With coronavirus disease 2019 (COVID-19) a lot of people have succumbed and older adults were disproportionately affected. (1,2) Also, grief is encountered frequently in clinical practice with the elderly, and can be defined as the natural response to the death of a loved one. Still, when a failure of adaptation occurs then a Prolonged Grief Disorder (PGD) can be diagnosed, which has been recently included in ICD-11. The principal feature of PGD is a persistent preoccupation or an intense longing for the deceased that lasts longer than 6 months after the death. (3)

Comprehend the grief in the elderly and its implications in their health.

The author conducted a literature review by searching the Pubmed database using the keywords elderly; grief; complicated grief; covid-19

PGD is relatively prevalent among the elderly and has been associated with some variables related to the death time of the deceased, being the prevalence inversely correlated with the deceased’s. (4, 5) Additionally, older adults present a higher risk of developing PGD when they are less

educated, male, have poorer cognitive performance, and a history of depression. (3) PGD is characterized by sadness, fascination with or excessive avoidance of the memories associated with the deceased, the memory of the loss and mental ruminations about death. According to some investigations, PGD reduces life expectancy, increasing the odds of death, causes severe behavioural symptoms, and is associated with longer-term functional impairment. (4,5)

Given these results, it is easy to understand the need for a closer monitoring of these patients during this global crisis. Moreover, it is also important to find new ways to do that while complying with COVID-19 rules and restrictions. A short-term evidence-based intervention for PGD effective in the elderly is based on support focused upon these seven themes: understanding their grief, managing emotional pain, thinkingabout the future, strengthening their relationships, telling the story of the dead, learning to live with reminders of the deceased, and connecting with memories. (3)

The primary aim is to establish the prevalence of loneliness and social isolation in older adults referred to a Psychiatry of Old-Age Service in the North-West of Ireland. Secondary aims include exploring associations between loneliness, social isolation and, well-being, depression, cognition and health- status. The overarching aim was to improve patient outcomes by tailoring mental health and social interventions appropriate to patient need.

Loneliness is a discrepancy between the social-relations one has and their desired level. It is estimated that one third of older adults will experience loneliness, which along with social isolation has links to poorer health-outcomes, reduced quality of life and cognitive decline. Government advice in Ireland to reduce social activity due to COVID-19 pandemic may compound social disconnection. We present preliminary findings of an ongoing study investigating loneliness, social isolation and related factors in older adults referred to a Mental-Health Service in the North-West of Ireland in 2020 - 2021.

Using a cross-sectional study design, participants completed University of California, Los-Angeles(UCLA) Loneliness Scale (UCLA maximum score =10); and Berkman-Syme Social Network Index. Quality of life is measured using WHO-Well-being Index(WHO-5) with a number of relevant personal, clinical and social factors also captured.

Data from 98 questionnaires (January 2020- May 2021), 52% female, showed average participant age was 74.4 years. Average perceived loneliness score was 3.67 and 85.7%, (n=84) reported some loneliness (UCLA >0) with 2% (n=2) reporting high loneliness levels (UCLA =10). The majority, 77.5% (n=76) were socially isolated; 35.7% (n=35) ‘mostly isolated’, 41.8% (n=41) ‘moderately isolated’. Females were noted to be more isolated.

Preliminary results illustrate majority of older adults referred to a mental-health service over a time- period spanning COVID-19 pandemic are lonely and socially isolated. This is likely compounded by changes to daily routines during COVID-19 pandemic. This is concerning given the adverse health implications. We hope final results will guide enhancement of clinical-care through linkage of mental- health services with community agencies, social-care supports and e-health technologies.

It´s been proved that cognitive stimulation (CS) has direct effects over the improvement of general cognitive functions in people with cognitive impairment (PCI). The restrictions in daily life associated to COVID-19 pandemic had an impact in the quality of life of PCI and it might have affected the efficacy of the CS programs targeting this population.

To analyse if there was a moderating effect of the pandemic on the efficacy of CS programs.

Participants were enrolled in a public memory clinic; 213 PCI were assigned to two groups: 173 received CS treatment before the pandemic (PRECOVID) and 40 received CS during the pandemic (COVID). Pre and post assessments were carried out with the Mini Mental State Exam (MMSE), the clock-test and the brief Geriatric Depression Scale. The treatment consisted of 32 sessions of CS held twice a week during 4 months. No significant differences (p<.05) were found between groups at baseline in age (74.46±7.80 years), cognitive function (MMSE=23.43±3.30), gender (58% women) and the remaining variables.

