Objectives: Apart from irrational polypharmacy, drug-drug interactions (DDIs) and potentially inappropriate medications for elderly patients, there are numerous challenges referring to psychopharmacological treatment in this patient subgroup prescribed psychotropic agents. Specifically, pharmacokinetics and pharmacodynamics essentially differ in elderly patients, complicating medication selection and dosing.

Methods: Pharmacokinetics involves absorption, distribution, metabolism, and elimination of the medication. Elderly patients often present distinct patterns of medication absorption as well as reduced elimination (due to decreased kidney function). DDIs are another major confounder of medication metabolism. This is particularly

common in elderly patients, as one out of two elderly patients with mental disorders receive polypharmacy which in turn requires careful dose adjustment. Medication adherence is an additional challenge in patients with mental disorders, further complicating pharmacotherapy.

Results: We discuss the benefits of therapeutic drug monitoring (TDM), i.e. the regular measuring of drug concentrations in plasma of patients prescribed psychotropic agents. TDM is a valuable personalized treatment tool; specifically, it allows the determination of the minimum effective dosage also improving safety outcomes. Basic TDM principles, such as steady-state, trough levels and therapeutic reference ranges in the context of elderly patients’ pharmacological treatment will be discussed.

Discussion: The use of TDM is of established clinical value in particularly vulnerable patient subgroups such as elderly patients. Summarizing practical recommendations for TDM in clinical routine we aim to enhance its use ultimately enabling an improvement of treatment effectiveness and safety outcomes in elderly patients prescribed psychotropic agents.

Objectives: UK policy priority is to support people with dementia (PLwD) to live at home for longer. Initial clinical assessment involves evaluating and managing risk to enable PLwD to live safely and well at home. Risk assessment scales are needed to identify, manage and reduce risk within contemporary dementia practice. The “Islington Dementia Navigator Risk Assessment Tool” (IDNRAT) is used by specialist and non-specialist staff to stratify the level of risk for PLwD and inform a risk management plan and the frequency of follow-up. We assessed whether IDNRAT enables risk detection and whether the risk intervention derived from it is implemented and improves the safety of people living at home with dementia.

Methods: A mixed Methods study to evaluate IDNRAT’s validity, and the feasibility and acceptability of the resulting risk management plan. We investigated the use of the IDNRAT to: (i) detect risk (concurrent validity) and measure the reliability of the tool; (ii) contribute to risk reduction (primary outcome was numbers of decisions implemented); (iii) explore patients’ and carers’ experience of risk stratification.

Results: We found risk stratification scores (n = 119) derived from IDNRAT and compared with gold standard clinical risk assessments showed concordance between clinicians’ ratings. Joint Dementia navigator and researcher interviews (n = 19) showed consistency between the different assessor scores demonstrating IDNRAT has good reliability. Care-plan data showed most participants (n = 275) scored in the low-risk band of IDNRAT (78.9%) at baseline assessment and risk severity ratings (red/amber/green) reduced over the 6–12-month time period. PLwD (n = 19) and family carers (n = 17) had differing perceptions about risk and the PLwD’s susceptibility to risk. Overall, participants found the risk assessment acceptable, were able to identify risks and felt included in decision-making processes.

Conclusions: We found that the IDNRAT used by non-specialist practitioners (dementia navigators) does enable people with dementia to live safely at home in terms of risk- identification, implemented risk enablement decisions and acceptability. IDNRAT is a valid risk assessment tool, which offers a tailored approach to the management of risk, and over 80% of care-plan decisions were implemented. This is consistent with best practice and the tool has potential for wider use.

Background: Dementia is rapidly increasing in Asia.

Aim: There has been an Asian forum to ascertain country-specific patterns of management of dementia and to investigate country-specific characteristics.

Methods: In 2009, 11 dementia experts on Alzheimer’s from Korea, Japan, mainland China, Hong Kong China, Taiwan, Singapore, Philippines, Malaysia, Indonesia, Thailand, and India were invited to participate in the survey. The 33-item questionnaire were answered; awareness of dementia, characteristics of patients with memory problems, referral, diagnosis of MCI and dementia, diagnostic tools including the high-technology device, pharmacological treatment of MCI and dementia, current issues on AD, barriers and challenges in the management of dementia. Since then, 3 surveys have been completed in 2009, 2012, and 2024.

