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PO3. Medical aspects

Detailed programme and abstracts

PO3.1. Assessment of dementia risk, timely diagnosis and post diagnostic support: a qualitative study of the attitudes and experiences of UK based primary care health professionals

WILCOCK Jane, WALTERS Kate, ROBINSON Louise, QURESHI Nadeem, RAIT Greta

Background: Improving the timely diagnosis of dementia is a priority in all National Dementia Strategies and is the principal right of the Glasgow Declaration. NHS England introduced dementia “case finding” in the form of the Dementia Enhanced Service in the 2015/16 GP contracts specifically to increase the numbers of people receiving a timely diagnosis. General practitioners were expected to question people at high risk of developing dementia about symptoms of dementia. This study explores what professionals in general practices think about dementia case finding and risk assessment what impact there may be and the harms or benefits to this approach.

Methods: Primary care health professionals (GPs, practices nurses, health care assistants in UK general practice) were purposively sampled and interviewed using semi structured interviews. Interviews were audio-recorded, transcribed and an iterative thematic analysis was conducted.

Results: Twenty primary health care professionals were interviewed in 2016-2017. We present findings from the thematic analysis. Topics include the benefits, shortcomings and factors to consider when undertaking dementia case finding, risk assessment, communication, & post-diagnostic support. Emerging themes include limitations to case finding such as lack of evidence and low yield; strengths of the approach are a more opportunistic timely diagnosis, benefits of knowing the diagnosis and post-diagnostic support. Case finding is not a catch all approach; hidden or hard to reach populations; cultural differences in families “protecting” elders; overshadowing from multi-morbidities, over-diagnosis and the limitations of a normal consultation were all mentioned as barriers to successful case finding approaches.

Discussion: The study findings will have immediate relevance to policy-makers and commissioners in informing the role, design and implementation of current and future dementia case-finding programmes. Additionally, we identified variations in attitudes and areas of educational need and will make recommendations for the professional curriculum and for improvements in the timely diagnosis of dementia.

PO3.2. Cross-cultural examinations of moral and social attitudes towards prodromal dementia diagnosis: How can it be done?

SCHWEDA Mark, SCHICKTANZ Silke, WERNER Perla

Despite considerable scientific advancement, the prevalence of dementia will continue to rise in the next decades, posing serious social challenges to health care systems worlwide. In the search for facing these challenges, research is moving increasingly into the earliest phase of the disease – prodromal dementia (PRD). To diagnose PRD, and to predict the onset and the course of the disease, various biomarkers are currently under examination and validation. However, the focus on preclinical dementia is accompanied by important moral and psycho-social dilemmas regarding the advantages and pitfalls of providing such a predictive diagnosis. 

Our presentation intends to discuss the importance of these topics and of the use of a cross-cultural approach to advance knowledge in this area.  Its aims are threefold: First, we will critically examine the current state of art on the ethical and social scholarly field to identify main lines of arguments, potential gaps or even dissent in regards to preclinical dementia. Second, we will propose research lines for the inclusion of views and perspectives of different stakeholders – including professionals, affected persons, family members, laypersons and decision makers – who might play a role in the diagnosis of prodromal dementia. Moreover, the methodological advantages and disadvantages of qualitative vs. quantitative methods of data collection for gaining the perspectives from various stakeholders, will be discussed. Thirdly, we will reflect on the need to do so in a cross-cultural comparison. We will argue that adopting a cross-cultural, multi-stakeholder’ framework will allow us to understand how moral (i.e. role of autonomy, well-being, justice, trust) and psycho-social (i.e., stigmatization) attitudes regarding the diagnosis of prodromal dementia are embedded in social and cultural contexts. 

PO3.3. Detection of cognitive disorders using web-based cognitive test battery - validation against traditional methods

MAHDIANI Shadi, PAAJANEN Teemu, BRUUN Marie, BARONI Marta, RHODIUS-MEESTER Hanneke, LEMSTRA Afina W., HERUKKA Sanna-Kaisa, PIKKARAINEN Maria, HÄNNINEN Tuomo, NGANDU Tiia, KIVIPELTO Miia, GILS Mark van, HASSELBALCH Steen, MECOCCI Patrizia, FLIER Wiesje M van der, REMES Anne, SOININEN Hilkka, LÖTJÖNEN Jyrki

Early and accurate diagnosis of cognitive disorders is essential for proper treatment of neurodegenerative diseases. We developed a battery of web-based cognitive tests which provides tools for early detection of cognitive decline.

The cognitive test battery, Muistikko, consists of seven computer-based tasks assessing episodic memory, processing speed and executive functions of subject. Muistikko was validated in three cohorts (Table 3): PredictND and VPH-DARE@IT (memory clinic patients), and FINGER (healthy cases at risk). We performed linear correlations of Muistikko measures with different clinical measures such as MMSE, RAVLT, CSF and MRI biomarkers. Such correlations indicate whether the Muistikko measures have concordance with the standard clinical measures.

Table 3. Diagnostic characteristics of cohorts

A global cognitive score (GCS), composed of age, sex and several clinical cognitive tests was developed from the independent Amsterdam Dementia cohort, as summary variable reflecting cognitive function. Then, GCS was computed for subjects of all cohorts. Thereafter, a linear regression model developed from the PredictND data was developed for predicting GCS (dependent variable) from Muistikko submeasures (independent variables). Furthermore, classification accuracies between cognitively normal (CN) and mild-cognitive impairment (MCI), and CN and dementia subjects were computed for PredictND cohort by using cross-validation.

Table 4 represents the correlation coefficients between the Muistikko measures, MGCS and GCS, MMSE, RAVLT-Learning, RAVLT-Recall, CSF-Ab, CSF-tau and MRI- hippocampus volume (CSF and MRI data were not available for FINGER).

Table 4. Correlation coefficients

The Pearson correlation coefficients between GCS and MGCS were 0.79, 0.76 and 0.59 for the PredictND, VPH-DARE@IT and FINGER cohorts, respectively. By using MGCS as an attribute for the classifier, we were able to separate CN from MCI and dementia subjects with 81.2% and 88.6% (p<0.05), respectively.

This study shows Muistikko measures are highly correlated with classical cognitive tests. The low-cost web-based cognitive test battery provides useful information about cognitive decline.

PO3.4. Detection of cognitive disorders using web-based cognitive games - validation against traditional methods

MAHDIANI Shadi, BRUUN Marie, BARONI Marta, RHODIUS-MEESTER Hanneke, LEMSTRA Afina W., HERUKKA Sanna-Kaisa, PIKKARAINEN Maria, HÄNNINEN Tuomo, GILS Mark van, HASSELBALCH Steen, MECOCCI Patrizia, FLIER Wiesje M van der, REMES Anne, SOININEN Hilkka, LÖTJÖNEN Jyrki

The ultimate goal in diagnostics of memory disorders is to detect subjects at the pre-symptomatic phase. CSF and PET biomarkers are relatively invasive and expensive, and hence not suitable for screening. Our aim is to investigate the ability of low-cost computer games to detect cognitive decline and to enable stratification of subjects for more detailed but expensive studies.

We developed a battery of web-based cognitive tests that includes three computer-based games (Memory Card, Crossword Hunt and Tap Fast) measuring different aspects of cognition. The cognitive test battery was validated in PredictND cohort that included: 197 cognitively normal (CN), 80 mild-cognitive impairment (MCI) and 46 subjects with other dementia diagnosis (DEM). Average age and MMSE were 67±13 and 29±1.5, respectively. To quantify cognitive disorders, a global cognitive score (GCS), composed of different clinical cognitive tests from Amsterdam Dementia Cohort was developed.  Then, GCS was computed for all the subjects. Eventually, a linear regression model was built between the game features (independent features) and GCS (dependent feature). Furthermore, the composite scores were used to classify patients to different diagnostic groups (CN and MCI, CN and dementia).

