Sensory Health and Dementia Care: Understanding and Addressing Unmet Needs in ADRD

Sensory health in dementia stands at the intersection of two major public health challenges. Hearing and vision impairments are among the most common and disabling comorbidities in dementia and may worsen the trajectory of decline yet frequently go unrecognized and unaddressed. Improving sensory function may be an accessible and cost-effective nonpharmacological intervention to aid in the management of neuropsychiatric symptoms, improve quality of life for persons with dementia, and reduce burden for care partners. This symposium presents the latest evidence on the impact of sensory impairment in dementia and efforts to integrate sensory health into the care of persons with dementia. This symposium will cover emerging evidence of the impact of hearing loss and vision impairment on persons living with dementia, specifically around neuropsychiatric symptoms, disability, and cost. In moving toward solutions, we will discuss new approaches to provide vision and hearing care for persons with dementia in diverse settings, from audiology to specialized memory clinics to home-based care. This discussion will include findings from a systematic review of telehealth in dementia care, which highlights the limitations of existing literature on accounting for the sensory needs of persons with dementia and their care partners. Finally, we will share new international practice recommendations on vision and hearing impairment among persons living with dementia. The symposium highlights the large, yet often unrecognized, sensory health needs of persons with dementia and the multi-prong approach required to identify and support sensory health and, ultimately, healthy aging among persons with dementia.

Renoprotection Induced by Aerobic Training Is Dependent on Nitric Oxide Bioavailability in Obese Zucker Rats

Aerobic training (AT) promotes several health benefits that may attenuate the progression of obesity associated diabetes. Since AT is an important nitric oxide (NO-) inducer mediating kidney-healthy phenotype, the present study is aimed at investigating the effects of AT on metabolic parameters, morphological, redox balance, inflammatory profile, and vasoactive peptides in the kidney of obese-diabetic Zucker rats receiving L-NAME (N(omega)-nitro-L-arginine methyl ester). Forty male Zucker rats (6 wk old) were assigned into four groups ( n = 10 , each): sedentary lean rats (CTL-Lean), sedentary obese rats (CTL-Obese), AT trained obese rats without blocking nitric oxide synthase (NOS) (Obese+AT), and obese-trained with NOS block (Obese+AT+L-NAME). AT groups ran 60 min in the maximal lactate steady state (MLSS), five days/wk/8 wk. Obese+AT rats improved glycemic homeostasis, SBP, aerobic capacity, renal mitochondria integrity, redox balance, inflammatory profile (e.g., TNF-α, CRP, IL-10, IL-4, and IL-17a), and molecules related to renal NO- metabolism (klotho/FGF23 axis, vasoactive peptides, renal histology, and reduced proteinuria). However, none of these positive outcomes were observed in CTL-Obese and Obese+AT+L-NAME ( p < 0.0001 ) groups. Although Obese+AT+L-NAME lowered BP (compared with CTL-Obese; p < 0.0001 ), renal damage was observed after AT intervention. Furthermore, AT training under conditions of low NO- concentration increased signaling pathways associated with ACE-2/ANG1-7/MASr. We conclude that AT represents an important nonpharmacological intervention to improve kidney function in obese Zucker rats. However, these renal and metabolic benefits promoted by AT are dependent on NO- bioavailability and its underlying regulatory mechanisms.

POS0155-HPR DIAPHRAGMATIC BREATHING RELAXATION TECHNIQUE TO DECREASE ANXIETY DURING JOINT INFILTRATION: A RANDOMIZED CONTROLLED TRIAL

