- Email: [email protected]
Where the rubber hits the road: Partnering with dementia caregivers in intervention design and implementation
Poster Presentations: P3
with CI secondary to FND and ND were enrolled in an outpatient CIT program (n¼219). The sample was divided into 2 groups: patients that received NRD (n¼85) (G1), and patients that did not receive NRD (n¼134) (G2). The groups were paired by age, education, Mini Mental State Examination, Beck Inventory (BI), time of progression, and number of sessions. Cognitive variables, behavioral variables, Activities of Daily Living (ADL) and Quality of Life (QoL) were compared at treatment start and treatment end. Parametric statistics and analysis were performed at paired samples. Results: Drug-use rates were as follows: 37% antiplatelet aggregating agents, 32.9% antidepressant agents; 21% cholinesterase inhibitors (60.9% donezepil), 22.4% antiepileptic agents, 20.1% antipsychotic agents (60.5% quetiapine), and 17.4% memantine. Regarding NRD: 32.9% (n¼72/219) received benzodiazepines, 4.6% (n¼10/219) anticholinergic agents, and 2.28% (n¼5/219) were administered barbiturates. At CIT end, G1 only evidenced improved QoL (mean change (MCh)¼4.78;p:0.01). G2 exhibited improved Subjective Memory (MCh¼5.74;p:0.03), basic ADL (MCh¼1.4;p:0.009) and instrumental ADL (MCh¼1.08;p:0.01), BI (MCh¼1.9;p:0.01), and Neuropsychiatric Inventory (MCh¼6.12; p:0.01). Conclusions: A significant number of patients with CI received NRD. CIT led to significant improvement at some of the study variables, with a lower effect on patients who received drugs with prejudicial effects on cognition.
P3-246
THE SPOUSAL CAREGIVER’S PERSPECTIVE: CHANGES IN THE MARITAL RELATIONSHIP DUE TO DEMENTIA
Hector Anthony Steele, Caja Costarricense de Seguro S, San Jose, Costa Rica. Contact e-mail: [email protected] Background: Qualitative research have found that spousal care-
givers of patients with dementia with report a sense of grief due to the feeling of “loss of their loved ones”, missing the way they were before dementia developed. This investigation is more ambitious, since it determines, away from this relational deprivation, other specific changes in the couple’s relationship due to this condition. The present study explores elderly spouses, investigating the changes in the dynamics of the couple attributed to dementia. Methods: Mixed (qualitative and quantitative) method was used throughout the investigation process. Changes in the couple’s relationship due to dementia were assessed through a semi-structured interview applied to eighty-two spousal caregivers, specifically through the following question: “Has the relationship changed after the development of dementia? In what aspects?” Results: The changes in the couple’s relationship mentioned by the spousal caregivers were: Social activities: for 58% of the caregivers their social activities had either decreased or disappeared due to caregiver roles. Individual space loss: due to the amount of time and effort dedicated to caregiving, 51% of the caregivers felt that this role had absorbed them enough to lose their sense of independence and personal space. Loss in the sense of company: 50% of interviewed caregivers reported a negative impact in terms of the company their demented spouses used to give them. Sexuality: Changes in sexual performance, as well as reduction in the number and quality of their sexual encounters were reported by 49% of the caregiver spouses. Changes in previous roles: for 15% of the spouses interviewed, there were changes in previously established roles, caregiver wives referring they had to
P725
assume the economics and administration of the house, while caregiver husbands took charge of domestic chores. Conclusions: This investigation adds qualitative knowledge regarding the patient-caregiver dyad in the conjugal context, determining that the main changes in the relationship associated with the onset of dementia are the decrease in social activities and the loss of both individual space and sense of company. Assessing these eventual changes in the marital scenario will enhance our comprehensive care of the demented patient.
