- Email: [email protected]
FREQUENCY AND ETIOLOGIES OF EARLY AND LATE ONSET DEMENTIA IN THREE TERTIARY REFERRAL CENTERS IN KOREA
P762
Poster Presentations: P3
Furthermore, an observational study shows that greater cardiorespiratory fitness is associated with slowed progression of dementia and brain atrophy in patients with AD. Objective was to assess the influence of physical activity and cognition on ADL. Methods: In the present study, data from the " Preserving quality of life, physical health and functional ability in A lzheimer’s d isease: The effect of physical ex ercise (ADEX) study" a randomized controlled multicentre study, was used. Baseline data from 166 patients with AD (age (mean 6SD): 70,9 67,5; gender (f/m): 72/94; Mini-Mental State Examination (MMSE)(mean 6SD): 24,1 63,6) were included.ADL was assessed by the Alzheimer’s Disease Co-operative Study - Activities of Daily Living (ADCS- ADL) scale and physical activity by the Physical Activity Scale for the Elderly (PASE) (caregiver interview).Furthermore, global cognitive function and mental speed/attention was assessed by the MMSE and Symbol Digit Modalities Test (SDMT), respectively. Two linear regression models were performed to investigate the impact of SDMT and PASE on ADCS-ADL. Covariates were PASE, age, gender and MMSE. In the second model, PASE was replaced by SDMT. Results: A significant association between ADL and PASE was found and between ADL and SDMT (B: 0,06; (SE: 6 0,02); b:0,27; and B: 0,06 (SE: 6 0,06); b:0,09, respectively). Conclusions: Both mental speed/attention (SDMT) and physical activity (PASE) had a significant but modest association with ADL. There was a tendency that low physical activity was associated with impairedADL to a greater extent than mental speed/attention. Future studies should to clarify if improving physical activity may supplement pharmacotherapy in postponing the decline in ADL in patients with AD. P3-358
FREQUENCY AND ETIOLOGIES OF EARLY AND LATE ONSET DEMENTIA IN THREE TERTIARY REFERRAL CENTERS IN KOREA
E. J. Kim1, Juhee Chin2, Noh Eul Han3, Ji-Hyang Oh1, Go Woon Kim1, JaeHong Lee3, Duk L. Na2, 1Pusan National University Hospital, Busan, South Korea; 2Samsung Medical Center, Seoul, South Korea; 3Asan Medical Center, Seoul, South Korea. Contact e-mail: [email protected] Background: To investigate the frequency and etiologies of early-onset dementia (EOD), as compared to late- onset dementia (LOD) in three tertiary referral hospitals in Korea. Methods: All patients from memory and dementia clinics of Pusan National University Hospital, Samsung Medical Center, and Asan medical center from January, 2010 to Jun, 2013 were included in the study. EOD and LOD were classified by an arbitrary onset cut-off age of 65. Results: A total of 6818 patients were seen and evaluated for dementia for about 4 years. Of these, 1801 patients met the criteria for dementia. However, out of the initial 1801 dementia patients, we excluded 533 patients who did not have either clear onset age or duration of illness. Thus, all further analyses were performed on the remaining 1268 patients. Among 1268 dementia patients, there were 346 (27.3%) EOD patients and 922 (72.2%) LOD patients. There were on significant differences between EOD and LOD patients in gender distribution, previous cancer history and a family history of dementia. However, EOD patients had longer duration of illness, higher level of education, and higher scores of MMSE than those of LOD patients. Vascular risk factors were more detected in LOD patients than EOD patients. Alzheimer’s disease (AD) was the most frequent cause of dementia in both EOD and LOD groups. While the second most common cause of dementia was vascular dementia, and the third being frontotemporal dementia (FTD) in the LOD group, FTD was significantly more common in the early onset group. Conclusions: EOD represented approximately 27% of patients with dementia in Korea. The underlying causes were considerably different in EOD compared with LOD patients, however AD was the most frequent cause in EOD. P3-359
DIAGNOSES OF ALZHEIMER’S DISEASE AND EVERYDAY LIFE
Fritze Tonny Norup Kristensen, University College North Jutland, Hjoerring, Denmark, Denmark. Contact e-mail: [email protected] Background: Nationally and internationally there is a focus on the importance of diagnosing dementia syndrome. The diagnostic criteria for Alzheimer’s disease (AD) reflect a biomedical concept of disease. The
