P4-172 CONCURRENT VALIDITY OF THE “CARERS’NEEDS ASSESSMENT SCHEDULE FORDEMENTIA”

Johannes Wancata, Gerda Kaiser, Monika Krautgartner, Maria Weiss,Barbara Marquart, Anne Unger, Medical University of Vienna, Vienna,Austria. Contact e-mail: johannes.wancata@meduniwien.ac.at

Background: Caregivers of dementia patients often suffer from numerousburdens. Several studies have shown that various interventions to caregiv-ers are effective to reduce their burden and improve the patients’ outcome.A recently developed research instrument for assessing the needs of care-givers (“Carers’ Needs Assessment Schedule for Dementia” � CNA-D)has been shown to have satisfactory inter-rater and retest reliability as wellas content validity. Objective(s): The aim of the present study was toinvestigate concurrent validity of the CNA-D. Methods: Forty five rela-tives of dementia patients were enrolled for this study. To evaluate ifplausible associations (i.e. indicators for concurrent validity) exist, twosummary scores of the CNA-D were used: the number of moderate orserious problems among the carers and the number of interventions needed.Further the “Camberwell Assessment of Needs for the Elderly” (CANE)and the “General Health Questionnaire” (GHQ-12) were used. Results:The numbers of carers’ problems (CNA-D) were positively associated withthe number of symptoms indicating anxiety disorders or depression (GHQ;r�0.625, p�0.000), the living situation of the patient (private householdvs. nursing home; r�0.642, p�0.000) and the amount of time spent withthe patient (r�0.330, p�0.040). Negative correlations were found with theextent of support the patient received from the private social network(r�0.430, p�0.005) or from professional services (r�-0.384, p�0.012).Similar results were yielded for the number of interventions needed (CNA-D). Conclusions: Overall, these results indicate that the concurrent validityof the CNA-D is satisfactory.

P4-173 THE PRISM-PC QUESTIONNAIRE

Malaz Boustani1, Anthony Perkins2, Patrick Monahan1, Lea Watson3,John Hopkins3, Chris Fox4, Mary Austrom1, Fredrick Unverzagt1,Chris Callahan1, Hugh Hendrie1, 1Indiana University School ofMedicine, Indianapolis, IN, USA; 2Indiana University Center for AgingResearch, Indianapolis, IN, USA; 3University of North Carolina Schoolof Medicine, Chapel Hill, NC, USA; 4University of Kent, Canterbury,United Kingdom. Contact e-mail: mboustani@regenstrief.org

Background: Patients’ acceptance and their perceived benefits and harmsof dementia screening as important in preparing the health care system forany current or future efforts in detecting dementia in a preclinical or earlyphase of the syndrome. Objective(s): We developed a questionnaire tocapture patients’ attitudes about dementia screening. Methods: Design:Cross-sectional study. Setting: Urban and rural primary care clinics inIndianapolis and North Carolina. Participants: A convenience sample of315 patients with a mean age of 72.8, 70% female and 44% AfricanAmericans. Measurement: the Perceptions Regarding InvestigationalScreening for Memory in Primary care (PRISM-PC) questionnaire wasadministered via face-to-face or phone interview. Results: The PRISM-PCquestionnaire consists of two separate scales; the patient’s acceptance ofdementia screening scale and the patient’s perceived harms and benefits ofdementia screening scale. The face validity of the PRISM-PC questionnairewas based on a systematic literature review and the expertise of 16clinician-researchers who nominated items that were important determi-nants of patients’ acceptance of dementia screening (8 items) and theirperceived benefits and harms of dementia screening (29 items). Explor-atory factor analyses for the acceptance scale revealed the presence of twodimensions; knowledge about dementia risk and testing for dementia. Forthe benefits and harms scale, exploratory factor analyses identified fourdimensions; perceived benefits of dementia screening, stigma of dementiascreening, suffering from dementia screening, and impact of dementiascreening on patient’s independency. The internal consistency of each ofthe above subscales was good; overall acceptance of dementia screening

(Cronbach’s Alpha, 0.88), knowledge of dementia risk (Cronbach’s Alpha,0.77), testing for dementia (Cronbach’s Alpha, 0.89), Benefits of dementiascreening (Cronbach’s Alpha, 0.79), stigma of dementia screening (Cron-bach’s Alpha, 0.74), suffering from dementia screening (Cronbach’s Al-pha, 0.58), and impact of dementia screening on patients’ independence(Cronbach’s Alpha, 0.72). Conclusions: We have developed a new ques-tionnaire, the PRISM-PC that captures primary care patients’ acceptance,perceived harms, and perceived benefits for dementia screening.

