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EXERCISE AND MEMORY DECLINE

EXERCISE AND MEMORY DECLINE

P220 Podium Presentations: Monday, July 25, 2016 maintaining websites and communication systems. Finally we will establish a Program to address the ...

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P220

Podium Presentations: Monday, July 25, 2016

maintaining websites and communication systems. Finally we will establish a Program to address the ethical, legal and social issues pertaining to research on dementia. Conclusions: The CCNA is attempting to establish a prototype for a national research initiative on dementia which leverages national areas of excellence, catalyzes new discoveries, and provides a unique viewpoint on dementia research issues. FTS2-01-03

THE AUSTRALIAN NATIONAL INSTITUTE OF DEMENTIA RESEARCH (NNIDR)

John McCallum, National Institute of Dementia Research (NNIDR), Canberra, Australia. Contact e-mail: [email protected] Background: In the 2014-15 Budget the Australian Government allocated $200 million over five years to the National Health and Medical Research Council (NHMRC) to boost dementia research in Australia. Consequently the NHMRC National Institute for Dementia Research (NNIDR; The Dementia Institute) was established 7th August 2015. The Institute is a collaboration between the peak health and medical research funding agency, the NHMRC, and the peak dementia consumer body, Alzheimer’s Australia National Office (AANO). The Dementia Institute services are provided by Alzheimer’s Australia under a contract with the NHMRC. Methods: The main objectives of the Institute are to: (1) identify essential dementia research priorities for Australia across the full spectrum from basic research to research translation; (2) bring together Australia’s dementia research, including existing NHMRC programs and other national initiatives, to ensure stronger coordination and collaboration; (3) synthesize information provided from current research and develop strong linkages with community groups, practitioners and other service providers to rapidly and flexibly translate research outcomes; (4) develop partnerships between researchers, industry and philanthropic organisations to help embed dementia research into the health system and stimulate the translation of research findings into policy and practice; and (5) ensure Australian participation in major international collaborations relevant to dementia research. Results: The NNIDR has committed AU$35.6M to 6 Dementia Research Team Grants, AU$46M to 76 new researcher Fellowships and $2.6 million in JPco-fuND 2015 call to 2 teams with Australian involvement. Conclusions: The Institute will provide the platform for strategically expanding dementia research in Australia, ensure better integration with international research and form a focus for rapid translation of evidence into policy and practice. Drawing on the expertise of high quality researchers, clinicians and key stakeholders across Australia, the Institute will aim to use Australia’s strength and expertise in health and medical research to drive improvements in dementia prevention, diagnosis and treatment. FTS2-01-04

THE DUTCH DEMENTIA DELTA PLAN (DDDP)

Philip Scheltens, VU University Medical Center, Amsterdam, Netherlands; Deltaplan Dementie, Amersfoort, Netherlands. Contact e-mail: [email protected] Background: Prevalence of dementia is increasing in the

Netherlands. A national approach was felt necessary to meet the challenges facing today’s patients and the patients in the future. Methods: A plan was set up to address the needs of patients suffering from dementia today, to meet the challenges in research and be able to participate in joint EU efforts for research and to create a dementia friendly society. In 2013 an 8-year plan was launched consisting of three pillars: research, covering 4 themes (fundamental, clinical, applied and care research, improvement of

daily care, including efforts to create a national dementia registry, and creating a dementia friendly society. The aim of the plan is to make dementia manageable and socially accepted within the time frame of the program, within a public-private partnership. Results: In 2016, almost halfway, research is well underway with initial government funding of 32M euro, 21 projects, many fellowships and additional 5 M euro private funding, the DDDP is established as a cooperative institution with a management board, care improvement plans have been designed and are being rolled out, and the first plan to create 1M ’dementia friends’ has been approved for additional funding of 10M for the next 4 years. Conclusions: The DDDP is well underway, generally well accepted and welcomed and with good prospects for the future. It has boosted a collaborative spirit all over the Netherlands and has created enormous additional awareness for dementia. FTS2-01-05

FROM THE WHO RESEARCH PRIORITIES AND RESEARCH PORTFOLIO ANALYSIS TO THE IDENTIFICATION OF RESEARCH GAPS TO REDUCE THE GLOBAL BURDEN OF DEMENTIA

