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P.5.b.002 Clinical correlates of apathy in patients with Alzheimer's disease
S582
P.5.b. Dementia and neurological disorders − Dementia (clinical)
dementia − a randomised placebo controlled clinical trial. International Journal of Psychiatry 2002; 17(6): 579−85. [4] Tariot 2005: Tariot PN, Raman R, Jakimovich L, Schneider L, Porsteinsson A, Thomas R, et al. Divalproex sodium in nursing home residents with possible or probable Alzheimer Disease complicated by agitation: a randomized, controlled trial. American Geriatric Psychiatry2005; 13: 942−9. [5] Herrmann 2007: Herrmann N, Lanctot KL, Rothenberg LS, Eryavec G. A placebo-controlled trial of valproate for agitation and aggression in Alzheimer’s Disease. Dementia and Geriatric Cognitive Disorders 2007; 23: 116−9.
P.5.b.002 Clinical correlates of apathy in patients with Alzheimer’s disease E. Cobanoglu1 ° , E. Ozel-Kizil1 , S. Kirici1 , N. Bal1 , Y. Hosgoren Alici1 , O. Yucel1 , B. Bilgin1 , E. Turan1 1 Ankara University Faculty of Medicine, Psychiatry, Ankara, Turkey Introduction: Apathy is the most common neuropsychiatric symptom in Alzheimer’s disease and it can be present both in early and late stages of the disorder [1]. Because apathy and depression have overlapping features and generally appear concomitantly in these patients, it is often difficult to distinguish them from one another [2]. Appropriate assessment of apathy in dementia is essential since it is associated with greater functional impairment, caregiver distress, cognitive decline, poorer prognosis and treatment-non response, thus increasing health expenditures [3,4]. The aim of this study is to evaluate the clinical correlates of apathy in patients with Alzheimer’s disease. We hypothesized that severity of apathy in Alzheimer’s disease is correlated with cognitive deficits independent of other neuropsychiatric symptoms like depressive or psychotic symptoms. Methods: A total of 67 outpatients with a diagnosis of Alzheimer’s disease and aged 60 years or over, who were admitted to a geriatric psychiatry outpatient clinic of a university hospital and their caregivers were recruited to the study. Patients with less than three years of education were excluded. The patients met the criteria for probable Alzheimer’s disease (NINCDS-ADRDA). Assessments including the evaluation of cognitive and functional status, depression, apathy and other neurobehavioral symptoms using Mini Mental State Examination (MMSE), Functional Activities Questionnaire (FAQ), Cornell Scale for Depression in Dementia (CSDD), Apathy Evaluation Scale (AES)-clinician version and Neuropsychiatric Inventory (NPI) were administered. The AES is a Likert-type (1−4) scale with 18 items which was administered by the clinician during the interview with the patient and the caregiver. The correlation between the scores of the AES and the MMSE, the CSDD, the NPI and the FAQ, age and years of education were analyzed. Results: The mean age of the sample was 76.42±6.78 (63−89 years). 47.8% (n = 32) of the patients were female and 52.2% (n = 35) were male. Mean years of education of the patients was 6.88±4.15 (3−20 years). The AES scores were significantly correlated with the scores of the MMSE (r = −0.47, p < 0.001), the FAQ (r = 0.72, p < 0.001), the apathy subscale of the NPI (r = 0.69, p < 0.001) and total NPI scores (R = 0.39, p = 0.001). The AES scores were not correlated with age (r = 0.04, p = 0.75), years of education (R = 0.15, p = 0.22), the CSDD scores (R = −0.05, p = 0.69), the delusions subscale of the NPI (R = 0.12, p = 0.32) and the hallucinations subscale of NPI (R = 0.18, p = 0.16). Conclusions: The AES is widely used for the assessment of apathy in patients with dementia, schizophrenia and other neuropsychiatric disorders like Parkinson’s disease and traumatic
brain injury. In this study, the severity of apathy evaluated with the AES was found to be correlated with the severity of the cognitive deficit as well as the functional impairment. However, apathy was not associated with other neuropsychiatric symptoms like depression or psychosis. Therefore, apathy seems to be an independent feature, although it is not specific for Alzheimer’s disease. Further research including healthy elderly controls should be carried out in order to determine neurobiological correlates of apathy in Alzheimer’s disease. References [1] Cipriani, G., Lucetti, C., Danti, S., Nuti, A., 2014 Apathy and dementia. Nosology, assessment and management. J Nerv Ment Dis 202,718–724. [2] Tagariello, P., Girardi, P., Amore, M., 2009 Depression and apathy in dementia: Same syndrome or different constructs? A critical review. Arch Gerontol Geriatr 49, 246–249. [3] Clarke, D.E., Kob, J.Y., Kuhla, A.E., van Reekum, R., Salvadora, R., Marin, R.S., 2011 Are the available apathy measures reliable and valid? A review of the psychometric evidence. J Psychosom Res 70, 73−97. [4] Stanton, B.R., Leigh, P.N., Howard, R.J., Barker, G.J., Brown, R.G., 2013 Behavioural and emotional symptoms of apathy are associated with distinct patterns of brain atrophy in neurodegenerative disorders. J Neurol. 2013 260, 2481–2490.
