- Email: [email protected]
Estimating dependence scale scores based on clinical dementia rating - sum of boxes scores in patients with mild cognitive impairment or mild to moderate Alzheimer's disease
P238
Poster Presentations P1
‘‘mobility’’, ‘‘pain/discomfort’’, and ‘‘anxiety/depression’’. Conclusions: We found a significant association between the severity of cognitive function impairment and problems in ‘‘self-care’’ and ‘‘usual activities’’ of EQ-5D dimensions and VAS. Cognitive function impairment did not affect other aspects of quality of life among the Chinese elderly. P1-208
HOW DOES THE CANADIAN GENERAL PUBLIC VIEW MODERATE ALZHEIMER’S DISEASE? DETERMINATION OF HEALTH UTILITY SCORES
testing. Conclusions: Evidence was obtained for the overall effectiveness of this memory education and intervention program. What remains to be explored is the long-term effectiveness of the gains obtained by the end of the program. In the light of the positive results obtained, the Athens Association of Alzheimer’s Disease and Related Disorders will continue the application of the program in larger scale. P1-210
DESIGN OF CARE FACILITIES FOR PEOPLE WITH ALZHEIMER’S DISEASE
Jean-Eric Tarride, Mark Oremus, Natasha Clayton, Parminder Raina, McMaster University, Hamilton, ON, Canada. Contact e-mail: clayton@ mcmaster.ca
William J. van der Eerden, Gemma Jones, De Drie Hoven, Amsterdam, Netherlands. Contact e-mail: [email protected]; wvandereerden@ osiragroep.nl
Background: Economic evaluations are playing an important role in decision making. Guidelines for the conduct of economic evaluations recommend eliciting preferences or health utility scores from members of the general public. The objectives of this study were to (1) To elicit health utility scores for moderate Alzheimer’s disease (AD) using the Canadian general public; (2) to compare utility scores for Canadians’ self-assessed health status with utility scores for health status defined as moderate AD; (3) to measure awareness of AD; and (4) to determine factors that influence utility scores. Methods: Five-hundred Canadians were chosen randomly to participate in a 13-minute telephone interview. The sample was national in scope and stratified by income. The EQ-5D was administered to measure utility for respondents’ current health status (i.e., no AD). After describing moderate AD, respondents were asked to answer the EQ-5D again, this time imagining they had moderate AD. AD awareness was measured with the Alzheimer’s Disease Knowledge Test (ADKT). Respondents were also asked about socio-demographics and whether they knew someone with AD. OLS regressions were conducted to identify determinants of EQ-5D utility scores. Results: The mean age of respondents was 51 years, 61% were female, and 42% knew someone with AD (e.g., family member). Mean ADKT score was 3.4 (SD: 1.1) out of 5 (higher scores indicate better knowledge of AD). Respondents’ mean EQ-5D score for their current health status was 0.857 (SD: 0.15). Mean EQ-5D score for a hypothetical, moderate AD health status was 0.638 (SD: .20), a utility decrement of 0.22. For the VAS component of the EQ-5D, scores were higher for the current health status (79.16 versus 57.66). Age and income were significant explanatory variables for current health status utilities, but only age was significant in the determination of the utility score under the assumption of moderate AD. Gender, knowledge of someone with AD, or AD awareness scores had no impact. Conclusions: When measured by the EQ-5D, Canadians would expect to assign a lower utility to their health status when they have moderate AD.
Background: This poster will provide an overview of insights coming from: 1) the experience of architects, planners and designers of residential and nursing homes, 2) those involved with identifying the knowledge base for, and developing the professionalization of dementia care, and 3) progress in the neuroscience understanding of visual (visuoperceptual) difficulties of people with Alzheimer’s disease (AD), 4) understanding of how visuoperceptual difficulties (mistakes) translate into certain types of ‘visual phenomena’ in AD; 5) understanding how visual perceptual difficulties combine with other cognitive difficulties. Methods: Information about a Dutch, large and smallscale care settings is presented, including recently opened small-scale living groups within large, multi-storey buildings, complete with phased levels of domotic monitoring technology, for different levels of dementia and safety risk assessment.The literature on dementia care home design contains a range of advice: from choosing locations, example blueprints of buildings, care and management models to activity considerations and de´cor and is extensively reviewed. Results: Considering the difficulties that normal elderly can have (and visual pathologies will not even be mentioned in this review), it is likely that most elderly people in care settings could benefit from design that takes visuoperceptual difficulties into account; not just those with AD, especially from visual cues that are highly visible, familiar, and salient. Given that people with AD are increasingly cared for in the community as long as possible, admission into specialist dementia care settings often occurs in Behavioural Stages 2 or 3 when significant, permanent visual and time perception difficulties exist. Conclusions: Design of dementia care facilities has gone through a considerable evolution, ranging from large care institutions to residential hotel-type settings and services and small-scale homelike living groups. Specific knowledge about ‘visuoperceptual difficulties’ in AD provides new opportunities for designers of care environments to anticipate these, and to enhance features of the physical environments so as to increase the likelihood that particular features will be accurately or symbolically perceived.
