- Email: [email protected]
P3-450: ALSOVA: A prospective intervention follow-up study on recently diagnosed patients with mild Alzheimer's disease and their caregivers—the study population at the baseline
Poster Presentations P3: P3-448
INTELLECT IN DEFAULT: INTEGRATING CONCEPTS OF NEUROSCIENCE, PSYCHOLOGY AND HUMAN NATURE
Mary J. Flossie, Hiram College, Massillon, OH, USA. Contact e-mail: [email protected]
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Background: Default mechanisms that surface when intellect fails are human instinct, rote responses, emotional intelligence and autonomic reactions. These keys to human survival are primal and unaffected by disease. Drawing from neuroscience, basic concepts of the limbic system in human development, and applying the psychology of subconscious activity to the primal urges at the core of human nature, we establish that when one can’t think, one still feels and can interpret interpersonal dynamics with profound accuracy. When the brain is destroyed by disease, intellect will default to instinct by nature. Recognition of what is left well intact leads to new approaches to care and intervention. Methods: This workshop hails the ’dementia dilemma’ from the victim’s perspective by revealing the extent to which behaviors are triggered instinctively by non-verbal, environmental and interpersonal stimuli. Retro-genesis in Alzheimer’s causes developmental regression as the memory of life experiences unrvels backward in time, leaving victims with a mental agenda isolated in a previous reality. Results: Defensive and suspicous behaviors are the result of fear, perceived threats and instinctive reactions to fear, over which the affected have no control. Lack of intellectual counterbalance, which is at the core of ‘seemingly’ unreasonable activity, co-exists with Retro-genesis and must be considered in conjunction with autonomic responses if effective ‘interventions’ are to be formulated. Conclusions: Care focus becomes blurred by unrelenting tasks that have to be managed with the cooperation of the confused. Well intended efforts become undermined by personal feelings of exasperation, grief and failure in the process. The obvious is overlooked because intellect itself contradicts understanding dementia. Much can be done to secure, comfort and minimize the fear and anxiety that leads to disturbances if one understands the true underlying causes and abandons dependence on language and learned expectations. Integrating diversity of knowledge equips carers toward improving the quality of life for the compromised as well as themselves. P3-449
BEHAVIORAL PROBLEMS AMONG DEMENTIA PATIENTS IN AN OUTPATIENT MEMORY CENTER IN THE PHILIPPINES
Maria Stella T. Giron, Jacqueline C. Dominguez, St. Luke’s Medical Center, Quezon City, Philippines. Contact e-mail: [email protected] Background: Dementia is characterized by progressive memory decline and associated with behavioral problems which impact on the patient’s quality of life and cause caregiver distress. This study aims to determine the frequency of behavioral problems among outpatients diagnosed with dementia. Methods: Thirty four patients from the Memory Center of St. Luke’s Medical Center, Philippines were diagnosed with dementia; 30 with Alzheimer’s disease, 3 with vascular dementia, and one with frontal lobe dementia. The Neuropsychiatric Inventory (NPI) was used to assess the patients’ behavioral problems. Dementia severity was assessed using the Clinical Dementia Rating (CDR) Scale. Results: Behavioral information was obtained from the patients’ spouses (41.2), children (41.2), other relatives (2.9), and hired help (14.7). The patients’ mean age was 73.5 (9.6 ⫾9.6), 70.6% were women, with a mean MMSE score of 26.2 (5.3). Thirty two (94.1%) were reported to have at least one behavioral problem. Apathy (79.4%), agitation (73.5%), aberrant motor behavior (73.5%), irritability (67.6), and appetite (55.9%) were the most common behavioral problems reported. Elation (8.8%) was the least frequently observed behavior. The total NPI scores increased significantly with increasing dementia severity (p⫽0.011) and correlated significantly with caregiver distress (P⫽0.000). Irritability and agitation were the problems most often reported to cause distress to caregivers. Conclusions: This study showed a high frequency of behavioral problems among this group of dementia patients and that its presence was significantly related to caregiver distress and increasing
