334extrapyramidal symptoms and signs in Alzheimer's: Prevalence and correlation with neurological findings

Poster Presentation:

s94

piBJ

INCREASING ONE-ON-ONE

THE RELEVANCE OF DISCOURSE THROUGH CONVERSATION IN ALZHEIMER’S DISEASE

14251DONEPEZIL TO SEVERE

Clinical Research II

TREATMENT IN PATIENTS WITH MODERATE ALZHEIMER’S DISEASE REDUCES CAREGIVER

STRESS Ruth M Tappen.

Patricia

B Kronk,

Florida

Atlantic

Univ,

Boca Ruton,

FL

Bruno Vellas, The progressive communication dysfunction of Alrheimer’s Disease (AD) is well documented hut few interventions to improve communicative function have been proposed or tested for their efficacy in clinical settings. In this Ftudy, a three-group repeated measures design with randomized assignment to treatment group, and raters blended to treatment group assignment, was utilized to test the effectiveness of regularly scheduled one-on-one conversation sessions with nursing home resident? wtth Alzheimer’s Disease. The conversation approach which was based on Holland’s recommended treatment of newly aphasic stroke patients was compared to activity and a combination of activity and conversation. All subjects received treatment 3 times a week for 30 minutes per session. The mean age of this sample was 87: thetr mean Mini-Mental State Examination score was I I .05 with a range of 0 to 23; and 85% were female. All were prescreened for a clinical diagnosis of probable AD using NINCDS-ADRDA criteria. A timed Picture Description Test developed by Bayles and Tomoeda was used to evaluate changes in oral dlxourae from pretest to posttest. Analysis of covariance controlling for baseline scores indicated a significant (F (3,5 1) = 16.44 p = .0002) decline in total number of words used over the four month treatment period across groups. However, subjects engaged in conversation declined only half as much on average as those engaged in activity (2’2% vs 50%). In addition, the mean number of information units (relevant content) produced on average by subjects in the one-on-one conversation treatment group increased by 10% while it declined significantly in the other groups (F (3,51) = 3.34 p = .04). Similarly. conciseness scores improved for the conversation group but declined for the others (F (3,5 I ) = 5.04, p = .Ol). In conclusion, it appears that some of the communication dysfunction may be due to excess disability that can be reduced through interventions buch as the one-on-one conversation approach ured in this rtudy. Further testing of various approaches is recommended.

p%iJ Mugdu Univ.

334EXTRAPYRAMIDAL MER’S : PREVALENCE LOGICAL FINDINGS

Tsolaki, MO

Konstantmu

Koknrida,

SYMPTOMS AND SIGNS IN ALZHEIAND CORRELATION WITH NEURO-

Aristides

D Kazis,

Vow

Iucovidou.

Vancouver Ctr for Daw

Toulouse

Hasp

Univ

& Health

Study on Aging,

ParkAustrulia:

Acad

Sci Ctr,

Verdun,

Ctr,

Albuquerque,

Vancouver,

PQ Cunada;

Pnnni Subbiah.

NM;

BC Canada; Jane Hecker,

Ed Whalen,

Pfizer

Howard

Feldman,

Serge Gauthier, Reputriation

Pharmuceuticuls

McGill

Gen Hasp, Group,

New

York, NY

Strategies to ameliorate stress experienced by caregivers of Alzheimer’s disease (AD) patients are likely to improve patient and caregiver quality of life and delay inrtitutionalization. To investigate this further, caregiver stress was assessed using the Caregiver Stress Scale (CSS) as part of a 24-week, double-blind, placebo-controlled tnal of donepeztl in moderate to severe AD. Patients from 32 centers were randomized to either donepad (5 mglday for 28 days followed by 10 mglday as per the clinician’s judgement, n= 144) or placebo (n= 147). Analyses were performed to ascertain whether baseline and changes in stress scores were associated wtth patient scores on the Severe Impairment Battery (SIB). Disability Assessment for Dementia (DAD), Neuropsychiatrlc inventory (NPI) and Functional Rating Scale (FRS). Baseline demographics were similar between the treatment groups (mean age: 73.6 years, range: 48-92; mean sMMSE scores: I I .8 ? 3.6 and 12.2 + 3.8 for donepezil and placebo groups, respectively). CSS mean change from baseline scores showed statistically significant benefits in favor of donepezil over placebo at Weeks 12 and 24 (ITT OC, p
Aristotle

