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P10. Risk factors and prevention

Detailed programme and abstracts

P10. Risk factors and prevention (Tuesday 1 Nov., 16.00 17.30)

P10.1. Depression negatively influences cognitive decline in early Alzheimer´s disease.

DEFRANCESCO Michaela,  FLEISCHHACKER Wolfgang, BLASKO Imrich, MARKSTEINER Josef, DEISENHAMMER Eberhard  

Objectives: Alzheimer’s disease (AD) is the most common cause of dementia in the elderly. Depression has been reported to be an important risk factor for cognitive impairment and an early manifestation of AD. Although cognitive deficits are the clinical hallmark of AD, various non-cognitive symptoms, such as depression, are common and are suggested to impair cognitive functions in addition to Alzheimer specific pathology.

Methods: We studied 347 patients with early AD at the time of diagnosis and at a follow-up visit at our memory clinic. All participants underwent a clinical examination and neuropsychological testing. Medication charts were reviewed and depression was assessed using the Geriatric Depression Scale (GDS). Mean changes of neuropsychological variables from baseline to follow-up between depressed (baseline GDS ≥ 10) and non-depressed (GDS < 10) patients were compared using the independent t-test.

Results: Of 347 patients (mean age 77.6 ± 7.6 years, 31% male, mean MMSE score 22.7 ± 4.1) 144 (41.5%) had depressive symptoms (mean GDS score 15.1 ± 4.2) at baseline. The comparison of depressed and non-depressed AD patients showed no group differences regarding demographic variables such as age, gender or education or any neuropsychological test results. At follow-up (mean 1.5 ± 0.9 years) depressed compared to non-depressed patients showed a significantly more pronounced decrease of the MMSE score (p = 0.044) and verbal fluency (p = 0.021).

Conclusions: Our results suggest that the presence of depression in the early stage AD impacts cognitive decline over the course of the disease negatively. Particularly speech related cognitive functions were negatively affected by depression, potentially caused by depression related social withdrawal. We therefore recommend special attention on even mild depressive symptoms in the treatment of early stage AD patients.

P10.2. Communicating Alzheimer’s disease risk in midlife: findings and recommendations from a European comparative focus group study

MILNE Richard, DIAZ Ana, BADGER Shirlene, GOVE Dianne, RICHARD Edo, FAURIA Karine, WELLS Katie, MOLINUEVO Jose Luis, RITCHIE Craig, BRAYNE Carol and on behalf of the ELSI Workpackage of the European Prevention of Alzheimer’s Dementia (EPAD) project

Research into new therapies for Alzheimer’s disease (AD) increasingly focuses on intervention at earlier stages of pathological processes linked to the expression of the dementia syndrome, identified by biomarkers thought to be proxies of pathology. The design of early intervention studies highlights challenges associated with the communication and disclosure of risk related to a late-onset chronic illness for which there are currently no effective preventative therapies, nor clear evidence of the level of risk of progression for any given individual. The objective of this research was to report the views of research participants from two European countries on the implications of the disclosure of the risk of developing Alzheimer's dementia.

The study comprised eight focus groups, held between November 2015 and January 2016 in London and Barcelona. Barcelona participants were recruited through the ALFA project, and UK participants were through the PREVENT cohort. Both cohorts focus on dementia prevention in mid-life and none of the participants in the London and Barcelona groups had dementia. In addition, one group discussion was held with 10 members of the European Working Group of People with Dementia of Alzheimer Europe. The study focused on two central questions:  what do potential research participants understand to be the main potential implications of the disclosure of Alzheimer’s disease risk status and what expectations, if any, do they have of any disclosure process.

The results describe the expected consequences of learning one’s Alzheimer’s risk status, and the impact of different sources of information – genetic, biomarker or lifestyle risk – on this. 

As part of the conclusions a set of recommendations for disclosure grounded in the preferences and concerns of participants and reviewed and agreed by all those involved in the research is outlined.

P10.3. Primary and secondary prevention interventions for cognitive decline and dementia- an overview of reviews

FLODGREN Gerd, BERG Rigmor

Background: The prevalence of dementia, including Alzheimer’s Disease (AD), is increasing due to the aging of the world’s population. As there is no cure for dementia, there is a great need to identify effective interventions to delay or prevent its onset. Methods: We searched eight databases from inception and up to January 2016. We included high quality systematic reviews of any intervention that included people who were either cognitively healthy or had mild cognitive impairment, we used standard review methods with independent screening, assessment and data extraction. Results: We identified eight eligible reviews. Five reviews involved interventions (blood pressure or cholesterol lowering drugs, Omega 3 FAs, cognitive training, and aerobic training) targeting cognitively healthy people. Three reviews concerned interventions (cholinesterase inhibitors, Omega 3 FAs, and vitamin E) targeting people with mild cognitive impairment. High to moderate certainty of evidence from seven of these reviews suggest that neither the pharmacological interventions, nor any of the nutritional supplements evaluated are effective in delaying or preventing cognitive decline, dementia or AD. The effects of aerobic training on cognition are uncertain, due to low to very low quality of evidence from one review. Moderate evidence from one review suggest that computerised cognitive training may lead to a small short-term improvement in cognitive function.

