- Email: [email protected]
World Alzheimer report 2014: Dementia and risk reduction
Poster Presentations: P4
P4-151
WORLD ALZHEIMER REPORT 2014: DEMENTIA AND RISK REDUCTION
Marc Wortmann, Alzheimer’s Disease International, London, United Kingdom. Contact e-mail: [email protected] Background: Alzheimer’s Disease International launches a World Alzheimer Report since 2009 and these reports have been agenda setting on relevant issues for the public policy agenda. The 2014 report is touching on risk factors because of the growing evidence in this area and the links with other main chronic diseases like diabetes, heart diseases and cancer. We wanted to know what evidence there is to support more inclusion of dementia. Methods: The research group that was commissioned
examined the evidence for the existence of modifiable risk factors for dementia in four key domains; developmental, psychological and psychosocial, lifestyle and cardiovascular risk factors. Results: The report was launched on 17 September 2014 and shows there is persuasive evidence that the dementia risk for populations can be modified. The strongest evidence for possible causal associations with dementia are those of low education in early life, hypertension in midlife, and smoking and diabetes across the life course. Conclusions: Improved detection and treatment of diabetes and hypertension, and smoking cessation, should be prioritised, including for older adults who are rarely specifically targeted in prevention programs. Increased physical activity and reduction in levels of obesity are also important. Based on this evidence, brain health promotion messages should be integrated in public health promotion campaigns such as non-communicable disease (NCD) awareness campaigns or tobacco cessation campaigns, stressing that it’s never too late to make these changes.
P4-152
A CLINIC-BASED INTERVENTION TO ADDRESS HEARING LOSS AND COMMUNICATION DIFFICULTIES IN PATIENTS WITH DEMENTIA AND THEIR CAREGIVERS
Sara K. Mamo, Carrie Nieman, Olivia Nirmalasari, Allison Simpson, Esther Oh, Frank Lin, Johns Hopkins University, Baltimore, MD, USA. Contact e-mail: [email protected] Background: Communication difficulties related to age-related peripheral hearing loss can contribute to increased stress and fatigue for individuals with dementia and their caregivers. However, current treatment options for hearing loss in older adults require 4-5 dedicated visits to an audiologist’s office and w$2000-4000 in out-of-pocket expense. The purpose of this exploratory study is to test an affordable and accessible hearing rehabilitative intervention to improve communication, social engagement, and reduce caregiver burden for individuals with dementia. Methods: Participants with cognitive impairment and dementia and their caregivers participated in a two-hour intervention that involved provision of hearing loss education, communication strategies, and a low-cost, over-the-counter amplification device. The intervention and instruction centered on patient/caregiver communication goal(s) determined at the beginning of the intervention session. Outcomes included measures of depression, communication, neuropsychiatric symptoms, and caregiver burden assessed at baseline and onemonth post-intervention. Results: To date, three participant/caregiver dyads have completed the one-month follow-up. Patients ranged from 79-97 years (caregivers 65-71 years) with baseline MMSE scores (serial 7’s) ranging from 13-21. Qualitative feedback at one-month post-intervention indicated that caregivers reported improved communication and less frustration due to communica-
P837
tion difficulties. Preliminary data from the Cornell Depression Scale suggest reduction in depressive scores from baseline to one-month post-intervention. Continued recruitment and data collection are in progress. Conclusions: Preliminary results from this on-going pilot investigation suggest improved communication and reduced depressive symptoms with the implemented hearing loss intervention. Recruitment and data collection continue as well as efforts to further refine and manualize the intervention protocol to allow for dissemination and scalability.
