- Email: [email protected]
Angiotensin-converting enzyme inhibitors and the calcium channel blocker
P220
Poster Presentations: P1
were used to analyze the relation between delayed recognition memory and functional activities of daily living (functional severity), which were respectively measured by the MCI Screen’s wordlist memory task and the Functional Assessment Staging Test procedure (FAST). The discriminability component (memory performance) of delayed recognition memory accurately predicted FAST staging, as well as converted it into a continuous measure. In the present study, we examine this cognitive-functional relationship for different diagnostic groups. Methods: The sample consisted of 304 patients (N), who had 2,086 repeated MCIS and FAST assessments (R) for up to 9 years. The ADRD diagnostic groups were normal cognition (N ¼ 19, R ¼ 85), AD (N ¼ 163, R ¼ 1274), cerebrovascular disease (VD: N ¼ 131, R ¼ 800), Lewy Body Disease (LBD: N ¼ 23, R ¼ 174), Frontal-Temporal Lobe Disease (FTLD: N ¼ 18, R ¼ 101), and multiple etiologies (Mixed ADRD: N ¼ 88, R ¼ 652). The HBCP model consisted of recognition memory performance parameters of discriminability and response bias (response strategy), evaluated at each FAST stage, and integrated into a hierarchical Bayesian framework that included diagnostic group effects. For each diagnostic group, and for all groups combined, a transfer function was used to relate discriminability to the continuum of values underlying the discrete FAST stages. Bayesian analysis was used to implement the model, and infer the parameters of the transfer function. Results: The transfer functions of the AD, LBD, VD and Mixed ADRD groups were well behaved and had narrow credible intervals, but those of the normal cognition and FTLD groups were unable to accurately inferred, possible due to small sample sizes. In VD, discriminability declined twice as slowly compared to other groups. Conclusions: HBCP models accurately translated memory performance (discriminability) to a continuous measure of functional severity in AD, VD, LBD and Mixed ADRD. The FAST procedure-originally developed for AD-appears useful for monitoring other ADRD etiologies. These models help characterize cognitive-functional relationships in individuals and groups in clinical practice and research.
P1-326
INCIDENT ESSENTIAL AND RESTING TREMOR IN AGING AND ITS RELATIONSHIP TO COGNITIVE PERFORMANCE AT ONSET
Erin Abner, Nawaz Hack, Gregory Jicha, University of Kentucky, Lexington, Kentucky, United States. Background: Previous studies have demonstrated decline in performance on tasks requiring both motor function and implicit memory with prevalent tremor. Additional studies have suggested an association between prevalent tremor and the development of dementia, however it is unclear if incident tremor is associated with cognitive decline at the time of first occurrence or if the association with cognitive decline is dependent on progressive striatal dysfunction. Methods: To investigate the association between incident tremor and cognitive performance, we screened the University of Kentucky Alzheimer Disease Center longitudinal clinical database for cases of incident tremor. Cases with normal cognition and incident essential tremor (ET; n ¼ 15) were compared to randomly selected age-, gender-, and education-matched non-tremor controls (NT; n ¼ 16), as well as cases with incident resting tremor not diagnosed with Parkinson’s disease (RT; n ¼ 8). Cognitive performance at onset of tremor symptoms was compared between groups on a broad neuropsychological cognitive test battery. Results: Groups did not differ on demographic variables, global cognitive assessments, or functional assessments. Total UPDRS scores differed significantly between groups (P <0.01), while subscales for bradykinesia that might have affected speed of motor performance on timed tasks did not. No significant between group differences or trends were seen for the Wechsler Logical Memory Paragraph immediate or delayed recall, the California Verbal Learning test immediate or delayed recall, digit span forward or reverse, animal naming, or CERAD praxis tests. Poorer performance on WAIS digit-symbol performance ap-
proached significance for ET vs. NT comparisons (P ¼ 0.08), but not for RT vs. NT (P ¼ 0.4). Trailmaking A, but not Trailmaking B, differed significantly between groups (P <0.005) and was carried by poorer performance in subjects with RT compared to those with NT (P <0.005) or ET (P <0.05). Conclusions: Incident tremor, whether essential or resting in character, should prompt early cognitive screening for subtle signs of cognitive decline in the aging population. Further work elucidating the temporal relationships between tremor and cognitive decline across the cognitive continuum should be pursued in an effort to better understand the complex relationships between motor performance and cognitive function in the aging population.
