17th asia pacific regional conference of alzheimer's disease international

www.aprc2014-india.com

Under the aegis of

Alzheimer's Disease International

Organised by

Alzheimer's and Related Disorders Society of India All India Institute of Medical Sciences

th17 Asia Pacific Regional Conferenceof Alzheimer’s Disease International

7-9 November, 2014, India Habitat Centre, New Delhi, India

“Emerging Challenges of Dementia in the Asia Pacific Region”

The Global Voice on Dementia returns to INDIA!

WELCOME NOTE


Pranab Mukherjee

President, India

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03

WELCOME NOTE

www.aprc2014-india.com02

WELCOME NOTE


The Alzheimer's and Related Disorders Society is happy to host the 17th Asia Pacific Conference of Alzheimer's Disease International. The theme chosen for this conference is 'Emerging Challenges of dementia in the Asia Pacific region”.

India and China together have not only the largest populations in the world, they also have the largest numbers of persons with dementia. Many of the countries in Asia have quite a few challenges that are common and this platform will help to facilitate the exchange of ideas and thoughts on how to tackle them and to evolve common strategies and plans for better diagnosis, care services, prevention and advocacy.

While stigma, myths and lack of awareness are the cause for low diagnosis, the lack of identification tools and centres as well as scarce care service facilities also add to the problems of persons with dementia and their families. With very little help from the government or the social sector, the persons with dementia and their families often feel helpless and marginalised by the community.

This year, during World Alzheimer's month, Alzheimer's Associations the world over spread the message on risk reduction and prevention of dementia. Since the developing world is where the incidence of dementia is growing, it is very appropriate to advocate measures for risk reduction. The World Alzheimer's Report 2014 on Risk reduction and dementia also highlighted the fact that there is persuasive evidence to suggest that dementia risk can be modified by having hypertension and diabetes under control and cutting down the use of tobacco.

In the absence of cure, it becomes more imperative to look at risk factors and measures to prevent dementia. Although these measures may be suggestive rather than conclusive, there can be no doubt that by adopting a healthy diet and doing regular physical and mental exercise, one can prevent cardio vascular diseases and thereby cut the risk of developing dementia. This is one area in our part of the world that needs a lot of attention. Thus, it is important for our national health programmes to promote healthy living to cut the epidemic of dementia that is slowly and silently growing.

It is my pleasure to welcome our eminent invited guests from different countries, the specialists from all over India, persons with dementia and their carers as well as all the delegates who will be attending the conference. I am confident that the conference will see stimulating presentations and discussions and we will be able to address some of the major challenges of dementia and get the attention of the government and the policy makers to develop more programmes and services for persons with dementia.

Mrs. Meera Pattabiraman

Chairperson - ARDSI National Office

Alzheimer's disease and other dementias are often regarded as difficult clinical problems like many other complexities of old age that the physicians have to address. However, in addition to health care concerns, dementia is also a prototype of social crisis of ageing societies. Long-term dementia care is challenging for the family as well as the health and social welfare system. The economic cost of dementia care has been well researched whereas it may be extremely difficult to assess the social cost of dementia. In past few decades dementia care has evolved well in several countries in the Asia Pacific.

Social policies and State interventions in care and protection of the victims have been put in place. Dementia supports groups have ensured that the dementia victims are not excluded from the development agenda of the society. However, in countries with relatively younger population, health and social welfare professionals are still not very familiar with the issues related dementia and dementia care. It is essential that they do not work hard to rediscover the solutions to the challenges of dementia but learn from the best practices and experiences of other societies within their own cultural context. Alzheimer's Disease International has been striving its best to network professionals across the continents towards this end.

The 17th Asia Pacific Regional Conference of Alzheimer's Disease International will provide a great platform for such interaction, learning and networking. While Alzheimer's disease reminds us about the limitations of modern medical science its also demonstrates the resilience of the families and societies in caring for its not so fortunate members.

Dr A B Dey

Chairman, Organizing Committee

Dr. A. B. Dey

Chairman - Organising Committee, APRC 2014

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WELCOME NOTE


ADI/14/GEN/

30th Oct.2014

Message from the Chairman, Alzheimer's Disease International

Dear Friends,

It gives me immense pleasure to welcome you to the 17th Asia Pacific Regional Conference of Alzheimer's Disease International being held at the India Habitat Centre, New Delhi. The significance of this conference are many. It was in Cochin, India in 1998 where we had the first regional meeting on the sidelines of the 14th International conference of ADI. This is the first regional conference after ADI has set up its regional office in Singapore. This conference shall also witness the launch of the Asia Pacific Dementia Report.

Nearly half the number of people with dementia lives in the Asia Pacific region. The unique family system in the region is under threat because of rapid urbanization, and migration. All efforts should be made to protect and support this sacred institution.

ARDSI, the host organization has taken great pains to organize a world class conference, with excellent speakers, venue and hospitality New Delhi is a city with a glorious past and a wide range of attractions to the visitors. I am sure all of you will go back enriched with new knowledge and ideas. Let this conference be a great opportunity for learning and sharing.

With all good wishes

Dr. Jacob Roy K

Chairman, ADI

Dr. Jacob Roy K

Chairman, ADI


COMMITTEES

05

Patrons

Dr. Jacob Roy

Dr. Vinod Kumar

Organising Committee

Dr. A. B. Dey, Chairman

Mr. R. Narendhar, Organising Secretary

Dr. Kiran Aggarwal

Mr. Mathew Cherian

Ambassador R. P. Singh

Dr. Ashish Goel

Mrs. Renu Vohra

Mr. Anil Aggarwal

Mrs. Nilanjana Maulik

Mr. Thomas Cherian

Mr. S. K. Jindal

Scientific Committee

Dr. Manjari Tripathi, Chairperson

Dr. Ashima Nehra, Co-Chairperson

Dr. K. S. Anand

Dr. Monica Thomas

Dr. N. N. Sarangi

Dr. Amit Dias

Dr. R. Sathianathan

Dr. Ajaya Mahanta

Dr. Mathew Varghese

07www.aprc2014-india.com www.aprc2014-india.com

GENERAL INFORMATION GENERAL INFORMATION

India offers myriad flavours mingling in the steam of a country coming of age. Teeming with over a billion people who voice

over a million concerns in fifteen hundred different languages, India is where people live with variety, thrive on diversity and

are too familiar with largeness to let it boggle them.

India is the country by area, the country with , and the most seventh-largest second-most populous over 1.2 billion people

populous in the world. Home to the ancient and a region of historic trade routes and vast democracy Indus Valley Civilization

empires, the was identified with its commercial and cultural wealth for much of its long history. Four Indian subcontinent

world religions— , , , and —originated here, whereas , , Hinduism Buddhism Jainism Sikhism Judaism Zoroastrianism

Christianity Islam CE diverse culture Indian , and arrived in the 1st millennium and also helped shape the region's . The

economy nominal GDP purchasing power parity market- is the world's tenth-largest by and third-largest by (PPP). Following

based economic reforms fastest-growing major economies newly in 1991, India became one of the ; it is considered a

industrialized country federal constitutional republic parliamentary system 29 . India is a governed under a consisting of

states and 7 union territories pluralistic multilingual. India is a , , and a multi-ethnic society. It is also home to a diversity of

wildlife protected habitats in a variety of .

06

India

Delhi

Delhi ( Hindustani pronunciation: Dilli ), also known as the National Capital Territory (NCT) of India is a metropolitan region .

With a population of 22 million in 2011, it is the world's second most populous city and the largest city in India in terms of

area. The NCR includes the neighbouring cities of Alwar, Baghpat, Gurgaon, Sonepat, Faridabad, Ghaziabad, Noida, Greater

Noida and other nearby towns, and has nearly 22.2 million residents.

A union territory, the political administration of the NCT of Delhi today more closely resembles that of a state of India, with its

own legislature, high court and an executive council of ministers headed by a Chief Minister. New Delhi is jointly

administered by the federal government of India and the local government of Delhi, and is the capital of the NCT of Delhi.

Delhi is India's only city-state.

Delhi has been continuously inhabited since the 6th century BC. Through most of its history, Delhi has served as a capital of

various kingdoms and empires. It has been captured, ransacked and rebuilt several times, particularly during the medieval

period, and the modern Delhi is a cluster of a number of cities spread across the metropolitan region. This is why Delhi is

sometimes called the City of cities.

Evidence of this eventful and prolific history exists in the numerous historical buildings present today in the architectural

ruins that dot Delhi's urban scape. In sheer volume and variety of its historical legacy, it rivals other acknowledged World

Heritage cities like Rome and Edinburgh. Some monuments like the Qutub Minar, Humayun's Tomb and Red Fort are so

exceptional that they have already been inscribed in UNESCO's World Heritage Site list.

Venue

Lost and Found

Lost items should be reported to the Registration Desk in the hub area of Indian Habitat Centre. Recovered items should be turned into the Registration Desk.

Messages

Messages can be left and collected at the Registration Desk.

Registered delegates will receive a Conference Badge, necessary to be worn at all times, for security reasons.

Congress registration fee includes

Congress kit•

Access to all scientific sessions•

Inaugural session & Welcome reception•

Luncheons and tea/coffee•

Getting around Delhi

Public transport in the metropolis includes the Delhi Metro, the Delhi Transport Corporation (DTC) bus system, auto-rickshaws, cycle-rickshaws and taxis. Other means of transit include suburban railways, inter-state bus services and private taxis which can be rented for various purposes. Recently, Radio Taxis have started to gain ground in Delhi. Some companies provide an on-call radio taxi service, which is slightly more expensive than conventional Black and Yellow taxis .

Registration

Date Operational Time Venue

07-Nov-14

08-Nov-14

09-Nov-14

08:00 - 17:00

08:00 - 17:00

08:00 - 13:00

Jacaranda Hall - Pre Function

HUB Area

HUB Area

Located in the central zone of the National Capital, it is India’s most comprehensive convention centre.

The INDIA HABITAT CENTRE was conceived to provide a physical environment which would serve as a catalyst for a

synergetic relationship between individuals and institutions working in diverse habitat related areas and therefore,

maximise their total effectiveness.

Delhi Metro lines in operation

Name No. Terminals Length (km) Stations Rolling Stock

Red

Yellow

Blue

Green

1

2

3

4

5

Dilshad Garden

Jahangirpuri - HUDA City Centre

Noida City Centre - Yamuna Bank - Dwarka Sector 9

Yamuna Bank - Anand Vihar

Inderlok - Mundka

25.09

45

47.40

6.25

15.15

21

34

42

5

14

23 Trains

40 Trains

43 Trains

4 Trains

13 Trains

Metro

The Delhi Metro is a rapid transit system serving Delhi, Gurgaon, Faridabad, Noida, and Ghaziabad in the National Capital Region of India. Delhi Metro is the world's 13th largest metro system in terms of length - 193.2 kilometres (120.0 mi) serving 139 stations. Delhi Metro is India's first modern public transportation system, which has revolutionized travel by providing a fast, reliable, safe, and comfortable means of transport. DMRC operates around 2,700 trips daily with an interval of 2 minutes 40 seconds between trains at peak frequency. The metro has an average daily ridership of 2.4 million commuters. Metro services run from 06:00hrs till about 23:00 hrs.


GENERAL INFORMATION GENERAL INFORMATION

08

Radio Taxi

Radio Taxis are available for local commuting as well as long distance purposes. Hiring a cab in Delhi allows you to get the cab number and driver's mobile number as well. The radio taxis are fitted with GPRS technology, digital fare meters and thermal printers for issuing bill/receipt etc. The billing is done on a per kilometer basis from point to point. Radio cabs are available 24x7 in Delhi, so there is no problem of timing and safety.

Contact numbers of leading radio taxi operators:

Delhi Cab : 91-11-44333222

Easy Cab : 91-11-43434343

Meru Cabs : 91-11-44224422

Mega Cabs : 91-11-41414141

Banking and Currency

The currency in India is the INR or ̀ (Indian National Rupee), which comes in denominations of 1, 2, 5, 10, 20, 50, 100, 500 and 1,000. Please use authorized money changers and banks to exchange currency. They will issue a certificate of exchange which is required at the time of re-conversion of any unused currency.

Under the Foreign Exchange Management Act 1999, it is an offence to exchange foreign currency other than through authorized money changers or banks. The currency may be exchanged at the airport on arrival. The currency exchange facility will also be available at the conference venue.

Most bank ATMs honour Visa, Visa Electron, Master& Maestro cards and you may use these ATMs also to withdraw money.

Most hotels, shops & other establishments accept credit cards. Master & VISA cards are accepted at almost all such establishments whereas some of them accept Diners & American Express cards as well.

Calling

The Country Code for INDIA is +91 or 0091

The City Code for NEW DELHI is 11

Landline numbers in major cities like, Delhi, Mumbai, Bangalore, Hyderabad and Chennai have eight digits whereas the numbers in smaller cities could have only 4-7 digits. All mobile numbers are 10 digits & begin with 7, 8 or 9.

Area Codes in India are referred to as STD codes. STD codes for some major cities are:

Mumbai : 22

Kolkata : 33

Chennai : 44

Bangalore : 80

Hyderabad : 40

Climate in Delhi

The month of November has a very favourable climate. At this time of the year, you can expect plenty of sunny weather, fairly pleasant temperatures. Expected temperature during the day would be about 30 degrees Celsius and about 20 degrees Celsius at night.

What to wear

Light woolen clothing made from natural fabrics like cotton is best for everyday wear. When visiting religious places people are advised to dress conservatively.

Smoking Policy

All conference rooms and public areas are strict no-smoking zones. Smoking in public areas eg. Hotels, airports, restaurants, theatres, shopping complexes, etc.) & transportation (eg. Airlines, railways, cars & coaches) is a punishable offence in india.

Most hotels, restaurants and even airport have smoking lounge or marked smoking areas.

Electric Current

Standard voltage is 220-240 volts, 50 Hz. Most hotels are equipped with transformers for 110-120 volts, 60 Hz. Sockets accept round pins. Should you wish to use appliances of 110 volts, some hotels may provide adaptors on request.

1. Police: 100 / 1090

2. Fire: 101

3. Ambulance: 102

4. Airport Manager (24x7 service): +91-124-337600/4797300

5. Delhi Airport - Domestic Terminal (T1): +91-11-25661000

6. Indira Gandhi International Airport (T3): +91-11-47197001/47197034

7. All India Institute of Medical Sciences (AIIMS): +91-11-26588700

8. Indian Red Cross Society: +91-11-24618073/24618915

Emergency Numbers


VENUE LAYOUT

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SCIENTIFIC PROGRAMME

11

PROCEEDING OPEN FOR MEMBERS ONLY

Day 1- Friday, 7 November 2014 Hall: Jacaranda, India Habitat Centre

8:30 - 17:00 - Registra�on

9:00 - 11:00 ADI-Asia Pacific - Business Mee�ng

11:00 - 11:15 - BREAK

11:15 - 13:00 ADI-Asia Pacific - Business Mee�ng

Proceedings open for all Delegates

13:00 - 14:00 - LUNCH BREAK

Workshops/Symposium Hall: Jacaranda

14:00 - 15:15 Partnering with Corporates - Mrs. Usha Menon, Singapore

15:15 - 16:15 Symposium on Demen�a Friendly Communi�es (DFC)- Moderated by Dr. Sudhir C.T, India

16:15 - 16:30 - BREAK

16:30 - 17:30

DFC con�nued…. Experiences of membercountries and way forward

Par�cipatory event of People Living with Demen�a a joint effort between Japaneseand Indian Alzheimer's Associa�ons (LQDC room at basement)

17:30 - 18:00 Aging Gracefully - Dr. Mathew Abraham, India

18:00 - 19:00 Welcome Recep�on

19:00 - 20:00 Inaugura�on at Stein Auditorium followed by dinner at IHC lawn.

Day 2 - Saturday, 8 November 2014 Hall: Stein Auditorium

Key Note LectureChairpersons: Dr. Vijay Chandra, India / Mr. Frank Schaper, Australia

9:00 - 9:30 Demen�a challenges in the Asia Pacific Region - Dr. K. Jacob Roy, Chairman, ADI, India

9:30 - 10:00 Consumer Empowerment and Service Delivery - Mr. Glenn Rees, Chairman Elect, ADI, Australia

10:00 - 10:30 Carer's Perspec�ve - Brigadier S.P. Bha�acharya, ARDSI, Kolkata Chapter

10:30 - 11:00 Demen�a Call for Ac�on - Mr. Marc Wortmann, Execu�ve Director, ADI, UK

11:00 - 11:15 - BREAK

Hall: Stein Auditorium 11:15 - 13:15 - Plenary Lecture| Chairperson: Dr. Vinod Kumar, India & Mrs. Ghazala Meenai

11:15 - 11:30 Improving Demen�a care in Geriatric Medicine - Dr. A.B. Dey, India

11:30 - 11:50 Popula�on data on cogni�ve func�on of elderly in selected Indian states - Dr. Sanjay Kumar, India

13www.aprc2014-india.com




12

11:50 - 12:15 Integra�ng Demen�a Care - Dr. Ng Li Ling, Singapore

12:15 - 12:40 The Lessons from the Na�onal Fights against Demen�a in Korea - Prof. Ki Woong Kim, Korea

12:40 - 13:05 Person First care: The need to transform services in care homes.- Prof. Graham Stokes, U.K.

13:05 - 13:45 - POSTER PRESENTATIONS & EXHIBITIONS AT CHARMINAR / LUNCH

13:45 - 15:30 - Parallel Sessions

Theme Topic: Management of Demen�aChairperson: Dr. Rajesh Sagar, IndiaHall: Stein Auditorium

Free papers Pla�ormChairpersons: Mrs. Nilanjana Maulik, India & Col. Pradeep Behal, IndiaHall: Maple Hall

Theme Topic: Neuro Imaging, advanced diagnos�cs & Technological innova�onsChairpersons: Dr. S.B. Gaikwad, India & Dr. Sobia Nisar, IndiaHall: Jacaranda I

13:45 - 13:55 Introduc�on Introduc�on Introduc�on Introduc�on

13:55 - 14:15

Novel neuro-imaging techniques: - Dr. Parvat Mandal, India

Approach to a Pa�ent with Demen�a - Dr. Monica Chandy, India

Theme Topic: Diagnosing Demen�a TypesChairpersons: Dr. Prasad Mathews, India & Dr. Prasun Cha�erjee, IndiaHall: Jacaranda II

1. The effec�veness of a personalised demen�a caregiver support interven�on for various migrant groups - Ms. LilY Xiao, Australia

2. Caregiver Burden in Demen�a- A Study from a Developing Na�on - Ms. Pallavi Sinha, India

3. Caring for Carers of Persons with Demen�a (PwD): Indian experiences - Mr. Om Prakash, India

4. Factors Associated with long term residen�al care for people with demen�a- Data from India's largest residen�al care facility - Ms. Sru� Sivaraman, India

5. Demen�a in developing countries: does educa�on play the same role in India as in the West? - Mr. Amulya Rajan, India

6. The prevailing nature of Social Rela�onship and Support System Post

14:15 - 14:35

Pharmacological management of BPSD - Dr. Davangere Devanand, USA

Rivas�gmine Transdermal System Reduces Caregiver Burden And Improves Treatment Compliance In Pa�ents With Alzheimer's Disease Under Daily Prac�ce - Dr. A.V. Srinivasan, India

Role of Nuclear imaging in Demen�a - Dr. Madhavi Tripathi, India

Vascular Demen�a Diagnosis and Therapy - Dr. Suvarna Alladi, India

14:35 - 14:55

Use of the Internet to spread demen�a awareness and to support demen�a care - Ms. Swapna Kishore, India

Changing lifestyle toprevent demen�a: What is the evidence? - Dr. Perminder Sachdev, Australia

14:55 - 15:15

Factors determining delay to first demen�a evalua�on: A study from south India - Dr. Robert Mathew, India

Mirror Agnosia and mirror image Agnosias in pa�ents with demen�a - Dr. S.R. Chandra, India

15:15 - 15:30

Risk factors for BPSD - Dr. Suman Kushwaha, India

Ques�ons & Answers/Summariza�on


Telemedicine enabled demen�a care model - Dr. Radha Murthy, India


Stroke in North India: A Qualita�ve Study - Mr. K.P. Rajendran, India

7. The effec�veness of life story book in improving one's self-iden�ty with demen�a - Mr. Ponnusamy Subramaniam, India

15:30 - 15:45 - BREAK

Parallel Session

Theme Topic: Non-Pharmacological Management of Demen�aChairperson: Dr. K.S. Anand, , IndiaHall: Stein Auditorium

Free papers Pla�ormChairperson: Dr. Kamal Kishore, IndiaHall: Maple

Theme Topic: Care ModelsChairperson: Dr. Ninan Kurien, UKHall: Jacaranda I

Free Papers Pla�ormChairpersons: Dr. B.K. Khandelwal & Dr. Sharmistha DeyHall: Jacaranda II


15:55 - 16:15

1. Incidence of and Risk Factors for Alzheimer's Disease and Mild Cogni�ve Impairment inKorean Elderly - Dr. Jong Bin Bae, India

2. Cogni�ve func�on in elderly with Late onset Depresssion: A cross sec�onal study - Mr. Sivakumar Palanimuthu Thangaraju, India

3. Clinical Prac�ce of Vascular Demen�a in a ter�ary care hospital of India - Ms. Pree� Sinha, India

4. A survey of general prac��oners awareness and management of pa�ents with demen�a in Hong Kong - Ms. Sylvia SM Ting, Hong Kong

5. Demen�a In Parkinson's Disease: An Indian Perspec�ve - Dr. Alakananda Du�, India

1. Homocysteine as an independent risk marker of severity of vascular demen�a - Dr. Mina Chandra, India

2. Study of Associa�on of APOE, CLU and PICALM Polymorphisms with Alzheimer's disease in Indian Popula�on -Dr. Bhagyalakshmi Mallapura Shankarappa, India

3. Holis�c Home based Neuropsychological Rehabilita�on of Persons with VCI. - Dr. Harsimarpreet Kaur, India

4. The Sensi�vity Of Ac�vi�es Of Daily Living Scales: Its Importance In Demen�a Assessment - Swa� Bajpai, India

5. Demen�a - Differen�al Profiling in Neuropsychological Presenta�on - Dr. Sakshi Chopra, India

16:15 - 16:35

Cogni�ve Impairment and Frailty - Dr. Ashish Goel, India

Public and Private partnership in Demen�a: a Kerala State Ini�a�ve - Dr. T.P. Ashraff, India

16:35 - 16:55

Household, economic burden of Demen�a and comparison with severe mental Illness - Dr. Srikala Bharath, India

Promo�ng cultural competency in demen�a care: a person centred approach - Dr. Karan Jutla, UK

Importance of Governance in developing Associa�ons.- Mr. Frank Schaper, Australia

Nutri�on and Demen�a - Dr. Rema Vazhapilly, Singapore

16:55 - 17:15

Addressing caregiver's issues in Demen�a - Dr. Shan� Bala Devi, India

Abuse of Elderly An Epidemiological study - Dr. Ashok Jyo� Deka, India



14


Freepapers Pla�orm Chairperson: Dr. Prasada Mathews, IndiaHall: Maple

Theme Topic: Mild Cogni�ve Impairment : Risk of Demen�a'Hall: Stein Auditorium

Theme: Country Presenta�onsChairperson: Mr. Francis Wong, SingaporeHall: Jacaranda I

Free papers Pla�ormChairperson: Dr. Ashish Goel, IndiaHall: Jacaranda II


6. Clinical Demographic and Pharmacologic Features Of The Residents In A Nursing Home In Turkey - Mr. Oya Ayasbeyo, Turkey

7. Impact of Music on Self-esteem of Older people residing in an Indian old age home - Ms. Sai Laxmi Gandhi, India

8. Sameer Guliani, Profile of Demen�a in a semi-urban Ter�ary care Hospital

17:15 - 17:30Ques�ons & Answers/

Summariza�onQues�ons & Answers/



Summariza�on

Day 3Sunday, 9 November 2014

Hall: Stein AuditoriumPlenary Lecture

Chairpersons: Dr. Srinath Reddy/Dr. N.K. Mehra

09:00 - 09:30 Demen�a in the Popula�on - Dr. Mary Ganguli, USA

09:30 - 09:55 The Preclinical phase of Alzheimer's Disease - Dr. Sudha Seshadri, USA

09:55 - 10:20 Complexity in Demen�a - Dr. Sube Banerjee, UK

10:20 - 10:45The Canadian Research Strategy on Demen�a and its Contribu�on to the World Demen�a Council Agenda - Dr. Yves Joana�e, Canada

10:45 - 11:10 Risk factors for Vascular Demen�a - Dr. Amos Korcyzn, Israel

11:10 – 11:30 BREAK

Parallel Session

6. Promising serum protein marker for early detec�on of Alzheimer's Disease - Dr. Rahul Kumar, India

7. Abdul Qadir Jilani

Comparison and correla�on of cogni�ve screening tools with severity of Alzheimer's disease.

8. Dr. Prasun K Roy Asia Pacific Programs on Brain Grids - The Indian Ini�a�ve : Mul�centric Neuroinforma�cs Analysis for Demen�a/MCI Screening and Monitoring

11:35 - 12:35

1. Spectrum of Behavioral abnormali�es in pa�ents with newly diagnosed Demen�a pa�ents - Mr. Bhagwat Narayan Rajput, India

2. Metabolic phenotype in amnes�c MCI converters on F-18 Fluorodeoxyglucose (FDG) Positron Emission Tomography/Computed tomography (PET/CT) - Dr. Madhavi Tripathi, India

3. As, Cd and Pb-mixture induces synergis�c, early-onset Alzheimer's-like amyloid pathology in rat brain: Involvement of oxida�ve stress and inflamma�on towards amyloidogenesis - Dr. Anushru� Ashok, India

4. Lithium: Possible Prophylac�c Role in Alzheimer's Disease - Dr. Digvijay Singh Goel, India

5. Evalua�on of Alzheimer's disease gene networks in pa�ent-derived cell lines using next genera�on sequencing approach.- Dr. Biju Viswanath, India

6. Correla�on between cogni�ve status and biomarkers of ageing in the oldest old - Dr. Akash Ambastha, India

7. Associa�on of frailty and cogni�ve impairment in older Indians - Dr. Swapnil Jathar, India

1. An overview - Dr. R. Sathianathan, India

2.Primary Progressive Aphasias - Dr. Amitava Ghosh, India

3.Risk Factors linked to MCI - Dr. Vinod Ganguli, India4.Bio-markers and imaging - Dr. M. Suresh Kumar, India

Bangladesh (BDAA)NepalSri LankaPakistan


1. Presence of Depressive symptoms in Family-caregivers of Persons having Alzheimer's disease - Dr. Sandhya Gupta, India

2. An innova�ve and holis�c approach to demen�a care for India: a good prac�se model from Kerala - Mr. Babu Varghese, India

3. Early detec�on of Cogni�ve Impairment in old age - Dr. Vijay Gujjar, India

4. Clinical and Biochemical profile Of Mild Cogni�ve Impairment In elderly Indians.- Dr. Gaurav Raj Desai, India

5. Care giver issues in demen�a pa�ents: a physician's perspec�ve - Dr. Venugopalan Gunasekaran, India

6. Assessment of pallia�ve care needs of pa�ents with demen�a - Dr. Sriniwas Thakur, India

7. Development of training strategies for primary caregivers of pa�ents with demen�a - Dr. Prakash Kumar, India






16


Parallel Session

PhRMA WorkshopHall: Jacaranda II

Theme topic: Health Policy and AdvocacyChairperson: Dr. A.B. DeyHall: Jacaranda I

Theme: Risk and preven�ve factorsChairperson: Dr. Rajinder JalaliHall: Stein Auditorium

WorkshopHall: Maple

13.45 - 13:50 Introduc�on Introduc�on Introduc�on

13.50 - 14:10

14.10 - 14:30

Helpage India - Ms. Rachna Thapliyal

Prof. Vinod KumarDiabetes and Demen�a

What puts you at Risk for AD - Dr. Manjari Tripathi, India

Integrated Medical Therapy for Demen�a.- Dr. E.S. Krishnamurthy, India

Alzheimer Disease & Cogni�on: An Approach to Staged Levels of Preven�on From Neuropsychological Perspec�ve - Dr. Ashima Nehra, India

14.30 - 14:50

14.50 - 15:10

Making of Demen�a India Report - Dr.Mathew Varghese, India

Neuro Produc�ve factors in Demen�a and Risk Protec�on - Dr. P. Prasad Rao, New Zealand

Person Centred Care (15.00-15.45) - Dr. Helen Sanderson, UK

Influencing Policy Makers of Government in suppor�ng the people with Demen�a in India -A Kerala Perspec�ve Case study - Mr. Sreekanth Krishnan, India

A symposium on Rights, abuse, ethical and social issues concerning People living with Demen�aModerated by Dr. Malakapur Shankardass & par�cipated by Dr. Ashish Goel, Mrs. Meera Pa�abiraman & Mrs. Nilanjana Maulik(13.45 – 15.00)

Title: The role of pa�ent organiza�ons in promo�ng and suppor�ng life changing and life- saving research into treatments or cures

Panel DiscussionsModerated by Prof: David Taylor, UCL School of Pharmacy

15.10 - 15:30

Nursing care issues of Pa�ents living with Demen�a - Dr. Sandhya Gupta,India

15.30 - 15:45 Ques�ons and Answers Ques�ons and Answers

15.45 - 16.00 - BREAK

Parallel Session

Theme: Collabora�ve effortsChairperson: Dr. Giriraj, IndiaHall: Jacaranda II

Theme: Social Issues of Demen�aChairperson: Col. V.K. KhannaHall: Stein Auditorium

Legal Issues concerning People living with Demen�a and their familiesMrs. Malavika Rajko�a

Mr. Prem Kumar Raja on Sourcing, Training and Retaining of Caregivers : Challenges and Opportuni�es for Bangalore ChapterMrs. Vidya Shenoy,Alternate Therapiesfor Mumbai Chapter

Theme: ARDSI Chapter ac�vi�esChairperson: Mrs. Meera Pa�abiramanHall: Jacaranda I

Mr. R. Narendhar, ARDSI & NISD representa�ve, NISD joint efforts in Geriatric and Demen�a care

Person Centred Care (contd 16.00-16.30) - Dr. Helen Sanderson, UK

16.00 - 16:15

16.15 - 16:30

Dr. Subhadra Menon PHFILeveraging the media to strengthen the response to Demen�a in the society.

Wg. Cdr. YP Singh for Delhi Chapter

Collabora�ve efforts between Indian and Netherlands medical ins�tu�ons.

16.30 - 17:00Concluding session & Curtain raiser for next year Asia Pacific Conference

Venue: Stein Auditorium

19www.aprc2014-india.com www.aprc2014-india.com18

Davangere P. Devanand, M.D.

Professor of Psychiatry and NeurologyColumbia University College of Physicians and SurgeonsNew York, NY 10032

EDUCATION AND TRAINING

1961-1971 St. Xavier's School, Calcutta, India (Senior Cambridge final exam: ranked in top 10 students in India and top 50 students in British Commonwealth)

1972-1979 Medical School and Internship at Christian Medical College, Vellore, India (M.B.B.S. degree)

1979-1980 Psychiatry Residency first year, National Institute of Mental Health and Neurosciences, Bangalore, India

1980-1982 PGY-I and PGY-II years of Psychiatry Residency, S.U.N.Y. Upstate Medical Center, Syracuse, New York (M.D. degree by reciprocity)

1982-1984 PGY-III and PGY-IV years of Psychiatry Residency at Yale University School of Medicine, New Haven, Connecticut

1983-1984 Chief Resident, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut

1985-1987 Research Fellow, Division of Biological Psychiatry, College of Physicians and Surgeons of Columbia University, New York

1986-1988 Dana Foundation Research Fellow in Clinical Neuroscience, Columbia University, New York

CURRENT APPOINTMENTS

University

Professor of Psychiatry and Neurology, College of Physicians and Surgeons of Columbia University Director, Division of Geriatric Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University

Hospitals

New York State Psychiatric Institute (Research/Attending Psychiatrist)New York Presbyterian Medical Center (Attending Psychiatrist; member, senior faculty practice)

HONORS AND AWARDS

1986-1988 Dana Foundation Research Fellow in Clinical Neuroscience, Columbia University

1987-1988 Fellowship Award: National Alliance for Research in Schizophrenia and Depression.

1991 International Psychogeriatric Association Research Award, International Psychogeriatric Association Congress, Rome, Italy

1998 Tsai Memorial Lecture in Geriatric Psychiatry, UCLA, Los Angeles, CA. Depression and cognitive impairment in the elderly.

