- Email: [email protected]
Neuropsychiatric symptoms in Alzheimer's disease: Prevalence and relationship to dementia severity
Poster Presentations P2
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0,72, respectively, considering a cutoff of 24. The area under the ROC curve for the ST was 0.89 (CI 95% 0.83 - 0.95) Conclusions: The Brazilian version of ST showed to be a rapid and easy to administer cognitive impairment screening, as well as presented adequate validity compared to the MMSE. P2-024
TELEPSYCHIATRIC CONSULTATION IN DEMENTIA CARE: A CASE OF FTD
Mikael S. Nornholm, Neuropsychiatric/Memory Clinic, SUS, Ska˚nes Universitetssjukhus, Lund/Malmo¨, Sweden. Contact e-mail: m.nornholm@ bredband.net Background: Information- and Communication Technology (ICT) has developed this last decade and the use in psychiatry has been exercised in different psychaitric areas. e-Health, especially in the US, is imlpemented, and many grass roots telepsychiatry projects are springing up. In Sweden, different programs to assist the old patient have evolved, and in rural areas both logopedic and dementia care projects are now under evaluation. By using ICT, the University hospital of Lund, Sweden, had its first Telepsychiatric Consultation with a rural memory clinic, 20 Swedish miles away. The aim was to evaluate the possibilities to meet a patient with Frontotemporal lobe dementia (FTD) and to consult medication, BPSD and care. The whole session was videorecorded in order to observe the availability and the use of the technology. Another reason for trying ICT in dementia care, was to find out timesaving and health economic gains. Methods: By using ASDL Telia telephone sockets, 6 different telephone lines, the meeting was set up between 10:00 -11:00 AM. The manufacturer was Ericsson and Telia, and the studio was under authorization the University. The cameras and system was of Tandberg Television. Three cameras were used, two to display the patient and consultants on each side and one to show the patient’s medication. There were seven people involved: one patient with possible FTD; two nurses, one head of the department (professor) and two dementia specialists (doctors) . Assistance of one technician was necessary. Results: Both patient, nurses and doctors could meet and discuss the case. This was very satisfying. It also gave both institutions a specialist center and small memory clinic - new experience and learned skills in order to execute future actions in Telepsychiatric Consultations of Dementia patients. The consultation also rendered one workshop on the ICT Conference in Gothenburg in the year of 2007 to furhter discuss the use in dementia care. Conclusions: This first Telepsychiatric Consultation of a FTD patient using Internet betwwen a Univserasity hoispital and a small rural memory clinic, in dementia care, showed the use and possibilities to make quality of life as well as health economic gains to the future work in dementia care. P2-025
DEMENTIA RESEARCH WITH DIVERSE ETHNOCULTURAL POPULATIONS: EXPLORING THE NEUROETHICS CHALLENGES
Umamon Puangthong, Sofia Lombera, Elana Brief, Judy Illes, University of British Columbia, Vancouver, BC, Canada. Contact e-mail: Umamon. [email protected] Background: More than a half million Canadians over the age of 65 years have dementia and the number is expected to reach 1.3 million in 2034. 25% of Canadians in this age cohort speak neither English nor French as their mother tongue (2006 Statistics Canada Census). Language and ethno-cultural background can affect health care for dementia including care-seeking, access to social support, disease diagnosis and treatment, and response to pharmacotherapy. To ensure the best health outcomes for Canadians, it is necessary incorporate language and culture in research and in the translation of new knowledge to clinical care. Methods: We conducted semi-structured, approximately one hour-long interviews with 13 researchers in Canada between June and October 2009. Selection criteria included clinical researchers and social scientists who conduct research on dementia with diverse ethno-cultural populations. The interviews focused on three themes: research design, recruitment and retention, and informed consent. We analyzed interviews using standard methods for content analysis. Results: Different perspectives emerged. Most researchers envisaged potential benefits
