Introduction: Young-onset AD (YOAD) affects people aged 65 years old or younger with greater initial loss of cognitive abilities, more significantly on attention, visuospatial function, motor- executive functions, and language.

Methods: 30 dyads, People with AD – caregivers, were evaluated. People with YOAD were assessed for: disease awareness, and depression. Caregivers were assessed for: depression, anxiety, coping, and burden. Additionally, caregivers provided information about mood, neuropsychiatric symptoms, dementia severity, and patients’ activities of daily living.

Results: Caregivers showed moderate level of burden 38.94 (SD = 14.74), low level of anxiety9.11 (SD = 9.8), moderate level of coping strategies 65.71 (SD = 11.7), and mild level of depressive symptoms 10.72 (SD = 8.8). People with AD had an average cognition score of 15.27, 50% had moderate dementia rating (CDR=2), mild depression index 12.35 (SD = 5.4), moderate index of neuropsychiatric symptoms 36.2 (SD = 23.3), and partially compromised disease awareness 9.06 (SD = 5.12). Coping strategy total score of caregivers was positively correlated with their cognition. Problem-focus is positively correlated with caregivers’ years of education, cognition and inversely correlated anxiety. The coping strategies were not correlated with the clinical variables of people with YOAD. Dysfunctional and emotional- focus did not have significant correlations with the clinical variables of people with YOAD or their caregivers.

Conclusions: Most caregivers, likely experiencing significant disruption in their personal lives, were similar-aged spouses to people with AD. Problem-focused coping strategies appear effective for caregivers, indicating that better cognitive health and higher education levels may enable them to use planning and active coping strategies to manage dysfunctional behaviors. Self-distraction was observed as a dysfunctional coping strategy, suggesting an association with anxiety and depression in caregivers, though our results do not confirm a causal relationship. Future studies with larger dyads samples should explore the relationship between coping strategies, clinical variables in patients with YOAD, and their caregivers, aiming to develop interventions to assist caregivers more effectively.

Introduction: This book aims to help children grasp the concept of Alzheimer’s disease and its impact on our loved ones using simple, accessible language and engaging educational activities.

Methods: The information will be presented using themes that capture children’s interest, such as magic and superheroes, and will be reinforced through activities including word searches, code-based tasks, synonym games, word syllable exercises, planning activities, scrambled words, word puzzles, basic math problems, open-ended questions, and Discussions about grandparents. It will address potential behavioral changes like forgetfulness, confusion, and agitation, and provide suggestions on how to cope, such as remaining calm, offering comfort, paying attention, and communicating clearly and simply. Throughout the book, the significance of family bonds will be emphasized, encouraging care and affection to strengthen connections. Even if a person with Alzheimer’s doesn’t recognize the child, they can still feel the love and support.

Conclusions: This book promotes values of respect, inclusion, and patience in the face of Alzheimer’s disease, underscoring the importance of empathy and understanding regardless of the challenges it presents.

Objectives: Patients with dementia (PWD) benefit from interdisciplinary care. Depression is a well-known risk factor for the progression of neurocognitive impairment and dementia; other psychiatric disorders (i.e. anxiety, post-traumatic stress disorder, bipolar disorder, psychotic disorders) also may confer an increased risk for dementia. PWD may also present with behaviours and psychological symptoms that overlap with psychiatric disorders. Our aim is threefold: (1) Review the current literature on managing psychiatric comorbidities in PWD. (2) Present an illustrative case series of PWD with psychiatric comorbidities. (3) Introduce a model of care on our Behavioural Neurology Unit (BNU) for treating PWD with psychiatric comorbidities.

Methods: Our BNU is a 20-bed quaternary inpatient unit for difficult-to-treat behaviours related to dementia. Psychiatric consultation is readily available to clinicians and often times for PWD with psychiatric comorbidities. We review best practices in managing these patients. We present a case series of PWD with psychiatric comorbidities predating their diagnosis of dementia who have significant behavioural and psychological symptoms and have failed other settings.

Results: Current guidelines for PWD do not discuss the management of psychiatric and neurologic comorbidities in detail. Among 26 cases, we highlight the judicious use of anticonvulsants, lithium, clozapine, and nabilone in PWD. We also demonstrate the importance of interdisciplinary care with primary care, neurology, psychiatry, and allied health support.

Conclusions: Dementia care is challenging and requires individualized attention and interdisciplinary collaboration. These challenges are augmented when dealing with psychiatric comorbidities. We advocate for increased attention and creative solutions to address these complex cases.

