Nighttime Behavior Research Articles

Sleep disturbances and predictive factors in caregivers of patients with mild cognitive impairment and dementia.

Background and PurposeWe examined the characteristics of sleep disturbances and sleep patterns in the caregivers of patients with amnestic mild cognitive impairment (aMCI) and dementia.MethodsWe prospectively studied 132 patients (60 with aMCI and 72 with dementia) and their caregivers, and 52 noncaregiver controls. All caregivers and controls completed several sleep questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). The patients were administered neuropsychological tests and the neuropsychiatric inventory to evaluate their behavioral and neuropsychiatric symptoms of dementia (BPSD).ResultsThe PSQI global score was 6.25±3.88 (mean±SD) for the dementia caregivers and 5.47±3.53 for the aMCI caregivers. The Insomnia Severity Index (ISI) and short form of the Geriatric Depression Scale (GDS-S) predicted higher PSQI global scores in aMCI caregivers, and higher scores for the ISI, Epworth Sleepiness Scale (ESS), and GDS-S in dementia caregivers. BPSD, including not only agitation, depression, and appetite change in dementia patients, but also depression, apathy, and disinhibition in aMCI patients, was related to impaired sleep quality of caregivers, but nighttime behavior was not. Age and gender were not risk factors for disturbed sleep quality.ConclusionsDementia and aMCI caregivers exhibit impaired quality of sleep versus non-caregivers. ISI, GDS-S, and ESS scores are strong indicators of poor sleep in dementia caregivers. In addition, some BPSD and parts of the neuropsychological tests may be predictive factors of sleep disturbance in dementia caregivers.

EPA-0742 – The neuropsychiatric inventory (npi): validation of the portuguese version

Introduction Assessment of neuropsychiatric symptoms is crucial to the management of dementia. In this context, the Neuropsychiatric Inventory (NPI) is the most widely used comprehensive tool, assessing twelve domains (delusions, hallucinations, dysphoria, anxiety, agitation/aggression, euphoria, disinhibition, irritability/lability, apathy, aberrant motor activity, night-time behaviour and appetite/eating abnormalities). NPI records severity, frequency and caregiver distress. It has been translated and validated into a number of languages and shown to be reliable in cross-cultural studies. Aim To present preliminary results of the NPI Portuguese validation study. Methods A cross-sectional study was conducted with a convenience sample of institutionalized elderly (≥ 60 years old) in three Nursing Homes in Portugal. All patients were also assessed with MMSE (cognition) and GDS (depression). NPI was administered to a formal caregiver, usually from the clinical staff. Inter-rater and test-retest reliability were assessed in a subsample of 25 randomly selected elderly. Results The sample included 166 elderly, with a mean age of 80.9 (10.2sd). Three out of the NPI behavioural items had significant negative correlations with MMSE: delusions (r=−0.177, p=0.024), disinhibition (r=−0.174, p=0.026) and aberrant motor activity (r=−0.182, p=0.020). The NPI subsection of depression/dysphoria correlated positively with GDS total score (r=0.166, p= 0.038). NPI showed good internal consistency (overall α=0.766; frequency α=0.737; severity α=0.734). The inter-rater reliability was excellent (ICC=1.00, CI95% 1.00–1.00), as well as test-retest reliability (ICC=0.91, CI95%0.80–0.96). Conclusion These results suggested that the Portuguese version is a valid and reliable instrument for the evaluation of neuropsychiatric symptoms in elderly people.

Neuropsychiatric profiles in patients with Alzheimer's disease and vascular dementia.

Background/Aims:The aim of the following study is to compare the behavioral and psychological symptoms of dementia (BPSD) in patients of Alzheimer disease (AD) and vascular dementia (VaD).Materials and Methods:We used National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for diagnosing AD and National Institute of Neurological Disorders and Stroke-Association International pour la Recherche et l’Enseignement en Neurosciences Criteria for diagnosing VaD. VaD cohort was further subcategorized into small vessel and large vessel disease. The severity of cognitive impairment and the BPSD were studied by means of the Clinical Dementia Rating Scale (CDR) and the Neuropsychiatric Inventory respectively.Results:We studied 50 AD and 50 VaD patients of whom 38 were small vessels and 12 were large vessels VaD. The severity of dementia was comparable in both groups. The agitation/aggression, depression/dysphoria, anxiety, apathy/indifference, irritability, aberrant motor behavior, appetite and eating behavior and night-time behaviors occurred significantly more frequently in patients with VaD than AD. We found a weak positive correlation between the CDR score and the number of neuropsychiatric symptoms per patient in both cohorts. Elation/euphoria, agitation/aggression was significantly more frequent in patients with large vessel in comparison to small vessel VaD.Conclusions:BPSD are common in both types of dementia and they are more severe in VaD than AD when the groups have similar levels of cognitive impairment.

