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Are depressive symptoms in mild cognitive impairment patients predictive for conversion to dementia?
Poster Presentations: P3 dementia has a core feature of longitudinal decline in visuospatial abilities, yielding strong psychometric evidence of a preclinical or MCI stage of PDD.
P3-081
CHANGES IN THE VETERANS AFFAIRS SAINT LOUIS UNIVERSITY MENTAL STATUS (SLUMS) EXAM SCORES OVER 7.5 YEARS’ FOLLOW-UP AND RELATED OUTCOMES: THE INFLUENCE OF REVERSIBLE COGNITIVE IMPAIRMENT AND CORRECTION OF SENSORY LOSS
Dulce Cruz-Oliver1, Theodore Malmstrom1, Nina Tumosa2, John Morley3, Saint Louis University School of Medicine, St. Louis, Missouri, United States; 2Geriatric Research Education and Clinical Centers, St Louis VAMC, Jefferson Barracks, St. Louis, Missouri, United States; 3Saint Louis University Medical Center, St. Louis, Missouri, United States. 1
Background: The Veterans Affairs Saint Louis University Mental Status (SLUMS) exam is a screening tool developed for the detection of cognitive impairment. As compared to the Mini-Mental State Exam (MMSE), the SLUMS exam has better sensitivity and specificity for the detection of both dementia and mild cognitive impairment (MCI). This study explores the SLUMS exam’s potential to identify the clinical course of MCI and dementia in patients with cognitive impairment after 7.5 years. Methods: Using the SLUMS exam and the MMSE at the Geriatric Research, Education and Clinical Center at the Veterans Affairs Hospital St. Louis, MO patients (N¼533) were screened for cognitive dysfunction in 2003. The rates of mortality, institutionalization and change in SLUMS exam score (back-conversion) were evaluated as outcome measures in 2010. In this prospective study the associations between outcome measures, MMSE and SLUMS exam total scores, individual item scores and cognitive status were examined using Kaplan-Meier curves and Cox proportional-hazards regression. Results: Five hundred thirty three charts were reviewed: 176/533 (33%) patients died and 31/526 (6%) were institutionalized during the 7.5-year follow-up period. Mean age was 75 years, all subjects were male, and most had high school education or greater (71%). MMSE dementia and SLUMS exam dementia (P<.001) groups had significantly higher mortality and institutionalization rates than the normal cognition group in the Kaplan-Meier curves. At 7.5-years follow up 228/357 (64%) patients completed the SLUMS exam, 36/228 (16%) progressed to MCI and 20/228 (9%) progressed to dementia. Interestingly, 47/228 (21%) converted back to normal from MCI (N¼34/47, 72%) or to MCI from dementia (N¼13/47, 28%). After 7.5 years back-converters mean SLUMS scores increased 4.062.0 points whereas ‘non-converters’ SLUMS scores decreased 1.263.7 points, (t¼9.4, P<.001). Further exploration revealed that correction of reversible causes accounted for most (N¼34/47, 72%) of back-conversion. The most frequently identified reversible causes among those who converted to: 1)MCI were dementia therapy n¼6/13(46.2%), hearing loss correction n¼4/13(30.8%), and discontinuation of anti-cholinergic drug n¼3/13(23.1%); and 2) normal were discontinuation of anti-cholingergic drug n¼11/34(32.4%), hearing loss correction n¼10/34(29.4%), and vision correction n¼7/34(20.6%). Conclusions: Back conversions based on SLUMS score over 7.5 year follow up were explained by reversible causes, in particular, discontinuation of anti-cholinergic drugs and sensory (hearing or vision) corrections.
P3-083
P481 ARE DEPRESSIVE SYMPTOMS IN MILD COGNITIVE IMPAIRMENT PATIENTS PREDICTIVE FOR CONVERSION TO DEMENTIA?
