Treatment of idiopathic normal-pressure hydrocephalus (iNPH) requires collaboration between dementia specialists and neurosurgeons. The role of dementia specialists is to differentiate patients with iNPH from patients with other dementia diseases and to determine if other dementia diseases are comorbid with iNPH. We conducted a nationwide hospital-based questionnaire survey on iNPH in medical centers for dementia (MCDs).

We developed a questionnaire to assess how physicians in MCDs evaluate and treat patients with cognitive impairment due to suspected iNPH and the difficulties these physicians experience in the evaluation and treatment of patients. The questionnaire was sent to all 456 MCDs in Japan.

Questionnaires from 279 MCDs were returned to us (response rate: 61.2%). Patients underwent cognitive tests, evaluation of the triad symptoms of iNPH, and morphological neuroimaging examinations in 96.8, 77.8, and 98.2% of the MCDs, respectively. Patients with suspected iNPH were referred to other hospitals (e.g., hospitals with neurosurgery departments) from 78.9% of MCDs, and cerebrospinal fluid (CSF) tap test was performed in 44 MCDs (15.8%). iNPH guidelines (iNPHGLs) and disproportionately enlarged subarachnoid space hydrocephalus (DESH), a specific morphological finding, were used and known in 39.4% and 38% of MCDs, respectively. Logistic regression analysis with “Refer the patient to other hospitals (e.g., hospitals with neurosurgery departments) when iNPH is suspected.” as the response variable and (a) using the iNPHGLs, (b) knowledge of DESH, (c) confidence regarding DESH, (d) difficulty with performing brain magnetic resonance imaging, (e) knowledge of the methods of CSF tap test, (f) absence of physician who can perform lumbar puncture, and (g) experience of being told by neurosurgeons that referred patients are not indicated for shunt surgery as explanatory variables revealed that the last two factors were significant predictors of patient referral from MCDs to other hospitals.

Sufficient differential or comorbid diagnosis using CSF tap test was performed in a few MCDs. Medical care for patients with iNPH in MCDs may be improved by having dementia specialists perform CSF tap tests and share the eligibility criteria for shunt surgery with neurosurgeons.

Psychotic disorders are not infrequent in late life and involve massive costs to society, affecting individuals and their caregivers. The epidemiology of late-life psychosis remains imprecise and despite its high prevalence, it remains a diagnostic and treatment dilemma. The aim of this article is to review the current literature regarding late-onset psychosis and whether it is recognized as a clinical entity on itself, differing from early-onset psychosis.

Review of the most recent literature regarding late-onset psychosis its clinical and epidemiological particularities. The research was carried out through the PubMed and UptoDate databases, using the terms “late-onset psychosis”, “late-life psychosis”, “dementia” and “elderly”.

Late-life psychotic disorders may originate in an intricate interaction between several biological, psychological, social, and environmental factors. These may include functional status, other physical diseases, hospitalizations, physical activity, and stability of care. Some authors refer that older age, and the presence of suicidal ideation were associated with incident late-life psychosis. Assuming the significant load associated with psychotic disorders in late life, their assessment should identify the potential causes and distinguish predictive factors. Treatment should include a combination of nonpharmacological approaches and psychotropic medications, used cautiously.

Late-life psychosis differs from early-onset psychosis on several characteristics. The treatment must be directed towards the cause and adapted to each individual. Non-pharmacologic interventions are frequently used as first line treatment, and pharmacotherapy must be used carefully. The crescent number of senior population must alert to this entity and the specificity of its approach.

Older adults are at greater risk for developing severe illness from SARS-COV2 infection and may be more vulnerable to negative mental health outcomes as a result of public health guidelines that increase social isolation. We assessed mental health outcomes in older adults with normal cognition (NC), past history of major depressive disorder (i.e., remitted; rMDD), or mild cognitive impairment (MCI) to determine the prevalence of depression, anxiety, general stress, and post-traumatic stress during the COVID-19 pandemic and the impact of diagnosis and sex.

