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Prostate cancer is a polygenic disease with a large heritable component. A number of common, low-penetrance prostate cancer risk loci have been identified through GWAS. Here we apply the Bayesian multivariate variable selection algorithm JAM to fine-map 84 prostate cancer susceptibility loci, using summary data from a large European ancestry meta-analysis. We observe evidence for multiple independent signals at 12 regions and 99 risk signals overall. Only 15 original GWAS tag SNPs remain among the catalogue of candidate variants identified; the remainder are replaced by more likely candidates. Biological annotation of our credible set of variants indicates significant enrichment within promoter and enhancer elements, and transcription factor-binding sites, including AR, ERG and FOXA1. In 40 regions at least one variant is colocalised with an eQTL in prostate cancer tissue. The refined set of candidate variants substantially increase the proportion of familial relative risk explained by these known susceptibility regions, which highlights the importance of fine-mapping studies and has implications for clinical risk profiling., Prostate cancer (PrCa) involves a large heritable genetic component. Here, the authors perform multivariate fine-mapping of known PrCa GWAS loci, identifying variants enriched for biological function, explaining more familial relative risk, and with potential application in clinical risk profiling.

PURPOSE: To compare registration strategies to align arterial spin labeling (ASL) with 3D T1-weighted (T1w) images, with the goal of reducing the between-subject variability of cerebral blood flow (CBF) images. MATERIALS AND METHODS: Multi-center 3T ASL data were collected at eight sites with four different sequences in the multi-center GENetic Frontotemporal dementia Initiative (GENFI) study. In a total of 48 healthy controls, we compared the following image registration options: (I) which images to use for registration (perfusion-weighted images [PWI] to the segmented gray matter (GM) probability map (pGM) (CBF-pGM) or M0 to T1w (M0-T1w); (II) which transformation to use (rigid-body or non-rigid); and (III) whether to mask or not (no masking, M0-based FMRIB software library Brain Extraction Tool [BET] masking). In addition to visual comparison, we quantified image similarity using the Pearson correlation coefficient (CC), and used the Mann-Whitney U rank sum test. RESULTS: CBF-pGM outperformed M0-T1w (CC improvement 47.2% ± 22.0%; P < 0.001), and the non-rigid transformation outperformed rigid-body (20.6% ± 5.3%; P < 0.001). Masking only improved the M0-T1w rigid-body registration (14.5% ± 15.5%; P = 0.007). CONCLUSION: The choice of image registration strategy impacts ASL group analyses. The non-rigid transformation is promising but requires validation. CBF-pGM rigid-body registration without masking can be used as a default strategy. In patients with expansive perfusion deficits, M0-T1w may outperform CBF-pGM in sequences with high effective spatial resolution. BET-masking only improves M0-T1w registration when the M0 image has sufficient contrast. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:131-140.

glycoprotein E and the AS01B adjuvant system (called HZ/su) had a clinically acceptable safety profile and elicited a robust immune response. METHODS: We conducted a randomized, placebo-controlled, phase 3 study in 18 countries to evaluate the efficacy and safety of HZ/su in older adults (≥50 years of age), stratified according to age group (50 to 59, 60 to 69, and ≥70 years). Participants received two intramuscular doses of the vaccine or placebo 2 months apart. The primary objective was to assess the efficacy of the vaccine, as compared with placebo, in reducing the risk of herpes zoster in older adults. RESULTS: A total of 15,411 participants who could be evaluated received either the vaccine (7698 participants) or placebo (7713 participants). During a mean follow-up of 3.2 years, herpes zoster was confirmed in 6 participants in the vaccine group and in 210 participants in the placebo group (incidence rate, 0.3 vs. 9.1 per 1000 person-years) in the modified vaccinated cohort. Overall vaccine efficacy against herpes zoster was 97.2% (95% confidence interval [CI], 93.7 to 99.0; P

Objective: To assess whether a high-salt diet, as measured by urinary sodium concentration, is associated with faster conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) and MS activity and disability. Methods: BENEFIT was a randomized clinical trial comparing early versus delayed interferon beta-1b treatment in 465 patients with a CIS. Each patient provided a median of 14 (interquartile range = 13–16) spot urine samples throughout the 5-year follow-up. We estimated 24-hour urine sodium excretion level at each time point using the Tanaka equations, and assessed whether sodium levels estimated from the cumulative average of the repeated measures were associated with clinical (conversion to MS, Expanded Disability Status Scale [EDSS]) and magnetic resonance imaging (MRI) outcomes. Results: Average 24-hour urine sodium levels were not associated with conversion to clinically definite MS over the 5-year follow-up (hazard ratio [HR] = 0.91, 95% confidence interval [CI] = 0.67–1.24 per 1g increase in estimated daily sodium intake), nor were they associated with clinical or MRI outcomes (new active lesions after 6 months: HR = 1.05, 95% CI = 0.97–1.13; relative change in T2 lesion volume: −0.11, 95% CI = −0.25 to 0.04; change in EDSS: −0.01, 95% CI = −0.09 to 0.08; relapse rate: HR = 0.78, 95% CI = 0.56–1.07). Results were similar in categorical analyses using quintiles. Interpretation: Our results, based on multiple assessments of urine sodium excretion over 5 years and standardized clinical and MRI follow-up, suggest that salt intake does not influence MS disease course or activity. Ann Neurol 2017;82:20–29.

ObjectiveTo determine whether exosomal microRNAs (miRNAs) in cerebrospinal fluid (CSF) of patients with frontotemporal dementia (FTD) can serve as diagnostic biomarkers, we assessed miRNA expression in the Genetic Frontotemporal Dementia Initiative (GENFI) cohort and in sporadic FTD.MethodsGENFI participants were either carriers of a pathogenic mutation in progranulin, chromosome 9 open reading frame 72 or microtubule-associated protein tau or were at risk of carrying a mutation because a first-degree relative was a known symptomatic mutation carrier. Exosomes were isolated from CSF of 23 presymptomatic and 15 symptomatic mutation carriers and 11 healthy non-mutation carriers. Expression of 752 miRNAs was measured using quantitative PCR (qPCR) arrays and validated by qPCR using individual primers. MiRNAs found differentially expressed in symptomatic compared with presymptomatic mutation carriers were further evaluated in a cohort of 17 patients with sporadic FTD, 13 patients with sporadic Alzheimer’s disease (AD) and 10 healthy controls (HCs) of similar age.ResultsIn the GENFI cohort, miR-204-5p and miR-632 were significantly decreased in symptomatic compared with presymptomatic mutation carriers. Decrease of miR-204-5p and miR-632 revealed receiver operator characteristics with an area of 0.89 (90% CI 0.79 to 0.98) and 0.81 (90% CI 0.68 to 0.93), respectively, and when combined an area of 0.93 (90% CI 0.87 to 0.99). In sporadic FTD, only miR-632 was significantly decreased compared with AD and HCs. Decrease of miR-632 revealed an area of 0.90 (90% CI 0.81 to 0.98).ConclusionsExosomal miR-204-5p and miR-632 have potential as diagnostic biomarkers for genetic FTD and miR-632 also for sporadic FTD.

Background/Purpose: As of 2011, approximately 747,000 Canadians suffer from some form of dementia; Alzheimer’s disease (AD) is one such form. AD is a neurodegenerative disease characterized by significant neuronal death. Neuronal death has been associated with two pathophysiological features: 1) neurofibrillary tangles within the neurons, and 2) amyloid beta plaque formation between neurons. Excessive production of these two features is manifested by severe cognitive impairment. One of the most extensively researched compounds, associated with these characteristics, is the amino acid, homocysteine, which has been found to be higher in blood plasma concentrations in patients with AD compared to healthy counterparts. Folate, vitamin B12, and vitamin B6 have been effective in reducing plasma homocysteine and this reduction has been associated with a reduction in amyloid beta and tau phosphorylation. However, this reduction in homocysteine has not resulted in improved cognitive performance. More recently, research focus has shifted to the universal methyl donor, S-adenosylmethionine (SAM), as a dietary supplement to treat both the pathophysiological features and cognitive impairment of the disease in mice and has shown promising results in alleviating both domains of the disease. Methods: Here, a meta-analysis was conducted to evaluate the effect size for Y maze performance between two groups of mice, one receiving a SAM supplemented diet and the other group receiving a non-SAM supplemented diet. A thorough literature review was conducted and all studies that met the inclusion criteria were included in the analysis. For each study, both groups of mice were fed a folate and vitamin E deficient diet for 1 month with or without SAM supplementation. Results & Conclusion: The results of four mouse studies demonstrated a significant effect of SAM supplementation on cognitive performance as measured by the percent of spontaneous alternations made in the Y maze, thus illustrating the utility of this supplement in research concerning mental health., Objectives: To identify primary care doctors knowledge, practices, and obstacles with regard to the diagnosis and management of dementia. Methods: Standardized questionnaires covering knowledge, practices, and obstacles were distributed among a random sample of primary care doctors in Kathmandu, Nepal. 380 physicians responded (response rate = 89%). Results: Knowledge of practitioners with regard to the diagnosis and management of dementia was unsatisfactory. Diagnosis and management barriers are presented with regard to GP factors, patient factors, systemic factors, and carer factors. Discussion: Specifically, the results address the following issues: time, communicating the diagnosis, negative views of dementia, difficulty diagnosing early stage dementia, acceptability of specialists and responsibility for extra issues, knowledge of dementia and ageing, less awareness of declining abilities and diminished resources to handle care, not specified guidelines, poor awareness of epidemiology, and less confidence to advise. Conclusions: Demographic changes mean that dementia will represent a significant problem in the future. The following paper outlines the problems and solutions that the Nepalese medical community needs to adopt to deal effectively with its diagnosis, care, and management., Background: As the number of individuals with dementia grows, we are seeing associated caregiving challenges. In one program for persons with dementia, involving caregivers in the creation of an individual’s life story is an important step in the development of a person-centred approach to care by identifying important life events and their meaning. This narrative contributes to individualized interventions for care. At the same time, the use of technology and ‘simulated presence’ is being explored with some caregivers as an additional intervention. Objective: This poster will demonstrate how ‘simulated presence’ can be an effective strategy to engage family or other significant caregivers and the interprofessional team in provision of a truly person-centred approach to care. Methods: Clients and caregivers are involved in creation of a life story when the client is first admitted to the program. Caregivers are also invited to participate in making audio-tapes where they provide reassurance or narration of care steps. These audio recordings are played during care, in order to redirect or engage the person with dementia. Elements of the person’s life story, as well as how to implement ‘simulated presence’, are integrated into a behavioural intervention plan. Several of these situations have been videotaped and caregivers have viewed the videos and participated in individual interviews, to learn about their perspectives on the use of ‘simulated presence’ in the care of their family member. Results: Videotapes of care when ‘simulated presence’ is part of the intervention demonstrate engagement of the person and a reduction in unwanted behaviour. The impact on care providers is also evident. With simulated presence, the number of staff required to provide care has been observed to be fewer than without this intervention. Interviews with family reveal a variety of themes. While they may have doubts about their ability to contribute to care, or about the effectiveness of ‘simulated presence’ for their family member, they are eager to participate in finding solutions to reduce responsive behaviours. Over time, observing changes in their family member’s behaviour and feeling like their participation has an impact on client care, can be reassuring and rewarding. Conclusions: Simulated Presence therapy is an intervention which uses recordings of a client’s family members to be played during care or at other times when responsive behaviours occur. This can be a meaningful way to engage caregivers and to enhance care for persons with dementia. Consideration should be given to who may or may not be appropriate for such an approach, and future research is warranted to further explore this unique element of a person-centred approach to care for persons with dementia., Background: Assessment of quality of life (QoL) of long-term care (LTC) residents presents significant challenges. People with dementia (PwD) may be unable to comprehend information being sought, lack insight into their own experiences, and be unable to formulate responses that express their perceptions of their own QoL. Yet they have been shown to be able to respond to such questions. Further, the perspectives of people with higher levels of cognition may not be well-served by instruments based predominantly on observation of behaviours and non-verbal indicators. Evaluation of the outcomes of care measures and performance improvement interventions is therefore challenging. A method of reliable and valid assessment of QoL of LTC residents is needed that is responsive to changes in clinical status, clinically feasible, an indicator of quality of care and performance, and a valid research measure. Objective: To compare and contrast selected measures of QoL of LTC residents in people with cognitive impairment levels ranging from none to severe dementia. This pilot study assessed the feasibility of a proposed protocol. Method: Instruments validated to assess QoL in PwD were compared and contrasted for validity and feasibility across levels of cognition in LTC settings. Seven instruments were selected for further evaluation. Twelve resident/staff member dyads were randomly selected and stratified based on cognitive status of residents (unimpaired, mild, moderate, severe impairment). All seven tools were administered to staff members. Two instruments were designed to be administered directly to PwD. Mini-Mental State Examinations were administered to residents. Semi-structured interviews were conducted in which resident and staff member participants evaluated the instruments in terms of representativeness of their concepts of QoL, formats of instrument items, relevance, and clinical feasibility. Preliminary qualitative analysis (open coding) was conducted. Results: Internal instrument consistencies ranged from Cronbach’s α = 0.678–0.914 (one outlier 0.039). Further quantitative analysis will be conducted on the subsequent full sample. In interviews, residents and staff members reported that instruments addressed all relevant domains; no omissions were identified. Both residents and staff members asked for clarification of various items within the scales. Preferences were expressed for scales with emphasis on observable behaviours and simplicity. Number of response options was not a determining criterion. Discrepancies were identified between residents’ self-evaluations and staff evaluations. Duration of caregiver data collection ranged from 31–66 minutes for testing and 5–23 minutes for interviews. Duration of data collection with residents was 15–33 minutes and 3–12 minutes, respectively. Residents with no, mild, and moderate impairment were able to complete the two instruments administered directly to them; none of the three severely impaired residents was able to complete the instruments. Caregivers commented that they found the data collection process to be long. Conclusions: Findings validated the feasibility of the proposed methodology. The number of instruments was reduced. Understanding of concepts and use of instruments was problematic. No single instrument was deemed appropriate across the cognitive range. Preliminary findings identify the need for a simple instrument in language easily understood by residents and staff with clearly expressed items based on objective observation of behaviours., Background/objectives: Low socioeconomic status (SES) has consistently been shown to increase the risk of developing Alzheimer’s disease (AD) and other dementias. Not surprisingly, a few studies have also linked low SES with an increased risk of mild cognitive impairment (MCI), a brain syndrome that often precedes dementia. However, it is not known what the relationship of SES is to the initial clinical presentation to a memory disorders clinic. We hypothesized that lower SES can lead to delayed medical attention and disease diagnosis and greater clinical severity at time of diagnosis, and be associated with reduced use of cognitive enhancers. Methods: Data from 127 AD and 135 MCI patients seen at a memory disorders clinic based in a large urban centre were analyzed retrospectively. We examined the relationship between SES and 1) the diagnosis of either AD or MCI; 2) the age of patients when they present to clinic; 3) objective cognitive tests using the Mini-Mental State Exam (MMSE) and Behavioural Neurology Assessment (BNA) to indicate clinical severity; and 4) the use of cognitive enhancers in patients with AD. SES was measured using the Hollingshead 2-factor index of social position, which is a linear scale from 11 to 77 that incorporates educational and occupational attainments, and is negatively correlated with SES. Upper and middle class (scores of 11–43) were compared with lower class (scores of 44–77) individuals. Results: AD patients had significantly lower SES than MCI patients (p < .001). Low SES was also associated with a greater age at initial time of diagnosis (U = 6006.5, p = .027). Among patients with MCI, those with low SES performed worse on the BNA than their higher SES counterparts after correcting for age (high SES: 91.4 ± 10.8; low SES: 82.4 ± 14.1; p = .005), although there was no effect of SES on the less comprehensive MMSE. SES did not affect cognitive scores in patients with AD. Lastly, the use of cognitive enhancers among AD patients was associated with higher SES (p < .001, r = 0.842). Conclusions: Individuals with lower SES presented more frequently with established dementia, while higher SES individuals presented more frequently with MCI. This, combined with the greater age found among low SES individuals, could indicate that low SES may lead to delayed referral to memory disorders clinics and delayed diagnosis of AD. Furthermore, higher SES is associated with better cognitive functioning in MCI patients and increased use of cognitive enhancers in AD patients, possibly because low SES patients come in too late to benefit from treatment. This has broad health policy implications in terms of developing strategies to engage patients with low SES in the early stages of dementia, perhaps through better identification of patients at the primary care level., Background: Home oxygen therapy is prescribed to people with various health conditions including lung and heart diseases, such as Chronic Obstructive Pulmonary Disease (COPD) and heart failure. Managing the use of oxygen can be difficult in patients with dementia who have cognitive and functional losses. Hypoxia can exacerbate confusion and worsen behavioural symptoms. Patients with cognitive impairment often have great difficulty to learn and remember how to use unfamiliar oxygen equipment properly. Mortality and readmission rate are high in this group of patients. The burden of symptoms significantly affects quality of life and health status of patients and caregivers. Older people with dementia who have medical co-morbidities require careful attention to minimize behavioural consequences and improve quality of life. Clinical management of these patients differs from the younger population and care professionals must adjust their management strategies to accommodate their special needs. Aim: Despite the fact that provision of home oxygen therapy is required by some older adults with cognitive impairment or dementia, there is no literature which describes the specific challenges and offers guidance to the provision of oxygen therapy. This study aims to explore the main issues associated with preparing older patients going home with oxygen therapy by inquiring the care providers’ perspective. Method: A total of 10 participants, including Physician, Respiratory Therapist, Physiotherapists, Occupational Therapist, Nursing and Social Work, participated in two focus groups. The participants from one group work in a local community hospital; the others work in the community sector. The focus group discussions were one hour each. The discussions were audio-taped and transcribed verbatim. Thematic analysis was undertaken to identify important themes and subthemes to reveal the challenges and specific areas for improvement. Results: Three broad themes emerged as main issues associated with preparing patients going home with oxygen. The first theme, ‘Education’, explored subthemes of Knowledge, Resources, and Barriers. For care providers in hospital, knowledge of equipment available in the community is needed to select appropriate equipment to meet varying needs of patients. The biggest barrier is patient-related factors including decreased cognition, visual and physical deficits, and language barriers that affect the learning ability of patients. Under the second theme, ‘Safety’, there were subthemes that considered environmental challenges and equipment. Participants reported high risk for falls due to long oxygen tubing in their homes and the manoeuvring of equipment. Other hazards include smoking, fire risks with gas stoves, and inappropriate levels of oxygen. The third theme, ‘Discharge Process’, discussed the subthemes of team collaboration, time limit, and home oxygen assessment. Participants consistently highlighted the importance of effective communication of information about patient’s cognitive, physical, and functional abilities, as well as safety issues to community teams. Conclusion: This study demonstrates that there is a need to improve current processes in order to provide patient-centred, safe, and efficient home oxygen therapy to geriatric patients, particularly to the group with cognitive impairment/dementia. Careful attention and adaptations are required to meet the special needs of this vulnerable population., Background: Environmental interventions are an untapped source of therapeutic potential. Given the fact that we have a burgeoning older population with dementia in acute hospitals, there can be great patient benefits and potential cost savings of utilizing environmental strategies to promote safe recovery, reduce loss of function, and avoid adverse events. Older adults with dementia have decreased ability to cope with environmental stressors; they are more sensitive to the impacts of environmental features. Research suggests that an environment that is safe, warm, and familiar not only supports cognitive and functional needs of older people with dementia, but may also contribute to improving quality and safety of care in patients of all ages. However, research on effective environmental interventions in the acute setting to support patients with dementia is lacking. Aim: Our study aims to: 1) provide a review of the literature to identify relevant evidence-based environmental interventions that may contribute to positive experience in older adults in acute hospitals, and 2) investigate the physical environment of a geriatric psychiatry unit in a community hospital to understand how physical environment may play a role in meeting needs of patients with dementia or other mental health needs. Method: We conducted a focused ethnography method on a 16-bed geriatric psychiatry unit in a community hospital. We began with a review of literature, an environmental scan, and a survey of 18 staff from different disciplines, including nurses, occupational therapists, and care aides. These guided our subsequent focused observations and interviews with patients and families. The sample included 7 patients (four of whom were diagnosed with dementia and three with depression/schizoaffective disorder), and 4 family members. We used purposive sampling to ensure we had a variety of patients with different behavioural symptoms and functional and psychosocial needs. A thematic analysis was conducted. Results: Our results demonstrate that physical environment plays an important role in impacting the hospitalization experience of older adults with dementia or other mental health needs and their families. The four inter-related themes of environmental qualities central in promoting healing and coping are: therapeutic; supportive in functional independence; facilitative in social connections; and personal safety. Therapeutic means the unit offers pockets of home-like environment and provides quality sensory stimulations. Supportive of functional independence refers to the environmental features that make it easy for older adults to use the bathroom, wash, groom, mobilize, locate places/rooms, and store personal belongings. Facilitative of social connection indicates the provision of safe and comfortable social spaces for patient, family, and staff to interact/engage in meaningful activities. The feeling of personal safety involves having staff in close proximity and minimizing disruptions (e.g., physical or verbal) from confused patients. Conclusion: The evidence indicates that physical environment plays an important role in making hospitals safe and supportive of healing for older adults with dementia and other mental health needs. Patients’ and families’ perspectives provide us with a better understanding of current challenges of the hospital environment and assist in identifying specific priorities and interventions to make improvement., Background: Alzheimer’s disease (AD) and depression share many common pathological features — for example, decrease in the number of synapses. The synapse forms an important communication unit between neurons to maintain neuronal viability and sustain whole brain functioning. Actin is the main cytoskeleton that forms the architecture of the synapse. Polymerization and depolymerization of actin allow actin filaments to constantly remodel and maintain synaptic plasticity. Furthermore, synaptic vesicle proteins involved in the docking and fusion of the vesicles to the membranes allowing for neurotransmitter release, including synaptophysin and synaptotagmin, are also important in maintaining synaptic function. Abnormalities in synaptic and cytoskeletal proteins have been observed in both depression and AD. Objectives: To investigate morphological and protein changes in the synapse after treatments with oligomeric beta-amyloid and corticosterone. Methods: 14-day-old hippocampal primary-cultured neurons were treated with either oligomeric beta-amyloid or corticosterone separately for 24 or 48 hours. Neurons were transfected with beta-actin to observe synaptic morphological changes. Immunocytochemical analysis was used to investigate changes in the vesicle proteins synaptophysin and synaptotagmin in neurons. FM4-64 dye was used to investigate functional changes. All of the above were imaged by multiphoton microscopy. Results: After treatments with oligomeric beta-amyloid or corticosterone, changes in beta-actin morphology were observed. Rod shaped actin began to form within the cell body, and also along and at the ends of dendrites. Oligomeric beta-amyloid significantly reduced the expressions of synaptic vesicle proteins, whereas corticosterone induced aggregation of these proteins. FM4-64 dye showed that the function of the neurons was compromised; more specifically, exocytosis appeared to be abnormal in the amyloid- or corticosterone-treated synapses. Conclusions: Our results show that both oligomeric beta-amyloid and corticosterone affect presynaptic vesicle proteins, cytoskeletons, and neuronal functioning. This may help to explain the decrease in dendritic spine number and dendritic regression observed in depression and AD. Moreover, such resulting neurodysfunction likely forms the basis of cognitive impairment seen in depressed and demented individuals., Background/Objectives: It is well established that persons with Alzheimer’s disease and their family care partners may hold differing views on how the disease has impacted various aspects of their lives. For example, previous research has identified discrepancies in care partner/receiver perceptions of depression, diagnosis, pain, values and care preferences, quality of life, and everyday functioning. One domain that has not been closely examined, yet which contributes to all other aspects of daily functioning, is a person’s ability to communicate. The present exploratory study investigated family care partner/receiver perceptions of the care receiver’s communication abilities in daily life. Methods: Seven participant dyads (care partner/receiver) were interviewed separately using the CLIMAT interview scale. Questions were asked regarding the care receiver’s abilities across four major domains: Social, Everyday Functioning, Cognitive, and Behavioural. The care partner and receiver interview data were transcribed and imported into Atlas-ti for coding. Open coding was undertaken to identify participants’ recurring comments and themes related to language and communication abilities, such as word-finding difficulty, repeating oneself, comprehension, initiating conversation, and engaging in social interaction. These themes were further analyzed to determine whether there were discrepancies between the care partner’s and receiver’s perceptions of functioning in each domain. Results: The results indicate that discrepancies were most apparent in describing the care receiver’s abilities to have meaningful conversations about recent events and to engage in social interaction outside the home. The differing views reflected care receivers’ underestimation of the impact of AD on their communication functioning. Possible sources of the diverging care partner/receiver perceptions include awareness and/or protection of self and others, and attitudes about the functional impact of AD. Conclusions: The differing views of care partners and receivers point to the need for them to have more open and ongoing dialogue about changes in communication ability and their potential impact on interpersonal interactions and quality of social life., Background: Preventing falls among older adults remains a focus of health professionals. While fall prevention and injury reduction initiatives involve many excellent, evidence-based strategies, these same strategies are not always applicable within a dementia population. Recent trends at a geriatric hospital reveal an increase in falls with critical injury with clients who have dementia and also exhibit responsive behaviours. This relationship between falls and behaviour indicates a need to explore possible interventions aimed at this population specifically. Clients who exhibit responsive behaviour often have underlying neurological conditions which may make traditional falls prevention strategies ineffective, as they are not aimed at the strengths of the client. Methods: As part of a larger Falls Prevention Initiative, a geriatric hospital implemented a three-month pilot project on two specific units involving strategies that were developed with a focus on the unique characteristics of each population. On one behavioural dementia unit, two falls prevention strategies: consistent, universal provision of hip protectors and a visual tracking of falls and falls with critical injury, were implemented for a three-month period. Results: Preliminary results from this pilot indicate that there have been zero falls with critical injury during the three-month period, and the average rate of falls is no different from the average falls rate observed during the past year. A visual tracking system, located in a lounge area in front of the care station, has been available for staff, clients, and families to observe and follow. Different team members were required to take on the duty of tracking falls, encouraging interprofessional accountability. Use of hip protectors was offered to all clients; however, many barriers arose to limit family members and staff from continuously implementing wearing of hip protectors over the course of the pilot project. Some examples of barriers include hip protectors limiting clients’ abilities to toilet themselves, clients exhibiting behaviours which may limit the effectiveness of hip protectors (e.g., disrobing, fidgeting, etc.), and having hip protectors contribute to responsive behaviours (e.g., restlessness). Conclusions: The pilot project has so far been successful, in that there have been no falls with critical injury observed on the unit and the number of falls has been regularly below the annual average. Having one universal strategy (hip protectors) has not been sustainable on this unit, due to individual differences within the patient population. The visual management strategy has engaged staff and families. While there is a trend in the number of falls in people who exhibit responsive behaviours, falls strategies need to be individualized as this population is highly heterogeneous. Taking a team approach, including team conferences and implementing collaborative interventions, helps to minimize the risk associated with falls in this population., Background: Older adults identify themselves by what they do and the activities that structure their lives (Laliberte-Rudman D, et al. 1997). People with dementia maintain this need for engagement, but are often unable to communicate their needs. A lack of attention to individual care needs may trigger responsive behaviours. The lack of coordination between care settings may exacerbate client’s behaviours when they move between care settings (Coleman EA. 2003). Methods: A geriatric hospital aimed to identify critical components of a process and develop a prototype to ease care setting transitions of patients with severe cognitive impairment and behavioural issues. A pilot project on the behavioural neurology inpatient unit in collaboration with the hospital’s Innovation, Technology, and Design Lab explored use of video communication across care settings. To showcase six clients’ engagement to subsequent care providers, videos were created of each client, depicting personhood, behaviour mitigation, and approach to care. A participatory action framework, based on the knowledge to action cycle was utilized (Graham ID. 