to culturally and linguistically tailored research protocols. However, they described their resistance to modifying existing protocols given internal barriers such as lack of relevant expertise, and external factors related to the fact that many cognitive measures have not been validated in diverse ethno-cultural populations, and that many tests only exist in English. Other researchers saw no benefit to adapting their protocols, and described diversity as a ‘‘nuisance variable,’’ especially as it relates to recruitment, retention, and consent. Conclusions: This study sheds light on barriers to conducting dementia research with diverse ethno-cultural populations. More research is needed, but our results suggest that fundamental to the problem is a lack of tools and resources for addressing diversity and, in some cases, a sense that, at the present time, the burden is greater than the benefits of doing so. For a country as culturally diverse as Canada, we view this as a significant ethical gap. We conclude that (1) improved resources, (2) interdisciplinary collaboration among dementia researchers and ethicists, and (3) better training curricula that attend specifically to diversity are needed. P2-026
RELATIONSHIPS BETWEEN APATHY AND SLEEP DISTURBANCES IN ALZHEIMER’S DISEASE: AN ACTIGRAPHIC STUDY
Emmanuel Mulin1, Renaud David1, Lea Friedman2, Jamy Zeitzer2, Jerome Yesavage2, Philippe Robert1, 1Memory Center, Hopital CIMIEZ, CMRR, CHU of Nice, France; 2Department of Psychiatry and Behavioural sciences, Stanford University, CA, USA. Contact e-mail: [email protected] Background: Apathy is the most frequent neuropsychiatric symptom across all stages of Alzheimer’s disease (AD). Both apathy and sleep disorders are known to have negative impact on the disease process and have been clustered as part of a common sub syndrome. The aim of the study was to assess the relationships between apathy and sleep/wake patterns in Alzheimer’s disease, using ambulatory actigraphy. Methods: 90 non-institutionalized AD patients were divided into two subgroups according to the presence or absence of apathy and wore a wrist actigraph continuously over 7 consecutive 24-hours periods. Apathy was assessed using apathy sub score of the NPI (cut-off>4) and an actigraphic parameter (daytime mean motor activity dMMA). Actigraphic nighttime sleep parameters included total time in bed (TIB), total sleep time (TST), sleep fragmentation score (WASO ¼ wake after sleep onset) and sleep efficiency (SE). Results: There was no statistical difference between the 2 subgoups for age (p ¼ .79) and MMSE (p ¼ .28). AD patients with apathy (mean age: 77 6 5.4; mean MMSE: 20,7 6 5.1) had significant lower daytime mean motor activity (p ¼ .037) and spent more time in bed during nighttime(p ¼ .046) than non apathetic subjects (mean age: 75.9 6 9.5; mean MMSE: 21.9 6 4.0). Apathetic patients had a lower W.A.S.O score (p ¼ .033) underlying the increase of wake duration whereas their wake numbers were not different. Conclusions: In the present study, apathy in AD was associated with increased time spent in bed during nighttime and increased wake duration after sleep onset, but sleep quality during night (sleep efficiency, fragmentation of night sleep) was not significantly different. This study may confirm the possible relationship between apathy and sleep disturbances in AD. P2-027
NEUROPSYCHIATRIC SYMPTOMS IN ALZHEIMER’S DISEASE: PREVALENCE AND RELATIONSHIP TO DEMENTIA SEVERITY
Said Ramdane1,2, 1Private, Skikda, Algeria; 2Algerian Society of Neurology and Clinical Neurophysiology, Skikda, Algeria. Contact e-mail: [email protected] Background: Neuropsychiatric symptoms associated with Alzheimer’s disease (AD) contribute to poor outcomes for patients and caregivers. Objectives: To estimate the prevalence and severity of behavioral and psychological symptoms (BPS) in a group of Alzheimer’s disease patients, and to assess their relationship to dementia severity; in a clinical practice setting study. Methods: 142 patients with AD (78 women; mean age:73.6 6 9.5 years) (DSM-3R; NINCDS-ADRDA criteria) from a private ambulatory of neurology, recruited in a community elderly in Skikda-Algeria (2004-
