Early Stages Of Dementia Research Articles

Predicting Brain Amyloid Status Using the National Institute of Health Toolbox (NIHTB) for Assessment of Neurological and Behavioral Function.

Amyloid-beta (Aβ) plaque is a neuropathological hallmark of Alzheimer's disease (AD). As anti-amyloid monoclonal antibodies enter the market, predicting brain amyloid status is critical to determine treatment eligibility. To predict brain amyloid status utilizing machine learning approaches in the Advancing Reliable Measurement in Alzheimer's Disease and Cognitive Aging (ARMADA) study. ARMADA is a multisite study that implemented the National Institute of Health Toolbox for Assessment of Neurological and Behavioral Function (NIHTB) in older adults with different cognitive ability levels (normal, mild cognitive impairment, early-stage dementia of the AD type). Participants across various sites were involved in the ARMADA study for validating the NIHTB. 199 ARMADA participants had either PET or CSF information (mean age 76.3 ± 7.7, 51.3% women, 42.3% some or complete college education, 50.3% graduate education, 88.9% White, 33.2% with positive AD biomarkers). We used cognition, emotion, motor, sensation scores from NIHTB, and demographics to predict amyloid status measured by PET or CSF. We applied LASSO and random forest models and used the area under the receiver operating curve (AUROC) to evaluate the ability to identify amyloid positivity. The random forest model reached AUROC of 0.74 with higher specificity than sensitivity (AUROC 95% CI:0.73 - 0.76, Sensitivity 0.50, Specificity 0.88) on the held-out test set; higher than the LASSO model (0.68 (95% CI:0.68 - 0.69)). The 10 features with the highest importance from the random forest model are: picture sequence memory, cognition total composite, cognition fluid composite, list sorting working memory, words-in-noise test (hearing), pattern comparison processing speed, odor identification, 2-minutes-walk endurance, 4-meter walk gait speed, and picture vocabulary. Overall, our model revealed the validity of measurements in cognition, motor, and sensation domains, in associating with AD biomarkers. Our results support the utilization of the NIH toolbox as an efficient and standardizable AD biomarker measurement that is better at identifying amyloid negative (i.e., high specificity) than positive cases (i.e., low sensitivity).

Timely dying in dementia: Use patients' judgments and broaden the concept of suffering.

Patients living with advanced dementia (PLADs) face several challenges to attain the goal of avoiding prolonged dying with severe suffering. One is how to determine when PLADs' current suffering becomes severe enough to cease all life-sustaining treatments, including withdrawing assistance with oral feeding and hydrating, a controversial order. This article broadens the concept of suffering by including suffering that cannot be observed contemporaneously and the suffering of loved ones. Four paradigm shifts operationalize these concepts. During advance care planning, patients can judge which future clinical conditions would cause severe suffering. To decide when to allow patients to die, treating physicians/providers only need to assess if patients have reached patients' previously judged, qualifying conditions. Questions: Will this protocol prevent PLADs' prolonged dying with suffering? Deter early-stage dementia patients from committing preemptive suicide? Sway decision-making surrogates from withholding life-sustaining treatments from patients with middle-stage dementia? Provoke providers' resistance to relinquish their traditional, unilateral authority to determine patients' suffering?

Money Management Difficulties and Older People: Detection of Early-stage Dementia in Financial Data

Money Management Difficulties and Older People: Detection of Early-stage Dementia in Financial Data

Experience Related to Acceptance of Illness among People with Early-Stage Dementia: A Phenomenological Study

Purpose: This study aims to describe the structure of the experience related to acceptance of illness among people with early-stage dementia (PWED).Methods: Participants were six people who had Alzheimer’s disease or vascular dementia. Their clinical dementia rating scores were 0.5 or 1. Data were collected from individual in-depth interviews. The collected qualitative data were analyzed based on Giorgi’s descriptive phenomenological method.Results: The five constituents and eight sub-constituents were derived from the experience related to acceptance of illness among PWED; ‘Facing the changed me’, ‘Facing changes in roles and relationships with others’, ‘Conflict between recognizing and denying dementia in daily life’, ‘Perceiving the limits and accepting dementia’, and ‘Reconstructing daily life for the prolongation of the current health status’.Conclusion: This study contributes to the expansion of the in-depth understanding of the experience related to acceptance of illness among PWED. The results of the study will be helpful as basic data for community health nurses to develop interventions to improve acceptance of illness of PWED.

