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Chathuri Yatawara,1 Fatin Zahra Zailan,1 Esther Vanessa Chua,1 Linda Lay Hoon Lim,1 Eveline Silva,1 Joanna Sihan Wang,1 Adeline Ng,1 Kok Pin Ng,1 Nagaendran Kandiah1– 3 1Department of Neurology, National Neuroscience Institute, Singapore, Singapore; 2Duke-NUS Medical School, Singapore, Singapore; 3Lee Kong Chian School of Medicine-Imperial College London, Nanyang Technological University, Singapore, SingaporeCorrespondence: Nagaendran KandiahNational Neuroscience Institute, Level 3, Clinical Staff Office, 11 Jalan Tan Tock Seng, Singapore, 308433, SingaporeTel +65 6357 7171Fax +65 6357 7137Email Nagaendran.Kandiah@singhealth.com.sgBackground: Rivastigmine is used to treat cognitive impairment in Alzheimer’s disease (AD); however, the efficacy of Rivastigmine in patients with AD and concomitant small vessel cerebrovascular disease (svCVD) remains unclear. We investigated the effectiveness of Rivastigmine Patch in patients with AD and svCVD.Methods: In this open-label study, 100 patients with AD and MRI confirmed svCVD received 9.5mg/24 hours Rivastigmine transdermal treatment for 24 weeks. The primary outcome was global cognition indexed using the ADAS-Cog. Secondary outcomes included clinical-rated impression of change (indexed using (ADCS‐CGIC), activities of daily living (indexed using ADCS-ADL) and side effects.Results: Overall, performance on the ADAS-Cog after 24 weeks deteriorated by 1.78 (SD = 5.29) points. Fifty-two percent of the sample demonstrated improvement or remained stable, while 48% demonstrated worsening of ADAS-Cog scores. Of the 52%, significant improvement (2 or more-point decline) on the ADAS-Cog was observed in 25% of the sample, with a mean change of − 5.08 (SD = 3.11). A decline on the ADAS-Cog was observed in 48% of the sample, with a mean change of 6 (SD = 2.98) points. Cognitive outcome did not interact with severity of svCVD. ADCS-ADL scores remained stable from baseline to week 24 and ADCS‐CGIC reports indicated that 81% of the patients remained stable after treatment. Side effects were reported by 16% of the patients, with contact dermatitis being the most common.Conclusion: Our findings suggest that Rivastigmine may have a role in the management of patients having AD and concomitant mild-severe svCVD, with minimal side effects.Keywords: rivastigmine, Alzheimer’s disease, small vessel cerebrovascular disease, treatment

BackgroundPersons with mild stroke experience minimal functional difficulties; nonetheless, they are at elevated risk for post-stroke cognitive impairment (PSCI) and cognitive decline. AimsWe report outcomes from an observational cohort study of a structured, multidomain intervention for persons with mild strokes. MethodsThe Stroke Memory RehabiliTation (SMaRT) program comprises weekly two-hour group sessions for six weeks on cognitive strategies, lifestyle and relaxation. Participants were recruited from a tertiary hospital between June 2018 to September 2019. They had MRI-confirmed ischemic strokes with mild functional difficulties (modified Rankin Scale score ≤3). Participants underwent assessments and questionnaires at baseline, 1-week post-program, 3 months post-program, and 6 months post-program. Results Participants (N=108, mean age=63.54±9.22, 31.5% female) demonstrated significant improvement in cognition, mood, activities of daily living (ADL) and quality of life (QOL) (ps vs. 25.80±2.83, Beta=1.26, 95% CI(0.78,1.74)), pppppConclusionsThe SMaRT program is a cost-effective, scalable, structured program for PSCI. Findings suggest its potential effectiveness in reducing cognitive decline and improving other domains of well-being, with carry-over benefits after 6 months.

