Rita de Cássia G. Marques

Characteristics of patients assisted at an ambulatory of dementia from a university hospital

OBJECTIVE To present socio-demographic characteristics, mean scores of tests and scales applied to patients with dementia and discuss the relationship between test scores, clinical diagnoses and the severity of dementia. METHOD Patients (n=113) were diagnosed according to the DSM-IV criteria, and the diagnostic work-up included physical and neurological examination, auxiliary exams, cognitive and functional tests, and the evaluation of neuropsychiatric symptoms. RESULTS Mean age was 74.0 years. Alzheimers disease (AD) was diagnosed in 62.8% of the patients, AD and vascular dementia in 8.8%, other dementias in 14.2%, and mild cognitive impairment in 2.7%. At least one neuropsychiatric symptom was diagnosed in 96.9% of the sample. There were significant differences on cognitive and functional performance between the groups classified according to dementia severity. CONCLUSION Neuropsychiatric symptoms were quite common in patients with dementia, being more frequent as severity increased, and those symptoms were associated with functional impairment in the patients.

Discourse analysis of Alzheimer's disease patients: From the lexicon to discourse

Background: Little attention has been given to the population with Alzheimer’s disease concerning the sociolinguistic underpinnings of their discourses. Language performance research has been the focus recently, especially for advancing our understanding of the multiple cognitive and sociolinguistic influences on the patients with dementia. Objective: to demonstrate the sociolinguistic underpinnings of Alzheimer’s disease patients Methods: The participants for this study were eight Alzheimer’s disease patients and six controls. The patients were four men and four women aged 80 and older, and the controls were three male and three female, aged 75 and older.All the patients were from PROTEROld Age Program ambulatory care of the Institute of Psychiatry of the School of Medicine of the University of São Paulo. The controls were their caregivers and/or relatives. The patients and controls had 4 to 11 years of education, their Mini Mental State Exam (MMSE) scores 13 to 30. The controls were also evaluated by other scales such as SRQ-20.Their discursive performances were recorded and analyzed by the computational tool Stablex, based on mathematical-statistical-computer assisted program which mainly distinguish the results of preferential, basic and differential vocabulary. Results: The sociolinguistic influences of the discourses of the patients are not necessarily destroyed compared to the discourse of the control subjects. The program Stablex shows that preferential vocabulary is constituted of the thematic vocabulary and the lexical components of more sociolinguistic frequency in the discourses. The patients produced more preferential words than the controls and they were shown to be statistically significant. The patients preserve more words with ideological, historical and cultural meanings Conclusions: Assessing the discourse performance of patients with Alzheimer’s disease provides opportunities to unravel the connections and changes among language, communication and behavior. For patients with dementia, analysis of sociolinguistic discourse is an access for a better communication with their caregivers.

Functional capacity, cognitive deficit and falls in Alzheimer's disease: A pilot study

with CDRS score 0.5, who did not meet the DSM-IV dementia criteria, were selected and diagnosed as MCI. 38 subjects with CDRS score 0.5 or more, who met the DSM-IV dementia criteria were diagnosed as AD. Old age, low levels of education, histroy of head trauma were associated significantly with AD (p<0.01, p<0.01 p<0.05). Interestingly, the proportion of subjects on DM medications was significantly different among the three groups (p<0.05). There were significant differences in the mean score of MMSE-KC and GDS-K among normal, MCI and the AD group (p<0.01, p<0.01). These scores were significantly correlated with each other in this study population (p<0.05). There was a significant correlation between the MMSE-KC score and serum total cholesterol and triglyceride levels in MCI group (p<0.05, p<0.05), but not in normal controls and AD group. Finally, we found that the mean score of Hachinski Ischemic Scale was significantly different among three groups (p<0.05). Conclusions: Our results strongly suggested that many vascular risk factors are associated with cognitive impairments in MCI and AD patients. In this study,serum lipid levels were associated with global cognitive dysfunction in MCI group. We confirmed that DM is a risk factor for MCI and AD in our Korean population.

