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PO18. Risk factors and prevention

Detailed programme, abstracts and presentations

PO18.1. Maintain Your Brain: An RCT of internet-based lifestyle intervention to prevent cognitive decline and dementia


Centre for Healthy Brain Ageing, UNSW, Sydney, Australia

Background: The failure to find disease modifying interventions for Alzheimer’s disease (AD) and other dementias plus evidence that environmental factors can delay the onset of dementia, have led to increased interest in dementia prevention. An issue for population-based lifestyle preventative approaches is scalability. An internet-based multicomponent Maintain Your Brain (MYB) RCT (Heffernan et al, 2019) funded by NHMRC is underway. 

Method: Invitations to participate in MYB were sent to 96,418 persons aged 55-77 years from the 45 and Up Study (conducted by Sax Institute), a population-based cohort study of one in ten people in NSW aged 45 years and older (n = 267,153) recruited from Medicare lists between 2006-2009. Participants were required to have risk factors rendering them eligible for 2-4 of these modules: physical activity, nutrition, cognitive training and peace of mind (depression/anxiety).

The 3 years RCT randomised participants into an active coaching group with weekly exercises for each eligible module and an information group who receive static internet monthly information. In year 1, modules run for ten weeks followed by a 2-week break. Participants receive booster sessions for their modules until end Year 3.

Results: Of 14,064 who consented, 6,236 completed all baseline assessments and were randomised. 16% met criteria for all four, 51% for three, 31% for two and 2% for one module. Twenty-one participants (<1%) were not eligible for any module. The first year of the trial will be completed in October 2019.

Conclusion: Most persons aged 55-77 years’ old who completed the baseline assessments have risk factors for cognitive decline that may be amenable to preventative interventions.  Lifestyle interventions have capacity to reduce the risk of cognitive decline and ultimately delay the onset of dementia. If successful, this trial evaluating the efficacy of delivering and monitoring a multipronged internet intervention, is scalable nationally and internationally.

PO18.2. Modifiable risk factors in participants of a program for the prevention of Alzheimer's dementia

ADLER Georg, MARCZAK Agnies, BINDER Jana, GNOSA Katharina

ISPG, Mannheim, Germany

Introduction: Epidemiological data suggest that 30% of Alzheimer cases may be attributed to modifiable risk factors. A reduction in their prevalence might substantially reduce the incidence of Alzheimer's dementia (AD). The applicability of this approach for dementia prevention was studied in participants of a program for the early detection and prevention of AD.

Method: This prevention program is offered to interested volunteers aged 50 or above. A detailed interview on medical history and self-perception of cognitive impairment, neuropsychological testing, physical examination and various technical investigations are carried out. The modifiable risk factors assessed include overweight, smoking, inadequate cardiorespiratory and motor fitness, hyperhomocysteinemia, hypercholesterolemia, carbohydrate metabolism disorders and arterial hypertension. In a debriefing session, cognitive status and individual risk factor profile are explained to the participants, recommendations for preventive measures or further diagnostics are given and follow-up investigations at annual intervals are offered.

Results: The initial examinations of 436 participants were evaluated. In 48 (11.0%) we found cognitive impairments caused by various disease processes, most frequently severe depressive symptoms, cerebrovascular disorders and harmful alcohol use. 64 participants (14.7%) were diagnosed with AD. The remaining 324 participants were 207 women (63.9%) and 117 men (36.1%) aged 50 to 89 years (mean+/-s: 63.3+/-8.7 years) with the following frequencies of modifiable risk factors (in part despite dietary or drug treatment): 1) hypercholesterolemia (67.6%), 2) overweight (61.7%), 3) inadequate cardiorespiratory fitness (37.1%), 4) inadequate motor fitness (33.6%), 5) hyperhomocysteinemia (29.0%), 6) arterial hypertension (22.5%), 7) diabetes mellitus or prediabetes (20.7%), 8) smoking (12.3%). The majority of subjects (58.9%) had two or three of these risk factors.

