Moderate Dementia Research Articles

EMBEDDING A PHYSICIAN REFERRAL PATHWAY TO LINK PEOPLE WITH DEMENTIA TO COMMUNITY SERVICE PROGRAMS

Abstract Dementia care quality and value can be enhanced by lateral integration between health systems (HS) and community-based organizations (CBOs), however clinical providers are often unaware of CBO programs. HS could heighten access to CBO programs among people living with dementia (PLWD) by recognizing CBOs as extended care teams, streamlining referrals, and facilitating information exchange through electronic health records (EHRs). Catalyzing CBO and HS integration, we piloted physician referral to a CBO for virtual delivery of Cognitive Stimulation Therapy (CST) in an embedded pragmatic trial. CST, a 14-session group intervention for PLWD, has been shown to benefit participant cognition and other outcomes, yet CST access is limited partially due to the risks and costs of in-person gathering. To enhance access, we trialed a version of virtual CST (vCST) and assessed patient follow-through on physician vCST referrals. Participating sites–one primary care clinic and one neurological specialty clinic—identified eligible PLWD via EHR (e.g., cognitive score indicating mild cognitive impairment to moderate dementia) and clinicians verified eligible PLWD appropriateness for vCST. Clinician-verified PLWD were randomized to intervention (referral, n=56) and control (no referral) groups, and clinicians provided vCST referrals. Results show the percentage of PLWD who followed through on (‘accepted’) the vCST referral. Similarities and differences—across demographics, cognitive scores, and referral sources—between PLWD who accepted versus declined referral are described. Future research will assess conversion rates from vCST referral to program completion, the completeness of outcome measures captured from EHRs, and the impact of vCST on cognitive scores.

EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY

Abstract In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Two-hundred forty-four community-dwelling adults aged 60 to 97 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and comorbidity was matched. Main outcomes were (A) number of hospitalization and 90-day rehospitalization rate, hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. One-hundred twenty-two patients were cared by primary care providers who received the IPETC;122 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021 of patients cared by providers with IPETC. Number of hospitalization with IPETC was fewer than those without IPETC (0.72 vs. 1.38, p < .01). Number of 90-day rehospitalization with IPETC was fewer than those without IPETC (0.14 vs. 0.30, p < .01). An average cost-saving of $20,289 per patient was observed among those with IPETC than those without IPETC (p < .001). CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.2% to 24.7% in documented advance care plans.

EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY

Abstract In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Fifty eight community-dwelling adults aged 67 to 94 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and level of physical impairment was matched. Main outcomes were (A) hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. Twenty nine patients were cared by primary care providers who received the IPETC;29 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021. An average cost-saving of $22,135 per patient was observed among those treated by the healthcare providers who received the IPE/telehealth curriculum training than those treated by the providers without the training. CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.8% to 42.8% in documented advance care plans. Innovative interdisciplinary education and telehealth primary care has shown improvement of quality and efficiency of dementia care in a provider shortage area.

EXPLORING THE IMPACT OF AN EBOOK CLUB PROGRAM ON APATHY AMONG OLDER CANADIANS IN LONG-TERM CARE: A FEASIBILITY STUDY

Abstract Apathy is a common and persistent problem among older people in institutional settings. Research has shown that apathy can lead to rapid decline in cognitive status, serious functional impairments and decrease in the life span of those affected, yet it is under-researched, and under-managed. The aim of this study was to explore ways by which apathy can be mitigated in this population using eReader technology during book club program implementation. We recruited participants from various long-term care facilities (N=18) and each participants took part in semi-structured interviews, and self-reported apathy assessment both at the start and end of the program. We tracked engagement in the eBook club and time commitment to reading using a logbook. The findings suggest that older people, including persons with mild to moderate dementia, are open to adopting new technologies and the use of eReaders during book club programs is feasible for long term care facilities. Overall, we found that the use of eReader technology is a safer and more effective way of delivering book club program to older people in long term care facilities particularly during pandemic such as COVID 19 as they are easy to disinfect in comparison to physical books. We recommend that long term care staff should adapt eReaders into their existing book club or literacy programs and consider utilizing it as a strategy to prevent or manage apathy in this population.

