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Does apathy predict decline in physical performance and fall

incidents in older individuals?

M.J. Henstra


, K-J. Lelivelt


, N.M. van Schoor


, K.M.A. Swart


, P. Lips



A.C. Ham


, A.G. Uitterlinden


, L.C.P.G.M. de Groot


, N. Van der Velde




Academic Medical Center,


VU Medical Center, Amsterdam,



University Medical Centre Rotterdam, The Netherlands,



University, Wageningen, The Netherlands


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.


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.


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.


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.


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.


Acetylcholinesterase inhibitors for Electro Convulsive Therapy-

induced cognitive side effects, a systematic review

M.J. Henstra


, E.P. Jansma


, N. Van der Velde


, E.L. Swart


, M.L. Stek



D. Rhebergen




Academic Medical Centre Amsterdam,


VU Medical



VU Medical Center and Academic Medical Centre,


VU 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-



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.


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.


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.


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. Hobson


, K.H. Rohoma


, S.P. Wong


, M.J. Kumwenda




Department of

Nephrology, Glan Clwyd Hospital, Besti Cadwaladr University Health

Board, United Kingdom;


Internal Medicine Department, Faculty of

Medicine, Alexandria University, Egypt


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.


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


s criteria for mild cognitive impairment (MCI) and Diagnostic

and Statistical Manual of Mental Disorders version 5, for dementia.


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).


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.


Quality improvement through personalised care planning in an

acute care setting

C. Hughes.



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.


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.


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