P3-448 INTELLECT IN DEFAULT: INTEGRATINGCONCEPTS OF NEUROSCIENCE, PSYCHOLOGYAND HUMAN NATURE

Mary J. Flossie, Hiram College, Massillon, OH, USA. Contact e-mail:jsnowbyrd@msn.com

Background: Default mechanisms that surface when intellect fails arehuman instinct, rote responses, emotional intelligence and autonomic re-actions. These keys to human survival are primal and unaffected bydisease. Drawing from neuroscience, basic concepts of the limbic system inhuman development, and applying the psychology of subconscious activityto the primal urges at the core of human nature, we establish that when onecan’t think, one still feels and can interpret interpersonal dynamics withprofound accuracy. When the brain is destroyed by disease, intellect willdefault to instinct by nature. Recognition of what is left well intact leads tonew approaches to care and intervention. Methods: This workshop hailsthe ’dementia dilemma’ from the victim’s perspective by revealing theextent to which behaviors are triggered instinctively by non-verbal, envi-ronmental and interpersonal stimuli. Retro-genesis in Alzheimer’s causesdevelopmental regression as the memory of life experiences unrvels back-ward in time, leaving victims with a mental agenda isolated in a previousreality. Results: Defensive and suspicous behaviors are the result of fear,perceived threats and instinctive reactions to fear, over which the affectedhave no control. Lack of intellectual counterbalance, which is at the core of‘seemingly’ unreasonable activity, co-exists with Retro-genesis and mustbe considered in conjunction with autonomic responses if effective ‘inter-ventions’ are to be formulated. Conclusions: Care focus becomes blurredby unrelenting tasks that have to be managed with the cooperation of theconfused. Well intended efforts become undermined by personal feelingsof exasperation, grief and failure in the process. The obvious is overlookedbecause intellect itself contradicts understanding dementia. Much can bedone to secure, comfort and minimize the fear and anxiety that leads todisturbances if one understands the true underlying causes and abandonsdependence on language and learned expectations. Integrating diversity ofknowledge equips carers toward improving the quality of life for thecompromised as well as themselves.

P3-449 BEHAVIORAL PROBLEMS AMONG DEMENTIAPATIENTS IN AN OUTPATIENT MEMORYCENTER IN THE PHILIPPINES

Maria Stella T. Giron, Jacqueline C. Dominguez, St. Luke’s MedicalCenter, Quezon City, Philippines. Contact e-mail: mtgiron@yahoo.com

Background: Dementia is characterized by progressive memory declineand associated with behavioral problems which impact on the patient’squality of life and cause caregiver distress. This study aims to determinethe frequency of behavioral problems among outpatients diagnosed withdementia. Methods: Thirty four patients from the Memory Center of St.Luke’s Medical Center, Philippines were diagnosed with dementia; 30 withAlzheimer’s disease, 3 with vascular dementia, and one with frontal lobedementia. The Neuropsychiatric Inventory (NPI) was used to assess thepatients’ behavioral problems. Dementia severity was assessed using theClinical Dementia Rating (CDR) Scale. Results: Behavioral informationwas obtained from the patients’ spouses (41.2), children (41.2), otherrelatives (2.9), and hired help (14.7). The patients’ mean age was 73.5 (9.6�9.6), 70.6% were women, with a mean MMSE score of 26.2 (5.3). Thirtytwo (94.1%) were reported to have at least one behavioral problem. Apathy(79.4%), agitation (73.5%), aberrant motor behavior (73.5%), irritability(67.6), and appetite (55.9%) were the most common behavioral problemsreported. Elation (8.8%) was the least frequently observed behavior. Thetotal NPI scores increased significantly with increasing dementia severity(p�0.011) and correlated significantly with caregiver distress (P�0.000).Irritability and agitation were the problems most often reported to causedistress to caregivers. Conclusions: This study showed a high frequency ofbehavioral problems among this group of dementia patients and that itspresence was significantly related to caregiver distress and increasing

dementia severity. Increased attention should be focused in identifying andtreating these problems in dementia patients.

