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PO4 - Medical aspects

Detailed programme, abstracts and presentations

PO4 - Medical aspects

P04.1. Treating Alzheimer's disease with Neprilysin secreted by adipose derived mesenchymal stem cells?

KELLNER Steven James, REIF Miriam

Alzheimer’s Disease pathology shows accumulations of extracellular amyloid-beta (Ab) containing plaques and intracellular neurofibrillary tau tangles in the brain. It should be noted that Ab is a naturally occurring endogenous peptide that may have normal physiological functions. Pathology associated with Ab is related to its aberrant accumulation/aggregation. The proteolytic degradation of Ab is a major route of clearance. Of these enzymes, neprilysin(NEP) is considered one of the most important for the control of cerebral Ab levels. NEP is primarily expressed in the kidney, however, it occurs at much lower levels in many other tissues, including brain, where it is located on neuronal membranes, both pre- and postsynaptically. Neprilysin occurs naturally in the secretome of the ad-MSC, which is produced in vitro and in vivo as a means of communication from cell to cells and as a reaction to external influences. The secretome of ad-MSC can be harvested as a clinical grade treatment for various illnesses.

Two of the major neuropathological hallmarks of AD, senile plaques and neurofibrillary tangles, take place with the aging of the human brain many years prior to the disease onset. This suggests that aging is the predominant risk factor for AD. In this respect, it is most important that a preventive medicine combined with presymptomatic diagnosis allows a substantial portion of aged people to escape from the scourge of dementing syndromes. There have been many reports indicating that neprilysin expression/activity declines with aging and in AD. Substitution with the secretome from adipose derived mesenchymal stem cells containing neprilysin should be able to prevent AD and maybe even reverse existing amyloid accumulation.

P04.3. Population-based longitudinal study on dementia and cognitive functions in the 70 – 74 year olds in a small city in the northern Italy: InveCe.Ab study [NH:NCT01345110]

ZACCARIA Daniele, POSSENTI Mario, SALVINI PORRO Gabriella, DAVIN Annalisa, GUAITA Antonio

Dementia constitutes one of the heavier public health problem in our aging societies. To build feasible prevention programs is crucial both for physicians and politicians to identify risk and protective factors. As prevalence studies can only demonstrate the existence of an association, incidence studies are needed to define risk/protective factors. However longitudinal studies are difficult and costly to carry out. In Italy only two dementia incidence studies have been performed: ILSA study (Di Carlo, 2002) about twenty years ago, and Conselice study, more than ten years ago (Ravaglia, 2005). InveCe.Ab study (Invecchiamento cerebrale in Abbiategrasso) is a longitudinal population study, started in 2009 and ended in 2014, involving people born between 1935-1939 and resident in Abbiategrasso, town near Milan. “Federazione Alzheimer Italia“supported this study, for which plays also the role of controller. All participants underwent multidimensional clinical-psico-social evaluation with a blood sample for genetic and biological analysis. In the table the participants in the three assessment sessions and the prevalent and incident cases of dementia:

 

Eligible

n(%)

Refused

n(%)

Participants

n(%)

Dementia prevalent cases

(n)

Dementia Incident cases

(n)

Baseline 2009-10

1644(100)

323(19,65)

1321(80.35)

39

=

Second wave 2012

1245(100)

131(10,5)

1114(89,5)

47

21

Third wave 2014

1179(100)

169(14,33)

1110(85,67)

69

40

The reported data are similar to other studies. There was no difference in gender, while Apoe4 confirmed to be a risk factor for both prevalent and incident dementia.

P04.4. Assessing independence of residents suffering from dementia in meeting basic living needs in Ljubljana nursing homes

KOBENTAR Radojka, ZORC MAVER Darja

Background: It is clear that a very high percentage of nursing home residents exhibit clinical signs of dementia, which affect the independence of the impaired individuals. The purpose of the study is to determine the residents’ independence level in performing basic life activities.

Methods: The research examines 233 residents of both sexes, with a clinical diagnosis of dementia that are aged 65 years and over that have resided in one of the four Ljubljana municipality nursing homes for at least one year prior to the beginning of the study. The autonomy in carrying out 11 basic live activities was measured on a three-level scale and their cognitive skills with a quick-test of cognitive abilities (KPSS). The data was processed with SPSS, ver. 13.0 through methods of descriptive statistics, whereby the statistic argumentation research questions was performed with the chi - square test.

