Spotlight

Spotlight: Stimulating Program on Tap for Joint Meeting of IPA, Royal College of Psychiatrists’ Faculty of Old Age

On behalf of the organizing committee, it gives me great pleasure to describe this exciting meeting, hosted by the Institute for the Health of the Elderly of the University of Newcastle upon Tyne. The theme, "Non-Alzheimer Cognitive Impairment," reflects growing awareness of the importance of investigating mechanisms of cognitive impairment in conditions apart from Alzheimer’s disease (AD), as well as emphasizing the growing need for the development of rational treatments for these disorders. Several research groups in the UK have a major interest in this area, and this meeting will provide a unique opportunity to gain an international perspective on key developments.

We are delighted by the number of internationally renowned speakers who have accepted invitations to attend, and hope you will agree that the scientific program (available, with abstracts, at www.ncl.ac.uk/psychiatry/ipa_conference/) offers an extremely varied and stimulating series of plenary lectures, symposia, new research presentations and poster sessions. 

The first presentation, on 5 April by Philip Scheltens, will focus on the use of neuroimaging in the differential diagnosis of non-Alzheimer dementia. However, the role of neuroimaging is not limited to that of diagnosis and Dr. Scheltens will also discuss how Magnetic Resonance Imaging (MRI) techniques (such as functional MRI) can study the memory system and its connections, and outline how this has relevance for our understanding of dementia. The symposium on frontal lobe dementia brings together leading groups from the UK (David Neary, Julie Snowden), Sweden (Lars Gustafson, Arne Brun) and the USA (Bruce Miller, Dan Geschwind) to provide a stimulating review of this fascinating condition which is a common cause of dementia in the under 65's.

There have been recent advances in diagnostic criteria and in the description of subtypes, which shall be discussed by David Neary and Lars Gustafson. Julie Snowden will highlight the role of the frontal and temporal lobes in the processing of emotions and illustrate the broad spectrum of repetitive behaviors that characterize frontotemporal dementia (FTD). Bruce Miller will discuss the interesting clinical and neuropsychological profile in patients with selective dysfunction of the right hemisphere who show marked abnormalities in social behavior, including loss of concern for others, loss of empathy, and intensification of political or religious ideas. Dan Geschwind will give an update on current issues in the genetics of FTD, an area in which rapid advances have recently been made. He will discuss the interesting condition of FTD and Parkinsonism (FTD-P). Forty percent of patients with this condition have a family history (usually with dominant transmission), making FTD-P the most common inherited dementia. Genetic linkages with chromosomes 17 and 3 have been demonstrated, a particularly interesting finding because several of the mis-sense mutations are in the gene coding for microtubual associated tau protein. Finally, the difficult and controversial area of neuropathological classification of FTD and Picks disease, and the relationship between the two, will be discussed by Arne Brun.

The importance of the often-neglected topic of cognitive impairment in functional disorders is highlighted by a special symposium devoted to this subject. Brian Lawlor will discuss the concept that the cognitive impairment of late-life depression may represent a "pre-dementia syndrome," while Philip Harvey will report a five-year follow-up study of over 1000 elderly patients with schizophrenia, finding that those at increased risk for cognitive and functional decline are patients with lower levels of formal education. This finding, possibly due to a smaller "brain reserve capacity" may have important parallels with the intriguing findings from several studies showing that higher education appears to be protective against the development of AD. Michael Davidson will present data supporting the use of atypical antipsychotics as having beneficial effects on cognition. 

The session on delirium will include presentations on the concept by James Lindesay, who will highlight that current diagnostic criteria are almost entirely based on descriptions from younger patients, and argue their emphasis on positive symptoms and identifiable external causes may not be applicable to elderly patients. Hannu Koponen will discuss possible neurochemical mechanisms and show that delirium is associated with changes in neuropeptides (somatostatin and beta-endorphin) and CSF acetylcholinesterase, as well as alterations in serotonergic metabolites. Risk factors for delirium will be summarized by Shaun O’Keeffe, the most consistent of these being old age, prior cognitive impairment, severe illness, dehydration, drug use, and visual impairment. Ingmar Karlsson will discuss management options.

