Scientific Program

Day 1 :

Keynote Forum

Linda Levine Madori

St. Thomas Aquinas College, USA

Keynote: Meditation and Creative Arts through the TTAP Method ®; A Replicable Approach Utilized with Residents with Mild Stage Alzheimer's disease Proves to Increase

Time : 10:00-10:40

Biography:

For the past thirty years Linda Levine Madori, PhD, has worked in the field of Health Care as a professor, therapist, advisor, researcher, supervisor and innovator of a replicable approach, the TTAP Method ® which utilizes the arts, is found to a stimulate both  the brain and cognition. Dr. Levine Madori has been an international speaker and recipient of the prestigious Fulbright Scholarship Award in 2006 and 2009. Dr. Levine Madori has worked as a tenured full professor at St. Thomas Aquinas College where she teaches and supervisor to students researching the TTAP Method® over the past two decades.

Abstract:

This research paper will review the past 5 years (2013-2018) of utilizing the Therapeutic Thematic Arts Programming (TTAP Method®) in 2 living assisted facilities in New York State with 25 individuals diagnosed within the first stage of Alzheimer’s disease. This quasi-experimental design is based on self-reported responses to pre-post questions asked before and after participating in TTAP Method® programming. The questions were based on the DABS Evaluation Tool which measures depression, anxiety, behavior and socialization. Results show a significant increase in relaxation, mood, memory, and cognition abilities in all participants.

The TTAP Method® is a multimodal approach designed to effect social, emotional, cognitive, physical, intrapersonal and interpersonal group dynamics of participants. The method provides stimulation to three distinct brain systems, encouraging brain wellness and neural regeneration, thereby providing a variable means for enhancing cognitive functioning through increased socialization. This multimodal approach is a replicable and structured twelve step therapeutic intervention that directs the focus of therapy on proven factors in helping cognition of those with mild cognitive impairment: the reinforcement and utilization of remaining strengths. Through a thematic, person centered approach; participants are continually accessing long-term memories which are reflected in various art modalities within the group. Starting with self-expression through conversation, participants are encouraged to paint, draw, write poetry, movement, and or reflect using phototherapy.  The TTAP Method Ⓡ has proven to have many therapeutic benefits coming from the arts, including language, communication, music, dance and drama  along with the physiological effects on the brain by stimulating the different regions of the brain through various activities. The results from these five year studies showed a strong correlation between active participation in the therapeutic activities and leveling of cognition functioning and psychosocial wellbeing.  The TTAP® approach enhances interaction through stimulation which positively increases neuronal activity, responses, and plasticity and addressing social, emotional and cognitive needs of those living with Alzheimer’s disease.

Keynote Forum

Linda Levine Madori

St. Thomas Aquinas College, USA

Keynote: Meditation and Creative Arts through the TTAP Method ®; A Replicable Approach Utilized with Residents with Mild Stage Alzheimer’s disease Proves to Increase

Time : 10:00-10:40

Biography:

For the past thirty years Linda Levine Madori, PhD, has worked in the field of Health Care as a professor, therapist, advisor, researcher, supervisor and innovator of a replicable approach, the TTAP Method ® which utilizes the arts, is found to a stimulate both  the brain and cognition. Dr. Levine Madori has been an international speaker and recipient of the prestigious Fulbright Scholarship Award in 2006 and 2009. Dr. Levine Madori has worked as a tenured full professor at St. Thomas Aquinas College where she teaches and supervisor to students researching the TTAP Method® over the past two decades.

Abstract:

This research paper will review the past 5 years (2013-2018) of utilizing the Therapeutic Thematic Arts Programming (TTAP Method®) in 2 living assisted facilities in New York State with 25 individuals diagnosed within the first stage of Alzheimer’s disease. This quasi-experimental design is based on self-reported responses to pre-post questions asked before and after participating in TTAP Method® programming. The questions were based on the DABS Evaluation Tool which measures depression, anxiety, behavior and socialization. Results show a significant increase in relaxation, mood, memory, and cognition abilities in all participants.

