Day 1 :
Keynote Forum
Deborah Oliveira
University of Nottingham, United Kingdom
Keynote: Recent developments on dementia risk reduction
Time : 09:30-10:15
Biography:
Oliveira is a Research Fellow Nurse working for the Institute of Mental Health, University of Nottingham. She is currently leading a national UK survey on dementia risk reduction funded by the Alzheimer Research UK and editing a book on this topic. Dr Oliveira completed her PhD in 2016, in which she developed and validated an age- and dementia-specific quality of life scale for use with older family carers – the DQoL-OC.
Abstract:
Individuals’ lifestyle contributes to the risk of dementia and lack of physical exercises, lack of social interaction, poor diet, smoking and alcohol consumption are among the major risk factors. Researchers have developed interventions aimed at promoting mental and physical fitness via increased cognitive and physical activity and improving diet and health, but too little is known about possible benefits or levels of uptake. Implementation of life style changes depends on individual attitudes and little is known about what and how much older people are prepared to change in order to prevent dementia. If the factors associated with better attitudes towards change of life style can be predicted, more accurate interventions tailored to these specific issues can be developed in order to reduce the risk of dementia. This presentation will show preliminary data from a national UK survey that involved aproximately 4,000 people aged 50+ without dementia. The study aimed to assess people’s willingness to change their lifestyle to potentially reduce their risk of future dementia, as well as understand more about factors that might predict willingness to change. Sociodemographic and current lifestyle information was collected. Motivation to change lifestyle was assesed using the MCLHB-DRR scale and non-validated questions based on the current lifestyle profile (e.g. if the individual smoked, it was asked how much he/she would be willing to stop smoking). The data suggests important differences in gender and age in relation to motivation to change lifestyle. These will be discussed in detail in this presentation.
*This research was funded by the Alzheimer’s Research UK Midland (2016-2017)
Keynote Forum
Jagdish Singh
North Dakota State University, USA
Keynote: Challenges and Opportunities for Drug Discovery for Neurodegenerative Diseases
Time : 10:15-11:00
Biography:
Jagdish Singh is Professor and Chair of the Department of Pharmaceutical Sciences at NDSU College of Pharmacy, North Dakota and a Fellow of American Association of Pharmaceutical Scientists (AAPS) and Fellow, Association of Biotechnology and Pharmacy. His efforts focus on the mechanistic studies for developing and testing novel delivery technologies to deliver biotechnologically derived molecules (e.g., peptide, protein, and gene). He has published over 150 peer-reviewed papers and 270 abstracts.
Abstract:
Neuro-degenerative diseases have become the most common cause of dementia among the elderly. There were 36 million people living with dementia worldwide in 2010, increasing to 66 million by 2030 and 115 million by 2050. In 2010, the global cost of dementia was $604 billion. This is 1% of global GDP and it is likely that these costs will increase in proportion to the number of people with dementia. Gene therapy has been identified to possess a broad potential for the treatment of numerous neurological diseases, including Alzheimer’s disease (AD). AD is a progressive neurodegenerative disease and the most common form of dementia caused by accumulation of toxic amyloid-β (Aβ) peptides in the brain, in which the development of effective therapies have been desired. However, the major challenge in the field of gene therapy is the design of safe vectors that can cross the blood brain barrier (BBB). It has been found that the transferrin receptors are present on the surface of brain endothelial cells. The liposomes, lipid based nanoparticles, can be surface modified with transferrin (Tf) protein for targeting the brain endothelial receptors and conjugated to cell penetrating peptide (CPP) for improving their internalization into brain by overcoming receptor saturation. In order to deliver gene/drug across the BBB, we conjugated the liposomes with two ligands (1) a receptor targeting protein (Tf) and (2) a CPP. Thus, we designed near-neutral, PEGylated liposomal nanoparticles encapsulating gene and drug and modifying the surface with Tf and CPP. Findings of in vitro characterization and in vivo bio-distribution will be discussed.