After treatment, both samples improved in depression (t = 4.56, p < .05), the COVID group improved in MMSE (t = -3.40, p < .05) and clock-test (t= -3.78, p < .05), the rest of the changes were not significant. Between group effect sizes favoured the COVID group intervention for MMSE (dc = 0.74) and the clock test (dc = 0.48). No between group differences were found for depression (dc = -0.48).

Older people participating of CS during the pandemic benefited more from the treatment than those participating before the pandemic. This apparently contradictory result might be explained by the context of lack of social, emotional and cognitive stimulation associated to the restrictions inherent to social confinement. The continuity of CS care to PCI is essential in the context of generalised restrictions in daily life associated to COVID-19 pandemic and might play an important role in preventing cognitive loss and associated disabilities.

Consistency between carers’ report of the people with dementia’s (PwD) performance of activities of daily living (ADLs) and observed performance has been an important topic in the literature, but most studies have investigated whether carer’s burden and depression affect this report.

To (1) investigate if carer’s report of PwD’s performance of ADLs is consistent with PwD’s observed performance; and to (2) evaluate if carer management style has an effect on this discrepancy.

Sixty-four PwD completed a performance-based ADL assessment (Assessment of Motor and Process Skills-AMPS) which entails the observation of ADL performance; their carers were interviewed using an informant-based ADL assessment (DAD), which records ADL performance as reported by the carer. Carers completed a dementia management-style scale (DMSS) that categorises the carer’s style in: criticism, active-management and encouragement. To investigate whether there was consistency between the DAD and the AMPS, a new continuous variable was created: the comparative ADL score. Cohen’s kappa was used to compare agreement/disagreement between the DAD and the AMPS. Multiple regression analysis explored whether carer styles could explain the discrepancy between the reported and observed performance of ADLs.

The majority of carers underestimated (71.9%) or overestimated (17.2%) (disagreement) the PwD’s ADL performance; only 10.9% of carers reached an agreement between reported and observed performance. Cohen’s kappa [k= -0.025 (95%CI -0.123 – 0.073)] indicated poor level of agreement between the DAD and the AMPS. Criticism, active-management and encouragement styles were included in the regression model: the comparative ADL score was used as the dependent variable. This combined model explained 18% (R2=0.178,F(3, 59)=4.26,p=<0.01) of the variance of the dependent variable. Active-management (β =0.037, t(62)=3.554, p=0.001) and encouragement (β =-0.024, t(62)=- 2.086, p=0.05) styles were the two factors that made the largest and statistically significant contribution to the model.

the disagreement between the reported and the observed performance proved to be high in this group. The styles that carers use when dealing with dementia-related problems affected their report of ADL performance, which means that the strategies applied by carers to support ADL performance can be targeted to reduce the gap between reported and observed performance.

With the incidence, prevalence, and cost of dementia care expected to rise, it has become crucial to develop a practical approach for managing behaviors in dementia. Presently non-pharmacological interventions, both interpersonal and environmental, are the gold standard for managing Behavioral and Psychological Symptoms of Dementia (BPSD). The purpose of the presentation is to reveal the reasons for paucity in developing effective pharmacological treatments for BPSD in moderate to advanced dementia and propose a new theoretical framework for labeling and classifying behaviors in moderate to advanced dementia. The LuBAIR paradigm will be less labor-intensive, more comprehensive, and improve the categorization of behaviors into clinically meaningful categories. It was also found that the LuBAIR Inventory has comparable inter-and intra-rater reliability and Construct and Criteria validity in comparison to BEHAV-AD and Cohen-Mansfield Agitation Inventory (CMAI).

The literature on BPSD reviewed, focusing on terminology, models of behaviors, and identified deficiencies in both.

Terminology to describe moderate to advanced dementia behaviors lacks consistency, accuracy, and reliability in both research and clinical settings. Standardized scales currently utilized to diagnose clinical conditions also lack validity and reliability in moderate to advanced dementia. Models for understanding the occurrence of behaviors in dementia are dichotomized along the biological versus psychosocial paradigm. The reliability and validity of the LuBAIR Inventory were established in an earlier study and workshops, where it found that the LuBAIR was less labor-intensive, more comprehensive, and offered improved categorization of behaviors into clinically meaningful categories. It was also found that the LuBAIR Inventory has comparable inter-and intra-rater reliability and Construct and Criteria validity in comparison to BEHAV-AD and Cohen-Mansfield Agitation Inventory (CMAI).