PERSONS LIVING WITH DEMENTIA AND MULTIPLE CHRONIC CONDITIONS IDENTIFYING HEALTH PRIORITIES WITH CARE PARTNERS

Abstract Many older persons living with dementia (PLWD) also live with multiple chronic conditions (MCCs). Care partners of PLWD will increasingly need to make care decisions for PLWD, but the health care priorities of PLWD with MCCs may vary. The Patient Priorities Care Health Priorities Identification Process is an evidenced-based tool to support older adults with MCCs to identify and communicate their health priorities. In this pilot study, we adapted this tool to engage care partners of PLWD as active listeners while the PLWD discussed their healthcare goals and priorities. We recruited dyads consisting of a care partner and a care recipient in the early stages of dementia. We assessed feasibility and acceptability of going through the process together through open-ended questions. Two coders used thematic analysis to examine their responses. Five dyads (N=10) participated in the pilot study. The PLWD ranged in age from 70-83 years and had a range of three to eight chronic conditions. Care partners ranged from 39-78 years of age. The PLWD had no issues completing the process with their care partners present and enjoyed having their care partner present. Care partners valued engaging as active listeners and had a better understanding of the PLWD’s health care priorities. Engagement in this process also helped them recognize that the PLWD is proactive in their own health goals. Involving care partners in a healthcare priorities identification process is a valuable, feasible, and acceptable way to prepare care partners to be care proxies.

RELATIONSHIP-TYPE DIFFERENCES IN SUPPORT SEEKING AND MENTAL HEALTH FOR ADULT CHILDREN OF PARENTS WITH MEMORY LOSS

Abstract Research shows that midlife children still rely on their parents for emotional and tangible support, which has implications for their mental health. Little is known about how these dynamics change when a parent enters the early stage of dementia or memory loss. One characteristic that may be important for these dynamics is the relationship-type (daughter-mother (n= 82), daughter-father (n= 29), son-mother (n=17), son-father (n= 14)). As part of a larger study, adult children 18 years of age and older (n= 142) completed self-report surveys including measures of emotional and tangible support seeking from their parent (Feeney, 2004), the 10-item CESD (Orme et al., 1986), the 12-item Zarit Burden Inventory (Bédard et al., 2001), and the PANAS (Watson et al., 1988). Results showed that tangible and emotional support seeking levels were low across all dyad-types, with no differences between groups. There was a trend for depressive symptoms (F= 2.559, p= .058) showing more in daughter-father than in son-mother dyads. Daughter-father dyads were the only group meeting the depression cut-off score. There were significant differences for burden (F= 3.377, *p= .020) with more burden in daughter-mother compared to son-father dyads. For the PANAS (F= 2.926, *p= .036), there was more negative affect in daughter-father compared to daughter-mother dyads. Results suggest that the relationship-type of the adult child and parent matters for mental health in the early stages of memory loss. This has implications for dyadic interventions helping adult children and their parents cope in the early stages of the dementia caregiving journey.