biomedical viewpoint becomes clearer with the inclusion of criteria for pathophysiological changes referred to as biomarkers in the proposed revisions of the diagnostic criteria.However research has identified limitations to the biomedical approach. This study is grounded in the continuation of this research by incorporating the concept of disease - a praxis - philosophical perspective on the diagnosis. Methods: Humanistic dialectical perspective focused on the relationship between impairments of neurological functions and the experience of living with AD. A philosophical personoriented, relational concept of disease. AD is viewed from two different standpoints: 1) a biomedical perspective, and 2) the person with AD - his or her experiences from conduct of life. Focus is confined to creating knowledge of the perspective of the person with AD. Critical psychology. The person is understood as pro- active, as a subject. Concepts which makes it possible to direct focus at, for example: preserved - and impaired personal action potency, participating in changing contexts. Design - qualitative longitudinal study Semi-structured interviews. Included: 5 persons diagnosed in a Department of Neurology, with AD in mild to moderate degree, and one of each person’s relatives. Medical records. Results: From the perspective of the person with AD - the diagnosing based on a biomedical understanding of disease implies: 1) Clarification: a diagnosis. 2) Focus:cognitive impairments. 3) Abstract knowledge: Test r esults, "AD", " progression", " medication stabilizes". 4) No recognition of well-preserved acting potencies. These results are critical because the person with dementia: Actively re establish conduct of life, diagnosing does not support herein. Result: a cleft between diagnosing and everyday-life. Rehabilitation is privatized, which may worsen symptoms. Conclusions: A diagnostic examination based a praxis - philosophical - and a critical psychology perspective - with increased integration of the person’s experiences from everyday life will make it is possible to meet his or her goals for rehabilitation - and thus raise the quality of care provided. P3-360
UNDERSTANDING DEMENTIA AMONG THE BANGLADESHI COMMUNITY IN ENGLAND
Muhammad Zakir Hossain1, Ann Dewey1, Yohai Hakak1, Karan Jutlla2, 1 University of Portsmouth, Portsmouth, England, United Kingdom; 2 University of Worcester, Worcester, England, United Kingdom. Contact e-mail: [email protected] Background: Despite a growing ageing South Asian immigrant population in England, little is known about the experiences of diagnosis and care for those living with dementia. Dementia in the South Asian ethnic groups has been characterized as ‘a hidden problem in a hidden population’ within a considerably marginalized group and for which the existing literature is limited. Worldwide, there have been a number of small, qualitative studies among South Asian people living with dementia. Consolidation through qualitative meta-synthesis can: (1) merge the experiences of a number of participants across studies to reveal fresh insights, (2) provide an enhanced understanding of the experience, (3) reduce replication by identifying gaps in current literature and (4) generate new research questions. Methods: Following a systematic search of the literature, included qualitative studies were assessed by two independent reviewers for methodological quality. Data were extracted using the Qualitative Assessment and Review Instrument (QARI) developed by The Joanna Briggs Institute (JBI). Findings were synthesized using JBI approach of meta-synthesis by meta-aggregation. Results: Synthesis from thirteen papers were aggregated into six meta-synthesis themes as: (1) Poor awareness and understanding of dementia, (2) Permeated stigma and shame, (3) Burdens or blessings of family caring? (4) Healthcare decision making power within family, (5) Food as coping mechanisms, (6) Attitudes to current and future provision of dementia care services. Conclusions: One research gap was identified using the population framework where despite increasing number of older people from the Bangladeshi community in England, little or no specific research has been carried out on their understanding and management of dementia. Yet, Bangladeshis have higher risk of developing type 2 diabetes and heart disease; both are important indicators of developing dementia in old age. In addition, in England they have lowest education rates, highest smoking rates, poorest socio-economic and worst health positions risk factors for
