Malaysian Journal of Psychiatry 2012; 21(Suppl)
Compilation of Abstracts
17th Malaysian Conference on Psychological Medicine
&
The 6th Asian Society Against Dementia International Congress
“Diversity & Harmony in Care”
14th - 16th June 2012 Venue: Sheraton Imperial Kuala Lumpur Hotel
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CONTENTS
Plenary Sessions Page 3-8
Symposia Sessions
ASAD Symposium Page 9-26
General Symposium Page 26-27
Lunch Symposium Page 28
Oral Free Paper Presentation Page 28-42
Poster Presentation Page 42-57
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PLENARY SESSIONS
Plenary 1 The Assessment and Care of Older People with Dementia from Culturally and Linguistically Diverse Backgrounds Prof. Dr. Daniel O’Connor Monash University, AUSTRALIA Cognitive assessment presents special challenges in the case of older people from culturally and linguistically diverse (CALD) backgrounds, particularly those with little education and limited fluency in the predominant language. Groups at risk of invalid assessment and incorrect diagnosis include members of marginalised indigenous communities, refugees and migrants. Even simple cognitive screening tests are subject to educational bias and examples will be given of attempts to develop more culturally appropriate tools. For CALD people who develop dementia, admission to a residential facility can result in great social isolation. Nursing homes that cater to members of particular ethnic groups help meet residents’ need for easy communication with staff and co-residents but such facilities are not always available or accessible. Ways of overcoming their isolation will be discussed.
Plenary 2 Early Onset Familial Alzheimer Disease (EOFAD): Opportunity to Test Disease Modifying Drugs for AD Prof. Dr. Serge Gauthier McGill University, CANADA There is great interest in Early Onset Familial Alzheimer’s Disease (EOFAD) because the mutation carriers can be treated with amyloid-acting drugs in pre-symptomatic and early symptomatic stages. The availability of revised diagnostic criteria taking into account biomarkers of amyloid deposition and of neurodegeneration facilitates the enrolment in early stages of disease. Furthermore the natural history of the progression of such biomarkers has been studied in untreated patients with EOFAD through the Dominantly Inherited Alzheimer Network (DIAN), using a model similar to the Alzheimer Disease Neuroimaging Initiative (ADNI). It is possible that disease-modifying drugs for AD will be more effective in this group with relatively homogeneous amyloid pathology compared to late onset AD with vascular and Lewy body co-morbidity.
Plenary 3 Restoring Circadian Rhythms: A New Way to Successfully Manage Depression Prof. Dr. Azhar Md Zain Universiti Putra Malaysia, MALAYSIA The heterogeneity of symptoms within MDD poses significant challenges for treatment and it is likely that current pharmacotherapies do not target all symptoms equally, although they may have similar efficacy rates. While there is still continuing interest in understanding monoamine interactions and consequent downstream effects, the limited efficacy and tolerability achieved with classical antidepressants provides a compelling argument to move beyond the monoamines. Recent advances in our understanding of the fundamental links between chronobiology and major mood disorders, as well as the development of new drugs (like Agomelatine) that target the circadian system, have led to a renewed focus on this area.
Plenary 4 Managing Broad Symptoms of Major Depressive Disorder - Looking Beyond Remission Prof. Dr. Azhar Md Zain Universiti Putra Malaysia, MALAYSIA Major Depressive Disorder (MDD) is a devastating illness to patients, families and society and will likely become more burdensome in the coming decade. It has a progressive course and may be associated with functional and structural changes in the brain. 5HT and NE influence the balance between excitatory and inhibitory activity in the prefrontal cortex and limbic system. MDD can present with a broad range of symptoms; not just emotional symptoms, but also anxiety and physical symptoms that may need to be addressed. Improvement of these symptoms associated with depression may
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MJP-21(Suppl)-2012 improve chances for remission. Successful treatment of broad range of symptoms may be an important consideration for optimizing depression treatment outcomes. Thus using an antidepressant that treats broad range of symptom increase the chance of remission and achieving optimal functioning outcomes.
Plenary 5 Therapeutic Goals in the Management of Bipolar Disorder, and the Potential Role of Asenapine (Saphris) Prof. Dr. John Tiller University of Melbourne, AUSTRALIA Bipolar disorders are severe, complex and cyclical mood disorders associated with considerable morbidity, mortality, and unmet needs. Bipolar disorders are multidimensional characterised by dramatic mood swings between manic/hypomanic and depressive episodes, with intervening periods of normal mood often interrupted by subsyndromal symptoms. Patients may also present in a mixed state, whereby they meet the criteria for both a manic and a depressive episode simultaneously. Patients with bipolar disorder can also experience rapid cycling, characterised as the occurrence of .4 mood episodes within 12 months. Co-morbid psychiatric and somatic conditions not only further complicate diagnosis and therapy but also increase mortality which is a major concern in individuals with mood disorders. The mortality rate from suicide alone in bipolar disorder is approximately 10 times that of the general population. Bipolar disorder is a highly recurrent illness; more than 90% of patients report multiple affective episodes across their lifetime. Recent, large-scale, prospective studies have revealed that patients remain symptomatic for approximately 50% of their lives. Consequently, bipolar disorder has a dramatic long-term impact on patient’s social and occupational function and quality of life. The therapeutic goals are for symptomatic response and preferably remission. More importantly is that of functional recovery and rehabilitation. The atypical antipsychotic agent asenapine has been shown to be effective in the treatment of mania. The potential role of asenapine in bipolar disorder treatment will be reviewed.
Plenary 6 The Relationship Between Depression, Cognitive Decline and Dementia: Reflecting on the New Criteria for the Dementias Prof. Dr. Daniel O’Connor Monash University, AUSTRALIA Most health professionals are now aware of the terrible consequences of falsely diagnosing dementia in older depressed patients. The pendulum has now swung the other way, though, with massive prescribing of antidepressant medications to people with dementia, often without adequate assessment or review. Our understanding of the relationships between depression, cognitive impairment and dementia is now much more nuanced. The cognitive impairment associated with depression does not always resolve and increases the risk of dementia in subsequent years. Conversely, some people with undoubted dementia are also persistently and severely depressed. Recent studies suggest that antidepressant medications are not effective in this group but contrary evidence and arguments will be presented to support their use in carefully selected cases.
Plenary 7 Reflecting on the New Criteria for the Dementias Prof. Dr. Nicola T Lautenschlager Melbourne University and St Vincent’s Health, AUSTRALIA Recently changes to the current classification of dementias and causes of dementia, such as Alzheimer’s Disease have been suggested, acknowledging that newly accumulated knowledge, for example on biomarkers, should be incorporated. This plenary will review the newly suggested criteria for dementia due to Alzheimer’s Disease, mild cognitive impairment due to Alzheimer’s Disease and the preclinical stages of Alzheimer’s disease by the National Institute on Ageing and the Alzheimer’s Association. It will also critically review the revised definition of Alzheimer’s Disease published by the International Working Group for New Research Criteria for the diagnosis of Alzheimer’s Disease and the suggestions how to replace the term dementia in DSM-V. Whilst it is encouraging that more knowledge on the 4
MJP-21(Suppl)-2012 development of the underlying pathologies of dementias is available these new criteria have to be carefully investigated regarding their clinical utility. They also raise a number of ethical issues and highlight the challenge to bridge newest developments in research with clinical health care provision.
Plenary 8 First Episode Schizophrenia: Treatment to Remission Assoc. Prof. Dr. Lee Wing-King Chinese University of Hong Kong, Shatin, New Territories, HONG KONG In this lecture, I shall re-visit the literature of the neuro-progression of schizophrenia, critical period hypothesis, the impact of duration of untreated psychosis (DUP) and the cost-effectiveness of specialized early intervention services versus generic services of first-episode psychosis, including Scandinavian TIPS, Danish OPUS, and UK LEO studies. Neuro-progression was demonstrated with duration and number of psychosis. DUP studies showed poorer prognosis with longer DUP. Early intervention studies demonstrated cost-effectiveness of specialized services compared with generic services. The primary outcome of time to and rates of discontinuation for any cause within 12 months of a recent large trial of first-episode schizophrenia and schizophreniform disorder was discussed. The result of a recent meta- analysis comparing second generation antipsychotics (SGAs) with first generation antipsychotics (FGAs) showed that 4 SGAs are more efficacious than other antipsychotic medications. The latest Maudsley Prescribing Guideline recommendation for treatment of first-episode schizophrenia was highlighted. Two clinical case vignettes illustrating the use of amisulpride after failing risperidone treatment and the management of hyperprolactinaemia side effect were shared in the lecture. In summary, schizophrenia requires early, comprehensive and effective intervention throughout the course of illness for optimal outcomes. Treatment with appropriate pharmacological option as early as possible is a critical strategy for enhancing recovery, achieving optimal multiple-domain outcomes, delaying relapse, preventing iatrogenic trauma due to hospitalization, improving illness trajectory, preventing treatment resistance and reducing carer burden.
Plenary 9 Current Trends of Major Depressive Disorder Management Dr. Abdul Kadir Abu Bakar MALAYSIA Abstract not available
Plenary 10 Physical Activity and Cognitive Function Prof. Dr. Nicola Lautenschlager Melbourne University & St Vincent’s Health, AUSTRALIA This plenary will give an overview on the current evidence on physical activity as a potential protective factor for the ageing brain. Recently the interest and number of publications have increased in regular physical activity as a potentially protective modifiable lifestyle factor to support cognitive function. This presentation will focus on the on-going debate on whether physical activity has the potential to delay the onset and progression of cognitive impairment in old age. Current hypotheses of the biological mechanisms which aim to explain the positive effects of physical activity on the brain will be discussed. Results of clinical studies both with cognitively healthy older adults as well as those with mild cognitive impairment and dementia will be critically reviewed. Several questions remain in the quest to develop an effective strategy of health promotion for the community such as what duration, intensity, type of physical activity is most suitable and how older adults can be best motivated.
Plenary 11 Genetically Manipulated Mouse Models for Human Diseases: Vascular Complications and Dementia Prof. Dr. Sookja Chung University of Hong Kong, HONG KONG Mouse genome has been manipulated to understand the pathogenesis of human diseases by employing the state-of-art technology, i.e., conventional, conditional and inducible transgenic and knockout mouse
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MJP-21(Suppl)-2012 technology. The genetically manipulated mouse models are powerful reagents for understanding the genes’ function and their role in complex disease processes. We have been focusing on the function of genes that are involved in hypoxic/ischemic, osmotic and oxidative stress and their dysfunctions in the pathogenesis of diseases, such as diabetes insipidus, hypertension, stroke, dementia, Parkinson’s disease, obesity, and diabetes mellius and its complications including diabetic neuropathy, nephropathy, cardiopathy, embryopathy, and retinopathy. The role of these genes in the pathogenesis of vascular complications and dementia will be discussed in more detail. The understanding of downstream signalling pathways of the genes mentioned above would lead to devise novel diagnostic tools and effective therapies for prevention of human diseases including dementia in order to improve the quality of life.
Plenary 12 Metabolic Syndrome Assoc. Prof. Dr. Ahmad Hatim Sulaiman MALAYSIA Abstract not available
Plenary 13 Symptom Relief,Remission & Restore Functionality Prof. Dr. Allan Young United Kingdom Abstract not available
Plenary 14 Treatment Resistant Depression Prof. Dr. John Tiller University of Melbourne, Australia Depression is one of the commonest psychiatric illnesses. It is not just unhappiness, or a transient response to loss or adverse social circumstance, but represents a potentially serious and always disabling mental disorder. Though a patient may present on several occasions with what appears to be unipolar depression, it may be only a later occasion that an episode of mood elevation is identified and the diagnosis revised to that of bipolar disorder, which may need different treatment. A common expectation in the community is that a person simply needs to “pull themselves together” in order to get well, and for mild depression, psychological interventions may well suffice to treat the disorder. For unipolar depression of moderate severity antidepressants are a reasonably well tolerated and effective treatment. They also can help associated anxiety though can have variable effects on sleep. While most patients might have an expectation of an antidepressant being successful, a typical response rate is about 70% while only about 50% in studies achieve remission. Acute treatment studies generally do not involve the additional critical element of psychosocial rehabilitation. Despite trying several antidepressants in conjunction with psychological techniques when appropriate, some patients just do not seem to respond. Depression is regarded as treatment resistant when two or more antidepressants have been tried in an adequate therapeutic dose for long enough for benefit to otherwise become apparent. Though historically agents like lithium carbonate have been used to augment antidepressants, there is now an increasing awareness of the benefit of atypical antipsychotics as augmenting agents. These agents and some anticonvulsants like sodium valproate, carbamazepine and lamotrigine are also useful for bipolar depression. Electroconvulsive therapy relates to many treatments with the common element of the use of an electrical stimulus to induce a fit for therapeutic purposes. There are many types of ECT, with older techniques causing significant memory impairments that are minimised or do not occur with newer techniques. ECT can help unipolar and bipolar depression and may be enhanced with atypical antipsychotics. As a result of these developments, effective treatment is now available for many who previously had resistant depressions.
Plenary 15 Dementia and the Great East Japan Earthquake 2011 6
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Prof. Dr. Kenichi Meguro Tohoku University Graduate School of Medicine, JAPAN The aim of our laboratory is to study the neuroscience of dementia and contribute to the welfare of elderly people. Our work in Miyagi prefecture has always been our priority. However, we never expected to experience such an extreme challenge as that of the March 2011 earthquake. The primary emergency stage, in which the activities of rescue and emergency teams play the most critical role, dementia patients were often confused in unfamiliar shelters, leading some troubles with healthy people. However, the use of the Long-Term Care Insurance was effective to care them. Ten days after the earthquake, the primary stage was followed by the secondary support stage. At this time, refugees from the most damaged areas began to arrive in less damaged areas, including our research areas. Responding to the Osaki City’s request to confirm the safety of residents, we visited 7,604 houses. We discovered various “weakness due to the disaster;” most of them were previously assessed as CDR 0.5. We also saw institutionalized patients. Group homes A and B were damaged by the Tsunami and the residents were evacuated to another home C. Aggravation of dementia was anticipated due to the overcrowded conditions. However, an investigation showed improved behaviors in 60%, suggesting the stimulation of their remote memory, together with the consideration of compatibility of residents by the staff. We would like to express our deepest sympathy for people who have suffered from this disaster.
Plenary 16 State-Of-The-Art Assistive Technology for People with Dementia Dr. Clifton Phua Institiute for Infocomm Research, SINGAPORE This presentation is motivated by the expanding demand and limited supply of long-term personal care for People with Dementia (PwD), and assistive technology as an alternative. Tele-care allows PwD to live in the comfort of their own homes for a longer time. It is challenging to have remote care in smart homes with ambient intelligence, using devices, networks, activity and plan recognition. The scope is limited to mostly related work on existing execution environments in smart homes, and activity and plan recognition algorithms which can be applied to PwD living in smart homes. PwD and caregiver needs are addressed in a more holistic healthcare approach, domain challenges include doctor validation and erroneous behavior, and technical challenges include high maintenance and low accuracy. State-of-the- art devices, networks, activity and plan recognition for physical health are presented; ideas for developing mental training for mental health and social networking for social health are explored. Recently, we have moved towards a more practical stakeholder-based design of assistive technology for PwD. We will share assistive technology needs we have elicited through focus group discussions with voluntary welfare organizations, nursing homes and other care homes, government organizations, and vendors.
Plenary 17 Treatment of Depression - Promises and Problems Prof. Dr. Maniam Thambu UKM Medical Centre, MALAYSIA Since the days of DSM III when the diagnosis of depression was simplified, diagnostic reliability has improved, but it is debatable whether the validity is any better. Major depression, for example, appears to be a mixed bag, and there are calls, by Ghaemi for instance, for a return to the earlier ways of looking at depression as a reaction to circumstances. Nevertheless, a diagnosis of major depressive disorder sounds sufficiently impressive to issue a prescription. Evidence appears to indicate that mild to moderate depressive illness does not require antidepressant drug treatment, unless it does not respond to psychotherapeutic approaches. Doctors appear to be “drug dependent” in the sense that we are overly reliant upon drugs. This “dependence” is troubling for many patients and relatives. Man, after all, is a social creature, and his brain, as Deakin put it, is a social brain, where receptor functions are affected by social stressors. A broken-hearted young man may meet criteria for major depression after 2 weeks, but reaching for the prescription book is not likely to be good enough. Paucity of resources in terms of time 7
MJP-21(Suppl)-2012 and trained personnel, accounts for much of this propensity for overprescribing In any case only about 50% of depressed persons respond to antidepressants and only about a third remit. Generally all SSRIs are about equally effective, whereas the SNRIs and NaSSa are claimed to be somewhat better. Cipriani’s network meta-analysis which took into consideration both efficacy and acceptability/tolerability issues of antidepressant drugs showed that Sertraline and Escitalopram had the most favourable outcome. The newer antidepressants did have good efficacy but were somewhat less tolerable. Network meta-analysis has its problems, though. Medications are necessary in many cases, especially those with severe depression, but they must be seen as not more than necessary platforms on which psychotherapeutic work is done. In situations where there is no response to usual treatment other treatment strategies include ECT, repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and kemadrine infusion.
Plenary 18 Managing Challenging Behaviors in the Community Dr. Ian Andrew James Newcastle Healthcare Trust The Newcastle Challenging Behaviour Community Service was established in 1997, and since this time it has contributed to the closure of 3 long term dementia wards and a specialist unit for treating Behavioural and Psychological Symptoms of Dementia (BPSD). A stepped-care model has been utilised, with early screening and advice being provided as a first step, prior to the use of more comprehensive, expensive and specialised input. This presentation looks at the work of the NCBCS over the last 15 years, highlighting some of the lessons learned.
Plenary 19 Forensic Psychiatry: Mothers who Kill Dr. Hjh Rabaiah Mohd Salleh Hospital Bahagia, MALAYSIA The murder of a child by a parent is known as filicide while neonaticide specifies the killing of a child on the day of birth. A mother who kills her child under the age of 12 months can be found guilty of infanticide, where she is said to have not fully recovered from the effects of giving birth causing her to suffer from some degree of mental disturbance. Filicide has been classified and described by many authors based on the perceived motives and whether the source of the impulse for the mother’s homicidal act comes from the child itself, the mother or the situation. Because of considerable overlap between the different classifications, the general findings indicate that filicide happens; 1. by mentally ill mothers, who kill their child in the context of psychotic illness or depression, 2. in unwanted children, whether by mother’s passive neglect or active aggression, 3. by retaliating women or spousal revenge of a mother who displaces aggression from her spouse to the child, 4. as accidental or unintentional death due to battery by abusive mothers who kill their child in an impulsive act stemming from the child’s behavior 5. in mercy killing which involves cases in which there was true suffering by the child without any apparent secondary gain to the mothers.
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ASAD Symposium
SYMPOSIUM 1A: SMC AND MCI
S1A-1 Clinical Significance of SMC in the Diagnosis of MCI Assoc. Prof. Dr. Anam Paulus Ong University Hasan-Sadikin, Bandong, INDONESIA Subjective memory complaints (SMC) are the expression of perceived everyday memory and related cognitive concerns by individuals who may or may not have deficits on objective testing. SMC may occur in up to 50% of the healthy elderly population although after the exclusion of depression the rate was around 20-30%. In cognitively impaired individual, the awareness of deficit usually decreases as severity of cognitive impairment increases. Association of SMC with objective cognitive impairment has not been consistently replicated, especially in cross-sectional studies. A recent meta-analysis study examining the diagnostic value of SMC in dementia, the pooled sensitivity was 43% and specificity was 85%. For MCI, the pooled sensitivity was 37.4% and specificity was 86.9%. In the community studies, SMC showed low positive and high negative predictive value 18.5% and 93.7% for dementia, and 31,4% and 86.9% for MCI. The clinical utility index suggested “poor” value for ruling in a diagnosis of dementia but “good” value for ruling out diagnosis.
S1A-2 Predictors of Conversion to Dementia from MCI Dr. Jacqueline Dominguez St Lukes Medical Centre, PHILIPPINES MCI refers to a clinical transitional state between the cognitive changes of aging and the earliest clinical features of dementia. The overall prevalence of MCI is probably in the 12% to 15%, and the incidence rates are in the 1% per year range, similar to those of AD. In general, patients with the aMCI of a presumed degenerative etiology (pre-AD MCI) progress to dementia, usually AD, at a rate of 10% to 15% per year. A major question in the field of MCI research concerns the ability to predict which MCI subjects are more likely to progress to dementia or AD more rapidly than others. Potential candidates for predicting progression have been studied: clinical severity, MRI hippocampal volumes, APOE4 carrier status, [18F] fluorodeoxyglucose (FDG)-PET, CSF biomarkers, molecular (amyloid) imaging. However these modalities are not yet for clinical use because of limitations: MRI tissue volume changes are not specific for AD and require intensive skilled labour; CSF measurements of total T-tau level and CSF amyloid beta1-42 (Ab42) which are not specific for AD, and do not readily change with disease progression; CSF Ab42 levels are not easily interpreted because CSF Ab is not exclusively brain derived and because production and clearance are not well characterized; CSF acquisition is invasive and amyloid imaging protocols are not readily available. These modalities need further validation before clinical use.
S1A-3 Mild Cognitive Impairment in the New Classification System Assoc. Prof. Dr. Chin Ai-Vyrnn University Malaya Medical Centre, MALAYSIA Preventing cognitive impairment has become an increasingly crucial issue as the world wide population ages. As there is no curative treatment at present for dementia, much interest has focused on pre- dementia states to better understand underlying pathological factors and identify possible interventional strategies. Such pre-dementia states have been described from antiquity. However, the term, Mild Cognitive Impairment (MCI), has only been used in the past few decades to describe a symptomatic pre- dementia stage following the publication of two clinical staging systems, the Clinical Dementia Rating Scale and the Global Deterioration Scale, in 1982. The concept of MCI as a transitional state between normal ageing and dementia, particularly dementia caused by Alzheimer’s disease was further developed by Petersen et al in 1999. A consensus report on MCI was published by the International Working group 9
MJP-21(Suppl)-2012 on MCI in 2004 to integrate clinical and research perspectives. A revised criteria and guideline for MCI was published by the National Institute on Aging- Alzheimer’s Association (NIA-AA) workgroups in 2011. Since MCI is a syndrome that cannot be diagnosed by a laboratory test but requires clinical judgement, clear diagnostic guidelines are essential for accurate diagnosis. The original diagnosis of MCI was limited to individuals with cognitive impairment in a single domain (memory) to distinguish it from dementia. This was later broadened to include non-amnestic and multiple domain presentations but required preservation of function. Recommendations from the NIA-AA working group and its implications, if any, for clinicians and researchers in this area will be discussed.
S1A-4 Spatial Navigation in MCI Assoc. Prof. Dr. Pai Ming-Chyi National Cheng Kung University, TAIWAN Spatial navigational impairment (SNI) frequently occurs in patients with Alzheimer’s disease (AD), even in the very early stage of the disease. When occurred, it may lead to unexpected results. Studies demonstrated that the occurrence of SNI in very mild AD patients is not parallel with their general cognitive functions. The mechanisms of SNI are complex and remain not entirely understood. In very mild AD patients, SNI is considered to be consequent to hippocampal dysfunction with disrupted cognitive maps or spatial representations of their familiar environments. SNI, however, can be resulted as well from an impaired visual perception of the street scenes, a loss of directional sense, egocentric disorientation, executive dysfunction or a combination of any of the above. Although not entirely dovetailed, the model adopted from focal brain damage, as proposed by Aguirre and D’Esposito (1999), is used for the explanation for SNI in AD. Some researchers believe that patients who manifest SNI in the early stage of AD may represent a variant of the disease when brain areas critical for human navigation are selectively damaged.
In this talk, I will present the clinical implication of SNI from the viewpoint of a behavioral neurologist and the findings from the works of our research team over the past years. I will also stress the role of SNI as a potential indicator to detect symptom in early or prodromal AD.
SYMPOSIUM 1B: PREVENTION AND RISK FACTOR
S1B-1 Diabetes, Cognitive Impairment and Dementia Dr. Stephen Jones Newcastle University Medicine (NUMED), MALAYSIA Diabetes and dementia are both becoming more common and present a major public health challenges. This presentation will explore the literature to define the nature of the link between the two conditions. The possibility of altering the prevalence of dementia, through improved diabetes treatment will be discussed. Finally some of the challenges of managing blood glucose effectively in people with dementia will be described.
