AAGP Annual Meeting 2008, March 14–17, 2008, Renaissance Sea World, Orlando, Florida

2008 AAGP Annual Meeting

AAGP Annual Meeting 2008 March 14 -17, 2008

Renaissance Sea World Orlando, Florida

Session Abstracts Friday, March 14, 2008 AAGP PRESIDENTIAL PLENARY AND AWARDS DINNER YEAR IN REVIEW Guy s. Moak, ~IDI 1University

ofMassachusetts Medical School, Worcester, :MA

MEDICINE AND TOXICITY: DOSE AND INTENT Bruce G. Pollock, :MD, PhD, FRCPCl

lThe Rotman Research Institute, Baycrest Centre for Geriatric Care Abstract: Patients older than age 65 currendy represent 120/0 of the population, yet they receive 400/0 of all prescription drogs and disproportionately suffer &om unwanted and unexpected adverse effects of medications. Psychotropics are the second leading class of medications responsible for preventable adverse drug events (ADRs) in elderly patients. Drug-Drug interactions, age-associated physical comorbic1ity, cognitive impainnen~ and pharmacokinetic or phaanacodynamic changes prevent the "simple" extrapolation to the dderly of data acquired in younger patients. It is also important to appreciate that the side effect profile of newer medications in the old may differ &om younger, healthier patients typically included in regulatory clinical trials. For example, age-associated concerns with antidepressant and antipsychotic use, such as effects on cognition, balance, hyponatremia, bone loss and mortality oo1y emerged after substantial clinical experience in a geriatric population. The dearth of basic information regarding these medications in frail older patients is unfortunate. The under-representation of typical elders in clinical trials occurs even for diseases that almost exclusively affect older people and has created a public health crisis. An improved understanding of dmg concentratt011 heterogeneity and response relationships would help predict and plevent ADRs and improve thetapeutics. In addition, to reviewing pertinent research, this lecture will stress how the i\.AGP is taking leadership in this area to improve the care of our patients. NEW BRAINS FOR OLD? THE FUTURE OF THE 21ST CENTURY MIND Baroness Susan Greenfield, CBRI 1Royal Institution

of Great Britain and the University of Oxford

Saturday, March 15, 2008 7:30 AM - 9:30 AM DEPRESSION AND COGNITIVE IMPAIRMENT: TWO DISORDERS OR ONE? Steven Roose, MD. ',.Jose Luchsinger, M.D., MP.H. 2, Gary Small, MD. 3, D. P. Devanaod, MD. 4 College of Physicians and Surgeons, Columbia University, New York, NY College of Physicians and Surgeons, Columbia University, New York, NY 3 David Geffen School of Medicine at UCLA, UCLA Center on Aging, Los .Angeles, CA .. College of Physicians and Smgeons, Columbia University, New York, NY 1

2

Abstract: We live in an aging society. By 2020, 300/0 of the population will be over the age of 65 and the most rapidly growing segment of the population is people over the age of 85. Therefore, illnesses that are prevalent in a late-life population will be an ever-

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2008 AAGP Annual Meeting increasing public health concem. Two of the most prevalent and devastating disorders in late life are depression and dementia. Traditionally, disorders of cognition and mood in the elderly have been considered separate entities that may frequently co-occur in late-life. Comorbidity was thought to be due to the high prevalence of both disorders in this population rather than reflect an intrinsic relationship between pathological processes, e.g., one illness is a risk factor for the development of the other. Recendy, different types of data strongly suggest that we must revisit the relationship between depression and dementia in late life. For example, epidemiological studies of community dwelling late-life populations strongly suggest that depression is a risk factor for the development of dementia. Studies of patients with depression and cognitive impairment report a high rate of conversion to dementia even if the depression has been adequately treated. Memory and mood disorders can no longer be considered distinct entities in late life. Recent epidemiological, genetic, imaging and patho-physiological studies illuminate the complex, multi-faceted association between these disorders. A more developed, nuanced model ofneuro-psychiatric disorders in late life necessarily leads to the possibility of more effective treatment strategies to minimize the impact of these devastating illnesses. This program was supported by an educational grant from Forest Research Institute. a division of Forest Pharmaceuticals, Inc.

EMERGING FROM THE ANGUISH: PROXIMATE ISSUES OF CO-MORBID INSOMNIA IN LATE-LIFE DEPRESSION George S. Alexopoulos!, M.D., David G. Halper, Ph.D., James M. Ellison3, ~(.D., M.P.H. The physiologic regulation of sleep will be briefly reviewed, as well as the nature of sleep in the elderly and changes in sleep due to depression. Proper treatment of depression and insomnia will be discussed, including long-tetm data for use of antidepressants and other pharmacologic therapies, new and upcoming therapies for treatment, as well as non-pharmacologic therapies. 'Weill-Comell Institute of Geriatric Psychiatry, White Plains, NY

2McLean Hospital, Belmont, :MA

3McLean Hospital, Belmont, MA

This program was supported by an educational grant from Novartis Pharmaceuticals Corporation.

10:30 AM - 12 Noon RESEARCH AWARD WINNERS' PAPER SESSION NICOTINIC VERSUS MUSCARINIC BLOCKADE ALTERS VERBAL WORKING MEMORY-RELATED BRAIN ACTIVITY IN OLDER WOMBN (Barty Lebowitz Junior Investigator Award) Julie A. Dumas, Ph.D) 'Clinical Neuroscience Research Unit, Department ofPsycbiatry, University ofVennont College of Medicine Objectives: An important aspect of furthering our understanding of the CNS function after menopause is to examine the cerebral circuitry that appears to be influenced by cholinergic antagonist drugs in the presence and absence of estrogen. This pilot study investigated the effects of two anticholinergic drugs on brain activation and working memory perfonnance in postmenopausal

women not taking estrogen. This approach simulates the effects of age- or disease-related neuroreceptor and/or neuronal loss by temporarily blocking pre- and postsynaptic muscarinic and nicotinic cholinergic receptors. ~: Six healthy postmenopausal women took part in three drug challenges using the anti-nicotinic drug mecamylamine (MECA, 20 mg, oral), the anti-muscarinic drug scopolamine (SCOP, 2.5IJ.g/kg, 1'7), and placebo during flvfRI. The cognitive measure was a visually presented verbalN-back test of working memory. Results: Neither MECA nor seop significandy impaired perfonnance on the verbal N-back. Functional MRI results showed greater increases in frontal lobe activation in the placebo condition relative to each drug condition with different specific regional activation for ~CA and SCOP. ConclusioQs: These preliminuy results suggest that brain activation pattems are sensitive to cholinergic modulation in posbDenopausal women and that differential effects may be observed following nicotinic venus muscarinic blockade. This approach offers a potentially valuable method for modeling age-related changes in brain function, and the findings may have implications for cholinergic contributions to normal and pathologic aging.

FACTORS AFFECTING QUALITY OF LIFE IN A MULTIRACIAL SAMPLE OF OLDER PERSONS WITH SCHIZOPHRENIA (Member-In-Training Research Award) Azziza o. Bankol~ M.D.1 ] State University of New York, Downstate Medical Center, Brooklyn, NY

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2008 AAGP Annual Meeting Rationale: There have been few studies of quality of life (QOL) in older schizophrenic adults. We employed an adaptation of Lehman's QOL model to examine factors that impact QOL in a multi-racial urban sample of older schizophrenic persons. Methods: The schizophrenia (S) group consisted of 198 persons aged 55+ living in the community who developed schizophrenia before age 45. A community comparison (q group (n=113) was recmited using randomly selected block-groups in which we attempted to intemew all persons age 55+. The questionnaire consisted of 23 scales that assessed psychiatric and physical health and functioning, cognition, service use, treatment, and various psychosocial indices. The QOL model consisted of 4 variable sets (demographic, objectiv~ clinic~ and subjective) comprising 19 independent variables. The dependent variable was the Quality of Life Index (QLI)- Results: The S group had a significandy lower QLI score than the C group (21.7 vs. 24.2; t=-5.36, DF =362, p= .(01). Within the S group, in bivariate analysis, 13 of 19 variables were significantly related to QLI. In regression analysis, 6 variables attained significance, viz., fewer depressive symptoms, more cognitive deficits, fewer acute life stressors, fewer medication side effects, lower financial strain, and better self-rated health. The model explained 55% of the variance in QLI, with the demographic, objective, psychiatric illness, and the subjective variable sets accounting for 6%, 35%, 9%, and 5% of the variance, respectively. Conclusions: Our findings confinned earlier reports that older persons with schizophrenia had a lower self-reported quality of life than their age matched peers. Our findings suggest that many of the factors impacting on QOL are potentially ameliorable and thereby provide an opportunity to enhance the well-being of this population.

GROUP THERAPY IN THE ELDERLY: EXPERIENCES WITH A STRUCTURED OUTPATIENT PROGRAM (SOP) Marc Agro~ M.D.', Dana Ryder, B.S.2, Shyla Ford, L.C.S.W. 3 1 Miami Jewish Home & Hospital for the Aged, ~ FL 2?vfiami Jewish Home & Hospital for the Aged, Miami, FL 3l\.fiami ] ewish Home & Hospital for the Aged, Miami, FL

Abstract: Group therapy for older adults can offer several distinct advantages over individual therapy, including: (1)structured socialization with peers; (2)normalization of age-associated problems and the process of sharing them with others; and(3)the opportunity with both peers and a group leader to give and receive feedback and positive reinforcement. Although there is empirical support fat a variety of group therapy modalities in late life, a structured, psychoeducational approach is often the most practical approach. The latter approach provides a comfortable and non-threatening environment for individuals new to psychotherapy, and offers practical infonnatioQ and strategies for individuals to implement outside of the group. The program is also designed to provide extra orientation cues and mentally stimulating exercises for individuals with mild cognitive impairment and apathy - two frequently encountered conditions in geriatric patients. In this symposium, we will present the design, implementation, and clinical experience running a daily structured outpatient program. or SOP for older individuals with mood, anxiety, adjustment, and personality disorders that have not fully responded to individual and/or psychopharmacological therapy. Our SOP program, caned "New Beginnings," is run in the outpatient mental health clinic at the Miami Jewish Home & Hospital for the Aged, Florida's lugest long-term care facility. It is comprised of two 50 minute back-ta-back group therapy sessions, separated by a 10 minute refreshment break. In addition to reviewing both the theory and practical aspects of the SOP model, including appropriate staffing, we will discuss diagnostic, therapeutic, and functional issues posed by the SOP's participants. This information will be presented by the program's director, therapist, and medical director.

INNOVATIVE RESEARCH IN CROSS-CULTURAL GEROPSYCHIATRY. M.S.2, Ge (Gail) ~ M.D., Ph.D.3, Lori Jervis, Ph.D.", Iqbal Ahmed, M.D.s,

John de Figueiredo, 1\I.D., Sc.D.I, Rajesh Tampi, M.D.~ Maria llorente, MD.' 1 Yale

University School of Medicin~ Cheshire, CT University School of Medicine, Cheshire, CT 3 University of Washington, Seattle, WA " University of Colorado Health Sciences Center, Auro~ CO 5John A. Bums School of Medicine at the University of Hawaii, Honolulu, HI 6 University Of Miami; I\fiami VA Healthcare System, Miami, FL 2 Yale

Abstract: The United States is a pluralistic and multiethnic society. The growth tate of cultural minorities is increasing, At the same time, minorities have difficulty at obtaining high quality mental health services, particuularly among the elderly_ This symposium wiD focus on cultural aspects of presentations of mental disorders, the doctor-patient relationship, and intetpretations of stressors. Issues to be examined will include biases in diagnosis, choice of medication, dosing, and recognition of advetSe effects. Some of these issues will be illustrated in two studies, one on cognitive test performance among older American Indians and the other on a

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2008 AAGP Annual Meeting comparison between two elderly groups, Chinese Americans in Seattle, Washington and Chinese residents of Beijing, China for dementia and depression.. UNDERSTANDING AND MANAGING AGGRESSIVE BEHAVIORS IN GEROPSYCHIATRIC PATIENTS

Helen Kyomeo, 1\lD., M.s. 1, Randy Nelson, PhD.2, Nhi-Ha Trinh, MD.3, Theodore Whitfield, SeD:', Barry Lebowitz, Ph.D.5 I

McLean Hospital, BelmoQt, MA

2 Ohio

State University, Columbus, OH

3 Massachusetts

General Hospital, Boston, lvIA Massachusetts General Hospital, Boston, IvIA 5 University of California - San Diego, La Jolla, CA

4

Abstract: Aggressive behavionl disturbances are extremely complex and can occur in relation to many situations and conditions in geropsychiatric patients. Aggressive acts can be overtly verbally, physically, or sexually intrusive, resistive in nature, and dit:ected extemally or at oneself. They can arise from perceived adaptive needs, conflicts, fear, pain, stress, or loss of impulse controL Intent to harm or damage has traditionally been associated with aggression, but this concept may not always be germane, for example, in patients with severe delirium or dementia. Aggressive behaviors can occur as a component of virtually all neuropsychiatric conditions: anxiety, mania, depression, psychosis, personality disotden;, substance abuse/dependence, deliriUOl, brain damage and neurodegenemtive conditions. Associated affective and behavioral manifestations include emotiooa1lability, behavioral disinhibition, irritability, and agitation. Aggressive behaviors can be difficult to manage, may lead to early institutionalization, self-injury or hann to others, increase patient disability and caregiver burden, and raise healthcare costs. Evidence-based treatments of aggressive behaviors in elderly geropsychiatric patients are limited. .L\nd many elderly patients may not tolerate medications that often are used to manage aggressive behaviors. Still, antipsychotics, anticonvulsants, sedative/hypnotics, lithium, serotonergic agents, nootropic dmgs, betaadrenergic blockers, and calcium channel blockers, in addition to psychosocial therapies and behavioral methods, are used empirically to manage these di.fficult behaviols in geropsychiatric patients. In this symposium, speakers from basic science and clinical research perspectives will discuss (1) various models for the neurobiological basis for aggressive behaviolS, (2) the prevalence of aggressive behaviors in geropsychiatric patients and the clinical, financial, and ethno-cultural impact of these behaviors on the healthcare system, and (3) the evaluation and management of aggressive behaviors in geropsycbiatric patients.

TROUBLESHOOTING EDUCATIONAL CHALLENGES IN THE GERIATRIC PSYCHIATRY FELLOWSHIP Lewis Krain, ~'!.D", 1\fark Lyubkin, MD.2, SusanIvlaixne~ ?vI.D.3, Loman Lin, M.D.", Esther Akinyemi, MD.S University of Arkansas for Medical Sciencest Little Rock, AR of Michigan, i\no Arbor, ~n 1 University of Michigan, .Ann Arbor, MI I

2 University

4

University of Michigan, ~o\nn Arbor, MI of Michigan, .Ann Arbor, MI

5 University

Abstract: The geriatric psychiatry fellowship can be a challenging teaching environment. The body of knowledge required for clinical mastery is large and complex, and demonstrating clinical competency to meet evolving RRC standards can be even more confusing. Moreover, given the fellows' advanced level of training, it can be difficult to match the curriculum to 611 the individual knowledge gaps. Additionally, there is a great deal of diversity in clinical style and approaches to geriatric psychiatry among different programs an.d faculty. Training a new generation of clinicians is veIY difficult when each faculty member in the department has different ideas about the "essential)' reading material, cognitive assessment tools, and clinical techniques needed to be an expert in the field This symposium will address these issues by presenting some strategies for troubleshooting and standardizing the educational cuaicu1um in a geriatric psychiatry fellowship program. We will present suggestions for a standardized reading list and bedside cognitive testing EXIT, CLOX, and SLUMS). We will discuss strategies for effective clinical supervision, battery (reviewing tests such as the ~rsE. techniques for assessment of clinical competency, and strategies for curriculum development. This content will come from the experience of two fellowship programs (one well-established and one newly implemented) as well as the feedback and resultant email discussion from our AA.GP symposium last year. We will also view these issues from the perspectives of trainees currently in geriatric psychiatry fellowships. In addition to this presented material, we will spend a portion of the time in group discussion with attendees. This will give the attendees an opportunity both to present real-world problems experienced in their own fellowships, as well as to share solutions and strategies not covered in our presentation. We hope to create a forum for geriatric psychiatry educators to shue their experiences so that each program does not have to "reinvent the wheel'" in its approach to common problems and

challenges.

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2008 AAGP Annual Meeting LATB LIFE SCHIZOPHRENIA RESEARCH: CUNICAL, ETHICAL, AND TRANSLATIONAL APPROACHES Jovier Evans~ Ph.D.!, Barton Palmer, Ph.D.2, Lisa Eyler, Ph.D.3,John Kasckow, M.D., Ph.D."'

National Insatue of Mental Health, National Institutes of Health Bethesd~ ofCalifomia, San Diego, La Jo~ CA 3 University ofCalifo~ San Diego, La]olla, CA 5 VA Pittsburgh Health Care System, Westem Psychiatric Instinne I

?vID

2 University

Abstract: Recent controversies surrounding effective treatment for people with schizophrenia highlight the need for more research into both better clinical treatments as well as more mechanistic studies to understand both the pathophysiology and mechanism of action of potential therapies. Couple these concerns with safety issues of atypical medications for the elderly and other medical comorbidities in late life argue for more research in older adults with psychotic disorders. This symposium will highlight some of the

work supported by the National Institute of Menta! Health (NIMH) in this area across a wide spectrum of translational research. Specifically, 1) Empirical work examining competency to participate in research and treatment. 2) A summary of existing neuroimaging studies of late-life schizophrenia and of the association between age and brain SUUetule and function among patients. and 3) A randomized clinical trial of an SSRI for depressive symptoms in a sample of older adults with schizophrenia. This will be fonowed by a discussion of future opportunities for researh in this area that would be of particular interest to the NIMH. CARDIOMBTABOLIC SYNDROMB: PREVENTION, INTBRVENTION, AND INTEGRATED MEDICAL CARE Stephen Bartels, M~D., M.S.l,]ohn Newcomer, ~f.D.2, David P. Folsom, M.D~, M.P.H.3, Sarah Pratt, Ph.D:', Christine McKibbin,. Ph.D.s 1 Dartmouth

Medical School, Lebanon, NH

2Wasbington University School of Medicine, St. Louis, MO 3 University of California - San Diego, La Jolla, CA .. Dartmouth Medical School, Lebanon, NH 5 University of Wyoming, Laramie, WY

Abstract: Alarming results from a recent multi-state study found that persons with schizophrenia and other serious mental illness (SMI) have a 25-year shorter lifespan compared to persons without a mental illness. Remarkably the most common cause of mortality was not due to suicide, but instead due to cardiovascular disease. Recent research shows that persons with S~fi are less likely to receive routine screening and health care for common disorders including hypertension, heart disease, and diabetes. An epidemic of obesity among persons with serious mental illness has also been associated with a combination of lifestyle and treatment with atypical antipsychotics. Federal, state, and professional organizations are have identified this "epidemict ' of obesity and cardiometabolic syndrome in persons with S:MI as a public health priority. This symposium will provide an overview of current research on the causes of cardiometabolic syndrome and outcomes for integrated prevention and intervention. First, Dr. John W. Newcomer will present results of current research on the relationship between adiposity and insulin sensitivity in patients and controls, and the effect of antipsychotics and mood stabilizers on adiposity, insulin sensitivity, hyperlipidemia, and risk for diabetes and cardiovascular disease in persons with schizophrenia. Second, Dr. Dilip Jeste will present data from an ongoing study of cerebrovascular, cardiovascular and metabolic results of atypical antipsychotics, in an Rot study randomly assigning older adults to one of four atypical antipsychotics. Third, Dr. Steve Bartels will present 2 year outcomes results from a 3 year ROt ReT evaluating health outcomes of an integrated model of nurse health management and skiDs training self-management intervention for persons age 50 and older with SMI. Finally Dr's Sarah Pratt and Christine McKibbin will co-present results from 2 ongoing pilot studies of exercise and dietary interventions in addressing obesity in persons with SMI. Drs Jeste and Newcomer will discuss the implications for clinical practice.

12:15 PM - 2:15 PM MODERATORS OF RESPONSE TO ANTIDEPRESSANTS AND PSYCHOTHERAPY IN LATE LIFE DBPRESSION. J. Craig Nelson, I\I.D.l, Scott Mackin, Ph.D.2, Patricia Arean, Ph.D. 3 1 University

of Califomia San Francisco, San Francisco, CA of Califomia San Francisco, San Francisco, CA 3 University of Califomia San Francisco, San Francisco, CA 2 University

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2008 AAGP Annual Meeting Abstract: Depression is common in late life and as the population ages, and the number of older adults grows, depression will become a major mental health problem. Both antidepressants and psychotherapy have been shown to be effective in late life depression (I.LD); howeve~ in many trials the difference between the specific treatments and non-specific supportive interventions identification of factors that moderate and predict response to treatment in un may hdp to guide treatmeot is small .L~S a tesul~ selection. Craig Nelson, M.D. will present a meta-aoalysis of antidepressant studies in late life depression. .Although these trials used similar outcome measures and had relatively similar designs, the analysis demonstrated significant heterogeneity. This suggests differences in patient characteristics may have affected outcomes. Dr Nelson will present preliminary data examining the effect of some of these characteristics on antidepressant response. One of the variables that has been reported to influence outcome in un is executive dysfunction (ED). Yet, ED is just one of several types of cognitive dysfunction that occurs in LLD. Scott Mackin, Ph.D. will review commonly utilized diagnostic criteria for ED and other fonns of specific cognitive impairments, the incidence of specific Depressive Disorde~ and the neuropsychological tests commonly used types of cognitive impaianent among older adults with ~lajor to define these impainnents. He will examine the incidence and severity of these impaianents observed in a prospective psychotherapy trial He will also present preliminary findings relating these various cognitive impairments to outcome and brain imaging findings.. Pat Arean, PhD.. will. review the evidence base for psychotherapy in late life depression. She will describe a preliminaty study exploring the efficacy of Problem Solving Therapy in un patients with ED and then report on a recent federally funded prospective study of PST in un patients with ED.. She will also provide a preliminary look at factors that moderate response to PST. At the conclusion of the symposium the participants should be familiar with factors that moderate antidepressant and psychotherapy treatment response in LOD and be able to apply these findings to help guide treatment selection. This program was supported by an educational grant &om Eli Lilly and Company.

DEMENTIA: TRANSLATING LATEST FINDINGS TO MEET TODAY'S MANAGEMENT CHALLENGES Martin Rhys Farlow, MD.t, Adam Rosenblatt, M.D.2, Paul B. Rosenberg, .0.1 Jeffrey L. Cummings, MD.4 I

Indiana University School of Medicine, Indianapolis, IN

2 Johns

Hopkins University, Baltimore, MD Hopkins University, Baltimoret :MD .. David Geffen School of lvIedicine, University of California-Los ,,\nge1es, Los i\ngelest 3 Johns

C~

Abstract: Acetylcholine plays a key role in leaming and memory, and it has been proposed that loss of cholinergic neurottansmission in the cerebral cortex, especially in the hippocampus, contributes significantly to the deterioration in cognitive function that is the hallmuk of dementia. In Alzheimer's disease (,,\0), by far the most common cause of dementia, patients experience deterioration across multiple domains, including cognition, function, and behavior. \'ery recent studies have demonstrated an expanded role for antidementia therapy, in various types of dementia, settings of care, stages of disease, and in combination therapy. i\S a result, clinicians need updated recommendations regarding the use of this therapy. The symposium, Dementia: Translating Latest Findings to Ivleet Today's Management Challenges, brings together researchers of recent ttials, an author of cuaent recommendations for best practices, and an author of the .A.AGP Position Statement Principles of Care for Patients With Dementia Resulting From i\lzheimer's Disease to present and discuss the results of the latest trials and the most promising approaches to the management of dementia. Cmrendy, underdosing of antidemeotia medications is common, and there is no widespread consensus on how to use these agents. For examp~ cholinesterase inhibitors (eEls) are the cornerstone of treatment for dementia, having repeatedly shown sustained, clinically meaningful benefit in randomized clinical trials. Howeve~ treatment rates with eEls remain low. In additio~ even though switching within a therapeutic class is common practice in other conditions, such as with narcotic analgesics in chronic pain, switching CEls when one agent pEoves inadequate is less common than discontinuation of therapy. Differing phannacologic profiles of the three available CEls raise the possibility of improving response by switching from one to another. The symposium., Dementia: Translating Latest Findings to ~feet Today's .Management Challenges will address these and other issues. For example, the loss of cholinergic functioning seen in Parkinson's disease dementia (POD) suggests that eEls might provide clinical benefits in this condition. Data will be presented describing the use of a CEI in POD, with resulting improvements in cognition and activities of daily living. 10 addition, the use of CEls is associated with a significant reduction in psychotropic therapy with antipsychotics, anxiolytics, antidepressants and/or mood stabilizers. This is of great clinical import since antipsychotic medications may worsen functional abilities through secondary parkinsonism, orthostatic hypotension, and sedation. Also, recent trials demonstrate that CEls may reduce use of benzodiazepines, an important benefit since these drugs can themselves impair cognitive functions. Finally, the presenters will discuss the recent trial with the first transdenna1 patch for -"\0, and integrate the individual presentations in a panel

discussiolL This program was supported by an educational grant from Novartis Phannaceuticals Corporation.

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3:00 PM - 4:30 PM DISTINGUISHBD SCIENCETIST AWARD LECTURE DEVELOPMENT OF THE NEUROPSYCHIATRY OF STROKE

Robert Robinson, M.D. t t

The University of Iowa, Iowa City~

IA

ADVANCES IN LATE-LIFE BIPOLAR DISORDER TREATMENT 2008 M.D)~ Martha Sajatovic, M.D.2~ Amy Kilbourne, Ph.D., M.P.H.3, Colin Depp, Ph.D.4, Robert Young, M.D.s Ariel Gildengers~ University of Pittsburgh School of ?\£edicine, Pittsburgh) PA Westem Reserve University, Cleveland, OH 3 University of :Micbigan~ Ann Arbor~ MI .. University of California - San Diego, La Jolla, CA SWell Medical College ofComel1 University, White Plains~ NY t

2 Case

Abstract: This symposium will review the cutting-edge research being done in late-life bipolar disorder treatmen~ focusing on clinically :relevant topics for clinicians, educators, and researchers. Presentations will focus on advances in phannacologic treatment, barriers to and complexities of care (medical co-morbidity, cognitive dysfunction), and targets of psychotherapy in older adults with bipolar disorder.. In the first presentation, new data will be presented on the roles of the anti-convulsant lamotrigine and the atypical antipsychotics, quetiapine and olanzapine. The second presentation will focus on the cardiovascular and metabolic risk factors

prevalent in older adults with bipolar disorder and the effectiveness of a brief intervention designed to enhance control of

intermediate physiological measures that represent risk factors for cerebro-vascular disease (e.g., blood pressure, fasting cholesterol). The third presentation will review the factors relating to cognitive dysfunction in patients with bipolar disorder and its impact on independence and quality of life. The last presentation will provide an overview of the targets for psychosocial intervention for bipolar disorder, along with how these can be tailored for the older adult.

COGNITIVE IMPAIRMENT AND OSTEOPBNIA IN OLDER AFRICAN AMERICANS WITH VITAMIN D DEFICIBNCY Consuelo Wdkins, M.D.t I

Washington University School of Medicine, Saint Louis, MO

Abstract: Background: Vitamin D deficency in older adults is common, especially among African Americans. Although there are many reported health disparities among African Americans, vitamin D deficiency is unique in that there is a known biologic reason for disparate vitamin D deficiency: differences in cutaneous synthesis of vitamin 0 foRowing ultraviolet light exposure. Recent data supports that vitamin D deficiency is not only associated with osteoporosis but is also associated with cognitive impairment and low mood. Objective: Compare the vitamin D status, cognitive performance, presence of mood disorder and bone mineral density (BMD) in a group of community-dwelling, ambulatory older African Americans (.A.A) and European Americans (EA). Methods: A cross-sectional study of 60 (30 African American and 30 European American) older adults participating in studies of cognitive and functional aging at the Memory and Aging Project at Washington University. Cognitive function, mood, physical performance, bone density, and 25 hydroxyvitamin 0 were assessed in all subjects. Results: Seventy-six percent ofAA and 27% of EA were vitamin D de6cient~ Subjects with vitamin 0 deficiency had worse perfonnance on the Short Blessed Test (SBT) (10.87 vs 6.31; p=.016) and

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2008 AAGP Annual Meeting lower BMD (0.823 vs 0.914; p= .005). Among African .Americans, those with vitamin D deficiency had worse performance on the :Mini-~Iental State Exam (29.14 vs 24.65; p= .OO8)and SBT (2.29 vs 11.78; p= .004, and lower B1\fi) of the hip (1.01 vs 0.83; p= .0001) compared to African Americans with nonnal vitamin D. Conclusions: African .Americans with vitamin D deficiency may be at inaeased risk for cognitive impairment and unrecognized low bone density.

PHARMACOTHERAPY OF UNIPOLAR PSYCHOTIC DEPRESSION: THE STOP·PD STUDY Ellen Whyte, MD.l, Benoit Mulsan~ M.D., MS., F.R.C.P.C. 2, .Anthony Rothschild, J.\,I.D.l, Bamett Meyers, MD... University of Pittsburgh School of Medicine, Pittsburgh, PA ofToronto and Centre for .l\ddiction and Mental Health (CAMH) 3 University of Massachusetts Medical Schoo~ Worcester, ~ of Weill Medical College of Comell University, White Plains, NY t

2 University

Abstract: Major Depression with Psychotic Features (MD-Psy) is a serious mental illness associated with significant morbidity and mortality. Older patients hospitalized for depression are more likely to present with psychotic features than younger patients. There is a paucity of data to guide the treatment of MD-Psy, especially in when it occurs in an older person. This Symposium will present I:esults from the recendy completed NIMI-I funded study uStudy of the Phumacotherapy of Psychotic Depression" (STOP-PD). This study randomized over 250 subjects with MD-Psy (500/0 of whom were older than 60 years old) to olanzapine + sertra1ine or olanzapine + placebo. This presentation will emphasize study findings direcdy applicable to the elderly. Four presentations will be included in this symposium. Anthony Rothschild MD will review the phenomenology of MD-Psy in older patients and discuss diagnostic challenges presented by this condition. Barry ~Ieyers ?vID will present the study's main outcome, comparing the efficacy of the two study phannacotherapy regimes in both younger and older participants. Benoit MuIsant, MD will discuss the experience of elderly participants in the STOP-PD study with regards to the tolerability of the two study pharmacotherapy regimes. Ellen Whyte, MD will present data regarding the influence of cerebrovascular disease risk factors and executive dysfunction on the presentation and treatment outcome of psychotic depression in late-life. The discussants will all address the clinical implications of this study and consider possible future research directions.

INNOVATIVE APPROACHES TO PROVIDING MENTAL HEALTH SERVICES IN COMMUNITY-BASED SETTINGS Jeanne Dalton, R.N., MN.I, Ellen Brown, &LD., ~f.S.t A.P.R.N., RN.2, Karen Bullock, Ph.D.3, Eve Byrd, M.S.N., M.P.H., F.N.P:', Merrie Kaas, D.N.Sc., ,t~.P.R.N., B.C., C.N.S.5 t Oregon State HospitaI. Salem, OR

International University College of Nursing and Health Sciences, 1\1iami, FL Hospital/Institute of Living, Hartford, cr .. Fuqua Center for Late I...ife Depression, Atlanta GA sUoiversity ofI\.finnesotat Minneapolis, MN 2 Florid2

3 Hartford

t

Abstract: Unique approaches are needed to provide mental health services to both homebound elders and those in long-term cate facilities. This symposium will discuss four different service methods to assess and treat mental health problems in the elderly. The Elders Counseling Elders program provides seMces to moderately depressed and anxious homeboU11d seniors by volunteer professional and lay counselors. Other older adults Jiving in senior housing buildings are provided mental health services in their residences rather than baving to go to a mental health clinic. Both of these projects help elders get the mental health services they need while not facing the barriers that usually prevent elden from getting treatment. Detection of depression in older adults living in residential facilities is the focus of two other unique programs. These programs also include elements of evidence-based guidelines and practices. Depression screenin& suicide prevention protocols, and care management consultation with a CNS/NP help community providers make appropriate referrals so that elders get adequate treatment. Training of nurses to detect depression in nursing facility residents also helped develop an evidence-based guideline for that assessment. ACADEMIC-COMMUNITY PARTNERSHIPS: TRANSLATING EVIDENCED-BASED MENTAL HEALTH INTERVENTIONS INTO PRACTICE Laurie lindamer, Ph.D.', Stephen Bartels, M.D., MS.2, Jo Anne SiteYt Ph.D.3~ Martha Broce, Ph.D., M.P.H.4, Joseph Gallo, MD., MP.H.5 t

University of California - San Diego; San Diego "A Healthcare System, San Diego, CA Medical Schoo~ Lebano~ NH

2 Dartmouth

AlB

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting 3 Weill

Comell Medical College, White Plains, NY

.. Weill Comell Medical College, White Plains, NY 5 University

ofPennsylvania, Philadelphia, PA

Absttact: Translating evidence-based mental health interventions designed in research settings into commun.ity practice is a high priority for geriatric psychiatry researchers and clinicians, as well as for consumers and their families. Partnerships between academic and public institutions can facilitate this translation. There have been a number of influential reports calling for increased translation of research to practice, and there have been some notable successes in building research..based, academic-..eommunity partnerships. Yet, only few of these collaborations have been cre1Ited, and even fewer have been sustained Moreover, evaluating the impact of these partnerships often proves challenging. We plan to present models of community partnership development and their application. as well as strategies for sustaining these collaborations using examples from developing and existing partnerships in geriatric psychiatry. Methods to evaluate the impact on both partners will also be discussed

3;00 PM - 6;00 PM IMAGES OF AGING IN THE CINEMA: LIFE REVIEW AND THE PSYCHOLOGICAL TASKS OF LATE-LIFE

AND ~WILD

STRAWBERRIES"

Life Review and the Psychological Tasks olLate-Life and "Wdd Strawbeaies" Elliott Stein, MD.1 I

Private Practice, lvfiami Beac~

FL

Abstract: There have been various cinematic portrayals of the psychological and emotional aspects of late-life. This program will review some of the theories of late-life development, including those of Buder, Erikson and Cohen, and how they have been reflected in the cinema. We will discuss life review and late-life psychological stages and tasks, as well as stereotypical images, as portrayed in several recent feature films. Attitudes of filmmakers and actors can confirm or challenge popular beliefs in their portrayals. The approach of Swedish writer/director Ingmar Bergman exemplifies the creative role of the film writer and director. This program will then explore these issues through the screening of a classic feature ~ Bergman's "Wild Strawberries", followed by an open discussion of the images and the attitudes that are presented."

4:45 PM - 6:15 PM GERIATRIC PROFESSIONAL'S GUIDE TO THE INTERNET: RECOMMENDED WEBSITES FOR PATIENTS ANDFAMIUES Ellen Dedefsen, D.L.S.l lUoiversity of Pittsbmgb, Pittsburgh, Pol\' Abstract: This symposium will introduce AAGP conference attendees to specific tools for finding useful patient and consumer information on the Web and the Intemet. This session will cover educational websites that you can recommend with confidence to your patients and their family caregivers. The symposium is open to all, and will be presented in a combination of demonstration and presentation. At the conclusion of the symposium, participants will be able to describe patient/consumer use of Intemet resources, use both a common search engine and several Web portals to find patient education materials. and be able to evaluate and recommend web-based resources for patients and their families/caregivers. Special attention will be given to identifying websites that are designed specifically for older pe[son~ and to available information on the use of the Web and the Intemet by senioD.

Sunday, March 16, 2008 8:30 AM - 10:00 AM POLICY AND POUTICS: SHAPING MENTAL HEALTH PRIORITIES IN A PRESIDENTIAL ELECTION YEAR .A.1lall.l"-nderson, MD. 1~ Amy Walter2, ~fichael Hash3

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2008 AAGP Annual Meeting I Dorchester General Hospital, Cambridge, MD 2The Cook Political Report, Washington, DC 3 Health Policy Altematives, Washington, DC

Abstract: This public policy session will provide an overview of the current legislative, regulatory and political environment that impacts the development and enactment of health and mental health legislation and policy at the Federal level Democratic control of the House of Representatives for the first time since t 994. coupled with a razor-thin Democratic majority in the Senate and the most wide-open presidential race in 80 years, means that Capitol Hill in 2008 will likely be a political battleground, not a place for reconciliation and accomplishment. Speakers will discuss the oudook for the Novemb~ 2008 Presidential and Congressional elections, with some emphasis on how those elections shape the issues, including the development of health legislation and policy. The second part of this session will consist of presentations on specific health policy issues that may be considered during the Second Session of the 110th Congress, including funding for mental health research and services; Medicare reimbursement for physicians' services; Medicare cuts and refonns; mental health parity; and geriatric medical education. Session speakers will address the oudook for action on these and other issues in 2008. The third part of this session will identify strategies for AAGP and individual geriatric psychiatrists to utilize to ensure that the voice of geriatric psychiatry is heard as Congress, the Federal regulatory agencies and the White House consider health care issues.

HITCHHIKER'S GUIDE TO TEACHING: BEYOND THE POWER OF POWERPOINT Andrew, M.D., MEd., F.R.C.P.C.I, Lisa Van Bussel, M.D., F.llC.P.C.2

~felissa

University, Kingston, ON St. Joseph's Health Care London, London, ON

1 Queen's 2

Abstract: Almost everyone uses PowerPoint for presentations, whether you like it or not. It has become the standard visual aid for use in teaching sessions in medical schoo~ at the residency level, and beyond Sometimes it seems that there is no other choice for presentations, whether the group is lar~ the room is small, or even if you need to bring your own projector. Because of its dominance over the educational spec~ during the planning of teaching sessions we may overlook consideration of some important questions ...are you choosing the best visual aids for your teaching task...and are you using them to the best possible effect? This workshop will focus on choosing the most effective audiovisual strategy for a variety of teaching situations, and on

maximizing the impact of your materials. Setting, audience, and topic may all influence this selection. The importance of considering learning style diversity in making these choices will be addresse~ as will the challenge of aligning the purpose of your teaching and your subject matter with the visual aids selected. Using a variety of audiovisual aids will facilitate active leamin& make your teaching more memorabl~ and encourage learners to go beyond the teaching session to leam more. We will look at the strengths and limitations of a variety of common visual aids including PowerPoint, handouts, overheads, and flip charts, and discuss a variety of innovative visual strategies. We will identify common pitfalls and strateg1ze about ways to avoid these, and we will demonstrate techniques to help your next presentation run smoothly, even if you are not a technical genius. COGNITION AND FUNCTION IN LATB-UFE SCHIZOPHRENIA Zabinoor Ismail, M.D., F.R.C.P.C.l, Philip Harvey, Ph.D.2, Barton Palmer, Ph.D.3, Dilip ]este, M.D:J I

University of Toronto, Toronto, ON

University School of rvIedicine, Atlanta, G.!~ of Califomia-San Diego, La Jolla, CA .. University of California-San Diego, La Jolla, CA 2 Emory

.1 University

Abstract: In addition to positive and negative symptoms of schizophrenia, cognition and function are important parts of the illness

and ofincreasing conceal, especially into late-life. The course of schizophrenia into late life is not consistent and there are multiple factors that can affect this course including age of onset, premorbid functioning, history of substance abuse, medication exposure, comorbid medications, lack of efficacy of treatments and cognitive impaianent. Cognitive impaianent impaits socio-vocational funtioning and functioning in the community, and it also results in poorer adaptive skills, poorer medication management, decreased adherence and significant cost. Younger patients with schizophrenia typically perfoan 1-2 standard deviations below the mean in cognitive tests assessing executive function, verbal skills, processing speed, and attention. However, the cognitive deficits in late-life schizophrenia have not been well characterized and ate clouded by medications, age-associated cognitive decline and dementia. While abnormal cholinergic mechanisms are well understood in dementia, there ate also cholinergic abnonnalities in schizoplu:enia. Abnoanalities in prefrontal nicotinic mechanisms result in impaired cognition. These abnonnalities may underscore the increased rates of smoking in this population as a way to self-medicate cognitive impairment. In this symposium we will. address factors affecting functioning in schizophrenia into late-life. We will also characterize some of the cognitive deficits in schizophrenia

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2008 AAGP Annual Meeting highlighting those that are more specific to this illness. Finally we will investigate abnonnal nicotinic mechanisms in schizophrenia as an avenue towards newer approaches to treatment of cognitive impainnent in this patient population.

UFESPAN PSYCHOLOGICAL DISTRESS AND RISK FOR DEMENTIA IN OLD AGE: TRANSLATIONAL RESEARCH Steven Arnold, M.D. I , Robert Wilson, Ph.D.2, Irwin Lucki, Ph.D.3

University of Pennsylvania, Philadelphia, PA University Medical Center, Chicago, IL 3 Univeaity of Pennsylvania, Philadelphia, PA I

2 Rush

Abstract: Accumulating evidence shows that people who experience greater degrees of psychological distress in the foan of anxiety, depression, and psychotic disorders are at higher risk for cognitive decline and frank dementia in late life. \'Vhile the phenomenology of this risk factor is becoming clearer, the neurobiology remains unexplained. This translational research symposium will consist of three talks: 1) Epidemiology and phenomenology of psychological disttess as a risk factor for cognitive impainnent in old age; 2) Cellular and molecular neuropathology in persons with varying degrees of psychological distress and cognitive impainnent; and 3) Emerging animal model approaches to determine neurobiological mechanisms by which stress interacts with age to cause neurobehavioral decline in old age. A major focus of the symposium will be current data from the Religious Orders Study and the Memory and Aging Project In these two longitudinal, epidemiological clinicopathological correlation studies of cognitive impainnent and dementia in late lifet we have found that people who score higher on measures of childhood adversity) depressive and anxious symptoms, and personality tendencies to experience greater psychological distress have a significantly higher risk of developing mental decline and frank dementia in late life. In postmortem research with over 300 brains from participants in these studies, we have further observed that this relationship between distress and decline is not explained by the abundance ofAlzheimer or other known neurodegenerative disease pathological lesions or cerebrovascular lesions. However) new data suggests abnonnal synaptodendritic marker expression in the hippocampus in people with higher distress scores, indicating that distress affects the integrity of cognition-related neural systems and contributes to cognitive decline in late life in its own rightt independent of typical neurodegenerative disease pathology. It is also reminiscent of oft-reported data from rodent models of chronic stress and suggests similar neurobiological mechanisms. To better understand this, we will discuss complimentary human and mouse model research approaches to investigate how chronic psychological distress may lead to changes in neuroplasticity and neurogenesis that may serve as proximal causes of neural dysfunction in the hippocampus and other limbic..cortical regions mediating memory and other cognitive abilities.

FIGHTING GERIATRIC MENTAL HEALTH DISPARITIES THROUGH INNOVATION: THREE ONGOING PROJECTS Mark l\£iller, M.D.!, Dolores GalIagher-Thompson, Ph.D.2, Patricia Arean, Ph.D.3 Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburg~ University School of Medicinet Stanford, CA 3University of Califomia - San Francisco, San Francisco, CA I

PA

2 Stanford

Abstract: Prominent among the recognized barriers to accessing adequate mental health services for the elderly are disparities along lines of ethnicity and income. This symposium will outline those factors for specifc populations in specific settings that are relevent for direct care or for adequate recruitment for research protocols. Recruitment of ethnic minorities in proportion to the local population is an NIMH mandate but not an easy one to achieve for a variety of reasons. In Pittsburgh, for exmapl~ there are few Asian or Hispanic minorities but 12% are African American. Transportation, fears about exploitation, and a preference for religious participation over mental health services are often. cited reasons for limited participation. Dr!s Gallagher-Thompson and Arean will share their broad experience working with Asian, Hispanic/Latino and economically disadvantaged populations regarding access barriers as well as the strategies they used that proved successful. Dr. Arean will also describe the effectiveness of the IMPACT modd in carrying out a research protocol in an economicaDy disadvantaged population. In our own research experience (Miller et al) implementing the PROSPECT study, we proposed that such a model utilizing a masters level clinician and off-site psychiatric backup might prove to be financially sustainable is the current fiscal environment as a care delivety model for the real world. A pilot program for funding was initiated between the service providers and the local dispursement agency for Medicare/Medicaid funds utilizing the PROSPECT model. These efforts to date will be discussed in detail with preliminuy outcome data that will include economic sustainability analysis. Outreach efforts to destigmatize the attainment of psychiatric services for elders within the conunuoity will also be presented for discussion.

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2008 AAGP Annual Meeting THE CHOLINERGIC HYPOTHESIS OF AGE AND DEMENTIA-RELATBD COGNITIVE DYSFUNCTION REVISITED AGAIN: RBCENT ADVANCES AND IMPLICATIONS FOR PREVENTION AND TREATMENT Paul Newhouse, M.O.J,jenny Rusted, Ph.O.2, Martin Sarter, Ph.D.3, Andrew Saykin, Psy.D:I,julie Dumas, Ph.D.s 1

U,,;'Oersity o!Vermont CoUege ofMedicinet BlITlington, VT

2 University

of Sussex, Brighton, United Kingdom University of Michigan, Ann Arbor, ~n .. Indiana School of Medicine~ Indianapolis, IN 5 University of Vermont College of ~{edicine, Burlingto~ 3

VT

The cholinergic hypothesis of cognitive aging, first fonnulated by Bartus in 1978, has had major heuristic and practical value in developing theories of brain aging and treatments for neurodegenerative conditions. Abnormalities in brain cholinergic system activity have been identified as a major contributor to the cognitive dysfunction associated with aging and neurodegenerative conditions, e.g. Alzheimer's disease (AD). However, the role(s) of this system in the functioning of specific cognitive domains in nonnal cognition and the contributions of altered or degenerating cholinergic systems to neuropathologic conditions has been difficult to ascertain due in part to the technical difficulties of study in cholinergic system activity and its relationship to specific cognitive operations. New advances in cholinergic neurobiology, functional brain imaging, and cognitive neuroscience have now dramatically improved the understanding of the role cholinergic system activity plays in normal and disordered human cognition. This symposium will present new research that has enabled the development ofmore comprehensive theories of how cholinergic systems affect attention and cognition in aging and pathologic conditions. Martin Sarter, Ph.D. (University of Michigan) will discuss new insights into the function of cortical cholinergic inputs based on experiments involving methods for the monitoring of cholinergic activity at a subsecond resolution. Furthermore~ the usefulness of mice exhibiting a 50% reduction of the choline transporter for research on cognitive aging will be discussed. Andrew Saykin, Psy.D. (Indiana University School of Medicine) will present new structural and functional brain imaging data demonstrating abnormalities in cholinetgic-system circuitry in patients with Mel, alterations in brain activation in response to phannacologic cholinetgic enhancement, as well as genetic factors influencing post medication £MRI changes. Jenny Rusted, Ph.D. (University of Sussex~ UK) will present behavioural data on cholinergic enhancement of prospective memory (a significant problem for older adults and people with dementia), introducing paradigms that provide new methods for componential breakdown of memory and attention processes, and data that address issues of definition and measurement of attention and cognitive effort in human studies. Julie Dumas, Ph.D. (University of Vennont) will present data on how sex honnones can modulate cholinergic system-related cognition in humans and how this may be critically important for maintenance of cognition in aging. Paul Newhouse, ~f.D. (University ofVeDllont) will discuss this work in the context of a refonnulation of the cholinergic hypothesis of cognitive aging and how this work might be applied to the treatment of age-related cognitive impairment and dementia.

10:15 AM - 11:45 AM CREATIVE RESILIENCE AND AGING: "DREAMS, SCHEMBS, It THBMES" FROM MUSIC & POETRY Jeffrey Lyness,l\.f.O. I, Paul Kirwin, M.D..2 t University of Rochester Medical Center, Rochester~ NY 2Yale University School of Medicine, New Haven, cr

Abstract: As clinicians working with older adults, we sometimes lose sight of the broader context of aging as we focus on the disorders" symptoms, and problems posed by our patients. We can enrich our efforts to improve and promote health by keeping in mind the widest range of possibilities in aging. These possibilities include opportunities for gro~ creativity~ and resilience, as well as more commonly considered clinical themes such as loss•.disability) and dying. As a follow-up to last year's session on Duke Ellington's final decades, this symposium will present audio / video clips and readings excerpted from the works of several popular musicians and poets, including artists well known to the general public (e.g., Bob Dylan, Robert Frost) and those known only to 'specialty' audiences (e.g., The Fugs,Jermy Joseph). We will discuss their work in the context of biographical vignettes - that is, the artists' own personal and professional development into later life - and tie the themes that emerge to larger-scale considerations of issues that arise in aging. These themes span the gamut ofhuman experiencet ranging from 'connectedness' (love, &eXt and friendships) to artistic expression (keeping the juices of creativity, humor, and playfulness flowing) to irreverence (the security to see it and say like it is), to resilience (facing adversity). We will then engage the attendees in an interactive discussion about the implications of these themes for our own lives and for our work caring for older persons and their families.

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2008 AAGP Annual Meeting TOXIC EFFECTS OF PBRSISTENT PAIN IN OLDER ADULTS Jordan Karp, M.D.I, Thomas Meeks, M.D.2, Stephen Thielke, M.D.3,Jiirgeo Uniitzer, MD., l\1.P.H., M.A." Westem Psychiatric Institute and Clinica, University of Pittsburgh School of~iedici.ne, University of California-San Diego, La JoDa, CA 3 DnivetSity of Washington, Seattle, WA "University ofWashingtoo, Seattle, WA I

Pittsburgh, PA

2

Abstract: The focus of the International Association for the Study of Pain Global Year .J,~gainst Pain for 2006-07 is "Pain in Older Persons." The .i\merican Pain Society has also identified the undertreatment of pain in older persons and in persons with cognitive impainnents as among the most pressing ethical concerns for clinicians. We hope to extend these messages to the geriatric mental health community for 2008-2009. Persistent pain conditions such as arthritis, neuropathy, 6bromyalgia, and back pain affect 40-500/0 of older adults. These conditions are highly comorbid with depression, anxiety, and cognitive impainnent. Research and clioical experience has shown that when pain, depression, and anxiety are present, these conditions are mutually exacerbating. Results from treatment and epidemiologic studies will be presented describing the effects of pain and opioid analgesics on cognition and sleep in older adults living in both the community and nursing homes. The assessment of pain in cognitively impaired nursing home residents will be addressed. The macrophage theory of depression will be introduced as a mechanistic model linking persistent pain and depressiolL Evidence will be provided illustnting the consequences ofglucocorticoid and pro-inflammatory eytokine hypersecretion on the malfunctioning of noradreoeIgic and serotoner:gic neurottansmissioQ which may be reflected as depression and anxiety. To achieve optimal outcomes, psychosomatic medicine suggests that when comorbid, both physical and psychiatric conditions should be treated simultaneously. Older adults with persistent pain, however, tolerate analgesics such as opioids~ anti-inflammatory drogs~ and adjunctive agents like tricyclic antidepressants less well than younger people. The result is often sedation and confusion. In addition, many older adults have misperceptions about the effective use of analgesic mediations. Qualitative data describing bamers to achieving analgesia among older adults with persistent pain will be discussed. The effects of race, culture, and gender on these barriers will be addressed. It is therefore crucial to recognize and promote the knowledge that treatments other than pharmacology are available. One model is the use of primary care-based care tnanagets to address the treatment of both depression and persistent pain. Pilot work from the IMPACT group will be presented illusaating the feasibility and efficacy of this approach to optimize physical, mental, and petformance outcomes in these patients.

ADHERENCE TO DEPRESSION TREATMENT AND THE OLDER PATIBNT Helen C. Kales, MD.!, Hillary R. Bogner, M.D., ~l.S.C.E.2, Kam Zivin, Ph.D.3,Jo Anne Sirey, Ph.D."' of Michigan. Ann Arbor, IvII of Pennsylvania, Philadelphia~ PA 3 University of:Michigan, Ann i\rbor, l\fi .. Weill Comell Medical College, White Plains, NY 1 University

2 University

Abstract: Depression in older adults has been detected, diagnosed, and treated more frequently in recent years. However, substantial gaps in effective treabnent remain. Poor depression treatment adherence is an important source of drug exposure variability but is often poorly measured in both tesearch trials and clinical practice: "treatment-resistant" depression may, in fact, represent undertreatment because of poor adherence. Thus, adherence to depression treatment can be viewed as the "next frontier" in the treatment oflate-life depression. Our series will provide evidence from ptimaJ:y care samples as well as national datasets that highlights the role of a number of key factors as impacting late-life depression care adherence. The potential for interventions development based upon these findings will be discussed with active participation of the audience encouraged.

DBMENTIA BEHAVIORS: NEW GUIDELINES FOR TREATMENT WITH BEHAVIORAL INTERVENTIONS Nancy Carlson, R.N., M.S., ,,\.P.R.N., ..B.C.I I

MedOptions, Inc~

Danbury, cr

Abstract: The purpose of this presentation is to increue understanding of dementia symptoms and related behaviot8 which affect residents, staff and all other caregivers. Ch.fS Guidelines require that behavioral interventions must be attempted and documented prior to treatment with medication. Emphasis will be placed on behavioral interventions, obtained from many sources in current literature as well as the experience of the presenters. Cultural issues will be discussed as they relate to both residents and staff in order to inaease understanding between both residents and staf£: The session will begin with an ovemew of dementia~ delirium and depression in an effort to differentiate between the diagnoses and their associated behaviors. Medical co morbidities which

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting frequendy occur with dementia will be discussed as they effect tteatment and prognosis. Compliance with the C~fS Guidelines (Ftag329) will be described in detail as they apply to the use of medications for behaviors. Differentiation of behaviors will be described as those possibly requiring medication, should behavioral intervention fail, or those not appropriate for medication intervention. There will be a discussion of behavioral interventions which begin with basic approach and communication skills. Therapeutic envitooment will be described in the day of a LTCF. Efforts to avoid escalating behavior with emphasis on anxiety recognition and calming techniques are central to this end. Specific behaviors will be addressed and appropriate inte!Ventions will be described for the following: 1.. Delusions, hallucinations 2...Aggression and combative behavior 3. Insomnia 4. Bathing 5.. Toileting, changing briefs 6. Grooming 7. Feeding 8. Sexually Inappropriate behaviors Interventions will include assessment for pain, hunger, loneliness, boredom, embarrassment wandering. Cultural aspects of both resident and staff person will be described as they help or hinder care. There will be a discussion about essential cultural attributes in health care and at least three specific cultures will be described as they apply to residents and caregivers alike.

MEDICAL UPDATES FOR THE PRACTICING PSYCHIATRIST: MEETING THE MEDICAL NEEDS OF OLDER ADULTS 1\felinda Lantzt M.D.I, Carmen Lewist M.D.) ]\f.P.H..2, RobertJones t M.D}, Lea Watson, MD., M.P.H." t Beth Israel Medical Center, New York, NY 2University of North Carolina at Chapel Hill, Chapel Hill, NC 3 Methodist Hospit~ Brookl~ NY "University of North Carolina at Chapel Hill, Chapel Hill, NC

Abstract: Geriatric psychiatrists deal with a population that faces mulitple medical comorbidities, medication side effects, variable access to medical and mental health services and increasing dependecy in activities of daily living. Many elderly with chronic mental illness utilize psychiatrists as their main source of medical care, while other older adults lack access to psychiatric services. This symmposium will outline several of the essential challenges that face the health care providers of this vulnerable population and address means to improve outcomes. The lack of access to medical care and system-based factors that present formidable barriers to care will be identified. Approaches to improving some of the most basic health promotion and iatrogenic iUnessness will be discussed. Use oflaboratory testing is common among older adults, but the interpretation of results often does not include consideration of baseline differences associated with age, race, ethnicity and gender. Lack of communication among physicians and care providers and the need for all providers to remain vigiligant to the high risk medictions and populations of elderly will be addressed Means of screening for drug-dtug interactions and avoiding adverse dnJg events, food and medication interactions and guidelines for monitoring side effects will be included Health promotio~ particularly the appropriate use of cancer screening tests among older adults will be reviewed. Guidelines for the use of screening across the lifespan and adjusted for comorbid medical and psychiatric status will be discussed. The use of judicious cancer screening among patients with dementia will be addressed. A comprehensive model utilizing the psychiatrist as care coordinator will be presented. A focus on the prevention of unnecessary poylphaDnacy and maximizing functional stanIS through vigilant monitoring of medication side effects will be presented. Evideocebased guidelines supporting these approaches will be presented and reviewed.Integrating models of communication between primary care physicians and psychiatrists will be reviewed, and successfull collaborative care models utilizing the psychiatrist as care coordinator will be discussed.

USB OF TECHNOLOGY TO PROVIDB MENTAL HEALTH SERVICES TO OLDER ADULTS

Carl Eisdorfer, Ph.D., M.D.t, Sara Czaja, Ph.D.2, Julie Malphun, Ph.D}, Raymond Ownby, MD., Ph.D...., David Loewenstein,

Ph.D.s

University of Miami Miller School of Medicine, ~ FL of ~fiami Miller School of Medicine, ~ FL 3 University of Miami M:iller School of Medicine, ~ FL .. University of Miami ~filler School of Medicine, ?\fiami, FL S University of Miami Miller School of Medicine, ~ FL I

2 University

Abstract: The presenters will each describe a state of the art technology which they have employed to improve patient care in four areas.. Several empirical studies evaluating the impact of information technology in reducing isolation, changing perceived burden and caregiver depression will be the focus of one presentation. The second report is on a study of patients with co-morbid Diabetes and Depression, populations typically requiring intensive management who were taught and monitored at home using a telehea1th program. Data on the impact of technologic supports to study and enhance patient adherence to medication regimes; and computerized focused cognitive intervention on patients with Mel and Alzheimer's disease will also be presented. Each presentation

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Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting will include appropriate data. The discussant will review the papers and discuss the future of technology in geriatric psychiatric care of diverse populations and families.

12:00 Noon - 2:00 PM CLINICAL RESEARCHERS DEBATE: THE COMPREHENSIVE TREATMENT OF ALZHEIMER'S DISEASE

Bany Lebowitz, Ph.D. I, David Sultzer, M.D.2, George Grossberg, M.D.3, Freddi Segal-Gidan, P.A., Ph.D4 4

University of California, San Diego, La Jolla, CA Geffen School of Medicine at UCLA; VA Greater Los Angeles Healthcare System, Los Angeles, Ci\. 3 St. Louis University School of ~redicine, St. Louis, MO "' University of Southem California Keck School of Medicine, Downey, CA I

2 David

Abstract: Itainical Researchers Debate: The Comprehensive Treatment of Alzheimer's Disease" will be a case-based (mcluding videos of patients), interactive, moderated dialogue between senior experts who care for patients with Alzheimer's disease. The symposium will allow for active discussion of participants'questions and encourage participants and experts to share their opinions and recommendations. The "Clinical Researchers Debate: The Comprehensive Treatment of Alzheimer's Disease" symposium will incorporate opportunities that apply principles participants willleam from studying patient cases. The dialogue will prompt attendees to identify the rationale for optimal treatment approaches (both phannacologic and non-plwmacologic).

This program is supported by an educational gIant from Forest Research Institute, division of Forest Phannaceuticals, Inc. UNCOVERING THE LINIC: PSYCHIATRIC AND SLEEP DISTURBANCES IN OLDER ADULTS Thomas Ro~ Ph.D.I, W. \'aughn McC~ ~tD., MS.2, Susan McCurry, Ph.D.3 Henry Ford Hospital, Detroit, :MI Forest Univetsity School of Medicine, W111ston-Salem, NC 3 University of Wasbingto~ Seattle, Wi\. t

2 Wake

Abstract: It is recommended that elderly patients with insomnia be treated with a combination of plwmacologic and behavioral therapies. Because behaviota1 changes may require several weeks to adopt and acquire, pharmacological treatment will be necessaty to treat insomnia for at least the short ten» while the patient is adjusting to a different sleep schedule, changing his/her behavior, or receiving treatment for underlying medical conditions. Thus, this program will cover both pharmacologic and nonpharmacologic options for elderly patients with insomnia and take into account how comorbid psychiatric illness affects treatment decisions. A limited number of head-to-head studies have examined insomnia phaanacotherapies in the geriatric population. But several have been published recendy and will be reviewed in this program. Including one study using pOStulaI sway as an indicator of instability" and thus, a measure of potential for causing noctumal falls...\t peak plasma levels after 14 days of treatment, patients treated with ramelteon did not signi 6candy affect body sway compared to placebo, while zopiclone significantly adversely affected body sway in subjects with chronic primary insomnia. Since nighttime falls are a significant concern when treating elderly patients, this type of clinical information is important for healthcare professionals to be aware of. In a second study, ramelteon demonstrated not to interfere when coadministered with donepezil, a common Alzheimer's medication. These studies show that although many therapeutic options ate available, careful selection of the appropriate agent is critical when treating elderly patients and patients with comorbid conditions. Program content will also cover data that supports the pathophysiologic link between insomnia and psychiatric disorders, including depression and .Alzheimer's disease. Faculty presentations will describe how insomnia influences the progression ofmental health disorders and patient outcomes in the aging patient. Finally, a discussion on medication adherence and compliance will be covered dwing an interactive activity. Throughout the entire program, participant activities will be sprinkled in between faculty presentations to engage the audience, and to make the learning experience unique and interesting. Participants will be asked to discuss a topic with the coneagues seated at their table, come to a consensus, and some wiD be asked to share their thoughts with the larger audience" The worksheets will seNe as a mechanism to collect infonnation and once complied, can be used for a primary needs assessment to design future programs that will address the educational gaps of this audience.

This program. is supported by an educational grant from Takeda Phannaceuticals North .America, Inc.

AN INTERACTIVE CASE-BASED APPROACH TO THE TREATMENT OF PSYCHIATRIC COMORBIDITIES IN PATIENTS WITH PARKINSON DISEASE William M. McDonald, M.D. (Chair)l, Bernard Ravina, MD., MSCE2, Matthew Menza, M.D}, Lama Marsh, MD." Emory University School of Medicine, Atlanta, GA of Rochester of Medicine, Rochester, NY 3 Robert Wood Jobnson Medical Schoo~ New Bmnswick, NJ I

2 University 4 Johns

Hopkins University, Baltimore, ~ID This program is supported by an educational grant from Boehringer-Ingelheim. Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting 2:15 PM - 3:45 PM APATHY IN PATlBNTS WITH LATE-LIFE NEUROPSYCHIATRIC DISORDERS: IDENTIFICATION AND TREATMENT Robert Robinson, ?\.LD.l, Constantine Lyketsos, ?vI.D., M.H.S.2, Ricardo Jorge, M.D) t

The University of Iowa, Iowa City, IA Hopkins University, Baltimore, lvID

2 Johns

3 The

University of Iowa, Iowa City, IA

Abstract: Many studies have documented the high frequency of apathy in patients with stroke, Parkinson's disease, Alzheimer's disease and other neurological disorders. This symposium will present the latest findings in the identification and diagnosis of apathy as well as its effect on emotion, cognition and behavior. The presentations will also discuss the specific clinical and functional manifestations in each of these neuropsychiatric disorders. Treatment alternatives will be presented as well as results of the first double-blind treatment trial.

HOW TO TEACH CULTURAL COMPETENCE IN GERIATRIC PSYCHIATRY: ADDRESSING UNMBT

PATIENT NEEDS

Warachal Faison, ~1.D.l,

Moises ?vlartinez, M.D.2, Vemon Nathaniel, M.D.3, Shunda McGahe~

MD.4, Cynthia Resendez, M.D.5

Medical University of South Carolina, North Charleston, SC University at Harlem Hospital Center, Fort Lee, NJ 3 Howard University, Washington, D.C. .. Massachusetts General Hospit~ Somerville, l\.fA 5 Family SetVice Agency of San Francisco, San Francisco, CA I

2 Columbia

Absttact: During the next 30 years, the number of older adults with major psychiatric illness is expected to double from 7 to 15 million persons. During this same time period, the United States will undergo a dramatic tmnsformation into a multi-ethnic/racial society, with minorities comprising 4()O/o of the US population by 2035. By 2020, 21°/0 of the US elderly population will belong to a minority group. Mental disorders occur commonly in ethnic minority elderly, are less likely to be detected, or treated, and are associated with higher utilization and costs ofgeneral medical services.. i\dditionally, ethnic minority elderly encounter unique barriers in communicating their healthcare needs, resulting in consistent reports of hea1thcare disparities, even after controlling for severity of disease and socioeconomic factors. ~~ong the interpersonal aspects of healthcare delivery that have been studied as explanatory factors for these disparities, has been the issue of lack of cultural competence of physicians. Three years ago, the APA Committee on Ethnic Minority Elderly undertook the development of a model eutticu1um for Cultural Competence in Geriatric Psychiatry, in part, to address this critical unmet patient need.

