Management Of Dementia Research Articles

Preliminary Findings of an Active Multicomponent Lifestyle Intervention for People with Dementia and Their Carers: Mixed Methods Study

There is a need for integrated and effective postdiagnostic rehabilitation programs for community-dwelling people with dementia and their carers to promote their quality of life and management of dementia. Here, we report on preliminary findings of the Sustainable Personalised Interventions for Cognition, Care, and Engagement (SPICE) Program conducted in Canberra, Australia. Over twelve weeks, six people with dementia and their carers completed five hours of weekly small group activities and separate individual appointments. SPICE is an active therapeutic intervention with five components delivered by allied health professionals: (1) cognitive stimulation therapy; (2) carer education, support, and capacity building; (3) physical activity; (4) Care Of People with dementia in their Environments (COPE) program; and (5) dietary assessment and advice. Participants completed questionnaires pre- and post-intervention and a program evaluation interview which was analysed by qualitative thematic analysis. The program demonstrated high program satisfaction ratings and program adherence (94% people with dementia and 92% carers) which supports intervention feasibility. The results of quantitative outcome measures suggest positive effects, but inferences cannot be drawn due to small sample size. Qualitative themes from participant experiences highlighted the following: (1) social connection, engagement, and interaction were key drivers of the success of the program; (2) clinicians fostered a positive and respectful culture; (3) carers were supported with strategies and skills to reframe dementia; and (4) reablement can be fun. The new combination of evidence-based interventions was feasible and considered valuable. Further results are required to confirm these findings and support a longer-term trial.

LETHE: A Digital Intervention for Cognitive Decline.

Dementia is the main cause of disability in elderly populations. It has been shown that the risk factors of dementia are a mixture of pathological, lifestyle and heritable factors, with some of those being provably modifiable. Early diagnosis of dementia and approaches to slow down its evolution are currently the most prominent management methodologies due to lack of a cure. For that reason, a plethora of home-based assistive technologies for dementia management do exist, with most of them focusing on the improvement of memory and thinking. The main objective of LETHE is prevention in the whole spectrum of cognitive decline in the elderly population at risk reaching from asymptomatic to subjective or mild cognitive impairment to prodromal Dementia. LETHE will provide a Big Data collection platform and analysis system, that will allow prevention, personalized risk detection and intervention on cognitive decline. Through the subsequent 2-year clinical trial, the LETHE system, as well as the respective knowledge gained will be evaluated and validated. The scope of the current paper is to introduce the LETHE study and its respective novel platform as a holistic approach to multidomain lifestyle intervention trial studies. The present work depicts the architectural perspective and extends beyond state-of-the-art guidelines and approaches to health management systems and cloud platform development.Clinical Relevance - Patient Management Systems as well as lifestyle management platforms have significant clinical relevance as they allow for remote and continuous monitoring of patients' health status. LETHE aims to improve patient outcomes by providing predictive models for cognitive decline and patient adherence to the multimodal lifestyle intervention, enabling prompt and appropriate medical decisions.

Mortality risk factors among patients undergoing hemodialysis in a nursing home.

This study aimed to verify the impact of low body mass index (BMI) on mortality in nursing home residents undergoing hemodialysis and to clarify other associated mortality risk factors. This retrospective study included patients admitted to a nursing home affiliated with Nagasaki Renal Center between April 2014 and March 2022. Medical data were collected on admission, and participants were divided into low and high BMI groups according to their median BMI values. The patients were followed up until March 2023. The association between survival and patient history was also analyzed. Of the 106 patients (average age, 81.3 ± 7.9 years; male, 36.8%; median dialysis vintage, 32.5 [interquartile range (IQR), 13.8-79.3] months), 52 and 54 were classified into the low (median < 18.4 kg/m2 ) and high (≥18.4 kg/m2 ) BMI groups, respectively. Multivariable Cox proportional hazards analysis indicated that BMI (hazard ratio, 0.87; 95% confidence interval [CI]: 0.82-0.94; P < 0.001) was closely associated with survival. Multivariable logistic regression revealed that dementia was associated with low BMI (odds ratio: 2.89, 95% CI: 1.07-7.83, P = 0.03). Low BMI was an important factor contributing to poor patient survival. Dementia was associated with low BMI. Therefore, the management of both nutrition and dementia is essential for nursing home residents undergoing hemodialysis. Geriatr Gerontol Int 2023; 23: 660-664.

