Merged As Critical to Harnessing the Potential of Digital Mental Health

2019 AAGP Annual Meeting

TABLE OF CONTENTS

Attendee Letter...... S1

Notes...... S2

Session Abstracts Physician Aid-in-Dying: Updates for Geriatric Psychiatrists ...... S3 Stretching Beyond Capacity: New Solutions for New Problems ...... S3 The Use of Multimodal Mri and Computational Approaches to Inform Novel Interventions for Aging and Mood Disorders...... S4 Building Your Clinician / Educator Career...... S5 Geriatric Psychiatrists’ Dilemma - Antipsychotics Prescribing in Long Term Care ...... S5 Diagnostic Considerations in Evaluating Geriatric Patients With Movement Disorders ...... S6 Writing and Getting Published: Developing This Important Skill Set for Geriatric Mental Health Professionals ...... S7 Mechanisms Informing Interventions: New Approaches to Treating Latelife Depression ...... S8 New Insights Into Loneliness and its Treatment in Older Adults...... S8 The Role of Empathy in Caring for Persons With Dementia...... S9 How They Measure Up: Rating Scales in Geriatric Psychiatry...... S10 Gay and Gray ix: Turning Red, White and Blue: How a History of Military Sexual Trauma Impacts The Lives of Older Lgbt Veterans ...... S10 Challenges in 21st Century Inpatient Geriatric Psychiatry and Long Term Care Practice...... S11 Research Award Session: Adventures in Dementia Epidemiology ...... S12 Older Refugees: Age-speciﬁc Challenges, Strengths, and Recommendations for Care...... S12 Suicide in Late-life: Collaborative Approaches for Assessment, Prevention, and Treatment ...... S13 Prevalence of Neuropsychiatric Symptoms Across The Cognitive Spectrum and Their Impact on Future Cognitive Decline...... S14 Innovations in The Delivery of Dementia Care in A Rapidly Evolving Health Care Landscape...... S15 Evaluation and Treatment of Sleep Complaints in The Older Adult ...... S15 Firearm Safety and Anticipatory Guidance for a Geriatric Patient With Alzheimer’s Dementia in The Outpatient Setting: A Fellow’s Dilemma ...... S16 Preparing for The Future and Diversity of Geriatric Mental Health ...... S16 Advances in The Molecular Imaging of Alzheimer’S Disease: Neurobiological Mechanisms of Disease and Neuropsychiatric Symptoms ...... S17 Management of Inappropriate Sexual Behaviors in Dementia Using Multidisciplinary Teams in The Continuum of Care ...... S18 Thinking Beyond The Clinic: Community-Based Interventions for Diverse Older Adults and Their Caregivers...... S18 Reading Between The Lines: Health Literacy Among Older Adults...... S19 Public Policy Session 3: Connecting Surplus Medicine With Patients: Policy & Technology ...... S20 Update on Electroconvulsive Therapy in Geriatric Depression ...... S20 Suicide-Related Outcomes in Older Veterans: Implications for Intervention and Prevention of Suicide ...... S21 Recipes for Adult Learning: Innovations in Teaching Geriatric Psychiatry...... S22 Ageist Policies - Discrimination Against Older Adults...... S23 Advocacy, Life and Death: Geriatric Suicide and Physician Assisted Suicide...... S23 Click Bait: Problematic Internet Pornography Use Among Older Adults ...... S24 Managing Behavioral and Psychological Symptoms of Dementia in The Era of Black Box Warnings...... S25 Developing Your Research Career ...... S25 Do No Harm: Identifying and Addressing Impaired Medical Providers ...... S26 Common Issues, Limited Options: Challenges Faced and Lessons Learned in The Outpatient and Inpatient Management of Psychotic Disorders ...... S26 Creative Resilience & Aging: Lady Be Good — Ella Fitzgerald’S Life in Song...... S27 Aging, Delirium, and Post-Intensive Care Syndrome: Novel Treatments and Future Directions ...... S27 A Novel Model for Late-Life Depression Intervention Development...... S28 Honors Scholars Alumni Session...... S29 Digital Tools in Geropsychiatry: From Research To Patient Care ...... S30 Public Policy Session 4: Ten Years Since The Federal Parity Law: What Next is Needed...... S30

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Racism and Ageism: Addressing Patient and Physician Barriers To Improve Older Adult Care ...... S31 International Medical Graduates and A Career As A Geriatric Psychiatrist ...... S31 Inﬂammation, Dopaminergic Decline, and Psychomotor Slowing As Pathologic Routes To Late Life Depression ...... S32 The Most Terrible Poverty: Addressing and Treating The Epidemic of Loneliness in Older Adults...... S33 With The Diversity in Perception of Caregiver Roles, Educating Healthcare Professionals, Engaging Families and Communities is Even More Essential To Promote Quality Care ...... S34 It’S The Path, Not The Destination: Lessons Learned From A Psychosocial Intervention for High Risk Depressed, Cognitively Impaired Older Adults ...... S35 Public Policy Session 5: Asleep At The Switch: How Geriatric Psychiatry, Implementation Science, and Health Policy Can Help To Reverse The Nation’S Greatest Health Disparity...... S36 Results of The Adni-Depression Study ...... S36 2018 Highlighted Papers for The Geriatric Mental Health Clinical Provider ...... S38 Deconstructing Delirium: Rethinking The Role of Biomarkers and Diagnostic Anomalies ...... S38 Psychopharmacology: Fact Or Fiction, Part 2 ...... S39 Advocating for Older Adults: When Guardianship is Not The Answer...... S39 Senior Investigator Workshop ...... S40 Survive, Thrive Or Die Out: Medicare and The Practice of Geriatric Psychiatry ...... S40 The Mind and Beyond: The Role of Mindfulness and Transcendental Meditation Practices in Late Life Mood Disorders...... S41 Firearms: Access and Implications in Older Adults With Cognitive Impairment ...... S42 Age-Related Hearing Loss As A Risk Factor for Late Life Depression and Cognitive Decline ...... S43 Update On Geriatric Psychiatry Maintenance of Certiﬁcation Program ...... S44 Two Roads Diverged in A Fellowship: Choosing Between Geriatric Psychiatry and Consultation-Liaison Psychiatry...... S44 Caring for Older Patients With Complex Problems: Challenges, Strategies, and The Veterans Health Administration Experience ...... S45 Sarcopenia, Sarcopenic Obesity and Frailty; Links To Cognitive Performance in Elders...... S46 Productive Aging and Creativity: The Lives and Art of M.C. Escher, Agnes Martin, Yayoi Kusama and Carmen Herrera...... S47 Driving in Dementia: Advances in Research and Clinical Approaches...... S47 Financial Abuse of The Elderly: The Role of Psychiatrists ...... S48 New Research On Older-Age Bipolar Disorder (Oabd) and Bipolar Disorder Across The Life-Span: An Update From The International Society of Bipolar Disorders Oabd Taskforce...... S49 Personality Disorders in Late Life: Perspectives From Clinic, Er and Long Term Care Settings...... S49 Bridging The Gap Between Neurology and Psychiatry-Atypical Presentation of Common Neurodegenerative Disorders ...... S50 Quality Measurement in Psychpro: Mips and Beyond...... S51 Oral Presentation 1: Geriatric Mental Health Workforce & Policy ...... S51 Oral Presentation 2: Non-Pharmacological Interventions...... S52 Oral Presentation 3: Affective Disorders...... S53 Alphabetical List of Presenters...... S55

Poster Abstracts Poster Abstracts by Title...... S101

Poster Abstracts by First Author ...... S107

Poster Abstracts...... S113

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2019 AAGP Annual Meeting

Dear Annual Meeting Attendee:

The American Association for Geriatric Psychiatry (AAGP) Annual Meeting is the premier educational program focused solely on late-life mental illness. The AAGP Annual Meeting provides the latest information on clinical care, research innovations, and models of care delivery.

This Supplement of the American Journal for Geriatric Psychiatry (AJGP) contains the abstracts of the scientiﬁc presentations that are scheduled for the 2019 Annual Meeting, “Engage for Change: Preparing and Partnering for the Future of Geriatric Mental Health” including session and poster presentations. We hope you ﬁnd it a useful resource for years to come.

We are pleased that we can provide this Supplement to those attending the AAGP Annual Meeting to maximize your attendance at the educational, research, and clinical presentations of interest to you, and also provide these abstracts, through on-line access (www.AJGPonline.org) to the subscribers of the AJGP, AAGP Annual Meeting website, and the AAGP Annual Meeting app.

Charles F. Reynolds, III, MD Melinda Lantz, MD Alex Threlfall, MD, MA Editor-In-Chief President 2019 Annual Meeting AJGP AAGP Program Co-Chair AAGP

Ilse Wiechers, MD, MPP, MHS 2019 Annual Meeting Program Co-Chair AAGP

Am J Geriatr Psychiatry 27:3S, March 2019 S1 2019 AAGP Annual Meeting

Notes

Session Abstracts

Within this supplement, session abstracts are organized by session number at the time this supplement was published.

Poster Abstracts

Within this supplement, poster abstracts are organized by poster session and poster number at the time this supplement was published. Poster abstracts are also listed alphabetically by title and by ﬁrst author listed.

All Session and Poster Abstracts appear as originally submitted to AAGP with only minor editing to conform to the style of this supplement.

Any typographical, grammatical, and/or syntax errors are solely the responsibility of the party submitting the abstract and/or abstract author. Content appears as submitted to the American Association for Geriatric Psychiatry for presentation.

The abstracts in this supplement for The American Journal of Geriatric Psychiatry are not peer-reviewed. Information contained in these abstracts represents the opinions of the authors.

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AAGP Annual Meeting 2019 Session Abstracts

PHYSICIAN AID-IN-DYING: UPDATES FOR GERIATRIC PSYCHIATRISTS Session 100 Edward Wicht, MD, JD1; Rohini Mehta, MD2; Sarah Anne Kleinfeld, MD3

1No afﬁliation provided 2Medstar Georgetown University Hospital, Washington, DC 3Washington, DC VA Medical Center

Abstract: At this time, five states (Oregon, Washington, Vermont, Hawaii, and California) and Washington, D.C. have statutes permitting PAD and outlining procedures for this process. One state, Montana, allows PAD under common law. At least thirty-six states have attempted to introduce legislation to legalize PAD. In states with statutes addressing PAD, patients are typically required to make multiple requests, both orally and in writing. They are required to have a terminal illness with a prognosis of six months or less as agreed upon by two physicians. Mental health and/or capacity assessments are typically not mandated unless at least one of the two evaluating physicians suspects a contributory underlying psychiatric illness or incapacitation. All states provide opt-out measures for conscientious objectors or those not wishing to participate. Initial data suggests that patients utilizing PAD are frequently college educated, insured, and engaged in hospice care. Patients requesting PAD are often those with terminal illnesses who are experiencing co-morbid severe pain, discomfort, and deterioration in functional status. Women, African-Americans, and those with cognitive impairments may be more likely to oppose PAD, highlighting the need to maintain protections for vulnerable patients where PAD is permitted. In one survey of physicians who have received requests for PAD (including those practicing in states where PAD has not been legalized), physicians reported a significant amount of co-morbid depression in those requesting PAD. Despite this, no legal requirements for psychiatric and/or capacity assessments exist in any state that has legalized PAD, except for Hawaii. In several European countries, chronic mental illness has been accepted as a terminal diagnosis, which may have significant impact in the United States as PAD is legalized in more states. Finally, as a federal entity, PAD is not permitted at VA facilities, even in states where it has been legalized. This may have major implications for patients and providers within the VA healthcare system.

Faculty Disclosures Edward Wicht Nothing to disclose

Rohini Mehta Nothing to disclose

Sarah Anne Kleinfeld Nothing to disclose

STRETCHING BEYOND CAPACITY: NEW SOLUTIONS FOR NEW PROBLEMS Session 101 Benjamin Brody1; Feyza Marouf2; Nancy Needell3

1Weill Cornell Medical College, Boston, MA 2MGH 3Weill Cornell Medical College

Abstract: Capacity assessments are an integral part of geriatric psychiatry. The tasks and decisions faced by older adults have changed radically in recent decades, yet many mental health and medical professionals still rely heavily on the criteria set forth by Applebaum and Grisso in their 1988 New England Journal of Medicine paper, "Assessing Patients’ Capacities to Consent to Treatment," in which they propose that a patient must communicate a choice, understand the relevant information, appreciate

Am J Geriatr Psychiatry 27:3S, March 2019 S3 AAGP Annual Meeting 2019 the situation and its consequences, and be able to use this information to make a reasoned choice. While this sequence remains critically relevant, we will present cases for which this process is not ﬂexible enough to capture the nuances of the momentous decisions faced by our patients. We propose additional ways in which capacity assessments can be augmented with the aim of balancing the often competing aims of patient autonomy and medico-legal paternalism.

Faculty Disclosures Benjamin Brody Nothing to disclose

Feyza Marouf Nothing to disclose

Nancy Needell Nothing to disclose

THE USE OF MULTIMODAL MRI AND COMPUTATIONAL APPROACHES TO INFORM NOVEL INTERVENTIONS FOR AGING AND MOOD DISORDERS Session 102 Faith Gunning1; Hilary Patricia Blumberg2; Lihong Wang3; Lindsay Victoria4

1Weill Cornell Medicine, White Plains, NY 2Yale School of Medicine 3UCONN Heatlh, Farmington, CT 4Weill Cornell Medicine

Abstract: Advances in neuroimaging methods and computational approaches provide an unprecedented opportunity to advance our understanding of the role of specific brain networks involved in cognitive and affective expressions of normal aging, major depression and bipolar disorder. In addition, these sophisticated neuroscience approaches can provide distinct targets for novel interventions for cognitive and affective symptoms. This session will present the results of state-of-the-art neuroimaging and computational approaches in normal aging, late-life major depression, and middle-aged and older adults suffering from bipolar disorder. First, Dr. Wang will present results using a novel analytic approach to combine structural and functional MRI data to measure compensatory mechanisms in older adults. In addition, she will relate this measure of brain compensatory mechanisms to exercise. Second, Dr. Victoria will use computational modeling of performance data and task-based fMRI data from a reversal learning task to parse the role of affective salience and reward functions in older adults and older adults with late-life depression. Third, Dr. Gunning will present data using a novel computational approach that is reliant on machine learning of resting state fMRI scans to classify older adults with into neurobiologically-defined subtypes of depression. Next, Dr. Blumberg will present data from multimodal MRI collected in older adults suffering from bipolar disorder and show abnormalities in systems involved in emotion regulation including gray and white matter decreases in ventral prefrontal cortex and in the white matter connections to the amygdala. The session will conclude with a discussion that integrates the findings from the four speakers with a focus on specific ways these approaches can inform novel interventions targeting specific brain network functions to improve cognitive and mood symptoms in older adults.

Faculty Disclosures Faith Gunning Nothing to disclose

Hilary Blumberg Aetna - Other Financial or Material Support

Lihong Wang Nothing to disclose

Lindsay Victoria Nothing to disclose

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BUILDING YOUR CLINICIAN / EDUCATOR CAREER Session 103 Alessandra Scalmati1; Brandon Courtney Yarns2; Dennis M Popeo3; Elizabeth J Santos4

1Albert Einstein College of Medicine 2VA Greater Los Angeles Healthcare System; UCLA School of Medicine, West Hollywood, CA 3NYU School of Medicine 4University of Rochester School of Medicine & Dentistry, Rochester, NY

Abstract: Opportunities for professional development and mentorship are vital for junior and mid-level faculty members to succeed in academic medicine. Too often, those opportunities are of short supply at institutions. In this special 2-hour, interactive workshop afﬁliated with the Teaching and Training Committee, learners will be exposed to several areas of professional development. Dr. Brandon Yarns and Dr. Alessandra Scalmati will build on their presentations from last year and discuss implementation and evaluation of a freshly developed curricula, focusing on choosing appropriate educational strategies and describing various designs for assessment and evaluation. Finally, barriers to introducing new curricula and tips about dissemination of the curricula will be discussed. Learners will also have a chance to practice what they learned. Dr. Dennis Popeo and Dr. Elizabeth (EJ) Santos will discuss helpful hints for junior faculty members. Dr. Popeo will speciﬁcally discuss things that he “wished he knew way back when” about career planning, negotiation and work-life balance. Dr. Santos will discuss networking − something that unnerves many people − and graceful self-promotion.

Faculty Disclosures Alessandra Scalmati Nothing to disclose

Brandon Yarns Nothing to disclose

Dennis Popeo Nothing to disclose

Elizabeth Santos Nothing to disclose

GERIATRIC PSYCHIATRISTS’ DILEMMA - ANTIPSYCHOTICS PRESCRIBING IN LONG TERM CARE Session 104 Amita Patel1; Chanida Siripraparat2; Donovan Maust3; Marie DeWitt4; Maureen Cecilia Nash5; Sandra S. Swantek6

1Dayton Psychiatric Associates, Dayton, OH 2Santa Clara County Behavioral Health Department 3University of Michigan, MI 4Oscar G Johnson VA Medical Center, Ypsilanti, MI 5Providence Elderplace Oregon, Portland, OR 6Rush University Medical Center, Chicago, IL

Abstract: Despite advances in the neurosciences, we continue to struggle with the treatment of neuropsychiatric symptoms in persons with dementia. There are very limited available treatments that are FDA approved. Recent statements and regulations have made the treatment of some neuropsychiatric symptoms of dementia more challenging. Despite the known risks of antipsychotics, APA has issued the statement indicating that there are still specific clinical situations which their use may be clinically appropriate. Conversely, CMS regulations have increased scrutiny of the use of antipsychotic medications in the Long- Term Care setting. The best interest of the patient seems to have been minimized, making it more difficult for us as geriatric psychiatrists to provide appropriate treatment for our patients. Our panel will discuss the following 1. The current data from examining antipsychotic and other psychotropic use among residents in long-term care using a national sample of Medicare data from 2009-2014, specifically focusing on antipsychotics and mood stabilizers. 2. The current CMS regulation of psychotropic medications prescribing with an emphasis on antipsychotics medication in Long-Term Care 3. The current public perception of

Am J Geriatr Psychiatry 27:3S, March 2019 S5 AAGP Annual Meeting 2019 dementia care 4. How CMS regulations of psychotropic medications affect the treatment of psychiatric patients and dementia care in nursing homes. 5. What we, as geriatric psychiatrists, can do to participate in the policy change to improve our ability to provide appropriate care to our patients in the current climate.

Faculty Disclosures Amita Patel Neurocrine - Speakers Bureau

Chanida Siripraparat Nothing to disclose

Donovan Maust Univadis - Speakers Bureau

Marie DeWitt Nothing to disclose

Maureen Nash Nothing to disclose

Sandra Swantek Alliance forPatient’s Access: Neurological Disease Working Group - Consultant

DIAGNOSTIC CONSIDERATIONS IN EVALUATING GERIATRIC PATIENTS WITH MOVEMENT DISORDERS Session 105 Joel Mack1; Laura Marsh2; Stewart Alan Factor3; William Mafﬁtt McDonald4

1VA Portland Healthcare System 2Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 3Emory University School of Medicine 4Emory University School of Medicine

Abstract: Dr.JoelMackisageriatricpsychiatristafﬁliatedwith the Oregon Health & Science University and the VA Hospital in Portland, OR. Dr. Mack will discuss aspects of the history and exam in functional movement disorders (FMDs) and the role the geriatric psychiatrist may play in a multidisciplinary approach to these disorders. FMD’s may be characterized by the full range of movement disorder phenomena but are inconsistent and incongruent with known “organic” neurological movement disorder syndromes. Despite the common belief that FMDs are a problem of the young, they are not uncommon among elderly movement disorder patients. Dr. Stewart Factor is currently Professor of Neurology, Director of the Movement Disorders Program and Vance Lanier Chair of Neurology at Emory University School of Medicine. Dr. Factor has collected hundreds of videos of neurologic patients with movement disorders and will focus his talk on the neurological evaluation of gait and the use of gait to both diagnose neurological dysfunction as well as subtle clues to a potential conversion disorders in the presentation. Dr. Laura Marsh is Executive Director of the Mental Health Care Line at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, TX where she is also Professor in the Departments of Psychiatry and Neurology at Baylor College of Medicine (BCM) and Director of the UCNS Behavioral Neurology and Neuropsychiatry Fellowship at BCM. Dr. Marsh will focus on anxiety disorders and their treatment in common neurological diseases in the elderly and highlights her work in Parkinson’s disease (PD). She will also highlight anxiety as it relates to fear of falling, an important topic in the elderly and particularly relevant to elderly patients with gait disorders.

Faculty Disclosures Joel Mack Nothing to disclose

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Laura Marsh Nothing to disclose

Stewart Factor Neurocrine - Consultant Lundbeck - Consultant Teva - Consultant Sunovion - Consultant Acadia - Scientiﬁc/Medical Advisory Board Member Sunovion - Scientiﬁc/Medical Advisory Board Member

William McDonald Neuronetics - Research Grant Site Principal Investigator Soterix - Research Grant Site Principal Investigator Cervel - Research Grant Site Principal Investigator Stanley Foundation - Research Grant Site Principal Investigator Oxford Press - Other Financial or Material Support

WRITING AND GETTING PUBLISHED: DEVELOPING THIS IMPORTANT SKILL SET FOR GERIATRIC MENTAL HEALTH PROFESSIONALS Session 106 Juan Young1; Meera Balasubramaniam2; Rajesh R. Tampi3; Shilpa Srinivasan4

1Case Western Reserve University MetroHealth Psychiatry 2NYU School of Medicine, NEW YORK, New York 3Cleveland Clinic Lerner College of Medicine, Strongsville, Ohio 4University of South Carolina School of Medicine, Columbia, SC

Abstract: Programs that train professionals in geriatric mental health expect the trainees to engage in scholarly activities including writing scientific manuscripts and getting them published either in books or journals. However, the training provided to achieve and or maintain academic and scholarly productivity is limited. Additionally, there is no standard format or curriculum to teach the trainees on how to acquire their own skill set to develop and implement their own academic portfolio. Furthermore, these deficiencies in developing scholarly productivity continue to hinder the career growth of the professional caring for older adults with mental health disorders. The clinical and administrative work load for these professionals often present additional challenges that prevents them from acquiring the skill set to develop a writing and publishing career. In this symposium, we will discuss ideas and methods on how a geriatric mental health professional can develop and implement their own scientific writing and publishing career. We will provide step by step instructions on how scientific manuscripts can be developed and published. Additionally, the faculty presenting at this symposium will provide case examples from their academic portfolio to illustrate how specific manuscripts were developed and published.]

Faculty Disclosures Juan Young Nothing to disclose

Meera Balasubramaniam Nothing to disclose

Rajesh Tampi Nothing to disclose

Shilpa Srinivasan Nothing to disclose

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MECHANISMS INFORMING INTERVENTIONS: NEW APPROACHES TO TREATING LATE- LIFE DEPRESSION Session 107 Eric Lenze1; Faith Gunning2; Jordan F Karp3; Warren D Taylor4

1Washington University in St Louis, St. Louis, MO 2Weill Cornell Medicine, White Plains, NY 3University of Pittsburgh, Pittsburgh, PA 4Vanderbilt University Medical Center

Abstract: Late-life depression is characterized by medical comorbidity and deficits in cognitive function, specifically in cognitive control deficits. These medical and cognitive factors are associated with poor antidepressant responses, and even when response occurs, rates are often poor andlimited.Moreover, remission may not persist and depressed elders are at a high risk of recurrence. Current antidepressant treatments are not only limited in the benefit they provide to affective symptoms, but typically do not benefit the comorbid medical problems and cognitive deficits common in this population. There is a substantial need for new treatment approaches that are both more robust and benefit these comorbid medical and cognitive domains. Across presentations, this symposium focuses on novel treatment approaches for late-life depression. Sessions willbeframed within NIMH’s Experimental Therapeutics paradigm, with discussions on the underlying mechanism and proposed targets for engagement. Given the clinical population, sessions will further integrate how treatments may provide benefit beyond mood symptoms. The first sessions will examine novel pharmacological treatments of drugs that may be repurposed for late-life depression. This includes findings from a recent trial examining the clinical effect and mechanisms of treatmentresponse of buprenorphine in older adults with treatment resistant depression. Next will bea presentation of results from a pilot trial of transdermal nicotine patches in depressed elders with subjective cognitive decline. These results include clinical and cognitive results, but also pilot neuroimaging results examining potential drug mechanisms. We then shift to discuss a computerized cognitive remediation approach,examining a video game intervention targeting the cognitive control network with the goal of improving both mood and executive function. Finally, the panel discussant will put these findings in context of past intervention studies in late-life depression. This will include a discussion on how to optimize current antidepressant medications and discusstherationale of the PCORI- funded OPTIMUMstudy of treatment-resistant older adults.

Faculty Disclosures Eric Lenze Nothing to disclose

Faith Gunning Nothing to disclose

Jordan Karp Pﬁzer—receipt of medication supplies for investigator initiated trial Indivior—receipt of medication supplies for investigator initiated trial

Warren Taylor Nothing to disclose

NEW INSIGHTS INTO LONELINESS AND ITS TREATMENT IN OLDER ADULTS Session 108 Joanna McHugh Power1; Kelsey Drew Biddle2; Nancy J Donovan3; Phaedra Bell4

1National College of Ireland, Dublin, Ireland, and Queen’s University, Belfast, UK 2Brigham and Women’s Hospital 3Brigham and Women’s Hospital 4University of California San Francisco

Abstract: Loneliness is a well-studied construct in the social sciences, in the epidemiology of aging and increasingly in gerontology but it is a relatively uncommon focus in psychiatric research. Loneliness is a perceived state of social and emotional isolation that is distinct from objective social isolation. Loneliness is understood to be both a perception and an emotion and may be a form of psychosocial stress. In large population-based studies, there is strong evidence that both loneliness and lower social engagement are

S8 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 independent predictors of accelerated cognitive decline and incident AD dementia. Psychosocial factors influencing loneliness are well known whereas little is known of the neurobiology and pathological correlates of loneliness, particularly in older people. The goal of this session is to illustrate the importance of social function and wellbeing to longitudinal cognition and Alzheimer’s disease progression in older adults. The four speakers will provide data from their own research examining associations of loneliness and social engagement to cognition and Alzheimer’s disease biomarkers. Dr. Joanna McHugh Power will describe six-year data defining patterns of loneliness and social isolation that are most predictive of semantic memory declines in over 8,000 participants from the Irish Longitudinal Study of Ageing. Dr. Nancy Donovan (Chair) will present a cross-sectional study defining associations of greater loneliness with higher cortical amyloid burden and regional tau deposition in a sample of cognitively normal older adults from the Harvard Aging Brain Study. Kelsey Biddle from Dr. Donovan’s group will describe longitudinal data from the Harvard Brain Study examining cortical amyloid deposition, cognition and psychosocial factors that are predictive of decline in social engagement over 3 years among cognitively normal elderly. Dr. Phaedra Bell will present data from a pilot study focusing on lonely older adults to assess the impact of a multimodal intergenerational intervention on ratings of loneliness and mood in these participants. Finally, Dr. McHugh Power (Discussant) will lead the speakers in a panel discussion, along with Q&A involving session attendees.

Faculty Disclosures Joanna McHugh Power Nothing to disclose

Kelsey Biddle Nothing to disclose

Nancy Donovan Alkermes PLC - Employee Avanir - Scientiﬁc/Medical Advisory Board Member Esai - Other Financial or Material Support Eli Lilly - Other Financial or Material Support

Phaedra Bell Nothing to disclose

THE ROLE OF EMPATHY IN CARING FOR PERSONS WITH DEMENTIA Session 109 Ellen Leslie Brown1; Jennifer Rebecca Stein2; Marc Edward Agronin3

1Florida International University and Miami Jewish Health 2Miami Jewish Health 3Miami Jewish Health, Miami, FL

Abstract: The purpose of this symposium is to provide a rationale for and steps to implement a new empathic caring-centered approach for the long term care setting called "EmpathiCare." The philosophy behind and evidence for EmpathiCare and a description of the three essential pathways will be provided. Additionally, presenters will provide the results of a systematic review that examined the impact of interventions focused on increasing empathy and empathic caring in health care staff providing care for individuals with dementia, strategies and barriers to implement change, limitations of current research, and recommendations for future research.

Faculty Disclosures Ellen Brown Nothing to disclose

Jennifer Stein Nothing to disclose

Marc Agronin Allergan - Speakers Bureau

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HOW THEY MEASURE UP: RATING SCALES IN GERIATRIC PSYCHIATRY Session 110 Insiya Nasrulla1; Meera Balasubramaniam2; Paroma Mitra3; Romika Dhar4

1NYU School of Medicine 2NYU School of Medicine 3NYU School of Medicine, New York, NY 4West Virginia University School of Medicine

Abstract: Clinical assessment in geriatric psychiatry is complex. It involves detection of subtle signs, separation of psychiatric symptoms from co-occurring medical and neurological manifestations, and work with families. Rating scales are a useful complement to clinical skills in ensuring all relevant questions have been asked, objectively detecting the presence or absence of an illness, quantifying its severity, as well as tracking response to treatment, and the course of an illness over time. This presentation will touch upon multiple available rating scales, with focus on the ones which will be of use to the busy clinician. The first section of the presentation will be a discussion on rating scales for depression, namely the Geriatric Depression Rating Scale (GDS), the Cornell Scale for Depression in Dementia (CSDD), the Hamilton Depression Scale (HDS), and the Montgomery Asberg Depression Rating Scale (MADRS). In the next section, we will describe an overview of the various types of assessment scales for dementia, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), St. Louis University Mental Status Exam (SLUMS), Alzheimer’s Disease Assessment Scale − Cognitive sub-scale (ADAS-cog), and the Modified Mini-Mental State Examination (3-MS). The third section of the presentation will constitute a discussion of rating scales to detect neuropsychiatric disturbances, such as the Neuropsychiatry Inventory (NPI), the Neurobehavioral Rating Scale (NBRS), and the Cohen Mansfield Agitation Inventory (CMAI). The final section will be a discussion of common rating scales used in assessing anxiety such as the Geriatric Anxiety Inventory (GAI) and the Geriatric Anxiety Scale (GAS). This section will also explore caregiver burden scales, with focus on the Zarit Caregiver Burden Interview. Every sub-section of the presentation will provide an overview of the literature and comparison in terms of clinical utility, practicality, and psychometric properties. Since primary care physicians provide majority of the medical care for the elderly, screening tools for primary care that can be incorporated in a busy clinical practice will also be discussed.

Faculty Disclosures Insiya Nasrulla Nothing to disclose

Meera Balasubramaniam Nothing to disclose

Paroma Mitra Nothing to disclose

Romika Dhar Nothing to disclose

GAY AND GRAY IX: TURNING RED, WHITE AND BLUE: HOW A HISTORY OF MILITARY SEXUAL TRAUMA IMPACTS THE LIVES OF OLDER LGBT VETERANS Session 111 Chadrick Lane1; Daniel D. Sewell2; Erawadi Singh3; Shafagh Nanaz Heidari4; Stephen Todd Smilowitz5

1Yale 2University of California, San Diego, San Diego, CA 3Touro College of Osteopathic Medicine - Middletown 4UC San Diego 5Case Western Reserve University School of Medicine, Cleveland, OH

Abstract: As the general population of older adults in the US continues to rapidly increase so is the population of older Veterans who belong to a gender or sexual minority. A subset of these older LGBT veterans experienced victimization while serving in the military inspired by their LGBT status some of these veterans even now are still experiencing the consequences of this trauma.

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The overarching goal of this session is to help mental health providers provide the best care possible for older veterans who were traumatized during their period of military service as a result of being LGBT. The session will cover the following areas: the history of LGBT individuals serving in the US Military, the scientiﬁc literature on PTSD in later life, three clinical vignettes of older veterans being treated for military sexual trauma and the potentially helpful clinical services currently available through the VA for older military sexual trauma survivors.

Faculty Disclosures Chadrick Lane Nothing to disclose

Daniel Sewell Higi, LLC - Research Grant Site Principal Investigator ActivCare Inc - Scientiﬁc/Medical Advisory Board Member DHHS/HRSA Geriatric Workforce Enhancement Program - Research Grant Site Principal Investigator PEACE-AD - Other Financial or Material Support

Erawadi Singh Nothing to disclose

Shafagh Heidari Nothing to disclose

Stephen Smilowitz Nothing to disclose

CHALLENGES IN 21ST CENTURY INPATIENT GERIATRIC PSYCHIATRY AND LONG TERM CARE PRACTICE. Session 112 Amita Patel1; Jessica O’Mara2; Marie DeWitt3; Swapnil Rath4

1Dayton Psychiatric Associates, Dayton, OH 2Pine Rest Christian Mental Health Services 3Oscar G Johnson VA Medical Center, Ypsilanti, MI 4Inpatient Geriatric Psychiatrist, Pine Rest Christian Mental Health Services

Abstract: With the increase in life span, there has been a rise in the number of older adults. In 2010, approximately 40 million persons aged 65 years and older lived in the United States and this statistic is projected to increase to 88.5 million by 2050, accounting for 20.2% of the population. The number of older adults with psychiatric disorders is also expected to increase to 15 million by 2030. A signiﬁcant proportion of these older adults will also have co-morbid medical issues, which may pose challenges. In this session, we will provide an overview of how nursing home facilities and inpatient geriatric psychiatry units are adapting to changes and challenges to provide care for this vulnerable population. In the last 20 years, the number of elderly patients cared for in nursing homes has increased, with facilities expanding to include more beds to respond to this need. The average resident age has also increased, with a corresponding increase in functional limitations, disabilities, cognitive and mental disorders requiring advanced care. Additionally, policy and industry changes over the years have affected the way we provide care for these residents. There has been rapid growth in assisted living facilities in order to provide an alternative care setting for these individuals who require more assistance with activities of daily living. This has led to the development of specialized units that will meet the needs of these residents. Since the implementation of the minimum data set (MDS) system, many prevalence reports have relied on either recorded diagnoses or scales derived from MDS to identify residents with psychiatric conditions. These have also been used as screening tools to identify residents in need of treatment. Available data indicates that there are an inadequate number of geriatric psychiatrists in the USA to care for these older adults with mental illness. The unfortunate consequence has been providers without specialist training or oversight attempting to provide care for residents. This often includes prescribing multiple psychotropic medications that are inappropriate for their symptoms and their age, which can ultimately lead to substantial psychological and functional morbidity. Additionally, these medication side effects and undertreated psychiatric disorders have a signiﬁcantly negative impact on the residents’ quality of life, disability, and cost of care. Approximately 75-80% of residents in long- term care have a neurocognitive disorder. Although most major neurocognitive

Am J Geriatr Psychiatry 27:3S, March 2019 S11 AAGP Annual Meeting 2019 disorders are incurable, appropriate comprehensive treatment can substantially improve the quality of life of a resident, their family, and their caregivers. Routine provision of evidence-based care by a mental health care team with expertise in long-term care is essential for maintaining dignity and reducing suffering for these patients. This includes ongoing staff education, discontinuation of inappropriate medications, optimal use of appropriate psychotropic medications and other behavioral interventions. We will review how the geriatric psychiatrist, along with other allied health care professionals, can work as a team in today’s highly regulated environment of long term care to improve patient outcomes. With the projection that the older adult population will swell over the next several decades, inpatient geriatric psychiatry facilities have arisen to address the need to provide acute services for these patients. These units appear to have distinct clinically relevant assessment and treatment advantages. They are more comprehensive in their diagnostic assessment of patients, are more likely to provide cognitive assessments and are more cognizant of potential side effects of psychotropic medications. They are also more likely to provide more age-speciﬁc aftercare recommendations, which is important in maintaining success after the hospitalization. However these specialized units are limited, expensive, and may encounter a unique set of challenges as the landscape changes for healthcare delivery, reimbursement and managed care. In this session, we will describe key characteristics of a typical geriatric psychiatry unit, discuss advantages of such a unit over a general psychiatry unit, discuss different models of geriatric psychiatry facilities, outline standard admission screening criteria for appropriate patient selection, address treatment challenges associated with the need for rapid improvement in patient psychopathologies and discuss the increased pressures in providing high quality care in the context of reduced length of stays with scarce resources for aftercare. At the end of our presentation, we will brieﬂy showcase the unique characteristics of our inpatient geriatric psychiatry unit.

Faculty Disclosures Amita Patel Neurocrine - Speakers Bureau

Jessica O’Mara Nothing to disclose

Marie DeWitt Nothing to disclose

Swapnil Rath Nothing to disclose

RESEARCH AWARD SESSION: ADVENTURES IN DEMENTIA EPIDEMIOLOGY Session 200 Mary Ganguli

University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA

Abstract: The study of dementia epidemiology, now embedded within the larger ﬁeld of population neuroscience, examines cognitive decline and dementia at the population or community level. Minimizing the selection bias which is unavoidable in clinical settings, we are able to look at the distribution as well as the determinants of these conditions in the population at large. Over the past 30 years, our group has conducted population-based studies of aging, cognition, and dementia both in the Monongahela Valley of Southwestern Pennsylvania and in the rural area of Ballabgarh in India. This presentation will cover key themes and ﬁndings from this body of research, emphasizing their relevance for clinicians and clinical researchers.

OLDER REFUGEES: AGE-SPECIFIC CHALLENGES, STRENGTHS, AND RECOMMENDATIONS FOR CARE Session 201 Ali A. Asghar-Ali1; Andreea L. Seritan2; Peter Ureste3; Tammy Duong4

1Baylor College of Medicine, Houston, TX 2UCSF, San Francisco, CA 3UCSF 4UCSF, San Francisco, CA

S12 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019

Abstract: There are 65.6 million individuals have been forcibly displaced due to conflict or persecution. Of those, 4% were 60 years or older, and this percentage may actually be higher as age disaggregated data are not readily available. Older adults in forced exile encounter age-specific challenges and have particular physical and mental health needs, which need to be identified and addressed. Anxiety, depressive disorders, post-traumatic stress disorder, and cognitive deficits are prevalent in this population and may pose additional barriers to seeking and receiving humanitarian aid and post-resettlement services. However, many older refugees also have great strength and resilience and can help preserve their families’ and communities structure and cultural identity. Clinicians working with older refugees should examine their implicit biases, consult existing resources, and strive to provide culturally-sensitive services, in order to minimize stigma and maximize benefit for this vulnerable population.

Faculty Disclosures Ali Asghar-Ali Nothing to disclose

Andreea Seritan Nothing to disclose

Peter Ureste Nothing to disclose

Tammy Duong Nothing to disclose

SUICIDE IN LATE-LIFE: COLLABORATIVE APPROACHES FOR ASSESSMENT, PREVENTION, AND TREATMENT Session 202 Kimberly Butterﬂy Rudd1; Robert Breen2; Shilpa Srinivasan3; Stephanie Hrisko4

1SCDMH 2SC DMH 3University of South Carolina School of Medicine, Columbia, SC 4Palmetto Health/University of South Carolina School of Medicine

Abstract: According to the most recent Centers for Disease Control (CDC) Morbidity and Mortality Weekly Report (MMWR), the tenth leading cause of mortality is suicide. Suicide is one of three causes of death that continues to increase. The suicide rates have increased 30% since 1999. Older adults are at high risk for suicide in that they comprise 18% of all suicides but only 14.5% of the population (8000 suicides in 2015) (CDC). Literature suggests that while older adults have fewer suicide attempts, they have a higher suicide completion rate than younger adults. Considering this high rate of suicide completion, suicide prevention is imperative. Older adults tend to seek treatment from primary care providers than mental health clinicians and are less likely to discuss depression and/or suicide than their younger counterparts. Seventy-three percent of older adults that died by suicide visited a primary care provider within one month prior to their death. Literature indicates that depressed older adults receiving collaborative care within the primary care setting have better outcomes related to depression and suicidal ideations. Therefore, all healthcare professionals who treat older adults need to be aware of assessment and treatment of late-life suicide. In this symposium, we will describe the epidemiology of late-life suicide. In addition, we will discuss risk factors for suicide in late life and suicide assessment in the geriatric population. We will also review the collaborative approaches for prevention and treatment of late-life suicide.

Faculty Disclosures Kimberly Rudd Nothing to disclose

Robert Breen McKesson - Stock Shareholder BRISTOL MYERS SQUIBB CO - Stock Shareholder Global Blood Therapeutics - Stock Shareholder GLAXOSMITHKLINE PLC SPON GLAXOSMITHKLINE PLC SPON - Stock Shareholder

Am J Geriatr Psychiatry 27:3S, March 2019 S13 AAGP Annual Meeting 2019

MERCK & COMPANY INC NEW - Stock Shareholder SANOFI SPON ADR - Stock Shareholder

Shilpa Srinivasan Nothing to disclose

Stephanie Hrisko Nothing to disclose

PREVALENCE OF NEUROPSYCHIATRIC SYMPTOMS ACROSS THE COGNITIVE SPECTRUM AND THEIR IMPACT ON FUTURE COGNITIVE DECLINE Session 203 Corinne Eleanor Fischer1; Krista Lanctot2; Linda Mah3

1St. Michael’s Hospital 2Sunnybrook Health Sci Ctr, Toronto, ONT 3University of Toronto

Abstract: In the recently published National Institute on Aging and Alzheimer’s Association (NIA-AA)’s Research Framework, the definition of Alzheimer’s disease (AD) shifts from a syndromal to a biological entity, defined by underlying pathology as evidenced by the presence of AD biomarkers in vivo or on post-mortem examination (Jack et al., 2018, Alzheimers Dement. 2018 Apr;14(4):535-562). The new NIA-AA framework also describes syndromal staging of cognitive continuum to define research cohorts, independent of biomarker profile. With respect to mild cognitive impairment (MCI), the current framework differs from the 2011 NIA-AA definition in its reference to “neurobehavioral” symptoms, defined as symptoms attributable to mood or behavioral disorders, such as anxiety, depression, and apathy, which “commonly coexist and may be a prominent part of the presentation” (Table 3, Jack et al., 2018). We argue that neurobehavioural or neuropsychiatric symptoms (NPS) across the spectrum of AD disease should not be conceptualized as simply co-existing alongside cognitive impairment or attributable to mood or behavioural disorders. Rather, NPS are core features of neurodegenerative cognitive syndromes that may serve as prognostic indicators of outcome. This symposium will review the prevalence of NPS across the cognitive spectrum; namely in subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer’s disease (AD), and highlight their association with AD biomarkers and contribution to future cognitive decline or disease progression in AD. Dr. Linda Mah will review the prevalence of neurobehavioural symptoms and their association with AD biomarkers and future cognitive decline in older adults who are cognitively unimpaired (CU) or who present with SCD, drawing from the extant literature and new data from an ongoing study of SCD. Dr. Krista L. Lanctôt will review the prevalence of NPS in mild neurocognitive disorder (NCD) and impact on progression. In addition, emerging evidence linking specific NPS with biomarkers of major NCD and the efficacy of interventions including pharmacologic, nonpharmacologic and neuromodulatory during this phase will be highlighted, with emphasis on recent findings. Dr. Corinne E. Fischer will review the prevalence and trajectory, clinical features and treatment approach to neuropsychiatric symptoms (NPS) in patients with established Alzheimer’s disease. Particular emphasis will be placed on studies demonstrating the link between disease biomarkers and NPS disease burden, highlighting specific NPS such as apathy, aberrant sleep behavior, psychosis and depression.

Faculty Disclosures Corinne Fischer Roche pharma trial-CREAD 1 - Research Grant Site Principal Investigator Vielight pivotal study−biotechnology - Research Grant Overall Principal Investigator Roche pharma−Graduate study - Research Grant Site Principal Investigator

Krista L. Lanct^ot Axovant Sciences Ltd. - Other Financial or Material Support AbbVie Canada - Research Grant Site Principal Investigator Otsuka − Consultant Abide − Consultant

Linda Mah BrainsWay Ltd - Research Grant Overall Principal Investigator

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INNOVATIONS IN THE DELIVERY OF DEMENTIA CARE IN A RAPIDLY EVOLVING HEALTH CARE LANDSCAPE Session 204 Brent Forester1; David Reuben2; Joel E. Streim3; Malaz A Boustani4

1McLean Hospital 2UCLA 3University of Pennsylvania 4Indiana University

Abstract: This session will review the imperative and substantial opportunity for implementing evidence based models of integrated dementia care for an evolving health care system that places an emphasis on quality and reducing escalating health care costs. Primary care physicians in 2018 are not adequately incentivized or educated to detect, assess and treat a rapidly growing population of individual with neurodegenerative disorders, including Alzheimer’s disease. Furthermore, there is no consistent existing infrastructure to allow for successful identiﬁcation and treatment of dementias within primary care leading to delays in diagnosis and lost opportunities for early treatment intervention, education of family caregivers, reducing safety complications, treating behavioral symptoms of dementia and de-prescribing BZDs, anticholinergics and sedative hypnotics. A re-engineering of the health care system is required to realize goals of improving the quality of care for individuals with dementia and easing the associated caregiver burden. Furthermore, as clinical trials progress towards realizing the ﬁrst disease modifying therapy for Alzheimer’s disease, our current health care system is ill-prepared to take advantage of the opportunity for slowing disease progression and reducing the staggering costs of dementia care. This symposium will outline evidence based models of integrated dementia care and discuss the challenges in implementing care re-design in an evolving and diverse health care system.

Faculty Disclosures Brent Forester Eli Lilly − Consultant Eli Lilly - Research Grant Site Principal Investigator Biogen - Research Grant Site Principal Investigator Biogen − Consultant

David Reuben Nothing to disclose

Joel Streim Pennsylvania Care Management Institute − Consultant RAND − Consultant, Christiana Care Health Services Inc − Consultant

Malaz Boustani Preferred Population Health Management LLC - Other Financial or Material Support

EVALUATION AND TREATMENT OF SLEEP COMPLAINTS IN THE OLDER ADULT Session 205 Ebony Dix1; Joel Dey2; Nery Aurora Diaz3; Rajesh R. Tampi4

1Yale University School of Medicine 2MetroHealth Medical Center 3Columbia University Irving Medical Center 4Cleveland Clinic Lerner College of Medicine, Strongsville, Ohio

Abstract: As the world’s population ages, it is imperative that clinicians be familiar with sleep disorders that are common in older adults. Insomnia affects 25-45% of adults over the age of 64. Sleep apnea affects 24-42% of older adults and periodic limb movement disorder affects 45% of older adults. Appreciating sleep disturbances in the geriatric patient is an important part of a thorough and thoughtful geriatric psychiatry evaluation. The differential diagnosis of insomnia and sleep apnea includes restless legs syndrome, periodic limb movement disorder, REM behavior disorder, and circadian rhythm sleep disorder. Identifying and

Am J Geriatr Psychiatry 27:3S, March 2019 S15 AAGP Annual Meeting 2019 treating sleep disturbances in late life is important in alleviating the burden of disease on the patient, minimizing caregiver burnout, and reducing the rate of institutionalization.

Faculty Disclosures Ebony Dix Nothing to disclose

Joel Dey Nothing to disclose

Nery Diaz Nothing to disclose

Rajesh Tampi Nothing to disclose

Case Presentation 1 Session 206

FIREARM SAFETY AND ANTICIPATORY GUIDANCE FOR A GERIATRIC PATIENT WITH ALZHEIMER’S DEMENTIA IN THE OUTPATIENT SETTING: A FELLOW’S DILEMMA Seetha Chandrasekhara, MD Lewis Katz School of Medicine at Temple University

NOVEL MANAGEMENT OF SEVERE MANIC DELIRIUM IN A COMPLEX AND FRAIL OLDER ADULT Rebecca Radue, MD University of Wisconsin Hospital and Clinics and William S. Middleton Memorial Veterans Hospital

THE USE OF ELECTROCONVULSIVE THERAPY FOR TREATMENT RESISTANT DEPRESSION IN AN ELDERLY WOMAN WITH A DEEP BRAIN STIMULATOR Melanie Gentry, MD Mayo Clinic

Faculty Disclosures Seetha Chandrasekhara Nothing to disclose

Rebecca Radue Nothing to disclose

Melanie Gentry Nothing to disclose

PREPARING FOR THE FUTURE AND DIVERSITY OF GERIATRIC MENTAL HEALTH Session 208 Carl I. Cohen1; Daniel D. Sewell2; Maria Llorente3; Rita Hargrave4

1SUNY Downstate, Brooklyn, NY 2University of California, San Diego, San Diego, CA 3WASHINGTON DC VAMC 4UC Davis, Oakland, CA

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Abstract: By 2050, more than one third of the US population older than 65 will be from an ethnic or racial minority. Delivering culturally competent care enhances health care outcomes and reduces disparities. Culture may refer to one’s belief system, values, religion, race, socioeconomic status, sexual orientation, geographic location, age, gender and occupational risks/exposures. This presentation brings together recognized experts in the ﬁeld of culturally competent geriatric mental health care. The presentation will review the upcoming demographic changes that are projected to occur in the US seniors. Several speciﬁc groups of interest will then be reviewed, with respect to what is currently known regarding psychiatric illnesses that are more commonly seen, and unique aspects of care delivery to improve communication and foster trust between provider and patient.

Faculty Disclosures Carl Cohen Nothing to disclose

Maria Llorente Nothing to disclose

Rita Hargrave Nothing to disclose

ADVANCES IN THE MOLECULAR IMAGING OF ALZHEIMER’S DISEASE: NEUROBIOLOGICAL MECHANISMS OF DISEASE AND NEUROPSYCHIATRIC SYMPTOMS Session 209 Adam P Mecca1; Gwenn S. Smith2; Jennifer R. Gatchel3; J. Nancy Donovan4

1Yale School of Medicine, New Haven, CT 2Johns Hopkins University School of Medicine, Baltimore, MD 3Harvard Medical School 4Harvard Medical School, Boston, MA

Abstract: The pathogenesis of Alzheimer’s disease (AD) remains elusive. The observed accumulations of beta amyloid and phosphorylated tau protein aggregates are thought to play key roles in initiating or propagating the disease. However, other processes including changes in synaptic proteins, neurotransmitter loss, inflammation and cerebrovascular disease have been suggested as important etiologies as well. Importantly, the recent, unprecedented advancements of positron emission tomography (PET) radiotracer chemistry allow investigations into molecular changes associated with AD. Until recently, much of what is known about AD pathology has been learned from post mortem studies and animal models. The advancements of PET imaging allows quantitative in vivo measurements of specific proteins within many brain regions. Because the manifestations of AD are heterogeneous. The use of PET imaging can be used to improve the understanding of diverse symptoms. For example, a majority of individuals experience neuropsychiatric symptoms during the disease process, but the onset and composition of these symptoms vary widely. Molecular imaging using PET allows us to study neurobiological processes both early in the disease process and longitudinally. PET imaging can be used in concert with other imaging modalities such as MRI, as well as assessments of cognition and neuropsychiatric symptoms to investigate the molecular underpinnings of AD. It is of great importance for clinicians to learn about these innovative and translational tools which will ultimately lead to the identification of disease biomarkers and therapeutic targets. The goal of this session is to illustrate the importance of in vivo molecular imaging in the study of AD with a specific emphasis on PET. Dr. Adam Mecca (Chair) will present results of cross- sectional studies that investigate synaptic protein alterations in individuals with AD. These investigations utilize specific PET tracers to quantify synaptic density and metabotrophic glutamate receptor subtype 5 (mGluR5). Dr. Nancy Donovan will describe research that examines the relationships between cortical and subcortical brain amyloid quantified using PET, anxiety, and AD risk in cognitively normal older adults. Dr. Jennifer Gatchel will present work on the association between depressive symptoms and in vivo cerebral tau and amyloid measurements. Dr. Gwenn Smith will describe the role of serotonin (5-HT), tau and amyloid b in cognitive decline in individuals with mild cognitive impairment and normal cognition. Finally, Dr. Donovan (Discussant) will lead the speakers in a panel discussion, along with Q&A involving session attendees.

Am J Geriatr Psychiatry 27:3S, March 2019 S17 AAGP Annual Meeting 2019

Faculty Disclosures Adam Mecca Eisai, Inc. - Research Grant Site Principal Investigator Hoffmann-La Roche - Research Grant Site Principal Investigator Cognition Therapeutics, Inc. - Other Financial or Material Support NIH/NIA - Research Grant Site Principal Investigator

Gwenn Smith Nothing to disclose

Jennifer Gatchel Nothing to disclose

Nancy Donovan Alkermes PLC - Employee Avanir - Scientiﬁc/Medical Advisory Board Member Esai - Other Financial or Material Support Eli Lilly - Other Financial or Material Support

MANAGEMENT OF INAPPROPRIATE SEXUAL BEHAVIORS IN DEMENTIA USING MULTIDISCIPLINARY TEAMS IN THE CONTINUUM OF CARE Session 210 Pallavi Joshi1; Rajesh R. Tampi2; Silpa Balachandran3

1Northwell Health-Staten Island University Hospital 2Cleveland Clinic Lerner College of Medicine, Strongsville, Ohio 3Metrohealth Medical Center

Abstract: Behavioral disturbances are seen in over 80% of individuals with dementia. Although inappropriate sexual behaviors in dementia (ISBD) are not as common as some of the other behavioral symptoms in dementia, these behaviors can cause immense distress to all those affected by them. Currently, there are no randomized trials evaluating the effectiveness of management strategies for these behaviors, but the available data suggest efﬁcacy for some commonly used treatment modalities. In this symposium, we will discuss the epidemiology, neurobiology and the differential diagnosis for ISBD. We will then provide an overview of the evidence-based assessment and management of these behaviors. We will end by describing the role of multidisciplinary teams in the continuum of care for the optimum management of ISBD.

Faculty Disclosures Pallavi Joshi Nothing to disclose

Rajesh Tampi Nothing to disclose

Silpa Balachandran Nothing to disclose

THINKING BEYOND THE CLINIC: COMMUNITY-BASED INTERVENTIONS FOR DIVERSE OLDER ADULTS AND THEIR CAREGIVERS Session 211 Daniel Jimenez1; Hae Ra Han2; Janiece L. Taylor3; Joseph John Gallo4; Mijung Park5

1University of Miami, Miami Shores, FL 2Johns Hopkins University 3Johns Hopkins University School of Nursing 4Johns Hopkins University 5University of California San Francisco

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Abstract: Demographic trends will increase the number of older adults and greatly increase the diversity of older adults in terms of ethnicity, gender, and disability associated with chronic mental illness and caregiving status. The unmet needs for depression and dementia care services are enormous while the mental health workforce shortage and access barriers remain persistent. A shift to focus on populations incentivizes thinking beyond clinical treatments and attending to the needs of diverse populations that are at-risk but do not engage in traditional services. Speakers in this symposium will discuss community-based interventions that provide dementia and depression care services for ethnically diverse older adults and their caregivers. The symposium will enable health care providers to understand the importance and effectiveness of non-clinical, non-pharmacological or non- professional interventions that impact health and utilization outcomes.

Faculty Disclosures Daniel Jimenez Nothing to disclose

Hae-Ra Han Nothing to disclose

Janiece Taylor Nothing to disclose

Joseph Gallo Nothing to disclose

Mijung Park Nothing to disclose

READING BETWEEN THE LINES: HEALTH LITERACY AMONG OLDER ADULTS Session 212 Amrita Mankani1; Anne Day2; Ariel Laudermith3; Gauri Khatkhate4

1Edward Hines, Jr. VA Hospital 2Edward Hines Jr VA Hospital 3Edward Hines Jr VA Hospital 4Edward Hines Jr VA Hospital, Oak Park, IL

Abstract: Adequate health literacy is necessary for effective communication between healthcare professionals and patients. Health literacy is deﬁned as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Ratzan et al., 2000). An individual’s health literacy is impacted by factors unique to the individual, the culture, and the social context. Studies have estimated poor health literacy in 27-44% of the population (Gazmararian et al., 1999). Understanding who is at risk for low health literacy, and knowing how to assess and intervene with these patients is of utmost importance for healthcare providers. In addition, there are special populations and circumstances under which adequate health literacy may be even more critical; namely, during end-of-life decision making and with patients who have limited access to healthcare. The presenters of this symposium work in two different areas of geriatric medicine that are relevant to the discussion of health literacy among older and/or chronically ill patients: Home Based Primary Care (HBPC) and Palliative Care. HBPC is a national program within Veterans Affairs hospitals designed to provide longitudinal care for medically complex, frail, elderly Veterans in their home. The interdisciplinary HBPC treatment team consists of primary care physicians, nurses, social workers, dietitians, pharmacists, kinesiotherapists, psychiatrists, and psychologists. Many of the patients enrolled in HBPC live in rural areas, and would otherwise lack access to appropriate care; they are thus a vulnerable population, and having a comprehensive understanding of their ability to utilize health-related information is critical. Palliative Care is an area of medicine in which patients are asked to make complex, serious decisions about their healthcare. These patients, too, are vulnerable; having healthcare providers who understand their unique circumstance is important.

Faculty Disclosures Amrita Mankani Nothing to disclose

Am J Geriatr Psychiatry 27:3S, March 2019 S19 AAGP Annual Meeting 2019

Anne Day Nothing to disclose

Ariel Laudermith Nothing to disclose

Gauri Khatkhate Nothing to disclose

PUBLIC POLICY SESSION 3: CONNECTING SURPLUS MEDICINE WITH PATIENTS: POLICY & TECHNOLOGY Session 213 George Wang

Sirum

Abstract: About 50 million people in the United States report skipping prescription drugs due to costs, which is detrimental to individual health outcomes and also increases costs for the entire healthcare system. Yet at the same time, over $5 billion of unexpired, unopened medicine from healthcare institutions goes to landﬁlls, waterways and incinerators each year. Recognizing donation as a preferable alternative to destruction, states have passed Good Samaritan laws allowing and protecting the donation of still usable, safe medicine. The nonproﬁt SIRUM has leveraged these policy changes and built technology to convert the standard medicine destruction process into a donation process, seamlessly delivering medicine to charitable pharmacies serving patients in need.

Faculty Disclosures George Wang various stocks and ETFs - Stock Shareholder Founder of SIRUM (nonproﬁt redistributing medicine) - Employee

UPDATE ON ELECTROCONVULSIVE THERAPY IN GERIATRIC DEPRESSION Session 300 Adriana P. Hermida1; Charles H Kellner2; Georgios Petrides3; William Mafﬁtt McDonald4; William Vaughn McCall5

1Emory University, Decatur, GA 2New York Community Hospital 3Donald and Barbara Zucker School of Medicine at Hofstra of Northwell Health Sys, New York, NY 4Emory University School of Medicine 5Medical College of Georgia

Abstract: Dr. McCall will review the data on the improvement in quality of life after treatment with ECT supporting the relationship of ECT treatment with significant improvements in mental health of older adults with severe recurrent depression. Dr. Petrides will summarize the data from the CORE group which over several decades has provided a roadmap to increasing the efficacy of ECT while minimizing cognitive side effects and preventing relapse. Dr. Hermida will discuss the use of ultrabrief right unilateral ECT (UB RUL), a form of ECT that may be particularly beneficial in the elderly due to the decreased cognitive side effects. She will review a case study of 100 patients treated with UB RUL who were diagnosed with psychotic depression and catatonia. Dr. Kellner will conclude with a discussion of the use of ECT in the United States. He will review the status of the use (actually underuse) of ECT in the United States. Recent data on the number of procedures performed, demographics of ECT patients, health economic impact of ECT, and details of how ECT is administered (technique, setting, practitioner information) will be covered. Given the suicide epidemic and the increased prevalence of treatment resistant depression, ECT remains a vital treatment for severe mood and psychotic disorders. Newer data suggest increased use of ECT could lead to improved public health outcomes.

Faculty Disclosures Adriana Hermida Nothing to disclose

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Charles Kellner Psychiatric Times - Research Grant Overall Principal Investigator UpToDate - Other Financial or Material Support Cambridge University Press - Other Financial or Material Support Northwell Health - Other Financial or Material Support

Georgios Petrides Nothing to disclose

William Vaughn McCall Wolters Kluwerr - Other Financial or Material Support Merck - Research Grant Site Principal Investigator MECTA - Research Grant Site Principal Investigator CME Outﬁtters - Speakers Bureau Sage Therapeutics - Scientiﬁc/Medical Advisory Board Member

SUICIDE-RELATED OUTCOMES IN OLDER VETERANS: IMPLICATIONS FOR INTERVENTION AND PREVENTION OF SUICIDE Session 301 Amy L. Byers1; Kimberly Allison Van Orden2; Lisa C Barry3; Ruth Morin4

1San Francisco VA Health Care System, Sausalito, CA 2University of Rochester School of Medicine, Rochester, NY 3University of Connecticut 4San Francisco VA Health Care System

Abstract: This session will highlight the particular challenges of addressing suicide among older veterans in VHA care using epidemiological and novel statistical approaches, and offer a promising way forward for early identification and prevention of late-life suicide. The research presented here will highlight various unique factors in older veterans that may be missing from the suicide prevention conversation, including the saliency of physical health, pain, high-risk subpopulations, and psychosocial interventions. Drs. Byers and Morin will present findings on late life suicide in VHA using medical record data for novel investigations of administrative data. First, using her database of over 5 million veterans receiving VHA care, Dr. Byers will provide a big picture overview of nationally based estimates of the occurrence of suicide-related outcomes, including non-fatal attempts and death by suicide, in veterans over age 50. Additionally, she will discuss factors that influence risk of a first attempt in later life, as well as factors that further influence, among survivors, who goes on to repeat an attempt and who does not. Next, Dr. Morin will describe physical and mental health comorbidity profiles of 2,131 veterans over 65 who attempted suicide between 2012 and 2014, and last saw a primary care provider prior to their attempt. The relatively minimal depression prevalence as well as high incidence of chronic pain in more than half of these attempters, as well as higher rates of fatality using firearms among these individuals compared to those with multiple mental health comorbidities will be discussed. These findings raise awareness about possible points of intervention in a group that may otherwise not be considered to be as high-risk as a population with significant comorbid mental health concerns. Drs. Barry and Van Orden will speak about more specific subgroups of older veterans, with recommendations for possible intervention to reduce unintended death and suicide, emphasizing the importance of transition of care models for prevention of late-life suicide. Dr. Barry will provide an example of increased risk for suicide and unintended death among older veterans transitioning from prison to the community. Findings show that those re-entering society following a prison sentence are at significantly higher risk for suicide attempt by multiple means, with higher rates of fatality compared to matched controls. These results highlight the urgent need for assistance during this vulnerable period of transition. Finally, Dr. Van Orden will discuss transition of care models more specifically and their importance in combating loneliness, a major risk factor for late-life suicide. She will share compelling findings related to a novel intervention currently being studied on the benefits of volunteer-provided peer companionship for older veterans transitioning

Am J Geriatr Psychiatry 27:3S, March 2019 S21 AAGP Annual Meeting 2019 from community living center (CLC) stays back into the community. This intervention is targeted to support upstream suicide prevention.

Faculty Disclosures Amy Byers Nothing to disclose

Kimberly A. Van Orden Nothing to disclose

Lisa Barry Nothing to disclose

Ruth Morin Nothing to disclose

RECIPES FOR ADULT LEARNING: INNOVATIONS IN TEACHING GERIATRIC PSYCHIATRY Session 302 Chadrick Lane1; Ebony Dix2; Manan Gupta3; Mario Fahed4

1Yale Psychiatry 2Yale University School of Medicine 3Yale University School of Medicine, San Antonio, TX 4Yale Psychiatry

Abstract: Recent data estimate the number of US residents age 65 or older to be roughly 40 million, accounting for 13% of the population. It is projected that the elderly will comprise more than 20% of the national population by 2050 (Federal Interagency Forum on Aging Statistic 2012, APA Textbook on Geriatric Psychiatry). This ballooning population of older persons will generate increased demand for health care and social resources, with an urgent need for affordable, and accessible, mental health services. The aging brain is susceptible to a number of psychiatric disorders, including depression, anxiety, and dementia, all adversely affecting quality of life and functional ability of an older person. Alzheimer’s Disease alone accounts for 50-70% of all cases of dementia and currently affects »5.7 million in the US. As the U.S. population ages, these rates are expected to increase, placing extraordinary demands on systems of care. By 2050, costs related to caring for those living with dementia are projected to top 1 trillion dollars, translating to a greater than 300% increase in Medicare cost (Alzheimer’s Facts and Figures, 2018). Given these trends, the public health demand for geriatric psychiatry education is critical. Health care systems need skilled geriatric psychiatrists to advise and assist in the care of a burgeoning older population, many with concomitant mental health issues (IOM report: “In Whose Hands”). Active learning approaches to the assimilation of knowledge are replacing more passive, lecture based approaches across the medical education system. Knowledge and experience in these novel techniques will impact Geriatric Psychiatric education and prepare the next generation of clinical educators. Learning should occur across the spectrum of training, beginning with student physicians in medical school. Given that the number of new geriatric psychiatrists graduating from fellowships each year is approximately 1 per US state, society will be best served by the training of clinical providers as early as possible. This session will provide a foundation for developing innovative attitudinal, knowledge, and skills based learning opportunities.

Faculty Disclosures Chadrick Lane Nothing to disclose

Ebony Dix Nothing to disclose

Manan Gupta Nothing to disclose

Mario Fahed Nothing to disclose

S22 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019

AGEIST POLICIES - DISCRIMINATION AGAINST OLDER ADULTS Session 303 Elizabeth J Santos1; Emily Justin2; Pallavi Joshi3; Tom Jacob4

1University of Rochester School of Medicine & Dentistry, Rochester, NY 2University of Rochester School of Medicine & Dentistry 3Northwell Health-Staten Island University Hospital 4University of Rochester School of Medicine & Dentistry

Abstract: In today’s society, we are often confronted with many “isms,” but one of the few discussed is Ageism. Unknown to most people, there are many institutional policies and governmental regulations that are based on ageist assumptions that cognitive function necessarily declines with age such that older adults are considered to be less capable than younger adults. For example, when many people are living healthy lives for a longer period of time, does it still make sense to impose mandatory retirement based on age? This symposium will bring to light some of the existing ageist policies related to physicians, pilots and judges in order to educate those of us who care about advocating for older adults.

Faculty Disclosures Elizabeth Santos Nothing to disclose

Emily Justin Nothing to disclose

Pallavi Joshi Nothing to disclose

Tom Jacob Nothing to disclose

ADVOCACY, LIFE AND DEATH: GERIATRIC SUICIDE AND PHYSICIAN ASSISTED SUICIDE Session 304 Karen Reimers1; Maria I Lapid2; Mark Komrad3; Melanie Tara Gentry4; Michael J Redinger5; Sherif Soliman6

1University of Minnesota 2Mayo Clinic 3Johns Hopkins and Sheppard Pratt 4Mayo Clinic 5Western Michigan University Homer Stryker M.D. School of Medicine 6Charlotte, NC

Abstract: Geriatric suicide and physician assisted suicide are important problems facing geriatric psychiatrists. Suicide in elderly populations is a major and growing concern, with those 85 and older having the highest rate of suicide among adults. As geriatric psychiatrists, we endeavor to understand why this is happening and provide essential services for prevention and treatment. Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/ or information to enable the patient to perform the life-ending act. There is growing public support for physician-assisted suicide, which is legal and increasingly common in other countries including the Netherlands, Belgium and Canada. However, most professional organizations in the USA maintain that allowing physicians to engage in assisted suicide would cause more harm than good, being incompatible with the physician’s role as healer, and difﬁcult or impossible to control. This session will highlight current issues related to geriatric suicide and physician assisted suicide. Dr. Karen Reimers will introduce the topic and speakers. Dr. Michael Redinger will provide an ethical and moral framework for these questions. Dr. Sherif Soliman will review the suicide of an older individual, Martin Manley, and discuss psychological changes of aging and coping with illness. Dr. Mark Komrad will discuss physician-assisted suicide, including special considerations for geriatric psychiatry and the slippery slope of extending it to those with non-terminal conditions. Dr. Maria Lapid will give an overview of the basics of hospice and palliative care, to put "end of life’ into context, and to clearly distinguish it from any medically-assisted suicide. Dr. Melanie Gentry will serve as discussant. All speakers will highlight key directions for future advocacy efforts in prevention of geriatric suicide and

Am J Geriatr Psychiatry 27:3S, March 2019 S23 AAGP Annual Meeting 2019 physician assisted suicide, and what AAGP and other professional organizations can do to and promote quality geriatric mental health services in the future. Robust discussion and audience participation will be encouraged.

Faculty Disclosures Karen Reimers Nothing to disclose

Maria Lapid Nothing to disclose

Mark Komrad Nothing to disclose

Melanie Gentry Nothing to disclose

Michael Redinger Nothing to disclose

Sherif Soliman Nothing to disclose

CLICK BAIT: PROBLEMATIC INTERNET PORNOGRAPHY USE AMONG OLDER ADULTS Session 305 Alyssa Tao1; Arnaldo Moreno2; Stefana Morgan3

1UCSF 2UCSF 3UCSF

Abstract: An increasing number of people over 60 years old accessing the internet. Some accounts report that over 65% of older people in developed countries use the internet. Problematic Internet Use (PIU) is a wide-spread phenomenon that is becoming increasingly prevalent in contemporary society. While only Internet Gaming Disorder was identiﬁed by the DSM-V as a condition of further study, growing evidence supports that a variety of other internet-based activities can impede function and cause distress. These online based activities include among others gambling, use of social media, online shopping and pornography. More evidence is emerging of problematic internet use among older population. Some authors suggest that older age predisposes to increased rates of certain kinds of PIU over others, including certain kinds of games and streaming of online media. Other studies conclude that older patients might be using more pornography as their ability to engage in sexual intercourse is more limited. This might have particular effects on the quality of their intimate relationships and their mental wellbeing. Gender seems to be another factor that associates with different PIU types. For example, while men in general might be more susceptible to all types of PIU, women tend to be more likely to engage in problematic online shopping, chatting and social media. PIU has been linked to worsening physical health due to sedentary lifestyle and worsening mental health due to suffering consequences such as ﬁnancial strain and loneliness. Other risk factors for PIU in older populations include the presence of GAD or OCD symptoms. There are public health implications in terms of better understanding the risk of PIU in the elderly. The elderly may be especially vulnerable to PIU, because of decreased mobility and dwindling social circles which might lead to increased reliance on online shopping and social media for connecting to others. In turn increased internet use might lead to diminished use of other more adaptive coping mechanisms and at the expense of deepening or maintaining real world relationships. As pornography use increases in the elderly, so does the opportunity for compulsive or impulsive use of pornography. Diminishing cognitive reserve and executive function in the elderly may be predispose these individuals to engage in more PIU due to impaired impulse control. Furthermore, patients with Parkinson’s disease who take agonists might be at higher risk of PIU. There is evidence that increased PIU may be increasing loneliness in older adults which in turn has been connected to increased incidence of suicide. Because certain platforms and activities might be more likely to lead to the development of PIU, targeting the delivery of online services and platforms to the elderly may positively affect public health.

Faculty Disclosures Alyssa Tao Nothing to disclose

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Arnaldo Moreno Nothing to disclose

Stefana Morgan Nothing to disclose

MANAGING BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA IN THE ERA OF BLACK BOX WARNINGS Session 306 Pallavi Joshi1; Piruz Huda2; Rajesh R. Tampi3; Shilpa Srinivasan4

1Northwell Health-Staten Island University Hospital 2Pacifc Lutheran University 3Cleveland Clinic Lerner College of Medicine, Strongsville, Ohio 4University of South Carolina School of Medicine, Columbia, SC

Abstract: Behavioral and Psychological Symptoms of Dementia (BPSD) refers to a group of non-cognitive symptoms and behaviors that occur commonly in patients with dementia. They result from a complex interplay between various biological, psychological and social factors involved in the disease process. BPSD is associated with increased caregiver burden, institutionalization, a more rapid decline in cognition and function and overall poorer quality of life. It also adds to the direct and indirect costs of caring for patients with dementia. Available data indicate efﬁcacy for some non-pharmacological and pharmacological treatment modalities for BPSD. However, recently the use of psychotropic medications for the treatment of BPSD has generated controversy due to increased recognition of their serious adverse effects. In this symposium, we will discuss the epidemiology, neurobiology, assessment and management of individuals with BPSD. We will also provide an evidence based guideline to assess and manage these individuals. Additionally, we will discuss the recent controversies that have been generate in the treatment of BPSD.

Faculty Disclosures Pallavi Joshi Nothing to disclose

Piruz Huda Nothing to disclose

Rajesh Tampi Nothing to disclose

Shilpa Srinivasan Nothing to disclose

DEVELOPING YOUR RESEARCH CAREER Session 307 Olivia Okereke, MD

Massachusetts General Hospital and Harvard Medical School, Boston, MA

Abstract: This meeting provides information on opportunities for new researchers in geriatric psychiatry and how to get started, obtain research training and support, and persist in the research ﬁeld.

Faculty Disclosures Olivia Okereke Nothing to disclose

Am J Geriatr Psychiatry 27:3S, March 2019 S25 AAGP Annual Meeting 2019

DO NO HARM: IDENTIFYING AND ADDRESSING IMPAIRED MEDICAL PROVIDERS Session 308 Ann Glassmoyer1; David E.J. Bazzo2; Steven Huege3; William Perry4

1UCSD 2UCSD 3UCSD 4UCSD

Abstract: There are many factors contributing to a greater level of awareness of providers who might lack the necessary physical, emotional or professional competence to practice in the medical ﬁeld. Greater scrutiny of the medical profession (on-line reviews and patient satisfaction surveys), less tolerance of work-place bullying/harassment, a rapidly changing healthcare landscape (technology, policy), ﬁnancial/productivity pressures, and an aging physician workforce represent several such factors. As health system and peer accountability increase, providers and administrators are often left navigating the complex and emotionally fraught process of identifying, reporting, assessing, and adjudicating peers and employees who may lack the competence to practice medicine. Educating medical teams regarding system and licensing board policies, identifying pathways for independent assessment, and strategies for counseling providers who can no longer safely practice can facilitate this challenging, but necessary aspect of the practice of medicine. With their expertise in aging, complex medical, occupational, and social dynamics, geriatric providers are uniquely equipped to function as a key resource for addressing matters related to provider impairment.

Faculty Disclosures Ann Glassmoyer Nothing to disclose

David Bazzo Nothing to disclose

Steven Huege Nothing to disclose

William Perry Nothing to disclose

COMMON ISSUES, LIMITED OPTIONS: CHALLENGES FACED AND LESSONS LEARNED IN THE OUTPATIENT AND INPATIENT MANAGEMENT OF PSYCHOTIC DISORDERS Session 309 Alexandria Harrison1; Erica Cristina Garcia-Pittman2; Nicholas Ortiz3; Nina Vadiei4

1Dell Medical School j The University of Texas at Austin 2Dell Medical School j The University of Texas at Austin 3Dell Medical School j The University of Texas at Austin 4Banner - University Medical Center South Campus j The University of Arizona

Abstract: Late-life psychosis presents clinicians with a unique set of treatment challenges. Compared to younger adults, older adults face more treatment barriers related to cognitive decline that can result in decreased medication adherence, a crucial component for successful management of psychotic disorders. With the use of LAI agents increasing to address issues related to adherence, clinicians are often faced with the challenge of managing these regimens in the absence of speciﬁc guidelines. Given there is limited data on the comparative safety/efﬁcacy of individual antipsychotic agents in older adults, it is important to shed awareness on the types of clinical challenges providers may encounter and discuss treatment strategies currently being used in practice.

Faculty Disclosures Alexandria Harrison Nothing to disclose

S26 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019

Erica Garcia-Pittman Nothing to disclose

Nicholas Ortiz Nothing to disclose

Nina Vadiei Nothing to disclose

CREATIVE RESILIENCE & AGING: LADY BE GOOD — ELLA FITZGERALD’S LIFE IN SONG Session 310 Jeffrey Lyness

University of Rochester School of Medicine & Dentistry

Abstract: This presentation will use biography and other techniques from the humanities to elucidate themes of creativity, resilience, and aging based on the life and career of singer Ella Fitzgerald (1917−1996). ‘Ella,’ as she was affectionately known by the public, was among the twentieth century’s best-loved performers. She pleased audiences around the world with live concerts and epochal recordings, helping establish the canon of the ‘Great American Songbook.’ Her gifts included an unerring sense of pitch, superb diction, a uniquely personal sense of rhythm, and the vocal dexterity and musical imagination to match any instrumentalist with her ﬂights of improvised scatting. She remained at the top of her profession across six decades. Yet she had to overcome many forms of adversity in her life and career, including: deprivation and poverty as an adolescent; frequent lack of critical respect (as she was often unfavorably compared to her contemporary, Billie Holiday); and declining physical health in her later years. She also had to navigate the turbulent male- and white-dominated music and entertainment industries. That Ms. Fitzgerald did so with such grace and success is testimony to the human spirit’s potential for resilience. In her last decade of performing she adapted her singing approach to ﬁt her fraying vocal instrument, managing to convey an even deeper emotional connection to her material. This presentation will illustrate her story with curated audio and video clips as well as critical analysis, in order to identify generalizable themes and consider their implications for our clinical work with aging patients and their families and for ourselves.

Faculty Disclosures Jeffrey Lyness Nothing to disclose

AGING, DELIRIUM, AND POST-INTENSIVE CARE SYNDROME: NOVEL TREATMENTS AND FUTURE DIRECTIONS Session 311 Babar A. Khan1; Dmitriy Golovyan2; Noll Campbell3; Patricia Serrano4; Sikandar Hayat Khan5; Sophia Wang6

1Indiana University School of Medicine 2Indiana University School of Medicine 3Purdue University 4Indiana University School of Medicine 5Indiana University School of Medicine 6Indiana University School of Medicine

Abstract: Delirium has been traditionally deﬁned as an acute onset of ﬂuctuating cognitive status, usually in the context of precipitating medical or surgical events. Most interventions have focused on in-hospital prevention and pharmacologic symptom-focused management. Recent data suggest, however, that delirium may be better conceptualized as a chronic disorder, with long-term cognitive, mental health, and physical effects. Delirium also impacts family members who witness loved ones suffering in the hospital and care for them after discharge. Currently, there are no evidence-based models focused on delirium survivors and their caregivers. This symposium presents innovative clinical care approaches and ongoing research that promote both the well-being of patients suffering from delirium, and their family members who care for them. Examples will focus on the intensive care unit (ICU) population because of the high prevalence of ICU delirium and the rapidly increasing number of ICU

Am J Geriatr Psychiatry 27:3S, March 2019 S27 AAGP Annual Meeting 2019 survivors. In this symposium, we will cover novel pharmacologic and non-pharmacologic approaches, including a pharmacologic bundle of care to treat established delirium, a personalized music intervention to prevent delirium, and a visual reality intervention to treat delirium. The second part will focus on groundbreaking work in two new areas of delirium clinical care and research: models of care for delirium survivors, and mental health symptoms in family members of patients with delirium. This part starts off with a presentation about models of care and ongoing clinical trials for ICU survivors. The Critical Care Recovery Center (CCRC) is a novel model of care for survivors of ICU delirium, and one of the ﬁrst ICU survivor clinics in the U.S. Then there will be discussion about ongoing novel research trials to study the efﬁcacy of home based care in ICU survivors, and a cognitive and physical training program to ameliorate long-term cognitive impairment from ICU delirium. Finally, there will be a presentation about PICS-family (PICS-F), the mental health symptoms that family members of ICU patients experience, and treatment approaches for caregivers of patients with delirium.

Faculty Disclosures Babar Khan Nothing to disclose

Dmitriy Golovyan Nothing to disclose

Noll Campbell Nothing to disclose

Patricia Serrano Nothing to disclose

Sikandar Khan Nothing to disclose

Sophia Wang APPI - Book royalties

A NOVEL MODEL FOR LATE-LIFE DEPRESSION INTERVENTION DEVELOPMENT Session 312 Dimitris Kiosses1; George S Alexopoulos2; Jo Anne Sirey3; Patricia Marino4

1Weill Cornell Medicine 2Weill Cornell Medicine 3Weill Cornell Medicine 4Weill Cornell Medicine

Abstract: We will present a novel model of deployment-based behavioral interventions and implementation, streamlined based on neurobiology models and augmented by mobile technology. Our model: 1) Develops its interventions jointly with community partners and a transdisciplinary team; 2) uses neurobiological concepts as a “simplification rule” for streamlining behavioral interventions so that they can be used by community clinicians; 3) integrates mobile technology to community interventions at the assessment, the intervention, and the adherence monitoring levels; and 4) tests its interventions at community sites using community clinicians to shorten the way to uptake and sustainability. To maximize our impact, we work both in settings in which most older and middle-aged people receive care (primary care) and in settings serving persons with special clinical (elder mistreatment) and social needs (poverty). Dr. Alexopoulos will discuss the rationale for developing this model and highlight how neurobiological findings can be used to streamline behavioral intervention so that they can be accurately used by community-based clinicians and sustained in community-based settings. The rest of presenters will discuss three interventions based on this model. Dr. Marino will present REDS (Reaching and Engaging Depressed Senior Center Clients), a community care model for senior center clients. More than 10,000 senior centers operate in the US and serve 1.25 million persons nationwide. Most have low income, and in NY City, 68% are non-Caucasian. About 10% have clinically significant depression but most receive no care. The Weill Cornell Institute of Geriatric Psychiatry has partnered with the NY City Department for the Aging to develop Reaching and Engaging Depressed Senior Center Clients (REDS). REDS relies on SMART-MH, a community care model, embedded in senior centers to improve recognition of depression, referral, and adherence to depression treatment. The REDS intervention is been administered in a group-format by licensed social workers in NYC senior centers. REDS is based on Engage, a stepped-care therapy, streamlined based on the assumption that a dysfunction of the reward

S28 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 network is central to the pathogenesis of depression and uses “reward exposure” as its principal intervention. If patients fail to engage in activities leading to “reward exposure”, therapists seek to identify and address barriers to reward exposure originating from other network dysfunctions (e.g. negativity bias, apathy, or emotional dysregulation) so that “reward exposure” can proceed unimpeded. Dr. Kiosses will present the theory and data on the implementation of “Relief”, a 9-session behavioral intervention for depression and chronic pain in primary care designed to be administered by licensed social workers and nurse practitioners in primary care practices. Chronic pain and depression frequently co-exist in late and mid-life and contribute to increased disability, care costs, psychiatric comorbidity, and suicide. Older and middle-aged depressed-pain patients are mainly treated in primary care practices and often receive opioids and benzodiazepines. Relief assumes that chronic pain and depression are characterized by an attentional bias assigning greater salience to interoceptive stimuli and to negative emotions along with difficulty shifting attention to a goal-oriented/reward-driven state, leading to inadequate engagement of the reward networks. Accordingly, Relief aims to shift patient attention away from pain and negative feelings and to increase their focus on pleasurable activities. Relief also assesses patient views of pain treatment (which may be adversely affected by depression), corrects unrealistic expectations, and helps to enhance patient-physician communication Dr. Sirey will discuss, EM/PROTECT, a behavioral intervention for depressed older mistreatment victims. Up to 10% of adults 60 years and older are victims of mistreatment. Approximately 1/3 of victims have clinically significant depressive symptoms. Depressed victims are less likely to utilize services to ameliorate the mistreatment and have higher mortality rates. We have developed a brief 9 session, behavioral intervention for depressed EM victims. EM/PROTECT is based on a model which postulates that chronic stress promotes dysfunction of the cognitive control (CCN) and reward networks, impairing the victims’ ability to flexibly respond to the environment and limits their rewarding activities. PROTECT therapists work with victims to develop action plans to reduce stress, and to increase rewarding experiences. The intervention is designed to work in synergy with EM mistreatment resolution services that provide safety planning, support services, and links to legal services. In this symposium, Dr. Sirey will describe the development of EM/PROTECT and its integration into elder abuse services in collaboration with the NYC Department for the Aging.

Faculty Disclosures Dimitris Kiosses NIMH Grant - Other Financial or Material Support George Alexopoulos Otsuka Pharmaceutical - Speakers Bureau Sunovion Pharmaceutical - Speakers Bureau Takeda Pharmaceutical - Speakers Bureau NIMH Grants - Research Grant Overall Principal Investigator Jo Anne Sirey Nothing to disclose Patricia Marino NIMH Grant - Other Financial or Material Support

HONORS SCHOLARS ALUMNI SESSION Session 313 Brandon Courtney Yarns

VA Greater Los Angeles Healthcare System; UCLA School of Medicine, West Hollywood, CA

Abstract: All Honors Scholars complete Scholarly Projects on clinical, educational, or research topics related to geriatric psychiatry over the year following receipt of their Honors Scholarships. Scholarly Projects are completed under the supervision of a geriatric psychiatrist mentor who is an AAGP member. Each year, the AAGP Scholars Program Planning Committee selects three to four outstanding Honors Scholars from the previous year to make presentations on their Scholarly Projects for the Honors Scholars Alumni Session. Honors Scholars Alumni selected for this session provide an overview of their Scholarly Projects and answer questions from the audience. Honors Scholars Alumni are selected by the committee in late Fall, so individual presentations are TBA. All current Honors Scholars and General Scholars are required to attend the session.

Faculty Disclosures Brandon Yarns Nothing to disclose

Am J Geriatr Psychiatry 27:3S, March 2019 S29 AAGP Annual Meeting 2019

DIGITAL TOOLS IN GEROPSYCHIATRY: FROM RESEARCH TO PATIENT CARE Session 314 Colin Depp1; Ipsit Vahia2; Karen L Fortuna3; Olusola Alade Ajilore4

1UC San Diego 2Harvard University 3Dartmouth College 4No afﬁliation provided

Abstract: The availability of new technologies continues to open up a vast range of diagnostic and clinical tools for geriatric psychiatry. As this space matures, we are recognizing the importance of factors such as optimal design to enhance patient engagement, the importance of leveraging easily available technologies, and the importance of in-home monitoring and continuous passive data collection. All of these factors have emerged as critical to harnessing the potential of digital mental health. Increasingly, the risks from these tools are also becoming evident−the lack of a regulatory structure and clear policy as well as major unanswered questions around data privacy and security are important factors in deciding whether these technologies will ever gain widespread adoption. This session will include 4 talks, all of which feature new data, and address the potential and pitfalls of digital tools in geriatric psychiatry.

