Caregiving for a family member with dementia is a highly stressful situation that may last up to several years, and has been associated with symptoms of depression, anxiety, and sleep problems. These disorders frequently co-occur, with previous studies suggesting a bidirectional relationship between sleep and psychiatric disorders (i.e., anxiety and depression). Several models have highlighted the role of hyperarousal for understanding sleep disorders; however, there is little evidence about how sleep problems, depression and anxiety are linked together. Network analysis (NA) could help exploring the mechanisms underlying the associations between anxiety, depression, and sleep disturbances.

Participants were 368 family caregivers of a person with dementia. The depression-anxiety-sleep symptoms network was composed of 26 items. All the analyses were done using R (version 4.1.1).

Symptoms of tension, shakiness, restlessness, nervousness, and anxiety were strongly connected with the symptom feeling depressed. Symptoms of insomnia were connected to trouble focusing, which was linked to feeling that everything is an effort and apathy. The strongest nodes in the network were shakiness, tension, restlessness, nervousness, and restless sleep. Tension was the node with the most predictive power, while restless sleep was the node with the highest betweenness. Central stability coefficient showed adequate indices.

Hyperarousal symptoms (e.g., tension, restlessness) were the most strongly connected symptoms and showed close connection with symptoms of depression. The strength of these nodes suggests a prominent role of hyperarousal to maintaining, or even fueling, anxiety and depressive symptoms. Besides, our results invite the hypothesis that sleep problems may trigger symptoms specific to depression via fatigue or energy loss. Even though this study is limited by its cross-sectional design, it is the first to examine the network structure of the associations between symptoms of depression, anxiety, and sleep problems in a sample of informal caregivers, and to explore the role of hyperarousal in this network. Future studies should explore the temporal association between symptoms and the network dynamics, including response to the potential treatments.

Delirium is an acute and fluctuating disorder characterized by a disturbance in attention and cognition that is commonly observed in hospitalized older adults; being present in up to 23% of patients admitted to a general medical service and as many as 85% of patients in the intensive care unit. Delirium causes complications such as increased morbidity, persistent functional decline, mortality, increased frailty and increased length of hospital stay. Nonetheless, it is often underdiagnosed, especially when it occurs in its hypoactive form. The objective of this study is to describe characteristics and factors associated with the presence of delirium in patients ≥65 years treated by the liaison psychiatric units in seven general hospitals.

This is an observational, cross-sectional, multicentre study. We obtained data from a sample of 165 patients (≥65 years) admitted to seven general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.

We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Delirium was diagnosed in 20% of the consultations. A multivariate analysis was developed with the presence of delirium as the independent variable. The nature of the underlying pathology, the presence of a previous mental disorder, functionality using the Barthel and Lawton Brody Indexes and the prescribed pharmacological treatments were used as dependent variables. Cohen’s kappa statistics were used to estimate the agreement between delirium diagnose made by psychiatrists and the diagnoses considered by the referring doctors. Low agreement was found for the presence of delirium (Kappa= 0,2341). We also explored the relationship between the presence of delirium and the mean length of stay, as well as the discharge destination of these patients.

There are still many difficulties in the diagnosis and treatment of patients with delirium. Better knowledge of the factors associated with its appearance would improve the management of these patients.

The purpose of this research is to review the association between the dementia diagnosis and suicide risk, to debate what to expect on this topic in the future, and to identify some strategies to control suicide risk after dementia diagnosis.

Non-systematic review of the literature with selection of scientific articles published in the last 10 years, using PUBMED as database and the following keywords: «suicide», «dementia» and «dementia diagnosis». Nine studies were included.

Nowadays, suicide account for one million deaths worldwide per year. Suicide rates are up to 8 times higher in the elderly than in general population, in relative numbers. Dementia is an incurable diagnosis and usually result in loss of mental competence. After being diagnosed with dementia, people face emotional challenges and use to feel loss, anger, and uncertainty.

Different studies found dementia as an independent risk factor for suicide. Also, some factors that increase the risk for suicide in dementia are described: the existence of psychiatric comorbidity, such as depression, anxiety, psychosis and substance use; The initial stages of dementia, often within three months of diagnosis, because the person perceive a higher threat to his life, with progressive physical and cognitive impairment, increasingly higher levels of dependence and concern on becoming a burden for their family, and, at the same time, preserving intellectual and volitive capacities to plan and carry out suicide; And younger age at dementia diagnosis, with higher difficulties in adjusting to the diagnosis.

We are moving towards pre-symptomatic and early dementia diagnosis utilizing biomarkers and genetic tests. This implies that the diagnosis is made in younger people, so concerns have been raised about a potential increase for suicidal behavior.