Background Southeast Asia represents 10% of the global population, yet little is known about regional clinical characteristics of dementia and risk factors for dementia progression. This study aims to describe the clinico-demographic profiles of dementia in Southeast Asia and investigate the association of onset-type, education, and cerebrovascular disease (CVD) on dementia progression in a real-world clinic setting. Methods In this longitudinal study, participants were consecutive series of 1606 patients with dementia from 2010 to 2019 from a tertiary memory clinic from Singapore. The frequency of dementia subtypes stratified into young-onset (YOD; Results Dementia of the Alzheimer’s type (DAT) was the most common diagnosis (59.8%), followed by vascular dementia (14.9%) and frontotemporal dementia (11.1%). YOD patients accounted for 28.5% of all dementia patients. Patients with higher lifespan education had a steeper decline in global cognition (pp=0.0006). Older patients with a moderate-to-severe burden of CVD demonstrated a trend for a faster decline in global cognition compared to those with a mild burden. Conclusions There is a high frequency of YOD with DAT being most common in our Southeast Asian memory clinic cohort. YOD patients with higher lifespan education and LOD patients with moderate-to-severe CVD experience a steep decline in cognition.

Background: To develop a model for collaborative care for persons with dementia and their family caregivers in the San Francisco Bay Area. Methods:By delivering consistent compassionate care, strong relationships can be built between providers and the patients/families they work with. Listening carefully to desires and needs, including a desire to help others, practitioners can then work with their philanthropic organization to develop a business plan that can be supported with donations. The goal of the partnership is to provide newly diagnosed patients and their families a range of dementia related services, support and education as the disease progresses. Results: With extensive research and development effort, we were able to secure a $20 million (US$) endowment gift to create a Brain Health Center (BHC) at California Pacific Medical Center in San Francisco. This center will offer a multidisciplinary care team to diagnose, assess, treat, counsel and support families throughout the course of Alzheimer’s and related disorders. The team consists of medical providers in neurology, psychiatry, pharmacy and geriatric medicine, neuropsychologists and therapists, neuro-imaging, social work, physical and occupational therapy, nutrition and nursing. The team also includes staff employed by the Alzheimer’s Association but housed within the BHC to work as a member of the “Care Navigation Team”. Education programs including “Savvy Caregiver” classes, “Living with Alzheimer’s Disease,” "Know the Ten Signs of Alzheimer’s", “Maximizing Your Memory” and various caregiver training programs are offered through the BHC by the onsite Alzheimer’s Family Care Specialist. This clinician and other team members offer structured and unstructured groups, provide referrals to off-site support services/groups, answer questions about the disease process and smoothly lead patients/families through the healthcare maze. Conclusions: This poster presents a conceptual framework for creating partnerships that utilize the strengths of each institution to positively impact quality of dementia care, and allow easier access to resources to facilitate earlier diagnosis. Given the increasing need for patient and family services that is becoming difficult to finance, this manner of program building will fill a gap going forward. This project can serve as a model for replication at other centers.

Background The incidence of post stroke cognitive impairment (PSCI) and predictive factors for PSCI among patients with acute lacunar infarcts is unclear. Objective To study the impact of acute lacunar infarcts and chronic white matter disease in the development of PSCI. Methods Prospective cohort study of stroke patients attending a tertiary neurology center. Patients with MRI confirmed acute lacunar infarcts without pre-existing dementia were recruited. Logistic regression was used to determine risk factors for developing PSCI. Results 145 patients with a mean age of 55.8 years were studied of which 48 patients (33.1%) were identified to have PSCI. Patients with PSCI performed worse on the MMSE, MOCA and FAB and had significantly greater white matter hyperintensity (WMH) in the frontal subcortical (FSC) region (p = 0.006) and higher frontal subcortical acute infarct load (p = 0.002). Logistic regression demonstrated that deep subcortical WMH (odds ratio, OR = 1.45) and acute FSC infarcts (OR = 1.51) were associated with PSCI. High WMH load without acute FSC infarcts was associated with increased risk of PSCI (OR = 4.1). When patients developed acute FSC infarcts on pre-existing severe WMH, the risk of PSCI increased substantially (OR = 11.0). Conclusions Patients with acute lacunar infarcts in the FSC region have 1.5 times risk of PSCI. This risk increases substantially to 11 times when there is pre-existing severe white matter disease.