Day 1 :
Suny Upstate Medical University, USA
Time : 10:00-10:40
Antonio Culebras is a Professor of Neurology, SUNY Upstate Medical University, and consultant in the Sleep Center of Upstate Medical University, Syracuse, New York.rnHe is Certified by the American Board of Psychiatry and Neurology and received his Doctorate of Medicine (PhD equivalent) from the University of Alicante, Spain. He isrnCertified by the American Board of Psychiatry and Neurology, Sleep Medicine. He has lectured in English and Spanish in over 40 countries. He has published 7 books onrnsleep disorders, co-edited 2 books on cerebrovascular disease, published over 200 articles in professional journals, and has served or serves in the editorial board of 15rnnational and international neurological publications.
Clinical evidence suggests that moderate to severe obstructive sleep apnea (OSA) is a risk factor for development of vascular cognitive impairment as a result of cerebral subcortical small vessel disease expressed as leukoaraiosis and silent infarctions. A recent studyrnshowed that old women with OSA AHI>15 were more likely to develop cognitive impairment (AOR, 1.85; [95% (CI), 1.11-3.08].rnOther authors have shown that. OSA AHI>15 is a risk factor for cerebral white matter changes in middle-aged and older patientsrn(OR:2.08 [95% (CI):1.05-4.13]) and for silent cerebral infarction in > 65 y/o patients (OR:2.44 [95% (CI):1.03-5.80]). Intermittentrnnocturnal hypoxia in patients with moderate to severe OSA contributes to ischemic damage in the cerebral periventricular territoryrnof long penetrating terminal arteries. Blood flow may be already precarious as a result of diabetic vascular autonomic dysregulationrnand poorly controlled hypertension. Ischemic damage to the cerebral periventricular white matter disturbs the connections of therncortex with the thalamus leading to subcortical dementia characterized by apathy, decreased executive functions, poor memory andrnin later difficulty walking and urinary incontinence. Treatment of OSA with CPAP may lower cerebrovascular risk by decreasing 24-hrnurinary catecholamine excretion, improving arterial stiffness, improving baroreflex sensitivity and reducing mean 24-h ambulatory blood pressure. CPAP applications may delay onset of dementia. However, CPAP applications will not modify structural lesions ofrnthe brain and therefore early diagnosis and treatment of sleep apnea before structural brain damage ensues is strongly recommended,particularly in patients with several risk factors for stroke.
De Montfort University, UK
Time : 10:40-11:20
Karan Jutlla has completed her PhD in 2011 at Keele University. She has worked as a Senior Lecturer in Dementia studies at the University of Worcester for five years. Shernrecently joined the School of Nursing and Midwifery at De Montfort University in Leicester as a Lecturer in Health and Social Care. Alongside her employment, she alsornworks as an Independent Consultant in Dementia Care supporting services to be culturally competent.
Vascular dementia has been reported as the most common form of dementia in South Asian communities living in the UK due tornhigher incidences of hypertension and diabetes. Research on dementia care in these communities has highlighted the need forrnthe need for cultural competency training for those working professionally with people with dementia and their families. It has been evidenced that while many health professionals feel that they need more training to both improve their knowledge about dementiarnand the cultural norms and religious practices of South Asian people with dementia, access to this sort of training is variable. Because of the acute lack of quantitative and qualitative data about the health and social care needs of South Asian communities and how theyrnare best met, training to improve cultural competency in services is difficult. This paper reports the findings of research with Sikhrncarers of a family member with vascular dementia living in Wolverhampton in the UK highlighting evidence that demonstrates therndiversity of the Sikh community and challenges assumptions of homogeneity. The evidence base presented highlights the importancernfor understanding the psycho-social perspectives of living with vascular dementia for migrant communities and the need for healthrncare professionals and service managers to apply a person-centered approach to care. This paper will help participants to considerrnperson centered care as a model for practice for achieving cultural competency with migrant communities living with dementia inrntheir countries of work.