Daily time management in dementia: qualitative interviews with persons with dementia and their significant others

BackgroundPersons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT for persons with dementia affects the situation of significant others. Moreover, there are a few previous qualitative studies on the experiences of time AT by persons with dementia. This study explores the experiences of persons with dementia and significant others in daily time management and their perceptions on how time AT affects everyday life.MethodSemi-structured interviews with persons with mild to moderate dementia (n = 6) and significant others (n = 9) were conducted three months after receiving prescribed time AT. Interviews were analysed using qualitative content analysis.ResultsA main category “Support by significant others is always part of daily time management”, and three categories “Facing new challenges”, “Using strategies to handle changes”, and “Time assistive technology in daily life” illustrated that significant others provided support for daily time management in all phases of dementia. This support was often embedded in other kinds of support for emerging challenges. Support in time management was needed from an early stage in dementia, and responsibility for time management was gradually transferred to significant others. Time AT could support time orientation and were important for sharing the time management conducted by others but did not enable independent time management.ConclusionsTime-related assessments and interventions should be offered at an early stage of dementia to increase the possibility of maintaining daily time management skills. Using time AT to communicate time might increase agency and participation in daily occupations for persons with dementia. Given the central role of significant others for daily time management, the society needs to adequately support persons with dementia lacking support from significant others.

Angiotensin Receptor-neprilysin Inhibitor Versus Renin-angiotensin System Inhibitor for Dementia Risk in Patients With Heart Failure.

The authors report the impact of angiotensin receptor-neprilysin inhibitor (ARNI) versus renin-angiotensin system inhibitor (RASI) on the management and outcomes in dementia among heart failure (HF) patients as obtained from the real-life nationwide registry. In this study, HF patients between January 1, 2017 and December 31, 2019 were divided into 2 groups, including subjects receiving RASI and ARNI. The incidence rate of dementia was calculated with the unit of 1000 person-years. Cox proportional hazard model was applied for the examination of the hazard ratio, and also presented with 95% confidence interval. Between 2017 and 2019, RASI and ARNI cohorts contain 18,154 subjects. After adjusting with age, sex, comorbidities, and medications, ARNI cohort had a lower risk of dementia (adjusted hazard ratio = 0.83; 95% confidence interval = 0.72, 0.95) than RASI cohort. The authors concluded that use of ARNI was associated with a lower risk of new-onset dementia in patients with HF.

Neuroprotective Properties of Nutraceuticals in Regulating Neurodegenerative Dementia

Dementia is a syndrome marked by a loss of mental abilities due to damage to at least one cognitive function, resulting in poor brain performance that compromises daily life activities. The multiple pathologic pathways underlying neurodegenerative dementia include protein misfolding, oxidative stress, neuro-inflammation, mitochondrial dysfunction, and calcium overload. The syndrome is a major concern to the healthcare system since the therapeutic options are limited and it has multiple adverse effects. Such therapeutic options function particularly to alleviate signs and symptoms. Recently, nutraceuticals have attracted significant attention due to their neuroprotective properties against dementia. However, few studies have focused on the mechanisms mediating the neuroprotective effects of nutraceuticals or their effectiveness against dementia, particularly in regulating neurodegeneration. Therefore, this review underlines the nutraceuticals used against dementia that includes omega-3 (PUFA), flavonoid, curcumin, resveratrol, and vitamins and to establish their neuroprotective mechanisms. The review covers relevant clinical trials demonstrating the effectiveness of nutraceuticals in supporting the possible treatment in neurodegenerative dementia. In conclusion, it is evident that certain nutraceuticals showed neuroprotective properties such as antioxidant, anti-inflammatory and anti-amyloidogenic. The findings will be useful when employing nutraceuticals in the management or treatment of dementia.

The effectiveness of educational interventions in the community that aim to improve informal carers knowledge of dementia anatomy, physiology, progression, and impact on behavior: a systematic review.