2000-2003 Independent Investigator Award, National Alliance for Research in Schizophrenia and Depression

2001 Scientific Award, Indo-American Psychiatric Association, American Psychiatric Association meeting, New Orleans, Louisiana

2003 Lewis Friedfeld Memorial Lecture, Beth Israel Medical Center, New York, NY. Dysthymic Disorder in the Elderly

2003-present Best Doctors in America, Best Doctors in New York

2014 American Psychiatric Association Jack Weinberg Memorial Award in Geriatric Psychiatry

Glenn Rees

Glenn Rees has worked at senior levels in the British and Australian Public Services. In Britain he worked as Private Secretary to senior Ministers, in the Cabinet Office and in Economic Departments. In Australia since 1976 he has worked in program and policy areas including Prime Minister and Cabinet, Employment and Training, Aged Care, Disabilities, Housing and the

Aboriginal and Torres Strait Islander Commission. He was Chair of the Nursing Homes and Hostels Review in 1986 and was involved in implementing the first wave of aged care reforms. He has been CEO of Alzheimer's Australia since 2000 and will be stepping down in 2015. During his time as CEO the Dementia Initiative was implemented in 2005 and important commitments made to tackle dementia in the 2012 Aged Care reforms. Dementia is now a National Health Priority Area. He is an active member of the National Aged Care Alliance and is a member of the new Aged Care Sector Committee. He is Chair Elect of Alzheimer's Disease International

Helen Sanderson

Affiliation: CEO Helen Sanderson Associates

Education

• Masters in Quality Assurance

• PhD in Psychology, thesis on person-centred planning and organisational change

Research Interests

• Personalisation

• Community

Research Publications

• Making Individual Services Funds work with people living with dementia (2014)

• Personalisation and dementia (2013)

• Creating Person-centred Organisations (2013)

Major Current Professional Activities

• Writing guidance on Care and Support Planning for the government

• Researching innovations in dementia

• Researching community connections and people living with dementia

Karan Jutlla

Affiliation: Senior Lecturer in Dementia Studies

Education

• Post Graduate Certificate in Higher Education (November 2012)

• Doctor of Philosphy (Thesis title: Caring for a person with dementia: a qualitative study of the experiences of the Sikh community in Wolverhampton, Decemeber 2011)

• Bachelor of Science (Honours) in Health Sciences (July 2006)

Research Interests

• Ethnicity and diversity in dementia care

• Creative arts in dementia care


JPND Funded Project: MEETINGDEM - Adaptive Implementation and Validation of the positively evaluated Meeting Centers Support Programme for people with dementia and their carers in Europe (Netherlands, UK, Italy and Poland). UK team: Professor Dawn Brooker, Dr Simon Evans, Dr Karan Jutlla and Dr Shirley Evans

Course lead for cultural competency training programmes

Marc Wortmann

Affiliation: Executive Director, Alzheimer's Disease International

Marc Wortmann is Executive Director of Alzheimer's Disease International (ADI). Marc studied Law and Art in the city of Utrecht in the Netherlands and was an entrepreneur in retail for 15 years. During this time Marc was a member of the Parliament of the Province of Utrecht and worked closely with various charities and voluntary organisations. He became Executive Director of Alzheimer Nederland in 2000. From 2002 to 2005 he chaired the Dutch Fundraising Association and

SPEAKER PROFILES SPEAKER PROFILES


was Vice-President of the European Fundraising Association from 2004 to 2007. Marc joined ADI in 2006 and is responsible for external contacts, public policy and fundraising. He is a speaker at multiple events and conferences on these topics and has published a number of articles and papers on dementia awareness and public policy.

Mary Ganguli

Affiliation: Professor of Psychiatry, Neurology, and Epidemiology, University of Pittsburgh,USA

Education

• MBBS: Christian Medical College, Vellore, Madras University, 1974

• General Psychiatry Residency: Memorial University (Canada) and University of Pittsburgh (USA)

• FRCP(C) Psychiatry; ABPN: General Psychiatry with Added Qualifications in Geriatric Psychiatry.

• MPH (Epidemiology): University of Pittsburgh.

Research Interests

• Epidemiology of late-life mental disorders including dementia and cognitive impairment.


• Research in psychiatric/neuroepidemiology.

• Clinical service in geriatric psychiatry.

• Teaching and mentoring.

Dr Ng Li-Ling

Dr Ng Li-Ling is a Senior Consultant Psychiatrist currently practising at the Department of Psychological Medicine, Changi General Hospital, Singapore. She received specialist training in the field of Psychogeriatrics in the United Kingdom in 1991. Since 1993, she has been the Vice-President of the Singapore Alzheimer's Disease Association. Dr Ng is currently the Chair of the National Dementia Network and actively involved in the development of dementia services in Singapore.

Perminder Sachdev

Perminder Sachdev AM MBBS MD FRANZCP PhD MFPOA is Scientia Professor of Neuropsychiatry, Co-Director of the Centre for Healthy Brain Ageing (CHeBA) in the School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney and Clinical Director of the Neuropsychiatric Institute (NPI) at the Prince of Wales Hospital, Sydney, Australia. He is the President of the International College of Psychoneuropharmacology (ICGP) and a former President of the International Neuropsychiatric Association (INA). He has broad research interests, with a major focus on dementia and cognitive ageing, drug-induced movement disorders, neuroimaging and brain stimulation. He leads a program of research which includes longitudinal cohort studies such as the Sydney Memory and Ageing Study, the Older Australian Twins Study and the Sydney Centenarian Study, and is co-investigator on the PATH Through Life Study. Prof Sachdev has published >500 peer-reviewed journal papers and 5 books, including one for lay readers (The Yipping Tiger and other tales from the neuropsychiatric clinic). He was named the 2010 NSW Scientist of the Year in Biomedical Sciences. In 2011, he was appointed Member of the Order of Australia (AM) for service to medical research in the field of neuropsychiatry, and to professional associations at a national and international level. He was also awarded the Founder's Medal by the Australian Society for Psychiatric Research in 2011. He was on the DSM-5 panel for Neurocognitive Disorders and was made an International Distinguished Fellow of the American Psychiatric Association in 2012.

Sube Banerjee

Is Professor of Dementia and Associate Dean at Brighton and Sussex Medical School, directing its Centre for Dementia Studies. Clinically he works as an old age psychiatrist. He was the Department of Health's senior professional advisor on dementia leading the development of its National Dementia Strategy. He developed the Croydon Memory Service Model and works with industry and governments on health systems, policy and strategies to improve health for older adults with complex needs and those with dementia. An active researcher, he focusses on quality of life in dementia, evaluation of new treatments and services, and the interface between policy, research and practice. He has been awarded national and international awards for work in policy and research in dementia.

Sudha Seshadri

Sudha Seshadri, MD is Professor of Neurology at the Boston University School of Medicine and a Senior Investigator at the Framingham Heart Study. Her interests include research into the genetic, lifestyle, vascular/metabolic and biomarker risk factors for cognitive aging, Alzheimer's disease and stroke. She has over 200 publications and serves as Principal Investigator on 3 NIH grants. She is also a clinician, educator and research mentor and serves on the Editorial boards of Neurology, Journal of Alzheimer Disease and Stroke and as a grant reviewer for the the NIH NAME Study section as well as several international funding agencies.

Her many national and international collaborations include leading the neurology phenotype working group within the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, serving as a Co-PI of the Alzheimer Disease Sequencing Project and as Vice Chair of the METASTROKE consortium and she collaborates in translational and imaging based efforts to understand the significance of recently identified genes and pathways underlying cognitive aging. She also serves as PI of the Framingham Heart Study Brain Bank. She studies the imaging, cognitive, genetic and biomarker precursors and characteristics of Preclinical Alzheimer Disease in the Framingham Study Offspring and 3rd Generation cohorts.

Dr. Seshadri completed her MBBS from the Christian Medical College and Madras Medical College, Madras University, and her MD in Internal Medicine and DM in Neurology from the All India Institute of Medical Sciences, New Delhi, India. Additionally, she has completed a Residency in Neurology at the Boston University School of Medicine and a Fellowship in the Neurobiology of Aging and Alzheimer Disease at the University of Massachusetts Medical Center. She has previously worked as Assistant Professor of Neurology at the All India Institute of Medical Sciences, New Delhi where she established a Dementia Clinic and also served as Assistant Professor of Neurology at the Sree Chitra Thirunal Institute of Medical Sciences and Technology where she was a founding member of the Trivandrum Chapter of the Alzheimer and Related Disorders Society of India (ARDSI). She participated as an invited speaker at the ADI meeting in Trivandrum in 1998 and has been a Plenary Speaker on the Genetics of Alzheimer Disease and Related Endophenotypes at the American Academy of Neurology (Boston, 2007) and the Alzheimer Association International Conference on Alzheimer Disease (Paris, 2011).

Usha Menon

Usha Menon is a keen observer, celebrated speaker and global connector having advised, trained and inspired non-profit leaders, philanthropists and foundation decision-makers, over the past 27 years. She has extensive experience working with patient organisations across Asia in building their capabilities to engage with the public sector to advocate for policy interventions, collaborate with the private sector to mobilise resources and help patient/ parent groups and NGOs to strengthen their impact and sustain their efforts.

Usha's efforts have helped 'for-impact' organisations to transform their performance in the areas of leadership, management and fundraising. Her clients include national, regional and international organisations, including charities, patient organisations, foundations, associations, social enterprises, think-tanks, educational and health institutions, UN agencies and Government departments.

Prior to launching her consultancy in 2009, Usha has held leadership positions at National Council of Social Service's Community Chest in Singapore and Habitat for Humanity International–Asia Pacific.

Usha Menon collaborated with fundraising experts from around the world, to bring Global Fundraising: How the world is changing the rules of philanthropy. She curated the sections on Asia, authored the chapter on Singapore and co-authored the India chapter. Usha is one of Asia's leading bloggers, sharing non-profit sector insights and observations regularly through her blog Asian Insights. Usha also co-authored the chapter on Diaspora Giving in the book 'Revealing Indian Philanthropy', a London School of Economics publication in collaboration with Swiss Bank UBS that focused on the trends in giving by the Indian high-net worth individuals. She authored the e-publication 'Social Media for the People Sector' to help non-profits to use the social channels effectively. Her twitter handle is @UshaMenon_Asia

Usha is presently based in Singapore. Prior to Singapore, she lived in Indonesia and in India. She is fluent in English and speaks a range of South and South-east Asian languages.

Mahatma Gandhi's "We must be the change we want in the world" is her guiding principle. She also believes that 'no time' is never a factor of time but that of intention. It is that passion that gives her the energy to be daughter, wife, mother of three, friend, mentor, trainer, volunteer, board member of charities and a successful NPO management and fundraising consultant all in one.



Ki Woong Kim, MD, PhD

University/Hospital

• Associate Dean, Seoul National University College of Medicine (2012-2014)

• Professor, Department of Psychiatry & Behavioral Science, Seoul National University College of Medicine, Seoul, Korea

• Professor, Department of Brain & Cognitive Science, Seoul National University College of Natural Sciences,

Seoul, Korea

• Professor, Interdisciplinary Program in Neuroscience, Seoul National University, Seoul, Korea

• Vice director, Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, Korea

• Head, Center for Dementia and Other Cognitive Disorders, Neuroscience Institute, Seoul National University Bundang Hospital, Seongnam, Korea

• Director, National Institute of Dementia of Korea

• President, Korean College of Geriatric Psychoneuropharmacology

• Member, the National Dementia Council of the Ministry of Health and Welfare

Education

• Graduate from College of Medicine, Seoul National University in 1989 (MD)

• Graduate from Graduate School of Medicine, Seoul National University in 1998 (PhD)

• Internship and residentship at Seoul National University Hospital from 1989 to 1994 (Board of Psychiatry)

• Fellowship at Department of Neuropsychiatry, Seoul National University Hospital from 1997 to 1998

• Visiting scholar at Department of Psychiatry, Duke University Hospital, USA in 2007

Dr. Ashima Nehra

Education

• Bachelors with Psychology as one of the subjects, Panjab University, Chandigarh, July 1984.

• Masters in Psychology (Clinical Psychology as optional subject), Panjab University, Chandigarh, J une 1986.

• Post-Graduate Diploma in Guidance & Counselling, 1987

• PhD in Clinical Psychology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 1997

Research Interests

• Dementia

• Epilepsy

• Head Injury

• Stroke

• Neuropsychological Rehabilitation


• Heading neuropsychology aspect in Cognitive Disorder Memory Clinic.

• Heading neuropsychological Rehabilitation clinic

• Chapter in press:“Neuropsychological Evaluation of Neuro-Cognitive Disorder." In Book: “A Clinical Manual Of Dementia.

Pravat Kumar Mandal

National Brain Research

Center, India & Johns Hopkins Medicine, USA

Education

• Ph. D (IIT Madras)

Research Interests

• Brain Imaging research in Alzheimer research

• Advance signal processing scheme development


• Member Society of Neuroscience

• Guest Editor of special issue, American Journal of Neuroradiology

• Guest Editor in the special issue in the journal of Alzheimer disease

CT Sudhir Kumar

Affiliation: Honorary Consultant Research and Development Centre,

Comprehensive Dementia Care Centre, ARDSI, Cochin, Kerala, India.

Education

• MD Psychiatry

• MRCPsych, Royal College of Psychiatrists, London

• Diploma in Geriatric Medicine, Royal College of Physicians

• MSc in Psychiatry for Developing Countries, Manchester

Research Interests

• Dementia and neuropsychiatry

• Cross-cultural Mental Health

• Bipolar Disorder


• Having trained and worked at the Institute of Psychiatry and the Maudsley

• Hospital in London he currently takes an active role in developmental activities in his honorary position with the ARDSI.

Vinodkumar Gangolli

With medical training and work spanning four countries- India, United Kingdom, United States of America and Canada, Dr. Vinod R. Gangolli's experience is rich in dealing with different environments, each presenting varied challenges and opportunities for learning.

After graduation in Medicine from Karnataka University, his career started in rural India where in addition to being a primary care physician, he was in charge of Family Planning Services. He pursued further studies in the U.K. and then moved to Canada where he completed postgraduate studies at Queen's University, Kingston Canada. He was part of the De-Institutionalization Program in Prince Edward Island, where mental health patients were moved out of institutions and integrated into mainstream society.

Since 1983 to date, he has a private practice in Kitchener, Canada and Mumbai, India.

He was an Assistant Clinical Professor in Psychiatry( Adjunct) in the Department of Neurobehavioral Sciences and Psychiatry at the McMaster University, Hamilton, Canada and Michael DeGroot School of Medicine, Kitchener, Canada from June 2007 till July 2013

He is a founding member of the Psycho-geriatric Advisory Group in India assisting in establishing Psycho geriatric clinics across India and providing psycho-geriatric training for geriatric mental health workers and professionals. He is a Visiting Geriatric Psychiatric Consultant at B.Y.L.Nair Hospital, Mumbai and Dean of Academics / Honorary Geriatric Psychiatry



Consultant at Masina Hospital, Mumbai, where he trains psychiatry residents for National Board examinations

He was invited to publish an article “TRAINING IN PSYCHOGERIATRICS-Realities, Needs, Challenges, and Strategies for Indian Psychiatrists”, in Indian Journal of Private Psychiatry, Special Issue October 2009.

Currently he is a member of the prestigious International Psycho-geriatric Association Board of Directors for a 4 year term representing India. He is appointed as a member of the Consultation Group on Classification of Mental and Behavioral Disorders in Old Age and member of the advisory group on drafting of the ICD 11, World Health Organization, Geneva, Switzerland. He is a Co-chair of Regional Initiatives Forum, Asia/Pacific region /International Psycho geriatric Association in promoting awareness and need for psycho geriatric services in the region. He is the Chairperson of the Committee on Forensic psychiatry and Geriatric Mental Health Act and Regulations, Indian Association of Geriatric Mental Health, India.

Committed to the development of the field of Psycho-geriatrics in India, Dr. Vinodkumar Gangolli sincerely endeavors to enhance the quality of care to the elderly by synthesizing the best practices offered across the globe.

Srikala Bharath

M.B., B.S., D.P.M., M.D.,(Psy) D.C.A.P., FRCPscyh

Professor at the Department of Psychiatry, NIMHANS, Bangalore. Also a Consultant at the Adult and Geriatric Services of NIMHANS, Bangalore

Has more than 25 years of Teaching Experience. Trains both the residents and other non medical personnel in old age psychiatry, guiding residents in research in various aspects of Old Age.

Liaison with various NGOs towards consultation, training and capacity building in elderly mental health.

Areas of interest and research and publication in Old Age Psychiatry are

1. Molecular Genetics (APOe ) in Dementia, Late Onset Depression and Late Onset Psychosis.

2. Carer Burden in Dementia

3. Cost of Dementia

4. Imaging in MCI and Alzheimer's Dementia in liaison with the Department of Imaging

5. Late Onset Depression and Psychoses in the Elderly

6. Community Based Care for Dementia and Depression.

Member of the 10/66 Dementia Research Group – an international body .

Member of the ARDSI – Bangalore Chapter and member of the National Body.

Member of the International Psychogeriatric Association.

Member of the Indian Association of Geriatric Mental Health and Section Co Ordinator for Forensic and Mental Health Policy.

Madhavi Tripathi

Education

• MD (Nuclear Medicine)

• DNB (Nuclear Medicine)

• IUSSTF Fellow

Research Interests

• Functional Imaging in movement disorders

• Functional Imaging in dementia & Epilepsy

• Novel tracers in PET Imaging

Research Publications (in Indexed Journals)

• 70


• Reviewer for Parkinsons Disease & Related Disorders

• Reviewer for Indian Journal of Nuclear Medicine

Swapna Kishore

Qualification:

• B. Tech (IIT Delhi)

• Post graduate in management (IIM Ahmedabad)

City: Bangalore, India

Activities related to dementia care:

T.P. Ashraf

Affiliation: Executive Director, Kerala Social Security Mission

Additional Professor,

Department of Paediatrics,

Institute of Maternal & Child Health,

Government Medical College, Kozhikod, Kerala.

Executive Director,

Kerala Social Security Mission

Poojapura, Thiruvananthapuram.

Project Director,

State Initiative on Disabilities

Department of Social Justice,

Government of Kerala.

Dr. Mala Kapur Shankardass

Dr. Mala Kapur Shankardass by education and specialization is a sociologist, gerontologist, health and development social scientist. Currently she is working as Associate Professor in Department of Sociology at Maitreyi College, University of Delhi, India. She is also a researcher, free lance consultant, writer and a social activist. She Consults for United Nations agencies at New York and India office and is a Resource person for national and international organizations. She has Chaired sessions, delivered Addresses/lectures, organized symposiums at various forums across the world. She writes articles for scientific journals, books and magazines, and is a Panelist in TV programs. She is author of the book 'Growing Old in India: Voices Reveal and Statistics Speak', published by BR Publications in 2004. She is also on Governing Body of the Alzheimer's and Related Disorders Society of India, Delhi Chapter and on the Board of few NGOs in India and abroad. She holds the Asia Chair of the International Network for the Prevention of Elder Abuse (INPEA). She is Member of Editorial Board, Journal of Adult Protection published from UK.

Ashish Goel

Dr Ashish Goel, completed his graduation from Mahatma Gandhi Institute of Medical Sciences, Sevagram and subsequently did his post-graduation in Internal Medicine from the same Institute. He completed his Senior Residency in Medicine and later did a Senior Research Associateship in Geriatric Medicine at the All India Institute of Medical Sciences. He has worked at the Lady Hardinge Medical College as an Assistant Professor in Medicine and is currently placed as Assistant Professor of Medicine at the University College of Medical Sciences in New Delhi. His areas of interest are Geriatric Emergency Medicine, End of Life Care, Medical Ethics and Medical Education with special focus in areas related to Frailty, Andropause, Elder Abuse, Home care and health of incarcerated inmates



Sandhya Gupta

Faculty: College of Nursing, AIIMS, NewDelhi, India

Formerly-Secretary-Indian Nursing Council of India

Education

• PhD-Geriatrics & MSc-Psychiatric Nursing

Research Interests

• Analysis of training needs of nurses in Gerontological nursing

• Development of E-learning packages for Gerontological nursing


• Expert for National and District Mental Health Programme, MOH&FW Govt.of India

• Chief Editor for Indian Journal of Psychiatric Nursing

• Reviewer for Indian Journal of Medical Informatics

• Reviewer for International Journal of Nursing Education

• Member of expert committee on National Nursing Portal, MOH&FW

Awards and Honours

• Awarded President's gold medal

• Awarded Prashasthi award-by Bhartiya Saathi Sangathan

• WHO fellow to Australia

• Fellow of Indian society of psychiatric nurses

• PhD Guide

• Written Modules for Nurses and Primary Health Nursing in Gerontology

• Written Chapters for Nurses and Primary Health Nursing Gerontology for booksz

S Premkumar Raja

Education

• MA, MPhil in Demography from Annamalai University

Research Interests

• Addressing Elder Abuse

• Quality Dementia Care

• Dementia Risk Reduction

• Empowering the elderly

• Developing regulatory mechanisms for old age home

Research Oriented Activities

• Develop a community based rural mobile medical programme for promoting maternal and child health.

• Replicating rural mobile medicare model in Rajasthan in the villages around Ranthambhore National Park

• Establishing Family Planning clinics in Chennai and Bangalore.


Co – Founder and Honorary Secretary of the Nightingales Medical Trust (NMT). A well-established and reputed NGO working for the well-being of the elderly since 1998 in Bangalore. NMT is striving to keep family bonds intact through innovative and community-based support systems for elders of all socio-economic groups. Their projects include 86 bed facility for dementia patients, Elder Enrichment Centres for mitigating loneliness, Elders Helpline jointly with Bangalore City Police addressing elder abuse, Nightingales Job 60+ for training and promoting employment opportunity for non-pensioned elders and Tele-medicine Enabled Dementia Care Centre. NMT is designated as the Regional Resource & Training Centre by the Government of India for building the capacity of NGOs engaged in age care in South India. Some of Nightingales' projects have emerged as models and are being replicated in other parts of the country. The projects of NMT are professionally


managed and the services are well utilized by growing numbers of elders. Over the years, NMT has earned recognition and awards both at national and international levels.

Professor Graham Stokes

Professor Graham Stokes has over 25 years of experience in specialist dementia care and is an internationally recognised authority on dementia care practice and policy. He is Director of Dementia Care at Bupa, a post he took up in 2009, where he oversees Bupa's dementia policy and practice around the world.

Prior to this, he was a senior consultant clinical psychologist at South Staffordshire and Shropshire Healthcare NHS Foundation Trust in the UK where he was Head of Psychology Services for Older Adults and Adults with Neurodegenerative Diseases.

He holds a number of academic posts, including: Honorary Research Fellow in the Faculty of Medical and Human Sciences, University of Manchester; Honorary Tutor in the School of Psychology and Honorary Lecturer in the Institute of Applied Social Studies at the University of Birmingham; and was previously Honorary Lecturer in the Faculty of Health and Sciences, Staffordshire University. He became a Visiting Professor at Bradford University in 2012.

He has written a number of books and papers including the series 'Common Problems with the Elderly Confused'; 'On Being Old: The Psychology of Later Life'; 'Challenging Behaviour in Dementia'; and most recently 'And Still The Music Plays: Stories of People with Dementia'. He co-edited 'Working with Dementia' and 'The Essential Guide to Dementia Care'. He has also written many papers and book chapters on dementia and person-centred care.

DR. A..V, SRINIVASAN

M.D,D.M,PhD,DSc,F.A.A.N,F.I.A.N.

F.R.C.P.(London)

Emeritus Prof. – The Tamilnadu DR M.G.R.Medical University

Former Adjunct Prof. – I.I.T (Madras) – (Bio – Technology)

Visiting Prof. - Clevland – Ohio – USA

Hershe Medical College- USA

Education

MBBS – Madras Medical College (1975)

MD (Gen Med) – Madras Medical College (1978)

DM (Neuro) Madras Medical College (1984)

PhD (Neuro) – Madras Medical College (2002)

DSc (Hon)- The Tamilnadu DR MGR Medical University 2011

F.R.C.P.(LONDON) -2012

Present Position

Emeritus Prof. – The Tamil Nadu Dr.M.G.R. Medical University

Former Adjunct Prof. – IIT (Madras) – (Bio – Technology)

Visiting Professor

Cleveland – Ohio – USA

Hershe Medical College, USA

Awards

Best Neuro Psychological Paper Award – 1990

Association of Indian Neurologists in America

Dean commendation Award – October 2001

International Medical Excellence Aware &

Gold Medal (international study) circle – New Delhi)

U.N.Mehtha Oration-(Torrent)- kolkatta-2010


29www.aprc2014-india.com28 www.aprc2014-india.com

P.S.G. Insitute of medical Sciences-CBE-2011-Dhanwanthiri Award

Prof C.U.Velmurugendran Oration-Madras Medical College -2012

Prof M.S Ramachandran oration-API , CHENNAI CHAPTER -2012

Srinivas Young Man's Association Seva Award- 2014

Fellowship

American Academy of Neurology (USA)

Indian Academy of Neurology(INDIA)

Royal college of physicians(LON)

Training

National Institute for Neurology & Neuro Surgery, Queens

Square, London- one year-1993-1994

CONDUCTED International Workshops on Electro Physiology, Epilepsy,

Movement Disorders and Headaches

Attended lot of National & International Neurology conferences and presented more than

60 papers in national conferences and 25 in International conferences.

His published works include 20 papers, and 15 chapters.

He published six books in Tamil on Parkinson disease, Stroke, Epilepsy,Headache,Dementia, and Autism

Attended Conferences and Presented papers in UK, USA, JAPAN, AUSTRALIA, EUROPE, CHINA, EGYPT, SINGAPORE, CEYLON and NEPAL

Dr. Pravat Kumar Mandal

Education

• Ph. D (IIT Madras)

Research Interests

• Brain Imaging research in Alzheimer research

• Advance signal processing scheme development


• Pravat K Mandal*, Karen Ritchie,and Vincenzo Fodale* Anesthetics and its Impact on the Brain and Alzheimer's Disease, Journal of Alzheimer's disease (2014) Editorial Vol 39 No 2 223-225.

• Jitesh Joshi, Sumiti Saharan and Pravat Mandal* " BOLDSync: A MATLAB-based Toolbox for Synchronized Stimulus Presentation in Functional MRI study" Journal of Neuroscience Methods (2014 ) 223 pages 123– 132

• Sumiti Saharan and Pravat K Mandal * "Emerging Role of Glutathione in Alzheimer's Disease. Journal of Alzheimer's disease. Vol 40 2014 (519-529)


• Member Society of Neuroscience

• Guest Editor of special issue, American Journal of Neuroradiology

• Guest Editor in the special issue in the journal of Alzheimer disease

Any Other (give title)

Dr. Pravat K.Mandal completed his doctoral research from IIT, Madras and his postdoctoral studies from University of California, Davis and later joined as Assistant Professor, Department of Psychiatry, University of Pittsburgh Medical School,USA. At present, he is a Professor at the National Brain Research Centre, Manesar and an Associate Professor (Adjunct) at the division of Neuroradiology at Johns Hopkins Medicine, USA. His research focuses on neuroimaging and neurospectroscopy in Alzheimer 's disease for early detection of Alzheimer's disease.

Dr Robert Mathew

Education

• DM Neurology

• PDF Dementia ,NuRA Australia

Research Interests

• Dementia


• National and international Journals


• Prof and Head of Department of Neurology

Dr. S.R. Chandra

Education

· M.D, D.M(Neurology)

Research Interests

• Neurophilosophy,

• Immunology & general Neurology,

• Dementia and other encephalopathies

• Research Publications

1. Reflected image processing

2. Apraxias and agnosias, etc. published and under study.


Major Achievements

(Honors/Awards/ Publications): National Merit Scholar, University medal in Surgery, Merit certificate Pathology, Forensic medicine, Surgery,President of India Medal as best lady medical graduate from Tamil Nadu, Best paper IAN,NSI, API, IMA, INPC, Prof K J oration\Prof K.S Endowment Lecture, Service award IMA kerala and Swayamsevaks. Eapen Samuel Award.Publications-50, Chapters-28, 3 vol of English and 1 vol Tamil poetry

• Membership to Professional Bodies:

IAN , NSI , API , IMA, BNS

VIDYA SHENOY

Affiliation: HON. SECRETARY

ARDSI, Mumbai Chapter

Education

• M.A. in Economics. Mumbai

• D.B.M. Mumbai

• ICFA. (International Certificate of Financial Advisers). UK.

• Certificate in Medical Transcription, USA.

• Certified in Hathyoga & Pranayam, Mumbai

• Pilates, Mumbai

• Geriatric Counselling

Research Interests

• Yoga and Pranayam.

• Alternative Therapies.



Dr. Jacob Roy Kuriakose

Dr. K. Jacob Roy is the chairman of Alzheimer's Disease International (ADI), the World Federation of 84 National Alzheimer's Association based in London. He had his under graduate medical education from University of Mysore, and post graduate training from National University of Ireland. He is currently working as the senior consultant Pediatrician at Malankara Medical Mission Hospital, Kunnamkulam, Kerala since 1984. He founded Alzheimer's & Related Disorders Society of India (ARDSI), a national voice for Dementia in 1992. He is also the founder chairman of Tropical Health Foundation of India (Voluntary organisation dedicated to the handicapped rehabilitation and geriatric care since 1986).

He is the state co-ordinator of Childhood Disability Group, Indian Academy of Paediatrics and past National Secretary, IAP disability group. He is a governing board member of Parumala Mar Gregorise Charitable trust, Thalacode, administering, an orphanage for 130 boys, and industrial training centre and production unit for women and a trustee of Nirmala Educational Trust, Thalacode, administering a high school, higher secondary school, teachers training college, Arts and Science College. He was made a Member of National Council for Older Persons, Govt. of India in the year 2007. He was a Rotary District Chairman for geriatric care and hospices (Rotary Dist. 3200). He was also past District Director for handicapped rehabilitation, care of the elderly and also children with Mentally Handicapped

Dr. Vinod kumar Gangolli

With medical training and work spanning four countries- India, United Kingdom, United States of America and Canada, Dr. Vinod R. Gangolli's experience is rich in dealing with different environments, each presenting varied challenges and opportunities for learning.

After graduation in Medicine from Karnataka University, his career started in rural India where in addition to being a primary care physician, he was in charge of Family Planning Services. He pursued further studies in the U.K. and then moved to Canada where he completed postgraduate studies at Queen's University, Kingston Canada. He was part of the De-Institutionalization Program in Prince Edward Island, where mental health patients were moved out of institutions and integrated into mainstream society.

Since 1983 to date, he has a private practice in Kitchener, Canada and Mumbai, India.

He was an Assistant Clinical Professor in Psychiatry( Adjunct) in the Department of Neurobehavioral Sciences and Psychiatry at the McMaster University, Hamilton, Canada and Michael DeGroot School of Medicine, Kitchener, Canada from June 2007 till July 2013

He is a founding member of the Psycho-geriatric Advisory Group in India assisting in establishing Psycho geriatric clinics across India and providing psycho-geriatric training for geriatric mental health workers and professionals. He is a Visiting Geriatric Psychiatric Consultant at B.Y.L.Nair Hospital, Mumbai and Dean of Academics / Honorary Geriatric Psychiatry Consultant at Masina Hospital, Mumbai, where he trains psychiatry residents for National Board examinations

He was invited to publish an article “TRAINING IN PSYCHOGERIATRICS-Realities, Needs, Challenges, and Strategies for Indian Psychiatrists”, in Indian Journal of Private Psychiatry, Special Issue October 2009.

Currently he is a member of the prestigious International Psycho-geriatric Association Board of Directors for a 4 year term representing India. He is appointed as a member of the Consultation Group on Classification of Mental and Behavioral Disorders in Old Age and member of the advisory group on drafting of the ICD 11, World Health Organization, Geneva, Switzerland. He is a Co-chair of Regional Initiatives Forum, Asia/Pacific region /International Psycho geriatric Association in promoting awareness and need for psycho geriatric services in the region. He is the Chairperson of the Committee on Forensic psychiatry and Geriatric Mental Health Act and Regulations, Indian Association of Geriatric Mental Health, India.

Committed to the development of the field of Psycho-geriatrics in India, Dr. Vinodkumar Gangolli sincerely endeavors to enhance the quality of care to the elderly by synthesizing the best practices offered across the globe.

Brigadier S.P. Bhattacharjya

Qualifications: BE (Electrical Engineering), Jadavpur University

Diploma(Advanced Electronics), Marconi College, UK

Experience: Served in the Corps of Electronics and Mechanical Engineering, responsible for ensuring the battle worthiness of all weapons systems of the army. Saw active operation during the 1965 and 1971 Indo-Pak war. On retirement, served the public sector and multinational companies in and around Kolkata.

Has been the primary caregiver for his wife, his partner of fifty years, suffering from Alzheimer's since 1994. Actively


• Any study or research related to Alzheimers and Dementia.

• Cause of senior citizens, spinal cord injury and children with special needs.


• Advocacy of Alzheimers & Dementia.

• Alternative Therapies at Hospitals & Daycare.

• Geriatric Counselling

• Teaching Piloga (fusion of Pilates&Yoga) for patients with Alzheimers, senior citizens and children with special needs

Brigadier S.P. Bhattacharjya

Qualifications: BE (Electrical Engineering), Jadavpur University

Diploma(Advanced Electronics), Marconi College, UK

Experience: Served in the Corps of Electronics and Mechanical Engineering, responsible for ensuring the battle worthiness of all weapons systems of the army. Saw active operation during the 1965 and 1971 Indo-Pak war. On retirement, served the public sector and multinational companies in and around Kolkata.

Has been the primary caregiver for his wife, his partner of fifty years, suffering from Alzheimer's since 1994. Actively associated with the Calcutta Chapter of the Alzheimer's and Related Disease Society of India(ARDSI) since 2005 as an executive member and training family caregivers. Authored a book titled 'In the Line of Azheimer's, The Mission Continues,' published by the Calcutta chapter of ARDSI in 2009. The book highlights the usual fault lines in family care giving and spells out some effective home grown therapies for providing quality of life to the victim as much and as long as possible, even in a worst case scenario, ensuring at the same time the caregivers own emotional survival.

Dr Radha S Murthy

Affiliation: Co-Founder & Managing Trustee, Nightingales Medical Trust President, ARDSI-Bangalore Chapter

Education: St. Johns Medical College, India, MBBS

Research Interests

• Addressing Elder Abuse

• Quality Dementia Care

• Dementia Risk Reduction

• Empowering the elderly


• Murthy, Radha (2010). "Assistive Technologies for Cognitive Deficit" in Assistive Technologies for healthcare edited by Sugan Bhatia and Vinita Sharma published by AISCCON, 2010.

• Murthy, Radha (2009). "Home Health Services - A new concept in Geriatric Care", in Ageing-in-place in Navi Mumbai edited by DS Chabukswar, Dr. SP Kinjawadekar, DN Chapke, and PS Kshetramade published by AISCCON, October 1, 2009.

• Murthy, Radha (2010). "Care giving stress in Elderly Woman" in Older Women in India: Development Challenges, edited by Sugan Bhatia and Mathew Cherian, AISCCON, 2010.


Co – Founder and Managing Trustee of the Nightingales Medical Trust (NMT). A well-established and reputed NGO working for the well-being of the elderly since 1998 in Bangalore. NMT is striving to keep family bonds intact through innovative and community-based support systems for elders of all socio-economic groups. Their projects include 86 bed facility for dementia patients, Elder Enrichment Centres for mitigating loneliness, Elders Helpline jointly with Bangalore City Police addressing elder abuse, Nightingales Job 60+ for training and promoting employment opportunity for non-pensioned elders and Tele-medicine Enabled Dementia Care Centre. NMT is designated as the Regional Resource & Training Centre by the Government of India for building the capacity of NGOs engaged in age care in South India. Some of Nightingales' projects have emerged as models and are being replicated in other parts of the country. The projects of NMT are professionally managed and the services are well utilized by growing numbers of elders. Over the years, NMT has earned recognition and awards both at national and international levels.



