- Email: [email protected]
Care management for VA patients with vascular risk factors and cognitive impairment: A randomized trial
P526
Oral Sessions: O3-05: Public Health and Psychosocial Focus: Interventions and Models of Care for People with MCI and Dementia
Ratio of 10 (1.7- 66.9) for agitation if patient had VaD. Logistic regression for sleep disturbances revealed both age and diagnosis as predictors. The frequency of the other NPS was not significantly different in AD and VaD patients. Conclusions: Neuropsychiatric symptoms were frequently present in AD and VaD. Agitation and sleep disturbances were more frequently encountered in VaD than AD. These differences are likely related to underlying pathology and warrant further study as they have implications for treatment. 1 Cummings, JL, Neurology,1997. 48(5 Sup6):pS10-6. 2McKhann, GM, et al., Alzheimers Dement,2011. 7(3):p263-9. 3Gorelick, PB, et al., Stroke,2011. 42(9):p2672-713. O3-04-06
FASTER FORGETTING: DISTINGUISHING ALZHEIMER’S DISEASE AND FRONTOTEMPORAL DEMENTIA WITH DELAYED RECALL MEASURES
Katija Khan1, Sarah Wakefield1, Daniel Blackburn2, Annalena Venneri1, University of Sheffield, Sheffield, United Kingdom; 2Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom. Contact e-mail: [email protected] 1
Background: Many neuropsychological features of Frontotemporal dementia (FTD) overlap with AD (Alzheimer’s disease) making differential diagnosis a challenge. While some FTD patients show impairment in executive functioning, others may also display relatively normal profiles. Deficits in visual and verbal memory have been noted in both dementias but are less severe in FTD. Qualitative examination reveal greater semantic memory impairment in AD than FTD, however, other quantitative analyses of memory measures may also prove useful in differentiating the two. Methods: Fifteen patients with AD, 15 patients with FTD and 15 controls were administered the Mini Mental State Examination, a visuospatial memory measure: Rey Osterreith Complex Figure and a verbal memory measure: Prose Memory. Copy, immediate, delay (10 minutes) and percentage recall scores were compared using ANOVA and post hoc analyses. Organisational strategy on the Rey Figure was assessed using the Hamby et al (1993) scoring system. Results: Age and years of education were similar across all three groups. MMSE scores were higher in the control group but similar across the FTD and AD groups. The AD group performed significantly worse on all measures. Immediate prose memory recall, Rey copy and organizational strategy scores distinguished AD from controls but not FTD. Delay measures on both the Rey figure and Prose memory distinguished both AD and FTD from controls as well as AD from FTD. Percentage recall scores on both measures differentiated AD from control as well as AD from FTD. Conclusions: Immediate recall, copy and organizational strategy scores were unable to distinguish AD from FTD. Delayed recall showed a progressive decay in scores across controls, FTD and AD respectively. This is consistent with reported findings which show retention problems in both dementias. Percentage recall scores for both visuospatial and verbal memory measures were significantly lower in AD but not FTD patients. These scores are based on the patient’s initial reproduction and not the original reproduction; therefore initial poor encoding is not penalized. AD patients exhibited faster forgetting while the performance of FTD patients was similar to controls. Thus in patients showing overlap of symptoms, faster forgetting in AD patients can be used to aid differential diagnosis.