Efficacy of pain treatment on mood syndrome in patients with dementia: a randomized clinical trial.

Depression is common in nursing home (NH) patients with dementia, and often clustered with anxiety and other mood symptoms. An association between pain and depressive symptoms has been reported, but the impact of pain management on depression and other mood symptoms has not been investigated. Secondary analyses of a cluster randomized clinical trial examine the response of dementia-related mood symptoms to a Stepwise Protocol of Treating Pain. Three-hundred fifty-two patients with moderate and severe dementia and significant behavioural disturbances, related to 60 clusters (i.e. clusters defined as single independent NH units) in 18 NHs of Western Norway, were included. All patients in the intervention group received individual daily pain treatment with paracetamol, extended release morphine, buprenorphine transdermal patch or pregabaline for 8 weeks, with additional follow-up assessment 4 weeks after completion of the intervention. Clusters randomized to control received usual treatment. A mood cluster consisting of depression, anxiety, sleep disorders, apathy and appetite items from the Neuropsychiatric Inventory-Nursing Home (NPI-NH) was the primary outcome. Analysed by Mann-Whitney U-tests, Stepwise Protocol of Treating Pain conferred significant benefit in treatment of the NPI-NH mood cluster (F = 13.4, df = 1;299, p < 0.001) and depression (F = 2.0, df = 1;301, p = 0.025). Further analyses highlighted improvements in apathy (F = 5.3, df = 1;300, p = 0.017), night-time behaviours (F = 3.1, df = 1;301, p = 0.050), and appetite items (F = 11.6, df = 1;301, p = 0.005), but not irritability (p = 0.092) and anxiety (p = 0.125). Mood symptoms including depression significantly improved with pain treatment, emphasizing the importance of more rigorous treatment of pain in agitated people with dementia. Findings have potentially immediate clinical relevance.

The Correlation between Problematic Behaviors and Activities of Daily Living of Elderly People with Dementia in Patients in a Geriatric Hospital

The purpose of this study is to determine the correlations between problematic behaviors and activities of daily living(ADL) targeting 106 demented elderly people hospitalized in a geriatric hospital. To examine the cognitive function of the subjects, the study used Korean Mini Mental State Examination(K-MMSE). For problematic behaviors and ADL, the study collected data based on Patient Assessment Forms in the geriatric hospital. Among problematic behaviors, apathy/indifference had the highest correlation with the items of ADL. Irritability/lability, agitation/aggression, depression/ dysphoria, night-time behavior and wandering also showed to be correlated to items of ADL(p<.05). This study demonstrated that cognitive function, problematic behaviors and ADL of the demented elderly hospitalized in the geriatric hospital are correlated to each other.

Modelled hydraulic redistribution by sunflower (Helianthus annuus L.) matches observed data only after including night‐time transpiration

The movement of water from moist to dry soil layers through the root systems of plants, referred to as hydraulic redistribution (HR), occurs throughout the world and is thought to influence carbon and water budgets and ecosystem functioning. The realized hydrologic, biogeochemical and ecological consequences of HR depend on the amount of redistributed water, whereas the ability to assess these impacts requires models that correctly capture HR magnitude and timing. Using several soil types and two ecotypes of sunflower (Helianthus annuus L.) in split-pot experiments, we examined how well the widely used HR modelling formulation developed by Ryel et al. matched experimental determination of HR across a range of water potential driving gradients. H. annuus carries out extensive night-time transpiration, and although over the last decade it has become more widely recognized that night-time transpiration occurs in multiple species and many ecosystems, the original Ryel et al. formulation does not include the effect of night-time transpiration on HR. We developed and added a representation of night-time transpiration into the formulation, and only then was the model able to capture the dynamics and magnitude of HR we observed as soils dried and night-time stomatal behaviour changed, both influencing HR.

