Search

To facilitate the development of new therapies for Prader-Willi syndrome (PWS), we sought to develop a reliable and valid assessment of anxiousness and distress, common characteristics that have a significant negative impact on individuals with PWS and their families.The PWS Anxiousness and Distress Behaviors Questionnaire (PADQ) was developed with extensive input from clinical experts, as well as caregivers of individuals with PWS, who participated in iterative sets of qualitative interviews. The psychometric properties of the PADQ were subsequently demonstrated in a cross-sectional evaluation using data from the Global PWS Registry provided by400 caregivers and confirmed using data from a phase 3 clinical trial of an oxytocin analogue (intranasal carbetocin, LV-101).Qualitative interview participants consistently endorsed the content of the PADQ and were confident they could accurately respond to each item based on their observations of their child's behavior. Analysis of cross-sectional data supported the computation of a total PADQ score, as well as the reliability and validity of the measure. The results of analyses using longitudinal clinical trial data confirmed these properties and provided evidence for the responsiveness of the PADQ, further supporting its appropriateness for the evaluation of new treatments targeting anxiousness and distress in PWS.The current body of evidence supports the conclusion that the PADQ measures observable behaviors that are meaningful to patients and their families and provides a valid and reliable method to assess beneficial treatment effects for some of the most challenging behaviors associated with PWS.

Abstract: This multisite quality improvement (QI) project reports on a psychotherapy group for family care partners of persons living with neurodegenerative conditions. Following the plan-do-study-act model, a team of geropsychologists iteratively developed, implemented, and refined the 8-week “Caring Through COVID” psychotherapy group across five cycles from January 2021 to April 2022. Participants were 21 spouses or adult children of persons living with neurodegenerative conditions. Across two clinics, participants evidenced moderate improvements in caregiver burden ( d = .59), self-efficacy for caregiving ( d = −.64), and self-efficacy for emotion regulation ( d = −.60). The group was perceived positively by participants. This QI project demonstrates the real-world implementation of a psychotherapy group developed during the COVID-19 pandemic and refined to remain ongoing.

Abstract. We surveyed 377 undergraduates, half in the spring (i.e., before COVID-19) and half in the fall (i.e., during COVID-19) term of 2020 on explicit attitudes toward and intention to work with older adults (OAs). We asked open-ended questions about their attitudes toward OAs resulting from COVID-19. We found significant differences with small effect sizes between the cohorts on explicit ageism. Thematic content analyses found that most students themselves did not perceive a change in their explicit attitudes toward OAs. Negative ageism predicted intention to work with OAs for the spring cohort, but this shifted to positive ageism for the fall cohort.

Supplemental Figure S1 Pharmacokinetics of cetuximab-IRDye800. Supplemental Figure S2 Fluorescent imaging of positive margin using intraoperative instrument. Supplementary Figure S3 Opportunity for tissue saving procedures.

Intraoperative video 2

Intraoperative video 1

Objective: The objective of this study was to identify the age of diagnosis for children with one of three neurogenetic conditions resulting from changes on chromosome 15 (Angelman syndrome [AS], Prader-Willi syndrome [PWS], and Duplication 15q syndrome [Dup15q]). Methods: Data about diagnostic process for each condition were contributed by the advocacy organizations. Median and interquartile ranges were calculated for each condition by molecular subtype and year. Comparison tests were run to explore group differences. Results. The median age of diagnosis was 1.8 years for both AS and Dup15q. PWS was diagnosed significantly younger at a median age of 1 month. Deletion subtypes for both PWS and AS were diagnosed earlier than nondeletion subtypes, and children with isodicentric duplications in Dup15q were diagnosed earlier than those with interstitial duplications. Conclusion. Understanding variability in age of diagnosis for chromosome 15 disorders is an important step in reducing the diagnostic odyssey and improving access to interventions for these populations. Results from this study provide a baseline by which to evaluate efforts to reduce the age of diagnosis for individuals with these conditions.

