Oisín Hannigan

Prosopagnosia as a Type of Conversion Disorder

Background Conversion disorder is a common and debilitating condition that remains poorly understood. We present a previously undescribed form of conversion disorder to highlight the complexity of the condition and consider the interplay of factors that produce conversion symptoms. Case A 50-year-old male presented with acquired prosopagnosia and language impairment. Neuropsychological testing indicated right temporal lobe dysfunction. Extensive work-up outruled an organic aetiology. Reactivation of childhood trauma coincided with the onset of his symptoms. Childhood trauma is known to have adverse effects on the developing brain which may affect an individuals emotional behaviour and coping style. Functional neuroimaging techniques suggest that conversion symptoms may be linked to the disruption of higher order neural circuitry involved in the integration of emotional processing and cortical functioning. Conclusions We propose that our patients adverse childhood experiences led to the development of a particular personality and coping style that “primed” him for a later abnormal emotional and behavioural response when confronted with reminders of his traumatic background. Further interdisciplinary studies are required to further elucidate the neurobiological basis for this condition.

173The Alzheimer’s Questionnaire: Optimising Cut Points for an Irish Memory Clinic Population

Oisín Hannigan, Ontefetse Ntlholang, Clodagh Power, Paul Claffey, Ruth Roseingrave, Rachel Farley, Irene Bruce, Matthew Gibb, Marie McCarthy, Keneilwe Malomo, Robert Coen, Mircea Balasa, Brian Lawlor, David Robinson Mercer’s Institute for Successful Ageing, St. James’s Hospital, Dublin 8, Ireland Global Brain Health Institute, Trinity College Dublin, Dublin 2, Ireland Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland

229Review on Teriparatide (Forsteo) Treatment on Older Patient Attending Bone Health Clinic in St. James’s Hospital

Background: Teriparatide (Forsteo) is an anabolic agent used in treatment of osteoporotic patients with high risk of vertebral fracture. It has been shown to reduce the risk of moderate to severe vertebral fractures by up to 80–90%. Vertebral fractures due to osteoporosis are common in older women. Methods: We aimed to identify the characteristics of older adults receiving teriparatide therapy at our bone health service. We also aimed to evaluate the effect of treatment with teriparatide on bone mineral density (BMD) as well as persistence with therapy. Data were obtained from our bone health service for all adults aged 70 or older who were treated with teriparatide for at least 18 months. Data included age, gender, baseline BMD and T scores as well as changes same with treatment. We dichotomised patients by age (70–79) and (≥80 + ) to evaluate for differences in the ‘older’ old. Results: Data for 250 patients were initially available but 20% did not persist with therapy leaving 198 in our analysis, 98 aged between 70–79 and 100 aged 80 or older. Overall 95% of those were female and approximately 60% had vertebral fractures in both groups. Mean T scores were between −3.5 to −3.6 (spine) and −2.7 at hip.There was significant increase in BMD of spine of 15.3% for aged ≥ 80 + and 13.3% in those aged 70–79 with P value < 0.05. While BMD at hip increased by 1.9 to 2.4%. Conclusions: Teriparatide was as effective at increasing BMD of spine in both age groups (70–79) as well as (≥80+). Our findings support using teriparatide in older adults including the ‘oldest old’ who have high risk of vertebral fractures and where benefit may be greatest.

297‘Flu and Far Between’ - Evaluation of Influenza Vaccination among Eligible Patients with Prolonged In-hospital Stay.

Background: Influenza is an important global cause of morbidity and mortality in older people. Vaccination remains the single best public health initiative. Much of the focus to date has been on community vaccination, however in 2015 there was a large outbreak of nosocomial related influenza in older people at St. James’s Hospital. Aim: The aim of this audit was to assess compliance with influenza vaccination guidelines in long-stay patients. Methods: Data was collected from 104 inpatients who had a length of stay (LOS) of >40 days. Demographic data was collected in those over the age of 65 or had COPD. An email reminder was circulated to clinicians highlighting the importance of vaccination, and identifying those patients under their care who had yet to be vaccinated. Following this intervention, a subgroup of 42 of the original cohort were re-audited. Results: Of the 104 patients reviewed, 20% received vaccination. 24% MedEl patients were vaccinated compared to 17% medical, and 18% surgical. Average age of patients reviewed was 77 years, 86% were >65. On re-audit of 42 unvaccinated patients that remained in hospital 4 weeks later, a further 8 patients had been vaccinated although overall vaccination rates remained low at 19%. Conclusion: Delayed discharge of older patients out of the acute hospital environment necessitates consideration of this important public health intervention for those patients with prolonged admissions. Awareness of the need for influenza vaccination among hospital physicians and surgeons is low, with only 20% of eligible patients receiving vaccination. Despite prompting, a re-audit showed persistently low levels of uptake. Given the strong indications for vaccination and prior inpatient outbreaks, we recommend hospital-wide physician education with regards to influenza vaccination of patients. Compliance will be optimised in the next influenza season through use of reminders on electronic prescribing for older people.

238Hyperparathyroidism: How Much do Calcium and Vitamin D Matter?

Background: Hyperparathyroidism is associated with increased bone turnover and fractures. We aimed to determine its prevalence in patients attending our osteoporosis clinic, and investigate relationships between their serum calcium, vitamin D, bone turnover markers, bone mineral density (BMD), DXA T-scores and fracture history. Methods: We identified records from 2003–2017, collecting data on parameters above, and parathyroid imaging. Normal calcium level defined as 2.35–2.50 nmol/litre; normal vitamin D =/> 50 nmol/litre; normal PTH < 2.65 pg/ml. Results: 7624 patients; 364 (4.77%) had elevated PTH; 27 with incomplete data excluded. Of remaining 337, 294 female, 43 male; median age 76, mean T-score spine −2.6, mean T-score hip −2.4; overall osteoporosis prevalence 68.8%; 19% had prior hip fracture, 49% vertebral, and 21% Colles. 16 with eGFR < 30 ml/min excluded. Of the remaining 321, 53 (16.5%) hypercalcaemic, 69 (21.5% normocalcaemic and 199 (62%) hypocalcaemic. 182 had low vitamin D, implying secondary hyperparathyroidism; 139 normal vitamin D, implying primary hyperparathyroidism. Of 139 with likely primary hyperparathyroidism, we compared those with normal calcium level to those with high calcium: No significant differences in BMD spine/hip, prevalence of osteoporosis or fragility fracture. P1NP – a bone formation marker – was significantly higher in normocalcaemic group (mean difference 17.483 ng/ml, p = 0.049). 57 patients had parathyroid ultrasound or isotope scans. 22 positive for adenoma; 35 negative. Scans significantly more likely to be positive in patients with high calcium compared with normal calcium (likelihood ratio 5.671, p = 0.0173, ChiSquare test). 13 positive scans were in patients with low vitamin D. Conclusions: Patients with hyperparathyroidism were relatively older, osteoporotic and had high prevalence of fractures, low serum calcium and vitamin D. Low vitamin D was a poor negative predictor of adenoma. Although normocalcaemic patients were less likely to have a radiologically-proven adenoma, they appeared to carry a similar risk of osteoporosis and fracture as those with high calcium/adenoma.