Wild Asian elephants distinguish aggressive tiger and leopard growls according to perceived danger

Prey species exhibit antipredator behaviours such as alertness, aggression and flight, among others, in response to predators. The nature of this response is variable, with animals reacting more strongly in situations of increased vulnerability. Our research described here is the first formal study to investigate night-time antipredator behaviour in any species of elephants, Asian or African. We examined the provocative effects of elephant-triggered tiger and leopard growls while elephants attempted to crop-raid. Tigers opportunistically prey on elephant calves, whereas leopards pose no threat; therefore, we predicted that the elephant response would be reflective of this difference. Elephants reacted similarly cautiously to the simulated presence of felids of both species by eventually moving away, but differed markedly in their more immediate behavioural responses. Elephants retreated silently to tiger-growl playbacks, whereas they responded with aggressive vocalizations, such as trumpets and grunts, to leopard-growl playbacks. Elephants also lingered in the area and displayed alert or investigative behaviours in response to leopard growls when compared with tiger growls. We anticipate that the methods outlined here will promote further study of elephant antipredator behaviour in a naturalistic context, with applications for conservation efforts as well.

Grouping of behavioural and psychological symptoms of dementia.

ObjectiveA wide range of behavioural and psychological symptoms (BPSD) are common in dementia, and it has been suggested that groups of correlated symptoms should be studied together. Here, we describe the groups of BPSD that have been identified in the literature and how they have been used to study associations, burden, treatment and underlying biology.MethodsThe literature database PubMed was searched for articles that identified clusters or factors of BPSD or used previously defined symptom groups.ResultsSixty-two studies were included. Generally, the following symptom groups were suggested: affective symptoms, including depression and anxiety; psychosis, including delusions and hallucinations; hyperactivity, including irritability and aggression; and euphoria. Symptoms that did not show consistent results include apathy, eating disturbances, night-time behaviour disturbances, disinhibition and aberrant motor behaviour. Symptom groups differed in their associations, treatment and biology.ConclusionsStudies investigating symptom groups show relatively consistent results. Studying symptom groups allows similar symptoms to be studied together, which might strengthen results and may point to differences in their aetiology and treatment. However, a large amount of the individual variability of the symptoms could not be explained by the factors, and authors should carefully address their research question and hypotheses to decide if symptoms should be studied in groups or individually. Clinicians need to consider each symptom in its own right and also to be aware of the interrelations between them when assessing patients and developing strategies for treatment. © 2013 The Authors. International Journal of Geriatric Psychiatry by John Wiley & Sons, Ltd.

Dementia behavioural and psychiatric symptoms: effect on caregiver's sleep

To examine caregiver sleep quality, especially in relation to the daytime and night-time behaviours and psychological symptoms exhibited by persons with dementias. Caregivers of persons with dementias experience poorer sleep in comparison with noncaregivers, and poor sleep is related to negative health outcomes. The reasons for caregivers' poor sleep are complex, and it is known that the night-time behaviours of the persons with dementia contribute to caregiver sleep disruption. However, the frequency of behavioural and psychological symptoms of dementia has hitherto not been sufficiently explored as a contributing factor to poor caregiver sleep. A nonexperimental cross-sectional design. Eighty caregivers completed questionnaires on the frequency of behavioural and psychological symptoms of the persons with dementia, the Dementia Severity Rating Scale, the Pittsburgh Sleep Quality Index and the Center for Epidemiologic Studies Depression Scale. Poor sleep was reported with awakenings by the persons with dementia occurring for more than half of the caregivers. The frequency of behaviours and symptoms did not make a unique contribution to the variance of caregivers' global sleep. The frequency of behaviours, and specifically of agitation and apathy, contributed to the variance in subjective sleep quality, as defined by the caregivers' appraisal of their sleep. The findings demonstrate the relationship between (1) daytime and night-time behaviours of persons with dementias and (2) their caregivers' sleep quality and emphasise the complexity of the factors that contribute to caregiver sleep quality. These findings suggest that nurses should be cognizant of the relationship between daytime behaviours of the persons with dementia and the caregivers' appraisal of their sleep, realising that appraising one's sleep as poor can be a contributing factor to perpetuating sleep problems. Interventions aimed at helping the caregiver manage the persons with dementia's agitation or the caregiver's emotional response to persons with dementia apathy may improve caregivers' perception of their sleep.

