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Poster Presentations: P4 P881
between vitamin B12 status and cognitive performance. Promising results
are expected from our intervention data.
P4-396 CLINICAL ADHERENCE OF TAKING
MEMANTINE IN MODERATE-TO-SEVERE
ALZHEIMER’S DISEASE IN TAIWAN
I-Chun Tseng1, Yuan-Han Yang1, Chun-Hung Chen2, 1Kaohsiung Medical
University, Kaohsiung, Taiwan; 2Department of Neurology, Kaohsiung
Medical University Hospital, Kaohsiung, Taiwan.
Contact e-mail: [email protected]
Background: The prevalence ofAlzheimer’s disease (AD) is rising due to ag-
ing population in Taiwan. Use of the NMDA-receptor antagonist, memantine,
has showed improvement in cognition, activity of daily living and neuro-be-
havior syndromes in patients with moderate to severe AD. Memantine seems
to provide a distinctive tolerability with very mild side effects. Little is known
about clinical adherence of takingmemantine in Taiwan. Our study is trying to
elucidate factors associated with withdrawal of taking memantine.Methods:
All of the recruited subjects were diagnosed with Alzheimer’s disease based
on the DSM-IV criteria at the department of neurology, Kaohsiung Medical
University, a medical center at southern Taiwan from Jan, 2008 to March,
2013. The neuropsychological assessment including clinical Dementia Rating
Scale (CDR), Mini-Mental State Examination (MMSE) and cognitive abili-
ties screening instrument (CASI) were performed at the beginning of taking
memantine and at the next annual assessment. Subjects with moderate to se-
vere AD having a baseline MMSE total score between 10 and 14 or CDR¼2
were eligible for the study. The clinical adherence of memantine to AD was
examined by telephone interview with caregiver of AD patients and the ther-
apeutic duration was recorded accordingly. Results: Twenty-seven subjects
were enrolled in this study (3 males and 24 females; mean age,82.9 6 6.3
(mean6 SD); mean educational level, 4.0 6 3.9 year; mean CASI, 29.3 613.1; mean MMSE,9.2 6 3.5). The mean with mean therapeutic duration
of memantine was 101.5 6 37.7 weeks among these 27 subjects. For 13
out of 27 discontinuing memantine, the main reasons accounting for the dis-
continue cause were unapproved by health care insurance (33.3%, 9/27) due
to the advanced disease severity, transferred to other hospitals or nursing
home (11.1%, 3/27) or death due tomultiple organ failure (3.7%, 1/27). There
were no reported adverse effects for the continuous treatment for the other 14
(51.9%) patients keeping the continuous treatment.Conclusions:Memantine
showed its potential with no reported adverse effect in the treatment of AD.
The clinical adherence of memantine to the moderate to severe stage of AD
was mainly determined by the national health insurance at Taiwan.
P4-397 SHORT-TERM EFFICACY FOR ACUTE
ELECTROCONVULSIVE THERAPY FOR
AGITATION AND AGGRESSION IN DEMENTIA
Brent Forester1, Deepa Acharya1, Eric Achtyes2, David Harper1,
Don Davidoff1, Lesley Adkison1, Manjola Ujkaj1, Steve Seiner1, 1McLean
Hospital, Belmont, Massachusetts, United States; 2Pine Rest Christian
Mental Health Services, Kalamazoo, Michigan, United States.
Contact e-mail: [email protected]
Background: Agitation and aggression are among the most frequent and
disruptive behavioral complications of dementia that contribute to increased
cost of care, hospitalization, caregiver burden, and risk of premature institu-
tionalization. The current study examined the safety and efficacy of electro-
convulsive therapy (ECT) as a treatment for behavioral disturbances in
dementia. We hypothesized that ECTwould result in a reduction of agitated
and aggressive behavior between baseline and discharge. Methods: Pro-
spective, naturalistic study. Setting: Geriatric Neuropsychiatry Unit at
McLean Hospital (Belmont, MA) and Older Adult Unit at Pine Rest Chris-
tianMental Health Services (Grand Rapids, MI). Participants: Twenty-three
participants with dementia, referred for ECT by their psychiatrist to treat ag-
itation/ aggression. Measurements: We administered the Cohen-Mansfield
Agitation Inventory (CMAI)-short form, Neuropsychiatric Inventory
(NPI)-Nursing Home Version, Cornell Scale for Depression in Dementia
(CSDD), and the Clinical Global Impression Scale (CGI) at baseline, after
the third, sixth, ninth and twelfth (where applicable) ECT sessions, and at
discharge. Results: Regression analyses revealed a significant decline
from baseline to discharge on the CMAI (F(4, 8) ¼13.31; p¼0.006) and
NPI (F(4, 31)¼ 14.64; p<0.001). Scores on the CSDD declined from base-
line to discharge; however, this decline was not statistically significant. CGI
scores on average changed from a rating of "markedly agitated/aggressive"
at baseline to "borderline agitated /aggressive" at discharge. Conclusions:
The study found ECT to be a safe and effective treatment for behavioral dis-
turbances in dementia, andmay be a useful treatment option for patients with
dementia who are refractory to medications for agitation and aggression.