2006). Focus groups were held with care providers at the discharge destination. Results: A thematic analysis was completed by the behavioural neurology unit and the Innovation, Technology and Design Lab which revealed three themes: 1) Video communication is valued as a medium for sharing client information; 2) Communication needs to be catered towards the discharge destinations, considering workload, culture, and accessibility; and 3) Staff value preserving client identities, through maintaining daily routines, incorporating their life story, and building connections with clients. Conclusions: The current process and lack of individualized care plans leave clients with unmet needs and decreases engagement. Care facilities value video, so long as it is tailored to the needs of the care setting and highlights the shared goal of preserving the client’s occupational identity. Enhancing communication through video technology is one strategy to help ease care transitions and support continuous meaningful engagement. Next steps include activating a Cloud—a portal that will allow staff in other institutions to access client information securely and enable better communication across settings., Background: Apathy and depression, two of the most prevalent behavioural disturbances in Alzheimer’s disease (AD), often contribute to decline in quality of life for patients and their caregivers. Symptoms of apathy and depression may be difficult to assess, particularly as cognition deteriorates. Our team developed the Visual Attention Scanning Technology (VAST), an eye-tracker which enables real-time measurements of attention patterns towards competing visual stimuli. Previous results suggest that VAST has the ability to distinguish between depressed patients without dementia and healthy controls. Using VAST in the AD population for the first time, we explored an objective method of assessing symptoms of apathy and depression that does not rely on patient verbal skills or caregiver reports. Methods: This is a cross-sectional study of patients with mild to moderate AD (NINCDS-ADRDA criteria; Mini-Mental Status Examination, MMSE). Participants were screened for significant depression (DSM-IV-TR; Neuropsychiatric Inventory, NPI depression, and apathy (NPI apathy). On a computer screen, participants were presented a series of 16 slides, containing 4 images of different themes (2 neutral, 1 social, 1 dysphoric), interspersed with filler slides. Patients were allowed 10.5 seconds to view each slide for a total test time of 20 minutes. Interest was measured using the number of fixations within specific images on a slide. Groups were compared using analysis of variance (ANOVA) and associations were determined using Pearson correlation coefficients. Results: Of the 37 AD patients (19 females, age =77.1±8.7, MMSE = 22.1±3.5) included in this preliminary analysis, 19 had neuropsychiatric symptoms (NPS, 12 significant apathy, 7 significant depression) and 18 had neither of these symptoms (non-NPS). These patients had comparable age, though depressed patients scored lower on MMSE compared with apathetic and non-NPS patients. There was a significant difference in number of fixations on social images between groups (F2,34 = 4.01, p = .027); specifically, apathetic patients were less interested in social images compared with non-NPS. No statistical significance was found between groups for dysphoric images (F2,34 = 0.35, p = .707). Higher apathy scores on the NPI were significantly correlated with decreased number of fixations on social images (r = 0.42, p = .009, n = 37). Conclusions: These preliminary findings suggest that interest in social stimuli using VAST can distinguish AD patients with different behavioural disturbances and is associated with severity of apathy. The results of this study will begin the development of a non-invasive and novel objective tool for evaluating apathy and depression severity in AD, which might also be a useful biomarker for predicting and monitoring treatment response., Background: Cholinesterase inhibitors (ChEIs) are considered the first line treatment for symptoms of Alzheimer’s disease (AD). Despite their modest efficacy, lack of data regarding long-term use, and potential for side effects, patients with moderate to severe AD on ChEIs tend to remain on these medications for long periods of time and often until death. This warrants the investigation of predictors of response to discontinuation of ChEI therapy to determine if, and for whom, it is appropriate. Methods: Institutionalized patients with moderate to severe AD (Mini-Mental Status Exam 2 years ChEI use were randomized, double-blind to ChEI continuation or placebo (with 2-week taper) for 8 weeks. Vitals: weight (kg), Clinician’s Global Impression (CGI), neuropsychiatric symptoms (Neuropsychiatric Inventory/Nursing Home Version [NPI-NH]), cognition (Severe Impairment Battery [SIB] and the MMSE), and safety (standardized symptom checklist) were monitored biweekly. Demographic and clinical characteristics were investigated at baseline. Results: To date, 25 patients (72% male, mean age 87.9±3.0, mean MMSE 6.8±5.2, mean NPI 17.6±13.6, mean CGI 3.8±0.7 at baseline) have been enrolled. Based on un-blinded results, patients were classified into two groups to determine whether baseline measures of vitals (blood pressure, pulse rate), weight, cognition (MMSE and SIB), and behaviour (NPI) were objective predictors of change in CGI status. When patients were grouped based on CGI status at study endpoint, a total of 8 (32%) patients worsened, while 16 (64%) showed no change and 1 (4%) had improvement. Preliminary data indicates that vitals (χ2 (3) = 4.642, R2 = .169, p =.200), weight (χ2 (1) = .864, R2 = .034, p =.343), cognition (χ2 (2) =.586, R2 = .023, p =.746), and behaviour (χ2 (1) =1.239, R2 = .048, p =.266) were not associated with CGI change in binary logistic regression models. As well, there were no predictors of change in behaviour (NPI) and cognition (MMSE and SIB). Conclusion: Thus far, there have been no baseline predictors of worsening. Once the recruitment goal of 60 patients is met and study treatment allocation revealed, placebo and ChEI continuation groups will be compared and predictors of response will be determined. Further assessment of predictors of improvement following ChEI discontinuation will provide data for guidelines for ChEI discontinuation., Background: Gait and cognition are interrelated. However, it is still unknown if there is a “motor signature” associated with cognitive dysfunction. Previous studies assessing older people with normal cognition, mild cognitive impairment (MCI), and with dementia have found that executive dysfunction is consistently associated with a slower gait. However, associations between episodic memory dysfunction and gait performance are inconsistent, and it is unknown if memory dysfunction, which is cardinal sign in MCI, is specifically associated with the gait disturbances seen in MCI. Objective: To determine whether gait performance in older adults with MCI differs based on their cognitive subtyping classification: amnestic type (aMCI) or non-amnestic type (na-MCI). Methods: Older adults (≥ 65 years) with MCI from the “Gait and Brain Study” were included in this analysis. Global cognition was evaluated using the MMSE and the MoCA. Specific cognitive domains were evaluated using a battery of neurocognitive tests: Trail Making Tests A and B, Rey Auditory Verbal Learning Test, Digit Span Test, and Letter Number Sequence Test. Gait performance was evaluated with the GaitRITE mat under usual and dual-task walking conditions (walking while naming animals out loud and walking while doing serials subtractions by 7). Participants were divided in aMCI and naMCI based on their episodic memory assessment performance. The relationship between cognitive group (aMCI vs. na-MCI) and gait variables was evaluated with linear regression modeling. Results: Sixty-four participants, mean age 77±6 years and 57.6% female were included. Forty-three were aMCI and 21 were na-MCI. Groups were similar in age, co-morbidities, level of physical activity, and history of previous falls. aMCI participants walked slower than na-MCI (98.5 vs. 112.1 cm/sec, p < .001). Multivariable linear regression, adjusted for age, gender, and executive function, demonstrate the aMCI group was significantly associated with gait dysfunction under dual-task testing and had a higher gait variability (p < .001), indicative of a more unstable gait pattern. Conclusions: Memory dysfunction, specifically episodic memory impairment, was associated with poor gait performance, particularly under dual-task test conditions. Associations were maintained even after adjustments for potential confounders in the multivariate logistic regression. Our findings suggest that there is a motor signature in aMCI characterized by slowing gait under dual-tasking and higher variability, which seems to be independent of executive dysfunction., Background: Extensive research in behavioural neuroscience has established that the hippocampus and the medial temporal lobe (MTL) systems are required to form new long-term declarative memory until slow consolidation processes allow neocortical networks to represent memory independently. Sharon et al. (2011; PNAS) demonstrated an important exception to this well-established theory by showing that adults with severe MTL amnesia were able to acquire novel arbitrary associations through Fast Mapping (FM). During FM, the meaning of new words and concepts is inferred by exclusion, and durable novel associations are incidentally formed. FM is most apparent during early childhood’s exuberant learning phase, but is also available to adults. Age-related changes commonly involve explicit memory decline that is correlated with hippocampal dysfunction. FM has never been tested in older individuals or neurodegenerative disorders. Objectives: Examine older adults’ ability to learn through FM, and the impact of dementia on such learning. Methods: Healthy older adults (OA), mild cognitive impairment (MCI), and Alzheimer’s disease (AD) patients performed an FM task. On each trial, participants saw pictures of two items—an unknown (e.g., umbretta) and a well-known (e.g., duck) item. They had to make a perceptual decision (e.g., “Is the umbretta’s beak purple?”) that required an inference about the association between novel labels and novel items. Sixteen new items were incidentally encoded in this way. Memory was tested using a 3-alternative-choice associative recognition task after 10 minutes and again after 1 week. A matched Explicit Encoding (EE) task was also used in which participants were simply asked to “remember the Caracara”, and testing was the same. Results: Similar to previous studies with young and middle-aged adults, OA perform better on EE than FM, but in addition they displayed moderate reductions in FM performance. AD and MCI patients demonstrated equivalent performance to OA when tested after 10 minutes following FM encoding, despite significant impairment on the EE task. By contrast, when tested after a week, FM gains were lost in AD, but not in OA or MCI. Brain behaviour correlations in AD and MCI patients showed that EE scores were correlated with hippocampal volumes and with clinical tests of episodic memory. By contrast, FM scores were correlated with neocortical regions such as ATL and specific frontal and parietal regions, and with semantic memory tasks. Conclusions: Our study concurs with that of Sharon and colleagues, that MCI and AD patients were able to learn new associations through FM despite an impaired episodic memory system. However, AD patients also demonstrated accelerated forgetting over a week. Interestingly, the pattern of correlations with brain volumes suggests FM is less sensitive to hippocampal atrophy and more sensitive to anterior and posterior neocortical degeneration that is also part of AD. These findings are in line with previous patient research that demonstrated learning through FM depends on the ATL probably due to its role in representing semantic associative networks. The data are consistent with the idea that acquisition of semantic information through FM and EE rely on distinct neural systems., Background: Dementia is a major predictor of the need for long-term home care and becomes increasingly common with greater age. Retirement living is an alternative residential option available to seniors that offers some support (e.g., cleaning, cooking, medical support) but is independent of provincial health services. Retirement living may facilitate physical and social activity among older adults by reducing health, social, and environmental barriers. Since regular physical activity is associated with slower cognitive decline, an increase in physical activity in retirement living may slow cognitive decline with age. Objective: The objective of this study is to (1) quantify changes in physical activity over the transition from community living to retirement living, and (2) describe the association between these changes and cognitive function. Methods: Older adults living in and on the wait-lists for retirement living were recruited for this study. Physical activity was assessed objectively with a tri-axial actigraph activity monitor and was self-reported using the CHAMPS questionnaire. Cognitive function was assessed using the MoCA and a 30 minute cognitive battery based on the vascular cognitive impairment harmonization standards, which assess cognitive domains including memory, executive function, and attention. Current residents participated in one assessment in which they reported current and past (prior to retirement living) physical activity; current activity was objectively measured. Wait-list participants reported physical activity and had both physical activity and cognitive function measured prior to and after their transition to retirement living. Discussion: Physical activity in retirement living will be compared to physical activity in the community using paired t-tests. The relationship between physical activity changes and cognitive function will be assessed with correlational analysis. Results: Sixty-seven percent of current residents increased weekly participation in purposeful exercise (e.g., aerobic classes, use of fitness equipment in the facility, and walking groups). Four residents reported beginning purposeful exercise activities only after the transition to retirement living. Conversely, the frequency of physical activity related to activities of daily living decreased among all residents. At this time, 10 wait-list residents have completed pre-transition assessments and will have post-transition assessments completed in the fall. These results will also be presented at the Canadian Dementia Conference. Conclusion: This study investigates the impact of a residential choice and alternative health care option (retirement living) on physical activity patterns and cognitive function. It is possible that this alternative care model may improve physical activity and thereby decrease cognitive decline and dementia among older Canadians., Background: In 2038, there will be 257,800 new cases of Alzheimer’s disease or a related dementia in Canada, equaling 756 million hours of informal care, and a projected economic burden of $153 billion for that year (Rising Tide: The Impact of Dementia on Canadian Society, 2009). The aging of the Canadian population has heightened the potential environmental, social, and economic impacts on those with dementia. Objectives: This paper focuses on the relationship between individuals with dementia and their environments. Specifically, it concentrates on improving quality of life for those with dementia and increasing the capacity of the existing urban spaces through safety, sense of community, equality of access and opportunity, and enabling independence. Discussion: The impact of public spaces on those affected by dementia is often overlooked in the academic literature and, more seriously, in public policy formulation. To help address the shortage of material on dementia-friendly public spaces, a review of the literature on dementia-friendly communities is included to produce recommendations for “best practices” addressing dementia, with special emphasis on dementia-friendly public environments. The paper then employs Penny McCourt’s ‘Dementia Policy Lens Toolkit’ to assess the new ‘dementia-friendly’ approaches in York, England in the context of the identified “best practices”. Addressing the questions: “How can we make our urban public spaces more dementia-friendly?’’ and ‘’What are the health implications of ‘dementia-friendly’ urban spaces?’’, the paper concludes with recommendations on implementing these best-practices in Canadian settings., Background: Recent prospective studies have shown that high Aβ amyloid is associated with a faster rate of memory decline in healthy older adults and adults with mild cognitive impairment (MCI). However, because these studies were conducted over shorter durations (i.e., 18 months), longer prospective studies are required to determine if Aβ-related memory decline is unremitting. Methods: Healthy older adults (n = 177), and adults with MCI (n = 48) underwent positron emission tomography (PET) neuroimaging using Pittsburgh Compound B (PiB) for Aβ amyloid, APOE ε4 genotyping, and cognitive assessment using Cognigram as part of their baseline assessment in the Australian Imaging, Biomarkers, and Lifestyle (AIBL) study. Cognitive function was reassessed 18 and 36 months later. Results: Compared to healthy older adults with low Aβ amyloid, healthy older adults and adults with MCI with high Aβ amyloid showed a moderate decline across 36 months on the Cognigram learning working memory composite. In contrast, adults with MCI and low Aβ amyloid showed a slight improvement on the Cognigram learning/working memory and psychomotor/attention composites across the 36 months. APOE ε4 carriage did not moderate the relationship between Aβ amyloid and cognitive decline. Conclusions: The results of this study suggest that in healthy older adults, high Aβ amyloid most likely indicates that AD-related neurodegeneration has begun. They also support the hypothesis that adults with MCI and high Aβ amyloid is indicative of incipient AD, while MCI with low Aβ amyloid may reflect the presence of other neurodegenerative or psychiatric processes. Once commenced, the rate of decline in cognitive function remains constant across the preclinical and prodromal stages of AD. Finally, the results indicate the sensitivity of the Cognigram learning and working memory composite to the effects of Aβ amyloid in non-demented adults., Background: Prospective studies show that in healthy older adults and adults with mild cognitive impairment (MCI), high levels of Aβ amyloid are associated with cognitive decline and more rapid progression to the next clinical disease stage. However, as yet single cognitive assessments or cognitive screening has not been able to differentiate non-demented individuals with low and high Aβ amyloid. Methods: Healthy older adults (n = 288) and adults with amnestic MCI (n = 56) enrolled in the Australian Imaging, Biomarkers and Lifestyle (AIBL) study, underwent positron emission tomography (PET) neuroimaging using Pittsburgh Compound B (PiB) for Aβ amyloid, and completed the Cognigram cognitive screen. Results: In healthy adults, performance on the attention/psychomotor function (d = 0.16) and learning working memory (d = 0.23) composites were equivalent between low and high Aβ amyloid groups. In MCI, performance on the attention/psychomotor function composite was equivalent between low and high Aβ amyloid groups (d = 0.21); however, performance on the learning working memory composite was significantly worse in the MCI high amyloid group compared to the MCI low Aβ amyloid group (d = 0.69). Conclusions: The data indicate that in MCI high Aβ is associated with more severe impairment in learning and working memory. In MCI, Aβ amyloid levels do not influence attention and psychomotor function. In healthy adults, cognitive screening is not sensitive to elevated amyloid levels. These data suggest that prospective cognitive screening may be necessary to identify high Aβ amyloid in healthy adults. However, in MCI more severe memory impairment can indicate that Aβ amyloid levels are abnormally high., Introduction: The objective of this study was to determine the role of music in promoting an enhanced brain reserve capacity in Franz Schubert and Maurice Ravel, two professional musicians who suffered from neurological disorders. Methods: We consulted medical journals, reports, historical reviews, memoirs, and books written in English describing the life of each composer, the progression of their disease, and its effects on their musical faculties. Results: Schubert suffered from a brain infection, most likely tertiary syphilis. In 1822, he experienced hair loss, skin rashes, ulcers in the mouth and throat, bone pain, and headaches—all characteristics of second stage syphilis. During this time however, Schubert composed numerous pieces, including “Die Schöne Müllerin”, which was written while being treated in the hospital. In the final year of his life, Schubert’s disease progressed to a tertiary phase where his brain was affected, resulting in chronic headaches, dizziness, paranoia, memory deficits, and eventually delirium. Despite the cognitive and physical deterioration, Schubert’s musical composition output remained intact with the completion of his last three piano sonatas just weeks before his death. In fact, Schubert was reported to have made corrections to Part II of his piece “Winterreise” a day before he died. Likewise, Ravel first exhibited symptoms of primary progressive aphasia with underlying corticobasal degeneration as early as 1927, about the same time as he composed his famous work, Bolero. His motor and cognitive deterioration accelerated following 1932 due to a car accident. Like Schubert, despite the onset of his cognitive decline, Ravel composed numerous works including his last two piano sonatas from 1929–1931 and “Don Quichotte à Dulcinée” a year after his car accident. Although his apraxia restricted him from composing music into the last couple of years of his life, his memoirs explicitly indicate that his musical sensibility was preserved. In describing his opera, “Jeanne d’Arc”, he claimed to have had so much music rushing into his head, but no way of physically expressing it. Likewise, Ravel retained the ability to remember his own music and identified errors in the performance of his work by other musicians. Conclusion: The literature on the preservation of musical competency in famous artists affected by various brain diseases such as frontotemporal dementia and Alzheimer’s disease is supported by our review on the musical integrity in Schubert and Ravel. We raise the hypothesis that the neural pathways recruited in composing and understanding music at a professional level are separate from those used in daily activities. These networks are unique in that they are resistant to neurodegenerative diseases. Therefore, music may serve as another basis for enhanced brain reserve capacity in artists., Background: Behavioural and psychiatric symptoms of dementia (BPSD) may disable a patient from performing activities independently; the reverse may be true in that losing independence may affect mood and behaviour. The purpose of this study is to investigate the association between function and severity of neuropsychiatric disturbance in the context of dementia. Methods: We analyzed data from a longitudinal study of caregiver informants responding to the Functional Rating Scale (FRS), Clinical Dementia Rating Scale modified for frontotemporal dementia (CDR-FTLD), Frontal Behavioural Inventory (FBI), and Neuropsychiatric Inventory (NPI). Participants granted 2–3 telephone sessions separated by at least one year. We performed bivariate correlations for the FRS and CDR-FTLD against the behavioural inventories and compared patterns among 3 subtypes of dementia and Mild Cognitive Impairment (MCI) who converted to Alzheimer’s disease (AD). Results: The dataset includes 20 sessions regarding 9 MCI converters, 194 sessions for 94 AD patients, 63 sessions for 28 behavioural variant frontotemporal dementia (bvFTD) patients, and 32 sessions for 14 primary progressive aphasia (PPA). For the total sample, we found positive correlations for FRS and FBI: r from .682 to .870, p < .01; CDR-FTLD and FBI: r ranging from .734 to .876, p < .01; FRS and NPI: r from .425 to .605, p < .05; CDR-FTLD and NPI; r from .442 to .544, p < .05. Among diagnostic groups, MCI converters showed the highest r values for all pairings of 4 instruments. Conclusion: This study indicates links between functional ability and severity of neuropsychiatric symptoms across several types of cognitive impairment. Further study will explore causality in the association, as well as seeking the relative roles of additional covariates, such as educational level or duration of illness., Background: Neuropsychiatric symptoms (NPS) are common in patients with dementia including Alzheimer’s disease (AD), vascular dementia (VaD), and mixed AD and VaD. The most common NPS encountered in dementia are apathy, irritability, agitation, depression, delusions, hallucinations, anxiety, disinhibition, and eating abnormalities (Cummings JL; 1997). These symptoms contribute to patients’ distress, caregiver burden and institutionalization. Different neurode-generative diseases may be associated with certain NPS, thus impacting treatment and care. Moreover, frontal lobe injury is often associated with development of NPS (Damasio A. In: Clinical Neuropsychology. 1993; Oxford University Press). Objectives: The aim of this study was to compare NPS in patients with AD, VaD and mixed AD and VaD, and to evaluate the differences in incidence of NPS in relation to frontal white matter hyperintensities (WMH). Methods: This was a retrospective chart review of 510 patients who presented to the Toronto Western Hospital Memory Clinic with cognitive complaints. Ninety-three patients with AD (McKhann GM, et al.; 2011), 34 patients with VaD, unrelated to stroke (Gorelick PB, et al.; 2011), and 54 patients with mixed AD and VaD who had a Neuropsychiatric Inventory (Cummings JL; 1997) score or data on NPS were included in the study. Binary logistic regression was used to determine whether diagnosis was associated with specific NPS. Left and right frontal WMH on the FLAIR images were manually segmented and their volumes calculated. One-way ANOVA tests were used to determine the relationship between NPS and the volumes of frontal WMH. Results: There were no significant differences in gender, education or MMSE (AD 21.7; VaD 23.8; mixed 23.8) between patients with AD, VaD, and mixed, but there was a significant difference in age with mixed being older (mixed 82.3±6.6, AD 76.6±10.2; VaD 75.3±10.2; p < .01). NPS were common in all three diagnoses. Controlling for age, VaD patients had significantly more agitation (p < .05; VaD 40%, AD 14%), aberrant motor problems (p < .05; VaD 31%, AD 12%), and sleep disturbances (p < .05; VaD 57%, AD 17%) than AD patients, but not more than mixed AD and VaD. VaD patients had significantly more depression than patients with mixed AD and VaD (p < .01; VaD 48%, mixed AD and VaD 20%). Irrespective of diagnoses, there was significantly more left, right, and total frontal WMH in those with delusions compared with those without (p < .01; delusions 1/0 = 519.4 mm3/181.2 mm3; 525.0 mm3/180.6 mm3; 1044.4 mm3/362.0 mm3, respectively). There was also more left, right, and total frontal WMH in those with hallucinations compared with those without (p < .05; hallucinations 1/0 = 400.4 mm3/193.3 mm3;405.7 mm3/192.3 mm3; 806.1 mm3/385.7 mm3, respectively). No other NPS were associated with WMH. Conclusions: NPS were prevalent in AD, VaD, and mixed AD and VaD, but their frequencies varied amongst the different dementia causes. Agitation, depression, sleep disturbances, and aberrant motor behaviour were most prevalent in VaD. Volumetric analysis revealed significantly more left, right, and total frontal WMH in patients with delusions and hallucinations versus those without these NPS. These differences are likely related to underlying pathology and warrant further study, as they have implications for treatment., Background: The ongoing pilot implementation of remote monitoring devices for dementia patients is facing impending dangers. The government perceives the initiative as an IT-based therapy for complementing pharmaceutical and non-pharmaceutical therapies, while health policy formulators are promoting the initiative because of its usefulness for tracking dementia patients. However, misconceptions are building up by the families of dementia patients and carers who will administer the surveillance therapy whenever it goes live regarding its compliance with best clinical practices in the areas of legal, data sharing, privacy, and security issues. Usually, experience shows that lack of acceptability and design flaws are central to the failures of most health service initiatives at the implementation and post-implementation stages over the years. Therefore, this paper investigates the aforementioned issues from the perspectives of families of dementia patients and carers. The results obtained suggest strategies for improving the success of the remote surveillance initiatives after implementation. Objectives: This study examined the perspectives of families of dementia patients and carers on resiliency, privacy, legal, and security of smart devices for tracking dementia patients. Tracking of vulnerable patients involves police and ambulance system. Thus, this study further seeks to proffer strategies for reducing the growing cost of managing dementia patients. Method: Thirty-six mental health and admiral nurses in UK and abroad participated in the survey. We introduce smart devices to them as knowledge-based systems for tracking dementia patients who are vulnerable to self-discharge. The inclusion and exclusion criteria are respondents that have experiences with patients officially diagnosed for early-onset dementia or late-onset dementia and with the following three characteristics: 1) acute dementia patients (ADP) are disorientated and confused patients, vulnerable to wandering, lost or putting family members, friends and carers into distress situations; 2) strong-minded dementia patients (SDP) are aggressive patients who discharge themselves against medical advices without referring to Mental Health Review Tribunal (MHRT) or certified by doctors; 3) isolated dementia patients (ISP) are patients that live alone and take care of themselves without recourse to relatives, friends or carers. Results: The degree of resiliency of smart devices if they are suddenly compromised by hackers is unanimous affirmed as an important issue to be investigated thoroughly. The results demonstrate that 86.10% of participants agree that some of the information regarding the patients can be adapted to many uses, while 44.40% believe that smart devices may have false positives detection rate. The results reveal correlations between IT-based therapy and continuous training, while 50.40% say patient’s health records are indirectly transferred to vendors of smart devices to manage. Conclusions: Continuous education and development of operational policies to cover privacy and security issues in the administration of smart devices are strategies to improve perceptions of mental health nurse, carers, and families. There is need to strengthen mental health laws to protect carers who will generally administer IT-based therapies. Unlawful accessibility to the devices and alerts they generate must be prevented using suitable Intrusion Detection and Prevention Procedures (IDPP) in accordance with best clinical standards., Background: The discovery of dementia sickness which often results into sudden declination or deterioration in the memory functionality and social functions of affected persons is a central problem in the social health-care services over the years. Several research findings have supported doll therapy in a recent decade. However, the methodology for applying doll therapy suffers moral criticisms in social care setting across the globe despite the benefits that are associated with the therapy whenever it is compared with pharmaceutical interventions. Firstly, critics are of the view that modelling specially loved personalities in the form of pets are deliberate attempts to reduce the dignity, worth, efforts, and invaluable contributions that the affected patients have done to the society during their active years. Secondly, conventional doll therapy is seen as dehumanizing and harmful to the mind of aspiring and productive youths. Thirdly, doll therapy is applied in fragments to patients without compliance to the best clinical practices. Consequently, this study proposes automated doll therapy for treating dementia patients in order to lessen the above issues. The results show that automated doll therapy has positive effects on society, patients, families, friends, and carers of dementia patients. Further analysis suggests that automated doll therapy is compliance to best clinical practices. Objective: The study reviews methodology for applying doll therapy against best clinical practices. Method: Thirty-four mental health practitioners, and 26 friends and family members of dementia patients volunteered to participate in the survey. The sample population were selected based on their experiences in in-patient wards in North, East, West or South of England. Participants were exposed to methods, strengths, and weaknesses of conventional and computer aided devices (CAD) methods for applying dolls to a group of dementia patients in a multimedia room within an in-patient. Thereafter, participants were interviewed on their perceptions on both methods. Their responses transcribed immediately. The perceptions of the respondents were repeated clarifications to improve data reliability and validity, and the results obtained were statistically analyzed. Results: Analysis of the results underpinned four hypotheses: 1) The perception that automated doll therapy will be better than the conventional method for managing dementia patients is high; 2) Automated doll therapy shows possibility of stabilizing emotions of patients with mild dementia problems to a certain degree; 3) Automated doll therapy suggests potential improvements in the perceptions of families, friends, and carers of dementia patients; 4) Automated doll therapy suggests positive impacts on social interactions among dementia patients in all age range of dementia patients. Conclusions: This survey suggests strategy for improving the efficacy and perception of families, friends, and carers of dementia patients on doll therapy irrespective of the ages of the patients. More so, 73.33% of the population sample agree that automated doll therapy is indicative of compliance to best clinical practices for treating dementia patients. Approximately 58.33% of the respondents elaborate health and safety issues, maintenance cost, training, and suitable space to set up a media room to implement the therapy as major barriers to the implementation of this framework., Background: Selective attention, the ability to maintain mental focus, declines across normal aging. This decline is exaggerated in Alzheimer’s disease (AD), which is reflected by increased reaction times and error rates on the Stroop task, a classic measure of selective attention. While it has been well established that impairment in selective attention is a common symptom of AD, often