Dementia caregiving is associated with a variety of negative outcomes including poor caregiver mental and physical health and low relationship satisfaction. Prior research has linked these negative caregiver outcomes to patients’ cognitive and psychiatric symptoms. However, few studies have examined the link between patients’ socioemotional functioning and caregiver outcomes. We examined how patients’ socioemotional functioning was related to caregiver marital satisfaction, physical health, and psychopathology in a sample of 103 caregivers of dementia patients (with a wide range of diagnoses). Measures included: (a) patient socioemotional functioning (Caregiver Assessment of Socioemotional Functioning), (b) patient cognitive functioning (Mini-Mental State Exam), (c) patient psychiatric symptomatology (Neuropsychiatric Inventory), (d) caregiver marital satisfaction (Locke-Wallace Marital Adjustment Test), (e) caregiver physical health (Medical Outcomes Study Health Survey), and (f) caregiver psychopathology (Symptom Checklist-90 -Revised). Results indicated that poor patient socioemotional functioning predicted lower levels of caregiver marital satisfaction (beta= −.45, p < .001) and physical health (beta= −.25, p < .05), and greater caregiver psychopathology (beta= .41, p < .001), above and beyond patient cognitive functioning and psychiatric symptoms. These findings suggest that low levels of socioemotional functioning in patients make important and unique contributions to negative caregiver outcomes.

Introduction: Older adults are at disproportionate risk of serious disease and mortality due to the novel coronavirus (COVID-19) pandemic. Further, the global response to the lockdown has rendered older adults particularly vulnerable to loneliness and social isolation due to the physical distancing and shelter in place mandate. We hypothesized that both these factors would lead to an increase in geriatric mental health problems during the COVID-19 pandemic.

Material and Methods: We undertook a clinical audit of all geriatric patients (above 60 years of age) attending the psychiatry emergency services at a tertiary care hospital. This audit was conducted over a period of 52 days dating from the cessation of non-essential services at the hospital as part of the national response to the COVID-19 pandemic (lockdown).

We used descriptive statistics to summarize the number, age, sex, presenting complaint and diagnoses of our patients. We further compared the average number of geriatric patients attending the psychiatry emergency services in the hospital during the lockdown to that of geriatric patients attending the same in the year before the lockdown.

Results: A total of 112 geriatric patients attended the psychiatry emergency services during the lockdown period. Of these, 62 were male and 50 female. The average number of geriatric patients attending the emergency services daily during this period (μ1 2.15) was significantly higher (z 5.36, p ≤ 0.01) than the average number of patients attending the emergency services in the year preceding the lockdown (μ2 1.34).

The most common presenting complaint was agitation in the preceding weeks. The most common diagnoses were late onset schizophrenia spectrum disorders followed by affective disorders and major neurocognitive disorders.

Discussion: The COVID-19 pandemic and the global response to the same constitute life events for older adults. They may contribute to biological, psychological and social risk factors for mental health problems in older adults during this period. The increase in geriatric patients attending our emergency services, despite an increase in restrictions on mobility which act as barriers in the pathway to care, is worrying. Under stimulation in older adults during this period may contribute to an increase in agitation.

Introduction Healthcare professionals working with people with dementia (PwD) have increasingly been moving away from task-oriented models of healthcare towards a more person-centered care (PCC) model. Several studies have showed positive results of PCC on the quality of life of PwD. Also, it shows positive effects on self -esteem and work satisfaction of healthcare professionals. An effective way to educate professionals in PCC and improve their knowledge and person-centered attitude is by using online learning tools.

We developed an e-learning in co-creation with end users focusing on well-being and (changing) behavior of PwD. The interactive e-learning supports healthcare professionals in developing a person-centered attitude, by using practical videos and exercises.

Methods In the current pilot study, the e-learning is evaluated. To date, 33 healthcare professionals working in Dutch care homes from different care organizations participated in the study and completed the e-learning. In addition, they filled in online questionnaires before and after completing the e-learning. The questionnaires include the Approach to Dementia Questionnaire, Dementia Knowledge, Person Centered Care, Sense of Competence in Dementia Care Questionnaire. Post-measurement also included questions about satisfaction with the e-learning and user-friendliness.

Results The final participants are currently completing their post-measurement questionnaires and final results are expected in September 2019. Preliminary data-analysis shows promising results. Positive effects on knowledge about dementia, person-centered attitude and sense of competence are expected. Also, user-friendliness, especially the flexibility of the e-learning (being able to follow the e-learning at home or at work and being able to stop and continue at any time) and the practice-oriented videos are positively evaluated.