SPEAKER ABSTRACTS

Davangere P. Devanand, M.D.

Abstract Title: Pharmacologic Management of Neuropsychiatric Symptoms in Dementia

Neuropsychiatric symptoms occur frequently in patients with dementia, of which Alzheimer's disease is the most common type. Agitation is the most common neuropsychiatric symptom and often persists over time in patients with Alzheimer's disease. Antipsychotic treatment for symptoms of agitation, aggression and psychosis shows a moderate advantage over placebo in controlled trials, but these medications are associated with several side effects including an increased risk of mortality. In patients with Alzheimer's disease with agitation and/or psychosis who respond to antipsychotic treatment, discontinuation has been shown to be associated with an increased risk of relapse for several months after discontinuation, emphasizing that antipsychotics may need to be continued for extended periods in patients who have shown clinical response. Selective serotonin reuptake inhibitors may have some efficacy based on a recent controlled trial with citalopram to treat agitation in Alzheimer's disease. Anticonvulsants, though used widely, have not shown efficacy in large-scale controlled trials. Depression is another common comorbid feature in patients with dementia, and can present diagnostic dilemmas because apathy and anhedonia are features common to both depression and dementia. There is some evidence that antidepressants may be effective in treating depression in patients with Alzheimer's disease, but there are some negative studies. Benzodiazepines may have efficacy in treating symptoms of anxiety but adverse cognitive effects and the risks of tolerance and falls are limiting factors. Management of neuropsychiatric symptoms continues to present clinical challenges and further research is needed to identify more effective treatments with acceptable side effect profiles.

Rivastigmine Transdermal System Reduces Caregiver Burden And Improves Treatment Compliance In Patients With Alzheimer's Disease Under Daily Practice C

A. V. Srinivasan*¹ , Ankur Malhotra²

¹EMERITUS PROFESSOR THE TAMILNADU DR MGR MEDICAL UNIVERSITY, India, [email protected], ²Novartis health care privete limited, India, [email protected]

Keyword :

Rivastigmine Alzeimers caregiver

Objective:

Rivastigmine, is the first cholinesterase inhibitor to be available in the transdermal formulation, for treatment of mild to moderate Alzheimer disease (AD). RECAP study (Real-World Evaluation of Compliance And Preference in the Treatment of Alzheimer's Disease) evaluated the caregiver preference and the patient compliance in patients with AD treated with oral or transdermal monotherapy. Here we describe experience and satisfaction of the rivastigmine patch in Indian patients with AD.

Methods:

In this non-interventional, multinational, prospective study, male and female outpatients, diagnosed with mild to moderate AD, were recruited. The total duration of study was 24±8 weeks. Efficacy outcomes were assessed every 12 weeks, and included caregiver preference for treatment and the caregiver assessment of patient compliance, assessed by the Caregiver Medication Questionnaire at end of study on Week 24.Secondary variables included physician's preference for treatment, concomitant use of psychotropic drugs, and adverse events (AEs). Patients were grouped into two groups on the basis of regimen prescribed, Oral (donepezil, galantamine, memantine, rivastigmine capsule) and Transdermal (rivastigmine patch).

Results:

A total of 574 patients were recruited for the study and data from 573 (M:F 367:206), mean age 69.6 years, was analysed, of which 313 (54.6%) and 260 (45.4%) were in the transdermal and oral therapy cohort, respectively.Demographic and baseline characteristics were comparable between 2 cohorts. Overall majority of patients (97.7%) were living with caregivers or other individuals.Out of the 504 caregiver's preference assessments available, 401 (79.6%) (95% CI, 75.8% to 83.0%) and 103 (20.4%) (95% CI, 17.0% to 24.2%), indicated preference for the transdermal treatment and oral medication, respectively. In categories defined by previous exposure to transdermal and/or oral medication (before and during study) preference for the transdermal treatment among caregivers was significantly higher than for the oral treatment (p<0.0001) at Week 24 (Figure-1).

Patient compliance was significantly higher in the transdermal than oral groups at 24 Weeks (mean scores: 8.50 vs. 6.14; p<0.0001) (Table-1). Of Twenty four physicians who provided their preference for medication, 22 (91.7%) physicians preferred transdermal treatment and 2 (8.3%) preferred the oral medication. The 2 most important reasons cited for transdermal treatment were, easier to use (36.4%) and easier to comply / better acceptance by the patient (31.4%). Use of concomitant psychotropic medication was similar between the two groups, and there was no significant difference in type of psychotropic medication used between the two groups. Proportion of patients reporting AEs was similar between two groups (Oral 9 [3.5%] and transdermal 6 [1.9%]). Gastrointestinal disorders were most common AEs reported by oral cohort


associated with the Calcutta Chapter of the Alzheimer's and Related Disease Society of India(ARDSI) since 2005 as an executive member and training family caregivers. Authored a book titled 'In the Line of Azheimer's, The Mission Continues,' published by the Calcutta chapter of ARDSI in 2009. The book highlights the usual fault lines in family care giving and spells out some effective home grown therapies for providing quality of life to the victim as much and as long as possible, even in a worst case scenario, ensuring at the same time the caregivers own emotional survival.

Dr. Manjari Tripathi

• Current Affiliations: Additional Prof Neurology

• Honours, Awards and Recognition: NIH FELLOW-UCLA

• Professional interests: EPILEPSY, COGNITION and SLEEP,

• President Alzheimers Related Disorders Society India- Delhi Chapter

• Observed functioning of Dementia clinic with Prof M Mesulam, Northwestern University, Chicago, USA in 2002 & with Mario Mendez, UCLA. Runs the Cognitive Disorders Clinic, AIIMS

• Member of Professional societies like American Academy of Neurology,10/66 International Dementia research group, National disability workgroup in Neurology, member tropical neurology subsection of Indian academy of neurology, Indian Academy of Neurology, She has research projects in dementia (Genetics, Risk factors, Functional imaging ) and guides residents & Phd students with there thesis. and research work. She has written a caregiver booklet for Northern India in Dementia published by the ARDSI. With the ARDSI has got Delhi its first Day care centre for dementia. Honoured with Orations and numerous awards.

• Publications: Risk factors of dementia in North India: a case-control study. Tripathi M, et al. Aging Ment Health. 2011 Jun 30.

• Kalaria RN, Tripathi et al, World Federation of Neurology Dementia Research Group. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol. 2008

• Mansoori N, Tripathi M, et al IL-6-174 G/C and ApoE gene polymorphisms in Alzheimer's and vascular dementia patients attending the cognitive disorder clinic of the All India Institute of Medical Sciences, New Delhi. Dement Geriatr Cogn Disord.

• Luthra K, Tripathi M, et al Apolipoprotein E gene polymorphism in Indian patients with Alzheimer's disease and vascular dementia. Dement Geriatr Cogn Disord. 2004

• Tripathi M, et al, Serum cobalamin levels in dementias. Neurol India. 2001.

• Tripathi M, Vibha D.Unusual risk factors for cognitive decline. J Alzheimers Dis. 2010;

• Raman Deep Pattanayak, and Manjari Tripathi Coping and its relationship to quality of life in dementia caregivers Dementia, 2011

• Co Authored Multiple publications in Stroke risk factors and intervention, Epilepsy and sleep disorders.

• Numerous chapters in Dementia, Reversible dementia, In national and International Journals.

SPEAKER PROFILES


and skin and subcutaneous tissue disorders were most common AEs reported by transdermal cohort.

Conclusions:

Most caregivers of patients with mild to moderate AD gave clear preference for the transdermal treatment. Caregivers also reported overall satisfaction, and ease of use for transdermal rivastigmine format, additionally patients in the transdermal cohort showed a better compliance with the treatment compared with patients in the oral cohort.

Perminder Sachdev

Abstract Title: Changing lifestyle to prevent Dementia: What is the evidence?

With the rapid increase in the health burden of dementia globally, there is an urgent need to develop and implement strategies to prevent dementia and/or postpone its onset. In the absence of effective pharmacological interventions for primary prevention, the focus has shifted to lifestyle and vascular risk factors. The modifiable risk factors identified in the literature include vascular factors (hypertension, diabetes, atherosclerosis, high cholesterol, mid-life obesity, smoking), low brain reserve (low education, complex mental activity or physical activity and poor social network), nutritional factors (low intake of antioxidants, high homocysteine, high alcohol use) and other (depression and head injury). The quality of evidence for these factors is varied, with most evidence being obtained from case control and observational cohort studies. Only some factors have been subjected to randomised control trials. The basic science evidence is not always consistent. This talk will examine some of the available evidence, identify the gaps in the literature and suggest a way forward. It will also ask the question whether observational evidence is sufficient to support large scale investment in interventions.

Madhavi Tripathi

Abstract Title: Nuclear Imaging in dementias.

Dementia is a syndrome with diverse clinical presentation, a challenging differential diagnosis, and not too many therapeutic options. The most common cause of neurodegenerative dementia in patients aged > 65 years is Alzheimer's disease, which now affects more than 44 million people worldwide. The role of functional imaging with nuclear medicine techniques in neurology is well established and continues to expand rapidly. Nuclear medicine imaging of the brain includes perfusion single-photon emission computed tomography (SPECT) and Fluorine-18 (F-18) fluorodeoxyglucose positron emission tomography (PET) as the two most common modalities. In addition detection of pathophysiological changes in the brain using amyloid and Tau based agents hold great promise for the assessment of patients with dementia, especially to improve specificity. Both perfusion and metabolism images of the brain demonstrate characteristic patterns of hypoperfusion and hypometabolism which have an overall accuracy of 96 % for the differential diagnosis of dementia subtypes (1). Perfusion and metabolism abnormalities in the brain are coupled and both SPECT and PET can be effectively used in differential diagnosis of dementia patterns, however the higher sensitivity and resolution of PET favours its use if cost issues are not taken into consideration. Alzheimers dementia (AD) is characterized by bilateral temporo-parietal hypoperfusion and hypometabolism which characteristically involves the precuneal and posterior cingulate cortices. Frontotemporal dementia (FTD)-behavioural variant, is characterized by bilateral frontal and temporal hypoperfusion and hypometabolism. FDA has approved F-18 FDG PET for differential diagnosis of AD from FTD. A review of the literature by Bohnen et al (2) has shown that the evidence for F-18 FDG PET in assessment of dementia has increased with new studies that include autopsy confirmation, wide-diagnostic-spectrum recruitment in primary care settings, historical and prospective cohort studies, and multicenter data analyses. Laforce et al, (3) demonstrated that F-18 FDG imaging led to a change in diagnosis in 29% of patients with suspected dementia, a reduction in unclear diagnosis from 39 to16%, the clinical impact being greatest in unclear and atypical cases.

Recently, the National Institute on Aging and the Alzheimer's Association identified specific structural and functional neuroimaging findings as valuable markers of biological processes occurring in the prodromal stage of AD. PET with amyloid imaging agents like C-11 Pittsburg compound and the F-18 labelled agents like Florbetapir, Florbetaben and Flutemetamol (all FDA approved) serve as direct markers of amyloidβ (Aβ) deposition (have higher retention in brain tissue harboring plaques composed of insoluble Aβ) while hypometabolism on F-18 FDG PET serves as a downstream marker of neuronal injury (loss of excitatory glutamate synapses secondary to the neurotoxic processes derive from soluble amyloid protein from the cleavage of the amyloid precursor protein). A positive marker for Aβ deposition along with hypometbolism suggestive of neuronal injury on F-18 FDG PET, increases the probability of mild cognitive impairment (MCI) to high likelihood of MCI due to AD. While a negative marker for Aβ deposition and neuronal injury decreases likelihood to MCI unlikely due to AD. It is likely that plaque imaging will play a role in the selection of 'at risk' patients for treatment, the leading target for therapy being beta-amyloid dimers.

References:

1. Mosconi L, Tsui WH, Herholz K, et al. Multicentre standardized F-18 FDG PET diagnosis of mild cognitive impairment, Alzheimers disease and other dementias. J Nucl Med 2008; 49: 390-398.

2. Bohnen NI, Djang DSW, Herholz K, et al. Effectiveness and safety of F-18 FDG PET in the vealuation of dementia: A review of the recent literature. J Nucl Med 2012; 53: 59-71.

3. Laforce RJ, Buteau JP, Paquet N, et al. The value of PET in mild cognitive impairmenttypical and atypical /unclear dementias: A retrospective memory clinic study. Am J Alzheimers Dis Other dementias 2010; 25: 324-332.

Swapna Kishore

Abstract Title: Use of the Internet to spread dementia awareness and to support dementia care

The Internet is a powerful tool to reach people. Internet usage is growing in every country, especially because of Internet on the smartphone. Unfortunately, this tool is often neglected or underutilized by volunteers and professionals. Our current methods of reaching out families affected by dementia are unable to cover many segments of society, and the Internet is a tool we cannot afford to neglect any more.

This talk discusses the possibilities and limitations of using the Internet to make information available and also to support families coping with dementia. It covers topics relevant to persons considering whether and how to use the Internet. These include content creation approaches and criteria, and how to increase the reach of online resources and services. The talk also covers aspects like community building, maintenance of online material, and how online resources can complement other modalities used for awareness and support. The talk briefly discusses how organizations can approach the project of developing online resources.

Radha S Murthy

Abstract Title: Telemedicne Enabled Dementia Care Model

The Dementia India report 2010 has estimated that over 3.7 million people are affected by dementia in India. This is expected to double by 2030. Most of these people affected with dementia require institutional care at some point of the illness, however, there are only a few institutions offering this service. There is a huge gap between the demand and availability.

Adding to this, dementia care specialist and services are only in few big cities and remains inaccessible to people in smaller towns. The best way to enhance the reach and access to dementia care services is through leveraging technology. With advances in Information and Communication Technology, it is possible to reach more number of people with dementia in distant and remote places.

These technological advances have facilitated the shift from traditional models of residential care to distant monitoring of day to day activities, virtual cognitive assessment and utilizing assistive aids to promote independence in persons with dementia. Using technological interventions such as telemedicine, software solutions and assistive aids not only make the services accessible but also affordable. ETCM- Nightingales Dementia Care Centre is one such approach. This 35-bed Dementia Care Centre located at the premises of ETCM Hospital, Kolar. This is India's first telemedicine enabled Dementia Care Facility based on hub & spokes model.

This Telemedicine Centre being the “Spokes” and Nightingales Centre for Ageing & Alzheimer's (NCAA), India largest residential care facility exclusively for PwD being the “Hub”. The clinical core team of NCAA in Bangalore constantly monitor the quality of care through video conferencing using specially designed Tele-dementia Management Software integrated with dispensing medicines, care plan, assessment scales, imaging files and patients reports. This includes provision for investigations, daily monitoring and framework for follow-up schedules thus ensuring effective monitoring without compromising on the quality of care.

A pilot study currently being undertaken to evaluate the utilization of telecare technology and management protocols in reducing the cost of residential care and making it accessible. Once the pilot project is completed with satisfactory results, this model will be replicated in different parts of the country.It is expected that this unique technology based high quality service delivery system will bring down the cost of residential dementia care by 40%. A model would be created which can eventually be replicated in more satellite centers enabling affordable and accessible dementia care.

SPEAKER ABSTRACTSSPEAKER ABSTRACTS


Karan Jutlla, BSc, PhD, PG Cert HE

Senior Lecturer in Dementia Studies

Association for Dementia Studies, University of Worcester, United Kingdom

Abstract Title: Promoting culturally competency in dementia care: a person centred approach

Research on dementia care in the United Kingdom (UK) in Black, Asian and Minority Ethnic (BAME) communities has highlighted the need for cultural competency training for those working professionally with people with dementia and their families. It has been evidenced that while many health professionals feel that they need more training to both improve their knowledge about dementia and the cultural norms and religious practices of BAME people with dementia, access to this sort of training is variable. Because of the acute lack of quantitative and qualitative data about the health and social care needs of BAME communities, and how they are best met, training to improve cultural competency in services is difficult. Whilst training for basic Asian language communication skills is useful, the diversity both between and within BAME communities also needs to be addressed. This paper reports the findings of research with Sikh carers of a family member with dementia living in Wolverhampton in the UK – highlighting evidence that demonstrates the diversity of the Sikh community and challenges assumptions of homogeneity. The findings of this research demonstrate the need for health care professionals and service managers to apply a person-centred approach to care when working with people with dementia and their families from migrant communities in the UK – a concept which is relevant worldwide. Cultural competency is a contested term with various understandings and definitions. This paper will present the evidence base to support the notion that cultural competency refers to an understanding of diversity and represents a value-based perspective that recognises individuality – similar to that of person-centred care.

Frank J Schaper

Abstract Title: The Importance of Governance in Developing Associations

There are many people who volunteer to support good causes and assist emerging not-for-profit on charitable organisations to become established. Many end up as members of Boards, or committees or even become Trustees without really understanding what is required of them. They are often so involved in all the “doing” that they fail to see the importance of good governance and what that entails.

This presentation explores what governance is, why good governance is important, and how to achieve it.

K.Shantibala Devi

Abstract Title: Addressing Care Giver Issues Of Dementia

Dementia is a progressive impairement of cognitive functions occurring in clear consciousness. The global impairement of intellect affect memory, attention, thinking comprehension, language, mood, personality, judgement and social behaviour. Prevalence is 5% above 65 years of age, 20%-40% above 85 years. There are reversible and irreversible (degenerative) dementias. The most common type of dementia is Alzheimer's disease (50%-60%).

Caring for loved one with dementia poses many challenges for families and care-givers. Dementia has devastating social, economic and emotional consequences for both the patient and the caregiver. Caring for dementia or Alzheimer person can be a long-drawn stressful and intensely emotional journey.

There are several suggestions and tips to help caregiver communicate with dementia person. It requires setting the right mood, environment and techniques to ways of asking questions, helping in activities, responding with respect, affection and reassurance, maintaining sense of humour etc. The behaviour of dementia patient is troubling, disturbing and embarrassing. However it can be managed if caregivers understand that the disease progress influences and shape the behaviour.

The agitated behaviour, wandering, incontinence, sleep disturbance and other disoriented behaviour can be taken care of with appropriate measures.

Psychotic symptoms which are quite common, inappropriate sexual behaviour, verbal outburst and other disorganized behaviour too can be medically managed over and above the caregivers' skill to handle the problem. Areas of self-care such as bathing, dressing, washing can be made comfortable and interesting if certain steps are followed.

Caring for Alzheimer's patient can be daunting and very stressful. The roles of caregiver need changes as the disease progress. Depending on the stages of Alzheimer's disease ie early, middle, late, different planning and strategies for care need to be expected from home care to making decisions for placement in nursing homes or hospice.

Since care giving for dementia is a full-time, all consuming activity there is high risk of developing frustration. This can have serious consequence to the caregiver and it is estimated that 30% to 40% of them experience depression, high level stress or

burnout. Understanding the disease, good coping skills, strong support network and participating in a support group can be a critical life-line.

Special concern for dementia caregiver is depression where women carer suffer move than men and majority of the caregivers are women. The 24 hour care-giving deprived many a carer of adequate sleep, leading to health problem. The depressive disorder may persist even after putting dementia patient in care-facility. Seeking treatment for depression is imperative but for 41% of women shame and embarrassment tends to be a barrier to treatment.

Feeling of frustration is another negative symptoms frequently experienced by caregiver. Few steps may be considered to counter frustration such as getting regular break or respite, eating and sleeping well, exercise, getting outside support to share feelings, medical help etc.

The national institute of mental health recommended that caregivers should not over-burden themselves with all responsibilities, to set a realistic goal, priorities, participation, not to isolate themselves or be secretive and most importantly to understand that it takes time to improve mood and to take help of family and friends.

Months or years of care-giving takes its toll and burn-out occurs with features of denial, anger, social withdrawal, exhaustion, sleeplessness, irritability, anxiety and depression. Coping strategy include seeking regular respite, to get moving, talking it over and trying new things. There is also caregivers training programme and education that offers consultation, education on dementia, stress-reduction coaching, environment management, home-setting, and strategies for behaviour managements.

Ashima Nehra

Abstract Title: Alzheimer Disease & Cognition: An Approach to Staged Levels of Prevention From Neuropsychological Perspective

Alzheimer's disease (AD) is the leading cause of dementia, and the most prevalent neurodegenerative disease in the elderly. Presently in India, an estimated 3.7 million Indian people aged over 60 have dementia (ARDSI Report, 2010) and the prevalence of dementia increases steadily with age. Moreover, around 10-37% of the elderly population with dementia in developing countries are classified as having potentially vulnerable living circumstances with requiring long-term and specialised care. Hence, a holistic prevention strategy is a need of an hour at all levels. Therefore, the aim of this talk is to enumerate different strategies of prevention ranging from primary prevention to tertiary prevention. The talk would comprise of sharing different neuropsychological strategies at all levels of prevention. The primary prevention strategies would help in reducing the incidence of the disease by creating awareness and screening the possible populations at the right time. At secondary prevention, a timely and precise diagnosis following a multi-speciality decision making approach which aims to detect the disease at an early stage, before any symptom has emerged, when treatment could halt or limit its progression would be discussed. Last but not the least at tertiary prevention, various cognitive rehabilitation techniques would be discussed in combination of pharmacological treatment which aid in ameliorating the impact of complications and disability of long-term diseases, thus it allows patient and their caregivers to maintain an acceptable quality of life.

Prof. Graham Stokes, U.K.

Abstract: Person First care: The need to transform services in care homes.

We know that the aged care system needs to change to meet the current and future needs of older people and their families. Currently 'at home care' is defined by tasks and provided on the basis of affordability. People typically enter residential care facilities when their dependency needs are high, and as a last resort. If they have dementia they are in the advanced stages and often in crisis.

This brings with it several challenges - emotional, health and financial - for everyone involved. It's unsustainable. Especially as we are all living longer, and the prevalence of dementia is increasing. Something needs to change...

At Bupa, we are taking these challenges and trying to address them in real life situations. Our dementia specialism across geographies puts us in a unique position to do so. From specialist dementia nurses (Admiral nurses), to Antipsychotic reduction, and new research and teaching environments some pieces of the puzzle are coming together, but there is still a lot more to collaborate, research and learn from. The key message is that there is a distinction between quality of care and quality of life. It is not one and the same thing. Good care contributes to a person's quality of life and to think otherwise sets the bar far too low. We must put the person first and urge governments around the world to make this care central to their National Dementia Plans; the single most powerful tool to transform national dementia care, support and risk reduction.



dementia). Emerging evidence suggests that there may be considerable error in making these assumptions and that failing to deal with complexity means failing those with dementia. In this session we will consider complexity and multimorbidity in dementia and what this means in our mission to improve the quality of life of people with dementia and those that support them by improving the quality of care that we provide.

The Preclinical phase of Alzheimer's Disease

Dr. Sudha Seshadri, USA

The pathophysiology of Alzheimer's disease starts over 2-4 decades prior to onset of clinical dementia; this has been demonstrated in families with dominantly inherited Alzheimer's disease (DIA), in autopsy studies, and to a limited extent in children of persons with late-onset AD. The earliest stages of preclinical AD are of great public health interest as preventive interventions are most likely to be effective at this phase and recently new criteria were defined for identifying preclinical AD. Putative markers of preclinical AD included a poorer performance on cognitive tests than expected for age and education, CSF biomarkers of amyloid and tau, and neuroimaging markers of brain amyloid, glucose metabolism, hippocampal atrophy and specific patterns of cortical atrophy. More exploratory markers include subjective symptoms of memory loss, tau imaging and resting state functional connectivity MRI. Large initiatives are underway to identify risk-enhancing and protective genetic factors and novel preventive interventions, both lifestyle related and drug treatments. There is limited data on prevalence and patterns of preclinical AD with a newly described entity of 'Suspected Non-Alzheimer Pathology' that nevertheless increases risk of clinical dementia. This talk will give a broad overview of preclinical AD and possible vascular contributions to preclinical AD with a special emphasis on work being done at the Framingham study and its relevance to the growing burden of dementia in India and other Asian-Pacific countries.

Mary Ganguli

Dementia in the population

Dementia is a clinical state in which adults lose their cognitive or intellectual abilities to such an extent that they are unable to independently carry out their daily functions. Several diseases can cause dementia, or contribute to dementia. Alzheimer's disease is the single most common cause of dementia, but a combination of Alzheimer's and vascular (blood-vessel-related) disease, i.e., mixed dementia, is probably the most frequent. As life expectancy improves across the planet, dementia makes a growing contribution not only to mortality but also to disability and global disease burden.

Basic sciences are providing a rapidly expanding understanding of what goes wrong in the brain in Alzheimer's disease, but we still do not know why it happens or what triggers the process. This makes it difficult to find a cure for the disease once it has started. Thus, more attention is being placed on preventing the disease in the first place, or at least delaying the onset of the dementia.

However, the science of epidemiology has helped us to identify potential risk factors which increase the likelihood of developing dementia, as well as potential protective factors which reduce the chances of developing dementia, at the population or community level. The challenges now lie in understanding the mechanisms of these apparent risk and protective factors, and translating them into effective preventive strategies. This lecture will cover some of the most interesting risk and protective factors and also highlight the importance of correctly interpreting the scientific data. Health care providers, advocacy groups, and the media all share the responsibility to avoid misrepresenting and sensationalizing scientific results, which not only discredits the science and slows down research, but also raises false hopes among patients and families.

Key Words: Epidemiology, population, risk factor, protective factor, prevention.

Evidence-based Emergency Management of BPSD

Studies have found that more than 90 percent of people with dementia develop at least one BPSD with a significant percentage of these individuals having serious clinical implications. Agitation, aggressive behavior, oppositional behavior, and psychotic disturbances are severe in nature and call for immediate intervention. These symptoms cause considerable

caregiver stress, and frustration is often the breaking point prior to institutionalization in developed countries and break up of family or elder abuse in developing countries. Many of these BPSD symptoms are also the impetus to falls, weight loss, infection and incontinence in individuals with dementia. Risk Factors linked to MCI

Dr. Vinod Ganguli

Our presentation will introduce the new Emergency Management of BPSD Module. To be effective, dementia care services in developing countries need to focus on management of BPSD at home. Development of a low cost, effective and

Cost of Dementia – India, a LAMIC country

Dr. Srikala Bharath

National Institute of Mental Health & Neurosciences, Bangalore, India

Dr. Girish Rao

National Institute of Mental Health & Neurosciences, Bangalore India

Published work on cost of dementia severe mental illness from lower and middle income countries like India is exceedingly sparse. However, there is an urgent need for such work to plan policies and program towards training, capacity building and services establishment in these countries.

Cost of any illness indicates societal cost that has an economic impact. It includes the Direct and Indirect Costs of various types – medical and social, formal and informal. In India as there is a paucity of formal care services for persons with dementia, care is predominantly informal by the kith and kin. Assessment of cost of informal care and social cost thereof has been an insurmountable task for most non communicable diseases including dementia.

The talk would focus on Out of Pocket Expenses (OOPS) for Indian families caring for a person with dementia. The methodology followed, difficulties in the approach, comparison of the cost of care in dementia to other severe mental illnesses and comparison to published cost from other countries in the region and world would be elaborated.

Two recent studies done in NIMHANS to estimate the household cost of caring for a person with dementia and the challenges faced would be presented to illustrate the above issues.

Sourcing, Training and Retaining of Caregivers : Challenges and Opportunities

S Premkumar Raja, Honorary Secretary, Nightingales Medical Trust

Caregiving is a large growing sector with enormous opportunity . More older people , longevity, urbanisation and nuclear family system has made caring for elders a challenging task. The need for someone to look after the elderly parents frail or disabled whilst children at work has increased.

It opens up space for young people who are not educated enough and from a lower socio economic group to build a career in geriatric care specially when they are trained to acquire special skills for handling people who have a long terms illness such as dementia.

The demand is rising not only in institutional set up but as well in home care. However, the stress is on quality and long term commitment.

In long term care environment and home care hiring and retaining of quality professional caregivers is essential to assure quality of care to older adults. Although recruiting can be difficult , the hardest part is retaining them as these younger people are always looking for a better Job which is less stressful.

Handling an older adults with disability is not easy. It is highly stressful and physically demanding. The expectation of the family further increases the pressure on the caregiver working at home while expectation from management increases pressure in institutional set up.

Letting them know what they are getting into, assessment of caregivers willingness to take up such a job, offering them training to build skills, retraining and constant support to overcome the deficit, psychoeducation for anger and depression management to handle the pressure of dealing with work specially when it is dementia and most importantly giving recognition to boost their job satisfaction are few steps through which caregivers can be retained

Here we share our experience in sourcing , training and retaining young caregivers in the field of geriatric care and specialised services such as dementia care. We have applied few ideas and learnt few over the course if time . It is still challenging . However , caring for older adults who are ill is going to be one of the booming business market as well as social demand

The challenge of complexity in dementia care

Prof Sube Banerjee

Complexity is the rule rather than the exception in dementia. People with dementia by definition have multiple challenges in multiple domains as a consequence of their dementia. In addition less than a fifth of people with dementia only have dementia. Four fifths have at least one other significant physical or mental disorder and many have a number of conditions simultaneously. Multimorbidity in those with dementia is therefore common. Many of our existing research and management paradigms are based on the notion of simplicity (ie addressing the dementia alone) or have a presumption of additiveness (ie that the treatment of Condition X in dementia is simply the treatment of Condition X and the treatment of



sustainable dementia care service should be given due importance by the policy makers in the developing world. Practice Guidelines for the assessment and management of these symptoms have been developed that can be used for training and educating both professional and family caregivers. We have drafted tools outlining possible causes/triggers including physiological (e.g. thirst, hunger), psychosocial (e.g. fear, change, loss of autonomy/control), environmental (e.g. sensory overload/excessive stimulation, sensory deprivation and isolation) and neuro-pathological causes. We describe an approach to the

evaluation and management including clinical assessment of patients to rule out physical health problems, comprehensive review of medications, correction of sensory deficits and behavioral assessment. We have described use of non-pharmacological treatment, first using psychosocial interventions and use of pharmacological interventions when needed.

Conclusion

The Emergency Management of BPSD Module will provide coalface clinicians with tools to guide their management of emergency situations. The main objective of these tools is to use them in training primary care physicians and geriatric mental health workers, so that they can treat BPSD in emergency situations, and prevent complications, improve quality of life and lessen the caregiver's burden

Workshop: Person-centred Practices to deliver Personalisation and Person-centred Care

Dr Helen Sanderson

Gill Bailey

Personalisation for people living with dementia means figuring out how people can have as much choice and control as possible in their day-to-day life. Personalisation was introduced into English social policy in the Putting People First 'concordat' (Department of Health 2007). At the heart of personalisation is 'self-direction' – the notion that people should not simply be passive recipients of services but should be able to exercise direction over their support, which should be designed around and with them. Research and evaluation of personalisation show positive effects on people's lives and higher levels of satisfaction. Person-centred practices are an important way to deliver personalisation for people living with dementia.

Person-centred thinking tools enable staff to deliver personalised services by helping to answer the following questions:

• How does the person want to live and be supported?

• How can the person have more choice and control in his life?

• What is our role in delivering what is important to the person and how he wants to be supported?

• How are we doing in supporting the person in the way he wants to live?

• How can we work together to keep what is working and change what is not working?

• How can we keep learning about the person and what we need to do to provide the best support?

The Skills for Care and Dementia UK guide Dementia: Workers and Carers Together (2012) recommends that providers keep up to date with best practice such as person-centred practices and approaches. Person-centred practices are also a way to deliver the National Dementia Declaration.

In this workshop we will introduce a range of person-centred practices including one-page profiles and person-centred reviews. Personalisation starts with the person: knowing who they are, what matters to them and how they want to be supported. A one-page profile therefore is the foundation of personalisation. Without this information, people are likely to be treated as a clinical condition – and their dementia will always be seen first. A one-page profile describes what people value about someone, what is individual about them, what is important to them and how best to support them.

Bacopa monnieri and Phosphatidylserine Conjugated Docosahexaenoic Acid for Improving Cognitive Function.

Rema Vazhappilly ¹, Ai Mey Chuah ¹, Qi Lin ¹, Isabella Hahn ¹, Richard W Gelling ¹ and Tapas Das ²

¹Abbott Nutrition R&D, Asia Pacific Center, Singapore; ² Global Nutrition R&D, Columbus, OH, USA.

Abstract

The objective of this study was to develop a nutritional product with Bacopa monnieri (Bacopa) and phosphatidylserine conjugated docosahexaenoic acid (PS-DHA) for improving cognitive function. Efficacy of Bacopa and PS-DHA to enhance cognitive function was evaluated by their effect on hippocampal short term potentiation in vitro, on hippocampal acetylcholine levels in vivo and on hippocampal-dependent short-term memory in vivo. Finally formulation feasibility of these ingredients in liquid and powder formulations were determined.

The combination of Bacopa and PS-DHA synergistically and significantly enhanced NMDAR dependent hippocampal short


term potentiation (STP) in vitro. Administration of Bacopa and PS-DHA combination produced significant synergistic enhancement in acetyl choline levels at the ventral hippocampus of freely moving rats. These cognition enhancing effects demonstrated by Bacopa and PS-DHA was indeed translatable to a functional outcome. i.e. the enhancement of hippocampal dependent short-term memory in adult rats. Bacopa and PS-DHA combination has not been used in any nutritional or food products probably because of intense undesirable organoleptic characteristics such as high level of bitterness and earthy flavor. In this study we developed a formulation containing de-bitterized Bacopa and PS-DHA in a vegetable or fruit juice base with acceptable organoleptic properties

In summary, PS-DHA and Bacopa combination synergistically improved preclinical surrogates of memory . We hypothesis that a nutrition product containing Bacopa and PS-DHA combination may clinically improve cognitive function in individuals with memory complaints or Mild Cognitive Impairment (MCI). In addition, Bacopa and PS-DHA are feasible to formulate in a low calorie vegetable or fruit juice base which may be suitable for a broad range of target population such as Obese and Diabetics.