COMPREHENSIVE APPROACH TO BURDEN AND BURNOUT IN CAREGIVERS AT HOME AND HEALTHCARB WORKERS IN LONG TBRM CARE SE'ITINGS Sanjay Vaswani, M.D.l, i\mita Pat~ J.\.f.D., C.M.D., MH.A.2, Mara Ferris, M.S., R.N.3 UuiVeISity of California - Los Angeles, Los Angeles, CA State University, Dayton, OH 3 Association for Gerontological Education, Exeter, NH I

2 Wright

Abstract: Caring for the cognitively and physically compromised elderly patient is challenging and can lead to devastating consequences at allleve1s of the care giving spectnnn The stress of care giving can result in physic~ emotional, mental and spiritual exhaustion. Decreased personal satisfaction, substance abuse, depression and errors of judgment are common. This constellation of symptoms is often referred to as Caregiver Burden and Bumout. In-home caregivers and staffs of skilled nursing and assisted living facilities are subject to Burden and Burnout. Psychiatrists, despite having a unique understanding of caregivers biological, psychologic~ social and spiritual factors are particularly at risk for experiencing Caregiver Burden and Bumout. The citcular effect of caregiver burden and bumout along the caregiver continuum needs to be recognized early to prevent further compromise of quality of care and life for the elderly patient. Part I will include two presentations (30 minutes each): 1. Caregiver Burden and Burnout in the '1-lidden Patients". Understanding the prevalence, identification and need for early intervention of primary in-home family caregiver's burden and bumout will be discussed. Emphasis will be placed on evidence-based tips on surviving the burden of care giving.. 2. Caregiver Burden and Burnout in health care staff of long teDn care facilities, Medical Directors and Consultallt Psychiatrists. The role of assessment and prevention of the burden and burnout in long term care will be addressed. Emphasis will

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2008 AAGP Annual Meeting be placed on application of psychiatrist-facilitated group therapies as intervention techniques and Part II will involve case presentations and discussions focused on identification of dangers and effective strategies to deal with the caregiver burden and bumout of professionals at long tean care facilities. Active audience participation will be the comerstone leaming experience. A question and answer session will follow with the goal of furthering the participants understanding of the complexities of care giving to elderly patients. DEMENTIA SCREENING IN CLINICAL AND COMMUNITY SETTINGS David Steffens, ~f.D., M.H.S.t, Soo Borso~ M.D.2,J. Wesson Ashford, M.D., PhD}, Loti Frank, Ph.D.4 'Duke University Medical Center, Durham, NC ZUniversity ofWashington School of Medicine, Seattle,. WA 3Stanford, VA Alzheimees Center, Redwood City, CA .. United Biosource Corporation, Bethesda, ~ Abstract: Currendy controversy surrounds several aspects of screening for dementia, in particular whether screening should occur. Criteria generally referred to for evaluating the value of screening include the following: 1) the disorder is common; 2) screening insttwnents permit detection with reasonable accuracy; 3) effective treatments exist, and 4) outcomes for treated individuals are superior to those of untreated individuals. The unknown cost-effectiveness of screening &om the societal perspective, the potential psychological hann and ethical consequences of proactive identification, and the limits of current screening instruments in tenns of sensitivity and specificity are among the main points mised when screening is called into question. In this symposium we will review specific evidence for and against dementia screening, review the clinical consequences of community-based vs. clioic-based screening, and provide guidelines for evaluating existing screening instnunents. Specific options and recommendations will be discussed for different settings (specialist, primary care, and community, including group screening administration). In addition, the distinction between screening and diagnosis will be addressed as will the clinical requirements and clinical consequences of each. For clinicians screening is presented as a gateway to a system of clinical care, with details of appropriate clinical assessment as follow up to positive screens. Dr. Steffens will comment on the presentations with respect to his experience with population research studies on depression and dementia that have included assessments of individuals from a community.

NEW QUALITATIVE RESEARCH ON LATE LIFE DISORDERS AND INTERVENTIONS Ladson Hinton~ M.D.l~ Colin Depp, Ph.D.2, Emily Dakin, Ph.D.3, Frances Barg, Ph.D.4, Carol Franz, Ph.D.s I

University ofCalifomi2 - Davis, Sacramento, CA

2 U Diversity

of California - San Diego~ La Jolla, CA State University School of Social Work, Fort Collins, CO .. University of Pennsyvlania, Philadelphia, PA 5 University ofCalifomia - San Diego, La Jolla, CA 3 Colorado

Abstract: The overall goal of this symposium is to present new research on mental disorders in late life that feature the use of qualitative methods alone or in combination with quantative methods. The presentations in this symposium will highlight a range of issues, including how depressed older adults perceive and experience mental health interventions" illness experiences among older persons with schizophrenia, and primary care physicians perspectives on bamers to mental health referral of persons with dementia. While the range of issues addressed by this panel are diverse, they share a qualitative approach (i.e. individual semi-structured interviews) that seeks an in-depth understanding of the experiences and perspectives of the research subject, including persons with mental illness (i.e. schizophrenia and clinical depression) as well as formal providers of care (i.e. primary care physicians).

FORENSIC GBRIATRIC PSYCHIATRY: CAPACITY ISSUES Allan Anderson, M.D.l,Jason Schillerstrom, M.D.2, Marsden McGuire, M.D.3 Shore Psychiatric Associates, llC, Camb~ ~ ofTexas Health Science Center at San Antonio, San Antonio, TX 3 Sheppard Pratt Health System, Baltimore, MD I

2 University

Abstract: With the aging population and the increase in prevalence ofdementia, there will be an increasing need for physicians to be involved in the evaluation of various mental capacities. While some of this may reside in the medical arena, such as capacity to consent to medical treatmen~ often capacity assessments are required to determine an elder individual's capacity to author a wia to sign a contract, to manage their assets, and others. Such evaluations are dearly in the domain of expertise ofthe geriatric psychiatrist. Perfonning such evaluations can provide more significant financial reimbursement to geriatric psychiatry practices currendy under

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2008 AAGP Annual Meeting fire from reductions in Medicare payments. This symposium will present practical aspects of adding this service to your clinical practice. Specific topics discussed will include the evaluation of executive function as it relates to capacity and the evaluation of capacity of cognitively impaired individuals for the pUlpose of entering a research study.

4:00 PM - 5:30 PM AGING AND MENTAL HEALTH AS A FACTOR IN NATIONAL ELECTIONS Martha Broce, Ph.D.~ MP.H.l Senator George McGovem2 1 Weill

Comell Medical College, White Plains, NY Senator (D-SD)

2 Former U.S.

Abstract: The Foundation is sponsoring a symposium on how the factors of mental health and aging impact and influence political elections. Special guest speaker, Senator George McGove~ will speak from personal experience and recoWlt the nation's response when it was discovered his first choice for a vice-presidential running mate in 1972 had been treated for depression. He will project whether the situation would be similar in today's society -- over 30 years later as well as talk about how the issues of both mental illness and aging will be part of the political agendas in 2008. Senator McGovem has been an outspoken advocate for fair and equal access to treabnent for mental disorders from his experience as a father whose daughter died from alcohol addiction. He has written Teay: My Daughter's Life-and..Death Struggle with .i\lcoholi~ a deeply moving chronicle of his third child's efforts to overcome her addiction to alcohol He bas established The I\.-IcGovem Family Foundation to help mise funds (or alcohol research, and a recovery facility, the Teresa McGovern Treatment Center, was erected in his daughter's memory in Madison, WiSconsin. As a policy make~ he brings years of experience including serving as both a u.S. Representative and Senator from South Dakota, was the Democratic nominee for President in 1974 and was appointed u.s. ambassador to the United Nations (UN) Food and Agriculture .i\gencies and UN Global Ambassador on World Hunger by the World Food Programme. In 2007, a celebration of McGovem's 85 years was held on Capitol Hill in Washington, D.C. Senator McGovem will give prepared remarks and then open up the session for discussion.

Monday, March 17, 2008

7:00 AM - 9:00 AM WITHOUT A MAP: TREATING GERIATRIC BIPOLAR DISORDER IN THE ABSENCE OF GUIDEUNES ~rtha Sajatovic, MD"l, Kenneth Shulman, M.D.2, Robert Young, MD.J, I Case Westem Reserve School of ~Iedici.ne, Cleveland, OH 2Uoiversity ofToronto Sunnybrook Health Sciences Centre, Toronto, ON 3 Weill Medical College of Comell, White Plains, NY

Abstract: Relatively little is known about the epidemiology, natural history, or appropriate treatment of bipolar disorder in older adults. These patients often have comorbid medical conditions; polyphannacy; may metabolize medications differendy; and are more susceptible to adverse events. Thus, there is a distinct need for clinical guidance in the management of geriatric bipolar disorder. The prevalence of bipolar disorder among individuals age 65 or older ranges from 0.1-0.5°/0. Other studies suggest that bipolar disorder accounts for 5-19% of all mood disorders in the elderly. Prevalence is expected to rise with growth of the geriatric population; the number ofAmericans over the age of 65 with a psychiatric illness is expected to grow from 7 to 15 million by 2030. Additionally, dderly patients with bipolar disorder have longer hospital stays and are more likely to use outpatient services. Emerging data suggest that bipolar disorder in late life has a Wlique clinical profile. Comorbid substance abuse may be less common compared to younger patients, whereas cognitive disorders and lower global functioning are more common. Psychiatric or medical comorbidities can complicate management; for example, deliriwn may mimic mania, and the presence of dementia can affect symptomatology and treatment Older patients may also have a new-onset fann of the illness~ which appears to differ from early-onset bipolar disorder at least in teans of resource utilization. Treatment challenges include the physiological changes that can alter the phaanacokinetics and phaanacodynamics of medications, increasing the risk of adverse events. Certain adverse events are especially troublesome in older patients, including movement disorders, which increase the risk of falls, and central and peripheral anticholinergic effects. lithium, for example, is associated with acute toxicity in 11 % to 23 % of geriatric patients and in up to 750/0 of medically ill patients. In community studies, n.ew lithium prescriptions for patients over 66 yeus of age fell over the previous decade, while new valproate prescriptions rose substantially. Nevertheless, data and guidelines regarding the use of valproate and other treatments for geriatric bipolar disorder are lacking, indicating a clear need for further study and education.

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2008 AAGP Annual Meeting

P""ier: AstraZeneca

9:15 AM - 10:45 AM THE HIDDEN DANGERS OF DEMENTIA: ASSESSING RISK FACTORS IN THE OFFICE BASED SETrING Paula Lester, ~lD.I, t

Izchak Kohen,

Wmthrop Uoive1'Sity Hospit~

2 LI]

- Hooker Hillside Hospit~

~lD.2

Mineola, NY

Glen Oaks, NY

Abstract: This symposium will provide an overview of the hidden dangers facing patients with advancing dementia. Unfortunately, patients and their families are often unaware of the risks that occur as cognition declines. The role of the clinician is to screen for risk factors, to educate caregivers, and to provide inte!Veotions that reduce such risks. We will discuss specific areas of concern in cognitively impaired individuals including driving, fall risk, wandering, dysphagia, home safety and the need for increasing supervision. For each topic, we will discuss the known data and current research regarding the prevalence of the risk factor as well as we will look at known interventions from the literature for each of the risk factors. We will its morbidity and mortality. In additio~ review assessment tools for the various risk factors. With regard to driving, we will review the reporting requirements of various states as well as the medical-legal liability of clinicians. As issues of autonomy and independence make it difficult for caregivers to intervene and to recognize the need for intervention, we will. focus on strategies for in-office interventions. We will discuss the role and responsibility of the physician and the need to work with patients and caregivers to enhance safety. We will also provide strategies for minimizing cont1ict between the patient, the caregivexs and the clinician. For this purpose, we will use examples from our clinical experience as well as from the media to demonstrate possible risks as well as appropriate therapeutic modalities~

TRANSLATIONAL RESEARCH IN GERIATRIC PSYCHIATRY Paul Rosenberg, MD.I, Brent Forester, M.D.2, Warren Taylor, M.D.l, Michelle I\fielke, Ph.D.4, Gwenn Smith, Pb.D.s I Johns

Hopkins University. Baltimore. MD

Mcaean Hospit~ Belmont, MA 3 Duke University Medical Cente~ Durham NC 2

..Johns Hopkins University. Baltimore, MD 5 Harvard Medical School. Belmont, !vIA 7 Harvard Medical School, Belmont, !\;IA 8 Centre for Addiction and Mental Health and the Rotman Research Institute, Toronto, ON

Abstract: New translational research methodologies are being applied to disease states important to the field ofgeriatric psychiatty. Biological markers can enhance diagnosis, prognosis, and monitoring of treatment response particu1arly to novel thempies. We present four examples of the application of new technologies to Alzheimer's disease (AD) and late-life mood disorders: 1) Magnetic resonance spectroscopy (MRS) quantitation of brain glutamate as a marker of changes in energy metabolism in a controlled trial of lamotrigine in late-life bipolar depression~ (Brent Forester, MD, Harvard University) 2) Assessment of frontal and limbic white matter integrity using diffusion tensor imaging (011) and stnlctural imaging, examining whether longitudinal changes predict outcome in late-life mood depression. (Warren Taylor, MD, Duke University) 3) Assessment of petipheml blood levels of novel lipid markers of neuronal functional (ceramides and sphingomyelins) as predictors of cognitive decline in a longitudinal study of elderly women. (Michelle Mielke, PbD,Johns Hopkins University) 4) PET imaging of microglial activation using (1 tq-R-PK11195 as a biomarker of neuroioflammation in AD. Microglial activation is an essential step in the neuroioflammatory processes of .ID, and quantitation of microglial activation may be a useful surrogate matker of outcome for novel anti-inflammatory therapies of AD. (paul Rosenberg, MD,]ohns Hopkins University). The presenters will demonstmte how each methodology has strengths and specificities that make it particulady useful in geriatric psychiatry research.

RESULTS FROM THE NIMH WORKSHOP ON PSYCHOSOCIAL INTERVENTIONS IN LATH UFE MENTAL ILLNESS Patricia.Arean, Ph.D), George Alexopoulos, M.D.2, Charles Reynolds, MD.3, George Niederehe, Ph.D." t

University of California - San Francisco, San Francisco, C1\ Medical College of Comell University, White Plains, NY

2 Weill

3 University of Pittsburg School of Medicine, Pittsburg, PA 4National Institute of Mental Healt~ Bethesda, MD

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2008 AAGP Annual Meeting Abstract: In October of 2006, the NIMH hosted a workshop to detennine the future directions of psychosocial interventions research for late life mental illness. Leading experts in psychosocial interventions research in late life mental illness met to discuss three substantive areas related to the promotion of a future research agenda. The topics for discussion in this two day workshop were issues surrounding incorporation of new therapy components, extemal validity/generalization issues, and promotion of new study questions and novel approaches to psychosocial interventions research. Drs. Alexopoulos, Arean and Reynolds will present the findings from this workshop as well as recommendations for future research directions.

DIAGNOSIS AND MANAGEMENT OF FRONTAL/SUBCORTICAL DEMENTIA Jonathan Stewart, MD. t 1 Bay Pines

VA J\JIedical Center, Bay Pines, FL

Abstract: ~~side from Alzbeimer's disease and Lewy body disease, most dementias initially present with predominant dysfunction of the frontal/subcortical systems. These patients present with a variety of behavioral problems that are commonly misunderstood and misdiagnosed. The &ontal/subcortical system is a neuroanatomically distnbuted system. consisting of parallel circuits that course from frontal cortical areas through subcortical white matter to the basal ganglia and the thalamus. Three of these circuits subserve behavior and cognitive function: Damage to the dorsolateral prefrontal circuit leads to loss of planning and goal-oriented behavior~ damage to the anterior cingulate circuit leads to abulia, and damage to the lateral orbitofrontal ciJ:cWt leads to disinhibited behavior. Detection of frontal/subcortical deficits is often mostly historical; bedside and neuropsychological testing are also useful, although the Folstein :MMSE does not detect these deficits. The differential diagnosis is broad, and includes vascular dementia, frontotemporal dementia, HIV-associated dementia and a wide variety of other common degenerative, infectious, toxic and traumatic disorders. ?vIanagement of the patient with frontal/subcortical dementia is mostly non-phannacologic, and involves mosdy ongoing focused caregiver education and support. Certain behavioral approaches are also beneficial, as are mobilization of clinical, financial and legal resources. Aside &om. treatment of the underlying condition, pharmacotherapy has a limited role in these patients, mostly in the treatment of problematic disinhibited behaviors.

NATURAL HISTORY OF ALZHEIMER'S DISEASE: FINDINGS FROM THE CACHE COUNTY DEMENTIA PROGRESSION STUDY JoAnn Tschanz, Ph.D), Constantine Lyketsos~ M.D., MH.S.2, Martin Steinberg, MD.3, M2ria Norton, Ph.D.~ State University, Logan, UT Hopkins University, Baltimore, MD 3 Johns Hopkins University, Baltimore, MD .. Utah State University, Logan, UT 1 Utah

2 Johns

Abstract: Many studies have examined the natural bistolJ of Alzheimer's disease (AD) but there is little information on coursemodifying factors, particularly from populations. Tremendous variability characterizes the rate of progression in AD, and subgroups of rapid and slow decliners have been identified. Neuropsychiatric symptoms (NPS) are common and often appear in clusters, though the presence ofindividual symptoms varies according to the severity of dementia. While certain features of the disease such as early cognitive, motor and psychotic symptoms predict more rapid progression, limited infoanation is available on modifiable factors that affect the course of dementia progression and NPS expression in ~-\D. In this symposium co-chaired by Drs. JoAnn Tschanz and Constantine Lyketsos, we will review the cuaent research on the natural course of AD, focusing on cognitive, functional and behavioral trajectories, and discuss modifiable and non-modifiable factors that influence their course. Using data from the Cache County (Utah) Dementia Progression Study, one of a few studies in the world longitudinally fonowing an incidence sample of dementia from a large population, Dr. Tschanz will illustrate patterns of decline, while presenting demographic, genetic (APOE) and vascular factors associated with progression. Dr. Martin Steinberg will present the cumulative prevalence of NPS over five years of follow-up, describe the variation in occurrence by dementia severity, and the clustering of symptoms into specific classes. Both presenters will highlight data that implicate vascular factors as modifiers of dementia progression and risk ofNPS, noting the complexity of their effects in their interactions with other factors such as age of dementia onset. Furthermore, Dr. Tschanz and Dr. Maria Norton will report on findings that specific vascular treatments and aspects of the care environment may be important modifiers of course, attenuating the rate of functional decline in AD. Dr. Constantine Lyketsos ofJohns Hopkins Univenity, an expert in the care and treatment of patients with Alzheimecs and related dementias will lead a discussion on potential mechanisms underlying the associations of the above factor:s to dementia progression and NPS, as well as their implications for treatment.

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2008 AAGP Annual Meeting REIMBURSEMBNT WORKSHOP: AAGP MEMBER FORUM ON EFFORTS TO ADDRESS REIMBURSEMENT BARRIERS Allan Anderson, M.D.1, Michael Hash~ David Greenspan, M.D3, Gary Moak, MD.4

Shore Behavioral Health Services, Cambridge, :MD Policy Alternatives, Washington, DC 3 Cattier Clinic, Philadelphia, PA 4University of Massachusetts Medical School, Worcester, MA I

2 Health

Abstract: This workshop of the Reimbursement Task Force is intended to provide a forum for member input into AAGP's efforts to address reimbursement barriers to access to geriatric psychiatry services. Membe%s of the Reimbursement Task Force will review the current status of reimbursement for geriatric mental health services and discuss current regulatory and legislative issues, along with an update on the work of the Medicare Relative Value Update Committee (RUC) and Current Procedural Terminology (CPT) coding issues. Initiatives taken and planned by i\.AGP will then be reviewed This will provide the background for an interactive discussion with participants. This will be an excellent way for attendees to leam about up-to-the-minute developments in reimbursement, and to share their practice experiences dealing with reimbursement barriers. The Reimbursement Task Force hopes that this component workshop will attract participants with not only first band experience, but also expertise in reimbmsement issues who will share their perspectives and ideas with the Task Force regarding AAGP's action agenda in this area.

11:00 AM - 12:30 PM A FRESH PERSPECTIVE ON VASCULAR DEPRESSION: NEW RESEARCH FROM NIMH KAWARDBES David Steffens, M.D.', Faith GU1U1ing-Dixon, Ph.D.2, Paul Holtzheimer, M.D.l,Joel Sneed, Pb.D.4, George ,,'\!exopoulos, MD.s

University Medical Center, Durham, NC Weill School of Medicine at ComeR University, White Plains, NY 3 Emoty University, Atlanta, GA oJ Columbia University, New York, NY 5 Weill Medical College at Comell University, White Plaios, NY 1 Duke

2

Abstract: The concept of vascular depression as a distinct diagnostic entity in late life has gained traction over the past decade. Several studies have examined the links between cerebrovascular disease and development of geriatric depression as well as the mood, cognitive and functional consequences of depression in the context of cerebrovascular disease. Now a new generation of investigators has tumed their research focus to this area This symposium will highlight new research from recipients of K Awards from the National Institute of?\iental Health. Faith GU1U1ing-Dixon is a neuropsychologist at Weill Comell Medical College of Come1l University whose K23 award ·'Anterior Cingulate Activation in Geriatric Depression" focuses on using cognitive and affective probes to elicit activation of frontolimbic networks in geriatric depressed patients and age-matched comparison subjects. Her project will extend previous research in vascular depression that focused on franto-striatal tract disruption by examining structural and functional abnormalities in subregions of the anterior ciogulate. Paul E. Holtzheimer, M.D., is a geriatric psychiatrist at Emory University. His K23.i\ward, cCInvestigating struetural..functiooal bmin abnormalities in late-life depl:essioo," will focus on using advances in strucnual and functional magnetic resonance imaging to understand the relationship between vasculat bmin changes and cognitive-emotional processing in late life depression within the context of developing nemal network models. Joel R. Sneed, Ph.D., is a clinical psychologist at Columbia University whose K23 Award, "Vascular depression: 1\ distinct diagnostic entity?" focuses on examining the validity of the vascular depression construct. Using a psychometric approach to diagnosis, Dr. Sneed distinguishes between internal (construct) validity and external (concurrent and predictive) validity and argues that intemal validity must be obtained prior to evaluating extemal validity. To this end, Dr. Sneed is applying latent class analysis to several latelife depression datasets to deteDDine whether a unique class of vascular depressed patients exists and what combination of features best defines its occurrence. Each of these young investigato!:s will present new research findings supported by their respective K olL'\wards. At the end of the presentations, Dr. George Alexopoulos of Weilll\Jledica1 College of Comell University will comment on their wolk and place it in a larger context of research in vascular depression.

INAPPROPRIATE SEXUAL BBHAVIORS IN DBMENTIA Rajesh Tampi, M.D., M.S6 1, Karin Kerfoot, M.D., F.R.C.P6C. 2, Kirsten Wtlkins, MD.3 I Yale University School of Medicine, New Haven, cr 2Yale University School of Medicine, New Haven, cr 3 Yale University School of Medicine, New Haven, cr

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting Abstract: Dementias are the most common type of neurodegenerative disorder. Behavioral distw:bances are seen in more than 80% of patients suffering from these disorders. Although sexually inappropriate behaviors are not as common as some of the other behaviors seen in dementia, they can cause immense distress to all who are affected. There are currently no randomized trials for the treatment of these behaviors, but the available data suggest efficacy for some commonly used treabnent modalities. In this symposium, we \Vill systematically review and discuss various aspects of these behaviors and available treatments.

MAKING TEAMS WORK: PROVIDING EFFECTIVE INTERDISCIPUNARY GERIATRIC MENTAL HEALTH CARE

Amber Gum, Ph.D.·, Katluyn Hyer, Ph.D.2, Jiirgen Uniitzer, M.D., M.P.H.3, Thomas Oxma.t1, MD.4 University of South Florida, Tampa, FL of South Florida, Tampa, FL 3 University ofWasbington, Seattle, WA 4 Dartmouth Medical School, Lebanon, NH I

2 University

Abstract: How do we best serve older adults with behavioral health disorders who present to various medical and. social service settings with multidimensiooal psycbiatri~ medic~ and social needs? Through teamwork. Several research studies now demonstrate that collaborative care models implemented by interdisciplinary teams (IDTs) provide older adults and their families with integrated services that improve satisfaction, access) psychiatric functioning, physical functioning, and quality oflife. But "good teams don't just hap~" and most behavioral health professionals receive little formal training in how to work effectively in an interdisciplinary team. Therefore, the purpose of this symposium is to provide participants with knowledge and skills to develop an interdisciplinary team to address older adults' behavioral health problems or enhance the performance of an existing team. First, Dr. Kathryn Hyer will describe the Geriatric Interdisciplinaty Team Training (GIn) Program, which helps organizations develop highly effective teams to serve older adults in a range of health care settings. GI1T is a multi-site program that helps organizations prepare to implement teams~ define the structure and functions of team members" and improve team functioning (e.g., effective communication, conflict resolution, team ethical issues). Dr. Hyer will discuss preparing an organization for implementing a team, roles and functions of various team members, including the patient and family in the team, and communication and conflict resolution. Second, to provide an example of one effective interdisciplinaty model to manage behavioral health issues in older adults, Dr. Jfugen Uniitzer will describe the team approach employed in IMPACT (Improving Mood Promoting Access to Collaborative Treatment). In IMP.A.CT, a depression care manager (usually a nurse, clinical social worker, or psychologist) coordinates depression care in collaboration with the primary care physician, nurse, and consulting psychiatrist. The patient is an active member of the team involved in treatment plaooing; available treatments involve antidepressants and problem-solving therapy, delivered by the depression care manager. ~ Dr. Thomas Oxman wiD. focus on the specific role of the consulting psychiatrist in developing and working effectively on interdisciplinary teams and on facilitating older adults' access to behavioml health services through collaboration with team members. The models that are ptesented have resources to help professionals actually implement what they leam in the symposium, including web-based assessment and ttaining resources, toolkits, and access to consultants.

END OF LIFE CARE IN DEMENTIA: PALLIATIVE CARE APPROACHES M.D.3~ Keith Stowell, MD., MS.P.H.4, Colleen

David Casey, M.D"~ Mercedes Rodriguez-Suarez, M.D.2, Una Sbihabud~ Northcott~ Ph.D.) MD., F.R.C.P.C.5

t University ofLouisviDe School of Medicine, Louisville, KY 2University of Miami, Hollywood, FL 3 Mount Sinai School of Medicine, Short Hills, NJ .. Western Psychiatric Institute and Clinic, University of Pittsburg Medical...., Pittsburg, PA S University of Bristish Columbia, ,,.ancouver, Be

Abstract: Palliative care is an interdisci.plinaty approach to tteaunent focused on relief of suffering for patients with advanced or tetminal illness. 1bis approach emphasizes commU11ication, symptom management, coordinated cate, and psychosocial support. Grief and bereavement issues are a part of the plan of care for both patients and their families. Palliative care is an approach that emphasizes relief from suffering rather than intensive medical intervention. It is a coping rather than curing approach. Palliative care. along with hospice, bas gained significant acceptance in the medical community as well as the community at luge. However, this approach has mosdy been utilized for those with terminal medical conditions, such as cancer or AIDS. In recent yeats, some psychiatrists as well as palliative care specialists have become interested in applying this approach to dementia care. In most cases~ dementia is essentially a teDninal disease, as patients will not recover. l\fany elderly patients with progressive dementia experience enormous emotional distress. Some of these elders also have issues of acute or chmnic pain. !\.o[anagement of pain in dementia is

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2008 AAGP Annual Meeting further complicated by the patient's inability to communicate. Dementia related behavioral clistmbances may be exacerbated by such pain disorders while management of difficult behaviors may deflect the clinician's attention away &om pain management. !\(any patients with advanced dementia have comorbid medical conditions requiring care, often involving multiple physicians and many medications. Extensive and sometimes intrusive medical evaluations and aggressive therapies may sometimes be recommended for these comorbid conditions. However, such measures usually require a cooperative and motivated patient who can participate in his or her own care. As cognition declines, patients may not be able to do so. Also, patients are often no longer able to understand the issues involved in their own care or express their preferences. They often resist medical procedures, requiring sedation or restraint. Families struggle with decision making in such cases t often leading to internal conflicts. J.\ palliative care approach for advanced dementia would encompass the notion that the overall plan of care, including pain management and care of comorbid conditions, should shift to one which emphasizes the patient's comfort and attempts to minimize intmsive medical interventions....~ acknowledgement is made that the dementia patient will not recover &om this illness, and that an aggressive approach to the care of comorbid conditions is likely to be fruidess and possibly counter-productive. In this symposiwn psychosocial and psychotherapeutic approaches to palliative care as well as phannacologic implications will be addressed Ethical issues inherent in a palliative care approach \Vill be discussed

GERIATRIC SUBSTANCE ABUSE: A CULTURALLY DIVERSE APPROACH TO RECOGNITION, ASSESSMENT

AND EVIDENCE BASED TREATMENT IN THE CUNICAL SE'ITING Louis Trevisan, ?vI.D.1, Gavin Friedman, ?vI.D.2, Phillip Whang, M.D.3, Raquel Lugo, ~f.D.4

cr cr cr cr

Yale Universty School of?\Jfedicine, West Haven, West Haven, 'Yale University School of Medicine, West Haven, 4 Yale University School of~fedicine]l West Haven" I

2Yale Uoiversty School of~fedicine,

Abstract: Up to 160/0 of the elderly have alcohol use disorders. In prim2ry care, at risk drinking has been estimated to occur in 5150/0 of the population. Older Americans are increasingly becoming more ethnically/culturally diverse. The cohort of ~'\mericans age 65 and older constitutes the fastest growing segment of the population. Cultural perspectives of elderly substance abuse are becoming increasingly important to general, geriatric and addiction psychiatrists. This workshop will focus on involving participants in an active decision making process based on case presentationst didactic presentations and group discussion concerning elderly substance abuse in a culturally diverse elderly population. Participants willleam to better identify problematic substance abuse using knowledge of risk factors, differential diagnostic systems and available screening tools with special attention to ethnically sensitive issues. Emphasis will be placed on pharmacologic interventions involving consideration of dose and drug-drug interactions. In addition, non-phannacologic interventionst including the use of brief interventions, psychosocial interventions and formal addiction treatment will also be reviewed. Symposium leaming objectives will be met by demonstrating a systematic and evidence-based approach to evaluating and tteating substance abuse in a culturally diverse elderly population. This will be accomplished through a combination of didactic presentations, representative videotaped interview vignettes t and real time audience participation using a participatOIY discussion fonnat at strategic points in the clinical management of cases. Didactic presentations will focus on specialized approaches with a cultural diverse population including: epidemiology" appropriate assessment techniques including use of standardized questionnaires, laboratory and medical assessments, and specialized treatment approaches (phannacologic, psychotherapeutic and psychosocial). This format is designed to educate and help guide the participants in making decisions based 00 real-life patient cases cooceming identification of problems, making accurate assessments and treatment interventions, and developing goals for substance abuse treatment in specific elderly populations.

TEACHING HEALTH SYSTEMS TO MANAGE COGNITIVELY IMPAIRED OLDBRADULTS Sao Borson, MD.l t Barbara Kamholz, ~LD.2, t

Adam Rosenblatt, MD.3

University ofWashingtoo, Seattle, WA of Michigan/Ann Arbor VA Health System, ~\nn

2 University

3 Johns

.l\rbor, rvn

Hopkins School of Medicine t Baltimore, ~ID

Abstract: Principles of good geriatric care call for identification and proactive management of chronic conditions and other risk factors for poor patient outcomes. In all geriatric care settings, cognitive disorders carry specific risks to safe, optimal management of psychosocial and physiological needs and concurrent chronic diseases. The Csilent epidemic' of cognitive disorders requires redesign of health systems to identifyt understand, and manage cognitively impaired patients w~ and to locate the specific points of care where innovations can be most effective in improving outcomes. Speakers focus sequentially on inpatient, assisted li~ and outpatient care, providing a brief overview and data supporting the need for system redesign in each setting and a targeted program for accomplishing needed change.

Am J Geriatr Psychiatry 16:3, Supplement 1

A33

2008 AAGP Annual Meeting

Sessions Alphabetically by Presenter Agronin, Mate E. GrollfJ Thtraf!I in the ElJlr!J: ExpnUnces IPith a StnI&llmd Outpatient Program (SOP) Ahmed, Iqbal I""olkltillt Hlsearch in Cross-Clllhtral GtnJpsydJiatry

Akinyemi, Esther O. TfOlibleshooting EdllCtltional Challenges in the Gniatrit PfYGhiatry FelloDlship Alexopoulos, George S. A Fresh Perspective on Vascular Depression: New Research from NIIMH K Awardees E11Iergingfro11l the Anll'ish: Proximate Issues of C011Jorbid Ins01llllio in Lzte - Lift Depression Rmi/a.frolll the NIMH Workshop on P{Ychosocialll1tmJmtio1/S ill Lat, Uft Mentall11111Js Anderson, Allan A. Fomui& Gniatric Pgchiany: Capod~

1sSlies PolirJ olld Politics: Shopillg Mental Health Priorities in tl PresitlmtialBledion Year Rei11l1»m,ment Worluhop: AAGPMember FOf'llfIJ on EffortJ to AJJress &ifIJbNrsl11lent Batriers

Andrew, Melissa H. Hitchhiletls GlliJI to Teachin§ BgonJ thl Power of PollltfjJOillt

Arean, Patricia A. Fighting Geriatric Mental Heahh Disparities thro"!/J In1lfJtJaJion: Th", Ongoing PrrJjeds Moderato" of &spollSt to Antidepressants and PJYthotherapy in Loti-life Depression Rmllttfrom the NIMH Workshop on PsychosociallnteTlJt1ltio1lS in Late Uft Menial II/ness Arnold, Steven E. UfeJjkm PgcholtJ!Jta/ Distress and Riskfor Dl11Ientia in OldAge: Translational Hlsearth Ashford,). Wesson

Dementia Smndng in Clillital and C01Jl1ll1Jni!J Settings

Barg, Frances K Ne. QuaBtatitJe R8searrh on Late Ii} Disorders aNi Intervmtiom Bartels, Stephen J. AGaJemic-Com11Jllnity Partnerships: Translating Evidenced-BasedMenial Health Inttl'Jlt1ltiollS i"to Prama Cartlio1lletabolic Syndrome: Prellllltioll, Intervention, and Int'lftllld M,dital Can

Bankole, Azziza O. Factors AffedingQllality OfUfe In A Mllltiradal Sampk OfOlder PersON With Schi~phrmia Bogner, Hillary R. Adherence fIJ Deprestion Treat1IIent anti the Oldlr Patie1lt Borson,Soo

DellJentia Smelling in CIi1liM/IlIIJ COIll1llIlni~ Settings reaching Health Syste1/JJ to Ma1llJgt Coll'iJitltty Impaired OlderAdllhs

Brown, Ellen

[nnoMa. Approaches to PtTJlJiJing Mental Heabh Senitls in Comlllllnity..Based Settings

Bruce, Mattha L. AGaJemic..col1l1lltmi~

Partnerships: Translating Evidenced·BaseJMental Health Interventions into Pradia

Am J Geriatr Psychiatry 16:3, Supplement 1

A35

2008 AAGP Annual Meeting .t1ginA alld Mental H6a1th as (J Fador i" NiIIional Elecnolls Bullock, Karen l1lnolJQ/i", Approachls to PnJuitlinl, Mental H,ahh Sema!inConJ11JIIni{y-.Bas.JS.lIings Byrd, EveH. S eslioll: 111110tJl1ti", Approaches to Providing Mental Health Semas is C011l11lNlIity-Bared Settings Carlson, Nancy B. Dementia Behaviors: New GNiJelinesfor Tnat1JJenl with BehOlliorallnteruentiolls Casey, David A. Elld ofLift Care in Dementia: PalliatitJe Care Approaches Catalano, Lucia DeVivo Dementia Behalliors New GuiJIlilleJfor the Treatment with BehaPiorall11tmelln01lJ Jeffrey L. Dementia: Trallslotillg Latest Findings To Meet Today ~ Malla!!1ll,nt Challenges

Cummings~

Czaja, Sara Use ofTechlloloO to Provide Melltal Health Semces to OM,r Adl/It.r

Dakin, Emily Ne. Qualittlliw Resemrh 011 1JJte Uft Disorders alld InfmJellnolls Dalton, Jeanne R.

I1tNOlJabiJt Approaches to

ProlJiJing Mell/al Health SenJias ill C01l1If111N!y-Bas,d S e/tilljs

de Figueiredo,john M. I"nolJaIi", Hlsearch iN Cmss..cultllral Gerop!ydJially Depp, Colin A. Advall&ts ill1.Ate-Iift Bipolar Disorder TreaJmlnt 2008 NI1IJ Ql/IJlikdi", Be/earch 011 Late Lift Disorders and In/mJentions Dedefsen, Ellen G. Geriatric ProfessiONals Gllide to tlH 11I1emel: Reco1ll1lllnded WebJitesfor Patilnts and FflIJIilUs Devanand, DP Depression Ilnd Cogni/i", Impoimtent: T1PO Disorders or One? Dumas, Julie Nit"Otink VerstIS Mmcarillic Blocleatk A/1m Verhol Working Mtlllory-Rt/aud BrtJilt Acti,;!! In Older Women The Cholill"lic Hypothesis ofAge a1ld De11lt1lua-'&lated Cognitiw Dysfunction RevisitedAgaill: Rla1lt Adl1lJ1Iar alld ImpucatiollSfor Prevention and Tretlt11Jent Eisdorfer, Carl Use ofTechnoJogy to Pmwde Mlnml Health Semees to OIJerAdults Ellison,James M.

Emergjngfrom the AngMish: Proxi11lom Isslies of C011lorbid Insomnia in Lote-Lift Depression Evans,jovier D. Late Lift Schi~phrellia

A36

&searrh: C611ical, Ethica~

and TranslationalApproaches

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Eyler~ Lisa T.. 1.411 Uft Sthi1fJjJhre"ia Ruemrh: Clinita/, Ethica~

and TranshtionalApproaches

Faison, Warachal

HOlll to Teach CNltNral Competence in Geriatric P~chiahy:

AdJnssing UntIle! Patient Needs

Farlow, Martin Rhys

Dementia: Translating Latest Findings to Meet Totltg i ManallfIJmt Challenges

Ferris, Mara Comprehlnsive Approach to Btmim aNi BI/mollt in Caregitlll1 at HOflJe and Healthcan Workln in Long Tem Can Settings Folsom, David P.

CtmHometabolic Syndrome: Prntntion, IntmJtntioll, tIIlJ Illtegrated Medical Care Ford, Shyla GmlljJ Therapy In The EIJet&: Experimtes With A S1rtIdtmtl Olltpatient Program (Sop) Forester, Brent

Translatio1ll1/ Research in Geriatric Pgchiahy Frank, Lori

Dementia Screening In COnical Anti C011l11l111ti!y Settings

Franz, Carol E. NIRIQllaliflltitJe &search on Ltde Lift Disorders and IntenJlntio1lJ

Friedman, Gavin Genilmc SI/bstQ1I&I Abuse: A Cl/ltNra/1J DilJt1'Se Approach to &cognition, Assessment tl1JJ EviJence Bared Tn(l/11Jmt in the Clinical Setting Gallagher-Thompson, Dolores

Fighting Geriatric MenltJI Health DiJpmi/ies throl/gh 11111OtKJtion: Time OllifJing ProjedS Gallo, Joseph

Academk-CofIJlI/Nnity ParI1Ierships: Translating Evitimad-Baseti Menla! H,alth IntenJelltions Into Pradice Gildengers, Ariel

Advances;" Late-lift Bipolar Disorder T"atmen12008 Greenfield, Susan

New Brains For Old? The FIltNf't OfThl21J1 C,nhny Mind Greenspan, David

Rnmbllf'stment Worluhop: AAGPMember FOf'l/fIJ 011 Efforts 10 Address Rti1lJbllrsellJ11l1 Barriers

Grossberg, George

Clinical Researchers Debate: The ComprelHnsive T1Im11/ent OfAltheimer's Dittose

Gum, Amber

MaJejng Tea1IJS Work: Providing Effective IntmJisdplinmy Geriotric Mental Health Cmr Gunning Dixon, Faith

A Fresh Perspedive 0" V fJSCllhr DepreJsiol1" NIDI RJsearch.from NIMH KAJIItJrdtes Harper, David G"

Emergingjvm theAnguish: Proximate [me ojComorWlmannia in Lote-Lifi! Dcpmion

Am J Geriatr Psychiatry 16:3, Supplement 1

A37

2008 AAGP Annual Meeting Harvey, Philip D. Cognition and Fllndion ;" Late-Lift Schi~h"nia Hash, 1\.Uchael Polig and Politics: Shaping Mental Health Priorities in a PrrsidmtiaJ Election Year ReimbNn""lIIt Worleshop: AAGP Member FOrN'" on Efforts to Address Rei",btme",ellf Banien Hinto~

Ladson

Nelli Q1HJ!itati", RJsearch 011 Late Uft Disorders And 1ntmJtntions Holtzheimer, Paul E. A Fresh PerspeditJe on VaI&1Ilar Depnssion: NIIP &searchfrom NIMH KAwardees Hyer, Kathryn

Making Teams Work.' Providing EjJidive Interdisciplinary Geriatric Mental Heahh Care Ismail, Zahinoor

Cognition and Fllnmoll ;" Late-Lift Schi~lm1tia

Jervis, Lori L. 11lnovatillt Rlsearrh in CnJss·CIIItNraI GeroPfYchiatry Jeste,Dilip V.

ColJlition ami PI/limon ill Late-Lift S&hi~hrmia

Jones, Robert

Medical Updates For The Pradicing P{YchitJtrist: Meeting The Medical Needs Of OltkrAtlNhs

Jorge" Ricardo E. ApatltJ i" Ptdimts lllith 1J:de-Lift Nellroj»ychiatric DiJorJm: Identification and Trratment

Kaas, Merrie

11lnovatillt Approaches To Providing Mental Heahb Smices 111 C01ll1ll1l1li!J-Bmed Settings

Kales, Helen C. Adherence /() Depression Tret1lmmt and the Older Patient Kamholz, Barbara Teaching Health Systems 10 Manage CognitiveIY Impaired OlderAdNIts Katp"Jordan F.

Toxic EffidJ of Persistent Pai" in Older AJNhs Kasckow,Joho !All life SdJj~phfrnia

Rnlmrh: Clinical, Ethica~

And TranslationalAppff)(J&hes

Kerfoot, Karin lnaj>prrJpriat8 SeXliaI Behauiors ill Deml1l/ia Kilboume, .l\my

AdPa1lm In Late·Lift Bipolar DisonierTreatmmt 2008

Kirwin, Paul Creative RtJiIi,na /Il1J.A&ing~·

'Dreams, Schemes, & The11lls"jrolll MIISic & POlity

Kohen, Izcbak The Hidden Dallllrs ofDementia: Assessing Risk FachJrs in th, OJ/itr Based Sitting

A38

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Krain, Lewis P.

Trollbleshooting EdNcational Cha/lmges;" tlJl Geriatric Pgchitlhy Fellowship

Kyomen, Helen H.

Understanding and Managing Aggressive Behaviors in GeropfJthiatric Palients

Lantz, Melinda

Medical Updates For The Practicing P!JthiaJrist: Meeting The Medical Needs 0fO''''r Ad"lt~

Lebowitz, Barry D.

Clinical &seorthers Debate: The Comprehmsive Treotment ofAI!(/Jeill/er's Disease UtuitrJtallding andManaNng .Aggressive Behaviors in Geropgchiatrk Patients

Lester, Paula E .

The HiJdln DtJ1lgtrl ofDl1JIentia: Assessing Risk Frxtors in the Offi&l Based Setting

Lewis, Canneo Medical Updates For The Practicing PJYchiatrist: Muting The MedkalNeeds OfOltllrAdMit! Li, Ge (Gail)

Innovative Research in Cross-CllltJiraJGerop!ychitlhy

Lin, Loman

TrDlibleshooting EdNcatio1lll1 Challmges In The Gniatric P&chiatry Fellowship

Lindamer, Laurie A. .AcadlmiC.C011111/mU!y Parlntrship.t: T1tJ1IJ/atin,g EviJmced.. BaseJMental Health Interventions illto Pradict

llorente, Maria D. I nnolJfJtive RJsearch in Cross-CJllturalGtroP!1chiut1y Loewenstein, David Use O/Technology To Provide Mental Health Senias To OlderAdMits

Luchsinger, Jose A. Depre.rJion and Cognitilll Impairment: Two Disorders or One? Lucki, Irwin

IifeJjxm Pgcholoical Distrrs~

And Rirk For Dementia In Old.Age: Translationa/ Ruearch

Lugo, Raquel Geritltric SlIb.rtana Ablls,: A CII!tNrfJJg DiverseApproach to Recognition, AtsesS1lJent and Evidence Bas,d Treat1llmt in the ClinicalSetting Lyketsos, Constantine G.

Apatfty In PatimtJ With 'Late-Lift NINroPfYChiatric Disortlm: Identification And Treatment Nahiral History ofAltheimer's Di/ease: FinJings.from the Cache COIiIl~ DlI1IellDa Propsion Shi4J Lyness, Jeffrey M

Creatiw &silie1lCl adAging:

'DfB(JI1JS,

Schemu, & Theme.r'Jrom MNJic & Poetry

Lyubkin, Mark Troubleshooting EtlllcationaJ ChaUmges In The Gniatne Pgchiatry Fellowship Mackin, Scott Moderators ofResponse to Antidepressants and P!ydJotherapy in 1..4tl-Lt]i Depression

Am J Geriatr Psychiatry 16:3, Supplement 1

A39

2008 AAGP Annual Meeting Maixner, Susan TrollbJeshooting EtlMcational Challmgu III The Geriatric Psychit1hy FeUoIPship Malphurs,Julie E.

Use oJTefhnololJ to Providl Mental Heahh Seruices to Older AdII/ls

Matsh, Laura

All Interactiue Case-Base' Approach To The Treatment Of P!1chiatric C01l/0rhidities In Patients With Parleinsoll ~ Disease :Martinez, Moises How to T,ach GiItNral Competence in Geriatric Pgchit1hy: AdtJressing Ulllllet Patient Needs McCall, W. Vaughn Uncolllnng the Unle: P!Y'hiatric and Skep Distllrballces ill OltkrAdults McCmry, Susan U1I&Owring the Unk; P!Jchiatric and Skep Distllrbances in OlderAdNlts McDonald, William All Inttraetiue Case-Base'Approach To The Treatment Of Pfjchialric ulJlorhidities In Patients With ParleillSOIl ~ Disease l\.£cGabee, Sbunda How to T,ach GiItNral Competence ill Geriatric Pgchit1hy: AdtJressing UlIIIIet Patient Needs McGovern, Senator George ami Mental Health as a Factor in National EkdiollJ

~ng

McKibbin, Christine L. CanJwmetaboli, Syndrome: PrelJ6lltion, In/mJtntion, ami Int'lfated Medical Care McQuire, Marsden

FO,.,IIJic Geriatric P~hit1hy:

Capacity Ismes

l\.£eeks, Thomas Toxic Effects OfPersisllnt Pain III OltkrAdtdts Menza, Matthew An Interactioe Case-BaredApproach To Th, T"a/menl Of Pg,hiatric CofllOrhiJitiu In Patients With ParleilUon'.r Diseas, Meyers, Barnett PhamltlCOtherapy ofU1Iipo1ar P!ychotic Depressioll: Th, STOP-PD SlIIify Mielke, Michelle M Translational Research in Geriatric P~hiahy :Miller, Mark D. Fighting Geriatric Mmtal Health Disparities tbroNgh InnotJt1fion.· Time Ongoing PtrJjeds Moak, Gary AAGP Year In &";6111 Rei11lbNrsl11l,,,t Work.rhop: All!/> Mmber FOnmJ 0" Efforts To AdtJress R8imbNrsemmt Barriers

Mulsant, Benoit H. Pharmacotherapy ofUnipolar Psychotic Depre.rsioll: Th, STOP·PD SJN4y Nathaniel, Vemon I.

HOJII to Teach CNIhiraI Competence in Geriatric P!Y'hiaby: AdtJressillg U1II1Iet Patient Needs

A40

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Nelson~ J. Craig Moderators of&spollse to Antidepressants and PsychotheraJ!1 is LAte-life Depression

Nelson, Randy

Utukrstantling and Mallaging Attfrssive Behalliol1 ill GmJp~Ghiatri&

Patients

Newcomer, john w.

CarJi011letabolit" Syndrome: Pnl1etltilJll, 11lttnJelltioll, fl1ItlllllegateJ Medical Care

Newhouse, Paul The ChoJiner;gic Hypo/hem ofAge and De11ltntia-RJlaud CognitiH Dysfllnction Revisited Again: RecentAJ""n,w and Imp/katiollJfor Prrventioll and

Tremmenl

Niederehe, George

RJsNltsfrom thl NIMH Workshop on P!JchoJoda!Int".",ntioIU in lAte Uft M,ntaIII/nets

Northcott, ColleenJ.

EIlQ ofVft Care ill Dementia: Palliative Carr Approaches

Norton, 1\faria NatHral History ofAlzheimer's Dilease: Fintlings.from th, Cache CONnty Dementia Prol!'ssion S11It& Ownby, Raymond L.

Use ofTechllologJ to Protlide Mmtal Health Semas to OltkrAdults

Oxman, Thomas

Making Teams Work: Providing Effective Intertlitcip6nmy Geriatric Mental Hlflhh Care Palmer, Barton W. Late Up SchiWJhrrnia Research: CHflical, Ethical, And TranslationalApproaches CO~II;tion tIflJ Fill/mOB il/ LIte-Lift Sthi~phrtllia Patel, Amita R.

Comprehen.ri", Approach 10 Bunkn and Bllmollt in CaregjtJefs at Hom, anti Healthcmr Workm in LJng Tn'1/I Care Settings

Pollock, Broce Medicine And Toxicity: Dosl And Intent Pratt, Sarah Cardiometabolic Syndrome: Prevention, Intervention~

and Integrated Medical Care

R2vina, Bemard

An I"teracli", Case-BasetiApp1'OfJth To The Trrat1Jlent Of Pgcbialric COl1lOrhidities IN Patients With Parkillsoll~

Disease

Resendez, Cynthia HOIII to Teach CnIturaJ Competellce i" Geriatric Psychiatry: AJJressing Un11lel Patient Needt

Reynolds, Charles ReINltsfrom the NIMH Workshop on PgchoJofitzllntlf7le1ltiollS in lAtl Lift Mental II/nets Robinson, Robert G. Apat*, ill Patients with Late-Lift Neuropsychiatric Disortlers: Itlmtification flIId Treatment DellllopmenJ ofthe NnlropJydJiatry ofStrolee

Am J Geriatr Psychiatry 16:3, Supplement 1

A41

2008 AAGP Annual Meeting Roose, Steven P. Depression alld Cognitil1l 1111jJaimJenJ: TIPO Disortlers or One? Rodriguez-Suarez, Mercedes End ofLift Can in Dt1IIllItia: PalliatilJl Care Approaches Rosenberg, Paul B. Tnmshtional Researrh in Geriatric Psychiatry Dementia: Translating Latest Findings To Meetillg TDtkg'.t Mallllgllllent Challenges Rosenblatt, Adam

Teaming Heahh Systems /0 Manai! Cognitiveg Impaired OltkrAdults Dementia: TtrJIIslating LAtesl Findings To Meetillg TDdtg'.t MfWllllllent Challenges Roth, Thomas UncotJtring the Link." Pgchiatric and S Itep Distllman"s ill OIJerAdMits Rothschild, Anthony PharmacotheraJ!J oj Unipolar P{}fhotic Depression." The STOP-PD ShHfy Rusted, Jenny TIN Choli1l"lic Hypothesis ofAge Qna Dl11Ientia-Rl/aud Cogni/i", DyJjRlIrtioll RmsitedAgain: Ream Advanas and Implicationsfor P"",,,tion and

Tnatment

Ryder,Dana GrolljJ Therapy ill the EIJer!J.. . ExpniellflJ JPith Q SlnIdNTed Outpatient Pm§ll11l (SOP) Sajatovic, Martha Withold A MIljJ: T"ating Geriatric Bipolar Disordlr ill the AbsellGe ofGllidelillu Adlla1lt'IJ In Late-life Bipolar Disorder Trea11llmt 2008 Suter, Martin The Cholin"lic Hypothesis ofAge and Dementia-Rllatld Cognitillf DysjNlIdiofl Rmsit,d Again." Re&llli Adlltllltes and Implicationsfor P""",tion and

Tnatment

Saykin, Andrew The Choli1l"lic Hypothesis ofAge and Demelllia-Rllatld Cognitillf DysjNlIfliofl Rmsit,d Agai1l: Re&lnl Adlltllltls and Implicationsfor P""",tion anti

Tnatment

Schillerstrom, Jasan

Formsic Geriatric Psychiatry.•. Capati!1 IsSllls

Sega1-Gidan, Freddi Clinifal Resetllfhef's Debate: The ComprehmJiw Treat1llmt ofAltheimer's Disease Shihabuddin, Lina End ofLiJe Care in Demmtia: PalliatilJl Care ApptrJathes Shulman, Kenneth I. Without A Map: Treatilll Gtriotric Bipolar Disordlr j" the Absena ofGIliJeIi"es Sirey,Jo Anne A,ade1ll;C-Co"",,Nmty Parl1lIrShips: Translating EtJidtn&ld-Bas,dMtntal Health In/mJt1ltiolls l"to Practice AJhmnt:e 1fJ Depnssioll Treallllellt and the OIJer Patient

Small, Gary Depression AIIJ CoN'itiw Impai1'1llenl: T1110 DisonJers Or Dill?

A42

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Smith, Gwenn

Translatiollo1 '&searth in Gmiztri& P!JChiatry Snee~Joel

A Fresh Perspective 011 V IJJt:lihr Depression: NnP Hesearth from NIMH KAwardees Steffens, David C. Demmtia Smenin.g In CliNical And COII/1II11nity Settings A Ftrsh Per.rpeditJe on V 4fctllar Depression: NtIIJ &SlQrchfrom NIMH K.Awardles stein, Elliott M. Images ofAd"!, ill the Cinema Steinberg, ~

NatNral History ofAltheimer's Dise(J!e: Findingsfrom the Cache COIl1t[y Dementia Proll'ssion St1It!Y Stewart,]onathan T.

Diagnosis and Ma1llJgt1lJIIlI ofFrontal1SNbcortica/ Dementia

Stowell, Keith End ofLiJe Care ill De11ltlltia: Palliative Cart Approaches Sultzer, David L

Clinical Restarrhef's Debate: The Comprehmsiue Tnal11lml ojAitheimer's Disease

Tampi, Rajesh R. Ill1UJlKJtilll Rl/earch ill Cross-Cllihlral Gemp!Jchiatry Il111/JPfOpriate S IXl/aJ Behaviors In Dementia Taylor, Warren

Translational &SlQrch in Geriatric P!JChiatry

Thielke, Stephen Toxic Effects OfPemm"l Pain III OlderAdNhs Trevisan, Louis A.

Geriatric SNbstance Abuse: A CllltNraJ!y Ditlme Approach to &cognition, Aise/Jm,,,t atld Buidlnce Based Tnatment ill the Clillical Setting

Trinh, Nbi-Ha T.

Understanding anti ManagillgAggre/sive BehavilJrs in GerofJ.!Y&hiatric Patients

Tschanz,}O.l\nn T.

Natural Hirt()'Y ofA~hei1l1"'~

Disease: Findingsfrom the Cache COII"[J Dementia Progression St1«fJ

Jiirgen Toxic Effects of Persistent Pain in OlderAdults Making Teams Work: PnJviJjng EjJictive Interdisciplinary Geriatric Mental Health Core Uniitze~

Van Busse!, Lisa Hitchhiker! GIliJe To Teaching: Bgolld The POlller OfPolPtljJOint Vaswani, Sanjay M.

ComprrhensiueApproach to BmrJen and BII17lf)/d in Caregivers (l/ Home and Heaho&fJTI Worker.r in ung TIf1I1 Can Settings

Walter, Amy Po~

and Politics: Shaping Mlntal Health Priorities ill a PresidtntialElection Year

Am J Geriatr Psychiatry 16:3, Supplement 1

A43

2008 AAGP Annual Meeting Watson, Lea

Metlical Updates For The Practicing P!Jchiatrist: Meeting The Medical Needs OfOlderAdNlts

Whang, Phillip Geriatric SNbs/ance AbliJe: A ClihuroJ& Divene Approach to Rerognition, ArleSS11Iellt and Eviden" Based Treatment in the Cliniall Setting Wbitfielct Theodore Understanding anti ManadngAggressive Behaviors in Gerop!ychiatric Patients Whyte, Ellen rvL

Pharmacotherapy of Unipolar P~chotic

Depression: The STOP-PD Stz«!y

Wtlki.os, Consue1o H. Cognitive Impairment and OJuopenia in OJJerAfrican AmericllIJs with Vitamin D Defitienq Wtlki.os, Kirsten Inappropriate SextIol Behaviors in Dementia Wtlson, Robert

Lifespan PgcholtJlical Di.ttres.r And Risk For Dementia In OM~:

Translational R8slarch

Young, Robert C.

ute-lift Bipolar Disorder Treatmml 2008 WithoutA Map: Treating Geriatric Bipolar Disorder [n The Absence OfGuidelines

AtJIJfl1ttlS in

Zivin, Kara Adherence to Depression Treatment and the O'''r Patient

A44

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting

AAGP Annual Meeting 2008 March 14 -17, 2008 RenussanceSea~orld

Orlando,Fl

Poster Abstracts Early Investigator Poster Session Saturday. March 15. 2008

1:QQ PM - 6:00 PM

Poster Number: 1 Seasonality Of Mood-Related Psychiatric Hospitalization Among The Elderly Brett Y. Lu 1, Reza Safavi 2, WilliamJ..Apfeldorf 3 University of Hawaii, Honolulu, HI University of New Mexico" Albuquerque, NM 3 University of New Mexico~ .Albuquerq~ NM I

2

Abstract: Studies have found season-related mood changes in adults. Depressive episodes occm more &equently in colder months while manic episodes are more common in wanner months. Whether these relationships also exist among the elderly, however, remains little studied. It has been proposed that older individuals may be less susceptible to climate-induced mood changes due decreased monoaminergic tone in the brain. To examine seasonal effect on mood in the elderly, we tracked the proportion of all patients admitted over a one year span (n=154t ages 65-96, median 77) for a depressive (n=43) or manic episode (n=20) in our inpatient unit, the main geriatric psychiatry hospital in . Albuquerque. Located in the high plains of southwestem United Sates, .Albuquerque has four very distinct seasons with average monthly daytime tempemture raogiog &om 48 to 92 Fahrenheit. Overall, we did not find a seasonal pattero in depression-related admission. In contms~ mania-related hospitalization was the highest in the summer (p=.05), indudingJune,]ulYt and August. Consistent with an earlier study, om findings support that the effect of seasonality on depression diminishes in the very elderly. As part of our secondary analysis, such diminished effect was not observed in a younger hospitalized population over the same period (age 50-65, median 59). This young-old population displayed an easily discemable seasonal pattem of depression-related admissions {p=.Ot)t with a peak in the fall and a trough in the summer. Unlike the weakening seasonal effect on depression with aging, seasonality of mania appears to be robust to the effects of aging, as both our old-old and the young-old populations exhibited similar seasonal admission trends. We propose that age-related molecular differences in the etiology of mania and depression likely Wlderlie the obsenred differences in seasonality-predicted mood changes. This research was funded by: N.ARSAD Poster Number: 2 Longitudinal Observations Of Cognitive Functioning In Older Adults With Bipolar Disorder . Adriana, Hyams 1, ~~el, Gildengers2, Meryl Butters3, Amy Beg1e 4, Charles ReynoldsS, David Kupfer 6, Benoit Mulsant 7 University of Pittsburgh, Pittsbw:gb, PA University of Pittsburgh, Pittsburgh, PA 3 UniveISity of Pittsburgh, Pittsburgh, PA -I University of Pittsburgh, Pittsburgh, PA S UDiversity of Pittsburgh, Pittsburgh, PA 6 University of Pittsburgh, Pittsburgh, PA 7 University ofToronto Centers for i\.ddicti.on and Mental Health, Toronto, ON t

2

Abstract: Authors: .i\driana Hyams. BA; Ariel Gildengers t 1\10; Meryl Butters, PhD; Amy Begley, MS; Charles Reynolds, MD; David Kupfert MD; Benoit Mulsant, MD Institution: From the Advanced Center for Intervention and Services Research, Department ofPsycbiatty; the Bipolar Disorder Center for Pe1U1sylvaoians, University of Pittsburgh School of Medicine; and the Centre for Addiction and

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting Mental Health, University of Toronto. Background: Recent studies demonstrate that patients with bipolar disorder have cognitive deficits after major mood symptoms remit. The majority of this research, however, is cross-sectional; longitudinal observations are imperative for comprehending the course of cognitive function. Cognitive decrements can lead to functional impainnents that reduce quality of life and increase dependence. Cla.rifying the etiology of cognitive decline will facilitate the development of interventions to enhance cognitive function and/or prevent decline. Methods: Twenty-seven subjects (19 women; 8 men) ages 50 years and older with bipolar disorder were administered the Dementia Rating Scale (DRS) at baseline and over two yeus of longitudinal follow-up. Their results were compared with age and education equated controls (0=45) without psychiatric history. Subjects were tested when euthymic, with scores of to or less on the Hamilton Depression Rating Scale and the Young ~lania Rating Scale. Results: Subjects with bipolar disorder had a mean age of 70.1 years (80=10.2; range=50-86). Mean years of education was 15.7 (50=2.7; range=9-20). Impairment was defined as scoring greater than t standard deviation below the control mean. Bipolar subjects performed variably on the DRS: 37% of subjects remained unimpaired over two years, 11 % were not impaired at baseline but deteriorated, 7.50/0 were impaired at baseline but became unimpaired, and 44.50/0 were impaired for the entire two year period. Conclusion: Older adults with bipolar disorder have substantial variability in longitudinal cognitive functioning but overall greater impainnent than controls. With adults surviving into their eighties, the likelihood for dementia increases dramatically. Adults with bipolar disorder may be at even greater risk of developing dementia, so understanding why certain patients decline over time while othen improve or remain stable is essential to comprehending how cognitive impairment can be halted or prevented by future treatments.

This research was funded by: National Institute of Mental Health Poster Number: 3 Lifetime History Of Manic Episodes And Risk Of Cognitive Decline Among Community Residents: Findings From The Baltimore Bea Follow-Up Study Christine M R2mseyl,Jeannie-l\&rie Leoutsakos2, Cynthia Mum03, Susan Lehmann4, Hochang B.Lee5 I 2

JoOOs Hopkins School of 1\IIedicine, Baltimore, ~ID Jobns Hopkins School of Medicine, Baltimore, MD

3Johns Hopkins School of Medicine, Baltimore, l\ID ..Johns Hopkins School ofMedicine, Baltimore 1\JID 5 Johns Hopkins School of ~fedicine, Baltimore) MD t

Abstract: Objectives: To investigate lifetime histoty of manic spectrum episodes (defined as having mania, hypomania, or subsyndromal mania) at either Wave I or II (1981-82) of the Baltimore ECA study as a risk factor for cognitive decline between Wave III (1993-96) and 1\7 (2004). Sample: 1071 community residents [mean age: 58.9 years (SD: 12.9 years)]; female: 62.90/0; race: 61.8% white, who participated in Waves I-IV of the Baltimore RCA follow-up study. Methods: Based on the responses to the Diagnostic Interview Schedule administered by a trained lay interviewer during Wave I and IT, each participant was categorized as having lifetime histoty' of'cmanic episoden (0 = 15), "hypomanic episode'" (0= 4), "subsynckomal manic episode" (0= 24), c'no affective episode" (n = 857) as previously described in Judd and Akiskal (2003). Cognitive decline was assessed by change in Mini Mental State Exam scores and performance on 20 item-recall tests (delayed recall, immediate recall, and word recognition; Comoni-HuntleyJet al1988) from Wave III to IV..i\nalysis: W'hile adjusting for potential demographic and health-related confounders, we estimated the risk of cognitive decline from Wa.ve III to Wave IV based on linear regression models with presence ofJifetime history of manic spectrum episodes (n= 43) as the main predictor. Results: Change in MMSE [manic spectrum episode = 0.37 (SD: 1.31) vs. no manic spectrum episode -0.37 (SD: 2.14)] and perfoanance on all memoty tests between Wave In and IV did not differ sigoi6candy between the two groups. No statistically significant (p< .05) associations were found between manic spectnun disorder and cognitive decline. Conclusions: These findings suggest that lifetime history of manic spectmm episodes is not associated with cognitive decline in late life among residents in the community. The study is limited by small sample size of manic episodes and attrition in the cohort. References: Judd LL, ~o\kiskal HS. The prevalence and disability of bipolar spectrum disorders in the US population: reanalysis of the Eei\. database taking into account subthreshold cases. Journal of Affective Disorders. 2003 Jan; 73(1-2):123-31. Jonn, .l\F. History of depression as a risk factor for dementia: an updated review. Aust N ZJ Psychiatry. 2001 Dec; 35(6):776-811.

