Podcast – AAIC 2020 – Day Four

Voice Over:

Welcome to the NIHR Dementia Researcher podcast, brought to you by demetiaresearcher.nihr.ac.uk. In association with Alzheimer’s research UK and Alzheimer’s society. Supporting early career dementia researchers across the world.

Adam Smith:

Hello. I’m Adam Smith. I’m delighted to be hosting this podcast for the NIHR Dementia Researcher website. I’m, once again, joined by a new panel today of dementia researchers to discuss day four of the Alzheimer’s Association International virtual conference. We’re going to be discussing some of the big news from the day and our personal highlights. As we know, many of you haven’t managed to attend over the last couple of days because you’re back in the labs and back at work so we hope this podcast will help direct you to some of the great content that’s out there. So I’m delighted to welcome back three people you’ll know from previous episodes. We have Dr. Riona McArdle from New Castle University, hi Riona.

Dr. Riona McArdle:

Hi, everyone.

Adam Smith:

We have Dr. Byron Creese from the University of Exeter. Hello, Byron.

Dr. Byron Creese:

Hello.

Adam Smith:

And we have Esther Wiskerke.

Esther Wiskerke:

Hello.

Adam Smith:

That’s completely pronounced wrong, right? I mean that’s not even how you just told me to pronounce it. Esther is with us again as well. Riona we haven’t seen you, is its last year’s AAIC since you were last with us?

Dr. Riona McArdle:

Yeah. It is.

Adam Smith:

It’s a whole year. Yeah. We really must do something more. I’d really love to do a podcast on your work on gait. You’re not the only one at the moment, are you? I’ve seen there’s quite a few posters and talks on gait this year.

Dr. Riona McArdle:

There was a few this year. Probably a bit less than actually last year. But there was a few and there was a lot of attendees who are very interested in gait as well, which is very good to hear.

Adam Smith:

It is. It is. Byron, so much of what’s being presented this year is from Exeter. It must be a good place to be.

Dr. Byron Creese:

Yeah, it’s good. I’m having a lot of fun there, enjoying me time and there’s a good bunch of people to work with. Good dementia research community for sure.

Adam Smith:

Fantastic. Well it’s great to see so much coming out of Exeter and the UK, particularly, and Esther, it’s not quite so long since we saw you last. And, of course, I should say that you’re Dutch. So I feel like we needed a token Dutch person to make up for the fact that we’re not in the Netherlands this year. Were you planning to attend had this not been virtual?

Esther Wiskerke:

I might’ve missed it, no. I fear I would’ve had to miss it due to work commitments.

Adam Smith:

I think it’s fantastic that I think so many other people who, otherwise wouldn’t have been able due to work or because the costs were quite prohibitive, are being able to attend. And your first day I see as well, Esther.

Esther Wiskerke:

Indeed. Because of it being virtual it has been a bit more accessible and yeah, I enjoyed it. It’s nice to have a peak.

Adam Smith:

Thank you all for joining us today. Do you know what? Today’s sessions were public health, dementia care, psychosocial factors and dementia care practice. That’s quite a lot to take into one day, but that was the focus for day four, so before I come to each of you to discuss your own highlights, perhaps we can talk about a couple of the main plenaries from the day. Byron, can I come to you first? Did you manage to attend the Ethics and Dementia plenary?

Dr. Byron Creese:

I did. I got to most of it anyways.

Adam Smith:

What did you see?

Dr. Byron Creese:

So it was all around, broadly, the ethics of disclosing biomarker information to the general public or research participants, even. I watched three talks, one from Scott Roberts in Michigan, one from Aida Rosdomsader in Cologne and one from Jennifer Lingler in Pittsburgh. I thought an interesting theme to come out of that was that you can disclose your oath, either Apoe or petamamoid status, does not really have much of an impact on people. People can deal with it, can handle the information. It does not adversely affect their wellbeing or psychological status in any kind of major way. I think there are important implications, probably, for the disclosure Apoe status effects somebody’s performance on a memory test or cognitive test. I think there’s some work going on in that space. That’s quite interesting for clinical trials, I think. So you can recruit Apoe four status and then oversee in a clinical trial, you’re going to be undertaking cognitive tests on people and the fact that someone’s in the trial in fact know they’re Apoe positive and, therefore, have an increased risk for Alzheimer’s disease. Does it affect their performance when testing? That was quite an interesting point, but the broader point about the impact on people, I thought, was an important take away point for me, for the research we’re doing.

Adam Smith:

It’s not a session I got to, but, just out of interest, did anybody from Gene Match, were there any of those presentations from the Gene Match services in the US?

Dr. Byron Creese:

No. What’s that? I’m not familiar with that.

Adam Smith:

So Gene Match is an extension of the Alzheimer’s Prevention Registry, where they send testing kits through the post, they know the results but they never discloses it to people, even when they randomize people to approach them on their Apoe status. I have to say, some of the listeners will know, but I’ve got some involvement and joined dementia research in the UK and things like knowing the Apoe status of part of our cohort could be incredibly valuable. Because so many of the studies that are coming through are looking for people of a certain age with one risk factor and a risk factor being Apoe, if we knew the Apoe status of people, it would massively reduce the number of people we had to screen for no reason and one of the really annoying things is, because so many of the trials don’t share data with each other, it’s quite feasible that somebody who’s motivated to participate in a trial might come in and have their Apoe status tested two, three times in a year. They never get enrolled into the study, but they try to enrol in the next study, they test Apoe as well and find it’s negative, never disclosed, and that person just keeps having their time wasted by trying to enrol in studies they couldn’t get into.

Dr. Byron Creese:

I don’t recall that coming up, but I suppose when you’re talking about ethics of disclosure, there’s maybe two points then. There’s the ethics of disclosing the information in a responsible way, but, actually, also the ethics of disclosing it so that somebody doesn’t go wasting their time getting tested repeatedly and wasting resources and so on. I think that’s an interesting point. It leads up, actually, to there’s a poster from Glasgow Memory Clinic and I forget the author. It was Glasgow Memory Clinic going through a flow chart of screening for a trial and then the number of people recruited into that trial based on their Apoe status and it was sort of 3,600 down to about 64. There’s a huge drop off rate in people needed to screen in order to get down to that and you wonder if more information is available if that wouldn’t happen.

Adam Smith:

Completely. In fact, I’m sure we can guess was that something like the generation’s trial or the tomorrow.

Dr. Byron Creese:

It was generation, I think.