Poster Presentations P2 2009); were assessed for BPS using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Dementia stage was established with the Clinical Dementia Rating (CDR). Results: 137 patients (96.5%) exhibited one or more of these symptoms in the month before examination, (average four). Frequency of presentation was the following: nighttime behavioral disturbances (74%), delusions (58%), agitation/aggression (48%), depression (39%), hallucinations (37%), irritability (35%), appetite/eating disturbances (32%), apathy (24%), anxiety (23%), aberrant motor behavior (19%), disinhibition (13%), and euphoria (3%). Sleep disturbances, delusions, agitation/aggression, hallucinations and depression were among the more clinically significant individual symptoms. Mean 12 domains total NPI-Q severity score was 8.4 6 3.7 points (range:0-16/36); mean 12 domains total NPI-Q distress score was 11.0 6 6.8 (range:0-25/60); no significant differences were found between genders. Total NPI-Q severity score was strongly correlated to total NPI-Q distress score (r ¼ 0.956). Across CDR staging: depression (60%), and anxiety (43%), were the most prevalent symptoms in CDR0.5-1 subgroup; sleep disturbances (92%), delusions (78%), agitation/aggressivity (67%), appetite/eating disturbances (43%), hallucinations (41%), aberrant motor behaviors (37%), predominated in CDR2 subgroup; CDR3 subgroup exhibited mostly sleep disturbances (96%), delusions (93%), agitation/aggressivity (87 %), hallucinations (74%), appetite/eating disturbances (58%), disinhibition (39%). CDR2 and CDR3 subgroups differed in prevalence of agitation/aggressivity (p ¼ 0.04), hallucinations (p ¼ 0.003), disinhibition (p ¼ 0.004) and aberrant motor behaviors (p ¼ 0.04). Both total NPIQ severity and total NPI-Q distress scores were strongly correlated to CDR; (r ¼ 0.907; r ¼ 0.914). Conclusions: These findings show a high prevalence of neuropsychiatric symptoms in Alzheimer’s disease, and differences in the prevalence and severity of the symptoms at different stages of illness. An almost stage specific stereotyped neuropsychiatric profile was observed. Symptoms severity as assessed by the Neuropsychiatric Inventory Questionnaire strongly correlated with associated caregiver distress. P2-028
ALZHEIMER’S DISEASE: INFLUENCE OF NUTRITIONAL STATUS ON COGNITIVE DEFICITS, BEHAVIORAL SYMPTOMS AND CAREGIVER’S BURDEN
Marco Vista1, Lucia Picchi2, Adriana Di Giorgio3, Cristina Dolciotti2, Gabriele Cipriani2, Ubaldo Bonuccelli4, 1Unit of Neurology, Lucca Hospital, Lucca, Italy; 2Unit of Neurology, Versilia Hospital, Lido di Camaiore, Italy; 3 University of Pisa, Pisa, Italy; 4Dept. of Neuroscience, University of Pisa, Pisa, Italy. Contact e-mail: [email protected] Background: Changes in nutritional state, primarily characterized by meaningful weight’s reduction, are reported during the course of Alzheimer’s Disease (AD). Recent literature highlighted the loss of weight as one of the signs of AD onset and nutritional state has been correlated to the cognitive status of the patients, showing that a bad nutritional status cause a faster impairment of the illness for cognitive, functional and behavioral symptoms (BPSD). The aim of this study was to evaluate the relationship among cognitive deficits, nutritional status, presence of BPSD and burden of primary caregiver. Methods: 87 patients with probable AD according to the criteria NINCDS-ADRDA and their respective caregivers were included, assessing degree of cognitive impairment (MMSE), nutritional status (MNA), presence of behavioral symptoms (NPI) and burden of primary caregiver (CBI). All patients have been divided in 3 groups: MNA 17 (Low); 17.5 MNA 23.5 (Medium); MNA 24 (High). Behavioral symptoms (NPI) and caregiver’s burden (CBI) were compared with ANOVA; moreover, the correlation between MNA and MMSE and the regression among two variables considering the MMSE score as independent variable were analysed. Results: There is a significant difference (p < 0.01) between MMSE and CBI scores among the 3 groups with different nutritional state; in ‘‘High’’ group, MMSE score is higher and the caregiver’s burden results lower. BPSD data showed significant differences in the 3 MNA groups for the items ‘‘delusion’’ and ‘‘euphoria’’ (p < 0.05) and ‘‘hallucinations’’ and ‘‘agitation’’ (p < 0.01). The correlation and the regression show low coefficients (r ¼ 0.57 and r ¼ 0.32), nevertheless the distribution of the NPI scores around
S321
the line of correlation between MMSE and MNA underlines greater scores with getting worse of nutritional state. Conclusions: Different nutritional states seem to be in partnership to the demonstration of different behavioral symptoms and to a different caregiver burden. P2-029
FUNCTIONAL COMMUNICATION: WHAT HAPPENS ALONG ALZHEIMER’S DISEASE?