Truncating mutations of the maternally imprinted, paternally expressed MAGEL2 gene are the predicted genetic cause of several rare neurodevelopmental disorders including Schaaf-Yang (SYS), Chitayat-Hall and Opitz Trigonocephaly C syndromes. MAGEL2 is also deleted or inactivated in Prader-Willi syndrome (PWS). Previous studies in mice have utilized Magel2 gene deletion models to examine the consequences of its absence. In this study, we report the generation, molecular validation, and phenotypic characterization of a novel rat model with a truncating Magel2 mutation generating a mutant peptide sequence more closely modeling variants associated with SYS-causing mutations. Within the hypothalamus, a brain region wherein mouse and human MAGEL2 is paternally-expressed, we demonstrate at the level of transcript and peptide detection that Magel2 in the rat exhibits a paternal, parent-of-origin effect. In the evaluation of behavioral features across several domains, juvenile Magel2 mutant rats display select alterations in anxiety-like behavior and sociability measures. Moreover, the analysis of peripheral organ systems detected alterations in body composition, cardiac structure and function, and breathing irregularities in Magel2 mutant rats. Several of these findings are concordant with reported mouse phenotypes, signifying the conservation of MAGEL2 function across rodent species for specific behavioral outcome measures. We conclude that our comprehensive analysis demonstrating impairments across multiple domains demonstrates the tractability of this model system for the study of truncating MAGEL2 mutations.

Objectives: Short-stay residents of nursing homes experience high rates of mental health (MH) distress compared to community dwelling counterparts, yet MH interventions are difficult to implement and sustain. We modified a music therapy framework to Effective Music in Psychotherapy. Using the modified model, we integrated music listening into MH group intervention and evaluated MH outcomes. This pilot study reports the development and evaluation of the Mental Health and Music Group for short-stay nursing homes residents.Method: The group was developed and refined to be non-sequential and non-cumulative, specific to the needs of short-stay nursing home residents. Pre-/post-session ratings examined affect, quality of life, and pain. Leaders monitored engagement across and between sessions. Qualitative interviews were conducted with a selection of attendees.Results: Findings indicated decreases in irritation and worry, and increases in mood, energy, and self-as-a-whole from pre- to post-session. There were no changes in pain, perception of physical health or life-as-a-whole, energetic, sad, or happy affect, or differences in engagement. Qualitative interviews demonstrated benefits of group modality and music to group cohesion and highlighted the relevance of music for mental health outcomes.Conclusion: The Mental Health and Music group was designed around a framework of Effective Music in Psychotherapy, for short-stay nursing home settings, and demonstrated promising results. Future research can solidify the interventions generalizeability to medical and rehabilitation settings addressing the specific population needs and preferences.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.1935463 .

Metabolic syndrome (MetS) is a cluster of vascular risk factors that can impact cognition. Cognitive reserve (CR), specifically early operators of reserve (e.g., education), have not been explored in the relationship between MetS and cognition. Adults 45-90 years old (n = 149) underwent neuropsychological testing and evaluation for MetS. Exploratory and confirmatory factor analyses defined neuropsychological domains and created a CR score based on early operators of CR. Regression analyses examined the association among MetS, CR, and neuropsychological performance. CFA revealed two neuropsychological factors: Episodic Memory and Executive Functioning. Controlling for age and physical ability, MetS and CR were significant predictors of the Factors. With CR in the model, MetS became a non-significant predictor of Executive Functioning; CR and physical ability were the most significant predictors. CR and MetS significantly predicted Episodic Memory . The results are discussed in the context of neuroprotective factors and cognitive aging.

OBJECTIVE Using the framework of Social Cognitive Career Theory, this study aimed to ascertain attitudes and perceptions of geropsychology career paths, given the present notable geriatric workforce shortage. METHODS An online survey was developed iteratively and disseminated through various modalities (i.e., internet, email, word-of-mouth). Participants included 28 predoctoral and 76 professional geropsychologists (N = 107; age M = 39.18, SD = 12.05). The sample was largely female (72%), non-Hispanic White (89%), and has or was working towards their PhD (82%). RESULTS Results delineate attractive and unattractive aspects of common career options (academic, clinical Veterans Affairs [VA], clinical non-VA), and assessed the hypothetical proclivity and feasibility of switching between academic and clinically focused careers. The results found gender (women vs. men) and career stages (predoctoral vs. professional) to be significant contributors to career perceptions. CONCLUSIONS The present study advances past literature by unveiling potential avenues to ameliorate this workforce shortage within both clinical and academic fields in geropsychology.

