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P10. Genetics, prevention and treatment: Managing behavioural and psychological symptoms of dementia

Detailed programme, abstracts and presentations

P10.1. TIME - A biopsychosocial approach to neuropsychiatric symptoms in dementia -  A randomized controlled trial

LICHTWARCK Bjørn1, SELBÆK Geir1,2,3, KIRKEVOLD Øyvind2,3,4, ROKSTAD Anne Marie Mork2,3,5, BENTH Jūratė Šaltytė1,2,6, LINDSTRØM Jonas1,6, SVERRE Bergh2,3

1University of Oslo, Ottestad, Norway, 2Innlandet Hospital Trust, Norway, 3Vestfold Hospital Trust, Norway, 4Faculty of medicine NTNU, Gjøvik, Norway, 5Molde University College, Molde, Norway, 6Akershus University Hospital, Lørenskog, Norway

Background: There is conflicting evidence about the effectiveness of nonpharmacological interventions for agitation in dementia. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms(TIME) represents a comprehensive assessment of the patient and one or more case conferences with the goal to create, and put into action, a tailored treatment plan. 

Aim: To determine the effectiveness of TIME, for reduction of agitation for persons with dementia in nursing homes.

Methods: In 2016, we conducted acluster randomised controlled trial in33 nursing homes in Norway. 229 patients with dementia and a moderate to severe degree of agitation were included. 104 patients in 17 nursing homes and 125 patients in 16 nursing homes were randomised to the intervention and the control group, respectively. The intervention group received TIME, and the control group received a brief education-only intervention.

Assessments were performed before randomisation (baseline), eight and 12 weeks later. The primary outcome was the between-group difference in change at the agitation/aggression item of the Neuropsychiatric Inventory, Nursing Home version (NPI-NH), between baseline and eight weeks. Secondary outcomes were the between-group difference in change in the same item between baseline and 12 weeks, and in other neuropsychiatric symptoms, quality of life, and use of psychotropic and analgesic medications between baseline and eight weeks and baseline and 12 weeks.

Results: A significant between-group difference in reduction of agitation at eight weeks (1.1; 95% confidence interval, 0.1 to 2.1; P=0.031) and 12 weeks (1.6; 95% confidence interval, 0.6 to 2.7; P=0.002) in favour of the TIME intervention was found. Symptoms of delusions at eight weeks, and depression, disinhibition, and quality of life at 12 weeks, showed significant between-group differences in favour of the TIME intervention.

Conclusion: The implementation of TIME resulted in a significant reduction of agitation among nursing homes patients with dementia.

P10.2. Creative Practice -Alzheimer Scotland's therapeutic approaches on film

BEATTIE Jan, BEATTIE Jan

Alzheimer Scotland, Glasgow, United Kingdom

Alzheimer Scotland is recognised for its human rights approach to dementia. This includes how our practitioners engage with and support people living with dementia and their carers. Human intervention is our most powerful way to support people living with dementia and their carers to maintain choice, dignity, control and wellbeing.

Alzheimer Scotland practitioners support people living with dementia in a variety of community settings. We wanted to accurately portrayhowour practitioners support people and evidence the therapeutic value of this support, to share with people who choose our support, families and donors as well as create an educational tool for our workforce.

To achieve this, we engaged with people living with dementia and family members to produce a series of films that capture therapeutic approaches delivered by Alzheimer Scotland practitioners. The films that will be shown for this presentation explore how Alzheimer Scotland practitioners deliver therapeutic support:

Reminiscing in a forest setting focussing on the therapeutic value of being in the outdoors as well as reminiscence.

Yoga, as a method of mind/body stimulation and relaxation. They are part of a wider suite of films that also include:

Cognitive Stimulation Therapy

Gardening

Sensory support

Tai Chi

The real power of the films is in hearing the voices of people living with dementia describe the value of interventions and the positive impact on their wellbeing.

The workshop will explore the principles and ideas in the films and how workshop participants can interpret them for their own settings.

