From Omics to Successful Ageing

Transcription

1 From Omics to Successful Ageing M O D U L E B O O K Bachelor Medicine, third year Course year Module coordinators: Dr. A.J.M. de Craen LUMC, Department of Gerontology & Geriatrics A.J.M.de_Craen@lumc.nl Dr. S.P. Mooijaart LUMC, Department of Gerontology & Geriatrics S.P.Mooijaart@lumc.nl

2 2014 Alle rechten voorbehouden LUMC Behoudens de in of krachtens de Auteurswet van 1912 gestelde uitzonderingen, mag niets uit deze uitgave worden verveelvoudigd en/of openbaar gemaakt worden door middel van druk, Photographkopie, microfilm, web-publishing of op welke andere wijze dan ook en evenmin in een gegevensopzoeksysteem worden opgeslagen zonder voorafgaande schriftelijke toestemming van de houder van de copyrights. Voor vragen of informatie kunt u contact opnemen met: Directoraat Onderwijs en Opleidingen, PB 9600, 2300 RC Leiden

3 Contents Module committee and teachers 1 Preface 3 Introduction and general information 5 Themes 15

4 Module coordinators Module committee and teachers Dr. A.J.M. de Craen LUMC, Department of Gerontology & Geriatrics Dr. S.P. Mooijaart LUMC, Department of Gerontology & Geriatrics Logistical support Secretary Mw. M. de Jeu LUMC, Department of Gerontology & Geriatrics Room C7-115 Telephone: ext Module committee Dr. M. Beekman, Molecular Epidemiology Dr. A.J.M. de Craen, Gerontology & Geriatrics Prof.dr. J. Gussekloo, Public Health and Primary Care Dr. H.J.L. van der Heide, Orthopaedics Dr. G.J. Liefers, Surgery Prof.dr. R.C. van der Mast, Psychiatry Dr. S.P. Mooijaart, Gerontology & Geriatrics Dr. M. Muller, Gerontology & Geriatrics Dr. S. Trompet, Cardiology and Gerontology & Geriatrics Teachers Prof. Dr. W. Achterberg, Public Health and Primary Care Prof. Dr. D. E. Atsma, Cardiology Dr. E. Bastiaannet, Surgery Dr. M. Beekman, Molecular Epidemiology Drs. A.S. Bertens, Radiology Dr. A.J.M. de Craen, Gerontology & Geriatrics Dr. E.M. van Fenema, Psychiatry Drs. J. de Gelder, Gerontology & Geriatrics Drs. N.A. de Glas, Surgery Prof.dr. J. Gussekloo, Public Health and Primary Care Dr. H.J.L. van der Heide, Orthopaedics Dr. N. Heim, Gerontology & Geriatrics 1

5 Dr. B.T. Heijmans, Molecular Epidemiology Prof. Dr. J.W. Jukema, Cardiology Prof. Dr. R.J.M. Klautz, Thoracic Surgery Dr. G.J. Liefers, Surgery Dr. M. Muller, Internal Medicine - Geriatrics Dr. Ingrid Meulenbelt, Molecular Epidemiology E. Spoor, Debat Instituut Dr M.J.P. van Osch, Radiology Prof.dr. R.C. van der Mast, Psychiatry Dr. S.P. Mooijaart, Gerontology & Geriatrics Dr. M. Muller, Gerontology & Geriatrics Dr. B. Sabayan, Gerontology and Geriatrics Prof. Dr. P.E. Slagboom, Molecular Epidemiology B. Tönissen, Debat Instituut Dr. S. Trompet, Cardiology and Gerontology & Geriatrics Dr. A.W. Wind, Public Health and Primary Care 2

6 Preface The western population is ageing rapidly. Over the last 160 years, life expectancy has increased from 40 years in 1840 to about 80 years in In the second half of the 19 th century and the beginning of the 20 th century, life expectancy predominantly increased because of declining infant and child mortality. However, in the second part of the 20 th century, life expectancy increased because of lower mortality rates at middle and old age. With the post World War II birth cohort reaching their 70s within the coming years, combined with the increased life expectancy, a major proportion of the population will be old to very old in the nearby future. This might give serious problems in health care since prevalence and incidence of disease is highest in old age. This means that future physicians and researchers should be well prepared for this epidemic of older people as it is likely that many patients will be old. In this 10-week minor you will learn about a great variety of health problems in the elderly from different perspectives, both from a clinical and a research perspective. You will see that the field of ageing is very dynamic, with interesting clinical problems and intriguing research questions. There are eight topics that will be covered: molecular epidemiology ( -omics ), cardiovascular, heart-brain connection, neuropsychiatry, mobility, cancer, geriatrics in primary care, and hospital geriatrics. You now enter the fascinating world of medicine for old people. We hope you enjoy the lectures, participate in lively discussions, and broaden and deepen your knowledge by reading, writing and presenting. 3

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8 Introduction and general information Overview programme From Omics to Successful Ageing consists of five themes: Theme 1: Evidence-based Medicine for Older Persons Theme 2: Cancer and Cardiovascular Disease Theme 3: Debate Theme 4: Mobility Theme 5: Mental Health Place of this module in the Bachelor of Medicine The Half minor From Omics to Successful Ageing is designed for medical and biomedical students who wish to increase their knowledge and understanding of age-related disease processes. The course aims to train students to effectively to participate in future health care and research for elderly people. 5