Results: New revised research diagnostic criteria for AD needing spinal tapping and brain imaging might not be adopted for clinical practice in memory clinics in Asia. Brain imaging studies like CT, MRI, SPECT, or PET are applied for more than 75% of patients as a usual part of the diagnostic workup in Korea, Japan, mainland China, Taiwan, Singapore, Indonesia, and Thailand, while 51 ∼ 75% in Philippines and 25 ∼ 50% in Hong Kong, Malaysia, and India. Proportion of patients who continue pharmacological treatment after the initial diagnosis of dementia varies country by country varies. Most countries endorsed all approved anti- dementia drugs, but some others approved a few of them (i.e., only donepezil present in Japan, galantamine absent in China, memantine absent in Indonesia, rivastigmine absent in Thailand. Cholinesterase inhibitors are prescribed in more than 90% of patients in 6 countries (i.e. Korea, Japan, Taiwan, Singapore, Philippines, Malaysia). In other 5 countries, medications like memantine, huperzine, ginkgo biloba, vitamin E, herb medicine or others are being more frequently prescribed than in above 6 countries.

Conclusions: Well-organized and planned governmental policies about dementia, in collaboration with dementia experts and their organizations, will effectively reduce burden of dementia in Asia, where an epidemic tide of dementia is approaching.

Introduction: Patients with mild to moderate dementia, progress to end stage dementia faster if they have more medical conditions (MCs) at their baseline evaluation, than those who have less MCs. Other recent studies have noted that the cognitive function of elderly people with subjective cognitive impairment (SCI) is five times more likely to further decline than those without SCI.

Objectives: Our aim was to determine; 1) whether the prevalence of medical comorbidities contribute to more rapid decline in cognitive functioning, and 2) whether the prevalence of medical conditions and the use of medications are different in patients with and without SCI.

Methods: Using rigorous inclusion and exclusion criteria, we enrolled 86 elderly people with normal cognition in a retrospective cross-sectional study.

Results: Our preliminary evaluation shows that medical conditions markedly influence the decline of cognitive functioning, even in the elderly with normal baseline cognitive function, and in the elderly with SCI have significantly more MCs and take more medications than those without SCI.

Conclusions: Further studies are needed to evaluate the change in the number of medications, frequency of cardiovascular diseases, history of surgeries and episodes or occurrences of depression between the evaluations.

Objectives: Antipsychotic use among patients with Alzheimer’s dementia can pose safety concerns, including accidents/injuries, cardiovascular events, extrapyramidal symptoms, and somnolence/sedation. In the US, brexpiprazole is approved for the treatment of agitation associated with dementia due to Alzheimer’s disease. This post hoc analysis aimed to evaluate the timing and duration of treatment-emergent adverse events (TEAEs) in three randomized clinical trials of brexpiprazole.

Methods: Data were included from three Phase 3, 12-week, randomized, double-blind, placebo-controlled trials of brexpiprazole in patients with agitation associated with Alzheimer’s dementia (ClinicalTrials.gov identifiers: NCT01862640, NCT01922258, NCT03548584). Data for all patients who received ≥1 dose of trial medication were pooled by randomized dose group: brexpiprazole 0.5 or 1 mg/day (fixed-dose), brexpiprazole 2 or 3 mg/day (fixed- dose) (FDA- approved recommended-to-maximum dose), brexpiprazole 0.5 – 2 mg/day (flexible-dose), and placebo. Time-to-event analyses were performed to first occurrence of any TEAE, any serious TEAE, discontinuation due to AE, and TEAEs of interest, separately, and presented using descriptive statistics and Kaplan–Meier Methodsology. The duration of all TEAEs in each category was also determined.

