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147 INCREASED RISK FOR UTILIZATIONS ASSOCIATED WITH SUBTLE COGNITIVE IMPAIRMENT
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Posters / Parkinsonism and Related Disorders 16S1 (2010) S11–S86
investigation, cognitive functions (CERAD; TMT-B; Clock Drawing) and the presence of risk factors for VaD. Schizophrenia was the most prevalent psychiatric disorder (87.4%). A great majority of the patients (86%) had at least one risk factor for VaD. The clinical conditions related to risk factors for VaD were hypertension (48.7%), heart disease (30.8%), hypercholesterolemia (25.6%), diabetes mellitus (23.1%), stroke (12.8%), triglyceride (12.8%), and obesity (5.1%). In terms of lifestyle, smoking (89.2%), alcohol abuse (16.7%), and sedentarism (87,5.1%) were other risk factors found. Definite risk factors for VaD were found in 83.3% of the patients. Previous interventions targeting risk factors were found in only 20% of the cases. The high rates of risk factors for VaD identified in this sample suggest that psychiatrists should be more attentive to these factors for the prevention of VaD. 145 THE RELATIONSHIP BETWEEN GAIT IMPAIRMENT AND SELF-EFFICACY IN PARKINSON’S DISEASE A.L. Gruber-Baldini1 , K.E. Anderson2,3 , W.J. Weiner2 , P.S. Fishman4 , S.G. Reich2 , L.M. Shulman2 . 1 Epidemiology and Preventive Medicine, 2 Neurology, 3 Psychiatry, University of Maryland School of Medicine, 4 Neurology, University of Maryland School of Medicine, Baltimore, MD, USA Objective: To investigate the relationship between gait impairment and self-efficacy in Parkinson’s disease (PD). Background: Self-efficacy is defined as the sense of confidence and control related to the belief that one can carry out behaviors to achieve desired health goals. The study hypothesis was that greater self-efficacy is associated with better gait and mobility. Methods: PD patients were assessed with the Unified PD Rating Scale (UPDRS), Older Americans Resource and Services Disability Subscale (OARS), Cumulative Illness Rating Scale (CIRS), MiniMental State Exam (MMSE), Brief Psychiatric Symptom Inventory (BSI-18), Social Activities Scale (SAS) and Lorig Self-Efficacy Scale. Gait-related function was measured based on gait-related items from the UPDRS, OARS and SAS. Multivariate regression analyses examined the relationship between the self-efficacy scale and gaitrelated function through a series of nested models that controlled for demographics, medical co-morbidity, disease severity, cognition and psychiatric symptoms. Results: The sample comprised 669 PD patients [65.8(10.8) yrs, 63% male, Total UPDRS 40.5(18.7)]. Self-efficacy was a significant and independent predictor of all domains of gait-related functioning, even when controlling for all covariates. Self-efficacy in fully adjusted models independently accounted for 4.4% of the variance in UPDRS gait items, 17.0% in social activities, and 13.0% in gait-related ADLs (all p < 0.001). Conclusion: In this cross-sectional analysis, greater self-efficacy is independently associated with better gait and mobility in PD. This illustrates the important association between mobility and confidence and control in daily life. Longitudinal studies are required to investigate the sequence and direction of causality between self-efficacy and gait impairment. 146 ODOR-INDUCED PSEUDODYSTONIA AND HYSTERICAL GAIT A. Hirsch, O.L. Ochoa Reina. Smell & Taste Treatment and Research Foundation, Chicago, IL, USA Background: Odors have been associated with the precipitation of migraine, epilepsy, burning mouth syndrome, vocal cord dysfunction as well as a variety of psychological complaints. Odor-induced dystonia with gait dysfunction has not heretofore been described. Methods: A 52 year old male, factory worker, suffered a traumatic subdural hematoma and cervical fracture. One and one-half years later, exposure to paint odor induced headaches and numbness of the face and back of the throat. His symptoms gradually generalized and became induced by virtually any strong odor.