Deficiencies in existing terminology, assessment scales, and models are acknowledged. There are twelve newly formed behavioral categories to classify behaviors in moderate to advanced Dementia. These categories were used to develop a new behavioral assessment inventory titled LuBAIR (Luthra’s Behavioral Assessment and Intervention Response). The LuBAIR model will help clinical staff to understand the 'meaning’ of behaviors in persons with Dementia (PwD).

To analyze the effectiveness of cognitive stimulation carried out through OroiCognitive, a virtual reality app, in older people, as well as its acceptance and attractiveness to them.

The research was carried out with 31 participants with a number two or three in the global deterioration scale (GDS).

15 of these participants were part of the control group, and 16 of the experimental group.

The intervention through virtual reality, with exercises more similar to daily activities, allows working on attention, language, memory, orientation, visuospatial skills and executive functions.

It was carried out in 12 sessions, 3 times a week, lasting 25 minutes each one, individually.

Bouth groups were evaluated using the MINI-MENTAL Cognitive Examination and some subtest of the Weschler Intelligence Scale for adults (WAIS-IV).

Regarding to the effectiveness of the stimulation, the results show significant improvements in vocabulary and information in those with GDS2, in the experimental group.

No statistically significant improvements were found in the rest of the areas. Regarding the assessment of the tool, 69% of the participants rated it as quite useful and interesting. According to the qualitative data collected by the therapists, the users were happier and more animated during and after the intervention.

Dementia due to probable Alzheimer’s disease (AD) represents between 60 and 80% of all dementias. The total number of estimated AD cases worldwide by 2030 is 65.7 million and 115.4 million by 2050; this represents a twofold population increase in the next 20 years.

Magnetic resonance imaging (MRI) has been the primary tool of interest to link hippocampal volume loss with dementia firmly.

MRI-based volumetry has been proposed as a promising biomarker.

Hippocampal volumetry is useful in discriminating not only cognitively normal individuals from those with dementia but can also differentiate Mild Cognitive Impairment (MCI) from various types of dementia.

To measure hippocampal volume in various types of dementia. (MMSE) and Activities of daily living (ADL) in patients with dementia.

A cross-sectional study conducted for period of one year among 21 patients with Alzheimer’s, vascular dementia, amnestic mild cognitive impairment and 20 healthy age matched controls. MMSE scale was used to stratify patients on cognitive function impairments. ADL scale to assess functional status of the patient ability to perform activities of daily living independently in diverse settings. Hippocampal volume measured using MRI 1.5 T Philips Ingenia, a coronal T1-weighted FFE (Fast Field Echo) 3D sequence.

Total Hippocampal volume was reduced by 35% in Alzheimer’s disease, 27% in vascular dementia and 10% in amnestic mild cognitive impairment, compared with control group

Moderate positive correlation between mean total hippocampal volume and MMSE scores in patients with dementia which was statistically significant. (P value= 0.001).

A screening tool for narcissistic personality disorder (NPD) in older adults is lacking.

The study aimed to develop a screening tool for detecting symptoms of the NPD and to validate its psychometric properties in older adults.

This Narcissistic Personality Screening Questionnaire (NPSQ) was developed by constructing items based on DSM-5 criteria of the narcissistic personality disorder (NPD). A literature review regarding the signs and symptoms of NPD was conducted. Interview with NPD patients, the patients’ key informants, and a focus group discussion among psychiatrists, psychiatric nurses and psychiatry residents who have experience in working with patients with NPD were performed. After the items were created, the content validity index (CVI) by 1 psychologist and 1 psychiatrist was analyzed. A field trial was conducted among older adult patients visiting the psychiatry and the cardiology departments at Maharaj Nakorn Chiang Mai hospital between March and April 2021. The internal consistency using Cronbach alpha was analyzed.

Item hierarchy, item difficulty, and item fit was also calculated using

Rasch analysis. Qualitative information was analyzed regarding language use and time to complete the test.

Originally, a total of 80 NPSQ items with 4-Likert scales i.e., strongly agree, moderately agree, slightly agree, and disagree were generated. The CVI was 0.75-1 for item-CVI and 0.89 for scale-CVI. The NPSQ was examined among 30 Thai older adults with a mean age of 70.76 ± 6.23 years. The percent of missing items of all 80 items ranged from 2.9% to 8.9%. Cronbach’s alpha for the 80-item NPSQ was

To determine the correlation of hippocampal volume with Mini-Mental State Examination 0.96. Rasch analysis identified 37 misfitting with a mean square > 1.50, therefore 43 items remained. Person-item map showed a good target between items and sample, even though some items may be redundant. Cronbach’s alpha for the 43-item NPSQ was 0.96. Some participants were confused about who the questions referred to, which were then revised before including it in the final draft version. Only one participant did not complete the questionnaire.

