Poster Presentations: P4 P881

between vitamin B12 status and cognitive performance. Promising results

are expected from our intervention data.

P4-396 CLINICAL ADHERENCE OF TAKING

MEMANTINE IN MODERATE-TO-SEVERE

ALZHEIMER’S DISEASE IN TAIWAN

I-Chun Tseng1, Yuan-Han Yang1, Chun-Hung Chen2, 1Kaohsiung Medical

University, Kaohsiung, Taiwan; 2Department of Neurology, Kaohsiung

Medical University Hospital, Kaohsiung, Taiwan.

Contact e-mail: u99000049@kmu.edu.tw

Background: The prevalence ofAlzheimer’s disease (AD) is rising due to ag-

ing population in Taiwan. Use of the NMDA-receptor antagonist, memantine,

has showed improvement in cognition, activity of daily living and neuro-be-

havior syndromes in patients with moderate to severe AD. Memantine seems

to provide a distinctive tolerability with very mild side effects. Little is known

about clinical adherence of takingmemantine in Taiwan. Our study is trying to

elucidate factors associated with withdrawal of taking memantine.Methods:

All of the recruited subjects were diagnosed with Alzheimer’s disease based

on the DSM-IV criteria at the department of neurology, Kaohsiung Medical

University, a medical center at southern Taiwan from Jan, 2008 to March,

2013. The neuropsychological assessment including clinical Dementia Rating

Scale (CDR), Mini-Mental State Examination (MMSE) and cognitive abili-

ties screening instrument (CASI) were performed at the beginning of taking

memantine and at the next annual assessment. Subjects with moderate to se-

vere AD having a baseline MMSE total score between 10 and 14 or CDR¼2

were eligible for the study. The clinical adherence of memantine to AD was

examined by telephone interview with caregiver of AD patients and the ther-

apeutic duration was recorded accordingly. Results: Twenty-seven subjects

were enrolled in this study (3 males and 24 females; mean age,82.9 6 6.3

(mean6 SD); mean educational level, 4.0 6 3.9 year; mean CASI, 29.3 613.1; mean MMSE,9.2 6 3.5). The mean with mean therapeutic duration

of memantine was 101.5 6 37.7 weeks among these 27 subjects. For 13

out of 27 discontinuing memantine, the main reasons accounting for the dis-

continue cause were unapproved by health care insurance (33.3%, 9/27) due

to the advanced disease severity, transferred to other hospitals or nursing

home (11.1%, 3/27) or death due tomultiple organ failure (3.7%, 1/27). There

were no reported adverse effects for the continuous treatment for the other 14

(51.9%) patients keeping the continuous treatment.Conclusions:Memantine

showed its potential with no reported adverse effect in the treatment of AD.

The clinical adherence of memantine to the moderate to severe stage of AD

was mainly determined by the national health insurance at Taiwan.

P4-397 SHORT-TERM EFFICACY FOR ACUTE

ELECTROCONVULSIVE THERAPY FOR

AGITATION AND AGGRESSION IN DEMENTIA

Brent Forester1, Deepa Acharya1, Eric Achtyes2, David Harper1,

Don Davidoff1, Lesley Adkison1, Manjola Ujkaj1, Steve Seiner1, 1McLean

Hospital, Belmont, Massachusetts, United States; 2Pine Rest Christian

Mental Health Services, Kalamazoo, Michigan, United States.

Contact e-mail: bforester@partners.org

Background: Agitation and aggression are among the most frequent and

disruptive behavioral complications of dementia that contribute to increased

cost of care, hospitalization, caregiver burden, and risk of premature institu-

tionalization. The current study examined the safety and efficacy of electro-

convulsive therapy (ECT) as a treatment for behavioral disturbances in

dementia. We hypothesized that ECTwould result in a reduction of agitated

and aggressive behavior between baseline and discharge. Methods: Pro-

spective, naturalistic study. Setting: Geriatric Neuropsychiatry Unit at

McLean Hospital (Belmont, MA) and Older Adult Unit at Pine Rest Chris-

tianMental Health Services (Grand Rapids, MI). Participants: Twenty-three

participants with dementia, referred for ECT by their psychiatrist to treat ag-

itation/ aggression. Measurements: We administered the Cohen-Mansfield

Agitation Inventory (CMAI)-short form, Neuropsychiatric Inventory

(NPI)-Nursing Home Version, Cornell Scale for Depression in Dementia

(CSDD), and the Clinical Global Impression Scale (CGI) at baseline, after

the third, sixth, ninth and twelfth (where applicable) ECT sessions, and at

discharge. Results: Regression analyses revealed a significant decline

from baseline to discharge on the CMAI (F(4, 8) ¼13.31; p¼0.006) and

NPI (F(4, 31)¼ 14.64; p<0.001). Scores on the CSDD declined from base-

line to discharge; however, this decline was not statistically significant. CGI

scores on average changed from a rating of "markedly agitated/aggressive"

at baseline to "borderline agitated /aggressive" at discharge. Conclusions:

