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Use of Health Services by Community-Based Elderly With Dementia
Hot Topics P4-127
COGNITIVE IMPAIRMENT AND DIFFERENCES BETWEEN EARLY AND LATE ONSET DEPRESSION IN A SAMPLE FROM OUTPATIENT SERVICE OF GERIATRIC PSYCHIATRY
Claudia M. Santana1,2, Karol C. Crepaldi2, Arthur G. Andrade1,2, Tania C. T. F. Alves1,2, 1University of Sa˜o Paulo Medical School, Sa˜o Paulo, Brazil; 2ABC Region Medical School, Santo Andre, Brazil. Contact e-mail: [email protected]. Background: Memory complaints are also common in older adults with depression. Cognitive impairment in late onset depression (LOD) may be a result of the depressive disorder or an underlying dementing condition. Studies suggest that LOD is more often associated with cognitive impairment than early onset depression (EOD). It also seems that incident depression and gender interact in old age. The physiological impact of depression may be greater for men than for women despite the greater prevalence of depression among women. Methods: A retrospective study with patients from the outpatient service of geriatric psychiatry (public health system) that seek medical advice due to mental health complains. All of them were evaluated by a psychiatrist. Psychiatric disorders were categorized according to International Codification of Diseases (ICD 10) criteria. Data from depressive patients were analyzed into two different groups: an early onset depression group, consisting of patients first exhibiting depressive episodes before the age of 60 years; and a late onset depression group which included patients with depressive episodes starting after the age of 60 years. We assessed vascular risk factors and co-morbidities such as high blood pressure (HBP), high cholesterol level (HCL), smoking, cerebrovascular disease (CVD), diabetes, and heart diseases. Additionally, we evaluated marital status, education and cognitive status using the Mini-Mental State Examination (MMSE). Results: A total data of 113 subjects were collected. From this sample, 25,66% (n¼ 29) full field criteria for LOD and 15,04% (n ¼ 17) for EOD. No difference between MMSE was noted (average ¼ 25); low level of education was noted in both groups (65,82% and 63,64% respectively, had up to 4 years of schooling). Gender difference was found: while 25,64% of women and 11,9% of men full field criteria for EOD; 23,08% and 26,19%, women and men, respectively, presented LOD. Conclusions: Differences between early and late onset depression have to be clarified in order to improve specific prevention, treatment and prognostic. Gender difference is a important feature to be analyzed. Beside of this sample not find difference between MMSE, a follow up will be conducted to evaluate the evolution of cognition in this groups. P4-128
USE OF HEALTH SERVICES BY COMMUNITYBASED ELDERLY WITH DEMENTIA
Claudia M. Santana, Eduardo Nakano, Julio Litvoc, Cassio M. C. Bottino, University of Sa˜o Paulo Medical School, Sa˜o Paulo, Brazil. Contact e-mail: [email protected]. Background: Demographic ageing is occurring at an unprecedented rate in Brazil. Chronic diseases, such as dementia, and their disabilities will become much more common. These demographic changes provide a major challenge to the health system, and have implications about the way they should be organized. The aim of this study is to describe the use of health services by the elderly from a community-based sample, and the difference between those with and without dementia. Methods: A cluster random sampling of a population of individuals aged 60 years and over from three different socioeconomics classes was used. A total of 1,563 subjects accepted to be visited by a trained interviewer. Assessment included questionnaires to investigate sociodemographic aspects, history of chronic medical diseases, history of depression, symptoms of depression, life habits, and health service utilization. Dementia screening was based on a combination of tests and scales (Mini Mental State Examination; Fuld Object Memory Evaluation; Informant Questionnaire on Cognitive Decline in the Elderly; and Bayer Activities of Daily Living Scale) and diagnosis of dementia on a second phase was made according to DSM-IV criteria. The use of health
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services (any community service) was measured as a binary outcome. Results: Mean age was 71.5 years (n ¼ 1563), and 58.3% had up to 4 years of schooling (68.7% was female).The estimated use of health services in this sample was 97.7% . Subjects who had more chronic diseases present a higher risk of using health services (OR ¼ 4.89, 95% CI 1.51 - 15.55), but the subjects who had dementia as a comorbidity showed a tendency to use less the health services than those without dementia (p ¼ 0.06). Conclusions: The access to health services for this population with dementia, a well known risk factor for worsening quality of life, should be improved. Despite of the growing number of dementia cases, health services in Brazil seem not prepared to take care of this increasing demand.
