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ERP analysis of patients with mild cognitive impairment
S326 for the identification of AD was 69/70, which had a sensitivity of 92% and a specificity of 85%. Conclusion: The K-ACE is a short, reliable, and valid neuropsychological test battery to screen dementia in the Korean elderly. P37-14 Effect of music therapy on hear rate variability in elderly patients with Alzheimer type dementia F. Segawa1 Faculty of Health & Social Services, Kanagawa University of Human Services, Kanagawa, Japan
1
Background: Music therapy is currently used to promote physiologic and psychological well being in various disease and conditions. In order to clarify the effect of music therapy for the elderly patients with dementia, we investigated the patients using spectral analysis of heart rate variability. With the power spectral analysis, the high-frequency component (HF power) mainly reflects parasympathetic activity, whereas the low-frequency component/high-frequency component ratio (LF/HF ratio) reflects sympathetic activity and sympathovagal balance. Music therapy includes a various type of approach and a various type of music were tried to use. We also compared the difference of the effect between the familiar song, unfamiliar song, and acoustic sound with gong. Method: ECG, heart rate variability before and during the music therapy was measured in 12 patients with Alzheimer type dementia (mean age, 79.4±6.9 years). Music therapy was administered by three licensed music therapists. Various songs and sounds were tried to use during the music therapy. Result: In the analysis of heart rate variability, significant changes were observed in the mean heart rate, HF power, and LF/HF ratio during the music therapy. When listening to the acoustic sounds with closing eye, HF power increased and LF/HF ratio decreased much more than. These effects to hear rate variability continued even after the music therapy. Mean heart rate and respiratory rate also reduce after music therapy. Conclusion: It is suggested that the music therapy could increase parasympathetic tone and reduce sympathetic tone even in the elderly patients with dementia. There was a difference of effect between the sounds and songs. If we select individually the appropriate approach and sounds in music therapy monitoring heart rate variability, much more effect will be expected. The music therapy is useful for alleviated anxiety, increasing comfort and facilitating relaxation for elderly patients with dementia. P37-15 Sympathetic skin response and AA-interval spectral analysis to screen Lewy body disease M. Negami1 , T. Maruta2 , H. Kado3 , H. Yoshikawa4 Health Service Centor, Keiju Hospital, Japan, 2 Neurological Center, Kanazawa-Nishi Hospital, Japan, 3 PET-CT Center, Keiju Hospital, Japan, 4 Health Service Center, Kanazawa University, Japan
1
Objective: Recently, acetylcholine esterase inhibitors are used for dementia treatment. Some reports showed side effects of this treatment such as bradycardia or syncope especially in the lewy body diseases (LBD) with autonomic dysfunction. Therefore, it is important to find LBD in cases with dementia for treatment selection. In the 3rd International Symposium of Dementia with Lewy Bodies, they recommended the MIBG cardiac scintigraphy (MIBG) as an examination for autonomous function. However, MIBG has some problems such as use of Radioisotope, inspection time (more than 3 hours) and the high running cost. Here we examined the sympathetic skin response (SSR) and the AA-interval spectral analysis (AISA) as screening method of LBD. Methods: First, MIBG and SSR were examined in 27 cases with dementia; 9 with LBD and 18 with Alzheimer disease (AD). Then, MIBG and AISA were examined in other 13 cases with dementia; 7 with LBD and 6 with AD. Results: In the 1st study, MIBG detected LBD with sensitivity 89% and specificity 73%. On the other hand, SSR detected LBD with sensitivity 89% and specificity 67%. In the 2nd study, MIBG detected LBD with sensitivity 100% and specificity 100%. On the other hand, AISA detected LBD with sensitivity 100% and specificity 87%. Conclusions: The sensitivities of SSR or AISA were almost equal to MIBG and the specificity of MIBG was superior to that of other examinations. From these results, we recommend the SSR or AISA as the 1st examination to screen LBD and MIBG should be performed as the 2nd examination to confirm LBD.
