bluuebunny/crossref_metadata_2025_split huggingface dataset:
2248 Clinical relevance of Donanemab treatment
Authors: Atri A , Wessels A , Doty E , Atkins A , Chandler J , Lu M , Ye W , Dennehy E , Brooks D , Sims J , Brookfield (Non-author Presenter) N 
Published: August 2024

Abstract

Objective
To assess in Alzheimer’s disease (ad), the treatment impact of donanemab, an amyloid plaque-reducing monoclonal antibody, on readily interpretable item-measures and constructs that matter to patients, care-partners, and clinicians.

Background
Positive outcomes were reported from TRAILBLAZER-ALZ2, a randomised, double-blind, placebo-controlled, 18-month, phase 3 study evaluating donanemab as an investigational treatment for mild cognitive impairment (MCI) or mild dementia due to ad. In 1736 participants, donanemab significantly slowed the rate of clinical decline (by 22–36%) as measured by the integrated ad Rating Scale (iADRS) and the Clinical Dementia Rating Scale—Sum-of-Boxes (CDR-SB); both measures of cognition and function as indications of global clinical severity. In these subsequent post-hoc exploratory analyses, the impact of donanemab treatment on individual iADRS cognition and function items, CDR domains, and risks of advancing to greater disease severity were assessed.

Methods
Mixed model repeated measures and Cox proportional hazard modelling methodology assessed treatment effects on iADRS items and CDR domains.

Results
Donanemab treatment was associated with significant beneficial effects on: 1) iADRS cognitive items related to episodic memory and executive function, and instrumental activities of daily living items related to communication and others (e.g. being left alone, making a meal, using household appliances); 2) all CDR-SB cognitive and functional domains (i.e. memory, orientation, judgement/problem solving, community affairs, home/hobbies, and personal care); and 3) lowering risk of progression to a more advanced clinical stage of disease.

Conclusions
These analyses explored the impact of donanemab treatment on constructs that matter to and are considered more readily interpretable by patients, care-partners, and clinicians. These results provide further support that treating those with MCI or mild dementia due to ad with donanemab can meaningfully reduce risk of progression to more severe clinical stages (e.g. moderate stage dementia), and potentially allow greater independence for a longer period of time.
2324 Feasibility of screening for frailty, sarcopenia and nutritional status in elective surgery for colorectal cancer
Authors: Humphry N , Wilson T , Bye K , Draper J , Hewitt J 
Published: August 2024

Abstract

Introduction
Preoperative frailty is a key determinant of post-surgical outcomes and often co-exists with sarcopenia and malnutrition. Older patients account for a significant proportion of patients undergoing surgery for colorectal cancer and are therefore more likely to be affected by these risk factors.

Methods
Patients aged 65 and over undergoing planned surgery for colorectal cancer were recruited across five sites. Participants were screened preoperatively using the Clinical Frailty Scale (CFS) and Groningen Frailty Indicator (GFI). Nutritional status was assessed using the short form mini nutritional assessment (MNA-SF) and participant collection of spot urine samples to objectively measure habitual dietary intake. Sarcopenia was assessed through grip strength, gait speed and psoas muscle measurement using preoperative CT imaging. The non-radiological screening measures were repeated eight-weeks postoperatively, with additional urine samples collected in the first and fourth weeks.

Results
Forty-three participants (mean age 76 years, 60% male) were recruited, of which 32% were frail. Using the mini-nutritional assessment 42% of participants were identified as at risk of malnutrition and 9% as malnourished. Urine assessment of habitual dietary intake is ongoing. There was a high prevalence of sarcopenia - 67% determined by hand grip strength and 42% by CT analysis. Mean length of stay following surgery was 6.9 days. 28% of participants were unable to complete the in-person post-operative follow up due to ill health, poor appetite and exhaustion.

Conclusions
This ongoing study has demonstrated the feasibility of incorporating frailty, nutritional status and sarcopenia screening alongside routine clinical care, in older adults undergoing surgery. However, retaining participants in observational studies during postoperative periods of convalescence, or whilst undergoing adjuvant treatment, is challenging. This study has also highlighted the potential of home urine sampling as a viable method of dietary assessment within community settings to aid malnutrition screening.
2327 Delirium predicts poor outcomes in Parkinson's disease
Authors: Gerakios F , Yarnall AJ , Bate G , Wright L , Davis D , Stephan BCM , Robinson L , Brayne C , Stebbins G , Taylor JP , Burn DJ , Allan LM , Richardson SJ , Lawson RA 
Published: August 2024

Abstract

Introduction
Reported delirium prevalence in inpatients with Parkinson’s disease (PD) varies widely across the literature and is often underreported. Delirium is associated with an increased risk of institutionalisation, dementia, and mortality, but to date there are no comprehensive prospective studies in PD. We aimed to determine delirium prevalence in PD compared to older adults and its associated risk with adverse outcomes.