Key words: Cognitive impairment, short-term potentiation, Acetylcholine, Phosphatidylserine, Bacopa monneirri

Consumer empowerment and service delivery

Glenn

The overarching goal of aged care and dementia services is to achieve services that respond to the needs of the individual by achieving the flexibility in services necessary to enable the person to stay at home longer. The purpose of this presentation is to capture what seem to be some of the key strategies world - wide in designing services which respond to that objective. These strategies start with empowering the person with dementia and their family carers to be a partner in decision making in determining the services that can be provided within available resources. They embody the principle of person centred care while recognising that models of care are needed that give the consumer the power to take decisions to the extent they wish and are able. Important too, in the design of services is to maximise the function of the person both to promote their independence and target resources efficiently on those in greatest need of support. The planning of services needs to achieve the right balance between community and residential care and to adopt approaches that promote the integration of services. If these strategies are to be achieved they need to be set in the context of dementia friendly societies that provide dignity, respect and a purpose in life for the person with dementia

Dementia Call for Action

Mr. Marc Wortmann

Alzheimer's disease and related dementias are the main health challenge for the 21st century. The global number of people with dementia was calculated at 44 million in 2013 and half of them live in the Asia Pacific region. In India alone there are now 4 million people living with the disease and that number is expected to triple to 12 million by 2050. It is also the most expensive disease for our health systems because of the long duration and the intensity of care needed in the more severe stage of dementia.

We can only tackle this problem if we make dementia a priority at the international, national and local/regional level. There is still a lot that need to be done to make this happen, but this work has been given a boost now the G7 is paying a lot of attention to dementia. This presentation will provide you with the latest information, including the results of the G7 meeting in Japan on 5-6 November 2014.

Alzheimer's Disease International contributes to the global discussion with its annual World Alzheimer Reports on key topics, which for 2014 was risk reduction. A systematic review of all the evidence regarding modifiable risk factors was carried out and the results will be presented.

Title: Improving dementia care in Geriatric Medicine

A B Dey

Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi

Old age care or Geriatric Medicine is an emerging specialist in India and most of the developing countries in the Asia Pacific Region. As the discipline evolves in the context of the socio-economic realities and health system functioning in each country, the common denominator for old age care in most societies is providing long term care to frail and dependent patients often with cognitive impairment. Dementia care is one of the best examples of multidisciplinary care, which is the corner stone of geriatric medicine. While neurologists and psychiatrists provide initial diagnostic and therapeutic input, addressing everyday problems and challenges need a holistic view. Older patients with dementia in addition to the cognitive



and behavioral symptoms also have other diseases and disabilities along with continuous biological decline, providing new issues to be addressed. Thus geriatric medicine training and service needs to have adequate emphasis on dementia care. Older subjects and their families are generally concerned about retaining cognitive capability till the very end. A geriatrician is often required to address these concerns with interventions to prevent, detect and manage cognitive decline as adisease process or as a part of overall biological decline of ageing. In addition, dementia patients are the largest receivers of long term care in old age. Geriatricians have an important role in managing long term care and thus need to have adequate training to be successful provider of long term care.

Integrating Dementia Care

Dr Ng Li-ling

Dementia is currently estimated to affect 44 million people worldwide and the number will double by 2030 and more than triple by 2050. Dementia not only affects individuals and their families but also has a tremendous impact on health and social systems and society. It is a public health priority that requires a public health approach to policy and effective implementation of plans and programmes that improve dementia care. Integrating dementia care into existing acute and long term services is essential to provide a comprehensive system of care for people living with dementia and their caregivers.

The Lessons from the National Fights against Dementia in Korea

Ki Woong Kim, M.D., Ph.D.

Korea is one of the fastest-aging countries in the world. According to the rapid population aging, number of dementia patients is expected to be doubled every 17 years, reaching 2 million in 2041. To face this dementia epidemic, Korean government prepared the first National Dementia Plan in 2008. This plan has four main aims to make Korea where people can live with dementia without discomfort; 'Promotion of early diagnosis and prevention of dementia', 'Enhancing care quality and public awareness for dementia', 'Developing systematic and individualized management of dementia', and 'Building key infrastructures for dementia management'. In 2012, the Korean government established the National Institute of Dementia (NID) based on the Dementia Management Act (DeMA), which went into effect in 2012.

In Korea, the diagnostic rate of dementia was 38% in 2008. However, it was considerably improved up to 73.8% in 2012 after introducing the National Dementia Early Detection (NDeED) service, an opportunistic population screen for dementia, based on the first National Dementia Plan. Based on this service, all Korean elders aged 60 years or older can get free dementia screening using MMSE at the dementia counseling centers nearby across the country. If they are found to have a significant cognitive impairment at the screen, they can get free diagnostic work-up for dementia including brain imaging and neuropsychological assessments, at the core dementia clinics affiliated to the dementia counseling centers. We found that the NDeED was cost-effective in the elderly aged 75 years or older in its current form, and would become cost-effective in all elderly people aged 65 years or older if we could increase the proportion of mild cases detected by this program higher than 70%.

Since 2012, we have built four dementia information channels; 'Dementia Information 365' (a web-based information portal), 'National Dementia Helpline', and two mobile applications named 'The Companion' (an app assisting care) and 'Check Dementia' (an app assisting diagnosis and prevention). Through these four unified channels, we try to keep Korean people informed up-to-date and with credible information about dementia 24 hours a day, 365 days a year.

There is an old Korean saying that 'a long illness wears out even a good son's filial devotion'. This is why the Korean society should be timely and efficiently prepared to face this dementia epidemic. At the same time, we hope our experiences can also make a meaningful contribution to the global efforts to overcome dementia.

What increases the risk of AD

Dr Manjari Tripathi

AD is an epidemic, affecting over about 3.7 million Indians and nearly 40 million people worldwide have this disease. “The major risk factor for AD is advanced age,” noted Small. "So what is Alzheimer's disease?” In 1906, German psychiatrist and neuropathologist Alois Alzheimer presented the first case of the condition that would bear his name. His initial patient died 4 years after her symptoms began, and on autopsy her brain contained the waxy protein fragments and twisted fibers now known to be amyloid plaque and tau tangle protein accumulations. Assumed to be a rare form of dementia, it wasn't until decades later that more progress was made. A 1968 paper by Blessed, Tomlinson, and Roth correlated plaques and tangles with "senility," pathologizing cognitive dysfunction previously thought to be a normal part of aging and igniting AD awareness. Diagnosing and monitoring AD initially proved tricky. The AD brain exhibits gross shrinkage and prominent

collections of plaques and tangles. But the "normal" brain can too, in lower concentrations. Plaques and tangles build up gradually as we age. Moreover, until recently, detecting such changes was difficult in living patients. Over the years, numerous potential AD biomarkers have been considered with varying degrees of success. Serum, blood, and cerebrospinal fluid assays have proved useful, particularly in research settings, as have genomics, vascular risk factor assessments, and neuroimaging. A CT or MRI scan is a must in cases of suspected AD to rule out other causes of impaired cognition such as stroke or tumor, as findings associated with AD such as generalized atrophy can be nonspecific.

High-fat foods also increase the risk for obesity and type 2 diabetes, common risk factors for Alzheimer's disease.

On the recommendation for vegetables, legumes, fruits, and whole grains, these foods are rich in vitamins, such as folate and vitamin B6, that play protective roles for brain health. Studies of Mediterranean-style diets and vegetable-rich diets, such as the Chicago Health and Aging Project, have shown reduced risk for cognitive problems compared with other dietary patterns. Several studies have found a correlation between exercise and a reduced risk for Alzheimer's.

There is evidence supporting the idea that physical activity reduces risk of Alzheimer's. And it is always good advice to keep to a healthy diet and stay active. There are certain regions in the world -- so-called "blue zones" -- with abnormally high clusters of centenarians, most notably Sardinia, Italy; Loma Linda, California; and Okinawa, Japan. These regions share a number of characteristics thought to contribute to collective longevity and prolonged brain health on which Small would later expand: Namely, their inhabitants tend to be physically active, socially engaged, and eat a healthy diet high in omega-3 fats, rich in healthy fish-heavy fare .With such striking epidemiologic examples, numerous lifestyle factors are now being taken seriously by researchers and clinicians as potential avenues for AD prevention, particularly given the current lack of disease-modifying treatments -- in other words, the lack of a cure.

Exercise

Of all lifestyle approaches that might contribute to AD prevention, the strongest evidence exists for exercise. People who routinely exercise exhibit better cognitive abilities and actually have larger brains.

Mental Stimulation

Read, write, and do a crossword: Mentally stimulating activities and certain brain-training programs are in the long term associated with lower brain amyloid levels and a decreased risk for AD, as are graduating from college or engaging in life-long learning. Many worry that our increasing reliance on technology hinders our mental stimulation -- that digital dependence will in fact hasten neurologic deterioration. Engaging with technology actually increased mental stimulation. However, like many tasks, once one gets more proficient at searching online, activity decreases as the brain becomes more efficient at the activity.

Eat Right and Relax

Stress is a known contributor to cognitive impairment and decline. Human studies show that chronic stress leads to an increased risk for dementia, AD, and depression. Manage stress with psychotherapy and personalized relaxation approaches.

Weight management and nutrition also play major roles in brain health. Several studies support an association between being overweight and increased dementia risk,

Other factors

curcumin, an anti-inflammatory compound found in turmeric, slows amyloid and tau build-up in the brain. Areas with turmeric and curry-heavy diets such as India have a lower rate of AD. Pomegranate extract, as daily consumption is associated with improved verbal memory.

Other lifestyle approaches that may benefit cognition include avoiding activities potentially traumatic to the head, avoiding smoking, having a positive outlook, and appropriate treatment of age-related illnesses like hypertension and hypercholesterolemia. Head trauma in particular is a major focus of study as progressive cognitive and psychiatric dysfunction among athletes due to chronic traumatic encephalopathy has become increasingly evident.

Risks include irreversible ones like aging, and genetics. The reversible ones are hypertension, diabetes, smoking, excess alcohol intake, repeated head injuries, eating unsaturated fats, increased body lipids, stress etc. On potentially harmful metals, excessive iron and copper have been linked to cognitive problems. And while the role of aluminium in Alzheimer's disease remains controversial, aluminum has been demonstrated in the brains of individuals with Alzheimer's disease, and studies in the United Kingdom and France have found increased Alzheimer's prevalence in areas where tap water contained higher aluminium concentrations.

"So can we control our brain health and prevent Alzheimer's disease? If you think of the term 'prevention' as meaning 'cure,' the answer is no. But if we set a more modest goal of forestalling symptoms, I think the evidence suggests that we can AND WE MUST- Protect it or Loose it- the choice is ours"



The treatment for Alzheimers rests on an early diagnosis and then early pharmacological treatment however certain recommendations and Dietary Principles do Reduce Alzheimer's Risk

1. Minimize saturated fats and trans fats.

2. Vegetables, legumes (beans, peas, and lentils), fruits, and whole grains should be the primary staples of the diet.

3. One ounce of nuts or seeds (one small handful) daily provides a healthful source of vitamin E.

4. A reliable source of vitamin B12, such as fortified foods or a supplement providing at least 2.4 μg per day for adults should be part of the daily diet.

5. Choose multivitamins without iron and copper, and consume iron supplements only when directed by your physician.

6. Avoid the use of cookware, antacids, baking powder, or other products that contribute dietary aluminium.

7. Engage in aerobic exercise equivalent to 40 minutes of brisk walking 3 times per week. Do challenging activities indulge in music, environmental enrichment,, pets, grandchildren, community, learn a new language do yoga and be a happy ager.

A public-private partnership in dementia care: an initiative from kerala

Dr. T. P. Ashraf, Executive Director, Kerala Social Security Mission

Kerala is greying faster than any other state in the country with 4 million older persons (2011 census). It is estimated that over 1.9 Lakh people will be affected by dementia in Kerala by 2015. The State urgently needs to develop social support systems because the burnout of care-givers of persons with dementia is emerging as a major issue. Families need better counselling and advice on caring for patients and while home-based care is the best, there are situations when families need support services such as care home. In this context, Kerala is taking the first step towards making dementia care a public health and social welfare priority by establishing a sustainable community-level care model with the joint efforts of Department of Social Justice, Kerala Social Security Mission and the Alzheimer's and Related Disorders Society of India (ARDSI). This is perhaps the first time that a State government is taking cognizance of dementia as an issue that needs a specific health strategy, separate from general geriatric care.

This pilot project has got the following distinct components

• Comprehensive dementia awareness in the community- This will be done by preparing IEC material (handouts, wall posters), pamphlets highlighting prevention through life style modification, stressing early detection/right diagnosis and listing services etc

• Equipping social and health care personnel in dementia care

• Memory Clinics in Medical Colleges for early diagnosis and intervention with a vision to reach it to the primary care level

• Model Dementia Day Care Centre at Trissur and Fulltime Care Center at Cochin

• Telephonic Helpline Service for dementia information and support

• Developing protocols for the diagnosis, treatment, and care of the dementia as well as standard operating procedures for the care homes

The above pilot initiative shall be upscaled and replicated in the ensuing years based on the experience. Since ARDSI has got different chapters across the state, the project will be replicated with the support ARDSI chapters. The project will also look for other dementia alliance group to work towards this initiative. This is going to be the first government-nongovernment partnership program in dementia care among the South Asian countries.

Alternative Therapies

Mrs. Vidya Shenoy,

Abstract for the presentation

The etiology of Alzheimers and Dementia is not yet known of. Although there is a continuous research being conducted all over the world to find the causes and a cure for the disease, there is always another option available, that of Alternative Therapies. Recently, researchers have been aroused with interest in this field because it is showing slow, but worth-considering, significant results. For not only those affected by the disease, but also with those who look after these patients, viz., the family or the caregivers who are burdened with its impact.

Volunteering with both, patients with Alzheimers and Dementia and their families, both in daycare and hospitals, one finds there is a plausible option of using alternative therapies, like Yoga, stretch Pilates, music, dance, laughter, pet and creative


arts as means to reach out to these patients and caregivers. And fortunately, these have shown some satisfyingly positive results. Why not share my views and experience with you all?

We will go into detail along these lines.

Rights of persons with dementia and ethical issues

Meera Pattabiraman

Dementia is a syndrome usually chronic, characterised by global deterioration of intellect. So, memory, learning, language, orientation and comprehension are affected due to disease of the brain. The early symptom of short term memory loss progresses gradually till in advanced dementia the person will forget to talk, walk, eat or use the bathroom. Such a person will become totally dependent on the carer for all activities of daily living.

People with dementia and their carers have the same rights as every other citizen, however due to the nature of the illness, they are faced with economic, cultural and social barriers in having their fundamental rights. In addition, persons with dementia and their carers need special rights because of the characteristics of the disease, the scare resources available in our country, the stigma and discrimination and the stress and marginalisation of the carers. And these special rights are self-interest rights, empowerment or welfare rights, participation righs, non-discrimination rights and legal rights.

Caring for a person with dementia does not mean just medical care in the form of medications or other therapies like physiotherapy, aromatherapy, reminiscences, etc; it involves a holistic and ethical approach to the care and treatment. Ethical guidelines on what is right or wrong cannot be black or white, they are many shades of grey in the case of dementia. Since a person with dementia ultimately loses control over his/her care, who takes these decisions – the family, the doctor, the professional carer, the institution where he or she is a resident. Sometimes religious and cultural sentiments could also play a role in the type of care that is provided. The major areas where there could be ethically sensitive issues are oral feeding, medication for behavioural problems, genetic testing, research or clinical trials, electronic tracking and end of life care.

Ethical issues play a crucial role in the care of dementia but they are often ignored. Hence it is imperative to develop guidelines with the help of medical professionals, carers and family members, experts in ethics and other stake holders.

Carer's Perspective - Brigadier S.P. Bhattacharya

Abstract

A decorated soldier and an electrical Engineer by profession I saw action with the Indian army through the 1965 and 1971 wars. But I was unaware that my greatest battle was still ahead of me when, in 1994, my wife of 38 years, Shukla was afflicted with Alzhiemers disease. Since then, I have been the primary caregiver for my wife.

In my presentation I shall present my experiences of caring for my wife Shukla, and also share an essential guide on how to improve the quality of life of a person with dementia while also bearing in mind the needs of the caregiver. At eightynine, and after fifty eight years of devoted partnership, the mission for me still continues….

Abstract No: 142

Abstract Title: Mirror Agnosia and mirror image Agnosias in patients with dementia

Topic Name: Others

S R Chandra*¹ , Thomas Gregor Issac² , Mirza Masoom Abbas³

¹National Institute of Mental Health and Neurosciences(NIMHANS) Bangalore, India, , ²National [email protected] of Mental Health and Neurosciences(NIMHANS) Bangalore, India, , ³National [email protected] of Mental Health and Neurosciences(NIMHANS) Bangalore, India, [email protected]

Keyword :

Mirror agnosia, mirror image agnosia, prosopagnosia, dementias,

Background :

Neuropsychiatric border zone symptoms are early features in cortical dementia. Awareness into them is important to recognize the organic basis of these symptoms. To study the prevalence, pattern of abnormalities in reflected self and object image recognition. 512 patients with dementia were seen in the last four years and were assessed for Apraxia and Agnosia by questionnaire and bedside testing. Those who had mirror related symptoms were assessed in detail using a 45x45 cm plain mirror, kept at 30 cm distance from the patient. They had to identify reflected objects, ornaments, dresses, self and images of care givers. In addition, to detailed face recognition assessment, mandatory dementia work up including 1.5T MRI.



Four patients had mirror agnosia and five patients had mirror image agnosia. The ones with mirror agnosia could identify the reflected images, but spatially displaced the real objects inside or behind the mirror. Those with mirror image agnosia, imagined reflected self images as belonging to god, friend or thief. All the patients showed right parietal atrophy and two patients had diffuse atrophy.

Patients have seen self images only as reflected images where as with reference to others the brain has processed both the real and virtual images. Reflected images are probably processed in the right parietal lobe in a way unique from other objects. It is likely that there are different data linking circuits for self images and images of other human beings and inanimate objects.

Bacopa monnieri and Phosphatidylserine Conjugated Docosahexaenoic Acid for Improving Cognitive Function.

Rema Vazhappilly ¹, Ai Mey Chuah ¹, Qi Lin ¹, Isabella Hahn ¹, Richard W Gelling ¹ and Tapas Das ²

¹Abbott Nutrition R&D, Asia Pacific Center, Singapore; ² Global Nutrition R&D, Columbus, OH, USA.

Abstract

The objective of this study was to develop a nutritional product with Bacopa monnieri (Bacopa) and phosphatidylserine conjugated docosahexaenoic acid (PS-DHA) for improving cognitive function. Efficacy of Bacopa and PS-DHA to enhance cognitive function was evaluated by their effect on hippocampal short term potentiation in vitro, on hippocampal acetylcholine levels in vivo and on hippocampal-dependent short-term memory in vivo. Finally formulation feasibility of these ingredients in liquid and powder formulations were determined.

The combination of Bacopa and PS-DHA synergistically and significantly enhanced NMDAR dependent hippocampal short term potentiation (STP) in vitro. Administration of Bacopa and PS-DHA combination produced significant synergistic enhancement in acetyl choline levels at the ventral hippocampus of freely moving rats. These cognition enhancing effects demonstrated by Bacopa and PS-DHA was indeed translatable to a functional outcome. i.e. the enhancement of hippocampal dependent short-term memory in adult rats. Bacopa and PS-DHA combination has not been used in any nutritional or food products probably because of intense undesirable organoleptic characteristics such as high level of bitterness and earthy flavor. In this study we developed a formulation containing de-bitterized Bacopa and PS-DHA in a vegetable or fruit juice base with acceptable organoleptic properties

In summary, PS-DHA and Bacopa combination synergistically improved preclinical surrogates of memory . We hypothesis that a nutrition product containing Bacopa and PS-DHA combination may clinically improve cognitive function in individuals with memory complaints or Mild Cognitive Impairment (MCI). In addition, Bacopa and PS-DHA are feasible to formulate in a low calorie vegetable or fruit juice base which may be suitable for a broad range of target population such as Obese and Diabetics.

Key words: Cognitive impairment, short-term potentiation, Acetylcholine, Phosphatidylserine, Bacopa monneirri

Abstract No: 183

Abstract Title: Factors determining delay to first dementia evaluation: A study from south India

Topic Name: Diagnosis

Robert Mathew*¹ , Sauda P² , Remya Prakash³

¹SK Hospital, Pushpagiri Institute of Medical Sciences, India, [email protected], ²SK Hospital, Trivandrum, Kerala, India, [email protected], ³SK Hospital, Trivandrum, India, [email protected]

Keyword :

Dementia,Diagnosis,Durarion,Delay

Background :

In spite of growing awareness of dementia patients in this part of the country are still reluctant to undergo dementia evaluation and come at an advanced stage only.

Objective:

To study the patient characteristics that influences the first formal dementia evaluation.

Method:

Cross sectional descriptive study (period 2010 to 2013).In patients as well out patients availing neurology service in 2 teretiary refereral hospitals were selected.

SPEAKER ABSTRACTS


Results:

Four hundred and twenty hospital based patients were screened positive for dementia. A diagnosis of dementia was made in 283(63.78%).The others were not willing for evaluation. Detailed evaluation including neuropsychology could be done in 158(37.5%).The rest either refused detailed evaluation or were medicaly unfit for the same. Mean age was 71.19(9.46), 250(59%) were males. Mean education was 8(SD4.4) years. Mean duration of illness at the time of first evaluation, as reported by caregivers was 3.16(SD 2.1) years. The mean ACE-R score was 36.26(SD 1.96).No correlation was seen between education, type of dementia or severity of dementia (as evidenced by ACE-R) score and time to first evaluation.(Spearman correlation,2 tailed p>0.01)

Conclusion:

Only 63.78% of suspected dementia patients in this cohort underwent dementia evaluation. The patients appears to have underwent dementia evaluation at an advanced stage of the disease. The delay to first visit was not determined by demographic features type of dementia or stage of dementia. Rather than the patient factors, it may be the caregiver factors that influence dementia evaluation.

Abstract No: 240

Abstract Title: Influencing Policy Makers of Government in supporting the people with Dementia in India -A Kerala Perspective Case study

Topic Name: Policy Advocacy

Sreekanth Krishnan*¹ , Malini Bhattathiry²

¹ARDSI, India, [email protected] , ²ARDSI Trivandrum, India, [email protected]

Keyword :

Policy Advocacy Government Dementia ARDSI India

Background :

There has been lots of effort to include Dementia as a priority disease in the Government agenda and the major bottle neck was the difficulty in sensitising the Policy makers .Policy advocacy was one of the major challenges that ARDSI in India was facing .. .Finally it started showing results in the state of Kerala ,through the restless effort of ARDSI since the last 15 years. Based on this ,a case study has been done and this paper is prepared as a model evolved through trial and error method.

Objectives

• To bring out the India specific Policy advocacy practical methods

• To set out a regional model for different states of the country and countries having similar governance settings.

• To enable a thought process in the minds of various decision makers and policy makers of Dementia specific organisations of various countries in the practical policy advocacy models

Methods:

Real time case study based on direct experience

Results:

The Policy makers become sensitive on dementia and related disorders and decided to provide funds for supporting dementia and sanctioned various projects for rehabilitation of dementia patients, Early detection and Training of care givers ,for the first time in the history of India.

Conclusion:

Consistent and regional specific methodologies ,adopted in sensitising, decision making and data support to the policy makers proved that a regional method of Policy advocacy methodology is evolved in Kerala, which can be modelled throughout the country.

Cognitive Status in Patients with Type 2 Diabetes Mellitus

V Balasundaram, R Mahajan, HP Paljor, V Kumar, Department of Medicine and Family Medicine, St. Stephens Hospital, Delhi.

Objective: To study and review cognitive status in patients with type 2 diabetes mellitus (DM).

Methods: Type 2 diabetic and age/sex matched non diabetic subjects were comparatively evaluated by history, examination and investigations including Hindi Mental State Examination (HMSE) and concerned studies were reviewed.

Results: Many but not all studies report a link between DM and decreased cognitive function. Diabetes related factors

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Abstract No: 137

Abstract Title: The effectiveness of life story book in improving ones self-identity with dementia

Topic Name: Non pharmacological management of dementia

Ponnusamy Subramaniam*¹

¹Universiti Kebangsaan Malaysia, Malaysia, [email protected]

Keyword :

Keywords; Dementia, Life Story Book, Identity, Case Study, Relatives

Background :

One's memory declines with the progression of dementia. The qualitative and quantitative evidences show that dementia would gradually erode a person's self-identity. However, to date, there are very limited researches focusing on the ways to enhance a person's memory which improves their knowledge pertaining themselves. Thus, the main question of this study was to determine the effectiveness of a life story book among participants with dementia in improving their self-identity. In this multiple case study design, five participants with mild to moderate dementia (DRS; stage 1 and 2) received their own life story book as a gift which was created by their relatives without involving the person with dementia. The life story books consist of stories and pictures of childhood to the most recent life event in chronological order of the person. The Twenty Statements Test (TST) and Tennessee Self Concept Scale (TSCS) were the measures used at the baseline and repeated after six weeks. Feedbacks on having the life story book were recorded from participants and also their relatives. All the participants showed improvement on the Twenty Statements Test (TST) and Tennessee Self Concept Scale (TSCS) after having the life story book for six weeks. The feedbacks showed that participants talk more about their life experiences while reviewing their life story book with family members. The results shed some lights on the feasibility in the usage of the life story book in enhancing an individual's self-knowledge with dementia. Therefore, life story book may support a person's sense of self.

Abstract No: 138

Abstract Title: Clinical Practice of Vascular Dementia in a tertiary care hospital of India


Preeti Sinha*¹ , Srikala Bharath² , S. R. Chandra³

¹National Institute of Mental Health and Neurosciences (NIMHANS), India, [email protected] , ²National Institute of Mental Health and Neurosciences (NIMHANS), India, [email protected] , ³National Institute of Mental Health and Neurosciences (NIMHANS), India, [email protected]

Keyword :

Vascular dementia, diagnosis, risk factor

Background :

There are at least 4 different diagnostic criteria for diagnosing vascular dementia (Vad)- NINDS-AIREN, DSM5, ADDTC, and ICD10, varying in defining the symptoms and vascular cause.

To compare them in clinical practice of VaD in a tertiary care hospital of India. To study the risk factors like age, metabolic factors, and past cardio/cerebro-vascular events in VaD

To compare the clinical practice of evaluating VaD in psychiatry and neurology. This is retrospective analysis of cases diagnosed as vascular or mixed dementia from 1st January 2013 onwards and either in neurology or psychiatry clinic by applying all the 5 diagnostic criteria, and noting neuroimaging findings and various risk factors.

A total of about 85 cases (39.7% of total dementia cases) were noted of VaD from 01/01/2013 to 31/03/2014. Overall, 60% met all 4sets of diagnostic criteria and 18% met none of them. ADDTC and DSM5 secured maximum number of diagnosis. NINDS-AIREN performs better for subcortical VaD specifically. Neuroimaging formed the most important factor for decision but detailed description as required in NINDS-AIREN is not followed. Compared to psychiatry, the neurology clinic looks actively for focal neurological deficits but misses out evaluation of risk factors. The most prevalent risk factor was hypertension (72%) and 8 cases had no risk factor.

There is a need for uniformity in diagnostic practice across the neurology and psychiatry for VaD. NINDS-AIREN criteria is advocated in view of specificity and inclination towards subcortical subtype. Broadly, DSM5 may be followed in clinical practice which lacks, however, objective measures.


(stroke, hypertension, dyslipidemia, cardiovascular disease, depression) may be responsible. However, prevalence of diabetes in dementia patients is equivocal and role of duration and control of diabetes on cognition is also not clear.

This study on 200 diabetics (Group 1) and 100 non diabetics (Group 2), mean age 61 and 60 years, comparable in their residential and socioeconomic status and in many symptoms revealed BMI > =25 in 65% and 45% of group 1 and 2 (p=0.0009). Among diabetics, 90% had HbA1c >6.5% and 60% had diabetes duration of >5 years. There was no significant difference in mean HMSE score between group 1 and 2 subjects (28.6 vs. 29.2; p 0.089) and between age up to 60 and >60 years in both groups. Duration and type of control of diabetes also did not influence HMSE score. Socioeconomic status (SES) wise, however, diabetics with high and middle SES had lower HMSE scores compared to non diabetics with similar SES.

Conclusion: HMSE scoring did not indicate cognitive defect amongst patients with type 2 diabetes mellitus including poorly controlled and long duration disease.

Key words: Diabetes; Cognition; HMSE score.

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Abstract No: 141

Abstract Title: Dementia In Parkinson Disease: An Indian Perspective

Topic Name: Risk factors and Prevention

Alakananda Dutt*¹ , Hrishikesh Kumar² , Chitrita Sengupta³ , Muktalekha Mukherjee⁴

¹Institute of Neurosciences - Kolkata, India, [email protected] , ²Institute of Neurosciences - Kolkata, India, [email protected] , ³Institute of Neurosciences - Kolkata, India, [email protected] , ⁴Institute of Neurosciences - Kolkata, India, [email protected]

Keyword:

Dementia, Parkinson's Disease, India

Background:

The prevalence of Parkinson's Disease (PD) is increasing in India and Dementia is commonly reported in advanced PD. However there is little or no research on the Indian population in this field. To determine the factors associated with Dementia in Indian patients with PD. 100 patients presenting in a Neurosciences super-speciality hospital of Eastern India with PD diagnosed by UK Brain Bank Criteria were assessed on the Unified Parkinson's Disease Rating Scale (UPDRS), Modified Hoehn and Yahr staging, Schwab and England activities of daily living (ADL) scale and the Mini Mental State Examination. Dementia was diagnosed by the Diagnostic and Statistical Manual IV-TR criteria, comorbid psychiatric disorders by the Mini International Neuropsychiatric Interview and Parkinson's associated psychosis by the National Institute of Neurological Disorders and Stroke, National Institute of Health (NINDS-NIMH) criteria. Patients with and without dementia were compared using independent t tests for continuous variables & chi square tests for categorical variables.

54% patients had dementia with 37% having mild and 17% having moderate cognitive impairment. Patients with dementia were significantly older (mean age 65.35yrs as compared to 59.33yrs), had significantly higher mean scores on motor symptoms subscale of the UPDRS and significantly lower mean scores on the Schwab and England ADL scale than those without dementia. Amongst psychiatric diagnoses a significant number of patients with dementia had psychosis as compared to those without Dementia.

Dementia in Parkinson's Disease is more likely to be associated with older age, greater motor dysfunction, co-morbid psychosis and greater impairment in activities of daily living.

Abstract No: 145

Abstract Title: Clinical Demographic and Pharmacologic Features of The Residents In A Nursing Home In Turkey

Topic Name: Others

Basak Bilir Kaya¹ , Oya Ayasbeyou*² , Nevbahar Didem Erimez³ , Duygu Kurtulu⁴

¹Turkey Ministry of Health Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Turkey, [email protected] , ²Turkey Ministry Of Health Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Turkey, [email protected] , ³Turkey Ministry Of Health Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Turkey, [email protected] , ⁴Turkey Ministry Of Health Umraniye Training and Research Hospital, Turkey, [email protected]

Keyword:

Alzheimer, Nursing Home

Background:

There are many nursing homes which serve older residents in Turkey. But only a few Alzheimer specific care centers. The purpose of this retrospective study was to determine the demographic and pharmacologic features and clinical profile of the residents in a Turkish nursing home . Study was conducted in a nursing home in Istanbul. All the 50 participants were residents of the nursing home. %24 of the residents were male and %76 of them were female. Mean duration in nursing home were 3.32 years. Age average was 81.9 years (max:101, min:63). Amount of drugs used per person per day was 5.46. %68 of the residents had hypertension, %16 had diabetes, %24 had cardiovascular disease, %24 had depression, %66 had osteoporosis, %80 had dementia. Among the dementia patients %71.5 had Alzheimers and %28.5 had vascular dementia. It is seen in the study that the biggest population of the nursing home were dementia patients (%80) and most of the dementia patients had Alzheimer type dementia (%71.5 of dementia patients).It was observed in this study that the dementia patients constituted the largest group among the population of the nursing home (%80) and most of the dementia patients had Alzheimer type dementia (%71.5 of dementia patients). These observations point to the need of conducting similar studies in a wider range of nursing homes; and establishing nursing homes directly targeted to serving dementia patients, especially with an emphasis on Alzheimer's care, if comparable disease distributions are observed.

Abstract No: 149

Abstract Title: Profile of Dementia in a semi-urban Tertiary care Hospital


Sameer Guliani*¹ , Daniel Saldanha² , Labanya Bhattacharya³ , Madhav Garg⁴ , Aneek Saha⁵

¹Dr. D.Y. Patil Medical College , Pune, India, [email protected] , ²Dr. D.Y. Patil Medical College , Pune, India, [email protected] , ³Dr. D.Y. Patil Medical College , Pune, India, [email protected] , ⁴Dr. D.Y. Patil Medical College , Pune, India, [email protected] , ⁵Dr. D.Y. Patil Medical College , Pune, India, [email protected]

Keyword:

Dementia profile

Background:

India is going through a phase of rapid demographic ageing. Control over infectious and other diseases have increased the life span.Elderlies are expected to reach 173 million by 2026.Currently 24.3 million suffer from dementia.

Hence the study to evaluate the profile of dementia in patients attending OPD services at a tertiary care hospital. Patients aged 60 years and above attending the medical OPD were screened for cognitive impairment. Inclusion criteria being that they should be 50 years and above, without gender bias and only those who score 23 or less on the screening tool of Mini Mental Scale (MMSE).Exclusion criteria being the cases with terminal systemic illness, unstable medical/surgical emergencies and major psychiatric disturbances. Institutional ethical clearance, appropriate tools and investigations were used.