Posters P37-16 Multivariate EEG/ERP analysis of patients with mild cognitive impairment J.V. Partanen1 , K. Palmu1 , S. Jantunen1 , P. Keski-Santti2 , M. Pitkonen1 , S. Liljander1 , A.S. Holm3 , M. Lehtovirta2 , K. Murros2 1 Department of Clinical Neurophysiology, Jorvi Hospital, University Hospital of Helsinki, Finland, 2 Department of Neurology, University Hospital of Helsinki, Jorvi Hospital, Finland, 3 Institute of Work Medicine, Helsinki, Finland Objective: It is important to diagnose patients with incipient organic brain disease among individuals with mild cognitive impairment (MCI). The aim of this study is to develop a multivariate analysis using EEG and ERP paradigms to distinguish probable organic brain diseases from the heterogeneous group of MCI patients. Methods: The study comprised 26 MCI patients and 10 healthy individuals with similar age. A 64-channel Cognitrace equipment was used. Fast Fourier transformation was performed to posterior waking EEG with eyes closed and eyes open. The absolute power of delta, theta, alpha and beta was calculated, as well as the diminution of alpha power with eyes open, compared to that with eyes closed. With scoring of 1 for mild and 2 for distinct alteration the maximum score was 12 per hemisphere. The N100 habituation with four auditory stimuli (interstimulus interval 0.5 s) was considered, as well as the amplitude of the P50 component. The late negativity for a multimodal audiovisual task was measured. The maximum score with ERPs was 4. The total score 0 6 was considered normal, 7 to 10 mild and more than 10 marked suspicion of organic involvement. Results: Of the 26 MCI patients 8 were normal, 12 showed mild and 6 marked abnormality (mean score 7.7). All 10 healthy individuals were in the normal range (mean score 2.4). In the MCI group, early Alzheimer disease was diagnosed in five patients: four showed marked and one mild abnormality (mean score 14.2). The patient group was heterogeneous but it was possible to conjecture the brain functions with distinct abnormalities. Conclusions: With a multivariate EEG/ERP analysis system it is possible to distinguish MCI patients with a probable organic brain dysfunction from those without. The EEG/ERP study is cheap, non-invasive and takes the time of an ordinary EEG recording. P37-17 Comparison of REM sleep behavior disorder and polysomnographic findings between dementia with Lewy bodies and Alzheimer disease T. Nomura1 , Y. Inoue2,3 , Y. Uemura1 , K. Nakashima1 1 Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan, 2 Japan Somnology Center, Neuropsychiatric Research Institute, Japan, 3 Department of Somnology, Tokyo Medical University, Japan Objective: REM sleep behavior disorder (RBD) is strongly correlated with synucleiopathies such as Dementia with Lewy bodies (DLB) and included as supportive issues of diagnostic criteria for DLB. On the other hand, RBD in Alzheimer dementia (AD) has not been reported. We compared RBD symptoms and polysomnographic findings between DLB and AD. Methods: Our subjects were 8 patient with DLB (3 male and 5 female, mean age: 79.8 years old) and 14 patients with AD (5 male and 9 female, mean age:74.5 years old). There was no significant difference of the scores of Mini Mental State Examinations (DLB: 22.4 v.s. AD: 21.9). We interviewed the patients and their bed partners about RBD symptoms including dream enactment behavior or vocalization while dreaming and performed PSG. During REM stage sleep, submental phasic EMG activity (defined as 3-second mini-epochs containing phasic twitches which are at least four times higher than the background EMG activity) or submental tonic EMG activity with durations of more than half of a 30-second epoch were scored as REM sleep without atonia (RWA). We compared clinical background, the existence of RBD symptoms, and the findings of PSG between the two disorders. Results: Group with DLB showed more patients with RWA on PSG than that with AD (DLB: 4 cases, AD: 2 cases) (p = 0.070). Moreover, four patients with DLB were diagnosed as having RBD although no patients with AD were diagnosed as having RBD (p = 0.001). Conclusion: We found a few patients with AD had RWA on PSG. They did not have RBD symptoms. We supposed that RBD was more strongly correlated with DLB than AD.