9 Study goals of the module / learning objectives Learning objectives explain which systems/processes change with increasing age explain how systems/processes change with increasing age look up and critically appraise relevant literature pertaining to medicine for older people identify deficiencies in the various knowledge domains (topics) of medicine for older people defend which deficiencies in the field of ageing are important to fill in and which not reason how the deficiencies can be filled in write up the findings in a proper, scientific way orally present the findings in a proper, scientific way Assessment Form Written exams, open questions Written exams, open questions Written and oral presentations Written and oral presentations Written and oral presentations Written and oral presentations Written presentations Oral presentations 6

10 Assessment matrix Learning objectives Knowledge Debating Writing Presenting test technique explain which systems/processes change with increasing age X explain how systems/processes change with increasing age X look up and critically appraise relevant literature identify deficiencies in the various knowledge domains (topics) X X X X defend which deficiencies are important to fill in and which not reason how these deficiencies can be filled in write up the findings in a proper, scientific way orally present the findings in a proper, scientific way X X X X X X X X X Assessment information Knowledge test 1,2,3 Debating technique Case report Literature review Oral presentation Type of exam Area Written exam Debate Written report, 1500 words, references Knowledge, scientific skills Academic skill Knowledge, Scientific skill, Collaboration Written report, 1000 words, 5-10 references Academic skill Scientific skill, Collaboration Oral presentation Academic skill Scientific skill, Collaboration Communiation Time Week 4½,7½,10 Week 5½ Week 2½ Week 7½ Week 4½, 10 7

11 Duration 3 x 1.5 hour 3 hours Not applicable Not applicable 3 hours Weight (% of end mark) Collaboratio n 3 x 15% Pass/fail 25% 10% 2 x 10% Individual Group (3p) Pair (2p) Pair (2p) Pair (2p) Assessed by Teachers Debating teacher Teachers Minor coordinator Number of questions 12 open questions Study books None. All study material for this course will be available at Blackboard. Minor coordinator Not applicable Not applicable Not applicable Not applicable Structure Theme 1, 2, 4, and 5 Theme 1, 2, 4, and 5 each comprise days in which a number of topics relating to the theme will be presented in lectures, where feedback and discussion is provided in working groups, and where students will work independently on Self Study Assignments and Theme Assignments. Theme 1 Theme 1 comprises 10 days in which a number of topics will be presented. Theme 1 ends with a case report, which is the summative test. Theme 2, 4, and 5 Theme 2, 4, and 5 each comprise days. Each theme comprises a number of topics that start with a lecture (approx. 1.5 hrs) and, mostly, ends with time for reflection and/or discussion in a Working Group in which the SSA will be discussed. These Working Groups will also include a formative test, which will be evaluated immediately during class, and will be a good preparation for the final summative test at the end of the theme. During the theme students will also work on a Theme Assignment, which will result in a written literature review (theme 4) or an oral presentation (theme 2 and 5). The topics for the theme assignments will be provided at the beginning of each theme. Theme 3 Theme 3 is a debating week where a professional trainer from the Nederlands Debat Instituut will give two workshops about professional debating techniques. The week will end with a discussion afternoon. Abbreviations of types of lessons Lecture Frontal teaching WG Working group, interactive, discussions SSA Self Study Assignment TA Theme Assignment Question Hour Time for personal questions about Theme Assignment 8

12 Schedule Below there is the schedule for all contact hours at the LUMC. The location of the classes can be found at Note that in the rooster schedule of the classes all activity types are called working group. In the scheme below, the correct activity type is listed. THEME 1: Evidence-based Medicine for Older Persons Week 1 Tuesday 02/09/ Evidence-based medicine in old age, an Lecture introduction Instruction theme assignment Lecture Week 1 Wednesday 03/09/ Feedback, discussion, reflection WG Medical treatment of severe diseases in old age: a typical example from the hospital Lecture Week 1 Thursday 04/09/ Help and feedback for theme assignment Question hour Week 1 Friday 05/09/ Pro-active detection of complex problems in the hospital: opportunities and evidence Lecture Week 2 Monday 08/09/ Feedback, discussion, reflection WG Week 2 Tuesday 09/09/ Optimise functioning as goal for medical care for the older patient in general practice and rehabilitation care opportunities and evidence Lecture Week 2 Wednesday 10/09/ Medical treatment of older patients with complex problems: a typical example from general practice Lecture Week 2 Thursday 11/09/ Help and feedback for theme assignment Question hour 9