The 43 item NPSQ shows good content validity and an excellent internal consistency among older adults. A study with a larger sample size is warranted.

Throughout the COVID-19 pandemic, older adults have been disproportionately impacted by both illness and fatalities. Of the nearly 39 million adults over age 65 in the United States, approximately 2.4 million older adults identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). LGBTQ older adults face unique challenges due to their intersecting identities and histories, including the effects of heterosexism, ageism, and being more likely to live alone, be single, and not have children. As we implement social distancing as a primary COVID-19 prevention method, older adults have faced increased isolation.

We presented a case of a lesbian older adult patient who has experienced increased depression during the COVID-19 pandemic. A table will be added featuring culturally competent recommendations for LGBTQ older adults from a literature review.

A 77-year-old female with history of major depression, attention deficit disorder, hypertension, xerostomia, and polymyalgia rheumatica. The patient has been on multiple trials of medications for depression as well as ECT treatments. She was initially engaged to a man and after some years fell in love with a woman. The patient is currently single and has no children. She typically has a strong support system with her lifelong friend and attends church. She transitioned from independent living to an adult living facility, with the hope of increased social activity and connectedness. However, due to COVID-19, she experienced her move as extremely difficult, and was disappointed that all social activities were canceled. For a period of several months, she was unable to visit her chosen family, was limited to attending church via Zoom, and was restricted from multiple areas of the complex. As a result, she reported increased depression, anxiety, and difficulty sleeping with passive suicidal ideation due to isolation and no direct family support.

Older LGBTQ populations are at disproportionately higher risk for mental health conditions and with the current social distancing measures in place, social isolation and loneliness has been exacerbated.

Connection with accepting family and community are well documented in the literature as key protective factors and sources of resiliency in LGBTQ populations. Culturally competent care is integral to psychiatric treatment of older LGBTQ adults.

This abstract was presented at the American Association of Geriatric Psychiatry 2021 Annual Meeting.

The Brain Health Test-7 (BHT-7) is a revised tool from the original BHT, containing more tests about frontal lobe function. It was developed with theaim of identifying patients with mild cognitive impairment (MCI) and early dementia.

Here we report the validity of the BHT-7 versus the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in differentpsychiatry or neurology clinics.

Patients with memory complaints were recruited in this study from the outpatient clinic of psychiatry or neurology in 3 different kinds of hospitals. Allpatients underwent the evaluation of the BHT-7, MMSE, MoCA, and clinical dementia rating (CDR). The clinical diagnosis (normal, MCI, dementia) was made by consensus meeting, taking into account all available data.

Demographic data and the scores of the MMSE, MoCA, and BHT-7 between groups were compared. Logistic regression was adopted for analysis of optimal cutoff values, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curve,and the area under the ROC curve (AUC).

We enrolled a total of 1090 subjects (normal 402, MCI 317, dementia 371); of them, 705 (64.7%) were female. There was a statistically significant differencein age, years of education, and 3 cognitive test scores among the 3 groups.

Compared with the MMSE and MoCA, the BHT-7 performed slightly betterthan MMSE and MoCA in differentiating MCI or dementia from the normalcontrols (Table 1). For BHT- 7, the cutoff point was 17 between normal andMCI, and 14 between normal and dementia. These cutoff points for BHT-7were consistent through 3 different clinical settings, but inconsistent for MMSE and MoCA. The testing time for the BHT-7 was about 5-7 minutes, shorter than that of the MMSE and MoCA.

Compared with MMSE and MoCA, the BHT-7 showed slightly better performance in differentiating normal from MCI or dementia subjects. The testing time for the BHT-7 was shorter, and its cutoff points were consistent through different outpatient clinic settings. The results support that BHT-7 is auseful cognitive screening tool for MCI or early dementia in various hospital settings.

Table 1

Comparisons of the performance of BHT-7, MMSE, MoCA

Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive test, appropriate for people with minimum completed level of education and sensitive to multicultural contexts. It could be a good instrument for cognitive impairment (CI) screening in Primary Health Care (PHC). It comprises the following areas: recent memory, body orientation, praxis, executive functions and language.