P1-327
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND THE CALCIUM CHANNEL BLOCKER
Chun-Hung Chen, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Background: Hypertension is strongly associated with cerebral vascular events and a promising target for cognitive decline prevention. In previous literatures, angiotensin-converting enzyme inhibitors (ACEI) modulate progression of amnestic mild cognitive impairment. On the other hand, calcium channel blocker (CCB) is a neuroprotective agent in memory performance. Our aim was to investigate the association between cognitive changes in elderly hypertensive patients with fixed-dose combination therapy or monotherapy. Methods: Between January 2010 and December 20 11, we enrolled 132 elderly hypertensive patients (mean age 66.01 6 8.34 years). There were 32 patients treated with fixed-dose combination therapy (Amtrel, amlodipine+benazepril), and the other 100 patients were received monotherapy (angiotension receptor blocker (ARB), ACEI, CCB, beta blocker, or diuretics). Cognitive Ability Screening Instrument (CASI) and Mini-Mental State Examination (MMSE) were performed to evaluate cognitive function change for each patient in 3rd and 9t h month after medication. And we recorded the score difference between these two tests. The two periods cognitive function were compared by t- testing, and we also evaluate d the difference of each domains of cognitive function; individually. Results: Among the 132 elderly hypertensive patients, CASI (74.11 6 21.74 vs 73.83 6 23.56) and MMSE (21.77 6 6.5 vs 21.63 6 6.9) were not significant change between 3rd and 9th months after medication. Our data showed significant association between fixed-dose combination therapy group and monotherapy group in MMSE (-1.28 6 4.31 vs 0.23 6 3.22) and CASI (-4.5 6 10.56 vs 1.07 6 10) scores. According to each functional domains of CASI, attention (ATT), list-generating fluency (FLU), and were significant difference within two groups. Conclusions: Our results reveal that fixed-dose combination therapy could worsen cognitive function then monotherapy. The results are not what we expected. Partial explanation for this may be that fixed-dose combination therapy group with older age (71.9768.75 vs 64.1612.34 years) and lower education level (5.564.51 vs 8.265.1). The other hand, stroke or dementia population rate is higher in fixed-dose combination therapy group (100% vs 82%). Third, the number of subjects in this study was small, and it may confound the interpretation of our results. So, we need collect more patients, record demographic factors, and long term follow up to improve our data.
P1-328
ENGAGING PATIENTS AT HIGH RISK OF DEMENTIA IN MULTIMODAL COGNITIVE HEALTH PROMOTING ACTIVITIES: THE THINKINGFIT STUDY
Martin Cleverley1, Zuzana Walker2, Thomas Dannhauser3, 1North Essex Partnership NHS Foundation NHS Trust, Chelmsford, United Kingdom;
Poster Presentations: P1
were used to analyze the relation between delayed recognition memory and functional activities of daily living (functional severity), which were respectively measured by the MCI Screen’s wordlist memory task and the Functional Assessment Staging Test procedure (FAST). The discriminability component (memory performance) of delayed recognition memory accurately predicted FAST staging, as well as converted it into a continuous measure. In the present study, we examine this cognitive-functional relationship for different diagnostic groups. Methods: The sample consisted of 304 patients (N), who had 2,086 repeated MCIS and FAST assessments (R) for up to 9 years. The ADRD diagnostic groups were normal cognition (N ¼ 19, R ¼ 85), AD (N ¼ 163, R ¼ 1274), cerebrovascular disease (VD: N ¼ 131, R ¼ 800), Lewy Body Disease (LBD: N ¼ 23, R ¼ 174), Frontal-Temporal Lobe Disease (FTLD: N ¼ 18, R ¼ 101), and multiple etiologies (Mixed ADRD: N ¼ 88, R ¼ 652). The HBCP model consisted of recognition memory performance parameters of discriminability and response bias (response strategy), evaluated at each FAST stage, and integrated into a hierarchical Bayesian framework that included diagnostic group effects. For each diagnostic group, and for all groups combined, a transfer function was used to relate discriminability to the continuum of values underlying the discrete FAST stages. Bayesian analysis was used to implement the model, and infer the parameters of the transfer function. Results: The transfer functions of the AD, LBD, VD and Mixed ADRD groups were well behaved and had narrow credible intervals, but those of the normal cognition and FTLD groups were unable to accurately inferred, possible due to small sample sizes. In VD, discriminability declined twice as slowly compared to other groups. Conclusions: HBCP models accurately translated memory performance (discriminability) to a continuous measure of functional severity in AD, VD, LBD and Mixed ADRD. The FAST procedure-originally developed for AD-appears useful for monitoring other ADRD etiologies. These models help characterize cognitive-functional relationships in individuals and groups in clinical practice and research.