The TTAP Method® is a multimodal approach designed to effect social, emotional, cognitive, physical, intrapersonal and interpersonal group dynamics of participants. The method provides stimulation to three distinct brain systems, encouraging brain wellness and neural regeneration, thereby providing a variable means for enhancing cognitive functioning through increased socialization. This multimodal approach is a replicable and structured twelve step therapeutic intervention that directs the focus of therapy on proven factors in helping cognition of those with mild cognitive impairment: the reinforcement and utilization of remaining strengths. Through a thematic, person centered approach; participants are continually accessing long-term memories which are reflected in various art modalities within the group. Starting with self-expression through conversation, participants are encouraged to paint, draw, write poetry, movement, and or reflect using phototherapy.  The TTAP Method Ⓡ has proven to have many therapeutic benefits coming from the arts, including language, communication, music, dance and drama  along with the physiological effects on the brain by stimulating the different regions of the brain through various activities. The results from these five year studies showed a strong correlation between active participation in the therapeutic activities and leveling of cognition functioning and psychosocial wellbeing.  The TTAP® approach enhances interaction through stimulation which positively increases neuronal activity, responses, and plasticity and addressing social, emotional and cognitive needs of those living with Alzheimer’s disease.

Keynote Forum

Robert J. Brent

Fordham University, USA

Keynote: Cost-Benefit Analysis of Dementia Interventions

Time :

Biography:

Robert J. Brent is a Professor of Economics at Fordham University in New York and he is currently teaching Public Finance and Policy courses, and Statistics. He has lived and worked at Universities in the US, UK and Africa, and was Coordinator of the Strategic Planning and Governance Program at the Asian Development Bank Institute in Tokyo, Japan in 1998. His area of specialism is Cost-Benefit Analysis (CBA) and he has written four textbooks, edited a fifth, and has had published over two-dozen articles on the subject related to health, mental health, transport, education and agriculture, covering both Developed and Developing countries. In 2003 Robert was given a Fulbright Research award to evaluate HIV/AIDS interventions in Tanzania and he lived there for 7 months. He has been working on HIV/AIDS interventions ever since then. His published articles cover condoms, female education, voluntary counseling and testing and anti-retroviral drugs in Africa. His recently completed research involves putting a value on stigma prevention and evaluating ARVs, both studies related to older adults with HIV in NYC.

Abstract:

Cost-Benefit Analysis (CBA) is the way to ascertain whether any kind of health care intervention is to be judged socially worthwhile.  A worthwhile intervention is one where the benefits (the outcomes of everyone affected valued in monetary terms), exceeds the costs, also valued in monetary terms. Since the costs of interventions are reasonably well understood, the main challenge for CBA is to obtain a method for estimating the benefits that recognizes the reality of the scarcity of economic resources, yet also incorporates principles of fairness and justice. 

In this talk, a number of different benefit methods will be presented.  Each method will be applied to a particular dementia intervention that has been evaluated using CBA. The expectation is that there will be at least one benefit method that someone would feel comfortable adopting for use in the CBA of any dementia intervention.  There will be four main dementia CBAs presented:  years of education, Medicare eligibility, hearing aids, and corrective lenses (glasses).

All four dementia CBAs relied on a very large US panel data set provided by the National Alzheimer’s Coordination Center (NACC).  The main strengths and weaknesses of the data will be explained. The instrument that is used to measure dementia in this data set is the Clinical Dementia Rating (CDR) scale, which covers six main domains:  memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. The advantages of using the CDR, which focuses on dementia symptoms (cognitive functioning) rather than dementia brain pathology (plaques, fibers, etc.) are then highlighted.

 The talk will conclude by showing how the four CBA interventions, that focus on dementia symptoms, are complementary with efforts in Europe and the US that seek to evaluate Dementia rehabilitation also on the basis of dementia behavior, especially TAP (the Tailored  Activity Program).

Keynote Forum

Nakisa Malakooti

Monash University, Australia

Keynote: Solving the mystery of Alzheimer's disease: Connections of Down syndrome

Time : 10:40-11:20

Biography:

Dr Nakisa Malakooti is an emerging scientist in the field of cognitive decline. She has expertise in Down syndrome and Alzheimer’s disease. Her dedication to solve the mystery of AD and find a cure led her to look closer into the connection of DS and AD. She has years of experience in research and teaching. She is passionate about her research and finding a cure for the Alzheimer’s disease in both DS and non-DS individuals.

Abstract:

Statement of the problem: Alzheimer’s disease (AD), the most common form of dementia is one of the leading causes of death worldwide. Statistics indicate that the number of dementia patients could reach 75 million by 2030. To date, no cure has been found. The world is in desperate need for a solution.

