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Low ambulatory blood pressure as predictor of cognitive decline in older subjects with dementia or mild cognitive impairment
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
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Low ambulatory blood pressure as predictor of cognitive decline in older subjects with dementia or mild cognitive impairment M.C. Pieraccioli a,∗ , E. Mossello a , N. Nesti a , M. Bulgaresi b , V. Caleri c , E. Tonon c , A.M. Mello b , C. Baroncini b , N. Zaffarana b , M.C. Cavallini b , C. Cantini c , F. Bencini c , C.A. Biagini c , N. Marchionni b , A. Ungar b a Cardiology And Geriatric Medicine, University of Florence and Careggi Hospital, Florence, Italy b Division Of Geriatric Cardiology And Medicine, University of Florence and Careggi Teaching Hospital, Florence, Italy c Division Of Geriatric Medicine, Azienda USL 3 Pistoia, Pistoia, Italy Text.– Introduction.– Few data are available about the prognostic role of arterial hypertension (AH) in dementia, and no study has adopted ambulatory blood pressure monitoring (ABPM) in this setting. The aim of this study is to evaluate the role of ABPM as predictor of progression of cognitive decline in a sample of subjects with Mild Cognitive Impairment (MCI) or dementia. Methods.– Subjects with either dementia or MCI, referred to two memory outpatient clinics, were included. All subjects underwent ABPM, with measurement of day-time and night-time systolic and diastolic pressure (SBP, DBP) and SBP 24-hour variability (SBP-SD). Cognitive (MMSE) and functional assessment was performed at baseline and after six months. Results.– We included 154 subjects (age 79 ± 6 years, 64% female), 25% with MCI (MMSE 26 ± 2), 75% with dementia (MMSE 20 ± 4), 73% with AH. MMSE score decline was significantly greater in the lower tertile of day-time SBP, both in dementia (P = 0.002) and MCI subgroup (P = 0.005), after adjustment for age and baseline MMSE score. The association between office SBP and MMSE change was not significant. No association was observed between other ABPM and MMSE change, nor between any ABPM parameter and functional decline. Conclusions.– Among these cognitively impaired older subjects, lower mean day-time SBP was associated to greater MMSE score decline after six months. These results may be explained by early neurodegeneration of brain areas controlling blood pressure. The absence of such association with office measurement supports the use of ABPM in these patients, to avoid AH overtreatment with progression of cognitive impairment. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.357 P357
The dimension of delirium in a continuing care unit R. Silva a,∗ , B. Ferreira b , J. Sousa a , H. Neves a Instituto De Ciências Da Saúde, Universidade Católica Portuguesa, Porto, Portugal b U.c.c. Vila Do Conde, ACES Grande Porto V, Póvoa de Varzim/Vila do Conde, Vila do Conde, Portugal
a
Introduction.– The Delirium is an episodic and reversible syndrome, also known as acute confusion. Delirium is a more restrictive concept, based on the Diagnostic and Statistical Manual of Mental Disorders, described by the American Psychiatric Association. Several researchers have reported the implications of this phenomenon due to the weak outcomes to which it is associated. With this perspective, we intend to identify the frequency of the phenomenon and characterize the patients hospitalized in a Continuing Care Unit. These units intend to promote independence by improving the functionality of the person in a situation of dependency. Method.– In this descriptive-exploratory study, data was obtained from the application of a diagnostic tool, NeeCham Confusion Scale (NeeCham) (translated/validated instrument for Portuguese
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language and culture), to all inpatients. The sample was nonprobabilistic by convenience. Results.– The sample consisted in 43 patients, of whom 60.6% have a diagnosis of cerebrovascular and neurodegenerative diseases. These patients are mostly female (n = 33), with an average of 82 years. By applying the NeeCham, it was found that 34.9% had moderate to severe confusion and 23.3% had mild confusion or early development of confusion. It was found a statistically significant relation between increasing age and delirium (r = –0.42, P = 0.004). There were no statistically significant differences between sex (P > 0.05), and pathology (P > 0.05) in the presence of this phenomenon. Conclusion.– The importance of this phenomenon is clearly reflected in its frequency. As so this diagnosis should be taken in account when a patient is admitted in these units, in order to provide better health outcomes. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.358 P358