S1B-2 Hypertension, Hyperlipidemia and Other Cardiovascular Risk Factors in Dementia Dato’ Dr. David Chew National Heart Institute, MALAYSIA With an increasingly aging population, the number of patients with dementia will also grow rapidly. Dementia will become an important health problem and economic burden. At present, there is no cure and available therapies provide only mild relief of symptoms. Both Alzheimer’s disease and vascular dementia have been associated with cardiovascular diseases, and cardiovascular diseases like heart failure has been associated with a higher risk of dementia. Hypertension, diabetes mellitus, hyperlipidemia and other cardiovascular risk factors have also been associated with a higher risk of dementia, suggesting common biologic pathways. The risk for dementia is especially high when multiple cardiovascular risk factors are present. These findings suggest that interventions targeting cardiovascular 10
MJP-21(Suppl)-2012 risk factors may not only prevent cardiovascular disease but also dementia and reduce the dementia epidemic. However it remains to be proven that treating cardiovascular risk factors will prevent dementia.
S1B-3 Traditional Diets – Role of Dietary Lifestyle in Preventing Dementia Prof. Dr.Ennapadam Krishnamoorthy TEJAS Healthcare, INDIA In this symposium we will begin by reviewing the current evidence with respect to nutrition and dementia. We will examine the role of nutrition as a risk factor for cognitive decline; the current evidence associating diets and cognitive status; the links between lifestyle diseases, nutrition and cognitive decline; and the current understanding of protective factors therein. We will then proceed to explore empirical understanding of traditional diets and their impact on cognitive decline with special reference to Indian systems of medicine- Ayurveda, Naturopathy & Yoga. This latter section will be illustrated through case studies from the clinical practice of integrative medicine, outlining also the comprehensive care model for dementia and other neurodegenerative disorders practiced by us in Chennai.
S1B-4 Mentally Stimulating Activities can Prevent Dementia Dr. Yau Weng Keong Hospital Kuala Lumpur, MALAYSIA The incidence and prevalence of dementia is expected to increase several fold in the coming decades. Given that the current pharmaceutical treatment of dementia can only modestly improve symptoms, risk factor modification remains the cornerstone for dementia prevention. The term cognitive reserve is frequently used to refer to the common finding that, during later life, those higher in education and knowledge exhibit higher levels of cognitive function. Perhaps the most interesting findings regarding cognitive reserve hypotheses were by Snowdon et al. who found that linguistic ability among nuns at a mean age of 22 was predictive of their cognitive performance and the risk of Alzheimer’s disease approximately 58 years later. Epidemiologic evidence suggests that higher occupational attainment and education, as well as increased participation in intellectual, social, and physical aspects of daily life, are associated with slower cognitive decline in healthy elderly and may reduce the risk of incident Alzheimer disease (AD). It has been hypothesized that such aspects of life experience may result in functionally more efficient cognitive networks and, therefore, provides a cognitive reserve that delays the onset of clinical manifestations of dementia. Prospective cohort studies have found that participation in mentally-stimulating activities is associated with a lower incidence of AD and even late-life mental activity exhibits a dose-dependent inverse relationship with dementia risk, independent of early life experiences. Consequently, it is possible that participation in complex mental activities at older age may offer protection from cognitive decline and hence mitigate dementia risk.
SYMPOSIUM 1C: ASSESSMENT
S1C-1 Evaluation of the Cognitive Screening Programme in the Primary Care in Malaysia Dr. Ho Bee Kiau Kapar Health Center Selangor, MALAYSIA Dementia is a worldwide problem with global prevalence of 6.1% for those over 65 years of age and older. In Malaysia, there have been few prevalence studies of dementia. Local study in Malaysia found that the prevalence of dementia in community was 6% for those elderly over 60 years of age and older and higher among the elderly in the long term care (at 36.5%). Current evidence does not support community screening or routine screening in the primary care setting for dementia in asymptomatic older persons. In Malaysia, cognitive screening in Primary Care is recommended for those older persons with subjective memory complaints. Screening tests used for dementia are either direct cognitive tests or functional assessments using patients and caregivers as informants. Many types of screening tools are 11
MJP-21(Suppl)-2012 available and the ideal tools at Primary care must be brief and time-limited. In 2007, Ministry Of Health Malaysia (family health division) embarked on a cognitive screening programme at the primary health care level in Malaysia by using a combination of instruments i.e. Symptoms of Dementia Screener (SDS), Elderly Cognitive Assessment Questionnaire (ECAQ), MMSE, Clock drawing test, 4-item Geriatric Depression Scale (GDS-4) plus Functional assessments (i.e. ADL & IADL). Even though cognitive screening instruments are available, this is superseded by the lack of evidence of positive health outcomes with screening and concerns which are raised about the attendant social, psychological and ethical implications of screening. Thus, Primary health care providers should have a high index of suspicion for dementia when patient presents with subjective memory complaints and cognitive screening is recommended in this group of patients. However, this recommendation should be reviewed as and when there are new developments, for example when there is effective treatment for mild cognitive impairment.
S1C-2 Assessing Dementia – Looking Beyond Deficits in Memory Assoc. Prof. Dr. Vorapun Senanarong Mahidol University, THAILAND Cognitive function has recently been re-described in the neurocognitive disorders of the DSM5. The cognitive domains are consisting of 6 domains: learning and memory, complex attention, executive ability, language, visuoconstructional perceptual ability, and social cognition. The neurocognitive disorders span all age groups and refer to when there is a decline from a previously higher level of cognition. Human brain organizes and processes the information in 3 steps namely registration, analysis, and hypothesis formation. This leads to learning and memory. Attention is the cognitive function that aids learning process. There are different types of attention. Focused Attention would respond to discrete visual, auditory, or tactile stimuli (i.e.: head turning to stimuli). Sustained attention is divided into vigilance (over time) and working memory (active holding and manipulating information). Selective attention is an ability to ignore irrelevant or distracting stimuli. Alternating attention is the capacity for mental flexibility. Divided Attention is an ability to respond to multiple, simultaneous tasks. Executive ability includes planning, decision making, working memory, responding to feedback/error correction, overriding habits, and mental flexibility. Expressive language function contains naming, fluency, grammar and syntax. Receptive language or comprehension can be assessed by asking about word definition and object-pointing tasks. Visuoconstructionalperceptual ability comprises of construction and visual perception. Social cognition is a new domain, introduced into cognition in order to be able to define frontotemporal dementia as having major neurocognitive disorder. Social cognition includes recognition of emotions, theory of mind, and behavioral regulation. Clinician should be able to assess these 6 cognitive domains at bedside or able to choose appropriate cognitive tests of these functions. Culture and education can play roles when clinicians interpreted the evaluation.
S1C-3 Informant Assessment in the Screening of MCI Dr. Yang Yuan-Han Kaohsiung Medical University, TAIWAN Informant-based assessments, on the other hand, may reveal early cognitive change because of a longitudinal perspective and having face validity, and are established in studies characterizing AD and in AD clinical trials. These informant-based examinations such as the Clinical Dementia Rating (CDR) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) incorporate information from a collateral source to assess change in the patient’s cognitive ability to conduct their accustomed activities. These systems do not require a baseline assessment for comparison and minimize issues such as practice effects and educational and socio-cultural influences that confound interpretation of performance-based assessments. These informant-based examinations, intra-individual comparisons, are more sensitive than cognitive function tests, inter-individual comparison, in detecting early stage of AD. Current informant-based assessments, however, are lengthy and require interpretation by an experienced
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MJP-21(Suppl)-2012 clinician; therefore, they are difficult to use in community practice. Given the brief period available to primary care physicians in a standard office visit, there will likely be some acceptable trade-off to the clinician, sacrificing specificity and sensitivity to detect dementia to keep the clinical tool brief. Here, I am going to report a study conducted in 4 Asian countries using AD8 to screen very mild dementia.
S1C-4 Using Lay People to do Screening Tests in the Community Prof. Dr. Nuntika Thavichachart Chulalongkorn University, THAILAND Lay-based questionnaire for screening of cognitive impairment and dementia in the community may be a method of collecting the prevalence of dementia. Screening for Dementia Scale (SDS) Thai version had been developed under cultural validity. SDS is a lay-based questionnaire comprised of 11 items asking the informant of the elderly with the answer “yes” or “no”. SDS Thai version has been tested the quality with good reliability and validity with sensitivity 90.2 % and specificity 84.6 %. The application of SDS in the 2-stage community survey by village health volunteers to find out the prevalence of dementia will be presented. The example of “Bangkok Memory Screening Day” project, Community survey to find out the prevalence of dementia under the policy of “Active Aging” using health service systems of the Ministry of Public Health will be shown.
SYMPOSIUM 2A: BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA
S2A-1 The Neuropsychiatric Aspects of PDD and DLB Prof. Dr. Lim Shen-Yang University Malaya Medical Centre, MALAYSIA I will provide an update on the latest developments in the field of Parkinson’s disease, including a framework with which to approach the myriad non-motor features that occur in this disease. I will discuss common neuropsychiatric problems, and then focus on PD-related dementia in terms of diagnosis and management. The closely related condition of dementia with Lewy bodies (DLB) will also be discussed.
S2A-2 Behavior and Psychological Symptoms of Dementia in People with MCI Dr. Susy Mathews Toowomba Hospital, AUSTRALIA Behavioural and psychological symptoms of dementia in people with mild cognitive impairment are an emerging concept that is widely accepted. Mild cognitive impairment is somewhere in between normal cognition and someone who is confirmed as demented. The other names associated with this condition include age associated memory impairment or mild neurocognitive disorder as it is classified in DSM5. In DSM5 Minor neurocognitive disorder needs a history of cognitive decline, with mild impairment and not interfering with independence in Instrumental activities of daily living. Delirium and psychiatric disorder needs to be excluded. Mild cognitive impairment requires a subjective complaint of memory impairment by either the patient themselves or a family member. More recently it is noted, that to distinguish MCI from dementia there need to be preservation of functional activities. The neuropsychiatric symptoms of mild cognitive impairment include apathy, anxiety, depression, irritability as well as agitation. These are seen in Behavioural and psychological symptoms of dementia as well. Other symptoms seen in MCI are feelings of persecution, hallucinations, sleep problems, wandering, confabulation and even misidentification. Depression is one of the more common symptoms in those with mild cognitive impairment. In view that Mild Cognitive Impairment (MCI) does have the above mentioned symptoms which could increase care giver stress and difficulties, it is then important to consider the appropriate treatment modalities for this condition. 13
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S2A-3 Apathy Among Patients Attending the Memory Clinics in Malaysia Assoc. Prof. Dr. Esther Ebenezer, Manveen Kaur, Suraya Yusoff UniKL Royal College of Medicine Perak l, MALAYSIA Background: Apathy is a prominent and extremely common feature of the behavioral and personality changes in Alzheimer’s disease (AD). Apathy symptoms present early in the illness and persist through the disease course and increases in prevalence with severity of disease. Apathy in dementia is often confused with dysphoric mood. Latest data-base from the Memory Clinic, Johor Bharu the prevalence of apathy among 313 demented patients using Neuropsychiatric Inventory was found to be as high as 88.4% and that of depression was 86.8%. Apathy one of the behavioral symptoms that is most likely to improve with Cholinesterase inhibitors (ChEI). Objective: To determine the efficacy of Cholinesterase Inhibitors in reducing the apathy and depression by treating the neuropsychiatric symptoms in patients with mild to moderate dementia. Methods: A prospective case control open label research carried out at the Memory Clinic in University Malaya Medical Centre. Patients newly diagnosed with mild to moderate Dementia treated with any of three ChEIs; Donepezil, Rivastigmine and Galantamine, were recruited. Patients who were not on treatment with ChEI were selected as controls. All patients were monitored on MMSE and Neuropsychiatric Inventory Questionnaire (NPI-Q) at baseline, 12 weeks and 24 weeks on. Results: A total of 150 patients were recruited, 100 were in the treatment arm with ChEI, and 50 controls were not treated with ChEI. They were followed up for a period of six months and there was no drop out. Mean age of the patients in the treatment and control group were (74.0 ± 7.6 and 75.7 ± 7.8) years respectively. There were 54% females and 46% males in the treatment group, compared to 60% females and 40% males in the control group. At baseline mean MMSE score of patients in ChEI group was 19.2 ± 5.6 versus 17.3 ± 5.7 in the control group (p=0.047); mean Neuropsychiatric Inventory Questionnaire (NPI-Q) severity of patients in ChEI was 11.7 ± 5.2 [median 12] versus 13.4 ± 6.0 [median 13] in the control group. Number of patients having apathy in ChEI group was 67(67%) and in control group was 34(68%) while depression was 58(58%) in ChEI and 29(58%) in control group. At six months, there was significant difference (p=0.001) in the mean MMSE score of patients in ChEI group was 20.1 ± 5.8 versus 16.44 ± 5.5 in the control group; similarly there was significant reduction (p=0.0001) in the mean NPI-Q severity of patients in ChEI was 8.1 ± 5.1 versus 15.1 ± 5.9 in the control group. The patients in ChEI group showed significant reduction in apathy (p = 0.001) as well as depression (p = 0.001); while the patients in control group showed increase in apathy and depression symptoms though not significantly different from the baseline. Conclusion: ChEIs are efficacious in treating neuropsychiatric symptoms such as apathy and depression in patients of mild to moderate dementia.
S2A-4 Sexual Disinhibition in Dementia Assoc. Prof. Dr. Simeon Marasigan University Santo-Tomas, PHILIPPINES Sexual disinhibition may be regarded as sexually inappropriate or “acting out” behavior. Impulsive behavior and poor judgment often occur in dementia, and inappropriate sexual impulses that were once controlled by intact judgment or moral values may emerge. Such behaviors have been reported more commonly in men. It is estimated that between 7% and 17% of patients with dementia exhibit inappropriate sexual behavior during the course of their illness. Causes of sexual disinhibition in the older individual are highly complex and include neurologic, psychiatric and social/environmental factors that accompany dementia. Whatever the underlying cause, sexual disinhibition creates major dilemmas for professional and family caregivers, as it is a disturbing behavioral problem in dementia and one of the most embarrassing for both informal and formal caregivers. Intervention is needed to curtail this antisocial behavior and restore a sense of safety/comfort for all. Management should start with an evaluation of the patient’s medical and sexual history to identify possible causes other than dementia. If no reversible causes have been identified, non-pharmacologic (behavioral/environmental) intervention should be attempted. When nonpharmacologic
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MJP-21(Suppl)-2012 attempts are unsuccessful, various medications have proven to be helpful, such as anti-androgens, estrogens, and GnRH analogues. Serotonergics and gabapentin may be considered.
SYMPOSIUM 2B: CAREGIVERS, COMMUNITY CARE AND CROSS-CULTURAL CARE
S2B-1 Cognitive Function of Elderly Living in Rural China Assoc. Prof. Dr. Huali Wang, Jianzhong ZHU, Bailing WANG, Shuaijun ZHOU, Tao LI, Na ZHANG, Huiying LI, Xiao WANG, Xin YU Peking University Institute of Mental Health, CHINA Objective: To explore the pattern of cognitive function of the elderly living in rural China, and to investigate the potential factors related to cognitive impairment. Methods: Three hundred and sixty cases were randomly sampled out of 551 registered elderly residents (aged of 60 and above) in 2 counties of rural area in Beijing. The survey was conducted in June-July, 2011. Totally 205 cases completed the survey questionnaire and neuropsychological examination. In addition to the questionnaire of demographic characteristics and life style, multiple cognitive domains were tapped into with a comprehensive neuropsychological battery tests, including general cognitive function, verbal memory, working memory, verbal fluency, reasoning and visuospatial function. Results: Nearly 99% of the participants were Han Chinese. There were no significant difference in the gender, educational level, and occupational status across different age groups. The life style, including smoking, alcohol-drinking, tea-drinking, exercise, leisure activity, dieting habit, and sleeping pattern, was similar in all age groups. 41.0% of the participants had MMSE total score lower than 24 and 86.4% of the participants had MoCA total score lower than 26. Among the total sample, the MMSE total score of participants aged below 64 was significantly greater than that of elderly aged over 75 (P<0.01). The MoCA total score of participants aged below 64 was greater than that of elderly aged over 70 (P<0.01). The performance of verbal learning test was significantly different among different age groups, and the group aged below 64 scored much higher than those aged over 80 (P<0.05). Conclusion: There was a age effect on cognitve function among the elderly living in rural areas. The cognitive impairment of the elderly living in rural areas should be attended to timely and appropriately.
S2B-2 Community Care and Outreach services for dementia in LMIC and LIC – an example of Malaysia. Dr. Suraya Yusoff Hospital Sultan Ismail Johor, MALAYSIA Ideally, a comprehensive care system for dementia should include the provision of consultation services, an inpatient care unit, day care and day hospital care, continuing care, education and training. However in most developing countries resources is severely lacking. Giving a good dementia care is akin to fixing a puzzle, as care maybe required in multiple aspects. In both the lower middle income countries (LMIC) and the low income countries (LIC) the burden of care will eventually fall on the shoulders of the family. Although dementia is a public health problem, Shaji believe that it should be a part of a range of psychiatric care services rather than be the main focus. The LMIC and LIC need to develop their own set-up for dementia care services. The direction and focus of care in those countries with poor resources would be to developed a good community based care on top of the development of centres with special interests in dementia in all general hospital, as well as a good priority research. All this should be carried out with continuous and sustainable training programmes at all levels of care. However the number of cases reaching the tertiary centres is only the tip of the iceberg. The main barriers to care may be both personal as well as systemic. Hence community based and outreach services should focus on case findings, assessment, referral, treatment and consultation. There are many evidences on the effectiveness of community based and outreach services in dementia care in the literature. In this presentation I will discussed on the development and progress of an example of a community based care in Malaysia and the progress that has been made since its inception in Johor Bahru.
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S2B-3 Dementia Caregiving in Singapore Dr. Philip Yap Lin-Kiat Khoo Teck Phuat Medical School, SINGAPORE The caregiving role of family members is vital as majority of persons with dementia (PWD) stay in their own homes. We recently conducted a study of more than 300 informal caregivers to deepen our understanding of the family caregiving situation in Singapore. The dementia caregiver is typically a middle-aged daughter with at least 10 years of education, in full or part-time employment and assisted by foreign domestic helpers (50%). Caregiver burden is significant with 27.2% expressing feelings of burden more often than sometimes. Conversely, caregivers experience personal gains through caregiving which can help buffer the burden experienced. Criticism and an authoritarian caregiving style are associated with increased caregiver burden while a nurturing and encouraging approach is associated with positive caregiving outcomes. Most caregivers (85%) prefer to care for PWD at home but practical issues such as absence of caregivers in the day and limited financial means to employ domestic help or afford day care are obstacles. Caregivers express the need for more training in coping with difficult behaviour in PWD and more opportunities to discuss care issues with doctors and healthcare professionals. However, only about 50% of caregivers utilise dementia services and knowledge and awareness of these services is the primary determinant of service use. It is hoped that these findings will help policy makers and care agencies better design services and assistance for caregivers.
S2B-4 Can Advance Care Planning Improve Dementia Care? Dr. Lam Chee Loong University Malaya Medical Centre, MALAYSIA With an ageing population, the prevalence of age related illness including dementia is expected to rise over the coming decades and deaths from dementia, and its complications will similarly follow. The challenge to deliver high quality end of life care in this population is considerable. Advance Care Planning (ACP) has been widely promoted and advocated in strategy and policy in some developed nations as a component to achieving this. In giving patients’ the opportunity to express their preferences for care while they maintain capacity, care may be individualised and delivered in line with these wishes as far as possible. Among some of the choices, patients may make statements of wishes, decisions to refuse treatment, or appoint substitute decision makers. The lack of capacity which is common in dementia however makes defining the goals of care and identifying quality of life indicators harder at later stages. Best interest decisions are often made on behalf of the patient by doctors and/or relatives. While some nations have legal frameworks to recognize ACP and respect such choices, many others do not. In principle, the practice of ACP represents good care and while hard evidence remains limited, it continues to grow. More research is undoubtedly needed, and more training among healthcare staff is essential to facilitate the sensitive honest and open communications with patients and families to clarify their priorities and goals, and plan their future care.
SYMPOSIA 3A: PSYCHOSOCIAL INTERVENTION
S3A-1 The Singapore Experience in Person-Centred Care Dr. Philip Yap Lin-Kiat Khoo Teck Phuat Medical School, SINGAPORE In recent years, person centred care (PCC) has become synonymous with best practice in dementia care. PCC adopts a bio-psychosocial model whereby the manifestations of dementia are not only attributed to brain pathology. PCC acknowledges that other factors, such as the person’s significant past (personality and biography) and the present environment (physical and social), can add to the varied presentations of dementia. Good care calls for a deep understanding of the person with dementia (PWD), adapting the environment to meet his needs and maintaining connectedness with him through meaningful relationships.
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Pockets of PCC began in Singapore 10 years ago with the a local trained in dementia care mapping (DCM) in Bradford, an enrichment programme in a tertiary hospital for PWD and their caregivers based on PCC principles, and a nursing home engaging Hammond Care Australia to train their staff in dementia care. The 1st PCC and DCM certification course in Singapore trained about 40 locals in 2007. In 2009, the Committee for PCC and DCM was inaugurated under the auspices of Alzheimer’s Disease Association of Singapore, in partnership with Bradford Dementia Group & the DCM International Group, to promote PCC as best practice for dementia in Singapore. Today, there are several PCC initiatives across healthcare settings in Singapore, ranging from tertiary hospital care, to home care and long-term care. The talk will feature these stellar examples of good care to explain the rationale for PCC and showcase its benefits.
S3A-2 Mental and Physical Activities Have Little Effect on the Course of Dementia in Nursing Home Residents Prof. Dr. Cheng Sheung-Tak Institute of Education, HONG KONG Objectives: To examine the effects of cognitive stimulation (mahjong) and physical exercise (Tai Chi [TC]) on the course of dementia. Design: Cluster-randomized open-label controlled design. Setting: Nursing homes. Participants: 110 residents. Inclusion criteria were Mini-Mental State Examination (MMSE)=10-24 and suffering from at least very mild dementia (Clinical Dementia Rating [CDR].0.5). Exclusion criteria were being bedbound, audio/visual impairment, regular activity participation prior to study, or contraindications for physical or group activities. Interventions: Homes were randomized into three conditions (mahjong, seated TC, and simple handicrafts [control]). Activities were conducted three times weekly for 12 weeks. Measurements: Primary outcomes were dementia severity as measured by the global CDR and CDR sum-of-box score taken at 0 (baseline), 3 (post-treatment), 6, and 9 months. Analysis: Intent-to-treat analyses were performed using mixed-effects linear regression for CDR sum of box and multilevel modelling for ordered responses for global CDR. Apolipoprotein EƒÃ4 allele and education included as covariates. Results: A treatment x time interaction was found for mahjong only with CDR sum of box, but not global CDR, as the dependent variable. No effect was found for Tai Chi. The interaction effect showed that mahjong stabilized cognitive impairment as measured by CDR sum of box while control participants tended to decline further during this period. However, the effect was small and failed to make an impact on the global CDR. Conclusions: For those with dementia, complex cognitive exericse such as mahjong may improve cognitive functioning within a narrow margin, thereby enhancing quality of life, although the course of illness in the long term remains unchanged. Limitations: the study period may not be long enough for the full range of benefits of activity interventions to unfold.
S3A-3 Outreach Intervention for Early-Onset Dementia by Multi-Disciplinary Staff Prof. Dr. Manabu Ikeda, Yuko Komatsu, Naoko Ichimi, Seishiro Kojima, Mamoru Hashimoto Kumamoto University, Fukuoka, JAPAN The needs of patients with early onset dementia (EOD) and their caregivers have become increasingly recognized in service development. However, the physical fitness and activity of a younger person may lead to challenges in care management, particularly in a service which is not age-appropriate (Freyne et al, 1999). According to the recent population-based study in Japan (Ikejima et al, 2009), the prevalence of EOD per 100000 is 42.3. It is clear that there is a sizable number of individuals with EOD in Japan who require access to public services although there are few EOD patients who use public services in mild dementia stage. The need for optimal or appropriate services for younger individuals with EOD is urgent issue in EOD healthcare policy. In this symposium, we will introduce our preliminary outreach
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MJP-21(Suppl)-2012 intervention for EOD patients by multi-disciplinary staffs.
S3A-4 Montessori Techniques in the Psychosocial Intervention of Dementia Prof. Dr. Daniel O’Connor Monash University, AUSTRALIA Abstract not available
SYMPOSIUM 3B: ASSISTIVE TECHNOLOGY
S3B-1 Harnessing Computer technology in Dementia Assessment Prof. Dr. Suh Guk-Hee Hallyn University, SOUTH KOREA A computerized neuropsychological interview and clinical examination, the Cognitive Assessment and Reference Diagnosis System (CARDS) was developed to incorporate in a single instrument all the information required to make an accurate clinical diagnosis of dementia, its subtype, depression and delirium, to present reference diagnoses just after completion of tests, and to detect early dementia. The CARDS has been widely used in Korea since 2003. The CARDS has made on-site confirmation of whether demented or not at the first visit to memory clinics by using a statistical equation to get rid of influence of compounding factors like age, education and gender. English version has been made and under validation at King’s College London. Translation into your own language will make on-site confirmation of dementia in your own memory clinic, which is greatly encouraged and supported.