Background: The ADI Accreditation Programme, launched in December 2020, aims to support all Alzheimer and dementia associations and other organizations, in improving care for people living with dementia. By providing a standards-based approach to knowledge and skills, ADI establishes benchmarks that program providers must adhere to. Successful completion of an evaluation allows carers, trainers, and program providers to earn ADI Accreditation, indicating that they have reached the required global standard for their training and learning activities, including culturally appropriate context to improve care quality. ADI Accreditation is open to ADI members, as well as other organizations including universities and training colleges.

Activities: Our Global Review Panel (GRP) Members consists of multi-discipline, cultural and regional experts in the global dementia field. Successful completion of an evaluation process: initial application, evaluation report, virtual/in-person or hybrid visit from our Global Review Panel Members, the program or providers can earn ADI Accreditation. The first provider to be accredited was Kiang Wu Nursing College (KWNC) of Macau on January 25, 2021. The pilot project involved Discussions on external and internal governance, trainers and program committees, students, graduates, and other stakeholders. A 3-day virtual visit to KWNC in September, including evaluation, involved carers, trainers, students, and collaboration with other organizations and people living with dementia, followed by a final review by the Global Review Panel in October andNovember.

Silverado Memory Care Communities became the first program to be accredited for their Dementia Care Program on December 22, 2022. In-person visits took place on August 16-17, 2022, involving trainers, stakeholders, family members, caregivers, associates, and staff. University of Bradford in the UK became the first university in UK/Europe to be accredited their Centre for Dementia Applied Science on December 22, 2022. In-person visits took place on June 20-21 June 2023, involving trainers, stakeholders, family members, caregivers, associates, and staff.

Wicking Dementia Research and Education Centre at the University of Tasmania received their accreditation after virtual visit on 29-30 August 2023. involving trainers, stakeholders, associates, andstaff.

As of 2024 Dementia Australia Is currently undergoing the accreditation process along with some new potential opportunities.

Results: In 2 years, Kiang Wu Nursing College of Macau, Silverado Memory Care, University of Bradford and University of Tasmania received ADI Accreditation. Kiang Wu Nursing College of Macau received 5 times more applicant.

Throughout the program, there has been an increase in awareness and understanding of the importance of high- quality culturally contextualized carer training achieved through accreditation.

Introduction: Dementia and cognitive impairment are major causes of admission to Nursing Homes. These conditions also lead to caregiver burden and decrease quality of life. Cognitive Stimulation Therapy (CST) is an evidence-based psychosocial intervention for people with dementia, recommended and implemented in many countries, including Brazil.

Objectives: The aim of the current study is to explore the feasibility and preliminary results of CST protocol in nursing homes for elders with cognitive impairment or dementia in Brazil.

Methods: Older adults with cognitive impairment were invited to participate in this study. Thirteen participants from two nursing homes were assessed at baseline with the Cambridge Cognitive Examination (CAMCOG), Cornell Scale for Depression in Dementia (CSDD), Pfeffer Functional Activities Questionnaire, Katz Activities of Daily Living Scale, Quality of Life in Alzheimer’s Disease (Qol-AD) and Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB). They were assigned to Usual Care/Waiting List and followed up for 7 weeks, being reassessed at the end of this period. Then, they underwent 14 CST sessions throughout 7 weeks and were reassessed at the end of the protocol. Repeated Measures ANOVA was selected to assess differences in time. This study was approved by the Ethics committee of the Federal University of Minas Gerais.

Results: There were no dropouts from the study, the CST protocol has shown to be feasible to be implemented in nursing homes. We found that the CST protocol had no statistically significant impact in CDR-SOB (F = 1.21, p = 0.315), CSDD (F = 1.61, p = 0.221), CAMCOG (F = 0.914, p = 0.414), but showed a statistically significant change in the Qol-AD scale (F = 3.618, p = 0.042). However, Mauchly’s test of sphericity is violated, and since it may lead to increased type I error, it is still premature to define a positive outcome.

Conclusions: These preliminary results are consistent with the previous literature, suggesting that the CST could be a useful psychosocial intervention to improve the quality of life of people with dementia living in nursing homes. Nevertheless, more participants need to be enrolled to address further consistent.

Objectives: Low- and middle-income countries face increasing burden of noncommunicable chronic diseases due to rapid population aging. The Objectives of this study is to estimate the association of co-occurring depression and diabetes with healthcare services utilization in the Brazilian population aged 50 years andolder.

