The association between caregiver and patient health-related quality-of-life in Alzheimer's disease

P568

Poster Presentations: P3

Background: To develop a model for collaborative care for persons with dementia and their family caregivers in the San Francisco Bay Area. Methods: By delivering consistent compassionate care, strong relationships can be built between providers and the patients/families they work with. Listening carefully to desires and needs, including a desire to help others, practitioners can then work with their philanthropic organization to develop a business plan that can be supported with donations. The goal of the partnership is to provide newly diagnosed patients and their families a range of dementia related services, support and education as the disease progresses. Results: With extensive research and development effort, we were able to secure a $20 million (US$) endowment gift to create a Brain Health Center (BHC) at California Pacific Medical Center in San Francisco. This center will offer a multidisciplinary care team to diagnose, assess, treat, counsel and support families throughout the course of Alzheimer’s and related disorders. The team consists of medical providers in neurology, psychiatry, pharmacy and geriatric medicine, neuropsychologists and therapists, neuro-imaging, social work, physical and occupational therapy, nutrition and nursing. The team also includes staff employed by the Alzheimer’s Association but housed within the BHC to work as a member of the “Care Navigation Team”. Education programs including “Savvy Caregiver” classes, “Living with Alzheimer’s Disease,” "Know the Ten Signs of Alzheimer’s", “Maximizing Your Memory” and various caregiver training programs are offered through the BHC by the onsite Alzheimer’s Family Care Specialist. This clinician and other team members offer structured and unstructured groups, provide referrals to off-site support services/groups, answer questions about the disease process and smoothly lead patients/families through the healthcare maze. Conclusions: This poster presents a conceptual framework for creating partnerships that utilize the strengths of each institution to positively impact quality of dementia care, and allow easier access to resources to facilitate earlier diagnosis. Given the increasing need for patient and family services that is becoming difficult to finance, this manner of program building will fill a gap going forward. This project can serve as a model for replication at other centers.

P3-311

SEVERITY OF PSYCHIATRIC SYMPTOMS CORRELATES WITH ACTIVITIES OF DAILY LIVING AND CAREGIVER BURDEN IN FRONTOTEMPORAL DEMENTIA

Amanda Ng, Esther Chua, Mei Mei Nyu, Nagaendran Kandiah, National Neuroscience Institute, Singapore, Singapore. Background: Frontotemporal dementia (FTD) is a major dilapidating neurodegenerative condition that has devastating effects on patients and caregivers. The contributors to caregiver burden among this set of caregivers are poorly understood. FTD patients can have high dependency and present

with challenging neuropsychiatric behaviors, which can elevate distress and burden in their caregivers. This increases the risk of depression in caregivers, adversely affecting quality of life for caregivers and patients, and serves to hasten institutionalization for patients. This study investigates the relationship between severity of neuropsychiatric symptoms and activities of daily living in patients with FTD, and level of caregiver burden. Methods: FTD patients were identified from the National Neuroscience Institute dementia clinic, and only those with reliable caregivers were included. Caregivers were interviewed on the Screening for Caregiver Burden questionnaire (SCB), Neuropsychiatric Inventory Questionnaire (NPI-Q) (which has Severity and Distress subsets), and the Alzheimer’s Disease Cooperative Study Group-Activities of Daily Living questionnaire (ADCS-ADL). Questionnaires were administered by experienced dementiatrained nurses. Results: 17 FTD patients with reliable caregivers were identified - Mean age 60.06 (SD¼7.01), 29.41% were Male and 88.24% Chinese. The caregivers rated a mean of 11.06 (7.15) on the SCB, 4.12 (3.39) on NPI-Severity, 4.47 (5.46) on NPI-Distress, and 29.94 (23.6) on ADSC-ADL. Spearman’s correlation showed that NPI-Severity and NPIDistress were both positively correlated with SCB (R¼0.49, P¼0.046 and R¼0.58, P¼0.014 respectively). ADCS-ADL was negatively correlated with SCB (R¼-0.54, P¼0.029). Conclusions: This study demonstrates that caregiver burden increases with presence of neuropsychiatric symptoms as well as increased dependency, as demonstrated by decrement in ADCSADL scores. More resources need to be channeled into supporting FTD caregivers in order to alleviate their burden as neuropsychiatric behaviors worsen and dependency increases in FTD patients as their condition progresses. P3-312