EXAMINING TWO CONSECUTIVE YEARS OF OLDER ADULTS’ EVERYDAY PROSPECTIVE MEMORY LAPSES AND INFLAMMATION BY GENDER

Abstract Prospective memory (PM, i.e., memory for future intention) is vital to daily life. Although PM deficits can distinguish healthy older adults from those in early stages of dementia, limited work has examined PM and biological markers associated with memory decline. Extending past work, we examined self-reported PM lapses in daily life and systemic (circulating) inflammatory markers by gender across two years. Older dementia-free adults (n=90, Mage=76.84 years; 62%women) enrolled in the ongoing Einstein Aging Study completed two-waves of data collection (approximately one year apart), each including two-week measurement bursts of daily self-reported PM lapses which were summed across respective bursts. Averaged levels of systemic inflammatory cytokines (IL-1β, IL-4, IL-6, IL-8, IL-10, TNF-a) and C-reactive protein were derived from two blood samples per wave (pre/post burst). Among men, cross-sectional and cross-lagged correlations between PM and IL-8 were significant, such that reporting more PM lapses correlated with higher levels of IL-8 (ps<.009). Among women, wave-1 PM correlated with wave-2 TNF-a (p=.018), and wave-2 PM correlated with wave-2 IL-10 (p=.041). No other links emerged. Consistent with past research, these preliminary findings suggest that IL-8 may be an important correlate of poor daily PM in men. The neural substrate of this association could include accelerated aging or increases in Alzheimer’s or vascular pathology. Among women, lagged relationships between PM and inflammation may be indicative of pathology. Continued investigation into PM and inflammation that account for gender may reveal longitudinal links that could aid in early identification of persons at risk for cognitive decline.

THE QUALITY OF DAY SCALE AND THE LIVING WELL INVENTORY: TWO NEW MEASURES FOR INDIVIDUALS WITH DEMENTIA AND CAREGIVERS

Abstract Background Differences in adaptive strategies used by individuals living with dementia have the potential to impact wellbeing. Two new measures were developed using human-centered design to capture daily adaptive strategies and outcomes. The Living Well Inventory for Dementia (LWI-D) and the Quality of Day Scale (QODS) capture important aspects of wellbeing that illuminate options for care and support. Purpose: To provide results from the initial evaluation of the LWI-D and the QODS for face validity, content validity and user acceptability. Methods Acceptability and feasibility testing was conducted with a sample of 17 community-dwelling individuals with early stage dementia (MOCA scores 12-30). After measure optimization, a second pilot test was conducted with 30 dyads (persons living with dementia and family caregivers) in community and residential settings. Results Persons with dementia can use and accurately interpret the QODS, preferring a version with graphic icons. Of the 31 items on the development version of the LWI-D, 17 items were acceptable, meaningful, and easily answered. Additional items yielded meaningful qualitative responses but needed minor revision. Some participants disliked the Likert-type response format, and new administration guidelines were used for the second pilot. Additional outcomes include convergent validity between the LWI-D and the QODS with measures of positive affect-balance, quality of life and wellbeing. Conclusion The LWI-D and the QODS are rigorously developed promising measures that warrant further testing and may enhance the ability to a) identify strengths in living well with dementia and b) identify and test news interventions to bolster care and support.

SELF-REPORTED COMPONENTS OF SELF-IDENTITY IN PERSONS LIVING WITH EARLY-STAGE DEMENTIA

Abstract The impending loss of “self” is a common concern of persons diagnosed with dementia. However, in contrast to the traditional biomedical model, there is qualitative and quantitative evidence that self-identity persists across stages of the disease. An understanding of the components of self-identity of persons living with early-stage dementia (PLWED) can inform treatment approaches and communication from care partners and providers. Consequently, the aim of the present study is to examine what PLWED identify as the facets of their self-concept. Participants were a purposive sample of 20 community-dwelling PLWED who attended a voluntary health program aimed at facilitating aging-in-place. Focus groups were conducted and recorded on-site at the health program. The interviews were transcribed verbatim from the audio recordings and were analyzed through a conventional content analysis approach. Content analysis of the narratives gleaned from focus group participants revealed six self-identity themes: vocation, family role, personal characteristics, hobbies and interests, religious affiliation, and social networks. Although the deterioration of explicit memory, including autobiographical memory, is a hallmark of dementia, overfocusing on this as the sole component of self-identity contributes to the representation of persons living with dementia as less than whole and lacking “selves.” Our findings suggest critical components of self-identity other than memory that should be recognized and supported in persons living with dementia.