Figure 1 shows the distribution of GCS and GGCS in different diagnostic groups.  The correlation coefficient between GCS and GGCS was 0.71. Table 5 shows classification results when using MMSE, GCS and games’ variables to separate subjects with CN from MCI and dementia subjects.

Figure 1. Distribution of GCS and MGCS shown for different diagnostic groups

Table 5. Classification accuracies between CN and DEM cases, and between CN and MCI cases using GCS, GGCS, MemoryCard game (MemC), CrossWordHunt (words, CW-W) game, CrossWordHunt (images, CW-I) and TapFast games (Tap).

This study shows the low-cost computer-based games provide useful information about cognitive decline. The games are able to classify CN from MCI and dementia patients with high performance.

PO3.5. Reasoning, reviewing and reducing antipsychotics in care homes using technology

ROYSTON Claire, STRAIN Joanne, SHEERAN Colin, MITCHELL Gary

Introduction: Sustained administration of antipsychotic medications can be associated with adverse effects including accelerated cognitive decline and over-sedation.  Despite this, there is evidence to indicate that 80% of people living with dementia, who receive these medications, may not derive appropriate therapeutic effect from these medications.

Service Development: Four Seasons Health Care (FSHC) have developed a specialist medication management application (App) which prompts review of antipsychotic medication that a person is prescribed.  The ‘App’, runs on standard IPads.

The standards set within the App are that each resident must have a documented annual review of medication from the resident’s GP and a care plan that clearly indicates the rationale for prescription. If these standards are not met, a referral to the GP is created and, operating the find and fix principle that is central to the functionality of the system, the referral is tracked until it has been completed. The App records data on individual dose and uses a pre-programmed algorithm which automatically triggers an urgent review process if the dose exceeds the normal therapeutic range.

Sample: The App was operationalised in 46 care homes that provide care for 1,818 residents living with dementia throughout England, Scotland, Wales and Northern Ireland.

Results: Through our analysis we found that 310 residents (17.05% of total sample) are currently prescribed antipsychotic medications.  We also identified 27 residents where prescribed dose of medication exceeded the normal therapeutic range, 62 residents were identified where there was not a clear rationale provided for the use of the antipsychotic medication and 6 residents were identified where a review had not been completed within the previous 12 months.

Discussion: The medication App has enabled our staff to detect and act on these findings.  Furthermore, we can report that the average time taken to resolve these issues is 2 days.

PO3.6. An interventional study to promote appropriate use of psychotropic drugs in care homes in people with dementia

GANGOPADHYAY Debjani

An estimated 90,000 people have dementia in Scotland in 2016. The term stress and distress in dementia refer to the non-cognitive behavioural and psychological symptoms presented in people with dementia. 90% of people with dementia experiences these symptoms at some point. Psychotropic drugs are often inappropriately used to control these symptoms despite documented side effects of these drugs.

The aim of this study is to explore the prescribing dynamics in care homes and assess the   reason for prescribing psychotropic drugs in stress and distress; followed by   development of

an intervention to reduce the use of these drugs. The primary objectives are to explore staff awareness of stress and distress in dementia, their knowledge about the indications and side effects of psychotropic drugs. Secondary objective is to develop a staff training/education package.

The research is mixed - methods pre- and post-test study method. In this study nurse’s attitude towards psychotropic drugs is explored in depth and a targeted intervention to change

attitude and behaviour of care staff to use of psychotropic drugs is developed based on The Theory of Planned Behaviour. Quantitative data looked at the prescription rates of psychotropic drugs in care homes and measured the knowledge and attitude of care staff towards stress and distress. Qualitative data was collected by semi-structured interviews to explore the objectives. An educational intervention to promote the use of alternative non-pharmacological interventions was developed according to the themes identified in the survey questionnaire and interviews. The intervention consisted of teaching sessions around the reasons for stress and distress and non-pharmacological methods of dealing with residents with stress and distress. The u-ACT model of care was developed and the teaching sessions were supplemented by information cards. The outcome of the intervention will be evaluated by monitoring prescriptions trends and conducting focus groups among care staff.

PO3.7. Authoritative or empathetic parental figure: what are the roles that care home staff adopt while responding to challenging behaviours in dementia?

VANDREVALA Tushna, CHRYSANTHAKI Theopisti, HEWSON Unity, LLEFSEN HOLM Sofie, GURUNG Pranisha, ANDERSON Aisha

People living with dementia (PLWD) can sometimes present challenging behaviours including shouting, restlessness, wandering, aggression and agitation. These challenging behaviours presented by PLWD can be upsetting to staff working in residential care homes. Yet little emphasis exists in the evidence base, on the reasons staff attribute towards challenging behaviours displayed by PLWD. The aim of the current study was to investigate care home staff’s views and experience of dealing with challenging behaviours displayed by people living with dementia (PLWD) in residential care homes.  Fifteen care home staff participated in semi-structured, face-to-face interviews in 2016 in Greater London. Thematic Analysis was used to identify salient themes. The representations of challenging behaviours ranged from understanding that the behaviour was a result of the illness, to associating behaviours to a personality trait with malicious intent. At times, these attributions resulted in infantilising persons with dementia. Depending on the representation held, staff members attributed triggers for challenging behaviours to unmet needs, historical and contextual reasons or self-blame. In these cases, staff often took on the role of an authoritative parental figure, an empathetic parental figure or a safeguarder, in their attempts to respond to challenging behaviours in a care home setting. The practical implications of these findings to care practice will be discussed.   

PO3.8. Evaluation of a dementia-specific case conference concept entitled WELCOME-IdA in German nursing homes

HOLLE Daniela, REUTHER Sven, TRUTSCHEL Diana, MÜLLER-WIDMER René, ROES Martina, HALEK Margareta

Background: Challenging behaviors exhibited by individuals with dementia might result from an unmet need. The dementia-specific case conference concept WELCOME-IdA represents a promising mean of analyzing and exploring these unmet needs. It was hypothesized that the use of WELCOME-IdA would lead to a reduction in the prevalence of challenging behavior and a maintenance in quality of life compared to control groups.

Methods: A cluster RCT was undertaken using a stepped-wedge-design to evaluate WELCOME-IdA in 6 nursing homes in Germany. Challenging behavior (NPI-NH) (primary outcome) and quality of life (QualiDem) of residents with dementia were measured every 3 months on all 6 nursing homes. A total of 7 time assessments took place over 19 months. Outcomes were analyzed using a linear mixed effect model and descriptive statistics. A process evaluation was conducted parallel to the effectiveness study to explore the implementation process.

Results: A total of 969 observations took place involving 167 residents (563 controls, 205 interventions, 201 follow-up). For the residents´ outcome a significant reduction in the prevalence of apathy (-0,20; 95% CL: [-0.39 -0.02], p = 0.031) was observed from control to intervention phase and from control to follow up phase (-0.25; 95% CI: [-0,50-0.003]; p = 0.048). No significant changes were observed for the mean score in quality of life. The data of the process evaluation indicate that 51 of 96 (53%) of dementia-specific case conferences were realized in which 46 different cases (residents) were discussed. Nursing staff adhered to duration, process structure, role structure and location of dementia-specific case conferences most of the time.

Discussion: WELCOME-IdA was able to diminish apathy and to retain quality of life of residents with dementia. The data of the process evaluation give important insight for further improvements of the implementation strategy of dementia-specific case conferences in nursing homes.

PO3.9. MOTivation Apathy aPplication (MOTAP)- application for assessment and prevention of motivational disorders in dementia patients

KÖNIG Alexandra, GROS Auriane, SOUBELET Andrea, PHAN Tran, MINH Khue, DERREUMAUX Alexandre, ROBERT Philippe

Apathy is one of the most frequent neuropsychiatric symptoms encountered in dementia and has been associated with substantial caregiver distress, with poor disease outcome, and reduced daily functioning. Apathy is defined as a persistent deficit of motivation reported by the subject himself or by his entourage, affecting behavioral (decreased goal-directed behavior), cognitive and emotional dimensions. Until today, apathy is diagnosed with the help of clinical rating scales such as the Neuropsychiatric Inventory (NPI) or the Apathy Inventory. However, these tools allow only a punctual and not continuous assessment and risk biases resulting from the assessor’ subjectivity, pointing to a need for additional systematic assessment tools.