Adam Smith:

The number of people you have to screen on those to get the numbers is massive and I think that’s one of the things with joined dementia research, we tried to encourage trial sites to share back screen fail data so that it improves the data of the person so that we don’t over approach people for trials. Particular things like MMSE score, if somebody self-reports of having an MMSE of 25 and they’re getting approached for MTI trials, but actually, when you brought them in, they’re testing more like 20 and that information never finds its way back into the data pool. People with MTI are in such high demand for studies that they’re hot property. They’re approached lots to participate in trials and we just drag people back into sights, no reason.

Adam Smith:

Thanks, Byron. That’s fascinating. I’m going to come to you next, Riona. The racial disparity session with Lisa Barnes was talked about a lot online yesterday. Could you give us a summary of that session?

Dr. Riona McArdle:

It was really interesting. Lisa Barnes kind of talking about racial equality between African-Americans and white people and she was talking about how African-Americans are twice as likely to develop dementia but they’re less likely to get a diagnosis or be represented in clinical trials, which, I think is something that was talk about a little bit last year, as well and it steadily getting more into the narrative of research that we really aren’t including minority groups into clinical trials. She also mentioned that there didn’t seem to be any difference in the rates of their actual cognitive decline in comparison to the white population, but they seem to start at a lower set on the cognitive tests. They’re getting lower scores going into any kind of studies, which could be influenced by factors affected by race, such as socioeconomic status or the literacy and also the fact that they’re less likely to get a diagnosis at those early stages, so it’s kind of hard to compare them, I think. It is interesting that they didn’t really find any particular differences. There was a few differences in pathology. So they find that people with dementia in African-Americans communities were more likely to have mixed pathology, but she also mentioned that, actually, they go to memory clinics for other problems for memory problems and that might be why we’re just seeing a more representative group of people who might also have hypertension or other factors.

Dr. Riona McArdle:

Then she went on to talk about just how the experiences of discrimination in their youth was actually impacting their health and the presentation of their cognition. For example, they found using FMRI studies, that there was less functional connectivity in places that were related to trust in people with dementia from African-American decent, and that this seemed to be linked to their experiences of discrimination in schools, particularly if they’d grown up in South America. I just thought that was a really interesting idea that I’d never thought of and it also got mentioned then later on in a LGBTQ session as well that, perhaps, that was something that would feed into LGBTQ experiences as well, that they felt more discrimination in their youth and that might affecting their later cognitive status. That was really interesting.

Adam Smith:

It was. Does anybody else have anything to add to that?

Esther Wiskerke:

I made that link as well. She talked, like Riona just said, about the integrated schools so you’d think [inaudible 00:12:13] “oh, that’s a great thing” but, actually, now it turns out it has some adverse effect later down the line and who could’ve thought that? That’s just really interesting to see, also, for future policies, I guess, that you’re thinking you make the right decision at one level but on another level, it might actually go the other way. It just shows the complexity, and also, you’re right, I picked up as well about the LGBTQ population, my goodness. And if you have a double, it gets really complex that way.

Dr. Riona McArdle:

Yeah. For sure.

Adam Smith:

I think a podcast panellist from a previous years AAIC, I think it might’ve been in 2018, Nika Soboleva, she also had a post yesterday looking at African-American populations and education, which was very interesting, so please, go have a look at that. She is Nika Soboleva, and that’s under the public health section in the posters. I don’t know if that’s an interesting Segway, because I was going to talk later about one of the big sessions yesterday which was the Lancet Report, looking at life’s modifiable lifestyle risk factors and, of course, for anybody who’s not picked up on this before, the Lancet Report brought together 28 world leading experts. It published, was it a year or two ago now for the first time?

Dr. Byron Creese:

It was ’17 I think.

Adam Smith:

Yeah. So, a few years ago now and they’d reported there was a 40% potential risk reduction if you employed the right prevention strategies and after analysing global best practice, they’ve increased the factors from 9 to 12 with three new ones added. And the new ones, I’m looking at my notes, are excessive alcohol intake, head injury in midlife, air pollution in later life but that added to. The greatest proportion came from less education in early life, hearing loss in midlife and smoking in later life. Sorry. The point I was trying to make was the education in early life, which can contribute in itself, a 7%. It’s no surprise that when you combine that with the problems experienced around race and those educations that that’s an amplified issue.

Esther Wiskerke:

I wonder, can you even link that back to what was discussed in the ethics session? What was raised by [inaudible 00:15:10] I can’t pronounce that. It’s a super Dutch name. Because, what I understood from that at least is that once she found ethic in her study for honest to correctly, that once people are being taught, that they have the gene, they have a more desire to actually control the future. Some of them started to make considerable changes in their life, even, of course, that the gene doesn’t necessarily mean that you’re going to develop it. So that’s interesting to see whether by telling people, if you say what the Lancet’s saying that, of course, things in life can impact your chances, but then it’s nearly a full circle. Does that make sense? Because by testing, you’re telling, people change their way of life, and if, in that way, your actions saying it, but that might actually then your chance of not developing it. You get my drift? On the other hand, apparently some people go a bit reckless as well, because if it’s not explained properly enough, that this is not your future telling, per se, people also might start being a bit reckless more or that I say, give up.

Dr. Byron Creese:

Scott Roberts’ talk I think had the same finding, that disclosure of Apoe prompted behaviour change. The thing I wonder about the other factors, though, is in terms of prompting behaviour change, is there are things like many lifestyle factors are risk factors for other cancers and heart disease, other stroke and so on. Do people their behaviour change, I don’t know. It’s a real challenge, isn’t it? The individual level behaviour change required to, sort of mitigate risk for dementia. I don’t know if it’d be any different for cancer or for stroke or for heart disease or diabetes.

Dr. Riona McArdle:

I think in that session, they really tried to amplify how policy level interventions is what’s needed opposed to putting the allness on the individual. So smoking always comes up, obviously it’s a big one, and that was like, hey, can we put a policy in that would actually get people to stop smoking, which would actually help many different types of disease and so on. So I think they were trying to take the allness a little bit less off the individual for the prevention factors.

Dr. Byron Creese:

I suppose smoking, they have done that. They put the messages on the packets and then they just make it really hard to buy and they make it really hard to do. So they don’t leave it up to the individual, it’s massive policy changes and you can see some stuff around the UK around advertising certain foods that’s been going on in the last couple of weeks. [crosstalk 00:18:10] Yeah. Exactly.

Esther Wiskerke:

A bit of a more scary comment from Scott Roberts, I found, is his comment about insurance change because now, of course, if you admit to smoke and drinking, you admit to it all because you’re probably having quite a bit of fun but a bad lifestyle. Your insurance works up so I wonder, also with testing, if that got in the hands of insurance, would that ultimately mean your insurance is going to go up and is it fair if that was the case?