Hiral Shah1, Emiliano Albanese2, Cynthia Duggan3, Igor Rudan4, Kenneth M. Langa5, Maria C. Carrillo6, Kit Yee Chan4, Yves Joanette7, Martin J. Prince8, Martin N. Rossor9, Shekhar Saxena10, Heather M. Snyder6, Reisa A. Sperling11, Mathew Varghese12, Huali Wang13, Marc Wortmann14, Tarun Dua10, 1Columbia University Medical Center, New York, NY, USA; 2University of Geneva & University Hospitals of Geneva (HUG), Geneva, Switzerland; 3Washington University School of Medicine, St. Louis, MO, USA; 4University of Edinburgh, Edinburgh, United Kingdom; 5University of Michigan, Ann Arbor, MI, USA; 6 Alzheimer’s Association, Chicago, IL, USA; 7Canada Institutes of Health Research, Montreal, QC, Canada; 8King’s College London, London, United Kingdom; 9UCL Institute of Neurology, London, United Kingdom; 10World Health Organization, Geneva, Switzerland; 11Center for Alzheimer Research and Treatment, Brigham and Womens Hospital, Harvard Medical School, Boston, MA, USA; 12National Institute of Mental Health and Neurosciences, Bangalore, India; 13Peking University Institute of Mental Health (Sixth Hospital), Beijing, China; 14Alzheimer’s Disease International, London, United Kingdom. Contact e-mail: [email protected] columbia.edu

This abstract is embargoed as part of the AAIC 2015 Featured News Program and will be released on Monday, July 25 after 8:00 AM. The full abstract content will be posted for your viewing after the embargo lifts. All abstracts will be published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. MONDAY, JULY 25, 2016 PLENARY SESSIONS PL-02 PL-02-01

EXERCISE AND MEMORY DECLINE

Laura D. Baker, Wake Forest University Health Sciences, Winston Salem, NC, USA. Contact e-mail: [email protected] Background: Aerobic exercise has potent protective and restorative

effects on multiple systems and processes that support the overall health of the body. The benefits of exercise on the brain, particularly for older adults with early changes associated with Alzheimer’s disease (AD), have become an important scientific focus over the last 10 years. Aerobic exercise improves vascular function and benefits lipid profiles, protects against metabolic and cardiovascular disease, promotes growth factor activity in the brain, has favorable effects on inflammation, mitigates physiological and psychological stress responses, and improves mood. Methods: We and others have shown that regular aerobic exercise can improve cognition in adults at

Podium Presentations: Monday, July 25, 2016

high risk for cognitive decline and Alzheimer’s dementia using randomized controlled trials. Results: In a recently completed study, we showed that moderate-high intensity aerobic exercise increased blood flow in key brain regions characteristically compromised by aging and by early AD pathological processes, and favorably altered disease biomarkers in cerebrospinal fluid. Magnitude of therapeutic response, however, may hinge on critical variables such as exercise intensity and duration, sensitivity of tools used to assess cognitive function, and participant characteristics. Conclusions: Although the challenges of successfully implementing an exercise intervention at the proper ‘dose’ are many, the balance of evidence to support aerobic exercise as an efficacious therapeutic intervention in adults with mild cognitive impairment appears to outweigh that provided by pharma trials to date. Given what we know so far, aerobic exercise ‘therapy’ to prevent or slow AD progression may be  worth the sweat. PL-02-02

ROLE OF PERIPHERAL INFLAMMATION IN COGNITIVE IMPAIRMENT AND ALZHEIMER’S DISEASE

Gabriela Constantin, University of Verona, Verona, Italy. Contact e-mail: [email protected]

Abstract not available. MONDAY, JULY 25, 2016 ORAL SESSIONS O2-01 DEMENTIA CARE PRACTICE: INNOVATIVE PROGRAMS AND SYSTEM IMPROVEMENTS O2-01-02

TRANSLATING THE CARE OF PERSONS WITH DEMENTIA IN THEIR ENVIRONMENTS (COPE) INTERVENTION FOR USE IN PUBLICLY FUNDED HOME CARE PROGRAMS IN THE UNITED STATES