Faculty Disclosures Colin Depp Nothing to disclose

Ipsit Vahia Nothing to disclose

Karen L Fortuna Nothing to disclose

Olusola Alade Ajilore Nothing to disclose

PUBLIC POLICY SESSION 4: TEN YEARS SINCE THE FEDERAL PARITY LAW: WHAT NEXT IS NEEDED Session 315 Eve Byrd1; Megan Douglas2

1Carter Center Mental Health Program 2Morehouse School of Medicine/ Kennedy-Satcher Center for Mental Health Equity

Abstract: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the Federal Parity Law) requires that insurers treat illnesses of the brain the same way that they treat illnesses of the body. However, ten years later many individuals, including older adults, are needing to pay more out of pocket to obtain treatment for illnesses of the brain. The Carter Center Mental Health Program in collaboration with The Morehouse School of Medicine/ Kennedy-Satcher Center for Mental Health Equity and The Kennedy Forum are taking action aimed at improving regulatory and enforcement activity in order to advance the goals of parity.

Faculty Disclosures Eve Byrd Nothing to disclose

Megan Douglas Nothing to disclose

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RACISM AND AGEISM: ADDRESSING PATIENT AND PHYSICIAN BARRIERS TO IMPROVE OLDER ADULT CARE Session 316 Ali Abbas Asghar-Ali1; Iqbal Ahmed2; Melanie Tara Gentry3; Tatyana P. Shteinlukht4

1Baylor College of Medicine 2Uniformed Services University of Health Sciences, Honolulu, HI 3Mayo Clinic 4McLean Hospital, Worcester, MA

Abstract: Robert Butler, the founding director of the National Institute on Aging first coined the term ageism. He included three domains in the definition, i.e., prejudicial attitudes, discriminatory practices, and institutional practices that negatively impact older adults. By some estimates, ageism is thought to be the most common “-ism” in the world. It has shown to affect the well-being of older adults in terms of their access to healthcare, employment, and psychological well-being. However, there is little done to address ageism in medical student education, for example, only 10% of medical schools require a geriatric medicine clinical experience and few include geriatric medicine in their didactic curricula. To address this gap, the session will aim to define ageism, contributors to ageist beliefs and practices, and then propose specific ways in which to overcome ageism including educational curricula, cultural approaches, and advocacy. On the other hand, healthcare providers can be recipients of prejudicial beliefs and behaviors by patients. In a recent survey, 70% of African American and 69% of Asian physicians reported having heard biased comments from patients. Nonetheless, educational curricula and training provide little guidance on how a physician could respond to racial intolerance. Not addressing these situations can cause significant barriers to providing care to patients and can contribute to burnout. During the session we will review the existing evidence about racism towards physicians and propose means by which this could be addressed by clinicians. Participants will have an opportunity to role play and discuss concrete steps to address racism. As with ageism, it will include consideration of educational curricula, cultural approaches, and advocacy.

Faculty Disclosures Ali Asghar-Ali Nothing to disclose

Iqbal Ahmed Nothing to disclose

Melanie Gentry Nothing to disclose

Tatyana Shteinlukht Nothing to disclose

INTERNATIONAL MEDICAL GRADUATES AND A CAREER AS A GERIATRIC PSYCHIATRIST Session 317 Amita Patel1; Fnu Syeda Arshiya Farheen2; Iqbal Ahmed3; Rajesh R. Tampi4

1Dayton Psychiatric Associates, Dayton, OH 2Metrohealth Medical center - Case Western Reserve University 3Uniformed Services University of Health Sciences, Honolulu, HI 4Cleveland Clinic Lerner College of Medicine, Strongsville, Ohio

Abstract: The population of the United States is aging. Currently people over the age of 65 years constitute 13% of the general population. By 2050 this number will rise to about 25% of the population. As the population ages, the number of older adults with mental illness will also rise. Available data indicates that there are inadequate numbers of trained geriatric psychiatrists in United States to care for older adults with mental illness. The additional burden for services in the future on an already strained healthcare system can lead to catastrophic failure of the system. International Medical Graduates (IMGs) constitute almost half of the work force of geriatric psychiatrists. The IMGs have had successful career as clinicians, educators, academics and

Am J Geriatr Psychiatry 27:3S, March 2019 S31 AAGP Annual Meeting 2019 researchers in geriatric psychiatry. In this symposium we will enumerate the unique challenges faced by the IMGs and strategies on enable them to integrate into the mainstream geriatric psychiatry workforce. We will review the roles of IMGs as private practitioners, educators, academicians and as researchers. We will also discuss how organizations like the AAGP can play a greater role in attracting larger number of IMGs to join the geriatric psychiatry workforce and also the AAGP. This will enable greater access to care for the older adults with mental illness and maintain the success of AAGP in being the national organization for geriatric psychiatry clinicians in the United States.

Faculty Disclosures Amita Patel Neurocrine - Speakers Bureau

Fnu Syeda Arshiya Farheen Nothing to disclose

Iqbal Ahmed Nothing to disclose

Rajesh Tampi Nothing to disclose

INFLAMMATION, DOPAMINERGIC DECLINE, AND PSYCHOMOTOR SLOWING AS PATHOLOGIC ROUTES TO LATE LIFE DEPRESSION Session 318 Breno Satler Diniz1; Bret R Rutherford2; Howard Aizenstein3; Jennifer C Felger4

1University of Toronto, Center for Addiction and Mental Health (CAMH), Houston, TX 2Columbia University 3University of Pittsburgh, Pittsburgh, PA 4Emory University School of Medicine

Abstract: LLD affects 3% of community-dwelling adults over 60 years old, and 15% of older adults have clinically significant depressive symptoms. LLD increases an older adult’s risk of disability by 67-73% over 6 year follow up, causes twice the functional impairment compared to those without LLD, increases mortality in patients with heart disease, and is associated with high rates of completed suicide in individuals over 65. LLD is highly recurrent, can become chronic, and is often difficult to treat. Decreased processing speed has been repeatedly found in patients with LLD relative to healthy controls and mediates the effects of depression and executive dysfunction on daily functioning. The development of decreased processing speed places older individuals on a trajectory of poor outcomes, including increased risk of dementia, dependence in activities of daily living, and driving cessation. Less well recognized is the fact that depressed older adults also experience motor performance deficits, including problems with coordination, slowed movement, and difficulties with balance and gait. Depressive symptoms lead to the development of decreased gait speed, and slowed gait speed leads to incident depression in older adults. Decreased gait speed has been associated with a greater risk of falls, disability, admission to the hospital, and all-cause as well as cardiovascular mortality. Psychomotor slowing and depression may be the end results of pro-inflammatory shifts accompanying aging combined with declining mesolimbic dopaminergic signaling. Peripheral IL-6 levels are typically low or undetectable in young people, begin increasing as healthy individuals exceed 50 years of age, and are often found to be very high in extremely aged adults. Similarly, post-mortem experiments and in vivo neuroimaging studies have shown that aging is associated with reduced dopamine levels, decreased D1/D2 receptor density, and loss of dopamine transporters (DAT). Mesolimbic dopaminergic tone modulates processing speed in both humans and animal models, and decreased striatal dopamine transmission has been associated with decreased motor speed, deterioration in frontal functioning, and impaired balance. Pro-inflammatory cytokines such as IL-6 further reduce dopaminergic transmission in the brain by limiting tetrahydrobiopterin (BH4) availability and decreasing dopamine synthesis, impairing vesicular release of dopamine in presynaptic neuronsbydecreasingexpressionof vesicular monoamine transporter 2 (VMAT2), increasing dopamine transporter (DAT) reuptake of synaptic neurotransmitter, and decreasing glutamate-dependent dopamine signaling. The overall goal of this symposium is to review data linking inflammation to hypodopaminergic states, psychomotor slowing, and depression as a means of characterizing a particular subgroup of Late Life Depressed patients who may benefit from precision treatment approaches targeting dopamine signaling. Dr. Bret Rutherford, who is Associate Professor of Clinical Psychiatry at Columbia University and Director of the

S32 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019

Neurobiology and Therapeutics of Aging Division at Columbia,willChairthesymposium.Specifically,hewillopenthe symposium with a brief introductory presentation and then proceed to introduce the speakers and discussant. Dr. Rutherford is well-positioned to serve this role, as he is an expert in Late Life Depression and is principal investigator of an NIMH-funded R61/R33 research project studying levodopa monotherapy as treatment for slowing and depressive symptoms in older adults. The first speaker will be Dr. Breno Diniz, who is a geriatric psychiatrist and Assistant Professor of Psychiatry at the Department of Psychiatry, University of Toronto and Clinician Scientist at the Center for Addiction and Mental Health (CAMH) in Toronto, Canada. Dr. Diniz will describe his group’s development of the “senescent-associated secretory phenotype” (SASP) as a risk biomarker for the development of adverse structural brain changes, depression, and cognitive decline. SASP proteins include inflammatory and immune-modulatory cytokines and chemokines, growth factors, and cell surface molecules, and thus this presentation will serve as a springboard for discussing the roles of immune-inflammatory pathways in depression more generally. Next, Dr. Jennifer Felger is Assistant Professor of Psychiatry and Behavioral Sciences at Emory University School of Medicine, where she studies the effects of inflammatory cytokines on neurotransmitters and neural circuits as they relate to behavioral change. Dr. Felger will further review the relationships between inflammatory status and dopaminergic signaling before presenting neuroimaging and clinical data from ongoing studies administering levodopa and pramipexole challenges in adults with depression. Preliminary data support the hypothesis that increasing dopamine with levodopa can reverse inflammation-related disruptions in corticostriatal reward and motor circuitry in patients with high inflammation (plasma CRP >3mg/L). Dr. Felger will go on to discuss the significance of this work for the development of novel dopaminergic strategies to treat patients with high inflammation late-life depression. The session Chair, Dr. Rutherford will then present results from his NIMH-funded study of levodopa treatment in depressed older adults with psychomotor slowing. In this project, N=50 adults aged > 60 years with a DSM 5 depressive disorder, significant depressive symptoms (CES-D > 10), and decreased gait speed received 3 weeks of treatment with levodopa 150mg to 450mg as well as pre- and post-treatment neuroimaging with [11C]-raclopride positron emission tomography (PET) as well as multimodal magnetic resonance imaging (MRI). Results from this recently-completed novel study will be presented along with an outline for the next research steps to follow. Finally, Dr. Howard Aizenstein, who is Charles F. Reynolds III and Ellen G. Detlefsen Endowed Chair in Geriatric Psychiatry and Professor of Bioengineering and Clinical and Translational Science at the University of Pittsburgh School of Medicine, will serve as the discussant. Implications of this inflammation/decreased dopamine/psychomotor slowed LLD subgroup will be discussed as it pertains to the goal of developing precision interventions for older depressed patients. Audience participation will be encouraged, with at least 20 min of time reserved for this purpose.

Faculty Disclosures Breno Diniz Nothing to disclose

Bret Rutherford Nothing to disclose

Howard Aizenstein Nothing to disclose

Jennifer C Felger Nothing to disclose

THE MOST TERRIBLE POVERTY: ADDRESSING AND TREATING THE EPIDEMIC OF LONELINESS IN OLDER ADULTS Session 319 Anne Day1; Ariel Laudermith2; Gauri Khatkhate3

1Edward Hines Jr VA Hospital 2Edward Hines Jr VA Hospital 3Edward Hines Jr VA Hospital, Oak Park, IL

Abstract: Loneliness is a major public health issue in older adults, one that is recognized but not widely discussed by geriatric mental health providers. Anyone who has worked with older adults has experienced the pervasiveness of this issue and the impact loneliness can have on the emotional wellbeing of our patients. One recent study showed that 43% of older adults surveyed endorsed being lonely. In addition to psychological suffering, loneliness has been linked to higher rates of depression, dementia, alcohol dependence, and suicidal ideation. Further, loneliness has been shown to be an independent predictor of frailty,

Am J Geriatr Psychiatry 27:3S, March 2019 S33 AAGP Annual Meeting 2019 functional decline and death. In this session, the speakers will provide an overview of the existing research into loneliness, including its causes and sequelae. We will also review assessment tools that providers can incorporate into routine assessments. Next, the speakers will present data from original research conducted in the VA Home Based Primary Care program in which they work. This will include information about the prevalence of loneliness in our population of home bound veterans and its physical and mental health correlates. Finally, the speakers will discuss interventions to address loneliness among older adults that have been tried at a local and national level, including implications for public health policy.

Faculty Disclosures Anne Day Nothing to disclose

Ariel Laudermith Nothing to disclose

Gauri Khatkhate Nothing to disclose

WITH THE DIVERSITY IN PERCEPTION OF CAREGIVER ROLES, EDUCATING HEALTHCARE PROFESSIONALS, ENGAGING FAMILIES AND COMMUNITIES IS EVEN MORE ESSENTIAL TO PROMOTE QUALITY CARE Session 320 Danielle Epstein1; Elmira Yessengaliyeva2; Sarah Myer3; Uma Suryadevara4

1University of Florida 2Western Michigan University 3Western Michigan University Homer Stryker MD School of Medicine 4University of Florida

Abstract: Compared to few decades ago, the diversity in the elderly patient population and their caregivers has significantly increased and so has the diversity in ethnicities of healthcare providers in the geriatric psychiatry work force. Given this cultural diversity, there is an exponentially greater chance that clinical encounters will occur between individuals of different origins. Multiple studies have shown that caring for an elderly family member with health problems can be associated with negative health outcomes but our understanding of how caregivers from different cultural backgrounds are differentially affected by caregiving is limited. They all have different perceptions about caregiver burden and capacity to accommodate caregiver burden or resilience. During this session, we will use review subjective caregiver burden, prevalence, variations noticed in the subjective burden and the common factors that affect caregiver burden like nature of the illness, degree of disability, relationship of the patient with the caregiver, age and gender of the caregiver. We will go over some case scenarios where it was tough to counterbalance the health and well-being of the caregiver with the rights of the elderly patient. The session will describe the individual meaning of the stressful care situation, analyzing the abilities and resources that caregivers have to cope with the stressful situation. We often notice that the attitudes or decisions of the professional is influenced by their own cultural roots and can become an additional level of discord and complexity to a case. We will talk about the cultural diversity of the healthcare professionals, generational attitudes of the newer healthcare professionals and how that might impact the care of the elderly patient and the caregiver who come from a different generation. Learning how to communicate across different generations is enriched by engaging families and communities early on in the process. This promotes quality care for our elderly patients. Through case illustrations, we will talk about the importance of educating and engaging all parties involved so that we understand the variations in caregiving, different styles of using social support and coping styles. The sooner we understand these concepts, the easier it is to help engage for a positive change. The first case involves a patient who is an 87-year-old Caucasian male with mild neurocognitive disorder and his wife, who was the patient’s primary caregiver, was unable to care for him and insisted on him being sent to a locked memory unit. Although the patient did not have significant behavioral issues and was able to perform his activities of daily living, his wife perceived the burden of caregiving to be greater than she could undertake and was insistent on long-term placement. We will talk about her perception, different healthcare professional’s attitudes towards the situation and how education and training helped improve the quality of care provided to the 87 year old gentleman. The second case involves a patient who is a 75-year-old Caucasian male with Parkinson’s disease and associated neurocognitive disorder whose primary caregivers are his wife and adult son. This patient had significant behavioral issues including verbal aggression, was tough to redirect, and unable to perform his activities of daily living independently. However, his wife and adult son

S34 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 displayed resilience in regard to caretaking of the patient prior to the patient’s residence in a nursing home setting. The family was experiencing signiﬁcant caregiver burden but were reluctant to institutionalize patient. We will talk about the healthcare professional’s attitudes towards this situation and how education was essential in order to support family situation. We will also talk about how engaging the community early on in the illness helped this patient stay at home longer. The current health care models are advocating for informal caregivers as a cost saving measure and this indirectly supports patient autonomy, staying at home versus as opposed to being institutionalized. And once the severity of the illness increases, we get into end of life care issues. Often in cases of patients who don’t have the capacity to make decisions, end of life decisions are made using advance directives or next of kin. In cases where these resources are absent the values of the healthcare professionals often plays a more prominent role in prioritizing the various factors used to make such decisions. Engaging the families sooner will also help avoid some of these complicated situations. We will end the session by forming smaller groups and talking about difﬁcult case scenarios where the participants felt that education and engaging families would have helped improve patient care.

Faculty Disclosures Danielle Epstein Nothing to disclose

Elmira Yessengaliyeva Nothing to disclose

Sarah Myer Nothing to disclose

Uma Suryadevara Nothing to disclose

IT’S THE PATH, NOT THE DESTINATION: LESSONS LEARNED FROM A PSYCHOSOCIAL INTERVENTION FOR HIGH RISK DEPRESSED, COGNITIVELY IMPAIRED OLDER ADULTS Session 321 Dimitris Kiosses1; Gary J. Kennedy2; Janice Korenblatt3; Mirnova Emmanuelle Ceide4

1Weill Cornell Medicine 2Montefiore Medical Center/Albert Einstein College of Medicine 3Montefiore Medical Center/Albert Einstein College of Medicine 4Montefiore Medical Center/Albert Einstein College of Medicine

Abstract: Older adults with depression particularly those with mild to moderate cognitive impairment face many barriers to mental health treatment. Both intrinsic factors due to cognitive deficits and extrinsic factors such as recurrent medical hospitalizations, limit the effectiveness of psychotherapy. Furthermore older adults are a high risk population as rates of suicide are elevated especially in older men ≥85 years old. Psychosocial interventions for suicidal older adults are underdeveloped and do not take into account the role of cognitive impairment, specifically executive dysfunction. Homebound older adults have limited access to mental health care, even though 40% have a psychiatric illness including 29% who have dementia. This underscores an important intersection in the care of older adults with high medical illness burden, cognitive impairment and depression. Most of these older adults are cared for by family and other caregivers. While collaborative care models address untreated depression through integration in primary care settings, older adults with suicidal ideation may be deemed too high risk. And while most collaborative care models address depressive symptoms using Problem Solving Therapy (PST), older adults with depression and cognitive impairment may not be able to participate in PST nor attend weekly appointments due to multimorbidity. Furthermore traditional delivery models of psychotherapy focus on the individual and disregard the patient- caregiver dyad. In contrast, Problem Adaptation Therapy (PATH) has been efficacious in reducing depression and disability in older adults with varying degrees of cognitive impairment. PATH utilizes a simplified problem solving approach, employing compensatory strategies and environmental adaptations to bypass cognitive and functional limitations. Importantly, PATH involves the caregiver when appropriate and necessary. Preliminary data from the original PATH study showed that PATH reduces mild suicidal ideation in older adults. These findings led to a randomized clinical trial of PATH for Suicide Prevention (PATH-SP) and Supportive Therapy (ST) in middle-aged and older adults with varying degrees of cognitive impairment after discharge from a suicide-related hospitalization. In 2016, the Montefiore Home Care Geriatric Psychiatry Program (MHC- GPP) and Geriatric Neurology Center collaborated with Cornell Westchester on a pilot study to implement PATH in the Montefiore Medical Center (MMC). MMC serves the diverse communities in the Bronx and Westchester counties which have a

Am J Geriatr Psychiatry 27:3S, March 2019 S35 AAGP Annual Meeting 2019 high rate of poverty, untreated depression and medical comorbidities. In this pilot study, PATH is delivered in English and Spanish, both in the home or office, in order to provide a patient centered psychosocial intervention that acknowledges the complexity of coping with depression for older adults with high medical illness burden and cognitive impairment. Supervision for the PATH therapist is provided by an interdisciplinary team including a psychologist, geriatric psychiatrist and licensed clinical social worker with training in family therapy. The adaptation of PATH to fit the needs of high risk older adults with cognitive impairment has yielded important lessons beyond treatment efficacy that have implications for future clinical trials and mental health care delivery in this population. During this session, presenters will describe how PATH has been tailored to meet the varying needs of high risk older adults. Presenters will describe the PATH-SP trial for recently discharged patients. Presenters involved in implementation and supervision of PATH at MMC will discuss chart review findings and clinical case examples which illustrate themes and helpful strategies in the treatment of depression in older adults with high medical illness burden and cognitive impairment. Finally presenters will describe how PATH aligns with systemic family therapy theories through clinical case examples. Presenters will discuss how findings will inform the evolution of PATH and future clinical trials of psychosocial interventions to cognitive impaired older adults.

Faculty Disclosures Dimitris Kiosses NIMH Grant - Other Financial or Material Support

Gary Kennedy Guilford Press - Other Financial or Material Support

Janice Korenblatt Nothing to disclose

Mirnova Ce€ıde Nothing to disclose

PUBLIC POLICY SESSION 5: ASLEEP AT THE SWITCH: HOW GERIATRIC PSYCHIATRY, IMPLEMENTATION SCIENCE, AND HEALTH POLICY CAN HELP TO REVERSE THE NATION’S GREATEST HEALTH DISPARITY Session 322 Stephen Bartels, MD, MS

Massachusetts General Hospital

Abstract: People with serious mental illness have a reduced life expectancy between 11-30 years compared to the general population, accounting for one of the nation’s greatest, but least recognized health disparities. The primary cause of early mortality is cardiovascular disease, cancer, and related risk factors including obesity, tobacco dependence, high blood pressure, and diabetes. The purpose of this presentation is to provide an update on research addressing this challenge, including research on aging and mental health combined with implementation science can help to promote access to care models and technology to address this health disparity, along with the health care reforms needed to get the job done.

Faculty Disclosures Stephen Bartels Nothing to disclose

RESULTS OF THE ADNI-DEPRESSION STUDY Session 323 Scott Mackin1; Duygu Tosun2; James Craig Nelson3; Ruth Morin4

1UCSF Department of Psychiatry; Mental Health Service San Francisco VA Medical Center 2UCSF 3UCSF 4San Francisco VA Medical Center

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Abstract: Results Of The ADNI-Depression Study. Overview: Late life depression (LLD) is one of the most common mental health disorders with which older patients are afflicted. LLD is complicated by the common co-occurrence of cognitive impairment (CI). Estimates suggest as many as 50-60% of older depressed patients may have mild cognitive deficits however the mechanisms contributing to CI are unclear. The ADNI-Depression (ADNI-D) Study is a 5-year two-site (University of California San Francisco and the University of Pittsburgh) NIMH sponsored study of late life depression. The study aims to characterize cognitive functioning patients with LLD and clarify neurobiological mechanisms contributing to cognitive impairment and accelerated cognitive decline in this patient population. The ADNI -D study partners with the Alzheimer’s Disease Network Initiative (ADNI) and utilizes its core labs for data management, brain imaging, and biomarker assessments. The ADNI D study has been designed to focus on evaluating the impact of reduced cerebral blood flow, cortical atrophy, white matter disease, and amyloid deposition on cognitive impairment in LLD. The study is longitudinal; after an initial assessment 1 subject are followed for 2 /2 years. ADNI-D is committed to rapid data sharing of the ADNI-D data. This session will present initial data from the ADNI-Depression Study baseline evaluation and will be organized into 4 topic areas. ADNI-D Methodology and Sample Characteristics (Nelson) The ADNI D sample is a well characterized sample of older adults with depression. The ADNI D methodology facilitates comparisons of this cohort of LLD participants with the larger ADNI study of non-depressed older adults with normal cognition, Mild Cognitive Impairment (MCI), and dementia in order to clarify neurobiological mechanisms contributing to cognitive impairment and accelerated cognitive decline. This session will be focused on describing the ADNI-D methodology for participant enrollment and data collection and to report ADNI D sample (n=121) characteristics for depression severity, lifetime history of depression and depression treatment, and functional impairment. Specifically, participant enrollment criteria and methods for the assessment of depression severity and lifetime history of depression and depression treatments will be summarized. Additionally, standardized methodology for collection of neuroimaging data, biomarkers, and data management will be presented. Cognitive Functioning in the ADNI Depression cohort (Morin). The clarification of types and severity of cognitive dysfunction in LLD remains a significant area of research. This session will focus on identifying the cognitive impairment rates of participants with LLD in the ADNI-D study at baseline, highlighting methodological considerations for matching subjects to ADNI participants on basis of cognitive functioning for biomarker analyses, and to assess the relationship of subjective cognitive complaints and ApoE status with objective measures cognitive performance. Association of Cortical Atrophy, White Matter Lesions, and Amyloid Accumulation with Cognition in Late Life Depression (Mackin) Cognitive impairment (CI) in LLD is often characterized by deficits of executive functioning (EF), memory, and language and LLD has been strongly linked to accelerated rates of cognitive decline in older adults. However, the causes of CI in LLD are not clear, in part due to limitations of previous work which have lacked comparisons to well characterized non-depressed older adults with CI caused by neurodegenerative diseases that are often concurrent with LLD, such as the early stages of Alzheimer’s disease (AD) and cerebrovascular disease (CVD). The ADNI-D study will facilitate clarification of neurobiological mechanisms contributing to CI in LLD. This session will be focused on evaluating the impact of reduced cerebral blood flow (hypoperfusion), cortical atrophy, and amyloid deposition on CI in LLD in the context of previously documented relationships between CI and subcortical white matter abnormalities and genetic risk factors. Functional Network Level Pathophysiologic Abnormalities Associated with Late Life Depression (Tosun) Cognitive impairment, particularly in the domains of information processing speed, executive functioning, and memory, in LLD is consistent with neurobiological conceptualizations of LLD as being heavily mediated by extended neural networks comprised of the orbitofrontal, medial prefrontal, and cingulate cortices, and anatomical connections with the temporal and parietal lobes, and basal ganglia. By disturbing the normal function and dynamics of different brain networks, the pathophysiological mechanisms of LLD may generate different specific clinical symptoms. Therefore we examine the extent to which multimodal neuroimaging techniques can identify biomarkers reflecting key pathophysiologic processes in LLD and whether such biomarkers may act as predictors, moderators, and mediators of depressive symptoms. This might facilitate development of personalized treatments based on a better understanding of the pathophysiological mechanisms of late life depression.

Faculty Disclosures Scott Mackin Johnson& Johnson - Research Grant Site Principal Investigator Spouse employed by Genetech − Employee AVID - Research Grant Site Principal Investigator Janssen Pharmaceuticals - Research Grant Site Principal Investigator

Duygu Tosun-Turgut Nothing to disclose

J. Craig Nelson Eisai − Consultant Janssen − Consultant

Am J Geriatr Psychiatry 27:3S, March 2019 S37 AAGP Annual Meeting 2019

Assurex - Scientiﬁc/Medical Advisory Board Member Avid - Other Financial or Material Support UpToDate - Other Financial or Material Support

Ruth Morin Nothing to disclose

2018 HIGHLIGHTED PAPERS FOR THE GERIATRIC MENTAL HEALTH CLINICAL PROVIDER Session 400 Juan Young1; Laurel Bessey2; Melanie Scharrer3; Silpa Balachandran4

1Case Western Reserve University MetroHealth Psychiatry 2University of Wisconsin School of Medicine and Public Health, Madison, WI 3University of Wisconsin School of Medicine and Public Health, Madison, WI 4Metrohealth Medical Center

Abstract: Geriatric psychiatrists and other geriatric mental health providers face several competing demands for their attention and time. Numerous scientific advances in this growing field are published each year. Providers are expected to engage in lifelong learning and to practice evidence-based medicine. This session will provide busy geriatric psychiatrists and mental health providers a highlighted overview of several of the most relevant updates pertaining to the clinical practice of geriatric psychiatry that have been published from the year 2018. We hope that after attending this session, the audience will find the information presented useful for their clinical practice and can disseminate these updates to their colleagues. This will promote efficient learning, application of acquired knowledge to clinical practice, and help busy providers who also serve as experts in geriatric psychiatry to disseminate knowledge about up-to-date advances to their colleagues back home.

Faculty Disclosures Juan Young Nothing to disclose

Laurel Bessey Nothing to disclose

Melanie Scharrer Nothing to disclose

Silpa Balachandran Nothing to disclose

DECONSTRUCTING DELIRIUM: RETHINKING THE ROLE OF BIOMARKERS AND DIAGNOSTIC ANOMALIES Session 401 Babar A. Khan1; Carol Chan2; Heidi Lindroth3; Jeffrey Browndyke4; Jo Ellen Wilson5; Sophia Wang6

1Indiana University School of Medicine 2Johns Hopkins Hospital, Baltimore, MD 3Indiana University School of Medicine 4Duke University Medical Center 5Vanderbilt University Medical Center, Nolensville, TN 6Indiana University School of Medicine

Abstract: The DSM-5 deﬁnition for delirium relies solely on clinical criteria. Recent developments in the National Institute on Aging-Alzheimer’s Association (NIA-AA) research framework have challenged clinicians to reﬂect on their approach for major and mild neurocognitive disorders, particularly with regards to biomarkers and preclinical Alzheimer’s disease. The implications of the NIA-AA research framework for delirium have not been fully explored. Given the overlap between delirium and dementia

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(major neurocognitive disorder), this is a crucial area of future study. Furthermore, there has been growing recognition of the clinical signiﬁcance of a number of diagnostic entities that do not neatly ﬁt within the DSM-5 criteria. These include patients who are at high risk for developing delirium, comorbid delirium and catatonia, and long-term cognitive impairment from delirium. This presentation will cover the role of biomarkers in delirium and perioperative cognitive disorders and these diagnostic anomalies. Finally, there will be audience-driven discussion on how future research can incorporate our current knowledge of delirium biomarkers into the current NIA-AA research framework, whether the discussed diagnostic anomalies should challenge clinicians to rethink the DSM-5 criteria for delirium, and how our current knowledge about biomarkers and diagnostic anomalies may change clinical practice.

Faculty Disclosures Babar Khan Nothing to disclose

Carol Chan Nothing to disclose

Heidi Lindroth Nothing to disclose

Jeffrey Browndyke Claret Medical − Consultant

Jo Ellen Wilson Nothing to disclose

Sophia Wang APPI - Book royalties

PSYCHOPHARMACOLOGY: FACT OR FICTION, PART 2 Session 402 Amy Hebbard1; Jessica L Broadway2

1Medical University of South Carolina 2Medical University of South Carolina

Abstract: Psychopharmacology is complex with many theories explaining mechanisms of action, but relatively few conclusive studies. This lack of high quality evidence often leads to misconceptions and possibly false beliefs, as well as perpetuation of anecdotal experiences with medications. This presentation aims to examine several commonly used medications in geriatric psychiatry and compare the existing evidence to theoretical effects and side-effects. We will also compare and contrast available evidence to support or refute theories and anecdotal experiences.

Faculty Disclosures Amy Hebbard Nothing to disclose

Jessica Broadway Nothing to disclose

ADVOCATING FOR OLDER ADULTS: WHEN GUARDIANSHIP IS NOT THE ANSWER Session 403 Alessandra Scalmati1; Dennis M Popeo2; Elizabeth J Santos3; Erica Cristina Garcia-Pittman4

1Albert Einstein College of Medicine 2NYU School of Medicine 3University of Rochester School of Medicine & Dentistry, Rochester, NY 4Dell Medical School j The University of Texas at Austin

Am J Geriatr Psychiatry 27:3S, March 2019 S39 AAGP Annual Meeting 2019

Abstract: When an adult is thought to be making poor decisions or is unable to care for him or herself, many people assume that a guardianship is necessary to secure that person’s well being. An older adult may require a guardian because of a new inability to care for themselves in the contest of a neurocognitive disorder, or after a lifetime of chronic mental illness, and self-neglect. The appointment of a guardian by the court can be lifesaving, provide much needed ﬁnancial protection from exploitation, and guarantee stable housing and access to health care. However, a guardianship may also leave older adults vulnerable to abuse and ﬁnancial exploitation. In many cases, the needs of older adults are layered and complex, and guardianship is not necessarily the best remedy, especially when the court-appointed guardians may be responsible for hundreds of clients.

Faculty Disclosures Alessandra Scalmati Nothing to disclose

Dennis Popeo Nothing to disclose

Elizabeth Santos Nothing to disclose

Erica Garcia-Pittman Nothing to disclose

SENIOR INVESTIGATOR WORKSHOP Session 404 Howard Aizenstein1; Olivia Okereke, MD2

1University of Pittsburgh, Pittsburgh, PA 2Massachusetts General Hospital and Harvard Medical School, Boston, MA

Abstract: The Research Committee will organize this workshop in collaboration with program ofﬁcers from the NIMH and NIA, who will serve as presenters. All independent researchers and interested research trainees are invited to participate.

Faculty Disclosures Howard Aizenstein Nothing to disclose

Olivia Okereke Nothing to disclose

SURVIVE, THRIVE OR DIE OUT: MEDICARE AND THE PRACTICE OF GERIATRIC PSYCHIATRY Session 405 Elliott M. Stein1; Karen Reimers2; Marie DeWitt3; Maureen Cecilia Nash4; Tatyana P. Shteinlukht5

1San Francisco Campus for Jewish Living 2University of Minnesota 3Oscar G Johnson VA Medical Center, Ypsilanti, MI 4Providence Elderplace Oregon, Portland, OR 5McLean Hospital, Worcester, MA

Abstract: Our fragile geriatric psychiatric population is at risk due to lack of outpatient clinicians available to take Medicare. PCPs and geriatric internists may be hesitant to accept elderly patients with behavioral problems or history of mental illness without the back up of a geriatric psychiatrist, but patients and families often struggle to ﬁnd an psychiatrist who takes Medicare. For clinicians, discouraging elements of Medicare include poor reimbursement and the strenuous regulatory requirements of

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MACRA/MIPS. Geriatric psychiatrists practicing in nursing homes face additional daunting regulatory burdens and hostility towards psychiatric diagnoses and psychotropic medications, particularly antipsychotics. In this session, members of the AAGP Clinical Practice Committee (CPC) will discuss major challenges in Medicare faced by geriatric psychiatrists. CPC Committee Chair Dr. Marie Dewitt will introduce the topic and the speakers. Dr. Maureen Nash will review challenges related to the use of antipsychotics in nursing homes and the Partnership to Improve Dementia Care (the challenges of appropriate prescribing of psychotropic medications like antipsychotics to decrease suffering in those who live in a nursing home). Dr. Chanida Siripraparat will further discuss the use of antipsychotics in nursing homes, with a focus on what AAGP needs to do as an organization to tackle this major problem. Dr. Elliott Stein will provide a brief review of challenges related to in Medicare billing, documentation and coding, including the Medicare Physician Fee Schedule Proposed Rule for 2019 (#MPFS2019) and its proposed Evaluation and Management (E/M) Changes. Dr. Karen Reimers will discuss forensic aspects of Medicare litigation in geriatric psychiatry and summarize curent Medicare advocacy efforts. Dr. Tatyana Shteinlukht will serve as discussant. All speakers will highlight key directions for future advocacy efforts to improve Medicare and promote quality geriatric mental health services in the future. Robust discussion and audience participation will be encouraged.

Faculty Disclosures Elliott Stein Nothing to disclose

Karen Reimers Nothing to disclose

Marie Dewitt Nothing to disclose

Maureen Nash Nothing to disclose

Tatyana Shteinlukht Nothing to disclose

THE MIND AND BEYOND: THE ROLE OF MINDFULNESS AND TRANSCENDENTAL MEDITATION PRACTICES IN LATE LIFE MOOD DISORDERS Session 406 Akshya Vasudev1; Michael Lifshitz2; S. Benjamin Peckham3; Soham Rej4; Susana Gabriela Torres-Platas5

1Western University, London, Canada, London, ONT 2Stanford University 3Lawson Health Research Institute 4McGill University, Montreal, QC 5Jewish General Hospital

Abstract: Mindfulness and transcendental meditation techniques have emerging research supporting them as positive additions to treatment as usual/standard care for mood and/or cognitive disorders among older adults. This session will highlight this recent research and evidence of the benefits of these interventions in the context of late-life depression (LLD) and late-life anxiety (LLA). In the spirit of the 2019 American Association of Geriatric Psychiatry (AAGP) conference’s theme of partnership, these results are presented by a team of researchers located at McGill University, Montreal,Quebec,Canada,theUniversityofWesternOntario,London,Ontario,Canada,andStanfordUniversity,Palo Alto, California. The aim of this session is to present findings of non-pharmacological, meditation-based intervention clinical trials for LLD and LLA, as well as potential effects on cognition. Dr. Torres-Platas will present research findings comparing mindfulness-based cognitive therapy (MBCT) to treatment as usual (TAU) for late-life depression and anxiety in the primary care setting. She will also present data examining the effects of MBCT on markers of inflammation in this population. Dr. Lifshitz will be presenting fMRI results for a randomized controlled trial of MBCT for adults, as well as briefly discussing the protocol for an upcoming MBCT and SSM neuroimaging study. Ben Peckham, M.Sc., will present findings of a study examining treatment as usual plus SSM compared to treatment as usual among a sample of patients with late-life depression. Following the presentations, there will be an interactive discussion, led by Dr. Vasudev

Am J Geriatr Psychiatry 27:3S, March 2019 S41 AAGP Annual Meeting 2019 and Dr. Rej, concerning the clinical applications of these interventions and directions for future research. The session will be chaired by Dr. Vasudev.

Faculty Disclosures Akshya Vasudev Nothing to disclose

Michael Lifshitz Nothing to disclose

S. Benjamin Peckham Nothing to disclose

Soham Rej Satellite Healthcare (Dialysis Company) - Research Grant Overall Principal Investigator

Susana Torres-Platas Nothing to disclose

FIREARMS: ACCESS AND IMPLICATIONS IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT Session 407 Juliet A Glover1; Kaustubh G Joshi2; Megan Nagle3; Stephanie Hrisko4

1University of South Carolina 2University of South Carolina School of Medicine 3Palmetto Health/USC 4Palmetto Health USC

Abstract: In this session, a case will be presented to introduce safety concerns regarding access to firearms in older adults with cognitive impairment. Extant evidence suggests there are particularly high risk times and possible contributing factors for suicide in those with cognitive impairment which will be explored. Homicide rarely occurs in elderly; however, available literature suggests cognitive disorders are among the most prevalent psychiatric diagnoses in elderly homicide perpetrators. Further, when suicides and homicides occur in this population, it is most often by firearm. The epidemiology of suicide and homicide by firearm in older adults with cognitive impairment will be discussed, and risk factors for suicide and homicide will be presented. It has been suggested that a public health approach to gun violence prevention be utilized with physicians having an essential role. Physician and patient attitudes about and strategies for assessing access to firearms will be discussed. Strategies include assessing for firearm access as part of the routine functional or safety assessment and, for those with access to firearms, using a structured approach to explore safety concerns. Firearm safety has been compared to safety concerns related to driving in those with cognitive impairment. Gun laws, like driving evaluations, can vary state to state; however, general legislative measures aimed at reducing gun violence will be explored with an emphasis on persons with cognitive impairment.

Faculty Disclosures Juliet Glover Nothing to disclose

Kaustubh Joshi Nothing to disclose

Megan Nagle Nothing to disclose

Stephanie Hrisko Nothing to disclose

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AGE-RELATED HEARING LOSS AS A RISK FACTOR FOR LATE LIFE DEPRESSION AND COGNITIVE DECLINE Session 408 Anu Sharma1; Bret R Rutherford2; Frank Lin3; Justin Scott Golub4; Katharine Kim Brewster5

1University of Colorado 2Columbia University 3Johns Hopkins University 4Columbia University 5Columbia University

Abstract: Age-related hearing loss (ARHL) is the third most common health condition affecting older adults after heart disease and arthritis and is the fifth leading cause of years lived with disability worldwide. The prevalence of ARHL rises steeply with age, from 3% among adults 20-29 to 49% of adults ages 60-69 and over 80% in individuals 85 years of age and older. Many hearing-impaired older adults avoid or withdraw from social contexts in which background noise will make it difficult to communicate, resulting in social isolation and reduced communication with family andfriends.Social isolation and loneliness have been linked to numerous adverse physical and mental health outcomes, including dementia, depression, and mortality, and they may also lead to decliningphysicalactivityandthedevelopmentofthesyndromeof frailty. Neuroimaging studies of ARHL have begun to elucidate the brain changes associated with degraded auditory input that provide plausible pathways by which chronic hearing loss may cause cognitive dysfunction and affective dysregulation. Specifically, compensatory activation increases in the cognitive control network (CCN) to support effortful listening may reduce the resources available for higher level tasks, while chronic deafferentiation leads to atrophy of primary auditory regions and impaired downstream cognitive and affective processing of speech. The overall goal of this symposium is to review data linking ARHL to depression and cognitive decline in an effort to make geriatric psychiatrists more aware of the implications of this ubiquitous aging process for their patients. Dr. Bret Rutherford, who is Associate Professor of Clinical Psychiatry at Columbia University and Director of the Neurobiology and Therapeutics of Aging Division at Columbia, will Chair the symposium. Specifically, he will open the symposium with a brief introductory presentation and then proceed to introduce the speakers and discussant. Dr. Rutherford is well-positioned to serve this role, as he has recently authored an American Journal of Psychiatry review article on hearing loss and late life neuropsychiatry and is principal investigator of an NIA-funded R21 research project focuses on treating ARHL in order to improve depressive symptoms. The first speaker will be Dr. Justin Golub, who is Assistant Professor of Otolaryngology—Head and Neck Surgery at Columbia. Dr. Golub has received a K23 Award from the NIA for a project titled "Mechanisms Linking Hearing Loss and Alzheimer’s Disease and Related Dementias" that examines the associations of objectively measured ARHL with imaging markers of ADRD and cognitive performance in late middle aged persons. Dr. Golub will discuss his longitudinal studies linking audiometrically assessed ARHL to AD neuropathology (brain amyloid b with 18F-Florbetaben positron emission tomography [PET] and tau in inferior and medial temporal lobes using18F-THK5351 PET), cerebrovascular disease (CVD) on MRI, as well as comprehensively assessed cognition. Next, Dr. Katherine Brewster, who is a PGY IV psychiatry resident working in Dr. Rutherford’s laboratory at Columbia, will present original data focusing on ARHL and depression. She will review a recent first-authored AJGP publication in which she analyzed Health Aging and Body Composition Survey data to show that ARHL increased risk for incident depressive symptoms in these otherwise healthy older adults over 10-year follow up. Dr. Brewster will go on to present data from a pilot randomized controlled trial in which older adults with comorbid hearing loss and Late-life Depression were prospectively treated under double-blind conditions with hearing aids or sham hearing aids. She will review the strengths of the study methodology, which include the first known effort to blind depressed subjects to hearing aid vs. sham treatment, and discuss implications of the initial study results. Finally, Dr. Anu Sharma, Professor of Speech, Language, and Hearing Sciences at the University of Colorado at Boulder, will present work from her research program on the neural consequences of auditory deprivation in older adults. This presentation will provide a neural mechanism for the clinical/epidemiologic links between hearing loss and depression/ dementia discussed in the first two talks using electrophysiologic and neuroimaging data from Dr. Sharma’s studies. The discussant will be Dr. Frank Lin, who is Associate Professor of Otolaryngology and Medicine (Geriatrics) in the Johns Hopkins School of Medicine and of Epidemiology and Mental Health at the Bloomberg School of Public Health. Dr. Lin is the ideal discussant for this topic, and his public health research focuses on understanding how hearing loss affects the health and functioning of older adults and the strategies and policies needed to mitigate these effects. From 2014-2016, Dr. Lin helped lead initiatives with the National Academies, White House and Congress focused on hearing loss, aging and public health which resulted in passage of the Over-the-Counter Hearing Aid Act of 2017 that overturned 40 years of established regulatory precedent in the U.S. As the director of the Cochlear Center at Johns Hopkins, Dr. Lin oversees nearly $30 million in committed NIH and philanthropic funding dedicated to advancing the mission areas of the Center.

Am J Geriatr Psychiatry 27:3S, March 2019 S43 AAGP Annual Meeting 2019

Faculty Disclosures Anu Sharma National Institutes of Health - Research Grant Site Principal Investigator

Bret Rutherford Nothing to disclose

Frank Lin Boehringer Ingelheim − Consultant Amplifon − Consultant Cochlear Ltd − Consultant

Justin Golub Grant for educational course - Other Financial or Material Support

Katharine Brewster Nothing to disclose

UPDATE ON GERIATRIC PSYCHIATRY MAINTENANCE OF CERTIFICATION PROGRAM Session 409 Josepha A. Cheong1; Muhammad Aslam2

1Professor of Psychiatry and Neurology at University of Florida College of Medicine in Gainesville, F, Nashville, TN 2University of Cincinnati /VA Medical Center

Abstract: Maintenance of Certification is a program required for continued board certification in geriatric psychiatry by the American Board of Psychiatry and Neurology. This symposium will provide AAGP meeting attendees with an update from a Psychiatry Director of the ABPN about its Maintenance of Certification (MOC) program (including recent changes in response to revised requirements issued by the American Board of Medical Specialties), information about how the AAGP can help support its members to maintain subspecialty certification, and an opportunity for participants to discuss issues related to maintaining ABPN subspecialty certification.

Faculty Disclosures Josepha Cheong MCG Health Inc - Employee VHA - VA hospital - Employee U Florida − Employee

Muhmmad Aslam VA R&D - Research Grant Site Principal Investigator ROCHE - Research Grant Site Principal Investigator ALLERGAN - Research Grant Site Principal Investigator AVANIR - Research Grant Site Principal Investigator

TWO ROADS DIVERGED IN A FELLOWSHIP: CHOOSING BETWEEN GERIATRIC PSYCHIATRY AND CONSULTATION-LIAISON PSYCHIATRY Session 410 1 2 3 4 Aengus O Conghaile ; Feyza Marouf ; Rachel Meyen ; Stephanie Collier

1University of Massachusetts Medical School 2Massachusetts General Hospital 3Boston VA/Harvard South Shore Residency Program, Cambridge, MA 4McLean Hospital, Newton-Wellesley Hospital

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Abstract: Recent trends in specialty training reveal decreased numbers of ﬁlled positions in geriatric psychiatry programs compared to ﬁfteen years ago, contrasted with a sharp rise in the number of consultation-liaison fellows. The implicationsof these trends for geriatric psychiatry are critical, given the existing shortage of providers, coming demographic shifts, and the expected prevalence of psychiatric disorders among elderly Americans. The demand for physicians well-versed in treating older adults will only become increasingly relevant, yet as a specialty we have been unable to grow our number of geriatric psychiatrists to meet current and future needs. In this session, we will discuss potential explanations for this trend, including analysis of resident experiences in multiple training programs, comparisons of the training curriculum between geriatrics and C/L, andvarieties of career options aftergraduation. We willpropose innovations to improve recruitment strategies and hear directly from recently graduated and newly accepted fellows about their experiences.

Faculty Disclosures Aengus O. Conghaile Nothing to disclose

Feyza Marouf Nothing to disclose

Rachel Meyen Nothing to disclose

Stephanie Collier Nothing to disclose

CARING FOR OLDER PATIENTS WITH COMPLEX PROBLEMS: CHALLENGES, STRATEGIES, AND THE VETERANS HEALTH ADMINISTRATION EXPERIENCE Session 411 Kathleen C Matthews1; Latrice Vinson2; Marie DeWitt3; Marsden McGuire4; Michele Karel5

1VA Central Iowa Health Care System 2Department of Veterans Affairs 3Oscar G Johnson VA Medical Center, Ypsilanti, MI 4Department of Veterans Affairs 5Department of Veterans Affairs

Abstract: An aging population with complex and interacting medical, functional, psychosocial, and behavioral concerns poses a challenge for our healthcare systems and healthcare policy. A small percentage of patients accounts for most health care spending in the United States, including in the Veterans Health Administration (VHA). In VHA, particular concern has focused on aging Veterans with medical, neurocognitive, and/or mental disorder comorbidities whose behaviors may be disruptive to care. These behaviors may put patients at risk for harm to self or others and lead to inefficient, ineffective, or inappropriate use of resources. This session aims to engage participants in considering varying definitions of patients with complex needs, and how VHA has worked to understand these needs, identify promising practices, and prepare a workforce capable of meeting these needs. In the first presentation, the presenter will discuss varying conceptualizations of “complex patients” and related challenges for targeted program development and dissemination. An overview of the development, activities, and plans for the VHA Care for Patients with Complex Problems Program will be presented. The audience will be engaged in discussing the challenges for providing geriatric behavioral care across inpatient mental health, nursing home, and rehabilitation care settings, and VHA efforts to develop guidance for teams wishing to enhance capacity to provide geriatric behavioral care in these settings will be shared. A unique program, the Behavioral Recovery Outreach (BRO) Team, that facilitates transitions of care for Veterans with complex behavioral needs from inpatient nursing care to community-based care settings will be described. A closing discussion with the audience will center around the next steps in policy and program development and evaluation needed to meet the needs of aging population with complex care needs.

Faculty Disclosures Kathleen Matthews Nothing to disclose

Am J Geriatr Psychiatry 27:3S, March 2019 S45 AAGP Annual Meeting 2019

Latrice Vinson Nothing to disclose

Marie Dewitt Nothing to disclose

Marsden McGuire Nothing to disclose

Michele Karel Nothing to disclose

SARCOPENIA, SARCOPENIC OBESITY AND FRAILTY; LINKS TO COGNITIVE PERFORMANCE IN ELDERS Session 412 Jaividhya Dasarathy1; Kathleen Rogers2; Rajesh Rajesh3

1Metro Health Medical Center 2University Hospitals of Cleveland 3Metrohealth

Abstract: Background: According to 2011 CDC data, more than 2.6 million adults aged 60 and older with cognitive impairment reported difficulty performing one or more ADLs. There are studies that link cognitive decline and physical impairment in terms of low-level chronic inflammation, oxidative stress, and depression. Skeletal muscle can produce IL-1, IL-6 and other important myokines that have been implicated in cognitive and physical functional degenerative processes. Oxidative stressors have been linked to physical frailty and sarcopenia as well as neurodegenerative processes further worsening cognitive impairment. What are Sarcopenia and Sarcopenic Obesity and its impacts on elders? Sarcopenia is a primary disease of the elderly population, characterized by loss of skeletal muscle mass and function. Sarcopenia is correlated with physical disability, poor quality of life, frailty, cognitive impairment, and death. Age, gender, and level of physical activity are the risk factors for the Sarcopenia. In addition to aging, malignancy and rheumatoid arthritis causes loss of lean body mass and even increase in body fat mass. The loss of muscle mass associated with increased body fat mass i.e. sarcopenic obesity causes weakness in aging. Sarcopenia, with or without obesity, results in impairment of IADL (Instrumental Activity of Daily Living) and eventually ADLs (Activities of Daily Living) among elders and results in need for long-term care and increased cost of health care. What is the link between Sarcopenia and Cognitive Impairment? Sarcopenia has not only has a greater effect on survival but also on cognitive impairment. Sarcopenia has been linked to global cognitive impairment and dysfunction in specific cognitive skills including memory, speed, and executive functions. While obesity may impair the executive functions of aging, the exact mechanism linking obesity to cognitive dysfunction is not clear. Improvement in muscular function of obese older adults has been linked to improvement of executive functions. Obesity and Sarcopenia were associated with the lower executive function such as working memory, mental flexibility, self-control and orientation when assessed independently and even more so when they occurred together. Sarcopenia is highly correlated with frailty and risk of falls in elders; it also represents an important risk factor for disability and mortality. Frailty is an independent predictor of dementia. How do you assess for the Sarcopenia? Sarcopenia with or without obesity can be used in clinical practice to assess the potential risk of cognitive impairment in elders. There are several ways to measure Sarcopenia − DEXA (Dual-Energy X-ray Absorptiometry), biometric impedance analysis (BIA), CT (Computed Tomography) scan and MRI (Magnetic Resonance Imaging). However, assessing BMI and testing grip strength by dynamometry can be easily administered during annual wellness visits to assess the risk of sarcopenic related cognitive impairments. Sarcopenia can be assessed using parameters such as 1) Measure walking speed in elderly (>65 years). If the walking speed is below 0.8 m/s at the 4-m walking test, measure the muscle mass. 2) Hand- grip strength if this value is lower than 20kg in women and 30kg in man then muscle mass must be analyzed. 3) Defining Fat mass and lean body mass using BIA 4) Muscle Mass assessment by DEXA or CT. What is the significance of assessing the Sarcopenia? It is important to identify the risk of cognitive impairment by assessing for the onset of this condition. Preventing or delaying onset will likely enhance survival and reduce the demand for long-term care. Increasing resistance physical training will help to improve physical deconditioning, strengthen skeletal muscle hypertrophy, overcome the pain syndrome and enhance overall mental well-being. Interventions such as resistance exercise and nutritional therapy need to be developed specifically to delay the onset of Sarcopenia. What is the need in the future? Team-based approach including multidisciplinary model involving primary care physicians, geriatric psychiatrists, pain management physicians and physical therapists is required to combat the complex interlinked Sarcopenia associated cognitive impairment. Screening programs that include identification of cognitive and functional impairment in the office setting will serve as the starting point for specific interventions. The training regimen that includes supervision and correct

S46 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 equipment with resistance exercise will be necessary to get proper training and delay the muscle loss in elderly. References: 1) Cruz-Jentoft et al; Prevalence of and interventions for sarcopenia in aging adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing. 2014 Nov;43(6):748-59. 2) Tolea MI, Galvin Sarcopenia, and impairment in cognitive and physical performance.Clin Interv Aging. 2015 Mar 30;10:663-71. 3) Zembron- ºacny A, Dziubek W, Rogowski º, Skorupka E, Dabrowska˛ G. Sarcopenia: monitoring, molecular mechanisms, and physical intervention. Physiol Res. 2014;63(6):683-91. 4) Chang KV Hsu TH Wu WT Huang KC, Han DS. Association Between Sarcopenia and Cognitive Impairment: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2016 Dec 1;17(12):1164.e7-1164.e15.

Faculty Disclosures Jaividhya Dasarathy Nothing to disclose

Kathleen Rogers Nothing to disclose

Rajesh Rajesh Nothing to disclose

PRODUCTIVE AGING AND CREATIVITY: THE LIVES AND ART OF M.C. ESCHER, AGNES MARTIN, YAYOI KUSAMA AND CARMEN HERRERA Session 413 Arnold Kozak1; Frank C. Parra2; Maria Llorente3

1University of Vermont Larner College of Medicine 2Private Practice 3WASHINGTON DC VAMC

Abstract: In some cases, the artist achieves early success and then continues work into older age. In others, the artist does not achieve acclaim until they reach an older age. In either case, understanding the value of participation in the arts facilitates preparing for older age, and enables the provider to partner with the older adult in unique ways. This series of presentations will highlight the work of several artists who in spite of life adversity, including mental illness, were able to achieve success in the arts in older age.

Faculty Disclosures Arnold Kozak Nothing to disclose

Francisco Parra Nothing to disclose

Maria Llorente Nothing to disclose

DRIVING IN DEMENTIA: ADVANCES IN RESEARCH AND CLINICAL APPROACHES. Session 414 David Carr1; Gary J. Kennedy2; Mark Rappoport3

1Washington University 2Albert Einstein College of Medicine, Monteﬁore Medical Center, New York, NY 3Sunnybrook Health Sciences Centre, University of Toronto

Abstract: Driving in dementia, even in early stages, is associated with an increased risk of impairment in skills needed to operate a motor vehicle. These skills deteriorate over time, and lead to an increased risk of motor vehicle collision. Many patients with mild dementia may be safe to drive before their disease progresses, and it is challenging to predict when driving becomes unsafe. Driving cessation is associated with increased dependence, emergence of signiﬁcant depressive symptoms, and mortality. The

Am J Geriatr Psychiatry 27:3S, March 2019 S47 AAGP Annual Meeting 2019 purpose of this symposium is to discuss recent advances in research and clinical approaches to assessing driving risk in dementia, planning driving cessation before it becomes too late, and minimizing the adverse consequences of cessation. Dr. Kennedy will discuss clinical approaches for geriatric psychiatrists assessing and guiding driving among patients with dementia, highlighting his own approach with case material. Dr. Carr will summarize research pertaining to the associations between amyloid biomarkers on brain imaging and CSF and driving cessation and on-road driving performance among older adults with normal cognition and mild cognitive impairment. Dr. Rapoport will discuss recent developments in practice guidelines pertaining to dementia and driving. He will review the limitations of the literature on driving cessation interventions to date for older adults, and will introduce an empirically-based framework and toolkit for assisting older drivers with dementia and their family caregivers through the driving cessation process. A panel discussion with attendees will address the complexities of these issues, and will provide clinical guidance of balancing the risks, and discuss future directions for research in this area.

Faculty Disclosures David Carr Missouri Foundation for Health - Research Grant Overall Principal Investigator St. Louis Chapter Alzheimer’s Association − Consultant National Alzheimer’s Association − Consultant The Trafﬁc Injury Research Foundation − Consultant Medscape − Consultant AAA Foundation for Trafﬁc Safety - Consultant

Gary Kennedy Guilford Press - Other Financial or Material Support

Mark Rappoport Nothing to disclose

FINANCIAL ABUSE OF THE ELDERLY: THE ROLE OF PSYCHIATRISTS Session 415 Aazaz Ul Haq1; Matthew L Edwards2; Nishina Ann Thomas3

1VA Palo Alto, Stanford University, Sunnyvale, CA 2Stanford University 3Stanford University

Abstract: Elder financial abuse is a common and underreported problem, causing more than $36 billion in losses annually and resulting in serious social and psychological consequences for its victims. Common sequelae of elder financial abuse include financial destitution, feelings of shame, guilt, anger, self-doubt, anxiety, insomnia, and depression. Psychiatric illnesses in late life can lead to diminished capacity to make financial decisions and render individuals vulnerable to undue influence, frauds, and scams. Elder financial abuse is best managed in multidisciplinary teams, with adult protective services workers, social workers, attorneys, law enforcement, psychiatrists and other physicians, family, and the patient all playing a role. Psychiatrists are important in the detection of elderly individuals who may be victimized by financial abuse and in helping them navigate the psychological sequelae of these circumstances. Psychiatrists can also be asked by attorneys for expert consultation in litigation regarding financial abuse in which the mental state of the elder is under question. Questions about capacity to make certain financial decisions, such as creating or changing a will or trust, assigning a financial durable power of attorney, or making investment or business decisions, as well as about vulnerability to undue influence, are among the most frequent types of questions asked of psychiatrists by the legal system. This session will speak about common types of elder financial abuse and about legal criteria for different decisional and functional financial capacities that psychiatrists can be asked to assess.

Faculty Disclosures Aazaz Haq Nothing to disclose

Matthew L Edwards Nothing to disclose

Nishina Thomas Nothing to disclose

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NEW RESEARCH ON OLDER-AGE BIPOLAR DISORDER (OABD) AND BIPOLAR DISORDER ACROSS THE LIFE-SPAN: AN UPDATE FROM THE INTERNATIONAL SOCIETY OF BIPOLAR DISORDERS OABD TASKFORCE Session 416 Ariel Gildengers1; David Harper2; Lisa T. Eyler3; Martha Sajatovic4

1University of Pittsburgh School of Medicine 2McLean Hospital, Harvard Medical School 3University of California, San Diego, La Jolla, CA 4Case Western Reserve University

Abstract: Bipolar disorder (BD) is a prevalent mental disorder that causes disability throughout the life-span. Because of demographic trends, there is a growing population of individuals with older-age bipolar disorder (OABD). This symposium, presented by members of the International Society of Bipolar Disorders OABD taskforce, will highlight new data relevant to OABD and to aging with BD. The session chair, Martha Sajatovic, will ﬁrst speak about the development of the Aging and Geriatric Experiments in BD (AGE-BD) integrated dataset, and present initial results regarding the interplay of clinical, demographic, and medical variables across adulthood. Second, Lisa Eyler will discuss the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) BD Working Group, a large, ecologically-valid sample of 3020 participants from 13 sites worldwide and present her analysis of ENIGMA data that showed advanced “brain age” among those with BD compared to those without and examined clinical correlates of advanced brain age. The third speaker, David Harper, will present recently analyzed resting state fMRI data in older bipolar depressed individuals vs healthy controls. The fourth speaker, Ariel Gildengers, will present on the relationship between bipolar disorder and medical burden on cognition and brain health in older adults.

Faculty Disclosures Ariel Gildengers Nothing to disclose

David Harper Nothing to disclose

Lisa Eyler Nothing to disclose

Martha Sajatovic Otsuka, Merck, Alkermes, Janssen, Reuter Foundation, Woodruff Foundation, Reinberger Foundation, National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) - Research Grant Site Principal Investigator Bracket, Otsuka, Pﬁzer, Sunovion, Neurocrine, Supernus − Consultant Springer Press, Johns Hopkins University Press, Oxford Press, UpToDate, Lexicomp - Other Financial or Material Support American Physician’s Institute, MCM Education, CMEology, Potomac Center for Medical Education, Global Medical Educa- tion, Creative Educational Concepts - Other Financial or Material Support Health Analytics - Consultant

PERSONALITY DISORDERS IN LATE LIFE: PERSPECTIVES FROM CLINIC, ER AND LONG TERM CARE SETTINGS Session 417 Feyza Marouf1; Mark Frankel2; Nancy Needell3

1Massachusetts General Hospital 2Hebrew Senior Life 3New York Presbyterian Hospital / Weill Cornell

Abstract: Clinicians are often challenged with identifying and managing difﬁcult personality disorders in older adults. Provocative and hostile behaviors can estrange treatment providers and interfere with care; indeed, patient attitudes in relation to caregivers and providers are often revealing of diagnosis, despite complexities of medical illness, cognitive changes and psychiatric co-morbidities. In this session, we will use case examples from multiple clinical settings (outpatient clinic, psychiatric emergency room, and long

Am J Geriatr Psychiatry 27:3S, March 2019 S49 AAGP Annual Meeting 2019 term care consultation service) to highlight the challenges geriatric psychiatrists face in working with older adults with severe personality disorders. Presenters will review age-related psychosocial stressors, including personal losses and debility, and connect them to varied dysfunction across the lifespan, including patterns of attenuation of symptoms over time, re-emergence of personality disorder in late life and chronically persistent illness. In the outpatient clinic, Dr. Marouf will review common difﬁculties associated with narcissistic and borderline personalities, including diagnostic dilemmas in the setting of medical and psychiatric co-morbidities and the evidence for a range of treatment options. In the acute emergency room, Dr. Needell will focus on the challenges of safety assessments in these patients and decision making around disposition planning to minimize risks. In long term care consultation, Dr. Frankel will discuss the impact of sociopathic and dependent personalities on quality of care and care delivery, including management of staff responses, milieu disruption and other challenges to facility administration.

Faculty Disclosures Feyza Marouf Nothing to disclose

Mark Frankel Nothing to disclose

Nancy Needell Nothing to disclose

BRIDGING THE GAP BETWEEN NEUROLOGY AND PSYCHIATRY-ATYPICAL PRESENTATION OF COMMON NEURODEGENERATIVE DISORDERS Session 418 Jagan Pillai1; Kamini Krishnan2; Kasia Gustaw Rothenberg3

1The Cleveland Clinic 2The Cleveland Clinic 3The Cleveland Clinic

Abstract: It is increasingly recognized that there is significant heterogeneity in phenotype and clinical trajectories both in Alzheimer’s as well as in Parkinson’s disease. Up to 25% of Alzheimer’s disease (AD) cases do not show the typical neuropathology. Recently subtypes and atypical non-amnestic AD presentations have been formalized in the International Working Group (IWG) clinical diagnosis criteria. Clinical diagnosis of atypical AD has significantly been improved by the availability of biomarkers, including cerebrospinal fluid levels of Ab42, total tau (t-tau) and phosphorylated tau181 (p-tau), MRI volumetric estimation of hippocampal and medial temporal atrophy, and amyloid brain PET imaging. We will review the typical and atypical forms of AD from these varied perspectives to help improve diagnostic confidence among clinicians. Special attention will be given to language variant of Alzheimer’s disease. A predominant deficit in the language domain is a key feature of primary progressive aphasia but language impairment is commonly present in Alzheimer’s disease. International diagnostic criteria for PPA and its three variants (agrammatic, logopenic, semantic) were published relatively recently in 2011. Since then, studies have investigated the validity of these criteria in classifying patients which includes clinical symptoms, neurocognitive presentations, distinct MRI signatures, and neuropathological differences. In this session, we will review the subtypes of PPA using the above parameters to assist clinicians in diagnosis of these conditions. Special attention will be given of logopenic PPA a syndrome frequently seen in atypical Alzheimer’s disease. Another common neurodegenerative disorder, Parkinson’s disease (PD) conceptualized as predominantly movement disorder presents with myriad of atypical features predominantly psychiatric in nature. Psychosis is one of the most debilitating symptoms of PD, as it is an independent risk factor for nursing home placements, increased caregiver distress and mortality. Visual hallucinations are the most common psychotic manifestation in PD. Auditory, olfactory, tactile and gustatory hallucinations are infrequently found and usually coexist with visual ones. Delusions occur in about 5% of Parkinson’s disease patients. Cognitive correlates of hallucinations and delusions appear to be different in PD. They may have distinct pathogenic mechanisms and possibly anatomical substrates. Global cognitive deficits including attention, frontal executive dysfunction, visuospatial abnormalities, language and verbal memory were associated with the presence of hallucinations in Parkinson’s disease, butdidnotcorrelatewiththepresenceofdelusions. APOE and glucocerebrosidase gene (GBA) mutations and polymorphisms found to be associated with a distinct cognitive profile of changes characterized by greater impairment in working memory/executive function and visuospatial abilities in PD patients. During this session new findings on pathognomonic, cognitive and genetic correlates of psychosis in PD will be presented.

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Faculty Disclosures Jagan Pillai Nothing to disclose

Kamini Krishnan Nothing to disclose

Kasia Rothenberg Nothing to disclose

QUALITY MEASUREMENT IN PSYCHPRO: MIPS AND BEYOND Session 419 Debbie Gibson1; Diana Clarke2; Philip Wang3

1American Psychiatric Association 2American Psychiatric Association 3American Psychiatric Association

Abstract: Quality of care and cost containment issues have put a spotlight on patient outcomes with questions being asked about appropriate types and levels of care associated with variation in medical practice. As such, clinicians’ interest in obtaining objective information about their practices has increased, and patients and purchasers want to know more about the quality of care available and patient outcomes. Measurement-based care (MBC) - the routine use of standardized tools or instruments to monitor the individual’s progress in achieving his or her care, treatment, or service goals - is identified as an appropriate and necessary part of the culture of mental health care and systems. The standardization of MBC requires innovative tools that are clinically useful, easy to use, and feasible to implement in clinical practice. PsychPRO, the APA’s qualified clinical data registry (QCDR), with its patient and clinician portals, provides the opportunity for participating psychiatrists and other behavioral health clinicians to implement MBC, monitor the quality of care they provide to their patients, and continuously improve their practice. Further, participation in PsychPRO, helps the field of psychiatry by putting the development of quality measures that impact the practice of psychiatry into the hands of psychiatrists. This current session is designed to 1) highlight PsychPRO’s performance in its inaugural year in terms of quality reporting and helping psychiatrists to meet MOC Part IV requirements; 2) explore the use of PsychPRO, in the implementation of quality measurement in a variety of practice settings with a focus on geriatric care; and 3) highlight the use of PsychPRO as a quality improvement tool and it use in facilitating MBC as well as quality measure development. We will discuss challenges including, what to measure and how to go about measuring it.

Faculty Disclosures Debbie Gibson Nothing to disclose

Diana Clarke Nothing to disclose

Philip Wang Nothing to disclose

Oral Presentation 1: Geriatric Mental Health Workforce & Policy

TOWARDS EQUITABLE ACCESS TO GERIATRIC EXPERTISE: GERIMEDRISK Sophiya Benjamin, MD McMaster University

GLOBAL COUNCIL ON BRAIN HEALTH: RECOMMENDATIONS FOR PROMOTING MENTAL WELL-BEING Lindsay Chura, PhD, AARP

Global Council on Brain Health

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ADVOCATING FOR IMPROVED GERIATRIC PSYCHIATRY TRAINING IN LOW AND MIDDLE-INCOME COUNTRIES: A SWOT ANALYSIS Julia Cromwell, MD

MGH/McLean Psychiatry Residency

STAFF TRAINING NEEDS REGARDING OLDER ADULTS WITH SERIOUS MENTAL ILLNESS IN RESIDENTIAL LONG-TERM CARE SETTINGS Anjana Muralidharan, PhD

VA Capitol Healthcare Network, Mental Illness Research Education and Clinical Center, Baltimore, MD, University of Maryland School of Medicine, Baltimore, MD

TELEPSYCHIATRY IMPLEMENTATION IN RURAL SKILLED NURSING FACILITIES IMPROVES ACCESS TO MENTAL HEALTHCARE Anurag Gupta, MD

Simple Access Healthcare, Zucker School of Medicine at Hofstra/Northwell, Icahn School of Medicine at Mount Sinai

Faculty Disclosures Sophiya Benjamin Nothing to disclose

Lindsay Chura Nothing to disclose

Julia Cromwell Nothing to disclose

Anjana Muralidharan Nothing to disclose

Anurag Gupta Simple Access Healthcare Inc - Corporate Board Member

Oral Presentation 2: Non-pharmacological Interventions

A DOUBLE-BLIND PLACEBO-CONTROLLED STUDY OF THE MEMORY EFFECTS OF POMEGRANATE JUICE IN MIDDLE-AGED AND OLDER ADULTS Gary Small, MD UCLA Division of Geriatric Psychiatry

“SHARING IS CARING” – CAREGIVER RESOURCES FROM PROVIDERS TO PATIENTS Theresa Toledo, MD

Henry Ford Hospital/Wayne State University, University of Michigan, Geriatric Psychiatry Fellowship Program

RIGHT UNILATERAL ELECTROCONVULSIVE THERAPY FOR THE TREATMENT OF PSYCHOTIC DISORDERS A. Umair Janjua, MD

Emory University School of Medicine

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REAL-WORLD UTILIZATION OF NON-PHARMACOLOGICAL THERAPY PRIOR TO INITIATION OF ANTIPSY- CHOTIC TREATMENT IN THE MANAGEMENT OF AGITATION IN PATIENTS WITH DEMENTIA: FINDINGS FROM A LARGE RETROSPECTIVE CHART REVIEW Myrlene Sanon, MPH

Otsuka Pharmaceutical Development & Commercialization, Inc.

EXERCISE GROUP FOR GERIATRIC PSYCHIATRY OUTPATIENTS - IMPROVING MENTAL HEALTH AND PHYSICAL STRENGTH Sivan Klil-Drori, MD

McGill University, Jewish General Hospital, Montreal

Faculty Disclosures Gary Small Lilly - Scientific/Medical Advistory Board Member Novartis - Scientific/Medical Advisory Board Member Otsuka - Speakers Bureau Otsuka - Scientific/Medical Advistory Board Member Axovant – Consultant Activis - Scientific/Medical Advistory Board Member Forum - Scientific/Medical Advistory Board Member TauMark, LLC - Stock Shareholder Herbalife – Consultant Novartis - Speakers Bureau

Theresa Toledo Nothing to disclose

A. Umair Janjua Nothing to disclose

Myrlene Sanon Nothing to disclose

Sivan Klil-Drori Nothing to disclose

Oral Presentation 3: Affective Disorders

MEMANTINE COMBINATION WITH ESCITALOPRAM IN GERIATRIC DEPRESSION Helen Lavretsky, MD UCLA

BIPOLAR DISORDER, SCHIZOPHRENIA, AND THE RISK OF DEMENTIA IN THE VETERAN POPULATION Eileen Ahearn, MD, PhD

William S Middleton VA Hospital/ University of Wisconsin

COMBINATION ESCITALOPRAM-MEMANTINE TREATMENT IN GERIATRIC DEPRESSION: A PRELIMINARY GENOME-WIDE EXPRESSION STUDY Adrienne Grzenda, MD, PhD

UCLA

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SOCIAL SUPPORT AND EXECUTIVE DYSFUNCTION AS PREDICTORS OF SUICIDAL IDEATION IN OLDER ADULTS WITH LATE LIFE DEPRESSION Nili Solomonov, PhD

Weill Cornell Medicine

THE SEARCH FOR NEUROENDOPHENOTYPES IN LATE-LIFE DEPRESSION Gillian Kruszka, BS

University of Pittsburgh School of Medicine

Faculty Disclosures Helen Lavretsky Forest Research Inst/Allergan - Research Grant Site Principal Investigator

Eileen Ahearn Nothing to disclose

Adrienne Grzenda Nothing to disclose

Nili Solomonov Nothing to disclose

Gillian Kruszka Nothing to disclose

S54 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting Alphabetical List of Presenters at Education Sessions

* Any typographical, grammatical, and/or syntax errors are solely the responsibility of the party submitting the abstract and/or abstract author. Content appears as submitted to the American Association for Geriatric Psychiatry for presentation.

Petal Abdool, MD

Early Clinical Exposure to Geriatric Psychiatry and Medical Students’ Interest in Caring for Older Adults: A Randomized Controlled Trial

Elise Abken, MS Successful use of electroconvulsive therapy for the treatment of neuropsychiatric manifestations of Dementia with Lewy bodies

Michelle Aebi, MA Age-Related Differences in Medication Adherence, Symptoms, Functioning, and Stigma Levels in Poorly-Adherent Adults with Bipolar Disorder

Awais Aftab, MD Age-Related Differences in Medication Adherence, Symptoms, Functioning, and Stigma Levels in Poorly-Adherent Adults with Bipolar Disorder Nutrition and Bipolar Disorders in Older Adults: A systematic Review Subjectively and Objectively Rated Mixed Affective States in a Mixed-Age Sample of Adults with Bipolar Disorder: Associations with Age, Suicidality, Symptom Severity, Cognition and Inﬂammation

Marc Agronin, MD EmpathiCare: Action Based Model of Care

Yesenia Aguilar-Faustino, BS Increased cortical thickness in late-life depression after anti-depressant treatment with levomilnacipran

Eileen Ahearn, MD, PhD An Interdisciplinary Model of Assessment and Treatment for Managing Behavioral and Psychological Symptoms of Dementia on an Inpatient Psychiatry Unit: An Adaptation of the TIME Model. Bipolar Disorder, Schizophrenia, and the Risk of Dementia in the Veteran Population

Hajra Ahmad, MD Pharmacotherapy for substance use disorders among older adults: A systematic review of randomized controlled trials

Iqbal Ahmed, MD International Medical Graduates and a Career as a Geriatric Psychiatrist: Academics perspective. Recommendations to address ageism and racism

Howard Aizenstein, MD, PhD EXERCISE AS AN AUGMENTATION TO PHARMACOTHERAPY FOR DEPRESSION IN OLDER AND YOUNGER ADULTS: A FEASIBILITY TRIAL EXPLORING BIOLOGICAL MECHANISMS Experiences of End-of-Life Care by Non-Western Patients: A thematic analysis. The Search for Neuroendophenotypes in Late-Life Depression

Olusola Ajilore

Am J Geriatr Psychiatry 27:3S, March 2019 S55 2019 AAGP Annual Meeting

Naheed Akhtar, MD An Interdisciplinary Model of Assessment and Treatment for Managing Behavioral and Psychological Symptoms of Dementia on an Inpatient Psychiatry Unit: An Adaptation of the TIME Model.

Esther Akinyemi, MD “Sharing is Caring” – Caregiver Resources from Providers to Patients

Poorvanshi Alag, MD Antidepressants for anxiety disorders in late-life: A systematic review

George S. Alexopoulos, MD Community Implementation of Neurobiologically Informed Interventions for Mid- and Late-Life Depression Health-Related Quality of Life in Remitted Psychotic Depression Safety Results from 3 Long-Term Valbenazine Studies in Younger and Older Adults with Tardive Dyskinesia Engagement in Socially Rewarding Activities as a Predictor of Outcome in Behavioral Activation Therapy for Late Life Depression Social Support and Executive Dysfunction as Predictors of Suicidal Ideation in Older Adults with Late Life Depression

Mena Alrais, PharmD Safety Results from 3 Long-Term Valbenazine Studies in Younger and Older Adults with Tardive Dyskinesia

Ravindra Amin, MD In Vivo Staff Education to Use an Objective Medication Guideline in the Management of BPSD by the Consulting Psychiatrist in the Long Term Setting to Reduce Unnecessary Antipsychotic Medications.

Alvina Anantram, BA A Wish to Die and the Older Adult: The Impact of Bespoking on Virtual Continuing Education

Ana Andreazza, PhD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Carmen Andreescu, MD Depressive Symptoms on the Decline in Older Adults: Birth Cohort Analyses from the Rust Belt

Ericha Anthony, MPH RE-KINECT, a Real-World, Prospective Tardive Dyskinesia Screening Study: An Evaluation of Baseline Characteristics in Older Patients

Patricia A. Area´n, PhD Engagement in Socially Rewarding Activities as a Predictor of Outcome in Behavioral Activation Therapy for Late Life Depression

Patrick Arthur, BS Transitioning Patients with Major Neurocognitive Disorders from Antipsychotic Medications to Citalopram - A Pharmacogenetically- informed Case Series

Ali Asghar-Ali Strengths and resilience of older refugees

David Atkinson, MD Mental health diagnoses in Veterans referred for outpatient geriatric psychiatric care at a Veterans Affairs Medical Center

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Mary Austrom, PhD Understanding the challenges, needs, and qualities of frontotemporal dementia family caregivers

Jimmy Avari, MD Telepsychiatry implementation in rural skilled nursing facilities improves access to mental healthcare

Nassima Azouaou, MD Efﬁcacy of a multidisciplinary specialized care unit in reducing severe behavioral and psychological symptoms of dementia (BPSD) in patients with major neurocognitive disorders: a retrospective study

Suzanne Azzazy, DO End of Life Care in Inpatient Psychiatry: A Case Study on End-Stage Alzheimer’s Disease

Adarsha Bajracharya, MD, MSc Telepsychiatry implementation in rural skilled nursing facilities improves access to mental healthcare

Ross Baker, PhD Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review

Silpa Balachandran, MD 2018 Highlighted Papers for the Geriatric Mental Health Clinical Provider

Sabish Balan, MD Nihilistic delusion in the context of major depressive disorder with catatonic features in a geriatric patient: A case Report and review of literature

Kripa Balaram, MD Pharmacotherapy for substance use disorders among older adults: A systematic review of randomized controlled trials

Meera Balasubramaniam, MD Antidepressants for anxiety disorders in late-life: A systematic review Writing and Getting Published: Developing This Important Skill Set For Geriatric Mental Health Professionals

Clive Ballard, MBChB A post hoc analysis of study ACP-103-019 evaluating the impact of a reduction in psychosis on the severity of agitation and aggression in patients with Alzheimer’s disease

Samprit Banerjee, PhD Health-Related Quality of Life in Remitted Psychotic Depression Relationship of Hair Cortisol Concentration with History of Psychosis, Neuropsychological Performance, and Everyday Functioning in Remitted Later-Life Major Depressive Disorder The Associations Among History of Psychosis, Neuropsychological Performance, and Functioning in Remitted Later-Life Major Depression

Azziza Bankole, MD BESI: Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment

Joseph Barfett, MD, MSc Association between neuropsychiatric symptom trajectory and progression to Alzheimer’s Disease Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Cerebrospinal Fluid correlates of neuropsychiatric symptoms in patients with Alzheimer’s disease/Mild Cognitive Impairment Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study

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Lisa Barry, Increased Risk of Suicide Attempts and Unintended Death Among Those Transitioning from Prison to Community in Later Life

Collietta Bassett, MS, RN Intensive Outpatient Mental Health Program for Geriatric Psychiatric Patients in Rural Mississippi

David Bazzo, MD Resources for Asessment of Impaired Providers: Physician Assessment and Clinical Education Program

Courtney Beard, PhD Electronic Media and Its Applications in Psychotherapy: Methods and a Geriatric Case Study

Charles Beasley, MD Telepsychiatry implementation in rural skilled nursing facilities improves access to mental healthcare

Serge Beaulieu, MD, PhD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Michel Bedard, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Patricia Belchior, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Phaedra Bell Early Insights from a New Program: the Multimodal Intergenerational Social Contact Intervention

Reina Benabou, MD, PhD Comparison of the Cognivue Òquantitative assessment tool and SLUMS to classify the risk of cognitive impairment Validity, reliability, and psychometric properties of CognivueÒ, a quantitative assessment of cognitive impairment

Sophiya Benjamin, MD Towards Equitable Access to Geriatric Expertise: GeriMedRisk

Shawn Bennis, RN, MSN “Sharing is Caring” – Caregiver Resources from Providers to Patients

Anna Berall, RN Measurement-based Care: Can Tools from Palliative Care Inform our Practice in Geriatric Mental Health?

David Bickford, BA Determinants of Suicidal Ideation in Older Adults with Major Depression – Associations with Perceived Stress

Kelsey Biddle Longitudinal Associations of Amyloid-Beta, Cognitive Function and Social Activity in Cognitively Normal Older Adults

Kathleen Bingham, MD Health-Related Quality of Life in Remitted Psychotic Depression Relationship of Hair Cortisol Concentration with History of Psychosis, Neuropsychological Performance, and Everyday Functioning in Remitted Later-Life Major Depressive Disorder The Associations Among History of Psychosis, Neuropsychological Performance, and Functioning in Remitted Later-Life Major Depression

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Kecia-Ann Blissett, MD Maintaining Serenity in the Therapeutic Relationship: Aromatherapy, Individualized Music or Both to Promote Engagement and Empower Choice

Frederic Blow, PhD Reducing Inappropriate Benzodiazepine Use among Older Adults

Hilary Blumberg, Multimodal MRI Findings on Aging in Bipolar Disorder

Robert Bodkin, RPh Towards Equitable Access to Geriatric Expertise: GeriMedRisk

Nikita Bodoukhin, B.Sc. Urinary Incontinence and Depression: A Longitudinal Analysis in Males

Malaz Boustani, MD, MPH Association between inﬂammatory biomarkers in patients with ICU delirium and two-year diagnosis of MCI or ADRD Implementing the Collaborative Dementia Care Model In the Real World. Longitudinal Trends in Incidence and Prevalence of Delirium in the Intensive Care Unit

Lisa Boyle, MD, MPH Updates from the GEAR-UP Project: Performance of Multidisciplinary Learners on Late Life Depression and Cognitive Impairment Simulations

Robert Breen Suicide Assessment and Prevention in the Geriatric Population

Jennifer N. Bress, PhD Engagement in Socially Rewarding Activities as a Predictor of Outcome in Behavioral Activation Therapy for Late Life Depression

Katharine K. Brewster, MD Age-Related Hearing Loss and Risk for Depression in Later Life Hearing Aids and Late-Life Depression: A Methods Study

Adam Brickman, MD, PhD Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD Hearing Aids and Late-Life Depression: A Methods Study

Jessica Broadway, MD Psychopharmacology: Fact or Fiction, Part 2

Henry Brodaty, MD, PhD Self-harm in the Very Old One Year Later: Has Anything Changed?

Benjamin Brody Assessing Decision Making Capacity for Do Not Resuscitate Requests in Depressed Patients

Ellen Brown, MS, RN, EdD, FAAN Empathy in Caring for Persons with Dementia: Barriers and Strategies

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Patrick Brown, PhD Hearing Aids and Late-Life Depression: A Methods Study

Jeffrey Browndyke Neuroimaging and Cerebrospinal Biomarkers of Postoperative Cognitive Dysfunction

Martha Bruce, PhD Tele-behavioral activation for social isolation in older home-delivered meals recipients: Preliminary results from an ongoing randomized controlled trial

Joshua Burke, MS Global Improvements in Tardive Dyskinesia and Patient Satisfaction with Valbenazine in Older and Younger Patients: Results from an Open-Label, Rollover Study Safety Results from 3 Long-Term Valbenazine Studies in Younger and Older Adults with Tardive Dyskinesia

Meryl Butters, PhD Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study EXERCISE AS AN AUGMENTATION TO PHARMACOTHERAPY FOR DEPRESSION IN OLDER AND YOUNGER ADULTS: A FEASIBILITY TRIAL EXPLORING BIOLOGICAL MECHANISMS The Search for Neuroendophenotypes in Late-Life Depression

Amy Byers, PhD National Estimates of Suicide-related Outcomes and Salient Targets for Prevention in Older Veterans

Roger Cadieux, MD Adapting a collaborative care model to facilitate reduction of high doses of prescription opioids in community dwelling elders

Noll Campbell The Double-Edged Sword: Do Drugs Cause or Cure Delirium?

Jessica Capistrano, RN Challenging Behaviors on Inpatient Medical Units: Integrated, Non-Pharmacological Approach for Patients with Dementia

Stanley Caroff, MD, BS RE-KINECT, a Real-World, Prospective Tardive Dyskinesia Screening Study: An Evaluation of Baseline Characteristics in Older Patients

David Carr Amyloid Biomarkers Predict Driving Behavior in Older Adults.

Richard Carson, PhD Region-Speciﬁc Atrophy as Measured by Cortical Gray Matter Volume is Associated with both Regional and Total Cortical Amyloid- Beta Burden in Cognitively Normal Individuals at Risk for Alzheimer’s Disease

Kristen Cassidy, MA Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset.

Grettel Castro, MPH Urinary Incontinence and Depression: A Longitudinal Analysis in Males

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Mirnova Ceide, MD The Busy Intersection: Engaging Medically Ill, Cognitively Impaired Older Adults with Depression in PATH The Effectiveness of Problem Adaptation Therapy (PATH) in a Culture and Language Rich Community

Pablo Cervantes, MD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Binu Chakkamparambil, MD Diagnostic Accuracy of The SLU AMSAD Scale for Depression in Non-Demented Elderly

Carol K. Chan, MSc, MBBCh Delirium Biomarkers: Going Beyond the Clinical Criteria The Effect of Physical Rehabilitation on Repeated Sustained Attention Tests in Critically Ill Patients

Grace Chan, PhD Patient versus Clinician Rated Depression Scores: A Comparison of Participant Scores on the Carroll Depression Scale and the Hamil- ton Depression Rating Scale

Seetha Chandrasekhara, MD, MA Firearm Safety and Anticipatory Guidance for a Geriatric Patient with Alzheimer’s Dementia in the Outpatient Setting: A Fellow’s Dilemma

Chung-Chou Chang, PhD Depressive Symptoms on the Decline in Older Adults: Birth Cohort Analyses from the Rust Belt

Naomi Chaytor, PhD Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset.