occurring early on in the disease, the neural correlates underlying these deficits remain elusive. The default mode network (DMN), a collection of functionally related brain areas, normally exhibits task-induced deactivation. However, this pattern of activation is altered in AD. We hypothesized that less DMN deactivation may contribute to errors in selective attention, especially in the AD group. Methods: Using an event-related Stroop task in a functional MRI paradigm, we tested 10 patients with mild Alzheimer’s disease (mean age 73.9±8.4) and 10 healthy elderly (HC) (mean age 63.6±7.8). To analyze failures of selective attention, we assessed the differences in neural activity preceding an incongruent error between HC and AD. Results: The AD group had significantly slower reaction time for incongruent stimuli compared to the HC group t(18) = −3.85, p < .05. The AD group also made significantly more incongruent errors than the HC group t(18) = −2.98, p < .05. The HC group showed greater activation in the left anterior cingulated cortex (ACC), left precuneus, left superior frontal gyrus, bilateral middle frontal gyrus, and right insula, all of which have been previously implicated in the Stroop task. In contrast, the AD group showed greater activity in more parietal and posterior regions, including the right lingual gyrus, right superior parietal lobule, and right inferior parietal lobule. Interestingly, the AD group also showed significant activity in the ACC and precuneus; however, this activity was lateralized to the right. Furthermore, the ACC activity in the AD group was more inferior compared to the HC group, and the precuneus activity was more superior to the HC group. Conclusions: While it is not surprising that the ACC was activated in both groups since its involvement in conflict detection, activation of different areas within these relatively large structures suggests that the ACC and precuneus are differentially affected by the disease. Thus the AD group showed more default mode network activity and the HC group showed more frontal activity preceding errors in the Stroop task. This result suggests that the neural correlates underlying errors of selective attention are different in AD than in HC., Background: Attentional lapses can occur on a daily basis and disrupt the completion of goal-oriented tasks. While the neural correlates of attentional lapses have been studied in young adults, it is unclear whether the mechanisms behind this phenomenon change with age. Methods: We scanned healthy young (n = 12) and older (n = 28) adults with functional magnetic resonance imaging while participants performed a trial-by-trial attention task, the Stroop task, where we measured the response time to each stimulus. We defined an attentional lapse as a longer response time relative to the average response time, and a fast reaction as a faster response time relative to the average. Results: Young and older adults performed equivalently on all behavioural measures, such as reaction time and accuracy (both p > .05). We found parietal regions in the default mode network, including the precuneus and inferior and superior parietal lobules, exhibited greater activity as reaction time to stimuli increased. Compared to fast reactions, attentional lapses were preceded by decreased activity in frontal attentional regions, including the anterior cingulate and inferior, middle, medial, and superior frontal gyri (all p < .05). These frontal areas also displayed significantly greater post-stimulus activity during attentional lapses compared to faster responses, potentially as a mechanism to recover from the initial lapse of attention. Older adults displayed reaction time-modulated activity in a greater number of frontal cortices and in more dorsal default mode regions, relative to young adults. Conclusions: Our results support previous research that activity in frontal and parietal regions of the attentional and default mode networks contribute to lapses of attention. Our results also suggest that the neural correlates of attentional lapses change with healthy aging, reinforcing the idea of functional plasticity to maintain high cognitive function throughout the lifespan., Objective: We investigated the relationship between the precuneus volumes (a component of the Default Mode Network or DMN) and cognitive scores, including scores of verbal memory, in older and younger adults to assess possible functional differences among age groups. Methods: A high-resolution anatomical scan was acquired with a T1-weighted, 3D MP-RAGE sequence in 30 older adults (21 cognitively normal and 9 patients with mild cognitive impairment or MCI); mean age 71.5 years and in 12 younger adults, mean age 23 years. Full cognitive testing had been administered to all subjects within 1–3 weeks of the MRI. The cognitive testing included the California Verbal Learning Test (CVLT), the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Exam (MMSE), and the Stroop test. Manual precuneus segmentation followed previously described anatomical guidelines, marked in the sagittal plane and then segmented in the coronal plane. Precuneus volumes were normalized by total intracranial volume (ICV). Pearson correlations were used to analyze the relation between precuneus volumes and cognitive scores. Results: Patients with MCI had significantly lower cognitive scores and precuneus volumes compared to the cognitively normal older control group and to the younger group. Among the 30 older participants there were highly significant correlations between the right precuneus and the CVLT short and long delay free and cued recall scores (SDFR r = 0.636, p < .0001; SDCR r = 0.593, p < .001; LDFR r = 0.551, p < .005; LDCR r = 0.634, p < .0001), and with the CVLT Learning Slope (LS) (r = 0.67, p < .0001). The left precuneus correlated only with the CVLT LS (r = 0.49, p < .01). There were also significant correlations between the Stroop, MoCA, and MMSE scores and the right and left precuneus volumes (p < .01 to p < .0001) among the older population, but there was no correlation between precuneus volumes and any of the cognitive scores in the younger population. Conclusions: The volume of the right precuneus appears to be related to scores of verbal memory in older adults but not in younger adults. Selective attention and scores of general cognitive function are also related to right and left precuneus volumes in older adults but not in younger adults. This may explain lack of deactivation of the precuneus during task performance among older adults., Background: We wanted to investigate whether amateur musical training and leisure playing can protect Alzheimer’s patients from degenerating their episodic memory for music, and to compare these effects with the deficits produced by Alzheimer’s disease (AD) using conventional memory measures. Methods: We recruited an amateur piano player with a 10-year history of studying music and the DSM IV diagnosis of probable AD. The patient was visited at his home each day for a week to conduct logical memory testing, as well as episodic memory testing specific to music. The logical memory section from the Wechsler Test was conducted at 1 and 15 minutes. Similarly, the patient was first shown the piece “A Winter Scene” and asked to sight-read the first 8 bars and then play the 8 bars with both hands from memory at 1 and 15 minutes. Results: The patient’s performance on the memory test was very poor at onset and showed no improvement over the course of the study. His ability to sight-read the 8 bars of music on the first day was intact and accurate. His immediate recall of the music on the first day showed accurate performance of the first 3–4 bars of music with notes played in both hands. From the second to the fifth day, the patient demonstrated difficulties remembering the melody line, especially in the left hand. The patient, however, was able to recall the right hand melody for the first 3–4 bars correctly on most days. Despite minimal improvements within the first five days, the patient’s performance on the sixth and seventh days reveals nominal improvements in musical expression. On the sixth day, he was able to recall four full bars of music with no errors in the right hand. On the last day, he accurately performed the four bars with both hands for the first time. Even when playing incorrectly, the patient remained within the music’s A-minor key. Conclusion: Our case study reveals differences in the way AD affects logical memory and episodic memory for music. The patient had deteriorated in logical memory, but was able to retain musical literacy, memory of music, music sensibility and, most importantly, the ability to learn music after repeated trials. Like our previous work on professional artists, our findings here suggest that exposure to music training and performance at an amateur level can preserve the brain’s memory networks involved in musical expression when faced with neurodegenerative disease., Background: Dementia is a highly prevalent condition among elderly residents in long-term care (LTC) facilities. BPSD can significantly increase both residents’ mortality risk and the burden on the health-care system. A large body of research has identified the importance of BPSD in the management of dementia in LTC. Yet very few studies have assessed the prevalence of BPSD in LTC as a function of the time of day during which symptoms are evaluated (i.e., day vs. evening vs. night). This is an important knowledge gap to be addressed, given that some symptoms may occur more frequently at or after dusk than during daylight hours, and that their emergence at a specific time of day may be associated with different risk factors. Objectives: To characterize and compare the prevalence of BPSD in a LTC setting as evaluated by front-line staff who work during the day, evening, and night shifts. Methods: As part of a larger study examining BPSD prevalence and incidence, we assessed neuropsychiatric symptoms of LTC residents over a 3-month period. Frequency and severity of symptoms over a 2-week window were assessed using the Neuropsychiatric Inventory Nursing Home Version (NPI-NH) during the day shift (07:00–15:00), the evening shift (15:00–23:00), and at night (23:00–07:00). The Cohen-Mansfield Agitation Inventory and the Pain Assessment Checklist for Seniors with Limited Ability to Communicate were also administered for all study residents. Results: A total of 72 residents were evaluated: 56 during the day, 44 during the evening, and 46 at night. Twenty-three residents were evaluated by staff from all three shifts, 24 by staff from two shifts and 25 by staff from one shift only. The prevalence of BPSD was 62.5% during the day, 68.2% during the evening, and 39.1% at night. Among residents who were awake at night, the proportion exhibiting BPSD was 50%. The percentage of residents identified as having more than 4 clinically significant BPSD symptoms increased significantly from 10.7% during the day to 34.1% in the evening (χ2 = 8.12, df = 1, p = .004), a possible indication of sundown syndrome. Agitation/aggression and irritability were the most frequently reported BPSD by all shifts, whereas apathy, anxiety, and sleep dysregulation were more frequently reported during the day, evening, and night, respectively. Conclusions: Our findings are consistent with data reported in previous studies which found BPSD prevalence in LTC as being above 60%, with agitation/aggression and irritability being the most common symptoms. We found evidence of an increased BSPD symptom load during the evening (sundowning) as compared with daytime, and a decrease in BPSD prevalence at night. Our results highlight the importance of considering the time of day during which BPSD symptoms are evaluated in LTC residents., Background: Older adults diagnosed with mild cognitive impairment (MCI) are considered as a high-risk population for progression to Alzheimer’s Dementia (AD) (e.g., Gauthier et al.; 2006), with a high conversion rate to AD (Chertkow et al.; 2008, Defranceso et al.; 2010)—up to 80%, within five years (Peterson et al.; 2004). Memory clinics in Canada offer clinical research trials to evaluate innovative treatment options, with a hope to ameliorate and/or delay disease progression from MCI to dementia. Multi-component cognitive training studies for MCI have yielded interesting results (e.g., Cipriani et al.; 2006, Talassi et al.; 2007, Rozzini et al.; 2007). One such promising technique was developed and validated by Belleville and colleagues (2006; MEMO program) for improving episodic memory function, subjective memory rating, and self-rating of well-being in amnestic MCI (aMCI) patients. Objective: Our study aimed to replicate the results of Belleville and colleagues (2006) with some modifications: 1) a bigger sample size, 2) inclusion of a wider range of MCI sub-types (not only aMCI), 3) inclusion of a Lifestyle Training control group to account for placebo effects and the impact of psychosocial interactions on cognition, and 4) the use objective primary outcome variables from CANTAB (Cambridge Neuropsychological Test Automated Battery) and neuropsychological tests. Methods: We conducted a pseudo-randomized clinical trial in which a treatment group (TR, N = 24, male =9) and a life-style training control group (Control, N = 20, male = 10) underwent a combined Relaxation/Tai Chi Therapy training for 3 weeks and a 6-week training using a modified MEMO method, while the Control group received 6 weeks’ health and lifestyle training program (e.g., discussing factors contributing to diabetes, the importance of exercise, how to prevent falls). All participants were older Francophone adults (age = 69.23±8.78 years, education = 15.50±4.34 years) referred to DMHUI Memory Clinic and having a diagnosis of one of the four subtypes of MCI. Significant medical, psychiatric, neurological or cognitive co-morbidities were ruled out. Participants were tested before and after intervention with cognitive screeners, computerized cognitive tasks, neuropsychological testing, and questionnaires about mood and subjective judgment of memory. Results: Preliminary results on Repeated Measure ANOVA controlling for age and education indicate a significant treatment (pre/post) effect (F(1,40) = 4.22; p =.047) and an age-by-treatment interaction (F(1,40) = 5.55; p =.023) on the CANTAB Short Reaction Time. A tendency towards a reduced number of errors (F(1, 3) = 2.99; p =.093) and improved strategy use (F(1,33) = 2.618; p =.115) was observed in the TR vs. Control group for the CANTAB Spatial Working Memory test. No effects were found on CANTAB Paired Associate Learning first trial memory score, Paired Associate Learning total errors, and Short Reaction Time Accuracy, or on formal neuropsychological testing of attention and memory, MMSE, MoCA, Squire Subjective Memory Questionnaire, mood, and self-esteem scales, when controlling for age and education. Feasibility and clinical implications will be discussed. Final results will inform about the effect of cognitive remediation and help determine best practice in the care of MCI patients., Background: Older persons with advanced Alzheimer’s disease or related disorders (ADR) receive numerous medications to treat an average of 21 health conditions. This is problematic given that the likelihood of drug–drug interactions and adverse drug events increase with the number of medications prescribed. Emergence of symptoms such as agitation, depression, constipation, and pain may in fact be due to adverse events caused by medications originally prescribed for the purposes of long-term prevention strategies. However, as ADR progresses, the objectives of care should shift from a curative to a palliative approach, and medication regimens should be revised and adjusted to reflect this change. There is limited research providing evidence with regard to the risk-benefit profiles of many medications for this specific patient population. Research evaluating interventions in which medication profiles are reviewed and adjusted in ADR patients is even more lacking, thereby underlining the need for new evidence-based guidance. Objectives: A scoping review of the literature and an ensuing Delphi panel were conducted to answer the following questions: 1. What criteria exist to determine whether a medication is still appropriate in patients with advanced ADR? 2. Which medications may be considered inappropriate for these patients? 3. Do interventions to optimize medication use in these patients currently exist? Methods: Phase I consisted of a scoping review (NICE, Cochrane Collaboration, Arksey and Levac). Thirteen scientific databases and websites of scientific and gray literature were searched in order to select articles for inclusion using an iterative process. Identified studies were analyzed by two independent reviewers. Studies were included if they were a guideline, review or a primary study, focusing on patients with ADR, at end-of-life, or the elderly, in either a palliative care, long-term care facility (LTCF), or unspecified setting. Letters, editorials, meeting abstracts or studies taking place in a hospital or ambulatory setting were excluded. In Phase II, a Delphi panel following the RAND approach sought consensus from 15 expert clinicians (family physicians, geriatricians, nurses, pharmacists, social workers, and an ethicist) to identify medications deemed inappropriate within the Quebec clinical care context. Interventions judged as promising and applicable were also identified. Results: The search strategy identified 6,186 references, of which 356 were retained after double screening. Forty articles were identified as being specifically relevant to the research questions at hand, among which 25 intervention studies provided evidence of small but significant reductions in potentially inappropriate medications, adverse events or medication load without associated consequences to morbidity or mortality. The Delphi panel produced three lists of medications: medications always appropriate, medications mostly appropriate, and medications rarely appropriate in these patients. The panel also identified promising key elements of a complex intervention to optimize medication use in this patient population. Conclusion: Medications frequently prescribed for patients with advanced ADR in LTCFs were categorized as being either always, mostly or rarely appropriate. Several key elements of multidisciplinary interventions involving patients, families, and care teams appear promising for improving medication use among this vulnerable patient population: a pilot study for such an intervention is under way., Background/Objective: Psychotic symptoms in dementia are associated with several negative outcomes, such as earlier institutionalization and increased caregiver stress. Most studies of psychosis in dementia have involved patients with moderate to severe cognitive impairment. Few have examined development of psychotic symptoms in patients who were non-psychotic at baseline. Knowledge of psychosis risk factors at the mild cognitive impairment or early dementia stage is important for understanding the mechanisms underlying psychosis in dementia, and for developing effective prevention and treatment strategies. Our objective was to examine factors associated with the development of delusions and hallucinations in a large sample of patients with an initial diagnosis of amnestic mild cognitive impairment (aMCI, CDR = 0.5) or early stage probable Alzheimer’s disease (AD, CDR = 1.0) who were non-psychotic at baseline. Methods: ADNI data for participants with aMCI (n = 397) or AD (n = 193) at baseline were examined. Individuals with psychosis at baseline were excluded, as were those who developed both delusions and hallucinations as their initial presentation of psychosis, resulting in a sample of 473 never psychotic and 79 who developed delusions (n = 56) or hallucinations (n = 23) as their initial psychotic symptom. The presence of delusions and hallucinations was ascertained from informant ratings on the Neuro-psychiatric Inventory Questionnaire (NPI-Q). Patients with/without delusions or hallucinations were compared with respect to demographic, genetic, and vascular risk factors (history of hypertension, baseline smoking) using chi-squared tests and t-tests. Results: A small minority of participants with an initial diagnosis of aMCI developed psychosis. Most of these (55.8%) had progressed to AD by the visit at which symptoms were first reported, with onset of psychosis typically occurring more than 6 months after dementia diagnosis (7.5 months for delusions, 13.2 months for hallucinations). In the combined aMCI/AD sample, more patients developed delusions (10.1%) than hallucinations (4.2%). Age, race (white vs. non-white), gender, baseline smoking status, history of stroke, and presence or number of ApoE-E4 alleles were unrelated to development of psychosis. Having a history of hypertension was associated with development of delusions, while patients who developed hallucinations had a lower level of education and lower baseline MMSE score (p < .05). Conclusions: Psychotic symptoms affect a significant minority of patients with early-stage AD. Hypertension was identified as a potentially modifiable risk factor for delusions in dementia. Participants who developed hallucinations had less education than those who were never psychotic, although the average person in both groups had some post-secondary schooling. Lower education is well-recognized as a risk factor for dementia in general, but the possibility of a relationship to hallucinations requires further evaluation. The finding of differing risk factors for delusions and hallucinations suggests that dementia with psychosis is not a unitary construct, and future studies should examine these symptoms separately., Background: The treatment and care methods used for Alzheimer’s disease (AD) operate within the perceptions of our culture; thus, developing care models for AD individuals is influenced by popular language and attitudes. Critical reflection of our culture and its influences unveils how it impacts beliefs and behaviours; from a health perspective, cultural biases could translate into certain diagnoses and treatment options prescribed by practitioners. Negative misconceptions about people with AD cause unhelpful behaviours that focus on the symptoms of dementia rather than the remaining abilities of the people affected. These misconceptions are reflected in the language associated with AD, which is consistent with the terminology used for “zombies” in media, reflecting our society’s negative views of aging with memory loss. This association is important since 81% of adult Canadians felt they would be treated and viewed differently if others knew they had received an AD diagnosis (Werner & Davidson; 2004). Objectives: This paper explores how references to zombies may limit care in North America by framing an individual as ‘dead’ rather than building upon treatments involving social approaches. This paper does not intend to imply causality, rather to associate the perception of AD individuals as zombified with the dominant care approach in North America. In contrast, Danish perceptions driving care are documented to highlight differing perspectives. Methods: Conducting a review of the zombie trope, its impact on stigma, identity, and care of those with AD, it was it was found that the ‘living-dead’ language was thematic throughout both lay and academic literature. Some examples that illustrate this theme include ‘living dead,’ ‘undead,’ and ‘death in slow motion’. Using this zombie language is not conducive to improving quality of life for those with AD. Results: Though attention for AD is increasing, it often propels a negative view through terms such as ‘living-death’. The presentation of AD in this way focuses on the fear of falling ill, rather than on the way persons with dementia are making the best of their abilities. The ‘living-death’ stigma correlates with the inhibition of developing social care approaches to AD treatment. Unfamiliarity and lack of knowledge incite fear about the illness, and if AD is continuously pushed away with negative stereotyping, we may never truly hear the voices of those with AD. The ‘living-dead’ perception of AD requires scrutiny because this popularised assumption shapes views, and continues to burden current AD practices despite the changes that we see occurring; discrimination and dehumanisation still need to be challenged. Conclusions: Treatment of dementia varies around the world, and through this exploration I propose that being reflective of our perceptions can lead to better quality of care for those with AD. All individuals exist within a dynamic web of relationships that form who we are and how we behave in the world; awareness of this interconnection reveals how our culture impacts AD., Background: The cognitive and neuropsychiatric symptoms associated with Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB), collectively known as Lewy Body Disease (LBD), are primarily treated with cholinesterase inhibitors (ChEIs). However, there is significant variability in adverse effects and response among LBD patients taking ChEIs. Objectives: To examine the efficacy of ChEIs in treating cognitive and neuropsychiatric symptoms of LBD longitudinally using brain perfusion SPECT. Methods: 53 patients diagnosed with PDD or DLB according to standard criteria were initiated on ChEI therapy and prospectively assessed for efficacy and adverse effects. A standardized neuropsychological battery, the Neuropsychiatric Inventory (NPI), and brain ECD-SPECT were ascertained at baseline (no treatment) and at 24 weeks. A repeated measures ANOVA design was used to determine change over time in these measures. Results: LBD patients treated with ChEIs showed significant improvements in visuospatial, attention, and phonemic fluency tasks (p < .05). They also showed significant reductions in the frequency and severity of visual hallucinations as assessed by the NPI-hallucinations subscale (NPI-HS; p < .05). Furthermore, as visual hallucinations diminished, perfusion in the right occipital lobe increased (r = −0.460, p < .05). Preliminary genetic analysis of the butyrylcholinesterase K-variant was not associated with response. Conclusions: Treatment with ChEIs was found to be effective in reducing visual hallucinations and improving cognitive function. The negative correlation found above suggests that perfusion in the occipital region could be developed as a bio-marker for use in distinguishing between LBD responders and non-responders to ChEIs in terms of visual hallucinations., Background: Retirement/residential homes (RHs) are a generally underappreciated component of the health-care system. A prevalence of > 70% dementia is recognized in long-term care homes, but the prevalence in RHs has not been established. The average age in both types of homes is approximately 86, and chronic geriatric conditions are common in both. In Ottawa, Ontario there are far more RH places (8,500) than long-term care beds (5,500). A previous study in an Ottawa RH showed recognized dementia in 40% and dementia screening was positive in an additional 32%. This study in the Prince of Wales Manor (POW) goes one step further in that specially trained nurses did a comprehensive cognitive assessment and, with geriatrician review, a diagnosis of normal cognition, mild cognitive impairment (MCI) or dementia was established. Methods: After resident/family consent,73 POW residents underwent: 1) chart review to establish residents with a diagnosis of MCI or dementia; 2) screening (Cognitive Quickscreen:CGS) of all residents without a diagnosis of MCI or dementia (the CQS was three-item: recall, clock drawing, and animal fluency); 3) cognitive assessment for those failing the CGS by trained nurse assessors (see assessment guide); and 4) diagnostic review by a geriatrician and resident attending physician to establish a cognitive diagnosis. Results: Chart review showed 30 residents with dementia (41%), 2 residents with MCI (3%), and 41 residents with neither (56%). The CQS results in the 41 remaining residents revealed 73% failure, 12% pass in all 3 items, and 15% refusal. The 30 residents failing the CQS and the 2 residents with MCI had comprehensive cognitive assessment, and provisional diagnoses were that 15 residents had dementia (22% of the original sample of 73 residents minus the 6 refusers). Additionally, 8 residents were felt to have MCI. Overall 45 of 67 residents (67%) were felt to have dementia, 8 (12%) had MCI, and only 14 (21%) were felt to be cognitively normal. Conclusions: Retirement/residential homes have a very high prevalence of dementia (67% in this study) with approximately 1 out of every 3 cases of dementia being unrecognized (15 out of 45 total). A cognitive screening and assessment program using a structured dementia assessment guide can be utilized in a time- and resource-efficient manner to address this important health-care issue. RH residents without a diagnosis of dementia or MCI should be screened for dementia at admission and regularly after admission., Background: The time required to complete a comprehensive geriatric assessment is significant, and the demand for specialized geriatric services is increasing through the current demographic shift in the Canadian population. Within a specialized memory clinic, more time is required to dictate detailed comprehensive geriatric assessment clinic visit reports. A timely report to the hospital electronic record is an essential element of good specialist care. To reduce report production time, an innovative solution was designed and implemented in the clinic’s new longitudinal research registry and documentation system. A novel approach to the automatic generation of a smart narrated synoptic report was developed allowing for reports to be autopopulated with the required patient data. Methods: Using computer-programming semantics, a report template was created for the initial assessment. The smart report template employed the use of algorithms to determine: 1) what clinical information will be reported; 2) whether the report will be in short or long form; 3) the specific places in the report where information from the clinical database would be injected; and 4) how the information is visually presented in the report. The wording generated in the smart report is determined through the logical analysis of the patient data collected. For example, depending on the context of the pronoun use, the gender (male/female) stored in the database indicates which version of the pronoun should be used. Results: These reporting algorithms can potentially have various steps of decision-making, or nodes, each with increasing complexity. When using a smart report template to generate a clinic report, each algorithm in the report is automatically evaluated by the system. The generated report shows the cumulative results from the algorithms as a complete, finished report. The user is presented with an automatically generated report that can then be modified and customized to meet any special needs for that particular report. The user may edit the final report by traditional keyboard, via dictation, or by inserting a report snippet. A report snippet is a predetermined piece of code which can represent a standard report element (e.g., a standard page letterhead), a data element extracted from the system (e.g., the patient’s birth date or referring physician’s name, etc.), or an automatically evaluated logic statement (as in the example of pronoun use above). Once inserted into the report, the report snippet is fully rendered, displaying the final report content which can be manually edited by the user. Conclusions: The use of the customized smart synoptic reporting solution has anticipated benefits on geriatric clinical practice. Since most of the report is automatically generated from a customized template, the amount of dictation time required is reduced. The use of this solution can improve report accuracy through the use of a standardized template, which can then be customized and sent to multiple recipients in short or long form. Smart reports can increase the timeliness of new reports, as reports can be generated at the end of the visit in short form with recommendations and instructions for patients and caregivers., Background: Current registries, information systems, and family practice electronic medical record systems are generic in nature and are not tailored to a specialist’s workflow or clinic needs. The use of an efficient data collection system, along with the application of an effective workflow model, can lead to significant improvements in the quality of health care provided to patients. We have developed a unique longitudinal web-based tracking system for patient treatment, outcome management, clinical reporting, and research. Methods: The system’s design was informed by health-care providers, a review of existing systems, and published literature. Several modules have been established to address the concerns of the adopting clinic, including: patient demographics, course of symptoms, co-morbid illnesses, medications, cognitive testing, physical and neurological examination, diagnoses, synoptic and detailed reporting, and data analysis for both clinical and research purposes. Conditional patient access provides an interactive model of care to the clinic and allows for future expansion with a patient portal. In a traditional system, baseline information is typically collected manually by a health-care provider using a paper-based form. These forms are transcribed or coded into an electronic database of patient record. This method of retrospective data entry leads to various quality control issues. To address this challenge, our platform was designed to be used not only with web-capable desktop and tablet devices, but with kiosk systems, as well. Various techniques were established to improve quality control and to ensure the accuracy of patient records. Demographic data can be imported or entered directly into the database by the patient, registration clerk or clinician. Furthermore, field validation is used to ensure that no data are missing or incorrectly filled. All data collection forms are clinical workflow oriented, with built-in secondary form validation, autocomplete, autosave, and dropdowns to facilitate fewer entry mistakes. Results: The resulting increase in quality control ensures accurate patient record entry—the more accurate the data, the more accurate the statistical analysis. The platform has been customized to provide the following system-wide features: side-by-side comparison of past and current information; real-time data entry collaboration between interdisciplinary team members; forms are modular in design to allow for easy expansion; look-up lists (e.g., national medication repository, clinic staff, past occupations, hobbies, standardized diagnostic codes from the US National Alzheimer’s Coordinating Centre); digital capture of cognitive tests; synoptic reporting; interactive progress notes and comments; simplified web-based modelling and statistical analysis tools. Conclusions: The benefits of utilizing such a registry platform can significantly increase both the quality of care provided to patients and the efficiency of clinical practice. Our registry can allow for the measurement of the quality of care indicators, reduce clinical and data-entry errors, and facilitate research since all clinical data can be analyzed statistically in real time., Background: Brain disorders that lead to aberrations of affect, cognition, and behaviour (ABC) constitute a growing and resource-demanding health crisis in Canadian