The effects of small vessel disease and amyloid burden on neuropsychiatric symptoms: a study among patients with subcortical vascular cognitive impairments

Neuropsychiatric symptoms (NPS) affect the quality of life of patients with dementia and increase the burden on caregivers. We aimed to evaluate how small vessel disease (SVD) such as lacunae or white matter hyperintensities (WMH), and amyloid burden affect NPS. We recruited 127 patients with subcortical vascular cognitive impairment who were assessed with brain magnetic resonance imaging, Pittsburgh compound-B (PiB) positron emission tomography and the neuropsychiatric inventory (NPI). To explore the association between lacunae, WMH, or PiB retention ratio and NPS, we performed multivariate regression analysis after controlling for possible confounders. Each additional lacuna, especially in the frontal region, was associated with higher odds of depression, apathy, aberrant motor behavior, nighttime behavior, appetite changes, and higher score of total NPI; larger WMH volume, especially in the frontal region, was associated with higher odds of apathy and higher score of total NPI. Furthermore, for the effects of lacunae or WMH on total NPI score we set Clinical Dementia Rating Sum of Boxes as the mediator. Greater PiB retention ratio was associated with higher odds of delusions and irritability. The SVD and amyloid pathologies did not show interactive effects on NPS. Our findings suggested that SVD and amyloid burden independently affected specific NPS.

The time budget of Atlantic salmon (Salmo salar) held in enriched tanks

In order to understand the impact of different experimental and husbandry procedures on fish, and ensure that the behavioural and physiological needs of fish used in research are met, it is necessary to have detailed knowledge of their behaviour. This knowledge is largely lacking for Atlantic salmon. Results from behavioural studies of rainbow trout are often extrapolated to Atlantic salmon even though this may not be correct. Pre-smolt Atlantic salmon show diurnal variation in behaviour in the wild, but there are no published descriptions of behaviour during the dark hours for salmon held in the laboratory. Thus, the first aim of this paper was to describe the time budget of singly-held salmon both during the light and dark hours on the first and seventh day after introduction to a new environment. Statistical differences in time budget between morning, afternoon and night are described. In addition, three environmental enrichments were provided, and the time spent using each resource was scored. In general, no behaviours differed in frequency between morning and afternoon registrations, but there were significant differences in the time-budget between day and night and also between day 1 and 7. Fish hid less and displayed more behaviours during the night than during the day, and also after 7 days in the tank compared to at the first day. The exceptions were bottom behaviours which were displayed with the same frequency during day and night and during day 1 and day 7, and hovering, which was unchanged at night from day 1 to day 7. Thus, different behaviours seem to be influenced by light and by the novelty of the surroundings to different degrees. Of the three enrichments included in the study, the hiding place and the inlet current were used most frequently. As far as the authors know, this is the first paper describing the daytime and night time behaviour of parr Atlantic salmon in a research facility in detail.

Predictors of Cognitive Improvement in Persons with Cognitive Impairment: A Naturalistic Study

Introduction: Dementia has traditionally been known as a progressive illness, but with earlier detection of cognitive impairment, clinicians have observed a more variable course. The literature has suggested that depression, anxiety, apathy, psychosis, disinhibition, and nighttime behaviors may be associated with both improvement and decline in cognition but it remains inconclusive. In this study we looked at factors that may predict improvement in MMSE score at later follow up. Methods: Patients from the Brooklyn Alzheimer’s Disease Assistance Center who were evaluated for cognitive impairment were included in the study. The sample consisted of 98 people who were evaluated on their 3rd visit (mean1⁄4243 days) and 85 people evaluated at their 4th visit (mean1⁄4366 days). Mean age was 77.6 years; 77% was female; 69% were Black, 14% were White, and 13% were Latino. The outcome measure of interest was the change in MMSE score from intake to the 3rd or 4th follow up visits. The diagnoses included in the study were Dementia, Alzheimer’s type, Vascular dementia, Mixed dementia and other diagnoses. Based on preliminary analyses and a literature review, 9 predictors of outcome were identified: age, gender, Black race, general medical condition, hypertension, nighttime behavioral disturbance, receiving a cognitive enhancer, receiving an antipsychotic medication, and MMSE score at evaluation. Results: 72.9% of the clinic population were diagnosed with Dementia, Alzheimer’s type, 9.6% with Vascular dementia, 6.5% with Mixed Dementia and 11% had other diagnoses. 38% and 32% of patients had an “improved” MMSE score of 3 or more points at the 3rd and 4th visits, respectively. Variables included in the linear regression analysis of the third visit included age, gender, Black race, General Medical Health rating, history of hypertension, receiving a cognitive enhancer at the third visit, receiving an antipsychotic at the third visit and initial MMSE. Black race (t1⁄42.822, p1⁄4.007), lack of hypertension (t1⁄4-2.180, p1⁄4.034), lower MMSE score at intake (t1⁄4-2.732, p1⁄4.008) were significantly associated with improvement in MMSE score at the 3rd visit. Variables included in the linear regression analysis of the fourth visit included age, gender, Black race, General Medical Health rating, history of hypertension, receiving a cognitive enhancer at the fourth visit, receiving an antipsychotic at the fourth visit and initial MMSE. Only the MMSE at intake (t1⁄4-4.113, p1⁄4.000) was significantly associated with improvement in MMSE at the fourth visit. Conclusions: Contrary to expectations, this naturalistic study found that nearly two-fifths and one-third of dementia patients were improved at approximately 8 months and 12 months after follow-up, respectively. Black race was associated with improved MMSE score at the 3rd visit consistent with past literature that suggests Black patients may have a more variable course of cognitive decline. The effect of Black race may also explain the high percentage of patients with improved cognition in our population. In addition normal or lower blood pressure was associated with improvement in MMSE at the third visit perhaps highlighting the role of blood pressure control in preventing progression of cognitive impairment. These findings suggest, in an outpatient setting, patients with cognitive complaints may have better outcomes in terms of cognition than previously thought.