Discussion: Two to three modifiable risk factors for the development of AD, most commonly hypercholesterolemia and overweight, were found in the majority of unselected participants of a dementia prevention program. This suggests practicable measures for dementia prevention.

PO18.3. Distinct epistemological concepts of AD and their role regarding secondary prevention


JLU Gießen, Berlin, Germany

In various ways Alzheimer’s disease (AD) is based on different ideas and kinds of knowledge. Two of those ways I want to introduce here. There are distinct epistemological concepts of AD regarding

clinical view on symptoms and diagnosis

the focus on prevention

(A) Nowadays it seems obviously that clinic and pathology work hand in hand and complement each other. However, until the 19th century clinical medicine used to be based on nosology and the identity of symptoms. When anatomic pathology arose, it became “the geography of nosology”. As it had the power of proving and locating diseases, it was changing the whole fundament of occidental medicine. Thenceforward the nidus might be the past (aetiology) or the future (prognosis) of the disease, or the disease itself (diagnosis). Anatomic pathology was able to modify the clinical way of viewing, which now had to admit that there is almost no disease without a nidus. This medicine-historical change meant more to clinic than an accumulation of knowledge. Clinic’s reference frame “nosology” got an own superordinate reference frame: “(anatomic) pathology”. This foundation of today’s medicine is also a foundation of today’s AD, which can lead us to several questions about discourses on dementia.

(B) Research for a medical treatment seeks AD in the brain matter. There is a clear paradigm of neurologic molecular biology as an instrument for managing a natural scientific problem. Prevention, on the contrary, constitutes a kind of abstract concept or idea, which is only treatable as a statistical risk. Fundamental dynamics of social action and all areas of all-day life might be concerned here. Regarding this distinction of concepts, I want to investigate the role of secondary prevention which is held out in prospect.

PO18.4. Associations of the kynurenine pathway with cognitive functioning in individuals with and without Type 2 diabetes mellitus: Results from the Maastricht study


1Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands 2Department of Epidemiology, Maastricht University, Maastricht, Netherlands 3Heart and Vascular Centre, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands 4Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands 5Department of Complex Genetics and Epidemiology, Maastricht University Medical Centre, Maastricht, Netherlands 6Bevital AS, Bergen, Norway 7Haukeland University Hospital, University of Bergen, Bergen, Norway

Background: The kynurenine pathway is a metabolic route of tryptophan synthesis. Subtle changes within this pathway have repeatedly been associated with metabolic disorders, various neurodegenerative diseases and impaired cognitive functioning. However, these studies were generally small and restricted to clinical samples. Therefore, the present study aimed to elucidate the role of the kynurenine pathway as a potential underlying biological correlate of cognitive functioning in a healthy-aging population with and without type 2 diabetes mellitus (T2DM).

Methods: The present study makes use of cross-sectional data from 2452 participants (aged 40-75 years) who completed the baseline survey of the population-based Maastricht study, enriched with participants with T2DM. Liquid chromatography-tandem mass spectrometry was used to determine blood plasma concentrations of kynurenine and seven kynurenine metabolites. From these metabolites, previously reported kynurenine ratios were computed. A standardized cognitive assessment was used to assess cognitive functioning. The association of kynurenine plasma concentrations and ratios with cognitive functioning was investigated in multiple regression analyses. Additionally, potential effect modification by glucose metabolism status was investigated.

Results: After controlling for age, gender, educational level and eGFR, no association was found between cognitive functioning and quinolinic acid, hydroxykynurenine, kynurenic acid, the kynurenine-to-tryptophan ratio or neopterin. However, higher cognitive functioning was significantly associated with higher levels of xanthurenic acid, and higher ratios of xanthurenic acid-to-hydroxykynurenine and hydroxyanthranilic acid-to-hydroxykynurenine. Stratified analyses indicated that these associations were more pronounced and consistent in participants with T2DM.