1
Background: Music therapy is currently used to promote physiologic and psychological well being in various disease and conditions. In order to clarify the effect of music therapy for the elderly patients with dementia, we investigated the patients using spectral analysis of heart rate variability. With the power spectral analysis, the high-frequency component (HF power) mainly reflects parasympathetic activity, whereas the low-frequency component/high-frequency component ratio (LF/HF ratio) reflects sympathetic activity and sympathovagal balance. Music therapy includes a various type of approach and a various type of music were tried to use. We also compared the difference of the effect between the familiar song, unfamiliar song, and acoustic sound with gong. Method: ECG, heart rate variability before and during the music therapy was measured in 12 patients with Alzheimer type dementia (mean age, 79.4±6.9 years). Music therapy was administered by three licensed music therapists. Various songs and sounds were tried to use during the music therapy. Result: In the analysis of heart rate variability, significant changes were observed in the mean heart rate, HF power, and LF/HF ratio during the music therapy. When listening to the acoustic sounds with closing eye, HF power increased and LF/HF ratio decreased much more than. These effects to hear rate variability continued even after the music therapy. Mean heart rate and respiratory rate also reduce after music therapy. Conclusion: It is suggested that the music therapy could increase parasympathetic tone and reduce sympathetic tone even in the elderly patients with dementia. There was a difference of effect between the sounds and songs. If we select individually the appropriate approach and sounds in music therapy monitoring heart rate variability, much more effect will be expected. The music therapy is useful for alleviated anxiety, increasing comfort and facilitating relaxation for elderly patients with dementia. P37-15 Sympathetic skin response and AA-interval spectral analysis to screen Lewy body disease M. Negami1 , T. Maruta2 , H. Kado3 , H. Yoshikawa4 Health Service Centor, Keiju Hospital, Japan, 2 Neurological Center, Kanazawa-Nishi Hospital, Japan, 3 PET-CT Center, Keiju Hospital, Japan, 4 Health Service Center, Kanazawa University, Japan
1
Objective: Recently, acetylcholine esterase inhibitors are used for dementia treatment. Some reports showed side effects of this treatment such as bradycardia or syncope especially in the lewy body diseases (LBD) with autonomic dysfunction. Therefore, it is important to find LBD in cases with dementia for treatment selection. In the 3rd International Symposium of Dementia with Lewy Bodies, they recommended the MIBG cardiac scintigraphy (MIBG) as an examination for autonomous function. However, MIBG has some problems such as use of Radioisotope, inspection time (more than 3 hours) and the high running cost. Here we examined the sympathetic skin response (SSR) and the AA-interval spectral analysis (AISA) as screening method of LBD. Methods: First, MIBG and SSR were examined in 27 cases with dementia; 9 with LBD and 18 with Alzheimer disease (AD). Then, MIBG and AISA were examined in other 13 cases with dementia; 7 with LBD and 6 with AD. Results: In the 1st study, MIBG detected LBD with sensitivity 89% and specificity 73%. On the other hand, SSR detected LBD with sensitivity 89% and specificity 67%. In the 2nd study, MIBG detected LBD with sensitivity 100% and specificity 100%. On the other hand, AISA detected LBD with sensitivity 100% and specificity 87%. Conclusions: The sensitivities of SSR or AISA were almost equal to MIBG and the specificity of MIBG was superior to that of other examinations. From these results, we recommend the SSR or AISA as the 1st examination to screen LBD and MIBG should be performed as the 2nd examination to confirm LBD.