P1-209
MEMORY GROUPS: IMPROVING MEMORY KNOWLEDGE, SATISFACTION AND FUNCTIONING OF HEALTHY ELDERLY
Olga Lymperopoulou1,2, Eleni Margioti1, Paraskevi Sakka1,2, 1Athens Association of Alzheimer’s Disease and Related Disorders, Athens, Greece; 2Hygeia Hospital, Athens, Greece. Contact e-mail: olympero@ath. forthnet.gr Background: The vast majority of older adults report memory decline, are concerned about dementia and are interested in learning techniques for enhancing memory functioning in their everyday lives. A memory education and intervention program was developed and administered to communitydwelling older adults aged 60þ attending Municipal Recreation Centers in Athens, Greece. Methods: To screen out participants with possible memory impairment, brief cognitive testing was conducted. Participants were also excluded if they had medical problems that could affect cognition (neurological diseases, major depression etc). 40 participants were recruited. The program consisted of 12 weekly 1hr sessions and was conducted by trained psychologists (volunteers from the Athens Association of Alzheimer’s Disease and Related Disorders) in 4 groups with 9-12 participants in each group. Results: The goals of the intervention were fully met: a) general knowledge regarding memory, aging and dementia increased and b) self-reported day-to-day memory functioning significantly improved. No significant changes were observed in objective memory performance as measured by formal memory
P1-212
ESTIMATING DEPENDENCE SCALE SCORES BASED ON CLINICAL DEMENTIA RATING - SUM OF BOXES SCORES IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT OR MILD TO MODERATE ALZHEIMER’S DISEASE
Josh T. Cohen1, Trent P. McLaughlin2, Peter Neumann1, Lisa Mucha3, Enchi Liu2, Michael Grundman2, Ron Black3, 1Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA, USA; 2Elan, South San Francisco, CA, USA; 3Wyeth Research, Collegeville, PA, USA. Contact e-mail: [email protected] Background: Clinical trials in Alzheimer’s disease (AD) need valid and reliable measures of disease severity that capture early stage (cognitive) through late stage (functional and/or behavioral) impacts, are sensitive to change over time, and are transparent to clinicians, patients, and policymakers. Information regarding the relationships between currently available measures would assist in interpreting results from interventions across different trial populations. The purpose of this analysis was to evaluate the relationship between two measures of disease progression in subjects 50-85 years of age with mild cognitive impairment (MCI) or mild to moderate AD. Methods: Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) and Dependence Scale (DS) scores were evaluated in a cohort of 157 AD and 60 MCI subjects enrolled at 40 study sites across the U.S. and Europe during 2006-2007. Recruitment criteria were
Poster Presentations P1 similar to those used in the AD Neuroimaging Initiative. We regressed DS scores (range 0-15) against CDR-SB (range 0-18) using simple linear, piecewise linear (spline), and polynomial (up to fifth order) models to investigate the strength and shape of the relationship (linear vs. non-linear) between the two measures. Model fit was evaluated using R2 and mean squared error (MSE). Results: Pearson correlation coefficients suggested a moderately high correlation between the two measures (r¼0.82430, p<0.0001). Simple linear regression performance (R2¼66.9%, MSE¼2.84) was similar to more complex models, including a cubic polynomial model (R2¼68.8%, MSE¼2.69) and a spline regression with two breakpoints (R2¼69.3%, MSE¼2.66), suggesting that a constant relationship slope for the DS across the range of CDR-SB scores. The simple linear regression provided an estimate of DS ¼ 0.93 þ 0.68(CDR-SB), indicating a one point change on the CDR-SB corresponded to a change of 0.68 DS points. Conclusions: In subjects with MCI or mild-moderate AD, the DS and CDR-SB, while measuring unique constructs, are well correlated, providing an opportunity to compare results across different populations where one measure but not the other was used. More complex regression models only modestly improved fit, indicating the DS can be well described as a linear function of CDR-SB. P1-213
STATED PREFERENCE METHODS IN QUESTIONABLE DEMENTIA EVALUATION: AN EMERGING METHODOLOGICAL PARADIGM IN HEALTH ECONOMICS