Discussion: In this population-based study, previously observed associations of neurotoxic quinolinic acid and 3-hydroxykynurenine and neuroprotective kynurenic acid with cognitive performance in clinical samples could not be confirmed. However, associations between other metabolites and ratios of putative neurotoxic-to-protective kynurenines were associated with cognitive functioning, especially in participants with T2DM. The kynurenine pathway might therefore play a role in the pathway of T2DM and dementia.

PO18.5. Schizophrenia PRS is associated with delusions in Alzheimer’s disease: Meta-analysis of 10 cohort studies

BERGH Sverre1, CREESE Byron2-3, VASSOS Evangelos4, ATHANASIU Lavinia5, JOHAR Iskandar6, RONGVE Arvid7-8, MEDBØEN Ingrid Tøndel3-9-10, DA SILVA Miguel Vasconcelos2-6, AAKHUS Eivind11, ANDERSEN Fred12, BETTELLA Francesco5, BRAEKHUS Anne9-10-20, DJUROVIC Srdjan8-13, PARONI Giulia14, PROITSI Petroula15, SALTVEDT Ingvild16-21, SERIPA Davide14, STORDAL Eystein17-22, FLADEBY Tormod18, AARSLAND Dag6, ANDREASSEN Ole11, BALLARD Clive2-3, SELBAEK Geir9-19

1Innlandet Hospital HF, Ottestad, Norway,2University of Exeter Medical School, College of Medicine and Health, Exeter, UK, 3Norwegian, Exeter King's College Consortium for genetics of neuropsychiatric Symptoms in Dementia, Exeter, United Kingdom, 4Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, 5CoE NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; CoE NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway, 6Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, 7Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia; Department of Research and Innovation, Helse Fonna, Oslo, Norway, 8Department of Clinical Medicine, University of Bergen, Bergen, Norway, Haugesund, Norway, 9Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway, 10Department of Geriatric Medicine, Oslo Univer, Oslo, Norway, 11Research centre of Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway, 12Department of Community Medicine, University of Tromsø, Tromsø, Norway, 13CoE NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway, 14Complex Structure of Geriatrics, Department of Medical Sciences, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy, 15Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, 16Department of Neuromedicine and Movement science, Norwegian University of Science and Technology, Trondheim, Norway, 17Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway, 18Akershus University Hospital, Lørenskog, Norway, 19Faculty of Medicine, University of Oslo, Oslo, Norway, 20Department of Neurology, Oslo University Hospital, Oslo, Norway, 21Geriatric department, St. Olav hospital, University hospital of Trondheim, Norway, 22Department of Psychiatry, Namsos Hospital, Namsos, Norway

Background: Psychosis (delusions and hallucinations) is common in Alzheimer disease (AD) and associated with worse clinical outcomes including accelerated cognitive decline and shorter time to nursing home admission. Atypical antipsychotics have limited efficacy which, along with emerging genomic research, suggests some overlapping mechanisms with other disorders characterized by psychosis, like schizophrenia. In this study, we tested whether polygenic risk score (PRS) for schizophrenia was associated with psychotic symptoms in AD.

Methods: Schizophrenia PRS was calculated using Psychiatric Genomics Consortium data at 10 GWAS p-value thresholds (PT) in 3,173 AD cases from 11 cohort studies. Association between PRS and AD psychosis status was tested by logistic regression in each cohort individually and the results meta-analyzed.

Results: The schizophrenia PRS was associated with psychosis in AD at an optimum PT of 0.01. The strongest association was for delusions where a one standard deviation increase in PRS was associated with a 1.17-fold increased risk (95% CI: 1.07-1.3; p=0.001).

Conclusion: These new findings point towards psychosis in AD, and particularly delusions, sharing some genetic liability with schizophrenia, and support a transdiagnostic view of psychotic symptoms across the lifespan.