Posters P37-16 Multivariate EEG/ERP analysis of patients with mild cognitive impairment J.V. Partanen1 , K. Palmu1 , S. Jantunen1 , P. Keski-Santti2 , M. Pitkonen1 , S. Liljander1 , A.S. Holm3 , M. Lehtovirta2 , K. Murros2 1 Department of Clinical Neurophysiology, Jorvi Hospital, University Hospital of Helsinki, Finland, 2 Department of Neurology, University Hospital of Helsinki, Jorvi Hospital, Finland, 3 Institute of Work Medicine, Helsinki, Finland Objective: It is important to diagnose patients with incipient organic brain disease among individuals with mild cognitive impairment (MCI). The aim of this study is to develop a multivariate analysis using EEG and ERP paradigms to distinguish probable organic brain diseases from the heterogeneous group of MCI patients. Methods: The study comprised 26 MCI patients and 10 healthy individuals with similar age. A 64-channel Cognitrace equipment was used. Fast Fourier transformation was performed to posterior waking EEG with eyes closed and eyes open. The absolute power of delta, theta, alpha and beta was calculated, as well as the diminution of alpha power with eyes open, compared to that with eyes closed. With scoring of 1 for mild and 2 for distinct alteration the maximum score was 12 per hemisphere. The N100 habituation with four auditory stimuli (interstimulus interval 0.5 s) was considered, as well as the amplitude of the P50 component. The late negativity for a multimodal audiovisual task was measured. The maximum score with ERPs was 4. The total score 0 6 was considered normal, 7 to 10 mild and more than 10 marked suspicion of organic involvement. Results: Of the 26 MCI patients 8 were normal, 12 showed mild and 6 marked abnormality (mean score 7.7). All 10 healthy individuals were in the normal range (mean score 2.4). In the MCI group, early Alzheimer disease was diagnosed in five patients: four showed marked and one mild abnormality (mean score 14.2). The patient group was heterogeneous but it was possible to conjecture the brain functions with distinct abnormalities. Conclusions: With a multivariate EEG/ERP analysis system it is possible to distinguish MCI patients with a probable organic brain dysfunction from those without. The EEG/ERP study is cheap, non-invasive and takes the time of an ordinary EEG recording. P37-17 Comparison of REM sleep behavior disorder and polysomnographic findings between dementia with Lewy bodies and Alzheimer disease T. Nomura1 , Y. Inoue2,3 , Y. Uemura1 , K. Nakashima1 1 Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan, 2 Japan Somnology Center, Neuropsychiatric Research Institute, Japan, 3 Department of Somnology, Tokyo Medical University, Japan Objective: REM sleep behavior disorder (RBD) is strongly correlated with synucleiopathies such as Dementia with Lewy bodies (DLB) and included as supportive issues of diagnostic criteria for DLB. On the other hand, RBD in Alzheimer dementia (AD) has not been reported. We compared RBD symptoms and polysomnographic findings between DLB and AD. Methods: Our subjects were 8 patient with DLB (3 male and 5 female, mean age: 79.8 years old) and 14 patients with AD (5 male and 9 female, mean age:74.5 years old). There was no significant difference of the scores of Mini Mental State Examinations (DLB: 22.4 v.s. AD: 21.9). We interviewed the patients and their bed partners about RBD symptoms including dream enactment behavior or vocalization while dreaming and performed PSG. During REM stage sleep, submental phasic EMG activity (defined as 3-second mini-epochs containing phasic twitches which are at least four times higher than the background EMG activity) or submental tonic EMG activity with durations of more than half of a 30-second epoch were scored as REM sleep without atonia (RWA). We compared clinical background, the existence of RBD symptoms, and the findings of PSG between the two disorders. Results: Group with DLB showed more patients with RWA on PSG than that with AD (DLB: 4 cases, AD: 2 cases) (p = 0.070). Moreover, four patients with DLB were diagnosed as having RBD although no patients with AD were diagnosed as having RBD (p = 0.001). Conclusion: We found a few patients with AD had RWA on PSG. They did not have RBD symptoms. We supposed that RBD was more strongly correlated with DLB than AD.