Paolo Prolo, Franco Posa, Sergio Luisoli, Social Security AdministrationInvalidity Insurance, Bellinzona, Switzerland. Contact e-mail: paolo. [email protected] Background: One focus of health economics is the trade-off between limited resources and the needs of a community. This is much more true when disability and compensation are involved. Claims of memory impairment are quite common in a social insurance setting. Distinguish between frank malingering and true claims is a tall order, a fast and correct assessment is essential. Mild cognitive impairment and cognitive impairment, no dementia, are emerging terms that encompass the clinical state between normal cognition and dementia. Controversy surrounds their characterization, definition and application in clinical practice and insurance medicine. The risk is not to recognize true cognitive impairment and leave people without compensation or aid for proper treatment. Methods: We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2008 that had mild cognitive impairment or cognitive impairment, no dementia, as the outcome. Vascular risk factors were excluded from the study. We identified 2590 articles, of which 24 were considered to be relevant and of good or fair quality. Of those, only 3 considered litigation as an issue. We compared evidence from the literature with data collected from 200 consecutive people seeking social security services at our institution in Switzerland. Results: We made a synthesis of the evidence and considered stated preferences from claimants. Family physicians should be aware that most types of dementia are preceded by a recognizable phase of mild cognitive decline. They should be familiar with the concepts of mild cognitive impairment and of cognitive impairment, no dementia. Patients with these conditions should be immediately assessed in a disability insurance (or worker compensation) setting and should be closely monitored because of their increased risk for dementia. Leisure activities, cognitive stimulation and physical activity could be promoted by disability insurances as part of a healthy lifestyle in working people over 50 years old claiming memory troubles. Conclusions: Stated preference techniques are still unfamiliar with policy makers and physicians, however they represent a valuable strategy in disability management. P1-214
STUDY OF THE USEFULNESS OF THE KOREAN STORY RECALL TEST IN PATIENTS WITH ALZHEIMER’S DISEASE
Min J. Baek1, Hyun J. Kim1, Hui J. Ryu2, Seung H. Lee3, Young S. Yang4, Hae R. Na3, Seol H. Han2, Sangyun Kim1,5, 1Department of Neurology and Clinical Neuroscience Center, Seoul National University Bundang Hospital,
P239
Gyeonggi-do, Republic of Korea; 2Department of Neurology, Konkuk University Hospital, Seoul, Republic of Korea; 3Department of Neurology, Bobath Memorial Hospital, Gyeonggi-do, Republic of Korea; 4Department of Neurology, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea; 5Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea. Contact e-mail: mjbaek [email protected] Background: The story recall test is one of the most reliable neuropsychological assessments for evaluating verbal memory function in order to distinguish between individuals with normal aging, mild cognitive impairment (MCI), and AD. The most representative test of the story recall test is the logical memory test in Wechsler Memory Scale-III (WMS-III). However, it is not suitable to apply the logical memory test in WMS-III directly to the Korean population without changing the contents because the familiarity of language and the frequency in use of a word are different in each culture. Therefore, it is possible to deteriorate the validity as the verbal memory test. Therefore, the Korean story recall test which was analogous to the logical memory test in WMS-III was recently developed and standardized to apply for the older adults in Korea. Therefore, the purpose of this study is to examine the validity of the Korean story recall test and its ability to discriminate between patients with MCI and AD. Methods: The Korean story recall test was compared with the other dementia rating scales (Clinical Dementia Rating (CDR); Global Deterioration Scale (GDS); Korean version of the Mini Mental State Examination (K-MMSE); the Korean version of the Hopkins Verbal Learning Test (K-HVLT)). Results: The results showed that the score of Korean story recall test was significantly correlated with the scores of the dementia rating tests (CDR, GDS, and K-MMSE) (p< .01) and the verbal memory test (K-HVLT) (p< .01). Conclusions: Thus, the Korean story recall test is a sensitive measurement of verbal memory function that can be used in clinical settings to discriminate between normal memory functioning and the very early and moderate stages of dementia in a Korean population. P1-215
RELIABILITY AND VALIDITY OF THE CAREGIVER-PERCEIVED BURDEN QUESTIONNAIRE (CPBQ) IN ALZHEIMER’S DISEASE