S3B-2 Early Clinical Trial Results On Automatic Detection of Confusion in Nursing Home Residents Dr. Clifton Phua Institute for Infocomm Research, SINGAPORE This clinical trial involves two nursing home residents sharing a common bedroom and bathroom. The goal is to non-intrusively monitor the activities of each resident, assisting them thereby alleviating confusion and frustration, and improving resident independence and quality-of-life, and caregiver burden as well. The site of the trial is the Hope RLA (Resident Living Area) in PeaceHaven Home in Singapore. We implemented an extensible context-aware system consisting of sensors embedded into environment, reasoning engine and UI (user interface) devices that are built in a modular fashion to interoperate and monitor events and activities within the shared space. Video cameras have been specifically prohibited due to privacy concerns. In order to obtain the residents’ identity accurately our solution incorporates a passive RFID tag. Except for this the remainder of the system is entirely unobtrusive, being based on ambient sensors and intelligence provided by a rule engine built on a server at the back end of the system. Early results indicate that the system is working correctly as validated with manually collected ground truth.
S3B-3 Internet Based Reminiscence Therapy for AD Patients with BPSD Dr. Yang Yuan-Han Kaohsiung Medical University Hospital, TAIWAN Dementia is a chronic progressive debilitating disease that is largely a disorder of old age. It is characterised by widespread impairment of mental functioning, progressive memory loss, language difficulties, confusion and disorientation. These impairments are often accompanied by behavioural and psychological disturbance. The behavioural disturbances associated with dementia are defined as symptoms of disturbed perception, altered thought content, mood and behaviour. Current treatments for dementia are limited to acety-lcholinesterase inhibitors and NMDA-antagonist with limited effects. For the behaviour and psychiatric problems, there are also no other consensus guideline to treat them. Psychosocial interventions, such as reminiscence, have the potential to improve the quality of life of people with dementia. However, while reminiscence is used widely in dementia care, its impact on the quality of life of people with dementia remains largely un-documented and there is a need for a robust and fair assessment of its overall effectiveness. One factor contributing to the reminiscence is that it can 18
MJP-21(Suppl)-2012 be used with early memories, which remain relatively intact for people with dementia, thus drawing on the person’s preserved abilities rather than focusing on level of impairment induced by the illness. Although used extensively, little is known about the effectiveness of reminiscence as a care intervention for people with dementia. We conducted a pilot study to examine the change of cognitive function, behaviour, and psychiatric disorders in AD patients with/without reminiscence therapy through internet- based service for patients living over a county.
S3B-4 A Real-time Algorithm for Wandering Pattern Detection Assoc. Prof. Dr. Chan Syin, Vuong NK, Lam CT, Lau KM Nanyang Technological University Objective: We develop a software algorithm to automatically classify movements of people with dementia into wandering patterns: pacing, lapping and random. Method: 24-hour movements of 5 people with dementia were used in our study. We first manually classified these 5 original datasets in order to establish the ground truth estimation. The original datasets were then input to the software program to examine the algorithm’s accuracy. We also injected white noise (from 6% to 27%) to the original datasets and input the noisy datasets to the program to evaluate the algorithm’s robustness and tolerability. Results: Our algorithm achieves a high accuracy (84% and above) in classifying the different wandering patterns. With the noise level of less than 20%, the algorithm achieves the highest level of accuracy on the set of wanderers with mild or moderate dementia whereas the performance decreases for the severely demented subject. Conclusions: We believe the automated algorithm to classify wandering patterns has the potential to assist healthcare professionals to improve the care for elderly wanderers with dementia. Specifically, by incorporating the real-time wandering pattern detection algorithm, an automated monitoring system can quantify wandering movements and provide early detection of physical and mental changes of people with dementia, thus enabling caregivers to arrange better care distributions, treatments or timely interventions for these patients.
SYPOSIUM 4A: VASCULAR COGNITIVE IMPAIRMENT
S4A-1 The Neuropsychology of VCI-Is There a Specific Cognitive Deficits Prof. Dr. Fuh Jong Ling National Yang Ming University School of Medicine , TAIWAN Vascular dementia (VaD) is the second most common dementia after Alzheimer’s disease (AD). The neuropathology of VaD is heterogeneous. Several vascular pathologies that include multiple cortical infarcts, multiple subcortical infarcts, both cortical and subcortical infarcts, strategic infarcts, lacunes with white matter lesion and even hemorrhage all can lead to dementia. Therefore, it is no surprise that the clinical presentation and course of different subtypes of VaD are varied. Hachinski coined the term “vascular cognitive impairment” (VCI) which refers to all etiologies of cerebrovascular disease including vascular risk which can result in brain damage leading to cognitive impairment. Mild form of VCI is referred to as VCI-no dementia while the more severe form of VCI is termed VaD. Recently, the American Stroke Association published a statement about the definitions, neuropathology, basic science, role of neuroimaging, associated risk factors, and potential opportunities for prevention and treatment of VCI. The clinical, pathology and functional brain imaging studies have clearly and consistently demonstrated there are important neuropsychological differences between AD and VCI. Briefly, VCI patients have more impaired executive functions including planning and sequencing, and mental speed. Compared to VaD, patients with AD may exhibit greater deficits in functions (including memory) mediated by posterior cortical structures, such as the temporal and parietal lobes. AD patients exhibit a faster rate of information decay, reduced ability to benefit from cues to facilitate retrieval, and higher frequency of intrusion errors. 19
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S4A-2 Cognitive Dysfunction of Vascular Dementia – Importance of Thalamus and Caudate Head Prof. Dr. Kenichi Meguro Tohuku University Graduate School of Medicine, JAPAN Vascular dementia (VaD) is a condition in which decreased cerebral perfusion causes cognitive deterioration. The fronto-subcortical network is considered to be important. I herein present two “strategic” important areas, the caudate head and thalamus, which are associated with the networks. I reported the case of a 77-year-old, right-handed man, who had a cerebral infarction in the left caudate head that manifested recurrent delusional ideas. He experienced three episodes of delusion. MRI findings of left caudate head infarction were the same for all three episodes. Decreased cerebral blood flow (CBF) in the frontal lobe was noted particularly in the second and third episodes, supporting the neurological background of disinhibition of emotional behavior. Regarding the thalamus, VaD patients with only left thalamic infarction were investigated. Among 120 consecutive outpatients, 18 had only left thalamic infarctions. As the previous theory, the patients with the anterior nucleus lesion showed “remembering” disorder, whereas those with the mediodorsal nucleus lesion disclosed “knowing” impairment. Both hemispheres showed decreased CBF. MMSE scores showed no correlations with CBF, but there were significant correlations between the left anterior cingulate CBF and word fluency scores, and between the right rectal gyrus CBF and the depressive scores. These are thought to be due to a remote effect that occurs via the network. We should be cautious that a small infarction in these areas, frequently judged as “unremarkable” in CT report, could cause various symptoms.
S4A-3 SICD, Cognitive Decline and Dementia Prof. Dr. Asita de Silva University of Kelaniya, SRI LANKA The term ‘‘Subcortical Ischaemic Cerebrovascular Dementia’’ (SICD) is used to describe the various categories of cognitive impairments related to ischemic changes in the brain, which has been identified previously as vascular dementia, vascular cognitive impairment or multi-infarct dementia. A large body of evidence supports a relationship between cardiovascular risk factors and cognitive impairment in the elderly. These factors include atrial fibrillation, diabetes mellitus, hypertension, dyslipidaemia, coronary artery disease and stroke. Stroke is a major risk factor for cognitive impairment and post stroke dementia can occur in up to 40% of patients over 5 years. Various mechanisms contribute to impaired vascularity in the brain that occurs with age. Hypoperfusion, hypotension, changes in the autonomic regulation of blood pressure, and cortical hypometabolism have all been cited as causes for cognitive changes that occur in the older population. However, the relationships between cognitive impairment, dementia and subcortical vascular lesions are poorly understood. Options for treatment of SICD are presently quite limited. In view of the limited role of medications in the treatment of SICD, and the increasing disease burden of cardiovascular disease, the focus is mainly on prevention. Recent studies including the ongoing 5-continent ‘Efficacy of Nitric Oxide in Stroke’ (ENOS) trial in previously independent individuals have shown cognitive impairment was common three months after stroke, and related to increasing age, stroke severity, hypertension, atrial fibrillation and the presence of cerebral atrophy on brain scanning. These results, in conjunction with other studies, encourage early treatment of cardiovascular risk factors in older individuals.
S4A-4 Vascular Lesions in Neuro-Degenerative Dementia Prof. Dr. Manabu Ikeda, Yusuke Ogawa, Mamoru Hashimoto Kumamoto University, Fukuoka, JAPAN Cerebral small vessel disease (SVD) is frequently observed in patients with Alzheimer’s disease (AD). However, the association between SVD and clinical symptoms exhibited by patients with AD remains unclear. This study examined the association of SVD as observed on magnetic resonance imaging (MRI) with behavioral and psychological symptoms of dementia and cognitive function of patients with probable AD. Consecutive patients with probable AD were included in this cross-sectional study of a
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MJP-21(Suppl)-2012 prospective cohort. Patients were divided into two groups based on the presence or absence of cerebral SVD. Patients with probable AD with cerebral SVD had significantly more delusions and depression than those without SVD. No significant differences were observed in other neuropsychiatric symptoms, MMSE or word recall and recognition tests between both groups.
SYMPOSIUM 4B: NON-AD DEMENTIAS
S4B-1 Reversible Dementias in the Medical Scenario Dr. Lee Fatt-Soon Hospital Kuala Lumpur, MALAYSIA Dementia is said to occur when there is a progressive loss of higher mental function. This involves memory, judgment, language, and executive function among others. Dementia is an umbrella term covering many etiologies, the more common being Alzheimer and vascular. As the person with dementia progresses, the symptomatological changes and concurrent diseases may cloud the picture further. This is especially so as epidemiologically, dementia occurs with increasing frequency as the population ages. This leads to many confounding factors as ageing leads to increasing co-morbidities which may affect cognition. In addition, medical interventions may lead to cognitive impairment and cloud the picture further. Hence co-morbidity may be the cause of dementia or be the precipitant for worsening of dementia. This is especially confusing in a person admitted to the acute medical ward. Hence excluding reversible factors would be an important intervention before attributing the cognitive impairment to be due to dementia alone.
S4B-2 Cognitive Enhancers in Vascular and Other Non AD Dementias Dr. Ramesh Sahathevan National University of Malaysia, MALAYSIA The non-AD dementias have roused much interest in the last few years. In particular, the epidemiology of vascular cognitive impairment (VCI) has been studied extensively. There have even been suggestions that AD and VCI are not separate clinical entities but part of an extended spectrum of cognitive dysfunction. This viewpoint is not without controversy. In addition to the role of acute or chronic ischaemic injury in developing dementia, recent evidence also supports an independent role for the vascular risk factors in developing dementia. Will treatment of these vascular risk factors result in a reduction of dementia in the long run and is there evidence to support this hypothesis? Are the current treatments used in control of the vascular risk factors able to reduce the long-term risk of dementia? Is there a role for pharmacological and non-pharmacological treatment modalities in enhancing cognitive function? In addition to VCI, other non-AD dementias are also increasingly becoming the focus of research. Conditions such as frontotemproal dementia (FTD), dementia of Lewy-bodies (LBD) and Parksinson’s-related dementia are more often recognised and referred for management. Currently, no evidence exists to support a role for either stroke or vascular factors in the development of these other conditions. The treatment of vascular risk factors in these conditions may not impact on incidence or progress of these conditions. However, is it possible that cognitive enhancers might play a role in long- term management of these conditions as well?
S4B-3 Whither the People with Young-Onset Dementia (YOD) Dr. Yang Yuan-Han Kaohsiung University Hospital, TAIWAN There are few population-based studies on the epidemiology of young-onset dementia. The estimated reported prevalence of dementia with onset between the ages of 30 and 65 years was 54 per 100 000 (95% CI 45–64) and 98 per 100 000 (81–118) between the ages of 45 and 65 years. However, the detailed information for the young onset dementia is still undetermined. Alzheimer’s disease, vascular disease, frontal-temporal lobar degeneration, and dementia with Lewy bodies are the most common diseases that cause dementia both in the elderly and in younger patients, although not in those who are younger than 35 years. However, the clinical features of these diseases in younger patients can differ 21
MJP-21(Suppl)-2012 from those seen at a later age. From our current study: Registration of Alzheimer’s disease in Taiwan, we will report the demographic characteristics for these young onset dementia (age <65 years old) and the features of informant for these patients.
S4B-4 Updates in Neurodegenerative Non-Alzheimer’s Disease Dementias Assoc. Prof. Dr. Simeon Marasigan, Catindig J-AS University Santo-Tomas, PHILIPPINES The accuracy in the clinical and pathological diagnosis of the neurodegenerative non-AD dementias has tremendously improved over the last decade because of: 1. Better understanding of their clinical course; 2. More accurate assessment tools, including neuropsychological tests and much enhanced neuroimaging techniques; 3. The discovery of more sensitive and specific genetic and abnormal protein biomarkers. In Frontotemporal Dementia (FTD) for example, more than 30 tau mutations in gene expression in up to 50% of cases were identified mostly between exons 9 and 13 which code for microtubule binding domains. Two distinct clinical syndromes verifiable by neuropsychological tests have evolved: 1. The behavioral variant (bvFTD); 2. Two language variants: the progressive non-fluent aphasia (PNFA) and semantic dementia (SD). MRI findings highly suggestive of structural lesions, metabolic uptake abnormalities by SPECT and PET and histopathological and histochemical findings of tau- and ubiquitin-containing inclusions are better understood. Dementia with Lewy bodies (DLB) on the other hand is characterized by a clinical triad of fluctuating cognition, parkinsonism, and vivid visual hallucination. The pathological findings of cytoplasmic inclusions of ɑ-synuclein positive Lewy bodies in specific areas of the hippocampus, cerebral cortex, and the brainstem describe a pattern of cognitive and motor symptoms identifiable clinically and accessible through neuropsychological tests. PET studies results strengthen the diagnosis. The third condition in the topic is Parkinson’s Disease Dementia (PDD) clinically diagnosed by asymmetric motor symptom onset (parkinsonism) and cognitive impairment at least one year after the onset of the motor problems (resting tremors, bradykinesia, rigidity and postural rigidity). The clinical onset and course may identify PDD much better than the non-specific and heterogeneous neuroimaging findings, electrophysiologic studies, and biomarkers.
SYMPOSIUM 4C: NEUROIMAGING AND BIOMARKERS
S4C-1 Biomarkers in Clinical Diagnosis and Management Dr. Christopher Chen National University of Singapore, SINGAPORE It has previously been established that cognitive testing and atrophy of brain structures predict for dementia. More recently, advances in dementia biomarker research have demonstrated that alterations in CSF tau and Aâ42, FDG-PET and amyloid PET occur years before clinical symptoms of AD become manifest. Together with acceptance that pathological processes leading to dementia start many years before symptoms appear, is apprehension that by the time patients are symptomatic, it may be difficult, if not impossible to reverse brain damage, thus disease modifying treatments may only be relevant in early disease. However, as we currently lack any such treatments, the hope of using biomarkers to find reliable and accessible ways of identifying people at risk of dementia is clearly a research imperative. Of more clinical relevance is the possibility of enrolling high risk subjects in prospective and interventional studies which utilize biomarkers as surrogate outcome measures to examine the natural course of the disease and to test more reliably in early phase trials potentially disease modifying drugs. However, these biomarkers may not enter the clinic for some time except as research tools.
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Hence the current role for biomarkers in clinical practice remains in differential diagnosis and prognostication. Translating novel biomarkers into clinical practice remains a major challenge, especially if these biomarkers and associated treatments are costly. The continuing challenge of raising awareness of the disease, in the medical community as well as in the general public, will determine the eventual impact biomarkers for dementia will have on clinical practice.
S4C-2 Diffusion Tensor Imaging – A biomarker for White Matter Integrity Assoc. Prof. Dr. Hsu Jung Lung Shin Kong Wu Ho-Su Memorial Hospital and Taipei Medical university, TAIWAN Changes in structural WM organization can be measured in vivo with diffusion tensor imaging (DTI), a relatively new imaging technique. With DTI the directionality and magnitude of random water movement in tissue can be estimated yielding several quantitative measures, such as the three principle diffusivities (i.e., the eigen values of the diffusion tensor: 1 > 2 > 3), mean diffusivity (MD = [ë1 + 2 + 3] / 3), transverse diffusivity (TD = [ë2 + 3] / 2), axial diffusivity (AD = 1), and the degree of diffusion anisotropy (e.g., the fractional anisotropy: FA). Without barriers, water molecules move uniformly in all directions, which results in isotropic diffusion. By contrast, in the presence of barriers, such as cell membranes, nerve fibers, or myelin sheets, the diffusion rate is typically larger in one direction than in another, which is then referred to as anisotropic diffusion (Beaulieu, 2002). Being quantitative in nature, these DTI based measures have been shown to be more sensitive to tissue abnormalities than the typical visual evaluation of WM hyperintensities observed in conventional MRI data. As these measures reflect the underlying cohesiveness of WM fiber tracts on a macroscopic level, DTI has been applied by many researchers to study the effect of various processes in brain WM. To date, DTI studies have revealed WM alterations through measurements of decreased FA and/ or increased MD in a variety of conditions, including aging (Hsu et al., 2008, 2010; Sullivan and Pfefferbaum, 2007; Van Hecke et al., 2008a), multiple sclerosis (Patel et al., 2007), schizophrenia (e.g., Carpenter et al., 2008), traumatic brain injury (e.g., Caeyenberghs et al., 2010a; Caeyenberghs et al., 2010b), amyotrophic lateral sclerosis (e.g., Sage et al., 2009) and Alzheimer’s disease (e.g., Stahl et al., 2007). For an in-depth discussion of DTI, the interested reader is referred to a recent review of Tournier et al (Tournier et al., 2011).
S4C-3 Retinal Imaging as a Biomarker for Dementia Assoc. Dr. Prof. Mohammed Kamran Ikram National University of Singapore, SINGAPORE Alzheimer’s disease (AD) is the most common cause of dementia. Over the last few decades, there has been a shift towards identifying earlier stages of AD, which include mild cognitive impairment (MCI). Improved methods of screening and early detection are essential to identify cognitively normal individuals who have a high risk of developing MCI and AD, so that interventions can be developed to delay the progression of specific disease-related pathologies. Thus far, novel biomarkers that have been examined include structural and functional neuroimaging as well as biochemical analysis of cerebrospinal fluid. However, in spite of these efforts there is still an urgent need for unravelling additional novel biomarkers for AD and MCI. As the retina shares many features with the brain including embryological origin, anatomical (such as microvascular bed) and physiological characteristics (such as blood-tissue barrier), it has been suggested that the retina may provide an easily assessable and non-invasive way of examining pathology in the brain. While most AD-related pathology occurs in the brain, the disease has also been reported to affect different regions of the retina, including the macular region and optic disc. Studies have suggested that retinal pathology such as deposits in the macular region, decreased retinal nerve fiber thickness, optic disc cupping and retinal microvascular abnormalities may be related to AD and cognitive impairment. This presentation presents a review of current literature on retinal involvement in AD and MCI.
S4C-4 Mixed Dementia in the Era of Amyloid Imaging Prof. Dr. Vincent Mok The Chinese University of Hong Kong, HONG KONG 23
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Pathology studies suggested that mixed dementia, in particular, mixed Alzheimer’s and cerebrovascular disease, is a frequent entity among elderly demented subjects. In demented subjects with a clinical diagnosis of Alzheimer’s disease, it is not difficult to detect cerebrovascular lesions using structural imaging (e.g. CR or MRI). However, in demented subjects with stroke or other cerebrovascular lesions, it is very difficult to detect in-vivo concurrent Alzheimer’s pathology using structural imaging. It is not until in the recent decade that amyloid plaques can be detected in-vivo using amyloid PET, e.g. Pittsburgh compound B (PIB) PET. In this lecture, findings on the prevalence and relevance of amyloid burden as detected by PIB PET in subjects with post-stroke dementia will be presented.
SYMPOSIUM 5A: LEGAL AND ETHICAL ISSUES
S5A-1 Assessing Capacity in Dementia Assoc. Prof. Dr. Chin Jing Jih Tan Tock Seng Hospital, SINGAPORE An inevitable consequence of the rapidly ageing population in Asia is the escalation in the prevalence of dementia. This leads in turn to a rising need for capacity assessment for various legal, clinical and social purposes. The assessment of mental or decision making capacity in patients is challenging and complex. While each assessment is a snapshot of the patient’s ability at a particular juncture of the illness, cognitive function in dementia changes with time and severity of the disease, and can be confounded by various factors and concomitant medical problems and psychopathology. Some categories of assessment require mainly the demonstration of comprehension (of relevant facts), appreciation (of consequences associated with various options) and absence of undue influence in the decision making. But there also capacity assessments ( such as those related to independent living and driving) that involve the performance of specific tasks, where the conventional interview may need to be supplemented with relevant competency-based testing. This paper seeks to discuss some of these practical challenges faced and those resulting from the unique interaction between clinical and legal concepts of capacity.
S5A-2 Assessing the Criminal Offenders with Dementia Dr. Dominic Johnson Newcastle University Medicine (NUMED), MALAYSIA This presentation will fall into two parts. The first will address issues with regard to the assessment of the older offender. It will consider relevant diagnosis and highlight specialist areas of assessment. Then it will move onto discuss a consideration of how current Malaysian criminal laws pertains to older adults particularly in regard to the insanity defence and dementia. This will be compared to UK legislation. The second part will discuss the issue of older offenders in prison. It will highlight the epidemiology, service requirements and ethical issues pertaining to the older adult in prison.
S5A-3 Inadequacies of the Mental Health Act for People with Dementia Dato’ Dr. Suarn Singh Hospital Bahagia Ulu Kinta, MALAYSIA The Mental Health Act (MHA) 2001 & Mental Health Regulations (MHR) 2010 came into force on 15 June 2010. This Act has provides care for mentally ill in psychiatric hospital, psychiatric nursing home (PNH) or community mental health centres (CMHC). Majority of the private homes have not registered under the MHA and are still operating under the Care Centres Act (CCA) 1993 (Act 506) with Amendment Act & Regulations (Act A1292 & P.U. (A) 248/1994). There are a number of elderly, persons with mental illness and some with dementia kept informally in care homes. In Malaysia, CCA 1993, provides for the registration, control, and inspection of care centres, which can be residential care or day care centre. However, with the implementation of the MHA 2001 all care centres lodging mentally ill persons come under the preview of the new Act. For the persons kept in care centers under the CCA 1993, the care provided is frequently of a poor standard, usually due to lack of trained staff.
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There is alleged overuse of neuroleptics in these centers. There are safeguards provided in the MHA 2001 & MHR 2010 that protects the mentally ill, patients’ rights, regular assessment, individual care plans, appeal mechanisms against detention. The use of physical restrain is not permitted in PNH & CMHC. With the implementation of the Disability Act 2008, people with severe mental illness and Dementia could register as disabled. They and the carers could then be eligible for benefits as provided by the government.
S5A-4 Assessing Mental Capacity for Everyday Life Decisions Dr. Victor Lui, Linda CW Lam, Rachel CH Chau, Ada WT Fung, et al. Tai-Po Hospital, Hong Kong Background: Everyday life decisions including managing one’s own medications and finance are essential for an older adult to live safely and independently. Dementia is a recognized cause of mental incapacity and mental incapacity to make such decisions can have significant clinical implications. There is a pressing need for the development of a reliable assessment method. Method: Two hundred and ninety-one Chinese community-dwelling older adult were recruited. Mental capacity was assessed by using the Chinese version of the Assessment of Capacity for Everyday Decision-Making (ACED) and independent clinician ratings based on the definition in the Mental Capacity Act 2005 of the United Kingdom. Results: Ninety-nine participants (34%) were diagnosed with amnestic mild cognitive impairment and ninety-five (33%) with mild Alzheimer’s disease. For mental capacity to decide on medication management, the inter-rater reliability of the ACED ranged from 0.8 to 0.9 for the abilities to understand, appreciate and reason. Conclusion: Mental capacity to make everyday life decisions can be measured reliably with a specific and structured assessment tool.