The findings of this research highlight the importance of providing support and paying attention to people with recent dementia diagnosis, particularly in the first year and for patients aged < 75 years. We suggest active management of pre-existing mental disorders, suicide risk evaluation, assessment of patient and caregiver needs and restricting access to lethal means.

An intersubjective understanding of mutual roles and responsibilities in the care process is needed to effectively co-create good care for residents of the care home.

This study offers insight into the perspectives of professionals, informal caregivers, and residents on their own role and responsibilities and that of others, and examines how this affects their co-creative relationships.

We conducted semi-structured interviews with professionals (n=9), informal caregivers (n=10), and residents (n=10) from two psychogeriatric wards. An inductive thematic analysis was then performed, using Margaret Urban Walker’s expressive- collaborative model of morality (1998) as a sensitizing concept.

Professionals and informal caregivers both view themselves as the main responsible for the resident’s wellbeing. Whereas professionals see themselves as experts on care for residents with psychogeriatric issues, informal caregivers see themselves as experts on the resident as a person. From these roles, both profess to know what is best for the resident. Further, professionals see themselves as someone naturally deserving trust due to their expertise, whereas they are seen by informal caregivers as someone who needs to win their trust. Informal caregivers see themselves as a warrantor for the residents wellbeing, whereas they are seen by professionals as someone who needs to relinquish control over care, so they can return to being the resident’s loved one. Although both professionals and informal caregivers ascribe a central role to the resident in the care process, their behaviors unintentionally urge residents towards a more passive role. Residents who are not generally compliant to the norms of the care home appear to view themselves as rebels. These (and more) differences in perceived roles and responsibilities lead to tensions in the co-creative relationships between professionals, informal caregivers, and residents.

Professionals, informal caregivers, and residents have differing perspectives on mutual roles and responsibilities in the care process, which hampers their co-creation of good care. This study implies that interventions aimed at improving the co-creation of good care may be focused on those involved first becoming acquainted with each other’s perceived roles and responsibilities.

The use of music in older people with advanced dementia is possible because perception, sensitivity, emotion, and memory of music may remain intact after other types of memory disappear. Previous literature is controversial about stress biomarkers response to music introduction in therapy routines for people with severe cognitive impairment and neural-behavioural disorders. Particularly, for these patients, it is possible that they feel lower pleasure levels with music-based therapies.

To characterize the immediate physiological effects of listening to music during psychomotor stimulation in an old participant with combined dementia and depression disorder and in a participant with a dementia diagnosis.

Two study cases with dementia diagnosis participated in this study (P1: 84yrs; male Parkinson; FAB=9; P2: 85 yrs; female; Alzheimer; FAB=11; depression diagnosis) and were submitted to psychomotor stimulation (2 sessions). The first 20 min. of each session was dedicated to psychomotor stimulation without music (A), followed by 20 minutes with music (B). Heart rate was monitored (H10 Polar sensor) in a continuous mode. Cortisol levels were collected at the beginning of the session (T0) and then repeated at periods A and B (μg/dL). The range between minimum and maximum HR values (beats per minute- bpm) and mean values for cortisol levels were considered for the stress response analysis.

Salivary cortisol levels were higher at T0 for P1 (0.393 vs 0.203). During period A, the P1 slightly decreased their values (↓0,076) and P2 had no changes. After introducing music, both P1 and P2 increased cortisol levels (↑0,085; 0,162↑). For both P1 and P2, a wide range of HR was detected during period B (P1: 13 vs 23 bpm) vs (P2: 15 vs 41 bpm).

Immediate responses to the music inclusion in a psychomotor intervention caused an augmented stress response in elderly participants with dementia, especially in P2. In specific, the depression diagnosis in this participant may be associated with a low capacity to handle emotions during new experiences, causing a higher stress response.

Immersive technologies have the potential to control cognitive and behavioural symptoms in people with dementia. A safe environment can be designed through a specific interactive scenario, according to the preferences and experiences of each user.

Mapping neuro-emotional responses during the interactive scenario therapy experience in a case study, with dementia, using electroencephalography (EEG).

A participant, 78 years old and diagnosed with moderate to severe Alzheimer's disease (female; Mini Mental State Examination score of 17 points; frontal assessment battery score of 8 points), underwent EEG analysis (EMOTIV EPOC X) using a protocol with interactive scenarios tailored to the participant's needs and preferences, the scenarios were designed from reminiscence strategies. The protocol included a stimulus that alternated between motor and cognitive activities (3 minutes), and breath-centered relaxation (1 minute). The scenarios used in this study were: setting up a living room; composing a cake recipe; shopping in the market to make a cake; looking for objects in the park; organizing a birthday party. These variables are provided, on a scale of 0 to 100, after processing by the algorithms of the EmotivPRO v3.0 software.

