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IPA Congress.2003,D) The proportion of elderly in total population in Turkey is rapidly growing. >60 y: 1990: 7,1% 2003: 10,8% >65 y: 1990: 4,3% 2003: 8% OECD Projection 7,7% in 2020 M" M    e ]P:Behavioral and Psychological Symptoms of Alzheimer Disease;;$  gBehavioral -Agression, hostility, agitation: 60% -Apathy: 70% -Wandering and other motor behavior: 30%-40% Psychological -Depression: 20%-50% -Anxiety: 40%-50% -Hallucinations or delusions: 10%-20% Mega Ms et al. Neurology. 1996;46:130-135; Rubin EH etal. J Geriatr Psychiatry Neurol. 1988;1:16-20; Tariot PN et al. Am J Psychiatry. 1993;150:1063-1069.` ZcZZZ              i[Why are BPSD Important$N Diminish patient quality of life Increase caregiver distress: decrease caregiver quality of life( most of the caregivers may have depressive symptoms) Increase cost of care Precipitate nursing home placement 6d    +  j\1Behavioral Precipitants of Nursing-Home Admission22$   P Physical aggression 16% Restlessness 13% Verbal outbursts, nonaggressive 13% Verbal outbursts, aggressive 9% Wandering 9% Pacing 3% Other 19% Behaviors that are unlikely to respond to pharmacotherapy: wandering, pacing, screaming, hypersexuality Cohen-Mansfield J 2001; Cohen-Mansfield J. J 1995>QZb3             ?7HThe Reasons of Prevalence and Presentation of BPSD in Different CulturesII      Culturally related factors " The concepts of dementia and behavioural disturbances in society (The typical features of dementia are widely recognized and named  Chinnan (literally childishness) in Kerala (Shaji et al. 2003) " The tolerance of symptoms in dementia " Not always possible direct observation of the patient by clinician No cultural appropriateness of rating scales Availabity of primary and secondary care services for demented patients with BPS A "ZZZZZf&  &+&  f ~       ?k]%Beds for Demented Patients in Turkey&& hE10% of the beds in all old age homes run by the Health Ministry and Municipalities are spared for demented and physically debilated patients These patients are separated from the rest of the building Some voluntary groups are engaged in looking after these patients The staff working in these parts of old age is well trainedFZFE l^;Services for Elderly People With Acute Psychiatric Problems<<  NThere are three specialist geropsychiatric unit in Istanbul The first geropsychiatric unit was organized in Cerrahpa_a Medical School,Istanbul University in 1993 The elderly with psychiatric problems are mostly placed in general psychiatry departments and are treated by general psychiatrists (Z(/6      m_:Older People and the Informal Health Care System in Turkey;;  In Turkey, families, friends and neighbours are extensively involved in the care of older people Demented patients are cared for mostly by their spouses,eldest daughters ,or daughter in-law Families approach instutional care as a last resort (Eker,1995) The Directoriate of Social Work and Care has developed a project recently  taking care of the elderly at home bpZZfJ%f> # '    70-BPSD in Turkish AD (Eker; Ertan; Engin, 2003)..$@  SAMPLE : 213 probable and possible AD cases EVALUATION: DSM-IV (APA, 1994) The Turkish vers. MMSE (Gngen, Ertan, Eker, 1998) GDS (Reisberg et al. 1982) Behave-AD (Reisberg et al. 1987) Neuroimagine technics (CT, MRI) Genetic studies (Apo E4) `fffXf) +$ && #81_Age, Gender, Educational Level, Total BEHAVE-AD Score, the MMSE Turkish Score (in 213 AD Cases)``     Age, years 74,018(45-95) Female, % 68.5 Education, years 7.6 5(0-17) Disease duration 4.3 3(1-20) The MMSE score 15.6 7(0-30) Behave-AD score l0.8 9 (0-47) Patients with symptoms 91.9% Pbf&2  && & $$(&(*,,,,z    A8TRESULTS (II) Stage Specific Mean BAHAVE-AD in Turkish AD patients Subcategory ScoresUU   Stage 3(n:24) Stage 4(n:50) Stage 5(n:74) Stage 6(n:56) Paranoid or delusional ideat 0.75 2(0-10) 1.6 1.5(0-7) 1.8 1.9(0-7) 4.4 3.5(0-15) Hallucinations 0.036 0.2(0-1) 0.6 1.3(0-5) 0.7 1.3(0-5) 1.9 2.6(0-13) Activity disturbances 0.42 0.9(0-3) 1.6 1.8(0-8) 1.7 1.8(0-7) 3.7 2.8(0-9) Aggressiveness 0.53 1.3(0-6) 1.4 2(0-7) 1. 