ORAL SESSIONS: O3-05: PUBLIC HEALTH AND PSYCHOSOCIAL FOCUS: INTERVENTIONS AND MODELS OF CARE FOR PEOPLE WITH MCI AND DEMENTIA O3-05-01
PHYSICAL ACTIVITY, INDEPENDENT FUNCTIONING AND EMOTIONAL WELL-BEING IN EARLY-ONSET DEMENTIA
Astrid Hooghiemstra1, Laura Eggermont2, Wiesje Van der Flier3, Philip Scheltens3, Erik Scherder2, 1VU University and VU University
Medical Center, Alzheimer Center, Amsterdam, Netherlands; 2VU University, Amsterdam, Netherlands; 3VU University Medical Center, Amsterdam, Netherlands. Contact e-mail: [email protected] Background: It is known that physical activity benefits emotional wellbeing. A positive relationship between physical activity levels and executive functioning, crucial for independent functioning, has been demonstrated in older persons with and without cognitive impairment. In view of the better physical shape of middle-aged adults compared to older persons, it is surprising that no studies regarding physical activity focus on patients suffering from early-onset dementia (EOD). The aims of the present study were twofold: 1) to assess the difference in the amount of daily physical activity between EOD patients and cognitively healthy middle-aged adults, and 2) to study whether higher levels of physical activity are related to better independent functioning and emotional well-being in EOD patients. Methods: EOD patients (n¼62) and cognitively healthy adults of middle age (n¼130) participated. EOD patients were recruited in order to participate in a physical activity program. Outcome measures were physical activity (pedometer and questionnaire: Physical Activity Scale for the Elderly (PASE)), executive functioning, (instrumental) activities of daily living, mood, and quality of life. Results: No differences existed between EOD patients and healthy adults in age and level of education (for mean and standard deviations see Table 1). The EOD group included relatively more males than the control group. 77% of EOD patients had probable Alzheimer’s disease. Preliminary results show that EOD patients reported less engagement in physical activities on the PASE compared to healthy adults (m¼144.8665.3 and m¼187.0676.0, p<.001). However, EOD patients and healthy adults take the same amount of steps every day (687163715 vs. 704862797), reflecting a less active lifestyle than recommended by the World Health Organization. In EOD patients, we observed a modest correlation (r¼.33; p¼.02) between the number of steps taken each day and the initiative to undertake (instrumental) activities of daily living, after controlling for age and sex. No other correlations reached significance. Conclusions: This is the first study to examine physical activity in EOD patients. Preliminary results indicate that physical activity is related to the extent of (dis)ability. Table 1 Demographics for EOD patients and healthy adults
Age (M 6 SD) Sex (_/\) Level of education# MMSE (M 6 SD) Diagnosis, n (%)
AD VaD DLB FTD
EOD (n ¼ 62)
Healthy adults (n ¼ 130)
p-value
61.8 6 4.9 41/21 5.3 6 1.2 24.3 6 3.5 47 (77%) 5 (8%) 7 (12%) 2 (3%)
61.2 6 4.4 62/68 5.4 6 1.0 29.1 6 1.4
.40 .02 .80 <.001
Independent samples t-tests were conducted for age and MMSE, MannWhitney U test for level of education and c2 -test for sex. EOD ¼ early-onset dementia; M ¼ mean; SD ¼ standard deviation; MMSE ¼ Mini-Mental State Examination; AD ¼ Alzheimer’s disease; VaD ¼ vascular dementia; DLB ¼ dementia with lewy bodies; FTD ¼ frontotemporal dementia # Categorization of education (low versus high education) is based on Verhage’s education classification (Verhage, 1964)
O3-05-02
CARE MANAGEMENT FOR VA PATIENTS WITH VASCULAR RISK FACTORS AND COGNITIVE IMPAIRMENT: A RANDOMIZED TRIAL
Laura M. Bonner1, Gayle Robinson1, Suzanne Craft2, 1VA Puget Sound Health Care System, Seattle, Washington, United States; 2Wake Forest
Oral Sessions: O3-05: Public Health and Psychosocial Focus: Interventions and Models of Care for People with MCI and Dementia
University, Winston-Salem, North Carolina, United States. Contact e-mail: [email protected] Background: Diabetes and hypertension are risk factors for Alzheimer’s disease and vascular dementia. Improved control of these prevalent conditions could prevent or delay dementia onset, but treatment adherence is difficult for patients, especially for those who are already experiencing cognitive deficits. Our goal was to improve diabetes and hypertension control among VA patients with mild cognitive deficits or mild dementia, via implementation of a 6-month, nurse-led care management intervention. Methods: We used VA databases to recruit VA patients with both diabetes and hypertension, who had poor control of one or both conditions (A1c>7 or systolic blood pressure >140). Participants were then screened for cognitive deficits using the Mini-Cog, Montreal Cognitive Assessment (MoCA), or a telephone screen. Those with cognitive deficits were offered enrollment into the study. Referrals were also accepted from VA primary care providers and neuropsychologists. Participants were randomly assigned to usual care or to the care management intervention. Cognitive performance and control of diabetes and hypertension were evaluated at baseline and at 6-months post-enrollment. Results: 34 VA patients enrolled in the study. 28 completed the 6-month cognitive assessment. Of these, 27 (96%) were male, 19 (70%) were White, 7 (26%) were African-American, 1 was Native American. Mean baseline MMSE was 26.7 + 2.25; mean Geriatric Depression Scale at baseline was 15 + 7.8. At 6-month follow-up, GDS scores were lower in the intervention group (p¼.034). Change scores (baseline6months) were computed for cognitive and medical variables. Change scores for delayed recall of short stories showed marginal improvement for intervention but not control participants (p¼.057); diastolic blood pressures decreased among intervention participants more than control participants (p¼.043). Conclusions: VA patients with multiple chronic conditions and cognitive deficits showed improvement in mood, cognitive performance and blood pressure control after a 6-month care management intervention. Care management may be an important approach to improving outcomes for these high-risk patients.