The values found in the EEG analysis will be described without stimulus and with stimulus respectively. Thus, engagement (68.57 to 71.86); arousal (57.86 to 49.86), focus (61.57 to 57.00), interest (54.86 to 49.57), relaxation (33.86 to 30.86), and stress (53.71 to 43.00). The EEG data showed an increase in engagement when the patient was stimulated (68.57 to 71.86). Relaxation also increased (30.86 to 33.86) when the stimulus was removed. The stress level, as analysed by the EEG, was also higher in the period without stimulus and reduced in the period with the stimulus (53.71 to 43).

During a stimulus period in interactive therapy, there was an increase in engagement, which was related to an increasing focus during the stimulus. Lower values were observed compared to the period without stimulus, indicating a period of recovery after a period of concentration/arousal. Therefore, therapy with an interactive and familiar scenario, using a circuit of stimulus-breathing exercises, promotes a positive and adequate neuro-emotional response in a person with dementia.

Geriatric depression and anxiety are increasingly relevant conditions in the ageing population of Singapore. Subsyndromal depression and anxiety in older adults is estimated at 20-50% of the population and often go undetected despite adverse effects on quality of life (Preisig et al., 2001), suicidality (Sadek and Bona, 2000), disability and inappropriate usage of medical services (de Beurs et al., 1999; Wagner et al., 2000), and cognition (Yoachim et al., 2013). BRIGHT is an early intervention group coaching programme to empower older adults to self-manage physical and mental health ailments so as to decrease healthcare utilization and expenditure. This paper aims to present the findings from three pilot runs of BRIGHT with older adults in the community setting.

BRIGHT consists of 4 half-day workshops with both didactic and interactive components that leverage on the group-based therapy setting to promote psychoeducation, self-reflection, and reminiscence. This was delivered by a multidisciplinary team comprising psychiatrists, psychologists, and medical social workers. Simple digital literacy skills were taught and a mobile application to promote active lifestyles was utilized.

Groups are kept small at less than 15 participants each who were referred from community partners. They have been screened for subclinical depression and anxiety using the Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), 12-item Short Form Survey (SF-12), and Health Confidence Score (HCS). The same scales were administered again immediately upon completion of the programme to capture (1) reduction in depressive and anxiety symptoms, (2) quality of life, (3) improvement in health confidence, and (4) participant satisfaction.

Average participant satisfaction was 82.2% - most qualitative feedback was positive but one group preferred the sessions to be conducted in Mandarin instead of English. GDS, GAI, HCS, and SF12 PCS scores improved by an average of 2.285, 0.969, 0.685, and 1.733 respectively. However, SF12 MCS scores decreased by an average of 1.795.

Preliminary quantitative data shows that BRIGHT appears to be an effective early intervention modality for older adults with subclinical depressive and anxiety symptoms. After an iterative process of refining the programme content, plans are underway to “train the trainers” so as to increase scale and sustainability.

Clinically, the older adults who do not respond to administrative surveys are at high risk for dementia and other diseases in many cases. The aim of this study is 1) to examine this hypothesis, and 2) to establish a support system to reach out to them and help them live well, in the community-based participatory research (CBPR) in Chiyoda-ward, Tokyo, Japan, using a mail survey as a starting point to visit older community-residents who did not respond to the administrative survey.

The participants were residents aged 65+, living in Chiyoda ward, Tokyo, Japan in 2021 (N=4009, mean aged 74.2±6.6, female 54.9%). We conducted the survey by following three steps. First, we distributed self-administered questionnaire to all participants by mail. Second, a survey request letter was mailed to the older adults who did not return the survey (N=675, aged70+). We conducting visit investigation by visiting nurses for old-old people (N=87), and conducting assessment to evaluate risks of dementia and physical health. Third supporting people with high risk of dementia through cooperation among various organizations and various professions, and conducting watching support by visiting nurses as prophylactic care.

For the investigation by mail, 2050 participants sent back the investigation form. Of the 87 people living alone or in aged households who responded to the request for a visit survey, we were able to conduct home-visit surveys for 46 participants (implementation rate: 52.9%). As a result of the comprehensive assessment, 15 participants (mean aged 81.9±5.0, female 53.6%, MMSE: 25.2±2.8), were regarded as participants with high risk of dementia, and 3people of them were started watching support work.