Background/objectives Interprofessional trainees need geriatrics training to prepare them to care for our aging population. Team-based care will help them be ready to work in an Age-Friendly Health System. The Geriatrics 5Ms provides a framework to engage learners in five main domains of caring for older adults from an interprofessional perspective: Mobility, Mind, Medications, Multicomplexity, and what Matters Most. Design We created a half-day workshop for interprofessional trainees using the Geriatric 5Ms framework to increase their preparedness in caring for older adults as part of an interprofessional team. Setting The New England Geriatric Research Education and Clinical Center. Participants A total of 66 trainees from 10 professions. Intervention After introductory sessions on careers in aging, participants engaged in an interactive session to learn about the professions represented. They then formed interprofessional groups to discuss a patient case using the Geriatrics 5Ms framework with a modified jigsaw format. Measurements Trainees were surveyed before and after the workshop on their attitudes toward careers in aging, understanding of skills and training paths of other professions, and familiarity with the Geriatrics 5Ms framework. Results Overall, 97% of the trainees rated the workshop highly. Trainee ratings significantly increased in the areas of understanding of other professions, and familiarity and applicability of the Geriatrics 5Ms, particularly for nonphysicians. Conclusion A workshop for interprofessional trainees using the Geriatrics 5Ms framework increased the readiness of trainees to care for older adults as part of an interprofessional team. This workshop offers a promising model for needed interprofessional geriatrics education. J Am Geriatr Soc 68:1857-1863, 2020.

Objectives: Group mental health interventions are difficult to implement into rehabilitation facilities, but no one has studied the specific barriers. This mixed-methods project systematically exam...

Previous research suggests that there is a relationship between music lessons early in life and cognitive functioning in late life. The current study examined 1) how lifestyle factors, including music lessons, physical and social activity, and health predict late life cognition and 2) how unique music training variables (e.g., hours practiced, years in lessons, age of acquisition) predicted cognitive scores for older adults.Participants completed a neuropsychological battery examining major cognitive domains, and completed questionnaires on music experience, physical and social activity, and physician diagnosed health factors.Results suggested that belonging to the musician group predicted scores on executive functioning, language, and visual spatial ability. Among instrumental musicians, number of years in formal training and current number of hours playing per week predicted scores on verbal memory. Age of acquisition was not a significant predictor of cognitive functioning.Music training significantly predicted scores on tests of executive function, visual spatial ability, and language, above and beyond other variables, including current age and health and lifestyle factors. The number of years of formal training predicted scores on verbal learning and memory, with significant implications for aging. The results are discussed in the context of cognitive aging and music education.

Previous research suggests some psychologists may not consider academic careers because of doubts about their teaching competency, and this is especially true for psychologists interested in aging (i.e., geropsychologists). To enhance competencies in the practice of education, we developed a webinar series, Advancing Your Confidence as an Educator, to bolster skills and attitudes toward teaching and improve attitudes about careers in aging. Seven hour-long webinars addressed key skills in developing and executing courses and professional presentations, and 2 panel sessions addressed attitudes toward teaching by featuring early- and later-career professionals discussing their paths to and satisfaction with jobs as educators. Attendance across the highly interactive sessions was robust (M = 50). Evaluation data suggest the webinar was effective in meeting educational needs. To promote sustainable impact, the webinars are archived and freely available online. Challenges in marketing and evaluation arose, but overall, this effort is one way of cultivating a more vigorous interest and self-confidence in teaching.

A shortage of individuals in academic geropsychology positions further perpetuates the shortage of clinicians trained to meet the needs of the aging population. Barriers to recruiting geropsychology trainees into academia and what attracts trainees into career paths within geropsychology are not understood. The current mixed-methods study examined 1) geropsychology trainees' (n = 28) knowledge and attitudes toward work in clinical or academic positions and 2) professional geropsychologists (n = 67) activities, career expectations, ideal activities, and work/life balance. We asked geropsychology trainees to estimate the amount of time their supervisors spent in clinical, research, education, and administrative activities, and professional geropsychologists reported how they currently spent their time in these same activities. We conducted qualitative interviews asking geropsychology trainees about experiences in academic or clinical settings and geropsychologists about career expectations, opportunities, and work/life balance. Geropsychology trainees had less accurate estimates of academic work time compared to clinically focused work time. Trainee interviews revealed negative perceptions of the university system, including bureaucracy, low salary, and perceived workload. Professional geropsychologists reported high agreement between actual and ideal work time with some individual differences. Each group discussed work-life balance, based on career stage or work setting. Interventions for recruiting more geropsychology trainees into academic jobs are discussed.