PO18.6. Blood pressure, antihypertensive medication and neuropsychiatric symptoms in patients with dementia: The COSMOS study


1Leiden UMC, Leiden, Netherlands, 2Department of Public Health and Primary Care, Leiden, Netherlands, 3Department of Biomedical Data Sciences, Leiden, Netherlands, 4Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, Bergen, Norway

Background: Neuropsychiatric symptoms (NPS) are very common in older patients with dementia and clinical management is a challenge. The etiology of NPS is multifactorial. There is increasing evidence that hypoperfusion of the brain plays a role in the development in NPS. The aim of this study is to assess whether there is an association between low systolic blood pressure (SBP) and NPS in patients with dementia and if NPS in more prevalent in patients using antihypertensive medication.  

Methods: We studied the baseline data from participants in the COSMOS study, a multicenter clustered trial with 545 participants from 67 nursing home units from 31 nursing homes in Norway. SBP (lowest quartile vs. rest) and use of antihypertensive medication were predictors; NPI-NH score (total and clusters) was the outcome. Missing data were imputed, except for missing data in predictors.  We used a mixed model analysis adjusted for age, sex and Minimal Mental State Examination (MMSE) score. In the sensitivity analysis, continues SBP values were used.  

Results: In total 412 patients were included with a mean age of 86.9 years. Of all patients, 53.9% had a MMSE score of <11. There was no difference in total NPI-NH score between low and high SBP (difference -1.07, P-value 0.62). There was also no difference between high and low SBP in the scores of the NPI-clusters. The use of antihypertensive drugs was not associated with a different NPI-NH score compared to no use (difference -0.99, P-value 0.95).  

Conclusion: We found no association between low SBP and NPI-NH score, nor between antihypertensive use and NPI-NH score. 

PO18.7. Gender inequalities across the life course: A societal perspective on gender differences in dementia

LEIST Anja, FORD Katherine

University of Luxembourg, Esch-sur-Alzette, Luxembourg

Introduction. Women are at increased risk of developing dementia, which can only partly be explained with differences in longevity, sex biology, or differences in detection/diagnosis. A promising approach at the population level is the systematic investigation of life course conditions for men and women across countries and cohorts in order to detect if schooling or work opportunities differ by gender. In the cognitive reserve framework, education and work reflect opportunities for cognitively stimulating activities, which increase cognitive reserve across the life course, and which could delay cognitive decline and the diagnosis of dementia.

Method. We develop a framework for systematizing gender inequalities across different life stages and life domains, with a focus on systematic disadvantages for women that could be relevant barriers to cognitive reserve development. For the empirical analysis, we gather individual information and performance on cognitive tests from several harmonized cross-national aging surveys, i.e. the U.S. Health and Retirement Study and sister studies (SHARE, ELSA, SAGE), separated by cohort. Historical figures on gender inequalities for countries and cohorts, and their relevant timings in the life course of the older respondents, e.g. during schooling, were gathered from different sources, and merged with the individual-level data.

Results. The new framework leads to testable hypotheses in both the Western and global context regarding life-course socialization and schooling and work opportunities that have been different for men and women. We will present first evidence of how female (dis)advantages on different cognitive tests – memory, executive functioning – are mirroring societal gender inequalities.

Discussion. We need to better understand how different life-course opportunities for men and women can create gender differences in dementia at old ages in order to identify individuals at risk today and improve conditions for future generations.

PO18.8. Hearing and cognition:  Evidence from non-Western nations and from Israel, England and Ireland

CUTLER Stephen1, ILINCA Corina2

1University of Vermont, Burlington, United States, 2University of Bucharest, Bucharest, Romania