O3-05-03
EARLY PSYCHOSOCIAL INTERVENTION DID NOT DELAY INSTITUTIONALIZATION IN PATIENTS WITH ALZHEIMER’S DISEASE: ALSOVA STUDY REPORTS
Anne Koivisto, Tarja V€alim€aki, Janne Martikainen, University of Eastern Finland, Kuopio, Finland. Contact e-mail: [email protected] Background: Our aim was t o assess the efficacy of an early psychosocial intervention for outpatients with mild Alzheimer’s disease (AD) and their caregivers to delay nursing home placement. Methods: Totally 240 patient-caregiver dyads living in three municipalities in Finland were recruited to a prospective, randomized, and controlled rehabilitation ALSOVA study. Inclusion criteria for the patients were 65 years of age, very mild (clinical dementia rating, CDR 0.5) or mild (CDR 1) AD, informed consent and a family caregiver. Eligible patient-caregiver pairs were randomized to one of two groups. The intervention group received usual care and additional intensive psychosocial courses during the first 2 years after diagnosis. The other group received only the usual care. A primary outcome was the effect of the intervention on risk of institutionalization during the three years of follow up. In addition, following secondary outcome measures were sociodemographic factors, cognitive function, behavioral symptoms, activities in daily living, specific health conditions, medication, health and social care resource utilization, generic quality of life, and Alzheimer’s disease specific quality of life were collected at each interview. Difference in risk of institutionalization between the randomized groups was evaluated by a hazard ratio from a Cox regression model. The research ethics committee of the University of Kuopio and Kuopio University Hospital gave approval to carry out the study. Results: After 36 months of follow-up totally 18% of patients with AD were dead and around 33% of them were institutionalized. Cox proportional hazard model’s log-rank test indicated statistically non-significant (p¼0.39) difference between groups in risk of institutionalization.
P527
Conclusions: Intensive psychosocial intervention for patients with mild Alzheimer’s disease and their caregivers did not manage to delay time to institutionalization. Even if, the ALSOVA study did not manage to show statistically significant difference between the study groups, it provides the valuable dataset for studying of long-term disease progression and its consequences for patients with Alzheimer’s disease and their caregivers.
O3-05-04
DOES AN INTERDISCIPLINARY NETWORK IMPROVE DEMENTIA CARE? RESULTS FROM THE IDEMUCK-STUDY
Jochen Rene Thyrian1, Leonore K€ohler1, Claudia Meinke2, Wolfgang Hoffmann1, 1German Center for Neurodegenerative Diseases, Greifswald, Germany; 2Institute for Community Medicine, Greifswald, Germany. Contact e-mail: [email protected] Background: The most persons with dementia (PWD) live at home and are treated in primary care. However, the ambulatory health care system in Germany contains a lot of "interface problems" and is not laid out for the future challenges. Innovative concepts like regional networks in dementia care exist but need to be tested for efficacy to encourage implementation. The goal of the study is the scientific evaluation of an already existing dementia network. Methods: Prospective cluster-randomized trial of 235 elderly with dementia and their caregivers to receive network treatment (n¼117) and usual care (n¼118) in a predominantly rural region. Eligible patients above the age of 55 were identified by screening (DemTect 8 points). The allocation to intervention or control group based on the network status of the screening GP and was validated by the study centers. Intervention patients received care according to defined treatment paths and guidelines attended to early diagnosis and course of disease. To estimate the efficacy of intervention standardized assessments were conducted at baseline and six to twelve month later. Main outcome measures were the utilization of medical treatment, dementia-specific medication, quality of life of the patients and the caregiver burden and health-related quality of life. Results: Network patients were more likely to receive antidementive drugs (50.5 % vs. 35.8 %; p¼.035). Intervention patients had more contact to neurologist or psychiatric (18.6 % vs. 2.8 %; p<.001). The utilization of other support services remained low. No group differences were found on patients’ quality of life, nor treatment effects neither treatment by time effects. Intervention caregivers reported no significant improvements in health related quality of life measured by sf-36 and EQ-5D. Conclusions: The management of dementia patients in an interdisciplinary network provides measurable advantages with respect to the provision of dementia-specific medication and the utilization of medical treatment i.e., referral rates to specialists.