Dementia education is a vital component of dementia care and management for patients and their informal carers and family. To fully understand dementia, some knowledge of the anatomy and physiology of the brain may be necessary and would help informal carers understand behaviors of dementia to help cope with care provision. This integrative review aims to identify, appraise, and assess whether dementia education resources include information detailing the anatomy of the brain and its relationship with dementia and whether this information improves knowledge (PROSPERO Registration Number: CRD42022320530). Literature published from 2012 until May 4, 2022 was searched in eight databases with six articles meeting the inclusion criteria. Using the Mixed Methods Appraisal Tool (2018) methodological quality varied across studies. There are limited educational interventions which incorporate information on the anatomy and the physiology of the brain. None of the interventions focused solely on providing neurological education; however, all contained at least some content that addressed this, as per inclusion criteria. In most cases, the educational interventions were well-received and delivered, which did not differ, whether they were delivered in person or virtually. The majority of the studies reported an increase in dementia knowledge (measured pre-post or perceived) following the intervention. Educational interventions on brain anatomy and physiology remain limited, and if included, are often not the focus, and as such more rigorous study is required to investigate the effect of educational interventions on dementia knowledge and their role in dementia care.

Dementia Management Knowledge, Attitude and Practice of Nurses, Executive Staff and Management from Three Homes of Epoch

Dementia Management Knowledge, Attitude and Practice of Nurses, Executive Staff and Management from Three Homes of Epoch

Physiological biomarkers of silent brain damage leading to cognitive impairment and Dementia – direct and accessible clinical evidence

AbstractBackgroundCognitive assessment is the best clinical tool to detect cognitive impairments, yet it is evident only at late stages of disease progression. In contrast, silent brain network changes occur at early stages of the disease and it is estimated that a large proportion of dementias may be prevented or at‐least delayed if detected during early pathophysiology stages. Neuroimaging studies have shown that silent brain network findings, including white matter hyperintensities, lacunar infarctions and temporal atrophy are evident before objective cognitive impairment is detected and even more in ‘at risk’ population with risk factors for dementia. We aimed to evaluate direct physiological biomarkers that provide accessible clinical evidence of silent brain network damage that precede clinical cognitive findings and provide early clinical biomarkers that can facilitate early interventions.MethodBrain network performance was evaluated in 168 subjects ‘at risk’ for developing dementia (Table 1). Direct electrophysiological imaging (“Delphi”) was used to measure magnetically induced brain network electrophysiological response. MRI scans included T1, T2, FLAIR, Diffusion Weighted Imaging (DWI) and (SWI). They were analysed according to Fazekas scale for white matter Hyperintensities (WMH), lacunar Infarctions and medial temporal lobe atrophy (MTA). Objective cognitive evaluations were performed by a neuropsychologist interview and a computerized cognitive battery (NeurotraxTM).ResultDirect electrophysiological imaging (“Delphi”) was able to distinguish between severities of different MRI detected silent brain network damage findings. Magnetically induced direct electrophysiological response wave form adherence (WFA) significantly decreased with increase in WMH (Fig.1A; p&lt;0.0001) and increase in MTA levels (Fig.1B; p&lt;0.0001). Furthermore, WFA significantly decreased in subjects with lacunar infarctions (Fig.1C; p&lt;0.0001).ConclusionSilent brain network deficits preceding dementia and cognitive decline are widely under detected due to lack of accessible tools. Data presented in this study demonstrates “Delphi” technology’s ability to detect silent brain network damage findings and severity levels that are identified in MRI scans. “Delphi” is a clinically accessible, direct, and objective technology that can facilitate early detection, prevention, delayed progression and management of mild cognitive impairment and dementia.