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Poster Number: 4 Prevalence Of Executive Dysfunction In Elderly Depressed Inpatients Kristin J. Somers1, Maria. I. Lapid2, Katherine M Piderman3t Susan M. Ryan\ Teresa A. Rummans5t Susanna R.. Stevens6 t

Mayo Clinic, Rochester, MN Clinic, Rochester, Mf\l

2 Mayo

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Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting 3 Mayo Clinic, Rochester,. ~ .. :h&yo Clinic, Rochester, MN 5 Mayo 6

Clinic, Rochester, MN Mayo Clini~ Rochester, MN

Abstract: Background/Objective: Geriatric depression is frequeody comorbid with impainnents in various areas of cognitive functioning, which may significandy impact treatment outcomes. We sought to detennine the prevalence of executive dysfunction among an inpatient population of elderly depressed individuals. Method: This is part of a larger study investigating the quality of life of elderly depressed inpatients. Individuals 65 years of age or older admitted to an inpatient geropsychiatric service with DSM-IV diagnoses of unipolar or bipolar depression with It.1MSE scores? 18 were recruited. Aside from quality of life measures, surveys were administered upon admission and discharge to measure severity of depression (Hamilton Depression Rating Scale, ~f-D), somatic burden that can affect both depression and cognition (Cumulative Illness Rating Scale, CIRS),. global cognitive functioning (Folstein I\1ini Mental Status Examination, J\.IM:SE), and 25 areas of executive functioning (Executive Interview, EXIT 25). Admission and dismissal scores were compared. using Wtlcoxon signed rank tests and associations between psychosocial measures were assessed with Speannan correlations. Results: We report preliminary results of 45 participants who completed the study. ~rean±SD age was 74±7, 67% female, 78% at least high school educated, and 93% with unipolar depression. ~fean±SD length of hospital stay was 11 ±6 daYSt and 38% received electroconvulsive therapy. HAM-D scores improved significandy &om admission to discharge (25±10 v 12±8, P < 0.0001). Thele were no significant changes in MMSE or EXIT scores from admission to discharge. Mean±SD EXIT 25 scores were 11±6 and 10±6 at admission and discharge, respectively,. where a score of 15 or above indicates clinically significant executive impainnent. Thirty percent of the group scored? 15 on EXIT 25 at either admission or discharge (9°10 at admission only, 9% at discharge only and 120/0 at both time points). Higher education was associated with less impainnent on the EXIT 25 (rho= -0.40, p=O.008 at admission and -0.58, p
Funding: 1\layo Clinic Department of Psychiatry and Psychology and the St. MarYs Hospital Sponsorship Board Poster Nwnber: 5

Electrophysiological RespoDses To A Stroop Task In Geriatric Depression: State Or Trait Bffects?

Vassilios Latoussakis1, Linden Spital2t Franees J. LeeJ, Faith Gunning-Dixon",. John FoxeS, George S. Alexopoulos', Christopher F.

Murphy7

Weill-Cornell Institute of Geriatric Psychiatry, White Plains, NY Weill-Cornell Institute of Geriattic Psychiatry, White Plains, NY 3Weill Comell Instinne of Geriatric Psychiatry, White Plains, NY "Weill Come1l Institute of Geriatric Psychiatry, White Plains, NY 5 Nathan S. Kline Institute of Psychiatric Research, Orangeburg, NY 6Weill Cornell Institute of Geriatric PSychiatryll White Plains, NY 7 Weill Comell Institute of Geriatric Psychiatry, White Plains, NY I

2

Abstract: Introduction: In order to study specific ACe processing abnormalities implicated in depression, we examined the error-related negativity (ERN) during a cognitive Stroop challenge in symptomatic and remitted elderly patients and a non-psychiatric comparison sample. The ERN is an event-related potential elicited by errors during task perfonnance, and represents the detection by the ACe of mismatch between the intended and actual response. The ERN generator is in medial prefrontal areas, in or vety near the dorsal Ace. We hypothesized that the ERN amplitude would be significantly lower in depressed vs. control, depressed vs. remitted, and remitted vs. control subjects. Methods: 27 elderly subjects were sttldied; 10 patients with major depression (mean HDRS-24=20), 8 patients in remission (HDRS=3), and 9 controls (HDRS=2). The three groups did not differ significantly in age. Subjects completed an ERG scan while performing the Stroop task. ERPs were recorded with the 128-channel high-density EGI System 200. ERN was the largest negative deflection within -25 to 150 msec after an incorrect response. ERN amplitude was measured at Fez. Results: The mean and SO of the ERN amplitude for the depressed, remitted, and control groups were -4.62 (2.43), -3.28 (1.38), and -2.17 (1.20), respectively. One-way ANOVA revealed significant differences in ERN amplitude between control and depressed subjects, (Dunner's T3 test, p= .04). Differences in ERN amplitude between depressed vs. remitted subjects and remitted vs. control subjects

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting did not reach significance. Discussion: The principal finding of this study is that elderly depressives showed sigoificandy lower ERN amplitude compared to controls. This is consistent with the implication of ACe processing abnormalities in depression. Depressed patients displayed the greatest variability in their ERP responses to task errors. This variability might reflect a greater heterogeneity in the depressed compared to the remitted or control groups. Although likely underpowered to detect significant differences in ERN

amplitude in the remitted vs. depressed and the controls vs. remitted~ we found ERN amplitude values in the remitted state to be intermediate between the control and depressed groups. This finding could be explained by either a state effect of depression, the presence of select subgroups of depressives with lower ERN amplitudes conferring treatment resistance, or both. Future studies could help delineate such subgroups with discrete treatment outcomes leading to novel, pathophysiologicaUy-informed, targeted therapeutic approaches. Poster Number: 6 Depression, Cognition, And Apoe: A Latent Class Approach To Identifying A Subtype Megan B. Richie l , Hillary R. Bogner I

University of Pennsylvania, Philadelphia, PA of Pennsylvania, Philadelphia, PA

2 University

Abstract: Objective: Previous research has indicated that the apolipoprotein ?4 (APOE-?4) allele is associated with decreased cognitive functioning in older adults. However, a similar association between APOE-?4 and depression has not been clearly established.. Our plUpOse was to employ latent class analysis (LCA) as a new way to explore these potential relationships.. Methods: The study sample consisted of 305 adults aged 65 or older with complete infonnation on APOE genotyping and covariates. We used the latent class model to classify respondents according to the Composite International Diagnostic Interview (CIOI) and four measures of cognitive function. We examined the relationship between class membership and APOE genotype, age, gender, ethnicityt education, and number of cardiovascular conditions. Results: The latent class model yielded three classes: a non-depressed group, a group with depressive symptoms but cognitive functioning amlUld the average, and a group with both impaired cognitive functioning and symptoms of depression (particularly thoughts of death and suicide). Possessing at least one APOE-?4 aDele was not predictive of class membership. African-Americans were more likely to be members of the cognitively depressed class than the non-depressed class (odds ratio [OR], 3.24; 950/0 confidence interval [CI), 1.16-9.10). Older adults with education levels of high school graduate or higher were less likely to be members of the cognitively depressed class as compared to the non-depressed class (OR, 0.32; 95% CI, 0.12-0.91). Conclusions: Among elderly respondents with depressive symptoms, a subgroup with cognitive impairment may exist that is not related to the APOE-?4 allele but that may be related to ethnicity and education level. These results have implications for the appropriate identification of depression among elderly adults. This research was funded by: Summer Training on .Aging Research Topics - Mental Health Fellowship through the National Institute of Mental Health and the University of California-San Diego.

Poster Number: 7 Is The MMSE An Adequate Screening Cognitive Instrument In Studies Of Late-Life Depression? Tarek K. Rajjil, Die1le Miranda2, Benoit H.. Mulsant3, Meredith Lotz", Patricia R. Houck5, Charles F. Reynolds, 1116, Meryl A. Butters'" Centre for Addiction and Mental Health, Toronto, ON Centre for Addiction and Mental Health, Toronto, ON ~ Centre for Addiction and Mental Health~ Toronto, ON .. Westem Psychiatric Institute and Clinic, Pittsburgh~ PA PA SWestem Psychiatric Institute and Clinic, Pittsb~ 6 Westem Psychiatric Institute and Clinic, Pittsburgh, PA 7 Westem Psychiatric Institute and Clinic, Pittsburgh, PA I

2

Abstract: Background: The Mini Mental State Examination (MMSE) has been frequendy used as the sole instrwnent to assess cognition in studies of late-life depression (LLD). More recendy the Dementia Rating Scale (DRS) has also been used in U.D studies for a more comprehensive characterization of cognition. These two instroments have been shown to agree in studies of healthy and demented subjects. To our knowledge, the relationship between the two instmments among subjects with U.D has not yet been assessed. Methods: 240 non-demented depressed older subjects were recruited in 3 clinical trials conducted at Western Psychiatric Institute and Clinic between 1996 and 2006. AU subjects were assessed with MMSE and DRS. Results: Mean (+/- SO) age of subjects is 72.5 (+/ - 7.4) years, 90% are Caucasians, and 70010 are female. Mean education level is 12.5 (+/ - 2.7) years. Mean baseline MMSE score is

A48

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting 28.0. Using cutoffs score of 25 for the MMSE, 7 for the Total Scaled DRS, and 132 for the Total Raw DRS, 91.7%, 67.90/0, and 65.8°/0 of the subjects ate classified as '~cognitively intac~', respectively. The MMSE scores correlate significandy with the total scaled and raw DRS scores (r=0.550, and r=O.638, respectively; p's
Poster Number: 8

Age At Onset And Cognitive Deficits In Schizophrenia: A Quantitative Review

Tarek K. Rajjil, Zabinoor, Ismai12, Benoit H. Mulsant3

Centre for Addiction and Mental Health, Toronto, ON Centre for Addiction and Mental Health, Toronto, ON 3 Centre for Addiction and Mental Heal~ Totonto~ ON I

2

Abstract: Background: Schizophrenia is a heterogeneous disotder~ particularly in teans of age at onset (AO). AO has been reported in youth (childhood and adolescence), adulthood, and late-life. Cognitive deficits are core features oftbe illness, irrespective of AD. We present a quantitative review, estimating the severity ofcognitive deficits among individuals with youth-onset (YOS)~ adults with first episode (FES), and late-onset schizophrenia (LOS). Methods: We define YOS, FES, and LOS as scbizoplu:enia with onset below the age of 18, between 19 and 44, and at 45 years of age and later, respectively. We conducted a literature search using the multidatabase search engine Scholars Portal Search tenns comprised schizopbreni~ scbi2oaffective, psychotic disorder, age atlof onset, childhood onset, adolescent onset, late onset, first episode, cognition, memory, and other cognitive search terms. We limited our search between t 980 and September 2007: 1980 was chosen because it coincides with the wide adoption of reliable diagnostic criteria" Only publications with healthy control groups were included. Drug trials were included if pretreatment cognitive data were reported. Publications were excluded if the analyzed sample was heterogeneous (e.g., including bipolar disorder); the AD classification spanned across more than one of our categories; or an adult-onset schizoplu:enia study did not analyze first-episode subjects separately. Publications reporting on the same sample were considered a single study; 22 cognitive constructs were chosen. Cohen's effect sizes (d's) were calculated for each cognitive construct and then raw means and their 95% confidence intervals were generated. Results: 768 publications were identified; 22 YOS, 75 FES~ and 9 LOS publications were included in the analysis. Total number of subjects: 692 (YOS); 3693 (FES); 261 (LOS). Weighted mean age: 16.0 (+ 0.3) (Y05), 24.2 (+ 0.7) (FES); 68.4 (+ 2.6) (LOS). Weighted mean i\O (+ SD): 13.6 (+ 0.7) (YOS); 60.7 (+ 4.2) (LOS). Adults with FES demonstrate large deficits (mean d > 0.8) on most cognitive constructs. Impainnent is most pronounced on performance IQ~ digit-symbol coding, verbal memory" vocabulary) arithmetic. and verbal fluency. Deficits on most of these functions also rank high among subjects with Yos. However~ these patients demonstrate comparably large deficits 00 visual memory, visuoconstructtonal ability, Stroop test) and trails making test-B.. This pattern is in contrast to that observed among subjects with LOS where visual attention, visuoconstruetional ability, and verbal fluency are relatively more impaired than digit-symbol coding, vocabulary, and arithmetic. Conclusions: Individuals with different AD appear to have different cognitive profiles. Our findings are limited by the relatively small number of sttldies assessing LOS. Future studies are needed to differentiate deficits related to the illness at different AD from those secondary to nonnal aging OJ: comorbid disease.

This research was funded by: Centre for ,,'\ddiction and Mental Health - US PHS grant :MH069430.

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2008 AAGP Annual Meeting Poster Number: 9 Examination OfDigit Span Errors Among Middle-Aged And Older Persons With Schizophrenia Sharron E. Dawes., Elizabeth W. Twamley2, Barton W. Palmee UCSD, Sao Diego, CA UCSD, San Diego, CA 3 UCSD, San Diego, CA I

2

Abstract: Introduction: Neurocognitive theories of schizophrenia often emphasize the potential role of impaired working memory. One widely used working memory test is the Wechsler Digit Span (DSp) subtest..Although there is considerable intragroup heterogeneity,. schizophrenia is associated with worse than age-normal DSp performance (fwamley et al. 2006). Most prior research on DSp performance among people with schizophrenia has focused 00 number of correct trials, or maximum recall span length. However, consideration of the specific types of ettors made by persons with schizophrenia on this task may provide insight into specific but perhaps more subtle underlying cognitive deficits. In the present study, we examined the frequency, pattern, and types of errors among middle-aged and older persons with schizophrenia. Method: Participants were t 60 community-dwelling persons aged >40 years with schizophrenia (mean [SD]: age 54 [8] years, education 12 [2] years) who completed DSp as part of a larger new:ocognitive test battery. The forward (DSp-F) and backward (DSp-B) trials were considered separately. For the present analyses, we examined the frequency of specific error types, including omissions (missing a digit), commissions (adding a digit), intmsions (swapping a correct digit for an incorrect one [including considering whether the intmsion was pbonemically similar versus dissimilar to the correct digit]), transposition errors of 2 or more consecutive digits (swapping order of digits), as well as simply not responding to the trial, and the conventional OSp scores (fotal correct and maximum span length). Percentages for each error type are expressed as the percentage of patients who exlubited that error at least once. Results: The mean (SO) total correct scores were OSp-F 8.7 (2.2), DSp-B 5.6 (2.1). Errors were more common on DSp-B; the most frequent error types were omitting a digit (DSp-F = 21.9%; DSp-B = 50.9%), transpositions (DSp-F 56..4%, DSp-B 72..7°/0), and intrusions (DSp-F = 40.90/0, DSp-B = 38..2%). Discussion: Results will be discussed in reference to specific cognitive failures related to schizophrenia and/or ooana! aging, such as vulnerability to distraction attention lapses or intrusions, perseverative responding, as well as conceptual errors. For instance, a trial omission may reflect distraction, basic attention, or motivation. Intmsions may indicate proactive interference or attention. Analysis of error types in the digit span test may illuminate cognitive processes underlying perfonnance on this test and may contribute to the differentiation between types ofworking memory.

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Poster Numbet: 10 Age-Related Changes Ia Functional Brain Response During An Atteational Task In Schizophrenia Heline lvlirzakhaniant , Allison R Kaup2, Lisa T. Ey1er1

UCSD, La Jo~ CA UCSD) La Jolla, CA 3UCSD, La Jolla, CA. t

2

Absttact: Patients with schizophrenia seem to show brain volumetric decreases with a~ cognitive stability with age, and either clinical improvements or stability with age. In an attempt to shed some light on these discrepant findings, we examined the relationship of age to functional brain response among individuals with schizophrenia during a simple visual vigilance task. Crosssectional measures of functional magnetic resonance imaging brain I:esponse were correlated with age among 28 patients with DSMIV schizophrenia or schizoaffective disorder who ranged in age &om 25 to 68. Brain response during identification of a target letter among similar..looking letters compared to response during fixation was measured with functional magnetic resonance imaging in each voxel of the brain. This measure was correlated with age within the schizopluenia group in each voxel, and clusters were considered reliably related to age if they contained more than 10420 voxels each with a correlation significant at p < 0.05. Patients with schizophrenia. showed a negative relationship between functional brain activation and age in several regions including clusters in the right cerebellar tonsil, right superior frontal gyms, and in the ci.ngu1ate gyms. This negative relationship was present although there was DO relationship between behavioral performance and age.. These cross-sectional results suggest that brain response to a simple attentional task may decline with age among patients with schizophrenia, consistent with previous PET studies of blood flow and metabolism. Further study is needed to determine whether the magnitude of age-related change is similar to or greater than that seen in healthy aging and longitudinal investigations are necessary to examine factors that may mitigate age-related effects. Poster Numbet: 11 Older Schizophrenia Patients Show Abnonnal Brain Response During An Attentional Task .l\l1ison R. Kaupl, Heline lvIirzakhaoiaJl2, Lisa T. Eyler1

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2008 AAGP Annual Meeting UCSD, San Diego, CA UCSD, San Diego, Ci\ 3 UCSD, San Diego, CA I

2

Abstract: Attentiooal deficits are prominent in schizophrenia and likely a core deficit of the disorder. FWlctional imaging can help reveal the brain systems underlying this abnonnality. Using a simple vigilance task, Eyler et al.(2004) found that schizophrenia patients, despite unimpaired behavioral perfonnance, show a diminished response in the inferior frontal cortex and an abnormally enhanced response in right parieto-temporal regions and left cerebellum. In an attempt to replicate Eyler et al., we compared 14 middle-aged and older patients with chronic schizophrenia (mean[SD] age =53[8.4D with 7 demographically-matched healthy controls (mean[SD] age =53[6.9]) using functional magnetic resonance imaging during a simple visual vigilance task. Furthermore, we explored the relationship between brain response and duration of illness in the schizophrenia group within the regions of

abnonnal brain response and hypothesized a negative relationship between the two. When brain response during identification of a target letter among similar-looking letters was compared to response during fixatio~ both groups showed multiple clusters of significant brain response in widespread cortical regions. Schizophrenia patients showed a diminished response in right cerebellar regions and the left fusifoan gyrus in comparison to controls, but did not show any regions of enhanced activity relative to the comparison group in this older sample.. Duration of illness was negatively associated with brain response in both regions at trend level (p=.06). This negative relationship suggests that abnormalities in brain response may become more prominent as the disease progresses.. The results replicate our previous finding that abnoanalities of brain response to attentional tasks can be observed among schizophrenia patients despite unimpaired bebaviotal performance and provide further evidence of attentional involvement in the pathophysiology of schizophrenia.. The results also suggest that older samples may be less likely than younger samples to show regions of compensatory a.ctivation. Poster Numbet: 12 Anxiety Symptoms And Functional Impairment In Very Old Community-DweDing Women i\dam P. Spin', Kristine Ensmd2, Kenneth Covinsky2, Kristine Yaffe'

University of California, San Francisco & San Francisco V.MvlC, San Francisco, CA Minneapolis V~~C & University of Minnesota, Minneapolis, Minneapolis, ?\!N 3 University of California, San Francisco & San Francisco V AMC, San Francisco, Ci\ 4University of California, San Franciso, San Fraoscisco, CA t

2

Abstract:

Introduction: Functional impairment is common in older adults and negatively impacts quality of life. Anxiety disorders also are common, but few studies have examined the association between elevated anxiety symptoms and functional outcomes in the elderly.

Because anxiety symptoms and depressive symptoms &equendy co-occur in older adults, it can be difficult to investigate the independent association between anxiety symptoms and outcomes if participants have co-morbid depressive symptoms. We detennined the association between elevated anxiety symptoms and functional impainnent in a large sample of the oldest community-dwelling women without evidence ofdepression. Methods: We conducted a cross-sectional study of 3t 061 older women (mean age 83.6 ±3.9) without evidence of depression, defined as a score <6 on the IS-item Geriatric Depression Scale. Our primary predictor variable was elevated anxiety, defined as a score ?6 on the Goldberg Anxiety Scale. Our outcome variables included difficulty with mobility (walking 2-3 blocks, ascending 10 steps. descending 10 steps) and difficulty with instrumental activities of daily living (IADLs) (preparing meals, doing heavy housework, and shopping). Results: 189 women (6.20/0) had elevated anxiety to smoke, to symptoms. Women with elevated anxiety symptoms were less educated, and were more likely to be African i\.meric~ have medical co-morbidities, and to take anti-anxiety medications than those without elevated anxiety symptoms. In multivariate regression analyses (adjusted for race, education, medical co-morbidities, smoking status, and use of anti-anxiety medications), elevated anxiety symptoms were associated with an increased risk of impairment in ?t of the six functional domains (OR 1.5, 95% CI t.t, 2.1), and with a higher risk of difficulty with ?t lADL (OR 1.6, 95% CI 1.2, 2.2).. Elevated anxiety symptoms were not significandy associated with greater risk of difficulty in ?1 mobility-s:e1ated functional domain (OR 1.2, 95% CI 0.9, 1.7). Discussion: Elevated anxiety symptoms are associated with impaired function, especially in lADLs, among very old community-dwelling women without evidence of depression. Longitudinal studies are needed to determine the direction of these associations. Because effective behavioral and phannacologic treatments exist for anxiety symptoms, evidence of a potential causal association between anxiety symptoms and functional decline could help establish late-life anxiety as a treatable risk fador for disability.

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This research was funded by: ROt AG05407, ROt ~0\R35582, i\G027576-22, 2 ROl AGOO5394-22Al, 2 ROl ~o\G027574-22Al!l

Am J Geriatr Psychiatry 16:3, Supplement 1

ROl ~'\.G05394, ROt AR35584, ROt and 5 T32 AGOOO212-14.

.~5583,

R01 AGO05407, R01

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2008 AAGP Annual Meeting

Poster Number: 13

Anxiety In Seniors Receiving Care Management From An Aging Services Agency .t'\dam.. Simningl, Thomas MRicbardson2, YeatesConwell' University of Rochester, Rochester, NY of Rochester, Rochester, NY 3 University of Rochester, Rochester, NY I

2 University

Abstract:

Background: Aging services providers ftequeody encounter older adults in the community who have mental disorders. High levels of depression have been documented in this population. Little is kno~ however, about the nature and prevalence of anxiety symptoms among seniors referred for social services interventions. This study aims to characterize anxiety symptoms, and their association with depression, among a sample of help-seeking older adults receiving in-home assessments by an aging services care manager. Methods: A random sample of clients aged 60 and older receiving care management services from an accredited social services agency was screened for anxiety using the Goldberg Anxiety Scale. The PHQ-9 scale was used to assess depression. Results: The subjects were 68% female, 84% white, and 61% unmarried, and 41 010 earned less than $1,250/month. Among these subjects, 39% scored at least 5, while 270/0 scored 6 or more on the 9-point Goldberg Scale (indicating high likelihood of an anxiety disorder). The most &equendy reported symptoms were worty (57%), feeling on edge (51%), and difficulty sleeping (51%). Other endorsements included woaying about your health (46°/0), difficulty relaxing (420/0), difficulty faDing asleep (38°/0), feeling irritable (37% ), headaches or neck aches (34%), and trembling, tingling, and dizzy spells (32%). The Spearman correlation coefficient between the PHQ-9 and Goldberg scores was 0.65 (p
This research was funded by: AHRQ T32HSOOOO44-15; NIHM R24MH071604; NIH T32GM07356. Poster Number: 14

Anxious and Depressed Elderly, A Parallel or Serial Relationship? Kah Hong, Goh l, Carl I. Coben2, Sulaiti ~littal3, Mario Gustave", Robert Yaffees State University of New York, Downstate, Brooklyn, NY University of New York, Downstatet Brookly~ NY 3 State University of New York, Downstate, Brooklyn, NY .. State University of New York, Downstate, Brooklyn, NY S State University of New York, Downstate~ Brooklyn, NY I

2 State

Abstract:

Objective: Depression and anxiety frequently coexist in older adults. The aim of this study is to examine the causal relationship among depression, anxiety and associated factors in a clinical sample of depressed elders. Method: The original sample consisted of 239 cogoitively intact persons aged 55+ in a multiracial group drawn from three psychiatry outpatient clinics and a geriattic day prognun in NYc. 149 persons were re-interviewed at a mean of30 months (mean age 68 yean, 860/0 female, 43% white). Depression was defined as a CES-D score of >8. An adaptation of Linda George's Social Antecedent Model was used to study 15 predictor variables of depression (rune 2) in a logistic regression analysis Results: 46% of the sample was non-depressed at both Time 1 and Tune 2, 24% was depressed at both Ttme t and TJme 2, 17% was not depressed at Time 1 (ft) but depressed at Time 2 (f2)t and 13% was depressed at Tl but oot at T2.Logistic regression indicated that 7 variables attained significance as predictors ofT2 depression: T1 depressive symptoms, presence of patanoid or psychotic symptoms at TI, longer time between Tl and T2 interviews, smaller proportion of reliable network members at Tt, more psychotherapy visits, the presence of subsyndromal or syndromal anxiety at Tl, and an increase in anxiety symptoms between n and T2. Discussion: Several clinical faetors--depression T1, psychoses/paranoid ideation, and anxiety-were predictors of T2 depression. Baseline and change in anxiety were strong predictors of depression. Treatment success may depend on more completely addressing other co-morbid clinical symptoms such as anxiety

and psychoses/paranoid ideation.

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2008 AAGP Annual Meeting Poster Number: 15 Depression in the Elderly: What Predicts the Outcome? Kah HoO& Goh1, Cad I.Cohen2, Sukriti :MittaP, ADa Prehogan\ Robert YaffeeS, Georges J CasiJnir6 6

1 State

UnivetSity of New York, Downstate, Brooklyn, NY State Univentiy of New York, Downstate, Brooklyn, NY 3 State Univesity of New Yolk, Downstate, Brooklyn, NY 4 State University of New York.. Downstate, Brooklyn, NY 5 State University of New Yo~ Downstate, Brooklyn, NY 6 State University of New York, Downstate, Brooklyn, NY 2

Abstract: Objectives: There has been a paucity of longitudinal data to examine predictors of depression outcome among currently depressed older community adults. We address this issue by examining predictors of depression in a multiracial sample of older persons in NYc. Methods: Using census data for Brooklyn, N.Y., we attempted to interview all cognitively intact persons age 55+ in randomly selected block groups. The initial sample consisted of 206 Caucasians and 818 Blacks (282 U.S. bom, 288 from English speaking islands, 248 from French speaking islands). Of these, we identified 249 persons who met criteria ofdepression based on a CESD score of >8. On follow-up (mean: 3 years; range 1 to 4.5 years), we located 159 of these depressed persons of whom 110 could be reinterviewed. We used George's Social Antecedent Model to examine 11 predictor variables of depression at Time 2. The sample was weighted by race and gender. To control for design effects, we used SUDAAN for the data analysis. Results: On follow-up, 270/0 of the respondents remained depressed at Tlme 2 (T2). In logistic regression analysis, we found 6 variables were significant predictors ofT2 depression: higher Time 1 cr1) CESD, higher Tl Anxiety Symptom Inventory (ASl) scores, presence ofTl psychoses/paranoid ideation, larger Tl social network size, lower Tl incom~ and greater change in .£'\SI between Tt and T20t Age, gender, race, L~L change, and mental health treatment were not significant6 During the fonow-up period, only 22% sought mental health treatment &om any source. Discussion: A substantial proportion of depressed persons in the general aging community remain depressed after 3 years. Only about one-fifth of deplessed persons sought any mental health assistance although the clinical predictors of T2 depression were potentially treatable. PCPs must not only more aggressively recognize and treat depression, but also co-occurring anxiety and psychoses/paranoia.. t

Poster Number: 16

White Matter Hyperintensity Burden Predicts Poor Respouse to Antidepressant Treatment in Depressed Elden Michael F. Walton l , Faith M. Gunning-Dixon2,Jaoice Cheng\jessica .ACU11a4, Sibe} Klimstra5, Mony E. Zimmeanan6, Adam M.

Brickman7, Matthew J. Hoptmao8, George S..Alexopoulos9

Weill ComeR Medical College, Weill Comell Institute of Geriatric Psychiatry, White Plains, NY Weill ComeR Medical College, Weill Come1l Institute of Geriatric Psychiatry, White Plains, NY 3 Weill Comell Medical College, Weill Comell Institute of Geriatric Psychiatry, White Plains, NY .. Weill Comell Medical College, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY 5 Weill Comell Medical College, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY 6 AlbeIt Einstein College of Medicine~ Bronx, NY 7 Taub Institute for Research on Alzheimerts Disease and the Aging Brain, Columbia University, New York, NY 8 Nathan Kline Institute, Orangeburg, NY 9 Weill Comell Medical College, Weill Comell Institute of Geriatric Psychiatry, White Plains, NY 10 Weill Cornell Medical College, Weill Comell Institute of Geriatric Psychiatry, White Plains, NY I

2

Abstract: Objective: Several studies documented that depressed elderly patients have higher burden of white matter hyperintensities (\V.MH) than psychiatrically normal elders on magnetic resonance imaging ~ scans. However, the evidence is equivocal regarding the relationship of \VMH to antidepressant treatment response.. The purpose of this study is to replicate the finding of greate£ \VMH butden in elders with major depression compared to controls. Further, the study tests the hypothesis that patients who failed to remit in response to treatment with escitalopram have a higher ~rn load than patients who achieved remission. Method: The patients were 21 non-demented individuals with non-psychotic major depression and 24 elderly comparison subjects. After a 2-week placebo period, subjects who still had a Hamilton Depression Rating Scale (HDRS) of 18 or greater received escitalopram 10 mg daily for 12 weeks. Remission was defined as a HDRS score of 7 or below for 2 consecutive weeks. Flair sequences were acquired on a 1.5 Tesla scanner and total ~D-I were quantified using a semi-automated thresholding approach. Patients were scanned during the placebo lead-in period. Analysis of covariance (.ANCOVA) was performed with age as a covariate. Results: ANCOVA revealed that depressed subjects had greater total \VMH burden when compared to non-depressed COQtrols. Furthennore, patients who failed to

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting remit (n = 10) following escitalopmm tte1ltment had signifieandy greater ~fi-lload than both patients who remitted (n = 11) and elderly comparison subjects. W1MH burden did not differ: between depressed patients who remitted and elderly comparison subjects. Conclusions: Depressed elders who failed to remit during treatment with escitalopram have significantly greater total \VMI-{ burden than both elderly comparison subjects and depressed patients who remitted with treatment. W1MH may reflect a cCdisconnection staten predisposing and perpetuating late life depression by interfering with the regulation of cortico-striato-limbic networks. Poster Number: 17 Outcomes of Subsyndromal Depression in Older Primary Care Patients i\ndrew, Grabovich l , Naij~ Lu2, Wan Tang\ Xin Tu4,Jeffrey Lyness5 University of Rochester Medical Center, Rochester, NY University of Rochester Medical Center, Rochester, NY 3 University ofRochester Medical Center! Rochester, NY 4 U Diversity ofRochester ~fedica1 Center! Rochester, NY I

2

5 University

ofRochester Medical Center! Rochestet. NY

Abstract:

Objective: ?vIajor depression has a point prevalence of 5-10% in older primary care patients, with considerable medical comorbidity, impact on functional status! and risk for suicide. Major depression is only the tip of the primary care iceberg, as less severe depressive conditions have even greatet cumulative associated morbidity. A large number of older persons suffer clinically significant depressive symptoms that do not meet criteria for major or minor depressive disorders. We hypothesized that patients with subsyndromal depression (SSD) would have worse psychopathological, medical, and functional outcomes at follow-up than non-depressed patients, but not as poor as those with minor or major depression. We also sought to explore the outcomes of three definitions of SSD to determine their relative prognostic utility. Methods: 745 primary care patients age 65 yeus or older were enlisted to undergo in... person intake interviews by a trained rater including the Structured Clinical Interview for DSM-I\T (SeID) and the 24-item version of the Hamilton Rating Scale for Depression (Ham-D). ~Iedical illness bwden, basic activities of daily living, overall physical impairments, and components of executive functioning were also measured with validated instnunents. Similar in-person follow-up interviews were completed at one year. Patients were grouped for analysis based on depression diagnosis, i.e., major depression, minor depression, SSD, or nonwdepressed categories. 1bree different definitions ofSSD were used based on previous work, each represen.ting a unique set of patients. Results: An three definitions ofSSD predicted outcomes at one year that were significandy worse than the non-depressed group. These three SSD definitions had varying relationships to specific outcome domains. Discussion: Subsyndromal depression is a useful category for predicting poor outcomes in patients that do not meet the criteria for minor depression. Researchers might choose their approach to SSD definition based on the outcomes of interest.

This research was funded by: NThffi grants R011\Hf61429 and 1<24 MH071509. Poster Number: 18

Patient Derived Depression Treatment Strategies: Using Multi-Dimensional Scaling for Services Research Britt, Dahlbergl , Frances K. Barg2,JosephJ. Gallo', Marsha N.Wittinkl of Pennsylvania, Philadelphia, PA of Pennsylvania, Philadelphia, PA 1 University of Pennsylvania, Philadelphia, Pi\ 1 University

2 University

"University ofPennsylv~

Philadelphia, PA

Abstract:

Objective: In this study, we: (1) assessed the range of strategies older adults say they use to address depression, and (2) identified the characteristics older adults use in evaluating the helpfulness of these depression strategies. Understanding the chuactenstics older adults value in depression treatments could help us to design interventions which incorporate patient preference and social resources into depression treatment plans. Methods: To elicit the range and typology of strategies older adults report for depression, we employed the pile sort method from cognitive anthropology. Pile sorting is designed to elicit socially shared ways in which people organize items within a domain. First we derived a list of 20 strategies older adults themselves reported using to address depression during open-ended interviews (n=64). Second, we asked a second set of 38 participants to sort the depression stmtegies into two piles: things they thought would help a depressed perso~ and things they thought would not be helpful We used multidimensional scaling (MDS) to depict the categories into which older adults grouped the strategies: items often placed in the same pile by participants appear close together on the graph. To identify the characteristics participants saw as common in items they sorted together, we analyzed what participants said about the strategies and their sorting rationale during semi-structured interViews, and

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Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting used this data to infonn our analysis of the MDS clusters. Results: The ~S revealed three clear clusters of strategies which older adults described as: general we1lness, specialty care~ and less helpful items. During semi-stmctured interviews, participants described the first cluster as activities they often did for their general weUness which could also help depression: pray~ spiritual help, talk to primuy care physician, talk to friends, talk to family, get more love, get companionship, interact with others, get a positive attitude, pick yourself up, do things you enjoy, exercise, get out of the house, and counseling. The items participants described as specialty care were: take medication for depression, see a psychologist, and see a psychiatrist. Participants described certain advantages and disadvantages particular to each of these two clusters.. Few participants thought Tylenol was relevant to depression care, and participants were mixed on the helpfulness of watching TV, and watching what you e2t or drink.. Conclusions: When asked what can help depression, older adults described a wide range of strategies -- linked to their interests, activities~ social networks, and churches - ofwhich '~standard" clinical treatments existed as only small one segment. We discuss implications for designing services. for depression relevant to the way older adults view them. This research was funded by: ROt IMH622l0-0t, ROt MH62210-0lS1, and ROl MH67077-0t from the National Institute of Mental Health.

Poster Number: 19 Effectiveness of ECT in Geriatric Tertiary Psychiatry Patients: 6 Year Retrospective Analysis Susan Rail t Trisha Kivisalu2, Ninnal Kangl, Kiran Rabhenr t

Riverview Hospital, Vancouver, Be

Be University of British Columbia, Vancouver, Be 4 Riverview Hospital, University of British Columbia, Vancouver, Be 2 Riverview Hospital, Vancouver,

1 Riverview Hospital,

Abstract: Electroconwlsive therapy (ECT) is widely recognized as a safe and effective treatment for certain psychiatric disorders and is reserved for severely ill patients who have not responded to or tolerated trials of medications. Routine use of standardized pre and post measures allows outcome analyses. Patients with dementia and mood disorders comprise up to 1/3 of all geriatric patients who receive Ecr. This study analyzes issues of efficacy and tolerability of BeT as a treatment option for geriatric inpatients and outpatients at a tertiary care geriatric psychiatry hospital; compares pre and post outcome measure scores on mood, behaviour and functioning in geriatric patients who have undergone EeT; determines whether a patient had improved, remained stable, or deteriorated on scales and describes demographics, clinical, medical and diagnostic characteristics. Systematic data was collected and tracked utilising a clinical ECT database over a six year period on 170 geriatric patients >60 years of age (range over 60-96 years) who received over 6000 BCTs. Retrospective analyses of pre and post ECT treatment outcome measure scores using Outcome Tools: Modified Mini l\.fental Scale(3MS); Brief Psychiatric Rating Scale-Anchored(BPRS-A); Comell Scale for Depression in Dementia; Hamilton Depression Scale(HAM-D); Functional Independence Measure(FIM); Neuropsychiatty Inventory Nursing Home Version(NPI-NH), Clinical Global Impression(CGI). Outcomes are examined in subgroups of accessible and inaccessible patients based on scores on the mini mental scale. 1. For those patients who are cognitively accessible at pre-treabnent assessments, EeT does not seem to improve cognitive functioning. However, patients show improvements in behaviour, mood, and functioning as they scored lower on psychosis, depression, global, and behavioural scales and higher on the FIM (requiring less staff assistance) post EeT indicating overall improvement. Patients with Dementia scored similarly except there was no overall change of scores on the Comell Depression rating scale and the FIM. 2. Patients deemed inaccesstble before (overall 34% geriatric patients) and after RCT also scored lower on psychosis, depression, global and behavioural scales and scored high on the FI~I showing improvement even while being inaccessible cognitively pre and post EeT. 3.Similady, patients deemed inaccessible before but accessible post ECf (21°,;1) of patients) scored lower on psychosis, depression, global and behavioural scales with no change on the FIM showing overall improvement. ECT pre-post measures show an overall decrease in symptoms and an overall increase in functioning. Evidence from this large database suggests ECT may be a helpful intervention and is reasonably well tolerated by elderly patients with or without cognitive impairment. lhis study illustrates BCT patient's wtique characteristics, treatment modalities and outcome measures which can help guide patient care and service delivery planning. Poster Number: 20

Depression Treatment ofAfrican Americans within a Primary Care Setting Yolanda R.Colemon l , Gary]. Kennedy2, Richard Mudge3, Mirta Martinez-Kekenak" 1 Montefiore

Medical Center, Yonkers, NY Montefiore Medical Center, Bronx, NY 3 Montefiore Medical Center, Yonkers, NY .. Monte6ore Medical Center~ Yonkers, NY 2

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2008 AAGP Annual Meeting Abstract: Background: While the prevalence rates of depression are often the same across ethnic groups, African J.-\mericans often do not seek treatment, have lower treatment rates, or are underrepresented in research studies compared to other ethnic groups. Methods: Primary care providers of Monte6ore Medical Center's Care Management Organization provided written consent for our research coordinator to contact their patients for consent to participate by telephone. These patients were then screened with the Patient Health Questionnaire (pHQ-2) for depressive symptoms and randomized to either routine or facilitated care. Those who screened positive received the PHQ-9. The routine care group received the PHQ-9 assessment at 4 and 12 weeks, while the facilitated group received assessments at 2, 4,6,8 and 12 weeks along with supportive telephone interaction that did not constitute psychotherapy. We screened 4768 recently discharged patients of whom 615 (12.80/0) screened positive and 240 (39%) consented to the study. Of those completing the study there were 64 in routine care, 60 in facilitated care, and 55 who screened positive on the PHQ-2 but were not sufficiendy depressed when given the PHQ-9. Results: 49.1 % (88) of the patients who completed the study were ~o\.frican .American. Of those receiving medications (31)~ 15 were African American compared to 16 from all other ethnicities (Caucasian and Hispanic combined). The average PHQ-9 score for the African i\merican participaots was 10.63 versus 11.36 in all others that participated. Conclusions: Preliminary data conttadicts the belief that African Americans participate in studies or receive treatment at rates that are inferior to other ethnic groups.

Poster Number: 21 Unclentanding Decision Processes in Depre8sion Treatment Marsha N. Wittinkl, Cary ht1ark2, Thomas TenHave3,JosephJ. Gallo"

University of Pennsylvania, Philadelphia, PA Philadelphia, PA 3 University of Pennsylvania, Philadelphia, PA .. UDiversity ofPennsylvania, Philadelphia, PA t

2 University ofPeonsylv~

Abstract: Background: Customizing interventions to reflect older patients' preferences for depl:ession treatment may result in increased patient involvement and interaction with physicians, thus improving adherence. This pilot study focused on the choice behavior of older adults with regard to the specific attributes of each medication and counseling within the context of primary care. Purpose: To determine the feasibility of using conjoint analysis to assess patient preferences for depression treatments of older adults in primaty care. Methods: We used focus groups to develop the attributes and levels of treatments deemed important to older primaty care patients. In the conjoint task we presented participants with choice tasks in which attributes of mediations would have to be played off against attributes ofcounseling in selecting preferred treatment. Employing the choice data, we then calculated the utilities for each attribute which indicates the importance of each attribute to the decisions. Following the conjoint task, patients participated in a short open..ended interview to determine the appropriateness of the selected attributes and levels. Results: Patients preferred counseling to medication (utility = -0.99) and respondents preferred the location of treatment at the primaty care doctors office (utility = 0.72). With regard to side effects ofmedications, patients were most tolerant of nausea (utility 0.47) and least tolerant of sexual dysfunction (utility = -.48). Semi-structured interviews with participants revealed other important attributes that patients consider in making treatment choices including the cost, severity of the condition and effectiveness of the treatment. Conclusions: The strong prefel:ence for the "treatment type" attribute (counseling over medication) suggest that the choice of medication or counseling was more important in a trade-off decision than the other attributes we defined.

=

This research was funded by: NIMH funded K23 (patient Oriented Career Development Award). Poster Number: 22 Losing and Using Faith: Older African Americans Discuss Religion, Spirituality and Depres8ion Marsha N. Wittinkl,Jin HuiJoo2, Lisa M Lewis3, FrancesKBargI

University of Peonsylvania, Pbila.delphia, PA of Pennsylvania, Philadelphia, PA 3 University of Pennsylvania, Philadelphia, PA .. University of Pennsylvania, Philadelphia, PA t

2 University

Abstract: Objective: To explore the role that religion and spirituality play in depression. Methods: Mixed method design. In phase one, we describe older individuals who considered religion to be an important aspect of their daily lives (n 355). In phase two, we analyzed open-ended interviews to derive themes related to depression and religious coping among older African .Americans (n =47)..

=

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Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Results: Respondents who considered religion to be an important part of their daily lives were more likely to be women, (800/0 VS. 58%, p
Desire for Involvement in Decision-Making in C6nical Encounten with Psychiatrists and Primary Care Providen Erica L.O'Neall, Sarah I. Pmtt2, Rosemarie S. Wolfe3, Meghan A. McCarthr, Kim T. MueserS, Robert E. Dmke6,. Stephen]. Barte1s7 Dartmouth Psychiatric Research Center, Leban~ NH Dartmouth Psychiatric Research Cente~ Concord~ NH 3 Dartmouth Psychiatric Research Center, Concord, NH 4 Dartmouth Psychiatric Research Center, Concord, NH 5 Dartmouth Psychiatric Research Center, Concord, NH I

2

6

7

Dartmouth Psychiatric Research Center, Leban~ NH Dartmouth Psychiatric Research Center, Lebanon. NH

Abstract: Background: Consumer involvement in decision-making may lead to improved adherence and clinical outcomes. However, little is known about preferences for involvement in decision-making in older adults with co-morbid mental and physical illnesses. The putpose of this study is to determine desire for involvement in decision-making and interest in receiving information in clinical encounters with psychiatrists and primary care doctors. Methods: Older adults with co-morbid serious mental illness and physical illness were recruited from an ongoing study of Integrated Illness ~fanagement and Recovery in a community mental health center. The Autonomy Preference Index (AP!), a 14-item scale langing &om 0 (no desire) to 100 (strongest desire), was used to elicit interest in infoanation and involvement in decision-making. We tested the relationships between interest in infoanation and involvement with decision-making and socio-demograpbic, wenness/ recovery, and self-efficacy variables. Results: Preliminary analysis of the i\PI results. from the 53 adults enrolled in the study to date, indicates a strong desire for information (73.20+8.50, 73.59+8.32) and a moderate desire for involvement in decision-making (49.36+16.77 t 51.30+12.98) with both primary care doctors and psychiatrists. Interest for infonnation (r=O.60,p
This research was funded by: NIl\!H R34 MH074786-0t, NIMH T321\fi-1 073553. Poster Number: 24

Religion and Quality of Life in Older Persons with Schizophrenia Sukriti Mittal1, Carl I.Coben2, Kah Hong Gob3, Hamed Rezaisbiraz4, Shilpa Diwan5, Azziza O. Bankole6, Paul M Ramirez' Brooklyn, NY, Brooklyn, NY Downstate Medical Center, Brooklyn, NY 3 SUNY Downstate Medical Center, BrooklYflt NY 4 SUNY Downstate Medical Center, Brooklyn, NY 5 SUNY Downstate Medical Center, Brooklyn, NY (. SUNY Downstate Medical Center, Brooklyn, NY I

SUNY Downstate Medical Ceote~

2 SUNY

7

Long Island University, Brooklyn, NY

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting Abstract: Objective: In this study, we examine the association between self reported religiosity and Quality of Life (QOL)t and mediating effects of religiosity on the factors affecting QOL, in a sample of older schizophrenic persons and community comparison groups. Methods: The schizophrenia group (5) consisted of 198 community-dwelling persons aged 55 and above, who developed schizophrenia before the age 45..A. community comparison group (q with 113 people was recruited using randomly selected blockgroups. An 8-item Religiosity Scale was developed by analyzing questionnaire items pertaining to religion using principal components analysis with vuimax rotation. Using an adaptation ofPearlin's Stress Process model we identified nine stress and two coping variables. Also, five demographic variables were identified as covanates. We separately examined each suess variable, and direct, intervening and buffering effects of religiosity on QOL using bierarchicallinear regression analysis. Results: There were no significant differences between 5 and C groups in their overall Religiosity scores or in any of the items of the religiosity scale except the frequency of attending the religious services (Mann\Vhitney U=8341; P
Facton Associated with Performance of Complex Tasks of Daily Living in Community-Living Older Adults Melina E. Griss 1, DavidJ. Schredeo2, Godfrey D. Pearlson~ Olin Neuropsychiatty Research Center, Hartford, cr t MD 3 Olin Neuropsychiatry Research Center, Hartford, cr & Yale University School of Medicine, New Haven, cr t

2

Johm Hopkins School of Medicine, Baltimore

Abstract: Background: Difficulties associated with daily functioning often first involve complex evetyday tasks, or instrumental activities of daily living (IADLs), as adults age. ?vlany aging-associated factors can adversely affect the ability of an elderly adult to complete IADLs. These include health problemst age-related cognitive decline, and depression. Here we report the effects of these factol'S on IADL function in a community sample of older adults. ~rethod: Participants from the two-site Aging, Brain Imaging, and Cognition study aged 60 years and above completed a physical examination (medical health rating) and neuropsychological battery (verbal & visualleaming and memory; executive function; attention; language; praxis). Self-ratings of depression (IS-item Geriatric Depression Scale) and independence for L\DLs (Lawton IADL Scale) were also obtained. Results: The sample (0 = 163) included slightly more women (5 t .5%) than men. The participants averaged 73.5 (SD = 8.2) years of age and completed an avemge of 13.5 (SD = 3.5) years of education. This cohort had minor health problems and were cognitive1y DOnna! ~E: mean 27.3; SD 23). .i\ series of stepwise regression analyses revealed that age, gender, and visualleaming ability accounted for 16.8% of the variance in IADL performance. An analysis limited to descriptive variables found that age, gender, ~IrvlSE, and medical health accounted for 24.40/0 of

=

=

the variance in L"\DL ability. When examining specific cognitive domains alODe t only performance on tasks of visualleaming. and not recall of visual infonnation, significandy accounted for 9..8% of the variance. Conclusions: Poor health and depressive symptoms did not contn1>ute to functional IADL impainnent in this sample of community-Jiving older adults.. Overall, increasing age, gender, and visual learning ability were found to be important detemUnants of IADL function.

This research was funded by: NThIH Rot lVlH60504-04. Poster Number: 26

The Depression-Disability Process: An Investigation from the PROSPECT Study .Amy L. Byers t , Martha L. Bruce2 t

Weill ComeR Medical College, \Vhite Plains, NY ComeR Medical College, White Plains, NY

2 Weill

Abstract:

Background: The objective of this research was to examine the tmnsitiooal states of depression and functional decline over time using the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (pROSPECI). PROSPECf, unlike other observational studies, over-sampled for depression and used a clinical measure to assess depression. Methods: PROSPECf is a multi-site, practice-randomized controlled trial of primary cue adults aged 60 years and older. For this analysis, 693 participants were examined who had disability data available at baseline and t-year follow-up. Depression was detennined using the Structured Clinical Interview

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Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting for DS~I-IV (SeID).. Disability was assessed with the 9-item L'\DL scale of the Philadelphia ~fultilevel Assessment Instnunent (MAI). Mixed-effects logistic regression models examined the relationship between transitional states of depression (e.g., going &om no depression at baseline to depression at I-year) and functional decline, as measured by a negative change in cumulative 1\.iAI score over time. Results: The sample included 56.70/0 of participants reporting at least one IADL impattment at baseline. The proportion of participants who experienced functional decline included 41.9% developing depression by l-year (N=43), 35.30/0 with depression over the year (N=119), 33.00/0 remitting by t-year (N=185), and 25.1% with no depression over the year (N=346) [Chi-square=9.13, DF=3, p=O.028]. Participants who developed depression by I-year had the largest odds of functional decline (OR=2.00, 950/0 CI=1.01-3..91).. In additio~ participants who experienced depression over 1-year (OR=1 . 72, 950/0 CI=I.08-2.74) and those who remitted(OR=1.55, 95% CI=1.03-2.33) bad a significantly greater odds of functional decline than participants who experienced no depression over 1-yeu, adjusting for age, gender, mcet medical burden, and design variables. Intervention status did not modify these results. Conclusion: This research potentially informs theory about the depression-disability process by suggesting that onset of depression is a particularly prominent time for functional decline. This research was funded by: K01 MH079093.

Poster Number: 27 Disability in Community-Based Older Women with Depression Denise Chisho1m1, Joan C. Rogers2, Charles F.Reynolds,III3, Margo B. Holm4

University of Pittsburgh, Pittsburgh, PA of Pittsburgb, Pittsburgh, PA 3 University ofPittsbmgh, Pittsburgh, PA .. University of Pittsbmgh, Pittsburgh, PA I

2 University

Abstract: Objective: Depression-related disability limits the scope of older adults' daily living activities, threatens their ability to live independendy, and increases their dependence on caregivers. Evidence suggests a reinforcing relationship between depression and disability however we know little about how depression severity is associated with limitations in specific daily activities. This prospective cross-sectional study examined disability in older women with depression treated as inpatients or outpatients to describe the range and varia.tion in activity limitations for differing levels of depression. A unique aspect of this study was the assessment of disability through perfoanance-testing versus patient-report. Methods: 119 community-dwelling older women with a DSM diagnosis of major depression were recruited from the geriatric: psychiatty services of an academic healthcare center. There were 60 inpatients (mean age 73.8 ± 6.8) and 59 outpatients (mean age 75.7 ± 4.1). Disability was measured with the Performance Assessment of SelfCare Skills (PASS). Testing included 24 PASS items in 4 domains (functional mobility [FNf]; basic activities of daily living [BADL); and instrumental activities of daily living with a physical or cognitive emphasis [lADL-physica1; IADL-cognitive]. Performance testing was conducted in an occupational therapy apartment, thus, subjects were tested on familiar tasks in an U11familiar setting. Rasch analysis ranked the 24 P.i\SS items by degree of difficulty based on the ability of om subjects; items ordered above and below the mean (logit = 0) were respectively the hardest and easiest items to perfonn. Results: Compared to the outpatients, the inpatients had greater depressive (GOS, t = 5.. 75, p? .01), cognitive (3l\J1S, t = -4.13, P ? .01) and physical (KFT, t = 3.27, P ? .05) impairment. For the total sample, balancing a checkbook (IADL-cognitive) was the hardest item to perform and stair use (FM) was the easiest 66.7% (16/24 tasks) of the items were at the difficult end of the hierarchy: 11 IADL-cognitive (checkbook balancing, shopping, stovetop/oven cooking, paying/mailing bills, small repairs~ using sharp utensils, telephone use), 3 IADLmanaging medicatio~ physical (changing bed linens, meal clean-up, removing garbage)~ 1 BADL (foot care), and 1 ~I (tub/shower ttaosfers). Easiest items were 2 L~L-cognitive (playing bingo, reading a newspaper)~ 1 Ll\DL-physical (sweeping), 1 BADL (dressiog), and 4 FM (bed/toilet transfers, walking, stair use). The inpatients evidenced signi.6candy more disability than the outpatients, in 22 of 24 items (p ? .001 or p ? .05) spanning all 4 domains (p ? .001). The inpatients' ability range was more variable and less (25% ?mean ability) than that of the outpatients. Conclusions: Using Rasch analysis, we substantiated, quantified, and specified disability for older women with varying degrees of depression. The task hierarchy can guide the resumption of activities as depression resolves.

This research was funded by: Advance Center for Intenrentions and Services Research (ACISR) (p30 !vnI7194). Poster Number: 28 Determinants of Specific Disabilities in Elderly Outpatients with Major Depressive Disorder Dora. KaneUopoulos l , JoAnne Sirey2, Patrick Raue3, George S..Alexopoulos4 I

Weill Cornell Medical College, White Plainst NY Cornell Medical College, White Plains, NY

2 Weill

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting 3 Weill Cornell Medical College, White Plains, NY .. Weill Cornell Medical College, White Plains, NY

Abstract: Objective: To identify determinants of seven domains of disability among elderly depressed outpatients. Inttoduction: Disability is a. broad concept that encompasses impairment in specific functions. This study seeks to identify clinical determinants to impairment in each of seven domains of function in older adults with Major Depression ~IDD). Method: 457 elderly patients with ~IDD were compared to 47 normal elders on measures of disability using the World Health Organization Disability Assessment Schedule n (WHODAS-II). Bivariate analysis compared variables associated with disability. Sepatate predictor models were then created for each WHODAS domain: Getting ,,-\round (GA); Life Activities (L\); Understanding and Communicating (Uq; Participation in Society (PS); Self Care (SC); Getting Along with Others (GAL); and Wodt (W). The Mini-Mental State Examination (MI\{SE), the 24-item Hamilton Depression Rating Scale (HDRS)" and the Charlson Comorbidity Index were used to assess cognitive impairment, severity of depression and medical burden. Results: Depressed subjects bad greater impairment in each WHODAS domain than controls (p
Poster Number: 29 Predicton ofHealthy Aging Among Older Homecare Recipients Mark I.Weinbergerl, Martha L Broce2,Jo.Anne Sircy3 1 Weill

College of Medicine ofComeD University, New York, NY Weill College of Medicine of Cornell University, White Plains, NY 3 Weill College of l\lec1icine of Comel1 University, White Plains, NY 2

Abstract: Interest in supporting successful aging bas grown the past decade (e.g. Depp & Jeste, 2006; Almeida et al., 2006). \Vhile there is no consensus on its definition, successful aging can be conceptualized as a process of adapting to challenges (von Faber et at, 2001). Adverse mental states such as depression and cognitive impairment compromise an individual's ability to achieve successful aging. In this study we examine factors that are associated with the emergence ofdepression and cognitive impairment among a group of medically compromised homebound elders initiating homecare services. We examined predictors of sustained euthymic mood and intact cognition among elders (M: age= 78.4) one year after admission to a Medicare home healthcare agency in Westchester County, New York. Studying predictors of sustained cgood' outcomes among frail individuals facing a health challenge can help identify factors that may be associated with adaptation. Our analyses are conducted with a subsample of elders (N=339) initiating homecare with no evidence of depression or cognitive impainnent at admission. At one year follow-up nearly three fourths of the sample appeared to have adapt~ defined as remaining euthymic and cognitively intact (730/0; 249/339). In bivariate analyses, adaptation at one year was associated with better self-rated health at admission (p=009), higher education (p=.OOO), a sense of "feeling useful to family" (p=.021), and higher life satisfaction on the GDS (p=..OO6). ADL and IADL functioning and medical comorbidity were not associated with mood and cognitive status at fonow-up. In a multivariate logistic regression model, significant independent baseline predictors were perceived overall health status (OR= 1..73~ p=.032)t higher education (OR= 1.23, p=.OOO), and higher life satisfaction (OR=2.93, p=.008). Findings underscore the importance of perceived health statust prior educational attainment, and overall life satisfaction adaptation in a vulnerable population. This research was funded by: 5R24MH064608 (Broce) K231vIH66381 (Suey).

Poster Number: 30 Depression and Psychosocial FactOR Affecting Attitudes and Beliefs about Medicare Part D Patricia. Marino·" Keay-~~ NeweD.2,jo .£-\nne Sirey3, Eros Papademetriou\ Martha L.Broces

Weill Cornell Medical College, White Plains, NY Weill Cornell Medical College, White Plains, NY }Weill Comell Medical College, White Plains, NY .. Weill Comell Medical Conege, White Plains, NY 5Wei1l Comelll\.ledical College, White Plains, NY I

2

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2008 AAGP Annual Meeting Abstract: Introduction: From November 15, 2005 to May 15, 2006, the great majority of the nation~s seniors were given the opportunity to obtain prescription drug coverage by enrolling in the Medicare Drug Prescription Plan (I'vfedicare Part D). To date, there have been no investigations of the factors that may affect the individual's attitudes and beliefs about the Medicare Part D. This study was developed to examine both social and clinical factors that impact the individuals' attitudes and beliefs about Medicare Part D among community dwelling older adults. Methods: Participants were recruited from the Westchester County's Administration 011 .A.ging's Congregate Meal Programs for Seniors (age > 60 years). Participants received an in-person intetview during the I\Jledicare Part D enrollment period. Interviews included the assessment of depression, social support characteristics and the attitudes and beliefs about the ~fedicare Part D and factors that affect the decision making process. Results: Three hundred and eight participants were interviewed. Their mean age was 76.5 years (S.D.= 7.0); 78.90/0 (N= 243) were female, 25.6% (N= 79) were i\frican American, and 6.5°10 (N= 20) Hispanic. Eighty six percent of participants reported already having prescription drug coverage prior to the implementation of ~fedicare Part D. Fifty-five or t 7.8% of participants met criteria for minor or major depression. Compared to those without depression, depressed participants were more likely to report being more worried about choosing a IvIedicare Part D (51.9% vs. 31.5% p=.003), experiencing difficulty selecting a Medicare Part D (65.50/0 vs. 41.6%, p=0.18) and not having enough infonnation to make a decision about Medicare Part D (54.7% vs. 37.8%, p=.Ol7). Depressed participants also reported lower rates of subjective social support than those without depression (17.8% vs. 42.3%, p<.OOl). Depressed participants were more worned about ~redicare Part D (59.1 0/0 vs. 32.7% t p=.OS) and less likely to believe they would benefit from. Medicare Part D if they had low vs. high social support (63% vs. 390/0, p=.05). Social support was also not associated with thoughts or beliefs about Medicare Part D among seniors who were not depressed. Conclusions: Findings suggest that among community dwelling older adults, depression affected seniors' level of worry and their experience selecting a Medicare Part D plan. In combination with low perceived social support, depressed seniors did not believe that they would benefit from ~Iedicare Part D. This research was funded by: R24 MH064608 IP..RISP: Treatment of Late Life Depression in Home Care, P30 MH068638 Comell ACISR for: Late-Life Depression.

Poster Number: 31

Depression as a Predictor ofAnalgesic Vse in Older Adults

Stephen M.Thielke 1, ~fark

Sullivan 2,Jmgen Unutzer 3

University ofWashingto~ Seattle, Wl, of Washington, Seattle, WA 3 University of Wasbingtont Seattlet W.\ I

2 University

Abstract: Background: Depression and pain have a bidirectional relationship in older adults. Depression exacerbates the experience of and distress from pain, and also affects treatments used for pain and provider decisions about pain management. Some treatments for pain, such as opiates, CQX-2 inhibitoD, and NSAIDS without a gastroprotective agent, are known to increase risks for adverse health outcomes. Methods: Our research examines the effect of depression in the use of analgesic medications in three large longitudinal datasets from 2002 to 2005: Arkansas Medicaid, HealthCore, and the Medicare Current Beneficiaries Survey. From ~ pharmacy, and sociodemograpbic data, we categorize patients according to pain-related diagnoses, depression, and prescription ofanalgesic medications.•o\nalgesic prescriptions are categorized as opiate, NSAID, COX-2, and other, and the dosing and duration of use are categorized. Using logistic regression, we estimate the effects of depression, sociodemograpbic factors, healthcare utilization, and comorbidities on the likelihood of using various analgesic medications at various doses (appropriate use, undemse, and ovemse). Results: Initial analyses indicate that patients with a diagnosis of depression received more opiate medications and fewer NSAIDs with gastroprotective agent than those without depression. ~lany older patients, and especially those with depression, received opiates at doses above current recommendations for safety. These findings are consistent with other research in younger populations suggesting that depression increases the likelihood of opiate use, regardless of pain complaint. This data is also consistent with the hypothesis that opiates are often associated with psychosocial distress rather than somatic pain. •-\dditional analyses will be perfonned to test these effects after adjustment for sociodemographic factors and comorbidities. Conclusions: Depression is strongly associated with pain, and may be a risk factor for use of potentially hazardous medications in older adults. Attention to current health services utilization can improve the treatments that older adults receive for pain, for instance by encouraging application of evidence-based guidelines for safety and effective pain management

Poster Number: 32 Does Depression Affect Healthcare and Social Sem.ces Utilization Among Aging Services CHents? Thomas M. Richardson l , Yeates Conwell2

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting

I

2

University of Rochester" Rochester, NY University of Rochester, Rochester, NY

Abstract: Background: The Aging Services Network is a national network which serves millions of seniors with social needs, many ofwhom also have affective disorders. Depression among seniors is associated with increased healthcare services utilization. This study examines utilization of healthcare and social services by aging services care management clients with and without a current major depressive episode. We hypothesize that depressed care management services will have greater utilization of healthcare services, social services and greater care management use than nondepressed clients. Methods: The Stmctured Clinical Diagnostic Interview for DSM-IV was used to assess for major depression and the PHQ-9 for depression symptom severity. .J.~ modified Comell Services Index was used to assess for health and social services utilization. An electronic administrative data.base (peerPlace) was used to determine the frequency and amount of care management. Results: l\ random sample of 380 aging services care management clients took part in this study. The avemge age was 76,32% were male, 16% were nonwhite, 58% bad high school or less education, 41% had a total household income of <$1,250 per month and 45% lived alone. 27% of subjects met criteria for current MOE. We will present the results of analyses that compare depressed and nondepressed care management clients with regard to utilization of health and human seMces. Conclusions: Because aging services attend to the social needs of a population of older adults in which the prevalence of clinically significant depression is high, aging services staIf may be in an ideal position to impact utilization pattems.

This research was funded by: NIMH R24I\tIH07t604~

AHRQ T32HSOOOO44, American Foundation for Suicide Prevention.

Poster Number: 33

Psychometric Properties of the Patient Heath Questionnaire (PHQ...2/9) Among Aging Services Clients

Thomas M Richardson l , Xin Tu2, Yeates Conwelll University of Rochester, Rochester, NY University of Rochester, Rochester, NY 3 University of Rochester, Rochester, NY I

2

Abstract: Background: The Patient Heath Questionnaire (PHQ-2/9) is a valid and reliable screening tool for depressive syndromes. Less work has specifically examined its psychometric properties among older adult populations. In this study we examine the psychometric properties of the PHQ2/9 among a sample of community dwe1ling older adults accessing aging social services. Methods: We conducted an in-home interview with 380 clients receiving an assessment for care management services.. The PHQ2/9 was used to screen for depression and the Structured Clinical Diagnostic Interview for DSM-IV was conducted to determine the presence of a current major depressive episode. Results: A random sample of 380 care management clients took part in this study. 84% Caucasian, 580/0 high school 01' less education, 41% Sample characteristics included, mean age of 76 years, two-thirds femal~ reported a total household income of <$1~50 per month and 450/0 lived alone. Twenty-seven percent of subjects met criteria for cuuent MOE (n=102). On the PHQ-9 33% scored between 0-4, 36% scored 5-9. 18% scoredl0-14 and 13% scored 15 or greater. Receiving operating curves and sensitivity, specificity, positive and negative predictive values for the PHQ-2 and the PHQ-9 will be presented Conclusions: The PHQ-2/9 has become a popular depression screening tool for many populations in many venues. This study presents data to determine its utility among a previously unstudied and important population of older adults at high risk for depressive disorders. This research was funded by: NIMH R241\£H07t604~

AHRQ T32HSOOOO44, American Foundation for Suicide Prevention.

