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Dementia Research in Grampian J Stephen Bell J Stephen Bell Consultant Clinical Neuropsychologist, NHS Grampian Honorary Reader, University of Aberdeen.

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Presentation on theme: "Dementia Research in Grampian J Stephen Bell J Stephen Bell Consultant Clinical Neuropsychologist, NHS Grampian Honorary Reader, University of Aberdeen."— Presentation transcript:

1 Dementia Research in Grampian J Stephen Bell 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 Modulation of endothelial function and arterial stiffness Anticholinergic drugs, functional status and outcomes in older patients Anticholinergic drugs, functional status and outcomes in older patients Cardiovascular safety Cardiovascular safety Role of arginine methylation in relationship between vascular risk factors and AD 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 Impact of vascular ageing and disease on the development of Alzheimer’s Disease Medical co-morbidity of AD Medical co-morbidity of AD Cognitive effects of hyponatraemia Cognitive effects of hyponatraemia

4 Alison Murray Clinical Senior Lecturer in Radiology Structural, functional and molecular imaging in brain ageing and dementia Structural, functional and molecular imaging in brain ageing and dementia Biomarkers of cerebrovascular disease and AD Biomarkers of cerebrovascular disease and AD Analysis of MRI data, ABC 1921 & 1936 Analysis of MRI data, ABC 1921 & 1936 SPECT and MRI, “rember” trial 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 Regional cerebral blood flow and cognitive performance, aberrant motor behaviour, prognosis, emotional facial processing in dementia fMRI entropy in old age fMRI entropy in old age Structural MRI – ABC 1921 & 1936 Structural MRI – ABC 1921 & 1936 Childhood variables and late life disease, disability and brain structure 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 Adult ageing and social and emotional skills Effects of dementia and stroke on social and emotional processing Effects of dementia and stroke on social and emotional processing Age, planning and prospective memory Age, planning and prospective memory Lifespan development of self-regulation Lifespan development of self-regulation

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

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

10 Bettina Platt Chair in Translational Neurosciences Preclinical models of CNS disorders Preclinical models of CNS disorders Mechanisms of neuronal plasticity, degeneration and protection Mechanisms of neuronal plasticity, degeneration and protection AD and neurodegeneration in the hippocampus 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 Epigenetics (gene-specific and genome- wide) of ageing and its links to early life events Cognitive ability and ageing Cognitive ability and ageing Dementia Dementia Stroke and vascular disease Stroke and vascular disease

12 Swinton J & Mowat H (2012) Aim: Understanding and meeting the spiritual needs of people with advanced dementia : Six Stepped Facilitated Process to identify community of care in residential care / hospital / home settings and church 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 :Screening by CPNs + GP Assessment Method:Screening by CPNs + GP Assessment

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

15 Cognitive training Education Cognitive stimulation Support/counselling Behavioural management MCI Exercise ADL Training MCI (> case management) 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) NON-PHARMACOLOGICAL INTERVENTIONS PWD CG PWD CG

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

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

22 FINDINGS Carer training achievable: good adherence, maintenance Carer training achievable: good adherence, maintenance CS by caregivers acceptable to PWD: no negative effect on well-being CS by caregivers acceptable to PWD: no negative effect on well-being No adverse effect on CG burden or QoL, limited impact on mood 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 CGs involved in presenting the intervention CG education, teaching CG skills (coping, challenging behaviour) and to stimulate PWD (physical and cognitive) CG education, teaching CG skills (coping, challenging behaviour) and to stimulate PWD (physical and cognitive) Manuals for CGs and trainers (health care professionals) Manuals for CGs and trainers (health care professionals) 8 sessions of CG training in small groups 8 sessions of CG training in small groups Main outcome PWD : daily functioning, QoL Main outcome PWD : daily functioning, QoL Main outcome CG : burden, QoL Main outcome CG : burden, QoL

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