Isabel Carvalho, Letı´cia L. Mansur, Faculty of Medicine, Sa˜o Paulo, Brazil. Contact e-mail: [email protected] Background: Since the beginning of Alzheimer’s disease (AD) the decline of memory, attention and language interfere with personal, professional and social life, causing negative impact on one’s independence and quality of life. Identifying communicative behavior associated with cognitive function through an ecological evaluation is important to verify communication problems along different stages of the disease. Such information may contribute to improving communication between family/caregivers and their patients. This study aimed to compare functional communication ability throughout stages of Alzheimer’s disease, using the Functional Assessment of Communication Skills for Adults (ASHA FACS) to verify what happens with their communication. Methods: Fifty one normal elderly, 32 mild and 25 moderate AD patients were selected. Participants were older than 65 years old, with no depression symptoms or non-controlled depression nor other neurological disease associated with AD. The ASHA FACS was answered by the family/caregiver about the elderly tested. Results: There are significant statistical differences when comparing ASHA FAC’s performance among control group (CG), mild AD and moderate AD in all domains (‘‘Social Communication’’, ‘‘Communication of Basic Needs’’, ‘‘Reading, Writing, Number Concepts’’, ‘‘Daily Planning’’) and in overall score (CG 6.42 (60.57); mild AD 5.53 (60.71); moderate AD 4.32 (61.05); (p < 0,001)). It was possible to track how communication changes from mild to moderate AD. Communicative situations that better differentiated non-demented elderly from mild AD were those that demanded abilities beyond language, involving semantic and episodic memory, attention, communicative intention and executive function. ‘Follow simple verbal directions’, ‘Add new information on a topic conversation’ are examples of highly complex items involving other cognitive functions besides comprehension and oral expression abilities. Basic reading and writing abilities were relatively preserved in mild AD and showed decline in moderate AD. Ability to maintain personal daily planning like ‘Keep scheduled appointments’ and ‘Use a calendar for time-related activities’ were compromised since the beginning of dementia syndrome and worsening in moderate stage. Conclusions: Communication efficiency suffers a great decline throughout AD. Ecological evaluation of communication ability identifies the cognitive-communicative deficits and contributes to therapeutic planning and familial/caregiver orientation. P2-030
SEXUALITY AND EMOTIONAL INTIMACY IN AGING AND COGNITIVE DECLINE IN A COMMUNITY-BASED SAMPLE
Gregory A. Jicha1, Andrea J. Seybert2, Stephanie J. Freeman1, Sarah A. Carr1, 1University of Kentucky, Lexington, KY, USA; 2Midway College, Midway, KY, USA. Contact e-mail: [email protected] Background: Changes in sexuality and emotional intimacy as one ages or begins to develop cognitive decline are poorly understood, yet considered by many to be an important aspect of life irrespective of age or cognitive status. Methods: A 38 item survey assessing sexuality, physical and emotional intimacy was administered to 314 subjects that are part of the UK ADC cohort, including data from both subject and partner for 76 couples. Standard comparative analyses of demographic, clinical, and survey data was performed. Results: Overall, there were no significant differences on any intimacy item comparing subjects with normal cognition (n ¼ 249) and those that met standard criteria for mild cognitive impairment or dementia (n ¼ 65). Among couples surveyed (n ¼ 76), cognitively impaired subjects reported less desire to be sexually active than their spouses or cognitively normal counterparts. Cognitively normal spouses of impaired
S320
0,72, respectively, considering a cutoff of 24. The area under the ROC curve for the ST was 0.89 (CI 95% 0.83 - 0.95) Conclusions: The Brazilian version of ST showed to be a rapid and easy to administer cognitive impairment screening, as well as presented adequate validity compared to the MMSE. P2-024
TELEPSYCHIATRIC CONSULTATION IN DEMENTIA CARE: A CASE OF FTD