350 patients were screened.77 scored 23 and below on MMSE. Males outnumbered females by 202/350(58%) to 148 (42%).22% were found with impaired cognition.63/77(81.82%) belonged to the age group between 60-70 years and 14/77(18.18%) were over the age of 71 years.45/77(58.44%) were Males and 32/77(41.56%) were females. 77 registered were further investigated. There were 27 drop outs. Mean scores of severity was mild 21.98, moderate 15.10 and severe 5.50. High risk for dementia was older age, low socio-economic status, low education, positive family history, presence of stroke. 42% were anemic and 70% had low Vit B 12 levels. 12 to 14% had high cholesterol and triglycerides levels.

Early intervention in dementia helps in treating the reversible causes and relieves the distress of patients as well as caregivers.

Abstract No: 150

Abstract Title: The effectiveness of a personalised dementia caregiver support intervention for various migrant groups Topic Name: Caregivers's issues and training

Lily Xiao*¹ , Anita De Bellis² , Helena Kyriazopoulos³ , Brian Draper⁴

¹Flinders University, Australia, [email protected] , ²Flinders University, Australia, [email protected] , ³Alzheimer's Australia, Australia, [email protected] , 4University of NSW, Australia, [email protected]

Keyword:

dementia, caregiver/caregiving, community-based aged care, dementia care services, culturally and linguistically appropriate care

Background:

In Australia approximately 12% of people with dementia are from a migrant background and the quality of dementia care for this population has become an issue of concern , . 1 2

Objectives:

This study tested a hypothesis that a personalised and coordinated caregiver support intervention for caregivers from a migrant background would improve their competence in managing care activities, quality of life and satisfaction with care services and that they will also experience less distress.

Methods:

A randomised controlled trial was utilised to test the hypothesis. Dementia caregivers from various migrant backgrounds who were users of community aged care packages in South Australia were recruited in the trial. Outcome variables were measured prior to the intervention, at 6 months and 12 months post int gression model was used to ervention . A linear re3-7estimate the effectiveness of the intervention.

Results:

In total 72 caregivers from 11 migrant cultural groups were recruited in the trial and 61 of them completed the trial. The intervention group showed a statistically significant increase in the caregivers' competence scores, a mental components

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summary score, a satisfactory score with services and a usage rate of respite care. There were no statistically significant differences in scores of the physical components summary score, caregiver distress.

Conclusion:

The personalised and coordinated support for dementia caregivers from migrant backgrounds showed improved caregivers' competence and their mental wellbeing. Future interventions need to focus on tailored services to meet the needs of migrant caregivers , , . 1 2 8

Abstract No: 152

Abstract Title: Study of Association of APOE, CLU and PICALM Polymorphisms with Alzheimerâ€™s disease in Indian Population

Topic Name: Others

Bhagyalakshmi Mallapura Shankarappa*¹ , Lakshmi Narayanan Kota²

¹NIMHANS, India, [email protected] , ²NIMHANS, India, [email protected]

Keyword:

Alzheimer's disease, Association Study, APOE, CLU and PICALM Background :

Objectives: To study the association of APOE, CLU (rs11136000) and PICALM (rs3851179) polymorphisms in Alzheimer's disease (AD) subjects compared to controls in Indian population.

Methods:

We have analyzed three polymorphisms among AD subjects (N = 243) and age matched healthy controls (N = 164). Participants were patients seen at the Geriatric Clinic of the Department of Psychiatry in National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore. The study was approved by the Ethics Committee of NIMHANS and informed consent was collected prior to participation. All the AD subjects were evaluated using a standard protocol. DNA was isolated from blood. APOE genotyping was performed using sequence specific primer (SSP)-PCR method [3] and Genotyping of rs11136000 (CLU) and rs3851179 (PICALM) was performed by predesigned TaqMan® SNP genotyping assays.

Results:

The allele frequencies of AD subjects and controls for APOE, CLU and PICALM (Table) did not deviate from Hardy-Weinberg equilibrium. The presence of APOE* 4 was associated with AD (p = <0.0001). There was no association observed with AD at both rs11136000 CLU(p = 0.25) and rs3851179 PICALM (p = 0.54).

Conclusion:

Our results confirmed significant association of ApoE4 carrier status with AD. No association was observed for CLU and PICALM with AD at the loci tested. Previous studies for these two SNPs in CLU and PICALM have shown population specific differences. This apparent lack of association in the present sample might be due to a different haplotype background and other SNPs in these genes need to be investigated further.

Abstract No: 252

Abstract Title: Dementia Differential Profiling in Neuropsychological Presentation

Topic Name: Standardised protocols for cognition in India

Ashima Nehra¹ , Sakshi Chopra*² , Harsimarpreet Kaur³

¹All India Institute of Medical Sciences, India, [email protected] , ²All India Institute of Medical Sciences, India, [email protected] , ³All India Institute of Medical Sciences, India, [email protected]

Keyword:

Neuropsychological Profile, Dementia, Alzheimer Disease, Mild Cognitive Impairment, Cognition, Activities of Daily Living, India

Objectives:

Clinical overlap in the presentation of Dementia of Alzheimer's Disease (AD), Vascular Dementia (VD), Fronto-Temporal Dementia (FTD) and Pseudo-Dementia, etc. poses significant challenges in differential diagnosis (Braaten et al, 2006). Neuropsychological profiling of all patients with Dementia was aimed to assist for differential diagnosis and aiding future treatment course in this study.

Methods:

Patients referred to Clinical Neuropsychology OPD, at the Cognitive Disorders & Memory Clinic (CDM), Neurosciences Centre, AIIMS, from April 2013 to May 2014, as having Mild Cognitive Impairment (MCI), AD, Parkinson's Disease (PD),

Pseudo-Dementia, Unspecified Dementia (UD), and others including Fronto-temporal FTD, Vascular Dementia VD, Progressive Cognitive Neurological Deficit, etc. were evaluated on cognition (n=76), Mental Status (n=102), Activities of Daily Living [ADL] (n=102), perceptual-motor functioning (n=102), and intellectual functioning (n= 57). Both genders, above 60 years, and all education levels were assessed using a flexible approach to assessment.

Results:

Profiling was done using both parametric & non-parametric tests (ANOVA & Kruskal-Wallis). Results showed statistically significant differences at the 0.01 level for each of the different domains, i.e. Recent Memory, Remote Memory, Temporal Sequencing, Attention & Concentration, Delayed Memory, Immediate Memory, Simple Memory, New Learning Ability, Visual Memory, Recognition, Mental Status, Perceptuo-Motor Functioning, ADL, and Intellectual Functioning in all the different types of patient groups, i.e., MCI, AD, PD, UD, and others.

Conclusion:

Different clinical presentations of Dementia have different Neuropsychological profiles. A detailed Neuropsychological evaluation is of utmost importance to confirm/reject provisional diagnosis which may further help in planning neuropsychological rehabilitation for such patients.

Abstract No: 155

Abstract Title: A survey of general practitioners awareness and management of patients with dementia in Hong Kong

Topic Name: Others

Claudia KY Lai*¹ , Justina YW Liu² , Sylvia SM Ting³ , Kin Choi⁴ , David LK Dai⁵

¹The Hong Kong Polytechnic University, Hong Kong, [email protected] , ²The Hong Kong Polytechnic University, Hong Kong, [email protected] , ³The Hong Kong Polytechnic University, Hong Kong, [email protected] , ⁴Hong Kong Medical Association, Hong Kong, [email protected] , ⁵Prince of Wales Hospital, The Hospital Authority of Hong Kong, Hong Kong, [email protected]

Keyword:

Attitude, Diagnosis, Managment, General Practice, Training and Education

Background:

Despite the importance of early diagnosis, multiple barriers interfered with the processes of assessment, diagnosis, and initiation of treatment, leading to under-recognition of dementia.

Objectives:

This study aimed to (i) explore general practitioners' (GPs) perception and attitude of dementia and dementia care; (ii) identify the confidence level of GPs in diagnosing and treating patients with dementia (PWD); and (iii) describe local GPs' pattern of care in treating dementia care so as to identify barriers to diagnosis and treatment.

Methods:

A postal survey with four sections was conducted - (Part A) demographic information, (Part B) daily practice about diagnosing and managing PWD, (Part C) attitudes towards treating PWD, and (Part D) education and training on dementia.

Results:

The final sample comprised 414 respondents. 64.8% of them aged 26-55 and had practiced for 19.5 years since graduation. Most were working in the areas of general medicine/GP/family physicians or internal medicine (59.3%). 40% of their patients aged 65 or above and about 10% of their patients seen in the last six months had dementia. 41% considered that dementia is best diagnosed and managed by specialists whereas 41.3% of them disagree that the primary care team has a very limited role to play.

Conclusion:

One crucial finding is that our results confirmed conventional wisdom about the pivotal role of education and training in service delivery – whether the respondent had received any specialized training was the most important factor affecting their confidence and their willingness to treat PWD.

Abstract No: 159

Abstract Title: Significant Brain Glutathione Depletion in Specific Brain Regions in Alzheimer's disease: A Non-Invasive Brain Imaging Study

Topic Name: Neuroimaging



Pravat K Mandal*¹ , Sumiti Saharan² , Geetanjali Murari³ , Manjari Tripathi⁴

¹National Brain Research Center, India, [email protected] , ²National Brain Research Center, India, [email protected] , ³National Brain Research Center, India, [email protected] , ⁴All India Institute of Medical Sciences, India, [email protected]

Keyword:

MRS= Magnetic Resonance Spectroscopy; ROC= Receiver Operating Characteristics; OS= oxidative stress.

Background:

Accumulating evidence suggests oxidative stress (OS) to be a major determinant of Alzheimer's disease (AD) onset and its ineluctable progression. Elevated oxidative damage in AD has been postulated to be a consequence of altered levels of antioxidant enzymes in the brain. The most abundant brain antioxidant is glutathione (GSH), which plays a very important role in maintaining redox homeostasis in the brain.

The main objective of this study is to correlate GSH with AD pathology through MRS technology. MRS data were acquired from bi-lateral frontal cortices (Fc) and hippocampi (Hp) regions for healthy old (HO), Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) subjects using 3T MRI scanner equipped with dual tuned transmit-receive multi-nuclear head coil.

The significant depreciation in GSH signal amplitude was observed in AD in both left and right Hp (LH, p=0.000; RH, p=0.01) as well as the right Fc (RFCÍ¾ p=0.006) when compared to HO as well as MCI subjects. The combined estimation of GSH in RFC and LH through receiver operating characteristics (ROC) yielded the highest diagnostic accuracy of 90.3% with 85.7% sensitivity and 94.1% specificity in differentiating AD from HO and a significant accuracy of 85.2% with 78.6% sensitivity and 92.3% specificity while differentiating AD from MCI.

The present study offers novel insight into the molecular underpinnings of AD pathology and convincingly evidences that GSH levels are selectively reduced in Fc and Hp brain regions in AD. The results of our ROC analysis are strongly indicating the potential of GSH estimation as a diagnostic biomarker for AD.

Abstract No: 174

Abstract Title: Presence of Depressive symptoms in Family-caregivers of Persons having Alzheimer's disease

Topic Name: Caregivers's issues and training

Sandhya Gupta*¹

¹AIIMS, India, [email protected]

Keyword:

Alzheimers disease, Depression, Family caregiver

Background:

Background of the study: Caregivers of persons having chronic illness are under high level of psychological distress.In case of chronic disorder there is increasing strain on family caregivers as a result of exhaustion. Objectives: 1) To assess presence of depressive symptoms in family caregivers of persons having Alzheimer's disease.2) To correlate demographic variables with depression.

Methodology cross-sectional design Sample: 60-Family caregivers of persons having Alzheimer's disease.Major findings: All together 8.4% Family caregivers of persons having Alzheimer's disease were found to be depressed. The presence of depressive symptoms was correlated with duration of caregiving of persons having Alzheimer's disease were found to be depressed. Conclusion: There is need to assess mental health of family caregivers of persons having chronic Alzheimer disease and assist them in making use of adaptive strategies. Provide psycho-education to family caregivers as per need. It is important to became more sensitive to the needs of caregivers. Albeit education and experience, caregiving is exhausting and emotionally draining.

Abstract No: 182

Abstract Title: Caregiver Burden in Dementia- A Study from a Developing Nation


Pallavi Sinha*¹ , Om Prakash² , Nimesh Desai³ , Suman Kushwaha⁴

¹Institute of Human Behaviour and Allied Sciences, India, [email protected] , ²Institute of Human Behaviour and Allied Sciences, India, [email protected] , ³Institute of Human Behaviour and Allied Sciences, India, [email protected] , ⁴Institute of Human Behaviour and Allied Sciences, India, [email protected]

Keyword:

Dementia, caregiver burden

Background:

To study the factors that influence Burden in caregivers of dementia patients.

Method:

32 Caregivers of patients with Alzheimer's dementia attending the Psychiatry OPD at a tertiary care institute were included in the study. A semi-structured proforma was applied on patients and caregivers to collect information about the demographic and clinical details. Dementia patients underwent assessment on Hindi mental state examination and clinical dementia rating scale to gauge their cognitive functioning and severity of dementia. Everyday Ability Scale for India was used to study the ability to do activities of daily living by the patient. Zarit Burden Interview was used to study the caregiver burden while General Health Questionnaire was used as a screening instrument to detect psychological distress amongst the caregivers.

Results:

The results from the data collected on 32 dementia patient-caregivers pairs were analysed keeping the objectives of the study in mind. Spouses and caregivers with increasing age carried greater caregiver burden in dementia. Severity of the dementia had a bearing on the caregiver burden. Caregiver burden in dementia was positively correlated with cognitive impairment and inability to carry out ADLs. Presence of psychological distress in caregivers was also an indicator for greater caregiver burden in dementia.

Conclusions:

Caregiving for the ill has emerged as a critically important public health issue. Innovative interventions are needed to remove burden from caregiving and make caregiving a meaningful practice integral to the Indian society.

Abstract No: 187

Abstract Title: As, Cd and Pb-mixture induces synergistic, early-onset Alzheimer's-like amyloid pathology in rat brain: Involvement of oxidative stress and inflammation towards amyloidogenesis


Anushruti Ashok*¹ , Nagendra Kumar Rai² , Sachin Tripathi³ , Rukmani Pandey⁴ , Sanghamitra Bandyopadhyay⁵

¹Indian Institute of Toxicology Research-CSIR, India, [email protected] , ²Indian Institute of Toxicology Research-CSIR, India, [email protected] , ³Indian Institute of Toxicology Research-CSIR, India, [email protected] , ⁴Indian Institute of Toxicology Research-CSIR, India, [email protected] , ⁵Indian Institute of Toxicology Research, India, [email protected]

Keyword:

Environment, metal mixture, early age, amyloidogenicity

Background:

Heavy-metal exposure are considered as major risk factors for Alzheimer's disease (AD), mainly reported among the elderly. Previous reports divulged AD-like pathology for individual As, Cd or Pb; however, their combinatorial effect remained unknown. Here, we show that a mixture of As, Cd and Pb, at frequently occurring concentrations in ground water of India induced Alzheimer's like amyloid pathology in developing rat brain. We exposed rats to As, Cd and Pb-mixture from gestation-05 until postnatal (P)-90, and examined AD biomarkers, oxidative stress and neuro-inflammation at developmental stages, by western blotting, Enzyme-linked immunosorbent assay, enzymatic analysis or immunohistochemistry. We investigated combination index through single metal treatments. We performed Morris water maze and passive avoidance tests. Our findings enlighten cumulative As, Cd and Pb exposure as risk factors for early-onset AD. Rat frontal cortex and hippocampus exhibited a dose- and time-dependent augmentation of amyloid beta and amyloid precursur protein, requiring oxidative stress and inflammation. Enhancement in beta secretase (BACE) activity, C terminal fragment-beta and presenilins (PS) signified amyloidogenic APP processing, prompting synergistic BACE, PS and Amyloid beta. Rats demonstrated cognitive impairments. The data proves that the effect is more-than-additive and brings forth the mechanisms specifically oxidative stress and synergistic elevation of interleukin-1 regulating amyloidogenicity.

Altogether, our findings for the first time illustrate that through oxidative stress and inflammation, As, Cd and Pb synergistically induce early-onset AD pathology, implying severity of their combinatorial exposure during development.



Abstract No: 189

Abstract Title: Lithium: Possible Prophylactic Role in Alzheimers Disease


Digvijay Singh Goel*¹

¹Mental Health Directorate, Southland Hospital, New Zealand, [email protected]

Keyword:

Lithium, Neuroprotection, Alzheimer's Disease

Background:

Paradoxically, the use of lithium is declining even as the evidence for its efficacy in the treatment and prophylaxis of bipolar disorder continues to grow. Bipolar patients treated with lithium are at significantly lower risk of developing dementia even when manic symptoms do not completely abate. Given this context, is there a possible role for lithium in the prophylaxis of Alzheimer's Disease (AD)? Objectives: To evaluate evidence indicating the efficacy of lithium in attenuating the conversion of mild cognitive impairment (MCI) into AD, along with overview of related research indicating novel uses for psychiatry's aspirin!

Methods:

Literature review to identify and critically evaluate relevant published research studies.

Results: Lithium reduces risk of dementia in patients of bipolar disorder, indicating a possible role in the treatment of neurodegenerative disorders like Alzheimer's, despite incomplete understanding of its mechanisms of action. Lithium-induced inhibition of GSK3B hampers the formation of amyloid plaques and neurofibrillary tangles, increases BDNF levels in patients with early AD, and reduces CSF P-tau in subjects with MCI who eventually do not convert to AD. This has obvious clinical implications in the prevention of AD. A recent meta-analysis addresses exaggerated fears regarding lithium toxicity and reaffirms its overall safety.

Conclusion:

Lithium's declining use despite increasing evidence regarding its efficacy and safety might be attributable to, inter alia, the pharmaceutical industry's disinterest, misplaced fears regarding toxicity, and inadequate training in its use. Its possible prophylactic role in Alzheimer's Disease strengthens the case for public health funded research in this crucial domain.

Abstract No: 193

Abstract Title: Metabolic phenotype in amnestic MCI converters on F-18 Fluorodeoxyglucose (FDG) Positron Emission Tomography/Computed tomography (PET/CT)


Madhavi Tripathi*¹ , Manjari Tripathi² , Mansi Verma³ , Ashima N Wadhawan⁴ , Parul Thakral⁵ , S Vivekanand⁶ , Sadanad Dwivedi⁷ , Chandra S Bal⁸

¹All India Institute of Medical Sciences, New Delhi, India, [email protected] , ²All India Institute of Medical Sciences, New Delhi, India, [email protected] , ³All India Institute of Medical Sciences, New Delhi, India, [email protected] , ⁴All India Institute of Medical Sciences, New Delhi, India, [email protected] , ⁵All India Institute of Medical Sciences, New Delhi, India, [email protected] , ⁶All India Institute of Medical Sciences, New Delhi, India, [email protected] , ⁷All India Institute of Medical Sciences, New Delhi, India, [email protected] , ⁸All India Institute of Medical Sciences, New Delhi, India, [email protected]

Keyword:

aMCI, AD, FDG, PET/CT

Background:

To compare the metabolic phenotype between amnestic Mild Cognitive Impairment (aMCI) progressing to Alzheimers dementia (converters) with non-converters (NC) at the end of 6 months (first follow up). Hypothesis being that there would be a difference in glucose metabolism between the two groups.

Methods:

This was a prospective study in which patients coming to the cognitive disorders and memory (CDM) clinic of AIIMS and receiving a diagnosis of a MCI were enrolled for the study, after ruling out reversible causes of cognitive impairment (TSH, Vit-B12, MRI). Each patient underwent a detailed neuropsychological evaluation and F-18 FDG PET/CT study. At the end of 6 months each patient was called for a clinical and neuropsychological evaluation for evaluating progression to Alzheimers dementia (AD). Based on conversion patients were divided into two groups converters (those who progressed to AD) and the

rest were NC. The converter group was compared with the NC using Statistical Parametric mapping (SPM, http://www.fil.ion.ucl.ac.uk/spm/).

Results:

Mean age of the 21 patients included was 65.8 ± 9.5 (SD) years, M:F= 15:6. MMSE score was 27.1 ± 2.0 (SD). 3 patients (14 %) received a clinical diagnosis of probable AD (NINCDS-ADRDA) at the 6 month follow-up. Significant areas of hypometabolism

Conclusion:

aMCI converters have reduced glucose metabolism in regions known to be preferentially affected by AD in comparison to NC. This reiterates the importance of glucose hypometabolism on FDG-PET as a useful marker for MCI due to AD (intermediate probability).

Abstract No: 195

Abstract Title: Caring for Carers of Persons with Dementia (PwD): Indian experiences


Om Prakash*¹ , KS Shaji² , Mathew Varghese³ , Vinod Gangolli⁴

¹Institute of Human Behaviour & allied Sciences (IHBAS), New Delhi, India, [email protected] , ²Medical College, Trissur, India, [email protected] , ³National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India, [email protected] , ⁴Masina Hospital, Byculla, Mumbai; Grand River Hospital, Kitchener, Ontario, Canada, India, [email protected]

Keyword:

Persons with Dementia; carers; care-giving; training program

Background:

Dementia seems to be the silent epidemic in India. Cases in the community remain unrecognised and undertreated. The current status of dementia services in India is rather disappointing. Dementia has a devastating impact on Persons with Dementia (PwD) and the families caring for them.

Discussion:

In India the responsibility of caring has traditionally been assigned to spouses, daughters and daughter-in-laws. Caregiving, especially when it is needed over long periods of time, can lead to tremendous emotional and physical strain for caregivers. Rapid changes in the family structure in India have made care of older people more difficult for the families. There is a felt need to develop services for PwD and their carers and to meet their needs. The present symposium addresses several issues. Firstly, it will explore burden and quality of life of family caregivers in PwD by investigating the research studies related to it. Secondly, it will illustrate the emotional problems of family caregivers by referring to indicators of emotional strain. Thirdly, the needs of PwD and their caregivers will be explored. Finally, caregiver training and support program for PwD will be proposed to meet the needs of Indian caregivers.

Sub-topics: The present symposium addresses carers'-related issues within this context:

1. Burden and Quality of Life for carers of Persons with Dementia (PwD): Om Prakash

2. Emotional problems in carers of PwD: KS Shaji

3. Needs of PwD and their carers: Mathew Varghese

4. Developing caregiver training and support program for PwD: Vinod Gangolli

Abstract No: 203

Abstract Title: Spectrum of Behavioral abnormalities in patients with newly diagnosed Dementia patients


Bhagwat Narayan Rajput*¹ , Aditya Kumar Gupta²

¹ST STEPHENS HOSPITAL, India, [email protected] , ²ST STEPHENS HOSPITAL, India,

[email protected]

Keyword:

Dementia,Behavioural abnormalities,psychiatric symptoms,Delusin,Depression,Anxiety,Agitation,MMSE,NPI

Background:

1. To investigate behavioral abnormalities in patients suffering from Dementia



2. Use of this data to suggest; Preventive and Clinical intervention at risk patient

Material & Methods:

The study conducted at the Department of Neurology ;St Stephens Hospital Tis Hajari .A sample size of 30 consecutive patients suffered from Dementia was taken for the study. Source of data – OPD & Inpatient – Medicine Ward & ICU , Neurology ICU & other wards (brought to Neurology attention).Patients & healthy controls; caregivers of the patients; interviewed with the Neuropsychiatric Inventory (NPI) & MMSE. Inclusion criteria ; Participation will be based Clinical diagnosis; Mini Mental Status Examination; & Neuroimaging as MRI or clinical history & symptomatology; Exclusion criteria ; Patients with prior H/o Head Injury, Psychosis, Delirium & Mental retardation

Results :

We investigated 30 consecutive patients who have suffered from suffered from Dementia was taken for the study. Diagnosed by Mini Mental Status Examination; & Neuroimaging as MRI or clinical history & symptomatology,behavioral abnormalities diagnosed by Neuropsychiatric Inventory (NPI) & compared with normal Healthy control subjects. The frequency and severity of the following 10 behaviors were assessed: delusions,depression, hallucinations, agitation, dysphoria, anxiety, euphoria, apathy, disinhibition, irritability, and aberrant motor behavior. Correlations among these 10 behaviors and their relationship with cognitive impairment were also investigated. 70 % of patients had measurable behavioral changes. All 10 behaviors were significantly increased as compared with normal subjects. The most common behavior was Agitation, which was exhibited by 70% of patients, followed by Irritability (60%), Apathy 58 % . Depression 54 % , Anxiety (50 %), Disinhibition (46%), Dysphoria and Aberrant motor behavior (both 40%), Hallucinations (36%) & Delusions (22%)

Conclusion:

Agitation, Apathy, Depression, Anxiety, Aberrant motor behavior , Hallucinations, Delusions & Dysphoria were significantly correlated with cognitive impairment.

Abstract No: 204

Abstract Title: Evaluation of Alzheimer disease gene networks in patient-derived cell lines using next generation sequencing approach.


Vishnu Amaram¹ , Shadaan Zulfiqar² , Tara Atmaram³ , Mohammed Farukh⁴ , Renu Kumari⁵ , Vinod Yadav⁶ , Biju Viswanath*⁷ , Meera Purushottam⁸ , Matthew Varghese⁹ , Sanjeev Jain¹⁰ , Mitradas M Panicker¹¹ , Odity Mukherjee¹²

¹National Centre for Biological Sciences, India, [email protected] , ²National Centre for Biological Sciences, India, [email protected] , ³National Centre for Biological Sciences, India, [email protected] , ⁴Institute of Genomics and Integrative Biology, India, e of Genomics and Integrative Biology, India, [email protected], ⁵[email protected] , ⁶Institute of Genomics and Integrative Biology, India, [email protected] , ⁷National Institute of Mental Health and Neuro Sciences, India, [email protected] , ⁸National Institute of Mental Health and Neuro Sciences, India, [email protected], ⁹National Institute of Mental Health and Neuro Sciences, India, [email protected] , 10National Institute of Mental Health and Neuro Sciences, India, [email protected] , 11National Centre for Biological Sciences, India, [email protected] , 12National Centre for Biological Sciences, India, [email protected]

Keyword:

Alzheimer's disease; Cell models; Pluripotent stem cells; Lymphoblastoid; Transcriptome

Background:

Alzheimer's disease (AD) is an increasingly common neurodegenerative disorder that leads to cognitive impairment. Genetic analysis has identified allelic variants at candidate loci that increase susceptibility to the disease, but the actual influence of these alleles is unknown. Whole genome transcriptome analyses like RNAseq allow for detailed molecular characterization of the underlying disease process. Differentiating neurons from patient-derived human induced pluripotent stem cells (HiPSC) is an ideal system for such transcriptome analysis as it allows the study for defective neurogenesis to adult late-onset disease mechanisms.

Aim:

We have carried out an RNAseq analysis on human neurons, lymphoblastoid cell lines (LCL) and HiPSCs cultures derived from patients and controls carrying the pre-disposing AD risk allele (APOE-4).

Methods:

We use two different kinds of patient-derived cell lines to study the genotype to phenotype conversions – (1) Individual-

specific LCL: derived by transformation of B cells, (2) iPSCs: derived by reprogramming these lines to a pluripotent state. These cells can be differentiated into multiple cell types and under various culture conditions to mirror the disease 'in vitro'.

Results:

Our preliminary data demonstrate significant changes in expression of coding genes implicated in the disease pathology in differentiated neuronal cultures derived from patient and control cell lines. Detailed characterization of the same is in progression.

Conclusion:

Our data further shows the utility of LCLs as a useful source of patient material and as an approach to derive surrogate model systems to study CNS disorders in humans, even in a late onset CNS disease.

Abstract No: 206

Abstract Title: Comparison and correlation of cognitive screening tools with severity of Alzheimers disease


Abdul Qadir Jilani*¹ , Shrikant Srivastava² , Sarvada Chandra Tiwari³

¹Resident, Department of Geriatric Mental Health, KGMU, Lucknow, India, [email protected] , ²Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore, [email protected] , ³Department of Geriatric Mental Health, KGMU, Lucknow, India, [email protected]

Keyword:

Cognitive screening tools, Staging of Alzheimer disease, Diagnosis of dementia

Background:

In developing countries like India, due to shortage of trained psycho-geriatricians and lack of time in busy Outdoor schedules, diagnosis and staging of dementias including Alzheimer disease is generally made on the basis of scores of screening tools. The aim of study is to compare score of screening tools and to correlate with severity of Alzheimer's disease.

Method:

This is single point cross sectional case control study with sample size of 45 (20 controls and 25 cases) of aged �60 years in a tertiary level Psychogeriatric centre. Following tools have been used namely: HMSE, MMSE, SLUMS, Mini-Cog, PGIMS and CDR. Study data were analysed using statistical software GraphPad InStat-3.10.

Result:

The mean (±SD) scores of cognitive screening tests of 'controls' (n=20, no memory complaints and psychiatric disorders) were as HMSE= 29.9 (±0.308), MMSE= 27.8 (±3.122), SLUMS= 26.2 (±3.722) and Mini-Cog= 4.2 (±1.005); with mean PGIMS score of 2.4 (±3.299). Similarly, scores of cases (n=25) were as HMSE= 16.48 (±7.078), MMSE= 12.84 (±6.349), SLUMS= 6.92 (±6.582) and Mini Cog= 1.04 (±1.098); with mean PGIMS score of 27.96 (±2.908). As expected, both the groups differ significantly on cognitive screening and PGI memory scale, with cases scoring significantly lower on screening tests and higher on PGIMS.

Conclusion:

Though, score of screening tests significantly negatively correlate with severity (CDR) of AD (mild to severe stage), but cut off range of screening scores to stage severity overlaps with each other.

Abstract No: 212

Abstract Title: Asia Pacific Programs on Brain Grids - The Indian Initiative : Multicentric Neuroinformatics Analysis for Dementia/MCI Screening and Monitoring

Topic Name: Others

Prasun K Roy*¹ , Saikrishna Mulpuru² , VP Subramanyam Rallabandi³

¹National Brain Research Centre, Ministry of Science & Technology, Govt. of India, Manesar, NCR Delhi, India, [email protected] , ²National Brain Research Centre, Ministry of Science & Technology, Govt. of India, Manesar, NCR Delhi, India, [email protected] , ³National Brain Research Centre, Ministry of Science & Technology, Govt. of India, Manesar, NCR Delhi, India, [email protected]

Keyword :

Brain Grid, Dementia screening, Mild cognitive impairment, Neuroinformatics, Big Data Analytics, Multicentric study

Background :

A major challenge in dementia research/trials is drawing meaningful findings from proper quantitative analysis of the



enormous clinical, genomic, imaging and psychometric data of multicentric studies spanning different provinces-countries-continents. Multiscale neuroinformatics approach can offer a resolution.

Objectives:

We develop a rapid Brain-Grid platform in India, for cooperative research/trials/data-analysis among investigators in different institutions, across Eastern-Western-Northern-Southern regions, whilst studying the feasibility of rapid automated dementia-screening thereby.

Methods:

Asia-Pacific neuroinformatics efforts has been initiated as BrainNetome-China, KeroNet-Korea, Medgrid-Japan, C.BrainGrid-Canada and ANI-Australia. However, to integrate various Indian institutions we develop the neuroinformatics architecture in Linux-Apache-MySQL-PHP bundle, and use Government of India's National Knowledge Network, NKN (gigabit digital-grid linking 1,200 institutes/universities/hospitals) and C.Brain prototype, the NKN being coupled to Asia-Pacific via Trans-Eurasian-Network/TIEN-3. We set-up zonal hubs in clinical institutions at Delhi-NCR, Calcutta, Bombay and Bangalore, the central-processing facility utilizes infrastructure from Delhi-NCR, viz. our institute and NKN/National Informatics Centre.

Results:

Tele-operable standardized digital acquisition platform for clinical, physiological, imaging and psychometric data are attained. Within 50-65 seconds, multimodal MRI scans (sMRI-DWI-fMRI: 1000-2000.MB) is transportable/accessible between the centres, as Postgraduate Medical Institute(IPGMER)-Calcutta and King Edward Medical Institute(KEM)-Bombay. Lossy decompensation < 1%. We obtained the feasibility of having structural MRI scans of the remote medical centres to be processed by our rapid automated MRI image-analysis platform at NCR-Delhi [U.S.Patent:8,577,106B2-(2013)], which differentiates normals from Mild cognitive impairment with 94%-96% accuracy, using tissue-textural parameters.

Conclusion:

An affordable country-wide Indian Brain Grid is enabled, for rapid multi-centric collaboration and analysis, with high-precision applications to automated diagnosis and monitoring of predementic/dementic conditions.

Abstract No: 224

Abstract Title: Cognitive function in elderly with Late onset Depresssion: A cross sectional study


Sivakumar Palanimuthu Thangaraju*¹ , Sridatta Rajur² , Nagalakshmi R M³ , Sugandhi ASM⁴ , Thennarasu Kandavel⁵ , Keshav J Kumar⁶ , Venkatasubramanian Ganesan⁷ , Preeti Sinha⁸ , Santosh Loganathan⁹ , Srikala Bharath¹⁰ , Mathew Varghese¹¹

¹National Institute of Mental Health And NeuroSciences(NIMHANS), India, [email protected] , ²National Institute of Mental Health And NeuroSciences(NIMHANS), India, [email protected] , ³National Institute of Mental Health And NeuroSciences(NIMHANS), India, [email protected] , ⁴National Institute of Mental Health And NeuroSciences(NIMHANS), India, [email protected] , ⁵[email protected], India, [email protected] , ⁶National Institute of Mental Health And NeuroSciences(NIMHANS), India, [email protected] , ⁷National Institute of Mental Health And NeuroSciences(NIMHANS), India, [email protected] , ⁸National Institute of Mental Health And NeuroSciences(NIMHANS), India, [email protected] , ⁹National Institute of Mental Health And NeuroSciences(NIMHANS), India, [email protected] , ¹⁰National Institute of Mental Health And NeuroSciences(NIMHANS), India, [email protected] , ¹¹National Institute of Mental Health And NeuroSciences(NIMHANS), India, [email protected]

Keyword :

Cognitive function, Late onset depression, Elderly

Background :

To evaluate the pattern of cognitive impairment in elderly with Late onset Depression (LOD) when compared with healthy controls

Methods:

This study recruited 42 Subjects with LOD (DSM IV diagnosis of Major Depression with onset of first episode after 50 years of age) and 36 healthy control subjects matched for age, sex and education. They were assessed with Geriatric Depression scale (GDS)-15 item scale, Hindi Mental State Examination (HMSE) and Cognitive tests from the NIMHANS Neuropsychological battery for Elderly (NNBE). The NNBE included tests for attention, memory (verbal, visual and working) and verbal fluency. Differences in the neuropsychological test performance between the two groups were compared by Mann- Whitney Test.

