- Email: [email protected]
Neuropsychiatric symptoms in dementia: Variation by care setting and gender
P758
Poster Presentations: P4
Table 2 Psychometric properties of 10/66 DRG diagnostic instrument and its subcomponents
10/66 DRG diagnostic instrument GMS CSI-D DF SCORE CSI-D COG SCORE
Sensitivity %
Specificity %
Area under ROC curve
Depression FPR %
No formal education FPR %
Formal education FPR %
92.0 94.0 92.0 98.0
95.1 77.1 90.3 49.3
0.94 0.86 0.91 0.74
8.51 29.2 17.0 46.7
7.7 28.9 9.2 40.8
6.3 21.4 18.4 44.4
100 cases (53 mild and 47 moderate dementia) and 144 controls. There were 158 (64.8%) women and 86 (35.2%) men. The age groups were 65-74 years old (78 persons or 32%), 75-84 (99, 40.6%), and 85 and above (67, 27.4%). 123 (50.4%) had no formal education 121(49.6%) had primary and above education. 10/66 DRG diagnostic instrument was shown to have excellent psychometric properties (Table and Figure). 10/66 instrument’s predictive power is superior to that of its subcomponents. Conclusions: 10/66 DRG diagnostic instrument is a valid instrument for epidemiological research in Arabic speaking population. P4-146
TALKING ABOUT THE PAST AND THE FUTURE: A CHARACTERIZATION OF RESPONSES TO QUESTIONS ABOUT PERSONAL PAST AND FUTURE PLANS IN TREATED AND UNTREATED PEOPLE WITH ALZHEIMER’S DISEASE
Elissa Asp1, Sherri Fay2, Kenneth Rockwood3, 1Saint Mary’s University, Halifax, Nova Scotia, Canada; 2CDHA, Halifax, Nova Scotia, Canada; 3 Dalhousie University, Halifax, Nova Scotia, Canada. Contact e-mail: [email protected] Background: Everyday correlates of Alzheimer’s disease (AD) and its change are of interest. Our group has focused on identifying clinically observable changes in cognition and/or function which may be relevant for assessing treatment efficacy or have potential as ’early warning’ signs of incipient AD. To discover whether responses to questions about personal past and future are sensitive to endogenous changes and/or mark treatment effects, we asked about personal past and future plans in mild/moderate AD patients. Methods: A subsample of patients (70/130) enrolled in a 4-month, double-blind placebo-controlled trial of galantamine (GAL) (CMAJ 2006;174:1099-1105; doi:10.1503/cmaj.051432) were video-recorded responding to a modified version of the Examination of Memory and Temporality (EMT) (Cortex. 1993;29:567-581). Responses were coded for content (e.g. informative, habitual, equivocal, confabulated, don’t know), weighted and summed to yield scores (EMTL) for each patient (0-100). Mean scores and change scores were used to examine associations with the trial’s other outcome measures. Results: Forty patients (galantamine (GAL)¼16, placebo (PLA)¼24) had EMT interview data recorded at baseline and 4-months. Baseline: Patients in each arm were demographically and functionally similar. EMTL scores were similar in both groups for past (GAL mean¼54.4 611.5, PLA mean¼53.8622.0) and future questions (GAL mean¼50.3 617.9, PLA mean¼48.6 620.1). Four months: The treatment arm significantly improved (Past GAL¼7.4 616.1 PLA¼-6.8 620.9, p¼0.03; Future: GAL¼18.4 615.1, PLA¼ -0.6 618.7, p¼0.02). Even so, group changes on EMTL showed limited correlation with other outcomes. EMTL-Future correlated negatively with Orientation (r¼-.561; p¼ .01) but not with ADAS-cog (p¼.06). EMTL-Past correlated with worsening DAD (p¼.02) scores, and showed trends on worsening ADLs (p¼.08), IADLs (p¼.09), Performance (p¼.09), and CIBIC (p¼.08) in the placebo group. Inspection of group mean changes showed non-significant improvement on some measures for GAL patients (Planning ¼ 7.369.5; IADL 3.4611.4; ADAS -3.965.9; Episodic Memory -2.863.9). Significant differences in group means appear only for Planning (p¼.04). Conclusions: The trends - modest (non-significant) improvements in the GAL group on Planning, IADLs, ADAS-cog and episodic memory—suggest positive changes in EMTL-Future and EMTL-Past are not epiphenomena, but are capturing a real effect. This possibility needs to be explored in a larger sample.