Conclusion Preliminary results of this pilot study suggest that the e-learning might contribute to developing a more person-centered attitude in healthcare professionals and indicate that participants have positive experiences with the e-learning module.

Objectives: Alzheimer's disease (AD) is the most common cause of dementia and it is associated with increased mortality. The use of antipsychotics is common among the elderly, especially in those with dementia. Evidence suggests an increased risk of mortality associated with antipsychotic use. Despite the short-term benefit of antipsychotic treatment to reduce the behavioral and psychological symptoms of dementia, it increases the risk of mortality in patients with AD. Our aim is to discuss the findings from the literature about risk of mortality associated with the use of antipsychotics in AD.

Methods: We searched Internet databases indexed at MEDLINE using following MeSH terms: "Antipsychotic Agents" AND "Alzheimer Disease" OR "Dementia" AND "Mortality" and selected articles published in the last 5 years.

Results: Antipsychotics are widely used in the pharmacological treatment of agitation and aggression in elderly patients with AD, but their benefit is limited. Serious adverse events associated with antipsychotics include increased risk of death. The risk of mortality is associated with both typical and atypical antipsychotics. Antipsychotic polypharmacy is associated with a higher mortality risk than monotherapy and should be avoided. The mortality risk increases after the first few days of treatment, gradually reducing but continues to increase after two years of treatment. Haloperidol is associated with a higher mortality risk and quetiapine with a lower risk than risperidone.

Conclusions: If the use of antipsychotics is considered necessary, the lowest effective dose should be chosen and the duration should be limited because the mortality risk remains high with long-term use. The risk / benefit should be considered when choosing the antipsychotic. Further studies on the efficacy and risk of adverse events with antipsychotics are needed for a better choice of treatment and adequate monitoring with risk reduction.

Sensory systems ensure the ability to perceive and recognize the world. Therefore, the temporal course and the severity of their involution through the aging process can be critical. In the elderly, sensory impairments significantly increase their risk of biological, psychological and social impoverishment. Olfactory loss, known to happen in bacterial and viral infections and considered an early biomarker in Alzheimer’s and Parkinson’s diseases neurodegenerative processes, has been reported also as an early indicator of current infection by SARS-CoV-2. At the translational level, in the present work, we have studied olfactory ethograms in normal and advanced AD-related pathological aging using wildtype and the 3xTg-AD mice, a genetic model of Alzheimer’s disease that presents AD-cognitive dysfunction but also a conspicuous BPSD-like phenotype. An olfactory paradigm, involving the equivalent to one day food deprivation, was used to investigate in middle-aged males and females with normal and AD-pathological aging the ethological patterns shown in the olfactory inspection of a new cage with beddings and the posterior detection, finding and consumption of food pellets hidden in this new anxiogenic environment. Males with normal and pathological aging were equally delayed in their first contact with food pellets, while in female sex this latency was dependent on the genotype (longer in 3xTg-AD mice, shorter in those with normal aging). Once the animals had inspected the arena, the latencies to smell, find and eat the food pellets were found progressively increased in males with normal aging, but consecutively developed in 3xTg-AD mice. In contrast, both groups of females exhibited longer delays as compared to males, and the temporal pattern of their ethogram to smell-find-eat the food was faster. In 3xTg-AD males, social isolation (naturally occurring due to death of counterparts) emphasized these olfactory patterns, which were independent of the punctual loss of weight of this paradigm. The results show that this paradigm provides distinct contextual, sex and genotype olfactory ethogram signatures useful to investigate olfactory function in normal and AD-pathological aging. Also, that isolation has an impact enhancing the changes in the olfactory signature here described, for the first time, in the 3xTg-AD mice model of Alzheimer’s disease.