The objective of this study is to assess the construct validity of RUDAS analysing its internal consistency and factorial structure.

Internal consistency will be calculated using ordinal Cronbach’s α, which reflects the average inter-item correlation score and, as such, will increase when correlations between the items increase. Exploratory Factor Analysis will be used to arrange the variables in domains using principal components extraction. The factorial analysis will include the extraction of five factors reflecting the neuropsychological areas assessed by the test. The result will be rotated under Varimax procedure to ease interpretation.

Exploratory factor analysis will be used to arrange the variables in domains using principal components extraction. The analysis will include Kaiser–Meyer–Olkin measure of sampling adequacy and Bartlett’s test of sphericity. Estimations will be based based on Pearson’s correlations between indicators using a principal component analysis and later replicated with a tetrachoric correlation matrix. The variance in the tetrachoric model will be analysed to indentify convergent iterations and their explicative power.

RUDAS is being administered to 321 participants older than 65 years, from seven PHC physicians’ consultations in O Grove Health Center. The data collection will be finished by August 2021 and in this poster we will present the final results of the exploratory factor analysis.

We expect that the results of the exploratory factor analysis will replicate the results of previous studies of construct validity of the test in which explanatory factor weights were between 0.57 and 0.82, and all were above 40%. Confirming that RUDAS has a strong factor construct with high factor weights and variance ratio, and 6-item model is appropriate for measurement will support its recommendation as a valid screening instrument for PHC.

Little is known regarding attachment styles among residents in long-term care homes and the relationship with depression and loneliness

The study evaluated the distribution of attachment among residents in long-term care (LTC) homes and identified their association with depression and loneliness.

This study involved 132 residents in LTC homes in Thailand. All of them were cognitively intact based on Mini-Cog. The Thai version of the Experiences of Close Relationships-Revised questionnaire (ECR-R-18), the Relationships Questionnaire (RQ) were used to assess attachment. The Thai version of Geriatric Depression Scale (GDS-6) and the 6-item Revised version of The University of California Los Angeles Loneliness Scale (RULS-6) were completed.

Participants included 85 females (64.4%) with mean age 74.89 (SD 7.89) years. The mean number of years of education was 6.81(SD 4.46) years. Most of the attachment styles were insecure (60.7%). The distribution of attachment style was 39.4% for secure, 15.2% for fearful, 16.7% for preoccupied, and 28.8% for dismissing. The mean score of attachment- anxiety was 3.58 and of attachment-avoidance was 3.61. Mean GDS score was 1.17 (SD 1.58), while depression based on the GDS cut-off was found in 31.1% of the residents. Mean RULS score was 2.36 (SD 0.75). Factors associated with Depression includes male (c2= 4.50, p <.05), anxious attachment (t = 3.51, p = 0.001) and loneliness (t = 4.90, p <0.001). Anxious attachment was associated with loneliness (p <0.001) and depression score (p <0.001), while avoidant attachment was not.

The majority attachment style among residents in LTC homes is insecure attachment, with dismissing style the most prevalent. Attachment with high anxiety i.e., preoccupied, and fearful was associated with loneliness and depression.

Alzheimer’s disease (AD) is a neurodegenerative pathology that develops mainly in elderly and senile people.

Disruption of BDNF transport or suppression of its production appears to be typical for people of old age. Objective: To investigate the influence of Alzheimer’s disease on the secretion of brain factors and correlate with neuropsychological profiles.

12 men (2) and women (10) with Alzheimer’s disease were examined. The average age of the subjects was 76.25 + 4.89. Methods: MMSE, ADAS-COG, laboratory - BDNF was performed using the G7611 BDNF Emax (R) ImmunoAssaySystem 5 x 96 wells, BDNF Emax® Immunological test.

2 patients have mild dementia, 8 patients have moderate dementia, 2 patients have severe dementia. The average age of patients with mild dementia was 72.0 + 1.0. The average MMSE score is 16.7 + 3.4. Correlation analysis showed a close relationship between a pronounced decrease in memory in memory tests (ADAS-COG) and a pronounced decrease in blood BDNF content (r = 0.676). A close statistically significant relationship was found between a low result of the recognition test and a low blood BDNF content (r = 0.598).

we assume that blood BDNF is a marker of pathologically accelerated aging of the central nervous system, since low test results for mnestic function are an indicator of severe degeneration in Alzheimer’s disease.