1.7(0-9) 2.5 3(0-9) Diurnal rhythm disturbances 0.43 0.9(0-3) 0.6 1(0-3) 0.4 0.9(0-3) 1.3 1.4(0-3) Affective Disturbances 0.53 0.9(0-3) 1.2 1.73(0-5) 0.8 1.29(0-6) 1.5 1.57(0-6) Anxieties and Phobias 0.75 0.9(0-3) 1.8 2.26(0-8) 2.08 2.1(0-6 2.7 2.6(0-11)Zbf_&  && & "$$(&(,,0&0448&8 <<&,&  && & !$$(&(,,0&0448&8<<&/&  && & *$$(&(,,0&0448&8<<&3&  && &  $$     A?B?C @ @B9MStage specific severity of each Behave AD subcategory in Turkish AD patiensNN   92JRESULTS (III) Most Frequent Symptoms in Turkish AD Patients (in 213 cases)KK   % n Purposeless activity 49.3 (105)  People are stealing things delusion 44.6 (95) Wandering 42.7 (91) Fear of being left alone 40.8 (87) Tearfulness 40.4 (86) Inappropriate activity 38.5 (82) Depressed mood: other 37.6 (80) Anxiety regarding upcoming events 36.6 (78) Verbal outbursts 36.2 (77) Day/night disturbances 33.8 (72) Visual halucinations 26.3 (56)\Zb%m                    teThe 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.HZZ Z@!Z ufThe 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.> :! vgThe 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.*  rcDelusions in Turkish Patients with AD :Could Analysing Specific Delusions be More Helpful ErtanT, Eker E, Engin F et al.2005(I) $, l   Aim: To analyse factors associated with presence of delusions to find out whether in individual analysis of delusions in the same group would be more informative Method :n:185 AD patiens(DSM-IV) MMSE, GDS,Behave-AD Dependent variable :one of the delusions Independent variables: gender,age, education,disease duration,GDS stage ,and presence of each type hallucination,and remaining types of delusions Logistic regression analysis was usedZP5P"#   %5   %sdDelusions in Turkish Patients with AD:Could Analysing Specific Delusions be More helpful (Ertan T,Eker E,Engin F.et al 2005)(II)&  $  ' Z # ! Result and Conclusions: None of the delusions was associated with age ,duration of disease ,and education Female gender was associated with only one delusion (delusions of theft) Disease stage(GDS :Stage 6) was associated with two delusions(delusion of home is not home and delusion of infidelity( negative association) Delusions of theft were also independently predicted by delusions imposter and visual hallucinationB% L!& B  !   V<5Conclusions (I)$ P 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 systemRQZf&R  '   0    #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 psychiatristsZl$    c    gYConclusions (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           0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>>  (    6D$   `}   v>As1l ba_l1k stili iin t1klat1n    0   `   As1l metin stillerini dzenlemek iin t1klat1n 0kinci dzey nc dzey Drdnc dzey Be_inci dzey/  f  00  ^ `   r*$b  0\  ^    t*&b  0  ^ `   t*&bB  s *33޽h ? 3380___PPT10.7D5, $Varsay1lan Tasar1m 0 ~v(    02`  P     r*$b    0\:`     `  t*&b  d  c $ ?  `   0=`   0 `  As1l metin stillerini dzenlemek iin t1klat1n 0kinci dzey nc dzey Drdnc dzey Be_inci dzey/  f  6dB`  _P  `  r*$b    6X`  _  `  t*&b  H  0޽h ? 3380___PPT10.pI  xp` (      0@Q  P     r*$b     0       t*&b     6(y  `P    r*$b     6XUy  `    t*&b  H   0޽h ? ̙3380___PPT10.ͳl  0 0<(  ~  s *  `}   ~  s *p5 P   H  0޽h ? ̙33y___PPT10Y+D='  = @B +$  0 @pd(  px p c $`  `}  `   p0  `A ?  `  ` H p 0޽h ? 33  0 Pt0(  tx t c $h+`  `}  `  x t c $`  ` `  H t 0޽h ? 33D  0 px(  xx x c $ `  `}  `  x x c $Я`  ` `  LB x c $DH x 0޽h ? 