Poster Number: 34

Somatic Symptoms and the Identification of Depression Among Elderly Primary Care Patients Puja R. Shaht, Hillaty R. Bogner2 I

Drexel University College of Medicine, Philadelphia, P A of Pennsylvania, Philadelphia, PA

2 University

Abstract:

Background: Somati2ation, the presentation ofmedically unexplained symptoms, is very common in the primary care setting. and is recognized as a common feature of depression.. In this study, we examined the relationship between somatization and depression as rated by primary care physicians. In addition, we investigated the characteristics of patients who were identified by the physician as somatizing, depressed, or both depressed and somatizing. Methods: Cross-sectional survey of 355 older adults with and without

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2008 AAGP Annual Meeting significant depressive symptoms. At the index visit, the physiciants ratings of somatization and depression were obtained on 341 of the 355 patients who completed in-home interviews. Patients were sorted into 4 groups based on physician ratings (somatizing only. depressed only, both somatizing and depressed, and none). Results: Patients who were rated as somatizing were 4.03 (950/0 CI [2.52t 6.45]) times as likely to be rated as depressed. Comparing the four groups (no depression/no somatization. somatization only, depression only, both depression and somatization) defined by physicians' ratings, functional status, etbni.city, number of medical conditions, depressive symptoms, and anxiety were statistically signifieandy different In particular, primary cue physicians were 3.945(95°/0 CI [1.53, 10.16]) more likely to identify older black patients as somatizing only versus depressed and somatizing compared to older white patients. Conclusion: Our study fiBs a gap in the literature by focusing on the primary care physician ratings of depression and somatization, and also specifically on older primary care patients. Blacks are less likely to be rated as depressed but this seems to reflect the tendency of doctors to rate them as somatizing. This research was funded by: Summer Training on Aging Reseuch topics - Mental Health Fellowship at the University of California, San Diego, with grant support from the National Institute of Mental Health -NIMH. Poster Number: 35 Envejecimiento Positivo: Comparison of Latina and Caucasian Older Women's Views of Successful Agiug Vetomca Cardenas!, Colin Depp2, Matthew .Allison], Dilip Jeste4 University of Califomiat San Diego San Diegot Ci\ University of California. San Diego, San Diegot Ci\ 3 University of California, San Diego, San Diego, CA .. U Diversity of California, San Diego, San Diego, CA t

t

2

Abstract: There is limited research asking individuals about their perceptions of the essential components of "successful aging" (phelan & Lanon, 2002). Notably, research on older adults' perceptions of successful aging has been largely restricted to Caucasians. Future defiJlitions of successful aging that incoq>0t8te seniors' attitudes and beliefs would benefit from illfonnation about the impact of cultural differences, particularly among U.S. Latinos - the fastest growing group of older adults. The pwpose of this study is to compare self-reported attih.ldes about the components of successful aging between older Latina and Caucasian women participating in the San Diego Women's Health Initiative. We hypothesize there will be significant differences between the two groups on their responses to what it means to .'age successfUlly" and in their selection of the '·5 most influential aspects of successfUl aging'" (e.g., good genes, healthy diet). Our sample will consist of 170 participants for each ethnic group. For descriptive purposes, age, ethnicity, annual income, preferred language, and educational attainment will be assessed. We will also compare ethnic groups on the mental and physical health Composites of the SF-36. We will conduct a chi-square test comparing frequency of endorsement of the 11 aspects of successful aging, and compare them via chi-square test in the single most influential aspect. For textual data, we will use a web-based program (www.textalyser.net) to assess frequency ofword occuneoce in definitions of successful aging. Obtained words and phrases may be different across groups; therefore, we will not conduct statistical analyses comparing groups.

Poster Number: 36 How Older Adults Express Depression: A Comparison ofThree Ethnic Groups in Primary Care Daniel E. Jimenez1, 1vIing-Yu Fan2, Ladson Hintoo3,Jw:gen Uniitzer', Stephen Bartels5 Dartmouth Psychiatric Research Center, Lebano~ NH University of Washington, Seattle, WA 3 University of California-Davis School of Medicin~ Saaamento CA 4 University ofWashington, Seattle, WA 5 Dartmouth Psychiatric Research Center, Lebanon, NH t

2

t

Abstract: primaty care physicians are less likely to detect depression among African-i\mericans and Latino patients than among Caucasians. This difficulty in recognizing depression may be a result of varied symptom expression among African-Americans, Latinos, and Caucasians. There has been a paucity of research in the area of depression symptom expression in older adults. In the ethnic minority population, misdiagnosis or lack of recognition can lead to perpetuating pte-existing health disparities. Since, ethnic minority elderly are much less likely than Caucasians to seek/use mental health services, it is important to undentand how depression is manifested, what type of services are they using, and how they access the few services they are using. The objectives of this study were to examine etbni.c differences in symptom expression of depression, health services used, and referrals to ThfPACT study among Caucasian, Latino, and African-American patients. Participants were from a multisite trial oflate life depression management in primary care (Caucasians = 1388; African-Americans = 222; Latinos = 138). Ethnic differences were found in the reporting of the individual symptoms on the HSCL-20. Cross-ethnic comparisons revealed significant «.05) differences in 7 of the

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting 20 symptoms of depression and health care seJ.Vice use with respect to proportion using alternative medicine, emergent services, and routine mental health outpatient services. Results also indicate that Latinos were more likely to be referred to IMPACT than either the Caucasian or African-.i\merican participantst while African-.i\mericans were more likely to have been screened for depression when compared to the other two groups. Since the majority of ethnic minority elderly receive their mental health care &om their primary care physicians, it is important to understand how they experience symptoms, access services, and use services in ord~ to develop culturally sensitive models of care. Poster Numbet: 37 Improving Detection of Home Health Nursing Needs FoDowing Geropsycbiatry Discharge James D. Tewl , Sara A.1Mi1ler2, LalithKumar Solai3,Jules Rosenal, Kalyani Gopalans, Frank Ghinassi6, Charles F. Reynolds, IIJ7 University of Pittsburgh, Pittsburgh, PA University of Pittsbut~ Pittsburgh, PA 3 University of Pittsburgh, Pittsburgh, PA of University of Pittsburgh, Pittsburgh, PA S University of Pittsburgh, Pittsburgh, PA G Univenity ofPittsbmgh, Pittsburgh, PA 7 University ofPittsbur~ Pittsburgh, PA t

2

Abstract: Background: Transitional care interventions using visiting nurses as ctransition coaches' to assist patients following medical hospital discharge have demonstrated reduced rates ofmedication errotS and re-hospitalization. Elderly patients discharged from psychiatric hospitals have complex service needs which are often overlooked in discharge planning. ~y patients who qualify for in-home skilled nursing support following discharge (according to lvledicare guidelines) do not receive these services. Objective: The authors conducted a QI project using a brief screening tool, the (CHorne Health Nursing Needs .i\ssessment Foan," to improve detection of in-home skilled nursing needs following geropsychiatry hospital discharge. Methods: The authors received IRB approval for this QI study. Over a five-month peri~ 213 consecutive adults hospitalized on a university geropsycbiatry inpatient unit were screened with the needs assessment Conn. Refettals were made when clinically indicated. Referral rates in this population were compared with tefeaal rates obtained from a chart review of all dischatges from the same geropsychiatry unit during the four-month period prior to the use of the foan (170 consecutive discharges). Results: The percentages of patients eligible for homecare refettal (eg, discharged to home, assisted living" or personal care home) were similar pre- to post-intervention (71 °/0 and 74% , respectively). The tate of referral for in-home services post-intervention was 430/0, compared to 18% pre-intervention (X2=27.1, p
of Rochester Medical Center, Rochester, NY University ofRochester Medical Center, Rochester, NY

Abstract: Renal dialysis is emblematic of the rising age for Iife-extendiog medical interventions of many kinds that, while they may forestall death, not uncommonly place patients and families in circumstances of needing to consciously and, along with clinicians, collaboratively de1iberate, authorize, and orchestrate life's close. Dialysis is also exceptional, as perhaps the quintessential example of a therapy that, while it extends biological life, does not maximize what most consider a good or full life. The character of patient participation in dialysis, then, reflects an adaptation to the substantial demands of therapy and an acceptance of a diminished life-a fact that complicates many patients' desire to continue treatment and continue living. Studies estimate that up to 380/0 of the eldedy dialysis patients who die each year "choose" to stop treatmerit before death. The nature of that choice-how and by whom it is made, according to which decisional criteria or deliberative steps, under what psychological and/or social circumstances" and at what noteworthy moments or transition points-is poorly understood. The character of conttnU3tton and patient commitment to the treatment, including what comprises and enables an acceptable quality oflife for older individuals on dialysis, likewise remains vague. This poster describes a mixed methods, longitudinal study exploring factors that influence clinical decision-making among dialysis

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2008 AAGP Annual Meeting patients age 70 and over with diabetes-ie. t patients for whom prognosis is poor, and end of life scenarios and choices are imminent-at an upstate New York outpatient unit. The study focuses on the roles of depression, death and suicide ideation in older patients' treatment choices. It also explores the understandings and criteria, shared and discrepant, that patients, families, and clinicians employ in making decisions as death neus. Poster Number: 39 FaDs in the Nursing Home: Does Time Matter? Izchak Kohen!, Paula E. Lester2, Haq :Maheoaaz3, Amruta "adnerkar4 Zucker-Hillside Hospital, Glen Oaks, NY Wmthrop University Hospital, Mineola, NY 3Wmthrop University Hospital, Mineola, NY of WlOthrop Univenity Hospital, Mineola, NY I

2

Abstract: Background: Falls are responsible for considerable morbidity, immobility, and mortality among older persons, especially those living in nursing homes. Falls have many different causes, and several risk factors that predispose patients to falls have been identified. There is currently no published data. regarding the time of falls in the nursing home setting. Objective: The purpose of this study is to assess whether falls in nursing home residents are more prevalent at particular times of the day. Method.: Retrospective chart review of falls in the first half of 2007 which OCCUtted in a nursing home in Long Island, New York looking at time, location and injury due to falls. Results: There were 220 reported falls.. There were 99 faDs during the 7a-3p nw:sing shift, 86 during 3p-11p, and 35 during I1p-7a. Twenty-six pelCent of falls occuaed between 4p-8p. There was no significant difference in whether the falls resulted in injury based on shift: 7a-3p (480/0 injuries), 3p-11p (50% injuries), and I1p-7a (46% injuries). Discussion: This study reveals a variation in the prevalence of falls in the nursing home based on time of day. One might have expected that more falls would happen at night when there is less staffing and residents may get up to go to the bathroom without asking for assistance or because residents are more likely to be confused and disoriented by their surroundings (ie: darkness of mi11eu). However, the data suxprisiogly did not support this hypothesis. The greatest percentage of falls occurred between 4p-8p which may be related to the syndrome of "sundowoing". Conclusion: More research is needed to further elucidate whether there is a temporal panem to falls in the nursing home. Perhaps specific interventions at times when falls are more common can be used to reduce the risk of falls. Poster Number: 40 Lifespan Pattems ofStrenuoU8 Exercise and WeD-Being Among Women in Late-Life Nicole ~1 Lanouette I, Colin Depp2, Matthew .A.llison3, Dilip ". Jeste4 University ofCalifomiat San Diego, LaJolla, CA UDiversity of California, San Diego, La JolIa, CA 3 Univetsity of California, San Diego, La JoDat CA .. University of California, San Diego, La Jolla, CA t

2

Abstract: Objective: To examine lifetime strenuous exercise patterns and their relationship to physical and mental well-being among older women. Methods: Participants in the Women's Health Initiative (WHI) (N=5,600) at the San Diego clinical center were invited to participate in a study on successful aging. Of these, 1,575 women who had complete data on lifetime strenuous exercise pattems were included in the current analysis. Participants were asked if they exercised strenuously 3 or more times per week at 4 time points: ages 18, 35,50, and currendy. We examined frequency of exercise at each age, and compared exetcise participation pattems by current health-related quality of life and presence of illnesses, measures of mental wel1- being such as optimism, attitudes toward aging, depressive symptoms, and cognitive complaints using ANOVAs. Results: The mean age was 73.1 (sd=7.1). The two most common pattems were never engaging in strenuous exercise (290/0) and exercising inconsistel1dy and not currendy (36%), followed by 18% who reported consistendy exercising through age 50 but not currently. There were 15% who initiated or restarted strenuous exercise at age 50 or older and only 3% of participants who endorsed strenuous exercise at every age. Paitwise comparisons revealed that women who were consistent exercisers, and those who initiated or restarted exercise at age 50 or older bad higher scores on selfrated physical functioning (p
Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting Poster Numbec 41 Relationship Between Frailty and Cognitive Decline in Older Mexican Americans Rafael Sampet-TementJ, Soham AI Snih2, ~fukaila A.Raji3, Kenneth J. Ottenbacher', Kiriakos S. Markidess I

2

University of Texas Medical Branch, Galveston, TX University of Texas Medical Branc~ Galveston, 'IX

3 University ofTexas Medical Branch, Galveston, TX .. University ofTexas Medical Branch, Galveston, 'fX 5 University oCTexas Medical Branch, Galveston, TX

Abstract: Objective: To Examine the association between frailty status and change in cognitive function over a ten year period in older ~fexican Americans. Design: Data used &om the Hispanic Established Population for the Epidemiological Study of the Elderly (HEPESE) (1995-96 - 2004-05). Setting: Five southwestern states: Texas, New Mexico, Colorado, .L'\rizo~ and California. Participants: 1,372 noo-institutionali%ed Mexican American men and women aged 65 and older with a Mini ?vlental State Examination-~E ? 21 in the second wave of the smdy. Measurements: Frailty defined as tluee or more of the following components: weight-loss, exhaustion, physical activity, walk-time and grip-strength; socio-demographic factors (age, sex, and education), MlvISE medical conditions (stroke, heart-attack, diabetes, and hypertension), and visual impainnent. Results: Of the 1372 subjects, 686 (SOO/o) were not frail, 626 (45.60/0) were pre-frail (1 - 2 components) and 60(4.4%) were frail (?3 components). Using general linear mixed model analysis~ frail subjects bad a greater rate of cognitive decline over to-years, compared with non-frail subjects. There was a significant frail status-by-time interaction with ~E scores. Frail subjects had greater cognitive decline over time (Estimate -0.63, SE 0.14; P< .0001) than non-frail. This association remained statistically significant after controlling for potential confounding factors. Conclusion: Frail status in older Mexican Americans with a ~E ? 21 at baseline is an independent predictor of ~E score decline over a 10-year period. Future research is needed to establish pathophysiological components that can clarify the relationship between frailty and cognitive decline and uncover new interventions to delay the onset of cognitive disability in older Mexican .Americans and improve their quality-of-life. t

=

=

Poster Number: 42 Determinants of Disability Among Newly-Admitted Assisted Living Residents Vary by Dementia Status Quincy M. Samus 1, Chiadi U. Onyike2,jason Brandt 3, i\lva Baker, Matthew McNabneyS, Lawrence Mayer6, Peter V. Rabins1, Constantine G. Lyketsos8 .I..l\.dam. Rosenblatt9 t

Johns Hopkins Uoiversityt Baltimore, ~ !\.ID 3Johns Hopkins University, Baltimore, l\ID .. The Copper Ridge Institute, Sykesville, lvID 5Johns Hopkins University, Baltimore, MD 6 Johns Hopkins Univetsity, Ba1timore~ :MD 7 Johns Hopkins University, Baltimore, ?\IT) 8 Johns Hopkins University,. Baltimore, rvID 9 Johm Hopkins University, Baltimore. rvID 10 Johns Hopkins University, Baltimore. rvID I

2

JoOOs Hopkins University, Baltimore~

Abstract: Background: Functional dependency (FD) is a major risk. factor for moving into an assisted living (AL) home and is an indicator of level of care and cost within .AL Few studies have examined FD in .AL and how it may differ by dementia status. Objective: To describe and contrast FD levels of l1L residents with and without dementia and assess the relative contribution of cognitive, behavioral, medical, and social factors to FD in each subgroup. Methods: 262 newly-admitted residents from 27 randomly-selected medical, AL facilities in h.fal'yland comprised the sample. All were given comprehensive dementia assessments. Cognitive, behavi.o~ and social factors were assessed at baseline. FD was operationalized as impairment in activities of daily living (ADLs). Results: Fiftynine percent of residents met DSM-IV criteria for dementia.. Residents with dementia had higher levels ofFD (p
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2008 AAGP Annual Meeting resident subgroups. Future research should examine whether specifically-targeted interventions can help preserve function in these sub-groups.

This research was funded by: National Institute of Mental Health; National. Institute on .Lo\ging Poster Number: 43 Research Trends in Alzheimer's Disease - A Perspective &om www.clinicaltrials.gov Mohd Shamsi1, Rajesh R. Tampi2 I 2

University of Missouri - Columbia, Columbia, MO Department ofPsychi.atry, Yale University School of Medicine, New Haven, cr

Abstract: Objective: It bas been estimated at over 5 million Americans suffer· from i\.lzheimer's disease. According to the Alzheimer's association, eve%)T 72 seconds somebody develops Alzheimer's disease. The number ofAmericans with Alzheimer's is expected to be between 11 million and 16 million by the year 2050. The number globally will be much higher as hugely populated countries like China and India are witnessing an increase in life expectancy. We wanted to get a perspective on research trends in Alzheimer's disease. The govemment monitored website, www.clinica1ttials.gov. is a valuable resource that contains basic infoanation on all human trials that have been registered and approved. Methods: The website is searchable using keywords, disease conditions, location etc. Alzheimer's disease was identified using the alphabetical listing of disease conditions. The results obtained were further explored using the search-within-results feature. The results were searched for symptom type, neurottansmitten, research by imaging modality, dmg names, brain pathology presentations, pathological protein type, new medication and investigational dmgs, vaccine and geographical distribution. Comparisons were made with other diseases of similar epidemiological significance. Results: A total of t 45 studies were found to be current as of September 9, 2007. By using the "include trials that are no longer recruiting" feature, a total of 334 shldies were retrieved. 23 sttldies were using imaging of some kind and 24 studies were exploring biomarkers at some stage. The most commonly investigated symptom was depression (17 studies) followed by agitation and resdessness (9 studies each). The most commonly investigated neurotransmitter was dopamine with 13 studies. The cognitive enhancer drug with the most search results was donepezil with 19 studies. A total of 4 vaccines and 10 novel treatment modalities were identified. The number of studies mentioning amyloid proteins was 13 and tau proteins were 4. The number ofcurrent studies on cancer was 6177 and obesity was 341. Conclusion: The current trend of research in Alzheimer's disease continues to follow a traditional path with a heavy focus on the amyloid hypothesis. There a strong focus to find biomatkers and is comparable to the research in .Alzheimer's imaging. New treatment modalities are expected and that might include vaccines. A wide disparity in the global distribution of trials was evident.

Poster Number: 44 What Kind ofDementia Care Do We Need? Sbaune M. DeMers·, Soo Borson2 I

University ofWashingtoo, Seattl~ WA ofWashington, Seattle, WA

2 University

Abstract: Background and Significance: Dementia is a 'silent epidemic' for which health care systems are ill prepared. Workable chronic care models are needed that incorporate the knowledge developed by geriatric specialists but can be delivered in a population-based primary care fmmewotk. Objective: To identify the critical elements of dementia care as articulated in the descriptive and prescriptive specialty literature, review data from the few randomized systems intenrention trials published to date, and sl.U1ll1laJ:ize recommendations for futme dementia health services research. Method: The world literature was searched using Medline, PsychInfo,. and the Cochrane Database of Systematic Reviews using multiple search terms to capture papers describing outpatient dementia care clinics, published recommendations from key specialty organizations, and randomized primary care intervention trials. Results: US sources contributed very little information about how dementia care is provided by specialists; the majority of papers come from the UK, Australia, and continental Europe. In contrast, four of the five randomized intervention trials identified in this search were conducted by US investigators. Specialty clinics were of two types: the memory clinic, and the old age psychiatry clinic. rvIemory clinics typically provided diagnostic and consultative services to patients, families, and primary care providers, with limited capacity for ongoing follow up. Old age psychiatry services more often manage older adults in thett homes, patients who have persisting mental illness or behavioral distmbances associated with dementia, and follow patients over time Most papers report the types of patients seen; fewer report the content of specific clinical programs in sufficient detail to allow replication in other settings. Recommendations from several different organizations were generally consistent regardless of specialty. Among the randomized primary care intervention trials, two were designed to improve dementia detection and diagnosis, and three to provide cue

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2008 AAGP Annual Meeting management for diagnosed patients. Limited outcomes reported from these trials include modest improvements in dementia detection, adherence to guidelines, and caregiver burden in the intervention group compared to usual practice. Conclusions: Dementia health services research is still in its infancy. The demand for dementia care services is growing, and most care will be provided in primary care settings. Empirical, clinically-focused, outcome-based data from alternative dementia care models are needed to complement expert panels' recommendations about dementia care and set practical tugets for interventions. Poster Number: 45

Does Brain Imaging Help Clinicians Diagnose Dementia? Shaune ~r. DeMers l Paul R. Borghesani2 Vivek Manchanda3, David H. Lewis", Sao Borsons t

t

University of Washington, Seattle, WA University ofWashington, Seattle, WA 3 University of Washington, Seattle, WA .. University of Washington, Seattle, WA 5 University of Washington, Seattle, WA I

2

Abstract: Objective: To quantify the contribution of stmctural (MRI) and perfusion (SPEC!) imaging to diagnosis of dementia. Subjects and Methods: 80 consecutive patients referred to a University-based dementia specialty clinic for diagnostic workup of cognitive decline. Research diagnostic criteria were used to generate a full differential diagnosis for each subject based on clinical data alone. Noncontrast ~fRl with a dementia-specific protocol and Tc-99m ECD (30 mCi) perfusion SPECf images were obtained. Sagittal and axial t TI, axial FLAIR, diffusion weighted, and coronal 3D FSPGR MR. images were evaluated for macro- and microvascular signs and morphological abno.analities (e.g. lobar atrophy). SPECf images were processed using 3D-SSP, and Z-score maps and transverse images were classified by published criteria into pattems typical of AD, DLB, vascular dementia, FID, and other frontal dysfunctions (ie., depression and alcoholism) as reference standards.. Atypical patterns were also recorded. Results: Combined stmetural and perfusion imaging contributed significantly to diagnosis in about 800/0 of cases. .Although 51 % had vascular abnonnalities on imaging, an initial diagnosis of a neurodegenerative disease was rejected by imaging in only two cases (2.5%). ,,-\dditional detailed results to be reported include: proportion of subjects with vascular imaging abnormalities and vascular disease or risk facton; proportion of subjects with a single clinical diagnosis confumed vs. refuted by imaging; proportion of subjects for whom t\Vo or mote diagnoses were entertained but imaging resolved the differential; and proportion for whom an unsuspected diagnosis was suggested by imaging. Conclusion: Suggestions will be provided for tailoring the use of imaging to subsets of patients with cognitive symptoms whose diagnostic assessment is most likely to be improved by imaging.

n

Poster Number: 46

Umecognized Cognitive Impairment in Hospice Patients Lana C. Diamond l , Elizabeth W.. Twamley2, Cynthia Zurbellen3, Barton W. Pahner4, Laura B. DU1U15, Dilip \'. Jeste6, Scon Irwin7 University of California San Diego, San Diego, Ci\ UCSD, San Diegot CA 3 UCSD, San Diego, CA I

2

.. UCSD, San Diego, CA 5 UCSF, San Francisco, CA 6 UCSD, San Diego, CA 7

San Diego Hospice and Pa1liative Care, San Diego, CA

Abstract: Presence of cognitive impairment in patients who are receiving hospice care can affect numerous practical, ethical, and legal considerations. Prevalence rates of cognitive impainnent vary considerably, and it remains under-recognized and thus undertreated The aim of this on-goiog study is to evaluate and better chancterize the presence of cognitive impainnent in hospice patients who do not have a known current or past diagnosis of any cognitive disorder. Thirty inpatients at San Diego Hospice and Palliative Care (SDHPq have undergone bedside cognitive testing thus far. The mean age ofthese participants was 63 years, with 51.90/0 being male, and 25.90/0 being ethnic minorities. Subjects are excluded if they had a past diagnosis of delirium or demen~ history of neurologic disease or injury, or if they had any other known cognitive impairment. Tests administered include the Mini-mental State Exam (MMSE), as well as tests of attention, word list learning and delayed recall, reasoning, and verbal fluency. Pilot data suggests that, on averaget the patients were impaired on the M1vfSE and on tests of learning, reasoning, and verbal fluency; however, their mean attention and delayed recall scores fell within normal limits. Furthermore, 41 % of the sample met DSM-I\' criteria for dementia based on impaired performance in memory and at least one other cognitive domain on testing. These results suggest that dementia frequendy goes undetected in hospice patients. Undetected cognitive impainnents can influence decision-making, which

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2008 AAGP Annual Meeting has practical and ethical implications for this vulnerable patient population and those caring for them. Interventions to improve learning and/or better detect cognitive impainnents in this population may be necessary. This research was funded by: John A. Hartford Center of Excellence in Geriatric Psychiatry at UCSD

Poster Number: 47 Decision Aid Development for Location of Care Options in Early Alzheimer's Disease Alice Andrews· Stephen Bartels2 t

I

The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH Psychiatric Research Center & Dartmouth Medical School, Lebanon, NH

2 Dartmouth

Absttaet: Objective: Alzheimer's Disease patients and family caregivers may delay location of care (Loq decisions (e.g., home/nursing

facility) until a crisis occurs or decisional capacity deteriorates. Early decision support with parlents, families, and service providers may increase patient voice, lead to choices more congruent with patient and family values, and reduce unwarranted institutionalization. We describe the development of a decision aid to support infonned choice for LOC decisions in early Alzheimer's Disease. Methods: Focus groups with long-term care COWlSelOrs, patients, and family caregivers in Grafton COWlty, NH were content-analyzed to elicit values salient to the LOC decision and to assess willingness to participate in decision support. Results were used to develop a decision aid for LOC decisions in early Alzheimer's Disease according to the Intemational Patient Decision Aid Standards (lPDAS). Results: Crises, safety concems~ and guilt drive caregiver LOC decision-making, while patient concems focus on pride, desire not to burden others, and independence. Patients may avoid LOC discussions or be reluctant to acknowledge problems with their current situation. Cost and access are critical barriers to decision-making. Caregivers and counselors emphasize the potential for a decision aid to help patients and families discuss this difficult topic, and believe this tool should result in decisions more congruent with patient and caregiver values and caregiver well-being. Early pilot experience with the decision aid will be discussed. Conclusion: Patients express reluctance to engage in conversations about LOC; a decision aid may help to catalyze these discussions. Caregivers and counselors recognize the crisis-driven nature ofLOC decisions and encomage development of decision support tools. The decision aid developed from this study will be evaluated in a system-wide randomized controlled trial.

This research was funded by: NIMH T32 MH 073553

Poster Nmnber: 48 Beyond Burden: Family Member Caregivers' Experiences and Interest in Enhancing Effectiveness Victoria M. Wtlkins 1, htlartha 1,. Bruce2, JoAnne Sirey3

Weill Medical College of Comell University, White Plains, NY Medical College of Cornell UDiversity, White Plains, NY 3 Weill Medical College ofeomeD UniVelSity, White Plains, NY t

2 Weill

Abstract: Background: Research on family caregivers of older adults has primarily focused on the stress and burden experienced by family members who provide care to patients with dementia and cognitive impainnent. In this study, we aimed to expand the research base by assessing a variety of caregiving constructs in family member caregivers of older adult homebound healthcare patients.. Method:

Participants in this study were 101 family member caregivers who were assessed for caregiver burden using a modified short-fonn of the Zarit Burden Inventory and were administered the major depression portion of the Structured Clinical Interview for DSM-IV. Participants also responded to questions regarding caregiving context and tasks, training preferences, and positive experiences. Results: The family caregivers l:eported that they provide a range of caregiving tasks. Many family members expressed interest in achieving greater effectiveness in these tasks, both among caregivers who already perfODll such tasks (e.g., 55/90.61°/0) as well as among caregivers who currently do not provide certain tasks (e.g., 7/11,64% ). The level of burden was similar to that observed in caregivers ofAlzheimer's patients. At the same time J many caregivers (88%) reported positive rewards of caregiving. Seven percent of the caregivers met criteria for major depression. Depressed caregivers were more likely to report burden (mean = 19.4 (8.2) vs. mean = 8.4 (6.8), P = 0.011) and relatively less likely to endorse positive aspects of caregiving. Conclusion: Findings support the need for greater awareness of the mixed experience of caregivers (i.e.~ bmden versus positive aspects), the identification and role of depression in family caregivers, and the desire of some caregivers for further training and support in performing caregiving tasks.

This research was funded by: R24 MH64608; T32 l\fii19132

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2008 AAGP Annual Meeting Poster Number: 49 Attachment Style and Caregiving Outcomes Jennifer Q. Morsel, William K Dooley2, David R.Shafferl, Richard Schu1z4, Gail M Williamson5 WPIC, Pittsbwgh, PA Murray State University, l\{uaay, KY 1 University of Georgia, ~\thens, GA .. University of Pittsburgh, Pittsburgh, PA I

2

5 Univenity

of Georgia, Athens, GA

Abstract: The burden of providing informal care to an ill or disabled elderly family member can lead to caregiver depression and poor or problematic caregiving. Given the interpersonal nature of caregiviog, some research has considered how chameteristics of the relationship between caregivers and care recipients impact caregiving outcomes. In this study, we applied attachment theory to predicting caregiver depression, problematic caregiving behavior, and exemplary caregiving behavior.. We present data collected from 444 caregivers in the Family Relationships in Late Life (FRILL 2) Project, a multi-site longitudinal study of informal caregiving. Age, gender, and view of self most coosistendy predicted caregiving outcomes. Caregivers with more positive views of themselves were less depressed, engaged in less problematic caregiving behavior, and provided more special attention (exemplary care) to the care recipient, suggesting that view of self may be useful in identifying caregivers at risk for depression and providing less than optimal care. This research was funded by: NIA

Poster Numbet: 50 Impact of Mood and Anxiety Symptoms in Mel DeidreJ. Devierl , Gregoty H. Pelton2, Matthias H. Tabertl , Katrina Cuasay\ D.P. Devanands I

New York State Psychiatric Institute/Colwnbia University~

New Yo~

NY

New York State Psychiatric Institute/Columbia University, New York, NY 3 New Yom State Psychiatric Institute/Columbia University, New York, NY .. New YOlk State Psychiatric Institute/Columbia UniveISity, New York, NY 5 New York State Psychiatric Institute/Columbia University, New York, NY 2

Abstract: Background: lvIild Cognitive impairment ~ICI) signifies transition between age-related memo!)' decline and Alzheimer disease (AD). Conversion to ,,\1) can be influenced by factors such as depression and anxiety. Persons with these symptoms may demonsttate cognitive deficits resulting from diminished attention or motivation, while in others they coexist with incipient dementia and confer a prognosis of future decline. One recent study identified symptoms of depression and anxiety more often in patients with rvrcI than controls and found that anxiety predicted cognitive decline in Mel. Other research has suggested that depression is a prodromal feature, and possibly a risk factor for AD. The primary goals were to measure the incidence of baseline depression and anxiety in patients with Mel and normal control subjects and to detennine if these symptoms were predictive of future cognitive decline. Methods: The inclusion criteria were broadly defined to enroll patients ranging between (Cnormal" and c'dementia" along with a cohort of oonna! controls. Conversion to .l\D was diagnosed according to the DSM-IV criteria along with possible or probable AD, according to NINCDS-ADRDA criteria. The IRB of the New York State Psychiatric Institute and Columbia University approved the research protocol, and written informed consent was obtained from each participant. Evaluation included

the Hamilton Rating Scale for Depression (HAM-D), the Spielberger State-Trait Anxiety Inventory (STi\I) and complete neuropsychological evaluation. Results: Thirty-three patients converted to .l\D during the 3-year fonow-up. The COQtrols and patients showed no significant demographic differences with regard to age or sex, though patients completed fewer yean of education and had lower :MI\1SE scores. Mel converters were older and scored lower on the MMSE than non-converters and had a greater decline in l\flvISE during follow-up. Patients had higher levels of anxiety and depression than controls, with no differences between Mel converters and non-converters. In logistic regression analysis with age and education as covariates and STAI and fL~l-D as independent variables predicting convemon to AD, age was the only significant predictor OR = 1.10950/0 CI 1.041.16, P .001. Discussion: In this clinic-based sample, anxiety and depression were more prevalent in patients with Mel than in normal controls, but did not predict who would develop .AD. Our entry criteria excluded anyone with active major depression leading to a tmncated range of HA.M-D scores. Since depression and anxiety are often co-morbid, we likely had a sample with reduced expression of anxiety even though anxiety was not excluded. Our study included a large group of well-characterized patients with MCI and a smaller normal comparison group. .Although depression and anxiety are common in patients with ~fCI, our study, which excluded major depression, did not find mood and anxiety symptoms to predict .t\D during follow-up.

=

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2008 AAGP Annual Meeting Poster Number: 51 Cholinesterase Inhibitor Discontinuation is Associated with Behavioral Changes in Nursing Facility Residents Lori A. Daiello 1, Brian R. Ott2, Kate L. Lapane3, Steve E. Reinettl,]ason T. Machan5, David D. Dore 6t t RI Hospital Alzheimer's Disease and MemolY Disorders Center, Warren Alpert School of Medicine at Brown University, Providence, RI 2 RI Hospital Alzheimer's Disease and MemoJY Disorders Center, Warren Alpert School of Medicine at Brown University Providence, RI 3 Brown University, Department of Public Health, Providence, RI .. Rhode Island Hospital, Providence, RI S Rhode Island Hospital, Providence, RI 6 Brown Medical School, Center for Gerontology and Health Care Research, Providence, RI

Abstract: Background: Discontinuation of stable cholinestemse inhibitor (eHEI) therapy is controversial and the outcomes have not been previously studied in skilled nursing facility settings. Placebo-controlled trials of CHEI treatment in Alzheimer's disease (AD) have reported modest cognitive and functional benefits; however, the effect of this class on neuropsychiatric symptoms is ofinterest in long term care settings due to the high prevalence of dementia and psychoactive medication utilization. Behavioral exacerbation post-eHEI discontinuation has been reported from a controlled trial ofdonepezil in community dwelling patients with AD. The behavioral changes that may be associated with CHEI discontinuation in frail populations with more severe dementia are unknown. Objectives: To investigate the behavioral or mood effects of discontinuing CHEI therapy in nursing facility residents with dementia compared to residents who continued CHEI. Methods: We conducted a retrospective cohort study of nursing facility residents enrolled in the Rhode Island Medicaid program that were prescribed CHEI therapy between January 1 2004 and December 31 2005. Prescription and patient level data was extracted from the RI Medicaid prescription claims database and the Minimum Data Set (MDS). Residents ?60 years with a diagnosis ofAD or other dementia who had received at least 3 months of CHEI therapy within the effective dose range (donepezilS-10mg/d; rivastigmine 6-12mg/d; galantamine 16-24mg/d) for? 275 days were identified (N=2157). The discontinuation cohort (CHEI..Dq received ?275 days of CHEI therapy, had at least one MDS assessment within the first 90 days ofCHEI therapy, and?2 ~IDS assessments up to180 days post-CHEI discontinuation (N;62). Each discontinuer was matched with at least one resident prescribed> 275 days of CHEI thempy (CHEI-CONl), had at least one documented MDS assessment within the first 90 days of CHEI therapy, and ?2 l\IDS assessments during eHEI treatment (0= 116). The primary outcomes were the change in the Aggressive Behavior Scale (ABS) score and the Depression Rating Scale (DRS). Results: Behavioral worsening, indicated by an increase in the mean ABS score (sum of physical abuse, inappropriate social behavior, verbal abuse, and resistance to care MDS items) over time occurred in the eHEI-DC group (p=.03), but not in the CHEI-CONT group and the between group change was significant (p=.03). There were no significant between group differences on the mean change in mood symptoms on the DRS, however, both groups improved slighdy over the observation period. Conclusions: This is the first exploration of behavioral and mood outcomes associated with eIfEl discontinuation in a nursing facility population. The retrospective database analysis suggests that compared with longer duration afCHEI therapy, discontinuation ofCHEIs after 3-9 months of treabnent in residents with dementia is associated with adverse behavioral changes. This research was funded by: NIH Grant # 5 1'32 AG020498-03 through Brown University Medical School.

Poster Number: 52 The Cost-Effectiveness of Olanzapine Treatment for Agitation and Psychosis in Alzheimer's Disease Stephanie E.Kirbach t , Kit N. Simpson2, Paul]. Nietert3,]acobo E. Mintzer Medical University of South Carolina, North Charleston, SC Medical University of South Carolina, Charleston, SC 3 Medical University of South Carolina, Charleston, SC .. Medical University of South Carolina, Charleston, SC I

2

Abstract: Background: Typical anti..psychotics have long been used to treat agitation and psychosis related to Alzheimer's disease (AD), but in a limited fashion due to troubling side effects. The new atypical anti-psychotics are effective and cause fewer side effects than firstgeneration drugs!ll but are currendy not FDA approved for use among the elderly demented because of a slight increase in death and serious cardiovascular events. However, a favorable side effect profile has led many physicians to prescribe these drugs as first line

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2008 AAGP Annual Meeting thempy for behaviotally disturbed AD patients. Clinical trials to evaluate the use of atypical anti-psychotics have produced varying results, and clarity has not yet been achieved. Thus, a quantitative sunmw:y of the risks and benefits may help inform complex decisions that must be made in this area. Objective: To compare the expected costs and outcomes for a community-dwelling cohort of patients with AD with agitation and/or hallucinations who are: 1) untreated; 2) treated with olanzapine; or 3) treated with haloperidol Methods: We constructed a Markov state-transition model using the best published data from several sources for AD patient progression and treatment. This model allows us to compare the expected costs and outcomes associated with olanzapine treatment, compared to haloperidol or no tteatment,for a synthetic cohort ofUS adults age 65 and older. The model cycles every six months, and continues until all patients die from AD progression or &om comorbid conditions. Outcome estimates included the inclemental cost-effectiveness ratio (ICER) and cost per quality-adjusted life year (QALY) gained The lobustness of the estimates was examined by sensitivity analyses of key parameters, including cost of care, olanzapine effectiveness, and ~-\D progression rates. Results: indicated that olanzapine was a cost-effective treatment for agitation and psychosis related to ~O\D when compared to no treatment (leER < $50,000). Howev~ when compared to haloperidol, the resultant leERs indicated that olanzapine may not be cost-effective (leERs >$50,000). CODclusioo: Treatment for behavioral problems is cost effective, but the leER is sensitive to drug cost. Further analysis should be perfonned as atypical anti-psychotics become generic and more infonnation on health utilities in the ~\D population becomes available. Poster Number: 53

Safety and Efficacy of Electroconvulsive Therapy (EC1) for the Treatment ofAgitation and Other Behavioral CompHcatioDs of Dementia Ujkajl, Brent P. Forester, Stephen). Seiner3, David Harper4, DonaldA. Davidof.P,James ~1 Ellison6

~fanjola

1 lvlcLean 2

Hospital- Harvard Medical Schoo~

Belmont, MA

McLean Hospital- Harvard Medical School, Belmont, ~\

l McLean Hospital - Harvard ~Iedical School, Behnont, l\.1A .. McLean Hospital - Harvard Medical School, Behnont, ~lA 5 McLean Hospital- Harvard Medical Schoo~ Belmont, MA 6 McLean Hospital - Harvard Medical School, Belmont, Mi\

Abstract: Background: i\gitation, one of the most &equent and dismptive behavioral complications of dementia impacts adversely both patient healing process and caregivers. Treatment options for agitation in dementia are currendy limited.. Clinical experience has indicated a potential role for Ref for the treatment of agitation in dementia patients but EeT's efficacy in this role has Dot been systematically explored. Objective: To evaluate retrospectively the efficacy and tolerability ofECf treatment for agitation in dementia patients. Methods: ~\ systematic chart review was conducted of aD patients admitted to the Geriatric Neuropsycbiatty Unit of McLean Hospital between 2004 and 2007. Patients with a diagnosis of Dementia (DSM-IV) treated with Ecr for agitation were identified and their charts independendy rated by 3 clinicians on the Pittsburgh i\gitation Scale (PAS) and the Clinical Global Impression (CGI) Scale before and after BeT. The Global Assessment Scale (G.i\F) score at admission and discharge, and other clinical and demographic data also were collected from the charts. Results: 16 patients were identified (15 women, 1 man; mean age 66.6 [5D=8.3] years). Eight patients (50%) suffered from Alzheimers disease and the other 50% from vascular dementia, frontotemporal dementia or dementia NOS (mean age of dementia ooset, 60.. 7 [80=8.3] years, and mean duration of dementia, 4.5 [5D=3.9] years). l\lean length of stay was 59.7 (5D=39.7; range 27-185) days and mean length of stay before starting ECT was 23.9 (5D=15.7; range 8-69) days. Patients Ieceived a mean of total BCf treatments of 9.2 (5D=3.3; range 2-15), two patients (12.50/0) received only unilateral treatments, nine (56.3%) only bilateral treatments, and five (31.3%) mixed treatments. Only one (6%) out of 11 patients (69%) who developed temporuy post-Ecr confusion discontinued ECf after the second treatment. Fourteen patients (880/0) showed significant reduced measures of agitation. One (6%) patient showed no improvement and one patient (6%) showed a worsening of agitation. Highly significant in between subjects changes in mean total PAS scores and subscores were observed from before to after RCT: Pi\S total 11.0 vs. 3.9 (p<.OOO); abermnt vocalizations 2.6 vs. 0.9 (p<.()()(); motor agitation 3.5 vs. 1.4 (p<.OOO); aggressiveness 2.3 vs. 0.6 (p<.OOl); resisting cue 2.6 vs. 1.0 (p<.OOO). Changes in CGI and GAF were also significant after Eef: CGI 6.0 vs. 2.1 (p<.OOO) and G~\F 23.0 vs. 27 (p<.032). There wete statistically significant reductions in rates of irritability, depressive and anxiety symptoms (Fisher's exact test respectively p<.OOl; p<.007; p<.037). Finally rates of delusions and hallucinations were reduced after ECf, but only the former one was statistically significant (p<.037). Conclusions: These results suggest that ECf may be an effective and safe treatment for agitation in dementia, leading to improvements in both behavioral and mood. symptoms.. Poster Number: 54

The Effect of Polypharmacy on Length-of-Stay in a Geropsychiauy Inpatient Unit Rebecca W. jones1,judith Wtlson2, Daniel C. Dahl3

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2008 AAGP Annual Meeting University of Alabama at Binningham, Birmingham, .AL of Alabama at Birmingham, Birmingham, AL 3 University of .Alabama at Binningham , Binningham, AL I

2 University

Abstract: Introduction: The elderly population in the United States is growing faster than any other age group. Many elderly patients have chronic illnesses for which multiple medications are prescribed. PolyphaDnacy has been defined as the use of multiple medications by a single patient or the use of multiple medications which are oot indicated. Polypharmacy has been shown to contribute to adverse drug effects and increased health care costs. In 2003, the prevalence of polyphaDnacy in the elderly was estimated to be 70/0. In the past, polypharmacy has been shown to be a predictor of hospitalization, nursing home placement, dea~ hypoglycemia, fractures, impaired mobility, pneumonia, and malnutrition. Methods: Data were collected from a chart review of the most recent discharges from the University ofi\labama at Birmingham Geriatric Psychiatric Inpatient Unit Institutional Review Board approval was obtained The most recent discharges were identifi~ and discharge summaries were located. All patients were included in the study except the following: patients younger than age 65, patients who were involuntarily admitted to the inpatient unit, patients who left against medical advice, patients with incomplete discharge summaries, patients who were transferred from an inpatient medical or surgical service, and patients who were transferred to an inpatient medical or surgical service. Data was entered into a database and analyzed using SPSS 12.0.1 for Wmdows. A one-way ANOV.~ was used to determine significance. For the purpose ofthis study, polyphaDnacy was defined as patients receiving greater than 10 medications. Psychiatric polyphaDnacy was defined as patients receiving greater than 2 psychotropic medications. Results: 198 charts were reviewed. 100 charts that met criteria listed above were entered into the database. Our patient population had a mean age of 77.75 (SD 7.78) with a range of 65 to 95 years of age. 69% of the patients in this study were female (n=69), and 31% were male (n=31). 780/0 of patients were Caucasian (n=78), and 22% were ",~frican-American (n=22). The mean length-oC-stay was 19.62 days (SD 11.5). Mean total number of medications was 10.76 (SD 3.57). Mean number of psychiatric medications was 3.41 (SD 1.21), and the mean number of non-psychiatric medications was 7.35 (SD 3.56). Two patients wete removed from the statistical analysis due to extreme data variables. Polyphannacy was significandy associated with increased length-of-stay (p=O.03t, F[t,96]=4.St). Psychotropic polyphannacy showed a trend toward increased length-of-stay, but this number was not statistically significant (p=0.95, F[1,96]=2.84) Conclusion: Polyphannacy in the geriatric inpatient population sigoificandy increases length-of-stay.

Poster Number: 55 Development of Risk Models for Psychotropic Medication Use in VA Nursing Homes Adam D. Hennan l, Patricia 1<. Panne1ee2, ~lary E. Kelley3, Dan R. Berlowitz4, Christine LJasiens \'JUde, Department of \'eteran Mfairs, Decatur, GA V~C, Department of \'eteran Affairs, Decatur, Gi\ 3 Emory University, Rollins School of Public Health, Atlanta, GA .. Bedford Vi\M:C, Department of Veteran Affairs, Bedford, ~lA 5 Atlanta V~IC, Department of" eteran Affairs, Decatur, GA 1 Atlanta

2 i\danta

Abstract: Rigorous measurement is central to quality improvement. There now exist standard quality indicators (QIs), based on the Minimum Data Set (MDS), to evaluate quality of psychiatric care in nursing homes (NHs). Risk models have been developed for I\ledicare- and ~fedicaid-supported NHs to control for resident characteristics that may confound interpretation of l'dDS-based QIs. However, these adjustments may not be appropriate across all settings. In particular, residents of Department of Vetemns Affairs (\'A) nursing home care units (NHCUs) differ substantially from non-VA NH populations. This project therefore developed statistical risk adjusbnent strategies for two QIs tapping psychotropic (antipsychotic and anxiolytic) medication use in VA NHCUs. In addition to captwiog differences between VA and non-VA sites, we sought to establish how use of population-appropriate risk adjustment sttategies affects MDS-based indicators of quality of psychiatric care. Methods: Modd derivation was based on Bedowitz's (1999) method, using a full year's 1MDS data for all VA NHCUs nationwide. Literature review and expert panel input identified MDS variables likely to be associated with use ofeach medication. From this poo~ variables with significant univariate associations were enteted into separate multivariate logistic [egression models for antipsychotics and anxiolytics. Results were then calibrated for prevalence and consistency of response patterns to yield a final predictive model. A second years' data were used to valid2te the derived model by applying estimates from the calibrated model to the new dataset and calculating area under the ROC ClttVe (C statistic). Raw and adjusted Qls were computed based on the derived VA-specific model as well as risk models currendy used in non-\'A NHs. Results: VA-specific risk models for both antipsychotics and anxiolytics yielded logical association with outcomes of interest The two models included some common predictors (e.g., age, cognitive function, documented neurological diagnoses), but differed substantially from each other and from non-VA models. i\pplication of VA...specific models yielded marked differences in QI scores vis-i-vis current non-Vi\. models. Conclusion: Marked differences in case mix across NHCUs recommend

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2008 AAGP Annual Meeting risk adjusting 1\.IDS-based QIs to ensure that they accurately depict care processes. However, use of "generic)' (non-V~\) risk models may yield inappropriate conclusions about quality of psychiatric care in VA NHCUs. Validation of VA-specific risk-adjusted QIs. as well as development of appropriate models for other outcomes, is a priority for evaluating quality of mental health care for frail elderly veterans. This research was funded by: Department ofVeteraos .Affain Health Services Reseuch & Development Service Grant IIR03-241 to Patricia ",b... Pamtelee, PhD Poster Number: 56 Do Antipsychotics Modify the Risk for Alzheimer's Disease in Schizophrenia? Ioana-Mhaela Popescu., Thomas E. Nordahl2~ Muy Wieneke, Greer 1\1. Murphy4

UCSF, Department of Psychiatry, Langley Porter Psychiatric Institute, San Francisco, CA UC Davis, Department ofPsychiatty, Sacramento, CA 3 i\ntioch University Seattle. Seattle, WA .. Stanford University School of ~Iedicine, Department of Psychiatry, Stanford, CA I

2

Abstract: Background: Several studies have reported an increased frequency ofAlzheimer's disease (.i\D) in elderly schizophrenics, and it has been hypothesized that medications used to treat schizophrenia may exacerbate AD histopathology. We tested the hypothesis that extended treatment with antipsychotics might decrease the risk for developing i\D lesions among patients with schizophrenia. Methods: Post-mortem tissue was obtained from 53 patients who had been treated at Napa State Hospital and Palo Alto V.AMC. .All subjects had complete gross and microscopic neuropathologic evaluations, which were reviewed for evidence ofAD. The total amount of antipsychotic drug, in chIotpromazine equivalents, was calculated, for every patient. Multilinear regression analysis was perfonned examining the relationship between age, total antipsychotic exposure, and the total number of AD lesions (the sum of plaques and neuro6brillaty tangles), separately for the 39 male and 14 female subjects (71.4 +/- 8.9 year-old).. Results: We found that the multilinear regression analysis was significant for male subjects (F2,36= 12.349, p
Poster Number: 57 Atypical Antipsychotics and Metabolic Changes in Older Adults in Primaq Care Clinic Shilpa Srinivasan1, Victor Hirth2, Rebecca H. Boland3, Mridul Mazumdert, Meera Narasimhans, Richard Harding6 University of South Carolina School of Medicine, Columbia, SC University of South Carolina School of Medicine, Columbia, SC 3 Palmetto Health, Columbia, SC .. University of South Carolina School of ~fedicine, Columbia, SC 5 UDiversity of South Carolina School of Medicine, Columb~ SC 6 Uni.versity of South Carolina School of Medicine, Columbia, SC t

2

Abstract:

Objective: To investigate atypical antipsychotic use and metabolic syndrome parameter changes in elderly patients in a primary care setting. Method: A retrospective electronic record review of Senior Primuy Care patients age 60+, receiving atypical antipsychotics between 2005 and 2007 was conducted. Data was de-identified in compliance with HIPPA and Palmetto IRB guidelines. Demographics, diagnosis, premorbid and new-onset metabolic changes, atypical antipsychotic prescriptions, weight/BMI, and lab data were gathered. Results: • 77 patients received atypical antipsychotics; 75.3% (n=58) for >6 months. Average treatment duration was 366 days.· Demographic distribution: 026% male, 740/0 female 0 87% White~ 130/0 Black 0 Mean age- 81.04 years· Quetiapine was most commonly prescribed (63.6%) followed by Rispetidone (23..4°/0), Aripiprazole (11.7°/0), Olanzapine (1.3%). No patients received Clozapine Ziprasidone ot Olanzapine-Fluoxetine. • Most commooly associated psychiattic diagnosis was depression (41.60/0) followed by dementia (33.8°/0) and psychosis (29.90/0). • In 2005, 20.8010 of the sample bad hypertension, 14.3°/0 had t

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2008 AAGP Annual Meeting hyperlipidemia, 50/0 had diabetes mellitus, 4% had cerebrovascular disease. • There wes:e no statistically significant diffetences in weight change, glucose or BMI based on duration of treatment • However among patients receiving Quetiapine vs. Risperidone, i\ripiprazole or Olanzapine, for >6 months, Quetiapine users lost weight (average 2.221bs.) while Risperidone, Aripiprazole, Olanzapine users gained weight (average 6.71lbs.), p=O.OO4. • Lack of available data precluded lipid profile change analysis. • There was no correlation between baseline BMI and weight change in the total sample. • Patients receiving quetiapine bad a non-statistically significant decrease in systolic blood pressure (average - t O.4mmHg). Conclusions: Preliminary results from this study indicate weight changes based on dumtion and type of atypical antipsychotic used in older adults.. Our s:esearch is on-going with larget sample sizes to p[ovide more insights into this finding. Poster Number: 58 Antipsychotic Use in Veterans with Parkinson's Disease: Analysis of a National Sample Peijun Chen l , Daniel Weintmub2, Rosalinda V.. Igoaci03, Helen C. Kales" Psychiatric Service, Oeve1and VAMC, Department o£Psychiatty, Case Westem Reserve University, Oeveland, OH Department of Psychiatry and Neurology, Philadelphia \'AMC) University of Pennsylvania, Philadelphia, PA 3 SMITREC, Ann ~l\rbor VAM:C, ~~ Athor, 1\fi 4 Department of Psychiatry, Ann Arbor "AMC, University of Mchigan, ..'\.nn i\.rbor, MI I

2

Abstract: Objective: Psychosis occurs in 2Q-4()O/0 of Parkinson's disease (PO) patients, often in the context of cognitive impairment little is known about pattems of antipsychotic (AP) use in this populatio~ which is complicated by its potential to wonen parkinso~ general side effect profile, association with increased morbidity and mortality in patients with dementia, and limited evidence for efficacy. We report 00 frequency and chataeteristics of AP use in veterans with PD. Methods: Using fiscal year 2002 national Veterans Affairs (VA) data, frequencies of ovemll and specific .AP prescribing were determined for; (1) PD patients with psychosis stratified by presence of dementia, and (2) patients with psychosis and dementia stratified by the presence of PD. ~fultiple logistic regression models were used to examine the impact of dementia, PD,l and demographic variables on AP use. Results: Fifty-seven percent of PD patients with psychosis were prescribed an AP with use more common in those who were younge~ whit~ and nonmarried. Typical.APs (usually high potency) were prescribed in 19.1 % of treated patients. Quetiapine (39.2»;0) olanzapioe (39.1 0/0) and risperidone (32.4%) were the most commonly prescribed antipsychotics, while clozapine (1.80/0) was ruely prescribed Overall.i\P prescribing did not differ between psychotic PD patients with and without dementia (57.6% vs 56.90/0, P=O.62)~ but quetiapine was prescribed more commonly in patients with dementia (27.20/0 vs 20.40/0 P
Westem Psychiatric Institute & Clinic, University of Pittsburgh School ofI\£edicine, Pittsbwgh, PA & Biostatistics, University of Pittsburgh School of Medicine, Pittsburgh, PA 3 Department of Psychiatty) University of Pittsburgh School of Medicine, Pittsburgh, PA ol Department of Phannacy & Therapeutics, University of Pittsburgh School of Phannacy, Pittsburgh, PA 5 Departments ofPsycbiatty, Neurology, & Epidemiology, University of Pittsburgh, Pittsburgh, P.A I

2 Department of Medicine

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Abstract:

Objectives: To identify predictors of sustained benzodiazepines use in older adults. Design: Prospective epidemiologic study. Setting: Community-based cohort in rural southwestem Pennsylvania. Participants: 1,342 individuals aged 65+ years followed for up to 12 years. Measurements: Demographics, medication use, depressive symptoms, sleep complaints, alcohol use, and smoking, at baseline and biennial fonow-up. Cross-sectional analysis was perfonned to identify factors associated with baseline and sustained benzodiazepine use. Lag-time analysis was used to detennioe characteristics that predicted sustained use. Results: At baseline, benzodiazepine users were more likely to be women, better educated, have at least five depressive symptoms, use more prescription medications, have lower self-rated health, have more difficulty maintaining sleep, and less likely to consume alcohol. Multivariable lag-time analysis showed that being female, using two or more prescription medications, and smoking were independendy associated with sustained benzodiazepine use. Conclusion: i\t the population level, women, smoken, and users of at least two prescription drugs have elevated probabilities of sustained benzodiazepine use once started. This information may help in assessment and counseling of older adults when prescribing benzodiazepines. Poster Number: 60

Sleep Disturbance and Alzheimer's Disease Zahinoor Ismail l , Nathan Henmann2, Philip Francis3, Lana Rothenbw:g4, Nancy Lobaugh5, Farrell Leibovitch6, Sanma Black7, Krista Lanctot! University of Toronto, Toronto, ON University of Toronto, Toronto, ON 3Uoiversity ofToronto, Toronto, ON .. University ofTorooto, Toronto, ON 5 University ofTofonto, Toronto, ON 6 University ofToronto, Toronto, ON 7 University of Toronto, Toronto, ON 8 University of Toronto, Toronto, ON t

2

Abstract: Purpose: In addition to the cognitive deficits in Alzheimer's Disease (.i\D), non-cogoitive behavioural and psychological symptoms of dementia (BPSD) are Also implicated in morbidity and functional decline. One of these BPSD domains is sleep. Studies have shown that many patients with AD have sleep disturbance but the mechanism is unclear. lbis study aimed to investigate the possible association of regional cerebral perfusion and sleep loss in AD. Methods: 55 patients (21 male, 34 female; mean ± SD age 73.2 ± 7.7) with probable AD or mixed dementia (NINCDS-i\DRDA criteria; mean ± SD MlvfSE 21.8 ± 5.5) were characterized as with (0=38, SL) or without (n=17 ~ NSL) nocturnal sleep loss based on a Neuropsychiatric Inventory (NPI) Sleep sub..scale score of 1 or greater and a Comell Depression Scale night time behaviour disturbance sub-scale score of 1 or greater. 99mTc..ECD single photon emission computer tomography (SPEC!) scans were perfonned and nonnalized to a standard SPECT template in !\£NI space. Images were scaled using the cerebellum mean voxe1 value. Whole-brain analysis using Statistical Parametrica1 Mapping version 5 (SPMS) was perfonned to compare perfusion across groups. Results: SPM analysis showed relative hyperpedusion in the right middle &ontal gyrus (R-~IFG~ BA 9~ p=O.016 [FWE-correeted]) in subjects with sleep loss versus those without. Conclusions: The right middle frontal gyrus may have a role in regulating sleep in this sample of patients with .i\D. Poster Number: 61 Meta-Analysis of Cerebrospinal Fluid Levels of Beta-Amyloid, Total Tau, and p-Tau in Patients with Mild Cognitive

Impairment

Benalfew Legesset , Cristian Sirbu2,James P. Griffith3

Department of Bebavioral ~1edicine and Psychiatry, West Vtrgioia University Charleston Divisioo, Charleston, W\' Charleston .Area Medical Center Health Education and Research Institute, Charleston, WV 3 Department of Behavioral rvledicine and Psychiatry, West V uginia University Cbadeston Division~ Charleston, WV t

2

Abstract: ~fild cognitive impairment ~fCI) is considered a tmnsitional state between notmal aging and dementia. Its relevance for an early diagnosis of dementia and the difficulty of characterizing ~fCI, support the recent efforts of identifying biological changes associated with this condition. Several studies have looked at cerebrospinal fluid (CSF) levels of beta-amyloid, total tau and phosphorylated tau (p-tau) proteins as biomarkers of Mel, however these results have not been summarized. Based on this assumption, we conducted a meta-analysis of studies comparing patients with Mel and controls for these biomarkers.•4. total of nine studies investigated CSF beta-amyloid, aD indicating a decreased level in Mel subjects compared to controls. A statistically significant difference was found in six of these studies. The overall effect size of the difference between Mel and controls was 1.15 (950/0

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2008 AAGP Annual Meeting confidence interval 0.97-1.33). Out of seven studies investigating the CSF total tau levels, six found a statistically significant increase in Mel subjects compared to controls. The effect size of the difference was 1.11 (95% CI 0.86-1.86). Six studies looking at CSF ptau found a statistically significant increase in levels in Mel subjects compared to controls. The effect size of this difference was 1..29 (95% CI 1.00-1.52). The results of the meta-analysis suggest a significant decrement in the CSF levels of beta-amyloid. and increment in total tau and p-tau in patients with Mel compared to controls. A careful standardization of the assays for these biomarkers will add an important clinical tool for the evaluation of patients with cognitive impairment. Poster Number: 62 Atrophic Changes in Patients with Comorbid Alzheimer's Disease and Major Depressive Disorder Julie ~-\. Kmiec l ,James T. Becker2, MetylA. Butters3, Nancy J. Lobaugh", Howard). Aizenstein5 Psychiatric Institute and CliniC,. University of Pittsburgh Medical Center,. Pittsburgh, PA Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 3 Westem Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA .. Sunnybrook Health Sciences Centre, Toronto, ON 5Western Psychiatric Institute and Clinic, University of Pittsburgh Medical CenteI, Pittsburgh, PA 1 Westem

2 Western

Abstract: Background: Structuml magnetic resonance imaging (MR1) studies have shown changes in brain structure in both ~o\Izheimer's Disease (AD) and ~1ajor Depressive Disorder ~IDD) . Some of the regions affected in these illnesses are shared. There is a high frequency of ZvIDD in AD,. most commonly in the mild and moderate stages of severity. The purpose of this study was to determine the locus and extent of differences in brain structure in .i\D patients as a function of the presence or absence of concomitant I\fi)D. Methods: Thirty-six patients diagnosed with probable AD and ~IDD were matched with 36 AD patients without depression. Each underwent a detailed neurobehavioml exam and an anatomical ~m.I scan. The MRI data were analyzed using standard procedures fOJ: modulated Voxel-Based Morphometry in SPM2. Following the identification of the specific areas of regional atrophy, volumes were extracted at the cluster level within the regions identified for between group comparisons.. Resuks: Patients with AD and lvIDD bad significant atrophy in the subgenual cingulate gyms, precuneus, and bilateral superior frontal gyri relative to patients with AD alone. Conversely, nondepressed AD patients did not have any areas of greater atrophy when compared to the AD patients with 1vIDD.. Conclusions: The co-occurrence of l\IDD in the context of.AD is reflected in the added atrophy in brain regions known to be affected in depression. Individuals who develop depression in the context of AD have brain structural changes that likely are risk factors for depression, and not a consequence of the depression. Longitudinal MRI studies are needed to develop an understanding of the relationship between :MOD and AD. This research was funded by: PSG AGOO5133,. ROt MH072947

Poster Number: 63 Laboratory Assays of Plasma Amyloid-Beta Olivia I. Okereke1, Francine Grodstein2 1 2

Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Bosto~

MA

Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA

Abstract: Background: Alzheimer Disease (AD) may take years,. if not decades, to develop. ThuS,. biomarkers that can predict i\D risk prior to clioica1 onset will both enhance early intervention and help investigators to identify preventive agents.. Plasma levels of amyloidbeta 140 (Abeta 40) and 1-42 (Abeta 42) species are examples of such candidate biomarkers. However, before any biomarker can be considered for widespread use, especially in large-scale studies of .AD p:a:evention, it is essential to investigate properties of its assay. Objectives: We conducted a study of plasma Abeta 40 and J.-\beta 42 assays in order to adcb:ess the following questions: Are assay results readily reproducible within laboratories? Ate assays equally effective across varying collection conditions (e.g., heparin versus EDTA for anti-coagulation)? What is the performance of the assays with respect to recovering amounts of known concentrations? Methods: Five major U.S. laboratories involved in research on plasma Abeta. were selected to participate.. The following 31 blinded samples were distributed across the 5 labs: 5 duplicate pairs of plasma samples, collected in EDT~\ tubes; 5 duplicate pairs of the same plasma samples, collected in heparin tubes; 3 replicates of pooled quality control plasma; 5 replicates of a second type of pooled quality control plasma; 3 specimens used to assess percent recovery of known concentrations in spiked plasma: 1) A background plasma sample (i.e.., blank. condition) 2) The plasma sample spiked with 400 pg/mL of Abeta 40 3) The plasma sample spiked with 400 pg/mL of Abeta 42. Results: ~redian intra-assay coefficients of variation (CVs) for all 5 laboratories ranged from 6240/0 for ~o\beta40, and 7-140/0 for Abeta42 Mean absolute values of plasma J.\beta species varied across the labs. However, within

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2008 AAGP Annual Meeting each laboratory, there were no differences in either mean Aheta concentrations or CVs by collection method (i.e., EDTA vs. heparin anticoagulant). Laboratoxy perfonnance in recovering expected concentmtions of Aheta species was modest, with only one lab recovering> 500/0 of expected Abeta 42. Conclusions: The 5 labs generally produced average CVs that were in the good-to-exce1leot range, demonstrating adequate within-lab reproducibility. Our results showed that, within each lab, there were no systematic differences in mean values of blinded identical samples collected in heparin vs. ROTA containers. Furthermore, the labs measured Abeta species equally well with either collection method, as reflected by CVs. The labs perfonned only moderately well in recovering the expected concentration of Aheta 40 and 42 in samples that had been spiked with a known amount of each. "aluable future studies might include assessment of the impact of post-collection sample ptocessing times or of long-term. sample frozen stonage on plasma Abeta 40 and 42 assays. This research was funded by: NIH AG24215 and ROt minority supplement to AG24215 Poster Numbet: 64

Dietary Glycemic Index and Brain Lesion Volume in the Elderly Martha E.Payne 1, Ken G. Weaver, David C. Steffens), Ronald]. Trone4 1 Duke

2

University, Durham, NC

Campbell University, Durham, NC

3 Duke

University" Durb~

NC

.. Campbell University, Durham, NC Abstract:

Background: Btain lesions commonly seen on magnetic resonance images ~fRl) of the elderly reptesent damage to gray and white matter and have been shown to be deleterious by causing impaired cognition, gait, and balance. Brain lesions may be an indicator or contributor to late life depression as described by the vascular depression hypothesis. There is evidence that serum glucose levels may be related to the occurrence of brain lesions due to ischemic damage to the brain. The objective of this cross sectional analysis was to determine if the volume of brain lesions was associated with dietary glycemic index and glycemic load in elderly individuals. Methods: Food intake was assessed in 137 subjects using the Block 1998 food frequency questionnaire. Daily values for glycemic index and glycemic load were calculated from the questionnaire. Brain lesion volumes were calculated from ~IRI. Subjects were 60 years of age or older. Results: Glycemic index and glycemic load were not associated with brain lesion volume in this subject sample. Both bivariate and multivariable analyses (controlling for potential confounders such as age, sex, hypertension, diabetes, and body mass index) found no significant associations. Discussion: No evidence was found for associations between dietary glycemic index Ot glycemic load and brain lesion volumes. Conclusions: Dietaty glycemic measures may be related to brain lesions only in subjects with poor glycemic control

This research was funded by: NThfrI grants: l"nl40159, MH54846, l\fii60451, and MH70027 Poster Number: 65

The Role of Low Testosterone Level in Older Men with Major Depression ]ennefer F. Wtlkinson l , Saima .Alam2, ~ L. Pratt), Christopher M Marano4, Wtlliam T. Regenold5, Tony PhiI1ips6, Zara Mehrabian7, Jian-I\4in ZbangS VAMC" Baltimore, MD University of Maryland Department of Psychiatry" Baltimore, MD 3 University of Maryland Department of Psychiatty, Baltimore, l\ID 4 University of1\.laryland Department of Psychiatry, Baltimore, MD 5 University of Maryland Department ofPsychiatty, Baltimore, MD 6 University of Muyland Department of Psychiatry, Baltimore, :MD 7 University of Maryland Department of Psychiatty, Baltimore, I\.fi) 8 University of~laryland Department ofPsychiatty, Baltimore, MD 1 Baltimore

2

Abstract: Blood levels of testosterone, a honnone which exerts important neurotrophic and neuroprotective effects on brain, decrease with age. Studies have been inconsistent in finding an association between low total testosterone levels and depression in elderly men. However, total testosterone level is not an accurate indicator of testosterone deficiency in elderly men, because the proportion of total testosterone that is protein-boW1~ and not able to bind androgen receptors, increases with aging. Therefore free testosterone level is a more accurate indicator of testosterone deficiency. The aim of this study was to determine whether testosterone deficiency, defined as free testosterone level lower than age-matched nonnal range, is more common in depressed

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2008 AAGP Annual Meeting elderly men compared to depressed younger men. Subjects were 19 men between the ages of 31 and 84 years who were treated at the University of Maryland Medical Center for Major Depressive Disorder (MOD). All subjects were diagnosed by structured interview according to DSMIV SCID research criteria. We divided subjects into two groups: over 60 (n=11) mean age=78) and under 50 (n=8, mean age=40). Mean ± SO Hamilton Depression (HAM-D) Rating Scale scores were 31.5 ± 3.3 for the older group and 24 ± 4.2 (ot the yotmger group (t=.3.53, df=12, p=O.OO4). Mean ± SD free testosterone levels were 0.35 ± 0.23 ng/dl for the older group and 1.26 ± 0.94 ng/dl for the younger group (t=3.25, df=17, p=O.005). The proportion of older men who had low free testosterone levels compared to their age-matched DOanal range (11/12) was significandy greater (Fishers exact test, p=O.038) than that of younger men (4/8). These preliminary data suggest that testosterone deficiency, indicated by lower than noanal age-matched free testosterone lev~ is significandy more common in men over 60 with MOD compared to younger men. However, given the significantly greater HAM-D scores of the older men, it is also possible that depression severity as well as age contributed to the difference between groups. A larger study, with well-matched groups is needed to conclusively determine the relative prevalence of testosterone deficiency in men with :MDD. Poster Number: 67 Depression Trajectories Predict Medical Burden Outcomes in Older Primary Care Patients Rebecca Drayu l , Xin Tu2, Wan Tang1, Xingjia Cui4,Jeffrey M LynessS 1 University

of Rochester School of lvledicine, Rocheste~ NY University of Rochester School of Medicine, Rochester, NY 3 University of Rochester School of h£edicine, Rochester, NY 4 Canandaigua VA Medical Center, Canandaigua, NY 5 University ofRochester School ofI\JIedicine, Rochester, NY 2

Abstract:

Background: Older adults in primary care frequently have depression in addition to multiple chronic medical conditions. Medical illness worsens the prognosis of depression, and vice versa. Furthermore, medical illness burden at one point in time can predict the subsequent trajectory of depression severity. Less is known., however, about whether the converse is true. Objective: We hypothesized that trajectories of depression severity would predict medical burden outcomes. Methods: In this 2-year observational study, 709 patieots over the age of 65 years were recmited &om intemal medicine and family practice offices in the Rochester area. Semi-structured research interviews were conducted at six-month intervals, and medical chart reviews were performed annually. Depression was assessed with the Structured Clinical Interview for DSM-IV (SeID). Weekly changes in depression severity were measured with the Longitudinal Interval Follow-up Evaluation (LIFE). The Cumulative Illness Rating Scale (CIRS) was used to quantify overall medical burden. Depression trajectories were calculated using cluster analysis, and generalized linear modeling was used to determine predictors of medical burden outcome. Results: 327 patients who completed follow-up assessments yielded six distinct trajectories of depression severity over time. Patients whose depression worsened had poorer outcomes of their general medical conditions, even after controlling for age, gender, baseline medical burden, history of depression, and antidepressant use. Conclusions: Depression trajectories predict medical burden outcomes. Further research is necessal:f to elucidate the mechanisms of this association. Elderly patients with worsening depression should be followed closely so that potential medical problems may be detected at an earlier stage. Poster Number: 68 Evaluation of Self-Awareness of Memory Impairment in the Community Elderly HongJinJeon1,Jee Hoon 501m2, Hyo Jung Lee3, Dong-Woo Lee4, Sung Man Chang\ Shinkyum KimG, You Ra Lee',Jun-Young Lees, ~eogJe Cho9 I

Seoul National University Hospital, Seoul, N / A

Seoul National University College of Medicine, Seoul, N/A 3 Seoul National University College of Medicine, Seoul, N / A 4 Inje University, College of Medicine, Seoul, N/ l\. 5 Kyungpook University, College of Medicine, Daegu, N/1\ 2

Seoul National University College of Medicine, Seo~ N/A Seoul National University College of Medicine, Seoul, NIA 8 Seoul National University College of Medicine, Seoul, N / A 9 Seoul National University College of Medicine, Seo~ N/A 10 Seoul National University College of Medicine, Seo~ N/A 6

7

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2008 AAGP Annual Meeting Abstract: Objectives: We aimed to evaluate discrepancies between self-awareness of memory impairment and actual memory functions in the community elderly. Methods: A total of 369 elderly aged over 65 years from four elderly community centers completed clinical evaluatio~ neuropsychological batteries of the Korean version of the Consortium to Establish a Registry for Alzheimer's disease (CERAD-K), Geriatric Depression Scale (GDS), Iostromental Activities of Daily Living (IADL), and the Hachinski Ischemic Score.. Results: .Among the community elderly, 26.30/0 showed incottect awareness for their memory impaiDnent The elderly with subjective memory complaints included 73.5°/0 of elderly with no memory impainnent, and the eldedy with no memory complaint included 11.3% of amnestic mild cognitive impainnent (~fCI) and 4..3% of Alzheimer's disease (AD). Subjective memory complaints were significantly associated with depression but neither AD nor aMCI. Incorrect awareness was significandy associated with 'no education year', and among the elderly with 00 memory complaint, it was associated with 'no education year and 'age over 80'. Incorrect awareness showed no association with 'gender', 'residence', and 'household income'. Conclusion: Incorrect awareness for memory impainnent is prevalent in the community elderly.. If we oo1y attend on eldedy with memory complaints, we might neglect many dderly with memory impainnent

This research was funded by: Fund of Korean Neuropsychiatric Association for Cultural Psychiaty (Donated by Se Jong Lee) Poster Number: 69

Correlation Between Ano8ognosia and Apathy in Older Adults with Abheimerts Disease

Mamta Sapra l ll Kye Kim2 t 2

University of Virginia (Roanoke-Salem) Program, Roanoke, VA Salem VA Medical Center, Salem, V..A..