The sample included 108 older adults (37 males, mean age=72.1 years): 71 older adults with normal cognition (NC) based on normal neuropsychological test performance and no psychiatric history, 21 rMDD participants based on DSM5 criteria, and 16 MCI participants based on NIA-AA criteria. Participants completed self-report measures of depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety [Patient-Reported Outcomes Measurement Information System (PROMIS)], general stress [Perceived Stress Scale (PSS)] and post-traumatic stress [Impact of Events Scale Revised (IES-R)] through video- or teleconferencing. Prevalence rates of clinically significant psychiatric symptoms were expressed as the percentage of participants with total scores that exceed the normal cut-offs. Separate MANOVAs were used to examine the effects of diagnosis and sex. Non-normally distributed data (PHQ-9 and PROMIS total scores) were rank-transformed.

Approximately 1/3rd of participants endorsed clinically significant symptoms based on scores exceeding the cut-off for normal: 33.7% on PHQ-9, 31.3% on PROMIS-Anxiety, 35.5% on PSS, 38.3% on IES-R. rMDD participants scored higher on all measures compared to NC participants (p’s < .005) while MCI participants scored higher on the PSS compared to NC (p=.035). Women scored higher on all measures compared to men.

These rates of approximately 1/3rd reporting clinically significant symptoms of depression, anxiety, general stress, and post-traumatic stress are higher than those described in population surveys of older adults but are comparable to prevalence rates of psychiatric symptoms in the general adult population. The effects of diagnosis and sex indicate that older adults with previous depression or current MCI, as well as women overall, are particularly vulnerable to developing clinically significant psychiatric

Motoric cognitive risk syndrome (MCR), which is defined as a pre-dementia syndrome characterized by subjective cognitive complaints and slow gait in older individuals free of dementia and mobility disability, has been associated with increased risks of dementia, functional dependence, and mortality. The aims of this study were to describe the prevalence and distribution of MCR and to explore the clinical profiles associated with MCR in rural-dwelling older adults.

The population-based cross-sectional study included 5,021 dementia- and disability-free participants (age ≥60 years; 56.48% women) in the baseline assessments (March-September 2018) of the Multimodal Interventions to delay Dementia and disability in rural China (MIND-China). The MCR syndrome was diagnosed when the participants had subjective memory complaints and gait speed ≥1 standard deviation (SD) below the age- (<75 and ≥75 years) and sex-specific means. We estimated the age- and sex-specific prevalence of MCR. We used logistic regression models to examine lifestyle and clinical factors associated with MCR while controlling for age, sex, and education.

The overall prevalence of MCR syndrome was 13.58%, with the prevalence being 11.53% in males and 15.16% in females (P<0.001). The prevalence of MCR was increased with age, from 10.43% in people aged 60-69 years and 15.97% in those aged 70-79 years to 21.71% among those aged ≥80 years. The demographic-adjusted odds ratio (95% confidence interval) of MCR was 1.30 (1.08-1.57) for being overweight (body mass index 24-27.9 vs. <24 kg/m2), 1.65 (1.32-2.05) for having obesity (≥28 kg/m2), 1.74 (1.41-2.15) for diabetes, 1.44 (1.20-1.73) for dyslipidemia, 1.59 (1.32-1.91) for having coronary heart disease, 2.17 (1.78-2.65) for having stroke history, 1.52 (1.24-1.86) for having osteoarthritis, and 3.40 (2.70-4.28) for having depressive symptoms. Ever (vs. never) smoking and alcohol consumption were related to odds ratio of 0.65 (0.48-0.86) and 0.71 (0.55-0.91), respectively, for MCR syndrome.

The MCR syndrome affects nearly 1 in 7 Chinese rural older adults, and the MCR prevalence appears to be higher in women than in men. Cardiometabolic risk factors (e.g., overweight/obesity, diabetes, and dyslipidemia), osteoarthritis, coronary heart disease, stroke, and depressive symptoms were associated with increased likelihoods of the MCR syndrome.

Deinstitutionalization of nursing care in European counties relies profoundly on the mobilization of the caregivers and municipal homecare services. Yet, caring for home-dwelling people with dementia (PwD) can be stressful and resource demanding. The LIVE@Home.Path trial tailored, implemented, and evaluated the multicomponent LIVE intervention on informal caregivers’ burden in dyads of home-dwelling PwDs and their families.