USE OF VIDEO-BASED DATA TO INFORM PSYCHOSOCIAL INTERVENTIONS FOR PEOPLE LIVING WITH DEMENTIA

Abstract The pandemic has accelerated technological developments in care services. Emerging evidence suggests feasibility of delivering evidence-based psychosocial interventions such as group cognitive stimulation therapy using information and communication technology (ICT) platforms. A unique opportunity offered by ICT is the more readily available data at session level to investigate nuanced, theoretically based outcome predictors, to improve efficacy of these complex interventions. Theoretically, the cognitive and wellbeing benefits of group cognitive stimulation therapy is related to the level of person-centred engagement. As part of an ongoing randomised controlled trial involving ICT-delivered group cognitive stimulation therapy, this study examines the use of big data analytics of session behavioural data to develop predictive algorithms of cognitive and wellbeing outcomes. In 78 people living with mild to moderate dementia from 26 groups, we create automatically estimated markers of facial expression and eye movement pattern, and hand-coded markers (using time-sampling method) of engagement level and speech/verbal production information, to autobiographical information presented in the session. These markers are used to predict changes in cognitive and wellbeing outcomes. Pilot analysis using hand-coded speech sample suggested strong correlation between time-sampled engagement level with cognitive benefits, and changes in information content and fluency with cognitive benefits after the group intervention (ranging from r=0.76 to 0.97, p< 0.001). The markers we develop in this study using video-based data from ICT-delivered therapy sessions, including deep learning-based emotion recognition and eye movement analysis with hidden Markov model, allow further application in understanding the mechanisms of action in different psychosocial interventions.

MEASURING DISTRESS IN DEMENTIA: A PILOT STUDY ON PERCEIVED MEMORY, DYADIC RELATIONSHIPS, AND SELF-EFFICACY

Abstract Prior literature has suggested that some individuals with dementia are capable of self-reporting details of their lived experience. With this, researchers have been increasingly interested in understanding what it is like to live with dementia from the individual’s perspective. To capture a more holistic image of the illness experience of individuals with dementia, it is important to consider how they perceive and cope with various aspects of their illness. While some work has suggested that the perceptions that individuals with dementia have about their illness are important to things such as well-being outcomes, no prior work has addressed the distress that results from these perceptions. This pilot study (N = 26) examined perceptions of difficulties and feelings of distress related to three different areas of the illness: one’s memory, the relationship with their caregiver, and self-efficacy. Results suggest that perceived memory distress (α = 0.71), dyadic relationship strain distress (α = 0.80), and self-efficacy distress (α = 0.82) are reliable measures when used in a sample of individuals with mild to moderate dementia (MMSE M = 20.5, SD = 5.20). Interestingly, some of these measures may even be related such as perceived memory distress and self-efficacy distress (r (24) = .50, p = .01). Including distress felt because of perceiving difficulties in various areas of one’s illness adds a layer of understanding to the illness experience. This can aid in addressing well-being outcomes and serve as intervention targets in future work.

PROTOCOLS FOR COLLECTING CONVERSATIONAL LANGUAGE IN PERSONS WITH DEMENTIA

Abstract We describe first-of-its-kind protocols for collecting spontaneous conversations in persons with dementia living in a community through conversation elicitation tools twice a month over six months. We also describe the preliminary feasibility of the protocol deployment in the first enrolled participants over the first month of data collection. Participants were recruited from the University of Washington ADRC registry. The audio was captured using RODE wireless microphone system. Four conversational elicitation techniques were used: 1) reminiscence using personal photographs; 2) reminiscence using generic historical images; 3) picture description test from neurocognitive batteries; 4) open-ended questions about daily activities. Health measures included Cornell Scale for Depression in Dementia (CSDD), Clinical Dementia Rating (CDR), and Clinical Frailty Scale (CFS). Four male and two female participants (average age 75) were recruited. Average health measures at baseline were CDR = 2, suggesting moderate dementia; CSDD=7, suggesting depressive symptoms, CFS=5, suggesting mild frailty. At baseline, the tasks’ average conversation time in seconds was as follows: daily activities =528; personal reminiscence=443; historical reminiscence =227; picture description =192. The corresponding average times for the subsequent home visits were 917; 518; 474, and 280 at visit 1 and 525; 767; 629, and 311 at visit 2. We established the feasibility of collecting conversational speech in this population. Participants seemed more interested in conversations focused on daily activities and personal pictures than general topics. There was an increase in the duration of conversations over time, which might be related to participants’ greater familiarity with the study protocol and data collectors.