Down syndrome (DS), trisomy 21, is the most common type of mental retardation. All Down syndrome individuals develop the neuropathology of Alzheimer’s disease. These include amyloid plaques, neurofibrillary tangles, and enlarged early endosomes. Amyloid precursor protein (APP) gene is on chromosome 21 and overexpressed in DS. However, studies have shown that APP is not enough to manifest AD. The purpose of the study was to investigate if there are other genes that overexpressed in Down syndrome are elevated in Alzheimer’s disease patients.  Intersectin-1 (ITSN1) and regulator of calcineurin-1 (RCAN1) were the targets of this investigation.

Methodology: We measured the level of two genes overexpressed in DS, ITSN1 and RCAN1 in white blood cells of AD patients and post-mortem brain samples from different types of dementia including AD.

Findings: The results showed that RCAN1 was elevated in AD and Dementia with Lewy body (DLB) brains. No elevation of ITSN1 or RCAN1 was detected in the white blood samples.

Conclusion and significance: The genes that are overexpressed in DS could contribute to the manifestation of AD and DLB. The nature of this contribution needs further investigation. More sensitive detection technology might enable us to use these proteins as biomarkers of the disease.

  • Dementia | Alzheimers Disease | Vascular Dementia | Dementia with Lewy Body (DLB) | Frontotemporal Dementia

Session Introduction

James Fontanesi

The ROAD Consortium, USA

Title: Radiation Therapy in the treatment of Alzheimer’s Dementia: Overview of the Rationale
Speaker
Biography:

Dr Fontanesi has been in practice more than 25 years .He received his medical education from American University of the Caribbean and performed his internship at Ellis Fishell State Cancer Center in Missouri.  He completed his Therapeutic Radiology residency at St. Mary’s Hospital and Medical Center/West Coast Cancer Foundation.  He also completed a Brachytherapy fellowship at the University of California – Davis/Veterans Administration Hospital.

He was one of the initial investigators in the AD program at William Beaumont Health Systems. He has over 100 peer reviewed publications and book chapters to his credit and continues to do both basic and clinical research.

Abstract:

Radiation therapy has been used in the treatment of various non CNS amyloidosis. In peer reviewed article for sites such as lung , trachea , head and neck and renal , the use of low dose radiation has provided early and durable resolution of the amyloid related symptoms.
 
Our initial investigation of this potential began after we completed a review of adults who suffered from Downs Syndrome and who also had been diagnosed with ALL and had received PCI. We were unable to find any death certificate indicating AD as a cause of death although it is well known that up to 90% develop AD by time they reach 45 years.
 
Based on these facts we initiated a series of investigations , both basic science and animal studies to determine if low dose radiation might play a role in the treatment of AD.
 
We investigated amyloid plaque burden, Tau pathology development and neurocognitive testing. These results will be presented at this meeting.
The positive results we found has led us to the start of a Ph1 clinical trial that will initially evaluate 2 radiation dose sequences ( 5 x 200 cGy and 10 x 200 cGy ) to determine any side effects but also to define with Amyvid PET scans and neurocognitive testing the impact of this treatment. 
We will also present our idea’s regarding future studies including hypofractionated radiation regimens and targeted therapy.

 

George Wilson

Beaumont Health, USA

Title: Low-dose radiation reduces amyloid-beta plaques and tau in animal models of Alzheimer’s Disease
Speaker
Biography:

George Wilson PhD is Chief of Radiation Biology at Beaumont Hospital, Royal Oak. He also serves as Scientific Director of the Beaumont BioBank & Director of the Erb Family Molecular and Genetics Laboratory and is a Professor of Biomedical Research at the Oakland University William Beaumont School of Medicine.  He has more than 40 years of experience in biomedical research and over 260 peer-reviewed publications.  He has focused his work primarily on the clinical application of radiobiology dealing with predictive assays and new treatment schedules. He has a particular interest in biological responses to radiation therapy and combining radiation with molecular targeted agents. He is currently spearheading the animal model studies into the use of low-dose radiation in the treatment of Alzheimer’s disease along with, Drs. James Fontanesi, Alvaro Martinez, Dan Michael, Michael Maddens and others.

Abstract:

Statement of the Problem: AD has a substantial impact on health and health care budgets and new cost-effective treatments are needed.

Given the complex neuropathology of AD more effective treatments of AD may be possible using combinations of therapy that target different facets of the disease. An alternative approach would be to discover a treatment modality that is pleotropic in its effect and interferes with the pathophysiology of AD at several levels. In this research we report the effect of low-dose radiation on amyloid-beta and tau in two animal models of AD.