P4-398 USE OF NEW TECHNOLOGY TO IMPROVE
DEMENTIA PREVENTION: THE HEALTHYAGING
THROUGH INTERNET COUNSELING IN THE
ELDERLY (HATICE) PROJECT
Francesca Mangialasche1, Miia Kivipelto2, Sandrine Andrieu3,
Nicola Coley4, Tiia Ngandu5, Eric Moll van Charante6, Carol Brayne7,
Yannick Meiller8, Bram Van de Groep9, Hilkka Soininen10, A. van Willem
Gool6, Edo Richard6, 1Karolinska Institutet, Stockholm, Sweden;2Karolinska Institutet, Stockholm, Sweden; 3INSERMUMR 1027, Toulouse,
France; 4INSERM UMR 1027, Toulouse, France; 5National Institute for
Health and Welfare, Helsinki, Finland; 6Academic Medical Center,
Amsterdam, Amsterdam, Netherlands; 7Cambridge University, Cambridge,
United Kingdom; 8Novapten, Paris, France; 9VitalHealth Software Inc,
Amsterdam, Netherlands; 10University of Eastern Finland, Kuopio, Finland.
Contact e-mail: [email protected]
Background: Despite substantial efforts, effective preventive measures for
dementia and Alzheimer’s disease (AD) are not yet available. The European
Dementia Prevention Initiative (EDPI) has been established to improve pre-
ventive strategies for dementia/AD. Internet-based platforms are interactive
tools which can facilitate implementation of preventive measures. EDPI has
started the Healthy Aging Through Internet Counseling in the Elderly (HA-
TICE) project to verify the efficacy of a multi-domain intervention based on
such tool. Methods: EDPI members lead three ongoing randomized con-
trolled trials (RCTs) (FINGER, MAPT, PreDIVA) in Finland, France and
the Netherlands. In these RCTs multi-domain interventions are used to si-
multaneously target several vascular and lifestyle-related risk factors for de-
mentia/AD. Analysis of pooled data from these RCTs will serve as a basis
for the design of HATICE. HATICE will enroll 4600 community-dwelling
elderly people (age 65+) withmultiple cardiovascular risk factors or disease,
and living in Finland, France and the Netherlands. Participants will be ran-
domly allocated to an interactive internet platform with nurse-led support to
optimize pharmacological and non-pharmacological management of vascu-
lar and lifestyle-related risk factors, or to general web-based health advice
(control group). Main outcomes will be effects on dementia incidence and
cardiovascular diseases.Results:HATICE started in January 2013. Datasets
from FINGER, MAPTand PreDIVA are being pooled and analyzed to eval-
uate efficacy and feasibility of various preventive regimens based on non-
pharmacological and pharmacological interventions. An innovative and
interactive internet platform for self-management of vascular and life-
style-related risk factors is under development. Interactive support by nurses
and patient’s own physician is being integrated, as well as monitoring of ad-
verse events. The platform will also facilitate access to internet-based cog-
nitive training and group activities (exercise, social events). Conclusions:
Through HATICE, lessons learned from existing dementia multi-domain
prevention studies are being tested in a large multinational RCT, to identify
effective preventive measures that can be implemented in the general pop-
ulation of older adults. The flexible internet-based intervention strategy
can be easily translated and adapted for use in different health-care systems.
It will allow for tailored interventions specifically suited to the needs of
older people and careful monitoring of side effects.