On presentation to odor, he develops paresthesias in the neck, stinging on his nose, along with headache and perception of mouth tightening followed by risus sardonicus and burning of his lower lip. Then, torticollis occurs followed by gait with right foot dragging, circumduction, decerebrate posturing of left arm. The episodes can last minutes to four days in duration, preventing him from driving and working. As a result, he has become agoraphobic and essentially confined to his house. Results: On physical examination, gait is normal. Exposure to odor of garlic induced decerebrate posture of left arm, torticollis to the left, hyperextension and decerebrate posture of left foot. Upon walking, right foot dropped with circumduction and holding left arm in a decerebrate posture. Upon running or distraction, gait improved towards normal. Conclusion: This is the first case report of psychogenic movement disorder (PMD) manifested by focal dystonia and hysterical gait precipitated by odor exposure. PMD should be included in the differential diagnosis of odor-induced phenomena. 147 INCREASED RISK FOR UTILIZATIONS ASSOCIATED WITH SUBTLE COGNITIVE IMPAIRMENT J.F. Sachs1,2 , R.E. Gangnon3 , B.L. Fischer4 , C.E. Gleason1,2 , J.E. Mahoney1 . 1 Section of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 2 Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, 3 Departments of Biostatistics and Medical Informatics and Population Health Sciences, University of Wisconsin-Madison, 4 Mental Health Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA Background: Previous work has illustrated an increased risk of falls in individuals with dementia. Recently, this association has been extended to those with mild cognitive deficits. However, little is known about the impact of the increased falls risk associated in individuals with only mild cognitive problems on hospital and nursing home utilizations. The purpose of this study was to clarify the relationship between utilizations and deficits in cognition in a group of high risk fallers. Methods: In a secondary analysis of the Kenosha County Falls Prevention Study, we examined the association between baseline MMSE and utilizations, number of nursing home admissions and number of hospitalizations, over 12 months. Results: Using a multivariate regression controlled for gender, marital status, baseline Barthel, previous injurious falls, and previous utilizations, the rate of utilizations increased with every point lost on the MMSE (rate ratio = 1.39, 95% CI = 1.09–1.77, p = 0.007 for nursing home admission and rate ratio = 1.29, 95% CI = 1.07–1.55, p = 0.008 for hospitalizations). Conclusion: In a population of high-risk fallers, small decrements in MMSE were associated with an increase in rate of both nursing home and hospital utilizations. This association was maintained for MMSE scores suggestive of only mild cognitive problems (range of 30 to 25). 148 ATTENTION NETWORKS IN PARKINSON’S DISEASE: FREEZING OF GAIT RELATED TO IMPAIRED CONFLICT RESOLUTION? J. Vandenbossche1,2 , J. Spildooren3 , S. Vercruysse3 , N. Deroost1 , E. Soetens1 , A. Nieuwboer3 , E. Kerckhofs2 . 1 Research Unit for Cognitive Psychology, 2 Neurological Rehabilitation & Rehabilitation Psychology, Vrije Universiteit Brussel, Brussels, 3 Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium Background and Aims: Freezing of gait (FOG) in Parkinson’s disease (PD) cannot be seen solely as a motor symptom. Revealing cognitive differences between freezers (PD-F) and non-freezers (PD-NF), can be useful in order to gain further insight into the mechanisms of
Posters / Parkinsonism and Related Disorders 16S1 (2010) S11–S86
investigation, cognitive functions (CERAD; TMT-B; Clock Drawing) and the presence of risk factors for VaD. Schizophrenia was the most prevalent psychiatric disorder (87.4%). A great majority of the patients (86%) had at least one risk factor for VaD. The clinical conditions related to risk factors for VaD were hypertension (48.7%), heart disease (30.8%), hypercholesterolemia (25.6%), diabetes mellitus (23.1%), stroke (12.8%), triglyceride (12.8%), and obesity (5.1%). In terms of lifestyle, smoking (89.2%), alcohol abuse (16.7%), and sedentarism (87,5.1%) were other risk factors found. Definite risk factors for VaD were found in 83.3% of the patients. Previous interventions targeting risk factors were found in only 20% of the cases. The high rates of risk factors for VaD identified in this sample suggest that psychiatrists should be more attentive to these factors for the prevention of VaD. 145 THE RELATIONSHIP BETWEEN GAIT IMPAIRMENT AND SELF-EFFICACY IN PARKINSON’S DISEASE A.L. Gruber-Baldini1 , K.E. Anderson2,3 , W.J. Weiner2 , P.S. Fishman4 , S.G. Reich2 , L.M. Shulman2 . 