Scientific Program

Day 1 :

Keynote Forum

Simon Hooper

CEO RemindMeCare (ReMe)

Keynote: New trends in the use of digital interventions: Digi therapeutics and Digi pharma in care

Time : 10:00 - 10:40 AM

Biography:

A co-founder of RemindMeCare, Simon Hooper has a tech background that is non-medical but which he has brought to bear on the care process, courtesy of his experience with the care needs of his family. Supported by academia and health care professionals, ReMe is the result of extensive work in numerous care settings. The company has worked closely with care facilities, day care centers and hospitals to create systems that are directed at improving care delivery.

 

Abstract:

Technology’s causing treatment paradigms to be reconsidered.. Previously, it was almost impossible to match treatment with cognitive and behavioral changes. Now Digital Therapeutics and Digiceuticals enable more flexible treatment and monitoring alternatives.Digital Therapeutics is defined as immersive programs that act reliably and remotely to change individual’s behaviors to achieve positive clinical outcomes and reduce medical cost growth. They’re often used in conjunction with medication but may replace conventional prescribing.Digi Pharma is consumer focused, such as nutritional supplements. They’re typically not reimbursed, FDA/NHS authorized and low priced, with consumers paying directly after marketing discovery.So where does ReMe fit in? ReMe discovers personal content through interactive response to activities, that positively impacts on behavior and calms agitation, reducing or complimenting the use of medication. ReMe achieves improved wellbeing, shows a propensity to support cognitive retention and recall and can be used in therapy and acute care strategies. So, in terms of definition, ReMe falls into both categories, subject to the deployment used.Current studies in Kingston Hospital, London, aim to establish ReMe’s potential to reduce medication, improve admission processes, enhance person centered care, as well as achieve efficiency and cost savings through digital reporting, reduced staffing, earlier discharge and optimal step down.If it can be shown that ReMe’s digital intervention achieve these outcomes then this dual role of Digi pharma in the community and  Digi therapy in the formal care setting, warrants ReMe being prescribed either as a supplement or alternative to traditional medication.The impact of digital prescribing on cost savings could be substantial and as a result business payment models will be developed that fit the new treatments. Answers will come when the evidence is there. ReMe offers an insight into what one new treatment configuration of the future could look like.

 

Keynote Forum

Markku Kurkinen

Professor Wayne State University School of Medicine USA

Keynote: Alzheimer's drug discovery: targeting synaptic glutamate signaling

Time : 10:40 AM to 11:20 AM

Biography:

Born October 8, 1949, Mikkeli, Finland. 1979 PhD, University of Helsinki, Finland. 1980-1983 postdoctoral work with Brigid Hogan, Imperial Cancer Research Fund (ICRF), Mill Hill London, UK. 1984-1985 Assistant Professor, University of Medicine and Dentistry of New Jersey (UMDNJ), Rutgers Medical School, Piscataway, New Jersey, USA. 1985-1992 Associate Professor, Chief of Connective Tissue Research, UMDNJ, Robert Wood Johnson Medical School (formerly Rutgers Medical School), Piscataway, New Jersey, USA. 1992 - Professor, Wayne State University School of Medicine, Detroit, Michigan, USA. Published work on Matrix Biology,molecular cloning, and gene regulation. Present researchinterests in novel drug discovery methods, targeting astrocyte regulation of synaptic glutamate signaling in developmental and neuropsychiatric brain disorders.

 

Abstract:

Glutamate, a non-essential amino acid, is the signaling molecule of neurons. Glutamate is neurotoxic. As soon as the glutamate signaling starts it is stopped in 0.1-2 ms by astrocytes, which take up and clear glutamate from synapses. This prevents too much glutamate causing impaired synaptic function and loss of neurons. Astrocytes make EAAT2 (excitatory amino acid transporter-2), the major glutamate transporter and 1% of brain protein. In Alzheimer dementia, astrocytes express less EAAT2. In experimental mouse models of Alzheimer, increasing EAAT2 expression slows dementia progression. To discover drugs that can activate EAAT2 in glutamate uptake, I describe a simple assay that targets the EAAT2 protein reconstituted in liposomes and measures glutamate uptake with fluorescent Oxonol VI red light. Importantly, by direct targeting the EAAT2 protein in liposomes, the assay should limit ‘off-targeting’ of drugs and adverse events, which are the main problems in Alzheimer’s drug discovery and clinical development. 

 

Keynote Forum

Joe Sam Robinson

President Georgia Neurosurgical Institute Georgia, USA

Keynote: Cervical Stenosis-Induced Chronic CSF Flow Obstruction as a Contributing Cause of Dementia

Time : 11:40-12:20

Biography:

Dr. Robinson is President of Georgia Neurosurgical Institute, Professor and Chief of Neurosurgery at Mercer University, Clinical Professor of Neurosurgery at Medical College of Georgia, and an author of over 100 peer review articles.