The relationship between polypharmacy and physical performance in patients with early-stage Alzheimer’s disease

Introduction Our aim was to evaluate the association between polypharmacy and certain physical performance measures used to assess ambulation in early-stage Alzheimer patients. Materials and methods This cross-sectional study was conducted in the dementia outpatient clinic of a tertiary care center. The usage of five or more drugs per day was accepted as polypharmacy and patients with moderate and severe dementia were excluded. Usual gait speed (UGS), timed up and go (TUG), and chair sit-to-stand test (CSST) were applied to assess physical performance status. Results There were 134 participants in our study (67.9% female, mean age 80.2 ± 7.9 years) and 75 (56%) patients were polypharmacy patients. The patients with polypharmacy showed poor physical performance compared to the patients without polypharmacy (UGS p = .005, TUG p < .001, CSST p < .001). The parameters that were significantly higher and more common in the polypharmacy group were body mass index (p = .026), hypertension (p = .013), diabetes mellitus (p = .018), ischemic heart disease (p < .001), atrial fibrillation (p = .030), depression (p = .012), and hypothyroidism (p = .007). In multivariate analyses, polypharmacy was independently associated with slow UGS [Odds ratio (OR) 1.248 (95%) confidence interval (CI) 1.145–1.523, p = .007]; long TUG [OR 1.410 (95%) CI 1.146–1.736, p = .001]; and long CSST [OR 1.892 (95%) CI 1.389–2.578, p < .001]. Conclusion Our study demonstrated the association of polypharmacy with poor physical performance in patients with early stage Alzheimer’s disease. Prospective long-term studies investigating the relationship of polypharmacy and drug subgroups with physical performance in elderly patients with Alzheimer’s disease would be appropriate.

Phonetic‐phonological disturbances of spontaneous speech in autosomal dominant Alzheimer disease due to A431E PSEN1 mutation

AbstractBackgroundConsiderable cognitive research in Alzheimer Disease (AD) has focused on memory as it is often the primary symptom; nevertheless, in A431E PSEN1 mutation carriers in Jalisco, a rapidly language impairment and verbal fluency decrease during the disease is reported (Petersen‐Dumois, et al., 2020) though this deficit is not well‐characterized. The aim of this study was to identify and characterize phonetic‐phonological abnormalities in the spontaneous speech through different stages of A431E PSEN1 mutation‐related AD.MethodEleven symptomatic A431E PSEN1 mutation carriers, with a mean age of 42.54 years (DE = 4.17) participated in the study: five with Mild Cognitive Impairment (MCI), three with Mild Dementia (MiD) and five with Moderate Dementia (MoD). We used three language tasks: trip planning, picture description, and narrative discourse of a risky and happy moment of their lives which were recorded and transcribed. For each participant, we computed the frequency of phonetic‐phonological features: stuttering, unintelligible productions, phonological paraphasias, fillers and pauses (≥2 seconds) and then converted into percentages dividing the number of occurrences of each feature by the number of words used on the speech sample (for pauses, time in seconds). Then, we obtained the percentage mean of each feature per group.ResultWe analyzed a total of 134.65 minutes of speech sample. Regarding verbal fluency, words per minute (means) varied across the groups MCI: 85.55 (SD = 39.34); MiD: 128.56 (SD = 34.14) MoD: 67.80. (SD = 32.71). All phonological features were present, stuttering: MCI: 1.38%; MiD: 3.2%; MoD: 4.05%; unintelligible productions: MCI: .22%; MiD: .64%; MoD: .76%; phonological paraphasias; MCI: 0.002%; MiD: .01% MoD: .01%; fillers: MCI: 2.05%; MiD: .29%; MoD: 2.88%; number of pauses: MCI: .04%; MiD: .05%; MoD: .03%. and pauses average: MCI: 3.42 (SD = .62); MiD: 2.55 (SD = .03) MoD = 3.43. (SD: 1.61).ConclusionWe found that A431E PSEN1 mutation carriers present phonetic‐phonological traits even in the earliest stage (MCI) and for three of them (stuttering, unintelligible productions, and phonological paraphasias) their frequency is greater the more severe the impairment (MoD). Stuttering is their most prominent feature. These disturbances in the spontaneous speech could be a phenotype trait of this ADAD mutation.