Results: The pooled sample comprised 1,043 patients. Median time to first TEAE was 24 days with brexpiprazole .5 or 1 mg/day (fixed-dose), 32 days with brexpiprazole 2 or 3 mg/day (fixed-dose), 28 days with brexpiprazole 0.5–2 mg/day (flexible-dose), and 28 days with placebo. Median duration of all TEAEs was 7 days, 6 days, 8 days, and 4 days (respectively). Median time to (and incidence of) discontinuation due to AEs was 45 days (8.9%) with brexpiprazole 0.5 or 1 mg/day, 46.5 days (4.9%) with brexpiprazole 2 or 3 mg/day, 30 days (6.8%) with brexpiprazole 0.5 –2 mg/day, and 30 days (3.4%) with placebo. The incidence of serious TEAEs and TEAEs of interest is presented in the Table.

Conclusions: In patients with agitation in Alzheimer’s dementia, time to first occurrence of any TEAE was similar between brexpiprazole 2 or 3 mg/day (FDA-approved recommended-to- maximum dose) and placebo, and time to discontinuation due to AEs was longer with brexpiprazole 2 or 3 mg/day than placebo. Overall, no unexpected safety concerns were revealed by this analysis.

Objectives: The aim of this study was to identify core and bridge symptoms between emergent neuropsychiatric symptoms and sleep disturbance in dementia-risk older adults with depressive symptoms in nursing homes using network analysis, and to further compare the structural differences in symptom networks between subthreshold depressive and depressive groups.

Methods: A total of 853 older adults in nursing homes participated in this study. We used the Mild Behavioral Impairment (MBI) and the Pittsburgh Sleep Quality Index (PSQI) to assess the severity of emergent neuropsychiatric symptoms and sleep disturbances, respectively, and the analyses also generated a network model of the MBI-PSQI in the sample and examined subthreshold depressive and depressive groups’ potential differences between network structure and connectivity.

Results: The core symptom in the global MBI-PSQI network of older adults with depressive symptoms in nursing homes was MBI8’’ (Lack of pleasure experience: 8.340), and the bridge symptom was PSQI7’’ (Daytime Dysfunction: 3.894). The edges connecting the nodes MBI2’’ (Lost curiosity in usual interests) and MBI3’’ (Decreased social initiative) in the global MBI-PSQI network has the strongest weight (0.798). Compared to the global network, for participants in the depression group, MBI8’’ (7.647) remains the most core symptom, and PSQI7’’ (4.028) serves as a critical bridge symptom between emergent neuropsychiatric symptoms and sleep disturbances. However, in the subthreshold depression group, the MBI-PSQI network structure exhibits distinct characteristics, with MBI2’’ (5.563) being revealed as the most significant symptom, closely followed by MBI8’’ (5.453). Furthermore, the bridge symptom connecting emergent neuropsychiatric symptoms to sleep disturbances shifts to PSQI4’’ (Sleep Efficiency: 1.386). Intriguingly, the strongest edge in both the global network and the subgroup network is MBI2-MBI3.

Conclusions: There is an association between emergent neuropsychiatric symptoms and sleep disturbance in dementia-risk older adults with depressive symptoms in nursing homes. In addition, heterogeneity in the network structure of subthreshold depression and depression, with shifts in core and bridge symptoms, providing directions for designing novel and targeted interventions.

Background: Mild behavioral impairment (MBI) in older people refers to a group of syndromes that are characterized primarily by clusters of neuropsychiatric symptoms without severe cognitive impairment, which is a high-risk population for dementia. Patients often experience a variety of symptoms and exhibit high heterogeneity in symptomatology across different individuals. Classifying the psychotic symptom characteristics of MBI patients aids in the implementation of precise interventions for the next steps.

Objectives: To explore the symptom characteristics of older people with MBI and to classify them based on their symptoms.

Methods: Using a multi-stage sampling Methods, the MBI-Checklist was employed to investigate symptom characteristics in 255 older people with MBI from 32 nursing homes in Fujian Province. Latent Class Analysis (LCA) was then employed to categorize these individuals based on their symptom profiles.

Results: The neuropsychiatric symptoms clusters in older people with MBI often present as a combination of lack of motivation and emotional dysregulation, lack of motivation and impulse control disorders, or emotional dysregulation and impulse control disorders; presentation of a single symptom cluster is relatively less common, accounting for 45.49%. Older people with MBI can be divided into 2 latent classes (P < 0.05) based on symptom characteristics. According to the conditional probability of each class, they were named the “high- level group’’ [211 (82.69%)] and the “low-level group’’[44 (17.31%)].

