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PO3. Medical and public health aspects

Detailed programme and abstracts

P03.1. Insight and awareness at the time of diagnosis and progression of dementia in Alzheimer’s disease patients

OLIVEROS CID Antonio1, SIERRA MARTINEZ Esther2, CANO LUQUE Laura2, CELORRIO LORENTE Victoria2, OVEJAS CATALAN Claudia2, JAIME FREGENAL Patricia2, GARCIA HOJAS Sarai2, OLIVEROS JUSTE Antonio3, CID LOPEZ Maria Angeles3

1Fundacion NEUROPOLIS, Zaragoza, Spain, 2PsyMS, Zaragoza, Spain, 3MD, PhD, Zaragoza, Spain

Introduction: Lack of awareness is a very common symptom in Alzheimer’s Disease (AD) patients, even from the first phases of the degree. We try to analyze the presence or absence or insight at the time of diagnosis, 12 months after, and to evaluate if it has any predictive value or influence in progression of the disease.

Objectives: Analytical, observational, prospective study, carried out in neurology outpatient clinic. All patients were assessed at the time of diagnosis and 12 months after by the same Neuroscience Unit (Neurology, Neuropsychology, Neurophysiology). Patients with mild to moderate dementia due to AD were included according to NIA-AA criteria. Cognitive scales (MMS and CAMCOG-R), disability (RDRS-2), neuropsychiatric (NPI-Q) and global (CDR-SOB) were evaluated at the time of diagnosis and at 12 months after. Clinical rating scales for insight were also used. 

Material and Methods: 62 patients (mean age at baseline 76 years; 66 % women, 32 % without formal studies; ApoE4+ 40.3 %,). Stratified by MMSE score, 25 patients (40.3 %) were diagnosed as “mild” (MMSE 21-26) and 37 patients (59.7 %) were considered “moderate” (MMSE 14-20). No moderately severe AD or severe AD patients were included in this study.

Results: Percentage of patients with preserved insight decreased from 35.4% at baseline to 27.4 % at 12 months. Absence of insight increased from 29 % to 35.5 %. A significant worsening was observed at 12 months in 29 % of patients with preserved consciousness and 33.9 % in those with lost insight.

Conclusion: Lost of insight /awareness about the deficit is frequent in AD at the time of diagnosis and worsens significantly in the following 12 months, and appears to deteriorate more intensively in patients with worst progression of the disease, although it is not associated with a significant worsening in overall functioning.

PO3.2. Utility of TAU-PET in individual cases of Alzheimer's disease patients

OLIVEROS CID Antonio1, CELORRIO LORENTE Victoria2, OVEJAS CATALAN Claudia2, CANO LUQUE Laura2, SIERRA MARTINEZ Esther2, UBIETO Miguel Angel3, GARCIA HOJAS Sarai2, JAIME FREGENAL Patricia2, CID LOPEZ Maria Angeles3, OLIVEROS JUSTE Antonio3

1Fundacion Neuropolis, Zaragoza, Spain, 2PsyMS, Zaragoza, Spain, 3MD, PhD, Zaragoza, Spain

Introduction: In several neurodegenerative diseases with “core” TAU pathology, like Alzheimer’s Disease (AD), progressive accumulation of TAU in the brain has been closely associated with neurodegeneration and cognitive impairment. Noninvasive detection of tau protein deposits in the brain would be useful to diagnose tauopathies as well as to track and predict disease progression in research studies. We try to describe PET-Tau results in patients diagnosed with Alzheimer's disease (AD) and analyze the relationship with the clinical presentation, individually analyzed for each patient.

Objectives: Descriptive, retrospective study, carried out on patients diagnosed with prodromal or mild AD and who underwent, after positive amyloid PET or LCR findings, a TAU-PET study and an extensive neuropsychological examination, including CDR and examination of 5 cognitive domains. Results of PET-Tau (location and quantification of the deposit) are described and are related to the affected cognitive domains, the functional impact (CDR 0,5 or 1) and the presence of amyloid deposition in Amyloid-PET.