O3-05-05
PROACTIVE DEMENTIA CARE: YEAR 2 EXPERIENCE
Edward Zamrini1, Troy Andersen1, Cassidy Simpson1, Angela Wang2, Tom Greene3, Jian Ying3, Stephen Bergquist1, Pramod Mandal2, Richard King2, Norman Foster2, 1University of Utah Center for Alzheimer’s Care, Imaging and Research, Salt Lake City, Utah, United States; 2 University of Utah, Salt Lake City, Utah, United States; 3Department of Family and Preventive Medicine and Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, United States. Contact e-mail: [email protected] Background: Early diagnosis enables caregivers to plan for inevitable known consequences of Alzheimer’s disease and to mitigate these through improved education and planning. We have developed proactive dementia care (PDC) - a program integrating health education and social work interventions into the management plan at time of diagnosis. The goal of PDC is to empower patients and family members with a unified plan tailored for their needs to maximize quality of life. Methods: We are conducting an ethics committee-approved randomized clinical trial, comparing the effectiveness of PDC and standard dementia specialist care (SDSC) in achieving important caregiver, patient, and health system outcomes: Attend support
Oral Sessions: O3-05: Public Health and Psychosocial Focus: Interventions and Models of Care for People with MCI and Dementia
Ratio of 10 (1.7- 66.9) for agitation if patient had VaD. Logistic regression for sleep disturbances revealed both age and diagnosis as predictors. The frequency of the other NPS was not significantly different in AD and VaD patients. Conclusions: Neuropsychiatric symptoms were frequently present in AD and VaD. Agitation and sleep disturbances were more frequently encountered in VaD than AD. These differences are likely related to underlying pathology and warrant further study as they have implications for treatment. 1 Cummings, JL, Neurology,1997. 48(5 Sup6):pS10-6. 2McKhann, GM, et al., Alzheimers Dement,2011. 7(3):p263-9. 3Gorelick, PB, et al., Stroke,2011. 42(9):p2672-713. O3-04-06
FASTER FORGETTING: DISTINGUISHING ALZHEIMER’S DISEASE AND FRONTOTEMPORAL DEMENTIA WITH DELAYED RECALL MEASURES
Katija Khan1, Sarah Wakefield1, Daniel Blackburn2, Annalena Venneri1, University of Sheffield, Sheffield, United Kingdom; 2Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom. Contact e-mail: [email protected] 1
Background: Many neuropsychological features of Frontotemporal dementia (FTD) overlap with AD (Alzheimer’s disease) making differential diagnosis a challenge. While some FTD patients show impairment in executive functioning, others may also display relatively normal profiles. Deficits in visual and verbal memory have been noted in both dementias but are less severe in FTD. Qualitative examination reveal greater semantic memory impairment in AD than FTD, however, other quantitative analyses of memory measures may also prove useful in differentiating the two. Methods: Fifteen patients with AD, 15 patients with FTD and 15 controls were administered the Mini Mental State Examination, a visuospatial memory measure: Rey Osterreith Complex Figure and a verbal memory measure: Prose Memory. Copy, immediate, delay (10 minutes) and percentage recall scores were compared using ANOVA and post hoc analyses. Organisational strategy on the Rey Figure was assessed using the Hamby et al (1993) scoring system. Results: Age and years of education were similar across all three groups. MMSE scores were higher in the control group but similar across the FTD and AD groups. The AD group performed significantly worse on all measures. Immediate prose memory recall, Rey copy and organizational strategy scores distinguished AD from controls but not FTD. Delay measures on both the Rey figure and Prose memory distinguished both AD and FTD from controls as well as AD from FTD. Percentage recall scores on both measures differentiated AD from control as well as AD from FTD. Conclusions: Immediate recall, copy and organizational strategy scores were unable to distinguish AD from FTD. Delayed recall showed a progressive decay in scores across controls, FTD and AD respectively. This is consistent with reported findings which show retention problems in both dementias. Percentage recall scores for both visuospatial and verbal memory measures were significantly lower in AD but not FTD patients. These scores are based on the patient’s initial reproduction and not the original reproduction; therefore initial poor encoding is not penalized. AD patients exhibited faster forgetting while the performance of FTD patients was similar to controls. Thus in patients showing overlap of symptoms, faster forgetting in AD patients can be used to aid differential diagnosis.