Abstract: Introduction: There have been few studies examining insight in Alzheimers disease. Anosognosia, a major problem in the treatment and care of.Alzheimers disease has been linked to impairment in right parietal function and some studies have shown association with impainnent in prefrontal function. Among other symptoms associated with prefrontal cortex dysfunctio~ apathy is the most common neuropsychiatric symptom reported among individuals with . .l liheimers disease. Objectives: The present study bas following aims: 1.To examine the frequency of apathy and anosgonosia in mad to moderate stages of..Alzheimer's disease and their association with sociodemographic factors and severity of cognitive deficits and functioning level.. 2.To study caudation between apathy and anosognosia. Methods: The sample consisted of 40 subjects, from outpatient memory disorders clinic and dementia unit at Salem Veteran Affairs Medical center. Subjects fulfilled the criteria for c'probable AD" based on NINCDS-ADRD.A.. and were in mild to moderate stage of Alzheimer's disease ~UvfSE scores from t 0-24). Marin's Apathy evaluation scale to assess apathy and Anosognosia questionnaire-Dementia to assess insight was used. Functioning level and depression was assessed using Bartel index and geriatric depression scale which are routinely done in our memory disorders clioic. Statistical analysis was carried out using one way analysis of variance and also did frequency distribution using chi square. Results: Apathy was diagnosed in 30% of pts and anosognosia in 25% of patients with Alzheimer's disease.Pts with anosognosia had significandy lower MMSE scores (p=.02).Apathy in Alzheimer's disease was sigoificandy associated with severe impainnent in insight in cognitive deficits and behavioral changes and activities of daily living.Apathy scores correlated with discrepancy in Anosognosia Questionnaire -Dementia scores (p=.Ol).Patients with apathy had more cognitive deficits.. Discussion: Anosgonosia and apathy are significandy related to severity of cognitive deficits and are associated with more significant impainnent in activities of daily living.Patients with apathy have less awateness of their cognitive and behavioral deficits and apathy scores coaelated with anosognosia scores. Our findings suggest treatment available for apathy may help in improving insight of Alzheimers disease pts into their illness which would help them adapt change in lifestyle to cope with the illness and improve their functioning level and reduce caregiver burden. References: 1. R Migliorelii, A Teson, L Sabe, G Petracca, M Petracchi, R Leigwlrda, S E.Starkstein, Anosognosia in Alzheimer's disease: . -. \. study of associated factors, The Joumal of Neuropsychiatry and Clinical neurosciences 1995;7: 338-344. 2. S E.Starkstein, G Patri~ E Chemerinski, J kremer: Syncb:omic validity of Apathy in Alzheimer's disease, American joumal of psychiatry 2001; 158: 872-877. Poster Number: 70

Comparison Among Penonality Profiles in Patients with Al2heimer's Disease, Vascular Dementia and Traumatic Brain Injury Robert Haddix', Raymond K. DiPin02, Cristian Sirbu3, Vicki Smith-School" I West Virginia Universityll Cbadesto~

WV

Department of Behavioral ~fedicine and Psychiatry, West \'irginia School of Medicine Charleston Div., Charleston, WV 3 Charleston Area Medical Center Health Education and Research Institute, Charleston, WV .. Department ofBehavioral Medicine and Psychiatry, West Vtrginia Schhol of Medicine Charleston Div., Charleston, WV 2

ABO

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Abstract: A prominent and persistent disturbance in mood that is seen as the direct effect of a geneul medical condition constitutes the DS~[-I\r diagnosis of "Personality Change Due To a ~tedica1 Condition" (.LWA, 1994). Personality change is often noted in patients diagnosed with dementia and can be one of the more impairing featutes of the illness (.Aitken et al. 1999).It may affect between 660/0 (Rubin et at. 1987a) to 100% (Seltzer & Shetwin 1983) of patients and is often "negative", i.e., reflecting a decline in certain personality characteristics with common changes including apathy, iaitability, passivity, loss of energy, agitatio~ and selfcentered behavior (petry et aL 1988; Rubin et aL 1987a, 1987b; Seltzer & Shetwin 1983). Tests such as the Personality ~\ssessment Inventoty (pAl, ~[orey,199t) can be used to measure the degree of change in personality due to a medical condition (Demakis et aL 2007). The current study used the PAI to compare personality profiles among three different diagnostic groups: patients with Alzheimer's Dementia (AD, N=14, Mage=66, S.D.age=8.68), patients with Vascular Dementia (VaD, N=37, Mage=59.4, S.D.age=8), and patients who have sustained a Traumatic Brain Injury (fBi\, N=46, 1\hge=40.43, S.D.age=15.1). Comparing subsca1es mean T scores among the tlttee diagnostic groups through the use of MANCOVA (with age as a covariate) revealed no significant differences; Fprofile x diagnosis (20,,930)=O.753,p=.772. Cluster analysis indicated that 85.6% of AD, 86.4% ofVaD and 80.4% ofTBI patient's personality profiles fell into one of the fonowing four clusters: Ouster 1 (normal), Cluster 2 (depressed and withdrawn), Ouster 7 (depression, anxiety and agitation), and Cluster 8 (somatic concerns). Further research focused on commonalities and differences among these groups should be conducted in order to generate normative personality profiles for subgroups within these diagnostic groups. Poster Number: 71

One Year Experience of a Geriatric Psycho-Oncology Clinic - What are the Common Psychiatric Problems in Blderly Patients with Cancer? Yesne Alici-Evcimen1, Andrew Roth2, Chris Nelson3~Jimmie

HoDand4, Talia Weisss

University of Pennsylvania, Philadelphia, PA Center. New York. NY 3 ~femorial Sloan-Kettering Cancer Center, New York, NY .. Memorial Sloan-Kettering Cancer Center, New York, NY 5 ~femorial Sloan-Kettering Cancer Center, New York, NY I

2 Memorial Sloan-Kettering Cancer

Abstract: Purpose: Cancer is a disease of the aging with approximately 60% of all cancers and 70010 of cancel mortality occurring in people aged 65 years or older. Despite some progress in our knowledge of cancer in older people, there remains a scarcity of systematically studied data on the psychosocial impact of cancer and the prevalence of psychiatric disordea in the elderly. Elderly patients with cancer are at risk for underdetection and undertreatment of their psychiatric diagnosis as a result of decreased self-report, cognitive deficits, co-morbidities, poor access to mental health care, and differences in phenomenology. The aim of this study is to ascertain the distribution of psychiatric diagnoses and treatment in patients 65 and older with a wide variety of cancer types and severity refened to Memorial Sloan-Kettering Cancer Cente~ Psychiatry Outpatient Clinic. Methods: We received approval from our Internal Review Board to review all new patients 65 and older tre2ted at the outpatient psychiatry clinic by psychiatrists and psychologists between July 1st 2005 andJune 30th 2006. We undertook a retrospective review from medical records of the reasons for psychiatric refeaal, cancer histolJ, current and past psychiatric diagnoses, and duration of psychiatric treatment Results-: 323 elderly cancer patients were seen during the one year study period. Mean age was 72±6 (range 65 to 94) with nearly equal numbers of male and female. 87% of patients were referred by their oncologist and only 8.7% of patients were self-referred. The most common type of cancer was prostate (26%)~ followed by breast (150/0) and lung (9.6%). 44% of cancer patients had localized, 33% had advanced canc~; about 200/0 of patients had no evidence of cancer at the time of referral Most common reason for refeaal was depression (41%), followed by sexual problems (150/0), anxiety (120/0), and difficulty coping (120/0). Psychiatric diagnoses were as follows: 47% adjustment disorder, t 70/0 mood disorder due to general medical condition (Gl\lq with depressive features, 1DOlo major depressive disorder, and 7% anxiety disorder. 100/0 of patients had some degree of cognitive impairment including patients with a history of dementia (1.90/0), mild cognitive impairment and newly diagnosed dementia due to GMC. 70% of patients with a diagnosis of major depressive disorder had a histoEY of depression. 56% of patients had no past psychiatry history prior to cancer diagnosis. The mean number of medical co-morbidities - other than cancer - were 2.7 (0-8). Conclusion: This review highlights the importance of psychosocial care of elderly cancer patients and sheds light to the wide mnge of psychiatric diagnoses. Geriatric psychiatrists should become more familiar with the assessment and management of psychiatric conditions commonly encountered in elderly patients with cancer, given increased lifespan and improved treatment options for different cancer types. Poster Number: 72

Cognitive Impairment and its Correlates in Seniors Receiving Case Management &om an Aging Services Agency Lisa L.Boy1e1, Thomas M. Ricbardson2, Xin Tul , Yeates Conwell"

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2008 AAGP Annual Meeting University of Rochester Medical Center, Rochester, NY University of Rochester Medical Center, Rochester, NY 3 University of Rochester Medical Center, Rochester, NY "University of Rochester ?vledical Center, Rochester, NY I

2

Abstract: Because the aging services network has expertise necessuy for maintaining seniors' independence and functioning in the community, it represents one potential component of a model for comprehensive services for seniors with dementia. However, litde is known about the cognitive or psychiatric profiles of seniors who seek aging services. Using data from 237 seniors age 60 years and over who received case management (Gl) from an aging services agency in upstate NY, we will test the hypotheses that eM clients with more cognitive impainnent have: 1) more medical comorbidity, 2) less depressio~ 3) more disability, and 4) higher utilization of services than those with less cognitive impaianent. Measures include the Six-Item Screen (SIS) to identify cognitive impainnent, a modified minimum dataset to chamcterize medical comorbidities, the Sttuetured Clinical. Interview for DSM-IV and the Patient Health Questionnaire-9 for depression diagnosis and symptom severity, checklists for Instrumental Activities of Daily Living (IADLs) and ADLs t and a modified Comell Services Index to measure service utilization. Subjects had a mean age of 77 yeus, 69% wel:e female, 16% non-white, and 26% had less than a high school education. 42% of subjects had one or more errors on the SIS. We wiD report results of regression analyses to determine the associations between cognitive impainneot and medical comorbidity, depression, disability, and service utilization, while controlling for age, gender, and education. The findings' implications for future research and care of seniors with dementia will be discussed This research was funded by: .AFSP grant (pI: Y Conwell), NIMH R24 MH071604 (pI: Y ConwelI), NIMH T32 MH073452 (pI: JM Lyness), AHRQ T32 HS000044-15 (pI: B Friedman Poster Number: 73

Determinants of Rehospitalization Among Geriatric Psychiatric Patients Paulo R. Shiromal , Teresa ~\ . Rummans2, ?vIana LLapid3, Kemuel L.Pbilbrick4,Juret W.. Richardson5 1 Mayo

Clinic, Rochester, Rochester, 1MN Clinic, Rochester, ~ 3lvIayo Clinic, Rochester, 1\.£N .. :Mayo Clinic, Rochester, ~ 5 lvIayo Clinic, Rochester, IvIN" 2 Mayo

Abstract: Background: Readmission of elderly patients shortly after discharge from a psychiatric hospital mayor may not be related to the previous hospitalization. However~ unplanned hospital readmission after an earlier hospital stay is one measure used to judge the quality of hospital care; therefore, monitoring and implementing strategies to reduce its tate is essential Unplanned hospital readmissions contribute to over-utilization of hetithcare cost and resources. The standard benchmuk used by the Centers for Medicare and Medicaid Services (eMS) is the 7 day readmission rate. Objective: We sought to investigate the incidence of readmission in a psychogeriatric and medical-psychiatric unit, and explore possible factors associated with readmission. Methods: A retrospective chart review was conducted on all discharges from an inpatient psychogeriatric and medical-psychiatric unit from January thru December 2006. Patients who were 60 yeus and older were included in the study, and demographic and clinical infounation was collected. Readmission rates were calculated, with readmission de6ned as any admission to the same inpatient unit occurring within 7, 15, or 30 days after a previous discharge. Results: In a 12-month period, there were 388 discharges from the units ofwhich 330 were unique patients, and 85% were aged 60 years and older. The readmission rate in this geriatric group was 8.5%, of which 62% was readmitted within 7 days, and the rest readmitted within 15-30 days. Factors related to readmissions will be examined and described. Conclusion: Further studies are needed to investigate readmissions among geriatric psychiatric patients, as early identification of those at risk may help prevent readmissions.. Such studies may lead to quality improvement strategies to focus on effective and safe discharge plans, improve healthcare delivery, and reduce overall healthcare cost. Poster Numbet: 74

Elder Mistreatment: A Community Survey

Elizabeth]. Santos·, Xin Tu2, Yeates Conwell3 of Rochester, Dept. of Psychiatry, Rochester, NY Depts. of Psychiatry and Biostatistics, Rochester, NY 3 University of Rochester, Dept.. ofPsycbiatry, Rochester, NY 1 University

2 University ofRochester~

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2008 AAGP Annual Meeting Abstract: It is estimated that over 5 million older adults in the United States ale affected by elder mistreatment (EM) every yeat.

Preventive interventions have been limited due to the paucity ofdata about prevalence, characteristics, and coaelates of EM:. Studies on prevalence have varied and are limited due to differences in definition, methodology, sample biases, and lack of validated screening instnunents. The National Research Council (2003) called for random sample surveys to more accurately assess EM in communities. The Monroe County ",\dult Health Sw:vey 2006 (NY) was a countywide random household telephone survey, conducted in both English and Spanish, to provide prevalence data on health behaviors and health status indicators. Data were weighted to correct for unequal chances of selection. 1'bis survey attempted to replicate the methods design of the CDC Behaviolal Risk Surveillance Survey. All respondents over 65 years were asked 6 questions &om the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EASl), a screening tool which assesses EM in relation to factors of '~en.bi1ity" and "coercion." For exampl~ "Are you altaid of anyone in your family?" and "Has anyone forced you to do things you didn't want to do?" The survey was completed by 2,545 county residents, with a response rate of 30.3%. 441 of the respondents were over 65 years old. PreliminaI:y findings indicate that 8% or 36 of the respondents over 65 years old screened positively for E~f. City residents (13%) were more likely to screen positively than suburban elders (5%). In our final analysis~ we will: 1) identify the prevalence of EM; and 2) describe charActeristics and correlates of IDvI in the following domains: a) demographic cha:racteristics~ b) access to health care~ c) health status, and d) mental health.

This research was funded by: NIMH grant T32 MH18911 (pI, E.D. Caine) Poster Number: 75 Clioical Correlates of Insight in Older Adults with Schizophrenia Pia Natalya T. Reyes!, Cad 1 Cohen2, Paul Ramirez3, Shilpa Diwan4, Nikhil PalekarS, Azziza Bankole6, Navin Natarajan7, Sukriti ~fittal8, Clarence Goh9 I

SUNY Downstate Medical Center, Broo~

NY

SUNY Downstate ~Iedical Center, Brooklyn, NY 30 Long Island Univemity, Brooklyn, NY 4 SUNY Downstate Medical Center, Brooklyn, NY 5 SUNY Downstate Medical Center, Brooklyn, NY 6 SUNY Downstate ~redical Center, Broo~ NY 7 SUNY Downstate Medical Center, Broo~ NY 8 SUNY Downstate ~Iedical Center, Brooklyn, NY 9 SUNY Downstate Medical Center, Brooklyn, NY 2

Absuaet:

Background: Lack of insight is found to be highly plevalent among patients with schizophrenia and insight deficits have been associated with pOOl: comse of illness and noncompliance with treatment. Insight is a multi-faceted concept, and different models have been proposed to describe insight. There are little data on its role in among aging persons with schizophrenia. In this study we examine the clinical correlates ofinsight in older adults with schizophrenia. Methods: The sample consisted ofa stratified convenience sample of 198 community-dwelling schizophrenic (5) persons aged 55+ in residential and non-residential settings. Using the most widely accepted definition ofinsight (Rickelman 2004, Kemp and Lambert 1995), several variables were identified addressing the 2 of 3 components of insight: awareness of illness and treatment compliance. We used two items from the PANSS (positive and Negative Symptom Scale) and three items on the ROMI (Rating of Memcation Influences Scale) to fODD the Total Insight Score. Using factor analysis, we were able to divide the overall scale into two subscales: ,,\wareoess of Illness and Treatment Compliance. All scales met acceptable levels ofinternal reliability. We conducted partial correlations between the overall scale and the two subscales with the following clinical variables: 5 subscales and total score on the Dementia Rating Scale (DRS), the Clinical Epidemiological Study for Depression scale (CES-D), positive and negative symptom scores on the P.ANSS. In each analysis of a clinical variable we controlled for demographic items as well as the other clinical variables. Results: The total Insight Score correlated significandy with higher CES-D scores, higher SCOles on the loitiation/Perseveration DRS subscale, and the total DRS. The Awareness of Illness subsca1e coae1ated significandy with higher CES-D scores, higher scores on the Attention and Initiation/Perseveration DRS subscales and the total DRS. The Treatment Compliance 5ubscale correlated significantly with higher CES-D scores. No significant correlations were found with the Pi\NSS positive and negative scores. Conclusion: The findings in older adults are consistent with sevem1 models described in YOWlger populations. Insight is associated with cognition, especially executive functioning, which is consistent with the neuropsychological model ofinsight.. It is also associated with depression, which is consistent with the psychological model of insight. Longitudinal studies are needed to deteanine how changes in insight affect clinical outcomes. t

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2008 AAGP Annual Meeting This research was funded by: NIGMS Grant S06G?vf54650 Poster Number: 76

Relationship between Trauma and Psychosis in Older Adults with Schizophrenia Nikhil Palekar1, Cad Coben2, Paul Ramirezl I 2

l

SUNY Downstate Medical Center, Broo~ NY SUNY Downstate Medical Center, Brooklyn, NY LICH, Brooklyn, NY

Abstract: Rationale: Trauma has been shown to have a significant relationship with psychosis in younger persons with schizophrenia. We examine the relationship between trauma and psychosis in older adults with schizophrenia along with associated soci.odemographic and clinical factors that may have impact on this relationship. Methods: The Schizophrenia (8) group consisted of t 98 person's age 55+ living in the community who developed schizophrenia before age 45. We excluded persons with substantial cognitive impainnent. We also developed a community comparison group (n=113) derived from random block sampling. We used the Trauma and \7ictimization Scale to measure the frequency and related distress of traumatic experience in this study. Using a median cut-off score on the trauma scale, we dichotomized the dependent variables into persons scoring in the low trauma group «8) and those scoring in the high trauma group (>8). Results: The 8 group showed significandy higher rates in the frequency as well as subjective distress of trauma as compared to the community sample. Looking specifically at the S group in bivariate analysis, 8 of 18 variables in our analysis attained significance in predicting trauma group. Being in the high trauma group was associated with lower age, higher P.ANNS positive scores, higher PANNS anxiety scores. higher cognitive functioning, higher CESD scores, higher proportion of intimate contacts, more acute stressors and increased financial strain. However, when the t 8 variables were entered into a binuy logistic regression only the PANNS positive scores (OR=1.19, 95% C.I=1.09-1.31) attained significance. Conclusion: The association between trauma and positive symptoms does not disappear with age. Ongoing and continuing trauma seems to have a significant impact on positive symptoms in schizophrenia in later life, although it is possible that increased positive symptoms may lead to more tmumatic events. Our findings underscore the value of a thorough review of cunent and lifetime trauma with older persons with schizophrenia and suggest more targeted psychotherapeutic and phannacological interventions may be required for persons in the high trauma group. This research was funded by: National Institute of General Medical Sciences G.rant no. S06GM54650 Poster Number: 77

The Relationship of Marital Status and Clinical Characteristics in Middle-Aged and Older Patients with Schizophrenia and Depressive Symptoms Maren Nyer1, Ian Fellows2,]ohn Kasckowl, Edith C. Lawrence4, Shah Golshan5, EDen Solonano', Sidney Zisook7 University of VttgitUa, Charlottesville~

VA Uoiversity of Califomia San Diego~ San Diego, CA. 3 V.~ Pittsburgh Health Care System and Western Psychiatric Institute of Clinics, Pittsburgh, PA .. University of VIrginia, Charlottesville, \7A 5 University of California San Diego, San Diego, c.'\. 6 University of California San Diego, San Diego, CA 7 University of California San Diego, San Diego, CA I

2

Abstract: Background: The relationship of marital status to symptomatology in middle aged and older patients with schizophrenia and depressive symptoms is not well understood. This study examines the relationship between current marital status and level of depression, positive and negative symptoms, quality of life, and suicidal ideation among patients with schizophrenia-spectrum disorders and subsyndromal depressive symptoms. Methods: The study included 212 outpatients who participated in a two-site NIl\Di sbJdy investigating the effectiveness of augmenting antipsychotic medications with antidepressants in older patients with schizophrenia-spectrum disorders. Patients WeIe: 1) aged 40 or older, 2) diagnosed with schizophrenia or schizoaffective disorders using the htIini Structured Clinical Interview (SCID)~ and 3) exhibited a score of >8 on the Hamilton Depression Rating Scale (HAM-D) but did not meet criteria for a major depressive episode. In addition to current marital status~ we assessed participants' level of depression, positive and negative symptoms of schizophrenia, suicidality, and quality of life. Results: Only 130/0 of participants were married or cohabitating (0 28), 46% divorced, widowed, or separated (0 = 98), and 400/0 single (n 85). Participants who were divorced, widow~ or separated had a later age of onset than those who were single (30.11 + 10.51 vs. 24.21

=

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2008 AAGP Annual Meeting + 8.90, respectively; F[2,179] = 7.28 P = .001). Additionally, married participants mted their quality of life higher than those who were single (F[2,160] = 5.10, P = .01) and had less suicidal ideation than those who were divorced, widowed or separated \1.40/0 vs. 29.20/0, respectively; ~te1-Haenszel M2(2) 6.24, P .045). Conclusion: These findings suggest that while marriage is not highly prevalent in middle aged and older patients with schizophrenia and depressive symptoms it appears to be related to their quality of life and protect against suicidal ideation.

=

=

This research was funded by: :MH6398-05 (SZ, JWK). JWK was supported by the VISN 4 ~fiRECC

and a VISN 4 CPPF grant

Poster Number: 78

CHnicai Remission in a Multi-Ethnic Urban Population of Older Adults with Schizophrenia

Azziza Bankolel , Cad Cohen2, Ipsit Vahia3, Shilpa Diwan", Pia ReyesS, Mamta Sapra6, Paul Ramirez1 Department ofPsychiatty, SUNY Downstate Medical Center, Brooklyn, NY Downstate Medical Center, Brooklyn, NY ) SUNY Downstate Medical Center, Brooklyn, NY .. SUNY Downstate Medical Center, Brooklyn, NY S Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY 6 Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY 7 Long Island University, Brooklyn, NY t

2 SUNY

Abstract: Objective: Clinical remission has been documented in patients with schizophrenia. This study aims to detennine the prevalence of clinical remission in older adults with schizophrenia. Methods: The Schizophrenia Group consisted of t 98 persons aged 55+ living in the community who developed schizophJ:enia before age 45. We excluded persons with substantial cognitive impainnent. We established criteria for clinical remission based on a comprehensive litemture review. The criteria we chose as a framework for remission chart the three dimensions of psychopathology in schizophrenia i.e. reality distortion, disorganisation, and negative symptoms. The Positive and Negative Symptom Scale (Pi\NSS) and history of hospitalization were the criteria used Scores of 3 or below on 8 domains of the PANSS (pt, P2, P3~ Nt, N4, N6, G5, & G9) and no hospitalizations within the previous year. Summed scores based on an these criteria detennined remission rates. No demographic variables correlated with remission. Results: 48.5% of our sample met the clinical criteria for remission. Using bivariate analysis, we found that remission correlated with a fewer network of contacts, greater proportion ofintimates, higher IADLt QLI, DRS scores and lower CESD and trauma SCOles. These individuals 4 variables-fewer total network also compared themselves favourably with others without mental illness. In logistic regressio~ fewer lifetime traumatic events, and higher DRS scores-retained significance. The type of contacts, greater proportion of intimates~ residence, use of mental he2lth services, and medication were not found to correlate with remission. Conclusions: Remission rates based on our data were consistent with rates reported in the literature. Our findings suggest that clinical remission is an attainable goaL Factors that influence clinical remission merit closer study, and development of treatment models based on these studies may augment outcomes in the older population with schizophrenia.

This research was funded by: The National Institute of General ~ledical

Sciences Grant no. S06GM54650

Poster Number: 79 Community Integration of Older Adults with Schi20phrenia Miguel A Sanchez-AImita I~ Pia Reyes2, Paul Ramirez3, Carll. Cohen4 1 SUNY

Downstate Medical Center, Brooklyn, NY SUNY Downstate Medical Center, Brooklyn, NY 3 Long Island University, Brooklyn, NY .. SUNY Downstate :Medical Center, Brooklyn, NY 2

Abstract: Objectives: Community integration refers to the extent to which a person lives, participates, and socializes in the community. As the number of older persons with chronic mental illness continues to grow rapidly, this concept deserves greater consideration. Using Wong and Solomon's (2002) model of community integration, we examine components of social integration and associated fa.ctors

in older adults with schizophrenia. Methods: The Schizophrenia(S) group consisted of a mixed racial stratified cOQvenience sample of t 98 persons aged 55+ living independendy and in supported residences in NYC who developed schizophrenia before age 45. We excluded pelSons with substantial cognitive impaianent. A community comparison(q group of 113 persons was derived &om

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2008 AAGP Annual Meeting interviews in randomly selected block-groups. We created the dependent variable, Community Integration (CI), using operational criteria suggested by Gulcur and colleagues (2007). .l'\fter standardizing the 12 variables comprising CI, factor analysis identified 4 components: psychological integratio~ independence, social physical integration, and social integration. Results: The S group differed significantly from the C group on the CI scale (t=4.70, d!=282, p<.OO1) and on each of the 4 subscales of the CI.. 43% and 71 % of S group scored below the 1st and 2nd quartiles values of the C group, respectively. Using regression analysis, we separately examined the S group and fOWld that three variables ptedicted higher CI: number of entitlements, fewer depressive symptoms, and fewer negative symptoms. Our 16 variable model accounted for 38% of the variance in CI. Conclusion: Although older adults with schizophrenia did not attain the level of CI of the comparison group, 57% were functioning above the lowest quartile of CI among their age peers. Importandy, clinical interventions to address depression and negative symptoms, and assistance in obtaining entidements may improve CI..

This research was funded by: NIH Poster Number: 80 Differentiating Late Onset SchizophreDia from Earlier Onset Schizophrenia Ipsit Vahia 1, Colin D epp2, Ian Fellowsl , Shabrokh Golsban4, Barton PalmerS, Helena C.Kraemer6, Dilip V. Jeste7 t

University of California, Sao Diego, San Diego~

2 UCSD,

CA

San Diego, CA

3 UCSD, San Diego, CA "' UCSD, San Diego, CA. S UCSD, San Diego, CA 6 Stanford University, Stanford, CA 7 UCSD, San Diego, CA

Abstract: Introduction: The tenn 'late onset scbi2opbreoia' refers to patients who have onset of schizophrenia after age 40 according to the International Late-Onset Schizophrenia Group. Studies have shown that persons with onset in their middle age are predominantly more delusions and less cognitive decline than those with earlier onset. However, past studies female, have fewer negative symptoms~ were limited by small samples and inconsistent assessment criteria. In this study we examined the phenomenology, cognitive ability and functioning of subjects with wide range of age of onset and assessed how this phenotype would change by changing the cutoff age. Methods: This is a study of 821 community dwelling outpatients aged over 40 (age range 40-101 yrs) who were recruited for studies of schizophrenia in older people. Psychopathology was assessed using Positive and Negative Symptom Scale for Schizophrenia (PANSS.) Overall functioning was assessed using UCSD Performance Skills Assessment (UPSA). Dementia Rating Scale (DRS) and several other cognitive and neuropsychiatric tests were used to assess multiple cognitive and neuropsychiatric domains. The sample was dichotomized into early and late onset groups using ages 25, 30, 35, 40 and 45 as cut-offs, and for each cutoff, differences between the groups were calculated and compared using Cohen's D. Results: The m.e2l1 age of onset for schizophrenia in our sample was 26.4 years. 39.50/0 were female and 64.1% were male. For all age cut-offs t the late onset group had lower scores on PANSS positive and negative symptom subscales and higher scores on UPSA indicating lower severity of symptoms and a higher level of functioning. Scores on all cognitive tests wee higher in the late=onset group. The highest value for Cohen's 0 among all the variables was for 0.30 for total P.i\NSS scores at age 40 Conclusions: Our preliminary findings suggest that late onset schizophrenia is phenotypically different from earlier onset schizophrenia. Late onset schizophrenia patients have milder psychopathology and higher functioning. The magnitude of difference changes if the age of cutoff is changed. This research was funded by: NI1\£H Grant MH66248 and the Department of\'eterans Affairs. Poster Number: 81 Correlations Among Symptom and Social Outcome Categories in Older Adults with Schizophrenia Sbilpa Diwan1, Carl I. Coheo2~ Pia Reyes3, Azziza Bankole", Nikbil Palekae, Paul Ramirez' SUNY Downstate Medical Center, Brooklyn, NY Downstate Medical Center, Brooklyn, NY 3 SUNY Downstate Medical Center, Brooklyn, NY 4 SUNY Downstate Medical Center, Brooklyn, NY 5 SUNY Downstate Medical Center, Brooklyn, NY 6 Long Island University, Brooklyn, NY I

2 SUNY

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2008 AAGP Annual Meeting Abstract:

Objectives: The aim of this study is to examine the associations among symptom and social outcome categories in a sample of oldet adults with schizophrenia. These data have implications with respect to recovery and the specificity of treatment needed to address each outcome category. Methods: We used a stratified convenience sample consisted of 198 persons age 55+ living independendy and in supported residences in NYC who developed schizophrenia before age 45. We excluded persons with substantial cognitive impainnent. We examined 4 symptom (cognitive functioning, positiv~ negative, and depressive symptoms) and 2 social functioning (quality of life, adaptive functioning) outcome categories using the PANSS, CES-Depressioo(D), Dementia Rating Scale(DRS), Quality of life Index(QLI), and the Instrumental..c'\ctivities of Daily Living Scale (IADL). Results: Controlling for race, gender, age, and education, partial correlation coefficients ranged from .01 to .54 (ie., 0 to 290/0 shared variance) among the 15 bivariate comparisons of the 6 outcome categories. The median partial correlation coefficient was .22 (40/0 shared variance). The highest associations were found between PANSS positive and P.i\NSS negative scales(r=.50) and the QLI and the CESD (r=-.54). The lowest associations were found between the DRS and the IADL scale (r=.Ol), CESD ([=.04), the PANSS negative scales ([=.04), and the QLI(r=.05). Conclusions: Given the modest correlations among the outcome categories, it is not surprising that full recovery in later life is rare. The findings also suggest that different treaunent strategies may be required for each outcome categoty, although in some instances, treating one category may have some impact on other categories. Because our prior research found that each outcome category is associated with various clinical and social variables, it is likely that effective treatments will require biological and psychosocial methods.

New Re8earch P08ler Se8sion

Sunday, March 16, 2008 t:OQ PM - 6:00 PM Poster Number: 1

Depression and Anxiety Symptoms Predict Cerebral FDDNP-PET Binding in Non-Demented Older Adults Helen Lavretskyl, Prabha. Siddarth2, Linda Ercoli3, Karen Miller, Gary W. Smalls, Vladimir Kepe6, Susan Bookheimer7, Henry HuangS, Michael E.Phelps9,Jorge R. Baaio 1o

University of California - Los Angeles, Los Angeles, CA University of California - Los Angeles, Los i\ngeles, CA 3 University of California - Los Angeles, Los Angeles, CA " University of Califomia - Los Angeles, Los Angeles, CA 5 University of Califomia - Los Angeles, Los Angeles, CA 6 U~ Molecular & Medical Phannacology, Los AngeleSt CA 7 U~ Semel Institute, Los Angeles, C-\ 8 U~ Molecular & Medical Phaanacologyt Los Angeles, CA 9 Molecular & Medical Pharmacology/Institute for Molecular Medicine/Crump Institute, Los Angeles, CA 10 Molecular & Medical Pharmacology/Institute for Molecular ~fedicine/Cnunp Institute, Los i\nge1es, CA t

2

Abstract Background: Amyloid senile plaques and tau neurofibrillaty tangles are neuropathological haJlrnarks of .Alzheimer's disease that accumulate in the cortical regions of the brain in persons with mild cognitive impairment ~fCI). These neuropathological changes may be associated with mood and anxiety symptoms that precede the diagnosis of dementia by several years and put subjects at additional risk for dementia. PET scans after intravenous injections ofFDDNP, a molecule that binds to plaques and tangles in vitto, demonstrate increased cerebral binding in subjects with Mel compared to cognitive1y intact controls. In the present study, we detemUoed whether symptoms ofdepression and anxiety in subjects with Mel or healthy controls were associated with increased regional and global FDDNP-PET binding. Methods: We performed clinical and neuropsychological assessments and FDDNPPET scans on 43 subjects (22 women, 21 men). Subjects were non-demented (mean [SO] Mini-Mental State Exam scores = 28.4 [1.5]), well-educated (mean [SD] education years = 17.1 [3.1) middle-aged and older (mean [SD] age =66.1 [12.4D vo)unteers t and 23 of them were diagnosed with htfCI, a risk state for developing dementia. All subjects underwent screening for depression and anxiety using the Geriatric Depression Scale (GDS) and the State-Trait Anxiety Inventory (STAI), and subjects with a diagnosis of major depression or anxiety disorders were excluded. All subjects received magnetic resonance Ch'fRI) scans that were co-registered to PET scans for determination of regions of interest, including medial and lateral temporal, posterior cingulate, parietal, frontal, and global (overall avemge) regions. Correlation analysis was used to detennine whether severity of depression and anxiety were associated with global and regional FDDNP binding. Results: The Mel and control subjects did not differ in the severity of depression as measured by the GDS (5.7 [4.4] vs 5.3 [3.7]) nor in their state (36.5 [10.0] vs. 31.7 [8.8)) and trait anxiety (35.2 [9.1] vs

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2008 AAGP Annual Meeting 30.9 [10.9]) scores, as measured by the ST.l\I. In the total sample of subjects, GDS scores correlated with FDDNP binding values in several regions, including global (r= 0.34, p=O.02), lateral temporal (I: = 0.30, p=O.04) and posterior cingulate (r = 0.33, p=0.03). The severity of state anxiety correlated with medial temporal lobe FDDNP binding values (r = 0.32, p=O.03), while the trait anxiety scores correlated with the global (r = 0.42, p=O.OO5), frontal (r = 0.39, p=O.Ol), medial temporal (r = 0.41, p=O.OO7) and posterior ciogulate (r 0.32, p=O.04) FDDNP binding values. Discussion: This is the first report to demonstrate a relationship between the symptom severity of depression and anxiety and the FDDNP binding values in non-demented middle-age and older people. The results suggest that this relationship between mood symptoms and cerebral amyloid deposition may be present for even relatively mild symptoms of anxiety and depression.

=

This research was funded by: NLo\-NIH Poster Number: 2 Enhancing Resilience to Stress and Quality of Life in Depressed Informal Dementia Caregivers Helen Lavretskyl, I\.ficbael R. Irwin 2 I

2

UCLl\, Semel Institute, Los Angeles, CA VCL'\, Semel Institutet Los Angeles, CA

Abstract to improve resilience to stress and quality of life in Objecmves: We assessed the potential of an antidepressant drug, escitalop~ depressed family dementia caregivers. Methods: We recruited 16 family caregivers (45-75 years of age 14 chilcken and 2 spouses; 13 women) who were taking care of their relatives with Alzheimer's disease and randomized them to receive either esctialopram 10 mg / day or placebo for 12 weeks. We assessed the severity ofdepression, negative ruminations, resilience burden, distress, quality of life, severity of care-recipient's cognitive and behavioral disturbances, and proinflammatory cytokines at baseline and at follow up. HDRS scores at baseline ranged between 11-30. Results: Most outcomes favored the antidepressant over placebo. The severity of depression improved with the drug compared to placebo (t=3.2; P=O.Ot). Interestiogly, subjects who took escitalopram demonstrated 86% improvement in resilience compued to 30/0 reduction in resilience in those on placebo (F-2.7; df=10; p=O.l). We observed reduction in the inflammation correlated with reduction in depression severity (r=-O.S) in both treatment groups. Conclusion: We concluded that antidepressant use in caregivers may improve depression and sleep, boost resilience, ease burden and distress, and improve quality of life. Inflammation may improve as a result of decrease in the depression severity with either dmg or placebo. Future studies should examine treatment response using different treatment modalities including psychosocial and miodbody intervention, and measure biological and psychosocial stress leading to the preventive intervention in the high risk individuals. t

This research was funded by: Forest Research Institute

Poster Number: 3 Age and Racial Differences in the Presentation and Treatment of Generalized Anxiety Disorder in Primary Care Gretchen A. Brenes1 Mark Knudson2, Vaughn McCal13,jeffWilliamson4, Michael :MillerS, Melinda A. Stanler t

Wake Forest University School ofMedicine, Wmston-Salem, NC Forest University School of ~fedicine, WlOston-Salem, NC .3 Wake Forest University School oflvIedicine, WUlston-Sale~ NC of Wake Forest Univetsity School of Medicine, WUlston-Sa1em, NC sWake Forest University School of Medicine, Wtnston-Salem, NC 6 Baylor College of Medicine, Houston, TX t

2 Wake

Abstract:

Background: The prevalence tates of Generalized Anxiety Disorder (GAD) are higher in the primary care setting and when comorbid with physical conditions, greater impaimlents in quality oflife and disability result. Given the inaeased reliance on primary care providers for the identification and treatment of mental health problems, it is important to study patients in this setting. The purpose of this study is to examine age and racial differences in the presentation and treatment of Gi\D in medical patients. Methods: The sample consisted of 1,111 patients from two university-affiliated medicine clinics. Twenty-seven percent of the sample were young adults (18-39 years), 45% were middle-aged adults (40-59 years), and 28% were older adults (60-94 years). The majority of the sample was well-educated (M = 14.0; SD =3.0) and female (73.2%); over one third of the sample was black (34.7°/0). The diagnosis of Generalized i\nxiety Disorder was based on the Patient Health Questionnaire. Participants also completed measures of anxiety symptoms (Beck Anxiety Inventory), depressive symptoms (Beck Depression Inventory), worry (penn State Worty Questionnaire), positive and negative affect (positive and Negative Affect Scale), and 2 questions regarding mental health

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2008 AAGP Annual Meeting treatment.. Results: The prevalence of GAD was lowest for older adults (14.. 3% for young adults, t 4.4% for middle-aged adults, 6.90/0 for older adults; X2(2) = 6.63, P < . 05). Symptoms of cognitive anxiety declined with age (F (2, 128) = 3.. 12, P < .05). Younger G.\D patients also reported significandy greater negative affect (F (2, 128) 5.28, P < .01) and depressive symptoms (F (2, 127) = 7.62, P = .001) than middle-aged and older adults. The only racial difference that emerged with respect to the presentation of GAD was that blacks reported greater positive affect than whites (F (1, 126) 7.88, P < .01). No age differences emerged with respect to mental health treatment. However, whites were more likely to report taking medication for anxiety or depression (66.7% vs. 41.80/0; ?2 (1) = 8.24; p < . 01) and were also more likely to have seen a mental health provider within the last year (50.()0/0 vs. 24.1 % ; (?2 (1) 9.06; p < .01) than blacks. Discussion: Significant age and racial differences emerged in the presentation and treatment of GAD in the primary care setting. The most notable age differences were a decrease in cognitive anxiety, negative affect, and depressive symptoms among middle-aged and older adults with GAD.. .Although there were no age differences in treatment, blacks were significandy less likely to be taking medications or seeing a mental health provider. This suggests that GAD may be more diffi.cult to detect in older adults due to the decreased negative affect and depressive symptoms, as physicians are more likely to detect depression. It also suggests that more efforts are needed to identify and appropriatdy treat blacks with GAD in the primary care setting.

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This research was funded by: NIH MH65281 Poster Number: 4 Efficacy and Tolerability of Duloxetine in Elderly Patients with Generatized Anxiety Disorder ] ames 1\fartinezl, Jonathan Davidson2, Christer .Allgulanderl, Mark Pollack4,James Hartford), Michael Robinson6, James Russell?, David Perabia8, Madelaine Woblreich9,Joel Raskin10

Lilly and Company, Indianapolis, IN Duke University, Durham, NC 3 Karolinska Institute~ Huddinge, Sweden 1 Eli

2

General Hospital., Boston, MA. Research Group, Cincionatis OH 6 Eli Lilly and Company, Indianapolis, IN 7 Eli Lilly and Company, Indianapolis, IN 8 The Gordon Hospital, Westminister, England 9 Eli Lilly and Company, Indianapolis, IN 10 Eli Lilly and Company, Indianapolis, IN

4 Massachusetts S Hartford

Abstract:

Purpose: To assess the efficacy and tolerability of duloxetine in elderly patients with generalized anxiety disorder (GAD). Methods: Acute-phase data from a subset of patients (>/=65 years) with GAD were pooled from 3 randomized~ double-blind, placebocontrolled trials of duloxetine (2 flexible, 1 fixed dosing). Patients were treated with duloxetine 60-120 mg once daily or placebo for 9·10 weeks. The primary outcome measure was the mean baseline-t/=65 years old.. Compared with placebo-treated patients, duloxetine-treated patients experienced significantly greater improvements 00 the HAMA Total (p=O.036) and Somatic .Anxiety factor (p=.050), but not the HAMA Psychic Anxiety factor or a\DS Depl:ession subscale (both p=.062). Oo1y nausea was reported significantly more often in duloxetine-treated patients (31.60/0 vs.. placebo, 8.7% , p=.035), and duloxetine-treated patients experienced greater weight loss (p=.028). Compared with placebo-treated patients, more duloxetine-treated patients discontinued treatment due to an adverse event (0% vs. 21.1 °/0; p=.OI4). Conclusion: Duloxetine was effective and well-tolerated in an elderly patient subset with GAD.

This research was funded by: Eli Lilly and Company and Boehringer Ingelheim Poster Number: 5 Frontal Gray Matter Changes in Late Life Bipolar Disorder john L.Beyerl , Maragatha Kuchibhatla2, Frederick Cassidy3. Ranga R Krishnan"

Duke University Medical Center, Durham, NC Duke University Medical Center, Durham, NC 3 Duke University Medical Center, Durham, NC of Duke Univetsity Medical Center, Durham, NC I

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2008 AAGP Annual Meeting Abstract: Objective: Morphometric brain imaging studies in adult bipolar patients have revealed regional brain abnoonalities. Specifically, the literature suggests that there is little difference in total brain gray matter volume in bipolar patients compared with controls, but there does appear to be a regional reduction of gray matter volume or a regional deaease in gay matter density in the prefrontal brain areas (such as anterior cingu1ate and subgenual prefrontal cortex) or temporal lobe structures (especially hippocampal or amygdala). However, most of these studies have been conducted on relatively small sample sizes with a wide range of ages. In late life bipolar patients, there have been velf few studies evaluating gray matter changes other than to note a general decline in gray matter volume with age or cognitive disability. The objective of this study was to detennine if there were distinct global or regional gray matter volume changes in late life bipolar patients. Methods: Forty-three older adults with bipolar disorder and 56 older comparison subjects were studied with high-resolution MRI. Cortical parcellation methods divided the cortex into 16 areas in order to obtain total and regional volume measures of gay matter. Volumetric differences were examined using multiple regression models controlling for age and gender. Results: Relative to controls, the older bipolar subjects bad significantly smaller frontal poles bilatetally. This area included the middle frootal gyms, inferior frontal gyrus, orbital frontal gyms, gyms rectus, and anterior cingulate. There was no difference in total gray matter volume between the two groups. Conclusions: Older adults with late life bipoLu: disorder show deficits in gray matter volume regionally. This is especially prominent in the frontal poles bilaterally, and may be of potential relevance for the pathophysiology of the disorder. This research was funded by: NIMH

Poster Number: 6 Brain Lithium Effects on Cognition and Mood in Geriatric Bipolar Disorder Brent P. Foresterl , Chris C. Streeter2, YosefBedow', Chelsea. Finn", David HatperS, Perry Renshaw', Constance 1\1. Moore1, Hua Tlan8

Belmont, MA Boston University School of I\J(ec1icine, Boston, MA 3 McLean Hospital, Belmont, ?vIA .. McLean Hospital, Belmont, MA 5 McLean Hospi~ Belmont, l\tIA 6 McLean Hospital, Belmont, MA 7 McLean Hospital, Belmont, 1\1A 8 Boston Univemty School of l\tledicine, Bosto~ 1\{A 1 Mclean Hospit~

2

Abstract: Background: lithium continues to be used as a treatment for mania in older adults. Concems regarding neurotoxic side effects have led to questions about the most effective way to use lithium in older adults with bipolar disorder (BD). The clinical practice of semm lithium level monitoring is based on the assumption that senun lithium levels accurately reflect brain lithium levels. However, in the elderly, this relationship may become more variable due to age related changes in metabolism, body composition and renal function that alter lithium phannacokinetics. Objective: We investigated the relationship between brain lithium, semm lithium and age, in adult subjects treated with lithium. We also investigated the association between brain and serum lithium with ftontallobe function and mood in a group of older lithium treated BP subjects. Methods: This is a cross-sectional study of 26 subjects, ages 20 to 85, diagnosed with DSM-IV-lR BD, currendy treated with lithium. Subjects were recruited from McLean Hospital and the Division of Psychiatry, Boston UDiversity School of Medicine. All subjects bad measurements of serum and brain lithium levels. Brain lithium levels were assessed using 7-lithium ~lagnetic Resonance Spectroscopy (!\'IRS) at 4 Tesla. .All subjects were administered mood mtings prior to the MRS examination (Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (¥MRS». Ten subjects older than 50 years also bad neuropsychological assessments, including tasks of executive functioning, (Stroop, Trails 1\ and B, Wisconsin Card Sorting Task (WCS1). Results: With an subjects classed together, there was an association between serum and brain lithiwn levels (r = 0.46, P < 0.02, n = 26). Post-hoc division of subjects into younger and older groups reaffirmed the presence of a correlation between semm and brain lithium levels (r = 0.65, P < 0.006, 0 = 16) in the younger subjects; however, we could not detect that this relationship was present in the older subjects (r 0.11, P < 0.76, D = 10). Bmin lithium levels bad a sigoi6cant adverse effect on the Stroop Interference Test (t = .. 3.77, P < 0.01) and the pelSeve.mtive en:ors on the WCST (t = ..3.64, P < 0.03). In contrast, serum lithium levels did not correlate with any of the neuropsychological tests.. For these older subjects, elevations in brain (but not serum) lithium levels were also associated with higher HDRS scores (r = 0.92, P < 0.0001, n = 9), due to increased somatic symptoms (r = 0.80, P < 0.01, n = 9). Conclusions: Elevations in brain, not serom., lithium levels were associated with executive dysfunction and higher depression scores in older adults with BD. These findings support recommendations of conservative lithium dosing in older adults. The absence of a predictable relationship between senun and brain lithium with

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2008 AAGP Annual Meeting advancing age beyond mid-life, however, makes specific individual predictions about target serum lithium levels in older adults difficult. This research was funded by: NARSAD, :MH58681. Poster Number: 7 Social Support in Older Individuals: The Role of the BDNF VaI66Met Polymorphism Warren D. Taylor·, Stephan Zuchner2, Douglas R. McQuoid3, David C. Steffens", Dan G. BlazerS, Ranga R. Krishnan6 University, Durham, NC University ofMWni, Miami, FL 3 Duke University, Durham., NC .. Duke University, Durham, NC 5 Duke University, Durham, NC 6 Duke University, Durham, NC 1 Duke

2

Abstract: Background: Although often viewed as a purely environmental construct, some work supports the theory that perception of social support may be mediated by genetic factors. This study examined the relationship between the brain-derived neurotrophic factor (BDNF) Va166Met polymorphism and social support measures in older subjects. Methods: The sample consisted of 243 depressed and 115 nondepressed older subjects, age 60 years or older; 233 were Val66 allele homozygotes, while 125 were Met66 allele carners. All subjects completed clinical assessments, including a self-report questionnaire assessing four social support domains, and provided blood for genotyping. Statistical models examined the relationship between scale scores of social support and BDNF \ral66Met genotype, while controlling for presence or absence of depression and other demographic factors significandy associated with social support. As social support measures were not nonnally distributed, both log-transformed and raw scores were examined. Results: the Met66 allele was associated with lower levels of subjective social Aftet controlling for depression diagnosis and educatio~ support Qog transfonned score: Ft, 357 5.33, P = 0.0216; raw score: Fl, 357 3.95, P = 0.0477). Conclusions: To our knowledge, this is the first report associating a measure of social support with a genetic polymorphism. This supports previous work that genetic factors may influence social support perception. Further work is needed to detennine the generalizability of this finding to the broader population, as well as its significance for clinical outcomes.

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This research was funded by: NIMH grants K23 MH65939, ROt MH54846 and P50 MH60451 and NIEHS grant ESl1961. Poster Number: 8 A Comparison of BriefScreening Measures for Caregivers Gaty Epstein-Lubow1, Matthew Hinckley2, Ivan W. MillerJ 1 Butler Hospital,

Providence, RI Women & Infants Hospital, Providence, RI 3 Butler Hospi~ Providenc~ RI 2

Abstract: Purpose: Caregivers of geriatric patients frequently experience symptoms of depression, anxiety and burden. The American Medical Association recently developed a screening tool for caregivers. This investigation compared the AMA's scale to several other brief assessments. Method: Participants were recmi.ted from several outpatient and inpatient geriatric psychiatry and neurology programs. Demographic information was collected along with the following self-adminstered measures: The American Medical Association's Caregiver Self-Assessment Questionnaire (CSAQ); The Center for Epidemiological Studies - Depression Scal~ 10-item version (CES-D); The Perceived Stress Scale, 4-item version (PSS4); The Rapid Screen for Caregiver Burden (RSCB); and, The.lnventory of Traumatic Grief, pre-loss version (ITG PL). Results: Fifty-one caregivers completed the questionnaire. Sixty-three percent of respondents were women (n = 32). The age of participants ranged from 28 to 85 with the majority of caregivers being geriatric (mean age = 65 years; SO 14.2) and 94 % were Caucasian (n = 48). Fifty-nine percent were spousal caregivers and 350/0 were adult children caring for a parent. The majority (810/0; n = 41) of care-recipients were reported to have dementia and the remainder suffered from mild cognitive impairment, depression or another neurological condition such as Parkinson's disease. The mean CSAQ total score was 5.6 (SD 3.8) and the mean CES-D was 9.1 (SD 6.2). The total score on all measures were significantly correlated with each other. Specifically, two-tailed Pearson correlations regarding the CSAQ showed this scale to be highly correlated with depression (CES-D; .792; P < .0(0), perceived stress (psS4; .668; P < .000), burden (RSCB; .710; p < .(00) and grief(ITG PL;

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2008 AAGP Annual Meeting .447; p = .001). Forty-three percent (0 = 22) of participants scored above the clinical cut-off of 10 or greater on the CBS-D. We conducted a sensitivity analysis to assess the ability of the CSAQ to predict depression as measured by the CES-D; using the recommended scoring roles for the CSAQ, the sensitivity was .818 with a specificity of .828. We then simplified the CSAQ scoring to a single cut-off equal to a total score of 6 or greater and the sensitivity increased to .909 while also improving specificity to .862. CODclusions: This preliminaty study supports previous data reporting increased prevalence of depressive symptoms in caregivers. burden and traumatic grief: The American Medical Association's Symptoms of depression are correlated with perceived stress~ Cuegiver Self-Assessment Questionnaire may be an adequate screening tool for depression in this population; however, simplifying the scoring should be considered. This research was funded by: Buder Hospital. Poster Number: 9

Depression in Green Ribbon Health's Medicare Health Support Program Jiitgen Uniitzer1, jennifer Taylor, Michael Schoenbaum3, Wayne Katon4, Harold Pincus5~

Diane Hogan6

of Washington, Seattle, Wi\. Green Ribbon Health, Tampa, FL 3 Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, ~ of University of Washington, Department of Psychiatry & Behavioral Sciences, Seatt1~ WA s Dept. ofPsycbiatty Columbia University and Director of Quality and Outcomes Research New Yotk-Presb, New York, NY 6 Green Ribbon Health, Tampa, FL 1 University

2

Abstract: Depression, one of the most common and disabling medical conditions among older adults bas negative effects on functional status, quality of life, adherence to chronic illness care, health care costs, and mortality. Section 721 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 authorized the testing of voluntary chronic care improvement programs, now called Medicare Health Support (lvIHS), to improve the quality of care and life for Medicare beneficiaries living with multiple chronic medical illnesses. Currently, 7 rMIS organizations are serving approximately 160,000 ?vledicare beneficiaries in eight states. Green Ribbon Health (GRH) is one such Medicare Health Support Organization (MHSO) serving Medicare beneficiaries in Florida. We will present initial findings from an NI~IH-funded research partnership with GRH that explores the impact of depression in the context of chronic medical illness and the role of evidence-based depression management strategies in the MHS program. To date, GRH has screened over 22,000 beneficiaries for depression using the PHQ-2. Contrary to prior reseaIch, using a telephonically administered PHQ2, only about 5% of this population screened positive for depression, but mailed PHQ-2 screener rates weJ:e over 14% • We will discuss a bietarehical depression case finding strategy using depression screening, ICD-9 depression claims and self reported medication data to identify co-morbid depression in large Medicare populations. We will also describe the effect of depression on health care costs and utilization. In the first year of the pro~ participants with a diagnosis or treaunent of

depression had average annual claims costs of$16,583 compared to $11,809 for patients without depression. Depressed participants were more likely to have inpatient medical admissions and emergency department visits than those without depression. We will discuss our findings in the context of existing literature suggesting substantially higher health care costs in Medicare patients with depression.

This research was funded by: NIMH. Poster Numbet: 10 Effect of Age/Gender on Efficacy/Safety of Desvenlafaxine in Adult Outpatients with MDD Christine Guico-Pabia 1, Anita H. Clayton2, Claudio N. SoaresJ, Sudharshan K. Padmanabhan", Susan G. Ahmed' 1 Wyeth

Komsteins~

Saeeduddin

Research, Collegeville, PA

2 University

of Virginia Health System, Charlottesville, VA lMclvIaster University, ON, Canada

.. Wyeth Research, Collegeville~ P.A 5 Virginia Commonwealth University, Richmond, VA 45 Wyeth Research, Collegeville, PA Abstract:

Objective: To evaluate the effect of age and gender on the efficacy and safety of desveolafaxine succinate (desvenlafaxine) treatment in patients with major depressive disorder (rvIDD). Methods: Data were pooled from 9 multicenter, mndomized, double-blind,

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2008 AAGP Annual Meeting placebo-controlled, 8-week studies of desvenlafaxine in adult outpatients with DSM-IV MOD. Five of these studies were fixed-dose studies (50, 100, 200, or 400 mg/d) and 4 were flexible-dose studies (100 to 400 mg/d). A model that included age, treatment, and treatment-by-age was used to examine the effect of age on response to desven1afaxine. Age groups of younger than 65 years (n=2798) and 65 years and older (n=115) were used A similar approach was used to examine the effect of sex on response to treatment. The primary efficacy variable W2S the 17-item Hamilton Rating Scale for Depression (HAM-Dl7) total score; data from the final on-therapy evaluation were analyzed. Results: l\. total of 2913 patients were included in the efficacy analysis (placebo 0=1108 desvenlafaxine n=1805). In the pooled 9 studies after adjusting for age effects desvenlafaxine treatment resulted in significandy lower HAM-Dt7 scores than placebo at end point (P
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Poster Number: 12 Folate Related Genes and Response to Antidepressant Medications in Late-Life Depression BrendaJamerso ., lvIartha Payne2, David C. Steffens3,Jaqueline Rimmlet4, Chris F. Potockys, Marcy C. Speer6,

Campbell University, Morrisville, NC University, Durham, NC 3 Duke University, Durham, NC .. Duke University, Durham, NC SDuke University, Durham, NC 6 Duke University, Durham, NC I

2 Duke

Abstract: Background: The folate related polymorphism, MfHFR677 cr, is a common genetic variant. Previous reports have shown that individuals who are homozygous (IT) as well as curielS crq are more likely to be depressed than those with the wild type (eq. An emerging body of evidence suggests that the elderly are at particulat risk for depression due to undernutrition. One aspect of uodemutrion, low folic acid levels, can occur in up to one-third of depressed patients and bas been associated with a lack of antidepressant response in some geriatric patients. We hypothesized that folic acid levels would modify the genetic predisposition to antidepressant response in late life depression. Based on this hypothesis, we sought to evaluate the relationship between response to antidepressant medication, reported folate intake and allelic variation in a variety of folate-related genes. Methods: 106 depressed patients participated in the NThfi-I-supported Conte Center for the study of depression in late life. Subjects were not demented and did not have another primary psychiatric disorder. They were assessed clinically for depression, completed self-report of food intake using the Block Food Frequency Questionnaire, and consented to give a blood sample for genetic research. A study psychiatrist treated patients using a guideline-based somatic treatment approach and assessed depression severity using the Montgomery-Asberg Depression Rating Scale (MADRS). Treatment response was measured as response (MADRS end 8-15 inclusive) or remission ~rADRS end <8) over the acute 12 week treatment period In collaboration with the Center for Human Genetics we examined single nucleotide polymorphism (SNP) and chromosome, in the following genes: MTHFR (methylene tetrahydrofolate reductase); MfR. (5-methyltetrahydrofolate-homocysteine methylttansfense); MTRR (5-methyltettahydrofolate-homocysteine methyltransferase reductase); BHMf (betaine-homocysteine methylttansferase); FOLRl (folate receptor 1); FOLR2 (folate receptor 2); MfHFD1 (methylenetetrahydrofolate dehydrogenase 1); SHl\rrt (serine bydroxymethyltranferase 1); CBS (cystathionine-beta-synthase); and TCN2 (transcobalamin II). Results: We found that compared with CC homozygotes at MTHFR RS1801131, AA homozygotes were less likely to achieve remission of depression (P=0.027). We also found that compared with Tf homozygotes at SHMfl RS1979277, CC homozygotes were less likely to achieve remission of depression (P = 0.0128) but bad a greater increase in remission with dietary folate than other genotypes (P=O..017). Conclusion: In our small sample size, we saw significant folate related gene differences not previously reported as related to antidepressant treatment response. We plan to conduct a larger study to determine if these findings can be replicated and deteJmine whether folate status can alter genetic suscepti.bility to antidepressant treatment response.

This research was funded by: Environmental Health Sciences Research Center.

