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Background: Anxiety and stress have been identified as potential risk factors of cognitive impairment, but research examining this association in midlife has been limited. Method: The current study examined the associations between anxiety and stress symptoms, and cognition in middle‐aged cognitively unimpaired adults (n = 2,463) enrolled in the Healthy Brain Project. Exploratory factor analysis was conducted on items in the Anxiety Subscale of the Hospital Anxiety and Depression Scale, Anxiety and Stress Subscales of the Depression, Anxiety and Stress Scale, and Perceived Stress Scale. Cognition was measured using the Cogstate Brief Battery (CBB). Result: The solution that resulted in the best fit to the data comprised five factors which explained for 48% of the variance: Over‐Reactivity, Panic, Low‐Control, Tension and Intolerance. Panic‐related symptoms were significantly associated with both poorer attention and memory. Having clinically meaningful anxiety symptoms, or both anxiety and stress symptoms, was associated with poorer memory. Conclusion: Anxiety and stress symptoms may be linked to a heightened risk of developing cognitive impairment. Specifically, panic‐related symptoms may play a significant role in the relationship between anxiety symptoms and cognition. Limitations include: 1) cross‐sectional nature of the study limited ability to ascertain direction of causality; 2) individuals with major psychiatric conditions were excluded from the study, thus limiting external validity of the current findings; 3) HBP sample has a higher proportion of individuals with a family history of dementia compared to the general population, hence the sample presents with an increased risk of developing dementia and generalizability of our findings may be limited. [ABSTRACT FROM AUTHOR]

The present research aims to establish the predictive validity of the Test of Memory Malingering (TOMM) in a Singaporean sample with mood and psychotic disorders. Its clinical utility was compared against other performance validity tests: Dot Counting Test (DCT), Rey 15-Item Memory Test II (Rey II), Medical Symptom Validity Test (MSVT), Nonverbal Medical Symptom Validity Test (NV-MSVT), Word Memory Test (WMT) and Victoria Symptom Validity Test (VSVT). Findings revealed that TOMM, MSVT, NV-MSVT, WMT and VSVT preserved the ability to distinguish between Clinical participants' simulation groups, and TOMM outperformed all tests except NVMSVT. Overall, findings supported continued use of TOMM. [ABSTRACT FROM AUTHOR]

Introduction: Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of person-centred care, has been shown to maintain quality of life (QOL) in PWDs and caregivers, a lack of service integration can hinder effectiveness. Methods: CARITAS, an integrated care initiative provided through a hospital-community care partnership, endeavours to provide person-centred dementia care through ambulatory clinic consults, case management, patient and caregiver engagement, and support. We evaluated CARITAS' clinical outcomes and cost-effectiveness with a naturalistic cross-sectional within-subject design. We assessed patients' function, QOL, and behavioural problems post-intervention. We estimated CARITAS' cost-effectiveness from a patient's perspective, benchmarking it against other dementia treatments and Singapore's Gross Domestic Product (GDP) per capita. Results: CARITAS care significantly improved health utility (p < 0.001), reduced caregiver burden (p < 0.001), and improved PWDs' behavioural problems (p < 0.001) related to "memory" (p < 0.001), "disruption" (p = 0.017), and "depression" (p < 0.001). CARITAS' benefits (dRMBPC = 0.357, dEQ5D index = 0.328, dZBI = 0.361) were comparable to those of other pharmacological and non-pharmacological interventions for dementia. CARITAS costs SG$133,056.69 per quality-adjusted life years gain, yielding an incremental cost-effectiveness ratio of 1.31 and 1.49 against the cost of donepezil in patients with mild Alzheimer's disease and Singapore's GDP per capita in 2019, respectively, falling within the cost-effectiveness threshold of 1.0-3.0. Discussion: CARITAS integrated dementia care is a cost-effective intervention that showed promising outcomes for PWDs and their caregivers. [ABSTRACT FROM AUTHOR]

Background: The experience of grief in family caregivers as they provide care for persons with dementia is often overlooked. The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) is one among the few scales that capture such experiences. In a recent study, MM-CGI was found to contain three subscales identifying dimensions of loss in caregivers-Personal-Sacrifice Burden (PSB), Heartfelt Sadness, Longing, and Worry (HSLW), and Felt Isolation (FI). We aimed to evaluate the validity and utility of these dimensions in a multiethnic Asian population.Methods: Family caregivers (n = 394) completed MM-CGI and scales assessing caregiver burden, depression, and gains. Internal consistency reliability was examined using Cronbach α; test-retest reliability using intraclass correlation coefficient; and construct validity using Pearson correlation coefficient. The utility of the MM-CGI dimensions was evaluated by comparing caregivers with high subscale scores across dementia stages and caregiving relationship.Results: The three dimensions of MM-CGI exhibited adequate internal consistency, test-retest reliability, construct validity, and known-group validity. PSB correlated most strongly with caregiver burden (r = 0.78); HSLW with caregiver depression (r = 0.75); and FI with caregiver burden and caregiver depression (r = 0.60, respectively). Caregivers with high total grief scores tended to experience most difficulty with HSLW (90.8%), followed by PSB (75.4%) and FI (46.2%). The three dimensions also increased across the dementia stages, with FI higher in mild dementia, PSB higher in moderate dementia, and HSLW higher in severe dementia. Spousal caregivers experienced most difficulty in HSLW, whereas children caregivers experienced similar levels of difficulty across the dimensions.Conclusions: The three dimensions of MM-CGI captured distinct aspects of caregiver grief in a multiethnic Asian population and would enable more individualized assessments and interventions for caregiver grief. [ABSTRACT FROM AUTHOR]