Discussion: As individuals with MBI are at high risk for developing dementia, early intervention can effectively delay or reduce the occurrence of dementia. Future interventions should be personalized based on the specific symptom characteristics of this population.

Summary: In his 1910 textbook, 8th Edition, Mental Illness in Old Age’’, E. Kraepelin stated, “The realm of late-life psychiatric disorders is perhaps the most unclear in the entirety of psychiatry.’’ More than a century later, it remains challenging to fully understand late-life psychiatric disorders, including late-life depression, late-life bipolar disorder, and late-life delusional states such as late paraphrenia. However, recent years have seen significant advancements. Neuropathological examinations of these late-life psychiatric disorders are gradually uncovering the underlying diseases. In addition, progress in neurofunctional imaging studies using positron emission tomography (PET) is shedding light on their neurological foundations. Traditionally, mood disorders and delusional conditions in the elderly were considered distinct from dementia. Yet, over time, more cases are being observed to progress into some form of dementia or neurodegenerative diseases. These cases are suspected to have diverse neuropathological entities based on the type of abnormal proteins accumulating in the brain, such as amyloidopathy, synucleinopathy, or tauopathy. Among these, we have specifically revealed that tauopathy is a background factor in some cases of late-life mood disorders and late-life delusional states, using Florzolotau tau PET imaging. We have also found that psychiatric symptoms like delusions are related to the degree of accumulation of tau proteins. The involvement of tau pathology in symptom formation in late-life psychosis suggests that disease-modifying drugs targeting tau, which may emerge in the near future, could be effective in treating these individuals.

Objectives: Highlight the presentation of behavioral symptoms in addition to the classic clinical trial in idiopathic normal pressure hydrocephalus in the elderly. Identify apathy as the most prevalent behavioral symptom in normal pressure hydrocephalus (NPH) in the elderly.

Methods: A bibliographic review of apathy as a behavioral symptom of NPH is carried out. Likewise, in addition to highlighting apathy as a possible diagnostic marker, the evidence of it as a prognostic marker of therapeutic response is discussed. For this, a review of publications in English and Spanish from the last 10 years was carried out in databases including Cochrane Library, EMBASE, MEDLINE/PubMed, SCOPUS. The MESH terms apathy, Hakims-Adams, idiopathic normal pressure hydrocephalus, chronic hydrocephalus, neuropsychiatric symptoms were used for the search.

Results: Sixteen articles were selected that verified the heterogeneity of the diagnostic criteria for apathy for its detection in patients with NPH. Likewise, it is identified that apathy is the most prevalent behavioral alteration with a prevalence of 60% of patients in this condition. Regarding its predictive value as a prognostic marker for shunt surgical treatment, the evidence is not conclusive either to confirm or to rule out the usefulness of apathy. Conclusions: Apathy should be considered as another diagnostic key in NPH. Thus, the classic description of this condition as a motor-cognitive-urinary syndrome must be reconceptualized as a motor-cognitive-behavioral- urinary syndrome.

Objectives: Health professionals in our setting rarely ask adequately about sleep disorders beyond insomnia in depressive patients. This presentation aims to review the possible clinical situations between geriatric depression (GD) and sleep apnea and hypopnea syndrome (SAHS) and highlight the clinical impact of their adequate detection and treatment.

Methods: Presentation of a sample of 25 older adult patients from the Geriatric Neuropsychiatry Clinic and the Psychogeriatric Section of the Department of Psychiatry of the CEMIC (Buenos Aires, Argentina) with diagnoses of GD and SAHS.

Results: Presentation of different groups of patients with possible relationships in which these two entities interact: a) GD as a risk factor for developing SAHS; b) SAHS as a risk factor for developing GD; c) GD and SAHS as comorbidities; d) GD and SAHS as risk factors for morbidity and mortality for multiple diseases; e) SAHS as a cause of pseudo-resistance to antidepressant treatment in GD; e) GD as a cause of pseudo-resistance to SAHS treatment; f) the treatment of GD as a cause of pseudo-resistance to SAHS treatment; g) the treatment of SAHS as “a cause of” and/or “aggravate” of GD.