13 Week 2 Friday 12/09/ Feedback, discussion, reflection WG Integrated patient demonstration Lecture Week 3 Tuesday 16/09/2014 Before Send in theme assignment via Blackboard --- THEME 2: Cancer and Cardiovascular Disease Topic: Cancer Week 3 Wednesday 17/09/ Introduction to cancer biology in the elderly Lecture Instruction theme assignment Lecture Week 3 Thursday 18/09/ Feedback, discussion, reflection, formative test WG Strength and limitations of clinical trial methodology Lecture Week 3 Friday 19/09/ Help and feedback for theme assignment Question hour Week 4 Monday 22/09/ Feedback, discussion, reflection, formative test WG Screening and treatment of breast and colon cancer Lecture Week 4 Tuesday 23/09/ Feedback, discussion, reflection, formative test WG THEME 2: CANCER AND CARDIOVASCULAR DISEASE Topic: Cardiovascular disease Week 4 Wednesday 24/09/ Cholesterol, treatment and cardiovascular disease Lecture Week 4 Thursday 25/09/ Feedback, discussion, reflection, formative test WG Aortic valve replacement in the elderly Lecture 10

14 Week 4 Friday 26/09/ Help and feedback for theme Question hour Week 5 Monday 29/09/ Feedback, discussion, reflection, formative test WG Cardiac regeneration Lecture Week 5 Tuesday 30/09/ Feedback, discussion, reflection, formative test WG Summative test of theme cancer and cardiovascular disease Test Week 5 Wednesday 01/10/ Oral presentations of theme assignments Test THEME 3: DEBATE Week 5 Thursday 02/10/ Basics of Parliamentary Debating Lecture Week 6 Monday 06/10/ Parliamentary Debating: Strategy and tactics Lecture Week 6 Wednesday 08/10/ Final debates: Parliamentary debates on prepared cases (grades for individual and group performance) Test THEME 4: MOBILITY Topic: Omics Week 6 Thursday 09/10/ Introduction to omics data and their use in Lecture molecular epidemiology of age-related disease Instruction theme assignment Lecture Week 6 Friday 10/10/ Feedback, discussion, reflection, formative test WG Early origin of ageing Lecture 11

15 Week 7 Monday 13/10/ Help and feedback for theme assignment Question hour Week 7 Tuesday 14/10/ Feedback, discussion, reflection, formative test WG Omics in mobility Lecture Week 7 Wednesday 15/10/ Feedback, discussion, reflection, formative test WG THEME 4: MOBILITY Topic: Orthopaedics Week 7 Thursday 16/10/ Arthroplasties: benefits and risks Lecture Week 7 Friday 17/10/ Feedback, discussion, reflection, formative test WG Osteoporosis and sarcopenia Lecture Week 8 Monday 20/10/ Help and feedback for theme assignment Question hour Week 8 Tuesday 21/10/ Feedback, discussion, reflection, formative test WG Management of fractures and fracture risk Lecture Week 8 Wednesday 22/10/ Feedback, discussion, reflection, formative test WG Summative test of theme Test Week 8 Thursday 23/10/2014 Before Send in theme assignment via Blackboard 12

16 THEME 5: MENTAL HEALTH Week 8 Friday 24/10/ Cognitive syndromes and dementia in old age (with Lecture patient demonstration (life or dvd)) Instruction theme assignment Lecture Week 9 Monday 27/10/ An introduction to neuropsychiatry at old age: cognitive, emotional and behavioural neuropsychiatry disorders (with patient demonstration (life or dvd)) Lecture Week 9 Tuesday 28/10/ Help and feedback for theme assignment Question hour Week 9 Wednesday 29/10/ Somatic morbidity and delirium (including a video of a patient with delirium) Lecture Week 9 Thursday 30/10/ Feedback, discussion, reflection, formative test WG Week 9 Friday 31/10/ Vascular and hemodynamic factors in relation to depression and apathy in old age Lecture Week 10 Monday 03/11/ Hemodynamics in cognitive decline and dementia in old age Lecture Week 10 Tuesday 04/11/ Help and feedback for theme assignment Question hour Week 10 Wednesday 05/11/ Feedback, discussion, reflection, formative test WG Brain imaging in cognitive and neuropsychiatric syndromes (includes visits) Lecture 13

17 Week 10 Thursday 06/11/ Feedback, discussion, reflection, formative test WG Summative test of theme mental health Test Week 10 Friday 07/11/ Oral presentations of theme assignment (summative test) Test 14

18 Theme 1 Evidence-based Medicine for Older Persons Background Elderly are becoming a more prominent proportion of modern Western societies, both in absolute and relative terms. This is the result of increasing life expectancy and population demographics, such as the baby boom after the Second World War and decreasing fecundity rates. As a result of both the increasing numbers of elderly and the higher prevalence of disease in older age, a sharp increase in health care demand by older people is foreseen in the near future. Evidence-Based Medicine (EBM) is the hallmark of modern medicine. Doctors are more and more expected to follow clinical guidelines, which are based on clinical studies. However, despite of their high consumption of health care, elderly are systematically excluded from these studies. Moreover, the elderly that are included in trials are likely not representative of the general aging population. Furthermore, the older body may require different treatment targets. For instance, at the age of 85 years, those with a high blood pressure live longer than those with a low blood pressure, in sharp contrast to the inverse relationship in middle age. Finally, specific problems that are common in older age, such as polypharmacy and multi-morbidity, may hamper implementation of treatment recommendation designed for younger patients, often with a single disease. The balance between the benefits and harms of a treatment may be different in the older patient. As a consequence, there is a realistic chance that elderly are not being treated effectively, which results in an increased burden of disease, loss of independence and quality of life, and higher healthcare cost. Learning objectives 1. The student can describe why evidence-based medicine for older persons could differ from evidence-based medicine for middle-aged persons, by taking into account large variety between older persons, different phenotypes the consequences of presence of multimorbidity and complex health problems changes in goals and prognosis of treatment different balance between benefit and harm 2. The student can interpret evidence in older patients and can explain possibilities to deal with lack of evidence 3. The student can work out a dilemma in clinical care for older persons with complex health problems by using the available guidelines, evidence and expert opinion. Theme Assignment The Theme Assignment for the theme Evidence-based Medicine for Older Persons consists of writing of a case report. The case will be presented in the first lecture. 15