M. Haim Erder1, Teresa Wilcox2, Wen-Hung Chen2, Juliana Setyawan1, Sean O’Quinn2, Judith Saxton3, 1Forest Research Institute, Jersey City, NJ, USA; 2United BioSource Corporation, Bethesda, MD, USA; 3Alzheimer’s Disease Research Center, Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA. Contact e-mail: [email protected] Background: Alzheimer’s disease (AD) treatments that can reduce perceived caregiver burden may help delay institutionalization. Currently, assessments to measure this outcome in clinical trials have not been available. The Caregiver-Perceived Burden Questionnaire (CPBQ) is a new measure to assess the burden perceived by caregivers of patients with AD. The objectives of this study were to evaluate its psychometric properties, develop scoring algorithms, and evaluate its validity in a clinical trial. Methods: The 50-item CPBQ was administered in a randomized, double-blind, placebo-controlled trial of memantine in moderate-to-severe AD (N¼677). The caregivers completed the questionnaire at Weeks 0 (baseline), 4, 12, and 24 (endpoint). Exploratory (EFA) and confirmatory factor (CFA) analyses for the domains were followed by item analyses, performed using the classical test theory and Rasch model analysis. The items were selected based on clinicians’ input and psychometric evidence. The validity, reliability, responsiveness, and minimal important difference (MID) of CPBQ were evaluated. Results: Two main subscales, the caregiver’s assessment of the patient (CAP) and the caregivers’ assessment of themselves (CAT), were identified using EFA and content review, and confirmed using CFA. A total of 20 CAP items and 10 CAT items were selected iteratively. Rasch scale scores and conventional scores for CAT and CAP were created. The CAP and CAT scales were internally consistent (CAP: person separation index [PSI]¼0.89, intra-class-correlation [ICC]¼0.87; CAT: PSI¼0.83, ICC¼0.58). The CAP Rasch score was significantly correlated (r>0.3) with NPI, SIB, ADCSADL19, CIBIC-Plus, and FAST2, and the CAT Rasch score with the NPI. CAP and CAT Rasch scores discriminated among clinician-rated severity,
Poster Presentations P1
‘‘mobility’’, ‘‘pain/discomfort’’, and ‘‘anxiety/depression’’. Conclusions: We found a significant association between the severity of cognitive function impairment and problems in ‘‘self-care’’ and ‘‘usual activities’’ of EQ-5D dimensions and VAS. Cognitive function impairment did not affect other aspects of quality of life among the Chinese elderly. P1-208
HOW DOES THE CANADIAN GENERAL PUBLIC VIEW MODERATE ALZHEIMER’S DISEASE? DETERMINATION OF HEALTH UTILITY SCORES
testing. Conclusions: Evidence was obtained for the overall effectiveness of this memory education and intervention program. What remains to be explored is the long-term effectiveness of the gains obtained by the end of the program. In the light of the positive results obtained, the Athens Association of Alzheimer’s Disease and Related Disorders will continue the application of the program in larger scale. P1-210
DESIGN OF CARE FACILITIES FOR PEOPLE WITH ALZHEIMER’S DISEASE
Jean-Eric Tarride, Mark Oremus, Natasha Clayton, Parminder Raina, McMaster University, Hamilton, ON, Canada. Contact e-mail: clayton@ mcmaster.ca
William J. van der Eerden, Gemma Jones, De Drie Hoven, Amsterdam, Netherlands. Contact e-mail: [email protected]; wvandereerden@ osiragroep.nl
Background: Economic evaluations are playing an important role in decision making. Guidelines for the conduct of economic evaluations recommend eliciting preferences or health utility scores from members of the general public. The objectives of this study were to (1) To elicit health utility scores for moderate Alzheimer’s disease (AD) using the Canadian general public; (2) to compare utility scores for Canadians’ self-assessed health status with utility scores for health status defined as moderate AD; (3) to measure awareness of AD; and (4) to determine factors that influence utility scores. Methods: Five-hundred Canadians were chosen randomly to participate in a 13-minute telephone interview. The sample was national in scope and stratified by income. The EQ-5D was administered to measure utility for respondents’ current health status (i.e., no AD). After describing moderate AD, respondents were asked to answer the EQ-5D again, this time imagining they had moderate AD. AD awareness was measured with the Alzheimer’s Disease Knowledge Test (ADKT). Respondents were also asked about socio-demographics and whether they knew someone with AD. OLS regressions were conducted to identify determinants of EQ-5D utility scores. Results: The mean age of respondents was 51 years, 61% were female, and 42% knew someone with AD (e.g., family member). Mean ADKT score was 3.4 (SD: 1.1) out of 5 (higher scores indicate better knowledge of AD). Respondents’ mean EQ-5D score for their current health status was 0.857 (SD: 0.15). Mean EQ-5D score for a hypothetical, moderate AD health status was 0.638 (SD: .20), a utility decrement of 0.22. For the VAS component of the EQ-5D, scores were higher for the current health status (79.16 versus 57.66). Age and income were significant explanatory variables for current health status utilities, but only age was significant in the determination of the utility score under the assumption of moderate AD. Gender, knowledge of someone with AD, or AD awareness scores had no impact. Conclusions: When measured by the EQ-5D, Canadians would expect to assign a lower utility to their health status when they have moderate AD.
