of individuals with AD. The interview results showed that, while awareness of existing technologies for dementia care in both samples was low, the American sample was more aware. Both samples preferred the same two emerging technologies, a GPS tracking system and a home health monitoring system, but Americans caregivers were generally more open to and accepting of new technologies than their German counterparts. Furthermore, both groups showed that the perceived usefulness of each technology was the most important predictor of acceptance, followed by the perceived ease of use, results which follow Davis’s model of technology acceptance (TAM). These cross cultural results are important for understanding the key role of technology awareness among AD caregivers in driving adoption, informing technology development and integrating technology into care.
Background: New and innovative models of care management have
been developed to improve the health of older adults with dementia. It is necessary, however, to examine whether elements of these best practice models can be effectively implemented in other countries, in very different health care systems. Methods: Qualitative comparison of different models for dementia care in primary care settings in the American and the German health care system. We compare the following practice models in our analysis: the “Aging Brain Care (ABC) Medical Home” (Indianapolis, IN, USA), the “Initiative dementia care in general Medicine (IDA)” and the “DelpHiMV-study (Dementia: life-and person centered help in Mecklenburg-Western Pomerania) models. Results: All 3 models include the following elements: (a) the use of home-based care (b) the selection and (c) training of a new type of front-line care provider. Programs like these show promise to meet the demands of a rapidly expanding population of vulnerable older adults. Conclusions: Innovative models in improving health of older adults are not easily transferred to other health care systems. However, there are common elements that can be identified between these programs. International exchange and collaboration can facilitate the transfer of ideas between health systems and improve the care that is provided to persons with dementia. O3-08-05
TECHNOLOGY IN DEMENTIA CARE: A CROSS-CULTURAL STUDY OF ACCEPTANCE
Birgit Kramer1,2, Olivia DaDalt2, Arielle A. Burstein2, Lisa A. D’Ambrosio2, Hans-Werner Wahl3, Joseph F. Coughlin2, 1Network Aging Research, Heidelberg, Germany; 2Massachusetts Institute of Technology, Cambridge, MA, USA; 3Institute of Psychology, Heidelberg University, Heidelberg, Germany. Contact e-mail: [email protected] Project Description: The demographic boom of aging adults worldwide has drastically increased projections of the number of older adults with dementia and Alzheimer’s disease (AD), which in turn means a greater demand for more family caregivers. Technology is often viewed as a solution to the caregiving dilemma – a way to improve care, reduce costs, and reduce the demand on caregivers all at once. A number of different technologies already exist that could potentially help with the care of someone with dementia, yet little is known
O3-08-06
SPECIALIZATION EVOLUTION OF GROUP HOMES FOR DEMENTIA-RELATED CARE OF ADULTS WITH INTELLECTUAL DISABILITIES
Matthew P. Janicki, University of Illinois at Chicago, Chicago, IL, USA. Contact e-mail: [email protected] Project Description: The US National Plan to Address Alzheimer’s Disease has recognized adults with intellectual disability (ID) as a special interest population. The National Task Group on Intellectual Disabilities (ID) and Dementia Practices has projected an increase in the number of adults with ID and dementia needing dementia-related care. As a result a public policy challenge is defining optimal care settings for this population after home-based care options are exhausted. Small dementia-capable group homes are a viable alternative which can provide for such long-term care. An opportunistic longitudinal study begun in 2010 and undertaken in a mid-western city examined the use of three such small group homes which were opened simultaneously. The study followed 15 adults with dementia (33% with Down syndrome) living in 3 co-located neighborhood group homes (2 of whom died and were replaced with new admissions) and a cohort of communitydwelling controls absent dementia. As dementia affects adults differentially, with respect to symptoms and decline pathways, it was hypothesized that given patterns of decline the level of care in such care homes would eventually be defined by