DAILY NEGATIVE AND POSITIVE EVENTS AND DAILY WELL-BEING: DYADIC LINKS IN COUPLES LIVING WITH EARLY-STAGE DEMENTIA

Abstract Spouses have powerful influences on well-being in middle and later life, but we know little about how daily events impact well-being in older couples that include persons living with dementia (PLWD). We examined associations between daily negative and positive events and daily well-being (negative mood and positive mood) in 36 heterosexual married couples living with early-stage dementia. Participants included PLWD (M = 71.47 years, SD = 6.90, range = 53-82 years) and their spouses (M = 69.69 years, SD = 7.26, range = 59-87 years) who both completed brief morning and evening phone interviews over 7 consecutive days. Longitudinal actor-partner interdependence models controlled for own and partner reports of daily well-being in the previous day, whether each day was a weekend day, and the gender of PLWD. We estimated separate models for negative mood and positive mood. Both PLWD and their spouses reported higher negative mood when they reported more negative events in the same day and when their partner reported more negative events in the previous day. Over and above these associations, both partners in the couple reported lower negative mood on days when spouses of PLWD reported more positive events. Spouses of PLWD reported higher positive mood on days when they reported more positive events, but lower positive mood on days when PLWD reported more positive events. These findings highlight the importance of understanding dyadic influences on daily well-being among PLWD and their spouses.

HEALTH AND WELL-BEING ACROSS ECOLOGICAL SYSTEMS AND TIME IN MID LIFE AND LATE ADULTHOOD

Abstract Health and well-being are shaped by peoples’ experiences and ecological contexts (Bronfenbrenner, 2005), reflecting the influence of complex person-context relationships. For example, experiences (e.g., daily stressors, early childhood adversity) occur within microlevel (e.g., marital relationships, neighborhoods) and macrolevel (e.g., societal inequalities) contexts, impacting both daily well-being and healthy aging. Further, a robust literature highlights the significance of naturally occurring everyday experiences for a range of health outcomes, underscoring how daily experiences have immediate and lasting effects on individual physical and cognitive health and psychological well-being. Drawing on Bronfenbrenner’s Ecological Model, the current symposium features novel research examining health and well-being outcomes across diverse ecological systems and time scales across midlife and old age, with the goal of articulating how innovative approaches for studying person-context interactions can be leveraged to understand both proximal and long-term health and well-being. Polenick and colleagues will examine associations between daily negative and positive events and well-being among heterosexual married couples living with early-stage dementia. Cichy et al. will examine gender differences in the prospective effects of daily stress processes on long-term chronic disease risk in midlife and later life. Next, Turner and Mogle will examine how positive and negative affect mediate the associations between daily memory lapses and psychological well-being. Finally, Choi, Munoz, Scott, and Sliwinski will examine whether current positive (i.e., neighborhood cohesion) and negative (i.e., neighborhood violence) neighborhood contexts moderate the effect of childhood stress exposure on cognitive function in adulthood. Robert Stawski will synthesize the presentations and offer insights for future research.

REVOLUTIONIZING DIGITAL ENGAGEMENT: EFFECTS OF AN APP ENABLING PERSONS WITH DEMENTIA TO LEAD ACTIVITIES FOR PEERS

Abstract A Cluster Randomized Trial was conducted to evaluate the effects of an app that enables long-term care (LTC) residents with early-stage dementia to lead activities for their peers—i.e., other persons living with dementia (PLWD). A total of 72 PLWD completed the study, including 35 Control Group PLWD (Standard Programming) and 37 Experimental Group PLWD (Resident-Led Programming). Resident-Leaders exhibited 99% overall adherence to the steps required to lead activities and required minimal help from staff. A series of repeated measures ANCOVAs, controlling for Mini Mental State Examination (MMSE) scores, were conducted to examine proximal (immediate) and distal (longer-term) effects of the intervention. Regarding proximal effects, there were significantly greater increases from baseline to treatment in Constructive Engagement (p<.01), Passive Engagement (p<.01), and Pleasure (p<.01), as well as significantly greater decreases in Distracted Engagement (p<.01) and Passive Engagement (p<.01), for the Experimental Group, as compared to the Control Group. Regarding distal effects, there were no significant differences between trends observed by Control and Experimental Group residents from baseline to post-treatment for neuropsychiatric symptoms, agitation, depression, or quality of life. However, for a subsample of the Experimental Group (PLWD who resided in Assisted Living), there was a significant decrease in depressive symptoms (p<.05) and increase in quality of life (p<.01). Data suggest that this is a highly engaging intervention that enables PLWD to lead activities for their peers. The intervention has its greatest impact during the session, when positive forms of engagement/affect are increased, and negative forms of engagement are decreased.

