European Geriatric Medicine - Supplement 1 - Volume 6

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Poster presentations / European Geriatric Medicine 6S1 (2015) S32

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S156

hyponatremia (112 mEq/L). Medical history includes vascular

dementia, hypertension and previous pulmonary tuberculosis. The

etiologic investigation revealed: urinary Na 110 mEq/L; urinary

osmolality 285 mOsmol/kg; seric osmolality 257 mOsmol/kg; ADH

9.2 pcg/mL. In both cases, hypothyroidism, hypocortisolism and

iatrogenic causes were excluded and hyponatremia was reversed

with fluid restriction. As so, in both cases, SIADH was assumed as

the cause of hyponatremia.

Discussion and Conclusion:

Both nosologic entities (SIADH and

vascular dementia) are relatively common among elderly patients

and can have a common cause: a vascular insult. However, SIADH is

still being overlooked as the etiology of hyponatremia in detriment

of causes such as congestive heart failure, acute kidney injury and

drugs.

With this article, we want to point out the association between

these two distinct pathologies with the same etiology and the

importance of its correct diagnosis and treatment.

P-068

Systematic evaluation of neuropsychiatric symptoms is

warranted in Alzheimer’s disease

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ALSOVA follow-up study

I. Hallikainen

, T. H¨anninen

, A. Koivisto

University of Eastern Finland, Kuopio, Finland;

Kuopio University

Hospital, Kuopio, Finland;

Kuopio University Hospital, University of

Eastern Finland, Kuopio, Finland

Objectives:

In addition to progressive cognitive and functional

deficits, neuropsychiatric symptoms (NPS) are common in

Alzheimer’s Disease (AD). These behavioural and psychological

symptoms may affect well-being of persons with AD and their

caregivers more than cognitive problems, but less attention have

been paid on them. We monitored the progression of NPS during a

five-year follow-up.

Methods:

We analyzed the five-year follow-up data of ALSOVA

study participants with very mild (CDR-0.5 group) or mild (CDR-1

group) AD at baseline. Of 236 included subjects, 73 participated in

the last follow-up visit. NPS was measured with Neuropsychiatric

inventory (NPI) and dementia severity with the Clinical Dementia

Rating Score (CDR).

Results:

Neuropsychiatric symptoms increased along with

dementia severity. Persons with very mild AD (CDR 0.5) at baseline

exhibited less NPS after three years than CDR-1 group had had at

baseline, even they had more severe disease. Statistically significant

difference between CDR-0.5 and CDR-1 groups maintained during

a five-year follow-up period. We also present the prevalence of

each neuropsychiatric symptom in annual visits during a five-year

follow-up. Some symptoms increased, while others declined or

fluctuated during the follow-up.

Conclusion:

Even if the total score of NPS increases during the five-

year follow-up after diagnosis, the prevalence of single symptoms

vary. Persons who were diagnosed in the early phase of the disease,

had less NPS during the first three years of the follow-up than

others at baseline. The results emphasize the importance of the

early detection of AD, and systematic evaluation of NPS during a

follow-up.

P-069

Grip strength and walking speed as indicators of cognitive

impairment among older people

E.S. Han

, Y.H. Lee

, J.H. Kim

Seoul National University Bundang Hospital, Seongnam, Republic of

Korea;

Ajou University School of Medicine, Suwon, Republic of Korea;

Institute on Aging, Ajou University Medical Center, Suwon, Republic

of Korea

Objectives:

To examine the association of grip strength and walking

speed with cognitive impairment in community-dwelling older

adults.

Methods:

Data were from the 2008 Living Profiles of Older People

Survey, with 10,106 aged 65 years or older living in South Korea.

Cognitive impairment was defined as more than 1.5 SD below the

age, gender, and education-specific mean on the Mini-Mental State

Examination. Grip strength and walking speed were measured.

Multiple logistic regression analysis was performed adjusting for

health-related covariates.

Results:

Of the participants 25.6% (31.2% of men and 21.9% of

women) were cognitively impaired. Compared with women, men

exhibited a higher grip strength (28.3

8.9 kg versus 17.2

6.2 kg)

and gait speed (4.7

2.6 m/sec versus 5.8

2.8 m/sec). Those with a

higher grip strength (odds ratio [OR]: 0.53, 95% confidence interval

[CI]: 0.45–0.62 for highest quartile [Q4] versus lowest quartile [Q1])

and faster walking speed (OR = 0.84, 95% CI: 0.71–0.98 for Q4

versus Q1) had a lower likelihood of cognitive impairment (p for

trend

0.001). Whereas grip strength was significantly associated

with cognitive impairment in both genders, walking speed was

significant only in women.

Conclusions:

In both men and women, higher grip strength was

associated with a lower odds of cognitive impairment. Faster

walking speed was, however, significantly associated with a

reduced likelihood of cognitive impairment only in women. Grip

strength may be a more sensitive indicator than walking speed in

identifying older adults who are cognitively impaired.

P-070

Pneumonia and intake problems: inherent to advanced

dementia?

S. Hendriks

, M. Smalbrugge

, A. van Gageldonk-Lafeber

F. Galindo-Garre

, M. Schipper

, C. Hertogh

, J. Van der Steen

EMGO+ Institute for Health and Care Research, VU University Medical

Center, Amsterdam, Netherlands;

Netherlands;

National Institute for

Public Health and the Environment (RIVM), Bilthoven, Netherlands;

VU University Medical Center, Amsterdam, Netherlands

Objectives:

We explore how pneumonia and intake problems affect

survival in nursing home residents with variable stages of dementia,

and whether and how dementia severity is related to pneumonia,

intake problems, and mortality.

Methods:

Data were collected as part of a longitudinal

observational study (DEOLD), with up to 3.5 years of follow-up

(28 facilities, 372 nursing home residents). Physicians registered

any incident pneumonia and intake problem. Dementia severity

was measured semi-annually with the Bedford Alzheimer Nursing

Severity-Scale. We examined relationships of dementia severity

with mortality, pneumonia and intake problems using joint

modelling, Cox models with time dependent covariates and

mediation analyses.

Results:

Pneumonia occurred in 28% (hazard rate during first year

0.27; 95% CI: 0.20–0.33), and intake problems in 34% of the residents

(hazard rate during first year 0.29; 95% CI: 0.23–0.35). The 1-year

mortality rate was 0.45 (95% CI: 0.37–0.53). Incident pneumonia

and incident intake problems were more strongly associated with

mortality risk (Hazard ratio (HR) 4.1; 95% CI: 3.1–5.4 and HR

8.4; 95% CI: 6.4–11, respectively) than dementia severity (HR 1.19;

95% CI: 1.14–1.23). Both incident pneumonia and incident intake

problems mediated the relationship between more severe dementia

and mortality (p = 0.026, p

0.001, respectively).

Conclusions:

The 1-year mortality rate was high, and mortality

risk, compared to dementia severity, depends more strongly on

the development of pneumonia and intake problems. A focus on

palliative care needs is therefore important in all stages of dementia,

and advance care planning may help patients and families prepare

for the future.