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

14. NON-PHARMACOLOGICAL INTERVENTIONS (NPIs)
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

15. NON-PHARMACOLOGICAL INTERVENTIONS
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