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dementia severity. Increased attention should be focused in identifying and treating these problems in dementia patients. P3-450
ALSOVA: A PROSPECTIVE INTERVENTION FOLLOW-UP STUDY ON RECENTLY DIAGNOSED PATIENTS WITH MILD ALZHEIMER’S DISEASE AND THEIR CAREGIVERS—THE STUDY POPULATION AT THE BASELINE
Sanna-Kaisa Herukka1, Tarja Va¨lima¨ki1, Anna-Maija Pietila¨1, Katri Vehvila¨inen-Julkunen1, Janne Martikainen1, Hannu Valtonen1, Juhani Sivenius1, Hilkka Soininen1,2, Pertti Karppi3, Asta Hiltunen4, Tuula Pirttila¨1,2, 1University of Kuopio, Kuopio, Finland; 2Kuopio University Hospital, Kuopio, Finland; 3Jyva¨skyla¨ Central Hospital, Jyva¨skyla¨, Finland; 4Pohjois-Karjala Central Hospital, Joensuu, Finland. Contact e-mail: [email protected] Background: Alzheimer’s disease (AD) imposes a heavy and rapidly increasing economic burden on the social and healthcare systems in different countries. The largest increase in dementia costs is related to institutional care. While dementia has devastating impact on quality of life of the family caregivers, the families play important roles in the patient care and decision making. Our objective is to examine and compare the factors that are related to the quality of life, coping and life control of both patients and caregivers. During the follow-up the effects of a psychoeducational and rehabilitation intervention program on quality of life of the patients and caregivers and caregivers’ burden will also be studied. Methods: The study is a prospective follow-up study that includes 241 recently diagnosed AD patient-caregiver pairs who entered the study between 2002 and 2006. Data collected includes age, sex, education, physical health, medication, household composition, living arrangements, general well-being, caregiver strain, depression, quality of life and resource utilization. The AD patientcaregiver pairs will be randomized to two study groups: (1) Traditional care ⫹ intensive psychoeducational courses for patient and caregiver during first two years after a diagnosis, and (2) traditional care. Results: At the baseline the caregiver was most frequently a spouse, in 70% of cases, and in 23% of the cases the caregiver was a child. A total of 73% of the patient-caregiver pairs were living together. The mean MMSE score of the patients was 21.5⫾3.4 and mean ADCS-ADL score was 65.⫾9,3. Only 18% of the patients had no neuropsychiatric symptoms, and 37% of the patients had symptoms in at least three different NPI domains. As many as 33% of patients could be diagnosed as having at least mild depression. Up to 43% of the AD patients had another medical condition besides AD, and 60% used at least three different medications. Almost all (96%) used AD medication, most often acetylcholinesterase inhibitors. Conclusions: Although the patients were at the early stage of AD at the baseline, the neuropsychiatric symptoms were surprisingly frequent in these patients. Patient’s depression was associated with quality of life of the patients at the baseline. P3-451
STRENGTH OF ASSOCIATION OF NEUROPSYCHIATRIC SYMPTOMS WITH LATINO CAREGIVER DEPRESSION VARIES BY CARE RECIPIENT COGNITIVE GROUP
Ladson Hinton, UC Davis, Sacramento, CA, USA. Contact e-mail: [email protected] Background: Few studies have examined stress among caregivers of elderly who are cognitively impaired but not demented. In prior research in Latinos, we found a stronger association of care recipient neuropsychiatric symptoms and caregiver depression in the cognitively impaired not demented group than the demented group. Methods: This study’s objective was to compare the relationship of caregiver depression (i.e. CES-D) with neuropsychiatric symptoms (i.e. Neuropsychiatric Inventory) in three groups of non-institutionalized Latino elderly (i.e. 27 cognitively normal, 20 cognitively impaired not demented, 24 demented) identified through the Sacramento Area Latino Study on Aging. Results: In the overall sample,
