Transcranial direct current stimulation (tDCS) has been proposed to affect long-term synaptic plasticity through LTP and LTD, thereby improving cognitive ability. In pathology, the amyloid deposits in AD disrupts the balance between long-term potentiation (LTP) and long-term depression (LTD) of neuronal cells and synaptic plasticity. An increasing number of studies have been concluded a positive therapeutic effect on cognition in AD. In brain stimulation, dorsolateral prefrontal cortex (DLPFC) was associated with improvements in memory enhancement, language, processing speed, global cognitive symptoms, and apathy over a period of treatment. Theoretically, the aftereffect of tDCS would need to be re-stimulated by tDCS to maintain its delayed plastic response benefits. In this pilot study, we investigate the maintenance effects of continuing tDCS at three different times, weekly, every two weeks, and every four weeks, for 12 weeks.

Twenty-eight AD participants aged 55-90 years were enrolled (mean age 72.7, 77.3, and 76.2 in the three groups - maintained weekly (7 cases), biweekly (9 cases) and every 4 weeks (12 cases)). The anodal electrode was placed over the left dorsal lateral prefrontal cortex and the cathodal electrode was placed over the right supraorbital area. In each active session, we applied a current intensity of 2 mA and an electrode size of 25 cm2 for 30 min. All subjects received a series of neuropsychological assessments including CDR, MMSE, CASI and WCST at (1) baseline, (2) post-10sessions of tDCS (in 2weeks), and (3) post-maintenance phase (total of 12 weeks). Chi-square tests, Wilcoxon signed rank tests and Mann-Whitney U tests were used to assess differences in participant demographic characteristics and to compare differences in test scores between groups.

After 10 sessions of tDCS stimulations, the total CASI scores in the 1-week group improved significantly from baseline to 2 weeks. However, there are no significant difference in MMSE, CASI or WCST between baseline and after maintain phase stimulations in each group.

Although tDCS has a positive effect in AD, it is recommended to prolong the number of tDCS stimulations, such as 20 sessions in 4 weeks.

There is increasing focus on effective preventative interventions applicable at the population scale such as through technology and web-based approaches. We aimed to reduce cognitive decline with ageing using an online package of interventions delivered intensively for 12 months followed by monthly boosters for 24 months.

Invitations were sent to people aged 55-77 years from the 45 and Up study, a population-based cohort study of one in ten people aged 45 years and older in New South Wales, Australia (n=267,000). Participants were required to be eligible for at least two of four modules addressing physical inactivity and associated health risks (Physical Activity), adherence to a Mediterranean-type diet and health risks associated with poor nutrition (Nutrition), cognitive activity (Brain Training) and mental well-being (Peace of Mind). Participants received modules based on their risks, with 1:1 randomized allocation to active personalised coaching modules (intervention) or static information-based modules (control). The primary outcome was change in an online combined multi-domain cognitive score measured using COGSTATE and Cambridge Brain Sciences tests using intention to treat analysis. Secondary outcomes included specific cognitive domain and ANU-ADRI risk scores.

From 96,418 invitations, 14,064 (14%) consented; 11,026 (11%) were eligible; and 6,104 (6%) completed all 10 baseline assessments. Over three years there was a significantly greater improvement in the global composite cognition z-score in the intervention group, ES = 0.106 (p<0.001). Significant benefits were also found in complex attention, executive function and learning and memory (all p<0.001), as well as on a validated dementia risk instrument (p=0.007).

An online platform that tailored physical activity, nutrition, brain training, depression and anxiety interventions to an individual’s risk factor profile over three years significantly delayed cognitive decline in older adults. This platform is scalable and if rolled out at a population level may help reduce the prevalence of dementia globally.

Explore end-user evaluations and feedback focused on lifestyle change in a large-scale multidomain online intervention targeting modifiable risk factors for dementia.