19 Tuesday 2 September Lecture Title Evidence-based medicine in old age, an introduction Instructors Dr. S.P. Mooijaart (Gerontology and Geriatrics) Prof.dr. J. Gussekloo (Public Health and Primary Care) Goals The student will be introduced in the topic evidence-based medicine for older persons. Why and how could this could differ from evidence-based medicine for middle-aged persons. Hereby the following topics will be presented and discussed: large variety between older persons, different phenotypes the consequences of presence of multimorbidity and complex health problems changes in goals and prognosis of treatment different balance between benefit and harm The student can interpret evidence in older patients. The student can explain possibilities how deal with lack of evidence Lecture Title Instruction theme assignment and competence development (writing skills) Instructors Dr. A.J.M. de Craen, theme assignment TA Wednesday 3 September TA WG Title Evidence-based medicine in old age, an introduction. Goals Further learning by discussion Lecture Title Medical treatment of severe diseases in old age: a typical example from the hospital (including patient demonstration) Instructor Dr. S.P. Mooijaart (Gerontology and Geriatrics) Goals An elderly patient will be presented who has recently faced a severe disease, for which treatment was given (e.g. initiation of hemo-dialysis or transplantation). Potentially, side effects or complications occurred. With the patient we will discuss about i) choice of treatment (was there any?), ii) importance of quality of life, and iii) expected vs. experienced treatment outcome. 16

20 Thursday 4 September TA Walk-in Title Help and feedback for theme assignment Instructor Dr. A.J.M. de Craen (Gerontology and Geriatrics) TA Friday 5 September TA Lecture Title Pro-active detection of complex problems in the hospital: opportunities and evidence Instructors Dr. N. Heim (Gerontology and Geriatrics) J. de Gelder (Gerontology and Geriatrics) Dr. S.P. Mooijaart (Gerontology and Geriatrics) Goals 1. The student can explain the concept of complex problems and what the differences are between older persons with and without complex problems 2. The student can explain which factors determine the probability of poor outcome in different hospital settings (outpatient, ward, emergency department) 3. The student can explain which approaches can be taken in the hospital to maximise safety of the older patient while in the hospital TA Monday 8 September TA WG Title Evidence based-medicine for older persons Goals Further learning by discussion 17

21 TA Tuesday 9 September Lecture Title Optimise functioning as goal for medical care for the older patient in general practice and rehabilitation care opportunities and evidence Instructors Prof. Dr. W. Achterberg (Public Health and Primary Care) Dr. A.W. Wind (Public Health and Primary Care) Goals 1. The student can explain the importance of functioning in daily life of patients and how to support this in medical care 2. The student can explain the consequences of presence of frailty for prognosis and treatment 3. The student knows how to assess complex problems TA Wednesday 10 September TA Lecture Title Medical treatment of older patients with complex problems : a typical example from general practice Instructor Karen van Eijk, general practitioner Goals A patient will be presented who was recently in contact with the GP and GP-nurse, since his/her daily living situation was worsening. Somatical, functional, psychological and social problems were influencing each other negatively. Independent living was threatened, family members were very concerned. The GP decided to make a care-plan to design, coordinate and facilitate the needed care. Thursday 11 September TA Walk-in Title Help and feedback for theme assignment Instructor Dr. A.J.M. de Craen (Gerontology and Geriatrics) 18

22 TA Friday 12 September WG Title Evidence based-medicine for older persons Goals Further learning by discussion Lecture Title Integrated patient demonstration Instructors Dr. S.P. Mooijaart (Gerontology and Geriatrics) Prof. dr. J. Gussekloo (Public Health and Primary Care) Goals In this lecture the patient of the assignment will be invited to the lecture room, with not only with his/her family members, but also with the general practitioner and responsible hospital specialists(s). The aim is to discuss the clinical dilemma of the assignment with the real hoofdrolspelers. After the patient has left, we will reflect on the discussion and take learning points. TA Monday 15 September TA Tuesday 16 September TA Put theme assignment on blackboard 16 September 2014 before