P178: Scope of post-diagnostic dementia care by Japanese primary care clinics using team-based care models

Objective:Primary care clinics (PCCs) in Japan have acquired the capacity for screening and diagnosing dementia in its early stage. They face challenges in accommodating the complex care needs of people with early-stage dementia in collaboration with other healthcare providers in the community. The study aims were; 1) to classify team-based care models of PCCs for post-diagnostic care for people with early-stage dementia in Japan’s Community-based Integrative Care System and 2) to compare the scope of care in each model.Methods:We conducted a cross-sectional postal survey to certified Dementia Support Doctors working in PCCs in Tokyo. To classify team-based care models, the questionnaire asked about the members, roles, and collaboration of the community-wide care team for early-stage dementia in which participants’ PCCs were involved. We gathered information on care provision across seven domains that PCCs offered for people with early-stage dementia. Three-step latent class analysis was performed to classify models and analyze differences in the proportions of care provision in each domain. The Tokyo Metropolitan Institute for Geriatrics and Gerontology institutional review board approved the study.Results:From the 188 responses, PCCs’ team practices were categorized into three classes, which we named “co-managed,” carved-out,” and “stand-alone” models. While the first two ran an extended care team through in-person communication across facilities in the community, the last applied a minimal team approach with limited and indirect external interaction. The “co-managed” and “carved-out” models were distinguished by how team members shared decision-making responsibilities for patient care. Maximum likelihood estimation grouped 46.6%, 32.8%, and 20.6% of the PCCs into each model in the above order. The three models significantly differed in the proportions of care provision in five of seven domains. The proportions in each domain were the highest for the “co-managed” model (60.7-100%), followed by the “carved-out” (46.2- 98.2%) and “stand-alone” (25.7-88.6%) models.Conclusion:PCCs in Japan’s Community-based Integrative Care System formed three models of post- diagnostic support for people with early-stage dementia. Considering the application of the team approach and the breadth of care provision, either “co-managed” or “carved-out” models are recommended with available community resources in mind.

Tolerability and Likeability of a Cognitive Training Program in an Outpatient Memory Care Clinic

AbstractBackgroundPatients with mild cognitive impairment (MCI) or early stages of dementia often search for treatments to improve their cognitive and daily functioning or help with managing their deficits. Research suggests that multi‐component non‐pharmacological interventions provided to patients with caregivers have similar benefits as pharmacological treatments but without any side effects. Previously, we presented about developing a multi‐component and multi‐domain cognitive training program for patients and care partners. Here, we present the information about the tolerability, likability, and efficacy of the cognitive intervention.MethodThe cognitive training consists of approximately 20 sessions provided to dyads of patients with MCI or early stages of dementia and their care partners. The cognitive training program includes three main components:• Psychoeducation, training, and problem‐solving for healthy brain behaviors.• Psychoeducation, training, and problem‐solving for compensatory strategies.• Psychoeducation and cognitive training addressing attention, processing speed, executive functioning, and memory domains.A total of 14 patients started the treatment (male = 9; female = 5) that ranged 62 to 85 years of age. Diagnoses included MCI due to TBI (n = 1), Alzheimer’s (n = 1), Vascular (n = 1), or unclear (n = 5) etiologies; or dementia due to Alzheimer’s (n = 2), Parkinson’s (n = 1), Mixed (n = 3) etiologies. At the end of the training, patients completed a brief survey about their experiences.ResultsFive out of 14 patients completed the training. Four patients with MCI who completed the treatment demonstrated improvements in cognition, quality of life, improved mastery of daily activities, reduced complaints of cognitive dysfunction, and reduced caregiver burden. Only one patient with dementia completed the treatment and remained stable. All patients who completed the treatment found it helped in their daily functioning and patients rated the treatment 4 out of 4, where 4 stands for “very likely” they would recommend this training to someone who is experiencing cognitive difficulties.Four patients with MCI with significant psychological symptoms did not complete the program and five patients with dementia needed more support with caregiving and resources.ConclusionMulti‐component and multi‐domain cognitive training program with patients and care partners is best tolerated by patients with MCI. Further research will establish statistical and clinical significance.