Results: The examined population sample shows a high cognitive decline measured on the KPSS scale, as 50.2% of subjects in mid-stage reached ≤ 24-11 points and 43.4% of those in the late-stage reached ≤ 10-0 points in the scale (out of 30 in total). Those in the early stage reached ≤ 29-25 points in only 6.4 % of the examined population. The significant findings may thus indicate a high overall average depending on the implementation of all 11 life activities (x = 2.57) on the three-level scale (1 being self-sufficient, 2 and 3 standing for partially dependent and entirely dependent, respectively).

Conclusions: The examined nursing home residents in the sample, suffering from dementia, show a high degree of dependency in performing basic life activities. The results thus present a starting point for the planning of programmes for increasing involvement of residents in psychosocial activities, through practical exercises in self-sufficiency and implementation of fundamental life activities.

PO4.5. Some differences in areas of cognitive function in Mini mental state examination in the Alzheimer’s and vascular dementia

KRSTESKA Roza, ICEVSKA Liljana

The cognitive assessment have important role in the diagnosis of people with dementia. The most widely used questionnaire in obtaining information on patient cognitive function is the Mini Mental State Examination (MMSE). It’s administered by physicians is useful in distinguishing patients with normal cognitive function from ones with cognitive impairment and future appropriate diagnostic and pharmacological access.

The object of the study was to analyze the Mini Mental State Examination in 30 patients with Alzheimer's and 30 patients with vascular dementia.

The study included 60 people with dementia diagnosed with Alzheimer's or vascular dementia (by ICD 10; MMSE; HIS; CT or NMR). The condition for the patients to enter this study was the age above 60 years. Average age of the patients in the group with vascular dementia is 72.6 years, and in the group with Alzheimer's dementia is 77 years (p < 0.0043).

The average time from the beginning of the vascular and Alzheimer's dementia was no statistically significant difference (3, 35±1,876 y. v.s. 3, 9±1,984 y) p = 0,4334.

A significant correlation was found between the average MMSE scores in the group with vascular and Alzheimer's dementia (16, 8±5,27 vs. 10, 9±5,46) p= 0,0001*.

According to our results there are more rapid cognitive decline and more severe cognitive impairment in patients with Alzheimer’s than in vascular dementia.

In our study tere were some statistical defferences in the question measure that tests the areas of cognitive function: orientation, recall, and language in repetition and three -stage command.

PO4.6. Cognitive training with games: the “giovani nel tempo” project

BEVILACQUA Petra, De VREESE Luc Pieter, GUIDI Laura, FABBO Andrea, CHATTAT Rabih

Cognitive training interventions are possible and effective in healthy elderly, ameliorating or delaying the rates of age-related decline. Cognitive training in small group settings offer to the participants an enjoyable experience and the benefit of social interaction promoting emotional well-being and combatting loneliness, in addition to cognitive improvements. “Giovani nel Tempo” consists of three board games stimulating working, semantic and episodic memories (Francia R., Guidi L., Bartorelli L. 24th Alzheimer Europe Conference, PO58, 2014). The aim of this semi-experimental study is to verifiy objectively the preliminary positive impressions collected from seniors who particpated  into the  “Giovanni nel Tempo” project, on cognition, emotion and wellbeing in a sample of seniors who regularly attend the Parish of the San Faustino neighborhood of the Muncipality of Modena. The board games sessions, each lasting 90 minutes, will be done twice weekly for two months with the supervision of a Psychologist, expert in memory games and cognitive ageing. Assessments will be done by two expert psychogeriatricians not directly involved in the game sessions at baseline, immediately after and two months later in follow up. The following domains will be explored: cognition (Addenbrooke’s Cognitive Examination Revised); mood (Geriatric Depression Scale-15); physical and mental wellbeing (General Health Questionnaire-12, SF-12 Health Survey) and metamemory (Memory Assessment Clinic Questionaire). 