Conclusions: Mental health professionals must actively investigate in their older patients the possible relationships between GD and SAHS in order to ensure the diagnosis and appropriate treatments adapted to such clinical situations.

Objectives: To identify the characteristics and principals’ diagnosis of the older patients of a mental service in order to design the basis of an intervention plan.

Methods: Retrospective longitudinal observational study based on a secondary database provided by Mentalitat. Results: On a year 30% of the attention were over 60 years old, 70% of them was women with anxiety disorder, mixed anxiety-depression disorder, and mayor neurocognitive disorder. Almost half of the dementias had not reported etiology despite the repeat attentions.

Conclusions: In order to improve the mental state and reduce hospitalization interventions should be focused on women with anxiety or/and depression and brain health to influence the incidence of neurocognitive impairment and the quality of life; emphasizing dementia training for mental health care.

Objectives: Older people with care needs are often supported by their older care-partners (50+). Over time, the increased demand in care needs can result in the care partner placing their own health needs aside. This study was aimed at establishing and piloting a novel co-designed Carer Health and Wellbeing Service (CHWS) that offers multidisciplinary (social work, psychology, occupational therapy, and physiotherapy) one-to-one support to care partners.

Methods: We conducted a pre-post 6-month study design including qualitative and quantitative Methods. Consenting individuals attending the CHWS completed five measures pre- and post- their interaction with the CHWS: Carer Support Needs Assessment Tool (CSNAT); Preparedness for Caregiving Scale (PCS); Family Appraisal of Caregiving Questionnaire (FACQ); EuroQoL Five Dimension Five Level Scale (EQ-5D-5L); and Health Economics Survey.

Results: Service operation commenced 1 day/week in March 2024 with 16 participants to date. Preliminary pre- service use indicates care partners feel underprepared for the carer role (particularly emotionally and psychologically), experience high levels of guilt when addressing their own care needs and are unsure about how to advocate or navigate the existing support system. Care partners have been coached to identify, prioritize, and address their current health and wellbeing needs. Additional findings regarding the implementation of the CHWS will be reported in this presentation.

Conclusions: The preliminary sample presents several emotional and psychological needs that need addressing. These will inform the type of support services to be provided as part of the CHWS, which will also be presented at the conference.

Objectives: This work was aimed at characterizing the experiences of discrimination, and report initial psychometric properties of a new tool to capture these experiences, among a global sample of people living with dementia.

Methods: Data from 704 people living with dementia who took part in a global survey from 33 different countries and territories were analysed. Psychometric properties were examined, including internal consistency and construct validity.

Results: A total of 83% of participants reported discrimination in one or more areas of life, and this was similar across WHO Regions. The exploratory factor analysis factor loadings and scree plot supported a unidimensional structure for the Discrimination and Stigma Scale Ultra Short for People Living with Dementia (DISCUS-Dementia). The instrument demonstrated excellent internal consistency, with most of the construct validity hypotheses being confirmed and qualitative responses demonstrating face validity.

Conclusions: The DISCUS-Dementia performs well with a global sample of people living with dementia. This scale can be integrated into large-scale studies to understand factors associated with stigma and discrimination. It can also provide an opportunity for a structured Discussion around stigma and discrimination experiences important to people living with dementia, as well as planning psychosocial services and initiatives to reduce stigma and discrimination.

Objectives: This study aims to explore the perceptions of family caregivers regarding their expressed emotions (EE) towards dementia patients and to identify factors associated with high and low EE.

Methods: We conducted qualitative descriptive research through semi-structured interviews with 64 family caregivers of dementia patients, regardless of cohabitation status, from 2021 to 2022. Each caregiver participated in three one-hour interviews over three months. We used the Family Attitude Scale (FAS), a validated 30-item, 5- point Likert scale, to measure EE. Higher scores indicate more critical emotions toward the dementia patient, with a maximum score of120. Based on expert advice and data distribution, we set a cutoff point at 40; scores above 40 indicate high EE, while scores of 40 or below indicate low EE. Interviews focused on the caregivers’ challenges, sources of encouragement, and support systems. Transcripts were analyzed using thematic analysis. The study received approval from the Clinical Research Ethics Committee of Osaka University Future MedicalCenter.