Adam Smith:

I am going to cheat slightly and quote some of Clive Ballard’s fantastic tweets. So he highlighted yesterday that we know that 40% of dementia risks could be prevented or delayed and that 12 of the risk factors accounted for 35% of dementia, but that rises to 56% in Latin America. There were some really obvious things in here like found that people wearing hearing aids reduced the risk of cognitive decline in people with hearing loss, for example. You would hope that somebody in government somewhere is looking at this Lance report, somebody in public health and saying “Let’s translate this into some policy and practice.” For anybody who’s not listened to it yet, if you go back a couple of episodes we have a podcast with my boss, professor Martin Rosser, looking at his work on the cognitive footprint and this idea that government policies and various other things can be scored in terms of cognition to give them a positive or negative score with. And you’d hope that many policies on other things like combinations of drugs can have a positive cognitive score or negative, but you can add all this up to try and create a positive cognition through policies and in society.

Adam Smith:

So that’s worth a look. Sorry. Was there anything to add on the racial disparities talk, Riona?

Dr. Riona McArdle:

No? Did we not cover that?

Adam Smith:

Sorry. I realize we jumped off to the Lancet report. Okay. Anything else to talk about on the Lancet report? We should give proper credit, of course, to Jill Livingston as well, from UCL, which is where I work, for a lot of the work and Clive Ballard and many of the others. We’d all recommend that you go back and look at that session, which I think was one of the live ones, so that will be available later today, being the 31st of July.

Dr. Byron Creese:

Maybe just to add one thing. I suppose we were talking a lot about the prevention aspect of dementia, there was Gaes Uhlbech, his talk. He’s at University of Oslo, which is more about the management and care of people with dementia, so including treatments for the disease itself, but also various symptoms of the disease, including behaviour and psychological changes, nursing home care and so on. His particular point was on the side of behaviour and psychological symptoms has no real effective drug treatments and there hasn’t been since the last report in 2017, but the good news is there’ve been a number of big studies looking at nonpharmacological interventions, particularly for people in nursing homes, it seems to work really well for agitation, depression, in particular. So nonpharmacological is going to be things like enhanced social interaction, stuff as simple as that, like talking to people more. A reminiscence and a bit of light exercise type things as well as care home staff, management things.

Adam Smith:

I think that came through as a theme in much of yesterday, which was highlighting the importance that care wasn’t just a case of caring for people. If you got the care right, it could also delay and mitigate some of the symptoms that we know are associated with dementia. I’m going to say things like, we’ll talk about in a while, the key to a diet suggested if you got diet right it might delay some of these other things we’ve been talking about now. Just emphasizing the importance of care, again, not just to make somebody comfortable, but to also, potentially give them a better quality of life through delaying the progress of a disease. Does that sound right?

Adam Smith:

I am going to go around the table now and ask people just to talk to what were their favourite sessions of the day. Esther, let’s come to you first.

Esther Wiskerke:

I liked the talk of David Hoffman, the key considerations for dementia capable preparedness plans but I also had some fun with some of the posters, if I may touch on that. I picked out three. The first one was from the faculty of medicine the Chinese University of Hong Kong, Calvin Soy, if I pronounced that right, and it was called The Companion Rulebook for Elderly Residents with Dementia: A cognitive behavioural analysis for new psychiatric symptoms. Obviously it’s a small poster so that was just talking about care is more than just giving care, but actually talking to people. So what they’re trying to do there is develop robots to actually interact with people, but it was ultimately a small study and I did interact with the poster and I saw a few other people did as well, asking actually how to robot interacted. Somebody else, like I said, was intrigued to find that out so that would be interesting to follow that a bit more and to see how that was done. There was actually no answer back to that, which was a shame, but another one was from the Canadian Alzheimer’s Society, Riley Melvern, and that was called the Out of the Shadows: Addressing resident to resident aggression in long term care.

Esther Wiskerke:

They’re developing an evidence based booklet on that to help carers and family members and they’re actually looking for suggestions to the terminology of resident to resident aggression and they’re looking for something more person centred and that sounds a little more respectful. So, actually, I responded to that poster and I got a very nice reply back and I wondered if they’re actually considering aftercare with residents because when there’s an altercation between two people, the people might be quite high on adrenaline because if you just had a fight you might either feel very vulnerable or if you’re the aggressor you’re super high and then it’s up to the care staff that they have to separate people, but then the complexities that, though you’ve separated two people, one might be super high, the other one might be feel very sad. The one who is necessarily the aggressor might also, equally, be the victim because the other one might have said something that caused the whole conflict and both may not remember. So I think the work they’re going to be doing is very, very good, actually. I look forward to that booklet in the end.

Esther Wiskerke:

Then there was one by Dr. Daven from the University of De Sao Paulo in Brazil and it was about the importance of personal possessions in the construction of institutional ambiance for elderly with Alzheimer’s disease and they’d done a literature review on that. That poster made me a little bit sad in a way, in the sense that the outcome was that it reinforces the sense of belonging if you bring along personal possessions to a new home. That, in a way, of course for every human on the planet, if you move house, there’s little people who do the total mindfulness and say, “I leave all my old stuff at home. I’m going to start fresh.” Who would do that? Not many people can have that mental strength. Generally, we bring all our nonsense with us and all our comforts with us and now we feel at home again in our new place. Why would we have to actually have to think about that for people with dementia? Obviously, they’re still people. Then I thought, wow, that we still have to look into that.

Adam Smith:

On that same subject, I saw a poster yesterday that talked about activities. Obviously, we know that activities in residential care is something that’s talked about a lot, both for keeping physically active but also to provide something to do, and this talked about the number of residents who used to do day to day household activities, that they couldn’t anymore. They weren’t expected to clean their own rooms or to do their own washing up or to make their own breakfast, which were activities that they took some comfort from. These were routines that they built up that they would polish their silver, they would make their own bed and this particular study looked at how you might introduce some of those activities, and it wasn’t just a ploy to reduce the number of staff they needed. This was genuinely people wanted to have a cleaning cupboard where they put their vacuum and their polish because they couldn’t access the cleaning stores because they were all locked away somewhere down the corridor because it wasn’t safe to let people have a tin of pledge and a duster. I can’t remember who did it. It was a poster from yesterday.

Esther Wiskerke:

That comes back to a sense of purpose because if you’re busy, then, of course, everybody wants to go to a hotel or all-inclusive, but it’s your sense of purpose at home, at least, that you want to do your own stuff.