From 2019 to 2021, we conducted a 24-month multicenter, multicomponent, stepped-wedge randomized control trial including dyads of people ≥65 years with mild to moderate dementia with minimum 1h/week contact with their informal caregiver. The user-developed Learning, Innovation, Volunteer support, and Empowerment (LIVE) intervention was implemented by municipal coordinators over 6 months periods. In an intention-to-treat analysis, we applied mixed-effect regression models accounting for time and confounding factors to evaluate the effect of the intervention on Relative Stress Scale (RSS), Resource Utilization in Dementia (RUD) and Clinical Global Impression of Change (CGIC).

A total of 280 dyads were included at baseline, mean age of PwD was 82.2 years, 63% female, 43% lived alone, 36% had Alzheimer’s dementia, median MMSE was 20 (range 0-30) and median FAST score 4 (range 1-7). Caregivers were on average 66 years, 64% female, 49% were the PwDs child. At baseline, 80 dyads were randomized to intervention sequence 1 of which 67 received the intervention, corresponding numbers for sequence 2 and 3 were 97/ 57 and 103/50. During the active intervention period, time spent in personal activities of daily living significantly increased with 2.8 hours/months compared to 1.2 hours/months increase in the control period, total score of RSS was stable in the intervention period (0.36 points) (range 0-60), while it increased significantly in the control period (27.0 points), CGIG increased significantly only in the intervention period (0.5 points) (range: -5 worsening, 5 improvement).

Although caregivers reported more care time during the intervention periods, they did not experience more stress which may be related to their increased understanding of dementia. Increase in reported care time might also reflect the increased understanding of dementia, leading to more realistic evaluation of own time contribution.

Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities. RCFs aim to provide person-centred care (PCC) to enhance the quality of life (QoL) of residents. Residents are dependent on their environment to fulfil their needs and wishes, such as drinking alcohol or smoking tobacco. Although alcohol and tobacco use can be experienced as a part of QoL in the final phase of life and the motivation to quit these substances is low, it can cause severe health problems in older adults. In RCFs this may cause a dilemma between the QoL of individual residents and the health and safety problems of all residents. This study aims to explore multiple perspectives on alcohol and tobacco use within the RCF.

A qualitative research design was chosen, and semi-structured interviews were conducted. A various sample was purposively selected in two organizations on two types of units (psychogeriatric units and units providing care for residents with mainly physical disabilities): residents who use alcohol and/or tobacco and those who do not. Subsequently, four of these 16 residents were invited to participate in an in-depth case study. To explore the dynamics of the social environment, both formal and informal caregivers were invited to participate.

Residents are satisfied with their current use and value their autonomy regarding alcohol and tobacco use. Residents acknowledge that their use could cause a nuisance to others. Multiple caregivers are involved in their use and residents experience dependency on these caregivers to smoke tobacco or drink alcohol. There was limited interaction between the residents and their (in)formal caregivers and amongst the caregivers on this topic. Moreover, caregivers tended to act from their own perspectives, based on their professional expertise, knowledge, and attitudes towards residents’ alcohol and tobacco use.

A dilemma arises between protecting residents from the adverse (health) outcomes of alcohol and tobacco use and sustaining their QoL by optimizing their autonomy. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health, and safety risks for all.

Suicidal behaviors represent a serious public health problem in terms of mortality, morbidity and social impact. Suicide in the elderly is a statistical reality little studied in the Latin American context. Method: It´s an observational study where we reviewed the records of the patients seen between January 2018 and December 2019 at the Psychogeriatrics Clinic of the Ramón de la Fuente Muñiz National Institute of Psychiatry; collecting sociodemographic, clinical information and evaluating the suicidal risk by the SAD PERSONS Scale. With the information obtained, we correlated variables with suicidal risk based on the Pearson and Spearman correlation indices.

A total of 404 files were reviewed, finding that in the last 5 years 1.4% of the patients had made a suicide attempt, what was directly related to a history of violence (r=0.256, p=0.011). Suicidal thoughts in the past year (15.4%) and increased suicidal risk were associated with PAS use (r=0.123, p=0.037) (r=0.207, p=0.001) and depressive disorder (r=0.148, p=0.012) (r=0.27, p=0.000).