P4-399 MORTALITY FROM ALZHEIMER’S DISEASE IN
SAO PAULO AND RIO DE JANEIRO
Jane Teixeira1, Mariza Theme2, 1FIOCRUZ, Rio das Ostras, Brazil;2FIOCRUZ, Rio de Janeiro, Brazil. Contact e-mail: janebteixeira@gmail.
com
Poster Presentations: P4P882
Background:Mortality in Brazil has undergone important changes over the
years, with a drop of infectious diseases and increase in chronic degenera-
tive diseases. Such changes are reflections of an aging population associated
with changes in lifestyle such as unhealthy eating habits, smoking, alcohol,
physical inactivity, poor education and social inequalities that contribute to
the multiple comorbidities. In the elderly population, increasing neurode-
generative diseases such as Alzheimer’s Disease (AD) is characterized by
progressive memory impairment and the presence of one or more cognitive
deficits. In the world according Burdelin et al. (2009), in 2010, an estimated
prevalence of 35 million individuals with AD, the year 2030. The World
Health Organization estimates that this prevalence occurs mainly in devel-
oping countries like Brazil, China, Russia and India. The study of mortality
rates, especially the AD, is an important mechanism for knowledge to action
planning specific to the elderly in care and the provision of health services
network of the Unified Health System (SUS) and support system the social
population. Methods: This is a descriptive study of mortality Alzheimer’s
disease, whose data were obtained from the Mortality Information System
(SIM), the Ministry of Health were selected statements deaths in the states
of Rio de Janeiro (RJ) and St. Paulo (SP) and individuals 60 more years in
2008. We calculated the standardized mortality rate for the Brazilian popu-
lation mortality AD states. Results: In 2008, the states were analyzed mor-
tality by 3548 AD and found higher prevalence in females was 2327, male
was 1221, rightly female rates of 1.7 and 1.5 per 100 000 hab. to the male,
and RJ respective SP. The overall mortality rate was SP, 12.4 and RJ of 4.9
per 100 000 habitants. Conclusions: The results point to the need for reor-
ganization of health services and social support to people with AD and their
families with the preparation of action plan for the promotion of health and
prevention of known risk factors for the disease, integration and intersec-
toral actions to securing life with more dignity by the people with AD.
P4-400 COMPARATIVE STUDY OF THE USES OF
GRAMMATICAL CATEGORIES: ADJECTIVES,
ADVERBS, PRONOUNS, INTERJECTIONS,
CONJUNCTIONS AND PREPOSITIONS IN
PATIENTS WITH ALZHEIMER’S DISEASE
Renne Alegria1, Celia Gallo2, Mirian Bolso1, Bernardo dos Santos3,
Cleide Rosana Prisco4, Cassio Bottino5, Nogueira Maria Ines6, 1PROTER,
S~ao Paulo, Brazil; 2PROTER, USP, S~ao Paulo, Brazil; 3Instituto de
Matem�atica e Estat�ıstica, S~ao Paulo, Brazil; 4University of S~ao Paulo, S~ao
Paulo, Brazil; 5PROTER, S~ao Paulo, Brazil; 6Universidade de S~ao Paulo,
S~ao Paulo, Brazil. Contact e-mail: [email protected]
Background:Many studies of language in Alzheimer’s disease focus on the
analysis of verbs and nouns, but language interaction is not only constituted
of those categories in the discourses of patients and caregivers. New studies
are necessary to verify the use of other grammatical categories in order to
improve communication between patients and caregivers. Objective: to
compare the number and percentage of the use of adjectives, adverbs, pro-
nouns, interjection, conjunctions and prepositions between patients and con-
trols. Methods: The twenty minute conversation of twenty three
Alzheimer’s disease patients and twenty three healthy controls were ana-
lyzed by Stablex, a mathematical-statistical-computer assisted program.