P10.3. General practitioners’ knowledge of and attitude to assessment and management of pain in people with dementia

JENNINGS Aisling, LINEHAN Maura, FOLEY Tony

University College Cork, Cork, Ireland

Background: Pain in people with dementia is often underdiagnosed, underestimated and undertreated. Pain can be a trigger for behavioural and psychological symptoms of dementia (BPSD).  Not correctly identifying pain as a cause of BPSD can lead to the inappropriate prescribing of potentially harmful psychoactive medications. General practitioners (GPs) play a key role in managing pain in people with dementia, however, no research has explored GPs’ knowledge of and attitude towards pain in dementia.

Methods: A self-report questionnaire was adapted from an existing validated questionnaire developed for nurses and was piloted with 5 GPs. The postal questionnaire was sent to a random selection of GPs in the southern region of Ireland. SPSS was used for data analysis.

Results: A total of 107 completed questionnaires were received, representing a response rate of 53.5% (107/200).  Over two-thirds (74/107) of respondents had a nursing home commitment. These GPs provided cared to a total of 1,596 people in nursing homes, over half of whom (851/1,596) had dementia. Of the respondents with a nursing home commitment only 16% (12/74) were aware of guidelines/policies on pain management in the nursing homes they attended. The majority of the respondents (74/107) felt that pain was under-recognized in people with dementia. Overall, respondents were knowledgeable on many aspects of the assessment and management of pain in people with dementia. There was no correlation found between the years of experience of the GP and their knowledge of and attitudes to pain. Nor was there any association found between the extent of the GPs’ experience with dementia and their knowledge of and attitudes to pain management in dementia.

Conclusion: Guidelines on the assessment and management of pain in dementia are not translating into clinical practice. However, the high levels of knowledge of and positive attitude towards pain management in dementia is encouraging.

P10.4. Neuropsychiatric symptoms profile in Mild Cognitive Impairment and conversion to dementia

VALERO Sergi1, BOADA Mercè2, ROBERTO Natalia2, HERNANDEZ Isabel2, MAULEÓN Ana2, ROSENDE Maité2, VARGAS Liliana2, RODRIGUEZ Octavio2, ABDELNOUR Carla2, GIL Silvia2, MARQUIÉ Marta2, ALEGRET Montse2, CAÑABATE Pilar2, RUIZ Agustín2

1Fundació ACE, Barcelona, Spain, 2Barcelona, Spain

Objectives: To identify clusters of patients with Mild Cognitive Impairment (MCI) based on their neuropsychiatric symptoms and to examine the risk of progression to dementia of these clusters.  

Design: Cohort study with 1.7 years’ median length follow-up (range 0.5-9.4 years) from the setting of Fundació ACE, Institut Català de Neurociències Aplicades.

Participants: Patients with MCI were included in the study. Inclusion criteria was: >45 years, MMSE>23 and a follow-up without conversion >6 months. The final sample was n=2138.

Analytical approach: The Neuropsychiatric Symptoms Questionnaire (NPI-Q) asses the presence of twelve neuropsychiatric behavioral domains: delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behavior, sleep and nighttime behaviors, and appetite and eating disorders. Latent Class Analysis was used to identify clusters of patients based on their NPI-Q, and Cox proportional hazards models were used to examine risk of progression to dementia based on clusters.

Results. Four clusters were identified: an irritable cluster (6.3%), and apathic cluster (12.7%), and depressive-anxious cluster (49.4%) and an asymptomatic cluster (31.6%). Compared to the asymptomatic class, irritable and apathic clusters appeared as risky clusters for conversion (Hazard Ratio=1.7), even at 4 years of follow-up and adjusting for relevant demographic and clinical variables. Depressive-anxious cluster has a comparable conversion profile than asymptomatic class.

Conclusions: Empirical grouping of MCI patients according their neuropsychiatric symptoms has a predictive conversion value. Non-cognitive symptoms could be considered not only relevant factors in the characterization of patients in risk for dementia but as specific risk factor for this conversion.   