Online survey and semi-structured interviews at conclusion of the Maintain Your Brain (MYB) randomized controlled trial. Participants were 55-77 years of age at baseline, and had engaged in assessments, brain training, nutrition and physical activity, and mental health modules over three years. Of 5,260 participants invited, 2,386 completed online surveys and 1,589 of these respondents provided free text comments. Nearly 250 survey respondents agreed to be contacted for additional interviews; 70 of these were invited, 40 interviewed. Survey respondents and interview completers endorsed whether they had made lifestyle changes because of MYB participation and whether they would continue healthy lifestyle changes going forward. Interview participants endorsed whether they thought similar programs can be useful in delaying or preventing dementia, whether their views regarding this type of program had changed over time, answered open-ended follow-up questions and provided additional feedback. Data were summarized using descriptive statistics and explored using multiple qualitative methods.

Of survey respondents, 90.5% endorsed intention to continue a healthier lifestyle; 63.2% endorsed that lifestyle changes had occurred. Interview participants thought similar programs could be useful in delaying or preventing dementia, but some were unsure. Trial participation had not changed many individuals’ views about online lifestyle programs. Survey free-text and interview comments indicated diversity in pre-intervention knowledge, lifestyle and health-related behavior. Many respondents reported improved knowledge and awareness, some detailed relevant and continued lifestyle change. Those who were already well informed and/or leading healthy lifestyles explained that trial participation had confirmed their existing practices. Trial characteristics, personal characteristics, social relationships and significant events impacted whether respondents had made and/or continued changes. More flexible, adaptive individually tailored goals and timely feedback were requested to better support change.

Surveyed participants who engaged in the 3-year MYB online multidomain dementia risk reduction program reported lifestyle changes and intention to continue having a healthier lifestyle. Older adults in this study suggested that similar online programs need to provide flexible, individualized guidance and feedback to support lifestyle change.

Ageism is defined by the World Health Organization as stereotypes, prejudice, and discrimination towards others or oneself based on age. Ageism is thought to pose a risk to the physical and mental health of older adults, but little is known about how to measure it in LPUs. We propose that a form of ageism can be detected by comparing the referrals made by liaison psychiatry services among patients over age 65 at discharge with functional status and medical comorbidity. Our hypothesis is that the worse the functional index and medical comorbidity, the fewer referrals to psychiatric services and the more referrals to primary care physicians.

This is an observational, cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to seven general hospitals in Spain referred from different departments to each LPU. Data was collected over a period of one and a half months. Psychiatric evaluations were performed while the patients were in the wards. Sociodemographic, clinical, and care variables were collected. Functional status was measured with the Barthel and Lawton index and comorbidity with the Charlson index.

We obtained a sample of 165 patients with a mean age of 76,03 years old. The mean Barthel index was 87,18 previous admission and 61,15 at the time of our first visit. The mean Lawton index was 5,266667 and the Charlson index was 6,03. The different options for referral were primary care physician, psychiatric facilities, nursing homes, substance use centers, or exitus. Statistical analysis was performed using the nonparametric Kruskal-Wallis test to determine if there were significant differences (p < 0,05) between the indices and referrals. Contrary to our hypothesis, statistical significance was observed only for the Lawton index, but with more referrals to psychiatric facilities among patients with the worst functional scores. No other statistical significance was observed.

Functional status and medical comorbidity did not play a role in the referral of inpatients managed by LPUs. Further studies are needed to clarify whether there is any form of ageism in the referral of elderly inpatients attended by Psychiatric Liaison Units.

Meaning and purpose in life has demonstrated positive effects on physical and mental health and loneliness. We wanted to understand whether, among older adult couples, the impact of meaning and purpose in life on loneliness was mitigated by their assessment of the quality of their relationship with their partner, and their social support from family and friends.

Participants were 101 nondemented older adults living with a spouse or partner and participating in an ongoing longitudinal study of couples. As part of their baseline visit, they completed a series of questionnaires to measure demographic information, physical and psychological well-being, loneliness, meaning and purpose in life, quality of dyadic relationship (measured by the Dyadic Adjustment Scale), and various aspects of social support (instrumental, informational, and emotional).