Neuropsychiatric Symptoms as Risk Factors for Progression From CIND to Dementia: The Cache County Study

To examine the association of neuropsychiatric symptom (NPS) severity with risk of transition to all-cause dementia, Alzheimer disease (AD), and vascular dementia (VaD). Survival analysis of time to dementia, AD, or VaD onset. Population-based study. 230 participants diagnosed with cognitive impairment, no dementia (CIND) from the Cache County Study of Memory Health and Aging were followed for a mean of 3.3 years. The Neuropsychiatric Inventory (NPI) was used to quantify the presence, frequency, and severity of NPS. Chi-squared statistics, t-tests, and Cox proportional hazard ratios were used to assess associations. The conversion rate from CIND to all-cause dementia was 12% per year, with risk factors including an APOE ε4 allele, lower Mini-Mental State Examination, lower 3MS, and higher CDR sum-of-boxes. The presence of at least one NPS was a risk factor for all-cause dementia, as was the presence of NPS with mild severity. Nighttime behaviors were a risk factor for all-cause dementia and of AD, whereas hallucinations were a risk factor for VaD. These data confirm that NPS are risk factors for conversion from CIND to dementia. Of special interest is that even NPS of mild severity are a risk for all-cause dementia or AD.

Abstract WMP119: Comparisons of Neurobehavioral Dysfunction in Small-vessel and Large-vessel Vascular Dementia

Background: Behavioral and psychological symptoms may be the presenting manifestations of dementia syndrome, appearing before cognitive alterations and heralding the onset of the dementia. Behavioral and psychological symptoms in vascular dementia (VaD) are rarely reported. We investigated the prevalence and related factors of behavioral and psychological symptoms in VaD and compared the severity and relative frequency of symptoms between small-vessel VaD and large-vessel VaD. Methods: Behavioral and psychological symptoms of 67 patients in VaD were determined using the Korean version of neuropsychological inventory (K-NPI). The following parameters were recorded and analyzed: education level, dementia duration, Korean version of Mini-mental Status Examination (K-MMSE), clinical dementia rating (CDR), global deterioration scale (GDS), Barthel index (BI), instrumental activity of daily living (IADL) and geriatric depression scale. Results: Based on MRI, patients were classified as having small-vessel and large-vessel VaD. The study group was composed of 27 large-vessel and 40 small-vessel disease. No differences were found between small-vessel and large-vessel VaD in the severity of cognition and ADL, use of psychotrophic medication and risk factors for stroke. Apathy was most prevalent (60%), followed by depression (43%), anxiety (37%), aberrant motor (34%), irritability (33%), night-time behavior (30%), agitation (28%) and disinhibition (28%) in VaD. Apathy was more common in small-vessel VaD than large-vessel VaD (P=0.011). Total K-NPI score was correlated with severity of deep white matter changes, CDR, GDS, BI and IADL. Multiple regression analysis revealed that total K-NPI score and prevalence of individual K-NPI sub-items were independently associated with number of microbleeds, severity of white matter changes, GDS and diabetes mellitus. Conclusions: Behavioral and psychological symptoms are relatively common in VaD. Patients with small-vessel and large-vessel VaD reveal different profiles of neurobehavioral symptoms. Apathy are more common in small-vessel VaD, reflecting disruption of white matter tracts.