PO4.7. Neuropsychological assessment and trace metal content in urine, hair and fingernails samples from inhabitants of a chemical industrial region (NW Portugal)

CABRAL PINTO Marina, ALMEIDA Agostinho, PINTO Edgar, ORDENS Carlos, CONDESSO de MELO M. Teresa, FREITAS Sandra, SIMÕES Mário, DINIZ Luísa, MOREIRA Paula, SILVA Maria, FERREIRA DA SILVA Eduardo, SILVA LOUREIRO Maria

The surroundings of the Estarreja Chemical Complex (NW Portugal) have an intense industrial activity with negative impact on soil, surface water and groundwater since the early 1950's, and its population historically relies on groundwater as a source of water supply for human and agricultural uses. This industrial activity produced a large volume of toxic waste solids and liquid effluents, which were disposed in areas that were not prepared for such purpose. During the 1990's, several rehabilitation actions resulted in an important reduction of the negative environmental legacy. However, we found concentrations (µg/l) of Al, Cu, Fe, Hg, Mn, Pb and Zn in groundwater well above the international and Portuguese recommended values. Less than ~10% of neurologic diseases have a strict genetic aetiology, while the majority have an unknown origin. Occupational and environmental exposures to several metals (e.g., Hg, Al, Mn, Cu, Pb, Fe and Zn) appear to be a risk factor for neurodegenerative pathologies, such as Alzheimer’s disease, Parkinson dementia, etc. Therefore, the study of the impact of these environmentally-present metals on human health requires further attention and a multi-disciplinary approach, merging neurosciences and psychology with environmental geochemistry. The neuropsychological assessment of a pre-selected population in the studied area is being performed and correlated with the content of selected metals on human biological samples. The experimental sample of this study to date has proved to consist mainly of normal subjects (40.2%), followed by the condition of dementia (36.6%) and the condition Mild Cognitive Impairment (18.3%). This study combined trace element profile in urine, hair and nails with survey information from 100 Estarreja inhabitants to assess the extent to which the biomarkers provide exposure to metals information. Urinary metal levels were elevated, above commonly accepted reference values. Median hair, fingernails and toenails levels (µg/g) were also elevated, particularly for Hg.

PO4.8. Occupational and environmental exposure to Mn in manganese mining areas (South Portugal) and the occurrence of dementia

CABRAL PINTO Marina, ALMEIDA Agostinho, PINTO Edgar,  FREITAS Sandra, SIMÕES Mário, DINIZ Luísa, MOREIRA Paula, SILVA Maria, FERREIRA DA SILVA Eduardo, SILVA LOUREIRO Maria, CONDESSO de MELO M. Teresa

Occupational and environmental exposure to manganese (Mn) has been suggested as a possible cause of neurodegenerative disorders. The inhalation and ingestion of Mn affects the central nervous system of mammals, particularly of humans. Various cases have been reported of neurological pathologies, and even deaths, induced by chronic consumption of water containing moderate to high levels of Mn (median values in groundwaters > 81.2 µg/L well above drinking water limits and > 17.1 mg/L in surface waters affected by acid mine drainage). In Baixo Alentejo region (South Portugal) there are several abandoned Mn mines, related with the Fe-Cu-Zn-Pb massive sulphides deposits, and close to the mines there are abandoned tailings deposits, freely exposed to weathering, rich in metal(loid)s such as Cu, Pb, Zn, As, Sb, Ag, Hg and Cd. The concentration of these metal(loid)s is being determined in soil, water and plants of target and control areas. Inhabitants were assessed by cognitive screening tests, for early detection of dementia. The following instruments were administered to each participant: 1) a complete socio-demographic questionnaire; 2) General Health Questionnaire; 3) Mini Mental State Examination; 4) Montreal Cognitive Assessment; 5) Clinical Dementia Rating scale; 6) Geriatric Depression Scale; 7) Recall Selective Free and Guided Test. The neuropsychological assessment of a pre-selected population in the studied areas is being investigated and correlated to the content of selected metal(loid)s on human biological samples (nails, hair, blood and urine). The environmental exposed inhabitants of this study has proved to consist mainly of subjects with Mild Cognitive Impairment (MCI) (36%), followed by normal subjects (34%) and subjects with dementia (30%). Maximum fingernails Mn level (1.43 µg/g) was found in a subject with Parkinson dementia, however the maximum toenails Mn level (1.38 µg/g) was found in subjects with MCI. Median fingernails levels (µg/g) were elevated for Hg, particularly in subjects with dementia (0.8), and also in MCI (0.6).