Method
Participants from the ‘Defining Delirium and its Impact in Parkinson’s Disease’ (DELIRIUM-PD) and the ‘Delirium and Cognitive Impact in Dementia’ (DECIDE) studies were included. People with PD (DELIRIUM-PD) or older adults from the Cognitive Function and Ageing Study II – Newcastle cohort (DECIDE) admitted to hospitals in Newcastle were approached to take part. Delirium was assessed prospectively using the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition criteria. Outcomes were determined by medical note reviews and home visits 12 months post discharge. Cox regression or binary logistic regression were used to evaluate the effect of delirium on institutionalisation, dementia, and mortality, independent of covariates.

Results
Delirium developed in 66.9% (n = 81/121) of PD participants compared to 38.7% (n = 77/199) of controls (p &lt; 0.001). Delirium was associated with a significant increased risk of developing dementia in one year in PD (OR = 6.1 (1.3–29.5), p = 0.024) and in controls (OR = 13.4 (2.5–72.6), p = 0.003). However, in only PD participants, delirium was associated with a significantly higher risk of institutionalisation (OR = 10.7 (2.1–54.6), 0.004) and mortality (HR = 3.3 [95% CI 1.3–8.6], p = 0.014).

Conclusion
This is the first comprehensive prospective study of delirium in PD, showing that over two-thirds develop delirium during hospitalisation compared to a third of older adults. Delirium in PD is associated with a significant risk of dementia, institutionalisation, and death in one year. Furthermore, this is the first study to show that PD increases the risk of mortality and institutionalisation over and above a delirium in older adults.
2332 Feasibility and utility of introducing handgrip strength measurement for outpatients living with Parkinson's disease
Authors: Barnard A , Wilkinson I , Eleftheriades C , Bandyopadhyay S , Philip S 
Published: August 2024

Abstract

Background
Patients living with Parkinson’s disease (PD) who are sarcopenic are at significantly higher risk of falling (Cai et al., Frontiers in Neurology,2021,12,598,035). Handgrip strength is a useful tool to assess for sarcopenia but is not commonly measured in clinical practice, despite the consequences that sarcopenia poses. This study aims to incorporate handgrip strength into the assessment of outpatients living with PD. Secondary objectives are to increase the understanding of whether exercise is associated with increased handgrip strength and to implement interventions for patients who are identified as sarcopenic; to improve their health outcomes.

Methods
Questionnaires were designed to gather quantitative data about patients’ demographics, how frequently they fall, disease severity and their weekly exercise. These were given to patients attending the movement disorders clinic at Crawley hospital, between February and October 2023. Patients without a diagnosis of PD were excluded. Their grip strength was measured using a standardised technique with a calibrated manometer. Data was input to Microsoft Excel and analysed using Spearman’s rank and Kruskal-Wallis test.

Results
Handgrip strength was obtained for 125 of 271 patients (46%) attending clinic over this period. Initially healthcare workers took 9.2 minutes to complete the questionnaire, but this improved to 4.3 minutes after updating the form. Sixteen patients were excluded, leaving 51 females and 58 males; both with a mean age of 80. Grip strength reduced with PD severity when adjusted for gender; this was significant in males (H = 51.9, p = 0.00) but not females (H = 4.8,p = 0.31). Grip strength was weakly correlated with exercise, although not significant (r2 = 0.15,p = 0.15) but did not appear to be related to frequency of falls (r2 = 0.01,p = 0.92).

Conclusions
Handgrip measurement can be successfully implemented into outpatient assessment. Handgrip strength could be used to monitor the effect of lifestyle change in individuals. Limitations include self-reporting bias; which activities each individual classifies as exercise.
2247 Clinical pharmacists working in primary care supporting people living with dementia: a UK survey
Authors: Vickerstaff V , Burnand A , Woodward A , Melo L , Manthorpe J , Jani Y , Orlu M , Bhanu C , Samsi K , Wilcock J , Rait G , Davies N 
Published: August 2024

Abstract

Background
Clinical pharmacists are increasingly working as part of primary care teams in UK. Many people living with dementia live at home with the support of primary care. Given the complexity of their health problems and their use of several medications, clinical pharmacists may potentially play a crucial role in their support.

Aims
To explore clinical pharmacists’ experiences of working in primary care with people living with dementia and identify any specific training needs to provide effective support for this patient group.

Methods
An online survey sent via email in 2023 through professional organisations, social media, and utilising research team contacts. The survey covered topics including clinical pharmacists’ background, experience of working with people with dementia, and training needs.