The average age of participants was 74.7 (SD = 6.71) and 49% were female. Bivariate correlations demonstrated statistically significant relationships between loneliness and meaning and purpose in life, relationship satisfaction, and emotional, informational and instrumental support but not age and gender. In a multiple regression analysis, meaning and purpose in life was the strongest predictor of loneliness (β = - 0.322, p < 0.001); relationship quality (β = -0.263, p = 0.005), emotional (β = -0.229, p = 0.048) and instrumental support (β = -0.203, p = 0.024), also predicted loneliness, F(5,95) = 12.19, p < 0.001, adjusted R2= 0.36.

In this study, all participants were older adults and members of a couple. Even when they rated their relationships with their partners as having high quality, they nevertheless expressed more loneliness when they had less meaning and purpose in life. While satisfaction with instrumental and emotional support had a positive impact on loneliness; perhaps surprisingly, relationship quality was less important than meaning and purpose in life. Apparently, having a sense of meaning and purpose in life is an ongoing need that extends to old age. This finding, if replicated in a larger longitudinal study has implications for social policy that facilitates inclusion of older adults in meaningful roles, rather than having them age out.

Health disparities between communities with greater and lesser advantages are a global concern. In the USA, self-identified race as African American (AA) is consistently associated with mild cognitive impairment (MCI) and dementia, compared to Americans of European descent. In a prospective population-based study, we sought to confirm this association and investigate potential explanatory factors.

The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) and Seniors Project 15104 (SP15104) studies recruited adults aged 65+ years from a group of small towns of lower socioeconomic status in the US. MYHAT recruited by age-stratified random sampling from the voter registration list for all towns; SP15104 recruited by intensive community engagement from three towns with populations that are 60% AA. Based on the Clinical Dementia Rating (CDR), MCI was defined as CDR=0.5 and dementia as CDR > 1. Using Cox proportional hazard models, we modeled time to incident CDR > 0.5 from baseline as a function of race (AA vs. all other), other demographics, and several other covariates at baseline.

The sample of 2120 individuals was 8% AA, and 62% female, with median age of 73y, and median educational level of partial college. During follow up of up to 14.5 years, 499 participants developed new-onset MCI/dementia (CDR >0.5). Cox models revealed that being AA was significantly associated with incident CDR > 0.5 (HR=1.45. 95% CI:1.01,2.10). Inclusion of age, sex, and education in the model increased the HR for race to 1.63 (1.1, 2.3). Adding number of regularly taken prescription drugs (reflecting overall morbidity), depression symptoms, preceding year alcohol consumption, and number of visits to emergency or urgent care together reduced the HR to 1.4 (0.96, 2.0), no longer statistically significant

In this population-based cohort study, self-identified African Americans had an about 40% elevated risk of developing MCI/dementia. Adjusting for demographics, the significant association between race and incident MCI/dementia was attenuated by variables reflecting depression, greater general morbidity, and lesser access to regular health services. These variables possibly reflect downstream effects of historic discrimination, but couldstill be modifiable risk factors for MCI/dementia. Addressing them could potentially mitigate ethno-racial disparities in cognitive impairment.

Telehealth has been an important method of health care delivery during the pandemic, particularly for older adults who have been more vulnerable to the physical and psychosocial impacts of the pandemic and associated isolation. Older adults have specific medical and mental health care needs that would benefit from having access to geriatric speciality services, however these services may be difficult to access especially for those living in rural areas. Though the use of technology and telehealth has greatly expanded during the pandemic, many health systems and clinicians lack the necessary knowledge, skills and attitudes to fully integrate technology in the health care of older adults. General telehealth competencies are available to guide educators, however, competencies to address the unique needs of older adults have yet to be developed.

This literature review was conducted to evaluate what approaches are needed for clinicians to gain skills and knowledge in order to competently deliver telehealth services to older adults.