Mild Dementia and the FIFA World Cup! A case report

AbstractBackgroundThe use of reminiscence therapy (RT) to prevent abnormal behaviors in patients with moderate dementia has been well‐established. It has many positive effects in the domains of quality of life, cognition, communication and mood. We are presenting a case where RT decreased abnormal behaviors.Method Case: An 83‐year‐old man with moderate dementia immigrated to the US. He lives with his family who provided care. No alcohol, tobacco use or illicit drug use was reported. The patient was evaluated by a geriatrician. The patient scored 12/30 in Montreal Cognitive Assessment indicating moderate cognitive impairment. Laboratory tests were unremarkable except Vitamin B12 level (slightly low 181). He was started on Donepezil and Vitamin B. Since his arrival to the US, the patient intermittently displayed abnormal behaviors including agitation, sleep disturbance and mood changes. Family members utilized his personal stories, hobbies and interests for behavioral interventions. A soccer‐focused RT method was applied. Several Youtube videos containing old matches during the FIFA World Cup were used whenever abnormal behavior was triggered.ResultFamily reports that the patient’s behaviors were relieved and interestingly improved using the soccer‐focused RT.ConclusionThis case report highlights the importance of a thorough evaluation of patients with dementia to include their life story and interests. In this case, behavioral modalities including RT were tried with considerable benefits. Technology‐based tools present a fertile land to explore regarding RT use in patients with moderate dementia.

FC18: Can rehabilitation improve functional independence of older people with dementia? A pragmatic randomized controlled trial (RCT) of the Interdisciplinary Home-bAsed Reablement Program (I-HARP)

Objective:The Interdisciplinary Home-bAsed Reablement Program (I-HARP) integrates evidence-based rehabilitation strategies into a dementia-specific person-centred, time-limited, home-based, interdisciplinary rehabilitation package. I-HARP was a 4-month model of care, incorporated into community aged care services and hospital-based community geriatric services. I-HARP involved: 8-10 individually tailored home visits by occupational therapist and registered nurse; 2-4 optional other allied health sessions; up to A$1,000 minor home modifications and/or assistive devices; and three individual carer support sessions. The aim of the study was to determine the effectiveness of I-HARP on the health and wellbeing of people living with dementia and their family carers.Methods:A multi-centre pragmatic parallel-arm randomised controlled trial compared I-HARP to usual care in community-dwelling people with mild to moderate dementia and family carers in Sydney, Australia (2018-22). Assessments of the client’s daily activities, mobility and health-related quality of life, caregiver burden and quality of life were conducted at baseline, 4- and 12-month follow-up. Changes from baseline were compared between groups.Results:Of 260 recruited, 232 (116 dyads of clients and their carers, 58 dyads per group) completed the trial to 4-month follow-up (89% retention). Clients were: aged 60-97 years, 63% female, 57% with mild dementia and 43% with moderate dementia. The I-HARP group had somewhat better mean results for most outcome measures than usual care at both 4 and 12 months, but the only statistically significant difference was a reduction in home environment hazards at 4 months (reduction: 2.29 on Home Safety Self-Assessment Tool, 95% CI: 0.52, 4.08; p=.01, effect size [ES] 0.53). Post-hoc sub-group analysis of 66 clients with mild dementia found significantly better functional independence in the intervention group: 11.2 on Disability Assessment for Dementia (95% CI: 3.4, 19.1; p=.005; ES 0.69) at 4 months and 13.7 (95% CI: 3.7, 23.7; p=.007; ES 0.69) at 12 months.Conclusion:The I-HARP model enhanced functional independence of people with mild dementia only but not significantly in people with moderate dementia, so did not result in better outcomes in the group overall. A different type of rehabilitation model or strategies may be required as dementia becomes more severe.