Methods: This is an analysis using baseline data of the ELSI-Brazil study. Measurements used were self-reported previous diagnosis for diabetes and a cut-off point of 4 on the CES-D-8 score for depression. Any medical consultations, specialist consultations and hospitalizations in the previous 12 months were assessed for measuring health services use. Logistic regression was used to estimate the association of having depression, diabetes, or both, compared to having none of the conditions with healthcare services utilization.

Results: In a final sample of 8303 participants, the adjusted odds ratios (95%CI) in the depression only group (27.9%), in the diabetes only group (9.7%), and in the depression and diabetes group (5.8%), for any medical consultations were 1.2 (1.01-1.42), 3.39 (2.4-4.79) and 3.12 (1.82-5.35); for specialist consultations, 1.05 (0.91-1.21), 1.34 (1.07-1.68) and 1.13 (0.86-1.49); and for hospitalizations, 1.42 (1.1-1.84), 1.42 (1.02-1.96) and 3.1 (2.12-4.54), respectively. All models were adjusted for sex, age, education, marital status, insufficient physical activity, current drinking and smoking, obesity and number of other diseases and conditions.

Conclusions: Those with diabetes seemed more likely to have any or specialized medical consultations. However, those with the depression and diabetes comorbidity were more likely than any other group to have been admitted to a hospital in the last year, which is distressing and costly. Screening for depression could be incorporated into diabetes usual care to reduce related complications and hospitalizations.

Funding: This study did not receive any funding. Authors: Ferri and Lima-Costa are recipient of CNPq research productive fellowship.

Summary: Globally, older adults grow faster than the rest of the population (United Nations et al., 2019). Ecuador predicts 2054 this group will represent 18% of the population. Cognitive and functional impairment affects quality of life of individuals and their families. Conditions such as dementia have increased, with almost 100,000 people affected in Ecuador.

Pharmacological treatments have modest efficacy for these problems (Buckley & Salpeter, 2015). In developed countries there are efforts to use non-pharmacological interventions (Klimova et al., 2016). In this context, computer-based cognitive interventions are considered a therapeutic tool to treat neurocognitive disorders. Benefit of using technology is that interventions are more accessible, flexible (Maldonado, 2016) and cost- effective (Gooding et al., 2016). Herrera et al. (2012) summarize a superiority outcomes over conventional cognitive rehabilitation in many aspects. Among them, use of portable devices allows bringing interventions to rural areas or homes (Brando et al., 2017).

In Spain, work is being done on it and there are studies associated with its usability and effectiveness. GRADIOR computer-based neuropsychological rehabilitation is a program for people with neurological etiologies. This one stands out from the rest, as it is exclusively for professionals. Allowing them to design, supervise and adapt the cognitive intervention based on their decisions, subsequent to the assessment of other cognitive, emotional and social aspects involved in the rehabilitative process, not only based on the Objectives results on the patient’s performance (Toribio-Guzmán et al., 2018).

This has led to the demand for a Neuropsychological Rehabilitation program that is accessible, parameterizable and adapted to the population of ECUADOR.

To meet this need, a doctoral thesis is being carried out in collaboration with CENTRO MAIOR Ecuador Centro de Especialidades del Adulto Mayor. Spanish program of Neuropsychological Rehabilitation has been tested in its population.

The study has been divided into different phases. A qualitative phase with focus group Methods in which health professionals from Ecuador participated. A phase of adaptation of the Spanish program to the Ecuadorian culture and currency. It is now in experimental phase (35 participants) with MCI and Mild Dementia. It is proposed to present the study, with a clinical case.

Summary: Lamotrigine is an antiepileptic and mood stabilizing drug. Among its adverse effects, the induction of mania has been described. We present the case of a 59-year-old man diagnosed with epilepsy since youth, with perictal psychotic symptoms effectively treated with haloperidol. The patient was treated with lamotrigine for over five years and presented symptoms of mania after two years of receiving it at moderate doses and being free of seizures. The symptoms improved with the lamotrigine switch. Previous cases of lamotrigine-induced manic symptoms have been predominantly observed in individuals with mood disorders, with only a few reported in children undergoing treatment for epilepsy. Further studies are necessary to elucidate the potential risk factors and the neurobiological mechanisms.

Objectives: To determine if and when to continue clozapine in patients with clozapine-induced thrombocytopenia.

Methods: A case report and literature review of a geriatric patient with Parkinson’s disease (PD) psychosis, on longstanding treatment with clozapine with recent development of thrombocytopenia, is presented.