PO4.10. Personal image and self in dementia: The perspective of the caregiver spouse

VODUŠEK Vid Vanja

“Self” and “identity” are conceived as essentially dissociable in the critical literature of the psychosocial approach to dementia: “self” is understood as a bare function of self-reference, “identity” as a set of different social roles which make up the content of this self-reference. On the basis of this dissociation, the authors of the critical approach argue that a person can lose a part of her identity by way of memory loss, but because the self-referential function remains intact, she can still participate in most communication situations: thus she can still coherently communicate the remaining parts of her identity, and through communication replace the ones that are missing. I argue that the self is essentially based in the social roles and perspectives an individual can assume: if a social perspective is lost, so is the ability to communicate from that perspective. To identify the behaviours and situations through which we can delineate the main structural change determinants of the self in persons with dementia, I have conducted two focus groups and 9 intensive interviews with caregiver spouses. By way of grounded theory I have shown how psychological dependency of persons with dementia increases in the course of the illness and how these persons lose their bearings in communication situations of the broader social context, whereas they are still competent communicators in their circle of friends and relatives. I conclude that the self of the demented person becomes increasingly structurally dependent on the interactions with significant others, and that the self's repertory of perspectives is narrowed in the direction of the core repertory of significant others' perspectives.

PO4.11. Cognitive and behavioural changes in patients with ALS – implications for treatment and disease management

ŠTUKOVNIK Vita

Traditionally, amyotrophic lateral sclerosis (ALS) has been viewed as a disease of the motor system, characterized by degeneration of both the upper and lower motor neurons, with no compromise of cognitive and behavioural functions. However, latest research provides evidence of extra-motor involvement in this disease. Studies suggest that up to 50 % of patients with ALS demonstrate mild to moderate cognitive and/or behavioural impairment and that up to 20 % of patients with ALS meet criteria for full-blown dementia syndrome. Deficits are characterised by executive and working-memory impairments, extending to changes in language and social cognition. Behaviour and social cognition abnormalities are closely similar to those reported in behavioural variant frontotemporal dementia, implying a clinical spectrum linking ALS and frontotemporal dementia (FTD). Despite the increased awareness of ALS as a multi-system disorder, the cognitive status of most ALS patients attending clinics remains unknown. Standard assessment procedures are often not appropriate to detect dysfunction due to progressive physical disability of patients. A new screening instrument was recently developed to detect the specific profile of cognition and behaviour changes in ALS (Edinburgh Cognitive and Behavioural ALS Screen, ECAS) and is currently being standardized in Slovenian language. Accurate assessment of cognitive and behavioural symptoms in ALS is crucial not only in the light of therapeutic trials, but also to the planning of care, compliance to interventions and end-of-life decisions. It was shown that patients with ALS–FTD are much more likely to be noncompliant with clinical interventions to improve their quality of life, such as non-invasive ventilation and occupational/physical therapy. The issue of cognitive (in)dependency may also be an important issue for ALS caregivers, whose burden was found to be even greater, when taking care of patients with cognitive impairment. As most people with ALS are cared for at home, more insight into patients’ cognitive status and support in symptom management might be crucial to provide a better quality of life for both patients and their caregivers.

PO4.12. Sequence of cognitive decline in Alzheimer’s Disease (AD) patients – Results from an Observational Study

DELL’AGNELLO Grazia, HENNEGES Carsten, REED Catherine, CHEN Yun Fei, LEBREC Jeremie

Introduction: Understanding the pattern of decline in cognitive functioning in Alzheimer’s disease (AD) could assist primary care physicians in explaining AD progression to patients and caregivers. The objective of this analysis is to determine if there is an identifiable order in which cognitive abilities are lost within the progression of AD.

Methods: GERAS is an 18-month observational study on AD.  Patients diagnosed with probable AD and Mini Mental State Examination (MMSE) ≤26 were enrolled. Proportional odds logistic regression model was applied to model MMSE subscales of orientation, registration, attention and concentration (spelling and counting), word recall, language and copying. The model converted ordinal scores of each subscale to corresponding probabilities of cognitive impairment at each MMSE total score level where the probabilities were estimated based on start of and complete cognitive impairment.

