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: u99000049@kmu.edu.tw

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: bforester@partners.org

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: miia.kivipelto@ki.se

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: realegrias@yahoo.com.br

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: m.blom@alzheimer-nederland.nl

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: elske.brouwer-brolsma@wur.nl