Methodology & Theoretical Orientation:  We have studied the effect of 5 fractions of 2 Gy, delivered using a hemi-brain irradiation (HBRT) technique (Fig. 1) on B6.Cg-Tg (APPswePSEN1dE9)85Dbo/J (005864) mice (APP/PS1) and B6;129-Tg(APPSwe,tauP301L)1Lfa Psen1tm1Mpm/Mmjax  mice (3xTg-AD) and used immunohistochemistry to stain amyloid-beta and tau model.

Findings: Five fractions of 2 Gy reduced amyloid-beta palques by 71.8% ±23.4 in the brains of APP/PS1 mice (p= >0.01). There was also a significant reduction in the size of the plaques in this model from 42.95 μm2±12.8 to 14.52 μm2 ±11.6. In the 3xTg-AD model there was a consistent and significant (p=0.028) reduction in plaque number in the irradiated side of the brain with an average of 40.2±8.9 on the unirradiated side and 23.6±5.2 on the irradiated side.  In this model there was considerable variation between mice in the number of tau-positive neurons from as low as 50 to a maximum of 154. However, each mouse showed a reduction tau on the irradiated side with the average change being a 20% reduction (p=0.0024).

Conclusion & Significance: Radiotherapy is a well-established and safe medical modality and is not hampered by the blood-brain barrier. Moreover, radiation therapy as a treatment approach for AD could be implemented quickly and inexpensively. 

Alvaro A. Martinez

The ROAD Consortium, USA

Title: Neurocognitive testing (NCT) results following low dose hemi / whole brain irradiation in genetically altered Alzheimer’s Dementia (AD) animal models
Speaker
Biography:

For over three decades, Dr. Alvaro Martinez has pioneered several cancer treatments in Radiation Oncology leading to the significant improvement of today's Radiation Therapy outcomes. These include Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT) to improve precision and accuracy in radiation treatment delivery, special applicators used to treat prostate, gynecological and other pelvic malignancies to preserve organ function as well as Omnibeam, which is designed for treating very difficult tumors deep within the body. He has published over 360 papers in medical journals and written 54 book chapters. Dr. Martinez was an integral part of the conceptual design of the radiation research program into AD and in the development of the clinical trial.

Abstract:

Statement of the Problem: The use of low dose radiation has been shown to be effective in the resolution of non CNS amyloidosis. Our consortium began looking at various hemi brain and whole brain low dose radiation doses to determine its impact on amyloid and neurocognitive function (NCT).

Methodology & Theoretical Orientation: The Detroit group used the APPswePSEN1dE9 murine model, and tested NCT using the Morris Water Maze. The animals received whole brain radiation of 5 x 2 Gy at age 64 week and were tested 5 days before treatment and 8 weeks after treatment. Spatial learning and memory was assessed. The Geneva group used the TgF344-AD rat model. Female animals were treated with 5 x 2 Gy hemi brain irradiation at age 15 months and tested 3 weeks and 3 months after treatment. Open field (locomotor activity) and y maze (working memory) testing were assessed. Control animals were also tested. Animals were sacrificed after testing to determine amyloid-beta plaque changes. 

Findings: Both models showed a statistically significant improvement in cognitive abilities in the treated animals. Data from Detroit I shown in Fig.1 The treated group displayed significantly reduced latencies (31.0±17.6 seconds) compared to the untreated group (53.9±14.9 seconds) across trials on day 5 (p = 0.03). These differences were not due to baseline ambulatory /swimming velocities. The Geneva animals showed increased spatial memory index and decreased hyperactivity at 3 months.The test for younger males showed a clear decrease in TSPO in bilateral hippocampi. At sacrifice the Detroit group had noted reduction in amyloid plaque density. The Geneva group could not document a reduction in amyloid density but this may be due to a much higher plaque density in this model.

Conclusion & Significance: Based on these results we continue to evaluate the use of different daily / total dose schedules and the use of targeted therapies to determine the role they may play in the treatment of AD.