The review was completed using the six-stage scoping review process in line with the PRISMA checklist in PubMed/Medline and other databases from years 2000 to 2023 based on concept areas of (I) education/competencies, (II) telehealth delivery and (III) older adults.

From a total of 813 articles, the authors found 88 eligible for full text review and 16 papers sufficiency relevant to the search criteria. Some evidence exists for telehealth competencies specifically for clinicians caring for older adults. Themes that emerged include the role of interprofessional and experiential learning, telepresence, technology training and support, and adaptations for older adults. Education of clinicians and trainees increased knowledge of its usefulness and improved attitudes related to acceptance and utilization. Training rather than ad hoc exposure to telehealth technology was emphasized. Clinician/student-provided training improved access and acceptance to telehealth in older adults. Suggested adaptations for older patients included the involvement of caregivers in the visit, especially for patients with cognitive impairment.

It appears that training – more than ad hoc experience – for clinicians and trainees increases knowledge, skills and attitudes toward telehealth for the care of older adults. Additional research is needed to define training interventions, cross-sectional versus longitudinal approaches and specify competencies (i.e., skills) and optimal learning methods.

Despite a need to provide support to people with dementia and informal caregivers to live well with dementia, the availability of psychological interventions to enhance wellbeing and support mental health problems such as depression for people with dementia are limited. A potential solution is behavioural activation, an evidence-based intervention for depression that seeks to target behavioural avoidance. Behavioural activation can be delivered in a written self-help format, with support provided by an informal caregiver, who in turn receives guidance from a healthcare professional. However, it is necessary to develop and tailor self-help interventions to the needs and preferences of specific populations.

To explore the needs and preferences of people with dementia, informal caregivers, and professional stakeholders to ensure cultural appropriateness, relevancy, and acceptability of the intervention.

Participatory action research with co-design principles using semi-structured interviews and focus groups. People with dementia (n=8), informal caregivers (n=19), healthcare professionals (n=18), and community stakeholders (n=7) were provided with draft versions of the behavioral activation written self-help intervention and a proposed intervention delivery model. Open-ended questions explored preferences concerning preferred intervention delivery setting, type of support and guidance provided, perceived relevance of the intervention content and language, and ways to enhance relevancy, cultural appropriateness, and acceptability.

Analysis resulted in an overarching theme: Tailoring and flexibility, and three categories: Intervention process, material and context; Support and guidance; and Time. Results informed adaptations to the intervention content and delivery model, including: (1) reducing the amount of material to minimise treatment burden; (2) increasing the relevance of case stories and illustrations to Swedish society and culture; (3) modernising the design and illustrations; (4) including a case story of a person with young onset-dementia; (5) increasing the flexibility of the delivery model (e.g., delivery outside of traditional health care settings); and (6) providing additional guidance to informal caregivers.

Stakeholders expressed a need for tailoring and flexibility throughout intervention delivery, and for cultural adaptations to intervention content to improve perceived appropriateness and relevance. A planned feasibility study will examine the feasibility, acceptability, relevancy and cultural appropriateness of the intervention and delivery model.

To explore barriers towards mental health services for older adults with symptoms of depression and/or anxiety in a low-resource community in Lima, Peru. We explored these barriers from the perspective of older adults and health providers.

We conducted an interview-based qualitative study. The first set of interviews was carried out between October 2018 and February 2019, and the second, between January 2022 and September 2022. In the first sample, we interviewed 38 older adults ≥60 years with symptoms of depression (Patient Health Questionnaire-9 ≥ 10), anxiety (Beck Anxiety Inventory ≥ 16), or those who had previous experience using formal mental health care irrespective of current symptoms. In the second sample, we included 20 health providers (8 psychologists, 2 general practitioners, 2 nurses, 4 psychiatrists, 4 social workers). We used an inductive thematic data analysis.