Chen Chen, MPH Hearing Aids and Late-Life Depression: A Methods Study

Jun Chen, MSc RE-KINECT, a Real-World, Prospective Tardive Dyskinesia Screening Study: An Evaluation of Baseline Characteristics in Older Patients

Josepha Cheong Life-Long Learning for Psychiatrists and Neurologists

Aarti Chhatlani, MD Pharmacotherapy for substance use disorders among older adults: A systematic review of randomized controlled trials

Victora Chima, MD Maintaining Serenity in the Therapeutic Relationship: Aromatherapy, Individualized Music or Both to Promote Engagement and Empower Choice

Bryan Choi, MD Poisoning Deaths among Late-Middle Aged and Older Adults: Comparison between Suicides and Deaths of Undetermined Intent

Namkee Choi, PhD Poisoning Deaths among Late-Middle Aged and Older Adults: Comparison between Suicides and Deaths of Undetermined Intent Tele-behavioral activation for social isolation in older home-delivered meals recipients: Preliminary results from an ongoing randomized controlled trial

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Birgitte Christensen, PhD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Adam Ciarleglio, PhD Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD

Sara Clark, MBA The association between a loneliness resource guide and health-related quality of life among a Medicare Advantage population

Diana Clarke, PhD, MSc Using PsychPRO to facilitate the implementation of measurement-based care

Martin Cloutier, MSc Level of Care Dependency and Functional Status Among Patients with Alzheimer’s Disease and Agitation/Aggression Symptoms Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review Severity of Agitation in Alzheimer’s Disease: Proportion of Individuals Transitioning to Long-Term Residential Care using US National Alzheimer’s Coordinating Center Data

Bruce Coate, MPH A post hoc analysis of study ACP-103-019 evaluating the impact of a reduction in psychosis on the severity of agitation and aggression in patients with Alzheimer’s disease

Carl Cohen, MD Older Immigrants: Invisible but At Risk Self–health: Its Validity and Utility in Older Adults with Schizophrenia Transitioning Patients with Major Neurocognitive Disorders from Antipsychotic Medications to Citalopram - A Pharmacogenetically- informed Case Series

Fred Coleman, MD Culturally Driven Mental Health Care in Hmong and Cambodian Refugee Populations

Stephanie Collier, MD Advocating for improved geriatric psychiatry training in low and middle-income countries: A SWOT analysis The Future of Geriatric Psychiatry: Experiences With Trainees and Innovations For Recruitment

Alexander Conley, PhD Tau and amyloid pathology in association with subjective cognitive performance in normal elderly and early mild cognitive impairment The use of cognitive and ERP biomarkers of cholinergic function in novel tests of muscarinic positive allosteric modulators

P. Jeffrey Conn, PhD The use of cognitive and ERP biomarkers of cholinergic function in novel tests of muscarinic positive allosteric modulators

Michelle Conroy, MD The State of Geriatric Psychiatry Training in General Psychiatry Residency: Data from a National Survey of U.S. Program Directors

Yeates Conwell, MD Late-Life Depressive Symptoms Following Nursing Home or Inpatient Rehabilitation in Medicare Beneﬁciaries

Alexander Crizzle, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

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Julia Cromwell, MD Advocating for improved geriatric psychiatry training in low and middle-income countries: A SWOT analysis

Ella J. Daly, MD Efﬁcacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression Post hoc analyses of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression

Rebecca Daly Subjectively and Objectively Rated Mixed Affective States in a Mixed-Age Sample of Adults with Bipolar Disorder: Associations with Age, Suicidality, Symptom Severity, Cognition and Inﬂammation

Jaividhya Dasarathy, MD Sarcopenia, Sarcopenic Obesity and Frailty; links to Cognitive Performance in Elders

Deirdre Dawson, PhD Relationship of Hair Cortisol Concentration with History of Psychosis, Neuropsychological Performance, and Everyday Functioning in Remitted Later-Life Major Depressive Disorder The Associations Among History of Psychosis, Neuropsychological Performance, and Functioning in Remitted Later-Life Major Depression

Anne Day, PhD Health Literacy Among Veterans in a Home Based Primary Care Loneliness in a Home-Based Primary Care Population

Colin Depp, PhD Subjectively and Objectively Rated Mixed Affective States in a Mixed-Age Sample of Adults with Bipolar Disorder: Associations with Age, Suicidality, Symptom Severity, Cognition and Inﬂammation Technology in bipolar disorder

Marie DeWitt, MD Addressing Complex Needs for Older Patients in Nursing Homes and Inpatient Mental Health Care Settings

Joel Dey, MD Clinical Evaluation of Insomnia in the Older Adult Differential Diagnosis for Insomnia in the Older Adult Pharmacotherapy for substance use disorders among older adults: A systematic review of randomized controlled trials

Romika Dhar, MD How do they Measure up: Rating Scales in Geriatric Psychiatry

Amitha Dhingra, MD Successful use of electroconvulsive therapy for the treatment of neuropsychiatric manifestations of Dementia with Lewy bodies

Nery Diaz, DO Differential Diagnosis for Insomnia in the Older Adult

Peter DiMilia, MPH Tele-behavioral activation for social isolation in older home-delivered meals recipients: Preliminary results from an ongoing randomized controlled trial

Diana DiNitto, PhD Poisoning Deaths among Late-Middle Aged and Older Adults: Comparison between Suicides and Deaths of Undetermined Intent

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Breno Diniz, MD, PhD Enhanced molecular senescence as a marker of accelerated brain and systemic aging in major depression: a lifespan approach

Ebony Dix Cultural Competency in Geriatric Psychiatry Differential Diagnosis for Insomnia in the Older Adult Treatment for Insomnia in the Older Adult

Bridget Doane, PhD Mental health diagnoses in Veterans referred for outpatient geriatric psychiatric care at a Veterans Affairs Medical Center

Annemiek Dols, MD, PhD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial Nutrition and Bipolar Disorders in Older Adults: A systematic Review

Nancy Donovan, MD Anxiety and Subcortical Amyloidosis in Cognitively Normal Older Adults Assessing Biomarkers of Synaptic Health in Alzheimer’s Disease using PET Imaging Loneliness and Pathological Tau Deposition in Cognitively Normal Older Adults

Viktoriya Donovan, MD Self–health: Its Validity and Utility in Older Adults with Schizophrenia Transitioning Patients with Major Neurocognitive Disorders from Antipsychotic Medications to Citalopram - A Pharmacogenetically- informed Case Series

Valerie Dorcelus, MD Visual Hallucinations as a Safety Concern in the Elderly

Brian Draper, MD Self-harm in the Very Old One Year Later: Has Anything Changed?

Ruth Duffy, PhD Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review

Johanne Duguay, RN Efﬁcacy of a multidisciplinary specialized care unit in reducing severe behavioral and psychological symptoms of dementia (BPSD) in patients with major neurocognitive disorders: a retrospective study

Tammy Duong, MD Mental health issues affecting older refugees

Richard E Carson, PhD Association Between Odor Identiﬁcation and Regional Gray Matter in Early Preclinical Alzheimer’s Disease

Theresa Ebo, MA Social Support and Executive Dysfunction as Predictors of Suicidal Ideation in Older Adults with Late Life Depression

Matthew Edwards Elder Financial Abuse: The Scope of the Problem

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Daniel Eguchi, BS The Effectiveness of Problem Adaptation Therapy (PATH) in a Culture and Language Rich Community

Sheina Emrani, PhD Affective Disturbance in Mild Cognitive Impairment

Danielle Epstein With the diversity in perception of caregiver roles, educating healthcare professionals, engaging families and communities is even more essential to promote quality care

Linda Ercoli, PhD A Double-Blind Placebo-Controlled Study of the Memory Effects of Pomegranate Juice in Middle-aged and Older Adults Increased cortical thickness in late-life depression after anti-depressant treatment with levomilnacipran

Kirk Erickson, PhD EXERCISE AS AN AUGMENTATION TO PHARMACOTHERAPY FOR DEPRESSION IN OLDER AND YOUNGER ADULTS: A FEASIBILITY TRIAL EXPLORING BIOLOGICAL MECHANISMS

Ricardo Escobar, MD Pharmacotherapy for substance use disorders among older adults: A systematic review of randomized controlled trials

Sophia Escobar, MSc Exercise Group for Geriatric Psychiatry Outpatients - Improving Mental Health and Physical Strength Group Mindfulness Meditation Based Cognitive Therapy Intervention for the Treatment of Late-Life Depression and Anxiety Symp- toms: A Randomized Controlled Trial

Denise Evans, MD Staff Training Needs Regarding Older Adults with Serious Mental Illness in Residential Long-Term Care Settings

Lisa Eyler, PhD Brain Aging in Bipolar Disorder: An Analysis of Data from the ENIGMA Bipolar Disorder Working Group Effect of Sex Differences on Inﬂammation in Schizophrenia: Relationships with Sleep Disturbances, Cognitive Functioning, and Car- diometabolic Risk Subjectively and Objectively Rated Mixed Affective States in a Mixed-Age Sample of Adults with Bipolar Disorder: Associations with Age, Suicidality, Symptom Severity, Cognition and Inﬂammation

Stewart Factor Common gait disorders in geriatric patients

Mario Fahed, MD The Great Treatment Plan Meeting

Mindy Fain, MD Psychotropic medication use patterns in home-based primary care: a systematic review

Khodayar Farahmand, PharmD Global Improvements in Tardive Dyskinesia and Patient Satisfaction with Valbenazine in Older and Younger Patients: Results from an Open-Label, Rollover Study Safety Results from 3 Long-Term Valbenazine Studies in Younger and Older Adults with Tardive Dyskinesia

Sara Feist, RN An Interdisciplinary Model of Assessment and Treatment for Managing Behavioral and Psychological Symptoms of Dementia on an Inpatient Psychiatry Unit: An Adaptation of the TIME Model.

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Jennifer Felger Levodopa reverses cytokine-induced reductions in striatal dopamine release

Howard Fillit, MD Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review

Corinne Fischer, MD Association between neuropsychiatric symptom trajectory and progression to Alzheimer’s Disease Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Cerebrospinal Fluid correlates of neuropsychiatric symptoms in patients with Alzheimer’s disease/Mild Cognitive Impairment Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study Prevalence and Trajectory of Neuropsychiatric Symptoms from Early to Late Stage Alzheimer’s Disease and their Association with Dis- ease Biomarkers

Alastair Flint, MD Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study Health-Related Quality of Life in Remitted Psychotic Depression Relationship of Hair Cortisol Concentration with History of Psychosis, Neuropsychological Performance, and Everyday Functioning in Remitted Later-Life Major Depressive Disorder The Associations Among History of Psychosis, Neuropsychological Performance, and Functioning in Remitted Later-Life Major Depression

Janine Flory, PhD Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD

Brent P. Forester, MD, MSc Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD) Mindfulness-based art psychotherapy group for older adults using digital tools|The State of Geriatric Psychiatry Training in General Psychiatry Residency: Data from a National Survey of U.S. Program Directors

Luis Fornazzari, MD Cerebrospinal Fluid correlates of neuropsychiatric symptoms in patients with Alzheimer’s disease/Mild Cognitive Impairment

Karen Foster, BS Efﬁcacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression Post hoc analyses of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression

Jocelyn Fotso Soh, MSc Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Kristin Foust, BSN Adapting a collaborative care model to facilitate reduction of high doses of prescription opioids in community dwelling elders

Susan Fox, PhD, MBChB Examining Parkinson’s disease psychosis treatment outcomes in the real world: interim Year 1 ﬁndings from the INSYTE Observa- tional Study

Mark Frankel Sociopathy and Dependency in Long Term Care Settings

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Robert Fraser, PhD Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset.

Doral Fredericks, PharmD, MBA Examining Parkinson’s disease psychosis treatment outcomes in the real world: interim Year 1 ﬁndings from the INSYTE Observa- tional Study

Madeline Friedman, BA Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD

Daryl Fujii, PhD Staff Training Needs Regarding Older Adults with Serious Mental Illness in Residential Long-Term Care Settings

Patrick Gagnon-Sanschagrin, MSc Level of Care Dependency and Functional Status Among Patients with Alzheimer’s Disease and Agitation/Aggression Symptoms Severity of Agitation in Alzheimer’s Disease: Proportion of Individuals Transitioning to Long-Term Residential Care using US National Alzheimer’s Coordinating Center Data

Jessica Galatioto, AuD Hearing Aids and Late-Life Depression: A Methods Study

Damien Gallagher, MD Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study

Mary Ganguli, MD Depressive Symptoms on the Decline in Older Adults: Birth Cohort Analyses from the Rust Belt

Sujuan Gao, PhD Association between inﬂammatory biomarkers in patients with ICU delirium and two-year diagnosis of MCI or ADRD Longitudinal Trends in Incidence and Prevalence of Delirium in the Intensive Care Unit

Erica Garcia-Pittman, MD Case Presentation: When Guardianship is Not the Answer Implementation of a Geriatric Psychiatry Track in the Fourth Year Curriculum Limitations of an Outpatient Commitment in a Geriatric Patient with Late-Life Mania Treating Bipolar I Disorder with Comorbid Parkinson’s Disease: A Catch-22

Sandra Gardner, PhD A Wish to Die and the Older Adult: The Impact of Bespoking on Virtual Continuing Education Measurement-based Care: Can Tools from Palliative Care Inform our Practice in Geriatric Mental Health?

Nidhi Garg, MD Telepsychiatry implementation in rural skilled nursing facilities improves access to mental healthcare

Jennifer R. Gatchel, MD, PhD Assessing Biomarkers of Synaptic Health in Alzheimer’s Disease using PET Imaging Depressive Symptoms, Cortical Amyloid, and Cognitive Decline in Older Adults Nutrition and Bipolar Disorders in Older Adults: A systematic Review

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Marjolaine Gauthier-Loiselle, PhD Level of Care Dependency and Functional Status Among Patients with Alzheimer’s Disease and Agitation/Aggression Symptoms Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review Severity of Agitation in Alzheimer’s Disease: Proportion of Individuals Transitioning to Long-Term Residential Care using US National Alzheimer’s Coordinating Center Data

Sahil Gehlot, MBBS In Vivo Staff Education to Use an Objective Medication Guideline in the Management of BPSD by the Consulting Psychiatrist in the Long Term Setting to Reduce Unnecessary Antipsychotic Medications.

Joel Gelernter, MD Association Between Odor Identiﬁcation and Regional Gray Matter in Early Preclinical Alzheimer’s Disease Region-Speciﬁc Atrophy as Measured by Cortical Gray Matter Volume is Associated with both Regional and Total Cortical Amyloid- Beta Burden in Cognitively Normal Individuals at Risk for Alzheimer’s Disease

Melanie Gentry, MD Racism in healthcare delivery The use of Electroconvulsive Therapy for Treatment Resistant Depression in an Elderly Woman with a Deep Brain Stimulator

Lauren Gerlach, MSc, DO Discontinuation of Chronic Benzodiazepine Use among Adults in the U.S.

Debbie Gibson Quality measurement using PsychPRO

Ariel Gildengers Effects of Bipolar Disorder (BD) and medical comorbidity on cognitive dysfunction in older adults

Ann Glassmoyer Substance Use and Provider Impairment

Juliet Glover, MD Elderly Homicide and Cognitive Impairment

Angela Golas, MD Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study

Jennifer Goldman, MD Examining Parkinson’s disease psychosis treatment outcomes in the real world: interim Year 1 ﬁndings from the INSYTE Observa- tional Study

Dmitriy Golovyan, Visual Reality: A New Viewpoint to ICU Delirium Treatment

Justin Golub, MD Hearing Aids and Late-Life Depression: A Methods Study Mechanisms Linking Hearing Loss to Alzheimer’s Disease and Related Dementias

Victor Gonzalez, MD Treating Bipolar I Disorder with Comorbid Parkinson’s Disease: A Catch-22

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Elisa Gonzalez Cuevas, BSc Anxiety, neuroticism and late-life depression

Allana Goodman, MSc Exercise Group for Geriatric Psychiatry Outpatients - Improving Mental Health and Physical Strength

Marianne Goodman, MD “Project Life Force-Geriatric”: A Novel Suicide Safety Planning Group Treatment Supporting Older Veterans with Suicidal Symptomology and their Caregivers with a Novel Treatment

Carrie M. Goodson, MD The Effect of Physical Rehabilitation on Repeated Sustained Attention Tests in Critically Ill Patients

Elizabeth Grecco, MS Adapting a collaborative care model to facilitate reduction of high doses of prescription opioids in community dwelling elders

Jason Greenhagen, DO Affective Disturbance in Mild Cognitive Impairment

Cindy Grief, MD, MSc A Wish to Die and the Older Adult: The Impact of Bespoking on Virtual Continuing Education Measurement-based Care: Can Tools from Palliative Care Inform our Practice in Geriatric Mental Health?

George Grossberg, MD Diagnostic Accuracy of The SLU AMSAD Scale for Depression in Non-Demented Elderly

Daphna Grossman, MD A Wish to Die and the Older Adult: The Impact of Bespoking on Virtual Continuing Education Measurement-based Care: Can Tools from Palliative Care Inform our Practice in Geriatric Mental Health?

George Grove, MS EXERCISE AS AN AUGMENTATION TO PHARMACOTHERAPY FOR DEPRESSION IN OLDER AND YOUNGER ADULTS: A FEASIBILITY TRIAL EXPLORING BIOLOGICAL MECHANISMS

Michael Grundman, MD Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review

Adrienne Grzenda, MD, PhD Combination Escitalopram-Memantine Treatment In Geriatric Depression: A Preliminary Genome-Wide Expression Study

Annie Guerin, MSc Level of Care Dependency and Functional Status Among Patients with Alzheimer’s Disease and Agitation/Aggression Symptoms Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review Severity of Agitation in Alzheimer’s Disease: Proportion of Individuals Transitioning to Long-Term Residential Care using US National Alzheimer’s Coordinating Center Data

Faith M. Gunning, PhD The Identiﬁcation of Resting State fMRI-Deﬁned Subtypes of Late Life Depression The Use of a Mobile Cognitive Intervention to Target Cognitive Control Dysfunction in Middle Aged and Older Adults with Depression Engagement in Socially Rewarding Activities as a Predictor of Outcome in Behavioral Activation Therapy for Late Life Depression

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Aarti Gupta, MD Antidepressants for anxiety disorders in late-life: A systematic review

Anurag Gupta, MD, MSc, MBA Telepsychiatry implementation in rural skilled nursing facilities improves access to mental healthcare

Manan Gupta, MD Association Between Odor Identiﬁcation and Regional Gray Matter in Early Preclinical Alzheimer’s Disease Capacity Assessment Training Module Region-Speciﬁc Atrophy as Measured by Cortical Gray Matter Volume is Associated with both Regional and Total Cortical Amyloid- Beta Burden in Cognitively Normal Individuals at Risk for Alzheimer’s Disease

Sheila Gupta Antidepressants for anxiety disorders in late-life: A systematic review

Michael Guskey, PharmD, MBA A post hoc analysis of study ACP-103-019 evaluating the impact of a reduction in psychosis on the severity of agitation and aggression in patients with Alzheimer’s disease

Keva Gwin, PharmD Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review

Harry Gwirtsman, MD Tau and amyloid pathology in association with subjective cognitive performance in normal elderly and early mild cognitive impairment

Christopher H van Dyck, MD Association Between Odor Identiﬁcation and Regional Gray Matter in Early Preclinical Alzheimer’s Disease

Hae Ra Han, Early Detection of Dementia, Dementia Literacy, Environmental Safety, and Navigation (EDEN), an transitional intervention for Korean older adults with dementia and their caregivers

Haruo Hanyu, MD Effect of Memantine on Behavioral and Psychological Symptoms of Dementia (BPSD) of Alzheimer’s Disease - Study of Changes in Cerebral Blood Flow By Spect Imaging-

Aazaz Haq, MD Financial Capacity and Vulnerability to Undue Inﬂuence

Rita Hargrave Lean on Me: Treatment Challenges with Older African Americans: Causes, Consequences and Collaborative Strategies

David G. Harper, PhD Comparison of Resting State Networks in Patients with Older Age Bipolar Disorder and Normal Controls. Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD)

Alexandria Harrison Common issues, limited options: Challenges Faced and Lessons Learned in the Outpatient and Inpatient Management of Psychotic Disorders

S70 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Ann Hartry, PhD Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review

Gil Haugh, MS The association between a loneliness resource guide and health-related quality of life among a Medicare Advantage population

Elaine Hawkes, MA, LMHC Mindfulness-based art psychotherapy group for older adults using digital tools

Keith Hawkins, PhD Depression Predicts Delirium after Coronary Artery Bypass Graft Surgery Independent of Cognitive Impairment and Cerebrovascular Disease: An Analysis of the NOAHS Study

Kaitlin Healy, MPH Examining Parkinson’s disease psychosis treatment outcomes in the real world: interim Year 1 ﬁndings from the INSYTE Observa- tional Study

David Heber, MD, PhD A Double-Blind Placebo-Controlled Study of the Memory Effects of Pomegranate Juice in Middle-aged and Older Adults

Shafagh Heidari An Overview of PTSD in Older Adults

Hannah Heintz, BA Mindfulness-based art psychotherapy group for older adults using digital tools

Benjamin Hellman, B.A. Urinary Incontinence and Depression: A Longitudinal Analysis in Males

Kyle Hendrie, Medical Student Longitudinal Trends in Incidence and Prevalence of Delirium in the Intensive Care Unit

Adam Herbstsomer, MD Experiences of End-of-Life Care by Non-Western Patients: A thematic analysis.

Nathhan Hermann, MD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Adriana Hermida, MD A Complex Case of Diagnosing Bereavement A case of bigeminy and successful completion of acute electroconvulsive therapy course Efﬁcacy of Ultrabrief RUL ECT in catatonia and psychosis Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD) Right unilateral electroconvulsive therapy for the treatment of psychotic disorders Successful use of electroconvulsive therapy for the treatment of neuropsychiatric manifestations of Dementia with Lewy bodies

Nathan Herrmann, MD Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study

Am J Geriatr Psychiatry 27:3S, March 2019 S71 2019 AAGP Annual Meeting

Joanne Ho, MD Towards Equitable Access to Geriatric Expertise: GeriMedRisk

Katherine Hobbs, BA Electronic Media and Its Applications in Psychotherapy: Methods and a Geriatric Case Study The State of Geriatric Psychiatry Training in General Psychiatry Residency: Data from a National Survey of U.S. Program Directors

Suzi Hong, PhD Effect of Sex Differences on Inﬂammation in Schizophrenia: Relationships with Sleep Disturbances, Cognitive Functioning, and Car- diometabolic Risk

Kreshnik Hoti, PhD Identiﬁcation and Evaluation of Behavioral Symptoms in Dementia Using Passive Radio Sensing and Machine Learning

Nien-Tsen Hou, MD Retrospectively Assessing the Efﬁcacy of Agomelatine in Behavioral and Psychological Symptoms of Dementia

Stephanie Hrisko, MD, MA Late-Life Suicide Case Presentation Self-injury and Suicide by Firearm in Older Adults with Cognitive Impairment

Ying-Che Huang, MD Retrospectively Assessing the Efﬁcacy of Agomelatine in Behavioral and Psychological Symptoms of Dementia

Piruz Huda, DPN Prioritizing Nonpharmacological Interventions in the Treatment of Behavioral and Psychological Symptoms of Dementia

Steven Huege, MD, MS. Ed. Physician Impairment and ACGME

Sehba Husain-Krautter, MD, PhD Determining Prevalence of Substance Use Disorder in the Geriatric Population During Consult Services

Stuart Isaacson, MD Examining Parkinson’s disease psychosis treatment outcomes in the real world: interim Year 1 ﬁndings from the INSYTE Observa- tional Study

Zahinoor Ismail, MD Cerebrospinal Fluid correlates of neuropsychiatric symptoms in patients with Alzheimer’s disease/Mild Cognitive Impairment

Tom Jacob Ageism in Relation to Judges

Amit Jagtiani, MD Nihilistic delusion in the context of major depressive disorder with catatonic features in a geriatric patient: A case Report and review of literature

Mary Janevic, PhD, MPH Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset.

S72 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

A. Umair Janjua, MD A case of bigeminy and successful completion of acute electroconvulsive therapy course Right unilateral electroconvulsive therapy for the treatment of psychotic disorders Successful use of electroconvulsive therapy for the treatment of neuropsychiatric manifestations of Dementia with Lewy bodies

Manel Jarboui, MD Efﬁcacy of a multidisciplinary specialized care unit in reducing severe behavioral and psychological symptoms of dementia (BPSD) in patients with major neurocognitive disorders: a retrospective study

Dilip Jeste, MD Effect of Sex Differences on Inﬂammation in Schizophrenia: Relationships with Sleep Disturbances, Cognitive Functioning, and Car- diometabolic Risk

Daniel Jimenez Implementation of a Psychosocial Intervention Program for Working Caregivers.

Gregory Job, MD Right unilateral electroconvulsive therapy for the treatment of psychotic disorders

Barbara Jobst, MD Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset.

Erica Johnson, PhD Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset.

Carrie Jones, PhD The use of cognitive and ERP biomarkers of cholinergic function in novel tests of muscarinic positive allosteric modulators

Jin Hui Joo, MD, MA Communication factors that lead to increased working alliance in a peer support intervention for older adults

Chinaka Joseph, BSc Association between white matter hyperintensities, frontal brain volumes and neuroticism in late life depression

Kaustubh Joshi Legal Interventions to Reduce High-Risk Persons’ Access to Firearms

Pallavi Joshi, DO, MA Ageism in Relation to Physicians Antidepressants for anxiety disorders in late-life: A systematic review Management of Inappropriate Sexual Behaviors in Dementia Using Multidisciplinary Teams in the Continuum of Care Managing Behavioral and Psychological Symptoms of Dementia In The Era Of Black Box Warnings

Emily Justin Ageism in Relation to Pilots

Zach Kabelac, PhD Identiﬁcation and Evaluation of Behavioral Symptoms in Dementia Using Passive Radio Sensing and Machine Learning

Sayan Kaishibayev, MD Self–health: Its Validity and Utility in Older Adults with Schizophrenia Transitioning Patients with Major Neurocognitive Disorders from Antipsychotic Medications to Citalopram - A Pharmacogenetically- informed Case Series

Am J Geriatr Psychiatry 27:3S, March 2019 S73 2019 AAGP Annual Meeting

Kurtis Kaminishi, MD, MBA Challenging Behaviors on Inpatient Medical Units: Integrated, Non-Pharmacological Approach for Patients with Dementia

Atsushi Kamiya, MD, PhD The Effect of Physical Rehabilitation on Repeated Sustained Attention Tests in Critically Ill Patients

Kiyoshi Kanaya, MD Effect of Memantine on Behavioral and Psychological Symptoms of Dementia (BPSD) of Alzheimer’s Disease - Study of Changes in Cerebral Blood Flow By Spect Imaging-

Hakmook Kang, PhD Tau and amyloid pathology in association with subjective cognitive performance in normal elderly and early mild cognitive impairment

Arushi Kapoor, MD, MSc Visual Hallucinations as a Safety Concern in the Elderly

Wael Karameh, MD Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder

Jordan Karp, MD EXERCISE AS AN AUGMENTATION TO PHARMACOTHERAPY FOR DEPRESSION IN OLDER AND YOUNGER ADULTS: A FEASIBILITY TRIAL EXPLORING BIOLOGICAL MECHANISMS The effect of low-dose buprenorphine for treatment-resistant depression

Dina Katabi, PhD Identiﬁcation and Evaluation of Behavioral Symptoms in Dementia Using Passive Radio Sensing and Machine Learning

Ira Katz, MD, PhD Bipolar Disorder, Schizophrenia, and the Risk of Dementia in the Veteran Population

Charles Kellner, MD ECT in America

Gary Kennedy Clinical Assessment of Driving in Patients with Dementia: The ‘Grandchild Rule’ and Beyond.

Sarah Kewin, BS Comparison of the CognivueÒquantitative assessment tool and SLUMS to classify the risk of cognitive impairment Validity, reliability, and psychometric properties of CognivueÒ, a quantitative assessment of cognitive impairment

Alexandra Key, PhD The use of cognitive and ERP biomarkers of cholinergic function in novel tests of muscarinic positive allosteric modulators

Zaira Khalid, MD Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset.

Babar Khan, MD, MS Association between inﬂammatory biomarkers in patients with ICU delirium and two-year diagnosis of MCI or ADRD Longitudinal Trends in Incidence and Prevalence of Delirium in the Intensive Care Unit The Forgotten Ones: Where Can Delirium Survivors Recover?

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Muhammad Khan, MD Adapting a collaborative care model to facilitate reduction of high doses of prescription opioids in community dwelling elders

Sikandar Khan, DO Association between inﬂammatory biomarkers in patients with ICU delirium and two-year diagnosis of MCI or ADRD Longitudinal Trends in Incidence and Prevalence of Delirium in the Intensive Care Unit Music to My Ears: Personalizing Non-Pharmacologic Approaches to Delirium

Gauri Khatkhate Health Literacy and Public Policy How to ﬁght loneliness: A review of interventions to address loneliness in older adults

Rita Khoury, MD Diagnostic Accuracy of The SLU AMSAD Scale for Depression in Non-Demented Elderly

Lisa Kilpatrick, PhD Associations between cytokines and cortical thickness in patients with late-life depression Increased cortical thickness in late-life depression after anti-depressant treatment with levomilnacipran

Ana Kim, MD Hearing Aids and Late-Life Depression: A Methods Study

Myra Kim, ScD Discontinuation of Chronic Benzodiazepine Use among Adults in the U.S.

Dimitris Kiosses, PhD “Relief”: A Behavioral Intervention for Depression and Chronic Pain in Primary Care Navigating the Perilous Road: PATH for High Risk Suicidal Older Adults The Effectiveness of Problem Adaptation Therapy (PATH) in a Culture and Language Rich Community Social Support and Executive Dysfunction as Predictors of Suicidal Ideation in Older Adults with Late Life Depression

Paul D. Kirwin, MD The State of Geriatric Psychiatry Training in General Psychiatry Residency: Data from a National Survey of U.S. Program Directors

Julie Kittel, MA Late-Life Depressive Symptoms Following Nursing Home or Inpatient Rehabilitation in Medicare Beneﬁciaries

Kimberly Kjome, MD Limitations of an Outpatient Commitment in a Geriatric Patient with Late-Life Mania

Sivan Klil-Drori, MD Exercise Group for Geriatric Psychiatry Outpatients - Improving Mental Health and Physical Strength

Rebecca Knapp, PhD Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD)

Mark Komrad The slippery slope of physician assisted suicide

Janice Korenblatt, MSW, LCSW The Effectiveness of Problem Adaptation Therapy (PATH) in a Culture and Language Rich Community The Family That Travels Together, Stays Together: Applying a Family Therapy Framework to PATH

Am J Geriatr Psychiatry 27:3S, March 2019 S75 2019 AAGP Annual Meeting

Ines Kortebi, BSN Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study

Arnold Kozak Longevity and Mental Illness in the New York School: The Art of Agnes Martin and Yayoi Kusama

Sandra Kraemer, MSW The Association of Resilience and Social Networks with Pain Outcomes Among Older Adults

Robert Krafty, PhD The Search for Neuroendophenotypes in Late-Life Depression

Beatrix Krause, PhD Associations between cytokines and cortical thickness in patients with late-life depression Increased cortical thickness in late-life depression after anti-depressant treatment with levomilnacipran

Timothy R. Kreider, MD, PhD A case of very-late-onset schizophrenia-like psychosis, an under-recognized and distinct syndrome in the geriatric population

Kamini Krishnan Language impairment in dementia-Primary Progressive Aphasia vs language variant of Alzheimer’s disease

Gillian Kruszka, BS The Search for Neuroendophenotypes in Late-Life Depression

Aneel Kumar, MD Diagnostic Accuracy of The SLU AMSAD Scale for Depression in Non-Demented Elderly

Dinesh Kumar, PhD Efﬁcacy of Lemborexant Compared with Zolpidem Extended Release and Placebo in Elderly Subjects with Insomnia: Results from a Phase 3 Study (SUNRISE 1) Safety of Lemborexant in Elderly Subjects with Insomnia: Results from a Phase 3 Study (SUNRISE 1)

Sanjeev Kumar, MD Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study

Seth Kunen, PhD, PsychD Epidemiology of Mental Health in U.S. Adult Emergency Department Patients

Evelina Kutyma, MPH Reducing Inappropriate Benzodiazepine Use among Older Adults

Helen Kyomen, MD, MSc Is It Mania, Delirium, or Catatonia? A Case Series on Delirious Mania in Older Adults Management Strategies to Prevent Stroke in Elderly with Major Neurocognitive Disorder and Psychosis Treated with Antipsychotic Medication

Israel Labao, MD, MPH An Interdisciplinary Model of Assessment and Treatment for Managing Behavioral and Psychological Symptoms of Dementia on an Inpatient Psychiatry Unit: An Adaptation of the TIME Model.

S76 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Annie Labbe´, MSc Efﬁcacy of a multidisciplinary specialized care unit in reducing severe behavioral and psychological symptoms of dementia (BPSD) in patients with major neurocognitive disorders: a retrospective study

John Lach, PhD BESI: Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment

Martin Ladoucer, MSc Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review

Nick Ladziak, PharmD Psychotropic medication use patterns in home-based primary care: a systematic review

Kelsey Laird, PhD Associations between cytokines and cortical thickness in patients with late-life depression Increased cortical thickness in late-life depression after anti-depressant treatment with levomilnacipran

Krista Lanctot Neuropsychiatric Symptoms in Mild Cognitive Impairment: Prevalence and Association with Conversion to Major Neurocognitive Disorder

Chadrick Lane, MD Applying Principles of Geriatric Psychiatry in Teaching the Biopsychosocial Approach: a small group, case based exercise

Melinda Lantz, MD “Put It On My Tab:” Assessing the Cost of Geriatric “Regulars” in the Psych ED. Maintaining Serenity in the Therapeutic Relationship: Aromatherapy, Individualized Music or Both to Promote Engagement and Empower Choice

Maria Lapid, MD “End of Life” in context - hospice and palliative care Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD)

Ariel Laudermith An overview of loneliness in older adults Health Literacy and End of Life Decision Making

Helen Lavretsky, MD, MS Associations between cytokines and cortical thickness in patients with late-life depression Combination Escitalopram-Memantine Treatment In Geriatric Depression: A Preliminary Genome-Wide Expression Study Increased cortical thickness in late-life depression after anti-depressant treatment with levomilnacipran Memantine Combination with Escitalopram In Geriatric Depression

Ellen Lee, MD Effect of Sex Differences on Inﬂammation in Schizophrenia: Relationships with Sleep Disturbances, Cognitive Functioning, and Car- diometabolic Risk

Hochang Lee, MD Depression Predicts Delirium after Coronary Artery Bypass Graft Surgery Independent of Cognitive Impairment and Cerebrovascular Disease: An Analysis of the NOAHS Study

Am J Geriatr Psychiatry 27:3S, March 2019 S77 2019 AAGP Annual Meeting

Jeannie Lee, PharmD Psychotropic medication use patterns in home-based primary care: a systematic review

William Lenderking, PhD RE-KINECT, a Real-World, Prospective Tardive Dyskinesia Screening Study: An Evaluation of Baseline Characteristics in Older Patients

Mitch Leskela, BS Mental health diagnoses in Veterans referred for outpatient geriatric psychiatric care at a Veterans Affairs Medical Center

Jennifer Levin, PhD Age-Related Differences in Medication Adherence, Symptoms, Functioning, and Stigma Levels in Poorly-Adherent Adults with Bipolar Disorder

Andrea Levinson, MD, MSc Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Zhaoping Li, MD, PhD A Double-Blind Placebo-Controlled Study of the Memory Effects of Pomegranate Juice in Middle-aged and Older Adults

David Libon, PhD Affective Disturbance in Mild Cognitive Impairment

Michael Lifshitz, PhD Mindfulness training regulates functional connectivity in major depression

Pilar Lim, PhD Efﬁcacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression Post hoc analyses of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression

I-Hsin Lin, PhD Depression Predicts Delirium after Coronary Artery Bypass Graft Surgery Independent of Cognitive Impairment and Cerebrovascular Disease: An Analysis of the NOAHS Study

Jean-Pierre Lindenmayer, MD Global Improvements in Tardive Dyskinesia and Patient Satisfaction with Valbenazine in Older and Younger Patients: Results from an Open-Label, Rollover Study

Heidi Lindroth, RN Association between inﬂammatory biomarkers in patients with ICU delirium and two-year diagnosis of MCI or ADRD Towards Deﬁning Preclinical Delirium

Craig Lindsley, PhD The use of cognitive and ERP biomarkers of cholinergic function in novel tests of muscarinic positive allosteric modulators

Thejasvi Lingamchetty, MD Pharmacotherapy for substance use disorders among older adults: A systematic review of randomized controlled trials

Maria Llorente, MD Why Can’t the Floor be the Ceiling? The Art of M.C. Escher

S78 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Tsz Wai Bentley Lo, BSc Association between neuropsychiatric symptom trajectory and progression to Alzheimer’s Disease

Sarah Lock, JD Global Council on Brain Health: Recommendations for Promoting Mental Well-Being

Karl Looper, MD Early Clinical Exposure to Geriatric Psychiatry and Medical Students’ Interest in Caring for Older Adults: A Randomized Controlled Trial Exercise Group for Geriatric Psychiatry Outpatients - Improving Mental Health and Physical Strength

Antonia LoPresti, MD, PhD Safety of Lemborexant in Elderly Subjects with Insomnia: Results from a Phase 3 Study (SUNRISE 1)

Mark Lumley, PhD Emotional Awareness and Expression Therapy or Cognitive Behavior Therapy for the Treatment of Chronic Musculoskeletal Pain in Older Veterans: A Pilot Randomized Clinical Trial

Jeffrey Lyness, MD Creative Resilience & Aging: Lady Be Good — Ella Fitzgerald’s Life in Song

Joel Mack Identifying functional movement disorders in geriatric psychiatry

R. Scott Mackin, PhD Determinants of Suicidal Ideation in Older Adults with Major Depression – Associations with Perceived Stress

Linda Mah, MD, MHS Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study Neurobehavioural Symptoms in the Preclinical Stage of Alzheimer’s Disease (AD) and their Association with Progression to Mild Cog- nitive Impairment or AD

Stephen Maher, MSIS Antidepressants for anxiety disorders in late-life: A systematic review

Madison Malone, Medical Student A Complex Case of Diagnosing Bereavement

Anuron Mandal, MD “Put It On My Tab:” Assessing the Cost of Geriatric “Regulars“ in the Psych ED.

Amrita Mankani Health Literacy Interventions

Kevin Manning, PhD Anxiety, neuroticism and late-life depression Association between white matter hyperintensities, frontal brain volumes and neuroticism in late life depression Cognitive Variability and Brain Aging in Late-Life Depression

Am J Geriatr Psychiatry 27:3S, March 2019 S79 2019 AAGP Annual Meeting

Kevin Manning, PhD, MSc, MA Anxiety, neuroticism and late-life depression Association between white matter hyperintensities, frontal brain volumes and neuroticism in late life depression Cognitive Variability and Brain Aging in Late-Life Depression

Outi Mantere, MD, PhD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Lea Marin, MD, MPH “Project Life Force-Geriatric”: A Novel Suicide Safety Planning Group Treatment Supporting Older Veterans with Suicidal Symptomology and their Caregivers with a Novel Treatment

Patricia Marino, PhD Health-Related Quality of Life in Remitted Psychotic Depression The Development of REDS: Reaching and Engaging Depressed Seniors Center Clients

Feyza Marouf, MD Older Adults with Narcissistic and Borderline Personality in the Outpatient Clinic What’s the Difference? Distinguishing Geriatric Psychiatry from Consultation-Liaison Fellowship Who Is Safe to Live Alone?

Laura Marsh Diagnosis and treatment of anxiety disorders in geriatric neurology

Shawn Marshall, MD, MSc Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

C. Nathan Marti, PhD Poisoning Deaths among Late-Middle Aged and Older Adults: Comparison between Suicides and Deaths of Undetermined Intent

Liana Mathias, BA Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD) The Application of Virtual Reality in Geriatric Mental Health: The State of the Evidence

Jessica Matos, MSW, LMSW The Effectiveness of Problem Adaptation Therapy (PATH) in a Culture and Language Rich Community

Emily Matusz, PhD Affective Disturbance in Mild Cognitive Impairment

Syed Maududi, MD Self–health: Its Validity and Utility in Older Adults with Schizophrenia Transitioning Patients with Major Neurocognitive Disorders from Antipsychotic Medications to Citalopram - A Pharmacogenetically- informed Case Series

Donovan Maust, MD, MS Discontinuation of Chronic Benzodiazepine Use among Adults in the U.S. Reducing Inappropriate Benzodiazepine Use among Older Adults The CMS National Partnership and psychotropic use in long-term care in the U.S.

Rose May, BS Identiﬁcation and Evaluation of Behavioral Symptoms in Dementia Using Passive Radio Sensing and Machine Learning

S80 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

David Mayleben, PhD Efﬁcacy of Lemborexant Compared with Zolpidem Extended Release and Placebo in Elderly Subjects with Insomnia: Results from a Phase 3 Study (SUNRISE 1)

Barbara Mazer, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

William McCall, MD Dementia: A Cognitive Disability and Role of Non-Pharmacological intervention AlzhaTV in Cognitive Remediation Quality of life and funciton in depressed elderly - effects of ECT

Elizabeth McCord, MD A case of bigeminy and successful completion of acute electroconvulsive therapy course

Marsden McGuire “Complex Patients” – What’s in a Name?

Joanna McHugh Powe Social Asymmetry Predicts Semantic Memory Decline in Older Adults

Rupert McShane, MD Efﬁcacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression Post hoc analyses of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression

Adam Mecca, MD, PhD Assessing Biomarkers of Synaptic Health in Alzheimer’s Disease using PET Imaging Region-Speciﬁc Atrophy as Measured by Cortical Gray Matter Volume is Associated with both Regional and Total Cortical Amyloid- Beta Burden in Cognitively Normal Individuals at Risk for Alzheimer’s Disease

Sheni Meghani, MD, MPH Diagnosis Does Matter: Medication Dosing in End-of-Life Care for Persons with Dementia

Rohini Mehta, MD Physician Aid in Dying: Update for Geriatric Psychiatrists

Emily Mellen, BA Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD)

Chantal Me´rette, PhD Efﬁcacy of a multidisciplinary specialized care unit in reducing severe behavioral and psychological symptoms of dementia (BPSD) in patients with major neurocognitive disorders: a retrospective study

Victor Mergel, PhD Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review

Rachel Meyen, MD The State of Geriatric Psychiatry Training in General Psychiatry Residency: Data from a National Survey of U.S. Program Directors

Barnett Meyers, MD Health-Related Quality of Life in Remitted Psychotic Depression

Am J Geriatr Psychiatry 27:3S, March 2019 S81 2019 AAGP Annual Meeting

Michaela Milillo, BS Increased cortical thickness in late-life depression after anti-depressant treatment with levomilnacipran

Marleni Fabiola Milla, MD Family Matters: Cultural Proﬁciency in the Present Day

Karen Miller, PhD A Double-Blind Placebo-Controlled Study of the Memory Effects of Pomegranate Juice in Middle-aged and Older Adults

Whitney Mills, PhD Staff Training Needs Regarding Older Adults with Serious Mental Illness in Residential Long-Term Care Settings

Catherine Mindolovich, PhD Nihilistic delusion in the context of major depressive disorder with catatonic features in a geriatric patient: A case Report and review of literature

Paroma Mitra, MD How do they Measure up: Rating Scales in Geriatric Psychiatry

Mamoona Mohsin, MD A case of bigeminy and successful completion of acute electroconvulsive therapy course

Vanessa Mok, MBBS “Put It On My Tab:” Assessing the Cost of Geriatric “Regulars” in the Psych ED.

Rachel Molander, MD An Interdisciplinary Model of Assessment and Treatment for Managing Behavioral and Psychological Symptoms of Dementia on an Inpatient Psychiatry Unit: An Adaptation of the TIME Model.

Victor Molinari, PhD Staff Training Needs Regarding Older Adults with Serious Mental Illness in Residential Long-Term Care Settings

Margaret Moline, PhD Efﬁcacy of Lemborexant Compared with Zolpidem Extended Release and Placebo in Elderly Subjects with Insomnia: Results from a Phase 3 Study (SUNRISE 1) Safety of Lemborexant in Elderly Subjects with Insomnia: Results from a Phase 3 Study (SUNRISE 1)

Frank Molnar, MD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Hasina Momotaz, MS Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset.

Patrick Monette Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD) Identiﬁcation and Evaluation of Behavioral Symptoms in Dementia Using Passive Radio Sensing and Machine Learning

Patrick Monette, BA Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD) Identiﬁcation and Evaluation of Behavioral Symptoms in Dementia Using Passive Radio Sensing and Machine Learning

S82 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Paige Moorhouse, MD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Arnaldo Moreno Sexual Health in the Older Adult

Aisa Moreno-Megui, BS The Effect of Physical Rehabilitation on Repeated Sustained Attention Tests in Critically Ill Patients

Julie A. Morgan, PhD Nutrition and Bipolar Disorders in Older Adults: A systematic Review

Stefana Morgan, MD Stories from My Youth: Theater based on life histories of LGBTQ older adults who lived in San Francisco and the Bay Area during the AIDS epidemic Case Study, Treatment Considerations and Policy Implications for the Problematic Internet Use and Pornography in Older Adults

Darby Morhardt, PhD, LCSW Understanding the challenges, needs, and qualities of frontotemporal dementia family caregivers

Neil Mori, MD, Medical Student A Complex Case of Diagnosing Bereavement

Ruth Morin, MD, PhD Cognitive Functioning in the ADNI Depression cohort Comorbidity Proﬁles for Older Veteran Suicide Attempters with a Recent Primary Care Visit Determinants of Suicidal Ideation in Older Adults with Major Depression – Associations with Perceived Stress

Istvan Mucsi, MD, PhD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Daniel Mueller, MD, PhD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Martina Mueller, PhD Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD)

Benoit Mulsant, MD, MSc Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study Health-Related Quality of Life in Remitted Psychotic Depression Relationship of Hair Cortisol Concentration with History of Psychosis, Neuropsychological Performance, and Everyday Functioning in Remitted Later-Life Major Depressive Disorder The Associations Among History of Psychosis, Neuropsychological Performance, and Functioning in Remitted Later-Life Major Depression

Usman Munir, PhD Identiﬁcation and Evaluation of Behavioral Symptoms in Dementia Using Passive Radio Sensing and Machine Learning

Am J Geriatr Psychiatry 27:3S, March 2019 S83 2019 AAGP Annual Meeting

David Munoz, MD, MSc, PhD Association between neuropsychiatric symptom trajectory and progression to Alzheimer’s Disease Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Cerebrospinal Fluid correlates of neuropsychiatric symptoms in patients with Alzheimer’s disease/Mild Cognitive Impairment Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study

Anjana Muralidharan, PhD Staff Training Needs Regarding Older Adults with Serious Mental Illness in Residential Long-Term Care Settings

Patricia Murphy, PhD Efﬁcacy of Lemborexant Compared with Zolpidem Extended Release and Placebo in Elderly Subjects with Insomnia: Results from a Phase 3 Study (SUNRISE 1) Safety of Lemborexant in Elderly Subjects with Insomnia: Results from a Phase 3 Study (SUNRISE 1)

Shirley Musich, PhD The Association of Resilience and Social Networks with Pain Outcomes Among Older Adults

Sarah Myer With the diversity in perception of caregiver roles, educating healthcare professionals, engaging families and communities is even more essential to promote quality care

Anita Myers, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Tarika Nagi, MD Nihilistic delusion in the context of major depressive disorder with catatonic features in a geriatric patient: A case Report and review of literature

Megan Nagle The Role of the Provider in Assessing Patient Access to Firearms

Gary Naglie, MD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Ali Najaﬁan Jazi, MD, MS Emotional Awareness and Expression Therapy or Cognitive Behavior Therapy for the Treatment of Chronic Musculoskeletal Pain in Older Veterans: A Pilot Randomized Clinical Trial

Katherine Narr, PhD Associations between cytokines and cortical thickness in patients with late-life depression Increased cortical thickness in late-life depression after anti-depressant treatment with levomilnacipran

Maureen Nash, MS Challenges of antipsychotics in nursing homes: Partnership to Improve Dementia Care Improving Dementia Care

Insiya Nasrulla How do they Measure up: Rating Scales in Geriatric Psychiatry

Marouane Nassim, MSc Early Clinical Exposure to Geriatric Psychiatry and Medical Students’ Interest in Caring for Older Adults: A Randomized Controlled Trial

S84 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Marouane Nassim, MSc, MHS Early Clinical Exposure to Geriatric Psychiatry and Medical Students’ Interest in Caring for Older Adults: A Randomized Controlled Trial

Nancy Needell Personality Disorders in the Emergency Room Ready, Willing, but Unable: How to Assess Financial Capacity in Internet Scams

Dale M. Needham, MD, PhD The Effect of Physical Rehabilitation on Repeated Sustained Attention Tests in Critically Ill Patients

J. Craig Nelson, MD Determinants of Suicidal Ideation in Older Adults with Major Depression – Associations with Perceived Stress

James Nelson, MD ADNI-D Methodology and Sample Characteristics

Yuval Neria, PhD Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD

Karin J. Neufeld, MD, MPH The Effect of Physical Rehabilitation on Repeated Sustained Attention Tests in Critically Ill Patients

Temple Newbold, MSN BESI: Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment

Paul Newhouse, MD Persistent Intrinsic Functional Network Connectivity Alterations in Middle-Aged and Older Women with Remitted Depression Tau and amyloid pathology in association with subjective cognitive performance in normal elderly and early mild cognitive impairment The use of cognitive and ERP biomarkers of cholinergic function in novel tests of muscarinic positive allosteric modulators

Paul Newhouse, PhD Persistent Intrinsic Functional Network Connectivity Alterations in Middle-Aged and Older Women with Remitted Depression Tau and amyloid pathology in association with subjective cognitive performance in normal elderly and early mild cognitive impairment The use of cognitive and ERP biomarkers of cholinergic function in novel tests of muscarinic positive allosteric modulators

Norman Ng, LCADC, CPHQ, MA “Put It On My Tab:” Assessing the Cost of Geriatric “Regulars” in the Psych ED.

James Norton, PhD A post hoc analysis of study ACP-103-019 evaluating the impact of a reduction in psychosis on the severity of agitation and aggression in patients with Alzheimer’s disease

Dusitn Nowaskie, MD Understanding the challenges, needs, and qualities of frontotemporal dementia family caregivers

Louis Nykamp, MD Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD)

Rachel Ochs-Ross, MD Efﬁcacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression Post hoc analyses of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression

Am J Geriatr Psychiatry 27:3S, March 2019 S85 2019 AAGP Annual Meeting

Ryan O’Dell, MD, PhD Region-Speciﬁc Atrophy as Measured by Cortical Gray Matter Volume is Associated with both Regional and Total Cortical Amyloid- Beta Burden in Cognitively Normal Individuals at Risk for Alzheimer’s Disease

Kaﬁlat Ojo, MD Nihilistic delusion in the context of major depressive disorder with catatonic features in a geriatric patient: A case Report and review of literature

Andrew Olagunju, MD, MSc Nutrition and Bipolar Disorders in Older Adults: A systematic Review

Mark Oldham, MD Depression Predicts Delirium after Coronary Artery Bypass Graft Surgery Independent of Cognitive Impairment and Cerebrovascular Disease: An Analysis of the NOAHS Study

Elizabeth Olson, PhD Hearing Aids and Late-Life Depression: A Methods Study

Jessica O’Mara Challenges in 21st century inpatient geriatric psychiatry.

Sheryl Osato, PhD Emotional Awareness and Expression Therapy or Cognitive Behavior Therapy for the Treatment of Chronic Musculoskeletal Pain in Older Veterans: A Pilot Randomized Clinical Trial

David Oslin, MD Adapting a collaborative care model to facilitate reduction of high doses of prescription opioids in community dwelling elders

Randy Owen, MD A post hoc analysis of study ACP-103-019 evaluating the impact of a reduction in psychosis on the severity of agitation and aggression in patients with Alzheimer’s disease

Praise Owoyemi, BA Electronic Media and Its Applications in Psychotherapy: Methods and a Geriatric Case Study

Praise Owoyemi, BS Electronic Media and Its Applications in Psychotherapy: Methods and a Geriatric Case Study

Adam P Mecca, MD, PhD Association Between Odor Identiﬁcation and Regional Gray Matter in Early Preclinical Alzheimer’s Disease

Frank Parra Staying Creative Past 100: Carmen Herrera, Art, Serendipity and Resilience

Amita Patel Challenges in 21st century long term care practice Ethical Dilemma of practicing Geriatric psychiatrist International Medical Graduates and a Career as a Geriatric Psychiatrist: Clinical perspective.

Boski R. Patel, MD Family Matters: Cultural Proﬁciency in the Present Day

S86 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Martina Pavlicova, PhD Hearing Aids and Late-Life Depression: A Methods Study

S. Benjamin Peckham, MSc Sahaj Samadhi Meditation leads to signiﬁcant improvement in depressive symptoms in patients with late-life depression compared to control

Carmelle Peisah, MD Self-harm in the Very Old One Year Later: Has Anything Changed?

Renee Pepin, PhD Tele-behavioral activation for social isolation in older home-delivered meals recipients: Preliminary results from an ongoing randomized controlled trial

Rossana Peredo Nunez de Arco, MSc Efﬁcacy of a multidisciplinary specialized care unit in reducing severe behavioral and psychological symptoms of dementia (BPSD) in patients with major neurocognitive disorders: a retrospective study

Anthony Perkins, MS Association between inﬂammatory biomarkers in patients with ICU delirium and two-year diagnosis of MCI or ADRD Longitudinal Trends in Incidence and Prevalence of Delirium in the Intensive Care Unit

Georgios Petrides, MD Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD) Summary of the ﬁndings from the Consortium on Reseach in ECT

Jagan Pillai Atypical forms of Alzheimer’s disease- clinical and biomarker heterogeneity

Robert Platt, PhD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Cindy Plunkett, B.Ed A Wish to Die and the Older Adult: The Impact of Bespoking on Virtual Continuing Education

Jan Polgar, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Bruce Pollock, MD, PhD Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study

Sherry Pomerantz, PhD Affective Disturbance in Mild Cognitive Impairment

Sonia Popatia, MD Limitations of an Outpatient Commitment in a Geriatric Patient with Late-Life Mania Treating Bipolar I Disorder with Comorbid Parkinson’s Disease: A Catch-22

Dennis Popeo, MD Background About Guardianship Stuff I Wished I Knew Way Back When...

Am J Geriatr Psychiatry 27:3S, March 2019 S87 2019 AAGP Annual Meeting

Michelle Porter, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Guy Potter, PhD Phenotyping prospective cognitive outcomes of late-life depression

Joshua Preciado, Undergraduate Cognitive Variability and Brain Aging in Late-Life Depression

Cristina Pritchett, MD Right unilateral electroconvulsive therapy for the treatment of psychotic disorders

Frank Provenzano, PhD Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD

Rebecca Radue, MD Novel Management of Severe Manic Delirium in a Complex and Frail Older Adult Updates from the GEAR-UP Project: Performance of Multidisciplinary Learners on Late Life Depression and Cognitive Impairment Simulations

Aniqa Rahman, BA Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD) The Application of Virtual Reality in Geriatric Mental Health: The State of the Evidence

Nurur Rahman, MD Nihilistic delusion in the context of major depressive disorder with catatonic features in a geriatric patient: A case Report and review of literature

Jayashree Rajamanickam, MD Diagnostic Accuracy of The SLU AMSAD Scale for Depression in Non-Demented Elderly

Rajesh Rajesh, MD Sarcopenia, Sarcopenic Obseity and Frailty; links to Cognitive Performance in Elders

Tarek Rajji, MD Early Clinical Exposure to Geriatric Psychiatry and Medical Students’ Interest in Caring for Older Adults: A Randomized Controlled Trial Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study

Mark Rapoport, MD Guiding Proactive Decision-Making and Coping with Driving Cessation: The Driving Cessation in Dementia Intervention Toolkit Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Patrick J. Raue, PhD Engagement in Socially Rewarding Activities as a Predictor of Outcome in Behavioral Activation Therapy for Late Life Depression

Michael Redinger Ethical and moral framework for suicide and physician assisted suicide

S88 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Tabatha Redlich, RN An Interdisciplinary Model of Assessment and Treatment for Managing Behavioral and Psychological Symptoms of Dementia on an Inpatient Psychiatry Unit: An Adaptation of the TIME Model.

William T Regenold, MD Nutrition and Bipolar Disorders in Older Adults: A systematic Review

Karen Reimers, MD Forensic aspects of Medicare and advocacy efforts

Michael Reinhardt, MD Self–health: Its Validity and Utility in Older Adults with Schizophrenia Transitioning Patients with Major Neurocognitive Disorders from Antipsychotic Medications to Citalopram - A Pharmacogenetically- informed Case Series

Soham Rej, MD, MSc Early Clinical Exposure to Geriatric Psychiatry and Medical Students’ Interest in Caring for Older Adults: A Randomized Controlled Trial Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial Exercise Group for Geriatric Psychiatry Outpatients - Improving Mental Health and Physical Strength

Suzane Renaud, MD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Andrew Renda, MD, MPH The association between a loneliness resource guide and health-related quality of life among a Medicare Advantage population

David Reuben A Health System, Population-based Approach to Dementia Care

Charles F. Reynolds III, MD EXERCISE AS AN AUGMENTATION TO PHARMACOTHERAPY FOR DEPRESSION IN OLDER AND YOUNGER ADULTS: A FEASIBILITY TRIAL EXPLORING BIOLOGICAL MECHANISMS

Meghan Riddle, MD End of Life Care in Inpatient Psychiatry: A Case Study on End-Stage Alzheimer’s Disease

Kathleen Rogers Sarcopenia, Sarcopenic Obesity and Frailty links to Congitive Performance in Elders

Benjamin Rolnik, BSN Memantine Combination with Escitalopram In Geriatric Depression

Deborah Rooney, RN Adapting a collaborative care model to facilitate reduction of high doses of prescription opioids in community dwelling elders

Steven Roose, MD Hearing Aids and Late-Life Depression: A Methods Study

Russell Rosenberg, PhD Safety of Lemborexant in Elderly Subjects with Insomnia: Results from a Phase 3 Study (SUNRISE 1)

Am J Geriatr Psychiatry 27:3S, March 2019 S89 2019 AAGP Annual Meeting

Kasia Rothenberg Psychosis in Parkinson’s Disease – pathognomonic, cognitive and genetic correlates

Anthony Rothschild, MD Health-Related Quality of Life in Remitted Psychotic Depression

Franc¸ois Rousseau, MD Efﬁcacy of a multidisciplinary specialized care unit in reducing severe behavioral and psychological symptoms of dementia (BPSD) in patients with major neurocognitive disorders: a retrospective study

Eric Rubin, MD, PhD Nihilistic delusion in the context of major depressive disorder with catatonic features in a geriatric patient: A case Report and review of literature

Albert Rubio III, MFA Stories from My Youth: Theater based on life histories of LGBTQ older adults who lived in San Francisco and the Bay Area during the AIDS epidemic

Kimberly Rudd, MD Collaborative Approaches to Management of Suicide in Late-life

Matthew Rudorfer, MD Health-Related Quality of Life in Remitted Psychotic Depression

Juan Ruiz-Pela´ez, MD, MMedSci Urinary Incontinence and Depression: A Longitudinal Analysis in Males

Bret Rutherford, MD Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD Hearing Aids and Late-Life Depression: A Methods Study Targeting Dopaminergic Mechanisms of Slowing to Improve Late Life Depression

Amy Ryan, MSc Examining Parkinson’s disease psychosis treatment outcomes in the real world: interim Year 1 ﬁndings from the INSYTE Observa- tional Study

Martha Sajatovic, MD A preliminary report from the Aging & Geriatric Experiments in Bipolar Disorder Database (AGE-BD) Age-Related Differences in Medication Adherence, Symptoms, Functioning, and Stigma Levels in Poorly-Adherent Adults with Bipolar Disorder Bipolar Disorder, Schizophrenia, and the Risk of Dementia in the Veteran Population Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset. Global Improvements in Tardive Dyskinesia and Patient Satisfaction with Valbenazine in Older and Younger Patients: Results from an Open-Label, Rollover Study Nutrition and Bipolar Disorders in Older Adults: A systematic Review Safety Results from 3 Long-Term Valbenazine Studies in Younger and Older Adults with Tardive Dyskinesia

Carlos Salgado, MD Urinary Incontinence and Depression: A Longitudinal Analysis in Males

Chloe Salzman, BA Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD

S90 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Sarah Sanford, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Myrlene Sanon, MPH Level of Care Dependency and Functional Status Among Patients with Alzheimer’s Disease and Agitation/Aggression Symptoms Real-world Utilization of Non-Pharmacological Therapy prior to Initiation of Antipsychotic Treatment in the Management of Agita- tion in Patients with Dementia: Findings from a Large Retrospective Chart Review Severity of Agitation in Alzheimer’s Disease: Proportion of Individuals Transitioning to Long-Term Residential Care using US National Alzheimer’s Coordinating Center Data

Elizabeth Santos, MD, MPH Master Amazing: Graceful Self-promotion, "slime free" networking and making the most of who you are and what you do.

Sybille Saury, MSc Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Manisha Sawhney, PhD Epidemiology of Mental Health in U.S. Adult Emergency Department Patients

Peter Scal, MD Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset.

Alessandra Scalmati Case Presentation: When Guardianship is Not the Answer Curriculum Development: Implementation and Evaluation Part II: Let’s do it!

Ayal Schaffer, MD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Melanie Scharrer, MD 2018 Highlighted Papers for the Geriatric Mental Health Clinical Provider Culturally Driven Mental Health Care in Hmong and Cambodian Refugee Populations

Jason Schillerstrom, MD The State of Geriatric Psychiatry Training in General Psychiatry Residency: Data from a National Survey of U.S. Program Directors

Tom Schweizer, PhD Association between neuropsychiatric symptom trajectory and progression to Alzheimer’s Disease Cardiovascular burden and cognition in older adults with mild cognitive impairment and major depressive disorder Cerebrospinal Fluid correlates of neuropsychiatric symptoms in patients with Alzheimer’s disease/Mild Cognitive Impairment Examining the impact of Cardiovascular Risk Factors on Neuropsychiatric Symptoms in the PACt-MD Study

Leslie Scoutt, MD Depression Predicts Delirium after Coronary Artery Bypass Graft Surgery Independent of Cognitive Impairment and Cerebrovascular Disease: An Analysis of the NOAHS Study

Ryan Seaver, MD Limitations of an Outpatient Commitment in a Geriatric Patient with Late-Life Mania

Marilyn Segal, MD Exercise Group for Geriatric Psychiatry Outpatients - Improving Mental Health and Physical Strength Early Clinical Exposure to Geriatric Psychiatry and Medical Students’ Interest in Caring for Older Adults: A Randomized Controlled Trial

Am J Geriatr Psychiatry 27:3S, March 2019 S91 2019 AAGP Annual Meeting

Stephen Seiner, MD Electroconvulsive Therapy for the Treatment of Acute Agitation and Aggression in Alzheimer’s Dementia (ECT-AD)

Trent Semeniuk, MD Early Clinical Exposure to Geriatric Psychiatry and Medical Students’ Interest in Caring for Older Adults: A Randomized Controlled Trial

Andreea Seritan Recommendations for clinicians working with older refugees

Patricia Serrano, MD Association between inﬂammatory biomarkers in patients with ICU delirium and two-year diagnosis of MCI or ADRD Post-Intensive Care Syndrome-Family (PICS-F): Critical Illness Also Scars Families, Not Just Patients

Vijay Seshadri, MD Cases of Fronto Temporal dementia Presenting with Psychosis

Daniel Sewell, MD The Mental Health of Older LGBT Adults

Huda Shalhoub, PhD RE-KINECT, a Real-World, Prospective Tardive Dyskinesia Screening Study: An Evaluation of Baseline Characteristics in Older Patients

Anu Sharma Cortical Neuroplasticity in Age-Related Hearing Loss

Sarah Sheikh, MD Self–health: Its Validity and Utility in Older Adults with Schizophrenia Transitioning Patients with Major Neurocognitive Disorders from Antipsychotic Medications to Citalopram - A Pharmacogenetically- informed Case Series

Andrew Shim, PharmD, JD Examining Parkinson’s disease psychosis treatment outcomes in the real world: interim Year 1 ﬁndings from the INSYTE Observa- tional Study

Gen Shinozaki, MD, MS Prediction of delirium, mortality, and fall risk in inpatients using bispectral EEG

Paulo Shiroma, MD Mental health diagnoses in Veterans referred for outpatient geriatric psychiatric care at a Veterans Affairs Medical Center

Sepideh Shokouhi, PhD Tau and amyloid pathology in association with subjective cognitive performance in normal elderly and early mild cognitive impairment

Alireza Showraki, MD Cerebrospinal Fluid correlates of neuropsychiatric symptoms in patients with Alzheimer’s disease/Mild Cognitive Impairment

Tatyana Shteinlukht, MD, PhD Role play/discussion

S92 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Prabha Siddarth, PhD A Double-Blind Placebo-Controlled Study of the Memory Effects of Pomegranate Juice in Middle-aged and Older Adults Associations between cytokines and cortical thickness in patients with late-life depression Combination Escitalopram-Memantine Treatment In Geriatric Depression: A Preliminary Genome-Wide Expression Study Increased cortical thickness in late-life depression after anti-depressant treatment with levomilnacipran Memantine Combination with Escitalopram In Geriatric Depression

Scott Siegert, PharmD Global Improvements in Tardive Dyskinesia and Patient Satisfaction with Valbenazine in Older and Younger Patients: Results from an Open-Label, Rollover Study Safety Results from 3 Long-Term Valbenazine Studies in Younger and Older Adults with Tardive Dyskinesia

Benjamin Silverman, MD Electronic Media and Its Applications in Psychotherapy: Methods and a Geriatric Case Study

Alexandra Simard, RN Efﬁcacy of a multidisciplinary specialized care unit in reducing severe behavioral and psychological symptoms of dementia (BPSD) in patients with major neurocognitive disorders: a retrospective study

Adam Simning, MD, PhD Late-Life Depressive Symptoms Following Nursing Home or Inpatient Rehabilitation in Medicare Beneﬁciaries

Erawadi Singh Three Case Reports of Older Veterans with a History of Sexual Military Trauma

Jo Anne Sirey, PhD EM/PROTECT: Improving Depression in Elder Abuse Victims Engagement in Socially Rewarding Activities as a Predictor of Outcome in Behavioral Activation Therapy for Late Life Depression

Miranda Skurla, BS The Application of Virtual Reality in Geriatric Mental Health: The State of the Evidence

Luke Slindee, PharmD The Association of Resilience and Social Networks with Pain Outcomes Among Older Adults

Gary Small, MD A Double-Blind Placebo-Controlled Study of the Memory Effects of Pomegranate Juice in Middle-aged and Older Adults Post-Menopausal Breast Arterial Calciﬁcations (BACs) in Women as a Possible Biomarker for Increased Risk of Developing Dementia: Study Rationale, Design, and Methodology

Scott Small, MD Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD

Stephen Smilowitz, BA A Brief History of LGBT Individuals and the US Armed Forces Age-Related Differences in Medication Adherence, Symptoms, Functioning, and Stigma Levels in Poorly-Adherent Adults with Bipolar Disorder

Gwenn Smith Assessing Biomarkers of Synaptic Health in Alzheimer’s Disease using PET Imaging Multi-Modality Imaging of Neurodegeneration in Late Life Cognitive Decline and Depression

Am J Geriatr Psychiatry 27:3S, March 2019 S93 2019 AAGP Annual Meeting

Tawny Smith, PharmD Treating Bipolar I Disorder with Comorbid Parkinson’s Disease: A Catch-22

Natalie Sohn, BS A case of very-late-onset schizophrenia-like psychosis, an under-recognized and distinct syndrome in the geriatric population

Lisa Sokoloff, MS, CCC-SLP A Wish to Die and the Older Adult: The Impact of Bespoking on Virtual Continuing Education

Sherif Soliman Anatomy of a geriatric suicide: Martin Manley

Nili Solomonov, PhD Engagement in Socially Rewarding Activities as a Predictor of Outcome in Behavioral Activation Therapy for Late Life Depression Social Support and Executive Dysfunction as Predictors of Suicidal Ideation in Older Adults with Late Life Depression

Saurabh Somvanshi, MD Nihilistic delusion in the context of major depressive disorder with catatonic features in a geriatric patient: A case Report and review of literature

Snezana Sonje, MD Visual Hallucinations as a Safety Concern in the Elderly

Benchawa Soontornniyomkij, PhD Subjectively and Objectively Rated Mixed Affective States in a Mixed-Age Sample of Adults with Bipolar Disorder: Associations with Age, Suicidality, Symptom Severity, Cognition and Inﬂammation

Angela Page Spears, BS “Project Life Force-Geriatric”: A Novel Suicide Safety Planning Group Treatment Supporting Older Veterans with Suicidal Symptomology and their Caregivers with a Novel Treatment

Tanya Spruill, PhD Depressive symptoms across the age span: Findings from an integrated epilepsy self-management clinical studies dataset.

Shilpa Srinivasan Late-life Suicide: A Brief Overview Managing Behavioral and Psychological Symptoms of Dementia In The Era Of Black Box Warnings Writing and Getting Published: Developing This Important Skill Set For Geriatric Mental Health Professionals

Natalie St. Cyr, LMFT Combination Escitalopram-Memantine Treatment In Geriatric Depression: A Preliminary Genome-Wide Expression Study

Sarah Stahl, PhD Digital Monitoring of Sleep, Meals, and Physical Activity as a Preventive Intervention for Depression in Older Bereaved Adults: A Pilot Study on Feasibility, Acceptability, and Symptom Improvement Experiences of End-of-Life Care by Non-Western Patients: A thematic analysis.

Srdjan Stankovic, MD, MSPH A post hoc analysis of study ACP-103-019 evaluating the impact of a reduction in psychosis on the severity of agitation and aggression in patients with Alzheimer’s disease

S94 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Elaine Stasiulis, MA Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

David Steenhard, MS The association between a loneliness resource guide and health-related quality of life among a Medicare Advantage population

David Steffens, MD, MHS Anxiety, neuroticism and late-life depression Association between white matter hyperintensities, frontal brain volumes and neuroticism in late life depression Cognitive Variability and Brain Aging in Late-Life Depression Patient versus Clinician Rated Depression Scores: A Comparison of Participant Scores on the Carroll Depression Scale and the Hamil- ton Depression Rating Scale Phenotyping prospective cognitive outcomes of late-life depression

Alexandra Stein, BA Hearing Aids and Late-Life Depression: A Methods Study

Elliott Stein, MD Challenges in Medicare billing, documentation and coding

Jennifer Stein Empathy in Caring: A Systematic Review

Joel Streim, MD A State-wide Program of Telephone-delivered, Caregiver-centered Dementia Care Management Adapting a collaborative care model to facilitate reduction of high doses of prescription opioids in community dwelling elders Telepsychiatry implementation in rural skilled nursing facilities improves access to mental healthcare

Julie Strominger, MS, MPH Discontinuation of Chronic Benzodiazepine Use among Adults in the U.S. Reducing Inappropriate Benzodiazepine Use among Older Adults

Kevin Sullivan, PhD Depressive Symptoms on the Decline in Older Adults: Birth Cohort Analyses from the Rust Belt

Sarah Sullivan, MS, MHC-LP “Project Life Force-Geriatric”: A Novel Suicide Safety Planning Group Treatment Supporting Older Veterans with Suicidal Symptomology and their Caregivers with a Novel Treatment

David Sultzer, MD Emotional Awareness and Expression Therapy or Cognitive Behavior Therapy for the Treatment of Chronic Musculoskeletal Pain in Older Veterans: A Pilot Randomized Clinical Trial Post-Menopausal Breast Arterial Calciﬁcations (BACs) in Women as a Possible Biomarker for Increased Risk of Developing Dementia: Study Rationale, Design, and Methodology

Margaret Sundel, BS The Effect of Physical Rehabilitation on Repeated Sustained Attention Tests in Critically Ill Patients

Uma Suryadevara With the diversity in perception of caregiver roles, educating healthcare professionals, engaging families and communities is even more essential to promote quality care

Am J Geriatr Psychiatry 27:3S, March 2019 S95 2019 AAGP Annual Meeting

Ashley Sutherland, MA Subjectively and Objectively Rated Mixed Affective States in a Mixed-Age Sample of Adults with Bipolar Disorder: Associations with Age, Suicidality, Symptom Severity, Cognition and Inﬂammation

Elizabeth Sutherland, PhD Challenging Behaviors on Inpatient Medical Units: Integrated, Non-Pharmacological Approach for Patients with Dementia

Sandra Swantek What can we do to advocate for ourselves and our patients?

Philip Szeszko, PhD Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD

Deena Tampi, RN, MBA Antidepressants for anxiety disorders in late-life: A systematic review

Rajesh Tampi, MD, MS, DFAPA Antidepressants for anxiety disorders in late-life: A systematic review Dementia: A Cognitive Disability and Role of Non-Pharmacological intervention AlzhaTV in Cognitive Remediation Differential Diagnosis for Insomnia in the Older Adult International Medical Graduates and a Career as a Geriatric Psychiatrist: Research perspective. Management of Inappropriate Sexual Behaviors in Dementia Using Multidisciplinary Teams in the Continuum of Care Managing Behavioral and Psychological Symptoms of Dementia In The Era Of Black Box Warnings Pharmacotherapy for substance use disorders among older adults: A systematic review of randomized controlled trials Writing and Getting Published: Developing This Important Skill Set For Geriatric Mental Health Professionals

Caroline Tanner, MD, Other RE-KINECT, a Real-World, Prospective Tardive Dyskinesia Screening Study: An Evaluation of Baseline Characteristics in Older Patients

Alyssa Tao Epidemiology, Prevalence, and Signiﬁcance of Problematic Internet Use and Pornography in Older Adults

Warren Taylor, MD, MHSc Persistent Intrinsic Functional Network Connectivity Alterations in Middle-Aged and Older Women with Remitted Depression The Effect of Transdermal Nicotine on Mood and Cognitive Symptoms in Late Life Depression

Lorraine Telleria-Bernal, MD Efﬁcacy of a multidisciplinary specialized care unit in reducing severe behavioral and psychological symptoms of dementia (BPSD) in patients with major neurocognitive disorders: a retrospective study

Adeyeye Temitope, MD Visual Hallucinations as a Safety Concern in the Elderly

Nishina Thomas Decisional Capacities: Testamentary Capacity and Marital Capacity

Paul Thuras, PhD Mental health diagnoses in Veterans referred for outpatient geriatric psychiatric care at a Veterans Affairs Medical Center

Alessia Tognolini, MD Post-Menopausal Breast Arterial Calciﬁcations (BACs) in Women as a Possible Biomarker for Increased Risk of Developing Dementia: Study Rationale, Design, and Methodology

S96 Am J Geriatr Psychiatry 27:3S, March 2019 2019 AAGP Annual Meeting

Theresa Toledo, MD “Sharing is Caring” – Caregiver Resources from Providers to Patients

Danielle Tolton, DO Patient versus Clinician Rated Depression Scores: A Comparison of Participant Scores on the Carroll Depression Scale and the Hamil- ton Depression Rating Scale

Gabriela Torres-Platas, PhD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Duygu Tosun Functional Connectivity Network Level Abnormalities Associated with Late Life Depression

Thu Tran, MD Implementation of a Geriatric Psychiatry Track in the Fourth Year Curriculum

Francesco Trepiccione, PhD Atorvastatin in the treatment of Lithium-induced Nephrogenic Diabetes Insipidus: The protocol of a Randomized Controlled Trial

Jeffrey Trotter, MBA Examining Parkinson’s disease psychosis treatment outcomes in the real world: interim Year 1 ﬁndings from the INSYTE Observa- tional Study

Linda Tseng, MSc Challenging Behaviors on Inpatient Medical Units: Integrated, Non-Pharmacological Approach for Patients with Dementia

Holly Tuokko, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Nina Vadiei, PharmD Common issues, limited options: Challenges Faced and Lessons Learned in the Outpatient and Inpatient Management of Psychotic Disorders Psychotropic medication use patterns in home-based primary care: a systematic review

Ipsit Vahia, MD Electronic Media and Its Applications in Psychotherapy: Methods and a Geriatric Case Study Identiﬁcation and Evaluation of Behavioral Symptoms in Dementia Using Passive Radio Sensing and Machine Learning Mindfulness-based art psychotherapy group for older adults using digital tools Radio sensors and social media–complementary approaches to capturing behavior The Application of Virtual Reality in Geriatric Mental Health: The State of the Evidence

Christopher van Dyck, MD Region-Speciﬁc Atrophy as Measured by Cortical Gray Matter Volume is Associated with both Regional and Total Cortical Amyloid- Beta Burden in Cognitively Normal Individuals at Risk for Alzheimer’s Disease

Kimberly Van Orden, PhD Decreasing Social Isolation and Increasing Social Functioning in Older Veterans at Risk for Suicide

Smita Varshney, MD Dementia: A Cognitive Disability and Role of Non-Pharmacological intervention AlzhaTV in Cognitive Remediation

Am J Geriatr Psychiatry 27:3S, March 2019 S97 2019 AAGP Annual Meeting

Upkar Varshney, PhD Dementia: A Cognitive Disability and Role of Non-Pharmacological intervention AlzhaTV in Cognitive Remediation

Jennifer Vega, PhD Persistent Intrinsic Functional Network Connectivity Alterations in Middle-Aged and Older Women with Remitted Depression

Salma Velazquez, MD Diagnosis Does Matter: Medication Dosing in End-of-Life Care for Persons with Dementia

Aninditha Vengassery, MD Self–health: Its Validity and Utility in Older Adults with Schizophrenia Transitioning Patients with Major Neurocognitive Disorders from Antipsychotic Medications to Citalopram - A Pharmacogenetically- informed Case Series

Phylicia Verreault, BSc Efﬁcacy of a multidisciplinary specialized care unit in reducing severe behavioral and psychological symptoms of dementia (BPSD) in patients with major neurocognitive disorders: a retrospective study

Lindsay Victoria Reward and Salience Abnormalities in Late-Life Depression: A Neuroimaging and Computational Modeling Approach

Latrice Vinson, The Veterans Health Administration Care for Patients with Complex Problems Program

Joseph Voigt, MD Transitioning Patients with Major Neurocognitive Disorders from Antipsychotic Medications to Citalopram - A Pharmacogenetically- informed Case Series

Brenda Vrkljan, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Art Walaszek, MD An Interdisciplinary Model of Assessment and Treatment for Managing Behavioral and Psychological Symptoms of Dementia on an Inpatient Psychiatry Unit: An Adaptation of the TIME Model.

Anne Wand, MD Self-harm in the Very Old One Year Later: Has Anything Changed?

Angela Wang, DO Is It Mania, Delirium, or Catatonia? A Case Series on Delirious Mania in Older Adults

Carol Sheei-Meei Wang, MD Retrospectively Assessing the Efﬁcacy of Agomelatine in Behavioral and Psychological Symptoms of Dementia

Lihong Wang, MD, PhD Anxiety, neuroticism and late-life depression Association between white matter hyperintensities, frontal brain volumes and neuroticism in late life depression Cognitive Variability and Brain Aging in Late-Life Depression Multimodal MRI Findings in Aging and Physical Exercise

Philip Wang Quality Measurement with PsychPRO: MIPS and Beyond

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Shaohung Wang, PhD The Association of Resilience and Social Networks with Pain Outcomes Among Older Adults

Sophia Wang, MD Association between inﬂammatory biomarkers in patients with ICU delirium and two-year diagnosis of MCI or ADRD From Delirium to Dementia: Acute Illness, Long-Term Damage

Lauren Welch, PharmD Updates from the GEAR-UP Project: Performance of Multidisciplinary Learners on Late Life Depression and Cognitive Impairment Simulations

Ellen Whyte, MD Health-Related Quality of Life in Remitted Psychotic Depression

Edward Wicht, MD, JD, Physician Aid in Dying: Update for Geriatric Psychiatrists

Kirsten Wilkins, MD The State of Geriatric Psychiatry Training in General Psychiatry Residency: Data from a National Survey of U.S. Program Directors

Jo Wilson, MD Is That Delirium, Catatonia, or Both?