Daniel B. Michael

Oakland University William Beaumont School of Medicine, USA

Title: Radiation Oncology for Alzheimer’s Disease: Mechanisms of Action
Speaker
Biography:

Dr. Michael is currently Professor and Founding Residency Director, Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Beaumont Health and a Director of the Michigan Head and Spine Institute.  He is Past Chairman of the AANS/CNS Section on Neurotrauma and Critical Care for 2016-2018. He received his MD from Wayne State university School of Medicine where he also earned a PhD in anatomy and cell biology. He became Chief of Neurosurgery at Detroit Receiving Hospital. He served in the US Army reserves 1999-2009 and was mobilized to active duty in 2007. He served as President of the Michigan State Medical Society 2010-2011. He has published clinical and basic science research in neurotrauma and co-authored some of the earliest work demonstrating altered gene expression in human brain following traumatic brain injury. His current research focuses on a novel use of external radiation for the treatment of Alzheimer's disease.

Abstract:

Alzheimer’s disease (AD) is a chronic progressive, fatal neurodegenerative disease which is the most common form of dementia among the elderly affecting over 5.8 million patients in the United States (US) and 36 million worldwide. Currently there is no effective treatment. Based on the observation that radiation therapy (RT) has been used to successfully treat systemic amyloidosis for over 2 decades our group hypothesized that RT could be used to treat AD. We have published preclinical data which supports this hypothesis using a transgenic murine model of AD.
 
Our experiments point to several molecular and cellular changes in AD which, alone or in combination, could be favorably impacted by RT. Each of these potential mechanisms require further investigation. We have shown RT reduces amyloid & tau possibly by increasing clearance of these molecules. RT is known to cause cell death, but the field of radiation genomics has shown RT can induce widespread changes in gene expression. Using microarray analysis we have shown expression changes in 84 genes thought to be related to AD including BACE2, presenilin 1 and Apo ε3.
 
Other beneficial RT mechanisms may include alteration of immune responses. We have shown several changes in cytokine expression and microglia activation in the hemi-irradiated model. RT effects on vascular changes, heat shock protein expression and epigenetic changes are planned.  
 
RT may reduce maladaptive neuroplasticity in the AD hippocampus, thus improving memory. Preliminary studies in our lab suggest synaptophysin is reduced in radiated versus un-radiated hippocampi supporting this theory (see Figure1).
 
We are currently investigating the sex differences in onset of amyloid deposition and response to RT in our model based on clinical observations of AD onset, severity and response to therapy in men and women.

Leland Rogers

The ROAD Consortium, USA

Title: The Use of Low Dose CNS Irradiation in the Treatment of Alzheimer’s Dementia: The ROAD Consortium Experience
Speaker
Biography:

Leland Rogers is a radiation oncologist and professor of radiation oncology at Barrow Neurological Institute. He is board certified in radiation oncology by the American Board of Radiology. His expertise includes the treatment of central nervous system tumors using radiation therapy and brachytherapy. He is a fellow of the American College of Radiation Oncology, the American College of Radiology, and the American Society for Radiation Oncology. He is a member of the American Brachytherapy Society, the American Medical Association, NRG Oncology, and the Society for Neuro-Oncology. He earned his medical degree from the University of Kentucky College of Medicine. He completed his residency in radiation oncology at the University of North Carolina at Chapel Hill and a clinical fellowship in radiation oncology at the American Cancer Society. His research focuses on meningioma, ependymoma, and other brain and spinal tumors; trigeminal neuralgia; and Alzheimer’s disease. He also studies brachytherapy in all its applications. 

Abstract:

The use of low dose radiation has shown early and long lasting responses in non CNS sites. The ROAD consortium has been studying the effect of similar doses on genetically altered animal models. Based on the success in the reduction in both amyloid burden, Tau pathologies and statistical improvement in neurocognitive testing ,  we elected to develop a Ph 1 trial , initially with the approval of the FDA and then expanded to include a larger patient population, using the same low dose schedule. We were initially encouraged to do this protocol based on 4 individuals with AD who also had been diagnosed with small cell lung cancer and underwent PCI. We followed these patients using MMSE and we encouraged that the MMSE had worsened by 2 point or less at up to 24 months.
 
To date at 3 centers 13 patients have been treated using the lowest dose we intend to use, 5 x 200 cGy. We have also obtained Amyvid PET scans at designated times along with MMSE and ADAG-COG neurocognitive testing. We have also collected toxicity data using CTCAE v 4.0 CNS criteria.
To date we have not experienced any acute toxicity and subjective evaluation from patient families have been very positive.
 
We will review updated MMSE / ADAS-COG and Amyvid PET scan results along with toxicity associated with this treatment.
 
