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Engin EKER, MD
Istanbul University, Cerrahpaa Medical School Dept. of Geriatric Psychiatry eneker@istanbul.edu.tr Regional Symposium on Alzheimers Disease and Related Disorders in the Middle East October 1-2,2005 Istanbul ,Turkey
EVALUATION: DSM-IV (APA, 1994) The Turkish vers. MMSE (Gngen, Ertan, Eker, 1998) GDS (Reisberg et al. 1982) Behave-AD (Reisberg et al. 1987) Neuroimagine technics (CT, MRI) Genetic studies (Apo E4)
Age, Gender, Educational Level, Total BEHAVE-AD Score, the MMSE Turkish Score (in 213 AD Cases)
Age, years Female, % Education, years Disease duration The MMSE score Behave-AD score Patients with symptoms 74,018(45-95) 68.5 7.6 5(0-17) 4.3 3(1-20) 15.6 7(0-30) l0.8 9 (0-47) 91.9%
RESULTS (II) Stage Specific Mean BAHAVE-AD in Turkish AD patients Subcategory Scores
Stage 3(n:24) Stage 4(n:50) Stage 5(n:74) Stage 6(n:56) Paranoid or delusional ideat 0.75 2(0-10) 1.6 1.5(0-7) 1.8 1.9(0-7) 4.4 3.5(0-15) Hallucinations 0.036 0.2(0-1) 0.6 1.3(0-5) 0.7 1.3(0-5) 1.9 2.6(0-13) Activity disturbances 0.42 0.9(0-3) 1.6 1.8(0-8) 1.7 1.8(0-7) 3.7 2.8(0-9) Aggressiveness 0.53 1.3(0-6) 1.4 2(0-7) 1. 1.7(0-9) 2.5 3(0-9) Diurnal rhythm disturbances 0.43 0.9(0-3) 0.6 1(0-3) 0.4 0.9(0-3) 1.3 1.4(0-3) Affective Disturbances 0.53 0.9(0-3) 1.2 1.73(0-5) 0.8 1.29(0-6) 1.5 1.57(0-6) Anxieties and Phobias 0.75 0.9(0-3) 1.8 2.26(0-8) 2.08 2.1(0-6 2.7 2.6(0-11)
RESULTS (III) Most Frequent Symptoms in Turkish AD Patients (in 213 cases)
% Purposeless activity 49.3 People are stealing things delusion 44.6 Wandering 42.7 Fear of being left alone 40.8 Tearfulness 40.4 Inappropriate activity 38.5 Depressed mood: other 37.6 Anxiety regarding upcoming events 36.6 Verbal outbursts 36.2 Day/night disturbances 33.8 Visual halucinations 26.3 n (105) (95) (91) (87) (86) (82) (80) (78) (77) (72) (56)
The 10/66 Dementia Group: Behavioral and Psychologiacal Symptom of Dementia in developing Countries (Int. Psychogeratrics 2004)
Method: Mild and moderate cases (CDR) Main care giver 21 centers in 17 developing countries Community screening Interview for dementia and geriatric mental state schedule (GMS) Result: At least one BPS was reported in 70,9% of the 555 participants.
The 10/66 Dementia Group: Behavioral and Psychologiacal Symptom of Dementia in developing Countries (Int. Psychogeratrics 2004)
Results: There were regional differences for individual behaviours High rates of agitation, wandering and sleep distrurbances among Indian participants. High rates of vocalization among Latin American people with dementia.
The 10/66 Dementia Group: Behavioral and Psychologiacal Symptom of Dementia in developing Countries (Int. Psychogeratrics 2004)
Results: Overall, numbers of reported BSD were highest in India, intermediate in Latin America and lowest in China. Depression, anxiety and schizophreniform, paranoid psychosis were commonest among people from Latin America and least common in China.
Conclusions (I)
BPSD is still a novel subject in Turkey. Lack of experienced medical staff in Turkey Psychiatrists, neurologists, GPs are just having necessary information on the subject AD patients are seen by the psychiatrists and neurologists at late stage (stage 5&6) Absence of formal services for demented patient No regular home visit system
Conclusions (II)
Rating scales (Such as GDS;CDR) and measurements for noncognitive symptoms (Behave-AD; NPI; ADAS-non cognitive) are used only by minority neurologists and psychiatrists
Conclusions (III)
There are no trained GP, community nurses, social workers We should educate family and professional caregivers We need more validation studies of observer rated BPSD screening scale We need cross cultural studies on BPSD developing countries