Results
57 clinical pharmacists responded to the survey; the mean time working as a clinical pharmacist was 9.6 years (standard deviation 8.6) and within a primary care setting was 6.1 years (standard deviation 6.1). Just over three-quarters of respondents (n = 31, 77%) work with people living with dementia. While almost two thirds (n = 35, 61%) had undertaken training for dementia care, such training often lasted a few hours (less than a day) (n = 17, 49%). Most respondents (n = 39, 89%) wanted further information or training; including non-pharmacological interventions to improve quality of life in dementia and how to support carers and relatives. Practice challenges reported included a lack of face-to-face consultations and getting assurance that the patient could safely take medications.

Conclusions
These findings indicate an interest in dementia care, a willingness to undertake further training but practice uncertainties that suggest a system approach might be beneficial.
2300 A survey on the underlying knowledge of doctors’ in conducting polypharmacy review and medication optimisation in older adults.
Authors: Weston E , Giridharan K , Waters R 
Published: August 2024

Abstract

Introduction
Polypharmacy is common among older adults and could result in adverse outcomes if not reviewed and optimised regularly (Davies et al, 2020). The aim of this survey is to assess and report on the variation in doctors’ understanding of medication reviews at Maidstone and Tunbridge Wells hospitals (MTW).

Method
A short, anonymised, online questionnaire was circulated to all current doctors at MTW via email and WhatsApp groups.

Results
38 doctors of different grades (Foundation Year One-Consultant) from a variety of medical and surgical specialties responded. Of these, 41% could correctly define appropriate polypharmacy, but only 6% could define problematic polypharmacy. Most respondents (59.5%) had not received any training on structured medication reviews (SMR). 51.4% were not aware of any tools used in medication optimisation. 43% said they ‘always carry out’ medication reviews in clinical practice and 8.3% said that they never do. Less than half (38%) felt confident in completing SMR. The main barriers to routine implementation of SMR identified by the respondents were: lack of confidence (27%), time pressures (26%), senior clinicians not giving importance to SMR (16%), 3% felt it was not the doctor’s responsibility. Most respondents (91.7%) said that they would benefit from further training in SMR.

Conclusions
The results show that there is a wide variation in the respondents’ understanding and practice of medication reviews. Also, that there is a clear and well- founded demand for training. Once training has been formulated and delivered a follow up survey of those attending should be used to help gauge its effectiveness. The small sample size is a limitation of this study affecting its generalisability as is the fact that it was a self-selected group completing the survey.
2336 Prevalence of anticholinergic burden across a cohort of frail older adults in a district general Hospital in South West Wales
Authors: Agarwal A , Marney Z 
Published: August 2024

Abstract

Background and Objectives
Polypharmacy is common in frail older adults who often live with multiple co-morbidities. This polypharmacy can carry a significant anticholinergic burden. Frail older adults are particularly sensitive to the anticholinergic side effects of medications which can include constipation, urinary retention and dry mouth. Medications with a high anticholinergic burden scores have also been evidenced to contribute to an increased frequency of falls, cognitive decline and increased mortality. For frail older adults, a medication review, considering anticholinergic burden, is therefore an essential part of Comprehensive Geriatric Assessment. A local frailty census was completed for all medical inpatients over the age of 65 years old and as part of this anticholinergic burden scores were collated.

Materials and Methods
As part of this whole hospital frailty census, an anticholinergic burden score (ACB) was calculated for 77 inpatients. This was calculated using the Anticholinergic Cognitive Burden Scales and Anticholinergic Burden scores.

Results
The average age of the patients was 80.19 (± 9.35). 80.01% of patients were taking one or more medications with an anticholinergic burden. Of those, 40.25% had a significant ACB score of 3 or more (3–8). The patients with the highest ACB scores were those with multi-morbidity, an already established diagnosis of dementia and patients with recurrent falls.

Conclusions
The ACB score for patients included within this frailty census appeared to correlate with certain co-morbidities as would be expected from the known complications associated with these medications in frail older adults. The proportion of our inpatients with a significant ACB score informs us that we need to develop a more robust approach to delivering polypharmacy reviews as part of Comprehensive Geriatric Assessment within our hospital and will help us to inform future service planning and delivery.
2272 Methodological challenges and strategies in understanding the lived experiences of childless Chinese older couples
Authors: Lee LYK , Tiu MMH , Low LPL , Cheng VS , Yau SY , Akingbade O , Hsu RHC 
Published: August 2024

Abstract

Introduction
With more cases of delayed marriage, voluntary childlessness and infertility among Chinese, childless older couples are anticipated to increase. Although evidence suggests that being childless in Western societies may benefit older couples, older Chinese couples without children are marginalised as no one is available to take care of their physical, psychosocial and financial burdens because children in the Chinese societies are often responsible for caring and supporting older individuals. This ongoing study explores the lived experiences of ageing among childless Chinese older couples. While the research methods are novel in the literature, this study highlights the methodological challenges encountered by the researchers.