Recent research shows a connection between hearing loss and dementia.  Our prior work has pointed to strong relationships between self-reported hearing ability and self-reports of memory functioning in the US (where much of the research on aspects of hearing and aspects of cognition has been conducted) as well as in 18 European nations.  One conclusion of that research was the need to replicate these relationships in Latin American nations and in other non-Western settings.  In the research to be reported here, relationships between hearing and cognition have been examined using data from China and South Korea, from Mexico and Costa Rica, from South Africa, from Israel, and from Great Britain and Ireland.  We use correlation analysis to examine bivariate relationships and regression analysis (with controls for age, marital status, education, gender, and health) to examine multivariate relationships.  In all of the eight countries examined in this study, the bivariate relationships between self-reported hearing and self-reported memory are positive and significant, averaging .259. Likewise, the multivariate relationships with controls are also positive and significant (the average beta is .176).  We conclude by noting (1) that the positive relationship between self-reported hearing and self-reported memory seems to be universal, (2) that the link between hearing and memory assessments and dementia warrants continued examination and study, and (3) that practitioners must pay attention to their patients’ and clients’ hearing for processes such as activation and informed consent to be effective. 

PO18.9. Changes over time in vision, binocular function and task-evoked pupil responses for people with dementia

PIANO Marianne1, NILFOROOSHAN Ramin2, EVANS Simon1

1University of Surrey, Guildford, United Kingdom, 2Surrey and Borders Partnership NHS Trust, Chertsey, United Kingdom

Depth perception problems are commonly experienced by people with dementia. Poor depth perception can frustrate fine hand-eye tasks, increase falls risk and induce anxiety. Sleep fragmentation can also occur for people with dementia, and coordination of both eyes for depth perception can be affected by fatigue, resulting in eye strain and double vision. Separately, task-evoked pupil responses can be affected by Alzheimer's Disease but it is not known how these responses might change with dementia progression. This exploratory longitudinal pilot study combines clinical visual function measures with pupillometry, to comprehensively evaluate clinical visual changes in people with dementia and explore relationships to changes in cognitive status and/or sleep quality over 8 months.

25 people diagnosed with dementia in the last 24 months (vascular dementia n = 7, Alzheimer's Disease n = 14, or mixed dementia n = 4), based on clinical assessment and imaging, received an assessment of visual and binocular function. Standard tests routinely used within the hospital eye service were employed. Cognitive function was assessed using the standardised Mini Mental State Examination. Sleep quality was measured using the Pittsburgh Sleep Quality Questionnaire. Participants completed the WMS-III digit span test (single digits announced verbally, 1 second intervals, followed by a recall period) at low (3-digit) and high (6-digit) cognitive load levels for task-evoked pupillometry assessment. Assessments occurred every 4 months (± 2 weeks) for a total of 3 visits spanning 8 months.

Baseline sMMSE scores ranged from 9-29 (mean 23.1 ± 5.07), and PSQI mean score was 4.32 ± 2.84. PSQI scores >5 indicate poor sleep quality, thus scores fell within normal limits.  The research will be completed by October 2019. Findings may provide supporting evidence for the role of annual eye tests as a part of routine dementia care, to mitigate falls risk and maximise quality of life. 

PO18.11. Navigating the complexity of Alzheimer’s disease via systems thinking

ULEMAN Jeroen1-2, MELIS René1-2, QUAX Rick2, HOEKSTRA Alfons2, ROUWETTE Etiënne1, OLDE RIKKERT Marcel1

1Radboud UMC University, Nijmegen, Netherlands, 2Institute for Advanced Study, Amsterdam, Netherlands

Alzheimer’s Disease (AD) is the most common cause of dementia and a source of great suffering worldwide for patients and caregivers. Despite numerous clinical trials based on the amyloid-cascade hypothesis, effective treatments for AD have yet to be identified. This attests that alternative ways of thinking are necessary, and has led to increased recognition of the heterogeneity of AD and several alternative causal hypotheses.

Systems thinking is becoming increasingly common in the field of bio-medicine and offers a promising alternative avenue for understanding this complex disease. Causal loop diagrams (CLDs) are tools to visualize how variables within a system interrelate and can integrate empirical findings with expert knowledge. Using this approach, a disease is not understood in terms of linear cause-effect relationships but rather as a complex interplay between relevant biological factors, an individual and its environment. Given the substantial heterogeneity in time-of-onset, brain pathology and disease progression, such an approach is warranted for AD as well.