We identified two main barriers: stigma towards mental health conditions and care, and ageism. Stigma and ageism interacted with each other and exacerbated other barriers to mental health services. Stigma led to negative labels for people with mental health conditions and shame among older adults to disclose their feelings to health providers. Looking at the health system, health care facilities were described as not being age friendly. Additionally, aside from psychologists and psychiatrists, most providers mentioned little previous training in mental health care, but even less about the nuances of treating mental health challenges in old age. Among older adults, other important barriers were the accumulated mistrust towards health professionals and lack of knowledge about existing services and how they work. Importantly, older adults mentioned competing priorities, for example, not having time to seek care because they needed to work to obtain food. Other barriers included hidden costs incurred for transportation to health centers or to obtain medications. For older adults with diminished physical mobility, lack of accompaniment to attend health appointments was another important barrier.

Community-based mental health interventions towards older adults need to address ageism and mental health stigma to improve access to care. Furthermore, training for health providers must be improved and expanded to prioritize older adult mental health care.

The numbers of older people experiencing both homelessness and Alzheimer’s disease and related dementias are growing, yet their complex health, housing and care needs remain undelineated and unmet. Older people experiencing homelessness have high levels of memory and cognitive impairment relative to stably housed age equivalent populations. In this study we aim to address a critical gap in understanding what can improve the care, support and experiences of older people experiencing homelessness with memory and other cognitive impairments.

To explore how stakeholders understand and experience memory problems among older people experiencing homelessness. We consider what they perceive to be meaningful outcomes for those living with memory problems and those supporting them and what gets in the way of achieving good care and support for these individuals.

We conducted reflexive thematic analysis of qualitative interviews (n=49) with 17 older people (aged ≥50 years) experiencing memory and other cognitive problems and homelessness, 15 hostel staff and managers, and 17 health, housing and social care practitioners working in England.

We identified four overarching themes. The population is not taken seriously; you ‘can’t see the wood for the trees’; risk of exploitation and vulnerability; and (dis)connection and social isolation. The transience of homelessness intensified the disorienting nature of memory and cognitive impairment. Older people experiencing homelessness and memory problems fall through gaps in service provision further fragmenting their lived experiences and intensified by cognitive difficulties. Those providing direct and indirect support required flexibility and persistence to advocate, provide care and safeguard individuals, with staff moving beyond traditionally commissioned roles to advocate, provide care and safeguard individuals.

Efforts to meet the needs of older people living with Alzheimer’s disease and related dementias and experiencing homelessness must reflect the complexity their lives and current service provision. These findings have been used to co-design a psychosocial care and support intervention for hostel staff to be tested in a feasibility trial.

Sleep disturbance affects all aspects of mental and physical functioning and quality of life and may lead to or worsen Alzheimer’s disease. Sleep disturbances in people with dementia living at home predicts care home admission and carer distress. Estimates of the prevalence of sleep disturbance vary, and it is unclear how prevalence rates differ according to setting. We conducted the first systematic review and meta-analysis on the prevalence of sleep disturbances in people living with dementia in the community. We aimed to examine demographic predictors and whether overall prevalence has changed over time.

We searched Embase, MEDLINE and PsycINFO for studies reporting the prevalence of sleep disturbances in people with dementia living at home. We meta-analysed data and calculated the pooled prevalence of sleep disturbances in people with dementia overall and in dementia subtypes. We used meta-regressions to investigate the effects of study characteristics, publication dates and participant demographics.

Eleven studies fulfilled the inclusion criteria. The pooled prevalence of any symptoms of sleep disturbance was 26% (95% confidence intervals (CI): 23-30%; n= 2719) and of clinically significant sleep disturbance 19% (95% CI: 13-25%; n= 2753). The pooled prevalence of sleep disturbance symptoms was significantly lower among people with Alzheimer’s disease (24%; 95% CI: 16-33%, n=310) than Lewy body dementia (49%; 95% CI: 37-61%, n=65). Meta-regression analysis did not find that publication year, participant’s age, sex and study quality predicted prevalence.