Therefore, MOTAP aimed to develop a pilot application to assess apathy in an implicit, more objective and dynamic way. The application will allow to obtain a score in each dimension (cognition, behavior, emotion) of apathy through the gameplay of three “serious game scenarios” combined with sensor extracted data which will help to guide the clinicians in their further care. 

We aim to obtain reliable psychometric measurements and for this a comparative validation study will be carried out in an elderly population (≥ 60 years) of 150 subjects (memory complaint n = 50, minor cognitive disorder n = 50, major cognitive disorder (including Alzheimer) n = 50, according to DSM 5). The main evaluation criterion will be the comparison of the results obtained through the serious games with the classical tools currently considered as gold standards as well the objective data extracted from various sensors (audio, video, actigraphy).

At present, serious games are particularly used for stimulation or care, but little or not at all for assessment. By integrating game scores, sensor and classical clinical data, MoTAP may allow an earlier and more complete assessment of first signs of apathy.

PO3.10. The influence of noise on people with cognitive impairments

DIETZ Birgit, DIEHL-SCHMID Janine

It is plausible that people with cognitive impairments have particular difficulty classifying sounds and using sound source localisation to orient themselves. Difficulties identifying the source of a sound may result in feelings of insecurity and disorientation and sustained noise may also contribute to a deterioration in cognitive ability in those already cognitively impaired. However, few studies have investigated the influence of noise on the condition of such patients in the absence of familiar surroundings, e.g. during a hospital stay. Moreover, little is known about the ability of the cognitively impaired to use sound to orient themselves.  

Patients with mild cognitive impairments and early stage dementia were recruited for this pilot study at the day-unit 50plus at the Clinic and Polyclinic for Psychiatry and Psychotherapy at the Technical University Munich. The study investigated: 1) whether any differences were apparent between people with cognitive impairments and a healthy control group in terms of noise sensitivity and the ability to recognise and classify everyday sounds; 2) whether those with cognitive difficulties were less able to locate sound sources than cognitively healthy people; 3) whether noise had an effect on the cognitively impaired when completing neuropsychological tests; and 4) whether different types of background noise affected the sense of well-being in patients with dementia and other mental illnesses.

People with early stage dementia proved to have significantly more difficulty in recognising everyday sounds than healthy controls. However, they had little difficulty with simple localisation tasks, which they performed as well as healthy controls. While noise appeared to have no effect on the performance of the cognitively impaired when completing neuropsychological tests, it impacted negatively on their sense of well-being. In contrast, their sense of well-being was improved by classical music and quiet.

The fact that patients even in mild stages of Alzheimer's disease or frontotemporal dementia either do not recognize or misinterpret environmental sounds must be taken into consideration, not only in everyday life, but in particular when patients need to leave their familiar living environment, whether temporarily (e.g. hospitalization) or permanently (e.g. nursing home admission). It has to have an influence on architecture.

In summary, this study investigates acoustics and dementia, a subject previously largely neglected in both research and clinical practice. It reports some interesting initial findings and paves the way for more extensive studies enabling more detailed investigations.

PO3.11. Implementation of structured approaches to challenging behavior into nursing homes

HOLLE Daniela, GERRITSEN Debby, HALEK Margareta, SMALBRUGGE Martin, ZWIJSEN Sandra

Introduction: Although several guidelines have been published on alternative approaches to challenging behavior in dementia than prescribing psychoactive drugs, tools are needed that convert the general recommendations of the guidelines into methods that can be used in practice. Two care programs – GRIP and a dementia-specific case conference concept (CC-IdA) were developed for practice that structure the steps of detection, analysis, treatment and evaluation of the treatment of challenging behavior. GRIP was developed in the Netherlands, CC-IdA was originated in Germany.

Method: The care programs were compared using the TIDieR template for intervention description and replication. Similarities and differences of the implementation processes were analyzed and discussed in the light of the results of process evaluations that were conducted parallel to the implementation of GRIP and CC-IdA.

Results: Both care programs started with educational sessions which emphasized the rational behind working multidisciplinary and methodologically on challenging behavior. Training sessions in GRIP were accomplished by worksheets that supported the care team in the detection, analysis, treatment and evaluation of treatment of challenging behavior. Multidisciplinary meetings were pre-arranged. Instead CC-IdA included case conferences in which the description and analysis of challenging behavior was guided by the Innovative dementia-orientated assessment system (IdA). Half of the case conferences were supervised by the project team and a telephone hotline was offered for prompt help.

Discussion: After the process evaluations, the implementation strategies for both care programs were adapted. For GRIP, the worksheets were digitalized in an online tool. Also, a train-the-trainer session was developed. For CC-IdA (renamed into WELCOME-IdA) educational sessions were added by trainings in moderation skills, an intensive on the job training and the setup of a steering group in each nursing home. Key persons and adapting to existing structures were important factors to the success of implementation of both care programs.

PO3.12. Should I stay or should I go? How healthcare professionals’ close encounters with people with dementia in the acute hospital setting

O’BRIEN Becca, GOLDBERG Sarah, ALLWOOD Rebecca, PILNICK Alison, HARWOOD Rowan, BEEKE Suzanne

Around a quarter of hospital beds in the UK are occupied by patients living with dementia (PWD), and communication impairments are common across all types of dementia, often exacerbated by the hospital environment.  Unsurprisingly, healthcare professionals (HCPs) report particular challenges in caring for this patient group, whilst trying to recognise and value their personhood as per the underpinning ethos of person-centred dementia care. However, whilst there is a growing body of research that underlines the importance of communication in dementia care, there is far less that actually examines this communication in real time interaction. Suggestions and pointers for good communication do exist, but these do not tend to be empirically derived, and sometimes conflict with empirical findings. This paper focuses on a specific area of interaction which has previously received very little attention: the way in which healthcare encounters are ended or closed. There is potentially a conflict between a pressure to manage a patient as efficiently as possible, and endeavouring to ensure person -centred care and deal with communication difficulties arising from dementia. Using conversation analysis, we examined forty-one video recordings of HCP/PWD interactions collected from an acute inpatient ward. We identify three phenomena around which there were recurring troubles in our dataset: ‘open-ended pre-closings’, ‘mixed messages’ and ‘non specifics and indexicals (for example saying “I’ll be around”)’.  We conclude that moves towards closing an encounter that appear intuitive to HCPs as competent interactants, and that may represent best practice in other healthcare settings, may in fact serve to confuse a PWD and create difficulties with closings. Our findings underline the importance of examining best practice guidance, using approaches which can unpack the interactional detail involved. They also emphasise the importance of context in the analysis of healthcare delivery, to avoid a ‘one size fits all’ approach.

PO3.13. Cognitive decline increases patient´s vulnerability to delirium

FERNANDES L, MARTINS, PINHO, CORREIA, MOREIRA, LOPES, PAIVA, AZEVEDO L

Introduction: Delirium is a complex neuropsychiatric syndrome, very common in elderly patients. Among known risk factors increasing patient´s vulnerability to delirium, dementia is the strongest one. Delirium superimposed on dementia ranges from 22% to 89% in the hospitalized and community-dwelling elderly. These patients have worst outcomes, namely higher mortality and healthcare costs. But studies about risk factors for delirium in Intermediate Care Units/IMCUs are still scarce. This study aims to analyze if preexisting cognitive decline is associated with delirium development during the IMCU admission.