P192: The Unmet Needs of People with Mild to Moderate Dementia During COVID-19 Pandemic in East Jakarta

Background:The number of elderly populations continues to increase as the advancement in healthcare grows, which is shown by the increase of life expectancy, the declining mortality rates, and the surge of people with dementia (PwD). This mental health issue is barely identifiable by health workers and the elderly themselves especially during COVID-19 pandemic. Therefore, it is important to evaluate and identify the unmet needs of people with dementia, especially mild to moderate dementia.Objective:To describe the unmet needs of people with mild to moderate dementia during COVID- 19 pandemic in 2021 in East Jakarta, Indonesia.Methods:This study is using the CDR (Clinical Dementia Rating Scale) to assess severity level of Dementia, then using the CANE (Camberwell Assessment of Need for the Elderly) instrument to assess the unmet needs of people with mild to moderate dementia.Results:96 participants were assessed suffer from mild dementia (75%) and moderate dementia (25%). This study procured five substantial unmet needs proportion, which are friendship (26.0%), psychological distress (20.8%), close relationships (19.8%), memory dysfunction (16.7%), and daily activities (10.4%). During interviews in conducting unmet needs assessments, people with mild to moderate dementia and accompanying families expressed their desire for an activity that would be useful to overcome their unmet needs.Conclusion:The COVID-19 pandemic for the people with mild to moderate dementia has an impact on friendships, psychological distress, memory dysfunction and daily activities so they need meaningful activities to overcome them.

Prescription profile of Alzheimer’s disease medications in the public health system in Southern Brazil

AbstractBackgroundAlzheimer’s disease (AD) accounts for 60‐70% of cases of dementia, and is characterized by progressive decline in cognition and functionality. Pharmacological treatment is fundamentally symptomatic, and consist mainly of three acetylcholinesterase (IChE) inhibitors (donepezil, galantamine and rivastigmine) and one N‐methyl‐D‐aspartate (NMDA) receptor, memantine. Although these drugs are freely available in the public health system in Brazil, there may be barriers to accessing them. We aim to evaluate the profile of prescription of AD medication in the public health system in the state of Rio Grande do Sul (RS), Southern Brazil.MethodsWe analyzed all AD medications requested in the state of RS during October/2021 in the public health system. Sociodemographic, Mini Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR) scale data were collected. We described the variables as median (interquartile range ‐ IQR) or frequencies. We also performed a spatial autocorrelation analysis of the medication prescribed in the RS municipalities. All analyses were performed in R.ResultsThe total of 2,382 AD patients were using any AD medication. Most were female (65.6%), had elementary education (71.7%) and a median age of 79 (73‐84) years. The patients' MMSE median was 15 [12‐18] and most had a CDR = 2 (55.2%, 1133). The most prescribed medication was donepezil, 42.6% (1014), alone or in combination with memantine (Table 1). The distribution of the variable patient/100,000/municipality was clustered, with Moran’s I of 0.17562 (p&lt;0.001) (Figure 1).ConclusionsMost patients using AD medications in the public health system had moderate dementia. The distribution pattern of these medications in the RS state was uneven. The identification of factors related to these patterns may provide valuable information about the barriers to the access to AD treatment in the state of RS.

A PROSPECTIVE STUDY OF ALZHEIMER’S DISEASE DIAGNOSIS AND PROGNOSIS (VALCODIS COHORT)

AbstractBackgroundThe Valencian Cognitive Diseases Study (VALCODIS) provides a large cohort of cases suffering from neurodegenerative diseases causing cognitive problems in their initial phases. This cohort is being obtained from admitted patients at Cognitive Disorders Unit Hospital Universitari i Politècnic La Fe (Valencia, Spain), as a basis to contribute on the Alzheimer’s disease (AD) diagnosis and prognosis research.MethodPatients who come to the Cognitive Disorders Unit at Neurology Department of Hospital La Fe can be recruited to the VALCODIS cohort after their informed consent have been obtained. Patients with moderate and severe dementia are not proposed to participate. Included patients were studied with standard analytical and neuroimaging procedures, commonly brain MR, and CSF biomarkers determination (β‐amyloid‐42, β‐amyloid‐40, p‐Tau, t‐Tau, neurofilament light chain). Patients on anticoagulation, other contraindications or not suitable for LP can be included if an amyloid brain PET can be obtained. In some patients, brain PET with FDG is also obtained. After amyloid status is assured, a detailed neuropsychological evaluation is obtained in every patient using at least MMSE, CDR, RBANS and GDS scales. Finally, blood samples were taken to determine some potential biomarkers (lipid peroxidation, lipids, proteins, microRNAs) and stored simultaneously with CSF samples.ResultA total of 1100 participants aged 50 to 80 years, who were on follow up from January 2017 to August 2022 have been included in the VALCODIS cohort. This cohort is composed by early AD patients (mild cognitive impairment (MCI), mild dementia), other dementias in their initial phases (frontotemporal dementia, Lewy body dementia, vascular dementia) and cognitively healthy persons. Also, some of MCI‐AD patients were followed‐up at 2 years to carry out a prognosis study, by means of neuropsychological evaluation and blood biomarkers.ConclusionThe VALCODIS cohort represents a valuable infrastructure describing 6‐year experience about early and specific AD diagnosis, and prognosis. This cohort will provide a large number of patients, biologically diagnosed by CSF biomarkers, as well as their demographical, clinical and biochemical data. In addition, the biological samples (blood, plasma, urine, saliva, CSF) were stored to carry out further biomarkers studies.