In this work, we offer a novel overarching alternative explanation for many of the causal hypotheses for AD that have yet to be unified: AD is multicausal and mediated by many resilience and resistance factors at several different spatial and temporal scales.

We report on the first CLD for AD, based on expert consensus rounds and extensive literature research, which explicitly includes variables at multiple spatial scales, including cellular, organ, organism and social.

The CLD is used to explore the reciprocity of cognitive decline with lifestyle-related factors such as social functioning, sleep, hypertension and sedentary behavior across AD stages, the bidirectional relationships between such factors and interactions with the biological substrates underlying them. In the future, the CLD will be used to develop a quantitative system dynamics model.

PO18.12. Caregiver`s burden, and nutritional status in survival of community dwelling mild alzheimer´s disease older adults


1Hospital Magalhães Lemos E.P.E., UNIFAI - Research Unit, Institute of Biomedical Sciences Abel Salazar/ Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; 2Department of Biomedicine, Biochemistry Unit, Faculty of Medicine / Institute for Research and Innovation in Health, University of Porto, Porto, Portugal, 3Faculty of Nutrition and Food Sciences, University of Porto / Faculty of Engineering, University of Porto, Porto, Portugal

Rationale: Several factors are linked to dementia mortality, such as age, gender, education, sociodemographic, severity of the disease, and nutritional status impairment. A decline of nutritional status is very common among Alzheimer`s disease (AD), and strongly impacts patients and their families. Nutrition status can be modified to improve life expectancy. It is unclear whether caregiver`s burden, and nutritional status are associated with mortality in community-dwelling mild AD older adults. The aim of this study was to quantify the association between baseline caregivers’ burden, nutritional status, and mortality in community-dwelling mild Alzheimer`s Disease older adults. 

Methods: A prospective observational study was conducted among 79 community-dwelling mild Alzheimer`s Disease older adults (32 men; age: 78.2±6.6 years). Nutrition status was evaluated using the full Mini Nutritional Assessment (MNA) score, body mass index, mid‑arm muscle circumference, calf circumference and the phase angle (PhA). Caregivers` burden disease was assessed by Zarit burden scale. Kaplan-Meier and adjusted Cox proportional hazard ratios (HR) analyses were conducted. The follow-up period was 60 months, and the survival time was calculated as the difference between the day of death and the initial date of study.

Results: Twenty-two Alzheimer`s disease older adults (27.8%) died during the follow-up. According the full MNA score, 87% patients were at undernutrition risk and 13% were undernourished. The probability of non-survival was for undernutrition: HR: 5.69 (95% CI: 2.21-14.61); underweight: HR: 3.24 (95% CI: 1.18-8.82); low PhA: HR: 2.35 (95% CI: 0.97-5.66), and severe caregivers overload: HR: 3.39 (95% CI: 1.27‑9.01).

Conclusion: In community-dwelling mild Alzheimer`s disease older adults, undernutrition, underweight, low phase angle, and high caregiver`s burden, were associated with higher probability of mortality over time.

Disclosure of Interest: None Declared

Keywords: Alzheimer`s Disease, caregiver`s burden, community-dwelling, older adults, nutritional status

PO18.14. Choosing the right instrument:  Investigating the feasibility of Cognitive Functions Dementia (CFD) for cognitive impairment in hospitalized patients


Oldenburg University, Oldenburg, Germany

With worldwide population ageing, the prevalence of different types of age-related cognitive impairment and neurodegenerative conditions tends to rise, yet both dementia and Mild Cognitive Impairment are widely underdiagnosed. Early diagnosis is fundamental for patients to take necessary interventions that may reduce or stop the course of the condition. Neuropsychological assessment tools are necessary to inform clinicians about the cognitive functioning of their older patients. The aim of this study was to test the feasibility of the tablet-based test set battery Cognitive Functions Dementia (CFD) to assess hospitalized geriatric patients with suspected cognitive impairment. CFD is a comprehensive multidimensional cognitive assessment tool. We started the assessment with 47 patients from the hospital Klinikum Leer with suspected cognitive decline, yet only 46% of them completed the battery. Incompliance was highest among patients with poorer performance in activities of daily living. High dropout rates point out that the battery length is not adequate to this group of patients. In a clinical setting, an alternative solution would be the to reduce the assessment to a limited number of subtests.