23 Theme 2 Cancer and Cardiovascular Disease Subtheme 2.1 Cancer Background Cancer is a common disease in the elderly and is characterized by a great heterogeneity, both of the patients as well as the disease. Older patients often suffer from multiple comorbidities and general frailty which is the main reason for a substantial underrepresentation in clinical trials. Therefore evidence based treatment guidelines do often do not apply to older patients. In geriatric oncology, it is recommended that treatment decisions are not (solely) based on calendar age, but rather on biological age or functional status. It is therefore mandatory that in the light of our greying population specific knowledge on biology, competing risk of mortality and treatment will be generated to cope with a growing clinical problem. Study goals At the end of this week the student can explain the similarities and differences in cancer biology between old and young can indicate major gaps in our knowledge of the treatment of elderly with cancer. Furthermore he is able to indicate different trial methodologies to fill these gaps. can play an active role in a multidisciplinary discussion on the treatment of a specific patient. can name strength and weaknesses of cancer screening in general and specifically in older patients. Wednesday 17 September Lecture Title Introduction to cancer biology in the elderly Instructor Dr. G.J. Liefers (Surgery) Goals 1. The student can describe the biological differences and similarities between cancer in young and older patients 2. The student can explain the role of a changing micro-environment in cancer development and progression. Lecture Title Instruction theme assignment Instructors Dr. A.J.M. de Craen (Gerontology and Geriatrics) SSA (and TA) Title Introduction to cancer biology in the elderly 20

24 Thursday 18 September SSA (and TA) Title Introduction to cancer biology in the elderly WG Title Introduction in cancer biology in the elderly Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the lecture goals Lecture Title Strength and limitations of clinical trial methodology Instructor Dr. E. Bastiaannet (Surgery) Goals 1. The student can name various trial methodologies including the strengths and weaknesses of each 2. The student understands the limitations of extrapolation of trial data to the general and older trial population. 3. The student can explain different end points in cancer trials aimed at the elderly Friday 19 September SSA (and TA) Title Strength and limitations of clinical trial methodology Walk-in Title Help and feedback for theme assignment Instructor Dr. A.J.M. de Craen (Gerontology and Geriatrics) SSA (and TA) Title Strength and limitations of clinical trial methodology Monday 22 September WG Title Strength and limitations of clinical trial methodology. Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the lecture goals 21

25 Lecture Title Screening and treatment of breast and colon cancer Instructor Drs. N.A. de Glas Goals 1. The student can explain the role of screening in reducing cancer cancer specific deaths (colon and breast). 2. The student can discuss the role of screening in an aging society 3. The student can discuss how screening programs are evaluated and the controversies known in the literature. Clinical During the lecture a breast cancer patient will be presented. SSA (and TA) Title Screening and treatment of breast and colon cancer Tuesday 23 September SSA (and TA) Title Screening and treatment of breast and colon cancer WG Title Screening and treatment of breast and colon cancer Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the lecture goals SSA (and TA) Title Screening and treatment of breast and colon cancer 22

26 Subtheme 2.2 Cardiovascular Background Cardiovascular disease is the leading cause of death in industrialized countries even at old age. The main causal factor for cardiovascular disease is the progression of advanced atherosclerosis with increasing age. However, classical risk factors for cardiovascular disease at middle age, like high blood pressure and cholesterol do not seem to be a risk factor at old age. On the contrary, treating these risk factors seems to be beneficial, even at old age. How can we explain this paradigm? New treatment strategies to treat cardiovascular disease are being developed, for example transplantation of human epicardium-derived cells in myocardial infarction. However, for both the old and new treatment strategies there is little evidence of efficacy and safety in the elderly. Therefore the EuroScore study, is set up to investigate the prevalence and outcome of aortic stenosis in the elderly, but also to investigate whether treatment with for example aortic valve replacement will also be successful in the elderly. Study goals At the end of this week the student can explain why high cholesterol is no longer a risk factor for cardiovascular disease in old age, but that cholesterol lowering therapy is still successful can discuss the problems and solutions of replacing aortic valves in the elderly and cardiovascular therapy in general understands the basic principle of cardiac regeneration with human epicardium-derived cells Wednesday 24 September Lecture Title Cholesterol, treatment and cardiovascular disease Instructor Prof. Dr. J.W. Jukema (Cardiology) Goals 1. The student can describe the difference between causal risk factors and non-causal risk predictors. 2. The student can explain why elderly patients still need cholesterol lowering medication while cholesterol itself is no predictor for cardiovascular disease at old age. 3. The student can explain the use of Mendelian randomisation studies with genetic factors. SSA (and TA) Title Cholesterol, treatment and cardiovascular disease Thursday 25 September SSA (and TA) Title Cholesterol, treatment and cardiovascular disease 23

27 WG Title Cholesterol, treatment and cardiovascular disease Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the lecture goals Lecture Title Aortic valve replacement in the elderly Instructor Prof. Dr. R.J.M. Klautz (Thoraxchirurgie) Goals 1. The student can explain the problems for aortic valve replacement in the elderly 2. The student can describe the studies that are needed to overcome these problems Friday 26 September SSA (and TA) Title Aortic valve replacement in the elderly Walk-in Title Help and feedback for theme assignment Instructor Dr. A.J.M. de Craen (Gerontology and Geriatrics) SSA (and TA) Title Aortic valve replacement in the elderly Monday 29 September WG Title Aortic valve replacement in the elderly Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the lecture goals Lecture Title Cardiac regeneration Instructor Prof. Dr. D. E. Atsma (Cardiology) Goals 1. The students can explain the basic principles of cardiac regeneration 2. The students can describe whether transplantation of adult human epicardium derived cells (EPDCs) into the infarcted heart, that is known to improve cardiac function would also be beneficial for the elderly. SSA (and TA) Title Cardiac regeneration 24

