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P489: Vitamin D and cognitive impairment among very old people
Late Breaker Posters / European Geriatric Medicine 5S1 (2014) S235–S253
Conclusions: There is notable variation in tools used to screen for cognitive impairment across Scottish geriatric medical units. Development of a national standardised assessment protocol may help drive up standards of assessment including enabling cross-unit comparisons of process and outcome of care. P488 The effects of cognitive and exercise interventions for people with mild cognitive impairment and dementia on carers: a systematic review D. Gondek, D. Patel, K. Pollock, R. das Nair, R. Harwood, V. van der Wardt University of Nottingham, Nottingham, United Kingdom Introduction: Increasing numbers of people with dementia will undoubtedly result in increased caregivers burden (various psychological, behavioural and physical interventions have been recommended to prevent or alleviate these problems), however their effects on carers are underexplored. The main objective of this study is to investigate the effects of physical and cognitive interventions for people with dementia, or mild cognitive, on their informal carers. Methods: We systematically searched CINAHL, EMBASE, MeDLINE, PsycINFO and Web of Science. Nineteen studies met inclusion criteria and were included. Eligible studies reported any caregiver related outcomes of exercise or cognitive interventions designed primarily for care recipients. The quality of studies was assessed, however study quality and design were not exclusion criteria. Results: Most studies, which used such intervention as cognitive rehabilitation, memory support system, reality orientation therapy and exercise programme indicated positive effects on caregivers in form of e.g. reduced burden, strain, depressive symptoms, anxiety, improved or maintained quality of life. Two studies indicated negative effects on caregivers (Kurz et al., 2012; Wade et al., 2003) such as increase in burden and strain, but neither of these had an beneficial effect on the care recipient. Conclusions: Cognitive and exercises interventions in general have favourable effect on carers. It appears that interventions indirectly help caregivers by improving care recipient related outcomes. The involvement of the carer in implementation of the intervention may also positively affect the carer-related outcomes. Nonetheless the comparison across included studies is problematic to high clinical and methodological heterogeneity. P489 Vitamin D and cognitive impairment among very old people M.C. Collins1 , C. Laubarie-Mouret1 , N. Cardinaud1 , M. Charenton1 , G.E. Collins2 , F. Dantoine1 1 CHU Limoges, Limoges, France; 2 Brown University, Providence, USA Introduction: Vitamin D link to cognitive functions remains unclear. Recent follow-up studies tend to associate vitamin D deficiency to cognitive decline. This study proposes to look for an association between vitamin D deficiency and cognitive impairment in a large population of very old adults. Material and Methods: Volunteering subjects 75 years and older underwent a comprehensive geriatric assessment at home. Volunteers suffering from severe dementia (MMS-E <10/30) were excluded. Cognitive impairment was assessed with MMS-E, while serum 25(OH)Vitamin D was assessed by a fasting morning blood test. The following confusion bias were considered: vitamin D assay method, cardiovascular risk factors, history of neurodegenerative disease, cardiovascular disease, dysthyroidism, vitamin B9/B12 deficiency, renal failure, sociocultural level, age, sex, and physical activity. A descriptive analysis was done, we then used a multiple logistic regression model on binary data. Results: 440 participants were included. The three main vitamin D assay methods were selected for a total of 382
S237
participants. We found no statistically significant association between 25(OH)vitamin D and cognitive impairment. Discussion: The final results will be presented at the EUGMS congress. To our knowledge, this is the first study on vitamin D and cognitive impairment with such a large sample of very old persons. Though, the power of this study might have been insufficient to unveil any association. Further studies are needed with a single assay method and a more sensitive cognitive assessment tool to executive functions, such as the Montreal Cognitive Assessment© . P490 Neuropsychiatric symptoms in patients with mild cognitive impairment and mild Alzheimer disease: a cross sectional comparison C.A.B. Brys1 , P. De Vriendt1 , E. Gorus2 1 Vrije Universiteit Brussel, Brussels, Belgium; 2 Universitair Ziekenhuis Brussel, Brussels, Belgium Introduction: The detection of early stages of dementia is important for early diagnosis and intervention. Early interventions are effective in improving therapeutic