33  0 0(  x  c $`  `}  `  x  c $`  ` `  H  0޽h ? 33D  0 (  x  c $`  `}  `  x  c $`  ` `  LB  c $DH  0޽h ? 33  0 <(  ~  s *  `}   ~  s *. %   H  0޽h ? ̙33y___PPT10Y+D='  = @B +  0 0(  x  c $.`  `}  `  x  c $/`  ` `  H  0޽h ? 33  0 0(  x  c $,`  `}  `  x  c $X`  ` `  H  0޽h ? 33  0 0(  x  c $`  `}  `  x  c $`  ` `  H  0޽h ? 33  0 0<(  ~  s *hX  `}  X  ~  s **X  ` X  H  0޽h ? ̙33  0 @<(  ~  s *|M  `}  M  ~  s *M  ` M  H  0޽h ? ̙33  0 P<(  ~  s *8M  `}  M  ~  s * M  ` M  H  0޽h ? ̙33$  0 `d(  ~  s *M  `}  M   0 ZA ?  @C  M H  0޽h ? ̙33  0 p<(  ~  s *` M  `}  M  ~  s *8!M  ` M  H  0޽h ? ̙33$  0 $(  r  S psM  `}  M  r  S 4tM  ` M  H  0޽h ? 3380___PPT10.Cp2$  0 $(  r  S M  `}  M  r  S M  ` M  H  0޽h ? 3380___PPT10.C$  0 $(  r  S M  `}  M  r  S ĂM  ` M  H  0޽h ? 3380___PPT10.D K  0 $(  r  S fM    M  r  S dgM  M  H  0޽h ? 33  0 $(  r  S xn  `}   r  S   `   H  0޽h ? 33  0 <(  ~  s *.X  `}   ~  s *aX  ` X  H  0޽h ? ̙33  0 <(  ~  s *|r  `}   ~  s *  `   H  0޽h ? ̙33  0 0(  x  c $s  `}   x  c $Xt  `   H  0޽h ? 33Rx\}lTWv?؞105^'|y 6)۱ c!I6l 1@B`6JdEHP%+!IiS)Q(iVI@"l҆sy8nYss=?ԫ>&uX-bDawkllL)N]4a:Tf!q$^oO?Qbf+ R߸lW%91W}HS8O?/wۏ0=<OLXM@c˥ #(@@դ;S8Cb !1A44 <ZBPMPh-Psګ*n>%_ ֿ`l__νyxjk܋)3t>Z |@Ao@+HfVh5h h-:н{VPt? 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"System=-@"Arial-.  2 eand.-@"Arial-. 2  Psychological.-@"Arial-. 2 TSymptoms  .-@"Arial-.  2 of .-@"Arial-. 2 #Dementia .-@"Arial-.  2 Rin .-@"Arial-. 2 ^Turkey.-@"Arial-. 2 26Engin EKER, MD.-@"Arial-. 2 : Istanbul.-@"Arial-. 2 :% University.-@"Arial-. 2 :B , Cerrahpa.-@"Arial-.  2 :as .-@"Arial-.  2 :da .-@"Arial-. 2 :iMedicall.-@"Arial-. 2 :School.-@"Arial-.  2 C(Dept.-@"Arial-. 2 C5. of l.-@"Arial-. 2 CA Geriatric.-@"Arial-. 2 C\ Psychiatry.-@"Arial-. 2 K/eneker.-@"Arial-.  2 KB@ .-@"Arial-. 2 KHistanbul.-@"Arial-.  2 Ka. .-@"Arial-.  2 Kcedu.-@"Arial-.  2 Kn. .-@"Arial-.  2 Kptr.--K/Kt-@"Arial-. $2 SRegional Symposium .-@"Arial-.  2 SNon .-@"Arial-. 2 SX Alzheimer.-@"Arial-.  2 Su .-@"Arial-. 2 Sw s Disease .-@"Arial-. 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IPA Congress.2003;Behavioral and Psychological Symptoms of Alzheimer DiseaseWhy are BPSD Important2Behavioral Precipitants of Nursing-Home AdmissionIThe Reasons of Prevalence and Presentation of BPSD in Different Cultures&Beds for Demented Patients in Turkey<Services for Elderly People With Acute Psychiatric Problems;Older People and the Informal Health Care System in Turkey.BPSD in Turkish AD (Eker; Ertan; Engin, 2003)`Age, Gender, Educational Level, Total BEHAVE-AD Score, the MMSE Turkish Score (in 213 AD Cases)URESULTS (II) Stage Specific Mean BAHAVE-AD in Turkish AD patients Subcategory ScoresNStage specific severity of each Behave AD subcategory in Turkish AD patiensKRESULTS (III) Most Frequent Symptoms in Turkish AD Patients (in 213 cases)The 10/66 Dementia Group: Behavioral and Psychologiacal Symptom of Dementia in developing Countries (Int. Psychogeratrics 2004)The 10/66 Dementia Group: Behavioral and Psychologiacal Symptom of Dementia in developing Countries (Int. Psychogeratrics 2004)The 10/66 Dementia Group: Behavioral and Psychologiacal Symptom of Dementia in developing Countries (Int. Psychogeratrics 2004)Delusions in Turkish Patients with AD :Could Analysing Specific Delusions be More Helpful ErtanT, Eker E, Engin F et al.2005(I)Delusions in Turkish Patients with AD:Could Analysing Specific Delusions be More helpful (Ertan T,Eker E,Engin F.et al 2005)(II)Conclusions (I)Conclusions (II)Conclusions (III)  Fonts UsedDesign TemplateEmbedded OLE Servers Slide Titles 8@ _PID_HLINKSAtmailto:eneker@istanbul.edu.tr(_0nico stanculescunico stanculescu  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|~Root EntrydO)PicturesCurrent UserSummaryInformation(}`PowerPoint Document( DocumentSummaryInformation8