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PO22-TH-05 Evaluation of an innovative, comprehensive management for patients with dementia in Thailand
19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
PO22-TH-04 Memantine hampers the progression of cognitive dysfunction and conversion to dementia in amnestic MCI patients O.V. Uspenskaya, N.N. Yakhno. Neurology, I.M. Sechenov Moscow Medical Academy, Moscow, Russian Federation Purpose: To evaluate the influence of treatment with NMDAreceptor antagonist memantine on the cognitive status and CSF biomarker levels in patients with amnestic MCI (MCI-a). Methods: 27 MCI-a patients underwent neuropsychological assessment, brain MRI and lumbar puncture (LP). CSF biomarkers (Abeta42 and P-tau181) were measured in duplicates with commercially available ELISAs. The patients were followed-up for 14.4±3.2 months, and the parameters of the cognitive status before and after therapeutic intervention with conventional medications and memantine were evaluated. Five patients with MCI-a underwent 2 measurements of CSF biomarker levels before and after treatment with NMDA-receptor antagonist memantine. Results: The baseline neuropsychological testing showed poor results in the modified Grober and Buschke (GB) test, the mean score in which was 14.2±3.0. The neuroimaging data showed an atrophic process in the temporal lobes, and the pattern of neurochemical biomarkers indicated a possible neurodegenerative etiology of cognitive dysfunction (Abeta42 = 401.9±76.2 pg/ml, P-tau181 = 103.6±50.9 pg/ml). We found correlations of P-tau181 and Abeta42 levels with FAB (r = 0.321, p = 0.028, r = −0.328, p = 0.024, correspondingly) and GB test scores (r = −0.551, r = 0.625, p < 0.0001 each). In the follow-up period the patients from the “memantine group” showed no progression of cognitive dysfunction. The patients from the “no memantine group” showed significant deterioration almost in all domains of cognitive status, 5 patients from this group converted to clinically pronounced dementia. Additionally, in patients with MCI-a after treatment with memantine the level of Abeta42 significantly increased (420±106 pg/ml in LP2 vs. 351±87 pg/ml in LP1, p = 0.02). Conclusions: Treatment with memantine can possibly influence the neurodegenerative process in predementia AD and hampers the progression of cognitive dysfunction and conversion to dementia in amnestic MCI patients. PO22-TH-05 Evaluation of an innovative, comprehensive management for patients with dementia in Thailand S. Tanprawate, N. Subanan, W. Tongsong, S. Chankrachang. Northern Neuroscience Center, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand To improve care and reduce problems for the patients with dementia since 2007 we innovated special service OPD from routine general Neurology OPD by dedicating the first Wednesday of the month to be dementia clinic. We also designed comprehensive management by training the health care team including nurses and nurse aids to be able to do both the screening test such as MMSE and to score the ADL. Small-scale and homelike facilities for dementia patients are also available at OPD. Nonpharmacologic ADL solving problems and social participation are emphasized in the group therapy. All health care team are welcome to participate in group therapy and discuss the treatment plan with physicians. We also train the caregiver to help the family caregiver with home care program. To evaluate the innovated and comprehensive management for the patients with dementia. We evaluate the 22 health care team including neurologists, nurses, trained caregivers by using questionnaires and direct observation. 22 family caregivers were also included. We use mean and srandard deviation for descrivtive analysis content analysis for quality data. The Health team satisfaction was high (4.26). The attitude for the management guideline was at high levels (4.28) which are also in the same level with family caregiver and also the trained
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caregiver. The situation analysis for program goal, job designs, process of work, performance outcome and performance evaluation was in moderate level which were 4.16, 3.73, 3.99, 3.59 and 3.57 respectively. The satisfaction of health team, the family caregivers, and the trained caregiver were at high level as compared with general Neurology OPD (P < 0.001). Summary: The innovated comprehensive health care program and homelike facilities and special OPD for dementia patients are highly suggestive. The caregiver training program should be promoted further. PO22-TH-06 Predictive validity study of MoCA on Turkish patients with MCI and Alzheimer dementia K. Selekler1 , B. Cangoz2 . 