Adam Smith:

That’s nice as holiday. Byron, sorry, you had something.

Dr. Byron Creese:

Yeah. I completely agree with what you said, Esther, about that is a simple, expected finding, and the same with you, Adam. Was polishing silver one of the examples? What kind of sample would you take?

Adam Smith:

It was. It really was and I’ve seen this on a video, as well. There was a lady that used to, once a month, she would polish the silver and she’d taken her silver with her, but it was annoying her that it was sitting there getting tarnished because the domestic staff that came in to help with the room didn’t polish it with the brasso. They would just give it a quick once over. Back to what you were saying.

Dr. Byron Creese:

There’s a lot of those simple things that some of the, there was a world study that whether 10 minutes a day or something is helpful and it’s like yeah. Yeah, that makes sense because it’s helpful to me, right? I don’t like being sat in lockdown here. I can see how horrible no social interaction is, but then they looked over 20 years and all of this knowledge comes about from research but it doesn’t get implemented into practice, necessarily, and 20 years ago the situation is more or less the same. So there’s a gap between research and practice.

Adam Smith:

Of course, this talks to, because I did watch your presentation yesterday. So exactly your work, as well, about measuring people’s movement using wearable technology and how much physical time they spend upright and doing things. It’s in the same space, isn’t it?

Dr. Riona McArdle:

Yeah. So there’s a lot of reasons that people aren’t moving about in long-term care facilities so my work that I presented yesterday showed that people with cognitive impairment living in nursing homes are doing very, very, very little activity in comparison to people in community dwelling settings. They’re doing maximum 2,000 steps a day, which is very little, and our study collects every step after three steps, so we’re really taking in a lot more than what a Fitbit or anything like that would show you. So we’re taking every step that you might possibly make, basically. So they’re doing a lot less activity. All of their activity is very much in shorter walking bouts and it shows that they’re really moving around a constrained setting and they’re not really getting up or moving about very much, which we know is really good for a population that lives in long-term care. Even moving a little bit more every day than what they do at their baseline has been shown in studies to be very beneficial for their quality of life and, also, to help them maintain some of their functional status as well.

Dr. Riona McArdle:

But there’s a lot of reasons why that doesn’t go ahead in those long-term care facilities. For example, the environment of the long-term care facility. I saw a talk on this yesterday, as well, about what environment looks like in those care homes. So when you have a traditional nursing home where it’s warded and people have their own small, little rooms and stuff like that, they’re more socially isolated, they’re not getting to interact, they’re not involved in activities. Whereas if they’re in small-scale nursing homes that have, say a big kitchen in the centre that they can come into, they much more likely to be able to interact with people and move around, and there was also a look in the Netherlands, Green Care Farms, where they mix agriculture with care. So you go and live on a farm and you help out on the farm, even though you’ve got dementia, like severe stages of dementia. That’s supposed to be really good for their social interaction with each other for getting involved and going outdoors.

Dr. Riona McArdle:

It’s kind of like the policies and the environment of the nursing homes and the long-term care that needs to change, as opposed to the individual because they’ll be asked to sit in the chair so that they don’t fall because that would be a big problem in a nursing home is if you have a fall, but then you’re making them more frail by doing that, so it’s quite hard. A hard sell.

Adam Smith:

Do you know why it’s tricky? I don’t think I’d want to be in a senior position in a care home group or things like that because the guidance does quickly change to reflect latest thinking and research and keeping on top of that when you’re a care home manager that’s tied down with day to day work, just trying to keep on top of the residents, is difficult. And I’ve had some interaction with the larger care home groups at senior level and, as much as quality of care is clearly important, it is a lot about occupancy rates. Over the last few years, so many of those larger care home groups were bought by venture capitalist firms that were quite interested in the properties and the land and things like that.

Dr. Riona McArdle:

It’s hard to get the right balance between being risk adverse and trying to promote independence within a care facility because, obviously, you could promote independence, but, for example, I’m doing a systematic review at the moment on activity in care homes, and there’s one study that found people who go outside and walk more are the most likely to fall, which is obviously a really negative thing to have happen in a care home. Yet, they seem also to be reporting to have better functional status and quality of life because they’re getting to go outside. Just trying to balance that, what’s more important? The face that they could fall and break their hip or the fact that they would like to have some independence or stimulation?

Dr. Byron Creese:

I suppose the fall statistics are shocking, aren’t they? If you break your hip, is the mortality in six months or a year? No wonder [crosstalk 00:34:27]

Esther Wiskerke:

In Holland they have developed an air bag for your hip and the moment you hit the floor, boom, it went off, and it sends a text message to your carer that you’ve fallen.

Dr. Riona McArdle:

That’s amazing.

Adam Smith:

Is that like the children that do horse riding, the eventing, they have vests like that, don’t they, that protect them if they get thrown?

Esther Wiskerke:

It’s super discreet and will fit into your clothes. You wouldn’t even know you’re wearing it.

Adam Smith:

Cool. We should look at that. Riona, I’m interested to know, did you do any heat mapping? Actual physical mapping to look at the layout of the care home and then make the hot spots as to where people were spending their time?

Dr. Riona McArdle:

No. I think that’s usually done through infrared sensors, so we just use non-intrusive, small wearable technologies. We don’t know where they are or what they’re doing, we have no GPS or anything, but there has been work that have done that and shown they move within certain paths within the care home and sometimes if they keep reusing the same paths, that can be an indication of wandering, but I think there’s still a lot of work ongoing with that.

Adam Smith:

I did some work on that in the NHS many years ago to look at where staff spent their time, how much of it was spent by bedside compared to at the nurses station or elsewhere around the place, which can indicate some fascinating behaviours as to what work is like. Fantastic. Sorry, Esther, we interrupted you there. Do you have anything else you wanted to highlight?

Esther Wiskerke:

Yeah. There was one very interesting one on demand and it was called Caregiving is Associated with Worse Sleep and Worse Sleep Related Health and Functioning by Kate Schachter. It was, actually, also a bit of a catch 22. It looked into that people who live with a caregiver, the people with dementia may actually disturb the caregiver by night and wandering, for instance, and then, in return, the caregiver sleeps badly and, therefore, starts to disfunction. And, actually, there’s a more risk of institutionalization of the care recipient. So it goes in a viscous circle, but it also highlights, again, a little bit, not rocket science, of course. Recently, I read something in the Harvard business review and they said managers who are sleep deprived don’t function. That it’s dangerous for your organization to have non sleeping employees, basically, and everybody knows the example of sleep deprived mothers. You love your darling dearly, but it doesn’t help getting through the day if your sleep has been disturbed.