Background: Disorders of sleep-wake stability have a negative impact on patient and caregiver quality of life. There is evidence that sleep disorders and their sequelae may be an underrecognized burden for people living with rare diseases. Given that the sleep-wake cycle is regulated via the hypothalamus, people with neurological disorders may be particularly affected. To collect real-world insights into the impact of sleep disturbances and excessive daytime sleepiness (EDS) on people with rare disorders, Harmony Biosciences organized a Summit on Sleep Disruption. The attendees were from seven patient advocacy groups, each representing a rare neurological disorder reporting sleep disturbances, specifically EDS: Angelman syndrome, idiopathic hypersomnia, Kleine-Levin syndrome, myotonic dystrophy, narcolepsy, Prader-Willi syndrome, and Smith-Magenis syndrome. One person represented COMBINEDBrain, a patient advocacy consortium representing 25 rare, genetic neurological disorders. Results: The overwhelming response was that disordered sleep, particularly EDS, is a major health problem within their populations that they feel is not adequately diagnosed or treated. Participants felt that burdens associated with sleep disturbances were underrecognized as a treatable medical issue and were not effectively addressed by health care providers. Participants noted the following unmet needs: patient and physician education on sleep disturbance, effective medications approved for these disease populations, and medically acceptable patient-centered devices to measure sleep parameters. Participants described impacts of disordered sleep and EDS on behavior and school performance, describing impaired wakefulness as an interference with normal daytime functioning. Participants also revealed tremendous burdens on the caregivers and family members who live with people experiencing sleep-wake instability. Conclusions: These results provide real-world insights that disordered sleep including EDS and subsequent impaired daytime functioning are major burdens in these rare disease communities. Furthermore, these burdens are underrecognized for caregivers and, for some rare diseases, among the patients themselves. Participants identified gaps in knowledge and treatment of sleep disorders and resolved to continue the dialog to find ways to raise awareness of disordered sleep and reduce burdens in these patient populations.

Summary Background Malignant glioma is the most common and lethal primary brain tumour, with dismal survival rates and no effective treatment. We examined the safety and activity of NSC-CRAd-S-pk7, an engineered oncolytic adenovirus delivered by neural stem cells (NSCs), in patients with newly diagnosed high-grade glioma. Methods This was a first-in-human, open-label, phase 1, dose-escalation trial done to determine the maximal tolerated dose of NSC-CRAd-S-pk7, following a 3 + 3 design. Patients with newly diagnosed, histologically confirmed, high-grade gliomas (WHO grade III or IV) were recruited. After neurosurgical resection, NSC-CRAd-S-pk7 was injected into the walls of the resection cavity. The first patient cohort received a dose starting at 6·25 × 1010 viral particles administered by 5·00 × 107 NSCs, the second cohort a dose of 1·25 × 1011 viral particles administered by 1·00 × 108 NSCs, and the third cohort a dose of 1·875 × 1011 viral particles administered by 1·50 × 108 NSCs. No further dose escalation was planned. Within 10–14 days, treatment with temozolomide and radiotherapy was initiated. Primary endpoints were safety and toxicity profile and the maximum tolerated dose for a future phase 2 trial. All analyses were done in all patients who were included in the trial and received the study treatment and were not excluded from the study. Recruitment is complete and the trial is finished. The trial is registered with ClinicalTrials.gov , NCT03072134 . Findings Between April 24, 2017, and Nov 13, 2019, 12 patients with newly diagnosed, malignant gliomas were recruited and included in the safety analysis. Histopathological evaluation identified 11 (92%) of 12 patients with glioblastoma and one (8%) of 12 patients with anaplastic astrocytoma. The median follow-up was 18 months (IQR 14–22). One patient receiving 1·50 × 108 NSCs loading 1·875 × 1011 viral particles developed viral meningitis (grade 3) due to the inadvertent injection of NSC-CRAd-S-pk7 into the lateral ventricle. Otherwise, treatment was safe as no formal dose-limiting toxicity was reached, so 1·50 × 108 NSCs loading 1·875 × 1011 viral particles was recommended as a phase 2 trial dose. There were no treatment-related deaths. The median progression-free survival was 9·1 months (95% CI 8·5–not reached) and median overall survival was 18·4 months (15·7–not reached). Interpretation NSC-CRAd-S-pk7 treatment was feasible and safe. Our immunological and histopathological findings support continued investigation of NSC-CRAd-S-pk7 in a phase 2/3 clinical trial. Funding US National Institutes of Health.