The profile of behavioral and psychological symptoms in vascular cognitive impairment with and without dementia

Objective:The objective of this study was to compare the occurrence and severity of behavioral and psychological symptoms of dementia (BPSD) between vascular dementia (VaD) and vascular cognitive impairment-no dementia (VCI-ND).Materials and Methods:Consecutive patients presenting with cognitive impairment at least 3 months after an ischemic stroke and with a Hachinski Ischemic Score ≥4 were included. VaD was diagnosed as per National Institute of Neurological Disorders and Stroke – Association Internationale pour la Recherche et l’Enseignement en Neurosciences criteria for probable VaD and VCI-ND on the lines of the Canadian study of health and aging. The severity of cognitive impairment and the behavioral/psychological symptoms were studied by means of the clinical dementia rating scale and the neuropsychiatric inventory (NPI) respectively.Results:All patients with VaD and 89% of those with VCI-ND had at least one BPSD. The mean no. of symptoms per patient and the total NPI scores were higher in VaD than in VCI-ND. Apathy and night-time behavior disturbances were significantly more common and severe in VaD.Conclusions:BPSD are very common both in VCI-ND and in VaD. The profile of BPSD is similar in both groups, albeit more severe in VaD. The net burden of BPSD is higher in VaD as compared to VCI-ND.

Swaddling: Maternal Option and Sleep Behaviour in Two-month-old Infants

This study aimed to assess possible association between swaddling and sleep behaviour in two-month-old infants. It comprised 198 apparently healthy infants from the community setting selected by chance (86 boys, 112 girls), aged two months, who were singletons born in St Petersburg in 2007. The mothers were asked to complete the questionnaires addressing infant, maternal, and demographic major characteristics with particular emphasis on maternal swaddling practice and infant sleep routine. As part of the interview, the mothers were asked to describe possible sleep disturbances in infants in five major sleep domains: bedtime problems, excessive daytime sleepiness, awakenings, regularity and duration of sleep and snoring. Of 198 infants, 120 babies (60.6%) were never swaddled at night-time, 35 (17.7%) were swaddled occasionally and 43 (21.7%) were swaddled regularly. No significant associations were found between regular swaddling and infant–parent(s) room and bed sharing, type of mattress used and preferred position in which the infant was habitually put to sleep. There was no association between swaddling and habitual position in which the baby was usually found awake and maternal reports on infant sleep disturbances. In conclusion, no convincing evidence was found on any beneficial effect of swaddling in terms of modifying baby's night-time sleep behaviour and sleep routine that might have been potentially protective against sudden infant death syndrome.

Behavioral and Psychological Symptoms of Dementia: Factor Analysis and Relationship with Cognitive Impairment

Background/Aims: Behavioral and psychological symptoms of dementia (BPSD) affect almost all people with dementia at some stage during the progression of disease. The current study aimed at replicating previous findings on BPSD clustering in behavioral sub-syndromes. Methods: One hundred and sixty-six consecutive outpatients with dementia attending a dementia outpatient clinic were enrolled and evaluated with the Neuropsychiatric Inventory and the Mini Mental State Examination. Results: BPSD were reported in 157 patients included in the final sample: 140 patients (89.17%) had Alzheimer’s disease (AD), while 17 patients had frontotemporal dementia or vascular dementia. The most frequent BPSD were depression in the whole sample and irritability in the AD subgroup. The severity of cognitive impairment was predicted by two BPSD in the whole sample (apathy and motor disturbance) and only by nighttime behavior in the AD subgroup. Factor analyses identified 4 factors, accounting for about 60% of variance in the whole group and in the AD subgroup of patients. Conclusions: The current study confirmed findings of previous studies on BPSD clustering, regarding the number of BPSD clusters and the total variance explained. This study has some limitations, including the small number of non-ADs and its monocentric character.