Sleep disturbances are common among people with dementia living in the community, especially in Lewy body dementia. There was no change in prevalence according to publication dates (between 2002 and 2018). This suggests that possible advances in treatment of sleep disturbance are not reflected in improvements for people living with dementia. This highlights the need to develop effective intervention strategies, reducing the prevalence of sleep disturbances in people living with dementia living at home in the community.

By the end of the session, participants will be able to:

1. 1. Describe the Baycrest Quick-Response Caregiver Tool

2. 2. Describe the role for the Baycrest Quick Response Caregiver Tool in BPSD

3. 3. Describe the results of studies to date

Behavioral and Psychological Symptoms of Dementia (BPSD) are common and are associated with poor outcomes and caregiver burden. A variety of frameworks and tools exist to assess and understand the symptoms and to plan interventions. The Baycrest Quick-Response Caregiver Tool TM (BQRCT) is different than other tools as it assists the caregiver in real time as the BPSD are occurring. A mixed methods feasibility study in family caregivers found favorable results. Scaling up this tool for long term care (LTC) staff can potentially benefit residents living with dementia. The goal of this presentation is for participants to describe this novel tool, its evidence, and its place within the known tools and frameworks for BPSD.

Participants will interactively learn about the BQRCT, how it is applied with caregivers, and how it works with other tools for BPSD. The training videos will be viewed and discussed. The evidence from a mixed methods study of this tool will be presented and compared to evidence for other tools. The methods and preliminary results (if available) for an ongoing study of the BQRCT in the LTC context with be presented.

A mixed methods study of family caregivers and health-care providers of persons with dementia and BPSD found that the BQRCT was helpful and participants reported high feasibility ratings. The group of health-care providers found the tool useful and most would recommend it to peers and clients. Participants also provided specific suggestions for improvement, such as including more examples of complex behaviours. The current study in LTC involves the creation of new videos of complex situations in LTC. Participants in LTC homes will complete the online training, and surveys pre/post and at 4 weeks post-intervention. A focus group of a sample of 20 participants will be conducted.

The BQRCT complements and works synergistically with existing strategies for managing BPSD. Care teams can use various frameworks and tools flexibly either concurrently or at different times in the episode of care of persons with dementia and BPSD. These tools must address the diversity and personal background of the person with dementia and caregivers.

MSNAP is a quality improvement and accreditation network for services that assess, diagnose and treat dementia in the UK. Accreditation assures patients, carers, frontline staff, commissioners, managers, and regulators that your memory service is of a good quality and that staff are committed to improving care. Our aims are to improve the quality of memory services nationally and internationally, through a thorough and supportive assessment against our standards.

Through a model of peer-reviews, MSNAP assesses memory services across the UK (currently 86 member services) against a set of evidence-based standards for memory services. The purpose of our standards is to improve the quality of care provided by memory services. The standards are drawn from relevant policies, guidelines and research literature and have been developed in consultation with our members, our partner organisations and patient and carer networks. MSNAP has launched a developmental membership option which is open to international members to receive an in-depth assessment against our standards.

MSNAP peer reviews of memory services reveal a national picture of challenges faced by memory services within the UK, as well as areas of best practice. These findings demonstrate where further support or resources may be needed within memory services in the UK. For example, the peer reviews have highlighted commonly unmet standards relating to the delivery of Cognitive Stimulation Therapy (CST) and conducting audits on the capacity to provide psychosocial interventions. Not all services are currently providing people with dementia with access to art/creative therapies.

MSNAP is a unique programme which is recognised globally as being robust and well established in supporting memory services to deliver best practice. The data collected from our MSNAP peer reviews provides a real-time comprehensive oversight that can shape future practices and influence national and local policies to ultimately benefit patients and carers.

Without intensive practical and emotional support to plan for, and eventually, cease driving, people with dementia are at high risk for depression, anxiety, grief, social isolation, unsafe and unlicensed driving and injury. This study focused on evaluation of a 7-module intensive support program targeted at people living with dementia and their care partners to manage driving cessation (“CarFreeMe”).