We found no reviews of interventions to promote other healthy lifestyle changes, e.g. conversion to a healthy diet, decreased alcohol intake, smoking cessation, etc., or addressing other risk factors for dementia, e.g. depression, lack of social interaction, and low educational attainment.

Conclusion: Evidence from systematic reviews of effective interventions to prevent cognitive decline, AD and dementia are lacking. Only single faceted interventions have been evaluated in systematic reviews. Due to the multifactorial aetiology of dementia, interventions addressing more than one modifiable risk factor may be needed.

P10.4. Greater levels of psychological distress, sleep disturbance and social isolation may place dementia caregivers at a greater risk of executive dysfunction

PERTL Maria, HANNIGAN Caoimhe, ROBERTSON Ian, BRENNAN Sabina, LAWLOR Brian

Background: Dementia caregivers are reported to be at an increased risk of cognitive decline themselves because of the chronic and often severe stress associated with providing dementia care. The impact of dementia caregiving on cognitive functioning may be mediated by psychosocial risk factors for cognitive decline/dementia that are known to be more prevalent among caregivers than non-caregivers. This study examined (1) whether caring for a spouse with dementia predicted poorer executive functioning and (2) whether relationships between caregiver status and cognitive performance were mediated by poorer psychological wellbeing, greater sleep disturbances and greater social risk factors (isolation and loneliness).

Methods: Eight-hundred and fifty community-dwelling older adults living in Ireland (caregiver n = 253) completed a test battery that included measures of executive functioning and as well as standardised scales to assess stress, anxiety and depression, sleep disturbance, social isolation and loneliness. A structural equation model with the maximum likelihood estimator and a full information likelihood approach to missingness was used to evaluate relationships between caregiver status, psychological distress, social risk factors, sleep disturbance, and executive function, controlling for age, gender, dementia risk score and grip strength (frailty) as covariates.

Results: We found that lower executive function performance was predicted by dementia caregiver status (β = -.048, p<.001)., along with higher scores for psychological distress (β =-.076, p=.04), social risk factors (β = -.102, p=.007) and sleep disturbance (β = --.443, p=.002). Caregiver status was positively associated with sleep disturbance (β =.012, p=.008), social risk (β = .070, p=.005), and psychological distress (β =.141, p=.005).

Conclusion: The negative relationships between dementia caregiver status and executive functioning may be at least partly explained by higher levels of psychological distress, social risk factors (isolation and loneliness) and sleep disturbances among this group.

P10.5. Discussing memory disease-prevention is becoming increasingly essential for Finnish Alzheimer associations

TAMMINEN Anna

In 2015, the Alzheimer Society of Finland conducted an online survey for its 43 local associations using the Surveypal customer platform. This survey was extensive and covered the competency-specifics of memory associations, resource distribution, priority activity sectors and their views regarding future priorities for memory-oriented activities.

Alzheimer associations work with people affected by memory diseases and their caregivers by organising peer support groups and providing guidance and counselling. Local assistance and lobbying as well as recreational activities are all important aspects. Nearly half of all Alzheimer Associations have full-time employees and half are still operated by volunteers. Association activities are mostly funded by the Finnish Slot Machine Association, municipalities and association members whereas the amounts given by businesses and private donations are fairly negligible. 

Associations have activities nearly all over the country. According to the survey, there are activities organised by Alzheimer associations in almost 93% of the Finnish municipalities. These Associations are realising that the promotion of brain health and providing useful information on memory disease prevention have become almost as essential as the peer support groups and guidance. As the majority of Finland’s population is getting older, memory diseases are considerable issues for public health. This is why all prevention-oriented information provided by these associations is so important for the entire Finnish population, pushing for brain health and ways to avoid memory diseases.

According to the survey, Finnish Alzheimer associations are highly appreciated within the society and among its members. Alzheimer association activities reasonably fulfil municipality hopes and expectations.  Associations still require national support for their assistance and lobbying work.  People with memory diseases and their caregivers still need close monitoring of their rights.  According to the associations, the increased involvement and individual activity support for people with memory diseases is becoming the major focus for association-specific activities with the same attitude expected from the Finnish society. The Alzheimer Society of Finland still has a lot to do for it to become a memory-friendly society by 2020.

 

 
 

Last Updated: Tuesday 10 January 2017

 

 
  • Acknowledgements

    The 26th AE Conference in Copenhagen received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimerforeningen gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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