Looking to the Year Ahead

Already 2023 is looking to be a great year for AMDA – The Society for Post-Acute and Long-Term Care Medicine. Our Annual Conference, PALTC23, held in Tampa, FL, was a huge success. We welcomed over 1,300 people, including 87 Futures Program participants, to learn and celebrate together, fully in-person for the first time since 2019. Some of the highlights of the conference were enjoying a much-needed laugh with our opening keynote speaker, honoring the Foundation’s award recipients and the giving campaign, and celebrating Chris Laxton’s last meeting as our fearless executive director. We also welcomed our incoming Executive Director Michelle Zinnert, CAE. Michelle officially joined the Society on April 24, 2023, and I am excited to work side by side and to learn from one another’s experiences to move our important strategic plan forward. Our Society has now closely aligned our education and clinical affairs teams. I am confident that this change will elevate the ability of our members to make an even bigger impact in PALTC through more integrated educational experiences and clinical products. We will continue to provide our most popular offerings, such as our various podcasts — which recently boasted over 200,000 downloads! A big thank you goes to Wayne Saltsman, MD, PhD, CMD, for starting the AMDA On-The-Go series, which is now being hosted by the multitalented Diane Sanders-Cepeda, DO, CMD. I also want to thank our other hosts, Karl Steinberg, MD, HMDC, CMD, Christian Bergman, MD, CMD, and Alex Bardakh, MPP, CAE, who work hard to bring important clinical information and news in a timely manner. We will continue to explore other andragogical methods to disseminate content, including interactive web-based education. To give all our members and consumers the best experience with our products, our website is undergoing a much-needed redesign this year, which will make it even easier to find information and engage with the Society. Lastly, if you haven’t yet downloaded our app, I encourage you to do so now. The AMDA App offers instant information right at your fingertips to maximize your work in PALTC. You will find links to clinical tools, our publications, AMDA Social, and the Guide to PALTC Coding, among other offerings. On the advocacy front, we continue to engage with key leaders in the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and the U.S. Congress to move key policy initiatives forward. For instance, after the release of the National Academies of Science, Engineering, and Medicine (NASEM) report The National Imperative to Improve Nursing Home Quality (National Academies Press, 2022) and the White House Fact Sheet, “Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes” (February 29, 2020, https://bit.ly/40DPAbM), the Moving Forward Coalition was formed to bring diverse stakeholder input to policy and practice. The Society has participated as a key stakeholder since its inception, with Chris Laxton as our representative. With Chris Laxton’s retirement, I have been appointed as the Society’s official representative on the Moving Forward Coalition’s steering committee. I am looking forward to representing the voice of our Society’s clinical leaders to improve the quality of life and care delivery of our patients and residents. This is only one of the many ways we are working together with partner organizations to meet our Society’s vision and mission. People have been asking me what things I personally hope to accomplish this year. First and foremost, I want to ensure that we have a smooth executive director transition. A new face brings renewed energy and excitement about the work we are doing, but the change includes many logistical challenges that take time and energy. Second, I want to ensure that all our committees have clear direction and strong support to formulate and complete their 2023–2024 work plans. Third, I plan to strengthen and enrich our new and long-standing external stakeholder relationships. We do not practice PALTC medicine in a vacuum — engaging with other medical and health care societies, government entities, and newly formed coalitions such as Moving Forward and Be Well in AL (assisted living) is critical to moving us closer toward completing our mission. I want to close with another expression of gratitude for everyone who has and continues to contribute to the Society’s wonderful work. I serve you all as your official representative, and I am proud to be part of this amazing organization. Dr. Little is an associate professor of geriatric medicine at Duke University. Her scholarly interests include interprofessional health education, deprescribing, and nonpharmacologic management of dementia.

The need for better dementia literacy: current public understanding and awareness of dementia symptoms, risk factors and subtypes

AbstractBackgroundImproving public knowledge of modifiable risk factors and presenting symptoms of dementia is vital to aid early diagnosis and treatment. Unfortunately studies across the world report low levels of public awareness, even for the most common type of dementia: Alzheimer’s disease. While many people associate dementia with memory loss, little attention has been given to measuring public knowledge of key symptoms in atypical or non‐Alzheimer’s dementia subtypes. This study aimed to determine public understanding of different forms of dementia and accuracy in knowledge regarding key symptoms and risk factors.MethodA 10‐minute face‐to‐face survey of 311 adults (58% women), aged 18 to 89 years, was conducted in Exeter, UK in 2018. The majority (93%) of participants were White/European and well‐educated. A third had some experience caring for a person with dementia. Participants were asked to define dementia, name as many subtypes as possible, indicate which of the main dementia types they had heard of, and answer knowledge questions regarding dementia symptoms, risk factors and treatment options in both Alzheimer’s and frontotemporal dementias.ResultAlthough two‐thirds of participants (68%) could state at least one key fact about dementia (usually memory loss), only 11% identified dementia as a neurological or brain disease that was degenerative. Almost all participants had heard of Alzheimer’s disease (98%), although only 43% spontaneously named this type. While 57% said they had heard of Vascular dementia, less than a quarter had ever heard of Fronotemporal dementia (23%) or Dementia with Lewy Bodies (17%). Accuracy of dementia knowledge was generally low, but greater for Alzheimer’s Disease (57% accuracy across questions) than for Frontotemporal dementia (27% accuracy across questions). Knowledge was poorest regarding risk factors. Having personally known or cared for someone with dementia and having higher education levels was associated with greater knowledge in Alzheimer’s Disease (all p &lt; .05).ConclusionOverall, public knowledge of dementia remains suboptimal, but particularly so for non‐Alzheimer dementias. Improving public awareness of non‐memory symptoms and how to reduce risk of dementia will be an important step for future management of dementia.