P3-247
VALIDATION STUDY OF THE MINI-MENTAL STATE EXAMINATION IN THE URDU LANGUAGE FOR A PAKISTANI POPULATION
Safia Awan, Aga Khan University Hospital, Karachi, Pakistan. Contact e-mail: [email protected] Background: This study was conducted primarily to validate and determine the optimal cutoff score in the diagnosis of dementia among Pakistani’s and study the effects of gender and education on the MMSE performance in our population. Methods: Four hundred participants took part in the study. Of these, 100 were dementia patients and 300 were non-dementia participants. Patient with dementia recruited from five major hospitals from Pakistan. The MMSE was translated into Urdu. In order to determine the optimal cutoff scores, the sensitivity and specificity were calculated. Results: There were 61 men and 39 women in dementia group and 225 men and 75 women in the control group. The mean score of Urdu MMSE were lower in patients with dementia 18.5 6 5.6 (range 0-30) as compared to the controls 26.8 6 2.6 (range 7-30). This difference between groups was statistically significant (p<0.001). Subjects with illiterate and up to 10 grades had significantly lower mean scores in patients with dementia group compare to those with higher education (p<0.001). Conclusions: These finding confirm the influence of level of education on MMSE score and education stratified cutoff scores should be used while screening for cognitive impairment in this population.
P3-248
WHERE THE RUBBER HITS THE ROAD: PARTNERING WITH DEMENTIA CAREGIVERS IN INTERVENTION DESIGN AND IMPLEMENTATION
Philip D. Sloane1, Anna S. Beeber2, Lisa P. Gwyther3, Bobbi Matchar3, Sheryl Zimmerman2, 1UNC-CH, Chapel Hill, NC, USA; 2Univ of NC-Chapel Hill, Chapel Hill, NC, USA; 3Duke University, Durham, NC, USA. Contact e-mail: [email protected] Background: Family caregivers are often the first to respond
when people with dementia develop medical problems such as cough or leg swelling; however few caregiver resources are available to help them address these issues. Methods: As part of an NINR-funded study of caregiver management of medical symptoms, an advisory group of caregivers of persons with dementia was convened to identify needs around medical symptoms and to work with an interdisciplinary professional team to develop and evaluate resources for caregivers in the management of medical symptoms and co-morbid illness. This study examined the process of partnering, including changes in plans (compared with grant proposal), process of
P726
Poster Presentations: P3
partnering, and results of field testing of the developed product. Results: The advisory panel consisted of 9 family caregivers that varied according to length of caregiving experience, type and severity of the care recipient’s dementia, gender, relationship to care recipient (spouse/child), and demographics. They met monthly for nine months to advise the team on the format (website), design, and content. Changes and innovations introduced due to caregiver input included inclusion of behavioral symptoms as well as traditional biomedical ones, addition of an “if you need to act fast” section under each symptom, a downloadable one-page health summary, and a section on dealing with the health care system. To field test the materials, 18 caregivers were recruited for an 8-month trial. Thirteen (76%) of the pilot participants rated the website as extremely easy to use, 15 (88%) thought the website was easy to understand, 12 (71%) thought it was an excellent resource, and 18 (100%) would recommend it to a friend or relative. Conclusions: Partnering with family caregivers in the design and implementation of interventions such as the Alzheimer’s Medical Advisor can help create resources that are relevant and user friendly. Furthermore, the use of a family caregiver advisory panel has vast implications to the design of future studies aimed at assisting family caregivers with the management of day-to-day challenges. P3-249
INCIDENT DEMENTIA, SUBCLINICAL, AND CLINICAL CORONARY HEART DISEASE IN OLDER INDIVIDUALS: THE CHS COGNITION STUDY