Keynote Forum
Si Ching Lim
National University of Singapore, Singapore
Keynote: Eating disorders and dementia
Time : 11:20-12:05
Biography:
Si Ching Lim has a special interest in dementia care particularly in patients with behavioural and psychological symptoms of dementia. She is currently In-charge of a 20 bedded dementia ward in a teaching hospital in Singapore and is responsible in developing the ward and training the staff in managing elderly with delirium and dementia with challenging behaviour. She is also an Adjunct Assistant Professor at National University of Singapore and Dukes Graduate Medical School.
Abstract:
Dementia is becoming an expensive disease worldwide and its prevalence is on the rise, particularly in the developing countries. Eating disorders are common among the different types of dementia at various stages of the disease process. In the early stages, cognitive deficits cause them to eat very frequently, having forgotten they had just eaten. At the late stages, metabolic rate gets down regulated as the disease cause increasingly severe atrophy and physical activities reduce. The patients develop anorexia and together with functional dysphagia, nutritional intake and adequacy becomes a big concern for the caregivers. In addition, they have difficulties using the cutlery, recognizing food and are easily distracted by changes in the environment. The presence of behavioural problems also interferes with meal times and nutritional intake. There are ways to manipulate and increase the nutritional values of their intake at the late stages and explore the pros and cons of tube feeding for the elderly with severe dementia, the ethical consideration of tube feeding, etc.
Keynote Forum
Markku Kurkinen
Wayne State University, USA
Keynote: Alzheimer’s drug discovery: Targeting astrocyte synaptic glutamate uptake
Time : 12:05-12:50
Biography:
Markku Kurkinen completed his PhD in 1979 at University of Helsinki, Finland and; Post-doctoral studies from 1980-1983 at Imperial Cancer Research Fund, Mill Hill, London, UK. He was an Assistant Professor from 1984-1986, at Rutgers Medical School, Piscataway, New Jersey, USA; Associate Professor 1986-1992, and Division Chief, Connective Tissue Research, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA. He is Professor at Wayne State University School of Medicine, Detroit, Michigan, USA. He has published more than 100 papers, reviews and book chapters.
Abstract:
According to the amyloid hypothesis, Alzheimer dementia begins in the brain with Aβ peptides accumulation and amyloid formation. However, clinical drug trials targeting Aβ peptides and brain amyloid have failed to help anybody living with Alzheimer. Instead of repeating similar trials and errors of 25 years, we have to discover novel drug targets and better our research to prevent and treat Alzheimer. Glutamate is the synaptic signaling molecule of neurons. As soon as the glutamate signaling starts it is stopped in 0.1-2 ms by astrocytes, which take up and clear glutamate from synapses. This prevents glutamate neurotoxicity causing synapse loss and neuron cell death. Astrocytes make EAAT2 (excitatory amino acid transporter-2), the major glutamate transporter and 1% of brain protein. In Alzheimer dementia, astrocytes are impaired in glutamate uptake. In experimental mouse models of Alzheimer, increasing EAAT2 expression slows dementia progression. To discover drugs that can activate EAAT2 in glutamate uptake; we describe a simple assay that targets the EAAT2 protein reconstituted in liposomes and measures glutamate uptake with Oxonol VI red light. By directly targeting the EAAT2 protein, the assay should limit ‘off-targeting’ of drugs and adverse events, which are the main problems in Alzheimer’s drug discovery and clinical development. We may have to screen a million or more drugs, chemical compounds and natural products, before we find what we are looking for. We believe our drug assay of liposome glutamate uptake, in a high-throughput screening (HTS) format, can do exactly that. For efficacy, specificity and safety, the EAAT2 activating drugs are studied in an experimental C elegans model of Alzheimer.
- Workshop
Location: Londres
Session Introduction
David Truswell
Culture Dementia, UK
Title: Raising awareness about vascular dementia in the African-Caribbean community in the London
Time : 13:40-14:30
Biography:
David has worked in community based mental health services in the UK for over thirty years developing services for people with complex care needs and enduring mental health problems in a career spanning the voluntary sector, local authority services, and the NHS.. From 2009 - 2011 he was the Dementia Implementation Lead for Commissioning Support for London, working with commissioners across London to improve dementia services. He is of Chair the Dementia Alliance for Culture and Ethnicity (www.demace.com) and an independent writer and researcher on dementia support and services for Black and minority ethnic communities, working with a number of projects and initiatives.
