DementiaDementia Research in Research in GrampianGrampian

J Stephen BellJ Stephen Bell

Consultant Clinical Neuropsychologist, NHS Grampian Honorary Reader, University of AberdeenNetwork Co-ordinator, Alzheimer’s Research UK

Arduino Mangoni Arduino Mangoni Chair in Medicine of Old AgeChair in Medicine of Old Age

• Modulation of endothelial function and Modulation of endothelial function and arterial stiffnessarterial stiffness

• Anticholinergic drugs, functional status Anticholinergic drugs, functional status and outcomes in older patientsand outcomes in older patients

• Cardiovascular safetyCardiovascular safety• Role of arginine methylation in Role of arginine methylation in

relationship between vascular risk relationship between vascular risk factors and ADfactors and AD

Roy SoizaRoy SoizaConsultant GeriatricianConsultant Geriatrician

• Impact of vascular ageing and Impact of vascular ageing and disease on the development of disease on the development of Alzheimer’s DiseaseAlzheimer’s Disease

• Medical co-morbidity of ADMedical co-morbidity of AD• Cognitive effects of hyponatraemiaCognitive effects of hyponatraemia

Alison MurrayAlison MurrayClinical Senior Lecturer in RadiologyClinical Senior Lecturer in Radiology

•Structural, functional and molecular Structural, functional and molecular imaging in brain ageing and dementiaimaging in brain ageing and dementia

•Biomarkers of cerebrovascular disease Biomarkers of cerebrovascular disease and ADand AD

•Analysis of MRI data, ABC 1921 & 1936Analysis of MRI data, ABC 1921 & 1936•SPECT and MRI, “rember” trialSPECT and MRI, “rember” trial

Roger StaffRoger StaffSenior Physicist, Biomedical PhysicsSenior Physicist, Biomedical Physics

•Regional cerebral blood flow and Regional cerebral blood flow and cognitive performance, aberrant motor cognitive performance, aberrant motor behaviour, prognosis, emotional facial behaviour, prognosis, emotional facial processing in dementia processing in dementia

•fMRI entropy in old agefMRI entropy in old age•Structural MRI – ABC 1921 & 1936Structural MRI – ABC 1921 & 1936•Childhood variables and late life disease, Childhood variables and late life disease, disability and brain structure disability and brain structure

Andrew WelchAndrew WelchChair in School of Medical SciencesChair in School of Medical Sciences

PET, development of PET, development of molecular imaging tracers for molecular imaging tracers for translational medicinetranslational medicine

Louise PhillipsLouise Phillips Chair in PsychologyChair in Psychology

•Adult ageing and social and emotional Adult ageing and social and emotional skillsskills

•Effects of dementia and stroke on Effects of dementia and stroke on social and emotional processingsocial and emotional processing

•Age, planning and prospective memoryAge, planning and prospective memory•Lifespan development of self-regulationLifespan development of self-regulation

Claude WischikClaude WischikChair in Mental HealthChair in Mental Health

•Protein aggregation in neuro-Protein aggregation in neuro-degenerative diseasedegenerative disease

•Molecular neuropathology of Molecular neuropathology of AD, particularly tau AD, particularly tau

Gernot RiedelGernot RiedelChair in Systems NeuroscienceChair in Systems Neuroscience

•Psychopharmacology and Psychopharmacology and physiological psychologyphysiological psychology

•Models for translational Models for translational medicine for preclinical medicine for preclinical drug development drug development

Bettina PlattBettina PlattChair in Translational NeurosciencesChair in Translational Neurosciences

•Preclinical models of CNS Preclinical models of CNS disorders disorders

•Mechanisms of neuronal plasticity, Mechanisms of neuronal plasticity, degeneration and protectiondegeneration and protection

•AD and neurodegeneration in the AD and neurodegeneration in the hippocampus hippocampus

Paul HaggartyPaul HaggartyHead of Lifelong Health at Rowett Head of Lifelong Health at Rowett

InstituteInstitute

•Epigenetics (gene-specific and Epigenetics (gene-specific and genome-wide) of ageing and its genome-wide) of ageing and its links to early life eventslinks to early life events

•Cognitive ability and ageingCognitive ability and ageing•Dementia Dementia •Stroke and vascular diseaseStroke and vascular disease

Swinton J & Mowat H (2012)Swinton J & Mowat H (2012)

Aim:Aim: Understanding and meeting the Understanding and meeting the spiritual spiritual

needs of people with advanced needs of people with advanced dementiadementia

Method:: Six Stepped Facilitated Process to Six Stepped Facilitated Process to identify identify

community of care in residential community of care in residential care /care /

hospital / home settings and churchhospital / home settings and churchcongregations; spiritual care support congregations; spiritual care support incorporated into person-centred care incorporated into person-centred care

planplan

Vaitheswaran S & Walker A Vaitheswaran S & Walker A (2012)(2012)

Aim:Aim: Assess the point prevalence of Assess the point prevalence of cognitive impairment depressive cognitive impairment depressive symptoms and symptoms and anxiety symptoms anxiety symptoms in community in community dwelling people dwelling people over 75 in Aberdeenover 75 in Aberdeen

