Meeting Report

Highlights of IPA 12^th Congress in Stockholm, Sweden

Whether you came to Stockholm and participated in this highly-rated program or were unable to attend, here are what some of your IPA colleagues reported as of their experiences at the 12^th Congress.

Daniel O’Connor – Australia
Congratulations to Bengt Winblad, John O’Brien and colleagues on a tightly organised meeting packed with new information and thinking on basic science, medical and psychological treatments, clinical practice, service delivery and ethics.

This meeting reflected more than most others the interests of professionals from medical, nursing and allied health disciplines who are committed to the care of anxious, depressed and confused older people. Even symposia devoted to pharmacological treatments took a strict, evidence-based approach for which I and other participants were grateful. This reflective spirit allowed space for consideration of our history, tensions and aspirations.

I was captivated by the address given on behalf of David Bowen, the British neurochemist who reported 30 years ago on the depletion in Alzheimer’s disease of cholinergic and other neurotransmitter systems. This was genuinely new territory. “Senile dementia” hardly figured as a public health concern at that time but Dr Bowen’s painstaking checks and re-checks of observations of brain bank tissue in a primitive laboratory have contributed substantially to the development of modern treatments. He was a worthy recipient of the 2005 IPA Luigi Amaducci Memorial Award.

Another striking award winner was Sweden’s own Queen Silvia who received the IPA Distinguished Service to the Field of Psychogeriatrics in the Congress Host Country Award.  Her mother’s death from Alzheimer’s disease prompted her to found a nursing home for people with dementia to impart first-class skills to doctors, nurses and other professionals. She arrived with little fuss and spoke with impressive brevity and sincerity.

This ethical concern was apparent too in a symposium on palliative care in which Ladislav Volicer of Florida USA condensed his many years of research into medical care to nursing home residents with end-stage dementia. Simple, home-based care is almost always best. Transfer to a general hospital results almost invariably in high-level interventions that fail to reduce mortality and render life a misery. Intravenous antibiotics, PEG feeding tubes and physical restraints can quickly result in neglect, pressure ulcers and worsened confusion. What is the point? The Dutch model of nursing home physicians looks very attractive. These are doctors who choose to work in this demanding environment and gain specialist qualifications. Can we learn more about this please, perhaps in a future edition of the IPA Bulletin?

It was refreshing to find a symposium on psychotherapy, a much neglected topic that will surely grow in strength as more psychologically attuned older people seek to resolve painful personal, marital and family concerns. Given the strength of evidence that major depression responds best to combined medical and psychological attention, psychiatrists and psychologists must boost their skills in this area. Two Canadians, Joel Sadavoy and Molyn Leszcz, led excellent discussions of individual and group psychotherapy respectively. I expect more such sessions in future IPA meetings with the re-vamping of special interest groups in nursing and psychology. Jason Hepple, a British psychiatrist, then spoke perceptively of the pressures that result from working with older people in ageist societies that can lead, if we lack support, to perfectionism, overwork and burnout. We must look after each other!

Frans Verhey – Netherlands
The 12^th Congress of IPA in Stockholm was an exciting and stimulating event for me. The presentations of the young researchers’ IPA awards were a highlight for me, being the proud supervisor of the first and second prize winners, Pauline Aalten and Ivo Aben (see below). I was also deeply impressed by the presentation of Her Majesty, Queen Silvia, and her openness when talking about her own experiences with her mother.

The sessions I was able to attend were very relevant, but especially Dilip Jeste’s lecture on old-age psychosis, Ingalill Hallberg’s talk on end of life caring and Simon Lovestone’s eloquent presentation on new insights into the molecular biology of dementia were highly interesting for me.

Pauline Aalten – Netherlands
Summary and impression of session FC11: Behavioural and Psychological Symptoms in Dementia (BPSD)

The free communications included in this session all discussed issues related to behavioural problems in dementia, but could be divided into presentations regarding the influence of antipsychotics in the treatment of BPSD (2 presentations), the presence of subsyndromes of BPSD (3 presentations), and a mixture of other topics related to BPSD (3 presentations).

The presentations related to antipsychotics concluded the preference to use rispiridone over haloperidol for the treatment of behavioural disturbances of dementia, because of reduced extrapyramidal symptoms and tardive dyskinesia in patients receiving rispiridone. Secondly, it was concluded that both olanzapine and haloperidol decrease agitation and aggression, but there were no differences between the two drugs. Nevertheless, it was concluded that clinicians should be reserved in prescribing antipsychotics because of often reported side-effects.

The next group of presentations all reported epidemiological data regarding BPSD, both in outpatients and institutionalised patients. It was of interest that all studies performed factor analyses to detect behavioural subsyndromes. At the moment there seems to be a high interest into the question whether there exist behavioural subsyndromes in dementia, and whether they are stable across different etiologies, dementia severities etc. The results of the different presentations showed some inconsistencies, adding to further discussion into this topic. Moreover, the main discussion was related to the question whether depression and apathy belong to the same behavioural spectrum, or whether they are separate subsyndromes. No final conclusion could be made.

The last group of presentation discussed several topics, namely, the concept of vascular depression in patients with dementia; the presence of self-injurious behaviour in nursing home patients with dementia; and the efficacy of physical exercise upon sleep disorders in elderly patients.

Inez Ramakers – Netherlands
During the IPA Congress I experienced a pleasant and relaxed atmosphere. The topics of presentations did appeal to me, and it was well organized. Besides the oral presentations there were several interesting posters.  For me it was the first international congress, and it was nice to see the people who are authors of the important articles.

It was nice that there were several sessions about Mild Cognitive Impairment. Because the focus of my PhD project is the course of Mild Cognitive Impairment (MCI), for me the presentations about MCI were most interesting. There was a broad spectrum of topics within MCI.

