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educating junior doctors on the importance of identifying memory

impairment and delirium, as well as providing a confusion bundle,

improved identification and management of high risk patients.


Clinicians assessment and management of cognitive

impairment can be significantly improved by education, an admission

proforma and confusion bundle.


The influence of the environment on behavioural symptoms

among nursing home residents with dementia: a systematic review

M.J. Krijger, R. Wetzels.

VOSON Radboud UMC Nijmegen


Behavioural symptoms of dementia (BSD), including

physical and verbal aggression, psychomotor and verbal agitation,

negativism, sleep wake disorders, irritable mood, sexual inappropriate

behaviour, obsessive behaviour, apathy are very common in nursing

home residents with dementia. Understanding the influence of the

environment on these behavioural symptoms might be the key to

reduce these symptoms by adequate interventions done by the

professional caregivers. Research question:

What is the influence of

the environment on clinically relevant behavioural symptoms among

nursing home residents with dementia?


A systematic review was achieved in accordance with

the Preferred Reporting Items for Systematic Review and Meta-

Analysis Protocols 2015 (PRISMA-P). A literature search was performed

in five electronic databases (Pubmed, Embase, Cochrane, PsycINFO and

CINAHL), using the synonyms for Dementia, Nursing Home Residents

and Behavioural Symptoms. The articles were screened individually

by two independent reviewers on title and abstract using predeter-

mined inclusion and exclusion criteria. Critical appraisal and data-

extraction were accomplished by two independent reviewers.


Our search yielded 4546 articles after excluding the dupli-

cates. Using the methods described, we critically appraised remaining

articles. The most relevant and valid articles were qualified for further

assessment and data-extraction was performed. Preliminary results

will be presented at the EUGMS congress.


We expect that the results will show that the environ-

ment appears to be a major influence on behavioural symptoms

among nursing home residents with dementia. And possibly that

interventions should be aimed primarily on changing the



Dementia care mapping: a tool to improve non-verbal

communication for people with dementia

J.C. Leners.

LTCF Ala and Pontalize, Luxembourg


Dementia care mapping (DCM) is a tool (T. Kitwood) to

evaluate the model of person centred care (PCC). It consist in assessing

patients with dementia in order to find out about wellbeing and stress

during day-times.


The mapping consist of an observation of patients in their

normal surroundings with a specific encoding system for different

types of activities.(feeding, leisure, etc). It allows to understand some

behaviors. We wanted to find out, if the non-verbal communication

was better after a 6 months implementation of PCC.


The population examined: 30 persons having lost oral

expression. By a standardized classification for non-verbal communi-

cation, the results for patients were: (a) acceptance of proposed

actions: 71%; (b) acquiescence: 17%; (c) expressed wishes: 6%; (d)

apathy: 4% and (e) opposition: 2%. The results from the nurse

s attitude

were: (b) guidance of activities: 31%; (b) recognition of participation:

25%; (c) negotiation: 21% (d) explanation: 12%; (e) basic stimulation:



Dementia care mapping is a useful tool for geriatricians

to understand the unusual behavior of persons in advanced stages of

dementia. Through this positive attitude, the physician is less often

confronted to negative attitudes of his patient and will prescribe less.

(reduction: 9% for psychotropics)


Dysphoric symptoms in relation to other behavioral and

psychological symptoms of dementia, among elderly in nursing


A. Lindbo, M. Gustafsson, U. Isaksson, P.O. Sandman, H. Lövheim.


Department of Geriatric Medicine, Umeå University,


Department of

Pharmacology and Clinical Neurosciences, Umeå University,



of Nursing, Umeå University,


Division of Nursing, Karolinska Institutet,

Stockholm, Sweden


Behavioral and psychological symptoms of dementia

(BPSD) are common and varies throughout the disease. The aim of this

study was to explore associations between BPSD and dysphoria at

different levels of cognitive impairment.


Survey assessments of 4,397 individuals in Swedish nursing

homes were analyzed. Data of cognitive function and BPSD were

collected using the Multi-Dimensional Dementia Assessment Scale

(MDDAS). Eight BPSD factors were plotted in relation to cognitive

function and level of dysphoria to investigate their relation with

concurrent dysphoria.


Dysphoric symptoms was most frequent in moderate cogni-

tive impairment, however, moderate to severe dysphoric symptoms

showed no clear variation with cognitive impairment. Further,

aggressive behavior, verbally disruptive/attention-seeking behavior,

hallucinatory symptoms and wandering behavior were more common

with concurrent dysphoria regardless of cognitive function. In

contrast, passiveness was more common with concurrent dysphoria

in mild cognitive impairment but not in moderate to severe cognitive



Several BPSD including aggressive behavior and halluci-

nations were more common with concurrent dysphoric symptoms,

providing further insight to behavioral and psychological symptoms

among individuals with cognitive impairment. Apathy was more

common with concurrent dysphoria in early stages of cognitive

decline but not in later stages, supporting the notion that apathy and

dysphoric symptoms represent separate concepts among people with

moderate to severe cognitive impairment.



an umbrella term misused as a diagnosis?

A. Mackett


, T. Lockington




Cambridge University Hospitals Trust,


Ipswich Hospital Trust


A patient, treated as Alzheimer

s dementia, presented

to us in crisis awaiting an end of life placement. Following re-diagnosis

and application of dementia with Lewy bodies (DLB) therapeutics he

subsequently spent two years at home, with a stable mini-mental state

examination of 27/30 [1]. A national dementia Commissioning for

Quality and Innovation was developed to increase the dementia

diagnosis rate. A single screening question is used but many have

questioned the evidence base [2]. It is vital that dementia does not

become a diagnosis in itself but the underlying pathology must be

rigorously pursued as clinical course/management vary significantly.


14 patients with DLB who had been misdiagnosed were

identified in a movement disorder clinic in a large district general

hospital over a 6 month period. Symptoms at time of diagnosis were



Initial dementia diagnosis: 71% Alzheimer

s, 14% vascular, 7%

frontal lobe or mixed type. Motor symptoms: 92% bradykinesia, 78%

rigidity and 64% resting tremor. Non motor symptoms: 71% REM sleep

disorder, 57% anosmia and constipation, 57% diurnal variation and 43%

visual hallucinations.


Patients were commenced on appropriate pharmaco-

logical interventions including Rivastigmine. There is clear efficacy

in the use of Rivastigmine in DLB including amelioration of hallu-

cinations, improvement in agitation, apathy and delusions and

improvement in the sleep/wake cycle [3]. Furthermore improvement

in cognition appears to be preserved over a significant period [4].

Outside specialist centres, potentially too much emphasis is placed on

Poster presentations / European Geriatric Medicine 7S1 (2016) S29