 

Abstract:

Statement of the Problem: Obvious CSF flow obstruction is a well-established acute and subacute cause of dementia. Unfortunately, the less-obvious vagaries of CSF production and absorption remain relatively unexplored and, logically, could play a role in neuronal destruction. The Purpose of this Study: The purpose of the study is to demarcate processes (particularly cervical stenosis) by which restricted (often episodic), CSF circulation subtly damages neuronal tissue, and to propose studies and arrangements to track and prevent the onset of such difficulties. Methodology and Theoretical Orientation: To assess the impact of recent new understandings of CSF flow dynamics, and on the possible etiology of dementia, a substantial literature review was conducted, and new suggestions proposed. Findings: A systematic literature review suggests the elevated prevalence of cervical stenosis, concomitant CSF flow obstruction and dementia, in an elderly population. The literature further suggests that cervical stenosis can significantly, often discreetly, compromise CSF circulation, thereby injuring neuronal tissue by direct untoward pressure, by restriction of cerebral CSF bulk flow retarding beta-amyloid clearance, and by ventricular ependymal cell damage allowing trans-ependymal CSF flow neuronal damage. Moreover, such restriction could contribute to the development of sleep apnea, thereby causing concomitant respiratory and circulatory dysfunction, promoting the development of a vicious cycle in which widespread direct neuronal injury as well as further increase in ICP occurs. Conclusion & Significance: We conclude that, among other obstructive possibilities, cervical stenosis could play a role in the development of dementia. Recognition of subtle, chronic CSF alterations (in some ways comparable to chronically abnormal blood pressure) calls for the development of, preferably non-invasive, technology to measure CSF circulation on a 24-hour basis. If the parameters of episodic abnormalities could be better adjudicated, prevention of such events could reasonably be effectuated by cervical decompression, therapeutic drug regimen, and altered sleep position.

 

  • Dementia | Alzheimers Disease | Vascular Dementia | Dementia with Lewy Body (DLB) | Frontotemporal Dementia | Causes and Risk Factors | Awareness and Care Practices | Recent Advances in Dementia Diagnosis | Treatment Modalities

Session Introduction

Francesca Pistollato

European Commission, Joint Research Centre, Ispra, Italy

Title: Alzheimer's disease research in the 21st century: past and current failures and the way forward.

Time : 12:20-12:50

Speaker
Biography:

Francesca Pistollato, Ph.D., currently works at the European Union Reference Laboratory for Alternatives to Animal Testing (EURL ECVAM) Joint Research Centre in Ispra (Italy), where she develops and supports the use of alternatives to animal testing in toxicology and regulatory testing and in biomedical research. She previously worked at the Physicians Committee for Responsible Medicine (PCRM), Washington DC, advocating for the use of a holistic, human-based approach for Alzheimer's disease research. Dr. Pistollato holds a master degree in nutrition and dietetics and published several works on the role of nutrition and lifestyle-related factors in the prevention of chronic degenerative diseases, such as Alzheimer's and dementia.  

 

Abstract:

Animal models of Alzheimer's disease (AD) have been extensively utilized in the last few decades in an effort to elucidate the pathophysiological mechanisms of the disease and to test novel therapeutic drugs. However, basic/fundamental and pre-clinical research successes have not translated into effective therapeutic treatments for AD patients. One of the possible reasons behind this translational failure may be the overreliance on animal models for AD, which have been shown useful to recapitulate some AD-associated features, such as amyloidosis and tauopathy, but have failed to deliver effective treatments for AD patients. On the other hand, the use and the implementation of human-based investigational methods, non-invasive neuroimaging technologies, and large scale epidemiological data set repositories, may contribute to the development of new preventive and treatment strategies. Here we present the challenges and opportunities in AD research and propose how we can mitigate this translational barrier by employing human-based methods to elucidate disease processes occurring at multiple levels of complexity (from gene expression to protein, cellular, tissue/organ to individual and population level). Novel human-based cellular and computational models are already being applied in toxicology and regulatory testing, and could be associated with noninvasive neuroimaging tools and epidemiological data to facilitate human-relevant data discovery.A paradigm shift towards human-based research, accounting for a multi-dimensional and multi-disciplinary approach is highly needed to tackle the ever-increasing prevalence of AD in the 21st century.