The Effectiveness of Reminiscence Therapy in Improving Cognitive Functions And Psychological Wellbeing in Older Adults With Early Dementia ‐ The Randomized Control Trial

AbstractBackgroundReminiscence therapy (RT) is a trending type of non‐pharmacological intervention in dementia care. RT is using life histories recalling and re‐experiencing the life events in older people in order to improve their psychological well‐being through the volitional or non‐volitional process of recollecting memories from their past.MethodParticipants' selection inclusion criteria are: (a) aged 65 or above, (b) early stage of dementia that was screened by the Montreal Cognitive Assessment (MoCA) with scoring of 17‐19, and (c) can read written instruction and consent. Participants were randomly assigned by block randomization with randomized block procedure. The participants attended eight group sessions, with each session lasting for 60 minutes. Sessions were administered two times a week over a 4‐week period. Participants' depressive symptoms were evaluated by Geriatric Depression Scale (GDS), Subjective well‐being (the cognitive components) was measured by Satisfaction With Life Scale (SWLS), mood change as measured by Visual Analogue Mood Scale (VAMS). All these evaluation were conducted baseline, mid‐way evaluation and post‐evaluation by a registered Occupational Therapist.ResultForty older people (29 male and 11 female) were eligible for the study. There was significant difference on depressive symptoms (p = .02, t = ‐2.38), mood change (p = .03, t = ‐3.38), but marginally significant in subjective well‐being (p = .05, t = ‐1.03) between intervention and control group. Further analyses were conducted whether depressive symptoms and mood change effect individuals' subjective well‐being. A two‐way ANOVA revealed that there was not a statistically significant interaction between the effects of depressive symptoms and mood change (F(3, 16) = 1.242, p = .311). Simple main effects analysis showed that depressive symptoms did not have a statistically significant effect on subjective well‐being (p = .975). Simple main effects analysis showed that mood change did have a statistically significant effect on subjective well‐being (p < .000).ConclusionThe findings of this study affirmed the benefit of RT to older people with early stage of dementia through improving depressive symptoms, mood and marginally on their subjective well‐being. The research data available support the inclusion of a structured RT as a part of the routine care given to older people. There are some limitations of our study.

Comparison of Functional Mobility Performances of People with Alzheimer’s Disease, Mild Cognitive Impairment, and Cognitively Healthy Individuals

AbstractBackgroundOne of the important factors that make it difficult to carry out activities of daily living independently is the decrease in functional mobility. Mobility‐related disability is a major public health issue that reduces the quality of life and increases the need for care, the burden, and the cost of care. However, in the early stages of dementia, the deterioration in motor skills is often overlooked. This study aimed to compare the mobility performance of healthy individuals and people with Mild Cognitive Impairment (pwMCI) and Alzheimer’s disease (pwAD).MethodCognitive level was measured with Montreal Cognitive Assessment (MoCA) and mobility performance was measured using Timed Up and Go Test (TUG) and 5 Times Sit to Stand Test (5XSTST). Statistical analysis was performed using One Way ANOVA in SPSS v.26 and the level of significance was accepted as p<0.05.Results36 pwAD (Age: 74.90±9.25, 53.12% Female), 14 pwMCI (Age: 63.82±12.55 years, 52.6% Female), and 10 cognitively healthy individuals (Age: 60.25±10.23 years, 82% Female) were included the study. The mean of MoCA scores were 12.62±6.36, 22.25±3.04 and 28.5±0.5; TUG results were 15.34±11.83 sec, 7.47±1.41 sec and 6.86±1.98 sec; 5XSTST results were 16,31±7.75 sec, 11.06±1.98 sec and 9.34±2.37 sec. A significant difference was found between the three groups in terms of TUG and 5XSTST results (p = 0.027, p = 0.015, respectively).ConclusionIn pwAD and pwMCI, the decrease in cognition appears to be accompanied by impairment in functional mobility. Motor skills should be evaluated not only in AD diagnosis but also during the prodromal stage to provide early intervention for loss of motor function. Improving motor function should be added to rehabilitation goals before impaired functional mobility begins to affect activities of daily living.