Results:

The study groups had no significant difference in age, sex and education (p>0.05). The LOD group had significantly poorer performance than control group in HMSE (U=445.5, Z=-3.213,p=0.001), Attention test (U=506, Z=2.226, p=0.026),Digit span forward (U=494.5, Z=-2.81,p=0.005), Digit span reverse (U=470.5, Z=-2.993, p=0.003), Spatial span forward (U=258.5, Z=-5.21, p.05).

Conclusion:

The LOD Group had significantly impaired performance in cognitive domains of attention, working memory and executive function. Executive function impairment is more prominent than episodic memory impairment in LOD. Considering the higher risk for dementia in LOD, comprehensive monitoring of cognitive function including non-memory domains may be required in elderly patients with LOD.

Acknowledgement:

Funding support from Indian Council of Medical Research and Department of Science and Technology, Government of India

Abstract No: 229

Abstract Title: Incidence of and Risk Factors for Alzheimers Disease and Mild Cognitive Impairment in Korean Elderly


Jong Bin Bae*¹ , You Joung Kim² , Ji Won Han³ , Ki Woong Kim⁴

¹Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea, South Korea, [email protected] , ²National Institute of Dementia, Seongnam, Korea, South Korea, [email protected], ³Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea, South Korea, [email protected] , ⁴Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 2. National Institute of Dementia, Seongnam 3. Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea, South Korea, [email protected]

Keyword :

Alzheimers disease, mild cognitive impairment, epidemiology, incidence, risk factor, Korea

Background :

Knowledge of incidence and risk factors is essential for the development of strategies to treat patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI).

Objectives :

Estimate incidence of AD and MCI and identify risk factors for AD and MCI in Korean elderly.

Methods :

A subpopulation of the Nationwide Survey on Dementia Epidemiology (460 Korean subjects aged �65 years from 2 rural and 2 urban districts) was followed up for 3.5 years. Age-specific incidence was estimated, and risk factors were identified.

Results :

The age-standardized incidence of AD and MCI was 7.9 and 28.1 cases per 1,000 person-years, respectively. MCI was associated with a 6-fold increased risk of AD. Depression was a risk factor for AD with MCI. Age, lack of formal education, illiteracy, rural residence, and marital status were associated with risk of AD.

Conclusion :

Strategies to control modifiable risk factors should be implemented to decrease the incidence of AD.

Abstract No: 235

Abstract Title: Impact of Music on Self-esteem of Older people residing in an Indian old age home


Sailaxmi - Gandhi*¹

¹National Institute of Mental Health & Neurosciences (Institute of National Importance), India, [email protected]

Keyword :

Music, self-esteem, older people, old age homes, non-pharmacological interventions

Background :

Self-esteem rises steadily as people age but starts declining around the time of retirement, according to a longitudinal study




of men and women ranging in age from 25 to 104. The objective was to evaluate the impact of music on self-esteem levels of older people. The hypothesis that there would be a significant change in the self-esteem levels of older people after listening to 30 mts. of instrumental music consisting of 6 ragas for 30 days was tested using a quasi-experimental research design to invite a convenience sample of 30 older persons, residing in an old age home to participate in the study. Data was collected using a socio-demographic profile and the 'Rosenberg's Self-esteem scale' which is a standardized tool with established validity and reliability. Ethical issues were ensured. Analysis was done using SPSS 18.

There were 15 females and 15 males, all Hindus, 73.3% had lost their spouse, 70% were more than 70 yrs. old and 76.6% were educated up to undergraduate level. RM ANOVA showed a significant increase from the pre-mean self-esteem score which was 11.37 ±2.93 to 14.93 ± 2.38 on the 15th day and 16.43 ± 2.16 on the 30th day (F (2,58) =234.578, p=0.000). Females had higher self-esteem values (12.20 ±2.93, t= -1.599, p=0.121) than males. RCTs with larger sample size, across various cultures and states in India may provide stronger support for music as an intervention to enhance self-esteem levels.

Music can help boost self-esteem in older persons and hence be therapeutic.

Abstract No: 236

Abstract Title: Clinical and Biochemical profile Of Mild Cognitive Impairment In elderly Indians.


Gaurav Rajesh Desai*¹ , Aparajit Ballav Dey²

¹All India Institute of Medical Sciences, India, [email protected], ²All India Institute of Medical Sciences, India, [email protected]

Keyword :

Mild Cognitive Impairment, Clinical, Biochemical profile, Indian, elderly

Background :

MCI continues to be a poorly defined entity despite being a stage of potential intervention and a focus of many interventions. Although it is a clinical diagnosis, newer biomarkers are being investigated for earlier identification.

We evaluated the clinical and biochemical profile of MCI subjects as well as estimating the prevalence of MCI subtypes.

Subjects were seen in the memory clinic and inpatient ward for memory complaints and were evaluated clinically and with cognitive scales (MMSE and Montreal Cognitive assessment) apart from biochemical tests including serum Adiponectine and Leptine. 113 patients were evaluated during the study period of whom 31 (27.4%) had MCI according to the Modified Petersen criteria. Prevalence of the Amnestic type was 18.5% and that of the non amnestic type was 8.9%. A majority of them were male and cerebrovascular disease was the predominant co morbidity. Reversible causes like Vitamin B 12 deficiency(3/31) and Hypothyroidism(2/31) constituted a smaller cohort. Serum Adiponectine amd Leptine levels are awaited.

Conclusion:

MCI is an increasingly identifiable stage especially in the urban settings in India. Prevalence of the Amnestic type of MCI was found to be higher compared to existing literature. It is an ongoing study with certain investigations being awaited and we hope more studies are carried out laying emphasis on incorporating both biochemical and clinical criteria for defining MCI.

Abstract No: 238

Abstract Title: Dementia in developing countries: does education play the same role in India as in the West?


Amulya Rajan*¹ , Gowri Krovi Iyer² , Suvarna Alladi³ , Thomas H Bak⁴ , Shailaja Mekala⁵ , Annapurna Mamidipudi⁶ , Divyaraj Gollahalli⁷ , Jaydip Ray Chaudhuri⁸ , Subhash Kaul⁹

¹Nizam's Institute of Medical Sciences, India, [email protected], ²Nizam's Institute of Medical Sciences, India, [email protected] , ³Nizam's Institute of Medical Sciences, India, [email protected] , ⁴University of Edinburgh, United Kingdom, [email protected] , ⁵Nizam's Institute of Medical Sciences, India, [email protected] , 6Maastricht University, Netherlands, India, [email protected] , 7Nizam's Institute of Medical Sciences, India, [email protected] , 8Yashoda Hospitals, India, [email protected] , 9Nizam's Institute of Medical Sciences, India, [email protected]

Keyword :

education, dementia, protective factors, bilingualism, rural dwelling, stroke, cognitive reserve

Background :

Evidence suggests that education protects from dementia by enhancing cognitive reserve. However, this may be influenced by several socio-demographic factors. Rising numbers of dementia in India, high levels of illiteracy and heterogeneity in socio-demographic factors provide an opportunity to explore this relationship. To study the association between education and age at dementia onset, in relation to socio-demographic factors.

Association between age at dementia onset and literacy was studied in relationship to potential confounding factors such as gender, bilingualism, place of dwelling, occupation, vascular risk factors, stroke, family history of dementia and dementia subtypes. Case records of 648 dementia patients diagnosed in a specialist clinic in a University hospital in Hyderabad, India were examined. All patients were prospectively enrolled as part of an ongoing longitudinal project that aims to evaluate dementia subjects with detailed clinical, etiological, imaging, and follow-up studies. Of the 648 patients, 98 (15.1%) were illiterate. More than half of illiterate skilled workers were engaged in crafts and skilled agriculture unlike literates who were in trade or clerical jobs. Mean age at onset in illiterates was 60.1 years and in literates 64.5 years (p=0.0002). Factors independently associated with age at dementia onset were bilingualism, rural dwelling and stroke, but not education.

Our study demonstrates that in India, rural dwelling, bilingualism, stroke and occupation modify the relationship between education and dementia.

Abstract No: 241

Abstract Title: AN INNOVATIVE AND HOLISTIC APPROACH TO DEMENTIA CARE FOR INDIA: A GOOD PRACTISE MODEL FROM KERALA

Babu Varghese*¹

India the second largest populated country ( 1.2 billion) in the globe has around 100 million elderly at present. The current estimates show 4.27 million Indians have dementia and this figure is predicted to rise up to 4.41 million overtaking USA by 2015. In India, families have traditionally supported elderly persons. So a sustainable and community based care practice is being regarded as the best dementia care model for India. However, consequent to factors like urbanisation, nuclearisation of families and economic migration changes have been happening in the social landscape of the country. There is a real need to mobilise social support to meet the needs of people with dementia in their own homes and in their own communities.

After the release of Dementia India Report 2010( a national strategy report prepared by ARDSI), we started working in Kerala on an assets based solutions approach. We tried to identify and utilize maximum of locally available resources and personnel with existing infrastructure in identifying, assessing, managing, and supporting increasing requirements of those suffering from dementia and their families. Bing a holistic model, it required partnerships of governmental agencies, health and social sectors and voluntary organisations. This model involves

• Empowering the existing health and social care professionals of government and nongovernment settings in dementia care to provide the services at their level; from identification to end of life care.

• Promoting dementia awareness and prevention strategies.

• Developing services to diagnose and manage dementia with equal emphasis on medical and psychosocial care starting at primary care level.

• Creating volunteers with a positive attitude towards dementia so that they can offer informal support to families.

• Developing a pool of trained professional caregivers identified from existing health and social care services to care for people with dementia in their own homes and care centres.

• Setting up specialised dementia care units in selected old age homes to ensure respite care for people with dementia thus supporting families in their long hours of caring.

• Overall coordination through national dementia helpline

This integrated care model with health and social care improves accessibility to care and services. It is a family-centric model aimed at equipping and empowering them. The real testimony towards this approach involves two time ADI-MetLife international awards, support from a public sector to set up a national dementia helpline, and collaborative efforts with government and other social and health care institutions in capacity building programs, awareness creation, and geriatric club formation. Recognising the expertise in this field, government of Kerala has now joined hands with us to take up state initiative on dementia. In a developing country like India, while dealing with several communicable diseases, it is hard to have a policy exclusively for Dementia. With our long efforts supported by families, we managed to convince the policy makers to make dementia a social and healthy priority and frame a policy which incorporate the key components of the model. Now there is a real possibility of replicating this model nationally.




Abstract No: 245

Abstract Title: Early detection of Cognitive Impairment in old age


Vijay Gujjar*¹ , Aparajit Ballav Dey² , Prasun Chatterjee³

¹All India Institute of Medical Sciences, India, [email protected], ²All India Institute of Medical Sciences, India, [email protected] , ³AIIMS, India, [email protected]

Keyword :

Cognitive impairment , early detection

Background :

In a rapidly ageing world, dementia is emerging as a public health challenge and a major cause of disability in old age. Though exact epidemiology of AD and other dementias is not yet established, it has been projected that two out of every three patients with dementia will soon be a possibility in developing countries.

Our objective was to evaluate the cognitive status in subjects with memory complaints with additional sub-objective of establishing a memory clinic facility and developing a clinical protocol . We also aimed to detect the causes of loss of memory in old age in hospital setting.

It was a cross-sectional observational study conducted among the patients attending the Geriatric Department OPD. 113 patients over the age of 60 with subjective memory complaints or family members were included during this period. A detailed evaluation of the cognitive status, functional status, co-morbidities and socioeconomic status was done.

Out of 113 patients, 86 were males and 27 females. More than 45% of the patients were between the age of 60-65 . Vascular dementia contributed to the greatest share of cognitive disability in the old age, followed by Alzheimer's disease. Malnutrition was prevalent in a large proportion of dementia patients. Depression also contributed largely to this cohort.

It was unsurprisingly found that patients who were aware about their cognitive misgivings were found to have better scores compared to those who were brought by family members. Patients with higher education level also had better scores.

Abstract No: 249

Abstract Title: Homocysteine as an Independent Risk Marker of Severity of Vascular Dementia


Mina Chandra*¹ , Kuljeet Singh Anand² , Ram Chandra Bajpai³

¹Department of Psychiatry PGIMER & Dr RML Hospital, New Delhi, India, [email protected], ²Department of Neurology,PGIMER & Dr RML Hospital, New Delhi, India, [email protected], ³Army Medical College, New Delhi, India, [email protected]

Keyword :

Homocysteine, Vascular Dementia, Severity, Ischemic brain lesions.

Background :

Homocysteine, postulated to contribute to endothelial dysfunction, thromboembolism, cererbal ischaemia, leukoariosis, (Leblhuber 2000, Sachdev 2004) Dementia and Stroke. (Serdareviz 2011, Pandey 2006, Seshadri 2002) has been considered either as a surrogate marker for concomitant B12 and Folate deficiency (Quadri 2004, Herrmann 2011) or an independent marker of vascular disease process. (Nilson 2013). This study was designed to examine the relationship between Serum Homocysteine levels and severity of Vascular Dementia. Subjects with Vascular Dementia attending memory clinic in a tertiary care hospital in New Delhi between 1/6/2013 and 31/5/2014 with intact hepatic, renal and thyroid functions and adequate Serum B12 and Serum Folate levels were assessed for severity of dementia using Clinical Dementia Rating Scale and investigated for fasting Serum Homocysteine levels.

Of 91 subjects [age 69.57 + 7.70 years; Male: Female= 46 (50.5%): 45 (49.5%)], 49 (53.8%) had mild, 24(26.4%) had moderate and 18 (19.8%) had severe dementia. Multinomial Regression analysis revealed Homocysteine predictive model as statistically significant (Chi square=66.303, df= 2 pË‚ 0.000; Nagelkerke Pseudo R2 =0.597; Wald statistic pË‚ 0.000) with Serum Homocysteine level as a moderately strong predictor of severity of vascular dementia with reference to mild dementia - both for moderate [Exp (B) = 1.15; 95% CI=1.04-1.26; Odds = 3.15] and severe states [Exp (B) = 2.065; 95% CI=1.47-2.90; Odds = 7.88].

We conclude that in subjects with intact liver, renal and thyroid functions, Serum Homocysteine level is a moderately strong risk predictor of severity of vascular dementia operating independent of nutritional factors like B12 and Folate.

Abstract No: 251

Abstract Title: Holistic Home based Neuropsychological Rehabilitation of Persons with VCI


Ashima Nehra¹, Harsimarpreet Kaur*² , Sakshi Chopra³

¹All India Institute Of Medical Sciences, India, [email protected], ²All India Institute Of Medical Sciences, India, [email protected] , ³All India Institute Of Medical Sciences, India, [email protected]

Keyword :

neuropsychological rehbailitation. vascular cognitive impairment, VCI, India, Stroke

Background :

The high cardiovascular disease burden in India, increasing stroke incidence, and ageing population have contributed to large numbers of patients with VCI in India. Scarce resources along with low awareness make it a problem that needs urgent attention. It's important to identify patients at early stages of cognitive impairment, to treat appropriately and prevent its progression to dementia. Therefore, attempts need to be made for the early rehabilitation of these patients. Studies have shown that Neuropsychological Rehabilitation (NR) plays a crucial role in improving the cognitive and basic functioning in these patients.(Clare et.al, 2003) Objective: Our aim was to facilitate holistic NR to persons having VCI in the Indian context aimed at improving their cognitive and language functioning.

Methods:

On an OPD level, reporting 2 case series after 1 to 6 months of stroke with education > 15 years, age 65 years & above with impaired cognitive functioning. ABA experimental design was used where neuropsychological assessment for cognitive functioning (Pershad &Wig, 1976), language functioning (Nehra & Pershad, 2012), depression (Sutcliffe & Lincoln, 1998), quality of life (Pershad et. al., 1985). The NR Sessions lasted for 4-8 weeks.

Results:

Post NR, there was marked improvement seen in neuropsychological assessment for cognitive functioning, language functioning along with depression showing the effectiveness of NR for patients with vascular cognitive impairments.

Conclusion & Future directions:

NR can help in improving the cognitive & language functioning of VCI patients thereby improving their QoL & preventing its progression to dementia. A larger sample size and RCTs are needed to prove the effectiveness of this programme.

Abstract No: 254

Abstract Title: The Sensitivity Of Activities Of Daily Living Scales: Its Importance In Dementia Assessment


Ashima Nehra¹ , Swati Bajpai*²

¹All India Institute of Medical Sciences, India, [email protected] , ²All India Institute of Medical Sciences, India, [email protected]

Keyword :

Dementia, activities of daily living, functional deficit, Elderly

Abstract No: 258

Abstract Title: CARE GIVER ISSUES IN DEMENTIA PATIENTS: A PHYSICIANS PERSPECTIVE


Venugopalan Gunasekaran*¹ , A.B. Dey²

¹All India Institute of Medical Sciences, India, [email protected], ²All India Institute of Medical Sciences, India, [email protected]

Keyword :

Caregiver, questinnaire

Background :

Taking care of dementia patients is an art for some, compulsion for many. It needs lot of patience, time, energy, motivation to take care of your loved one who at times forgets themselves. To reduce the burnout of care giver is an inherent duty of doctor taking care of demented patients. In India with a strong family support system most of the dementia patients are taken care




of by family members. They often lack basic idea about disease process or special needs of patients. This lead to the critical question for this study: “How does Indian family support or cope up with dementia patients?” Understanding care givers problems in our setup will aid in knowing areas of need. This will help in devising solution for their problems. With this background we devised “Care giver questionnaire” to ascertain the degree of burden, causes of burden and other domains. Questions were framed to assess patients' dependency status, time and money spent by care givers. Questions also tried to find out mental and health problems of care givers and their ability to cope up. This questionnaire will help to give a targeted training to care giver in future.

Abstract Title: The prevailing nature of Social Relationship and Support System Post Stroke in North India: A Qualitative Study

KP Rajendran¹, Naresh Kumar²

Stroke is currently the chief cause of neurological disability in India. The impact of stroke is felt through high economic burden, lowered dignity and limited social relations other than the significant residual impairment of physical, psychological, and overall quality of life.

Objectives:

To understand how crucial are social relationship and support systems in stroke rehabilitation and what is the economic burden on the family

Methods:

Case study analysis of 20 stroke rehabilitation patients and their families belonging to various age groups who are currently availing stroke rehabilitation services in GRTC.

Results:

The key themes identified by the patients were: family and critical support in performing ADL, communication and speech therapy, autonomy, social role adjustments, sexual relationship and stigma.

Conclusion: Provides insights on how stroke altered social relationships within families -spouses, social relationships-friends and others and the economic burden of managing the continuous treatment of AD.

Factors Associated with long term residential care for people with dementia- Data from India's largest residential care facility.

Sruti Sivaraman

Background:

Understanding the reason for institutionalization in an Indian scenario is an important process to measure the need for residential care.

Objective:

1. To identify the factors associated with the decision for long term residential care for people with dementia in India

2. To explore the correlation between caregivers' reason for institutionalization with i) severity of the disease ii) caregiver burden iii) challenging behaviors and iv) physical dependency

Method:

This was a qualitative study. The sample included people with dementia visiting the memory clinic of Nightingales centre for Ageing and Alzheimer's from April 2010 to Dec 2013.The reason for institutionalization and the views of the caregiver regarding residential care in dementia was captured qualitatively by asking families to describe the reason in the agreement for admission.

Results:

The family carer had cared for the patient since the diagnosis of illness and had explored all the options available. There was a greater correlation between caregiver burden and challenging behavior and physical dependency as opposed to severity of the disease. The other reasons for considering institutionalization included a better quality of life with opportunity for cognitive stimulation, practical reasons such as most of the family living abroad and not able to supervise care at home, carer well being and health.

Conclusion:

Institutionalisation is been chosen as a last resort. Implementing more accessible day care and short term stay facilities and availability of community support system will help the caregivers in managing challenging behaviors and to provide better quality of life for PwD

Title: Association of frailty and cognitive impairment in older Indians

Topic: Risk factors and Prevention

Authors: Swapnil Jathar, A K Ambastha, S Dey, R Lakshmy, SN Dwivedi, A B Dey

Background and Objectives:

Frailty is important geriatric syndrome. Frailty renders an older individual to be more susceptible to adverse health related outcomes, including death and hospitalization. Frailty is linked to the process of aging as has been the cognitive decline. The prevalence of both frailty and cognitive impairment increases with age. In this paper the relationship of these health states in old age was examined.

Methodology:

143 older patients from Geriatric Medicine ward and outpatient department were classified as frail or non-frail based on established diagnostic criteria. Their cognitive status was assessed with standard tools. Correlation was established with standard statistical methods.

Results:

The proportion of patients with impaired cognition was significantly higher among the frail patient compared to the non-frail (p < 0.01). Those with impaired cognition also had poorer gait speed and hand grip strength compared to those with normal cognition, which were two important components of assessment of frailty. Frail patients with cognitive impairment had distinctively different biomarker profile compared to the cognitively intact non-frail patients.

Conclusion:

Frail individuals have statistically higher prevalence of cognitive impairment, and both frailty and cognitive decline are associated with poor physical performance measures like gait speed and grip strength and abnormal biomarker profile.

Title: Correlation between cognitive status and biomarkers of ageing in the oldest old

Topic: Risk factors and Prevention

Authors: Akash K Ambashtha, S Jathar, S Dey, R Lakshmy, N Kumar, S N Diwedi, A B Dey

Department of Geriatric Medicine, All India Institute of Medical sciences, New Delhi

Background:

In recent years there has been enormous scientific interest in evaluating the health, functional status and biomarkers of the oldest old (over 85 years). In this paper, we report correlation between the different biomarkers with cognitive impairment.

Methodology:

A total of 100 oldest old (aged 85 years or more) subjects from Geriatric Medicine outpatient department were subjected to detailed multi dimensional assessment comprising of assessment through clinical evaluation, review of medical record and established assessment questionnaires; functional assessment and a series of biomarkers. Correlation between 37 different biomarkers and cognitive impairment was assessed using standard statistical method.

Result:

Mean (SD) age of the participants was 86.18(2.51) years, 66 were males and 34 were females. Mean (SD) number of diseases were 3.1(1.8). 83 subjects presented with multi-morbidities. Dependence in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) was noted in 45 and 69 subjects respectively. Thirty five participants had cognitive impairment. Grip strength, TUG score and depression were statistically significant correlation with cognitive decline. Low haemoglobin and low serum albumin levels were also detected to be significantly associated with cognitive impairment. However, telomere length, serum sirtuin levels, serum BNP, serum vitamin D levels or HbA1c didn't show any correlation with cognitive impairment.

Conclusion:

Cognitive impairment, multi-morbidity and disability were very common in this subset of population. Markers of physical strength, depression, anaemia, and malnutrition are important predictors of failing cognition in later life.

Title: Assessment of palliative care needs of patients with dementia

Topic: Non pharmacological management of dementia

Authors: S Thakur, A B Dey

Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi




Objective:

Dementia is a progressive life limiting condition with increasing prevalence and complex needs. Traditionally, clinicians and researchers within palliative care community have focused on care for advanced stage cancer patients. Palliative care needs of patients with dementia are often poorly understood.

Methodology:

This is a cross sectional observational study involving older patients with dementia from the Geriatric Medicine outpatient department and memory clinic of the AIIMS hospital. Assessment` of dementia was carried out with standard assessment tools. Palliative care needs of these patients were assessed in detail by using Inter-RAI Palliative Care tool.

Results:

30 patients were evaluated. Majority of the study population was male and cerebrovascular disease was the pre-dominant comorbidity. With regard to palliative care needs, apart from memory impairment, the predominant areas of concern were: alteration in bowel habits (78%), sleep disturbances (69%), depression (68%), nutritional impairment (60%) and pressure ulcers (30%).

Conclusion:

Research into palliative care in patient with dementia is very limited. Assessment of palliative care needs and institution of specific interventions is essential and should be included in the management plan early for holistic care planning of dementia.

Title: Development of training strategies for primary caregivers of patients with dementia

Topic: Caregivers' issues and training

Authors: P Kumar, Sobia Nisar, A K Ambashtha, S Jathar, V Kumar, A B Dey

Department of Geriatric Medicine, All India Institute of Medical sciences, New Delhi

Objectives:

Caregiver burden is a reality in long term care. In society with large older population and uncertain institutional care mechanism, caregiver burden has an important connotation in the face of changing structure and functioning of the family. Issues related to support and training of caregivers who are usually the family members, have importance place in any programme for dementia care. This report attempted to assess perceived burden among caregivers of dementia patients and in need of training and education in dementia care from the health system.

Method:

A volunteer sample of 20 caregivers of patients suffering from probable Alzheimer's disease or Vascular Dementia participated in the study. These patients were recruited from Memory Clinic of the Department of Geriatric Medicine of AIIMS Hospital. Subjective burden among caregivers of elderly with dementia were collected using 22 items self reported inventory Zarit Burden Interview. This scale examines burden associated with functional/behavioral impairments and the home care situation.

Results:

The results showed that 90% (18) of caregivers were mild to moderate burden (21-40), and 10 % (2) exhibited moderate to severe burden. (41-60). Burden was related to patients' behavioral symptom, severity of dementia, caregiver gender (female>male), income and level of education. On continuous interview caregiver need assistance in many task including personal care household, shopping, transportation, financial, emotional and monitoring tasks.

Conclusion:

Multi-component training manual for caregiver needs to be developed with counseling, awareness, environmental modification, activity chart, recreational and leisure activities which would provide practical strategies for dementia on continuous basis.

Title: Promising serum protein marker for early detection of Alzheimer's Disease

Topic: Diagnosis

Authors: Sharmistha Dey , R Kumar, A Gupta, V Sahu, AP Singh, S Kumar, Kusum Singh , Manjari Tripathi and A. B. Dey

Departments of Biophysics , Neurology and, Geriatric Medicine

All India Institute of Medical Sciences, New Delhi, India

Background:

Sirtuin (SIRT) pathway has a crucial role in Alzheimer's disease (AD). The present study evaluated the alterations in serum sirtuin1 (SIRT1) concentration in healthy individuals (young and old) and patients with AD and mild cognitive impairment (MCI) to explore its clinical relevance.

Methods:

Blood samples were collected from 40 AD and 9 MCI patients as cases and 22 young healthy adults and 22 healthy elderly individuals as controls. Serum SIRT1 was estimated by Surface Plasmon Resonance (SPR), Western Blot and ELISA.

Results:

A significant (p<0.0001) decline in SIRT1 concentration was observed in patients with AD (2.27±0.46 ng/μl) and MCI (3.64±0.15 ng/μl) compared to healthy elderly individuals (4.82±0.4ng/μl). The serum SIRT1 concentration in healthy elderly was also significantly lower (p<0.0001) compared to young healthy controls (8.16±0.87 ng/μl).

Conclusion:

This study, first of its kind, has demonstrated, decline in serum concentration of SIRT1 in healthy individuals as they age. In patients with AD and MCI the decline was even more pronounced, which provides an opportunity to develop this protein as a predictive marker of AD in early stages with suitable cut off values.

Dementia Friendly Communities- opportunities and challenges

Dr. CT Sudhir Kumar MD, MRCPsych.

Concept

The concept of Dementia Friendly Communities (DFC) has been gaining attention in different parts of the world. Dementia Friendly Communities aim to improve the inclusion and quality of life of people with dementia. It recognises the challenges involved in living with dementia, for the person and their families. The focus is on increasing awareness and making the community more sensitive to the needs of people with dementia, thus making it a better place to live. There is no universal definition to what constitutes a DFC. It consists of environmental and social aspects. The domains to work on and the goals to achieve differ based on local contexts. Though the usual pillars described include people, place, resources and networks; priorities may change depending on the situation. The understanding of DFC in a low resource setting may be quite different from what a high resource setting, which has already achieved basic standards of care, proposes. DFC may be better seen as supportive and inclusive of everyone with dementia irrespective of the nature and degree of their condition.

Components

Recognising the need to act is the starting point to build a DFC. Views and opinions of people who have travelled the dementia journey should form the foundation stones. The steps towards becoming a DFC will include creating awareness regarding dementia among all sections of the society, improving diagnosis; medical and psychosocial treatments, providing support to families and carers, engaging key stake holders by increasing their understanding of dementia, adapting facilities and developing services for people with dementia and their carers. An asset based solutions approach exploring already existing strengths of the community, to divert into dementia care is a template which may work in low resource setting.

Session

This symposium during the Asia Pacific Regional Conference of Alzheimer's Disease International 2014, is an important landmark for DFC in the region. The session will start with exploring the opportunities DFC present. An overview of progress at the international level will be reviewed. Methodological considerations and challenges while adapting the concept to low resource settings both in defining and implementing will be deliberated. In addition, it will also focus on the work already done in the region and will have inputs from patient and caregiver perspectives. The importance of collaborative efforts between government, non-governmental and voluntary sectors will be emphasised. It is important to discuss about devising a national recognition system of DFC and what outcome measures to look for. The work we have done so far in India and the challenges involved will be presented. This session is expected to be the launch of a concerted action for delegates from participating countries where the work has not started yet and exchange of ideas for those who have been working in the area. The session will hopefully be a launch pad and possible formation of DFC liaison networks. We believe this will be an opportunity for various member associations and chapters to make a commitment to act toward creating Dementia Friendly Communities, with whom the leadership can be entrusted.



Rights of persons with Dementia and Ethical Issues

Mrs. Meera Pattabiraman and Mrs. Nilanjana Maulik

Dementia is a syndrome usually chronic, characterised by global deterioration of intellect. So, memory, learning, language, orientation and comprehension are affected due to disease of the brain. The early symptom of short term memory loss progresses gradually till in advanced dementia the person will forget to talk, walk, eat or use the bathroom. Such a person will become totally dependent on the carer for all activities of daily living.

People with dementia and their carers have the same rights as every other citizen, however due to the nature of the illness, they are faced with economic, cultural and social barriers in having their fundamental rights. In addition, persons with dementia and their carers need special rights because of the characteristics of the disease, the scare resources available in our country, the stigma and discrimination and the stress and marginalisation of the carers. And these special rights are self-interest rights, empowerment or welfare rights, participation righs, non-discrimination rights and legal rights.

Caring for a person with dementia does not mean just medical care in the form of medications or other therapies like physiotherapy, aromatherapy, reminiscences, etc; it involves a holistic and ethical approach to the care and treatment. Ethical guidelines on what is right or wrong cannot be black or white, they are many shades of grey in the case of dementia. Since a person with dementia ultimately loses control over his/her care, who takes these decisions – the family, the doctor, the professional carer, the institution where he or she is a resident. Sometimes religious and cultural sentiments could also play a role in the type of care that is provided. The major areas where there could be ethically sensitive issues are oral feeding, medication for behavioural problems, genetic testing, research or clinical trials, electronic tracking and end of life care.

Ethical issues play a crucial role in the care of dementia but they are often ignored. Hence it is imperative to develop guidelines with the help of medical professionals, carers and family members, experts in ethics and other stake holders.

Challenges of Dementia in Asia Pacific Region

Dr. Jacob Roy Kuriakose, Chairman, Alzheimer's Disease International

The Asia Pacific countries already have around half of the world's population. More than 11% of the population in the region is over 60 years of age. By 2050 a quarter of the total population in the Asia Pacific region will be aged 60 years or older. The number of people living with dementia in the Asia Pacific region will triple between now and 2050. In the Asia Pacific region, the number of people with dementia is estimated to increase from 23 million people in 2015 to 71 million people by the year 2050. For the Asia Pacific region, costs associated with dementia have been estimated at US$185 billion. These figures are likely to increase as the numbers of people with dementia grow, and the mounting societal demand in countries with emerging economies. Large populations in the region includes India, China and Indonesia. The determining factors for this can be listed as urbanisation, cultural and family structures, public health infrastructure, care services, gross domestic product, government.

The Asia Pacific region faces certain specific challenges to dementia such as limited awareness of dementia in many countries, cultural context that denies its existence or attaches stigma to dementia, an assumption that dementia is a natural part of ageing and not a result of a disease, inadequate human and financial resources to meet the care needs of people with dementia, limited policy on dementia, inadequate training for professional carers, lack of support for family carers. The paper talks about dementia pathways, which can provide a way of conceptualising the journey of dementia. It sets out the needs for services and supports at different stages in the development of dementia and provides an opportunity to develop a policy framework which provides support and action at all stages of the disease. The dementia pathways should work on family and carer support, awareness creation, diagnosis, management and care, and end of life care.

The recommendations to address the challenges of dementia in this region such as countries to develop national dementia action plans detailing key areas for action including research, awareness and education, improving quality of care, prevention and risk reduction, assessment and diagnosis also will be discussed in detail. The Kyoto Declaration provides a framework of possible strategies for countries to consider.

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Abstract No: 140

Abstract Title: Preliminary results of a clinical trial on the effect of acupressure for agitation in nursing home residents with dementia


Rick Yiu Cho Kwan*¹ , Mason Chin Pang Leung² , Claudia Kam Yuk Lai³

¹The Hong Kong Polytechnic University, Hong Kong, [email protected] , ²The Hong Kong Polytechnic University, Hong Kong, [email protected] , ³The Hong Kong Polytechnic University, Hong Kong, [email protected]

Keyword:

Dementia, acupressure, agitation, nursing home, RCT

Background:

The purpose is to examine the effect of acupressure for agitation of people with dementia (PWD) in nursing home.

Methods:

It is a randomized controlled trial conducted in 12 nursing homes in Hong Kong, and participant recruitment is ongoing with a target of recruting 99 subjects. PWD with agitation, aged over 65 and residing in nursing homes are being recruited. Participants are assigned by permuted block randomization into three groups in a 1:1:1 ratio. In the acupressure group (AG), participants receive acupressure at five acupoints. In the sham-acupressure group (SG), participants receive pressure at five non-acupoints. In the usual-care group (UG), participants receive no intervention. The outcome measure in this trial is agitation measured by the Cohen-Mansfield Agitation Inventory (CMAI) at four intervals: the week before commencement of the intervention (T0), and one week (T1), three weeks (T2), and six weeks (T3) after its completion. The General Estimated Equation (GEE) model is used to compare the effects among groups and intervals.