Funder: Foundation for Prader-Willi Research; doi: http://dx.doi.org/10.13039/100002889, Prader-Willi syndrome (PWS) is a rare neurodevelopmental genetic disorder associated with a characteristic behavioral phenotype that includes severe hyperphagia and a variety of other behavioral challenges such as temper outbursts and anxiety. These behaviors have a significant and dramatic impact on the daily functioning and quality of life for the person with PWS and their families. To date, effective therapies addressing these behavioral challenges have proven elusive, but several potential treatments are on the horizon. However, a limiting factor for treatment studies in PWS is the lack of consensus in the field regarding how to best define and measure the complex and interrelated behavioral features of this syndrome. The International PWS Clinical Trials Consortium (PWS-CTC, www.pwsctc.org) includes expert PWS scientists, clinicians, and patient advocacy organization representatives focused on facilitating clinical trials in this rare disease. To address the above gap in the field, members of the PWS-CTC “Behavior Outcomes Working Group” sought to develop a unified understanding of the key behavioral features in PWS and build a consensus regarding their definition and description. The primary focus of this paper is to present consensus definitions and descriptions of key phenotypic PWS behaviors including hyperphagia, temper outbursts, anxiety, obsessive–compulsive behaviors, rigidity, and social cognition deficits. Patient vignettes are provided to illustrate the interrelatedness and impact of these behaviors. We also review some available assessment tools as well as new instruments in development which may be useful in measuring these behavioral features in PWS.

Individuals with Prader–Willi syndrome (PWS) may be at higher risk of developing blood clots as compared to the typical population, but this risk is poorly understood. It is also unclear if laboratory testing of D-dimer concentration might be useful to screen for thrombosis in PWS. Here, we surveyed the thrombosis history of 883 individuals with PWS and evaluated the D-dimer concentration in a subset of 214 asymptomatic individuals, ages 5–55. A history of at least one blood clot was reported by 3.6% of respondents. Thrombosis increased with age, but no significant difference was found on the basis of sex or family history. Genetic subtype was a significant factor when considering only those with a known subtype, and individuals with a history of edema had significantly more blood clots. In the D-dimer sub-study, ≈15% of participants had high D-dimer concentrations, and 3.7% had D-dimer values more than twice the normal upper limit. One participant with a high D-dimer result was found to have a blood clot. No significant differences in D-dimer results were found on the basis of age, sex, genetic subtype, family history of blood clots, edema history, or BMI. The D-dimer test does not appear to be a sensitive and specific screening tool for blood clots in asymptomatic individuals with PWS.

Objectives: The current cross-sectional study examines the relationship between both frequency and perceived enjoyment of leisure activities and cognitive scores.Methods: We collected self-reported frequency and perceived pleasure of leisure activities from 58 healthy, community-dwelling older adults and administered a battery of cognitive tests, assessing all major domains (i.e., verbal memory, executive functioning, attention, language, and visuospatial ability).Results: Perceived pleasantness or enjoyment of Socializing and Being Effective predicted higher scores on tests of attention, processing speed, and language. Frequency of activity participation in Being Effective and Doing subscales predicted lower scores on executive functioning tasks.Conclusions: The results imply that frequency and perceived enjoyment of some activities are related to cognition in later life.Clinical Implications: Although the frequency of activities is often measured and subsequently used to address mental health and cognitive concerns in late-life (e.g., Behavioral Activation), we discuss the importance for clinicians to formally assess for enjoyment of these activities as well.

Prader-Willi syndrome (PWS) is a rare genetic disorder associated with varying degrees of hyperphagia, obesity, intellectual disability, and anxiety across the affected individuals' lifetimes. This study quantified caregiver priorities for potential treatment endpoints to identify unmet needs in PWS.The authors partnered with the International Consortium to Advance Clinical Trials for PWS (PWS-CTC) and a diverse stakeholder advisory board to develop a best-worst scaling instrument. Seven relevant endpoints were assessed using a balanced incomplete block design. Caregivers were asked to determine the most and least important of a sub-set of four endpoints in each task. Caregivers were recruited nationally though patient registries, email lists, and social media. Best-worst score was calculated to determine caregiver priorities; ranging from 0 (least important) to 10 (most important). A novel kernel-smoothing approach was used to analyze caregiver endpoint priority variations with relation to age of the PWS individual.In total, 457 caregivers participated in the study. Respondents were mostly parents (97%), females (83%), and Caucasian (87%) who cared for a PWS individual ranging from 4-54 years. Caregivers value treatments addressing hyperphagia (score = 7.08, SE = 0.17) and anxiety (score = 6.35, SE = 0.16) as most important. Key variations in priorities were observed across age, including treatments targeting anxiety, temper outbursts, and intellectual functions.This study demonstrates that caregivers prioritize hyperphagia and, using a novel method, demonstrates that this is independent of the age of the person with PWS. This is even the case for parents of young children who have yet to experience hyperphagia, indicating that these results are not subject to a hypothetical bias.