Dementia with Lewy bodies (DLB) is now widely recognized as the second most common cause of degenerative dementia in the elderly. David Munoz will distinguish between the pathology of DLB and the many different causes of dementia in Parkinson’s disease, as well as discussing the pathological overlap between DLB and AD. Teodore Del Ser will present data on the accuracy of clinical criteria for DLB, suggesting that, although clinical criteria are capable of distinguishing pure DLB from AD, mixed AD and DLB cases have a similar clinical profile to AD cases. Matthew Walker will present his work seeking to obtain more objective quantification of fluctuation, a key symptom of DLB but one difficult to operationally define or standardize, using a semi-quantified scale of fluctuating consciousness and variability in neuropsychological and electrophysiological measures. Clive Ballard will introduce the term neurocardiovascular instability (NVI), which refers to conditions such as orthostatic hypertension and carotid sinus hypersensitivity, both important causes of dizziness and syncope in later life. These conditions may be particularly common in dementia and NVI of at least one type was seen in over half AD cases and 80% of DLB. Somewhat worrying is preliminary data suggesting that cholinesterase inhibitor treatment may worsen such problems. Finally, Zuzana Walker will discuss the potential of a SPECT ligand for the dopamine transporter (FP-CIT) as a tool in the differential diagnosis of DLB from AD. 

We are delighted that Simon Lovestone from the Institute of Psychiatry has accepted the invitation to give a plenary and public lecture on the genetics of dementia. His presentation will review research data in the context of how this information should be used, in other words, provide us with a scientific update as well as advice on what we should say to sufferers, families, and others.

The plenary presentation on 6 April by Jim Lowe will describe the main four pathological types of non-Alzheimer degenerative dementia: tauopathies such as FTD-P and Pick’s disease; synucleinopathies which include DBL; ubiquitin inclusions seen in conditions such as Motor Neurone Disease Dementia, and cases with only neuronal loss and microvacuolation. Prion dementias, particularly important in the UK where several cases of new variant Creutzfeldt-Jakob disease (nvCJD) have been described, will be the focus of a plenary presentation by Robert Will. He will describe recent scientific evidence which seems to prove "beyond reasonable doubt" that nvCJD did arise from cattle infected with Bovine Spongiform Encephalitis (BSE), while pointing out the potentially alarming fact that, even now, accurate predictions of the future number of cases of nvCJD cannot be made with any confidence.

In the session on Vascular Dementia (VaD) Raj Kalaria will discuss neuropathological changes, while David Desmond will address the important issue of dementia after stroke, which affects 25% of elderly patients three months after stroke. Leonardo Pantoni will outline the significance of white matter change, or "leukoaraiosis," concluding that such changes are more prevalent in demented subjects, are an independent predictor of dementia after stroke, and are associated with alterations in specific cognitive domains such as attention, visuospatial skills, and frontal lobe functions. The "non-Alzheimer" focus of the meeting may be somewhat challenged by Ingmar Skoog, who will summarize recent epidemiological and neuropathological studies suggesting a large degree of overlap between AD and VaD, postulating that similar mechanisms may be involved in the pathogenesis of both.

The accumulating evidence that similar therapies may be effective in a range of disorders is reflected in a single symposium on that theme. Kenneth Rockwood will discuss trial design, while Ian McKeith will present new evidence from a randomized double-blind placebo controlled study that rivastigmine can improve non-cognitive symptoms, particularly apathy, hallucinations, delusions, and anxiety, in DLB. Timo Erkinjuntti will outline possible strategies for intervention in vascular dementia and Ron Petersen will discuss therapy of mild cognitive impairment (MCI), suggesting that either vitamin E or anticholinesterase medication will reduce the rate of conversion from MCI to AD by 15% over the course of three years.

Friday morning, 7 April, will consist of a series of plenary sessions on Age-Related Cognitive Decline (Karen Ritchie), the Neuropsychology of Frontotemporal dementias (Karalyn Patterson), Diagnostic Criteria for VaD (Gustavo Román), and Service Provision for Non-Alzheimer dementias (Mary Marshall). 

The conference venue is in the heart of Newcastle upon Tyne, a lively and vibrant city renowned for its warmth of welcome, friendliness, and night life. The local area is steeped in history, with many unique examples of historic Roman Britain close at hand, including Hadrian’s Wall and several Roman forts, in addition to miles of beautiful, unspoiled coastline, superb castles, and the magnificent Northumberland National Park. Delegates can visit historic Holy Island and discover 7th century Britain known by the Venerable Bede or relive the traditional lead and coal mining industries of the area. Alternatively, the lively Quayside area (adjacent to the main conference hotel, the Copthorne) is famed for its restaurants, hotels, pubs, cafés and night clubs, and provides an ideal aprés conference venue. A taste of history also will be provided by an Elizabethan Banquet, held at nearby Lumley Castle, where traditional food (eaten authentically, using only fingers and a dagger!), plenty of wine, and period entertainment will give a lasting and memorable impression of life in 16th century Britain. Other social events include a Welcome Reception and main Conference Dinner. We look forward to meeting you in Newcastle for what we anticipate and hope will be a most successful meeting, both in terms of scientific content, social interaction, and as a vehicle for forging ever stronger links between IPA and the Royal College of Psychiatrists.

John T. O’Brien
on behalf of the Organizing Committee

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