P4-174 CLINICAL ASSESSMENT OF FINANCIALCAPACITY IN ALZHEIMER’S DISEASE

Daniel C. Marson, Roy Martin, Virginia Wadley, H. Randall Griffith,Britt Anderson, Patricia Goode, Cleveland Kinney, Anthony Nicholas,Terri Steele, Edward Zamrini, Lindy Harrell, University of Alabama atBirmingham, Birmingham, AL, USA. Contact e-mail: dmarson@uab.edu

Background: As our society ages, increasing numbers of older adults willlose financial skills as a result of Alzheimer’s disease (AD) and relateddementias. Physicians, psychologists, and other clinicians are increasinglycalled upon to evaluate the financial capacity of their patients. Thesejudgments are challenging, and have important ethical and legal implica-tions. Clinicians have had limited training and tools with which to makejudgments of financial capacity. Objective: To investigate financial capac-ity in cognitively impaired older adults using a structured financial capacityinterview and five physician raters. Methods: The authors, including fivephysicians with dementia and competency assessment expertise, developeda 25 minute structured clinical interview for assessing financial capacity indementia (SCIFC). The SCIFC assesses eight domains of activity (basicmonetary skills; conceptual knowledge; cash transactions, checkbook man-agement; bank statement management; judgment; bill payment; and knowl-edge of personal assets/estate arrangements), and also overall financialcapacity. The study sample consisted of 69 healthy older controls, 54patients with amnestic MCI, 98 patients with mild AD, and 27 patients withmoderate AD. Using the SCIFC, each study physician evaluated each studyparticipant, either through live interview or via videotape review of thatinterview. Capacity judgments (capable, marginally capable, or incapable)were obtained for each of the eight SCIFC domains and for overallfinancial capacity. Results: Study physicians made a total of over 11,000individual financial capacity judgments across the four groups. Inter-rateragreement (defined as 80% agreement, or 4/5 physicians in agreement) wasconsistently high across all groups and SCIFC variables. Financial capacityoutcomes differed across groups. Relative to healthy controls, MCI patientsshowed impairments in checkbook management, bank statement manage-ment, financial judgment, and overall financial capacity. Mild AD patientswere impaired on all financial variables relative to controls and MCIpatients. Moderate AD patients were impaired relative to the mild AD andother groups on all variables. Conclusions: Cognitively impaired olderadults representing the Alzheimer’s dementia spectrum demonstrated pro-

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gressive impairments in financial skills as evaluated by experienced phy-sicians. Financial capacity in older adults can be reliably and accuratelyevaluated in the clinical setting using a brief, structured interview.

P4-175 A COMPARISON OF PENTAGON COPYING ANDTHREE CLOCK SCORING METHODS AMONGILLITERATE OR LOW EDUCATED ELDERLYKOREAN

Moon Ho Park1, Sangmee Ahn Jo2, Inho Jo2, Eunkyung Kim2,Changsu Han1, Min Kyu Park1, 1Korea University Medical College,Ansan Hospital, Ansan-si, Republic of Korea; 2Department ofBiomedical Science, National Institute of Health, Seoul, Republic ofKorea. Contact e-mail: parkmuno@yahoo.co.kr

Background & Objective(s): Illiteracy or low education is prevalentamong current elderly Korean. Although dementia screening tests areavailable, they have not gained widespread use in community or primarycare settings in Korea. This study compared the dementia screening per-formance of Pentagon copying and three clock drawing test (CDT) scoringsystems for elderly Korean. Methods: We reviewed the charts of consec-utive subjects referred between 2004 and 2005 to the geriatric health clinicand research institute (GHCRI). Subjects included were 30 Alzheimer’sdisease (AD) subjects and 60 normal subjects. All subjects had all under-gone the CERAD-K as well as an MMSE-K, pentagon copy (scored byBourke method and MMSE method) and CDT (scored by 3 methods: theSunderland method, the Rouleau method, and the Watson method). Re-sults: AD subjects with low education were found to copy significantlyworse pentagons than those with high education or normal subjects. Copy-ing scores and CDT scores significantly correlated with MMSE scores forthe AD and normal groups. Using the CERAD-K as the good standard, thesensitivity and specificity of the pentagon copying scores and the Watsonmethod of scoring CDT to predict an abnormal CERAD-K score were 65%and 72%, 60% and 71%, respectively. Conclusions: Deterioration in pen-tagon copying and CDT correlates with severity of global cognitive im-pairment in low educated elderly Koreans. This study suggests that in thesocio-cultural context for Korean, pentagon copy as well as CDT arefeasible for use in a clinical setting for dementia screening.

P4-176 ACTIGRAPHIC MEASUREMENT OF AGITATEDBEHAVIOR IN DEMENTIA

Sebastiaan Engelborghs1,2, Guy Nagels1,3, Ellen Vloeberghs1,Barbara A. Pickut2, Peter P. De Deyn1,2, 1University of Antwerp /Institute Born-Bunge, Antwerp, Belgium; 2Middelheim General Hospital,Antwerp, Belgium; 3National Multiple Sclerosis Centre, Melsbroek,Belgium.