P4-147
NEUROPSYCHIATRIC SYMPTOMS IN DEMENTIA: VARIATION BY CARE SETTING AND GENDER
Colleen Maxwell1, Meaghan Zehr1, Mary Vu1, David Hogan2, Scott Patten2, Nathalie Jette2, Susan Bronskill3, Marie-Jeanne Kergoat4, George Heckman1, Oana Danila1, John Hirdes1, 1University of Waterloo, Waterloo, Ontario, Canada; 2University of Calgary, Calgary, Alberta, Canada; 3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; 4Institut Universitaire de Geriatrie de Montreal, Montreal, Quebec, Canada. Contact e-mail: [email protected] Background: Neuropsychiatric symptoms associated with dementia present significant challenges to family caregivers and health providers yet data illustrating variation in the prevalence and correlates of symptoms across care settings or by gender are scarce. We sought to estimate the prevalence and associated correlates of neuropsychiatric symptoms across home care (HC), long-term care (LTC) and complex continuing care (CCC) settings and by gender. Methods: Cross-sectional study of all HC clients (n¼470,183), LTC residents (n¼127,285), and CCC residents (n¼93,206) aged 50+ years assessed with the Resident Assessment Instrument (RAI-HC or RAI 2.0) in Ontario, Canada from 2004 to 2010. Multivariable logistic regression models were used to identify correlates of neuropsychiatric symptoms across care settings. Results: There were 100,500 (21.4%) HC clients, 72,732 (57.1%) LTC residents, and, 23,459 (25.2%) CCC residents with a diagnosis of dementia. The severity of impairment associated with dementia generally increased from HC to LTC to CCC; however, there were important differences across care settings. LTC residents with dementia were significantly older, more likely to be women, to exhibit depression, aggressive behaviours, and to be receiving 1+ antipsychotics and/or antidepressants whereas those with dementia in CCC [despite showing comparable levels of cognitive impairment to LTC residents with dementia] were more likely to be functionally dependent, to have significant health instability, a recent decline in mood, apathy, anxiety (and use of 1+ anxiolytics) and loss of appetite. The proportion of persons with dementia exhibiting 1+ neuropsychiatric symptom(s) was higher in LTC and CCC (w98%) than in HC (w61%). Adjusting for age and functional status, women with dementia were significantly more likely to exhibit depression and anxiety (HC & LTC), appetite/eating issues (LTC & CCC), delusions (HC & LTC) and night-time behaviours (LTC). Conversely, men with dementia were significantly more likely to exhibit agitation/aggression/disinhibition (LTC & CCC), apathy, irritability, motor disturbance (CCC) and hallucinations (HC). Conclusions: We observed significant differences in the profile of neuropsychiatric symptoms among persons with dementia across care settings and by gender. These differences suggest the need for more targeted care planning and interventions to better prevent and manage select neuropsychiatric symptoms across the care continuum. P4-148
MICROGRAPHY IN ALZHEIMER’S DISEASE
Fabiano Moraes1, Carla Giacominelli2, Paulo Bertolucci3, 1Federal University of S~ao Paulo, S~ao Paulo, Brazil; 2UNIFESP, S~ao Paulo, Brazil; 3 UNIFESP, S~ao Paulo, Brazil. Contact e-mail: [email protected] Background: Micrography is a typical manifestation of Parkinson’s disease but has also been related to stroke, infectious, inflamatory or neoplastic diseases. The areas of the brain involved included the frontal lobe, parietal lobe, basal ganglia and the thalamomesencephalic region. Its presentation is not a commom feature in Alzheimer’s disease. We present a case of acute onset micrography in a patient with Alzheimer’ disease. Methods: An 86 years
Poster Presentations: P4
Table 2 Psychometric properties of 10/66 DRG diagnostic instrument and its subcomponents