SYMPOSIUM 5B: CO-MORBID MEDICAL CONDITIONS
S5B-1 When Delirium Complicates Dementia Dr. Lesley Young Newcastle University Medicine (NUMED) MALAYSIA Delirium is a common finding in hospitalised older people. Traditionally viewed as a transient reversible epi-phenominum, it has become clear that it is an independent risk factor for poor outcomes. More recently it is also emerging that delirium can lead to permanent decline in cognitive function, particularly in those with pre-existing neurodegenerative problems. Dementia is one of the most significant risk factors for the development of delirium, and evidence suggests that up to 40% of incident delirium could be prevented using targeted multi-component interventions. In this presentation I will discuss the latest understanding of the pathophysiology of delirium and how we can better manage this challenging condition in the context of pre-existing dementia.
S5B-2 Pain Assessment and Management in the Cognitively Impaired Dr. Richard Lim Boon-Liang Hospital Selayang, MALAYSIA Pain is a common symptom in elderly patients from a variety of causes such as musculo-skeletal problems, arthritis, gout, cancer, osteoporosis, neuropathies and headaches. Dementia is also a common condition encountered in the elderly. Hence the combination of pain in cognitive impairment is not umcommon. The prevalence of pain in elderly nursing home residents has been reported between 40- 80% while other reports show that about 50% of nursing home residents have cognitive impairment. Assessment of pain in the cognitively impaired can therefore be challenging as the gold standard for pain assessment has commonly been self-reports of pain. Typical pain assessment tools may therefore be inappropriate in the cognitively impaired and commonly alternative pain assessment tools observing pain behaviours may be necessary. There is currently no ideal tool to assess pain in the cognitively impaired
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MJP-21(Suppl)-2012 and it has been suggested that pain behaviours observed in patients with cognitive impairment may not be specific towards pain alone and may be a response to other forms of distress. Management of pain can also be challenging as once again the typical principle of pain management which involves assessment, treatment and reassessment may be difficult in the cognitively impaired. Patients may be unable to indicate the degree of response to treatment and may also not be able to complain of the side effects of treatment.
S5B-3 Management of Falls in Patients with Dementia Assoc. Prof. Dr. Tan Maw Pin University Malaya Medical Centre, MALAYSIA Dementia is a major risk factor for falls. In addition, patients with dementia often possess other risk factors for falls including multiple medications, heart disease, muscle weakness and visual problems. Individuals with dementia are more likely to suffer fractures and other adverse consequences of falls. The management of falls in patients with dementia pose a particular challenge. Many falls studies have excluded patients with cognitive problems. The published evidence on the management of falls in patients with dementia will be evaluated, and potentially beneficial treatment strategies will be highlighted.
S5B-4 The Management of Frail Hospitalized Patients with Dementia Assoc. Prof. Dr. Shahrul Bahyah Kamaruzzaman University Malaya Medical Centre, MALAYSIA Dementia will generally not be identified as the reason for hospitalization of an elderly person but rather the cause of the medical morbidity that led to the acute hospitalization. Compared with other older people, older people with dementia have three times as many hospitalizations, four times as many hospital days and almost three times as many visits to the emergency department. Until recently, it was commonly believed that the average life expectancy after being diagnosed with Alzheimer disease was 8-10 years. Current evidence, however, suggests a shorter median survival of approximately 3.17 to 4.2 years for men, and 3.36 to 5.7 years for women. Mortality may be higher among the hospitalized, with one study citing a median survival of 6 months among severely demented patients recently admitted to the hospital with an acute illness Frail demented patients are more likely to experience adverse outcomes such as new delirium, pressure ulcers, incontinence, functional decline, inappropriate use of psychotropic medications, physical restraints, untreated pain as well as unnecessary feeding tubes. This vulnerability or frailty needs to be identified during an inpatient stay to prevent poor outcomes that may lead to further decline and recurrent admissions. The impact of dementia on acute hospitalization, including the mechanisms by which dementia prolongs the hospital stay, requires further investigation.
General Symposium
OPPORTUNITIES FOR DEMENTIA RESEARCH IN ASIA
GS-1 Amnesia and Dementia: Has the Time Come for a New Paradigm? Prof. Dr. Jean-Marc Orgogozo University of Bordeaux, FRANCE A slowly progressive loss of verbal and episodic memory is the key symptom of Alzheimer’s disease (AD), of which it is the most characteristic and, many believe, the first to appear. However dementia is not only a dysmnesia (WHO, ICD 10, 1993). Pure verbal and episodic amnesia, without other cognitive disturbances, arises from lesions of both hippocampi, such as in Vit. B1 deprivation (Korsakoff’s syndrome), paraneoplasic syndromes or after surgery like the famous case H.M., operated by Penfield in 1953, who survived for 48 years without remembering anything. These relatively rare cases have near- normal intellectual functions otherwise, without significant loss of autonomy. They therefore do not meet the criteria of dementia. Conversely, AD dementia is usually defined (as in the DSM-4, APA, 1994) as the combination of 1) verbal (episodic) memory loss, 2) any other modal cognitive impairment, 26
MJP-21(Suppl)-2012 particularly executive function which includes attention, and 3) functional disability (Barberger-Gateau et al, 1999), observed first in the more complex (instrumental), then in the more basic activities (of self- care) in daily life. As these disabilities worsen, the demented patients become more and more dependant of others, which puts a growing burden on their caregivers and results in ever increasing costs for their families and the third payers (Jonsson et al, 2006). As the number of such patients grow steadily in a majority of countries, due to the continuing aging of the population, this gets to become a major challenge for the economy of developed, but also less developed nations (e.g. China) throughout the world (Ferri et al, 2005; ADI, 2009). Even if much less known and understood than memory, executive function which is, in some ways, the monitor and administrator of the thinking and working brain (Fabrigoule et al, 1998) may well be the main determinant of dementia. It combines and coordinates working memory (what am I doing now and for what purpose?) planning of action by combining conscious strategies (explicit choice of options), combined with implicit implementation of acquired routines, while controlling their execution (hence its name), which needs an efficient and persistent attention (Kadir et al, 2006). So, impairment of executive function may well be a more important determinant of dementia than is memory loss, which is typical associated with AD but not to other types of dementia. Memory loss is absent or secondary in fronto-temporal dementia (FTD) and in many cases of vascular dementia (VaD) (Roman et al, 1993). Even if they are not primarily amnestic, these conditions may get as disabling as AD. So, a group of experts (Roman et al., 2004) proposed to replace memory loss by impairment of executive function as the primary criterion in the definition of VaD – the second most frequent dementia after AD. This major change of paradigm has been implemented in research and in large scale trials (PERFORM) since.
GS-2 Multiculturalism and the Challenges of Research in Asia Prof. Dr. Linda Lam The Chinese University of Hong Kong The World Alzheimer report 2011 stipulated that the greatest proportional increase in dementia population in the coming decades would come from the developing region. An indispensible component of quality dementia care will be advancement of research. The socioeconomic and cultural characteristics of this region have posed major challenges for researchers. Asia is a rapidly developing region. Polarity of economic status is found not only across countries, but also within a nation. Research facilities and expertise vary widely, affecting the efficiency of multi-centre collaboration. To enable with international comparison, assessment tools for research need validation and adaptation. The multi-ethnic background of Asian nations requires a lengthy process for the development of calibrated assessment battery applicable in the locality. Asian elders are brought up in an environment that emphasizes modesty and tolerability. While they are resilient to hardships in life, the readiness to accept novel manoeuvres in research may be low. A typical example will be the difficulty in obtaining consent for cerebrospinal fluid biomarker assay in early prediction of Alzheimer disease. Challenges are associated with opportunities. The dense population of emerging older population provides a fertile ground for new research ideas to flourish. The interesting indigenous medicinal practice such as diet, exercise and meditative practice since ancient times brings additional dimension for lifestyle intervention in presymptomatic and preclinical disease. It is of immense interest to explore if integration of cutting edge scientific approach in the west and the eastern philosophy will open a new chapter for dementia management and prevention.
GS-3 Epidemiology and Treatment of Tau Pathology in AD - Plans for TauPx’s Global Phase 3 Program in Asia Prof. Dr. Claude Wischik University of Aberdeen, UNITED KINGDOM Abstract not available
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Lunch Symposium
LS-1 Combination Treatment in Alzheimer’s Disease – What is the Rationale? Prof. Dr. David Wilkinson UNITED KINGDOM The growing incidence of Alzheimer’s disease (AD) in the general population throughout the world poses important challenges, considering its enormous economical and social costs. The hope that a cure would soon emerge from attempts to modify amyloid metabolism has not materialised but that should not engender therapeutic nihilism. In fact, we have drugs that, if used rationally, can substantially reduce symptoms in Alzheimer’s patients and slow clinical progression of the disease. The use of acetylcholinesterase inhibitors and of memantine can pharmacologically modulate some of the pathological mechanisms underlying Alzheimer’s disease, with confirmed clinical benefits. I am going to review the potential for synergy if used these drugs are used in combination. From the preclinical data looking at mechanisms of action that could underlie the synergistic action of acetylcholinesterase inhibitors and memantine through the short term randomised controlled trials and to the longer term naturalistic studies. Short- and long-term data support superior efficacy and effectiveness for combination therapy with combination therapy producing additional benefits which may translate into reduce clinical decline and delayed nursing home placement.
LS-2 Optimal Use of the Cholinesterase Inhibitors: Can the Dose be Safely Increased? The case of Exelon Patch Prof. Dr. Serge Gauthier CANADA Maximal doses of cholinesterase inhibitors (CI) have been determined during pivotal randomized clinical trials, comparing different doses to placebo or to lower CI doses. These maximal doses (donepezil 10mg/day, rivastigmine oral 12mg/day, rivastigmine patch 9.4mg/day, galantamine 24mg/day) were determined for groups of patients at mild to moderate stages of Alzheimer’s dementia, and do not take into account individual variability in transport of the drug into brain and level of cholinesterase inhibition. Furthermore side-effects (predominantly gastro-intestinal) limited attempts at prescribing higher doses. A study comparing rivastigmine patch 9.4 to size “15” was successfully completed and leads the way to potential use of that CI in patients losing symptomatic benefits from the standard maximal dose.
Oral Free Paper Abstracts
MO1. Sexual dysfunction among breast cancer survivors Maryam Amaran, Hasanah Che Ismail Hospital Universiti Sains Malaysia Introduction: Sexual dysfunction is a frequent side effect of cancer treatment. Research suggests that about 50% of long-term breast cancer survivors experience global and profound sexual dysfunctions. Not like many other side effects of cancer treatment, sexual problems continue for few years after the treatment. Furthermore, this sexual problem will have an effect on marital relationship and overall quality of life. Objectives: To determine the sexual dysfunction among breast cancer survivors attending follow up in oncology clinic HUSM and its related factors. Method: This was a cross sectional study using a self-administered validated questionnaire. Samples were taken among breast cancer survivors attending follow up at oncology clinic HUSM. The socio-demographic and clinical profiles were analyzed as descriptive statistics. The dependent variable was the sexual function score which was analyzed as a numerical variable using ANCOVA to see whether sexual dysfunction is associated with breast cancer survivors after controlling for several covariates. The sexual scores were then changed to 28
MJP-21(Suppl)-2012 categorical variables. The factors related to the sexual dysfunction in breast cancer patients were analyzed using multiple logistic regressions to see the associated factors. Results: There were 61 breast cancer survivors eligible for the study. 61% presented at early stages of illness. The median duration of illness since first diagnosis was 4.0 (3.8) years. Majority of the breast cancer survivors had mastectomy done (70.5%), underwent chemotherapy (88.5%), radiotherapy (88.5%), and received anti hormone treatment (83.6%). The quality of life of breast cancer survivors was good with mean PGWBI score of 74.08 (14.79). 11.5% of the breast cancer survivors reported anxiety in self rating scale, and another 6.6% had depression. Global sexual dysfunction was seen in 24.6% breast cancer survivors, and it was higher compared to a matched group without breast cancer, even after controlling for other confounders. The most common sexual dysfunction was sexual dissatisfaction (44.3%) followed by sexual desire disorder (31.1%) and sexual arousal disorder (23.0%). Sexual dysfunction in breast cancer survivors was associated with husband’s age, duration on anti-hormone therapy, quality of life and depression. Conclusions: Sexual dysfunction is higher among breast cancer survivors compared to individuals without breast cancer. Sexual dysfunction in breast cancer survivors are related to husband’s age, duration on anti-hormone therapy, quality of life and depression.
MO2. Illness characteristics of migrant workers in a psychiatric inpatient unit- a descriptive study Arlina Nuruddin*, Maniam Thambu**, Sarfraz Manzoor Hussain*, Loh Sit Fong** *Department of Psychiatry and Mental Health, Hospital Kuala Lumpur **Department of Psychiatry,Universiti Kebangsaan Malaysia Medical Centre Introduction: Malaysia has a total of 2.3 million registered migrant workers and Malaysia’s workforce constitutes approximately 21% migrants coming from the neighbouring countries. However, there are only few studies that have paid attention to the mental health of migrant workers although it is an important issue that may give rise to the economic and social implications. Objective: To explore the pattern of psychiatric disorders among migrant workers and its relationship to life events in Malaysia; also to make recommendations to reduce the social and economic impact of illness caused by the migrant workers. Methodology: A cross-sectional study was conducted on 57 migrant workers admitted to psychiatric wards in Hospital Kuala Lumpur. Diagnosis fulfilling DSM-IV was determined using Mini Neuropsychiatric Interview (M.I.N.I.) and the presence of life events was determined using Interview for Recent Life Events Questionnaire (IRLE). Result: The mean age was 29.2 years, most of them were female (63.2%), came from Indonesia (40.4%) and Myanmar (24.6%). A majority of the patients were single (52.6%), had a primary education or no formal education (56.1%), 38.6% were working as maids, 31.6% in the services sector and the remaining 17.5% in other sectors. Almost one- third of them had past psychiatric illness and almost a quarter had family history of psychiatric illness. The commonest psychiatric illness was psychoses (79%). The commonest life events found in this study were work-related life events (40.4%), financial (17.5%) and family and social problems (17.5%). Conclusion: A proper pre-employment mental health screening is important. The information from the descriptive data can be used to guide multiple agencies in handling mental health issues among migrants. Policies can be constructed in order to assist the workers who are facing work-related and financial problem, also to protect the mental health of the migrant workers and to prevent social and economic implications towards migrant workers, employers and country.
MO3. Sexual dysfunction in male patients with schizophrenia in remission Ong Kheng Yee*, Hasanah Che Ismail**, Eni Rahaiza Muhd Ramli* * Department of Psychiatry and Mental Health, Taiping Hospital ** Universiti Sains Malaysia Objectives: To determine the prevalence and the factors associated with sexual dysfunction in male patients with schizophrenia in remission. Methods: A cross-sectional study with non-probability sampling method was conducted in Taiping Hospital psychiatric outpatient clinic over a 7-month period. Male schizophrenia patients in remission and male relatives as controls were assessed for sexual function with a validated Malay version of the International Index of Erectile Function-15 in the domains of erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. Multiple logistic regression and Analysis of Covariance were used for analyses. Results: One hundred 29
MJP-21(Suppl)-2012 and eleven male schizophrenia patients in remission and 111 controls were recruited. All the five domains of sexual functioning showed a prevalence of dysfunction ranging from 78.4% to 97.1%. The results on the sexual dysfunction were significantly independent when compared to the controls. After controlling for confounding factors, only orgasmic dysfunction had significant association with race i.e. Chinese were at lower risk for impairment than Malays (OR=0.23; 95% CI: 0.07, 0.76; p=0.018), education i.e. patients with higher education were at higher risk for dysfunction than those with primary education (OR=6.49; 95% CI: 1.32, 32.05; p=0.022) and PANSS-positive subscale i.e. higher PANSS- positive score was a protective factor for orgasmic dysfunction (OR=0.54; 95% CI: 0.33, 0.89; p=0.015). Conclusions: The prevalence of sexual dysfunction was relatively high compared to other studies. Malays and patient with education higher than primary level were risk factors for orgasmic dysfunction whereas higher PANSS-positive score was protective against the dysfunction.
MO4. Klein Levin Syndrome in Malaysia Bahari R*, Ahmad SH** *Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia **Universiti Institut Teknologi MARA (UiTM) Shah Alam, Malaysia Introduction: A rare sleep disorder, to date, only 186 cases of Klein Levin Syndrome had been reported worldwide (Arnulf, Zeitzer et al. 2005). More recently a case was reported in Thailand (Sithinamsuwan, Ruangwittayawong et al. 2010). Case Presentation: A 13-year-old boy presented with a 2 weeks history of tearfulness, childish behaviour, separation anxiety, hypersomia, hyperphagia and sexual disinhibition following a brief episode of fever. This had recurred yearly since the age of 6, but had fortunately been brief and self limiting. An array of consultations with doctors and traditional health practitioners failed to diagnose his condition. The above consultation was initiated by his mother when the illness did not spontaneously recover after 1 week. Examination and investigations did not reveal anything significant apart from him being slightly overweight. A trial of 1mg of Risperidone daily gave no impact whatsoever, but fortunately one week following the above consultation, his symptoms disappeared spontaneously. He was back to his usual shy and serious self again without the help of any medications. Conclusion: This case report illustrated how diagnosis, education and support can make a difference to a patient with a rare illness that has no cure and help his parents handle him better.
MO5. Hypoactive sexual desire among malay diabetic women in Malaysia: Who are at risk? Adibah Hanim Ismail*, Rawa Baw**, Hatta Sidi***, Ng Chong Guan****, Rosdinom Razali*** *Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia **Bintulu Health Clinic, Department of Health (Bintulu) ***Department of Psychiatry, Universiti Kebangsaan Malaysia ****Department of Psychological Medicine, Faculty of Medicine, University Malaya Objectives: This study aims to determine the prevalence and associated factors of hypoactive sexual desire disorder among Malay women in Malaysia with type 2 diabetes mellitus. Methods: This is a cross-sectional study involved 347 women (174 non diabetic and 173 diabetic subjects) who attended the diabetic clinic in a university hospital. Hypoactive sexual desire was assessed using the Desire subscale of Malay Version of the Female Sexual Function Index (MVFSFI). Socio-demographic information of the subjects was collected with a pre-designed questionnaire. Results: Prevalence of hypoactive sexual desire disorder among Malay women with type 2 diabetes mellitus was 28.3% and the control group was 25.9%. The difference was not statistical significant. Multivariate logistic regression analysis showed that older age (adjusted OR = 1.10, CI = 1.00, 1.21) and unemployment (adjusted OR = 1.95, CI = 1.15, 3.30) were significantly associated with hypoactive sexual desire. Conclusion: Hypoactive sexual desire is highly prevalent among the Malay women regardless of the diabetic state. Increased age and unemployment are highly associated with hypoactive sexual desire disorder in Malaysian Malay women.
MO6. Cross-cultural narratives on death and bereavement among medical students - implications for curriculum development AE Margarita Malayapillay*, Arokimary Bharathy** *Penang Association of Counseling and Psychology (PACP) ** Penang Medical College 30
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Introduction: Culturally competent communication with patients and families around the time of death places particular demands for knowledge, awareness and sensitivity. Little is known about how best to prepare our future doctors in this area. Interactive, small group learning has been recommended. However, it is unclear how viable such approaches in practice. Objective: (a) To explore how medical students engage with issues of death and bereavement in an interactive, multi-ethnic group (b) To discuss the implications for introducing similar processes in undergraduate teaching. Method: A purposeful sample of 13 PMC students from diverse ethnic and religious backgrounds was recruited to a focus group study. Students’ personal narratives surrounding death and bereavement and their reactions to the group itself were explored in an audio-recorded, semi-structured interview, co-led by the authors. Thematic analysis of verbatim transcripts was performed. Results: Participants provided rich narratives of religious practices surrounding death and bereavement and the students valued these experiences together with support from family and friends. Contributions emerged from a minority of participants for whom strict religious observance appeared less salient. Feelings of suppressed grief, guilt, and detachment were expressed. Recognition of the commonality of support needs across different traditions was evident. Some participants acknowledged difficulty in expressing emotions but yet experienced the group positively. Conclusion: This exploratory study suggests that small-group teaching of culturally sensitive topics is well accepted. However, the generalizability of findings from one study is limited and replication in other medical school settings with different student populations is recommended.
MO7. Stress among final year medical students at School of Medicine, University Malaysia Sabah Narasappa Kumaraswamy, Kamaruddin D Mudin School of Medicine, University Malaysia Sabah Introduction: Stress is a part & parcel of every one’s life and is not an exception. Objective: The main objective of this study is to assess the stress among final year medical students. Method: The students are in Shadow Houseman posting (SHOP) and attending a workshop on stress management. School of Medicine made it compulsory to all final year students to attend this workshop which will help them to cope their stress during their houseman ship. Reports from newspapers states, “overworked Houseman”. “The darker shades of houseman’s life”. “Houseman’s still being overworked, bullied sending home in to depression”. In the present study the final year students were asked to complete a student stress rating scale and tick the life events they had for the past 12 months. Results: There are 69 students, based on the scores they are divided in to groups low stress, borderline stress & high stress. 42% reporting low stress,29%as borderline stress & 21% reported having high stress. It was noted that 21%(15) final year students reported as having high stress & these are likely to have problem while doing housemanship. Discussion: The workshop on stress was conducted keeping these students as targeted group. The feedback from the workshop was good. In view of the present findings we suggest the authorities of the medical school should take preventive measures by instituting stress coping mechanism with counseling to needy students throughout the medical school years.
MO8. Psychological impact of peacekeeping mission deployment among Malaysian military personnel Siti Nordiana Dollah*, Lin Naing**, Shamsul Azhar Shah***, Azlin Baharudin* * Dept. Of Psychiatry, UKM Medical Center, Cheras, Malaysia **Institute of Medicine, University of Brunei Darussalam ***Dept. of Community Health, UKM Medical Center, Cheras, Malaysia Introduction: Mental stress among Malaysian military personnel is frequently reported. Military deployments are the fundamental constituent of military life. The association between psychiatric morbidity and military deployment has been established and extensively studied in Western countries. However, very few studies have been carried out locally and yet; there was no single local study on the association between psychiatric morbidity and deployment despite a rising trend of Malaysia Armed Forces participation in United Nation peacekeeping. Objective: To examine the psychological impacts of peacekeeping mission to the military personnel. Method: A follow up study of affiliates of Malcon East 5 peacekeeping troop to Lebanon, was conducted from November 2009 to November 2010 at Malaysian Royal Armored Corps 1, Kuantan, Pahang. Of 310 personnel in the troop, 268 fulfilled the 31
MJP-21(Suppl)-2012 study criteria. However only 217 completed follow up. Psychiatric disorder was assessed using Mini International Neuropsychiatric Interview whereas psychological morbidity was determined using Malay version of Depression Anxiety Stress Scale. Results: The prevalence of psychiatric disorder was significantly increase from 0.9% to 3.7% after the deployment as compared to before deployment (p=0.031). There was significant difference in DASS score at pre and post deployment for depression (p=0.001) and anxiety (p<0.001) subscale but not stress. Conclusion: There is inclining of psychiatric disorder as well as attenuation of personnel emotional and psychological well being in related to peacekeeping deployment. Therefore both prevention and early intervention measures are essential in order to preserve the well-being of our personnel.
MO9. Criteria for mentally ill Malaysian pilgrims: Time to revisit Norazam Harun Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan Objective: To revise the criteria for mentally-ill individuals’ eligibility to perform pilgrimage to Mecca. Methodology: All psychiatric consultations in Mecca and Madina during pilgrimage year 2010 and 2011 were selected. The demographic data, diagnosis and past history in the Malaysian pilgrims’ medical book were assessed and analysed. Past psychiatric history was obtained by asking the patients or relatives whether they had had received any psychiatric treatment or has seen any psychiatrists in Malaysia. The retrospective history was then compared with the information in the pilgrims’ medical book. Results: There was increase of 18.6% of psychiatric consultation and admissions during pilgrimage in 2011. Those who sought psychiatric consultations in 2011 were significantly from female patients, of young age group (40-59 years old) and those who came under private-paying companies Depression/anxiety remained the most common diagnoses among Malaysian pilgrims. Dementia/confusion has been persistent in term of numbers among the pilgrims in the last two years. However there was quadruple increase numbers of psychotic patients in particular Schizophrenia among the pilgrims in 2011. Only 27% of mentally-ill persons have consulted and approved by psychiatrists in Malaysia. Those who have been approved came for psychiatric review during pilgrimage despite on regular medication especially those who came to Mecca accompanied by different gender person. Conclusion: Criteria for mentally-ill individuals should be reviewed in order to assist the medical personnel in primary health care (PHC) setting to detect and subsequently refer for psychiatric evaluation. Psychiatrists should be given guidelines to help determine the eligibility of the mentally-ill person prior to their departure to Mecca/Madina. This presentation is to highlight the problems of current criteria and suggestions of a screening instrument to minimize the number of individuals who are at risk of developing psychiatric problems during haj in Mecca each year.