Grerce

334The objective of this study was to examme the prevalence of extrapyramidal signs (EPS) in patients with probable Alzheimer’\ diseax and to determine the relationship between the presence of EPS and the neuropsychological findings in these pattents. Eighty seven patients were examined by a neurologist of the Memory Department in the 3rd Neurological Clinic of Aristotle University of Thessaloniki because of progressive cognitive decline. We also examined 25 age and sex comparable healthy subject7 with no history of neurological or psychiatric disorder and no past or present intake of drugs that could produce EPS. Characterization of dementia into two categories (mild to moderate and severe) was based on an interview with the patient and a neuropsychologtcal evaluation with the Mini Mental State Examination (51 patients with MMSE score over I I and I9 patients with MMSE score less than I I). Unified Parkinson’s Disease Rating Scale and the Extrapyramidal Symptom Rating Scale were used for detection of EPS. Only 7 patients (10%) were free of EPS, while the respective percentage of the control group was 56%. The most common type of EPS found in patients with probable A.D was: hypominia (60%, while in the control group the respective percentage was 12%). Fpeech disorders (57% in patients, 10.67% in the control group), bradykinesia (52.86% in patients, 12% in the control group). abnormal gait portural instability (56% in patients, 12% in the control group). rigidity (36% in patient\. 48% in the control group). walking difficulty (35.24%in patients, 13.32%in the control group). No significant dlfferencer were found while examining the presence of reyting tremor, other tremors, dyakinesia\ and dystonia. The severity of EPS manifestations wac found to be related to the degree of cognitive mpairment. The prevalence of EPS was Ggnificantly higher in the subgroup of patient\ with severe dementia. 334 In conclusion, the study showed a specific association between AD. and the presence of EPS, as well as significant relationship between the vzverity of dementia and the prevalence and severity of EPS.

p%J Michel

USE OF THE SEVERE IMPAIRMENT BATTERY IN A CLINICAL TRIAL OF DONEPEZIL IN MODERATE TO SEVERE ALZHEIMER’S DISEASE Pmissrt.

McGdl

Feldmnn,

Vunwuwr

Gauthirr.

McGill

Repatriation Albuquerque,

Gm NM;

Ctr for

Hasp Ctr

for

Hosp. Daw Ponni

Study

&

Health

Study

on

on Aging, Sci

Aging.

Pm-k Australia:

Subbiuh,

Ctr,

Verdun,

Verdun. Bruno

Ed Whulen.

PQ

Vancouver, PQ

Vellur.

Pfizer

Cunadu;

BC Canudrr;

Toulouse

Phurnruceuticals

Howard

Cmadu: Jane

Srrge Hr(,ker.

Univ Acad Ctr. Group.

New

York, NY

Cholineaterase (ChE) inhibitors have been shown to slow cognttive decline in patients with mild to moderate Alzheimer’s disease (AD). However, data to support their possible benefits in more advanced AD have been limited to date. This sub-analysis of a 24.week, double-blind, placebo-controlled trial of donepezil investigated the use of the Severe Impairment Battery (SIB) compared with the atandardiad Mini-Mental State Examination (sMMSE) to detect cognitive change in moderate to severe AD patients. Patients from 32 centers were randomized to either doneperil (5 mg/day for 28 days followed by IO mg/day as per the clinician’s judgement, n= 144) or placebo (n= 147). Patients were analyred by severity subgroups, as having moderate (\MMSE 12-17, “~170) or severe (sMMSE <12, n=120) AD at baseline. Baseline demographics were similar between the treatment group!, (mean age: 73.6 years, range: 48-92; mean sMMSE scores: Il.8 -C 3.6 and 12.2 + 3.8 for donepuil and placebo groups, respectively). Baseline demographics were also similar withm each severity subgroup. At Endpoint (Week 24 ITT LOCF), treatment differences in sMMSE mean change from baseline scores showed an improvement for donepezil compared with placebo of 2.13 points (p