Practice and improvement plans of the tailored dementia case management in local dementia centers: A qualitative study using focus group

Purpose: With the nationwide expansion of local dementia centers (LDCs) after the National Responsibility for Dementia System, the number of tailored dementia case management (TDCM) programs increased significantly, but qualitative improvement in TDCM is still a remaining task. The purpose of this study was to explore the current practice of the TDCM in LDCs and suggest directions for future program improvement. Methods: A focus group interview was conducted with seven hands-on workers who had experience in TDCM at the LDCs. Participants (mean age=40 years old) were nurses, social workers, and occupational therapists with an average of 9.1 years of working experience in TDCM. Data were analyzed using qualitative content analysis. Results: The results were summarized into three core themes and fourteen sub-themes. The three core themes were ‘Job Characteristics of TDCM’, ‘Barriers to the effective operation of TDCM’, and ‘Improvement plans for successful TDCM’. Conclusion: To establish the function and role of TDCM within the domestic dementia management system, we propose five areas for improvement: 1) Developing a standardized TDCM manual; 2) Quantitative and qualitative expansion of case manager working capacity; 3) Activating a multidisciplinary team approach; 4) Forming a collaborative network between related organizations and local community councils; 5) Active promotion of TDCM.

A novel approach towards behavioral and psychological symptoms of dementia management

Dementia is the loss of cognitive functioning to the extent that it interferes with the person’s daily routine functioning. Evidence suggests that there are millions of people living with dementia and this number is ever increasing as the younger age mortality is on the decline. The various causes of dementia can be diagnosed by a thorough medical history, a general and systemic examination, laboratory investigations, and neurological imaging. Although cognitive impairment is required and even sufficient for the diagnosis of dementia, the disease may also be accompanied by neuropsychiatric symptoms known as behavioral and psychological symptoms of dementia (BPSD), which are widespread and have a significant impact on the disease’s prognosis and treatment. In this case report, we will be discussing about a novel approach undertaken when managing the BPSD symptoms of two patients older than 90 years of age. The patients were admitted to the inpatient department of a tertiary care hospital. The patients were started on low-dose medications initially but due to no improvement, a more rigorous approach had to be taken.

Epidrugs in the Therapy of Central Nervous System Disorders: A Way to Drive on?

The polygenic nature of neurological and psychiatric syndromes and the significant impact of environmental factors on the underlying developmental, homeostatic, and neuroplastic mechanisms suggest that an efficient therapy for these disorders should be a complex one. Pharmacological interventions with drugs selectively influencing the epigenetic landscape (epidrugs) allow one to hit multiple targets, therefore, assumably addressing a wide spectrum of genetic and environmental mechanisms of central nervous system (CNS) disorders. The aim of this review is to understand what fundamental pathological mechanisms would be optimal to target with epidrugs in the treatment of neurological or psychiatric complications. To date, the use of histone deacetylases and DNA methyltransferase inhibitors (HDACis and DNMTis) in the clinic is focused on the treatment of neoplasms (mainly of a glial origin) and is based on the cytostatic and cytotoxic actions of these compounds. Preclinical data show that besides this activity, inhibitors of histone deacetylases, DNA methyltransferases, bromodomains, and ten-eleven translocation (TET) proteins impact the expression of neuroimmune inflammation mediators (cytokines and pro-apoptotic factors), neurotrophins (brain-derived neurotropic factor (BDNF) and nerve growth factor (NGF)), ion channels, ionotropic receptors, as well as pathoproteins (β-amyloid, tau protein, and α-synuclein). Based on this profile of activities, epidrugs may be favorable as a treatment for neurodegenerative diseases. For the treatment of neurodevelopmental disorders, drug addiction, as well as anxiety disorders, depression, schizophrenia, and epilepsy, contemporary epidrugs still require further development concerning a tuning of pharmacological effects, reduction in toxicity, and development of efficient treatment protocols. A promising strategy to further clarify the potential targets of epidrugs as therapeutic means to cure neurological and psychiatric syndromes is the profiling of the epigenetic mechanisms, which have evolved upon actions of complex physiological lifestyle factors, such as diet and physical exercise, and which are effective in the management of neurodegenerative diseases and dementia.

