Second day of 33rd Alzheimer Europe Conference focuses on brain health and prevention and on intersectionality in dementia
Helsinki, 18 October 2023 – The second day of the 33rd Alzheimer Europe Conference (#33AEC) “New opportunities in dementia care, policy and research” took place yesterday, 17 October 2023, with the programme focusing on brain health and prevention and on intersectionality in dementia.
Brain health and prevention
The second plenary of the conference was on “Brain health and prevention” and was co-moderated by Jean Georges, Executive Director of Alzheimer Europe and Kim Coppes from Live Online Events. Their dynamic and interactive approach with the audience during the Opening Ceremony on Monday and again at Tuesday morning’s Brain health and prevention session has been a hit with conference delegates. The pair will co-moderate all remaining plenary sessions.
Professor Miia Kivipelto, University of Eastern Finland and Karolinska Institutet, was the first speaker at this session, discussing “Building the evidence base for multi-modal interventions through European and International collaborations”. She said that risk reduction of cognitive impairment and dementia is possible and indeed is already happening. Brain health, she stressed, should be a priority for society. She then urged everyone to ensure that we “fill the implementation gap” and start fully implementing the available evidence.
She reminded the audience:
“It is never too early, never too late. We can and we should offer preventive interventions supporting brain health to people without cognitive symptoms, but also those already experiencing symptoms, to help maintaining brain functions”.
With an increasing body of evidence from clinical trials to show that multidomain interventions targeting several risk factors are effective and feasible, the EU-FINGERS and World-Wide FINGERS networks are now working on further developing and adapting these interventions to different target populations and settings.
In closing, she stated that:
“We need to connect and combine prevention, early detection, and interventions, both non-pharmacological and pharmacological. We are moving towards precision prevention and combination therapies”. She also stressed the importance of global strategies, public engagement, and broad collaborations with all key stakeholders, including academia, industry, advocacy groups, regulatory bodies and citizens.
Nikolaos Scarmeas, Professor of Neurology, National and Kapodistrian University of Athens was next to take the floor, with his presentation “The role of nutrition in the prevention of dementia”. He highlighted the associations between healthy dietary patterns and risk reduction for dementia, noting that these have been reported but have not yet been fully confirmed in randomised trials.
Many different aspects of nutrition, including chronobiological aspects (i.e. at which times during the day, or in relation to sleep, or how often we eat certain foods and nutrients, etc.) are still unexplored, he said, also noting that new studies have started utilising precision nutrition approaches in relation to cognitive function. “Chrononutrition and precision nutrition are new avenues of exploration in relation to cognition”, he enthused.
The third speaker in this plenary session was Professor Katja Kanninen, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, who spoke about environmental factors and air pollution as risk factors for dementia. She highlighted that there are 12 modifiable risk factors that account for around 40% of worldwide dementias, noting that air pollution had recently been added to the list of modifiable risk factors for dementia.
Epidemiological studies, she said, demonstrate that “life in highly-polluted areas is linked to increased incidence of cognitive impairment and risk of neurodegenerative disease”.
The fourth and final speaker in this plenary session on Brain health and prevention was Giovanni Frisoni, Director, Centre de la mémoire, Geneva University Hospital and Professor in Clinical Neurosciences, University of Geneva. His presentation, titled “Dementia prevention in memory clinics: recommendations from the European task force for brain health services”, opened with the assertion that dementia prevention is currently done either when it is too early (primary prevention in the general population) or too late (tertiary prevention in those who already have dementia).
A European Task Force, he noted, has summarised available evidence for the much-needed area of secondary prevention, i.e. in persons without dementia but at a higher risk of dementia. Procedures have been drafted for dementia risk assessment, communication and reduction, as well as cognitive enhancement, he said, while emphasising that these would need to be delivered in ad hoc services called “Brain Health Services” for the prevention of dementia.
After the plenary, delegates were able to view poster presentations, exhibited in the conference centre and to speak to poster presenters about their research. They also had the chance to join one of eight parallel sessions.
“Dementia Researchers of the future” - a special symposium highlights the work of ten early stage researchers who won bursaries to attend and present
From 12.00-13.00, a special symposium was held, to present the work of the ten early stage researchers who were selected by our jury in July, to benefit from the bursaries provided by the Alzheimer Europe Foundation to attend and present at the 33rd Alzheimer Europe Conference.
The selection of the ten bursaries was based on the best average scores each received from the jury members. The session, called “Dementia Researchers of the future”, was chaired by Iva Holmerová (Czech Republic) and Fania Dassen (Netherlands). The researchers, and their presentations, were:
• Thanos Chatzikostopoulos (Greece): The effects of pomegranate seed oil on mild cognitive impairment
• Carlos Gómez Martínez (Spain): COVID-19 and cognitive impairment in older adults: Longitudinal analysis from the PREDIMED-PLUS Cohort
• Ieva Petkutė (Lithuania): Photovoice practice and carer of people living with dementia involvement for transformative change in Lithuania
• Thais Lorenzo (Spain): Engaging participants in lifestyle interventions to prevent cognitive decline: The role of psychoeducation in the PENSA study
• Aysan Mahmoudi Asl (Spain): Acceptability of the Social Robot Mini and Attitudes of People with Dementia and Mild Cognitive Impairment
• Miren Altuna Azkargorta (Spain): Down Syndrome - Basque Alzheimer Initiative (DS-BAI): Integrative health care plan based on personalized medicine and clinical-biological research cohort
• Rafaela Troulou (Greece): Music-making for older people with and without dementia in residential care facilities: Preliminary findings from a community music intervention
• Naia Ros (Spain): Including the socio-emotional approach in a finger-like multi-domain intervention to prevent cognitive decline. CITA Go-On Study
• Electra Chatzidimitriou (Greece): Premorbid personality traits and their relationship with functional impairment in early-stage behavioural variant frontotemporal dementia
• Marina Makri (Greece): Attitudes, motivations, and barriers to pre-symptomatic Alzheimer's disease screening: a comparison between informal caregivers in five European countries.