Background: Actigraphic recordings have already been used to detectactivity-rest disturbances in dementia and seem a promising tool to studyagitation in a standardized fashion. Objectives: As actigraphy has not yetbeen validated as a measure of agitation in dementia, we examined thecorrelation between actigraphic measures and a validated assessment scaleof agitated behavior in dementia, the Cohen-Mansfield Agitation Inventory(CMAI). Methods: Diagnosed according to strictly applied clinical diag-nostic criteria, patients with Alzheimer’s disease (AD; n�65), mixeddementia (MXD; n�20), frontotemporal dementia (FTD; n�9) and de-mentia with Lewy bodies (DLB; n�16) were included in the study (totaln�110). All patients underwent actigraphic recordings for 48 hours. CMAIwas scored by professional caretakers, who were responsible for the patientduring his or her actigraphic recording. Results: Mean age of the patientsincluded was 78�8 years. Average MMSE was 15.1�6.8. Patients withhigh total CMAI scores (�50) clearly had higher levels of activity duringthe day as measured by means of actigraphy than patients with low totalCMAI scores (ANOVA, F�126.75, p�0.0001). Patients with low MMSEscores (�20) also had higher activity levels during the day than patientswith higher MMSE scores (ANOVA, F�85.74, p�0.0001). Correlationsbetween actigraphic data and CMAI total scores were moderate but highly

significant. Conclusions: We conclude that actigraphy is a useful tool toexamine agitated behavior in dementia.

P4-177 COMPUTERIZED MAZE NAVIGATION AND ON-ROAD PERFORMANCE IN DRIVERS WITHDEMENTIA

Brian R. Ott, Elena Festa, Melissa Amick, Janet Grace, Jennifer Davis,William C. Heindel, Brown University, Providence, RI, USA. Contacte-mail: BOtt@lifespan.org

Background: Preliminary studies of small numbers of subjects with de-mentia suggest that maze test performance may be a useful predictor ofimpaired driving. Objective(s): To examine a computerized maze test as apredictor of impaired driving by older and cognitively impaired drivers.Methods: We examined 133 older drivers, including 65 with probableAlzheimer’s disease (AD), 23 with possible AD, and 45 controls. Subjectscompleted five computerized maze tasks employing a touch screen andpointer as well as a battery of standard neuropsychological tests, includingMMSE, Trails A, Trails B, Rey-Ostereith figure, HVLT1, HVLT delay,and dominant hand tapping. Parameters measured for mazes includederrors, planning time, drawing time, and total time. Subjects were thenexamined by a professional driving instructor on a standardized road testmodeled after the Washington University Road Test. Results: Road testtotal score was significantly correlated with total time for the five mazes(r � .54, p�.0005). This maze score was significant for both AD subjects(r �.40, p�.0005) and control subjects (r �.53, p�.0005). One maze inparticular, requiring less than two minutes to complete, was highly corre-lated with driving performance score (r � .57, p�.0005) for the entiresample. For the other neuropsychological tests, highest correlations wereseen with Trails A (r � .50, p�.005) and HVLT1 (r � -.47, p�.05) for theentire sample, HVLT1 (r � -.37, p�.05) and Trails A (r � .36, p�.005)among AD subjects, and Trails A (r � .58, p�.0005) and hand tapping(r � -.37, p�.05) among normal subjects. Multiple regression models forroad test score revealed significant independent contributions for totalmaze time, HVLT1 and Trails A for the entire group, total maze time andHVLT1 for AD subjects, and Trails A for normal subjects. Conclusions:As a visual analog of driving, a brief computerized test of maze navigationtime compares well to standard neuropsychological tests of psychomotorspeed, scanning, and working memory as a predictor of driving perfor-mance by persons with mild AD and normal elders. Further developmentof this test and technology may lead to a practical screening test to easilyidentify potentially hazardous older drivers.

P4-178 DEMENTIA SCREENING WITH THE CSI-D: AVALIDATION STUDY IN SURINAME

Huib van Dis1,2, Merel Sipsma1, Rudi Dwarskasing3,Eric A. Kafiluddin4, 1University of Amsterdam, Amsterdam, TheNetherlands; 2Onze Lieve Vrouwe Gasthuis, Amsterdam, TheNetherlands; 3Psychiatric Centre Suriname, Paramaribo, Suriname;4Department of Neurology, Academic Hospital, Paramaribo, Suriname.Contact e-mail: h.vandis@uva.nl

Background: The CSI-D (Community Screening Interview for Dementia)is developed as a screening-instrument for dementia in cross-cultural stud-ies, and is used by 10/66 Research Group van Alzheimer International indeveloping countries. The CSI-D exists of two components, a cognitivescreening-test (CSID-COG) for literate and illiterate populations and aninformant interview of the carer (CSID-INFO) concerning cognitive anddaily functioning. De CSI-D is translated and adapted to the Surinamesituation. Suriname has a great cultural diversity, large differences ineducation and a high percentage of illiteracy in the generation above 55years of age. Objective: The CSI-D is validated for its use in the diagnosisof dementia in Suriname. Methods: 60 demented patients (included via aday-care facility for demented people, a 24-hours care-facility for elderly,a psychiatric outpatient-clinic and a neurological outpatient-clinic) and 81non-demented elderly participated in the study. Results: The CSID-COG

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