0729 Alzheimer disease, object naming, and “nuisance” variables

Poster Abstracts Background: EUROTEST is a brief, easy, useful and valid tool for the detection of Cognitive Impairment (CI) and Dementia. It can be applied to illiterate people and it is not influenciable by socioeducational factors. Objective: To evaluate EUROTEST test-retest reliability (Rt_,) and interobserver reliability (R d. Method: To analyze EUROTEST Rt-r one single investigator evaluated a sample of 29 subjects without CI twice with an interval period of 1-3 months. To analyze EUROTEST R~ 15 independent investigators evaluated in a blinded fashion video tape recordered examinations taken from another sample of 10 patients. Rt¢ and Ri of the distraction tool employed in the EUROTEST, namely the Verbal Fluency Test (VFT), were also calculated. Results: Both samples had similar sociodemographic characteristics and they did not differ from a previous sample used for the EUROTEST validation. EUROTEST Rt¢ was 0.94 (10.87-0.97) and its R~ 0.92 (10.84-0.97); VFT Rt~ was 0.51 (10.19-0.74) and its R~ 0.95 (9.89-0.98). Conclusidn: EUROTEST has not only excelent psychometric, qualities and is easy to applicate, but also it has a high Rt¢ value. This fact convert it as a good instrument to assess clinical outcome and therapeutical responsiveness in patients with CI or Dementia. Besides, its excellent R~ make it very useful in a wide broad of dementia mrits where different investigators are involved in the clinical exanrination of patients.

0727 Intluence of socioedueationM factors in the diagnostic accuracy of screening tests for Dementia Frank-Garcia, A ~, Carnero-Pardo, C a, Garcia-Ltpez, T a, Garzdn-Maldonado, F 3, L ~ a - L s r a , n l, Miralles-Martinez, A ~, G a r d a de la Rocha, M 4, Dobato-Ayuso, js, Cousido Martinez-Conde, S s. 1Department of Neurology" - University Hospital

La Paz, Madrid, Spain; 2Hospital Torrecdrdenas, Almerfa, Spain; 3Hospital Virgen de la Victoria, Mdlaga, Spain; 4Hospital Central de la Defensa, Madrid, Spain; SHospita[ Fundaeitn Aleoretn, Aleoretn, Spain; C'Hospital Puerto del Mar, C6.diz, Spain Background: One of the most important inconvenient of the diagnostic accuracy (IDA) of some brief neuropsychological tests (BNT) for dementia screening derives on their lrigh influence related to socioeducational variables. Objective: To evaluate the D A of BNT used previously in the TRANSEUROTEST study and to analyze the sodoeducational influence. Method: Tiffs is a transversal, multicentric study in which patients aged over 60 years who attended a general neurological practice clinic were invited to participate. Each participant underwent following tests: EUROTEST, a verbal fluency test (VFT) and one or more among MMSE, MEC or SPMSQ. Subjects were classified as "non-demented" or "demented" according to DSM-IV criteria for Dementia. DA was evaluated by determining the area under the ROC curves (AUC). Socioeducational influence in DA was measured through a logistic regression analysis following a "step by step" strategy. The dependent variable was dementia diagnosis, whereas independent variables were scores from BNT and socioeducational variables. Results: EUROTEST D A (0.93 ± 0.01; A U C ± ee) resulted similar to that of MMSE (10.92 ± 0.02), M E C (10.90 ± 0.03) and SPMSQ (10.94 ± 0.03) and lrigher than VFT DA (0.87 ± 0.02). All models had a similar total variance percentage (R z > 0.65) and in all cases the main predictive variable was the score from each BNT. EUROTEST DA was not influenced by socioeducational variables. Conclusions: EUROTEST shows similar or even higher DA compared to those from common BNT employed in the clinical practice. Moreover, EUROTEST also has the advantage not to be influenced by socioeducational aspects.

Wednesday, November 9, 2005

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0728 EpidemiologicM Evolutive Study of moderate to severe Alzheimer's Disease (AD) in Spain (5E Study). 12 months foUow-up evaluation Frank Garcia, A 1, Agiiera Ortiz, L 2, Manubens Bertran, j3, Gil Gregorio, p4, Moreno Gonzfilez, A 5, Rabes, C s. 1Hospital