Background: This poster will provide an overview of insights coming from: 1) the experience of architects, planners and designers of residential and nursing homes, 2) those involved with identifying the knowledge base for, and developing the professionalization of dementia care, and 3) progress in the neuroscience understanding of visual (visuoperceptual) difficulties of people with Alzheimer’s disease (AD), 4) understanding of how visuoperceptual difficulties (mistakes) translate into certain types of ‘visual phenomena’ in AD; 5) understanding how visual perceptual difficulties combine with other cognitive difficulties. Methods: Information about a Dutch, large and smallscale care settings is presented, including recently opened small-scale living groups within large, multi-storey buildings, complete with phased levels of domotic monitoring technology, for different levels of dementia and safety risk assessment.The literature on dementia care home design contains a range of advice: from choosing locations, example blueprints of buildings, care and management models to activity considerations and de´cor and is extensively reviewed. Results: Considering the difficulties that normal elderly can have (and visual pathologies will not even be mentioned in this review), it is likely that most elderly people in care settings could benefit from design that takes visuoperceptual difficulties into account; not just those with AD, especially from visual cues that are highly visible, familiar, and salient. Given that people with AD are increasingly cared for in the community as long as possible, admission into specialist dementia care settings often occurs in Behavioural Stages 2 or 3 when significant, permanent visual and time perception difficulties exist. Conclusions: Design of dementia care facilities has gone through a considerable evolution, ranging from large care institutions to residential hotel-type settings and services and small-scale homelike living groups. Specific knowledge about ‘visuoperceptual difficulties’ in AD provides new opportunities for designers of care environments to anticipate these, and to enhance features of the physical environments so as to increase the likelihood that particular features will be accurately or symbolically perceived.
P1-209
MEMORY GROUPS: IMPROVING MEMORY KNOWLEDGE, SATISFACTION AND FUNCTIONING OF HEALTHY ELDERLY
Olga Lymperopoulou1,2, Eleni Margioti1, Paraskevi Sakka1,2, 1Athens Association of Alzheimer’s Disease and Related Disorders, Athens, Greece; 2Hygeia Hospital, Athens, Greece. Contact e-mail: olympero@ath. forthnet.gr Background: The vast majority of older adults report memory decline, are concerned about dementia and are interested in learning techniques for enhancing memory functioning in their everyday lives. A memory education and intervention program was developed and administered to communitydwelling older adults aged 60þ attending Municipal Recreation Centers in Athens, Greece. Methods: To screen out participants with possible memory impairment, brief cognitive testing was conducted. Participants were also excluded if they had medical problems that could affect cognition (neurological diseases, major depression etc). 40 participants were recruited. The program consisted of 12 weekly 1hr sessions and was conducted by trained psychologists (volunteers from the Athens Association of Alzheimer’s Disease and Related Disorders) in 4 groups with 9-12 participants in each group. Results: The goals of the intervention were fully met: a) general knowledge regarding memory, aging and dementia increased and b) self-reported day-to-day memory functioning significantly improved. No significant changes were observed in objective memory performance as measured by formal memory
P1-212
ESTIMATING DEPENDENCE SCALE SCORES BASED ON CLINICAL DEMENTIA RATING - SUM OF BOXES SCORES IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT OR MILD TO MODERATE ALZHEIMER’S DISEASE
Josh T. Cohen1, Trent P. McLaughlin2, Peter Neumann1, Lisa Mucha3, Enchi Liu2, Michael Grundman2, Ron Black3, 1Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA, USA; 2Elan, South San Francisco, CA, USA; 3Wyeth Research, Collegeville, PA, USA. Contact e-mail: [email protected] Background: Clinical trials in Alzheimer’s disease (AD) need valid and reliable measures of disease severity that capture early stage (cognitive) through late stage (functional and/or behavioral) impacts, are sensitive to change over time, and are transparent to clinicians, patients, and policymakers. Information regarding the relationships between currently available measures would assist in interpreting results from interventions across different trial populations. The purpose of this analysis was to evaluate the relationship between two measures of disease progression in subjects 50-85 years of age with mild cognitive impairment (MCI) or mild to moderate AD. Methods: Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) and Dependence Scale (DS) scores were evaluated in a cohort of 157 AD and 60 MCI subjects enrolled at 40 study sites across the U.S. and Europe during 2006-2007. Recruitment criteria were
