Andrea Fabbo

This qualitative study explored the experiences of caregivers of people with dementia who received home-based occupational therapy from the Modena Memory Clinic. Five participants were interviewed through semi-structured conversations analyzed using thematic analysis. Results identified three main mechanisms underlying the effectiveness of the intervention: education, empowerment, and collaboration. Therapist-tailored interventions helped caregivers recognize remaining abilities, improve problem-solving, and enhance daily care strategies. The home environment supported comfort and engagement, while collaboration with professionals strengthened continuity of care. These findings highlight occupational therapy as a key component of community-based and person-centered dementia care.

Background: The Dementia Attitude Scale (DAS) is a validated instrument used to capture the affective, behavioural, and cognitive components of attitudes toward people living with dementia (PLwD). This study conducts confirmatory and exploratory factor analyses (CFA and EFA) of the DAS assessed by caregivers of PLwD and BPSD enrolled in the RECage multicentre clinical trial. Methods: The baseline questionnaire was completed by 485 caregivers (29.7% male, 70.3% female), from six European countries, reflecting diverse cultural contexts. CFA tested the two-factor structure of the original model, while EFA thoroughly explored the factor structure. Results: The CFA results showed a poor model fit, with significant deviations from ideal values for RMSEA (0.0861), SRMSR (0.0781), and CFI (0.7117), showcasing an inadequate representation of the data. EFA revealed a three-factor structure, explaining the 45.2% variance for social comfort, 28.8% for social discomfort, and 25.9% for dementia knowledge. The social comfort items reflected positive caregiver attitudes toward PLwD, while social discomfort captured feelings of discomfort and uncertainty about caregiving. Dementia knowledge included items related to understanding dementia’s symptoms and needs. Conclusions: The three-factor model highlights the importance of emotional comfort, knowledge of dementia, and social discomfort as key dimensions in caregiver attitudes.

Background: Social restrictions and closures of services due to COVID‐19 pandemic had a negative impact on the social inclusion and well‐being of older people. In fact, older adults present risk factors both in terms of health ‐ such as frailty or multimorbidity ‐ and in terms of quality of life ‐ for example institutionalization ‐ and poor social support. The main objective is to evaluate whether social support had the role of an effect modifier on the incidence of cognitive frailty. Material: single‐center, cohort study, based on retrospective data collected during the emergency phase of the COVID‐19 pandemic and on a re‐evaluation performed in the post‐emergency phase. To evaluate social support, Cohen’s Social Support Scale (CSSS) was used, whose higher scores identify subjects with a low level of social support. To screen for cognitive impairment, the Mini Mental State Assessment (MMSE) was used, with an adjusted score of 26 ore less indicative of cognitive impairment. Frailty was assessed through a frailty index and cognitive frailty was defined as the co‐occurence of both cognitive impairment and physical frailty.Methods: patients belonging to the frailty clinic of the Modena AUSL with a first evaluation carried out between October 2020 and June 2021 and with data relating to social support are re‐evaluated between october and December 2023.Results: 105 participants were enrolled. 68 (64.7%) were found to be frail at baseline. There was no statistically significant difference in mean CSSS between non‐frail and frail patients (8.7 ± 2.1 vs. 9.3 ± 2.2, p = 0.173). At December 2023, 50 patients were reevaluated. During follow‐up, 25 out of 37 patients developed cognitive frailty. The OR of cognitive frailty was higher when basal Cohen’s social support scale was higher (1.91, 95% CI 1.08‐3.25). Discussion: the impact of the pandemic, in terms of reduced social support should be assessed in the transition phase between the emergency and post‐emergency phaseConclusions: investments should be made to implement psychosocial support interventions to reduce further incidence of cognitive frailty among older adults

Background: Mild cognitive impairment (MCI) is a condition in which individuals shows overt cognitive impairment with minimal impairment of instrumental activities of daily living (IADLs). Individuals with MCI have a 10‐fold increased risk of developing dementia as compared to cognitively normal individuals. Several factors are involved into progression from MCI to dementia and sarcopenia is one of them. Hence, physical exertion is an appropriate treatment for people with MCI. But older adults should integrate physical activity with a nutritional programme. The aim of our project is to evaluate the effect of physical training alone and combined physical training and dietary intervention on MCI progression towards AD.Method: open‐label single centre trial. It compares two cohorts of patient with MCI during a follow‐up period of 2 years: 200 participants are divided in two cohorts (50 intervention group, 150 control group, 1:3 ratio). Inclusion criteria are being > = 65 years old with a diagnosis of MCI made upt to 6 months before the enrolment. Exclusion criteria are Tinetti Scale score of > = 24, Clinical Frailty Scale (CFS) < = 5 and concomitant psychiatric disorders or chronic alcoholism. For each participant in the control group, a twice a week plan of up to 40 minutes of aerobic exertion is conducted by a technician with a degree in sports science belonging to the UOC Medicina dello Sport of AUSL Modena Physical activity programme lasts two months and is scheduled at month 4, and then rescheduled at month 10, month 16 and month 21. In addition to the same twice‐a‐week physical activity exertion plan scheduled for the control group, a supplementation of essential amino acids pharmacological preparation, according to WHO daily ratio is furnished for participants in the intervention group. The main endpoint is to evaluate the efficacy, in terms of incidence rate ratio of developing an overt AD over a 24‐months period.Result: currently, the project has been approved by the ethic committe (AOU 0026789/22)) and the enrolment is ongoing.Conclusion: this study will provide more evidence about the efficacy and the feasibility of integrated physical exertion and nutrition programme in MCI population.