Lewis H. Kuller, Oscar L. Lopez, James T. Becker, Anne B. Newman, Yuefang Chang, University of Pittsburgh, Pittsburgh, PA, USA. Contact e-mail: [email protected] Background: Success in preventing coronary heart disease (CHD) and improved survival after a heart attack and stroke has produced a recent increase in longevity. There is a delay in age of first heart attack, especially for women (now age 72) but more prevalent clinical CHD with recurrent myocardial infarction, congestive heart failure (CHF), and atrial fibrillation. Improved survival has resulted in a larger population of very elderly (age 80+) at risk of dementia. Methods: We evaluated the relationship between CHD and dementia in the Cardiovascular Health Study-Cognition Study (CHS-CS) from 199899 to 2011-12 among 532 participants mean age of 79. By 2011, 69% of the men and 62% of the women were deceased and 58% of the men and 65% of the women had incident dementia. Results: The incidence of CHD and dementia increased with age. Dementia incidence among women was much higher than CHD incidence; 65/1000 person-years (PYs) for dementia versus 21/1000 PYs for CHD. Among men, the incidence of dementia was also higher than CHD but only after the age of 80: 123/ 1000 PYs dementia versus 55/1000 CHD. The primary determinants of CHD and total mortality were measures of clinical and subclinical vascular disease, including coronary artery calcium (CAC), highly sensitive cardiac troponin, and N-terminal probrain natriuretic peptide. Women with very low CAC had reduced risk of dementia (not significant). Risk factors for dementia were IQ, higher education, higher hippocampal volume and the size of lateral ventricles (measures of brain neurodegeneration), cognitive test scores in 1991-92, number of blocks walked per week,
and apolipoprotein-E4. Participants who had incident CHF and stroke had increased risk of dementia. Conclusions: The reduction in CHD and total mortality and greater longevity, especially for women, results in a larger population at risk for dementia. The most important question is whether women with little coronary atherosclerosis at older age with greater longevity have also a reduced risk of dementia.
P3-250
HAPTOGLOBIN GENOTYPE MODULATES THE RELATIONSHIPS OF GLYCAEMIC CONTROL WITH COGNITIVE FUNCTION IN ELDERLY INDIVIDUALS WITH TYPE 2 DIABETES
Elizabeth Guerrero-Berroa1, Ramit Ravona-Springer2, Anthony Heymann3, James Schmeidler4, Andrew Levy5, Derek Leroith6, Michal Beeri6,7, 1The Icahn School of Medicine at Mount Sinai, NY, NY, USA; 2Department of Psychiatry and The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel; 3Department of Family Medicine, University of Tel Aviv, Tel Aviv, Israel; 4The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5Technion, Haifa, Israel; 6Icahn School of Medicine at Mount Sinai, New York, NY, USA; 7Sheba Medical Center, Tel-Hashomer, Israel. Contact e-mail: [email protected] Background: Elderly individuals with type 2 diabetes are at
increased risk for cognitive compromise and dementia, with genetic factors and poor management of type 2 diabetes among possible underlying causes. Haptoglobin 1-1 (Hp 1-1) and poor glycaemic control have been associated with poor cognitive function. The possible involvement of the Hp genotype in the association of glycaemic control with cognition have not bee examined. Thus, the purpose of this study was to investigate whether the association of glycaemic control with cognitive function is modulated by Hp 1-1 in cognitively normal elderly with type 2 diabetes. Methods: We examined 793 participants who were genotyped for Hp (80 Hp 1-1 carriers and 713 Hp 1-1 non-carriers) enrolled in the Israel Diabetes and Cognitive Decline (IDCD) study. Glycaemic control was operationally defined by HbA1c level. The outcome measures were performance in four cognitive domains (episodic memory, attention/ working memory, language/semantic categorisation, executive function) and overall cognition, a composite of the domains. Effect sizes were obtained from hierarchical linear regression analyses for each outcome measure, controlling for demographics, type 2 diabetes-related characteristics, cardiovascular risk factors, and their interactions with Hp genotype. Results: Interaction analyses showed significantly stronger associations of HbA1c with poorer cognitive function among Hp 1-1 carriers than noncarriers; attention/working memory (p < 0.001) and overall cognition (p ¼ 0.003). For these two cognitive domains, associations were significant for Hp 1-1 carriers despite the small sample size (p < 0.00001 and p ¼ 0.001, respectively), but not for noncarriers. Conclusions: Our findings suggest that patients with type 2 diabetes and poor glycaemic control carrying the Hp 1-1 genotype may be at increased risk of cognitive impairment, particularly in the attention/working memory domain. The association of glycaemic control with this domain may indicate cerebrovascular mechanisms. The findings presented in this abstract are cross-sectional. At the AAIC, 36-months longitudinal data will be presented.