Material and Methods. Results: 8 patients included: CDR 0.5 (n = 4) and CDR 14 (n = 4). The dominant symptom was hippocampal-type memory involvement, and the PET-Amyloid images were similar: diffuse and generalized deposition, regardless of the CDR or GDS stage. Patients in CDR 0,5 presented less regional Tau deposition in the temporal lobes than patients in CDR 1. In general brain regions with the most Tau deposits were coincident with those with more affected domains, but not with Amyloid-PET findings

Conclusion: Previously reported results for PET-Tau in research studies seems to be replicated in this small group. Although more studies are need, Progression of cognitive dysfunction may be related to the additional tau accumulation in regions of higher Braak stage even in individual cases, suggesting its utility to evaluate progression and profile of the disease in individual cases

PO3.3. Contribution of CSF biomarkers in the diagnosis of Alzheimer's disease

OLIVEROS CID Antonio1, CANO LUQUE Laura2, SIERRA MARTINEZ Esther2, CELORRIO LORENTE Victoria2, ABASCAL RUIZ Juan Antonio3, OLIVEROS JUSTE Antonio3, OVEJAS CATALAN Claudia2, CID LOPEZ Maria Angeles3

1Fundacion Neuropolis, Zaragoza, Spain, 2PsyMS, Zaragoza, Spain, 3MD, PhD, Zaragoza, Spain

Objective: To assess the utility of CSF biomarker determination for the diagnosis of Alzheimer's Disease (AD) in the prodromal phase and atypical forms.

Descriptive study of clinical, sociodemographic, psychiatric (AP), cardiovascular (FRV) and family history of AD, neuropsychological study (NPS), neuroimaging and analysis of results in patients who have requested CS biomarkers in CSF at our center.

Material and Methods: 16 CSF biomarker determinations. 62.5 % women. Average age: 74 years. All underwent MRI, lab test, neurological and neuropsychological evaluation before Lumbar puncture. The most frequent profiles were: amnestic hippocampal, amnestic with multiple domain areas deterioration, posterior cortical disfunction and others (50 %).

CSF results confirmed AD in 37.5 %, negative 31.25 % and 31.25 % inconclusive. Anyway, profiles demonstrated to be very useful to orientate treatment in most of cases.

Results: CSF biomarker determination of CSF confirmed the diagnosis of atypical AD and / or prodromal AD. The amnestic cognitive deterioration with a hippocampal profile is the neuropsychological pattern most correlated with the positivity of CSF biomarkers of AD. In patients with inconclusive CSF, the determination of Aβ40 would have helped, due to the great personal variability in the production of ABβ42. The negativity of CSF biomarkers for AD has allowed supporting the diagnosis of impairment in the context of psychiatric pathology, vascular or metabolic diseases and DFT-behavioral variant.

Conclusion: CSF profiles in “very mild” prodromal and “atypical” cases of dementia appear to be a very useful and valuable tool for diagnosis. Inclusion of Aβ40 levels seems to show as a measure of great utility to clarify all cases, but mainly those very “premature” and “atypical”. We suggest to include it as a standard parameter to measure in CSF lab test for Dementia.

PO3.4. Preferences of people with memory complaints and their significant others regarding a timely diagnostic process for dementia and decision-making in that process: a systematic integrative review

LINDEN Iris1, WOLFS Claire2, PONDS Rudolf2, DIRKSEN Carmen3, PERRY Marieke4

1Maastricht University/Alzheimer Center Limburg, Maastricht, Netherlands, 2Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, Netherlands, 3Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, Netherlands, 4Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, Netherlands

Background: Researchers, policymakers, and health care professionals often stress the importance of early dementia diagnosis in a mild stage of the disease. However, there is a lack of consensus on the advantages and disadvantages of an early dementia diagnosis. As a consequence, the debate is shifting away from advantages of an early diagnosis in favor of a timely diagnosis. A timely diagnosis implies that a diagnostic process is initiated at the right time for the person with memory complaints and their significant other(s) so as to meet their preferences, needs and expectations.

Objectives: An integrative review will be conducted to explore and map the available scientific evidence about the preferences of people with memory complaints and their significant others regarding a timely dementia diagnosis and the decision-making processes in that regard as well as GPs views on their patients’ preferences. This review aims to summarize and synthesize the current literature and formulate key themes in dementia diagnosis preferences in order to facilitate timely diagnoses.