society. The number of individuals with dementia, which is an important disorder of ABC, is rapidly increasing. Specialist input is often sought in the diagnosis and treatment of dementia. However, several specialties and subspecialties manage dementia, including geriatric medicine, neurology, geriatric psychiatry, and Care of the Elderly family practice. Other specialists, including neurosurgeons, are becoming involved in the management of dementia. Many of these specialists have either “learned on the job” or taken informal additional training to acquire special competency in the area, without standardization or formal recognition of that training. Creating a standardized training program for physicians wanting to acquire additional competency in disorders of ABC would assure quality of care and attract more physicians to this area, which will be needed to cope with the increased burden that will be posed by ABC disorders. Such training would gather specialists into a more harmonized community of practice in disorders of ABC, and could lead to the emergence of transdisciplinary knowledge and competencies that will allow trained physicians to better cope with these conditions, especially dementia. Methods: The Department of Psychiatry at the University of Toronto recently sponsored a meeting for a “grass-roots” group of specialists from across Canada, who all deal with disorders of ABC to a substantial degree in their practice. They explored the creation of a Royal College of Physicians and Surgeons of Canada (RCPSC) Diploma program in disorders of ABC. This presentation highlights the results of that meeting and forthcoming efforts. Results: There was broad consensus that such a Diploma program would be useful. The precise name of this field of training is still being debated, although the preliminary frontrunner is “Integrative Brain Medicine”. A consensus definition for this field of study was agreed upon. A “core” training program for the Diploma was proposed, to be accompanied by additional specific “streams” that trainees could choose to focus on, including one in dementia. Conclusions: A transdisciplinary team of medical educators, with the support of RCPSC, is developing a new Diploma training program to formally recognize training in disorders of ABC, including dementia, and to boost the number of physicians undertaking this training. This is a meaningful step to stem the “rising tide” of these disorders. The Diploma program proposed at the Toronto meeting is being refined with further input from interested stakeholders being sought and warmly welcomed, with the goal of presenting a full proposal to the RCPSC in the spring of 2014. Please contact the first author, Dr. Alex Henri-Bhargava, at alexhb@uvic.ca to participate., Background: Traditionally physicians have viewed mild memory complaints in older people to be benign. However, subjective memory complaints in people who have “normal” cognition on testing is termed Subjective Cognitive Impairment (SCI), a pre-MCI stage, and may last up to 15 years. Memory loss as a self-observed complaint is more easily identified than changes in executive function. Identifying people with MCI who are at increased risk for dementia/Alzheimer’s disease, and arranging for follow-up is the current best practice recommendation from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD3). For the last five years, we have advertised during Alzheimer Awareness Month (January) and Senior’s Awareness Month (June) for people 55 years and over who have memory concerns, who are interested in research, and who have not had a stroke. Objectives: 1) To classify the clinical suspicion of memory complaints in respondents and offer follow-up. 2) To complete clinical assessments in those with a clinical suspicion of MCI or dementia on case finding, confirm a clinical diagnosis, and offer research studies for which they may be eligible. Methods: Over the last 5 years a total of 166 people 55 years and over responded to newspaper advertisements with self-reported memory concerns. Participants received cognitive screening tests using the standardized MMSE, the MoCA, the 15-point GDS, the AD8, the Cornell Scale for Depression in Dementia, and the Lawton Brody Activities of Daily Living Scale. The test results were case-conferenced with a geriatrician and a clinical suspicion of SCI, MCI, depressive symptoms, mixed picture, possible dementia or other was given. All participants agreed for their test results to be sent to their family physician. Fifty-eight individuals have repeat measures on these tests from 2009 to 2013. Results: Of the 58 follow-up subjects, 45 returned for follow-up after one year and 29 returned for follow-up after two years. In 2013, of those 58 follow-up participants, 54% (31) had no change on their cognitive tests. However 33% (21) had declined over the 5 years and 10% (6) had improved. Of those who were given the clinical suspicion of SCI in 2009 or 2010, 39% had progressed to amnestic MCI or multiple-domain MCI. Those individuals who reported depressive symptoms in 2009 (32%) tended to have lower scores on the GDS and Cornell on follow-up visits. Individuals who declined follow-up appointments maintained that their memory was ‘fine’ and no longer wished to be followed. Conclusions: Of those who returned for follow-up, 33% progressed to MCI within 5 years; however, they only represent 35% of the total sample. Therefore a conservative estimate would be 12% of the participants progressed to MCI. It is uncertain whether those who declined follow-up represent individuals who have reverted to ‘normal.’ Limitations: 1) The participants are drawn from those who have insight to changes in their memory, therefore it may understate the total number; 2) 65% to date have elected not to return for follow-up., Background: A growing number of middle-aged individuals presenting with concerns of memory loss and decreased mental efficiency are being diagnosed with previously unrecognized attention deficit/hyperactivity disorder (ADHD). However, specific neuropsychological tools to differentiate adult ADHD from prodromal Alzheimer’s disease or mild cognitive impairment (MCI) are lacking. One of the core deficits that have been consistently associated with both childhood and adult ADHD is impairment in inhibitory control, as commonly measured using the Stop Signal Task (SST). One study has found mild differences in inhibitory control between MCI and normal controls (NC), but this is still being investigated. Deficits in visual working memory (VWM) have also been reported in both ADHD and MCI. These deficits can be examined using a task that specifically distinguishes random errors from errors due to the inability to divert attention from non-target objects to target objects during visual encoding. No previous studies have yet examined performance on these specific measures in adult ADHD and MCI. Objectives: The aim of the present study is to compare performance on both the SST and this VWM task between individuals with ADHD and MCI and examine potential correlations with regional grey matter volumes. We hypothesize that deficits in inhibitory control and VWM errors due to non-target responses will discriminate ADHD from MCI. Our second hypothesis is that ADHD subjects will show increased medial and lateral prefrontal cortical thinning and lower putamen and caudate volumes than both MCI and NC. Methods: 25 ADHD and 25 single and multi-domain amnestic MCI participants will be recruited from the memory clinic at Sunnybrook Health Sciences Centre. All participants will be assessed using the Adult ADHD Self-Report Scale-V1.1 and Connors’ Adult ADHD Rating Scale-S:L. The Albert and Peterson Criteria will be used to diagnose MCI. The SST will be administered to obtain measures of inhibitory control, response latency and variability, and error monitoring. Intra-individual variability will be studied using ex-Gaussian fitting, and error monitoring will be assessed based on the extent to which participants slow their response following inhibition failures. A previously described VWM task will be administered in which multiple items are presented in the visual field and the subject must recall the colour of a probed item. The proportions of target responses, non-target responses, and random errors will be calculated for each participant. Discussion: Results will be compared between groups using Analysis of Covariance (ANCOVA), correcting for age and education. Assessments of memory, attention, and executive function will be obtained through standard neuropsychological testing. Cortical thickness and grey matter volumes of targeted structures will be measured from structural 3D T1 MRI using a previously published semi-automatic pipeline. Partial correlations, controlling for age and education, will be used to assess the relationship between neuropsychological measures and brain volumetrics. Significance: This study will explore the utility of neuropsychological tools to differentiate ADHD among middle-aged patients presenting with memory complaints from MCI. This study will also provide the foundation for a larger project aimed at examining the relationship between ADHD and Alzheimer’s disease in the baby boomer population., Background: Vitamin D (25OHD) insufficiency has been associated with cognitive decline and dementia. In addition to comparatively worse global cognitive performance, individuals with deficient or insufficient vitamin D levels (less than 75 nmol/L) tend to perform worse on tasks of executive functioning. It remains unclear if “supratherapeutic” levels (100 nmol/L or greater) are associated with even better cognitive performance than sufficient levels. The present study sought to address this question, hypothesizing that executive functioning tasks would be most associated with vitamin D insufficiency (less than 75 nmol/L) and that cognitive performance would not differ significantly between those with sufficient and supratherapeutic levels. Methods: Healthy adults, at least 20 yrs of age participated in the winter phases of the D-COG (Nov. 2010–March 2011) and D-COG2 (Nov. 2011–March 2012) studies. Cognitive testing consisted of the Symbol Digit Modalities Test, Verbal (phonemic) Fluency, Digit Span, and CANTAB computerized battery. Body mass index (BMI) and mood (i.e., Beck Depression Inventory-II) were also assessed. Participants were also asked about vascular risk factors and physical activity. Serum vitamin D (25OHD) levels were analyzed via liquid chromatography/mass spectrometry. PTH, phosphorous, and ionized calcium levels were also obtained. Results: Data from the D-COG (n = 43) and D-COG2 (n = 99) were pooled due to identical study protocols. The 142 participants were 56.3±14 yrs old with 14.9±4 yrs of education and 71.8% female. They were categorized into the following three groups depending on vitamin D levels: Insufficient (less than 75 nmol/L; n = 73); Sufficient (75–99.9 nmol/L; n = 36), and Supratherapeutic (> 100 nmol/L; n = 33). Vitamin D levels were significantly correlated with performance on Verbal Fluency (partial correlation corrected for age, education, r = .23, p = .01), and the mean scores differed between groups: Insufficient 12.9±4.2, Sufficient 13.2±4.2, Supratherapeutic 16.7±6.6, ANCOVA(covariates: age, yrs of education), F(4, 140) = 6.30, p = .0001. Post hoc Scheffe analyses indicated significant differences between the Supratherapeutic and both the Insufficient (p = .002) and Sufficient (p = .01) groups. Vitamin D sufficiency status remained an independent predictor of Verbal Fluency performance, even after correction for multiple potential confounders including age, education, sex, BMI, amount of physical activity, vascular risk factors, and depression (linear regression, p = .001). Conclusions: Vitamin D levels were positively and linearly associated with performance on verbal fluency, a task that assesses executive functioning and language. Surprisingly, Supratherapeutic levels were associated with even better performance than sufficient levels on this task. Importantly, however, these sufficiency categories are based on bone health guidelines and the optimal level of vitamin D for cognition is not known. This study suggests that levels exceeding 100 nmol/L may be optimal for at least some aspects of cognition, including executive functioning and perhaps language. What effects vitamin D supplementation has on these and other cognitive domains is not known, but is currently being tested in a randomized supplementation study., Background/Objective: Impaired memory is a core component of Alzheimer’s disease (AD), and patients with AD have been shown to have increased impairments in working memory. Along with this loss in memory, patients also often experience difficulties in attention and, in fact, studies have posited that it is the attentional impairments that underlie many of the deficits in cognition and function seen in patients with AD. Our team has developed the Visual Attention Scanning Tool (VAST), an eye-tracker which enables real-time measurements of attention patterns towards competing visual stimuli. The objective of the present analysis is to observe the spontaneous visual scanning patterns of AD patients in the presence of novel and repeated stimuli using a modified n-back paradigm in order to explore working memory in a naturalistic setting. Methods: This is cross-sectional study of patients with mild to moderate Alzheimer’s disease (probable AD by NINCDSARDRA criteria, with a Mini-Mental State Examination score > 10). Visual attention was assessed using the VAST system. Patients were presented with 48 slides, each containing four images simultaneously presented. All four images have similar complexity, valance, and arousal. Two images on each slide were novel and two were repeats of images that were shown previously—repeats of one slide back (n = 1) and 2 slides back (n = 2). Images on each slide were arranged 2 by 2, with the position of the novel stimuli and previously shown stimuli randomly intermixed. Comparisons between and within groups were conducted using two way ANOVA. Results: 61 patients have been recruited to date (37 AD, 24 controls). Overall, the average age was 74.6±9.2 years, with patients with AD being older than controls (77.1 vs. 70.7 years). The average Mini-Mental State Examination score was 24.4±4.2, with AD patients having a lower score (22.1 vs. 28.0). There was a significant main effects of disease (F1,118 = 23.5, p < .0005) and image type (F1,118 = 79.3, p < .0005), as well as an interaction between factors (F1,118 = 9.6, p = .002) for relative fixation time in the 1-back condition. Similar results were found in the 2-back condition: disease (F1,118 = 10.6, p = .001) and image type (F1,118 = 5.2, p = .024) main effect, in addition to a significant interaction (F1,118 = 5.7, p = .018). Discussion: These preliminary data for our n-back paradigm of working memory suggest that the orientation towards novel stimuli observed in cognitively intact subjects was not observed in AD patients. These findings suggest that working memory deficits can be detected in AD patients without requiring verbal communication., Background: Neuropsychiatric symptoms associated with dementia present significant challenges to family caregivers and health providers, yet data illustrating variation in the prevalence and correlates of symptoms across care settings or by sex are scarce. We sought to estimate the prevalence and associated correlates of neuropsychiatric symptoms across home care (HC), long-term care (LTC), and complex continuing care (CCC) settings and by sex. Methods: Cross-sectional study of all HC clients (n = 470,183), LTC residents (n = 127,285), and CCC residents (n = 93,206) aged 50+ years assessed with the Resident Assessment Instrument (RAI-HC or RAI 2.0) in Ontario, Canada from 2004 to 2010. Multivariable logistic regression models were used to identify correlates of neuropsychiatric symptoms across care settings, for total samples and stratified by sex. Results: There were 100,500 (21.4%, 95% CI 21.3–21.5%) HC clients, 72,732 (57.1%, 95% CI 56.9– −57.4%) LTC residents, and 23,459 (25.2%, 95% CI 24.9–25.4%) CCC residents with a diagnosis of dementia. The severity of impairment associated with dementia generally increased from HC to LTC to CCC; however, there were important differences across care settings. LTC residents with dementia were significantly older, more likely to be women, to exhibit depression and aggressive behaviours, and to be receiving 1+ antipsychotics and/or antidepressants, whereas those with dementia in CCC (despite showing comparable levels of cognitive impairment to LTC residents with dementia) were more likely to be functionally dependent, to have significant health instability, and to have a recent decline in mood, apathy, anxiety (and use of 1+ anxiolytics), and loss of appetite. The proportion of persons with dementia exhibiting 1+ neuropsychiatric symptom(s) was higher in LTC and CCC (∼ 98%) than in HC (∼ 61%). Adjusting for age, cognitive and functional status, women with dementia were significantly more likely to exhibit depression and anxiety, appetite/eating issues, delusions (HC & LTC), and night-time behaviours (LTC). Conversely, men with dementia were significantly more likely to exhibit agitation/aggression/disinhibition, apathy (LTC & CCC), irritability, motor disturbance (CCC), and hallucinations (HC). The percentage of HC clients with a distressed caregiver was higher among males with dementia and for both men and women, increased with number of neuropsychiatric symptoms. The associations between age, functional and cognitive impairment levels, and selected neuropsychiatric symptoms were generally similar for females and males with dementia, although there were some notable differences. For example, female HC clients with dementia showed stronger associations between increasing cognitive impairment and agitation/aggression/disinhibition and irritability, whereas male HC clients with dementia showed stronger associations between increasing cognitive impairment and anxiety. Conclusions: We observed significant differences in the profile of neuropsychiatric symptoms among persons with dementia across care settings and by sex. These differences suggest the need for more targeted care planning and interventions to better prevent and manage select neuropsychiatric symptoms across the care continuum., Background/Objectives: Alzheimer’s disease (AD) leads to cognitive declines in language, memory, and executive function, affecting an individual’s ability to complete activities of daily living (ADLs) independently. At the moderate and severe stages of AD, there is a need for formal caregivers (e.g., a nurse, personal support worker) to assist residents with AD during the completion of self-care tasks (e.g., grooming and washing). Unfortunately, breakdowns in communication commonly occur between formal caregivers and residents with AD during ADLs, leading to strained communication interactions and task completion difficulties. The systematic examination of which verbal and nonverbal task-focused communication strategies caregivers’ use to support residents with AD during task completion has been done. However, there is a need for the systematic examination of (1) which communication strategies contribute to fewer communication breakdowns during daily tasks, and (2) which communication strategies effectively repair communication breakdowns when they do occur. This systematic observational comparison study aims to examine which task-focused communication strategies formal caregivers’ use to repair communication breakdowns that occur while assisting residents with moderate and severe AD during the completion of a basic ADL: teeth-brushing. Methods: Fifteen (15) formal caregivers (personal support worker = 14; nurse = 1) and thirteen (13) residents with a confirmed diagnosis of AD (moderate = 6; severe = 7) participated in this study. Participating caregivers and residents with AD were recruited from two different community-based, long-term care facilities. Established caregiver–resident dyads were observed during the completion of six separate teeth-brushing sessions (78 teeth-brushing sessions in total). Each teeth-brushing session was transcribed verbatim into the Systematic Analysis of Language Transcripts (SALT), a language analysis software program. Next, utilizing conversation analysis (CA) method and the trouble source-repair (TSR) sequence paradigm, communication breakdowns were identified. In addition to the identification of communication breakdown and repairs, instances of no trouble source-repair (NTSR) sequences were identified. Finally, the TSR sequences (i.e., trouble source, repair signal, repair type, and resolution) and the NTSR sequences will be coded. Descriptive statistics will be used to analyze the relative frequency of task focused communication strategies occurring during TSR sequences and NTSR sequences as a function of disease severity. Correlation analysis will be used to examine the relationships between the resolution of repair strategy (outcome) and the relative frequency of communication strategies as a function of disease severity. Results: Across 78 observed teeth-brushing sessions, 215 TSR sequences and 150 NTSR sequences were identified. Agreement analysis was performed on 20% of the transcripts using occurrence percent agreement. Two raters showed 92% agreement for the identification of TSR sequences and 92.4% agreement for the identification of NTSRs. The complete analysis of the TSR sequences and the NTSR sequences is currently underway. Conclusion: We will present results and conclusions at the 7th CCD. Findings from this study will help to understand further which communication strategies are most effective when assisting residents with AD during daily activities. Moreover, findings from this study will be used to help inform the development of evidence-based communication guidelines for caregivers assisting individuals with AD., Background: The NIMH-Provisional Diagnostic Criteria for depression of Alzheimer’s Disease (PDC-dAD) have been proposed over a decade ago. However only few studies examined the validity of depression scales, including the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Ãsberg Depression Rating Scale (MADRS), for this novel diagnostic approach to depression of AD (dAD). The validity of brief self-report scales with a parallel version for informant to provide collateral input for assessment of depression of AD has not been examined. Objectives: To study the validity of the Geriatric Depression Scale (GDS-30) developed for older adults and validated for the DSM [Major Depressive Disorder (MDD)] in detecting dAD, and to compare the subject (GDS-30) to the informant scale (GDS-IF-30). Methods: Subjects with AD and their informants, recruited at the UBCH-CARD (Clinic for Alzheimer Disease and Related Disorders) completed the GDS-30 and GDSIF-30, Neuropsychiatric Inventory (NPI) (informants), Quality of Life in AD (QoL-AD), and Montreal Cognitive Assessment (MoCA) (subjects). Subjects were assessed by a UBCH-CARD clinician for dAD according to the NIMH-PDC. Inclusion criteria were: a) subject meets possible or probable AD criteria (Mini Mental State Examination (MMSE) = 10 to 26); b) is able to communicate in English; c) has a knowledgeable informant who has contact at least 3–4 times/week. To examine concurrent validity, we performed ROC analyses on the accuracy of GDS scores in detecting a dAD diagnosis. To examine convergent validity, we computed correlations between GDS, NPI depression item scores, and QOL-AD. To examine discriminant validity, we performed correlations between GDS and MoCA scores. Results: The sample consisted of 21 subject/informant dyads (subject mean age = 71.33; mean education = 14.67; mean MMSE score = 22.2; 11/21 (53%) were men). Six subjects were found to have dAD (mean age = 69.33; mean education = 14; mean MMSE = 23.5; 50% were men) and 15 were non-dAD (mean age = 72.13; mean education = 14.93; mean MMSE = 21.6 (n = 14); 53% were men). The AUC for GDS-30 was 0.79 (p value = .027) with the optimal cut-off score of 8 (sensitivity = 67%, specificity = 80%, positive Likelihood Ratio of 3.33). For GDSIF-30, AUC was 0.83 (p value = .048) with the best cut-off score of 15 (sensitivity = 83%, specificity = 93%, positive Likelihood Ratio of 12.50). GDS-30 and GDSIF-30 were positively correlated (r = 0.635; p value = .05). GDS-30 and GDSIF-30 were inversely correlated with QOL-AD (r = −0.552, and −0.524, respectively). GDS-30 and GDSIF-30 were not correlated with MoCA (r = −0.043, and 0.047, respectively). Conclusions: The Geriatric Depression Scale based on subject and informant showed good accuracy in detecting dAD. The cut-off scores for dAD were lower than those reported for DSM-MDD. The correlation between GDS-30, GDSIF-30, NPI-depression item, and QOL-AD support the depression scales convergent validity. The lack of correlation between GDS-30 and GDSIF-30 and MoCA supports the depression scales discriminant validity. Overall, the study provides validity of inference for GDS-30 and GDSIF-30 with a limited sample of 21 dAD and non-dAD., Background: “Poster cortical atrophy (PCA) is a neurode-generative syndrome that is characterized by progressive decline in visuospatial, visuoperceptual, literacy, and praxic skills. The progressive neurodegeneration affecting parietal, occipital, and occipitotemporal cortices that underlies PCA is attributable to Alzheimer’s disease in most patients.”(Crutch et al., 2012; pg. 170.) The role of occupational therapy (OT) in Alzheimer’s disease (AD) is widely recognized, particularly related to memory. However, in some AD variants, such as PCA, the initial core clinical manifestation is progressive visual dysfunction and not memory. There is growing recognition for the importance of the OT role in the management of PCA, though few resources exist to inform practice in this area. Overview: A brief review of the clinical features and subsequent safety concerns of PCA will be provided, as well as the limited options for pharmacotherapy and non-pharmacologic therapy management. The OT role and general intervention strategies for patients with PCA will be presented, including a recently developed set of recommendations for OT intervention for use with patients experiencing AD-related visual dysfunction. The process of developing an OT specific resource for clinicians providing direct and consultative services for patients with AD-related visual dysfunction will be discussed. The interprofessional context of the tool and the tool itself will be reviewed with recommendations for its use, including practical visual aid interventions and adaptations that address 7 main areas of concern in relation to visual dysfunction in dementia. A brief description of an early stage, international systematic study looking at the effectiveness of visual compensatory strategies for this population will be discussed. Conclusion: While prevalence and incidence of PCA are currently unknown, with the rapidly expanding older population and forecasted increase in dementia in the coming decades, it is evident that the incidence of PCA will expand and subsequently the demand for OT services to optimize the independence and safety of this population at home. Occupational therapists who are experts in the analysis of function that are aware of the issues regarding PCA play a vital role in the management of this patient population for which no other management currently exists. While there is considerable research demonstrating the impact of visual impairment on ADL and IADL performance in the older adult population and the research examining the effect of OT in this area is growing, further research is required to measure the unique contributions of OT, especially for people with PCA, for which no research current exists., Introduction: Corticobasal syndrome (CBS) is a progressive, neurodegenerative condition typified by asymmetric motor symptoms (dystonia, rigidity, akinesia, myoclonus) in the setting of cortical sensory impairment, apraxia, and in prototypic cases, alien limb phenomenon. A diversity of pathologies including Alzheimer’s disease (AD), Lewy body disease (LBD), and cerebrovascular disease have been associated with CBS. Similarly, AD is itself associated with significant phenotypic variation and may result from an array of genetic mutations, in particular in presenilin-1 (PS1), presenilin-2, and amyloid precursor protein, all producing a highly aggressive, early-onset phenotype. PS1 in particular has been described in association with a heterogeneous phenotypic array, although not as CBS. Here we describe the first known association between a novel PS1 mutation and CBS in two brothers, one with right-predominant CBS, and the other with left-predominant CBS. These cases illustrate not only remarkable phenotypic mimicry, with an AD gene resulting in CBS, but also the phenotypic heterogeneity that may result even when the same causative mutation is present. Methods: Two brothers were assessed at the Sunnybrook Health Sciences Centre, Toronto, Canada between October 2008 and June 2010 (Brother RP: follow-up 11 months with 3 visits; Brother LP: 19 months with 4 visits). Both underwent detailed neurologic assessment including physical examination, screening blood work, detailed conventional neuropsychological testing, MRI (1.5 T), and SPECT (T99 ECD). Both brothers consented to and underwent post-mortem pathologic assessment, as well as genetic analysis by deep gene sequencing for PSEN1 mutations. Case Descriptions— Case 1: Right Predominant (Brother RP). RP was a 55 y.o. dentist with right arm myoclonus, dystonia, and mild rigidity for about 1 year prior to initial presentation. His wife also noticed word-finding difficulties, poor comprehension, and empty speech for 2 years, with significant apathy and depression emerging more recently. On initial examination he had impaired stereognosis and graphesthesia, subsequently developing significant apraxia. Based on these findings RP met criteria for probable CBS2. Post-mortem confirmed Braak stage VI/VI Alzheimer’s pathology. Genetic analysis demonstrated a PSEN1 mutation of phenylalanine to leucine at codon 283 (F283L). Case 2: Left Predominant (LP). LP was a 56 y.o. urban planner with left arm myoclonus and apraxia at initial presentation and left predominant akinesia and rigidity emerging 1 year later. Initial examination demonstrated impaired stereognosis and graphesthesia on the left. At last follow-up, he additionally had left arm and leg weakness, left facial droop, and left tongue fasciculations. Mood or behaviour was normal. LP’s speech was slowed at onset, eventually becoming nonsensical. Based on these findings, RP met criteria for probable CBS2. Post-mortem confirmed Braak stage VI/VI Alzheimer’s pathology. As with PR, LP demonstrated the same F283L mutation of PSEN1. Position-specific independent counts (PSIC) analysis yielded a score of 2.5, suggesting good likelihood of protein dysfunction resulting from this mutation. Conclusions: This is, to our knowledge, the first description of an autosomal dominant case of AD resulting in the CBS phenotype, caused by a novel F283L mutation in PSEN1. Further, these cases, presenting on opposite sides of the body, illustrate how phenotypic heterogeneity can occur despite identical genotype., Background: Elderly nursing home residents often have multiple medical co-morbidities and are prescribed numerous medications. With the use of more medications comes the risk of adverse drug reactions due to pharmacokinetic and pharmacodynamic changes, as well as drug interactions. Previous studies have found a relation between polypharmacy and a higher number of care problems (falls, pain, or constipation). There are various criteria regarding medications that are potentially inappropriate in the geriatric population, such as the Beers criteria; however, there seems to be less known about the use of medications and nutritional supplements which are generally not considered harmful, but may no longer be providing benefit, and which may be worsening quality of life, particularly in late dementia. Method: After appropriate ethics approval, we conducted a chart review on nursing home residents with advanced dementia (Fast Stage 7) living on dementia units at 4 nursing homes. De-identified data were sent to a clinical advisory team consisting of a pharmacist, a specialist in the use of nutrient supplements, a family physician with expertise in the care of the elderly, and a geriatric psychiatrist. The advisory team members completed standardized questionnaires regarding the appropriateness and potential problems with each medication and nutritional supplement, taking into consideration a clinical summary (prepared by the first author) on each study participant. A follow-up meeting with the advisory team reviewed and debated the results of the questionnaires and attempted to come to consensus decisions about the use of each medication based on the clinical context of each patient. Results were summarized by the first author. Results: Consensus was achieved on many, but not all, of the individual medications prescribed, with differences related to the clinical experiences and specialty of the advisory team member. Many vitamins were prescribed at excessive doses, while other recommended vitamins were not prescribed at adequate doses, or frequency. Reasons for administration of PRN medications were often not specified, contributing to the risk of prescribing of those medications for inappropriate reasons (such as using antihistamines for sleep or behavioural problems). Medications with a long time to benefit and significant adverse effects (such as statins) were prescribed in some patients, even those with short anticipated life expectancy and challenges with oral medication administration. Conclusions: In end-stage dementia there are many factors to consider when determining which medications may or may not be appropriate. Determining medication appropriateness is simpler when a particular medication is known to have significant adverse effects with little benefit. Choosing appropriate medications is more complicated when the medication has few or mild side effects, but a long time to benefit. Many of these patients have swallowing difficulties and medications can contribute to overall burden of illness., Background: Reaction to a diagnosis of dementia among patients and caregivers varies. Factors predicting reaction to such a diagnosis in a clinical setting are, however, not well characterized. Understanding of the contribution of such factors, possibly including psychiatric and other co-morbidities, knowledge of dementia, and degree of social support, may help guide individualized approach to disclosure. Methods: A comprehensive search of articles investigating reaction to a diagnosis of dementia was conducted. Results: The majority of research is largely qualitative consisting of semi-structured interview and limited to small numbers of patients. Many earlier studies revolved around the decision to disclose a diagnosis of dementia. Only one study, of absent or mild dementia, used a validated scale administered prospectively. Conclusions: Evidence outlining the factors contributing to reaction to a diagnosis of dementia is lacking. Only one study administered a validated scale, an unlikely component of routine interview and an uncertain outcome measure of reaction to diagnosis. There is a need to quantitatively explore the contribution of variables, (e.g., co-morbidity and educational level), including those gleaned on interview such as life reflection and strength of social support.