MO10. Psychological distress of first year medical students who underwent two different admission processes during a stressful period Muhamad Saiful Bahri Yusoff*, Ahmad Fuad Abdul Rahim*, Abdul Aziz Baba*, Shaiful Bahari Ismail *, Hatta Sidi**, Ab Rahman Esa*** * Universiti Sains Malaysia, Kelantan, Malaysia ** Universiti Kebangsaan Malaysia, Cheras, Malaysia *** Universiti Sultan Zainal Abidin, Terengganu, Malaysia Introduction: The study of medicine is often regarded by students as a stressful environment particularly during examination period. Studies found a high percentage of medical students experience significant psychological distress during the examination period. Objective: This study compared percentage and level of psychological distress between two batches of first year medical students who underwent different selection admission processes during a stressful examination period. Methods: A comparative cross-sectional study was done on two batches of first year medical students; one group selected based on academic merit (2008/2009 batch) and the other selected based on academic merit, psychometric tests and interview (2009/2010 batch). The psychological distress was measured by the 12- item General Health Questionnaire (GHQ-12). Data was collected right after the final examinations. Results: A total of 99 (46.05%) medical students of the 2008/2009 batch and 196 (100%) medical students of the 2009/2010 batch participated. The percentage of medical students had psychological distress of the 2008/2009 and the 2009/2010 batches were 58.59% and 42.3% respectively. The mean 32
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GHQ-12 score and percentage of psychological distress were significantly different between the two batches (p< 0.01). The older batch had 2.01 times higher risk for developing psychological distress compared to the newer batch (p < 0.01). Conclusion: The newer batch of medical students had better psychological health status and was less likely to develop psychological distress during the stressful period compared to older batch.
MO11. Sexual dysfunction among pregnant women attending a Malaysian antenatal clinic Rosdinom Razali* Kartini Balakrishnan** , Hatta Sidi*,, Japaraj Robert Peter*** , Thinakaran Malapan****, Zainul Rashid Mohamad Razi***** *Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur **Department of Psychiatry, Hospital Raja Permaisuri Bainun Ipoh, Perak ***Department of Obstetrics and Gynaecology, Hospital Raja Permaisuri Bainun Ipoh, Perak ****Department of Obstetrics and Gynaecology, Hospital Taiping, Perak *****Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur Objective: The aim of this study is to determine the prevalence of sexual dysfunction among pregnant Malaysian women and determine the socio-demographic factors associated with it. Methods: A cross- sectional study was conducted on a group of pregnant women attending the antenatal clinic of Hospital Raja Permaisuri Bainun Ipoh, at all stages of their pregnancy. Selection of subjects was made using the universal sampling method. Women aged less than 18, single mothers with no live-in partners or those undergoing termination of pregnancy were excluded. The validated semi-structured Malay Version Female Sexual Function Index (MVFSFI) was used to assess sexual functioning. This questionnaire categorizes sexual dysfunction in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain. Results: The prevalence of sexual dysfunction among the 175 eligible subjects was about 37%. Types of sexual dysfunction experienced were low sexual desire (35%) and problems with arousal (25%), lubrication (28%), orgasm (21%), satisfaction (30%) and pain (23%). Their mean age was 31 (SD 4.9) years with a mean gestational period of 26.8 (SD 6.9) weeks and having at least a secondary school education (97%). Most were primigravidas (41%) and in their third trimester of pregnancy (55%). Almost all (98.3%) described their marriage as ‘happy’ and their current pregnancy as ‘planned’ (74%). Conclusion: More than a third (37%) of them experienced sexual dysfunction, mainly lack of desire, despite having a ‘happy’ marriage.
MO12. Depression and anxiety in patients with psoriasis: why it is not skin deep Rozaidah Jaafar*, Fauziah Mohammed**, Nik Ruzyanei Nik Jaafar* * Dept. Of Psychiatry, UKM Medical Center, Kuala Lumpur, Malaysia **Hospital Besar Tengku Ampuan Rahimah, Klang, Malaysia Introduction: Chronic medical illness is frequently associated with greater decrements in health quality and daily functions. Study by WHO had revealed that up to 20% of patients with chronic physical diseases had co-morbid depression. Many studies all over the world including in Malaysia had looked more on the relationship between ‘serious’ or high morbidity illnesses with psychiatric morbidity such as depression and anxiety. Therefore, it is interesting to find out the psychological impact of the ‘less serious’ or ‘non-life threatening’ chronic physical disease. Hence psoriasis, one of the chronic skin diseases was chosen. Objective: The aims of this study was to determine the rates of depression and anxiety disorders among patients with psoriasis and to determine the factors that are associated with these emotional disorders. Methods: This cross-sectional study was conducted on 174 patients with psoriasis at Dermatology clinic, Hospital Tengku Ampuan Rahimah Klang. Mini International Neuropsychiatric Interview (MINI) was used to generate the diagnosis of depression and anxiety. Other included study instruments were Depression, Anxiety, Stress Scale 42 (DASS-42), Rosenberg Self- Esteem Scale (RSES) and Coping Inventory in Stressful Situations (CISS). Results: Study results showed that over a third (37.4%) of the subjects had major depressive disorder and 17.2% had anxiety disorders. Bivariate analysis showed that female (p=0.003) and younger (p=0.031) patients, with higher stress level(p < 0.001), lower self-esteem(p < 0.001) and used of emotional-coping (p < 0.001) were more likely to have depression. Similar factors except age were significantly related to anxiety disorders. Higher stress level (OR=1.16, CI=1.09-1.23) and lower self-esteem (OR=0.89, CI=0.81-0.97) remained significant with regression analysis (R2=0.43) for depression. Meanwhile, adaptation of emotional- oriented coping style (OR=1.10, CI=1.04-1.16) besides the higher stress level (OR=5.05, CI= 1.87-
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13.59) were found as significant predictors of anxiety disorders (R2 = 0.36). Conclusion: Interestingly, duration of psoriasis, its severity and presence of skin lesions over the exposed body areas had shown no significant relationship. The findings in this study had established that psychological factors rather than clinical features will predict the development of depression and anxiety in patients with psoriasis. Therefore, the recognition of this ‘skin and mind’ connection will support the importance of psychological approach in the management of psoriasis or other chronic medical conditions.
MO13. A study of psychiatric disorder among female delinquents in Taman Seri Puteri and its association with family environment Salhana Wazir*, ChanLai Fong**, Ling Naing ***, Shamsul Azhar Shah****, Wan Salwina Wan Ismail ** *Hospital Bahagia Ulu Kinta, Perak, Malaysia **Department of psychiatry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia ***PAPA Rashidah Sa’adatul Bolkiah, Institute of Health Sciences, Universiti Brunei Darussalam, Brunei ****Department of Community Health Medicine, Universiti Kebangsaan Malaysia Objective: The main of this study is to determinethe prevalence of psychiatric disorder among female delinquents. This study also examines the association between family environment and psychiatric disorder. Methods: A cross sectional study of female delinquent detained in Taman Seri Puteri was conducted between August and November 2010. A total of 100 inmates who participated in the study were assessed using Family Environment Scale and Mini International Neuropsychiatric Interview for Child and Adolescent (M.I.N.I.Kid). Results: The prevalence of psychiatric disorder among female delinquents was 56%. Conduct Disorder had the highest prevalence at 23% followed by Oppositional Defiant Disorder at 17%, major Depressive Disorder at 15% and Dysthymia at 145. The Presence of Anxiety Disorder, Substance related Disorder and Adjustment Disorder was recorded at 18%, 9% and 1% respectively. Psychiatric disorder showed significant association with maternal age (p=0.047) and achievement orientation in the family (p=0.010). Conclusions: This study demonstrates that the prevalence of psychiatric disorders is high among female delinquent and emphasizes the need for better assessment and intervention for this group of people.
AO1. Multidimensionality of the Zarit Burden interview across the severity spectrum of cognitive impairment: an Asian perspective Cheah W,K*, Han H.C.**, Chong M.S.**, Anthony P.V. **, Lim W.S. ** *Taiping Hospital, Taiping Perak, Malaysia **Department of Geriatric Medicine, Tan Tock Seng Hospital Annex, Singapore Introduction: We aimed to examine the multidimensionality of the Zarit Burden Interview (ZBI) beyond the conventional dual-factor structure among caregivers of persons with cognitive impairment in a predominantly Chinese multi-ethnic Asian population, and ascertain how these dimensions vary across the spectrum of disease severity. Methods: We studied 130 consecutive dyads of primary caregivers and patients attending a memory clinic over a 6-month period. Caregiver burden was measured by the 22- item ZBI, and disease severity was staged via the Clinical Dementia Rating (CDR) scale. We performed principal component analysis (PCA) with varimax rotation to determine the factor structure of the ZBI. The magnitude of burden in each factor was expressed as the item to total ratio (ITR) and plotted against the stages of cognitive impairment. Descriptive and inferential statistics were applied to study the relationships between dimensions with disease and caregiver characteristics. Results: We identified 4 factors: demands of care and social impact, control over the situation, psychological impact, and worry about caregiving performance. ITR of the first three factors increased with severity of disease and were related to recipients’ functional status and disease characteristics. ITR in the dimension of worry about performance was endorsed highest across the spectrum of disease severity, starting as early as the stage of mild cognitive impairment and peaking at CDR 1. Conclusion: Multidimensionality of ZBI was confirmed in our local setting. Each dimension of burden was unique and expressed differentially across disease severity. The dimension of worry about performance merits further study.
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AO2. Profile, clinical characteristics and risk factors among elderly hospitalized patients diagnosed with delirium *Suhaila M.Zahir, **Nazilaton B., **Suraya Yusoff * Hospital Kuala Lumpur, **Hospital Sultan Ismail, Johor Bahru Introduction: Delirium is common among the hospitalized elderly patients, with a prevalence of up to 25-40%. This is a retrospective study, of elderly hospitalized patients who were diagnosed with delirium from January 2010 until June 2011. Objective: To collect data on profile, clinical characteristics and identified precipitating factors for in elderly patients with delirium. Methods: Database of elderly patients referred to Department of Psychiatry and Mental Health Hospital Sultan Ismail from January 2010 until June 2011 were examined. Based on Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revision (DSM IV TR) those who fulfilled diagnosis of delirium were included in the study. Patients database were examined and data for demographic profile, clinical characteristics and relevant precipitating factors were gathered using general questionnaire. Result: Descriptive analysis was done using SPSS version 16.0. Majority of patients diagnosed with delirium were those aged 76 years and older. There was high percentage of patients with electrolytes derangements and abnormal serum albumin. Mean score of Malay version of mini mental state examination (M-MMSE) was 14.58. Five main precipitating factors for delirium were identified, which include metabolic problems, sepsis, cardiac insufficiency, pre-existing dementia and cerebrovascular accident. Among these factors, metabolic derangement contributed to the highest percentage. Majority of the patients were discharged well with 21.7% mortality rate following delirium. Conclusion: Clinical relevance of the study refers to the importance of identifying the profile and clinical parameters that precipitate delirium. This indicates an essential need for recognition of delirium and the possible treatable precipitating factors so that early treatment intervention could be implemented in order to improve outcomes.
AO3. Comparison of risk of developing serious adverse events between atypical antipsychotic and non-antipsychotic users in persons with dementia Chew Chien Lin*, Low Suat Fern*, Han Yan Yi Audrey***, Shanti Shridhar Shetty*** , Yap Lin Kiat Philip** *Department of Pharmacy, Khoo Teck Puat Hospital, Singapore **Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore ***Yoo Loo Lin School of Medicine, National University of Singapore, Singapore Introduction: Atypical antipsychotics (AAP) are frequently used off-label for the management of behavioural and psychological symptoms of dementia (BPSD) but have been associated with increased mortality and other safety concerns. Methods: Patients’ database from Khoo Teck Puat Hospital ambulatory dementia clinic was screened over a follow-up period that averaged 15.6 months. Patients who were 65 years or older were included. Patients with schizophrenia or whose clinical data were unavailable were excluded. Out of a total sample size of 515 patients, 331 satisfied inclusion criteria. Socio-demographic, clinical characteristics and medications history were compared. Serious adverse events (SAEs) leading to hospitalization and death between AAP users and non-users were analysed. Multivariate regression was used to compare the incidence of admission due to SAE and death between both groups. Results: AAP users (n=67) were significantly different in age, severity of dementia, existence of BPSD, exposure to anti-cholinergics and psychotropics and history of fall, compared to non- users (n=264). Thirty-nine (58%) cases of hospitalization and no deaths were reported in AAP users compared to 138 (52.3%) cases of hospitalization and 7 (2.7%) deaths in non-users and this difference did not reach statistical significance. In multivariate analysis, significantly higher incidence of falls or fracture (31.3% vs. 11.7%, p=0.03) was found in AAP users. Conclusion: Although there was no significantly increased risk of death and hospitalization, and serious cardio and cerebrovascular events between AAP users and non-users in dementia patients, AAP users did suffer an increased risk of falls and fractures.
AO4. Apolipoprotein E genotypes and behavioural and psychological symptoms of dementia in Malaysian patients with dementia
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Rosdinom Razali*, Zanariah Mat Saher**, Elinda Tunan***, Wan Zurinah Wan Ngah****, Then Sue Mian****, Suriati Mohamed Saini*, Abdul Hamid Abdul Rahman*, Shamsul Azhar Shah*****. *Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia **Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Malaysia ***Department of Psychiatry, Hospital Serdang, Kuala Lumpur, Malaysia ****UKM Medical Molecular Biology Institute, Kuala Lumpur, Malaysia *****Department of Social Preventive Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia Objective: The aim of this study was to determine the relationship between Apo E genotypes and ‘behavioural and psychological symptoms of dementia’ (BPSD). Method: A cross-sectional study was conducted on outpatients with dementia (aged 60 and above) and their caregivers attending the psychogeriatric clinics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and Hospital Kuala Lumpur. Neuropsychiatric Inventory (NPI) was used for the assessment of BPSD. The patients’ blood sample was taken for Apolipoprotein genotyping if consented by the caregivers. Results: There were more female (69.6%) and Chinese (50%) patients with a mean age of 73.7 years. Apo E ε3/ε3 was the most common Apo E allele (60.7%), and mostly found in Chinese patients. Apo E genotype was significantly associated with ethnicity (p=0.03) and marital status (p=0.01). Alzheimer disease was the most common subtype of dementia (41.3%) and the highest carrier of Apo E ε3/ε3 (30.4%). The Apo E ε4/ ε4 scored highest in BPSD median score 44 (17.5 - 90) but the relationships between Apo E genotypes and subtypes of dementia or BPSD scores were not significant (p=0.20; p=0.64). Agitation was the most common symptom, with delusions showing the highest scores on the NPI with no significant association to Apo E 4 allele. Conclusion: There were no significant relationships between Apo E genotypes and severity or types of BPSD in dementia patients.
AO5. Antipsychotic use in elderly with dementia in memory clinic, Hospital Sultan Ismail, Johor Bahru Chan Yee Fai, Suraya Yusoff Hospital Sultan Ismail, Johor Bahru Introduction: Antipsychotic agents are commonly prescribed to elderly patients with dementia. Around 80% of people with dementia will have behavioural and psychological symptoms in the course of illness. These symptoms will reduce the quality of life for both patients and carers, and frequently result in transfer of patients to institutions with higher cost. Furthermore, they are associated with caregivers’ stress and depression. Various drugs are used to treat behavioural and psychological symptoms of dementia (BPSD) including antipsychotics, antidepressants, mood stabilizers, anxiolytics, cholinesterase inhibitors and NMDA receptor modulators. Antipsychotics are commonly prescribed to elderly patients with dementia for decades, despite not being licensed for the use in patients with dementia-related psychosis by FDA. Objective: The objective of this study was to review the characteristic of patients with dementia, the use of antipsychotics and the adverse effects associated with the use of antipsychotics. Methods: In this hospital-based, retrospective study, we identified a total of 314 older patients with dementia came for outpatient treatment in the memory clinic, Hospital Sultan Ismail, Johor Bahru from 2008 till 2011. We analyzed the use of antipsychotics in these patients with dementia. Result: About one third of the patients with dementia were prescribed with antipsychotics. 97% of the patients were on atypical antipsychotics. Majority of the patients were treated with Risperidone. 57% of the patients needed antipsychotics for less than 6 months. Extrapyrimidal side effect is the most common cause of antipsychotic discontinuation. Conclusion: The use of antipsychotics is common in patients with dementia. Atypical antipsychotic is widely prescribed and a large number of them needed to be given for more than 6 months. They have a higher risk to develop metabolic syndrome and cerebrovascular adverse events thus adequate monitoring is essential.
AO6. HIV – associated dementia S.B. Rianawati, Masruroh Rahayu, Shahdevi Nandar K Neurology Department of Universitas Brawijaya Medical Faculty/Saiful Anwar Hospital Malang Indonesia Introduction: HIV - Associated Dementia (HAD) or AIDS Dementia Complex (ADC) is the decrease of cognitive functions occurring for minimum a month. Descriptively 26 HIV patients (57.8%) with a Mini Mental State Examination (MMSE) score < 24 had Probable Cognitive Dysfunction. Antiretroviral (ARV) combination of minimum 2 drugs (zidovudine, stavudine, abacavir, lamivudin, nevarapine, efavirin, indinavir) can enter the brain. Case: Patient (43 year-old male) complained of forgetfulness 36
MJP-21(Suppl)-2012 since 3 months ago i.e. misplacing farming tools, forgetting new information, date and day. Sometimes incoherent when spoken to, especially in long, complex conversation, but can still carry out daily activities; remember frequently visited places and names (of families and people around). Complaint of severe shortness for 2 days, weight loss, white patches inside the mouth, and fever in the last 2 months. Denied suffering from frequent diarrhoea, taking drugs, using tattoos, free sex, and leaving town. Discussion: HIV diagnoses on clinical basis. Weight loss > 10%, fever > 1 month, pulmonary tuberculosis, pneumonia (WHO St. III) and laboratory determinants reactive CD 4:3 cells/mL (T-Helper is very deficient). Anamnesa: forgetting placement of objects, incoherence. Neurobehaviour examination found a decrease in the MMSE, Clock Drawing Test, Forward and Backward Digit Span, Word List Memory Task. Conclusion: Diagnosis of HIV-Associated Dementia (HAD) used HIV clinical criteria set by WHO, very low CD4 examination, and decline in cognitive function with neurobehaviour examination. In the management of HAD, supply of ARV has a very important role.
AO7. Parkinson disease patients’ cognitive in Polyclinic Neurology, Hospital Dr. Saiful Anwar Malang S.B. Rianawati*, Shinta Kusumawati** *Neurology Department of Universitas Brawijaya Medical Faculty/Saiful Anwar Hospital Malang **Neurology Resident of Universitas Airlangga Medical Faculty/Soetomo Hospital Surabaya Introduction: Parkinson's Disease (PD) is often accompanied by non-motor complications, like cognitive impairment which may develop into dementia that can worsen the prognosis, increase individual and socioeconomic burdens. Mild cognitive impairment (MCI) affects nearly one-third of PD patients, yet little attention is given to cognitive problems in Parkinson as it is not an early symptom of PD. Early detection of cognitive impairment in PD patients is very necessary to further pursue preventive efforts against dementia in people with Parkinson's. Objective: To determine the presence of early cognitive impairment in PD patients at RS. dr. Saiful Anwar in August - September 2011. Methods: Descriptive study. Cognitive assessment based on the MMSE and CDT, by assessing the degree of PD by Hoehn & Yahr stage. Results: 20 Parkinson's patients, 11 males (55%) and 9 females (45%), peak age of onset of PD: 60-69 years. Percentage of cognitive impairment based on MMSE (<24): 20% and CDT ( 2): 30%. The severity of PD which experienced cognitive impairment stage I: 25%, stage II: 50%, stage III: 20%, stage IV/V: 5%. Cognitive disorders began to appear at age 60-69 (MMSE <24) and 40-49 years (CDT 2), while based on PD Hoehn & Yahr stage, cognitive impairment is more elevated in stage II. Conclusion: In this study, the percentage of cognitive impairment in patients with Parkinson’s appeared at 40-49 years old with the CDT examination and occurred more frequently in patients with PD stage II.
AO8. Role of sleep in rehabilitation of dementia & their associated disorders- a review Tarun Amalnerkar, Swapneela Jacob, Manish Gunjan Masterskill College of Health Sciences, Ipoh, Perak, Malaysia Introduction: Sleep is an imperative & vital aspect of our daily routine. In this rush of existence and convolution of life now a days it is common to have inevitable issues of sleep disorders such as insomnia, short nap or dozing in the day etc. It affects people of all age but in general it can be said that commonly it affects young college adult & old age people. Causes of lack of proper sleep other than pathological (Alzheimer’s diseases, multi infarct dementia, frontal lobe & alcohol related etc.) could be neglected aspect of modern day’s life style. Objective: This review is an attempt to throw light on studies conducted on sleep & cognitive functions there by showing importance of sleep in rehabilitation of patient’s old age as inevitable senile dementia & other associated psycho morbidity. Methodology: A systematic review was performed to establish specific effect of sleep on normal cognitive functions. “Relevant studies and information collected from the sciencedirect, cochrane library, pubmed, and pedro databases embase, amed, mantis, cinhal, google search engines. In the available corroborated scientific studies few of the researchers discussed about the evidences of sleep deprivation also may be due to non pathological causes for example night shifts, constant worry. Young adult & college students may sleep late due to using late night internet & playing computers games on the other hand sleepless nights due to anxiety and loneliness is normally in old age. Sleep deprivation whether partial or total largely can 37
MJP-21(Suppl)-2012 produce symptoms like anxiety, agony, lack of attentiveness & emotional instability. For few it affects abstract thinking, decision making, mathematic functions, vigilance, planning, critical reasoning & judgment etc. Enormous strives have been made for the psychiatric rehabilitation of it. Result: Few literatures show that a good sleep augments the level of activity and arousal. Sleep tranquillize and unruffled individual of irrespective of age. Sleep gives enough time to brain to rejuvenate & maintain the blood circulation. In addition life style modification, relaxation sessions give feeling of psychological well-being. At the same time it plummet muscle spasm, regularizing cardiovascular rhythm by regularizing cardiac cycle. Conclusion: Several studies reveals effect of T.S.D. & other sleep deprivation on fMRI, CT scan, cerebral blood flow to specific areas such as frontal lobe, cingulated gyrus, parietal lobe etc. However there is a strong need of more research and corroborated studies to determine efficacy of sleep as an adjunct in psychiatric rehabilitation so in future we can develop proper protocols and techniques specific the different age group suffering with dementia & other psychiatric conditions.
AO9. Comparing locally validated MMSE and MOCA in detecting vascular Dementia in first ever Ischemic stroke at JRRMM Steve S. Arellano, Jose C. Navarro, Simeon M. Marasigan. Jose R. Reyes Memorial Medical Center (JRRMMC) Introduction: Screening for vascular cognitive impairment (VCI) has long been considered inadequate because the widely used screening tool, the MMSE (Folstein, 1975) is inadequate because of its inability to detect early dysexecutive symptoms which maybe the initial presentation of VCI. Objective: To compare the screening ability of the recently validated Philippine version of the MoCA and the 2002 validated Philippine version of the MMSE in detecting cognitive impairment in stroke, we performed the tests to consecutive first ever ischemic stroke patients admitted at the Jose R. Reyes Memorial Medical Center in Manila within three (3) months after admission. Methodology: We studied 30 consecutive patients, composing of 15 males, and 15 females, with mean age≈60 years (youngest 41 and oldest 77), who had first-ever ischemic stroke within the designated study period (May to November, 2011), randomly chosen during their follow up check up at the Out Patient Department of Jose R. Reyes Memorial Medical Center. All the subjects underwent baseline neurological examination and cognitive screening test utilizing the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE), within the period of 3 months up to 6 months post discharge. The subjects were chosen with the following basic inclusion criteria: 1) Subjects were screened strictly those who had first ever stroke, 2) Ischemic stroke using the Oxfordshire Community Stroke Project Classification of Stroke Subtypes (LACS, PACS, TACS, POCS)¹, 3) Able to read and write, and can understand English, although the MoCA and the MMSE have both Filipino versions (validated), 4)Subject must be fully awake, 5) Subject must have no major disabilities, 6) mRS 0 to 4, as well as mRS 5 but can assume sitting position and able to do things by upper extremity/ies . The following are the exclusion criteria: 1) Hemorrhagic stroke, 2) Aphasic or no verbal output, 3) Unable to read and write, 4) Bed ridden, or in vegetative state. The patients were chosen according to the inclusion criteria, and with complete laboratory work up, including neuro-imaging studies. The subjects in this study were admitted at the Neurology Ward of the Jose R. Reyes Memorial Medical Center and were all treated accordingly. All of them underwent cranial CT Scan, and some with Cranial MRI (DWI/ADC map) to support the neurological diagnosis. Conclusion: Using the MoCA and MMSE as tools in determining or detecting vascular dementia in first ever ischemic stroke, one would notice the sensitivity and superiority of MoCA over the MMSE, especially those of mild cognitive impairment or in the early phase of dementia.