ORAL SESSIONS: O3-05: PUBLIC HEALTH AND PSYCHOSOCIAL FOCUS: INTERVENTIONS AND MODELS OF CARE FOR PEOPLE WITH MCI AND DEMENTIA O3-05-01
PHYSICAL ACTIVITY, INDEPENDENT FUNCTIONING AND EMOTIONAL WELL-BEING IN EARLY-ONSET DEMENTIA
Astrid Hooghiemstra1, Laura Eggermont2, Wiesje Van der Flier3, Philip Scheltens3, Erik Scherder2, 1VU University and VU University
Medical Center, Alzheimer Center, Amsterdam, Netherlands; 2VU University, Amsterdam, Netherlands; 3VU University Medical Center, Amsterdam, Netherlands. Contact e-mail: [email protected] Background: It is known that physical activity benefits emotional wellbeing. A positive relationship between physical activity levels and executive functioning, crucial for independent functioning, has been demonstrated in older persons with and without cognitive impairment. In view of the better physical shape of middle-aged adults compared to older persons, it is surprising that no studies regarding physical activity focus on patients suffering from early-onset dementia (EOD). The aims of the present study were twofold: 1) to assess the difference in the amount of daily physical activity between EOD patients and cognitively healthy middle-aged adults, and 2) to study whether higher levels of physical activity are related to better independent functioning and emotional well-being in EOD patients. Methods: EOD patients (n¼62) and cognitively healthy adults of middle age (n¼130) participated. EOD patients were recruited in order to participate in a physical activity program. Outcome measures were physical activity (pedometer and questionnaire: Physical Activity Scale for the Elderly (PASE)), executive functioning, (instrumental) activities of daily living, mood, and quality of life. Results: No differences existed between EOD patients and healthy adults in age and level of education (for mean and standard deviations see Table 1). The EOD group included relatively more males than the control group. 77% of EOD patients had probable Alzheimer’s disease. Preliminary results show that EOD patients reported less engagement in physical activities on the PASE compared to healthy adults (m¼144.8665.3 and m¼187.0676.0, p<.001). However, EOD patients and healthy adults take the same amount of steps every day (687163715 vs. 704862797), reflecting a less active lifestyle than recommended by the World Health Organization. In EOD patients, we observed a modest correlation (r¼.33; p¼.02) between the number of steps taken each day and the initiative to undertake (instrumental) activities of daily living, after controlling for age and sex. No other correlations reached significance. Conclusions: This is the first study to examine physical activity in EOD patients. Preliminary results indicate that physical activity is related to the extent of (dis)ability. Table 1 Demographics for EOD patients and healthy adults
Age (M 6 SD) Sex (_/\) Level of education# MMSE (M 6 SD) Diagnosis, n (%)
AD VaD DLB FTD
EOD (n ¼ 62)
Healthy adults (n ¼ 130)
p-value
61.8 6 4.9 41/21 5.3 6 1.2 24.3 6 3.5 47 (77%) 5 (8%) 7 (12%) 2 (3%)
61.2 6 4.4 62/68 5.4 6 1.0 29.1 6 1.4
.40 .02 .80 <.001
Independent samples t-tests were conducted for age and MMSE, MannWhitney U test for level of education and c2 -test for sex. EOD ¼ early-onset dementia; M ¼ mean; SD ¼ standard deviation; MMSE ¼ Mini-Mental State Examination; AD ¼ Alzheimer’s disease; VaD ¼ vascular dementia; DLB ¼ dementia with lewy bodies; FTD ¼ frontotemporal dementia # Categorization of education (low versus high education) is based on Verhage’s education classification (Verhage, 1964)
O3-05-02
CARE MANAGEMENT FOR VA PATIENTS WITH VASCULAR RISK FACTORS AND COGNITIVE IMPAIRMENT: A RANDOMIZED TRIAL
Laura M. Bonner1, Gayle Robinson1, Suzanne Craft2, 1VA Puget Sound Health Care System, Seattle, Washington, United States; 2Wake Forest
Oral Sessions: O3-05: Public Health and Psychosocial Focus: Interventions and Models of Care for People with MCI and Dementia