residents’ residual functional skills and personal care needs. Changes in resident functioning were observed over time as were differentiations between group home residents with dementia and controls. One aim was to see if home specialization would occur. It was found that level of dementia care was affected by differences in complexity of impairments and co-incident conditions found in adults with ID and dementia. There were significant differences in the number of comorbidities, staff time devoted to specialized care, and frequency of occurrence of dementia-associated behaviors between dementia-care group home residents and controls. Residents with Down syndrome were younger and had significantly less comorbidities. Trending in specialization was evident of differentiation among the homes over four years (with respect to staff numbers, costs, and resident functional capacities). Agencies need to
Podium Presentations: Tuesday, July 21, 2015
consider the utility of matching incoming residents by stage of dementia impairment to maximize care outcomes. Results point to the need for specialization of homes to correspond with staging and impairment. TUESDAY, JULY 21, 2015 ORAL SESSIONS O3-09 NEUROIMAGING: CONNECTIVITY STUDIES O3-09-01
DIFFERENTIAL FUNCTIONAL DISRUPTION, HYPOMETABOLISM, AND ATROPHY BETWEEN VENTRAL AND DORSAL POSTERIOR CINGULATE CORTEX NETWORKS IN MILD COGNITIVE IMPAIRMENT AND ALZHEIMER’S DISEASE
Justine Mutlu1, Robin de Flores2, Clemence Tomadesso2, Brigitte Landeau2, Florence Mezenge2, Vincent de La Sayette3,4, Francis Eustache2, Ga€el Chetelat2, 1Inserm-EPHE-UCBN U1077, Caen, France; 2Inserm-EPHE-UCBN U1077, Caen, France; 3 Inserm-EPHE-UCBN U1077-CHU de Caen, Caen, France; 4CHU de Caen, U1077, Caen, France. Contact e-mail: [email protected] Background: The posterior cingulate cortex (PCC) is an important brain connectivity network hub which is particularly sensitive to AD. This heterogeneous structure can be subdivided into ventral (vPCC) and dorsal (dPCC) regions that showed distinct connectivity. The aim of the present work was to highlight functional connectivity (FC) disruption, atrophy, and hypometabolism within the vPCC and dPCC networks in patients with amnestic Mild Cognitive Impairment (aMCI) and AD. Methods: Forty-three healthy elderly (HE) (68.7 6 6 years), 34 aMCI (73.4 6 6.8) and 24 AD (70.9 6 9.1) patients underwent resting-state functional MRI, FDG-PET and anatomical T1-weighted MRI. FC maps from the vPCC and dPCC were obtained, and compared to identify the ventral and dorsal networks. Functional connectivity, gray matter volume and metabolism within each network were then compared between
Figure. Differential functional disruption (A), atrophy (B) and hypometabolism (C) between ventral and dorsal posterior cingulate cortex (PCC) networks in Mild Cognitive Impairment and Alzheimer disease. The ventral PCC network is in purple and the dorsal PCC network is in blue. For the three modalities, disruptions in the ventral PCC network are shown in red and disruptions in the dorsal PCC network are shown in green.
P237
groups. Results: In HE, the ventral network included the hippocampus and temporo-parietal regions, whereas the dorsal network involved the precuneus, supramarginal, anterior temporal and dorso-medial prefrontal regions. aMCi patients had impaired ventral network FC in the bilateral hippocampus while the dorsal network FC was preserved. . In AD, the ventral network FC disruption spread into the left parahippocampal and angular regions and the dorsal network FC was also affected in the right inferior middle temporal region. The ventral network was atrophied in bilateral hippocampus in aMCI and in the vPCC and angular regions as well in AD. The dorsal network was only atrophied in AD in the dPCC, bilateral supramarginal and temporal regions. By contrast, hypometabolism was already present in both the vPCC and the dPCC networks in aMCI patients and further extended to include the whole networks in patients with AD. Conclusions: The vPCC and dPCC connectivity networks are differentially sensitive to AD. In the vPCC network, FC disruption, atrophy and hypometabolism occur early (in aMCI patients) and amplify in AD. By contrast, the dPCC network is only hypometabolic in the aMCI stage and becomes atrophic and FC disrupted in AD. This suggests that atrophy and FC disruption spread from the ventral to the dorsal PCC networks while hypometabolism is not constrained by these networks. O3-09-02
AN EEG STUDY INTO FUNCTIONAL CONNECTIVITY AND HUBS IN ALZHEIMER’S DISEASE: WHAT’S GOING ON IN THE POSTERIOR REGIONS?