AO10. Dementia literacy in the Philippines Tess Sibbaluca, Jose C. Navarro, Simeon M. Marasigan Jose R. Reyes Memorial Medical Center (JRRMMC) Introduction: Background: Dementia literacy or the people’s understanding of dementia has always been an issue even in the most advanced nations. Even more so in most developing countries because of the impact of culture and religious beliefs in the understanding, concept and acceptance of aging and
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MJP-21(Suppl)-2012 dementia. Methods: This study aims to investigate the recognition of dementia beliefs regarding prognosis, cause, and risk reduction in the Philippines. This is a descriptive study using questionnaire on selected community dwelling adults among eight most dominant ethnic groups with diverse languages in the Philippines. Results: Seventy percent of the sample correctly identified “Dementia” or “Alzheimer’s” from a vignette. There were seventy three percent of the respondents thought that partial recovery would occur given appropriate treatment. Most of the respondents thought that old age (65 %), genetics (18.75%), excessive thinking (18.12%), and stress (15%) were among the most common factors contributed to a person getting dementia. Eighty percent thought that the risk of dementia could be reduced and the most suggested methods of risk reduction were consultation with a doctor/medication (48.1%), proper nutrition (13.1%), vitamins or memory enhancer (9.4%), wide reader/mental exercise (10%), family bonding (10%) and socialization (10%). Conclusion: Majority of the Filipinos recognizes the symptoms of dementia and risk can be reduced. However, most do not know of the association between dementia and cerebrovascular as well as cardiovascular risk factors. Public policies to improve education and awareness campaign could potentially have a role in the prevention of dementia.
AO11. An initial evaluation of the training of healthcare professionals from the central Johor region, on the use of the Malaysian CPG for the Management of Dementia Suraya Yusoff*, Koh Choo Tek*, Muhamad Amin**, Suhaila Mohd Zahir*** *Hospital Sultan Ismail, Johor Bahru **Health Technology Assessment, MOH ***Hospital Kuala Lumpur Introduction: The Malaysia Clinical Practise Guideline (CPG) was completed in late 2009 and was officially launched on April 2010. The training of the core trainers, which comprised of specialists from all the states were done in September 2010, based on the training modules that were specifically developed. Subsequently echo trainings were done for all categories of health workers nationwide. Objectives: The aim of the study was to look into the improvement in the knowledge of dementia following the training of the health care professionals on the guidelines for dementia, as reflected by the results of the evaluation and the number of referrals for suspected dementia. Methods: Health care professionals who attended the CPG training for the Hospital Sultan Ismail were given a set of pre and post-test evaluations questions based on the contents of the CPG Management of Dementia. The questions were divided into 21 categories, and further merged into 9 main topics of the training module. The number of referrals for suspected dementia, were also compared a year before and a year after the CPG training programme. Results: There is an improvement in the knowledge of dementia (pre-training score of 54,52% vs post-training score of 74.74%) among the healthcare professionals following the training on the use of the CPG on Management of dementia. This improvement is statistical significant difference (p=0.000). When analysed for each topics, the improvement was again significant except for the topic of psychosocial intervention (p-0,032). The outcome of the training programme was reflected in the increase in number of referrals to the memory clinic to Hospital Sultan Ismail (29.23% before training vs 63.08% after training). Conclusion: Training of the healthcare professionals in dementia is effective and should be done on a continuing basis.
AO12. Apathy, as a prodrome of future conversion to dementia in patients with amnestic mild cognitive impairment Daiki Takano, Takashi Yamazaki, Tetsuya Maeda, Yuichi Satoh, Rena Muraoka, Tomomi Shinoda, Mayumi Watanabe, Ken Nagata Department of Neurology, Research Institute for Brain and Blood Vessels. 6-10 Senshu-Kubota-Machi, Akita 010-0874 Japan Depressive mood or apathy. In previous epidemiological studies, depression and apathy are detected in patients with mild cognitive impairment (MCI). Although depression and apathy were suspected to be the risk of future cognitive decline, there were only a few studies in Asian people. Objective: The present study was designed to elucidate the relationship between affective symptoms and cognitive status in Japanese MCI patients. Methods: The present study was based on 131 amnestic MCI patients who visited our memory clinic from 2005 to 2011. All subjects underwent mini-mental state
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MJP-21(Suppl)-2012 examination (MMSE), Zung’s self-rating depression scale (SDS) and Starkstein's apathy scale (SAS) at baseline and follow-up evaluation which was performed in one year interval. The subjects were classified into three groups according to the tertiles of SDS and AES. We investigated the correlation between MMSE and SDS/AES at the baseline and follow-up evaluation. Results: Forty of our 131 MCI patients were diagnosed as converted to AD in one year. The SAS correlated negatively with MMSE score (p<0.05), whereas no relationship was found between SDS and MMSE. The highest SAS tertile group showed a significantly greater decline in MMSE score in one year than the lowest SAS tertile group (-1.953 vs. -0.617, p=0.0247). No such relationship was found between SDS and MMSE score. Discussion: In the results, apathy was associated with the subsequent conversion to AD in amnestic MCI patients, but such relationship was not found for depression. Our results were consistent with the previous studies. Although both depression and apathy are listed in the behavioral and psychological symptoms of dementia in textbook, apathy was thought to have strongly related to the spontaneity, concentration and executive dysfunction in amnestic MCI patients. Conclusion: Apathy was considered to be one of the prodromes of future conversion to dementia in amnestic MCI patients.
AO13. An Assessment of the Correlation between Plasma Insulin and Cholesterol and Statin Use with Cognitive Impairment in Type 2 Diabetes Mellitus (T2DM) Deborah Amanda Goh*, Catherine Dong Yanhong**,***, Boon Seng Wong* *Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore **National University of Health Sciences, Memory, Aging and Cognition Centre (NUHS-MACC) ***School of Psychiatry, University of New South Wales, Australia Introduction: T2DM has been implicated in poor cognition. Objective: This study aims to associate plasma insulin and cholesterol biomarkers characteristic of the T2DM phenotype with performance across cognitive domains. It also aims to study how statin usage alters these associations. Methods: Forty self-reported T2DM subjects and 20 non-T2DM non-diabetic subjects with no history of dementia were recruited by Lilly-NUS Centre for Clinical Pharmacology. Subjects were Singaporean Chinese males (aged ≥55). Upon enrollment, they were administered the MMSE, MoCA and a modified National Institute of Neurological Disorders (NINDS) Harmonization Battery. Total cholesterol, high-density lipoprotein cholesterol (HDL), low-density cholesterol (LDL), triglycerides, insulin, glucose and HbA1c were quantified from drawn blood samples. Results: Among diabetic non-statin users, HDL levels were negatively correlated with performance in attention (r=-0.423, n=40, p=.006). Among diabetic statin users the following was observed. HDL (r=‐0.685, n=22, p<.001), LDL (r=‐0.491, n=22, p=.020) and total cholesterol (r=-0.570, n=22, p=.006) were negatively correlated with executive function task completion duration. A shorter duration indicates superior performance. Thus, HDL, LDL and total cholesterol were positively correlated with executive function performance. Insulin and insulin resistance were negatively correlated with both performance in attention (r=-0.557, n=22, p=.007; r=- 0.568, n=22, p=.006, respectively) and visuomotor speed (r=-0.424, n=22, p=.049; r=-0.468, n=22, p=.028, respectively). Conclusion: Among diabetic non-statin users, HDL levels can be used to predict for attention. Among diabetic statin users, HDL, LDL and total cholesterol predict for executive function; peripheral insulin and insulin resistance predict for attention and visuomotor speed. Future work would investigate the specific role of statins in cognition.
AO14. Comparison of MoCA and MMSE in detecting md-MCI: a community-based study Lee Wah Yean*, Dong YanHong*,******, Tay Stephen Ziyang*, Ikram Mohammad Kamran**,***, HilaL Saima*, Saini Monica****, Wong Tien Yin**,***, Qiu Anqi*****, Venketasubramanian Narayanaswamy****, Chen Christopher Li-Hsian* *Department of Pharmacology, National University Health System, Singapore **Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore ***Singapore Eye Research Institute, Singapore ****Department of Medicine, National University Health System, Singapore *****Department of Bioengineering, National University of Singapore, Singapore ******School of Psychiatry, University of New South Wales, Australia Introduction: The Montreal Cognitive Assessment (MoCA) has demonstrated superior discriminatory ability compared to the Mini-Mental State Examination (MMSE) in detecting Mild Cognitive Impairment (MCI) in memory clinics. However, its discriminatory ability in detecting elderly at higher risk for incident dementia (i.e., multiple domain-MCI, md-MCI) in community has not been evaluated.
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Objective: We examined the discriminant validity of the MoCA and the MMSE in detecting md-MCI in a Chinese community-dwelling elderly sample. Methods: Subjects (age ≥60 year) were recruited from the Chinese cohort of the on-going Singapore Epidemiology of Eye Disease (SEED) Program. All subjects received MoCA, MMSE and a comprehensive formal neuropsychological battery. Consensus diagnoses of NCI and MCI were made upon evaluation of neuroimaging, laboratory blood tests, cognitive performance and clinical assessments. MCI subtypes were defined by Petersen’s criteria. Receiver operating characteristic (ROC) analyses were conducted to compare the discriminatory abilities of the MoCA and the MMSE. Results: 321 subjects were recruited, of which 159 (49.5%) were diagnosed with NCI, 64 (20.0%) with single domain-MCI and 98 (30.5%) with md-MCI. The MoCA had significantly larger AUCs than the MMSE in discriminating md–MCI from NCI [MoCA 0.94 (95% CI, 0.92–0.97) vs MMSE 0.89 (95% CI, 0.85–0.93), p = 0.001]. At the recommended cutoff points, the MoCA (21/22) remained superior to the MMSE (25/26) in detecting md–MCI [sensitivity: 0.87 vs 0.85; specificity 0.82 vs 0.75]. Conclusion: The MoCA is superior to the MMSE in detecting elderly with cognitive impairment at higher risk for incident dementia in the community.
AO15. A validation study of the Malay version of the Neuropsychiatric inventory (MVNPI) Ng Inn Tiong*, Rosdinom Razali**, Teh Ewe Eow, Norhayati Arif*, Ng Chong Guan***, Hatta Sidi** *Department of Psychiatry, Hospital Pulau Pinang, Penang **Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur ***Department of Psychological Medicine, Universiti Malaya Medical Centre, Petaling Jaya, Selangor Objectives: The prevalence of behavioral and psychological symptoms of dementia (BPSD) is high among patients with dementia, affecting caregiver’s overall well-being. However, validated scales for the assessment of BPSD in local population is still lacking. The objective of this study is to validate the Malay translated version of the Neuropsychiaric Inventory (MvNPI). Methodology: A total of 138 patients with dementia and their caregivers participated in this two-stage cross-sectional study conducted at Psychiatric and Neurology Clinics in Hospital Pulau Pinang. Patients were assessed for severity of dementia using the Mini Mental State Examination (MMSE). The original NPI and MvNPI were administered twice, a week apart, by the same researcher on the same caregiver. Results and Discussion: The individual items and total scale score of MvNPI were shown to have high internal consistency, with Corrected Item-Total Correlation ranging from satisfactory to good (0.410 to 0.771). The Cronbach’s Alpha for all the NPI domains was good (0.83), and subtotal for severity and distress scores were perfect (0.998). The test-retest mean scores were not significantly different (p>0.05) but correlations between two tests were perfect (0.996 to 1.00). Content validity indicated mild and inverse relationship between MMSE scores and severity and distress score (-0.281 and -0.268, respectively, with p<0.001). Discriminant validity calculated using Mann-Whitney U test was found to be significant (p<0.000) in differentiating between mild & moderate, and severe cognitive impairment. Factor analysis revealed four possible components existed in MvNPI. Conclusion: The MvNPI is a valid and reliable tool in assessing BPSD among the Malay-speaking local population.
AO16. Correlation Between Subjective Memory Complaints and Score of Zung Self-Rating Anxiety and Depression Scale and Montreal Cognitive Assessment among Geriatric Patients in Memory Clinic Hasan Sadikin Hospital Bandung Dewi Utari*, Anam Ong** *Resident of Neurology Department of Padjadjaran University, Bandung, Indonesia **Staff of Neurology Department of Padjadjaran University, Bandung, Indonesia Objective: Subjective memory complaints are common in older people and often thought to indicate cognitive impairment. However, whether these memory complaints are related to objective memory deficits or to subsequent development of dementia remains unclear, because patients psychiatric conditions or different culture and other comorbidity are also important predisposising factor. The purpose of this study was to evaluate the correlation between SMC and the score of anxiety, depression rating scale and MoCA among geriatric patients in Hasan Sadikin Hospital Bandung, Indonesia. Methods: This is a observational analytic study in cross sectional method, performed at memory clinic Hasan Sadikin Hospital, Bandung. Sixty-seven subjects, consisted of geriatric patients, age 60-87 years
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MJP-21(Suppl)-2012 old, that underwent Zung Self-Rating Anxiety (ZAS), Zung Self-Rating Depression Scale (ZDS), and MoCA. Pearson test and Chi-Square were use to analyze the correlation. Results: From 67 subject, 50 female (74,6%) 17 male (25,4%), Mean for SMC is 4,06%, ZAS 34,97%, ZDS 32,60%, and MoCA is 22,73%. 14,9% patients are mild to moderate anxiety, 7,5% mildly depressed, and 29,9% with mild cognitive impairment. Correlation of SMC is significant between ZAS (0,001) and ZDS (0,002) p<0,05. But there is no correlation between SMC and MoCA (0,275) p>0,05. Conclusions: The presence of SMC was not associated to objective memory impairment in this group of geriatric patients. But it was more associated with anxiety and depression.
Poster Presentation Abstracts
MP1. Depression, anxiety and stress among the adult population of Orang Asli in Kampung Kenang, Perak Umi Khalsom Abd Aziz, Suriati Sukri, Mohamed Izzat Ishak, Izzat Hafifie Hazmi, Mohd Firdaus Mohd Sobri, Sum Ying Ying, Abdul Rashid Khan Md Jagar Din Penang Medical College Objective: The objective of the study was to determine the level of depression, anxiety and stress among the Temiar Orang Asli living in Kampung Kenang, Sungai Siput, Perak. Methods: A cross-sectional study was conducted using the Bahasa Melayu version of DASS 21. All residents of the village aged 14 and above who consented and were able to communicate effectively were eligible to participate. Result: A total of 160 respondents out of the 180 eligible residents participated in the study (response rate 88.9%). The prevalence of depression was 13.8% (22), anxiety 8.1% (13) and stress 4.4% (7). Among the depressed 16 (10.0%) were mildly depressed, 4 (2.5%) moderately depressed and 2 (1.3%) extremely depressed. Among the anxious, 5 (3.1%) were mildly anxious, 6 (3.8%) moderate and 2 (1.3%) severely anxious. Among the stressed, 3 (1.9%) each were mildly and moderately stressed and 1 (0.6%) severely stressed. The mean score for depression was 3.69 (SD 5.08), anxiety 2.48 (SD 3.45) and stress 4.55 (SD 5.25). The mean depression score for participants with secondary/tertiary education (5.33) was significantly (p=0.021) higher than informal/primary education (3.18). The mean anxiety score of participants with secondary/tertiary education (3.43) was significantly (p=0.009) higher than illiterates (1.0). The mean stress score for participants with secondary /tertiary education (6.40) was significantly (p=0.009) higher than illiterates (2.80) and informal/primary education (3.08) (p=0.012). Conclusion: Although the depression rate was about the same as that reported for Malaysian population, the anxiety and stress levels were considerably lower compared to other rural populations in Malaysia.
MP2. The Stress of caregiving: a study of caregivers of breast cancer patients receiving treatment at a Malaysian General Hospital Raynuha M*, Nik Ruzyanei Nik Jaafar*, Siti Hazrah Selamat Din**, Rosdinom Razali*, Suriati Mohd. Saini*, Azlin Baharudin* *Department of Psychiatry, UKM Medical Center, Kuala Lumpur, Malaysia ** Department of Psychiatry, Hospital Seremban, Malaysia Introduction: Caregiving is a highly stressful task and many studies among caregivers of breast cancer patients have revealed that stress affects a significant proportion of this particular group. The situation among caregivers of breast cancer patients in Malaysian population was however not known. Objectives: To determine the proportion of cases with stress among the caregivers of breast cancer patients receiving oncologic treatment in Kuala Lumpur Hospital who participated in the study and to determine the associations between the patients’ as well as the caregivers’ factors with the outcome. Methods: A cross-sectional study was conducted on 130 breast cancer patients receiving treatment at the Institute of Radiotherapy & Oncology, Kuala Lumpur Hospital and their caregivers. Subjects were recruited by non-random sampling method. Data on the patients and caregiver’s socio-demographic status, the patient’s illness characteristics and the caregiving factors and caregiver’s perceived social 42
MJP-21(Suppl)-2012 support were collected. Caregivers were screened using Depression, Anxiety, Stress Scale (DASS-21). Results: Sixty-four (49.2%) of the caregivers were found to meet the cut-off point for the scales in DASS-21 where 24.6% (n=32) were found to be stressed. Duration of caregiving, sharing of caregiving burden, patient’s age and patient’s functionality were found to be significantly associated with stress (p value <0.05). Except for duration of caregiving, all these factors continue to be significant in the logistic regression analysis (p value <0.05). Conclusions: This study found that 1 in 4 caregivers of breast cancer patients were stressed. Several factors were found to be associated with this outcome which may help in identification and prevention of stress in this group of caregivers.
MP3. Behavioural and emotional problems of children in a Kuala Lumpur residential care home Fairuz Nazri Abd Rahman*, Wan Salwina Wan Ismail*, Tuti Iryani Mohd Daud*, Shamsul Azhar Shah**, Susan Tan Mooi Koon*. *Department of Psychiatry, Faculty of Medicine, UKM Medical Center, Universiti Kebangsaan Malaysia, Malaysia **Department of Community Health, Faculty of Medicine, UKM Medical Center, Universiti Kebangsaan Malaysia,Malaysia Introduction: This study is aimed at describing the behavior and emotional problems in a sample of children in a government residential care home and compare them with their classmates living with their birth parents. Methods: A comparative cross-sectional study was carried out where carers from both groups were asked to fill in the translated Bahasa Melayu version of the Child Behavior Check List. Results: Forms for 53 residential care children and 61 classmates were completed. The residential care children had significantly higher scores on the rule-breaking (p<0.001) and DSM conduct problem subscales (p<0.001). Residential care children’s age significantly correlated with DSM somatic problems (p=0.03) and post-traumatic stress (p=0.023). Duration of care is significantly positively correlated with rule-breaking (p=0.008), DSM conduct problems (p=0.018) and externalizing scores (p=0.017). Abuse and neglect cases had higher anxiety and depression scores (p=0.024). Number of reasons in care positively correlated with several subscales including total behavior problem score (p=0.005). Academically poor residential care children significantly differentiated from the academically good to average children on several subscales including total behaviour problem score (p=0.034). Logistic regression revealed the more number of reasons for placement a child had was significantly associated with having externalizing scores in the clinical range (p=0.016). However, after Bonferroni correction, only the initial findings regarding rule-breaking and DSM conduct problem scores remained significant. Conclusion: Malaysia is not exempt from challenges in managing residential care children, especially regarding externalizing behavior.
MP4. Alcohol use and abuse: knowledge, attitude and practice among Malaysian youths Zawaha Haji Idris*,Suriati Mohamed Saini**, Siti Sa’adiah Hassan Nudin*, Azmawati Mohammed Nawi***,Sulaiman Che Ros*,Azlin Baharudin**,Nik Ruzyanei Nik Jaafar**,Maniam Thambu** * Institute for Health Behavioural Research, Ministry of Health Malaysia, Jln Rumah Sakit Bangsar, Kuala Lumpur, Malaysia **Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia ***Department of Public Health, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia Introduction: Malaysia is ranked as one of the world's lowest per capita consumers of alcohol. Cultural diversity and religion shapes the attitude & use of alcohol amongst different ethnic group in Malaysia. Objective: This study aimed to assess the knowledge, attitude and practice of alcohol usage in Malaysian youth. Methods: A cross-sectional study on 4591 adolescents from 9 youth camps in Selangor, Malaysia. Their knowledge, attitude and practice on alcohol use and abuse were assessed using self-administered questionnaires developed by local experts. Results: The results demonstrate that 25.4% of participants had consumed alcohol. Male and Sabahan participants had significantly high alcohol consumption (p < 0.001). Females (Adjusted odds ratio = 1.2; 95% C.I. = 1.02-1.23) and Muslim participants (Adjusted odds ratio = 1.2; 95% C.I. = 1.04-1.33) were having good knowledge on alcohol. However, there was low correlation between knowledge and attitude towards alcohol consumption r = 0.072, p < 0.001. 21% of participants had relatives and 36.4% had friends drinking alcohol. Conclusion: This study found that alcohol was widely used by adolescents in Malaysia. The government should acknowledge and take into account the patterns of alcohol use and abuse in different ethnic groups in Malaysia, and initiate public health program by focusing on prevention of alcohol uptake in this high risk group.
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MP5. Psychiatric comorbidity among community-based, treatment seeking opioid dependents in Klang Valley Azlin B*, Lotfi A*, Osman CB***, Suriati S*, Rosdinom R*, Nik Ruzyanei NJ* *Dept of Psychiatry UKMMC **Dept of Psychiatry Hospital Angkatan Tentera Tuanku Mizan ***Dept of Psychiatry UITM Objective: The main objectives in this study were to determine percentage of psychiatric comorbidity among treatment seeking opioid dependents in Klang Valley. Methods: A cross sectional study of opioid dependence patients was conducted between December 2007 and May 2008 at ten community- based drug substitution therapy clinics in Klang Valley. A total of 204 opioid dependence patients participated in the study which used the The Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) as its instrument. Results: The percentage of psychiatric comorbidity among treatment seeking opioid dependents was 43.6%. Major depressive disorder had the highest prevalence at 32.6%, followed by Dysthymia at 23.6% and Panic disorder at 14.6%. Psychiatric comorbidity were found to have significant differences (p<0.05) in connection with history of polysubstance abuse, previous history of court sentences (legal status), family history of psychiatric illnesses and lower means for number of support. Conclusion: This study shows that the prevalence of psychiatric comorbidity is high among the opioid dependents. It highlights the urgent need for the psychiatric comorbidity to be assessed and early intervention is important for this group of patients.
MP6. High risk behavior among methamphetamine and heroin dependent in Malaysia Mohd Fadzli*, Ahmad Hatim*, Ng Chong Guan*, Mas Ayu*,Hatta Sidi** *University Malay, Kuala Lumpur, Malaysia **Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Objective: The objectives of this study were to describe the pattern of high risk sexual behaviour, sexual desire, sexual interest, sexual drive and sexual obsession in relation to methamphetamine and heroin use. Methods: A cross-sectional study was carried out in three Malaysian cities: Kota Kinabalu, Kota Bharu and Kuala Lumpur. The subjects were all methamphetamine and heroin dependent who were living in the community and have satisfactory psychosocial functioning. This study was primarily based on a validated sexual behaviour self-rated questionnaire followed by a brief face-to-face interview. Results: A total of 227 subjects were included in this study with 124 (54.6%) subjects were using methamphetamine while 103 (45.4%) subjects were using heroin. Majority (218; 96%) of the participants was heterosexuals with 104 (45.8%) subjects reported having been involved in high risk sexual behaviour. Methamphetamine subjects were 1.97 times more likely than heroin subjects to be involved in high risk sexual behaviour. More methamphetamine than heroin subjects reported that their sexual thoughts, feelings and behaviours were associated with the drug used (p<0.05). The subjects reported that methamphetamine caused them to be more obsessed with sex and preoccupied with sexual thoughts while being under the influence of the drug (p<0.05). They also agreed that the use of methamphetamine had positively affected their sexual interest and drive (p<0.05). Heroin subjects reported negative effects of the drug on their sexual behaviour. Conclusions: Methamphetamine subjects reported positive effect on sexual domain which was sexual interest, drive and obsession while heroin subjects reported many negative effects of the drug on sex. Methamphetamine subjects were more likely than heroin subjects to be involved in high risk sexual behaviour.