P.5.b.003 The effect of memantine treatment for sleep disturbances in patients with alcohol-related dementia D. Shin1 ° , D. Bae1 South-Korea
1 Sun
General Hospital, Psychiatry, Daejeon,
Introduction: Alcoholism is a chronic and typically progressive disease. [1] Chronic exposure to alcohol may have direct or indirect effects on the brain that can lead to cognitive impairment and various types of dementia. [2] The severe alcohol drinking can lead to brain damage and increase the risk of alcohol-related dementia.(ARD) [3] Sleep length and architecture are potential biomarkers of progressive cognitive impairment [4]. Sleep disturbances are common among alcohol-dependent individuals. Also the patients with ARD have been more sleep disturbances. [1] There are several studies suggest that memantine(NMDA receptor antagonist) treatment had the improvement of sleep disturbances in patients with Alzheimer’s dementia. [5] But there is no study in memantine treatment for ARD with sleep disturbances. We investigated memantine treatment might be related to improvement of sleep disturbances in patients with ARD. Methods: Twenty patients (age, 65−75 years) were evaluated. ARD was diagnosed according to ICD-10 criteria. The patient had no history of head injury, computed tomography showed no typical findings of Alzheimer’s disease, and no depression. Patients were asked if their sleep was satisfactory (yes or no). The patients were unsatisfied. Total sleep time had to be excluding daytime naps. The patients had that total sleep time was less than 5 hours. We analyzed from 10 factors-including demographic characteristics, dependence variables, biologic markers, family history of alcohol dependence, cognitive decline, functional impairment for activities of daily living and self-reported sleep satisfaction and length of sleep. We investigated the efficacy of 20 mg memantine for sleep disturbances in patients with ARD. Pittsburgh sleep quality index (PSQI) and Total sleep time (TST) were completed before and after the 2 months memantine treatment period. The Mann– Whitney test was used to compare. Spearman’s correlation analysis was used to compare PSQI with TST and to compare functional
P.5.b. Dementia and neurological disorders − Dementia (clinical)
dementia − a randomised placebo controlled clinical trial. International Journal of Psychiatry 2002; 17(6): 579−85. [4] Tariot 2005: Tariot PN, Raman R, Jakimovich L, Schneider L, Porsteinsson A, Thomas R, et al. Divalproex sodium in nursing home residents with possible or probable Alzheimer Disease complicated by agitation: a randomized, controlled trial. American Geriatric Psychiatry2005; 13: 942−9. [5] Herrmann 2007: Herrmann N, Lanctot KL, Rothenberg LS, Eryavec G. A placebo-controlled trial of valproate for agitation and aggression in Alzheimer’s Disease. Dementia and Geriatric Cognitive Disorders 2007; 23: 116−9.
P.5.b.002 Clinical correlates of apathy in patients with Alzheimer’s disease E. Cobanoglu1 ° , E. Ozel-Kizil1 , S. Kirici1 , N. Bal1 , Y. Hosgoren Alici1 , O. Yucel1 , B. Bilgin1 , E. Turan1 1 Ankara University Faculty of Medicine, Psychiatry, Ankara, Turkey Introduction: Apathy is the most common neuropsychiatric symptom in Alzheimer’s disease and it can be present both in early and late stages of the disorder [1]. Because apathy and depression have overlapping features and generally appear concomitantly in these patients, it is often difficult to distinguish them from one another [2]. Appropriate assessment of apathy in dementia is essential since it is associated with greater functional impairment, caregiver distress, cognitive decline, poorer prognosis and treatment-non response, thus increasing health expenditures [3,4]. The aim of this study is to evaluate the clinical correlates of apathy in patients with Alzheimer’s disease. We hypothesized that severity of apathy in Alzheimer’s disease is correlated with cognitive deficits independent of other neuropsychiatric symptoms like depressive or psychotic symptoms. Methods: A total of 67 outpatients with a diagnosis of Alzheimer’s disease and aged 60 years or over, who were admitted to a geriatric psychiatry outpatient clinic of a university hospital and their caregivers were recruited to the study. Patients with less than three years of education were excluded. The patients met the criteria for probable Alzheimer’s disease (NINCDS-ADRDA). Assessments including the evaluation of cognitive and functional status, depression, apathy and other neurobehavioral symptoms using Mini Mental State Examination (MMSE), Functional Activities Questionnaire (FAQ), Cornell Scale for Depression in Dementia (CSDD), Apathy Evaluation Scale (AES)-clinician version and Neuropsychiatric Inventory (NPI) were administered. The AES is a Likert-type (1−4) scale with 18 items which was administered by the clinician during the interview with the patient and the caregiver. The correlation between the scores of the AES and the MMSE, the CSDD, the NPI and the FAQ, age and years of education were analyzed. Results: The mean age of the sample was 76.42±6.78 (63−89 years). 