We established a support system for people living with dementia that consist early detection and continuous support by the visiting nurse. There were many cases in which the home-visit nurses investigation led to continuous support. For the further research, it is necessary to review the long-term outcomes of those who received early support concerning whether they could maintain their quality of life.

The Time for Dementia (TFD) is an educational programme for healthcare students to learn from ‘experts by experience’ through longitudinal contact with a family affected by dementia. Since 2014, over 1,900 families have taken part. In December 2021, as a result of a student complaint about racism, expectations of inclusivity, diversity and inclusion (EDI) were examined and an anti-discriminatory practice plan for TFD was developed.

One of the proposed outputs of this plan was the creation of a communique to outline the expectations on EDI for circulation to participant families and students in TFD. Several considerations were acknowledged to be important: i) Generational differences and expectations about anti-discrimination; specifically, the use of language; ii) The complexity of addressing this issue with people with dementia; who may have difficulties with recall or disinhibition due to their condition; iv) The need to enhance understanding of different perspectives and needs between families and students.

The iterative development (January-September 2022) of the final communique included;

1. 1. The formation of a working group including student inclusivity representatives and TfD families to develop the communique.

2. 2. A draft set of ‘inclusivity principles’ was created and feedback was sort from a sample of TFD participants independent of the working group (n=15).

3. 3. As a result of feedback, these principles were amended by the working group.

4. 4. The circulation of these inclusivity principles to the families taking part in TFD from July 2022.

5. 5. A qualitative research study was conducted on the reception of these principles (n=14).

This poster will present the communique that was developed, the results of the thematic analysis on its reception, and key reflections on its development.

Universities have a responsibility to prevent and effectively deal with discrimination on placements and this includes educational programs with ‘experts by experience’. Educational programs with people with dementia and their carers, who are volunteers, not patients, need special consideration. While this marks the start of TFD engagement with EDI issues, we hope by sharing our experiences will offer inspiration and confidence to other educators in psychogeriatrics to engage with these issues.

The aim of this review was to describe the usage and efficacy of Montessori senior methods of engaging the elderly with dementia reported in the existing literature.

Three databases were searched (PubMed, EMBASE, Scopus) using the key words “Montessori” “senior”. No date restrictions were placed. Inclusion criteria specified: language of the article (English), type of article (research) and the necessity of the Montessori intervention being directed at seniors.

The search initially identified 15 articles. After eliminating duplicates and evaluating titles and abstracts three studies were included in the review. One focused on staff-led Montessori interventions, and two analyzed the effectiveness and benefits of elderly-le interventions – residents of facilities who were screened using MMS and trained to provide activities for their less lower cognitive functioning peers were selected. The total number of participants from all studies was: 55 people (10 leaders and 45 participants). All three studies reported positive, statistically significant improvements in participants’ functioning. All studies used the MPES to asses psychological variables (constructive engagement (CE), passive engagement (PE), other engagement (OE), pleasure (P).

In first study (Skrajner&Camp, 2007) (CE: p<0.01 and p<0.001); OE: p<0.001, p<0.01; NE: p<0.05, p<0.01; P: p<0.01, p<0.05) classes conducted using the Montessori method were significantly more effective than those conducted using the traditional method among the same group of seniors.

Other two studies reported improvement among observations during Montessori classes scores vs scores during regular activities – Camp and Skrajner, 2004 - CE: p<0.01; OE: p<0.001; P: p<0.06); Orsulic-Jeras, Judge, Camp, 200 - CE: p<0.01, Affect Rating Scale: Pleasure: p<.001 (treatment), p<0.03 (time), Anxiety/Fear: p<0.003 (treatment), p<0.003 (time)).

The research identified indicates the positive impact that Montessori-based programmes can have on elderly people with dementia. More studies need to be conducted, because the number of participants in the current study is relatively small. Further research with larger number of participants is needed to fully prove the effectiveness of Montessori programs implemented delivered to or by older people.

The relevance of pets in long-term home care is increasingly recognized due to their positive effects on health outcomes in clients, and the growing numbers of pet-owning clients receiving long-term care at home (LTCH). In the Netherlands, there is a lack of supportive materials concerning pet-related issues in LTCH. The aim of this project was to develop materials to support care for LTCH-clients with pets. Using a participatory research approach, LTCH-clients with pets, family caregivers, and professional caregivers collaborated using the Experience-Based Co-Design (EBCD) method that we fine-tuned for frail clients (EBCD+) to create the PET@Home Toolkit.