Method:: Screening by CPNs + GP Screening by CPNs + GP AssessmentAssessment

NON-PHARMACOLOGICAL NON-PHARMACOLOGICAL INTERVENTIONS (NPIs) INTERVENTIONS (NPIs)

•Alternatives and adjunctsAlternatives and adjuncts

•Positive effects (>50% RCTs; = medication)Positive effects (>50% RCTs; = medication)

•General absence of side-effectsGeneral absence of side-effects

•Positive impact on caregiverPositive impact on caregiver

•Benefits diminish quickly after treatment Benefits diminish quickly after treatment cessation cessation

•Multi-component interventions betterMulti-component interventions better

•Education and support; behavioural Education and support; behavioural management; cognitive and physical stimulation management; cognitive and physical stimulation

Cognitive trainingCognitive training Education EducationCognitive stimulation Cognitive stimulation Support/counselling Support/counselling Behavioural management Behavioural management MCIMCIExerciseExerciseADL TrainingADL TrainingMCI (MCI (>> case management) case management)

(music, light, massage, sensory stimulation, (music, light, massage, sensory stimulation, recreation, reminiscence, relaxation, acupuncture) recreation, reminiscence, relaxation, acupuncture)

NON-PHARMACOLOGICAL NON-PHARMACOLOGICAL INTERVENTIONSINTERVENTIONS

PWDPWD CGCG

Cognition Cognition Mood Mood ADLs ADLs Wellbeing Wellbeing

Behaviour Behaviour QoLQoL Mood Mood QoL QoL Institutionalization delay Institutionalization delay

OUTCOMES – which?OUTCOMES – which? PWDPWD CG CG

ISSUESISSUES

•Evidence (and ideally, theory) base•Availability•Accessibility•Specialist expertise•Appropriateness•Acceptability•Flexibility•Cost•Sustainability•Generalisation•Integration with other resources

CAREGIVER TRAININGCAREGIVER TRAINING

•Achievable?•Treatment integrity?•Maintenance?•Adverse impact on carer burden and well-being?•Efficacy?•Long-term benefit?•Cost-effectiveness?

Maarten MildersMaarten Milders

Reader in Psychology, Heriot Watt Reader in Psychology, Heriot Watt UniversityUniversity

(Formerly Senior Lecturer in Psychology,(Formerly Senior Lecturer in Psychology,University of Aberdeen)University of Aberdeen)

Milders M, Bell S, Lorimer A, Milders M, Bell S, Lorimer A, MacEwan T & McBain A (2012)MacEwan T & McBain A (2012)

Cognitive stimulation by caregivers Cognitive stimulation by caregivers for people with dementia: for people with dementia: acceptability and treatment integrityacceptability and treatment integrity

METHODMETHOD• 30 pairs, PWD + main CG30 pairs, PWD + main CG

• CG trained to carry out 3 CS sessions per CG trained to carry out 3 CS sessions per weekweek

• 2 initial sessions, 4 follow-up; manual2 initial sessions, 4 follow-up; manual

• Support during first 8 weeks onlySupport during first 8 weeks only

• PWD : cognition, mood, ADL, QoLPWD : cognition, mood, ADL, QoL

• CG : burden, mood, QoLCG : burden, mood, QoL

• Pre –, Post – (+8 and +16 weeks)Pre –, Post – (+8 and +16 weeks)

• 33/58 consented (-4)33/58 consented (-4)

• 21/29 completed21/29 completed

FINDINGSFINDINGS

• Carer training achievable: good adherence, Carer training achievable: good adherence, maintenancemaintenance

• CS by caregivers acceptable to PWD: no CS by caregivers acceptable to PWD: no negative effect on well-being negative effect on well-being

• No adverse effect on CG burden or QoL, No adverse effect on CG burden or QoL, limited impact on moodlimited impact on mood

Milders M, Bell S, Lorimer A, MacEwan Milders M, Bell S, Lorimer A, MacEwan T, Law J, Connelly P, Norrie J, Law E, T, Law J, Connelly P, Norrie J, Law E,

McBain A & McCalden A (2012)McBain A & McCalden A (2012)

Multi-component intervention Multi-component intervention for people with dementia and for people with dementia and family caregiversfamily caregivers

Can multicomponent NPI be Can multicomponent NPI be offered by health services and offered by health services and maintained in sustainable way?maintained in sustainable way?

• CGs involved in presenting the interventionCGs involved in presenting the intervention

• CG education, teaching CG skills (coping, CG education, teaching CG skills (coping, challenging behaviour) and to stimulate challenging behaviour) and to stimulate PWD (physical and cognitive)PWD (physical and cognitive)

• Manuals for CGs and trainers (health care Manuals for CGs and trainers (health care professionals)professionals)

• 8 sessions of CG training in small groups8 sessions of CG training in small groups

• Main outcome PWD : daily functioning, QoLMain outcome PWD : daily functioning, QoL

• Main outcome CG : burden, QoLMain outcome CG : burden, QoL