Abstract:
London, the UK capital is home to 58% of all those who identified themselves as African-Caribbean in the UK 2011 National Census. It is demographically the oldest of the Black populations in the Census categories and proportionally has a higher rate of dementia than the White UK majority. With research indicating that vascular dementia and early onset dementia ia growing issues for Caribbean men under the age of 65 strong cultural beliefs lead many of those most at risk to dismiss any mainstream efforts at preventative health education. Denial of problems and refusal to seek help or diagnosis can often lead to a major crisis before there is any engagement with professional support services and frustrate efforts to develop ongoing links with services. Culture Dementia UK a voluntary organisation has been working on awareness raising and providing support in the African-Caribbean community in London. The presentation explores how the African-Caribbean cultural narrative of independence and resilience mitigates against help-seeking in dementia and some of the approaches adopted by Culture Dementia UK to raise awareness and encourage people to look for support.
- Vascular Dementia and Stroke | Causes and Prevention | Vascular Cognitive Impairment | Dementia: Risk Factors | Prevention of Dementia | Dementia Stages
Location: Londres
Chair
Fan Fan
University of Mississippi Medical Center, USA
Session Introduction
Christopher J Winrow
Ironwood Pharmaceuticals, USA
Title: Evaluating nitric oxide and soluble guanylate cyclase signalling in vascular dementia
Time : 14:35-15:00
Biography:
Christopher Winrow completed his Ph.D. at the University of Alberta and post-doctoral fellowship at the Salk Institute. He has authored 70 publications and has over 15 years of neuroscience drug discovery and development experience, delivering five compounds from HTS through successful clinical proof of concept. He led the Belsomra® discovery team from screening to regulatory approval in less than 10 years, resulting in this first-in-class CNS therapeutic garnering approvals by U.S. and international regulatory agencies. Dr. Winrow is Senior Principal Investigator at Ironwood Pharmaceuticals in Cambridge, MA where he is responsible for leading multidisciplinary teams through proof of concept for clinical-stage compounds.
Abstract:
The nitric oxide (NO)-soluble guanylate cyclase (sGC)-cGMP signalling pathway plays a fundamental role in modulating diverse physiological processes including blood flow, inflammation, neuroprotection, fibrosis and metabolism. sGC is expressed throughout the CNS. sGC stimulators are small-molecule agonists of sGC that synergize with and enhance endogenous NO signalling. As such, sGC stimulators may provide therapeutic benefits in diseases either associated with loss of NO signaling or where stimulation of this pathway will restore homeostasis. Impaired endothelial cell function and reduced NO bioavailability have been observed across a variety of diseases affecting both micro- and macro vascular health, including vascular dementia where impaired blood flow, disrupted neurovascular coupling, inflammation and neuronal loss are thought to be core aspects of the disease. We are developing IW-1973 and IW-1701 as oral, once-daily sGC stimulators for both cardiovascular and non-cardiovascular indications. Phase 1 data in healthy human subjects demonstrate attractive pharmacokinetic properties and clear evidence of target engagement and expected hemodynamic effects, in a well-tolerated dose range. Phase 2 studies are currently ongoing. In addition, we are developing IW-6463, a novel, first-in-class CNS-penetrant, sGC stimulator with potential application to CNS disorders including vascular dementia and Alzheimer’s disease. Preclinical characterization of IW-6463 supports the broad therapeutic potential and multi-faceted pharmacology of this compound. We believe that sGC stimulation can afford therapeutic benefit for vascular dementia and other diseases, and that there are opportunities for multiple therapeutic products differing in their pharmacology, distribution and pharmacokinetics.
Molly Carlile
The Deathtalker, Australia
Title: Dealing with dementia as a terminal illness
Time : 15:00-15:25
Biography:
Molly Carlile A M is a multi-award winning international speaker, author and specialist in the field of palliative care, grief and loss, education and community development. She has a significant clinical background and has held senior leadership roles in acute and community healthcare in addition to sitting on numerous health service boards, department of health advisory committees and academic committees in both nursing and palliative care. She has won local, national and international awards for her work in the field and was awarded a Member of the Order of Australia for her contribution to palliative care. She has presented her papers at national and international conferences for the past 10 years, is a regular media commentator and is currently working on her third book about death and grief.