Factors influencing access to nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia: An integrative review.

Research has shown effectiveness of nonpharmacological interventions in improving or maintaining cognition, mood, functioning, self-efficacy and quality of life for persons with mild-to-moderate dementia (PWDs). These interventions are critical during the earlier stages of dementia. However, Canadian and international literature report underutilization of and difficulty accessing the interventions. To our knowledge, this is the first review that explored factors influencing seniors' utilization of nonpharmacological interventions in the earlier stages of dementia. This review contributed to the discovery of unique factors such as PWDs' beliefs, fears, perceptions, and acceptability of nonpharmacological interventions and environmental influences on intervention provision. PWDs' intervention uptake may appear as a matter of personal choices related to individuals' knowledge, beliefs and perceptions. However, the analysis of the research evidence suggests that PWDs' choices are shaped by environmental factors such as formal and informal caregiver support, acceptability and accessibility of nonpharmacological interventions, dementia care workforce, community's attitudes towards dementia and funding. The complex interplay among factors highlights the importance of targeting health promotion strategies at both individuals and their environments. The review findings feature opportunities for healthcare practitioners, including mental health nurses, in advocating for PWDs' evidence-informed decision-making and access to desired nonpharmacological treatments. Involvement of patients and families in care-planning through ongoing assessment of health and learning needs, as well as enablers and barriers to using interventions, continuing information provision, and personalized referrals to appropriate services can promote PWDs' rights to healthcare. INTRODUCTION: Despite the significance of nonpharmacological interventions in optimal management of mild-to-moderate dementia, it remains unclear in the literature how persons with mild-to-moderate dementia (PWDs) view, understand and access nonpharmacological interventions. The purpose of this review was to explore the extent and nature of evidence concerning factors that influence the use of nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia. An integrative review was undertaken following Toronto and Remington (A step-by-step guide to conducting an integrative review, 2020)'s instruction which expanded Torraco (Human Resource Development Review, 2016, 15, 404)'s and Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546)'s guidance. The review of 16 studies suggests that PWDs' use of nonpharmacological interventions is shaped by a complex interplay of various personal, interpersonal, organizational, community and political influences. The findings highlight the complex, interrelated relationships among multiple factors and subsequent limitations of behaviour-oriented health promotion strategies. To assist PWDs in making healthier choices, health promotion strategies need to direct attention to both individuals' behaviours and environmental conditions impacting the behaviours. The findings of this review can inform multidisciplinary health practitioners' (including mental health nurses) practice with seniors living with mild-to-moderate dementia. We recommend actionable ways in which they can empower patients and their families in dementia management.

A pre experimental study to evaluate the effectiveness of structured teaching programme regarding management of dementia among geriatric care givers