A passive, neural correlate of verbal fluency in Mild Cognitive Impairment using Fastball neurocognitive assessment

AbstractBackgroundFastball provides a passive and objective measure of an individual’s ability to discriminate between different visual categories using Fast Periodic Visual Stimulation and EEG. Our previous work adapted this approach to assess recognition memory in Alzheimer’s disease (Stothart et al., Brain, 2021). This research builds on previous findings by expanding the range of cognitive functions assessed to include visuo‐perceptual performance, and working with patients in an earlier stage of dementia, i.e., Mild Cognitive Impairment (MCI). The aim was to determine whether Fastball responses are sensitive to visuo‐perceptual performance in the early stages of dementia (MCI).MethodAll EEG data were collected in patients' homes using low‐cost, portable systems. Healthy older adult controls (n = 56, ACE‐III = 96 +‐ 6) and MCI patients (n = 50, ACE‐III = 82 +‐ 21) completed a battery of Fastball and neuropsychological tasks (ACE‐III, Freiburg visual acuity) designed to assess visuo‐perceptual performance. We created a letter recognition Fastball task using diffeomorphically scrambled letters as standards and whole letters as oddballs, see Figure 1.ResultA one‐way (Group; Old vs MCI) ANCOVA, controlling for basic steady state magnitude, was conducted to test for differences in oddball responses. Controls had significantly increased oddball responses compared with MCI patients (F (1,103) = 9.61, p = .003, d = 0.48). Oddball responses did not correlate with any neuropsychological measure of vision, but correlated strongly with verbal fluency performance as measured by the ACE‐III, (MCI patients (r(48) = .46, p = .001), controls (r(54) = .34, p = .01)), see Figure 2. There were no correlations between oddball responses and any other neuropsychological measure.ConclusionThese results were not anticipated as we originally hypothesised that oddball responses would correlate with visual performance. Instead, the specific relationship with verbal fluency performance indicates that the Fastball letter recognition task may provide a novel, passive correlate of verbal fluency performance in early dementia. We propose that whole letter oddball stimuli are more salient to participants with greater verbal fluency, resulting in larger oddball responses. A passive measure of verbal fluency could potentially bypass educational and linguistic confounds that can affect traditional measures of verbal fluency performance.

Call and response: Ethnomusicological methods to awaken specific memories with targeted songs encoded in neuronal populations of a dementia patient

AbstractThis study collaborates with a fellow expert ethnomusicologist Sean Williams to trigger specific contextual memories associated with songs of her mother Julian Williams, born in 1932, and currently struggling with the early stages of dementia. The goal was to ascertain the success rate of a one‐to‐one correspondence type: The use of targeted, known songs of the dementia patient as a means to trigger the patient’s contextual memories.By adopting a methodology in Ethnomusicology involving the autobiography of one’s music history and their corresponding memories of the patient Julian Williams, I set up the experiment for Sean Williams to conduct. Dividing the study into discrete music time periods (infancy, childhood, teenager, young adult, older adult), I asked Sean Williams to choose specific songs with specific memories to the patient to be sung. The memory responses of the patient on video were then recorded.Each of those songs had deep levels of recognition by the Alzheimer’s patient, as evidenced in her singing with some memories (lyrics and contextual environment) stronger than than others. The fact that there is some autobiographical recall, despite a weakened sense of time and space after the onset of Alzheimer’s, suggests there may be use for this technique in dementia care. Of note, is the fun‐filled disposition of the participants during the recording of the singing. That speaks to a higher quality of life one could expect by using music as a memory‐recall and time‐ travel companion.This single case study needs to be broadened into a larger‐scale experiment involving many participants from different cultures to ascertain the use of individualized targeted songs to awaken specific memories of the dementia patients. In the area of dementia care, this approach also makes it possible for families to participate actively since the songs will probably be known to them as well.