Results: 1495 patients were analyzed. Figure 1 shows the probability estimates of start of and complete impairment for each subscale. The first aspect of cognition to become impaired is word recall, followed by orientation in time. The last abilities to fully deteriorate are orientation in place, language, and registration.

Conclusions: The process of cognitive decline was visualized by means of probability estimates of key aspects of cognition. This might be useful to set expectations on disease progression for patients/caregivers.

PO4.13. Use of Fortasyn Connect in asymptomatic dementia

FRANCONE Caterina, SANTILLO Antonella, BRUNO Patrizia, De ROSA Giuliana, MARANO Francesca

Introduction: In the last few years, scientific research has studied some nutritional supplements, such as Fortasyn Connect, which aim is to stimulate the formation, maintaining and functioning of the synapses between neurons. Such therapeutic necessity derives from the ever-growing evidence of cases of dementia in pre-clinical form, that do not present full-blown combinations of symptoms (Dubois, et al.,2007), evident enough to justify the delivery of traditional drugs.

Goal: We present the case of F. and C., subjects with subjective memory disturbance and good compensation in the capabilities of daily autonomy. Both underwent a full geriatric and neuropsychological evaluation, both pre and post the assumption of the supplement Souvenaid. Our objective is to demonstrate how the consumption of such supplement, in patients in the pre-clinical stage of dementia and therefore asymptomatic, can contribute to the stabilisation of the cognitive frame and to better the quality of life in general.

Materials and Methods: Both subjects showed clinical negativity both neurological and general. Such negativity was confirmed by diagnostic tests, apart from the cerebral CAT scan. This last test highlighted an increase in the atrophy-related periencephalic spaces. The formalised neuropsychological evaluation has been structured so that all cognitive domains (memory, language, attention, custom and executive functions) could be examined individually, and carried out by an expert neuropsychologist. Both subjects completed the set of psychometric tests in two distinct moments: before consuming the supplement and 6 months later.

Results and Conclusions: The test-retest comparison showed a substantial stabilisation of the performances of the analysed subjects. In particular, it showed significant improvements in the attentive capabilities, short-term special memory and the ordered lexical research by phonemes, index of good cognitive flexibility.  In conclusion, using new treatment options such as nutritional supplements is necessary and useful to fill a therapeutic void.

PO4.14. Factors underlying adherence to transdermal therapy in Alzheimer’s dementia

KNOX Sean, RIEPE Matthias, WEINMAN John, MULICK CASSIDY Amy, CHAVES Ricardo, MUELLER Beate

Background: Poor adherence to prescribed treatments is a major barrier in the care of patients with Alzheimer’s Disease (AD). To effectively manage AD and maximise therapeutic efficacy, adherence to treatment is paramount.

Objectives: The study was aimed to identify patient and caregiver-related factors influencing adherence to transdermal therapy.

Methods: Patients with mild-to-moderate AD prescribed transdermal therapy in 18 centres across Germany were included in this study. Socio-demographic, clinical and psychosocial data about patients and their caregivers were collected at 3 months after treatment initiation (Visit 1; n=127). Standardised questionnaires were used to assess factors associated with adherence to transdermal therapy and treatment satisfaction at 3 and 6 months (Visit 2; n=110) post initiation of medication. Predictors of adherence were identified using stepwise linear regression models.

Results: At the second-follow up visit, 66.2% of caregivers reported being adherent and 77.0% were satisfied with the transdermal therapy. Higher adherence to transdermal therapy chiefly correlated with higher caregiver satisfaction with information on medication and patients’ better tolerability to therapy (both p≤0.001). Caregiver contact of ≤3 hours per day or once/twice per week, patients living at home alone, greater caregivers’ concerns about transdermal therapy and patient belief in ‘other’ causes of their AD predicted lower adherence (all p<0.03).

Conclusions: Patient living conditions, frequency of caregivers’ visits, caregiver satisfaction with information, tolerability to transdermal therapy, caregivers’ concerns with treatment, and patient belief in ‘other’ causes of their AD were amongst the factors associated with adherence to transdermal therapy. Further studies are required to explore whether modifying these factors could affect adherence to treatment.