Background:Joint infiltration is the injection of therapeutic substances directly into a joint. It may be a stressful experience for patients as imagined different from other usual injections. Several techniques are used to manage anxiety and pain during such a procedure.Objectives:To evaluate the effectiveness of diaphragmatic breathing relaxation on reducing anxiety and pain during joint infiltration.Methods:Patients scheduled for a joint infiltration at the rheumatology department’s daycare unit were recruited. All infiltrations were performed using steroids without anesthetic therapy except for the hip. Patients were randomized into two groups (cases=38, controls=34). Cases learned from a trained health agent diaphragmatic breathing relaxation technique to perform it immediately before and during the procedure while controls received the usual procedure. We used the Visual Analogue Scale (VAS) to assess self-estimated both anxiety (VAS-Anx) and pain (VAS-Pain) as evaluated on pre and post-joint infiltration. VAS-Pain was evaluated as expected then as experienced respectively on pre and post-infiltration. We also assessed heart rate and blood pressure on pre and post-procedure.Results:Seventy-two participants were included with a mean age of 55.48 ± 12.39 years (39-78), treated for an inflammatory rheumatic or degenerative disease (21, 51 respectively), and receiving joint infiltration for the first time among 37. Sites of infiltrations were: wrist=7, elbow=10, shoulder=17, hip=1, knee=22, epidural=6, plantar heel=9. There were no significant differences in pre-proceduralVAS-Anx, VAS-pain, or physiological parameters between cases and controls. Cases had a significant decrease in VAS-Anx from pre to post-infiltration (Mean post-VAS-Anx=23.33/100, p=0,017) but not significant compared with controls (p=0.297). Patients who have performed the breathing technique had no significant decrease in VAS-Pain from pre- to post-infiltration (p=0.083) and compared with controls (p=0.662). Physiological parameters showed a significant decrease in heart rate of cases from pre to post-infiltration (p<0,0001) and compared with controls (p=0,036), but no significant decrease in systolic or diastolic blood pressure from pre to post-infiltration and compared with controls. There were no correlations between all participants’ VAS-Anx/VAS-Pain and age, gender, infiltration site or history and joint pain causes.Conclusion:This study suggests that diaphragmatic breathing relaxation is an effective nonpharmacological intervention that could be used in controlling anxiety and experienced pain during joint infiltration.Disclosure of Interests:None declared

Advancing Stroke Recovery Through Improved Articulation of Nonpharmacological Intervention Dose

Dose articulation is a universal issue of intervention development and testing. In stroke recovery, dose of a nonpharmaceutical intervention appears to influence outcome but is often poorly reported. The challenges of articulating dose in nonpharmacological stroke recovery research include: (1) the absence of specific internationally agreed dose reporting guidelines; (2) inadequate conceptualization of dose, which is multidimensional; and (3) unclear and inconsistent terminology that incorporates the multiple dose dimensions. To address these challenges, we need a well-conceptualized and consistent approach to dose articulation that can be applied across stroke recovery domains to stimulate critical thinking about dose during intervention development, as well as promote reporting of planned intervention dose versus actually delivered dose. We followed the Design Research Paradigm to develop a framework that guides how to articulate dose, conceptualizes the multidimensional nature and systemic linkages between dose dimensions, and provides reference terminology for the field. Our framework recognizes that dose is multidimensional and comprised of a duration of days that contain individual sessions and episodes that can be active (time on task) or inactive (time off task), and each individual episode can be made up of information about length, intensity, and difficulty. Clinical utility of this framework was demonstrated via hypothetical application to preclinical and clinical domains of stroke recovery. The suitability of the framework to address dose articulation challenges was confirmed with an international expert advisory group. This novel framework provides a pathway for better articulation of nonpharmacological dose that will enable transparent and accurate description, implementation, monitoring, and reporting, in stroke recovery research.

Comparative Efficacies of Antimigraine Drugs Using Nitroglycerin Induced Migraine Rats Model