Eva Dierckx1, Sebastiaan Engelborghs2, Stefan Van der Mussele3, Peter Paul De Deyn3, Ingrid Ponjaert-Kristoffersen1, 1Vrije Universiteit Brussel, Brussels, Belgium; 2Antwerp University, Antwerp, Belgium; 3 Antwerp University, Antwerp, Belgium. Background: Depressive symptoms are common in all types of dementias and at all disease stages, including in mild cognitive impairment (MCI). However, there is still disagreement whether these symptoms are predictive of conversion to dementia. In this study, we want to explore the predictive accuracy of the presence of depressive symptoms (it is the total score on the Geriatric depression scale (GDS)) for Alzheimer’s Disease (AD) in amnestic MCI (aMCI) patients, both at 1.5 years and 4 years of follow up. Methods: 40 aMCI patients from a memory clinic were tested at baseline with the GDS, the cognitive part of the Cambridge Examination for Mental Disorders of the Elderly (CAMCOG), the Mini Mental Status Examination (MMSE) and several other neuropsychological tests. After 18 months and after 4 years, MCI-patients were reassessed with the CAMCOG, MMSE and GDS and a follow up diagnosis was established. Of those who were seen for follow up after 1.5 years (n¼31), 7 fulfilled (NINCDS-ADRDA) criteria of probable AD, while 24 did not convert. After 4 years, 28 patients were seen for follow up; 17 received a diagnosis of AD, while 11 did not convert. Results: Binary logistic regression analyses revealed that scores on the GDS at baseline were not able to predict conversion to AD in aMCI patients after 18 months of follow up (Wald X 2(1) ¼ 3.20, p ¼ .074 (CI95%: 0.983-1.447), nor at the 4-year follow up (Wald X 2(1) ¼ 0.21, p ¼ .647 (CI95%: 0.875-1.239). Conclusions: In our study, the presence of depressive symptoms as measured with the 30-item GDS at baseline was not associated with a conversion to dementia in aMCI patients. P3-084
DISCORDANCE FOR HIPPOCAMPAL ATROPHY AND AMYLOID BURDEN IN AMNESTIC MILD COGNITIVE IMPAIRMENT MAY IDENTIFY DISTINCT SUBGROUPS OF PATIENTS
Gerald Novak1, Steven Einstein2, Spencer Guthrie2, Richard Margolin2, Hui Jing Yu3, Luc Bracoud3, Boubakeur Balaroussi3, Charles S. DeCarli4, Chahin Pachai3, 1Janssen Pharmaceutical Research and Development, Titusville, New Jersey, United States; 2Janssen Alzheimer Immunotherapy, South San Francisco, California, United States; 3Bioclinica, Lyon, France; 4 University of California-Davis, Sacramento, California, United States. Background: The relative value and concordance of hippocampal atrophy (HA) and amyloid burden as “enrichment” criteria for clinical trials in prodromal Alzheimer’s disease have not been defined. Methods: The Alzheimer’s Disease Neuroimaging Initiative cohort of subjects with amnestic mild cognitive impairment served as a reference dataset. Of 265 subjects with an MRI at baseline and clinical status known or inferred at 36 months, 164 who had either CSF or PiB-PET were selected for further analysis. Mean right and left hippocampal volumes (HCV) were adjusted for age and intracranial volume. Subjects were classified amyloid positive if either CSF A b 142<192 pg/mL or PIB-PET SUVr>1.5. HA was defined as HCV<3150
Table 1. Characteristics of Subjects Based on HA or Amyloid Status HA
Amyloid
Criterion
HA(-)
HA(+)
P
Amyloid(-)
Amyloid(+)
P
N % male Age, y (sd) ApoE4 alleles (0/1/2) HCV, mm3 (sd) Baseline CDR-SOB (sd) Annualized DCDR-SOB (sd) % converted
64 64 75.6 (8.0) 39/21/4 3433 (201) 1.33 (0.63) 0.50 (0.84) 33
100 63 73.1 (7.2) 35/48/17 2704 (284) 1.68 (0.96) 1.28 (1.59) 66