BACKGROUND: No treatments have been approved for primary progressive multiple sclerosis. Fingolimod, an oral sphingosine 1-phosphate receptor modulator, is effective in relapse-onset multiple sclerosis, but has not been assessed in primary progressive multiple sclerosis. We assessed the safety and efficacy of fingolimod in patients with primary progressive multiple sclerosis. METHODS: In INFORMS, a multicentre, double-blind, placebo-controlled parallel-group study, patients with primary progressive multiple sclerosis recruited across 148 centres in 18 countries were randomly allocated (1:1) with computer-generated blocks to receive oral fingolimod or placebo for at least 36 months and a maximum of 5 years. Patients were initially assigned to fingolimod 1·25 mg per day or placebo (cohort 1); however, after a protocol amendment on Nov 19, 2009, patients were switched in a masked manner to fingolimod 0·5 mg, whereas those on placebo continued on matching placebo. From then onwards, patients were assigned to receive fingolimod 0·5 mg/day or placebo (cohort 2). Key inclusion criteria were age 25-65 years, clinical diagnosis of primary progressive multiple sclerosis, 1 year or more of disease progression, and two of the following criteria: positive brain MRI; positive spinal cord MRI; or positive cerebrospinal fluid. Additional eligibility criteria included disease duration of 2-10 years and objective evidence of disability progression in the previous 2 years. Patients and study investigators were masked to group assignment. We used a novel primary composite endpoint based on change from baseline in Expanded Disability Status Scale (EDSS), 25' Timed-Walk Test, or Nine-Hole Peg Test to assess time to 3-month confirmed disability progression in study participants treated for at least 3 years. All randomised patients took at least one dose of study drug. The primary efficacy analysis included all patients in cohort 2 and those assigned to placebo in cohort 1. The safety analysis included all patients in cohorts 1 and 2. This study is registered with ClinicalTrials.gov, number NCT00731692. The study is now closed. FINDINGS: 970 patients were randomly assigned between Sept 3, 2008, and Aug 30, 2011 (147 to fingolimod 1·25 mg and 133 to placebo in cohort 1; 336 to fingolimod 0·5 mg and 354 to placebo in cohort 2). The efficacy analysis set (n=823) consisted of 336 patients randomly allocated to fingolimod 0·5 mg and 487 to placebo. Baseline characteristics were similar across groups and representative of a primary progressive multiple sclerosis population (48% women, mean age 48·5 years [SD 8·4], mean EDSS 4·67 [SD 1·03], 87% free of gadolinium-enhancing lesions). By end of study, 3-month confirmed disability progression had occurred in 232 and 338 patients in the fingolimod and placebo groups, respectively, resulting in Kaplan-Meier estimates of 77·2% (95% CI 71·87-82·51) of patients in the fingolimod group versus 80·3% (73·31-87·25) of patients in the placebo group (risk reduction 5·05%; hazard ratio 0·95, 95% CI 0·80-1·12; p=0·544). Safety results were generally consistent with those of studies of fingolimod in patients with relapse-onset multiple sclerosis. Lymphopenia occurred in 19 (6%) patients in the fingolimod group versus none in the placebo group, bradycardia in five (1%) versus one (

The opinions expressed in the abstracts are those of the authors and are not to be construed as the opinion of the publisher (Canadian Geriatrics Society) or the organizers of the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society. Although the publisher (Canadian Geriatrics Society) has made every effort to accurately reproduce the abstracts, the Canadian Geriatrics Society and the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society assumes no responsibility and/or liability for any errors and/or omissions in any abstract as published., Objectives: To identify current practices and care gaps for elderly patients admitted following a hip fracture, and to characterize patients’ patterns of functional recovery over 1-year. Relevance Increased awareness of existing gaps and improving our understanding of patients’ recovery can help optimize patients’ outcomes. Methods: Forty community-dwelling participants with an osteoporotic hip fracture (≥ 65 years) were recruited and followed over 1 year. Patients were divided according to their pre-fracture mobility: low, medium, and high. Recovery was defined in two ways: “traditional definition” based on return to pre-fracture mobility, and “acceptable” based on ability to do stairs. Statistical analysis: Single-subject design approach for analyzing small samples was used to identify sources of variability in recovery over time. Results: Some gaps in services received during hospitalization and at the time of discharge were: (i) 63% had a surgical delay > 48 hours; (ii) > 75% had inadequate osteoporosis management; and (iii) only 35% had a home visit within 1 week of returning home. Using the traditional definition for recovery: 80%, 52%, 33% recovered from the low, medium, and high baseline groups, respectively; 40%, 43%, 33% maintained this recovery up to 1 year. Using the definition for acceptable recovery, 20%, 43%, 71% recovered, respectively, and 10%, 38%, 57% maintained the recovery. Patients generally lost functional improvement between 6–12 months, following waning of rehabilitation services. Conclusion: Despite the plethora of guidelines specifically for osteoporosis management following hip fracture, gaps exist in care practices across the continuum. The extent of recovery depended on the definition however, after initial improvement, the majority of patients deteriorated after 6-months. A booster rehabilitation program is indicated., The language of aging is burdened with history. In this presentation, I consider “the grey tsunami”: a charged metaphor that has been urgently deployed over the past decade to describe the socio-economic threats posed by population aging. As a research associate in geriatric medicine and a PhD candidate in English Literature, I apply methods of literary analysis to interpret “the grey tsunami” as a timely example of interdisciplinarity’s darker side: specifically, how the overlapping language and textual practices of popular journalism, health policy, and literature co-operate to engender an ideologically-loaded, ageist metaphor masquerading as self-evident fact. My paper presents a concise and synthetic overview of the veiled meanings implied by “the grey tsunami” by conducting close readings of this term as recently employed by influential health agencies and organizations (e.g., CIHR, Alzheimer Society of Canada). I propose that the implications of this contemporary metaphor can be traced back to the mid-nineteenth century, when Western medical advances first made possible the reality of an aging population. I show that the deepest anxieties about population aging actually took shape in numerous poems and novels of that period—by esteemed authors including Matthew Arnold, Alfred Tennyson, Charles Dickens, and Anthony Trollope—which depicted society as morbidly “burdened” by an unprecedented, overwhelming, elderly mass. By charting the as-yet unexamined conceptual history of “the grey tsunami”, I aim to demonstrate how literature and the humanities—often viewed as a preventive measure against societal ageism—can also serve to legitimize prejudice toward older persons., Background: Frailty is characterized by increased vulnerability for falls, fractures, institutionalization, and death. Several models for identifying frailty have been developed, including Fried’s widely accepted Frailty Phenotype Index (FPI). However, the FPI can be time-consuming and difficult to apply in clinical practice due to the requirement of hand grip and gait measurements. Alternatively, a nine-category Clinical Frailty Scale (CFS), ranging from 1 (“Very fit”) to 9 (“Severely Frail”), has been proposed based on clinical information and physical exam. The CFS, to date, has not been validated against the FPI. We aimed to test the agreement between the FPI and CFS in identifying seniors with frailty in the community. Methods: 109 community-dwelling seniors, aged ≥ 75, were classified as “not frail”, “pre-frail” or “frail” using the FPI. Subsequently, two clinicians, blinded from the first assessment, determined frailty status in each participant using the CFS and differences in scoring were resolved by consensus. Inter-rater reliability was assessed using kappa statistics. Gamma Correlation coefficients compared CFS frailty status to FPI components in individuals. Results: Analysis of kappa statistics showed a substantial agreement among raters in applying the CFS (κ = 0.76, 95% CI = 0.68, 0.84). The CFS was positively correlated with an increasing number of FPI frailty components., Objectives: The Vitamin D in Osteoporosis (ViDOS) study is a knowledge translation intervention to increase best practices for osteoporosis and fracture prevention in long-term care (LTC), particularly widespread use of vitamin D supplementation. Methods: ViDOS is a cluster randomized controlled trial underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. Using baseline data on demographic, medications, and disease conditions collected from the pharmacy database, we evaluated vitamin D and calcium use for all residents in the study, and bisphosphonate use in high-risk residents (documented osteoporosis and/or a prior hip fracture). Results: 5,409 residents (71% women, mean age = 82.8 [SD 10.8]) were included. 87.5% of the homes are for-profit. The mean number of beds in the homes is 142 (range 43–378) with an average of six treating physicians per home. At baseline, 40% of all residents were taking Vitamin D (≥ 800 IU/day) and 33% were taking calcium (≥ 500 mg/day). Of 760 (14%) residents with documented osteoporosis, 62% were taking vitamin D and 51% were on a bisphosphonate. Of 351 (6.5%) residents with documented hip fracture, 58% were taking vitamin D ≥ 800 IU/day and 35% a bisphosphonate. Conclusions: At baseline, 60% of residents were not taking adequate amounts of vitamin D. Vitamin D and bisphosphonate use was higher in high-risk residents but was still sub-optimal. Identification of osteoporosis and fractures is essential to initiating appropriate treatment and preventing future fractures. Our analysis revealed a care gap in the recognition of residents with osteoporosis and prevalent hip fracture., Background: Aging is often associated with a gain in fat mass and loss of lean tissue, mainly muscle, which has been related to insulin resistance. Dietary protein intake is considered an easy approach to combat loss of muscle mass, but contrarily to plant source of proteins, animal proteins may increase the risk of insulin resistance. Objective: To elucidate the complex interrelationships of dietary protein intake, muscle mass, and insulin resistance. Methods: 441 non-diabetic, 68- to 82-year-old men and women of the Quebec Longitudinal Study NuAge with complete datasets. Muscle mass index (MMI; kg/height in m2) and percent body fat were derived from DXA and BIA. Insulin resistance was based on the HOMA-IR, physical activity on the PASE questionnaire, and protein intake and sources on three non-consecutive 24-h food recalls. Path analysis of a proposed model including age, sex, number of chronic diseases, and smoking served to identify if our theoretical causal pathway fitted with the data. Through several fit statistical indices, we attained a final model. Results: Significant, direct positive associations were observed for HOMA-IR with MMI (β = 0.42; 95% CI: 0.24; 0.6) and % body fat (β = 0.094; 95% CI: 0.07; 0.11), and for physical activity with muscle mass (β = 0.0028; 95% CI: 0.001; 0.004), but not for animal protein intake with MMI (β = 0.019; 95% CI: −0.006; 0.044) or HOMA-IR (β = 0.092; 95% CI: −0.03; 0.048). Significant, direct negative associations were observed for plant protein intake with MMI only (β = −0.068; 95% CI: −0.13; −0.003), and for physical activity with fat mass (β = −0.01; 95% CI: −0.021; 0.0). Significant, indirect associations were observed negatively for plant protein (xb = - 0.07; 95% CI: - 0.1; 0.0), and positively for animal protein (β = 0.0321; 95% CI: 0.01; 0.05) with HOMAIR mediated through MMI and fat mass. Our final model fitted with our data (Chi-Square = 4.83). Conclusions: Interestingly and contrarily to expectations, muscle mass and HOMA-IR were positively associated in these elderly participants. Results suggest that plant protein is beneficial for reducing insulin resistance but at the expense of muscle mass loss, whereas the reverse stands for animal protein. Physical activity has significant beneficial effects in body composition. These findings can shed some light on the directions to promote healthy aging through optimalization of protein diet and physical activity. (Supported by CIHR), Introduction: Mild cognitive impairment (MCI) is a heterogeneous condition affecting up to 40% of seniors. Almost a third with MCI will progress to dementia. Similarly, gait abnormalities, depressive symptoms, and executive dysfunction are commonly found in seniors, and this “triad” has been linked with brain ischemic lesions. To date, the presence of such a “triad” and its relationship with vascular risk factors (VRF) has not been described in MCI. We hypothesized that seniors with MCI who have high VRFs will be more likely to exhibit the “triad” of gait abnormalities, depressive symptoms, and executive dysfunction. Methods: Baseline data from 62 participants of the “Gait and Brain Study”, an ongoing prospective cohort of seniors with MCI at London, Ontario, was used for this project. Biannual assessments include executive function test (Clock Drawing and TMT B), quantitative gait analysis (velocity), and depression ratings (Geriatric Depression Scale), among other evaluations. VRFs were assessed at baseline using a modified Vascular Risk Factor Index which ranges from 1 to 7. Results: Forty-four percent of the participants had at least one VRF. There was a significant association between the number of VRFs and the presence of the triad (MANOVA, F(3,36) = 3.41, p = .025, controlled for age and sex). Conclusions: VRF were prevalent in our MCI cohort. VRFs were associated with the specified triad. A future prospective analysis of this cohort should elucidate causal mechanisms for this relationship. VRFs may play an important role in the development of cognitive, mobility, and mood dysfunction in people with MCI., Background & Objectives: Various explicit criteria exist for determining potentially inappropriate medications in older adults such as the Beers criteria. Our objective was to determine the nature and frequency of potentially inappropriate medications for patients admitted to Acute Care for Elders (ACE) units using modified Beers criteria, and the association with adverse outcomes with respects to patient mortality, readmission within 30 days, and length of stay. Methods: We prospectively studied consecutive patients 70 years or older admitted to the Acute Care for Elders (ACE) units at Vancouver General Hospital over two months. Detailed medication histories were obtained and outcomes data were tracked for each patient longitudinally. Results: A total of 168 consecutive patients were screened and 67 provided informed consent. An average of 6.2 prescription medications was used per patient. Of the total number of medications, 18 (7.4%) were deemed potentially inappropriate by modified Beers criteria, with 12 of 18 being considered to be of high severity for potential harm. For patients with Beers criteria medications, the median length of hospital stay was 15 days compared with 12 days in patients without Beers medications, despite similar frailty and co-morbidity indices. The mortality rate during hospitalization was 18.7% (3/16) among patients with Beer’s medications versus 9.8% (11/51) among those without. Conclusion: Inappropriate medications were used commonly in our cohort. Despite similar co-morbidity indices between groups, there was an association with a longer length of stay and increased mortality in patients with Beers criteria medications. Further outcomes-related studies are warranted to confirm the association we found., Introduction: The management of delirium includes a search for underlying acute medical illnesses, which may include urinary cultures. However, guidelines recommend only treating bacteriuria in the elderly if accompanied by urinary symptoms. This is based on RCTs showing no benefit in morbidity, mortality, or chronic urinary incontinence with routine screening or treatment of asymptomatic bactueruria, even in cognitively impaired individuals. The objectives of this study were to: (i) review the literature citing an association between urinary tract infections (UTIs) and delirium, and (ii) to look at the prevalence of treating asymptomatic UTI in a delirious medical in-patient population Methods: A MEDLINE search was conducted using the MeSH terms ‘urinary tract infection’, ‘bacteruria’ or ‘asymptomatic bacteruria’ AND either ‘delirium’, ‘confusion’ or ‘altered mental status’. Inclusion criteria included English articles, age > 65, and not undergoing a urological procedure. Data were used from a previously conducted prospective observational study of CAM-diagnosed delirium in consecutive medical in-patients. Data on signs and symptoms of infection, urinary symptoms, and whether a UTI was treated were collected from participants’ medical charts. Results: Studies (n = 65) relaying an association between delirium and UTIs were observational and lacked control groups. Preliminary results showed out of 315 delirious patients, 44% were treated for UTI but only 26% of treated patients had symptoms of a UTI or signs of an infection. Conclusions: Asymptomatic UTIs are often treated in delirious in-patients, despite a lack of good studies. This warrants further study., Introduction: TAVI decreases mortality and morbidity in older patients who are deemed inoperable or at high risk for surgical aortic valve replacement. Premorbid functional status and rates of geriatric-specific postoperative complications have not been well described. This study aimed to clarify these issues. Methods: Data collection occurred through the Division of Cardiology at St. Paul’s Hospital in Vancouver, Canada. Information on activities of daily living (ADLs), instrumental activities of daily living (IADLs), clinical frailty score (CFS), timed up and go (TUG), and a mini-mental state examination were collected prospectively by a study nurse. Patient charts were reviewed for medical co-morbidities, cardiac-specific metrics, pre-specified delirium criteria, complications, and discharge disposition. Results: Twenty-six cases were reviewed. The average patient age was 80 years and average Charlson Co-morbidity Index score was 3.5. Despite the advanced age and presence of significant co-morbidities, the incidence of delirium was low at 8% (2/26), with only 15.5% (4/26) receiving psychotropic medications during the hospitalization. All patients with available functional data were independent for ADLs at baseline (18/18), with 89% (16/18) requiring assistance with 2 IADLs or less. The mean scores on the CFS, TUG, and MMSE were 4, 12.8 seconds, and 27.9, respectively. Ninety-two percent (16/18) of patients were discharged home, with two patients going to a rehabilitation institution and eventually being discharged home. Conclusion: Appropriately selected older adults, with the functional and cognitive attributes noted above, appear to tolerate this procedure very well from a geriatrics point of view. Studies involving larger patient populations are warranted., Introduction: Socio-economic status is related to health both at the individual and country level. The health status of the older population of each country can be monitored by measuring its frailty status. Objectives: To examine the relationship between the Frailty Index (FI) and national economic indicators. Methods: 30,025 participants aged 50+ years (13,700 men, 16,325 women) from 12 countries (Austria, Belgium, Denmark, France, Germany, Greece, Israel, Italy, Netherlands, Spain, Sweden, Switzerland) which participated in the Survey of Health, Ageing and Retirement in Europe comprised the study sample. Following a standard procedure, an FI was constructed from 71 items. The economic indicators used for cross-country comparison were: gross domestic product (GDP), gross national income (GNI), health expenditure, and an inequality measure. Results: Across countries, the mean FI increased with age and was higher in women. Between countries, the mean FI ranged from 0.11 (Switzerland) to 0.21 (Israel). GDP, GNI, and health expenditure were negatively correlated with both the mean (r = GDP −0.85; GNI −0.86; health expenditure −0.86)., Introduction : Des travaux réalisés dans différents milieux de soins suggèrent que les personnes âgées qui sont atteintes de troubles cognitifs reçoivent des soins de moins bonne qualité. À partir d’une étude primaire évaluant la qualité des processus de soins offerts dans les UCDG du Québec, nous avons voulu vérifier si celle-ci était influencée par le statut cognitif. Matériel et méthode : Les dossiers médicaux de patients (n = 765) a dmis e n U CDG (n = 44) p our u ne c hute a vec traumatisme ont été étudiés. Le statut cognitif des patients (sans atteinte, n = 276; atteint, n = 489) a été déterminé par un gériatre. Deux dimensions de la qualité des soins, soit la globalité et la continuité informationnelle, ont été évaluées en mesurant l’écart entre les activités retrouvées au dossier et celles inclues dans deux grilles standardisées reflétant une prise en charge de qualité selon des données probantes et le jugement clinique multidisciplinaire consensuel. Des analyses de régression multiniveaux ont été effectuées afin de déterminer l’impact du statut cognitif sur la qualité des soins. Résultats : Les résultats pour la globalité des soins et la continuité informationnelle sont plus élevés chez les patients atteints (respectivement 4% (p < .001) et 2% (p = .054)). Ces dimensions de la qualité étant corrélées (Pearson, r = 0,391; p = .01), l’effet indépendant du statut cognitif sur la continuité n’est pas significatif. Conclusion : Les professionnels de la santé oeuvrant dans les UCDG dispensent un processus de soins de qualité égale ou même supérieure aux patients présentant des troubles cognitifs., Background: In response to challenges to recruiting older adults with Mild Cognitive Impairment (MCI) into a longitudinal study of on-road driving performance, we explored barriers and facilitators to their participation in driving studies. Methods: We conducted two focus group discussions with eight individuals with MCI. All participants held valid driver licenses and identified themselves as current drivers. The focus group discussions were audio recorded, transcribed, and analyzed according to standard qualitative coding techniques. Predominant themes were identified. Results: Primary barriers to driving research participation included the potential for punitive outcomes associated with poor performance on study on-road driving tests (e.g., mandatory reporting to participants’ physicians potentially leading to driver license removal), inherent biases associated with the on-road driving evaluation (e.g., inclusion of driving situations that the participant avoids), and a perceived lack of direct personal benefits. Research designs that offer participants with MCI the opportunity to receive training to improve their cognition, detailed feedback about their driving ability, and remediation for poor driving skills with an opportunity for an on-road re-test post-remediation were described as being facilitators of driving research participation. Conclusions: Driving study research designs that include on-road driving assessments that can result in negative outcomes such as potential license loss will likely fail in terms of recruitment of participants if they do not incorporate important elements that facilitate participation. These include offering driving remediation and follow-up on-road assessments to monitor progress. Participant recruitment can be maximized when the possibility of perceived biased and/or punitive outcomes are removed altogether., Background: The aging population challenges medical schools to improve geriatrics education to better prepare medical students for future practice. A fourth-ear geriatrics selective was planned as part of developing a comprehensive four-year undergraduate geriatric curriculum based on the Canadian Geriatric Society (CGS) competencies. Objectives: This survey aimed to identify medical students’ preferred methods of learning and content, in order to design an optimum geriatrics selective. Methods: All U of T medical students were invited to participate in an online survey consisting of 10 questions exploring preferred methods of teaching and content based on CGS competencies. Results: The response rate was 14.2% (n = 134). Most responders were female (73%), and were first, second, and third year students (33.3%, 31.1%, 24.2%); 46.7% were interested in geriatric medicine; 66% expressed interest in taking this selective due to demographic imperative; 56.6% preferred a two-week selective. Students showed interest in learning from staff physicians (93%), residents (87%), and interdisciplinary teams (76%). Preference was for bedside clinical education (94%), while less interest was shown in seminars (44%) or a manual (52%); in contrast, students favoured online resources (76%). Content areas preferred by students were biology of aging (97.1%), cognitive impairment (94.3%), health-care planning (93.4%), and medication management (88.7%). Least interest was shown in urinary incontinence (72.8%), adverse events of medications (76%), and transitions of care (80.2%). Conclusions: This survey provided insight into students’ preferences regarding a geriatrics selective. Students preferred clinical bedside experiences, taught by experienced clinicians, supported by online resources, with identified preferences for certain key content areas., Objective: Cognitive deficits are among the strongest predictors of function in younger adults with schizophrenia. The objective of this study is to assess the extent to which cognition also predicts functional abilities in older adults with schizophrenia. Methods: Community-dwelling individuals over the age of 50 who met DSM-IV TR criteria for a current diagnosis of schizophrenia (n = 76) and controls who did not meet criteria for a mental disorder (n = 34) were assessed with clinical interviews, neuropsychological tests, and functional measures. Cognitive ability was assessed using the MATRICS Consensus Cognitive Battery (MCCB). Functional competence was measured using the University of San Diego Performance Skills Assessment (UPSA), the Medication Management Ability Assessment (MMAA), the Performance Assessment of Self-Care Skills (PASS), and the Function and Disability Instrument (FDI). The schizophrenia and control groups were compared. Results: Demographic and baseline clinical, cognitive, and functional characteristics are reported for participants with schizophrenia and controls. The mean number of years of education was lower in the schizophrenia group than the control group. Participants with schizophrenia scored higher than controls on all clinical measures: the Positive and Negative Symptoms Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Simpson Angus Scale (SAS), and Subjective Well-Being on Neuroleptic Medications (SWN). Participants with schizophrenia also scored lower on all cognitive and functional measures. Conclusion: In future, analyses will be conducted to investigate relationships between cognitive and functional measures. Clinical measures will be controlled for as confounders to isolate the effect of cognition on real-life functional ability., Background: Since 1991, the Canadian Geriatrics Society has sponsored the biennial Summer Institute in Geriatrics (SIG) for Canadian medical students with the aim to improve awareness and encourage careers in geriatric medicine. However, the effectiveness of this program has not been evaluated. With recent fiscal constraints, it has been questioned whether there is ongoing merit in continuing the SIG. The objective of this study was to determine whether the SIG influences medical students to pursue careers in geriatric medicine, geriatric psychiatry, or care of the elderly and, if so, to what extent? Method: Past SIG participants were contacted by mail and invited to complete a survey containing questions about participant demographics, motivation for attending the Institute, residency training, influence of the SIG on career choice, ultimate career choice, and its perceived overall value. Results: Eighty-one physicians (54.4%) responded. Nineteen percent had current or planned careers in geriatrics disciplines, while 48% spent more than 50% of their time with adults over the age of 65. Seven participants are currently working as geriatricians, two as geriatric psychiatrists, and two as family doctors with care of the elderly training. Fifty-three percent were motivated to enroll in electives following the Institute, while 43% believed that the Institute influenced their career choice. All participants felt that the SIG improved their knowledge of geriatrics. Conclusions: Participants of the SIG do go on to have careers in geriatric disciplines. Those that do not still gain valuable knowledge that may be applied to the care of older adults in other disciplines. Participants provided several suggestions for how the Institute could be more effective at influencing career choice., There are urgent calls for care models that address the unique needs of geriatric patients, who