- Email: [email protected]
O1-06-02 The caregiver burden inventory in evaluating the burden of caregivers of elderly demented patients: results from a multicenter study
Oral Session 01-06: Psychosocial/Neuropsychology - l
IN THE T R E A T M E N T O F IO1-05-08 ] GALANTAMINE DEMENTIA WITH LEWY BODIES: AN I N T E R I M 24 WEEK ASSESSMENT Keith R. Edwards* 1,2. 1Neurological Research Center, Bennington, VT, USA; 2Harvard Medical School, Boston, MA, USA. Contact e-mail: kedwards @vtneuro, corn
Background: Dementia with Lewy bodies (DLB) is an important cause of dementia with visual hallucinations, fluctuating cognition and Parkinsonian features being core manifestations of the disease. A significant cholinergic deficit has been demonstrated in patients with DLB, thus suggesting that cholinesterase inhibitors (ChEIs) may be of value in treating this disorder. Objective: To evaluate the safety and efficacy of galantanfine in patients with dementia with Lewy bodies (DLB). Methods: The study is an open-label, 24-week, multicenter trial conducted in the United States and France. An analysis was performed at Week 24 in the first 32 completers of 50 patients enrolled in the study. The patients were begun on galantamine 4 mg twice dally for 4 weeks, then 8 mg twice dally for 4 weeks, then 12 mg twice daily or the highest tolerated dose. Results: A mean improvement at 24 weeks was seen from baseline in NPI-12 of 8.5 (p = 0.0009), NPI-4 improved 4.125 (p = 0.002). Patients demonstrated improvement in cognition (ADAS-cog) of 4.41 points (p = 0.013). There was no significant improvement in the ADCS/ADL but a 0.625 point improvement (p = 0.01) occurred in the CGIC. MMSE improved 1.125 point (not significant). UPDRS improved 1.56 points (p=NS). One day clinical fluctuations improved 2.06 points (p = 0.02) and clinical fluctuations improved 2.41 points (0.0007). The PSQI with a sleeping partner present improved 7.56 points (p = 0.02). Galantamine was safe and well tolerated during this study. The most frequently reported adverse events (AEs) were nausea (24%) and fatigue (12%). Conclusions: This interim analysis suggests that galantamine is safe and effective in patients with DLB. Not only were behaviours typical of DLB improved, but clinical fluctuations and sleep disturbance were also improved. Word count: 313 Key words: galantamine, dementia with Lewy bodies, treatment
O r a l S e s s i o n O1-06: P s y c h o s o c i a l / N e u r o p s y c h o l o g y -
1
1 O1-06-01 ] COGNITIVE IMPAIRMENT IS THE MAJOR RISK FACTOR OF ADVERSE EVENTS IN HOSPITALISED ELDERLY PATIENTS Patrizia Mecocci* 1, Eva von Strauss 2, Antonio Cherubini 1, Sara Ercolani 1 Umberto Senin 1, Bengt Winblad 2, Laura Fratiglioni2. 1University ofPerugia, Perugia, Italy; 2Karolinska Institutet, Stockholm, Sweden. Contact e-mail: mecocci@ unipg.it
Background: Elderly subjects have an increased risk of adverse events during hospitalisation, which can cause, particularly in the very old, an irreversible decline in functional status and an increased rate of placement in nursing home after discharge Objective(s): To detect the main factors associated with the development of adverse events in hospitalised elderly patients. Methods: 13,729 patients aged 65 years and more, consecutively admitted to medical, or geriatric acute wards during twenty months in the period between 1991 and 1998 were evaluated in 35 community and university hospitals throughout Italy in this observational prospective study. Occurrence of pressure sores, faecal incontinence, urinary incontinence, and falls during the stay in hospital. Results: Pressure sores were already present in 3% of hospitafised subjects (2.8% in males and 3.2% in females), faecal incontinence in 7.3% (5.9% males and 8.6% females) while urinary incontinence was evaluated on a subgroup of total population (4268 subjects), with a prevalence of 22.3% (19.9% males and 24.5% females). The cumulative incidence of adverse events -for a mean of 15 days of stay in hospital was 0.5% for pressure sores, 0.4% for faecal incontinence, 1% for urinary incontinence and 2% for falls. In multivariate analyses, cognitive impairment, advanced age (85+ years), length of stay (more than three weeks) and severe disability were the main independent predictors of development of adverse events. Cognitive impairment always represented the most significant risk factor, although the diagnosis of dementia was
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reported in only 36.8% of subjects with a severe impairment evaluated by means of a cognitive test. Conclusions: Pressure sores, faecal and urinary incontinence and falls represent preventable adverse events in the oldest-old group of hospitalised patients for whom cognitive impairment, the major risk factor, is often underestimated. A more standardised comprehensive evaluation of elderly patients could be helpful but it requires a specific commitment to improve the approach to the elderly in clinical settings, promoting different organization and management
O1-06-02 [ THE CAREGIVER BURDEN INVENTORY IN EVALUATING THE BURDEN OF CAREGIVERS OF ELDERLY DEMENTED PATIENTS: RESULTS FROM A MULTICENTER STUDY Elena Mariani* 1, Martina Marvardi I , Paola Mattioli 1, Liana Spazzafumo 2, Umberto Senin 1, Patrizia Mecocci 1.1Dept" of Gerontology and Geriatrics, University of Perugia, Perugia, Italy; eINRCA, Ancona, Italy. Contact e-mail: [email protected]
Background: The burden perceived by caregivers of patients with dementia is a fundamental prognostic aspect in the history of the disease. Objective(s): The aim of this study is to demonstrate the internal consistency of the Caregiver Burden Inventory (CBI) a scale used to quantifies burden in different aspects of caregiver's life and the influence of patients and caregivers characteristics on its different dimensions. Methods: 419 demented outpatients patients of 16 Geriatric Centers in Italy and their caregivers were evaluated. Cognitive status and behavioral disturbances were assessed by the Mini Mental State Examination (MMSE) and by the Neuropsychiatric Inventory (NPI), respectively. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were also evaluated. Comorbidity was assessed by the Cumulative Illness Rating Scale (CIRS). Dementia severity was evaluated by the Clinical Dementia Rating (CDR) score. Caregiver distress due to behavioral problems of the patient was assessed by the Neuropsychiatric Inventory-Distress, a subscale of NPI that evaluates stress caused by each behavioral disturbance of the patient, and by the Brief Symptom Inventory that evaluates anxiety and depression. Burden was evaluated by the CBI. Results: CBI had very high internal consistency (Cronbach alpha value > 0.80). Factor analysis showed that the items clustered into four dimensions and not five as originally proposed. Multiple regression analysis revealed that patients' behavioral disturbances and disability were the major predictors of time dependence burden while psychophysical burden was explained mainly by caregiver anxiety and depression. Conclusions: CBI proved to be an effective multidimensional tool for evaluating the impact of burden on many aspects of caregivers' lives. I
O1-06-03 I DO ALZHEIMER'S DISEASE PATIENTS WANT TO I
PARTICIPATE IN AN AD TREATMENT DECISION AND WILL THEIR FAMILY LET T H E M ? Kareu B. Hirschman* I, Bryan D. James 1, Colette M. Joyce 2, Jason H. Karlawish I , David Casarett 3. 1 University of Pennsylvania, Philadelphia, PA, USA; 2Department of Sociology at the University of Pennsylvania, Philadelphia, PA, USA; 3Center for Health Equity Research and Promotion at the Philadelphia Veterans Affairs Medical Center and Department of Medicine, the Leonard Davis Institute of Health Economics, the Center for Bioethics, Philadelphia, PA, USA. Contact e-mail: hirschk @mail.reed, upenn, edu
Background: Alzheimer's Disease (AD) causes substantial impairments in a person's abilities to make decisions about their care. Little research has examined the ability of persons with AD to make decisions about treating their disease and how the people who live with and care for them - their caregivers (CGs) - involve them in these decisions. Objective(s): To compare AD patient's desire to be involved and whether their CGs thinks their relative would want to participate in making a decision to use an AD slowing treatment and to assess how AD patients and their CGs resolve a disagreement about using the treatment. Methods: Interviews
IN THE T R E A T M E N T O F IO1-05-08 ] GALANTAMINE DEMENTIA WITH LEWY BODIES: AN I N T E R I M 24 WEEK ASSESSMENT Keith R. Edwards* 1,2. 1Neurological Research Center, Bennington, VT, USA; 2Harvard Medical School, Boston, MA, USA. Contact e-mail: kedwards @vtneuro, corn
Background: Dementia with Lewy bodies (DLB) is an important cause of dementia with visual hallucinations, fluctuating cognition and Parkinsonian features being core manifestations of the disease. A significant cholinergic deficit has been demonstrated in patients with DLB, thus suggesting that cholinesterase inhibitors (ChEIs) may be of value in treating this disorder. Objective: To evaluate the safety and efficacy of galantanfine in patients with dementia with Lewy bodies (DLB). Methods: The study is an open-label, 24-week, multicenter trial conducted in the United States and France. An analysis was performed at Week 24 in the first 32 completers of 50 patients enrolled in the study. The patients were begun on galantamine 4 mg twice dally for 4 weeks, then 8 mg twice dally for 4 weeks, then 12 mg twice daily or the highest tolerated dose. Results: A mean improvement at 24 weeks was seen from baseline in NPI-12 of 8.5 (p = 0.0009), NPI-4 improved 4.125 (p = 0.002). Patients demonstrated improvement in cognition (ADAS-cog) of 4.41 points (p = 0.013). There was no significant improvement in the ADCS/ADL but a 0.625 point improvement (p = 0.01) occurred in the CGIC. MMSE improved 1.125 point (not significant). UPDRS improved 1.56 points (p=NS). One day clinical fluctuations improved 2.06 points (p = 0.02) and clinical fluctuations improved 2.41 points (0.0007). The PSQI with a sleeping partner present improved 7.56 points (p = 0.02). Galantamine was safe and well tolerated during this study. The most frequently reported adverse events (AEs) were nausea (24%) and fatigue (12%). Conclusions: This interim analysis suggests that galantamine is safe and effective in patients with DLB. Not only were behaviours typical of DLB improved, but clinical fluctuations and sleep disturbance were also improved. Word count: 313 Key words: galantamine, dementia with Lewy bodies, treatment
O r a l S e s s i o n O1-06: P s y c h o s o c i a l / N e u r o p s y c h o l o g y -
1
1 O1-06-01 ] COGNITIVE IMPAIRMENT IS THE MAJOR RISK FACTOR OF ADVERSE EVENTS IN HOSPITALISED ELDERLY PATIENTS Patrizia Mecocci* 1, Eva von Strauss 2, Antonio Cherubini 1, Sara Ercolani 1 Umberto Senin 1, Bengt Winblad 2, Laura Fratiglioni2. 1University ofPerugia, Perugia, Italy; 2Karolinska Institutet, Stockholm, Sweden. Contact e-mail: mecocci@ unipg.it
Background: Elderly subjects have an increased risk of adverse events during hospitalisation, which can cause, particularly in the very old, an irreversible decline in functional status and an increased rate of placement in nursing home after discharge Objective(s): To detect the main factors associated with the development of adverse events in hospitalised elderly patients. Methods: 13,729 patients aged 65 years and more, consecutively admitted to medical, or geriatric acute wards during twenty months in the period between 1991 and 1998 were evaluated in 35 community and university hospitals throughout Italy in this observational prospective study. Occurrence of pressure sores, faecal incontinence, urinary incontinence, and falls during the stay in hospital. Results: Pressure sores were already present in 3% of hospitafised subjects (2.8% in males and 3.2% in females), faecal incontinence in 7.3% (5.9% males and 8.6% females) while urinary incontinence was evaluated on a subgroup of total population (4268 subjects), with a prevalence of 22.3% (19.9% males and 24.5% females). The cumulative incidence of adverse events -for a mean of 15 days of stay in hospital was 0.5% for pressure sores, 0.4% for faecal incontinence, 1% for urinary incontinence and 2% for falls. In multivariate analyses, cognitive impairment, advanced age (85+ years), length of stay (more than three weeks) and severe disability were the main independent predictors of development of adverse events. Cognitive impairment always represented the most significant risk factor, although the diagnosis of dementia was
$21
reported in only 36.8% of subjects with a severe impairment evaluated by means of a cognitive test. Conclusions: Pressure sores, faecal and urinary incontinence and falls represent preventable adverse events in the oldest-old group of hospitalised patients for whom cognitive impairment, the major risk factor, is often underestimated. A more standardised comprehensive evaluation of elderly patients could be helpful but it requires a specific commitment to improve the approach to the elderly in clinical settings, promoting different organization and management
O1-06-02 [ THE CAREGIVER BURDEN INVENTORY IN EVALUATING THE BURDEN OF CAREGIVERS OF ELDERLY DEMENTED PATIENTS: RESULTS FROM A MULTICENTER STUDY Elena Mariani* 1, Martina Marvardi I , Paola Mattioli 1, Liana Spazzafumo 2, Umberto Senin 1, Patrizia Mecocci 1.1Dept" of Gerontology and Geriatrics, University of Perugia, Perugia, Italy; eINRCA, Ancona, Italy. Contact e-mail: [email protected]
Background: The burden perceived by caregivers of patients with dementia is a fundamental prognostic aspect in the history of the disease. Objective(s): The aim of this study is to demonstrate the internal consistency of the Caregiver Burden Inventory (CBI) a scale used to quantifies burden in different aspects of caregiver's life and the influence of patients and caregivers characteristics on its different dimensions. Methods: 419 demented outpatients patients of 16 Geriatric Centers in Italy and their caregivers were evaluated. Cognitive status and behavioral disturbances were assessed by the Mini Mental State Examination (MMSE) and by the Neuropsychiatric Inventory (NPI), respectively. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were also evaluated. Comorbidity was assessed by the Cumulative Illness Rating Scale (CIRS). Dementia severity was evaluated by the Clinical Dementia Rating (CDR) score. Caregiver distress due to behavioral problems of the patient was assessed by the Neuropsychiatric Inventory-Distress, a subscale of NPI that evaluates stress caused by each behavioral disturbance of the patient, and by the Brief Symptom Inventory that evaluates anxiety and depression. Burden was evaluated by the CBI. Results: CBI had very high internal consistency (Cronbach alpha value > 0.80). Factor analysis showed that the items clustered into four dimensions and not five as originally proposed. Multiple regression analysis revealed that patients' behavioral disturbances and disability were the major predictors of time dependence burden while psychophysical burden was explained mainly by caregiver anxiety and depression. Conclusions: CBI proved to be an effective multidimensional tool for evaluating the impact of burden on many aspects of caregivers' lives. I
O1-06-03 I DO ALZHEIMER'S DISEASE PATIENTS WANT TO I
PARTICIPATE IN AN AD TREATMENT DECISION AND WILL THEIR FAMILY LET T H E M ? Kareu B. Hirschman* I, Bryan D. James 1, Colette M. Joyce 2, Jason H. Karlawish I , David Casarett 3. 1 University of Pennsylvania, Philadelphia, PA, USA; 2Department of Sociology at the University of Pennsylvania, Philadelphia, PA, USA; 3Center for Health Equity Research and Promotion at the Philadelphia Veterans Affairs Medical Center and Department of Medicine, the Leonard Davis Institute of Health Economics, the Center for Bioethics, Philadelphia, PA, USA. Contact e-mail: hirschk @mail.reed, upenn, edu
Background: Alzheimer's Disease (AD) causes substantial impairments in a person's abilities to make decisions about their care. Little research has examined the ability of persons with AD to make decisions about treating their disease and how the people who live with and care for them - their caregivers (CGs) - involve them in these decisions. Objective(s): To compare AD patient's desire to be involved and whether their CGs thinks their relative would want to participate in making a decision to use an AD slowing treatment and to assess how AD patients and their CGs resolve a disagreement about using the treatment. Methods: Interviews