Trakia University, Bulgaria
Keynote: Asymptomatic carotid stenosis, arterial hypertension and cognitive impairment: A longitudinal population-based epidemiological study
Time : 11:40-12:20
Petya Mineva has completed her PhD in 2006 from the Medical University, Sofia and Post-doctoral studies from the Trakia University, Medical Faculty, Stara Zagora. She is a Head of the Healthcare Department at the Medical College of the Asen Zlatarov University, Burgas and an Associate Professor and a Lecturer in Neurology at the TrakiarnUniversity, Medical Faculty, Stara Zagora. She has published more than 20 papers in reputed journals.
The aim of this epidemiological study is to estimate the significance of asymptomatic carotid stenosis (ACS≥50%) andrnarterial hypertension (AH) for cognitive impairment (CI) in a population without signs and symptoms of stroke or TIA.
A total of 500 volunteers, aged 50-79 years, were enrolled and followed-up for cognitive performance. CI has been definedrnas a score between 24 and 27 of MMSE. Additional neuropsychological tests have also been conducted.
CI in persons without any degree of ACS has been detected at only 13.85% (27/195). In comparison to the whole grouprninvestigated (p<0.012), as well as to the subgroup without ACS, CI has significantly increased in participants with ACS<50% (22.3% -rn61/273, p<0.01) and especially with ACS≥50% (40.6% - 13/32, p<0.001). Significant differences in the prevalence of CI have also beenrnfound between the two subgroups with ASC<50% or ACS≥50% (p<0.05). Logistic regression analysis has been conducted betweenrnthe group with ASC≥50% and an age and sex adjusted control group. It has revealed no relation between CI and ACS≥50%. However,rnmultiple logistic regression analysis has shown that the combination of ACS≥50% and systolic AH (SAH) attributes to CI (OR=10.7;rn95%CI: 3.36-34.14; p=0.0001). CI has been presented as a declinein attention, verbal fluency and verbal working memory at the endrnof the study.
This pattern of CI, which is specific for a cerebral small vessel disease in long lasting AH, has supported the thesis thatrnSAH and ACS≥50%, not only ACS≥50%, are attributable for CI.
Saperstein & Salomon, USA
Time : 12:20-13:00
Steven Benvenisti is a partner at one of the largest personal injury law firms in the United States of America, with offices in New York and New Jersey. For the past fivern(5) years, he has been included on the list of the National Trial Lawyers “Top 100 Trial Lawyers”.He is honored to be the Vice-Chairman of the Board of Directors forrnMothers Against Drunk Driving National and is also one of the directors of the Brain Injury Alliance. Steven has received over 30 awards, including a US CongressionalrnCitation, US House of Representatives Certificate of Special Congressional Recognition and “Citizen of the Year”. Steven authored Spring Break: A True Story of Hopernand Determination about a famous case he handled involving a severely brain injured college student who received long-term inpatient and outpatient acute care and rehabilitation. Spring Break credits the doctors, nurses and rehabilitation professionals for the wonderful work that they do in improving the lives of patients and their families.rnHe has been a keynote speaker at over 100 conferences and gladly donates 100% of his honoraria to charity.
Traumatic brain injury is the silent epidemic of our time. In spite of the millions who sustain a T.B.I. every year, very few medicalrnprofessionals, legal scholars, employers and educators understand the reality of what the survivor and family members experience.rnThe most powerful way to get a full understanding of the impact of T.B.I. is directly from the perspective of a survivor. I present thisrnprogram as an attorney regarding a “law case” of an “All American” college student on vacation with his college friends. One nightrnhe was walking and was struck by a drunk driver’s vehicle. His parents were called in the middle of the night and asked to consent tornorgan donation due to their son’s severe traumatic brain injury and other catastrophic injuries. The parents’ declined to consent tornorgan donation and instead got a room in the hospital to be with their son 24/7. After seeing the powerful photographs of the studentrnin a coma, the audience is delighted to learn that he awoke after almost two (2) weeks, survived and had a full recovery. They arernthen astounded by the announcement that the attorney speaker before them is actually the T.B.I. survivor who is the feature of thernprogram. The remainder of the program educates the audience about T.B.I. from the perspective of the survivor and family, while alsornproviding valuable tools to help them in their own professional and personal capacities when dealing with Traumatic Brain Injury.