Marjolein M.A. Engels1,2, Cornelis J. Stam1,2, Wiesje M. van der Flier1,2, Philip Scheltens1,2, Hanneke de Waal1,2, Elisabeth C.W. van Straaten1,2, 1 VU University Medical Center, Amsterdam, Netherlands; 2Neuroscience Campus Amsterdam, Amsterdam, Netherlands. Contact e-mail: mm. [email protected] Background: Former electroencephalography (EEG) studies have shown that posterior brain regions of patients with Alzheimer’s disease (AD) have weaker functional connectivity than controls. Analyses of these brain networks have shown that posterior regions have a central role within the network. How the severity of the disease influences the role of these areas within the functional brain network, is insufficiently known. Methods: We studied resting-state EEG of 318 AD patients (categorized into three subgroups based on disease severity) and 133 agematched controls. Functional connectivity between EEG channels was estimated with the Phase Lag Index (PLI). From the PLI-based connectivity matrix, the minimum spanning tree (MST), a loopless network containing the connections with the highest PLI values, was derived. For each node (EEG channel) in the MST, the betweenness centrality (BC) was computed, which is a measure to quantify the relative importance of a node within the network. A node with a high BC value is assumed to be a hub. Multivariate linear models with PLI or BC values as dependent variables and the groups as continuous variables were used to estimate the p for trend. Results: Functional connectivity in the posterior brain regions in the alpha band decreased with increasing disease severity (p for trend <0.05). In addition, the global, anterior and central regions showed rising BC values with increasing disease severity while the BC of the posterior regions remained unchanged. This suggests that disruption of functional connectivity increases during the course of AD in the posterior region. As a result, all other regions relatively gain importance in the network. Thus, we found a gradual shift of
Podium Presentations: Tuesday, July 21, 2015
to have their memory evaluated, actual screening behaviors were more likely to occur in individuals with high self-efficacy for discussing memory problems, perceived accessibility to dementia services, already present preventive health behaviors, and a social support system. These constructs can be used to develop interventions to evaluate and improve cognitive health in African Americans. O3-08-04
INNOVATIVE HEALTH CARE MODELS FOR PERSONS WITH DEMENTIA: A COMPARISON OF OUR GERMAN AND AMERICAN EXPERIENCES
Jochen Rene Thyrian1, Michael A. LaMantia2, Cathy A. Alder2, Mary Guerriero Austrom2, Verena Leve3, Tilly Eichler4, Wolfgang Hoffmann4,5, Malaz M. Boustani6, Horst Christian Vollmar3, 1 German Center for Neurodegenerative Diseases, Greifswald, Germany; 2 IU Center for Aging Research, Indianapolis, IN, USA; 3Institute of General Practice, University of D€ usseldorf, D€usseldorf, Germany; 4DZNE, Greifswald, Germany; 5University Medicine Greifswald, Greifswald, Germany; 6Indiana University Center for Health Innovation and Implementation Science, Indianapolis, IN, USA. Contact e-mail: rene. [email protected]
about caregivers’ awareness and perceptions of these technologies. To address this question, we compare German and American caregivers’ awareness of and attitudes toward existing technologies, with a more detailed discussion of five emerging technologies. In-depth qualitative interviews were conducted with over 100 German and 34 US caregivers of individuals with AD. The interview results showed that, while awareness of existing technologies for dementia care in both samples was low, the American sample was more aware. Both samples preferred the same two emerging technologies, a GPS tracking system and a home health monitoring system, but Americans caregivers were generally more open to and accepting of new technologies than their German counterparts. Furthermore, both groups showed that the perceived usefulness of each technology was the most important predictor of acceptance, followed by the perceived ease of use, results which follow Davis’s model of technology acceptance (TAM). These cross cultural results are important for understanding the key role of technology awareness among AD caregivers in driving adoption, informing technology development and integrating technology into care.