The severity of the current scenarios in this pandemic will leave important psychological traces. In fact, the first clinical reports available already refer to increased incidence of depression and anxiety disorders such as obsessive-compulsive disorder (OCD) and post-traumatic stress disorder. At the translational level, modelling of such neuropsychiatric alterations in animal models relays in neuroethological perspectives since response to fearful situations and traumatic events, critical for survival and adaptation to the environment, are strongly preserved in phylogeny. In the wild, mice dig as a ‘defensive behavior’ which is considered to reflect the anxiety state of animals. In the laboratory, mice dig vigorously in deep bedding to bury food pellets or small objects they may find. Thus this behavior, initially used to screen anxiolytic activity was later proposed to better model meaningless repetitive and perseverative behaviors characteristic of OCD or autism spectrum disorders. In the present work, we have studied the digging ethograms in normal and advanced AD-related pathological aging using wildtype and the 3xTg-AD mice, a genetic model of Alzheimer’s disease that presents AD-cognitive dysfunction but also a conspicuous BPSD-like phenotype. We also studied the effects of isolation in this respect, using very old (18 month-old) 3xTg-AD mice that survived to their cage mates, as mortality rates in this animal model are high after 13 months of age. Two digging paradigms, involving different anxiogenic and contextual situations were used to investigate the digging patterns in these very old males with normal and AD-pathological aging, as well as the effects of isolation. The temporal course and intensity of this behavior was found increased in those 3xTg-AD mice that had lost their ‘room partner’ and lived isolated. However, when they were tested under neophobia conditions, incidence of this behavior was smaller and the pattern of digging was disrupted. The results show that this combined paradigm unveils distinct features of digging signatures that can be useful to provide an animal model for these perseverative behaviors and their interplay with anxiety states, which represent an important part of BPSD or can now emerge as a result of the enhancement of obsessive-convulsive behaviors by social-isolation.

The coronavirus pandemic (COVID-19) that has ravaged the entire world presents the most dramatic scenarios in the most vulnerable populations, with exacerbated focus on the elderly people, especially the most frail needing home-care or living in nursing homes. The urgency and severity of the outbreaks forces the use of segregation in restricted areas and confinement in individual rooms as desperate strategies to avoid the spreading of disease and the worse scenario of becoming a deadly trap. Residents are becoming socially isolated, lacking the social and environmental enrichment that are key rehabilitation factors against their progressive physical and/or mental deterioration. Recently, a study on gender perspective in COVID -19 found that men have more severe disease and are over twice as likely to die. It is well known that dementia is associated with increased mortality and males show worse survival than females. On the other hand, the asymmetric neurodegeneration of subcortical structures in Alzheimer’s disease (AD) has been recently demonstrated and proposed as a powerful imaging biomarker. In the present work, we studied the impact of long-term isolation in old male 3xTg-AD mice modeling advanced-stages of AD and as compared to age-matched counterparts with normal aging. A battery of behavioral tests resembling several areas in nursery homes was used. Atrophy of left and right hippocampus, cortex and cerebellum was measured. Our results are the first evidences of brain atrophy asymmetry being demonstrated in an animal model of AD, thus modeling that found in human patients. The main findings aware of a consistent impact of isolation increasing the hippocampal and cortical atrophy asymmetries. Isolated animals showed a prominent hyperactive pattern in both gross and fine-motor functions, re-structured negative valence system with the emergence of bizarre behaviors and flight copying-with-stress strategies. Overall, these results from translational neuroscience aware of the impact of isolation enhancing the neurodegenerative asymmetry and BPSD-like behaviors. They also highlight the relevance of personalized-based interventions tailored to the heterogeneous and complex clinical profile of the individuals with dementia, and to pay special attention to BPSD behaviors that may worse their caregivers’ burden in these times of coronavirus and post-COVID-19 pandemic scenario.

Time factor and human support are major constrains in the management of the COVID-19 pandemic and they enhance the challenges to adapt the lifestyles and intervention programs, with greater impact on the elderly people, especially those who are the most physically or cognitively frail. The restrictive confinement and the closing of the day centers has left those whose frailty requires permanent rehabilitation programs at home. In the case of Alzheimer’s disease (AD) and other dementias, non-professional home care may not be enough to cover the needs and demands of these complex disorders. On the other hand, as elder people, these patients can be particularly affected by social isolation, which can cause changes in behavior and decrease functional performance in the basic activities of daily life, worsening their BPSD and cognitive impairment. In this context, and under the gaze of normal and pathological aging, we are developing a functional model of psycho-motor evaluation that allows us to study psycho-motor function, including motor learning and memory. Its translational value relays in the modeling of tests used in clinical settings. Here we present the very first results. We have selected the gold standard C57BL/6 mice together with the triple transgenic model of AD (3xTg-AD) to apply our psycho-motor protocol. We have included a series of measurements that make possible to differentiate several dimensions of basal motor learning, and the learning associated with fragile situations. We have found common as well as distinctive features between the sample of normal and AD-pathological aging, and under the isolation scenario. Among all, we can highlight the gender factor and the level of physical activity as a protective mechanism when indicators of frailty are present. Particularly, the 3xTg-AD mice show greater deterioration in physical aspects, but they retain their motor learning capacity comparable to the controls. On the other hand, higher performance in tests of exercise tolerance and muscle strength stand out in these mice, where genotype and gender appear to be determinant factors in overall physical performance: This generates new hypotheses of underlying biological protection mechanisms in translational scenarios relevant for the rehabilitation of geriatric and AD-patients.