THE ASSOCIATION BETWEEN CAREGIVER AND PATIENT HEALTH-RELATED QUALITY-OF-LIFE IN ALZHEIMER’S DISEASE

Mark Oremus1, Jean-Eric Tarride1, Natasha Clayton1, CANADIAN WILLINGNESS-TO-PAY STUDY GROUP2, Parminder Raina1, 1McMaster University, Hamilton, Ontario, Canada; 2Various Universities, Hamilton, Ontario, Canada. Background: Health-related quality-of-life (HRQoL) is an important means of measuring the human impact of Alzheimer’s disease (AD) on caregivers and patients. We examined whether caregiver HRQoL is associated with patient HRQoL in AD. Methods: We recruited 216 caregiver-patient dyads from nine memory and geriatric clinics across Canada and collected data via one-on-one personal interviews. Patients lived in the community or institutions and had mild or moderate stage AD. We measured HRQoL using the EuroQoL-5 Dimension (EQ-5D) scale and converted responses into utility scores between 0.0 (death) and 1.0 (perfect health). Patients and caregivers underwent separate interviews and both responded to the EQ-5D for themselves. We did not use caregiver proxy estimates of patient HRQoL. Interviewers also elicited data on sample characteristics (e.g., age, sex, education). Caregivers used the Dementia Behavior Disturbance Scale (DBDS) to rate the extent of patients’ behavior problems. We assessed the association between caregiver and patient HRQoL by calculating a Pearson correlation coefficient and by regressing patient HRQoL (utility score) on caregiver HRQoL (utility score), controlling for caregiver and patient age, sex, and education, as well as caregiver employment status and relationship to patient, DBDS score, and AD disease stage. Results: Median ages were 69 years (caregivers) and 80 years (patients); 142 caregivers and 106 patients were female. Median utility scores were 0.83 (caregivers) and 0.84 (patients); utility scores were uncorrelated (r¼0.11; 95% confidence interval [CI]¼-0.02 to 0.24). In the multivariable regression analysis, caregiver utility scores were not associated with patient utility scores (regression coefficient¼0.1086; 95% CI¼-0.0248 to 0.2420). Only caregiver education was statistically significantly associated with patient utility scores: caregivers with at least some university education or a completed undergraduate degree were caring for patients with higher utility scores (regression coefficient¼0.0360; 95% CI¼0.0002 to 0.0717). Conclusions: When HRQoL is measured using utility scores calculated from the EQ-5D, caregiver HRQoL is not associated

Poster Presentations: P3 with patient HRQoL in AD. These results suggest that independent sets of factors determine caregiver and patient HRQoL, despite the close relationships formed between these two groups of people during the course of disease.

P3-313

MULTI PERSON HAND-MOTION ANALYSIS FOR MONITORING ALZHEIMER’S DISEASE PROGRESS

Ovgu Ozturk Ergun1, Davut Ozcan1, Turker Sahiner2, Melike Sahiner3, 1 Bahcesehir University, Istanbul, Turkey; 2Anadolu Medical Center, Turkey; 3 Acibadem University Faculty of Medicine, Istanbul, Turkey. Background: In this work, we developed a video processing framework, which simultaneously analyzes hands motion of multiple-people to understand the type of action, to measure the reaction time and accuracy of the motion during physical exercise or social activity. The location of the hands, head and center of the body are captured to encode the motion characteristic at each frame from a video sequence. The system can detect multiple people and analyze their hands motion. In the experiments, analysis of various hands motion of two elderly patients is presented. Methods: Recently released Kinect sensor is used to capture depth data and skeleton data along with an RGB camera. The positions of the hands, head, shoulders, elbows and body center are extracted and stored as key points in a 2-dimensional matrix, which is called a location map. Location maps are generated from skeleton views. Later, each location map is compared with a previously defined matrix for each activity and the most similar one is chosen to recognize the type of the activity. The accuracy of the motion is given by the value of the similarity; and the reaction time is given by the time between voice order and realization of the action. Extracting depth data helps us avoid occlusions and easily distinguish people and body parts in the scene. Various activities (Hands Up, Hands Down, Hands on Head, Hand Shaking, Hands Up Arms Straight, Hands Up Arms Bended, Hands Reunited Front, etc.) are encoded in real-time by using the positions of key points in the 2D location map. Results: In the supplementary figure, five different activities (normal position, hands clapping, hands on shoulder, hands up, hand shaking) are investigated for two patients by using the proposed framework. Skeleton views for each frame are extracted and the position of nine key points (head, neck, shoulders, elbows, hands, center) from each skeleton are calculated to compose location maps. Location maps are used to categorize the activity. Conclusions: In this work, a video processing framework to simultaneously capture and categorize hands motion of multiple-people is presented. Experimental results show the potential usage and successful application of the system to analyze five different types of activity.