Universitario La Paz. Neurology Dept. Madrid," ~Psyehogeriatries Unit. Hospital Doee de Oetubre. Madrid," 3Neurology Dept. Hospital l~Trgen del Camino. Pamplona; 4Dept. of Geriatrics and Gerontology. Hospital CUnico San Carlos. Madrid; 5Pharmacology Dept. Hospital Clinico San Carlos. Madrid; 6Scientific Dept. Labs. Andr&naco, S. A; ZAdvisory Cornmiuee of the Study', on behalf of the study" investigawrs Objectives: To perform a descriptive analysis of clinical and demographic characteristics of a sample of moderate-severe AD patients at one-year follow-up. Methods: Prospective, observational study, carried out by 141 Spmrish investigators (neurologists, geriatricians and psychiatrists). Patients who met N I N C D S - A D R D A criteria for probable or possible moderate-severe AD (CDR -- 2-3) signed informed consent before inclusion. Demographic and clinical data and information on spedflc therapy were collected in 2 visits, V1 (baseline) and V2 (12 months). Applied scales: cogtrition (MMSE); severity (CDR with sum of boxes); function (Blessed); caregiver burden (Zarit). Statistical analysis: Chi-square, Fischer exact test, Student's t and ANOVA. Results: 1406 patients were included: mean age of 77.7 -c 7.1 years; mostly females (71.2%). Moderate C D R in 58.79% and severe in 41.11% of cases; 25.43% were treated with memantine, 18.66% with an attticholinesterasic (IChE) and 20.21% with b o t h . Data from 1168 cases were obtained at V2 (83%). C D R increased in patients treated with IChE alone or in combination (p < .0001), but not in those receiving only memantine (p - 0.9158). MMSE decreased 0.8 ± 3.45 points (p < 0.0001). Blessed score showed a trend towards global improvement, statistically sigtrificant in those with specific therapy (A _ 0.53 ± 3.21; p -- 0.0097). Regardless o f therapy, V1 C D R influenced V2 Blessed variation: for C D R -- 2, Blessed increased: A _ +0.32 (13 -- 0.0036), whereas for C D R -- 3, Blessed decreased: A --0.49 (i3 -- 0.0249). Zarit remained unchanged (iJ - 0.4919). Conclusions: Loss of follow-up over one year was scarce. Outcome of patients on memantine monotherapy was better. Initial severity (CDR) may be an inverse predictive factor of functional activity maintenance. A longer follow-up period could be useful to confirm these results.

0729 Alzhehner Disease, Object Naming, and "Nuisance" Variables Moreno, FJ 2, Frank-Garcia, A a, Tall6n-Barranco, A 1. eHospital

Universitario La PaG Servicio de Neurolog&. Universidad Autrnoma de Madrid, Spain; 2 Universidad Naeional de Edueaeign a Distaneia, Madrid, Spain Background: The study of categorial dissociations (CD) between living and nonliving domains in Alzheimer's disease (AD) is a matter of debate among researchers. One possible explanation could be that some studies did not control correctly some important cognitive and psycholinguist variables (CPV's) which can influence the processing of the living/nonliving items. Our goal was to study whether the presence of CD in DAT could be due to CPV's such as, familiarity, prototipycity or lexical frequency, among others. Method: We administered a new color photograph nanring task to 15 mildly impairment Alzheimer disease patients (AP) 0NINCDS A D R D A criteria), and 16 elderly controls with similar demographic characteristics. Informed consent was obtained from partidpant and fanrily members. The nanring task was composed by 80 items: 40 from living tiring domain (categories of animals, flowers, fruits, insects and vegetables) and 40 from nonliving thing domain (categories of tools, furniture, clothes, kitchen utensils, and vehicles). We carried out two

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Poster Abstracts

Wednesday, November 9, 2005

different statistics analysis: 1) without controlling C.PV's, 2) controlling C.PV's with an ANCOVA. Results: The first analysis showed an impairment o f AP, due to a Domain factor effect. The second one showed the same impairment of AP, but without any effect of Domain factor. Conclusions: Results showed that CD in AD could be due to lack of control of some C.PV's, nevertheless it would be important to enlarge our sample to confirm this find. The results show that is necessary to control C.PV's in order to elaborated more precise semantic batteries than present ones. 0730 Damage to the cortical cholinergie pathways and responsiveness to donepezil in patients with Alzheimer's disease Fukui, T z, Bocti, C 2, Black, SE 3. JShowa University Northern

Yokohama Hospital, Yokohama, Japan; :University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada; 3Sunnybrook and Women's College Health Sciences Centre, Toronto, Canada Background: The trajectories of the cortical cholinergic pathways have recently been identified to originate from the cholinergic basal nucleus of Me?alert and course strategically in the white matter. Involvement of the cholinergic pathways in wlfite matter lesions has been suggested, but not yet established, to be associated with greater severity of dementia and less benefit from cholinesterase inhibitors in patients with Alzheimer's disease (AD) and vascular dementia. The purpose is to investigate whether damage to the cortical cholinergic pathways affect cognitive function attd/or therapeutic responsiveness to donepezil in 67 patients with AD. Method: Baseline cognitive function was assessed using the Hasegawa Dementia Scale Revised, Clinical Dementia Rating and clock drawing test (CDT). According to the temporal CDT score changes, patients were operationally classified as true responders (30 patients), unchangers (28) or non-responders (19). We scored M R lesions in the periventricles, deep white matter and basal ganglia by the standard methods. Damage to the cortical cholinergic pathways was evaluated semi-quantitatively by a newly developed C.holinergic Pathways Hyperintensities Scale (CHIPS). We used a linear regression and multiple logistic regression analyses to find association between vascular lesions and severity of dementia and/or therapeutic responsiveness. Results: The intensity of vascular lesions and CHIPS scores did not influence baseline cognitive function. Unlike periventricular or white matter hyperintensities, CHIPS was significantly associated with poorer therapeutic responses. Conclusions: Baseline cognition may be determined by the severity of AD per se while therapeutic responsiveness may be affected significantly by concomitant damage to the cortical cholinergic pathways. 0731 Is brain SPECT a useful tool for detecting the rapid progression of mild cogtdtive impairment (2VICI) to dementia? Gabryelewicz, T z, Pfeffer, A ~, Luczywek, E ~, Barczak, A ~, Wasiak, B ~, C.zyzewski, K ~, BarcJkowska, M a. 1Medical Research Center, Polish