Methods: This pilot study included elderly patients, admitted into two IMCUs of the Intensive Care Medicine Service/CHSJ-Porto. Exclusion criteria were: Glasgow Coma Scale (score ≤11), transference from ICU, brain injury, blindness/deafness, unable to communicate. All patients were daily screened for delirium, with the European Version of the Confusion Assessment Method/CAM. Premorbid cognition/cognitive decline within the past 2 years was determined using the Informant Questionnaire on Cognitive Decline in the Elderly/IQCODE-SF, filled by a family/caregiver. Cognitive decline was compared between the two groups with and without delirium, using Fisher’s exact test for dichotomous variables at a significance level of 0.05.

Results: The final sample (n=42) was equally disturbed by gender, 47.6% were widowed, with a mean age of 78(sd=7) and with low educational level (63.8% 0-4 years). Overall 28.6% of patients developed delirium during IMCU hospitalization. Significant differences were found in the cognitive status between the two groups, with 72.7% of delirium patients presenting pre-existing cognitive decline, while the group without delirium, this proportion is only 19% (X2=8.875;p=0.006).

Discussion: These results are in line with previous research findings, supporting that elderly patients with preexisting cognitive decline are more likely to develop delirium during IMCU admission. The present study appears as a contribution to the identification of risk factors for delirium in specific medical settings not yet fully explored.

This work was supported by FCT(SFRH/BPD/103306/2014), ERDF through the operation POCI-01-0145-FEDER-007746 funded by COMPETE2020, by National Funds through FCT within CINTESIS, R&D Unit (Ref.UID/IC/4255/2013)

PO3.14. Improving wayfinding in the hospital environment

GIBB Matthew, COLE Natalie, GREENE Noel, LAWLOR Brian, O'CONNOR Cora

St James's Hospital, Dublin undertook a three-year project to improve the experiences of people with dementia within the hospital setting and in its’ links with the local community. Part of this project involved making changes to the environment to make it more ‘dementia-friendly’. This has covered a number of different areas including improved wayfinding and redesigning dayrooms.

In relation to wayfinding an opportunity arose to introduce environmental cues into a new building on the hospital campus. Disorientation and confusion are common problems for people with dementia and these problems can be particularly acute in busy and stressful environments such as hospitals. The challenge in the hospital was to amalgamate the accepted principles of wayfinding and dementia design and incorporate the Irish language, a legislative necessity. Drawing on best practice examples environmental cues including specially designed signage, colour and artwork were introduced to help orientate patients, visitors and staff.

The paper will discuss the concepts of successful wayfinding and how these can help the person with dementia navigate complex spaces independently and with a minimum amount of stress. It will also highlight the additional benefit to the hospital of having patients arriving on time at clinics with low levels of anxiety.

PO3.15. Blueprint for an advanced dementia specialist unit

TAGGART Maureen, KINNAIRD Lindsay

This presentation will outline the process of developing a blueprint for an Advanced Dementia Specialist Unit and approach to transition from hospital to the community.  The National Dementia Nurse Consultant carried out a largescale review of hospital provision for people with dementia – this included visits to 60 individual specialist care environments throughout Scotland.  The purpose of these visits was to evaluate the quality and appropriateness of provision and understanding the issues around transition and discharge to more appropriate care settings.  This process included considerable engagement with professionals, care staff, families and people with dementia.  The work was initiated by the problems identified by the Mental Welfare Commission’s report “Dignity and Respect: Dementia Continuing Care Visits”.  

The in-depth evaluation along with the review of the evidence base provided elements of good practice that have been incorporated into the blueprint.  It also covers complex issues such as working with families to manage change and issues of capacity that hamper transitions to more appropriate care settings.   

The Advanced Dementia Specialist Unit presents a blueprint for health boards to review their provision.  It presents the appropriate model of care for people with dementia who have a clinical need to be in hospital.  It outlines the professional team involved in providing the care required to respond to the complex nature of dementia and co-morbid illness.  It also provides the economic argument, presenting long term cost savings for the health board. 

It provides the approach to transition for people who do not have a clinical need to be in hospital and who would be more appropriately cared for in the community.  In doing so it highlights the care and support required in the community to enable this transition – including care home provision and supporting people in their own home.   

PO3.16. The communication between patients with dementia, caregivers and nurses in a hospital

DE KRAMER Lisa, KAMPER Ad, PAASMAN-PEELEN Dian

Background: For people with dementia, hospitalization is associated with cognitive and functional decline, a greater chance of staying in a care institution and higher mortality rates. Additional, the increasing group of people with dementia makes it important to respond to this by providing dementia care. An important factor of dementia care is the communication to and with people with dementia. The purpose is to map the communication in hospitals between patients with dementia, caregivers and nurses and to provide insight in the experiences of patients and caregivers.

Methods: This study involves a qualitative study using semi-structured observations and interviews. The observations (N=5) have been done during the morning while the nurses took care of the patient. During the observation, both verbal and non-verbal communication of the nurse to the patient were observed. The interviews were conducted with patients (N=5) and their caregivers (N=5) to explore their experiences of the communication from the nurses.

Results: From the observations, it appeared that the diagnosis dementia is not clearly stated in the system. If the nurse is aware of the diagnosis, they mostly adjust their voice and attitude. The patients were mostly positive, although they were not able to describe what they loved or missed in the communication. The caregivers think that the communication to the patients is appropriate, but that the information transfer to the caregiver from the nurse was not proactive and that they were not always heard.

Conclusion: The way in which a nurse communicate to the patient is in most cases coincidental appropriate. The problem is that the diagnoses dementia is not traceable enough in the system, so the nurses are not always aware of the adjustment they should make. Besides, the patient is not able to retell the information the nurses gave. This makes the communication between the nurse and the caregiver more important than by patients without dementia.

PO3.17. Intepirdine on top of stable donepezil therapy in mild-moderate alzheimer’s disease: efficacy on subdomains and factors of activities of daily living in a phase 2b study

RAMASWAMY Geetha, BRUINSMA Bote, FOGEL Ilan, ASARE Ebenezer, LOMBARDO Ilise

Introduction: Intepirdine is a novel 5-hydroxytryptamine 6 (5HT6) receptor antagonist in development for the treatment of mild-moderate Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Intepirdine has been studied in 20 completed clinical trials involving over 2,000 subjects, including a 48-week placebo-controlled study of 684 subjects with mild-moderate AD. We present results of an analysis of the ADCS-ADL scale as well its sub-domains, and factors of items of the ADCS-ADL.

Methods: In this 48-week double-blind, placebo-controlled study, 684 subjects with mild-moderate AD (MMSE 10-26) receiving stable background donepezil therapy were randomized to receive 35 mg intepirdine, 15 mg intepirdine, or placebo. An analysis was performed of the overall ADCS-ADL, ADL subdomains (Basic ADL, Instrumental ADL, and Total Independence Score), and factor clusters (Household Activities, Basic ADLs, Communication and Engagement, Outside Activities).

Results: At 12, 24 and 36 weeks, 35 mg intepirdine demonstrated statistically significant benefits versus placebo on top of stable donepezil therapy on the overall ADCS-ADL scale (24 weeks: 2.0 points, p= 0.024). In addition, 35 mg intepirdine demonstrated statistically significant benefits at multiple time points on the Instrumental ADL Score (week 24: 1.7 points, p= 0.020) and the Total Independence Score (week 24: 1.0 points, p= 0.001) versus placebo on top of stable donepezil therapy. Moreover, 35 mg intepirdine on top of stable donepezil demonstrated a statistically significant effect on the communication and engagement factor throughout the 48-week treatment period.

Conclusions: In this study in mild-moderate AD, 35 mg intepirdine on top of stable donepezil demonstrated a statistically significant benefit on overall ADCS-ADL score, Instrumental ADL Score and Total Independence Score. Moreover, 35 mg intepirdine demonstrated a particularly robust effect on the Communication and Engagement factor of the ADCS-ADL. These results suggest that intepirdine has the potential to benefit important aspects of function in AD.