Evaluation of a behavioral treatment package to reduce sleep problems in children with Angelman Syndrome

The purpose of this investigation was to evaluate the effectiveness of a behavioral treatment package to reduce chronic sleep problems in children with Angelman Syndrome. Participants were five children, 2-11 years-of-age. Parents maintained sleep diaries to record sleep and disruptive nighttime behaviors. Actigraphy was added to provide independent evaluations of sleep-wake activity. The treatment package targeted the sleep environment, the sleep-wake schedule, and parent-child interactions during sleep times. Treatment was introduced sequentially, across families, and evaluated in an interrupted time series, multiple baseline design. Data show that prior to treatment, baseline rates of nighttime disruptive behavior were stable or increasing and none of the participants were falling to sleep independently. With the introduction of treatment, all participants quickly learned to initiate sleep independently. Gradual reductions were reported in disruptive behaviors and these improvements were sustained over time. Results were replicated with two participants when treatment was withdrawn and reinstated. Changes in disruptive bedtime behaviors and in sleep onset were found to be statistically significant. Parents indicated high satisfaction with the treatment. A behavioral treatment package was found to be effective with five children with long histories of significant sleep-related behavior problems. These results suggest that behavioral treatment may be a reasonable way to address sleep problems in some children with Angelman Syndrome.

P4‐325: Ketones enhance mitochondrial function and reverse synaptic deficits in hippocampal slices from triple transgenic ALZHEIMER'S DISEASE mice

Background: Neuropsychiatric symptoms (NPS) in AD may reflect dysfunction in frontal areas. In patients with NPS, anterior cingulate Myo-inositol elevations correlated with NPS severity (Shinno et al., 2007). ELND005, an amyloid anti-aggregation agent, demonstrated pathological and cognitive benefits in preclinical models. In Study AD201 (Salloway et al. 2011), ELND005 treatment led to dose-dependent reductions in brain Myo-inositol, and to reduced emergence of NPS (Tariot et al. Neurology 2012). Methods: Study AD201 evaluated 3 ELND005 doses (250mg, 1000mg and 2000mg, all BID) versus placebo in 351 patients. Brain Scyllo-inositol and Myo-inositol were assessed by magnetic resonance spectroscopy (MRS, n1⁄4104): percent changes from baseline (PCBLs) were calculated from observedMRS data. Across the four treatment groups, four quartiles of PCBL in Scyllo-inositol andMyo-inositol brain levels were plotted against the emergence probability of individual NPS. Logistic regression models were estimated to quantify the effect of exposure to 250mg of ELND005 compared to placebo.Results:Of 12 NPS, depression, anxiety, apathy, and irritability exhibited a V-shaped pattern with lowest probability of emergence mostly at 2 nd quartile of brain Scyllo-inositol AUC 0-24 hr, corresponding to the 250V‘mg dose. Plots of NPS emergence versus Myo-inositol PCBL showed a similar V-shaped pattern for depression, anxiety, apathy with Myo-inositol PCBL of 30%50%, also correspondng to the 250mg ELND005 dose. Logistic regressions revealed trends (p< 0.1) at various visits for decreased emergence of agitation, depression, anxiety, disinhibition, and nighttime behavior. At some visits, trends further reached significance (p< 0.05) for agitation, depression, and nighttime behavior. Conclusions: Decreased emergence of affective NPS was associated with specific ScylloandMyo-inositol changes in brain assessed by MRS. The neuropsychiatric effects of ELND005 may be partly mediated by brain Myo-inositol regulation.

Prevalence of Neuropsychiatric Symptoms in CIND and Its Subtypes: The Cache County Study

1) To report rates of neuropsychiatric symptoms (NPS) in cognitive impairment, no dementia (CIND). 2) To compare the 30-day prevalence of NPS in CIND with that in dementia and cognitively normal individuals. 3) To compare the prevalence of NPS in amnestic MCI (aMCI) with other predementia syndromes. Comparison of prevalence proportions among several defined groups. Population-based study. A subsample of the permanent residents of Cache County, Utah, aged 65 years or older in January 1995 (N = 5092) and who had completed clinical assessments and had an informant-completed Neuropsychiatric Inventory. Chi-square statistics, tests for trend, and logistic regression models were used to analyze the three objectives listed earlier. The most prevalent NPS in those with CIND were depression (16.9%), irritability (9.8%), nighttime behaviors (7.6%), apathy (6.9%), and anxiety (5.4%). Trend analyses confirmed that the CIND group had NPS prevalence rates that fell between the normal and dementia groups for most NPS. Logistic regression models showed no significant difference between aMCI and other CIND participants in the prevalence of any NPS (lowest p: 0.316). These data confirm the relatively high prevalence of NPS in CIND reported by other studies, especially for affective symptoms. No differences in NPS prevalence were found between aMCI and other types of CIND.