Methods: The scientific databases PubMed, PsycINFO, CINAHL, Web of Science and Embase will be systematically searched for studies on dementia diagnosis preferences published between January 2010 and June 2020. Methodological quality of the included studies will be assessed with the Mixed Method Appraisal Tool.

Conclusions: It is anticipated that this integrative review provides important input for optimizing clinical guidelines and could facilitate a more-in depth discussion in the consulting room of the general practitioner (GP) about starting a diagnostic process. Moreover, results could be used to support the development of patient decision aids that support decision making about a dementia diagnosis in general practice. Results are expected by October 2020 and will give an overview of the existing evidence in this field.

PO3.5. Epilepsy profile in Alzheimer's disease patients

OLIVEROS CID Antonio1, CID LOPEZ Maria Angeles2, SIERRA MARTINEZ Esther3, CANO LUQUE Laura3, CELORRIO LORENTE Victoria3, GRACIA GARCIA Patricia2, OLIVEROS JUSTE Antonio2, FAYED MIGUEL Nicolas2

1Fundacion Neuropolis, Zaragoza, Spain, 2MD, PhD, Zaragoza, Spain, 3PsyMS, Zaragoza, Spain

Introduction: Alzheimer's disease (AD) is a risk factor for developing epilepsy. Early diagnosis and treatment improve quality of life, but are usually late due to different factors. Our objective is to describe the clinical characteristics of our patients with AD and epilepsy.

Objectives: Retrospective review of patients diagnosed of developing Epilepsy in the context of Alzheimer’s Disease (just before or after).

Descriptive analysis was performed based on clinical data related to epilepsy in AD patients, collected retrospectively.

Material and Methods: 8 patients related to develop epilepsy after initiating cognitive symptoms. No patients with symptomatic to other different diseases (neoplasm, hemorrhage, cranial trauma) were included.

Results: 1 presented primary generalized tonic-clonic seizures, and 7 reported focal onset seizures, 1 of them with generalization.

Epileptiform abnormalities were shown in all patients were EEG was recorded before initiation of Antiepileptic Drugs (AED) therapy (3/8). All patients undergo an EEG after therapy.  6/8 patients improved after first AED (5/8 seizure free). 1/8 patient improved after monotherapy with a second AED, and 1/8 required polytherapy.

Among those patients, 5/8 were diagnosed of having AD after epilepsy diagnosis.

Conclusion:Understanding the mechanistic link between epileptiform activity and AD is a research area of growing interest. Further understanding of the connection between neuronal hyperexcitability and Alzheimer's as well as the potential role of epileptiform activity in the progression of AD will be beneficial for improving treatment strategies.  The choice of AEDs is still made empirically, considering the side-effect profile of each drug and the presence of concomitant symptoms, but usually AED therapy is effective.

PO3.6. The extrapyramidal syndrome risk of herbal medicine and antipsychotics combined usage in dementia patients

CHOU Hui-Jer1, LIN Shun-Ku2

1Taipei City Hospital, Renai Branch, Taipei, Taiwan, Province Of China, 2Taipei, Taiwan, Province Of China

Extrapyramidal syndrome (EPS) is a well-known side effect of Antipsychotic drugs of dementia patients. Previous studies have shown that the combined use of traditional Chinese medicine (TCM) and antipsychotic drugs may increase the risk of EPS. The retrospective cohort study aimed to assess the extrapyramidal syndrome risk of drug-herb combination. We enrolled 74558 dementia patients who took antipsychotic drugs and divided participants into three groups: patients combined using high risk traditional Chinese medicine (TCM) (n = 59188, 79.4%), patients combined using other TCM (n = 11826, 15.9%), and patients who didn’t combine using TCM (n = 3544, 4.8%). Compared to the patients who do not combine use, patients with the high-risk TCM combination show a 1.32 hazard ratio (95% confidence interval: 1.14 - 1.53, p<0.05) of EPS after adjusting for age, gender, insured amount, urbanization and comorbidity disease. Besides, patients who combine used more than 14 days show a higher relative risk (hazard ratio 1.71 with 95% confidence interval:1.42-1.93, p = 0.01). In conclusion, the long-term herb-drug combination might increase the risk of EPS.