PO4.15. Whole-body cryostimulation as possible prevention of cognitive deterioration

SZCZEŚNIAK Dorota, URBAŃSKA Katarzyna, TRYPKA Elżbieta, STAŃCZYKIEWICZ Bartłomiej, RYMASZEWSKA Joanna

Background: Limitations of currently available treatment methods of dementia imply constant need to search for new, supplementary therapy strategies. Hypothesis of translating whole-body cryostimulation in psychogeriatric field is pointed out despite the fact that there were no research studies addressed the impact of extremely low temperatures on the cognitive functions. The possible biological mechanisms can be based on already improved anti-inflammatory (a modification of the concentration of proinflammatory cytokines) and antioxidative effect of extremely low temperatures on human body as well as the hormonal and lipid changes they cause. Our aim was to assess the influence of whole-body cryostimulation on cognitive functions as well as on mood and quality of life of patients with MCI.

Methods: The RCT design is used divided patients (over 55 yrs.) with MCI into two groups (1) experimental: -110°C till -160°C, 2-3 minutes each day and (2) placebo: -20°C, 2-3 minutes each day undergo 10 sessions of WBCT.  The cognitive functions (CDR, MoCA, TYM, DemTect, SLUMS), quality of life (WHOQOL – BREF), depressive symptoms (HAM-D) and biochemical parameters are measured at baseline and in follow-up.

Results: We hypothesize that whole-body cryostimulation will significantly improved the cognitive functions and quality of life. Moreover the worse the cognitive deficits of the patients were prior to the cryotherapy, the stronger its effect in comparison to the control group. The results of currently conducted study will be presented during the conference.

Discussion: Short, intense series of whole body cryo-stimulation could be recognized as the complementary prevention and treatment method of the early stages of cognitive impairments leading to dementia.

PO4.16. Effect of early care recourse to specialist in dementia on institutionalization and functional decline: findings from a population-based study

PIMOUGUET Clément, LE-GOFF Mélanie, BERR Claudine, DARTIGUES Jean François, HELMER Catherine,

Objectives: To investigate the influence of early specialist consultation for dementia on institutionalization and functional decline in Activity of Daily Living (ADL).

Design: Prospective longitudinal cohort

Setting: Population-based study (the 3C study)

Participants: Non-institutionalized incident dementia participants (n=179) for institutionalization; Non-institutionalized incident dementia participants who were free of ADL disability (n=243) for functional decline.

Main outcomes measures: Incidence of institutionalization and rate of ADL dependency for dementia participants who had an early specialist consultation in comparison with those who did not.

Results: Only one third of the incident demented individuals had consulted early a specialist for cognitive problems (36%). After adjustment on potential confounders and competing risk of death, participants who had consulted a specialist early in the disease course presented a higher rate of being institutionalized than those who did not (Subdistribution Hazard Ratio = 1.98, 95% Confidence Interval 1.11-3.55). Specialist recourse was not associated with further functional decline (Hazard Ratio = 1.09, 95% CI. 1.71-1.67).

Conclusions: Early specialist recourse in dementia is associated with increased risk of institutionalization but not with functional decline in ADL. These findings suggest that early care recourse in dementia may be a marker of concern for patients and/or caregivers; subsequent medical and social care could be suboptimal or inappropriate in order to allow patients to stay longer at home.

PO4.17. Risk factors for development of dementia: the Prospective Epidemiologic Risk Factor (PERF I) study

NEERGAARD Jesper S., DRAGSBÆK Katrine, HANSEN Henrik B., HENRIKSEN Kim, CHRISTIANSEN Claus, KARSDAL Morten A.

Objective: Despite the extensive research effort, the list of putative risk factors in relation to dementia is still inadequate to confidently assess their association with disease. It is not yet clear whether the results of the previous studies are of sufficient strength to warrant specific recommendations for disease treatment and/or prevention. In the present study we assessed the incidence and identified risk factors for development of dementia in the largest individual prospective cohort of elderly women.

Methods: The Prospective Epidemiologic Risk Factor (PERF I) study, an observational, prospective follow-up study of Danish women, was conducted between 1999 and 2001 (n=5,855). Follow-up information was retrieved from the national Danish registries. A Cox proportional hazards regression model was applied to calculate adjusted hazard ratios (HR) for potential risk factors.

