S136 THIRD INTERNATIONAL CONFERENCE ON ALZHEIMER’S DISEASE

Patients received either 400 mg BC-PS or placebo daily for 12 veeks with an open 4 week placebo phase at the end of the trial.

Phosphatidylserine, vhich is a naturally occurring phospholipid extracted from bovine brain, has demonstrated biochemical, pharma- cological and clinical properties indicating a potential use in treating aging disorders.

The results presented were obtained from an interim analysis undertaken without having broken the randomization code, by dividing the patients into groups A and 8.

Ihe following parameters were investigated: Ao extensive psycho- metric test battery, investigator assesslnent of clinical global impression (CGI) and an assesssent of daily activities. Several centers also undertook EEG and brain mapping. These have not yet been analysed.

The interim results indicated a greater responder rate as assessed by CGI under treatment A for those patients stratified as moderate- -severe (Global Deterioration Scale of 5-6) of A:70% compared vith B:33.3%. The improverwnt in daily activities (Gottfries, Brane, Steen Scale) also demonstrated a similar effect for trearment A compared to treatment B.

537 MEDICAL CARE UTILIZATION AMONG ELDERLY PATIENTS WITH DEMENTIA, Mona Baumgarten, Research Center, Cote- des-Neiges Hospital, 4565 Queen Mary, Montreal QC, H3W 1 W5, Canada; and University of Montreal.

The objectives of this study were to: 6) quantify the use of medical services among elderly patients with dementia, (ii) determine whether the frequency of physician utilization was higher among dementia patients than in a comparable control group, and (iii) identify correlates of medical care utilization among dementia patients. Results of a study of family caregiving completed in 1990 were merged with utilization data obtained from the Quebec Health Insurance Board (QHIB). Information concerning medical acts is submitted by physicians to the QHIB for billing purposes; the completeness of reporting is estimated to be 98%. All services provided by physicians in hospitals, outpatient settings, private offices, and emergency rooms are re- corded. Several diagnostic and therapeutic services may be provided at a single visit.

The dementia group was made up of 95 elderly community- residing persons with Alzheimer’s disease or other dementia (mean age: 79.4 Years). The comparison group was made up of 102 nondemented elderly persons undergoing cataract surgery (mean age: 73.0 years). Preliminary analyses indicate that an average of 22.2 physician services per year were provided to the dementia group in the years 1981 to 1990. In the control group, the mean number of physician services per year was 20.8 over the same time period.

Among dementia patients, there was a pattern of increasing utilization in the Years following onset of dementia. Thus, in the three Years preceding onset, the mean annual number of physician services was 18.2. In the Year of reported onset, the mean number of services was 19.6 whereas, in the three years after onset, the mean numbers were 17.6, 32.2, and 35.1.

The results of this study suggest that utilization of physician services is higher among patients with dementia than among nondemented elderly persons, and that there is a trend of increasing utilization in the Years following diagnosis.

538 WEIGHT CHANGES AND DEMENTIA. M.K. Aronson, D. Cox, P. Guastadisegni, B. Nesje. Jewish Guild for the Blind, New York, N Y., U.S.A. and Morningside House Nursing Home, Bronx, N.Y., U.S.A. It has been observed that a significant proportion of persons with Alsheimer-type dementia exhibit unexplained weight loss; however there is no agree- ment regarding the nature and the etiology of this phenomenon. There is not even consensus on when in the course of dementia this phenomenon is most prevalent, whether it is episodic or continuous, or what intrinsic or extrinsic variables are corre- lates. It is clear, however, that weight loss often leads to undernutrition, which can create extensive and expensive care needs--e.g., increased risk of fracture and therefore immobility and institutional-

ization, potential skin breakdown, and increased infection risk. While there is scattered literature regarding putative explanations, including increased activity, decreased caloric intake, changed food preferences, and unknown metabolic changes, most reports are descriptive. There is a paucity of studies, and most of these have metbodologic limi- tations. This paper will present data obtained in three studies: a ten-year prospective study of the development of dementia in a cohort of initially non-demented old old persons a six-month study of weight change in a well-worked up group of communi- ty-residing subjects with SDAT; and a retrospective review of a cohort of nursing home patients. The weight history of the prospective study subjects varied according to their dementia status, other co- morbidities, and mortality. In the community weight study, there was unexplained weight loss in one- third of the subjects, despite normal biomedical and endocrinoloqic blood studies, documented adequate food intake, and no change in activity level. Retrospective data regarding nursing home patients revealed sub patterns of weight change. With the prevalence of dementia increasing with advancing age and the increased longevity of the very old, ad- dressing this issue would improve quality of life and care and potentially conserve needed resources.

539 (XFZRS OF DEMENTED PATIENTS: LIFE STYLES AND COPYING ABILITIES. V. Puviani*. E. Ande-cher, S. Rubichi and H. Neri, Ass. It. Dal. Alzheimer* di Mode&s; Inst. of Gerontology, Univ. of Hodena, 41100 Modena, Italy. Dementia is one of the most important causes of disabilities and is emerging as a major public health problem. Furthermore, it is the largest source of distress for care- givers, represented in most cases by the patient*s closest family members - .spOuae and/or adult children. The pharmacological approach to dementia seems to be effective only in reducing some of the emerging symptoms. Formal medical and Paramedical care, even though specific, does not appear fully successful in the management of the Patient because of both the negative effects on symptoms and high management costs. Hence most of demented are cared for within the family, abruptly changing the life-style of its members for many years after. Given that aocio-cultural aspects,which differ from one country to another, could influence the type and rate of stress, a study was planned to identify the family member most involved in caring for the Patient (Main Care Giver) and to examine her/his coping abilities. Fifty MCG were tested using Psychometric evaluation scales such as Relative’s Stress scale (Greene, J.G. 19&Z), Symptom Rating scale (Italian version by Paw, G. 1981) and Family Apgar (Smilketein, S. 1978). Dxing the same session, the Patient “a* evaluated, assessing behaviour , cognitive functioning and affective state as well. On the whole, preliminary evidence is in keeping with the results of Previous studies, suggesting that socio- cultural aspects do not play a major role in coping strategies. No significant correlationa were found between stress scores and the age of Patients, while stress appeared to be related to behavioral changes, the higher correlations being those pertaining to motor and emotional disorders. It is worthwhile to mention that behavioral impairment due to cognitive deficits was not found to be highly related to stress. This finding could highlight the differences between carer and physician judgements on the effectiveness of the care of the Patient.

540 THE CHALLENGE OF TREATING UNTREATABLE OLD-AGE DEMENTIAS: CONTRIBUTIONS OF THE CLINICAL RESEARCH. U. Senin, L. Parnetti. Inst. Gerontol. & Geriatr., Perugia University, Italy.

Old-age dementia6 represent the first neurological cause of disability in the elderly. Alzheimer’s disease (AD) alone accounts for more than half, perhaps nearer 6074, of all cau8e8 of dementia. Since clinical AD is an exclusion diagnosis, great effort has to be made in identifying treatable causes of dementia, following a strict "stepwise" protocol. Nevertheless, in clinical practice a great limitation is the impossibility of