PO3.7. Systematic mapping review on factors impacting the pathway from health to dementia

LENART Marta1, LENART Marta1, ŁUC Mateusz1, PAWŁOWSKI Marcin1, SZCZEŚNIAK Dorota1, SEIFERT Imke2, WIEGELMANN Henrik2, GERHARDUS Ansgar2, WOLF-OSTERMANN Karin2, ROUWETTE Etienne4, RYMASZEWSKA Joanna1

1Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland, 2Department of Human and Health Sciences, University of Bremen, Bremen, Germany, 4Radboud University Medical Center, Nijmegen, Netherlands

The multitude of available dementia studies and their wide scope requires systematic data synthesis in order to be able to contribute to the knowledge of the complexity of its pathogenesis through an integrated approach.The systematic review aims to provide comprehensive maps of evidence for all factors that affect cognitive functions in the context of the development and course of dementia. In addition, it highlights the role of social aspects and identifies knowledge gaps in dementia research.

The review is a part of JPND project Social Health And Reserve in the Dementia patient journey (SHARED). Five databases: Medline, PsycINFO, CINAHL Complete, Cochrane and Epistemonikos were searched for systematic reviews and meta-analyses from 2009 to 2019. All abstracts and full texts were independently screened and reviewed. Methodology appraisal was conducted using a standard checklist.

Among 310 included papers, 613  factors were grouped into 7 categories with 61 subcategories: personal (22), environmental (30), socioeconomic (40), psychological (44), social (50), lifestyle (152) and bio-medical (275). Majority of the factors were significantly associated with cognitive functions or dementia (62% with negative and 20% with positive impact), in 3.5% of cases no influence has been proved and for 14% this effect remained unclear.

The results indicate the dominance of research carried in European countries (36%) and in China (29%), related to biology and medicine (45%) and health behaviour (24.8%). Identifying social factors in the trajectory of cognitive decline suggests their positive role against cognitive decline and dementia by reducing the risk or delaying the onset.

Obtained data indicate the lack of studies reporting results on cognitively healthy individuals, protective factors, cognitive reserve, and the need for further research on modifiable factors, such as social and psychological aspects.

PO3.8. Assessing knowledge & perceptions towards people with Alzheimer´s disease among employees of a pharma company

GARCIA ARCELAY Elena1, GARCIA RIBAS Guillermo2, MONTOYA Alonso2, MAURIÑO Jorge1

1Roche Farma, Madrid, Spain, 2Hospital Ramón y Cajal, Madrid, Spain, 3Hoffmann-La Roche Limited, Mississagua, Ontario, Canada

Objectives: Increased knowledge about an illness may help identifying the disorder to seek for an earlier intervention and appropriate healthcare. However, information about how the public knows about its risk factors, diagnosis, course, and management are limited. The main aim of this study was to assess knowledge and perceptions about AD from the caregiver/non-caregiver perspectives using a standardized battery of questionnaires.

Methods: A non-interventional, cross-sectional, anonymized web-based study was conducted among employees of Roche Spain. Participants answered sociodemographic questions and the Alzheimer´s Disease Knowledge Scale (ADKS). Caregivers answered questions related to their personal experience caring for someone with AD and fulfilled the Satisfaction with Life Scale, Beck Depression Inventory-Fast Screen, and the disruption dimension of the Revised Memory and Behavior Problems Checklist.

Results: A total of 447 subjects participated (19% of the total of employees). 63% were between 30-50 years old, 65% were female, and 83% had bachelor or master degrees. Forty-two (9%) of participants were caregivers, mainly of moderate to severe dementia subjects. Overall knowledge about AD was moderate (mean ADKS score = 21.2 ± 2.8 [71% of correct answers]). Risk factors and caregiving were the lowest scores domains (correct answers percentage= 59% and 63%, respectively). Mean ADKS score was significantly higher in participants caring people with AD compared with non-caregivers (22.1 ± 2.9 and 21.0 ± 2.8; p=0.02, respectively). The scores were not influenced by age, sex, or educational level. Most caregivers were satisfied with life (mean SWLS score = 26.8 ± 5.6) showing a low impact reaction to disruptive behaviors (mean RMBPC score = 9.1 ± 9.1). Six of them (14%) were scored as depressed. 