Method
This qualitative study adopts the interpretive phenomenological approach with photovoice. Twenty childless older couples are recruited to participate in two face-to-face interviews and submit photos before the second interview. The photos convey contextual details that are challenging to express in words, thereby enhancing the richness of the interview data. Data are analysed using the van Manen’s thematic analysis and Oliffe’s photographic analysis.

Results
Some challenges experienced so far include difficulties in recruiting participants, as certain spouses refuse to participate while their partners choose to do so. Also, certain couples are reluctant to talk about dying as the last stage of their ageing or be interviewed simultaneously. Similarly, certain couples may not know how to take and submit photos. Strategies utilised include providing simple and clear explanations before the interview, allowing some couples to be interviewed separately, assuring confidentiality in data handling, and recruiting those competent in using smartphones.

Conclusion
The methodological challenges and related strategies surrounding recruiting older couples and using photovoice provide valuable implications for future researchers. Acknowledgement The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (UGC/FDS16/M09/23).
2321 Therapeutic use of film screenings for care home residents: a scoping review
Authors: Ali K , Hughes A , Abrams R 
Published: August 2024

Abstract

Introduction
Symptoms of depression and anxiety, with and without dementia, are common in older care home residents. It is postulated that that watching films can help residents to share emotions, enhance social connectedness and engage in reminiscence. As such, films can ameliorate depression and promote well-being. This scoping review summarises the evidence for the therapeutic benefits of film-based interventions in care homes.

Methods
Electronic databases MEDLINE, Embase, EMCare and CINAHL were searched for quantitative and qualitative studies in English including adults aged 65 years and older in years 2005–2023. The search terms were: older adults, dementia, depression, carers, caregivers, care homes, and film.

Results
Five studies met our criteria: Campbell-Sills, 2006, USA; Kim, 2014, Korea; Davison et al., 2016, Australia; Bjornskov et al., 2018, Denmark; and Breckenridge et al., 2020, UK. All subjects were care home residents except for Bjornskov et al., who included 63 institutional caregivers. The number of study participants ranged from 11 to 120. There was a female predominance throughout the studies, and all residents had dementia of varying severity. Study designs included: direct comparison of participants with mood/anxiety disorder versus controls (Campbell-Sills); non-equivalent control group pretest/posttest (Kim); randomised single-blind crossover (Davison); qualitative focus-group caregiver interviews (Bjornskov); and cross-sectional observation (Breckenridge). Observation/follow up periods ranged from 6–10 weeks.

Findings were as follows
Campbell-Sills: residents with mood/anxiety disorders were identified by suppressing negative emotions induced by films; Kim: group reminiscence therapy using cinema increased ego integrity and reduced depression severity; Davison et al: using a personal computer platform that included films resulted in reductions in anxiety, depression and agitation; Bjornskov et al.: caregivers reported that films can evoke reminiscence; Breckenridge et al.: small-group film viewing enhanced social connectivity.

Conclusions
Film screenings for ageing care home residents have the potential for improving mood and encouraging social connections.
2351 Clinical phenotype and epidemiology of delirium-onset dementia with Lewy bodies – a scoping review
Authors: Mancey I , Kane JPM , Sweeney AM 
Published: August 2024

Abstract

Introduction
Dementia with Lewy bodies (DLB) is the second most common form of dementia, however it can be difficult to recognise and is often misdiagnosed. Many cognitive, motor and psychiatric symptoms occur in the prodromal phase of DLB, years before clinical diagnosis. Delirium-onset DLB is one of three purported prodromal pathways by which DLB develops (McKeith et al., 2020). As delirium itself is an under-recognised clinical syndrome, this scoping review aimed to determine the epidemiology and clinical phenotype of delirium-onset DLB.

Methods
Electronic databases MEDLINE (ALL), Embase, Web of Science and PsycINFO were searched in December 2023. Two reviewers then independently screened titles, abstracts and full-text reports. Conflicts were resolved by a third reviewer. Data were then extracted by the lead reviewer and quality assessments were conducted.

Results
Following the removal of duplicates, the search yielded 719 results. Of these, 154 studies underwent full-text review and 38 were eligible for inclusion. This review describes 64 cases of delirium-onset DLB in case studies/reports (n = 18), observational studies (n = 3), retrospective cohort studies (n = 12) and clinicopathological studies (n = 5).

Conclusion
Delirium-onset DLB is an under-researched area. There is a dearth of evidence regarding both the epidemiology and clinical phenotype of this prodromal phase. Clear and systematic methods for the diagnosis of both delirium and DLB are needed to elucidate this pathway. At present, it is not clear what role biomarkers play in the detection of delirium-onset DLB. Further investigation of these tools, combined with neuropathological studies, could shed light on the pathogenesis of this disease.