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2008 AAGP Annual Meeting Poster Number: 13 Profiles of Functional Impairment in Older Patients Treated for Major Depression Celia F.Hybels l t Carl F. PieF, Dan G. Blazer', Richard Landerman\ Gerda G. Fillenbaum5, David C. Steffens6 Duke UnivetSity Medical Center~ Dur~ NC Univenity Medical Center, Durham, NC 3 Duke University Medical Center, Durham, NC .. Duke University Medical Center, Dutbam, NC S Duke University Medical eentet; Dutbam, NC 6 Duke University Medical Center, Durham, NC I

2 Duke

Abstract: The relationship between depression and disability in older adults is complex, with depression leading to functional decline and functional decline predicting the emetgence or worsening of depressive symptoms. The objective of this research was to explore profiles of functional impainnent in older patients treated for major depression in order to subsequently link these profiles to depression outcome. Participants were 366 patients age 60+ with major depression enrolled in a naturalistic treatment study and followed for up to t 1 years. Depression was assessed with the MAnRS. Mobility and IADLs included walking tA mile, going up/down stairs, getting aroW1d the neighborhood, shopping, handling money, taking care of children, cleaning house, preparing meals, and doing yardwork/gardening. Latent class cluster analysis was used to identify profiles of functional impairment at baseline. Three profiles ofimpairment were identified: Ouster 1) a group with low probability of any functional limitation - 57% of the patients; Ouster 2) a group with moderate limitations in mobility (such as walking and climbing stairs) and higher probability of limitations in IADL tasks (such as shopping and preparing meals) compared to Ouster 1, but lower than Cluster 3 - 250/0 of the patients; and Ouster 3) a group with generally high probabilities of endorsing all measured items (limitations in both mobility and IADLs) - 1SOlo of the sample. duster membership was associated with age, sex, education, marital status, cognitive functiooin& initial MADRS score, bistoqr of stroke, and self-rated health. These findings suggest within a sample of older patients with major depression there are latent clusters of individuals who share similar characteristics of functional impairment. Analysis is underway to examine trajectories of depressive symptoms associated with each cluster. These findings can identify which clusters of patients are at risk for poorer outcomes. This research was funded by: K01 :MH 066380, ROt MH 080311, K24 MH70027, ROl :MH54846, and P50 :MH60451. Poster Number: 14 Correlation ofMR Spectroscopy with Cognitive Impairment in Remitted Late-Life Major Depression Cheng-Sheng Chen I, Hsiu-Fen Lin2, Yu-Ting Ku03 Department ofPsychiatty, Kaohsiung Medical University, Taiwan, Kaohsiung" Taiwan Department of Neurology, Kaobsiuog Medical Universityt Kaohsiung, Taiwan 3 Department of Medical Imaging, Kaohsiung :Medical University, Kaohsiung, Taiwan I

2

Abstract: Objective: The goal of this study was to examine the biochemical abnormalities of remitted late-life major depression in the basal ganglia, dorsolateral prefrontal lobe, and hippocampus by using 3-T proton magnetic resonance spectroscopy (MRS). Correlations between cognitive function and biochemical abnormalities above these regions will be investigated. Method: Forty-four elderly patients with major depressive disorder and 44 age- and sex-match comparison elders received 3-T l\.fRS. ~m.s spectra were acquired from voxe1s which were placed in the frontal white matter, periventticular white matter, basal ganglia and pons. Ratio levels of Nacetylaspartate (NAA), choline, and mya-inositol reference to creatine were calculated. A cognitive battety tapping executive function, memoty, and infonnation processing speed were conducted Bonfenoni correction was applied to reduce type I error from multiple testing. Results: Patients with late-life major depressive disorder in remission bad a sigoificandy lower NAA/creatine at the basal ganglia and dorsolateral prefrontal lobe, and higher choline/creatine at the basal gan~ dorsolateral prefrontal lobe and hippocampus a.s compared to the control subjects. Among all biochemical abnormality at each region, only lower NA1\/creatine at basal ganglia associated with poor perfoanance of executive function, delayed recall memolY and infonnation processing speed. Conclusions: The elderly with major depressive disorder shows abnonnal brain biochemical change even in remitted state. Neuron loss at basal ganglia played a neurobiological basis for the cognitive dysfunction among the depressive elders. Poster Nmnber: 15 Amyloid-Associated Depression: A Prodromal Depre8sion of Alzheimer's Disease?

Xiaoyao Sun1, Wendy Qiu2

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Tufts-New England Medical Center, Boston, MA England Medical Ceoter~ Boston, Mi\

2 Tufts-New

Abstract: Background: Low amyloid-? peptide 42 (Abeta42) in plasmat leading to a high Abeta40/Abeta42 ratiot is associated with depression in the elderly, suggesting the existence of a potential distinct depression subtype which we have termed "amyloid-associated depression". Objective: 1his follow-up study was to characterize cognitive patterns in individuals with amyloid-associated depression, non-amyloid depression and in controls. Design, Setting and Participants: We evaluated 995 homebound elders in a cross-sectional study. Subjects were defined as depressed if they had a Center for Epidemiological Studies Depression (CES.. D) score > 16. Amyloid-associated depression was further defined by having a plasma Abeta40/Abeta42 ratio> median I\.fain Outcome Measures: Cognitive domains of memory~ laoguaget executive and visuospatial functions were evaluated among the three subgroups: without depression, non-amyloid depression and amyloid-associated depression. Results: The subjects with amyloid-associated depression had significandy lower memoJ:y scores (Logical Memory Delayed Recall Mean + SO: 15.9 + 9.6 vs. 18.9 + 9.2, P = 0.004), language (Verbal Fluency Mean + SD: 23.9 + 10.9 vs. 26.5 + 11.7, P = 0.03) and executive function (frails B Median: 301 vs. 212, P 0.01), than those with non-amyloid depression. After adjusting for potential confounding variables, relative to those without depression, amyloid-associated depression continued to be associated with impairments in memory, visuospatial ability and executive function; in contras~ non-amyloid depression was not associated with memory impairment, but remained associated with other cognitive domains. Lower plasma A?42 was correlated with poorer memory (? + 0.29, P 0.005) only among those with the highest plasma A?40 quartile who presented with depression. Conclusions: The combination of low plasma Abeta42 and high plasma Abeta40, resulting in a high A?40/A?42 mtio is associated with incident .AD in two large populations. These reported results suggest that amyloid-associated depression presenting with poor mem.oq may represent a prodromal manifestation of i\D. t

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Poster Number: 16 Pooled, Meta-Analysis of BriefAlternatives to MMSE in Detecting Dementia Srinivasa S. MaDadiIt Alex J. Mitchell2 t 2

Northamptonshire He2lthcare NHS Trust, Oundle, Northamptonshite Leicestershite Partnetship NHS Trost, Brandon l\lental Health Unit, Leicester, Leicestershire

Abstract: Aim: To evaluate the diagnostic accuracy of aD brief multi-domain altematives to the Mini Mental State Examination (l\fMSE) in detecting dementia. Methods: .L~ literature search, critical appraisal and pooled analysis was conducted of robust diagnostic validity studies. 30 distinct brief batteries were subjected to validation testing in 4 t luge scale analyses. 14 studies took place in specialist settings (J in memory clinics and 7 in secondary care). 27 studies took place in non-specialist Oow prevalence) settings (13 in primary care, 13 in the community and 1 in a nursing home).We excluded studies that presented inadequate data for inclusion in the analysis and studies which looked only at screening for mild cognitive impairment (MCI).We perfonned a sample size calculation based on which we only included those studies with over 195 subjects. We used the fonowing grades of diagnostic accuracy adapted from those suggested by Landis and Koch, 1977. 900/0 Accuracy = "Excellent"; 800/0 accuracy = "Good"; 75% accuracy = "Satisfactory"; <75% accmacy ''UnsatisfactoryIPoor." In particular we assessed if any methods scored above 800/0 on all measures (Se Sp pp\r NPV) as suggested by the Ronald and Nancy Reagan Research Institute. Results: In non-specialist settings the prevalence of dementia was 21.9%. Short screening methods of no more than 10 minutes had an overall sensitivity of 80.6% t specificity was 86.60/0 with a positive predictive value of 62.7% and negative predictive value of 94.1 °/0. The most successful individual screens in nOQspecialist settings were the Abbreviated Mental Test Score/Mental Status Questi011118ire combination, the Blessed dementia rating scale (BDRS) and the revised Blessed dementia rating scale (rBDRS). In specialist settings the prevalence of dementia was 42.70/0. Short screening methods had an overall sensitivity of 82.3% , a specificity of 85.1°/ot a pp\r of 80.4% and an NP\' of 86.6°/0. Saeeniog tools fot dementia were more successful. at case-finding in specialist than non-specialist settings and conversely more successful at mling out possible cases in non-specialist settings. The most successful individual screens in specialist settings were the and the 6-item Cognitive Impaianent Test. Head-to..head comparison with the l\.IMSE by meta-analysis DemTect, the ~Iini-Cog suggested that brief screening batteries were of comparable accuracy to the I\tIMSE. Only three analyses looked specifically at accuracy in eady stage dementia but these showed equivalent diagnostic accuracy. Conclusion: A large number ofalternatives to the ~fSE have now been validated in large samples with favourable rule-in and role-out accuracy. Clinicians may choose from many potentially briefer alternatives to the MMSE with confidence.

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Poster Number: t 7 Pooledt Meta-Analysis of Single Domain Cognitive Tests to Detecting Dementia Srinivasa S. MaDadi', .Alex]. Mitchell2

Am J Geriatr Psychiatry 16:3, Supplement 1

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I 2

Northamptonshire Hea1thcare NHS Trust, Doodle, Northamptonshire Leicestetshtte Partnership NHS Trost, Brandon Mental Health Unit, Leicester, Leicestershire

Abstract: Aim: To evaluate the diagnostic accuracy of all very brief single domain methods of detecting dementia. These methods ~amined only one aspect of cognitive function such as ori.entatio~ memory or fluency. Methods: .J.~ literature se~ critical appraisal and pooled analysis were conducted. There were 12 single domain methods analysed in 25 studies~ including 17 head-to-head with the MMSE.7 studies took place in specialist settings (4 in memory clioics and 3 in secondaty care). 18 studies took place in nonspecialist (low prevalence) settings (8 in primary care and 10 in the community.We excluded studies that presented inadequate data for inclusion in the analysis and studies which looked only at screening for mild cognitive impaianent (MCI).We performed a sample size calculation based 00 which we oo1y included those studies with over 195 subjects. We used the following gmdes of diagnostic accuracy adapted from those suggested by Landis and Koc~ 1977. 90% Accuracy = c40Excellent"; 800/0 accuracy = c'Good"; 75% accuracy; "Satisfactory"; <75% accuracy ::: "Unsatisfactory/Poor." In particular we assessed if any methods scored above W/o on all measures (Se Sp PPV NPV) as suggested by the Ronald and Nancy Reagan Research Institute. Results: In non-specialist settings single domain methods had a Sensitivity (Se) of 65.2% and Specificity (Sp) of 88.6% (pPV 65.1 %, NPV 88.7% ). In specialist settings single domain methods had a Se of 72. t % and Sp of 78.5% (pPV 76.3%~ NPV 75.3°/0). Thus these short methods were most successful in non-specia1ist settings (Youden 53.8 vs 5 t .4) and most suited to ruling out non-eases where they would be accurate in 9 out of 10 people without dementia. Individually memoJ:Y tests appeared to perfonn best, particularly the MIS, the EBMT and 3 word recall &om the MI\fSE. Verbal fluency tests also performed well. Indeed on meta-analysis verbal fluency was no less accurate in tenns of sensitivity than the MI\fSE and individual memory tests were no less accurate than the ~SE in tenus of specificity. Conclusion: When used alone single domain tests are not suited to secondary care but can be used in primary care as a quick method of ruling out people without dementia who initially have memoty complaints. Poster Number: 18 Early Predictors of Dementia: The Development ofTwo Classification Models Hannie C. Comijsl, Tessa N. van den Kommer2, Miranda G. Dik3, Cees Jonker, DodyJHDeegS

,ru University Medical Center, Amste~

NH VU University Medical Center~ Amste~ NH 3VU Univenity Medical Center, .Amsterdam, NH 4 VU University Medical Center, Amsterdam, NH 5 VU UDiversity Medical Center, iUnsterdam, NH I

2

Abstract: Objective: To develop two classification models in order to identify persons at risk for dementia in an early phase of the disease. Methods: Data was used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing population-based study~ men and women aged 55-85 years at baseline (T1; (N=3,107). In the first model, predictors were included that were easily enquit~ such as sociodemographic variables and memory complaints, and in the second model predictors requiring additional measurement (e.g. markers detennined in blood) were included The l\.ofioi-Meotal State Score was included when other predictors were no longer significant Results: Persistent cognitive decline was present in 4.0% of the sample. In the first model, age was the strongest predictor of dementia, with an increased risk for persons older than 75 (RR 10.72, 950/0 CI 5.92-19.42). In addition, having memoty problems and a M}dSE-score of £ 24~ resulted in a predictive value for dementia of 33.3%. In the second classification model, age was again the strongest predictor. In the group of persons> 75 years, having a low total cholesterol level « 5.0 mgld1) and a MMSE-score of £ 24 resulted in a predictive value for dementia of 30.00/0. In persons with a total cholesterol level of 3 5.0 mgldl, carrying the ApoE e4 allele and a M}dSE-score of £ 24 resulted in a final positive predictive value of 12.00/0. Conclusion: Both models lead to a substantial increase of the predictive value for persistent cognitive decline and thus for dementia, that is 4.00/0 to 33.3% and 30.()%~ respectively. Therefore, they could be useful with respect to the identification of a group of frail elderly, contributing in a feasible and cost-effective way to case-finding of people at risk for dementia. This research was funded by: LASA is funded by the Dutch Ministry of Heal~

Welfare, and Sports and the VU University.

Poster Numbet: 19 Initial Longitudinal Validation: The Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment Emory Hill!, Jane Tomatore2, Maty Reid3, Joel S. Ross" t

Screen. Inc., Seattle, WA

2 Alzheimers Association,

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Seattle, WA

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting 3 Screen, of

Inc., Seattle, WA Memory Enhancement Center of.America, Long Branch, NJ

Abstract: Background: Early identification of the mild cognitive impairments that progress to .AD could delay placements in nursing homes and reduce the rate of disease progression. The CANS-l\IICI is a computerized screening measure designed for usability and efficiency in clinicians' offices to help deteanine the need for full diagnostic dementia evaluations. Objective: To detennine the effectiveness oCCANS-MCI longitudinal scoring algorithms for detecting Mel, using the criterion standards of full, longitudinal neuropsychological evaluations and diagnostic correlates in a primary care setting. Methods: 410 elderly community-dwelling volunteers enrolled in a 3-year longitudinal NIA-funded study. Logistic regression and ROC curve analyses were run on a sub-sample of study participants who received baseline and t-year follow-up full neuropsychological evaluations (N= 74). Follow-up analyses are presented here along with longitudinal data on 60 self-referred patients in a prinw:y care office. Conclusions: Based on the criterion standard categorization (nonnal vs. mildly impaired) scoring algorithms were generated using logistic regression that best fit the data for baseline and 1-year follow-up scores. Two separate algorithms were created based on level of education 12 yrs. and 13+ yrs.)" These correcdy classified 85% of participants with a high school degree or less (Chi-square = 11.74) and so% of those with at least some college (Chi-square = 31.41). ROC curve analyses on the two educational levels revealed that cut-points lead to sensitivities/specificities of.93/.83 «=12 yrs) and .84/.74 (13+ yo). Areas under the curve were high (.917 for <= 12 yrs education and .888 for 13+ yrs). The CANS-Mel is an effective screen for the need to perfonn full neuropsychological evaluations. A clioical sample (N=59) followed for at least one year confinned this finding with respect to diagnostic correlates. Multiple screenings over time are recommended for highest predictive validity.

«=

This research was funded by: Saeen, Inc.

Poster Number: 20 The MetaboHc Syndrome and Episodic Memory Deficit: Gender Differences Vasava Nairl, NMK Ng Ying Kin2, George Schwartz3,Joseph X Thavundayil4 Douglas Mental Health University Institut~ Montreal, QC Mental Health University IQStitut~ MOQtreal, QC 3 Douglas rvrental Health University Institute, Montreal, QC -I Douglas ~tal Health University Institute, Montreal, QC I

2 Douglas

Abstract: Introduction: Reports from several epidemiological studies suggest that diabetes as well as other metabolic factors may be important risk factors in the development of i\]zheimer's Disease. As part of an on-going longitudinal study on brain aging to detect early markers of dementia~ 70 (36 me~ 34 women) physically and psychiatrically healthy subjects (mean age 69 yrs; range 47-83) underwent complete physical and neurological examinations yearly which included a battery of neuropsychological tests, serial blood sampling for melatonin and cortisol levels and routine blood chemistty. Over a period of 6 years, seven men and six women developed significant episodic memory deficit (EMD), a well-known hallmark. for early Alzheimer's Disease. Aim: To determine whether there were any differences in MSy and its individual cardiovascular risk factors between subjects that bad developed EMO over this period and those that had not. Results: There were no differences in gender across the two groups: 7 of 13 subjects (54°/0) that developed EMO and 29 of 57 (51°/0) of subjects that did not were men. There were five subjects that met the National Cholesterol Education Program i\dult Treatment Panel III criteria of the National Heart, Lung, and Blood Institute for the ~fetabolic Syndrome (MSy), although none was diabetic. No difference was found in teans of the number of subjects that had MSy (normals n = 4; 7.0010 and E~ID n = 1; 7.10/0). On the other band, there were differences found in some of the individual cardiovascular risk factors. In tenus of the E1vID group's mean compared to the 950/0 confidence interval (CI) of the nonnal group, the findings were as follows: Systolic blood pressure (BP) was higher in men (131 mmHg; CI= 116 - 126) but not women (122 mmHg; CI = 118 - 130). Diastolic BP was higher in both genders (men 76 mmHg; CI= 70 - 76. women 78 mmHg; CI= 65 - 77). The lipid profile also showed gender differences with levels higher in women but lower in men with both triglycerides (men 1.28 mmol/L; CI = 1.39-1.93. women 1.81 mmol/L; CI = 1.11 - 1.80) and total cholesteJ:ol (men 5.4 mmol/L; CI 5.4-6.1 & women 7.1 mmol/L; CI 5.5-6.4). HDL cholesterolleve1s were lower in men oo1y (1.1 mmol/L; CI= 1.2 - 1.4 & women 1.7 mmol/L; CI=1.41.8). Glucose levels were found lower in women only (5.12 mmol/L; CI= 5.21 - 5.65 & men 5.64 mmol/L CI= 5.35 - 5.96). Conclusion: This study finds no association between metabolic syndrome and the development of episodic memoty deficit, which is known to be an early baJJmark for Alzheimer's Disease. However, a gender-dependant relationship was found with some individual cudiovascular markers within the syndrome.

=

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting Poster Numbec 21 Modulation of Human Memory Circuit by Minor Depression in Late Life: An fMRI Study Sboshana L. Wool, Steven E. Prince2, Caroline Hellegers3,]effrey RPetrella4, P. Murali Doraiswamy5 Duke University School ofMedicin~ D~ NC Duke University Medical Center, D~ NC 3 Duke University Medical Center, Durham, NC .. Duke University ~fed.ical Center, Durh.am, NC S Duke University Medical Center, Durham, NC I

2

Abstract: Background: There is great interest in studying the relationship between late-life depression (UD) and cognitive dysfunction. LLD can not only masquerade as pseudodementia but may also be a prodrome or risk factor for Alzheimer's disease. The mechanism by which depression impacts human memory is not known. Functional PMC deactivation is a physiological process involved in normal memory, and impairment of this process bas been linked to Alzheimer's disease. Methods: 62 nondemented subjects (ages 60-85) underwent f1vIRI at 4 Tesla during a face-name associative memory encoding task, with novel-versus-familiar stimuli. Depression symptoms were quantified using the Beck Depression Inventoty (BDl). A !egression model was created to isolate brain activation that co-varied with BDI score. Results: After adjusting for age, gender, education, and baseline ~fSE, BDI score was negatively correlated (p<0.05) with posteromedial cortex (pMq deactivation. Increased depression scores were associated with loss of PMC deactivation. Conclusioll8: Our findings raise the hypothesis that even lateOAlife minor depression may impair physiological Pl\fC deactivation. Further studies in more severely depressed individuals may be warranted. This research was funded by: Ewald W Busse NIMH Fellowship in Late Life Mood Disorders; NIA R01AG019728.

Poster Number: 22 Executive Deficits in Alzheimer's Disease: An FDG-PET Imaging Study Benjamin KP. WOOl, Dylan G. Harwood2, Mark M. Mandelkem3,.Amy Walston4, Rebecca). MelJ:ose5, Olivia Campa6, David L.Sultzer7

University of California, Los Ange1es, Bakersfield, Cl\ UCLA, Los Angeles, CA 3 UCLA, Los Angeles, CA .. UCLA, Los .i\ngeles" CA 5 UCLA, Los Angeles, CA 6 UCLA, Los Angeles, CA. 7 Veterans .i\ffairs Greater Los Ange1es Healthcare System, Los Angeles, CA I

2

Abstract: Objective: Executive dysfunction is common in patients with Alzheimer's disease (AD), contributes prominendy to clinical disability, and may be associated with frontal lobe pathology. This study examined regional cerebral hypometabolism associated with executive deficits in patients with AD. Methods: Forty-one subjects with probable AD underwent 18F-fludeoxyglucose positron emission tomography (FOG-PEl) imaging and clinical assessment. Neuropsychological measures of executive control included the Conceptualization (Cone) and Initiation/Perseveration (I/P) subscales of the l\(attis Dementia Rating Scale, Wechsler Adult Intelligence Scale Similarities subtest, Tower test, and the Ruff Figural Fluency test (Ruff). Voxel-based analyses were conducted using Statistical Parametric Mapping (SPM2) to measure the correlation between glucose metabolism and executive scores. State Examination ~lMSE) score Cottelations independent ofglobal cognitive impairment were identified by including ~fini-~feotal as a covariate in the model Results: There were significant positive relationships between metabolic rate and I/P score in bilateral middle frontal gyri (BA9/46) and bilateral angular gyri (BA7); between Cone and bilateral middle frontal gyri (BA9/46), right inferiot frontal gyms (Bi\45), left inferior/middle temporal gyri (BA 20/21), left angular gyms (BA39/17), and bilateral superior parietal lobule (BA7); between Similarities and left inferior temporal lobe (BA 38/21/20/37) and left angular gyros (BA7); between Tower test and right middle/inferior frontal gyri (Bol\ 46/45); and between Ruff and right inferior temporal lobe (BA38/21/20/37), and angular gyms (BA7/19). Control for global cognition yielded a statistical trend towards a positive association between lIP and metabolic activity in the left middle frontal gyms (BA9). There were positive significant associations between metabolic rate and the Conc score in the left anterior inferior prefrontal cortex (HAlO/1I /45)t and left lingual gyrus (BA17/18/19); between Similarities and left inferior temporal lobe (B.A28/20/37); between Tower test and right middle frontal gyrus (B.l\46), left inferior frontal gyrus/insula (BA45), and right insula; and between Ruff Fluency and right fusifoml gyrus (Bi\37). In sum, with control for overall cognition, several executive measures were associated with metabolic mte in heteromodal prefrontal and temporal regions.

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Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Conclusion: Some but not aU executive deficits in .AD are associated with hypometabolism in lateral and inferior aspects of the prefrontal cortex, notably deficits in abstract reasoning and verbal/motor fluency. These data suggest that some executive skills are critically dependent on neural activity in the frontal cortex. Executive dysfunction is a common manifestation of AlzheimeCs disease, and frontal impairment may serve to predict executive deficits and functional disability. This research was funded by: :MH56031 from the National Institute of&fental Health and by the Department of Veterans Affairs. Poster Number: 23

Evidence for Inflammatory Cytokines as the "Final Common Pathway" of Delirium Pathogenesis Sandra A. Jacobsonl , Dianne Lorton2 1 Sun 2

Health Research Institute, Sun City, AZ Sun Health Research Institute, Sun City, AZ

Abstract: Delirium is a syndrome of disturbed consciousness, cognition, and perception that develops acutely in the context of medical disease and/or in the post-operative period Symptoms include disorientation, memory problems~ inattentio~ incoherent speech, hallucinations, excessive daytime somnolence, nighttime wakefulness, and episodic severe agitation. That deliriwn is associated with physical disease is cle~ but little is known about its pathogenesis from direct study. The most common medical conditions associated with delirium in elderly patients are infections in other areas of the body (lungs, urinary tract), metabolic derangements, fluid/electrolyte imbalance" and medication reactions. The most common surgeries associated with post-opemtive delirium are orthopedic surgeries (e.g.~ hip &acture repair) and open-heart surgery. A final common pathway is believed to exist. linking these diverse etiologies with the delirimn syndrome, although no common biomarker bas been identified. It is of note that many of these conditions ate known to be associated with increased serum levels of pro-inflammatory eytokines, particularly IL-l,

IL-6, TNF-alpba, and the interferons. When an insult such as an infection or inflammation from surgical trauma occms in the periphery]l the eNS is signaled by these eytokines, and reactive gIia in tum produce eytokines]l resulting in what has been called "sickness behavior." Components of sickness behavior include hypersomnia, lisdessness, weakness, malaise, inability to concentrate, withdrawal from usual activities, cessation of oral intake~ internal preoccupatio~ and apparent depression. These behaviors overlap significandy with delirium symptoms; in fact, considering the context in which each of these syndromes arises, it would be reasonable to hypothesize that the two tenDS describe the same or similar state. Sickness behavior is believed to enhance the febrile response as part of an organized strategy to fight illness. If applicable to delirium, this model could place delirium. in an understandable evolutionary context, a concomitant of serious illness that promotes rest. Evidence will be presented from the literature that levels of inflammatory cytokines assayed in serum are elevated in deliDmn from heatstroke, influenza, and acute hepatic encephalopathy (among other conditions), and that high semm levels of these cytokines noanalize with recovery. In addition, data regarding post-operative serum eytokine elevations will be shown, and prelimiwu:y data &om our ongoing prospective smdy of inflammatory cytokines in elderly patients who undergo hip surgery will be presented. The potential clinical significance of the "eytokine hypothesis" will be discussed, as will the possible relationship between inflammatory mechanisms in delirium and inflammatory mechanisms in diseases such as Alzheimer's dementia.

This research was funded by: Lifespan Developmental Grant Award, Sun Health Research Institute Developmental Grant Award. Poster Number: 24

Testing the Role of Cognitive Reserve-Associated Cortical Networks with fMRI-Guided rTMS Bruce Luber!, Arlelle Stanford2, Peter Bulow3~ Yaakov Stem4, Sarah H. LisanbyS NY State Psychiatric Institute, New York, NY State Psychiatric Institute, New Yode, NY 3 NY State Psychiatric Institute, New York, NY .. Columbia University, New Yo~ NY SNY State Psychiatric Institute, New Yo~ NY t

2 NY

Abstract: Much of the cognitive decline due to aging can be explained by decline in working memory (WlvJ). We have attempted to model age-related WM decline by applying repetitive transcranial magnetic stimulation (rThIS) to young adults, testing the tole of selected cortical regions in mediating sleep-deprivation induced deficits in visual WM perfonnance. Three rTMS targets were selected using an fMRI-identified network associated with sleep deprivation-induced WM performance impairment (Habeck et al., 2004): two regions &om the network (left superior occipital and micDine parietal cortex) and one non-netwotk region (left inferior occipital cortex). Fifteen participants Wlderwent total sleep deprivation for 48 hours. rTMS was applied at 5Hz during a WM task in a withiosubject sham-controlled design. rTMS to the superior occipital site resulted in a reduction of the sleep-induced reaction time deficit,

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting while stimulation at the other sites did not (p<.Ol). Each subject had undergone £MRI scanning while perfonning the task both preand post-sleep deprivation, and the degree to which each individual activated the £MRI network was measured. The degree of performance enhancement with superior occipital rThfS cotte1ated with the degree to which each individual failed to sustain network activation (p<.025). These results suggest that the activity of the network exhibited properties of neural reserve, a mechanism for cognitive reserve where a gteater capacity or efficiency in the network allowed some individuals to maintain perfonnance in the face of a reversible "pathology.n Moreover, our results suggest that rTMS was able to enhance network activity in those who were not able to maintain performance, artificially facilitating neural reserve. \Vbile the neural mechanisms behind the rThiS-aided facilitation remain speculative, the results here demonstrate how rThIS could be applied to test the functional significance of £MRI-identified networks associated with resilience to cognitive decline.

This research was funded by: D.ARPA. Poster Number: 25

Plasma Kynurenine to Tryptophan Ratio is Associated with Post-Stroke Cognitive Symptoms Krista L. Lanctot l , Nathan Hernnann2, Sandra E. Black 3, Lana S.Rothenburg4,JOt1 E.Weens, Demetrios J. Sabia 6, David]. Gladstone', Richard Aviv8, Scott Walker9 Health Sciences Centre, Toronto, ON Sunnybrook Health Sciences Centre, Toronto, ON 3 Sunnybrook Health Sciences Centre, Toronto, ON "'Sunnybrook Health Sciences Centre, Toronto, ON 5 Baycrest Hospital, Toronto, ON 6 Sunnybrook Health Sciences Centr~ Toronto, ON 7 Sunnybrook Health Sciences Centre, Toronto, ON 8 Sunnybrook Health Sciences Centre, Toronto, ON 9 Sunnybrook Health Sciences Centre, Toronto, ON 10 Sunnybrook Health Sciences Centre, Toronto, ON 1 Sunnybrook

2

Abstract:

Background: The kynurenine to tryptophan ratio (K/1) is thought to be a direct measure ofindoleamine-2,3-dioxygenase (IDO)

activation. We measured the plasma KIT ratio in patients with ischemic stroke to determine the behavioural correlates of increasing KIT ratios. Methods: 56 (30M/26F, mean age±SD: 70.1±15.1) patients (43 inpatients, 13 outpatients) with recent (28±40 days) mild-moderate (NIHSS score=8.6±5.6) ischemic stroke (NINCDS criteria) and no histoEy of cognitive impainnent were studied. Results: The KIT ratio (?mol/mmo~ was measured in 55 of 56 participants (162±69S1 range 71 to 456). When patients in the highest KIT tertile (?180 ?mol/mmol, n=15) were compared to those in the lower tertiles (n=45) they had significantly lower M:MSE scores (24.2±4.9 vs 27.. 1±4.0, p=.038) with significandy higher concentrations of the antiinflammatory cytokine JL.I0 (p=.04) and trends for increases in some (IL-18, p=.08; IL-6 p=.13) but not all (IFN-ganuna, IL-l beta) pro-inflammatory cytokines. Regression analyses showed low M:MSE, elevated eytokines and anterior lesion location predicted KIT ratio, even when time since stroke was considered (F5,32=6J3, p<.001). Conclusions: These preliminaty findings suggest that an elevated KIT mtio is associated with increased cognitive symptoms post-stroke. This finding may be important since an elevated KIT ratio can increase the production of neurotoxic metabolites.

This research was funded by: Heart and Stroke Foundation of Canada. Poster Number: 26

E8trogen Interacts with the Chotinergic SY8tem to Affect Verbal Memory in Postmenopausal Women Julie 1\. Dumas 1, Catherine Hancur-Bucd2, Magdalena R.. Naylor3, Cynthia Site", PaulA. Newhouse5 of \7ermont College of Medicine, Burlington, VT University of" ermont College of Medicine, Burlington, VT 3 University of Vermont College of Medicine, Burlington, \rr .. University of Alabama School of ~redicine, Birmingham, AL 5 Univetsity of Vennont College of Medicine, Burlington, 'TT 1 Univelsity 2

Abstract: Estrogen bas been shown to interact with the cholinergic system to affect cognition in post-menopausal women. This study further investigated the interaction of estrogen and cholinergic system. functioning on verbal memoty in two groups of healthy younger (ages 50-62) and older (ages 70-80) post-menopausal women. Twenty-two postmenopausal women were randomly and

AI00

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting blindly placed on 1 mg of 17-beta estradiol orally for one month then 2 mg for 2 months or matching placebo pills after which they participated in three anticholinergic challenge sessions during which verbal memory performance was assessed Subjects were administered either the antimuscarinic dmg scopolamine (SCOP), the antinicotinic dmg mecamylamine (?vfECA) or placebo. After the first challenge phas~ they were crossed over to the other hormone treatment for another 3 months and repeated the challenges. Results showed that estradiol pretreatment sigoificandy (p < .01) attenuated the anticholinergic dmg-induced impainnents on the test of episodic memory (the Buschke Selective Reminding test) for the younger group only, while estradiol tJ:eatment impaired perfonnance of the older group. The results suggest that there maybe a critical period for the benefit of estrogen treatment to be seen on cholinergic system integrity. This research was funded by: NIA ROl AG021476, NIA F32 AG23430, AA IIRG-99-t81 1, GCRC M01-O0109. Poster Number: 27

Estradiol with or without Progesterone Eft'eets on Chotinergic-Related Cognitive Performance in Older Women PaulA. Newhouse1,Julie A. Dumas2, Christy Edgren], Emily Codetre4, Magdalena RNaylorS,Julia Jobnson6

University ofVennont College of Medicine, Burlington, VT of Vennont College of ~fedicine, Burlington, vr 3 University of Vermont College of ~Iedi~ Burlingto~ VT .. University of Vermont, Burlington, VT SUniversity of Vermont College of Medicin~ Burliogto~ VT 6 University of Vermont College of Medicine, Burlington, vr I

2 University

Abstract: Estrogen has been shown to interact with the cholinergic system and influence cognition in animal models and in humans. Our prior studies found that 1 mg estradiol (E2) per day attenuated the effects of anticholinergic drugs on attention and speeded tasks in healthy postmenopausal women (PMW) and 2 mg E2 improved episodic memory in younger PMW. Current reconunendations include progesterone (PRO) with estrogen treatment for most women. However, the cognitive effects of adding progesterone on cholinergic functioning are not well undentood in humans. The current study investigated whether adding PRO per day to E2 would reduce the anticholinergic-induced impainnent on memory tasks in. addition to the attention measures. Thirteen DOnna! PMW were blindly placed on 2 mg of 17.. ? E2 with either micronized PRO (200 mg) or placebo for 3 months after which they participated in 5 anti-cholinergic dmgchallenges using the anti-muscarinic dmg scopolamine (SeOp, 2.5 and 5 ?g/kg, IV), the anti-nicotinic dmg mecamylamine (MECA, 10 and 20 mg, oral), and placebo After the first challenge phase they were crossed over to the other combination for an additional 3 months and repeated the challenges. Preliminary analysis showed that the addition of PRO significandy (p<.03) reduced the ability of estrogen to protect against slowing of psychomotor speed after cholinergic blockade. However there was also evidence for improvements in recognition memory with the addition of PRO to E2. The addition of progesterone may have variable effects on different cognitive domains due to variable effects of PRO and/or neurosteroid-like metabolites. The results suggest that estrogen and progesterone status affects cholinergic system tone and may be important for age.. related cholinergic system integrity. This research was funded by: NIA ROt AG021476~

NIA F32 AG23430~

GCRC M01-00I09.

Poster Number: 28

Apathy in Dementia: Relationship to Depression, Functional Competence, and Quality of Life Catherine A Yeagerl ~ Lee Hyer2 t

2

Essex County Hospital Center, Institute for Mental Health Policy, Research and Treatment, Cedar Grove, NJ Nem:osurgical Institute of Georgia, Mercer University Medical School" Macon, GA

Abstract:

Background: Apathy is the most common symptom reported by patients with Alzheimer's disease (AD)~ affecting up to 70% of patients in the mild to moderate stages ofthe disease. Apathy often overlaps with depression in dementia but is distinguished by the absence of dysphoria. Apathy also is associated with cognitive impainnent: as cognitive decline becomes more severe, apathy inaeases. This is especially true for tasks that require good executive functioning (EF). Quality oflife (QoL) also suffers as apathy worsens. The present study investigated the nature of apathy in dementia by examining its association with depression, functional competence~ and QoL in the context of high versus low levels of COgnitiOIL Method: A sequential sample of sixty-eight outpatients from a university dementia clinic was evaluated by a multidisciplinary team to detennine the nature/extent of cognitive, functional, and medical impainnents. The sample was primarily Caucasian (85%) and female (600/0). AD or Dementia-NOS were the most common diagnoses. Scales included: Apathy Evaluation Scale, ComeR Scale fOI Depression in Dementia, an executive function test -

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting the Stroop Color Word, traditional ADL and IADL measures, the Functional Activities Questionnaire, and the Disability Assessment for Dementia scale" which assesses EF. QoL was calculated from 5 relevant items on the Geriatric Depression Scale SF. Two groups were created: high global cognition (MMSE ? 22) and low global cognition (I\'IMSE ? 21). Results: High vs. Low cognition groups differed on depression symptoms in the context of apathy; depression was significantly more likely to appeu with apathy in the low cognition group only. The low cognition group only showed a significant relationship between apathy and traditional ADLs/L~Ls; the more apathy, the less able one was to manage basic hygiene and typical daily living activities. In contrast, the high cognition group showed significant negative coaelations between apathy and traditional IADLs and complex LU>Ls that stress executive functioning. Increased apathy was associated with poorer Stroop performance in the high cognition group only. Finally, increased apathy was significantly correlated with worse QoL, but this held for the high cognition group only. Discussion: Findings suggest that depression and apathy are orthogonal constructs in the context of dementia, as evidenced by the lack of association for patients with better cognitive functioning. Findings also suggest that dementia patients with better cognition, but who are apathetic, have difficulty managing complex daily living activities and that this deficit is consistently associated with pOOl: executive functioning. too, supports the ugument that apathy in dementia is frontally mediated. 1ms pattem did not occur in the low cognition group, suggesting that poor cognition may be a more potent influence on functional competence than apathy.

nus?

Poster Numbet: 29

High Incidence ofAggression in Pemons with Dementia Madt E. Kuoik l , Lynn Snow2,Jessica A.Davilal , Avila B. Stee1e4, Valli Balasub:mmaoyamS, Rachelle Doodf, Paul E. Schulz', Jagadeesh S. KalavarS, Robert O.Morgan9 E. DeBAkey VAMC, Baylor College of Medicine, Housto~ 1X University of .Alabama., Tuscaloosa, AL 3 Michael E. DeBAkey VAMC, Baylor College of Medicine, Houston, 'IX 4 Michael E. DeBAkey V.AMC, Baylor College of Medicin~ Housto~ TX 5 :Michael E. DeB.i\key VAMC, Baylor College of Medicine, Houston, TX 6 Baylor College of Medicine, HoustOD; 'IX 7 Michael E. DeBAkey VAMC, Baylor College of Medicin~ Housto~ TX 8 Michael E. DeBAkey VAMC, Baylor College of Medicine, Houston, TX 9 :Michael E. DeBAkey VlUvIC, Baylor College of Medicine, Houston, TX 10 :Michael E. DeBAkey VAMC, Baylor College of Medicine, Houston, TX 1 Michael

2

Abstract: .-\ggression is among the most distressing and dangerous symptoms of dementia, yet uncertainty remains about its incidence and causes. The objective of this study was to conduct a two-year longitudinal examination of patients newly diagnosed with dementia who bad been previously nonaggressive, and to identify the incidence of aggression and factors that predicted the development of aggression. Methods: Newly diagnosed, nooaggressive dementia patients were initially identified primarily through VA Administrative Databases and VA primary cate physicians. Inclusion criteria were age over 60 years and a new diagnosis of dementia. Newly diagnosed was defined as receiving an initial outpatient lCD, 9th revision, Clinical ~10di6cation (ICD-9-0d) code for dementia (code 290-XX, 291.2,292.82,294.1,294.8, or 331.0) in the 12 months before their screening. Exclusion criteria were 1) presence of aggressive behavior; 2) current residence in a nursing home; or 3) having a caregiver less than 8 hours per week. Participants and their caregivers were assessed monthly for 24 months. The dependent variable was aggression (Cohen-Mansfield Agitation Inventory Aggression subscale). The independent predictor variables included: Depression (Hamilton Rating Scale for Depression), Psychosis (Neuropsychiatric Inventory), Pain (philadelphia Geriatric Center Pain Intensity Scale), Caregiver Bumen (Bmden Index), Caregiver Relationship ~utuality Scale) and Environmental Quality (pleasant Events Scale). Baseline cognitive status (Dementia Rating Scale) was considered a contro1ing variable. Results: The cohort of 215 patients incidence of aggression was 0.37 per year at risk. Using bivariate analyses, significant baseline differences existed between those who developed aggression and those who did not were observed in terms of dementia severity (p ? .004), depression (p ? .02), mutuality (p ? .002), burden (p ? .0001), delusion (p ? .007) and hallucination (p ? .004). Using cox proportional hazard analyses, higher total mutuality (p ? .006) scores at baseline were associated with decreased risk. of onset of aggression, while higher levels of caregiver burden (p ? .0(01) and pain (p ? .03) were associated with increased risk of aggression. For our change measures, increases over time in depression (p ? .04) and pain (p ? .05), and declines in total mutuality (p ? .0001) were also all associated with increased risk of onset of aggression. Conclusion: The common occurrence of aggression and identification of several potentially mutable factors raise the importance of assessing and treating these factors, which have the potential to prevent and lessen the adverse consequences of aggression.

This research was funded by: VA HSR&D.

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2008 AAGP Annual Meeting Poster Number: 30 Agitation and Resistiveness to Care are Two Separate Behavioral Syndromes of Dementia Ladislav Volicer1, Elizabeth A Bass2, Stephen L" Luther-l University of South Florida, Land O'Lakes~ VA Hospital, Tampa, FL 3 J.A.Haley \TA Hospital, Tampa, FL I

2 J.A.Ha1ey

FL

Abstract: Objective: This study was to distinguish two behavioral syndromes of dementia: agitation and resistiveness to care by analysis of Minimum Data Set (1\'IDS). MDS from Veterans Administration nursing homes collected from October 13, 2000 through October 14, 2004 were used to identify 23,837 residents with a diagnosis for Alzheimer's disease or dementia other than Alzheimer's. Detennination of agitation in each patient was based on the recorded value for six MDS variables: repetitive questions, repetitive verbalizations, expressions of what appear to be unrealistic fears, repetitive health complaints, repetitive anxious complaints or concerns and repetitive physical movements. Patients who exhibited the MDS variable "resists care)), defined as "resisted taking medications/injections, ADL assistance or eating" anytime within the last 7 days of the assessment, and whose behavior was not easily altered were considered "resistive to care." Severity of dementia was measured by the Cognitive Performance Scale using three MDS items: short term memory, cognitive skills for daily decision making and making self undeIStood. Agitation alone was present in 170/0, resistiveness to care alone in 90/0 and both syndromes in 80/0 of residents. Agitation and resistiveness to care had different relationships to dementia severity. Agitation was present in a significant number of residents who wete borderline intact, was most common in subjects with moderate cognitive impairment and decreased thereafter. In contrast, resistiveness to care was relatively rare in borderline intact and mildly impaired residents and increased gradually, with the highest prevalence in those with vety severe cognitive impairment. The prevalence of resistiveness to care increased as the ability to understand deteriorated. Most residents who were rated as having abusive symptoms were also resistive to care. These results indicate that agitation and resistiveness to care are two separate behavioral syndromes that may also oeem together. It is important to distinguish between agitation and resistiveness to care because these syndJ:omes require different management strategies(1). (t)Resistiveness to care. In: Management ofChallengiog Behaviors in Dementia. ~lahoney,E.K.; Volicer,L.; Hurley,A.C. Chapter 9, pp 146-153. Baltimore: Health Professions Press; 2000.

Poster Number: 31 Neuropsychiatric ConditioDs Associated with Aggression in Geropsycbiatric Inpatients: Potential Targets for IntervenuoD Helen H. Kyomen l , Theodore H. Whitfield2 I 2

McLean Hospital, Belmont~ MA Massachusetts General Hospital, Boston, MA

Abstract: Objectives: The objectives of this pilot study were (1) to detennine what neuropsychiatric conditions were most prevalent in patients who displayed aggressive behaviors pr:oximate to hospitalization on an acute care geropsychiatric unit, and (2) to deteanine whether any of these neuropsychiatric conditions predicted aggressiveness proximate to admission and could thus be potential tugets for intervention" Method: Reaospective descriptive and logistic regression analyses of medical record data of 270 patients who were consecutively hospitalized on a geropsychiatric acute care hospital unit between 1998-2000. Results: Aggressive behaviors were defined as actions directed towards others, oneself or the environment which cause or threaten to cause physical and/or emotional distress or hann. One hundred eighty eight of 270 patients (69.6%) bad aggressive behavior proximate to hospital admission. Of these, 93 (49.5°/0) were diagnosed with dementia, 87 (46.3°10) with a general medical condition (GMq related mood or psychotic disorder, 63 (33.5°/0) with major depression, 61 (32.5%) with delirium, 30 (16%) with alcohol abuse/dependence, 22 (11" 7%) with bipolar disorder, and 8 (4.3% ) with a psychotic disorder not othenvise specified (NOS). Logistic regression analyses showed that dementia predicted aggressiveness proximate to admission (odds ratio 1.99, robust standard error 0.55, 2=2,,49, p=0.013, 95% CI=1.16--3.43); these findings remained statistically significant after adjusting for age, Mini-Mental State examination (IvIMSE) score, education and gender. Bipolar disorder also predicted aggressiveness proximate to admission (odds ratio 3.49, robust standard error 2.20, z=1.98, p=O.048, 95°/oCI=1.01--12.04). G~[C related disorders, major depression, delirium, alcohol abuse/dependence and psychotic disorder NOS did not predict aggressiveness proximate to admission. Conclusions: Geriatric patients often have complex neuropsychiatric conditions that may contribute to the development of aggEessive behavioral distutbances. In clinical settings, health care professionals who specialize in gerontology have been trained to evaluate for and treat acute, subacute and chronic conditions that may exacerbate aggressive behaviors. This pilot study showed that, using logistic regression modeling, dementia and bipolar disorder predicted aggressiveness proximate to geropsychiatric hospitalization. Several other neuropsychiatric conditions, for which the patients were comprehensively evaluated and treated during their hospital stay~ were not predictive of aggressiveness proximate to admission.

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2008 AAGP Annual Meeting Poster Number: 32 Tertiaty Care Geriatric Psychiatry Patients: Diagnostic and Clinical Characteristics Barbara Bureel, Rhonda Malyuk2, Carol Wongl., Arvind Kang', Kiran Rabheru5, Marilynn MacDougall' Rivenriew Hospital, Coquitlam, Be Coquitlam, Be 3 RiveEView Hospital, Coquitlam, BC .. Riverview Hospital, Coquitlam, BC 5 Riverview Hospital, Coquitlam, BC 6 Riverview Hospital, Coquitlam, Be I

2 Riverview Hospital,

Abstract: Background: Clinicians have observed changing patient characteristics within hospitalized geriatric psychiatry patients. With incleasing pressure to decrease length of stay, attention has focused on patient characteristics and care needs. In 2003, Riverview Hospital (RVH), a tertiary care facility, implemented a quality improvement program (QI) to assess treatment outcomes using standardized validated tools. A database was developed for multivariate analyses of clinical variables, outcome measures and length of stay. Purpose of the Study: Identify clinical symptoms necessitating tertiary care and determine their impact on length of stay (LOS). Identify subgroups of patients with different diagnostic and clinical characteristics and resulting care needs. Method: Retrospective analyses of 390 patients admitted and discharged within a 4-year period to describe diagnostic, clioical, functional and medical clw:actenstics and length of stay. Data &om the QI instruments included: Neuropsychiatric Inventory (NPI-NH), Functional Independence Measure (FIM), Modified Cumulative Illness Rating Scale (MCIRS), RVH Geriatric Psychiatty Needs i\ssessment Tool and medication records. Patients with bipolar and schizopluenia/schizo-affective disorders were compared to all other patients in the program. Results: Overall, discharged patients had improvement in total FIM (improved ADLs), total NPI-NH (decreased psychiatric symptoms), and required fewer staff for care (all p < .01). The effects were moderated by level of dementia with poorer outcomes for increasing dementia severity. Two subgroups of patients will be described: those with long-standing mental illness (bipolar and schizophrenia/scbizoaffective disorder) and those with severe dementia with BPSD. Patients with modetate/severe dementia presented with higher psychopathology and required more staff for care (p < 0.01). Interesting medication trends differentiated by diagnosis have also emerged. Conclusion: Standatdized scales can identify clinical characteristics of tertiaty care psychiatric patients that impact LOS. In addition, distinct subgroups presented with different characteristics and care needs. This information contributes to individual patient treatment planning as well as appropriate service delivery development for long-teon community care.

Poster Number: 33 Measuring Outcome Effects of Medic:ation Changes in Tertiary Geriauic Psychiatry Patients Rhonda ?vla1yukl, Barbara Bmee2, Carol Wongl, Arvind Kang', NUmal Kaog\ Kiran Rabheru6,:Marilynn MacDougal17 Riverview Hospital, CoquitIam. Be Coquitlam, Be 3 Riverview Hospital, Coquitlam, Be .. Rivem.ew Hospital, Coquitlam, BC 5 Riverview Hospital, Coquitlam, BC 6 Riverview Hospital, Coquitlam, Be 7 RiveIView Hospital, Coquitlam, Be I

2 Riverview Hospital,

Abstract: Background: All patients admitted to Riverview Geri-Psych Program are assessed with standardized validated outcome tools at admission, evety 3 months and discharge. Commencing in 2003, outcome data coupled with demographic and medication infODDation has been entered into a database. The database now has infonnatioD on BOO admitted and discharged patients. Objectives: To determine changes in neuropsychiatric symptoms, function and length of stay (LOS) with wee types of medication interventions. Methods: Retrospective analyses of admission / discharge data to determine demographics, outcome score changes, and LOS in three groups of patients. 1. Patients not receiving benzodiazepines (BDZ) on admission and discharge vs patients with Bnzs reduced or discontinued. 2. Patients requiring aotlbiotic(A) treatment at admission vs a control group. 3. Patients on no antipsychotics (AP) on admission/disclw:ge vs AP added during hospitalization. Outcome Tools: Neuropsychiatric Inventory (NPINH);Functional Independence Measure (FIM); Modified Cumulative Illness Rating Scale (MCIRS) Results: Preliminary analysis: 390 patients. Mean (M) age 75.6yr. Female: 52.6%. >60% Dementia 1.21.3% on BDZ at admission, 64% BDZ were discontinued: Total FThi improved (p=.08) with a significant improvement in Mobility subscale (p=.Ol). Total NPI-NH improved for all groups but

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2008 AAGP Annual Meeting greatest in BDZ D / C group.. MCIRS/LOS: no significant change. 2. Antibiotics at admission: 21 % Significantly older M-age 77..99 vs 74..94 (p=.004), more comorbidity, p<.OOI, reduced ~f-LOS 111.37 vs 142.28 (p=.02). Functional improvement greater in antibiotic group. 3. 63 patients (16%) no antipsychotic (.AP) at admission. 1/3 i\P at discharge. No antipsychotics at admission & discharge had lowest lvI-NPINH on admission & shortest ~f-LOS. Only the group discharged on antipsychotics showed significant improvement in Total FIM(p<.013) Be mobility subset (p=.043) and a greater improvement in Total NPI-NH (p=.057) and NPI-NH .o\gitation/irritability/ disinhibition subset (p=.. 027) Conclusions: Discontinuing benzodiazepines in this group of patients can significantly impact mobility and improve overall function and neuropsychiatric symptoms. Infections and the need for antibiotic treatment continues to be prevalent in patients admitted to tertiary geri-psych facilities. Early treatment can significantly decrease LOS and improve function. Continued community education is needed to look for infectious causes of worsening psychiatric symptoms. Adding antipsychotics to patients with significant psychopathology can significandy improve symptoms and function. These preliminary findings demonsttate that reuospective database analysis provides important infonnauoo on outcomes with medication changes in a diverse group of tertiary geri-psych inpatients. Poster Number: 34 Correlates and Predictors of Behavioral Health Hospitalization in Nuamg Home Residents Marion A. Beckerl , Ross Ande12, Timothy Boaz3 University of South Florida, Tampa, FL University of South Florida, Tampa~ FL 3 University of South Florida, Tam~ FL t

2

Abstract: Objectives: Prior research indicates the quality of mental health care provided to nursing home residents is suboptimal. Little is known, however, about the prevalence or coaelates and predictors of resident discharge to hospital for behavioral health reasons. This study examined resident and facility characteristics associated with behavioral health hospitalizations for ~fedicaid enroDed nursing home residents in Florida. Design: This retrospective study employed three years (FY 02-05) of Medicaid eligibility, fee-forservice, and phannacy data to examine resident characteristics. Online Survey Certification and Reporting (OSCAR) data were used to identify specific nuning facility characteristics. lvlultivariate logistic regression analysis, adjusted for individual and facility levels of data, was employed to determine the relative importance of predictive factors for experiencing a psychiatric hospitalization. Setting: Medicaid certified nursing homes located through-out the state of Florida. (N=584). Participants: A total of 23.475 female and 8,,843 male l\.fedicaid enrolled nursing home residents. Measurements: Outcome variable: discharge from the nursing home for a behavioral health hospitalization. Predictor variables included demographic, diagnostic and facility characteristics.. Results: Among nursing home residents, behavioral health hospitalizations were associated with YOWlger age, male gender, poor physical health, serious mental illness and dementia. Those over age 65 were 60% less likely to be hospitalized. \Vhile a dementia diagnosis more thaD doubled the hospitalization rate, a major psychotic disorder increased the odds more than 12 times. Among facility level characteristics, only being a member of a chain yielded a result that approached statistical significance. Conclusions: Study findings indicate that resident characteristics impact the risk of behavioral health hospitalizations and facility characteristics were less important in predicting hospitalizations. The fact that 52% of the residents hospitalized for behavioral health conditions had dementia is of particulat concem because such individuals are at high risk for relocation sttess syndrome (RSS). This in tum is associated with increased mortality and morbidity. Relocation by hospitalization thus presents a major health risk for nursing home residents. This research was funded by: Florida Agency for Health Care Administration.

Poster Number: 35 The Control ofAcute Psychosis or Agitation in a Geriatric Population: Use of Intramuscular Ziprasidone .Alina Raisl, Kristi Wtlliams2, Theodor Rais3, Tanvir Singh4, Manjo Tamburrin05 The University ofToledo Health Science Campus, Toledo~ OH The University of Toledo Health Science Campus, Toledo, OH 3 The University ofToledo Health Science Campus, Toledo, OH "'The University ofToledo Health Science Campus, Toledo, OH sTIle University of Toledo Health Science Campus, Toledo, OH I

2

Abstract: The pwpose of this open label study was to assess the safety and efficacy of ziprasidone 1M in controlling acute psychosis and agitation in geriatric patients. Patients above 60 years old who were admitted to a Geriatric Psychiatry inpatient unit were invited to participate. Exclusion criteria included: history of auhythmias, recent myocardial infarction, electrolyte imbalance, severe vomiting

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting or diarrhea, and QTc interval> 450. Patients who became acutely psychotic or agitated could receive ziprasidone 1M 10 mg q 6-8 hours, up to a maximum dose of 20 mg/24hours. Most subjects (790/0) received only one 10 mg dose. The Brief Psychiatric Rating Scale (BPRS), Delirium Rating Scale (DRS) and the Behavioral Activity Rating Scale (BARS) were obtained at baseline and at 0.5, 2 and 24 hours after the first dose of ziprasidone 1M. The data were analyzed using paired t-tests comparing individual differences between two variables, and one way repeated measures ANDVA to determine if the means differed over time. Fourteen patients, six male and eight female, mean age 77 + 8 years participated in this study. Each patient had a diagnosis of dementia, co-occuningwith one of the following: delirium, major depressive disorder with psychotic features, schizophrenia, bipolar disorder, or schizoaffective disorder. Physiologic measures, including QTc intervals, remained unchanged pre- and post-study. Compared with baseline scores, there was significant improvement in BPRS (p
=

=

=

=

This research was funded by: Pfizer. Poster Number: 36 Weight Gain and Use ofAtypical Antipsychotics in Loug-Term Care Elderly: A Retrospective Chart Review Shilpa Srinivasan l , Ronald E Prier2, John Magill3, Kimberly B. Rudd"', Micah BaxleyS, Christian Neal6,james Bouknight', Paul K.SwitzerS, Richard Hardin'

Kimberly B. Rudd 1, ~cah Magill8, Richard Hardin'

Baxley2, Shilpa Srinivason3,james Bouknight', Christian Neals, Paul K. Switzer6, Ronald E. Prier7,john

of South Carolina School of Medicine, Columbia, SC University ofSouth Carolina School of Medicine, Columbia, SC 3 University of South Carolina School of Medicine, Columbia, SC .. University of South Carolina School of Medicine, Columbia, SC 1 University

2

J

U"iwrsity ofSouth Carolina School ofMedicine, Columbia, SC

University of South Carolina School of Medicine, Columbia, SC University of South Carolina School of~ledicine / South Carolina Department of Menta! Health, Columbia, SC 8 South Carolina Department of Mental Health, Columbia, SC 9 University of South Carolina School of Medicine, Columbia, SC 6

7

Abstract: Objective: To investigate the association between weight gain and atypical antipsychotic use in elderly long-tenn care patients. Methods: A retrospective chart review of 28 patients ages 60+, admitted between 1995- 2007 to C.M.Tucker Long-Tenn Care Center was conducted. Data included demographics, diagnosis, premorbid cardiovascular disease and diabetes (DM), atypical antipsychotic prescriptions, weight, new-onset diabetes and cardiovascular disease.. 64% received atypical antipsychotics during the period investigated. The most common diagnosis was dementia (710/0), followed by schizophrenia (210/0). 68% of patients were male, 71 % African Ameri~ 29% Caucasian. Results: • The most commonly prescribed agent was Risperidone (610/0), followed by Olanzapine (550/0), Quetiapine (28%), Ziprasidone (220/0) and Aripiprazole (0.050/0). • 430/0 of patients had cardiovascular disease and 18% had diabetes prior to admission. • 75% with new onset diabetes (0=4) had been prescribed Olanzapine prior to D?\.f diagnosis. • Weight parameters (on admission): 0460/0 of patients were overweight (BW 25-29.9) 0460/0 of patients were normal weight (BM! 18.5-24.9) • 61% (n=11) of patients prescribed atypicals lost weight (0.55- 29.6Ibs, mean 14.33lbs). Dementia was the most commODdiagnosis (82%) in these patients. • 33% of patients receiving atypicals gained weight, with Risperidone and Olanzapine prescribed in the most (830/0 and 66% respectively). • 660/0 with weight gain on atypicals had normal BMIs on admission. • There was no difference in the number of individuals with weight gain vs.loss among those patients not receiving atypical antipsychotics (n=10). Conclusions: Results from our review are reflective of other preliminary studies showing lack of association between weight gain or treatment emergent diabetes in elderly long-tean care patients receiving atypical antipsychotics. Our research is on-going with larger sample sizes to provide more insights into this finding.

Poster Number: 37 Cost-Utility of the Rivastigmine Transdermal Patch in the Management of Patients with Moderate Alzheimerfs Disease in the

US

Balazs Nagyl, Alan Brennan2, AgnesBrandtmii1lerl, Simu K. Thomar, Sean D. SullivanS, Ron Akehurst6

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1 School

of Health and Related Research, University of Sheffield, University of Sheffield, Sheffield School of Health and Related Research, University of Sheffield, Sheffield 3 School of Health and Related Reseatch, University of Sheffield, Sheffield .. Novartis Phatmaceuticals, East Hanover, NJ 5 University of Washington School of Public Health, Seattle~ W4.~ 6 School of Health and Related Resear~ University of Sbef6e1~ Sheffield 2

Abstract: A novel rivastigmine transdennal patch has recendy been approved in the US for the treaUDent of 4.lliheimer's disease (AD) and Pukinson's disease dementia (PDD). The current objective was to model the incremental cost-utility of the rivastigmine patch versus best supportive care (BSC; no active treatment) in the management of i\D~ from the perspective of a US payer. The incremental costs and number ofinstitutional days avoided with the rivastigmine patch versus BSC over 5 years were calculated using an economic model Changes in !vfini 1vIental State Examination (1vfMSE) scores over a 5-year period were used as a measure of the progression of AD. The clinical pathway was populated based on the results ofa large clinical trial, with 12-month fonow-up data from patients who received the rivastigmine patch (0 = 383) and 6-month follow-up data from patients who received placebo (0 = 282). Progression of the disease was modeled beyond the study period using published equations to predict the nanual decline of ~E in AD patients. Costing variables included drugs, community care and institutionalization. The rivastigmine patch was shown to actually save $1,986 per patient and help avoid 64.3 instttutional days over 5 yeats, proving it to be a dominant strategy over BSC. One-way sensitivity analysis suggested that the main detemlinants of cost-effectiveness were; the likelihood of institutionalization; the relationship between M1vISE states and quality of life; and the analytic perspective adopted. In this model, the rivastigmine patch has a more favorable cost-effectiveness profile compared with many treatments curtendy reimbursed by US health care agencies. Further research studies focusing on effects on activities of daily living to demonstrate cost effectiveness and benefits of treatment are warranted.

This research was funded by: Novartis Pharmaceuticals Corporation. Poster Number: 38

Tarenf1urbil Delays Time to Clinically Significant Psychiatric Events in Alzheimer's Disease (AD) Jacobo ~fintzerl, Suzanne Hendrix2, Kenton Zavitz3, Edward Swabb4 1 Medical

University of South Carolina, Charlesto~ SC Pharmaceuticals, Inc.., Salt Lake City, UT 3 Myriad Pharmaceuticals, Inc., Salt Lake City, UT .. Myriad Pharmaceuticals, Inc., Salt Lake City, UT 2 ~fyriad

Abstract: Background: Tarenflurbil (lMPC-7869, Flurizan) is a Selective Abeta42-Lowering Agent (Si\.I..u.o\) that lowers brain levels of.t\.beta42 in a mouse model of .i~D and chronic dosing in this model prevents defects in learning and memory. These data and the Phase 2 study indicating sustained benefit in activities of daily living, global function and cognition in mild i\D patients suggest the potential for taren£lurbil to have disease-modifying properties. The goal of this analysis is to explore a possible effect of tarenflurbil on time to onset of psychiatric adverse events in .AD subjects.. Methods: This was a placebo-controlle~ l-year study evaluating tarenflurbil in 207 patients with mild-to-moderate AD. At randomization, 940/0 of subjects were on stable acetylcholinesterase inhibitor therapy. An exploratory post-hoc analysis was performed which compared time to adverse psychiatric events between treatment groups. Results: In subjects with mild AD (ldZvISE 20-26) thele was a significant delay in time to clinically significant adverse psychiatric events in the 800 mg BID group compared to placebo (P=O.ot 1). The median time to event was approximately 106 days in the placebo group among the 35% of this group who had an event. In the 800 mg BID group~ the median time to event was greater than 333 days with only 14% of this gtoup having an event. The most common psychiatric events reported in the placebo group were agitation, aggressiOl\ confusional state and depression. Conclusion: In addition to the reported significant benefit observed in activities of daily living (p=0.033) and global function (P=O.042), this exploratory analysis revealed a significant delay in time to psychiatric events. These results are consistent with the hypothesis that treatment with tarenflrubil may delay progression of AD.

This research was funded by: Myriad Pharmaceuticals, Inc. Poster Numbet: 39

Alzheimer's Disease Clinical Trial Designs: Toward a Practical DemoDstration of Disease ModificatioD Suzanne Hendrix 1, Scott Horton2,]ean-Marc Orgogoz03

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting Phannaceuticals, Inc., Salt Lake City, UT Pharmaceuticals, Inc., Salt Lake City, UT 3 Univetsity of Bordeaux, Bordeaux, Bordeaux 1 Myriad

2 !vlyriad

Abstract:

Background: Demonstration of Disease Modification in AD is a complicated methodological and regulatory issue that has been approached in several ways. Among the strategies proposed are those based on measuring clinical outcomes in modified cross-over type studies: t. the (randomized withdrawal' design and 2. the cstaggered start' design. These two designs are complicated by long study duration, leading to lUlbalanced dropout rates introducing bias. A suggested alternative is a parallel groups design comparing slopes and severi.tyof disease at baseline. Methods: The staggered start design can be mathematically proven to be equivalent to the randomized withdrawal design. A proposed ccoatuml history staggered star(' design based on parallel groups is compared to the staggered start and randomized withdrawal designs to see whether it is capable of distinguishing between a disease modifying and a symptomatic treatment. Results: A "natural histoty staggered start" design is described in which an analysis of slope divergence is combined with an analysis assessing differences in treatment effect depending on severity of disease at baseline. This design is shown to be mathematically equivalent to a staggered start or randomized withdrawal design. Conclusion: The staggered start and randomized withdnwal designs are impractical because of the long duration of treatment require~ the bias and loss of power introduced by the associated high dropout rates, and ethical concerns. A novel and practical parallel groups design allows measurement of the same underlying patterns of drug effect, with differentiation of symptomatic and disease modification drug effects, without the drawbacks of these cross-over approaches.

This research was funded by: Myriad Phannaceuticals, Inc. Poster Number: 40

Clinical Persistence: How Long do Patients Remain on ChoHnesterase Therapy?