Mood disorders are common psychiatric illnesses that represent a major cause of disability worldwide. With life expectancy and the percentage of elderly people rising in many developed and undeveloped countries around the globe, cognitive impairment and dementia are gaining a societal importance. The relation between mood disorders and cognitive function is a twofold. On the one hand, cognitive deficits within mood disorders have been studied extensively, in which there seems to be a persistent neurocognitive impairment, both in acute phases and in interepisodic euthymic phases. Although results have not always been consistent, an overall pattern of specific impairments – in executive function, attention and memory - has become evident. On the other hand, recent research suggests that mood disorders, in general, may be risk factors for the development of mild cognitive impairment and dementia. In this sense, of the many models for the association of mood disorders and dementia, two are favored by several authors. One suggests that mood disorders are a risk factor for earlier clinical manifestation of dementia. The second sees mood disorders as the cause of dementing states, for instance through neuronal loss via dysregulation of the glucocorticoid cascade. In fact, there is suggestion that impairment of neuroplasticity may underlie the pathophysiology of mood disorders as such, and not only of neurocognitive impairment. In some patients, specific neurocognitive functions may be present before the onset of mood disorder and may constitute a trait factor or even an endophenotype. The aim of the present work is to, through a basic narrative review of published research on the main databases, summarize the main evidences of the association of mood disorders and dementia.

Objective: To present an atypical clinical case and to review the literature on frontotemporal dementia (FTD) focusing on the most frequent psychopathological findings.

Methods: Case report and a non systematic review using databases Pubmed, UpToDate, Medscape, between 2007 to 2020. Keywords: frontotemporal dementia, psychiatry, psychopathology.

Results: FTD is a neurodegenerative syndrome that appears most frequently in the fifth and sixth decades, mostly before the age of 65. Six to seven years before the diagnosis of FTD, psychiatric disorders such as major depression can appear. The behavioral variant DFT is characterized by symptoms such as disinhibition, apathy or inertia, loss of empathy, hyperorality, persevering behaviors, executive dysfunction, and it is also associated with changes in imaging exams, namely frontal and temporal cortical atrophy, which may affect one or both hemispheres. We present the case of a 66-year-old female patient, accompanied for a long time in psychiatry by conversion and dissociative symptoms, associated with histrionic personality traits. She was hospitalized for deteriorating functioning, pauted by great agitation and maladjusted behavior, alteration of thought and speech, and marked perseverance, as well as periods of space-time disorientation. Analytically, there were no changes, as well as in imaging exams such as CT and MRI. It was performed an electroencephalogram (EEG) that demonstrated diffuse cortical dysfunction.

Discussion/Conclusion: This case is atypical in the DFT pattern, regarding the age of onset and the absence of imaging findings. However, there was alterations in the EEG, which together with the symptomatic presentation point to DFT. This case exemplifies the difficulty in the management of symptoms, whose therapy is purely symptomatic and psychoeducational strategies for the family and caregivers are fundamental.

Visual Hallucinations (VH) are a common psychiatric symptom of Parkinson’s Disease (PD) and Dementia with Lewy Bodies (DLB). According to the Perception-Attention Deficits Model, VH stem from impaired perceptual (bottom-up), including dorsal (DVS) and ventral visual streams (VVS), and attentional (top-down) processes, with a persistent Default Mode Network (DMN) activity and a dysfunctional imbalance of Dorsal (DAN) and Ventral Attentional Networks (VAN).

We review the literature on the neurobiological underpinnings of VH in DLB and PD, concerning overlapping and different mechanisms.

In DLB hallucinators, PET-scan findings of disconnection between higher and primary visual areas and dysfunctional recruitment of the VVS, corroborate other imaging and neuropathologic studies which document inferior longitudinal fasciculus damage and increased temporal lobe Lewy body (LB) pathology. The alteration of network topography is more pronounced in the DAN and DMN. The involvement of anterior cortical regions, clustering around attentional networks, is demonstrated in neuropathologic, volumetric and perfusion studies. VH severity closely correlates with anterior cingulate cortex and inferior temporal cortex hypoperfusion, structural changes in the DVS (superior parietal gyrus and precuneus) and increased diffusivity of the right thalamic projections to parieto-occipital cortices. Thalamocortical dysfunction alongside decreased cholinergic activity in reticular nucleus, which receive projections from the nucleus basalis of Meynert, seems to play a crucial role.