Severe Impairment Rating Scale (SIRS) in assessing patients with severe dementia in Chinese Community

AbstractBackgroundLike other advanced countries, Hong Kong is facing the challenges of an aging population, reduced fertility, and increasing longevity. Most older people who diagnosed with moderate to severe dementia would need institutional care. Nevertheless, the current instruments available in the Chinese population are having flooring effects in measuring the functional conditions for this specific group of population.MethodThis study aims to validate the 14‐item Chinese Severe Impairment Rating Scale (C‐SIRS), as an instrument designed to measure functional condition of older people with moderate and severe dementia. The development of this validation study was under classical test theory to examine and test (1) the degree of clarity, understandability, and relevance (i.e. content validity), (2) the test‐retest reliability score of SIRS, (3) the degree of the inter‐relatedness among SIRS items like internal consistency, and (4) the correlation between SIRS score and the functional measures by Hong Kong Montreal Cognitive Assessment (HK‐MoCA) and Modified Barthel Index 100 (MBI‐100).ResultWhen assessing the relevance and sensitivity of the question with the universal agreement calculation method, the scale‐level content validity index (S‐CVI/UA) of C‐SIRS received relevance ratings of “almost agree” or “absolutely agree” by all the experts. The Fleiss' kappa showed that there was moderate agreement between the panellists’ judgements, with at least 8 years of experience, κ = .326 (95% CI, .319 to .343), p &lt; .001. 105 older people with moderate to severe dementia recruited from nursing home were enrolled in the validation, the C‐SIRS had a high level of internal consistency, as determined by a Cronbach’s alpha of 0.99 with F = .005, p = .831. The SIRS shows significant correlation with both cognitive, as measured by MoCA (with r = .337, p &lt; .001), and functional measures as measured by MBI (with r = .64, p &lt; .01).ConclusionC‐SIRS is sensitive in measuring the functional condition in older people with moderate to severe dementia. Moreover, C‐SIRS is easier to administrate with shorter time required. Further study should help by investigating the sensitivity of C‐SIRS to assess the change over a longer period of time.

Health‐related quality of life in full spectrum of Alzheimer’s disease: a longitudinal analysis

AbstractBackgroundUnderstanding the health‐related quality of life (HR‐QoL) in subjective cognitive decline (SCD), mild cognitive impairment (MCI) and demented patients is essential from the health economic perspective for evaluating new disease‐modifying treatments and preventive interventions. This study aims to assess HR‐QoL and the factors associated with longitudinal change in HR‐QoL in the full spectrum of Alzheimer’s disease.MethodLongitudinal data from 918 SCD and 1,346 MCI patients from the MEMENTO cohort were included in the study. MCI was defined as performing one standard deviation (SD) worse than the age, sex and education‐level thresholds in one or more cognitive domains identified within six months of the study enrollment. SCD was defined as having isolated subjective cognitive complaints but without any objective cognitive deficit and aged 60 years or older. HR‐QoL was measured by EuroQol EQ‐5D‐3L patient‐reported version. Linear mixed‐effect models with disease stage as a time‐varying covariate were used to (1) assess the utility changes over time across the dementia spectrum and (2) compare the utility changes between amyloid positive and negative SCD and MCI patients.ResultAt baseline, mean utilities were 0.84 ± 0.16 and 0.81 ± 0.18 in SCD and MCI patients. Linear mixed effect models estimated that the utilities were ‐0.016 (SE 0.003), ‐0.07 (SE 0.009), ‐0.18 (SE 0.014) and ‐0.36 (SE 0.034) lower than SCD in patients with MCI, mild, moderate and severe dementia over the study period. Time is associated with a significant decrease in utility with ‐0.008 (SE 0.001) per year. Baseline age, BMI, female, diabetes, cardiovascular history, neuropsychiatric symptoms and inability to perform Instrumental activity of daily living (IADL) were negatively associated with utilities. Amyloid‐positive SCD patients showed a faster decline in utility than amyloid‐negative SCD patients (p &lt; 0.05). The decrease was not statistically significant in amyloid‐positive MCI patients compared to amyloid‐negative MCI.ConclusionHealth utilities decrease over time in all stages of dementia, and the decline is steeper in moderate and severe stages. Positive amyloid accelerates health utility decline in SCD but not MCI individuals. The ability to perform IADL is the major factor affecting HR‐QoL in all phases of dementia.