–
39 74 75.2 (8.7) 31/8/0 3122 (482) 1.37 (0.72) 0.26 (0.78) 26
125 60 73.7 (7.2) 43/61/21 2946 (417) 1.59 (0.89) 1.20 (1.48) 62
– 0.098 0.323 <0.001 0.046 0.122 <0.001 <0.001
0.89 0.048 0.003 <0.001 0.006 <0.001 <0.001
P3-081
CHANGES IN THE VETERANS AFFAIRS SAINT LOUIS UNIVERSITY MENTAL STATUS (SLUMS) EXAM SCORES OVER 7.5 YEARS’ FOLLOW-UP AND RELATED OUTCOMES: THE INFLUENCE OF REVERSIBLE COGNITIVE IMPAIRMENT AND CORRECTION OF SENSORY LOSS
Dulce Cruz-Oliver1, Theodore Malmstrom1, Nina Tumosa2, John Morley3, Saint Louis University School of Medicine, St. Louis, Missouri, United States; 2Geriatric Research Education and Clinical Centers, St Louis VAMC, Jefferson Barracks, St. Louis, Missouri, United States; 3Saint Louis University Medical Center, St. Louis, Missouri, United States. 1
Background: The Veterans Affairs Saint Louis University Mental Status (SLUMS) exam is a screening tool developed for the detection of cognitive impairment. As compared to the Mini-Mental State Exam (MMSE), the SLUMS exam has better sensitivity and specificity for the detection of both dementia and mild cognitive impairment (MCI). This study explores the SLUMS exam’s potential to identify the clinical course of MCI and dementia in patients with cognitive impairment after 7.5 years. Methods: Using the SLUMS exam and the MMSE at the Geriatric Research, Education and Clinical Center at the Veterans Affairs Hospital St. Louis, MO patients (N¼533) were screened for cognitive dysfunction in 2003. The rates of mortality, institutionalization and change in SLUMS exam score (back-conversion) were evaluated as outcome measures in 2010. In this prospective study the associations between outcome measures, MMSE and SLUMS exam total scores, individual item scores and cognitive status were examined using Kaplan-Meier curves and Cox proportional-hazards regression. Results: Five hundred thirty three charts were reviewed: 176/533 (33%) patients died and 31/526 (6%) were institutionalized during the 7.5-year follow-up period. Mean age was 75 years, all subjects were male, and most had high school education or greater (71%). MMSE dementia and SLUMS exam dementia (P<.001) groups had significantly higher mortality and institutionalization rates than the normal cognition group in the Kaplan-Meier curves. At 7.5-years follow up 228/357 (64%) patients completed the SLUMS exam, 36/228 (16%) progressed to MCI and 20/228 (9%) progressed to dementia. Interestingly, 47/228 (21%) converted back to normal from MCI (N¼34/47, 72%) or to MCI from dementia (N¼13/47, 28%). After 7.5 years back-converters mean SLUMS scores increased 4.062.0 points whereas ‘non-converters’ SLUMS scores decreased 1.263.7 points, (t¼9.4, P<.001). Further exploration revealed that correction of reversible causes accounted for most (N¼34/47, 72%) of back-conversion. The most frequently identified reversible causes among those who converted to: 1)MCI were dementia therapy n¼6/13(46.2%), hearing loss correction n¼4/13(30.8%), and discontinuation of anti-cholinergic drug n¼3/13(23.1%); and 2) normal were discontinuation of anti-cholingergic drug n¼11/34(32.4%), hearing loss correction n¼10/34(29.4%), and vision correction n¼7/34(20.6%). Conclusions: Back conversions based on SLUMS score over 7.5 year follow up were explained by reversible causes, in particular, discontinuation of anti-cholinergic drugs and sensory (hearing or vision) corrections.
P3-083
P481 ARE DEPRESSIVE SYMPTOMS IN MILD COGNITIVE IMPAIRMENT PATIENTS PREDICTIVE FOR CONVERSION TO DEMENTIA?