Abstract:
Western cultures are notoriously death denying and this applies equally to people in later life who are often living with multiple chronic illnesses, dementia being one. Dementia, though known to be a terminal illness is rarely discussed as such and the grief a person and their family experience on receipt of a diagnosis of dementia is often under explored by health professionals. Why is this? Health professionals often feel ill-equipped to undertake difficult conversations with patients and their families, and so their grief goes un-addressed and end of life issues remain unexplored until the person enters the active dying or imminent death phase, at which time both the person and their family are ill-prepared for the palliative nature of the care that is now appropriate. In order to provide the best level of care and quality of life for people living with dementia, it is essential for health professionals to assist them to explore their values, their fears and apprehensions and to understand what a good death and high level of quality of life looks like for each individual diagnosed with dementia. This presentation will explore the importance of advance care planning, holistic care and exemplary end of life care (including exploring the issues of grief and loss) for people and their families living with dementia and the road blocks that currently exit that prevent these conversations from happening early in the illness trajectory.
Hans Von Holst
Karolinska Institutet, Sweden
Title: Vascular dementia in traumatic brain injury and stroke
Time : 15:25-15:50
Biography:
Hans von Holst received his Medical Doctor’s degree in 1976 and specialist in Neurosurgery in 1982 at Karolinska University Hospital. In 1985, he earned his PhD and Associate Professorship in Neurosurgery, Clinical Neuroscience at Karolinska Institute. During 1991-1996, he was appointed as Chairman of the Department of Neurosurgery and Division Manager of the Neuro-clinics at Karolinska University Hospital, respectively. He has been appointed as Senior Neurosurgeon from 1974 to 2015. From 1995-2015, he was appointed as Professor in Neuro-engineering at Royal Institute of Technology. He has published around 140 original papers in reputed journals, reviews and books and has been serving as an Editorial Board Member in several journals
Abstract:
Vascular dementia is the second most common dementia type after Alzheimer’s disease. Although the epidemiology of vascular dementia is somewhat difficult to estimate exactly, it is substantial nationwide as stroke is one of the major causes. It may also be defined as cerebrovascular dementia as the etiology results in reduced blood flow to parts of the brain tissue. A majority of the cases are elderly people over 70 years. The causes to vascular dementia include high blood pressure, lipids, obesity and diabetes as well as external traumatic brain injury. The clinical picture presents different symptoms depending on injury location and includes, among others, memory problems, reduced thinking and impaired linguistic abilities, slow motoric motion, depression, aggressiveness and impaired judgment. Also, temporary confusion caused by different stress situation is not uncommon. With the introduction of advanced imaging technology such as computerized tomography, magnetic resonance tomography and positron emission tomography, the anatomical location of the defect tissue area can better be identified. The treatment of vascular dementia varies depending on its cause as well as on anatomical location. With the introduction of more advanced laboratory and imaging technology, it is possible to better understand the consequences to vascular dementia on a molecular level including the protein metabolism. With better knowledge from medical and technical development, the primary prevention of vascular dementia will be highlighted such as reducing metabolic disorders but also by the primary prevention in avoiding traumatic brain injuries following fall, traffic accidents and due to different leisure activities.
- Ageing and Dementia | Treating Dementia | Advances in Dementia Diagnosis| Dementia Care Management
Location: Londres
Chair
Hans Von Holst
Karolinska Institutet, Sweden
Session Introduction
Felipe Padilla Vazquez
Instituto Nacional de NeurologÃa y NeurocirugÃa, Mexico
Title: Cerebral arteriovenous malformations, hemodynamics, risk of hemorrhage and relationship with dementia
Time : 16:15-16:40
Biography:
Felipe Padilla Vazquez Specialist in Neurointervention, Neuropathic Endovascular Therapy, Cerebrovascular Diseases, Column Surgery, CNS Oncological Surgery, Headaches, Neuropathic Pain and present time he is Member of the Mexican Society of Neurological Surgery AC.
