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Dementia Research in Grampian

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1 Dementia Research in Grampian
J Stephen Bell Consultant Clinical Neuropsychologist, NHS Grampian Honorary Reader, University of Aberdeen Network Co-ordinator, Alzheimer’s Research UK

2 Arduino Mangoni Chair in Medicine of Old Age
Modulation of endothelial function and arterial stiffness Anticholinergic drugs, functional status and outcomes in older patients Cardiovascular safety Role of arginine methylation in relationship between vascular risk factors and AD

3 Roy Soiza Consultant Geriatrician
Impact of vascular ageing and disease on the development of Alzheimer’s Disease Medical co-morbidity of AD Cognitive effects of hyponatraemia

4 Alison Murray Clinical Senior Lecturer in Radiology
Structural, functional and molecular imaging in brain ageing and dementia Biomarkers of cerebrovascular disease and AD Analysis of MRI data, ABC 1921 & 1936 SPECT and MRI, “rember” trial

5 Roger Staff Senior Physicist, Biomedical Physics
Regional cerebral blood flow and cognitive performance, aberrant motor behaviour, prognosis, emotional facial processing in dementia fMRI entropy in old age Structural MRI – ABC 1921 & 1936 Childhood variables and late life disease, disability and brain structure

6 Andrew Welch Chair in School of Medical Sciences
PET, development of molecular imaging tracers for translational medicine

7 Louise Phillips Chair in Psychology
Adult ageing and social and emotional skills Effects of dementia and stroke on social and emotional processing Age, planning and prospective memory Lifespan development of self-regulation

8 Claude Wischik Chair in Mental Health
Protein aggregation in neuro-degenerative disease Molecular neuropathology of AD, particularly tau

9 Gernot Riedel Chair in Systems Neuroscience
Psychopharmacology and physiological psychology Models for translational medicine for preclinical drug development

10 Bettina Platt Chair in Translational Neurosciences
Preclinical models of CNS disorders Mechanisms of neuronal plasticity, degeneration and protection AD and neurodegeneration in the hippocampus

11 Paul Haggarty Head of Lifelong Health at Rowett Institute
Epigenetics (gene-specific and genome-wide) of ageing and its links to early life events Cognitive ability and ageing Dementia Stroke and vascular disease

12 Swinton J & Mowat H (2012) Aim: Understanding and meeting the spiritual needs of people with advanced dementia Method: Six Stepped Facilitated Process to identify community of care in residential care / hospital / home settings and church congregations; spiritual care support incorporated into person-centred care plan

13 Vaitheswaran S & Walker A (2012)
Aim: Assess the point prevalence of cognitive impairment depressive symptoms and anxiety symptoms in community dwelling people over 75 in Aberdeen Method: Screening by CPNs + GP Assessment

Alternatives and adjuncts Positive effects (>50% RCTs; = medication) General absence of side-effects Positive impact on caregiver Benefits diminish quickly after treatment cessation Multi-component interventions better Education and support; behavioural management; cognitive and physical stimulation

PWD CG Cognitive training Education Cognitive stimulation Support/counselling Behavioural management MCI Exercise ADL Training MCI (> case management) (music, light, massage, sensory stimulation, recreation, reminiscence, relaxation, acupuncture)

16 OUTCOMES – which? PWD CG Cognition Mood ADLs Wellbeing Behaviour QoL Mood QoL Institutionalization delay

17 ISSUES Evidence (and ideally, theory) base Availability Accessibility
Specialist expertise Appropriateness Acceptability Flexibility Cost Sustainability Generalisation Integration with other resources

18 CAREGIVER TRAINING Achievable? Treatment integrity? Maintenance?
Adverse impact on carer burden and well-being? Efficacy? Long-term benefit? Cost-effectiveness?

19 Maarten Milders Reader in Psychology, Heriot Watt University (Formerly Senior Lecturer in Psychology, University of Aberdeen)

20 Milders M, Bell S, Lorimer A, MacEwan T & McBain A (2012)
Cognitive stimulation by caregivers for people with dementia: acceptability and treatment integrity

21 METHOD 30 pairs, PWD + main CG
CG trained to carry out 3 CS sessions per week 2 initial sessions, 4 follow-up; manual Support during first 8 weeks only PWD : cognition, mood, ADL, QoL CG : burden, mood, QoL Pre –, Post – (+8 and +16 weeks) 33/58 consented (-4) 21/29 completed

22 FINDINGS Carer training achievable: good adherence, maintenance CS by caregivers acceptable to PWD: no negative effect on well-being No adverse effect on CG burden or QoL, limited impact on mood

23 Milders M, Bell S, Lorimer A, MacEwan T, Law J, Connelly P, Norrie J, Law E, McBain A & McCalden A (2012) Multi-component intervention for people with dementia and family caregivers

24 Can multicomponent NPI be offered by health services and maintained in sustainable way?
CGs involved in presenting the intervention CG education, teaching CG skills (coping, challenging behaviour) and to stimulate PWD (physical and cognitive) Manuals for CGs and trainers (health care professionals) 8 sessions of CG training in small groups Main outcome PWD : daily functioning, QoL Main outcome CG : burden, QoL


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