are typically managed with several medications. Multiple-medication treatment regimens present many challenges for health professionals and patients. For health professionals, these challenges include those of reconciling the list of medications generated by multiple prescribers with the patient and often their caregiver(s) to ensure accuracy and completeness. For older patients, the challenges of understanding how to take multiple medications and the treatment burden imposed by complex medication regimens may result in poor adherence and poor health outcomes. Our objectives are to develop and assess new approaches to medication regimen reconciliation, consolidation, and simplification. Here, we present an interprofessional approach to medication reconciliation piloted in Project IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) for community-dwelling patients 65 years of age or older, with three or more chronic diseases and five or more long-term medications. A measure of medication regimen complexity (MRC), as the number of rules in the consolidated medication script, was also developed and validated in this study population. We present the protocol we developed for consolidating a medication list and reducing MRC, along with novel findings regarding the characteristics of medication regimens and associated issues for these older patients with multiple chronic conditions. These new approaches to medication management may be particularly useful in the person-centered care of the elderly., Transitions between health care settings are a high-risk period for care quality and threatened patient safety. This is especially significant for older persons with complex care needs, such as those with hip fracture or other musculoskeletal (MSK) disorders, as they often require care from multiple health professionals within and between care settings. To gain a better understanding of transitional care, we recruited older hip fracture patients from acute care and followed them as they moved through the health-care system. Participants were purposively sampled. At each transition, semi-structured interviews were conducted with the patients (N = 6) and members of their care network (N = 22). Transitions between hospital-based acute care and inpatient rehabilitation, as well as community-based home care and retirement living, were captured. Data were gathered and analyzed using a focused ethnographic approach. Facilitators and barriers of transitional care were identified from the perspective of patients, as well as their formal and informal caregivers. Important areas of interest that emerged included: continuity of care surrounding shift work and team-based care, insufficient time on behalf of the health-care providers to adequately communicate with their patients and each other, the impact of cultural competency on interactions within the care network, proactive strategies utilized by informal caregivers, and using health records to facilitate communication. A number of practical strategies for promoting successful transitions were also recommended by the participants., Delirium is an acute confusional state characterized by inattention, disorganized thinking, and perceptual disturbances. Previous research has shown that hospitalized elderly patients on a general medicine ward were more likely to develop incident delirium if they had baseline cognitive impairment, vision impairment, dehydration, and/or severe illness. Environmental factors likely play a role in delirium development. The primary study objective was to determine if room changes are associated with an increased incidence of delirium per patient days in elderly patients on a general medicine ward after controlling for baseline risk factors. Secondary objectives were (1) to determine if room changes increase the length of delirium in patients who had delirium at admission, (2) to determine if room changes increase length of hospital stay, and (3) to determine if bed-spacing and room characteristics affect these outcomes. Our study sample consists of patients 70 years of age or older who were admitted to the general medicine service at St. Michael’s Hospital between October 2009 and September 2010. A total of 1,384 patients met these criteria. A validated chart abstract abstraction technique was used to identify patients with delirium, and Decision Support data was used to identify room changes and bed spacing. So far, 1,354 patient charts have been abstracted. A total of 388 patients (28.7%) had delirium at admission, and 140 (14.5%) of the remaining patients developed delirium during their first week of hospital stay. We are expecting to complete data abstraction and analysis by the end of February 2012., Background: Women comprise the majority of the older population and have a greater burden of illness compared to men. This is evident in the home-care setting, where necessary services are provided to community-dwelling older adults. Whether the quality of these services differs between genders has not been examined. Objective: To determine if there are gender differences in home-care quality received by older individuals in Ontario and whether variations exist across planning regions. Methods: Retrospective cohort study using data from the Home Care Reporting System database using the RAI-HC Instrument. Study population: 119,795 Ontario home-care clients 65+ years receiving government-funded services from April 2009—March 2010. Home-care quality was assessed using validated indicators and risk-adjusted models developed by interRAI for decline in activities of daily living (ADL), cognitive decline, depressive symptoms, and pain control. For each indicator, unadjusted and risk-adjusted rates were calculated and stratified by gender. Results: All unadjusted quality indicators suggested gender differences. After risk-adjustment, 45.7% of women and 44% of men reported decline in ADLs; 50.8% of women and 50.5% of men reported cognitive decline; 11.9% of women and 11% of men reported depressive symptoms; 21.2% of women and 21.6% of men reported inadequate pain control. Rates varied 1.3- to 3.0-fold across planning regions after risk-adjustment. Conclusions: After risk-adjustment, no important gender differences exist in home-care quality. Differences in unadjusted rates between genders illustrate differences in health status and care needs. Regional variations in care quality across planning regions illustrate opportunities for improvement., Background: In Canada, 93% of older adults live at home and a substantial proportion of this population has complex and inter-related health and social problems. This sometimes renders them frail and homebound and poorly-served by predominantly office-based primary care delivery models. Several comprehensive and ongoing home-based primary care models have emerged internationally in order to address access-to-care deficiencies, postpone adverse health trajectories, and reduce overall costs for homebound elders. Objective: To identify the successful operational components of home-based primary care programs. Methods: We completed a systematic review of studies investigating home-based primary care programs for community-dwelling older adults that measured at least one of: hospitalizations, emergency department visits or long-term care admissions as an outcome of their intervention. Using the Cochrane, PubMed, and MEDLINE databases, 322 articles were identified and seven met our criteria for review. Results: The seven reviewed interventions were all based in the United States, with four emerging from the Veteran Affairs System. All seven programs demonstrated substantial effect on at least one of our inclusion outcomes, with four programs effecting two outcomes. All interventions were characterized by three common design principles: 1) house calls are made by the ongoing primary care provider, 2) the primary care provider leads an interprofessional care team, and 3) the program provides after-hours support. Conclusion: Specifically designed home-based primary care programs can substantially affect patient, caregiver, and systems outcomes. Adherence to the core design principles identified in this review could help guide the development and spread of these programs in Canada., Introduction: In Canada, 42% of cancer incidence and 59% of cancer mortality occur in persons aged ≥ 70 years. It has been reported that cancer is often under-treated in older patients due to co-morbidities, impaired functional status, and treatment toxicity. Objectives: The purpose of this ongoing study is to: 1) describe the health and functional status of the patient population referred to our Geriatric Oncology clinic, and 2) explore the reasons for referral and recommendations made. Methods: A chart review was conducted of 107 randomly selected patients who were seen in our clinic between 2006 and 2011. Data pertaining to demographic information, health, and functional status from the first visit were collected in a SPSS database. Health and functional status were assessed according to our Comprehensive Geriatric Oncology assessment consisting of co-morbidities, medications, functional status (ADLs, IADLs, ECOG), social support, cognition (MMSE Folstein, Montreal Cognitive Assessment test-MOCA), mood (Geriatric Depression Scale), mobility, nutritional status, and strength (grip strength by dynamometer). Descriptive techniques such as frequencies, means, and proportions were used for the statistical analysis. Results: In our sample of patients, lung, breast, and gynecological malignancies were the most common tumour sites. Average age of patients seen was 79 years old, and the majority of patients were referred for cognitive impairment (50.5%) and opinion on treatment plan (34.6%). As a result of our evaluations, we have uncovered and addressed previously undetected problems, such as mild cognitive impairment, dementia, polypharmacy, and mood disorders., Background: Given the growing proportion of older people, the prevention of cognitive decline is an important issue for patients, clinicians, and policy makers. There is significant interest in finding the “magic bullet” which will keep us cognitively intact for as long as possible. Objective: To complete a systematic review of the literature to determine the effectiveness of pharmacological therapies for preventing cognitive decline in healthy older adults and in those older adults with mild cognitive impairment. Methods: We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from date of onset to August 2011. No restrictions were placed on date of publication. Publications were excluded if they were not randomized control trials or systematic reviews, were not examining older adults (age > 65) with normal cognition or mild cognitive impairment, if they did not list adverse outcomes of their interventions, or if they were published in a language other than English. Two investigators independently completed study selection, quality assessment, and data abstraction. Quality assessment of articles was conducted using Cochrane Risk of Bias. Our initial search yielded 3,882 potential articles. An abstract review by two independent reviewers narrowed search results to 226 articles that met inclusion criteria. Further assessment of full-text articles resulted in 45 articles for data abstraction and analysis. Data synthesis is underway and will be completed by April 2012. Conclusions: While final results of the systematic review are currently pending, it is evident from our preliminary results that there are very few high-quality studies that demonstrate any successful interventions to prevent cognitive decline in older adults., Purpose: Few data are available regarding the utilisation of radiation therapy in patients aged 90 years and over. This study examines the utilisation of radiotherapy in this population. Methods: The clinical records of every nonagenarian referred at the Department of Radiation Oncology, CHUQ - L\’Hôtel-Dieu de Québec, between April 1, 2010 and March 31, were retrospectively reviewed. Results: Twenty-five nonagenarian patients with median age of 92 were seen in consultation. The majority had skin or rectal cancer. The tumors were early stage in seven patients, locoregionally advanced in five, recurrent in two and systemic in eleven. Six patients received radiation at more than one sites. 92% had their cancer pathologically proven and most of them in the same year as their referral in radiation oncology. Nine patients had a previous oncological surgery and none received chemotherapy. The intent of radiation treatment was definitive in six patients. Five treatments were not completed as planned. Polypharmacy, comorbidities, and dependance level for ADL and IADL were usually mentionned in the consultation report. Other geriatrics syndroms such as history of fall, cognitive impairments, depression or delirium were less frequently mentionned. Half of patients had a follow-up visit. Five patients had a complete response and nine had a partial response. Only five patients had toxicity; low grade dermatitis or diarrhea. Nine deaths occured, at a median time of two months. Conclusions: The current review showed that radiation therapy can be feasible and tolerable in nonagenerians. When applicable, definitive radiation therapy should also be considered., Background: Despite a looming demographic imperative, clinical rotations in geriatrics are not mandatory in North American undergraduate medical training. This is based on the rationing premise that, given curriculum time pressures, medical students can acquire geriatric competencies in clinical rotations with a significant number of older patients. We explored the clinical and teaching discussions regarding older patients on one such unit, the Internal Medicine Clinical Teaching Unit (CTU). Methods: Focusing on the admission case review and discharge summary, we asked: 1) What medical issues are emphasized when the CTU team cares for older patients? and 2) What geriatric core competencies are addressed? Using a multiple case study approach, over two separate 8-week periods we collected 19 cases of patients admitted to one of three CTUs. Case materials included transcripts of audio-recorded case reviews and de-identified patient discharge summaries. Results: 15 of the 19 patients were aged >65; these underwent inductive analysis for issues emphasized during review, and deductive analysis for geriatric content that could have been discussed according to Canadian undergraduate geriatric core competencies. Discussions focused narrowly on the patient’s chief complaint and the interpretation/correction of abnormal lab values. References to geriatric core competencies were infrequent, as was teaching regarding geriatric issues. Conclusion: While trainees regularly encounter patients with geriatric issues on CTU, these issues are rarely emphasized during case review. Similar findings are likely on other rotations where older patients are cared for, calling into question the suitability of current curricular rationing decisions pertaining to geriatrics teaching., Our health care system exists in “silos” of functions and services carefully marking out turfs. Patient safety, quality of experience, and consistent positive clinical outcomes will remain challenged in this fragmented system. Communication between the various system segments is often poor and creates confusion leading to mistakes and threatens consistency of care, especially for the most complex and vulnerable – our seniors. The North Perth Family Health Team, Listowel, Ontario serving a population of approximately 17,000 has created a model to support seniors and families with navigation and transition from sector to sector. A Nurse Practitioner, with specialized geriatric education, works closely with primary care physicians, consulting geriatrician, hospital, community agencies, and retirement homes by providing assessments where the senior is located. Regular visits are made to the local retirement homes every two weeks, the hospital weekly, a geriatric clinic with the consulting geriatrician monthly, and office and home visits as needed. Education is provided concurrently with these services, as part of chronic disease management. The patients’ electronic health record can be accessed in all of these settings to ensure that information is not duplicated and that documentation and communication can occur efficiently. This model of providing Complex Geriatric Care can be easily replicated in small Rural communities for enhanced efficiencies and concerted patient care., Background: Gait velocity is a strong identifier of physical frailty. However, it has been postulated that gait variability can be more sensitive to subtle impairments and may help in early frailty detection. Gait variability measures gait regulation, and high variability predicts falls, fractures, and cognitive decline even when gait velocity failed to do so. Thus, high gait variability may reflect an increased vulnerability in early stages before frailty is complete manifested. Associations of gait variability with frailty models which do not use gait velocity as a frailty component, have yet to be determined. Methods: Our sample included 106 community-dwelling older adults, aged ≥75. Frailty status was assessed using the 9-category Clinical Frailty Scale (CFS), a validated model which does not include the gait velocity criterion in identifying frailty. Quantitative gait variables were assessed under “usual” and “fast” pace using an electronic walkway. Linear regression analysis evaluated association between CFS levels and gait variability. Results: Frailty status ranged from 1 (“Very Fit”) through 6 (“Moderately Frail”). Increased frailty status was significantly associated with higher variability in stride length (p=0.023), stride width (p=0.015) at usual pace; and, higher variability in stride time (p=0.001), stride length (p=0.017) and stride width (p=0.019) at fast pace. Conclusion: High gait variability in several gait parameters is associated with frailty, even at early stages. Our findings help to explain the high vulnerability and risk of falls and fractures in community seniors with pre-frail and frailty status., Background: Disadvantaged seniors living in non-family situations in Toronto are more likely than seniors living in family situations to have less economic security, less social support, and less choice in housing. Seniors who live in poverty, and are precariously housed, are more likely to be chronically ill, to live with multiple illnesses, to have poor nutrition, high stress and loneliness, all of which are strongly associated with the determinant of health social exclusion. Methods: To understand how support services for income, housing, food security, social support, and health care mitigate the effects of social exclusion, we interviewed 15 male seniors at the Good Neighbours Club in downtown Toronto. The semi-structured interview is designed to assess barriers to, utility of, and perceived impact of support services available to disadvantaged seniors living in the central core of Southeast Toronto. Conclusion: Results suggest support services play a vital role in not only mitigating the effects of social exclusion, support services reduce the level of social isolation experienced by these seniors., Background: Considering the psychosocial factors at play, the management of elderly patients requires an interdisciplinary approach centered on the patient and his/her caregivers. An effective communication between the professionals is nevertheless an important asset in the client’s management. The Individualized Interdisciplinary Intervention Plan (IIIP) is a tool aimed at documenting and communicating information discussed during team meetings. Optimization of the IIIP is necessary to facilitate access to its information, to respect confidentiality and to integrate with existing computerized system. Objectives: To devise a computerized IIIP intent on optimizing quality of care and access to patient information. Methods: Modification of the pre-existing IIIP was done based on literature review, integration of the geriatric vital signs (AINÉES), the OPTIMAH (OPTIMisation des soins aux personnes Âgées à l’Hôpital) approach, and training in Project management using the Interprofessional Collaborative Approach. A demo session with team members of the two geriatric assessment units was organized prior to conducting a 6-month trial. A survey was created in order to gather feedback from users in both units. Results: An updated version of the IIIP was developed. Analysis of the survey is underway and the tool will be modified accordingly. Conclusions: The updated version of the computerized IIIP assures optimal management of elderly hospitalized patients and their caregivers. Not only is the IIIP accessible and easily integrated in existing computerized system, but it also respects the confidentiality code of conduct. It allows effective communication between interprofessional team members during current or future hospital stays, which is at the core of quality care., Objective: To study the long-term effects of glucocorticoids (GC) on fracture risk. Design: CaMos is an ongoing 10 year prospective cohort study. Population: Age and sex matched Canadian population who are non-institutionalized individuals and reside in nine CaMos study centers. Methods: Data from 2819 men and 6444 women were classified as current GC users and non-users. New fractures based on self-reports from an annually completed questionnaire included vertebral, hip, other (excluding hip, vertebral, toes, fingers, skull fractures) and any fracture (excluding toes, fingers, skull fractures). Multivariable survival analyses were conducted to examine the association between the time to new fracture and GC use. Hazard ratios and 95% confidence intervals (CI) were calculated. Results: The mean age, femoral neck T-score (standard deviation) and GC use at baseline of the cohort was 62.0 (13.3), −1.07 (1.03), and 128 (1. 4%), respectively. During the 10-year period, 130 (1.4%), 157 (1.7%), 869 (9.7%) and 1102 (11.9%) individuals developed a new osteoporotic vertebral, hip, other and any fracture. Ever taking GC for a minimum of one month in both men and women had a hazard ratio of 1.4 (95% CI: 1.0 −1.8), 1.9 (95% CI: 1.0–3.6), 0.97 (95% CI: 0.4–2.2),1.2 (95% CI: 0.9–1.6) for developing a new non-spine, hip, spine and any fracture as compared to those who never took GC, respectively. Conclusions: CaMos is the first prospective long-term study with data over 10 years showing that GC use is associated with higher incident fragility fractures., Introduction: Vitamin D is important in the management of osteoporosis and falls. Current Canadian guidelines recommend empiric supplementation (≥800 IU/day) for older adults. Before guideline publication, it was our practice to measure serum 25-hydroxyvitamin D levels (Vitamin D levels) on the first visit to our specialized falls clinic, serving adults aged ≥65 years. The extent to which this population would be undertreated by following the guidelines and delaying testing for 3–4 months after supplementation is currently not known. Methods: In this retrospective cross-sectional study, we determined the clinical benefit of a strategy of pre-emptive measurement of vitamin D levels. Chart reviews were conducted for 121 patients seen in the St. Paul’s Hospital Falls Clinic between January 2009 to November 2011. Baseline data, including fall risk, medications & supplements, laboratory testing and performance measures, were recorded. Results: 43 patients (35.2%) were taking ≥800IU of daily Vitamin D at their initial visit. Of the 94 patients who had Vitamin D levels measured, the average level was 80.4 nmol/L. Only 42 patients (44.7%) had sufficient Vitamin D levels (>75 nmol/L). Testing led to recommendations for dose adjustment for insufficient levels among 13 patients (13.8%), 5 of whom were previously on guideline-based supplementation doses. Conclusions: Many falls clinic patients are not taking adequate doses of Vitamin D and less than half of these patients have sufficient vitamin D levels. Preemptive testing led to correcting vitamin D insufficiency among a nearly 15% of patients in this high-risk population., Purpose: We present 2 case reports suggesting a possible association between delirium and swallowing deficits (or dysphagia) in older hospitalized adults. Method(s): Patient 1, a 96-year-old man, was previously highly functional without cognitive problems. He was admitted with pneumonia and developed delirium and new-onset dysphagia. Despite treatment of the patient’s pneumonia, the delirium was slow to recover, as was his dysphagia. Patient 2, a 78-year-old man with a history of dementia (likely alcohol related), was admitted with a fall and fractured humerus. The patient developed delirium and dysphagia while in hospital. Despite the patient’s persistent cognitive problems due to dementia, both his delirium and dysphagia resolved. Results: Both cases describe older adults with acute and chronic medical issues, delirium and dysphagia. In one case, persistence of delirium occurred concurrently with persistence of dysphagia, and, in the second case, improvement of dysphagia was associated with improved delirium symptoms. Conclusion: Delirium is a frequent problem for older hospitalized adults and is associated with a number of adverse outcomes as well as rising health-care expenditures. A potential association between delirium and dysphagia may be a very important consideration in the assessment, treatment, and prognoses of dysphagia. Although prior studies have reported associations between impaired ability to do activities of daily living and persistent delirium, a possible association between delirium and functional swallowing has not previously been reported. Further research into the relationship between delirium and swallowing deficits is necessary., Background: Slower gait is an early sign of cognitive decline in older adults. No studies have examined yet the brain morphometric substrate for slower gait in MCI. The purpose of this cross-sectional study was to determine whether gait speed was associated with lateral cerebral ventricle volume (LCVV), a measure of brain atrophy, and white matter lesions (WML) among older adults with MCI. Methods: Twenty community-dwellers with MCI, free of hydrocephalus, aged 76years [69/80] (median[25th/75th percentile]) (35% female) from the ‘Gait & Brain cohort study’ were included in this analysis. Gait speed was measured at usual pace with a 6 m electronic portable walkway (GAITRite). LCVV was quantified using semi-automated software from three-dimensional T1-weighted Magnetic Resonance Images. WML were visually rated on a 10-point scale from 0 to 9 (worst), and coded severe if grade was ≥2. LCVV, severe WML and age were used as covariables. Results: Median gait speed was 118.7 cm/s [104.4/131.3], and LCVV 39.9 mL [30.0/46.6] with no difference between right and left ventricles (p=0.052). Thirteen subjects (65%) had severe WML. Severe WML was associated with decreased gait speed (adjusted β=-17.94[95CI:-35.71;-0.16], p=0.048). LCVV was also inversely linearly associated with gait speed (adjusted β=-0.62 [95CI:-1.21;-0.03], p=0.041). More specifically, the enlargement of the left ventricle, unlike the right one, inversely correlated with decreased gait speed (p=0.002 and p=0.068, respectively). Conclusions: This study shows for the first time slower gait speed is associated with severe WML burden and left lateral ventricle enlargement in MCI, suggesting involvement of impaired sequential thinking in slowing gait during the early stages of dementia., Background: The predictive significance of hip fracture risk factors has been variably reported. This may at least in part be due to the effects of age. Objective: To determine the prevalence of validated risk factors for hip fracture in a relatively younger (60–80 years) and older (over 80 years) female age cohorts. Methods: Consecutive admissions of Caucasian females aged over 60 years presenting with the 1st osteoporotic hip fracture during a 24-month period were prospectively assessed. A group comparison was undertaken for the clinical risk factors used in the FRAX calculator, falls within 12 months, use of gait aid, dementia, neuromuscular disorders, usual residence, serum 25 (OH) D, current use of benzodiazepine and other baseline descriptive characteristics. Results: There were 83 and 90 patients in the ‘younger’ and ‘older’ age cohorts, respectively. Patients >80 yrs were more likely to have suffered a fall (57%, p=0.001), to use a gait aid (59%, p=0.001) and live in a hostel (28%, p=0.01). The prevalence of secondary causes of osteoporosis was greater (19%, p=0.048%) in the younger age cohort. There were no group differences for other risk factors. However, over 50% in each age cohort had a prior history of fracture and the mean 25 (OH) D in the younger and older age cohorts were 38+16.6 nmols/l and 34+18.6 nmols/l, respectively. Conclusion: The findings may have implications for the validity of fracture risk assessment tools that do not incorporate falls and/or other age associated hip fracture risk factors for stratifying hip fracture risk in the very old., Background: Although the principle goal of hip fracture management is a return to pre-event functional level, most survivors fail to regain their former autonomy. One of the most effective strategies to mitigate the fracture’s consequences is exercise. Purpose: To review the reported effect of an extended exercise rehabilitation program offered beyond the regular rehabilitation period on improving physical functioning for patients with hip fractures. Methods: Sources: The Cochrane Bone, Joint and Muscle Trauma Group, the Cochrane Central, PubMed, CINAHL, PEDro, EMBASE, and reference