1 Epidemiology and Preventive Medicine, 2 Neurology, 3 Psychiatry, University of Maryland School of Medicine, 4 Neurology, University of Maryland School of Medicine, Baltimore, MD, USA Objective: To investigate the relationship between gait impairment and self-efficacy in Parkinson’s disease (PD). Background: Self-efficacy is defined as the sense of confidence and control related to the belief that one can carry out behaviors to achieve desired health goals. The study hypothesis was that greater self-efficacy is associated with better gait and mobility. Methods: PD patients were assessed with the Unified PD Rating Scale (UPDRS), Older Americans Resource and Services Disability Subscale (OARS), Cumulative Illness Rating Scale (CIRS), MiniMental State Exam (MMSE), Brief Psychiatric Symptom Inventory (BSI-18), Social Activities Scale (SAS) and Lorig Self-Efficacy Scale. Gait-related function was measured based on gait-related items from the UPDRS, OARS and SAS. Multivariate regression analyses examined the relationship between the self-efficacy scale and gaitrelated function through a series of nested models that controlled for demographics, medical co-morbidity, disease severity, cognition and psychiatric symptoms. Results: The sample comprised 669 PD patients [65.8(10.8) yrs, 63% male, Total UPDRS 40.5(18.7)]. Self-efficacy was a significant and independent predictor of all domains of gait-related functioning, even when controlling for all covariates. Self-efficacy in fully adjusted models independently accounted for 4.4% of the variance in UPDRS gait items, 17.0% in social activities, and 13.0% in gait-related ADLs (all p < 0.001). Conclusion: In this cross-sectional analysis, greater self-efficacy is independently associated with better gait and mobility in PD. This illustrates the important association between mobility and confidence and control in daily life. Longitudinal studies are required to investigate the sequence and direction of causality between self-efficacy and gait impairment. 146 ODOR-INDUCED PSEUDODYSTONIA AND HYSTERICAL GAIT A. Hirsch, O.L. Ochoa Reina. Smell & Taste Treatment and Research Foundation, Chicago, IL, USA Background: Odors have been associated with the precipitation of migraine, epilepsy, burning mouth syndrome, vocal cord dysfunction as well as a variety of psychological complaints. Odor-induced dystonia with gait dysfunction has not heretofore been described. Methods: A 52 year old male, factory worker, suffered a traumatic subdural hematoma and cervical fracture. One and one-half years later, exposure to paint odor induced headaches and numbness of the face and back of the throat. His symptoms gradually generalized and became induced by virtually any strong odor.
On presentation to odor, he develops paresthesias in the neck, stinging on his nose, along with headache and perception of mouth tightening followed by risus sardonicus and burning of his lower lip. Then, torticollis occurs followed by gait with right foot dragging, circumduction, decerebrate posturing of left arm. The episodes can last minutes to four days in duration, preventing him from driving and working. As a result, he has become agoraphobic and essentially confined to his house. Results: On physical examination, gait is normal. Exposure to odor of garlic induced decerebrate posture of left arm, torticollis to the left, hyperextension and decerebrate posture of left foot. Upon walking, right foot dropped with circumduction and holding left arm in a decerebrate posture. Upon running or distraction, gait improved towards normal. Conclusion: This is the first case report of psychogenic movement disorder (PMD) manifested by focal dystonia and hysterical gait precipitated by odor exposure. PMD should be included in the differential diagnosis of odor-induced phenomena. 147 INCREASED RISK FOR UTILIZATIONS ASSOCIATED WITH SUBTLE COGNITIVE IMPAIRMENT J.F. Sachs1,2 , R.E. Gangnon3 , B.L. Fischer4 , C.E. Gleason1,2 , J.E. Mahoney1 . 1 Section of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 2 Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, 3 Departments of Biostatistics and Medical Informatics and Population Health Sciences, University of Wisconsin-Madison, 4 Mental Health Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA Background: Previous work has illustrated an increased risk of falls in individuals with dementia. Recently, this association has been extended to those with mild cognitive deficits. However, little is known about the impact of the increased falls risk associated in individuals with only mild cognitive problems on hospital and nursing home utilizations. The purpose of this study was to clarify the relationship between utilizations and deficits in cognition in a group of high risk fallers. Methods: In a secondary analysis of the Kenosha County Falls Prevention Study, we examined the association between baseline MMSE and utilizations, number of nursing home admissions and number of hospitalizations, over 12 months. Results: Using a multivariate regression controlled for gender, marital status, baseline Barthel, previous injurious falls, and previous utilizations, the rate of utilizations increased with every point lost on the MMSE (rate ratio = 1.39, 95% CI = 1.09–1.77, p = 0.007 for nursing home admission and rate ratio = 1.29, 95% CI = 1.07–1.55, p = 0.008 for hospitalizations). Conclusion: In a population of high-risk fallers, small decrements in MMSE were associated with an increase in rate of both nursing home and hospital utilizations. This association was maintained for MMSE scores suggestive of only mild cognitive problems (range of 30 to 25). 148 ATTENTION NETWORKS IN PARKINSON’S DISEASE: FREEZING OF GAIT RELATED TO IMPAIRED CONFLICT RESOLUTION? J. Vandenbossche1,2 , J. Spildooren3 , S. Vercruysse3 , N. Deroost1 , E. Soetens1 , A. Nieuwboer3 , E. Kerckhofs2 . 1 Research Unit for Cognitive Psychology, 2 Neurological Rehabilitation & Rehabilitation Psychology, Vrije Universiteit Brussel, Brussels, 3 Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium Background and Aims: Freezing of gait (FOG) in Parkinson’s disease (PD) cannot be seen solely as a motor symptom. Revealing cognitive differences between freezers (PD-F) and non-freezers (PD-NF), can be useful in order to gain further insight into the mechanisms of