28 Tuesday 30 September SSA (and TA) Title Cardiac regeneration WG Title Cardiac regeneration Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the lecture goals Test Title Summative test of theme Cancer and Cardiovascular Ageing Wednesday 1 October TA Presentations Title Oral presentations of theme assignments 25

29 Theme 3 Debate Background The art of debate is often dismissed as a game of oral trickery between politicians during election seasons. This course will feature a stylized simulation of such political debates, with a crucial difference: debaters will not be expected to act as mere politicians, but as true philosopher-kings and - queens. Discourse within this setting will not be dominated and restricted by popular opinion, conventional logic or tradition. As a result, all positions will need to be supported by practical and moral argumentation that appeals to a reasonable, neutral third party of arbiters. This debating course aims to develop students skills and confidence in (academic) debates. The workshops will cover both logic and argumentation as well as the fundamentals of persuasive public speaking: preparation, speech structure, tone, facial and vocal expressiveness, and anxiety management. Study goals At the end of this week the student Can speak confidently in public Can express structured, logical arguments Can identify and rebut common fallacies Can prepare structured speeches Can analyse a debate and Being able to fulfil different roles within a debate Being able to judge debates on style and content from a neutral point of view Thursday 2 October Workshop Title Basics of Parliamentary Debating Instructor Eva Spoor & Bas Tönissen Goals 1. The student can participate in debates with full knowledge of applicable rules and roles. 2. The student can deliver structured speeches with integrated rebuttal. 3. The student can identify and tackle basic fallacies. Monday 6 October Workshop Title Parliamentary Debating: Strategy and tactics Instructor Goals Eva Spoor & Bas Tönissen 1. The student can prepare cases strategically (finding relevant clashes). 2. The student can pose relevant Points of Information in debates. 3. The student can provide conclusive analysis on Burdens of Proof in debates. 26

30 Wednesday 8 October Test Title Final debates: parliamentary debates on prepared cases (grades of individual and group performance). 27

31 Theme 4 Mobility Subtheme 4.1 Omics Background Aging, defined as the gradual deterioration of physiological function with age, occurs to all of us. Some people have a low aging rate while others exhibit a high aging rate, part of which is linked to immune function and metabolism. Some aspects of ageing even go back to adverse events in early development. People which show little decline in metabolic health seem to have a low aging rate, resulting in lower prevalence of type 2 diabetes, hypertension, myocardial infarction and osteoarthritis. To further investigate the underlying mechanism of the metabolic health and disease, we collect so called omics data (GWAS, next-generation sequencing, lipidomics, metabolomics, transcriptomics) and apply state-of-the-art data-analysis approaches to identify genomic regions and metabolic patterns associated with health parameters. Such data may eventually be valuable to predict on the one hand the risk of disease (biomarker) and on the other hand to provide insight in the cause of disease or exceptional health (aetiology). Study goals At the end of this week the student can explain at which biological levels omics data are generated for ageing research. can explain how omics data can serve as health biomarkers. can explain how omics data can contribute to understand the aetiology of age-related disease. can defend that processes involved in ageing and metabolic health may also be involved in early development. Thursday 9 October Lecture Title Introduction to omics data and their use in molecular epidemiology of age-related disease Instructor Prof. Dr. P.E. Slagboom (Molecular Epidemiology) Goals 1. The student can describe the differences in omics data types that are being used in the molecular epidemiology of ageing. 2. The student can explain why omics data are being explored in clinical and ageing studies from an aetiological perspective. 3. The student can describe why omics data are used for disease risk prediction. 4. The student can describe how omics data are used for disease risk prediction. 5. The student can describe by which study designs omics data are used for disease risk prediction. Lecture Title Instruction theme assignment Instructors Dr. A.J.M. de Craen (Gerontology and Geriatrics) 28

32 SSA (and TA) Title Introduction to omics data and their use in molecular epidemiology of age-related disease Friday 10 October SSA (and TA) Title Introduction to omics data and their use in molecular epidemiology of age-related disease WG Title Introduction to omics data and their use in molecular epidemiology of age-related disease Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the lecture goals Lecture Title Early origin of ageing Instructor Dr. B.T. Heijmans ((Molecular Epidemiology) Goals 1. The student can discuss how the early-life environment can influence the risk of age-related disease in adulthood. 2. The student can explain the biological role of epigenetic regulation and in particular DNA methylation. 3. The student can describe how DNA methylation marks can be measured. Monday 13 October SSA (and TA) Title Early origin of ageing Walk-in Title Help and feedback for theme assignment Instructor Dr. A.J.M. de Craen (Gerontology and Geriatrics) SSA (and TA) Title Early origin of ageing 29

33 Tuesday 14 October WG Title Early origin of ageing Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the lecture goals Lecture Title Omics in mobility Instructor Dr. Ingrid Meulenbelt Goals 1. The student can explain what osteoarthritis is. 2. The student can explain which tissues are involved in osteoarthritis. 3. The student can describe several hypotheses of the aetiology of osteoarthritis. 4. The student can describe several age-related biomarkers osteoarthritis. 5. The student can explain how the integration of omics-data can contribute to understand the aetiology of osteoarthritis (and other age-related disease). SSA (and TA) Title Omics in mobility Wednesday 15 October SSA (and TA) Title Omics in mobility WG Title Omics in mobility Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the goals lecture 3 TA