Dementia is a chronic progressive debilitating disease that is largely a disorder of old age. It is characterized by widespread impairment of mental functioning, progressive memory loss, language difficulties, confusion and disorientation. These impairments are often accompanied by behavioral and psychological disturbance. The behavioral disturbances associated with dementia are defined as symptoms of disturbed perception, altered thought content, mood and Behavior. A pre-experimental research design with one group pre-test and post-test design was adopted. Sixty samples of geriatric care givers were selected from Chhatauna and Mandir Hausad, Arrang, Raipur, (C.G.). Samples were using by convenient sampling technique. A self structured knowledge questionnaire was prepared as a tool to assess socio demographic variables, and knowledge of geriatric care givers regarding management of dementia. Collected data was analyzed using paired „ z‟- test and chi-square test. : In the pretest 38 (63.33%) are having poor knowledge,22 (36.66%) are having Average knowledge and no one had good Knowledge. After administration of structured teaching programmein the post test level of knowledge has improved in 34 (56.66%) are having average Knowledge and26 (43.33%) are having good knowledge and no one had poor knowledge. Hence it can be interpreted that in the pretest majority of the geriatric care giver were in the poor category and after structured teaching programme the geriatric care giver gained adequate knowledge regarding management of dementia of the subject were in the good category. In the pre test the calculated mean is 9 the mean score 30% the standard deviation is 3.86 and in the post test the calculated mean is 20.5, the mean score 66.83% and the standard deviation is 5.27, hence it can be interpreted that there is a striking difference between the mean pretest and post test knowledge score of geriatric care giver which explains that the structured teaching programme was effective in enhancing the knowledge score regarding management of dementia among geriatric care givers in selected area of Raipur, Chhattisgarh. Hence, it can conclude that the structured teaching programme was highly effective. And they gain knowledge i.e 36.83% using„ z‟ test it was found that at 0.05 level of significance the table value is 2.00 and the calculated value is 7.81(p&amp;#62;0.05) which shows that the calculated value is higher than the table value, so the test was highly Significant at 0.05 level. Research hypothesis (H) was accepted. Findings of the study indicates significant difference in the knowledge level after administration of Structured teaching Prgramme regarding Management of Dementia among Geriatric care Givers in Selected Area of Raipur, Chhattisgarh.

Alzheimer's disease pathology: pathways between chronic vascular risk factors and blood-brain barrier dysfunction in a cohort of patients with different types of dementia.

Blood brain barrier (BBB) breakdown is considered a potential mechanism of dementia. The Alzheimer's disease (AD) biomarkers and vascular factors are also associated with BBB permeability. In the present study, the combination effects of neuropathological biomarkers of AD and chronic vascular risk factors for BBB were investigated. The cerebrospinal fluid (CSF)/serum albumin ratio (Qalb), an indicator of BBB permeability, was measured in a total of 95 hospitalized dementia patients. The demographics, clinical information, and laboratory tests were collected from the inpatient records. The CSF neuropathological biomarkers of AD and apolipoprotein E (APOE) genotype were also collected. The mediation analysis model was used to calculate the associations among neuropathological biomarkers of AD (mediator), the Qalb, and chronic vascular risk factors. Three types of dementia, AD (n = 52), Lewy body dementia (LBD, n = 19), and frontotemporal lobar degeneration (n = 24), were included with a mean Qalb of 7.18 (± 4.36). The Qalb was significantly higher in dementia patients with type 2 diabetes mellitus (T2DM, p = 0.004) but did not differ based on the presence of APOE ε4 allele, CMBs, or amyloid/tau/neurodegeneration (ATN) framework. The Qalb was negatively associated with the levels of Aβ1-42 (B = -20.775, p = 0.009) and Aβ1-40 (B = -305.417, p = 0.005) and positively associated with the presence of T2DM (B = 3.382, p < 0.001) and the levels of glycosylated hemoglobin (GHb, B = 1.163, p < 0.001) and fasting blood glucose (FBG, B = 1.443, p < 0.001). GHb is a direct chronic vascular risk factor for higher Qalb (total effect B = 1.135, 95% CI: 0.611-1.659, p < 0.001). Ratios of Aβ1-42/Aβ1-40 or t-tau/Aβ1-42 were mediators of the association between the Qalb and GHb; the direct effect of GHb on the Qalb was 1.178 (95% CI: 0.662-1.694, p < 0.001). Glucose exposure can directly or indirectly affect BBB integrity through Aβ and tau, indicating glucose affects BBB breakdown and glucose stability plays an important role in dementia protection and management.

Health Disparities in Medication Use for the Treatment of Dementia in the Outpatient Setting (P4-9.003)

