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Oral Poster Presentations OP

Detailed Programme and abstracts

Friday, 1 October: 13.00-14.00 (Yellow Room)

OP1. Alzheimer Diagnostic Challenges: Romanian Healthcare System Flaws

Razvan Ioan Trascu1, Luiza Spiru1

1 Ana Aslan International Academy of Aging, Romania

email: rit@brainaging.ro, lsaslan@brainaging.ro

Background: Based on an estimated increase of the overall number of people diagnosed with Alzheimer Disease (AD) from 35mn to 116mn within the next 30 years, it becomes obvious that improving early detection of AD should become a priority.

An increasing number of voices fear that AD is currently underdiagnosed.

Method: We performed a literature analysis based on Romanian medical publications, correlated with worldwide reported results.

Results: Some claims reported that there’s good reason to delay an official diagnostic in families which struggle for solving legal matters. Gofton & Weaver (2006) confirmed that family coaching may be playing a role in patient performance, hence masking initial cognitive impairment, especially if MMSE scores play a major role in the final diagnostic.

A leading reason worldwide for late diagnostic is the common (traditional) misconception that memory loss / cognitive impairment is a common and normal feature in old-aged patients. Unfortunately, given the lack of nationwide standardized care and practice guidelines with respect to AD, such misinterpretation is quite common amongst general practitioners (GPs).

Furthermore, healthcare system limitations to general practitioners may further impede access to specialized care for initial stages of AD and various forms of mild cognitive impairment (MCI).

In Romania, for instance, while no private health insurance is currently available, the social health insurance system does not cover brain imaging studies if recommended by GPs. The market value for CT brain scans reaches 46 EUR, while MRI studies reach 100 EUR (no contrast agent).

Moreover, the AD medication (i.e. donepezilum, rivastigminum, galantaminum, memantinum) can only be initiated and prescribed (as part of the national program providing free medication to patients suffering from certain disorders) by psychiatrists, neurologists and geriatricians. This prohibits patients from disadvantaged (mainly rural) regions in accessing this medication, since the counter value of medication reaches about 80-90 EUR while the average old-age pension is equivalent to ~180 EUR.

Conclusions: Given the reluctance of decision makers in quick-solving these aspects and the scarcity of time and financial resources, Romanian GPs can at best just screen for possible cognitive impairment, in an attempt to refer patients to in-hospital settings specialized in diagnostic workup and treatment as early as possible. Such practices are, however, more costly system-wide and can only aggravate the ongoing financial crisis of the Romanian healthcare system.

Further analysis of cost distribution in AD healthcare is required, in order to more cost-effectively approach primary care of AD patients and to optimize early detection of AD.

OP2. Results of a cognitive and physical training programme for people with MCI

A. Efthymiou1, V. Konstantinidis1, E. Dimakopoulou1, C. Kondyli1, P. Sakka1

1 Athens Association of Alzheimer’s Disease and Related Disorders, M. Mousourou 89, Athens, Greece, 11636 kentroalz@ath.forthnet.gr

Objective: The Dementia Day Care Centre of the Athens Association of Alzheimer's Disease and Related Disorders provides a wide range of activities to people with dementia and their families. An intervention program specifically for people with Mild Cognitive Impairment (MCI) including cognitive and physical training was implemented last year. The present study evaluates the results of this intervention and compares them with a random control group of people with MCI from our Memory Clinic.

Methods: 24 MCI people aged 70 (± 7) years participated in a three-hour program delivered twice a week for 8 months and were compared with a control group of 20 MCI patients aged 67 years (± 8). Demographics were recorded for both groups. Their cognitive performance was measured before and after the intervention (Mini Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test, Verbal Fluency, BNT-15, Simplified Rey Figure).

The statistical package for the social science (SPSS, version 13) was used to analyse collected data.

Results: The group of people with MCI patients who attended the training sessions showed significant improvement at the end of the eight-month period in verbal and nonverbal episodic memory, executive functions and language skills. In contrast, the control group showed no significant improvement at the reassessment of their cognitive abilities.

Conclusion: As expected and according to literature, MCI participants in this study benefited from the intervention in comparison to the control group. Cognitive training and physical exercise seem to be the non pharmachological therapy of choice for people at the prodromal stage of Alzheimer’s Disease. Health professionals in Care facilities for elderly people should encourage people with MCI to participate in interventions of non pharmacological therapies.