Conclusions: There is a continuing need to improve the understanding of AD to fulfill the gaps in knowledge of AD, even in a population working in healthcare with a high level of education.

PO3.9. The functional communication scale for patients: a French test evaluating residual communication skills

LEFEBVRE Laurent1, BOURGEOIS-MARCOTTE Josiane2, SIMOES-LOUREIRO Isabelle1, MONETTA Laura2

1Service de Psychologie cognitive et Neuropsychologie - University of Mons, Mons, Belgium, 2Centre de recherche de l'Institut universitaire en santé mentale du Québec, Québec, Canada

Objectives: Verbal and nonverbal communication impairments are observed in the context of neurodegenerative diseases. It is crucial for patients with an advanced stage of the Alzheimer’s disease (AD). Identifying the appropriate communication strategies for each patient would help to maintain his autonomy and to improve his quality of life. The aim of this study is to propose a tool adapted for people with cognitive disorders in advanced stages of the AD.

Methods: Two major steps were necessary, the development of the tool (A) and the evaluation of its psychometric properties (B). The step A allowed the development of a tool aimed at the observation of communication skills during a situation of natural interaction and the analysis of communication according to various activities. The second step (B) consisted to measure the validity of the content and the criterion of the test, as well as its fidelity between judges. The final version of the tool is composed of two grids, an examiner’s guide and a patient’s test sheet.

Results: Psychometric properties demonstrated good content validity and good criterion validity. Fidelity was measured and judged to be good. After that, a pre-test with patients has been carried out.

Conclusion: This functional communication scale should address a significant clinical need to enable clinicians to rapidly describe communication skills in a patients and to recommend communication strategies for formal and informal caregivers.

PO3.10. Ethical issues considering Alzheimer`s disease. Diagnosis disclosure in the patient/family/caregiver relationship

NICULESCU Mihaela Cosmina1, IOANCIO Ioana1, DOSCAN Ana Maria1, RASUCEANU-DIACONESCU Alexandra1, MAXIM Tatiana1, SPIRU Luiza1-2

1”Elias” Emergency University Hospital – Clinical Department of Geriatrics, Gerontology and Old Age Psychiatry, Bucharest, Romania, 2“Carol Davila” University of Medicine and Pharmacy, "Ana ASLAN" International Foundation, EPMA - Bucharest, Romania

Background: In the context of population aging, mankind is confronted with numerous challenges of the so called “Alzheimer Crisis”. Diagnostic disclosure is a shock to patients and their families, who fear their own possible proneness to this illness. Moreover, because of reasons such as accessibility to medical services or lack of medical education in the general population, more and more of them come to the physician and are diagnosed beyond mild stages. In addition, the current lack of drugs to improve the disease, leads to distrust and reluctance to recommended therapeutic protocols. We are often confronted with various problems in our Memory Clinic in Bucharest, related to illness acceptance, understanding, dark feelings and projections, treatment mistrust and non-compliance of the patient, as well as stumbles in the necessary empathy/support of their formal/informal caregivers.

Material and methods: We designed and operated two simple (Yes/No) questionnaires: (1) a questionnaire for diagnosticians and (2) a questionnaire for patient’s relative(s)/caregiver(s). We applied them on our diagnosticians team and on 140 relatives/caregivers dealing with Alzheimer`s Disease patients. The dialogue with the questioned doctors, relatives/caregivers was simple and concise, adapted to the given level of their education.  The answers were processed as percentage of positive/negative options for every question and group of respondents.

Results & conclusions: Alzheimer’s Disease diagnostic disclosure is not only the first but also a crucial step in approaching Alzheimer`s Disease patients. Although it is a challenging moment for both healthcare professionals, patients and their relatives/caregivers, the diagnostic disclosure of Alzheimer`s Disease represents a beneficial turntable for a long-lasting period of concerns and defenselessness of this frail patients who need both professional support from the multidisciplinary team and empathy, patience and support from those who matter the most to them (relatives, formal/informal caregivers), if carefully, empathetic and professionally done in a proper environment.