P4-129
LEXICAL FLUENCY MEASURES FOR PRIMARILY SPANISH-SPEAKING ADULTS IN THE UNITED STATES
Adriana M. Strutt, Bonnie M. Scott, Michele K. York, Baylor College of Medicine, Houston, TX, USA. Contact e-mail: [email protected]. Background: Many of the neuropsychological measures utilized with primarily Spanish-speaking adults in the US are literal translations, which do not account for the influence of language and culture and for which normative data is non-existent. Clinical and research settings have utilized three lexical fluency measures with primarily Spanish-speakers: FAS, (literal translation) and PMR and ABS, which are published, alternate forms based on cultural modifications. The goal of this study is to examine possible differences in performance across lexical fluency measures in primarily Spanish-speaking adults and to provide a comparison between our collected age and education stratified data and the English norms, which are commonly used. Methods: Forty-nine primarily Spanish speaking HCs, ages 50-59, were administered lexical fluency measures (FAS, PMR & ABS) and the Beck Depression Inventory-II (BDI-II) as part of a norming study for a comprehensive neuropsychological older adult battery. Results: Of the 49 HCs, one participant was excluded due to cognitive declines associated with a medical condition and 5 participants due to moderate-to-severe levels of depression. The group was stratified by level of education (basic education [BE]¼6-12 years and college education [CE]¼13 years plus). The BE group had a mean age of 54.4 and 8.68 years of education. The CE group was on average 54.4 years of age with 14.7 years of education. A statistically significant difference was found between the HCs on the 3 measures of verbal fluency with the BE group providing less responses on the FAS measure in comparison to their college educated counterparts (p ¼ 0.04). A significant difference was not found for either PMR or ABS based on educational attainment. In comparison to English normative data, significant differences varied for the BE group (p ¼ 0.66; p ¼ 0.10; p ¼ 0.03) depending on the normative data utilized. Thus, the clinical classification of strengths and weaknesses for the Spanish-speaking HCs varied across English normative data. Significant differences between the CE group and the English normative data were not found. Conclusions: The need to norm current translations of English neuropsychological measures is warranted. As was shown with our BE group, the use of English normative data may not always accurately identify areas of cognitive strength and weakness.
P4-130
NQO1-DEPENDENT NAD+ PRODUCTION PREVENTS AGING-DEPENDENT DEMENTIA AND ENHANCES LEARNING ABILITY OF APP/PS1 MICE
JeongSook Lee1, Hanjik Ko2, Seonmi Jo1, Sanghee Lee3, Kinam Min2,3, Seokjin Yang4, Taehwan Kwak2, Jinman Kim3, Youngil Yeom4, Daesoo Kim1, 1Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea, Republic of; 2Mazence Inc R&D Center, Suwon, Korea, Republic of; 3Chungnam National University School of Medicine, Daejeon, Korea, Republic of; 4Medical Genomics Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea, Republic of. Contact e-mail: [email protected].
COGNITIVE IMPAIRMENT AND DIFFERENCES BETWEEN EARLY AND LATE ONSET DEPRESSION IN A SAMPLE FROM OUTPATIENT SERVICE OF GERIATRIC PSYCHIATRY
Claudia M. Santana1,2, Karol C. Crepaldi2, Arthur G. Andrade1,2, Tania C. T. F. Alves1,2, 1University of Sa˜o Paulo Medical School, Sa˜o Paulo, Brazil; 2ABC Region Medical School, Santo Andre, Brazil. Contact e-mail: [email protected]. Background: Memory complaints are also common in older adults with depression. Cognitive impairment in late onset depression (LOD) may be a result of the depressive disorder or an underlying dementing condition. Studies suggest that LOD is more often associated with cognitive impairment than early onset depression (EOD). It also seems that incident depression and gender interact in old age. The physiological impact of depression may be greater for men than for women despite the greater prevalence of depression among women. Methods: A retrospective study with patients from the outpatient service of geriatric psychiatry (public health system) that seek medical advice due to mental health complains. All of them were evaluated by a psychiatrist. Psychiatric disorders were categorized according to International Codification of Diseases (ICD 10) criteria. Data from depressive patients were analyzed into two different groups: an early onset depression group, consisting of patients first exhibiting depressive episodes before the age of 60 years; and a late onset depression group which included patients with depressive episodes starting after the age of 60 years. We assessed vascular risk factors and co-morbidities such as high blood pressure (HBP), high cholesterol level (HCL), smoking, cerebrovascular disease (CVD), diabetes, and heart diseases. Additionally, we evaluated marital status, education and cognitive status using the Mini-Mental State Examination (MMSE). Results: A total data of 113 subjects were collected. From this sample, 25,66% (n¼ 29) full field criteria for LOD and 15,04% (n ¼ 17) for EOD. No difference between MMSE was noted (average ¼ 25); low level of education was noted in both groups (65,82% and 63,64% respectively, had up to 4 years of schooling). Gender difference was found: while 25,64% of women and 11,9% of men full field criteria for EOD; 23,08% and 26,19%, women and men, respectively, presented LOD. Conclusions: Differences between early and late onset depression have to be clarified in order to improve specific prevention, treatment and prognostic. Gender difference is a important feature to be analyzed. Beside of this sample not find difference between MMSE, a follow up will be conducted to evaluate the evolution of cognition in this groups. P4-128