Aim: The migraine pathology is still not explained effectively. There is a common relationship between anxiety, depression, and migraine. So the aim of the study to illustrate effectively the behavioural and biomarker changes in the migraine condition. Methods: Nitroglycerin (NTG) induced migraine rats model was used the present study. Twenty-five male Wistar rats were randomly divided into five groups. Ergotamine, sumatriptan, and BIBN4096 were used as antimigraine drugs. The behavioural activity was measured by scratching head, body shaking, and social interaction task. ELISA detected biomarkers like interleukin 6 (IL-6), Substance P (SP) and 5-hydroxytryptamine (5-HT) in various rats brain regions such as cortex, brain stem, trigeminal ganglion. Results: A significant reduction in hyperalgesic response and behavioral changes like scratching head, body shaking and social interaction task. Biomarkers like 5-HT, SP and IL-6 were significantly reduced in the various brain regions such as prefrontal cortex, brain stem and trigeminal ganglia of the rats in the BIBN4096 treated groups. Conclusion: The present study showed a good antimigraine efficacy with a calcitonin gene-related peptide (CGRP) antagonistic agent BIBN4096 than ergotamine and sumatriptan but still lack of behavioural pattern, need to explore nonpharmacological intervention along with the drug treatment.

Balancing science and public policy in Pakistan’s COVID-19 response

Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan’s response to COVID-19 has been under scrutiny for its granularity, reach and impact. Aims: This study aimed to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan. Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic. Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case introduction from pilgrims returning from the Islamic Republic of Iran, followed by widespread community transmission. The National Command and Operations Centre, established through civilian and military partnership, was critical in fast tracking logistics, information gathering, real-time reporting and smart lockdowns, coupled with a massive cash support programme targeting the poorest sections of society. Cases peaked in June 2020 but the health system was able to cope with the excess workload. Since then, although testing rates remain low (> 300 000 cases confirmed to date), case fatality rates have stabilized, and with 6300 deaths, Pakistan seems to have flattened the COVID-19 curve. Conclusion: Despite notable successes in controlling the pandemic, several weaknesses remain and there are risks of rebound as the economy and educational systems reopen. There is continued need for strong technical and programmatic oversight, linked to civic society engagement and working with religious scholars to ensure nonpharmacological intervention compliance.

Music Therapy Clinical Trials in Cross-Cultural Settings

Music therapy in clinical trials has shown efficacy as a nonpharmacological intervention for multiple medical conditions and procedures. Every culture has music and virtually everyone on this globe enjoys music suggesting the universality of music therapy. However, in the US, most music therapy clinical trials participants are English-speaking Caucasians. That narrow pool limits our understanding of the benefits of music in an ethnically and culturally heterogeneous nation. This study looks to the international clinical trials for lessons and information that can advance U.S. studies by expanding the methodology and clinical reach to benefit a more extensive population of patients. A review of 449 studies in 48 countries from clinical trials registries supports an effort to expand music therapy studies and interventions by incorporating a cross-cultural perspective. Researchers and clinicians using international resources can increase their understanding and capacity. Globally, many standardized measures have been translated, including self-report measures of behavioral and mental health, pain, sleep, medical conditions, and symptom severity used for outcome measures, as well as music therapy measures and intervention checklists. Scientifically accepted physiological outcome measures have shown the benefits of music interventions for older adults regardless of cultural or ethnic differences. For example, neuroimaging research supports the clinically derived notion that music can address needs of people with dementia. The future will require new standards for multi-cultural research. To expand studies and methodologies, we need to include more diverse populations. This paper proposes that to do that, we must look to the global scientific community.

The Implementation of Birdsong: A Non-Pharmacological Intervention for Persons With Dementia

Birdsong is a person-centered, nonpharmacological intervention for people with dementia. Using a touch-screen tablet, residents with dementia are stimulated with content customized based on individual interests such as sports, videos, music or brain games. The increased stimulation is expected to redirect negative behaviors, decrease the use of anti-psychotic medications and increase positive emotions. Birdsong is being implemented in a 100% Medicaid funded, long-term care facility. Two 10-week experimental design studies were implemented with 39 residents. Preliminary findings suggest a lack of independence with the tablets among the residents, but positive stimulation of emotions and redirection of negative behaviors with assistance of staff or volunteers. A team of practitioners, faculty and student researchers continue to examine the intervention, its implementation and effects on this population by examining the Minimum Data Set (MDS data) and observations of the residents as they utilize Birdsong.