The project started with a literature review on the roles of pets for older adults. To determine if similar roles were also relevant in LTCH, individual interviews were conducted with LTCH-clients, family caregivers, and professional caregivers. Thereafter, the original EBCD-method was used including group interviews with (1) LTCH-clients and family, (2) professional caregivers (3) mixed groups of (1) and (2). Participants could participate in multiple phases. Professional caregivers preferred online and weekday meetings and LTCH-clients and family caregivers preferred in person and weekend meetings. Therefore, we organized additional interviews, and separate online and in-person groups. Hence, the EBCD+ method included a review, complementary interviews, the original EBCD-method and continuous refinement and testing of instruments.

The review and complementary interviews revealed similar roles related to pets in LTCH (e.g. Relational Aspects, Physical Health, and Social Aspects) to those as in the review on older adults. Based on the results, preliminary tools were developed, e.g., an information brochure. Furthermore, we conducted 14 semi-structured interviews, 6 focus groups, a psychology students workshop, and 4 online meetings with experts in human-animal interaction, education, and animal interest organizations (e.g., a veterinarian). It resulted in the Toolkit with different instruments, e.g., information brochure, e-learning module, and infographic.

We successfully used the EBCD+ method to develop an extensive and practically applicable Toolkit to support caregivers and their pet-owning LTCH-clients. The PET@home Toolkit will be available via the University Knowledge network for Older adult care Nijmegen (www.ukonnetwerk.nl).

Ageism, defined as stereotyping, prejudice, or discrimination against older people, is an emerging public health concern [1]. Ageist attitudes and behaviors in health care are found to negatively affect the physical and mental well-being of older individuals [2]. This study is the first to investigate ageism and its determinants in Lebanese healthcare settings.

We diffused an online survey including the Fraboni Scale for Ageism (FSA) [3] and other variables to nurses, physicians, nursing, and medical students at an urban university hospital in Lebanon. We obtained online consent from participants prior to filling the survey. The study was approved by the Institutional Review Board of St. Georges Hospital University Medical Center (IRB-REC/O/066-21/3321).

We recruited 233 participants (47.2% medical students, 21.5% nurses, 20.6% physicians and 10.7% nursing students). Mean age was 29.2 (Standard Deviation—SD = 12) years. Almost two-thirds were female. Half the sample came from rural areas. Almost 60% currently live or have lived with an adult aged≥ 60 years. The FSA total score ranged between 33 and 87 (mean 58.9; SD 10.2). The mean/SD scores were 22.6 (4.5), 17.2 (3.2) and 19.1 (4.3) for the antilocution, discrimination and avoidance subscales of the FSA respectively. There was a positive correlation between age and FSA total score (p=0.041), in addition to discrimination and avoidance subscores (p=0.0001). Originating from rural areas was associated with significantly lower discrimination scores. Living or having lived with an older individual was associated with significantly lower overall ageism and discrimination scores. In addition, students (nursing and medical) were found to have lower ageist perceptions and attitudes compared to healthcare professionals (nurses and physicians). Table 1 shows the results of bivariate analyses performed. Regression analyses showed that only living or having lived with an older person remained significantly associated with lower ageism scores (p=0.036) after accounting for other covariables.

Lower ageism was found among students compared to practicing nurses and physicians. Having lived with an older person was a protective factor against ageism. Specific anti-ageism interventions may need to be implemented to mitigate its impact in healthcare among students and practitioners.

Table 1

Bivariate analyses of FSA total score and subscores on covariates of interest

Average life expectancy in Nepal has been increasing annually (1991: 54 y/o, current: 72 y/o). The growth rate of the elderly population is faster than that of the total population in Nepal.

With only one Geriatric Psychiatrist in Nepal, Dr. Nidesh Sapkota, who received fellowship training at Saint Louis University (SLU), there is a need to develop a Geriatric Mental Health Program, similar to the model created in India by Dr. George Grossberg. Working with the Patan Academy of Health Sciences School of Medicine (PAHSSM) in Nepal, the objective is to develop added mental health resources for the aging population by teaching and integrating evaluative materials from our Geriatric Psychiatry clinic at SLU.

We received funding from Graduate Medical Education to spend 1-month at the PAHSSM with Dr. Sapkota in May 2023. The goal is to learn about Psychogeriatric issues in Nepal by observing faculty and trainees working with geriatric patients and assessing the country's unmet needs for this population. The framework of the pre-existing program will be updated with current science in Psychogeriatrics with the support of the Nepalese government and WHO. The methodology includes training healthcare providers to use screening tools, developing educational programs, and mental health and aging conferences with educators, researchers, and physicians from around the world, as well as establishing an exchange program for residents in Nepal and SLU for Geriatric Psychiatry training.