34 Subtheme 4.2 Orthopaedics Background Life is movement and movement is life, without mobility patients lose their independence and a lot of their joy in life, our goal is to keep the elderly people mobile. Total knee en hip arthroplasties are very successful operation but some patients benefit more than others. Osteoporosis is a well-known phenomenon, but the same decline also takes place in the muscles and is called sarcopenia, which is a decline in muscle (strength) and results in a decline of mobility. Due to the osteoporosis and sarcopenia elderly patients are at higher risk for fractures which also leads to a decline in their mobility. Learning objectives At the end of this week the student can describe the various predictors for good outcome of hip- and knee arthroplasty can describe the pathophysiology of osteoporosis and sarcopenia can describe the effects of osteoporosis and sarcopenia on fracture risk and mobility is aware of the difference in outcome measures in hip- and knee arthroplast, osteoporosis and sarcopenia, and fractures Thursday 16 October Lecture Title Arthroplasties: benefits and risks Instructor Dr. H.J.L. van der Heide (Orthopaedics) Goals 1. The student can describe what the (contra)indications are for total hip- and knee arthroplasty 2. The student can describe what the different outcome measures for arthroplasties are. 3. The student can explain why it is difficult to compare outcomes of different cohorts of patients with an arthroplasty SSA (and TA) Title Arthroplasties: benefits and risks Friday 17 October SSA (and TA) Title Arthroplasties: benefits and risks WG Title Arthroplasties: benefits and risks Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the lecture goals 31

35 Lecture Title Osteoporosis and sarcopenia Instructor Dr. H.J.L. van der Heide (Orthopaedics) Goals 1. The student can describe the basic concepts of both osteoporosis and sarcopenia in relation to the ageing process. 2. The student can describe what the risks are from both osteoporosis and sarcopeniae for elderly patients and if it can be prevented. 3. The student can explain if and how sarcopneia and osteoporosis are related. Monday 20 October SSA (and TA) Title Osteoporosis and sarcopenia Walk-in Title Help and feedback for theme assignment Instructor Dr. A.J.M. de Craen (Gerontology and Geriatrics) SSA (and TA) Title Osteoporosis and sarcopenia Tuesday 21 October WG Title Osteoporosis and sarcopenia Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the lecture goals Lecture Title Management of fractures and fracture risk Instructor Dr. H.J.L. van der Heide (Orthopaedics) Goals 1. The student can describe the basic principles of treating proximal femoral fractures in the elderly. 2. The student can describe both primary and secondary fracture prevention. 3. The student can explain some major biases and confounders in comparative studies on fracture treatment in the elderly. SSA (and TA) Title Management of fractures and fracture risk 32

36 Wednesday 22 October SSA (and TA) Title Management of fractures and fracture risk WG Title Management of fractures and fracture risk Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the goals lecture 3 Test Title Summative test of theme Mobility Thursday 23 October TA Put theme assignment on blackboard 23 October 2014 before 17.00h 33

37 Theme 5 Mental health Background Late life is frequently accompanied by neuropsychiatric disorders that include the cognitive, emotional and behavioral disturbances that are part of degenerative and vascular brain diseases. The presence of cognitive decline (including dementia), mood and anxiety disorders, somatic comorbidity & delirium, and functional decline (frailty) makes older people vulnerable for behavioral problems and further neuropsychiatric symptoms (multimorbidity and complexity). It is important to unravel underlying pathophysiologic pathways in late-life psychopathology, in order to prevent cognitive decline and neuropsychiatric disturbances at old age and to improve care for older people with complex multimorbidity and care needs. At middle age, vascular risk factors like blood pressure, stroke, diabetes, and obesity are implicated in the pathogenesis of cognitive decline and dementia in old age, probably through atherosclerosis and vascular stiffness. The same may be true for common neuropsychiatric disturbances in older people, particularly depression and apathy. Although both cardiac dysfunction and cognitive impairment as well as depression and apathy are prominent features of older people, little is known of the relation between heart and brain (dys)functioning at old age. Recent evidence suggests that autoregulation of the cerebral blood flow is not able to protect the brain from hypoperfusion, when cardiac output is reduced and/or (cerebral) atherosclerosis is prominent. This suggests a close link of cardiac (dys)function with brain (hypo)perfusion and, consequently, cognitive (dys)functioning as well as depression and apathy, at old age. Study goals At the end of these two weeks the student The student can discuss the clinical picture of the various neuropsychiatric symptoms and disorders that frequently occur at old age, and knows how to differentiate them from each other The student can discuss the classification of neurocognitive disorders The student can explain in what way cognitive decline, somatic morbidity and functional decline are associated with neuropsychiatric symptoms and disorders The student can discuss possible prevention strategies and treatment options for the most important neuropsychiatric disorders such as dementia, delirium, depression and apathy The student can explain which vascular risk factors at middle age contribute to cognitive decline, dementia, depression and apathy at older age The student can explain how hemodynamics, autoregulation and cerebral perfusion affect brain aging (brain function and structure) at old age. 34