PO3.11. What to eat and what nutritional supplements intake you need to reduce your risk of Alzheimer’s disease

IVANOV Bogdan, IVANOV Simona

Smart EpiGenetX, Voluntari, Romania

The risk of cognitive impairment, Alzheimer’s disease, and dementia can be reduced. There are different factors that might reduce these risks and keep the brain healthy. One of them is proper nutrition.

The NutriCare.Life platform uses the latest research in metabolic health, genetics and nutrition to provide personalized insights to encourage healthier eating behaviours. Our proprietary technology uses digital and biological markers to make ultra-personalized recommendations on the ideal intake of carbohydrates, proteins, fats, vitamins, and minerals. We make this actionable for people with Alzheimer by providing a comprehensive list of foods and supplements that best suit their nutritional personalized requirements.

Researchers at the National Institutes of Health recently published a study (https://www.ncbi.nlm.nih.gov/pubmed/32285590) that evaluated the lifestyles of over 7,750 participants followed for five to 10 years. Participants filled out questionnaires to determine their eating habits and had cognitive tests of memory, language, and attention administered over the phone. They used these data to determine the dietary factors most important in lowering your risk of cognitive impairment, as well as the dietary factors most important in lowering your risk of cognitive decline.

Study conclusion: Fish was the single most important dietary factor in lowering the risk of cognitive impairment. Vegetables were second best, and all other foods showed smaller, insignificant effects.

Using our nutrition assessment digital platform people with Alzheimer will be able to follow the study recommendation and to cover at the same time all minerals and vitamin deficiencies to live a longer and healthier life. 

PO3.12. Investigating the relationship between maternal control, APOE and brain structure in MRC NSHD participants

GHEORGHE Delia, GALLACHER John, BAUERMEISTER Sarah

University of Oxford, Oxford, United Kingdom

The ε4 allele of the apolipoprotein E gene (APOE) is associated with a range of neurological problems, including amyloid-β aggregation in Alzheimer’s Disease (AD). Alongside these well-established findings, more recent studies suggest a relationship between ε4 and hypothalamic–pituitary–adrenal (HPA) axis functioning, with ε4 carriers and AD cases exhibiting higher glucocorticoid levels, which may accelerate brain atrophy. This evidence, in conjunction with other research suggesting that early maternal care has long-lasting effects on brain development contributing to the dysregulation of HPA axis activity, we investigate the relationship between perceived maternal control, APOE genotype and brain structure.

These analyses were conducted on the Dementias Platform UK Data Portal, utilizing data collected for the “Insight 46” sub-study of the 1946 birth cohort, the National Survey of Health and Development (NSHD). The APOE genotype was determined based on two SNPs (rs429358, rs7412). The sample included 388 participants (48% females), aged 69-71 years who were cognitively healthy (MMSE >=27). The neuroimaging pipeline used the libraries available in the FSL toolbox (FMRIB's Software Library). Segmentation of the imaging phenotypes of total cortical and subcortical volumes were computed using the fsl_anat, FAST and FIRST tools.

There were no differences in overall brain volume and subcortical imaging phenotypes (hippocampus, amygdala, thalamus, dorsal and ventral striatum) based on APOE genotype. However, when considering low, medium and high maternal control groups, preliminary results controlling for age, gender and birthweight suggest that low perceived maternal control, indicative of positive upbringing, predicts larger dorsal striatum structures in ε4 non-carriers, and larger left hippocampal volumes in ε4 carriers. These results suggest that positive rearing conditions may have a protective effect in the face of genetic vulnerability, as well as on key structures related to reward processing.  