10/66 DRG diagnostic instrument GMS CSI-D DF SCORE CSI-D COG SCORE
Sensitivity %
Specificity %
Area under ROC curve
Depression FPR %
No formal education FPR %
Formal education FPR %
92.0 94.0 92.0 98.0
95.1 77.1 90.3 49.3
0.94 0.86 0.91 0.74
8.51 29.2 17.0 46.7
7.7 28.9 9.2 40.8
6.3 21.4 18.4 44.4
100 cases (53 mild and 47 moderate dementia) and 144 controls. There were 158 (64.8%) women and 86 (35.2%) men. The age groups were 65-74 years old (78 persons or 32%), 75-84 (99, 40.6%), and 85 and above (67, 27.4%). 123 (50.4%) had no formal education 121(49.6%) had primary and above education. 10/66 DRG diagnostic instrument was shown to have excellent psychometric properties (Table and Figure). 10/66 instrument’s predictive power is superior to that of its subcomponents. Conclusions: 10/66 DRG diagnostic instrument is a valid instrument for epidemiological research in Arabic speaking population. P4-146
TALKING ABOUT THE PAST AND THE FUTURE: A CHARACTERIZATION OF RESPONSES TO QUESTIONS ABOUT PERSONAL PAST AND FUTURE PLANS IN TREATED AND UNTREATED PEOPLE WITH ALZHEIMER’S DISEASE
Elissa Asp1, Sherri Fay2, Kenneth Rockwood3, 1Saint Mary’s University, Halifax, Nova Scotia, Canada; 2CDHA, Halifax, Nova Scotia, Canada; 3 Dalhousie University, Halifax, Nova Scotia, Canada. Contact e-mail: [email protected] Background: Everyday correlates of Alzheimer’s disease (AD) and its change are of interest. Our group has focused on identifying clinically observable changes in cognition and/or function which may be relevant for assessing treatment efficacy or have potential as ’early warning’ signs of incipient AD. To discover whether responses to questions about personal past and future are sensitive to endogenous changes and/or mark treatment effects, we asked about personal past and future plans in mild/moderate AD patients. Methods: A subsample of patients (70/130) enrolled in a 4-month, double-blind placebo-controlled trial of galantamine (GAL) (CMAJ 2006;174:1099-1105; doi:10.1503/cmaj.051432) were video-recorded responding to a modified version of the Examination of Memory and Temporality (EMT) (Cortex. 1993;29:567-581). Responses were coded for content (e.g. informative, habitual, equivocal, confabulated, don’t know), weighted and summed to yield scores (EMTL) for each patient (0-100). Mean scores and change scores were used to examine associations with the trial’s other outcome measures. Results: Forty patients (galantamine (GAL)¼16, placebo (PLA)¼24) had EMT interview data recorded at baseline and 4-months. Baseline: Patients in each arm were demographically and functionally similar. EMTL scores were similar in both groups for past (GAL mean¼54.4 611.5, PLA mean¼53.8622.0) and future questions (GAL mean¼50.3 617.9, PLA mean¼48.6 620.1). Four months: The treatment arm significantly improved (Past GAL¼7.4 616.1 PLA¼-6.8 620.9, p¼0.03; Future: GAL¼18.4 615.1, PLA¼ -0.6 618.7, p¼0.02). Even so, group changes on EMTL showed limited correlation with other outcomes. EMTL-Future correlated negatively with Orientation (r¼-.561; p¼ .01) but not with ADAS-cog (p¼.06). EMTL-Past correlated with worsening DAD (p¼.02) scores, and showed trends on worsening ADLs (p¼.08), IADLs (p¼.09), Performance (p¼.09), and CIBIC (p¼.08) in the placebo group. Inspection of group mean changes showed non-significant improvement on some measures for GAL patients (Planning ¼ 7.369.5; IADL 3.4611.4; ADAS -3.965.9; Episodic Memory -2.863.9). Significant differences in group means appear only for Planning (p¼.04). Conclusions: The trends - modest (non-significant) improvements in the GAL group on Planning, IADLs, ADAS-cog and episodic memory—suggest positive changes in EMTL-Future and EMTL-Past are not epiphenomena, but are capturing a real effect. This possibility needs to be explored in a larger sample.