Esther Wiskerke:

And I guess that links, also again, to a really good point that David Wathen made later. He said some people with dementia are in a comparable situation as in childhood, only their legal status is different. So a lot of those issues we’re going into are a little bit comparable, but, of course, they’ve moved on in life so they’re adults. So that’s where the ethics gets a little bit tricky, how much can you intervene? Even, Riona, what you said earlier about walking around. A mom that lets her child run around to play ground and then fall and drop and climb on things, obviously the child is going to hurt themselves, but, probably, it is better for child to run around for their physical abilities, but may hurt terribly. So there’s always a bit of a catch finding this balance and that is tricky ethically speaking. Makes it complicated to solve.

Adam Smith:

I saw that Kate Schachter talk as well, she’s from the University of Wisconsin and the reason why carers were getting worse sleep was either down to being, obviously, woken up by the person that they were caring for. That they felt they needed to be vigilant all the time and they simply stayed up later and woke up earlier. Staying up later because once you’ve managed to put down the person you’re caring for to bed, that becomes your free time. That’s when you want to sit down and relax but then you have to get up early in the morning because you can’t leave them lying in bed in the morning. Honestly, I don’t think we’d be very surprised by the results. I think it kind of confirms what they’ve seen in this rest study and the take away of that was strategies are needed to support sleep health in carers. Any ideas, anyone? I think that’s going to be a tricky one. Esther, I’m going to have to move on, I’m afraid, and give everybody else the chance to come to their talks. Ri, let’s come to you next.

Dr. Riona McArdle:

So I saw quite a few interesting talks and a couple of posters yesterday. One of the talks that I thought was really interesting was in the LGBTQ session from Jason Flat, he’s from the University of Nevada, and he was talking about prevalence rates of dementia in LGBTQ populations, but also the challenges that are affecting them that we’re not very good at thinking about, in terms of policy when we think about dementia care. So he was saying that those comparable to higher rates of dementia in LGBTQ older adults, however, the problems with this is that they are less likely to have access to a caregiver, they’re twice as likely to live alone, they’re often scared of going into medical care because they’ll have faced discrimination through medical care. He did mention, I can’t remember how many years ago, but he mentioned that being transgender has only, more or less, recently stopped being a mental health condition in America and seen as one.

Dr. Riona McArdle:

So there’s obviously a lot of stigma that they’re still trying to break through. And some of the things I thought was really interesting that he mentioned was that we need more data on these kind of populations and we also need to be tailoring care to be more inclusive and we need to understand that not everyone has a biological family that can take care of them. Some of them have families of choice, and those families also need to be informed of their medical needs and their needs to be something in place for that. So I thought that was a really interesting session and just highlighted, again, that we’re not always that good at thinking about minority populations within research and we need to be a little bit better at being inclusive to these populations. Thought that was really interesting.

Dr. Riona McArdle:

I also saw a really good poster from Oregon by Lindsey Miller, who is part of Jeffery Kaye’s lab group. She was looking at sensor data on couples and older adult couples in the home and how they spend their time together because that could be indicative of their well-being and their health. So she looked at patterns of how much time couples spend together inside and out of the home and she found there’s patterns of people who spend a lot of time together and people who spend a lot of time apart, and the people who spend a lot of time together was protected by men having lower cognitive abilities and being less active and that this might be an indicator for their waning independence and increased caregiver strain and it reminded me of a talk from last year by Neil Clemmons, who used to be in that group as well, I think, that indicated that the more time that couples spent together in bathrooms was an indication of low functional ability of the person with dementia. So I thought that was sort of an interesting way to look at patterns and, again, what you said, thinking about where people are actually in the room and how that might indicate daily behaviour as well, Adam. So I thought that was really interesting.

Dr. Riona McArdle:

Finally, I also really enjoyed a talk by Shannon Holloway from Rush University. So, she was looking at standing activity as recorded by accelerometer. So this is, in my research interest anyway to have a look at, she was reporting from the mind trial. So Rush University have got a lot of sensor data anyway that’s really interesting and she was looking at standing, in particular, because basically any activity breaks up sedimentary behaviour, and that’s always good for a person with dementia, for older adults. And she said there has been some findings that standing and cognitive function are related, but there’s never been any looking at this in the real world. So she looks at it in the real world using seven day data and recording how many minutes a person spends standing a day and what that standing activity intends to use and she’s explaining we do spend a lot of our day standing. For example, if you were chopping something in the kitchen, you would probably be standing to do that or if you were just moving around doing your cleaning, that would mostly be recorded as standing and it can break up the day.

Dr. Riona McArdle:

She found that standing acts of the intensity was associated with perceptual speeds, ones she controlled for all the of the confounders. So kind of like information processing, which often comes up with other motor activities like gait, as well. So that was good for me to hear and she suggested that we need to think about doing interventions to increase standing behaviours because they interrupt sedentary behaviours and might be more feasible than people doing broad scale aerobic activity or walking for a long time if they’re not able to do that. So I thought that was a really nicely presented talk and some quite interesting novel findings from Shannon Holloway as well.

Adam Smith:

Well it makes absolute sense, doesn’t it, when you think about it? Standing activities. We’ve all got standing desks and things now. Why wouldn’t you employ some of those same tools in that setting? Let’s come to you next, Byron.

Dr. Byron Creese:

It’s probably an obvious one but I really enjoyed the Lancet commission talks, but we’ve already spoken about those.

Adam Smith:

Sorry. Did I steal your thunder?

Dr. Byron Creese:

No. It’s fine. That was my only thing. No. I’m joking. So I did go to the talk, and we did the ethics one, and I went to the talk on the ketogenic diet. I’ve been working on a big study in Exeter, which is kind of an older adult tracking study called Protect, and we take a lot of information about people’s diet and lifestyle and it’s all kind of in the same areas as the factors highlighted in the Lancet commission, so I went to that because I think people often ask me, “what about the keto diet?” And aiding Alzheimer’s disease risk and so on so I thought I’d go, primarily, not because it’s something I researched, necessarily, but just out of interest, and that was from Susan Craft at WakeForest School of Medicine in the US.

Dr. Byron Creese:

She just presented a few studies showing that, maybe, there’s some effect of the keto diet on memory and some biomarkers of Alzheimer’s disease, but the study was pretty small. I think it was in the 10s of people and then I think most other studies in this area have been really small as well, so I’m not sure there’s that much we can draw into it. I highlighted that that particular diet in mice reduces Alzheimer’s pathology in transgenic mice, but I think a lot of things do in transgenic mice, as far as I understand from my animal research colleagues, it’s good to be a mouse with Alzheimer’s disease.