- Dementia, Vascular Dementia, Managing Dementia
Location: Melia Valencia Palacio De Congresos
Hospital Universitario Donostia, Spain
Independent Researcher Consultant Culture Dementia, UK
United Christian Hospital, Hong Kong
Time : 13:50-14:20
Yung Cho Yiu graduated from the University of Hong Kong in 1981. He was also nominated fellowship in various international colleges of physicians. He has been a specialist in Geriatric Medicine in Hong Kong for decades. Currently he is the Head of the Division of Geriatric Medicine and the Deputy Chief of Service of the Department of Medicine & Geriatrics in the United Christian Hospital, Hong Kong. His main interests are on cognitive impairment and urodynamics. He publishes widely in international journals. He has also validated the Hong Kong version of the Addenbrooke Cognitive Examination Revised (ACE-R).
Behavioral and psychological symptoms of dementia (BPSD) constitute an integral component of cognitive impairment including, vascular dementia. They could contribute significantly not to caregiver stress but also to escalating healthcare costs. Method: 100 consecutive patients attending a Memory Clinic, located in a district hospital in Hong Kong diagnosed to have vascular dementia were reviewed. The National Institute of Neurological Disorders and Stroke Association Internationale pour la Recherche et I’Enseignement en Neurosciences (NINDS-AIREN) criteria were used to establish the diagnosis of vascular dementia. The Global Deterioration Scale (GDS) was used to stage the severity of the disease. The assessment of BPSD was based on collateral clinical history, patients’ subjective experiences and objective behavior. Neuropsychiatric Inventorywas adopted as the assessment tool. Results: 62% were GDS stage and 38% stage 5. About 91% of stage 5 patients had BPSD and 8% in stage 4 patients. The prevalence of BPSD was about 40%. Amongst these, the pattern of various domains reviewed: individual behaviors include delusion (20%), hallucination (12%), depression (42%), apathy (21%), anxiety (16%), elation (12%), disinhibition (8%), aggression (11%), irritability (13%), aberrant motor behavior (11%), sleep and nighttime behavioral disorders (26%) and eating disorders (19%).
Conclusion: BPSD are frequent in vascular dementia of mild-to-moderate severity.Like other types of dementia, correct identification and evaluation of these symptoms is a crucial component of the clinical approach to vascular dementia.
University of Catania, Italy
Title: United Nations and World Health Organization engagement in treating global mental health, with a special focus on vascular dementia
Time : 14:20-14:50
Daniela Fisichella is an Academic Researcher in International Law and International Organizations. Her teaching position covers all fields of Public International Law and European Union Law and currently, she teaches European Internal Market and Energy Law at the MA Course in Internationalization of Commercial Relations in Catania. Her main research interests are on European politics, EU Constitutionalism, International Human Rights. She’s the Scientific Supervisor of NMUN Project promoted by UniOne, a professional training centre recognized by the Sicilian Region.
A meaningful attention of International Law, and most of International Organizations, is drawn to mental health and to mental illness in XXI century. As a consequence of human rights huge extension, mental health is nowadays a target of international efforts striving to address both state behavior and international achievements. World Health Organization (WHO) is expressly engaged, but United Nations (UN) showed the path in early nineties, by UN General Assembly (UNGA) 46/119 of 17 December 1991. The protection of persons with mental illness and the improvement of mental health care, where mental health care and facilities are pointed out; and if mental illness couldn’t be defined, Principle 4 (Determination of mental illness) of this Resolution is crucial to direct next improvements layout. From there, UN and WHO have been carrying on a unique approach to mental health, as proved by binding and not binding international acts, surveys, guidelines – as the 2010 WHO mhGAP Intervention Guide - adopted as a result of states consultation. UNGA Resolution 70/1 of 21 October 2015, Transforming Our World: the 2030 Agenda for Sustainable Development, envisaging 17 Sustainable Development Goals (replacing past 8 Millennium Development Goals to be gained in 2015 at last) is the last step on the road of a global approach to health, intended as physical and as mental within an holistic view of human beings. As stated in Declaration’s Introduction, § 4, “no one will be left behind” and § 7 “A world with equitable and universal access to quality education at all levels to health care and social protection, where physical, mental and social well-being are assured.”. The paper aims to investigate mental health as an international legal issue on a broad sense, meaning it not only as lack of mental illness, but in a comprehensive view and vascular dementia prevention above other mental diseases is perceived in a global frame of domestic economic and social balance.