In the older adult population, some of the clinical and sociodemographic factors associated with suicidal risk described for the general population could continue to be considered risk factors, among them: being male, low level of education, diagnosis of depressive disorder, having medical comorbidities and the use of SPA.

Episodes of lucidity (EL) are clinically and potentially epidemiologically significant events that occur among individuals with advanced dementia. EL are characterized by a spontaneous return of abilities previously thought to have been lost and are predominantly reported near end of life. Audiovisual observation offers a valuable approach to studying EL, providing opportunities to characterize verbal/non-verbal features of EL as well as their surrounding contexts. Approaches to capturing and characterizing audiovisual data and potential verbal/non-verbal indicators of EL near end of life are lacking.

This study determined the acceptability and feasibility of a multi-faceted observational study protocol to characterize potential observable indicators of EL among people with advanced dementia near end of life.

This study incorporated longitudinal audiovisual observation, informant field interviews/case review of potential EL events by informants. We examined enrollment and retention rates, task load and usability ratings from clinician and research staff across data collection and processing tasks, and surveys and qualitative appraisal from participants and staff regarding feasibility and acceptability. The NASA TLX Task Load Index measures workflow assessment to generate a combined score between 0-20, with 0 indicating higher workflow assessment. The modified System Usability Scale (SUS) measures usability with a score of 0-100, with 100 indicating higher usability and a target score ≥68 indicating usability higher than 50% of the average score.

Five eligible individuals were enrolled, yielding a 100% enrollment/retention rate, and 103 observations totaling 280 hours of observation across participants. NASA TLX Task Load Index scores of 2.9 over 4 months, with vast improvement over time indicate study procedures with iterative refinements were feasible. Average modified SUS score for clinician and research staff was 96 and 82.4 respectively, indicating high usability with notable improvement over time. Surveys and qualitative appraisal from participants and staff endorse high rates of acceptability and feasibility. Additionally, the study team identified 9 potential EL across 3 participants. Seven caregivers and two clinicians participated in case reviews to review the corresponding audiovisual data, resulting in 3 endorsed EL.

Treatment-resistant depression (TRD) is not uncommon in older people. Brain stimulation, such as 4-6 weeks of repetitive transcranial magnetic stimulation (rTMS) or theta burst stimulation (TBS) targeting the left dorsolateral prefrontal cortex, has been evidenced as an essential intervention for adult TRD and also documented in the current international treatment guideline. In 2018, Taiwan Food and Drug Administration cleared the rTMS as a treatment option for TRD and now rTMS is still a treatment at their own expense in Taiwan. Additionally, prolonged intermittent TBS (piTBS) protocol has been proven its similar antidepressant efficacy as standard 4-6 weeks rTMS/iTBS in adult TRD, but in a shorter treatment course of 2 weeks. For older adults with depression, 4-6 weeks of treatment course may burden their caregiver due to their limited ambulation and transportation ability. However, hitherto there was no study to investigate the antidepressant efficacy of left-sided prefrontal piTBS in treating older TRD.

A chart review was performed at a single Taiwan hospital from 2018 to 2020. 17-items Hamilton Depression Rating Scale (HDRS-17) was measured before and after the piTBS intervention. Maudsley Staging Method was used for the depression treatment refractoriness.

We identified 23 old adults with TRD (mean [SD] age, 66.0[5.2]; 78% female) who underwent 10-20 sessions of daily piTBS (1800 pulses/session; 10sessions, n=18, 15sessions,n=4, 20session,n=1). On continuous outcomes, mean(SD) HDRS-17 total scores improved from 20.5(6.62) to 11.8(7.7) after receiving piTBS intervention. The mean percent improvement of HDRS-17 was 46.0%±29.4%. Dichotomous outcomes showed response rate of 43.5% and remission rate of 34.8%. No seizures or other serious adverse events were noted, and no premature discontinuation was noted.

This study is the largest study demonstrating the piTBS protocol provides a comparable reduction in depression symptoms in older adults with TRD, similar to the effectiveness in adult TRD and the efficacy of standard sequential bilateral rTMS/iTBS in older TRD in the FOUR-D trial. Regarding desirable efficiency and effectiveness, piTBS may be an optimal form of rTMS in treating older adults with TRD. Further large comparative effectiveness trials with standard iTBS or high-frequency rTMS in this population are warranted.