Adam Smith:

We can cure everything in mice. They’re going to rule the world one day, aren’t they?

Dr. Byron Creese:

Yeah. So I thought it was interesting because it’s a huge topic to the general public, I think, diet. And I did think it was interesting, however, that diet was left out of the Lancet commissions, it’s not one of the 12 risk factors. So I assume that means that, although the evidence might me emerging, it’s not yet in a place where you can say that any of these diets actually prevent dementia. Although they may be healthy, for a variety of other reasons.

Adam Smith:

Is weight one of the risk factors? The BMI? [crosstalk 00:46:48]

Dr. Riona McArdle:

It is in the WHO report.

Adam Smith:

I suppose diet and exercise combination. I went to those keto sessions as well. Did you see the one by Steven Cunnane? Benefit trial?

Dr. Byron Creese:

No. I just caught this one right here.

Adam Smith:

He was great. I would really recommend anybody go back and watch this. So Stephen Cunnane reported on the benefit trial. He’s from Sherbrooke University in Quebec and they gave people a five milligram substitute, not substitute, drink and he had this awesome analogy of how the brain runs compared to a hybrid or a traditional car. Old fashioned cars run on petrol, your brain would run on glucose, but, actually, if you were to get a hybrid car, if you could run a certain percentage of it from the keto, it will have a longer effect. I’m butchering this so I would recommend you go see it, but what he showed was that once you got MCI, your brain stopped being very good at running on glucose, but it did continue to be good to run on the ketone generated energy. So swapping diet at that stage, their study found that there was improvements in executive function, language function and episodic memory are all using this Boston scale. I’m not doing this justice. I suggest you go look at it. The analogy he used for the electric car was fantastic and I was sold on it. I know that, maybe I’m just easy to persuade, but the images he showed of the brain running on the different fuels, did suggest that there’s something really in that, potentially, as a way to slightly delay the onset of things.

Adam Smith:

Go see it. Steven Cunnane. Sherbrooke. Sorry, Byron, please do carry on.

Dr. Byron Creese:

I saw a few posters yesterday. My favourite poster was a couple days ago, but yesterday there was three posters on psychosis in Alzheimer’s disease and I think they’re all linked, in some way, to making the case for Pimvanserin for psychosis in dementia because I’m not sure we mentioned Pimvanserin but I think that’s a subtext because two of them were from Acadia, who’s the pharmaceutical company that make that drug. They were looking at cost associated with Lewy Body dementia psychosis versus other psychosis and found that psychosis and found that psychosis in Lewy Body dementia were associated with higher health care costs. Then there were health care practitioners perceptions of antipsychotic efficacy. So that was first one was from Victor Egar, Acadia and this next one was from Jenny Chin at Acadia, as well. So that’s just showing that in a real world setting, healthcare practitioners report that their atypical antipsychotics, usually people don’t get much better or they don’t work very well, basically. Again, I suppose that’s slightly setting the scene for their new drug, but it reports what we already know and a lot of these drugs are used, but they’re not really much good, in general.

Dr. Byron Creese:

So there’s that gap at the moment, where there are some people that evidently need some kind of treatment for psychosis, but there’s nothing available except these older antipsychotic drugs. There was just another poster about the need to develop educational tools for dementia related psychosis so that it’s better recognized by healthcare practitioners and that was Thomas Indigan at Medscape Education, but it’s done in collaboration, I think, with Jeffery Cummings, as well. That was developing an educational tool for practitioners so they can learn more about psychosis, learn more about treatment options available, what works, what doesn’t work, what the dangers are and so on.

Dr. Byron Creese:

I feel those three were interesting. They must be, I don’t know if it’s cynical. I think their positions to support some new compound, I suspect.

Adam Smith:

Yeah. I think, even some of the trials that we’ve seen that have been less successful in things, that they’re trying to make the point now that it’s not necessarily that the trials didn’t work, it’s that you have to give the right drug to the right person at exactly the right time and that personalized medicine is the key factor here. It’s not that they’re bad drugs, they were just giving them to people at the wrong time. Which is something that’s come up a few times over the last few days.

Adam Smith:

I’m going to, very quickly, draw attention to a few things that caught my eye. Karen Chastry from Toronto did a very interesting talk on creating tech for people with dementia and MCI, which I thought was very interesting. Jane Senior from Manchester, I wasn’t sure if she was presenting Katrina Forsythe’s work or if it was the other way around. That was very interesting. That was about prison population. 16% of people in prisons are older now but, yet, prisons are designed for younger people and that if you were an older person in prison, you were four times less likely to have a diagnosis of dementia compared to the general population outside of prison. Which then did get me thinking about do they need some specific facilities for older prisoners or, actually, is this more to do with looking at more how we disperse justice? Do we create new facilities? It’s got me thinking about various things, but that’s an interesting talk, Jen Senior from Manchester.

Adam Smith:

I love this one. So Gregory Day from the Mayo Clinic in Florida, I’ll cut straight to his highlight. They were looking at assessing the reliability of reported medical history in older adults compared to actual medical history and this is something that is important because so much time and money and cost and, not just for people performing trials but people who want to participate in them as well, they’ve lost it in screen failure. Screen failure is this thing that everybody wants to try and reduce. It’s an awful term, isn’t it? Because people feel like they failed then if they don’t get randomized. Anyway, they checked the likelihood of diabetes and stroke being accurately reported by people when they came to be tested. One in four people who reported being diabetic weren’t and one in six people who reported not having a stroke, had. Which I thought was fascinating stats.

Dr. Byron Creese:

It wasn’t that they’d had a stroke and not known about it. [crosstalk 00:54:54]

Adam Smith:

Okay. You’re right. People that had strokes didn’t realize. One in six people said they hadn’t had a stroke but actually had. One in four people thought they were diabetic, but weren’t.

Dr. Riona McArdle:

It’s kind of the same for diabetes, though, isn’t it? They’ve all been told that they have diabetes at some point and then might’ve gotten their levels back to normal and now they don’t have it but they still think that they’ve got it because they’ve not been told, probably, that they don’t. That was a really interesting talk, though. You’re right, Adam.