Introduction: The growing prevalence of dementia is of concern in Singapore as it poses significant health, social and economic burden on individuals, families and the healthcare system. While it widely known that dementia is best managed by a multidisciplinary team of healthcare providers working together across different healthcare settings, dementia care has been primarily delivered by tertiary hospitals in Singapore. Hospital-centric dementia care is insufficient because needs of persons with dementia PWDs and their caregivers extend beyond medical needs and are best provided for in the community. As demand continues to rise, the healthcare system now faces the challenges of ensuring sustainability, appropriateness and quality of dementia care. To cope with these, the CARITAS network was established in 2012 to foster integrated, person centered care across different healthcare settings through i formation of primary care and community PCC providers network ii empowerment of PCC to manage PWD in the community iii empowerment of caregivers and iv integration between tertiary hospital and PCC through clinical, professional and functional integration. With these strategies, the CARITAS aims to provide a comprehensive, accessible, responsive, individualized, trans-disciplinary, accountable and seamless care for PWDs in the northern part of Singapore within their community. Methods: To support further development of the CARITAS network, this study was designed as a formative evaluation. Using sequential exploratory mixed methods, we aim to examine the degree of care integration within the CARITAS network, identify moderating factors that affect its implementation by taking into consideration the context in which it operationalized so as to identify areas for improvements. Guided by the Rainbow Model of Integrated Care RMIC, the RMIC measurement tool RMIC-MT was first administered to 100 healthcare providers within the CARITAS network. Then, based on the findings from the RMIC-MT, 30 healthcare providers and caregivers were invited to participate in interviews to gather insights into the moderating factors of the implementation of the CARITAS network. Data from the various sources will initially be analyzed according to their data types and subsequently triangulated according to the RMIC. Recommendations for improvements will then be made. Results & Discussions: The results which will be presented at the conference have significant implications on a few levels. It will potentially i provide information for improvement of the CARITAS network, ii provide insights to other countries that are experimenting with new models of dementia care and iii contribute significantly to the international literature on improvement science. Lessons Learned: In the evaluation of complex healthcare intervention such as the CARITAS network, it is essential to conduct process evaluation in conjunction with outcome evaluation so as to account for variability in implementation. Without process evaluation, it would be difficult to determine actions to take for improving the intervention. Limitations: As this is a single site study, findings gathered from this study needs to be interpreted with consideration of the context in which the CARITAS network is implemented. Suggestions for future research Future research should be conducted to examine the effectiveness of the CARITAS network in improving its intended outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The capability and capacity of the primary and community care (PCC) sector for dementia in Singapore may be enhanced through better integration. Through a partnership involving a tertiary hospital and PCC providers, an integrated dementia care network (CARITAS: comprehensive, accessible, responsive, individualised, transdisciplinary, accountable and seamless) was implemented. The study evaluated the process and extent of integration within CARITAS., Design: Triangulation mixed-methods design and analyses were employed to understand factors underpinning network mechanisms., Setting: The study was conducted at a tertiary hospital in the northern region of Singapore., Participants: We recruited participants who were involved in the conceptualisation, design, development and implementation of the CARITAS Programme from a tertiary hospital and PCC providers., Intervention: We used the Rainbow Model of Integrated Care-Measurement Tool (RMIC-MT) to assess integration from managerial perspectives. RMIC-MT comprises eight dimensions that play interconnected roles on a macro-level, meso-level and micro - level. We administered RMIC-MT to healthcare providers and conducted in-depth interviews with key CARITAS stakeholders., Primary and Secondary Outcome Measures: We assessed integration scores across eight dimensions of the RMIC-MT and factors underpinning network mechanisms., Results: Compared with other dimensions, functional integration (mechanisms by which information and management modalities are linked) achieved the lowest mean score of 55. Other dimensions (eg, clinical, professional and organisational integration) scored about 70. Presence of inspiring clinical leaders and tacit interdependencies among partners strengthened the network. However, the lack of structured documentation and a shared information-technology platform hindered functional integration., Conclusion: CARITAS has reached maturity in micro-levels and meso-levels of integration, while macro-integration needs further development. Integration can be enhanced by assessing service gaps, increasing engagement with stakeholders and providing a shared communication system., Competing Interests: Competing interests: PY is a key clinical leader of the CARITAS integrated dementia care network., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of person-centred care, has been shown to maintain quality of life (QOL) in PWDs and caregivers, a lack of service integration can hinder effectiveness., Methods: CARITAS, an integrated care initiative provided through a hospital-community care partnership, endeavours to provide person-centred dementia care through ambulatory clinic consults, case management, patient and caregiver engagement, and support. We evaluated CARITAS' clinical outcomes and cost-effectiveness with a naturalistic cross-sectional within-subject design. We assessed patients' function, QOL, and behavioural problems post-intervention. We estimated CARITAS' cost-effectiveness from a patient's perspective, benchmarking it against other dementia treatments and Singapore's Gross Domestic Product (GDP) per capita., Results: CARITAS care significantly improved health utility (p < 0.001), reduced caregiver burden (p < 0.001), and improved PWDs' behavioural problems (p < 0.001) related to "memory" (p < 0.001), "disruption" (p = 0.017), and "depression" (p < 0.001). CARITAS' benefits (dRMBPC = 0.357, dEQ5D index = 0.328, dZBI = 0.361) were comparable to those of other pharmacological and non-pharmacological interventions for dementia. CARITAS costs SG$133,056.69 per quality-adjusted life years gain, yielding an incremental cost-effectiveness ratio of 1.31 and 1.49 against the cost of donepezil in patients with mild Alz-heimer's disease and Singapore's GDP per capita in 2019, respectively, falling within the cost-effectiveness threshold of 1.0-3.0., Discussion: CARITAS integrated dementia care is a cost-effective intervention that showed promising outcomes for PWDs and their caregivers., (© 2020 S. Karger AG, Basel.)