PO3.13. ADAIR – novel biomarker discovery to unravel the link of air pollution and Alzheimer’s disease

CHEW Sweelin1, DINNYÉS András2, GIUGNO Rosalba3, IKRAM Arfan4, MALM Tarja1, OUDIN Anna5, SANDSTRÖM Thomas5, TOPINKA Jan6, ZENG Xiaowen7, KANNINEN Katja1

1University of Eastern Finland, Kuopio, Finland, 2Biotalentum Ltd, Gödöllö, Hungary, 3University of Verona, Verona, Italy, 4Erasmus MC, Rotterdam, Netherlands, 5University of Umeå, Umeå, Sweden, 6Institute of Experimental Medicine, Czech Academy of Science, Prague, Czech Republic, 7Sun Yat-sen University, Guangzhou, China

Despite decades of Alzheimer’s disease (AD) research, the molecular pathophysiology of the disease is still poorly understood, and treatment strategies remain controversial. Remarkably little attention is paid to the involvement of environmental factors, which epidemiological studies reported to strongly influence AD development. Air pollution is an important environmental and public health issue globally. Evidence from epidemiological and animal studies shows that exposure to air pollutants impairs the brain. Furthermore, living in polluted areas is associated with exacerbated cognitive dysfunction and AD. Although, information on air pollutant effects on brain health is scarce. Importantly, no biomarkers for air pollution and AD risk prediction exist, which hinders identifying individuals at-risk for harmful air pollution effects.

Drawing upon unique areas of expertise and methods, the ADAIR consortium consists of a multidisciplinary network of researchers spanning the fields of neurobiology, epidemiology, clinical science, environmental science, bioinformatics, and data science. The project is poised to provide crucial insight on air pollutant effects on brain function and discover biomarkers for air pollution and AD risk prediction. ADAIR applies a precision medicine approach to stratify subgroups for risk estimation and future AD prevention, ultimately aiming to target air pollutant-induced processes in individuals who can most benefit from them.

PO3.14. Dementias Platform UK (DPUK): facilitating multi-modal digital data access for dementias research

BAUERMEISTER Sarah, GALLACHER John

University of Oxford and Dementias Platform UK (DPUK), Oxford, United Kingdom

Dementias Platform UK (DPUK) is a £53M public-private partnership established by the MRC to provide free access to large-scale cohort data and accelerate the research and discovery of new treatments for dementia. DPUK facilitates multi-modal data access to 42 cohorts across 3.4M individuals within a remote access data repository, the DPUK Data Portal.  Globally, there is the need for a solution to manage, process and curate data which is secure, robust, persistent and auditable.  DPUK meets this need by managing datasets that are increasingly large, complex, sensitive and are decreasingly feasible to download, transfer and store. DPUK invests in standardisation of cohort data for cross-cohort analysis with C-Surv, the DPUK data curation programme. We present the latest data discovery and curation developments for the DPUK Data Portal and, how digital innovation is enhancing cross-cohort and multi-modal analysis for dementias research.

PO3.15. Professional stress – a major risk factor in Alzheimer’s disease

DOSCAN Ana Maria, SPIRU Luiza, IOANCIO Ioana, NICULESCU Mihaela Cosmina

”Elias” Emergency University Hospital – Clinical Department of Geriatrics, Gerontology and Old Age Psychiatry, Bucharest, Romania

Introduction: Early brain aging (objectified by decreasing the age of onset of neurocognitive impairment) in the 35-50 age segment has become a major concern for longevity medicine. Hence the need to extensively investigate chronic occupational stress and its effects on human brain, especially when acting as a risk factor for early Alzheimer’s disease.

Aims: Preventive diagnosis of stress vulnerability, identification of demands that may exceed the individual's ability to respond effectively, quantification and objectification of stress, will help the deceleration of early brain aging process.

Methods: The study is designed to evaluate professional chronic stress that includes: history of stress in patients’ life, neurocognitive stress scales evaluation, biological evaluation of stress hormones - urinary determination of serotonin, melatonin, adrenalin /noradrenalin, dopamine and salivary cortisol and measurement of heart rate variability. 

Results: Our study results, based on the evaluation of 150 patients aged between 35-50 years old, who work in stressful environment, show the link between elevated cortisol levels and the occurrence of clinical manifestations of neurocognitive impairment in the context of persistent occupational stress, and also the presence of depressive disorder in patients’ life history, in the context of changes in biological stress markers.