The 8-Item Informant Interview to Differentiate Aging and Dementia (AD8) was developed as a screening tool for dementia with a cutoff of 2 suggested by the initial study. However, various studies found different cutoff values, and many found a cutoff of 2 might result in a high false positive rate. Furthermore, a higher false positive rate in Taiwan was repeatedly shown when AD8 was self-administered in local government screening programs. This study aimed to test the performance of AD8, define its best cutoff value, review factors that may affect its performance, and reconsider its proper role in clinical practice.

We recruited 118 participant-informant dyads from a university teaching hospital. For each informant, the AD8 was administered first and then the Clinical Dementia Rating to minimize contamination effect. For each participant, two geriatric psychiatrists considered history, physical and mental status examination, laboratory testing, neuropsychological testing, and neuroimaging results to make the final consensus diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The receiver operator characteristic curve was used to assess the diagnostic performance of AD8.

There were 59 subjects with normal cognition, 28 with mild neurocognitive disorder, and 31 with major neurocognitive disorder or dementia. To discriminate between dementia and non- dementia, a cutoff of 2 resulted in a sensitivity of 0.903, specificity of 0.598, and area under the curve (AUC) of 0.751. Moving the cutoff to 3 and 4 led to better specificity (0.7126, 0.8621) and greater AUC (0.776, 0.818), albeit some loss in sensitivity (0.8387, 0.7742). The best cutoff score was 4 based on the Youden index. Without considering the mild cognitive impairment group, the optimal cutoff remained at 4, with equal sensitivity and even higher specificity.

Our findings suggest the AD8 may perform better and have a lower false positive rate with a cutoff value higher than 2. A literature review found its performance could be affected by disease prevalence across various healthcare settings, education level, regions, respondents’ personality and understanding of questions, conduct of test, flow of test administration, etc. We will discuss the details and best screening strategies at the IPA Congress.

The Min-Mental State Exam (MMSE) is the most common exam for screening and follow-up of cognitive impairment. One of 30 points is allocated to correct orientation to the weekday (“day orientation”).

The purpose of this study is to assess whether day orientation correlates with the weekday in which the exam was conducted, hypothesis being that orientation would be better on the work day immediately following the weekend (in Israel – Sundays).

All digitally recorded MMSE scores from Shalvata MHC’s were collected. The percentage of correct answers to day orientation was compared between weekdays. Differences between in/correct answers were assessed by Chi-square tests, with Cramer's V for the effect size of the correlations. Differences in total score between groups were assessed by independent t- tests with Cohen's d for effect size (p=0.05)

The cohort consisted of 2,049 MMSE taken by 1,376 patients [average age 80.3 (SD 9.3) 56.4% Female] between 2016 and 2022. Due to very few responses (n=7) on Friday and Saturday, these days were excluded from analyses. Overall, 67.8% of exams were correctly oriented to the day. Correct response rate according to the weekday yielded a significant result (X2 = 20.77, p < .001, Cramer's V = 0.104), with the largest effect difference was found on Sundays (53.4%), and then on Mondays (38.9%). The relative odds ratio (OR) for providing a correct response was found for Sunday (OR=1.55, p=.001), while for other days no significant OR was found. Patients who responded correctly showed higher final total scores in comparison with patients who did not respond correctly across all days. Similar analysis was carried out for orientation to the month, comparing between the first 5 days and last 5 days of the month, but no statistically significant difference for correct answers was found.

MMSE delivered on the first working day of the week may entail a better day orientation, and thus a higher total score. This finding may have significant implications for assessments (as in clinical trials) and thus treatment.

Most frequently felt needs in dementia concern maintaining self-management and participation in meaningful activities. E-health interventions may support these aspects of social health but few have undergone large-scale evaluations. The effectiveness of the FindMyApps intervention, an app selection tool and tablet training, designed to support people to find and use tablet apps that meet their needs and interests, was evaluated.