Poster Presentations: P3
Furthermore, an observational study shows that greater cardiorespiratory fitness is associated with slowed progression of dementia and brain atrophy in patients with AD. Objective was to assess the influence of physical activity and cognition on ADL. Methods: In the present study, data from the " Preserving quality of life, physical health and functional ability in A lzheimer’s d isease: The effect of physical ex ercise (ADEX) study" a randomized controlled multicentre study, was used. Baseline data from 166 patients with AD (age (mean 6SD): 70,9 67,5; gender (f/m): 72/94; Mini-Mental State Examination (MMSE)(mean 6SD): 24,1 63,6) were included.ADL was assessed by the Alzheimer’s Disease Co-operative Study - Activities of Daily Living (ADCS- ADL) scale and physical activity by the Physical Activity Scale for the Elderly (PASE) (caregiver interview).Furthermore, global cognitive function and mental speed/attention was assessed by the MMSE and Symbol Digit Modalities Test (SDMT), respectively. Two linear regression models were performed to investigate the impact of SDMT and PASE on ADCS-ADL. Covariates were PASE, age, gender and MMSE. In the second model, PASE was replaced by SDMT. Results: A significant association between ADL and PASE was found and between ADL and SDMT (B: 0,06; (SE: 6 0,02); b:0,27; and B: 0,06 (SE: 6 0,06); b:0,09, respectively). Conclusions: Both mental speed/attention (SDMT) and physical activity (PASE) had a significant but modest association with ADL. There was a tendency that low physical activity was associated with impairedADL to a greater extent than mental speed/attention. Future studies should to clarify if improving physical activity may supplement pharmacotherapy in postponing the decline in ADL in patients with AD. P3-358
FREQUENCY AND ETIOLOGIES OF EARLY AND LATE ONSET DEMENTIA IN THREE TERTIARY REFERRAL CENTERS IN KOREA
E. J. Kim1, Juhee Chin2, Noh Eul Han3, Ji-Hyang Oh1, Go Woon Kim1, JaeHong Lee3, Duk L. Na2, 1Pusan National University Hospital, Busan, South Korea; 2Samsung Medical Center, Seoul, South Korea; 3Asan Medical Center, Seoul, South Korea. Contact e-mail: [email protected] Background: To investigate the frequency and etiologies of early-onset dementia (EOD), as compared to late- onset dementia (LOD) in three tertiary referral hospitals in Korea. Methods: All patients from memory and dementia clinics of Pusan National University Hospital, Samsung Medical Center, and Asan medical center from January, 2010 to Jun, 2013 were included in the study. EOD and LOD were classified by an arbitrary onset cut-off age of 65. Results: A total of 6818 patients were seen and evaluated for dementia for about 4 years. Of these, 1801 patients met the criteria for dementia. However, out of the initial 1801 dementia patients, we excluded 533 patients who did not have either clear onset age or duration of illness. Thus, all further analyses were performed on the remaining 1268 patients. Among 1268 dementia patients, there were 346 (27.3%) EOD patients and 922 (72.2%) LOD patients. There were on significant differences between EOD and LOD patients in gender distribution, previous cancer history and a family history of dementia. However, EOD patients had longer duration of illness, higher level of education, and higher scores of MMSE than those of LOD patients. Vascular risk factors were more detected in LOD patients than EOD patients. Alzheimer’s disease (AD) was the most frequent cause of dementia in both EOD and LOD groups. While the second most common cause of dementia was vascular dementia, and the third being frontotemporal dementia (FTD) in the LOD group, FTD was significantly more common in the early onset group. Conclusions: EOD represented approximately 27% of patients with dementia in Korea. The underlying causes were considerably different in EOD compared with LOD patients, however AD was the most frequent cause in EOD. P3-359
DIAGNOSES OF ALZHEIMER’S DISEASE AND EVERYDAY LIFE
Fritze Tonny Norup Kristensen, University College North Jutland, Hjoerring, Denmark, Denmark. Contact e-mail: [email protected] Background: Nationally and internationally there is a focus on the importance of diagnosing dementia syndrome. The diagnostic criteria for Alzheimer’s disease (AD) reflect a biomedical concept of disease. The