Tomorrow Wilson, PhD Reducing Inappropriate Benzodiazepine Use among Older Adults

Tricia Woo, MD, MSc Early Clinical Exposure to Geriatric Psychiatry and Medical Students’ Interest in Caring for Older Adults: A Randomized Controlled Trial

Liwen Wu, MS The Search for Neuroendophenotypes in Late-Life Depression

Rong Wu, PhD Anxiety, neuroticism and late-life depression Association between white matter hyperintensities, frontal brain volumes and neuroticism in late life depression

Stephanie Yamin, PhD Perspectives from the ﬁeld: Designing the Driving Cessation in Dementia Intervention Toolkit (DCD-IT)

Brandon Yarns, MD, MS Curriculum Development: Implementation and Evaluation Part I: Introduction and Literature Review Emotional Awareness and Expression Therapy or Cognitive Behavior Therapy for the Treatment of Chronic Musculoskeletal Pain in Older Veterans: A Pilot Randomized Clinical Trial Honors Scholars Alumni Session

Jillian Yeargin, PhD Associations between cytokines and cortical thickness in patients with late-life depression Memantine Combination with Escitalopram In Geriatric Depression

Charlotte Yeh, MD The Association of Resilience and Social Networks with Pain Outcomes Among Older Adults

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Rachel Yehuda, PhD Cognitive and Neural Mechanisms of the Accelerated Aging Phenotype in PTSD

Karen Yeomans, BSc RE-KINECT, a Real-World, Prospective Tardive Dyskinesia Screening Study: An Evaluation of Baseline Characteristics in Older Patients

Chuck Yonan, PharmD RE-KINECT, a Real-World, Prospective Tardive Dyskinesia Screening Study: An Evaluation of Baseline Characteristics in Older Patients

Juan Young, MD 2018 Highlighted Papers for the Geriatric Mental Health Clinical Provider Antidepressants for anxiety disorders in late-life: A systematic review

Erica Youngblood, RN Challenging Behaviors on Inpatient Medical Units: Integrated, Non-Pharmacological Approach for Patients with Dementia

David Yuh, MD Depression Predicts Delirium after Coronary Artery Bypass Graft Surgery Independent of Cognitive Impairment and Cerebrovascular Disease: An Analysis of the NOAHS Study

Gary Zammit, PhD Efﬁcacy of Lemborexant Compared with Zolpidem Extended Release and Placebo in Elderly Subjects with Insomnia: Results from a Phase 3 Study (SUNRISE 1)

Kasra Zarei, MD, PhD Prediction of delirium, mortality, and fall risk in inpatients using bispectral EEG

Beth Zerr, PharmD Psychotropic medication use patterns in home-based primary care: a systematic review

Tatyana Zharkova, MD, PhD Management Strategies to Prevent Stroke in Elderly with Major Neurocognitive Disorder and Psychosis Treated with Antipsychotic Medication

Svetlana Zlotnik, MD Maintaining Serenity in the Therapeutic Relationship: Aromatherapy, Individualized Music or Both to Promote Engagement and Empower Choice

Michelle Zmuda, BS The Search for Neuroendophenotypes in Late-Life Depression

Jessica Zwerling, MD, MS The Effectiveness of Problem Adaptation Therapy (PATH) in a Culture and Language Rich Community

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AAGP Annual Meeting 2019 Poster Abstracts

Poster Number: EI - 1 HEARING AIDS AND LATE-LIFE DEPRESSION: A METHODS STUDY Katharine K Brewster1; Alexandra Stein1; Martina Pavlicova2; Chen Chen1; Patrick Brown1; Ana Kim2; Justin Golub2; Jessica Galatioto2; Elizabeth Olson2; Megan Kuhlmey2; Steven Roose1; Adam Brickman2; Bret Rutherford1

1New York State Psychiatric Institute / Columbia University 2Columbia University Medical Center

Introduction: Age-related hearing loss (AHRL) is the third most common health condition affecting older adults after heart disease and arthritis. The prevalence of clinically significant hearing impairment rises steeply with age, from 3% among adults 20-29 to 49% of adults ages 60-69 and over 80% in individuals 85 years of age and older. Initial studies suggest that remediation of hearing loss using hearing aids may decrease depressive symptoms over longitudinal follow-up. However, important limitations to these studies call for controlled trials of hearing remediation as a treatment for late-life depression (LLD). We conducted the first double-blind randomized clinical trial utilizing rigorous control groups, objective documentation of compliance of the hearing aid, enrollment of subjects with clinical depression, and incorporation of comprehensive neuropsychological assessments. Our main aims were to consider the feasibility, acceptability, tolerability of such a study, as well as ability to blind the hearing aid devices. Methods: 12 individuals were recruited who were aged ≥60 years, diagnosed with a clinically significant depressive disorder, and had mild-severe hearing loss. Baseline psychiatric, audiometric, neuropsychological, and functional assessments were performed. Participants were then randomized to receive either full-amplitude active hearing aids or low-amplitude sham hearing aids over a 12-week prospective trial, either as monotherapy or as an augmentation with antidepressant medications. The sham hearing aid was programmed to a hearing threshold of 10dB, which resulted in a small volume increase without substantively improving the subject’s ability to hear. The baseline evaluation was repeated at the study endpoint. Results: Of the 12 subjects who completed the study, 7 received active and 5 received sham hearing aids. Acceptability of the hearing aid, evaluated as the duration of time participants wore the hearing aids between the active and sham groups, was high as all subjects used the devices for >9 hours a day and the duration was not statistically significant between groups (p = 0.05). Tolerability was measured as proportions of subjects who experienced adverse events during participation, which were acceptable and included insomnia, drowsiness, and excitement. Feasibility was also acceptable, as 86.7% of the enrolled subjects completed the 12-week study. Blind assessments were evaluated as proportions of subjects who correctly guessed whether they were wearing active or sham hearing aids and was not in effect as the majority of subjects guessed correctly (92% in sham [p < 0.0001], 71% in active [p = 0.0031]. The study was not powered to detect statistically significant differences in outcome measures such as depression, social functioning, and cognition. Conclusions: Data from this study suggests that the study design of a double-blind randomized clinical trial of hearing aids as a treatment for LLD was highly acceptable to the subjects. Future studies with larger sample sizes should investigate whether hearing remediation may be an effective therapeutic strategy for LLD. Efforts should be made to improve the ability to blind the hearing aid such as increasing the hearing threshold of the sham devices. Should future studies prove to be successful, this suggests a novel therapeutic strategy for LLD and thereby mitigate its public health burden, while also contributing to the increased recognition and treatment of ARHL more generally. This research was funded by: CaMPR Phase II: Columbia University Irving Institute for Clinical and Translational Research (Rutherford [PI]) Phonak, a hearing assistance company, supplied the Audeo BR 90 hearing aid devices. PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000298/AAGP2019-000298_Fig1.pdf PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000298/AAGP2019-000298_Fig2.pdf

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TABLE 1. Baseline Demographics

Active Sham N=7 N=5 N (%)/Mean (SD) N (%)/Mean (SD) Gender (%Male) 4 (57%) 3 (60%) Age 65.8 (2.8) 76.4 (7.0) Race Asian 1 (14%) 0 (0%) Black/African-American 1 (14%) 1 (20%) White 4 (57%) 4 (80%) Don’t know 1 (14%) 0 (0%) Marital Status Single 4 (57%) 2 (40%) Divorced/separated 0 (0%) 1 (20%) Married/living with partner 3 (43%) 1 (20%) Widowed 0 (0%) 1 (20%) Education Years 14.5 (3.0)a 13.0 (na)b

TABLE 2. Acceptability − Duration of hearing aid use (hours/day) over the 12-week study HA Group Week N Mean Std Dev Sham 2 4 10.3 2.114238 N=5 6 5 10.5 0.896103 9 4 11.8 0.6245 12 3 11.1 0.750555 Active 2 5 10.3 2.318405 N=7 6 6 9.3 4.334397 9 7 9.5 2.402578 12 7 9.6 3.336094

TABLE 3. Tolerability - proportions of subjects who experienced adverse events over the 12-week study

Active Sham

Mild Severe Mild Severe NNNN Insomnia 1 1 Drowsiness 1 1 Excitement 1 Confusion Rigidity Tremor Dystonia Akathisia Syncope Tachycardia 1 Bradycardia Congestion Dry Mouth 2 1 1 Salivation Vision Nausea Vomiting Anorexia 1 Diarrhea Constipation 1 Dermititis Headache 1 1 Dizziness 1 Faintness Weakness 1

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TABLE 4. Blind assessment − proportion of subjects correctly guessed in sham vs. active hearing aid Sham Week Correct Wrong Missing Diff <> 50% Week 2 5 (100%) 0 (0%) 0 (0%) Week 4 4 (80%) 1 (20%) 0 (0%) Week 6 5 (100%) 0 (0%) 0 (0%) Week 9 5 (100%) 0 (0%) 0 (0%) Week 12 4 (80%) 1 (20%) 0 (0%) Sum 23 (92%) 2 (8%) 0 (0%) p < 0.0001 Active Week Correct Wrong Missing Diff <> 50% Week 2 5 (71%) 1 (14%) 1 (14%) Week 4 3 (43%) 3 (43%) 1 (14%) Week 6 5 (71%) 2 (29%) 0 (0%) Week 9 6 (86%) 1 (14%) 0 (0%) Week 12 6 (86%) 1 (14%) 0 (0%) Sum 25 (71%) 8 (23%) 2 (6%) p = 0.0031

Poster Number: EI - 2 DIAGNOSTIC ACCURACY OF THE SLU AMSAD SCALE FOR DEPRESSION IN NON-DEMENTED ELDERLY Rita Khoury; Binu Chakkamparambil; John Chibnall; Jayashree Rajamanickam; Aneel Kumar; George Grossberg

Department of Psychiatry and Behavioral Neuroscience, Saint Louis University

Introduction: Despite its significant impact, geriatric depression remains both underdiagnosed and undertreated (1). In the absence of specific diagnostic criteria, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria currently represent the gold standard diagnostic tool for late-life depression. Given the fact that most elderly patients receive mental health care in primary care settings (2), there is an increasing need to develop practical diagnostic tools to be used by primary care practitioners. The Saint Louis University (SLU) AMSAD tool is a brief (5-item) questionnaire that was recently developed to screen for late- life depression. The 5 items reference appetite, mood, sleep, activity and death ideation using simple language and scaling. Previous research has supported its validity and reliability in cognitively intact older adults, in relation to the Geriatric Depression Scale (GDS)-15 and the Montgomery-Asberg Depression Rating Scale (MADRS) (3). However, few studies have examined the diagnostic accuracy of depression screening instruments in older adults. The objective of this study was to evaluate the accuracy and reliability of the SLU AMSAD regarding diagnosis of major depressive disorder (MDD) per DSM-5 criteria in a sample of older adults without major neurocognitive disorder. Methods: A convenience sample of 50 patients, ≥ 65 years of age was enrolled through our specialized geriatric psychiatry outpatient clinic. Patients with a clinical suspicion/diagnosis of major neurocognitive disorder as reflected by a Saint Louis University Mental Status (SLUMS) score of < 20 were excluded. MDD diagnosis was determined by the treating physician using the DSM-5 criteria. The SLU AMSAD, GDS-15 and MADRS, were then independently administered by a member of the research team who was blind to the MDD diagnosis. Internal consistency reliability of the SLU AMSAD was determined using Cronbach’s coefficient alpha. Diagnostic accuracy was evaluated using receiver operating characteristic curve (ROC) analysis, with area under the curve (AUC) and sensitivity/specificity parameters calculated. Correlations coefficients (Spearman rho) were calculated between the various screening measures and MDD diagnosis. Results: Descriptive Analysis The sample had a mean (SD) age of 73.5 (7.1) years; 58% (n = 28) were women, 88% (n = 44) were Caucasian, and 86% (n = 43) had at least a high school level of education. The mean SLUMS score was 25.9 (2.9). For the depression measures, mean scores were 6.5 (4.5) for the GDS-15; 15.6 (11.4) for the MADRS; and 4.9 (3.2) for the SLU AMSAD. The SLU AMSAD evidenced adequate internal consistency reliability (alpha = .77). 30% (n = 15) of patients met DSM-5 criteria for MDD diagnosis. Diagnostic Accuracy and Correlations In the initial ROC analysis, total scores (continuous variables) for the GDS-15, MADRS, and SLU AMSAD were evaluated in relation to the DSM-5 designation of No MDD vs. MDD. AUC values were uniformly high (≥ .93), with correspondingly high levels of sensitivity (.93) and specificity (≥ .80). Optimal cut-offs were 9+ for GDS-15, 18+ for MADRS, and 7+ for SLU AMSAD. The SLU AMSAD was equivalent to GDS-15 and superior to MADRS in these analyses.

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ROC analyses using established categories for the depression measures were then executed. When score results were categorized as No vs. Any (Mild, Moderate, or Severe) Depression, AUC values ranged from .69-.79, with perfect sensitivity (1.0) but modest speciﬁcity (range = .37-.57). When score results were categorized as No-Mild vs. Moderate-Severe Depression, AUC values were again high (range = .82-.89), with adequate levels of sensitivity (.87-.93) and speciﬁcity (.71-.86). Moreover, total score correlations were nearly uniform across the depression measures (.69-.70). Scores categorized as No vs. Any (Mild, Moderate, or Severe) Depression yielded correlations with DSM-5 MDD that ranged from .39-.53; scores categorized as No-Mild vs. Moderate-Severe Depression yielded correlations ranging from .59-.75. When scores were categorized according to the optimal cut-off value, SLU AMSAD and GDS-15 had correlations of .75 with DSM-5 MDD, while the MADRS correlation was .68. Conclusions: The results indicated strong diagnostic accuracy for all three depression scales in relation to the DSM-5, by ROC and correlational analyses. The SLU AMSAD performed at least as well as the GDS-15 (three times the length of the AMSAD) and slightly better than the much longer and complex MADRS. However, the clinical superiority of the SLU AMSAD for depression screening in the elderly, in relation to the other measures, is supported by the fact that it encompasses only 5 simply- worded, simply-scaled items. Thus, the SLU AMSAD emerges as a potentially strong candidate for depression screening in busy clinical settings, including primary care but also in the emergency department. This research was funded by: No funding was received for this research.

TABLE 1. Receiver Operating Characteristic Curve Analyses and Correlation of Depression Scales with DSM-5 MDD Diagnosis Area Under the Curve / Sensitivity / Speciﬁcity/ rho (p-value): DSM-5 (No vs. MDD) Measures Total Score (Continuous) No vs. Any (Mild-Mod-Sev) Depression No-Mild vs. Mod-Sev Depression GDS-15 .94 / .93 / .86/.70 (< .001) .79 / 1.0 / .57/.53 (< .001) .89 / .93 / .86/.75 (< .001) MADRS .94 / .93 / .80/.70 (< .001) .69 / 1.0 / .37/.39 (.005) .85 / .87 / .83/.66 (<.001) SLU AMSAD .93 / .93 / .86/.69 (< .001) .71 / 1.0 / .43/.43 (.002) .82 / .93 / .71/.59 (<.001)

References: 1. Hall CA, Reynolds CF: Late-life depression in the primary care setting: Challenges, collaborative care, and prevention. Maturitas 2014;79(2):147–152. 2. Alexopoulos GS: New Concepts for Prevention and Treatment of Late-Life Depression. American Journal of Psychiatry 2001;158(6):835–838. 3. Chakkamparambil B, Chibnall JT, Graypel EA, Manepalli JN, Bhutto A, Grossberg GT: Development of a brief validated geriatric depression screening tool: the SLU “AM SAD”. The American journal of geriatric psychiatry: ofﬁcial journal of the American Association for Geriatric Psychiatry 2015;23(8):780–783.

Poster Number: EI - 3 AGE-RELATED DIFFERENCES IN MEDICATION ADHERENCE, SYMPTOMS, FUNCTIONING, AND STIGMA LEVELS IN POORLY-ADHERENT ADULTS WITH BIPOLAR DISORDER Stephen Smilowitz; Awais Aftab; Michelle Aebi; Jennifer Levin; Martha Sajatovic

Department of Psychiatry, Case Western Reserve University School of Medicine/University Hospitals Cleveland Medical Center, Cleveland, OH, USA

Introduction: Poor medication adherence in people with bipolar disorder (BD) is common. Younger age is a reported risk factor for medication non-adherence in individuals with BD. The literature on the relationship between adherence and symptoms is conflicting. Additionally, self-stigma in BD patients is well-documented, and could have negative effects on self-care that includes medication treatments. Stigma experienced by BD patients may have implications on quality of life, social dysfunction, and suicidality. Lastly, while previous analysis demonstrates that a customized adherence enhancement (CAE) program targeted to mixed-age poorly adherent patients with BD increases medication adherence and functional status compared to a rigorous BD-specific educational (EDU) program, how specific adherence promotion efforts improve adherence in relation to patient age has not been studied. This secondary analysis from a completed randomized controlled trial (RCT) comparing two interventions in poorly adherent patients with BD evaluated medication adherence, psychiatric symptom severity, functional status, and internalized stigma levels in older (age ≥55 years old) vs. younger (age <55 years old) adults at baseline and over time. Given demographic changes that

S116 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 project an increase in both proportions and absolute numbers of people with serious mental illnesses such as BD, ﬁndings may have practical implications for clinical care. Methods: Data for this analysis derived from a prospective six-month NIMH-funded RCT comparing a CAE intervention intended to promote BD medication adherence with EDU in 184 poorly-adherent individuals with BD. We chose an age 55 cut-off to differentiate younger (n=144) vs. older (n=40) subgroups within the sample, consistent with a recent consensus recommendation to consider that people with BD on average lose one to two decades of life compared to the general population.

Medication adherence was measured with the Tablets Routine Questionnaire (TRQ). BD symptoms were measured using the Montgomery−Asberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS). Participants were also rated with Clinical Global Impression—Bipolar Version (CGI-BP). Global Assessment of Functioning (GAF) was used to measure functional status. Attitudes regarding self-stigma were assessed with the Internalized Stigma for Mental Illness scale (ISMI). To evaluate for age-related differences in change over time in TRQ, BPRS, and GAF in the entire sample, treatment arms were combined and younger vs. older subgroups were compared. Mann-Whitney U was used to analyze non-parametric continuous variables, chi-square for categorical variables, and t-test for normally distributed continuous variables. In analysis with very small N comparisons, Fisher’s exact test was used. To evaluate for age-related differences in change over time in TRQ, BPRS, and GAF in each treatment arm, mixed longitudinal models were fit. Covariates included main effects for age, treatment, and time, as well as three-way interaction terms involving age, treatment, and time. Results: BASELINE FINDINGS In our sample, older participants had significantly lower anxiety disorder comorbidity compared to younger participants, considering participants with one or more (56.4% vs. 78.4%) and two or more anxiety disorders (41.0% vs. 57.5%). Therewerenostatisticallysignificantdifferencesinpast-week and past-month adherence with BD medications between older and younger participants (past week TRQ: 37.2 vs. 43.0; past month TRQ: 38.5 vs. 40.8). There were no significant differences in YMRS, BPRS, and GAF scores between the two groups. Older adults had significantly lower MADRS scores than their younger counterparts (14.9 vs. 18.9, p=0.011) and significantly lower CGI-BP (3.08 vs. 3.47, p=0.025), indicating comparatively lower depressive and overall symptom severity. Older adults had significantly lower ISMI scores than their younger counterparts (61.95 vs. 69.27, p=0.001), indicating relatively lower internalized stigma. These findings remained significant in four of five ISMI subscales: alienation (p=0.017), stereotype endorsement (p=0.002), discrimination experience (p=0.001), and social withdrawal (p=0.013). Only age-related differences in the subscale of stigma resistance were not significant (p=0.450). LONGITUDINAL FINDINGS In the combined group (CAE plus EDU), evaluation over time showed no significant difference between older and younger participants in TRQ, BPRS, and GAF. There were no significant findings and no interaction between time and age group when analyzed globally, regardless of treatment arm assignment at baseline. In analysis evaluating for change over time between older and younger participants by treatment arm, for TRQ, there was a significant finding of interaction between time, age group, and treatment arm (p = 0.007) such that there was a trend for older individuals to have worse adherence over time in the EDU vs. the CAE intervention arm. For BPRS and GAF, there were no significant findings and no interaction between time, age group, and treatment arm. Conclusions: This secondary analysis from an RCT comparing two interventions in poorly adherent patients with BD found that older adults may be less depressed and anxious, with less self-stigma compared to younger people with BD and poor adherence. CAE is a behavioral intervention that may yield sustained benefit with respect to medication adherence in adults with BD who are age 55 and older. This research was funded by: Research reported in this poster was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH093321. Support was also received from the Clinical and Translational Science of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research.

Poster Number: EI - 4 THE ASSOCIATIONS AMONG HISTORY OF PSYCHOSIS, NEUROPSYCHOLOGICAL PERFORMANCE, AND FUNCTIONING IN REMITTED LATER-LIFE MAJOR DEPRESSION Kathleen Bingham1; Deirdre Dawson1,2; Benoit Mulsant1,3; Samprit Banerjee4; Alastair Flint1,5

1University of Toronto 2Rotman Research Institute, Baycrest Health Sciences 3Centre for Addiction and Mental Health 4Weill Cornell Medical College 5University Health Network, Centre for Mental Health

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Introduction: Observational studies report that people with psychotic major depressive disorder (PMD) have poorer functional outcome than those with non-psychotic major depression (NPMD), but this finding could be explained by less robust recovery and residual symptoms in PMD. In addition, neuropsychological performance is worse in those with PMD than NPMD, both acutely and in remission. The aim of this study was to examine the relative contributions of a history of psychosis and neuropsychological performance to impaired everyday function in patients with remitted later-life major depressive disorder (MDD). We hypothesized that, in later-life patients with MDD, a history of psychotic features and poorer neuropsychological function would be independently associated with poorer everyday functioning, but that poorer neuropsychological performance would be more strongly associated with poorer functioning compared to history of psychosis. In order to place the results in a broader context, we examined everyday functioning in an age- and gender-matched non-psychiatric comparison group. Methods: This cross-sectional design study included 73 patients aged 50 years and older with a history of MDD (n = 51 with NPMD and n = 22 with PMD) in sustained remission and 42 non-psychiatric comparison subjects. Sociodemographic, clinical, neuropsychological, and functional data were collected by an investigator blind to the history of psychotic features. Everyday functioning, the dependent variable, was divided into general functioning (measured by participant-report) and IADL performance (measured by observer-rated assessment). The independent variables were i) history of psychosis and ii) neuropsychological performance in the domains of processing speed, memory, and executive function. Relationships between each independent variable and functioning were analyzed using multiple linear regression models. The relative contribution of history of psychosis and neuropsychological performance to functioning was analyzed using multiple regression models with history of psychosis entered in the first step and the neuropsychological variable in the second step. All models included covariates that were potential confounders. We also calculated effect sizes for the difference in functioning between MDD and non-psychiatric comparison participants. Results: Patients with PMD exhibited substantial deficits in measures of processing speed and, to a lesser extent, executive function, compared to NPMD patients and to population norms. History of psychosis was independently related to poorer IADL performance (b = 0.262, t = 3.03, p = 0.004) and general functioning (b = -0.29, t = -2.46, p = 0.017). Poorer performance on measures of processing speed (b = -0.468, t = -4.99, p <0.0001), executive function-inhibition (b =-0.458, t = -5.04, p <0.0001), and verbal learning (b = -3.05, t = -3.25, p = 0.002) were associated with poorer IADL performance and poorer general functioning (processing speed b = 0.454, t = 4.31, p <0.0001; executive function-inhibition b = 0.334, t = 2.93, p = 0.005; verbal learning b = 0.307, t = 2.78, p = 0.007). When history of psychosis and each neuropsychological measure were entered together into models for IADL and general functioning, psychosis was no longer associated with function. In comparison to non-psychiatric subjects, the effect size of functional impairment in patients with remitted PMD was large (Cohen’s d for IADL function = 0.80; Cohen’s d for general functioning = 0.97), whereas the impairment was small to moderate in remitted NPMD (Cohen’s d for IADL function = 0.10; Cohen’s d for general functioning = 0.64). Conclusions: Later-life remitted PMD is associated with poorer everyday functioning compared to NPMD, with clinically- significant deficits. However, this relationship is no longer significant when neuropsychological function, especially processing speed, is accounted for. This study advances previous literature by including only patients with rigorously-defined sustained remission and measuring functioning comprehensively using both participant-report and performance-based measures. We will discuss future directions of these research findings, including examining neurobiological correlates of processing speed deficits in remitted PMD. This research was funded by: This study was funded by the University Health Network Centre for Mental Health’s research grant ($14,000)

Poster Number: EI - 5 DEPRESSIVE SYMPTOMS ON THE DECLINE IN OLDER ADULTS: BIRTH COHORT ANALYSES FROM THE RUST BELT Kevin Sullivan1; Anran Liu2; Hiroko Dodge3,4; Carmen Andreescu5; Chung-Chou Chang2; Mary Ganguli1,5,6

1Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 2Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 3Department of Neurology, Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, Michigan 4Department of Neurology, Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, Portland, Oregon 5Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 6Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Introduction: Many older adults with depressive symptoms have adverse health outcomes and reduced quality of life, but do not meet the clinical threshold for Major Depressive Disorder (MDD). Studies suggest that prevalence of MDD and depressive symptoms is increasing in children and younger adults, but little is known about population trends in depressive symptoms in older adults over age 65.

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Methods: We pooled data from two large prospective community-based epidemiological studies of older adults in southwestern Pennsylvania between 1987-Present. We identified four birth cohorts of sufficient sample size: 1902-1911 (n=305), 1912-1921 (n=1202), 1922-1931 (n=1051), 1932-1941 (n=669). In both studies, a modified Center for Epidemiological Studies Depression Scale (mCESD) was used to determine presence of symptomatic depression (≥5 symptoms) at each wave of examination. The percentage of participants in each birth cohort who had at least one study visit with symptomatic depression varied by age but ranged between 22.9-23.1% for the 1902-1911 cohort, 19.5-26.0% for the 1912-1921 cohort, 9.8-17.0%% for the 1922-1931 cohort, and 12.2-15.4% for the 1932-1941 cohort. To minimize potential bias due to the association between depression and attrition, we fit a shared parameter model that jointly modeled depressive symptoms and attrition. Results: The 1922-1931 and 1932-1941 cohorts were significantly less likely to report ≥5 depressive symptoms than the 1902- 1911 cohort (p<.01). Specifically, when compared to our oldest cohort (1902-1911), we report 55% lower odds of symptomatic depression in the 1922-1931 cohort and 65% lower odds in the 1932-1941 cohort. When the mCESD was factor analyzed into four composite factors, there was significantly lower endorsement of items comprising Factor 1 (blues, depressed, happiness, loneliness, crying, and sadness) and Factor 2 (effort, hopefulness, enjoyment, and get-going) in the more recently born birth cohorts. Models were adjusted for follow-up time, baseline age, sex, education, dementia diagnosis, and antidepressant medication use. Conclusions: Understanding trends in older adult depression will help identify relevant subgroups and factors which will improve ability to plan better mental health services for our aging population. This research was funded by: This work was supported by the National Institute on Aging at the National Institutes of Health (R01 AG023651, U01 AG06782, R01 AG07562, P30 AG053760, P30 AG008017 and T32 AG000181).

Poster Number: EI - 6 ANXIETY, NEUROTICISM AND LATE-LIFE DEPRESSION Elisa Gonzalez Cuevas; Lihong Wang; Kevin Manning; Rong Wu; David Steffens

University of Connecticut School of Medicine

Introduction: Late-life depression (LLD) is associated with psychiatric comorbidities that may worsen mood outcomes in older adults, yet these comorbid conditions remain underdiagnosed and understudied in LLD. Anxiety and neuroticism have been independently associated with depression, but the interplay between these traits in older adults is uncertain and may be key to understanding the development and important mood and cognitive outcomes of LLD. In this study, we analyzed the relationship between neuroticism, anxiety and depression in older adults and hypothesized that higher anxiety measures would be associated with: (1) higher depression severity, (2) higher neuroticism, (3) lower cognitive scores at baseline, and (4) cognitive decline. Methods: Older non-demented adults who were either depressed or never depressed (controls) were recruited. Anxiety, neuroticism, depression and cognition were assessed using the State-Trait Anxiety Inventory (STAI), NEO Personality Inventory (NEO PI), Montgomery-Asberg Depression Rating Scale (MADRS) and the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) cognitive battery, respectively. A study psychiatrist confirmed or ruled out diagnosis of depression for depressed and control subjects. The psychiatrist followed a guided treatment algorithm in which sertraline was initially offered to all subjects at baseline. A sub-group analysis was performed on sertraline intention to treat (ITT) subjects. Subjects in the depression group were followed every two weeks by the psychiatrist, who made dosing adjustments and administered the MADRS. Results: Baseline study results were obtained from a sample of 121 older depressed subjects and 39 never depressed controls. Longitudinal results were obtained from a sample of 93 depressed subjects for 3-month outcomes (3M), and 57 subjects for 12-month outcomes (12M). The sub-group sertraline-ITT analysis was performed for 51 subjects for 3M and 36 subjects for 12M. At baseline, state and trait anxiety scores were highly associated with depression scores in both study groups. Higher state and trait anxiety scores were associated with lower baseline cognition scores in the control group, and significantly less so in the depressed group. Baseline total neuroticism was associated with higher state and trait anxiety, and with higher depression scores in both groups. At baseline, total neuroticism was not significantly associated with lower cognition scores. For longitudinal results, we found that baseline trait anxiety was a predictor of 3M and 12M depression scores in the depressed group, but not a predictor of change from baseline. Trait anxiety and total neuroticism were predictors of 3M depression scores in the ITT subgroup. We also found that the anxiety, depression and stress vulnerability domains of neuroticism were predictors of 3M depression scores, for both the depressed group and the ITT sub-group. The impulsiveness facet of neuroticism was a predictor of 12M depression in both group and sub-group analyses. The only significant predictor of 12M cognitive score was baseline state anxiety. Conclusions: Anxiety and neuroticism in late life are highly prevalent among older depressed individuals. We found that anxiety measurescorrelatedwithdepressionmeasures in older adults, regardless of clinical diagnosis as depressed or non-depressed.

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Interestingly, anxiety correlated with lower cognitive performance only in the non-depressed individuals. These results highlight a differential effect of anxiety on cognition between non-depressed older adults and those adults suffering from LLD. Several baseline neuroticism and anxiety traits were found to predict depression scores, but none was found to correlate with signiﬁcant changes in depression and cognition in this 12-month analysis. There is a complex interplay between mood and personality traits in older adults, and studies that include a longer follow-up are needed to identify important predictors of mood and cognitive outcomes in LLD. This research was funded by: The Leo and Anne Albert Charitable Trust National Institute of Mental Health Grant R01 MH108578

Poster Number: EI - 7 TREATING BIPOLAR I DISORDER WITH COMORBID PARKINSON’S DISEASE: A CATCH-22 Victor Gonzalez; Sonia Popatia; Erica Garcia-Pittman; Tawny Smith

The University of Texas at Austin Dell Medical School

Introduction: The current population growth of older adult psychiatric patients has resulted in an increased prevalence of patients experiencing comorbid illnesses that can further complicate care of their psychiatric disorders. One specific example of this situation are patients with Bipolar I disorder who develop Parkinson’s disease. Unfortunately, there is a limited amount of literature available describing comorbidities of Bipolar I disorder such as Parkinson’s disease, much less any established treatment options for patients with these dual conditions. Furthermore, the underlying proposed mechanism of pathology for both disorders, with bipolar disorder worsened by increased dopamine while Parkinson’s disease being a result of decreased dopamine, makes it difficult to treat each illness without affecting the other. Through this poster presentation, we hope to discuss the case of a geriatric patient initially diagnosed with Bipolar I disorder who later developed Parkinson’s disease. We will highlight the course of illness leading to diagnosis of Parkinson’s disease, as well as the challenges with pharmacological management of his psychiatric and neurological illnesses. Methods: This case report focuses on a geriatric patient with Bipolar I disorder and comorbid Parkinson’s disease, and the associated complexities in treatment that resulted. Patient’s clinical documents in our electronic medical records system were reviewed. A literature survey was performed on the topics of Bipolar I disorder with comorbid Parkinson’s disease, and current approaches to pharmacological treatment. Results: A 67 year old Caucasian man was seen in outpatient geriatric psychiatry clinic for management of Bipolar I disorder. While on lithium for mood stabilization, he experienced what was initially believed to be medication induced Parkinson’s symptoms. However, after persistence of symptoms and further workup by neurology, he was diagnosed with Parkinson’s disease. Careful coordination with neurology led to patient being started on dopaminergic medication for movement disorder, adjusting dosage as tolerated while monitoring for worsening mood symptoms. Concurrently, patient’s psychotropic medications were evaluated and maintained, while also monitoring for worsening movement symptoms despite not having to use any dopamine antagonists. Conclusions: Geriatric patients with Bipolar I disorder and comorbid Parkinson’s disease present a unique and challenging treatment problem due to the pathological mechanisms of these illnesses. Lack of evidence based treatment options adds to the difficulty of treating these patients. However, through care coordination with other medical specialists and careful monitoring of symptoms, it is possible to offer a well-balanced pharmacological treatment approach that adequately controls the symptoms of patients with both Bipolar I disorder and Parkinson’s disease. This research was funded by: N/A

Poster Number: EI - 8 SUBJECTIVELY AND OBJECTIVELY RATED MIXED AFFECTIVE STATES IN A MIXED-AGE SAMPLE OF ADULTS WITH BIPOLAR DISORDER: ASSOCIATIONS WITH AGE, SUICIDALITY, SYMPTOM SEVERITY, COGNITION AND INFLAMMATION Awais Aftab; Colin Depp; Rebecca Daly; Ashley Sutherland; Benchawa Soontornniyomkij; Lisa Eyler

University of California, San Diego

Introduction: Mixed affective states in bipolar disorder have been associated with increased number of mood episodes, increased suicidality, higher rates of co-occurring conditions, and poorer response to treatments. In order to better understand mixed

S120 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 symptomatology in bipolar disorder, here we examine the prevalence and associations of subjectively reported states of simultaneously high sadness and high energy as well as objectively rated concurrently high depressive and manic symptoms. Methods: We used baseline data from an ongoing longitudinal study of subjects with Bipolar Disorder (BDs) and Healthy Controls (HCs). Our mixed-age sample (mean age 48.5, SD 7.7) included 50 BDs and 91 HCs. Baseline evaluation consisted of a 2-week burst of data collection. All subjects underwent objective tests of cognitive performance, lab tests for inflammatory markers, and BDs were assessed for suicidal ideation (SI) and suicidal behavior (SB) using Columbia-Suicide Severity Rating Scale (C-SSRS) at baseline, middle and end of the 2-week period. The proportion of ratings in which SI or SB was reported (P- SI and P-SB respectively) was used as a measure of degree of SI and SB. Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Brief Psychiatric Rating Scale (BPRS), and 36-Item Short Form Health Survey (SF-36) were administered to BD subjects at baseline. Participants were given a mobile phone and affective ratings were gathered 3 times per day for 14 days at random intervals approximating morning, mid-day, and evening. Ratings were scored on a scale of 0-7 across domains such as sad/depressed, happy, energetic, etc. Short Lived Mixed Affective States (SLMAS) were defined as instances of affective ratings with simultaneously high sadness/depression (≥4) and high energy (≥4). The proportion of total reported ratings with SLMAS (P-SLMAS) were calculated for all subjects. A group with objective mixed states (group M, N=15 [30.6%]) was defined as BDs with concurrently high HAM-D and YMRS scores (HAM-D ≥ median score of 17, YMRS ≥ median score of 6). These were compared to BD patients with both HAM-D and YMRS scores lower than median (group L; N=13 [26.5%]), with high depression/low mania (group D; N=20 [20.4%]), and with high mania/low depression (group Y; N=11 [22.4%]). We examined the association of subjective mixed affect (P-SLMAS) and objective mood state group with age, suicidality, symptom severity, cognition and inflammation and to each other using correlations and ANOVAs. Results: Groups were well-matched on age and sex. In terms of subjective affective ratings, while both groups had low P-SLMAS overall, BDs had significantly higher P-SLMAS compared to HCs: 9.7% (SD 13.1%) vs 3.5% (SD 7.3%), p <0.001. The proportion of subjects with at least one reported SLMAS was also significantly higher in BDs compared to HCs (60.0% vs 38.5%, p=0.014). In the BD group, P-SLMAS was significantly correlated with BPRS total score (r=0.373, p=0.012), BPRS item-3/depression score (r=0.41, p=0.004), HAM-D total score (r=0.413, r=0.004), and SF-36 mental component score (r=-0.430, p=0.011), while no significant correlation was found with YMRS total score (r=0.079, p=0.598). Significant correlations were also noted with Cognitive Failures Questionnaire-25 score (r=0.347, p=0.048) and Brief Symptom Inventory Anxiety Scale score (r=0.349, p=0.043). These significant correlations remained significant on linear regression even when proportion of ratings with high- sadness and high-energy as separate variables were taken into consideration, indicating that these significant associations with P- SLMAS were not being driven by high-sadness or high-energy individually. No correlation was found between P-SLMAS and P- SI (r=0.104, p=0.525) and P-SB (r=0.062, r=0.668). No correlation was found between age and P-SLMAS (r=0.055, p=0.520), nor were there associations of P-SLMAS with gender, race, marital status or living situation. Furthermore, no correlation was found between P-SLMAS and objective tests of cognitive performance or inflammatory markers. In terms of objectively rated mixed states, Group M had significantly higher P-SI compared to groups L, D and Y (50% vs 0%, 21% and 5% respectively, p=0.003). Group M also had higher P-SB (10% compared to 0% for all other groups), however, this did not reach statistical significance (p=0.098). No significant difference was found between groups L, D, Y and M with regards to age and other demographic variables. No differences were found with regards to CFQ-25 score, BSIAS score, objective tests of cognitive performance, or inflammatory markers. Subjectively rated mixed affect and objectively rated mixed states were not strongly associated. P-SLMAS were not significantly different across L, D, Y and M groups (p=0.103), with groups D and M showing similarly high P-SLMAS (13.4% and 14.6% respectively) and groups L and Y showing similarly low P-SLMAS (4.5% and 4.8% respectively). Conclusions: SLMAS, subjectively reported short-lived states of high sadness and high energy, are reported with greater frequency in BDs compared to HCs. SLMAS appear to be a marker of depressive pathology (akin to ‘agitated depression’) and are associated with greater symptom severity. SLMAS do not show a relationship with manic symptom severity, and therefore do not show a relationship with objectively defined mixed states. While SLMAS are not associated with suicidality, objectively rated concurrently high depressive and manic symptoms are associated with greater frequency of suicidal ideation. Future work will examine relationship with psychiatric comorbidities and treatment response. This research was funded by: This work was supported by NIMH grant R01 MH103318 and the Desert-Pacific Mental Illness Research, Education, and Clinical Center.

Poster Number: EI - 9 DEPRESSIVE SYMPTOMS ACROSS THE AGE SPAN: FINDINGS FROM AN INTEGRATED EPILEPSY SELF-MANAGEMENT CLINICAL STUDIES DATASET. Zaira Khalid1; Hasina Momotaz1; Kristen Cassidy1; Naomi Chaytor2; Robert Fraser3; Mary Janevic4; Barbara Jobst5; Erica Johnson3; Peter Scal6; Tanya Spruill7; Martha Sajatovic1

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1CWRU 2WSU 3UW 4UofM 5Dartmouth 6UMN 7NYU

Introduction: Epilepsy has been reported by the CDC to have a prevalence of 1.2% in the United States, which accounts for roughly 3.4 million adults in 2015. Nearly 1 million of those adults are aged 55 or older.1 Epilepsy is more likely to develop in older adults because risk factors for epilepsy are more common as people age including stroke/cardiovascular disease, neurodegenerative disorders, brain tumor and long-term sequelae of alcohol abuse.2 As our population ages, there will be even more older people with epilepsy. A common comorbidity in epilepsy is depression. While the prevalence of depression in patients with epilepsy varies in literature, it is estimated to be between 15% and 37%.3 The significance of depressive symptoms on quality of life has been shown to be greater than that of short-term seizure control.4 For older people, balancing epilepsy treatment in conjunction with other health problems can present with great difficulty. Many antiepileptic’s also have side effects such as bone loss, dizziness and greater risk for falls, which can make someone more likely to fall and become injured.5 This analysis, from a large pooled dataset of multiple epilepsy treatment studies, examined presence and symptom severity of depression in older adults (age > 55) with epilepsy in comparison to younger adults (age <55) with epilepsy. Methods: Analysis was completed using baseline data and clinical variables from 9 studies of the Managing Epilepsy Well (MEW) Network integrated research database (MEW DB). Patients were divided into two groups; age 18-55 and age greater than or equal to 55. A total of 935 adults participated, out of which 161 (17.2 %) were of age 55 or greater and 774 adults younger than 55 (82.8 %). Other demographics included were gender, race, marital status, highest education level and annual income. Standardized rating scales included Quality of Life in Epilepsy (QOLIE-10) and Patient Health Questionnaire (PHQ-9) for depressive symptoms. The QOLIE-10 scoring was harmonized to accommodate slightly different versions of this scale within the integrated dataset. Results: The mean age for older patients was 61.5 vs. 34.4 for younger patients. Approximately 60% of patients in both groups were females. Among older patients 109 (76.2%) were white, 24 (16.8%) African Americans, and 4 (3.1%) Hispanic. Majority of these patients (78.6%) had a college education and 53.4% were either married or co-habiting. Demographics of the under 55 group were largely similar. Mean PHQ-9 score was 8.5 in older patients vs. 9.5 in younger patients (p= 0.07). Amongst older patients, those with moderate-severe depression defined as PHQ-9 > 10 had an average of 7 seizures in 30 days, compared to those with scores <10 with an average of 2.7 seizures in 30 days (p=0.447). QOLIE-10 scores followed a similar pattern in that severe depression (PHQ 9 >10) in both younger and older groups was associated with worse QOL (p=<0.001). Conclusions: Depression is common in people with epilepsy across the lifespan. Depression is more common in those with poorly controlled epilepsy, and more severe depressive symptoms are associated with poorer quality of life. However, we did not find that these findings were different in older vs. younger patients. Methodological limitations such as the clinical trials’ data source and relatively young age of the sample overall could have biased findings. Future analyses need to sample more elderly people with epilepsy including the “old-old” and those with more extensive medical comorbidity. This research was funded by:: This study was supported in part by CDC grants U48DP001930 (CWRU), U48DP005030 (CWRU) U48DP005008 (NYU), 148DP005013 (WA), and 1U48DP005018 (Geisel School of Medicine at Dartmouth) under the Health Promotion and Disease Prevention Research Centers Program.

Poster Number: EI - 10 ENGAGEMENT IN SOCIALLY REWARDING ACTIVITIES AS A PREDICTOR OF OUTCOME IN BEHAVIORAL ACTIVATION THERAPY FOR LATE LIFE DEPRESSION Nili Solomonov1; Jennifer N. Bress1; Jo Anne Sirey1; Faith M. Gunning1; Patrick J. Raue2; Patricia A. Arean2; George S. Alexopoulos1

1Weill Cornell Medicine 2University of Washington

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Introduction: Late life depression has detrimental effects on older adults’ functioning and well-being. Depressed older adults often experience loneliness and social isolation, which are risk factors for incident depression, increased depression severity, and medical illness. Neurobiological studies suggest that depressed individuals of all ages exhibit impairments in the reward systems and recent studies suggest that socially rewarding experiences may be especially important for depressed older adults. Results of a pilot study conducted by our group has shown that “Engage”, a neurobiologically informed, streamlined brief behavioral activation for depression, led to signiﬁcant reduction in depressive symptoms. “Engage” targets impairments in positive valence system function through “reward exposure” (i.e. engagement in rewarding and meaningful activities). However, it is unknown whether engagement in certain types of rewarding activities is more beneﬁcial than others. We predicted that given the centrality of social isolation in late life depression, social (versus non-social) rewarding activities would predict greater improvement in depression severity.

Methods: Forty-eight older adults with unipolar depression without cognitive impairment received 9 sessions of “Engage” psychotherapy. Depression severity was assessed using the Montgomery−Asberg Depression Rating Scale (MADRS) and behavioral activation was measured using the Behavioral Activation for Depression Scale (BADS) at baseline, weeks 6 and 9. We also assessed depression severity on a weekly basis using the Patient Health Questionnaire (PHQ-9). Patients’ weekly behavioral plans were categorized into three groups: a) solitary activities; b) social-group activities (attending a social gathering or going to a social setting such as church or a senior center); c) social-individual activities (engaging in an interpersonal interaction with a specific friend and/or family member). Results: Logistic regression analyses showed that higher percentage of social-individual activities (compared to solitary and social-group activities) predicted subsequent improvement in depressive symptoms and increase in behavioral activation, when controlling for baseline scores on MADRS and BADS respectively. Preliminary analysis suggests that patients who selected social individual activities, in addition to solitary and social group activities, had a steeper reduction of depression by the third session compared to patients lacking social individual activities in their reward exposure plans. This observation suggests that engagement in social individual activities is associated with early response of depression to Engage. Conclusions: Our preliminary results suggest that exposure to socially rewarding experiences could contribute to the efficacy of psychotherapy for late-life depression. Additionally, these findings highlight the importance of studying the effects of engagement in specific types of rewarding activities in behavioral activation treatment for late-life depression. This research was funded by: P50 MH113838 R01 MH102252 T32 MH019132

Poster Number: EI - 11 IS IT MANIA, DELIRIUM, OR CATATONIA? A CASE SERIES ON DELIRIOUS MANIA IN OLDER ADULTS Angela Wang1,2; Helen Kyomen1,3,4,5

1St. Elizabeth Medical Center 2Tufts University School of Medicine 3Boston University School of Medicine 4McLean Hospital 5Harvard Medical School

Introduction: Delirium can be thought of as acute brain failure and is characterized by a disturbance in attention and awareness as well as cognition which develops over a short period of time. It is a serious condition that is associated with high morbidity and mortality, particularly in critically ill patients. Although delirium has been described for thousands of years, it is frequently overlooked and the pathophysiology remains poorly understood. Our understanding of the different presentations of delirium continues to evolve. Delirious mania was studied in 1849 by Bell, with a 75% mortality in the cohort investigated. Although there has been over a century and a half since that description, there continue to be limited diagnostic criteria and treatment guidelines for delirious mania. Methods: Case series, systematic literature review Results: Case Identification: Cases of delirious mania have been identified and described in the literature. Delirious mania is characterized with the typical disturbances in attention, awareness, and cognition along with mania and psychosis. In one of the first attempts to define the condition, Bell proposed that there was no association with prior mental or systemic disorder. Multiple case studies since then have described an acute onset of a delirious and manic state in the absence of a history of bipolar or depressive disorder. Past history of a personal or family history of psychiatric conditions such as bipolar illness or a depressive disorder may provide diagnostic guidance and help identify a primary psychiatric disturbance. In older adults with mania or

Am J Geriatr Psychiatry 27:3S, March 2019 S123 AAGP Annual Meeting 2019 psychosis, delirium must be considered in the differential as they often have compromised reserve capacities and are prone to developing delirium from conditions that may not be deliriogenic in younger adults. We describe two cases that we believe reflect delirious mania in patients that were previously diagnosed with mania stemming from a psychiatric disorder. Treatment: A case series (with patients aged 50-67) by Karmacharya et al. (2008) put forth electroconvulsive therapy (ECT) as the definitive treatment for delirious mania. They also found that clozapine, quetiapine, lithium, and valproate which may otherwise have been prescribed in a manic episode were not first line treatments. The medications, even when helpful, took an unacceptably long time to work. Curiously, high dose benzodiazepines have also been found to be effective which has led to the association with catatonia. . One of the cases illustrates prolonged recovery while on clozapine, but did not require a high dose of benzodiazepines for rapid improvement despite being in a similar age range. Much like previous case reports, our cases also help to illustrate the overlap of the symptoms of hyperactive delirium with mania and catatonia, particularly in older adults. Conclusions: The cases described illustrate characteristics of delirious mania in patients with a previously diagnosed psychiatric history. They highlight the importance of comparing the patient’s current episode to previous psychiatric presentations. Both cases were originally thought to be due to mania, hence warranting admission to psychiatric units. However, they were found to have a large and complicated medical component to their illness. The initial admission to psychiatric units delayed treatment of their serious medical illnesses and may have contributed to a prolonged hospital stay. The argument can be made to manage these patients on a medical floor with psychiatric services given the critical nature of the medical presentation and more immediate access to life supporting interventions. These cases reiterate the need for formal diagnostic criteria to aid in the early diagnosis of delirious mania. This research was funded by: Non-applicable

Poster Number: EI - 12 PATIENT VERSUS CLINICIAN RATED DEPRESSION SCORES: A COMPARISON OF PARTICIPANT SCORES ON THE CARROLL DEPRESSION SCALE AND THE HAMILTON DEPRESSION RATING SCALE Danielle Tolton; David Steffens; Grace Chan

University of Connecticut Psychiatry Residency

Introduction: In clinical practice, physicians and other medical providers rely heavily on self-assessment tools to screen and assess severity of psychiatric illness, including depression. Ensuring that these self-rating depression scales correlate to investigator rated depression scales is important for diagnosis, validity, and patient care. Several studies have demonstrated a strong correlation between adult patient rated scales compared to clinician completed depression scales which served to establish the validity of self-reported tests. To the best of our knowledge, no studies have been performed in depressed older adults to compare the correlation of self-report versus clinician completed depression scales. We hypothesized that older adults would rate depression higher on self-reported scales compared to clinician completed depression scales and that variables such as cognition would contribute to these findings. Methods: Using data collected from the Neurobiology of Late Life Depression (NBOLD) study, we compared the 61-item self- report Carroll Depression Scale − Revised (CDS-R) scores against the 17-item clinician rated Hamilton Depression Rating Scale (HAM-D) scores in 100 depressed patients that were obtained on the same day as part of the study baseline assessment battery. Based on the crosswalk between CDS-R and HAM-D, the first 52 questions from the CDS-R were compared with the HAM-D. Spearman correlation, weighted kappa coefficient (k), scatter plot, and linear regression were used to determine the agreement between CDS-R scores and HAM-D scores, and evaluate potential influencing factors for any discrepancy. Both total score and the 17 individual domain-specific subscale scores were examined. Results: Consistent with the hypothesis, CDS-R total score (mean 19.6, SD 6.8) were found to be, on average, six points higher than HAM-D total score (mean 13.4, SD 3.9). This six point difference between CDS-R and HAM-D was consistent along the range of depression severity, as demonstrated in figure 1. Comparing domains within each assessment tool, suicidal tendency, weight loss, early insomnia had the highest correlation, while agitation, insight, and general somatic symptoms had lower correlations. The relationship between CDS-R total score and HAM-D total score was not affected by age, gender, Montgomery and Ǻsberg Depression Rating Scale (MADRS), and Cumulative Illness Rating Scale (CIRS) total scores. Cognition, as indicated by CERAD total score, was the only statistically significant covariate for predicting CDS-R total score in a model that included HAM-D score, which supported the hypothesis. Conclusions: Self-assessment screening tools, including those for depression, are important tools for researchers and clinicians alike. These screening tools, such as the Carroll Depression Scale, have demonstrated positive correlation compared with clinician completed scales, such as the Hamilton Depression Rating Scale. Similarly, this data analysis demonstrated positive correlation between the CDS-R and HAM-D in older adults. Limitations of this study include small sample size and mild to

S124 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 moderate depression scores in this ambulatory population. Additional studies would be beneﬁcial to compare other depression rating scales, especially in older adults. Other research is needed to investigate variables that may attribute to higher rates of self- reported depression symptoms. This research was funded by: Not Applicable

Poster Number: EI - 13 ASSOCIATION BETWEEN INFLAMMATORY BIOMARKERS IN PATIENTS WITH ICU DELIRIUM AND TWO-YEAR DIAGNOSIS OF MCI OR ADRD Patricia Serrano1; Sophia Wang1; Anthony Perkins2; Sujuan Gao1; Sikandar Khan1; Heidi Lindroth1; Malaz Boustani3; Babar Khan1

1Indiana University School of Medicine 2Center for Healthcare Innovation and Implementation Science 3University of Indiana

Introduction: Delirium is characterized by acute onset of fluctuation in attention and cognition and is present in 60−87% of older adults in the intensive care unit (ICU).1 Delirium is associated with subsequent Alzheimer’s disease (AD) and other related dementias (ADRD), but underlying mechanisms connecting the two disorders are poorly understood.2 Previous work has established a relationship between inflammatory biomarkers and delirium. Our study tested the hypothesis that inflammatory biomarkers measured during an episode of delirium would correlate with a diagnosis of mild cognitive impairment (MCI) or ADRD within two years of discharge from the ICU. Methods: We performed a secondary data analysis of delirious patients enrolled in the Pharmacologic Management of Delirium (PMD) Trial l.3 ICD-9 codes for MCI and ADRD in the two years after discharge were obtained from the Indiana Network for Patient Care database. Prescriptions for memantine or anti-cholinesterase inhibitors were counted as evidence of MCI or ADRD. Patients who died at discharge or who had a prior diagnosis of MCI or dementia were excluded. To test for the association of the biomarkers, we used proportional hazards regression to model the time to dementia/MCI diagnosis. Patients who died were censored at their time of death. We performed a sensitivity analysis with logistic regression for patients who did not die during follow-up. Results were similar to the survival analysis, so we only report results from the proportional hazards regression. Models were adjusted for age, gender, race, Apache II, Charlson score, sepsis diagnosis, and usual care. Results: A total of 251 patients were included in the analysis. Of these, 231 patients had blood samples collected on Day 1 post randomization to the PMD study, and 149 patients had blood samples collected on Day 8 or upon discharge, whichever was sooner. Within two years of ICU discharge, 12 patients were diagnosed with ADRD, and 43 were diagnosed with MCI. There was no association between inflammatory biomarkers (IL-6, IL-8, IL-10, TNF-Alpha, CRP) drawn on Day 1 and a diagnosis of MCI or ADRD. There was a trend toward significance for higher levels of interleukin-6 (IL-6) drawn at Day 8/discharge and a diagnosis of MCI or ADRD (p = 0.077). Conclusions: This preliminary study suggests that higher levels of IL-6 may be associated with a diagnosis of MCI or ADRD after ICU discharge in patients with delirium. However, future larger-scale studies are needed to study the relationship between inflammatory biomarkers in patients with delirium and the subsequent development of MCI and ADRD. This research was funded by: S.W. is supported by NIA 2P30AG010133 and NCATS UL1TR001108 (Project Development Team). L.S. is supported by NIA P30AG024827. B.K. is supported by NHLBI R01HL131730, and NIA R01AG055391. M.B. is supported by NIA R01AG034205. The authors declare no relevant financial interests related to this manuscript.

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Poster Number: EI - 14 DIAGNOSIS DOES MATTER: MEDICATION DOSING IN END-OF-LIFE CARE FOR PERSONS WITH DEMENTIA Sheni Meghani1; Salma Velazquez2

1VA Eastern Kansas Healthcare System 2Kansas University Medical Center

Introduction: Background: We provide end-of-life care to veterans with various diagnoses both in acute and long-term care settings. During our practice we noticed differences in dose requirements of various medications used to control symptoms based on primary terminal diagnoses. Literature review did not show any evidence suggesting correlation of doses of medications and primary terminal diagnoses in end-of-life care. Objective: To review medication use, doses, symptoms and diagnoses to establish whether terminal diagnosis would impact the amount of medications required for symptom management in end-of-life care. Methods: We conducted a retrospective chart review of patients who died in the Topeka VA Medical Center inpatient setting from January 1, 2018 to May 31, 2018. Various clinical events were reviewed during the last 48 hours of life of these deceased patients. Results: There were 20 patients who died during the review period; 19 (95%) of them were men. Average age was 74.45 years (range 66 to 95). Out of the total, 5 (25%), 5 (25%) and 4 (20%) of patients had terminal diagnosis of dementia, malignancy and thought disorder respectively. Thirteen (65%) died in acute medical setting and the rest of them died in long-term care setting. None of these patients had a change in care setting during last 48 hours of life. All of these patients experienced pain, anxiety and terminal delirium during last 48 hours of their life, based on clinical assessment. Opiates, lorazepam and haloperidol were used to manage these symptoms during end-of-life care. All of these patients required parenteral (intravenous or subcutaneous) use of medications for symptom control during the last 48 hours of life. Data showed differences in dose requirements of medications based on the primary terminal diagnosis. During the last 48 hours of life, patients with primary terminal diagnosis of dementia required 146.8 mg of parenteral morphine equivalent (PME), 40.9 mg of lorazepam and 68.5 mg of haloperidol in comparison to 42 mg, 11.7 mg and 14.9 mg of respective medications for patients without primary terminal diagnosis of dementia. During the same period, patients with primary terminal diagnosis of thought disorders required 53.6 mg of haloperidol compared to 19 mg for other patients. The PME requirement for patients with and without malignancy as primary terminal diagnosis was 67.8 mg and 68.4 mg respectively. Conclusions: During the last 48 hours of their life, patients with primary terminal diagnosis of dementia required 3 times more morphine, 4 times more lorazepam and 4 times more haloperidol than patients without primary terminal diagnosis of dementia for management of end-of-life symptoms. During the last 48 hours of their life, patients with primary terminal diagnosis of thought disorder required 2.5 times more haloperidol than patients without primary terminal diagnosis of thought disorder. During the last 48 hours of their life, patients with primary terminal diagnosis of malignancy required almost the same doses of morphine equivalent as patients without primary terminal diagnosis of malignancy. Limitations: - Very small sample size - Retrospective review of charts - Single site - Short period of study Implications for Future Research: Our data suggest that patients with dementia required much higher doses of opiate, lorazepam and haloperidol for symptom management during their end-of-life care. This is contradictory to the commonly prevalent clinical understanding that these medications should be used in lower doses in patients with diagnosis of dementia. Further research is needed to study the relation of terminal diagnosis and medication requirements in end-of-life care. Further research is also needed to study physiological and biochemical changes during the terminal state that might inﬂuence amount of medications required to treat symptoms. Sponsored by the VA Caucus This research was funded by: None

Patients with primary terminal Patients without primary terminal diagnosis of dementia diagnosis of dementia Parental Morphine Equivalent 146.8 mg 42 mg Lorazepam 40.9 mg 11.7 mg Haloperidol 68.5 mg 14.9 mg

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Poster Number: EI - 15 EFFICACY OF A MULTIDISCIPLINARY SPECIALIZED CARE UNIT IN REDUCING SEVERE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD) IN PATIENTS WITH MAJOR NEUROCOGNITIVE DISORDERS: A RETROSPECTIVE STUDY Francois¸ Rousseau1,2; Evelyn Keller1,2; Nassima Azouaou2; Manel Jarboui2; Lorraine Telleria-Bernal2; Alexandra Simard3; Phylicia Verreault1,4; Chantal Merette2,4; Johanne Duguay1; Annie Labbe4; Rossana Peredo Nunez de Arco4

1IUSMQ 2Laval University 3CHU de Quebec 4CERVO brain research center

Introduction: Behavioural and psychological symptoms (BPSD) associated with major neurocognitive disorder (MNCD) represent the psychological and behavioural problems that appear as the disease progresses. BPSD may vary according to the etiology and stage of MNCD, and are associated with a higher risk of premature institutionalization. Non-pharmacological interventions and pharmacological interventions have been widely used to address BPSD. The literature supports the use of an integrated approach including person-centered non-pharmacological and pharmacological interventions. Methods: The aim of this study was twofold: to characterize the patient population of a multidisciplinary specialized care unit involving at the IUSMQ in Quebec City using non-pharmacological and pharmacological interventions for patients with severe BPSD symptoms. Second, to evaluate the efficacy of the specialized care unit in reducing BPSD symptoms as measured by the neuropsychiatric inventory (NPI). Data were retrospectively collected from the medical chart and entered into a database. Only the participants for whom a measure of the NPI was recorded at admission and at discharge were included in this study (N = 54 participants). Results: Analysis of this clinical sample revealed that the NPI score was significantly reduced at discharge as compared to admission. The subscales showing a statistically significant reduction were agitation/aggression, anxiety, disinhibition, irritability/lability and aberrant motor activity. Conclusions: These results suggest that a combined approach implemented by a multidisciplinary team can reap significant benefits for BPSD patients with advanced stage MNCD hospitalized on a special care unit. This research was funded by: Cashman-Gauthier foundation Quebec Alzheimer’s disease association PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000339/AAGP2019-000339_Fig1.pdf Results of the paired samples ttest evaluating change in neuropsychiatric symptoms between admission and discharge for N = 54 participants

Mean difference SD tp 95% CI Cohen’s d Total score - 9.15 15.22 -4.42 < .001 -13.30 − -4.99 0.60 Delusions - 0.26 3.18 -0.60 .552 -1.13 − 0.61 0.10 Hallucinations - 0.09 2.44 -0.28 .781 -0.76 − 0.57 0.04 Agitation/Aggression - 2.37 3.92 -4.44 < .001 -3.44 − -1.30 0.69 Depression/Dysphoria 0.06 1.69 0.24 .810 -0.41 − 0.52 0.03 Anxiety - 1.11 3.76 - 2.17 .034 -2.14 − -0.08 0.30 Elation/Euphoria - 0.54 2.03 - 1.94 .058 -1.09 − 0.02 0.30 Apathy/Indifference 0.13 3.85 0.25 .806 -0.92 − 1.18 0.41 Disinhibition -1.33 4.39 -2.23 .030 -2.53 − -0.14 0.82 Irritability/Lability - 1.54 4.28 - 2.64 .011 -2.70 − -0.37 0.43 Aberrant motor activity - 0.85 2.94 - 2.13 .038 -1.65 − -0.05 0.22 Night-time behavioral disturbances - 0.54 3.20 - 1.23 .223 -1.41 − 0.34 0.17 Appetite/Eating abnormalities -0.69 4.10 -1.23 .225 -1.80 − 0.43 0.21

Note. Paired samples ttest evaluating if the mean difference is statistically different than zero. SD = standard deviation, CI = conﬁdence interval. Cohen’s dis a measure of effect size (0.20 = small effect size, 0.50 = medium effect size, 0.80 = large effect size). Negative scores indicate a reduction in symptoms.

Am J Geriatr Psychiatry 27:3S, March 2019 S127 AAGP Annual Meeting 2019

Poster Number: EI - 16 POST-MENOPAUSAL BREAST ARTERIAL CALCIFICATIONS (BACS) IN WOMEN AS A POSSIBLE BIOMARKER FOR INCREASED RISK OF DEVELOPING DEMENTIA: STUDY RATIONALE, DESIGN, AND METHODOLOGY Alessia Tognolini1,2; David Sultzer1,2; Gary Small1,3

1UCLA Health 2West Los Angeles VA Medical Center 3Semel Institute for Neuroscience & Human Behavior

Introduction: Although historically considered two distinct entities, both vascular dementia (VD) and Alzheimer’s Dementia (AD) are associated with increased odds of cerebrovascular disease. While early-onset AD (<65yo) is often caused by inheritable mutations, modifiable, multifactorial risk factors impact late-onset AD and VD. Ischemic pathophysiology has been linked to declining episodic memory and executive function and has been shown to contribute to the development of white matter disease (WMD). Arterial stiffening (AS) also has also been shown to play a key role in cognitive decline. Yee et al (Brain. 2017;140:1987-2001) analyzed the effects of cerebrovascular resistance on progression of cognitive decline and found it to be independent of WMD. Moreover, in their cohort, subcortical (but not cortical) cerebrovascular resistance was found to be related to WMD burden. Recent research also suggests that while brain amyloid b and WMD occur independently, their combination is associated with the highest incidence of AS further increasing risk for cognitive impairment. A small but growing body of evidence suggests that breast arterial calcifications (BACs) may be markers of cardiovascular disease due to AS. The increased prevalence of AD in women compared with men of the same age suggests that sex differences and menopause may play a part in the pathogenesis. To address the findings that peripheral artery disease (PAD) and AS play a key role in the development of both VD and AD, we plan to determine the relationship between BACs and dementia. We hypothesize that women with dementia have more severe BACs than healthy controls. Methods: This is a multisite (UCLA Health, West Los Angeles VA Medical Center) study involving review of electronic medical records (EMRs) at these two affiliated institutions. Our primary objectives are to (1) evaluate whether higher degrees of BACs correlate with clinical diagnosis of dementia, and (2) validate screening mammograms as biomarkers for identifications of women at risk of dementia. Secondary objectives are to (1) evaluate whether higher degrees of BACs correlate with greater WMD on brain MRIs, and (2) identify contributing metabolic factors to BACs as potential targets for prevention of AS and therefore dementia. We will extract data from EMRs of post-menopausal women 50 years and older with a diagnosis of dementia over the past 10 years and sex/age-matched controls without dementia. All women will have undergone mammogram within two years of dementia diagnosis. We anticipate approximately 800 subjects. The following characteristics will be analyzed as co-variates/ confounding factors: chronic kidney disease, diabetes, osteoporosis, hormone replacement treatment, vitamin D level, estrogen level, BMI as well as h/o smoking, stroke and/or TIA, depression, and head trauma. For imaging analysis, degree of BACs will be scored using a four-point scale, considering severity and extent of calcifications (see Figure). For women with brain MRI scans available within one year of the mammogram study date, degree of WMD will also be scored on a four-point scale according to the Fazekas (AJR. 1987;149:351-6) score. For statistical analysis, we will first compare women with dementia and controls on demographics to ensure that they are well- matched, or identify variables to use as covariates in the analyses. Calcification burden will be compared between these subject groups using t-tests or ANCOVAs (if covariates are needed). For women with MRI scans, we will use chi-squared or Fisher’s exact tests to test for associations between calcification burden and WMD. Results: This study recently received IRB approval from one of the two participating sites and is pending IRB review from the second site. Preliminary data are estimated to be available for presentation at the time of the 2018 Annual Meeting. Conclusions: Previous reports indicate that the prevalence of mammographically-detected BACs can be as high as 29%. In clinical practice, however, BACs are not consistently reported because are considered “incidental findings” having no relation to breast malignancy. A 2014 meta-analysis demonstrated a strong association between BACs and cardiovascular disease. In a recent 2018 autoptic study (Overisgaran et al. Acta Neuropathol. 2018 Oct 17. doi: 10.1007/s00401-018- 1920-1) including postmortem data from 1453 individuals concluded that women had higher levels of AD pathology as well as more severe arteriolosclerosis. While there are other more invasive methods to assess AS, mammograms can provide a simple and readily available and provide longitudinal “snap-shots” of PAD in asymptomatic women and may help elucidate the relationship between medial artery sclerosis as a separate entity in increasing risk for cognitive impairment.

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This research was funded by: UCLA Health, U.S. Department of Veterans Affairs, Semel Institute for Neuroscience & Human Behavior

Poster Number: EI - 17 CEREBROSPINAL FLUID CORRELATES OF NEUROPSYCHIATRIC SYMPTOMS IN PATIENTS WITH ALZHEIMER’S DISEASE/MILD COGNITIVE IMPAIRMENT Alireza Showraki1; Geetanjali Murari1; Zahinoor Ismail2; Joseph Barfett1,3; David Munoz1,4,5; Tom Schweizer1,6,7,8,9; Luis Fornazzari10; Corinne Fischer1,6,11

1Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON, Canada M5B 1T8 2Departments of Psychiatry and Neurology, Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Insti- tute, University of Calgary, 1403 29 St NW Calgary, Calgary, AB, T2N 2T9 3Department of Medical Imaging, St. Michael’s Hospital, Toronto, ON, Canada 4Department of Laboratory Medicine and Pathobiology, University of Toronto 5Division of Pathology, St. Michael’s Hospital, Toronto, ON, Canada 6Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada, M5S 1A8 7Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada, M5S 1A8 8Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, ON, Canada, M5S 1A8 9Division of Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada, M5B 1W8 10Division of Neurology, St. Michael’s Hospital, Toronto, ON, Canada 11Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada, M5S 1A8

Introduction: Neuropsychiatric symptoms (NPS) are common in Alzheimer’s Disease (AD) and Mild Cognitive Impairment (MCI) but their association with disease biomarkers remains unknown. The aim of this systematic review is to identify potential

Am J Geriatr Psychiatry 27:3S, March 2019 S129 AAGP Annual Meeting 2019 cerebrospinal fluid (CSF) biomarkers of neuropsychiatric symptoms in Alzheimer’s disease (AD) and MCI based on a systematic review of the current literature. Methods: We developed a pre-defined search strategy focused on the association between CSF biomarkers and NPS in patients with AD/MCI using an extensive list of relevant keywords and controlled vocabulary. The search was then performed on four databases: Pubmed, EMBASE, Cochrane, and PsycINFO. 8838 results were recorded and screened by 2 independent reviewers. Studies were selected for critical appraisal based on our inclusion/exclusion criteria. Inclusion criteria were defined as, (1) Study must be in English (2) at least one AD CSF biomarker has been measured (3) at least one NPS from the neuropsychiatric inventory (NPI) has been assessed (4) study population should at least include patients with AD or MCI (5) some type of statistical analysis has been done in an effort to elaborate the association between an AD CSF biomarker and the status of NPS. Furthermore, Non-English, animal and review studies or studies not including an NPS, AD CSF biomarker or AD/MCI patients were excluded. Eventually, a total of 23 studies qualified for the final systematic review and are presented in the study Results: Among all neuropsychiatric symptoms, depression was the most evaluated NPS followed by sleep, psychosis, anxiety, agitation/aggression, eating/appetite, apathy, and irritability. Most studies have reported conflicting results regarding the presence/absence of any significant association between any NPS with any of the AD CSF biomarkers. However, the NPS of agitation/aggression was significantly related to at least one CSF biomarker across all the studies evaluating this NPS. Conclusions: Our study has revealed agitation/aggression as the most consistent NPS related to AD CSF pathology based on a review of the current literature. However, multiple studies have also revealed a conflicting relationship between AD CSF biomarkers and other NPS. Future studies are required to clarify these associations. Future studies should also focus on other NPS such as elation/euphoria, motor disturbances, and disinhibition as it seems to be the neglected domains in previous studies. Our study has also revealed a great degree of heterogeneity among studies, hence calling for a more standardized “objective” approach for the evaluation of NPS in dementia. This research was funded by: Not Applicable

Poster Number: EI - 18 END OF LIFE CARE IN INPATIENT PSYCHIATRY: A CASE STUDY ON END-STAGE ALZHEIMER’S DISEASE Suzanne Azzazy; Meghan Riddle

Vanderbilt University Medical Center

Introduction: Dementia is the sixth leading cause of death in the United States with Alzheimer’s disease being the leading cause of dementia. To avoid unnecessary suffering and even harmful resuscitation, patients with dementia, or their designated decision-makers, can choose to sign a do-not-resuscitate (DNR) or do-not-intubate (DNI) order when they are critically ill. These patients and their designated decision-makers may also choose to receive hospice care to treat their symptoms and improve their quality of life in their final days. The percentage of patients with dementia receiving hospice care in 2018 was 11%, and this percentage is fast growing of hospice patients. However, caring for patients with advanced dementia who are nearing end of life poses many challenges for inpatient psychiatrists and staff. This case aims to examine a patient with Major Neurocognitive Disorder due to Alzheimer’s disease with behavioral disturbances and the challenges to honoring the patient’s DNR/DNI status and coordinating discharge to hospice. Methods: Case Description: Patient is a 78-year old male diagnosed with Major Neurocognitive Disorder due to Alzheimer’s disease with behavioral disturbances admitted to Vanderbilt Psychiatric Hospital for uncontrollable physical aggression. This was his second psychiatric hospitalization in one year due to aggression. On initial evaluation, he was oriented to self only, which was his baseline. He was admitted on the following medications: donepezil 10mg daily, haloperidol 3 mg twice daily, melatonin 1.5 mg at bedtime, finasteride 5 mg daily, tamsulosin 0.8 mg at bedtime, aspirin 81 mg daily, a multivitamin daily, and comfort medications as needed. Behavioral interventions were initiated to reduce agitation. On hospital days 1-6, he was physically aggressive towards staff during activities of daily living. During this time, he was tapered off haloperidol and risperidone was titrated to target physically aggressive behavior, although this was eventually discontinued due to ineffectiveness. On hospital day 8, he was started on olanzapine for physical aggression, resulting in improvement. During this time, olanzapine was adjusted to 5 mg at bedtime and melatonin to 3 mg at bedtime. While his aggressive behavior improved, his food intake and mobility continued to decline. The geriatric psychiatry team recommended patient’s POA consider hospice care. Palliative care was consulted, but declined to see the patient while he was hospitalized psychiatrically. On hospital day 26, the patient started displaying autonomic instability, though did not appear to be in distress. He was started on supplemental oxygen. The Geriatric Medicine consult team recommended morphine 5-10 mg every 2 hours as needed for dyspnea or pain. Two community hospice services were consulted and determined him appropriate for their facilities. The psychiatric nursing staff expressed concern his DNR/DNI could not be honored if he were to decompensate further prior to transfer. The Chief Medical Officer was involved

S130 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 who conﬁrmed the DNR/DNI status could be honored as the policy had recently changed. On hospital day 28, the patient was discharged to a nursing home with hospice care, and he died nine days later. Results: Discussion: Inpatient psychiatrists and staff are not as familiar as their counterparts at a medical center in managing end-of-life care and death of patients, despite geriatric psychiatrists commonly treating patients of advanced age or with terminal illness. An increasing number of patients with advanced dementia and associated behavioral disturbances are psychiatrically hospitalized, and they represent the fastest growing group of hospice patients. This patient’s agitation needed stabilizing before he could transfer to a nursing home safely. When he began displaying autonomic instability, multiple members of his treatment team were concerned his advanced directives would not be honored if he died while on the psychiatric unit, and expressed additional concerns around the impact his death would have on staff and other patients. Conclusions: Experts suggest the ﬁnal stage of Alzheimer’s disease include the inability to ambulate, speak, perform activities of daily living, and appropriately swallow. When these signs are present, it is important to recognize any limitations in the care available, involving hospice or palliative care experts if needed, to honor a patient’s end of life wishes accordingly. This research was funded by: Not applicable.

Poster Number: EI - 19 TRANSITIONING PATIENTS WITH MAJOR NEUROCOGNITIVE DISORDERS FROM ANTIPSYCHOTIC MEDICATIONS TO CITALOPRAM - A PHARMACOGENETICALLY- INFORMED CASE SERIES Aninditha Vengassery; Sarah Sheikh; Syed Maududi; Viktoriya Donovan; Sayan Kaishibayev; Patrick Arthur; Joseph Voigt; Carl Cohen; Michael Reinhardt

SUNY Downstate Medical Center

Introduction: The successful and safe psychopharmacologic management of older adults suffering with major neurocognitive disorders with behavioral disturbances and has remained a challenging therapeutic dilemma − despite recently published guidelines on the topic. Available guidelines would suggest that individuals with severe agitation, violence, or distress related to their agitation or psychosis should receive pharmacotherapy in addition to behavioral and social management. Citalopram and other SSRIs have shown promise in treating agitation and psychosis in the context of major neurocognitive disorders, however treatment with antipsychotics for this indication has not appreciably declined on the national stage despite the increased risk of morbidity and mortality associated with these medications. While the literature has given much thought to the initial choice of medication for these patients, an important question remains as to whether there are patients whom might benefit from a transition to citalopram after an antipsychotic has already been initiated. Given the high potential for symptom recurrence when transitioning from an antipsychotic, methodology that would allow some measure of individualized response prediction would be of clinical value. Interestingly, low expression alleles of the SLC6A4 (serotonin transporter) gene have been linked to decreased response to citalopram in major neurocognitive disorders. Methods: Three cases from the ambulatory Center of Excellence for Alzheimer’s Disease at SUNY Downstate are presented in which patients suffering with major neurocognitive disorders and associated neuropsychiatric symptoms were transitioned from antipsychotic medications to citalopram. Case histories and scores on the neuropsychiatric inventory and CGI scales are presented for review. Pharmacogenetic testing results are presented for the final case in which transition to citalopram was not successful. Results: Two of three cases were successfully transitioned from antipsychotic medications to citalopram, resulting in near total remission of psychosis and agitation on the CGI Agitation and Psychosis scales. The third case offers a compelling explanation for the treatment failure − pharmacogenetic polymorphisms that impacted both the metabolism (CYP2D6 ultrarapid metabolizer, CYP2C19 intermediate metabolizer) of citalopram and its effectiveness (homozygous for the short promoter of the serotonin transporter gene - SLC6A4). Conclusions: This case series presents an important treatment approach for older adults with major neurocognitive disorders that have already been started on antipsychotics for their neuropsychiatric symptoms. Transitioning from an antipsychotic to citalopram was effective in two out of three cases, limiting their exposure to a class of medications with a higher risk profile. The third case, while unsuccessful, highlights the complexities of treatment choice and the importance of a personalized approach to medicine. Given previous reports that low expression alleles of the SLC6A4 gene may be linked to decreased response to citalopram, further controlled study evaluating the transition from antipsychotic medications to citalopram utilizing pharmacogenetic testing to personalize treatment could potentially improve treatment choice in this vulnerable population. This research was funded by: This study received no outside support.

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Poster Number: EI - 20 THE USE OF COGNITIVE AND ERP BIOMARKERS OF CHOLINERGIC FUNCTION IN NOVEL TESTS OF MUSCARINIC POSITIVE ALLOSTERIC MODULATORS Alexander Conley1; Alexandra Key1; P. Jeffrey Conn2; Craig Lindsley2; Carrie Jones2; Paul Newhouse1

1Vanderbilt University Medical Center 2Vanderbilt University

Introduction: The decline of cholinergic functioning is associated with increased cognitive decline and the development of Alzheimer’s disease (AD) pathology. At present, there is no pharmacological agent that slows the progression the disease. Muscarinic post positive allosteric modulators (PAMs) are a new class of compounds aiming to restore cholinergic functioning in patients suffering from AD pathology. PAMs of the M1 receptor can potentiate the response of the M1 receptor to acetylcholine, without inducing the harmful side-effects. This is due to the fact that PAMs do not bind at the target site, rather they boost the signal of acetylcholine when is engaged at the orthosteric receptor. The downside of using PAMs is that they have low affinity to radioactive ligands, so this reduces the utility of PET imaging. This creates a challenge in how to establish functional efficacy of the compound in both preclinical and clinical trials. Methods: To address this challenge, we plan on using cognitive tasks and electroencephalography (qEEG) to identify dose-depended changes in cholinergic functioning. These functional biomarkers allow us to develop more detailed models of how M1PAMs may influence downstream cognitive processing. The cognitive and EEG measures presented have been shown to modulate cholinergic tone, therefore we should be able to identify effective target engagement. Results: Cognitive tasks tested spatial and sustained attention, episodic and working memory, perceptual vigilance and psychomotor speed. Tasks recorded by EEG tested auditory and visual discrimination using oddball tasks, and incidental memory. Conclusions: These cognitive and electrophysiological results will assist in establishing functional targets for future studies using M1PAMs. This research was funded by: Funding for this research comes from an Alzheimer’s Association and the Alzheimer’s Drug Discovery Foundation.

Poster Number: EI - 21 CARDIOVASCULAR BURDEN AND COGNITION IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT AND MAJOR DEPRESSIVE DISORDER Wael Karameh1,2,3,4; Ines Kortebi5; Sanjeev Kumar1,2; Damien Gallagher5,6; Angela Golas1,2,4; Tom Schweizer3,5; David Munoz3,5; Joseph Barfett3,4; Meryl Butters7; Christopher R Bowie2,8; Alastair Flint1,9; Tarek Rajji1,2; Nathan Herrmann1,6; Bruce Pollock10; Benoit Mulsant1,2; Linda Mah1,11; Corinne Fischer1,4

1Department of Psychiatry, University of Toronto, Toronto, Canada 2Centre for Addiction and Mental Health, Toronto, Canada 3Keenan Research Centre for Biomedical Research, St. Michael’s Hospital, Toronto, Canada 4St. Michael’s Hospital, Toronto, Canada 5University of Toronto, Toronto, Canada 6Sunnybrook Health Sciences Centre, Toronto, Canada 7Department of Psychiatry, University of Pittsburgh School of Medicine, USA 8Queen’s University, Kingston, Canada 9Centre for Mental Health, University Health Network, Toronto, Canada 10Campbell Family Mental Health Research Institute, Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada 11Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, Canada

Introduction: Cardiovascular risk factors are associated with both cognitive impairment and depression. However, the extent to which these factors are associated with cognitive impairment in patients with mild neurocognitive disorder with and without a history of lifetime depression needs to be clariﬁed. Methods: We looked at the distribution of Framingham Risk Scores (FRS) for cardiovascular disease in three groups of participants age 60 years and older in the Prevention of Alzheimer’s Dementia with Cognitive Remediation plus Transcranial Direct Current Stimulation (PACt-MD) study: those with mild cognitive impairment (MCI; n = 42), remitted major

S132 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 depressive disorder (MDD, n =29), or MCI plus remitted MDD (n = 21). We also examined the association between cardiovascular risk factors and cognitive scores on the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MOCA), and the Montgomery−Asberg Depression Rating Scale (MADRS) using the non-parametric Spearman’s rank order correlation test. Results: There were no differences in the severity of FRS across the three diagnostic groups (p=0.281). Comparison of age, gender, education, and cognitive scores across FRS severity groups showed a significant correlation of increased FRS severity with higher age (p=0.016) and lower MOCA (p=0.023). When we assessed the correlation between specific cardiovascular risk factors (i.e hypertension, hypercholesterolemia, smoking, diabetes, hyperlipidemia) and MMSE, MOCA, and MADRS, the only significant correlation was found to be between a history of hypertension and lower MOCA scores (p=0.001). Conclusions: The similar FRS distribution across MDD and MCI provides further support for the association of cardiovascular burden with both MDD and cognitive impairment. Hypertension was the only cardiovascular risk factor that was correlated with cognitive impairment. Future research is needed to clarify the mechanism behind this association. This research was funded by: This Project has been made possible by Brain Canada through the Canada Brain Research Fund, with the financial support of Health Canada and the Chagnon Family.

Poster Number: EI - 22 CASES OF FRONTO TEMPORAL DEMENTIA PRESENTING WITH PSYCHOSIS Phani Mulakaluri1; Vijay Seshadri1

1Chetana Hospital

Introduction: Fronto Temporal Dementia presents in varied clinical situations, here we are presenting 2 cases that presented to Neurologist with Behavioural symptoms with No cognitive decline and symptoms suggestive of Psychosis. Both the cases were treated with neuroleptics and were considered to be Psychosis. MRI of the brain and Labs were normal. Only PET CT Scan of the brain showed probable Fronto Temporal Dementia. Methods: Report of case series Results: CASE 1 62 Year old female from middle socio economic status, Homemaker with Family history of psychiatric illness in brother was referred by the neurology team with behavioural manifestations, Initially presented with irrelevant talk, talking to self since last 2 years. She gradually started becoming withdrawn, but managed to be independent in her Activities of Daily Living till few months back.Since the last couple of months she was not interested to her house hold chores, confining herself to indoors, and reduced self care. Since couple of months predominantly silent, occasionally responds to what family says and at times does the opposite. No hallucinations and delusions. No history of clear cognitive decline except for occasionally misplacing things which was felt normal. On examination: she was able to walk, mute, active and passive negativism. Labs and MRI brain done were within normal limits. No other significant medical history was present. A Diagnosis of “Catatonia” was made, Trial of lorazepam was given with mild improvement in speech and communication, food intake was better, obeying simple commands better. In discussion with neurologist and a trial of ECT was considered. AS the improvement was marginal a PET CT Scan was done which was Suggestive of Fronto Temporal Dementia. CASE 2 A 60 year old lady, divorced in a couple of years after marriage, coping well worked as a teacher, Pre-morbidly stubborn and demanding, Family history of depressive disorder in first degree relative Behavioural changes noted at the age of 50 years manifested by being withdrawn, reduced involvement in regular activities, increased food consumption reduced self care, would pass urine stools at inappropriate places and be unmindful. Admitted at general hospital- diagnosed to have Hypertension, Diabeted Mellitus, Hypothyroidism and Irritable Bowel Syndrome. She occasionally

Am J Geriatr Psychiatry 27:3S, March 2019 S133 AAGP Annual Meeting 2019

mentioned people were talking about her but difﬁcult to elicit other psychotic Symptoms. She was shifted to old age home at Hyderabad where she had leg pains and diagnosed as RLS and responded to treatment. MRI of the brain was normal. During subsequent follow up with the Neurologist she was noted to be “depressed” and started on Escitalopram-unclear response. In the next few months the episodes of passing stools inappropriately came down, hyperphagia persisted and would occasionally report of apprehension that someone may harm her and could see some vague shadows. This prompted her to be started on Amsulpride but stopped in few days as developed EPS at about 200mg/day. Despite stopping medications she started having signiﬁcant increase in appetite, would start intruding into other peoples rooms and take whatever food items were there. She was subsequently told not to come into the common mess as she would consume large proportions of food from others plate as well. She was threatened to be thrown out of the old age home and they only agreed if she will be restricted to room. Being off all medications, noted to have occasional forgetfulness. Her “hyperphagia” continued and started developing involuntary Right upper limb choreo-athetotic movements. She also was noted to have repeated touching and rubbing of the face. A PET CT scan of the Brian was suggestive of Fronto Temporal Dementia. Conclusions: A diagnosis of Fronto temporal Dementia should be suspected in all cases presenting with late onset psychosis and mild cognitive disturbances. Implication of the the diagnosis and treatment will be discussed. This research was funded by: NIL

Poster Number: EI - 23 AN INTERDISCIPLINARY MODEL OF ASSESSMENT AND TREATMENT FOR MANAGING BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA ON AN INPATIENT PSYCHIATRY UNIT: AN ADAPTATION OF THE TIME MODEL. Israel Labao1; Tabatha Redlich2; Sara Feist2; Naheed Akhtar1,2; Rachel Molander1,2; Art Walaszek1,2; Eileen Ahearn1,2

1University of Wisconsin Department of Psychiatry, UW Hospital & Clinics, Madison, WI, United States 2William S. Middleton Memorial Veterans Hospital, Madison, WI, United States

Introduction: Patients are admitted to inpatient psychiatric units to help manage behavioral and psychological symptoms of dementia (BPSD). The estimated percentage of hospitalized inpatients with dementia is significant, ranging from 12.9 to 63.0% (Mukadam et al, 2011). As the population ages and the expected prevalence of dementia increases, inpatient psychiatric admissions for BPSD treatment will increase. Managing BPSD in the psychiatric setting can be challenging and requires an interdisciplinary approach. Currently there are no models of care for BPSD in the acute psychiatric setting. In this feasibility study, we adapted a model initially developed for BPSD treatment in a nursing home and tested it in our inpatient unit. We explored the model’s efficacy in reducing BPSD and the model’s acceptability and ease of implementation. Methods: We modified the Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME Model) (Lichtwarck et al, 2015, 2018) for use on our inpatient psychiatric unit at the William S. Middleton VA hospital. Outcome measures included the Montreal Cognitive Assessment (MOCA), Functional Assessment and Staging for Alzheimer’s Disease (FAST), Neuropsychiatric Inventory Questionnaire (NPI-Q), Cornell Scale for Depression in Dementia (CSDD), Pain Assessment in Advanced Dementia (PAINAD), and a Family Questionnaire regarding neuropsychiatric symptoms. Notable modifications included not utilizing the full Neuropsychiatric Inventory-NH due to staffing/time constraints, and limiting the duration of behavioral data collection to 3 days, both prior to and following the team meeting. TheessentialprocesswasthesameastheTIMEModel,with identification of behaviors or symptoms tracked by nursing, the collection of preliminary data regarding frequency, and a systematic approach to interpreting the patient’s behavior and formulating SMART goals as a team. In addition, an online staff satisfaction questionnaire was deployed to collect feedback from staff regarding the perceived value of the model. Primary outcome variables included a reduction in neuropsychiatric symptoms as measured by the NPI-Q and staff satisfaction with the model. Results: Currently, this protocol has been implemented on our inpatient psychiatry unit with data collection in process. An analysis of findings will be presented at the AAGP meeting. Conclusions: A systematic approach to appropriately manage behavioral and psychological symptoms of dementia (BPSD) on inpatient psychiatry is needed. We tested a modification of the TIME Model for use on an acute inpatient psychiatric unit. This research was funded by: The authors received no specific funding for this work.

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References: 1. Lichtwarck B, Selbaek G, Kirkevold O, Rokstad AMM, Benth JS, Lindstrom JC, Bergh S: “Targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms: A cluster randomized controlled trial. Am J Geriatric Psych 2018;26(1):25–38. 2. Lichtwarck B, Tvera AM, Roen I: Targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms. Ottestad, Norway: Age Psychiatric Research, Innlandet Hospital Trust, 2015. 3. Mukadam N, Sampson EL: “A systematic review of the prevalence, associations, and outcomes of dementia in older general hospital inpatients”. Int Psychogeriatr 2011; 23:344–355.