P3-314

P569 PICTORIAL EDUCATION OF SAFE MEDICATION FOR THE ELDERLY WITH COGNITIVE IMPAIRMENT

Myonghwa Park, Seok Jo Yang, Chungnam National University, Daejeon, South Korea. Background: Medication-related health problems in the Korean elderly have been increasing very rapidly in Korea with the population of the aged increased. User-friendly interactive pictorial education promotes better understanding of medication instruction for safe medication, particularly among the old people with limited health literacy or cognitive impairment. The purpose of this study was to develop a pictorial education program using Web-based interface to improve understanding of medication instruction of the elderly with cognitive impairment in the community settings. Methods: The development of the program involved the coordinated actions of the researcher as a content expert and a multimedia designer responsible for animation, and game production. An adaptation of the model for developing interactive multimedia was used to guide program construction: Analysis - Planning - Design - Production - Operation - Evaluation phase. Interactive pictorial education in this study consisted of animation with pictogram based medication information, and interactive Web games. The content consisted of OTC drug such as pain relievers, antacids, acid reducers, cold remedies, and nutritional supplements and prescription drug for hypertension and diabetes mellitus. Results: The education was guided with a big picture map which showed the route of educational sessions on the Web. Each session was educated with animations which contained the information about type, usage, storage, interaction, and side effects of medication. The animation consisted of a story about taking medication safely and was provided with the subtitle and sound. All information was provided with both picture and text. The users can learn counting pills, taking medication at right time and methods, drug and food matching by playing Web-based games. Games were designed to facilitate learning of safe medication. The animations and games can be repeated according to the user’s need. Conclusions: The interactive pictogram-based Web education could play an innovative role in health education, particularly aimed at elders with low health literacy and low cognitive function.

P3-315

MUSIC AND MEMORY IN ALZHEIMER’S DISEASE: DISSOCIATION OF FAMILIARITY AND RECOLLECTION USING FUNCTIONAL MUSICAL MNEMONICS

Andrew Budson1, Nicholas Simmons-Stern1, Rebecca Deason1, Brian Brandler1, Bruno Frustace1, Levi Miller1, Brandon Ally2, 1Boston University Alzheimer’s Disease Center, Boston, Massachusetts, United States; 2Vanderbilt University, Nashville, Tennessee, United States. Background: In a previous study (Simmons-Stern, Budson, and Ally 2010), we found that in patients with Alzheimer’s disease (AD) visually presented lyrics were better recognized when the lyrics were also sung rather than spoken at encoding. The present study sought to further investigate the effects of music and memory in patients with AD by making the content of the song lyrics relevant for the daily life of an older adult, and examining how musical encoding alters several different aspects of episodic memory. Methods: Patients with AD and healthy older adults studied visually presented novel song lyrics related to relevant for daily life that were accompanied by either a sung or a spoken recording. Each lyric studied was one of a pair with related content, to allow testing of both general and specific content. Results: Overall, participants performed better on the test of general content for lyrics that were sung versus spoken. Participants performed equally well, however, with sung and spoken lyrics for their memory of the specific content. Additionally, in a test of basic recognition memory for the lyrics, we found that sung lyric presentation resulted in a conservative recognition response bias and spoken lyric presentation resulted in a liberal recognition response bias for patients with AD. On the same test, healthy older adults demonstrated conservative response bias for both sung and spoken stimuli. Patients with AD demonstrated equal discrimination for sung and spoken