Adam Smith:

It was. They did highlight that there are national screening programs for diabetes, as well. Whether people go to the follow ups is the key. The main take away here was that medical history should be objectively confirmed. No surprises. I reached out to them because I’m quite interested, we have this in joined dementia research, I did a lot of screening for one of the biogen studies. One of the interesting things about that was how many people tended to actually… we always thought that people would, let me get this the right way around, under report their seriousness. So if you say somebody how severe is your symptoms? They would generally say they’re more severe than they actually are, and we thought it would be the other way around, that people would underestimate and go, no, I’m fine. Actually, they don’t. It’s completely reversed. So back to that point about screening earlier, I’m quite interested to look at how real life screening data compared to what people reported in a register, like joined dementia research, to see if there are differences there and if we can start to predict what those might be to do better matching and better recruitment to trials. There’s some potential in that.

Adam Smith:

Sorry, Ri. Did you have anything to add on that Gregory Day study?

Dr. Riona McArdle:

Not really. One of the things that they said for the stroke was that one of the independent factors that predicted an inaccurate reporting of having a stroke was the use of unrelated collateral sources as well. So, basically, people who weren’t related to them may not know as much about them, but I spoke to Gregory Day about it as well, and he said that they made sure to have the collateral sources and the patients in different rooms from each other so they couldn’t influence each other’s thinking. And that’s something I was interested in because in a lot of healthcare settings, often, say a couple might go in and then they might be more biased in their answers so that they’re not upsetting the other member of their couple. For example, you could ask them do you feel really depressed right now? And they might not want the other member to know, so they’ll be like no I’m absolutely fine, and you won’t get a really accurate report that way. But they said that they keep them out for that reason, but it is a consideration then, when you think about actual clinical practice, that that could be increasing inaccurate practice as well.

Adam Smith:

That’s interesting. I’ll have to bare that in mind when we’re looking at new systems for enrolment trials and things and, obviously there’s been a lot of talk about how trials have been affected by COVID over the last few days and how we need to embrace technology to ensure that we can fill in the gaps and the data doesn’t get lost. And being able to perform, exactly, to have that objectivity that you mentioned there whilst using that new technology might be something we have to think about. Or somebody does.

Adam Smith:

The other thing to highlight that Alzheimer’s Association highlights yesterday was the SOL-INCA study that found that Apoe four, the gene with the strongest impact on Alzheimer’s risk for white European decent of populations appears to be less accurate predictor of risk in populations from Latin America. So please do have a look at that. They’ve tweeted about it as well. I think that’s the last of my notes. We’ve probably run dreadfully over time, as usual. Before we start to think about wrapping this up, obviously we’ve talked about one of your presentations, have you been presenting other stuff this week?

Dr. Riona McArdle:

I also presented a poster this week looking at novel jill task cognitive measure for gait to see if a specific type of jill task was better at discriminating Lewy Body disease from Alzheimer’s disease in comparison to usual gaits, where you just walk at your comfortable pace. Spoiler alert: it’s not. Usual gait seem to be the same, if not better than this particular jill task. So that was quite interesting, just summing up some of the last bits of my Ph.D. but the main one for me was the presentation, looking at care homes versus community dwelling people with cognitive impairment and that was in collaboration with University of Auckland and Auckland University of Technology as well. It was really nice to get the opportunity to do that.

Adam Smith:

I did see that. Were you angling for a nice little trip to New Zealand off the back of it?

Dr. Riona McArdle:

No. Not quite. I, hopefully, if I get a fellowship, I would hopefully be working with [inaudible 01:00:14] he’s the professor on that study and would do a small couple of trips to New Zealand to collaborate with her there, and they’re collaborating with my PI professor in Rochester at the moment [inaudible 01:00:28] so I was fortunate enough to be allowed to look at some of the data that I thought matched well with my Ph.D. data.

Adam Smith:

Cool. Are you caught up in this awful suspension of funding rounds for fellowships right now? Are you caught up in the middle of that?

Dr. Riona McArdle:

Yeah. A little bit. I was hoping to apply for the Alzheimer’s Society, but I don’t think that they’re going to go ahead this year. I’ve applied for the Henry Welcome so we’ll have to see how that goes and then have a look again in January when the NHR open up.

Adam Smith:

Well fingers crossed and good luck for that. Byron, did you have anything that you’re presenting this week?

Dr. Byron Creese:

I had a poster about using bioengematic techniques to understand side effects of antipsychotics and then yesterday presented in an on demand session and then a Q and A later on. The on demand session was organized by Clyde Feldman and it was about advancing clinical trials in the digital age, I think, was the title. Not of my presentation, of the session, and then I talked about a particular tool called the “Mild behavioural impairment checklist” which we think might be a pretty quick and easy way to enrich samples for people at risk of dementia. So might normally do an Apoe test or a cognitive test, but both of those take a little bit of time. We’ve shown that on MBI screening can be done with a questionnaire which takes about 10, 15 minutes to fill out. And you get an idea of the level of new onset psychological symptoms, which for some people can be the very first manifestation of new age degenerative disease, even before obvious cognition. So if you can do that quickly and at scale, there’s more and more emerging data about links with MBI to pet pathology changes, genetics, so on.

Dr. Byron Creese:

Just eluding back to what we were talking about in difficulties in screening, it might be a quick and easy way to enrich samples for people that are more likely to progress further through each screening.

Adam Smith:

Thanks, Byron. And if anybody is really interested in your on MBI, of course, you did very kindly record a webinar with us last month.

Dr. Byron Creese:

I did.

Adam Smith:

I believe that is available on our YouTube channel, which is YouTube.com/dementia research. Let’s think about wrapping up now then. This is the last of our podcasts for the AAIC 2020. There is another day of the conference starting shortly. We’re recording this Friday morning so there is another set of sessions this afternoon which include the ask sessions where, I believe, you can put your questions to senior researchers, the various PIA sessions and educational workshops. I wanted to highlight, of course, the way the conference is being delivered this year does mean that all the posters and presentations and the live sessions have been recorded and they’ll be available via the platform for the next 30 days, however, I think you do have to be registered by today, the 31st of July, to be able to access those over the next 30 days.

Adam Smith:

So if you haven’t already registered, quickly register now and then you can watch this at your leisure over the next 30 days or 60 days if you’re an ISTAART member and ISTAART does have 50% off its membership right now. So do have a look at joining ISTAART. I believe, also, as well, that ISTAART has a whole range, the professional interest areas have a whole range of activities planned over the next two, three weeks with lots of webinars and on demand sessions and Q and A sessions and things so if you are a member of ISTAART, you can access that content, some of which is very relevant for early career research and such things.

Adam Smith:

I particularly challenge you to go look at things that are outside of your comfort zone, given it’s free. You’ve got 30 days or 60 days. Go browse through the content. Challenge yourself to look at something that’s out of your immediate sphere of interest and do encourage your colleagues, maybe from other disease areas to go and have a look as well? We keep talking about the need to collaborate more with researchers in different disease areas so it’d be great if the way the conference is being delivered this year enables some of that.