Poster Presentations P1 similar to those used in the AD Neuroimaging Initiative. We regressed DS scores (range 0-15) against CDR-SB (range 0-18) using simple linear, piecewise linear (spline), and polynomial (up to fifth order) models to investigate the strength and shape of the relationship (linear vs. non-linear) between the two measures. Model fit was evaluated using R2 and mean squared error (MSE). Results: Pearson correlation coefficients suggested a moderately high correlation between the two measures (r¼0.82430, p<0.0001). Simple linear regression performance (R2¼66.9%, MSE¼2.84) was similar to more complex models, including a cubic polynomial model (R2¼68.8%, MSE¼2.69) and a spline regression with two breakpoints (R2¼69.3%, MSE¼2.66), suggesting that a constant relationship slope for the DS across the range of CDR-SB scores. The simple linear regression provided an estimate of DS ¼ 0.93 þ 0.68(CDR-SB), indicating a one point change on the CDR-SB corresponded to a change of 0.68 DS points. Conclusions: In subjects with MCI or mild-moderate AD, the DS and CDR-SB, while measuring unique constructs, are well correlated, providing an opportunity to compare results across different populations where one measure but not the other was used. More complex regression models only modestly improved fit, indicating the DS can be well described as a linear function of CDR-SB. P1-213
STATED PREFERENCE METHODS IN QUESTIONABLE DEMENTIA EVALUATION: AN EMERGING METHODOLOGICAL PARADIGM IN HEALTH ECONOMICS
Paolo Prolo, Franco Posa, Sergio Luisoli, Social Security AdministrationInvalidity Insurance, Bellinzona, Switzerland. Contact e-mail: paolo. [email protected] Background: One focus of health economics is the trade-off between limited resources and the needs of a community. This is much more true when disability and compensation are involved. Claims of memory impairment are quite common in a social insurance setting. Distinguish between frank malingering and true claims is a tall order, a fast and correct assessment is essential. Mild cognitive impairment and cognitive impairment, no dementia, are emerging terms that encompass the clinical state between normal cognition and dementia. Controversy surrounds their characterization, definition and application in clinical practice and insurance medicine. The risk is not to recognize true cognitive impairment and leave people without compensation or aid for proper treatment. Methods: We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2008 that had mild cognitive impairment or cognitive impairment, no dementia, as the outcome. Vascular risk factors were excluded from the study. We identified 2590 articles, of which 24 were considered to be relevant and of good or fair quality. Of those, only 3 considered litigation as an issue. We compared evidence from the literature with data collected from 200 consecutive people seeking social security services at our institution in Switzerland. Results: We made a synthesis of the evidence and considered stated preferences from claimants. Family physicians should be aware that most types of dementia are preceded by a recognizable phase of mild cognitive decline. They should be familiar with the concepts of mild cognitive impairment and of cognitive impairment, no dementia. Patients with these conditions should be immediately assessed in a disability insurance (or worker compensation) setting and should be closely monitored because of their increased risk for dementia. Leisure activities, cognitive stimulation and physical activity could be promoted by disability insurances as part of a healthy lifestyle in working people over 50 years old claiming memory troubles. Conclusions: Stated preference techniques are still unfamiliar with policy makers and physicians, however they represent a valuable strategy in disability management. P1-214
STUDY OF THE USEFULNESS OF THE KOREAN STORY RECALL TEST IN PATIENTS WITH ALZHEIMER’S DISEASE