INTELLECT IN DEFAULT: INTEGRATING CONCEPTS OF NEUROSCIENCE, PSYCHOLOGY AND HUMAN NATURE
Mary J. Flossie, Hiram College, Massillon, OH, USA. Contact e-mail: [email protected]
W
IT
H
D
R AW
N
Background: Default mechanisms that surface when intellect fails are human instinct, rote responses, emotional intelligence and autonomic reactions. These keys to human survival are primal and unaffected by disease. Drawing from neuroscience, basic concepts of the limbic system in human development, and applying the psychology of subconscious activity to the primal urges at the core of human nature, we establish that when one can’t think, one still feels and can interpret interpersonal dynamics with profound accuracy. When the brain is destroyed by disease, intellect will default to instinct by nature. Recognition of what is left well intact leads to new approaches to care and intervention. Methods: This workshop hails the ’dementia dilemma’ from the victim’s perspective by revealing the extent to which behaviors are triggered instinctively by non-verbal, environmental and interpersonal stimuli. Retro-genesis in Alzheimer’s causes developmental regression as the memory of life experiences unrvels backward in time, leaving victims with a mental agenda isolated in a previous reality. Results: Defensive and suspicous behaviors are the result of fear, perceived threats and instinctive reactions to fear, over which the affected have no control. Lack of intellectual counterbalance, which is at the core of ‘seemingly’ unreasonable activity, co-exists with Retro-genesis and must be considered in conjunction with autonomic responses if effective ‘interventions’ are to be formulated. Conclusions: Care focus becomes blurred by unrelenting tasks that have to be managed with the cooperation of the confused. Well intended efforts become undermined by personal feelings of exasperation, grief and failure in the process. The obvious is overlooked because intellect itself contradicts understanding dementia. Much can be done to secure, comfort and minimize the fear and anxiety that leads to disturbances if one understands the true underlying causes and abandons dependence on language and learned expectations. Integrating diversity of knowledge equips carers toward improving the quality of life for the compromised as well as themselves. P3-449
BEHAVIORAL PROBLEMS AMONG DEMENTIA PATIENTS IN AN OUTPATIENT MEMORY CENTER IN THE PHILIPPINES
Maria Stella T. Giron, Jacqueline C. Dominguez, St. Luke’s Medical Center, Quezon City, Philippines. Contact e-mail: [email protected] Background: Dementia is characterized by progressive memory decline and associated with behavioral problems which impact on the patient’s quality of life and cause caregiver distress. This study aims to determine the frequency of behavioral problems among outpatients diagnosed with dementia. Methods: Thirty four patients from the Memory Center of St. Luke’s Medical Center, Philippines were diagnosed with dementia; 30 with Alzheimer’s disease, 3 with vascular dementia, and one with frontal lobe dementia. The Neuropsychiatric Inventory (NPI) was used to assess the patients’ behavioral problems. Dementia severity was assessed using the Clinical Dementia Rating (CDR) Scale. Results: Behavioral information was obtained from the patients’ spouses (41.2), children (41.2), other relatives (2.9), and hired help (14.7). The patients’ mean age was 73.5 (9.6 ⫾9.6), 70.6% were women, with a mean MMSE score of 26.2 (5.3). Thirty two (94.1%) were reported to have at least one behavioral problem. Apathy (79.4%), agitation (73.5%), aberrant motor behavior (73.5%), irritability (67.6), and appetite (55.9%) were the most common behavioral problems reported. Elation (8.8%) was the least frequently observed behavior. The total NPI scores increased significantly with increasing dementia severity (p⫽0.011) and correlated significantly with caregiver distress (P⫽0.000). Irritability and agitation were the problems most often reported to cause distress to caregivers. Conclusions: This study showed a high frequency of behavioral problems among this group of dementia patients and that its presence was significantly related to caregiver distress and increasing