1 Neurology, Hacettepe University, Ankara, Turkey; 2 Psychology, Hacettepe University, Ankara, Turkey Purpose: The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 30 points, a score of 26 or above is considered normal in original version. The main aim of this study is to evaluate the validity of the MOCA in Turkish Mild Cognitive Impairement (MCI) and Alzheimer Dementia (AD) patients. Method: The study group covers 20 subjects with MCI, 20 subject with AD and 165 healthy subjects. Between groups the mean scores that were obtained from MOCA was compared by ANOVA. The mean age was 72.95 years in MCI group, 73.30 years in AD group and 71.21 years in control group. Results: The MOCA total score was significantly different between three groups (F (2, 185) = 18.65, p < 0.001). The healthy control group showed a higher performance in comparison to the MCI and AD group on MoCA score. MoCA scores differentiated each groups. Age and education level variables were no significant main effect on MoCA score. Conclusion: Our results revealed that the TMT is a valid a psychometric instrument in differentiating and assessing Turkish MCI and AD patients. Our results yielded that MOCA score was significantly correlated with MMSE score. PO22-TH-07 Progress in health-related quality of life (HRQoL) measurement in dementia 1 C.J.M. Scholzel-Dorenbos ¨ , E.M.M. Adang2 , P.F.M. Krabbe2 , M.G.M. Olde Rikkert3 . 1 Memory Clinic/Alzheimer Centre, Slingeland Hosp/Radboud University Medical Centre, Doetinchem/Nijmegen, The Netherlands; 2 Dept of Epidemiology, Biostatistics and HTA, Radboud University Medical Centre, Nijmegen, The Netherlands; 3 Dept of Geriatrics/Alzheimer Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
Aim: Dementia is a complex neurodegenerative syndrome with multifunctional decline. There is emerging consensus that besides cognition and functioning, patient-reported outcomes (PROs) such as HRQoL are warranted for outcome measurement. As PROs become more established, measurement biases such as response shift, decrease in cognition with declining self-reporting capabilities, and less valid but unavoidable proxy-rating, must be addressed to arrive at reliable measurement. Method: Narrative review of measurement scales and problems. Design of disease-specific HRQoL classification with relevant domains, applicable as utility measure in dementia research. Results: Instruments could be categorized into generic and diseasespecific. Generic scales rate HRQoL regardless of presence/absence of diseases and enable cost-utility analysis. Cost is measured
PO22-TH-04 Memantine hampers the progression of cognitive dysfunction and conversion to dementia in amnestic MCI patients O.V. Uspenskaya, N.N. Yakhno. Neurology, I.M. Sechenov Moscow Medical Academy, Moscow, Russian Federation Purpose: To evaluate the influence of treatment with NMDAreceptor antagonist memantine on the cognitive status and CSF biomarker levels in patients with amnestic MCI (MCI-a). Methods: 27 MCI-a patients underwent neuropsychological assessment, brain MRI and lumbar puncture (LP). CSF biomarkers (Abeta42 and P-tau181) were measured in duplicates with commercially available ELISAs. The patients were followed-up for 14.4±3.2 months, and the parameters of the cognitive status before and after therapeutic intervention with conventional medications and memantine were evaluated. Five patients with MCI-a underwent 2 measurements of CSF biomarker levels before and after treatment with NMDA-receptor antagonist memantine. Results: The baseline neuropsychological testing showed poor results in the modified Grober and Buschke (GB) test, the mean score in which was 14.2±3.0. The neuroimaging data showed an atrophic process in the temporal lobes, and the pattern of neurochemical biomarkers indicated a possible neurodegenerative etiology of cognitive dysfunction (Abeta42 = 401.9±76.2 pg/ml, P-tau181 = 103.6±50.9 pg/ml). We found correlations of P-tau181 and Abeta42 levels with FAB (r = 0.321, p = 0.028, r = −0.328, p = 0.024, correspondingly) and GB test scores (r = −0.551, r = 0.625, p < 0.0001 each). In the follow-up period the patients from the “memantine group” showed no progression of cognitive dysfunction. The patients from the “no memantine group” showed significant deterioration almost in all domains of cognitive status, 5 patients from this group converted to clinically pronounced dementia. Additionally, in patients with MCI-a after treatment with memantine the level of Abeta42 significantly increased (420±106 pg/ml in LP2 vs. 351±87 pg/ml in LP1, p = 0.02). Conclusions: Treatment with memantine can possibly influence the neurodegenerative process in predementia AD and hampers the progression of cognitive dysfunction and conversion to dementia in amnestic MCI patients. PO22-TH-05 Evaluation of an innovative, comprehensive