Dementia

Introduction:

At present no single symptom appears to be favoured in choosing primary outcomes for dementia with Lewy bodies (DLB) trials, nor are the perspectives of people affected by DLB reflected in their design. The aim of this study is to elicit the preferences of DLB patients and their care partners with respect to the DLB symptoms that they would most like to see improved upon by a potential therapy. We will do so using two complimentary health economic approaches in a single online survey: a best-worst scaling (BWS) exercise and a discrete choice experiment (DCE).

Methods:

Using global voluntary sector networks, we will recruit 100 individuals who either have a diagnosis of DLB or who are a care partner for an individual with DLB. The BWS and DCE will be applied together in a self-administered online survey. Both will be informed by evidence from a scoping review of existing literature and piloted in person with a group of local volunteers.

In the BWS, participants will be presented with a series of choice sets of three symptom domains and asked to determine which domain they consider the most and least important to treat.

In the DCE, participants will be presented with a scenario and asked to choose their preference from one of two hypothetical treatments, each with different characteristics (such as target symptom and side effect profile).

Expected Results:

We will determine the relative importance of DLB symptoms and the potential trade-offs made in benefit-risk decisions related to treatments. Our findings will inform choice of primary and secondary outcomes in DLB trials. They will inform our understanding of the levels of risk and benefit individuals will tolerate, which is important as trials of potentially disease modifying agents, such as amyloid therapies, are pursued.

Introduction
Person-centred care is recognised as best practice for the care of people with delirium or dementia. In Cardiff and Vale University Health Board (CAVUHB), “Read About Me” (RAM) documents are used to support person-centred care in these patient groups. However, there are significant barriers to their routine use in clinical practice (Clark, E, Wood, F, Wood, S. Health Expect. 2022; 25: 1215- 1231). We conducted a two-cycle audit investigating the use of these documents on geriatric wards in two acute hospital sites, and trialled two interventions to increase their usage.
Methods 

Both rounds evaluated patients on 9 acute geriatric wards at CAVUHB. Patients with a diagnosis of dementia or delirium were identified by ward staff and medical notes, which we also used to see if a RAM had been completed. Intervention one was the installation of noticeboards on geriatric wards encouraging RAM usage. Intervention two was the implementation of a ward admission checklist as well as engagement with CAVUHB “dementia champions” to advocate for their usage.
Results 

Taking the 9 wards surveyed individually, in round one, the median usage of RAMs was 25% (range of 0% to 55%), which improved to 33% (range of 15.2% to 66.6%) after our intervention. Re-evaluation 3 months later, prior to intervention two, showed that RAM usage had regressed (median 27.2%, range 0% to 50%). We will re-evaluate after intervention two.

Conclusions

Long-term improvement in RAM usage was not achieved after installation of noticeboards. This loss of drive may be due to the wearing off of the novelty of the noticeboards, leading to prioritisation of other clinical tasks. We believe a better approach could be to combine a checklist to reduce cognitive workload with engagement of dementia champions in order to improve RAM usage and therefore improve person-centred care.

Introduction: With the unprecedented population growth of older adults worldwide, higher life-expectancies are creating increasingly more multigenerational interaction. Funded by the General Research Fund of the Research Grant Council in Hong Kong, the study examined the effects of telephone-administered perspective-taking intervention in the context of intergenerational caregiving. The data was collected from 2019 to 2021 in Hong Kong.

Method: Through a cluster-randomized trial, one-hundred seventy-six adult child caregivers of persons living with Alzheimer’s disease (AD) were randomized into two twelve-week interventions: 1) Connecting through Caregiving with intergenerational perspective-taking reappraisals (n=91) and 2) Basic Skill Building (n=85). All interventions are administered via telephone, Both groups receive the basic skills training including 1) monitoring mood and scheduling pleasant events and 2) communication with the care recipient & 3) communication skills with other family member and helping professionals. The CTC group spends less time on basic skills and focused on perspective-taking reappraisals aiming to promote balance between self-care and caring of others. These reappraisals include: 1) connecting with self through enhancing self-awareness, 2) connecting with the care-recipient and 3) connecting with others who can help.

Results: In terms of primary outcomes, as compared to the BSB group, the CTC group reported significantly greater reductions in depressive symptoms and higher levels of psychological well-being. For the secondary outcomes, the CTC group scored higher in emotional and instrumental support and also lower levels of perceived presence  and reaction to behavioral and memory problems of the care recipient. Perspective-taking was found to mediate between intervention effects and reduction of depressive symptoms of the caregiver.

Conclusion: The results provided evidence for the efficacy of the CTC program. The telephone-administered intervention was very useful in supporting caregivers during COVID.  With population aging, there is a rapid increase of people suffering from dementia and those who will provide caregiving. The study contributes towards enhancing sustainability of caregiving in dementia

Intracerebroventricular streptozotocin (ICV-STZ) injection is among the best animal models to simulate sporadic Alzheimer’s disease (sAD). Abnormality in brain insulin signaling, neurodegeneration, neuroinflammation, cholinergic damage, mitochondrial dysfunction, genetic abnormality, respiratory problem, oxidative stress, gliosis, sleep disturbances are associated with cognitive abnormalities seen in ICV-STZ injected rats. Available experimental evidence has used varying doses of STZ (<1 to 3mg/kg) and studied its effect for different study durations, ranging from 14-21 (short), 30-42 (mild), 90-105 (moderate) and 250-270 (long) days. These studies indicated that 3mg/kg of body-weight is the optimum dose for inducing sAD in the rodents. However, studies on the pathological process with related the morphological and functional abnormalities reported were illusive. Hence in the present study, we have investigated the morpho-functional changes after 3mg/kg ICV-STZ treatment with a follow-up of two months in 54 male Wistar rats (ethical no. 937/IAEC/PhD-2016). Results exhibited a spatial, episodic and avoidance memory decline and increase in anxiety (p<.05) in icv-stz group progressively with time from 15th day to 60th post-injection. morphometry showed hippocampal atrophy ca1, ca3 layer thinning (p="0.007)" ≤0.01) and loss of neurons (p<0.0001) associated third ventricular enlargement rats versus sham, along-with extracellular amyloid plaque ad congored staining. addition, spine golgi-cox impregnation mossy fiber a reduction density control sham (p<0.0001). finally, immunohistochemistry gsk3ß, pi3k mtcox-1 antigen coronal sections revealed an increase mean intensity gsk3ß decrease brain areas limbic system on day. these findings suggests, progressive dementia anxiety 3mg />kg STZ treated rats, which may be due to hippocampal atrophy, amyloidopathy, ventricular enlargement, synaptic dysfunction and deficits in energy homeostasis of brain.