DEMENTIA RISK ASSESSMENT AND RISK REDUCTION USING CARDIOVASCULAR RISK FACTORS

Given the poor efficacy of disease modifying treatments and evidence that Alzheimer’s Disease (AD) pathophysiology begins in middle-age, efforts to reduce the substantial disease burden have shifted towards preventative intervention in midlife. Up to a third of all AD(the commonest cause of dementia) is attributable to modifiable cardiovascular risk factors. A tool for predicting risk of future dementia using only cardiovascular risk factors has been validated and the effect of lifestyle modification on future cognitive decline is under investigation. In the UK, the QRISK3 risk calculator is used to quantify 10-year risk of cardiovascular disease. Lifestyle changes and lipid modifying therapy are recommended to patients based on their risk score. We will compare the emerging evidence for dementia risk assessment and risk reduction using cardiovascular risk factors with the evidence used to support the implementation of QRISK3 for cardiovascular disease risk assessment and intervention. This will guide future research to determine whether cardiovascular risk assessment can also be used to inform patients of risk of future dementia and advise on risk reduction strategies, in a primary care setting

CHARITY, HOSPITALITY, AND THE HUMAN PERSON

We believe that in order to properly interpret all aspects of human scientific enquiry in terms of its impact on human beings it is necessary to have an adequate all encompassing model of the human person. We began this presentation by discussing the differences between the \u27Cartesian\u27 Dualistic model of the human Person and that of Aquinas and Augustine (which depend on Aristotle and Plato respectively). While the \u27Cartesian\u27 describes a completely separate \u27soul\u27 or \u27mind\u27 from the physical body, the Thomistic model of the Human Person is that of an Embodied Spirit, in which every aspect of the human spirit is reflected in an aspect or function of the physical body. We argued that the \u27Cartesian view\u27, in the modern age of \u27Evidence Based Science\u27 is inadequate, because the absence of evidence of a separate Mind allows the existence if this to be challenged by the application of \u27Ockham’s Razor\u27, whereas the Thomistic or Augustinian view need not be so challenged, since every aspect of the human spirit is reflected in an aspect or function of the physical body. Thus we argued that the \u27embodied spirit\u27 model of the Human Person can be an appropriate model in understanding the relationship of modern neuroscience to the reality of the human person. We were able to observe numerous examples from Neuroscience, at the level of organs, neural systems and also at the molecular level in which a dualistic model was inadequate to explain experimental observations. We then related these ideas to the idea of Empathy, the neural system for which appears to be the same as the system for establishing a sense of self for the person. We argued that therefore since the Concept of Charity, that is caring for others, related to the concept of Empathy, then the same neural system existed to promote Charity, as a function of the Human Person. We used anthropological data on the confraternities of \u27Our Lady of Charity\u27 to describe how humans had, since Roman Times at least given expression to thin imperative for Charity , and took this further to show how paintings of the Roman story see Pero, who secretly breastfeeds her father, Cimon, after he is incarcerated and sentenced to death by starvation, expresses the need for Charity as a \u27giving of self\u27 to others which can be explained by the embedded of the neural network for empathy in the human brain, closely linked with the sense of self. Finally, we moved to hospitality, most easily expressed among humans by the sharing of a meal. We showed the Confraternities of \u27Our Lady of Charity\u27 used paintings of the feast of the Marriage of Cana to express hospitality and their charitable work. We took the metaphor of sharing a meal further, and suggested that in paintings of the Trinity by Andrei Rublëv and the Supper of Emmeus by Caravaggio expressed that hospitality, as in sharing a meal, can link the human person to the Transendent ... perhaps through the mediation of the Neural system which expresses both sense of self and empathy. We concluded that \u27In the consultation we should treat people as embodied spirits\u27, and that \u27Treating people as an embodied spirit - demands charity, in which we give of our own embodied spirit\u27

DEMENTIA RISK ASSESSMENT AND RISK REDUCTION USING CARDIOVASCULAR RISK FACTORS

Given the poor efficacy of disease modifying treatments and evidence that Alzheimer’s Disease (AD) pathophysiology begins in middle-age, efforts to reduce the substantial disease burden have shifted towards preventative intervention in midlife. Up to a third of all AD(the commonest cause of dementia) is attributable to modifiable cardiovascular risk factors. A tool for predicting risk of future dementia using only cardiovascular risk factors has been validated and the effect of lifestyle modification on future cognitive decline is under investigation. In the UK, the QRISK3 risk calculator is used to quantify 10-year risk of cardiovascular disease. Lifestyle changes and lipid modifying therapy are recommended to patients based on their risk score. We will compare the emerging evidence for dementia risk assessment and risk reduction using cardiovascular risk factors with the evidence used to support the implementation of QRISK3 for cardiovascular disease risk assessment and intervention. This will guide future research to determine whether cardiovascular risk assessment can also be used to inform patients of risk of future dementia and advise on risk reduction strategies, in a primary care setting

A REVIEW OF THE EPIDEMIOLOGY OF MAJOR DEPRESSIVE DISORDER AND OF ITS CONSEQUENCES FOR SOCIETY AND THE INDIVIDUAL

Depression is a common and debilitating disease that affects people from adolescence to old age. The impact of depression extends beyond the individual with depressive symptoms. Depression adversely affects the mental and physical health, and the social and financial welfare of the individual and society. We will address how factors including sex, age, ethnicity and societal changes affect the prevalence of depression, consider common co-morbid conditions and highlight the lessons learned from treating depression