MP7. Hypertension and sexual dysfunction: facts to ponder Srijit Das*, Marhani Midin**, Nik Ruzyanei Nik Jaafar** , Hatta Sidi** *Department of Anatomy, Universiti Kebangsaan Malaysia **Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre There is a paucity of data on the association of hypertension and sexual dysfunctions in both males and females. The hypertensive patients on different anti-hypertensive medications may experience various sexual dysfunctions. These sexual dysfunctions may include erectile dysfunction and orgasm problems. Attending clinicians need to be aware of all such adverse effects of anti-hypertensives and plan remedies to combat such sexual dysfunctions. This may help in better quality of life amongst hypertensive patients. Even the compliance factor can be looked in detail. The present review article is a humble 44
MJP-21(Suppl)-2012 attempt to discuss in detail the problem of hypertension and its associated sexual dysfunctions, the underlying mechanism involved, choice of proper drugs and the future remedial steps to be taken.
MP8. Factors associated with erectile dysfunction among Malaysians with hypertension. Mohd Ariff Fadzil*, Nik Ruzyanei Nik Jaafar**, Hatta Sidi**, Ng Chong Guan***, Nor Aini Mohd Noor* *Universiti Teknologi MARA-Population Health and Preventive Medicine, Selayang, Malaysia **Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur Malaysia. Introduction: While erectile dysfunction (ED) is highly prevalent among patients with hypertension, the rates vary widely across the countries. In Malaysia, its prevalence and contributing factors have yet to be identified among its multiracial population. Objective: To determine the prevelance of ED among Malaysian hypertensive patients and its associated sociodemographic, health and lifestyle factors. Methods: A cross-sectional study was conducted among male patients with hypertension who attended two suburban outpatient clinics. Results: The overall prevalence rate of ED was 77.7%; the prevalence of ED in the hypertension only group was 71.8% and those with hypertension and diabetes mellitus were 80.1% respectively. Multiple logistic regression analysis with ED status as the dependent variable, indicated that older age (<50 years old (adj. OR=1.0), 50-59 years old (adj. OR=3.80, 95% CI=1.37- 10.55), 60-6 years old (adj. OR=6.11, 95% CI=2.11-17.13), ≥70 years old (adj. OR=39.96, 95% CI=6.64, 240.51)), Chinese ethnicity (adj. OR=3.04, 95% CI=1.05-8.78), presence of diabetes mellitus (adj. OR=2.78, 95% CI=1.22-6.34), patients on diuretics (adj. OR=2.95, 95% CI=1.09-7.95) but not ARB therapy (adj. OR=0.041, 95% CI=0.003, 0.52) were significant factors in the final model. Conclusions: The prevalence of ED among Malaysian hypertensive patients is high and significantly predicted by age, Chinese ethnicity, concomitant diabetes mellitus and the use of diuretics. However, angiotensin receptor blocker (ARB) treatments seem to improve erectile function. Health care providers should consider these factors when managing hypertensive patients.
MP9. Risk Factors for post stroke depression: a review Mas Ayu Said*,**, Ahmad Hatim Sulaiman***, Noran Naqiah Mohd Hairi*,**, Hatta Siddi**** *Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia **Julies Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia ***Department of Psychological Medicine, Faculty of Medicine, University of Malaya Kuala Lumpur, Malaysia ****Department of Psychiatry, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur Stroke has been shown to be a major cause of death and disability in many societies. Depression after a stroke is common. Many studies have demonstrated the high prevalence of depression in both acute and chronic stroke populations. Depression can significantly reduce the speed and success of rehabilitation. Hence it is very important for the clinician to recognize post-stroke depression early. Unfortunately clinicians often do not recognize the signs and symptoms of post-stroke depression and hence such cases are missed and left untreated. Failure to recognize depression among these patients will worsen the prognosis and thus significantly reduce the quality of life. Knowledge of risk factors for depression after stroke is important because it could help to identify patients’ early and appropriate referrals and treatment could be made. This will hopefully prevent further complications, deteriorations and impairments. Some of the risk factors are easy to identify and some are amenable to interventions.
MP10. Psychoses in Parkinson’s patients Abdul Hamid Abdul Rahman*, Ibrahim Abu Samah**,Suriati Mohd Saini* *Department of Psychiatry, University Kebangsaan Malaysia,Kuala Lumpur,Malaysia. **Department of Psychiatry and Mental Health,Hospital Muar,Malaysia Objective: This study aims at examining the prevalence of psychosis in Parkinson’s Patient and factors associated with psychosis among Parkinson’s patients in UKM Medical Centre. Methods: This is a descriptive cross-sectional study of 108 Parkinson’s patients from the neurological clinic PPUKM were selected between Jan 2004 to July 2004. Psychoses were determined using SCID, the severity of psychoses was rated using BPRS .The cognitive function was evaluated with MMSE and the severity of depression was assessed with HAM-D. Results: 13% of Parkinsons patients in this sample were found to have psychoses. Age of the patient, severe depressive episode and cognitive impairment were significantly associated with psychoses. Conclusion: Psychoses is a common occurrence in patients 45
MJP-21(Suppl)-2012 with Parkinson’s disease. Age of patients, severe depressive episode and cognitive impairment were significantly associated with psychoses.
MP11. Neuropsychological assessment 3 months after head injury Ramli Ali, Suzaily Wahab, Abdul Hamid Abdul Rahman. Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Introduction: The study looked into the rate and pattern of neuropsychological impairment in patients with traumatic brain injury patients at three months post injury. Methods: 40 subjects were included in the study. Benton Visual Retention Test (BVRT), Rey Auditory Verbal Learning Test (RAVLT), Digit Span Test and Mini Mental State Examination (MMSE) were done. Results: 45% (n=18) sustained moderate to severe head injury. 25% (n=10) have abnormal BVRT result. 75% (n=30) have abnormal RAVLT result while 35% (n=14) have abnormal Digit Span Test result. 77.5% (n=31) have at least one neurological deficit. There was significant association between severity of head injury (GCS score) and Neuropsychological deficit. Conclusion: This study highlights the point that in post head injury patients there are high occurrence of cognitive dysfunction. MMSE plays a significant and important role in assessing cognitive dysfunction. Severity of head injury as determined by GCS scores also influence the outcome in patients with head injury.
MP12. Motor neurological soft signs among patients with schizophrenia: A clinical significance Hazli Z*, Nik Ruzyanei NJ*, Azlin B*, Normala I**, Marhani M, Abdul Hamid AR*. *Department of Psychiatry, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur **Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang. Introduction: Neurological soft signs (NSS) are subtle indicators of brain dysfunction which are present in excess among patients with schizophrenia. Its clinical significance remains unclear despite extensive researches. Objective: To determine the proportion of schizophrenia patients who have motor NSS and then to compare the clinical features between these two groups; with and without motor NSS. Methods: This cross-sectional study utilized the Brief Motor Scale (BMS) to investigate the presence of motor NSS in 80 schizophrenia patients attended Universiti Kebangsaan Malaysia Medical Centre (UKMMC) psychiatric clinic. The diagnosis was confirmed by Mini International Neuropsychiatic Interview (MINI). Symptomatology and abnormal motor movement were assessed using the Brief Psychiatric Rating Scale (BPRS) and Abnormal Involuntary Movement Scale (AIMS) respectively. A brief battery of cognitive tests covering aspects of attention, working memory and executive function was administered. Bivariate and multivariate analyses were applied to look for any relationship between study factors. Results: Majority of schizophrenia patients (68.8%) in this study have motor NSS. The motor NSS were correlated with performance in cognitive assessment; verbal fluency, digit span forward, digit span backward, and trail making B but not with trail making A (p < 0.05).
MP13. Quality of life in Malaysian colorectal cancer patients Natrah MS*, Sharifa Ezat WP*, Syed MA**, Mohd Rizal AM*, Saperi S*, Ismail S*, Fuad I*, Muhd Azrif MA* *National University of Malaysia, Cheras, Kuala Lumpur, Malaysia **United Nations University-International Institute for Global Health Introduction: Rapidly increasing colorectal cancer (CRC) incidence in Malaysia and the introduction of new treatments, which prolong survival advocating treatment outcome measures to be evaluated. This includes patient’s quality of life (QOL) assessment. There is limited data on QOL in CRC patients in Malaysia. This study aims to determine the QOL in CRC patients according to cancer stages and age. Methods: A cross sectional study was done from June to September 2011 at three public tertiary hospitals. The EORTC QLQ C-30 questionnaire was used through face to face interview and review of medical records of 160 respondents. Results: The mean age of respondents is 58.47 + 12.04 years with 57.5% are males and 42.5% females. By ethnicity; 60.6% are of Malay ethnicity, 28.8% Chinese, 10% Indian and 0.6% is Sikh. Majority are educated up to secondary level (49.4%) and 91.2% respondents are in CRC stage III and IV. Median global health status (GHS) score is at 83.33 (IQR 16.67). Sikh and Indian have a higher median GHS score as compared to other ethnicities (Kruskal Wallis, X2=12.12, p=0.007). Median scores for functional status (physical, emotional, role, cognitive, social) ranges 46
MJP-21(Suppl)-2012 between 93.33 (SD 20.00) to 100.00 (SD 16.67). Emotional, cognitive and social function is higher in respondents with earlier stage of the disease (Kruskal Wallis, X2=6.06,6.36,10.58, p=0.048,0.042,0.005). Mean symptoms scores (fatigue, pain, nausea/vomiting, constipation, diarrhea, insomnia, dyspnoea, loss of appetite) ranges between 4.48 (SD 12.36) to 16.46 (SD 26.96). Median score of Pain, Dyspneoa, Diarrhea and Financial implication are significantly higher in advanced stage (Kruskal Wallis, X2=9.31,6.26,6.77,7.28, p=0.010, 0.044,0.034,0.026). Median score of diarrhea (p=0.012) have a significant difference between age groups. Conclusion: QOL in CRC patients in this study is comparable to other studies done in developed countries. Emotional, cognitive and social function deteriorates with advanced stage of the disease. Patients with advanced stage of the disease experience more pain, dyspnoea, diarrhea and financial implications. A Systematic screening programme to detect the cases as early as possible is essential nationwide.
MP14. The percentage of agreement and kappa value for diagnosis among psychiatric outpatients at Universiti Kebangsaan Malaysia Medical Centre, Malaysia. S. Aishvarya*,**, A.Z. Shamsul * , T. Maniam*, TPS Oei** *Universiti Kebangsaan Malaysia Medical Centre, Malaysia **University Of Queensland , Australia Objective: This study was conducted to determine the percentage of agreement and Kappa value for the diagnosis among psychiatric outpatients at Universiti Kebangsaan Malaysia Medical Centre. Methods: A total of 33 patients who attended psychiatric outpatient clinics with the diagnosis of depressive disorders, anxiety disorders or comorbid depressive and anxiety disorders were recruited. Patients had been diagnosed with one of the diagnosis above by psychiatrists, registrars or medical officers who were doing their specialization in psychiatry. These patients were later assessed by a clinical psychologist using the MINI to verify their diagnosis. Results: A Kappa value of 0.829 was found and the percentage of agreement was 91% for patients with depressive disorders, 83.3% for patients with anxiety disorders, 100% for the diagnosis of comorbid depressive and anxiety disorders. Conclusions: MINI can be used to verify the diagnosis given by mental health professions.
MP15. Remission of symptoms among Schizophrenia patients receiving assertive community treatment (ACT) 1 in Malaysia: 1 year follow up Rahima Dahlan*, Marhani Midin** *Psychiatric Department, Hospital Kajang, Kajang, Selangor **Psychiatric Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Introduction: Assertive Community Treatment (ACT) is one of the most important elements of mental health care reform in Malaysia. Many studies worldwide have reliably found that ACT has positive impact on several outcome domains such as reduced hospitalization rate, improvement of symptoms and quality of life. This study aimed to assess the outcome of ACT in the aspect of symptom remission and its influencing factors among patients with schizophrenia in the urban city of Kuala Lumpur. Methods: A cross sectional study was conducted on 155 patients with schizophrenia who received Assertive Community Treatment in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The abbreviated BPRS was used to determine the status of symptom remission. The socio- demographic and relevant clinical data were also assessed. Results: Total of 76% (118) was noted to be in remission. According to logistic regression, the strongest predictor of patients receiving ACT with symptom remission was having good social support (p<0.001) and with higher educational level (p=0.024). Discussion: The study revealed the effectiveness of ACT in terms of high prevalence of patients with symptom remission. This was despite the model of ACT being studied not fulfilling all fidelity measurements of the standard version of the service. The finding would hopefully act as a propeller for further development in this service area. However, the study needs to be replicated through studies with better designs and involving more psychiatric centers.
MP16. Hospital-based community psychiatric service in Kuala Lumpur: a 1-year follow-up study on rehospitalization 47
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Rahima Dahlan*, Marhani Midin** *Psychiatric Department, Hospital Kajang, Kajang, Selangor **Psychiatric Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Introduction: Hospital-based community psychiatric service (HCPS) is a developing intervention in Malaysia targeted for patients with severe mental illnesses (SMI’s). Its effectiveness had not been systematically measured. Objectives: This study aimed to assess the outcome of HCPS in the aspect of rehospitalization and its influencing factors among patients with schizophrenia in the metropolitan city of Kuala Lumpur. Methods: A naturalistic and retrospective cohort study was conducted on 155 patients with schizophrenia who received HCPS in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The hospital admission profiles were obtained from clinical records. The socio-demographic and relevant clinical data were also assessed through clinical interviews. Results: Hundred and forty (90%) from 155 respondents had low rate of hospital admission with significant reduction of being hospitalized within one year after receiving ACT (p<0.001). According to logistic regression, the strongest predictor of low hospitalization rate was having good social support (p=0.017). Conclusions: The study revealed the effectiveness of HCPS in terms of reducing rates of hospital admission among patients with schizophrenia in Malaysia. The finding may be used as an evidence to develop the service further especially in hospitals without the service. However, the finding needs to be replicated through studies with better designs and involving more psychiatric centers.
MP17. Ethnicity and Suicidal behavior: where are we after half a century of suicide studies? T. Maniam, Chan Lai Fong Department of Psychiatry, Faculty of Medicine, UKM Medical Center, Universiti Kebangsaan Malaysia, Malaysia The relationship between ethnicity and suicidal behavior is complex. Data from hospital studies, small scale community surveys and national epidemiological studies over more than 50 years in Malaysia have consistently shown that there are real ethnic differences in terms of suicides and attempted suicides in this country, though some of these differences appear to be narrowing somewhat. Malays have shown significantly lower rates of suicidal ideas, attempts and completed suicides. Indians, on the other hand, figure prominently at the other end with high rates in all the above parameters. The reason for these are also necessarily complex. Experience elsewhere from studies of the Indian diaspora have elucidated a number of explanations, viz. the effects of poverty, acculturation, alcoholism, the lack of a strong religious protective factor as well as increased rates of mental ill-health, among others. Detailed studies of suicide problems in Sabah and Sarawak are lacking. Though a national suicide prevention programme was first mooted in 2004, efforts to contain this public health problem have been somewhat patchy. This has largely depended on efforts by non-government organizations such as Befrienders. Official response seems to lack the political will to provide the financial and other resources necessary for a national program. This paper shall review the relevant literature and suggest steps to provide a fresh impetus to suicide prevention in Malaysia.
MP18. Deliberate self harm among psychiatric outpatients at Universiti Kebangsaan Malaysia Medical centre, Malaysia S. Aishvarya*,**, T. Maniam*, TPS Oei **. *Universiti Kebangsaan Malaysia Medical Centre, Malaysia **University Of Queensland , Australia Introduction: Deliberate self-harm is known to be one of the predictors for suicide among psychiatric patients. Objective: This study aimed to look at the demographic features among the psychiatric outpatients with the history of deliberate self-harm at University Kebangsaan Malaysia Medical Centre Malaysia. Results: A total of 84 patients with the diagnosis of depressive disorders (82%), anxiety disorders (9.5%) or comorbid depressive and anxiety disorders (8.5%) were studied from January to September 2011. Results showed that 52 (62%) patients had history of deliberate self harm once and 32 (38%) had twice or more times. Thirty two patients (38%) had low wish to die, with 33 (39%) with moderate wish to die and 19 (23%) with high wish to die. The act of deliberate self harm was found to be significantly more among female (77.4%) patients compared to the males (22.6%). The rest of the demographic features will be discussed.
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MP19. Knowledge and attitude on sex among medical students of a Malaysian university CY Wong*, AH Ammar*, AR Siti Hajar*, A Zulfahmi*, A Murnira*, M Raynuha*, SF Loh*, WP Sharifah**, H Sidi*, MH Shaharom***, M Ramli****, S Das***** *Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur **Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur ***Department of Psychiatry and Mental Health, Faculty of Medicine, Cyberjaya University College of Medical Sciences, Cyberjaya. **** Department of Psychiatry, Kulliyah of Medicine, International Islamic University of Malaysia (IIUM), Kuantan, Pahang ***** Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur Objective: The objective of this study was to determine the relationship between clinical/socio- demographic factors with knowledge and attitude on sex among medical students of the National University of Malaysia (UKM). Methods: A cross-sectional study assessing 452 students using a self- administered questionnaire of Knowledge and Attitude was done with a response rate of 80%. Majority of the respondents were Malays (56%), females (57.5%), lived in urban (66.4%), median family income of RM3000 and perceived themselves as moderately religious (60%). Results: The overall score on knowledge on sex was 21.7 out of 35 marks (higher score indicates better knowledge on sex). It was noted that 73.2% of students felt that they did not receive adequate training in medical school to deal with patient’s sexuality and sexual problems, while 51.5% students felt uncomfortable talking to patients about it. Students in the clinical year were more knowledgeable than their counterparts in the pre-clinical years (22.67 vs. 20.71, p<0.001). No significant differences were found in term of their backgrounds, such as being from urban or rural areas (p=0.349) and between genders (p=0.286). Only 54.9% of students achieved satisfactory level of knowledge on sex, which is >22 marks (median score). Discussion: Students’ attitude on sex is considered well reserved as the majority of them disagreed on premarital sex, masturbation, abortion, homosexuality and oral sex. Gender and religiosity have major influence on attitude towards controversial sexual issues whereas clinical status plays a little role in this. Knowledge on sex among UKM medical students is inadequate and their attitude on sex is considered conservative. An integration of sexual medicine and health module in medical curriculum is crucial for students to function more effectively in addressing patient’s sexual problems and to promote non- judgmental attitude towards patients.
MP20. The prevalence and associated factors of sexual dysfunction in Malaysian menopausal women Hatta Sidi*, Malini Mat Napes**, Shuhaila Ahmad***, Norzilawati Mohd Naim**** , Marhani Midin*, Mohd Zulkifli Mohd Kasim*****, Ng Chong Guan****** * Department Of Psychiatry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia ** Department Of Obstetrics &Gynaecology, Hospital Kuala Terengganu, Terengganu, Malaysia ***Department Of Obstetrics &Gynaecology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia ****Department Of Community Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia *****Department Obstetrics & Gynaecology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia ******Department Of Psychological Medicine, Faculty Of Medicine, University Malaya, Kuala Lumpur, Malaysia Objective: This study aimed to measure the prevalence of and factors associated with female sexual dysfunction (FSD) in Malaysian menopausal women. Methods: It was a cross-sectional study involving 310 menopausal women who visited a menopausal clinic in a secondary referral hospital in the East Peninsular Malaysia. Sexual dysfunction was assessed using the Malay Version of the Female Sexual Function Index (MVFSFI). Possible asoociated factors were collected using a pre-designed questionnaire. Results: The prevalence of FSD for the menopausal women was 21.3%. Younger age was the only factor significantly associated with FSD in the study subjects (Adjusted odds ratio=0.916, 95% CI=0.851-0.987). Conclusion: The prevalence of FSD was low in the Malaysian menopausal women and associated with younger age.
MP21. Sexual response cycle among Malaysian women who attended infertility clinic: a factorial analysis study Yeoh Seen Heng*, Hatta Sidi*, Zainul Rashid** *Dept. of Psychiatry, Universiti Kebangsaan Malaysia Medical Center. **Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur Objective: To determine the sexual response cycle (SRC) of Malaysian women who attended the infertility centre in Kuala Lumpur. Methods: A total of 119 subjects who fulfilled the inclusion and exclusion criteria were recruited from September 2012 to January 2011. A validated questionnaire was used to determine the sexual functioning of the subjects. Results: Most of the subjects were relatively 49
MJP-21(Suppl)-2012 young, Malay and well-educated with tertiary education. Using the factor analysis with Principal Component Analysis (PCA), we found that the six domains of the women’s sexual functioning can be divided into three construct or concepts. The first construct comprises of sexual arousal, lubrication and pain. The second construct comprising orgasm and sexual satisfaction. Sexual desire remains as the independent third component. Conclusion: By looking at the first and second construct, this study endorsed a circular rather than linear model of SRC among women who attended infertility clinic.
MP22. Pre-marital sex and its predicting factors among Malaysian youths Rizal A.M.*, Mastura M. T.*, Hatta Sidi**, Marhani Midin**, Nik Ruzyanei Nik Jaafar**, Srijit Das*** *Department of Community Health Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur **Department of Psychiatry, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur ***Department of Anatomy, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur Objective: This study aimed to examine the prevalence of pre-marital sex and its predicting factors among youths trainees undergoing a national skill training programme in the state of Malaysia. Methods: Participants filled up health screening surveys at the beginning of their training period. A total of 1328 out of 1377 trainees were included in the study. Logistic Regression were done to determine the potential predicting factors of pre-marital sex among the trainees. Results: Most trainees were 18 years old (97.1%) and 56% were female and 44% were male. The prevalence of pre-marital sex among trainees of these youths was 4.6%. A total of 6.2% of the female trainees as compared to 2.6% of their male counterpart had had pre-marital sex. Analysis using multiple logistic regression revealed only six significant predictor variables which were religion, race, lover, reading or watching porn, masturbation and bullying. Conclusion: The prevalence of pre-marital sex amongst Malaysian youths is low as compared to those in developed countries. However, as pre-marital sex and pregnancy outside wedlock are largely socially unacceptable in Malaysia and may be kept hidden from others, the complications and social problems that may follow from this behaviour should be taken into consideration. Measures such as sex education and awareness programs are needed to help our youth to deal with this sexual activity.
MP23. Reliability and validity of the Malay version of attitudes toward lesbians and gay men (MVATL/MVATG): a study on a group of medical students in Malaysia Ng Chong Guan*, Tan Lee Khing*, Jesjeet Singh Gill Jeswant Singh*, Koh Ong Hui*, Stephen Jambunathan*, Subash Kumar Pillai Subramaniam*, Hatta Sidi** *Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia **Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Objective: To study the validity and reliability of the Malay Version of Attitudes Toward Lesbians and Gay Men (MVATL/MVATG) among a group of medical students in Malaysia. Methods: A cross-sectional study on 173 medical students in the Faculty of Medicine, University of Kuala Lumpur, Malaysia was conducted. They were given the MVATL/MVATG, Index of Attitudes Toward Homosexuals (IATH), Homosexuality Attitude Scale (HAS) and the English version of Attitude Toward Lesbians and Gay Men. Two weeks later, these students were given the MVATLG again. Result: Significant correlation was found between the individual scores of MVATL and MVATG with IATH and Homosexuality Attitude Scale (HAS). The scale was able to differentiate Muslim and Non Muslim subjects. The internal consistency (Cronbach’s alpha) of both the MVATL and MVATG were good, at 0.76 and 0.82 respectively. The parallel form reliability (Pearson’s correlation) of MVATL was 0.73 and 0.74 for MVATG. The test-retest reliability of MVATL/MVATG was good (Intraclass correlation coefficient, ICC=0.67 for MVATL and 0.60 for MVATG). Conclusion: The MVATLG demonstrated good psychometric properties in measuring attitudes toward homosexuality among a group of medical students in Malaysia and it could be used as a simple instrument on young educated Malaysian adults.