Richard H. Fortinsky1, Laura N. Gitlin2, James Grady1, Catherine V. Piersol3, Laura T. Pizzi4, Julie T. Robison1, Sheila Molony5, 1 University of Connecticut School of Medicine, Farmington, CT, USA; 2 Johns Hopkins University School of Nursing, Baltimore, MD, USA; 3 Thomas Jefferson University College of Health Professions, Philadelphia, PA, USA; 4Thomas Jefferson University College of Pharmacy, Philadelphia, PA, USA; 5Quinnipiac University School of Nursing, Hamden, CT, USA. Contact e-mail: [email protected] Background: COPE, an evidence-based, non-pharmacologic inhome intervention, uses occupational therapists and advanced practice nurses to maximize function and activity engagement in persons with dementia (PWD), and teaches family caregivers (CG) how to manage dementia symptoms and care for themselves. The COPE CT translational study is designed to test the effectiveness of incorporating COPE into the care plan of PWD enrolled in Connecticut’s Medicaid waiver home care program. In this presentation, we will explain the COPE intervention and translational study design, and provide results regarding PWD and CG characteristics, intervention completion rates, and implementation successes and challenges. Methods: Eligible PWD and CG dyads are randomly assigned either to COPE plus usual care plan services, or usual care plan services only. The 4-month, 12-session COPE intervention provides CGs with problem solving skills for managing functional dependence, behavioral symptoms, and their own stress and wellbeing. Also, PWD are assessed for abilities, interests, and underlying medical conditions that may affect function and behavior. Numerous PWD and CG health-related outcomes are pre-specified. Additional study components include an implementation evalua-

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tion, and a cost-benefit analysis to determine the net financial benefit of COPE. The recruitment goal is 290 dyads. Results: To date, 76 dyads are enrolled; the enrollment pace corresponds to recruitment goals. Among PWD, 80.3% are female, mean (s.d.) age¼84.8 (7.7), 78% White, and 20% Black. Among CG, 71.7% are female, mean (s.d.) age¼61.2 (12.2), 74% White, 20% Black, 54% daughters, and 16% spouses. Of 14 dyads completing COPE to date, 9 completed all sessions, and 3 completed all but one session; all dyads currently receiving COPE are proceeding per protocol. Nurse assessment of PWD has uncovered medical conditions warranting physician treatment. Conclusions: The COPE CT study is the first to translate COPE into an existing Medicaid waiver program. Replicability potential is high because all states offer similar Medicaid waiver programs. COPE is a clinically relevant approach with important PWD and CG benefits. Findings will provide critical insight regarding its effectiveness and costs within existing home care programs. Implementation lessons learned will be relevant to other countries seeking to improve home care for PWD and CG. O2-01-03

THE COORDINATED-TRANSITIONAL CARE (CTRAC) PROGRAM: SUPPORTING PATIENTS WITH ALZHEIMER’S DEMENTIA (AD) AND THEIR CAREGIVERS DURING CARE TRANSITIONS FROM THE HOSPITAL TO THE COMMUNITY

Amy J. Kind1,2, Andrea Gilmore-Bykovskyi1,2, Korey Kennelty1,2, Laury Jensen2, Emily Schmitz1, Carol Hermann1, Jenna Mineau1, 1 University of Wisconsin, Madison, WI, USA; 2William S Middleton Hospital, United States Department of Veterans Affairs, Madison, WI, USA. Contact e-mail: [email protected] Background: Poor quality care transitions from the hospital to the

community cause care discontinuity, patient dissatisfaction, rehospitalizations and serious medication errors resulting in delirium, falls or functional loss—the most common, preventable post-hospital complications in AD patients. Available evidence-based transitional care interventions, which use education-focused home visits to support patients after hospitalization, improve medication management, patient health and reduce rehospitalizations. However, these interventions have high patient refusal rates, are resource-intensive, and are typically unsustainable in lowresource (e.g., rural) settings. Objective: To develop and pilot the Coordinated-Transitional Care (C-TraC) Intervention—a novel, low-cost, intensive phone-based intervention designed to improve transitional care quality, rehospitalizations and patient/ caregiver outcomes in hospitalized AD patients discharged to community settings. Methods: Implementation science engineering techniques and adult learning theory (i.e., spaced retrieval) were employed to produce a highly-detailed transitional care protocol, including phone scripts, clinical templates, contact tempos and real-time metric collection, using methods that are efficient, system-sensitive and maximize options for local sustainability. Patient characteristics and outcomes were abstracted from the medical record for all eligible AD patients during the 6 months prior to the pilot intervention launch (N¼64) and for AD patients enrolled in the 18 month C-TraC pilot (N¼81). No AD patients refused enrollment. Results: Intervention patients experienced fewer 30-day rehospitalizations than the baseline group (20% intervention versus 33% baseline). Adjusting for patient age, sociodemographics, and comorbidity using multivariate-logistic regression, C-TraC patients had lower risk for 30-day rehospitalization than baseline (adjusted odds ratio ¼ 0.34, 95% confidence interval ¼ 0.14, 0.82). Patients and caregivers reported that the intervention