Results of this pilot grant will be shared at future IPA meetings.

This experience will lead to opportunities to assess mental health disorders influenced by cultural and social differences. This can give us a better understanding of the lack of mental health needs and how we can close the gap, primarily for low-middle income aging populations across the globe. Increased understanding of cultural differences impacting mental illness amongst other ethnic communities specifically how various forms of dementia are experienced, viewed and treated can lead to more appropriate interventions. This project will help initiate a Global Geriatric Mental Health program at SLU that can draw attention to the disparities of the burden of mental illness across the globe by providing access to care within/between countries.

Although various clinical indicators of suicide have been recorded, the previous suicide attempt is meaningful as one of the most robust risk factors predicting subsequent suicide attempts but there are lacking in biomarkers for evaluating suicide attempts. This study aimed to analyze the correlation of changes in oxygenated hemoglobin concentration with lifetime suicide attempt during verbal fluency test.

A total of 60 patients with major depressive disorder (MDD) were enrolled. Demographic, clinical, physical, and psychological evaluations were conducted. We evaluated the suicidal behaviors through MINI suicidality item. We indicated verbal fluency test to examine prefrontal activation during the cognitive execution while fNIRS was observed.

54 of enrolled patient with MDD (23 those with a lifetime history of suicide attempt; 31 those without a lifetime history of suicide attempt) are eligible for the subject. The patients were 35.19% of those with a lifetime history of suicide attempt. The values of the changes in oxygenated hemoglobin involving the entire regions of prefrontal cortex were smaller in those with a lifetime history of suicide attempt. The biggest difference is in right VMPFC, the mean score of those with a lifetime history of suicide attempt and those without a lifetime history of suicide attempt were 0.095(SD, 1.032) and 0.610(SD, 1.038) although the statistically non-significance. We discovered that a small value of changes in oxygenated hemoglobin was related to lifetime suicide attempt through multivariable logistic regression analysis. After adjusting for age, sex, years of education, and HAMD, there was a significant difference in the right VMPFC [OR = 0.491(95% CI=0.235~0.916), p = 0.036].

Study result indicated that the values of the changes in oxygenated hemoglobin were smaller in who attempted suicide before during cognitive execution. The adjusted regression analysis was presented significant result in right VMPFC. Therefore, the changes in oxygenated hemoglobin measured by fNIRS can be applied as a biomarker for suicidal behavior such as lifetime suicide attempt.

Capgras syndrome is a delusion in which the patient believes that a particular individual has been replaced by an imposter. It is observed in patients with psychiatric disorders such as schizophrenia but also occurs in patients with a neurodegenerative disease including Lewy body disease and Alzheimer’s disease. Here we report a patient with early-onset Alzheimer’s disease who presented with a unique form of Capgras syndrome.

An early 60’s right-handed woman with 12 years of education, visited our outpatient clinic for evaluation of her memory impairment. Neurological examination was not remarkable. A MMSE score was 25/30 and a neuropsychological examination indicated mild impairment of attention and episodic memory, and relatively preserved visuospatial function. Six months after the initial visit of our clinic, she started to claim that she met several imposters of her husband. She called each imposter in different name, described each as a slightly different appearance, and expressed different level of sense of familiarity. An additional examination of face recognition using photographs of her husband revealed that there was a difficult to recognize her husband especially viewed from the side of his face. In addition, she showed a difficulty in discriminating between two different unknown faces and in judging approximate age of face in photographs. Brain MRI showed no significant atrophy and IMP-SPECT showed an extensive hypoperfusion in the bilateral, right-side dominant temporal, parietal, and occipital lobes. Both FP-CIT SPECT and MIBG scintigraphy were negative. Florbetapir PET was positive. Thus, a diagnosis of early-onset Alzheimer's disease was made. Acetylcholinesterase inhibitors and antipsychotics were used to treat her Capgras syndrome, but the symptom lasted for more than a year.

There are several possible factors that may induced patient’s unique Capgras syndrome: (1) psychodynamic background- the patient and her husband had been in a long-term common-law relationship; (2) mild impairment in face recognition; (3) dysfunction of right hemisphere, which is known to be strongly related to Capgras syndrome. The combination of these factors may result in the occurrence of multiple imposters of her husband with different degrees of familiarity.

We want to assess the use of a telematics tool against the ordinary follow-up in consultations in the control of Behavioral and Psichological Symptoms of Dementia (BPSD) in a group of patients with dementia.