Results: 85-year-old male with a history of PD complicated with sialorrhea, constipation, levodopa-induced dyskinesia, rapid eye movement sleep behavior disorder, neurocognitive impairment, and PD psychosis who follows up with the Emory Brain Health Center. Medications include carbidopa-levodopa, clozapine, donepezil, and rasagiline. He reports distressing delusional jealousy and egodystonic visual hallucinations. He has tried multiple antipsychotics with insufficient response. He has been on clozapine for nearly 10 years with moderate efficacy. His current dose is 62.5mg daily. Absolute neutrophil counts have been normal, but he developed thrombocytopenia. Though he had normal platelets at baseline, his platelets fell to 134,000/μL and have gradually decreased within a year, most recently to 82,000/μL. He has been asymptomatic without easy bleeding or bruising. His clozapine dose has remained the same with ongoing laboratory monitoring. He follows with his primary care doctor and was referred to hematology.

Conclusions: The literature on clozapine-induced thrombocytopenia is limited. Incidence is variable and ranges from 0.083%-8.2% in larger samples. Most cases occur within the first 18 weeks of clozapine initiation. It is generally transient and self-resolving, usually lasting under 13 weeks, though a case report noted it to last up to 40 months. It is imperative to have hematologic baselines. The manufacturer recommends discontinuing the drug when platelet counts fall below 100,000/μL, resuming therapy when they return to normal, and permanently discontinuing if this reoccurs. UK guidelines recommend that if platelet counts fall below 50,000/μL, clozapine should be discontinued, with monitoring frequency increased. Therapy can be resumed once platelet counts normalize and if asymptomatic. Special caution must be taken in geriatric patients who are prone to fall and balance-related injuries.

Objectives: Swallowing dysfunction is a significant health concern among older individuals, prompting widespread efforts to prevent it. While articulation training using repeated syllables is a common approach, maintaining motivation and habituating to the practice can be challenging, particularly for those facing mental hurdles.

In contrast, the ancient practice of sutra chanting, which has been embraced for centuries, holds potential for improving well-being by offering mental tranquility through the recitation of meaningful Buddhist words, including non-daily vocabulary. While the health benefits of these vocalization techniques remain understudied, they are believed to have positive effects from a geriatric medicine standpoint.

Methods: Our intervention program consisted of 60-minute sessions held at a temple per week for 7 weeks, including homework tasks. Sessions involved group Discussions, preparatory exercises, multiple recitations of the Heart Sutra with loud voices, and talks by a Buddhist priest. This one-arm intervention study targeted older community residents. Pre- and post- assessments, including mental health questionnaires and measurements of swallowing and oral function, were conducted. Paired t-tests were used to compare the data. Post-intervention interviews were conducted by a psychologist and a priest. This study was approved by the Ethics Committee of Taisho University.

Results: Eighteen participants, with an average age of 76.1 ± 8.2 years (8 males, 10 females), showed significant improvements in maximum phonation time, hyoid bone displacement during swallowing, tongue pressure, and mental health. Interview narratives revealed improvements in mental well-being attributed to sutra chanting, including the alleviation of death anxiety and attainment of mindfulness.

Conclusions: The study suggests that the sutra-chanting program, consisting of immersive temple experiences, exposure to Buddhist priest talks, and training in breathing techniques and vocalization through sutra chanting, may contribute to improved mental and physical health.

Overview: In Canada, 30 % of seniors experience social isolation, which is associated with cognitive decline. Studies suggest that co-viewing videos with positive emotional content promotes communication and social engagement (Ansaldo et al., 2021). Seniors spend approximately 4 hours per day watching television. It is important to explore the impact of this fact on communication and global behavior in seniors and their proxies.

Objectives: To identify the emotions experienced by dyads, and the parameters modulating them, as well as communication.

Methods: 19 dyads of elderly individuals watched 20 videos with positive emotional content. During co-viewing, facial expressions, heartbeat and respiratory rates were measured. After each video, participants completed a questionnaire measuring emotions (PANAS), and a semi- structured interview. Quantitative and qualitative analyses were conducted.

Results: Significant results in favor of positive emotional valence for each video were observed following quantitative analyses (t-test) of the PANAS; participants primarily felt enthusiastic, interested, and inspired. Analyses of semi-structured interviews confirm that dyads experienced positive emotions particularly with nature, animals, and children related videos. Most of the dyads perceived co-viewing as a means to promote communication and evoke memories. Machine learning supported analysis show a correlation between screen content type, and participants’ engagement as reflected by pupil dilation, and respiratory ratestabilization.