PO3.18. Economic evidence on non-pharmacological interventions for persons with dementia: a systematic review

NICKEL Franziska, BARTH Janina, PENDERGRASS Anna, GRAESSEL Elmar, KOLOMINSKY-RABAS Peter

Objective: Over the last decade research on non-pharmacological interventions for persons with dementia (PwD) has gained momentum. The aim of this systematic review was therefore to assess the economic evidence on non-pharmacological interventions directly targeted at PwD.

Methods: A systematic literature search was conducted in the following databases: Cochrane Library, Centre for Reviews and Dissemination, EconLit, Embase, PsycINFO and PubMed. Trial-based economic evaluations published between 2010 and 2016 were included. Study quality was assessed according to the Drummond checklist.

Results: In total, nine RCT-based economic evaluations were identified. Of these, two studies evaluated exercise interventions for community-dwelling PwD. Considering the outcomes physical functioning and behavioral and psychological symptoms, these exercise programs were found likely to be cost-effective.

Another study indicated that individually tailored occupational therapy for PwD exhibiting behavioral and psychological symptoms is cost-effective.

Furthermore, the economic evidence on cognitive interventions was inconsistent. Joint reminiscence groups for community-dwelling PwD and informal caregivers as well as a carer-led individual cognitive stimulation therapy were unlikely to be cost-effective. In contrast, there is evidence that a group-based maintenance cognitive stimulation therapy for PwD residing in care homes or visiting day care centers is cost-effective.

With regard to psychological and behavioral treatments two interventions, namely self-management group rehabilitation for PwD and their spouses as well as cognitive-behavioral therapy for PwD-caregiver dyads, demonstrated effectiveness and cost-neutrality.

Discussion: There is some evidence on cost-effective non-pharmacological interventions for PwD. However, the included studies showed a high degree of methodological heterogeneity with regard to outcomes, sample size, perspective and time horizon. In particular, quality-of-life values of PwD should be interpreted cautiously, this holds as well for proxy-rated values.

This research work was funded by the Karl and Veronica Carstens-Foundation as part of the national graduate college ‘Optimisation strategies in Dementia – OptiDem’.

PO3.19. An assessment of dependence in dementia using an algorithm to convert adcs-adl scores to dependence levels: analysis of a phase 2b double blind placebo controlled trial of Intepirdine (rvt-101) in mild-moderate Alzheimer’s disease

RAMASWAMY Geetha, BRUINSMA Bote, FOGEL Ilan, ASARE Ebenezer, LOMBARDO Ilise

Background: Alzheimer’s disease (AD) trials typically focus on cognitive and functional outcomes. However, there has been increased interest in using the Dependence Scale, a 13-item scale that assesses the degree of assistance needed by patients. The Dependence Scale captures a combination of cognitive, functional, and behavioral changes in AD, with cost correlations reported in the literature. We examined dependence in a study of intepirdine, a novel 5HT6 receptor antagonist, using a published conversion algorithm from ADCS-ADL scores.

Methods: In this 48-week double-blind, placebo-controlled study, 684 subjects with mild-moderate AD (MMSE 10-26) receiving stable background donepezil therapy were randomized to receive 35 mg intepirdine, 15 mg intepirdine, or placebo. Multiple cognitive and functional endpoints were evaluated during the study, including the ADAS-cog, ADCS-ADL, and CDR-SB scales. Primary endpoints of this study were change from baseline in ADAS-cog and CDR-SB at 24 weeks. The ADCS-ADL scores were converted to Dependence Scale scores using a published algorithm. These Dependence Scale scores were translated into discrete Dependence Levels.

Results: Baseline Dependence Levels were similar across groups. Progressors were defined as those who demonstrated an increase of one or more Dependence Levels. The percentage of subjects who progressed to higher Dependence Levels was lower in the group that received 35 mg intepirdine on top of stable donepezil compared to the group that received placebo on top of stable donepezil. This difference was statistically significant (p < 0.05) at weeks 36 and 48.

Conclusion: Based on this conversion from ADCS-ADL scores in a prior Phase 2b study of intepirdine to Dependence Levels using an algorithm, the addition of 35 mg intepirdine on top of stable donepezil was associated with reduced progression in Dependence Levels over 48 weeks. The Dependence Scale is a sensitive outcome measure to describe the real-world impact of drugs for dementia.

PO3.20. Optimizing clinical outcomes versus amount of disease modifying treatment (DMT) delivered in patients with significant memory concern (SMC)

TAFAZZOLI Ali, KANSAL Anuraag

Results of recent AD trials indicate that reduction of amyloid might be more effective in the beginning stages of AD before symptoms occur. Early treatment, however, may require exposing patients to the costs and risks associated with many years of treatment. Strategies that ensure treatment is provided only when most effective may help manage these risks.

We simulated progression of 250 amyloid-negative SMC patients with CDRSB = 0.5 from the ADNI database. Patients were simulated using the AD Archimedes Condition-Event (ACE) simulator. The AD ACE incorporates a system of disease progression equations which predict temporal evolution using data from ADNI and literature. A hypothetical DMT was constructed in the simulation which reduced the rate of cognitive decline by 20% in 5 years.  We evaluated clinical outcomes across a range of initiation and discontinuation rules in different combinations that provided similar total amount of treatment to the population. Rules tested included thresholds for MMSE and CDRSB.

Among initiation/discontinuation rules yielding a 3-year mean treatment duration, the best outcomes were observed when patients were treated at MMSE range of 29-27 or CDRSB range of 0.5-2; resulting in an additional 0.21 LY and 7% less AD cases over lifetime vs no treatment. Most benefits were lost, however, when treatment was delayed. For example, treating patients from an MMSE of 27 until 20 yielded a similar total amount of treatment, with fewer patients treated but for a longer period; but only achieved a survival benefit of 0.03 LY and 1% reduction in AD cases. Treatment initiating when patients first cross to amyloid-positive also provided limited clinical benefit, though with slightly less total treatment delivered.

In simulation with a hypothetical DMT, treatment of SMC patients was predicted to yield greater long-term benefits, while minimizing total drug delivered, when initiated early and before patients become amyloid-positive.

PO3.21. Making meaning, creating connection: principles to define and describe the delivery of arts interventions as a treatment for people with dementia

COUSINS Emily, DENING Tom, TISCHLER Victoria, GARABEDIAN Claire

Arts interventions are hugely beneficial in the treatment and management of dementia. Employed widely and successfully around the world, they enhance the care, wellbeing and quality of life of people with dementia. The arts can improve memory, mood, cognitive function and selfhood. Examples include singing groups, craft and drawing sessions, dance classes and shared reading.

However, there is currently no consensus regarding the definition and description of these interventions and what they should contain and include. Developing a common language of classification will illustrate the rationale for different creative approaches, support the evaluation and improvement of arts interventions, and enable their benefits and impact as a treatment and management solution for people with dementia to be communicated more effectively.

This presentation will share findings from a study tasked with producing an International Taxonomy of arts interventions for people with dementia. A Taxonomy is a way to classify and name the component parts of arts interventions in order to understand what these treatment options should be comprised of.

Using a qualitative framework of Realist methodology, a review of the literature was undertaken to identify what key principles drive the delivery and outcomes of arts interventions for people with dementia. This analysis was complemented by a series of stakeholder focus groups and Nominal Group Technique workshops to incorporate the lived expert experience of carers, artists, practitioners and care staff.

High quality, person-centred arts interventions are characterised by the following principles: Animation, Transcendence, Selfhood, Humanity, Expression, Connection, Possibility, Involvement, Awareness. Each principle is supplemented by a range of explanatory and detailed features.

This definition and description of arts interventions articulates their content and context. The principles constitute the underlying mechanisms that enable the arts to be such an enriching, cost-effective management technique for people living with dementia.

PO3.22. Association between carotid artery stenosis and cognitive impairment in memory clinic patients

KNASIENĖ Jurgita, NEKROSIUTĖ Greta, SESKEVIČIUS Arnas

Background: Patients with carotid artery stenosis have much worse cognitive functions, that is why an early diagnosed carotid artery stenosis and interventions could help to reduce symptoms and progression of cognitive disorders.