This session was organised by the Alzheimer Europe Foundation and the INTERDEM Academy, with thanks to Roche for supporting the meeting space.
Following this and a simultaneous symposium organised by Alzheimer Nederland and focusing on “Housing and dementia” was a lunch break, before conference attendees had the choice of a further eight parallel sessions.
Intersectionality in dementia
The third plenary of the conference covered topics related to intersectionality in dementia. A presentation on “Achieving Cultural Inclusivity in Dementia Care” was delivered by Karan Jutlla, Head of Health Research Centre & Dementia Lead for the University of Wolverhampton.
Dr Jutlla discussed ways for improving cultural inclusion to reduce inequalities in dementia and ensure widespread accessibility to care becomes a reality. As evidenced in her latest report, co-production is integral to achieving equitable access to support services for people with dementia and their family members and carers. She also highlighted the importance of co-production and invited the audience to consider how culturally-inclusive care can be achieved, via a person-centred approach:
“In order to achieve cultural inclusivity in dementia care, we must recognise the importance of intersectionality and practice person centred dementia care”, she said.
Dr Alain Dekker from Alliade Care Group and University of Groningen/UMCG (Netherlands) was the second speaker to take the stand. He discussed “Dementia in people with intellectual disabilities: introduction to both Down syndrome and severely disabled populations”. He began by stating that a diagnosis of dementia in people with intellectual disabilities is important for understanding changes and making informed choices about support, treatment and organisation of care. People with Down syndrome, he noted, are at extremely high genetic risk to develop dementia due to Alzheimer’s disease.
In people with severe/profound intellectual disabilities, whom he said are until now a largely neglected group when it concerns dementia, the observability of dementia symptoms is different and diagnosing dementia therefore requires closer observation of small changes, in specific daily contexts. He said this depends on acquired skills at baseline and requires a newly-developed diagnostic aid.
The next speaker was Linn Sandberg, whose presentation was called “Are they here, are they queer? LGBTQ People with Dementia and the limits of person-centred care”. Dr Sandberg, Associate Professor Gender Studies, Södertörn University, Sweden, reminded delegates of the importance of challenging heteronormativity in dementia care. Dementia care staff in her current research often stated that they ‘treated everyone the same’ and that sexual and gender identities were very rarely discussed. But, she said that this results in a continuous invisibility and lack of recognition of lesbian, gay, bisexual, trans and queer (LGBTQ) people living with dementia.
“Having to repeatedly ’come out’, to navigate heteronormative care, and to advocate for one’s rights puts undue stress on LGBTQ people living with dementia and on their partners”, she said, stressing that dementia illnesses, as well as the organisation of dementia care, poses particular challenges for LGBTQ people to communicate their life histories, maintain relationships and connections to communities that have been significant to them:
“Dementia care needs to be organised in ways that enable people to express their gendered and sexual selves, to communicate queer life histories and have their relationships in the past and present recognised”, she finished.
The fourth and final speaker was Päivi Topo, Ombudsman for Older People in Finland, who discussed “How to better support people living with dementia from socio-economically disadvantaged groups”. The Ombudsman for Older People in Finland is an autonomous and independent authority that promotes the realisation of the rights and best interests of older people.
The Ombudsman highlighted several virtual health promotion activities, including web-based activities that require no digital skills which she said are very important. Digital skills are rarer among older adults in lower socioeconomic groups than other older adults, she said, also sharing that provision of digital tools with no cost and availability of personal support in the use of the digital tools was a priority. Most important, however, from her perspective is that older adults find the activities on offer to be both interesting and beneficial. Group activities are particularly helpful in this respect as they help create social contacts.
Explaining the service model of online exercise for older adults, she noted its development project which took place from 2017-2020 and which was then implemented in pilot programmes with municipalities and NGOs. The study on implementation began in 2019 and ran until 2023, with structural and cultural factors affecting implementation in municipalities.
Two national programmes promoting health and exercise for older adults exist in Finland, with emphasis being put on better access to care of older adults in socially disadvantaged groups, but improvements are needed in several areas, as there is a lack of knowledge about memory disorders and possibilities for treatment, the cost of getting a diagnosis is high and there are difficulties in accessing diagnostic services. Medicines, care and assistance are also expensive and the care system is highly complex, meaning difficulties in access to care. Finally, she noted that there is a lack of information about care services and social security system and how to apply social security benefits.
“People with dementia living alone with no social network are at high risk of not receiving support, services and care they need across all socioeconomic groups”, she concluded.
The conference programme for day two ended with the opportunity to attend either a session including ten Quick Oral Presentations on the topic of brain health and prevention, a special symposium on “Psychosocial interventions and dementia: a European overview”, organised by the Fondation Médéric Alzheimer, or one called “From ideas to reality: real life experience and tangible examples of developing and implementing national dementia plans”, held by the European Federation of Pharmaceutical Industries and Associations (EFPIA).
Alzheimer Europe would like to extend a warm welcome to all delegates and remind everyone to use the hashtag #33AEC to join/follow the conversation on Twitter.
Acknowledgement
Alzheimer Europe gratefully acknowledges the support of all conference sponsors, with particular thanks to our Gold sponsors, Lilly and Roche and Bronze sponsors, BioArctic, Eisai, MSD and Prothena.