with CI secondary to FND and ND were enrolled in an outpatient CIT program (n¼219). The sample was divided into 2 groups: patients that received NRD (n¼85) (G1), and patients that did not receive NRD (n¼134) (G2). The groups were paired by age, education, Mini Mental State Examination, Beck Inventory (BI), time of progression, and number of sessions. Cognitive variables, behavioral variables, Activities of Daily Living (ADL) and Quality of Life (QoL) were compared at treatment start and treatment end. Parametric statistics and analysis were performed at paired samples. Results: Drug-use rates were as follows: 37% antiplatelet aggregating agents, 32.9% antidepressant agents; 21% cholinesterase inhibitors (60.9% donezepil), 22.4% antiepileptic agents, 20.1% antipsychotic agents (60.5% quetiapine), and 17.4% memantine. Regarding NRD: 32.9% (n¼72/219) received benzodiazepines, 4.6% (n¼10/219) anticholinergic agents, and 2.28% (n¼5/219) were administered barbiturates. At CIT end, G1 only evidenced improved QoL (mean change (MCh)¼4.78;p:0.01). G2 exhibited improved Subjective Memory (MCh¼5.74;p:0.03), basic ADL (MCh¼1.4;p:0.009) and instrumental ADL (MCh¼1.08;p:0.01), BI (MCh¼1.9;p:0.01), and Neuropsychiatric Inventory (MCh¼6.12; p:0.01). Conclusions: A significant number of patients with CI received NRD. CIT led to significant improvement at some of the study variables, with a lower effect on patients who received drugs with prejudicial effects on cognition.
P3-246
THE SPOUSAL CAREGIVER’S PERSPECTIVE: CHANGES IN THE MARITAL RELATIONSHIP DUE TO DEMENTIA
Hector Anthony Steele, Caja Costarricense de Seguro S, San Jose, Costa Rica. Contact e-mail: [email protected] Background: Qualitative research have found that spousal care-
givers of patients with dementia with report a sense of grief due to the feeling of “loss of their loved ones”, missing the way they were before dementia developed. This investigation is more ambitious, since it determines, away from this relational deprivation, other specific changes in the couple’s relationship due to this condition. The present study explores elderly spouses, investigating the changes in the dynamics of the couple attributed to dementia. Methods: Mixed (qualitative and quantitative) method was used throughout the investigation process. Changes in the couple’s relationship due to dementia were assessed through a semi-structured interview applied to eighty-two spousal caregivers, specifically through the following question: “Has the relationship changed after the development of dementia? In what aspects?” Results: The changes in the couple’s relationship mentioned by the spousal caregivers were: Social activities: for 58% of the caregivers their social activities had either decreased or disappeared due to caregiver roles. Individual space loss: due to the amount of time and effort dedicated to caregiving, 51% of the caregivers felt that this role had absorbed them enough to lose their sense of independence and personal space. Loss in the sense of company: 50% of interviewed caregivers reported a negative impact in terms of the company their demented spouses used to give them. Sexuality: Changes in sexual performance, as well as reduction in the number and quality of their sexual encounters were reported by 49% of the caregiver spouses. Changes in previous roles: for 15% of the spouses interviewed, there were changes in previously established roles, caregiver wives referring they had to
P725
assume the economics and administration of the house, while caregiver husbands took charge of domestic chores. Conclusions: This investigation adds qualitative knowledge regarding the patient-caregiver dyad in the conjugal context, determining that the main changes in the relationship associated with the onset of dementia are the decrease in social activities and the loss of both individual space and sense of company. Assessing these eventual changes in the marital scenario will enhance our comprehensive care of the demented patient.