Adam Smith:

I’m going to come back to everybody, just final reflections on how we think the week’s gone as our last one. We look back on the format, the tech, the layout. How did you find it, Esther, as your first AAIC? Because you don’t know what a physical one is like. How did you find the platform?

Esther Wiskerke:

It was good. Like you said, it made it accessible for myself and I thought just spare a thought for the IT people behind the scenes. I thought the way they did their timings was pretty good. I think some speakers could possibly do with a bit of a workshop on how to speak less monotonous.

Adam Smith:

That’s neurologists for you. Honestly, if you’ve ever been to a neurology concert there.

Esther Wiskerke:

Some were hard to get through. There was no standing ovations in the audience. Not many, at least.

Adam Smith:

Neurologists hated me everywhere.

Esther Wiskerke:

That could improve, I suppose. Other than that, lovely and particularly put together and well done for [inaudible 01:06:32]

Adam Smith:

Thanks, Esther, and thanks very much for joining us today. What about you, Ri?

Dr. Riona McArdle:

Yeah. I really enjoyed the format. I thought they did it really well. It was a lot to get through. I think I felt a lot more pressure to watch a lot more stuff because, normally, you have to pick a session and stick to it. That wasn’t really the case this year so I definitely watched an awful lot of things and I felt fatigued by the end of yesterday. But I did really enjoy it. I think it’s good format. Really accessible format to people as well. I know they had like 21,000 people or something this year at it, which is insane. I did miss the crack, though, from going to an actual AAIC conference and having a ridiculous opening ceremony with dancers and all sorts of [inaudible 01:07:21] so, hopefully we’ll be back again next year for it.

Adam Smith:

I agree. Actually, I think I came away feelings slightly less guilty because, usually, I’ll often come away thinking oh my god, I didn’t see as much as I would. It’s so expensive to come here. You’ve travelled so far to do it and then if you accidentally walk into the wrong room at the wrong time, you can end up sitting in there for two hours, unless you get out and run across the conference hall to find the next place. So I really enjoyed it in that respect. I think it’s amazing that they’ve done this for free, that they haven’t still tried to charge people because they must’ve taken already, by that point a lot, the early bird had been gone. They had a lot of money in the bank. The fact that they continue to do this for free, I think is amazing. And many of the other conferences later this year are still trying to charge full price, should take a long hard look at their models to provide this in this way, if they can afford to. So I think that’s brilliant.

Adam Smith:

What about you, Byron?

Dr. Byron Creese:

I think it’s awesome they kept it online and great that it’s free and, I think going forward, hopefully, they can maintain some accessibility for people being able to attend that wouldn’t be able to by keeping some of these features. I, personally, find one of the most beneficial things of conference is I end up talking to people and chatting about work and we get ideas and I’d been talking to Zayn Arishman in Calgary every week, literally, more or less, every week for the last two years because we met at AAIC and loads of work has come out of that, for example. He’s in Calgary, which is miles away. So that sort of thing is really good and I miss that and it did take, this is a personal thing, it just took me a couple of days to get my head around it. I just couldn’t. All these emails come in about it and I just couldn’t work it out. But that’s just me.

Adam Smith:

I know what you mean. I think, if you’re the kind of person that’s pretty who’s pretty active on Twitter, I think, that kind of Twitter complimented this quite well. I’m not convinced that the chat rooms and chat functions were about this experience, though, through the dementia researcher website, we killed our chat rooms off because nobody used them and I’m not convinced that worked amazingly.

Dr. Riona McArdle:

I think it’s hard, like already listened to you talk hours ago and then you go into the chat room and you’re like, I listened to seven other talks now. I don’t know what’s happened.

Dr. Byron Creese:

So the on demand sessions, I realized you can just view them at any time, which is great, because it doesn’t matter so much that I missed two days, almost, into the conference. But we did a Q and A yesterday evening. I think it was pretty well attended and, actually, it was good. It was mostly the presenters chatting with each other to talk about work we’re going to do because we were from different places and that sort of thing. So that was really good.

Adam Smith:

I’ve left a few questions on posters and talks and not had replies and then, of course, I can’t necessarily remember which ones I did to go back and look to see if I’ve had a reply and I don’t seem to get any notification or prompt that they replied to me, so then, unless I can remember and write good notes and go back and find it, or I have gone back and looked and there’s been no reply. I asked a question yesterday about the ketones session about what participants were in that trial and 24 hours later, there’s no reply. We’ll have to see. But, honestly, I think Alzheimer’s Association, congratulations on putting together an awesome conference with short notice and I think if there’s a way of making future conferences have a way to engage like this through an online platform, as well as in a physical attendance, I think that would be great. You could maybe charge half price for people to engage online, now that people know what to expect and I’m pretty sure people would still pay. If you had a choice of $1,000 to go to it or $500 to participate online, I’m fairly sure you’d still get a lot of people who would go for the online option.

Adam Smith:

Agree? Maybe?

Dr. Riona McArdle:

$500 is a bit steep to pay for something online.

Adam Smith:

Yeah. Maybe. They’d pay something, I think. It’s good to have an online offering because, otherwise, it’s prohibitively expensive if you don’t have it billed into a grant or some other funding. It is. And next year’s AAIC, which we hope will go ahead as a physical thing in Boston in July, it’s when you add in the fact that you need a hotel for a week, you’ve got flights to the US for a week, you’ve got $1,000 for the ticket. It adds up, whereas, a few hundred dollars to participate virtually, I think would be great.

Adam Smith:

Well thank you very much, Esther, Byron and Ri for joining us today. As we said. Alzheimer’s Association provides a whole load of content over the next couple of weeks so please do take a look. Please remember to like, subscribe, review our podcast through wherever you get your podcast. We are going to have a couple weeks off now because we’ve had a bit of a full on two weeks of podcasts with the relay one’s last week and AAIC ones this week. We will be back on the 10th of August with Megan Torville, Sarah Carpaninis and Tom Phillips from the University of Cardiff to talk about mouse models in AD. If you’re a new listener, please be sure to register on our website to get your Friday bulletins and lots of news for our website. Thank you very much, everybody, and we’ll look forward to seeing you at podcasts very soon, I hope.

Voice Over:

Brought to you by dementiaresearcher.nihr.ac.uk. In association with Alzheimer’s research UK and Alzheimer’s Society. Supporting early career dementia researchers across the world.

END