10:15 Uhr
Leben mit FASD
G. Michalowski (Lingen, DE)
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Autor:innen:
G. Michalowski (Lingen, DE)
K. Lepke (Mutterstadt, DE)
Oft werden zuerst die Komorbiditäten diagnostiziert und behandelt, bevor die Diagnose FASD gestellt wird.
Die Folgen sind, dass die Menschen mit FASD nicht die richtigen Therapien etc. erhalten, die eigentlichen Bedarfe nicht erkannt und dadurch nicht adäquat erfüllt werden. Menschen mit FASD fühlen sich unverstanden und werden oft auf Grund ihres IQ und ihrer verbalen Fähigkeiten überschätzt und somit überfordert. Therapien laufen ins Leere, eventuelle paradoxe Reaktionen auf Neuroleptika/Psychopharmaka können nicht eingeordnet werden.
10:27 Uhr
DECIDE: ein Projekt zur Reduktion sedierender Psychopharmaka bei Heimbewohner:innen mit Demenz
S. Kohl (München, DE)
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Autor:innen:
J. Diehl-Schmid (DE)
J. Hartmann (DE)
S. Kohl (München, DE)
M. Trojan (DE)
Einführung: Die Verschreibungshäufigkeit sedierender Psychopharmaka bei in Pflegeeinrichtungen lebenden Menschen mit Demenz wird mit bis zu 50% angegeben. Das DECIDE-Projekt verfolgt das Ziel, für einen bewussteren und verantwortungsvolleren Umgang mit sedierender Medikation bei Menschen mit Demenz zu sensibilisieren und so nachhaltig die Verschreibungshäufigkeit zu reduzieren.
Methode: In „DECIDEvorOrt“ wurden von 1461 Bewohner*innen aus 14 zufallsausgewählten Pflegeheimen in Bayern die Kranken- und Pflegeunterlagen gesichtet. Bei allen Heimbewohner*innen mit Demenz (n=799) wurde die Verschreibungshäufigkeit sedierender Psychopharmaka erfasst. Bei 115 der Heimbewohner*innen mit Demenz wurden konkrete Empfehlungen in Hinblick auf eine mögliche Reduktion der sedierenden Medikation gegeben.
Ergebnisse: Die Verschreibungshäufigkeit festangesetzter sedierender Psychopharmaka bei den Heimbewohner*innen mit Demenz lag bei 53,7%, wobei die Männer signifikant häufiger sedierende Medikamente erhielten als die Frauen (59,5% vers. 51,5%). Den Großteil der festangesetzten sedierenden Medikation machten Antipsychotika, wie Risperidon (33%), Pipamperon (30%), Quetiapin (22%) und Melperon (17%) aus. Benzodiazepine und Z-Substanzen spielten mit jeweils 9% eine geringere Rolle. Bei 39 der 115 durchgeführten individuellen Arzneimittelchecks wurde fachärztlich-psychiatrisch eine Reduktion oder ein Absetzen der antipsychotischen Medikation empfohlen (≙34%).
Diskussion: Konkrete medikamentöse Optimierungsempfehlungen hinsichtlich der Reduktion der antipsychotischen Medikation bei Heimbewohner*innen mit Demenz sind perfekt dazu geeignet, Ärzte, Heimleitungen und Pflegepersonal zu informieren und für die Problematik der sedierenden Psychopharmakotherapie zu sensibilisieren.
Schlussfolgerung: Das Bewusstsein für die Notwendigkeit zum Ausschleichen von Antipsychotika muss geschärft und den behandelnden Ärzt*innen eine Hilfestellung bei der Durchführung der Reduktion gegeben werden.
10:39 Uhr
Gender-specific design and effectiveness of non-pharmacological interventions against cognitive decline and dementia – systematic review and meta-analysis of randomized controlled trials
A. Zülke (Leipzig, DE)
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Autor:innen:
A. Zülke (Leipzig, DE)
S. Riedel-Heller (Leipzig, DE)
F. Wittmann (Leipzig, DE)
A. Pabst (Leipzig, DE)
S. Röhr (Leipzig, DE)
M. Luppa (Leipzig, DE)
Background: Preventive approaches constitute a promising strategy to counter the dementia epidemic. Gender differences regarding modifiable risk factors for dementia have been reported, still, little is known about gender-specific effectiveness of lifestyle trials against cognitive decline and dementia. We conducted a systematic review and meta-analysis on gender-specific design and effectiveness of randomized controlled trials against cognitive decline and dementia.