A non-blinded, single-centre, randomized controlled trial and process evaluation were conducted in the Netherlands between January 2020 and November 2022. Participants were community-dwelling people with mild dementia (MMSE <26 and >17) or mild cognitive impairment, and their informal caregivers. FindMyApps was compared with digital care as usual (normal tablet computer and general advice). Data regarding primary outcomes (self-management and social participation of the person with dementia, sense of competence of the caregiver) and secondary outcomes (including quality of life) were collected with standardized instruments at baseline and after a three months intervention period. ANCOVAs were conducted on post-test outcome measures, corrected for baseline scores, to investigate group differences.

Data collection was completed in November 2022 and analyses are underway. Of 150 dyads randomized, 128 completed the three-month follow-up (64 experimental, 64 control). Results of ANCOVAs investigating the effect and effect size of FindMyApps on the primary and secondary outcomes at three months, will be reported, as well as results of post-hoc analyses that explored the effect on outcomes of: previous tablet experience and education level of participants; observed use of the FindMyApps app; and reported adherence to recommended frequency of tablet use.

Results of this study will indicate whether FindMyApps is an effective intervention for supporting social health of people with mild dementia and MCI. Comparisons with previous studies of FindMyApps and other digital interventions for social health in dementia will be drawn and implications for professionals, concerning implementation of FindMyApps, and for researchers regarding further development, translation and evaluation of FindMyApps discussed. Finally, establishing feasibility and utility of randomized controlled trials in this field, the results of this study will set the bar for future evaluations of eHealth interventions in general.

Older adults have low levels of mental health literacy relating to anxiety which may contribute to delaying or not seeking help. Lifestyle interventions, including physical activity (PA), have increasing evidence supporting their effectiveness in reducing anxiety. The COVID-19 pandemic also highlighted the potential for technology to facilitate healthcare provision. This study aimed to investigate perspectives of older adults about their understanding of anxiety, possible use of PA interventions to reduce anxiety, and whether technology could help this process.

The INDIGO trial evaluated a PA intervention for participants aged 60 years and above at risk of cognitive decline and not meeting PA guidelines. Twenty-nine of the INDIGO trial completers, including some with anxiety and/or cognitive symptoms, attended this long-term follow-up study including semi-structured qualitative interviews. Transcripts were analyzed thematically.

There was quite a diverse understanding of anxiety amongst participants. Some participants were able to describe anxiety as involving worry, uncertainty and fear, as well as relating it to physical manifestations and feeling out of control. Others had less understanding of the concept of anxiety or found it confusing. Participants generally believed that PA could potentially reduce anxiety and thought that this could occur through a “mindfulness” and/or “physiological” process. Technology use was a more controversial topic with some participants quite clearly expressing a dislike or distrust of technology or else limited access or literacy in relation to technology. Participants who were supportive of using technology described that it could help with motivation, information provision and health monitoring. Wearable activity monitors were described favorably, with online platforms and portable devices also being options.

Our results highlight the importance of increasing information and education about anxiety to older adults. This may increase awareness of anxiety and reduce delays in seeking help or not seeking help at all. Findings also emphasize the need for clinicians to support understanding of anxiety in older adults that they are seeing and provide information and education where needed. It is likely that PA interventions to reduce anxiety, with the option of a technology component with support, will be acceptable to most older adults.

People living with depression are at increased risk of poor health outcomes, including dementia. Interventions to reduce dementia risk (dementia risk reduction (DRR)), include physical activity, diet and vascular health interventions. These can also benefit depressive symptoms and broader health, making DRR an important part of holistic mental health care for depression. However, enabling engagement and adherence, and embedding interventions in mental health clinician practice are ongoing challenges that limit the impact of interventions and implementation in clinical practice. Improved intervention tailoring and new approaches to intervention design and implementation are urgently needed. Co-design approaches have been shown to improve engagement and the impact of complex interventions in diverse fields, but have not previously been used in DRR.

The ENGAGED study will examine DRR intervention needs specifically for people living with depression, then co-design a tailored DRR intervention for use in mental health clinical settings.

The study will adapt a co-design model for mental health settings that emphasizes lived-expertise, and incorporate processes and evidence from behavioral science. Participants will include middle-aged and older people living with depression, and mental health clinicians.