P4-147
NEUROPSYCHIATRIC SYMPTOMS IN DEMENTIA: VARIATION BY CARE SETTING AND GENDER
Colleen Maxwell1, Meaghan Zehr1, Mary Vu1, David Hogan2, Scott Patten2, Nathalie Jette2, Susan Bronskill3, Marie-Jeanne Kergoat4, George Heckman1, Oana Danila1, John Hirdes1, 1University of Waterloo, Waterloo, Ontario, Canada; 2University of Calgary, Calgary, Alberta, Canada; 3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; 4Institut Universitaire de Geriatrie de Montreal, Montreal, Quebec, Canada. Contact e-mail: [email protected] Background: Neuropsychiatric symptoms associated with dementia present significant challenges to family caregivers and health providers yet data illustrating variation in the prevalence and correlates of symptoms across care settings or by gender are scarce. We sought to estimate the prevalence and associated correlates of neuropsychiatric symptoms across home care (HC), long-term care (LTC) and complex continuing care (CCC) settings and by gender. Methods: Cross-sectional study of all HC clients (n¼470,183), LTC residents (n¼127,285), and CCC residents (n¼93,206) aged 50+ years assessed with the Resident Assessment Instrument (RAI-HC or RAI 2.0) in Ontario, Canada from 2004 to 2010. Multivariable logistic regression models were used to identify correlates of neuropsychiatric symptoms across care settings. Results: There were 100,500 (21.4%) HC clients, 72,732 (57.1%) LTC residents, and, 23,459 (25.2%) CCC residents with a diagnosis of dementia. The severity of impairment associated with dementia generally increased from HC to LTC to CCC; however, there were important differences across care settings. LTC residents with dementia were significantly older, more likely to be women, to exhibit depression, aggressive behaviours, and to be receiving 1+ antipsychotics and/or antidepressants whereas those with dementia in CCC [despite showing comparable levels of cognitive impairment to LTC residents with dementia] were more likely to be functionally dependent, to have significant health instability, a recent decline in mood, apathy, anxiety (and use of 1+ anxiolytics) and loss of appetite. The proportion of persons with dementia exhibiting 1+ neuropsychiatric symptom(s) was higher in LTC and CCC (w98%) than in HC (w61%). Adjusting for age and functional status, women with dementia were significantly more likely to exhibit depression and anxiety (HC & LTC), appetite/eating issues (LTC & CCC), delusions (HC & LTC) and night-time behaviours (LTC). Conversely, men with dementia were significantly more likely to exhibit agitation/aggression/disinhibition (LTC & CCC), apathy, irritability, motor disturbance (CCC) and hallucinations (HC). Conclusions: We observed significant differences in the profile of neuropsychiatric symptoms among persons with dementia across care settings and by gender. These differences suggest the need for more targeted care planning and interventions to better prevent and manage select neuropsychiatric symptoms across the care continuum. P4-148
MICROGRAPHY IN ALZHEIMER’S DISEASE
Fabiano Moraes1, Carla Giacominelli2, Paulo Bertolucci3, 1Federal University of S~ao Paulo, S~ao Paulo, Brazil; 2UNIFESP, S~ao Paulo, Brazil; 3 UNIFESP, S~ao Paulo, Brazil. Contact e-mail: [email protected] Background: Micrography is a typical manifestation of Parkinson’s disease but has also been related to stroke, infectious, inflamatory or neoplastic diseases. The areas of the brain involved included the frontal lobe, parietal lobe, basal ganglia and the thalamomesencephalic region. Its presentation is not a commom feature in Alzheimer’s disease. We present a case of acute onset micrography in a patient with Alzheimer’ disease. Methods: An 86 years