outcomes. The presence of neuropsychiatric symptoms (NPS) predicts unfavorable outcomes in dementia, such as poor prognosis, high caregiver burden, institutionalization and drug use. Although there is some evidence that NPS are common in dementia, they have received less attention in the prodromal stages. Methods: In this study, 39 patients with MCI (mean age = 80.4; SD = 4.7) and 45 patients with mild Alzheimer’s Disease (AD) (mean age = 80.7; SD = 5.1) were recruited in a Geriatric Day Hospital. Cognitive functioning was assessed using the Mini Mental State Examination and Cambridge Examination for Mental Disorders of the Elderly. NPS were measured with the Neuropsychiatric Inventory Questionnaire (NPI-Q). Results: There was no significant difference (p < 0.05) between MCI and mild AD for the total NPI-Q score (MCI: 10.5±8.5; AD: 16.2±14.6), total score severity (MCI: 4.7±3.6; AD: 7.4±6.3), nor for the number of behavioral and psychological symptoms (MCI: 2.7±1.7; AD: 3.6±2.7). Only a significant difference between MCI and AD for delusions (respectively 1 in MCI and 9 in AD) and aberrant motor behavior (respectively 2 in MCI and 10 in AD) appeared. Furthermore, no correlations between cognition and NPS were observed. Conclusions: These findings suggest that neuropsychiatric symptoms are already present in MCI in the same degree as in mild AD and support the hypothesis that NPS might constitute an important early sign of mild AD. P491 The Advanced Activities of Daily Living tool has discriminative power in the diagnosis of mild cognitive decline in an older population P. De Vriendt1 , T. Mets1 , M. Petrovic2 , E. Gorus1 1 Vrije Universiteit Brussel, Brussel Jette, Belgium; 2 UGent, Ghent, Belgium Mild Cognitive Impairment (MCI) is characterized by subjective and objective memory impairment in the absence of manifest functional decline. However, mild changes in activities of daily living (ADL) are present in MCI and probably predict conversion to dementia. In the present study, the discriminative power of the advanced (a-)-ADL tool is evaluated. The tool comprises high level activities and, taking each subject as his own reference, distinguishes a global Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), based on the total number of activities performed and the severity and causes of the functional problem. Participants were on average 80 years old (SD 4.6; 66–90), community dwelling, and diagnosed as (1) cognitively healthy subjects (n = 50); (2) patients with a-MCI (n = 53), or (3) mild AD
Conclusions: There is notable variation in tools used to screen for cognitive impairment across Scottish geriatric medical units. Development of a national standardised assessment protocol may help drive up standards of assessment including enabling cross-unit comparisons of process and outcome of care. P488 The effects of cognitive and exercise interventions for people with mild cognitive impairment and dementia on carers: a systematic review D. Gondek, D. Patel, K. Pollock, R. das Nair, R. Harwood, V. van der Wardt University of Nottingham, Nottingham, United Kingdom Introduction: Increasing numbers of people with dementia will undoubtedly result in increased caregivers burden (various psychological, behavioural and physical interventions have been recommended to prevent or alleviate these problems), however their effects on carers are underexplored. The main objective of this study is to investigate the effects of physical and cognitive interventions for people with dementia, or mild cognitive, on their informal carers. Methods: We systematically searched CINAHL, EMBASE, MeDLINE, PsycINFO and Web of Science. Nineteen studies met inclusion criteria and were included. Eligible studies reported any caregiver related outcomes of exercise or cognitive interventions designed primarily for care recipients. The quality of studies was assessed, however study quality and design were not exclusion criteria. Results: Most studies, which used such intervention as cognitive rehabilitation, memory support system, reality orientation therapy and exercise programme indicated positive effects on caregivers in form of e.g. reduced burden, strain, depressive symptoms, anxiety, improved or maintained quality of life. Two studies indicated negative effects on caregivers (Kurz et al., 2012; Wade et al., 2003) such as increase in burden and strain, but neither of these had an beneficial effect on the care recipient. Conclusions: Cognitive and exercises interventions in general have favourable effect on carers. It appears that interventions indirectly help caregivers by improving care recipient related outcomes. The involvement of the carer in implementation of the intervention may also positively affect the carer-related outcomes. Nonetheless the comparison across included studies is problematic to high clinical and methodological