P3-450 ALSOVA: A PROSPECTIVE INTERVENTIONFOLLOW-UP STUDY ON RECENTLY DIAGNOSEDPATIENTS WITH MILD ALZHEIMER’S DISEASEAND THEIR CAREGIVERS—THE STUDYPOPULATION AT THE BASELINE

Sanna-Kaisa Herukka1, Tarja Va limaki1, Anna-Maija Pietila 1,Katri Vehvila inen-Julkunen1, Janne Martikainen1, Hannu Valtonen1,Juhani Sivenius1, Hilkka Soininen1,2, Pertti Karppi3, Asta Hiltunen4,Tuula Pirttila 1,2, 1University of Kuopio, Kuopio, Finland; 2KuopioUniversity Hospital, Kuopio, Finland; 3Jyvaskyla Central Hospital,Jyvaskyla, Finland; 4Pohjois-Karjala Central Hospital, Joensuu,Finland. Contact e-mail: Sanna-Kaisa.Herukka@uku.fi

Background: Alzheimer’s disease (AD) imposes a heavy and rapidlyincreasing economic burden on the social and healthcare systems in dif-ferent countries. The largest increase in dementia costs is related to insti-tutional care. While dementia has devastating impact on quality of life ofthe family caregivers, the families play important roles in the patient careand decision making. Our objective is to examine and compare the factorsthat are related to the quality of life, coping and life control of both patientsand caregivers. During the follow-up the effects of a psychoeducationaland rehabilitation intervention program on quality of life of the patients andcaregivers and caregivers’ burden will also be studied. Methods: The studyis a prospective follow-up study that includes 241 recently diagnosed ADpatient-caregiver pairs who entered the study between 2002 and 2006. Datacollected includes age, sex, education, physical health, medication, house-hold composition, living arrangements, general well-being, caregiverstrain, depression, quality of life and resource utilization. The AD patient-caregiver pairs will be randomized to two study groups: (1) Traditionalcare � intensive psychoeducational courses for patient and caregiverduring first two years after a diagnosis, and (2) traditional care. Results: Atthe baseline the caregiver was most frequently a spouse, in 70% of cases,and in 23% of the cases the caregiver was a child. A total of 73% of thepatient-caregiver pairs were living together. The mean MMSE score of thepatients was 21.5�3.4 and mean ADCS-ADL score was 65.�9,3. Only18% of the patients had no neuropsychiatric symptoms, and 37% of thepatients had symptoms in at least three different NPI domains. As many as33% of patients could be diagnosed as having at least mild depression. Upto 43% of the AD patients had another medical condition besides AD, and60% used at least three different medications. Almost all (96%) used ADmedication, most often acetylcholinesterase inhibitors. Conclusions: Al-though the patients were at the early stage of AD at the baseline, theneuropsychiatric symptoms were surprisingly frequent in these patients.Patient’s depression was associated with quality of life of the patients at thebaseline.

P3-451 STRENGTH OF ASSOCIATION OFNEUROPSYCHIATRIC SYMPTOMS WITHLATINO CAREGIVER DEPRESSION VARIES BYCARE RECIPIENT COGNITIVE GROUP

Ladson Hinton, UC Davis, Sacramento, CA, USA. Contact e-mail:ladson.hinton@ucdmc.ucdavis.edu

Background: Few studies have examined stress among caregivers ofelderly who are cognitively impaired but not demented. In prior research inLatinos, we found a stronger association of care recipient neuropsychiatricsymptoms and caregiver depression in the cognitively impaired not de-mented group than the demented group. Methods: This study’s objectivewas to compare the relationship of caregiver depression (i.e. CES-D) withneuropsychiatric symptoms (i.e. Neuropsychiatric Inventory) in threegroups of non-institutionalized Latino elderly (i.e. 27 cognitively normal,20 cognitively impaired not demented, 24 demented) identified through theSacramento Area Latino Study on Aging. Results: In the overall sample,

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