Welcome to the WCN 2023 Interactive Program

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Pharmacological treatment of Alzheimer’s disease (AD) has been object of increasing research efforts in the last three decades. Given the complexity of AD pathophysiology, investigation of effective and safe treatments is challenging.

Cholinesterase inhibitors and memantine are currently used for symptomatic treatment of dementia due to AD worldwide. Although the overall clinical effects are modest, these drugs may offer significant benefits to some affected people and their caregivers and, in general, have a favorable safety profile. Moreover, besides the short-term cognitive, behavioral and functional effects, recent studies have described positive long-term outcomes of cholinesterase inhibitors, such as reduction of mortality and lower risk of progression to severe dementia, suggesting possible effects over the clinical course of the disease.

In the last years, randomized clinical trials with some anti-amyloid agents have shown significant effects in reducing cognitive and functional decline over 18 months of treatment in individuals with mild cognitive impairment and mild dementia due to AD. After 20 years of negative results of several drugs investigated for AD treatment, these are relevant news. However, the magnitude and the clinical significance of these effects have been subject of great debate within the scientific and clinical community in the last two years. Safety is also an important concern, given the emergence of amyloid-related imaging abnormalities (edema and hemorrhage) in a substantial proportion of treated individuals, particularly those who are APOE ε4 allele carriers.

The presentation will provide a brief and critical review about the role of these drug classes for AD treatment.

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In the last few decades, a plethora of behavioural and neuropsychological approaches have made headway with the aim of supporting function, well-being, and health in people with dementia. WHO, in its Global action plan on the public health response to Dementia 2017-2025, advocates for people with dementia to have access to rehabilitation, and this statement is seconded by national agencies such as NICE in the UK. Yet, people with dementia remain an underserved group in the provision of rehabilitation services. This presentation aims to raise awareness and familiarise the audience with currently available non-pharmacological approaches to treat cognitive and behavioural symptoms of dementia. We will discuss the rationale behind a rehabilitative pathway in dementia care and the available evidence on symptom-specific rehabilitation techniques and multi-component complex interventions. The evidence provided by experimental series and randomised clinical trials will be analysed, addressing aspects relevant to clinical practice: outcome measures, endpoints, the dosage of therapy, generalisation and maintenance of gains, and cost-effectiveness of treatment. Adherence and acceptance of these therapies have also been investigated in the recent literature, as well as barriers and facilitators for clinical implementation. In relation to these facilitators, we will review the role of teletherapy to increase access to rehabilitation for people with dementia by overcoming geographical barriers. This session will conclude with a presentation of clinical cases to illustrate the potential and feasibility of rehabilitation therapies and to encourage further research and broad adoption in clinical practice.

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The Virtual Behavioural Medicine Program (VBM) is unique in the world and functions as a “virtual inpatient behavioural neurology unit” for management of patients with severe neuropsychiatric symptoms of dementia such as agitation and aggression. Through VBM, we have shown a 60% reduction in need for admissions to specialized behavioural units in patients with dementia and neuropsychiatric symptoms. These patients are from long-term-care (LTC), acute care, and the community. The patients are seen virtually and thus are not uprooted from their familiar environment in LTC or the community to be transferred to emergency departments, acute care hospitals, or specialized behavioural units. VBM is a novel virtual neurobehavioural unit for treatment of neuropsychiatric symptoms due to dementia and is a game changer that can reduce preventable emergency department visits and acute care hospital admissions. It is also a scalable model of novel virtual care that can be adopted across the world.