P3-472: Pilot study of art therapy with family caregivers of patients with Alzheimer's disease

about caregiver burdens, including psychosocial burden, biological burden, negative thinking; people relationship, the dependence of patients, the ignominy burden. Moreover, there produced affective, tool, and information support factors, respectively, from the demand and satisfaction aspect. The reliability of each factor has greater than 0.6. Pearson Production Moment analysis revealed that psychosocial, biological burden factors were significant correlation with information and tool support factors, respectively. Furthermore, the dependence of dementia patient factor is marked significantly related with affective support factor. However, the negative thinking burden factor is significant negative correlation with information support. Conclusions: Armed with the results of above mentioned, the need of supports, in terms of information, tool, affective, for the caregiver burden of dementia family members is strong and not satisfied. Thus, to bridge the gap of the demand and satisfaction between dementia family members and multiple aspects supports is urgent.

P2-456: Clinical and psychiatric comorbidities and drug use among patients with dementia

Background: The prevalence of Dementia in the elderly is very high as the chance to develop other chronic diseases that can disable them functionally. The use of medication for the control of the diseases is very common. The comorbid profile of these patients and the drugs that are most frequently taken by them are very important for the planning of effective therapeutic schemes that do not offer potential side effects or other complications related to the drug abuse and drugs interactions.Objective: To assess medication use and comorbidity in patients with dementia. Methods: Data review of patients in ambulatory care from 2003 to 2007 (n 71) at a tertiary hospital. Dementia diagnosis was made using DSM-IV-TR criteria, physical examination, test application (CAMCOG, MMSE, NPI and B-ADL) and laboratory exams. The patients were classified according the CDR classification. Results: It was verified that approximately 81.7% of patients were diagnosed with Alzheimer’s disease, while 18.3% had other types of Dementia. The average index of CIRS comorbidity was 0.97 and the index of CIRS severity was 1.24. The most frequent clinical comorbidity was high blood pressure, and the most common psychiatric comorbidity was mood disorder. At least one medication was taken regularly by 82.2% of patients, and 29.5% took more than tree medications. According to CDR, patients with CDR 1 and 2 used less medication than those with CDR 0.5 and 3. Conclusions: High blood pressure and mood disorders are the most common comorbidities in patients with dementia and the cholinesterase inhibitors and antihipertensives are the most commonly used drugs.

P4-218: Prevalence of caregiver burden in Alzheimer’s disease and cognitively impaired not demented subjects from a community-sample in São Paulo, Brazil

Background: The caregiver burden is seen as all the physical and psychological consequences that might be experienced by any of the family members or close friends who take care of elderly patients with cognitive disorders. Objective(s): Assess the prevalence and associated factors of caregiver burden in Alzheimer’s Disease (AD) patients, and Cognitively Impaired Not Demented (CIND) subjects compared to Normal Elderly individuals selected from the same community-based sample in São Paulo, Brazil. Methods: We evaluated 68 caregivers of patients with AD, 24 caregivers of subjects with CIND and 75 caregivers of elderly controls, diagnosed as a result of a populational study, performed between 2002 and 2005. The community sample consisted of 1563 elderly subjects, and screen positives were submitted to a work-up for dementia, with physical and neurological examination, cranial Computerized Tomography or cerebral Magnetic Resonance Imaging, the Cambridge Examination for Mental Disorders, Clinical Dementia Rating Scale (CDR) and the Neuropsychiatric Inventory (NPI). Diagnosis was made according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The caregiver burden in the three groups was evaluated with the Zarit Scale. Results: The mean Zarit scale score of the AD caregivers was 19.79, CIND caregivers was 3.92, and controls caregivers was 2.35. The age of the patient, the neuropsychiatric disturbances measured by the NPI and the higher severity of Dementia assessed by the CDR resulted in higher Zarit scale scores. Comparing the groups, AD caregivers showed a higher mean score on the Zarit scale than controls and CIND subjects. Conclusions: The caregiver burden can be considered a dynamic interaction between external stress and subjective perceptions. On the present sample, a higher mean score on the Zarit was observed in the AD caregivers group. However, the caregiver burden of the 3 groups can be considered minimum as the cut-off point for mild burden on the scale is over 46. This finding can be possibly explained by the mild cognitive deficit.