Results: High EE caregivers (scores above 40) reported themes such as: poor pre-existing family relationships, lack of a confidant, severe behavioral and psychological symptoms of dementia (BPSD) in the patient, unemployment, low self-esteem, involvement in toileting assistance, inadequate explanations from physicians, and a tendency to reject public support. Additional themes included feelings of frustration and helplessness, lack of emotional support from other family members, and increased caregiver burden due to high care demands. In contrast, low EE caregivers (scores of 40 or below) highlighted themes including: respect for the care recipient, having multiple confidants, mild BPSD in the patient, employment, cooperation from supporters, and a sense of gratitude for caregiving. Further themes identified in this group were effective communication with healthcare professionals, active engagement in caregiver support groups, higher levels of resilience and coping strategies, and a positive outlook on the caregiving role as a meaningful and rewardingexperience.

Conclusions: The study identified distinct factors associated with high and low EE among family caregivers of dementia patients. Understanding these factors can help tailor interventions to support caregivers, improve their emotional well-being, and enhance the quality of care for dementia patients.

Objectives: More than 80% of all long-term care services globally are provided by informal caregivers. However, they are often overlooked, underrecognized and insufficiently supported. This study analyses how providing informal care affects mental health and how the negative effects may be prevented or mitigated.

Methods: A cross-sectional study was conducted among informal caregivers in Serbia. Compassion fatigue and compassion satisfaction (CS) were measured with the Professional Quality of Life Scale (ProQOL) version 5. Compassion fatigue is a concept from the formal care setting, a known work-related phenomenon linked to secondary trauma from prolonged work with suffering/ traumatized patients. ProQOL subscales demonstrated good reliability with a Cronbach alpha coefficient of 0.917 on the CS subscale, 0.891 on the burnout (BO) and 0.857 on the Secondary Traumatic Stress (STS) subscale.

Results: A total of 187 informal caregivers participated, with an average age 56.95 ± 12.86 years. 74.9% of the participants were female; the majority married or partnered (62.6%). The median time spent in caregiving was 4 years, ranging from several months to 50 years. The majority of the sample had a moderate compassion satisfaction (72.2%) with moderate levels of compassion fatigue, represented by the BO (67.4%) and STS (64.2%) subscales. Very few participants scored high on CS (3.7%) and high on STS (5.3%). Sex based differences were found for CS and BO domains, with both CS and BO being higher among women (p = 0.002 and p = 0.026, respectively). BO was found to be higher among singles (p = 0.049). Differences were found regarding urban/rural community, with CS being higher among informal caregivers in urban community (p = 0.041) and STS being higher in rural community (p = 0.004). There was no correlation between age and years spent in caregiving and ProQoL domains.

Conclusions: Over the coming decades, in the absence of a proactive approach, the increasing needs for care will significantly increase the burden of informal caregivers and intensify its consequence on mental health, by pushing moderate levels of burnout and STS towards higher values.

Objectives: In the UK, district nursing services (DNS) deliver care to people in their own homes and have regular contact with people living with dementia. Research conducted with nurses working in similar roles outside the UK suggests their contribution to high quality dementia care is limited by compassion fatigue, lack of dementia training and low levels of confidence. However, there is a paucity of research exploring the role and learning and support needs of nurses within DNS. The aim was to gain insight into the role and experiences of nurses caring for people living with dementia at home.

Methods: The study was informed by a descriptive phenomenological approach. Semi- structured interviews were conducted with a purposive sample of ten nurses working in DNS. Data were analysed using a thematic approach.