Min J. Baek1, Hyun J. Kim1, Hui J. Ryu2, Seung H. Lee3, Young S. Yang4, Hae R. Na3, Seol H. Han2, Sangyun Kim1,5, 1Department of Neurology and Clinical Neuroscience Center, Seoul National University Bundang Hospital,
P239
Gyeonggi-do, Republic of Korea; 2Department of Neurology, Konkuk University Hospital, Seoul, Republic of Korea; 3Department of Neurology, Bobath Memorial Hospital, Gyeonggi-do, Republic of Korea; 4Department of Neurology, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea; 5Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea. Contact e-mail: mjbaek [email protected] Background: The story recall test is one of the most reliable neuropsychological assessments for evaluating verbal memory function in order to distinguish between individuals with normal aging, mild cognitive impairment (MCI), and AD. The most representative test of the story recall test is the logical memory test in Wechsler Memory Scale-III (WMS-III). However, it is not suitable to apply the logical memory test in WMS-III directly to the Korean population without changing the contents because the familiarity of language and the frequency in use of a word are different in each culture. Therefore, it is possible to deteriorate the validity as the verbal memory test. Therefore, the Korean story recall test which was analogous to the logical memory test in WMS-III was recently developed and standardized to apply for the older adults in Korea. Therefore, the purpose of this study is to examine the validity of the Korean story recall test and its ability to discriminate between patients with MCI and AD. Methods: The Korean story recall test was compared with the other dementia rating scales (Clinical Dementia Rating (CDR); Global Deterioration Scale (GDS); Korean version of the Mini Mental State Examination (K-MMSE); the Korean version of the Hopkins Verbal Learning Test (K-HVLT)). Results: The results showed that the score of Korean story recall test was significantly correlated with the scores of the dementia rating tests (CDR, GDS, and K-MMSE) (p< .01) and the verbal memory test (K-HVLT) (p< .01). Conclusions: Thus, the Korean story recall test is a sensitive measurement of verbal memory function that can be used in clinical settings to discriminate between normal memory functioning and the very early and moderate stages of dementia in a Korean population. P1-215
RELIABILITY AND VALIDITY OF THE CAREGIVER-PERCEIVED BURDEN QUESTIONNAIRE (CPBQ) IN ALZHEIMER’S DISEASE
M. Haim Erder1, Teresa Wilcox2, Wen-Hung Chen2, Juliana Setyawan1, Sean O’Quinn2, Judith Saxton3, 1Forest Research Institute, Jersey City, NJ, USA; 2United BioSource Corporation, Bethesda, MD, USA; 3Alzheimer’s Disease Research Center, Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA. Contact e-mail: [email protected] Background: Alzheimer’s disease (AD) treatments that can reduce perceived caregiver burden may help delay institutionalization. Currently, assessments to measure this outcome in clinical trials have not been available. The Caregiver-Perceived Burden Questionnaire (CPBQ) is a new measure to assess the burden perceived by caregivers of patients with AD. The objectives of this study were to evaluate its psychometric properties, develop scoring algorithms, and evaluate its validity in a clinical trial. Methods: The 50-item CPBQ was administered in a randomized, double-blind, placebo-controlled trial of memantine in moderate-to-severe AD (N¼677). The caregivers completed the questionnaire at Weeks 0 (baseline), 4, 12, and 24 (endpoint). Exploratory (EFA) and confirmatory factor (CFA) analyses for the domains were followed by item analyses, performed using the classical test theory and Rasch model analysis. The items were selected based on clinicians’ input and psychometric evidence. The validity, reliability, responsiveness, and minimal important difference (MID) of CPBQ were evaluated. Results: Two main subscales, the caregiver’s assessment of the patient (CAP) and the caregivers’ assessment of themselves (CAT), were identified using EFA and content review, and confirmed using CFA. A total of 20 CAP items and 10 CAT items were selected iteratively. Rasch scale scores and conventional scores for CAT and CAP were created. The CAP and CAT scales were internally consistent (CAP: person separation index [PSI]¼0.89, intra-class-correlation [ICC]¼0.87; CAT: PSI¼0.83, ICC¼0.58). The CAP Rasch score was significantly correlated (r>0.3) with NPI, SIB, ADCSADL19, CIBIC-Plus, and FAST2, and the CAT Rasch score with the NPI. CAP and CAT Rasch scores discriminated among clinician-rated severity,