P10.5. More self-reliance and autonomy for nursing home residents with dementia: a nurse-led intervention (SOCAV project)

GRAFF Maud, VAN DER VEEN Dinja, ROETS-MERKEN Lieve

Radboud University Medical Center Nijmegen , Nijmegen, Netherlands

Background: The SOCAV project was one of the projects in the program “Dignity and pride” of the Ministry of Health in the Netherlands. There is a need for more respect, dignity, self-reliance and autonomy for people with dementia (PWD) in nursing homes since care is mostly focused on taking over personal care, decisions and responsibilities of residents in nursing homes.

Methods: a longitudinal study with repeated measurement design with measurements at baseline, 3, 6, 9 months’ follow-up to evaluate the effects and process of the SOCAV intervention (n=57 PWD, n=37 caregivers, n=92 nurse-assistants, n= 8 peer-coaches). Intervention: a nurse-led intervention which is supervised by peer-coaches to empower the self-reliance and autonomy of PWD living in a nursing home. Effect outcomes: 1) self-perceived performance and satisfaction of meaningful activities assessed by the Canadian Occupational Performance Measure (COPM) of PWD, from the perspective of a) the PWD, b) their family caregiver, c) the responsible nurse; 2) well-being score of Dementia Care Mapping assessment. Process outcomes: 1) diaries of all nurse-assistants including: a) their reflections on the interaction with the PWD, b) their reflections on their own learning process based on their self-defined learning goals; 2) the diaries of the peer-coaches with their reflections on the learning goals and learning process of the nurse-assistants. Descriptive variables: age, sex, marital status, relation family caregiver to resident with dementia, years of workings experience with dementia; years of admission, cognitive status.

Results: the SOCAV intervention showed significant improvements on the COPM self-perceived performance and satisfaction effect scores from all three perspectives at 6 months. Positive COPM improvements remained at 9 months’ follow-up. Process outcomes showed positive changes on self-reliance supporting attitudes and behavior of nurse-assistants and peer-coaches. Implementation of SOCAV was positively evaluated.

Conclusions: this study showed positive improvements after SOCAV intervention. Implementation was successful.

P10.6. EU Joint Action Act on Dementia WP5: Implementation of best practices on preventing and dealing with BPSD

HOOGENDAM Jacqueline

Ministry of Health, Welfare and Sport (VWS), The Hague, Netherlands

WP5 leaders: Nicola Vanacore (ISS, Italy) and Jacqueline Hoogendam (VWS, The Netherlands). Participating countries: France, Bulgaria, Scotland.

The EU JA Act on Dementia focuses on developing a consensus on the best evidence of effective action in four key areas (diagnosis and post-diagnostic support, crisis and care co-ordination, quality of care in residential care settings and dementia-friendly communities) and after that on testing the best evidence of effective action in localities to develop a greater understanding of how change can be taken forward in practice.

WP5 has the objective to provide to the EU Member States clear, evidence-based and tested information and recommendations on how to effect change and improvement in care co-ordination and crisis response services for people with dementia, living at home.

To reach this objective, we performed a mapping of relevant research on and practices of dementia care co-ordination in participating countries, including defining dementia crisis and care co-ordination, including an update of ALCOVE Research on BPSD. This resulted in the identification of the key principles / best practices in care co-ordination and crisis response services for people with dementia. Those best practices were analysed on the feasibility of their implementation.

We will present our report on the identified best practices and the feasibility of implementation. And show, up-to-the-minute, the firsts results of the implementation of best practices in the participating countries.

Practices to be discussed are:

  • Case management for people with dementia
  • Multidisciplinary approach in all dimensions of support systems for BPSD 
  • Mobile teams with specific skills for the caring of BPSD, both in the home and nursing home setting
  • A training for case manager’s/district nurses on how to deal with BPSD
  • Use of nurses-practitioners in a GP’s practice to deal with BPSD

 

 
 

Last Updated: Tuesday 13 November 2018

 

 
  • Acknowledgements

    The 28th AE Conference in Barcelona received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe, CEAFA and Fundación Alzheimer España gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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