European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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P-115
Does apathy predict decline in physical performance and fall
incidents in older individuals?
M.J. Henstra 1, K-J. Lelivelt1, N.M. van Schoor2, K.M.A. Swart2, P. Lips2,
A.C. Ham 3, A.G. Uitterlinden3, L.C.P.G.M. de Groot4, N. Van der Velde1,3.
1Academic Medical Center, 2VU Medical Center, Amsterdam, 3Erasmus
University Medical Centre Rotterdam, The Netherlands, 4Wageningen
University, Wageningen, The Netherlands
Rationale: Apathy, common in older individuals, is characterized by
diminished motivation in cognition, behavior and emotions. Apathy,
physical performance as well as falls are associated with cardiovas-
cular disease (CVD). Common pathways may be present, warranting to
study the associations between apathy and physical performance and
falls and a possible mediating role for CVD.
Aim: To investigate the association between apathy and physical
performance score (PPS), its decline and time-to-first-fall using
data from the B-Vitamins for the PRevention Of Osteoporotic
Fractures (B-PROOF): 2919 community-dwelling individuals aged
≥ 65 years, follow-up-period two years.
Methods: Apathy was assessed with Geriatric-Depression-Score3. PPS
was calculated with three performance tests (walking-test, chair- and
tandem-stand, range 0–12 points). Multivariate logistic and Cox
regression analyses were used to assess adjusted Odds Ratio ’s (ORs),
Hazard Ratio’ s (HRs) and its 95% Confidence Intervals (CI95) for the
association between apathy and low vs high PPS, decline in PPS and
time-to-first-fall respectively. Mediation by CVD was also investigated.
Results: Apathy was associated with low PPS (0–8 points) (OR 2,23;
CI95 1,75–2,84). Next, apathy was associated with decline in PPS
in women aged 65–80 yrs (OR 1.17, CI95 1.07–2.75) and in men (OR
1,76, CI95 1.12–2.76). There was no association between apathy and
time-to-first-fall (HR 1,05; CI95 0,90 –1,22). CVD was not an inter-
mediate in either association.
Conclusion: Apathy is associated with low physical performance
score, and in women aged 65 –80 yrs and men, with its decline. In
clinical practice, identifying apathy may be used to target mobility
preserving interventions.
P-116
Acetylcholinesterase inhibitors for Electro Convulsive Therapy-
induced cognitive side effects, a systematic review
M.J. Henstra 1, E.P. Jansma2, N. Van der Velde1, E.L. Swart3, M.L. Stek 4,
D. Rhebergen 4. 1Academic Medical Centre Amsterdam, 2VU Medical
Center, 3VU Medical Center and Academic Medical Centre, 4VU University
Medical Center, Amsterdam, The Netherlands
Background and Objective: Electroconvulsive therapy (ECT) is an
effective treatment for severe late life depression (LLD), but ECT-
induced cognitive side-effects frequently occur. The cholinergic
system potentially plays an important role in the pathogenesis.
We systematically reviewed the evidence for acetylcholinesterase-
inhibitors (Ache-I) to prevent or reduce ECT-induced cognitive side-
effects.
Methods: A search was performed in Pubmed, EMBASE, PsychINFO
and the Cochrane Database to identify clinical trials investigating the
effect of Ache-I on ECT-induced cognitive side-effects and published
until March 2016. Key search terms included all synonyms for ECT
and acetylcholinesterase-inhibitors. Risk of bias assessment was
conducted by using the Cochrane Collaboration’ s Tool.
Results: Five clinical trials were eligible for inclusion. All studies
focused on cognitive functioning as primary endpoint, but assessment
of cognitive functioning varied widely in time point of assessment
and cognitive tests that were used. There was also great variety in
study-medication, route and time of administration and dosages,
duration of drug administration and ECT techniques. Despite the
aforementioned differences, without exception, all studies demon-
strated better cognitive performance in individuals treated with
acetylcholinesterase inhibitors.
Conclusions: Ache-I have beneficial effect on ECT-induced cognitive
side-effects, endorsing an association with the cholinergic system in
ECT-induced cognitive impairment. Although a bias risk assessment
was performed with negative results, publication bias cannot be ruled
out completely. Methodological sound studies controlling for putative
confounders are warranted.
P-117
The utility of the Mini-Addenbrooke’s Cognitive Examination
Assessment as a screen for cognitive impairment in elderly patients
with chronic kidney disease and diabetes
P. Hobson1, K.H. Rohoma2, S.P. Wong1, M.J. Kumwenda1. 1Department of
Nephrology, Glan Clwyd Hospital, Besti Cadwaladr University Health
Board, United Kingdom; 2Internal Medicine Department, Faculty of
Medicine, Alexandria University, Egypt
Objectives: The assessment of cognition in the busy clinical or bedside
setting where more comprehensive neuropsychological assessment is
not possible or practical is often hampered with the lack of a suitable
screening instrument. The aim of this investigation was to determine
the utility of the 30-item Mini-Addenbrooke’ s Cognitive Examination
(m-ACE) in a cohort of older adults with Chronic Kidney disease (CKD)
and diabetes.
Methods: A total of 78 patients attending a nephrology clinic with a
diagnosis of CKD stage >3 and diabetes (M:F + 45:33; Age = 78.1 (sd
7.7), without known pre-existing diagnosis of cognitive impairment,
were screened with the ACE III and the MMSE. The m-ACE scores were
obtained from the more comprehensive ACE-III. A diagnosis of
cognitive impairment was based upon patient and informant review,
clinical case review, neuropsychological assessment and application of
Peterson’s criteria for mild cognitive impairment (MCI) and Diagnostic
and Statistical Manual of Mental Disorders version 5, for dementia.
Results: Upon assessment, 23 patients were diagnosed with dementia,
and 21 with MCI. The area under the receiver operating curve for the
m-ACE was .968, (95% CI 0.936–1.00). Sensitivity and specificity for a
dementia diagnosis at the cut point <25 was 0.78 and 0.97, and at cut
point <21 it was 0.77 and 1.00. The mean m-ACE score was 23.3 (4.78).
The m-ACE and MMSE correlated strongly (0.87, p < 0.001). Mean m-
ACE scores differed significantly between normal, demented and MCI
groups (p < 0.001).
Conclusion: The M-ACE allows for rapid assessment in the clinical
setting taking on average less than five minutes to complete. As a brief
assessment of global cognitive function the m-ACE is an easily
administered test with better sensitivity and specificity to capture
and assist in the diagnosis of dementia or MCI than the MMSE.
P-118
Quality improvement through personalised care planning in an
acute care setting
C. Hughes. BHRUT
Background: Poor standards in person centred care planning adver-
sely impact on outcomes for patients with dementia in acute care and
can contribute to avoidable harms such as falls. Aim: To implement
and evaluate personalised care plans combined with distraction
activities to improve dementia patients’ well-being and reduce
adverse events (falls) in an acute care setting.
Methodology: Quality improvement Plan Do Study Act (PDSA) cycles
were implemented over a two month period. PDSA 1: Nurse Education
sessions (n = 8) to increase awareness and use of dementia and
delirium pathways. PDSA 2: Staff worked with relatives and carers to
develop personalised care plans including distraction activities. PDSA
3 Observer feedback on patient well-being using The Bradford Well-
Being Profile observation Tool (n = 5 patients) Evaluation involved a
pre and post audit of personalised care plans (n = 30) and routinely
collected falls data.
Results: In the post intervention audit, 77% of personalised care plans
were completed compared to 4% at baseline. Due to increased use of
personalised plans falls prevention strategies were initiated in 97% of
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S59