Background: New and innovative models of care management have
been developed to improve the health of older adults with dementia. It is necessary, however, to examine whether elements of these best practice models can be effectively implemented in other countries, in very different health care systems. Methods: Qualitative comparison of different models for dementia care in primary care settings in the American and the German health care system. We compare the following practice models in our analysis: the “Aging Brain Care (ABC) Medical Home” (Indianapolis, IN, USA), the “Initiative dementia care in general Medicine (IDA)” and the “DelpHiMV-study (Dementia: life-and person centered help in Mecklenburg-Western Pomerania) models. Results: All 3 models include the following elements: (a) the use of home-based care (b) the selection and (c) training of a new type of front-line care provider. Programs like these show promise to meet the demands of a rapidly expanding population of vulnerable older adults. Conclusions: Innovative models in improving health of older adults are not easily transferred to other health care systems. However, there are common elements that can be identified between these programs. International exchange and collaboration can facilitate the transfer of ideas between health systems and improve the care that is provided to persons with dementia. O3-08-05
TECHNOLOGY IN DEMENTIA CARE: A CROSS-CULTURAL STUDY OF ACCEPTANCE
Birgit Kramer1,2, Olivia DaDalt2, Arielle A. Burstein2, Lisa A. D’Ambrosio2, Hans-Werner Wahl3, Joseph F. Coughlin2, 1Network Aging Research, Heidelberg, Germany; 2Massachusetts Institute of Technology, Cambridge, MA, USA; 3Institute of Psychology, Heidelberg University, Heidelberg, Germany. Contact e-mail: [email protected] Project Description: The demographic boom of aging adults worldwide has drastically increased projections of the number of older adults with dementia and Alzheimer’s disease (AD), which in turn means a greater demand for more family caregivers. Technology is often viewed as a solution to the caregiving dilemma – a way to improve care, reduce costs, and reduce the demand on caregivers all at once. A number of different technologies already exist that could potentially help with the care of someone with dementia, yet little is known
O3-08-06
SPECIALIZATION EVOLUTION OF GROUP HOMES FOR DEMENTIA-RELATED CARE OF ADULTS WITH INTELLECTUAL DISABILITIES
Matthew P. Janicki, University of Illinois at Chicago, Chicago, IL, USA. Contact e-mail: [email protected] Project Description: The US National Plan to Address Alzheimer’s Disease has recognized adults with intellectual disability (ID) as a special interest population. The National Task Group on Intellectual Disabilities (ID) and Dementia Practices has projected an increase in the number of adults with ID and dementia needing dementia-related care. As a result a public policy challenge is defining optimal care settings for this population after home-based care options are exhausted. Small dementia-capable group homes are a viable alternative which can provide for such long-term care. An opportunistic longitudinal study begun in 2010 and undertaken in a mid-western city examined the use of three such small group homes which were opened simultaneously. The study followed 15 adults with dementia (33% with Down syndrome) living in 3 co-located neighborhood group homes (2 of whom died and were replaced with new admissions) and a cohort of communitydwelling controls absent dementia. As dementia affects adults differentially, with respect to symptoms and decline pathways, it was hypothesized that given patterns of decline the level of care in such care homes would eventually be defined by residents’ residual functional skills and personal care needs. Changes in resident functioning were observed over time as were differentiations between group home residents with dementia and controls. One aim was to see if home specialization would occur. It was found that level of dementia care was affected by differences in complexity of impairments and co-incident conditions found in adults with ID and dementia. There were significant differences in the number of comorbidities, staff time devoted to specialized care, and frequency of occurrence of dementia-associated behaviors between dementia-care group home residents and controls. Residents with Down syndrome were younger and had significantly less comorbidities. Trending in specialization was evident of differentiation among the homes over four years (with respect to staff numbers, costs, and resident functional capacities). Agencies need to
Podium Presentations: Tuesday, July 21, 2015
consider the utility of matching incoming residents by stage of dementia impairment to maximize care outcomes. Results point to the need for specialization of homes to correspond with staging and impairment. TUESDAY, JULY 21, 2015 ORAL SESSIONS O3-09 NEUROIMAGING: CONNECTIVITY STUDIES O3-09-01
DIFFERENTIAL FUNCTIONAL DISRUPTION, HYPOMETABOLISM, AND ATROPHY BETWEEN VENTRAL AND DORSAL POSTERIOR CINGULATE CORTEX NETWORKS IN MILD COGNITIVE IMPAIRMENT AND ALZHEIMER’S DISEASE
Justine Mutlu1, Robin de Flores2, Clemence Tomadesso2, Brigitte Landeau2, Florence Mezenge2, Vincent de La Sayette3,4, Francis Eustache2, Ga€el Chetelat2, 1Inserm-EPHE-UCBN U1077, Caen, France; 2Inserm-EPHE-UCBN U1077, Caen, France; 3 Inserm-EPHE-UCBN U1077-CHU de Caen, Caen, France; 4CHU de Caen, U1077, Caen, France. Contact e-mail: [email protected] Background: The posterior cingulate cortex (PCC) is an important brain connectivity network hub which is particularly sensitive to AD. This heterogeneous structure can be subdivided into ventral (vPCC) and dorsal (dPCC) regions that showed distinct connectivity. The aim of the present work was to highlight functional connectivity (FC) disruption, atrophy, and hypometabolism within the vPCC and dPCC networks in patients with amnestic Mild Cognitive Impairment (aMCI) and AD. Methods: Forty-three healthy elderly (HE) (68.7 6 6 years), 34 aMCI (73.4 6 6.8) and 24 AD (70.9 6 9.1) patients underwent resting-state functional MRI, FDG-PET and anatomical T1-weighted MRI. FC maps from the vPCC and dPCC were obtained, and compared to identify the ventral and dorsal networks. Functional connectivity, gray matter volume and metabolism within each network were then compared between
Figure. Differential functional disruption (A), atrophy (B) and hypometabolism (C) between ventral and dorsal posterior cingulate cortex (PCC) networks in Mild Cognitive Impairment and Alzheimer disease. The ventral PCC network is in purple and the dorsal PCC network is in blue. For the three modalities, disruptions in the ventral PCC network are shown in red and disruptions in the dorsal PCC network are shown in green.