T653
dementia severity. Increased attention should be focused in identifying and treating these problems in dementia patients. P3-450
ALSOVA: A PROSPECTIVE INTERVENTION FOLLOW-UP STUDY ON RECENTLY DIAGNOSED PATIENTS WITH MILD ALZHEIMER’S DISEASE AND THEIR CAREGIVERS—THE STUDY POPULATION AT THE BASELINE
Sanna-Kaisa Herukka1, Tarja Va¨lima¨ki1, Anna-Maija Pietila¨1, Katri Vehvila¨inen-Julkunen1, Janne Martikainen1, Hannu Valtonen1, Juhani Sivenius1, Hilkka Soininen1,2, Pertti Karppi3, Asta Hiltunen4, Tuula Pirttila¨1,2, 1University of Kuopio, Kuopio, Finland; 2Kuopio University Hospital, Kuopio, Finland; 3Jyva¨skyla¨ Central Hospital, Jyva¨skyla¨, Finland; 4Pohjois-Karjala Central Hospital, Joensuu, Finland. Contact e-mail: [email protected] Background: Alzheimer’s disease (AD) imposes a heavy and rapidly increasing economic burden on the social and healthcare systems in different countries. The largest increase in dementia costs is related to institutional care. While dementia has devastating impact on quality of life of the family caregivers, the families play important roles in the patient care and decision making. Our objective is to examine and compare the factors that are related to the quality of life, coping and life control of both patients and caregivers. During the follow-up the effects of a psychoeducational and rehabilitation intervention program on quality of life of the patients and caregivers and caregivers’ burden will also be studied. Methods: The study is a prospective follow-up study that includes 241 recently diagnosed AD patient-caregiver pairs who entered the study between 2002 and 2006. Data collected includes age, sex, education, physical health, medication, household composition, living arrangements, general well-being, caregiver strain, depression, quality of life and resource utilization. The AD patientcaregiver pairs will be randomized to two study groups: (1) Traditional care ⫹ intensive psychoeducational courses for patient and caregiver during first two years after a diagnosis, and (2) traditional care. Results: At the baseline the caregiver was most frequently a spouse, in 70% of cases, and in 23% of the cases the caregiver was a child. A total of 73% of the patient-caregiver pairs were living together. The mean MMSE score of the patients was 21.5⫾3.4 and mean ADCS-ADL score was 65.⫾9,3. Only 18% of the patients had no neuropsychiatric symptoms, and 37% of the patients had symptoms in at least three different NPI domains. As many as 33% of patients could be diagnosed as having at least mild depression. Up to 43% of the AD patients had another medical condition besides AD, and 60% used at least three different medications. Almost all (96%) used AD medication, most often acetylcholinesterase inhibitors. Conclusions: Although the patients were at the early stage of AD at the baseline, the neuropsychiatric symptoms were surprisingly frequent in these patients. Patient’s depression was associated with quality of life of the patients at the baseline. P3-451
STRENGTH OF ASSOCIATION OF NEUROPSYCHIATRIC SYMPTOMS WITH LATINO CAREGIVER DEPRESSION VARIES BY CARE RECIPIENT COGNITIVE GROUP
Ladson Hinton, UC Davis, Sacramento, CA, USA. Contact e-mail: [email protected] Background: Few studies have examined stress among caregivers of elderly who are cognitively impaired but not demented. In prior research in Latinos, we found a stronger association of care recipient neuropsychiatric symptoms and caregiver depression in the cognitively impaired not demented group than the demented group. Methods: This study’s objective was to compare the relationship of caregiver depression (i.e. CES-D) with neuropsychiatric symptoms (i.e. Neuropsychiatric Inventory) in three groups of non-institutionalized Latino elderly (i.e. 27 cognitively normal, 20 cognitively impaired not demented, 24 demented) identified through the Sacramento Area Latino Study on Aging. Results: In the overall sample,