Hospital Miguel Domínguez, Spain
Title: Rehabilitation in vascular dementia: Rehabilitation of speech and language manifestations of cognitive impairment in vascular dementia using a spaced repetition based approach
Time : 14:50-15:20
David Gallego is graduated in speech therapy from Valladolid University, Spain, with 10 years of experience in the speech and therapy rehabilitation field related to brain damage (BD). He recently moved to Dublin, Ireland but keeps collaborating with hospital Miguel Domínguez from Galicia, Spain where he worked as head of the speech therapy service for the last 4 years. He also collaborates with the Speech Therapy School from Valladolid University and is collegiated in the Speech Therapy Association of Castilla León.
One of the most common clusters of manifestations of cognitive impairment associated to vascular dementia is related to the handling of language. Regarding rehabilitation approaches, spaced repetition based techniques offer advantages in cases on mild and severe cognitive deterioration because they allow the automation in the use of Word families of key importance in daily communication for patients with severe impairment in cognitive processing. Objective: To analyze the effectiveness of spaced repetition based rehabilitation of speech language in vascular dementia.
2 patients diagnosed of mild vascular dementia and 1 patient diagnosed of severe vascular dementia were submitted to rehabilitation using spaced repetition exercises with vocabulary organized into Word families related to basic actions and events from their daily life. Each patient was stimulated with three groups of twenty words each and supported by graphic material. Measures in the naming of words when confronted with the item were made pre-rehabilitation and post-rehabilitation monthly over a period of 8 months.
All patients improved in denomination of chosen items and kept that improvement during periodical assessments over the 8 month periodical though a slight declination in performance was observed from the 6th month. Case 1 named 8, 5 and 7 words at baseline. After rehabilitation, performance improved to 16, 12 and 15 and declined to 13, 11 and 12 after the 8 month period. Baseline in Case 2 was 6, 8 and 9 words and improved to 15, 18 and 13 after rehabilitation with a decline to 13,15 and 10 after the 8 month period. Case 3 performed 2, 4 and 7 at baseline and improved to 10, 13 and 11 after rehabilitation with a decline to 10, 11 and 9 after the 8 month period.
Spaced repetition based exercises is a useful asset when dealing with vocabulary re-acquisition in patients affected by vascular dementia and offers a reasonable prognosis over time despite neurodegenerative factors.
Black Country Partnership Foundation Trust, UK
Title: Diagnosing vascular dementia in South Asian communities: The importance of a culturally appropriate assessment tool
Time : 15:40-16:10
Harjinder Kaur is a Community Psychiatric Nurse for Wolverhampton City. In 2001, she was appointed as the Asian Link nurse with a specialist role to increase contact between specialist old age psychiatry services and older people from Black, Asian and Minority Ethnic (BAME) communities. She has played an important role in disseminating information about dementia and related conditions and in educating the South Asian community and professionals on the help available. Since her appointment, she has made remarkable efforts to ensure that the BAME communities residing in Wolverhampton have fair access to services and has consequently increased the diagnosis rates of dementia within these often hidden and marginalised communities.
There is a current estimate of nearly 25,000 people with dementia from Black, Asian and Minority Ethnic (BAME) communities in England and Wales. This number is expected to grow to nearly 50,000 by 2026 and over 172,000 people by 2051. This is nearly a seven-fold increase in 40 years. It compares to just over a two-fold increase in the number of people with dementia across the whole United Kingdom (UK) population in the same time period. BAME communities in the UK are not just getting older but they are also growing in numbers. It is therefore extremely important to have a tool that is suitable to assess dementia amongst these communities so that diagnosis is made early and that patients get the support and treatment they need and require. Currently, this area of work is underdeveloped and a ‘culturally appropriate’ diagnostic tool is yet to be developed. This presentation discusses current diagnostic tools for Vascular Dementia arguing the case for the Rowland Universal Dementia Scale (RUDAS) as a tool for diagnosing Vascular Dementia in BAME communities who may not only lack English fluency but also literacy skills. The information presented is based on the speaker’s experience of working with people from South Asian communities, to share good practice and raise awareness about some of the challenges and barriers for diagnosing Vascular Dementia. Though based in the UK, this information is transferable to other countries working with people from different cultural backgrounds.