P237
groups. Results: In HE, the ventral network included the hippocampus and temporo-parietal regions, whereas the dorsal network involved the precuneus, supramarginal, anterior temporal and dorso-medial prefrontal regions. aMCi patients had impaired ventral network FC in the bilateral hippocampus while the dorsal network FC was preserved. . In AD, the ventral network FC disruption spread into the left parahippocampal and angular regions and the dorsal network FC was also affected in the right inferior middle temporal region. The ventral network was atrophied in bilateral hippocampus in aMCI and in the vPCC and angular regions as well in AD. The dorsal network was only atrophied in AD in the dPCC, bilateral supramarginal and temporal regions. By contrast, hypometabolism was already present in both the vPCC and the dPCC networks in aMCI patients and further extended to include the whole networks in patients with AD. Conclusions: The vPCC and dPCC connectivity networks are differentially sensitive to AD. In the vPCC network, FC disruption, atrophy and hypometabolism occur early (in aMCI patients) and amplify in AD. By contrast, the dPCC network is only hypometabolic in the aMCI stage and becomes atrophic and FC disrupted in AD. This suggests that atrophy and FC disruption spread from the ventral to the dorsal PCC networks while hypometabolism is not constrained by these networks. O3-09-02
AN EEG STUDY INTO FUNCTIONAL CONNECTIVITY AND HUBS IN ALZHEIMER’S DISEASE: WHAT’S GOING ON IN THE POSTERIOR REGIONS?
Marjolein M.A. Engels1,2, Cornelis J. Stam1,2, Wiesje M. van der Flier1,2, Philip Scheltens1,2, Hanneke de Waal1,2, Elisabeth C.W. van Straaten1,2, 1 VU University Medical Center, Amsterdam, Netherlands; 2Neuroscience Campus Amsterdam, Amsterdam, Netherlands. Contact e-mail: mm. [email protected] Background: Former electroencephalography (EEG) studies have shown that posterior brain regions of patients with Alzheimer’s disease (AD) have weaker functional connectivity than controls. Analyses of these brain networks have shown that posterior regions have a central role within the network. How the severity of the disease influences the role of these areas within the functional brain network, is insufficiently known. Methods: We studied resting-state EEG of 318 AD patients (categorized into three subgroups based on disease severity) and 133 agematched controls. Functional connectivity between EEG channels was estimated with the Phase Lag Index (PLI). From the PLI-based connectivity matrix, the minimum spanning tree (MST), a loopless network containing the connections with the highest PLI values, was derived. For each node (EEG channel) in the MST, the betweenness centrality (BC) was computed, which is a measure to quantify the relative importance of a node within the network. A node with a high BC value is assumed to be a hub. Multivariate linear models with PLI or BC values as dependent variables and the groups as continuous variables were used to estimate the p for trend. Results: Functional connectivity in the posterior brain regions in the alpha band decreased with increasing disease severity (p for trend <0.05). In addition, the global, anterior and central regions showed rising BC values with increasing disease severity while the BC of the posterior regions remained unchanged. This suggests that disruption of functional connectivity increases during the course of AD in the posterior region. As a result, all other regions relatively gain importance in the network. Thus, we found a gradual shift of