Comparison of Executive Functioning between Ageing Urban and Rural Participants in India: A Cross‐sectional Analysis

AbstractBackgroundOlder adults living in urban areas differ from their rural counterparts in many ways, including the cognitive performance. Executive functioning is one of the few cognitive domains that is implicated to be affected in early stages of dementia. However, there are very few studies that have explored differences in cognitive functioning across rural and urban contexts in India. Our objective was to evaluate differences in executive functioning across urban and rural participants.MethodOur study sample includes ageing individuals (≥ 45 years): 1089 from the urban Tata Longitudinal Study on Ageing (TLSA) cohort and 4913 from the rural Srinivaspura Ageing, Neuro Senescence and COGnition (SANSCOG) study cohort. The TLSA and SANSCOG are parallel, harmonised, community‐based cohort studies in urban and rural India exploring the risk and protective factors associated with cognitive changes due to normal ageing, dementia and other related disorders. The difference in executive functioning measured by Categorical fluency, Letter fluency, Visuospatial span and Stroop tests were compared across both cohorts.ResultUrban participants were older, had more years of education had less Geriatric Depression Score (GDS) as shown in Table 1. They did not differ in gender and proportion of cognitive impairment. Multiple Linear Regression analysis was performed to examine the effects of each executive functioning tests between both the cohorts (urban participants were coded as reference category) while age, years of education and GDS were adjusted.Urban participants performed better than Rural participants on Categorical fluency (β = ‐2.379, p < 0.001), Letter fluency (β = ‐4.343, < 0.001), Visuospatial span (β = ‐0.279, < 0.001) and Stroop (β = 0.934, < 0.001). Similar results were obtained after gender stratification as shown in Table 2.ConclusionUrban participants performed better than their rural counterparts in all tests examining executive functioning. Poorer cognitive functioning in the rural ageing cohort could be due to a number of reasons including limited or less cognitively demanding occupations. There is a need for more such longitudinal studies in India that explore community environment on cognitive function across different cohorts.

P142: Dementia diagnosis: the potential onset of suicidal risk

Objective:Being diagnosed with dementia can be a hectic and critical period. While severe dementia may act as a shield when it comes to suicidal risk, mild and early dementia stages may still preserve cognitive functions to elaborate a suicidal plan. Having insight may lead to feelings of despair and sadness that patients find unbearable to deal with. The aim of this article is to review the current literature regarding suicidal risk after a dementia diagnosis.Methods:Review of the most recent literature regarding the risk of suicide among patients with a recent dementia diagnosis. The research was carried out through the PubMed and UptoDate databases, using the terms “dementia”, “diagnosis” and “suicidal risk”.Results:Previous research showed inconclusive findings, with some authors suggesting a higher risk of an early suicide attempt in patients recently diagnosed with dementia, and others suggesting otherwise. Nowadays, the literature mainly reports that older adults with recent dementia diagnoses are at increased risk of endeavoring suicide. There is an important requirement to offer appropriate support to patients and their families, at the time, or as soon as possible, when a dementia diagnosis is made, to diminish the risk of suicide attempts in these patients.Conclusion:Patients with recent diagnosis of dementia, or diagnosed at an earlier age, seem to have higher suicidal risk. The period immediately after diagnosis is when individuals need greater support, so these results demand for better assistance for those experiencing such intellectual decline.