1Kazakh National Medical University, Kazakhstan 2Almaty City Clinical Hospital #1, Kazakhstan
Time : 16:10-16:40
Saule T Turuspekova (MD, PhD) is a Neurologist of highest category and Professor of the Department of internship and residency in Neurology of KazNMU. In 1995, she completed PhD Thesis, “Vegetative-vascular disorders in cerebral manifestations of diabetes mellitus” and in 2010-Doctoral thesis - "The influence of small doses of ionizing radiation on the nervous system". She has published over 100 scientific papers which were presented at international conferences in many countries. She received state scholarship for talented young scientists of the Ministry of Science of the Republic of Kazakhstan. She served as the Coordinator of the Russian Youth Academy of Sciences (Samara), 2015-the personal physician of the Kazakhstan astronaut Aydin Aimbetov. She is the Member of the ESO, WSO, «Neurosciences», EAN.
Arterial hypertension (AH) is considered as one of the causes of vascular dementia. Brief Montreal Cognitive Assessment Scale (MoCA) can be sensitive to the detection of cognitive impairment (CI) in AH.
To evaluate the validity of the use of MoCA test for the detection of CI in patients with AH lasting no more than 10 years.
Material & Methods:
Observed 60 patients with a higher education (females -24, males -36) aged 40-60 years with AH lasting no more than 10 years. To determine the degree of CI, MMSE and MoCA were used.
80% of patients with AH are pre-demention CI which is identified in the application of MoCA-test, whereas MMSE was not informative. According to MoCA average value was 19.5±2.5 points and according to the MMSE - 30 points. At the same time moderate CI (22.5±2.5 points) detected in 56.6% of cases, heavy CI (16.5±2.5) was diagnosed in 23.3%. Among patients with a duration of up to 5 years of AH is well coped with the tasks of MoCA40%, 60% of detected light CI. In patients with AH from 5 to 10 years, MCI identified in 53.4% of cases (21±1.0 points), 46.6% of patients had a dementia (14-19 points).
Conclusions: The observed decline in cognitive function in patients with AH that can possibly be regarded as a predictor of dementia. These results make it necessary and justified to make use of MoCA-test for the universal screening for CI.
Helen Fountain is the Reminiscence Officer at the Oxford University Museums Partnership. Following University, she began working in the Social Care sector in 1997, working with vulnerable young people at Coventry YWCA and with homeless people at Coventry Cyrenians, followed by a role with Coventry City Councils’ Social Services Department commissioning and monitoring support services for elder people. A part time role at the Herbert Art Gallery began to inspire the idea of the creative potential of partnerships between elder people and the heritage sector. Following her Master’s Degree in Museum Studies from the University of Leicester, she took up her current post in 2009. The role of Reminiscence Officer for Oxford University Museums has offered fantastic opportunities to devise and deliver museum activities for older people including a reminiscence outreach services, bespoke reminiscence projects, community exhibitions, intergenerational events and working with local NHS Partners to deliver reminiscence activities to older people in hospital settings. In 2015 she, along with the Oxford Institute for Population and Ageing carried out research into the impacts of her work, the findings are due to be published later this year. She is also a Dementia Champion with the Alzheimer’s Society Dementia Friends scheme.
Oxford University Museums Partnership has an excellent track record of delivering museum community engagement services to elder people in Oxford and Oxfordshire. The seminar will focus on how reminiscence and museum activities are used in a variety of ways (including oral history projects, artistic projects, drama projects and music projects) to engage with older people living with Dementia in community and healthcare settings. The seminar will offer delegates the opportunity to participate in practical skills sharing which will equip them with techniques for using reminiscence as a therapeutic activity for people living with Dementia. It will focus on the positive impact that participation in such activities can have on wellbeing, both for the older person and their carers, drawing on UK research findings to make the case for reminiscence as an activity for enhancing quality of life for elder people living with Dementia and their carers.