Background and Objectives Agitation, a critical behavioral and psychological symptom in dementia, has a profound impact on a patients’ quality of life as well as their caregivers’. Autonomous and objective characterization of agitation with multimodal systems has the potential to capture key patient responses or agitation triggers. Research Design and Methods In this paper, we describe our multimodal system design that encompasses contextual parameters, physiological parameters, and psychological parameters. This design is the first to include all three of these facets in an n > 1 study. Using a combination of fixed and wearable sensors and a custom-made app for psychological annotation, we aim to identify physiological markers and contextual triggers of agitation. Results A discussion of both the clinical as well as the technical implementation of the to-date data collection protocol is presented, as well as initial insights into pilot study data collection. Discussion and Implications The ongoing data collection moves us toward improved agitation quantification and subsequent prediction, eventually enabling just-in-time intervention.

Introduction Growing evidence suggest a bidirectional relationship between circadian and sleep regulation, and the pathology and progression of dementia. Behavioral and psychological symptoms of dementia (BPSD) are very prevalent, and lead to an enormous disease burden in patients, families and caregivers. Indications for a possible disruption of circadian regulation of emotions and behavior in dementia, can be found in the phenomenon known as ‘sundowning’, exacerbation of neuropsychiatric symptoms during the late afternoon and early evening. Aggression in particular can be a very debilitating symptom of dementia, and previous animal and human studies point to a possible role of the circadian rhythm in the propensity for aggressive behavior. Therefore, we examine here the timing of aggression in a dementia cohort. Methods We studied the timing of aggression incidents on a university psychiatric hospital unit treating patients with dementia and additional behavioral problems. During a 6-month period (November 2020 - April 2021) 84 patients were admitted to the ward. Data of these patients were retrospectively analyzed. During this period 335 individual incidents of aggression (verbal and/or physical) were reported by the nursing staff. Results Among the 84 subjects, 42 (50%) had at least one aggression incident during hospital admission. 41% of all incidents occurred between 4-10pm. (5-9pm (36.4%), 9pm-1am (11.6%), 1-5am (5.7%), 5-9am (22.7%), 9am-1pm (10.7%), 1-5pm (12.8%)). In every investigated month, a peak in number of incidents could be seen between 7 and 8pm. Aggression incidents were most likely to occur in Alzheimer’s dementia (OR: 3.75). Patients who exhibited aggression had worse cognitive impairment (difference in mean MMSE: 4.57 ± 2.1 , p=0.034). Conclusion Aggression incidents were most prevalent during the late afternoon and evening. Furthermore, the severity of cognitive impairment and type of dementia negatively impacted the prevalence of aggression.Our study thus confirms a possible role of the circadian rhythm in aggression. The role of the circadian rhythm in the pathophysiology of neurodegenerative disorders, and specifically in their neuropsychiatric symptoms, warrants further research. Support (If Any) Supported by the Funds Malou Malou, Perano, Georgette Paulus, JMJS Breugelmans and Gabrielle, François and Christian De Mesmaeker, Managed by the King Baudouin Foundation of Belgium, No. 2021-J1990130-222081.

Introduction Nocturnal hallucinations can be part of a wide array of different disorders, like sleep disorders (e.g. narcolepsy), visual impairment (e.g. Charles-Bonnet syndrome), neurodegenerative disorders (e.g. Lewy Body Dementia) and psychiatric disorders (e.g. schizophrenia). We explore the differential diagnosis, the challenging diagnostic workup and the limited therapeutic options in this patient with complex visual nocturnal hallucinations. Report of Cases: A 64 year old woman was referred with detailed and vivid visual nocturnal hallucinations (seeing her dog smoking a cigar, seeing someone in the room moving her bed, etc.). The hallucinations started 1-2 months ago, were mainly present at night (both when falling asleep and during the night) but occasionally also during the day. She had also been suffering from worsening daytime sleepiness for 3-4 months, and from memory problems for 1 year. Cataplexy and sleep paralysis were absent. Clinical neurological examination was normal. The patient had been diagnosed in the past with OSAS. She had been treated with CPAP for 3 years and recent polysomnography showed good control of her apnea. She had also been diagnosed with Crohn’s disease, COPD and cardiomyopathy. Because of her age, the vivid hallucinations, and the memory problems, we first wanted to rule out Lewy Body Dementia. Neuropsychological testing ruled out dementia. MRI of the brain showed some white matter lesions, without substantial atrophy. At a subsequent multidisciplinary consultation, her cardiologist considered her cardiomyopathy as a contraindication for stimulants. Therefore, and because we believed the a priori probability for narcolepsy to be low, an additional MSLT was not considered useful. Based on further pulmonary tests, we hypothesized that hypoxia could play a role in the hallucinations and hypersomnolence. The hallucinations improved over time, the hypersomnolence remained, but we found there were no good treatment options available, considering the cardiac contraindications for stimulants. Conclusion There is a wide-ranging differential diagnosis for nocturnal visual hallucinations. The specific patient characteristics are important both for further diagnosis and treatment options. Support (If Any) Supported by the Funds Malou Malou, Perano, Georgette Paulus, JMJS Breugelmans and Gabrielle, François and Christian De Mesmaeker, Managed by the King Baudouin Foundation of Belgium, No. 2021-J1990130-222081.