Methods: Literature searches were conducted in MEDLINE, PsycINFO, Web of Science, Cochrane Central and ALOIS. Studies assessing global and/or domain-specific cognitive function in older adults free from dementia were eligible for the systematic review. We assessed between-group effect sizes using random-effects meta-analysis. Methodological quality of studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN)-checklist.
Results: The systematic review and meta-analysis included 34 and 31 studies, respectively. Effects on global cognition were non-significant overall (g = .27; 95% CI: -.01; .56) and for men (g = -.05; 95% CI: -.55; .45), and small for women (g = .38; 95% CI: .05; .72). Small effects were found for memory (overall: g = .38; 95% CI = .17; .59), with significant effects only for women (g = .39; 95% CI = .13; .65; men: g = .37; 95% CI = .00; .73).
Discussion: We found evidence for small differences in the effectiveness of lifestyle interventions on global cognition and memory in favor of women. However, small numbers of trials targeting men and reporting gender-specific results for older adults with mild cognitive impairment warrant further attention. Assessing differences in modifiable risk factors for dementia in men and women and systematically addressing aspects of gender in trial conduction and recruitment in future studies might increase knowledge on gender-specific effectiveness of lifestyle trials against cognitive decline and dementia.
10:51 Uhr
Patients with amyotrophic lateral sclerosis and cognitive deficits are impaired in recognising negative facial emotions
A. Meyer (Basel, CH)
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Autor:innen:
A. Meyer (Basel, CH)
A. Semenkova (Basel, CH)
C. Gerber (Basel, CH)
D. Lulé (DE)
K. Schweikert (CH)
M. Weber (CH)
J. Wendebourg (CH)
R. Schlaeger (CH)
R. Kressig (CH)
O. Piguet (AU)
M. Sollberger (Basel, CH)
Einführung: There is evidence that patients with amyotrophic lateral sclerosis - frontotemporal dementia (ALS-FTD) are more impaired in emotion recognition than ALS patients without dementia. However, it is unclear whether emotion recognition capacities vary between different subtypes of ALS without dementia [i.e., ALS, ALS with cognitive impairment (ALSci), ALS with behavioural impairment (ALSbi)]. We aimed to determine whether ALS patients, ALSci patients and healthy controls (HC) differ in discriminating between negative facial emotions (i.e., anger, disgust, fear and sadness).
Methode: We compared performance on facial emotion discrimination between 44 ALS patients [31 ALS and 13 ALSci according to the Strong et al. (2017)] and 37 age-, sex and education matched HC by use of the Facial Emotion Intensity Rating Task - Congruent and Incongruent (FEIRT-CIC), a recently developed sensitive and short test of facial emotion recognition. Scores of the FEIRT-CIC and scores of a control task on facial features (gender discrimination task) were compared across groups using the Kruskal-Wallis-Test (gender discrimination task) and ANOVAs (FEIRT-CIC).
Ergebnisse: Overall, ALS patients were not impaired in discriminating between gender presented as facial features. They were, however, impaired in discriminating negative emotions overall compared with HC (p=.01). ANOVA post-hoc analyses revealed that the ALSci group, but not the ALS group, showed impaired negative emotion discrimination (p=.02). Impaired negative emotion discrimination was similar for the four negative emotions.
Schlussfolgerung: The capacity in negative emotion discrimination in non-demented ALS patients varies depending on whether a cognitive impairment is present or not. This finding is in line with the results of a recent study by Lillo et al. (2020). As a next step, we will analyse whether ALS patients with behavioural impairment are more impaired in negative emotion discrimination than ALSci patients.
11:03 Uhr
Blood-based biomarker prescreening in the SKYLINE secondary prevention study with gantenerumab
R. Perneczky (München, DE)
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Autor:innen:
R. Perneczky (München, DE)
C. Rabe (South San Francisco0)
T. Bittner (Basel, CH)
M. Mertes (Basel, CH)
K. Riley (Basel, CH)
A. Jethwa (Penzberg, DE)
I. Schrurs (Rotkreuz, CH)
G. Babitzki (Penzberg, DE)
E. Stomrud (Lund, SE)
S. Palmqvist (Lund, SE)
R. Doody (Basel, CH)
Background
SKYLINE (NCT05256134) is a secondary prevention study in Alzheimer's disease (AD) enrolling amyloid- β positive (Aβ+) cognitively normal (CN) individuals at risk for clinical AD between 60–80 years and treating them with gantenerumab or placebo for 4 years. Based on other studies, 15% of people are expected to be Aβ+ in this screening population. A blood-based biomarker (BBBM) prescreening test was developed to screen out participants who have a low likelihood of being Aβ+ by positron emission tomography (Aβ+-PET) or cerebrospinal fluid (CSF) testing before entering SKYLINE screening.