P4-153
INFLUENCE OF VASCULAR BURDEN ON THE EFFECT OF DONEPEZIL IN PATIENTS WITH ALZHEIMER’S DISEASE
Takashi Yamazaki, Ken Nagata, Daiki Takano, Tetsuya Maeda, Research Institute for Brain and Blood Vessels, Akita, Japan. Contact e-mail: [email protected] Background: Although hypertension, diabetes, and dyslipidemia are now considered as vascular risk factors (VRFs) for Alzheimer’s disease (AD), it is unclear whether they influence on the effect of treatment in AD patients. We investigated the influence of VRFs on the evolution of cognitive decline in AD patients on Donepezil. Methods: The present study was based on 120 patients (37 men and 83 women) who were diagnosed according to the NINCDSADRDA criteria. All patients were treated with donepezil, and underwent laboratory testings, MRI and neuropsychological evaluation including MMSE which was repeated every year. The effect of donepezil was evaluated by comparing the MMSE scores between the baseline and follow-ups. According to the differences in MMSE scores, the patients were classified into 2 groups: those in whom MMSE score declined by more than 3 points per year (non-responders), and those in whom the reduction in MMSE score was less than 3 points per year (responders). Differential analysis was used for the evaluation of the relationship between the number of untreated VRFs and responsiveness to donepezil. Results: The mean reduction of MMSE score was 2 points per year although all patients were on donepezil. The baseline MMSE score correlated positively with HDL-cholesterol (p<0.05), and negatively with alcohol consumption (p<0.05). There was no difference in the age, educational carrier, body mass index, or MMSE at baseline between the two groups. The difference in MMSE score correlated negatively with the educational carrier and the number of untreated VRFs after 4 years (p<0.05). The number of untreated VRFs significantly influence on the effect of treatment with donepezil (p<0.05). Conclusions: The present results indicate that the efficient management of VRFs may contribute to the stabilization of cognitive function in elderly AD patients who are treated with donepezil.
P4-154
THE TAILORED ACTIVITIES PROGRAM (TAP) FOR THE MANAGEMENT OF FRONTOTEMPORAL DEMENTIA: A CASE STUDY
Claire M. O’Connor1, Lindy Clemson1, Henry Brodaty2, John R. Hodges3,4, Olivier Piguet3,4, Laura N. Gitlin5, Eneida Mioshi6, 1University of Sydney, Sydney, Australia; 2Dementia Collaborative Research Centre – Assessment and Better Care (DCRC-ABC), School of Psychiatry, UNSW Medicine, UNSW Australia, Sydney, Australia; 3University of New South Wales, Sydney, Australia; 4Neuroscience Research Australia, Sydney, Australia; 5 JHU School of Nursing, Baltimore, MD, USA; 6University of Cambridge, Cambridge, United Kingdom. Contact e-mail: [email protected]
P4-151
WORLD ALZHEIMER REPORT 2014: DEMENTIA AND RISK REDUCTION
Marc Wortmann, Alzheimer’s Disease International, London, United Kingdom. Contact e-mail: [email protected] Background: Alzheimer’s Disease International launches a World Alzheimer Report since 2009 and these reports have been agenda setting on relevant issues for the public policy agenda. The 2014 report is touching on risk factors because of the growing evidence in this area and the links with other main chronic diseases like diabetes, heart diseases and cancer. We wanted to know what evidence there is to support more inclusion of dementia. Methods: The research group that was commissioned
examined the evidence for the existence of modifiable risk factors for dementia in four key domains; developmental, psychological and psychosocial, lifestyle and cardiovascular risk factors. Results: The report was launched on 17 September 2014 and shows there is persuasive evidence that the dementia risk for populations can be modified. The strongest evidence for possible causal associations with dementia are those of low education in early life, hypertension in midlife, and smoking and diabetes across the life course. Conclusions: Improved detection and treatment of diabetes and hypertension, and smoking cessation, should be prioritised, including for older adults who are rarely specifically targeted in prevention programs. Increased physical activity and reduction in levels of obesity are also important. Based on this evidence, brain health promotion messages should be integrated in public health promotion campaigns such as non-communicable disease (NCD) awareness campaigns or tobacco cessation campaigns, stressing that it’s never too late to make these changes.