The aim of study: To establish a link between cognitive dysfunction and carotid artery stenosis.

Methods: Data of 124 patients were investigated in Kaunas Clinical Hospital Memory Clinic. We used Mini Mental State Examination (MMSE), carotid artery stenosis and plaque state were measured during neck ultrasound examinations. During ultrasound examinations, both sides of carotid artery intima-media thickness (mm), atherosclerotic plaque size (%), the maximum blood vessel blood stream velocity (m/s) were registered.

Results: The study population consisted of 44 men (35.5%) and 80 women (64.5%). The average age - 76.7 ± 10.0 years. MMSE scores average - 21.2 ± 5.8. According to the survey data MMSE 34.7% of the subjects there was no cognitive disorder found, 26.6% of the subjects were found mild cognitive disorder, 30.6%-moderate cognitive disorder, 8.1%-severe cognitive disorders. Estimated carotid stenosis degree: 80.6% of the subjects had mild right carotid artery stenosis, moderate - 15.5% and severe - 4.8%. 78.2% of the subjects had mild left carotid artery stenosis, moderate - 16.1% and severe - 5.6%. There was established a statistically reliable relationship between cognitive dysfunction and clinically relevant right (p = 0.012) and left (p = 0.023) carotid artery stenosis - the higher the cognitive disorder, the more often carotid artery stenosis was established.

Conclusions: 65.3% of subjects were established to have a cognitive disorder, 38.7 % of them had a moderate or severe illness. Clinically significant right carotid artery stenosis was found in 19.3% of the subjects, left carotid artery stenosis was found in 21.7% of the subjects. There was established a statistically reliable relationship between cognitive dysfunction and clinically significant carotid stenosis.

PO3.23. Clinical and cost effectiveness of targeted cognitive testing for early identification and intervention in neurocognitive disorders: A randomized controlled trial in secondary care

HWANG Aljoscha Benjamin, BAUMGART André, BOES Stefan, NYFFELER Thomas

Background: Major neurocognitive disorder (NCD) affects around 144’000 people in Switzerland, with numbers expected to double to 300’000 by 2040. The total number of new cases each year, was estimated to be nearly 30’000. Only around half of those affected have been diagnosed. Thus, improving diagnosis rates is a key aspect of the National Dementia Strategy. Routine testing of high-risk patients has been contemplated but there is a lack of empirical data on the benefits and harms. This trial seeks to provide information about the benefits, harms and costs of routine testing for mild NCD in high-risk inpatients.

Method: Single-blinded, parallel, randomized controlled clinical trial with a 1:1 randomization of subjects. Around 400 elective inpatients aged ≥ 65 years, with increased risk for major NCD but without known diagnosis of NCD and known mental disorder will be consecutively enrolled in either a) cognitive testing at day of hospital admission or b) cognitive testing after 18months. Cognitive testing will be done, using BrainCheck and Montreal Cognitive Assessment. Subjects who show signs of mild NCD will be referred to standard subsequent testing and a training for cognitive dysfunction, which will be provided in clinical routine at the local Memory Clinic. Data on health care utilization, caregiver burden, health related quality of life and anxiety and depression will be collected monthly, for 18 months.

Results: The poster will present preliminary results on the prevalence of high-risk inpatients and mild NCD in older people with planed admission to an acute general hospital in Switzerland.

Discussion: The overarching goal of this trial is to determine whether targeted cognitive testing in inpatients promotes access to suitable services and thereby leads to higher health-related quality of life in inpatients and/or caregivers as measured by the EuroQol5D-5L. We hypothesize higher values at 18 months post-testing in those, who are tested at day of admission/baseline, compared to those who are tested at 18 months.

PO3.24. Trajectories in real life and risk factors of dementia (TRAIL-DEM) Protocol for the nursing home study

MJØRUD Marit, ENGEDAL Knut, KNAPSKOG Anne-Brita, STRAND Bjørn Heine, BERGH Sverre, BJERTNESS Espen, EDWIN Trine Holt, AMLAND Rachel, SELBÆK Geir

There is a lack of studies on dementia trajectories from symptoms, to diagnosis, nursing home (NH) admission and death. Risk factors for the progression rate of dementia disorders are poorly described and survival after a diagnosis depends on numerous factors such as dementia sub type, age and disease severity. In Norway, most persons with advanced dementia are admitted to NH.

Method: In Trail-Dem data from three cohorts will be combined: The Norwegian Register of Persons Assessed for Cognitive Symptoms in specialist health care services (NorCog) (n=5,500), Resource Use and Disease Course in Dementia (REDIC) (n=1,000), and Course of dementia and neuropsychiatric symptoms among community-dwelling elderly receiving in-home care (CONSIC) (n=1,001), with registry information on nursing home admission, morbidity and mortality.

NorCog constitutes a clinical network of 26 clinical specialist out-patient clinics. To examine the prognosis of the patients from diagnosis to NH admittance and time of death, clinical data on persons who are included in the NorCog and are admitted to a NH, will be retrieved from the NH records or from interviews with NH staff. For those deceased journal data from the time of admittance and time of death will be collected. Clinical data that will be collected are: date of admission, moving within the facilities, mortality, clinical diagnoses, drug use, dementia type and progression as well as physical and cognitive function (CDR, PADL, NPI etc). In addition, NH organizational data will be collected; number of staff per leader, number of patients and staff per unit, and level of staff education, use of methods for person centered care and participation in ABC for dementia.

Conclusion: this study will provide knowledge on progression of dementia and contribute to a national research network.

PO3.25. Validation of Affect-GRADIOR: ICT based emotion recognition test for older adults with Alzheimer’s disease and amnestic MCI

VANOVA Martina, GARCÍA-CASAL Antonio, MARTÍNEZ-ABAD Fernando, SOTO-PÉREZ Felipe, PEREA-BARTOLOMÉ Victoria, FRANCO-MARTÍN Manuel

Because of the damage to the neural networks involved in the processing of facial expressions, a decrease of the ability to identify them has been found in people with dementia and has been related to the evolution of amnestic mild cognitive impairment (aMCI) into AD. A timely detection of emotion recognition deficits could improve the access to treatments having an impact in the quality of life of this people. Emotion recognition assessment could also be useful both for early screening and for differential diagnosis, as emotion recognition abilities may help identify aMCI and Alzheimer´s disease.

The aim of this study was to carry out the pilot validation of Affect-GRADIOR, a computer-based emotion recognition test, with people with AD (N=84), aMCI (N=59) and healthy older adults (N=69).

There was a significant difference in age between healthy participants, people with aMCI and people with AD. In a simple regression analysis, age had a predictive power over correct answers (R2 = .055; t = -3.497; p = .001), but not over processing speed (R2 = .013; t = -1,694; p = .092). To determine if age explained the variance of Affect-GRADIOR outcomes, a multiple regression analysis (enter method) was performed with total correct answers and total emotion recognition processing speed as dependent variables and the participant based variables as independent variables (age and group). The resulting regression model excluded age as a significant factor.

The diagnostic group (HC, AD or aMCI) explained 21% of the total variance of total correct answers (R2 = .206; F = 27.068; p < .001).

The present study suggests that Affect-GRADIOR emotion recognition test has good psychometric characteristics and high usability and acceptability among older adults with and without cognitive impairment.

PO3.25a Monitoring devices, internet and virtual reality based instruments for dementia and cognitive impairment screening. Systematic literature review

VANOVA Martina, GARCÍA-CASAL Antonio, TORIBIO-GUZMÁN Miguel, CSIPKE Emese, PEREA-BARTOLOMÉ Victoria, FRANCO-MARTÍN Manuel

The reduction in cognitive decline depends on timely diagnosis. The aim of this literature review was to analyse the current screening instruments based on monitoring devices, the internet and virtual reality in terms of validity, reliability and usability.