ROAD will update our experience with this potential treatment option for AD. To date we have not identified any acute toxicity associated with this treatment regimen. We continue to accrue patients and are planning on expanding ROAD to 2 new centers in the next 6 months.

Louise Makarem Oliveira

Federal University of Amazonas School of Medicine, Brazil

Title: Normal-pressure hydrocephalus: a critical review
Speaker
Biography:

Louise Makarem Oliveira is a medical student at the Federal Univeristy of Amazonas, Brazil. She has published over 10 papers in reputed journals, and presented oral presentations at renowned confererences.

Abstract:

Background: Normal-pressure hydrocephalus (NPH) is a potentially reversible and often misdiagnosed syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia, and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted.

Methods: We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords “normal-pressure hydrocephalus” / “idiopathic normal-pressure hydrocephalus” / “secondary normal-pressure hydrocephalus” / “NPH” / “ventriculoperitoneal shunt”.

Results: The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. Our findings reinforced the large-volume lumbar puncture (Tap Test) importance to corroborate NPH diagnosis, with the gait speed being the most responsive parameter. This test, however, has a low negative predictive value. Therefore, alternative diagnostic methods need to be developed. We found that Arterial Spin-Labeling MRI may be helpful, as an enhanced cerebral blood flow after the Tap Test has been related to clinical improvement in patients with NPH. Furthermore, there seems to be an strong relation between obstructive sleep apnea and NPH, determining that patients with suspected NPH must undergo a nocturnal polysomnogram.

Conclusion: NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.

Junghee Ha

Yonsei University College of Medicine, Republic of Korea

Title: Plasma clusterin as a potential link between diabetes and Alzheimer’s disease
Speaker
Biography:

Dr. Ha has her expertise in evaluation of neurodegenerative disease and passion in improving the health and wellbeing of elderly people.

Diabetes mellitus is most common metabolic disease and it is considered a risk factor for Alzheimer disease; however, there is a lack of research on how clusterin levels change in relation to both AD and DM when considered simultaneously. Therefore, we aimed to examine the triadic relationship between plasma clusterin, AD, and DM, expecting to find interactive effects between the two diseases. Hope this study will provide future direction of further research on AD.

Abstract:

BACKGROUND Plasma clusterin is a promising biomarker of Alzheimer's disease (AD). Interestingly, it has also been associated with several metabolic diseases including diabetes mellitus (DM). However, clusterin has not been investigated considering a relationship with both DM and AD. 

PARTICIPANTS & METHODS We aimed to examine the triadic relationship between plasma clusterin, AD, and DM by classifying participants according to the severity of their cognitive (normal cognition (NC), mild cognitive impairment (MCI, AD) and metabolic (healthy control, prediabetes, DM) impairments. We evaluated cognitive and metabolic functions of the participants with neuropsychological assessments, brain MRI, and various blood tests, to explore potential relationships with clusterin.

RESULTS Plasma clusterin was significantly higher in participants with AD compared to those with NC and MCI (p < 0.001). Participants with metabolic impairments (prediabetes, DM) had increased plasma clusterin levels, compared to healthy controls (p = 0.002). A two-way ANCOVA revealed no synergistic, but an additive effect of AD and DM on clusterin levels (interaction; p = 0.351). Clusterin was correlated with cognitive scores of the Mini-Mental State Examination (MMSE), delayed word recall, and the Clinical Dementia Rating Sum of Boxes (CDR-SB). Clusterin was also associated with metabolic status indicated by HbA1c, the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index, and fasting C-peptide. In addition, we found significant correlations between clusterin and the degree of medial temporal atrophy and periventricular white matter lesions, indicating neurodegeneration and microvascular insufficiency, respectively. Since our multivariate linear regression analysis pointed to metabolic impairment (prediabetes, DM) as the most significant predictor of clusterin, we performed a mediation analysis to further understand the triadic relationship between clusterin, AD, and DM. The result revealed a potential of clusterin as a mediator of the indirect relationship between DM and AD.

CONCLUSION These results demonstrate that clusterin is a promising biomarker of DM as well as of AD. Additionally, our data suggest that clusterin may have a role in linking DM with AD as a potential mediator between the two diseases.