A randomized prospective clinical study with two parallel intervention groups Unicentro of the Geriatrics service of the General Hospital of Hospitalet (CSI). Two groups of patients/caregivers were compared: a control group (CG) that followed regular controls in the office and another telematic group (TG) that followed controls on the TECUIDE platform. The follow-up has been carried out for one year.

Data on age, gender, comorbidity, treatment received, analytical parameters, and functional, nutritional, and sensory status were collected, as well as the Reisberg GDS scale and the self-administered Cummings Neuropsychiatric Inventory (NPI).

72 CG patients. 76 TG patients. mean GDS of CG: was 4.5, and the mean GDS of TG: was 4.7.

Total group baseline SPCD: Delusions: 48.6%, hallucinations: 43.8%, agitation/aggression: 46.6%, depression 66.4%, anxiety 5.7%, euphoria: 12.3%, apathy: 76%, disinhibition: 39%, irritability: 57.5%, abnormal motor behavior: 43.2%, sleep disorder, 37%, eating disorder: 46.6%.

Mean NPI at the beginning of the study: GC: 5.3, TG: 6. Mean NPI at the end of the study: GC was 4.5 and GT was 4. That is, the average SPCD is higher in the TG than in the GC at the beginning of the study, while at the end of the study, the GC exceeds the TG.

When comparing the BPSD at the beginning and end of the study, a decrease is seen in all in general in the TG and an increase in hallucinations and sleep disturbances in the CG.

In the analysis of drugs, an increase in the consumption of neuroleptics in the CG was observed with a statistically significant difference (p 0.039).

The TECUIDE telematic program is an effective tool for the control of patients with dementia, reducing BPSD and the consumption of drugs (neuroleptics, benzodiazepines, and antidepressants).

Delirium is a potential emergency with serious consequences. Little attention has been paid to residents of nursing homes, although they are at extreme risk for developing delirium. Health Care Professionals (HCPs) such as nurses and general practitioners are assumed to know little about delirium in nursing homes.

The German project DeliA (delirium in nursing homes) comprises three sub- studies and two reviews. The sub-studies have the following objectives: (1) to determine the prevalence of delirium and its sub-types in German nursing homes; (2) to describe and assess the quality of delirium care practices (prevention, diagnosis, therapy) of HCPs in nursing homes; and (3) to develop a Technology Enhanced Learning (TEL) to increase the delirium- specific knowledge of HCPs in nursing homes. The reviews aim to (a) summarize the prevalence of delirium reported in international studies and (b) to find out how, why and under what context education for HCPs in nursing homes works.

A systematic review of the reported prevalence of delirium in nursing homes will be conducted (a). The prevalence study (1) will assess delirium and its proposed associated factors in at least 50 nursing homes using validated measurements. Medication schedules of participating residents will be analyzed to determine potential for delirium. To describe current practice, process-oriented semi-structured guided interviews will be conducted with 30 representatives of the (nursing home) medical service and the nursing service of nursing homes (2). As a theoretical basis for the TEL, a realist review will be conducted to understand the active ingredients of educational interventions and to develop an initial program theory (b). The curriculum for the proposed TEL will be developed based on a synthesis of existing curricula and evaluated by Delphi experts for relevance, comprehensiveness, and content. A final feasibility study will assess the potential increase in knowledge about delirium among HCPs (n = 50) in nursing homes (3).

It is expected that the project and the dissemination of its findings will raise awareness among HCPs and the public about delirium in nursing homes. The developed TEL and its underlying program theory will be further tested.

Sleep disturbance is negatively associated with subjective well-being in older people, but the potential underlying mechanisms of this association remain unclear. This study aimed to disentangle the pathways linking subjective versus objective sleep disturbance to subjective well-being through the serial mediation effect of loneliness and depression among community- dwelling older people.

This cross-sectional study was conducted in Sakai city of Japan. A total of 212 aged 65 and over participated in this study. The Athens Insomnia Scale, UCLA Loneliness Scale, Geriatric Depression Scale, and Self-perceived well-being were used to assess subjective sleep quality, loneliness, depression, and subjective well-being, respectively. A non-wearable actigraphy device was used to evaluate the objective sleep quality. Total sleep time, sleep latency, sleep efficiency, wake after sleep onset, number of awakenings, and average activity during sleep were recorded. Serial multiple mediation analysis was performed using SPSS PROCESS Version 4.1 macro. This study was approved by the Institutional Review Board of Osaka University.