47.8% (n = 32) of the patients were female and 52.2% (n = 35) were male. Mean years of education of the patients was 6.88±4.15 (3−20 years). The AES scores were significantly correlated with the scores of the MMSE (r = −0.47, p < 0.001), the FAQ (r = 0.72, p < 0.001), the apathy subscale of the NPI (r = 0.69, p < 0.001) and total NPI scores (R = 0.39, p = 0.001). The AES scores were not correlated with age (r = 0.04, p = 0.75), years of education (R = 0.15, p = 0.22), the CSDD scores (R = −0.05, p = 0.69), the delusions subscale of the NPI (R = 0.12, p = 0.32) and the hallucinations subscale of NPI (R = 0.18, p = 0.16). Conclusions: The AES is widely used for the assessment of apathy in patients with dementia, schizophrenia and other neuropsychiatric disorders like Parkinson’s disease and traumatic
brain injury. In this study, the severity of apathy evaluated with the AES was found to be correlated with the severity of the cognitive deficit as well as the functional impairment. However, apathy was not associated with other neuropsychiatric symptoms like depression or psychosis. Therefore, apathy seems to be an independent feature, although it is not specific for Alzheimer’s disease. Further research including healthy elderly controls should be carried out in order to determine neurobiological correlates of apathy in Alzheimer’s disease. References [1] Cipriani, G., Lucetti, C., Danti, S., Nuti, A., 2014 Apathy and dementia. Nosology, assessment and management. J Nerv Ment Dis 202,718–724. [2] Tagariello, P., Girardi, P., Amore, M., 2009 Depression and apathy in dementia: Same syndrome or different constructs? A critical review. Arch Gerontol Geriatr 49, 246–249. [3] Clarke, D.E., Kob, J.Y., Kuhla, A.E., van Reekum, R., Salvadora, R., Marin, R.S., 2011 Are the available apathy measures reliable and valid? A review of the psychometric evidence. J Psychosom Res 70, 73−97. [4] Stanton, B.R., Leigh, P.N., Howard, R.J., Barker, G.J., Brown, R.G., 2013 Behavioural and emotional symptoms of apathy are associated with distinct patterns of brain atrophy in neurodegenerative disorders. J Neurol. 2013 260, 2481–2490.
P.5.b.003 The effect of memantine treatment for sleep disturbances in patients with alcohol-related dementia D. Shin1 ° , D. Bae1 South-Korea
1 Sun
General Hospital, Psychiatry, Daejeon,
Introduction: Alcoholism is a chronic and typically progressive disease. [1] Chronic exposure to alcohol may have direct or indirect effects on the brain that can lead to cognitive impairment and various types of dementia. [2] The severe alcohol drinking can lead to brain damage and increase the risk of alcohol-related dementia.(ARD) [3] Sleep length and architecture are potential biomarkers of progressive cognitive impairment [4]. Sleep disturbances are common among alcohol-dependent individuals. Also the patients with ARD have been more sleep disturbances. [1] There are several studies suggest that memantine(NMDA receptor antagonist) treatment had the improvement of sleep disturbances in patients with Alzheimer’s dementia. [5] But there is no study in memantine treatment for ARD with sleep disturbances. We investigated memantine treatment might be related to improvement of sleep disturbances in patients with ARD. Methods: Twenty patients (age, 65−75 years) were evaluated. ARD was diagnosed according to ICD-10 criteria. The patient had no history of head injury, computed tomography showed no typical findings of Alzheimer’s disease, and no depression. Patients were asked if their sleep was satisfactory (yes or no). The patients were unsatisfied. Total sleep time had to be excluding daytime naps. The patients had that total sleep time was less than 5 hours. We analyzed from 10 factors-including demographic characteristics, dependence variables, biologic markers, family history of alcohol dependence, cognitive decline, functional impairment for activities of daily living and self-reported sleep satisfaction and length of sleep. We investigated the efficacy of 20 mg memantine for sleep disturbances in patients with ARD. Pittsburgh sleep quality index (PSQI) and Total sleep time (TST) were completed before and after the 2 months memantine treatment period. The Mann– Whitney test was used to compare. Spearman’s correlation analysis was used to compare PSQI with TST and to compare functional