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

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P-149
Decline in mortality in patients with dementia: results from a
nationwide cohort of 44,258 patients in The Netherlands during
2000 –2008
I.E. van de Vorst, I. Vaartjes, M.L. Bots, H.L. Koek. University Medical
Center Utrecht
Introduction: We aimed to investigate whether mortality and
readmission risks in dementia have changed over the last decade.
Methods: A prospective nationwide hospital-based cohort of 44,258
patients with a clinical diagnosis of dementia (admitted to a hospital/
visiting a day clinic) was constructed from January, 2000 through
December, 2008 (61.5% women, 81.3 years (SD 7.0)). Absolute risks
(ARs) of one- and three-year mortality and one-year hospital read-
mission were quantified and stratified by type of care (day clinic or
inpatient care). Cox regression models were used to compare hazard
ratios (HRs, adjusted for age, sex, comorbidity) of death and read-
mission across the years using year 2000 as the reference group.
Results: One-year mortality declined over years among men visiting a
day clinic (AR in 2008 versus 2000 was 13.0% and 29.9%; HR 0.41, 95%CI
0.30–0.55). In the same period these ARs among inpatients were 48.7%
versus 53.0%, respectively (HR 0.85, 95%CI 0.77– 0.94. Three-year
mortality also declined (AR for men visiting a day clinic 37.5% versus
58.4%, HR 0.53, 95% CI 0.43– 0.64; and for inpatients 74.4% versus
78.9%, HR 0.80, 95% CI 0.73– 0.88). Whereas one-year readmission risk
decreased among men visiting a day clinic (AR 44.1% versus 65.9%, HR
0.52, 95%CI 0.43 – 0.63), the risk increased among inpatients (AR 36.9%
versus 27.6%, HR 1.48, 95%CI 1.28 –1.72).
Conclusion: Mortality among patients with dementia remarkably
declined between 2000 and 2008. During the same period, one-year
hospital readmission risk increased among inpatients and decreased
among patients visiting a dayclinic.
P-150
The effect of psychotropic drug use on quality of life in nursing
home residents with dementia
A. van der Zon1, M. Smalbrugge2, H. Bor 1, R.T.C.M. Koopmans1,3,
S.U. Zuidema4, D.L. Gerritsen1,3. 1Department of Primary and
Community Care, Radboud Alzheimer Centre, Radboud University
Medical Center, Nijmegen, 2Department of General Practice and Elderly
Care Medicine/EMGO+ Institute, VU University Medical Center,
Amsterdam, 3Joachim en Anna, Center for Specialized Geriatric Care,
Nijmegen, 4Department of General Practice, University of Groningen,
University Medical Center, Groningen, Netherlands
Introduction: Psychotropic drugs (PDs) are frequently prescribed in
nursing home residents with dementia. Neuropsychiatric symptoms
and PDs may affect residents ’ quality of life (QoL). The aim of this study
is to assess the effect of PD use on quality of life in nursing home
residents with dementia.
Methods: A longitudinal multicentre cohort study was conducted in
twelve nursing homes in the Netherlands and included nursing home
residents with dementia. QoL was assessed using the Qualidem and
PDs were registered using patients’ or pharmacist files. Assessments
were made at baseline and each six months during eighteen months.
Mixed models were used to assess the effect of PDs on QoL, correcting
for age, gender, cognition (SIB-8), ADL, neuropsychiatric symptoms
(NPI-Q) and use of other PDs.
Results: 196 residents completed the study period, of whom 23
residents continuously used an antipsychotic (thus during 18 months)
and 112 residents never used an antipsychotic (AP). No statistically
significant differences in Qualidem scores were found when compar-
ing the cohorts with continuous AP use and no AP use. Similarly, no
differences were found between the cohort with continuous anti-
depressant (AD) use (n = 35) and the cohort with no AD use (n = 108).