Results: Of 5,840 eligible subjects, 582 developed dementia after 15 years of follow up, leading to an overall incidence of 8.3 per 1000 person years. The incidence approximately doubled every 5 year starting at the age of 60.

Depression was associated with increased risk of dementia (HR = 2.18 [95% CI 1.59-2.98]). A dose-response relation was observed with fasting plasma glucose leading hazard ratios of 1.37 [1.13-1.66] and 1.50 [1.00-2.25] for impaired (5.6-6.9 mmol/L) and hyperglycemic (≥7.0 mmol/L) fasting glucose levels, respectively. Overweight (BMI 25-29.9) and physical activity (≥1 time/week) was negatively association with risk of dementia leading to hazard ratios of 0.69 [0.56-0.85] and 0.73 [0.61-0.89], respectively.

Interpretation: We confirm some of the most widely studied risk factors for dementia in the largest individual cohort of elderly women. Physical inactivity, depressive symptoms and impaired fasting glucose were associated with increased risk of dementia. Overweight was protective towards development of dementia. Risk factors all considered modifiable leaving large potential for primary prevention in the future.

PO4.18. Avoidable hospitalizations in incipient dementia

PIMOUGUET Clément, RIZZUTO Debora, LAGERGREN Märten, FRATIGLIONI Laura, XU Weili

Objectives: To determine whether avoidable and all-cause hospitalizations are associated with incipient dementia.

Design: Prospective longitudinal cohort of 2240 dementia-free participants aged 60+ years and followed-up to 6 years.

Setting: The Swedish National Study on Aging and Care in Kungsholmen (SNAC-K).

Methods: Avoidable hospitalizations and all-cause hospitalizations were tracked through the inpatient register. Avoidable hospitalisation was defined by a hospitalisation for any ambulatory care-sensitive condition as categorised by the National Board of Health and Welfare and Swedish Association of Local Authorities and Regions. All-cause hospitalization was defined as any hospitalization requiring an overnight stay. Dementia was diagnosed followingDSM-IVcriteria at baseline and at the first follow-up. Rates of hospitalizations occurring over the period between baseline and the first follow-up were compared between participants who developed dementia at the first follow-up (incipient dementia) and those who remained free of dementia. Zero inflated Poisson regression models were used to analyze hospitalizations rates. Case/control analyses were performed after matching on age, gender and chronic diseases in order to test the robustness of the findings.

Results: Of all dementia-free participants, 158 participants developed dementia at the first follow-up. Avoidable hospitalization was associated with incipient dementia (odds ratio (OR) =2.67, 95% CI: 1.12-6.45) after controlling for potential confounders including comorbidities, cognitive and functional disability at baseline. Moreover, higher rate (OR=1.93, 95% CI: 1.11-3.34) and number of all-cause hospitalizations (incident rate ratio=1.43, 95% CI: 1.25-1.64) were also related to incipient dementia. Results from case-control analyses confirmed these main findings.

Conclusion: Avoidable hospitalization is associated with incipient dementia.Our findings suggest that primary care for elderly people with incipient dementia is suboptimal. They argue in favor more systematic cognitive screening and subsequent clinical monitoring in primary care.

PO4.21. Zdravljenje demence

LAH Samira

Zaradi staranja populacije je demenca pojav, katerega pojavnost hitro narašča in ne  prizadene le posameznikov in njihovih svojcev, pač pa zadeva tudi širšo družbo. Ob takšni naraščajoči pojavnosti menimo, da je ključna tudi njena preventiva. Študije, ki raziskujejo rizične dejavnike za demenco, so si nemalokrat nasprotujoče, a kljub temu številne raziskave nakazujejo, da obstajajo pomembni rizični dejavniki, na katere imamo kot posamezniki vpliv, da delujemo preventivno.

Namen našega prispevka je osvetlili nekatere preventivne aktivnosti, ki po našem mnenju pripomorejo k zmanjševanju oziroma upočasnjevanju dejavnikov tveganja za razvoj bolezni.

