MEDICATIONS FOR DEPRESSION IN ALZHEIMER’S AND RISK OF MORTALITY: A LONGITUDINAL OBSERVATIONAL STUDY FROM THE ADTI

MEDICATIONS FOR DEPRESSION IN ALZHEIMER’S AND RISK OF MORTALITY: A LONGITUDINAL OBSERVATIONAL STUDY FROM THE ADTI

Poster Presentations: Monday, July 25, 2016 The current study examines the effects of hearing impairment and audiologic rehabilitation on older indiv...

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Poster Presentations: Monday, July 25, 2016

The current study examines the effects of hearing impairment and audiologic rehabilitation on older individuals with cognitive impairment and their family members. Preliminary findings indicate that provision of hearing aids can serve to reduce a spouse’s subjective burden related to communication difficulties, and improve the patient’s ability to engage in social activities and leisure activities such as watching television. We will discuss the findings in the context of potential changes to best practice techniques that could optimize benefits for patients with hearing impairment and cognitive impairment.

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USE OF NOVEL OBSERVATIONAL METHODOLOGY FOR MEASURING AFFECT AND BEHAVIORS IN A BEHAVIORAL INTERVENTION FOR PERSONS WITH DEMENTIA HOSPITALIZED FOR BEHAVIORAL SYMPTOMS

Katherine A. Marx1, Laura N. Gitlin2, Kimberly S. VanHaitsma3, 1JHU School of Nursing, Baltimore, MD, USA; 2Johns Hopkins University School of Nursing, Baltimore, MD, USA; 3PSU School of Nursing, University Park, PA, USA. Contact e-mail: [email protected] Background: Direct observation of neuro-psychiatric behaviors al-

lows for more accurate accounting of behaviors but it is often not feasible. This study tested the use of video recording and Observer software to measure behaviors throughout an intervention, the Tailored Activity Program (TAP), on a geropsych unit in a large hospital. Methods: Participants in the TAP intervention were recorded at Baseline, and up to 6 subsequent sessions. The recordings were analyzed using The Observer XT software program. Four domains were used by raters (affect, verbal, nonverbal, engagement) to capture the experiences and reactions of participants. Results: There were 63 total sessions videotaped and analyzed. The most common affects observed were General Alertness (97.5%), Pleasure (15%), and Anxiety (11.5%). The most common types of verbalizations observed were Positive Statements (56%) or No verbal expression (41.5%). Negative verbalizations such as Non-sensical statements (7%), Somatic complaints (2.5%), and Repetitive statements (2%) were less frequent. The most common Non Verbal Behaviors were Positive Gestures (51.5%) and No NonVerbal Behaviors (37%). Other behaviors such as Positive touch (11%), Distracted (4%), Eyes closed (3.5%), Facial Disturbances (3%) were less frequent. Participants in this study were observed as very actively engaged (91%), and to a lesser extent, passively engaged (37.5%). Lack of any engagement (2%) or disruptive engagement (1.5%) was observed infrequently. In general, compared to baseline, participants showed a large number of enhanced positive outcomes during the intervention sessions. Participants demonstrated better emotional outcomes (increased Pleasure, decreased Anger, Anxiety); a reduction in all types of negative verbalizations (Repetitive, Somatic, Rejection of Care, Nonsensical phrases, Verbal Aggression, Somatic complaints); an increase in Positive behavior (gestures/movements) a decrease in negative behavior (Distracted, Eyes Closed, Facial and Motoric Disturbances); and an increased in Passive Engagement and a decrease in disengagement and disruptive engagement. Conclusions: Video recording and the Observer software allowed the research team to directly observe participants reactions to the TAP intervention. The pattern of responses by participants suggests a pattern of predominantly good outcomes, though these very preliminary results should be viewed with caution in light of the highly qualitative nature of the numbers presented in this pilot project.

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MEDICATIONS FOR DEPRESSION IN ALZHEIMER’S AND RISK OF MORTALITY: A LONGITUDINAL OBSERVATIONAL STUDY FROM THE ADTI

Amir Ali Sepehry1,2, Guiping Liu3,4, Carra Dujela3,4, Helena Kedlac3,4, B. Lynn Beattie5, Neena L. Chappell3,4, Ging-Yuek Robin Hsiung1,6, 1 University of British Columbia, Vancouver, BC, Canada; 2Clinic for Alzheimer Disease and Related Disorders, Vancouver, BC, Canada; 3 University of Victoria, Victoria, BC, Canada; 4Centre on Aging, Victoria, BC, Canada; 5The University of British Columbia, Vancouver, BC, Canada; 6 Clinic for Alzheimer’s Disease and Related Disorders, Vancouver, BC, Canada. Contact e-mail: [email protected] Background: Depressive symptoms are highly prevalent in Alz-

heimer’s disease (AD), accentuating patient and caregiver distress. Antidepressant and antipsychotics are frequently used for depression in AD, but their benefits in older adults are uncertain. Aim: To examine the effect of antidepressant, antipsychotic, or the combination on the rate of progression and mortality in AD. We hypothesize that the users of antipsychotic, antidepressant, or both, will have a dissimilar disease trajectory on cognitive and functional outcomes and mortality. Method: The Alzheimer’s Drug Therapy Initiative (ADTI) is a British Columbia (Canada) initiative that provides coverage for cholinesterase inhibitors (ChEIs) for AD patients. Physicians prescribing ChEIs are required to fill out a Special Authority (SA) form with repeat Standardized Mini-Mental State Examination (sMMSE) and Overall Patient Assessment Rating (OPAR) to maintain coverage. SA data was linked to provincial administrative databases. We used Generalized Estimated Equation to examine the longitudinal effect of medication use, considering age, sex, and baseline sMMSE as covariates. Hazard ratios (HR) were used to compare the rate of mortality over time. Results: Overall, 19307 AD cases were eligible for analyses; 13387 used antidepressants, 9981 used antipsychotics, and 15477 used either antidepressants or antipsychotics at any time during follow-up. More users of antidepressants or antipsychotics, and male sex, were associated with the diagnosis of depression (P < 0.001). Antidepressant use was associated with slower cognitive decline (sMMSE, P<0.0001), and lower mortality within the first 2 years of follow-up [HR: 0.892, P<0.003], but this effect disappears by 4 years [HR: 1.040, P¼0.169]. Antipsychotic usage was associated with greater cognitive (P<0.0001) as well as functional decline (OPAR, P<0.0001) over the 2 years of observation. No significant difference was seen between antipsychotic users and non-users regarding mortality up to 2 years [HR: 0.969, P¼0.405], but a significantly higher mortality in users was observed at 4 years [HR: 1.284, P<0.0001]. Conclusion: The use of psychotropics for depression in AD may affect rate of disease progression differentially. Antidepressant use was associated with short-term cognitive benefit whereas antipsychotic use was associated with faster cognitive decline in the short term and higher mortality in the long term. P2-409

PRIMARY CARE MEMORY CLINICS: WHAT ELEMENTS OF CARE ARE MOST HIGHLY VALUED?

Linda Lee1, Karen Slonim2, 1Centre for Family Medicine Family Health Team/McMaster University, Kitchener, ON, Canada; 2Centre for Family Medicine Family Health Team, Kitchener, ON, Canada. Contact e-mail: lee. [email protected] Background: Dementia is a challenging-to-manage condition in primary care that requires a high degree of collaboration between health professionals, patients, and care partners. A key facilitator