cognitive decline not dementia (group II) and 16.8% converted to dementia (group III). Results: In group 1 61% patients showed the most sigrfificant reduction of relative blood flow in the following areas: left frontal, frontotemporal, temporal and right temporal. In group II 53.4"/0 patients showed the most reduction in the following areas: left temporal, frontal, temporoparietal, frontotemporal, frontoparietal. In group III 70.6% patients showed reduction in the following areas: right temporal, left frontotemporal, temporoparietal, frontoparietal, frontal. ConcluSions: Baseline comparison of three different groups of patients didn't show statistically significant differences in reduction o f relative blood flow in selected brain areas. Over of 2.1 years period from baseline these measures cannot be regarded as being of predictive value of conversion in individual cases. Longer prospective follow-up of the study sample is needed to indicate if results of SPECT may predict a more rapid deterioration from MCI to clinical dementia. 0732 Encephalopathy Associated With Autoimmune Thyroiditis: Report Of 2 Cases Gaxau M L l, Demey 11, Ysrraelit MC 1, Deutsch S~, Melmann M ~, Arias R 3, Basta C 4, Pagano M 1. 1Neurology Unit; :Endocrinology Unit;

3Pathology Unit; 4Autoirnmunity Unit. Hospital ,Juan A. Ferndndez, Buenos Aires, Argentina Background: Encephalopathy associated with autoimmune thyroiditis is a controversial and rare entity. We report two cases with good response to inmmnomodulatory treatment. Case reports: Case 1: A 70 years old female, developed fluctuating confusional states, seizures, paranoid ideation, hallucinations, myoclonus, tremor and gait instability, with cognitive decline. MRI and routine laboratory exams were normal. EEG showed diffused slow rhythm, CSF had a slightly increase in protein level. Thyroid hormones were witlfin normal limits. Antithyroid antibodies were increased in serum. Thyroid biopsy was consistent with thyroiditis. A second laboratory exam showed hypothyroidism. Treatment with hormone replacement and corticosteroids was started with sustained remission. Case 2: A 64 years old female under treatment due to hypertension and hypothyroidism developed seizures, extrapiramidal signs, stroke-like episodes, fluctuating confusional states, multifocal myoclonus and trunk ataxia. A n MRI showed diffuse T2 hyperintensity in the white matter. The EEG showed generalized slowing with occasional paroxysmal activity and CSF showed increased protein level. Antithyroid antibodies were increased in serum. A good response was seen first with corticosteroids and then with azathioprine. Conehisions: There are different autoinmmne diseases associated with encephalopathy, being thyroiditis one of them. This is characterized by subacute cognitive decline with superimposed episodic and recurrent eonfusional states, seizures, stroke-like episodes, tremor and myoclonus. Elevated antithyroid antibodies are consistently found, being their significance still poorly understood. Due to the good clinical response to inmmnomodulatory treatment, we suggest that this entity should be considered in the differential diagnosis of subacute and fluctuating cognitive decline.

Academy Of Sciences, Poland Background: MCI is heterogeneous clinical syndrome that lies on the cognitive continuum between normal ageing and dementia. Objective: The aim of this study was to detemrine whether regional blood flow (rCBF) patterns measured with YC-99m labelled HMPAO in patients with MCI are useful in predicting progression to dementia. Method: The subjects of this study were 101 consecutive out-patients with MCI. The diagnosis was made according to the criteria of Mayo Clinic Group. Conversion to dementia over the average o f 2.1 years period was determined. Over the follow-up period 40.6"/0 patients were stabile or showed little improvement (group I), while 42.5"/0 showed

0733 Demographic characteristics of patients with cogtdtive impairment in a eommmdty hospital in Buenos Aixes, Argentina Garau M L z, Calvo L 1, Bozzola F 1, Pagano M. 1. 1Neurology Unit.

Hospital Juan Ferndndez, Buenos Aires, Argentina Background: Cognitive impairment is a frequent complaint in neurological practice. The frequency o f different pathologies and their association with different variables may vary depending on the population studied. The aim of the present study is to report the