Osnovno izhodišče, ki ga zavzemamo pri intervencijah, je približati terapevtske učinke posameznih aktivnosti skozi igro, ki povezuje različne vrste učenja: socialno, čustveno, miselno, govorno, jezikovno,  senzomotorične spretnosti in orientacijo. Vse to pa so področja, ki so v procesu napredovanja bolezni najbolj izpostavljena.

V prispevku želimo prikazati različne didaktične materiale in pristope, ki pri posamezniku razvijajo ta področja. Pri tem smo se povezali tudi z igroteko Mariborske knjižnice Nova vas, ki ima več kot 2000 didaktičnih iger.

V prispevku želimo osvetliti aktivnosti, povezane s krepitvijo področij:

•               orientacije (časovne, prostorske, osebne);

•               motorike in koordinacije oko – roka (vaje za spodbujanje ravnotežja, gibljivosti, ročne spretnosti);

•               govorno, jezikovno področje, ki se vključuje tudi  v vseh ostalih aktivnostih;

•               senzomotorične vaje (povečujemo diferenciacijo in prepoznavanje čutnih vtisov);

•               kognitivne vaje (spomin, pozornost, koncentracija); 

•               socialne veščine (pripomorejo, da je posameznik čim dlje časa aktiven na področju komunikacije in druženja z ljudmi);

•               krepitev zdravega življenjskega stila in skrb za zdravo prehrano.

Z aktivnostmi želimo posameznikom ponuditi možnost za socialni stik med generacijami ter zmanjševati strah pred negotovo prihodnostjo, kar menimo, da pripomore h gradnji človeku bolj prijazne in strpne družbe.

PO4.22. Tehnološka podpora pri oskrbi ljudi z demenco v skupnosti

MALI Jana, ŽITEK Nina

Demence postaja v življenju sodobnega človeka vedno bolj prepoznaven pojav. Po novejših strokovnih spoznanjih predstavlja demenca tudi možnosti in priložnosti za nove življenjske izide. V središču pozornosti ni demenca, temveč človek, ki ima demenco in za samostojno življenje potrebuje veliko podpore. Predstaviti želimo projekt, katerega namen je razviti takšne rešitve za ljudi z demenco v njihovem domačem okolju, ki izhajajo iz potreb ljudi z demenco in z uporabo informacijsko - komunikacijske tehnologije prispevajo h krepitvi moči ljudi z demenco. V projektu študentje Fakultete za socialno delo in Fakultete za elektrotehniko sodelujejo z Zavodom za oskrbo na domu Ljubljana in podjetjem ComSensus. Sodelovanje omogoča razvoj pomoči, ki temelji na interdisciplinarnem sodelovanju in zagotavlja oskrbo v domačem okolju. Iskanje sodobnih tehnoloških rešitev temelji na potrebah ljudi z demenco, izhaja iz njihovih življenjskih razmer, stopnje demence, s ciljem odpravljanja konkretnih ovir in tveganj v vsakdanjem življenju. Projekt z interdisciplinarnim iskanjem rešitev in s participacijo ljudi z demenco na inovativen način prispeva k razvoju kakovostne oskrbe v domačem okolju ljudi z demenco. Projekt je inovativen v zagotavljanju interdisciplinarnega povezovanja študentov in strokovnjakov iz prakse, omogoča pa tudi sodelovanje obeh mentorjev na fakultetah. Inovativen je pristop do ljudi z demenco, njihovo neposredno vključevanje pri razvijanju rešitev kar še ni uveljavljen način praktičnega delovanja pri nas. Prav tako pri nas uvajanje tehnoloških rešitev v vsakdanje življenje starih ljudi še ni utečena praksa, poznajo pa jo v tujini. Povezovanje socialnih vidikov demence in tehnoloških rešitev za ljudi z demenco je inovacija tudi na nacionalni ravni. Inovativna je tudi aktivna vloga študentov pri iskanju konkretnih izboljšav v življenju ljudi z demenco. Glede na aktualnost projekta pričakujemo, da bodo imele predlagane rešitve uporabno vrednost za dvig kvalitete življenja ljudi z demenco v domačem okolju.

 

 
 

Last Updated: Monday 05 October 2015

 

 
  • Acknowledgements

    The 25th AE Conference in Ljubljana received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Spominčica gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
  • SCA Global Hygiene
 
 

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