Lucia Torres-Simon

Universidad Complutense de Madrid, Spain

Title: Characterization of brain functioning in vascular cognitive impairment with EEG and MEG: systematic review
Speaker
Biography:

Lucia Torres-Simon has her bachelor’s in psychology. She has two master’s degrees concerning neuropsychological evaluation and rehabilitation of brain/cognitive damage, and neuroimaging tools analysis and applications. She has passion in understanding impaired brain functioning and mechanisms of rehabilitation. She is developing deep knowledge about cerebrovascular disease in her doctoral studies, trying to shed light on the neurophysiological characterization of different subtypes of vascular cognitive impairment.

Abstract:

Statement of the problem: Vascular disease is the second most common cause of dementia after Alzheimer disease (AD). Nevertheless, the lack of consensus in concept definition, classification and diagnosis criteria in both research and clinical fields, difficulties consistent progress in early identification and treatment. Consequently, the establishment of unified subgroups and diagnosis criteria is a crucially important clinic, scientific and social goal. With this purpose, international research groups have invested a great deal of resources to reach a consensus, setting down neuropsychological and neuroimaging (i.e. MRI, CT) protocols for the diagnosis of vascular cognitive impairment (VCI). However, these studies have not found enough harmony and consistency, for neurophysiological techniques such as electroencephalography (EEG) or magnetoencephalography (MEG), to include them as diagnostic criteria. The purpose of this study is to identify neurophysiological brain patterns for different subtypes of VCI, either mild or major, also called vascular dementia (VaD) according to VICCCS-1(Figure 1).
 
Methodology & Theoretical Orientation: a systematic search from 2000 in PubMed, Chrocane, Web of Science and PsycInfo databases for physiological patterns, with EEG and/or MEG, findings in VCI subtypes was performed. Chrocane screening and data extraction tool (COVIDENCE) was used for peer-review and risk of bias assessment.
 
Findings: Significant differences between VCI patients and healthy control were found in spectral, connectivity and evoked potential brain signal analysis. Also, significant neurophysiological discriminatory information between VCI and AD is reported, even in early stages.
 
Conclusion & Significance: After this review it could be conclude that EEG could provide relevant discriminatory information between VCI or VaD and healthy control or AD. However, further research is needed to get reliable data to introduce neurophysiological features as clinical diagnostic criteria, trying to discriminate and classify VCI subtypes. Based on the present review, we suggest that future VCI research take into consideration 1) operate with homogeneous criteria established in updated international consensus; 2) emphasize MEG based studies due to its more accurate space resolution combined with other neuroimaging tools.

Katherine Strick

University of Exeter, UK

Title: Conceptual model of the purpose of meaningful occupation for people living with dementia developed through Systematic Review and Qualitative Evidence Synthesis
Speaker
Biography:

Katherine is undertaking a PhD investigating meaningful occupation for people living with dementia in residential care settings at Exeter medical School. She has previously worked for the Alzheimer’s Society as part of the Side by Side project, and as an information worker. She has also worked as an activity coordinator in care homes. Her passion for supporting people with dementia to live well has led her to organise multiple charity events and volunteer with a local Dementia Action Alliance and in memory cafes. She completed her MSc in Dementia Studies through the University of Bradford in 2016.

 

Abstract:

Guidance for the provision of care for people with dementia asserts that occupation people find meaningful is essential for wellbeing, however definitions of meaningful occupation are often very broad with the intrinsic meaning coming from within the person rather than the activity. As such the purpose of meaningful occupation, and how to gauge its effectiveness can be inconsistent.

Through analysing the different purposes that occupation for people with dementia is perceived to have, this study created a conceptual model depicting the types of meaning that are seen as stemming from occupation.

The conceptual model was based on systematic review and evidence synthesis of 20 qualitative papers using meta-ethnography.

The fundamental purpose of occupation identified was to support the person with dementia to feel they were living a meaningful and fulfilling life. Three domains which support a person to gain a sense of fulfilment through their occupations:

A catalytic environment: For an occupation to be meaningful for a person with dementia it must be perceived by them as having value and legitimacy, this is supported by the physical and social environment around the person.

A meaningful life: Living a meaningful life involves the person with dementia continuing to maintain links from across their life course in a way which supports their sense of personal value. This is reflective of their past, though also supports their present and future identity.