USE OF HEALTH SERVICES BY COMMUNITYBASED ELDERLY WITH DEMENTIA
Claudia M. Santana, Eduardo Nakano, Julio Litvoc, Cassio M. C. Bottino, University of Sa˜o Paulo Medical School, Sa˜o Paulo, Brazil. Contact e-mail: [email protected]. Background: Demographic ageing is occurring at an unprecedented rate in Brazil. Chronic diseases, such as dementia, and their disabilities will become much more common. These demographic changes provide a major challenge to the health system, and have implications about the way they should be organized. The aim of this study is to describe the use of health services by the elderly from a community-based sample, and the difference between those with and without dementia. Methods: A cluster random sampling of a population of individuals aged 60 years and over from three different socioeconomics classes was used. A total of 1,563 subjects accepted to be visited by a trained interviewer. Assessment included questionnaires to investigate sociodemographic aspects, history of chronic medical diseases, history of depression, symptoms of depression, life habits, and health service utilization. Dementia screening was based on a combination of tests and scales (Mini Mental State Examination; Fuld Object Memory Evaluation; Informant Questionnaire on Cognitive Decline in the Elderly; and Bayer Activities of Daily Living Scale) and diagnosis of dementia on a second phase was made according to DSM-IV criteria. The use of health
e61
services (any community service) was measured as a binary outcome. Results: Mean age was 71.5 years (n ¼ 1563), and 58.3% had up to 4 years of schooling (68.7% was female).The estimated use of health services in this sample was 97.7% . Subjects who had more chronic diseases present a higher risk of using health services (OR ¼ 4.89, 95% CI 1.51 - 15.55), but the subjects who had dementia as a comorbidity showed a tendency to use less the health services than those without dementia (p ¼ 0.06). Conclusions: The access to health services for this population with dementia, a well known risk factor for worsening quality of life, should be improved. Despite of the growing number of dementia cases, health services in Brazil seem not prepared to take care of this increasing demand.
P4-129
LEXICAL FLUENCY MEASURES FOR PRIMARILY SPANISH-SPEAKING ADULTS IN THE UNITED STATES
Adriana M. Strutt, Bonnie M. Scott, Michele K. York, Baylor College of Medicine, Houston, TX, USA. Contact e-mail: [email protected]. Background: Many of the neuropsychological measures utilized with primarily Spanish-speaking adults in the US are literal translations, which do not account for the influence of language and culture and for which normative data is non-existent. Clinical and research settings have utilized three lexical fluency measures with primarily Spanish-speakers: FAS, (literal translation) and PMR and ABS, which are published, alternate forms based on cultural modifications. The goal of this study is to examine possible differences in performance across lexical fluency measures in primarily Spanish-speaking adults and to provide a comparison between our collected age and education stratified data and the English norms, which are commonly used. Methods: Forty-nine primarily Spanish speaking HCs, ages 50-59, were administered lexical fluency measures (FAS, PMR & ABS) and the Beck Depression Inventory-II (BDI-II) as part of a norming study for a comprehensive neuropsychological older adult battery. Results: Of the 49 HCs, one participant was excluded due to cognitive declines associated with a medical condition and 5 participants due to moderate-to-severe levels of depression. The group was stratified by level of education (basic education [BE]¼6-12 years and college education [CE]¼13 years plus). The BE group had a mean age of 54.4 and 8.68 years of education. The CE group was on average 54.4 years of age with 14.7 years of education. A statistically significant difference was found between the HCs on the 3 measures of verbal fluency with the BE group providing less responses on the FAS measure in comparison to their college educated counterparts (p ¼ 0.04). A significant difference was not found for either PMR or ABS based on educational attainment. In comparison to English normative data, significant differences varied for the BE group (p ¼ 0.66; p ¼ 0.10; p ¼ 0.03) depending on the normative data utilized. Thus, the clinical classification of strengths and weaknesses for the Spanish-speaking HCs varied across English normative data. Significant differences between the CE group and the English normative data were not found. Conclusions: The need to norm current translations of English neuropsychological measures is warranted. As was shown with our BE group, the use of English normative data may not always accurately identify areas of cognitive strength and weakness.
P4-130
NQO1-DEPENDENT NAD+ PRODUCTION PREVENTS AGING-DEPENDENT DEMENTIA AND ENHANCES LEARNING ABILITY OF APP/PS1 MICE
JeongSook Lee1, Hanjik Ko2, Seonmi Jo1, Sanghee Lee3, Kinam Min2,3, Seokjin Yang4, Taehwan Kwak2, Jinman Kim3, Youngil Yeom4, Daesoo Kim1, 1Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea, Republic of; 2Mazence Inc R&D Center, Suwon, Korea, Republic of; 3Chungnam National University School of Medicine, Daejeon, Korea, Republic of; 4Medical Genomics Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea, Republic of. Contact e-mail: [email protected].