Psychometric properties of a German short version of the patient-rated Dementia Quality of Life Questionnaire (DEMQOL-K)
M. Richter ∗ , M. Damian , K. Jekel , L. Hausner , L. Froelich Department Of Geriatric Psychiatry, Central Institute of Mental Health, Mannheim, Germany
Introduction.– Dementia affects about 35 million people worldwide with increasing number (Brodaty et al., 2011); in Germany, 8% of people older than 65 years are diagnosed with it (Eschweiler et al., 2010). For no cure is available yet, patients’ wellbeing and quality of life (QoL) is of growing importance. To investigate QoL in dementia, reliable and feasible instruments are important. Here, we present a patient-rated German short version of the Dementia Quality of Life Questionnaire (DEMQOL-K; English long version by Smith et al., 2005). Methods.– Data of 1124 out-patients with mild to moderate dementia participating in a surveillance study were analysed. Variables included dementia severity, cognitive status, QoL, medical data, and residential status. Data were collected at two time points three months apart. Changes in cognitive functioning, QoL, and affective state evaluated by the general practitioners (GPs) in charge were also assessed. DEMQOL-K feasibility, reliability, and validity were analysed, a potential factor structure was explored. Results.– A 2-factor model of the DEMQOL-K accounting for 51% of the variance was found. No ceiling and floor effects were detected. Acceptability was good with over 95% of patients completing the questionnaire twice. Internal consistency (Cronbach’s ␣ = 0.89) and retest-reliability (ICC = 0.798) were good. The DEMQOL-K sum score correlated significantly with a global QoL rating (Kendall’s = 0.45). GPs’ evaluations correlated with patient-rated DEMQOL-K moderately. Conclusion.– The DEMQOL-K is a reliable and valid tool to assess mainly cognitive and emotional aspects of QoL in mild to moderate dementia that can easily be applied and is well accepted by patients. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.359
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Low ambulatory blood pressure as predictor of cognitive decline in older subjects with dementia or mild cognitive impairment M.C. Pieraccioli a,∗ , E. Mossello a , N. Nesti a , M. Bulgaresi b , V. Caleri c , E. Tonon c , A.M. Mello b , C. Baroncini b , N. Zaffarana b , M.C. Cavallini b , C. Cantini c , F. Bencini c , C.A. Biagini c , N. Marchionni b , A. Ungar b a Cardiology And Geriatric Medicine, University of Florence and Careggi Hospital, Florence, Italy b Division Of Geriatric Cardiology And Medicine, University of Florence and Careggi Teaching Hospital, Florence, Italy c Division Of Geriatric Medicine, Azienda USL 3 Pistoia, Pistoia, Italy Text.– Introduction.– Few data are available about the prognostic role of arterial hypertension (AH) in dementia, and no study has adopted ambulatory blood pressure monitoring (ABPM) in this setting. The aim of this study is to evaluate the role of ABPM as predictor of progression of cognitive decline in a sample of subjects with Mild Cognitive Impairment (MCI) or dementia. Methods.– Subjects with either dementia or MCI, referred to two memory outpatient clinics, were included. All subjects underwent ABPM, with measurement of day-time and night-time systolic and diastolic pressure (SBP, DBP) and SBP 24-hour variability (SBP-SD). Cognitive (MMSE) and functional assessment was performed at baseline and after six months. Results.– We included 154 subjects (age 79 ± 6 years, 64% female), 25% with MCI (MMSE 26 ± 2), 75% with dementia (MMSE 20 ± 4), 73% with AH. MMSE score decline was significantly greater in the lower tertile of day-time SBP, both in dementia (P = 0.002) and MCI subgroup (P = 0.005), after adjustment for age and baseline MMSE score. The association between office SBP and MMSE change was not significant. No association was observed between other ABPM and MMSE change, nor between any ABPM parameter and functional decline. Conclusions.– Among these cognitively impaired older subjects, lower mean day-time SBP was associated to greater MMSE score decline after six months. These results may be explained by early neurodegeneration of brain areas controlling blood pressure. The absence of such association with office measurement supports the use of ABPM in these patients, to avoid AH overtreatment with progression of cognitive impairment. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.357 P357