Results: Participants described having considerable contact with people with dementia and managing increasingly complex situations despite little training in this field. Care was provided across the illness trajectory from detection and diagnosis of dementia through to end-of-life and the involvement of DNS was instrumental across all stages. Five main themes were identified: ‘Home as a care setting’ reflected how delivering home-based care shaped participants experiences of caring for people with dementia; ‘Taking it in their stride’ revealed how participants adapted and responded to the complexity of care needs for people with dementia; ‘Complexity and unpredictability’ related to the unpredictable nature of people with dementia’s care needs and the impact this had on participants’ workloads; ‘Expertise and support within the wider team’ detailed which networks nurses used for advice and support to manage the complex needs of people living with dementia at home; ‘Specialist support’ identified the need for structural changes and resources to enable the nurses to deliver the care needed.

Conclusions: This study enables better understanding of the role of DNS in supporting people with dementia to live at home. This is important for defining how dementia care can become effectively integrated into primary care. Recommendations include improved models of care, which factor in specialist nurses, additional time for home visits and greater emphasis on education and training.

Background: The Netherlands allows Medical Assistance in Dying (MAID) based on a diagnosis of dementia under strict legal conditions. The number of dementia MAID cases gradually increase every year up to 288 cases in 2022; 282 were decisionally competent and 6 were decisionally incompetent. In decisionally incompetent patients MAID has been granted based on a written advance directive. To assess decisional competence the Dutch euthanasia review committees, refer to criteria of Appelbaum and Grisso.

Objectives: To examine which factors, and how, influence the judgment of decisional competence for MAID requests of patients with dementia.

Methods: A qualitative analysis was performed of 60 dementia MAID case summaries as published online by the Dutch euthanasia review committees between 2012 and 2021: 20 cases had an advance directive and were decisionally compromised at time of MAID, 40 patients were decisionally competent at time of MAID, of which 20 also had an advance directive (purposive sampling). Two researchers independently coded all text related to decisional competence (thematic analysis). A theoretical framework about the assessment of decisional competence was developed.

Results: The four cognitive criteria of Appelbaum and Grisso were dimensional, and cut-off points were influenced by six factors that also directly impacted on competence assessment, i.e. level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and the patient-physician relationship.

Conclusions: The framework illustrates the complex multidimensional nature of assessment of decisional competence in dementia patients requesting MAID. Subjectivity of the final judgement poses ethical and legal issues and argues for continuous quality improvement processes.

Objectives: The primary aim of this study is to assess the relationship between different aspects of physical activity (PA) and dementia occurrence in older adults from Brazil.

Methods: It is a secondary analysis of the first wave data derived from the ELSI-Brazil study, a longitudinal study of aging in Brazil with a representative sample of Brazilians aged 50 years and older (n = 9,412). We employed two distinct approaches to assess PA. First, participants’ levels of PA were classified in low, moderate and high based on their reported physical exertion over the preceding seven days at the time of interview. Also, PA was classified as sufficient or not sufficient, according to the World Health Organization (WHO) recommendation. Dementia was defined as those who were 60 years and older, had a cognitive performance ≤1.5 z-score compared to a sub- sample defined as control-group, and also had an impairment in instrumental activity of daily living. Logistic regression was used to estimate the association between physical activity and dementia (crude and adjusted for age, gender, schooling, marital status, smoking and alcoholconsumption).

Results: After excluding those younger than 60 years old and had missing data to any of the variables analyzed, our sample was composed by 4,994 individuals (table 1), with a mean age of 69.7 (SD = 7 .5), 4.7 years of schooling (SD = 4.3) and 214 (4.1%) classified as living with dementia. We also found that higher levels of PA were associated with lower occurrences of dementia (table 2) (moderate OR 0.57 95% CI 0.37 –0 .90, p < 0.05; high OR 0.32 95% CI 0.19 –0.56, p < 0.001). Also, practicing the level of PA recommended by WHO had an inverse association with dementia (table 3) (OR 0.49 95% CI 0.30 – 0.79, p < 0.05).

Conclusions: The main limitation of our study is its cross-sectional nature. Therefore, we cannot determine the direction of relationships between variables. Our findings show a significant inverse association between levels of PA and dementia occurrence. Additionally, adherence to the WHO’s recommendation for PA also showed a significant inverse association with dementia occurrence. These results underscore the importance of promoting regular physical activity as a potential preventive measure against dementia among older Brazilian adults.