Electronic searches identified 1785 articles of which 34 met the inclusion criteria and were grouped into test batteries, measures of isolated tasks, behavioural measures and diagnostic tools.

Thirty-two instruments were analysed. Eighteen were based on monitoring devices, 9 on the internet and 5 on virtual reality. Twenty-seven of the 34 instruments reviewed reported good discriminant validity in the detection of cognitive impairment, and 15 reported good discriminant validity in the detection of dementia, with six providing good specificity and sensitivity values. Half of the devices reviewed were not available in a home deliverable format. Even though many studies stated that their instruments were accessible, usable or user friendly, only two addressed the issue.

Research suggests that we further develop screening for dementia through monitoring devices and virtual reality. Internet and virtual reality based instruments should look to monitoring devices to improve their possibilities of offering independent home based administration. Providing the amount and diversity of instruments reviewed, it would be advisable to use those which have been validated and standardised for older adults. Usability and end user’s participation should be included in the design protocols of screening instruments.

PO3.26. Developing early detection of dementia with people with intellectual and developmental disabilities

ERIKSSON Maria, SUNDIN Markus

Introduction: In Finland there is a lack of a unified approach to the early detection of dementia for people with intellectual and developmental disabilities (IDD). The aim of this presentation is to describe a currently underway collaboration project, which responds to this challenge.

In our opinion, there are two essential elements in early detection of dementia with people with IDD: 1) an overall description of the psychosocial functioning of the person and 2) a screening method for dementia, which developed for persons with IDD. These two components are shortly outlined.

Psychosocial functioning: Early detection of neurocognitive disorders in people with IDD is multidisciplinary teamwork. The Finnish Association of Intellectual and Developmental Disabilities (FAIDD) has published two methods for this purpose (the Toimi and the Psyto), and we recommend using these methods in the assessment of dementia in people with IDD as well. For example, it is important to distinguish the symptoms of dementia from other possible psychological disorders (like mood disorders and psychotic symptoms).

Translation of the National Task Group Early Detection Screen for Dementia (NTG-EDSD): Commonly used assessment methods (like the Cerad and the Mini-Mental) may not be applicable for people with IDD. In our project, we decided to translate the NTG-EDSD into Finnish. The EDSD is already available online in many other languages (www.aadmd.org/ntg/screening). As the authors write, the NTG-EDSD is not an assessment or diagnostic instrument, but an administrative screen that can be used by people who know the client well.

Conclusion: We plan to introduce the Finnish version of the NTG-EDSD during this year. We will train staff and other people working with people with IDD to use the screen within the perspective of psychosocial functioning.

PO3.27. Factors that influence the perioperative care of people with dementia

DIAZ Alicia, BROOKE Joanne, PENDLEBURY Sarah, JACKSON Debra

Background: Hospital care of patients with dementia currently represents a challenge for the person with dementia and healthcare staff. The number of people with dementia is expected to increase worldwide during the upcoming years. It is estimated that by 2050, 50% of people with dementia aged over 65 will require a surgical procedure. However, there is no comprehensive understanding of the impact of the perioperative trajectory on people with dementia.

Aim: To identify factors which influence perioperative care for people with dementia.

Methods: Relevant literature published in English between 1st January 2006 and 1st January 2017 was searched on the electronic databases CINAHL, PubMed, BNI and PsychINFO.

Results: A total of six articles met the eligibility criteria for inclusion in the review. Papers explored the impact on patients with dementia and staff across the perioperative trajectory. Themes that emerged from the data included: Difficulty in assessment because of cognitive impairment, increased risk of postoperative complications, identifying early stages of postoperative complications, and the need for consistent protocols and guidelines.

Discussion: Patients with dementia are at a greater risk of harm than patients without dementia when they undergo a surgical procedure. Healthcare professionals acknowledge their need to develop assessments, protocols and guidelines to support the perioperative care of patients with dementia.

Conclusion: There is a wealth of information on the impact of a hospital stay for people with dementia, but very little related to the perioperative trajectory. The findings from this review demonstrate the need to develop perioperative care to support patients with dementia, including the development of guidelines and educational packages specifically for surgical patients with dementia, acknowledging the current needs of both patients and healthcare professionals.

PO3.28. The effectiveness of GRADIOR a cognitive rehabilitation programme in people with mild dementia. A randomised controlled trial

VANOVA Martina, IRAZOKI Eider, GARCÍA-CASAL Antonio, TORIBIO-GUZMÁN Miguel, FRANCO-MARTÍN Manuel

Cognitive rehabilitation is a highly individualised intervention specific to patients’ needs and goals which in people with mild dementia is used to maintain their cognitive status. In recent years’ cognitive rehabilitation has been developed also for various IT platforms. In this study we aim to evaluate the effectiveness of cognitive rehabilitation software GRADIOR in a single-blinded randomised control trial with people with mild dementia and mild cognitive impairment.

GRADIOR is a computer-based programme used for neuropsychological rehabilitation for people with various cognitive impairments of different aetiology as well as for cognitive stimulation of healthy individuals. EhcoButler is an international e-health platform available via the internet which aims to promote physical and mental health, social participation, quality of life and personal wellbeing.

Eligible participants (people diagnosed with mild dementia N=200 and mild cognitive impairment n=200) will be randomised in equal proportion between 4 groups receiving treatment in a form of psychosocial stimulation (EhcoButler), psychosocial stimulation together with cognitive rehabilitation (EhcoButler and GRADIOR), cognitive rehabilitation (GRADIOR) or treatment as usual.  All groups will receive an adequate treatment for a period of one year.

This is a randomised control trial, interviewer blinded, with four parallel groups, 1:1:1:1 allocation ratio. All participants will be assessed for cognitive functions, activities of daily living, mood state, relationship with a carer and quality of life at the beginning of the intervention, at 4 and 12 months. The primary outcome of this trial is to determine any relevant changes in participants’ cognition during the treatment and in a 4 months and 1-year follow-up.

In this poster we present the RCT set up and preliminary results from the usability assessment of GRADIOR programme.

PO3.29. FindMyApps; (Cost-)effectiveness and user satisfaction of a person-centred intervention to help people with mild dementia find and use suitable apps that support their self management and social participation

MANGIARACINA Floriana, KERKHOF Yvonne, MEILAND Franka, GRAFF Maud, ORRELL Martin, DRÖES Rose-Marie

Background: There is growing evidence that hand-held touch-screen devices (tablets) and applications (apps), e.g. apps for social contact and activities, can support people with mild dementia to manage their life and engage in meaningful activities. However, not all people with dementia are familiar with using tablets and apps and not all apps are suitable for all people. Therefore, a person-centred tablet programme was developed that consists of a training to teach people to use the table and a tool to easily find suitable apps.

Aim: To evaluate the (cost-)effectiveness and user satisfaction of the FindMyApps intervention compared to Usual care (tablet use without FindMyApps intervention). The study will be conducted within the Marie Curie funded INDUCT project, an Interdisciplinary Network for Dementia Using Current Technology.

Method: To investigate the effectiveness of FindMyApps on self management and social participation a randomized controlled trial (RCT) will be conducted with three measurements: at baseline (T0), after 3 months’ intervention (T1) and at follow-up (3 months after T2). An economic evaluation will be conducted from a societal perspective; a budget impact analysis from a societal, care provider and care insurer’s perspective. A process evaluation will inventory tablet/apps use and factors/user experiences that influenced the intervention outcomes, tablet use and user satisfaction. A user evaluation in the FindMyApps and Usual Care group will compare the satisfaction of people with dementia and their carers with tablet use at T1 and T2.

Conclusion: The personalized e-Health intervention FindMyApps potentially contributes to the empowerment of people with mild dementia to manage their lives and remain connected to the social environment. FindMyApps will be implemented among the target group via memory clinics, meeting centres, day care centers and Alzheimer association and will be downloadable for free (or low price). To ensure implementation a business case will be developed.