PO18.15. Does family carer burden vary in contexts of care? Investigating factors associated with burden in dementia and frail elderly


1School of Health Sciences, University of East Anglia, Norwich, United Kingdom, 2Federal University of Sao Carlos, Sao Carlos, Brazil, 3University of East Anglia, Norwich, United Kingdom

Burden is one of the main negative outcomes of caring and seems to be associated with carers’ low quality of life. However, to best support carers, we first need to understand if different contexts of care may lead to different needs in support programmes. Caring in the context of dementia and in the context of old age may have different factors associated with burden, even though both care recipients may share certain characteristics, eg. cognitive deficits. We investigate if factors associated with burden in carers of people with dementia (DemCarers) and carers of elderly with cognitive impairment non-dementia (CogCarers) would differ. Sixty-five DemCarers and 175 CogCarers. Burden was assessed by ZBI-12. Demographic data (carer sex/age) was collected. Emotional-focused coping, problem-focused coping and dysfunctional coping were evaluated through two similar assessments: DemCarers completed the COPE and CogCarers completed the Coping Strategies Inventory. Depressive symptoms were measured by the DASS-21 in DemCarers and GDS-15 in CogCarers. Z calculations were performed to standardize variables assessed with different questionnaires. Regressions were performed to identify if carers’ demographic characteristics, coping skill styles and depressive symptoms were to predict high burden in the two different carers’ groups. There was similar proportion of females in DemCarers and CogCarers (75.4%; 73.1%). Proportion high burden was greater (p=0.05) in DemCarers (40%) compared to CogCarers (23.4%). High level of dysfunctional coping (OR=4.6; 95%CI: 1.3-15.3; p=0.012) and depressive symptoms (OR=5.9; 95%CI: 1.3- 26.6; p=0.02) were associated with high burden in DemCarers. In CogCarers only depressive symptoms were linked with burden (OR=2.0; 95%CI: 1.0-4.0; p=0.049). Diversity in the two contexts of care may explain factors in high burden across carers. Identifying the factors associated with each caring context can support the development of tailored interventions to support carers that could ultimately reduce the negative impact in mental health and quality of life.

PO18.16. The importance of nutritional status and individual nutritional intervention in the context of depression symptoms in the elderly


University of Medical Science, Clinic of Palliative Medicine; WSWOP Home Hospice Poznan, Poznan, Poland

300 million people around the world have depression, according to the WHO. It occurs in 7% of the general older population and accounts for 5.7% of YLDs among those over 60. Etiology of depression is believed to be multifactorial and related to chronic stress, dietary behavior as well as inflammation. Depressive symptoms downgrade functioning alike other chronic medical conditions, e.g. diabetes. Rapid changes in everyday life and dietary habits, both self-inflicted and objective, constitute potential threats to mental wellbeing.

52 people of both sexes aged 60 and more were included into the nutritional intervention that lasted for three months. In all of the participants, nutritional status (MNA), dietary habits (three-day diary of current quotation) and symptoms of depression (GDS) were assessed both at the beginning and at the end of the intervention. The GDS scale is a screening tool for depression that allows to confirm the presence of its symptoms. The test evaluates the psychological well-being of the subject during two weeks that preceded the survey. The GDS test showed a significant reduction in the mean score (3.7 ± 2.9 points, median: 2.5 points, range: 0-10 points and 3.2 ± 2.9 points, median: 2.0 points; range: 0-10 points - p <0.0001) after the intervention. There was a tendency for less frequent depression symptoms, which were found in 17 subjects (33%) before, and in 12 patients after the intervention (23%) (p = 0.0736). Symptoms of depression occurred in 22 patients (37%) malnourished and at risk of malnutrition and in two (5%) with good nutritional status. People with poor nutritional status had significantly more symptoms of depression than those with normal nutritional status (p = 0.0001). Poor nutritional status is associated with a higher incidence of symptoms of depression, and therefore assessment of nutrition and nutritional interventions are crucial in its course.