Semi-structured interviews with both participant groups will examine unmet intervention needs. Illuminated shared experiences and themes will be explored further through focus group discussions to develop consensus intervention priorities. They will also be analyzed to produce a contextualized model of relevant behavior change. Participants and researchers will then work together to co-design intervention components and refine prototypes. Finally, mixed methods survey will evaluate the co- design process and participant experiences.

This study will provide two key outputs to enhance future intervention tailoring and engagement:

1. 1. 1) a pragmatic blueprint for DRR intervention with people experiencing depression across diverse mental health clinical settings, ready for evaluation and implementation

2. 2. 2) a model of DRR behavior change that is specified to this population.

This research addresses the need for new approaches to tailored, integrated mental, physical and cognitive healthcare for people living with depression that emphasize stakeholder expertise and engagement to facilitate holistic support.

Assessment scales for motor symptoms in Parkinson’s disease (PD) lack the sensitivity and resolution to monitor symptoms over time. Wearable sensors in people with PD have shown potential to assess motor symptoms. The DIGI.PARK study explores the use of consumer- and research-grade wearables such as Fitbit Sense (FS), Oura ring (OR) and Empatica E4 (EM) to track behavioral patterns and symptoms of PD over time.

The DIGI.PARK pilot study (12.2021 to 12.2022) included N = 30 participants living in Bergen, Norway (N=15 persons with PD and N=15 controls). Outcome measures: self-reported diary of symptoms and behavior combined with data streams from three wearable devices (FS, OR, EM). Data was collected over 2 weeks: continuously by devices, and diary data every second day consisting of activities, sleep, medication timing (PD) and symptom occurrence (PD). The device data were segmented into 24-hour epochs. Heart rate (HR), heart rate variability (HRV), acceleration, blood volume pulse (BVP), inter-beat interval (IBI), electrodermal activity, metabolic equivalent of task (MET) and hypnogram were visualized as time series. The resulting graphs were annotated with the reported diary data and a manual checking procedure was applied to determine the correlation between sensor outputs and the logged instances of activity, sleep and symptoms.

Self-reported behavior was discernable in the measurements of HR, EDA, BVP, HRV, acceleration, MET and hypnogram. We found considerable differences in device outputs regarding data type, data size, resolution, and periods of active measurements. Tremor symptoms were observable in the raw data provided by EM when worn on the affected hand. Behavioral patterns such as sleep, waking and physical activities were illustrated using aggregated data.

Sensor congruence with diary data support their usefulness for long term monitoring of behavioral patterns and symptoms in PD. For PD research, output from consumer- and research-grade devices have both shown usefulness. The choice of device should be tailored to the purpose and be mindful of the specific strengths and weaknesses of different device types. Aggregated data allow for monitoring behavioral patterns over time, whereas raw data provided the resolution to discern symptoms.

Social connection is important for health, quality of life and care in long-term care (LTC) homes. However, research on how to improve social connection in LTC has been limited by lack of consensus on best approaches to measurement.

We will present a systematic review of measures of social connection developed for use in LTC residents, which aims to identify all existing measures and evaluate their measurement properties including structural validity, internal consistency, reliability and construct validity.

We are following Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic review methods. We searched multiple bibliographic databases from inception to November 2021 for studies that were conducted in LTC resident populations, quantified any aspect(s) of social connection, and reported at least one psychometric property for the measure(s) of social connection. We conducted a second targeted search in April 2022 based on our list of identified measures, supplemented with a list of measures used in previous research in this population. We are currently evaluating the measurement properties reported for each identified measure in accordance with COSMIN guidelines.

We have identified 68 studies reporting on 35 measures used to assess multiple aspects of social connection in LTC homes. The majority (n=25) were measures of quality of life, wellbeing or life satisfaction, which included a social connection subdomain, whilst only 10 measures specifically target social connection. From our pooled evaluation of 20 measures to date, we have found that 20% (n=4) have sufficient evidence of structural validity, 15% (n=3) have sufficient internal consistency, 25% (n=5) have sufficient reliability, and 15% (n=3) have sufficient construct validity.