University, Winston-Salem, North Carolina, United States. Contact e-mail: [email protected] Background: Diabetes and hypertension are risk factors for Alzheimer’s disease and vascular dementia. Improved control of these prevalent conditions could prevent or delay dementia onset, but treatment adherence is difficult for patients, especially for those who are already experiencing cognitive deficits. Our goal was to improve diabetes and hypertension control among VA patients with mild cognitive deficits or mild dementia, via implementation of a 6-month, nurse-led care management intervention. Methods: We used VA databases to recruit VA patients with both diabetes and hypertension, who had poor control of one or both conditions (A1c>7 or systolic blood pressure >140). Participants were then screened for cognitive deficits using the Mini-Cog, Montreal Cognitive Assessment (MoCA), or a telephone screen. Those with cognitive deficits were offered enrollment into the study. Referrals were also accepted from VA primary care providers and neuropsychologists. Participants were randomly assigned to usual care or to the care management intervention. Cognitive performance and control of diabetes and hypertension were evaluated at baseline and at 6-months post-enrollment. Results: 34 VA patients enrolled in the study. 28 completed the 6-month cognitive assessment. Of these, 27 (96%) were male, 19 (70%) were White, 7 (26%) were African-American, 1 was Native American. Mean baseline MMSE was 26.7 + 2.25; mean Geriatric Depression Scale at baseline was 15 + 7.8. At 6-month follow-up, GDS scores were lower in the intervention group (p¼.034). Change scores (baseline6months) were computed for cognitive and medical variables. Change scores for delayed recall of short stories showed marginal improvement for intervention but not control participants (p¼.057); diastolic blood pressures decreased among intervention participants more than control participants (p¼.043). Conclusions: VA patients with multiple chronic conditions and cognitive deficits showed improvement in mood, cognitive performance and blood pressure control after a 6-month care management intervention. Care management may be an important approach to improving outcomes for these high-risk patients.
O3-05-03
EARLY PSYCHOSOCIAL INTERVENTION DID NOT DELAY INSTITUTIONALIZATION IN PATIENTS WITH ALZHEIMER’S DISEASE: ALSOVA STUDY REPORTS
Anne Koivisto, Tarja V€alim€aki, Janne Martikainen, University of Eastern Finland, Kuopio, Finland. Contact e-mail: [email protected] Background: Our aim was t o assess the efficacy of an early psychosocial intervention for outpatients with mild Alzheimer’s disease (AD) and their caregivers to delay nursing home placement. Methods: Totally 240 patient-caregiver dyads living in three municipalities in Finland were recruited to a prospective, randomized, and controlled rehabilitation ALSOVA study. Inclusion criteria for the patients were 65 years of age, very mild (clinical dementia rating, CDR 0.5) or mild (CDR 1) AD, informed consent and a family caregiver. Eligible patient-caregiver pairs were randomized to one of two groups. The intervention group received usual care and additional intensive psychosocial courses during the first 2 years after diagnosis. The other group received only the usual care. A primary outcome was the effect of the intervention on risk of institutionalization during the three years of follow up. In addition, following secondary outcome measures were sociodemographic factors, cognitive function, behavioral symptoms, activities in daily living, specific health conditions, medication, health and social care resource utilization, generic quality of life, and Alzheimer’s disease specific quality of life were collected at each interview. Difference in risk of institutionalization between the randomized groups was evaluated by a hazard ratio from a Cox regression model. The research ethics committee of the University of Kuopio and Kuopio University Hospital gave approval to carry out the study. Results: After 36 months of follow-up totally 18% of patients with AD were dead and around 33% of them were institutionalized. Cox proportional hazard model’s log-rank test indicated statistically non-significant (p¼0.39) difference between groups in risk of institutionalization.