heterogeneity. P489 Vitamin D and cognitive impairment among very old people M.C. Collins1 , C. Laubarie-Mouret1 , N. Cardinaud1 , M. Charenton1 , G.E. Collins2 , F. Dantoine1 1 CHU Limoges, Limoges, France; 2 Brown University, Providence, USA Introduction: Vitamin D link to cognitive functions remains unclear. Recent follow-up studies tend to associate vitamin D deficiency to cognitive decline. This study proposes to look for an association between vitamin D deficiency and cognitive impairment in a large population of very old adults. Material and Methods: Volunteering subjects 75 years and older underwent a comprehensive geriatric assessment at home. Volunteers suffering from severe dementia (MMS-E <10/30) were excluded. Cognitive impairment was assessed with MMS-E, while serum 25(OH)Vitamin D was assessed by a fasting morning blood test. The following confusion bias were considered: vitamin D assay method, cardiovascular risk factors, history of neurodegenerative disease, cardiovascular disease, dysthyroidism, vitamin B9/B12 deficiency, renal failure, sociocultural level, age, sex, and physical activity. A descriptive analysis was done, we then used a multiple logistic regression model on binary data. Results: 440 participants were included. The three main vitamin D assay methods were selected for a total of 382
S237
participants. We found no statistically significant association between 25(OH)vitamin D and cognitive impairment. Discussion: The final results will be presented at the EUGMS congress. To our knowledge, this is the first study on vitamin D and cognitive impairment with such a large sample of very old persons. Though, the power of this study might have been insufficient to unveil any association. Further studies are needed with a single assay method and a more sensitive cognitive assessment tool to executive functions, such as the Montreal Cognitive Assessment© . P490 Neuropsychiatric symptoms in patients with mild cognitive impairment and mild Alzheimer disease: a cross sectional comparison C.A.B. Brys1 , P. De Vriendt1 , E. Gorus2 1 Vrije Universiteit Brussel, Brussels, Belgium; 2 Universitair Ziekenhuis Brussel, Brussels, Belgium Introduction: The detection of early stages of dementia is important for early diagnosis and intervention. Early interventions are effective in improving therapeutic outcomes. The presence of neuropsychiatric symptoms (NPS) predicts unfavorable outcomes in dementia, such as poor prognosis, high caregiver burden, institutionalization and drug use. Although there is some evidence that NPS are common in dementia, they have received less attention in the prodromal stages. Methods: In this study, 39 patients with MCI (mean age = 80.4; SD = 4.7) and 45 patients with mild Alzheimer’s Disease (AD) (mean age = 80.7; SD = 5.1) were recruited in a Geriatric Day Hospital. Cognitive functioning was assessed using the Mini Mental State Examination and Cambridge Examination for Mental Disorders of the Elderly. NPS were measured with the Neuropsychiatric Inventory Questionnaire (NPI-Q). Results: There was no significant difference (p < 0.05) between MCI and mild AD for the total NPI-Q score (MCI: 10.5±8.5; AD: 16.2±14.6), total score severity (MCI: 4.7±3.6; AD: 7.4±6.3), nor for the number of behavioral and psychological symptoms (MCI: 2.7±1.7; AD: 3.6±2.7). Only a significant difference between MCI and AD for delusions (respectively 1 in MCI and 9 in AD) and aberrant motor behavior (respectively 2 in MCI and 10 in AD) appeared. Furthermore, no correlations between cognition and NPS were observed. Conclusions: These findings suggest that neuropsychiatric symptoms are already present in MCI in the same degree as in mild AD and support the hypothesis that NPS might constitute an important early sign of mild AD. P491 The Advanced Activities of Daily Living tool has discriminative power in the diagnosis of mild cognitive decline in an older population P. De Vriendt1 , T. Mets1 , M. Petrovic2 , E. Gorus1 1 Vrije Universiteit Brussel, Brussel Jette, Belgium; 2 UGent, Ghent, Belgium Mild Cognitive Impairment (MCI) is characterized by subjective and objective memory impairment in the absence of manifest functional decline. However, mild changes in activities of daily living (ADL) are present in MCI and probably predict conversion to dementia. In the present study, the discriminative power of the advanced (a-)-ADL tool is evaluated. The tool comprises high level activities and, taking each subject as his own reference, distinguishes a global Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), based on the total number of activities performed and the severity and causes of the functional problem. Participants were on average 80 years old (SD 4.6; 66–90), community dwelling, and diagnosed as (1) cognitively healthy subjects (n = 50); (2) patients with a-MCI (n = 53), or (3) mild AD