lists of articles were searched from inception to October, 2010. Study Selection: Included were all randomized controlled trials comparing extended exercise programs to usual care for community dwelling after hip fracture. Data Extraction and Synthesis: Two reviewers conducted each step independently. The data from included studies were summarized and then pooled estimates were calculated for nine functional outcomes. Results: Ten articles were included in the review and eight in the meta-analysis. The extended exercise program showed small–modest effect sizes which reached significance for knee-extension strength for affected and non-affected sides 0.46 (CI 95%: 0.2–0.6) and 0.45 (CI 95%: 0.16–0.74), respectively, balance 0.29 (CI 95%: 0.7–0.51), fast gait speed 0.52 (CI 95%: 0.18–0.85 p=0.002), and physical performance-based tests 0.53 (CI 95%: 0.27–0.78). Conclusions: To our knowledge this is the first meta-analysis to provide evidence that an extended exercise rehabilitation program for patients with hip fractures has a significant impact on various functional abilities. The focus of future research should go beyond just effectiveness and study cost-effectiveness of extended programs., Background: Sedentary behavior has been proposed as an independent cardiometabolic risk factor even in adults who are otherwise physically active through leisure-time recreational activities. Because little is known about the metabolic effects of sedentary behavior in seniors, we examined the relationship between sedentary behavior and cardiometabolic risk in physically active older adults. Methods: Enrollment is underway with 19/50 projected subjects currently included (mean age 73.1 years). Subjects were in good health and free of known diabetes. Activity levels were recorded with accelerometers worn continuously for 7 days. Blood pressure, waist circumference, body mass index (BMI), fasting glucose, lipids, HgbA1C and 2hr glucose tolerance were measured. Results: Time engaged in sedentary behavior was strongly positively correlated with triglycerides and BMI. Average amount of steps taken per day was strongly positively and negatively correlated to HDL and BMI respectively. All subjects met Canada Health guidelines for an active “fit” adult. Conclusion: Sedentary behavior is associated with adverse metabolic parameters in older adults, even those who are otherwise physically active and meet Canada Health guidelines for an active “fit” adult. Emphasizing activities that accumulate steps (eg: walking, light housework) may be a practical recommendation to reduce sedentary behavior in older adults., Background: Despite the importance of self-care, evidence suggests that people with heart failure (HF) do not consistently engage in such behaviours. One possible reason for poor self-care may be the presence of underlying and undetected mild cognitive deficits (MCD) Objective: This study is prospectively evaluating whether MCD measured with the MoCA in HF patients aged ≥60 years at hospital discharge is associated with impaired ability to self-care (measured with the Self-Care Heart Failure Index (SCHFI – 3 subscales: self-maintenance, self-management, self-confidence). Methods: Exclusion criteria: no caregiver, not English speaking, living in a long term care (LTC) facility, documented cognitive impairment, visual or hearing impairment, or life expectancy., Background: Failure to thrive (FTT) does not have an universally agreed definition in adults but is often used to describe a syndrome of global decline that occurs as an aggregate of frailty, cognitive impairment, and functional disability. The aim of this project was to better understand this population in an attempt to improve diagnosis and management. Objective: To explore characteristics and medical investigations commonly conducted among older adults with a diagnosis of FTT. Methods: Part 1: We searched Medline (Pubmed), Embase, and Cochrane databases from 1948 until 2011. Two investigators independently reviewed citations and then full-text articles. Inclusion criteria included published in English, population aged 65 or over, contained primary data, not a case report or case series. A summary of data was created and meta-analysis determined inappropriate. Part 2: Data from the local acute care electronic medical record for patients 65 years or older admitted with a diagnosis of FTT from January 2010 to January 2011 were reviewed. Several variables were analyzed that explored investigations in hospital. Results: The systematic review identified 62 citations. 46 full text articles were reviewed. 6 articles met inclusion criteria. All the 6 articles were cohort studies of small size. The local data revealed a cohort of 603 patients ranging in age from 65 to 104 years. The length of hospital stay varied from 0 to 106 days. Extensive investigations were ordered including CT, Echo and Ultrasound. A variety of medical specialists and allied health professionals were consulted during the patients’ hospitalizations., Objectives: Falls are well recognized to be associated with adverse health outcomes, especially when complicated by fracture. Falls are also more common in people who are frail and readily related to several items in the frailty phenotype. Less is known about the relationship between falls and frailty defined as deficits accumulation. Our objective was to investigate the relationship between falls, fractures, and frailty based on deficit accumulation. Methods: Design: Representative elderly cohort study with over 8 years of follow-up on mortality, recurrence falls and fractures. Setting: The Beijing Longitudinal Study of Aging (BLSA). Participants: 3257 Chinese people aged 55+ years at baseline. Measurements: A frailty index (FI) based on the accumulation of health deficits was constructed using 33 deficits, excluding falls and fractures. The rates of falls, fractures and death as a function of age and the level of FI were analyzed. Multivariable models evaluated the relationships between frailty and the risk of recurrent falls, fractures, and mortality adjusting for age, sex, and education. Self or informant reported fall and fracture data were verified against participants’ health records. Results: Of 3,257 participants at baseline (1992), 360 (11.1%) people reported a history of falls, and 238 (7.3%) people reported a history of fractures. 1155 people died over the eight-year follow-up. The FI was associated with an increased risk of recurrence falls (OR=1.54; 95% confidence interval (CI)=1.34–1.76), fractures (OR=1.07; 95% CI=0.94–1.22), and death (OR=1.50, 95% CI=1.41–1.60). The FI showed a significant effect on the proportional hazards in a multivariate Cox regression model (HR=1.29, 95% CI=1.25–1.33). When adjusted for the FI, neither falls nor fractures were associated with mortality. Conclusion: Falls and fractures were common in older Chinese adults, and associated with frailty. Only frailty was independently associated with death., Purpose: The primary purpose of this pilot study is to prospectively gather and evaluate patient characteristics, surgical outcomes and quality of life (QOL) outcomes of women with endometrial cancer undergoing robotic-assisted surgery. Methods: An unselected cohort of endometrial cancer patients, medically competent from the Jewish General Hospital were approached and offered robotic surgery. The da Vinci® Surgical System was used for the surgery. Results: From December 2007 to December 2009, 109 women underwent robotic-assisted surgery for their endometrial cancer. 68 women were under 70 years old and 41 were 70 years or older. 45 (69.2%) women under 70 experienced a post-operative pain level of 1 on a 7-point scale at one week post-surgery compared to 19 (48.7%) women 70 and older, p=0.037. At 3 weeks this trend persisted 47 (71.2%) compared to 20 (50.0%), p=0.028 respectively. 30 (46.2%) women under 70 experienced unusual urinary symptoms post-operatively compared to only 10 (25.6%) women 70 and older, χ2(1)=4.33, p=0.037. There was a significant effect of age on number of days required to resume typical activities. Older women resumed more rapidly to regular activities (8.4) than younger women (12.9), F (1, 87)=4.78, p=0.031. Conclusions: Elderly women undergoing robotic-assisted surgery for endometrial cancer experience less post-operative pain, less urinary symptoms and resume to their typical activities faster than younger women., Introduction : Les personnes âgées constituent une part toujours croissante de la population ayant recours aux hôpitaux. Haut lieu de technicité, le système hospitalier n’a pas été conçu en ayant en perspective les besoins spécifiques de cette clientèle. Les données s’accumulent pour démontrer que l’hôpital contribue souvent à une détérioration de leur état de santé par des modes de pratique mal adaptés. Les modèles de processus de soins efficaces existent mais ne sont pas appliqués. Objectif : Présenter le contenu du document : Cadre de référence sur l’Approche adaptée à la personne âgée en milieu hospitalier. Cet ouvrage sensibilise, guide et outille le personnel clinique et administratif des centres hospitaliers dans une démarche rigoureuse visant à prévenir le déclin fonctionnel iatrogène par des actions de prévention systématiques, individualisées et hiérarchisées. Méthodes : Une équipe de professionnels expérimentés s’est penchée sur cette problématique et propose des façons d’améliorer la qualité du séjour et des soins offerts aux personnes âgées en milieu hospitalier. Résultats : Le sujet est traité sous l’angle de la prévention et d’une meilleure gestion du delirium et du syndrome d’immobilisation. Un algorithme de soins cliniques est proposé dès l’arrivée, selon des interventions en paliers, déterminées par la condition physique initiale et la vulnérabilité face au système hospitalier. On propose des principes directeurs pour les organisations, des outils cliniques et d’implantation ainsi que des indicateurs de résultat. Conclusion : Le réseau hospitalier doit revoir en profondeur son fonctionnement afin de répondre adéquatement et sans délai aux besoins diversifiés des personnes âgées., Introduction : Le cadre de référence « Approche adaptée à la personne âgée en milieu hospitalier » est assorti d’outils cliniques pour faciliter son application. Ces fiches cliniques opérationnalisent la démarche clinique structurée et hiérarchisée de l’approche adaptée. Objectif : Présenter le contenu des 10 fiches théoriques et pratiques organisées selon trois paliers d’évaluation et d’interventions : systématiques et préventives, spécifiques et spécialisées, et traité sous trois angles : physique, psychosocial, environnement. Méthodes : Les fiches ont été rédigées par des cliniciens praticiens et enseignants d’expérience. Des experts de contenu ont été associés à la révision des fiches de même qu’une équipe d’infirmières oeuvrant elles-mêmes auprès des personnes âgées hospitalisées. Résultats : Chaque fiche théorique est organisée de la façon suivante: • présentation et définition de la dimension clinique ciblée; • éléments d’évaluation et d’intervention appropriés aux paliers systématique, spécifique et spécialisé; • bibliographie exhaustive suggérée; • annexes contenant des outils cliniques validés ou des suggestions du type trucs du métier. • fiche pratique-synthèse d’une page qui reprend avec concision les données stratégiques. Elle se présente sous forme de carnet et peut être gardée sur soi par l’intervenant et servir de ressourcement dans son travail au quotidien. Finalement, une fiche synthèse extrêmement concise résume les interventions essentielles systématiques pour les intervenants des urgences. Conclusion : Ces outils s’avèrent précieux pour soutenir les intervenants dans leurs actions quotidiennes auprès de la personne âgée hospitalisée., Introduction : Les soins aux personnes âgées sont une priorité inscrit dans la planification stratégique du MSSS du Québec. Le MSSS considère essentiel d’implanter l’AAPA et a mis sur pied une structure provinciale afin de soutenir les établissements du réseau dans ce changement important de pratiques. Objectif : Présenter la structure provinciale et les outils de reddition de compte qui accompagnent l’implantation de l’approche adaptée dans tous les établissements de courte durée du Québec. Méthode : Une coordination provinciale et régionale a été mise en place pour veiller à l’implantation de l’approche adaptée. Des éléments de l’approche sont intégrés dans les ententes de gestion des établissements qui doivent rendre compte de leurs progrès. Résultats : La structure est organisée comme suit: - Coordination provinciale par le MSSS: travail étroit avec les instituts de gériatrie de Montréal et Sherbrooke; conférences téléphoniques mensuelles avec les répondants régionaux; suivi personnalisé à l’occasion. - Coordination régionale: Répondant régional désigné; soutien aux établissements de sa région via des rencontres ou des suivis personnalisés. - Répondant local: organisation du déploiement dans son hôpital; planification des sessions de formation (avec les coaches); Des outils de reddition de compte (ententes de gestion, préalables, composantes), sont suivis rigoureusement. Conclusion : Cette structure et ces outils ont été mis en place dans toute la province afin de réussir l’adaptation du réseau hospitalier aux besoins de la personne âgée, Introduction : Afin de se donner des conditions gagnantes pour implanter l’approche adaptée, dans tous les hôpitaux du Québec, un programme de formation a été mis sur pied pour les intervenants du réseau de la santé. Il soutiendra l’instauration de nouvelles pratiques pour mieux répondre aux besoins des personnes âgées hospitalisées. Objectifs : Présenter le programme de formation qui s’adresse à tous les membres du personnel ainsi qu’aux gestionnaires des hôpitaux. Il comprend six modules de formation accompagnés d’activités de coaching qui permettent d’optimiser l’intégration des connaissances. Méthodes : Le programme de formation, basé sur l’Approche adaptée, est offert en ligne. Il a été créé par des experts cliniques et techno pédagogiques . Un comité d’experts a ensuite révisé les contenus qui ont été validés par des professionnels des établissements de santé avant d’être rendus disponibles à l’ensemble du réseau. Résultats : Les modules de formation touchent les thèmes suivants : introduction à l’approche adaptée à la personne âgée en milieu hospitalier, vieillissement normal et pathologique, adapter l’environnement, opérationnalisation de l’approche adaptée, le syndrome d’immobilisation, le delirium. Chaque module est accompagné d’un guide pour les coaches et de suggestions d’activités de coaching. Conclusion : Les modules de formation sont des outils polyvalents et conviviaux. Ils favorisent l’intégration de nouvelles connaissances et leur application au quotidien., Introduction : En centre de soins de longue durée, le maintien d’un état nutritionnel optimal peut s’avérer difficile. L’Hôpital Sainte-Anne (n=400 résidents et âge moyen= 90 ans; Ste-Anne de Bellevue, Québec) est un des rares établissements canadiens ayant choisi la pesée mensuelle et le suivi de l’indice de masse corporelle (IMC=Poids/Taille2) pour en faire une évaluation systématique et pratiquer une approche préventive. Cette initiative a été reconnue comme une pratique exemplaire par Agrément Canada (2011). L’IMC permet d’estimer le risque associé à un poids inadéquat. Un taux de mortalité plus faible est associé à un IMC >25 kg/m² chez les résidents institutionnalisés. Un IMC de 24 kg/m2 a été sélectionné comme norme optimale à l’Hôpital Sainte-Anne. Objectifs : 1) Utiliser l’IMC moyen de l’ensemble des résidents et des résidents dysphagiques comme indicateur de performance des interventions nutritionnelles pour les divers programmes d’intervention clinique; 2) Évaluer systématiquement l’efficacité des interventions nutritionnelles selon un protocole de pesée pré-établi. Méthodologie : Les résidents sont pesés mensuellement. Les changements de poids significatifs sont identifiés. Le résident et l’équipe de soins sont avisés de l’évolution de l’état nutritionnel, des problématiques associées et des changements au plan de soins nutritionnels. Les IMC individuels et moyens sont calculés. La conformité du protocole de pesée et la calibration de nos appareils sont évaluées régulièrement. Résultats : L’IMC global moyen et l’IMC des résidents dysphagiques sont 24.5 kg/m2 et 24.3 kg/m2, respectivement. Conclusion : Comme activité de dépistage, cette pratique permet de prendre rapidement en charge les états nutritionnels problématiques et aide à prévenir ou retarder l’apparition des conséquences fâcheuses de la dénutrition., Purpose: To assess the responsiveness of a variety of quality of life (QOL) measures in patients with Alzheimer’s disease (AD). Methods: We recruited 272 community-living AD patients and their caregivers. Patients with MMSE scores greater than 10 rated their QOL using the EQ-5D, Quality of Well-Being scale, a visual analogue scale and the QOL in AD (QOL-AD) instrument. Caregivers rated patient\’s QOL using these measures as well as the Health Utilities Index (HUI) and Short-Form-36. QOL and patients’ cognition, function and neuropsychiatric symptoms were assessed at baseline, 6, 12 and 24 months. We evaluated internal responsiveness using the standardized effect size and response mean and external responsiveness using ROC curves for the QOL measures based on a decline or no decline in a composite score based on the first principal component of the core dementia symptoms. Results: At baseline, patients’ mean age was 82.8, 50.2% were female and mean MMSE was 20.2. For patient self-ratings, the QOL measures did not exhibit meaningful responsiveness over time. For caregiver ratings of patient QOL: the internal responsiveness of the QOL measures at 12 and 24 months was small (0.12 to 0.28) and small to moderate (0.22 to 0.59), respectively; the external responsiveness at 12 and 24 months was greatest for the EQ-5D, QOL-AD and HUI, with areas under the ROC curves of 0.67 to 0.77. Conclusions: Over 24 months of follow-up, patient self-ratings of QOL did not exhibit meaningful responsiveness, while caregiver ratings of patient QOL with the QOL-AD, HUI and EQ-5D exhibited moderate responsiveness., Increasing incidence and prevalence of dementia and staff time constraints have created the need for an improved and streamlined system of care for dementia patients in primary care. The objective of this study was to develop a collaborative model of dementia care in partnership with and endorsed by staff members and stakeholders at a Primary Care Network (PCN) in Alberta. Phase 1 involved a retrospective chart review with Phase 2 involving focus groups and structured questionnaires that were distributed to staff members to assess their perspectives on dementia care. Phase 3 involved the creation of a preliminary care model for patients with dementia, followed by feedback on the model from staff members using consensus based methodology. Phase 4 of the project will focus on the implementation of the model in the PCN, with process and formative evaluation of the model planned. In this presentation, we provide a comprehensive overview of our model, components of the model, and resources that are foundational to successful implementation., Background: Falls are a common condition that had important impacts in elderly patients. Previous study suggested that falls lead to limitation of activities due to fear. Purpose: To report impacts of falls, expectations on Thai health-care system and fall events in falling elderly patients with chronic disease. Designs & Methods: Qualitative in-depth interviews, using an interview guide, were conducted with 18 participants who were referred from primary care clinic, geriatrics clinic and home health care unit. Content analysis was performed for analysis. Results: Falls were not found to be related to chronic disease in elderly patients. The most common reaction was fear, particularly fear of being dependent and burden to family members. Chronic pain was the most common illness developed after fall. Patients tended to be more careful, walking slowly, decrease activities, decrease traveling, and use gait aid more regularly. Most patients eventually told family member’s about their falls. Family’s reaction to patient’s fall included concern of patient’s condition, distrust, sarcastic comments. Doctors did not take falls into account by not asking patients about their falls. In addition, patient did not mention their falls events to doctors particularly, specialist doctors. Patients focused more on results of falls compared to causes of falls. Accident was the most common cause in fall event. Conclusion: Falls affected patients not only physical aspect, but also psychological status, behavior and their families. Health care providers should pay more attention to elicit causes of falls in elders., Background: Arthritis is largest contributor to disability in both Canada and the United States of America. Primary clinical features include pain and dysfunction. The effect of physical inactivity as a modifiable risk factor of arthritis is not clearly understood. Purpose: To elucidate the association between physical activity and arthritis in the Canadian population. Methods: Physical activity was evaluated in respondents with and without arthritis using a national health survey, the Canadian Community Health Survey 2007–2008 which consists of over 108,000 community-dwelling respondents 18 years or older. Respondents were asked a series of questions pertaining to physical activity over the past 3 months. Estimates of physical activity are obtained in terms of metabolic equivalent of task (METs). Logistic regression model was developed using demographic (age, gender, education, marital status) and behavioural (smoking, drinking, obesity) characteristics along with physical activity as potential risk factors for arthritis. Results: The prevalence of arthritis was 16.0%. The mean age for respondents with arthritis was 60.0 (SD=0.15) years with 40% being male. Mean Body Mass Index (BMI) was 27.0 (SD=0.06) Kg/m2 for respondents arthritis and 26.0 (SD=0.03) Kg/m2 for respondents without arthritis. The proportion of moderate and vigorous activities were significantly associated with having arthritis than those without arthritis (Moderate: OR 0.73, 95% CI 0.66–0.80; Vigorous: OR 0.80 95% CI 0.72–0.88). Conclusion: People with active lifestyle had a reduced likelihood of having arthritis; however, factors such as age and smoking can reduce the significance of physical activity in explaining arthritis., Background: Elder abuse is a growing problem in Canada that is underdiagnosed and overlooked by healthcare services with devastating consequences for older persons, such as increased morbidity and mortality, poor quality of life and loss of property and security. Objective: Examine the accuracy and precision of existing elder abuse screening tools to facilitate the introduction of more valid detection strategies for healthcare practitioners. Data Sources: We searched MEDLINE (1960–July 15, 2011), EMBASE (1980–July 15, 2011), PsycINFO (1984¬–July 15, 2011) and CINAHL (1982–July 15, 2011), plus gray literature, reference lists and review articles. Study Selection: Studies that included original data focusing on the accuracy and precision of instruments for screening of elder abuse, in which instruments were compared with a reference standard that included assessment by at least one expert. The subject of the screening assessment could be the patient, family member, caregiver, cohabitant and/or friend. Data Extraction: Study design, patient populations and settings, methods of assessment, and outcome measures were extracted, and a modified- QUADAS tool was applied to evaluate study quality. Two investigators independently completed each level of screening and data abstraction. Results: The literature search identified 5769 citations. Review of abstracts led to the retrieval of 83 full-text articles for assessment; 24 articles met inclusion criteria. Data synthesis is underway. Conclusion: Few studies provide data on screening tools that accurately and precisely identify elder abuse. Further research is needed to increase evidence-based knowledge on which healthcare practitioners may rely to improve identification of elder abuse., While much knowledge is gained from quantitative health research, illness itself is subjective. By appreciating the experience of failing health and its impact on outcomes for individual patients, it is hoped that healthcare providers will be able to practice more humanely and effectively. Falls are a common and serious health problem experienced by older persons. How they perceive and interpret the experience of falling can influence the long-term consequences of the event. Other than work done with fear of falling, to date this has not been rigorously studied. Our primary objective in this pilot study was to explore whether there was additional value in obtaining a patient’s narrative as part of the assessment of older persons who had fallen. We interviewed a convenience sample of 5 patients referred to the Calgary Fall Prevention Clinic (CFPC) using the Narrative Interview technique proposed by Jovchelovitch and Bauer. These narratives and the CFPC assessments underwent separate analyses for themes and patterns. Phenomena generated from narratives were determined through several readings of the transcript, using original audio recordings and field notes to help provide context. A comparison between phenomena found in the narrative analyses and the CFPC assessments was performed to highlight commonalities and gaps. Our findings will be presented to a focus group consisting of members of the CFPC who will discuss the potential usefulness of narratives in care planning for these patients. These deliberations will inform further research on the use of narratives in the assessment of patients referred to the CFPC., Purpose: Determine the prevalence of cognitive impairment in older cancer patients referred to a Geriatric Oncology clinic. Identify the type of cognitive impairment (dementia, mild cognitive impairment (MCI), cognitive changes related to cancer or its treatment). Methods: Ongoing study on data collected since 2006 for each patient visit in the Consultation service for senior oncology patient clinic at the Jewish general Hospital. A comprehensive assessment including data on demographics, comorbidities, functional status mood, mobility, nutritional status and level of energy is available. Cognition is evaluated with Mini Mental State Exam (MMSE), Montreal Cognitive Assessment test (MoCA) and neuropsychology in selected cases. Brain imaging is used when indicated. Descriptive techniques were used to analyze demographic data and diagnoses of cognitive impairment. Results: Preliminary analysis from November 1, 2006 to November 30, 2010 reveals a mean age of 79 years old (range 46–104) for a total of 240 referrals. 35% of these referrals were for cognitive impairment, our evaluations uncovered and addressed nearly 60% of cognitive impairments (dementia, MCI, cancer or cancer treated related cognitive changes) revealing a growing number of older patients with this issue. Conclusion: Findings from this study provide insight into the usefulness of having a formal cognitive screening evaluation pre and post cancer treatment of older cancer patients referred to an outpatient Geriatric Oncology clinic. Additional research is required to understand, prevent and treat cognitive impairement in older cancer patients, early recognition and identification is paramount., In preparation for the 2012 Canadian Consensus Conference on Dementia, background papers are being written on 8 topics in order to make recommendations for clinical practice. Rapidly Progressive Dementia (RPD) is an uncommon condition with numerous possible causes, for which there is no universally accepted definition. We conducted a systematic review to make recommendations about [1] definitions for RPD in (a) dementia developing in previously healthy individuals, and (b) individuals with an existing dementia who experience unusually rapid cognitive decline; [2] a logical diagnostic approach based upon the prevalence of conditions which cause RPD. The initial search identified over 900 articles. Each abstract was assessed for relevance (to [1] and [2] above) by two independent reviewers. If either reviewer deemed an article relevant or possibly relevant, it was fully reviewed for quality against pre-agreed criteria; if assessed of good quality, data were extracted. In the example of a report of a case series, a good article described patient population (and referral bias if any), diagnostic criteria for dementia, and definition of RPD. We describe the process of conducting the review, proposing criteria for standard definitions, and the iterative process leading to a recommended diagnostic approach., Background: Various methods are being used to ensure geriatric core competencies are being taught throughout Canadian medical schools. In 2011, the University of Saskatchewan (U of S) became the first Canadian medical school to incorporate a geriatric skills day (GSD) into the curriculum. The GSDs were based on the successful program created by the U of S’s Geriatric Interest Group. Methods: A full day GSD was held twice in Saskatoon and once in Regina, Saskatchewan. Interdisciplinary team members from both health regions facilitated interactive sessions on various geriatric competencies. The GSDs, accounting for 25% of the overall course mark, coordinated with the didactic geriatric lectures. In addition, an OSCE station, worth 20%, examined one of the skills taught. Student evaluations included rating their satisfaction with each session on a 5-point scale as well as pre- and post-assessments of students’ self-rated ability to perform 24 specific skills (on a 10-point scale). Results: 84 (98%) of the third-year medical students participated. The session evaluations (n=403) rated very high with a median rating of 5.0 on all questions. Student’s self-rated assessments of their ability to perform geriatric skills improved from median scores between 3–7/10 before to 8–9/10 after the GSD. Students also performed well on the OSCE station several weeks after the GSD. Conclusions: The geriatric skills day was well received by the medical students. The synergy created by combining didactic lectures with a skills day improved medical students confidence with their ability to perform specific geriatric skills., Introduction: The training of Specialist Geriatricians (SpGrtn) within Canada has not kept pace with the aging of the population over the last 15 years. The anticipated retirement of existing SpGrtns in Canada will exacerbate the shortfall for specialized geriatric services (SGS) across the country. Objectives: 1. To document the existing number of SpGrtns and practicing Care of the Elderly (CofE) trained Family Physicians practicing in SGS. 2. To project the anticipated number of SpGrtns that will retire over the next 15 and 30 years. 