The dimension of delirium in a continuing care unit R. Silva a,∗ , B. Ferreira b , J. Sousa a , H. Neves a Instituto De Ciências Da Saúde, Universidade Católica Portuguesa, Porto, Portugal b U.c.c. Vila Do Conde, ACES Grande Porto V, Póvoa de Varzim/Vila do Conde, Vila do Conde, Portugal
a
Introduction.– The Delirium is an episodic and reversible syndrome, also known as acute confusion. Delirium is a more restrictive concept, based on the Diagnostic and Statistical Manual of Mental Disorders, described by the American Psychiatric Association. Several researchers have reported the implications of this phenomenon due to the weak outcomes to which it is associated. With this perspective, we intend to identify the frequency of the phenomenon and characterize the patients hospitalized in a Continuing Care Unit. These units intend to promote independence by improving the functionality of the person in a situation of dependency. Method.– In this descriptive-exploratory study, data was obtained from the application of a diagnostic tool, NeeCham Confusion Scale (NeeCham) (translated/validated instrument for Portuguese
S141
language and culture), to all inpatients. The sample was nonprobabilistic by convenience. Results.– The sample consisted in 43 patients, of whom 60.6% have a diagnosis of cerebrovascular and neurodegenerative diseases. These patients are mostly female (n = 33), with an average of 82 years. By applying the NeeCham, it was found that 34.9% had moderate to severe confusion and 23.3% had mild confusion or early development of confusion. It was found a statistically significant relation between increasing age and delirium (r = –0.42, P = 0.004). There were no statistically significant differences between sex (P > 0.05), and pathology (P > 0.05) in the presence of this phenomenon. Conclusion.– The importance of this phenomenon is clearly reflected in its frequency. As so this diagnosis should be taken in account when a patient is admitted in these units, in order to provide better health outcomes. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.358 P358
Psychometric properties of a German short version of the patient-rated Dementia Quality of Life Questionnaire (DEMQOL-K)
M. Richter ∗ , M. Damian , K. Jekel , L. Hausner , L. Froelich Department Of Geriatric Psychiatry, Central Institute of Mental Health, Mannheim, Germany
Introduction.– Dementia affects about 35 million people worldwide with increasing number (Brodaty et al., 2011); in Germany, 8% of people older than 65 years are diagnosed with it (Eschweiler et al., 2010). For no cure is available yet, patients’ wellbeing and quality of life (QoL) is of growing importance. To investigate QoL in dementia, reliable and feasible instruments are important. Here, we present a patient-rated German short version of the Dementia Quality of Life Questionnaire (DEMQOL-K; English long version by Smith et al., 2005). Methods.– Data of 1124 out-patients with mild to moderate dementia participating in a surveillance study were analysed. Variables included dementia severity, cognitive status, QoL, medical data, and residential status. Data were collected at two time points three months apart. Changes in cognitive functioning, QoL, and affective state evaluated by the general practitioners (GPs) in charge were also assessed. DEMQOL-K feasibility, reliability, and validity were analysed, a potential factor structure was explored. Results.– A 2-factor model of the DEMQOL-K accounting for 51% of the variance was found. No ceiling and floor effects were detected. Acceptability was good with over 95% of patients completing the questionnaire twice. Internal consistency (Cronbach’s ␣ = 0.89) and retest-reliability (ICC = 0.798) were good. The DEMQOL-K sum score correlated significantly with a global QoL rating (Kendall’s = 0.45). GPs’ evaluations correlated with patient-rated DEMQOL-K moderately. Conclusion.– The DEMQOL-K is a reliable and valid tool to assess mainly cognitive and emotional aspects of QoL in mild to moderate dementia that can easily be applied and is well accepted by patients. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.359