Discussion: The use of adapted video content encourages person-centered communication and empathy, thereby contributing to the maintenance of social engagement among the elderly.

Conclusions: These results provide evidence for the benefits of using adapted video content to promote communication in old age and point to innovative avenues in the study of co-viewing effects on communication and engagement in individuals living with major neurocognitive disorders.

Objectives: Patients with mild cognitive impairment (MCI) employ compensatory cognitive processes to maintain independence in day-to-day functioning as compared to patients with Alzheimer’s dementia (AD). The dorsolateral prefrontal cortex (DLFPC) supports cognitive compensation in normal aging and MCI. Using Paired Associative Stimulation combined with Electroencephalography (PAS-EEG) we have previously shown that patients with AD have impaired DLPFC plasticity compared to healthy control (HC) individuals. The aim of this study is to examine whether DLPFC plasticity in individuals with MCI is preserved compared to those with AD and HC, serving as a potential mechanism underlying cognitive compensation in MCI.

Methods: We analyzed a combined cross-sectional data of 47 AD, 16 MCI, and 40 HC participants from three different studies that assessed their DLPFC plasticity using PAS-EEG. PAS-EEG assesses DLPFC plasticity via the induction of Long Term Potentiation (LTP)-like activity, thereby referred to as PAS-LTP. Using multiple regression, we compared PAS-LTP in MCI to PAS-LTP in AD and HCs, after adjusting for age andgender.

Results: Among the 47 participants with AD (mean [SD] age = 75.3 [7] years), 29 were women and 18 were men; among the 16 participants with MCI (mean [SD] age = 74.8 [6] years), 11 were women and 5 were men; and among the 40 HCs (mean [SD] age = 76.4 [5.1] years), 22 were women and 18 were men. After adjusting for age and gender, there was an impact of diagnostic group on PAS-LTP [F (2,95) = 4.19, p = 0.018, between-group comparison η2 = 0.81]. Post-hoc comparisons showed that participants with MCI had a higher PAS-LTP (mean [SD] = 1.31 [0.49]) than those with AD (mean [SD] = 1.09 [0.28]) (Bonferroni corrected p = 0.042) but not different from PAS-LTP in HCs (mean [SD] = 1.25 [0.33]) (Bonferroni corrected p = 1.0).

Conclusions: Our findings indicate that plasticity is preserved in the DLPFC among individuals with MCI, supporting the hypothesis that DLPFC plasticity contributes to cognitive compensation towards delaying progression to AD. Thus, further enhancement of longer preservation of DLPFC plasticity in individuals with MCI could further delay the onset of AD in this population.

Introduction: Throughout the course of the dementia, patients generally need a guardian to protect their rights due to the severity of their mental disabilities. The laws and procedures for guardianship for people with disabilities have been updated in several countries based on the UN Convention on the Rights of Persons with Disabilities promulgated in 2006.

Objectives: To compare the law and procedures for guardianship for people with mental disabilities of twelve countries from six continents.

Methods: Narrative review searching for civil codes/guardianship procedures, date of promulgation, scope of the guardian authority, preferred guardian, duration of the guardianship.

Results: Most countries predominantly promulgated their laws after the year 2000, being half of them updated after 2006. Most countries have two types of guardianship scopes: one concerning financial affairs and the other concerning personal affairs (such as welfare and medical care). Generally, guardianship concerning financial matters is the first to be established. In addition, most countries maintain the ward’s right to vote. In five out of twelve countries, there is an order of preference for choosing the guardian, being the spouses and adult children the preferred guardians. All these countries have the possibility of temporary guardianship. Three countries have a maximum period for guardianship with the possibility of renewal, while all others have indefinite time for guardianship duration. Only France explicitly grants the right to the ward to make medical decisions within guardianship procedures. Brazil’s Civil Code restricts guardianship to financial matters, whereas the Civil Procedure Code requires judges to define the scope of guardianship’s authority for each of the activities of the civil life. Since both codes hold equal authority, judges typically determine the extent of guardianship on a case- by-case basis.

Conclusions: Half of the nations have updated their laws after the promulgation of the UN Convention on the Rights of Persons with Disabilities.

Dementia is expected to increase worldwide and further Discussion concerning the rights of people with dementia is still needed. Although there is no ideal legal framework, the comparison of procedures from different countries may lead to valuable insights for further Discussions andassessments.