P1-326
INCIDENT ESSENTIAL AND RESTING TREMOR IN AGING AND ITS RELATIONSHIP TO COGNITIVE PERFORMANCE AT ONSET
Erin Abner, Nawaz Hack, Gregory Jicha, University of Kentucky, Lexington, Kentucky, United States. Background: Previous studies have demonstrated decline in performance on tasks requiring both motor function and implicit memory with prevalent tremor. Additional studies have suggested an association between prevalent tremor and the development of dementia, however it is unclear if incident tremor is associated with cognitive decline at the time of first occurrence or if the association with cognitive decline is dependent on progressive striatal dysfunction. Methods: To investigate the association between incident tremor and cognitive performance, we screened the University of Kentucky Alzheimer Disease Center longitudinal clinical database for cases of incident tremor. Cases with normal cognition and incident essential tremor (ET; n ¼ 15) were compared to randomly selected age-, gender-, and education-matched non-tremor controls (NT; n ¼ 16), as well as cases with incident resting tremor not diagnosed with Parkinson’s disease (RT; n ¼ 8). Cognitive performance at onset of tremor symptoms was compared between groups on a broad neuropsychological cognitive test battery. Results: Groups did not differ on demographic variables, global cognitive assessments, or functional assessments. Total UPDRS scores differed significantly between groups (P <0.01), while subscales for bradykinesia that might have affected speed of motor performance on timed tasks did not. No significant between group differences or trends were seen for the Wechsler Logical Memory Paragraph immediate or delayed recall, the California Verbal Learning test immediate or delayed recall, digit span forward or reverse, animal naming, or CERAD praxis tests. Poorer performance on WAIS digit-symbol performance ap-
proached significance for ET vs. NT comparisons (P ¼ 0.08), but not for RT vs. NT (P ¼ 0.4). Trailmaking A, but not Trailmaking B, differed significantly between groups (P <0.005) and was carried by poorer performance in subjects with RT compared to those with NT (P <0.005) or ET (P <0.05). Conclusions: Incident tremor, whether essential or resting in character, should prompt early cognitive screening for subtle signs of cognitive decline in the aging population. Further work elucidating the temporal relationships between tremor and cognitive decline across the cognitive continuum should be pursued in an effort to better understand the complex relationships between motor performance and cognitive function in the aging population.
P1-327
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND THE CALCIUM CHANNEL BLOCKER
Chun-Hung Chen, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Background: Hypertension is strongly associated with cerebral vascular events and a promising target for cognitive decline prevention. In previous literatures, angiotensin-converting enzyme inhibitors (ACEI) modulate progression of amnestic mild cognitive impairment. On the other hand, calcium channel blocker (CCB) is a neuroprotective agent in memory performance. Our aim was to investigate the association between cognitive changes in elderly hypertensive patients with fixed-dose combination therapy or monotherapy. Methods: Between January 2010 and December 20 11, we enrolled 132 elderly hypertensive patients (mean age 66.01 6 8.34 years). There were 32 patients treated with fixed-dose combination therapy (Amtrel, amlodipine+benazepril), and the other 100 patients were received monotherapy (angiotension receptor blocker (ARB), ACEI, CCB, beta blocker, or diuretics). Cognitive Ability Screening Instrument (CASI) and Mini-Mental State Examination (MMSE) were performed to evaluate cognitive function change for each patient in 3rd and 9t h month after medication. And we recorded the score difference between these two tests. The two periods cognitive function were compared by t- testing, and we also evaluate d the difference of each domains of cognitive function; individually. Results: Among the 132 elderly hypertensive patients, CASI (74.11 6 21.74 vs 73.83 6 23.56) and MMSE (21.77 6 6.5 vs 21.63 6 6.9) were not significant change between 3rd and 9th months after medication. Our data showed significant association between fixed-dose combination therapy group and monotherapy group in MMSE (-1.28 6 4.31 vs 0.23 6 3.22) and CASI (-4.5 6 10.56 vs 1.07 6 10) scores. According to each functional domains of CASI, attention (ATT), list-generating fluency (FLU), and were significant difference within two groups. Conclusions: Our results reveal that fixed-dose combination therapy could worsen cognitive function then monotherapy. The results are not what we expected. Partial explanation for this may be that fixed-dose combination therapy group with older age (71.9768.75 vs 64.1612.34 years) and lower education level (5.564.51 vs 8.265.1). The other hand, stroke or dementia population rate is higher in fixed-dose combination therapy group (100% vs 82%). Third, the number of subjects in this study was small, and it may confound the interpretation of our results. So, we need collect more patients, record demographic factors, and long term follow up to improve our data.
P1-328
ENGAGING PATIENTS AT HIGH RISK OF DEMENTIA IN MULTIMODAL COGNITIVE HEALTH PROMOTING ACTIVITIES: THE THINKINGFIT STUDY
Martin Cleverley1, Zuzana Walker2, Thomas Dannhauser3, 1North Essex Partnership NHS Foundation NHS Trust, Chelmsford, United Kingdom;