Nathan Hemnano l , William Dalziel2, Carin Bindee, Steve Smyth"', Fernando Camachos University of Toronto, Toronto, ON Ottawa Hospital, Ottawa, ON 3 ]anssen-Ortho Inc., Toronto, ON t

2 The

"Janssen-Ortho Inc., Toronto, ON S Damas Inc., Toronto, ON

Abstract: Introduetioa: Treatment for.AD tends to be required for long periods of time and currently cholinesterase inhibitors (ChEIs) are the tteatment of choice. The putpose of this study was to examine ChEI utilization including days on thempy and numbers of patients persisting with these drugs, in a population-based sample,. Methods: Persistence defined a priori as: allowed missed days of medication < twice the number of days of the previous prescription; breaks in prescriptions not to exceed 30 days at one time; total number of missed days allowed per year? 120 days. Data was based on the Ontario Drug Benefit Programs database. The database was examined for persistence the ChEIs available in Ontario: rivastigmine(RIV), donepezil(DON), galantamine extendedrelease(G.AL ER) and galantamine immediate-release(G.AL IR). The dataset comprised all patients initiated to new ChEI prescriptions from Feb-May 2006; followed prospectively up to 1year. A comparison of patients beginning therapy with GAL ER(Feb - ?vfay 2006)& GAL IROan-4~pr 2005)was performed. The analysis was based on an ANOVA model with either persistence or time on medication as the response~ medication (GAL ER, DON, RIV) as the main factor and month as replication. \Vhen a significant medication effect was observed, Tukey's analysis was conducted to determine differences among the medications. The dataset was examined to whether patients had been prescribed ChEI therapy in the previous 5 years. Results: For the period of FebMay 2006 there were 4031 REM ER(mean age:82 years),1045 RIV (mean age:80 years),3398 DON(mean age:81 years) new prescriptions. There were 1633 REM IR(mean age:81 years) new prescriptions from] an-Apr 2005. Statistical analyses of clinical persistence demonsttated a significant medication effect at 1 year for GAL ER(p< 0.(01). The mean days of medication dispensed statistically favoured GAL ER (p=O.OOl). Tukey's analysis to detect differences between ehEI medications indicated GAL ER had significandy higher persistence (67.8% )(p
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2008 AAGP Annual Meeting This research was funded by: )ansSet1-0rtho Inc. Poster Number: 41

The Relationship Between Cardiopulmonary Fitness and Depressive Symptoms in Patients with Stable Coronary Artery Disease Nathan Hemnann l , Krista L. Lanctot2, Walter L. Swatdfager3, yekta Dowlati4, Alex Kisss, Paul I.Oh6

Sunnybrook Health Sciences Centre, TOlonto, ON Health Sciences Centr~ Toronto, ON 3 Sunnybrook Health Sciences Centre, Toronto, ON "' Sunnybrook Health Sciences Centre, Toronto, ON 5 Sunoybrook Hetith Sciences Centre, Toronto, ON 6 Toronto Rehabilitation Institute, Toronto, ON I

2 Sunnybrook

Abstract: Background: Late-life depression is associated with signs and symptoms of underlying cerebrovascular disease but causal relationships between cerebrovascular risk factors and depressive symptoms remains controversial Likewise, Major Depressive Disorder is at least two-fold more prevalent in patients with Coronary .Artery Disease (CAD) but vascular predictors of depressive symptoms have not been extensively investigated in patients with stable CAD. Design: Cross-sectional cohort study. Methods: Consecutive patients entering a cardiac rehabilitation and secondary prevention program underwent screening for depressive symptoms using the Centre for Epidemiological Studies Depression (CES-D) scale and cardiopulmonaty fitness testing to quantify peak oxygen consumption ('702 Peak). Sociodemographic characteristics, medical comorbidities, cardiac history, cardiopulmonary parameters and concurrent medication use were extracted by electronic chart review. Factors previously associated with depression were entered into a backwards elimination multiple linear regression model to identify significant independent predictors of depressive symptoms. Results: 22.3% of patients with CAD (0=366) reported at least mild (CES-D3 16) and 10.4% reported significant (CES-D323) depressive symptoms. .t\ntidepressant medications were being used by only 6.30/0 of patients. Sociodem.ograpbic, cardiopulmonary and cardiac chamcteristics, and medical comorbidities previously associated with depression accounted for 14.7% of the variance in the final regression model (F=8.713, p
The Drummond Foundation, The Physician's Services

Poster Number: 42 Comparative Safety and Tolerability ofAlzheimer's Disease Treatments Gustavo Alval,Jeffrey L.Cummings2, ~la1ca Resnick3, l\{icbael Tocco", Stephen Graham5

A1P Clinical Researc~

Costa Mesa, CA Alzheimer's Disease Research Center, Los Ange1est 3 Forest Research Institut~ Jersey City, NJ .. Forest Research Institute,Jersey City, NJ S Forest Research Institute, Jersey Cityt NJ I

2

c.'\

Abstract:

Purpose: In the U.S., mild to moderate Alzheimer's disease (AD) is treated with cholinesterase inhibitors (ChEIs), while moderate to severe AD is treated with the N1vIDA receptor antagonist memantine and the ehEI dooepeziL The pmpose of this study is to review the safety and tolerability of the ehEIs and memantine, based upon manufacturers' data &om prescribing infonnation (PI) documents. Methods: US prescribing infoanation documents for donepezil, galantamine, rivastigmine, and memantine were obtained from American manufacturers' websites, accessed inJuly 2007. Quantitative data about adverse events (AEs) from each PI document were reviewed. In additio~ the odds of each AE occurring in the active vs. placebo group for each drug were compared by means of odds ratios. Descriptive safety data are presented without statistical analysis. Results: A review of prescnbing infonnation data indicated that the ChEIs donepezil, rivastigmine, and galantamine are associated with cholinomimetic effects. Nausea and vomiting were consistendy reported across all ebBI trials as the most common reasons for trial discontinuation.

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting Dizziness, anorexia, and dW:rbea were also commonly reported AEs in all ebBI ttials. The most frequently reported AEs in memantine trials were dizziness, headache, and confusion. No AEs led to trial discontinuation in >10/0 of memantine-treated patients and at a frequency greater than that observed in placebo-treated patients. Odds ratio analysis of i\Es occurring in mote than 50/0 of patients (rounded to the closest integer) in the active treatment group suggests that, donepezil treatment - compared to placebo - was associated with significandy higher odds of experiencing diarrhea, muscle cramps, and nausea compared to placebo treatment in patients with mild to moderate AD, and of experiencing anorexia, diarrhea, ecchymosis, nausea, and vomiting in patients with severe AD. Galantamine treatment was associated with sig0i6candy higher odds of experiencing anorexia, dizziness, headache, nausea, vomiting, and weight decrease compated to placebo treatment. Patients treated with orally delivered rivastigmine had significantly higher odds ofexperiencing abdominal p~ accident, anorexia, asthenia, depression, diarrhea, dizziness, fatigue, headache, nausea, and vomitin& compared to conttol; whereas there were 00 AEs with significantly higher odds in patients treated with the standarddose rivastigmine transdeanal patch. For memantine treatment, sigoi6candy higher odds ratios compared to placebo were found for headache. Conclusions: .All FDA-.approved AD treatments are safe and tolerab~ including the co-administration of memantine and donepezil. It is dif.fieult to make comparisons between drugs studied in different trials, but available data suggest that gastrointestinal AEs, typical of ChEls, may be gready reduced by transdeanal administmtion. Memantine provides a distinct tolerability profile that may be of use to physicians

This research was funded by: Forest Laboratories, Inc. Poster Number: 43 Memantine Improves Functional Communication in Patients with Moderate to Severe Alzheimer's Disease Pierre N. Tariotl,Judith Saxton2, ?vfichael Tocco3, Robert K. Hofbauer, Mala Resnick5, Stephen M. Graham6 Banner Alzheimer's Institute, Phoenix, AZ Disease Research Center, Pittsb. PA 3 Forest Research Institute, Jersey City, NJ .. Forest Research Institute, Jersey City, N] 5 Forest Research Institute, Jersey City, N] 6 Forest Research Institute, Jersey Oty, NJ 1

2 Alzheimer's

Abstract:

Background: Memantine, an uncompetitive antagonist of N-methyl-D-aspartate receptors, is approved in the United States and Europe for the treatment of moderate to severe i\lzheimer's disease (AD). In a previously publish~ 24-week double-blind, placebocontrolled trial in patients with moderate to severe AD who were receiving stable doses of donepezil (MEM-}dJ)-02; Tariot et al, JAMA, 2004), the memantine-tteated group (n=202) petfonned significantly better than the placebo-treated group (n=201) on all protocol-specified outcome measures, including those assessing cognition (100-point Severe ImpaiDnent Battery [Sill]), function (19item AD Cooperative Study -.Activities of Daily Living scale [ADCS-ADL19]), and behavior (Behavioral Rating Scale for Geriatric Patients [BGp]). In this post hoc analysis of the MEM...MD-02 study, the effects of memantine on language and functional communication were evaluated using only the language items from the SIB and functional communication items from the ADCS.ADL19, and BGP. Methods: The language items on the sm were grouped into three subscales: Naming, Reading/Writing, and Comprehension/Repetition/Discourse. In addition, a Functional Communication score was calculated using items from the ADCSADL19 (e.g. ecOid the subject...pay attention to conversation or small talk...'~ and BGP (e.g. "The patient makes him/herself understood by speakin& writing, or gestures"), which assess the patient's verbal and non-verbal communication abilities as reported by the caregiver. Analyses using an observed cases (oq and last observation carried forward (LOCF) approach were based on an analysis of covariance (ANCOVA) model, with treatment group and study center as factors and baseline value as covariate. The mixed-effects model with repeated measurements (M:MR1v'J) analysis used treatment group, time, treatment-group-by-time interaction and center as factors, baseline value as covariate and an unstructured covariance matrix. For each post hoc measure, the groups were compared in terms of change from baseline at week 24 (LOCF, OC, ~J:MRM). Results: At week 24, patients receiving memantine performed significandy better than patients taking placebo on the Naming subscale (OC: P=O.009; LOCF: P=O.032; MMRM: P=O.020). The Functional Communication score was also sig0i6caody better in the memantine group compared to placebo at week 24 (OC: P=.OO4; LOCF: P=.022; ?vfi\.1lUd: P=.OO4). Conclusions: In patients with moderate to severe AD receiving stable doses of donepezil, the addition of memantine treatment was associated with sig0i6cant benefits in naming and functional communication relative to patients treated with placebo. This research was funded by: Forest Laboratories, Inc.

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2008 AAGP Annual Meeting Poster Number: 44 Dimebon Stabilizes Neuropsychiatric Symptoms in Alzheimer's Disease: One-Year Clinical Trial Results Jeffrey L.Cummings1, Rachelle Doody2, Svetlana I. Gavrilova3,1vfaty Sano", Paul S. Aisens, Lynn Seelt, David Hung? University of California, Los Ange1es~ Los Angeles, CA College ofMedicine, Houston,. TX 3 Russian Academy Medical Sciences, Moscow, Moscow .. Mount Sinai Medical Center, New York, NY 5 Georgetown University Medical Center, Washington, DC 6 Medivatioo, Inc., San Francisco, CA 7 Medivation, Inc., San Francisco, CA 1

2 Baylor

Abstract: Background: Dimebon is a novel dmg for Alzheimer's Disease (AD) that has recently been shown to improve cognition, activities of daily living (ADL), behavior and global function in a randomized, double-blind, placebo-controlled study of patients with mild-tomoderate AD.. Dimebon-tteated patients were stabilized on all five endpoints assessed at one year, whereas placebo-treated patients declined over the one-year course of the study. nus paper reports the results of analysis of the 12 subdomains of the Neuropsychiatric Inventoty' (NPI), a measure designed to assess the neuropsychiatric symptoms of AD. Methods: t 83 patients were randomized at 1 t sites in Russia to 26 weeks of treatment and were then offered the opportunity to continue double blind treatment in the originally-randomized group for an additional 26 weeks. Endpoints included the ADAS-cog, 1\1MSE, ADCS-ADL, NPI, and the CIBIC-plus to assess overall function. The NPI was assessed at baseline (Week 1) and at Weeks 12, 26, 39, and 52. Results: Dimebon-treated patients were significantly improved on the NPI total score (frequency x severity) compared to placebo-treated patients at Week 26 (-3.3, p= 0.006 using last observation carried forward for imputation; - 3.3~ P = 0.01 observed case [oq) and at Week 52 (-3.5, P =0.04 oq. The total NPI score at Week 52 for Dimebon-treated patients was not different from the score at baseline whereas placebo-treated patients worsened over the 52-week study period. Dimebon treatment resulted. in overall improvement vs. placebo in all subdomain scores (frequency x severity) at Week 52 except for delusions, elation/euphoria, and disinhibition. The greatest benefit ovetall was seen in the subdomains of depression/dysphoria, apathy/indifference, and motor disturbance.. Dimebon-treated patients with symptoms at baseline showed greatest reductions in depression/dysphoria, apathy/indifference, and motor disturbance at Week 52. Dimebon-treated patients without symptoms at baseline had lower scores on the subdomains of delusions, hallucinations" depression/dysphoria, anxiety, apathy/indifference, irritability/lability, and motor disturbance at Week 26 and lower scores on hallucinations, apathy/indifference, irritability/lability, nighttime behaviors, and appetite/eating at Week 52. Caregivers of Dimebon-tteated patients reported less distress at Weeks 26 and 52 than did caregivers of placebo-treated patients (-2.3~ p 0..004 at Week 26; -2.~ P = 0.04 at Week 52). Conclusions: Dimebon treatment stabilized the neuropsychiatric symptoms of AD over one year and decreased caregiver distress. Benefits were seen across most subdomains, but were most prominent in the subdomains of depression/dysphoria, apathy/indiffetence, and motor disturbance. Dimebon-treated patients developed fewer new symptoms of delusions and hallucinations.

=

This research was funded by: Medivation, Inc. Poster Number: 45 Donepezil for Severe Abheimer's Disease: Behavioral Effects in Patients with Multi-Domain Responses Jeffrey L. Cummings1,joan A. Macke1l2, Anita Murthy3, Richard Zhang4 1 UCLA

Alzheimer Disease Center, Los Angeles, CA Pfizer Inc, New York, NY 3 Eisai Inc, Woodcliff Lake, NJ .. Pfizer Inc, New York, NY 2

Abstract: Background: Behavioral and neuropsychiatric symptoms are important clinical manifestations of Alzheimer's disease (AD) and are associated with greater caregiver burden, greater cost of care, and are a major reason for nursing home placement.. In randomized clinical trials of donepezil, behavioral benefits have been demonstrated, but significant dmg-placebo differences in total Neuropsychiatric Inventol'f (NPI) scores are not always apparent. Analysis ofindividual behaviors may be more meaningful than the total score of a behavioral measure. Objective: To examine behavioral benefits in donepezil-treated patients whose cognition and global function/activities of daily living (ADL)/behavior stabili2ed or improved. Methods: Patient data were pooled from two 6month randomized, placebo-controlled studies of donepezil in severe AD (MMSE ?12, FAST 5-7d). Cognition was assessed by the Severe Impainnent Battery (Sm)~ global function by the Clinician~s Interview-Based Impression of Change-Plus caregiver input or

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2008 AAGP Annual Meeting the Clinical Global Impression of Improvement, ADL by the AD Coopemtive Study ADL-severe~ and behavior by the 12-item NPI. month 6, changes in total NPI and in individual NPI items were analyzed for l'IT-LOCF donepezil patients showing multidomain responses. Results: Neither study showed significant between-group differences in total NPI for the overall donepeziltreated and placebo-treated groups, although all groups showed improvement from baseline. Among a pooled subgroup of donepezil-treated patients showing combined domain response A-stabilized/improved cognition and improved global function or ~\DL or behavior-significaot improvements vs. a pooled placebo group were seen for the total NFl (P=O.OO32) and for apathy/indifference (P=O.OI31), anxiety (P=O..OI72), and agitation (P=0.0311). For combined response B-stabilized/improved cognition and global function and ADL-significant improvements were seen for the total NPI (P=O.0057) and for apathy/indifference (P=O.0355) and anxiety (p=O.0154)" with agitation (P=O.0678) and eating disorders (P=O.0894) showing borderline significance; for combined response C-improved cognition (?4 8m points) and stabilized/improved global function and ADL-significant improvements were seen for the total NPI (P=O.OO14) and for apathy/indifference (p=O.0054), with anxiety (P=0.0553), agitation (P=O.0690), aberrant motor behavior (P=O.0795) and eating disorders (P=0.0516) showing borderline significance. Notable differences between donepezil responders and the pooled placebo group were not seen for other individual NPI items. ConclusioDs: Patients with severe AD who show positive multiple--domain responses to donepezil may demonstrate distinct patterns of improvement in individual neuropsychiatric and behavioral symptoms, despite vatying and/or inconclusive total NPI results for the overall donepezil-treated population. ~~t

This research was funded by: Eisai Inc. and Pfizer Inc. Poster Number: 46 Donepezil in Mild Alzheimer's Disease: Meta-Analysis of Patient Cohort with Mild Dementia .A.nita K. rvIurthyl, Robert Goldman2, Richard Zbang3, Yijun Sun4 Eisai Inc., Woodcliff Lake, NJ Pfizer Inc, New Yo~ NY 3 Pfizer In~ New York, NY "' Eisai Inc., Woodcliff Lake, NJ I

2

Abstract: Background: The benefits of treating AD with donepezil in the early stages have been demonstrated in clinical trials. Donepezil showed improvement in cognitive measures (Alzheimer's Disease Assessment Scale-cognitive subscale [ADAS-cog] and Mini-Mental State Examination ~1SE]) in a 6-month study of patients with mild ,,\1) ~ISE 21-26; Seltzer et al. Arch New:ol. 2004;61:18521856). Objective: To further evaluate the effects of donepezil in mild AD in a meta-analysis ofindividual patient data from the donepezil clinical development program. Methods: The donepezil clinical trial database was searched for placebo-controlled studies that included patients with mild AD.. The Seltzer study was not included. Patients with baseline Ml\.fSE scores of 21-26 were included in the analysis. Summary statistics for AD..AS-cog and ~IMSE scores in the donepezil and placebo anns were calculated from individual patient data and compared using an l\nalysis of Covariance (ANCOVA) model with baseline as covariate" Donepezil and placebo were analyzed at Week 12 and Week 24, both as observed cases (oq and last observation canied forward (LOCF). Results: Preliminary findings from seven studies included MMSE data for 723 patients (443 donepezil, 280 placebo) with mild AD. Change from baseline in MMSE scores favored donepezil at Week 12 DC (treatment difference 0.7 points, P =.001) Week 12 LOCF (0..8t P .OO(2)t Week. 24 OC (1.. 3, P < . 0001), and Week 24 LOCF (1.3, P < .0001).. Eight studies included ,,'\nAS-cog data for 1040 patients (690 donepezil, 350 placebo). Change from baseline on the ADAS-cog favored donepezil at Week 12 DC (treatment difference 1.5 points, P < .0001), Week 12 LOCF (1..7, P < . 0001), Week 24 DC (1 . 0, P = .02), and Week 24 LOCF (1.2, P = .003). Conclusions: In this meta-analysis, donepezil was associated with significant cognitive benefits in a large cohort of patients with mild AD.

=

This research was funded by: Pfizer Inc and Eisai Inc. Poster Number: 47 Dementia in Fragile X-Associated Tremor/Ataxia Sydrome (FXTAS): Comparison with Alzheimer's Disease .\nclreea Seritan l , Danh Nguyen2, Ladson Hinton3,Jim Gtigsby4, Randi HagetmanS

DC Davis Psychiatry, Sacramento, CA UC Davis, Davis" CA 3 DC Davis, Sacramentot CA 4 University of Colorado at Denver Health Sciences Center, Aurora, CO 5 University of California, Davis, Sacramento, CA I

2

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2008 AAGP Annual Meeting Abstract: Neurocognitive difficulties in &agile X-associated tremor/ataxia syndrome (FXTAS) involve attentional controL working memory, executive functionin& and both declarative and proceduralleaming. A FXTAS frontal-subcortical dementia syndrome was postulated. We seek to better characterize the clinical dementia picture in FXTAS and compare it with the cortical dementia of Alzheimers type. To date, no studies comparing FXTAS with other dementias have been done. Methods: Retrospective chart review of 68 adult patients (50 men, 18 women) with FXTAS. 25 men had cognitive impairment. Inclusion criteria represented a clinical diagnosis of dementia. Exclusion criteria were: other neurodegenerative dementias, history of cerebrovascular accidents, traumatic brain injury, and alcohol use. The final sample consisted of 20 men with FXTAS and dementia. The comparison group consisted of patients with mild Alzheimer's dementia (AD), matched by age, gender, and education level. Neuropsychological measures were compared between the two groups, including: Boston Naming Test (BNT, for language), phonemic fluency tests, indicative of executive function (Controlled Oral Word Association Test, COWAT, and CFL), and digit span forward (DSF, assessing attention) and backward (DSB, for working memoty). Comparisons were based on the analysis of covariance and t-tests to assess significant differences between groups with respect to the neuropsychological measures. Results: 500/0 of men and no women were cognitively impaired. with onset of cognitive impairment following the onset of motor symptoms by a variable time interval (average 3.9 years). Mean performance scores of verbal fluency were lower in FXTAS (22.83) than AD (28.83), although not statistically significant (p=O.1123). On working memory (DSB: 4.80 in AD vs. 5.41 in FXTAS, p=O.3590) and language (BNT: 48.54 in AD vs. 54.20 in FXTAS, p=0.0885) patients with AD had lower scores, although these differences were again not significant Digit span fotwatd measuring attention was significandy higher in subjects with FXTAS (8.59, vs. 7.10 in AD, P = 0.01). Conclusion: Individuals with FXTAS have significant cognitive deficits, on the order of those in AD, although the cognitive profiles in these dementias are not similar. The FXTAS cognitive component is a major part of the disease, and it appears to represent a mixed cortical-subcortical dementia picture. Further research is needed, including additional measures of &ontal dysfunction, the molecular basis and treatment in FXTAS.

This research was funded by: NINDS # NS 044299 O. Grigsby, PI), NICHD # H 036071 (R. Hagennan), and National Center for Research Resources #ULI RR 024146 (0. Nguyen). Poster Number: 48 Distinguishing Impulse Control Di80rden from Bipolar Disorder in Parkinson's Disease Susan W. Lehmann1, Greg Pontone2, Karen Anderson3, Guy Chase" John littleS, Elama Hirsch6, Russel Margolis1, James Williams8, Peter V. abins9, Laura 1\rfarsh 1o Johns Hopkins University School of Meclicine, Baltimore, l\ID Hopkins University School of Medicine, Baltimore, :MD 3 University of ~faryland School of ~fedicine, Baltimore, MD .. Hershey Medical Center, Hershey, PA 5 Georgetown University School of ~Iedicine, Washington, DC 6 Johns Hopkins University School ofMedicine, Baltimore,:rvID 7 Johns Hopkins University School of~ledicine, Baltimore, MD 8 Johns Hopkins University, Baltimore, ~ 9 Johns Hopkins University School of~fedicine, Baltimore, MD 10 Johns Hopkins University School of Medicine, Baltimore, ~ID t

2 The Johns

Abstract: Behavioral disturbances in patients with Parkinson's disease (PD) can be features of a number of psychiatric disorders, and manic-like impulse control disorders (lCDs). These including bipolar affective disorder (BPAD), new-onset secondal:)' mani~ conditions are often difficult to distinguish from each other, yet accurate diagnosis is cmcial to proper treatment In this analysis, prevalence of BPAD, secondary mania, and lCD's and their tates of co-occuaence were examined in a sample of patients with PO who were participants in the MOOD-PD Study, an ongoing NIH-funded study of mood disorders in PD in 3 community-based neurology practices. Final best-estimate psychiatric diagnoses were established by an expert panel of geriatric psychiatrists, based on a detailed psychiatric interview, interviewer-rated scales, and a separate interview of a knowledgeable informant. Of 127 participants, there were 17 cases of either bipolar disorder or leD {12 men, 5 women; mean (SD) age =60.5(9.5) years (range 46 to 79 years)} . leDs were present in 14 (11.0%), including 7 individuals with pathological gambling, 3 with compulsive shopping, 1 with a compulsive eating disorder, 2 with hypersexual behavior, t subject with compulsive eating and hypersexuality, and 1 individual with pathological gambling and shopping behaviors as well as hypersexual behavior. There were 3 (2.4°10) cases with BPAnt each of which antedated onset of PD. Unlike the patients with BPAD, no patient with an ICD had ever experienced a manic episode or a sustained. elevation in mood although 8 ICD patients also had a history of a depressive disorder. In this population of community-

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2008 AAGP Annual Meeting dwelling patients with Parkinson's disease, ICDs were more common than BPAD and occurred in the absence of an elevated mood state, suggesting that impulse control disorders in Parkinson's disease are distinct from bipolar manic episodes. This research was funded by: NIH-MH69666.

Poster Number: 49 Interpreten in Mental Health: A Team Approach to Cross-Cultural COUDseling, Case Report Irena F. Ginsburgl, Ellen Dekker2 t 2

On Lok Lifeways, San Francisco, CA On Lok Lifeways, San Francisco, CA

Abstract: On Lok Senior Health Services, a comprehensive health care organization for frail seniors, serves 1225 clients who speak 30 different languages. This level of diversity frequendy requires the utilization of interpreter services. The presence of an interpreter can complicate and contaminate the treatment process. Therefore, it is important to understand and control the impact the interpreter has on the clinical frame. A 76 year old hiexican-American woman, monoJingual Spanish speaking, was refeaed to the On Lok Mental Health Team for treating severe symptoms ofP'TSD. The client was treated with an antidepressant which led to some improvement in her ovenill. mood, but did not alleviate her anxiety. 4o\.n. interpreter was brought into the psychotherapy process, which initially exacerbated the client's anxiety, creating a negative clinical impact. The interpreter then was educated on the Team ,,'\pproach to Cross-Cultural Counseling which allowed her to enter the clinical £tame more effectively. The intetpreter's role as a cultural liaison minimized misunderstanding and increased tmst; proper training in the Team Approach enswed that the therapist maintained control of the process. Recognizing and working with the interpreter on the clinical setting enabled therapy to proceed successfully.. Cross-cultural counseling, which may necessitate using an interpreter, complicates and possibly contaminates the treatment process. Geriatric clients suffering from PTSD may have entrenched dissociative and hypervigilant respoDSes~ making it difficult for them to cope with an interpreters presence. The Team Approach recognizes the impact that an intetpreter has on the clinical frame. Training interpreters to work effectively in a clinical environment can reduce common intetpreter errors. By working in a team modality, interpreters and therapists can collaborate more effectively with clients, both minimizing the impact of cultural differences as well as encow:aging the cultural competency of the therapists. Interpreten leam to let therapists lead sessions as well as miaor therapistfs responses, enabling psychotherapy techniques to be set out in a systematic and accurate fonnat. As our society grows increasingly diverse, we must learn to face the challenges ofproviding services to clients of many different cultures who speak different languages. The Team Approach supports the collaborative relationship between therapis~ interpretert and client necessary for effective psychotherapy.

Poster Number: 50 Diversity in Geriatric Psycbiatty: AAGP Memberst Attitudes and Experiences Katen Bullock1, .A.~-\GP Diversity Committee2, Karen Blaok3 Institute ofLiving/ Hartford Hospital, Hartford, cr AAGP, Bethesda, 1vID 3 Institute of Living/ Hartford Hospital, Hartford, cr I

2

Abstract: As the United States population becomes increasingly more divetSe, delivery of quality mental health services to patients, regardless of race, ethnicityt culture, sexual orientation, and language proficiency, becomes more of a challenge for practitioners. Cross-cultural training and experiences are mechanisms for improving quality of care for an patients..Attracting and retaining a diverse workforce may contribute to overall improvement of care to diverse patient populations. Objective: To assess AAGP members' attitudes and experiences of diversity in geriatric psychiatry, peteeptioos of their preparedness to deliver care to diverse patients, and their opinions about factors that promote (or dissuade) diversity in geriatric psychiatry. Methods: An online survey was developed and administered by .t\.A.GPs Diversity Committee. Descriptive analyses were perfonned.. Results: 236 AAGP members of diverse ra~ etbnicity, culture, sexual orientation, and language proficiency responded to the survey. 51 % percent considered themselves to be from diverse ethnic, racial, religious. or sexual backgtounds. Although practitioners generally self-reported competence to treat ~~frican American and most Latino patients, they felt lacking sufficient knowledge to provide care to other diverse groups. W'hile only 20% felt lacking in sufficient knowledge to provide care to homosexual older adults, higher rates were revealed for treating bisexual and transsexual patients. Noteworthy proportions felt under-qualified to provide care to persons of all surveyed religions except for Christianity andJudaism. Translation availability in work setting was inadequate or unavailable in 33 percent of care settings. Data on respondents considering themselves of diverse backgrounds will be presented. Conclusion: This research suggests that .AAGP member respondents have positive attitudes toward diversity. Most feel competent to treat diverse

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2008 AAGP Annual Meeting racial, ethnic and religious groups. However, areas ofinsufficient knowledge and/or discomfort exists in treating other identified groups. This presentation highlights those findings. Poster Numbet: 51

Psychiatric Epidemiology of the Elderly Population in Chile Robert Kohnl , Benjamin Vicente2, Sandra Saldivia3, Silverio Toxres4 I

Brown University, Providence, RI

2 Uoiversidad de Concepcio~

Concepcio~ Chile de Concepcion, Concepcion, Chile .. Universidad de Concepcion, Concepcion, Chile 3 UmvetSidad

Abstract: Objectives: Little attention bas been given to the tate of mental illness among the elderly in Latin .i\metica. Unlike the USA where the population over the age of 65 comprises neady 12.40/0 of the population, in Latin America the elderly account for only 5.20/0 and in Chile 6.8% of the population. Methods: The Composite International Diagnostic Interview (CIDI) was administered to a stratified random sample of 2,978 individuals from four provinces representative of the country's population age 15 and older. The elderly Lifetime and t2-month prevalence rates were estimated. Results: Of the 2,659 interviewed 352 were age 65 or old~. sample bad more women, were less likely to be married, and had lower education. Overall, the elderly had lower rates of lifetime disorders than the younger populatio~ 30% in compared to 34%. Major depressio~ dysthymia~ agoraphobia, simple phobia, alcohol dependence, and somatofonn disorders were all noted to be less common among the eldedy. The old-old in comparison to the old group had lower rates of disorders. A sizable proportion of the disorders among older adults began after the age of 59. One-third of the elderly with major depression had a late onset disorder. Service utilization was similar between the elderly and younger respondents, except for use of specialized psychiatric services which was lower among the elderly. Conclusions: Late onset disorders in the elderly are not Wlcommoo. Additional studies of the rates of disorders among the elderly in Latin America are needed to make appropriate public he21th planning. Poster Number: 52

A Web-Based Response to Addressing the Current NIMH Funding Climate for Geriatric Mental Health Researchers Brian Shanahanl , Barty D. Lebowitz2, Stephen). Bartels3, rvIartha L.Bmce4, Maureen Halpains, Enid Ligbt6, Charles F. Reynolds7, Gwenn Smith8,joel E.Streinl9,jiirgen Uniitzer10 MediSpin, Inc, New York, NY University of California, San Diego, San Diego, CA 3 New Hampshire Dartmouth Psychiatric Research Center, Lebanon, NH t

2

.. Weill Medical College Comell University, White Plains, NY 5 University of Califomia, San Diego, San Diego, Ci\ 6 NThIH, Bethesda, MD University of Pittsburgh School ofMedicin~ Pittsburgh, PA University of Toronto" Toronto" ON 9 University of Pennsylvaoia School of Medicine" Philadelphia, Pi\ 10 University of Pennsylvania School of Medicine, Philadelphia, PA

1

8

Abstract: FY 2008 NIH funding has decreased by $250 million from the previous year, with NIMH funding being bard-hit in the areas of behavioral and social science research. This continues the ongoing trend in decreased NIH funding that is negatively impacting NIMH's ability to sustain multi-year research grants initiated in the last few years. These funding decreases also result in fewer hires, lower salaries, and increased layoffs in the pool of postdoetoml researchers" not only discouraging PhD candidates, but even college students from pursuing careers in NIMH-related areas~ including geriatric mental health research. Additionally, decreases in funding in established research areas, such as Alzhei.meis disease, mean that fewer funds are allocated for the shorter (Ito 5-year) research grants that comprise the agency's primary mechanism for encouraging both new researchers and new ideas. In summuy, as stated by the AAGP: "The critical disparity between Federally funded research 011 mental health and aging and the projected mental health needs of older adults is continuing.·f The NIH-funded MedEdMentoring.org Web site provides infoanation on alternative sources of funding, as well as timely related issues in various formats including live Webcasts and teleconferences; current presentations; researcher roadmaps that give insight into bow established researchers addressed a broad range ofissues in the course of their careers; Q&A (questions are fielded by nationally recognized experts in geriatric mental health); a slide library of archived presentations; message boards on relevant issues; and up-to-date news items.. The availability and extensive exchange of current infonnation at this site, constantly being updated, gives researchers in the field ofgeriatric mental health at all levels a

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2008 AAGP Annual Meeting powerful resource for meeting the challenge of change in a political and economic climate direcdy impacting funding and other issues critical to the research environment.

This research was funded by: NIMH. Poster Number: 53 Evaluating the Eldercare Clerkship: Geriatric Knowledge, Attitude, and CHnical SkiDs Lisa VanBussel1, Laura Diachun2, Kevin T. Hansen3, Andrea C. Dumbrell", Michael). RiOOerS Schulich School of Medicine and Dentistry, UWO, London, ON and Dentisay, UnivetSity ofWestem Ontario (UWO), London, ON 3 St. Joseph's Health Care, London, London, ON .. St. Joseph's Health Care, London, Londo~ ON 5 Schulich School of Medicine and Dentistty, UWO, London, ON t

2 Schulich School of Medicine

Abstract: In 2003, the University of Westem Ontario (UWO) created a new two-week 'emden:aren clerltship combining teaching in Geriatric Medicine and Geriatric Psychiatry. Trainees and faculty who believe clerks receive sufficient training in Eldercare elsewhere in the clerkship have questioned the value of having this rotation. We therefore posed the following research question: Do clinical clerks who complete a clerkship year that contains a two-week Elden:are rotation develop superior knowledge, clinical skills, and attitudes in caring for older patients than clems who complete a clerkship year that does not include an Eldercare rotation? A randomized, controlled trial was conducted involving thUd-year clerks from the Oasses of 2001 and 2008 at UWO. Cerks were assigned to complete a clerkship year either with or without an Eldercare rotation; the clerkships were otherwise similar in content and exposure to geriatric patients. Geriatric knowledge and attitudes were assessed by survey prior to beginning the clerkship, with knowledge, attitude, and clinical practice being assessed by survey in the final month of clerkship. Objective clinical skills were assessed for the Class of 2007 using the Eldercare station of the clerkship exit oseE in January 2007. The Class of 2008 will undergo their exit OSeE in 2008. Subjective clinical skills were evaluated by survey questions on self-reported clinical practice. 204 clerks (132 Eldercare, 72 non-Eldercare) took part in the study. Eldercare clems demonstrated significant improvement 011 the knowledge measure (t [1,149]=3.84, p
2

Abstract: Objectives: i\s the literature suggests that physicians may underreport elder abuse, this project sought to understand the reasons foro this phenomena by exploring elder abuse education for primary care physicians. We surveyed Michigan primary care residency programs to learn about elder abuse education, both in terms of formal curricula as well as clinical contacts. Design: A survey questionnaire mailed in two waves Setting: i\ll1vfichigan primary care residency programs. Measurements/Results: Survey response rate was 60% (0=42). Neady 2()O/0 (n=8) of all programs did not have any didactic information or clinical exposure to elder abuse and elder abuse education played a major role in residency curriculum in slighdy more than a third of all programs (36.5a% " n=15).

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2008 AAGP Annual Meeting Of the 31 programs that had elder abuse lectures, 77% (0=24) requited attendance at lectures. Two thirds (63.40/0, n=25) of all programs expressed a need to leam more about screening tools and half (65%, n=23) of all residencies did not use any sort of screening assessment in their inpatient or outpatient clinical care. However 67.6% , (n=25) of respondents rated their experience with the reporting agency (Adult Protected Services) as "poor". Programs with more elder abuse topics in their curriculum had a more positive APS relationship than those that did not. Conclusions: The results of this survey indicate that elder abuse education is not consistent or highly prioritized in many primary are residency programs.. The need for standardized educational goals and objectives as well as clinical exposure would help to address the variance in both quality and quantity of elder abuse exposure.. Primary care voiced a need for additional screening educational materials, suggesting that future research should focus on the development of more valid easy to use screening tools.

This research was funded by: Blue Cross Blue Shield of :Michigan. Poster Number: 55

Infrequent Depression Treatment Among the Oldest Suicide Victims in New York City Robert C. Abrams 1,Andrew C. Leon2, Kenneth TardiffJ, Peter M. Matzuk'I Weill Cornell Medical College, New York, NY Weill Comell Medical College, New York, NY 3 Weill Comell Medical College, New York, NY .. Weill Comell Medical College, New York, NY I

2

Abstract: Objectives: We examined post-mortem evidence of antidepressant, analgesic and anxiolytic-hypnotic dmgs and alcohol among suicide victims aged 65 and older. Methods: We included medical examiner-certified suicide victims aged 65 or older &om 20002004 who had resided and died in New York City and who underwent toxicological investigation for antidepressant, analgesic, and anxiolytic-hypnotic drugs and alcohol Based on the elimination half-lives of the substances studied, subjects were required to have had injmy-death intervals of 72 hours or less for toxicological testing for the medications, and 2 hours or less for analysis for alcohol (ethanol). The fi:equency of detectable medications or their metabolites in these classes and of alcohol were compared across 3 age strata: 65-74, 75-84, and 85 and older. Mean annual population-based suicide tates were also calculated for age strata and for the overall age group. Results: Evidence of antidepressant medication was found in only 16.70/0 of suicide victims aged 85 and older who underwent post-mortem toxicological testing, although this age stratum also had the highest suicide rates in the geriatric (65 and older) population at 42.7 per lOOK population. Antidepressants were less likely to be found in suicide victims aged 85 and older than in those aged 65-74 or 75-84.. In all age strata, anxiolytic-hypnotics were more frequendy found than antidepressants. In all but the oldest individuals. analgesics were less frequently found than antidepressants. IvIales more &equendy had evidence of medications and alcohol than females, and detection of alcohol was less frequent than that of the medications.. Conclusions: The frequency of detectable antidepressant medication was low for all geriatric suicide victims) especially the oldest. Anxiolytic-hypnotics appear to be more readily prescribed than antidepressants to elders who commit suicide. These findings highlight problems in the delivery of specific pharmacological treatment for depression to the "old-old/'

This research was funded by: National Institutes of Health (grant R01 DA006534). Poster Number: 56 Depression Screening, Morbidity and Mortality Among Primary Care Patients Discharged from Hospital Guy J. Kennedyl, William Woolis2,johnine Cummings3, Richat:d Mudge4 Kathy Freemans, Mirta Martinez-Kekenak6 9

t

Monte6ore Medical Center, Bronx, NY

2 Montefiore

Medical Center, Bronx, NY Medical Center, Bronx, NY .. Montefiore Medical Center, Bro~ NY S Montefiore Medical Center, Bronx, NY 6 MontefiOIe Medical Center, Bronx, NY 3 Montefiore

Abstract: Among older adults dischat:ged &om hospital with chronic debilitating illnesses, depression complicates adherence with treatment and self care and may increase the risk of re-hospitalization. We sought to reduce symptoms of depression and frequency of re-hospitalization with serial telephone assessments of depressive symptoms and treatment response which provided guidance to primary care physicians and support for their depressed patients. Primary care physicians of Montefiore Medical Center's Care l\fanagement Organization provided written consent for our research coordinator to contact their patients for consent to participate

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2008 AAGP Annual Meeting by telephone. Consenting patients were then screened by phone with the abbreviated Patient Health Questionnaire (PHQ-2) for depressive symptoms and randomized to either routine or facilitated care; those who screened positive then received the full PHQ-9. The routine care group subsequently received the PHQ-9 assessment at 4 and 12 weeks. The facilitated group received assessments at 2, 4, 6, 8 and 12 weeks along with supportive telephone interventions but not psychotherapy. We screened 4768 recently discharged patients of whom 615 (12.80/0) screened positive and 240 (39%) consented to join the study. Of those completing the study there were 64 in routine care, 60 in facilitated, and 55 who screened positive on the PHQ-2 but were not sufficiently depressed as assessed with the PHQ..9 to warrant intervention (PHQ-9 negative group). We did not find differences in symptom outcomes or frequency of antidepressant use among the routine and facilitated care groups. However comparing routine, facilitate~ and PH-9 negative groups we found differences in hospital readmission rates (71.9°/0 vs. 66.60/0 vs. 61.8°/0), mean days to readmission (123 vs. 132 vs. 148), and mortality (15.6% vs. 15.(>
Poster Number: 57 Specialist and Non-SpeciaHst HospitaHsation for Psychiatric Disorden in Australia Brian Draper1, Lee-Fay Low2 t 2

University of NSW Randwick, NSW University of NSW, Sydney, NSW t

Abstract: Introduction: Hospital treatment for psychiatric disorders in Australia occurs in both non-specialised and specialised mental health settings. The extent to which this varies with age is unknown. Aim: To compare the separation rates for specialised versus nonspecialised psychiatric care in Australian hospitals by age and diagnosis. Methods: Data on inpatient separations with a primary diagnoses ofa psychiatric disorder were obtained from the Australian National Hospital Morbidity Database forJuly 2001-June 2005. Separations were examined by diagnostic group, age and gender. Specialised care was defined as admissions to psychiatric wards ofgeneral hospitals or psychiatric hospitals. Results: Patterns of specialised versus non-specialised separations were similar by gender, and across the four years. Avemged across the four years the proportion of non-specialised psychiatric care increased with age for all groups of disorders. For instance, the proportion ofolder adults (65+) who received non-specialist psychiatric care was significantly higher than young adults (20-29 years) for depressive disorders (40.7% vs 33.3%), neurotic, stress related and somatofonn disorders (74.6°/0 vs 37.60/0), schizophrenic disorders (30.8°/0 vs 16.80/0), manic disorders (27.3% vs 14.6°10), alcohol abuse disorders (82.2% vs 73.7°10), other substance related disorders (78.5°/0 vs 49.00/0) and organic disorders (86.10/0 vs 41.90/0) (Chi squared ranged from 4123.5 to 137.0, all p<.0001). There were more treatment days per separation for specialised compared with non-specialised care and this difference decreased with age. ConclusioDs: Treatment of psychiatric disorders in non-specialised mental health settings in general hospitals significantly increase with age in Australia. These findings emphasise the importance of having adequate Consultation-Liaison psychiatry services for older people in general hospitals. It is also possible that non-specialised care is being used due to a deficiency in specialist mental health beds for older people in Australia. Poster Number: 58

Identification of Behavioral Healtb Issues in Reeipients of HODie-Based AgiDg Services Amber M.Gum1, Andrew Petkus2, Sarah). McDougal3, Melanie Presenr, Bellinc1a King-Kallimaniss University of South Florida, Tam~ FL of South Florida, Tampa, FL 3 University of Washington. Seattle, WA t

2 University

.. University of South Florida" Tam~ 5 University

FL

of South Florida, Tampa, FL

Abstract: Introduction: Recipients of aging services are at high risk of mental health problems, and the national aging services network represents a rich opportunity for addressing these issues. Yet, little collaborative research on mental health has been conducted within this network. The current study is part of a collaborative research program with aging service agencies in four Florida counties who briefly assess the mental health needs of older adults receiving in-home case management. Aims and methods: The aims of the cw:rent study were to assess identification of behavioral health needs based on a standardized research interview (including the Structured Clinical Interview for DSM-IV Diagnosis and the Brief Symptom Inventory-18) and participants' self-perceptions.

Al18

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2008 AAGP Annual Meeting Participants were recruited by their case managers during routine home visits, resulting in a convenience sample of t 41 participants. Results: The sample was predominandy female (79.4%), white (73.80/0) or black (19.90/0), not currendy married (85.1%), and was an average age of 74.7. On the SCID, 21.9% had a diagnosable depressive, anxiety, or substance disorder, and an additional 12.1% had an adjustment disorder. Of those with a problem identified by the interviewer, 39.70/0 of clients reported having a mental or emotional problem. Participants identifying a problem were more likely to have a diagnosed disorder, higher BSI-18 symptoms, greater thought suppression, and family member or friend with a mental or emotional problem, although only knowing someone with a problem remained a significant predictor in a multivariate logistic regression model Conclusions: Findings suggest that a significant portion of recipients of in-home aging services experience behavioral health problems, which clients often do not recognize. Clients' familiarity with such problems predicted their own recognition of problems. Additional resources are needed to feasibly implement screening and education about behavioral health problems for aging service clients.

This research was funded by: Univenity of South Florida New Researcher Grant and University of South Florida Department of ,,'\ging and Mental Health. Poster Number: 59 Prevalence and Predictors of Mood, Anxiety, and Substance Abuse Disorders for Older Americans in the National Comorbidity Survey-Replication Amber M. Gum1, BeUinda King-KaUimanis2, Robert Kohn3 University of South Florida, Tampa, FL University of South Florida, Tampa, FL 3 Department of Psychiatry and Human Behavior, Brown University, Providence, RI I

2

Abstract: The aims of this study were to report the prevalence and risk factors for psychiatric disorders in older adults (age 65+) from the National Comorbidity Survey-Replication, using the public-use dataset from this nationally representative U.S. epidemiological study conducted in 2002-2003 (N =9,282). Psychiatric diagnoses were made according to the Composite Intemational Diagnostic Interview. Prevalence of mood, anxiety, and substance abuse disorders were examined across ages and found to be lower for older adults. For older adults, 12-month prevalence was 7.0% for anxiety disorder (18-44 = 20.7%; 45-64 = 18.7%),2.6% for mood disorder (18-44 10.2%; 45-64 = 8.00/0), and 0 (18-44 6.0%; 45-64 = 1.7°/0) for any substance use disorder. For older adults, 8.5% had any of these disorders (18-44 = 28.5%; 45-64 =22.6°/0). In a logistic regression, for older adults! the presence of a mood disorder was predicted by younger age, female sex, being at or below t.5 times the poverty line, and having one or more disabilities. The presence of an anxiety disorder was predicted by younger age, female sex, less than high school education, not married, and one or more disabilities. Interactions between age and sex and age and disability were investigated; however no significant relationships were found. This study provides current data on the prevalence of psychiatric diagnoses for older adults and documents the continued trend of lower rates of formal diagnoses in this population. Such findings do not necessarily indicate lower need for mental health services for older adults, however, given the potential for under-diagnosis, clinical significance of subthreshold symptoms in older adults, and lack of representation from more vulnerable older adults at the greatest risk of psychiatric disorders, including those in medical and long-tenn care settings.

=

=

This research was funded by: 'This study is based on the public use dataset available from the NCS-R. The NCS-R is funded by NThfif, NIDA, SAMHSA~ RWJF, andJW Alden Trust. Poster Number: 60 The Old Man's Crack Club: Characteristics of Older Crack Cocaine Usen Diana L Thome 1,James G.. Bouknight2, Shelby L. Rials', Kimberly Ba Rudd4

Dam VA Medical Center, Columbia, SC Health/ USC SOM, Columbia, SC 3 Dom VA Medical Center, Columbia, SC .. Palmetto HealthlUSC SOrM, Columbia, SC I

2 Palmetto

Abstract: Objective: To determine demographics and co morbidities of older crack cocaine users in a sample ofveterans treated at the Dom VA Medical Center in Columbia, South Carolina. Methods: The electronic medical records were reviewed for 1t 6 patients over 50 years of age currently treated for crack cocaine use at the Dom VA Medical Center. The demographic characteristics of this group were determined and their main medical, psychiatric and substance abuse diagnoses were noted. Results: The average age of the

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2008 AAGP Annual Meeting patients was 56 years old.. At the time of their last use of CIack cocaine the average age was 55 years old. All of the patients were male. 28% were currently married. 80% were .i\frican .American and 200/0 Caucasian.. There were no other minorities represented in this group.. We found that the most common substance related co-morbidities were alcohol dependence/abuse (950/0), cannabis dependence/abuse (62%) and other substance dependence/abuse (22%). The most common psychiatric co morbidities were PTSD (430/0), mood disorders (180/0) and schizophrenia (8%). The most common medical illnesses in the group were back pain (43°/0), hypertension (43%) and hepatitis C (18%). The most interesting finding was that 140/0 of the surveyed patients first used crack cocaine after they were older than 50. Conclusions: We concluded that older crack cocaine abusers were likely to have significant medical co morbidities that are at least partly the result of crack cocaine use (i.e. hepatitis and hypertension). They also had conditions that caused physical pain. We also noted that a significant portion of crack cocaine use in this group represents new onset substance use ather than COQtinuing use.. PosterNumber: 61

Telephone Assessment of Depressive Symptoms in the Recmitment of Older Adults Abstract: Standardized assessment tools are often administered by phone to recruit community-based older patients for mental health research, but underreporting of symptoms is possible with a "cold-ea1l" method Symptom undeaeporting may be of particular concern in older men who have been found in prior research to be less likely than older women to endorse core depressive symptoms. In order to recruit subjects for a study on adherence behaviors in later life depression, we administer the nine item depression scale of the Patient Health Questionnaire (PHQ-9) by telephone to patients aged 60+ with a recent primary carerecommended depression treatment. For eligible patients (PHQ>5), we conduct an in-person baseline interview within 1 month of screening, including repeat PHQ-9 and the Geriatric Depression Scale (GDS). To date, we have enrolled 54 subjects, with a mean age of 68 (range 60-90). We compared screening and baseline PHQ-9 scores for evidence of possible minimization of symptoms during telephone screening. We also compared patients' baseline responses to the PHQ-9 and the GDS for consistency of reported depression symptom severity. Although mean screening PHQ-9 scores were actually slightly higher than at baseline for the entire sample:t half ofmen and 39% ofwomen showed an increase in symptom scores at baseline. In general, fewer depressive symptoms were endorsed by men than women on both screening and baseline PHQ-9, but this difference was not statistically significant There was a trend-level association for men to report more depressive symptoms on the GDS than the PHQ-9. While telephone screening appean to be an effective method to identify eligible older patients with depression for mental health research, more accw:ate measurement of depressive symptoms might be captured in older men by using the GDS. Poster Number: 62

How Homebound Elderly Accept Antidepressants Kathleen Buogayl t

Tufts-New England Medical Center, Boston, l\(t\

Abstract: Objective: To explore older people's motivations and methods of handling their medication taking especially antidepressants. Methods: Patients from the Nutrition, Aging and Memory in Elders (N~ffi) study were interviewed by telephone, audio-taped and transcribed. Questions addressed: personal medication taking methods, reasons for: taking medications, starting, continuing 63% whit~ 37% blac~ 6 antidepressants, or for not taking antidepressants. Results: Patients (0=32) were 72 yrs, 780/0 female~ chronic conditions t average of 9.8 medications, 63% depressed(CESD > 16), 63% on antidepressants t 4()O/0 on antidepressants and depressed. Interviewees described taking medications as a routine; some were taking for 30+ years. "It's gotten to be such a habit, that's what it is. It's a routine.." It is not a separate part of daily existence with chronic illnesses.. Reasons for starting antidepressants were: symptom control (crying, anger control) or crisis situation (surgery, loss) related. For example: " .... to help me to face life (husband died)", " ... to help me stop crying " to help me control my temper'l'. Reasons for continuing, related to positive results: "I stopped aying. so I figured it was working n Even the 'acceptors' and 'continUeD' did not consider themselves having depression. This unwillingness, conscious or unconscious, to relate antidepressants to depression was evident in patients' medication reporting. rdedications were usually listed as: medication - reason; antidepressant introduction was preceded by a justification/explanation of why the medication was taken. Discussion: Medication taking is a part of life for elderly people.. Medications for depressive symptoms are Okay; medications for the disease labeled cdepression' are NOT Okay. Antidepressant use is reported differendy than other chronic medications. We should consider the context when introducing an antidepressant into an established medication regimen; using symptoms as a reason to start an antidepressant may ease acceptance. Resistance to taking antidepressants can be reconciled (by patient) with justifications.

This research was funded by: NIMH K23 MH068634..

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Poster Number: 63

Impact of Patient Preference for Depression Treatment on Initiation, Adherence, and Remission Patrick]. Raue', Herbert C. Schulberg2, Martha L.Bruce3, Moonseong Heo.... Sibel KlimstraS

Weill ComeR Medical College, White Plains, NY Comell Medical College, White Plains, NY 3 Weill ComeR i\tledical College, White Plains, NY .. Weill Comell Medical College, White Plains, NY I

2 Weill

5 Weill

Cornell Medical College, White Plains, NY

Abstract: Purpose: Treatment of depression in primuy care settings is effective yet most depressed patients do not receive appropriate care, due in part to limited patient participation in guideline-based treatments. We hypothesized that strength of patient treatment preferences for antidepressant medication or psychotherapy would predict treatment initiation, adherence, and depression remission. Methods: 60 patients (22<60 and 38>60 yeatS old) who met SCID criteria for major depression were randomized to treatment that was either congruent or incongruent with their primary stated preference. Patients received either escitalopram or Interpersonal Psychot:hempy (IP1) for 20 weeks. Patients were reassessed at weeks 4, 8, 12, and 24 for adherence to treatment and depression severity. Results: Both elderly and mid-life patients bad stronger preferences for psychotherapy over antidepressant medication. Preference strength was associated with treatment initiation (OR=5.3, 950/0 CI=4.3, 6.3, p=O.OOl) and 12-week adherence as a continuous variable (F=tO.71, p=O.OO2), but not deplession remission at t2 (OR=O.9, 95% CI=O.3, 1.4, p=O.64) or 24 weeks (OR=O.8, 95% CI=O.3, 1.4, p=O.46). Interaction terms of preference strength by age group, treatment type, and depression severity were not significant. Conclusions: Interventions that incorporate patient preferences positively influence treatment initiation and adherence. To impact clinical outcomes, however, mote focus should be placed on the treatment decision-making process so that a fuller range of variables is adequately identified and inco1porated into the treatment process.

This research was funded by: K23 MH069784. Poster Number: 64

Suicidal Ideation Predicts Five-Year Mortality Among Elderly Primary Care Patients Patrick]. Raue 1, Knashawn H. Morales2, Edward P.Post3, Hillary RBognerl, Thomas Ten HaveS, 1vIartha L. Bruce6

Weill ComeR Medical College, White Plains, NY University of Pennsylvania School of Medicine, Philadelphia, PA 3 University of Pittsburgh School of Medicine, Pittsbwgh, PA .a Umveristy of Pennsylvania, Philadelphia, P.A 5 U Diversity of Pennsylvania School of Medicine, Philadelphia, P.A 6 Weill ComeR Medical College, White Plains t NY I

2

Abstract: Purpose: We examined the impact of suicidal ideation on 5-year mortality among elderly primuy care patients, as a function of baseline depressive status (Le., major, minor, none). We also examined whether a depression care management intervention moderated these relationships. Methods: 20 primuy care practices in the PROSPECf study were randomized to care management Intervention or Usual Care. 1,202 participants were identified via two-stage, age-stratified (60-74; 75+) depression screening of randomly sampled participants. Baseline assessments of suicidal ideation, major and minor depression, and medical and functional status were obtained. 5-year vital status was detennined using the National Death Index. Results: After a median follow up of 52.8 months, 221 (18.40/0) participants had died. In adjusted models, suicidal ideation predicted 5-yeu mortality among Usual Care participants with no depression (hazard ratio =1.70), minor depression (hazard mtio=1.78), and major depression (hazard ratio=1.86). Suicidal ideation also predicted mortality among Intervention participants without depression (hazard ratio=t.70), but not among those with minor (hazard ratio=O.97) or major depression (hazard ratio=O.55) (3-way interaction p
This research was funded by: ROt ?vIH065539.

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Poster Number: 65

Attitudes Toward Mental Health Services: An Age Group Difference in Korean American Adults Yuri langl, David Chiriboga2, Sumie Okazaki] University of South Florida, MHC 1400, Tampa University of South Florida, Tampa, FL 3Uoiversity of Illinois at Urbana-Champ~ Champaign, IL I

2

Abstract: Responding to the heightened calls to reduce racial/ethnic disparities in mental health and service utilization and to consider within-group variations in ethnic minorities, the present study examined the attitudes toward mental health services held by younger (aged 20 to 45) n = 209) and older (aged 60 and over, n= 462) groups of Korean Americans. Following the Andersen behavioral health model, predisposing (age, gender, marital status, and education), need (anxiety and depressive symptoms), and enabling (acculturation, health insurance coverage, and personal experience and beliefs) variables were considered Culture... intluenced beliefs were found to have a substantial contribution to the model of attitudes toward mental health services in both age groups. The belief that depression is a medical condition was fOlUld to be a common predictor of positive attitudes across the groups. In the older adult sample, more negative attitudes were observed among those who believed that depression is a sign of personal weakness and that having a mentally ill family member brings shame to the whole family. Findings provide implications for developing age-specific interventions to reduce cultural misconceptions and stigma and to increase mental health literacy among ethnic minorities.

This research was funded by: NIA R03 and .l\PA rvIinority Fellowship Program. Poster Numbet: 66

Utilization of Complementary and Alternative Medicine (CAM) Among Older Adults with Serious Mood Disorders Daniel KeatonI, Nathan Lamkin2, Kristin A. Cassidyl, William]. Meyerl, Rosalinda V. Ignacio5, Lakyntiew Aulakh6, Frederic C. Blow7, ~fartha Sajatovic8

Case Westem Reserve University School ofMedicine, University Hospitals Case Medical Center, Cleveland, OH Case Western Reserve University, Clevelan~ OH ] Case Westem Reserve University, Clevelan~ OH .. Case Western Reserve University, Cleveland, OH 5 Health Services Research and Evaluation Center (SMITREC), University of l\!lichigao, Ann .&~bor, MI 6 The H6pital regional de Sudbury Regional Hospital, Sudbury, ON 7 Health Services Research and Evaluation Center (S~fiTREq, University of Michigan, Ann Arbor, MI 8 Case Westem Reserve University School of~fedicine, Cleveland, OH I

2

Abstract:

Aims: There has been a rapid expansion of consumer's use of Complementary and ,i\lternative medicine (CAM) in the United Statesl including fairly extensive use in populations with mental disordets, who are often taking prescription psychotropic compounds. The issue of CAM use among older adults with psychiatric illoess is clinically important as it is known that some alternative compounds may worsen or precipitate psychiatric symptoms, however little data has been published on CAM use in older individuals with mood disorders. Methods: This is a cross-sectional analysis of CAM use in 50 older adults with bipolar disorder and 50 older adults with major depression which evaluated factual knowledge of C~I, individual perspective of efficacy and safety of C-\M, patterns of CAM use and discussion of CAM with health care providers. Results: Approximately 300/0 of older individuals with serious mood disorders use CAM Over 40% of older adults believe that CAM is FDA...regulated and 14-200/0 prefer to take C~"\l compared to physician-prescribed psychotropic medications. The use of CAM is more common among older adults with bipolar disorder (nearly 50%) compued to older adults with major depression (less than 200/0). The majority of older adults with serious mood disorders \14%) have not discussed use of CAM with their treating physicians. Conclusions: C'\M is widely used by older adults with serious mood disorders, particularly among older adults with bipolar disorder.. Most individuals do not discuss use of CAM with their physicians and nearly one in two individuals incouecdy believes that CAM is FDA-regulated. Given the common use of eMf in geriatric populations with mood disorderst clinicians need to assess for CiUvf use in older adults with mood disorders, particularly with respect to illness outcomes and potential drug-drug interactions. Poster Numbet: 67

Outpatient FoUow-Up Referral Rates for Older Depressed Consultation-Liaison Patients Lisa s. Seyfriedl~ Helen S. Kales2, Fred C. Blow]

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2008 AAGP Annual Meeting University of Michigan Department of Psychiatry, "A Ann Mbor Healthcare Syste~ Ann Arbor, ~n UDiversity of Michigan Department of Psychiatry, VA Ann Arbor Hea1thcare Systetllt Ann Albor, :Ml 3 University of Michigan Department ofPsycbiatty, VA Ann Arbor Healthcare System, Ann .Arbor, MI I

2

Abstract: Depression in the medically ill population has an independent effect on health outcomes. Despite its importance, depression in older medical and surgical patients often goes under-recognized and under-treated Consultation on medical and surgical patients provides an excellent opportunity for the diagnosis and treatment of depression and can act as a gateway to appropriate follow-up care. To dat~ however, little work has examined processes of care for older patients with depression at one of the important junctures in the intervention and treatment nexus, the psychiatty consultation-liaison (eL) setting. In this pilot study, we examined the medical records of all patients seen by ow: university hospital-based CL team during a 1-month period In total, 111 patients were evaluated. Of the 35 patients age 60 and older, 11 were diagnosed with a depressive disorder. Only 1 of these patients had follow-up arranged at time of discharge. Eighty-two patients younger than 60 years of age were evaluated, and 29 were diagnosed with a depressive disorder. Of these~ 14 bad fonow-up in place at discb.uge. While the tate of depressive disorder diagnosis was similar between the two groups of patients (32% vs. 34%)~ a smaller proportion of older patients had outpatient fonow-up in place at time of discharge (90/0 vs 480/0, P = 0.09). The results of this pilot study indicate that older medically ill patients may be less likely to receive st:ruetured outpatient follow-up for depression than younger patients. Further analyses will examine determinants of the receipt of outpatient follow-up for depression in medically ill patients with a latger sample size.

Poster Number: 68 Mental Health Resources for the Elderly in the Americas: Developing New PoHcies Lilian Scheinkman1, Carlos A. MeodoncaLima2, i\ooette Leibing3 Umversidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janetto 3 Institute of Social Gerontology of Quebec, Quebec, Canada t

2 Universidade

Abstract: Many countries are facing a rapid ageing of their population with a steady increase in the number of older people with mental disorders. These disorders account for a substantial proportion of disability and emotional and financial burden on families, caregivers and govemmental agencies. Despite the rapid growth in the numbers of elderly with mental i1lness~ current resources for this particular age group are not adequate. This study presents data collected for the World Health Organization (WHO) region of Americas (~lRO) and describes, in particular detail, the situation of Geriattic Psychiatry, at the present time, in Brazil. Special attention is given to the imbalance between eutteot needs and availability of resources. We specifically collected data on the resources available for this group in an attempt to better understand the organization of care for older persons. 'The lack of infoanation on resources is emphasized as well as its consequences on public policy and regulations.. From the data. presented, it can be concluded that the availability and the quality of mental health resources need to be improved in order to meet cuaent and future needs of this growing population in the area of study. The challenge to find solutions is in the hand of researchers, policy makers, clinicians and the general. population. We present the proposal for development of Geriatric Psychiatry for the American countries including the consensus on the minimum actions required for mental health care of older persons. These include actions in primary and interventions for caregivers, care, the organization of services in the community, prevention programs, education programs~ national policies and legislation, the availability of psychotropic drogs when needed, the involvement of communities families and consumers, the development of human resources as well as the development of research efforts. Each particular action is presented and explained in detail.. We discuss how the proposed actions are expected to be implemented and how they are supposed to address the needs of this population and improve the lives of the elderly with mental illness in the areas studied.. t

Poster Number: 69 Volunteering as a Predictor ofAll Cause Mortality: What Aspects ofVolunteenng ReaDy Matter? Liat Ayalool I

Bu Ilan University, Ramat Gan, Israel

Abstract: The study evaluated the predictive effects of different aspects of volunteering (e.g., volunteering status, number of hours, number of years, and type of volunteering activity) on all cause mortaIity. A seven-year follow-up dataset of a nationally representative sample of Israeli older adults over the age of 65 was used. As expected volunteering was associated with a reduced mortality risk even after adjusting for age, gender, education, baseline mental health and physical health, activity level, and social engagement (HR=.69, 95% CI:.51-.92; ?2 [18]=933.5, p<.OO1). Those who volunteered for 10 to 15 years had a reduced mortality risk relative to non-volunteers (HR=.36, 95°/oCI: .15-.86;?2 [21]=944.2, p<.OOt). In addition, those who volunteered privately, not as part of an official organization, also had a reduced mortality risk (HR=.S9; CI: . 37-.95,?2 [19]=935.5, P<.OOl) compared to non-

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2008 AAGP Annual Meeting volunteers. Number of years of volunteering was not a significant predictor of all cause mortality in the fully adjusted model (?2 [21]=949.1, p<.OOl). Results suggest that not all aspects of volunteering have the same predictive value and that the protective effects oflength ofvolunteering time and type ofvolunteering are particularly important. Further research 00 the motivational. aspects of volunteering is needed. Poster Number: 70 Sense ofWeU Being in Older Adults FoDowing the War: The Moderating Effect of Lifelong Trauma and Health Status Liat Ayalon! t Haya Itzbaky2 1 Bar

2 Bar

Dan University, Ramat Gan, Israel Ilan University, Ramat Gan, Israel

Abstract: Context: Research has shown that personal resources (e.g., spirituality, mastery, coping), social resources (e.g., community identity, social support) and lifelong trauma impact the ability of the individual to adjust to more recent stressors. It remains lUlclear whether the effects of pe%Sonal and social reSOlUCes are moderated by lifelong traumatic events. It also is unclear whether health status moderates the relationship between personal and social resources, lifelong trauma and well being. Methods: 1\ cross sectional sample of 146 older adults three to six months after the second Lebanon war. Results: Those ofgreater levels of mastery and a stronger community identify reported higher levels of well being. In addition, there was a significant interaction between lifelong trauma and health status. Among the sickest older adults, lifelong trauma was associated with worse levels of well being, whereas among the healthiest older adults, lifelong trauma was associated with better levels of well being. Conclusions: Potentially, healthy older adults axe better able to utilize lifelong traumatic events for their benefit and thus, report higher levels of well being. Alternatively, healthy older adults are more resilient to begin with and have been able to utilize past adversaries for their benefit throughout their lives. Poster Number: 71 Subjective Cognitive Functioning as a Predictor ofAll Cause Mortality Liat Ayalon1 1 Bar

Dan University, Ramat Gan, Israel

Abstract: Objective: Cognitive functioning bas been identified as a predictor of all cause mortality in several epidemiological studies. As a result, researchers have suggested the use of short cognitive screens as prognostic indicators in older adults. Little is known, however, about subjective perception of cognitive functioning as a predictor of all cause mortality. Methods: 7-year follow-up data National sample of4,921 Israelis over the age of 60. Maio predictors were subjective complaints of memory problems~ confusio~ and recognition problems. Results: As expected, in the fully adjusted model, age, gender, subjective health, and ADL and IADL impainnents were significant predictors of all cause mortality. In addition, complaints about difficulties recognizing familiar people also were associated with a greater risk for mortality (HR=1.66, CI: 1.16-2.36). Conclusions: Asking older adults whether they have problems recognizing familiar people can serve as an easy and rime-efticient method to identify a sma1l fraction of the population of older adults that is at a greater risk for death.