management for patients with dementia in Thailand S. Tanprawate, N. Subanan, W. Tongsong, S. Chankrachang. Northern Neuroscience Center, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand To improve care and reduce problems for the patients with dementia since 2007 we innovated special service OPD from routine general Neurology OPD by dedicating the first Wednesday of the month to be dementia clinic. We also designed comprehensive management by training the health care team including nurses and nurse aids to be able to do both the screening test such as MMSE and to score the ADL. Small-scale and homelike facilities for dementia patients are also available at OPD. Nonpharmacologic ADL solving problems and social participation are emphasized in the group therapy. All health care team are welcome to participate in group therapy and discuss the treatment plan with physicians. We also train the caregiver to help the family caregiver with home care program. To evaluate the innovated and comprehensive management for the patients with dementia. We evaluate the 22 health care team including neurologists, nurses, trained caregivers by using questionnaires and direct observation. 22 family caregivers were also included. We use mean and srandard deviation for descrivtive analysis content analysis for quality data. The Health team satisfaction was high (4.26). The attitude for the management guideline was at high levels (4.28) which are also in the same level with family caregiver and also the trained
S275
caregiver. The situation analysis for program goal, job designs, process of work, performance outcome and performance evaluation was in moderate level which were 4.16, 3.73, 3.99, 3.59 and 3.57 respectively. The satisfaction of health team, the family caregivers, and the trained caregiver were at high level as compared with general Neurology OPD (P < 0.001). Summary: The innovated comprehensive health care program and homelike facilities and special OPD for dementia patients are highly suggestive. The caregiver training program should be promoted further. PO22-TH-06 Predictive validity study of MoCA on Turkish patients with MCI and Alzheimer dementia K. Selekler1 , B. Cangoz2 . 1 Neurology, Hacettepe University, Ankara, Turkey; 2 Psychology, Hacettepe University, Ankara, Turkey Purpose: The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 30 points, a score of 26 or above is considered normal in original version. The main aim of this study is to evaluate the validity of the MOCA in Turkish Mild Cognitive Impairement (MCI) and Alzheimer Dementia (AD) patients. Method: The study group covers 20 subjects with MCI, 20 subject with AD and 165 healthy subjects. Between groups the mean scores that were obtained from MOCA was compared by ANOVA. The mean age was 72.95 years in MCI group, 73.30 years in AD group and 71.21 years in control group. Results: The MOCA total score was significantly different between three groups (F (2, 185) = 18.65, p < 0.001). The healthy control group showed a higher performance in comparison to the MCI and AD group on MoCA score. MoCA scores differentiated each groups. Age and education level variables were no significant main effect on MoCA score. Conclusion: Our results revealed that the TMT is a valid a psychometric instrument in differentiating and assessing Turkish MCI and AD patients. Our results yielded that MOCA score was significantly correlated with MMSE score. PO22-TH-07 Progress in health-related quality of life (HRQoL) measurement in dementia 1 C.J.M. Scholzel-Dorenbos ¨ , E.M.M. Adang2 , P.F.M. Krabbe2 , M.G.M. Olde Rikkert3 . 1 Memory Clinic/Alzheimer Centre, Slingeland Hosp/Radboud University Medical Centre, Doetinchem/Nijmegen, The Netherlands; 2 Dept of Epidemiology, Biostatistics and HTA, Radboud University Medical Centre, Nijmegen, The Netherlands; 3 Dept of Geriatrics/Alzheimer Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
Aim: Dementia is a complex neurodegenerative syndrome with multifunctional decline. There is emerging consensus that besides cognition and functioning, patient-reported outcomes (PROs) such as HRQoL are warranted for outcome measurement. As PROs become more established, measurement biases such as response shift, decrease in cognition with declining self-reporting capabilities, and less valid but unavoidable proxy-rating, must be addressed to arrive at reliable measurement. Method: Narrative review of measurement scales and problems. Design of disease-specific HRQoL classification with relevant domains, applicable as utility measure in dementia research. Results: Instruments could be categorized into generic and diseasespecific. Generic scales rate HRQoL regardless of presence/absence of diseases and enable cost-utility analysis. Cost is measured