OP3. Dementia screening and memory enhancing project in a population of urban dwelling elderly people.

Sakka P., Margioti E., Zoi P., Kalligerou F., Lymperopoulou O.

Athens Association of Alzheimer’s Disease and Related Disorders, Greece.

Introduction: Athens Association of Alzheimer’s Disease and Related Disorders in collaboration with Athens Municipality organized a project aiming to increase awareness of Alzheimer’s Disease and promote prevention and early diagnosis of dementia. The project was carried out in 20 Municipal Recreation Centers for the elderly located in different areas of Athens and ran in two stages: 1) On site presentations regarding memory and dementia followed by memory testing 2) memory enhancement group sessions for cognitively healthy elderly.

Method: A group of Neurologists and cognitive psychologists gave presentations regarding memory and interviewed those of the attendants interested in memory evaluation. Demographics and reason for taking the examination were recorded for all participants. Cognitive tests performed were: Mini Mental State Examination (MMSE), Clock Drawing Test (CDT) and Geriatric Depression Scale (GDS). 10 Memory groups were formed among cognitively intact people aged 60+, with 9-12 participants in each. The program consisted of 12 weekly, one-hour sessions, was conducted by trained health professionals and included practical strategies to enhance memory, mnemonics, use of external memory aids and tips to remember names-faces-shopping lists.

Results: 1)1800 elderly people attended the presentations and 286 participated in memory testing. Mean MMSE score was 26.5 (±3.5) and 82% of the participants scored over 25. Mean CDT was 5/10 (±3,3). According to GDS scores, 66% of the participants had no depression, 22% had mild depressive symptoms while 12% showed severe depression. Those diagnosed with cognitive decline or depression were referred to Memory Clinics

2) 105 healthy elderly were recruited for the memory education and intervention program. At the end of the treatment period, participants reported day to day improvement in memory functions although no significant changes were measured by formal cognitive testing.

Conclusions: Elderly people are concerned about memory decline and are eager to improve their knowledge about dementia and Alzheimer’s Disease and learn techniques for enhancing memory function. Memory complaints of the participants on the project were not related to actual memory deficits but more to bad mood and anxiety.

OP4. A journey of possibilities – A logotherapeutic model of dementia care

Sirkkaliisa Heimonen, Line Manager, The Age Institute

Minna Laine, Project Coordinator, The Orivesi Association of Nursing Services

Logotherapy is a positive way of thinking about life where the main themes are human value and finding meaning. In dementia care, the ideas of logotherapy emphasize the human value and uniqueness of the person with dementia, the meaning of possibilities, resources and hope and also the significance of the nurse’s philosophy, attitude and choices. According to logotherapeutic thinking, the meaningfulness of life can be fulfilled by adopting an attitude, by acting or by experiencing. In the early stages of a dementia, the significance of attitude is high but, with the advancing illness, the experiences of success and self-realisation through action become more important. It is possible to enjoy experiences to the very end.

The Logos project (2008-2010) by the Orivesi Association of Nursing Services aims to improve the quality of life of people with dementia and their nurses and to support the continuance of life stories. The project combines the philosophical thinking of logotherapy with the latest knowledge of good dementia care. It also develops a logotherapeutic model of dementia care in five care units. The model of care is based on the idea that persons with a dementia have a right to a meaningful life and they have a right to be encountered as unique and valuable persons with resources whose life stories continue despite the illness. The development project was carried out in twelve months including such methods as joint training days (7), monthly tutorial meetings, and diaries with evaluations and experiences of the development process together with a summary of the logotherapeutic model of care in each unit. The aim was to make the development work alive in regular discussions in each unit and thus implement the model as a part of the activities in the units.

The results of the development project were significant. The nurses reported an increase in the capacity to find alternatives and possibilities, their understanding of the situation of persons with dementia had improved, and their experience of the importance of their work had increased. They also reported increased skills, responsibility and resources. Many nurses said these changes opened new aspects and helped them to recognize the significance of their work. The logotherapeutic thinking has shown to be highly applicable in the care of people with dementia.

OP5. A nationwide telephone helpline

Eric Sanchez, e.sanchez@premalliance.com

The Social Welfare Department of the Prémalliance Group, in partnership with the Institute for Alzheimer‘s disease (IMA) and the Samaritans (SOS Amitié), was set up in October 2006.