Eva Dierckx1, Sebastiaan Engelborghs2, Stefan Van der Mussele3, Peter Paul De Deyn3, Ingrid Ponjaert-Kristoffersen1, 1Vrije Universiteit Brussel, Brussels, Belgium; 2Antwerp University, Antwerp, Belgium; 3 Antwerp University, Antwerp, Belgium. Background: Depressive symptoms are common in all types of dementias and at all disease stages, including in mild cognitive impairment (MCI). However, there is still disagreement whether these symptoms are predictive of conversion to dementia. In this study, we want to explore the predictive accuracy of the presence of depressive symptoms (it is the total score on the Geriatric depression scale (GDS)) for Alzheimer’s Disease (AD) in amnestic MCI (aMCI) patients, both at 1.5 years and 4 years of follow up. Methods: 40 aMCI patients from a memory clinic were tested at baseline with the GDS, the cognitive part of the Cambridge Examination for Mental Disorders of the Elderly (CAMCOG), the Mini Mental Status Examination (MMSE) and several other neuropsychological tests. After 18 months and after 4 years, MCI-patients were reassessed with the CAMCOG, MMSE and GDS and a follow up diagnosis was established. Of those who were seen for follow up after 1.5 years (n¼31), 7 fulfilled (NINCDS-ADRDA) criteria of probable AD, while 24 did not convert. After 4 years, 28 patients were seen for follow up; 17 received a diagnosis of AD, while 11 did not convert. Results: Binary logistic regression analyses revealed that scores on the GDS at baseline were not able to predict conversion to AD in aMCI patients after 18 months of follow up (Wald X 2(1) ¼ 3.20, p ¼ .074 (CI95%: 0.983-1.447), nor at the 4-year follow up (Wald X 2(1) ¼ 0.21, p ¼ .647 (CI95%: 0.875-1.239). Conclusions: In our study, the presence of depressive symptoms as measured with the 30-item GDS at baseline was not associated with a conversion to dementia in aMCI patients. P3-084
DISCORDANCE FOR HIPPOCAMPAL ATROPHY AND AMYLOID BURDEN IN AMNESTIC MILD COGNITIVE IMPAIRMENT MAY IDENTIFY DISTINCT SUBGROUPS OF PATIENTS
Gerald Novak1, Steven Einstein2, Spencer Guthrie2, Richard Margolin2, Hui Jing Yu3, Luc Bracoud3, Boubakeur Balaroussi3, Charles S. DeCarli4, Chahin Pachai3, 1Janssen Pharmaceutical Research and Development, Titusville, New Jersey, United States; 2Janssen Alzheimer Immunotherapy, South San Francisco, California, United States; 3Bioclinica, Lyon, France; 4 University of California-Davis, Sacramento, California, United States. Background: The relative value and concordance of hippocampal atrophy (HA) and amyloid burden as “enrichment” criteria for clinical trials in prodromal Alzheimer’s disease have not been defined. Methods: The Alzheimer’s Disease Neuroimaging Initiative cohort of subjects with amnestic mild cognitive impairment served as a reference dataset. Of 265 subjects with an MRI at baseline and clinical status known or inferred at 36 months, 164 who had either CSF or PiB-PET were selected for further analysis. Mean right and left hippocampal volumes (HCV) were adjusted for age and intracranial volume. Subjects were classified amyloid positive if either CSF A b 142<192 pg/mL or PIB-PET SUVr>1.5. HA was defined as HCV<3150
Table 1. Characteristics of Subjects Based on HA or Amyloid Status HA
Amyloid
Criterion
HA(-)
HA(+)
P
Amyloid(-)
Amyloid(+)
P
N % male Age, y (sd) ApoE4 alleles (0/1/2) HCV, mm3 (sd) Baseline CDR-SOB (sd) Annualized DCDR-SOB (sd) % converted
64 64 75.6 (8.0) 39/21/4 3433 (201) 1.33 (0.63) 0.50 (0.84) 33
100 63 73.1 (7.2) 35/48/17 2704 (284) 1.68 (0.96) 1.28 (1.59) 66
–
39 74 75.2 (8.7) 31/8/0 3122 (482) 1.37 (0.72) 0.26 (0.78) 26
125 60 73.7 (7.2) 43/61/21 2946 (417) 1.59 (0.89) 1.20 (1.48) 62
– 0.098 0.323 <0.001 0.046 0.122 <0.001 <0.001
0.89 0.048 0.003 <0.001 0.006 <0.001 <0.001