MP24. A case report on gender identity disorder with recurrent depressive disorder Syed Masroor Ali Department of Psychiatry, Faculty of Medicine, International Islamic University Malaysia Individuals having this disorder often exhibit discomfort about their actual anatomic gender, and they may have wish to alter their bodies. The disorder affects person's self-image, and consequently impact 50
MJP-21(Suppl)-2012 the person's mannerisms and behavior. Sex role-stereotypes adopted during childhood are the beliefs, characteristics and behaviors of individual cultures that are considered normal and appropriate for boys and girls to possess. These "norms" are influenced by ones family and friends, the mass-media, and their community. Since some cultures disapprove of cross-gender behavior, it often results in significant problems for affected individuals and those in close relationships with them. The importance of treatment is not only because of the high rate of mental health problems, including Depression but with higher suicide rate among untreated transsexual people than in the general population. These problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-deviated individuals. An example which classically illustrates GENDER IDENTITY DISORDER is the case of a young man from Brunei Darussalam, who was seen and treated. This contribution will highlight the cultural and religious perspective of this Disorder.
MP25. Spirituality and psychiatry Mohamed Hatta Shaharom*, Hatta Sidi** *Cyberjaya University College of Medical Science **Universiti Kebangsaan Malaysia The dawn of the 20th century saw the advent of modern psychiatry that would for many decades restrain the psyche of psychiatrists and psychologists with the iron grip of hostility towards spirituality and religiousity. Psychoanalysts and behaviourists held sway over the realm of psychiatry through the complete divorce of spirituality from the understanding and management of psychiatric disorders. Not only were proponents of spirituality and religiosity sidelined, any hint of introducing ideas of a religious nature would be frowned on and regarded as a tangential deviation from mainstream psychiatry. But the last few decades of the century saw earnest efforts by practising psychiatrists and researchers in the area bearing fruit. Gradually, by the turn of the century, the academic and professional world has gathered empirical evidence on the effectiveness of religion and spirituality in psychiatric care, controversies notwithstanding. This review looks at the issue of spirituality and religion in psychiatry, its progress and controversies, and its postmodern development in the foreseeable future.
MP26. The impact of a reflective writing assignment within the undergraduate psychiatry teaching curriculum- a qualitative study. Vincent Russell*, Joseph Jacob Panikulam*, Chean Kooi Yau** *Dept. of Psychiatry, Penang Medical College **Dept. of Family Medicine, Penang Medical College Background: Consensus expert opinion regards reflective learning as an essential component of medical education. Among various approaches to teaching in this area, reflective writing (RW) is relatively well established- yet debate persists regarding its usefulness. Aims: To explore the impact of a reflective writing (RW) exercise among fourth year medical students and discuss the implications for curriculum planning. Methods: A reflective learning module introduced within an 8 week psychiatry posting included a 600 word RW assignment (compulsory but not graded) on the subjects of professionalism and attitudes to mental illness. Thematic analysis of how students approached the subject material was undertaken and the level of reflection achieved was evaluated using the REFLECT rubric. Students’ self- reported understanding of reflective learning and the value attached to the RW experience was also documented. Results:All 28 students completed the assignment. While some based their RW on personal clinical encounters many maintained a relatively detached and intellectual position. RW submissions frequently demonstrated “thoughtful action or introspection” using the REFLECT rubric, but examples of more advanced levels of reflection were infrequent. Almost all students reported a good understanding of reflective learning but were polarized regarding the value they attached to the RW exercise with a minority regarding it as unhelpful. Conclusions: Our findings support previous research illustrating the challenges of incorporating reflective writing within under-graduate medical curricula. The value of a single RW assignment during clinical postings may be limited. Key issues to address in future research include the influence of students’ aptitude and preparedness for RW during pre-clinical years and the potential for offering greater student choice in reflective learning methods 51
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MP27. Survey findings of depression, anxiety and stress from a mental health booth Umadevi P.K.R.V, Abdul Rashid Khan, Vincent Russell Penang Medical College
Introduction: The third National Health and Morbidity Survey 2006 indicated that 11.2% of adults in the country have some form of psychological distress or mental disorders at any one time. Objective: To determine the prevalence of depression, anxiety and stress among the attendees of a mental health information booth. Methods: A descriptive survey using DASS 21 was conducted among the consenting attendees to a mental health information booth in a large shopping complex in Kuala Lumpur. Results: The main reason (53.6%) for attending the booth was awareness. Out of the 100 attendees who participated in the survey, 47 (45.6%) were depressed - 12 (11.7%) mild, 21 (20.4%) moderate, 4 (3.9%) severe and 5 (4.9%) extreme depression; 54 (52.4%) were anxious - 8 (7.8%) mild, 17 (16.5%) moderate, 11 (10.7%) severe and 15 (14.6%) extremely anxious; 39 (37.9%) were stressed – 18 (17.5%) mild, 8 (7.8%) moderate and 9 (8.7%) severely stressed. Higher mean depression (p=0.011 / p=0.04), anxiety (p=<0.001 / p=0.006) and stress (p=0.002 / p=0.006) scores statistically significant for the younger age group and participants of Indian ethnicity. There is a negative correlation between age and depression (Pearson= -0.200 /p=0.049), anxiety (Pearson= -0.261/ p=0.009) and stress (Pearson= - 0.280 /p=0.005) scores. Conclusions: Higher scores among participants of Indian ethnicity and younger age group is a cause of concern.
AP1. Neuropsychiatric inventory in persons with dementia: confirmatory factor analysis Mak Pui Man, Emily Dept. of Psychological Studies, Hong Kong Institute of Education Objective: To study the cluster symptoms on Neuropsychiatric Inventory and the prevalence of the cluster symptoms in mild and moderate Alzheimer’s disease in Hong Kong. Methods and Results: Confirmatory factor analysis was used to analyze the data and the result showed that a 4-factor model was generated namely behavior problem (e.g. agitation, disinhibition, irritability, aberrant motor behavior), psychosis (e.g. delusion, hallucination), mood disturbance (e.g. depression, anxiety, sleep, appetite, apathy) and euphoria. The most prevalence symptoms clusters were behavioral problem, mood disturbance, psychosis and euphoria. In addition, the 4-factor model was replicated in another independent sample. The 4 syndromes offer a conceptualization neuropsychiatric symptoms corresponding to clinical observations and neurochemical changes of AD.
AP2. Correlation between neuropsychiatric syndromes of Alzheimer’s disease, burden and depression in Hong Kong Chinese caregivers Ng Siu Siu, Natalie Dept. of Psychological studies, Hong Kong Institute of Education Objective: This study aimed at investigating the effects of different neuropsychiatric syndromes of Alzheimer’s disease (AD) on caregiver burden and depression. Methods: 142 caregivers were invited to join the study. Numerous scales were used namely caregiver burden such as the Revised Memory and Behavior Problem Checklist (RMBPC), Zarit Burden Scale and Pearlin’s measure of role overload. Neuropsychiatric Inventory (NPI) and Hamilton Depression Rating Scale were applied to measure different neuropsychiatric syndromes of AD and caregiver’s depression respectively. Multiple regression analysis was used to analyze the data. Results: Result showed that Zarit Burden and role overload consistently predicted NPI-behavior and NPI-mood meanwhile RMBPC-memory predicted Zarit Burden. No neuropsychiatric symptom clusters had independent effects on burden and role overload. When the effect of burden, role overload and other covariates were controlled, NPI-behavior predicted caregiver depression exclusively. Conclusion: It was concluded that not all neuropsychiatric symptoms have an effect on caregiver’s burden and depression. Overt behavior problems and mood disturbance consistently predicted burden. 52
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AP3. Feasibility and acceptability of the informant AD8 in a primary healthcare setting
Dong Yan Hong *,****, Gan Daniel Zheng Qiang**, Tsou Keith Yu Kei***, Pang Wan Shin*, Cheng Tuck Seng*, Hsu, Chia-Ling*,Chen Christopher Li- Hsian* *Department of Pharmacology, National University Health System, Singapore **Department of Medicine, National University Health System, Singapore ***NHG Polyclinics, National Healthcare Group, Singapore ****School of Psychiatry, University of New South Wales, Australia Introduction: The AD8, a brief informant interview for dementia screening, has been reported to reliably detect mild dementia in tertiary healthcare settings. However, its use as a cognitive screening instrument in primary healthcare settings has not been investigated. Objective: Hence, we aimed to examine the feasibility and acceptability of the informant AD8 in a primary healthcare setting in Singapore. Methods: Eligible patients (aged≥60) attending the ‘Chronic Illnesses’ clinic at Bukit Batok Polyclinic were recruited from March to April 2012. The AD8 was administered to patients’ informants in person or over the telephone. Positive screening results were provided to consulting physicians for referral to specialist memory clinics. Results: Of 364 eligible patients, 205 (56.3%) accepted screening. Of screened patients, 199 (97.1%) completed the informant AD8. Of these, 59 (29.6%) were deemed cognitively impaired by a cutoff score of AD8 >2. Of patients with positive screening results, 11 (18.6%) accepted referral to specialist memory clinics. 88.9% of informants completed the AD8 within 4mins. 94.9% of informants interviewed in person found it acceptable to complete AD8 while waiting for medical consultation. Although clinicians considered the AD8 useful in facilitating referral, most referral recommendations (81.4%) were declined by patients and/or their informants mainly due to limited insight into the health implications of cognitive impairment. Conclusion: The AD8 can be easily administered and is well-tolerated. It could detect cognitive impairment in one third of eligible and consenting elderly patients. However, it requires further validation before adoption for routine cognitive screening in a busy primary healthcare setting.
AP4. Discriminatory ability of the test your memory (TYM) to detect early Alzheimer’s disease (AD) and mild cognitive impairment (MCI) in Singapore Lim Ben Swie Leon*, Pang Wan Shin*, Hilal Saima*, Narayanaswamy Venketasubramanian Ramani**, Merchant Reshma Aziz**, Collinson Simon Lowes***, Chen Li Hsian Christopher*, Dong Yanhong*,**** *Department of Pharmacology, National University Health System, Singapore **Department of Medicine, National University Health System, Singapore ***Department of Psychology, National University of Singapore, Singapore ****School of Psychiatry, University of New South Wales, Australia Introduction: The TYM, a self-administered cognitive test, has been reported to be sensitive in detecting AD but there are inconsistent findings on the ability of the TYM to discriminate between MCI and No Cognitive Impairment (NCI). Objective: We aimed to examine the discriminatory ability of the TYM in detecting patients with AD and MCI in Singapore. Methods: 76 subjects (age≥50 years) were recruited. Patients with AD or MCI were from the National University Health System Memory Clinic whilst NCI participants were from the community. Subjects were administered the modified TYM. Receiver Operator Characteristic (ROC) curve analysis was conducted to evaluate the discriminatory ability of TYM in discriminating between the diagnostic groups. Results: AD subjects (n=21) were significantly older, less educated and had lower TYM scores than MCI (n=25) and NCI (n=30) (age: 76.2±6.4 vs 71.6±8.0 vs 64.0±5.7, p<0.001; years of education: 6.0±5.7 vs 7.4±5.0 vs 12.1±4.8, p<0.001; TYM scores: 22.2±7.4 vs 31.8±7.6 vs 45.6±4.1, p<0.001). All subjects with ≤6 years of education and 57% of those with >6 years of education required some assistance in completing the TYM. TYM≤36 was the optimal cutoff for discriminating AD from NCI (AUC=0.998; sensitivity: 100.0%, specificity: 96.7%, PPV: 95.5%, NPV: 100.0%, 98.0% correctly classified). TYM≤39 was the optimal cutoff for discriminating MCI from NCI (AUC=0.951; sensitivity: 84.0%, specificity: 93.3%, PPV: 91.3%, NPV: 87.5%, 89.1% correctly classified). Conclusions: TYM demonstrates good discriminatory ability in detecting early AD and MCI in Singapore. However, most patients required trained raters to complete the TYM.
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AP5. Comparison of AD8 and MoCA in detecting MCI at a Singapore memory clinic Lee Wah Yean*, Pang Wan Shin*, Lim Leon Ben Swie*, Hilal Saima*, Venketasubramanian Narayanaswamy**, Merchant Reshma Aziz**, Collinson Simon Lowes***, Chen Christopher Li-Hsian*, Dong YanHong *,**** *Department of Pharmacology, National University Health System, Singapore ** Department of Medicine, National University Health System, Singapore ***Department of Psychology, National University of Singapore, Singapore ****School of Psychiatry, University of New South Wales, Australia Introduction: The discriminatory ability of the informant AD8 (brief dementia screening instrument) for Mild Cognitive Impairment (MCI) compared to the Montreal Cognitive Assessment (MoCA) developed to detect MCI has not been reported. Objective: Thus, we aimed to compare the discriminant validity of both instruments in detecting MCI at a memory clinic. Methods: Elderly patients (age ≥50 years) with consensus diagnoses of No Cognitive Impairment (NCI) and MCI were recruited from the National University Health System Memory Clinic in Singapore. Patients received MoCA whilst AD8 was administered to their informants. The discriminatory ability of the AD8 and the MoCA were compared through analysis of the area under the Receiver Operating Characteristic (ROC) curve. Results: 51 subjects were recruited. MCI subjects (n=30) were significantly older, less educated, with poorer MoCA scores and more functional decline than NCI (n=21) (age: 72.1±8.3 vs 64.0±5.7 years, p<0.001; years of education: 7.3±5.1 vs 12.1±4.8, p=0.002; MoCA: 19.0±5.0 vs 27.1±3.0, p<0.001; AD8: 4.3±2.5 vs 0.7±1.4, p<0.001). The discriminatory ability of the informant AD8 was comparable to that of the MoCA in discriminating MCI from NCI [AD8: 0.91 (95% CI, 0.81–1.00) vs MoCA: 0.92 (95% CI, 0.83–1.00), p = 0.792]. At their optimal cutoffs, the informant AD8 (≥2) is comparable to the MoCA (≤23) in detecting MCI [sensitivity: 0.90 vs 0.86; specificity 0.83 vs 0.90; PPV 0.79 vs 0.86; NPV 0.93 vs 0.90]. Conclusion: The informant AD8 is equivalent to the MoCA in detecting MCI and may be adopted as a brief screening instrument at memory clinics.
AP6. Self-efficiency moderates the relationship between behavioural problems of Alzheimer’s disease and caregiver burden in Hong Kong Chinese caregivers Lau Wing Lam, Rosanna Hong Kong Institute of Education Introduction: There has been much research interests on the positive aspects of caregiving (PAC) and caregiver self-efficacy as attributes that may improve the well-being of caregivers. Self-efficacy offers a sense of mastery that has been found to moderate the relationship between care-recipient behavioral problems and caregiver burden. However, whether self-efficacy also moderates the relationship between behavior problems and PAC has never been investigated. Methods: 99 caregivers of family persons with Alzheimer disease responded to the Zarit Burden Interview, Pearlin and colleagues’ Role Overload scale, the Hamilton Depression Rating Scale, the Neuropsychiatric Inventory, the Positive Aspects of Caregiving Scale, and a brief version of the Revised Caregiver Self-Efficacy Scale, besides other questions such as caregiving hours per week, care-recipients’ functional impairment, etc. Results were analyzed with multiple regression with caregiving hours, functional impairment, etc. as covariates. Results: Caregiver self-efficacy moderated the relationship between care-recipient behavioral problems and caregiver burden/overload and depression. Moreover, the effect of caregiver self-efficacy on depression was completely mediated by burden. However, self-efficacy did not moderate the relationship between behavioral problems and PAC. For PAC, the only significant was caregiver gender; women reported higher PAC than men. Conclusions: Caregiver self-efficacy reduced the effect of care-recipient behavioral problems on caregiver burden. However, PAC remains a poorly understood experience. More research is needed to understand PAC so as to allow researchers and practitioners to promote the conditions under which PAC may flourish.
AP7. Development, validation and standardization of quality of life of Filipino elderly with Alzheimer induced dementia (Qol-FD) Magpantay, Cely D St. Luke’s Medical Center, Quezon City, Philippines, UERMMMCI, Quezon City, Philippines Objective: Life value of an elderly with Alzheimer Induced Dementia is essential in the assessment of their quality of life. It will cater the promotion of holistic quality care among elderly suffering from this 54
MJP-21(Suppl)-2012 condition. In the Philippines, the use of a self-constructed instrument to assess the quality of life were very limited; hence the need for developing culturally sensitive quality of life measures can be an adjunct in neuropsychological assessment. Methods: Test construction methodology is utilized as a research design. Patients coming from St. Luke’s Hospital Memory Clinic and Community dweller in Marikina were identified through purposive sampling. Results: The Qol-FD Scale was pretested to a sample of 211, 20 elderly were diagnosed of mild to moderate level of dementia with demographics of 60-75 years of age and attained up to 14 years of education. The items generated a convergent validity using Pearson r value of 0.96 and a split half reliability using Spearman Brown formula value of 0.98. Cronbach’s Alpha Coefficient was used for internal consistency value and obtained a 0.98 level. In the standardization of the Qol-FD scale, the tool was field tested to 360 and 101 elderly were considered. The validity value of Pearson r is 0.90 and the spilt half reliability values using Spearman Brown Formula is 0.92 while it generated an internal consistency value of 0.90 using the Cronbach’s Alpha measure. Conclusion: The Qol-FD scales showed to be a psychometrically sound instrument that is valid and reliable tool for measuring quality of life.
AP8. Survey of patients with dementia in Japan consulting memory clinics Katsuyoshi Takahashi*, Yukari Seki**, Shino Morizane**,Sayuri Kobayashi**, Ryoko Rokkaku**, Akira Honma*** *Dementia Care laboratory, Yokyo, Japan **University of Technology,Tokyo, Japan ***Dementia Care Research and Training Tokyo Center,Tokyo,Japan Background and Objective: Memory clinics are important for the early diagnosis and management of dementia. Memory clinics’ nurses’ role should be discussed to appropriately care for patients with dementia and their families. This study seeks to clarify how they consulted memory clinics. Methods: A memory clinic was selected as the study setting. We used irreversibly anonymized data from 65 clinic patients (mean age, 80.0years, range 43-95years) and their families. The study period was January 2011 to March 2012. Their demographic data, disease-related data and the series of events that lead them to visit the clinic were reported by the clinic staff. Our Ethical Review Board judged a review was unnecessary because of the use of irreversibly anonymized data. Result: There were twenty-three patients who live with their sons and their family, and thirty-two patients who did not apply for the Certification of Needed Long-Term Care Insurance. Median time from onset to initial memory clinic visit was 27.7±23.4 months. The most common reason was memory loss. Twenty-six patients were referred to the memory clinic by care managers and twenty-three families found it on the Internet. Forty patients had been to other clinics/ hospitals for other diseases after onset. Conclusion: It took a long time for patients to visit the memory clinic, despite family living. The memory clinic nurses should collaborate closely with care managers and other medical setting staff so patients with dementia receive early treatment.
AP9. Behavioural and psychological symptoms of dementia (BPSD) in patients attending memory clinic of Hospital Kuala Lumpur U.M.Z Ameen, R. Rizah, A. Pok, P. Selestine, R. Ng, W K Yau, F S Lee Geriatric Division, Department of Medicine, Kuala Lumpur Hospital Introduction: BPSD are common in dementia and is associated with worse prognosis, increased caregiver burden, earlier nursing home referral and additional care costs. Objective: The aim of this study is to look into the characteristics of patients with BPSD and their presentation in the memory clinic of Hospital Kuala Lumpur. Method: This was a retrospective study of 109 patients who attended memory clinic HKL between 2003 and April 2012.Data were obtained from randomly selected clinic notes.Functional status and Mini Mental State Examination (MMSE) were evaluated during their first and last visit. The types of behaviour symptoms seen in these patients are categories based on the Behavioural Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD). Results: 53 patients were identified to have behavioural problem. After excluding patients with haemorrhage, normal pressure hydrocephalus and depression, 42 were diagnosed with BPSD. Mean age was 73.2 (s.d.±7.1), 14(33.3%) were male and 28 (66.7%) were female. 14(33.3%) were Malay, 20 (47.6%) were Chinese and 8 (19%) were Indian. 29 (69%) were diagnosed with Alzheimer’s disease, 6 (14.3 %) Vascular 55
MJP-21(Suppl)-2012 dementia, 5 (11.9 %) Mixed Dementia, and 1 (2.4%) each for Parkinson with dementia and Frontotemporal dementia (FTD). 14 (33.3%) had paranoid and delusional ideation, 17 (40.5%) had hallucination, 11 (26.3%) had activity disturbance , 17 (40.5%) had aggressiveness, 13 (31%) had diurnal rhythm disturbances, (23.8%) had affective disturbance, 5(11.9%) had anxieties and phobias. Acetylcholinesterase inhibitors were used in 39 patients (92.8%) of which 6 of the patients were changed to NMDA glutamate receptors blocker (14.2%). 17 patients (40.5%) were on psychotropic medications. 2 (4.8%) patients presented with MMSE 27-30, 11 (26.2%) MMSE 21-26, 14 (33.3%) with MMSE 15- 20, 9(21.4%) MMSE 10-14, and 3(7.1%) MMSE 0-9 giving a mean MMSE of 17.8 (sd ±5.9). As for functional status, 20(71.4%) of patients were functionally independent, 11 (26.2%) partially dependent and 1 (2.4%) totally dependent. Mean length of treatment for these patients were 40 ± 5 months. Conclusion: Behavioural problem is common in patients attending memory clinic. The most common underlying cause is Alzheimer’s disease and vascular dementia. Most of the patients are functionally independent with a low mean MMSE score. BPSD is a condition that imposes significant impact on health services as well as caregivers and adequate resources and planning for the care and follow up of a patient should be considered for at least 40 months duration.
AP10. Memory clinic – Hospital Kuala Lumpur: a 9-years experience Pok WKA, Peter S, Rizah M, Ameen J, Ng KLR, Lee FS, Yau WK Geriatric Division, Department of Medicine, Kuala Lumpur Hospital Objective: To study the demography and clinical characteristics of patients attending the Memory Clinic in Hospital Kuala Lumpur over the past 9 years. Method: Retrospective study of Hospital Kuala Lumpur Memory Clinic patients by reviewing randomly selected patient case notes. Parameters such as age distribution, sex and race, underlying diagnosis and risk factors were studied. Results: A cohort of 109 patients was obtained, with ages ranging from 52 to 95. 57% were female. Chinese patients outnumbered that of other races at 56% compared to Malays at 27% and Indians at 17%. The largest proportion of patients was referred to the Memory Clinic by doctors in General Internal Medicine (32%) followed by those in Health Clinics (21%). Majority of new referrals were for impaired memory, and only 12% patients were referred for behavioural changes. 43% of patients scored more than 20/30 in the Mini-Mental State Examination (MMSE) upon entry and 73% of new referrals were independent of activities of daily living (ADL). Alzheimer dementia was the most frequent diagnosis (61%) followed by vascular dementia (17%). 9% of patients referred were found to have other causes for cognitive impairment, such as depression and normal pressure hydrocephalus. 8% of patients had thyroid abnormalities, 8% had low vitamin B12 levels and 4% had positive syphilis serology. Hypertension was found in 73%, diabetes mellitus 50%, stroke 26%, ischemic heart disease 21%, chronic kidney disease 17% and depression in 15% of the sample. Conclusion: A significant number of patients were referred to Memory Clinic from General Internal Medicine and Health Clinics, and most patients were referred early, reflected by their high MMSE and good level of independence. This may be due to better awareness and greater detection of cognitive problems by doctors in those fields. Nearly 10% of cases of cognitive impairment had secondary, non-dementia causes. In addition 4-7% of patients were found to have reversible causes of cognitive impairment, such as hypothyroidism and B12 deficiency. These conditions should be actively looked for as they are easily treated.
AP11. Anxiety and Depression among Elderly Patients: A Cross Sectional Study in Medical Clinics UKMMC B Azlin, TS Lee, SB Hafizah, E Noralia, AR Hadi, BH Khoo, R Rosdinom Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre Introduction: Depression and anxiety are common among the elderly. Objective: This study aimed to determine the percentage of anxiety and depression and factors associated with it. Methods: This is a cross sectional study of elderly, aged 60 years and above was conducted between March and May 2010 at various medical clinics in Universiti Kebangsaan Malaysia (UKMMC). A total of 347 elderly patients participated in this study which used the Hospital Anxiety and Depression Scale (HADS) as its instrument. Results: The percentage of depression was 21.9% and about 11.5% was observed to have
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MJP-21(Suppl)-2012 anxiety. Anxiety was found to have significant differences (p<0.05) with gender. Female respondents have more anxiety as compared to male respondents. There is a significant relationship between depression and race (p<0.05). Depression is much more common among the Malays respondents. Conclusion: The presence of anxiety and depression is often missed due to its mixed presentations. Early detection is important for early treatment so as to improve clinical outcomes and decrease the health costs. Further research is also important to determine the underlying mechanisms of associated factors and also to test interventions to reduce the risk of co-morbid anxiety and depression and their adverse outcomes.
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