Mikael S. Nornholm, Neuropsychiatric/Memory Clinic, SUS, Ska˚nes Universitetssjukhus, Lund/Malmo¨, Sweden. Contact e-mail: m.nornholm@ bredband.net Background: Information- and Communication Technology (ICT) has developed this last decade and the use in psychiatry has been exercised in different psychaitric areas. e-Health, especially in the US, is imlpemented, and many grass roots telepsychiatry projects are springing up. In Sweden, different programs to assist the old patient have evolved, and in rural areas both logopedic and dementia care projects are now under evaluation. By using ICT, the University hospital of Lund, Sweden, had its first Telepsychiatric Consultation with a rural memory clinic, 20 Swedish miles away. The aim was to evaluate the possibilities to meet a patient with Frontotemporal lobe dementia (FTD) and to consult medication, BPSD and care. The whole session was videorecorded in order to observe the availability and the use of the technology. Another reason for trying ICT in dementia care, was to find out timesaving and health economic gains. Methods: By using ASDL Telia telephone sockets, 6 different telephone lines, the meeting was set up between 10:00 -11:00 AM. The manufacturer was Ericsson and Telia, and the studio was under authorization the University. The cameras and system was of Tandberg Television. Three cameras were used, two to display the patient and consultants on each side and one to show the patient’s medication. There were seven people involved: one patient with possible FTD; two nurses, one head of the department (professor) and two dementia specialists (doctors) . Assistance of one technician was necessary. Results: Both patient, nurses and doctors could meet and discuss the case. This was very satisfying. It also gave both institutions a specialist center and small memory clinic - new experience and learned skills in order to execute future actions in Telepsychiatric Consultations of Dementia patients. The consultation also rendered one workshop on the ICT Conference in Gothenburg in the year of 2007 to furhter discuss the use in dementia care. Conclusions: This first Telepsychiatric Consultation of a FTD patient using Internet betwwen a Univserasity hoispital and a small rural memory clinic, in dementia care, showed the use and possibilities to make quality of life as well as health economic gains to the future work in dementia care. P2-025
DEMENTIA RESEARCH WITH DIVERSE ETHNOCULTURAL POPULATIONS: EXPLORING THE NEUROETHICS CHALLENGES
Umamon Puangthong, Sofia Lombera, Elana Brief, Judy Illes, University of British Columbia, Vancouver, BC, Canada. Contact e-mail: Umamon. [email protected] Background: More than a half million Canadians over the age of 65 years have dementia and the number is expected to reach 1.3 million in 2034. 25% of Canadians in this age cohort speak neither English nor French as their mother tongue (2006 Statistics Canada Census). Language and ethno-cultural background can affect health care for dementia including care-seeking, access to social support, disease diagnosis and treatment, and response to pharmacotherapy. To ensure the best health outcomes for Canadians, it is necessary incorporate language and culture in research and in the translation of new knowledge to clinical care. Methods: We conducted semi-structured, approximately one hour-long interviews with 13 researchers in Canada between June and October 2009. Selection criteria included clinical researchers and social scientists who conduct research on dementia with diverse ethno-cultural populations. The interviews focused on three themes: research design, recruitment and retention, and informed consent. We analyzed interviews using standard methods for content analysis. Results: Different perspectives emerged. Most researchers envisaged potential benefits