biomedical viewpoint becomes clearer with the inclusion of criteria for pathophysiological changes referred to as biomarkers in the proposed revisions of the diagnostic criteria.However research has identified limitations to the biomedical approach. This study is grounded in the continuation of this research by incorporating the concept of disease - a praxis - philosophical perspective on the diagnosis. Methods: Humanistic dialectical perspective focused on the relationship between impairments of neurological functions and the experience of living with AD. A philosophical personoriented, relational concept of disease. AD is viewed from two different standpoints: 1) a biomedical perspective, and 2) the person with AD - his or her experiences from conduct of life. Focus is confined to creating knowledge of the perspective of the person with AD. Critical psychology. The person is understood as pro- active, as a subject. Concepts which makes it possible to direct focus at, for example: preserved - and impaired personal action potency, participating in changing contexts. Design - qualitative longitudinal study Semi-structured interviews. Included: 5 persons diagnosed in a Department of Neurology, with AD in mild to moderate degree, and one of each person’s relatives. Medical records. Results: From the perspective of the person with AD - the diagnosing based on a biomedical understanding of disease implies: 1) Clarification: a diagnosis. 2) Focus:cognitive impairments. 3) Abstract knowledge: Test r esults, "AD", " progression", " medication stabilizes". 4) No recognition of well-preserved acting potencies. These results are critical because the person with dementia: Actively re establish conduct of life, diagnosing does not support herein. Result: a cleft between diagnosing and everyday-life. Rehabilitation is privatized, which may worsen symptoms. Conclusions: A diagnostic examination based a praxis - philosophical - and a critical psychology perspective - with increased integration of the person’s experiences from everyday life will make it is possible to meet his or her goals for rehabilitation - and thus raise the quality of care provided. P3-360
UNDERSTANDING DEMENTIA AMONG THE BANGLADESHI COMMUNITY IN ENGLAND
Muhammad Zakir Hossain1, Ann Dewey1, Yohai Hakak1, Karan Jutlla2, 1 University of Portsmouth, Portsmouth, England, United Kingdom; 2 University of Worcester, Worcester, England, United Kingdom. Contact e-mail: [email protected] Background: Despite a growing ageing South Asian immigrant population in England, little is known about the experiences of diagnosis and care for those living with dementia. Dementia in the South Asian ethnic groups has been characterized as ‘a hidden problem in a hidden population’ within a considerably marginalized group and for which the existing literature is limited. Worldwide, there have been a number of small, qualitative studies among South Asian people living with dementia. Consolidation through qualitative meta-synthesis can: (1) merge the experiences of a number of participants across studies to reveal fresh insights, (2) provide an enhanced understanding of the experience, (3) reduce replication by identifying gaps in current literature and (4) generate new research questions. Methods: Following a systematic search of the literature, included qualitative studies were assessed by two independent reviewers for methodological quality. Data were extracted using the Qualitative Assessment and Review Instrument (QARI) developed by The Joanna Briggs Institute (JBI). Findings were synthesized using JBI approach of meta-synthesis by meta-aggregation. Results: Synthesis from thirteen papers were aggregated into six meta-synthesis themes as: (1) Poor awareness and understanding of dementia, (2) Permeated stigma and shame, (3) Burdens or blessings of family caring? (4) Healthcare decision making power within family, (5) Food as coping mechanisms, (6) Attitudes to current and future provision of dementia care services. Conclusions: One research gap was identified using the population framework where despite increasing number of older people from the Bangladeshi community in England, little or no specific research has been carried out on their understanding and management of dementia. Yet, Bangladeshis have higher risk of developing type 2 diabetes and heart disease; both are important indicators of developing dementia in old age. In addition, in England they have lowest education rates, highest smoking rates, poorest socio-economic and worst health positions risk factors for