Occupation as a tool: Occupation can also be used a tool by people with dementia and those supporting them as a means to bring about a desired effect e.g. relieving anxiety

Conclusions: The model proposes how occupation could support meaning in multiple ways, and considered how these forms of meaning were influenced by the world views and values of the individual, and context in which they were experienced

Ebenezer Larnyo

Jiangsu University, China

Title: Reducing the Burden of Dementia in Sub-Saharan Africa Through the Use of Wearable Devices
Speaker
Biography:

Ebenezer Larnyo is a PhD Candidate and a Graduate Research Fellow of the Department of Health Policy and Management at Jiangsu University. His research is focused on technological innovation management, health informatics and machine-learning in the fields of healthcare management and public sector administration. His is currently a member of a team of researchers investigating the Dynamic Assessment and Policy Choice for Long-Term Care for Disabled and Mentally Handicapped Elderly in China a project funded by The National Natural Science Foundation of China (NSFC). He has also published several papers in reputed journals.

Abstract:

Statement of the Problem: Dementia affected about 50 million people globally in 2018, making it the seventh leading cause of death according to the World Health Organization. This figure is projected to rise to 131.5 million by 2050 with about 10% of people developing the disorder at some point in their lives and about 9.9 million new cases diagnosed yearly translating into one case every second. In Sub-Saharan Africa, an estimated 2.13 million people were living with dementia as of 2015, with numbers projected to nearly double every 20 years, increasing to 3.48 million by 2030 and 7.62 million by 2050. This translates into over 367,000 new cases of dementia in a year in the region. As dementia is becoming more common and prevalent in Sub-Saharan Africa, its burden on family carers and healthcare stakeholders is inevitable. Thus, there is the need for increase in both the quality and variety of healthcare services offered to these patients.

Methodology & Theoretical Orientation: Using Partial Least Squares based on structural equation modeling, this study analyzed 350 proxy responses of dementia caregivers who have either dealt previously with or were currently taking care of patients with dementia to determine the factors that influence the adoption of healthcare wearable among these patients and how these factors help in reducing the burden of the disease in the region.

Findings: The results of the study revealed that social influence, effort expectancy, facilitating conditions and behavioral intention significantly influence the actual use of healthcare wearable devices among patients with dementia with p-values of 0.05 and predictive accuracy of predictive accuracy of 70.7%.

Conclusion & Significance: This study offers researchers important insights into analyzing acceptance behavior of dementia patients in developing countries and also suggests the need to invest more into the adoption of these devices for patients with dementia in order to help reduce the costly nature of dementia care for all stakeholders.

Setare Eslami

Kaweah Delta Health Care District, USA

Title: Untreated Neuroborreliosis presenting with somatic delusions and subjective memory impairment
Speaker
Biography:

Setare Eslami completed her Medical degree at Mashad University of Medical Sciences, Mashad Iran. She is currently in her 3rd year as part of the Adult General Psychiatry, Residency Program at Kaweah Delta Health Center, in Visalia California. Her passion for geriatric psychiatry has grown following performing research at Stanford University as clinical project manager involved in several clinical trials on novel treatment for major neurocognitive disorder.

Abstract:

Lyme disease is a tick-borne spirochete illness with multi systemic involvement. Although its neurological manifestations are becoming increasingly well recognized, its psychiatric presentations are not well known. Physicians who treat patients with lyme disease need to be aware of its neuropsychiatric symptoms, which may emerge months to years after the initial infection. Prompt diagnosis and effective treatment are needed to avoid the debilitating and possibly irreversible mental illness associated with the neuropsychiatric involvement of the disease. It has been reported that the areas of the United States with the highest prevalence of lyme disease also have the highest rate of schizophrenia.
We report a case of a 63-year-old male with psychiatric history of distorted thought content, detachment from reality and somatic delusions. He reported delusions of being poisoned seven years ago which caused damage to all his body with residual poison in the fat cells despite self treating with various antioxidants, multivitamins and over the counter hepatic cleansers. Patient had history of being seen by multiple specialties including cardiologist, orthopedic surgeon, infectious disease specialist, pain specialist and different internists believing they are not able to understand the effects of poison on his body. During psychiatric evaluation the patient exhibited personality changes, disinhibited behavior and mild memory impairment. In spite of acceptable scores on mini mental status exam and Montreal cognitive assessment, patient scored borderline on Frontal lobe battery assessment.
Thorough medical work up was completed and he was found to have hyperintensity in frontal lobe on brain MRI. Spinal tap was done which was within normal limit. Complete Serology testing was remarkable for lyme antibody IgG. He was started on a course of doxycycline and following completion of antibiotic therapy the patient showed significant improvement in his delusions.