Conclusions: Persistent professional stress can cause changes in the body's normal defense response to stress factors. Early identification of occupational stressors, clinical and biological knowledge of stress as well as the development of preventive and personalized measures, may define a future approach in the context of preventing stress induced pathologies like depression and anxiety, but also neurocognitive disorders (from mild cognitive impairment to early Alzheimer’s disease).

PO3.16. The development of a microsimulation model to predict the future burden of dementia

BRÜCK Chiara1, WOLTERS Frank2, IKRAM Arfan2, DE KOK Inge1

1Department of Public Health, Erasmus MC, Rotterdam, Netherlands, 2Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands

Background: Microsimulation models are a useful tool in dementia research as they can evaluate uncertainties about the development of dementia, synthesise complex information, take trends in risk factors into account, and estimate long-term and population wide effects of (hypothetical) interventions.

Methods: Based on the well‐known Microsimulation Screening Analysis (MISCAN) model from cancer research, we developed a dementia microsimulation model. It synthesises incidence data from the Rotterdam Study (Ikram et al., 2017) with severity stage duration estimates from the literature (Vermunt et al., 2019). The onset of mild cognitive impairment (MCI) was calibrated on observed dementia incidence rates by age from the Rotterdam Study. The model simulates the life histories of individuals, each of whom can develop MCI which can then progress to mild and moderate/severe dementia and finally death. The number of dementia cases, dementia deaths, (quality adjusted) life years of patients and caregivers, and costs can be evaluated by age and gender. Finally, the model can estimate the effect of interventions on the life histories and subsequently the outcome measures.

Result: The MISCAN-Dementia model consists of three modules: a demography module, a natural history module, and a screening module. Given this structure, the model can be used to evaluate long‐term benefits and harms of important interventions at different disease stages: 1) changes in risk factors; 2) earlier detection and treatment by population screening; and 3) care and cure. We were able to fit the observed dementia incidence in The Netherlands. We will present the structure of the model and first prediction results.

Conclusion: The dementia microsimulation model developed in this study predicts how the burden of dementia will develop over the coming decades, including incidence, mortality, costs, and quality of life. Modelling the effect of interventions on a population level will provide essential information for policy makers and researchers.  

PO3.17. COVID-19 era: new technological strategies to manage Behavioral and Psychological Symptoms in Dementia (BPSD)

BAZZANO Salvatore, FORMILAN Marino, VERONESE Nicola, CESTER Alberto, BOLZETTA Francesco, MASELLI monica, CHIAROMANNI Federica, BUSONERA Flavio, BONOMETTO Pietro, ROMANO Antonietta

AULSS 3 Serenissima, italiana, Italy

Introduction: The COVID-19 pandemic has recently changed the interaction with healthcare users. Current challenge of healthcare is to provide services for COVID-19 disease but also for acute and chronic diseases. While the COVID-19 evolves, telemedicine has becoming an important tool for patients care. Telehealth could be particularly useful in the group of older patients affected by dementia. In this group, telemedicine may help to keep patients safe and to identify/treat Behavioral and Psychological Symptoms of Dementia (BPSD). The aim of this project is to use a telemedicine program to manage older patients with BPSD.

Materials and methods: Two rooms with a continuous recording video surveillance are available in our geriatric ward. This system allows to monitor older patients with BPSD. Based on this experience, we are developing a new model of Cognitive Disorders Clinic, with patient monitoring and management based on telemedicine. The model includes an online platform and an app that allow the caregivers to share clinical and video information with clinicians. This service could identify BPSD and other disorders, enabling faster and more effective remote management. The Maladaptive Behavior Scale (MABS) will be used for a quantitative measurement of behavioral disorders.

Expected results: The idea of this project is to develop a telehealth program that may reduce the risk of infection of patients and health personnel and provides a highly effective remote monitoring system for disorders correlated to dementia. This could improve the patient's quality of life, optimize the management of BPSD, reduce the waiting list for visits and, at the end, improve the quality of health services.

Conclusions: In the COVID-19 period, the telehealth services could be particularly useful in older patients with dementia and BPSD.

 

 
 

Last Updated: Tuesday 30 June 2020

 

 
  • Acknowledgements

    The 30th AE Conference received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe gratefully acknowledges the support of all conference sponsors.
  • European Union
  • Roche
 
 

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