Our intervention was person-centered according to geographic location and needs of participants. Participants were encouraged to consider future transport arrangements, plan for lifestyle changes, form realistic expectations of life changes after driving cessation, practice using alternative transport, and supported in their emotional adjustment to the role loss. We collected program evaluation from PWD and care partners via survey, including open and closed questions. Participants reported their satisfaction with content and delivery on a scale of 1-10 (where 1 = not satisfied at all, 10 = extremely satisfied).

We describe our program and report the results of evaluation from 41 participants (PWD = 54%) who completed the survey after program conclusion. There was overall satisfaction with the program, program Content was rated on average 8.6/10, program Presentation and Delivery was rated average 9.1/10. Content analysis identified ‘personalized support’, ‘finding and trying out alternative transports’, ‘psychoeducation’ and ‘a safe space to discuss grief and loss’ as most relevant and helpful to participants.

Findings indicated that PWD and care partners valued the individualized support for the cessation process, and highly valued the psychoeducation components and strategies to address the practical and emotional challenges. Additionally, feedback indicated that for PWD who had involuntarily retired from driving, more focused attention to coping with grief and loss was needed before moving on, accepting support, and finding alternative ways to get out and about.

The Interdisciplinary Home-bAsed Reablement Program (I-HARP) integrates evidence-based rehabilitation strategies into a dementia-specific person-centred, time-limited, home-based, interdisciplinary rehabilitation package. I-HARP was a 4-month model of care, incorporated into community aged care services and hospital-based community geriatric services. I-HARP involved: 8-10 individually tailored home visits by occupational therapist and registered nurse; 2-4 optional other allied health sessions; up to A$1,000 minor home modifications and/or assistive devices; and three individual carer support sessions. The aim of the study was to determine the effectiveness of I-HARP on the health and wellbeing of people living with dementia and their family carers.

A multi-centre pragmatic parallel-arm randomised controlled trial compared I-HARP to usual care in community-dwelling people with mild to moderate dementia and family carers in Sydney, Australia (2018-22). Assessments of the client’s daily activities, mobility and health-related quality of life, caregiver burden and quality of life were conducted at baseline, 4- and 12-month follow-up. Changes from baseline were compared between groups.

Of 260 recruited, 232 (116 dyads of clients and their carers, 58 dyads per group) completed the trial to 4-month follow-up (89% retention). Clients were: aged 60-97 years, 63% female, 57% with mild dementia and 43% with moderate dementia. The I-HARP group had somewhat better mean results for most outcome measures than usual care at both 4 and 12 months, but the only statistically significant difference was a reduction in home environment hazards at 4 months (reduction: 2.29 on Home Safety Self-Assessment Tool, 95% CI: 0.52, 4.08; p=.01, effect size [ES] 0.53). Post-hoc sub-group analysis of 66 clients with mild dementia found significantly better functional independence in the intervention group: 11.2 on Disability Assessment for Dementia (95% CI: 3.4, 19.1; p=.005; ES 0.69) at 4 months and 13.7 (95% CI: 3.7, 23.7; p=.007; ES 0.69) at 12 months.

The I-HARP model enhanced functional independence of people with mild dementia only but not significantly in people with moderate dementia, so did not result in better outcomes in the group overall. A different type of rehabilitation model or strategies may be required as dementia becomes more severe.

Focus on the capacity and potential of persons with dementia is needed to enable people and their families to adapt to the changes dementia brings in their lives. For those with young onset dementia (YOD), support to remain in work for as long as possible can preserve one’s self-esteem and sense of purpose in life. However, guidance on how to support people with YOD at their workplace is lacking. This study therefore aims to explore experiences, work values, and support needs of people with YOD in the workplace and other stakeholders involved.

In this qualitative study, semi-structured interviews were held with several target groups namely employees with an established dementia diagnosis, relatives of employees with YOD, employers and co-workers, occupational physicians, human resource professionals, and healthcare professionals involved in dementia care. A topic guide was developed, based on recent literature and consultation of experts, and addressed the following themes: experiences regarding the influence of dementia in the workplace, values such as the importance of work, and support needs in the workplace. Themes were explored in the period before and after diagnosis. The interview data were transcribed and analyzed by means of an inductive content analysis.