P4-152
A CLINIC-BASED INTERVENTION TO ADDRESS HEARING LOSS AND COMMUNICATION DIFFICULTIES IN PATIENTS WITH DEMENTIA AND THEIR CAREGIVERS
Sara K. Mamo, Carrie Nieman, Olivia Nirmalasari, Allison Simpson, Esther Oh, Frank Lin, Johns Hopkins University, Baltimore, MD, USA. Contact e-mail: [email protected] Background: Communication difficulties related to age-related peripheral hearing loss can contribute to increased stress and fatigue for individuals with dementia and their caregivers. However, current treatment options for hearing loss in older adults require 4-5 dedicated visits to an audiologist’s office and w$2000-4000 in out-of-pocket expense. The purpose of this exploratory study is to test an affordable and accessible hearing rehabilitative intervention to improve communication, social engagement, and reduce caregiver burden for individuals with dementia. Methods: Participants with cognitive impairment and dementia and their caregivers participated in a two-hour intervention that involved provision of hearing loss education, communication strategies, and a low-cost, over-the-counter amplification device. The intervention and instruction centered on patient/caregiver communication goal(s) determined at the beginning of the intervention session. Outcomes included measures of depression, communication, neuropsychiatric symptoms, and caregiver burden assessed at baseline and onemonth post-intervention. Results: To date, three participant/caregiver dyads have completed the one-month follow-up. Patients ranged from 79-97 years (caregivers 65-71 years) with baseline MMSE scores (serial 7’s) ranging from 13-21. Qualitative feedback at one-month post-intervention indicated that caregivers reported improved communication and less frustration due to communica-
P837
tion difficulties. Preliminary data from the Cornell Depression Scale suggest reduction in depressive scores from baseline to one-month post-intervention. Continued recruitment and data collection are in progress. Conclusions: Preliminary results from this on-going pilot investigation suggest improved communication and reduced depressive symptoms with the implemented hearing loss intervention. Recruitment and data collection continue as well as efforts to further refine and manualize the intervention protocol to allow for dissemination and scalability.
P4-153
INFLUENCE OF VASCULAR BURDEN ON THE EFFECT OF DONEPEZIL IN PATIENTS WITH ALZHEIMER’S DISEASE
Takashi Yamazaki, Ken Nagata, Daiki Takano, Tetsuya Maeda, Research Institute for Brain and Blood Vessels, Akita, Japan. Contact e-mail: [email protected] Background: Although hypertension, diabetes, and dyslipidemia are now considered as vascular risk factors (VRFs) for Alzheimer’s disease (AD), it is unclear whether they influence on the effect of treatment in AD patients. We investigated the influence of VRFs on the evolution of cognitive decline in AD patients on Donepezil. Methods: The present study was based on 120 patients (37 men and 83 women) who were diagnosed according to the NINCDSADRDA criteria. All patients were treated with donepezil, and underwent laboratory testings, MRI and neuropsychological evaluation including MMSE which was repeated every year. The effect of donepezil was evaluated by comparing the MMSE scores between the baseline and follow-ups. According to the differences in MMSE scores, the patients were classified into 2 groups: those in whom MMSE score declined by more than 3 points per year (non-responders), and those in whom the reduction in MMSE score was less than 3 points per year (responders). Differential analysis was used for the evaluation of the relationship between the number of untreated VRFs and responsiveness to donepezil. Results: The mean reduction of MMSE score was 2 points per year although all patients were on donepezil. The baseline MMSE score correlated positively with HDL-cholesterol (p<0.05), and negatively with alcohol consumption (p<0.05). There was no difference in the age, educational carrier, body mass index, or MMSE at baseline between the two groups. The difference in MMSE score correlated negatively with the educational carrier and the number of untreated VRFs after 4 years (p<0.05). The number of untreated VRFs significantly influence on the effect of treatment with donepezil (p<0.05). Conclusions: The present results indicate that the efficient management of VRFs may contribute to the stabilization of cognitive function in elderly AD patients who are treated with donepezil.
P4-154
THE TAILORED ACTIVITIES PROGRAM (TAP) FOR THE MANAGEMENT OF FRONTOTEMPORAL DEMENTIA: A CASE STUDY
Claire M. O’Connor1, Lindy Clemson1, Henry Brodaty2, John R. Hodges3,4, Olivier Piguet3,4, Laura N. Gitlin5, Eneida Mioshi6, 1University of Sydney, Sydney, Australia; 2Dementia Collaborative Research Centre – Assessment and Better Care (DCRC-ABC), School of Psychiatry, UNSW Medicine, UNSW Australia, Sydney, Australia; 3University of New South Wales, Sydney, Australia; 4Neuroscience Research Australia, Sydney, Australia; 5 JHU School of Nursing, Baltimore, MD, USA; 6University of Cambridge, Cambridge, United Kingdom. Contact e-mail: [email protected]