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PL3. Improving the diagnosis and management of dementia

Detailed programme and abstracts

PL3.1. An overview of current epidemiological trends in dementia

BICKEL Horst

Epidemiology is concerned with the frequency and distribution of diseases in human populations and examines the factors associated with the development, course and consequences of diseases. The overall objective is the provision of data for disease control through prevention and by an improvement of health care.

The present contribution outlines the scientific issues of epidemiology in regard to dementia illnesses, describes the current state of our knowledge and describes the limitations and gaps in our knowledge.

PL3.2. Advances in Alzheimer’s diagnosis; implications for clinical practice?

van der FLIER Wiesje

The advances in diagnosis of AD using MRI, markers in Cerebrospinal Fluid (CSF), and amyloid-imaging using PET are among the largest successes of AD research. Nonetheless, in a large proportion of patients, a diagnosis is only made in a late disease stage. A better and earlier diagnosis would be very beneficial, as with timely diagnosis, patients can receive help quicker and more effectively.

ABIDE is a Dutch project that aims to improve AD diagnosis in memory clinics, by promoting effective application of MRI, CSF, and PET for diagnosis of MCI and AD in memory clinics, taking into account patients’ perspective and wishes on their use. PredictND is a European project that aims to develop a clinical decision support system to integrate the wide array of diagnostic test results.

In this lecture, innovations in diagnosis will be discussed with a focus on practical implications at everyday memory clinics. Focus groups with patients, caregivers and professionals provide support for the notion that decisions on diagnostic testing should be made in a setting of shared decision making. The predictND tool serves to integrate data from many different tests, allowing the clinician to weigh and combine all test results, supporting the clinician to arrive at a balanced diagnostic decision. In the context of ABIDE, we developed individualized risk models that allow estimation of probabilities of progression from MCI to dementia, taking into account patients’ characteristics. The risk models will be integrated in an easy to use app, called the ADappt. Patients and caregivers also stress that they would value more specific information on what diagnostic test results mean for them. The ADappt therefore provides support for the diagnostic conversation, aiming to improve doctor-patient communication.

With the development of new diagnostic tests, we enter an era where we can actually start to translate findings from science to everyday clinical practice. Tools to support the diagnostic process, may act as a catalyst for quicker and more effective diagnosis.

PL3.3. Are we getting closer to better treatments for Alzheimer’s disease?

JESSEN Frank

The challenge of developing a new treatment for Alzheimer’s disease is enormous. So far all promising drugs for disease modification, but also new compounds for symptomatic treatment have failed to show clinical efficacy. The reasons for these failures are most likely several, including target of treatment, mode of action and selection of patients. Still, there is strong research activity in academia and industry. Despite negative primary outcomes, several things have been learned from the recently failed studies. Very early treatment and combination therapies are the upcoming next steps. Importantly, recent studies also showed promising results in the field of non-pharmacological interventions with regard to prevention of dementia. In addition, there is development in the treatment of behavioral symptoms at the stage of dementia.

The presentation will give an update on the current state of treatment development in AD and will highlight upcoming topics.

PL3.4. Reducing dementia risk by targeting modifiable risk factors in mid-life: the lessons of the In-MINDD project

IRVING Kate, O’DONNELL Catherine, PIERCE Maria, KÖHLER Sebastian, DECKERS Kay, van BOXTEL Martin P. J

Dementia has been described as the condition of our time. Its prevalence is high and increasing.  It is the condition of aging most likely to create fear and existential dread in the population.  Associations between neuropathology and the clinical condition are not fully understood.  Such fear coupled with uncertainty has lead to an industry of products and services claiming to ‘re-wire your brain’ or ‘delay dementia by 10 years’.  Much of this industry has no grounding in research evidence.  The creation of myths around dementia prevention, have to some extent damaged legitimate sources of evidence.

In-MINDD sought to take the best available evidence and integrate this within a communication and support tool to help communicate reliable and important messages to the public and the health and social care community via a website designed with this purpose.  The website uses valid and reliable research tools to collect data on 12 areas of lifestyle which are modifiable and reliably relate to brain health. Our LIBRA (Lifestyle for brain health) system then triggers people to ‘remember to manage well’ (existing conditions which confer risk; diabetes for e.g.) ‘room for improvement’ ‘and keep it up’. Evidence based clearly communicated information is given to explain the factors, how the scores are arrived at and how the person might improve their overall lifestyle for brain health.

The study took a mixed methods approach to look at the feasibility of an online tool as a mechanism for behaviour change.  Although the intervention did not demonstrate a significant change in behaviour in our participants, lessons were learned concerning the process of normalizing new complex interventions into existing care and the role of technology in supporting behavior change to support cognitive health.

 

 
 

Last Updated: Monday 23 October 2017

 

 
  • Acknowledgements

    The 27th AE Conference in Berlin received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Deutsche Alzheimer Gesellschaft e.V. gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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