Psychosocial and physiological effects of choir singing in people with dementia: A pilot study

AbstractBackgroundResearch suggests that music‐based interventions can improve emotional well‐being and quality of life in people with dementia. However, investigations are generally confined to specific music therapy settings. Complex music‐based interventions from day‐to‐day life, such as choir singing, have rarely been studied, not least because of the methodological challenges. Here we report on a pilot study examining the benefits of singing in persons with dementia that had joined a choir created especially for them.MethodIn preparation for a larger study on the impact of regular choir singing in dementia, we conducted a feasibility study to assess the expected effects on psychosocial and physiological outcomes. Emotional well‐being, depression, neuropsychiatric symptoms, physiological stress markers and quality of life were measured in the 19 choir members, all of whom had mild to moderate dementia (age: M = 76.95 [SD = 8.18]; f = 10 (52.6%); MMSE: M = 16.42 [SD = 5.79]) and were accompanied by their caregiving relatives. The weekly choir rehearsals took place over two months. Sessions were evaluated individually (situational measurements) and overall (pre/post‐tests).ResultOur data suggested significant increases in emotional well‐being during the choir sessions (p &lt; .05; Cohen’s dRM between 0.5 and 0.9), as well as significant reductions in cortisol levels in saliva as an indicator of stress (p &lt; .05; dRM between ‐0.2 and ‐0.76). A pre‐post evaluation (paired sample t‐tests) showed noticeable, but not significant improvements in neuropsychiatric symptoms, depression, and quality of life. Caregivers’ observations confirmed the positive influence of choir singing on participants’ emotional and communication behavior.ConclusionThe results of the pilot study reveal the therapeutic potential of choir‐based music interventions in persons with dementia and show that these effects can be demonstrated under real‐world conditions. A large‐scale randomized controlled study should further investigate the effects of choir singing in dementia.

Dementia with Lewy bodies Drug Therapies in Clinical Trials: 2022

AbstractBackgroundReviews of randomized clinical trials (RCTs) in Dementia with Lewy bodies (DLB) are essential for informing ongoing research efforts of symptomatic therapies and potentially disease‐modifying therapies (DMTs).MethodsWe performed a Systematic Review of DLB drug development by examining 3 international registries: ClinicalTrials.gov, the European Union Drug Regulating Authorities Clinical Trials Database, and the International Clinical Trials Registry Platform, to identify drugs in trials in DLB. We analyzed recruitment status, the disease stage and diagnostic groups included in clinical trials, number of trials participants and treatment exposure, use of repurposed agents per clinical trial phase, description of outcome measures for primary endpoints, use of biomarkers for inclusion and/or outcome measures, sponsorship, and global distribution.ResultsWe found 25 agents in 40 trials assessing symptomatic treatments and disease modifying therapies for DLB: 7 Phase 3, 31 Phase 2, and 2 Phase 1 trials. We found an active pipeline for drug development in DLB, with most ongoing clinical trials in phase 2. We identified a recent trend towards including participants at the prodromal stages, although more than half of active clinical trials will enroll mild to moderate dementia patients. Additionally, repurposed agents are frequently tested representing 65% of clinical trials.ConclusionTo accelerate DLB drug development there is a need for more clinical trials, increased diagnosis at earlier stages of the disease, disease‐specific outcome measures and biomarkers, as well as augmenting global representation and including more diverse populations.