Poster Number: EI - 24 MANAGEMENT STRATEGIES TO PREVENT STROKE IN ELDERLY WITH MAJOR NEUROCOGNITIVE DISORDER AND PSYCHOSIS TREATED WITH ANTIPSYCHOTIC MEDICATION Tatyana Zharkova1,2; Helen Kyomen1,3,4,5

1St. Elizabeth Medical Center 2The Tufts University School of Medicine 3Boston University School of Medicine 4McLean Hospital 5Harvard Medical School

Introduction: Despite improvements in the diagnosis and treatment of cardiovascular disease in the elderly population, it remains the largest single cause of disability and the second leading cause of death in the world. Effectively preventing cardiovascular disease may be the best approach for reducing the burden of stroke in elderly patients. Geriatric psychiatrists often face the challenge of managing patients with major neurocognitive disorders (MNCDs) presenting with behavior disturbances and requiring psychopharmacological intervention. In those elderly patients with MNCD and psychosis who are treated with antipsychotic medication (AP), there is concern that cardiovascular adverse event (CVAE) risks are likely to be compounded. Stroke is a life-changing event that affects not only stroke patients themselves but their family members, caregivers, and the health care system. Relatively little is known about CVAE prevention in elderly patients with MNCD, as this group has often been excluded from interventional studies. Clinicians need to be cautious when extrapolating the results of clinical trials in patients without MNCD. The aim of this review is to summarize the current scientific knowledge about stroke prevention in elderly patients with MNCD with behavioral disturbances who are on antipsychotics. Management strategies for reducing stroke risk in patients with MNCD and psychosis when antipsychotic medications are necessary, were proposed based on patients evaluated on a geriatric psychiatry unit. Methods: Systematic literature review, case series. Results: Based on our literature review and case series, the following daily practice strategies for the primary prevention of stroke in elderly with major neurocognitive disorder and psychosis who are taking antipsychotic medication include the following: Appropriate Health Education It is essential to educate elderly patients who are at risk of stroke, and their caregivers, to implement a heart-healthy diet and lifestyle with attention to a holistic approach to health care and stress management. Identifying and Implementing Appropriate Alternatives to the Use of AP Medication Determining alternatives to APs for treating psychosis in patients with MNCD start with careful evaluation and providing interventions for co-occurring physical, medical, psychiatric or psychosocial conditions that may trigger the behavioral disturbance. This is of tantamount importance and requires astute, persevering assessment of the patient and the system in which the patient resides and operates. A number of nonpharmacological interventions can be used to manage many of the non- cognitive signs and symptoms of MNCD, and these strategies should be attempted as first-line approaches. Other options include the use of other psychotropic drugs. No antipsychotics are approved in the United States for psychosis associated with dementia, although these drugs are commonly used in patients with MNCD and psychosis. Prioritizing Indications for the Use of AP Medication Patients with severe psychosis and agitation may be prioritized for treatment with APs if immediate patient or patient community safety is a concern and if the benefits from such treatment exceed the associated risks. Recent longitudinal research findings suggest that psychosis and agitation can lead to increased rates of mortality beyond that introduced by the APs themselves. Weighing the risks vs. benefits of treatment with APs can help guide whether this medication may be used to enhance well-being. A palliative approach, rather than a curative stance to treatment may be helpful when evaluating treatment for the purposes of wellbeing in many patients with MNCD, stroke and psychosis.

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Managing the Neurologic and Cardiovascular Stroke Risks Associated with AP Medication Use The following suggestions may provide some guidance in managing the neurologic and cardiovascular stroke risks associated with APs. 1. Start with low doses of APs and increase the dose gradually. Continue to monitor the patient’s progress over time andconsider stopping some medications if the situation has changed. 2. Monitor the body mass index (BMI). 3. Monitor the glucose level to keep the HA1c level below 7.0 4. Maintain blood pressure at or below 140/90 without inducing hypotension. 5. Consider using low doses of aspirin as an antiplatelet treatment. 6. Provide anticoagulation treatment for those with atrial fibrillation. 7. Consider using statins, at high doses if appropriate, to keep the LDL level below 70 8. Provide smoke cessation assistance for those who smoke cigarettes. Encourage influenza vaccination as epidemiological and clinical trial evidence provides support that this can reduce the risk of vascular events, including stroke Managing AP Medication Related Metabolic Syndrome Which Can Increase Stroke Risk Monitoring BMI, blood glucose levels/HA1c and lipid levels on a regular basis and making lifestyle changes such as encouraging weight loss and engaging in modest exercise can be helpful. Conclusions: The CVAE risks of elderly with MNCD and psychosis who need AP is significant. This review illustrates how such risks may be managed through promoting a heart healthy diet and life style changes, identifying and implementing appropriate alternatives APs, prioritizing indications for the use of APs, managing the neurologic and cardiovascular stroke risks associated with APs, and managing AP medication related metabolic syndrome which can increase stroke risk. This research was funded by: none

Poster Number: EI - 25 SUCCESSFUL USE OF ELECTROCONVULSIVE THERAPY FOR THE TREATMENT OF NEUROPSYCHIATRIC MANIFESTATIONS OF DEMENTIA WITH LEWY BODIES A. Umair Janjua; Amitha Dhingra; Elise Abken; Adriana Hermida

Emory University School of Medicine

Introduction: Dementia with Lewy bodies (DLB) is one of the most common neurodegenerative disorders. DLB is characterized by progressive cognitive decline, executive dysfunction, visual hallucinations, fluctuating cognition, and Parkinsonism. Up to 65% of patients with Lewy Body Dementia have depression. Psychiatrists frequently treat individuals with DLB given prominent neuropsychiatric manifestations, including depression, hallucinations, delusions, agitation, and fluctuating cognition. Individuals with DLB require a comprehensive but specific treatment approach given sensitivity to both antipsychotic medications and anticholinergic side effects of other medications. Electroconvulsive therapy (ECT) is often omitted from the treatment model for DLB because of limited evidence. We highlight the use of electroconvulsive therapy (ECT) in a case of DLB. Methods: We provide a case report and literature review on the use of ECT for the treatment of DLB. A 67-year-old male veteran with depression, 10-year history of REM sleep behavior disorder, bradykinesia, three-year history of cognitive impairment, and visual hallucinations was admitted for depressed mood and disturbing visual hallucinations featuring a saw blade swinging around his head and somatic delusion of a water hose traversing his body. At night he moved to avoid being hit by the blade. His wife reported word-finding difficulty, memory problems, and having to manage their finances. Four years prior to presentation, he stopped working as a pastor due to inability to write sermons. On admission, his MOCA was 19/30 and QIDS was 22. Medication trials including paroxetine, sertraline, escitalopram, vilazodone, bupropion, mirtazapine, venlafaxine, quetiapine, aripiprazole, alprazolam, buspirone, and lorazepam failed to address his depression and hallucinations. Results: Brain MRI was unremarkable, with mild microvascular ischemic changes in periventricular white matter. Iodine-123 dopamine transporter SPECT (DAT-scan) imaging showed abnormal uptake consistent with a Parkinsonian syndrome (supporting the diagnosis of DLB). Considering past medication failures, patient consented for an acute course of ECT. He received eight right unilateral (RUL) ultra-brief pulse treatments utilizing Mecta Spectrum over the course of three weeks without any major side effects. For muscle relaxation he received succinylcholine; methohexital and remifentanil were given for anesthesia. Over his acute course of treatment, charge was progressively increased from six, to eight, to ten times the seizure threshold. At the end of his acute course of eight ECT treatments, his MOCA improved from 19/30 to 23/30 and QIDS improved from 22 to 12. Following the course of ECT, his visual hallucinations disappeared, and he was more interactive, engaged, and less depressed. The patient’s improvement is congruent with other case reports in the literature showing clinical

S136 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 improvement following ECT for symptoms related to DLB. A table with a literature review describing the use of ECT for DLB will be presented. Conclusions: DLB presents frequently to psychiatrists secondary to prominent psychiatric manifestations of the illness such as mood and behavioral disturbances. The treatment of psychiatric symptoms in DLB is often challenging due to the sensitivity of antidopaminergic medications on motor symptoms. ECT is a feasible alternative to treat neuropsychiatric manifestations of DLB; however, infrequently considered due to fear of complications and stigma. Modiﬁcations to the treatment such us holding dopamine agonists the morning of ECT to avoid delirium, decreasing the frequency of ECT to twice per week to minimize cognitive effects, and close monitoring of the patient’s cognitive function are measures that can be implemented to optimize ECT in this population. No double-blinded randomized control trials exist in this area; comparing standard treatment to ECT would help further delineate the role of ECT in treating patients with DLB. This research was funded by: None.

Poster Number: EI - 26 A CASE OF BIGEMINY AND SUCCESSFUL COMPLETION OF ACUTE ELECTROCONVULSIVE THERAPY COURSE A. Umair Janjua1; Mamoona Mohsin2; Elizabeth McCord1; Adriana Hermida1

1Emory University School of Medicine 2Charleston Area Medical Center/West Virginia University School of Medicine

Introduction: Electroconvulsive therapy (ECT) remains stigmatized in the broader medical community due to misunderstandings about treatment procedures, mortality rates, and cardiovascular complications. Several concerns have risen regarding the safety of ECT on the cardiovascular system. ECT causes periprocedural hemodynamic variability due to the surges in parasympathetic and sympathetic nervous systems following the administration of the electric current.1 Patients experience an increase in cardiac workload and oxygen demand, which is potentially dangerous for patients with preexisting heart disease. Several ﬁndings suggest the incidence of cardiac complications is relatively rare and occurs most frequently in patients with underlying cardiovascular disease. Methods: We describe a case report of a 53 year old female with history of bipolar I disorder current episode depressed, hyperlipidemia undergoing ECT who developed cardiovascular complications after her seventh brief pulse right unilateral (BRUL) treatment. Electrocardiogram (EKG) monitoring revealed bigeminy for two to three minutes (heart rate in 80s) during post-anesthesia care. Results: The cardiovascular system undergoes various changes during ECT including events secondary to the parasympathetic release such as asystole, hypotension, bradycardia, and events secondary to sympathetic release such as hypertension and tachycardia. Other complications include arrhythmias, ST elevation, and Takotsubo Cardiomyopathy. The patient was seen by cardiology for further work-up. EKG, 2-D cardiac echocardiogram, 48-hour Holter monitoring, and coronary CT calcium scan were performed. She was found to have rare premature atrial contractions (PACs) (8 in 48 hours). Her bigeminy resolved spontaneously. The patient was able to complete the acute course of BRUL ECT and continued onto maintenance ECT with good effect. We also present a table with the common cardiovascular side effects from ECT and the most recent evidence-based treatment strategies to manage them. Conclusions: Generally, ECT is a safe procedure; complications are minor and manageable. Most major complications caused by ECT are related to the cardiovascular system; however, with an appropriate pre-ECT evaluation and a comprehensive multidisciplinary-team approach the cardiovascular complications can be well managed and minimized. Our case highlights the beneﬁts of a multidisciplinary care model between psychiatry, anesthesia, and cardiology. Providing proper cardiac clearance can prevent cardiac complications and provide timely care to treatment-resistant populations who are at risk for excessive morbidity and suicide. This research was funded by: None.

Poster Number: EI - 27 IN VIVO STAFF EDUCATION TO USE AN OBJECTIVE MEDICATION GUIDELINE IN THE MANAGEMENT OF BPSD BY THE CONSULTING PSYCHIATRIST IN THE LONG TERM SETTING TO REDUCE UNNECESSARY ANTIPSYCHOTIC MEDICATIONS. Sahil Gehlot; Ravindra Amin

Coler Rehabilitation and Nursing Care Center

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Introduction: Antipsychotics have had a history of being prescribed at a high rate in nursing homes(NH). 30% of all newly- admitted NH residents received antipsychotic medications in 2006. In 2012, Centers for Medicare & Medicaid Services (CMS) launched the Partnership to Improve Dementia Care in Nursing Homes to promote comprehensive dementia care and therapeutic interventions for NH residents with dementia-related behaviors in partnership with various national organizations. The appropriate use of the medication is still an uneven practice and clinicians often are unclear when to start, continue or stop the medication. We endeavor to present the outcomes following the implementation of the guidelines at our facility. Methods: In an 800 bed facility, the psychiatrists implemented a user-friendly objective medication guideline in the management of BPSD, while concurrently providing staff education to the frontline staff beginning 2011.The elements of the guideline include - a) non-medication interventions, b) when to start, continuation and discontinuation criteria. We reviewed changes in antipsychotic medication rate over the past 7 years at the facility while comparing the commensurate national data available in CMS archives from quarter 1 of 2011 (2011Q1) to quarter 1 of 2018 (2018Q1). Results: Point prevalence of antipsychotics at the facility in Q1 of each year were 38%(2011), 25%(2012), 12.9%(2013), 13.6% (2014), 14.1%(2015), 14.55%(2016), 11.67%(2017) and 9.14%(2018). The national point prevalence during the same duration were 23.6%(2011), 23.8%(2012), 21.64%(2013), 19.79%(2014), 18.68%(2015), 16.6%(2016), 15.7%(2017) and 14.8%(2018). The point prevalence for the facility went down from 38% in Q1 of 2011 to 9.14% in Q1 of 2018, a decrease of 76%. The national point prevalence during the same duration of 7 years decreased from 23.6% to 14.8%, a decline of 37%. The prevalence for the facility has registered a faster decline than the national average (76% vs 37%). The prevalence of antipsychotics was higher for the facility in 2011 (38% vs 23.6%) and 2012 (25% vs 23.8%) compared to the national average. We are collecting data for the rate of use of psychotropics other than antipsychotics in the management of BPSD at the facility. Conclusions: Psychiatry can play a signiﬁcant role in implementing appropriate medication use guidelines while providing in- vivo education to the primary care team. The guidelines help provide an objective standardized manner of right-sizing the dose or appropriate usage of the medication. It helps involve all stakeholders, including, the psychiatrist, primary care provider, nursing and family, in providing adequate care to the NH residents. Using an objective behavior assessment tool (Neuropsychiatric Inventory Questionnaire - NPI) may further improve medication prescribing practices. The pattern of prescription of other classes of psychotropics will also help rationalize appropriate behavioral management. This research was funded by: None.

Long term Antipsychotic Use 2011Q1 2012Q1 2013Q1 2014Q1 2015Q1 2016Q1 2017Q1 2018Q1 National prevalence 23.6% 23.8% 21.64% 19.79% 18.68% 16.6% 15.7% 14.8% Coler prevalence 38% 25% 12.9% 13.6% 14.1% 14.55% 11.67% 9.14%

Poster Number: EI - 28 AFFECTIVE DISTURBANCE IN MILD COGNITIVE IMPAIRMENT Jason Greenhagen; Emily Matusz; Sheina Emrani; David Libon; Sherry Pomerantz

Departments of Geriatrics, Gerontology, and Psychology, New Jersey Institute for Successful Aging, Rowan University-School of Osteopathic Medicine, Stratford, NJ, USA

Introduction: Mild cognitive impairment (MCI) is an identifiable, prodromal stage of cognitive impairment. To better identify the differences in patients with MCI, the diagnosis has been further defined into subtypes: amnestic, language, executive functioning, and multi-domain/mixed MCI (Jak et al. 2009). Determining these subtypes can be helpful in predicting the trajectory and prognosis of a patient’s disease. Affective disturbance can be present in a number of different types of dementia and MCI and carries significant stress to both the patient and caregivers. The most common mood changes occur as depression, anxiety, apathy, and irritability (Hwang et al., 2004, Rozzini et al., 2008, Lulio et al., 2010). The appearance of these symptoms has been found in up to 50% of patients with dementia prior to the onset of neurocognitive symptoms and has been related to a more rapid neurocognitive decline (Trivedi et al., 2013, Gallagher et al. 2017). Consequently, there has been an increased interest in identifying both neurocognitive and neuropsychiatric symptoms as early as possible for quicker intervention.

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Previous papers have looked at affective disturbance in an individual subtype of MCI but not the differences between subtypes. The purpose of this study is to (1) examine the differences in depression, anxiety, and apathy between MCI subtypes; and (2) assess the relationship between the neurocognitive domains (executive functioning, language, and episodic memory) and affective symptoms. We hypothesize that apathy will be greater in dysexecutive/mixed MCI (dys/mixed MCI) and related to greater neurocognitive deﬁcits compared to depression or anxiety. Methods: This is a retrospective study of 111 patients from the New Jersey Institute for Successful Aging Memory Assessment Program (MAP) who were administered a comprehensive neuropsychological protocol assessing executive functioning, language, and episodic memory. All tests were administered by an experienced neuropsychologist. Patients meeting criteria for dementia were excluded. Affective symptoms of depression, anxiety, and apathy were assessed by caregiver report using the Neuropsychiatric Inventory (NPI). Differences in age, gender, and instrumental activities of daily living were also recorded. Using Jak, Bondi (2009) criteria neuropsychological test performance categorized patients as presenting with non-MCI (patients that do not meet MCI criteria), amnestic MCI (aMCI), or a combined dys/mixed MCI. Patients were assigned to the aMCI group if memory test scores were more than one standard deviation below the normative values in 2 of 3 episodic memory parameters. Patients were assigned to the dys/mixed MCI group if the test scores were more than one standard deviation below the normed mean in 2 of 3 tests across multiple neurocognitive domains. Patients with dysexecutive and mixed MCI were combined due to the small number of patients meeting criteria for dysexecutive MCI. Prior research has shown that dysexecutive MCI and mixed MCI patients present with similar patterns of impairment on executive tests (Bondi et al., 2014, Thomas et al., 2017, & Eppig et al., 2012). Results: The three MCI groups will be compared on symptoms of depression, anxiety, and apathy as measured by the NPI, using analysis of co-variance. A second analysis will look at the three tests that comprise each of the three cognitive domains as they are related to anxiety, depression, and apathy using a step-wise multiple regression. Conclusions: We hypothesize that apathy will be greater in dysexecutive/mixed MCI (dys/mixed MCI) and related to greater neurocognitive deﬁcits compared to depression or anxiety. The results and conclusion will be completed soon for the poster as well as submission for publication. This research was funded by: All resources were supplied by the Departments of Geriatrics, Gerontology, and Psychology, New Jersey Institute for Successful Aging, Rowan University-School of Osteopathic Medicine, Stratford, NJ, USA.

Poster Number: EI - 29 UNDERSTANDING THE CHALLENGES, NEEDS, AND QUALITIES OF FRONTOTEMPORAL DEMENTIA FAMILY CAREGIVERS Dusitn Nowaskie1; Mary Austrom1; Darby Morhardt2

1Indiana University School of Medicine 2Northwestern University Feinberg School of Medicine

Introduction: Caregivers of persons with frontotemporal disorders (FTD) have unique challenges and needs. They show higher levels of stress, depression, and burden than those caring for persons with Alzheimer’s disease. The clinical profiles and pathologies associated with FTD are heterogeneous and characterized by two main phenotypes: a progressive deterioration in behavior, emotion, and interpersonal conduct known as behavioral variant FTD (bvFTD) and a decline in language skills known as primary progressive aphasia (PPA). While there is abundant literature regarding the experience of caregiving for persons with AD, there are very few studies examining the experience of caring for persons with FTD and none that have compared behavior and language variant caregivers. Methods: Caregivers of persons with bvFTD (Indiana University) and PPA (Northwestern University) were invited to participate in in-depth individual interviews to understand the nature of living with FTD from early symptoms to diagnosis and caregiving over time. 9 caregivers (5 bvFTD and 4 PPA) were interviewed. Interviews were recorded and transcribed. Transcripts underwent content analysis for emerging themes within the same profile and then discussed among authors for similarities and differences between profiles. Results: Analysis revealed the following resulting themes: 1) Obtaining an accurate diagnosis was a difficult and lengthy process; 2) Finding lack of available information and misunderstanding the diagnosis; 3) Adapting to changing roles; 3) Experiencing significant financial and legal challenges; 4) Grieving losses, particularly developmentally non-normative losses due to younger age of onset; 5) Finding lack of disease specific services and knowledgeable providers; and 6) Receiving support in disease specific programs. Within these common general themes, there were differences in how disease presentations impacted functioning and challenged relationships. Conclusions: Caregivers of persons with FTD experience distinctive challenges that involve psychosocial, financial, and legal aspects of their lives. Likewise, their needs include finding accurate and specific information as well as competent providers. Perseverance and adaptability are two key qualities involved in caring for persons with FTD, yet caregiver burden remains high.

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The ﬁndings from these interviews illuminate the need for greater attention and support for FTD caregivers by knowledgeable care providers. This research was funded by: Not applicable.

Poster Number: EI - 30 ASSOCIATION BETWEEN WHITE MATTER HYPERINTENSITIES, FRONTAL BRAIN VOLUMES AND NEUROTICISM IN LATE LIFE DEPRESSION Chinaka Joseph; Lihong Wang; Kevin Manning; Rong Wu; David Steffens

University of Connecticut School of Medicine

Introduction: The neurobiology of neuroticism in late life depression (LLD) is understudied. Previous structural imaging research has linked both smaller hippocampal volumes and greater volume of vascular white matter changes to LLD. We hypothesized older depressed subjects scoring high in measures of neuroticism would have smaller hippocampal volumes compared with non-neurotic older depressed subjects and with non-depressed controls. Methods: Non-demented subjects were recruited and were either depressed with high neuroticism, depressed with low neuroticism or not depressed (control). Neuroticism was assessed using the NEO PI. A study psychiatrist confirmed or ruled out diagnosis of depression for depressed and control subjects. Brain MRIs were performed. Results: The study sample consisted of 128 older depressed subjects and 36 never depressed controls. Subjects had a mean age of 72 and were 70% female. 50% of depressed subjects scored high on the NEO-PI neuroticism measure. For outcomes focusing on white matter changes, we found that non-neurotic depressed subjects had a higher volume of white matter vascular change than did neurotic depressed subjects and non-depressed controls. For imaging outcomes focused on volumetric analyses, we several frontal lobe regions for which depressed subjects with high neuroticism scores had smaller volumes compared with non-neurotic older depressed subjects and with non-depressed controls, controlling for age and gender. These regions included frontal pole, medial orbitofrontal cortex and left pars orbitalis. We did not find significant between-group differences in hippocampal volume. Conclusions: In late-life depression hippocampal volume was not associated with depression or neuroticism. Our finding that those depressed subjects low in neuroticism had higher white matter vascular change volumes is consistent with prior literature on “vascular depression.” However, our finding that those high in neuroticism had similar white matter vascular change to controls implies that there may be a different neurobiological mechanism in older neurotic depressed group. This notion is supported by our finding that several frontal lobe structures were smaller in patients who scored high in measures of neuroticism than in non-neurodepressed subjects and in non-depressed controls. Our results suggest that multiple biological pathologies that can lead to different clinical expressions of LLD. This research was funded by: The Leo and Anne Albert Charitable Trust National Institute of Mental Health Grant R01 MH108578

Poster Number: EI - 31 EXERCISE AS AN AUGMENTATION TO PHARMACOTHERAPY FOR DEPRESSION IN OLDER AND YOUNGER ADULTS: A FEASIBILITY TRIAL EXPLORING BIOLOGICAL MECHANISMS Swathi Gujral1,2; Howard Aizenstein2; Meryl Butters2; Charles F. Reynolds III2; George Grove2; Jordan Karp2; Kirk Erickson2

1VA Pittsburgh Healthcare System Mental Illness Research and Education Clinical Center 2University of Pittsburgh

Introduction: Exercise interventions for depression that also examine biological mechanisms are rare and none have included both younger and older adults with Major Depression. Our pilot intervention study tested the feasibility of conducting a physical exercise intervention as augmentation to pharmacotherapy for depression in younger and older adults while also exploring possible neural mechanisms underlying the antidepressant effects of exercise. Methods: Fifteen sedentary younger (20-39 years) and older adults (60-79 years) meeting criteria for a Major Depressive Episode were randomized to receive a 12-week medication regimen of venlafaxine XR or venlafaxine XR plus physical exercise.

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The exercise intervention involved supervised moderate-intensity aerobic exercise sessions three times per week for 12 weeks. The primary aim was to develop the infrastructure for conducting an exercise intervention in adults with Major Depression while also collecting brain imaging measures to better understand mechanisms. The Montgomery Asberg Depression Rating Scale (MADRS) was used to assess change in depressive symptoms, the VO2submaximal test was used to assess change in cardiorespiratory fitness, and 7T structural MR imaging was used to assess change in regional brain morphology (i.e., cortical thickness) relevant to depression. Data analysis was conducted using repeated measures ANOVA and paired-samples and independent samples t-tests. Results: Our results demonstrated feasibility of conducting a physical exercise intervention combined with pharmacotherapy trial in depressed younger and older adults. Ten younger adults and five older adults were randomized to receive treatment and 11 participants completed the study. There was 0% attrition and a 91% attendance rate (i.e., 33/36 sessions) among participants engaged in the exercise intervention. Although efficacy of the intervention was unable to be tested, trends suggested that the addition of physical exercise to medication treatment for depression may lead to rapid and stable decline in depressive symptoms and exercise-related improvements in cardiorespiratory fitness may be linked to an increase in cortical thickness in regions sensitive to depression (i.e., orbitofrontal cortex, anterior cingulate cortex, parahippocampal gyrus). Further, sensitivity analyses suggested that treatment-related increases in cortical thickness in the right medial orbitofrontal cortex and right rostral anterior cingulate cortex were associated with improved performance on measures of verbal learning and memory (p< 0.05). Conclusions: This pilot clinical trial involving physical exercise as an augmentation to antidepressant medication treatment enabled this interdisciplinary research team to develop the infrastructure for conducting an exercise intervention for depression in late-life and early adulthood while also examining biological mechanisms. Recruitment challenges were overcome, and intervention adherence was exceptional. Trending associations between exercise-related improvements in fitness and changes in cortical thickness are promising avenues for future large-scale studies to explore. This research was funded by: This project was supported by the Advanced Center for Intervention and Services Research (ACISR). PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000336/AAGP2019-000336_Fig1.pdf PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000336/AAGP2019-000336_Fig2.pdf

Medication Only Medication +Exercise Variable Older (N=3) Younger (N=5) Older (N=2) Younger (N=5) Age 62.33 33.60 67.50 28.60 Sex (% Female) 100 60 50 60 Education 15.33 14.40 16.00 16.40 Race (%White) 100 80 50 60 MADRS Baseline 22.33 (3.51) 24.50 (5.20) 24.50 (0.71) 24.50 (6.46) Duration MDE (weeks) Baseline 208.44 (269.91) 55.8 (47.0) 27.50 (34.64) 28.2(29.3) Age at st MDE 53.00 (8.89) 24.00 (4.63) 41.5 (16.26) 17.20(8.34) % Antidepressant Use Baseline 33 20 0 0 BMI Baseline 30.35 (1.70) 32.04 (3.61) 26.62 (4.19) 28.34 (7.40) Est. VO2 Max Baseline 27.73 (8.13) 26.73 (3.47) 26.12 (6.78) 30.40(6.62)

Poster Number: EI - 32 EXPERIENCES OF END-OF-LIFE CARE BY NON-WESTERN PATIENTS: A THEMATIC ANALYSIS. Adam Herbstsomer; Sarah Stahl; Howard Aizenstein

University of Pittsburgh

Introduction: The use of end-of-life services, including palliative care and hospice, is increasing worldwide. However, ethnic minority groups utilize end-of-life services at a lower rate than majority groups despite having greater morbidity and mortality associated with both malignant and non-malignant terminal conditions. Additionally, the quality of patient experience has been demonstrated to be lower among ethnic minority groups. While the field of palliative care has recognized the importance of a cross-cultural approach, the specifics regarding how this could be implemented are ill-defined. One major barrier is that no one provider can be familiar with the many cultural groups that they may encounter in clinical practice. The purpose of this study is

Am J Geriatr Psychiatry 27:3S, March 2019 S141 AAGP Annual Meeting 2019 to summarize the evidence on the individual patient and family experiences of end-of-life services among non-Western cultures through a thematic analysis of the published literature. Methods: The PubMed database was searched for qualitative studies on patient and family member experiences of end-of-life services among non-Western cultural groups. The outcome − end-of-life services − was defined as palliative care, hospice, or management by primary care medicine at the end of life. Results: Of 392 abstracts identified in the initial search, the full-texts of 55 relevant articles were reviewed. The final yield amounted to 20 articles that met eligibility criteria. These 20 articles collectively represent the experiences of over 300 patients and family members. Multiple themes were identified. Themes include the role of language (including the use of professional interpreters, end-of-life vocabulary, use of family members for interpretation), the flow of information (use of alternative sources of medical information such as the internet, cultural healers, withholding of information by family members, and desire to know prognostic information), and the role of religion (religious interpretations of causation of illness, facing illness as a test of faith, fear of discussing religious beliefs with Western providers). Conclusions: This review demonstrates the accumulating evidence supporting the importance of a cross-cultural approach to end-of-life care. Results indicate the benefits of including interpreters in medical communications, asking about patients’ religious beliefs, and providing medical information in a way that is individualized to the patient and family to improve the ethnic minority experience of Western end-of-life care. This research was funded by: This work is supported by the Clinical and Translational Research Training in Late-Life Mood Disorders NIMH T32 (MH019986, PI: Aizenstein).

Poster Number: EI - 33 STORIES FROM MY YOUTH: THEATER BASED ON LIFE HISTORIES OF LGBTQ OLDER ADULTS WHO LIVED IN SAN FRANCISCO AND THE BAY AREA DURING THE AIDS EPIDEMIC Stefana Morgan; Albert Rubio III

UCSF

Introduction: LGBTQA older adults who lived in San Francisco during the 1980s and 1990s are uniquely affected by AIDS- related losses and traumas. Many of these adults feel isolated from the youth-centered San Francisco LGBTQA community and think their struggles are forgotten in the age of PreP. Indeed, many younger LGBTQA individuals may not understand the experiences of these elders, perpetuating the divide between the two generations. Theater and other storytelling art forms may be one way to bridge the divide, collect the stories of LGBTQA elders and help educate younger generations about HIV and AIDS. There is a long rich history of using life histories in geriatric psychiatry and palliative care to improve wellbeing of older adults. While collecting these stories for posterity is in itself worthwhile, turning these stories into art has the potential to connect generations, promote HIV prevention among younger individuals and help older LGBTQA adults reﬂect on and process their experiences and feel more connected to the larger LGBTQA community. Methods: Albert Rubio, MFA is San Francisco based actor, playwright and director who spent a year collecting the stories of one gay man who was a nurse during the AIDS Epidemic in San Francisco and other parts of California. This project gave rise to a solo piece of theater entitled: Stories From My Youth, which has served as an inspiration of our project. Our goal is to use mixed methods, including autoethnography and theater psychology theory to better understand the process of creating theater, being a subject of theater and experiencing theater, along with its potential to heal and prevent. First, we used qualitative methods to analyze the impact of Stories From My Youth and the product of this analysis is the focus of this presentation. Next, we used the themes distilled during the qualitative work to design the semi-structured questions for the next step. The second step of the project involves collecting stories from a diverse group of long-term AIDS survivors and other LGBTQA individuals who lived during the AIDS crisis in San Francisco using qualitative methods informed by medical anthropology. We will use semi-structured interviews led by the artist which will be audio- and video-recorded. Next, we will use these stories to create an anthology of 10 short plays using theater psychology approaches to showcase the experiences in a way that is compelling for younger and older audiences. Telling the stories from the perspective of the participants when they were young, may be one such approach. Additionally, we will use autoethnographic approaches to understand the artistic process. Older adults will also provide quantitative data in screening and exit interviews with the research staff, as well as reﬂect on the process of providing their life history. We will characterize the mental health and social networks of older adults and their interactions with younger adults. At the end of the project, we hope to have performances of the plays in front of diverse age audiences and conduct focus groups and quantitative measures. We hypothesize that the process of reminiscing about their life histories and knowing that they will be written down as legacy and used to create theater may be transformative and/or healing for LGBTQ older adults. It is possible that knowing that their stories will

S142 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 be performed in front of a large mixed age audience will bring relief that the lessons of the AIDS epidemic will not be forgotten. Additionally, we are interested in the power of theater to change attitudes towards HIV in younger adults. We plan to measure the impact of the performance on younger adults, speciﬁcally their health behaviors and practices that expose them to HIV. Results: We used qualitative methods to analyze Stories From My Youth, and identify the most meaningful and impactful aspects of the stories. Two coders read the screenplay and saw the performance twice in person. We used Interpretative phenomenological analysis (IPA) to gain insights into how an individual who has lived during the AIDS crisis in the San Francisco Bay Area makes sense of their experiences as they look back on them. The coders reached consensus on nine themes that emerged during the analysis. These themes include: 1) First queer experience in SF, 2) First love, 3) First friend diagnosed with HIV or AIDS, 4) First loss from AIDS, 5) Critical memory from the AIDS epidemic, 6) Perspective on the similarities and differences between the culture during the 80’s and 90’s and today’s culture, 7) Reaction to diagnosis then and now, 8) Effect of HIV diagnosis on social relationships and social network, 9) Reaction to the advance of Highly Active Anti-Retroviral Therapy (HAART). We then used these themes to design the semi-structured interview questions for the larger project. Conclusions: The process of creating theater from the experience on one older gay man who lived through the AIDS crisis allowed the subject to discuss and reﬂect on many meaningful and traumatic parts of his life. This process is akin to the life history approach in palliative care and reminiscence therapy. Storytelling and theater have the potential to help older LGBTQA adults process and heal from traumas accumulated during their experiences during the AIDS crisis. This research was funded by: None

Poster Number: EI - 34 FAMILY MATTERS: CULTURAL PROFICIENCY IN THE PRESENT DAY Boski R. Patel; Marleni Fabiola Milla; Sarah A. Nguyen

University of Connecticut

Introduction: The United States is projected to have over 78 million people over the age of 65 by the year 2035, with an increasing rise in culturally, ethnically, and racially diverse population largely driven by international immigration. An important aspect of assessment and treatment in geriatric psychiatry is the ability to include family members into evaluations and treatment plans. Cultural sensitivity about beliefs, traditions, and perceptions on aging and mental illness play an important role in understanding and treating psychiatric disorders and increases the probability of a therapeutic relationship by enhancing trust and improving communication between clinicians and patients. Although there is mention of “family” and “sociocultural” in all six ACGME core competencies, these are not explicitly expanded upon. With the changing demographics in the US in the years to come, it is imperative to recognize and incorporate more elements of family and culture into training. Methods: Demonstrate, through a series of case vignettes, the impact of addressing cultural expectations and context with family members and patients to improve clinical outcomes. Personal factors of race and ethnicity, along with cultural biases, will be identified to show how these factors influence the therapeutic alliance and interventions. Results: These vignettes illustrate how establishing a sense of cultural safety allowed both the families and patients to collaborate more openly with the treatment team to provide effective therapeutic outcomes for culturally diverse older adults. Recognition and understanding of how culture influences family dynamics, beliefs, and support systems allowed trainees to more comprehensively understand the cultural formulation and guide treatments that were more culturally sensitive and pertinent to various psychiatric disorders. Conclusions: In depth training during psychiatry residency regarding family and culture are often lacking, especially since the ACGME requirements for training related to diversity and culture are broad and not explicitly stated. By recognizing the important role that families and culture play in the treatment of older adults, residents can more easily address sensitive issues that affect treatment outcomes. As such, training programs should have more detailed didactics and curriculum to help residents feel more comfortable sitting with and including families, as well as understanding and acknowledging how culture influences the care of diverse older adults.

Poster Number: EI - 35 CULTURALLY DRIVEN MENTAL HEALTH CARE IN HMONG AND CAMBODIAN REFUGEE POPULATIONS Melanie Scharrer1; Fred Coleman2

1UW Health, WisPIC 2Madison Counseling Service

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Introduction: In the wake of the Vietnam war and Cambodian genocide, approximately 5,000 Hmong and 3,000 Cambodians have settled in the Madison area. A high percentage of these individuals live with severe health problems, such as depression, posttraumatic stress disorder, and chronic pain that were caused by their war and refugee experiences. The Hmong and Cambodian communities, through collaboration with local mental health agencies, academic centers for higher learning, refugee services, and local and federal government agencies, have developed a culturally-driven model of mental health care for Southeast Asian refugees. Methods: In Hmong, the word “Kaj Siab” describes the relief of stress and the freedom from worrying about the safety of loved ones. Transitioning from village to western city, many elders found themselves physically, culturally, and linguistically isolated. Leaders from the Hmong and Cambodian community partnered with mental health professionals, starting in 1989. The design and building of the programs took place with groups at community locations and in home visits. Kajsiab was the idea of creating space where elders can be together and receive care for mental health issues. The community identified goals of engagement and socialization of community elders in a supportive environment. In 1995, the Cambodian community built a Buddhist temple, which facilitates community engagement in the Khmer heritage, including the care-taking of a Buddhist monk, the offering of devotion to ancestors, and the chance to meet with other Khmer speakers. In conjunction with traditional Buddhist teachings and meditation, on-site psychologists offer a culturally-driven model of cognitive behavioral therapy for Post Traumatic Stress Disorder, integrated with the daily rhythms of the temple. Psychiatric services are also available to participants. In 2000 Kajsiab was able to find a physical home with on-site gardens. The Southeast Asian project has developed innovative and collaborative models of healthcare. Both programs include a shared meal, which is prepared by community members in a traditional style. Participants can grow food and harvest seasonal vegetables in community gardens. Other services which have been offered include physical Therapy with Tai Chi movements, adapted to cultural movements familiar to traditional village life, such as grinding or harvesting rice. The Hmong Shaman provide traditional healing practices, such as soul-calling. Traditional massage or acupuncture has been made available and may be utilized in collaboration with western treatment recommendations. Traditional herbal medicine treatments are not discouraged and when used are taken into consideration if prescribing western medication. The women’s groups provide a safe place in which to disclose sensitive concerns of substance use or domestic violence. When warranted, an intervention may involve the clan or community leadership. If necessary, clients are connected with mainstream social services for support. On-call mental health crisis intervention services are handled by case managers who are linguistically and culturally fluent. Psychiatrists are familiar with cultural idioms of anxiety, PTSD, or depression. Clients may be asked if they have experienced loss of soul, wind, thinking too much, or interaction with the spirit realm. Case managers provide social support, culture brokering and translation services for medical appointments, citizenship application, drivers licensing, and social services applications. The community centers have invited public health interventions such as flu shot clinics and blood pressure screening checks. Several intergenerational projects have supported cultural and familial ties for Hmong and Cambodian youth. The Teen Village model identified at-risk youth in middle and high schools for increased community and peer support in a traditional cultural framework. Art therapy and cultural dance have also utilized traditional forms of expression to facilitate healing and connect participants to deeper cultural values. Results: For many reasons, Hmong and Cambodian communities experience mental health concerns, poverty, and isolation at higher rates than the general population. Consequently, both populations are at increased risk for hospitalization and suicide. Additionally, linguistic and cultural barriers limit access to healthcare resources, especially in the traditional western medical clinic model. Since 1985 there have been no suicides and no mental health hospitalizations. With a lack of control group, it is difficult to quantify the true effects of culture brokering during medical healthcare appointments and preventative psychiatric, medical, and social interventions at the clinic. However, it appears that these outcomes do separate from national trends in other Hmong and Cambodian communities. Primary care providers and case managers have stated that they value the services of the Southeast Asian Project, which cannot be replicated in the current HMO and insurance delivery models. Conclusions: A community member may have summed the model up best: ““Being able to be with each other is a treatment”. Community mental health care provides a unique opportunity to creatively partner with cultural communities overcoming traditional barriers in getting mental and physical healthcare needs met. Culturally Driven care begins in the community with the community definition of needs, goals, practices. When mental health care providers bring in scientifically verified processes or programs and adapt them to fit the clients’ culture, the result is delivery of culturally competent care and healing in the community setting. This research was funded by: No funding sources for this poster presentation. The Southeast Asian Project was initially, in part, funded by a SAMSHA grant.

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Poster Number: EI - 36 UPDATES FROM THE GEAR-UP PROJECT: PERFORMANCE OF MULTIDISCIPLINARY LEARNERS ON LATE LIFE DEPRESSION AND COGNITIVE IMPAIRMENT SIMULATIONS Rebecca Radue1; Lisa Boyle2; Lauren Welch3; Steven Barczi3

1University of Wisconsin Hospital and Clinics and William S. Middleton Memorial Veterans Hospital 2University of Wisconsin School of Medicine and Public Health and William S. Middleton Memorial Veterans Hospital 3William S Middleton Memorial Veterans Hospital

Introduction: The Madison VA Geriatric Research, Education, and Clinical Center (GRECC) provides training to multidisciplinary health professionals at a variety of learner levels. The Wisconsin Geriatric Workforce Enhancement Program (GWEP) is a consortium of five collaborating organizations and many community partnerships. Since 2013, the GRECC and GWEP have collaborated on the Geriatrics Equipped and Ready for Unsupervised Practice (GEAR-UP) project, with a primary goal of designing an adaptable, competency-based learning experience that develops “geriatrics-equipped” inter-professional team members. Within the GEAR-UP project, an interdisciplinary team (IDT) of geriatric educators at the Madison VA implemented a simulation experience to be completed by learners during geriatric training. This allows educators to assess learner competency in 3 core areas of geriatrics: falls, late life depression, and cognitive impairment. Moreover, an online simulation for late life depression, designed to complement the simulated patient assessment has been developed and will launch in the spring of 2019. This poster provides an update on the GEAR-UP Project, and will present representative competencies and curricula that have been adopted to teach geriatric psychiatry to internal medicine interns and other learners, along with updated data on performance of learners on the late life depression and cognitive impairment simulated patient assessments. The GEAR-UP project highlights the need for broad health professions education on late life depression and cognitive impairment, and provides innovative ideas on ways to incorporate such education into trainee curricula. Methods: In 2014, the IDT team developed curricula for a one-month geriatric rotation for internal medicine interns which incorporated standardized in-person patient simulations (objective clinical skills examinations, or OSCEs) in the three content areas. These simulations were tested in collaboration with the University of Wisconsin Health Sciences Learning Center (HSLC) Clinical Training and Assessment Center (CTAC) site in March 2014, and have run monthly to date. The simulation experiences were designed for both instruction and evaluation, and are strategically placed near the mid-point of the learners’ geriatric rotations to heighten their learning experience in the core geriatric principles. This provides a formative assessment in these topics to highlight areas for improvement for the remainder of the geriatric rotation. Assessment scores are maintained in a current database that can be used for further assessment of learner performance against their peers. Here we present i) specific competencies and sample curricula developed to teach geriatric psychiatry; ii) data from academic years 2014 to present for the late life depression and cognitive impairment simulations (as the assessment points varied from year to year in an effort to optimize the experience for learners, only common key, evidence-based evaluation points were examined in the comparison across years); and iii) portions of the online LLD simulation. Results: There were a total of 123 learners from academic years 2014 through present. The distribution of learner disciplines across all academic years is shown in Figure 1. The largest group of learners were general medicine interns (including transitional year interns). Geriatric scholars represent VA providers already in practice who participate in a one-week immersion experience with the GRECC, and come from a variety of disciplines including social workers, nurse practitioners, pharmacists in clinical practice, and psychologists. PharmD residents are pharmacists in their first year of post-graduate clinical training specific to the nationwide VA system. Medical students represent MS4 students completing geriatric medicine sub-internships. The fellows who completed the simulations are largely geriatric medicine fellows. Learner performance broken down by learner discipline is shown in Figure 2, with geriatric medicine fellows demonstrating the highest performance on both simulations, and medical students the lowest. Currently, we are working on analyzing the data for individual performance items. We anticipate having this analysis done by time of poster presentation if selected. Conclusions: There were observed differences in performance among the disciplines and levels of training. Performance on the late life depression assessment was overall higher than on the cognitive impairment assessment among most learner groups, with the exception of the medical student group. The comparative performance of the learners appear congruent with their level of training, with the exception of geriatric scholars. One explanation for the comparatively low performance of the geriatric scholars is that through their years of practice they have likely grown unfamiliar with the OSCE format. Possible broad explanations for variations in learner performance include discipline specific biases, differences in training programs, time out of core training and differences in content exposure related to time allocated for geriatric training in different disciplines. Several images are included from the online computer-based simulation for late life depression, to illustrate the interface. Rather than a costly OSCE with standardized patients, the computer simulation is customizable to learner discipline and level of training, and includes options for non-prescribers, basic prescribers, and advanced prescribers. Although the initial investment is considerable, this will be a tool that can be utilized broadly across disciplines, training sites, and even institutions.

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This research was funded by: William S. Middleton Veterans Administration (VA) Geriatric Research, Education and Clinical Center (GRECC) & University of Wisconsin (UW) Department of Medicine, Madison, WI — This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant U1QHP28712 (Geriatrics Workforce Enhancement Program). The information or content and conclusions contained herein are those of the authors and should not be construed as the ofﬁcial position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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Poster Number: EI - 37 IMPLEMENTATION OF A GERIATRIC PSYCHIATRY TRACK IN THE FOURTH YEAR CURRICULUM Thu Tran1; Erica Garcia-Pittman2

1Dell Medical School at the University of Texas in Austin 2The University of Texas at Austin

Introduction: The field of geriatric psychiatry is a growing field with a need for providers increasing as well. Due to this, we have implemented a "geriatric psychiatry track" into the fourth year curriculum in our program which was piloted this year for the first time. This innovative track allowed for more in depth-training in the geriatric field for a resident who will not be pursuing a geriatric psychiatry fellowship. We feel that though fellowship may not be the decided path for some residents, there should still be the option for increased training for treating the geriatric population which will become important in their future careers. I was such a resident in our program and in working with Dr. Garcia-Pittman, we created this track which we feel will be a beneficial option in other programs as well. Methods: This poster will discuss the track we created and its implementation. Results: N/A Conclusions: Having more robust geriatric psychiatric training in the general adult residency program can be a very beneficial option for residents. Most residents who will be practicing adult psychiatry in any setting will very likely treat geriatric patients and this knowledge background will be important to provide good care. In addition, with the geriatric population ever-growing, they may not all be seen by board-certified geriatric psychiatry and thus it is additionally important to have general adult psychiatrist be knowledgeable in the care of this population. This research was funded by: N/A

Poster Number: EI - 38 ADAPTING A COLLABORATIVE CARE MODEL TO FACILITATE REDUCTION OF HIGH DOSES OF PRESCRIPTION OPIOIDS IN COMMUNITY DWELLING ELDERS Muhammad Khan1; Kristin Foust2; Elizabeth Grecco2; Deborah Rooney2; Suzanne DiFilippo3; Shahrzad Mavandadi4; David Oslin5; Roger Cadieux6; Joel Streim1

1University of Pennsylvania 2University of Pennsylvania Perelman School of Medicine 3Cpl Michael J Crescenz Veterans Affairs Medical Center and VISN 4 Mental Illness Research Education and Clinical Center 4Perelman School of Medicine at the University of Pennsylvania and Corporal Michael J. Crescenz VA Medical Center, Mental Illness Research, Education, and Clinical Center 5Perelman School of Medicine, University of Pennsylvania and Cpl Michael J Crescenz Veterans Affairs Medical Center and VISN 4 Mental Illness Research Education and Clinical Center 6Consultant for PACE program

Introduction: In 2008, the Pennsylvania Department of Aging (PA DoA) and its pharmacy beneﬁts programs for low- to low- middle income older Pennsylvanians—the Pharmaceutical Assistance Contract for the Elderly (PACE) and PACE Needs Enhancement Tier (PACENET)—partnered with the University of Pennsylvania (Penn) to establish a telephone-delivered clinical service that supported geriatric patients and their primary care providers in delivering mental health care integrated within the primary care setting. This evidence-based collaborative care service improved outcomes for elderly Pennsylvanians with disorders of mood or cognition. In the context of the current opioid epidemic, PACE/PACENET and Penn agreed to pilot a new telephone-delivered collaborative care service to help geriatric patients with chronic pain who receive continuing prescriptions for very high doses of opioids. Objectives: To report preliminary ﬁndings from a pilot project that adapted an existing collaborative care service to facilitate reduction of high doses of prescription opioids in community dwelling elders. The principle aims were to measure levels of patient participation and engagement, and to determine the extent to which engaged patients and their prescribers achieve opioid dose reduction. Methods: Patient Sample: From May through October 2018, a convenience sample of elderly patients receiving chronic opioid prescriptions for > 120 mg morphine-equivalent dose (MED) was referred by PACE/PACENET to the Penn collaborative care service. Clinical Intervention: Patients who agree to participate undergo comprehensive assessments of mental health, cognition, sleep, pain, and functional status by a Behavioral Health Lab (BHL) technician. Measures include the Patient Health

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Questionnaire-9 (PHQ-9); Generalized Anxiety Disorder -7 (GAD-7); Blessed Orientation-Memory-Concentration test (BOMC); Insomnia Severity Index (ISI); Pain intensity, interference with Enjoyment of life, and interference with General activity (PEG); pain self-efficacy questionnaire (PSEQ); and Veterans RAND 12-item Health Survey (VR-12) for mental and physical function. A follow up baseline interview with a BHL clinician (LSW or RN) includes self-reported daily opioid dose, assessment of medical-psychiatric co-morbidity, other medications and pain treatment modalities, and identification of unmet biopsychosocial needs. The BHL clinician engages the patient in individualized treatment planning, with emphasis on goals of opioid dose reduction to safer levels. Modalities of treatment offered include but are not limited to (1) behavioral pain management, (2) general medication education, (3) reinforcing positive health behaviors, (4) addressing barriers to change, (5) scheduling positive activities, and (6) relaxation techniques. Summary reports are sent to prescribers with recommendations for pain care management and opioid dose reduction. Program Evaluation: “Participation” was defined as patient agreement to participate in the initial health assessment with a BHL technician. “Engagement” was defined as completion of the baseline health assessment and at least two follow-up contacts with a BHL clinician. “Substantial dose reduction” was defined as at least 20% reduction from the self-reported baseline MED within the first 12 weeks of program engagement. Results: 71 patients were referred over the first 5 months, 3 of whom were unable to participate due to communication barriers. Of the remaining 68 eligible patients, 49 (72%) participated in the initial health assessment. Of these participants, 25 (36.8% of eligibles) had at least 2 follow-up contacts with a BHL clinician and were considered “engaged” in the program. Participants’ mean age was 73.9 years (range, 65-87); 61.5% were male; 94.2% were White, 1.9% were Black; 96.2% were non-Hispanic, 1.9% were Hispanic. Participants’ mean PHQ-9 score was 8.3; mean GAD-7 score 4.3; mean BOMC score 4.1; and mean ISI score was 6.3. Mean baseline PEG and PSEQ scores were 7.1 and 6.0, respectively. Mean VR 12 mental health score was 47.4 indicating average overall functioning, and VR-12 physical score was 20.4 indicating low overall functioning. Of the 25 engaged patients, 21 (84%) achieved dose reductions, with a mean MED of 420 mg on initial assessment and 276 mg at the last contact. 36% of engaged individuals achieved dose reductions of >20%. Conclusions: In this pilot program for elderly patients taking very high doses of prescription opioids, we found a high rate of participation in the initial assessment, and a moderate rate of engagement in follow-up. Although 36% of the engaged patients achieved substantial opioid dose reductions, these patients were still receiving unsafe doses. Nevertheless, these findings suggest that it is possible to adapt a collaborative care model to help some older adults achieve substantial reductions from high doses of prescription opioids. This research was funded by: Pennsylvania Department of Aging

Poster Number: EI - 39 NIHILISTIC DELUSION IN THE CONTEXT OF MAJOR DEPRESSIVE DISORDER WITH CATATONIC FEATURES IN A GERIATRIC PATIENT: A CASE REPORT AND REVIEW OF LITERATURE Saurabh Somvanshi; Sabish Balan; Catherine Mindolovich; Amit Jagtiani; Tarika Nagi; Nurur Rahman; Eric Rubin; Kaﬁlat Ojo

Harlem Hospital Columbia University Program, NY

Introduction: Nihilistic delusion (ND) is one of an assortment of narrowly deﬁned monothematic delusions characterized by nihilistic beliefs about self’s existence or life itself. It is estimated to occur in less than 1% of older adults, 3% of older adults with severe depression (Chiu, 1995), and less than 1% of patients with psychotic disorders (Ramirez-Bermudez et al., 2010; Stompe and Schanda, 2013). There are no standardized treatments for ND, although, case reports have documented effectiveness of pharmacological treatment as well as electro-convulsive treatment (Debruyneet al., 2009; Grover et al., 2014). Recent reports have also brought attention to the role cognitive-behavioral therapy (CBT) techniques for delusions may play in effective treatment (Coltheart et al., 2007). Given the unique content of beliefs in ND, additional research to understand the important role life circumstances − including religious beliefs − play in the development and maintenance of this condition is needed (Ghaffari Nejad et al., 2013). In this report we present the case of ‘Ms. E,’ an individual with spiritually mediated ND in the context of major depressive disorder with catatonic features, and review the relevant literature on biological, psychological, and social factors associated with ND. Methods: In this report we present the case of ‘Ms E’ a 74 yr Caucasian female, a retired medical technologist with 47-Year diagnosis of depression (Major Depressive disorder with catatonic features), with mild neurocognitive impairment. Pt has no coexisting medical illness, no substance use disorder, no traumatic brain injury or other neurological diagnosis. Patient’s sister who was a SW in mental health facility, indicated that Ms. E suffered her ﬁrst psychiatric break in Colorado at age 27 requiring in-patient hospitalization in context of “spiritual emergencies” she characterizes it as depersonalization. She was prescribed medication, but never followed up with psychiatric outpatient care due to her preference for treating her condition

S148 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 with prayers. During episodes of depressed mood patient reported having episodes of feeling as if she is in a spiritual realm and that she is “Mother Teresa”. Patient reports two past suicidal attempts in 1980s (overdosing on sleeping pills) and later in 2011 (overdosing on Benadryl pills) requiring ICU admission. Later, after divorce from her husband, patient relocated to New York City. She has been living with her partner for past several years and participates in all activities of daily living. Earlier this year, patient’s partner experienced a fall and was admitted to the hospital. Mobile crisis team, activated based on partner’s concerns, found patient to be decompensated, grossly oriented, with psychomotor retardation, hesitant speech with long pauses, anxious mood, and restricted affect. Thought process was tangential, and her cooperation was limited due to her preoccupation with delusions that she was dropping in an abyss and progressing towards spiritual crisis of dying. When asked about suicidal ideation (SI) she indicated, “I am already dying, how can I be suicidal?”. Of note, patient’s nihilistic beliefs, included strong religiously mediated content, are not shared by her family. A computed tomography (CT) scan (Figure 1) performed in March 2018 revealed Mild to moderate global volume loss for age with cerebral atrophy. No evidence of any white matter abnormality, mass, hydrocephalus, acute intracranial hemorrhage, abnormal extra-axial fluid collection, or obvious cortical infarct in the brain were noted on imaging. Results: During patient’s month-long admission on the inpatient unit repeated inquiry about her religious experience changed in the content of delusion from literal and concrete beliefs that her ‘spiritual emergency’ was physically leading her to dead to more abstract and metaphorical descriptions of spiritual death, however her belief that spiritually she is destined to be dead persisted. Continued exploration about the patient’s observed improvement in daily activities of living (eating, drinking, showering) when posed to patient as evidence that she was in fact improving, she indicated that she was ‘probably improving.’ Approximately 1 month into her admission, she re-gained insight that content of her speech was focus on spirituality, death and self-negation. She was ultimately discharged after 4 weeks of hospitalization. On discharge, the patient’s partner and sister noted that she was less delusional with more linear thought process than at baseline. Conclusions: Our case of Ms. E underscores the complexity of managing depression with co-existing nihilistic delusions. Given this increased susceptibility for violent acts and self-harm, the presence of delusions characterized by nihilistic beliefs about the body’s existence or life itself should prompt vigilance and clinical assessment of violent or self-harm behavior. While co-occurring ND and depression is rare, the consistency and longevity of the delusional content, increased risk of self- harm behavior, presence of significant depressive symptoms, attributional style, and neuropsychological performance can each help to identify ND within this population. Within limitations of a case report, we suggest that co-occurring ND and major depressive disorder may increase the risk of self- harm due to the specific nihilistic content of the delusions. Taking action, or refraining from taking action, as a consequence of nihilistic beliefs about the existence of one’s body or of life itself may lower ones inhibition for violence. This research was funded by: Not Applicable. (Authors report no relevant disclosures for this report.)

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Poster Number: EI - 40 PSYCHOTROPIC MEDICATION USE PATTERNS IN HOME-BASED PRIMARY CARE: A SYSTEMATIC REVIEW Nina Vadiei1; Carol Howe1; Mindy Fain2; Beth Zerr1; Nick Ladziak1; Jeannie Lee1

1University of Arizona 2Arizona Center on Aging

Introduction: Up to a third of patients seen by home-based primary care providers suffer from mental health problems, predominantly major depressive disorder. These conditions tend to be under-recognized and under-treated for patients receiving home-based care. This may be due to providers feeling inadequately trained on how to screen for various mental health disorders, and/or how to provide comprehensive mental health treatment. Given the high prevalence of patients suffering from mental health problems in this setting, the goal of this systematic review was to evaluate current psychotropic use patterns for patients receiving home-based primary care (HBPC). Methods: Using controlled vocabulary terms (e.g. MeSH, Emtree) and keywords, a medical librarian conducted systematic literature searches in the following seven databases: Ovid/MEDLINE, Wiley/Cochrane Library, Elsevier/Embase, Elsevier/ Scopus, Clarivate/Web of Science, EBSCO/CINAHL, and EBSCO/PsycInfo, limiting articles to those published between January 1, 2007 and January 5, 2018. Two independent reviewers screened all titles and abstracts and resolved differences by consensus. Two independent reviewers screened the full text of all publications selected in the screening phase. Differences were resolved by consensus with a third reviewer. Studies were selected if a) they were conducted in home-based primary care settings and b) identified psychotropic use/prescription patterns. We specifically did not include studies that were limited to patients in hospice care or nursing or rehabilitation facilities. Studies were excluded if they were: not in English; drug trials; limited to pediatric patients; or opinion pieces, case studies, case series, meeting abstracts, reviews, systematic reviews, or meta-analyses. Results: Of the 2,675 publications identified through the seven database searches, 1,388 remained after duplicates were removed (Figure 1). Of these, 1,329 were eliminated because of irrelevance to the topic and 59 were selected for full text screening. Of these, four met full selection criteria and were included in the data extraction and analysis. Citation checking of these four, as well as of relevant review articles, resulted in the selection of an additional 15 articles for full text screening. None of these additional articles met the full selection criteria. Conclusions: Pending ongoing investigation. This research was funded by: This research did not receive any grants from funding agencies in the public, commercial, or not- for-profit sectors.

Poster Number: EI - 41 LIMITATIONS OF AN OUTPATIENT COMMITMENT IN A GERIATRIC PATIENT WITH LATE-LIFE MANIA Kimberly Kjome; Erica Garcia-Pittman; Sonia Popatia; Christopher Powell; Ryan Seaver

The University of Texas at Austin Dell Medical School Psychiatry Residency Program

Introduction: The prevalence of mania among >65-year-olds ranges from 0.1% to 0.4% and its treatment poses several challenges for clinicians. Aside from the challenges posed when selecting a medication, there is also the challenge of patients lacking insight into their illness. This can be a speciﬁc challenge for geriatric patients who have not had previous psychiatric diagnoses and struggle with adjusting with a diagnosis of bipolar disorder which is associated quite often with shame and denial. This can often lead to involuntary inpatient commitment and court ordered medications but also an outpatient commitment process. In this case, we discuss the limitations of enforcing the outpatient commitment process with a patient who presented with late life mania. Methods: This case report focuses on a geriatric patient with corticosteroid-induced mania who was ﬁrst seen and treated in the inpatient psychiatric hospital and then was followed in an outpatient resident geriatric clinic. Patient’s clinical documents were reviewed both in the inpatient setting and outpatient setting. A literature survey was performed on the topics of corticosteroid- induced mania, involuntary commitment process, and outpatient commitment process as well as ethical considerations involved regarding involuntary commitment and court- ordered medications. Results: A previously healthy, 75 year old Caucasian male was acutely hospitalized in an inpatient psychiatric hospital after presenting with manic symptoms with psychosis after taking prednisone prescribed for his rheumatoid arthritis. The patient displayed poor insight into his symptoms and refused medications. Involuntary hospitalization was pursued as well as court-

S150 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 ordered medications. The patient agreed to take his medications but continued to demonstrate poor insight into his illness. Based on concerns from his providers as well as his family, the patient was placed on an outpatient commitment to help with treatment adherence, and he was seen in geriatric psychiatry resident clinic. He would present for appointments but was self- titrating doses of medications and had discontinued his antipsychotic medication. Through this case, more knowledge was gained about the limitations of the outpatient commitment process and how its effectiveness is not as robust as an inpatient commitment. This patient eventually discontinued all treatment and terminated care with the clinic. Conclusions: The involuntary outpatient commitment process was put in place to allow patients who lacked insight into their mental illness to access psychiatric care. There has been much discussion about the ethical principles of beneﬁcence and autonomy that are pitted against each other when discussing the outpatient commitment process, but the hope is that this process helps providers to care for patients especially geriatric patients who are diagnosed with late-life bipolar disorder and may lack the insight with being diagnosed with a psychiatric illness. However, from treating this patient, we have come across challenges that exist with implementing and enforcing the outpatient commitment process. This warrants a discussion on the limitations it poses and what are the other strategies that we can implement to continue treating this population.

Poster Number: EI - 42 THE EFFECT OF PHYSICAL REHABILITATION ON REPEATED SUSTAINED ATTENTION TESTS IN CRITICALLY ILL PATIENTS Carol K. Chan1; Carrie M. Goodson2; Margaret Sundel3; Aisa Moreno-Megui1; Atsushi Kamiya1; Dale M. Needham2; Karin J. Neufeld1

1Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences 2Johns Hopkins University School of Medicine, Department of Medicine, Division of Pulmonary and Critical Care Medicine 3Johns Hopkins University School of Medicine

Introduction: Delirium, a clinical syndrome defined as an acute and fluctuating disturbance of consciousness and impaired attention (American Psychiatry Association, 2013), affects up to 90% of mechanically ventilated patients in the intensive care unit (ICU) and is associated with long-term cognitive impairment (Pandharipande, et al., 2013). While evidence for pharmacological therapy for delirium is limited, several non-pharmacological interventions, including physical rehabilitation, reduce delirium incidence and duration (Alvarez et al., 2009; Schweickert et al., 2009). This study evaluates the effects of physical rehabilitation on attention - a fundamental cognitive domain disrupted in delirium. Methods: Adult medical ICU patients without neurological pathology, dementia, or coma, receiving physical rehabilitation as part of routine care were included in this study. All patients were assessed for delirium at approximately 8 am, and then completed two standardized tests of attention, separated by about 3 hours, using the Edinburgh Delirium Test Box for the ICU (EDTB-ICU) (Green et al., 2017). The EDTB-ICU is a non-invasive, computerized neuropsychological testing device that quantitatively measures attention via a method that is suitable for non-verbal ICU patients, including those who are mechanically ventilated. The EDTC- ICU includes 3 levels of increasing difficulty, consisting of 3 trials each, with a total score range of 0-9. Patients were randomized in a 1:1 ratio to complete the second attention test either before vs. after the routine care physical therapy session (referred to as the control vs. study group, respectively) using computer-generated permuted block randomization created using STATA 14. The allocation sequence was concealed from the researcher, but assessors were not blinded to treatment condition. Baseline data regarding patients’ cognitive and functional status were collected from direct testing and informant interview. Delirium was assessed via the Confusion Assessment Method (CAM) (Inouye et al., 1990) and Delirium Rating Scale-Revised-98 (DRS-R98) (Trzepacz et al., 2001). Each instrument was rated after direct standardized cognitive function testing and patient examination, medical record review, and collateral informant interview by trained personnel. Patient performance on the EDTB-ICU did not contribute to these ratings and was evaluated separately. Group differences in baseline data were compared using Mann-Whitney U tests for continuous variables and Fisher’s exact tests for dichotomous variables. Within-subject change in sustained attention performance was calculated using the Wilcoxon signed-rank test. To compare the effect of intervening physical rehabilitation (study group) vs. no physical rehabilitation (control group) on change in attention, a mixed effects model with a random intercept was fitted. Significance was defined as p<0.05. Statistical analyses were completed using SPSS 25 and R (R Core Team, 2013). The study protocol was approved by the Johns Hopkins IRB (IRB00101824). All participants and/or their legally authorized representatives provided written informed consent. Results: Of 1,711 patients screened, 31 were eligible, consented and completed the study protocol (Fig. 1). Table 1 reports baseline characteristics of the cohort (n=31), study group (n=15), and control group (n=16). The two groups were similar at baseline. Table 2 reports median initial and repeat EDTB-ICU scores. The control group declined by an average of 1.0 point (95% CI: -1.9, -0.1; p=0.02) while the study group declined by an average of 0.3 points (95% CI: -2.4, 1.9; p=0.2). This difference in change over time between the study vs. control group was not significantly different (p=0.25).

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Conclusions: This pilot study did not demonstrate a signiﬁcant difference in sustained attention for critically ill patients who were randomized to receive repeated attention testing with vs. without intervening physical rehabilitation. Given prior randomized controlled trials demonstrating reductions in delirium in ICU patients receiving vs. not receiving physical rehabilitation, larger-sized studies evaluating the impact of physical rehabilitation on attention, a critical domain in assessing delirium, are needed to further investigate these ﬁndings. This research was funded by: Research Funding Source: Hitachi Ltd.

TABLE 1. Baseline characteristics of control and study groups. P-value calculated using Mann-Whitney U tests for continuous variables and Fisher’s exact tests for dichotomous variables. (IQR, interquartile range; SOFA, Sequential Organ Failure Assess- ment; RASS, Richmond Agitation and Sedation Scale; CAM, Confusion Assessment Method; DRS-R98, Delirium Rating Scale-Revised-98) All in analyses Control Group Study Group (n = 31) (n = 16) (n = 15) p-value Age, median (IQR) 61 (46-67) 62 (57-69) 58 (38-65) 0.20 Male, N (%) 16 (52) 9 (56) 7 (47) 0.59 Mechanically ventilated, N (%) 7 (22) 4 (25) 3 (20) 1.00 SOFA organ failure score, median (IQR) 6 (5-8) 5 (5-7) 6 (5-8) 0.50 RASS sedation score, median (IQR) 0 (0) 0 (0) 0 (0) 0.38 Delirious (Positive CAM), N (%) 13 (42) 6 (38) 7 (47) 0.72 DRS-R98 delirium severity score, median (IQR) 5 (3-10) 6 (3-16) 5 (3-8) 0.52

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TABLE 2. Within-subject change in sustained attention performance after rest period in control group, and physical rehabilitation in study group. P-values calculated by Wilcoxon signed-rank test. (IQR, Interquartile range; EDTB-ICU, Edinburgh Delir- ium Task Box for the ICU) Initial EDTB-ICU, Repeat EDTB-ICU, Median (IQR) Median (IQR) p-value Control Group (n = 16) 7.5 (1.5-8.0) 5.5 (0-8.0) 0.03 Study Group (n = 15) 5.0 (3.5-8.0) 6.0 (1.5-8.0) 0.55

Poster Number: EI - 43 EMOTIONAL AWARENESS AND EXPRESSION THERAPY OR COGNITIVE BEHAVIOR THERAPY FOR THE TREATMENT OF CHRONIC MUSCULOSKELETAL PAIN IN OLDER VETERANS: A PILOT RANDOMIZED CLINICAL TRIAL Ali Najaﬁan Jazi1,2; David Sultzer1,2; Mark Lumley3; Sheryl Osato1,2,4; Brandon Yarns1,2

1Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles 2Mental Health Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA 3College of Liberal Arts and Sciences, Wayne State University 4Department of Psychology, University of California, Los Angeles

Introduction: Chronic pain affects as many as 80% of older veterans and is one of the mostly costly disorders treated in Veterans Affairs (VA) settings. Both the CDC and VA recently recommended psychosocial treatments as first-line treatments for chronic pain, along with non-opioid pharmacologic options. Yet standard psychosocial treatment options currently implemented in VA, such as Cognitive Behavioral Therapy (CBT), have only modest benefits for a minority of patients. In contrast, a novel manualized psychotherapy approach with a heretofore underutilized mechanism, Emotional Awareness and Expression Therapy (EAET), has shown medium-to-large effect size benefits for some patients, which may indicate promise for helping older patients avoid riskier treatment options such as opioid analgesics and invasive procedures for their pain. Methods: This study is a pilot randomized (1:1) clinical trial (RCT) comparing two group psychotherapy treatment conditions (EAET and CBT) for chronic musculoskeletal pain in Veterans age 50 years and older, currently underway (target N=64). The main objectives of this pilot were to assess the acceptability and feasibility of the treatments, and to provide limited-efficacy testing and obtain an estimated effect size for power calculations for a subsequent larger RCT. Patients received one 90-minute individual session and eight 90-minute group psychotherapy sessions according to the condition to which they were randomly assigned. EAET sessions were conducted by either the study principal investigator or a psychology intern, and CBT sessions were conducted by an experienced psychologist and a geriatric psychology fellow. Demographics (age, gender, years of education) and clinical variables (number of medications, number of medical conditions, presence of opioids) were collected at baseline. Patient-centered outcomes, including pain severity (primary outcome), pain interference, depression, anxiety, PTSD symptoms, sleep disturbance, fatigue, and treatment satisfaction, were collected at baseline, posttreatment, and at three-month follow-up. Two-sample t-tests were used to assess group differences on change scores for each outcome. Effect sizes were calculated using the following formula: (posttreatment mean − baseline mean)/baseline SD. Results: To date, 48 patients were enrolled, and 35 patients completed baseline and posttreatment assessments. No differences between treatment conditions were found on any demographic or clinical variable at baseline. Patient drop-out rates were relatively low and comparable in each treatment condition. Similarly, no differences were found between treatment conditions in patient attendance or treatment satisfaction. However, a non-significant trend toward more improvement in the primary outcome of pain severity was found which favored EAET over CBT (t=1.868, p=0.07). Several patients in the EAET condition (N=3, 18%) had large improvements in pain severity, greater than -3 on an 11-point (0-10) scale, whereas no patient in the CBT condition had such large improvements. Overall, EAET delivered a moderate effect size of -0.60 for pain severity, whereas CBT had a small effect size of -0.22. Improvements in secondary outcomes (pain interference, depression, anxiety, sleep disturbance, fatigue, and PTSD symptoms) were generally small and did not differ between groups. Conclusions: EAET appears to be a reasonable, and potentially more efficacious, alternative to CBT for older veterans with chronic musculoskeletal pain. Additional groups are planned for this pilot, and 3-month follow-up data are currently being analyzed. In addition, a larger RCT using therapists who are not involved in the research design and methods is planned. Further research is also needed to elucidate the distinct and similar mechanisms of action for each treatment approach and to assess baseline predictors of treatment response, especially given the large improvements among some patients in the EAET condition.

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This research was funded by: This research was supported with a Beginning Scholar Pilot Grant from the American Psychoanalytic Association.

Poster Number: EI - 44 MAINTAINING SERENITY IN THE THERAPEUTIC RELATIONSHIP: AROMATHERAPY, INDIVIDUALIZED MUSIC OR BOTH TO PROMOTE ENGAGEMENT AND EMPOWER CHOICE Kecia-Ann Blissett1,2; Victora Chima1,2; Svetlana Zlotnik1,2; Melinda Lantz1,2

1Mount Sinai Beth Israel 2Icahn School of Medicine a Mount Sinai

Introduction: The use of complementary and integrative methods in the care of older adults is increasingly popular. Elderly persons who suffer from chronic, persistent or severe mental illness are less likely to be offered or encouraged to utilize these interventions. Engagement in treatment is an issue that plagues the mental health system and is associated with better outcomes and less use of costly inpatient hospital stays when involvement and empowerment of patients is integrated into care. Aromatherapy is a popular cultural and spiritual intervention. Many elderly people utilize components of aromatherapy as part of developmental and family rituals with strong historical roots. Individualized music is one of the most powerful forms of complementary interventions being utilized as part of treatment regimes for disorders ranging from acute psychosis to anxiety to dementia. Compliance with medications and treatment regimes is considerably higher when patients are allowed to make choices regarding care. This project describes the use of aromatherapy with and without individualized music to enhance patient engagement in therapeutic sessions and treatment discussions. Methods: A convenience sample of older adults being treated in diverse clinical areas: the psychiatric emergency department, a 31-bed acute inpatient unit and an outpatient clinic; each part of a large urban tertiary care hospital were offered options prior to being involved in therapy sessions or clinical interviews. Patients were offered of three essential oils: Lavender (Lavendula angustifolia), Grapefruit (Citrus paradisi) or Peppermint (Mentha piperita) prior to clinical interviews or therapy appointments. Oils were provided on individual wood sticks that were immersed in the oil and given to the patient with instructions to hold under the nose and inhale deeply for at least 3 deep breaths. They were also offered the ability to listen to individual music choices for brief periods of up to 3 minutes in a variety of genres that included classical, jazz, showtunes, latin, soft rock, dance and easy listening. Music was offered via wireless headphones that could be worn over the ear for several minutes in a waiting area. This was offered both separately and in combination with aromatherapy. Rating of satisfaction with the intervention using a 5-point Likert type scale, likelihood of recommending to others and decision to return for further care. Results: The aromatherapy was widely accepted with >90% of patients choosing an oil and utilizing the intervention. Average age of the patients was 77 years old with range from 55 years to 95 years. Our sample included patients from very diverse cultural backgrounds that are present in a urban New York City population. The majority were not native English speakers and the population as a whole included those speaking more than 20 different languages. Diagnostic diversity was also quite enriched and included those with Anxiety disorders and issues related to life stress as well as many with Schizophrenia and Bipolar disorder. Most patients made a choice of an oil for aromatherapy (75%) or took a recommendation from the therapist (25%). Impact on acceptability, satisfaction with the intervention and likelihood to recommend to others was rated on a 5-point Likert type FACES scale that allowed patients to identify their response without language barriers. More than 90% of patients reported being Very Satisfied with the aromatherapy. Music was less likely to be chosen as a brief intervention (55%) both with or without aromatherapy. Most patients felt that the brief time period of 5 minutes or less was not long enough for their preference although among those that accepted the intervention, 85% reported being Very Satisfied with the use. No participant reported a negative response or adverse effect from with or both interventions. Conclusions: Use of individualized aromatherapy greatly increases sense of engagement and appreciation of care. Our patient sample included a diverse sample of very acute patients many of whom entered the hospital on an involuntary basis, as well as those who were presenting for follow up outpatient visits. The clinical acuity was extremely diverse but also included a Comprehensive Psychiatric Emergency Program (CPEP) where the need for care was urgent. The interventions had widespread acceptability in a variety of clinical services and with patient form very cultural diverse backgrounds. Brief music was not as widely accepted, in part because the use of headphones as a delivery mechanism was not as well received by patients. Use of choice with both interventions was felt to be inherently empowering to patients. Most patients were very satisfied with being more involved in making choices that affected their ability to engage with care and treatment in an open manner. Patients expressed a clear desire to recommend and share these interventions with others. This research was funded by: Mount Sinai Beth Israel

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Poster Number: EI - 45 DIGITAL MONITORING OF SLEEP, MEALS, AND PHYSICAL ACTIVITY AS A PREVENTIVE INTERVENTION FOR DEPRESSION IN OLDER BEREAVED ADULTS: A PILOT STUDY ON FEASIBILITY, ACCEPTABILITY, AND SYMPTOM IMPROVEMENT Sarah Stahl

University of Pittsburgh

Introduction: Following the death of a spouse, many older adults have difficulty performing self-care activities. For example, they may feel no reason to wake up, eat meals, or go to bed on a regular schedule. Disruptions of these key social “time cues”, or zeitgebers, in turn decrease the stability of circadian rhythms, placing these individuals at high risk for major depressive disorder (MDD) and other adverse health consequences related to poor self-care. Preserving the stability of individuals’ time cues (sleep, meals, and physical activity) after the death of a spouse may reduce depression symptoms, thereby preventing the onset of MDD and promoting a healthy adaptation to bereavement. The purpose if this study is to examine the feasibility and acceptability of a behavioral intervention that is grounded in the circadian timing system and its impact on depression symptoms in older spousally bereaved adults. Methods: We developed the Widowed Elders’ Lifestyle after Loss (WELL), a pilot randomized controlled prevention trial of digital monitoring of sleep, meals, and physical activity for older spousally-bereaved adults who were at high risk for MDD. The design of WELL builds on prior studies addressing circadian rhythms in bereaved adults for the reduction of depression symptoms. The intervention arm involved 12 weeks of behavioral self-monitoring using a tablet-based app (designed by the STS), in which older adults aged 60+ track the timing and regularity of sleep, meals, and physical activities. Participants in the intervention arm also received weekly motivational health coaching. Participants were assessed at baseline, directly after the 12-week intervention period, and then at 3, 6, and 9 months post-intervention using structured diagnostic interviews and symptom rating scales. Participants in the enhanced usual care arm who reported new depression symptoms were referred to their primary care physician, as in the intervention arm. The primary outcomes of the trial were feasibility and acceptability of intervention components. The secondary outcomes were change in depression symptoms. Actigraphic technology was used to examine the 24-hour rest-activity rhythm − a downstream indicator of the circadian clock − as a mediator of depression outcomes. Results: WELL randomized 50 participants, 96.2% of eligible and 34.5% of all older adults screened. Participants in the treatment arms were similar at baseline in structured self-reports. WELL was rated highly by participants; 88% were compliant in digital monitoring and 96% were retained over follow-up. One comment speaks for many in that “WELL helped organize my life.” Depression symptom burden in the intervention arm significantly declined over follow-up, compared to enhanced usual care. There was a significant increase in the regularity of participants’ rest-activity rhythm from pre- to post-intervention. The significant increase in rhythm regularity was correlated with reductions in depression symptoms, as measured by the Hamilton Rating Scale for Depression. These data will be used in confirmatory clinical trial of efficacy. Conclusions: A behavioral intervention that is based on the circadian timing system, using both digital monitoring and motivational health coaching, appears to be feasible and acceptable to participants. An intervention that targets the regularity of day- and nighttime activities may reduce depression in older spousally-bereaved adults. The methodological innovations of this project may advance the field of late-life depression prevention. This research was funded by: Supported in part by NIH MH103467

Poster Number: EI - 46 A COMPLEX CASE OF DIAGNOSING BEREAVEMENT Madison Malone; Neil Mori; Adriana P. Hermida

Emory University School of Medicine

Introduction: Diagnostic criteria regarding mood symptoms that develop after the loss of a loved one have changed signiﬁcantly with the introduction of the DSM V. The DSM V provides additional guidance regarding the diagnosis of several disorders in the setting of a loss. These include normal grief, Major Depressive Disorder, Persistent Complex Bereavement Disorder with or without traumatic bereavement, and PTSD. However, accurate diagnosis may still pose a challenge, as the symptoms of these diagnoses have signiﬁcant overlap especially when the loss is in the context of trauma. A case that highlights this diagnosticchallengewillbepresented.Thiscasealsoillustratestheimportanceof

Am J Geriatr Psychiatry 27:3S, March 2019 S155 AAGP Annual Meeting 2019 gaining a thorough understanding of a patient’s symptoms and associated thought content to distinguish between diagnoses. Methods: Ms. A is a 70-year-old patient seen in the geriatric psychiatry clinic for depressive symptoms one year after the traumatic death of her longtime boyfriend. He had a cardiac arrest in their home, and she provided CPR until EMS arrived and took him to the hospital where he later passed. Despite the time that has lapsed, she still thinks of the circumstances surround his death quite often, and she feels significant guilt about his passing and about what more she could have done to save him. She also reports flashbacks to the event where she sees herself doing CPR on him, though she has no avoidance behaviors and goes on dates occasionally. Though she feels like she is slowly ‘getting over’ the loss, she has had worsening middle insomnia, lack of energy, and mild anhedonia for the past few months. Her mood is intermittently poor, feeling irritable and isolative for parts of the day and lasting for a few hours each time. She has had some weight gain, but no changes in concentration or appetite. She also denies thoughts of death and dying, and does not have thoughts of wanting to join her boyfriend in death. Results: Testing included MOCA: 23/30, GAD-7: 2, DAST-10: 0, PHQ-9: 4. She did not meet diagnostic criteria for MDD or PTSD. As her symptoms have persisted more than 6 months after the stressor, Adjustment Disorder is not an appropriate diagnosis. Her final diagnosis was determined to be Persistent Complex Bereavement Disorder with Traumatic Bereavement. She was referred for psychotherapy, and an SSRI was deferred because of her wish to minimize medications. She was also started to trazadone 50mg at night for symptomatic relief of her sleep disturbance. Conclusions: Understanding the subtleties of these symptoms is paramount in establishing an accurate diagnosis and therefore referring patients to the most effective therapy. This case demonstrates some complexities of psychiatric diagnosis in the setting of grief in the context of trauma. As part of this case presentation, a chart comparing symptoms among the differential diagnoses will be outlined. This research was funded by: None PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000371/AAGP2019-000371_Fig1.pdf

Poster Number: EI - 47 LONGITUDINAL TRENDS IN INCIDENCE AND PREVALENCE OF DELIRIUM IN THE INTENSIVE CARE UNIT Kyle Hendrie1,2; Sikandar Khan1,3; Anthony Perkins4; Sujuan Gao4; Babar Khan1,3; Malaz Boustani1,5,6,7,8

1Indiana University Center of Aging Research, Regenstrief Institute, Indianapolis, IN 2Marian University College of Osteopathic Medicine 3Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 4Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana 5Indiana University Center of Health Innovation and Implementation Science, Indianapolis, IN 6Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, IN 7Division of Geriatrics and General Internal Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 8Indiana Clinical and Translational Research Institute, Indiana University School of Medicine, Indianapolis, Indiana

Introduction: Delirium in the intensive care unit (ICU) is associated with increased risk of dementia, institutionalization following hospital discharge, and increased risk of death in patients older than 65. While recent efforts have been made to prevent delirium, any change in delirium incidence has not been described. The aim of this study was to determine the longitudinal incidence and prevalence of ICU delirium. Methods: Data was obtained from participants enrolled in a randomized clinical trial testing the effectiveness of a multicomponent delirium reduction strategy (PMD trial). They were admitted to the medical-surgical ICU at an urban, academic-afﬁliated hospital between May 2009 and January 2014. Twice daily sedation and delirium assessments were performed using the Richmond Agitation Scale Score (RASS), and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), respectively. Demographic and clinical data was obtained from the study and the Regenstrief Medical Record System (RMRS). A mixed effects logistic regression model was used to determine longitudinal trends in incident and prevalent delirium, and odds of delirium were reported with 2014 as reference year. Results: In this study, 3381 patients were included. The mean age of the study sample was 57.7 years (SD 16.0), with 33% (n=1114) over the age of 65. The overall prevalence of delirium was 19.6% (n=663), and overall incidence was 28.1% (n=209). Delirium prevalence and incidence decreased yearly. The odds ratio for delirium prevalence was 3.32 in 2009 (95% CI 2.13- 5.16, p<0.0001) which decreased to 3.17 in 2011 (95% CI 2.10-4.79, p<0.0001) and 2.21 in 2013 (95% CI 1.42-3.46,

S156 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 p=0.0001). A similar decreasing trend was seen for delirium incidence where the odds ratio in 2009 was 5.56 (95% CI 2.77- 11.52, p<0.0001) and 3.85 in 2011 (95% CI 2.02-7.33, p<0.0001). While this trend was maintained in 2012 and 2013, the yearly decrease in odds ratios for delirium incidence was not statistically signiﬁcant (2012 OR= 2.03, 95% CI 1.00-4.09, p=0.048; 2013 OR = 1.71, 95% CI 0.82-3.57, p=0.152). Conclusions: We found a longitudinal decrease in delirium incidence and prevalence observed in this study. Further research is needed to analyze whether this decrease may be associated with implementation of bundled care programs to prevent delirium, especially in elderly adults who are at greater risk of complications following delirium. This research was funded by: MB is supported by NIA R01 AG040220-05, AHRQ P30 HS024384-02, CMS 1 L1 CMS331444-02-00 and NIA R01 AG030618-05A1. BK is supported by NIA K23-AG043476.