INTRODUCTION: Previous studies have found that music paired with lyrics at encoding may improve the memory performance of patients with mild Alzheimer’s disease (AD). To further explore memory for different types of musical stimuli, the current study examined both implicit and explicit memory for music with and without lyrics compared to spoken lyrics. METHOD: In this mixed design, patients with probable mild AD (n = 15) and healthy older adults (n = 13) listened to auditory clips (song, instrumental, or spoken lyrics varied across three sessions) and then had their memory tested. Implicit memory was measured by the mere exposure effect. Explicit recognition memory was measured using a confidence-judgment receiver operating characteristic (ROC) paradigm, which allowed examination of the separate contributions made by familiarity and recollection. RESULTS: A significant implicit memory mere exposure effect was found for both groups in the instrumental and song but not the spoken condition. Both groups had the best explicit memory performance in the spoken condition, followed by song, and then instrumental conditions. Healthy older adults demonstrated more recollection than patients with AD in the song and spoken conditions, but both groups performed similarly in the instrumental condition. Patients with AD demonstrated more familiarity in the instrumental and song conditions than in the spoken condition. CONCLUSIONS: The results have implications for memory interventions for patients with mild AD. The implicit memory findings suggest that patients with AD may still show a preference for information familiar to them. The explicit memory results support prior findings that patients with AD rely heavily on familiarity, but also suggest that there may be limitations on the benefits that music can provide to recognition memory performance.

Previous research suggests that ongoing cognitive engagement in late life may help maintain cognitive functioning. We assessed cognition across all major domains in older adult instrumental musicians (active vs. former) and non-musicians using a standardized neuropsychological battery and collected self-report information on levels of physical activity, social activity, and overall health. We used ANCOVAs to determine if there were differences in cognitive test scores among groups. Results showed that all musicians (active and former) had higher scores on a test of language (Boston Naming Test) and of language and executive functioning (Controlled Oral Word Association) compared to non-musicians. However, active musicians scored higher than both non-musicians and former musicians on a version of the Stroop task (Delis-Kaplan Executive Function System: Color Word Interference). These findings suggest that, in some types of executive functions, there may be continued benefit to participating in musical activities later in life. However, in the domain of language, gains from playing an instrument are sustained even if a musician stops playing. We discuss these results in the contexts of cognitive reserve and crystallized and fluid intelligence, including cognitive benefits of early life music lessons that remain in late life.

Background. Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder causing quality of life impairments such as insatiable hunger (hyperphagia) and obesity. We explored caregivers’ willingness to assume treatment risk in exchange for reduced hyperphagia according to a PWS-validated observer-reported outcome measure. Methods. We partnered with PWS patient organizations to develop a discrete-choice experiment exploring caregivers’ benefit-risk tradeoffs for emerging PWS treatments. The treatment benefit was a reduction in hyperphagia (as measured by a 0-, 5-, or 10-point change on the Hyperphagia Questionnaire for Clinical Trials [HQ-CT]). Treatment risks included weight gain (none, 5%, 10%), added risk of skin rash (none, 10%, 20%), and risk of liver damage (none, 1 in 1000, 10 in 1000). Preference models were estimated using mixed logistic regression and maximum acceptable risk. We explored differences in preferences across familial caregivers of patients with and without hyperphagia. Results. Four hundred sixty-eight caregivers completed the online survey. The majority of caregivers reported that patients experienced hyperphagia (68%) and half of patients experienced obesity (52%). Caregivers of patients without hyperphagia were willing to accept greater weight gain (16.4% v. 8.1%, P = 0.004) and a higher risk of skin rash (11.7% v. 6.2% P = 0.008) as compared to caregivers of patients with hyperphagia. Caregivers of patients with hyperphagia would accept a higher risk of liver damage as compared to caregivers of patients without hyperphagia (11.9 out of 1000 v. 6.4 out of 1000, P = 0.04). Conclusions. This research demonstrates that caregivers are willing to accept risk in exchange for a five-point improvement on the HQ-CT, a smaller marginal improvement than had been previously classified as meaningful. Patient experience with hyperphagia is a modifier in how much risk caregivers will accept.

