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P OSTER
A BSTRACTS
antigen >1:32. Early diagnosis and appropriate management is crucial
to reduce the high morbidity and mortality with CNS cryptococcosis.
C32
WEIGHT LOSS ASSOCIATED WITH SWITCHING
CHOLINESTERASE INHIBITORS.
J. T. Stewart, 1,4 I. Sheyner, 2,5 L. V. George, 3 K. M. Mattox, 3
K. T. Stover. 2 1. Psychiatry, James A Haley VA Hospital, Tampa, FL; 2.
Geriatrics, James A Haley VA Hospital, Tampa, FL; 3. Pharmacy,
James A Haley VA Hospital, Tampa, FL; 4. Psychiatry, University of
South Florida College of Medicine, Tampa, FL; 5. Geriatric Medicine,
University of South Florida College of Medicine, Tampa, FL.
Supported By: There was no funding or other support for this work.
BACKGROUND: Weight loss is common in dementia, leading
to poor quality of life and increased mortality. Weight loss is reported
in up to 20% of patients receiving cholinesterase inhibitors. It is not
known which of these agents are more likely to cause weight loss, nor
whether patients who have lost weight on one agent can be treated
with another.
METHODS: Case report, literature review.
RESULTS: An 86 year old man with vascular dementia had
been treated with donepezil for six years; he had improved cognitively
and had never experienced any nausea, anorexia or weight loss.
Galantamine SR was substituted in 2010. Over the next 17 months he
and his daughter reported poor appetite and a loss of 48 pounds.
There was no nausea or vomiting. Ultimately donepezil was reinstated.
His appetite returned and he regained 30 pounds over the
next three months (Figure).
CONCLUSIONS: Cholinesterase inhibitors have modest benefits
in dementia but are not without risk. Weight loss in dementia can
have catastrophic effects on health and quality of life and a reasoned
risk-benefit analysis is essential in all prescribing. The literature does
not guide the clinician when a patient has clear benefit from a
cholinesterase inhibitor but also develops significant weight loss. This
case suggests that weight loss from one agent does not necessarily
predict weight loss from other agents in the class and that switching
to a different agent may be a reasonable strategy. It is not known
whether galantamine is more likely to cause weight loss than other
agents, nor whether its secondary effect of modulating nicotinic receptors
is salient; controlled studies will be necessary to examine
these questions.
C33
A PILOT RANDOMIZED TRIAL OF A BEHAVIORAL SLOW-
BREATHING INTERVENTION TO TREAT URGENCY
INCONTINENCE IN WOMEN.
A. Huang, D. Grady, A. Appa, S. Leslee. University of California, San
Francisco, CA.
Supported By: National Institutes of Health
Background: Urgency urinary incontinence affects up to a quarter
of middle-aged and older women and can have profound adverse
effects on functioning and quality of life. Existing anti-cholinergic
treatments for incontinence are associated with frequent side effects
and high rates of discontinuation in the community. Multiple studies
have indicated that urgency incontinence is associated with increased
levels of perceived stress as well as abnormalities in autonomic nervous
system activity, suggesting that behavioral relaxation interventions
that reduce stress and improve autonomic balance may be helpful
in alleviating this condition.
Methods: Pilot feasibility randomized trial in 20 ambulatory
women with ≥7 episodes of urgency incontinence per week and no
major urologic or neurologic co-morbidities. Women were randomized
to use a portable guided-breathing device (RESPeRATE) to
slow their breathing to