P3-247
VALIDATION STUDY OF THE MINI-MENTAL STATE EXAMINATION IN THE URDU LANGUAGE FOR A PAKISTANI POPULATION
Safia Awan, Aga Khan University Hospital, Karachi, Pakistan. Contact e-mail: [email protected] Background: This study was conducted primarily to validate and determine the optimal cutoff score in the diagnosis of dementia among Pakistani’s and study the effects of gender and education on the MMSE performance in our population. Methods: Four hundred participants took part in the study. Of these, 100 were dementia patients and 300 were non-dementia participants. Patient with dementia recruited from five major hospitals from Pakistan. The MMSE was translated into Urdu. In order to determine the optimal cutoff scores, the sensitivity and specificity were calculated. Results: There were 61 men and 39 women in dementia group and 225 men and 75 women in the control group. The mean score of Urdu MMSE were lower in patients with dementia 18.5 6 5.6 (range 0-30) as compared to the controls 26.8 6 2.6 (range 7-30). This difference between groups was statistically significant (p<0.001). Subjects with illiterate and up to 10 grades had significantly lower mean scores in patients with dementia group compare to those with higher education (p<0.001). Conclusions: These finding confirm the influence of level of education on MMSE score and education stratified cutoff scores should be used while screening for cognitive impairment in this population.
P3-248
WHERE THE RUBBER HITS THE ROAD: PARTNERING WITH DEMENTIA CAREGIVERS IN INTERVENTION DESIGN AND IMPLEMENTATION
Philip D. Sloane1, Anna S. Beeber2, Lisa P. Gwyther3, Bobbi Matchar3, Sheryl Zimmerman2, 1UNC-CH, Chapel Hill, NC, USA; 2Univ of NC-Chapel Hill, Chapel Hill, NC, USA; 3Duke University, Durham, NC, USA. Contact e-mail: [email protected] Background: Family caregivers are often the first to respond
when people with dementia develop medical problems such as cough or leg swelling; however few caregiver resources are available to help them address these issues. Methods: As part of an NINR-funded study of caregiver management of medical symptoms, an advisory group of caregivers of persons with dementia was convened to identify needs around medical symptoms and to work with an interdisciplinary professional team to develop and evaluate resources for caregivers in the management of medical symptoms and co-morbid illness. This study examined the process of partnering, including changes in plans (compared with grant proposal), process of
P726
Poster Presentations: P3
partnering, and results of field testing of the developed product. Results: The advisory panel consisted of 9 family caregivers that varied according to length of caregiving experience, type and severity of the care recipient’s dementia, gender, relationship to care recipient (spouse/child), and demographics. They met monthly for nine months to advise the team on the format (website), design, and content. Changes and innovations introduced due to caregiver input included inclusion of behavioral symptoms as well as traditional biomedical ones, addition of an “if you need to act fast” section under each symptom, a downloadable one-page health summary, and a section on dealing with the health care system. To field test the materials, 18 caregivers were recruited for an 8-month trial. Thirteen (76%) of the pilot participants rated the website as extremely easy to use, 15 (88%) thought the website was easy to understand, 12 (71%) thought it was an excellent resource, and 18 (100%) would recommend it to a friend or relative. Conclusions: Partnering with family caregivers in the design and implementation of interventions such as the Alzheimer’s Medical Advisor can help create resources that are relevant and user friendly. Furthermore, the use of a family caregiver advisory panel has vast implications to the design of future studies aimed at assisting family caregivers with the management of day-to-day challenges. P3-249
INCIDENT DEMENTIA, SUBCLINICAL, AND CLINICAL CORONARY HEART DISEASE IN OLDER INDIVIDUALS: THE CHS COGNITION STUDY