 

Peter Watson

Trustee, YPWD UK

Title: Delivering empowering care

Time : 13:50-14:20

Speaker
Biography:

Peter worked for a US IT company, resigning to look after his wife who was diagnosed with Vascular Dementia at the age of 59. After she began living in a nursing home he wanted to use his experiences to improve the lot of others affected by dementia. He campaigned to get the plight of carers recognised, helped design the implementation plan for the UK Dementia Strategy, and served two terms on the Board of the Dementia Action Alliance. With others he built a charity, YPWD, to support people affected by young onset dementia where he is now a trustee. He is on the Dementia Programme Board overseeing the implementation of Government strategy for dementia. He also helped form, and is on the steering group of, the Young Dementia Network, on the Carer’s Advisory Panel of the charity Dementia Carers Count, and a member of the Thames Valley Dementia Network.

Abstract:

A diagnosis of dementia so often leads to social isolation, exclusion from “normal” activities, unmanageable carer stress and unplanned calls on NHS resources. It needn’t be like that. Providing quality respite for carers knowing the person they care for is receiving support that makes life meaningful and worthwhile helps alleviate these problems. The charity YPWD in Berkshire, UK delivers activities reflecting typical community life – art, sport and exercise, gardening, music and drama. Group activities take place within the community bringing “normality” and reducing stigma. Education courses for patients and carers run in parallel. Outcomes include longer time to residential care need, fewer unplanned medical interventions, some stabilization in MMSE scores, and expressions of greater wellbeing by patients and carers. The empowerment realized has delivered self-help peer support between both groups. YPWD delivers these services to those affected by young onset dementia, but it is equally applicable across the dementia spectrum.

 

Lena Chauhan

Cofounder, RISE IQ UK

Title: Awareness: The Perception of dementia in the UK

Time : 14:20-14:50

Speaker
Biography:

Lena Chauhan is the Co- Founder of Rise IQ, which involves Creating Solutions for Mental Health. Prior to setting up RiseIQ, she was the Co-founder of a Health- tech start-up. She is a trained as a medical navigator to help empower patients and introduced the service to financial institutions. Her mission is to create awareness about Dementia

 

Abstract:

A recent YouGov survey commissioned by Alzheimer’s Research UK in 2015 revealed that, when asked what they think dementia is and who it affects, just 23% of British adults specifically mentioned brain disease or degeneration… This left a huge majority believing something else to be going on Research was carried out with families affected by dementia and the public to get a better grasp on how dementia is perceived If we don’t understand in detail the level and depth of public awareness of dementia, we won’t be able to communicate effectively with people or help to educate and address misconceptions. Across the groups – regardless of their make-up – north, south, east, and west –a consistent observation was made that was certainly food for thought. The main groups questioned didn’t recognise that dementia was caused by diseases – like Alzheimer’s – in the brain. They didn’t think about Alzheimer’s in the same way they thought about cancer. To be reductive, they didn’t think Alzheimer’s was a “physical disease”. The obvious follow-on question to ask was “what is it then?” A variety of answers were offered here: a part of ageing, just getting old, crossed wires, forgetfulness, but evidently people don’t feel these symptoms are disease-driven. This misunderstanding around the physicality of the diseases that cause dementia – Alzheimer’s is most common – If we can help people understand that we are dealing with aggressive and physical diseases, and not “craziness” or natural decline, it might help emancipate people to seek and talk about a diagnosis. There should not be shame in having these diseases, in the same way we don’t shame people with cancer or heart disease. The terminology used around dementia doesn’t help us. Dementia is often referred to as a disease in itself, which isn’t quite right. We need simple language and easy analogies to enable us to understand what is going on. A point where we get the “aha” moment and realise that it’s something we can learn to understand and manage. If I can briefly mention the Contented Dementia Trust- run by the fabulous Penny Garner. She paints a picture of the memory of someone with and without symptoms of Dementia by describing a photograph album There is no mention of Hippocampus! Every single person who I have presented this analogy to has understood it completely and they themselves feel empowered at having basic understanding of the symptoms displayed. It doesn’t need to be a scientific understanding. Make it real and make it life like and relatable- Once people get it – their minds by default open up to listen. The mood changes A large percentage of the UK population living with Dementia are from socially disadvantaged backgrounds.   They also represent a large portion of the cost to the Social and NHS services. These explanations would and have led to a better understanding for them. Another statistic that occasionally appears in the press is that dementia is “the most feared health condition” - sounds like a 911 warning! particularly in the over 55s. So, we have a situation where there is a lot of anxiety around dementia, but perhaps not a strong grasp of what is actually going on in the condition.