Overall Cohort Incidence Cohort Admission Year OR 95% CI Low 95% CI High P-Value OR 95% CI Low 95% CI High P-Value 2009 3.32 2.13 5.16 <.0001 5.65 2.77 11.52 <.0001 2010 6.98 4.60 10.58 <.0001 6.22 3.19 12.11 <.0001 2011 3.17 2.10 4.79 <.0001 3.85 2.02 7.33 <.0001 2012 2.38 1.55 3.64 <.0001 2.03 1.00 4.09 0.048 2013 2.21 1.42 3.46 0.001 1.71 0.82 3.57 0.152 2014 (Reference) 1.00 1.00

Poster Number: EI - 48 ATORVASTATIN IN THE TREATMENT OF LITHIUM-INDUCED NEPHROGENIC DIABETES INSIPIDUS: THE PROTOCOL OF A RANDOMIZED CONTROLLED TRIAL Jocelyn Fotso Soh1; Gabriela Torres-Platas2; Serge Beaulieu3; Outi Mantere3; Robert Platt4; Istvan Mucsi5; Sybille Saury3; Suzane Renaud3; Andrea Levinson6; Ana Andreazza6; Benoit Mulsant6; Daniel Mueller6; Ayal Schaffer7; Annemiek Dols8; Nancy Low9; Pablo Cervantes9; Nathhan Hermann7; Birgitte Christensen10; Francesco Trepiccione11; Tarek Rajji6; Soham Rej1

1Geri-PARTy Research Group, Jewish General Hospital 2Jewish General Hospital (Montreal) 3Douglas Mental Health University Institute 4Department of Epidemiology, Biostatisitcs and Occupational Health, McGill University Health Centre 5University Health Network, University of Toronto 6Centre for Addiction and Mental Health, University of Toronto 7Sunnybrook Research Institute, University of Toronto 8Department of Psychiatry, Geest, Amsterdam 9Department of Psychiatry, McGill Health University Centre 10Department of Biomedicine, University of Aarhus, Denmark 11Department of Nephrology, Univeristy of Naples, Italy

Introduction: Lithium is the gold-standard treatment for bipolar disorder, is highly effective in major depressive disorder, and is being investigated for therapeutic benefits in dementia, stroke, and even cancer. Approximately 350,000 Canadians use lithium and more could benefit. Despite this, clinicians are avoiding lithium, largely due to fear of renal toxicity, including irreversible chronic kidney disease (CKD). Nephrogenic Diabetes Insipidus (NDI) occurs in 20% of lithium users and independently predicts a 2-3 times increased risk of CKD. To date, amiloride is the only medication with randomized controlled trial (RCT) evidence for treating NDI, however it can increase lithium toxicity risk. There is a need for novel, well-tolerated treatments for NDI. We recently found that statins are associated with lower NDI risk in a cross-sectional study (n=71 lithium users). 0% (0/17) of statin users compared to 20.4% (11/54) of non-users had NDI (p=0.055), with atorvastatin 10-40mg/day being the main statin used. Mice studies from our collaborators have also been promising. We present the protocol for a pilot human RCT of statins in NDI to guide a larger confirmatory RCT. Methods: We propose a 12-week, double-blind placebo-controlled pilot RCT of atorvastatin in patients with lithium-induced NDI. We will recruit 60 psychiatric patients, aged 18-85, who are on a stable lithium dose for ≥2 months and who have NDI, defined as a 10-hour fluid restriction urine osmolality (UOsm) <600mOsm/Kg. This RCT will be performed at the Jewish General Hospital and Douglas Institute (McGill University, Canada). We will randomize patients to atorvastatin (20mg/day) or placebo for 12 weeks and examine whether this improves measures of NDI: 10-hour water-restriction urine osmolality (primary outcome), Urine Volume (mL/24h), and Self-Reported Fluid Intake. Atorvastatin and placebo groups will be compared for main

Am J Geriatr Psychiatry 27:3S, March 2019 S157 AAGP Annual Meeting 2019 outcomes using repeated measures ANOVA. Whether atorvastatin treatment affects aquaporin (AQP2) excretion will also be assessed. Results: The protocol of this study will be presented. Results will be ready in late 2019. Conclusions: Atorvastatin is found to be useful in treating NDI, lithium could be used more safely in patients with a reduced subsequent risk of CKD, as well as hypernatremia, and acute kidney injury (AKI). This could also allow many additional patients with bipolar disorder, depression, and other psychiatric/neurological conditions to beneﬁt from lithium. This could also potentially prevent medical health service utilization related to psychiatric, neurological, and renal disease, saving signiﬁcant health costs. This research was funded by: Kidney Foundation of Canada

Poster Number: EI - 49 DISCONTINUATION OF CHRONIC BENZODIAZEPINE USE AMONG ADULTS IN THE U.S. Lauren Gerlach1; Julie Strominger1,2; Myra Kim1,2; Donovan Maust1,2

1University of Michigan 2VA Ann Arbor Healthcare System

Introduction: Benzodiazepine (BZD) use is common and growing in the U.S., with a prescription filled by 5.6% of adults in the U.S., including 8.6% of those ≥65. Clinical guidelines and expert opinion recommend that BZDs should primarily be prescribed on a short-term basis, yet chronic BZD use (i.e., >120 days) is common—ranging from 14.7% among those 18-35 who are prescribed a BZD to 31.4% among adults ≥65—and increasing. As chronic BZD use continues and grows, increasing numbers of adults in the U.S. will accumulate time at-risk for BZD-related harms. To understand more about patients with chronic prescription BZD use and which patients discontinue use, we evaluated 2014-2016 healthcare claims from a large U.S. health insurer. The objectives of this study were to: 1) determine the rate of BZD discontinuation among chronic users; 2) identify which patient clinical characteristics predict discontinuation; 3) determine whether additional non-clinical characteristics (e.g., geography, provider) are associated with discontinuation; and 4) determine the relative contribution of these patient and provider-level factors to BZD discontinuation. Methods: We performed a retrospective cohort study using nationwide insurance claims data (Optum Clinformatics Data Mart data) from 2014-2016 of U.S. adults ≥18yearsoldwithchronicBZDuse(i.e.,>120 days) during the baseline year. The primary outcome was BZD discontinuation among chronic users after one year of follow-up. A series of multilevel logistic regression models examined the association of BZD discontinuation with patient and provider characteristics and estimated variation in discontinuation attributable to provider. Covariates included patient sociodemographics, medical and psychiatric comorbidity, co-prescribed opioids and other psychotropics, and characteristics of the prescribed BZD. Results: Of 144,184 chronic BZD users, 13.2% discontinued use after one year. 57.0% of chronic BZD patients received an opioid prescription, which was more common than any clinical diagnosis. Census division was strongly associated with discontinuation (e.g., relative to the Mid-Atlantic, patients in the Pacific had an adjusted odds ratio [AOR] for discontinuation of 1.83 [99% confidence interval [CI] 1.60-2.10]). Females had lower odds of discontinuation (AOR 0.83, 99% CI 0.79-0.87), while African-American patients had higher odds (AOR 1.12, 99% CI 1.03-1.21). Those prescribed a high-potency BZD had lower odds of discontinuation (AOR 0.51, 99% CI 0.48-0.55), as did those prescribed an opioid (AOR 0.94, 99% CI 0.89- 0.99). After adjusting for patient and provider-level factors, differences between providers accounted for 5.8% of variation in BZD discontinuation. The median odds ratio for provider was 1.54, an association with discontinuation larger than almost all patient-level clinical variables. Conclusions: A small minority of patients prescribed chronic BZD in a given year are no longer prescribed BZDs one year later. The decision to prescribe and then discontinue a BZD—or any other medical treatment—should be driven by a clinical need. However, we found there is significant variation in the likelihood of discontinuation accounted for by non-clinical factors such as race, geography, and a patient’s provider. Given the harms associated with co-prescribing of BZDs and opioids, it is worrisome that use of a prescription opioid was more common among chronic BZD patients than any other clinical diagnosis and was associated with lower odds of BZD discontinuation and efforts should continue to focus on those co-prescribed opioids. Finally, since chronic BZD use is rarely the goal when a new BZD is started, clinicians may increase the likelihood of discontinuation by selecting a low-potency option. This research was funded by: Dr. Maust receives support from the Beeson Career Development Award Program (NIA K08AG048321, the American Federation for Aging Research, The John A. Hartford Foundation, and The Atlantic Philanthropies) and 1R01DA045705.

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Poster Number: EI - 50 VISUAL HALLUCINATIONS AS A SAFETY CONCERN IN THE ELDERLY Arushi Kapoor; Adeyeye Temitope; Valerie Dorcelus; Snezana Sonje

Howard University Hospital

Introduction: Between 30 and 40 percent of community-dwelling- people over the age of 65 years, and 50 percent of those in long-term facilities, fall each year. Fall-related injuries are associated with significant subsequent morbidity: the decline in functional status, increased likelihood of nursing home placement, and greater use of medical services. Complications arising from falls are the leading cause of death from injury in the geriatric population as mortality is three times higher for seniors sustaining falls compared to the younger individuals. Falls in older individuals are most often due to multiple causes, including age-related declines in balance and gait, superimposed by acute illness, medication, and cognitive impairment. Gait physiology includes the presence of at least two out of three intact sensory systems (visual, vestibular and somatosensory). With a diminished proprioception response due to age-related decline, impairment in either visual or vestibular system compromises gait and balance. In addition, the annual incidence of falling is approximately twice as high for patients with cognitive impairment and dementia as it is for people with no cognitive impairment. In the elderly, visual hallucinations have been particularly associated with dementia, delirium, visual impairment, and social isolation. As for prevalence, estimates vary widely from 10 to 29% of the elderly outpatients experienced visual hallucinations. Current literature is lacking data regarding falls associated with visual hallucinations. Methods: We present a case of an elderly female who was found on the ground status post fall out of her wheelchair while trying to run from new onset visual hallucinations that varied from two men to headless animals. Her initial assessment included delirium with possible underlying undiagnosed dementia (MOCA 20, MMSE 24/30), ruling out other causes of visual hallucinations including Lewy Body Dementia, Charles Bonnet and medication-induced psychosis. Results: As with many new-onset psychotic symptoms, organic causes were ruled out with negative findings on CT Head, Xray of femur and hip. Dementia workup including EEG was completed with negative findings. She continued to experience vivid visual hallucinations of animals and children during her hospital stay. Conclusions: Due to the limited research evaluating any causal relationships between visual hallucinations and falls in the geriatric population, further studies are recommended to assess the presence or absence of this causality. It is also crucial to screen for visual impairments, including visual hallucinations, in the high-risk geriatric population to minimize the fall risk and associated morbidity and mortality. Falls in older persons can occur commonly and are major factors threatening the independence of older individuals. This research was funded by: Funding: Not applicable

Poster Number: EI - 51 A CASE OF VERY-LATE-ONSET SCHIZOPHRENIA-LIKE PSYCHOSIS, AN UNDER- RECOGNIZED AND DISTINCT SYNDROME IN THE GERIATRIC POPULATION Natalie Sohn1; Christine Cummings1; Timothy R. Kreider1,2

1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell 2Department of Psychiatry, Zucker Hillside Hospital at Northwell Health

Introduction: Schizophrenia is classically viewed as a neurodevelopmental disorder that manifests at an early age. However, geriatric presentations of schizophrenia-like illness have been described, suggesting a distinct syndrome and warranting a diagnosis of very-late-onset schizophrenia-like psychosis (VLOSLP). Methods: A case from an acute geriatric psychiatry unit at an academic hospital is reported. Results: Ms. L was a 76-year-old single Barbadian woman with no prior psychiatric or medical history who presented for inpatient evaluation of persecutory delusions and auditory hallucinations in the context of increasing paranoid behavior over the past year. She believed her neighbors were placing recording devices in her home, stealing money from her bank account, trying to deport her, and take over her apartment. For two months, she had been hearing them talk about her and could also hear Donald Trump telling her she’d be deported. Her family history was signiﬁcant for a grandmother who had similar new onset of delusions and hallucinations at age 80. On exam, the patient was pleasant, cooperative, euthymic, linear, and alert and fully oriented. MMSE and MOCA performed on admission were both 29/30. Medical workup of psychosis was unrevealing and there was no recent medication or substance use. Her functional impairment due to the new symptoms was limited to slightly

Am J Geriatr Psychiatry 27:3S, March 2019 S159 AAGP Annual Meeting 2019 reduced sleep and eating (due to fear of poisoning by neighbors); she otherwise had maintained her ADLs, IADLs, and a busy social calendar with multiple volunteer activities. Conclusions: The case of Ms. L illustrates a rare presentation of ﬁrst episode of psychosis at advanced age with relative sparing of cognitive and functional status. This syndrome has been called very-late-onset schizophrenia-like psychosis. The poster will describe the features of this distinct syndrome and advocate for its inclusion in future diagnostic manuals. This research was funded by: none

Poster Number: EI - 52 EFFECT OF SEX DIFFERENCES ON INFLAMMATION IN SCHIZOPHRENIA: RELATIONSHIPS WITH SLEEP DISTURBANCES, COGNITIVE FUNCTIONING, AND CARDIOMETABOLIC RISK Ellen Lee; Suzi Hong; Lisa Eyler; Dilip Jeste

UC San Diego

Introduction: Persons with schizophrenia (SZ) have life expectancies that are 15-20 years shorter than the general population, primarily due to cardiovascular-related deaths. In addition to premature mortality, persons with SZ have high rates of disability largely due to cognitive deficits. While cardiometabolic risk as well as cognition are known to be associated with poor sleep and inflammation in the general population, this has not been systematically examined in persons with SZ, although SZ is associated with inflammatory pathology and sleep disturbances that predate the use of antipsychotic medications and accumulation of poor lifestyle habits. Within the general population, women have higher inflammatory marker levels and are more likely to have sleep disturbances and cognitive decline as they age. This study examines the link between sleep, cognition and cardiometabolic risk within persons with SZ, focusing on sex differences. Methods: The sample included 152 subjects with SZ (DSM-IV-TR criteria) and 141 non-psychiatric comparison (NC) subjects (age range 26 to 65 years; mean 48), with comparable sex and race distribution. We examined sleep (self-reported duration and quality), cardiometabolic risk [Framingham 10-year Risk of cardiovascular disease, high-sensitivity C-reactive protein or hs- CRP, insulin resistance using the Homeostatic Model of Assessment for Insulin Resistance or HOMA-IR], cognition [executive functioning (D-KEFS), overall cognitive functioning (TICS - modified)]; and blood-based inflammatory markers (TNF-a, IL-6, IL-10). In a subset of subjects, we also examined objective measures of sleep (total sleep time (TST), wake after sleep onset (WASO), latency, and efficiency) using wrist-worn actigraphy. The sleep-inflammation-cardiometabolic risk links were examined using Spearman’s correlations and general linear models with a backward elimination approach to trim the models. Results: The SZ group reported higher total sleep time and worse sleep quality, worse cardiometabolic risk, and increased levels of inflammatory markers compared to NCs. Within the SZ group, SZ men had higher Framingham Risk, lower hs-CRP and IL-6 levels, as well as better overall cognitive functioning than SZ women (Cohen’s d = -0.65, 0.48, 0.38, and -0.33, respectively.) In SZ men, shorter sleep duration and poor sleep quality was associated with higher IL-6 and TNF-a levels and better executive functioning. Within the SZ group, Framingham Risk was associated with sex (as expected), age, IL-6, TNF-a, and overall cognition such that younger women with lower levels of IL-6 and TNF-a as well as better overall cognition had lower Framingham Risk (partial eta- squared = 0.19, 0.27, 0.03, 0.04, and 0.02, respectively). The levels of hs-CRP and HOMA-IR were not associated with sex. The levels of hs-CRP was associated with age, IL-6 and overall cognition (partial eta-squared = 0.02, 0.19, and 0.08, respectively). HOMA-IR was associated with age, duration of sleep, sleep quality, IL-6, and overall cognition such that younger persons with longer sleep duration, better sleep quality, lower inflammation and better cognitive functioning had less insulin resistance (partial eta-squared = 0.02, 0.02, 0.05, 0.03, and 0.08, respectively.) Objective measures of sleep disturbances (TST, WASO) were associated with HOMA-IR, executive functioning, as well as levels of hs-CRP and IL-6. Conclusions: There are complexities in the associations of different inflammatory biomarkers with clinically meaningful measures of sleep, cardiometabolic health and cognition that reveal sex differences in SZ. Self-reported sleep disturbances and increased inflammation are associated in persons with SZ. Levels of inflammation and sleep disturbances, and their relationships, were sex-dependent in the SZ group, but not the NC group. Longitudinal examination of the sleep-inflammation links, their contribution to clinical outcomes, and the relationship with objective sleep measures and sex-specific factors is warranted. This research was funded by: This study was supported, in part, by the National Institutes of Health (grant R01MH094151-01 to DVJ [PI]), by the National Institute of Mental Health T32 Geriatric Mental Health Program (grant MH019934 to DVJ [PI]), by the Stein Institute for Research on Aging at the University of California San Diego, and by the National Institutes of Health, Grant UL1TR001442 of CTSA funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Poster Number: EI - 53 REDUCING INAPPROPRIATE BENZODIAZEPINE USE AMONG OLDER ADULTS Tomorrow Wilson; Evelina Kutyma; Julie Strominger; Frederic Blow; Donovan Maust

University of Michigan

Introduction: Benzodiazepine use in the United States is common and increases with age, used by 8.7% of patients aged 65- 80 years (Olfson, King, & Schoenbaum, 2015). Benzodiazepines—which include well-known medications such as Xanax, Ativan, and Klonopin—are most commonly used for anxiety and insomnia, even though psychotherapy and alternative medications are now recommended preferentially over benzodiazepines (Baldwin, Woods, Lawson, & Taylor, 2011; Smith et al., 2014; Wu, Appleman, Salazar, & Ong, 2015). Use is a particular concern among older adults, given the links between benzodiazepine prescribing and a variety of adverse outcomes including falls (Woolcott et al., 2009), fractures (Wang, Bohn, Glynn, Mogun, & Avorn, 2001) and motor vehicle accidents (Dassanayake, Michie, Carter, & Jones, 2011). Attempts to reduce benzodiazepine use have met with limited success in the real world, as patients are reluctant to consider the possibility of stopping them and providers may be reluctant to suggest the possibility. In the course of a brief return visit in primary care, providers may not have the time or incentive to engage in a potentially difficult, lengthy discussion with patients about reducing or stopping their benzodiazepine. The goal of this project was to evaluate direct patient education compared to direct patient education paired with additional support and encouragement from a care manager in order to reduce chronic benzodiazepine use. Strategies to help reduce benzodiazepine use are of great interest to providers and our findings would have significance for all providers, and may even conceivably improve the care of patient both inside and outside the Medicaid program. Methods: We used electronic health records of four clinics in southeast Michigan to identify patients aged 50 and older who were prescribed benzodiazepines for ≥20% of days over the past 12 months (i.e., someone that gets ≥3 £ 30-day supplies would be included). Patients that agreed to participate completed a brief baseline interview about their benzodiazepine use as well as symptoms of anxiety, depression, and insomnia. Participating patients received an 8-page educational brochure informed by motivational enhancement that presented information about the potential harms of benzodiazepine use and suggested patients consider talking with their physician about possibly reducing use. Patients were contacted again at 3 and 6 months to determine whether they discussed benzodiazepine use with their providers and whether symptoms had changed. Change in daily use of benzodiazepines was assessed using the electronic health record. Results: Data collection has recently completed. Analyses presented will entail repeated measures ANOVAs examining changing in daily doses from baseline through the 3- and 6-month check-ins. T-tests will be conducted to examine group differences between those who discussed use with their providers or pharmacist and those who did not. Additional t-tests and chi-squares will also be conducted to examine sample characteristics (e.g., gender or other substance use) that may be associated with talking to one’s providers or pharmacist. Resulting data will be presented after the above analysis is complete. Conclusions: Participants’ benzodiazepine use, alcohol and illicit drug use, as well as possible risk or protective factors will be discussed. Results will inform development of direct patient education initiatives to reduce benzodiazepine use and benzodiazepine-related harms among older adults. This research was funded by: Support for this work provided by the Ravitz Family Foundation.

Poster Number: EI - 54 PHARMACOTHERAPY FOR SUBSTANCE USE DISORDERS AMONG OLDER ADULTS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS Rajesh Tampi1,2; Aarti Chhatlani3,4; Hajra Ahmad3,4; Kripa Balaram3,4; Joel Dey3,4; Ricardo Escobar3,4; Thejasvi Lingamchetty3,4

1Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, Ohio 2Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio 3Department of Psychiatry, MetroHealth, Cleveland, Ohio 4Case Western Reserve University School of Medicine, Cleveland, Ohio

Introduction: Substance use disorders are a growing problem among older adults that is largely unexplored and unaddressed. Acamprosate, disulﬁram, and naltrexone are Food and Drug Administration (FDA) approved for the treatment of alcohol use disorder and buprenorphine is approved for the treatment of opiate use disorder. There is limited data on the use of these medications for the treatment of substance use disorders among older adults. The purpose of this review is to systematically review the literature on the efﬁcacy and tolerability of these medications for the treatment of substance use disorders in the older adults.

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Methods: We performed a literature search of PubMed, MEDLINE, Cochrane, and Google Scholar. The search was restricted by age. Only double-blinded, randomized control trials published in English language were included in the final analysis. Results: Two articles that evaluated the use of pharmacologic treatment of substance use disorders in the older adults were identified. One trial evaluated the use of naltrexone when compared to placebo for the treatment of alcohol use disorder among individual ≥ 55 years in age. The other trial evaluated the use of naltrexone or placebo as adjuncts with sertraline in the treatment of alcohol use disorder among individuals ≥55 years in age. Both trials indicated that the use of naltrexone had efficacy in reducing the rates of relapse among older adults with alcohol use disorder. We did not identify any randomized controlled trials that studied the use of buprenorphine, acamprosate, or disulfiram for substance use disorders among older adults in this systematic review. Conclusions: This systematic review indicates that naltrexone is effective for the treatment of alcohol use disorder among older adults. Data from controlled trials on the use of other medications that are FDA approved for the treatment of substance use disorders among younger adults is nonexistent among older adults with substance use disorders. This research was funded by: Not applicable.

FIGURE 1. PRISMA Flow Diagram

TABLE 1. Summary of included studies Total number Name and year of study of participants Age (years) Type of setting Comparators Duration Oslin et al, 1997 44 50-70 Veterans Affairs (VA) Naltrexone vs placebo 12 weeks Oslin DW, 2005 74 ≥55 Outpatient Naltrexone + sertraline vs 12 weeks Placebo + sertraline

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TABLE 3. Summary of results from included studies Name of study Outcomes Tolerability Limitations Oslin D et al Drank alcohol: 1.9% of days in the nal- Sleep disturbances and anxiety were Small number of subjects trexone group vs 6.5% of days in the the most common side effects. Method of assessment was placebo group, P=0.275 Naltrexone: depression, sedation, self-report Relapse occurred in 25% of all clinical constipation subjects: 14.3% in the naltrexone group Placebo: memory lapse, asthma vs 34.8% in the placebo group, P=0.117 attack, “ﬂeeting thoughts” and fre- Sampled alcohol, relapsed: 3 of 6 in the quent urination naltrexone group vs 8 of 8 in the pla- No medication effect prevented sub- cebo group, P=0.024 jects from dropping out of study. No differences in abstinence rates between the two groups, P=0.659 No effect in prolonging abstinence between the two groups, P = 0.532 Oslin DW Relapsed: 35.1% in the naltrexone group Common adverse events during Small number of male vs 32.4% in placebo group, OR: 1.25, noted during treatment: veterans P=0.690 58.1% headache Method of assessing was Abstinent: 43.2% in the naltrexone group 51.4% anxiety self-report vs 54.1% in the placebo group, OR: 41.9% nausea Measured outcomes were 1.34, P=0.575 39.2% decreased sexual functioning dually dependent on Depression remitted: 51.4% in the nal- 24.3% vomiting depression remission and trexone group vs 54.1% in the depres- Adverse effects were no different lack of relapse on alcohol sion group, OR: 1.40, P=0.537 between the two groups Overall improvement: 40.5% in the nal- Symptoms were not related to com- trexone group vs 43.2% in the depres- pletion of the trial or to adherence sion group, OR: 1.40, P=0.537 to the medication

Poster Number: LB - 1 URINARY INCONTINENCE AND DEPRESSION: A LONGITUDINAL ANALYSIS IN MALES Nikita Bodoukhin; Benjamin Hellman; Grettel Castro; Carlos Salgado; Juan Ruiz-Pelaez

Florida International University Herbert Wertheim College of Medicine

Introduction: Urinary incontinence (UI) is a prevalent problem in retirement-aged males that has long been suspected to have significant social consequences. UI has been demonstrated as a significant risk factor for developing depression in retirement- aged females, but this association has been relatively unexplored in males of the same age group. Methods: Study Design and Setting: A secondary data analysis was performed on the Health and Retirement Study cohort, a study of adults 51-61 years at recruitment when the first wave was assembled in 1992; all participants were followed up every two years. Information on UI is available from 1996 onwards. Data from biennial follow up of men from 1996 until 2014 was used. Men with probable depression at baseline were excluded from analysis. Variables: The outcome of interest was probable depression, defined as a score of ≥3 on the 8-item Center for Epidemiologic Studies-Depression scale. UI was defined based on questions about experience of urine loss. Statistical Analysis: Data was then analyzed using a time-dependent recurrent event survival analysis by Cox regression employing the counting process approach. Hazard estimates were adjusted for demographic, psychosocial and health status variables found to confound the association between UI and the outcome of interest. In the final multiple-failures-per-subject model, all variables were treated as time-dependent with the exception of race and ethnicity. As a test of our methodology, we ran the previously described analysis using a female sample and were able to replicate a previously reported association between UI and developing depression. Results: Our final model included 8,897 men. Notable baseline characteristics of the study population include 8% of men reporting incontinence in the past year. Additionally, 0.6% were living in a nursing home at entry into the study. A history of psychiatric disease was reported by 7%. Time-dependent recurrent event survival analysis by Cox regression employing the

Am J Geriatr Psychiatry 27:3S, March 2019 S163 AAGP Annual Meeting 2019 counting process approach yielded an unadjusted hazard ratio of 1.9 (95% CI: 1.7, 2.0). Adjusting for these confounders in a time-dependent fashion yielded a hazard ratio of 1.3, (95% CI: 1.1, 1.4). Conclusions: Urinary incontinence is positively associated with incident depression in previously non-depressed retirement-age men. Increased awareness on the part of treating physicians to the beneﬁt of patient’s psychosocial welfare is warranted. Limitations included using surrogate probable depression using CES-D score over three instead of clinical diagnosis and many participants were excluded based on incomplete data. Additionally, urinary incontinence was assessed based on previous 12 months, whereas depression only based on the previous week making a temporal interaction more difﬁcult to assess. This research was funded by: Not applicable PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000481/AAGP2019-000481_Fig1.pdf

Adjusted Hazards for Developing Depression Characteristic HR 95% CI P>z Incontinence 1.3 1.1 - 1.4 <0.001 Age 1.0 1.0 - 1.0 0.810 Race Black 1.0 0.9 - 1.2 0.835 Other 1.1 0.9 - 1.3 0.477 Hispanic ethnicity 1.3 1.1 - 1.5 0.003 Education HS/GED/Some College 0.8 0.7 - 0.9 <0.001 Bachelor’s or above 0.6 0.6 - 0.7 <0.001 BMI 18-24.9 0.8 0.5 - 1.3 0.378 25-29.9 0.8 0.5 - 1.3 0.355 >=30 0.8 0.5 - 1.4 0.466 Smoking status Former smoker 1.2 1.1 - 1.3 0.001 Current smoker 1.5 1.3 - 1.8 <0.001 Heart disease 1.2 1.1 - 1.3 <0.001 Diabetes 1.2 1.1 - 1.3 0.001 Cancer 1.2 1.1 -1.4 0.001 Psychiatric illness 2.2 2.0 - 2.5 <0.001 Stroke 1.0 0.9 - 1.2 0.791 Alcohol use >3 days/week 1.0 0.9 - 1.1 0.911 Prostate Screening 1.0 0.9 - 1.1 0.432 Difﬁculty with IADL 1.3 1.1 - 1.5 <0.001 Difﬁculties with ADL 1-3 2.4 2.2 - 2.7 <0.001 4-5 2.1 1.6 - 2.7 <0.001 Living alone 1.6 1.4 - 1.8 <0.001 Nursing home resident 0.3 0.2 - 0.5 <0.001

Poster Number: LB - 2 DETERMINANTS OF SUICIDAL IDEATION IN OLDER ADULTS WITH MAJOR DEPRESSION − ASSOCIATIONS WITH PERCEIVED STRESS David Bickford1; Ruth Morin1,2; J. Craig Nelson1; R. Scott Mackin1,2

1University of California, San Francisco 2San Francisco Veterans Affairs Medical Center

Introduction: Depression has been strongly linked to suicide ideation in older adults. However, the role of other factors is less clear. Perceived stress is a factor that is emerging as a potential contributing factor in suicide ideation in older adults. We hypothesized higher levels of perceived stress would be associated with increased self-reported suicidal ideation independent of depressive symptom severity in older adults with LLD. Methods: This study used data from community-dwelling older adults aged 65 with current diagnosis of major depression. Eligible participants completed measures of depression symptom severity (Hamilton Depression Rating Scale-17 item), current suicidal ideation (Geriatric Suicide Ideation Scale; GSIS), and perceived stress (Perceived Stress Scale; PSS). Statistical analyses

S164 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 were conducted using SPSS version 20. Descriptive statistics, including demographic and clinical characteristics of the participants were obtained. A linear regression analysis was then conducted, assessing the relationship of perceived stress to suicidal ideation, controlling for the effects of age, education, gender, and depression symptom severity. R2 were then calculated based on standardized beta values in the final model. Results: Participants were 225 older adults with a mean age of 71.4 (SD = 5.6), who were 64.9% female. Sixteen percent of the variance in suicidality (GSIS total score) was accounted for by the variables assessed. In particular, lower education (B = ¡.13, p = .04), male gender (B = ¡.13, p = .04), greater depression severity (B = .15, p = .02) and higher current perceived stress (B = .32, p < .001) were all significantly associated with higher suicidality ratings. In this model; perceived stress accounted for 10.1% of the variance in suicide ideation ratings, over half of the variance explained by the total model. Conclusions: Our findings suggest that increased perceived stress might be a particularly important factor of those more likely to think about suicide. Perceive stress may thus be a useful factor that could improve early identification and intervention of suicide ideation among late life depression patients at a high risk for suicidal behaviors. Mechanisms and coping strategies to reduce perceived stress could be directly implemented in depressed patients with suicidal ideation. Further research is warranted on perceived stress in relation to suicidal ideation. This research was funded by: This work was supported by R01 MH0977669: (PI:Mackin), R01 MH101472 (PI:Mackin); UCSF Epstein Endowment Fund

Geriatric Suicide Ideation Measure GSIS Total Score Independent Variables std beta p R2 Age .014 .82 0.02% Education ¡.129 .04 1.66% Gender ¡.129 .04 1.66% HAMD17 .148 .02 2.19% PSS Total Score .321 <.001 10.30%

Poster Number: LB - 3 PERSISTENT INTRINSIC FUNCTIONAL NETWORK CONNECTIVITY ALTERATIONS IN MIDDLE-AGED AND OLDER WOMEN WITH REMITTED DEPRESSION Jennifer Vega1; Kimberly Albert1; Jason Gandelman1; Brian Boyd1; Paul Newhouse1,2; Warren Taylor1,2

1Vanderbilt University Medical Center, 2VA TVHS Geriatric Research Education and Clinical Center (GRECC)

Introduction: In younger populations, residual functional neural network alterations persist in remitted depression, yet there are less data for older adults who are at high risk of recurrence. This study tested for differences in intrinsic network functional connectivity in midlife and older women with remitted depression. Methods: 69 women (24 with a history of depression and 45 with no psychiatric history) over age 45 entered the study and completed 3T MRI with a resting state acquisition. Participants with past depression met DSM-IV-TR criteria for an episode in the last 10 years, but not in the prior year. Whole-brain seed-to-voxel analyses examined the default mode network (DMN), executive control network (ECN), and salience network (SN), plus bilateral hippocampal seeds. All analyses adjusted for age and were conducted with a cluster FDR correction of p < 0.05 and a height threshold of p < 0.001 uncorrected. Results: Women with a history of depression exhibited decreased connectivity between the SN, using a right insula seed, and ECN regions, speciﬁcally the left superior frontal gyrus. They also exhibited increased connectivity between the left hippocampus and the left postcentral gyrus. We did not observe any differences in connectivity for DMN or ECN seeds. Conclusions: Remitted depression in women is associated with connectivity differences between the SN and ECN, and between the hippocampus and the postcentral gyrus, a region involved in interoception. Further work is needed to determine whether these ﬁndings are related to functional alterations and whether they are related to recurrence. This research was funded by: K24 MH110598

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Poster Number: LB - 4 ANTIDEPRESSANTS FOR ANXIETY DISORDERS IN LATE-LIFE: A SYSTEMATIC REVIEW Meera Balasubramaniam1; Pallavi Joshi2; Poorvanshi Alag3; Sheila Gupta4; Stephen Maher1; Deena Tampi5; Aarti Gupta6; Juan Young3; Rajesh Tampi7

1NYU School of Medicine 2Northwell Health-Staten Island University Hospital 3MetroHealth 4SUNY Buffalo 5Diamond Healthcare 6Yale School of Medicine 7Cleveland Clinic

Introduction: Anxiety disorders are encountered frequently in late life, and contribute to distress, disability, and increased mortality. Late-life GAD has been linked to increased risk of incident stroke [3]. Anxiety is associated with an increased risk for cognitive impairment and dementia in community dwelling older adults independent of psychosocial risk factors [6]. Despite these impairments, late-life anxiety disorders are largely untreated in primary care, with only 36.3% of recurrent cases in a community sample receiving treatment [7]. Antidepressants are considered to be first-line pharmacological treatment for anxiety disorders [8]. Current evidence for the treatment of anxiety disorders in the elderly is extrapolated from studies on younger adults. However, older adults suffer from medical conditions that affect renal, hepatic, and cardiac function. Pharmacokinetic considerations such as variable drug absorption and decreased volume of distribution may also contribute to reduced safety and tolerability of antidepressants in the elderly [5]. To date, there has not been a systematic review on the use of antidepressants for anxiety disorders in older adults. The aim of this systematic review is to provide updated information on the efficacy and tolerability of antidepressants in treatment of anxiety disorders among older adults from randomized controlled studies. Methods: This systematic review was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The objective of this review is to summarize the results from published randomized controlled clinical trials of antidepressants for late-life anxiety. We performed a literature search of PubMed, MEDLINE, EMBASE, PsychINFO, and Cochrane collaboration databases through October 18th, 2018, using the following keywords: “late life”, “elderly”, aged, “senior citizen”, or “geriatric” combined with the keywords “anxiety” or “anxiety disorder”, and “antidepressant” or “antidepressive agents” or their pharmaceutical names. The search was restricted to English-language studies conducted in human subjects. We reviewed the bibliographic databases of the published articles for additional studies. Results: Our search yielded a total of 12 randomized controlled trials. Two of these studies [14, 15] were pooled analyses of randomized controlled trials, which have been included as they fulfilled our selection criteria. We found 8 trials of selective serotonin reuptake inhibitors (SSRIs): 3 studies on sertraline [16, 17, 18], 2 each on citalopram [19, 20] and escitalopram [21, 22], and 1 trial of paroxetine [23]. We found 3 studies on serotonin-norepinephrine reuptake inhibitors (SNRIs), including 1 study on duloxetine [24], and 1 study each on duloxetine [14] and venlafaxine [15] reporting pooled analyses. There was 1 study of a tricyclic antidepressant (TCA), namely imipramine [25]. Three studies were rated “good”, 8 were rated “fair” and 1 was rated “poor” according to our quality appraisal criteria. Conclusions: This systematic review supports the use of antidepressants as an efficacious and well-tolerated treatment option for late-life anxiety. Future research should focus on other anxiety disorders such as phobias and post-traumatic stress disorders, and should include older adults as well as those with cognitive impairment to increase their generalizability to community settings. Long term trials are needed to assess the efficacy of antidepressants in maintenance and prevention of relapse of anxiety, and provide necessary data on long-term tolerability. Head-to-head trials of antidepressants and other agents used for anxiety such as gabapentin and quetiapine are needed to compare their efficacy and safety. Future studies should include treatment modalities commonly used in the elderly such as problem-solving therapy, as well as newer modes of service delivery such as tele-psychiatry and home-visits to conceptualize efficacious treatment options for anxiety disorders in late-life that are commonly encountered in clinical settings. This research was funded by: The authors did not receive any funding for this study

Poster Number: LB - 5 ELECTROCONVULSIVE THERAPY FOR THE TREATMENT OF ACUTE AGITATION AND AGGRESSION IN ALZHEIMER’S DEMENTIA (ECT-AD) Brent P. Forester1; Emily Mellen1; Liana Mathias1; Patrick Monette1; Aniqa Rahman1; David G. Harper1; Martina Mueller2; Rebecca Knapp2; Adriana Hermida3; Louis Nykamp4; Maria Lapid5; Stephen Seiner1; Georgios Petrides6

S166 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019

1McLean Hospital, Belmont, MA 2Medical University of South Carolina, Charleston, SC 3Emory University Medical School, Atlanta, GA 4Pine Rest, Grand Rapids, MI 5Mayo Clinic, Rochester, MN 6The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY

Introduction: Alzheimer’s disease (AD) is the most prevalent neurodegenerative disease of aging, affecting approximately 5.4 million individualsintheUS,andpredictedtoincreaseto13.8millionby 2050. Occurring in over 90% of AD patients, neuropsychiatric symptoms such as agitation, depression and apathy, contribute to caregiver burden and increase patient morbidity and mortality. With no FDA-approved options available, treatments for severe agitation in people with advanced dementia are limited, with modest evidence for efficacy and substantial safety concerns. Behavioral therapies are recommended as first-line treatments for agitation in AD; however, they require substantial time to take effect and may be less efficacious for the most severely agitated patients. Psychotropic medications, especially antipsychotics, are widely used off-label to treat agitation in AD even with documented limitations in efficacy and safety concerns. Therefore, new treatments for severe agitation in AD refractory to standard interventions are timely and warranted. Randomized controlled trials have demonstrated the safety and efficacy of electroconvulsive therapy (ECT) for the treatment of severe psychiatric disorders of late life, including depression, mania and psychosis. Recently, small open label studies suggest efficacy and safety of ECT for agitation in individuals with AD who are refractory to standard therapies. The present randomized controlled trial builds upon prior work and aims to determine the efficacy and safety of ECT for severe agitation in moderate to severe stage AD, while also examining the durability of the acute treatment effect in an exploratory maintenance naturalistic design. Methods: We describe an NIA-funded multi-site, single blind, randomized trial of ECT plus usual care (UC) versus Simulated- ECT (S-ECT) plus UC. We will enroll 200 inpatients with severe agitation and moderate to severe dementia, who have not responded well to prior trials of psychotropic medications. Our primary efficacy outcome measure is the Cohen Mansfield Agitation Inventory (CMAI), and the Neuropsychiatric Inventory − Clinician Version (NPI-C), Alzheimer’s Disease Cooperative Study-Clinical Global Impression of Change Scale (ADCS-CGIC), and Pittsburgh Agitation Scale (PAS) will be secondary measures. Safety and tolerability will be assessed with the Severe Impairment Battery − 8 item (SIB-8), the Confusion Assessment Method (CAM), and adverse event monitoring. Results: Preliminary open-label data from our team suggests acute ECT treatment is safe and effective in reducing agitation in this population as measured by the CMAI, PAS, CGI, and adverse event monitoring. A multi-site, prospective case series investigated ECT treatment in 23 consecutive inpatients with dementia and severe agitation who did not benefit from standard behavioral interventions and pharmacotherapy. Eighteen of the 23 subjects experienced a significant reduction in agitation from baseline to discharge on the CMAI. In a retrospective chart review study of 16 patients undergoing ECT for agitation related to AD, only two experienced more than transient confusion post-ECT that required treatment, and no other clinically significant adverse events were noted in this group. We hypothesize ECT+UC will be more efficacious in reducing severe agitation in AD subjects than S-ECT+UC, as measured by our primary and secondary efficacy measures, and that there will be no difference in tolerability/safety outcomes for ECT+UC and S-ECT+UC as measured by cognitive decline (SIB-8), development of delirium (CAM), and serious adverse event monitoring. Conclusions: This innovative study will fill a gap in the current clinical practice of treating severe agitation in AD using a rigorous methodological approach thus providing evidence for a new therapeutic application (severe agitation in AD) of a well- studied, established, and safe treatment (ECT). Study findings may demonstrate support for a new therapeutic use of ECT for severe agitation in AD. Successful management of neuropsychiatric symptoms reduces long-term care placement, decreases the risk of mortality, and enhances patient and caregiver quality-of-life. Such an approach has the potential to offer enormous relief to the substantial socioeconomic burden of AD-related behavioral disturbances. This research was funded by: National Institute of Aging R01 AG061100-01

Poster Number: LB - 6 IDENTIFICATION AND EVALUATION OF BEHAVIORAL SYMPTOMS IN DEMENTIA USING PASSIVE RADIO SENSING AND MACHINE LEARNING Ipsit Vahia1; Zach Kabelac2; Usman Munir2; Kreshnik Hoti2; Rose May1; Patrick Monette1; Dina Katabi2

1McLean Hospital 2Massachusetts Institute of Technology

Introduction: Behavioral symptoms of Alzheimer’s disease (e.g. delusions, wandering, aggression, sleep disturbance) lead to increased emergency room visits, caregiver burden, and transfers to memory care facilities. Sensor technologies may hold the

Am J Geriatr Psychiatry 27:3S, March 2019 S167 AAGP Annual Meeting 2019 potential to facilitate early detection and pre-emptive intervention for these symptoms by enabling continuous passive monitoring in a way that in-person monitoring may not be able to. We present preliminary data for such an approach using a device called the Emerald, developed at MIT, which emits low-powered radio signals and can identify and track parameters related to human behavior (sleep, motion, spatial motion, and respiratory rate) based on how these waves reflect off the human body. Artificial Intelligence (AI) algorithms elicit behavioral markers from sensor data. The device does not require any contact or direct interaction by the person being monitored, thus representing true passive sensing. Methods: The Emerald device was installed in the rooms of two dementia patients (N=2) with behavioral symptoms residing in an assisted living facility (ALF). Motion data was gathered continuously for a period of three months and was mapped on to spatial location and time frame. Data processing and analysis occurred simultaneously during the collection period. Additionally, study staff administered weekly standardized assessments to both the participant (MMSE) and ALF staff (NPI- NH, CMAI, PAS) to augment data collected from the Emerald. Device data was compiled and made available to the study clinician for clinical analysis and identification of emergent behavioral complications. Results: In both participants, device data were used to identify specific behavioral patterns. The device detected variations in behavior by time of day, escalations in pacing, and moments of restlessness throughout the night for both participants. For one participant, clinical interpretation of device data led to the proposition that the participant was experiencing Periodic Limb Movement Disorder, which was unbeknownst to the participant or clinician prior to study participation. The device was able to identify periodic spasms, which occurred when the person was asleep, and localize these to the patient’s legs. The second participant showed increase pacing, wandering, and motor agitation before being hospitalized for heightened anxiety and aggression. Device data indicates the period prior to hospitalization featured increased movement episodes relative to this participant’s baseline. Conclusions: We propose that behavioral phenotyping using an AI-backed passive sensing approach is feasible and safe, and that this approach can help digitally phenotype behavior symptoms in dementia. While the device merits validation against the current standard of behavior measurement in dementia, its advantages include low cost and ongoing engagement, and continuous monitoring while giving patients the option of stopping monitoring at their discretion. Further studies evaluating sensitivity and reliability are warranted to validate the clinical utility of this device. This research was funded by: This project is supported by an Innovations grant from the Massachusetts Institute of Technology.

Poster Number: LB - 7 EARLY CLINICAL EXPOSURE TO GERIATRIC PSYCHIATRY AND MEDICAL STUDENTS’ INTEREST IN CARING FOR OLDER ADULTS: A RANDOMIZED CONTROLLED TRIAL Klara Pokrzywko1,2; Susana Gabriela Torres-Platas1; Petal Abdool3; Marouane Nassim1; Trent Semeniuk4; Yara Moussa1; Chloe Leon3; Wayne Baici3; Michael Wilkins-Ho5; Paul Blackburn5; Jess Friedland4; NP Vasavan Nair4; Karl Looper6; Marilyn. Segal6; Tricia Woo7; Marie-Andree Bruneau2; Tarek Rajji3; Soham Rej1,3

1Geri-PARTy Research Group, Dept. of Psychiatry, Jewish General Hospital, McGill University 2Dept. of Psychiatry, University of Montreal 3Div. of Geriatric Psychiatry, Center for Addiction and Mental Health, University of Toronto 4Div. of Geriatric Psychiatry, Douglas University Mental Health Institute, McGill University 5Division of Geriatric Psychiatry, University of British Columbia 6Dept. of Psychiatry, Jewish General Hospital, McGill University 7Div. of Geriatric Medicine, St. Peter’s Hospital, McMaster University

Introduction: We expect that in the next 25 years, the population aged older than 65 will nearly double in the Unites States and Canada and other developing countries alike. This age group will require an increased amount of health care with increasing psychiatric, cognitive and medical complexity. However, there are few new incoming doctors wishing to care for older adults as part of their general medical practice, or to specialize in geriatric psychiatry or geriatric medicine. We hypothesize that early clinical exposure to elderly patients’ care could increase students’ interest in caring for older adults during their future career. Methods: We conducted a pragmatic medical education randomized controlled trial at the Jewish General Hospital and the Douglas Mental Health Institute, McGill University in Montreal, Canada. 3rd year Medical students undergoing their mandatory 16-week half-time clerkship rotation in psychiatry were randomized to the equivalent of 2-4 weeks full-time exposure to clinical geriatric psychiatry (n=84). The main outcome measured was change in “interest in caring for older adults as part of your future practice” at the end of the mandatory psychiatry clerkship rotation. The secondary outcomes were change in “interest in becoming a geriatric psychiatrist” and change in “comfort in working with geriatric patients and their families”.

S168 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019

We compared the intervention and control groups for demographic and other potentially confounding variables using the Chi- Squared Test and we examined bivariate associations between exposure to geriatric psychiatry and interest in caring for older adults using Chi-Square and the Mann-Whitey-U tests. Results: Being randomized to geriatric psychiatry exposure (n=44/84) was associated with increased “comfort in working with geriatric patients and their families” at a 16-week follow-up (x2 (1) =3.9, p=0.05) but there was no signiﬁcant association found between geriatric psychiatry exposure and change “in interest in caring for older adults” (x2 (1) =0.3, p=0.6), or change in “interest in becoming a geriatric psychiatrist” (x2 (1) =0.2, p=0.7). Conclusions: The results of this pragmatic geriatric psychiatry education RCT suggest that exposing 3rd year medical students to 2-4 weeks of geriatric psychiatry did not increase their interest to care for older adults in their future medical career or did not make them want to become a geriatric psychiatrist. However, it did increase their comfort level in working with older adults and their families, an important established predictor in the literature for choosing a medical career with patients 65 years and over. We believe these RCT results will help inform the design of medical school curricula in preparation for an increasingly again population in America and worldwide. However, more research is necessary to decorticate and identify potential co-synergic variables that would inspire and increase medical students’ interest in caring for older adults as part of their future careers. This research was funded by: This project was supported by Charitable Donations to the Jewish General Hospital, as well as the Canadian Institutes of Health Research Fellowship Award. Dr. Rej is supported by a Fonds de Recherche SanteQuebec (FRQS) Clinician-Scientist Award and has investigator-initiated grant funding from Satellite Healthcare (dialysis company) for an unrelated project.

TABLE 1. Medical Students’ Baseline Characteristics (n=84) Exposed Geriatric Unexposed Geriatric Psychiatric Rotation Psychiatric Rotation Variable (n=44) (n=40) Statistics ((df), p) Age, y 19-25 68.2%(n=30) 57.5%(n=23) 26-30 27.3%(n=12) 32.5%(n=13) c2(3) =3.6, p=0.3 31-35 2.3%(n=1) 10%(n=4) 36-40 2.3%(n=1) 0%(n=0) Female 65.9% (n=29) 50% (n=20) c2(1) =2.2, p=0.1 Caucasian 63.6%(n=28) 57.5%(n=23) c2(1) =0.3, p=0.6 Having experience caring 52.3%(n=23) 62.5%(n=25) c2(1) =0.9, p=0.3 for older adults before medical school

TABLE 2. Effect of 3rd Year Medical School Clerkship Geriatric Psychiatry Intervention on Outcomes (n=84) Exposed Geriatric Unexposed Geriatric Psychiatric Rotation Psychiatric Rotation Variable (n=44) (n=40) Statistics Change in interest in caring for older adults 0.98 (+/-2.31) 0.57(+/-2.52) U =851, p=0.8 (10-point scale) Increase in interest in caring for older adults 54.5% (n=24) 60% (n=24) c2(1) =0.3, p=0.6 (yes/no) Change in interest in becoming a Geriatric Psychiatrist 0.73(+/-2.03) 0.33(+/-2.18) U =837.5, p=0.7 (10-point scale) Increase in interest in becoming a Geriatric Psychiatrist 34.1%(n=15) 30%(n=12) c2(1) =0.2, p=0.7 (yes/no) Change in comfort in working with geriatric patients 0.70(+/-2.30) ¡0.08(+/-2.45) U =683, p=0.08 and their families (10-point scale)

Am J Geriatr Psychiatry 27:3S, March 2019 S169 AAGP Annual Meeting 2019

Poster Number: LB - 8 “PUT IT ON MY TAB:” ASSESSING THE COST OF GERIATRIC “REGULARS” IN THE PSYCH ED. Anuron Mandal1; Norman Ng1; Vanessa Mok2; Melinda Lantz1

1Mount Sinai Beth Israel 2Changi General Hospital

Introduction: Emergency Departments (ED) have seen an increasing number of mental health visits over the past decade, resulting in increasing strain on health care resources. With an aging population the general consensus is that this demand is expected to rise dramatically. Appropriate resource allocation by the national health care system will be a key part of preparing for this upcoming crisis. This study seeks to assess the financial strain that geriatric high utilizers place on the system, and whether their needs are met in the psychiatric ED. Methods: This study took place at a single metropolitan hospital with a separate psychiatric emergency department called the Comprehensive Psychiatric Emergency Program (CPEP). This study looked at visits by patients age 60 and above who came to the CPEP more than 5 times in 2017 (117 visits), compared to a random sample of CPEP visits (146) throughout the year. Results: Results show that only 15.5% of geriatric high utilizers visits in 2017 resulted in admission, with the rest being outpatient referrals. In comparison, 43.8% of a random sampling of (non-high utilizer) CPEP visits resulted in admission. This percentage of admission increased to 58% when focused on geriatric, non-high utilizers. Interestingly, geriatric high utilizers were domiciled during 83.2% of visits, in supportive housing 14.0% of visits, and undomiciled only 0.9% of visits. Geriatric high utilizers had an outpatient psychiatrist for 40.2% of visits. Substance abuse history was noted for 14% of visits. Conclusions: This data suggests that the geriatric high utilizer population has basic needs met (i.e housing), only has limited substance use issues, and so has other needs that either are not or cannot be met by psychiatric emergency services. At a conservative estimated cost of $1350 per visit, geriatric high utilizer visits in 2017 that did not result in admission had a yearly cost of $125,550. This money came directly from tax payers as no high utilizer had commercial insurance. This cost becomes alarming given the fact that it was incurred by only 11 individuals visiting one hospital. Our study does not account for visits by these same individuals to other CPEP’s at nearby hospitals. The cost is expected to increase significantly if the definition of high utilizer is expanded to those who come at least 3 times per year. All of this serves as evidence for the need to develop a program to evaluate and address the needs of geriatric patients that cannot be met by a psychiatric emergency department, if only to help alleviate the financial burden over-utilization causes. This research was funded by: NA

Poster Number: LB - 9 TELE-BEHAVIORAL ACTIVATION FOR SOCIAL ISOLATION IN OLDER HOME- DELIVERED MEALS RECIPIENTS: PRELIMINARY RESULTS FROM AN ONGOING RANDOMIZED CONTROLLED TRIAL Renee Pepin1; Peter DiMilia2; Namkee Choi3; Martha Bruce1

1Geisel School of Medicine at Dartmouth 2Dartmouth-Hitchcock Medical Center 3The University of Texas at Austin

Introduction: Homebound older adults are often unable to participate in social interactions and activities that require leaving the home, resulting in a high prevalence of isolation among this population. Isolation is associated morbidity, disability, and mortality. Technology has been explored as a potential avenue for meaningful social interaction for homebound seniors. We present preliminary results of an ongoing randomized controlled trial evaluating the acceptability, feasibility and comparative effectiveness of delivering two interventions by video-conferencing technology to promote social connectedness among homebound older adults receiving home-delivered meals: 1. Behavioral activation (tele-BA) vs. 2. Friendly visitors (tele-FV). To our knowledge, this is the ﬁrst randomized controlled trial to leverage local Meals on Wheels (MoWs) agencies to engage homebound, socially isolated older adults in a telehealth intervention for social isolation. Methods: Older adults in New Hampshire and central Texas were recruited for our study by local MoWs agencies during the routine annual evaluation of their home-delivered meals clients. After a brief eligibility screening by their MoWs case workers and indicated interest, MoWs clients were referred to our study team and contacted by telephone for a full eligibility assessment. Eligible

S170 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 participants endorsed social isolation (6 or greater on the 3-item UCLA Loneliness Scale), but did not report symptoms of moderate to severe depression (PHQ-9 < 10) or suicidal ideation. Those with hearing, vision, or memory impairment and active psychiatric illness were excluded. Participants were randomly assigned to either participate in the tele-BA intervention or the tele-FV comparison condition for hour-long, weekly videoconference sessions for five weeks. Both interventions were delivered by a trained lay provider. The tele-BA intervention included a version of behavioral activation modified for social isolation and tele-delivery; the comparison condition (tele-FV) consisted of unstructured friendly visits. Participants were assessed at baseline, post-intervention, and 12 weeks post-intervention with the PROMIS 8-Item Social Isolation measure and 9-item Patient Health Questionnaire. Participants were also asked questions related to their experience with tele-BA or tele-FV at the post-intervention assessment. Results: In the first year of our study, 50 socially isolated older adults (age M§SD73.5§9.2 years; range 51 to 90 years) participated in either the tele-BA intervention (n=28) or tele-FV comparison condition (n=22). Participants were predominantly non-Hispanic white (70%), female (65%), of lower SES (56% less than $20,000 annual income) and living alone (68%). When asked, all participants indicated they would recommend this tele-program to family and friends (Net Promotor Scale 0-10: M§SD 9.7§0.9; range 6-10). Most participants (92%) found these tele-sessions moderately to very acceptable for their social isolation and 95% indicated somewhat positive to very positive general reaction to the program. Preliminary data at 12-week follow-up showed reduction on the 8-item Social Isolation measure and the PHQ-9, with a trend towards greater improvement in participants who participated in the tele-BA group. Conclusions: Overall, participants found tele-Behavioral Activation and tele-Friendly Visits to be positive experiences and acceptable for their social isolation, and would recommend the program to their friends and family. Preliminary data showed improvement in isolation and depressive symptoms for both groups, which is sustained through 12 weeks of post-intervention follow-up. Our preliminary results suggest the feasibility, acceptability and potential effectiveness of using tele-technology to deliver interventions for homebound older adults who report social isolation. We also found potential evidence of the effectiveness of modified tele-behavioral activation program, compared to friendly visitors, in reducing social isolation and subclinical depressive symptoms in this population. Finally, we demonstrated the feasibility of working in collaboration with community-based Meals on Wheels agencies to identify socially isolated clients and refer them to this program. This research was funded by: AARP-Foundation

Poster Number: LB - 10 ELECTRONIC MEDIA AND ITS APPLICATIONS IN PSYCHOTHERAPY: METHODS AND A GERIATRIC CASE STUDY Katherine Hobbs1; Praise Owoyemi1; Courtney Beard1; Benjamin Silverman2; Kerry Ressler2; Ipsit Vahia2

1McLean Hospital 2McLean Hospital; Harvard Medical School

Introduction: A growing body of literature indicates that clinically signiﬁcant behavior markers can be extracted from mobile and communication data. However, it remains less clear whether and how such data can be incorporated into the care process, and whether they may actually have an impact in psychotherapy. Here, we describe the methodology of a novel study that assesses the feasibility and impact of incorporating data from patients’ electronic media (e.g. email, text messaging, social media) into therapy. We describe this study design, as well as our protocol for an adaptive approach anchored around privacy and patient control of data, as well as the technological infrastructure required for real-time signal extraction from passive data, and communication to clinicians. Methods: We developed a protocol for initial study phase - an open trial designed to implement a process for accessing patient’s electronic media, incorporating natural language processing and behavior measurement, as well as patient feedback. We also developed a process for identifying appropriate outcome measures and developing a clinician dashboard to incorporate these data into the patient’s session in real time. We selected the geriatric clinic at McLean Hospital as the primary study site. Finally, we implemented the protocol as an N=1 study focused on how text messaging content impacts psychotherapy in a 77-year-old man with depression and anxiety. Results: Preparatory surveys for study launch indicated that clinicians are already incorporating electronic media into psychotherapy, with text messaging and email content noted to be more valuable than social media. Among older adults, text messaging and actual phone calls may be primary markers for digital phenotyping. Relevant outcome measures include the working alliance (measured by the Working Alliance Inventory-Short Revised (WAI-SR) and the Ratings of Emotional Attitudes to Client by Therapist (REACT), and changes in subjects’ depression and anxiety symptoms (measured by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7). Conclusions: Our initial ﬁndings from the process of study launch indicate that behavior around electronic media (i.e. how frequently a person may use or interact with electronic media) may be a more accessible metric for psychiatric symptoms. The process of accessing content from electronic communications raises complex questions around privacy, including those around

Am J Geriatr Psychiatry 27:3S, March 2019 S171 AAGP Annual Meeting 2019 third parties that may be communicating with patients. However, patients increasingly recognized that data from their digital lives can enhance the quality of care. Our initial feasibility study with a 77-year-old man illustrated the importance of incorporating patient feedback into study design and procedure. Our feasibility study also indicates that patients may be more willing to share private electronic media directly with physicians, rather than unrelated third parties. This research was funded by: This work is supported by the Once Upon a Time Foundation

Poster Number: LB - 11 MINDFULNESS-BASED ART PSYCHOTHERAPY GROUP FOR OLDER ADULTS USING DIGITAL TOOLS Elaine Hawkes1; Hannah Heintz1; Brent Forester1,2; Ipsit Vahia1,2

1McLean Hospital 2Harvard Medical School

Introduction: Art therapy is effective for older adults by stimulating cognitive processes, helping to externalize and express emotions, and creating the potential for meaningful activity. Mindfulness has been shown to improve working memory and focus, and enhance integration of verbal and nonverbal processing. Phototherapy involves taking, viewing, manipulating, and interpreting photographs as a therapeutic process. Because of its relatively easy accessibility, spontaneity, and the ability to easily correct errors, phototherapy is an especially approachable form of art therapy compared to painting or drawing. The explosion of digital tools for phototherapy in the past 5 years offers the capability to maximize the potential of this modality by facilitating combination of both mindfulness and phototherapy for exponential treatment impact. In this study we report preliminary findings from a digital phototherapy-based mindfulness group in the SAGE program within the Division of Geriatric Psychiatry at McLean. The primary objective of this study was to assess the feasibility and qualitative effectiveness of a mindfulness-based phototherapy group for older adults experiencing anxiety and depression. Methods: This was an observational pilot study of a 13-week group of 4 older women. Each session was 60 minutes long, which was later expanded to 75 minutes to allow times for mindfulness exercises and group sharing. Each participant learned how to take pictures and use the MyMoments, Union, Fuse, & Collage apps on their iPhone and iPad. Effectiveness was evaluated both qualitatively and quantitatively, by collecting unstructured participant feedback at Week 13 and administering the Rosenburg Self-Esteem Scale (RSES) and the Day to Day Experiences Scale at baseline and Week 13. Results: We demonstrated that an approach combining digital phototherapy with mindfulness is feasible and possible to implement in a group of older adults. We also demonstrated the feasibility of teaching this cohort the use of apps for phototherapy in a group setting. While we did not conduct quantitative analysis of intervention efficacy, we noted 3 out of 4 patients scored higher on the Day to Day Experiences Scale at Week 13 compared to baseline; in addition, on the RSES at Week 13, participants endorsed statements indicative of higher self-esteem compared to baseline. Qualitative feedback indicated that participants felt a sense of mastery and continued interest in both mindfulness and phototherapy practices. Conclusions: Our preliminary study points to the vast potential of incorporating technologies to accelerate and expand the process of art therapies such as phototherapy. Our findings bear replication and quantitative validation but point to the possibility of improving self-esteem and mindfulness skills in older adults. They may also serve as a model of how to incorporate digital tools into the process of clinical care in group and individual settings. This research was funded by: This study was supported by the McLean Hospital Division of Geriatric Psychiatry.

Poster Number: LB - 12 CHALLENGING BEHAVIORS ON INPATIENT MEDICAL UNITS: INTEGRATED, NON-PHARMACOLOGICAL APPROACH FOR PATIENTS WITH DEMENTIA Kurtis Kaminishi1; Elizabeth Sutherland2; Erica Youngblood2; Jessica Capistrano2; Linda Tseng2

1San Francisco VA / UCSF 2San Francisco VA

Introduction: Inpatient medical care is a critical hospital function, but is costly and associated with risks to both patients and staff. Patients often demonstrate behavioral problems that interfere with care, prolong length of hospitalization, increase

S172 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 utilization of resources, delay discharge, and even lead to staff injury. To address these challenges, the San Francisco VA Health Care System (SFVAHCS) developed the Behavioral Education and Support Team (BEST). This team is comprised of psychiatry, psychology, nursing, and occupational therapy staff. BEST provides support, education, and interventions to patients who are engaging in treatment interfering behaviors. Goals include reducing risk to patients and staff, improving treatment adherence, reducing utilization of resources, shortening length of stay, and facilitating discharge. BEST staff also collaborate with inpatient staff to develop and consistently implement behavioral treatment plans. Since implementation in October 2015 to March 2018, BEST has served 488 veteran patients. Data demonstrate that BEST is associated with a 40% reduction in staff injuries in acute medicine settings, a 42% reduction in emergency psychiatric codes, and a 25% reduction in formal inpatient setting complaints. In addition, it is estimated that BEST reduces inpatient costs due to improved time to discharge and reduced staffing turnover and work loss due to injury. This presentation will provide an overview of the BEST team function and outcomes. Given the critical nature and high costs of inpatient medical care, the SFVAHCS determined that investment in a dedicated team to address these problems would be justified by reducing utilization of resources, length of hospitalization, overall cost, and adverse patient and staff outcomes. Methods: The BEST team was initially implemented as a behavioral consultation team for inpatient medical patients in October, 2015, and was comprised of 5 members: A RN team coordinator A part-time psychiatrist (.2 FTE) A psychologist An RN team member An Occupational Therapist The data from the BEST consultations between October 2015 and March 2018 were reviewed, and analyzed. Analysis of data included identification of total number of consultations, average age of patients, marital status, discharge status, themes for admission, days in hospital, presence of psychiatric disorder, dementia, serious mental illness, staff injury frequency, frequency of emergent psychiatric code calls, frequency of formal inpatient complaints. Results: Since initiation in October, 2015, the BEST program has served 488 patients. Complex geriatric patient accounted for 78.7%. As of July, 2017, the majority of veterans served had a psychiatric disorder or need, including depression (50%), dementia (26%), delirium (21%), serious mental illness (18%), and suicidal ideation (10%). Adherence to treatment was a target problem in 56% of those referred. Specific Outcomes: 40% reduction in staff injuries among acute medicine staff 42% reduction in emergency psychiatric code calls 25% reduction in formal inpatient complaints. In addition, a conservative estimate suggests that improving compliance with treatment and reducing length of stay by 1 day per non-compliance referral, extrapolated to the current time point, would generate a savings of approximately $835,000. In addition, inpatient nursing staff report a subjective increase in morale and perception of competence for coping with behavioral disruptions. Consult Summary (October 2015 to March 2018) 488 Consults Average Age 69 (youngest 29 to oldest 101 466 Males and 22 Females Marital Status − 156 Never Married; 96 Married; 18 Separated; 181 Divorced; 33 Widowed; 4 Unknown Discharge Status − 11 Against Medical Advice; 10 Died; 4 Homeless; 87 Skilled Nursing Facilities; 219 Home/Board & Care/Shelters; 31 Mental Health Rehabilitation; 83 Long-Term Care; 35 Unknown; 8 Acute Hospital Themes for Admission − 55 Altered Mental Status; 43 Failure to Thrive; 28 Placement Issues; 15 Falls; 68 Pain; 39 Shortness of Breath Days in the Hospital: 13,827 Total days in the hospital 7,218 Days in the hospital awaiting placement after being cleared by medical team $28 Million − cost awaiting placement Conclusions: Since implementation of the BEST team at the SFVA Medical Center, data reveal overall reduction in utilization of resources, length of hospitalizations, overall costs, and adverse patient and staff outcomes. Specifically: 1. A dedicated behavioral team can significantly improve the experience of inpatient nursing staff, reducing injuries, improving morale, reducing staff turnover and burnout.

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2. A behavioral intervention team can signiﬁcantly reduce psychiatric codes and patient complaints, while improving clinical outcomes and patient satisfaction. 3. Reductions in staff injuries and improvements in treatment adherence can recoup costs for team stafﬁng. 4. Reducing risk factors for disruptive behaviors reduces overall costs to the system and overutilization of resources. This research was funded by: Funded through the San Francisco VA

Poster Number: LB - 13 THE APPLICATION OF VIRTUAL REALITY IN GERIATRIC MENTAL HEALTH: THE STATE OF THE EVIDENCE Liana Mathias1; Aniqa Rahman1; Miranda Skurla1; Ipsit Vahia1,2

1McLean Hospital 2Harvard Medical School

Introduction: In recent years, there has been a rise in the prevalence of cognitive and affective disorders in the ageing population. This has led to an impetus on innovative, scalable and engaging interventions for these disorders, and technology has proved to be a promising frontier. In the past decade, virtual reality (VR) technology has seen a shift from two-dimensional non-immersive projections to three-dimensional fully immersive experiences, allowing for the development of more sophisticated simulations. There have been successful applications of VR in clinical settings with children and teens, including social cognition training for autism, sustained attention in attention-deficit hyperactivity disorder (ADHD), exposure-based therapies for anxiety disorders, and depression pathology. However, VR has been less studied in the geriatric population. The purpose of this study is to determine the existing levels of evidence for use of VR in clinical settings and identify areas where more evidence may guide translation of existing VR interventions for older adults. Methods: This study is a systematic review. We conducted a search on PubMed in December 2018 for peer-reviewed journal articles published in English within the last 10 years. We narrowed the search to VR technology and its applications in older adults, as well as studies of VR in normal aged adults for comparative value. We rejected articles if the title and abstract did not meet inclusion criteria and authors LM, AR and MS agreed by consensus on which articles were relevant. We also used the bibliographies of selected articles to find additional articles that we may have missed in the initial search. We then reviewed article content to classify the articles into appropriate domains of geriatric mental health (content domains) and research objectives (research domains). Results: Based on our review, a total number of 426 articles were found, and 49 met our inclusion criteria related to older adults. We conducted a yearly count for the number of search results to identify if there has been an increase in researchinthefield.Thenumberofsearchresultsbyyeararepositivelycorrelated(seeFigure1).Wealsoidentified5 additional articles which focused on younger adults which we opted to include in the review based on internal consensus amongst all authors that they reflected VR application in domains of mental health that are known to apply to older adults as well. We found that the articles fell across several content domains: Cognition, conditions along the mood spectrum, anxiety, post-traumatic stress disorder (PTSD), and caregiver burden. The research domain with the highest number of articles was VR validity testing (26), followed by cognitive training (18), indicating that these are the VR applications for which the best evidence exists currently. Conclusions: Currently, existing evidence offers clear support for the use of VR as a screening tool for cognitive impairment in older adults, and as a training tool to improve cognitive skills. VR-based tasks demonstrated validity comparable to some traditional paper-based assessments of cognition. Furthermore, there are indications that VR can play a role in delaying the onset of Alzheimer’s Disease (AD), mild cognitive impairment (MCI), and other forms of dementia. More work is needed to refine VR screening capabilities for more specific diagnoses, but the potential for innovation in VR environments and tasks makes VR a promising medium to achieve this specificity. Additionally, there were many different VR environments used across studies, which may show a need for standardization of environments before comparisons can be made between VR simulations. Given the robust evidence of VR as a treatment in affective disorders in younger adults, we see potential for the same intervention in older adult mood spectrum disorders and other psychiatric conditions. Finally, future studies should address key issues surrounding VR use in clinical settings, such as usability, data privacy, and confidentiality. This research was funded by: Anonymous philanthropic donation to McLean Hospital.

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Poster Number: LB - 14 A POST HOC ANALYSIS OF STUDY ACP-103-019 EVALUATING THE IMPACT OF A REDUCTION IN PSYCHOSIS ON THE SEVERITY OF AGITATION AND AGGRESSION IN PATIENTS WITH ALZHEIMER’S DISEASE Michael Guskey1; James Norton1; Bruce Coate1; Randy Owen1; Srdjan Stankovic1; Clive Ballard2

1ACADIA Pharmaceuticals 2University of Exeter

Introduction: The objective of this post hoc analysis was to evaluate whether Alzheimer’s disease (AD) patients with psychosis who experience an improvement in their hallucinations and delusions with pimavanserin treatment also experience an improvement in agitation and aggression. Methods: ACP-103-019 was a 12 week, randomized, double-blind, placebo-controlled study that evaluated the efficacy of pimavanserin (PIM) 34mg once-daily in reducing the frequency and/or severity of hallucinations and delusions in patients with AD psychosis. The primary endpoint was change from baseline in the Neuropsychiatric Inventory Nursing Home Version Psychosis Score (NPI-NH PS) [domain A (delusions) + domain B (hallucinations)] at Week 6. A post hoc analysis was conducted to determine if there was a greater reduction in agitation and aggression, as measured by NPI-NH Domain C (agitation/aggression) and Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF), in patients who experienced a reduction in the frequency and/or severity of their hallucinations and delusions when compared with those who did not experience a reduction in hallucinations and delusions. Results: Overall in ACP-103-019, there were only minor differences between the placebo (n=91) and PIM (n=87) treatment arms when evaluating changes from baseline to Week 6 in Agitation/Aggression based on CMAI SF total score or NPI-NH Domain C score (0.30 [p=0.8031] and -0.66 [p=0.254], respectively). However, when subjects treated with PIM who responded to the treatment (n=48), defined as a 30% reduction in NPI-NH PS at Week 6, were compared with those who did not respond to PIM treatment (n=28), there was a greater reduction in both CMAI-SF and NPI-NH Domain C scores: -3.74 (p=0.0550) and -2.75 (p=0.0021), respectively. When response was defined as a 50% reduction in NPI-NH PS at Week 6, the greater improvement of agitation/aggression in responders (n=44) vs non-responders (n=32) was also observed for both CMAI-SF and NPI-NH Domain C: -3.714 (p=0.0483) and -3.64 (p<.0001), respectively. In addition, when patients with symptoms of agitation/aggression at baseline (defined as NPI-NH Domain C ≥6) were evaluated, there was also a greater improvement in agitation/aggression in patients who responded to PIM over those who did not. Conclusions: In this post-hoc analysis, some AD patients whose hallucinations and delusions responded to pimavanserin also experienced improvement in their symptoms of agitation and aggression. These results suggest a correlation between a reduction in hallucinations and delusions and a reduction in agitation/aggression in AD patients with psychosis. This research was funded by: Sponsored by ACADIA Pharmaceuticals Inc. (San Diego, CA, USA).

Poster Number: LB - 15 DETERMINING PREVALENCE OF SUBSTANCE USE DISORDER IN THE GERIATRIC POPULATION DURING CONSULT SERVICES Sehba Husain-Krautter

Delaware Psychiatric Center

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Introduction: Objective: To determine the prevalence of substance use disorders (SUDs) in the geriatric population referred to the addiction consult and liaison services over a 6-month period, from July 2018 to December 2018. Methods: Method: All referrals during the 6-month will be reviewed and individuals aged ≥ 65 on the day of admission will be included in the study. Results: Preliminary results show that out of the 412 referral charts reviewed this far, the geriatric population makes up roughly 19% of the total referrals. Amongst that cohort, the most common substances being used are alcohol, benzodiazepines and opioids with a prevalence rate of 33.8 %, 13.9%, and 6.8% respectively. Conclusions: While alcohol remains the most common substance being used, the increasing number of elderly with opioid use disorder is following earlier trends in younger populations. Our results document the growing trend in this vulnerable population, and we hope that our data will aid towards increasing awareness of SUDs in older adults

Poster Number: LB - 16 POISONING DEATHS AMONG LATE-MIDDLE AGED AND OLDER ADULTS: COMPARISON BETWEEN SUICIDES AND DEATHS OF UNDETERMINED INTENT Namkee Choi1; Diana DiNitto1; C. Nathan Marti1; Bryan Choi2

1University of Texas at Austin 2Brown University

Introduction: In violent deaths, forensic autopsy is often regarded as the means for making the final medical diagnosis of the cause and manner of death; however, without other corroborative evidence (e.g., suicide note, prior history of suicide attempt/ intent disclosure), drug intoxication and other poisoning deaths, especially among individuals with pre-existing substance use and/or mental health problems, pose challenges in determining the intent/manner of death. Given the rapid increase in prescription and illicit drug poisoning deaths in the 50+ age group, we examined precipitating/risk factors and toxicology results associated with poisoning deaths classified as suicides compared to intent-undetermined death (UnD) among decedents aged 50+. Methods: The National Violent Death Reporting System, 2005-2015, provided data. The 2005-2015 NVDRS contained 56,118 suicide decedents and 7,752 UnDs aged 50+. Of these 50+-year olds’ deaths, poisoning deaths were 18.5% (N=10,363) of suicides and 65.7% (N=5,090) of UnDs. The present study focused on these 15,453 poisoning decedents and stratified them into three groups—suicide decedents who left a suicide note, suicide decedents who did not leave a note, and decedents classified as UnD. Following descriptive statistics using x2 tests, multinomial logistic regression models were used to test study hypotheses (associations of intent/manner of death with precipitating/risk factors and positive toxicologies) controlling for incident year (time), state, and demographic variables. We chose suicide decedents who did not leave a suicide note as the baseline comparison group to better examine potential differences and similarities between them and UnDs. Results: Of all poisoning deaths, 29.4% were classified as suicide decedents who left a note, 37.7% as suicides without a note, and 32.9% as UnDs. Of all NVDRS participating states, Maryland and Utah had the highest proportions of all poisoning deaths (82.8% and 58.9%, respectively) and the highest numbers of UnDs (52.5% of all UnDs in this study). We also found that of all states, Maryland had the highest proportion of Black decedents (34.6% of both poisoning suicides and UnDs). Analysis of time trend showed that the proportions of UnD cases in 2005 and 2015 were 36.5% and 30.0%, respectively, with a generally declining trend over the 11-year period. Multinomial logistic regression analysis showed that compared to suicide decedents without a note, those with a note were more likely to have been depressed and had physical health problems and other life stressors, while UnD cases were less likely to have had mental health problems and other life stressors but more likely to have had substance use and health problems. UnD cases were also more likely to be opioid (RRR=2.65, 95% CI=2.42-2.90) and cocaine (RRR=2.59, 95% CI=2.09-3.21) positive but less likely to be antidepressant positive (RRR=0.79, 95% CI=0.72-0.87). Those who left a note were older and more likely to be non-Hispanic White, but Blacks were more than twice as likely as non- Hispanic Whites to be UnDs. Gender was not a significant factor. Results from separate regression models in the highest UnD states (Maryland and Utah) and in states other than Maryland/Utah were similar. Conclusions: The finding that UnDs had a higher likelihood of substance use problems and positive opioid and cocaine toxicology results suggests that their substance use/abuse was largely and directly responsible for their death. We could not compare UnDs to accidental overdose deaths, as the NVDRS does not include the latter, but such research among middle-aged and older adults is needed as many UnDs may be more correctly classified as unintentional overdose deaths. The extremely high UnD rates in Maryland and Utah are also likely reflections of the opioid epidemic that has raged in these two states. The study limitations were that as data on precipitating circumstances were largely collected from decedents’ informal support systems, the validity of these proxy-derived data is a concern as is incomplete/unknown data, and substantial numbers of toxicology-tested decedents had missing test results. However, the findings show that along with more accurate determination processes for intent/

S176 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 manner of death, substance use treatment and approaches to curbing opioid and other drug use problems are needed to prevent intentional and unintentional poisoning deaths. Racial disparities in UnDs also underscore the need for more effective approaches to prevention and curbing drug availability in communities with concentrations of low-income and racial/ethnic minority populations.

Poster Number: NR - 1 LATE-LIFE DEPRESSIVE SYMPTOMS FOLLOWING NURSING HOME OR INPATIENT REHABILITATION IN MEDICARE BENEFICIARIES Adam Simning; Julie Kittel; Yeates Conwell

University of Rochester

Introduction: Millions of Medicare beneficiaries receive rehabilitation services in skilled nursing facilities or inpatient rehabilitation facilities. This study was designed to study whether receipt of rehabilitation services in nursing homes or inpatient settings is associated with clinically significant depressive symptoms at follow-up among older adult Medicare beneficiaries. Methods: We utilized data from National Health and Aging Trends Study (NHATS), which is an annual survey of a nationally representative sample of Medicare beneficiaries aged 65 years and older. Our study included 6,329 participants of the 2015 and 2016 NHATS interviews. The PHQ-2 assessed for the presence of clinically significant depression, and interview questions addressed rehabilitation, demographic characteristics, socioeconomic status, and health and functioning variables. Results: Medicare beneficiaries who received rehabilitation services in nursing home or inpatient settings had higher levels of depression at follow-up than those who did not receive these services (25.2% vs. 11.1%; p<0.001). In multivariable logistic regression analyses that accounted for demographic characteristics, socioeconomic status, health and functioning variables, and baseline depression, older adults who received nursing home or inpatient rehabilitation services in the prior year were at an increased risk of having depressive symptoms (OR=1.78; 95% CI: 1.20-2.64) at the follow-up interview. Conclusions: Even after accounting for factors such as medical conditions, baseline depressive symptoms, and changes in ability to engage in self-care and household activities, older adults who receive nursing home or inpatient rehabilitation services comprise an at-risk group for having depression. As depression is associated with considerable morbidity and can interfere with the rehabilitation process, additional efforts to identify and treat depression in these older adults may be warranted. This research was funded by: The National Health and Aging Trends Study dataset is publicly available and is sponsored by the National Institute on Aging (grant number NIA U01AG032947) through a cooperative agreement with the Johns Hopkins Bloomberg School of Public Health. Dr. Simning was supported by the National Institute on Aging (K23AG058757). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the NIH.

Poster Number: NR - 2 HEALTH-RELATED QUALITY OF LIFE IN REMITTED PSYCHOTIC DEPRESSION Kathleen Bingham1; Ellen Whyte2; Benoit Mulsant1,3; Anthony Rothschild4; Matthew Rudorfer5; Patricia Marino6; Samprit Banerjee7; George Alexopoulos6; Barnett Meyers6; Alastair Flint1,8

1University of Toronto 2University of Pittsburgh 3Centre for Addiction and Mental Health 4University of Massachusetts 5National Institute of Mental Health 6Weill Cornell Medicine 7Weill Cornell Medical College 8University Health Network, Centre for Mental Health

Introduction: Health-Related Quality of Life (HRQL) (deﬁned as a person’s perceived life functioning and wellbeing in the physical, mental and social domains of health) is recognized as an important outcome to consider in healthcare delivery, research, and policy. Patients with depression report more impaired HRQL than population norms and with impairment persisting in some patient groups despite clinical remission. Psychotic depression is a severe disorder associated with signiﬁcant disability and poor HRQL during acute episodes. No studies have investigated HRQL in remitted psychotic depression, and it is therefore not known to what extent impairment of HRQL persists into sustained remission in this group. The primary aim of this study is to examine HRQL in both acute and remitted psychotic depression and to compare it to age- and gender-adjusted

Am J Geriatr Psychiatry 27:3S, March 2019 S177 AAGP Annual Meeting 2019 population norms. In addition, exploratory aims are to examine i) the relation of age group to HRQL and change in HRQL from baseline to remission, and ii) the association of depression scores, medical burden, and neuropsychological function in remission with HRQL. Methods: This study is a secondary analysis of the Sustaining Remission of Psychotic Depression (STOP-PD II) dataset. STOP-PD II is a randomized, placebo-controlled trial investigating the benefits and risks of continuing antipsychotic medication in persons between 18 and 85 years of age with psychotic depression that had remitted with the combination of sertraline and olanzapine. STOP-PD II has 3 phases: acute, stabilization, and randomized. This analysis includes only participants who experienced sustained remission of both depression and psychosis by the end of the stabilization phase (n = 119). Our primary outcome of HRQL was measured using the Medical Outcome Survey Short Form (SF-36)—a tool that contains eight scales reflecting physical, emotional and social domains of subjective health status—administered at baseline (entry to the study) and at the end of the stabilization phase. Paired t-tests were used to compare SF-36 scores between baseline and remission. To compare SF-36 scores in STOP-PD II participants with those of the general American population adjusting for age group and gender, SF-36 scores were standardized to z-scores for each age/gender stratum provided in the SF-36 manual. We examined the z-scores descriptively via means, standard errors and confidence intervals using the normative population mean of zero as a point of reference. We also compared the SF-36 scores of younger (18-59 years) and older (60 years or older) participants. Independent t-tests compared in these age groups: i) SF-36 scores at baseline and remission, and ii) the magnitude of change in SF-36 scores between baseline and remission. Finally, we explored the relationship between SF-36 scores and depression scores, medical burden, and neuropsychological performance at remission using correlation analyses. Results: SF-36 scores improved significantly from baseline to remission for all scales. As expected, improvement from baseline to remission was largest for the mental health-related scales, and smallest for scales related to medical health. At baseline, all of the SF-36 z-scores except Bodily Pain were significantly lower than the population mean of zero, with Mental Health and Social Functioning scores approximately two standard deviations lower (see Table 1). By contrast, at remission, standardized SF-36 scores were very close to the population mean, with most of the confidence intervals including zero (see Table 1). Of the SF-36 scale scores at baseline or remission, only physical functioning was significantly different between age groups (baseline t= -3.12, df = 116, p = 0.0023; remission t = -2.73, df = 111, p = 0.0074). None of the change scores differed significantly between age groups. In remission, depression scores were moderately correlated with SF-36 scales (r ranging from 0.37-0.53) with the exception of bodily pain; medical burden and trail making scores were moderately correlated with SF-36 scales measuring physical symptoms (r ranging from 0.3 -0.52). The neuropsychological measures of coding and delayed recall had very weak correlations with the SF-36 scale scores in remission (r ranging from -0.09 - 0.19). Conclusions: This study is the first to investigate HRQL in remitted psychotic depression. Participants with psychotic depression in sustained remission demonstrated similar levels of HRQL to population norms, regardless of age group, despite marked impairment on most HRQL domains when acutely ill. This finding is encouraging, as it suggests that, when treated in a rigorous and systematic manner, many patients with this severe illness improve significantly from both a clinical and HRQL perspective. Nevertheless, even in a sustained remitted state, low levels of depressive symptoms still influence HRQL. This research was funded by: This secondary analysis did not receive any funding. The STOP-PD clinical trial was funded by USPHS grants MH 62446, MH 62518, MH 62565, and MH 62624 from the National Institute of Mental Health. Eli Lilly did not provide funding for this study but provided olanzapine and matching placebo pills; Pfizer did not provide funding for this study but provided sertraline.

TABLE 1. Age- and gender-adjusted SF-36 scale z scores at baseline and remission Baseline (n = 113)1 Remission (n = 117)1 Mean z Lower Upper Mean z Lower Upper SF-36 Scale score2 (SE) 95% CL 95% CL score2 (SE) 95% CL 95% CL Physical Functioning ¡0.25 (0.12) ¡0.47 ¡0.03 0.11 (0.1) ¡0.06 0.28 Role-Physical ¡0.6 (0.12) ¡0.85 ¡0.36 ¡0.04 (0.1) ¡0.23 0.157 Role-Emotional ¡1.85 (0.07) ¡2 ¡1.70 ¡0.12 (0.1) ¡0.32 0.08 Bodily Pain ¡0.20 (0.11) ¡0.41 0.01 0.36 (0.09) 0.19 0.54 Vitality ¡1.47 (0.08) ¡1.64 ¡1.31 0.06 (0.08) ¡0.11 0.22 General Health ¡0.77 (0.1) ¡0.97 ¡0.56 0.31 (0.08) 0.15 0.47 Social Functioning ¡1.98 (0.1) ¡2.18 ¡1.79 ¡0.12 (0.09) ¡0.30 0.06 Mental Health ¡2.43 (0.08) ¡2.59 ¡2.28 ¡0.09 (0.09) ¡0.27 0.09

1Of the 119 total participants, six were missing only baseline SF-36 data and two were missing only stabilization SF-36 data 2Weighted by number of participants per age group-gender stratum

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Poster Number: NR - 3 RELATIONSHIP OF HAIR CORTISOL CONCENTRATION WITH HISTORY OF PSYCHOSIS, NEUROPSYCHOLOGICAL PERFORMANCE, AND EVERYDAY FUNCTIONING IN REMITTED LATER-LIFE MAJOR DEPRESSIVE DISORDER Kathleen Bingham1; Benoit Mulsant1,2; Deirdre Dawson1,3; Samprit Banerjee4; Alastair Flint1,5

1University of Toronto 2Centre for Addiction and Mental Health 3Rotman Research Institute, Baycrest Health Sciences 4Weill Cornell Medical College 5University Health Network, Centre for Mental Health

Introduction: Psychotic features are more prevalent in older adults with depression than in younger depressed adults. Psychotic major depressive disorder (PMD) is associated with poorer neuropsychological performance and poorer everyday functioning, in both acute and remitted states, compared with non-psychotic major depressive disorder (NPMD). In addition, PMD is also associated with more pronounced dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, including elevated cortisol levels, but it is not known whether this difference between PMD and NPMD persists in remission. The goal of this exploratory study was to test the hypothesis that a history of psychotic features, poorer neuropsychological performance, and poorer everyday functioning were associated with higher cortisol levels in sustained remission of major depressive disorder. If confirmed, it could suggest a possible mechanism for neuropsychological and functional impairment in remitted PMD. In order to examine the relationship between sustained HPA dysfunction in remission and the aforementioned variables, we measured hair cortisol concentration (HCC), a measure of longer-term cortisol exposure. Methods: This study used a cross-sectional design and included 60 participants aged 50 years or older with a history of major depressive disorder (n = 17 with NPMD and n = 43 with PMD) in sustained remission and 36 non-psychiatric comparison participants. Hair samples were collected using standardized methods and cortisol concentrations were determined from the first 3-cm hair segment most proximal to the scalp, or from as much hair as was available for participants with shorter hair. This hair segment represents the hair growth over the 3-month period prior to the sampling. HCC was measured in a research laboratory with extensive experience in this analysis using a validated high sensitivity enzyme immunoassay (EIA) that is standard in the field. In order to examine the relationships between HCC and i) history of psychotic features, ii) neuropsychological performance (processing speed, executive function, and verbal memory), and iii) everyday functioning (participant-report general functioning and observer-rated IADL performance), we performed three sets of correlation analyses, one for each variable of interest (point biserial for psychosis history and HCC; Pearson’s r for neuropsychological and functional measures). We calculated effect sizes and 95% confidence limits in order to compare HCC results between patient and non-psychiatric comparison groups. HCC data were highly skewed and were log transformed for all analyses. Results: NPMD and PMD groups had mean (SD) HCCs of 18.86 (32.97) pg/mg and 12.48 (11.26) pg/mg, respectively. The correlation between HCC and history of psychosis was weak (r = -0.02), as were the correlations between HCC and the neuropsychological measures (r ranging between -0.11 and 0.1). The correlations between HCC and i) IADL performance (r = -0.04) and ii) general functioning (r = -0.074) were also weak. None of these correlations were statistically significant. The mean (SD) HCC for non-psychiatric comparison subjects was 13.86 (20.06) pg/mg. Both effect sizes for the difference between the clinical and non- psychiatric comparison groups were small (0.26 for NPMD versus Comparison group and 0.25 for PMD versus Comparison group). Conclusions: This is the first study to assess HCC in PMD and to examine the relationship between HCC and cognition and between HCC and everyday functioning in MDD. We did not find a correlation between HCC and history of psychosis, neuropsychological performance, or functioning in later-life patients with MDD in sustained remission. Further, there was no substantial difference in mean HCC between the patient and non-psychiatric comparison group. There is variability in the literature regarding HCC in MDD and regarding the relationship between HPA-axis function and neuropsychological performance in remitted MDD. Our findings will be discussed in this context. This research was funded by: This study was funded by a research grant from the University Health Network Centre for Mental Health ($14,000)

Poster Number: NR - 4 ASSOCIATIONS BETWEEN CYTOKINES AND CORTICAL THICKNESS IN PATIENTS WITH LATE-LIFE DEPRESSION Lisa Kilpatrick; Beatrix Krause; Prabha Siddarth; Kelsey Laird; Jillian Yeargin; Katherine Narr; Helen Lavretsky

UCLA

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Introduction: Late-life depression (LLD), defined as depression that occurs after the age of 60 years, is associated with a poor quality of life, cognitive impairment, and increased morbidity and mortality. Immune factors are now recognized as involved in the pathophysiology of depression. We aimed to evaluate the relationship between plasma cytokine levels and cortical thickness in patients with LLD. Methods: Blood samples and structural magnetic resonance imaging scans (Siemens 3T Prisma) were acquired in 29 older adults (≥60 years old) with major depression (62% female; mean age, 70.7 (7.3) years; mean MADRS 15.9 (3.2)). Associations between plasma cytokine levels (log-transformed) and cortical thickness were evaluated in a multivariate analysis using partial least squares. Cytokines with detectable levels in at least 27 of the 29 subjects (exotaxin, IFN-a2, GRO, MDC, IL-12(p70), sCD40L, IL-8, IP-10, MCP-1, MIP-1b, TNF-a, and VEGF) were included in the analysis. Results: The first latent variable was significant (accounting for 32% of the cross-block covariance, p=.036) and reflected negative correlations between exotaxin, IL-8, IP-10, MIP-1b, and TNF-a levels and cortical thickness in numerous brain regions, including cingulate, insular, temporal, orbitofrontal, and prefrontal cortices (Figure 1). Conclusions: Patients with LLD who have high plasma levels of exotoxin, IL-8, IP-10, MIP-1b, and TNF-a have less cortical thickness in brain regions previously implicated in depression than patients with LLD who have lower levels of these chemokines and pro-inflammatory cytokines. The affected brain regions have functions in self-referential processes, emotional regulation, social cognition, and attentional switching. Thus, the observed reductions in cortical thickness may contribute to the emotional, cognitive, and behavioral disturbances in LLD. Recently, chemokines have been implicated in many neurobiological processes and are considered to play a role in linking peripheral and central inflammation. The present results further support the importance of chemokines and proinflammatory cytokines in depressive pathophysiology. This research was funded by: Sponsored by NIMH R01 MH097892, NCCIH AT009198, MH086481; Alzheimer’s Research & Prevention Foundation, Allergan, PCORI; Advisory Board: Alzheimer’s Research & Prevention Foundation; Royalties for books from Oxford University Press and Hopkins University Press.