Poster Number: 72 Pain-Personatity-Opioid-Dependence Interaction and Impact on Length of Stay in Elderly Pre-Spine Surgery Patients Leon A. Hyer l , Dana M Darmohray2, Mohammad Sami Wali 3, Mary R. Toole4 Georgia Neuroswgicallnstitute, Macon, G.A Macon, GA 3 Georgia Neurosurgical Institute, Macon, GA 4 Georgia Neurosurgical Institute, !\£aeon, GA t

2 Mercer University,

Abstract: Chronic pain and prescription pain medication abuse are two growing national problems, especially for the elderly. Elderly patients have more comorbidities as well as altered drug phannacokinetics and phannacodynamics. In addition, they are more likely to be prescribed long-term and multiple prescriptions, which could lead to drug interaction and increase side effects. 1\ key marker of all this is opioid-dependence (00). In surgery, on patients are looked at as extremely demandi.n& difficult to satisfy patients who lead to increased hospital length of stay (LOS) and hospital costs. The purpose of this study is to evaluate older and younger adults on four variables: OD status, pain, personality and length of stay. A questionnaire based on WHO clinical guidelines fOI: a definite

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diagnosis of "dependence" that requires three or more of six characteristics was designed and given to a random group of 150 spine surgery [48 lumbar diskectomy (LMD), 60 cervical decompression and fusion (CDF) and 42 lumbar decompression and fusion (LDF)] patients on opioids. Patients were interviewed before smgery, given infonned consent, and queried. on pain level and length of pain problem. LOS data was gathered after discharge from hospital. Personality was evaluated using the personality adjective checklist. Results show that 30 (20%) patients met the WHO criteria for the diagnosis of OD (22 younger and 8 older) and that no significant correlation (1=0.08, p>O.l) exists between OD and age. Percentages ranged from 14.580/0 to 23.81% aaoss gender and ethnic divisions. Focusing on type of surgery, the percentage of OD was highest among LDF patients (23.810/0), followed by COF (21.670/0) and LMD (14.580/0). No overall correlation (r=0.09, p>O.I) was discovered between opioid-dependence and LOS. The average LOS for 00 patients compared to non-dependent patients was: LMD 0.14 (n=7) vs. 0.07 (n=41); CDF 2.08 (n=13) vs. 1.73 (n=47) and LDF 4.00 (n=10) vs. 4.00 (n=32). Results also show that pre-spine surgery patients keep suffering from severe pain despite opioid use. Frequency and intensity of personality disorders were noted among elderly patients with severe pain. We discuss the high prevalence of opioid-dependence (200/0) among spine surgery patients; the lack of relationship between 00 and age; the lack of effect of opioid-dependence on LOS; and the relationship with personality. Poster Number: 73

Physical and Mental Health-Related Quality of Life Among Middle-Aged and Older Penons with Schizophrenia

David P. Folsom 1, Colin Depp2, Barton Palmerl, DiJip V. Jeste4, Brent Mausbach5 University of Califomia San Diego, San Diego, CA ofCalifomia San Diego, San Diego, CA 3 University of California San Diego, San Diego" CA .. University of Califomia San Diego, San Diego, CA 5 University of California San Diego, San Diego, CA t

2 University

Abstract: Introduction: The concept of schizopluenia, since the time of Kraeplin, has been that of a disorder with progressive deterioration in functioning. An important aspect of functioning is both physical and mental health-related quality of life (HRQoL). This study sought to examine the relationship of age to both physical and mental HRQoL in individuals with schizophrenia as compared to normal comparison subjects (NCs). Methods: Two groups were compared, community-dwelling middle-aged and older outpatients with schizophrenia (N=486) compared to NCs (N=101). The primary dependent measures were the Physical Health and ~fental Health Component scores of the Short Form - 36 (SF-36). Results: Patients with schizophrenia had lower SF-36 Physical Health Component (PHC) and Mental Health Component (MHC) scores than NCs [pHC: 44.0 (10.8) vs 47.6 (10.1) p=.002; MHC: 44.9 (12.2) VB. 55.3 (7.3) p<.OOl] and these differences persisted after adjusting for the age difference between the two groups. The relationship between age and mental health-related quality of life (HRQoL) was significantly different between the patients with schizophrenia and the NCs. Specifically. older age was associated with higher mental health-related quality of life among patients with schizophrenia (r=.189 t p<.OOI), but not among the NCs (r= -.102t p= .31). This association between older age and better mental HRQoL among patients with schizophrenia remained significant after examining multiple potential confounding demographic and clinical variables. Conclusions: The findings challenge the traditional notion of schizophrenia in late-life as being characterized by poor outcome. Longitudinal studies are warranted to confinn our finding, and to examine potential mechanisms responsible for possible improvement in mental HRQoL with age.

This research was funded by: NIMH. Poster Nwnber: 74

Risk ofAccidents in Older Adults Taking Medications for IftSomnia

Alon Y. Avidan t , Liisa A.Palmer2,]ustin F. Doan3, Robert W. Baran4 UCLA Department of Neurology, Los Angeles, CA Thomson Hea1thcare, Wasbingto~ DC 'Takeda Global Research and Development Center, Deerfield, a .. Takeda Global Research and Development Center, Deerfield, IL I

2

Abstract: Purpose: Many of the medications used to treat insomnia in older adults have been associated with an increased risk of accidental events including falls and fractures. The putpose of the current study was to examine the risk of accidental events in older adults taking insomnia medications of different classes and with different mechanisms of action. The risk of accidents associated with a selective melatonin receptor agonist (l\fit), the sedating antidepressant (SAD) trazodone, and a variety ofbenzodiazepine receptor

Am J Geriatr Psychiatry 16:3, Supplement 1

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2008 AAGP Annual Meeting agonists (BzRAs), including long-acting benzodiazepines (L,'\B), short-acting benzodiazepines (SAB), and nonbenzodiazepines (nBz)

were examined. Methods: Older adults (age >65 years) with newly initiated pharmacological treatment of insomnia were identified from the Thomson 1\farketScan(J) Medicate Supplemental and Coordination of Benefits database Oanuary 1,2000, thtough]une 30, 2006). Prohit models were used to evaluate the probability of an accidental. event in each therapeutic cohort. Results: A total of 445,329 subjects (988 ~£R., 44,256 SAD, 162,015 lAB, 81,083 SAB, and 156,987 nBz) were included in this controlled analysis. Subjects with prescriptions for LL\B (1.21 odds ratio), SAB (1.16 odds ratio), or nBz (1.12 odds ratio) had a signifieandy higher probability of experiencing an accidental event during the first month following treatment initiation compared with patients taking MR (P
various medications used to treat insomnia in older adults.

This research was funded by: Takeda Global Research and Development Center.

Poster Number: 75

Placebo-Controlled Trial of Quetiapine for Sleep Disturbance in Dementia and Mel Francine Nanda 1, Clifford Singer2 I

University of \Teanont, Burlington, VT of \'ennont, Burlington~ VT

2 University

Abstract: Introduction: Sleep disturbance is common in dementia and very stressful for caregivers. No intervention has been shown to be effective in large trials (Singer et at. 2003). Since quetiapine, an antipsychotic medication with mood stabilizing properties, is commonly used to treat neuropsychiatric symptoms, including sleep disturbance, in dementia, we are systematially investigating its sleep-promoting effects in this population. Methods: This is an on-going, single-blind placebo-controlled trial of quetiapine for the treatment of nighttime sleep awakenings in dementia patients. Eight patients with either AD, non-AD dementia or ~[CI were treated with a one-week placebo ron-in, followed by 5 weeks of quetiapine in using a flexible dose-titration schedule, increasing the dose by 25 mg each week to a maximum dose of 125 mg. The primary efficacy was the measure of nighttime (20:00-08:00) sleep by wristaerigraph. Results: We report primary outcome data on the first 8 subjects.. Nighttime sleep (in minutes by wtist-acrigraph) increased during quetiapine treatment versus placebo baseline. A clear dose response increase in nighttime sleep was seen., with even the 25 mg dose producing a treatment effect-size compatible to sedative hypnotics in non-demented individuals (36.4 +/ - 13.4 minute difference, p=O.Ol). At week 6 (mean dose 113 mg qhs; range 50-125), there was an average of81.8 (+/-28.4) minutes more sleep per night compared to placebo baseline (p=O.03). No drug-related serious adverse events or drug-related drop outs have occuo:ed thus far. Conclusion: Quetiapine has shown good tolerability and has increased nighttime sleep relative to placebo baseline. The treatment effect size is largest we've seen from a sleep intervention in this population A larger clinical trial is warranted. Support: This study was supported by an investigator-initiated research pot provided by AstraZeneca.

This research was funded by: AstraZeneca Investigator-Initiated Grant.

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Am J Geriatr Psychiatry 16:3, Supplement 1

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Poster Abstracts by Tide

(EI # - Indicates Early Investigator Session and Poster Number; NR # - Indicates New Investigator Session and Postel Number)

Poster Abstract Tide A Comparison of Brief Screening Measures for Caregivers

Poster Number NR8

A Web-Based Response to i\ddressiog the Current NIMH Funding Climate fOI: Geriatric Mental Health Researchers Age and Racial Differences in the Presentation and Treatment of Generalized Anxiety Disorder in Pri.mary Care Age at Ooset and Cognitive Deficits in Schizophrenia: A Quantitative Review

NR52

Age-Related Changes in Functional Brain Response During an Attentional Task in Schizophrenia Agitation and Resistiveness to Care are Two Separate Behavioral Syndromes of Dementia

Ell0

.Alzheimerls Disease Clinical Trial Designs: Toward a Practical Demonstration of Disease Modification .Amyloid-Associated Depression: 1\ Prodromal Depression of,A.lzheimer's Disease?

Antipsychotic Use in Veterans with Parkinson's Disease: Analysis of a National Sample Anxiety in Seniors Receiving Care Management from an Aging Semces Agency

NR3

EI 8

NR30 NR39 NR15

EI 58

Anxiety Symptoms and Functional Impairment in Very Old Community-Dwelling Women

EI 13 EI 12

Anxious and Depressed Elderly, A Parallel or Serial Relationship?

BI

Apathy in Dementia: Relationship to Deptession, Functional Competence, and Quality of Life Atrophic Changes in Patients with Comorbid Alzheimer's Disease and 1\JIajor Depressive

NR28

14

EI 62

Disorder

Attachment Style and Caregiving Outcomes

BY 49

Attitudes Toward Mental Health Services: An Age Group Difference in Korean i\merican

NR65

Adults

Atypical.Antipsychotics and Metabolic Changes in Older Adults in Primary Care Clinic

EI 57

Beyond Burden: Family Member Caregivers' Experiences and Interest in Enhancing Effectiveness Brain Lithium Effects on Cognition and Mood in Geriatric Bipolar Disorder

EI

Cholinesterase Inhibitor Discontinuation is Associated with Behavioral Changes in Nursing Facility Residents Clinical Correlates of Insight in Older Adults with Schizophrenia

EI 51

Clinical Persistence: How Long do Patients Remain on Cholinesterase Therapy?

NR40

Clinical Remission in a Multi-Ethnic Urban Population of Older Adults with Schizophrenia

EI 78

Cognitive Impainnent and its Correlates in Seniors Receiving Case Management from an Services AaencY Community Integration of Older Adults with Schizophrenia

EI 72

A~

48

NR6

EI 75

EI

79

Comparative Safety and Tolerability ofAlzheimer's Disease Treatments

NR42

Comparison .Among Personality Profiles in Patients with Alzheimer' s Diseas~ Vascular Dementia and Traumatic Brain Injury Correlates and Predictors ofBehavioral Health Hospitalization in Nursing Home Residents

EI 70

Correlation Between Anosognosia and Apathy in Older Adults with Alzheimer's Disease

EI 69

Correlation of MR Spectroscopy with Cognitive ImpaiDnent in Remitted Late-Life Major ,Depression Correlations Among Symptom and Social Outcome Categories in Older Adults with Schizophrenia

NR14

Am J Geriatr Psychiatry 16:3, Supplement 1

NR34

EI 81

A127

2008 AAGP Annual Meeting

Poster Abstract Tide

Poster Number

Decision Aid Development for Location of Care Options in Early Alzheimer's Disease

EI 47

Dementia in Fragile X-Associated Tremor/Ataxia Sydrome (FXTAS): Comparison with Alzheimer's Disease Depression and Anxiety Symptoms Predict Cerebral FDDNP-PET Binding in NonDemented Older Adults Depression and Psychosocial Factors Affecting Attitudes and Beliefs about Medicare Part

NR47 NR1 EI 30

D EI 31

Depression as a Predictor of Analgesic Use in Older Adults

NR9

Depression in Green Ribbon Health's Medicare Health Support Program Depression in the Elderly: What Predicts the Outcome?

EI 15

Depression Sae~ Morbidity and Mortality Among Primary Care Patients Discharged from Hospital Depression Trajectories Predict l\[edical Burden Outcomes in Older Primaty Care Patients

NR56 EI 67

Depression Treatment of African Americans within a Primuy Care Setting

EI 20 EI 6

Depression, Cognition, and APOE: A Latent Class Approach to Identifying a Subtype Depression, Death and Suicide Ideation, and End-of-Life Decision-Making Among Older Dialvsis Patients Desire for Involvement in Decision-Making in Clinical Encounters with Psychiatrists and Primary Care Providers Determinants of Disability Among Newly-Admitted Assisted Living Residents Vary by Dementia Status Determinants ofRehospitalization Among Geriatric Psychiatric Patients

EI 38

Determinants of Specific Disabilities in Elderly Outpatients with Major Depressive Disorder Development of Risk Models for Psychotropic J\.{edication Use in VA Nursing Homes

EI 28

Dietary Glycemic Index and Bmin Lesion Volume in the Elderly

EI 64

Differentiating Late Onset Schizophrenia from Earlier Onset Schizophrenia

NR80

Dimebon Stabilizes Neuropsychiatric Symptoms in Alzheimer's Disease: One-Year Clinical Trial Results Disability in Community-Based Older Women with Depression

NR44 EI 27

Distinguishing Impulse Control Disorders from Bipolar Disorder in Parkinson's Disease

NR48

Diversity in Geriatric Psychiatry: AAGP Members' Attitudes and Experiences

NR50

Do Antipsychotics Modify the Risk fot Alzheimer's Disease in Schizophrenia?

EI56

EI 23 BI42

EI 73

EI 55

E45

Does Brain Imaging Help Clinicians Diagnose Dementia? Does Depression Affect Healthcare and Social Services Utilization Among Aging Services Clients? Donepezil for Severe Alzheimer's Disease: Behavioral Effects in Patients with Multi.Domain Responses Donepezil in Mild Alzheimer's Disease: Meta-Analysis of Patient Cohort with Mild Dementia Early Predictors of Dementia: The Development ofTwo Oassification Models

EI 32

Effect of Age/Gender on Efficacy/Safety ofDesvenlafaxine in Adult Outpatients with

NR 10

NR45 NR46 NR18

MDD Effectiveness of ECT in Geriatric Tertiary Psychiatry Patients: 6 Year Retrospective

EI 19

Efficacy and Tolembility of Duloxetine in Elderly Patients with Generalized Anxiety Disorder Elder Abuse Education in Primary Care

NR4

Analysis

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NR54

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting

Poster Abstract Title Elder ~streatment

A Community Survey

Electrophysiological Responses to a Stroop Task in Geriatric Depression: State or Trait Effects? Enhancing Resilience to Stress and Quality ofLife in Depressed Infonnal Dementia Caref.tivers Envejecimiento Positivo: Comparison ofLatina and Caucasian Older Women's Views of Successful Aging Estradiol with or without Progesterone Effects on Cholinergic-Related Cognitive Perionnance in Older Women Estrogen Intezacts with the Cholinergic System to Affect Verbal Memoty in Postmenopausal Women Evaluating the Eldercare Clerkship: Geriatric Knowledge, Attitude, and Clinical Skills Evaluation of Sdf-Awareness of Memory Impairment in the Community Elderly Evidence for Inflammatory Cytokines as the "Final Common Pathway" of Delirium

Poster Number EI74

EI 5 NR2 NR35

NR27

NR26 NR53

EI68 NR23

PathoJ:te!lesis Examination of Digit Span Errors Among :f\.fiddle-Aged and Older Persons with Schizophrenia Executive Deficits in Alzheimer's Disease: An FOG-PET Imaging Study

EI 9

NR22

Factors Associated with Performance of Complex Tasks of Daily living in CommunityLivinK Older Adults Falls in the Nursing Home: Does TJme J\.latter?

EI 39

Folate Related Genes and Response to Antidepressant Medications in Late-Life Depression

NR12

Frontal Gray Matter Changes in Late Life Bipolar Disorder

EI25

NR5

High Incidence ofAggression in Persons with Dementia

NR29

How Homebowtd Elderly Accept Antidepressants

NR62

How Older Adults Express Depression: A Comparison of Three Ethnic Groups in Primary

Care

Identification of Behavioral Health Issues in Recipients of Home-Based Aging Services Impact of Mood and Anxiety Symptoms in MCI

EI36

NR58 EI50

Impact of Patient Preference for Depression Treatment on Initia.tion~ Adherence, and Remission Improving Detection of Home Health Nursing Needs Following Geropsychiatty Discharge

NR63

Infrequent Depression Treatment Among the Oldest Suicide Victims in New York City

NR 55

Initial Longitudinal Validation: The Computer-Administered Neuropsychological Screen for Mild CoJ?;l1itive Impainnent Interpreters in Mental Health: A Team Approach to Cross-Cultural Counseling, Case

NR 19

EI 37

NR49

Report Is the MMSE an Adequate Screening Cognitive Instnlment in Studies ofLate-Life Depression? Laboratory Assays of Plasma Amyloid-Beta

EI 63

Lifespan Patterns of Strenuous Exercise and Well-Being Among Women in Late-Life

EI 40

EI 7

Lifetime History ofManic Episodes and Risk of Cognitive Decline Among Community Residents: Findinas from the Baltimore RCA Follow-Up Study Longitudinal Observations of Cognitive Functioning in Older Adults with Bipolar Disorder

EI 3

Losing and Using Faith: Older African Americans Discuss Religion~ Spirituality and Depression Measuring Outcome Effects of Medication Changes in Tertiary Geriatric Psychiatry Patients

EI22 NR33

Memantine Improves Functional Communication in Patients with Moderate to Severe

NR43

Am J Geriatr Psychiatry 16:3, Supplement 1

EI 2

A129

2008 AAGP Annual Meeting

Poster Abstract Tide

Poster Number

Alzheimer's Disease Mental Health Resources for the Elderly in the Americas: Developing New Policies

NR 68

Meta-Analysis of Cerebrospinal Fluid Levels ofBeta-Amylo~ Total Tau, and p-Tau in Patients with Mild Co~tive Impairment Modulation of Human Memory Circuit by Minor Depression in Late Life: An fMRI Study Neuropsychiatric Conditions Associated with Aggression in Geropsychiatric Inpatients: Potential T~ts for Intervention Older Schizophrenia Patients Show Abnonnal Brain Response During an Attentional Task One Year Experience of a Geriatric Psycho-Oncology Clinic - What are the Common Psychiatric Problems in Elderlv Patients with Cancer? Outcomes of Subsyndromal Depression in Olde£ Primary Care Patients

EI 61 NR21 NR 31 EI 11 EI 71 EI 17

Outpatient Follow-Up Referral Rates for Older Depressed Consultation-Liaison Patients

NR 67

Pain-Personality-Opioid-Dependence Interaction and Impact on Length of Stay in Elderly Pre-Spine Suraety Patients Patient Derived Depression Treatment Strategies: Using Multi-Dimensional Scaling for Services Research Physical and Mental Health-Related Quality of Life Among :Middle-Aged and Older Persons with Schizophrenia Placebo-Controlled Trial of Quetiapine for Sleep Disturbance in Dementia and MCI

NR 72

Plasma Kynurenine to Tryptophan Ratio is Associated with Post-Stroke Cognitive Symptoms Pooled, Meta-Analysis of Brief Altematives to ~E in Detecting Dementia

NR 25

Pooled, Meta-Analysis of Single Domain Cognitve Tests to Detecting Dementia

NR17

EI 18 NR 73 NR 75

NRt6

Predictors of Healthy Aging Among Older Homecare Recipients

EI 29

Prevalence and Predictors of Mood, Anxiety, and Substance Abuse Disorders for Older Americans in the National Comorbidity Survey-Replication Prevalence of Executive Dysfunction in Elderly Depressed Inpatients

NR59 EI 4

Profiles of Functional Impairment in Older Patients Treated for Major Depression

NR13

Psychiatric Epidemiology of the Elderly Population in Chile

NR51

Psychometric Properties of the Patient Heath Questionnaire (PHQ-2/9) Among Aging Services Clients Relationship Between Frailty and Cognitive Decline in Older Mexican Americans

EI33

Relationship between Trauma and Psychosis in Older Adults with Schizophrenia

EI76

Religion and Quality of Life in Older Persons with Schizophrenia

EI24

Research Trends in Alzheimer's Disease - A Perspective from www.clinicaltrials.gov

EI 43

Risk ofAccidents in Older Adults Taking Medications for Insomnia

NR74

Safety and Efficacy of Electroconvulsive Therapy (Eel) for the Treatment of Agitation and Other Behavioral Complications of Dementia Seasonality of Mood-Related Psychiatric Hospitalization Among the Elderly

EI 53

Sense of Well Being in Older Adults Following the War: The Moderating Effect of Lifelong Trauma and Health Status

NR70

Sleep Disturbance and Alzheimer·s Disease

EI60

EI41

EI 1

Social Support in Older Individuals: The Role of the BDNF Val66Met Polymorphism

NR7

Somatic Symptoms and the Identification ofDepression Among Elderly Primaty Care Patients Specialist and Non-Specialist Hospitalisation for Psychiatric Disorders in Australia

EI34

A130

NR57

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting

Poster Abstract Tide

Poster Number

Subjective Cognitive Functioning as a Predictor of All Cause Mortality

NR71

Suicidal Ideation Predicts Five-Year Mortality Among Elderly Primary Care Patients

NR64

Sustained Benzodiazepine Use in a Community Sample of Older .i\.dults

EI59

Tarenflurbil Delays Tune to Clinically Significant Psychiatric Events in Alzheimer's Disease (AD) Telephone Assessment of Depressive Symptoms in the Recnntmeot of Older Adults

NR38 NR61

Tertiary Care Geriatric Psychiatry Patients: Diagnostic and Clinical Characteristics

NR32

Testing the Role of Cognitive Reserve-Associated Cortical Networks with RdR.I-Guided

NR24

The Control of Acute Psychosis or Agitation in a Geriatric Population: Use of IntJ:amuscular Ziprasidone The Cost-Effectiveness of Olanzapine Treatment for Agitation and Psychosis in Alzheimer's Disease The Cost-Utility of the Rivastigmine Transdermal Patch in the l\Ianagement of Patients with Moderate Alzheimer's Disease in the US The Depression-Disability Process: An Investigation from the PROSPECT Study

NR35

The Effect of Polypharmacy on Length-of-Stay in a Geropsychiatty Inpatient Unit

EI54

The Metabolic Syndrome and Episodic Memory Deficit: Gender Differences

NR20

The Old Man's Crack Club: Characteristics of Older Crack Cocaine Users

NR60

The Relationship Between Cardiopulmooaq Fitness and Depressive Symptoms in Patients with Stable Coronary Artery Disease The Relationship of Marital Status and Clinical Characteristics in !\fiddle-Aged and Older Patients with Schizophrenia and Depressive Symptoms The Role of Low Testosterone Level in Older Men with Major Depression

EI 41 EI77

Understanding Decision Processes in Depression Treatment

EI 21

rTIvIS

HI 52 NR37

EI26

EI65

Unrecognized Cognitive Impairment in Hospice Patients

EI46

Utilization of Complementary and i\ltemative Medicine (CAM) Among Older Adults with Serious Mood Disorders Volunteering as a Predictor of All Cause Mortality: \Vhat Aspects of Volunteering Really Matter? Weight Gain and Use of Atypical Antipsychotics in Long-Tenn Care Elderly: A Retrospective Chart Review \Vhat.Kind of Dementia Care Do We Need?

NR66

White Matter Hyperintensity Burden Predicts Poor Response to i\ntidepressant Treatment in Depressed Elders

Am J Geriatr Psychiatry 16:3, Supplement 1

NR69 NR36

EI 44 EI 16

A131

2008 AAGP Annual Meeting

Poster Abstracts by Presenting Author

(EI # - Indicates Early Investigator Session and Poster Number; NR # - Indicates New Investigator Session and Poster Number)

Last Name First Name Middle Initial Abrams

Robert

AliciEvcimen Alva

Yesne

Andrews

Alice

Avidan

Alon

Ayalon

Liat

c.

Gustavo

Y.

Ayalon

Liat

Ayalon

Liat

Bankole

Azziza

Becker

Marion

Beyer

John

L.

Boyle

Lisa

L.

Brenes

Gretchen

A.

Bullock

Karen

Bungay

Kathleen

Buree

Barbara

Byers

Amy

Cardenas

Veronica

Chen

Peijun

Chen Chisholm

ChengSheng Denise

Colemon

Yolonda

R.

Comijs

Hannie

c.

Cummings

Jeffrey

L.

Cummings

Jeffrey

L.

Dahlberg

Britt

A132

A.

L.

Poster Abstract Tide In&equent Depression Treatment Among the Oldest Suicide Victims in New York City One Year Experience of a Geriatric Psycho-Oncology Clinic - What are the Common Psychiatric Problems in Elderly Patients with Cancer? Comparative Safety and Tolerability of Alzheimer's Disease Treatments Decision Aid Development for Location of Care Options in Early Alzheimer's Disease Risk of Accidents in Older Adults Taking Medications for Insomnia

Poster Number NR55 EI71 NR42

EI47 NR74

Sense ofWell Being in Older Adults Following the War: The Moderating Effect of Lifelong Trauma and Health Status Subjective Cognitive Functioning as a Predictor of All Cause Mortality

NR 70

Volunteering as a Predictor of All Cause Mortality: What Aspects of Volunteering Really Matter? Clinical Remission in a Multi-Ethnic Urban Population of Older Adults with Schizophrenia Correlates and Predictors of Behavioml Health Hospitalization in Nurs~ Home Residents Frontal Gray Matter Changes in Late Life Bipolar Disorder

NR69

Cognitive Impainnent and its Correlates in Seniors Receiving Case Man~ement from an AJtinJt Services ~CV Age and Racial Differences in the Presentation and Treatment of Generalized Anxiety Disorder in Prinw:y Care Diversity in Geriatric Psychiatry: AAGP Members' Attitudes and Experiences How Homebound Elderly Accept Antidepressants Tertiary Care Geriatric Psychiatty Patients: Diagnostic and Clinical Characteristics The Depression-Disability Process: An Investigation from the PROSPECf Study Envejecimiento Positivo: Comparison of Latina and Caucasian Older Women's Views of Successful A~K Antipsychotic Use in Veterans with Parkinson's Disease: Analysis of a National Sample Correlation of:MR. Spectroscopy with Cognitive Impainnent in Remitted Late-Life Major Depression Disability in Community-Based Older Women with Depression Depression Treatment of African Americans within a Primary Care SettinR Early Predictors of Dementia: The Development ofTwo Classification Models Dimebon Stabilizes Neuropsychiatric Symptoms in Alzheimer's Disease: One-Year Clinical Trial Results Donepezil for Severe Alzheimer's Disease: Behavioral Effects in Patients with Multi-Domain Responses Patient Derived Depression Treatment Strategies: Using MultiDimensional Scalin~ for Services Research

NR 71

EI78 NR34 NR5 EI72

NR3 NRSO NR62 NR32 EI26

NR35 EI58 NRt4

EI27 EI20 NRt8

NR44 NR45 EIt8

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting

Last Name FintName Middle Initial DaielIo

Lori

A.

Dawes

Shumn

E.

DeMers

Shaune

DeMers Devier

Poster Abstract Title

Poster Number

M.

Cholinesterase Inhibitor Discontinuation is Associated with Behavioral ~s in NllISinR Facility Residents Examination of Digit Span Errors Among Middle-Aged and Older Persons with Schizophrenia Does Brain Imaging Help Clinicians Diagnose Dementia?

EI45

Shaune

M.

What Kind of Dementia Care Do We Need?

EI44

Deicke

J.

Impact of Mood and Anxiety Symptoms in Mel

EISO

Diamond

Lana

C.

Unrecognized Cognitive Impainnent in Hospice Patients

EI46

Diwan

Shilpa

EI81

Draper

Brian

Drayer

Rebecca

Dumas

Julie

EpsteinLubow Folsom

Gary

Correlations .£o\mong Symptom and Social Outcome Categories in Older Adults with Schizophrenia Specialist and Non-Specialist Hospitalisation for Psychiatric Disorders in Australia Depression Trajectories Predict Medical Burden Outcomes in Older PDmary Care Patients Estrogen Interacts with the Cholinergic System to Affect Verbal Memory in Postmenopausal Women A Comparison of Brief Screeniog Measures for Caregivers

David

P.

Forester

Brent

P.

Ginsburg

Irena

F.

Goh

KahHong

A.

Physical and Mental Health-Related Quality of Life Among ~dle-Aged and Older Persons with Schizophrenia Bmin Lithium Effects on Cognition and Mood in Geriatric Bipolar Disorder Interpreters in Mental Health: 4~ Team Approach to Cross-Cultw:al CounselinJt. Case Report Anxious and Depressed Elderly, A Parallel or Serial Relationship?

EI51 EI9

NR57 EI67

NR26 NR.8

NR73

NR6 NR49 EI14

Goh

KahHong

Depression in the Elderly: \Vbat Predicts the Outcome?

HItS

Gmbovich

Andrew

Outcomes of Subsyndmmal Depression in Older Primary Care Patients

EI17

Gass

Melina

Factors Associated with Perfoanance of Complex Tasks of Daily Living Older Adults Effect ofAge/Gender on Efficacy/Safety ofDesvenlafaxine in Adult Outpatients with MDD Identification of Behavioml Health Issues in Recipients of Home-Based

EI25

E.

in Community-Li~ Guice-Pabia Christine

Gum

Amber

M.

NRl0

NRS8

~Services

Gum

Amber

Haddix

Robert

Hendrix

Suzanne

Heanan

Adam

Herrmann

Nathan

Hemnann

Nathan

Hill

Emory

Hyams

Adriana

Hybels

Celia

M.

Prevalence and PredictoIS of M()()(), Anxiety, and Substance Abuse Disorders for Older ,,~ricans in the National Comorbidity Survey-

NRS9

Replication

D.

F.

Comparison .t'\mong Personality Profiles in Patients with Alzheimer's Disease, Vascular Dementia and Traumatic Blain Iniury Alzheimers Disease Clinical Trial Designs: Toward a Practical Demonstration of Disease Modification Development of Risk Models for Psychotropic Medication Use in VA Nursin2 Homes Clinical Persistence: How Long do Patients Remain on Cholinestemse Therapy? The Relationship Between Cardiopulmonary Fitness and Depressive Symptoms in Patients with Stable Coronary Artery Disease Initial Longitudinal Validation: The Computer-Administered NeuropsycholoW.ca1 Screen for Mild Co~tive Impairment Longitudinal Observations of Cognitive Functiooing in Older Adults with Bipolar Disorder Profiles of Functional Impairment in Older Patients Treated for Major

Am J Geriatr Psychiatry 16:3, Supplement 1

EI70

NR39 EISS

NR40 EI41

NR19 EI2 NRt3

A133

2008 AAGP Annual Meeting

Last Name First Name Middle Initial

Poster Abstract Tide

Poster Number

Depression

A.

Hyer

Leon

Ismail

Zahinoor

~acobson

Sandm

~amerson

Brenda

Oang

Yuri

creon

Hong]in

~imenez

Daniel

E.

~ones

Rebecca

w.

A.

Paio-PetSonality-Opioid-Dependence Interaction and Impact on Length of Stay in Elderly PEe-Spine S1.11'ReEY Patients Sleep Disturbance and Alzheimer's Disease

NR72

NR23

Kaup

Allison

Kavanagh

~anet

Keaton

Daniel

Kennedy

Gary

J.

Kirbach

Stephanie

E.

Kmiec

~ulie

A.

Kohen

Izchak

Evidence for Inflammatoqr Cytokines as the "Final Common Pathway" of Delirium Patho~esis Folate Related Genes and Response to Antidepressant Medications in Late-Life Depression Attitudes Toward Mental Health Services: An Age Group Difference in Korean American Adults Evaluation of Self-Awareness of Memory Impairment in the Community Elderly How Older Adults Express Depression: A Comparison ofTbree Ethnic Groups in PrimaJ:y Care The Effect of Polyphannacy on Length-of-Stay in a Geropsychiatty llnpatient Unit Determinants of Specific Disabilities in Elderly Outpatients with Major Depressive Disorder Older Schizophrenia Patients Show Abnormal Brain Response During an Attentional Task Telephone Assessment of Depressive Symptoms in the Recruitment of Older Adults Utilization of Complementary and Alternative Medicine (CAM) Among Older Adults with Serious Mood Disorders Depression Screening, Morbidity and Mortality Among Primary Care Patients DiscbarJted from Hospital The Cost-Effectiveness of Olanzapine Treatment for Agitation and Psychosis in Alzheimer's Disease Atrophic Changes in Patients with Comorbid .lllibeimer's Disease and Major Depressive Disorder Falls in the Nursing Home: Does Time Matter?

Kohn

Robert

Psychiatric Epidemiology of the Elderly Population in Chile

Kanellopoul Dora

as

R.

in Persons with Dementia

Kunik

Mark

E.

High Incidence of ~-\ggression

Kyomen

Helen

H.

Lanctot

Krista

L.

Lanouette

Nicole

M.

Latoussakis

Vassilios

Lavretsky

Helen

Lavretsky

Helen

Legesse

Benalfew

Lehmann

Susan

w.

Lu

Brett

Y.

Neuropsychiatric Conditions i\ssociated with l\ggression in Geropsychiatric Inpatients: Potential TaIKets for Intervention Plasma Kynurenine to Tryptophan Ratio is Associated with Post-Stroke CoJtQitive Symptoms Lifespan Pattems of Strenuous Exercise and Well-Being Among Women in Late-Life Electrophysiological Responses to a Stroop Task in Geriatric Depression: State or Trait Effects? Depression and Anxiety Symptoms Predict Cerebral FDDNP-PET Bin. in Non-Demented Older Adults Enhancing Resilience to Stress and Quality ofLife in Depressed Infoanal Dementia Careaivers Meta-Analysis of Cerebrospinal Fluid Levels of Beta-Amyloid, Total Tau, and p-Tau in Patients with Mild COROitive Impairment Distinguishing Impulse Control Disordets from Bipolar Disorder in Parkinson's Disease Seasonality of Mood-Related Psychiatric Hospitalization Among the Elderlv

A134

EI60

NR12

NR65

EI68 EI36 EI54

EI28 EI11 NR61

NR66

NR56 EI52 EI62

EI39 NR51

NR29 NR31

NR25 EI40

EI5 NRl NR2 EI61 NR48

Elt

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting

Last Name FintName Middle Initial Luber

Bruce

Malladi

Srinivasa

s.

Malladi

Srioivasa

s.

Malyuk

Rhonda

Marino

Patricia

Martinez

James

Mintzer

Jacobo

MiIZakhania Heline n

Poster Abstract Tide Testing the Role of Cognitive Reserve-Associated Cortical Networks with fMRI-Guided rTIdS Pooled, ~Ieta-Analysis of Bnef Alternatives to ~fSE in Detecting Dementia Pooled, Meta-Analysis of Single Domain Cogoitve Tests to Detecting Dementia lvIeasuring Outcome Effects of Medication Changes in Tertiary Geriatric Psychiaav Patients Depression and Psychosocial Factom Mfecting i\ttitudes and Beliefs about Medicare Part D Efficacy and Tolerability of Duloxetine in Elderly Patients with Generalized Anxiety Disorder Tarenflurbil Delays T101e to Clinically Significant Psychiatric Events in Alzheimer's Disease (AD) Age-Related Changes in Functional Brain Response During an Attentional Task in Schizophrenia Religion and Quality of Life in Older Persons with Schizophrenia

Mittal

Sukriti

Morse

Jennifer

Q.

Attachment Style and Categiving Outcomes

~furthy

Anita

K.

Nagy

Balazs

Nail

Vasavan

Nanda

Francine

Newhouse

Paul

Nyer

1\(areo

Okereke

Olivia

I.

Donepezil in Mild Alzheimer's Disease: Meta-Analysis of Patient Cohort with Mild Dementia The Cost-Utility of the Rivastigmine Transdennal Patch in the ~agement of Patients with Moderate i\lzheim.er's Disease in the US The Metabolic Syndtome and Episodic Memory Deficit Gender Differences Placebo-ConttoDed Trial of Quetiapine for Sleep Disturbance in Dementia and Mel Estradiol with or without Progesterone Effects on Cholinergic-Related CaRnitive Performance in Older Women The Relationship of Marital Status and Clinical Characteristics in Middle.t\Jted and Older Patients with Schizophrenia and Depressive Symptoms Laboratory Assays of Plasma Amyloid-Beta

O'Neal

Erica

L.

Palekar

Nikhil

Payne

Martha

Popescu

loana..

A.

E.

Mihae1a Rai

Susan

Rais

Alina

Rajji

Tarek

K.

Rajji

Tarek

K.

Ramsey

Christine

M

Raue

Patrick

~.

Desire for Involvement in Decision-Making in Clinical Encounters with Psychiatrists and Primary Care Providers Relationship between Trauma and Psychosis in Older Adults with Schizophrenia Dietary Glycemic Index and Bmin Lesion Volume in the Elderly Do Antipsychotics Modify the Risk for Alzheimer's Disease in Schizophrenia? Effectiveness of Ber in Geriatric Tertiary Psychiatry Patients: 6 Year Retrospective Analysis The Control ofAcute Psychosis or Agitation in a Geriatric Population: Use of Intramuscular Ziprasidone Age at Onset and Cognitive Deficits in Schizophrenia: A Quantitative Review Is the ~rsE an Adequate Screening Cognitive Instmment in Studies of Late-life Depression? Lifetime HistoIJ of Manic Episodes and Risk of Cognitive Decline Among Community Residents: Findings from the Baltimore ECA Follow-Up Studv Impact ofPatient Preference for Depression Treatment on Initiation, Adherence, and Remission

Am J Geriatr Psychiatry 16:3, Supplement 1

Poster Number NR24 NR16 NR17 NR33 EI30

NR4 NR38 EI10 EI24

EI49 NR46 NR37 NR20

NR75

NR27 EI77

EI63 EI23

EI76 EI64 EI56 EI19

NR35 EIS

EI7 EI3 NR63

A135

2008 AAGP Annual Meeting

Last Name First Name Middle Initial

Raue

Patrick

Reyes

Pia Natalya

~. T.

Richardson Thomas

M.

Richardson Thomas

M.

Richie

Megan

B.

Russ

Ann

~.

SamperTemeot Samus

Rafael Quincy

M

Sanchez.Almira Santos

~guel

A.

Elizabeth

~.

SapIa

Mamta

Poster Abstract Tide

Suicidal Ideation Predicts Five-Year Mortality Among Elderly Primaty Care Patients Clinical Co:aelates of Insight in Older Adults with Schizophrenia

Poster Number NR64

EI75

Does Depression Mfect Healthcare and Social Services Utilization AmOlUt ~ Services Clients? Psychometric Properties of the Patient Heath Questionnaire (PHQ.. 2/9) AmOflD Ao1.no- Services Clients Depression, Cognition, and APOE: A Latent Class Approach to Iden~ a Subtype Depression, Death and Suicide Ideation, and End-of-life Decision.. Makina Amona Older Dialvsis Patients Relationship Between Frailty and Cognitive Decline in Older Mexican Americans Detemlinants of Disability Among Newly-Admitted Assisted living Residents Varv bv Dementia Status Community Integmtion of Older Adults with Schizophrenia

EI32

Elder Mistreatment: A Community Survey

EI74

Correlation Between Anosognosia and Apathy in Older Adults with

EI69

EI33

EI6 EI38

EI41 EI42 EI79

Alzheimer's Disease

Scheinkman Lilian Seritan

Andreea

Seyfried

Lisa

S.

Shah

Puja

R.

Shamsi

Mohd

Shanahan

Brian R.

Shiroma

Paulo

Simning

Adam

Somers

Kristin

Spira

Adam

Srinivasan

Shilpa

Srinivasan

Shilpa

Stowell

Keith

Sun

Xiaoyan

Tariot

Pierre

N.

Taylor

Wanen

D.

Tew

~ames

D.

Mental Health Resources for the Elderly in the Americas: Developing New Policies Dementia in Fragile X-Associated Tremor/i\taxia Sydrome (FXTi\S): Comparison with Alzheimer's Disease Outpatient Follow-Up Refeaal Rates for Older Depressed ConsultationLiaison Patients Somatic Symptoms and the Identification of Depression Among Elderly primaty Care Patients Research Trends in .Alzheimer's Disease - A Petspective &om www.clinicaltrials.RQv A Web-Based Response to Addressing the Current NThfi-I Funding Climate for Geriatric Mental Health Researchers Detennioants of Rehospitalization Among Geriatric Psychiatric Patients Anxiety in Seniors Receiving Care I\ofanagement from an Aging Services

NR68 NR47 NR67

EI34 EI43 NR52

EI73 E113

AJteOcy

A136

Prevalence of Executive Dysfunction in Elderly Depressed Inpatients

EI4

~. P.

Anxiety Symptoms and Functional Impainnent in "ery Old Community-

EI12 EI57

R.

Atypical Antipsychotics and Metabolic Changes in Older Adults in Primary Care Clinic Weight Gain and Use ofAtypical i\.ntipsychotics in Long-Term Care Elderly: A Retrospective Chart Review Sustained Benzodiazepine Use in a Community Sample of Older Adults

DwellinJt Women

Amyloid-Associated Depression: A Prodtomal Depression of Alzheimer's Disease? Memantine Improves Functional Communication in Patients with Moderate to Severe .Alzheimer's Disease Social Support in Older Individuals: The Role of the BDNF Val66Met Polymorphism Improving Detection of Home Health Nursing Needs Following Geropsvchiatry Dischar2e

NR36 EI59 NR15 NR43 NR7 EI37

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting

Last Name First Name MidcDe Initial

Poster Absttaet Tide

Thielke

Stephen

M.

Depression as a Predictor of Analgesic Use in Older Adults

Thome

Diana

L.

The Old Man's Crack Oub: Characteristics of Older Crack Cocaine Users

Ujkaj

I'vianjola

Uniitzer

Jiirgen

Vahia

Ipsit

VanBussel

Lisa

Safety and Efficacy of Electroconvulsive Therapy (EC1j for the Treatment of Agitation and Other Behavioral Complications of

Poster Number EI31 NR60

EI53

Dementia Depression in Green Ribbon Health's Medicare Health Support Program Differentiating Late Onset Schizophrenia from Earlier Onset Schizophrenia Evaluating the Eldercare Clerkship: Geriatric Knowledge, Attitude. and

NR9

NRBO NR53

Clinical Skills Volicer

Ladislav

Wagenaar

Deborah

B.

Walton

:Michael

F.

Agitation and Resistiveness to Care are Two Separate Behavioral Syndromes of Dementia Elder Abuse Education in Primary Care

NR30 NRS4

White Matter Hyperintensity Burden Predicts Poor Response to Antidepressant Treatment in Depressed Elders Predictors of Healthy Aging Among Older Homecare Recipients

EI16

EI48

EI29

Weinberger Mark

I.

Wllkins

Victoria

M.

Wllkinson

Jennefer

F.

Wittink

Marsha

N.

Wittink

Marsha

N.

Beyond Burden: Family Member Caregivers' Experiences and Interest in Enhancing Effectiveness The Role of :Low Testosterone Level in Older Men with Major Depression Losing and Using Faith: Older African Americans Discuss Religion, Spirituality and Depression Understanding Decision Processes in Depression Treatment

Woo

Benjamin

KP

Executive Deficits in Alzheimer's Disease: An FOG-PET Imaging Study

NR22

Woo

Shoshana

L.

NR21

Yeager

Catherine

A.

~fodu1ation of Human lvlemoty Circuit by IMinor Depression in Late Life: An fMRI Study Apathy in Dementia: Relationship to Depression, Functional Competence, and Quality ofLife

Am J Geriatr Psychiatry 16:3, Supplement 1

EI65 EI22

EI21

NR28

A137

2008 AAGP Annual Meeting

Faculty Disclosures - Sessions Only Marc E . .L~nin, M.D. Nothing to disclose

M.D. Iqbal Ahme~ Nothing to disclose Esther Akinyemi, MD. Nothing to disclose George S. Alexopoulos, MD. Research support Cephalon, Forest Speaker's bureau: CephalOD, Forest, Lilly, Bristol Meyers Squibb, Glaxo, Pfizer, Janssen Consultant: Scientific Advisory Board of Forest, Sanofi-Aventis, Novartis .Allan A. Anderson, MD. Speaker's bureau: Jansen, Forrest, Novartis, Pfizer

Melissa H. Andrew, MD., MEd., F.R.C.P.C. Nothing to disclose Patricia A. Arean, Ph.D. Nothing to disclose Steven E. Arnold, MD. Nothing to disclose Frances K. Barg, Ph.D. Nothing to disclose

Stephen J. Bartels, M.D., MS. Research support: NIMH, CDC, S.Al\H-ISA, Endowment for Health Consultant: Westat, NRI

Hillary R. Bogner, MD., M.S.C.E. Nothing to disclose Azziza O. Baokole, M.D. Nothing to Disclose Ellen Brown Ed.D., M.S., A.R.N.P., RN.

Other: NIMH Grant Soo Borson, MD. Nothing to disclose

Martha L" Broce, Ph.D., M.P"H. Nothing to disclose

Karen Bullock, Ph.D. Nothing to disclose

Eye H. Byrd, M.S.N., M.P.H., A.P.R.N.-B.C. Nothing to disclose

A138

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Nancy B. Carlson, M.S., A.P.R.N.-B.C. Speaker's bmeau: Abbott, AstraZeneca, Forest David A. Casey, MD. Speaker's bureau: Pfizer, Abbott, Eisai Jeffrey L. Cllmmings, MD.

Speaker's Bureau: Eisai, Forest, Janssen, Lundbeck, Merz, Novartis, Pfizer Consultant Acadia, Astellas, Athenagen, Avanir, Cephalong, Eiasai, EnVivo, Forest, Janssen, Lilly, Lundbeck, Merck, Merz, Myriad, Neurochem, Novartis, Ono, Pfizer, Sanofi-Aventis Sam Czaja, Ph.D. Nothing to disclose

Emily Dakin, PILD. Nothing to disclose Jeannine R. Dalton, R.N., MN. Nothing to disclose John M. de Figueiredo, MD., Se.D. Nothing to disclose Colin A. Depp, Ph.D. Nothing to disclose Ellen G. Dedefsen, D.L.S. Nothing to disclose DP Devanand, M.D. Research Support: Eli Lilly and Company, Forest Pharmaceuticals, Inc., GlaxoSmithKline Julie Dumas, Ph.D. Nothing to disclose Carl Eisdotfer, Ph.D., M.D. Nothing to disclose James M. Ellison, M.D., MP.H.

Grant Research: GlaxoSmithI
Jovier D. Evans, Ph.D. Nothing to disclose

Lisa T. Eyler, Ph.D. Nothing to disclose. Warachal Faison, M.D. Nothing to disclose (Compare with BOD disclosures)

Am J Geriatr Psychiatry 16:3, Supplement 1

A139

2008 AAGP Annual Meeting Martin Rhys Farlow, MD. Research Support: Eunol, Inc., Novartis, Forest Laboratories, Eli Lilly, Ono/PbannaNet, Elan, Pfizer Speaker's Bureau: Novartis, Forest, Pfizer, Eisai Consultant Novartis, Forest, Eli Lilly, Ono/PharmaNet, Accera, Best Practice, GlaxoSmithKline, Saoofi-Aventis, Memory Pharmaceuticals, Abbott, Adamas, CoMentis, CephaloD, Eisai, MedivatioD, lvferck, Neurocbem, Octaphanna, Schering-Plough, Talecris, Toyama Phann., Worldwide Clinical Trials Other: Spouse is employed by Eli Lilly and Co.

Mara Ferris, MS., RN. Consultant Independent nurse consultant to health care organizations David P. Folsom, MD., MP.H. Nothing to disclose

Shyla Ford, L.C.S.W. Nothing to disclose Brent Forester, MD. Research support: Pfizer, GlaxoSmithKline, The Rogers Family Foundation Speaker's bureau: Eli Lilly, Abbott, Novartis,Janssen, Pfizer, i\straZeoeca Lori Frank, Ph.D. Nothing to disclose. Carol E. Franz, Ph.D. Nothing to disclose

Gavin Friedman, M.D. Nothing to disclose Dolores GaIlagher-Thompso~ Nothing to disclose

Ph.D.

Josepha Gallo, M.D., M.P.H. Nohing to disclose.

Ariel Gildengers, M.D. Nothing to disclose Susan Greenfiel~ BeE Other: Partial ownership in privately funded finn, Synaptica and has a stake in ?vIindweavers David Greenspan, M.D. Nothing to disclose Geotge Grossber& M.D. Research Support: BMS, AstraZeneca, Pfizer, Forest, Novartis, Wyeth Consultant Forest, Glaxo, Novartis, Wyeth, Sano6

Amber Gum, Ph.D. Nothing to disclose

Faith Gunning Dixon, Ph.D. Nothing to disclose David G. Harper, Ph.D. Nothing to disclose

A140

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Philip D. HatVey~ Ph.D. Research support: Bristol Myers Squibb Consultant: Pfizer, Janssen, Sanofi, AstraZeneca~

Abbott, Memory, Merck, Lilly~ FaIreSt

MchaelHasb Nothing to disclose

Ladson Hinton, MD. Nothing to disclose Paul E. Holtzheimer, ~I.D.

Nothing to disclose Kathryn Hyer, Ph.D. Nothing to disclose Zahinoor Ismail, M.D., F.Re.p.C. Nothing to disclose Lori L. Jervis, Ph.D. Nothing to disclose

'T.

Dilip ]este, M.D. Research support: AstraZeneca, Bristol-Myers Squibb, Eli Lilly donate antipsychotic medications for our NThfii funded Rot: Metabolic Effects of Newer Antipsychotics in Older Pts RobertJones, MD. Nothing to disclose Ricardo E. Jorge, MD. Nothing to disclose

Merrie Kaas, D.N.Sc., A.P.R.N.-B.C., C.N.S. Nothing to disclose

Helen C. Kales, M.D. Nothing to disclose Barbara Kamholz, MD.

Nothing to disclose Jordan F. Karp, MD. Research support: Eli Lilly Speaker's bureau: Eisai, Inc. Consultant Eli Lilly John Kasckow, M.D., Ph.D. Research Support Lilly, Bristol ~leyers Squibb, Forest, Pfizer, Johnson andJohnson Speaker's Bureau: Lilly~ Bristol Meyers Squibb, Forest, Pfizer, Johnson and Jobnson Consultant: Lilly, Bristoll\.feyers Squibb, Forest, Pfizer, Jobnson and Johnson Karin Kerfoot, M.D., F.R.e.p.c. Nothing to disclose

Amy Kilboume, Ph.D., MP.H. Nothing to disclose

Am J Geriatr Psychiatry 16:3, Supplement 1

A141

2008 AAGP Annual Meeting Paul Kirwin, MD. Nothing to disclose Izcbak Kohetlt MD. Nothing to disclose

Lewis p~

~ 1\£.D. Nothing to disclose

Helen H. Kyomen, ?vI.D., M.S. Research support: Bayer, Bristol-Meyen Squibb, Eli Lilly, Merck, Pfizer, Roche, UeB Phanna, Wyeth-Ayent COEpOrations Glaxo-SmitbKline, Novartis Consultant: 4~straZenec~ Melinda Lantz, MD. Nothing to disclose

Batty D. Lebowitz, Ph.D. Consultant: Servier, Roche, Forenap Phanna

Paula E. Lester, M.D. Nothing to disclose Cannen Lewis, MD., M.P.H. Nothing to disclose

Ge (Gail) Li, M.D., Ph.D. Research support: World Health Organization Loman Lin, MD. Nothing to disclose

Laurie A. Lindamer, Ph.D. Nothing to disclose

!vfaria D. llorente, I'vLD. Nothing to disclose

David Loewenst~ Ph.D. Research Support: NIH

Jose A. Luchsinger, MD., M.P"H. Nothing to disclose

Irwin Lucki, Ph.D. Research Support: Forest Laboratories, Epix Laboratories, AsttaZeneca Consultant: Wyeth

Raquel Lugo, ~f.D. Nothing to disclose Constantine G. Lyketsos, MD., MH.S. Research support: Grant Support (research or C1\ffi): NIMH, N~ Associated Jewish Federation ofBa1timo~ Kline, Eisai, Pfizer, Astta-Zeneca, Lilly,Ortho-1vlcNeil, Bristol-Myets, Novartis Consultant: Consultant/Advisor: Astta-Zeneca, Glaxo-Smith Kline, Eisai, Novartis, Forest, Supemus, Adlyfe Shareholder: Other: Honorarium or travel support: Pfizer, Forest, Glaxo-Smith Kline, Health ~[ooitor

A142

Forest, Glaxo-Smitb

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Jeffrey M Lyness, M.D. Nothing to disclose

!Mark Lyubkin, MD. Nothing to disclose Scott J\.fa~ Ph.D. Nothing to disclose

Susan Maixner, MD. Nothing to disclose

Julie E. Malphurs, Ph.D. Nothing to disclose

Laura Marsh, M.D..

Research Support: Forest Laboratories, Eli Lilly, Boehringer Iogelheim

Consultant: Boehringer Ingelbeim, Ovation Pharmaceuticals, Acadia Pharmaceuticals Moises I\fartinez, M.D.

Nothing to disclose

Vaughn W. McCall, M.D., M.S. Research Support: Sepracor, Sanofi, Mini Mitte~

GSK, Takeda

Speaker's Bureau: Sepracor, GSK Consultant: Sepracor, Takeda

Susan McCwry, Ph.D. Nothing to disclose

Wtlliam M McDonald, MD.

Grants: Boehringer Ingelheim, Fuqua Foundation, Janssen. NIMH, Neuronetics Speaker's Bureau: Bristol-Myers Squibb, Forest,janssen, Solvay Senator George McGovern, N/A Nothing to disclose Christine 1,. I\tlcKibbin, Ph.D. Research support: NIMH

Marsden McQuire, MD. Nothing to disclose Thomas IvIeeks, M.D. Nothing to disclose

Matthew ~leDZa, M.D. Research Support: NINDA, AsttaZeneca, Bristol-lvleyers Squipp, Boehringer Ingelh~ Lilly, Merck & Co., Pfizer, Sanofi-Aventis, Sepracor, Takeda, Wyeth

Speakers bureau: Sanofi-.A.ventis

Consultant: NThfH, NINDS, GlaxoSmithKline~

Forest Laboratories, GlaxoSmithKline, Eli

Kyowa, Lilly Research Laboratories, Pfizer, Sepracor, Takeda

Bamett Meyers, 1\II.D. Research Support~ Forest Laboratories, Eli Lilly Inc., Pfizer Phaanaceuticals Consultant: Forest Laboratories, Cyberonics Inc.

:Michelle M. :Mielke, Ph.D. Nothing to disclose

Am J Geriatr Psychiatry 16:3, Supplement 1

A143

2008 AAGP Annual Meeting IvIadt D. Miller" MD. Speaker's bureau: Wyeth, Lilly Consultant: Forest Phaanaceuticals, GSK Gary S. Moak, MD

Speakers bureau: Pfizer, Janssen, Eli Lilly and Co., Forest, Bristol IviyersSquipp Benoit H. Mulsant, M.D., MS., F.R.C.P.C. Research support: .£\straZeneca, Bristol-Myers Squibb Company, Corcept Therapeutics, Eli Lilly and Co., GlaxoSmithKline,JanssenOItho Inc., Lundbeck Inc., Pfizer Inc. Shareholder: Akzo-Nobel N.V., .Alkennes, Inc., AsttaZeneca, Biogen Idee, Cdsion Cotp., Elan Corp., pIc, Eli Lilly and Co., Forest Pharmaceuticals, The Immune Response Corporation, Pfizer Inc. Vemon I. Nathaniel, M.D. Nothing to disclose ]. Craig Nelson, M.D. Consultant: Consultation and Advisory Board: Biovail, Bristol Myers Squibb, Corcept, Eli Lilly, Forest, GlaxoSmithkline, Novartis, Orexigen, Organon, Pfizer Ph.D. Randy Nelso~ Nothing to disclose John W. Newcomer, M.D. Research support: NIMH, N.ARSAD, Sidney R. Baer Foundation, Janssen Pharmaceutica, Pfizer, Inc., Bristol-Myers Squibb Company, Wyeth Pharmaceuticals, Inc. Consultant:]anssen Pharmaceuticals, Pfizer, Inc., Bristol-Myers Squibb Company, i\straZeneca Pharmaceuticals, GlaxoSmithKline, Organon, Solvay, Wyeth Pbattnaceuticals, Inc. Other: Compact CIinicals - Product Development Royalties (for Metabolic Screening form) Paul Newhouse, 1\i.D. Speaker's bureau: Pfizer Inc.) Forest Pharmaceuticals, Novartis George Niederehe. Ph.D.

Nothing to disclose Colleen). Northcott, Ph.D., MD., F.R.C.P.C. Nothing to disclose

Maria Norton, Ph.D. Nothing to disclose Raymond L. Ownby, 1'f1D., Ph.D. Research support Natio02l Institute on Agin& Pfizer, Takeda Speaker's bureau: Pfizer, Forest, Takeda, Jansen, Glaxo Smith Kline Consultant: Pfizer,)ansen Slw:eholder: Enalan Communications, Inc. Thomas Oxman, MD. Consultant: Dr. Oxman is the managing partner of 3CM, ILC, an outgrowth of the ~raci\.rthur Initiative on Depression and Primary Care providing consultative and educational services to help health care organizations understand, implement, adapt, and evaluate the Three Component Model

Barton W. Palmer, Ph.D. Nothing to disclose

A144

Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting Amita R. Patel, M.D., C.M.D.., MH.A. Speaker's bureau: Eli Lilly & Co, Bristol Myers Squibb, Glaxo Smith Kline, Forest Pharmaceuticals Consultant Eli Lilly & Co Bruce Pollock, M.D., Ph.D., F.R.e.p.C. Research Support: NIMH, Janssen Phannaceuticals Speaker's bureau: Lundbeck and Forest Phaanaceutica1s Consultant Lundbeck and Forest Pharmaceuticals Sarah Pratt, Ph.D. Research Support: NIMH, New Hamsphire Endowment for Health, CDC

Bemard Ravin&, M.D., M.S.C.E. Research Support/Consultant: Acadia, Envivo, Novartis., Vernalis, NIH, DOD, Link, Neose Cynthia Resendez, M.D. Nothing to disclose

Charles Reynolds, M.D. Research support: GS~ Forest, Pfizer, Lilly, BMS MD.

Robert G. Robinso~ Nothing to disclose

Steven P. Roose, M.D.. Research support: Forest Phannaceuticals, Inc. Consultant Forest Pharmaceuticals, Inc, Lilly, and Wyeth Mercedes Rodriguez-Suarez, M.D. Nothing to disclose

Paul B. Rosenberg" MD. Research support: Glaxo Smith Kline" l\ferck Adam Rosenblatt, M.D. Consultant: Pfizer, Eisai, Novartis

Research Support: Forest

Thomas Roth, Ph.D. Research support Sano~ SchoeringPlough, Somaxon, Takeda, TransOral Consultant: Accadia, Arena, Cephalon, Eli Lilly, Forest, GlaxoSmithKline,Jazz, Merck, Neurim, Neurocrine, Neurogen, Orexo, Organon, Proctor & Gamble, Pfizer, Roche, 52006, SchoeringPlough, Sepracor, Shire, SOIll2XOn, Syrex, TransOral Anthony Rothchild, M.D. Research Support: CephalaD Inc., Cyberonics, Forest, Lilly" Novartis, Wyeth Consultant: Forest Phannaceuticals" Pfizer" Eli Lilly, GlaxoSmithKline

Jenny Rusted, Ph.D. Nothing to disclose Dana Ryder, B.S.

Other: Dana Ryder is an employee of Diamond Healthcare, a mental health provider that is jointly implementing the SOP program attheM]HHA 1dartba Sajatovic~

MD.

Research support: GlaxoSmithKline Speaker's bureau: AstraZeneca Consultant AstraZeneca

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2008 AAGP Annual Meeting Martin Sarter, Ph.D. Research Support Abbott Laboratories, Pfizer Inc. Consultant: Abbott Laboratories, Sonexa Pharmaceuticals Andrew Saykin, Psy.D. Research support: Pfizer

Jason Schillerstrom, M . D. Nothing to disclose Freddi Segal-Gidan, P.A., Ph.D. Other: Honoraria directly from Commercial Interest of their agents': Novartis

Una Shihabuddin, M.D. Nothing to disclose Kenneth I. Shulman, MD. Nothing to disclose Jo Anne Sirey, Ph.D. Nothing to disclose GaryS~MD.

Speaker's Bureau: Pfizer, Eisai, Abbo~ Ortha-McNeiI, Novartis, Siemens, and Forest Consultant: Pfizer, Eisai, Abbott, Ortho-McNeil, Novartis, Siemens, and Forest Other: oinventor of FDDNP-PET. UCLA has patented and licensed this technology to Siemens. Gwenn Smith, Ph.D. Nothing to disclose Joel Snee~ Ph..D . Nothing to disclose David C. Steffens, MD. Speaker's bureau: Forest Pharmaceuticals, Wyeth Pharmaceuticals Elliott M. Stein, M.D. Nothing to disclose

Martin Steinberg, MD. Research support: NIA AG21136; Progression of Dementia, A Population Study Jonathan T. Stewart, M.D. Speaker's bureau: Astra-Zeneca; Forest; Eli Lilly

Keith Stowell, MD., MS.P.H. Other: APA/GlaxoSmithKline Fellow

David L. Sultzer, MD. Research support: Forest Laboratories Rajesh R. Tampi, MD., MS. Nothing to disclose

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Am J Geriatr Psychiatry 16:3, Supplement 1

2008 AAGP Annual Meeting

Wuren Taylor, M.D. Research Support: GlaxoSmitbKline Speaker's Bureau: Pfizer Inc, Janssen Pharmaceutica Products, L.P. Consultant Wyeth-Ayerst Phannaceuticals Stephen Thielke, MD. Nothing to disclose Louis A. Trevisan, M.D. Nothing to disclose Nhi-Ha T. Trinh, MD. Nothing to disclose )o.t\nn T. Tschaoz, Ph.D. Nothing to disclose )iirgen Uoiitzer, M.D., MP.H., ~lA. Nothing to disclose Lisa Van Busse), MD., F.R.C.P.C. Nothing to disclose Sanjay M. Vaswani, M.D. Speaker's bureau: Wyeth Pharmaceuticals, Bristol Myers Squibb, Eli Lilly & Co, Pfizer Pharmaceuticals, Glaxo Smith Kline Consultant Abbott Labs Amy Walter Nothing to disclose

Lea Watson, MD., MP.H. Nothing to disclose

Phillip Whang, M.D. Nothing to disclose Theoddore Whitfie1~

Sc.D.

Research Support: AstraZeneca Enen M Whyte, MD. Research support: Pfizer Pharmaceuticals, Lilly Phaanaceuticals Consuela H. Wdkins, MD. Research support NIH- Beeson Career Development ~\ward Speaker's bureau: Pfizer, Janssen

K23.i\G026768

Kirsten Wdkins, M.D. Nothing to disclose Robert Wilson, Ph.D. Nothing to disclose Robert C. Young, MD. Research support: Janssen

Kara Zivin, Ph.D. Nothing to disclose

Am J Geriatr Psychiatry 16:3, Supplement 1

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