Ageist attitudes are concerning when considering who will enter the geriatric workforce. The impact of ageism on intent to work with older adults (OAs) between North American and non-North American individuals is unclear. We collected data from N=186 students (n=153 N. American, n=33 non-N. American), examining ageist attitudes and intent to work with OAs. We found significant differences between groups in ageist attitudes; North American students had more positive views of aging (M=88.64, SE=0.72) than non-North American students (M=85.33, SE = 1.42; t (167) = 2.04, p = 0.04, d=0.39), but there were no differences between groups for intent to work with OAs (t (174) = 0.09, p = 0.93). Ageist attitudes predicted intent to work with OAs for North American students only (F (2, 112) = 8.82, p < 0.001, R2 = 0.14). We discuss implications of ageism and intent to work with OAs from a cross-cultural lens.

Ageism is recognized around the world as detrimental to older adults’ health and well-being, and there are differences in how cultures view older adults. Infrequently are ageist attitudes among cultures compared within one study. Here, we sought to examine views on older adults across cultures in a sample of university students attending school in North America (n=31). As part of a larger survey of ageist attitudes, we conducted a thematic analysis on open-ended responses to the question “How are older adults viewed in your culture?” Half of the respondents were international students. Results found similarities and differences between groups. First, both groups saw older adults as individuals who are and should be respected. Second, however, North American students viewed older adults as “important” and “role models”, whereas international students viewed older adults as “leaders” of and at the “head of the family”. Third, North American students saw older adults as “needing extra help.” In contrast, international students reported that families “should provide care” as a duty or responsibility. Fourth, North American students believed older adults provide “wisdom,” “love,” and “support” but the international students felt older adults provided knowledge, experience, and opinions that are valued by the family and society that are important to decision making. Finally, North American students describe negative perceptions and experiences with older adults, which was completely absent from the international students responses. Results are discussed in a cultural context of personal and formal relationships with elders.

Assessment of decision-making capacity of older adults is a growing area of practice but training opportunities are lacking. We present a needs assessment, program characteristics, pilot clinic process (n= 52 referrals) and outcome training (n= 4 interns) data for a capacity training clinic. Process data reveal that the training clinic provided consistent referrals (1 per week) across multiple capacity domains (independent living, treatment consent, and financial capacities), with 27% of referrals providing opportunities for training in protective services. Outcome data found three of the four interns reported proficient skills in capacity assessment, as well as improved skills in six areas related to capacity assessment: knowledge of limitations of assessment methods, person-environment interaction, identifying and applying ethical and legal standards, utilizing cognitive assessments, communicating results and recommendations, and assessing risk. The discussion shares lessons learned for the development of future training rotations and clinics in the capacity assessment.

ABY-029, a synthetic Affibody peptide, Z03115-Cys, labeled with a near-infrared fluorophore, IRDye® 800CW, targeting epidermal growth factor receptor (EGFR) has been produced under good manufacturing practices for a US Food and Drug Administration-approved first-in-use human study during surgical resection of glioma, as well as other tumors. Here, the pharmacology, phototoxicity, receptor activity, and biodistribution studies of ABY-029 were completed in rats, prior to the intended human use. Male and female Sprague Dawley rats were administered a single intravenous dose of varying concentrations (0, 245, 2449, and 24,490 μg/kg corresponding to 10×, 100×, and 1000× an equivalent human microdose level) of ABY-029 and observed for up to 14 days. Histopathological assessment of organs and tissues, clinical chemistry, and hematology were performed. In addition, pharmacokinetic clearance and biodistribution of ABY-029 were studied in subgroups of the animals. Phototoxicity and ABY-029 binding to human and rat EGFR were assessed in cell culture and on immobilized receptors, respectively. Histopathological assessment and hematological and clinical chemistry analysis demonstrated that single-dose ABY-029 produced no pathological evidence of toxicity at any dose level. No phototoxicity was observed in EGFR-positive and EGFR-negative glioma cell lines. Binding strength and pharmacokinetics of the anti-EGFR Affibody molecules were retained after labeling with the dye. Based on the successful safety profile of ABY-029, the 1000× human microdose 24.5 mg/kg was identified as the no observed adverse effect level following intravenous administration. Conserved binding strength and no observed light toxicity also demonstrated ABY-029 safety for human use.