PO3.30. Involving patients to develop person-centred dementia care in acute wards

HUNG Lillian, MANN Jim

Staying in the hospital can be a very stressful experience for patients with dementia. This innovative project took a participatory approach to involve patients with dementia, families and a team of interdisciplinary staff in a large Canadian hospital to co-create dementia education. A person who is living well with Alzheimer’s disease served as an advisor and worked closely with a PhD student to support the development of staff education. Five patients with dementia in a medicine ward were involved to co-produce videos for dementia education. The involvement of people with dementia was guided by the ethical framework developed by the Alzheimer Society of Canada. This poster will present how the ethical framework was operationalized in this research project. In the study, the researcher had conversations about project design and action activities with persons with dementia, who provided invaluable expert advice, which helped to shape research outcomes and create a greater research impact. In the beginning, the patient advisor provided an education workshop for staff, which inspired tremendous interest and engagement of staff in the dementia project. In the end, an interactive education brochure was co-developed with patients, families and staff in the hospital. Our experiences suggest that there is a great and untapped potential to involve people with dementia in research and practice development. Meaningful involvement of people with dementia can contribute to making care practice in the hospital more responsive to patients’ needs.

PO3.32. Memory complaints in older age: from theory to assessment

KRAKOVSKÁ Simona, BRANDOBUROVÁ Petra

Memory complaints and concerns about cognition are often perceived by people in older age. In many cases they can indicate objective problems in cognition and future progression to dementia. As stated by National Institute on Aging of Alzheimer´s Association, they can be a key for dementia prevention and detection. This king of complaints and concerns therefore should be taken seriously by neuropsychologists responsible for assessment of cognition.

The presentation analyses a theoretical background of concept of memory complaints from different perspectives and reviews and evaluates methods currently used for assessment (MFE, CFQ, PRMQ, MFQ, SMCQ, CDQ EMQ, EEM and MMQ). We analyze the possibilities of assessing the memory complaints in the context of neuropsychological examination, based on the experiences of a Memory Centre, memory clinic providing first assessment of persons with subjective or objective concerns about cognition in Slovakia.

The theoretical and practical knowledge as analyzed in the presentation is a basis for selection of a method for memory complaints assessment - Multifactorial Metamemory Questionnaire (Troyer, 2002) – to be included in neuropsychological battery NEUROPSY, that is currently being developed and standardized in Slovakia as a part of a project SRDA-15-0686. A questionnaire enables multifactorial evaluation of memory complaints, memory-related emotions and ability to use strategies to strengthen the cognitive functions and is generally applicable in clinical practice and research.

PO3.33. Slovak version of EMQ and MMQ: preliminary findings

BRANDOBUROVÁ Petra, KRAKOVSKÁ Simona, HAJDÚK Michal

Growing interest in understanding the relationship between subjective memory complaints (SMCs) and objective measures of memory abilities emphasizes the importance of SMC assessment for diagnostic purposes. The present study investigated the relationship between SMCs and objective memory deficits in older adults by using two different measures of SMCs and cognitive screening test.  The Everyday Memory Questionnaire (EMQ; Sunderland, Harris, & Baddeley, 1983) was developed as a subjective measure of memory failure in everyday life. The Multifactorial Memory Questionnaire (MMQ; Troyer & Rich, 2002) was developed to assess separate dimensions of memory ratings that are applicable to clinical assessment and intervention. Slovak versions of these instruments have not been available yet. The Montreal Cognitive Assessment (MoCA; Nasreddine, 1996) was designed as a rapid screening instrument for mild cognitive dysfunction. The aim of the present study was to examine the relationship between SMCs and objective cognitive performance in the group of 80 elderly adults.

PO3.34. CLEAR dementia care: understanding behavioural and psychological symptoms

DUFFY Frances, HARVEY Marc

People with dementia living in Care Homes can present with Behavioural and Psychological Symptoms of Dementia (BPSD) that Care staff find challenging and difficult to understand.  These behaviours are often a sign of the stress and distress the person experiences as they try to cope with the daily challenges of living with their condition.  Failure to understand the behaviour and address the unmet need can result in unnecessary breakdown in placement, unnecessary admission to hospital and increased distress for the person with dementia. CLEAR Dementia Care ©(Duffy, 2016) was developed with the multidisciplinary Dementia Home Support Team (DHST) in the Northern Health and Social Care Trust (NHSCT).  The aim is to help carers to understand behaviour in the context of the person and their environment, and identify unmet need.  Simple assessment and recording tools have been developed to facilitate timely formulation and intervention.  A CLEAR Dementia Care training programme provides education, case studies and tools to help accurately assess and record behaviour.  Following training, care staff report increased knowledge of (1) different types of dementia and the symptoms associated with these (2) ways to effectively communicate with a person with dementia and (3) how many factors, including life story, can contribute to behaviour in dementia.  Since the implementation of CLEAR Dementia Care there has been a reduction in admissions to the dementia inpatient ward.  This shows that care staff are better able to understand behaviour are find ways to address unmet need.  The feedback from care staff is extremely positive.  CLEAR Dementia Care helps carers to see the whole person with dementia.  When carers understand the perspective of the person, they can find ways to reduce distress.  The outcome is better care and enhanced quality of life for the person with dementia.

PO3.35. General hospital experiences of older people with cognitive impairment

ABLEY Clare, PRATO Laura

This presentation will outline the background, methods, findings and conclusions of an ethnographic study of the experiences of older people with cognitive impairment (dementia and / delirium) whilst in hospital. This study is part of an NIHR Clinical Lectureship to improve general hospital care of older people with cognitive impairment. Numbers of patients with dementia and / or delirium in general hospitals are significant, with about half of patients over the age of 65 having dementia, delirium or both conditions. The aim of this study was to identify what leads to positive and negative experiences for older people with cognitive impairment in general hospitals. A case study approach using ethnography was adopted, with data being collected throughout the patient’s hospital stay. Data collection methods included observation and staff and carer interviews. Interview data was transcribed verbatim. Data was analysed using interpretative phenomenological analysis (IPA) and stored / retrieved using NVIVO. A total of 6 patients were followed throughout their hospital stay, with in depth data collected for each patient. A number of important themes emerged from the data, namely: i) valuing the person, ii) empowerment and iii) the social and physical environment. Each of these themes will be explained and elucidated using data extracts. Several important discussion points will be raised related to the findings, including any study limitations. The main conclusions will be outlined. 

PO3.36. Developing a dementia communication skills training course

HARWOOD Rowan, O’BRIEN Becca, GOLDBERG, Sarah, PILNICK Alison, BEEKE Suzanne, SCHNEIDER Justine

Poor communication is a barrier to processes essential for good treatment and care.  People with dementia and those who work with them can experience difficulties in communicating and interacting.  The hospital environment can be a particular challenge for communication as patients and staff do not have long to get to know each other and the environment can be very busy, noisy and fast paced.  To improve care, we developed an evidence based dementia communication skills training course for healthcare professionals.

The components of the training course were developed using the results of a systematic review, conversation analysis of video recordings of naturally occurring conversations between healthcare professionals and patients with dementia in an acute hospital and expert opinion.  The course was developed over a series of four whole day meetings which involved nurses, doctors, speech and language therapists, family carers of people with dementia, communication experts, education experts and actors. 

The course consists of two days of training, a month apart, with a reflective exercise to be completed in clinical practice between the two days.  Attendees are a mixture of doctors, nurses and therapists to support interdisciplinary team working. The training involves a variety of methods, with an emphasis on experiential learning.  It includes presentation, video workshops, reflection on clinical practice and simulation workshops.  Simulation workshops involve specially trained actors as simulated patients in small group facilitated sessions.  These workshops give the participants an opportunity to practice their communication skills in real time and reflect on their own practice and that of others.  The intervention was evaluated using mixed qualitative and quantitative methods. 

In this presentation, we will discuss the methods we used to develop the training course and the rationale behind the choices made. 

 

 
 

Last Updated: Monday 18 September 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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