3. To calculate the ideal number of Geriatricians in Canada, based on published ratios.1,2 Methods: Using the ratio of 1.25 SpGrtns: 10,000 people 65+1 or 1 SpGrtns: 4,000 people 75+2 and 2006 Canadian Census data (low, med. and high pop. projections 65+ or 75+) over the next 30 years, the need for SpGrtns was identified. The anticipated retirement of present Canadian SpGrtns 40 years beyond their medical degree (MD) was determined. Results: In 2011, there were 256 SpGrtns in Canada and 93 CofE physicians. The calculated need in 2011 is 613 SpGrtns (1.25:10,000 65+) or 688 (1:4,000 75+). The calculated need for SpGrtns in 2026 is 969 (±27 (1.25:10,000 65+). Across Canada, 10 SpGrtns are trained annually (150 in 15 years). Over the next 15 years, 105 of the existing SpGrtns will have practiced 40 years beyond the date of their MD. Conclusions: In 2026 there will be 301 SpGrtns (256- 105+150) resulting in a shortfall of 668 SpGrtns (969–301) in Canada., Introduction: ‘Sitters’ have been used for some time for delirium. However, the specifics surrounding their use and involvement in patient care combined with their impact on delirium outcome is not known. Associated cost expenditure is considerable when compared to that for special care aides whom have considerably more training and experience, thus concerns have been raised about these sitters thus the reason for performing this chart review. Objective: The two objectives for this chart review are to review the current use of sitters in one of the local acute care hospitals, and the second was to assess the impact sitter use has on delirium outcomes. Method: A retrospective chart review was performed from the years April 1st 2009 to December 2010. 1252 charts in total were initially identified and reviewed, with 32 charts being included in the final analysis. Results: 32 charts documented the use of sitters. Two charts had client attendant forms completed. Sitters were hired for delirious and agitated patients. No information was provided about shift number, duration, activities performed or number of patients sitters were responsible for. The clinical impact sitter use had on delirium was assessed by looking at the complication rate (i.e., number of falls) and requirement for certain interventions (i.e., intravenous fluid (IVF)). Complication rate revealed 11 patients fell and 14 had a reduction in functional capacity. The intervention rate revealed 12 patients required IVF, three patients required artificial nutrition, 25 patients experienced sleep deprivation, 19 patient’s required pharmacological therapy and 11 patients required restraints., Background: There is increased mortality in older people following cold. This has been attributed to cardiovascular disease but others argue that cold alone is responsible. The effect of environmental cold on mortality for those in a protected environment remains unknown. This study examined whether elderly nursing home (NH) residents are protected from excess cold related mortality. Method: Weekly deaths of people >65 years old in Edmonton from 2000–2009 were obtained from Vital Statistics Canada. Corresponding weekly mean temperatures were obtained from the Weather Channel. Data were dichotomized into “NH” and “community” deaths. Results: There were 72629 deaths, 54516 of those >65 years old. Deaths in NH increased annually. Excess death related to cold was observed only for NH residents. Conclusions : The difference between deaths at the highest and lowest temperature deciles was statistically significant., Background Benign prostatic hyperplasia (BPH) with bladder outlet obstruction (BOO) can result in lower urinary tract symptoms (LUTS). Early, accurate diagnosis may reduce pain and complications. Objective: To systematically review the evidence on the diagnostic accuracy of office-based tests for BPH with BOO in males with LUTS. Methods: Search of MEDLINE and EMBASE (1950 to August 12, 2010), Cochrane Central Register of Controlled Trials via Ovid, and references of retrieved articles. Data selection: Prospective studies comparing at least one diagnostic test, feasible in a clinical setting and readily available to non-specialist clinicians, to the gold standard reference test, invasive urodynamics. Results: There were 6692 unique citations identified with 9 prospectively conducted studies (N=1217 patients) meeting inclusion criteria and describing use of 2 symptom questionnaires as well as individual symptom(s). The best constellation of symptoms suggesting BPH with BOO was ‘poor stream and frequency and/or nocturia’ (positive LR, 1.76; 95% CI, 1.17–2.64). The most useful symptom for which the absence made a diagnosis of BPH with BOO less likely, was nocturia (negative LR, 0.19, 95% CI, CI 0.05–0.79). The best symptom questionnaire to support or rule out a diagnosis of BPH with BOO was the International Prostatic Symptom Score (I-PSS) at a cut-off of 8 (summary positive LR, 1.34; 95% CI, 1.06–1.70; summary negative LR, 0.28, 95% CI, CI 0.12–0.70). Conclusions: Although urodynamic testing is the gold standard for diagnosis of BPH with BOO, symptoms obtained through history may be useful. The best evidence supports asking about nocturia, stream and frequency., “An Exploration of the Care of Older Adults in Acute NHS Trusts”, also focussed on nutrition, an area scrutinised by the media. The Council of Europe produced a “Resolution” – 10 characteristics of good nutritional care, from which the Nutritional Team of Southend Hospital created the Southend Universal Nutritional Screening (SUNS) Tool as a simple alternative to MUST (Malnutrition Universal Screening Tool), and introduced measures to improve patient nutrition. 3-part survey on inpatients (total = 83) across 4 wards:- two geriatric wards – one with a special interest in nutrition; an acute medical ward; a surgical ward where measures were not in place. Using the European guidelines, ward facilities were assessed, patient notes were audited, and patients provided their perspective. All wards had multiple dietary options. Not all implemented protected mealtimes. All patients were screened within 24 hours in Medicine, but only 63% of surgical patients. Many had a nutritional plan, although often not comprehensive, and few were re-screened within 1 week. Patients were satisfied with meals and nutritional services, but did not feel they had 24-hour access to food, or informed enough about nutritional care. There was no standardised screening across departments, although back-up pathways allowed unscreened patients to access nutritional services. Some low-risk patients (as identified by SUNS) developed complications so the tool requires adaptation to better identify at-risk patients. Weekly re-assessments need improving. These results reflect that a simple pathway for all departments across all hospitals would provide better patient care by moving the NHS towards national standardisation., Introduction : Puisque la prévalence de l’insuffisance cardiaque (IC) augmente avec l’âge, le fardeau de l’IC augmentera considérablement dans les prochaines années. L’objectif de la présente étude est de décrire les caractéristiques socio-démographiques et d’utilisation de soins de santé et de médicaments selon les groupes d’âge chez les individus âgés de 65 ans ou plus ayant eu un premier diagnostic d’IC entre 2000 et 2009 au Québec. Méthode : À partir des données de la Régie d’assurance médicaments du Québec (RAMQ), nous avons effectué une étude de cohorte incluant les individus âgés de 65 ans et plus recevant un diagnostic d’IC entre les années 2000 et 2009. Les caractéristiques étudiées sont celles se rapportant à l’utilisation des services de santé, de l’usage des médicaments et les caractéristiques socio-démographiques. Les analyses statistiques effectuées sont des moyennes, des médianes et des proportions. Résultats : Cette étude permet de comprendre les caractéristiques des individus âgés de 65 ans et plus souffrant d’IC afin de pouvoir appliquer les considérations soulevées par les lignes directrices., Background: By 2050, the proportion of seniors is estimated to increase to 27% from 14% currently. In 2011, there were only 238 Canadian specialists certified in Geriatric Medicine. Beyond the expansion of geriatric specialists, an improvement in physicians’ attitudes, knowledge and skills in geriatrics is important regardless of the specialty. Objectives: This study aimed to identify changes in attitudes of preclerkship University of Toronto (UofT) medical students towards geriatric care after participating in an interdisciplinary Geriatric Clinical Skills Day (GCSD) organized by UofT’s Geriatrics Interest Group.Methods. This was a before and after study. First and second year UofT medical students registered for the GCSD participated in this study. Method: A questionnaire, including the validated UCLA Geriatrics Attitudes Scale, was administered before and after the GCSD. Both a one-sample t-test and the signed rank non-parametric test were used to determine any changes in attitudes. Results: Of 19 study participants, four students did not complete the post-test questionnaire. 42.1% indicated an interest in Geriatric Medicine, 26.3% in Geriatric Psychiatry, and 63.2% in working with elderly patients. Both pre- and postmean scores were greater than 3 (neutral), indicating a positive attitude before and after the intervention (p0.11). Conclusions: There is an overall positive attitude towards geriatrics among study participants. However, a one day GCSD did not alter attitudes towards geriatric care. This small study warrants further investigation in a larger multicentred trial., Canada’s population is aging and research has shown that primary care physicians find it difficult to care for elderly patients. Canadian family physicians have appreciated need for geriatrics continuing medical education (CME) and based on the expert opinions of experienced care of the elderly family physicians, geriatric knowledge and skills felt necessary for a family physician caring for the elderly, were put into a curriculum based on the 5 weekend program style. The University of Toronto Department of Family & Community Medicine developed a 5 weekend leadership program in the mid 1990’s and this format allowed community physicians to train without giving up regular clinical time. The Five Weekend Care of the Elderly Certificate Course used discussion in small groups of four as per Malcolm Knowles’ theory of andragogy and adult learning. These discussions were directed carefully as per Dave Davis’ research on effective CME. Donald Schon’s theory of reflective practice shaped the course homework assignments. These homework assignments were created to allow immediate «reflection in action» with real life patient experiences and «reflection on action» later during presentation of their written essays to the entire class. Participants were asked to complete a survey regarding their self rated knowledge of curriculum topics before and after the course. The results showed improved family physician self-reported knowledge of the curriculum topics. Favourable response to small group discussion and debriefing of assignments showed that there is interest amongst family physicians to these types of interactive learning., Background: Carotid sinus hypersensitivity (CSH) is a common cause of fainting and falls in older adults and is diagnosed by carotid sinus massage (CSM). Previous work has suggested that age-related stiffening of blood vessels reduces afferent input from the carotid sinus leading to central upregulation of the overall arterial baroreflex response. A potential intevention to reduce carotid sinus hypersensitivity is aerobic training. Objective: We examined whether aerobic exercise could reverse carotid sinus hypersensitivity in older adults with Type 2 diabetes complicated by co-morbid hypertension and hyperlipidemia. Methods: 15 older adults (mean age 72.2±0.7) with diet-controlled or oral hypoglycemic-controlled Type 2 diabetes, hypertension, and hypercholesterolemia were recruited. Subjects were randomized to each of 2 groups: an aerobic group (AT, 3 months vigorous aerobic exercise), and a nonaerobic (NA, no aerobic exercise) group. Exercise sessions were supervised by a certified exercise trainer 3 times per week, and utilized a combination of cycle ergometers and treadmills. Arterial stiffness was measured using the Complior device. Results: Although aerobic exercise significantly increased arterial compliance as measured by both radial (p=0.005) and femoral (p=0.015) pulse wave velocity, there was no training effect on either the bradycardic (p=0.251) or vasodepressive (p=0.523) response to CSM. Conclusions: Although aerobic training can reverse arterial stiffness, there is no evidence for a corresponding reduction in carotid sinus hypersensitivity in older adults with diabetes., Background: Providing geriatric education to health science students becomes increasingly important as Canada’s population ages. The University of Saskatchewan’s Geriatric Interest Group (GIG) developed Geriatric Skills Days (GSD) to provide students additional opportunities to improve skills and knowledge in geriatric core competencies (GCCs). Methods: The GSDs, facilitated by the Geriatric Evaluation and Management Program’s interdisciplinary team, covered GCCs including comprehensive geriatric assessment, falls, polypharmacy, cognitive assessment, and functional assessment. Students rated satisfaction with each session (on a 5-point scale). In 2011, students also completed pre-post ratings (on a 10-point scale) of perceived ability to perform 11 skills. Results: Eighty health science students from seven different colleges attended GSDs. In the 2010 cohort, students felt the sessions had clear objectives, met those objectives, met their objectives as learners, provided enough time for discussion, and were well organized (all Mdn=5.0, N=151). We received 148 session evaluations from the 2011 cohort. Students agreed the sessions had clear objectives (Mdn=4.0) and met those objectives (Mdn=5.0); met their own objectives as learners (Mdn=5.0), provided enough time for discussion (Mdn=4.0), and were well organized (Mdn=5.0). Also in 2011, students’ (N=18) median self-rated ability to perform each skill ranged between 2 and 6 before the GSD (eight skills received scores of 2 or 3). Post-participation ratings increased markedly, with medians ranging between 7 and 9 (N=24). Conclusions: Participant responses were very positive to the GIG initiated GSD. This positive experience influenced the decision to incorporate a GSD into the College of Medicine’s 2011–2012 third-year curriculum., The Canadian Consensus Conference on Diagnosis and Treatment of Dementia in 2006 dealt with a wide range of topics in considerable depth. Many of those recommendations retain their relevance today. Since that time remarkable advances have occurred in the diagnosis of Alzheimer’s disease, including cerebral amyloid imaging and CSF studies of Abeta 42, and phosphorylated tau. Recent publications have attempted to redefine Alzheimer’s disease as a pathological entity which can now, perhaps, be identified by biomarkers ahead of any cognitive changes. However serious ethical dilemmas surround findings such as abnormal accumulations of cerebral amyloid, in normal or minimally symptomatic people. Should these promising but as yet unproven technologies be restricted to the research arena? How can we prevent premature “bleeding” into clinical practice before their benefits and risks can be adequately assessed? These and other dilemmas constitute the reasons for a new CCCD. The steering committee members are listed above. Background papers will be produced and posted to a website, where CCCD members can comment. Recommendations will be submitted for consensus prior to the Conference in Montreal in May. Dissemination will be actively managed through the Dementia Knowledge Translation Network. The CCCD will address the following topics: • Definitions (critique of recently published revised U.S. definitions) • Fluid biomarkers • Neuroimaging • Diagnostic approach to rapidly progressive dementia • Management of early onset dementia • Update on pharmacological treatment., Objectives: 1. To determine if frailty is associated with lower life satisfaction (LS); 2. To determine which domains of LS are influenced by frailty. Methods: Analysis of 1751 community-dwelling older adults (65+ years) from the Manitoba Study of Health and Aging. Measures: LS was measured using the Terrible-Delightful Scale. One item measures overall LS and was scored on a 7 point Likert-type scale. Satisfaction was also measured with individual domains: health, finances, family relations, friendships, housing, recreation activity, religion, self-esteem, and transportation. Satisfaction with employment and living partner were not considered because there were many missing responses. Frailty was determined by the Canadian Study of Health and Aging definition of frailty, and was categorized as no frailty; incontinence only; mild frailty; and moderate/severe frailty. Age, gender, education, marital status, and living arrangement were self-reported. Depressive symptoms were measured using the Centre for Epidemiologic Studies – Depression scale. Bivariate and multivariate linear regression models were conducted. Results and Conclusions: Most older adults, including frail older adults, were satisfied with life overall, and with most aspects of their lives. In bivariate analyses, frailty was associated with lower levels of LS overall (5.3 versus 4.9)., Purpose: To present the inspiring case of Ms. P who is a 103 year old lady we followed in our Geriatric Oncology clinic. Description: Ms. P. was 100 years old when she first walked into the clinic using her cane. She lived at home with her 105 year old sister, had a private caregiver for assistance with ADLs and IADLs and was not demented. She was diagnosed with left breast cancer in 1993, treated by local excision and hormonal therapy only. She was also known for bilateral hip surgery, one episode of pulmonary edema, osteoporosis and hypothyroidism. She presented in 2008 with local progression of disease over the left breast (painless red nodules and infiltration of the skin with minimal exudate). Investigations revealed no evidence of distant metastasis. In May 2009, she received radiotherapy for ulcerated skin nodules covering 70% of the breast and purulent discharge. She responded very well to treatment with complete resolution of the open wounds. However, the skin lesions recurred a few months later. In an attempt to control the disease while minimizing toxicity, she received a total of 4 monthly doses of Faslodex intramuscularly; this was discontinued because of side effects of anorexia and fatigue with arthralgias. In January 2011, she received a second course of palliative radiotherapy with good response. She passed away at home in October 2011. Our comprehensive evaluation and personalized interventions proved beneficial for this patient, who otherwise would not have received further treatment because of her advanced age., Background: Smoking is common in China, where the population is aging rapidly. This study evaluates the relationship between smoking and frailty and their joint impact on survival in older Chinese adults. Methods: Data come from the Beijing Longitudinal Study of Aging. Community-dwelling people (n=3257) aged 55+ years at baseline were followed between 1992–2007, during which time 51% died. A frailty index (FI) was constructed from 27 self-reported health deficits. Results and Conclusions: Nearly half (45.6%) of the participants reported smoking (66.8% men, 25.3% women). On average, male smokers were frailer (FI=0.18±0.15) than male nonsmokers (FI =0.14±0.10; p=0.030) and had an increased risk of death (risk ratio=1.66 age and education adjusted, 95% CI=1.46–1.88., Introduction : En 2003, quatre Réseaux Universitaire Intégrés de Santé (RUIS), établis autour des facultés de médecine et de leurs établissements de santé affiliés, ont été institués. Ils doivent mieux répondre aux enjeux socio-sanitaires actuels et futurs. À l’initiative de l’Institut universitaire de gériatrie de Montréal (IUGM), le RUIS de l’Université de Montréal a créé (2009), un comité de gériatrie. Objectifs : Favoriser les meilleures pratiques cliniques; proposer la mise en place de corridors de services pour les soins plus spécialisés; favoriser la concertation et complémentarité en recherche, enseignement, évaluation des technologies et prévention /promotion de la santé; être un leader auprès des instances universitaires et gouvernementales sur l’organisation des services de santé aux personnes âgées. Méthodologie : Processus de révision des services gériatriques spécialisés; inventaire du temps de formation universitaire consacré aux soins aux personnes âgées; inventaire des activités de prévention/promotion de la santé; élaboration d’un projet pilote de télépsychogériatrie auprès des partenaires de l’IUGM. Résultats : Une typologie des services gériatriques spécialisés a été définie. Le temps de formation obligatoire varie par discipline entre 0 % (service social) et 17% (médecine - psychiatrie), tandis que le travail auprès de la clientèle varie de 12% (orthophonie) à 61% (physiothérapie). Le répertoire en prévention/promotion a été complété ainsi que le projet pilote de télépsychogériatrie. Conclusion : Pour une meilleure coordination et intégration de ses composantes avec le réseau de première instance, le MSSS a instauré une table de gériatrie dans chacun des RUIS, fédérées au niveau national, Introduction : Le rôle des unités de courte durée gériatriques (UCDG) est d’offrir des soins spécialisés dans le continuum des soins et services de santé offerts à la personne âgée. Les professionnels de ces programmes doivent maintenir leurs compétences cliniques, et les gestionnaires mettre en place des processus organisationnels efficaces. Un besoin d’échange et d’actions spécifiques au niveau national a été exprimé par la majorité des responsables d’UCDG. Objectifs : Améliorer de façon continue la qualité des soins dans les services hospitaliers de gériatrie, généraliser de hauts standards de pratique afin d’y traiter des patients aux situations cliniques complexes et agir comme milieu de référence. Méthodes : 1) Création d’un comité exécutif composé de médecins et gestionnaires provenant des diverses régions du Québec; 2) Embauche d’une coordonnatrice; 3) Développement d’un site internet (www.rushgq.org) pour dépôt de documents et d’échanges via un forum de discussion. Résultats : 60% des centres hospitaliers ont adhéré au RUSGHQ. Les activités en cours sont : 1) Circonscrire la population cible des UCDG; 2) Harmoniser les mécanismes d’évaluation et d’intervention cliniques sur la base des meilleures pratiques; 3) Mettre à la disposition des membres une « boîte à outils » clinique et de gestion pertinente; 4) Établir les ratios de ressources professionnelles nécessaires à un fonctionnement optimal; 5) Offrir des activités de développement professionnel continu. Conclusion : Une communauté de pratique en gériatrie a été mise sur pied facilitant réflexions et apprentissages collectifs des professionnels de la santé et des gestionnaires travaillant en milieu hospitalier., Introduction: The Effective Management of Alzheimer’s disease (AD) By Treating pAtients and relieving Caregivers with Exelon* Patch (EMBRACE) is a prospective, observational, single-cohort, open-label, multicentre study with an 18-month treatment period. Study objectives were to evaluate the effectiveness of rivastigmine patch in patients with mild to moderate AD as measured by changes in cognition, daily function and behavior from baseline. Secondary outcome measure included the evaluation of the caregiver-reported compliance and treatment satisfaction. Results: A cohort of 1204 Canadian AD patients participated in this trial. Following results are for all evaluable patients (n=969) at the end of the study. The majority of patients were outpatients (80.5%) and treatment-naïve or “de novo” (69.4%). Mean baseline MMSE was 21.8 (95% CI: 21.5, 22.1). Mean change in MMSE from baseline to 18 months was −0.4 (95% CI: −0.7, −0.1). For subjects previously treated with oral cholinesterase inhibitor therapies, approximately 88% (122/139) of their caregivers preferred rivastigmine patch, citing ease of use and patient preference over previous medication as the two most common reasons. The most commonly reported category of adverse event in the safety population n=1204) was “Skin and subcutaneous tissue disorders” (9.3%) the most reported event being pruritus (4%). Conclusion: Final results of this registry demonstrate the effectiveness and good tolerability of rivastigmine patch in patients with AD. Cognitive function, as measured by MMSE, showed a relative stabilization over an 18 month time period. The benefit of rivastigmine patch treatment is further supported by the caregiver preference results.

Teriflunomide reduced the annualized relapse rate (0.54 for placebo vs. 0.37 for teri flunomide at either 7 or 14 mg), with relative risk reductions of 31.2% and 31.5%, respectively (P

Cladribine provides immunomodulation through selective targeting of lymphocyte subtypes. We report the results of a 96-week phase 3 trial of a short-course oral tablet therapy in patients with relapsing–remitting multiple sclerosis. We randomly assigned 1326 patients in an approximate 1:1:1 ratio to receive one of two cumulative doses of cladribine tablets (either 3.5 mg or 5.25 mg per kilogram of body weight) or matching placebo, given in two or four short courses for the first 48 weeks, then in two short courses starting at week 48 and week 52 (for a total of 8 to 20 days per year). The primary end point was the rate of relapse at 96 weeks. Among patients who received cladribine tablets (either 3.5 mg or 5.25 mg per kilogram), there was a significantly lower annualized rate of relapse than in the placebo group (0.14 and 0.15, respectively, vs. 0.33 ; P

Summary Background Interferon beta-1a and glatiramer acetate are commonly prescribed for relapsing-remitting multiple sclerosis (RRMS), but no published randomised trials have directly compared these two drugs. Our aim in the REGARD (REbif vs Glatiramer Acetate in Relapsing MS Disease) study was to compare interferon beta-1a with glatiramer acetate in patients with RRMS. Methods In this multicentre, randomised, comparative, parallel-group, open-label study, patients with RRMS diagnosed with the McDonald criteria who had had at least one relapse within the previous 12 months were randomised to receive 44 μg subcutaneous interferon beta-1a three times per week or 20 mg subcutaneous glatiramer acetate once per day for 96 weeks to assess the time to first relapse. A subpopulation of 460 patients (230 from each group) also had serial MRI scans to assess T2-weighted and gadolinium-enhancing lesion number and volume. Treatments were assigned by a computer-generated randomisation list that was stratified by centre. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00078338. Findings Between February and December, 2004, 764 patients were randomly assigned: 386 to interferon beta-1a and 378 to glatiramer acetate. After 96 weeks, there was no significant difference between groups in time to first relapse (hazard ratio 0·94, 95% CI 0·74 to 1·21; p=0·64). Relapse rates were lower than expected: 258 patients (126 in the interferon beta-1a group and 132 in the glatiramer acetate group) had one or more relapses (the expected number was 460). For secondary outcomes, there were no significant differences for the number and change in volume of T2 active lesions or for the change in the volume of gadolinium-enhancing lesions, although patients treated with interferon beta-1a had significantly fewer gadolinium-enhancing lesions (0·24 vs 0·41 lesions per patient per scan, 95% CI −0·4 to 0·1; p=0·0002). Safety and tolerability profiles were consistent with the known profiles for both compounds. The overall number and severity of adverse events were similar between the treatments and were not an important cause for discontinuation of the trial during the 96 weeks. Interpretation There was no significant difference between interferon beta-1a and glatiramer acetate in the primary outcome. The ability to predict clinical superiority on the basis of results from previous studies might be limited by a trial population with low disease activity, which is an important consideration for ongoing and future trials in patients with RRMS. Funding EMD Serono; Pfizer.