Many measures have been used to assess social connection in LTC settings, but few are specifically designed for this purpose and they often have insufficient evidence for psychometric properties. This review will provide detailed evidence of the quality of these measures to enable future researchers to prioritise higher quality tools and will inform our development of a new person-centred social connection measurement tool for LTC residents in the Social Connection in Long-Term Care Home Residents (SONNET) study.

Previous studies investigating neuropsychological profiles of cognitive impairment people have found a learning curve can be a useful indicator of AD diagnosis or progression. However, the data on the relationship between amyloid β (Aβ) deposition status and the learning curve in amnestic mild cognitive impairment (aMCI) are limited. In this study, we investigate the role of the learning curve in predicting Aβ deposition status in patients with aMCI.

This is a cross-sectional study of 67 aMCI patients (N = 67; 33 aMCI with amyloid positive (Aβ-PET (+)), and 34 aMCI with amyloid negative (Aβ-PET (-))). All participants underwent Seoul Neuropsychological Screening Battery for a comprehensive neuropsychological test battery and brain MRI. To determine Aβ deposition status, each participant underwent amyloid PET scans using 18F-florbetaben. The learning curve was obtained using immediate recall of Seoul Verbal Learning Test-learning curve (SVLT- learning curve). The association of cognitive test scores and dichotomized Aβ deposition status was examined using logistic regression models in patients with aMCI. Receiver operating characteristic (ROC) curves were used to examine the predictive ability of cognitive test to detect Aβ deposition status in aMCI.

Logistic regression models showed that SVLT-learning curve and Rey Complex Figure Test- delayed recall (RCFT-delayed recall) scores were significantly associated with Aβ deposition status. In ROC analysis to assess the predictive power, SVLT-learning curve (area under the curve (AUC) = 0.734, P = 0.001) and RCFT-delayed recall (AUC = 0.739, P = 0.001) independently discriminated Aβ-PET (+) and Aβ-PET (-). The combination of these clinical markers (SVLT-learning curve and RCFT-delayed recall) improved the predictive accuracy of Aβ-PET (+) (AUC = 0.833, P < 0.001).

Our findings of association of Aβ deposition status with SVLT-learning curve and RCFT- delayed recall suggest that these cognitive tests could be a useful screening tool for Aβ deposition status among aMCI patients in resource-limited clinics.

Reviews show that music interventions may be effective in reducing depressive symptoms among nursing home residents. Since interventions use various ways to include music, results on the effectiveness on depressive symptoms are often inconsistent. A previous review found that receptive music interventions (e.g., music listening) are more effective than active music interventions to reduce depressive symptoms among nursing home residents. Other research suggest that active music interventions (e.g., playing instruments, dancing) are more effective. Moreover, therapists seem to prefer using active music interventions. Because of its low costs, the previously found effectiveness and low side effects, it is important to gain more insight into components specific to the intervention that may contribute to its effectiveness in reducing depressive symptoms. This insight may help to fine-tune interventions and develop treatment protocols.

A Bayesian Network Meta-analysis was conducted to calculate the relative effectiveness of interventions including music. In addition, different network-meta-regression analyses were conducted to explorer components that may contribute to the effectiveness of the included studies.

Our search strategy resulted in N=22 eligible Randomized Controlled Trials (RCT), that included music in the reported interventions. Compared to Care as Usual, a multidisciplinary approach including music was the most effective (MD=-0.92, 95% CrI -2.8 to 0.97), followed by music interventions focused on sensory stimulation (MD=-0.43, 95% CrI -1.1 to 0.19), music interventions with reminiscence (MD=-0.38, 95% CrI -1.2 to 0.45) and cognitive interventions with music (MD=-0.31, 95% CrI -2.0 to 1.40). Level of depression (ƅ=-0.88, CrI 95% [-1.81 to 0.06]), and being physical dependent (ƅ=-0.29, CrI 95% [-1.20 to 0.61]), moderated the effectiveness of interventions, although this was not significant. We did not found any difference between active and receptive music interventions.

In the constructed network, interventions that included music, were not more effective in reducing depressive symptoms among nursing home residents when compared to the care as usual group. However, some subgroups seem to benefit more from music than others. To gain more insight in the effectiveness of music in reducing depressive symptoms, more research is needed, targeting those specific target groups.