The aging processes are accelerating in all regions of the world. The involvement of older people in production and social processes determines the need to maintain a high level of social and psychological adaptation, despite the progressive pathology of the brain caused by its aging. This increases the relevance of research related to the study of biological reserves of the brain and psychological and social mechanisms of human adaptation in late adulthood. The risk of developing cognitive disorders is not fatal. According to some observations, even in the hippocampal type of UKR, despite the content of amyloid in the brain, the functional and social activity of the elderly remains high. Prospective studies show that people with high cognitive reserve have a lower risk of developing dementia. Cognitive reserve is the brain’s resistance to damage. Cognitive reserve is the ability of the brain to cope with the consequences of damage caused by external influences, brain stroke, chronic brain ischemia, neurodegenerative diseases, and age-related changes. Cognitive reserve is the brain’s ability to functionally compensate for and minimize clinical manifestations of cognitive impairment. The mechanisms of cognitive reserve in normal and Alzheimer’s disease are different. In healthy older adults, a higher cognitive reserve correlates with larger brain sizes and effective strategies for performing cognitive tasks. In the early stages of Alzheimer’s disease and Alzheimer’s disease, the size of the brain decreases. But high brain activity helps preserve cognitive resources. Excessive brain activity in dementia is a compensatory mechanism. This is confirmed by the results of functional magnetic resonance imaging of the brain. Of course, the degree of brain atrophy is a predisposing factor for dementia, but it is not a mandatory factor for cognitive decline. So, the symptoms of dementia do not appear until you have crossed the critical border of damage to the brain substance. Progressive brain atrophy underlies the clinical manifestations of dementia in neurodegenerative diseases, but the correlation between the degree of brain damage and cognitive impairment is not linear.

An observational 10-year longitudinal study was conducted. In 2006, moderate cognitive impairment was found in 66 patients. The group of patients included 49 women and 49 men. Their average age in 2006 was 59.3±5.2 years. In 2006, the severity of cognitive decline was 26.2±1.9 points on the MMSE scale. This corresponds to indicators of moderate cognitive impairment. Research methods: clinical and psychopathological, psychometric, statistical. Questionnaire “Loss and acquisition of personal resources” (N. Vodopyanova, M. Stein), MMSE scale.

In 2006, amyloid was detected in the spinal fluid of all patients selected for the study group. If a patient developed dementia, they were given specific therapy. The dynamics of cognitive functions in patients was different. Mild dementia was formed in 53% of patients. Moderate dementia was formed in 10.6% of patients. Moderate cognitive impairment (pre-dementia) persisted in 36.4% of patients. Hereditary burden of dementia in patients with moderate dementia was detected 2 times more often. Back in 2006, we identified the leading sensory systems of patients. The master sensor system determines the modality of the main information flow. This is the most important part of the information that a person interacts with. This is the basis of interaction with reality. This is the basis of cognitive functions. Correlations of age-specific lesions of the corresponding sensory systems with the severity of cognitive decline were found in patients with the corresponding sensory modality (Spearman’s Correlation Coefficient-r, p<0.05): presbyacoussis – auditory r=0.667, presbyopia-visual r=0.705. The influence of psychosocial factors on the condition of patients was studied. In dementia, significant history of psychotrauma was found in 35.7%. Moderate stress was detected in the group of patients with moderate cognitive impairment in 33.3%. Moderate stress was detected in the group of patients with dementia in 83.3%. Stress of loss of life meaning was detected more often in patients with dementia 76.7%. It is important not only what stresses a person endures, but how they can cope with them. Dementia patients were statistically more likely to have unproductive coping strategies that did not help them cope adequately with stress.

The concept of cognitive reserve suggests possible causes of heterogeneity in the dynamics of cognitive decline in the initial stages of atrophic-degenerative brain diseases: biological causes and psychosocial causes. The concept of cognitive reserve helps to study and develop individual programs for the prevention of severe cognitive disorders.

The growing prevalence of severe cognitive impairment in populations, the involvement of a significant number of people of working age in the medical, economic, psychological and social problems associated with late dementia, the insufficiency and inconsistency of information about the mechanisms of formation of these disorders actualize a comprehensive medical and social study of dementia.

The goal is to study the psychosocial mechanisms of the formation of clinical, functional disorders in dementia, to develop comprehensive medical and psychosocial programs to help patients with dementia and those involved in caring for them, based on the proposals of the psychosocial model of dementia.