Results:

62 participants have completed the intervention and data collection. The interaction effect between time and group is significant (p=0.002). The CMAI difference in AG between T0 and T3 is also significant (MD=-7.321, 95%CI: -13.02, -1.62). There is no significant difference of CMAI in any of the other pair-wise comparisons.

Conclusion:

Preliminary data confirm that acupressure can significantly reduce agitation on PWD compared with sham-acupressure and usual care. However, its effect may not begin immediately or last until six weeks after completion of the intervention. More data is needed to confirm this observation.

Abstract No: 143

Abstract Title: TRANSCRANIAL MAGNETIC STIMULATION AS AN EARLY MARKER TO DIFFERENTIATE BETWEEN EARLY ALZHEIMERS DISEASE AND FRONTOTEMPORAL DEMENTIA.


S R Chandra¹, Thomas Gregor Issac*², B C Nagaraju³

¹National Institute of Mental health and Neurosciences(NIMHANS), India, [email protected] , ²National Institute of Mental health and Neurosciences(NIMHANS), India, [email protected] , ³National Institute of Mental Health and Neurosciences(NIMHANS) Bangalore, India, [email protected]

Keyword:

Transcranial magnetic stimulation(TMS), central motor conduction time(CMCT),Alzheimers dementia(AD), frontotemporal dementia(FTD), Hindi mental Status Examination(HMSE),electromyography(EMG)

Background:

Currently there is no available tool for early definite diagnosis of cortical dementias. Since motor pathways are harbored in the frontal lobe and modulatory inhibition is the function of the parietal lobe, early prolongation of Central motor conduction time(CMCT) hypothesized in FTD and impaired cortical inhibition in AD.

Inclusion criteria;1.FTD and AD Patients.2.HMSE(Indian version of MMSE) score>20 Exclusion:1.Seizure history2.Pacemakers,aneurysm clips etc.Evaluated using single pulse figure of eight coil and right first dorsal interossei muscle contraction. Motor threshold (MT) estimated on dominant motor cortex by- 10 stimuli applied and at least 5 complexes >50mcV elicited. Supramaximal stimuli applied and latency calculated(T1).Second site over C7 (T2). CMCT is



equal to T1-T2. Then Silent period assessed by the period of EMG arrest from the end of motor evoked potential while FDI is contracted.

Out of the 25 patients, 17(68%) had AD and rest had FTD and majority were males. Comparing AD and FTD groups, there was significant difference in HMSE scores with AD patients scoring less(p= 0.001),and also had lesser cortical inhibition as evidenced by lower MT(p=0.013) compared to FTD group whereas CMCT prolonged in FTD compared to AD(p= 0.048). A trend of consistently lower SP was also seen among the FTD patients. This could mean that using TMS, subtle cortical changes in early dementias can be picked, identified and therapy initiated accordingly paving a better understanding of the function of GABAnergic system as well as regarding the therapeutic role of GABA agonists.

Abstract No: 144

Abstract Title: Craft as conduit: Tangible approaches for engagement and connection


Gail Kenning*¹ , Katy Fitzerald² , Cathy Treadaway³

¹University of Technology Sydney (UTS), Australia, [email protected] , ²Alzheimer's Australia New South Wales, Australia, [email protected] , ³Cardiff Metropolitan University, United Kingdom, [email protected]

Keyword :

Ageing, dementia, craft, activity, behaviours, tangible, design

Background :

Appropriate dementia care requires innovative and effective ways of managing people with dementia to provide opportunities for meaningful engagement. Simultaneously, the relentless task of carers to minimise feelings of boredom and frustration associated with dementia, is often met with aggressive and challenging behaviour. This paper reports on a project that explores how tangible objects and activities involving touch, provide opportunities for connection, engagement and fun. Purposefully designed objects used as 'connectors' may offer avenues to address these urgent needs.

This paper reports on a study of lace makers, using qualitative research approaches to examine their engagement and connection with their craft and with each other. The findings from this study can be used to contribute to our understanding of the joy of touching, making and connecting through activity and inform subsequent work with people with dementia.

The sample group of craft practitioners was an articulate group of older women. Many had engaged in craft since early childhood, using this as a means of connecting socially; being physically and mentally challenged; providing comfort when alone and support to others. This sample group provided insights into how craft contributed to their wellbeing; gave them purpose; connection, and opportunity to 'give back' through craft.

These findings reinforce the need for all people to feel useful and connected. These feelings are alive within people with dementia. Thus findings from this study are relevant and transferrable. Building on the findings of this study, researchers are now exploring opportunities to trial connectors, with people with dementia.

Abstract No: 151

Abstract Title: Joint analysis of multiple biomarkers for Alzheimer's disease risk in North Indian population


Puneet Talwar*¹ , Suman Kushwaha² , Rachna Agarwal³ , Ritushree Kukreti⁴

¹CSIR-Institute of Genomics and Integrative Biology, India, [email protected] , ²Institute of Human Behaviour and Allied Sciences, India, [email protected] , ³Institute of Human Behaviour and Allied Sciences, India, [email protected] , ⁴CSIR-Institute of Genomics and Integrative Biology, India, [email protected] :

APOE, Single nucleotide polymorphism, gene-environment interaction Background :

Alzheimer's disease (AD) is a progressive neurodegenerative disease with multifactorial risk factors including genetic predisposition and exposure to environmental factors.

Objectives:

Here, we aim to examine the gene-environment interaction with reference to APOE ε4 polymorphism and level of serum biomarkers as predictors of AD risk.

Methods:

A case control study involving 55 cases and 55 non-demented healthy controls was performed to examine association among APOE genetic variants identified by sequencing of 5.5kb region and serum biomarkers.

Results:

APOEε4 allele frequency was significantly higher (p value=0.001,OR=4.41,95%CI=1.72-11.26) in AD as compared to controls whereas APOEε2 (p:0.001, OR=0.07, CI=0.01-0.56) was overrepresented in controls. A significant difference (p<0.05) in levels of total cholesterol, HDL, CPK, GGT, urea, T3, copper, free copper, ceruloplasmin, copper/ceruloplasmin and leptin was observed between AD patients and controls. Significant correlation of CPK and free T3 with copper/ceruloplasmin and free copper, urea with APOEε4 allele and GGT with ceruloplasmin was found. Age adjusted multivariate logistic regression analysis identified APOEε4 (OR=9.13; 95%CI= 2.34-35.71) and copper/ceruloplasmin ratio (OR=1.87; 95%CI=1.03-3.39) as optimal independent predictors of AD. The area under the ROC curve of the combined panel with age, APOE ε4 and copper/ceruloplasmin ratio for predicting AD risk was higher (AUC=0.81, p<0.0001, 95%CI=0.711-0.913), as compared to APOEε4 (AUC=0.71, 95%CI=0.58-0.83) or copper/ceruloplasmin ratio (AUC=0.72, 95%CI=0.60-0.84) alone.

Conclusion:

The findings provide evidence on the ability of a panel including age, APOEε4 status and copper/ceruloplasmin ratio to discriminates AD cases from non-demented healthy controls.

Abstract No: 154

Abstract Title: GERIATRIC MENTAL HEALTH CAMP AT SOUTHERN RAILWAY H.Q HOSPITAL, CHENNAI

Topic Name: Others

Kannamma Ramanujam*¹ , Usha Rajendrakumar² , Hemalatha Perumal³

¹Southern Railway H.Q. Hospital, Chennai, India, [email protected] , ²Southern Railway H.Q. Hospital, Chennai, India, [email protected] , ³Southern Railway H.Q. Hospital, Chennai, India, [email protected]

Keyword:

Geriatric Mental Health, Cognitive decline, Geriatric depression

Background:

Mental health week is celebrated in our hospital every year in the month of October. Last year theme for mental health being Geriatric mental health, a screening camp was planned.

This geriatric mental health screening camp was conducted for three days in view of the mental health week celebrations in our Head Quarters Hospital of Southern Railways by the Department of Psychiatry on 10, 11 and 12th of October 2013. A total of 102 patients were screened for mental health problems focusing on cognitive decline, depression and other related problems.

Tools used for patients were GP COG, GHQ 12, PHQ 9 and INFORMANT'S INTERVIEW (administered to one of the family members). A review after six months is also done during the months of May and June 2014. Results would be discussed in detail in the paper presentation. The psychosocial issues and psychological dimentions of elders in our society would be elabarated.

Abstract No: 173

Abstract Title: The Little Sun: The Pathway of Dementia Care in Rural Community after Disaster

Topic Name: Dementia friendly environmentsLing Ying Chen1 , Ying Hui Wu*² , Wei Ting Chen³ , Ya Lun Yeh⁴ ¹Yulin Long-Term Elderly Care Association, Taiwan, [email protected] , ²Taiwan Alzheimer's Disease Association, Taiwan, [email protected] , ³Yunlin Long-Term Elderly Care Association, Taiwan, [email protected] , ⁴Yunlin Long-Term Elderly Care Association, Taiwan, [email protected]

Keyword:

Resources and cooperation platform, elderly volunteers, dementia friendly care and environment

Background:

The earthquake in Sep.21, 1999 measuring 7.3 on the Richter scale shook Taiwan, caused severe damage to infrastructure in several cities and counties. Gu-ken, Yulin was one of them.

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Local resources were limited because of the agriculture-oriented environment. Most of the local youth had moved to cities for education or job. The situation became worse in a complex devastating dimension. There were soaring home-alone and demented elderly, prevailing pessimistic mood, children education and mental rehabilitation etc. involved.

Objectives :

Yunlin Long-Term Care Association was set up based on the needs of the elderly and the community.

Methods :

We will describe how a rural organization started from home care to day care to community center. By helping low-income, transiting services, building up support and self-support network, conducting vocational training, dialoging with government agencies as well as private sectors, all of mobilizing aging in place from the earthquake aftermath will be discussed.

Results :

The recovery became possible and successful through continuous modification of local needs assessment and the development of friendly community services.

Conclusion :

This article will share the followings: 1.the establishment of resources and cooperation platform 2. training and task force of the local elderly volunteers 3. the person-centered care and care services toward dementia elderly 4. the pathway and accomplishment in the past 12 years.

Abstract No: 179

Abstract Title: A Cost of care of Dementia: a study of Indian caregivers seeking healthcare for person with Dementia in a tertiary centre


Vinutha Ravishankar*¹ , Srikala Bharath² , Girish N Rao³ , Chandra S R⁴

¹National Institute of Mental Health and Neurosciences, India, [email protected] , ²National Institute of Mental Health and Neurosciences, India, [email protected] , ³National Institute of Mental Health and Neurosciences, India, [email protected] , ⁴National Institute of Mental Health and Neurosciences, India, [email protected]

Keyword :

Dementia; cost of illness; India

Background :

With a projected increase in the number of elderly with dementia and amidst a diminutive health services, the need to undertake an economic analyses of the services for PwD is urgent and imperative.

Objective:

To assess the informal cost of care to the families taking care of People with Dementia in an urban set up in India

Method:

Cost of illness in 113 People with Dementia and their primary caregiver was assessed over the retrospective 3 month period and extrapolated annually using structured scale modified for the Indian setting.

Results:

The median annual informal care cost per PwD was 45,000INR. 99.1% of the financial assistance for the treatment of dementia was contributed by the family members. The total mean duration of time spent for assisting ADL of PwD was 4.9±2.7 hours/day of which 1.3±0.9, 1.54±1.2, and 2.0±1.7 hours/day was spent on IADL, BADL and hours of supervision respectively.

Conclusion:

Dementia has economic burden that is substantial and major brunt of the burden is borne by the family at the household level.

Abstract No: 180

Abstract Title: Comparative Study Of Behavioral And Psychological Symptoms In Patients With Dementia Of Alzheimer Type And Vascular Dementia.

Topic Name: DiagnosisSarah Javed*¹ , Rakesh Kumar Gaur² , Piyush Prakash Singh³ , Azfer Ibrahim⁴ , Manawar Ahmad⁵ ¹Jawaharlal Nehru Medical College, Aligarh Muslim University Aligarh, India, [email protected] , ²Jawaharlal Nehru Medical College, Aligarh Muslim University Aligarh, India, [email protected] , ³Jawaharlal Nehru Medical College, Aligarh Muslim University Aligarh, India, [email protected] , ⁴Jawaharlal Nehru Medical College, Aligarh Muslim University Aligarh, India, [email protected] , ⁵Jawaharlal Nehru Medical College, Aligarh Muslim University, India, [email protected]

Keyword :

Dementia of Alzheimer's type (DAT), Vascular Dementia (VD), Behavioural and Psychological Symptoms of Dementia (BPSD).

Background :

Behavioural and Psychological Symptoms of Dementia (BPSD) are an important aspect of dementing illness but the studies on BPSD between common type of dementia, dementia of alzhiemer type and vascular dementia had shown inconsistent result.

This study aimed (i). to compare the behavioural and psychological symptoms of dementia between patients with Alzheimer disease and Vascular dementia. (ii).to investigate the correlates of BPSD between them. (iii). to suggests potential difference in strategies to manage the BPSD symptoms of these illnesses.

We recruited patients with Dementia of Alzheimer's type (DAT) and Vascular Dementia (VD) from Psycho- Geriatric Clinic, Department of Psychiatry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh India who attended this clinic between March 2012 to April 2014. The Behavioral Pathology In Alzheimer's Disease (BEHAVE-AD) scale was used to measure the BPSD severity. Clinical Dementia Rating (CDR) and Hindi version of Mini Mental Status Examination (MMSE) were used to determine the severity of dementia. SPSS version 17 was used for statistical analysis.

64 patients with dementia, 43 Dementia of Alzheimer type and 21 Vascular Dementia attended psycho geriatric clinic during this period. 81.39% patients of DAT and 80.95% patients of VD had behavioural and psychological symptoms. There was no significant difference in the scores of BEHAVE-AD, CDR and MMSE between the two group. No significant correlation was found between various variables and BEHAVE-AD except with severity of dementia. BPSD were almost equally common in patients with DAT and VD and correlates significantly with severity of dementia.

Abstract No: 185

Abstract Title: Contribution of Stress in persons with Mild Cognitive Impairment and Dementia


Shalini Manoj*¹ , Krishna Dalal² , Manjari Tripathi³ , Ashima Nehra⁴ , Rajesh Sagar⁵

¹All India Institute of Medical Sciences, India, [email protected] , ²All India Institute of Medical Sciences, India, [email protected] , ³All India Institute of Medical Sciences, India, [email protected] , ⁴All India Institute of Medical Sciences, India, [email protected] , ⁵All India Institute of Medical Sciences, India, [email protected]

Keyword:

Stress, Mild Cognitive Impairment, Dementia, Presumptive Stressful Life Event Scale, Instrumental Activities of Daily Living Background :

Objective was to understand correlation between stress and cognitive impairment in persons suffering from (i) mild cognitive impairment and (ii) mild to moderate Alzheimer's disease (AD) (active group) as compared with age and gender matched controls (reference group).

Methods:

A total of 14 subjects were enrolled in active group (age group 55-75; M:F=11:3) post screening for mild cognitive impairment using Peterson criteria among population visiting Neurology OPD in All India Institute of Medical Sciences. Selection criteria for active group were cognitively impaired subjects having cause of impairment due to AD. Reference group consisted of 5 subjects without reported neurological disorder. Socio-demographic variables were collected using personal data sheet. Severity of cognitive impairment was assessed using cognitive dementia rating scale with a scale rating of 1, 2 and 3 categorised respectively into mild, moderate and severe cases. Stress was assessed using (i) Presumptive



Stressful Life Event Scale (PSLES) with a score of more than 300 taken as severe one, and (ii) Instrumental Activities of Daily Living Scale (IADL) represented percentage impairment in daily activities.

Results:

Mean±S.D. scores of PSLES were found to be 608±292 and 225±90 for active and reference groups respectively reflecting statistically severe stress among cognitively impaired persons (p=value=0.002). Median (range) IADL scores were observed to be 73.6(0-100) and 5(0-10) respectively for active and reference groups highlighting statistically severe impairment in activities of daily living in cognitively impaired persons (p-value=0.004).

Conclusions:

The study explicitly reveals the plausible role of stress as a major accelerating factor of cognitive impairment.

Abstract No: 190

Abstract Title: Dementia in Developing Countries: Does Education play the same role in India as in the West.

Topic Name: Others

Suvarna Alladi*¹, Gowri K Iyer², Thomas H Bak³, Shailaja Mekala⁴, Annapurna Mamidipudi⁵, Amulya Rajan⁶, Divya Raj⁷, Jaydip Roy Chaudhuri⁸

¹Department of Neurology, Nizam's Institute of Medical Sciences, India, [email protected] , ²Department of Neurology, Nizam's Institute of Medical Sciences, India, [email protected] , ³Department of Psychology, Center for Cognitive Aging & Cognitive Epidemiology, Center for Clinical Brain Sciences, University of Edinburgh, United Kingdom, [email protected] , ⁴Department of Neurology, Nizam's Institute of Medical Sciences, India, [email protected] , ⁵Department of Science,Technology &Society Studies, Maastricht University, Netherlands, [email protected] , ⁶Department of Neurology, Nizam's Institute of Medical Sciences, India, [email protected] , ⁷Department of Neurology, Nizam's Institute of Medical Sciences, India, [email protected] , 8Department of Neurology, Yashoda Hospitals, India, [email protected]

Keyword:

Education, Dementia , Stroke, Bilingualism, Rural dwelling

Background:

Evidence suggests that education protects from dementia by enhancing cognitive reserve. However, this may be influenced by several socio-demographic factors. Rising numbers of dementia in India, high levels of illiteracy and heterogeneity in socio-demographic factors provide an opportunity to explore this relationship.

To study the association between education and age at dementia onset, in relation to socio-demographic factors. Association between age at dementia onset and literacy was studied in relationship with other potential confounding factors, in a memory clinic in Hyderabad, India. Case records of 648 dementia patients diagnosed in a specialist clinic were reviewed. All patients were prospectively enrolled as part of an ongoing longitudinal project that aims to evaluate dementia subjects with detailed clinical, etiological, imaging, and follow-up studies. Patients were referred to the memory clinic by general practitioners and neurologists, and the patient profile typically represented a pattern of disease seen at a tertiary, referral neurology service in an urban city of India.

Of 648 patients, 98(15.1%) were illiterate. More than half of the illiterates were engaged in crafts unlike literates, who were in trade, or clerks. Mean age of onset in illiterates was 60.1years and in literates 64.5 years(p=0.0002). Factors independently associated with age at dementia onset were bilingualism, rural dwelling and stroke, but not education.

Our study demonstrates that in India, rural dwelling, bilingualism, stroke and occupation modify the relationship between education and dementia.

Abstract No: 191

Abstract Title: National Dementia Helpline Services in Taiwan

Topic Name: Others

Yunching Chen*¹, Liyu Tang²

¹Taiwan Alzheimer's Disease Association, Taiwan, [email protected], ²Taiwan Alzheimer's Disease Association, Taiwan, [email protected]

Keyword:

Dementia, Caregiver, Helpline

Background:

Taiwan Alzheimer Disease Association has set upnational dementia helpline service since 2003 and has received over 20,000 calls. We analyzed the calls from 2009 to 2013 and found that 78% of calls were made by family caregivers. The top three frequent asked questions received were : (1) management of behavioural problems (2) activity arrangement and (3) social resources. We found that consultation service, continuous support services and accessible services for people with dementia are very important for the families taking care of people with dementia.

Based on the experience of helpline service, TADA set up a dementia social support website. There are information of dementia, dementia care, caregiver coping and social resources on the website. We found family caregivers are afraid of using services and they have difficulty to make the visit. TADA tried to organize site visits for family caregivers and had visited more than fifty care centers in Taiwan. We set up online consultation service also.

Because the need of telephone consultation is growing, Taipei City Government provided funds for twenty four hours helpline servicesfor Taipei citizens since September 2013. We have just applied for the fund for twenty four hours national helpline serviceand hope to win the bid.

Abstract No: 194

Abstract Title: Vascular dementia mimic lewy body dementia ; A case report

Topic Name: Others

Gautam Anand*¹

¹Ruxmani Ben Deepchand Gardi Medical College , Ujjain , Mp , India, [email protected]

Keyword:

MMSE- Mini Mental Status Examination MSE-Mental Status Examination CDR-Clinical Dementia Rating Scale

Background:

A patient 80years old came to psychiatric OPD at RDGMC for his complaints of muttering, irrelevant and abusive behaviour, forgetfulness, involuntary micturition,from last one year. He had CVA 5 years ago. Patient does not have significant family history of psychiatric illness.He used to smoke bidi,a bundle in a day. The physical examination reveals significant gait deformities,of stoop and flexor gait and resting tremors in hands,rigidity and bradykinesia was present during examination.

MSE showed conscious and alert ,speech was slurred and disarticulated, thought process is seemed to retarded ,memory immediate and recent were impaired,remote was found transitional and patchy loss,thinking illogical and has abstractly.MMSE score was 14/30 and CDR 2/3.Laboratory investigation;Hb-11.4%,TLC-6800/cumm,NP-69%,L-27%,E-1%,M-35%ESR-10 mm,RBS-66 mg/dl,creatinine-0.7mg/dl,TBIL-1.2 mg/dl,BU-1.0mg/dl,AST-31 IU/L,ALT -19 IU/L,ALP-96 IU/L. MRI STUDY showed –Bilateral multiple basal ganglia infarct with periventricular ischemia and generalize diffuse cortical atrophy with ventricular dilatation.Diagnostic Formulations ;The patients has memory loss upto moderate level 2/3 on CDR(Clinical Dementia Rating) scale and MMSE score 14/30 “(moderate ) impairment of cognitive function, presented with features of Parkinsonism seen as radykinesia,tremor and slow step and stoppage gait,radiological features show bilateral multiple infarct ,cortical atrophic changes are suggestive of Parkinson's disease dementia and predisposing vascular episodes favors the progression of Alzheimer's disease with vascular dementia with Parkinsonism.

Abstract No: 196

Abstract Title: Dementia Care in Bangladesh - an Exercise in a Virgin Territory

Topic Name: Dementia friendly environments

Jiban Kanai Das*¹

¹Sir William Beveridge Foundation, Bangladesh, [email protected]

Keyword:

Seeking Dementia Friendly Environment



Background:

Bangladesh is a small, developing country with a population of 160 millions. Between the years 2000 and 2005, life expectancy was only 60.7 years and evidently there was no need to look at dementia seriously. To-day, we have nearly 12 million people over 60 years – with life expectancy nearing 69. Can we afford to remain blissfully ignorant about dementia anymore? It is potentially a dreadful scenario in the Year 2050.

The emerging socio-economic condition is breaking the traditional joint family living into small ones. There is a continuous flight of young and mid-level family members from the villages to the cities and from Bangladesh to outside world in search of better opportunities. The elders are left mostly to themselves to take care of. It is in this backdrop that Sir William Beveridge Foundation from the UK pressed into service a home care model for the elderly in Dhaka city in 2008. That indeed was the eye-opener.

Armed with information and support from Alzheimer's Australia (WA) Ltd, we began to assess the situation. We find that old people are going missing, meeting accidents, families are repenting that they misbehaved with someone unknowingly when s/he was actually suffering from dementia.

We launched a nation-wide awareness campaign, formed Dementia Action Alliance with sister organisations, sensitising the government, media and the society on this unfolding health challenges, fielding trained volunteers and streamlining the care service – all to ensure better quality of life of nearly 300.000 dementia affected persons.

Abstract No: 197

Abstract Title: A STUDY OF NON PSYCHIATRIC COMORBIDITIES IN PATIENTS WITH ALZHEIMERS DISEASE

Topic Name: Others

Umamaheswari Vanamoorthy*¹ , Rakesh Balachander²

¹National Institute of Mental Health and Neuroscience, India, [email protected], ²National Institute of Mental Health and Neuroscience, India, [email protected]

Keyword:

Alzheimers Dementia, Non psychiatric comorbidities

Background:

To study the Frequency of non psychiatric comorbidites in patients with alzheimers disease

Methodology:

A retrospective file review of patients who were evaluated in detail in Geriatric clinic, NIMHANS between Jan 2002 to May 30th 2013 with the ICD 10 diagnosis of Alzheimers disease was done. The study sample included 209 patients with Alzheimers Dementia and presence non-psychiatric comorbidities such as hypertension, diabetes mellitus, coronary artery disease, cerebro-vascular accident, thyroid disturbances, anaemia, vitamin b12 deficiency, seizure disorder. Appropriate analysis was used to arrive at meaningful conclusions.

Results:

Out of the 209 patients of Alzheimers dementia, almost 107 (51.9%) had comorbid physical illness. Among the 107 patients with comorbid physical illness 53 (49.53%) of them were hypertensive, 24 (22.42%) of them diabetic, 13 (12.14%) of them had vitamin b12 deficiency, 8 (7.47%) patients had thyroid disturbances, 4 (3.73%) patients had comorbid seizure disorder, and 2 (1.86%) of them had coronary heart disease and stroke.

Conclusion:

Physical comorbidities make important contributions to cognitive and functional decline in Alzheimers disease and they also provide important clues to the underlying pathological mechanism of this important condition.

Abstract No: 199

Abstract Title: Quality of life and care burden of caregivers with Dementia


Bhupendra Singh*¹ , Satabdi Chakraborty² , Hitesh Khurana³ , Rajeev Gupta⁴

¹Post Graduate Institute of Medical Sciences, India, [email protected] , ²Post Graduate Institute of Medical Sciences, India, [email protected] , ³Post Graduate Institute of Medical Sciences, India, [email protected]

⁴Post Graduate Institute of Medical Sciences, India, [email protected]

Keyword :

Quality of life, Care Burden, Dementia

Background :

Quality of Life (QoL) is a multi-dimensional concept that includes domains related to physical, mental, emotional, and social functioning. It goes beyond direct measures of population health, life expectancy, and causes of death, and focuses on the impact health status has on quality of life.

Family caregivers play a major role in providing care giving assistance to persons suffering from dementia. The process of care giving can be stressful for those involved in the care giving process of dementia patients, which has been referred to as burden of care in many studies. Chronic diseases like dementia and depressive disorder even in milder form put a considerable burden on family caregivers who take the sole responsibility of caring giving in community.

Aim:

To assess the quality of life and care burden of caregivers of persons living with dementia and depressive disorder.

To find out the differences of quality of life and burden of care between caregivers of patients dementia and depressive disorder

Material and method:

On the basis of purposive sampling technique 60 persons aged between 60-80 years age (30 Dementia and 30 Depressive disorders) and their caregivers were selected for the study. Informed consent was sought socio demographic information was collected for patients as well as their care givers, and Quality of life scale and Burden assessment schedule was administered on the caregivers.

Result:

Result would be discussed at the time of presentation.

Abstract No: 201

Abstract Title: Profile of Dementia Patients and Dementia research in Pakistan

Topic Name: Others

Quratulain Khan*¹ , Quratulain Khan²

¹Aga Khan University, Pakistan, [email protected] , ²Aga Khan University, Pakistan, [email protected]

Keyword :

Dementia, Pakistan, registry, demographics, alzheimerâ€™s, developing, midle income

Background :

62% of the world's dementia population resides in developing countries and may contribute significantly to current knowledge. Pakistan with its rapidly increasing population provides a rich ground for research.

We aim to study demographics of dementia population in Karachi, Pakistan, and to review current status of dementia research in the country.

I started a dementia registry at Aga Khan University from Oct 1st, 2013 which is ongoing. Details including demographics and clinical features have been collected. Dementia was diagnosed according to DSM-IV criteria.

I also reviewed current status of dementia research in Pakistan by reviewing literature on pubmed using “dementia”, “Pakistan”, “developing”, “low and middle income countries”, 10/66”.

We have 40 patients in the registry so far. Average age is 66 years, 63 % of the patients are males, 24 % have no formal education, 13 % have up to 8 years and 26 % have 10-12 years of education. Mean MMSE and average duration of symptoms at presentation was 13 and 7.6 years respectively and positive family history and Parkinsonism was present in 31 %. 63% had probable Alzheimer's dementia.

Literature search did not reveal any clinical or population based studies in Pakistan. Some work has been done in the fields of genetics and molecular sciences mostly in collaboration with other countries.

Currently limited knowledge about demographics of dementia population in Pakistan from this first registry may be expanded, more registries need to be established in across the country and population based studies should be started.



Abstract No: 205

Abstract Title: Caregiver distress associated with Behavioral and Psychological Symptoms of Dementia (BPSD) in Indian elderly


Priyanka Goyal*¹ , Om Prakash² , Suman Kushwaha³ , Praveen Tripathi⁴

¹Institute of Human Behaviour & allied Sciences (IHBAS), New Delhi, India, [email protected] , ²Institute of Human Behaviour & allied Sciences (IHBAS), New Delhi, India, [email protected] , ³Institute of Human Behaviour & allied Sciences (IHBAS), New Delhi, India, [email protected] , ⁴Institute of Human Behaviour & allied Sciences (IHBAS), New Delhi, India, [email protected]

Keyword:

Caregiver distress; Behavioral and Psychological Symptoms of Dementia (BPSD); Indian elderly

Background:

BPSD are noncognitive features of dementia which are considered an important aspect in care of dementia patients. Despite growing recognition about BPSD as source of caregiver distress there is dearth of indian studies evaluating the same.

Objective:

The purpose of this study was to investigate caregiver distress associated with Behavioral and Psychological Symptoms of Dementia (BPSD) in Indian elderly.

Methods:

The study had a cross-sectional design. Fifty caregivers of patients with dementia who visited the Psychiatry and Neurobehaviour clinic of a tertiary care hospital were recruited. BPSD were assessed using the neuropsychiatric inventory (NPI); caregiver distress was evaluated using the NPI caregiver distress scale (NPI-D).

Results:

The study results revealed that BPSD played a significant role on caregiver distress. The results showed a statistically significant positive correlation between the total NPI-D score and the total NPI score which illustrated a strong correlation between the severity of BPSD and caregiver distress. Agitation was found to be the most distressing symptom for the caregiver followed by aberrant motor activity, delusion and irritability.

Conclusion:

The study findings suggest that improvement of treatments for agitation, delusion, irritability and aberrant motor activity among dementia patients may reduce caregiver distress.

Abstract No: 208

Abstract Title: Validation process of a comprehensive neuropsychological test battery for Vascular Cognitive Impairment for use across India.

Topic Name: Standardised protocols for cognition in India

Gowri K Iyer*¹ , Suvarna Alladi² , Aparna Dutt³ , Ratnavalli Ellajosyula⁴ , Amitabha Ghosh⁵ , Subhash Kaul⁶ , Mathuranath P S⁷ , Robert Mathew⁸ , Ramshekar Menon⁹ , Manjari Tripathi¹⁰ , Jwala Narayanan¹¹ , Ashima Nehra¹² , Apoorva Pauranik¹³ , Urvashi Shah¹⁴ , Meenkashi Sharma¹⁵

¹Department of Neurology, Nizam's Institute of Medical Sciences, India, [email protected] , ²Department of Neurology, Nizam's Institute of Medical Sciences, India, [email protected] , ³Apollo Gleneagles Hospital, Kolkatta, India, [email protected] , ⁴Manipal Hospital, Bangalore, India, [email protected] , ⁵Apollo Gleneagles, Kolkatta, India, [email protected] , ⁶Department of Neurology, Nizam's Institute of Medical Sciences, India, [email protected] , ⁷NIMHANS, Bangalore, India, [email protected] , ⁸Government Medical Collge, Aleppey, India, [email protected] , ⁹SCTIMST, Trivandrum, India, [email protected] , ¹⁰AIIMS, Delhi, India, [email protected] , ¹¹Manipal Hospital, Bangalore, India, [email protected] , ¹²AIIMS, Delhi, India, [email protected] , ¹³MY Hospital, Indore, India, [email protected] , ¹⁴KEM Hospital, Mumbai, India, [email protected] , ¹⁵ICMR, Delhi, India, [email protected]

Keyword:

Indian VCI battery, Validation protocol, neuropsychological testing, post-stroke cognitive testing

Background:

Given the burden of stroke, the proportion of patients with Vascular Cognitive Impairment (VCI) in India has increased exponentially. Harmonisation of their diagnoses across India is challenging due to heterogeneity of languages, cultures and literacy levels. The Indian Council of Medical Research has therefore commissioned research for this purpose, i.e., to develop and validate cognitive testing tools for VCI to be used uniformly in India. Globally and in India there have no studies that have validated a comprehensive test battery across multiple languages.

To validate a comprehensive neuropsychological Indian test battery for VCI across different literacy levels and languages.

A multicentric group of neurologists and neuropsychologists collaborated to develop a common methodology to study cognition in stroke in five languages: Hindi, Bengali, Telugu, Kannada and Malayalam. Tests were derived and adapted from the VCI harmonisation criteria laid down by NINDS-AIREN and Canadian Stroke Network consortium. 1200 normal controls and 750 patients are part of the study.

Our initial investigations reveal the heterogeneity, diversity and challenges faced when examining cognition in our study cohort. Levels of test equivalence for different cognitive domains, literacies, cultures and languages were examined.Stringent processes were implemented to ensure that the final test battery is reliable and valid. Statistical methods for establishing test invariance across languages will also be established.

A key outcome of this study was to validate a pan-Indian a comprehensive neuropsychological test battery for testing VCI across India with the aim of generalizing it to other types of dementias.

Abstract No: 209

Abstract Title: PSYCHOLOGICAL WELL-BEING AND ADJUSTMENT OF CAREGIVERS OF PERSONS WITH DEMENTIA: A COMPARATIVE STUDY


Poonam Gupta*¹, Hitesh Khurana² , Manju Rana³

¹Deptt. of Psychiatry, PGIMS, Rohtak, India, [email protected] , ²Deptt. of Psychiatry, PGIMS, Rohtak, India, [email protected], ³Deptt. of Psychiatry, PGIMS, Rohtak, India, [email protected]

Keyword:

Dementia, Well-being, Caregivers

Background:

Care giving involves a significant expenditure of time, energy, and money for long periods. It involves tasks that may be unpleasant and stressful. Dementia caregivers often feel need of assistance .They need to cut down time from their recreational and personal activities to take care of dementia patients. So, care of persons with dementia is a great challenge for the caregivers because they face a lot of critical adjustment problems. Hence we planned to explore well being and global adjustment of care givers of the patients with Dementia.