The study found ECT to be a safe and effective treatment for behavioral dis-

turbances in dementia, andmay be a useful treatment option for patients with

dementia who are refractory to medications for agitation and aggression.

P4-398 USE OF NEW TECHNOLOGY TO IMPROVE

DEMENTIA PREVENTION: THE HEALTHYAGING

THROUGH INTERNET COUNSELING IN THE

ELDERLY (HATICE) PROJECT

Francesca Mangialasche1, Miia Kivipelto2, Sandrine Andrieu3,

Nicola Coley4, Tiia Ngandu5, Eric Moll van Charante6, Carol Brayne7,

Yannick Meiller8, Bram Van de Groep9, Hilkka Soininen10, A. van Willem

Gool6, Edo Richard6, 1Karolinska Institutet, Stockholm, Sweden;2Karolinska Institutet, Stockholm, Sweden; 3INSERMUMR 1027, Toulouse,

France; 4INSERM UMR 1027, Toulouse, France; 5National Institute for

Health and Welfare, Helsinki, Finland; 6Academic Medical Center,

Amsterdam, Amsterdam, Netherlands; 7Cambridge University, Cambridge,

United Kingdom; 8Novapten, Paris, France; 9VitalHealth Software Inc,

Amsterdam, Netherlands; 10University of Eastern Finland, Kuopio, Finland.

Contact e-mail: miia.kivipelto@ki.se

Background: Despite substantial efforts, effective preventive measures for

dementia and Alzheimer’s disease (AD) are not yet available. The European

Dementia Prevention Initiative (EDPI) has been established to improve pre-

ventive strategies for dementia/AD. Internet-based platforms are interactive

tools which can facilitate implementation of preventive measures. EDPI has

started the Healthy Aging Through Internet Counseling in the Elderly (HA-

TICE) project to verify the efficacy of a multi-domain intervention based on

such tool. Methods: EDPI members lead three ongoing randomized con-

trolled trials (RCTs) (FINGER, MAPT, PreDIVA) in Finland, France and

the Netherlands. In these RCTs multi-domain interventions are used to si-

multaneously target several vascular and lifestyle-related risk factors for de-

mentia/AD. Analysis of pooled data from these RCTs will serve as a basis

for the design of HATICE. HATICE will enroll 4600 community-dwelling

elderly people (age 65+) withmultiple cardiovascular risk factors or disease,

and living in Finland, France and the Netherlands. Participants will be ran-

domly allocated to an interactive internet platform with nurse-led support to

optimize pharmacological and non-pharmacological management of vascu-

lar and lifestyle-related risk factors, or to general web-based health advice

(control group). Main outcomes will be effects on dementia incidence and

cardiovascular diseases.Results:HATICE started in January 2013. Datasets

from FINGER, MAPTand PreDIVA are being pooled and analyzed to eval-

uate efficacy and feasibility of various preventive regimens based on non-

pharmacological and pharmacological interventions. An innovative and

interactive internet platform for self-management of vascular and life-

style-related risk factors is under development. Interactive support by nurses

and patient’s own physician is being integrated, as well as monitoring of ad-

verse events. The platform will also facilitate access to internet-based cog-

nitive training and group activities (exercise, social events). Conclusions:

Through HATICE, lessons learned from existing dementia multi-domain

prevention studies are being tested in a large multinational RCT, to identify

effective preventive measures that can be implemented in the general pop-

ulation of older adults. The flexible internet-based intervention strategy

can be easily translated and adapted for use in different health-care systems.

It will allow for tailored interventions specifically suited to the needs of

older people and careful monitoring of side effects.

P4-399 MORTALITY FROM ALZHEIMER’S DISEASE IN

SAO PAULO AND RIO DE JANEIRO

Jane Teixeira1, Mariza Theme2, 1FIOCRUZ, Rio das Ostras, Brazil;2FIOCRUZ, Rio de Janeiro, Brazil. Contact e-mail: janebteixeira@gmail.

com