Methods
Multiple individual key BBBMs (measured with Elecsys® prototype assays) and combinations in the BioFINDER-1, AIBL, A4 cohorts of CN and subjective cognitive decline/mild cognitive impairment participants were explored. Predefined thresholds for amyloid PET and/or CSF pTau/ Aβ42 were used as the reference standard for amyloid positivity. BBBM performance was assessed by evaluating positive and negative predictive values (PPV and NPV) for Aβ+, and screen-out proportions based on potential thresholds. Those metrics were translated into the total number of participants that need to be screened and the reduction of the number of participants that require PET or CSF testing to reach the target sample size.
Results
A combination of two key biomarkers were identified and expected to enable a high NPV at moderate PPV, screening out 40–50% of participants, amongst whom are 3–5% true amyloid positives (falsely ruled out). This BBBM prescreening would reduce the need for PET or CSF testing by 40% while requiring screening of 8% more participants to compensate for the wrongly excluded amyloid positives.
Conclusion
Elecsys® BBBM prescreening in SKYLINE will reduce site and participant burden, accelerate the study enrollment, and save screening costs by reducing downstream screening assessments, e.g. cognitive batteries, magnetic resonance imaging, and PET or CSF testing.
11:15 Uhr
Using an external control to contextualize efficacy data from patients with prodromal and mild Alzheimer’s disease treated with gantenerumab in SCarlet RoAD and Marguerite RoAD open-label extension studies
T. Grimmer (München, DE)
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Autor:innen:
T. Grimmer (München, DE)
P. Delmar (Basel, CH)
Z. Huang (Shanghai, CN)
A. Neve (Basel, CH)
G. Klein (Basel, CH)
G. Kerchner (Basel, CH)
P. Fontoura (Basel, CH)
M. Baudler (Basel, CH)
R. Doody (Basel, CH)
Background:
Gantenerumab, a human monoclonal antibody targeting aggregated beta-amyloid (Abeta), is a potential disease-modifying treatment for early (prodromal-to-mild) Alzheimer’s disease (AD). SCarlet RoAD (SR) (NCT01224106) and Marguerite RoAD (MR) (NCT02051608) were two Phase III trials with open-label extensions (OLEs), during which participants were treated with up to 1,200 mg/month of subcutaneous gantenerumab for up to 5 years. Substantial Abeta removal was confirmed without new or unexpected safety findings. This work aims to evaluate the gantenerumab treatment effect during the SR and MR uncontrolled OLE studies by using an external control group based on the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort.
Method:
Participants from the ADNI studies were weighted to make their demographics and baseline characteristics more comparable to participants in the pooled OLE studies. In the weighted sample, the gantenerumab treatment effects, per change from the OLE Baseline in Clinical Dementia Rating – Sum of Boxes (CDR-SB), Alzheimer’s Disease Assessment Scale – Cognitive subscale 13 (ADAS-Cog13), and Mini-Mental State Exam (MMSE) at Weeks 104 and 156 were investigated by a mixed-effect model of repeated measure.
Results:
Applying inclusion criteria from the ongoing GRADUATE gantenerumab trials (NCT03444870, NCT03443973) to the OLE cohorts, 164 OLE participants and 1,218 ADNI participants were selected. After weighting, the demographics and baseline characteristics were comparable between the two populations. Between the two populations, differences in CDR-SB, ADAS-Cog13, and MMSE (95% CI) at Week 156 were –1.5 (–2.4 to –0.7), –3.5 (–6.4 to –0.5), and 0.6 (–0.7 to 1.8).
Conclusions:
Gantenerumab slowed cognitive decline in the OLE studies compared with weighted ADNI participants on the CDR-SB and ADAS-Cog13 scales, with a smaller effect on MMSE. The efficacy and safety of gantenerumab in early AD participants will be assessed in the GRADUATE trials.