Surgical guidance with fluorescence has been demonstrated in individual clinical trials for decades, but the scientific and commercial conditions exist today for a dramatic increase in clinical value. In the past decade, increased use of indocyanine green based visualization of vascular flow, biliary function, and tissue perfusion has spawned a robust growth in commercial systems that have near-infrared emission imaging and video display capabilities. This recent history combined with major preclinical innovations in fluorescent-labeled molecular probes, has the potential for a shift in surgical practice toward resection guidance based upon molecular information in addition to conventional visual and palpable cues. Most surgical subspecialties already have treatment management decisions partially based upon the immunohistochemical phenotype of the cancer, as assessed from molecular pathology of the biopsy tissue. This phenotyping can inform the surgical resection process by spatial mapping of these features. Further integration of the diagnostic and therapeutic value of tumor metabolism sensing molecules or immune binding agents directly into the surgical process can help this field mature. Maximal value to the patient would come from identifying the spatial patterns of molecular expression in vivo that are well known to exist. However, as each molecular agent is advanced into trials, the performance of the imaging system can have a critical impact on the success. For example, use of pre-existing commercial imaging systems are not well suited to image receptor targeted fluorophores because of the lower concentrations expected, requiring orders of magnitude more sensitivity. Additionally the imaging system needs the appropriate dynamic range and image processing features to view molecular probes or therapeutics that may have nonspecific uptake or pharmacokinetic issues which lead to limitations in contrast. Imaging systems need to be chosen based upon objective performance criteria, and issues around calibration, validation, and interpretation need to be established before a clinical trial starts. Finally, as early phase trials become more established, the costs associated with failures can be crippling to the field, and so judicious use of phase 0 trials with microdose levels of agents is one viable paradigm to help the field advance, but this places high sensitivity requirements on the imaging systems used. Molecular-guided surgery has truly transformative potential, and several key challenges are outlined here with the goal of seeing efficient advancement with ideal choices. The focus of this vision 20/20 paper is on the technological aspects that are needed to be paired with these agents.

Given the complex interplay of ethical, clinical, and legal factors, evaluating capacities in older adults is an important competency for geropsychologists. However, the amount of quality of training in this area varies, and geropsychology trainees report less confidence in their capacity evaluation skills. To date, only the Pikes Peak Self-Assessment Tool includes items measuring competency and growth in decisional capacity evaluations. However, it is a broad self-report measure assessing general geropsychology competencies. We developed a performance-based measure of decision-making capacity evaluations, the “Capacity Assessment Training and Competency Evaluation Tool (CATCET).” Using the ABA/APA Assessment of Older Adults with Diminished Capacity as a guide, expert panels created two clinical cases across 5 capacity domains. This presentation will discuss the creation of the CATCET, its application as a training and evaluation tool, and initial performance data among psychology graduate students, intern, and fellows across settings.

To educate generalists for work with older adults, geriatric specialists will increasingly be used as educators and consultants. Recent work found many Geropsychologists felt well trained as clinicians and researchers, but they did not feel as prepared to educate; further few choose primarily educational careers. To address these issues, Geropsychologists from the VA and University partnered to develop a national webinar entitled “Advancing your Confidence as an Educator in geriatrics and gerontology” 9/2017 to 5/2018. Monthly session attendance ranged between 40–70 individuals. On average, 69% of attendees were psychologists, 13% were nurses, and 13% were social workers; 74% of attendees reported specialty training in aging, 14% reported some training in aging, and 12% reported no training in aging. 45% were faculty/staff in hospital settings, 28% were faculty/staff in academic settings, and 23% were students/trainees. In our presentation we will describe the development and implementation of the webinar in further detail.

Previous research suggests that individuals with musical training may show better performance compared to non-musicians in some neurocognitive domains. The purpose of these studies was to examine neuropsychological performance across levels of previous musical training in healthy older adults, examining how musical training impacts normal cognitive aging. Results showed that musical training had a positive effect on some neuropsychological test scores, including those that measure executive functioning, visual spatial ability, and language, but not on tests of attention, processing speed, or memory. Results also found that older adult musicians who continue to play show benefit in executive functioning over musicians who retire from playing, but musician groups remain equivalent regardless of their current play status in other domains, including language. Results suggest that music training has long-lasting impact on the brain’s functioning, including during the normal cognitive aging process.