A selective observational comparative dynamic study of 315 people with Alzheimer’s dementia and 214 people who care for the patients was carried out. The study used clinical, clinical, psychopathological, neuropsychological, psychometric, sociometric, and statistical research methods.

An increase in the severity of dementia contributes to a significant (p <0.05) increase in the number of patients in a dependent position in the family. The appearance of psychotic (painful ideas [r = 0.589]), behavioral (agitation/aggression [r = 0.654]), affective (anxiety [r = 0.536], unstable mood/irritability [r = 0.581]) symptoms of dementia contribute to family role changes structure and increase interpersonal distance in the dyad “caretaker - patient.” Decreased functional activity of the patient (r = 0.758), development of behavioral disorders (aberrant behavior [r = 0.675], agitation/aggression [r = 0.713], impaired night behavior [r = 0.597]), affective symptoms (anxiety [r = 0.685]) contribute to aggravation of the distress of the caregiver. Those who provide unprofessional care for dementia patients in a statistically significant (p <0.05) majority of cases have a high level of emotional involvement in the care process. Changes in family-role and social parameters, a high level of “expressed” emotions of caregivers have an adverse effect on the development of psychotic (r = 0.618), affective (r = 0.701), behavioral (r = 0.837) dementia disorders. The degree of adherence to anti- dementia therapy by the caregiver is one of the important factors determining the amount of care received by the patient (r = 0.698). Agitation/aggression (r = 0.761), anxiety (r = 0.562), sleep disturbances (r = 0.521) contribute to increased compliance. The low satisfaction of the caregiver with premorbid (r = 0.698) and current (r = 0.653) relationships with the patient leads to a decrease in the compliance of the caregiver.

It was revealed that the formation of cognitive impairment is caused by biological factors, their severity depends on the severity of dementia. The mechanism of psychopathological symptoms, functional disorders is heterogeneous, depending on the biological causes and psychosocial conditions of functioning of patients.

Caregivers are essential in providing valuable patient information to medical providers. With limited available research investigating caregiver burden among those caring for patients receiving ECT and the new life challenges presented by the COVID-19 pandemic, it is more important now than ever to take a closer look at the caregivers’ experiences.

Emory’s Wesley Woods Geriatric Hospital is one of the busiest ECT services in the country with around 2000 treatments completed every year. In this chart review, researchers are looking at caregivers’ responses to the Zarit Caregiver Burden Interview. This assessment includes 22 questions assessing the caregivers’ current emotional state in order to examine the impact of the patient’s condition on

caregiver wellbeing. The score ranges from 0 (no burden) to 88 (severe burden). Other objective assessments completed with ECT patients are BDI (Beck Depression Inventory), BDI Suicide, Sheehan Disability Scale, ECCA (Electrocompulsive Cognitive Assessment), GAD-7 (Generalized Anxiety Disorder Scale), and CGI (Clinical Global Impression). The purpose of this chart review is to investigate whether the higher severity of depression in patients correlates with higher levels of caregiver burden and whether the pandemic contributed to caregiver burden.

The Zarit Caregiver Burden Interview has been administered on twelve caregivers (n=12; 6 male and 6 female), all providing care for patients currently undergoing ECT for depressive symptoms. Out of the twelve caregivers, 66.6% reported little caregiver burden, 16.6% reported mild to moderate burden, and 16.6% reported moderate to severe burden. Additional patients are being interviewed in the ECT suite and further data collected will be presented at the 2021 IPA Virtual International Congress.

As the world adjusts to life in the COVID-19 era, caregivers face new challenges in providing care for vulnerable, at-risk populations. Caregivers of patients receiving ECT facilitate frequent COVID testing and limited visitation policies while continuing to provide care and emotional support to patients with advanced age and a mental illness. Administrating the Zarit Caregiver Burden Interview can help providers look at the degree of burden in caregivers of patients receiving ECT for depressive symptoms and provide better caregiving strategies during and post pandemic.

Dementia with Lewy bodies (DLB) is the second most common form of degenerative dementia after Alzheimer’s disease. In some patients with DLB, relatively rare delusions are known to emerge, such as Othello syndrome, delusional parasitosis and delusion of duplication. Erotomania, also known as de Clerambault’s syndrome, is characterized by the delusion that a person has fallen in love with the patient. It occasionally appears secondary to psychiatric disorders and organic brain diseases. However, there have been no reports on cases secondary to patients with DLB.