Subjective sleep disturbance was found to impact subjective well-being through three significant mediation pathways: (1) loneliness (B=-0.024, 95% CI=-0.055, -0.004), which accounted for 25.72% of the total effect, (2) depression (B=-0.020, 95% CI=-0.044, -0.001), which accounted for 20.94% of the total effect, and (3) loneliness and depression (B=-0.008, 95% CI=-0.019, -0.001), accounting for 8.93% of the total effect. The total mediating effect was 55.58%. As for the objective sleep disturbance, the wake after sleep onset can indirectly impact subjective well-being through loneliness (B=0.005, 95% CI=0.001, 0.010), depression (B=-0.005, 95% CI=-0.011, -0.001), and both (B=0.002, 95% CI=0.001, 0.004); the number of awakenings can indirectly impact subjective well-being through loneliness (B=0.041, 95% CI= 0.012, 0.085), depression (B=-0.034, 95% CI=-0.076, -0.002), and both (B=0.018, 95% CI=0.005, 0.036); the average activity during sleep can also indirectly impact subjective well- being through loneliness (B=0.137, 95% CI=0.034, 0.275), depression (B=-0.128, 95% CI=- 0.282, -0.010), and both (B=0.055, 95% CI=0.011, 0.118).

These findings provided new insights into possible avenues for improving subjective well- being among older people through sleep-based interventions with a multi-faceted approach to mental health.

Virtual Reality (VR)-based Biofeedback (BF), a relatively new intervention, is rapidly increasing for the treatment of mood disorders. However, research on whether VR-based BF is more effective than traditional BF is still lacking.

A total of 131 adults from the community enrolled in the study. Participants scored ≥10 on Patient Health Questionnaire-9 (PHQ-9) or ≥9 on Panic Disorder Severity Scale (PDSS) were randomly assigned to VR or BF group. Those who have not met the criteria of PHQ-9 and PDSS were classified as the control group. All participants visited three times across 3 months and received either VR-based or conventional BF intervention. The control group received the same treatment as the VR group. Also, on each visit, the participants completed Montgomery-Asberg Depression Rating Scale (MADRS), State-Trait Anxiety Inventory (STAI), and Visual Analogue Scale (VAS).

The analysis included 118 participants in total (VR: 40, BF: 38, Control: 40). There was no significant difference in demographic variables among the 3 groups. After the treatment, VR and BF groups exhibited significant decreases in MADRS, PHQ-9, STAI, and VAS compared to the baseline within each group (p<0.005). Importantly, compared to the BF group, the VR group showed a significantly greater decrease in STAI (p<0.05). Further analyses revealed that scores of MADRD, PHQ-9, STAI, and VAS also significantly decreased in highly stressed group compared to the control group.

Findings suggest that the application of VR-based BF was effective in reducing anxiety and depressive symptoms in highly stressed people. Compared to conventional BF, VR-based BF can be a cost-effective treatment option especially for relieving anxiety.

Due to a lack of validated assessment instruments, this study aimed to pilot test the newly developed Health and Social Care Professionals’ Knowledge & Attitudes Towards Later Life Sexuality (HSCP-KALLS) instrument. The HSCP-KALLS instrument is designed to assess health and social care professionals’ knowledge (46 items) and attitudes (40 items) towards later life sexuality including components related to dementia, sex worker services and Lesbian, Gay, Bisexual, Transgender, Intersex or Queer/Questioning (LGBTIQ+).

A group of health and social care professionals (n = 22) and Healthcare-related educator (n = 2) were invited to complete the HSCP-KALLS instrument. Feedback on items phrasing and the experience of completing the instrument was sought.

Written feedback regarding either phrase of items or use of the instrument was not specifically addressed by participants. A high level of internal consistency was revealed for both the knowledge and attitude items (α = 0.84 & 0.88, respectively). A decent level of knowledge (M=39.75, SD=4.90) and positive attitudes (M=161.04, SD=13.50) towards later life sexuality were demonstrated by participants. Participants had greater knowledge on items related to ageing, intimacy, and sexuality (95%), with a lower level of knowledge on items related to sexuality diversity (e.g., LGBTIQ+). Providing more trainings about later life sexuality was frequently addressed in the knowledge written feedback. Participants generally demonstrated positive attitudes towards later life sexuality. However, a high proportion of ambivalent responses were noted on some attitude items (e.g., A9 & A18) that participants indicated in written feedback that their responses would depend on circumstances.

Preliminary reliability and feasibility of using the HSCP-KALLS instrument has been encouraging, with further testing in large samples now, required to robustly establish psychometric properties. Supporting later life sexuality is essential and the use of HSCP-KALLS instrument can inform and identify professional development needs of health and social care professionals to improve care provision for older people by supporting their expression of sexuality in healthcare settings.