<h3>Objective:</h3> To investigate disparities along racial/ethnic lines regarding medications used in the outpatient management of dementia. <h3>Background:</h3> The benefits of medications used in the treatment of dementia are not equally distributed in society, and there is evidence for disparities in their utilization in nursing homes and hospitals. However, there remains limited data on these disparities in the outpatient setting. <h3>Design/Methods:</h3> In this retrospective study, information on demographics (including self-reported race/ethnicity), outpatient medications, and referrals to specialists was collected on all patients with a diagnosis of dementia seen at Mount Sinai, a multicenter academic healthcare institution. Frequencies for the utilization of five medication classes (cholinesterase inhibitors, NMDA-antagonists, SSRIs, antipsychotics, and benzodiazepines) were compared among patients with different race/ethnicity using Chi-square and logistic regression, controlling for age, sex, primary language, marital status, and insurance type. <h3>Results:</h3> Black patients living with dementia were receiving cognitive enhancers less frequently in comparison to White patients (20.4% vs. 30% for cholinesterase inhibitors, 9.9% vs. 16.7% for NMDA-antagonists). Additionally, Black patients living with dementia less frequently received medications for behavioral and psychological management in comparison to White patients (23.9% vs. 39.9% for SSRIs, 18% vs. 21.7% for antipsychotics, and 17.5% vs. 36.8% for benzodiazepines; p&lt;0.001). A logistic regression controlling for confounders showed that Black patients received all medications significantly less frequently than White patients, despite receiving more referrals to specialists than white patients. Black patients who received neurology consults received cholinesterase inhibitors and NMDA antagonists comparably to White patients. <h3>Conclusions:</h3> Racial disparities exist in the utilization patterns of all dementia-related medications, with Black patients receiving them less frequently than White patients in the outpatient setting. Referrals to specialists such as neurologists may decrease these disparities. More research is needed to understand the root cause of such disparities and design programs to eliminate them. <b>Disclosure:</b> Dr. Hawkins has nothing to disclose. Parul Agarwal has nothing to disclose. Dr. Jette has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ILAE Epilepsia. The institution of Dr. Jette has received research support from NIH. The institution of Dr. Jette has received research support from AES. The institution of Dr. Jette has received research support from PCORI. Dr. Naasan has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Genentech .

The participatory value-sensitive design (VSD) of a mHealth app targeting citizens with dementia in a Danish municipality.

The Sammen Om Demens (together for dementia), a citizen science project developing and implementing an AI-based smartphone app targeting citizens with dementia, is presented as an illustrative case of ethical, applied AI entailing interdisciplinary collaborations and inclusive and participative scientific practices engaging citizens, end users, and potential recipients of technological-digital innovation. Accordingly, the participatory Value-Sensitive Design of the smartphone app (a tracking device) is explored and explained across all of its phases (conceptual, empirical, and technical). Namely, from value construction and value elicitation to the delivery, after various iterations engaging both expert and non-expert stakeholders, of an embodied prototype built on and tailored to their values. The emphasis is on how moral dilemmas and value conflicts, often resulting from diverse people's needs or vested interests, have been resolved in practice to deliver a unique digital artifact with moral imagination that fulfills vital ethical-social desiderata without undermining technical efficiency. The result is an AI-based tool for the management and care of dementia that can be considered more ethical and democratic, since it meaningfully reflects diverse citizens' values and expectations on the app. In the conclusion, we suggest that the co-design methodology outlined in this study is suitable to generate more explainable and trustworthy AI, and also, it helps to advance towards technical-digital innovation holding a human face.

Vascular dementia subtypes, pathophysiology, genetics, neuroimaging, biomarkers, and treatment updates along with its association with Alzheimer's dementia and diabetes mellitus

Dementia is a chronic progressive cognitive decline illness that results in functional impairment. Vascular dementia (VaD), second only to Alzheimer's disease (AD), is one of the most prevalent forms of dementia in the elderly (aged over 65 years), with a varied presentation and unpredictable disease development caused by cerebrovascular or cardiovascular illness. To get a better understanding of the changes occurring in the brain and to drive therapy efforts, new biomarkers for early and precise diagnosis of AD and VaD are required. In this review, Firstly, we describe the subtypes of vascular dementia, their clinical features, pathogenesis, genetics implemented, and their associated neuroimaging and biomarkers, while describing extensively the recent biomarkers discovered in the literature. Secondly, we describe some of the well-documented and other less-defined risk factors and their association and pathophysiology in relation to vascular dementia. Finally, we follow recent updates in the management of vascular dementia along with its association and differentiation from Alzheimer's disease. The aim of this review is to gather the scattered updates and the most recent changes in blood, CSF, and neuroimaging biomarkers related to the multiple subtypes of vascular dementia along with its association with Alzheimer's dementia and diabetes mellitus.