P527
Conclusions: Intensive psychosocial intervention for patients with mild Alzheimer’s disease and their caregivers did not manage to delay time to institutionalization. Even if, the ALSOVA study did not manage to show statistically significant difference between the study groups, it provides the valuable dataset for studying of long-term disease progression and its consequences for patients with Alzheimer’s disease and their caregivers.
O3-05-04
DOES AN INTERDISCIPLINARY NETWORK IMPROVE DEMENTIA CARE? RESULTS FROM THE IDEMUCK-STUDY
Jochen Rene Thyrian1, Leonore K€ohler1, Claudia Meinke2, Wolfgang Hoffmann1, 1German Center for Neurodegenerative Diseases, Greifswald, Germany; 2Institute for Community Medicine, Greifswald, Germany. Contact e-mail: [email protected] Background: The most persons with dementia (PWD) live at home and are treated in primary care. However, the ambulatory health care system in Germany contains a lot of "interface problems" and is not laid out for the future challenges. Innovative concepts like regional networks in dementia care exist but need to be tested for efficacy to encourage implementation. The goal of the study is the scientific evaluation of an already existing dementia network. Methods: Prospective cluster-randomized trial of 235 elderly with dementia and their caregivers to receive network treatment (n¼117) and usual care (n¼118) in a predominantly rural region. Eligible patients above the age of 55 were identified by screening (DemTect 8 points). The allocation to intervention or control group based on the network status of the screening GP and was validated by the study centers. Intervention patients received care according to defined treatment paths and guidelines attended to early diagnosis and course of disease. To estimate the efficacy of intervention standardized assessments were conducted at baseline and six to twelve month later. Main outcome measures were the utilization of medical treatment, dementia-specific medication, quality of life of the patients and the caregiver burden and health-related quality of life. Results: Network patients were more likely to receive antidementive drugs (50.5 % vs. 35.8 %; p¼.035). Intervention patients had more contact to neurologist or psychiatric (18.6 % vs. 2.8 %; p<.001). The utilization of other support services remained low. No group differences were found on patients’ quality of life, nor treatment effects neither treatment by time effects. Intervention caregivers reported no significant improvements in health related quality of life measured by sf-36 and EQ-5D. Conclusions: The management of dementia patients in an interdisciplinary network provides measurable advantages with respect to the provision of dementia-specific medication and the utilization of medical treatment i.e., referral rates to specialists.
O3-05-05
PROACTIVE DEMENTIA CARE: YEAR 2 EXPERIENCE
Edward Zamrini1, Troy Andersen1, Cassidy Simpson1, Angela Wang2, Tom Greene3, Jian Ying3, Stephen Bergquist1, Pramod Mandal2, Richard King2, Norman Foster2, 1University of Utah Center for Alzheimer’s Care, Imaging and Research, Salt Lake City, Utah, United States; 2 University of Utah, Salt Lake City, Utah, United States; 3Department of Family and Preventive Medicine and Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, United States. Contact e-mail: [email protected] Background: Early diagnosis enables caregivers to plan for inevitable known consequences of Alzheimer’s disease and to mitigate these through improved education and planning. We have developed proactive dementia care (PDC) - a program integrating health education and social work interventions into the management plan at time of diagnosis. The goal of PDC is to empower patients and family members with a unified plan tailored for their needs to maximize quality of life. Methods: We are conducting an ethics committee-approved randomized clinical trial, comparing the effectiveness of PDC and standard dementia specialist care (SDSC) in achieving important caregiver, patient, and health system outcomes: Attend support