The vocation of the Social Welfare Department of the Prémalliance Group is to give advice, guidelines and help to its beneficiaries and members. It organizes preventive actions and sets up innovative projets with its partners. For several years now it has been providing support to Alzheimer patients and their carers with various courses of action: participating in the cost of a day in a care centre, talk groups for carers, memory sessions, preventive periods in institutions

  • The Institute for Alzheimer’s disease carries out individualized and collective actions to give support to all those who accompany Alzheimer sufferers (or patients suffering from similar ailments), in their everyday, family lives or as professionals.
  • The Samaritans of Marseille / Aix-en-Provence

The Samaritans is a state-approved voluntary body which since 1960 has been providing moral and psychological support over the telephone to all those in difficulty or distress.

Why call Allo Alzheimer ?

  • Somebody you know or a relative or friend has contracted Alzheimer ‘s :
  • you spend 24 hours a day, 7 days a week with a patient and you feel exhausted or even depressed : and you need someone to listen to your problems…
  • you feel the need to be listened to more attentively, to be guided towards organizations which can help you: psychological support, day care, accommodation etc…
  • you find it more and more difficult to cope with the disease and its effects on those around you…
  • you are professionally involved and feel the need to talk and exchange experiences concerning the problems you come across in your work.

What is Allo Alzheimer?

Allo Alzheimer is a helpline. Its aim is to give support and information over the telephone to those who care for or live with a person who suffers from Alzheimer’s disease or a similar disorder.

Who listens to you when you call Allo Alzheimer ?

Your correspondents are all voluntary workers trained by professionals to answer you on the telephone and give you help and support by listening with great attention ; they remain, of course, entirely anonymous.

OP6. Messages and strategies for public health

Michael Splaine, Director, State Affairs, Alzheimer’s Association US, mikesplaine@verizon.net

In the US the development of comprehensive state government Alzheimer plans has led to the creative engagement of the public health community in promotion of early detection, care coordination for persons with ADRD and other chronic disease and the beginnings of delivery of brain health promotion messages. This session will review messaging, data and relationship building with this sector of government as a new collaborator in the ADRD space

OP7. Professional caregiving and workforce training in Romania

Luiza Spiru, Ileana Turcu

Ana Aslan International Academy of Aging, Bucharest – Romania, lsaslan@brainaging.ro

Background: The Alzheimer’s Crisis induced by the actual demographic changes is a true challenge for medicine and for society. It requires sustained research, healthcare and economical strategies able to ease social and family burden and improve the quality of life for people with dementia. One of the critical issues in the prevention, monitoring and personalized therapeutic approach of people with dementia is the availability and specialization of the involved medical and social workforce – neurologists, psychiatrists, family physicians, nurses, social workers and formal and informal care givers.

Methods: We are presenting the concept and the main clues of our national program, recently accepted in the FP7 financial support: “Training in the Actual Medical Technologies for physicians and nurses acting in hospitals and ambulatory care facilities”.

Results: The training program, conceived and implemented in cooperation with the Romanian College of Physicians and The Order of Generalist Nurses from Romania, includes as the main objective the training of doctors and nurses working in neurology, neuro-psychiatry, medical imaging, laboratory and molecular medicine, nursing and bio-ethics departments, in the particularities of brain aging and its specific pathology, especially of dementia type, based on newest trends and technologies in the field. Other objectives include promoting nation-wide strategic partnerships, building-up of a national network of brain aging specialists, transferring medical expertise, orienting toward patients’ need for personalized assistance, observing the European trends with respect to management of competencies, covering medical staff needs for training in the new medical technologies (including IT&C). The project will be implemented in all 8 regional development centers defined for Romania and will train 1220 physicians and 1600 nurses.

Conclusions: Despite the ongoing, prolonged political transition and economical crisis, Romania is striving to amend the scarcity of medical staff unable to numerically cover the needs of old people with brain aging related pathology (especially Alzheimer’s). The concept of this program and the activities included therein are designed to cover both the training needs of the medical staff and the need to update the health care services to better fit the real needs of Romanian elders. This third-age brain aging pathology training received no financial support from Romanian public funds.