Abstract:
Background & Aim: Cerebral arteriovenous malformations (AVM) are hemodynamic lesions which must be studied as such, to determine the cerebral blood flow, average velocity, the Reynolds number to determine turbulent or laminar flows, to calculate in each one their risk of hemorrhage and their anatomical characteristics in this way make therapeutic decisions. In some lesions with venous hypertension or fistulous nests, they generate a high degree of hyper flow, which can cause perilesional vasculopathy to the AVMs nidus, areas of hypoperfusion that can generate dementia.
Method: We did a retrospective study that included 639 patients with ruptured and un-ruptured AVMs. We proposed a new classification score (1-4 points) for AVM rupture risk using three factors; feeding artery mean velocity (Vm), nidus size and type of venous drainage. We employed descriptive statistics and logistic regression analysis. We analysed the different type of nidus in each AVM (plexiform, mixto and fistulous), angiopathy data were determined by recruitment in some lesions and their perinidal repercussion. The patient´s clinic was determined as well as the study of superior mental functions with a mini-mental test.
Results: A total of 639 patients with cerebral AVMs, 388 (60%) had un-ruptured AVMs and 251 (40%) had ruptured AVMs. Logistic regression analysis revealed a significant effect of Vm (mean velocity), nidus size and venous drainage type in accounting for the variability of rupture odds (P=0.0001, R2=0.437), for patients with AVMs. Based in the odds ratios, grades 1 and 2 of the proposed classification were corresponded to low risk of hemorrhage, while grades 3 and 4 were associated with hemorrhage: 1 point OR=0.10795% CI;0.061-0.188, 2 point OR=0.227 95%, CI; 0.153-0.338, 3 point OR=3.292 95%, CI;2.325-4.661, and 4 point OR=23.304 95%, CI; 11.077-49.027. We catalog different types of venous drainage, type 1, the anterograde (downstream or normal flow); type 2 the retrograde (upstream or reverse flow) and type 3, retrograde (upstream or reverse flow)+facial venous drainage. We observed that patients who had retrograde flow associated with large AVMs with a fistulous nidus were those that presented dementia data.
Conclusion: This classification is useful and easy to use, and it may allow for the individualization of each cerebral AVM and the assessment of rupture risk based on a model of categorization. The retrograde flow and the fistulous nidus of the AVMs have a high risk of dementia.
Si Ching Lim
National University of Singapore, Singapore
Title: Management of challenging behaviors in dementia – A Geriatrician’s perspective
Time : 16:40-17:05
Biography:
Si Ching Lim has a special interest in dementia care particularly in patients with behavioural and psychological symptoms of dementia. She is currently In-charge of a 20 bedded dementia ward in a teaching hospital in Singapore and is responsible in developing the ward and training the staff in managing elderly with delirium and dementia with challenging behaviour. She is also an Adjunct Assistant Professor at National University of Singapore and Dukes Graduate Medical School.
Abstract:
Dementia is becoming an expensive disease worldwide and its prevalence is on the rise, particularly in the developing countries. The non-cognitive symptoms of dementia, also known as neuropsychiatric symptoms or behavioural and psychological symptoms of dementia (BPSD) is particularly challenging for the caregivers resulting in significant caregiver stress, leading to burnout and institutionalization. BPSD occurs in >90% of people with dementia at some point during the course of their illness. An overview of BPSD-types of behavioural problems encountered aetiology of BPSD, approach to treatment of BPSD focusing on Person Centred Care (PCC) and treatment options. For healthcare workers, particularly the ones not trained in geriatric and gerontology, BPSD is challenging and stressful. The majority of caregivers will end up restraining- either physically or chemically, the patients for their safety. Restraining the elderly comes with complications like physical deconditioning, DVT, UTI, urinary retention, constipation, pneumonia, pressure sore, etc. The aim of this presentation is to introduce to the audience the causes of challenging behaviour and how to manage the agitated patients non-pharmacologically, with restraints as a later alternative. The presentation will include two-three cases for discussion.