Læknablaðið : fylgirit - 01.08.2003, Blaðsíða 7

ABSTRACTS / 27TH NORDIC PSYCHIATRIC CONGRESS I
depression in the elderly seems to be underdiagnosed, undertreated
or mistreated in the non-demented elderly.
N-4 Wednesday 13/8,11:30-11:50
Evidence-based treatment of dementia. State of the art
Carsten Emil Olscni. MD, NAPE, Poulsen^ HD, MD, PhD, Lublin2 HKF, MD,
DrMedSC.
■Hvidovre University Hospital, Copcnhagen, Denmark, 2 Rigshospitalet, Copenhagen
Denmark
Background: Drug therapy of dementia in the elderly is today
possible. Furthermore, behavioural and psychological symptoms of
dementia (BPSD) can be treated with anti-psychotics and possibly
with anti-dementia drugs. Due to an increase in the number of
elderly, evidence-based treatment of dementia is required.
Material and methods: Evidence-based (level 1 b) review of peer
reviewed, double-blind, randomized trials of donepezil, galanta-
mine, rivastigmine and memantine up to December 2002. A total of
26 studies were included.
Results: Donepezil, galantamine, rivastigmin, and possibly also
memantine improve the cognition and the global level of func-
tioning in rnild to moderate Alzheimer (AZ). Most evidence is
present concerning galantamine and donepezil. Rivastigmine is the
only drug documented to be effective in Lewy body dementia.
Some evidence exists regarding galantamine, and perhaps donepe-
zil, in vascular dementia. No solid documentation exists for the
treatment of severe dementia.
Conclusion: Elderly with possible dementia should be medically
examined and offered anti-dementia drugs. Today’s indication for
anti-dementia drugs only includes Alzheimer’s disease, and should
be considered to be expanded.
N - 5 Wednesday 13/8, 11:50-12:00
Dementia and ageing. An epidemiological study of the
detection, preclinical phase, course and prognosis of
dementia at age 85 to 88
Ólafur Þór Ævarsson, Institute of Clinical Neuroscience, Department of Psychiatry,
Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
forvarnir@mmedia. is
A population in Gothenburg was followed from age 85 (N=494) to
88 (N=248). Methods included a neuropsychiatric and physical
examination, key-informant interview, MMSE, and CT-scan. Medi-
cal records and death certificates were studied. I. The prevalence of
dementia increased in women (31% to 46%) but not in men (27%
to 25%). Proportion of vascular dementia was 47% at age 85 and
54% at 88, despite a higher mortality in vascular dementia. II. The
incidence of dementia was 90.1/1000/year (61.3 men; 102.7 women;
p=0.085). The incidence of Alzheimer’s disease was 36.3/1000/year,
vascular dementia 39.0/1000/year (p=1.000) and other dementias
9.1/1000/year. III. In the preclinical phase, both Alzheimer’s disease
and vascular dementia were preceded not only by cognitive
impairments, but psychiatric, behavioral, and subcortical signs as
well. IV. At the age of 85, the non-demented subjects had a mean
score of 27.7 on MMSE, and demented 14.5 (p<0.001). More than
half of those with mild dementia scored above the cut-off score
23/24. Of the non-demented, 75% scoring below 24 and 37% of
those scoring 24 to 25 became demented during the follow-up.
Subjects not developing dementia had a mean decline in MMSE-
score of 0.6/year, while those who became demented declined by
2.3/year. Correlation was found between MMSE scores and
education both in non-demented and demented. V. Among 20
mental and physical disorders studied, dementia was the most
important predictor of mortality, predicting 31% of all deaths in
men and 50% of all deaths in women, calculated by Population
Attributable Risk (PAR). Life expectancy decreased with dementia
severity. Survival in women with mild Alzheimer’s disease was
similar to that of non-demented women.
N - 6 Wednesday 13/8,12:00-12:10
Dementia and mental disorders among elderly in primary
care
María Ólafsdóttir, NAPE, MD, PhD, General Practitioner, Ass. Professor University of
Iceland, The Primary Care, Reykjavík, Mávahrauni 1,220 Hafnarfirði, Iceland. Skoog I,
Marcusson J.
maria. olafsdottir@simnet. is
Aims: In order to investigate how elderly patients with dementia
and mental disorders were managed in primary care, the prevalence
of the diseases and detection was investigated.
Design: Patients aged 70 years and older visiting a primary care
centre (PCC) in Linköping (N=1225) were examined with a Mini
Mental Status Examination (MMSE). In a sub-sample (N=350) a
comprehensive neuro-psychiatric examination and an interview
with a close informant were conducted. AU medical records (N=350)
in the PCC were reviewed regarding diagnoses, medication and the
number of visits to the centre. Dementia and mental disorders were
diagnosed according to DSM-III-R.
Results: The prevalence of dementia and mental disorder according
to the psychiatric interview was 33% (16% dementia, 17% mental
disorders). The frequency of psychiatric symptoms among those
with no mental disorder was up to 66%. Dementia was detected in
25% of cases, depression in 12% of cases and anxiety in 30% of
cases.
Conclusions: The prevalence of dementia and mental disorders in
an elderly PCC population is high. As the major problem in the
management of dementia and mental disorder has been under
detection, some screening tool for cognitive function in this group is
recommended and the formation of an effective network, to
manage the continuing care of patients.
N-7 Wednesday 13/8,14:00-15:30
Psychiatric epidemiology of old age
Ingmar Skoog Institute of Clinical Neuroscience, Department of Psychiatry, Sahlgrenska
University Hospital, SE-413 45 Gothenburg, Sweden
Dementia and other mental disorders are examined in representa-
tive samples followed longitudinally in Gothenburg, Sweden; The
LÆKNABLAÐIÐ / FYLGIRIT 48 2003/89 7