PO18.17. Traditional gamelan musical activity and cognitive function in balinese elderly


1Stichting Alzheimer Indonesia Nederland, Groningen, Netherlands, 2Udayana University, Denpasar, Bali, Indonesia

Background: In 2030, the number of elderly people (aged ≥ 60 years old) in Indonesia is projected to reach 38.9 million (13.2% of the population). As the elderly population has increased, so have the threats of cognitive frailty. One of the activities that can enhance cognitive function is musical activity. Gong Kebyar Gamelan, a traditional Balinese music ensemble, has become the most common traditional music played by Balinese people for decades. This research aimed to identify whether gamelan musical activity can potentially enhance cognitive function in the elderly people.

Methods: This was an analytic-observational research using a cross-sectional method. One hundred healthy elderly (male, aged ≥ 60 years old) were divided into two groups: 1) group with gamelan musical practice (n=50) comprising subjects who had experienced playing gamelan musical instruments for at least one year; 2) group without gamelan musical practice (n=50) comprising subjects who had never received the gamelan musical training. Structured interviews were conducted to obtain subjects’ information and gamelan musical activity characteristics, followed by a general cognitive function assessment using Mini Mental State Examination (MMSE). 

Results: There were no significant differences of age, education and occupation between groups. The mean of MMSE scores of Group 1 (25.96±2.74) was significantly higher than that of Group 2, i.e. 23.50±3.25 (p<0.001). In Group 1, those who currently still played gamelan had a significantly higher MMSE mean scores than those who already stopped (p=0.01). However, no significant MMSE score difference was found between those with single and multiple instruments mastered.

Conclusions: Elderly people who played Balinese gamelan had better cognitive function than those who did not, as well as those who still actively played compared to those who ceased out. This indicates that traditional gamelan musical activity might play a role as a protective factor against cognitive decline in Balinese elderly.

PO18.18. The occurrence of cognitive impairment and small vessel disease in a cohort study in Poland – Preliminary results


Wroclaw Medical University, Wroclaw, Poland

Introduction: The exploration of a complex picture of factors linked to the profile of cognitive functioning was undertaken in the present study. The objective was to analyse the incidence of covered cerebral ischemia and the prevalence of impaired cognitive functioning in the Polish cohort of the PURE (Prospective Urban and Rural Epidemiological) study.

Methods: The study sample taken into account in the current analysis consisted of 702 subjects (mean age: 61.1 yrs range: 39-81 yrs, F/M: 443/260). The study protocols included medical history and psychometric cognitive examination measured with Montreal Cognitive Assessment (MoCA mean score: 26.3, sd=2.5), TMT test, Digit Symbol Substitution, followed by a structural brain MRI.

Results: Lacunar infarcts were detected among 6% (n=41) while periventricular and/or subcortical white matter hyperintensities (WMHs) assessed with Fazekas score were found among 80% (n=558) of the study group. Cognitive impairment (MoCA<26) was diagnosed in 36% (n=260) of the subjects. Among people with normal cognitive status 4% (n=16) had lacunar infarcts and 11% (n=47) showed high burden of WMHs (Fazekas score ≥3). At the same time 11% (n=31) of subjects with cognitive impairment did not show any lacunar infarcts or WMHs.

Conclusions: Small vessel disease seems not to influence cognitive functioning alone. Further analyses taking into account clinical and social factors will be carried out in order to obtain a full picture of the influential factors for cognitive deficits.



Last Updated: Thursday 07 November 2019


  • Acknowledgements

    The 29th AE Conference in The Hague received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimer Nederlands gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche