- Email: [email protected]
P2-347 Reducing apathy, depression and behavioral dyscontrol in patients with Alzheimer's disease residing in anursing home
Poster Session P2: Social and Behavioral Research - Pharmacologic Approaches to Behavioral Symptoms
Poster Session P2: Social and Behavioral Research Pharmacologic Approaches to Behavioral Symptoms
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SAFETY AND EFFICACY OF D R O N A B I N O L IN THE T R E A T M E N T O F A G I T A T I O N IN PATIENTS W I T H ALZHEIMER'S DISEASE: A P I L O T STUDY IN C O M M U N I T Y D W E L L I N G PATIENTS REFRACTORY TO TRADITIONAL MEDICINE
Joshua R. Shua-Haim*, Mark D. Pass, Suhas Patel, Sameer Patel, Paul Lee.
Jersey Shore University Medical Center, Neptune, NJ, USA. Contact e-mail: [email protected] Background: Mid-Atlantic Geriatric Fellowship Program, Department of Geriatrics, Jersey Shore University Medical Center & Ocean Medical Center, NJ Objective: To investigate the safety & efficacy of dronabinol as treatment for agitation associated with Alzheimer's disease Methods: Alzheimer's disease (AD) patients who had unsatisfactorily controlled agitation as reported by family members or staff nurses were prescribed dronabinol and evaluated. All met the DSM-IV & NINCDS-ADRDA criteria for possible AD. There were no exclusion criteria. Study subjects resided in a dementia unit in an assisted living facility and in a nursing home. Dronabinol 5 nag/day in two divided doses was given initially & titrated up to a maximum of 10 rag/day. Concomitant medications were recorded. After 4 weeks of treatment, nurses were asked to complete a questionnaire regarding their impression of treatment efficacy. Results: Seventy three patients were treated with dronabinol. Average age was 83. Average MMSE was 13. All patients were treated with atypical neuroleptics and at least one additional medication to control behavior including but not limited to SSRI's, atypical antidepressants, anti-convulsants, and benzodiazepines. All patients had concomitant diagnoses of anorexia and weight loss. As reported by staff nurses and nurses aids, agitation improved in 58 (79%) of the patients. In 19 (26%), there was an average increase in MMSE of 1.2 points (range +1 to +3). Functional improvement was reported in 47 (64%) patients. 15 (20%) patients had no response and the medication was discontinued. No additional treatment for agitation was requested at the four week follow up visit for any of the patients on the medication. One patient experienced increase daytime somnolence, but no significant adverse events were reported (falls, syncope, seizures, exacerbation of agitation or depression.) Conclusion: Dronabinol treatment for agitation in AD patients who reside in long term care facilities was effective in 58 out of 73 patients who were refractory to other medications.
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SEARCHING FOR PERIPHERAL PREDICTORS O F C H O L I N E R G I C DRUG RESPONSE IN ALZHEIMER'S DISEASE
Daniel R. Saumier .1 , Ron Schondorf I , Howard Bergman 1, Natalie Phillips 2, Howard Chertkow I . lBloomfield Centre for Research in
Aging, McGill University, Montreal, PQ, Canada; 2Concordia University, Department of Psychology, Montreal, PQ, Canada. Contact e-mail: daniel, saumier@ mail.mcgill, ca Background: Administration of acetylchollnesterase inhibitors has been found to improve cognition in Alzheimer's disease. The moderate efficacy of these medications underlines the importance of a chollnergic deficit in at least some of the symptoms of AD, and in at least some of the patients who suffer from this illness. At the same time, it is clear that cholinomimetic drugs have variable success in their ability to enhance cognitive ability in patients with AD. Objective(s): The current study examine whether the variability in response to the acetylcholinesterase inhibitors donepezil in AD subjects is a reflection of the variability in the degree of derangement of the peripheral cholinergic system across these individuals. Methods: Donepezil 10 mg was administered in an open-label treatment study for 6 months to 30 individuals with mild probable AD. Global treatment response was assessed using an algorithm combining changes in the ADAS-cog (Alzheimer's Disease Assessment Scale-cognitive subscale), MMSE (Folstein Mini-Mental State Exam) and CIBIC (Clinician Interview-based Impression of Change), with
$331
"response" defined as improvement or stabilization on the combination algorithm over the six-month period. Peripheral cholinergic status was assessed according to three measures. They included - Apo-E genotyping, middle latency auditory evoked potentials, and autonomic testing of sweat production and the cardiac pressor response in reaction to tilting. We also tested a group of matched elderly controls with these measures. All measures were repeated after 6 months for comparison. Results: Eighteen subjects were rated as having responded favourably to donepezil, while 12 were rated as non-responders. The peripheral cholinergic assessments reveal the following findings. First, there is no evidence of a peripheral autonomic dysfunction in AD vs. Normal elderly. Second, we find no evidence that APO-FA or autonomic test scores any effect on donepezil efficacy. Finally, the amplitude of the middle latency auditory evoked response did not differ reliably between donepezil responders and non-responders. Conclusions: There was no evidence of significant peripheral cholinergic dysfunction in patients with AD. Prospective application of peripheral cholinergic assessments is not likely to predict the clinical response to donepezil.
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SAFETY AND E F F I C A C Y O F O X C A R B A Z E P I N E IN THE TREATMENT OF HYPERSEXUALITY IN ALZHE1MER'S DISEASE PATIENTS R E S I D I N G IN THE C O M M U N I T Y
Suhas Patel*, Joshua R. Shna-Haim, Mark D. Pass, Paul Lee. Jersey Shore
University Medical Center, Neptune, NJ, USA. Contact e-mail: markpass @hotmail.corn Background: Mid-Atlantic Geriatric Fellowship Program, Department of Geriatrics, Jersey Shore University Medical Center & Ocean Medical Center, NJ Objective: To evaluate the safety and efficacy of oxcarbazepine for the treatment of Alzheimer's disease (AD) patients who exhibit hypersexual behavior. Methods: In a cross-sectional study during a three month period, all patients with AD who were treated with oxcarbazepine for hypersexual behaviors were evaluated. All patients were being evaluated at our clinical practice as outpatients. All fulfilled the DSM-IV and NINCDS-ADRDA criteria for possible AD. There were no exclusion criteria. Treatment was started at 150 rag/day, and if no improvement or adverse effects, the dose was titrated every three days by 150 rag/day in two divided doses. Titration at this pace continued until the patient's behavior was controlled, or a maximum dose of 900 rag/day was reached. Follow up blood chemistries for possible hyponatremia were performed bimonthly. Results: Twenty three male patients were evaluated. All were treated with other medications to control hypersexual behavior. Information regarding each patient's behavioral status was retrieved from caregivers who lived with the patients. Thirteen of the patients evaluated also experienced occasional aggressive behaviors. Efficacy was reported in all patients after two weeks, 4 weeks, and 8 weeks of treatment. Average effective dose for treatment was 600-750 rag/day. No adverse events were reported. Blood chemistries were unchanged. Conclusion: Oxcarbazepine treatment for hypersexual behavior in AD patients was effective and well tolerated.
~
R E D U C I N G APATHY, DEPRESSION AND B E H A V I O R A L D Y S C O N T R O L IN PATIENTS W I T H
ALZHEIMER'S DISEASE RESIDING IN ANURSING HOME Jeffrey M. Robbins*, Eileen Salmanson, Doreen Rentz. Brigham and
Women's Hospital, Boston, MA, USA. Contact e-mail: jrobbins @partners. org Background: The three most common problems facing patients with AD who residing in nursing homes are apathy, depression and behavioral dyscontrol. Due to staffing limitations, the one aspect of care that is most noteably absent for residents is the capacity for staff to spend 1 : 1 time with residents in order to meet their emotional needs, beyond the routine aspects of their care. Residents are thus deprived of the one aspect of care that is likely to be meaningful to them. Objective: A volunteer program for high school students fulfilling a community service requirement was conceived
$332
Poster Session P2: Social and Behavioral Research - Program Evaluation and Translation
pairing a student trained in communicating effectively with residents with AD over the course of one semester (4 months). Quantitative measures were obtained to determine whether w e e n y 1:1 visits with a student over the course of several months would decrease apathy, depression and behavioral dyscontrol. Methods: 19 residents and 19 students participated in a behavioral intervention targeting the symptoms of apathy, depression and behavioral dyscontrol. The intervention involved a 1:1 weekly visit with a high school student trained in the art of communicating effectively with residents. One hour prior to this intervention a facility staff member rated the resident on the adapted version of the Behavior Rating Scale for symptoms associated with apathy, depression and behavioral dyscontrol. One hour after the intervention staff again rated the residents for these same symptoms. Scores were tabulated as group averages for each behavioral symptom pre and post intervention. Conclusion: The overall group results indicate a reduction in disruptive behaviors in each behavioral domain following the intervention. Apathy and depression were most significant. Analysis of group data revealed consistent reductions in symptoms at the one-hour post intervention period. While pre-intervention data for depression and behavioral dyscontrol fall to consistently show a carry over effect over time, apathy was reduced from baseline and stayed reduced throughout the 4 month intervention. This study demonstrated that a simple social interaction with moderately to severely impaired Alzheimer's patients has a beneficial effect of reducing problematic symptoms and behaviors such as apathy, depression and behavioral dyscontrol.
Poster Session P2: Social and Behavioral Research Program Evaluation and Translation
•
L L O FfH O S P• I T A L PA R O G R AN M TO IMPROVE P THEA2AWARENESS OF AND C O M M U N I C A T I O N
WITH PEOPLE WITH COGNITIVE IMPAIRMENT, LINKED TO A BEDSIDE COGNITIVE IMPAIRMENT IDENTIFIER Mark W. Yates*, Meredith Theobald. Ballarat Health Services, Victoria, Australia. Contact e-mail: [email protected]
Background: Hospitals are currently not geared to best meet the needs of people with cognitive impairment (CI) or their carets. An understanding and application of effective verbal and non-verbal communication techniques are fundamental to quality hospital care. These communication skills and family involvement are not solely the domain of medical and nursing staff; equally important are hospital ancillary staff. Dementia and delirium are difficult to identify and yet this is a common condition in hospitals. The lack of easy identification of people with CI who require more appropriate communication and sensitivity to family needs results in ineffective targeting of support and a lack of awareness of their prevalence. Objective: The introduction of an education program with a CII (copyright Ballarat Health Services) to assist in better targeting of appropriate support will improve the hospital care experience for patients with dementia and their carets. Methodology: This study conducted in a 250-bed hospital will be completed in June 2004. Screening MMSE and Clockface is part of the standard admission process. A focus group of 39 people with dementia mad their families designed the CII along with 9 key educational targets. All patients with an abnormal MMSE and/or Clockface are offered a CII at the
bedside. A hospital wide education program has been conducted to improve both the awareness of CI and the communication requirements of people with CI. Questionnaires were used to measure staff understanding about CI and communication, acceptance of the CII and carer/family hospital experience pre and post CII use. Results: 200 hospital staff including engineers, ward clerks, doctors and nurses have participated in education and 70% have returned their 6 week follow-up questionnaires. 20-25% of the 25 baseline carer questionnaires completed indicated dissatisfaction with some of the key communication targets. Hospital processes have changed in admission, postoperative and ward areas. Of the 52 patients so far offered participation in this project 2 have declined Conclusions: These preliminary results suggest a sensitively designed CII is acceptable and can provide a focus for hospital process change and staff participation in education. The final results will be available for presentation.
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EFFECTS OF REPETITIVE W O R K ON M A I N T A I N I N G F U N C T I O N IN A L Z H E I M E R ' S DISEASE
Theressa Burns* 1, j. Riley McCarten I, Geri Adler 2, Mary Bauer 1, Michael A. Kuskowski 1.1VA Medical Center, GRECC, Minneapolis, MN, USA; 2University of South Carolina, Columbia, SC, USA. Contact e-mail: theressa, burns @reed.va.gov
Background: Effects of repetitive work on Alzheimer's disease (AD) patient functioning were examined when nine veterans were moved from an individualized work program to a traditional adult day program. Fiscal decisions around budget deficits and hospital resources resulted in closing the Adapted Work Program (AWP), and transferring the former workers to a traditional program, the Adult Day Health Care (ADHC). Objective: Assess the cognitive and functional status of subjects, including activities of daily living (ADL) at home. Methods: Nine male subjects diagnosed with mild to moderate AD prior to starting the work program were reassessed four months after the transition between programs. Initial MMSE scores at AWP entry ranged from 7 to 26 with a mean of 18.6. The average rime spent in the AWP prior to being discharged to the ADHC was 36.3 months and ranged from 12 to 65 months. Subjects were reassessed with the MiniMental State Examination (MMSE), Cognitive Performance Test (CVI'), and Geriatric Depression Scale (GDS). Individual slopes were calculated for seven subjects who had longitudinal scores for comparison from their AWP participation, and expected scores were predicted based on the calculated rate of decline. All nine subjects completed the GDS and their spouses completed the caregiver questionnaire. Frequencies were analyzed for items on the questionnaire. Results: Observed scores were significantly lower than expected scores. The mean difference between expected and observed MMSE was 4.9, with an expected mean of 17.7 and an observed mean of 12.9. The mean difference between expected and observed CPT was 0.64, with an expected mean of 4.7 and an observed mean of 4.0. All nine caregivers reported declines in activities of daily living. The GDS did not change. Conclusions: Subjects declined rapidly in function. The programs had existed side-by-side and the former workers were familiar with the ADHC staff and space. Weekly attendance hours and the staff-to-patient ratio remained the same. Therefore, the type of program activity, as opposed to the environment, was the primary change. Compared to traditional day care activities, work activities involve sequencing skills and practice may translate into self-care activities at home.
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COSTS ASSOCIATED W I T H I N C R E A S I N G SEVERITY OF DEMENTIA - A REVIEW OF THE LITERATURE
Shalini L. Kulasingam*, David B. Matchar, Donald Schmechel. Duke Universil~; Durham, NC, USA. Contact e-mail: [email protected]
Background: Although there are numerous studies of the costs associated with Alzheimer's dementia (AD), few have examined costs by AD severity. Objective: To review the literature to determine annual costs associated with increasing severity of Alzheimer's dementia (mild, moderate and
Poster Session P2: Social and Behavioral Research Pharmacologic Approaches to Behavioral Symptoms
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f
•
SAFETY AND EFFICACY OF D R O N A B I N O L IN THE T R E A T M E N T O F A G I T A T I O N IN PATIENTS W I T H ALZHEIMER'S DISEASE: A P I L O T STUDY IN C O M M U N I T Y D W E L L I N G PATIENTS REFRACTORY TO TRADITIONAL MEDICINE
Joshua R. Shua-Haim*, Mark D. Pass, Suhas Patel, Sameer Patel, Paul Lee.
Jersey Shore University Medical Center, Neptune, NJ, USA. Contact e-mail: [email protected] Background: Mid-Atlantic Geriatric Fellowship Program, Department of Geriatrics, Jersey Shore University Medical Center & Ocean Medical Center, NJ Objective: To investigate the safety & efficacy of dronabinol as treatment for agitation associated with Alzheimer's disease Methods: Alzheimer's disease (AD) patients who had unsatisfactorily controlled agitation as reported by family members or staff nurses were prescribed dronabinol and evaluated. All met the DSM-IV & NINCDS-ADRDA criteria for possible AD. There were no exclusion criteria. Study subjects resided in a dementia unit in an assisted living facility and in a nursing home. Dronabinol 5 nag/day in two divided doses was given initially & titrated up to a maximum of 10 rag/day. Concomitant medications were recorded. After 4 weeks of treatment, nurses were asked to complete a questionnaire regarding their impression of treatment efficacy. Results: Seventy three patients were treated with dronabinol. Average age was 83. Average MMSE was 13. All patients were treated with atypical neuroleptics and at least one additional medication to control behavior including but not limited to SSRI's, atypical antidepressants, anti-convulsants, and benzodiazepines. All patients had concomitant diagnoses of anorexia and weight loss. As reported by staff nurses and nurses aids, agitation improved in 58 (79%) of the patients. In 19 (26%), there was an average increase in MMSE of 1.2 points (range +1 to +3). Functional improvement was reported in 47 (64%) patients. 15 (20%) patients had no response and the medication was discontinued. No additional treatment for agitation was requested at the four week follow up visit for any of the patients on the medication. One patient experienced increase daytime somnolence, but no significant adverse events were reported (falls, syncope, seizures, exacerbation of agitation or depression.) Conclusion: Dronabinol treatment for agitation in AD patients who reside in long term care facilities was effective in 58 out of 73 patients who were refractory to other medications.
•
SEARCHING FOR PERIPHERAL PREDICTORS O F C H O L I N E R G I C DRUG RESPONSE IN ALZHEIMER'S DISEASE
Daniel R. Saumier .1 , Ron Schondorf I , Howard Bergman 1, Natalie Phillips 2, Howard Chertkow I . lBloomfield Centre for Research in
Aging, McGill University, Montreal, PQ, Canada; 2Concordia University, Department of Psychology, Montreal, PQ, Canada. Contact e-mail: daniel, saumier@ mail.mcgill, ca Background: Administration of acetylchollnesterase inhibitors has been found to improve cognition in Alzheimer's disease. The moderate efficacy of these medications underlines the importance of a chollnergic deficit in at least some of the symptoms of AD, and in at least some of the patients who suffer from this illness. At the same time, it is clear that cholinomimetic drugs have variable success in their ability to enhance cognitive ability in patients with AD. Objective(s): The current study examine whether the variability in response to the acetylcholinesterase inhibitors donepezil in AD subjects is a reflection of the variability in the degree of derangement of the peripheral cholinergic system across these individuals. Methods: Donepezil 10 mg was administered in an open-label treatment study for 6 months to 30 individuals with mild probable AD. Global treatment response was assessed using an algorithm combining changes in the ADAS-cog (Alzheimer's Disease Assessment Scale-cognitive subscale), MMSE (Folstein Mini-Mental State Exam) and CIBIC (Clinician Interview-based Impression of Change), with
$331
"response" defined as improvement or stabilization on the combination algorithm over the six-month period. Peripheral cholinergic status was assessed according to three measures. They included - Apo-E genotyping, middle latency auditory evoked potentials, and autonomic testing of sweat production and the cardiac pressor response in reaction to tilting. We also tested a group of matched elderly controls with these measures. All measures were repeated after 6 months for comparison. Results: Eighteen subjects were rated as having responded favourably to donepezil, while 12 were rated as non-responders. The peripheral cholinergic assessments reveal the following findings. First, there is no evidence of a peripheral autonomic dysfunction in AD vs. Normal elderly. Second, we find no evidence that APO-FA or autonomic test scores any effect on donepezil efficacy. Finally, the amplitude of the middle latency auditory evoked response did not differ reliably between donepezil responders and non-responders. Conclusions: There was no evidence of significant peripheral cholinergic dysfunction in patients with AD. Prospective application of peripheral cholinergic assessments is not likely to predict the clinical response to donepezil.
•
SAFETY AND E F F I C A C Y O F O X C A R B A Z E P I N E IN THE TREATMENT OF HYPERSEXUALITY IN ALZHE1MER'S DISEASE PATIENTS R E S I D I N G IN THE C O M M U N I T Y
Suhas Patel*, Joshua R. Shna-Haim, Mark D. Pass, Paul Lee. Jersey Shore
University Medical Center, Neptune, NJ, USA. Contact e-mail: markpass @hotmail.corn Background: Mid-Atlantic Geriatric Fellowship Program, Department of Geriatrics, Jersey Shore University Medical Center & Ocean Medical Center, NJ Objective: To evaluate the safety and efficacy of oxcarbazepine for the treatment of Alzheimer's disease (AD) patients who exhibit hypersexual behavior. Methods: In a cross-sectional study during a three month period, all patients with AD who were treated with oxcarbazepine for hypersexual behaviors were evaluated. All patients were being evaluated at our clinical practice as outpatients. All fulfilled the DSM-IV and NINCDS-ADRDA criteria for possible AD. There were no exclusion criteria. Treatment was started at 150 rag/day, and if no improvement or adverse effects, the dose was titrated every three days by 150 rag/day in two divided doses. Titration at this pace continued until the patient's behavior was controlled, or a maximum dose of 900 rag/day was reached. Follow up blood chemistries for possible hyponatremia were performed bimonthly. Results: Twenty three male patients were evaluated. All were treated with other medications to control hypersexual behavior. Information regarding each patient's behavioral status was retrieved from caregivers who lived with the patients. Thirteen of the patients evaluated also experienced occasional aggressive behaviors. Efficacy was reported in all patients after two weeks, 4 weeks, and 8 weeks of treatment. Average effective dose for treatment was 600-750 rag/day. No adverse events were reported. Blood chemistries were unchanged. Conclusion: Oxcarbazepine treatment for hypersexual behavior in AD patients was effective and well tolerated.
~
R E D U C I N G APATHY, DEPRESSION AND B E H A V I O R A L D Y S C O N T R O L IN PATIENTS W I T H
ALZHEIMER'S DISEASE RESIDING IN ANURSING HOME Jeffrey M. Robbins*, Eileen Salmanson, Doreen Rentz. Brigham and
Women's Hospital, Boston, MA, USA. Contact e-mail: jrobbins @partners. org Background: The three most common problems facing patients with AD who residing in nursing homes are apathy, depression and behavioral dyscontrol. Due to staffing limitations, the one aspect of care that is most noteably absent for residents is the capacity for staff to spend 1 : 1 time with residents in order to meet their emotional needs, beyond the routine aspects of their care. Residents are thus deprived of the one aspect of care that is likely to be meaningful to them. Objective: A volunteer program for high school students fulfilling a community service requirement was conceived
$332
Poster Session P2: Social and Behavioral Research - Program Evaluation and Translation
pairing a student trained in communicating effectively with residents with AD over the course of one semester (4 months). Quantitative measures were obtained to determine whether w e e n y 1:1 visits with a student over the course of several months would decrease apathy, depression and behavioral dyscontrol. Methods: 19 residents and 19 students participated in a behavioral intervention targeting the symptoms of apathy, depression and behavioral dyscontrol. The intervention involved a 1:1 weekly visit with a high school student trained in the art of communicating effectively with residents. One hour prior to this intervention a facility staff member rated the resident on the adapted version of the Behavior Rating Scale for symptoms associated with apathy, depression and behavioral dyscontrol. One hour after the intervention staff again rated the residents for these same symptoms. Scores were tabulated as group averages for each behavioral symptom pre and post intervention. Conclusion: The overall group results indicate a reduction in disruptive behaviors in each behavioral domain following the intervention. Apathy and depression were most significant. Analysis of group data revealed consistent reductions in symptoms at the one-hour post intervention period. While pre-intervention data for depression and behavioral dyscontrol fall to consistently show a carry over effect over time, apathy was reduced from baseline and stayed reduced throughout the 4 month intervention. This study demonstrated that a simple social interaction with moderately to severely impaired Alzheimer's patients has a beneficial effect of reducing problematic symptoms and behaviors such as apathy, depression and behavioral dyscontrol.