Introduction: Recurrent major depressive disorder (MDD) has been associated with cognitive impairment and hippocampus atrophy. Additionally, in older adults it is related to increased dementia risk, as well as being dementia’s prodromal syndrome.

Case Report: A 68-year-old female patient, with a history of MDD beginning in 2014, has been under the care of the Psychogeriatrics service at HC-UFMG. In 2015, she was 60-year-old and underwent her first MRI scan. At that time, the Medial Temporal Atrophy Score (MTA) was 2 and she had a treatment resistant depression (TRD). She began multimodal treatments, including ECT, achieving only partial remission. Since then, the patient had recurrences of depression without the remission of cognitive impairment. In 2021, her MTA Score was still 2 with TDR symptoms. Currently, she is on Venlafaxine 150mg, Mirtazapine 30mg, Lithium 300mg, Olanzapine 5mg, Clonazepam 0.25mg and maintenance ECT every 45 days. The patient remains with cognitive impairment that leads to disabilities but had not significantly progressed. On the other hand, the main impact in functionality is related to depressive symptoms, especially to the loss of interest and apathy.

Discussion: This case stands out due to the combination of hippocampal atrophy at a relatively young age and severe depression with cognitive impairment that has not progressed to dementia in 9 years. Severe depression can lead to significant cognitive deficits, as well as, hippocampus atrophy. While depression is related to hippocampus atrophy, it has not been related to TRD in a review study with Voxel-Based Morphometry. Conversely, Alzheimer’s Disease is related to MTA ≥2 scores, as well as depressive symptoms. MTA 2 in a person of 60 years of age is not considered normal. When combined with cognitive impairment, these findings are generally related to neurodegeneration. Since both MTA and cognitive deficits were relatively stable, the hypothesis of a cognitive impairment and hippocampus atrophy due to depression were more likely.

Conclusions: MDD leads to cognitive impairment in older adults, as well as hippocampus atrophy. Nevertheless, depression and age are important risk factors for dementia and, therefore, a progression to dementia due to a neurodegenerative disease is still possible.

Background: The Cognitive Domains and Functional Assessment Questionnaire (CDFAQ) assess cognitive and functional decline based on the DSM-5 criteria for Neurocognitive Disorders. Its accuracy has been assessed and was translated and validated into English. The informant version (CDFAQ-IV) is a 30-item questionnaire that assesses six cognitive domains with 5 items each: Complex Attention (CA), Executive Functions (EF), Learning and

Memory (LM), Language (L), Perceptual-Motor (PM) and Social Cognition. The development of CDFAQ-IV was based on theDSM-5 cognitive domains, but its factor analysis has not been done yet.

Objectives: To perform a Confirmatory Factor Analysis of the CDFAQ-IV to assess the six-factor cognitive domain model.

Methods: Older adults and their informants were invited to participate in this study. The CDFAQ-IV was applied in 292 older adults’ informants. We used the JASP for a Confirmatory Factor Analysis based on Lavaan R Packages. The confirmatory factor analysis was chosen to manual six-factor model. This study was approved by the ethics committee of UFMG.

Results: Concerning model fitness in the confirmatory factor analysis the X2 was significant (p < .001), standardized root mean square residual (SRMR) was .059 (accepted < .08) and the goodness of fit index (GFI) .984 (accepted > .9). However, the root mean square error of approximation (RMSEA) was marginal to the accepted fitness .066 (accepted < .06) and the comparative fit index CFI was .839 under the accepted cutoff (accepted > .9).

Conclusions: The six-factor model of the showed a good fit for three parameters, marginal for one and negative for the CFI. These results point to a convergence of the questionnaire and factors the DSM-5 cognitive domains. These are still preliminary results and we aim to increase our sample to further assess the confirmatory factor analysis.

Summary: Disorders related to progressive cognitive decline constituting an important cause of global death and disability-adjusted life years because conditions are also associated to impairment of several brain functions, psychological and behavioral changes, regardless of economic status. Brain-derived neurotrophic factor (BDNF) is a neurotrophin highly relevant in memory, learning and neuroplasticity processes in adults. The amount of plasma BDNF has been considered to partly reflect its secretion in the brain. Its deficiency is associated with affective disorders and neurodegenerative pathologies such as Alzheimer disease and Parkinson’sdisease.