The session about the DESCRIPA-study was very interesting. The Maastricht University has also been participating in the data collection of this study, and it was interesting to see the results of the total population, consisting of data collected in whole Europe. It was nice to meet researchers of other centers of the DESCRIPA-study and to see what topics of the study they are interested in. Also the debate session about MCI on Wednesday morning was very instructive. It was nice to see the different views about the same topic.

Suk-ling Ma – Hong Kong
Thanks to IPA for awarding the 3^rd place Research Award to me and giving me the opportunity to attend the IPA 12^th Congress in Stockholm.  The contents of the scientific programme were multi-discipline and covered a variety of topics, from clinical issues to advancement of biological knowledge on psychiatric diseases such as Alzheimer’s disease and depression. 

Among a number of distinguished sessions I attended, I would like to highlight a few which have impressed me most.  The recent hypothesis on intracellular signaling in Alzheimer’s disease and the advancement of stem cell transplantation for dementia were discussed in the plenary lectures on the second day.  Professor Lovestone presented a complicated but interesting story on glycogen synthase kinase-3 and the intracellular signaling of Alzheimer’s disease, which inspired me as to the possibilities of shared pathways between different diseases.  On the other hand, stem cell transplantation is a hot issue in therapeutic strategies of diseases and not limited to dementia.  The presentation given by Professor Minger brought me to a new horizon in cell-based approach of treatment and the possibility of regenerative mechanisms in human brain.

The discussion on the “Anti-amyloid therapies” in Symposium 13 also attracted my attention.  Beta-amyloid immunization in Alzheimer’s disease is always a controversial issue.  Other than active immunization, speakers presented the relationship between IGF-1, NSAIDs and cholesterol to amyloid.  All these pathway/hypotheses may represent potential targets for Alzheimer’s disease research in understanding the disease pathology and drug development.

With high quality scientific programmes, attending the 12^th Congress in a nice city, Stockholm, made it a memorable event for me.

Ivo Aben – Netherlands
It probably goes without saying that for me as a proud prize winner in the IPA 2005 Award Competition (2nd prize), the opening ceremony was the part of the congress that affected me most. It was an honour to receive this international award among a group of distinguished clinicians and scientists who have been so important for many proceedings in the field of Psychogeriatrics during the past decades. Especially, I would like to mention Prof. David Bowen, who received the Luigi Amaducci Memorial Award for his extensive work on Alzheimer’s disease but who, unfortunately, could not attend to accept the award and give his lecture personally. In addition, the official opening of the congress by Her Majesty, Queen Silvia of Sweden gave true meaning to the congress as she emphasized the importance of psychogeriatric care that aims at alleviating the suffering of patients and families with severe mental illness, such as dementia. In a frank and dignified way, Her Majesty revealed why she is viewed as a true ambassador for all those families who face the difficult and challenging task to care for a relative with Alzheimer’s disease.

In my opinion, the congress offered a balanced scientific programme that combined basic neuroscience with clinical studies that aimed to improve patient care. To illustrate this, I would like to mention two symposia that I attended. First, the symposium on Vascular Cognitive and Behavioral Disorders gave an overview of recent research findings into the relationship between localised vascular brain damage and neuropsychiatric syndromes such as late-life depression and dementia. It was shown that vascular damage may be an important pathogenic factor in the development of such disorders and that progress is made in determining the pathophysiologic pathways and anatomic structures that underlie these conditions. Potential targets for treatment were discussed but at present this field of research is still in an early state. 

Second, the symposium on Behavioural and Psychological Symptoms in Dementia presented some excellent projects that aimed to implement new non-pharmacological interventions for reducing behavioural problems in Alzheimer disease patients and caregiver burden in their families on an evidence basis. A telephone-based intervention for caregivers of dementia patients was shown to evoke such positive effects that its feasibility in the treatment of other psychopathologic conditions such as post-stroke psychopathology should be considered.

Due to these kinds of high quality symposia, the congress certainly inspired many of us with new ideas to continue to improve our knowledge of psychogeriatric conditions and develop new treatments and care strategies. 

Vivian Leung Pui Yiu – Hong Kong
As a Psychogeriatrician paying most of my time and effort in running clinical service, it was a refreshing experience for me to attend the congress in Sweden this year. It was encouraging to see that various disciplines and people around the world were working with dedication for the betterment of psychogeriatric clients. I was particularly impressed by the newest development in the biomolecular/genetic, imaging and transplant research in dementia which help to better understand the pathological mechanism and show new hope for the treatment of this disease.  I was also astonished to have witnessed that Sweden has such a strong tradition and enthusiasm for dementia research, including support from the Royalty.  The last and the most important, is to know that IPA is developing ways to disseminate knowledge and valuable experience and wisdom from research and has the mission to help deprived and underdeveloped countries in the growth of psychogeriatric research and services.

Ajit Shah – United Kingdom & Kirsten Abelskov – Denmark
(Co-chairs of the IPA Service Delivery Task Force)
IPA Service Delivery Task Force Symposium: Squalor: An Update 

This symposium at the Stockholm congress was organized by the IPA Service delivery Task Force. Despite being on the penultimate afternoon it was well attended with well over 100 delegates in the room. There were four presentations covering the basic clinical and demographic features, methods of dealing with this group of patients in Denmark and Australia and speculation that the final common pathway may be frontal lobe dysfunction. Presentations by Professor Snowdon, Dr. Halliday and Dr. Abelskov were illuminated by graphic pictures of the living conditions of some of these patients. Question time generated a lively discussion on various aspects of this topic and ideas for new research. We wish to thank all the four speakers (the forth was Dr. Shah) for such a lively symposium.

Reprinted from IPA Bulletin, November 2005, Volume 22, Number 4