Teacher-assistant partnerships in special schools in Ireland and N.Ireland

To investigate the nature of teacher-assistant partnerships in special schools from the perspective of the assistant

Do palliative care patients and relatives think it would be acceptable to use Bispectral index (BIS) technology to monitor palliative care patients' levels of consciousness? A qualitative exploration with interviews and focus groups for the I-CAN-CARE research programme

BACKGROUND: Bispectral index (BIS) monitoring uses electroencephalographic data as an indicator of patients' consciousness level. This technology might be a useful adjunct to clinical observation when titrating sedative medications for palliative care patients. However, the use of BIS in palliative care generally, and in the UK in particular, is under-researched. A key area is this technology's acceptability for palliative care service users. Ahead of trialling BIS in practice, and in order to ascertain whether such a trial would be reasonable, we conducted a study to explore UK palliative care patients' and relatives' perceptions of the technology, including whether they thought its use in palliative care practice would be acceptable. METHODS: A qualitative exploration was undertaken. Participants were recruited through a UK hospice. Focus groups and semi-structured interviews were conducted with separate groups of palliative care patients, relatives of current patients, and bereaved relatives. We explored their views on acceptability of using BIS with palliative care patients, and analysed their responses following the five key stages of the Framework method. RESULTS: We recruited 25 participants. There were ten current hospice patients in three focus groups, four relatives of current patients in one focus group and one individual interview, and eleven bereaved relatives in three focus groups and two individual interviews. Our study participants considered BIS acceptable for monitoring palliative care patients' consciousness levels, and that it might be of use in end-of-life care, provided that it was additional to (rather than a replacement of) usual care, and patients and/or family members were involved in decisions about its use. Participants also noted that BIS, while possibly obtrusive, is not invasive, with some seeing it as equivalent to wearable technological devices such as activity watches. CONCLUSIONS: Participants considered BIS technology might be of benefit to palliative care as a non-intrusive means of assisting clinical assessment and decision-making at the end of life, and concluded that it would therefore be acceptable to trial the technology with patients

Management of Fracture Risk in Patients with Chronic Obstructive Pulmonary Disease (COPD): Building a UK Consensus Through Healthcare Professional and Patient Engagement

Introduction: Osteoporosis and bone fractures are common in chronic obstructive pulmonary disease (COPD) and contribute significantly to morbidity and mortality. Current national guidance on COPD management recommends addressing bone health in patients, however, does not detail how. This consensus outlines key elements of a structured approach to managing bone health and fracture risk in patients with COPD.Methods: A systematic approach incorporating multifaceted methodologies included detailed patient and healthcare professional (HCP) surveys followed by a roundtable meeting to reach a consensus on what a pathway would look like.Results: The surveys revealed that fracture risk was not always assessed despite being recognised as an important aspect of COPD management by HCPs. The majority of the patients also stated they would be receptive to discussing treatment options if found to be at risk of osteoporotic fractures. Limited time and resource allocation were identified as barriers to addressing bone health during consultations. The consensus from the roundtable meeting was that a proactive systematic approach to assessing bone health should be adopted. This should involve using fracture risk assessment tools to identify individuals at risk, investigating secondary causes of osteoporosis if a diagnosis is made and reinforcing non-pharmacological and preventative measures such as smoking cessation, keeping active and pharmacological management of osteoporosis and medicines management of corticosteroid use. Practically, prioritising patients with important additional risk factors, such as previous fragility fractures, older age and long-term oral corticosteroid use for an assessment, was felt required.Conclusion: There is a need for integrating fracture risk assessment into the COPD pathway. Developing a systematic and holistic approach to addressing bone health is key to achieving this. In tandem, opportunities to disseminate the information and educational resources are also required

Neuronal surface autoantibodies in dementia: a systematic review and meta-analysis.

Funder: UCLH Biomedical Research Centre; doi: http://dx.doi.org/10.13039/501100012317Funder: National Institute for Health Research; doi: http://dx.doi.org/10.13039/501100000272INTRODUCTION: Neuronal antibodies can cause encephalopathy syndromes often presenting with subacute cognitive impairment, sometimes resembling neurodegenerative dementias. METHODS: We searched Medline and Embase for studies reporting associations between neuronal surface antibodies in all-cause dementia versus controls. Random-effects meta-analysis was used to pool adjusted estimates across studies. RESULTS: Six studies were included, all reporting frequency of serum NMDAR antibodies in dementia with four also reporting frequency in atypical dementias. Both IgG [OR = 8.09 (1.51; 56.85), p = 0.036] and IgA/IgM NMDAR antibodies [OR = 42.48 (11.39; 158.52), p < 0.001] were associated with atypical dementia, but neither were associated with all-cause dementia. DISCUSSION: In the first meta-analysis to explore this literature, serum IgG and IgA/IgM NMDAR antibodies were significantly more common in atypical dementias. However, methodological issues and small-sample sizes necessitate caution interpreting this result. Further studies measuring both serum and CSF antibodies are needed to investigate the role of neuronal antibodies in dementia, since evidence of pathogenicity in even a subset of patients could pave the way for novel treatment options