The aim of this study was to identify quantifiable biomarkers (serum levels of BDNF) and clinical marker (state of depression and anxiety) that allow early detection of cognitive impairment risk. We made an analytic and transversal study with a representative sample (n:307) of the population over 50 years old in the south of Chile (X region). We determine the cognitive condition of the population by applying cognitive functionality tests, such as the minimental status examination (MMSE) test and identify demographic and psychosocial characteristics that constitute impairment cognitive risk. Subsequently, we determined depression status (scale of Yesavage) and anxiety status (Beck inventory), and finally we made a quantitative determination of human BDNF at the blood level using ELISA technique.

Our results revealed that 26.7% of the participants exhibited some degree of cognitive impairment, being higher in women (55.7%) with average age of 70,7. A 18,2% of subjects manifested indicators of depression and 33,2% have a very hight level of anxiety. The correlation analysis revealed a significant positive correlation between MMSE test (p < 0.001) and both BDNF plasma levels (p < 0.001) and education level (p < 0.001) scores. The results additionally indicated a negative correlation between cognitive functions and age range/anxiety state, suggesting low age level/hight level of anxiety in subjects with more pronounced cognitive decline (p < 0.001),. In consistent, the results of our study point towards decreases plasma BDNF levels and hight levels of anxiety in cognitive impairment subjects compared with cognitive normal subjects, which may be due to the early and middle stages of neurodegeneration process.

Objectives: To estimate the proportion of older adults in primary care screening positive for depression and identify associated factors.

Methods: A cross-sectional study was conducted involving 1,639 older adults (aged ≥ 60 years) from fourteen primary care units in a city of São José dos Campos in the state of Sao Paulo, Brazil, between December 2023 and April 2024. Depression was assessed using the Patient Health Questionnaire (PHQ-2), with a score ≥ 3 being considered to indicate the presence of depression. Logistic regression analyses were carried out to evaluate associations between sociodemographic characteristics (sex, age, marital status and employment) and health related variables (any chronic disease, alcohol consumption, and tobacco use) with a positive PHQ-2 score.

Results: The mean age of the 1,639 participants was 68.6 (SD ± 6.2; range: 60– 95). The prevalence of a positive PHQ-2 score was 20.5%. Women, those with chronic diseases, and current smokers were more likely to have a positive score, (OR: 1.72; 95% CI: 1.33 –2.23, p < 0.000), (OR: 3.13; 95% CI: 1.50–6.56, p: 0.002), and (OR: 1.55; 95% CI: 1.10– 2.18, p: 0.011), respectively. Those who had a job or a partner were less likely to have a positive score, (OR: 0.60; 95% CI: 0.37–0.97, p: 0.036) and (OR: 0.71; 95% CI: 0.55– 0.92, p < 0.010), respectively. There were no significant associations between age and alcohol consumption and screening positive for depression.

Conclusions: Mental health services in primary care typically serve as the initial interface between the community and healthcare services. A substantial proportion of older adults screened positive for depression, which was particularly associated with being female, not having a partner, being unemployed, chronic diseases, and tobacco use. Despite the cross-sectional nature of this study, the results suggest that these factors may play a significant role in the development of depression in this population, and underscores the importance of considering these factors when designing interventions and prevention strategies aimed at the mental health ofolderadults.

Background: There are no approved treatments for Alzheimer’s disease psychosis (ADP). Xanomeline, a brain- penetrant M1/M4 preferring muscarinic receptor agonist, showed antipsychotic efficacy in placebo-controlled trials in subjects with AD [Bodick NC et al. 1997; DOI: 10.1001/archneur.1997.00550160091022]. Despite promising efficacy, further development of xanomeline was limited by cholinergic adverse events. The investigational antipsychotic xanomeline and trospium combines xanomeline with trospium, an FDA-approved muscarinic receptor antagonist that does not measurably cross the blood-brain barrier. Trospium acts to mitigate the peripheral procholinergic side effects of xanomeline, providing a strategy for using xanomeline to stimulate brain muscarinic receptors with a decreased side effect burden. Unlike available antipsychotics, xanomeline and trospium have no direct dopamine D2-blocking activity, and as such, its safety and tolerability profile is different.

Methods: The phase 3 ADEPT-1 trial is a double-blind, flexible-dose, placebo-controlled randomized withdrawal study to evaluate the safety and efficacy of xanomeline and trospium in decreasing the risk of relapse in subjects with ADP. Subjects aged 55-90 years with moderate to severe psychosis associated with mild to severe AD (Mini- Mental State Exam score range 8-22) will be enrolled into the study. Subjects will receive single-blind xanomeline and trospium for 12 weeks. Each subject will be flexibly titrated to the maximum dose of xanomeline and trospium 200 mg xanomeline/20 mg trospium/day. At the end of the single-blind treatment, eligible responders will be randomized to either continue xanomeline and trospium or be switched to matched placebo for a 26-week double- blind treatment period. A responder is defined as a subject with a ≥40% decrease (improvement) on the Neuropsychiatric Inventory- Clinician: Hallucinations + Delusions (NPI-C: H+D) score compared with baseline (day 1) and a Clinician Global Impression–Change (CGI-C) score of 1 or 2 (very much improved or improved).