to culturally and linguistically tailored research protocols. However, they described their resistance to modifying existing protocols given internal barriers such as lack of relevant expertise, and external factors related to the fact that many cognitive measures have not been validated in diverse ethno-cultural populations, and that many tests only exist in English. Other researchers saw no benefit to adapting their protocols, and described diversity as a ‘‘nuisance variable,’’ especially as it relates to recruitment, retention, and consent. Conclusions: This study sheds light on barriers to conducting dementia research with diverse ethno-cultural populations. More research is needed, but our results suggest that fundamental to the problem is a lack of tools and resources for addressing diversity and, in some cases, a sense that, at the present time, the burden is greater than the benefits of doing so. For a country as culturally diverse as Canada, we view this as a significant ethical gap. We conclude that (1) improved resources, (2) interdisciplinary collaboration among dementia researchers and ethicists, and (3) better training curricula that attend specifically to diversity are needed. P2-026
RELATIONSHIPS BETWEEN APATHY AND SLEEP DISTURBANCES IN ALZHEIMER’S DISEASE: AN ACTIGRAPHIC STUDY
Emmanuel Mulin1, Renaud David1, Lea Friedman2, Jamy Zeitzer2, Jerome Yesavage2, Philippe Robert1, 1Memory Center, Hopital CIMIEZ, CMRR, CHU of Nice, France; 2Department of Psychiatry and Behavioural sciences, Stanford University, CA, USA. Contact e-mail: [email protected] Background: Apathy is the most frequent neuropsychiatric symptom across all stages of Alzheimer’s disease (AD). Both apathy and sleep disorders are known to have negative impact on the disease process and have been clustered as part of a common sub syndrome. The aim of the study was to assess the relationships between apathy and sleep/wake patterns in Alzheimer’s disease, using ambulatory actigraphy. Methods: 90 non-institutionalized AD patients were divided into two subgroups according to the presence or absence of apathy and wore a wrist actigraph continuously over 7 consecutive 24-hours periods. Apathy was assessed using apathy sub score of the NPI (cut-off>4) and an actigraphic parameter (daytime mean motor activity dMMA). Actigraphic nighttime sleep parameters included total time in bed (TIB), total sleep time (TST), sleep fragmentation score (WASO ¼ wake after sleep onset) and sleep efficiency (SE). Results: There was no statistical difference between the 2 subgoups for age (p ¼ .79) and MMSE (p ¼ .28). AD patients with apathy (mean age: 77 6 5.4; mean MMSE: 20,7 6 5.1) had significant lower daytime mean motor activity (p ¼ .037) and spent more time in bed during nighttime(p ¼ .046) than non apathetic subjects (mean age: 75.9 6 9.5; mean MMSE: 21.9 6 4.0). Apathetic patients had a lower W.A.S.O score (p ¼ .033) underlying the increase of wake duration whereas their wake numbers were not different. Conclusions: In the present study, apathy in AD was associated with increased time spent in bed during nighttime and increased wake duration after sleep onset, but sleep quality during night (sleep efficiency, fragmentation of night sleep) was not significantly different. This study may confirm the possible relationship between apathy and sleep disturbances in AD. P2-027
NEUROPSYCHIATRIC SYMPTOMS IN ALZHEIMER’S DISEASE: PREVALENCE AND RELATIONSHIP TO DEMENTIA SEVERITY
Said Ramdane1,2, 1Private, Skikda, Algeria; 2Algerian Society of Neurology and Clinical Neurophysiology, Skikda, Algeria. Contact e-mail: [email protected] Background: Neuropsychiatric symptoms associated with Alzheimer’s disease (AD) contribute to poor outcomes for patients and caregivers. Objectives: To estimate the prevalence and severity of behavioral and psychological symptoms (BPS) in a group of Alzheimer’s disease patients, and to assess their relationship to dementia severity; in a clinical practice setting study. Methods: 142 patients with AD (78 women; mean age:73.6 6 9.5 years) (DSM-3R; NINCDS-ADRDA criteria) from a private ambulatory of neurology, recruited in a community elderly in Skikda-Algeria (2004-