The patient was an 83-year-old woman who lived alone. Mild cognitive impairment appeared at the age of 82 years. Soon after, she had the delusional conviction that her family doctor was in love with her. Her symptoms, such as gradually progressive cognitive impairment, cognitive fluctuations, and parkinsonism, indicated DLB. Although small doses of quetiapine, brexpiprazole and risperidone were prescribed for the treatment of the delusion, each of them was discontinued soon because of the adverse reactions. Finally, the delusion was successfully treated with a small dose of blonanserin without sever side effects.

This case report suggests the possibility of de Clerambault’s syndrome during the early stages of DLB. Recently, psychiatric-onset DLB has increasingly gained attention in recent years. Further accumulation of knowledge about delusions in patients with DLB for an early diagnosis.

Older patients with dementia and/or delirium often have challenging behaviours such as refusal of care and aggression. These cause much distress to both healthcare staff and patients, increase burden of care and put older patients at risk of functional decline. Humanitude, a methodology of care developed by Gineste and Marescotti, is a relationship- centred and compassionate care approach that aims to enable patients. The aim of this study is to investigate the effectiveness of Humanitude on older patients’ well-being, mobility and activities of daily living (ADLs).

Quasi-experimental, non-equivalent controlled trial design.

Acute care hospital

Twenty patients diagnosed with dementia and/ or delirium were recruited from two geriatric wards. Ten were in the Humanitude ward and the other ten in a conventional ward received usual care for older patients served as concurrent controls.

Patients in Humanitude ward received Humanitude care by trained healthcare workers during day-to-day care, which is based on the 4 pillars of gaze, speech, touch and verticality (maintaining an upright position). Every patient encounter utilizing Humanitude techniques follow a structured care sequence that helps draw the patient into the care relationship.

The outcome measures include Modified Perme ICU Mobility Score, Bradford Well- being Profile and Modified Barthel Index (MBI).

There was significant improvement of median score within the Humanitude group from admission to discharge in mobility (admission: 9.0 [0-27] vs discharge 19.5 [1-36], p=0.002**), MBI (admission: 20 [0.0-46] vs discharge: 54.3 [3-81], p = 0.002**) and well-being (admission: 7.0 [1-15] vs discharge 20.0 [8-26], p=0.002**). The median increase in the score of Humanitude group was also significantly higher than usual care group in mobility (Humanitude: 8 [1-24] vs usual care 0 [-9-16], p= 0.02*), MBI (Humanitude: 17.5 [3-64] vs usual care 0 [-3-17], p= <0.001***), and well-being (Humanitude: 11 [6-20] vs usual care 0 [-5-4], p= <0.001 ***).

Humanitude care improves outcomes in mobility, ADL function and well-being for patients with dementia and/ or delirium in the acute hospital.

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Long term care organisations in the Netherlands organize day time activities for people with dementia who receive care at home to prevent burden of informal caregivers. Clients with dementia that are characterised as highly educated and/or highly intelligent often refuse to participate in such activities. Boredom, a lack of association with and unwillingness to mix with other participants are often reported. In 2006, the spiritual counselling department of long term care organisation Respect, The Hague, started with Studiegroepen (pronounced ‘studee-groo-pen’, study groups). This initiative provides adjusted leisure activities and group conversations about present-day topics and shared life experiences.

Existential philosophical themes form the basis for discussions. Although Studiegroepen seems very successful and there are long waiting lists, the program is barely studied and is unknown in other organisations.

(1) to explore the opinions of the participants, their informal caregivers (mainly partners), and spiritual counsellors about Studiegroepen and the way the program meets the participants needs for autonomy, competence and relatedness (Self Determination Theory); (2) for the development of implementation material for other organisations, the aim was to reveal specific components of the program and to explore their barriers and facilitators.

A thematic analysis in Atlas.ti of semi-structured interviews with 15 clients, eight informal caregivers and four spiritual counsellors revealed extremely positive evaluations. There were strong indications that the program meets clients’ needs for autonomy, competence and relatedness. A striking example of a positive evaluation was a cancellation of relocation of a client-partner couple due to the lack of Studiegroepen in that city. Results suggest positive effects on mood, and quality of life. Several informal caregivers perceived a delay in dementia progression. The research revealed specific program components and barriers and facilitators to implement them.

Studiegroepen is a very positively evaluated initiative for highly educated and/or highly intelligent long time care clients with dementia living at home. This initiative should be systematically studied and described, while implementation material needs to be developed. This may help to introduce the program in other organisations and to further explore effects on outcomes in participants, and in informal caregivers.