Poster Session P2: Social and Behavioral Research Program Evaluation and Translation
•
L L O FfH O S P• I T A L PA R O G R AN M TO IMPROVE P THEA2AWARENESS OF AND C O M M U N I C A T I O N
WITH PEOPLE WITH COGNITIVE IMPAIRMENT, LINKED TO A BEDSIDE COGNITIVE IMPAIRMENT IDENTIFIER Mark W. Yates*, Meredith Theobald. Ballarat Health Services, Victoria, Australia. Contact e-mail: [email protected]
Background: Hospitals are currently not geared to best meet the needs of people with cognitive impairment (CI) or their carets. An understanding and application of effective verbal and non-verbal communication techniques are fundamental to quality hospital care. These communication skills and family involvement are not solely the domain of medical and nursing staff; equally important are hospital ancillary staff. Dementia and delirium are difficult to identify and yet this is a common condition in hospitals. The lack of easy identification of people with CI who require more appropriate communication and sensitivity to family needs results in ineffective targeting of support and a lack of awareness of their prevalence. Objective: The introduction of an education program with a CII (copyright Ballarat Health Services) to assist in better targeting of appropriate support will improve the hospital care experience for patients with dementia and their carets. Methodology: This study conducted in a 250-bed hospital will be completed in June 2004. Screening MMSE and Clockface is part of the standard admission process. A focus group of 39 people with dementia mad their families designed the CII along with 9 key educational targets. All patients with an abnormal MMSE and/or Clockface are offered a CII at the
bedside. A hospital wide education program has been conducted to improve both the awareness of CI and the communication requirements of people with CI. Questionnaires were used to measure staff understanding about CI and communication, acceptance of the CII and carer/family hospital experience pre and post CII use. Results: 200 hospital staff including engineers, ward clerks, doctors and nurses have participated in education and 70% have returned their 6 week follow-up questionnaires. 20-25% of the 25 baseline carer questionnaires completed indicated dissatisfaction with some of the key communication targets. Hospital processes have changed in admission, postoperative and ward areas. Of the 52 patients so far offered participation in this project 2 have declined Conclusions: These preliminary results suggest a sensitively designed CII is acceptable and can provide a focus for hospital process change and staff participation in education. The final results will be available for presentation.
•
EFFECTS OF REPETITIVE W O R K ON M A I N T A I N I N G F U N C T I O N IN A L Z H E I M E R ' S DISEASE
Theressa Burns* 1, j. Riley McCarten I, Geri Adler 2, Mary Bauer 1, Michael A. Kuskowski 1.1VA Medical Center, GRECC, Minneapolis, MN, USA; 2University of South Carolina, Columbia, SC, USA. Contact e-mail: theressa, burns @reed.va.gov
Background: Effects of repetitive work on Alzheimer's disease (AD) patient functioning were examined when nine veterans were moved from an individualized work program to a traditional adult day program. Fiscal decisions around budget deficits and hospital resources resulted in closing the Adapted Work Program (AWP), and transferring the former workers to a traditional program, the Adult Day Health Care (ADHC). Objective: Assess the cognitive and functional status of subjects, including activities of daily living (ADL) at home. Methods: Nine male subjects diagnosed with mild to moderate AD prior to starting the work program were reassessed four months after the transition between programs. Initial MMSE scores at AWP entry ranged from 7 to 26 with a mean of 18.6. The average rime spent in the AWP prior to being discharged to the ADHC was 36.3 months and ranged from 12 to 65 months. Subjects were reassessed with the MiniMental State Examination (MMSE), Cognitive Performance Test (CVI'), and Geriatric Depression Scale (GDS). Individual slopes were calculated for seven subjects who had longitudinal scores for comparison from their AWP participation, and expected scores were predicted based on the calculated rate of decline. All nine subjects completed the GDS and their spouses completed the caregiver questionnaire. Frequencies were analyzed for items on the questionnaire. Results: Observed scores were significantly lower than expected scores. The mean difference between expected and observed MMSE was 4.9, with an expected mean of 17.7 and an observed mean of 12.9. The mean difference between expected and observed CPT was 0.64, with an expected mean of 4.7 and an observed mean of 4.0. All nine caregivers reported declines in activities of daily living. The GDS did not change. Conclusions: Subjects declined rapidly in function. The programs had existed side-by-side and the former workers were familiar with the ADHC staff and space. Weekly attendance hours and the staff-to-patient ratio remained the same. Therefore, the type of program activity, as opposed to the environment, was the primary change. Compared to traditional day care activities, work activities involve sequencing skills and practice may translate into self-care activities at home.
•
COSTS ASSOCIATED W I T H I N C R E A S I N G SEVERITY OF DEMENTIA - A REVIEW OF THE LITERATURE
Shalini L. Kulasingam*, David B. Matchar, Donald Schmechel. Duke Universil~; Durham, NC, USA. Contact e-mail: [email protected]
Background: Although there are numerous studies of the costs associated with Alzheimer's dementia (AD), few have examined costs by AD severity. Objective: To review the literature to determine annual costs associated with increasing severity of Alzheimer's dementia (mild, moderate and