 

Speaker
Biography:

Sara is a psychogeriatric nursing lecturer at King Abdulaziz University and now a PhD candidate at the University of Southampton. Currently, she is working on a project to investigate nurses' perception and learning needs when caring for people with dementia using a diary-interview method. Her research interests include nursing education, psychogeriatric nursing care, and people with dementia care.  "I aim to be capable of developing and communicating new knowledge in psychogeriatric nursing through designing and carrying out high-quality research and training".

 

Abstract:

Background: Knowledge, attitude, and perception interact to influence each other differently. The concept of knowledge is ambiguous, however, in nursing, it can be defined as the cognitive ability to care for people since it underpins the role of nurses in healthcare. While perception is an understanding or interpretation of nursing behaviours. The interpretation can be based on people’s thoughts or from the viewpoints of the nurses. Though, nurses’ perception of their behaviour is significantly influenced by external factors such as knowledge and public opinion. Attitude is the tendency of individual thoughts, beliefs, and feelings relative to a psychological object. The performance of the nurse is influenced by attitude since feelings, beliefs, and behaviours occur in the long-term. Nurses attitudes drive their competence in their performance. The concept of attitude in nursing relates to how nurses feel, thought or belief about their profession and its part of what drives competency in nursing. Research question: what are nurses’ attitude, knowledge, and perceptions when caring for people with dementia globally? Method: a systematic search was conducted in scientific databases between November 2017 and April 2018 using specific keywords. Results: N=79 articles were included in the study and NVivo software been used to analyse the literature that emerged the following themes (1) Dementia Knowledge Improves Communications Skills, (2) Tools for Assessing and Improving Nurses’ Dementia Knowledge. (3) Nurses’ Attitudes in Acute Care Settings, (4) Nurses’ Attitudes toward End-of-Life Care, (5) Relationship Between Knowledge and Nurses’ Attitudes, (6) Approaches to Care and Nurses’ Attitudes, (7) Involving People with Dementia in Decision-making, (8) Managing Dementia with other Complications, (9) Nurses’ Perceptions on Their Care for People with Dementia, and (10) Nurses’ Perceptions Affected by Their Knowledge. Conclusion: Nurses attitudes, knowledge and perceptions are important facets that influence the competency of nurses in caring for people with dementia. It can have a profound negative impact on the person with dementia, their families, and the country.  Many policy-makers and policy-making organisations, including the WHO, have realised the importance of improving the care that is accorded to people with dementia. Improving care means gathering enough evidence, knowledge, and attitude of people who are directly involved with people with dementia or their close relations. 

Sherin Yohannan

National Institute of Mental Health and Neurosciences,India.

Title: Psychosocial support for families of persons with dementia through home based care program from a developing country

Time : 15:40-16:05

Speaker
Biography:

Ms.Sherin Yohannan, PhD scholar in the department of Psychiatric Social Work, NIMHANS, Bangalore, India. My research area is on Dementia care. I completed my M.Phil. in Psychiatric social work from NIMHANS in 2015 and my dissertation was on stress, burden, social support and desire to institutionalization among caregivers of persons with dementia.I have completed my Masters in Social Work with the specialization in Medical and Psychiatric Social Work from BCM College, India in the year 2012.  
 

Abstract:

Among older people, dementia is the leading chronic disease contributor to disability and need for care. In India, person with dementia continue to live with their families. Dementia care is usually a joint effort by the adult members of the family who stay in the same household (Dementia India report, 2010). In this background, this study proposes to promote a healthy adjustment of the family to the disease, improving quality of life and encouraging the link between family and formal support systems through a multi component home based family care program for the families. The objective of the study is to develop a home based care program for the families of person with dementia and to assess the impact of the programme. The study design is Quasi-experimental design – pre and post assessment without control group. 40 caregivers of dementia patients undergoing treatment from the Geriatric Clinic outpatient department  of National Institute of Mental Health And Neurosciences, Bengaluru were taken through random sampling method.Socio-demographic sheet used to assess background information, The Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, The Zarit Burden Interview and a Self-constructed questionnaire administrated at baseline and post intervention.Intervention modules developed through extensive literature review, opinions and views from field experts, organizations involved in the community and home based care and the family members of patients with dementia. Psychosocial intervention module for home based care programme covers the psychological, social and general health aspects in the broader term based on the family centred participatory and integrated approach. Results showed that home based programme was effective for the caregivers in reducing their unhealthy adjustments, stress and burden by increasing the awareness in caregiving process and meeting their personal and emotional needs. The quality of care for the dementia patients has enhanced through the improvement of physical, social and psychological wellbeing of caregivers. In conclusion, Communitybased care, preferably at home would be ideal, and evidence in support of such care is accumulating.With adequate training, these programs can even be offered by health and welfare sector personnel in the community.