Lewis H. Kuller, Oscar L. Lopez, James T. Becker, Anne B. Newman, Yuefang Chang, University of Pittsburgh, Pittsburgh, PA, USA. Contact e-mail: [email protected] Background: Success in preventing coronary heart disease (CHD) and improved survival after a heart attack and stroke has produced a recent increase in longevity. There is a delay in age of first heart attack, especially for women (now age 72) but more prevalent clinical CHD with recurrent myocardial infarction, congestive heart failure (CHF), and atrial fibrillation. Improved survival has resulted in a larger population of very elderly (age 80+) at risk of dementia. Methods: We evaluated the relationship between CHD and dementia in the Cardiovascular Health Study-Cognition Study (CHS-CS) from 199899 to 2011-12 among 532 participants mean age of 79. By 2011, 69% of the men and 62% of the women were deceased and 58% of the men and 65% of the women had incident dementia. Results: The incidence of CHD and dementia increased with age. Dementia incidence among women was much higher than CHD incidence; 65/1000 person-years (PYs) for dementia versus 21/1000 PYs for CHD. Among men, the incidence of dementia was also higher than CHD but only after the age of 80: 123/ 1000 PYs dementia versus 55/1000 CHD. The primary determinants of CHD and total mortality were measures of clinical and subclinical vascular disease, including coronary artery calcium (CAC), highly sensitive cardiac troponin, and N-terminal probrain natriuretic peptide. Women with very low CAC had reduced risk of dementia (not significant). Risk factors for dementia were IQ, higher education, higher hippocampal volume and the size of lateral ventricles (measures of brain neurodegeneration), cognitive test scores in 1991-92, number of blocks walked per week,
and apolipoprotein-E4. Participants who had incident CHF and stroke had increased risk of dementia. Conclusions: The reduction in CHD and total mortality and greater longevity, especially for women, results in a larger population at risk for dementia. The most important question is whether women with little coronary atherosclerosis at older age with greater longevity have also a reduced risk of dementia.
P3-250
HAPTOGLOBIN GENOTYPE MODULATES THE RELATIONSHIPS OF GLYCAEMIC CONTROL WITH COGNITIVE FUNCTION IN ELDERLY INDIVIDUALS WITH TYPE 2 DIABETES
Elizabeth Guerrero-Berroa1, Ramit Ravona-Springer2, Anthony Heymann3, James Schmeidler4, Andrew Levy5, Derek Leroith6, Michal Beeri6,7, 1The Icahn School of Medicine at Mount Sinai, NY, NY, USA; 2Department of Psychiatry and The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel; 3Department of Family Medicine, University of Tel Aviv, Tel Aviv, Israel; 4The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5Technion, Haifa, Israel; 6Icahn School of Medicine at Mount Sinai, New York, NY, USA; 7Sheba Medical Center, Tel-Hashomer, Israel. Contact e-mail: [email protected] Background: Elderly individuals with type 2 diabetes are at
increased risk for cognitive compromise and dementia, with genetic factors and poor management of type 2 diabetes among possible underlying causes. Haptoglobin 1-1 (Hp 1-1) and poor glycaemic control have been associated with poor cognitive function. The possible involvement of the Hp genotype in the association of glycaemic control with cognition have not bee examined. Thus, the purpose of this study was to investigate whether the association of glycaemic control with cognitive function is modulated by Hp 1-1 in cognitively normal elderly with type 2 diabetes. Methods: We examined 793 participants who were genotyped for Hp (80 Hp 1-1 carriers and 713 Hp 1-1 non-carriers) enrolled in the Israel Diabetes and Cognitive Decline (IDCD) study. Glycaemic control was operationally defined by HbA1c level. The outcome measures were performance in four cognitive domains (episodic memory, attention/ working memory, language/semantic categorisation, executive function) and overall cognition, a composite of the domains. Effect sizes were obtained from hierarchical linear regression analyses for each outcome measure, controlling for demographics, type 2 diabetes-related characteristics, cardiovascular risk factors, and their interactions with Hp genotype. Results: Interaction analyses showed significantly stronger associations of HbA1c with poorer cognitive function among Hp 1-1 carriers than noncarriers; attention/working memory (p < 0.001) and overall cognition (p ¼ 0.003). For these two cognitive domains, associations were significant for Hp 1-1 carriers despite the small sample size (p < 0.00001 and p ¼ 0.001, respectively), but not for noncarriers. Conclusions: Our findings suggest that patients with type 2 diabetes and poor glycaemic control carrying the Hp 1-1 genotype may be at increased risk of cognitive impairment, particularly in the attention/working memory domain. The association of glycaemic control with this domain may indicate cerebrovascular mechanisms. The findings presented in this abstract are cross-sectional. At the AAIC, 36-months longitudinal data will be presented.