Poster Presentations P2 2009); were assessed for BPS using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Dementia stage was established with the Clinical Dementia Rating (CDR). Results: 137 patients (96.5%) exhibited one or more of these symptoms in the month before examination, (average four). Frequency of presentation was the following: nighttime behavioral disturbances (74%), delusions (58%), agitation/aggression (48%), depression (39%), hallucinations (37%), irritability (35%), appetite/eating disturbances (32%), apathy (24%), anxiety (23%), aberrant motor behavior (19%), disinhibition (13%), and euphoria (3%). Sleep disturbances, delusions, agitation/aggression, hallucinations and depression were among the more clinically significant individual symptoms. Mean 12 domains total NPI-Q severity score was 8.4 6 3.7 points (range:0-16/36); mean 12 domains total NPI-Q distress score was 11.0 6 6.8 (range:0-25/60); no significant differences were found between genders. Total NPI-Q severity score was strongly correlated to total NPI-Q distress score (r ¼ 0.956). Across CDR staging: depression (60%), and anxiety (43%), were the most prevalent symptoms in CDR0.5-1 subgroup; sleep disturbances (92%), delusions (78%), agitation/aggressivity (67%), appetite/eating disturbances (43%), hallucinations (41%), aberrant motor behaviors (37%), predominated in CDR2 subgroup; CDR3 subgroup exhibited mostly sleep disturbances (96%), delusions (93%), agitation/aggressivity (87 %), hallucinations (74%), appetite/eating disturbances (58%), disinhibition (39%). CDR2 and CDR3 subgroups differed in prevalence of agitation/aggressivity (p ¼ 0.04), hallucinations (p ¼ 0.003), disinhibition (p ¼ 0.004) and aberrant motor behaviors (p ¼ 0.04). Both total NPIQ severity and total NPI-Q distress scores were strongly correlated to CDR; (r ¼ 0.907; r ¼ 0.914). Conclusions: These findings show a high prevalence of neuropsychiatric symptoms in Alzheimer’s disease, and differences in the prevalence and severity of the symptoms at different stages of illness. An almost stage specific stereotyped neuropsychiatric profile was observed. Symptoms severity as assessed by the Neuropsychiatric Inventory Questionnaire strongly correlated with associated caregiver distress. P2-028
ALZHEIMER’S DISEASE: INFLUENCE OF NUTRITIONAL STATUS ON COGNITIVE DEFICITS, BEHAVIORAL SYMPTOMS AND CAREGIVER’S BURDEN
Marco Vista1, Lucia Picchi2, Adriana Di Giorgio3, Cristina Dolciotti2, Gabriele Cipriani2, Ubaldo Bonuccelli4, 1Unit of Neurology, Lucca Hospital, Lucca, Italy; 2Unit of Neurology, Versilia Hospital, Lido di Camaiore, Italy; 3 University of Pisa, Pisa, Italy; 4Dept. of Neuroscience, University of Pisa, Pisa, Italy. Contact e-mail: [email protected] Background: Changes in nutritional state, primarily characterized by meaningful weight’s reduction, are reported during the course of Alzheimer’s Disease (AD). Recent literature highlighted the loss of weight as one of the signs of AD onset and nutritional state has been correlated to the cognitive status of the patients, showing that a bad nutritional status cause a faster impairment of the illness for cognitive, functional and behavioral symptoms (BPSD). The aim of this study was to evaluate the relationship among cognitive deficits, nutritional status, presence of BPSD and burden of primary caregiver. Methods: 87 patients with probable AD according to the criteria NINCDS-ADRDA and their respective caregivers were included, assessing degree of cognitive impairment (MMSE), nutritional status (MNA), presence of behavioral symptoms (NPI) and burden of primary caregiver (CBI). All patients have been divided in 3 groups: MNA 17 (Low); 17.5 MNA 23.5 (Medium); MNA 24 (High). Behavioral symptoms (NPI) and caregiver’s burden (CBI) were compared with ANOVA; moreover, the correlation between MNA and MMSE and the regression among two variables considering the MMSE score as independent variable were analysed. Results: There is a significant difference (p < 0.01) between MMSE and CBI scores among the 3 groups with different nutritional state; in ‘‘High’’ group, MMSE score is higher and the caregiver’s burden results lower. BPSD data showed significant differences in the 3 MNA groups for the items ‘‘delusion’’ and ‘‘euphoria’’ (p < 0.05) and ‘‘hallucinations’’ and ‘‘agitation’’ (p < 0.01). The correlation and the regression show low coefficients (r ¼ 0.57 and r ¼ 0.32), nevertheless the distribution of the NPI scores around
S321
the line of correlation between MMSE and MNA underlines greater scores with getting worse of nutritional state. Conclusions: Different nutritional states seem to be in partnership to the demonstration of different behavioral symptoms and to a different caregiver burden. P2-029
FUNCTIONAL COMMUNICATION: WHAT HAPPENS ALONG ALZHEIMER’S DISEASE?