FC46: The effectiveness of a multicomponent intervention on caregiver burden and informal care time in home-dwelling people with dementia and their caregivers. Results from the stepped wedge randomized controlled LIVE@Home.Path tria

Background:Deinstitutionalization of nursing care in European counties relies profoundly on the mobilization of the caregivers and municipal homecare services. Yet, caring for home-dwelling people with dementia (PwD) can be stressful and resource demanding. The LIVE@Home.Path trial tailored, implemented, and evaluated the multicomponent LIVE intervention on informal caregivers’ burden in dyads of home-dwelling PwDs and their families.Method:From 2019 to 2021, we conducted a 24-month multicenter, multicomponent, stepped-wedge randomized control trial including dyads of people ≥65 years with mild to moderate dementia with minimum 1h/week contact with their informal caregiver. The user-developed Learning, Innovation, Volunteer support, and Empowerment (LIVE) intervention was implemented by municipal coordinators over 6 months periods. In an intention-to-treat analysis, we applied mixed-effect regression models accounting for time and confounding factors to evaluate the effect of the intervention on Relative Stress Scale (RSS), Resource Utilization in Dementia (RUD) and Clinical Global Impression of Change (CGIC).Results:A total of 280 dyads were included at baseline, mean age of PwD was 82.2 years, 63% female, 43% lived alone, 36% had Alzheimer’s dementia, median MMSE was 20 (range 0-30) and median FAST score 4 (range 1-7). Caregivers were on average 66 years, 64% female, 49% were the PwDs child. At baseline, 80 dyads were randomized to intervention sequence 1 of which 67 received the intervention, corresponding numbers for sequence 2 and 3 were 97/ 57 and 103/50. During the active intervention period, time spent in personal activities of daily living significantly increased with 2.8 hours/months compared to 1.2 hours/months increase in the control period, total score of RSS was stable in the intervention period (0.36 points) (range 0-60), while it increased significantly in the control period (27.0 points), CGIG increased significantly only in the intervention period (0.5 points) (range: -5 worsening, 5 improvement).Conclusion:Although caregivers reported more care time during the intervention periods, they did not experience more stress which may be related to their increased understanding of dementia. Increase in reported care time might also reflect the increased understanding of dementia, leading to more realistic evaluation of own time contribution.

Impact of Infection Control Measures on Effectiveness of Cognitive Stimulation Therapy

AbstractBackgroundPeople living with dementia are at higher risk of contracting and dying from SARS‐CoV‐2. Protection measures such as wearing a mask remained necessary in dementia service facilities, despite their limiting effects on communication and interactions. Their impacts on existing evidence‐based psychosocial interventions offered in these facilities, such as Cognitive Stimulation Therapy (CST), are yet unknown.MethodMixed‐methods study using data from a larger randomised controlled trial partially disrupted by the COVID‐19 pandemic. People with mild or moderate dementia randomised into receiving CST (n = 72) were compared with those receiving usual care (n = 72) for cognitive (ADAS‐Cog) and quality of life (QoL‐AD) changes. To investigate the impact of infection control measures on CST effectiveness, interaction effect between timing of enrolment (before vs after COVID‐19 outbreak) and intervention group was tested. Focus groups were conducted with persons with dementia who have received CST and their families (n = 22).ResultParticipants who received CST reported better quality of life (B = 4.195, F = 28.159, p &lt;0.001) compared with those who received usual care, controlling for demographics and antidementia medications. For cognition, an interaction effect was observed (F = 4.557, p = 0.036) between timing of enrolment and group. CST maintained cognition only in groups before COVID‐19 outbreak (marginal means of ADAS‐Cog improvement: +0.453 in CST vs ‐1.465 in usual care) but not in groups after the outbreak (‐2.104 vs +0.716). Persons living with dementia and their families reported difficulties hearing, being heard, recognising and interacting with other CST group members, and reduced efforts in participation due to discomfort wearing a mask,ConclusionInfection control measures may reduce the cognitive benefits of CST, which may be due to their effects on speech intelligibility and other interactions in a psychosocial intervention group. In the post‐COVID era, alternative measures such as virtual CST delivered via an online meeting platform should be investigated.