38 Friday 24 October Lecture Title Cognitive syndromes and dementia in old age (with patient demonstration (life or dvd)) Instructor Dr. M. Muller (Internal Medicine - Geriatrics) Goals 1. The student can describe what the differences and/or similarities are between Alzheimer dementia, vascular dementia, Lewy body dementia, and frontotemporal dementia 2. The student can explain which and how vascular risk factors at middle age contribute to cognitive decline and dementia in older age 3. The student can explain which and how vascular risk factors at old age contribute to cognitive decline and dementia Lecture Title Instruction theme assignment Instructors Dr. A.J.M. de Craen (Gerontology and Geriatrics) SSA (and TA) Title Cognitive syndromes, neuropsychiatry, and delirium at old age Monday 27 October SSA (and TA) Title Cognitive syndromes, neuropsychiatry, and delirium at old age Lecture Title An introduction to neuropsychiatry at old age: cognitive, emotional and behavioural neuropsychiatric disorders (with patient demonstration (life or dvd)) Instructor Prof. dr. R.C. van der Mast (Psychiatry) Goals 1. The student can describe the different neuropsychiatric symptoms. 2. The student can describe the different neuropsychiatric disorders. 3. The student can explain in what way cognitive decline, somatic morbidity and functional decline are associated with neuropsychiatric symptoms and disorders. Tuesday 28 October SSA (and TA) Title Cognitive syndromes, neuropsychiatry, and delirium at old age Walk-in Title Help and feedback for theme assignment Instructor Dr. A.J.M. de Craen (Gerontology and Geriatrics) 35

39 SSA (and TA) Title Cognitive syndromes, neuropsychiatry, and delirium at old age Wednesday 29 October SSA and (TA) Title Cognitive syndromes, neuropsychiatry, and delirium at old age Lecture Title Somatic morbidity and delirium (including a video of a patient with delirium) Instructor dr. E.M. van Fenema (Psychiatry) Goals 1. The student can describe the different clinical pictures (subtypes) of delirium, and how this may affect diagnosing delirium 2. The student can explain which and how predisposing and precipitating factors contribute to the development of delirium 3. The student can discuss preventive strategies for delirium. SSA (and TA) Title Cognitive syndromes, neuropsychiatry, and delirium at old age Thursday 30 October SSA (and TA) Title Cognitive syndromes, neuropsychiatry, and delirium at old age WG Title Cognitive syndromes, neuropsychiatry, and delirium at old age Instructors Dr. E.M. van Fenema (Psychiatry) Prof. dr. R.C. van der Mast (Psychiatry) Dr. M. Muller (Internal Medicine - Geriatrics) Goals: 1. Further learning by discussion of home assignments and self-study 2. Formative assessment of lecture 1, 2, and 3 Friday 31 October Lecture Title Vascular and hemodynamic factors in relation to depression and apathy in old age Instructor Drs. A.S. Bertens (Radiology) Goals 1. The student can explain what the differences are between depression and apathy. 2. The student can discuss which vascular risk factors, vascular disease and hemodynamic factors are potentially treatable causes of depression and apathy in old age 36

40 SSA (and TA) Title Vascular factors and hemodynamics in neuropsychiatric syndromes in old age Monday 3 November SSA (and TA) Title Vascular factors and hemodynamics in neuropsychiatric syndromes in old age Lecture Title Hemodynamics in cognitive decline and dementia in old age Instructor Dr. B. Sabayan (Gerontology and Geriatrics) Goals 1. The student can describe the most important regulators of hemodynamics, autoregulation, and cerebral perfusion 2. The student can explain how hemodynamics, autoregulation, and cerebral perfusion affect brain aging (brain function and structure) in old age. Tuesday 4 November SSA (and TA) Title Vascular factors and hemodynamics in neuropsychiatric syndromes in old age Walk-in Title Help and feedback for theme assignment Instructor Dr. A.J.M. de Craen (Gerontology and Geriatrics) SSA (and TA) Title Vascular factors and hemodynamics in neuropsychiatric syndromes in old age Wednesday 5 November WG Title Vascular factors and hemodynamics in neuropsychiatric syndromes in old age Instructors Drs. A.S. Bertens (Radiology) Dr. B. Sabayan (Gerontology and Geriatrics) Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the goals lecture 4 and 5 37

41 Lecture Title Brain imaging in cognitive and neuropsychiatric syndromes Instructors Dr. B. Sabayan (Gerontology and Geriatrics) Dr M.J.P. van Osch (Radiology) Goals 1. The student can describe different imaging techniques used in the diagnosis of cognitive and neuropsychiatric syndromes 2. The student can name different imaging techniques to measure cerebral autoregulation Includes site visit to Department of Radiology (MRI-3T and 7T) and Neurophysiology (echo Doppler) TA Thursday 6 November TA WG Title Brain imaging in cognitive and neuropsychiatric syndromes Instructors Dr. B. Sabayan (Gerontology and Geriatrics) Dr M.J.P. van Osch (Radiology) Goals 1. Further learning by discussion of home-assignment 2. Formative assessment of the goals lecture 6 Test Title Summative test of theme Mental Health Friday 7 November TA Presentations Title Oral presentations of theme assignments 38