In total 33 semi-structured interviews were conducted. Eight themes were derived from the interviews in people with YOD, namely 1) difficulties experienced at work, 2) long diagnostic trajectory and involvement of work-and care professionals, 3) Impact of YOD and coping with YOD, 4) Wish to work, 5) Diagnostic disclosure, 6) The role of the work environment, 7) Phasing out work and future perspectives, and 8) Perception and awareness of YOD. Data of the other target groups is currently being analysed. These results are expected in spring 2023.

This study will result into a better understanding of the possibilities of working with YOD. These insights can be used as a starting point to develop practical tools to support and provide guidance to people with YOD and their (work)environment to prevent loss of work or find meaningful alternatives.

Lewy body dementia (LBD) is the second most common degenerative dementia in people over 65 (1,2). LBD is underdiagnosed, with only one third of patients correctly diagnosed in daily clinical practice (3); data on the distribution of the disease are scarce. Our study was designed to measure the incidence, prevalence and clinical characteristics of LBD in south-eastern Spain. Healthcare system in Spain is free and universal.

Prospective epidemiological study of LBD in San Vicente del Raspeig between October 18, 2021, and October 17, 2022. The total population aged 60 or over based on the 2019 census was 11445 inhabitants (5227 males, 6218 females). Diagnosis of LBD was based on 2017 McKeith criteria. Only “probable” cases were registered for greater diagnostic certainty. Incidence was studied for the one-year period. Collected data included gender, age, cardinal symptoms for LBD, abnormal biomarkers, neuropsychiatric symptoms, medical treatment, years from diagnosis and GDS score (Reisberg) in the last visit. Protocol was approved by the ethical committee.

Global prevalence was 0.67% among the population over 60. Annual incidence was 3.2/1000 person-year.

Mean age of prevalent cases was 78 years (SD 7.5). 68.8% were studied with at least one biomarker (mainly 123I-ioflupane and less frequent polysomnography or MIBG gammagraphy); most suffered 2 or 3 core symptoms (79.2%) (in descending order: parkinsonism, visual hallucinations, rapid eye movement sleep behavior disorder and fluctuations). Two out of five prevalent cases were in an early phase of the disease: 22.1% in mild cognitive impairment (MCI) and 16.9 % in mild dementia. Mean me of disease was 1.9 years (SD 2.2). Other neuropsychiatric symptoms appeared in up to 74% of patients (apathy 18,2%, anxiety 19,5%, depression 23,4%, minor hallucinations 22%, delusions 17%, auditory and tactile hallucinations 1,2%).

Prevalence is in line with previous reports. Higher incidence than previously reported may be due to high attention on MCI-LBD and our expertise as a referral Memory Unit. We found a wide dominance of aged women and high prevalence of neuropsychiatric symptoms.

Previous studies have reported that the structure and function of the striatum are important in bvFTD, and the striatum can be divided into more subregions. Changes within brain regions has recently attracted increasing attention, but most studies have explored the relationship between the striatum and other brain regions. Therefore, the aim of this study was to explore the changes in the intra-striatal resting-state functional connectivity (RSFC).

We acquired fMRI data from 26 bvFTD patients and 36 healthy controls. The Human Brainnetome Atlas was used to define the spatial extent of the striatum and delineate its subregions. Intra- and extra-striatal FC values were then calculated for each individual and compared between bvFTD and control groups.

Compared to healthy controls, bvFTD showed decreased intra-striatal FC. Both intra-hemispheric and inter-hemispheric functional connectivity were compromised. There was also a gradient reduction in terms of the functional connectivity within striatum: the left dorsolateral putamen showed most decrease and the left ventral caudate exhibited the least (Fig 1). The extra-striatal FC between striatum and the insula was also decreased.

The loose intra-striatal functional connectivity may underly the neural substrate of bvFTD.