Stablex was used to determine preferential, basic and differential vocabu-
lary in patients and controls. The results of the frequency by Stablex and
with the Kruskal-Wallis test were compared the number and percentage
of adjectives, adverbs, pronouns, interjection, conjunctions and prepositions
between controls and patients. The patients were ten men and thirteen
women aged78 to 82, andthecontrols were eight male and fifteen female,
aged 65 and older, they were twelve mild and eleven moderate. All patients
were from PROTER- Old Age Program - ambulatory care of the Institute of
Psychiatry, School of Medicine, the University of S~ao Paulo. The patients
had 4 to 26 years of education; their Mini Mental State Exam (MMSE)
scores 13 to 30. Controls had 4 to 18 years of education and they were
also assessed with SRQ-20- Self reporting Questionnaire. Results: The re-
sults of the number and percentage used by the participants were compared
and showed that the number are different between groups but the percentage
of the other grammatical category are similar: percentage of adjectives and
conjunction do not interfere with the disease progression p¼0.515 and
p¼0.794. On the other hand, the percentage of the interjections is very
high in the moderate patients p<0.001and adverbs, pronouns, prepositions
are p¼0.008, p¼0.002 and p<0.001 respectively. Conclusions: Studying
the grammatical categories adjectives, adverbs, pronouns, interjections,
conjunctions and prepositions in patients with Alzheimer’s disease will cre-
ate more understanding on language impairment and create language stim-
ulation with those patients.
P4-401 EFFECTIVENESS OFAN INTERNET
INTERVENTION FOR FAMILY CAREGIVERS OF
PEOPLE WITH DEMENTIA
Marco Blom1, Anne Margriet Pot2, 1Alzheimer Nederland, Amersfoort,
Netherlands; 2Netherlands Institute of Mental Health and Addiction,
Utrecht, Netherlands. Contact e-mail: [email protected]
Background: In November 2008, the innovative eMental Health inter-
vention for family caregivers of people with dementia, called ’Dementie
de Baas’ (’Mastery over Dementia’), was launched in the Netherlands.
The intervention has been developed by the Netherlands Institute of
Mental Health and Addiction, in collaboration with Alzheimer Neder-
land (Dutch Alzheimer’s Society)and Geriant, a regional outpatient
care provider for people with dementia and their family caregivers.
The intervention is build on principles of psycho-education, cognitive
behavioral therapy, problem solving behavior, relaxation therapy and as-
sertiveness training. Themes covered in the course are: coping with be-
havioral problems, arranging help from others, time for yourself,
thinking and feeling, non-helping thoughts, helping thoughts, assertive-
ness and communicating problems. Methods: In May 2010, a pragmatic
RCTwas started to study the effectiveness of the internet intervention. The
interventions consist of eight lessons and a booster session (follow-up).
Each lesson consists of information, practice rehearsal and some home-
work. During the intervention, caregivers are supported on-line by a psy-
chologist (coach) who gives feedback on the exercises sent by the
caregivers. Caregivers in the comparison group receive a minimal inter-
vention. The intervention consists of e-Bulletins with practical informa-
tion about caring for someone with dementia. The bulletins are sent by
mail according to a fixed schedule. Topics of the bulletins do not overlap
with the content of the internet intervention. Caregivers in the comparison
group have no contact with a coach. In total, 245 caregivers were enrolled
in the study. Results: Outcome measures in the RCT are depressive symp-
toms (CES-D), anxiety symptoms (HADS-A), feelings of role overload
(SPPIC), sense of competence (SSCQ), perceived control (Mastery scale)
and caregiver perceived stress (RMBPC). Both groups receive a pre-test
(at baseline) and post-test (at the end of the intervention). Caregivers in
the intervention group were also measured 3 months and 6 months later.
Analyses are conducted according to the intention to treat principle. To
examine differences between outcomes paired t-tests are conducted.
By using multiple regression, we correct for possible confounders.
Conclusions: Results show that family caregivers who followed the inter-
net intervention have a greater reduction in depressive and anxiety symp-
toms compared to family caregivers in the comparison group.
P4-402 EXPLORING ASSOCIATIONS BETWEEN SERUM
25-HYDROXYVITAMIN DAND DOMAIN-SPECIFIC
COGNITIVE PERFORMANCE USING
RESTRICTED CUBIC SPLINES: A CROSS-
SECTIONAL STUDY IN DUTCH ELDERLY
Elske Brouwer-Brolsma1, Rosalie Dhonuskhe-Rutten1, Janneke van
Wijngaarden1, Nikita van der Zwaluw1, Paulette in ’t Veld1, Roy Kessels2,
Edith Feskens1, CONSORTIUM MEMBER VU MEDICAL CENTRE AMSTERDAM3,
Suzanne van Dijk4, Lisette de Groot1, 1Wageningen University,
Wageningen, Netherlands; 2UMC St. Radboud, Nijmegen, Netherlands;3VU Medical Centre, Amsterdam, Netherlands; 4Erasmus Medical Centre,
Rotterdam, Netherlands. Contact e-mail: [email protected]