Objectives:

To study and compare the Psychological Well Being and the Global Adjustment of Caregivers of Persons with Dementia and Normal Old Persons.

Methods:

Thirty caregivers of persons with ICD-10 dementia (Aged � 65) and 30 caregivers of normal old age persons (Aged � 65) were selected after voluntary informed consent. Severity of dementia patients were assessed by the Clinical Dementia Rating Scale. General Health Questionnaire was administered to screen out the psychiatric morbidity of caregivers of both groups. Psychological General Well- Being Schedule was used to assess the subjective well being of care givers. Global Adjustment Scale was used to assess the adjustment. The data were analyzed by using students two tailed t test and Pearson's Correlation test.

Results:

Result are indicative if need of improving well being of care givers of dementia patients.

Conclusion:

The meaning of care giving is more important to caregiver well-being than the amount of care provided.



Abstract No: 211

Abstract Title: COMPARATIVE STUDY OF BURDEN OF CARE ON FAMILY MEMBERS OF PATIENT WITH DEMENTIA AND SCHIZOPHRENIA


Azfer Ibrahim*¹ , Karrar Husain²

¹Jawahar Lal Nehru Medical College, India, [email protected] , ²Jawahar Lal Nehru Medical College, India, [email protected]

Keyword :

Family caregiver, Dementia, Schizophrenia

Background :

Dementias are common degenerative disorders in the elderly. Most patients are cared for at home by family members, usually elderly spouses. The effects of being a family caregiver, though sometimes positive, are generally negative, with high rates of burden and psychological morbidity as well as social isolation, physical ill-health, and financial hardship.

Objective:

This study aimed to assess the burden of care on the family members of the patients suffering from dementia and compare it with schizophrenia.

Methods:

30 patients and their primary caregivers were selected in both groups for this study, from psychiatry OPD of Jawahar Lal Nehru medical college, Aligarh. A semistructured performa was used for obtaining the sociodemographic profile. DSMIV TR was used for the clinical diagnosis of dementia. Patients were screened using HMSE and BPRS scales .Caregivers' burden was assessed using Pai & Kapur's Family burden interview schedule, which is a validated & widely used instrument. SPSS version 20 was used for statistical analysis.

Results:

Overall disruption of routine family activities , disruption of family interaction and financial burden were significantly higher in caregivers of schizophrenia patients compared to caregivers of dementia patients. There was no significant difference in disruption of family leisure, effect on physical health of others and effect on mental health of others between both the groups.

Conclusion:

Dementia is associated with high degree of burden on family caregivers, often comparable to schizophrenia.

Abstract No: 221

Abstract Title: A Comparative Investigation into Verb Naming Impairment in Telugu-English speaking Bilinguals with Progressive Nonfluent Aphasia vs.Semantic Dementia

Topic Name: Others

Sonal Vijay Chitnis*¹ , Sudheer R Bhan² , Suvarna Alladi³ , Vani Rupela⁴ , JaydipRay Chaudhury⁵

¹Bharati Vidyapeeth University School of Audiology & Speech language Pathology,Pune India, India, [email protected] , ²Hyderabad Central University, Hyderabad India, India, [email protected] , ³Nizam's Institute of Medical Sciences, Hyderabad India, India, [email protected] , ⁴Nizam'a Institute of Medical Sciences, Hyderabad India, India, [email protected] , ⁵Yashoda Hospitals, Hyderabad India, India, [email protected]

Keyword:

verb naming, Primary Progressive Aphasias, bilingualism

Background:

Verbs play an important role in communicating effectively in both expressive and receptive language. Many studies reveal impaired verbal semantics in cognitive communication disorders following neurodegenerative disorders. The present study aimed to investigate verb naming in bilingual Telugu-English speaking persons with primary progressive aphasia (PPA) and an age-education matched control group. Patterns of naming errors were examined in relation to transitive vs. intransitive verbs across the groups in an exploratory fashion.

Method(s):

The cross sectional study included total 14 participants in three groups, persons with Progressive Non Fluent Aphasia (PNFA) (4), persons with Semantic Dementia (SD) (3) and cognitively healthy normal individuals(7) who were matched in terms of age, gender, education and bilingual exposure and tested in detail for inclusion criteria of the study. Verb test battery including 21 motion verbs was developed and participants were asked to describe pictures in Telugu (first language: L1) and English (second language: L2).

Results:

A significant difference was (P<.001) observed in comparison of verb naming in persons with PPA and control group. Among persons with PPA, SD had significant impairment in verb naming task over persons with PNFA. There was no statistically significant difference observed in naming transitive vs intransitive verb in all three groups. Person with PNFA exhibited more phonological errors such as groping and phonemic paraphasias whereas persons with SD exhibited semantic jargon, semantic paraphasias. Regression in L2 was observed more in persons with SD than PNFA.

Conclusion:

The study demonstrates significant findings regarding verb naming and bilingualism in persons with PPA.

Abstract No: 222

Abstract Title: INSOMNIA: A DIAGNOSTIC CRITERIA FOR ALZHEIMER DISEASE


Vivek Kumar Sharma*¹ , Vinay Thakur² , Rajender Guleria³ , Ranjit Singh⁴

¹govt college of Pharmacy rohru distt shimla himachal pradesh, India, [email protected] , ²govt college of Pharmacy rohru distt shimla himachal pradesh, India, [email protected] , ³govt college of Pharmacy rohru distt shimla himachal pradesh, India, [email protected] , ⁴govt college of Pharmacy rohru distt shimla himachal pradesh, India, [email protected]

Keyword:

BDNF,CREB, dementia, sleep

Background:

Sleep has been proposed to be having a rejunuvative, supportive role and to clear the brain free of the day's debris.People who suffer from chronic sllep deprivation(insmonia) are about 11 times more likely to develop Alzheimer's disease (AD), a most common yet untretable neurodegenerative disorder. Dementia is the most common feature and complication of AD. Nearly 36 million people worldwide are living with dementia & this number is expected to be more than triple by 2050. India is one of the countries with the largest number of people with dementia (3.7million). People with AD and dementia often have poor biological rhythms. Sleep deprivation is the common neuro-behavioral feature of Alzheimer's disease, may be attributed to consistent decrease of pineal function with age, change in light input pathway (reduction in photoreception due to pupillary miosis and impaired crystalline lens light transmission) and impaired pineal innervation/interconnection between the Suprachiasmatic nucleus and the pineal gland.Sleep–wake cycle directly influences levels of Aβ, tau (most common characteristic features of AD). With advancing age there is also reduction in adenosine receptor (a neuromodulator and regulator of sleep).Beside this sleep deprivation lead to decrease in antioxidant defence, increase in excitotoxic neurotransmission, increased microglial activation reslting in inflammatory neurotoxic response. Chronic insomnia leads to change in expression of neurotrophic factors like BDNF and CREB leading to nourishment of environmemnt making one susceptible for AD.Thus changes in sleep cycle should be considered as a prime daignostic feature for AD and dementia.

Abstract No: 230

Abstract Title: Impact of Group Intervention with Primary Caregivers on Neuropsychiatric Symptoms of Persons with Dementia and Caregiver Distress


Subhash Das*¹, Manoj Kumar Bajaj²

¹Department of Psychiatry, Government Medical College & Hospital, Chandigarh, India, [email protected] , ²Department of Psychiatry, Government Medical College & Hospital, Chandigarh, India, [email protected]



Keyword :

dementia; caregiver distress; group intervention.

Background :

It has been extensively investigated and found that intervention with the caregivers has a positive impact in the form of reduced care giving distress which further results into reduction in the neuropsychiatric symptoms in person with dementia. Aims and objectives of this study is see the impact of group intervention with primary caregivers on neuropsychiatric symptoms of persons with dementia and also on caregiver distress. To achieve the aim of the study, sample of fifteen persons with Dementia (as per ICD-10 diagnostic criteria) and fifteen of their primary caregivers were recruited to the group intervention program . After the required assessments they were administered the neuropsychiatric inventory scale (NPI) in which their neuropsychiatric symptoms frequency, severity and caregivers distress was assessed. After that caregivers were provided four once weekly sessions in group format in which each session lasted for one to one and half hours. Each session dealt with the different area of functioning and management techniques. After one month persons with dementia and their caregivers were again assessed on the NPI. Results were analysed with the help of pertinent statistical techniques to see the impact of intervention on the neuropsychiatric status of the persons with dementia and caregivers distress. This study is currently under process therefore results and conclusion will be presented in the conference.

Abstract No: 232

Abstract Title: Antisense-mediated exon skipping as a potential therapy for tauopathies

Topic Name: Pharmacotherapy of dementia

Reeteka Sud*¹ , Evan Geller² , Gerard Schellenberg³

¹University of Pennsylvania, United States, [email protected] , ²Yale University, United States, [email protected] , ³University of Pennsylvania, United States, [email protected]

Keyword :

tau protein, aggregation, proof-of-concept, therapy

Background :

Direct correlation between the density of tau protein aggregates (tangles) and the extent of cognitive decline in patients qualifies this microtubule-associated protein as an attractive target. We propose that reducing total tau production would diminish free tau available for aggregation and potentially inhibit tangle formation. To this end, we investigated whether interference with splicing of tau-encoding gene, MAPT, could decrease tau levels.

We tested 31 morpholinos, complementary to the sense strand of MAPT gene to identify oligonucleotides that can downregulate MAPT expression and reduce the amount of tau protein produced. Oligonucleotides were tested in human neuroblastoma cell lines. In vitro findings were confirmed in mice transgenic for entire MAPT gene that expresses human tau protein.

We identified several morpholino oligos that reduced MAPT mRNA expression upto 50% and tau protein upto 80%. The two most potent oligos spanned the 3'-boundaries of exons 1 & 5, masking their 5'-splice sites. Both oligos skipped the targeted exons.

These studies demonstrate the feasibility of altering tau expression using modified oligos. The next steps in this study will be to further characterise these antisense oligos as a therapy for dementias where tau aggregates are a common pathology.

Abstract No: 233

Abstract Title: Genetic Deletion of PGI2 IP Receptor Exacerbates Global Cerebral Ischemia in Young and Aged Mice

Topic Name: Pharmacotherapy of dementia

Sofiyan Saleem*¹

¹SBMRI, United States, [email protected]

Keyword :

global cerebral ischemia, aging, cognitive deficit, Prostaglandin I2, mouse

Background and Objectives :

Transient global cerebral ischemia causes delayed neuronal death in the hippocampal CA1 region. It also induces an up

regulation of cyclooxygenase 2 (COX-2), which generates several metabolites of arachidonic acid, known as prostanoids, including Prostaglandin I2 (PGI2). The present study investigated whether the PGI2 IP receptor plays an important role in brain injury after global cerebral ischemia in aged mice.

Methods:

Adult young and aged male C57Bl/6 wild-type (WT) or IP receptor knockout (IP KO) mice underwent a 12 min bilateral common carotid artery occlusion (BCCAo) or a sham surgery. Behavior tests (neurologic deficit and T-maze) were performed 3 and 7 days after BCCAo. After seven days of reperfusion, the numbers of cells positive for markers of neurons, astrocytes, microglia, myeloperoxidase (MPO) and phosphorylated CREB (p-CREB) were evaluated immunohistochemically.

Results:

Interestingly, in young and aged IP KO ischemic mice, there was a significant increase (p < 0.01) in cognitive deficit, hippocampal CA1 pyramidal neuron death, microglia and MPO activation, while p-CREB was reduced as compared to their corresponding WT controls.

Conclusion:

These data suggest that following ischemia, IP receptor deletion contributes to memory and cognitive deficits regulated by the CREB pathway and that treatment with IP receptor agonists could be a useful target to prevent harmful consequences.

Abstract No: 234

Abstract Title: High frequency repetitive transcranial magnetic stimulation is effective on the cognitive behavior and hippocampal synaptic plasticity of old mice


Yuan Geng*¹ , Mingwei Wang²

¹Department of Neurology, the First Hospital of Hebei Medical University Brain aging and cognitive neuroscience key laboratory of Hebei, China, [email protected] , ²Department of Neurology, the First Hospital of Hebei Medical University Brain aging and cognitive neuroscience key laboratory of Hebei, China, [email protected]

Keyword:

High frequency repetitive transcranial magnetic stimulation; aged; cognitive behavior; synaptic plasticity

Background:

Aging is a well-known risk factor of dementia. Early prevention is particularly important to the cognitive impairment. To observe the effect of high frequency rTMS on the cognitive behavior and hippocampal synaptic plasticity of aged mice,45 Kunming mice (15-month-old) were randomly divided into sham, subthreshold and upthreshold groups. Two sessions of 25Hz rTMS comprising of 1000 pulses in 10 trains were delivered every day for 14 days. Spontaneous motor activity, step-down test and Morris water maze (MWM) were conducted following the rTMS. The synaptic structures of hippocampal CA1 region were observed by TEM.

Compared with sham group, spontaneous motor activity were no significant difference between each test group (p >0.05); In step-down test, the latency of reaction increased and the number of errors decreased in both test groups (p<0.05); In hidden platform trials of MWM, the mean escape latency were significantly shorter in subthreshold group, however, in spatial probe test, the time spend in and the number of crossing original platform were significantly increased in upthreshold group (p<0.05). Shown by TEM, the thickness of postsynaptic density (PSD) was increased, the synaptic cleft width and the synaptic curvature were decreased, the ratio of perforated synapse was increased (p<0.05).

25Hz high frequency rTMS has no significant effect on the emotion of aged Kunming mice. Up- and sub-threshold intensity of rTMS both could improve the passive avoidance behavior, and influence the hippocampal synaptic morphology; Subthreshold rTMS improve the spatial learning capacity, while upthreshold rTMS improve the spatial memory.

Abstract No: 237

Abstract Title: Dementia Friendly Communities India (DFCI)-the road ahead


Sudhir Kumar CT*¹ , Babu Varghese² , K Jacob Roy³

¹Research and Development Centre, ARDSI, Cochin and Development , India, , ²[email protected]



Centre, ARDSI, Cochin, India, , ³Alzheimer's Disease International, United Kingdom, [email protected] [email protected]

Keyword :

Dementia, Friendly, Communities, Environments, India

Background :

Dementia Friendly Communities is an emerging concept which has gained much popularity in several developed countries. Though the concept has taken slightly different forms depending on the location, the essence of the programme lies in creating physical and social environments conducive to enable people with dementia lead a community life with maximum quality of life. Before proposing an Indian model for Dementia Friendly Communities, we closely looked at some of the ongoing international efforts including those in the US, Australia, Japan and the several local models in a number of l towns and cities across. In the United Kingdom, Alzheimer's Society is leading the way in showing the world what could be achieved by a mass movement with significant support from the government. All these efforts focus on fostering what the person with dementia is capable of doing rather than focusing on the deficits associated with the illness.

Proactive attempts at social inclusion of those affected by dementia have been well received by the patients and their families. There are several challenges when adapting the model to a developing country like India. However ARDSI being the voice of people with dementia in India, believe these challenges should not be the deterrent in trying to improve the quality of life of people with dementia in India. We look at evaluating the dementia friendliness based on the four cornerstones model viz. people, place, resources and networks. In this paper the processes we adopted, challenges we foresee and outcomes we envisage are summarised.

Abstract No: 239

Abstract Title: A SUSTAINABLE AND INCLUSIVE INITIATIVE IN MEETING THE CHALLNGES OF DEMENTIA: A DEMENTIA FRIENDLY KERALA MODEL


Babu Varghese*1 , Sudhir Kumar C.T.² , K. Jacob Roy³

¹RESEARCH AND DEVELOPMENT CENTER, ARDSI, India, [email protected] , ²RESEARCH AND DEVELOPMENT CENTER, ARDSI, India, [email protected] , ³ADI, India, [email protected]

Keyword:

Dementia friendly, Kerala, India, policy, government, initiative

Background:

Prevalence of dementia and Alzheimer's disease is higher than many other parts of the subcontinent, in the south Indian state of Kerala. It is estimated, over 1.9 Lakh people will be affected by dementia in Kerala by 2015. Despite this magnitude, there is gross ignorance, neglect and scarce services for people with dementia. Exclusive reliance on specialists and secondary services to identify and manage patients with dementia is unrealistic considering the lack of resources and manpower in the state. Having a large elderly proportion and dementia prevalence in the country, Kerala needs to make dementia a public health and social welfare priority. Maximal utilisation of locally available resources and personnel including training and integration with existing infrastructure in identifying, assessing, managing and supporting people with dementia and their families will not add any financial burden to the government. In this context, Government of Kerala in association with Alzheimer's and Related Disorders Society of India (ARDSI) has taken the initiative to develop a sustainable initiative to meet the challenges posed by dementia and aiming to facilitate the efforts in making Kerala, the first dementia friendly state in the country. This initiative will focus on (i) promoting dementia awareness, (ii) capacity building of social and health care professionals (iii) setting up community based dementia screening and case finding facilities and (iv) promoting dementia friendly institutions with specific care standards. We will highlight the processes, facilitators and barriers involved in the conception, development and implementation of the Kerala model of Dementia Friendly approaches.

Abstract No: 242

Abstract Title: The Impact of Training on Dementia Care


Cheika Zafeerah Banoo Mohamed Jahangeer*¹ , Naushad Ali Mamode Khan²

¹UOM, Mauritius, [email protected] , ²University of Mauritius, Mauritius, [email protected]

Keyword:

Dementia, Factor Analysis, Training, Carers

Background:

Caring for dementia is very challenging and requires expertise in the field. This study analyzes and compares the impact of training on the knowledge and practice among female carers in dementia care. Carers were interviewed via a questionnare in five nursing homes in Mauritius to determine their knowledge, practice and were evaluated in three specific nursing skills: assisting patients in taking bath, assisting patient with oral care and patients' feeding.

The questionnaire consists of the demographic details of the carers and likert scale questions related to the three nursing skills. The demographic details were analyzed using statistical measures whereas the Likert scale questions were analyzed using an exploratory factor analysis that would determine the most influential components in the three nursing skills for trained and untrained carers respectively.

The majority of the staff was aware of Alzheimer's disease. Trained personnel adopted better approaches to caring for these elderly as compared to untrained carers. Trained personnel excelled in communication, establishing appropriate patients rapport and gaining patients' confidence. Effective communication tactics seemed to be a lacking factor among the untrained carers. Proper assessment skills are very important especially with patient who cannot communicate verbally. Untrained staff skipped some important steps and did not use the appropriate available equipment.

Carers require the appropriate knowledge and skill to care for dementia patients. Lack of knowledge, appropriate communication and observation skills and good judgement are the greatest obstacles to the quality of care being provided. Appropriate training is thus fundamental to successful caring for dementia.

Abstract No: 244

Abstract Title: Comparative Effect Of Exogenously Administered AÎ²1-40 And AÎ²1-42 In Rat Hippocampus And Amygdala On Glutathione Enzyme System

Topic Name: Others

Neha Mishra*¹ , Deepak Sharma²

¹Jawaharlal Nehru University, India, [email protected] , ²Jawaharlal Nehru University, India, [email protected]

Keyword :

Alzheimer's disease, amyloid beta, toxicity, glutathione reductase.

Background :

Amyloid oligomers are intricately involved with Alzheimer's disease, but the exact relationship between the oligomers and the disease pathology is not known. Most of the Alzheimer's therapies have been targeted towards clearance of core amyloid plaques, but unless the parameters like pathophysiology, biochemistry, biophysics, and seeding are not well understood it is difficult to design effective therapeutic approaches. Another factor, which has been overlooked, is the region specific toxicity of the oligomers (plaques). In this study, Aβ1-40 and Aβ1-42 aggregates were stereotaxically administered hippocampus and amygdala of rat brain, followed by biochemical estimations of glutathione reductase and total thiol content of the brain to assess the comparative toxicity. Glutathione redox system is of grave importance as it has been proposed as a candidate for Alzheimer's therapy. In out study, amyloid beta42 oligomer was found to be significantly more toxic when administered in the hippocampal region. There was greater reduction in glutathione reductase levels and elevation in total thiol levels with 42 beta oligomer. Thus, toxicity in the brain in also region specific, not just oligomer specific.

Abstract No: 250

Abstract Title: Cognition improving effects of PHYLSARONE-2 on sodium nitrite-induced hypoxia and ethanol-induced neurodegeneration in animal models relevant to Alzh

Topic Name:Pharmacotherapy of dementia

Hanumanthachar Joshi*¹ , Sandhya P²

¹Sarada Vilas College Of Pharmacy, India, [email protected] , ²Vishveswaraya Technological University, Gulbarga, India, [email protected]

Keyword:

Alzheimer's disease, neurotrasnmitters, hypoxia, neurodegeneration



Objective:

To study the effects of on sodium nitrite-induced hypoxia and ethanol-induced neurodegeneration in animal models.

Methods:

PHYLSARONE-2 (PS) a phytochemical based formulation was administered (5, 2 and 1 mg/kg p.o.) was administered to the mice. to mice and screened for Sodium nitrite induced hypoxia and ethanol induced neurodegeneration. Behavioral models such as rota rod, Passive shock avoidance paradigm, elevated plus maze and Morris water maze were used. Acquisition, retention, Transfer latency (TLT), Time spent in target quadrant (TSTQ), Step down latency (SDL) and Escape latency (ELT) were assessed. Biochemical parameters such as AChE, MAOA, TBARS, epinephrine, 5 HT were determined. DNA fragmentation studies was carried out.

Results:

PS prevented the motor impairment by increasing locomotor activity in Rota rod and Actophotometer. PS significantly (p < 0.001) protected the mice from Sodium nitrite induced memory impairment. It improved acquisition and retention memory significantly (p < 0.001) by decreasing the TLT, ELT, TSTQ and increased the SDL in dose dependent manner. PS exhibited profound Acetylcholinestrase activity, increased the GSH concentrations and decreased the TBARS of whole brains of mice. PS (5mg/kg, p.o.) significantly inhibited MAOA activity and reduced the metabolism of epinephrine, 5-HT and thus improved levels of neurotransmitters PS (5mg/kg, p.o.) protected the DNA fragmentation of frontotemporal cortex of the brain from hypoxic effect induced by Sodium nitrite in Gel Electrophoresis studies. The results were compared with donepezil.

Conclusion:

PHYLASARONE-2 can be beneficial in the management and treatment of Alzheimer's disease.

Abstract No: 256

Design and development of Clinical decision support system for the diagnosis and treatment of Alzheimers disease


Sandhya Joshi P*¹ , Joshi Hanumanthachar K²

¹Visvesvaraya technological University, India, [email protected] , ²sarada vilas college of pharmacy, India, [email protected]

Keyword:

Clinical Decision Support system, Alzheimers disease, Support vector machine.

Background:

There has been a steady rise in the number of patients suffering from Alzheimer's disease (AD) all over the world. Medical diagnosis is an important but complicated task that should be performed accurately and efficiently and its automation would be very useful. The current study focuses Design and implementation of clinical decision support system for Alzheimer's disease which can help and support neuro physicians, psychiatrist and clinical care givers at all key stages in the care delivery pathway, including diagnosis, treatment and monitoring. The present study consisted of records of 746 patients collected from various neuro imaging centers and Hospitals of south India. The data consisted of selection of more than 32 feature subsets, fishers score method was employed for identifying the most prominent features. Features were fed to the Support Vector Machines classifier and Particle Swarm Optimization method was used for optimizing the parameters to design a clinical decision support system (CDSS) for the diagnosis of the various stages of AD. The results were compared with SVM based on the grid search technique and principle component analysis (PCA-Grid-SVM) in terms of their classification accuracy. In addition, classification accuracy of the present study was compared to the previous studies and the proposed system achieved the highest classification accuracy with 98.75% when compared to the existing methods. Hence, the proposed CDSS can be used as a supporting tool and can be enormous help in assisting the physicians to make the accurate diagnosis on the patients with AD.

Abstract No: 257

Abstract Title: A STUDY ON DEMENTIA ALONG WITH ITS EPIDEMIOLOGICAL CORRELATES AMONG ELDERLY LIVING IN URBAN AREAS OF GUWAHATI CITY


Ajaya Mahanta¹ , Ankumoni Saikia² , Ashok Jyoti Deka*³

¹Dispur Hospital, India, [email protected] , ²Gauhati Medical College, India, [email protected], ³Fakhrudin Ali Ahmed Medical College, India, [email protected]

Keyword:

Dementia, Early Dementia Questionnaire, Follow up

Background:

Dementia is a major cause of disability in late life.Most of the people consider forgetfulness or early dementia as a part of normal aging and only overt cases come to clinician's notice. Early diagnosis of dementia is crucial to prevent or delay the consequences of the disease.

Objectives:

- To find out the prevalence of dementia in the community.

- To identify various epidemiological correlates associated with dementia.

Methods:

A Community based cross-sectional study was done in urban areas of Guwahati city, Assam between 1st June to 31st August, 2013. 400 Elderly persons (>60 years) were interviewed with Pre-designed, pretested schedule and Early Dementia Questionnaire (EDQ).

Results:

• Prevalence of dementia is 13.6%

• Significant statistical association was found between dementia with

- Type of Diet i.e. vegetarian or non-vegetarian diet and

- IADL (Instrumental Activities of daily Living).

• No Significant statistical association found between dementia with

- Gender

- Education

- Socio-economic status

- ADL (Activities of daily Living)

- Co-morbid conditions (DM, HTN)

- Personal habit (tobacco, and alcohol use) and

- Elderly abuse

Conclusion:

Considering high prevalence of dementia with early dementia questionnaire, further longitudinal studies need to be conducted. As activities of demented persons are affected, advance preparedness of the family members, community and the system is the answer to cope up the burden of those cases in future. Follow up assessment of these early demented persons are needed as the process is progressive.

Abstract No: 260

Abstract Title: A better Quercetin analog for Alzheimer's disease: An experimental and computational approach.


Ruchi Jakhmola Mani*¹ , Deepshikha Pande Katare²

¹Amity Institute of Biotechnology, Amity University, India., India, [email protected] , ²Amity Institute of Biotechnology, Amity University, India., India, [email protected]

Keyword:

Alzheimer's Diseases, Quercetin, Schrodinger, BBB, Zebrafish.

Background:

Alzheimer's disease (AD) is a condition in brain which causes constant degradation of neurons. AD brains have less amount


1 140 Rick Yiu Cho Kwan Preliminary results of a clinical trial on the effect of acupressure for agitation in nursing home residents with dementia

2 143 Thomas Gregor Issac Transcranial magnetic stimulation as an early marker to differentiate between early alzheimers disease and frontotemporal dementia.

3 144 Katy Fitzerald Craft as conduit: Tangible approaches for engagement and connection

4 151 Puneet Talwar Joint analysis of multiple biomarkers for Alzheimer's disease risk in North Indian population

5 154 Kannamma Ramanujam Geriatric mental health camp at southern railway H.Q hospital, Chennai

6 173 Ying Hui Wu The Little Sun: The Pathway of Dementia Care in Rural Community after Disaster

7 179 Vinutha Ravishankar A Cost of care of Dementia: a study of Indian caregivers seeking healthcare for person with Dementia in a tertiary centre

8 180 Sarah Javed Comparative Study Of Behavioral And Psychological Symptoms In Patients With Dementia Of Alzheimer Type and Vascular Dementia.

9 185 Shalini Manoj Contribution of Stress in persons with Mild Cognitive Impairment and Dementia

10 190 Suvarna Alladi Dementia in Developing Countries: Does Education play the same role in India as in the West.

11 191 Yunching Chen National Dementia Helpline Services in Taiwan

12 194 Gautam Anand Vascular dementia mimic lewy body dementia ; A case report

13 196 Jiban Kanai Das Dementia Care in Bangladesh - an Exercise in a Virgin Territory

14 197 Umamaheswari Vanamoorthy A study of non psychiatric comorbidities in patients with Alzheimers Disease

15 199 Bhupendra Singh Quality of life and care burden of caregivers with Dementia

16 201 Quratulain Khan Profile of Dementia Patients and Dementia research in Pakistan

17 205 Priyanka Goyal Caregiver distress associated with Behavioral and Psychological Symptoms of Dementia (BPSD) in Indian elderly

18 208 Gowri K Iyer Validation process of a comprehensive neuropsychological test battery for Vascular Cognitive Impairment for use across India.

19 209 Poonam Gupta Psychological well-being and adjustment of caregivers of persons with dementia: a comparative study

20 211 Azfer Ibrahim Comparative study of burden of care on family members of patient with dementia and schizophrenia

21 221 Sonal Vijay Chitnis A Comparative Investigation into Verb Naming Impairment in Telugu-English speaking Bilinguals with Progressive Nonfluent Aphasia vs.Semantic Dementia

Poster Presentation Days: 08 - 09 November 2014Mounting Time: 08:30

Dismounting Time: 19:00

Poster Board No Abstract No Presenting Author Abstract Title


of Acetylcholine (Ach) due accumulation of beta amyloid fragments (plaques) and hyperphosphorylated tau (tangles) which interfere with the ability of ACh to pass the brain signals and in turn initiate responses that produce reactive oxygen species (ROS). Brain has multiple sources of ROS but it can't reduce oxidative stress by itself. Today the focus is being placed on the discovery of oxidative stress biomarkers to study the increased oxidative damage during disease progression.

Objective:

Objective of the current study is to infer the best quercetin analog with good binding energies with AChE and efficient BBB crossing activity.

Methods:

Quercetin Analogs were constructed using Schrödinger and analyzed for better binding energies with AChE. Selected analogs were prepared and tested with the Zebrafish model to assess the highest protection against oxidative stress.

Results:

A few leads were finalized for further synthesis and animal testing.

Conclusion:

Few quercetin analogs with highest protection against oxidative stress and good binding energies with AChE can be taken further as a substitute for today's synthetic drugs which have long term toxicities.

Abstract No: 262

Abstract Title: Cerebral small-vessel-disease in patients attending memory clinic in Qatar: A cross-sectional study


Anoop Sankaranarayanan*¹, Hanadi Al Hamad² , Essa AlSulaiti³ , Marwan Ramadan⁴ , Rajvir Singh⁵ , Fatma AbuNajma⁶¹Senior Consultant Psychiatrist, Department of Geriatrics, Rumailah Hospital, Qatar, [email protected] , ²Hamad Medical Corporation, Qatar, [email protected] , ³Hamad Medical Corporation, Qatar, [email protected] , ⁴Hamad Medical Corporation, Qatar, [email protected] , ⁵Hamad Medical Corporation, Qatar, [email protected], ⁶Hamad Medical Corporation, Qatar, [email protected]

Keyword:

small vessel disease, cerebral small vessel disease, neuroimaging, neurodegenerative disease, dementia

Background:

Small vessel disease has an important role in cerebrovascular disease and is the most common pathology in vascular dementia and vascular cognitive impairment.

Objectives:

To study the prevalence and correlates of cerebral small vessel disease among patients attending memory clinic in Qatar.

Methods:

Socio-demographic and clinical data of all patients attending the memory clinic service at Rumailah Hospital in Doha between January 2013 and October 2014 will be included in the study provided they had recent (within the past six months of clinical contact) brain imaging (CT or MRI). We will use descriptive statistics (mean, standard deviations for interval variables and frequency and percentages with 95% C.I.) for prevalence's, chi-square test to study association between categorical variables and student t tests will to study association between interval and binary categorical variables. P value 0.05 (two-tailed) will be considered for statistical significance level. SPSS 21.0 package will be used for the analysis.

Results:

We presently have data for 48 patients; majority (58%) was females and the mean age of the sample was 74.5 (SD 8.18) years. 73% of the sample had small vessel disease, with periventricular white matter hyperintensities being the commonest type (48%). Among the vascular risk factors, hypertension alone showed a trend for association with small vessel disease (0.07) whereas type 2 diabetes and dyslipidemia did not.

Conclusions:

There was a significant association between gender type of dementia; the remainder of the results will be discussed at the conference.

POSTER PAPERS


POSTER BOARD NO


22 222 Vivek Lumar Sharma Insomnia: a diagnostic criteria for Alzheimers Disease

23 230 Subhash Das Impact of Group Intervention with Primary Caregivers on Neuropsychiatric Symptoms of Persons with Dementia and Caregiver Distress

24 232 Reeteka Sud Antisense-mediated exon skipping as a potential therapy for tauopathies

25 233 Sofiyan Saleem Genetic Deletion of PGI2 IP Receptor Exacerbates Global Cerebral Ischemia in Young and Aged Mice

26 234 Yuan High frequency repetitive transcranial magnetic stimulation is effective on the cognitive behavior and hippocampal synaptic plasticity of old mice

27 239 Babu Varghese A sustainable and inclusive initiative in meeting the challnges of dementia: a dementia friendly kerala model

28 242 Cheika Zafeerah Banoo Mohamed Jahangeer The Impact of Training on Dementia Care

29 244 Neha Mishra Comparative Effect Of Exogenously Administered A?ý1-40 And A1-42 In Rat Hippocampus And Amygdala On Glutathione Enzyme System

30 250 Hanumanthachar Joshi Cognition improving effects of PHYLSARONE-2 on sodium nitrite-induced hypoxia and ethanol-induced neurodegeneration in animal models relevant to Alzh

31 256 Sandhya joshi P Design and development of Clinical decision support system for the diagnosis and treatment of Alzheimers disease

32 257 Ashok Jyoti Deka A study on dementia along with its epidemiological correlates among elderly living in urban areas of guwahati city

33 260 Ruchi Jakhmola Mani A better Quercetin analog for Alzheimer's disease: An experimental and computational approach.

34 262 Anoop Sankaranarayanan Cerebral small-vessel-disease in patients attending memory clinic in Qatar: A cross-sectional study

Poster Presentation Days: 08 - 09 November 2014Mounting Time: 08:30

Dismounting Time: 19:00

Poster Board No Abstract No Presenting Author Abstract Title

POSTER BOARD NO


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