Those who never used an anxiolytic/hypnotic during the study period
(n = 108) were found to have a better QoL on the subscale “Restless
tense behaviour ” (b = 1.20, SE = 0.58, P = 0.043) compared to residents
who continuously used an anxiolytic/hypnotic (n = 29).
Conclusion: This study suggests that QoL between residents with
continuous PD use (during 18 months) is comparable to QoL of
residents who never used PDs.
P-151
Treatable vascular risk and cognitive performance in persons aged
35 years or older: longitudinal study
M.E.A. van Eersel1, H. Joosten1, R.T. Gansevoort2, J.P.J. Slaets1, G.J. Izaks1.
1University of Groningen, University Medical Center Groningen,
University Center for Geriatric Medicine, 2University of Groningen,
University Medical Center Groningen, Department of Nephrology,
Groningen, The Netherlands
Objectives: Poor cognitive performance is associated with high
vascular risk. However, vascular risk is largely based on age. It is
unclear whether cognitive performance is associated with compo-
nents of vascular risk that are amenable to treatment.
Methods: In this longitudinal study 3,572 participants aged 35–82
years were followed over average period of six years. Cognitive
performance was measured as a composite score of two tests: the Ruff
Figural Fluency Test (range score 0– 175 points) and the Visual
Association Test (range score 0 to 12 points). Treatable vascular risk
score was based on the treatable components of the Framingham
Risk Score for General Cardiovascular Disease (range score − 5 to +17
points).
Results: The mean (SD) cognitive performance changed from 0.00
(0.79) at the first measurement to 0.39 (0.82) at the third measure-
ment (Ptrend <.001). Adjusted for age, educational level and con-
secutive measurement, the change in cognitive performance between
two measurements decreased with 0.004 per one-point increment of
treatable vascular risk (95%CI,−0.008 to 0.000; P = .05) and with 0.006
per one-year increment of age (95%CI, −0.008 to −0.004; P <.001).
Conclusion: Change in cognitive performance was associated with
treatable vascular risk in persons aged 35 years or older. Vascular risk
reduction in middle-age and later may contribute to the prevention of
cognitive impairment and dementia in late-life.
P-152
Randomized study of the impact of physical activity in vascular
cognitive impairment
A. Verdelho1, S. Madureira1, H. Bárrios1, P. Vilela 2, A.C. Santos1,
M. Gonçalves-Pereira3, J.M. Ferro1, M. Correia4, H. Santa-Clara5, on
behalf of the AFIVASC study group. 1Dep. Neurosciences, H. Santa Maria/
CHLN, IMM and ISAMB, Faculty of Medicine, University of Lisbon, Lisbon,
2H. Loures and H. Luz, 3CEDOC, NOVA Medical School/FCM, Univ. Nova
Lisboa, 4H S António, Porto, 5FMH, University of Lisbon, Portugal
Introduction: Vascular cognitive impairment is one of the most
frequent causes of cognitive impairment associated with ageing. There
is no approved treatment for vascular cognitive impairment, and
pharmacological trials have generated disappointing results. In the last
years, observational studies have suggested that physical activity could
prevent progression for cognitive impairment of vascular etiology, but
the level of evidence is quite low.
Methods: We present the protocol of the randomized study of physical
activity in vascular cognitive impairment. The primary objective is to
evaluate the impact of physical activity (moderate intensity-walking
plus additional exercises aimed to promote balance, flexibility and
motor coordination, supervised over 6 month) in cognitive abilities
of patients with evidence of cerebral vascular disease. We also aim to
evaluate the impact in quality of life, autonomy and motor perform-
ance (secondary objectives). Inclusion criteria are clinical evidence
of cerebral vascular pathology (previous acute vascular event more
then 6 months ago, or complaints compatible to vascular etiology
supported by neuro-imaging). Exclusion criteria are mild amnestic
cognitive impairment/other non-vascular cognitive etiology, contra-
indication for MRI, formal indication for physical rehabilitation.
Follow-up will be 12 months. Estimated sample is 300 participants.
The same protocol will be used at inclusion, 6 and 12 months. All
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S68