Background: People with dementia (PwD) require high levels of care, most of which is provided by either family or informal caregivers. Psychosocial interventions have been demonstrated to reduce caregiver burden and delay nursing home admission. Telemedicine could provide caregivers access to such interventions, increasing their sense of competence and resilience.Method: Through a co‐design process involving geriatricians, psychologists, neurologists, nurses, occupational therapists and 25 dyads, a telerehabilitation program has been developed and tested through a 12‐months Beta Test protocol. The program comprises a multidimensional clinical assessment and a telerehabilitation plan. Whilst occupational therapists act as care manager interface towards caregivers through a telemedicine platform, a multidisciplinary team including nurses, psychologists and geriatricians, regularly oversees each plan and delivers interventions whenever required.Results: Almost all caregivers were spouses or children (22 out of 25). 79% were female and 59% lived with the care recipient in the same household. The average age of caregivers was 63,72 and Zarit index 36,88. On average PwD’s age was 83,75, Barthel Index 61,27, IADL 0,97, NPI Index 24,86 with 4,8 BPSD. The program has required on average 18,8 sessions per caregiver: which comprised of 4,5 sessions for multidimensional evaluation of both PwD and caregiver, 9,1 sessions for the execution of the telerehabilitation plan and 5,2 sessions for follow up. Sessions could range from 45 minutes (clinical scales‐based assessment) to 10 minutes (follow up). 48% of telerehabilitation sessions addressed BPSD, 17% provided emotional support, 14% supported caregivers in ADL activities, 11% addressed comorbidities and 10% addressed other issues (communication and cognition). A self‐developed caregivers' reported outcome questionnaire (24 responders out of 25) reported that 88% of caregivers improved their health literacy, 87% their sense of competence and 97% felt emotionally supported. After at least 6 months, a follow up analysis on 13 PwD and 10 family caregivers, NPI Index has improved on average by 41% while Zarit Index by 16%. Average yearly cost of the program reached 2 euro per day per dyad.Conclusions: The beta test showed encouraging outcomes in terms of caregivers’ satisfaction that require further investigation in terms of clinical outcomes and cost‐effectiveness.

Background: One of the most widely used instruments for assessing agitation in dementia patients is the Cohen-Mansfield Agitation Inventory (CMAI), nevertheless no global score has been proposed. The aim of this study is: (a) to conduct a confirmatory (CFA) and exploratory factor analysis (EFA) of CMAI on people with dementia and Psychological and Behavioral Symptoms (BPSD), and (b) to propose an alternative structure, based on clinical criteria including all CMAI items. Methods: Confirmatory and exploratory factor analyses were carried out on the CMAI 29 items administered at baseline to 505 patients with dementia (PwD) and BPSD enrolled in the international observational RECage study. Results: The three-factor structure has not been confirmed by the CFA, whilst the EFA was carried out respectively on 25 items disregarding 4 items with a prevalence ≤5% and then on 20 items disregarding 9 items with a prevalence ≤10%. The four-factor structure explaining 56% of the variance comprised Physically Aggressive behavior, Verbally Aggressive behavior, Physically non-aggressive behavior, and Physically and verbally aggressive behavior. Conclusions: A new grouping of all items according to a clinical criterion is proposed, allowing for a more sensible evaluation of the symptoms leading to better differentiation.

Background: The “Cogs Club” is a multi‐modal intervention based on the Cognitive Stimulation Therapy (CST, Spector A.).CST is cost‐effective for people with mild‐to‐moderate dementia and is recommended in the UK by NICE. CST, in our adaptative model, is related to other psycho‐social activities (OT, music, physical activity). Cogs Club changes a traditional session of about an hour into 4 hours of activities.Objectives: the aim of this study is to verify the efficacy of this muldimodal psychosocial interventionMethod: the project is promoted by the local Alzhemer’s associations situated in Modena (Italy) and conducted by 3 professionals (a psychologist, an OT and a fisioterapist) who provide scheduled interventions ad : cognitive stimulation therapy (CST), occupational therapy and physical activities with music. Partecipants who took part in the study (n° 26 people with mild‐ moderate Alzheimer’s dementia, M9: F17, mean age 78.23 ±5.11 years, education: 7.2 ± 3.86 years) were submitted at T0 (basal evaluation) and T1 (after 3 months) to an assessment composed by ACE‐R, GDS‐15, DAD, QoL‐AD and ZBI. People with sensorial deficit, motor or behaviour disorder was excluded.Result: at T1 all indicators (cognitive: MMSE 22,6 vs 23,4, p 0,096; ACE – R 63,54 vs 65,96 p 0,066; functional: DAD 0,68 vs 0,69, p 0,103; emotional‐affective : GDS 5,35 vs 4,12 p 0,039 and quality of life : QoL AD pz 31,5 vs 33,38, p 0.129; Qol AD cg: 29,04 vs 30,96, p 0,459) of the PWD have improved even if only the depression is of clinical relevance. Regarding the caregiver we found an improvement in their quality of life even with an increase in perceived care stress (Zarit 34,09 vs 36,65, p 0,098).Conclusion: the purpose of the project is also to create a context for the socialisation and a net of formal and informal connection to people with mild‐ moderate dementia who traditionally don’t ask to access health services. The main goal is to delay as much as possible the development of the disability but further studies are necessary to encourage this preliminary results.