Results: The primary endpoint of the study, time from randomization to relapse during the double-blind, randomized withdrawal treatment, will be evaluated by survival analysis using Kaplan-Meier Methods. The study started in August 2022 and will randomize approximately 200 subjects.

Conclusions: The trial design of the ADEPT-1 study is an efficient way to assess the potential for xanomeline and trospium to provide clinically meaningful benefit in preventing the return of ADP in patients who have responded to xanomeline and trospium.

Objectives: In an era marked by a 100-year life expectancy, nearly everyone may eventually become a caregiver to a family member or someone close, yet caregiver support remains insufficient in Japan. Outside the government’s comprehensive community-based integrated care system, Buddhist temples are notable for supporting caregivers of individuals with dementia at home. To evaluate the rationale, feasibility, strengths, and fairness of using temples as a community resource within a community-based integrated care system, it is crucial to critically analyze views from secular healthcare professionals familiar with these activities. This study aims to explore the characteristics and potential of caregiver cafés hosted in Buddhist temples from the perspective of staff members involved in secular community- based integrated care system.

Methods: Initially, a preliminary questionnaire survey was administered to 13 priests at Jodo Shu temples that host caregiver cafés to ascertain the current status of these cafés and explore potential collaboration routes with public organizations for future research. Subsequently, semi-structured interviews were conducted with 15 staff members from public organizations involved in community-based integrated care, such as community-based integrated support centers, social welfare councils, and NPOs, who participate in caregiver cafés at Buddhist temples.

Results: All temples were found to cooperate with public institutions involved in community- integrated care. Thematic analysis led to the identification of 20 subcategories from 150 discourses. These subcategories, which had similar content, were further consolidated into a single category and ultimately grouped into four major categories: temples as social resources, temples and priests leveraging their strengths, familiar temples open to the community, and fair temples.

Conclusions: The findings suggested that temples have significant potential to integrate into community-based care systems and play crucial roles in supporting Japan’s super-aged society.

Objectives: Depression is the second most prevalent mental illness among the elderly. Nonetheless, treatment- resistant depression (TRD) is prevalent among the elderly; one-third of elderly patients with major depressive disorder (MDD) who received antidepressant treatment failed to achieve remission. Although there have been several studies regarding the associations between MDD and increased mortality and suicidal risk, studies between TRD and mortality/suicidal risk in the elderly still remains limited. In this national cohort study, we examined the association between TRD, non-TRD MDD, and non-depression with all-cause mortality, accident mortality, and suicide mortality.

Methods: For this retrospective longitudinal analysis on the entire population, the National Health Insurance Research Database of Taiwan, which comprises claims data from a lifetime insurance program and provided comprehensive medical inpatient and outpatient information categorized by ICD-9-CM and ICD-10. The National Mortality Registry offered information regarding mortality resulting from all causes, natural causes, suicide, and accidents. A cohort of ≥60-year-old patients, including both those with and without MDD, was observed between January 2003 and December 2017. Individuals were classified as TRD if they had undergone aminimum of two distinct antidepressant trials within the current episode’s two-year duration and dose, as documented in the prescribing records. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated for mortality risk utilizing Cox regression models.

Results: Among those >60 years old, after adjusting with sex and comorbidities, TRD was associated with increased risk of suicide (aHR 7.4, 95% CI [5.6-9.8]; MDD without TRD 4.4 [4.1- 4.6], compared with non-MDD group). Simliar risk of accident mortality was observed among three groups (TRD aHR 1.3 [0.9-1.9]; MDD without TRD 0.9 [0.9-1.0], compared with non-MDD group). Surprisely, TRD might presented lower mortality risk of natural mortality than the non- MDD group (TRD aHR 0.8 [0.7-0.8]; MDD without TRD 0.9 [0.8-0.9], compared with non- MDD group).

Conclusions: The suicide mortality among elderly patients with TRD is higher in comparison to non-MDD patients; nevertheless, accident mortality does not appear to have increased and the natural mortality rate is reduced. The lower mortality may reflect patient selection, and the contributing factors need further evaluation.