Poster Number: NR - 5 EFFICACY AND SAFETY OF ESKETAMINE NASAL SPRAY PLUS AN ORAL ANTIDEPRESSANT IN ELDERLY PATIENTS WITH TREATMENT-RESISTANT DEPRESSION Rachel Ochs-Ross1; Ella J. Daly1; Yun Zhang2; Rosanne Lane1; Pilar Lim1; Karen Foster3; David Hough1; Husseini Manji1; Wayne C. Drevets4; Gerard Sanacora5; Caleb Adler6; Rupert McShane7; Rapha€el Gaillard8; Jaskaran B. Singh4

1Janssen Research & Development, Titusville, NJ, USA 2Janssen Research & Development, Fremont, CA, USA 3Janssen Research & Development, Raritan, NJ, USA 4Janssen Research & Development, San Diego, CA, USA 5Yale University School of Medicine, New Haven, CT, USA 6University of Cincinnati College of Medicine, Cincinnati, OH, USA 7University of Oxford, Oxford, United Kingdom 8H^opital Sainte Anne, Paris, France

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Introduction: Estimates of 18-40% of elderly patients with depression suffer from treatment-resistant depression (TRD), defined as non-response to at least two antidepressants. Elderly patients experience greater disability and functional decline, decreased quality of life, and greater mortality from suicide than younger patients. Esketamine nasal spray is being investigated for treatment of TRD. We evaluated the efficacy, safety, and tolerability of flexibly dosed esketamine nasal spray (ESK) (28 mg, 56 mg or 84 mg) plus a newly initiated oral antidepressant (AD), compared with AD plus placebo nasal spray (PBO), for the treatment of TRD in elderly patients. Post hoc analyses, performed to better assess the data from this first large clinical trial of TRD in the elderly, are presented in the companion abstract. Methods: Patients ≥ 65 years of age (N=138) in this phase 3, double-blind, multicenter, active-controlled study

(NCT02422186) were randomized (1:1) to either ESK + AD (n=72) or AD + PBO (n=66). The primary endpoint was the change in the Montgomery−Asberg Depression Rating Scale (MADRS) total score from day 1 (baseline) to the end of a 4-week double-blind treatment phase. Statistical analysis employed mixed-effects model for repeated measures (MMRM), with a weighted combination test to account for an interim analysis for sample size re-estimation, using a one-sided 0.025 significance level. Pre-specified subgroup analyses were performed for ages 65-74 years (n=116) and ≥75 years (n=21). Remote raters, blinded to the treatment arm, conducted the MADRS assessments by telephone. Results: The mean (SD) patient age was 70.0 (4.52) years and mean (SD) baseline MADRS total score was 35.2 (6.16). The mean (SD) change in MADRS total scores from baseline to day 28 was -10.0 (12.74) for ESK + AD and -6.3 (8.86) for AD + PBO. Based on MMRM analysis, the median-unbiased estimate of the difference between ESK + AD and AD + PBO was -3.6 (95% CI: -7.20, 0.07; one-sided p=0.029). A treatment difference favoring ESK+AD was seen for the 65-74 years subgroup. The difference in LS mean (SE) change at day 28 was -4.9 (2.04) for 65-74 years (one-sided p=0.009) and -0.4 (5.02) for ≥75 years (one-sided p=0.465). The most common treatment-emergent adverse events (TEAEs) in the ESK + AD group were dizziness (20.8%), nausea (18.1%), headache, fatigue, increased blood pressure, dissociation (12.5% each) and vertigo (11.1%). The most common TEAEs in the AD + PBO group were anxiety, dizziness and fatigue (7.7% each). Conclusions: While treatment with ESK + AD did not demonstrate a statistically significant difference vs treatment with AD + PBO using the weighted combination test on the primary outcome, a statistically significant treatment effect was observed for patients aged 65-74 years, but not for the limited number of patients aged ≥75 years. Safety results were consistent with previous studies in younger adult populations; no new safety concerns were identified. This study was funded by Janssen Research & Development, LLC. This research was funded by: Janssen Research & Development, LLC

Poster Number: NR - 6 POST HOC ANALYSES OF ESKETAMINE NASAL SPRAY PLUS AN ORAL ANTIDEPRESSANT IN ELDERLY PATIENTS WITH TREATMENT-RESISTANT DEPRESSION Rachel Ochs-Ross1; Ella J. Daly1; Yun Zhang2; Rosanne Lane1; Pilar Lim1; Karen Foster3; David Hough1; Husseini Manji1; Wayne C. Drevets4; Gerard Sanacora5; Caleb Adler6; Rupert McShane7; Rapha€el Gaillard8; Jaskaran B. Singh4

Introduction: Major depressive disorder in the elderly is correlated with lower response and remission rates, greater disability, decreased quality of life, and greater mortality from suicide; approximately 18-40% develop treatment-resistant depression (TRD). Moreover, the elderly respond less well to currently available treatments and may be more vulnerable to their adverse effects. The severity of TRD in the elderly is exemplified by a 5-fold increased use of electroconvulsive therapy, highlighting a critical need for alternative safe and effective treatments. A companion abstract discusses results from the first large phase 3 study of esketamine nasal spray in elderly patients with TRD. Post hoc analyses presented here explored factors that may have contributed to the lack of statistical significance observed in the study, despite a numerical advantage on the primary endpoint−Montgomery Asberg Depression Rating scale (MADRS) LS mean scores−in the esketamine arm vs the control arm of the trial. Methods: The primary phase 3, double-blind, multicenter, active controlled study (NCT02422186), included adults ≥65 years of age (N=138) with TRD. Patients were randomized (1:1) to flexibly-dosed esketamine nasal spray (28, 56 or 84 mg twice

Am J Geriatr Psychiatry 27:3S, March 2019 S181 AAGP Annual Meeting 2019 weekly) and a new oral antidepressant (esketamine/antidepressant), or a new oral antidepressant and placebo nasal spray (antidepressant/placebo). Change from baseline was analyzed using mixed-effects model for repeated measures (MMRM). Analyses were conducted at a 2-sided significance level of 0.05. Findings from the primary analysis are described in the companion abstract. Post hoc analyses explored factors that may have affected the study outcome including (1) impact of study stage, i.e. pre interim analysis (IA) (stage 1) or post IA (stage 2): modifications were made early in the study including training of remote MADRS raters to work with elderly and site discussions related to dose that, because of timing for implementation of the changes, had the greatest impact on stage 2; (2) impact of dose assessed by stage of the IA; (3) age subgroups (65-74 and ≥75 years); (4) age of onset of depression (<55 or ≥55 years); and (5) duration of treatment to assess changes in MADRS scores beyond the 4 weeks of the study using data from patients continuing in a long term open label safety study. Results: For reference, the primary efficacy endpoint, the LS mean (95% CI) difference for change in MADRS total scores from baseline to day 28 between the esketamine/antidepressant group and the antidepressant/placebo group using MMRM was -3.6 (¡7.20, 0.07; p=0.059). Post hoc analyses included (1) a marked difference in efficacy between stages of the IA: LS mean (95% CI) difference was -1.6 (-6.85, 3.70) in stage 1 vs -5.6 (-10.78, -0.32) in stage 2. The primary analysis applied equal weight to stage 1 (51 patients) and stage 2 (87 patients) effectively down-weighting the results of stage 2. Overall analysis, without adjusting for the IA, showed LS mean (95% CI) change of -4.0 (-7.71, -0.25); (2) use of maximum dose of 84mg: 52.5% at day 25 of stage 1 vs 71.8% at day 25 of stage 2; (3) age: 65-74 years LS mean (95% CI) change of -4.9 (-8.96, -0.89) vs ≥75 years -0.4 (-10.38, 9.50); (4) age at onset of depression <55 years LS mean (95% CI) change -6.1 (-10.33, -1.81) vs ≥55 years 3.1 (-4.51, 10.80) and (5) duration of treatment with esketamine/antidepressant: 122/137 patients who received additional esketamine treatment after continuing in an open label safety study showed an approximate two-fold reduction in MADRS total scores after an additional 4 weeks of treatment, sustained for up to 48 weeks of follow up. Conclusions: While MADRS improvement with esketamine/antidepressant vs treatment with antidepressant/placebo was not statistically significant in the primary analysis, a nonsignificant favourable trend was found, with a treatment effect size similar to that seen in younger adult esketamine studies. Post hoc analyses assessed factors potentially affecting the primary outcome. In the short-term study, use of lower doses earlier in the study may have decreased efficacy. In the post hoc analysis, a 95% CI of difference that did not include 0 indicated that esketamine/antidepressant was favoured over antidepressant/placebo without the corrective weighting for the IA, as well as for patients 65-74 years of age, and for those with the onset of depression at age <55 years. Additionally, LS mean differences between the treatment groups showed a magnitude at least as great as that seen with many currently available antidepressants in nontreatment resistant MDD. Furthermore, longer duration of treatment improved efficacy, with an approximate two-fold reduction in MADRS total scores for patients treated an additional 4 weeks, which was sustained for up to 48 weeks of follow up. No unexpected safety concerns were identified. This research was funded by: This study was funded by Janssen Research & Development, LLC.

Poster Number: NR - 7 PHENOTYPING PROSPECTIVE COGNITIVE OUTCOMES OF LATE-LIFE DEPRESSION Guy Potter1; Douglas McQuoid1; David Steffens2

1Duke University 2University of Connecticut

Introduction: It has long been known that major depressive disorder during later life (LDD) is associated with cognitive decline and development of Alzheimer’s disease and other dementias. Less is known about the characteristics of LLD that contribute to individual cognitive outcomes, but identifying phenotypes of these outcomes could make important contributions to early detection and treatment. The current study explored clinical and neuroimaging phenotypes associated with normal and non- normal cognitive diagnostic outcomes in LLD. Methods: The data were from a prospective study of individuals (N = 240) with acute depression at baseline and followed under treatment for a minimum of five years. Baseline assessment included clinical measures of mood, neuropsychological assessment, and neuroimaging. Mood was assessed during regular treatment over the course of each year, and neuropsychological assessment was obtained annually. A consensus review was held annually to assign clinical diagnoses based on cognitive status, which included categories of normal cognition; cognitive impairment, no dementia (CIND); dementia, with subtypes including Alzheimer’s disease (AD). The current study analyzed diagnostic outcomes at five years from study entry, and the clinical characteristics that predict these outcomes. Results: We found that 90% of cognitive diagnostic outcomes over five-years of follow-up were in three diagnostic categories: 1) cognitively normal, 2) persistent CIND, and 3) AD. The remaining 10% were non-AD dementias and various medical and neuropsychiatric diagnoses. Individuals with normal cognition were 50% of the sample, and this endpoint was associated with first depression onset before age 60 and indicators of heightened sensitivity to stress. Individuals with persistent CIND (22%)

S182 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 were not associated with age of depression onset, but were associated with clinical characteristics of frailty and indicators of cerebrovascular pathology on neuroimaging. Individuals with AD (18%) were associated with age of depression onset after age 60, depressive symptoms of appetite/weight loss, reduced hippocampal volume, and worse memory performance at study entry. Conclusions: The current study found distinct clinical and neuroimaging profiles associated with the three major cognitive endpoints of LLD. Approximately half of individuals with LLD maintained normal cognition over five years, which appeared to be associated with a lifetime predisposition to depression and heightened sensitivity to stress. In contrast, nearly 20% of individuals with LLD converted to AD within five years of follow up, and results suggest a clinically detectable phenotype of prodromal AD based on appetitive disturbance, reduced hippocampal volume, and memory deficits. Individuals with persistent CIND demonstrated a profile consistent with physical decline and cerebrovascular pathology, which did not manifest as dementia over 5 years, but may represent a slower progress toward vascular dementia relative to those with AD. These clinical phenotypes reflect a starting point for mechanistic discovery while also improving current treatment of LLD by identifying individuals on distinct cognitive trajectories who many benefit from differentiated approaches to the treatment of mood and cognition. The current cohort is part of a collaborative project to further detect and characterize linkages between cognitive outcomes of LLD and their clinical and neuroimaging phenotypes. This research was funded by: This research was supported by funding from the National Institute of Mental Health (R01MH108560), and the Leo and Anne Albert Charitable Trust. The authors have no industry or other conflicts to report.

Poster Number: NR - 8 COGNITIVE VARIABILITY AND BRAIN AGING IN LATE-LIFE DEPRESSION Joshua Preciado1; Kevin Manning2; Lihong Wang2; David Steffens2

1The University of Texas at El Paso 2University of Connecticut Health Center

Introduction: Dispersion across cognitive test scores, a measure of variability in cognitive performance, may be an indication of pathological aging. The aim of the current study was to investigate the association of test dispersion with structural brain variables and cognitive decline in non-demented older adults with major depression (MD) and healthy controls (HC). We hypothesized that those with greater dispersion would have lower hippocampal volumes (HPC) and higher white matter hypointensities (WMH) and that dispersion would predict cognitive decline at one-year follow-up. Methods: Subjects included 121 MD and 39 HC subjects who participated in the NBOLD study at UConn Health. Inclusion criteria were age 60+ and a psychiatrist’s diagnosis of MD for the patient group. Dementia and other major neuropsychiatric illnesses were exclusion criteria. Dispersion was calculated as the standard deviation of z-scores divided by group mean z-scores of a demographically adjusted neuropsychological test performance across a comprehensive battery. Results: Dispersion positively correlated with WMH in both HC (r=0.386; p =.001) and MD (r=0.318; p=0.001), and negatively correlated with left HPC volume in MD (r=-0.191; p=0.034). Linear regression analyses accounting for baseline cognitive performance, demographics, and depression found that dispersion predicted cognitive tasks performed at a year follow up. For older adults with MD word list (WL) 1-3 (p=.038), WL delayed recall (DR) (p=.020) and symbol digit modality test (SDMT) (p=.035) were predictors. For HC dispersion was predicted for logical memory (LM) DR (p=.004) and Benton test (p=.003). Conclusions: Dispersion is correlated with evidence of brain aging in older adults with MD. Future studies may look at ways to reduce dispersion in older adults and help prevent cognitive decline. This research was funded by: Research reported in this poster was supported by the National Institute of General Medical Sciences of the National Institutes of Health under linked Award Numbers RL5GM118969, TL4GM118971, and UL1GM118970. The content is solely the responsibility of the authors and does not necessarily represent the ofﬁcial views of the National Institutes of Health. Educational and research grant from the Leo and Anne Albert Charitable Trust.

Poster Number: NR - 9 EFFECT OF MEMANTINE ON BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD) OF ALZHEIMER’S DISEASE - STUDY OF CHANGES IN CEREBRAL BLOOD FLOW BY SPECT IMAGING- Kiyoshi Kanaya1; Haruo Hanyu2

1Tokyo Medical University Hachioji Medical Center 2Tokyo Medical University Geriatric Medicine

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Introduction: The mechanism of the onset of BPSD associated with Alzheimer’s disease (AD) is unclear, and the incidence and frequency of these symptoms are difficult. We conducted a retrospective study on sites of decreased cerebral blood flow(CBF) during onset along with sites of increased blood flow following administration of memantine (MEM) for three BPSD parameters consisting of “agitation/irritability”, “hallucinations/delusions” and “wandering/appeal to return home” using SPECT imaging. Methods: The study was targeted at 41 outpatients diagnosed with AD and presenting with BPSD (agitation/irritability: 11 cases, hallucinations/delusions: 19 cases, wandering/appeal to return home: 11 cases). Sites of decreased CBF during onset of BPSD were extracted using the statistical parametric mapping (SPM8) followed by an examination of their responsible lesions. SPECT was repeated about six months after additional administration of MEM followed by an examination of the correlation between sites of increased CBF attributable to MEM and improvement of symptoms. Results: 1 With respect to agitation/irritability, decreases in CBF were observed in the dorsolateral prefrontal cortex bilaterally, angular gyrus, right-dominant parietal association area and posterior cingulate gyrus, while increases in CBF following administration of MEM were observed in the orbital gyri bilaterally, right occipital lobe and left ventral prefrontal cortex. 2 With respect to hallucinations/delusions, decreases in CBF were observed in the posterior cingulate gyrus, occipital lobe and lt.-dominant parietal association area, while increases in CBF following administration of MEM were observed in the parietal lobe, orbital gyrus and prefrontal cortex bilaterally. 3 With respect to wandering/appeal to return home, decreases in CBF were observed in the mid-cerebellum, occipital lobe and parietal lobe, while increases in CBF following administration of MEM were observed in mid-cerebellum, left parietal lobe, occipital lobe, posterior cingulate gyrus, prefrontal cortex and ventral central pons. Conclusions: There was suggested to be a correlation between sites of CBF following administration of MEM and improvement of BPSD.

Poster Number: NR - 10 ASSOCIATION BETWEEN ODOR IDENTIFICATION AND REGIONAL GRAY MATTER IN EARLY PRECLINICAL ALZHEIMER’S DISEASE Manan Gupta; Ryan S O’Dell; Joel Gelernter; Richard E Carson; Christopher H van Dyck; Adam P Mecca

Yale University School of Medicine

Introduction: Poor performance on odor identification tests has been associated with mild cognitive impairment (MCI) and dementia due to Alzheimer’s disease (AD-dementia) in older individuals (Mesholam RI et al., 1998). In addition, longitudinal studies have indicated that the University of Pennsylvania Smell Identification Test (UPSIT) is a sensitive measure that predicts conversion from MCI to AD-dementia (Devanand DP et al., 2015) However, precise biological correlates between smell identification and neurodegeneration remain to be identified. Autopsy studies and PET imaging studies indicate amyloid bplaques and neurofibrillary tangle deposition in the olfactory network, suggesting the olfactory bulb as a possible contributor (Kovacs T et al., 1999). Regardless of the etiology, deficits in smell identification measured by the UPSIT may be a useful biomarker for early presymptomatic AD. In a recent study by Risacher et al., (2017), lower UPSIT scores were inversely associated with tau burden in the temporal lobe of cognitively normal (CN) older individuals (mean age 68.5). However, no association was found between UPSIT score and amyloid deposition or neuro-degeneration as measured by gray matter (GM) volume in CN individuals. In a previous study, we reported that in middle-aged preclinical participants with varying genetic risk for AD, amyloid burden correlated inversely with the GM fraction but not with UPSIT scores. In this study, we aim to investigate the correlations between smell identification scores and regional GM fraction among CN middle-aged individuals at varying genetic risk for AD. Methods: Sample consisted of 45 cognitively normal participants aged 50-66 with a first-degree family history for AD divided among three groups: APOE genotype e4e4(n=15),e3e4(n=15),ande3e3 (n=15), who underwent [11C]PiBPET,MRI,and neuropsychological testing. The UPSIT was administered to all participants. To quantify GM within 9 regions (ROIs), we applied inverse transformations of the AAL from MNI to subject space and calculated GM fraction as the number of voxels segmenting as GM divided by the total number of voxels in a region. The ROIs were basal ganglia, posterior cingulate, frontal cortex, lateral parietal cortex, lateral temporal cortex, medial temporal lobe, occipital cortex, precuneus and composite cortex. GM fractions which account for intersubject variability in brain size were thus generated for each ROI using the AAL atlas after the structural MRI of each participant was normalized to the MNI template. Statistical analysis was performed using SPSS version 24.0 (IBM Corp). Pearson’s r was calculated to assess bivariate correlations. p-values < 0.05 for 2-sided tests were interpreted as statistically significant. Results: Mean age of the participants was 59.1 years (SD=4.71). The mean UPSIT score was 34.58 (SD=4.09). 22 subjects (out of 45) met quantitative criteria for a positive amyloid PET scan using the [11C]PiB BPNDcut-off of 0.08 in this cognitively normal sample (Villeneuve et al., 2015). No statistically significant correlations were found between the UPSIT and GM

S184 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 fraction in any ROI. (Table 1). Additional analyses were performed on groups stratified by genetic risk. After excluding individuals with lower genetic risk (APOE e3e3) from the sample, no statistically significant correlation was found between UPSIT scores and GM fraction (Table 2). Similarly, no correlation was found between UPSIT score and GM fraction in participants with APOE e4e4 genotype or APOE e3e3 genotype. Conclusions: In middle aged preclinical AD participants, olfactory identification performance did not correlate with gray matter fraction. Our findings appear consistent with previously reported studies and indicate that olfactory identification may not be a sensitive biomarker for early preclinical disease. Further studies to assess associations between olfactory identification deficits and pathological tau accumulation in a similar early preclinical sample may be warranted. This research was funded by: This research was supported by the Alzheimer’s Association IIRG-07-60026 (CHvD) and National Institute on Aging (P50-AG047270). APM was supported in part by the NIH/NIA K23-AG057794. RSO was supported in part by the NIMH R25 IMPORT grant (R25MH071584).

TABLE 1. Correlations between UPSIT score and regional GM fraction (all subjects) Region Pearson’s r p Medial temporal 0.156 0.306 Lateral temporal 0.146 0.337 Occipital 0.109 0.475 Frontal ¡0.009 0.954 Basal Ganglia ¡0.267 0.076 Precuneus ¡0.061 0.690 Posterior Cingulate 0.065 0.672 Lateral parietal 0.008 0.957 Composite cortex 0.025 0.868

UPSIT mean: 34.5 (SD:4.09), N=45

TABLE 2. Correlations between UPSIT score and regional GM fraction (Apo e4 at least 1 copy) Region Pearson’s r p Medial temporal 0.260 0.165 Lateral temporal 0.295 0.113 Occipital 0.248 0.187 Frontal 0.121 0.526 Basal Ganglia ¡0.304 0.102 Precuneus 0.011 0.955 Posterior Cingulate 0.225 0.231 Lateral parietal 0.051 0.787 Composite cortex 0.147 0.438

UPSIT mean:34.6 (SD:4.3), N=30

Poster Number: NR - 11 PERSPECTIVES FROM THE FIELD: DESIGNING THE DRIVING CESSATION IN DEMENTIA INTERVENTION TOOLKIT (DCD-IT) Mark Rapoport1; Stephanie Yamin2; Brenda Vrkljan3; Holly Tuokko4; Sarah Sanford5; Elaine Stasiulis5; Michelle Porter6; Jan Polgar7; Anita Myers8; Paige Moorhouse9; Frank Molnar10; Barbara Mazer11; Shawn Marshall10; Isabelle Gelinas11; Alexander Crizzle12; Anna Byszewski10; Patricia Belchior11; Michel Bedard13; Gary Naglie5

1Sunnybrook Health Sciences Centre, University of Toronto 2Saint Paul University 3McMaster University 4University of Victoria 5Baycrest Health Sciences 6University of Manitoba

Am J Geriatr Psychiatry 27:3S, March 2019 S185 AAGP Annual Meeting 2019

7Western University 8University of Waterloo 9Dalhousie University 10University of Ottawa 11McGill University 12University of Saskatchewan 13Lakehead University

Introduction: Decision-making about driving cessation and transitioning to non-driving is a challenging and complex issue faced by drivers diagnosed with dementia and their families. Driving cessation is associated with adverse psychosocial and health- related impacts for persons with dementia including a reduction in quality of life. To address the gap in evidence-based interventions that support individuals in the driving cessation process, we developed the Driving Cessation in Dementia Intervention Toolkit (DCD-IT). Our objective in this study was to further develop and refine the DCD-IT (content, design and mode of delivery) to facilitate its effective implementation in settings that support older adults with dementia. Methods: Representatives (n=15) from Alzheimer Society organizations in British Columbia, Manitoba, Ontario and Nova Scotia reviewed the DCD-IT and provided feedback via a webinar, questionnaire and in-depth interviews. Data analysis techniques included thematic coding and inductive analysis. Results: Participants emphasized the lack of accessible and trusted driving cessation resources specific to meeting the needs of persons with dementia (PWD) and their family caregivers. They identified gaps and corresponding areas of focus to inform the continued development and design of the DCD-IT, which included: materials directed separately to PWD encompassing appropriate content, language and design; resources geared to helping healthcare providers engage in discussions with PWD and family caregivers; information for PWD, family caregivers and healthcare providers about region-specific driving regulations and alternative transportation options. Conclusions: Obtaining the perspectives of Alzheimer Society representatives have informed improvements to the content and design of the DCD-IT. Next steps include evaluating the implementation process of the intervention framework and toolkit in Alzheimer Society chapters in community settings in Ontario with the aim of informing widespread implementation and adaption across Canada. This research was funded by: Canadian Institute of Health Research/Canadian Consortium on Neurodegeneration in Aging.

Poster Number: NR - 12 REGION-SPECIFIC ATROPHY AS MEASURED BY CORTICAL GRAY MATTER VOLUME IS ASSOCIATED WITH BOTH REGIONAL AND TOTAL CORTICAL AMYLOID-BETA BURDEN IN COGNITIVELY NORMAL INDIVIDUALS AT RISK FOR ALZHEIMER’S DISEASE Ryan O’Dell; Manan Gupta; Joel Gelernter; Richard Carson; Christopher van Dyck; Adam Mecca

Yale University School of Medicine

Introduction: Models of preclinical Alzheimer’s disease (AD) have proposed that cerebral amyloidosis and subsequent neurodegeneration may occur years, if not decades prior to observable cognitive decline. We previously demonstrated that total cortical amyloid-beta burden was inversely associated with cortical gray matter volume but not episodic memory in a sample of cognitively normal, middle-aged participants, with a ﬁrst-degree family history and varying genetic risks of AD (Mecca et al., 2018). The current study utilizes an exploratory approach to determine the regional contribution of cortical amyloid deposition to gray matter volume and neuropsychological test performance in pre-symptomatic individuals at varying genetic risk for AD. Methods: As described previously (Mecca et al., 2018), cognitively normal participants aged 50-66 with a ﬁrst-degree family history for AD were genetically screened to select three groups: APOE genotype e4e4 (n=15), e3e4 (n=15), and e3e3 (n=15), matched for age and sex. Participants were then studied with [11C]PiB PET, MRI, and neuropsychological testing. PET and MR images were co-registered for application of a ROI template (AAL for SPM2) to generate regional time-activity curves with cerebellum as the reference region. MRI images were segmented into gray matter, white matter, and CSF. Mask images of these » segments were smoothed to the system resolution ( 6mm), and gray matter values of BPND were partial volume corrected (PVC). PVC-BPND was then computed using SRTM2 for frontal, posterior cingulate, precuneus, lateral parietal, lateral temporal, medial temporal, occipital, and basal ganglia ROIs. A cortical BPND (cortical amyloid) was also calculated by taking a weighted average of only the frontal, posterior cingulate, precuneus, lateral parietal, and lateral temporal regions. To quantify GM within each ROI, we applied inverse transformations of the AAL from MNI to subject space and calculated GM fraction as the number of voxels segmenting a GM divided by the total number of voxels in a region.

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Results: The study sample consisted of 24 females and 21 males with an average age of 59.12 (SD 4.72) and 16.33 (SD 1.86) years of education. Participants demonstrated an average MMSE score of 29.66 (SD 0.91), GDS score of 0.71 (SD 1.25), WAIS-III FSIQ score of 115.04 (SD 13.32), and WRAT-3 Reading score of 109.47 (SD 9.64). As previously reported, mean § APOE e e § APOE e e § APOE e e cortical BPND was 0.145 0.131 for - 3 3, 0.297 0.299 for - 3 4, and 0.389 0.222 for - 4 4 participants. An exploratory analysis was performed to examine the regional contributions to the association between cortical amyloid burden and gray matter volume. There were significant inverse associations between gray matter fraction and cortical amyloid in the frontal (spearman r=-0.459, p=0.002), lateral temporal (spearman r=-0.546, p<0.001), medial temporal (spearman r=-0.442, p=0.002), and occipital lobes (spearman r=-0.369, p=0.013). Interestingly, when regional gray matter fractions were correlated with regional amyloid, significant inverse associations were again observed, in the frontal (spearman r=-0.490, p<0.001), lateral temporal (spearman r=-0.521, p<0.001), and occipital lobes (spearman r=-0.361, p=0.015), as well as in the posterior cingulate (spearman r=-0.311, p=0.037). Conclusions: Based on our regional exploratory analyses, the inverse association between cortical amyloid burden and gray matter volume is strongest in the frontal, lateral, and medial temporal lobes. This is consistent with models of preclinical AD in which neurodegeneration occurs early in the disease process and before manifest cognitive decline. Interestingly, although the occipital lobeis traditionally thought to be a region of low amyloid deposition, we find the regional gray matter volume is significantly correlated with both regional and cortical amyloid. This perhaps implicates the occipital lobe as part of the cortical signature of AD, at least in cognitively normal middle-aged individuals with an increased risk of developing AD. It is also noted that medial temporal lobe atrophy isn’t associated with regional amyloid, but instead significantly correlated with total cortical amyloid deposition. This is expected given the medial temporal lobe’s reputation as a known area of early atrophy but not amyloid deposition in AD. This research was funded by: This research was supported by the Alzheimer’s Association IIRG-07-60026 (CHvD) and National Institute on Aging (P50-AG047270). APM was supported in part by the NIH/NIA K23-AG057794. RSO was supported in part by the NIMH R25 IMPORT grant (#R25MH071584).

Poster Number: NR - 13 TAU AND AMYLOID PATHOLOGY IN ASSOCIATION WITH SUBJECTIVE COGNITIVE PERFORMANCE IN NORMAL ELDERLY AND EARLY MILD COGNITIVE IMPAIRMENT Sepideh Shokouhi1; Hakmook Kang2; Alexander Conley1; Harry Gwirtsman1,3; Paul Newhouse1,3

1Department of Psychaitry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 2Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 3Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Medical Center, Nashville, TN, USA

Introduction: Subjective cognitive decline (SCD) is increasingly recognized as the initial outward sign of preclinical Alzheimer’s disease. The ability to explore associations between individual domains (memory, language, executive function, and visuospatial processing) within SCD and pathological biomarkers of early Alzheimer’s disease (AD) would provide an important tool to understand the pathological basis of SCD and the risk of developing AD. This study utilizes multiple data analysis strategies to characterize the severity of tau and amyloid burden in clinically normal elderly adults (CN) and early mild cognitive impairment (EMCI) subjects in association with their subjective cognitive decline. Methods: All subject data were downloaded from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. These included [18F]flortaucipir tau and [18F]florbetapir amyloid positron emission tomography (PET) images as well as the subjects’ SCD scores. For SCD, we used the self- and informant-reported individual items of Everyday Cognition questionnaire, including Everyday Memory, Everyday Language, Everyday Visuospatial abilities, Everyday Planning, Everyday Organization, and Everyday Divided Attention. The severity of the amyloid burden was calculated as the global PET standardized uptake value ratio (SUVR). The severity of the tau burden was assessed with both standard uptake-based approaches (tau SUVR in entorhinal, limbic, and isocortical Braak regions) and with a novel texture analysis tool, the weighted two-point correlation (wS2) analysis, which characterizes the spatial clustering of the tau-PET image as a sensitive early biomarker of abnormal tau accumulation and spread. Using a series of backward-elimination regression models, we identified the combination of predictors (from tau PET, global amyloid-PET, sex, APOE, and age) that constructed the best model to predict each Everyday Cognition item. Results: Across the different cognitive tests, the wS2-based tau measures explained more variability, as indicated by p-values and elevated R-squared values, than standardized uptake value ratios from different anatomical regions, including the entorhinal cortex which is believed to be among the first regions to show signs of tau pathology. Our backward-elimination regression analyses (figure 1) suggested that the strongest models for predicting some of the subjective cognitive items (Everyday Memory,

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Everyday Language, Everyday Organization) were more likely amyloid-related whereas other items (Everyday Visuospatial, Everyday Planning) were more tau-related (together with age and sex). Conclusions: Different pathological pathways may inﬂuence the manifestation of different subjective cognitive items. In vivo texture analysis techniques may be used as sensitive tools to explore these pathological pathways in association with the earliest signs of cognitive changes.

Poster Number: NR - 14 ASSOCIATION BETWEEN NEUROPSYCHIATRIC SYMPTOM TRAJECTORY AND PROGRESSION TO ALZHEIMER’S DISEASE Tsz Wai Bentley Lo1; Wael Karameh2,3,4; Joseph Barfett2,5; David Munoz2,6,7; Tom Schweizer2,8,9,10,11; Corinne Fischer2,3,8

1Faculty of Psychology, University of Toronto Scarborough 2Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital 3Faculty of Medicine, Department of Psychiatry, University of Toronto 4Centre for Addiction and Mental Health 5Department of Medical Imaging, St. Michael’s Hospital 6Department of Laboratory Medicine and Pathobiology, University of Toronto 7Division of Pathology, St. Michael’s Hospital 8Institute of Medical Sciences, University of Toronto 9Institute of Biomaterials and Biomedical Engineering, University of Toronto 10Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto 11Division of Neurosurgery, St. Michael’s Hospital

Introduction: Objective: Neuropsychiatric symptoms (NPS) are a key characteristic and known biomarker of Alzheimer’s disease (AD). Our study investigates the potential of NPS as measured by the Neuropsychiatric Inventory score (NPI) to predict progression from Mild Cognitive Impairment (MCI) to AD. In addition, we have analyzed the trajectory of NPS in comparison to global cognitive scores. Introduction: NPS are common in MCI and based on prior studies they are a signiﬁcant risk factor for progression to AD. Working memory and episodic memory are also known to decline with progression of AD. Cognitive tests such as MMSE have been utilized to track patients’ level of cognition and the decline in these cognitive tests is a well-known predictor of dementia. However, how NPI scores relate to cognitive test scores in predicting progression to AD is still unknown. We propose to analyze NPI (total score and sub scores) longitudinally for 6 years and to compare scores between MCI- converters (MCI-C) and MCI- non converters (MCI-NC). We hypothesize that converters may have higher scores compared to non-converters. In addition, we expect that MMSE score should correlate inversely with NPI score. Symptoms associated with progression to AD that are prevalent in our study should match those that are shown in previous studies (depression, delusion, agitation, and apathy.) Methods: We selected 150 subjects from Alzheimer’s Disease Neuroimaging Initiative phase 3 (36 MCI-C and 114 MCI-NC). The only inclusion criteria were that subjects must have NPI scores at two or more time points. Gender, age, and education were matched across all subjects. To measure NPI scores longitudinally, subjects were divided into two groups, MCI-C and MCI- NC. We also grouped subjects according to their NPI scores to measure their cognition using MMSE: healthy (N=55), mild (NPI score= 1-9, N=65), and severe (NPI score= 10 and above, N=30). The NPI total score and MMSE were measured across 6 years and compared at 12-month intervals. All statistical analyses were performed using SPSS 25. Analyses of variance (ANOVA) were used to compare MCI-C and MCI-NC group differences. If the assumption of homogeneity was violated, Brown-Forsythe Test p-value was reported instead. Post-hoc analyses was done by using Gabriel and Dunnett’s T3 test. The 12 NPI sub scores were also counted as percentage to analyse the progression of NPS.

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Results: The NPI total scores at all time points for the duration of 6 years were significantly different between MCI-C and MCI- NC (p<0.05) except at baseline (N=150, p=0.164). Notably, there was a steady increase in the NPI total score suggesting that MCI-C subjects are developing more NPS (figure 1) with clinical progression. MMSE scores were inversely correlated with NPI total score. All time points were significant (p<0.05) except for baseline (N=150, B-F p= 0.260) (figure 2). Post-hoc revealed that MMSE scores in healthy and severe NPI group are significantly different (p<0.05); whereas healthy and mild group were non significant. There was also an increase in eating disorder (6% to 13%), agitation (6% to 10%), apathy (9% to 14%), and aberrant motor (1% to 7%) when we compared mild versus severe NPI group. Conclusions: Our study has confirmed previous findings that NPI scores increased with progression of clinical symptoms from MCI to AD in MCI-C relative to MCI-NC. In addition, MMSE scores varied between NPI groups at all time points after baseline. Both of the scores showed a deteriorating trend in their respective scale in MCI-C relative to MCI-NC. This research was funded by: Data collection and sharing for this project was funded by the Alzheimer’s Disease Neuroimaging Initiative (ADNI) (National Institutes of Health Grant U01 AG024904) and DOD ADNI (Department of Defense award number W81XWH-12-2-0012). ADNI is funded by the National Institute on Aging, the National Institute of Biomedical Imaging and Bioengineering, and through generous contributions from the following: AbbVie, Alzheimer’s Association; Alzheimer’s Drug Discovery Foundation; Araclon Biotech; BioClinica, Inc.; Biogen; Bristol-Myers Squibb Company; CereSpir, Inc.; Cogstate; Eisai Inc.; Elan Pharmaceuticals, Inc.; Eli Lilly and Company; EuroImmun; F. Hoffmann-La Roche Ltd and its affiliated company Genentech, Inc.; Fujirebio; GE Healthcare; IXICO Ltd.; Janssen Alzheimer Immunotherapy Research & Development, LLC.; Johnson & Johnson Pharmaceutical Research & Development LLC.; Lumosity; Lundbeck; Merck & Co., Inc.; Meso Scale Diagnostics, LLC.; NeuroRx Research; Neurotrack Technologies; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Piramal Imaging; Servier; Takeda Pharmaceutical Company; and Transition Therapeutics. The Canadian Institutes of Health Research is providing funds to support ADNI clinical sites in Canada. Private sector contributions are facilitated by the Foundation for the National Institutes of Health (www.fnih.org). The grantee organization is the Northern California Institute for Research and Education, and the study is coordinated by the Alzheimer’s Therapeutic Research Institute at the University of Southern California. ADNI data are disseminated by the Laboratory for Neuro Imaging at the University of Southern California.

Poster Number: NR - 15 BESI: BEHAVIORAL AND ENVIRONMENTAL SENSING AND INTERVENTION FOR DEMENTIA CAREGIVER EMPOWERMENT Azziza Bankole1; Martha Anderson1; John Lach2; Tonya Smith-Jackson3; Temple Newbold1

1Virginia Tech Carilion School of Medicine 2University of Virginia 3North Carolina A&T State University

Introduction: Caregiver burden associated with dementia-related agitation is one of the most common reasons community- dwelling persons with dementia (PWD) transition to a care facility. Agitation in dementia can be defined as “inappropriate verbal, vocal, or motor activity that is not explained by needs or confusion per se” and is “consistent with emotional distress”. Agitation can be physically non-aggressive, aggressive, or verbally agitated behavior. Up to 90% of PWDs experience agitation and it is one of the principal factors for institutionalization. Agitation can be unpredictable, remain undetected in the early stages, and quickly escalate. Caregivers of PWD report high levels of emotional, physical, and financial stress and are susceptible to disease and health complications. BESI is an interactive, cybersociophysical system comprising of in-home and body-worn sensors, a caregiver tablet interface, online modeling, and caregiver notifications built to help detect the environmental triggers and early signs of agitation in PWD. Methods: This is a mixed method, prospective study using descriptive, qualitative, and quantitative measures of caregiver-PWD dyads. Baseline psychosocial and behavioral status for both members of the dyad were assessed using validated assessment tools. Phase 1 (System Verification) - controlled settings (laboratory and homes of 2 healthy volunteers) and study settings (homes of 2 study dyads) & usability testing Phase 2 (System Effectiveness) - homes of 10 study dyads for 30 days each Home Visits First: provide detailed description of study, obtain informed consent, and document demographic and medical information. Second: complete assessment battery and BESI system installation. Results: Phase 1

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The tablet application usability was assessed and revised showing it to be a viable tool. We observed and documented caregiver emotional-state evolution over the day in relation to agitation episodes, the correlation between agitation events and accelerometer Teager energy magnitudes, and the variability in environmental parameters across rooms temporally and during agitation episodes. Audio levels did not yield enough information for more complex audio processing such as verbal agitation detection. We concluded that additional model training and evaluation was needed for physical agitation detection and PWD room localization. Phase 2 An upgraded audio data collection system was implemented to provide more complex audio processing. Comparing this with the verbal agitation episode reports on the tablet application, this method produced a 76.7% accuracy in detecting verbal agitation events. Multiple models were explored for physical agitation detection, with long short-term memory (LSTM) cell based recurrent neural network providing the highest performance. Decision rules was used to structure covariance factor retention for each dyad to feed into artiﬁcial neural network models. Doorway-based sensors and Markov models with room transition probabilities provided »90% room-level tracking accuracy of the PWD. Conclusions: Phases 1 & 2 results facilitated targeted changes in BESI, thus improving its overall usability for the ﬁnal phase of the study. This research was funded by: This study is funded by the National Science Foundation Smart and Connected Health Program. [Grant Number 1418622]

Poster Number: NR - 16 THE EFFECTIVENESS OF PROBLEM ADAPTATION THERAPY (PATH) IN A CULTURE AND LANGUAGE RICH COMMUNITY Daniel Eguchi1; Jessica Matos1; Janice Korenblatt1; Jessica Zwerling1; Dimitris Kiosses2; Mirnova Ceide1

1Monteﬁore Medical Center/Albert Einstein College of Medicine 2Weill Cornell Medicine

Introduction: About 40% of homebound older adults have an unrecognized psychiatric disorder such as dementia, depression and substance abuse. Behavioral health programs have systematically excluded older adults with significant disability and/or cognitive impairment as they have difficulty engaging in various types of psychotherapy including Problem Solving Therapy (PST). Problem Adaptation Therapy (PATH) is a treatment developed at Weill Cornell’s Westchester Division by Dimitri Kiosses, PhD for older adults with depression, cognitive impairment, and disability. PATH utilizes a problem-solving approach along with caregiver participation, compensatory mechanisms, and environmental adaptations. In 2016, Montefiore Medical Center collaborated with Cornell to pilot PATH in a diverse and bilingual patient population funded by the Fan Fox & Leslie R. Samuels Foundation. While most of the patients and caregivers enrolled have reported their satisfaction with the program, it is unclear if there are aspects of PATH that vary in effectiveness based on cultural and language factors. In this study, our objective was to assess if PATH worked equally well in English and Spanish speakers. Variables of interest include presence of suicidal ideation, caregiver stress, coping strategies employed and treatment response.

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Methods: We reviewed the EPIC Electronic Health Records of 70 Montefiore Home Care and Geriatric Neurology Center patients (≥60 years old) seen between January 2017 and April 2018. Patients who did not complete PATH treatment were excluded; therefore 57 patients were included in the analysis. Important variables identified by chart review included primary language (English or Spanish), initial and final PHQ9 scores(Patient Health Questionnaire), presence of suicidality at initial and final PATH visits, the presence of moderate anxiety using BAI (Beck Anxiety Inventory) or GAD7 (Generalized Anxiety Disorder), caregiver stress measured by AMA caregiver stress scores, and coping strategies employed. Coping strategies employed in PATH fall into 4 categories: acoustic (timers), visual (notes), planning (step-by-step plan), and attentional (shaping procedure to sustain attention). Descriptive and bivariate analyses were conducted using SPSS 25 (Statistical Package for the Social Sciences). Chi-squared test was completed for categorical variables. Fisher’s exact test was used when greater than 20% of cells had less than 5 expected observations. Independent sample t-test was utilized to compare mean differences of continuous variables. Results: The mean age was 79.6 (§9.0) years; 85% were female; and 37% were Spanish-speaking. Spanish speakers had significantly higher initial PHQ9 scores than English speakers [PHQ9 Mean Score 11.7 (§3.1) vs. 8.9 (§5.1), p-value= 0.03]. Furthermore, Spanish speakers were significantly more likely to have moderate anxiety than English speakers (42.9% vs. 9.7%, x2= 6.6, p-value= 0.02). Initial caregiver stress scores did not differ significantly based on language status. Also, the types of coping strategies employed during treatment did not differ significantly in Spanish and English speakers. In terms of treatment response for the entire cohort, the mean difference in PHQ9 score from initial to final visit was a 3.0 (§1.9) (p-value= 0.01), which was a significant decrease in scores. 37% of participants achieved remission (defined by 50% decrease in PHQ9 score) by the end of treatment. Remission rates were not significantly different by language status. Conclusions: This study found that overall PATH (an innovative psychosocial intervention for depressed, cognitively impaired older adults) achieved 37% remission in this clinically and culturally complex population. Spanish speakers presented with higher depression and anxiety than English speaking counterparts. This could be due to either: reporting differences or late presentation due to stigma around seeking mental health treatment. The reasons behind these associations warrant further investigation in a larger cohort and more complex regression models, adjusting for important confounders. Based on similar treatment strategies and response to treatment, we can conclude that PATH was equally effective in both English and Spanish speakers. This similar response was present despite more severe presentations amongst Spanish speakers at baseline. The results of the proposed study will be used to inform implementation of this psychosocial intervention for depressed cognitively impaired older adults in a culturally diverse, urban community. This research was funded by: Fan Fox & Leslie R. Samuels Foundation

Poster Number: NR - 17 SEVERITY OF AGITATION IN ALZHEIMER’S DISEASE: PROPORTION OF INDIVIDUALS TRANSITIONING TO LONG-TERM RESIDENTIAL CARE USING US NATIONAL ALZHEIMER’S COORDINATING CENTER DATA Martin Cloutier1; Marjolaine Gauthier-Loiselle1; Patrick Gagnon-Sanschagrin1; Annie Guerin1; Myrlene Sanon2

1Analysis Group 2Otsuka Pharmaceutical Development & Commercialization, Inc.

Introduction: Agitation is among the most common behavioral symptoms of dementia and poses a major challenge for the treatment and management of individuals with dementia. A few studies have shown agitation may be an important predictor of institutionalization; however, these studies were limited to very small sample sizes and focused on behavioral symptoms in general. This study aimed to assess the rate of institutionalization by agitation severity level in patients with dementia. Methods: A retrospective cohort analysis was undertaken using the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS), comprising data from 39 past and present Alzheimer’s Disease Centers across the United States supported by the National Institute on Aging/National Institute of Health. Eligible individuals had dementia due to Alzheimer’s disease, were not institutionalized as of the index date, and had known information on key variables (including residence status) as of the index date and the following annual visit. Agitation severity level was assessed using reported scores per the Neuropsychiatric Inventory Questionnaire (NPI-Q), a behavioral assessment scale. More specifically, agitation was defined per the NPI-Q agitation/aggression scale, where 1=mild (noticeable, but not a significant change), 2= moderate (significant, but not a dramatic change), and 3=severe (very marked or prominent; a dramatic change). Patients with no agitation at any time were included in the “No agitation cohort”. For each patient in the “No agitation cohort”, one visit was randomly selected among all of the patient’s visits during which a score on the NPI-Q for the agitation domain was recorded, and the date of the selected visit was defined as the index date. Patients with at least one visit with a score greater than 0 on the agitation domain of the NPI-Q at

Am J Geriatr Psychiatry 27:3S, March 2019 S191 AAGP Annual Meeting 2019 any time were included in the “Agitation cohort” and classified in the Mild, Moderate, or Severe cohort based on their score on the agitation domain of the NPI-Q as of their index date. For each patient, one visit was randomly selected among all of the patient’s visits where a score greater than 0 on the NPI-Q for the agitation domain was recorded, and the date of the selected visit was defined as the index date. Entropy balancing was used to reweight baseline characteristics of individuals included in the “Agitation cohort” and those in the “No agitation cohort” based on age; gender; race; ethnicity; education; primary language; marital status; blood pressure (systolic and diastolic); resting heart rate; active depression; and Clinical Dementia Rating, Geriatric Depression Scale, Modified Hachinski Ischemia Scale, and Functional Activities Questionnaire scores. Institutionalization rates were assessed among balanced cohorts at the first annual visit following the index date. Results: A total of 4,344 individuals met the sample selection criteria for the study, of whom 2,798 (64%) were classified as having agitation per the NPI-Q agitation/aggression scale and 1,546 (36%) were in the “No agitation cohort”. Among patients in the balance cohort, 50% were female, 82% were white, and the mean age was 75.2 years § 9.7. The proportion of patients by agitation severity level at index was 62.2% with mild agitation, 29.5% with moderate agitation, and 8.3% with severe agitation. The risk of transitioning to long-term care over a 12-month period was 4.78% for no agitation, 7.84% for mild agitation, 8.19% for moderate agitation, and 10.13% for severe agitation. Conclusions: Study findings support increasing rates of long-term residential placement as agitation progresses which is interlinked with the natural disease progression. To our knowledge, this is one of the few studies reporting rates of institutionalization by agitation severity level, underscoring a need for research and innovation in a prevalent yet underserved condition. This research was funded by: Otsuka Pharmaceutical Development & Commercialization, Inc. Lundbeck LLC

Poster Number: NR - 18 LEVEL OF CARE DEPENDENCY AND FUNCTIONAL STATUS AMONG PATIENTS WITH ALZHEIMER’S DISEASE AND AGITATION/AGGRESSION SYMPTOMS Martin Cloutier1; Marjolaine Gauthier-Loiselle1; Patrick Gagnon-Sanschagrin1; Annie Guerin1; Myrlene Sanon2

1Analysis Group 2Otsuka Pharmaceutical Development & Commercialization, Inc.

Introduction: Agitation is among the most common behavioral symptoms of dementia and poses a major challenge for the treatment and management of individuals with dementia. Very few studies report patients’ dependence levels by agitation severity. This study aims to assess the level of care dependency including patients’ functional status. Methods: A retrospective cohort analysis was undertaken using the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS), comprising data from 39 past and present Alzheimer’s Disease Centers across the United States supported by the National Institute on Aging/National Institute of Health. Eligible individuals had dementia due to Alzheimer’s disease and known information on key variables. Agitation severity level was assessed using reported scores per the Neuropsychiatric Inventory Questionnaire (NPI-Q), a behavioral assessment scale. More specifically, agitation was defined per the NPI-Q agitation/aggression scale, where 1=mild (noticeable, but not a significant change), 2= moderate (significant, but not a dramatic change), and 3=severe (very marked or prominent; a dramatic change). Functional status was based on scores reported from the Functional Activities Questionnaire (FAQ) scale ranging 0 to 30, where a score higher than 9 indicates impaired function and possible cognitive impairment. Dependence status was assessed per the question assessing level of dependence and response options included: 1) able to live independently, 2) requires some assistance with complex activities, 3) requires some assistance with basic activities, 4) completely dependent, and 5) unknown. Patients were classified as having agitation if they were reported to have agitation based on the NPI-Q scale for at least one visit. The index date was randomly selected among all visits with agitation, and the severity of agitation was based on the NPI-Q scale as of the index date. For patients without agitation, the index date was randomly selected among all visits. Outcomes were assessed during the 12-month periodfollowingtheindexdate(orthenextvisitiftherewereno other visits within 12 months). Results: A total of 11,346 individuals met the sample selection criteria for the study, of whom 4,745 (42%) were classified as having no agitation per the NPI-Q agitation/aggression scale, 3,861 (34%) with mild agitation, 2,084 (18%) with moderate agitation, and 656 (6%) with severe agitation. The proportion by severity level who reported being “completely dependent” were as follows: 10.2% for no agitation, 21.8% for mild agitation, 29.0% for moderate agitation, and 35.4% for severe agitation. Mean FAQ scores were 14.5 for no agitation, 18.0 for mild agitation, 20.6 for moderate agitation, and 21.9 for severe agitation.

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Conclusions: Study ﬁndings show greater dependency and higher functional impairment with progressing agitation. To our knowledge, this is one of the few studies reporting rates of care dependency by agitation severity level, underscoring a need for research and innovation in a prevalent yet underserved condition. This research was funded by: Otsuka Pharmaceutical Development & Commercialization, Inc. Lundbeck LLC

Poster Number: NR - 19 DEMENTIA: A COGNITIVE DISABILITY AND ROLE OF NON-PHARMACOLOGICAL INTERVENTION ALZHATV IN COGNITIVE REMEDIATION Smita Varshney1; William McCall2; Rajesh Tampi3; Upkar Varshney4

1AlzhaCare LLC 2Medical College of Georgia, Augusta University 3Case Western Reseve University 4Georgia State University

Introduction: The current number of 5.7 million seniors with neurocognitive disorders is expected to double by 2030, and triple by 2050 (alz.org/facts). American Disability Act defines a person with disability as a physical or mental impairment that substantially limits one or more major life activities, by history or record or as perceived by others. Cognitive disability in dementia is recognized by United Nations. However, governments and professionals are slow to accept it (Peter Mittler, 2018). Psychiatric and behavioral symptoms are seen in 72% of nursing home patients, 81% of nursing home patients have dementia or neurocognitive disorders, and 75% receive psychotropic medication (Selbaek et al 2007). Neurocognitive disorders patients receive pharmacological and non-pharmacological interventions. Some pharmacological interventions are associated with increased mortality and death risk (Tampi et al). Non-pharmacological interventions are difficult to implement due to lack of resources for additional nursing home staff to provide them. Cognitive stimulation showed some promise in cognitive and general functioning in the treatment of Alzheimer’s disease (Sitzer et al 2006). Inclusion of spousal caregivers in cognitive remediation for dementia showed improvements in immediate memory, problem solving and verbal fluency (Quayhagen et. al. 2001). A difficult to apply mix of classroom and 24-hour reality orientation provided by family members showed significant cognitive improvement but increased depression in caregivers (Spector et. al. 2001). Cognitive training and rehabilitation had no positive or adverse effects (Clare et al 2006). Cognitive training didn’t improve cognitive functioning, mood, or activities of daily living in mild to moderate Alzheimer’s disease or vascular dementia patients.(Bahar-Fuchs et al 2013). Video exposure and one-on-one social interaction (Cohen-Mansfield et al. 2015) have been effective in managing agitation and improving cognition, behavior, and mood in dementia patients. In AlzhaTV study (Varshney et al 2018) distant family members provided cognitive remediation via videos using smart phone AlzhaTV App to address cognitive disability of their loved ones decreased NPI-NH (Neuropsychiatric inventory − Nursing home) scores by 85% by day 90 and decreased the overall use of psychotropic medications in nearly all patients. These videos were seen by the patients on their personal TV set again and again. In this poster presentation, we present the data on number and types of videos and the pattern of display of these videos to the patients, to help determine further whether specific type of videos, length of video or the pattern of display helped achieve reductions in NPI-NH scores and psychotropic medications. Methods: We obtained AlzhaTV study (Varshney et al 2016) data on 9 patients who were between ages of 61 to 95 from five different nursing homes for 90 days. These patients had dementia (due to Alzheimer’s, Parkinson’s, Vascular, or head injury), depressive disorders, and anxiety disorders. We reviewed the details of videos such as number of videos, type of videos, and how videos were displayed to the patients. Family videos that were made using AlzhaTV App varied in length from 20 seconds to 7 minutes. Videos uploaded from the smart phone varied in length up to 30 minutes. Public video subscribed using AlzhaTV App included sports, comedy, music, politics, TV shows, movie clips from the past 1960s to 90s, and travel videos. We went to each patient’s AlzhaTV account and counted number of videos made by family members and categorized these as reorientation/reassurance or encouragement and entertainment videos. We also looked at the whether the patient watched these videos continuously all day long or at intervals throughout the day based on availability of Wi-Fi. We were able to reach family members to confirm the details of AlzhaTV use. Please see table 1 and figure 1 for the number of videos made by family members and table 2 for types of videos seen by the patients and NPI-NH at baseline, day 30, 60, 90 and MMSE at baseline and day 90. Figure 2 shows types of videos seen by the patients and NPI-NH at baseline, day 30, 60, 90. Results: We found that there was overall decrease in the NPI-NH scores regardless of the number of videos. Endless reality orientations and reassurances helped decrease anxiety and agitation while encouragement to cooperate with care improved

Am J Geriatr Psychiatry 27:3S, March 2019 S193 AAGP Annual Meeting 2019 cooperation with care. Entertainment videos and videos of grand-kids pleasantly distracted the patients and brought them immense happiness. Patient #3, 7, and 8 watched a mixture of continuous reality orientation, reassurances, encouragement to cooperate with care and entertainment videos made by family. Patient #1, 2, 4, 5, and 9 watched a mixture of reality orientation, reassurances, encouragement to cooperate with care and entertainment videos at intervals throughout the day also have good outcomes. Patient#6, Spanish speaking only, quit after continuously watching same 10 family videos to reorient, reassure and encourage to cooperate with care without screaming all day long for 2 weeks, also had good outcome. Based on our small study, 3 or more family videos and 2 or more entertainment videos or combination of two have the potential to lower overall agitation and use of psychotropic medications. Conclusions: Cognitive remediation to contain cognitive disability of nursing home major neurocognitive d/o patients was beneficial in decreasing agitation and overall use of psychotropic medications. Our study found flat dose-response relationship between the number of videos and clinical outcome. More studies are needed to replicate these findings, and, recognize and address cognitive disability in dementia patients. This research was funded by: Not Applicable

TABLE 1. Patient and number and different types of videos Reorientation/RA/ Patient Encourage By family Fam/Entertainment Total #1 95WM AD, BD, psychosis and severe agitation 7 0 7 #2 61 WF MDE, Cerebellar ataxia, MSA 12 49 61 #3 69 WF PD, Bipolar d/o 46 2 48 #4 88 WF AD, MDE 4 18 22 #5 72 AAF VD, ARF 10 3 13 #6 87 HF AD, psychosis, MDE 10 0 10 #7 87 WM AD, PD, BD 22 2 24 #8 66 WM Dementia due to head injury, psychosis, BD 27 23 50 #9 77 WF AD, MDE, Anxiety, BD-picking at skin 3 2 5

(AD: Alzheimer’s disease, PD: Parkinson’s disease, BD: Behavioral disturbances, MSA: Multi System Atrophy, VD: Vascular dementia, MDE: Major Depressive disorder, ARF: Acute Respiratory Failure)

TABLE 2. Types of videos, pattern of use and reductions in NPI-NH, changes in MMSE

Videos NPI-NH MMSE Reorientation/Reassurance Entertainment Day 0 Day 30 Day 60 Day 90 Day 0 - Day 90 Patient Continuous Intermittent Continuous Intermittent #1 95WM X X 96 24 2 0 0-16 AD, BD, psychosis and severe agitation #2 61 WF MDE, Cerebellar X X 64 26 14 5 Unable to ataxia, MSA understand speech #3 69 WF X X 54 27 6 2 21-22 PD, Bipolar d/o #4 88 WF X X 3 0 30 1 18-13 AD, MDE #5 72 AAF X X 26 23 quit quit On vent VD, RF

(continued)

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TABLE 2. (continued)

Videos NPI-NH MMSE Reorientation/Reassurance Entertainment Day 0 Day 30 Day 60 Day 90 Day 0 - Day 90 Patient Continuous Intermittent Continuous Intermittent #6 87 HF X −−43 9 quit quit 10-0 AD, psychosis, MDE #7 87 WM X X 62 33 10 8 Unable to Understand AD, PD, BD speech #8 66 WM Dementia due to X X 84 46 67 30 0 head injury, psychosis,BD #9 77 WF AD, MDE, Anxi- X X 22 20 4 7 22-22 ety, BD-picking at skin

(AD: Alzheimer’s disease, PD: Parkinson’s disease, BD: Behavioral disturbances, MSA: Multi System Atrophy, VD: Vascular dementia, MDE: Major Depressive disorder, RF: Respiratory Failure)

Poster Number: NR - 20 EFFICACY OF LEMBOREXANT COMPARED WITH ZOLPIDEM EXTENDED RELEASE AND PLACEBO IN ELDERLY SUBJECTS WITH INSOMNIA: RESULTS FROM A PHASE 3 STUDY (SUNRISE 1) Gary Zammit1; David Mayleben2; Dinesh Kumar3; Patricia Murphy3; Margaret Moline3

1Clinilabs Drug Development Corporation 2Community Research 3Eisai Inc

Introduction: Difficulties initiating sleep and maintaining sleep throughout the night are reported by more than 50% of elderly individuals. Many treatments for insomnia are not indicated for the treatment of sleep maintenance insomnia, which can be an issue particularly for elderly individuals whose primary complaints tend to be sleep maintenance insomnia. Here we report results from the subgroup of elderly subjects (65+ years) enrolled in a Phase 3 study of the dual orexin receptor antagonist lemborexant. The study enrolled older individuals (55+ years) with sleep maintenance insomnia, in which the efficacy of lemborexant, measured by polysomnography (PSG), was compared with both placebo (PBO) and zolpidem tartrate extended release (ZOL), the formulation of zolpidem that has been approved to treat sleep maintenance problems. Methods: SUNRISE 1 was a randomized, double-blind, placebo- and active-controlled, 1-month, global Phase 3 study. The overall study enrolled female subjects age 55 and older and males age 65 and older. Results of the current analysis include only those age 65 and older. Subjects met DSM-5 criteria for insomnia disorder, and had a primary complaint of sleep maintenance insomnia. Current insomnia symptoms were confirmed with both a sleep diary and PSG. Subjects with symptoms of other sleep disorders (e.g., moderate to severe sleep apnea, periodic limb movement disorder, restless legs syndrome) were excluded, but those with sufficiently-treated comorbid medical or psychiatric conditions could be included. After an approximately 2-week single-blind Run-in Period where all subjects received placebo (PBO), subjects were randomized to PBO, ZOL (6.25mg), or lemborexant (LEM; 5mg [LEM5] or 10mg [LEM10]) for 1 month. Study drug was taken within 5 min of the start of the sleep period, which was calculated based on the mean habitual bedtime from the sleep diary. Average values from paired PSGs from each subject at Baseline (during the placebo run-in), Nights 1/2, and Nights 29/30 were analyzed for latency to persistent sleep (LPS), wake after sleep onset (WASO), WASO in the second half of the night (WASO2H), and sleep efficiency (SE). SE is defined as total sleep time divided by the time in bed, which was standardized for all subjects at 8 hours. Results: A total of 1006 were randomized into the study. Of these, 453 (45%) were 65 years or older (137 males, 316 females) and are included in the results presented below. Most subjects (433/453; 95.6%) completed the study. A total of 8 (1.8%) subjects discontinued due to an adverse event. Table 1 shows difference from placebo in change from baseline values for PSG variables by timepoint (Nights 1/2, Nights 29/30). All comparisons of LEM5 and LEM10 to both PBO and ZOL were statistically significant at p<0.01 at both the beginning and end of the 1 month of treatment. The most common AEs in elderly subjects (>2% of elderly subjects in any active treatment group and >PBO) were headache, with rates of 4.3% (PBO), 4.2% (ZOL), 5% (LEM5), and 5% (LEM10), and somnolence, with rates of 2.2% (PBO), 0.8% (ZOL), 3.4% (LEM5), and 7.4% (LEM10).

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Conclusions: Lemborexant improved both sleep onset and sleep maintenance compared to both PBO and ZOL. Importantly, LEM was significantly better than ZOL at reducing the amount of time spent awake during the second half of the night, which is the time when elderly individuals have the most difficulty maintaining sleep. These subpopulation analyses are similar to the results from the overall study, which included older adults 55-64 years as well. In this study, lemborexant appeared to be well- tolerated. Results of this study support the efficacy and safety of lemborexant as a treatment for insomnia disorder in elderly individuals who suffer from sleep maintenance insomnia. This research was funded by: Eisai Inc. and Purdue Pharma L.P.

TABLE 1. Treatment Difference from Placebo for Polysomnography Variables

Poster Number: NR - 21 SAFETY OF LEMBOREXANT IN ELDERLY SUBJECTS WITH INSOMNIA: RESULTS FROM A PHASE 3 STUDY (SUNRISE 1) Russell Rosenberg1; Gleb Filippov2; Antonia LoPresti2; Dinesh Kumar2; Patricia Murphy2; Margaret Moline2

1NeuroTrials Research, Inc 2Eisai Inc

Introduction: Increased risk of falls and other safety concerns such as abuse potential, tolerance and aberrant nocturnal behaviors are associated with currently available insomnia medications. Here we report safety parameters in elderly individuals with insomnia from a Phase 3 study of the dual orexin receptor antagonist lemborexant Methods: SUNRISE 1 was randomized, double-blind, placebo- and active-controlled, 1-month, global Phase 3 study. Eligible subjects were females age 55 and older, and males age 65 and older. This report will summarize safety data from the subgroup of elderly subjects age 65 and older. Subjects met DSM-5 criteria for insomnia disorder, and had a primary complaint of sleep maintenance insomnia. Current insomnia symptoms were confirmed with both a sleep diary and PSG. Subjects with symptoms of other sleep disorders (e.g., moderate to severe sleep apnea, periodic limb movement disorder, restless legs syndrome) were excluded, but those with sufficiently-treated comorbid medical or psychiatric conditions could be included. After an approximately 2-week single-blind Run-in Period when all received placebo (PBO), subjects were randomized to PBO, zolpidem tartrate extended release (ZOL [6.25mg])or lemborexant (LEM; 5mg [LEM5] or 10mg [LEM10]) for 1 month. Study drug was taken within 5 min of the start of the sleep period, which was calculated based on the mean habitual bedtime from the sleep diary. Adverse events were obtained throughout the study. Additional safety parameters included: clinical laboratories, electrocardiograms (ECGs), vital signs and weight; potential rebound insomnia assessed via the sleep diary during a 2-week Follow-up Period; postural stability immediately upon morning awakening after the first 2 nights and last 2 nights of treatment using an ataxiameter measuring amount of body sway in 60 seconds (in units of 1/3 degree angle of arc, with higher values indicating more body sway), and tests of attention and memory

S196 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 immediately upon morning awakening at 8 hours postdose. Self-ratings of sleepiness/alertness were assessed on the sleep diary. Analyses of safety relating to study disposition, adverse events, and postural stability are reported here; all other safety-related assessments will be presented once subgroup analyses by age have been completed. Results: A total of 1006 were randomized into the study. Of these, 453 (45%) were 65 years or older (137 males, 316 females) and are included in the results presented below. Most elderly subjects (433/453; 95.6%) completed the study. A total of 8 (1.8%) elderly subjects discontinued due to an adverse event, including 1 in PBO, 3 in ZOL, 2 in LEM5, and 2 in LEM10. There were 3 subjects with SAEs, all on ZOL; none were considered treatment-related, and all resolved without sequelae. Most AEs were mild to moderate in severity. The most common AEs (>2% in any active treatment group and >PBO) are listed in Table 1. At each visit, subjects were explicitly asked whether they had experienced a fall since the last visit. There were 4 falls in elderly subjects, all in the LEM5 treatment group. All were considered mild in severity, and none were considered treatment-related. An expert committee adjudicated all falls; none was classified as cataplexy. When postural stability was assessed immediately upon awakening, there was no significant treatment difference in body sway for either LEM treatment group compared to PBO at either the beginning (LEM5 difference from PBO 0.16 units, N.S.; LEM10 difference from PBO 2.69 units, N.S.) or end of treatment (LEM5 difference from PBO -0.87 units, N.S.; LEM10 difference from PBO 0.87 units, N.S.). In contrast, after the first 2 doses of ZOL, the change from baseline in body sway was significantly greater than PBO (difference from PBO 6.97 units, p<0.01) and than both doses of LEM (LEM5 difference from ZOL -6.81 units, p<0.01; LEM10 difference from ZOL -4.29 units, p<0.05). At the end of treatment, the amount of body sway in ZOL remained numerically higher than all other treatment groups, but was no longer statistically significantly different from either PBO or LEM. Conclusions: Lemborexant appeared to be well-tolerated in this population of older individuals. Combined with robust efficacy of LEM in this Phase 3 study (data showing that lemborexant significantly improved both sleep onset and sleep maintenance compared to both placebo and zolpidem will be presented separately), safety-related results from Phase 3 suggest that lemborexant, if approved, may be an optimal treatment for the population of older patients with sleep maintenance insomnia. This research was funded by: Eisai Inc. and Purdue Pharma L.P.

TABLE 1. Summary of AEs >2% in Any Active Treatment Group and >PBO in Elderly (N=453)

Poster Number: NR - 22 INCREASED CORTICAL THICKNESS IN LATE-LIFE DEPRESSION AFTER ANTI- DEPRESSANT TREATMENT WITH LEVOMILNACIPRAN Michaela Milillo; Beatrix Krause; Lisa Kilpatrick; Prabha Siddarth; Linda Ercoli; Kelsey Laird; Yesenia Aguilar-Faustino; Katherine Narr; Helen Lavretsky

UCLA

Introduction: Late-life depression (LLD) is associated with signiﬁcant medical comorbidity, cognitive impairment, and suboptimal treatment response compared to depression in younger adults. More efﬁcacious treatment to improve mood, cognition and quality of life in LLD are urgently needed. Levomilnacipran (LVM) is a novel anti-depressant whose effects on neuroplasticity have not yet been studied. We investigated the effect of LVM on brain cortical thickness in a randomized placebo-controlled trial. Methods: Twenty-nine older adults (>60 years) with major depression (48.3% female; mean age=71.5[SD=5.8] years; mean education=16.0[SD=1.7] years) were randomized to either LVM or placebo for 12 weeks. T1-weighted images were acquired at baseline and 12-weeks using a Siemens 3T Prisma system. Freesurfer version 6.0 was used for cortical reconstruction and a whole-brain longitudinal voxel-wise two-stage model was used to investigate between-group differences in symmetrized percent change in cortical thickness from baseline to post-treatment. Age and total intracranial volume were used as covariates. Results: Fifteen participants (6 LVM and 9 placebo) completed the study. Both groups improved on the Montgomery-Asberg Depression Rating Scale (MADRS; main effect of time F(8,111)=5.4, p<.0001; mean DMADRS improvement: LVM, -6.37

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(SD=2.13), t(111)=2.99, p=.003; placebo, -7.10 (SD=1.91), t=3.71, p=.0003). Dropout and remission rates did not differ between the groups (Fisher exact>=0.07). The LVM group had significantly more side effects compared to placebo (p=0.03). No serious side effects were reported. In addition, the LVM group showed larger increases in cortical thickness in the right postcentral gyrus (primary somatosensory) X=44, Y=-26.9, Y=53.8; cluster size=966mm2), the precentral gyrus (primary motor) (X=17.3, Y=-22.1, Z=15.7; 948.9mm2), and the lateral occipital cortex (visual cortex) (X=19.6, Y=-94.9, Z=15.7; 930mm2) compared to the placebo group. Conclusions: Both LVM and placebo groups showed a clinically significant improvement in depression severity over 12 weeks without significant group differences. Side effects were significantly higher with LVM treatment compared to placebo. However, the LVM group demonstrated a gain or preservation of cortical thickness in primary sensorimotor and visual regions compared to the placebo group. Larger and longer follow up studies are required to explore the effect of LVM on neuroplasticity in relationship to clinical outcomes and side effects. This research was funded by: Forest research Institute LVM-IT-02 (Allergan Fetzima Study IIT-10018); NCT02466958

Poster Number: NR - 23 MEASUREMENT-BASED CARE: CAN TOOLS FROM PALLIATIVE CARE INFORM OUR PRACTICE IN GERIATRIC MENTAL HEALTH? Cindy Grief1,2; Daphna Grossman1,2,3; Sandra Gardner1,2; Anna Berall1

1Baycrest 2University of Toronto 3North York General Hospital

Introduction: Measurement-based care, which encompasses the use of self-report scales for tracking patients’ responses to treatment, has been systematically reviewed in the context of primary care where it has been shown to enhance communication between providers and patients1. Among older adults with mood disorders, pain and somatic symptoms are common and often under-recognized2,3. Scales for monitoring mood, anxiety and physical symptoms have been well validated in older adults with psychiatric disorders within inpatient and outpatient settings. In the palliative care context, the Edmonton Symptom Assessment Scale (ESAS) and the Patient Dignity Inventory (PDI) are commonly used to track burden of symptoms and impact of illness on dignity. We explore the utility and relevance of using self-rating scales as part of a measurement-based care initiative in geriatric mental health at Baycrest, an academic health sciences centre in Toronto, Canada. We examine the relationship between depression, anxiety and somatic symptoms and introduce the use of the ESAS and PDI in a non-palliative care context. 1) Wray LO et al. Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation. BMC Health Serv Res. 2018; 18: 753. 2) Chodosh J, Solomon DH, Roth CP et al. The quality of medical care provide to vulnerable older patients with chronic pain. J Am Geriatric Soc. 2004; 52:756-761. 3) Meeks TW, Dunn LB, Kim DS et al. Chronic Pain and Depression among geriatric psychiatry inpatients. Int J of Geriatr Psychiatry. 2008; 23:637-642. Methods: Participants were recruited from an inpatient geriatric mental health unit and an outpatient day hospital for mood and related disorders. Self-report rating scales tracking mood, anxiety and somatic symptoms were completed, including the Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), the ESAS and the PDI. Demographic characteristics were gathered from a retrospective chart review. Inpatient and outpatient groups were compared using Fisher’s exact test for categorical variables and Wilcoxon tests for continuous variables.

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Longitudinal cross-sectional models used generalized estimating equations and an exchangeable working correlation (WC) matrix to adjust for repeated measures within patient across time. Cross-sectional models including time-varying covariates measured concurrently with the outcome and were adjusted for baseline values for age, number of comorbidities and medications and level of cognition. Results: Data were obtained for 33 English speaking patients (inpatients N=17, outpatients N=16) with a mean age of 76.5 (SD=6.1), 69.7 % female and 48.5% married. Inpatients had a signiﬁcantly higher number of comorbidities than outpatients. Self-reported scales were measured from 1 to 17 weeks (mean number of weeks was 8.2, SD=4.7). At baseline, prevalence of moderate to severe ESAS symptoms (4 or higher score) ranged from 19% to 75% (Table 1). Higher GDS scores were signiﬁcantly correlated with self-ratings for poor dignity and high anxiety (p<.0001) and increased symptom burden (p<.0001, Table 2). GDS and PDI scores had a similar pattern to the mean ESAS pain item score across time (Figure 1). Mean scores for all the scores increased indicating worse scores for those remaining under follow up. Some example longitudinal modelling results are as follows: GDS scores decreased over time but less rapidly for patients reporting a higher degree of pain (p=0.02, WC=0.80). PDI scores decreased across time but higher PDI scores were associated with higher ESAS drowsiness (p=0.002, WC=0.82). Conclusions: Self-report scales yielded relevant clinical information including the high physical symptom burden experienced by older adults in geriatric mental health inpatient and outpatient settings. This study suggests there is value in using self-report rating scales to track mood, anxiety, dignity, pain and other symptoms. Measurement-based care can create a dialogue between patient and clinician about symptom variability over time, and its usage in geriatric psychiatry warrants further exploration. In our study, there was an association between subjective distress experienced by participants and underlying pain. Over time, Geriatric Depression Scale scores tended to remain elevated for patients who simultaneously reported higher pain. As well, the Edmonton Symptom Assessment Scale was highly correlated across time with the GDS. Incorporating a palliative care lens may suggest new approaches to care and have relevance to inpatient and outpatient geriatric mental health settings where burden of symptoms is high. While our study is limited by its small sample size, the use of self-report scales commonly used in palliative care within a geriatric mental health context merits replication in other settings. This research was funded by: A stipend was provided by Baycrest’s Department of Psychiatry’s Academic Development Fund.

ESAS Symptom Mild Moderate to Severe N (%) N (%) Pain 18 (56.3) 14 (43.8) Tiredness 10 (31.3) 22 (68.8) Drowsiness 15 (46.9) 17 (53.1) Nausea 26 (81.3) 6 (18.8) Appetite 26 (78.8) 7 (21.2) Shortness of breath 22 (68.8) 10 (31.3) Depression 8 (25.0) 24 (75.0) Anxiety 13 (40.6) 19 (59.4) Well-being 11 (34.4) 21 (65.6)

*multiple responses

Inpatient Outpatient Total** Correlation Coefﬁcient Correlation Scales (N = 17) (N = 16) (N=33) with GDS* p-value Mean* (SD) GDS 16.8 (8.2) 17.2 (8.4) 17.0 (8.2) n/a n/a PDI 58.5 (21.3) 53.6 (16.7) 56.1 (19.1) 0.81 <0.0001 GAI 10.4 (6.2) 9.8 (6.3) 10.1 (6.2) 0.78 <0.0001 ESAS 36.5 (19.3) 35.5 (16.8) 36.0 (17.9) 0.79 <0.0001

*At baseline; **No signiﬁcant group differences

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Poster Number: NR - 24 A WISH TO DIE AND THE OLDER ADULT: THE IMPACT OF BESPOKING ON VIRTUAL CONTINUING EDUCATION Cindy Grief1,2; Lisa Sokoloff1,2; Cindy Plunkett1,3; Sandra Gardner1,2; Alvina Anantram1; Daphna Grossman1,2,4

1Baycrest 2University of Toronto 3University of Ontario Institute of Technology 4North York General Hospital

Introduction: Older adults with depression or chronic illness may express a wish to die. Front-line healthcare professionals may be clinically tasked with the challenging scenario of distinguishing whether a patient is depressed, suicidal and/or requesting a medically assisted death (MAID), a procedure recently legalized in Canada. Baycrest, a large academic geriatric health centre in Toronto, offers virtual interactive learning through modules and webinars, which have been shared nationally with healthcare professionals interested in geriatric mental health. Our mandate is to create continuing education that engages learners and optimizes learning outcomes. In our most recent module, “A Wish to Die: MAID, Depression and the Older Adult”, we introduced the process of customization or bespoking and examined the impact on learning of this novel educational methodology. Methods: 1) Bespoking A free learning event, “Depression, MAID and the Older Adult” was advertised through national memberships and databases of Canadian healthcare professionals working in the area of seniors’ mental health. Through SurveyMonkey, participants were asked to choose the nature of the case (acute care vs. community vs. long-term care) and other components that could be individualized and customized. A small group of registrants was not bespoked and comprised the comparison group. 2) Virtual Blended Learning An interactive online module was made available for 2 weeks and was followed 1 week later by a live, facilitated webinar to consolidate learning. 3) Evaluation Knowledge and comfort in working with older adults who express a wish to die were assessed pre-module and post-webinar. Impact and change in practice (e.g., use of a new tool) were assessed at 6 weeks post-webinar. The data were summarized using descriptive statistics, including Fisher’s exact tests to compare groups, and longitudinal logistic regression with random intercepts. All analyses were done using SAS version 9.4. Results: The proportion of participants with an approach to working with older adults who express a wish to die significantly increased from 22% (pre, N=27) to 63% (post, N=27, p=0.003) and non-significantly increased from post to 86% at follow up (N=22, p=0.08) for the Bespoke group (Figure 1). The non-Bespoke group significantly increased from 28% (pre, N=36) to 72% (post, N=36, p=0.0003) but then non-significantly decreased from post to 58% at follow up (N=19, p=0.32). There was no significant group difference in the change in proportions from pre to post (p=0.85) but the change in proportions from post to follow up was significantly greater for the Bespoke group compared to the non-Bespoke group (p=0.05). At follow up, the Bespoke group had a larger proportion with an approach to working with an older adult who expresses a wish to die, but it was not significant (86% versus 58%, p=0.08). At 6 weeks post-webinar, »89% (N=45, all participants) reported participation in the learning activity had a positive impact on their practice. »72% indicated that participation had helped with client/patient care (N=43). 93% (N=27, Bespoke group) wanted more bespoke education opportunities. Conclusions: A large majority of study participants responded that the learning activity had a positive impact on their practice and helped with patient care. Interest in further bespoke learning opportunities was high. Learning outcomes were similar between groups with a positive trend for bespoked participants to identify having an approach to an expressed wish to die after the intervention. Bespoking is easy to implement, appears to contribute to engagement and through virtual technology, can target the needs of multiple learners simultaneously. Incorporating customization into the development of an online learning module was an effective means for transmitting knowledge about a clinical approach to an older adult who expresses a wish to die. The utility and feasibility of using bespoke methodology in continuing education merits study in other subject areas, both within geriatric psychiatry and more broadly, with larger sample sizes. This research was funded by: This project was funded by the Ontario Ministry of Health and Long-term Care Academic Health Sciences Centres Alternate Funding Plan Innovation Fund.

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Group Time point Proportion have approach Bespoke Pre 0.22 Bespoke Post 0.63 Bespoke Follow up 0.86 Non Bespoke Pre 0.28 Non Bespoke Post 0.72 Non Bespoke Follow up 0.58

Poster Number: NR - 25 DEPRESSION PREDICTS DELIRIUM AFTER CORONARY ARTERY BYPASS GRAFT SURGERY INDEPENDENT OF COGNITIVE IMPAIRMENT AND CEREBROVASCULAR DISEASE: AN ANALYSIS OF THE NOAHS STUDY I-Hsin Lin1; Mark Oldham2; Keith Hawkins3; Leslie Scoutt4; David Yuh5; Hochang Lee2

1Yale School of Public Health, Yale Center for Analytical Sciences 2University of Rochester Medical Center, Department of Psychiatry 3Yale School of Medicine, Department of Psychiatry 4Yale School of Medicine, Department of Radiology 5Stamford Health, Department of Surgery

Introduction: Although depression is a putative risk factor for delirium after coronary artery bypass graft (CABG) surgery, it is unclear to what extent this risk is independent of cognitive impairment and cerebrovascular disease. This study concurrently examines depression (mild or major), mild cognitive impairment (MCI) and cerebrovascular disease (deﬁned as intracranial atherosclerosis) as post-CABG delirium risk factors. Methods: This prospective, observational cohort study recruited and assessed 131 subjects without dementia undergoing CABG surgery at a tertiary-care, academic hospital. Preoperative cognitive assessment included Clinical Dementia Rating and neuropsychological battery; depression was assessed using Depression Interview Structured Hamilton. Baseline intracranial stenosis was evaluated by transcranial Doppler of bilateral middle cerebral arteries (MCA). Study psychiatrists assessed delirium on postoperative days 2−5 using the Confusion Assessment Method. Results: Average age of the study sample was 65.8 (SD: 9.2) years, and 27% were female. MCI prevalence was 24%, preoperative depression 10%, lifetime depression 35%, and MCA stenosis (≥ 50%) 28%. Sixteen percent developed delirium.

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Multivariate analysis revealed that age, MCI (OR 5.1, 95% CI 1.3−20.1), and preoperative depression (OR 9.9, 95% CI 1.3 −77.9)—but not lifetime depression—predicted delirium. MCA stenosis and its severity predicted delirium in univariate but not multivariate analysis. Right MCA stenosis severity predicted delirium severity but left-sided stenosis severity did not. Conclusions: Our ﬁndings indicate that the risk of delirium attributable to depression could extend beyond the potential moderating inﬂuence of cognitive impairment and cerebrovascular disease. Even mild depression and cognitive impairment before CABG appear to deserve recognition for their effect on post-CABG cognitive health. This research was funded by: The NOAHS study (PI: HB Lee) is supported by R01 MH085740. Exploratory analysis of this study was supported by the CEDARTREE Program (K07 AG041835; PI: SK Inouye).