OP8. Breakthrough Technologies in Professional Dementia Healthcare

Luiza Spiru, Ileana Turcu

Ana Aslan International Academy of Aging, Bucharest – Romania, lsaslan@brainaging.ro

Background: Some of the most important answers to the challenges arising from population aging and from the Alzheimer’s Crisis are the developments in eHealth and Ambient Assisted Living (AAL) technologies (smart, IT&C based devices and services). Such technologies could improve the quality of life for old people (especially for those with special physical and mental needs) and for their (in)formal caregivers. Moreover, AAL technologies enable older, dependent patients to still remain in their own homes providing added security and, if needed, continuous monitoring. Such developments could also lower health and social care costs while allowing the design of more effective healthcare politics.

Methods: We are presenting the concept of AAL and its intrinsic particularities and challenges for people with special mental needs, as well as certain learned lessons arising from our participation to two EU-funded projects targeting the design of eHealth and AAL platforms.

Results: The elaboration of eHEALTH and AAL applications for people with special mental needs (memory and other cognitive disturbances) are a special challenge for the developers of such devices and services. The general concept of such application deals with patient profiling (what needs to be supported), the adaptability of device performance to the ever-evolving changes in patient’s needs, the capability to be personalized as interfaces and guides as well as with the problems related to patients’ and their caregivers’ compliance to IT&C technology and to some bio-ethical correlates. All these aspects are briefly overviewed in our presentation.

The lessons acquired from being a medical partner in the SHARE-it project investigated limits and solutions for cognitive patient profiling, required for the design of three smart assistive platforms. We identified certain methods for testing and validating devices. We further refined usable tools for designing human-machine interfaces and user guides, including some ethic guidelines relating to human-machine compliance for people with special mental needs.

The lessons learnt from our second (K4Care) project were focused on the elaboration of patient ontologies (patient electronic health record files, case profiling ontology, care giver ontologies) and formal intervention plans (a complete step-by-step medical and non-medical guideline).

Conclusions: The huge variability of mental disabilities amongst elders could be surpassed if defining clusters of such disabilities as templates for designing highly adaptable, easy to use smart applications. While smart assistive technologies capable of supporting physically disabled elders are quite developed, those supporting mental disabilities in cognitive patients still require sustained, multidisciplinary research efforts as well as sustained public and private funding.

OP9. Consequences of the lack of policies for people with dementia: A case report from Spain.

Ramona Lucas Carrasco, Private practice, Spain, Lucas.Ramona@gmail.com

Background: disclosure of diagnosis to a person with dementia (PDem) is not common practice in Spain. Social relations, mainly family relations are known to contribute to quality of life in PDem. Our aim is to present a case study where health, social and legal services neglect what research has shown important for PDem.

Method: this is a case study report. Ms. L is 89 y.o. widowed; she has nine children, grandchildren and greatgranchildren. Like many women her age in Spain, her life was devoted to her family. She was diagnosed with Parkinson disease in 2001; cognitive impairment in 2003, and Mix Dementia (probable Alzheimer disease, Parkinson, and vascular dementia) in 2005. No disclosure of the diagnosis was given to her; but her neurologist prescribed a cholinesterase inhibitor (drops), given that Ms L. was reluctant to take any medication. Detailed analysis of the medical, social and legal process is examined.

Result: Possible lack of understanding about the illness and lack of compliance with medical advice from part of her children in relation to her daily care (sleep routine, nutrition, physiotherapy, etc), made that some of her children following advice from Ms. L neurologist started a process of incapacitation (summer 2007). Non cooperative children took Ms. L to a notary and made her to sign a paper (tutelage), changed the neurologist to a private one, and isolated Ms. L in her home. The illness became a legal problem rather than a medical problem. The Supreme Court in Barcelona, based on the Catalan Family Law accepted the notarial document and sentenced “the rest of children can visit Ms. L every Sunday from 5 to 7pm”. Now, at the end of Ms. L life, part of the family and the legal system deprive Ms L of what has been her reason for living, part of her family and love from her family, violating part of her most basic human rights.

Conclusion: Professionals specialized on the field of dementia, both from the public and private system as well as the legal system (notaries, lawyers and judges) seems to ignore that caregivers and loved ones of PDem, play an important role; and that the person with dementia is a valuable human being and needs to be treated with respect and dignity. National policies, rather than local policies that neglect and help to violate part of the most basic human rights of PDem and families are needed in Spain.

 

 
 

Last Updated: Thursday 16 September 2010

 

 
 

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