Both DLB and demented PD hallucinators have more frontal cortical atrophy, yet greater in DLB, supporting top-down mechanisms.

Regarding PD hallucinators, findings of cortical atrophy in inferior parietal lobule, cuneus, lingual lobule, and precentral gyrus correlated with hallucination scores. However, some studies did not evidence volumetric cortical differences between hallucinators and non-hallucinators. Moreover, LB are not necessarily present in hallucinators, suggesting other neuropathologic mechanisms in the genesis of VH, namely altered neurochemical circuitry. Volume loss in pedunculopontine nucleus and right-thalamus support the hypothesis of a dysfunctional cholinergic brainstem control of the cortex. PET-scan studies discovered higher 5-HT2A receptor levels in the inferolateral temporal and prefrontal cortices. A greater nigrostriatal impairment is documented in the right-caudate of hallucinators. Therefore, VH may arise from an inability to activate DAN (in which caudate is involved) and consequent faulty visuo-perceptual processing by DMN and VAN.

Objectives: More and more referrals to memory clinics are expected, but diagnostic routes are already challenged. In order to be able to follow the advice to diagnose dementia more often and earlier in the process, but also to be able to handle the increasing numbers of referrals, a fast but reliable triage test is needed.

According to the Cochrane review, “the MoCA can help identify people who need specialist assessment and treatment for dementia”. It has been validated in multiple institutions and languages. However, many of these studies are designed with a case-control design using healthy, community-based individuals as controls, which can lead to spectrum bias.

Our cohort of referrals to a memory clinic with patients suspected of having cognitive disorders (mild dementia and MCI) after initial assessment in an old age psychiatric clinic, needs to be validated because different settings can give different results.

Design: our reference standard consisted of a consensus-based diagnosis according to international criteria for detecting MCI and MD, and this was compared with patients suspected of MCI/MD - but excluded from cognitive disorders (NoCI)- from the same cohort.

Results: The mean MoCA scores differ significantly between the groups: 24 in NoCI, 21 in MCI and 16.5 in MD. The AUC of MD against non-demented (MCI+NoCI) was 0.83 resulting in 90% sensitivity, 65% specificity, 50% PPV and 94% NPV at a best cut-off of <21 according the Younden index. For CI (MD+MCI) against NoCI the results were respectively 0.77AUC, 95%sens, 47%spec, 88%PPV, 68%NPV at a cut-off <26.

On an individual basis, as a box plot of DSM IV diagnoses showed, the MoCA score has limitations and clinical aspects need to be taken into account: FTD, high education to the upside; MCI including psychiatric etiology to the downside.

Conclusions: by using a cut-off score of <21, 90% of people with positive MoCA have CI, while 94% of people with negative MoCA (≥21) will not have dementia. The MoCA can significantly reduce referrals (50%) by excluding patients for further diagnostic work-up at a memory clinic, even if they are suspected of CI after initial assessment.

Background Mild Cognitive Impairment is an at-risk stage for dementia and early detection has been increasingly recommended to facilitate beneficial interventions and forward planning. Changes in cognition and function can be insidious. In ageing populations, relying on relatives to detect changes is not sustainable. Moreover, resource scarcity necessitates that we innovate to find less manpower dependent methods for early detection and assessment.

Objectives In two separate feasibility studies, we set out to evaluate if sensors could be utilized to (1) detect changes in behaviour patterns in homes of community dwelling elderly* & (2) evaluate instrumental activities of daily living (iADLs) in a smart home lab setting.

Method In the first study, 59 community-dwelling seniors (aged >65 years) were observed over the course of 2 months through the use of motion sensors, smart plugs, bed sensors and activity bands. Behaviour metrics such as forgetfulness, outings and sleep were tracked. In the second study, a smart lab was equipped with similar sensors and 35 seniors were tasked to complete two iADLs (using the telephone and counting money) while being evaluated by the sensor system.

Results In both studies, we found that it was feasible and seniors found the sensors to be acceptable. Over 80% of seniors had positive feedback for the in-home system and over 95% of seniors had found the lab-based evaluation of iADLs to be acceptable.

Conclusion Sensor technology and smart homes are feasible to utilize for assessment and monitoring of cognition and function. Knowing that seniors find it acceptable is a crucial initial step. Much more needs to be done to refine the systems and the clinical information it yields.