Univariate model Multivariate modelb Age 1.05 (0.99, 1.11) 1.09 (1.01, 1.18) Female sex 3.74 (1.42, 9.82) 4.27 (0.98, 18.57) MCI 2.97 (1.11, 7.92) 5.10 (1.29, 20.13) Preoperative depression 3.98 (1.16, 13.71) 9.92 (1.26, 77.88) MCA stenosis > 50% 3.43 (1.12, 10.45) 2.53 (0.65, 9.90) CCI 1.29 (1.05, 1.59) Removed Lawton score 1.51 (1.14, 2.01) Removed

Poster Number: NR - 26 EXAMINING THE IMPACT OF CARDIOVASCULAR RISK FACTORS ON NEUROPSYCHIATRIC SYMPTOMS IN THE PACT-MD STUDY Ines Kortebi1; Wael Karameh2,3,4; Sanjeev Kumar3; Damien Gallagher1,5; Angela Golas2,3,4; Tom Schweizer1,6; David Munoz1,6; Joseph Barfett4,6; Meryl Butters7; Christopher R Bowie3,8; Alastair Flint2,9; Tarek Rajji2,3; Nathan Herrmann2,10; Bruce Pollock11; Benoit Mulsant2,3; Linda Mah2,12; Corinne E Fischer2,6

1University Of Toronto, Toronto, Canada 2Department of Psychiatry, University of Toronto, Toronto, Canada 3Centre for Addiction and Mental Health, Toronto, Canada 4St. Michael’s Hospital, Toronto, Canada 5Sunnybrook Health Sciences Centre, Toronto, Canada 6Keenan Research Centre for Biomedical Research, St. Michael’s Hospital, Toronto, Canada 7Department of Psychiatry, University of Pittsburgh School of Medicine, USA 8Queen’s University, Kingston, Canada 9Centre for Mental Health, University Health Network, Toronto, Canada 10Sunnybrook Health Sciences Centre, Toronto 11Campbell Family Mental Health Research Institute, Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada 12Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, Canada

Introduction: Although cardiovascular risk factors (CVRFs) have been identiﬁed as important risk factors for both major depression and cognitive decline in later life, their association with neuropsychiatric symptoms (NPS) has not been fully elucidated. Furthermore, CVRFs, particularly hypertension, hypercholesterolemia, and diabetes, may ultimately lead to physical conditions such as small vessel disease known to disrupt cognition, thereby leading to the onset of NPS. Thus, a better understanding of the association between CVRFs and NPS could improve the development of treatments and preventative measures for NPS. Methods: Using baseline data from the Prevention of Alzheimer’s Dementia with Cognitive Remediation plus Transcranial Direct Current Stimulation (PACt-MD) study, a multi-site intervention study targeting older patients with depression and cognitive decline, we analysed the distribution of CVRFs (Framingham risk scores; Hachinski ischemic score; presence of hypertension, hypercholesterolemia, hyperlipidemia, diabetes, and smoking) in patients with and without NPS as determined by a score of 1 and above or 0 on the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Participants fell into one of the following three diagnosis groups: Mild Cognitive Impairment (MCI) with a lifetime history of major depression (MDD); MCI without MDD; and MDD without MCI. Comparisons of distributions of CVRFs between NPI positive and negative groups were conducted using the non-parametric Mann-Whitney U test at a signiﬁcance level of <0.05.

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Results: In a combined sample of 140 participants, there were no significant differences in any CVRF between positive and negative total NPI groups. However, some NPI subscale scores, notably agitation/aggression, anxiety, disinhibition, irritability, and night-time behaviour were significantly associated with increased CVRFs (p<0.05). Conclusions: None of the CVRFs were associated with overall total NPI-Q scores, however, these preliminary analyses suggest that some specific CVRFs were associated with certain NPI-Q subdomains. This suggests that CVRFs contribute to specific NPS domains rather than overall NPS burden. This research was funded by: This project has been made possible by Brain Canada through the Canada Brain Research Fund, with the financial support of Health Canada and the Chagnon Family.

Poster Number: NR - 27 COGNITIVE AND NEURAL MECHANISMS OF THE ACCELERATED AGING PHENOTYPE IN PTSD Madeline Friedman1; Chloe Salzman1; Yuval Neria2; Scott Small2; Adam Brickman2; Adam Ciarleglio2; Frank Provenzano2; Rachel Yehuda3; Janine Flory3; Philip Szeszko3; Bret Rutherford2

1New York State Psychiatric Institute 2Columbia University Medical Center 3James J. Peters VA

Introduction: Posttraumatic Stress Disorder (PTSD) affects 6.8% of adults in the United States and is associated with high rates of disability, comorbid medical and psychiatric disorders, and suicide. Older adults make up an increasingly large proportion of PTSD patients as the population skews older and Veterans from recent conflicts age. PTSD in older adults is often chronic, leads to increased mortality from cardiovascular disease and other medical conditions, and promotes adverse aging associated syndromes such as frailty. Moreover, older PTSD patients exhibit faster cognitive decline and have twice the risk of dementia compared to individuals without PTSD. Accelerated biological aging may explain these findings, as PTSD is associated with similar brain changes to those occurring with cognitive aging, including bilateral hippocampal volume reductions specifically in the cornu ammonis 3 (CA3) and dentate gyrus (DG) sub-regions and increased microvascular lesions (white matter hyperintensities). The goal of this presentation is to describe ongoing work from our laboratories characterizing the mechanisms by which PTSD accelerates aging cognitively and physically. We will present data linking cognitive dysfunction in PTSD with indicators of brain health such as DG CBV and increased white matter hyperintensities and physical decline with increased levels of inflammation and oxidative stress. Methods: To date. N=17 adults 50 years and older with PTSD and N=9 trauma exposed healthy controls (TEHCs) have undergone testing to assess cognitive function and physical performance. Neuropsychological testing and magnetic resonance imaging (MRI) including cerebral blood volume (CBV)-fMRI were used to assess cognitive function and brain health. Neuropsychology testing included a modified form of the Benton Visual Retention Task (ModBent), a task that has been validated as a measure of DG function relative to age. Tasks such as gait speed and tests of strength, including grip strength and the short physical performance battery, were used to assess physical decline. Inflammatory markers IL-6, CRP, and telomere length, and urinary isoprostanes, a measure of oxidative stress, were also used to examine physical decline. Measures were compared between the PTSD patients and trauma exposed healthy controls. We expect to substantially increase the sample size available for presentation by the time of the Annual Meeting. Results: Enrolled PTSD subjects to date show deficits in every cognitive domain when compared to the TEHC, particularly on measures of processing speed and executive function, where their performance is > 1 SD below that of age-matched TEHCs. CBV fMRI (N=15) analyzed to date shows PTSD patients to have diminished DG CBV compared to TEHC, and lower DG CBV is associated with increasing symptom severity as measured by the Clinician Administered PTSD Scale (r=-0.49). Reaction time on ModBent increased (worsened) with increasing symptom severity (r=0.50). Overall hippocampus volume is smaller in PTSD patients than TEHC (d=-.23), although PTSD patients have on average greater ICV (d=0.30). PTSD patients also display deficits in every physical performance task compared to the TEHC patients and report reduced physical activity and worse physical conditions. PTSD patients have higher levels of inflammatory markers IL-6 (d=0.18) and CRP (d=0.25) as well as urinary isoprostanes (d=0.05), a marker of oxidative stress. Conclusions: These data indicate that PTSD, particularly chronic PTSD, is associated with unhealthy aging trajectories. These findings are consistent with the hypothesis that older adults with PTSD have marked neurocognitive and physiologic performance decrements compared to age-matched TEHC. This research was funded by: NIMH. PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000325/AAGP2019-000325_Fig1.pdf

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Poster Number: NR - 28 THE STATE OF GERIATRIC PSYCHIATRY TRAINING IN GENERAL PSYCHIATRY RESIDENCY: DATA FROM A NATIONAL SURVEY OF U.S. PROGRAM DIRECTORS Rachel Meyen1; Michelle Conroy2; Brent P. Forester3; Katherine Hobbs4; Paul D. Kirwin5; Jason Schillerstrom6; Kirsten Wilkins2

1Boston VA HealthCare System, Boston, MA 2Yale School of Medicine, New Haven, CT 3McLean Hospital, Harvard Medical School, Boston, MA 4McLean Hospital, Boston, MA 5Yale University School of Medicine, New Haven, CT/Tulane University School of Medicine, New Orleans, LA 6University of Texas Health Science Center at San Antonio, TX

Introduction: The 2012 Institute of Medicine (IOM) report identified a staggering increase in older adults with anticipated need for mental health and substance use treatment (1). By 2030, the United States population of elderly adults is anticipated to increase from 40.3 to 72.1 million, with 14-20% of this population estimated to have a mental health or substance use disorder (1). However, the IOM report cautions that the projected workforce remains inadequate to meet these pressing needs. Geriatric psychiatrists play a critical role providing subspecialty care to elderly patients with mental health, substance use, and neurocognitive disorders. Since 2010, the total number of geriatric psychiatry fellows has plummeted by 31% (4-6); this decrease in numbers (2) is a substantial concern. This study aims to investigate geriatric psychiatry training opportunities in general adult psychiatry residency programs and specific educational factors which may be associated with residents pursuing geriatric psychiatry subspecialty training. Methods: The American Medical Association’s Fellowship and Residency Electronic Interactive Database Access (FREIDA) was queried to compile a contact list of program directors from Accreditation Council on Graduate Medical Education (ACGME) accredited general adult psychiatry residency programs (3). The program directors were emailed an anonymous multiple choice survey using Qualtrics software to ascertain the nature of their program’s geriatric psychiatry training experiences. The survey’s domains of inquiry included the following: the quantity and quality of geriatric clinical and didactic experiences, the settings of training in geriatric psychiatry, the number of faculty with geriatric psychiatry specialization, and the number of graduates who pursued geriatric fellowships. Program directors were also asked about their familiarity with the American Association for Geriatric Psychiatry (AAGP) Scholars Program. Data analysis will be performed on survey responses. Results: The authors will present survey data and compare results to previously published literature. Conclusions: This work will contribute to the field by describing the current state of geriatric training in general psychiatry residency and examining whether these educational factors correlate to residents pursuing geriatric psychiatry fellowships. This research was funded by: No funding sources supported this work.

References: 1. Committee on the Mental Health Workforce for Geriatric Populations, Board on Health Care, Institute of Medicine: in The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? Edited by Eden J, Maslow K, Le M, et al. Washington (DC), National Academies Press (US), 2012. 2. Juul D, Colenda CC, Lyness JM, et al: Subspecialty training and certiﬁcation in geriatric psychiatry: A 25-year overview. The American Journal of Geriatric Psychiatry 2017; 25:445–453. 3. FREIDA, the AMA Residency & Fellowship Database [database online]. American Medical Association, 2018. 4. Warshaw GA, Bragg EJ, Layde JB, et al: Geriatrics education in psychiatric residencies: A national survey of program directors. Academic Psychiatry 2010; 34:39–45. 5. Number of Accredited Programs and On-Duty Residents for the Academic Year by Specialty (2018-2019) [ACGME Web site]. Available at: https://apps.acgme.org/ads/Public/Reports/Report/3. Accessed August 20, 2018. 6. Number of Accredited Programs and On-Duty Residents for the Academic Year by Specialty (2006-2007) [ACGME Web site]. Available at: https://apps.acgme.org/ads/Public/Reports/Report/3. Accessed August 20, 2018.

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Poster Number: NR - 29 INTENSIVE OUTPATIENT MENTAL HEALTH PROGRAM FOR GERIATRIC PSYCHIATRIC PATIENTS IN RURAL MISSISSIPPI Collietta Bassett

Brandman University

Introduction: Every eight seconds a Baby Boomer turns 60 (Rao, Praveena, & Rao, 2010). The number of people over age 65 in the United States with a mental illness is expected increase to 15 million persons in 2030 (McGovern, Lee, Johnson, & Morton, 2008). Mental health services in the U.S. are insufﬁcient due to lack of providers and limited options. The scenario worsens when you add factors such as rural and geriatric populations. Mendenhall, MS is indicative of this phenomena. There are few mental health services in Simpson County and even fewer options for geriatric patients. The county has two hospitals with Simpson General Hospital (SGH) in Mendenhall housing a ten bed geriatric psychiatric unit but the need is much greater. Mendenhall’s census is 2,509 residents with 17.7% being over age 64. Simpson county has a census of 27, 463 residents with 15.6% being over age 65 (United States Census Bureau, 2015). The hospital is plagued by a revolving door syndrome with multiple readmissions in the midst of congress’ mandate that the Centers for Medicare and Medicaid Services (CMS) penalize hospitals with 30-day readmission rates. An Intensive Outpatient Program was implemented in Mendenhall, MS in conjunction with SGH. The program provided outpatient mental health treatment for 12 geriatric patients with multiple 30 day readmissions throughout the previous year. Methods: The subjects for this study were patients with 3 to 6 readmissions within 30 days within one year from the geriatric psychiatric unit. Twelve patients participated and were part of a convenience sample. The study was conducted by use of comparison of readmission rates in 30 days between the intervention(implementation of outpatient program) and pre- intervention archival data that showed readmission rates monthly for one year prior to readmission rates. Data during intervention were collected via daily sign in sheets and hospital daily census records. Results: Prior to the intervention, the number of admissions per month ranged from 11 to 16 per month, and readmissions ranged from 4 to 8. The average pre-intervention readmission rate was 43.6%. During the month of the intervention program, only one readmission occurred relative to the 18 total admissions, which resulted in a clinically substantial reduced rate of only 5.6%. A Fisher’s exact test was conducted to compare the average pre-intervention readmission rate to the intervention rate, and showed a statistically signiﬁcant reduction in the 30-day readmission rate (p = 0.012). Conclusions: Offering programs such as Intensive Outpatient Mental Health Services can reduce costly readmission rates and penalties while increasing available services to geriatric patients in rural Mendenhall, MS. This research was funded by: Funding was supplied from host hospital, Simpson General Hospital in Mendenhall, MS. Participation in the program was paid through Medicare reimbursement. Monthly hospital readmission rates.

Month-Year Readmissions Census Percent Pre-intervention Aug-16 5 11 45.5% Sep-16 5 12 41.7% Oct-16 6 12 50.0% Nov-16 4 12 33.3% Dec-16 5 16 31.3% Jan-17 5 13 38.5% Feb-17 7 14 50.0% Mar-17 8 12 66.7% Apr-17 6 16 37.5% May-17 6 12 50.0% Jun-17 5 14 35.7% Average pre-intervention 6 13 43.6% During intervention July 17,2017-August 18, 2017 1 18 5.6%

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Poster Number: NR - 30 MENTAL HEALTH DIAGNOSES IN VETERANS REFERRED FOR OUTPATIENT GERIATRIC PSYCHIATRIC CARE AT A VETERANS AFFAIRS MEDICAL CENTER David Atkinson1,2; Bridget Doane1; Paul Thuras1,2; Mitch Leskela1; Paulo Shiroma1,2

1Minneapolis Veterans Affairs Health Care System 2University of Minnesota

Introduction: In 2015, 47% of the U.S. Veteran population consisted of individuals 65 years of age and older. This percentage is projected to remain stable for at least the next 15 years. Relative to non-veterans of similar age, older Veterans are at higher risk for mental health disorders. The negative impacts of these conditions are substantial. Later-life depression and neurocognitive disorders are associated with impaired function, increased mortality, diminished health and functioning of caregivers, and significant health care costs to society. There is a relative shortage of geriatric specialty-trained providers, and a lack of necessary knowledge and skills to meet the mental health needs of the aging population, particularly among Veterans. With recognition that the supply of geriatric specialty-trained providers is unable to keep pace with the number of Veterans seeking their services, we are conducting a Quality Improvement initiative to advance the efficiency and delivery of mental health interventions for older Veterans served at the Minneapolis Veterans Affairs Health Care System (MVAHCS). This presentation reports the initial efforts to understand the demographic and diagnostic characteristics of Veterans seen for outpatient geriatric subspecialty mental health care at MVAHCS. Methods: Retrospective chart review of demographics and psychiatric diagnoses in Veterans seen for outpatient geriatric mental health intake between May 1, 2011 and April 30, 2016, at the MVAHCS. Descriptive statistics were performed using Microsoft Excel. Chi-square analysis of diagnosis by military service era were conducted using SPSS version 19. Results: A total of 1059 Veterans were evaluated. Descriptive statistics on age, sex, race, marital status, military service era and mental disorder prevalence are reported in the Table. 1732 mental health diagnoses were coded among the Veteran sample. The top ten mental health diagnostic categories, in descending order of prevalence, included: depression, neurocognitive, anxiety, posttraumatic stress, alcohol use, adjustment, sleep, mood/bipolar, personality, psychosis. Prevalence of depressive, neurocognitive, anxiety, posttraumatic stress, and alcohol use disorders showed a statistically significant association with service era. Depressive disorders were most prevalent in Vietnam Veterans (56%), whereas neurocognitive disorders were most prevalent in World War II Veterans (71%) (see Figure). Conclusions: The prevalence of major mental health conditions is high in Veterans seen in geriatric psychiatry. When examining diagnoses within service era subgroups, these subgroups differ in the prevalence of several major diagnostic categories. Vietnam Veterans show a relatively higher prevalence of depressive, posttraumatic stress, and alcohol use diagnoses. This finding is consistent with other studies supporting elevated rates of psychiatric problems in Vietnam Veterans relative to other service eras, potentially due to differing military experiences and relatively less homecoming support. As the relatively younger group, they represent the cohort that geriatric specialists will see in larger proportion over the coming years. Also, as age is the primary risk factor in later-life neurodegenerative diseases, we anticipate greater incidence of neurocognitive disorders among Vietnam Veterans in the future. In the present study, post-hoc analysis of the association of age with neurocognitive disorder prevalence showed a significant positive correlation (Spearman’s rho = 0.38, p < 0.01). With an understanding of the most common psychiatric diagnoses affecting Veterans referred for geriatric specialty treatment, we aim to develop data-informed, targeted educational approaches for general providers − in mental health as well as primary care − that will optimize the ability to meet the needs of the aging population. Further details and updates on this project will be discussed during the presentation. This research was funded by: None.

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Age Years Mean 73.5 SD 9.4 Range 57 − 99 n% Sex Male 1025 96.8 Female 34 3.2 Race White 914 86.3 Black or African American 36 3.4 Native Hawaiian or Other Paciﬁc Islander 12 1.1 American Indian or Alaska Native 10 0.9 Asian 1 0.1 No data 86 8.1 Marital status Married 590 55.7 Divorced 236 22.3 Widowed 115 10.9 Never married 88 8.3 Separated 20 1.9 Single 6 0.6 No data 4 0.4 Service Era Vietnam War 636 60.1 World War II 163 15.4 Korean War 155 14.6 Post-Korean War 71 6.7 Post-Vietnam War 16 1.5 Persian Gulf War 14 1.3 Pre-Korean War 3 0.3 No data 1 0.1 Diagnosis Depression 502 47.4 Neurocognitive 450 42.5 Anxiety 235 22.2 Posttraumatic stress 87 8.2 Alcohol use 84 7.9 Adjustment 77 7.3 Sleep 66 6.2 Mood/Bipolar 61 5.8 Personality 38 3.6 Psychosis 36 3.4

Poster Number: NR - 31 NUTRITION AND BIPOLAR DISORDERS IN OLDER ADULTS: A SYSTEMATIC REVIEW Andrew Olagunju1; Jennifer R. Gatchel2; Julie A. Morgan3; Awais Aftab4; Peijun Peijun Chen5; Annemiek Dols6; Martha Saja- tovic5; William T Regenold7

1McMaster University 2Harvard Medical School 3Discipline of Psychiatry, The University of Adelaide, Adelaide, AUSTRALIA 4Department of Psychiatry, University of California, San Diego, CA, USA.

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5Case Western Reserve University School of Medicine 6GGZinGeest and VUmc University Medical Center 7University of Maryland School of Medicine

Introduction: Nutrition is an important factor that contributes to physical health and general wellbeing, and particularly so in the elderly. For instance, malnutrition has been linked with poor health outcomes, and old age is associated with micro-nutrients changes that appear to significantly correlate with poorer health outcomes including cerebrovascular diseases, bone demineralization, frailty and impaired immune function. However, little is known about the role of nutrition in older adults with bipolar disorders (OABD). To better understand this issue, we conducted a systematic review of literature on nutrition in OABD. Methods: We searched databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Register FDA, and clinical trial registries till May 2018 for eligible reports. The search string combined MeSH terms for Bipolar disorder, nutrition and older adults. This was supplemented by snowball searching of references of included studies and relevant reviews for additional studies. Data extraction was done by at least two persons independently. Results: Fifteen studies that included a subpopulation of OABD were included. The topic foci of the papers include nutritients (including vitamins B12, vitamin D, folate, homocysteine, and creatinine) deficiencies, use of herbal-nutritional products, influence of nutrients on affective and cognitive outcomes, and relationship of nutritional factors with MRI measures of white matter densities. The sample sizes of OABD are generally small and follow-up is limited. Conclusions: Our findings underscore the need for novel research including trials to shed more light on the benefits and therapeutic applications of nutrition in OABD. This research was funded by: No Funding to declare.

Poster Number: NR - 32 THE ASSOCIATION BETWEEN A LONELINESS RESOURCE GUIDE AND HEALTH- RELATED QUALITY OF LIFE AMONG A MEDICARE ADVANTAGE POPULATION Yongjia Song; Sara Stevenson; Tristan Cordier; Angelica Shea; Sara Clark; David Steenhard; Gil Haugh; Andrew Renda

Humana Inc.

Introduction: Loneliness and social isolation have been associated with worsening health-related quality of life (HRQOL), increased mortality, and other poor physical and mental health outcomes among older adults. It is believed early identification of loneliness and related patient characteristics can guide more targeted and effective interventions. The objective of this study was to measure the association between the dissemination of a loneliness resource guide and HRQOL among a sample of a Medicare Advantage population with a high propensity for loneliness. Methods: A random sample of 50,000 individuals enrolled in a Medicare Advantage plan, by a national health and wellbeing company, was scored using a model to predict propensity for loneliness. The top 20% (N=10,000) of the sample, predicted to be most lonely and not eligible for Medicare before age 65 because of disability, was randomly assigned to an intervention (n=5,000) and control group (n=5,000). In October 2017 the intervention group was mailed a loneliness resource guide, which provided information, worksheets, and resources for loneliness. The content was designed to describe loneliness, educate about related risk factors, and direct individuals to appropriate resources. Health-related quality of life was measured by Healthy Days, a valid set of HRQOL measures developed by the Centers of Disease Control and Prevention (CDC), which measured the physical and mental Unhealthy Days in the past 30 days. Total Unhealthy Days (UHD) was reported as the sum of physical and mental Unhealthy Days. In September and October of 2017 the intervention and control groups were administered the Healthy Days measures, telephonically. Healthy Days data was collected again in January and February of 2018, after the intervention. A linear mixed model using repeated measures assessed the longitudinal association between the intervention group and UHD. Stratified post-hoc analyses were used to identify characteristics association with the greatest change in UHD. Results: Average total UHD for the intervention group (n= 782) was 14.93 UHD (pre) and 14.17 UHD (post). Average total UHD for the control group (n= 813) was 15.35 UHD (pre) and 15.18 UHD (post). Dissemination of the loneliness resource guide was associated with a reduction of 0.58 UHD (95% CI: -2.15, +0.98) when compared to the control group. Stratified analyses identified the loneliness resource guide was associated with a reduction of 2.31 UHD (95% CI: -4.96, +0.35) compared to the control group among those without evidence of depression or disability (in the prior 2 years); Average total UHD for the intervention group (n= 262) was 11.77 UHD (pre) and 10.81 UHD (post). Average total UHD for the control group (n= 244) was 12.18 UHD (pre) and 13.53 UHD (post).

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Conclusions: Our analyses identiﬁed the largest reduction in HRQOL among individuals with a high propensity for loneliness, who were non-disabled and without a history of depression. Future loneliness research should continue to explore this population. This research was funded by: Humana Inc. was the study sponsor; no external funding was involved in this study.

Poster Number: NR - 33 GROUP MINDFULNESS MEDITATION BASED COGNITIVE THERAPY INTERVENTION FOR THE TREATMENT OF LATE-LIFE DEPRESSION AND ANXIETY SYMPTOMS: A RANDOMIZED CONTROLLED TRIAL sophia escobar

McGill university

Introduction: Approximately 10-20% of older adults treated in primary care settings suffer from symptoms of depression and/or anxiety. As our population ages, the number of older adults in primary care increases, and the urgent need to find cost-effective and efficient alternative therapies become crucial. The present RCT study aim was to investigate the effect of mindfulness-based cognitive therapy (MBCT), adapted to older adults with symptoms of depression and/or anxiety. Methods: 61 participants were randomized to either MBCT treatment or TAU (treatment as usual) control groups. We examined as our primary outcome changes in depression scores (using PHQ-9 scale) between baseline and 8-weeks follow up. The secondary outcomes was changes in anxiety scores (using GAD-7). Exploratory outcomes quantified changes in the quality of life (EuroQol), the quality of sleep (AIS), and the mindfulness (CAMS-R). Results: In this study, 53 participants completed pre and post questionnaires at baseline and 8-week follow-up. For completers in the intervention group, results showed a significantly decreased in the depression and/or anxiety symptoms, an increased in quality of life and in mindfulness after the intervention. There were not significant changes observed for quality of sleep and quality of life, compared to participants’ scores in the intervention group. Conclusions: In our study of older adults in primary care suffering from depression and/or anxiety symptoms, MBCT reduced symptoms of depression and anxiety, and increased quality of life and mindfulness. Future research could examine longer-term effects of MBCT in this population, using an active control group, as well as assessments of cognition and neural functioning. This research was funded by: N/A.

Poster Number: NR - 34 THE ASSOCIATION OF RESILIENCE AND SOCIAL NETWORKS WITH PAIN OUTCOMES AMONG OLDER ADULTS Shirley Musich1; Shaohung Wang1; Luke Slindee1; Sandra Kraemer2; Charlotte Yeh3

1Optum 2UnitedHealthcare 3AARP

Introduction: Depression, perceived stress and poor sleep quality have been associated with increased pain among older adults with chronic pain conditions. Positive resources, such as resilience and social networks, may help to buffer the impacts of negative attributes on pain outcomes. Our primary objective was to determine the relative effects on pain outcomes (severity; interference) of positive resources (resilience; social networks) relative to negative attributes (depression; stress; poor sleep quality) among older adults with diagnosed pain conditions. Methods: The study sample (N=15,000) was identiﬁed from older adults ≥65 years enrolled in AARPÒ Medicare Supplement and AARPÒ MedicareRx plans (both insured by UnitedHealthcare Insurance Company) with diagnosed back pain, osteoarthritis and/or rheumatoid arthritis. Members received a survey assessing positive resources, negative attributes and pain outcomes associated with chronic pain. Depression, perceived stress, sleep quality, resilience, social networks, pain severity and pain interference were measured using validated scales. Opioid and other medication use were determined from claims. The population was propensity weighted to adjust for survey non-response bias and weighted to be generalizable to members with

Am J Geriatr Psychiatry 27:3S, March 2019 S209 AAGP Annual Meeting 2019 diagnosed pain conditions. Multinomial logistic regression modeling was used to determine the relative associations of positive and negative attributes on pain outcomes. Results: Among survey respondents (N=4,161; response rate 29%), the prevalence of self-reported pain severity and interference for no/mild, moderate and severe categories was 61%, 21% and 18% for severity and 67%, 16% and 17% for interference, respectively. In bivariate models adjusted for demographics and health status, negative attributes of depression, stress and poor sleep had stronger associations with pain severity and interference than the moderating effects of positive resources of high resilience and diverse social networks. In full multivariate models, controlling for demographics, socioeconomics, health status, resilience, social networks, and medication use, the strongest associations with moderate and severe pain severity and interference remained depression, stress and poor sleep. Conclusions: Based on these results, multidimensional pain management strategies should include management of depression, stress and poor sleep along with enhancement of positive resources and analgesics as needed for the effective management of chronic pain. This research was funded by: No funding sources to report.

Poster Number: NR - 35 SELF-HARM IN THE VERY OLD ONE YEAR LATER: HAS ANYTHING CHANGED? Anne Wand1; Carmelle Peisah1,2; Brian Draper1; Henry Brodaty1

1University of New South Wales, Sydney, Australia 2University of Sydney, Australia

Introduction: In an ageing population, very old men appear most vulnerable to suicide. Most suicide research in late life is quantitative and focuses on determining the risk factors for suicidal behaviour. There is a close relationship between self-harm in older people and suicide; with shared risk factors and greater intent to die and lethality of self-harm in older people. Few studies have explored the experience or meaning of self-harm in older people, the experiences of care and outcomes. This study seeks to understand the outcomes for a cognitively, culturally and linguistically diverse cohort of older people who have harmed themselves, their needs, and perceptions of clinical care. We hypothesise that participants who have not had their needs met following the self-harm will remain distressed, with ongoing thoughts of or actual self-harm, and poorer engagement with clinical services. Methods: A cohort of 27 people aged 80 or more and their 29 nominated carers who were interviewed after an episode of self- harm a year earlier, were followed-up. Outcomes including recurrence of self-harm, hospitalisation, contact with mental health services, place of residence, and death were recorded. In addition to information obtained by interview, the medical records of patients were screened for outcomes. Individual qualitative interviews utilised narrative inquiry to facilitate participants’ discussion of their reflections upon the self-harm, clinical care and outcomes. Audio recordings were transcribed and N-VIVO used to perform the thematic analysis. Results: Eighteen people aged over 80 who had self-harmed and 25 of their carers were available at follow-up. Six of the patients and one carer died of natural causes during the follow-up period. There were no deaths by suicide. Four participants declined to participate and one could not be contacted. In the follow-up period four participants (4/18 = 22%) had repeated self-harm and 16/27 (60%) were living in residential care. Three of the four patients who repeated self-harm were living in a facility, which for two patients was the main contributing factor to repeat self-harm. By contrast, not moving into residential care after the initial self-harm was a key reason underlying repeat self-harm for another patient. Repeat self-harm in the fourth patient related to symptoms of psychotic depression. Themes from the patient interviews were grouped under three headings; reflections on the self-harm (subthemes: denial and avoidance; secrecy; the persistent wish to die); perceptions of alienation from the clinicians (mistrust; ignored and invalidated) and the perceived outcomes of self-harm which were largely negative (persistent suffering and hopelessness; rejection; being a burden; miserable in residential care), but not exclusively (the problem was fixed; eliciting care). Carer themes included reflections on the self-harm (subthemes: denial and avoidance; secrecy; the persistent wish to die); perceptions of alienation from the clinicians (therapeutic nihilism; ignored and invalidated; craving communication; risk management) but also a divergent theme of holistic integrated care; and reflections on perceived outcomes (carer burden; untreated depression and suffering; resigned acceptance; better understanding of the patient). Reactions to residential care were complex and predominantly negative - subthemes included distress at initial adjustment to residential care; grief and guilt at residential care; defeated and waiting to die; desperate to leave; and poor quality care. A divergent subtheme regarding residential care was they are cared for now. Conclusions: There was considerable synergism between patient and carer themes, suggesting triangulation of data generation. Specifically, reflections on self-harm were characterised by denial, avoidance, secrecy, and often a persistent wish to die. Such

S210 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 maladaptive responses suggest a role for interventions which enhance insight and promote openness. The considerable reported carer burden identified at baseline and still present a year later was independently identified and appreciated by patients; a key target for ongoing clinical care. Self-harm would ideally be met with a clinical response of better engagement of patients and carers, not alienation and invalidation as was reported. Education for clinical staff should anticipate and actively address such perceptions. Some older people moved into residential care as a consequence of their self-harm. A striking aspect of the perception of outcomes for both patients and carers was the distress associated with living in residential care. Although nursing homes may be seen as a solution to provide a safe environment or ensure routine care, in reality patients and carers experience considerable difficulty adjusting to placement, and associated responses of defeat and misery. Clinicians need to better understand the complex emotional responses to residential care for patients and carers. Anticipating and proactively addressing these responses could better support patients and carers in this situation. Older people and their carers may be affected by the sequelae of self-harm long after the event. The responsiveness of clinical care may wane over time, leaving patients and carers feeling isolated in their distress. For those who enter residential care after self-harm, particular interventions should be developed to facilitate, support and reduce associated negative emotional responses in both patients and carers. This research was funded by: Not applicable.

Poster Number: NR - 36 COMPARISON OF THE COGNIVUEÒ QUANTITATIVE ASSESSMENT TOOL AND SLUMS TO CLASSIFY THE RISK OF COGNITIVE IMPAIRMENT Diego Cahn-Hidalgo1; Reina Benabou2; Sarah Kewin2

1Internal Medicine of Brighton 2Cognivue Inc.

Introduction: Background: CognivueÒ* was developed based on clinical experience and NIH funded laboratory research into the neural mechanisms of functional impairment in aging and dementia. The computerized testing tool provides an automated brain functional assessment tool not tied to traditional question & answer testing. CognivueÒ consists of 3 sub-batteries of 10 separately scored sub-tests presented in a 10 minute automated sequence. These include basic motor & visual ability (visuo- motor and visual salience), perceptual processing (letter, word, shape, and motion discrimination), and memory processing (letter, word, shape, and motion memory). Objective: To determine the CognivueÒ cut-off scores corresponding to the St. Louis University Mental Status (SLUMS) 3-level classification for risk of cognitive impairment. Methods: Adults (age 55-95 y) at-risk for age-related cognitive decline or dementia were invited via posters and email to complete the SLUMS and CognivueÒ tests. Optimization analyses by positive percent agreement (PPA) and negative percent agreement (NPA), as well as by accuracy and error bias were conducted. Results: 92 subjects, at 5 sites, completed SLUMS (reference standard) and CognivueÒ tests. Based on SLUMS score, 50% were not impaired (>26), 38% were intermediate (26‒21), and 12% were impaired (<21). Analyses using 2 measures of objective function (inaccuracy and error bias), showed that a SLUMS cut-off score of <21 (impairment) corresponded to a CognivueÒ score of 54.5 (NPA=0.92; PPA=0.64). The SLUMS cut-off score of >26 (no impairment) corresponded to a CognivueÒ score of 78.5 (NPA=0.5; PPA=0.79). Based on the 2 separate analysis techniques, results showed that CognivueÒ scores between 55‒ 64 corresponded to SLUMS scores for impairment, and CognivueÒ scores between 74‒79 corresponded to SLUMS scores for no impairment. Conclusions: CognivueÒ scores ≤50 provide a conservative standard for high risk of impairment that will avoid misclassification of an individual as impaired. CognivueÒ scores ≥75 provide a conservative cut-off for no risk of impairment that will avoid misclassification of an individual as not unimpaired. This research was funded by: This study was supported by Cognivue, Inc. *INDICATIONS FOR USE: CognivueÒ testing is indicated as an adjunctive tool for evaluating perceptual and memory function in individuals aged 55-95 y. It is not intended to be used as a stand-alone device to identify the presence or absence of clinical diagnoses. CognivueÒ is intended to be used by medical professionals qualified to interpret the results of a cognitive assessment examination.

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Poster Number: NR - 37 VALIDITY, RELIABILITY, AND PSYCHOMETRIC PROPERTIES OF COGNIVUEÒ, A QUANTITATIVE ASSESSMENT OF COGNITIVE IMPAIRMENT Diego Cahn-Hidalgo1; Reina Benabou2; Sarah Kewin2

1Internal Medicine of Brighton 2Cognivue Inc.

Introduction: Background: Many tools for assessing decline in cognitive function have limited utility due to issues of accuracy, testing bias, and uptake among clinicians. CognivueÒ* is a brief, easy-to-use, FDA-cleared tool for the adjunctive assessment of cognitive impairment risk. Objective: To clinically validate CognivueÒ via agreement analysis of impairment risk classifications, retest reliability assessment, and psychometric property comparison. Methods: Adults age 55-95 y at risk for age-related cognitive decline or dementia completed CognivueÒ, St. Louis University Mental Status (SLUMS), and other neuropsychological tests including Rey Auditory Verbal Learning Test (RAVLT) & Trail Making Test A/B (TMT-A, TMT-B). Analyses included: regression analyses for agreement and re-test reliability, and rank linear regression and factor analysis for psychometric comparisons. Results: Data were available for 401 subjects who completed ≥1 testing session, and 358 who completed 2 sessions 1-2 weeks apart. Previously determined CognivueÒ classification scores were validated, demonstrating good agreement with SLUMS scores (weighted k 0.57; 95% CI 0.50-0.63). The study of test-retest reliability showed similar scores across repeated testing for CognivueÒ (regression fit, R2, 0.81; r, 0.90), and SLUMS (regression fit, R2, 0.67; r, 0.82). The CognivueÒ risk classifications of high, low to moderate, and no risk of impairment, did not differ significantly across repeat testing; however, for SLUMS, the relationship between scores and classifications across repeated testing was less robust. The psychometric validity of the CognivueÒ cognitive test battery was demonstrated compared to traditional paper & pencil neuropsychological tests. Scores were most closely correlated with measures of verbal processing, manual dexterity/speed, visual contrast sensitivity, visuospatial/ executive function, and speed/sequencing. Conclusions: The CognivueÒ validation study demonstrated good agreement between CognivueÒ and the SLUMS test; good test-retest reliability of CognivueÒ test results; and validated the psychometric properties of the CognivueÒ test battery compared to traditional neuropsychological tests. This research was funded by: This study was supported by Cognivue, Inc. *INDICATIONS FOR USE: CognivueÒ testing is indicated as an adjunctive tool for evaluating perceptual and memory function in individuals aged 55-95 y. It is not intended to be used as a stand-alone device to identify the presence or absence of clinical diagnoses. CognivueÒ is intended to be used by medical professionals qualified to interpret the results of a cognitive assessment examination.

Poster Number: NR - 38 PREDICTION OF DELIRIUM, MORTALITY, AND FALL RISK IN INPATIENTS USING BISPECTRAL EEG Kasra Zarei1; Gen Shinozaki1

1University of Iowa

Introduction: Delirium is a prevalent yet under-diagnosed and under-treated condition. Although questionnaire instruments are capable of detecting delirium if implemented rigorously, they have not been effectively used due to their lack of efficiency in busy hospital workflows. Their subjective nature is also a drawback. Electroencephalography (EEG) can objectively detect the “diffuse slowing” of brain waves that is characteristic of delirium. While standard EEG is not suitable for mass screening due to its size, cost, and the expertise required for lead placement and interpretation, simplified two channel EEG devices can still be used to measure frontal EEG changes. Our goal was to investigate if frontal EEG activity could be used to detect delirium and to predict fall risk and mortality among elderly inpatients. Methods: A single center, prospective design was used to collect frontal EEG activity (Fp1 and Fp2 EEG signals) from elderly patients (>55 yo) after admission or at the time of an emergency room visit. EEG features (band powers and different combinations of frequency bands) were calculated for both channels and averaged. A bispectral EEG score (“BSEEG score”) was calculated based on the distribution of the scores from the study participants, and normalized with a mean value of zero and one standard deviation (SD) above the mean as 1. The top 9 EEG features were selected using machine learning methods, Random

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Forest. Subjects were assessed for the clinical presence of delirium and the primary outcomes measured were fall history, and mortality. K-nearest neighbors, logistic regression, support vector machine (SVM), kernelized SVM, and neural network approaches were used to assess the ability of bispectral EEG to predict delirium status, falls and survival. Results: EEG features and outcome data for 274 patients was available for analysis. Clinical presence of delirium and BSEEG score were significantly associated (P = 6.14 £ 10-6; unadjusted, P= 1.17 £ 10-5; adjusted). Of all the classification methods, kernelized SVM yielded the highest prediction accuracies of 69%, 89%, and 81%, for delirium status, falls and mortality, respectively. Hazard ratio (HR) for survival controlling for age, gender, CCI and delirium status based on one SD change of BSEEG score at the time of admission was 1.32, (CI = 1.03 to 1.70, P=0.026). Conclusions: In our study, bispectral EEG in delirious elderly inpatients was able to predict patient outcomes including mortality and fall risks. Bispectral EEG monitoring may also be applicable in settings including the primary care clinic, emergency department, and in nursing home or home-care settings. Delirium is particularly dangerous when patients experience it outside of hospitals because they do not have medical attention available on site. The simple, noninvasive nature of a simplified EEG test makes it potentially ideal for routine screening. Potentially it can be used as a next vital sign to monitor the risk of delirium, mortality, and falls among elderly patients. As the aging population is expanding rapidly, such a test would be in high demand. This research was funded by: This study was supported by the University of Iowa Research Foundation GAP funding award for Gen Shinozaki. Gen Shinozaki has grant support from NSF1664364 and K23 MH107654.

Poster Number: NR - 39 “PROJECT LIFE FORCE-GERIATRIC”: A NOVEL SUICIDE SAFETY PLANNING GROUP TREATMENT Lea Marin1,2; Sarah Sullivan3; Angela Page Spears2; Marianne Goodman3

1Icahn School of Medicine at Mount Sinai 2James J Peters Veterans Affairs Medical Center 3James J. Peters Veterans Affairs Medical Center

Introduction: Older Veterans are the largest and fastest growing segment of the Veteran population. Additionally, the rates of suicide completion are highest in older Veterans; 68% of all deaths by suicide are in Veterans that are 50 and older. [1] Lethality of attempts is also greatest in the geriatric population. Youth typically have 25 attempts per one completed suicide, whereas older adults have only four attempts per one completed suicide. [2] Despite their elevated risk, there is limited research and fewer interventions targeting suicide risk in older Veterans. Therefore, there is an urgent need for effective interventions in reducing the risk of suicide in the geriatric population. Our research team hopes Project Life Force-Geriatric (PLF-G) can fill this gap in treatment. Methods: Creating a Suicide Safety Plan (SSP) is an effective treatment for Veterans with suicidal ideation and behaviors [3,4]. PLF is an open-label, 6-month study conducted at the James J. Peters VA Medical Center, that piloted a skills group consisting of ten sessions implementing the SSP in Veterans deemed high risk for suicide. However, this PLF pilot sample only included individuals aged 25-66 years old (average: 46.43 years). To target the high-risk geriatric population, our research team is developing PLF-G. In adapting PLF-G for older adults, accommodations have been made for potential hearing and vision impairments as well as limitations in attention spans among older adults who may have mild deficits in working memory and short-term memory. These modifications include: frequent breaks during sessions, writing key points and agenda items on the white board in large print, using select assessments targeted specifically to geriatric population (e.g. the Geriatric Depression Scale), sessions will be 60-minutes (vs. 90-minutes in PLF pilot), paper handouts in addition to mobile applications, and written summaries for each session using large fonts. See Table 1. Results: PLF-G specific data will be included in final presentation, but is not yet available. Below are results from the initial PLF study. In the initial PLF study, Veteran participants were assessed at baseline and post intervention (month 3). Demographic information was collected on 37 participants. The average age was: 46.43 years old (range: 25-66 years). Males accounted for 78%. This was a diverse sample with 52.6% identifying as Hispanic. The PLF study resulted in a statistically significant decrease in suicidal ideation, suicidal behavior, hopelessness, and depression as measured by the Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), and the Beck Scale for Suicide Ideation (BSS). See Figure 1. There were no suicide attempts or completions throughout the course of treatment. A paired samples t-test was performed to compare pre- and post-intervention scores and there were significant decreases in:

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1. Suicidal ideation on the BSS; t(20) = 4.41, p = 0.000 2. Depressive symptoms on the BDI-II; t(20) = 3.989, p = 0.001 3. Hopelessness on the BHS; t(20) = 2.330, p = 0.030 Conclusions: The initial PLF decreased suicidality in a non-geriatric Veteran population. During this preliminary treatment, the 80-page manual was finalized, the program yielded encouraging results, it was well tolerated, feasible, and effective in reducing suicidal ideations and behaviors. One significant limitation to the pilot study was the lack of representation of high-risk geriatric patients; therefore, a new pilot study titled PLF-G will be conducted within the geriatric population beginning in January 2019. The results of which will be included in final presentation. This research was funded by: This research was supported by VA Merit Award (RX-001911-01A1) and the VISN 2 South MIRECC.

TABLE 1. Project Life Force - Geriatric Session Outline Session Number and Focus Skill Covered 1 Introduction, psychoeducation about suicide, Crisis Management Skills SSP step #5- crisis numbers, meet local SPC Urge Restriction 2 SSP step #1 - Identiﬁcation of Warning Signs Emotion Recognition Skills 3 SSP step #2 - Internal Coping Strategies Distress Tolerance and Coping Skills 4 SSP step #3 - Identifying people to help distract Making Friends Skills 5 SSP step #4 - Sharing SSP with Family Interpersonal & Asking For Help Skills 6 SSP step #5 - Professional Contacts Skills to Maximize Treatment Efﬁcacy & Adherence 6 SSP step #6 - Making the Environment Safe Means restriction, Psychoeducation about Methods 7 Improving Access to the SSP Use of the Hope Kit 8 Physical Health & Medical Illness Management Skills to Maximize Physical Health and Wellbeing 9 Building a Positive Life Building Reasons for Living 10 Recap/Review Recap, sharing of SSPs 11 Add on session Dealing with a death of a group member (suicide or otherwise)

Poster Number: NR - 40 EPIDEMIOLOGY OF MENTAL HEALTH IN U.S. ADULT EMERGENCY DEPARTMENT PATIENTS Seth Kunen1; Manisha Sawhney2

1Clinical & Medical Psychologist, Baton Rouge, LA 2University of Mary, Bismarck, ND

Introduction: Interest in mental health (MH) of the elderly is growing because of the increase in the expected lifespan of the elderly. Individuals aged 65 and older are expected to represent 16% of the population in 2020, the largest it has ever been (UN, 2010). Emergency department (ED) use tends to increase as age increases. Those over 65 may represent more than 25% of all MH related ED visits, and over half of these MH visits among those 65 and over appears to result in hospitalization. In contrast

S214 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019 to the community MH rates, which range from 20% to 25%, the MH rates found among ED patients is much lower, and the reported rates typically range from about 3.5% to almost 8%, far below the community rates (Weiss et al., 2016). Before the MH needs of younger and older adults who visit ED’s can be assessed, the epidemiology of MH visits among adults needs to be more carefully assessed because of the large discrepancy between the community and ED MH rates. Methods: We examined seven years of NHAMCS MH ED data (2009 − 2015) collected by the Centers for Disease Control using sampling parameters that permitted estimation of population rates. The NHAMCS is a nationally representative sample of ED’s in the US. We analyzed MH diagnoses made by a variety of healthcare professionals (e.g., physician, resident, nurse, PA, and mental health provider) across younger (25 to 64) and older adults (65+). Results: When we assessed the MH disorder rate across all diagnosticians, the MH rate was 6.8%, which is consistent with previous studies. However, when we examined the MH rates when mental health professionals were part of the diagnostic team, the rates jumped to an enormous 63%. A logistic regression analysis showed that the odds of a diagnostic team that includes a mental health provider making a psychiatric diagnosis were nearly 28 times that of a diagnostic team without a mental health provider. While the MH rates were very high for all adults, the rates were twice as high for the younger adults (67%) than for the older adults (31%). Conclusions: We discuss the importance of having MH care professionals on ED diagnostic team, given that there appears to be an under-diagnosis of MH problems among adults when MH care professionals are not on the diagnostic team. This research was funded by: This is a non-funded project.

Poster Number: NR - 41 SUPPORTING OLDER VETERANS WITH SUICIDAL SYMPTOMOLOGY AND THEIR CAREGIVERS WITH A NOVEL TREATMENT Sarah Sullivan1; Angela Page Spears2; Lea Marin3; Marianne Goodman1

1James J. Peters Veterans Affairs Medical Center 2James J Peters Veterans Affairs Medical Center 3Icahn School of Medicine at Mount Sinai

Introduction: Older Veterans are the largest and fastest growing segment of the Veteran population. In a report published by the Veterans Affairs (VA), the rate of depression is doubled in Veterans aged ≥65 years as compared to the general population within the same age group (VHA Report, 2015). Additionally, the rates of suicide completion are highest in older Veterans; 68% of all deaths by suicide are in Veterans that are 50 and older (VA National Suicide Data Report, 2005-2015, 2018). Despite their elevated risk, there is limited research and fewer interventions targeting suicide and suicidal behavior in older Veterans. Methods: Creating a Suicide Safety Plan (SSP) is an effective treatment for Veterans with suicidal ideation and can decrease suicidal behaviors (Miller et al., 2017; Stanley et al., 2016). Due to the deaths of spouses and friends, many older adults do not have a strong social network and very few whom they would turn to in a suicidal crisis. Therefore, increasing communication between the existing social supports and increasing the usage of the Safety Plan would be possibly life-saving to older Veterans. Additionally, it could also reduce caregiver burden that may exist in the existing social supports. A current randomized clinical trial titled Safe Actions for Families to Encourage Recovery (SAFER), a novel, 4-session manualized family-based intervention being conducted at the James J. Peters VA Medical Center, focuses on implementing the SSP in Veterans at moderate-risk for suicide. Using psychoeducation and disclosure, SAFER provides the structure to support caregiver involvement in suicide safety planning with the development and revision of both the Veteran and a complementary family member safety plan. Please see Table 1. Results: The current SAFER sample only includes five individuals 65 and older (total sample average: 56.53 years). Reviewing preliminary data from the Beck Scale for Suicidal Ideation suggests that those over the age of 65 experienced almost twice as much ideation (M=25.33, SD=9.45) as compared to those under 65 (M=13.61, SD=9.54). An independent samples T-test was performed to further explore this relation suggesting that even in this small sample the difference in scores was approaching significance t(24)= -2.003, p=.057. These initial findings conceptualize a need for research and treatment targeting the geriatric population. To target the moderate-risk and high-risk geriatric population, our research team is developing ways to adapt SAFER. In adapting SAFER for older adults, accommodations will be made for potential hearing and vision impairments as well as limitations in attention spans among older adults who may have mild deficits in working memory and short-term memory. Additionally, modifications will also need to be made for the caregivers of older adults, such as co-morbidities or possible memory loss of the older adult. Please see Table 2 for existing SAFER session outline.

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Full data set to be included in ﬁnal presentation. Conclusions: Many elderly adults experience challenges, such as retirement, loss of spouse or close friends, depreciated physical capabilities, survivor guilt, unresolved grief, and limited social support (Rose, 2017). These challenges can be a trigger for suicidal symptoms; therefore, more research and interventions should target suicide and suicidal behavior in older Veterans. One signiﬁcant limitation to the ongoing study is the lack of representation of geriatric patients; therefore, a future direction of SAFER is to have modules focusing the geriatric population This research was funded by: This research was supported by VA Merit Award (1I01RX002432-01) and the VISN 2 South MIRECC. PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000446/AAGP2019-000446_Fig1.pdf PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000446/AAGP2019-000446_Fig2.pdf

Poster Number: NR - 42 GLOBAL IMPROVEMENTS IN TARDIVE DYSKINESIA AND PATIENT SATISFACTION WITH VALBENAZINE IN OLDER AND YOUNGER PATIENTS: RESULTS FROM AN OPEN- LABEL, ROLLOVER STUDY Martha Sajatovic1; Jean-Pierre Lindenmayer2; Joshua Burke3; Roland Jimenez3; Khodayar Farahmand3; Scott Siegert3

1University Hospitals Cleveland Medical Center 2New York University School of Medicine 3Neurocrine Biosciences, Inc.

Introduction: Older adults have an increased risk of developing tardive dyskinesia (TD), a persistent and often debilitating movement disorder that is associated with antipsychotic treatment. Valbenazine is currently approved to treat TD in adults of all ages, with no dose adjustment required for older patients. Valbenazine has been evaluated in 2 long-term Phase III studies (KINECT 3, KINECT 4) in which adults with TD (18 to 85 years) received once-daily treatment (40 or 80 mg) for up to 48 weeks. Completers from these studies were eligible to enter a long-term, open-label rollover study (NCT02736955) in which global improvements and patient satisfaction were assessed. Data from the rollover study were analyzed post hoc to further investigate the long-term effects of valbenazine in participants categorized by age (<55 years, ≥55 years). Methods: Completers from KINECT 3 or KINECT 4 were re-initiated at 40 mg following washout of prior valbenazine treatment. Dose was escalated after 4 weeks to 80 mg based on tolerability and clinical assessment of TD. Reduction to 40 mg was allowed if 80 mg was not tolerated; participants unable to tolerate 40 mg were discontinued from the study. The study was designed to include 72 weeks of treatment, but few participants reach Week 60 and none reach Week 72 because valbenazine became commercially available. Both doses of valbenazine (40 and 80 mg) were pooled. Analyses were conducted at Week 48 and end-of-treatment (EOT), based on the last available post-baseline value. Assessments included the Clinical Global Impression of Severity-TD (CGIS-TD: range, 1 [normal/not at all ill] to 7 [extremely ill]) and Patient Satisfaction Questionnaire (PSQ: range, 1 [very satisfied] to 5 [very dissatisfied]). All outcomes were analyzed descriptively in age subgroups (younger, <55 years; older, ≥55 years). Results: The study included 51 younger participants (mean age, 47.9 years; range, 34-54 years) and 109 older participants (mean age, 62.5 years; range, 55-83 years). A total of 56 participants reached the Week 48 visit (<55y, n=18; ≥55y, n=38); 156 were included in EOT analyses (<55y, n=47; ≥55y, n=109). Mean decreases (improvements) from baseline in CGIS-TD score were similar in the younger and older subgroups at Week 48 (<55y, -1.7; ≥55y, -1.8) and greater in the older subgroup at EOT (<55y, -1.5; ≥55y, -1.9). In both subgroups, the percentage of participants with CGIS-TD score ≤2 (normal/not at all ill or borderline ill) increased from baseline (before restarting valbenazine) (<55y, 14.0%;≥55y, 14.7%) to Week 48 (<55y, 50.0%; ≥55y, 71.1%) and EOT (<55y, 61.7%; ≥55y, 72.5%). At baseline, almost all participants (<55y, 100%; ≥55y, 98.2%) were somewhat or very satisfied with their prior valbenazine experience (PSQ score ≤2). Participants continued to express satisfaction with valbenazine with PSQ scores ≤2atWeek48(<55y, 100%; ≥55y, 97.4%) and EOT (<55y, 93.6%; ≥55y, 98.1%). Conclusions: A clinician-based global assessment indicated ongoing, meaningful TD improvements with once-daily valbenazine in both younger and older adults. Patient satisfaction rates remained high, even in patients treated for >1 year. These results, along with the safety results presented separately at this meeting, indicate that valbenazine is an effective long-term treatment for TD. This research was funded by: This research was fully funded by Neurocrine Biosciences, Inc.

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Poster Number: NR - 43 SAFETY RESULTS FROM 3 LONG-TERM VALBENAZINE STUDIES IN YOUNGER AND OLDER ADULTS WITH TARDIVE DYSKINESIA George Alexopoulos1; Martha Sajatovic2; Mena Alrais3; Joshua Burke3; Khodayar Farahmand3; Scott Siegert3

1Weill Cornell Medical College 2University Hospitals Cleveland Medical Center 3Neurocrine Biosciences, Inc.

Introduction: Older age is a significant risk factor for developing tardive dyskinesia (TD). Valbenazine, a novel and highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor, is approved to treat TD in adults, regardless of age. We report a comparison of the long-term safety and tolerability of once-daily valbenazine in adults with TD aged ≥55 vs. <55 years. Methods: Data were pooled from two phase 3 studies, KINECT 3 (NCT02274558: valbenazine 40 or 80 mg, 6-week double- blind placebo-controlled period, 42-week double-blind extension) and KINECT 4 (NCT02405091: valbenazine 40 or 80 mg, 48-week open-label treatment). KINECT 3/4 study completers could enroll in a subsequent rollover study (NCT02736955: valbenazine 40 or 80 mg, additional ≤72-week open-label treatment or until valbenazine became commercially available). For safety analyses, participants were categorized by age (older, ≥55y; younger, <55y), and valbenazine doses were pooled. Outcomes included treatment-emergent adverse events (TEAEs), vital signs, electrocardiograms (ECGs), and the Columbia- Suicide Severity Rating Scale (C-SSRS). Significance testing between age subgroups (≥55y vs. <55y) was conducted for summary TEAEs. Results: Analyses included 383 KINECT 3/4 participants (≥55y=239; <55y=144) and 160 rollover participants (≥55y=109; <55y=51). Mean ages [and ranges] were as follows (older, younger): KINECT 3/4 participants (62.5 [55 to 83] years; 46.9 [26 to 54] years); rollover participants (62.5 [55 to 83] years, 47.9 [34 to 54] years). In KINECT 3/4, the summary of TEAEs in older and younger participants was as follows (≥55y vs. <55y): any TEAE (77.8% vs. 64.6%; P<0.01); serious TEAE (19.2% vs. 10.4%; P<0.05); and discontinuation due to TEAE (19.7% vs. 11.8%; P<0.05). Headache was the most common TEAE in both age subgroups during KINECT 3/4 (≥55y, 9.6%; <55y, 8.3%). In the rollover study, the incidence of TEAEs was not significantly different between older and younger participants (≥55y vs. <55y): any TEAE (53.2% vs. 52.9%; P>0.05); serious TEAE (10.1% vs. 9.8%; P>0.05); and discontinuation due to TEAE (3.7% vs. 9.8%; P>0.05). The most common TEAE was somnolence among older participants (4.6%) and cough among younger participants (9.8%). During both KINECT 3/4 and the rollover study, no clinically important changes in vital signs or ECGs were found in either age subgroup, and most participants (>90%) had no worsening in C-SSRS scores from baseline. Conclusions: In older (≥55y) and younger (<55y) adults who received >1 year of once-daily valbenazine for TD, TEAEs and other safety outcomes were consistent with previous long-term analyses. These results confirm that valbenazine is generally safe and well-tolerated in all adults with TD. This research was funded by: This research was fully funded by Neurocrine Biosciences, Inc.

Poster Number: NR - 44 RE-KINECT, A REAL-WORLD, PROSPECTIVE TARDIVE DYSKINESIA SCREENING STUDY: AN EVALUATION OF BASELINE CHARACTERISTICS IN OLDER PATIENTS Stanley Caroff1; Andrew Cutler2; Caroline Tanner3; Karen Yeomans4; William Lenderking5; Huda Shalhoub5; Jun Chen5; Ericha Anthony6; Chuck Yonan6

1Corporal Michael J. Crescenz Veterans Affairs Medical Center and the Perelman School of Medicine, University of Pennsylva- nia, Philadelphia, PA, USA 2Meridien Research, Tampa, FL, USA 3UCSF School of Medicine and San Francisco VA Health Care System, San Francisco, CA, USA 4Evidera, Montreal, QC, Canada 5Evidera, Waltham, MA, USA 6Neurocrine Biosciences, Inc., San Diego, CA, USA

Introduction: Older age is a risk factor for developing tardive dyskinesia (TD), a persistent movement disorder associated with prolonged exposure to antipsychotics. In older patients, TD symptoms may appear after shorter antipsychotic treatment. RE-KINECT (NCT03062033), a real-world study of outpatients prescribed antipsychotics, was designed to identify the presence of drug-induced involuntary movements consistent with TD (i.e., “possible TD”) and to characterize the impact of

Am J Geriatr Psychiatry 27:3S, March 2019 S217 AAGP Annual Meeting 2019 these movements on health-related quality of life. Baseline data from RE-KINECT were analyzed to explore the patient experience of possible TD and how it affects functioning in older adults (≥55 years). Methods: Adults with ≥3 months of lifetime exposure to antipsychotics and ≥1 psychiatric disorder were recruited. The presence of possible TD was based on clinicians’ observation and assessment of involuntary movements in 4 body regions (head/ face, trunk/neck, upper extremities, and lower extremities). Patients were categorized into Cohort 1 (without visible movements or possible TD) or Cohort 2 (with visible movements and conﬁrmed by clinician as consistent with possible TD). Baseline outcomes for all patients included demographics, clinical history, patient-reported health status (score range, 0 [“no health problems”] to 10 [“health as bad as you can imagine”]), and the patient-reported EuroQoL 5-Dimensional 5-Level questionnaire (EQ-5D-5L; domain score range, 1 [no problems or symptoms] to 5 [extreme problems or symptoms]). Clinicians also assessed the location and severity (ratings, “none”, “some”, or “a lot”) of abnormal movements in Cohort 2 patients. Exploratory statistical testing was conducted between older adults (≥55 years) in Cohorts 1 and 2. Results: Of the 738 patients enrolled in the study, the results of those ≥55 years (N=300, 41%) are presented here. Within this subgroup, 114 (38%) had clinician-conﬁrmed possible TD (Cohort 2) and 186 (62%) had no visible movements or had movements that were inconsistent with TD (Cohort 1). In Cohort 2 patients, the highest frequencies of severe abnormal movements (severity rating: “a lot”) were observed in the head/face (25%) and upper extremities (14%). Cohort 2 patients were less likely to be married,morelikelytoliveincarehomes,andweremorelikelytohave longer lifetime exposure to antipsychotics than Cohort 1 patients (Table). More patients in Cohort 2 had schizophrenia or schizoaffective disorder, while those in Cohort 1 were more likely to have a mood disorder. Patients in Cohort 2 also had slightly higher mean EQ-5D-5L scores atbaselineinfourEQ-5D-5L domains, suggesting a somewhat greater impact on health-related quality of life, particularly in the domain of self-care. Conclusions: Results from this real-world sample of older psychiatric outpatients suggest that the greater risk and severity of TD in this population may be associated with more limited support systems and reduced quality of life, which are separate from the effects of age itself. This research was funded by: This research was fully funded by Neurocrine Biosciences, Inc.

TABLE 1. Baseline Characteristics in Older Adults (≥55 Years) Cohort 1: Without Cohort 2: With Possible Possible TD N=186 TD N=114 P-valuea (Exploratory) Mean age, years 62.8 64.3 0.118 Female, % 66 57 0.118 White, % 80 74 0.249 Marital status, % Single 28 32 0.415 Married 34 23 0.037 Divorced 26 31 0.422 Widowed or separated 12 14 0.585 Current living situation, % Living alone 30 35 0.326 Living with other (e.g., spouse) 59 43 0.007 Other (e.g., assisted living) 11 22 0.020 Employment status, % Employed full-time 6 4 0.435 Employed part-time 8 9 0.832 Retired 24 27 0.499 Disabled 47 49 0.762 Unemployed 12 10 0.552 Psychiatric diagnosis, % Schizophrenia 16 30 0.005 Schizoaffective disorder 10 21 0.011 Mood/other disorder 84 68 0.002 Mean lifetime exposure to antipsychotics, years 12.2 19.1 <0.001 Mean overall health status 4.6 5.0 0.205 Mean EQ-5D-5L domain score Mobility 1.8 1.9 0.265 Self-care 1.4 1.7 0.029

(continued)

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TABLE 1. (continued) Cohort 1: Without Cohort 2: With Possible Possible TD N=186 TD N=114 P-valuea (Exploratory) Usual activities 1.9 2.0 0.501 Pain/discomfort 2.2 2.4 0.121 Anxiety/depression 2.4 2.4 0.494

a Bold indicates P<0.05.

Poster Number: NR - 45 RETROSPECTIVELY ASSESSING THE EFFICACY OF AGOMELATINE IN BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA Carol Sheei-Meei Wang1,2,3; Chia-Hung Tang1; Ming-Chuan Hu1; Nien-Tsen Hou4; Ying-Che Huang4

1Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan 2Department of BioMedical Engineering, National Cheng Kung University, Tainan City, Taiwan 3Department of Psychiatry, National Cheng Kung University Hospital, Tainan City, Taiwan 4Department of Neurology, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan

Introduction: Behavioral and psychologic symptoms of dementia (BPSD) are sources of increasing stress to patients and caregivers and escalate the cost of overall care for dementia cases. Moderate and severe BPSD often need medical treatment to improve symptoms. However, the use of antipsychotic medications or antidepressants often leads to side effects and increases disability. Agomelatine is a selective melatonergic (MT1/MT2) agonist that has normalizing effect on disturbed circadian rhythms and disrupted sleep−wake cycles. Its activity of 5HT-2C receptor antagonism is associated with antidepressant and antianxiety and increases slow-wave sleep. Agomelatine is also considered to be antioxidant and anti-inflammatory activity. It restores stress-affected hippocampal neuronal activity and promotes adult hippocampal neurogenesis and neuroplasticity. Previous clinical findings prompt that agomelatine can improve the BPSD of dementia patients. This retrospective cohort study was used to evaluate the BPSD of dementia cases before and after agomelatine use. Methods: Dementia cases who ever received agomelatine treatment for depressive symptoms in a general hospital for past 2.5 years were fully reviewed. Their chart records, including the scores of Neuropsychiatric Inventory (NPI), were recorded. The changes of NPI score were used to evaluate the difference of psychological and behavioral symptoms before and after agomelatine use. The linear mixed-effect model is used to model the changes by controlling the confounding effects of age and sex, hypnotics, antipsychotic drugs, and the adjuvant drug −Mesyrel using. The side effects of agomelatine use were also invest. This study was approved by the institutional review board of National Cheng Kung University Hospital. Results: There are 75 cases (male 26, female 49) with Alzheimer’s Dementia (AD) 25, Dementia with Lewy Bodies (DLB) 21, Vascular Dementia (VaD) 15, Mixed type dementia 9, and other type dementia 5 cases having both NPI records, pre-and post- agomelatine use 3 months or more. The mean age is 80.7 years old. The dose of agomelatine is from 12.5mg to 50mg per day. The severity and distress of NPI records all show improvement after agomelatine use (p=0.001), especially in the items of delusion, hallucination, agitation/aggression, depression/dysphoria, anxiety, disinhibition, irritability/lability, motor disturbance, sleep/nighttime behavior disturbance (p<0.001) (table 1). Only the item of Elation/Euphoria shows no significant change between pre-and post-agomelatine use. In general, the scores of NPI were decreased after agomelatine use. However, there was no statistical significant scores change of NPI between pre-and post-agomelatine use in the other type of dementia probably due to the small sample size. Eight cases discontinued from agomelatine use due to side effects: 6 with headache, oversleep, dizziness; 1 ever had violence in the midnight, and 1 increased falling down risk in the night. The causes of switching from other antidepressants (such as sertraline, citalopram, escitalopram, paroxetine, venlafaxine, duloxetine, mirtazepine, bupropion, imipramine, doxeine or trazodone) to agomelatine were depression related symptoms not improved or the side effects of using these antidepressants. These side effects include psychomotor slowing, drowsiness or insomnia, dizziness, fatigue, weak, increasing extrapyramidal symptoms, loss of appetite, constipation, bruising or increasing skin itching. Conclusions: Agomelatine is effective on improving behavioral and psychological symptoms of dementia, no matter in depression, sleep disturbance, delusion, hallucination, or aggression. The start low and go slow rule should be considered since side effects of headache, dizziness, sedation or triggering the fall. This research was funded by: Agomelatine is effective on improving BPSD.

Am J Geriatr Psychiatry 27:3S, March 2019 S219 AAGP Annual Meeting 2019

TABLE 1. Comparison NPI scores pre- and post agomelatine using in different dementia.

NPI AD (n=25) DLB (n=21) diagnosis severity distress severity distress v1 v2 WSRT p v1 v2 WSRT p v1 v2 WSRT p v1 v2 WSRT p Delusions 1.1§1.2 0.6§0.8 -2.75 0.006 1.6§2.0 0.7§1.3 -2.83 0.005 1.6§1.3 0.5§0.7 -2.99 0.003 2.2§1.8 0.6§1.0 -3.32 0.001 Hallucinations 1.0§1.3 0.4§0.8 -2.07 0.038 1.2§1.6 0.4§1.0 -2.23 0.026 1.4§1.4 0.5§0.7 -2.98 0.003 1.8§1.8 0.6§1.2 -2.61 0.009 Agitation/ 1.3§1.2 0.8§0.9 -2.22 0.027 2.0§1.9 1.2§1.4 -2.45 0.014 1.3§1.3 0.7§1.0 -2.56 0.010 1.9§2.0 0.8§1.3 -2.83 0.005 Aggression Depression/ 1.4§1.0 0.6§0.6 -3.53 0.000 2.2§1.5 0.6§0.8 -3.77 0.000 1.9§1.2 0.8§0.7 -3.26 0.001 2.3§1.6 1.1§1.2 -3.09 0.002 Dysphoria Anxiety 1.2§1.0 0.8§0.9 -1.77 0.077 1.6§1.6 0.9§1.2 -2.25 0.025 2.0§1.2 1.1§0.9 -2.40 0.016 2.5§1.8 1.5§1.4 -2.21 0.027 Elation/Euphoria 0.0§0.0 0.0§0.0 0.00 1.000 0.0§0.0 0.0§0.0 0.00 1.000 0.1§0.3 0.1§0.5 -0.45 0.655 0.0§0.2 0.0§0.2 0.00 1.000 Apathy/ 0.7§0.9 0.5§0.9 -1.41 0.157 0.9§1.3 0.6§1.1 -1.41 0.157 1.4§1.4 1.0§1.1 -1.57 0.116 1.7§1.9 1.1§1.5 -1.56 0.119 Indifferency Disinhibition 0.9§1.3 0.5§0.9 -1.93 0.053 1.3§1.9 0.7§1.3 -2.03 0.042 1.2§1.4 0.8§0.9 -2.71 0.007 1.6§1.9 1.0§1.4 -2.33 0.020 Irritability/Lability 1.7§1.2 1.0§1.1 -2.85 0.004 2.4§1.8 1.3§1.5 -3.11 0.002 1.8§1.3 0.8§0.9 -3.31 0.001 2.3§1.9 1.0§1.4 -2.80 0.005 Motor Disturbance 0.8§1.2 0.6§1.0 -1.13 0.257 1.1§1.7 0.7§1.1 -2.31 0.021 1.5§1.3 0.9§1.0 -2.04 0.041 2.0§1.8 1.0§1.2 -2.29 0.022 Nightime 1.7§1.2 0.8§0.9 -3.16 0.002 2.5§2.0 1.0§1.3 -3.37 0.001 2.2§1.1 1.1§1.0 -2.38 0.017 3.0§1.5 1.5§1.6 -2.43 0.015 Behaviors Appetite/Eating 0.9§1.1 0.5§0.7 -2.16 0.031 1.3§1.5 0.7§1.2 -1.90 0.057 1.2§1.3 0.9§1.2 -1.12 0.263 1.5§1.8 1.1§1.7 -0.76 0.447 Total 12.7§6.3 7.1§5.2 -4.24 0.000 18.3§9.6 8.8§7.5 -4.20 0.000 17.5§6.7 9.1§6.0 -3.79 0.000 22.7§10.8 11.5§10.9 -3.38 0.001 diagnosis *mixed type demantia (n=9) VaD (n=15) Severity distress severity distress v1 v2 WSRT p v1 v2 WSRT p v1 v2 WSRT p v1 v2 WSRT p Delusions 2.0§1.5 1.0§0.9 -2.25 0.024 2.7§2.1 1.4§1.4 -2.03 0.042 1.7§1.3 0.9§1.0 -2.81 0.005 2.5§2.1 1.1§1.4 -2.59 0.010 Hallucinations 1.9§1.5 0.7§0.7 -2.33 0.020 2.7§2.2 1.3§1.7 -2.03 0.042 1.1§1.3 0.5§0.8 -1.56 0.119 1.3§1.7 0.6§1.1 -1.55 0.121 Agitation/ 2.0§1.3 0.9§0.8 -2.27 0.023 3.0§2.1 1.3§1.2 -2.21 0.027 2.0§1.0 0.9§1.2 -2.68 0.007 2.8§1.7 1.2§1.8 -2.33 0.020 Aggression Depression/ 2.4§1.0 1.0§0.7 -2.60 0.009 3.3§1.7 1.6§1.3 -2.38 0.017 1.7§1.0 0.7§0.9 -2.74 0.006 2.5§1.7 0.9§1.3 -2.83 0.005 Dysphoria Anxiety 2.1§1.1 0.8§0.7 -2.40 0.016 3.0§1.9 1.1§1.3 -2.39 0.017 2.1§1.1 0.9§0.9 -2.71 0.007 2.9§1.7 1.1§1.2 -3.05 0.002 Elation/Euphoria 0.0§0.0 0.0§0.0 0.00 1.000 0.0§0.0 0.0§0.0 0.00 1.000 0.6§1.1 0.1§0.4 -1.63 0.102 0.8§1.5 0.1§0.4 -1.79 0.074 Apathy/ 1.2§1.3 0.9§1.1 -1.34 0.180 1.8§1.9 1.3§1.5 -1.63 0.102 1.1§1.1 1.0§1.1 -0.52 0.603 1.9§1.8 1.4§1.7 -1.41 0.157 Indifferency Disinhibition 1.7§1.2 0.8§0.8 -1.84 0.066 2.6§2.1 1.1§1.4 -1.84 0.066 1.3§1.2 0.9§1.0 -1.28 0.201 1.9§1.9 1.3§1.6 -1.24 0.217 Irritability/Lability 2.1§1.1 0.7§0.7 -2.39 0.017 3.1§1.7 1.1§1.3 -2.39 0.017 2.1§0.8 1.2§1.1 -2.50 0.013 3.1§1.3 1.7§1.7 -2.46 0.014 Motor Disturbance 1.1§1.4 0.2§0.7 -1.63 0.102 1.7§2.1 0.3§1.0 -1.60 0.109 1.6§1.2 1.0§1.1 -2.25 0.024 2.0§1.9 1.5§1.9 -2.27 0.023 Nightime 2.6§1.0 1.2§1.0 -2.40 0.016 3.7§1.9 1.7§1.4 -2.37 0.018 2.1§1.1 1.0§0.8 -2.95 0.003 3.3§1.8 1.1§1.2 -2.91 0.004 Behaviors Appetite/Eating 0.9§1.1 0.6§0.7 -1.13 0.257 1.1§1.5 0.8§1.1 -0.82 0.414 1.0§1.2 0.7§1.0 -1.52 0.129 1.5§1.9 0.9§1.8 -1.91 0.056 Total 20.0§9.7 8.7§5.7 -2.67 0.008 28.6§16.7 13.1§11.5 -2.67 0.008 18.4§4.6 9.9§6.8 -3.18 0.001 26.3§9.0 13.0§10.2 -3.23 0.001 diagnosis **Other type (n=5) Total (n=75) Severity distress severity distress v1 v2 WSRT p v1 v2 WSRT p v1 v2 WSRT p v1 v2 WSRT p Delusions 1.4§1.1 0.8§0.8 -1.34 0.180 1.4§1.5 0.8§1.3 -1.34 0.180 1.5§1.3 0.7§0.8 -5.43 0.000 2.1§1.9 0.9§1.3 -5.50 0.000 Hallucinations 1.0§1.2 0.4§0.5 -1.34 0.180 1.0§1.4 0.4§0.5 -1.34 0.180 1.2§1.3 0.5§0.7 -4.57 0.000 1.5§1.8 0.6§1.1 -4.24 0.000 Agitation/ 1.0§1.0 0.8§0.8 -1.00 0.317 2.0§1.9 1.2§1.6 -1.41 0.157 1.5§1.2 0.8§1.0 -4.93 0.000 2.3§1.9 1.1§1.4 -5.02 0.000 Aggression Depression/ 2.0§1.0 0.6§0.5 -1.63 0.102 2.2§0.8 1.0§1.2 -1.60 0.109 1.8§1.1 0.7§0.7 -6.19 0.000 2.4§1.6 0.9§1.1 -6.22 0.000 Dysphoria Anxiety 1.0§0.7 0.6§0.5 -1.41 0.157 1.4§1.1 0.8§0.8 -1.34 0.180 1.7§1.1 0.9§0.8 -4.72 0.000 2.3§1.8 1.1§1.2 -5.01 0.000 Elation/Euphoria 0.2§0.4 0.2§0.4 0.00 1.000 0.2§0.4 0.2§0.4 0.00 1.000 0.2§0.5 0.1§0.3 -1.20 0.230 0.2§0.7 0.1§0.2 -1.79 0.074 Apathy/ 1.4§1.5 1.0§1.2 -1.00 0.317 1.2§1.3 0.4§0.5 -1.34 0.180 1.1§1.2 0.8§1.0 -2.44 0.015 1.4§1.7 1.0§1.4 -2.96 0.003 Indifferency Disinhibition 1.0§1.0 0.8§0.8 -1.00 0.317 1.2§1.6 1.2§1.6 0.00 1.000 1.2§1.3 0.7§0.9 -3.68 0.000 1.7§1.9 1.0§1.4 -3.57 0.000 Irritability/Lability 1.2§0.8 0.6§0.5 -1.34 0.180 1.6§1.1 0.8§0.8 -1.34 0.180 1.8§1.2 0.9§1.0 -5.60 0.000 2.5§1.7 1.3§1.5 -5.44 0.000 Motor Disturbance 0.4§0.5 0.2§0.4 -1.00 0.317 0.4§0.5 0.2§0.4 -1.00 0.317 1.2§1.2 0.7§1.0 -3.64 0.000 1.5§1.8 0.9§1.3 -4.22 0.000 Nightime 2.2§0.8 0.8§0.4 -1.89 0.059 2.6§1.7 0.8§0.4 -1.84 0.066 2.1§1.1 1.0§0.9 -5.61 0.000 2.9§1.8 1.2§1.3 -5.78 0.000 Behaviors Appetite/Eating 0.8§0.8 0.4§0.5 -1.00 0.317 1.4§1.5 0.8§1.3 -1.00 0.317 1.0§1.1 0.6§0.9 -2.93 0.003 1.4§1.7 0.9§1.5 -2.64 0.008 Total 13.6§5.5 7.2§3.7 -1.83 0.068 16.6§8.0 8.6§6.9 -1.83 0.068 16.1§7.0 8.4§5.7 -7.14 0.000 22.2§11.2 10.9§9.5 -6.93 0.000

*Mixed type dementia: simultaneously occurs more than one type of dementia, such as AD plus VaD, ESRD plus VaD, etc. **Other type dementia: include 1 normal pressure hydrocephalus, 2 End stage renal disease, 1 parkinson’s disease with dementia, and 1 alcohol related dementia.

S220 Am J Geriatr Psychiatry 27:3S, March 2019 AAGP Annual Meeting 2019

Poster Number: NR - 46 EXAMINING PARKINSON’S DISEASE PSYCHOSIS TREATMENT OUTCOMES IN THE REAL WORLD: INTERIM YEAR 1 FINDINGS FROM THE INSYTE OBSERVATIONAL STUDY Jennifer Goldman1; Susan Fox2,3; Stuart Isaacson4; Doral Fredericks5; Jeffrey Trotter6; Kaitlin Healy6; Amy Ryan6; Andrew Shim5

1Rush University Medical Center 2Toronto Western Hospital 3University of Toronto 4Parkinson’s Disease and Movement Disorders Center of Boca Raton 5ACADIA Pharmaceuticals 6Worldwide Clinical Trials

Introduction: Parkinson’s disease is the second most common neurodegenerative disease, and over half of patients diagnosed will experience the symptoms of psychosis at some point during the course of the disease. Despite the prevalence of Parkinson’s disease psychosis (PDP), longitudinal studies have not evaluated treatment modalities and outcomes in actual medical practice, and a considerable gap exists in our understanding of the extent to which outcomes achieved in controlled clinical trials can be replicated in the general population. Healthcare providers managing PDP currently utilize a wide range of antipsychotics (AP) off-label, including those that primarily block postsynaptic dopamine receptors, a practice that goes against specific recommendations from evidence-based reviews. Minimal data are available on AP therapy in PDP, regarding mitigating the burden of PDP by reducing hospitalizations and long-term care facility entry, or in improving other outcomes such as activities of daily living and sleep. Additionally, absent such “real world” data, factors that may be predictive of best clinical, economic, and/or humanistic outcomes cannot be fully ascertained. The goal of the INSYTE Study − Management of Parkinson’s Disease Psychosis in Actual Practice − is to examine real-world management of PDP and its treatment outcomes, including the role of medication adjustments and AP usage, as well as the impact of PDP on healthcare resource utilization. The study also evaluates treatment decisions and their effect on humanistic measures, including quality of life, treatment satisfaction, sleep quality, activities of daily living, and patient and caregiver burden. Methods: The INSYTE Study is enrolling up to 750 patients and their caregivers, from up to 100 sites in the United States. To achieve the study objectives, a prospective, observational design has been implemented to accommodate and describe standard medical practice associated with PDP management. Patients participating in the INSYTE Study will have a diagnosis of PDP prior to enrollment, or else will meet the symptomatic criteria for the condition (for example, Parkinson’s disease with a history of delusions and/or hallucinations). INSYTE employs validated assessment instruments, although as an observational study, it does not impose a predefined visit schedule, medical tests, laboratory tests, procedures, or interventions. The INSYTE Study will compile clinical assessments and other data at follow-up visits for up to three years from enrollment. Results: Preliminary baseline findings from 55 enrolling sites indicate that investigators at the majority (75%) of enrolling sites are neurologists, of whom 44% are in private practices, as opposed to academic or hospital-based centers. Baseline findings from 334 enrolled patients indicate that most are Caucasian (95%), male (63%), retired (76%), married (75%), and live in a private residence (92%). Most patients (86%) are participating in INSYTE with a caregiver. Average patient age is 74.7 years. Mean duration since PD and PDP diagnosis were 8.8 and 2.6 years, respectively. At baseline, 12% had no cognitive impairment, 50% had slight or mild impairment, and 38% had moderate or severe impairment. At enrollment, 33% of patients were utilizing an AP: of those, 82% were utilizing AP as monotherapy (primarily pimavanserin [50%] and quetiapine [25%]). Pimavanserin+quetiapine was the most frequently employed combination AP therapy (15%); other combinations (<3%) included quetiapine+clozapine, pimavanserin+olanzapine, and pimavanserin +quetiapine+clozapine. Conclusions: The INSYTE Study is the largest observational study to date to explore PDP treatments and patient outcomes in a real-world (clinical practice) setting. Results from this study will better inform the scientific community on current practices and potentially support updates to treatment guidelines and standards of care for the management of PDP. The findings to date reflect the enrollment of approximately half (n=334) of the planned patients from 55 actively participating sites. These data represent baseline characteristics of the enrolled patients (and caregivers, when present). The currently enrolled patients represent 0−38 years since their PD diagnosis, but an average of 8.8 years, and an average of 2.6 years since PDP symptom onset. Patients were also on a wide array of PDP treatments. To date, patients and caregivers have responded well to various questionnaires, as have healthcare professionals from participating sites. These clinical, economic, and humanistic findings will be updated to reflect year 1 interim analyses in Q1 2019. This research was funded by: The INSYTE Observational Study is funded by ACADIA Pharmaceuticals, Inc. (San Diego, CA, USA).

Am J Geriatr Psychiatry 27:3S, March 2019 S221 AAGP Annual Meeting 2019

Poster Number: NR - 47 SELF−HEALTH: ITS VALIDITY AND UTILITY IN OLDER ADULTS WITH SCHIZOPHRENIA Aninditha Vengassery; Carl Cohen; Sarah Sheikh; Syed Maududi; Viktoriya Donovan; Sayan Kaishibayev; Michael Reinhardt

SUNY Downstate Medical Center

Introduction: Self-rated health has been a widely used measure in gerontology. It has been used in a few investigations of older adults with schizophrenia (OAS). Self- health can potentially be as an important research tool for OAS for several reasons: It is a global measurement of the state of physical health, psychological wellbeing, and quality of life; it is easily obtained through one single question; it is an indicator significantly associated with the population’s state of health and possibly with mortality; it can be used to guide healthcare needs; it can identify at-risk individuals; and It may be used by policy makers to tailor health services. Unfortunately, at this point, it is unclear if self-health is a valid measure for OAS. This study of self-health aims to: (1) Determine its validity by examining its correlations with various measures of physical, psychological, and social well-being in OAS; (2) Contrast these findings with a community comparison group; (3) Determine its impact on various outcome measures on 53-month follow-up. Methods: The initial sample comprised 249 outpatients with schizophrenia(S) aged 55+ who developed the disorder prior to age 45 (M= 61 years, 51% male, 55% white) and a normal community comparison(C) group (n=113). 104 of the S group were seen on follow-up (M=53 months; range:12 to 116 months). The self-health item was rated on a 4 point scale from poor (1) to excellent (4). Results: Self-health correlated significantly (p<0.05) with the number of physical disorders (S= -.29;C=-.52), physical health “stands in the way” of doing things(S=-0.41; C=-0.46); total activities of daily living (S=0.18; C=0.32); Center for Epidemiologic Studies −Depression Scale (S=-0.37; C=-0.38); Quality of Life Index (S=0.41; C=0.40); and Community Integration Scale (S= 0.21; C=0.34); self-rating of health versus age peers (S=0.46; C=0.50).Total PANSS score and PANSS positive score were significant correlated in the S group. There were no significant associations with age, gender, education, or race in either group. In the S group, baseline self-health significantly predicted several variables at follow-up (physical health “stands in the way”), number physical disorders, Quality of Life Index, and Community Integration Scale; however, after controlling for age, gender,and baseline values of these variables, none of them attained significance. Mortality was not predicted by baseline self-health. Conclusions: 1. Consistent with the gerontological literature, we found self-health serves as a global indicator of physical, mental, and social well-being in OAS. 2. There was a strikingly similarity between the correlations of the schizophrenia and the comparison groups, although correlations for the latter were somewhat more robust for several physical health variables. 3. In OAS, baseline self-health did not predict any physical, mental, or social outcomes on 53 month follow-up. The findings strongly suggest that using self-health in OAS has comparable validity to its use in normal older adults in the community and can serve as a global indicator of contemporaneous well-being. However, its value as a long-term predictor of biopsychosocial outcomes was not demonstrated in this study. This research was funded by: None.

S222 Am J Geriatr Psychiatry 27:3S, March 2019