Isabel Carvalho, Letı´cia L. Mansur, Faculty of Medicine, Sa˜o Paulo, Brazil. Contact e-mail: [email protected] Background: Since the beginning of Alzheimer’s disease (AD) the decline of memory, attention and language interfere with personal, professional and social life, causing negative impact on one’s independence and quality of life. Identifying communicative behavior associated with cognitive function through an ecological evaluation is important to verify communication problems along different stages of the disease. Such information may contribute to improving communication between family/caregivers and their patients. This study aimed to compare functional communication ability throughout stages of Alzheimer’s disease, using the Functional Assessment of Communication Skills for Adults (ASHA FACS) to verify what happens with their communication. Methods: Fifty one normal elderly, 32 mild and 25 moderate AD patients were selected. Participants were older than 65 years old, with no depression symptoms or non-controlled depression nor other neurological disease associated with AD. The ASHA FACS was answered by the family/caregiver about the elderly tested. Results: There are significant statistical differences when comparing ASHA FAC’s performance among control group (CG), mild AD and moderate AD in all domains (‘‘Social Communication’’, ‘‘Communication of Basic Needs’’, ‘‘Reading, Writing, Number Concepts’’, ‘‘Daily Planning’’) and in overall score (CG 6.42 (60.57); mild AD 5.53 (60.71); moderate AD 4.32 (61.05); (p < 0,001)). It was possible to track how communication changes from mild to moderate AD. Communicative situations that better differentiated non-demented elderly from mild AD were those that demanded abilities beyond language, involving semantic and episodic memory, attention, communicative intention and executive function. ‘Follow simple verbal directions’, ‘Add new information on a topic conversation’ are examples of highly complex items involving other cognitive functions besides comprehension and oral expression abilities. Basic reading and writing abilities were relatively preserved in mild AD and showed decline in moderate AD. Ability to maintain personal daily planning like ‘Keep scheduled appointments’ and ‘Use a calendar for time-related activities’ were compromised since the beginning of dementia syndrome and worsening in moderate stage. Conclusions: Communication efficiency suffers a great decline throughout AD. Ecological evaluation of communication ability identifies the cognitive-communicative deficits and contributes to therapeutic planning and familial/caregiver orientation. P2-030
SEXUALITY AND EMOTIONAL INTIMACY IN AGING AND COGNITIVE DECLINE IN A COMMUNITY-BASED SAMPLE
Gregory A. Jicha1, Andrea J. Seybert2, Stephanie J. Freeman1, Sarah A. Carr1, 1University of Kentucky, Lexington, KY, USA; 2Midway College, Midway, KY, USA. Contact e-mail: [email protected] Background: Changes in sexuality and emotional intimacy as one ages or begins to develop cognitive decline are poorly understood, yet considered by many to be an important aspect of life irrespective of age or cognitive status. Methods: A 38 item survey assessing sexuality, physical and emotional intimacy was administered to 314 subjects that are part of the UK ADC cohort, including data from both subject and partner for 76 couples. Standard comparative analyses of demographic, clinical, and survey data was performed. Results: Overall, there were no significant differences on any intimacy item comparing subjects with normal cognition (n ¼ 249) and those that met standard criteria for mild cognitive impairment or dementia (n ¼ 65). Among couples surveyed (n ¼ 76), cognitively impaired subjects reported less desire to be sexually active than their spouses or cognitively normal counterparts. Cognitively normal spouses of impaired