Community life withdrawal with MCI progression

Poster Presentations: P3 completed (median interval¼109 days) telephone interviews, featuring the same 7-item questionnaire and a 9-measure neuropsychological battery encompassing: general cognition (Telephone Interview for Cognitive Status); immediate and delayed word and paragraph (East Boston Memory Test) recall; category fluency; working memory (digit span-backwards); executive function (Oral Trail-Making Test-B [OTMT-B]). Informants completed self-administered, validated questionnaires (Structured Interview and Scoring Tool-MADRC-Informant Report). Results: Absolute agreement between self- and telephone-administered STIDA items ranged from 5894%. Several items were infrequently endorsed; thus, chance-corrected agreement was predictably low (kappa range¼0.05-0.41; weighted kappa for sum-of-items¼0.33). Participants were more likely to endorse memory complaints (e.g., remembering a list of items) in self-administered vs. telephone-interview formats (45% v. 31%, McNemar’s P¼0.04). Participants were more likely to endorse memory problems (e.g., overall change in memory ability) than informants (80% vs. 52%, McNemar’s P<0.001); however, informants appeared more likely to report “executive” symptoms (e.g., trouble following group conversations or a plot: 16% vs. 7%, McNemar’s P¼0.06). Regarding neuropsychological testing, STIDA responses were generally uncorrelated with performance. However, informant reports were significantly related to objective testing: e.g., mean difference in global z -score averaging all tests¼-0.37 units (P¼0.03) for "trouble following group conversions/plots "-yes/no; mean difference in OTMT-B¼11.1 seconds (P¼0.05) for "difficulty understanding/following instructions "-yes/no. Conclusions: Participants were more likely to endorse complaints when providing unobserved, written responses versus during interviews, which may have important implications for screening in healthy samples without selfidentified memory concerns. Participants were more likely to report memory concerns, and informants to report executive problems. Finally, informantreported problems were associated with significantly worse objective global cognitive and executive performance, indicating validity and value of informant reports in cognitive studies using remote assessment methods. P3-088

THE AD8 DEMENTIA SCREENING TEST DETECTS MILD COGNITIVE IMPAIRMENT

James Galvin1, Catherine Roe2, John Morris3, 1New York University, New York, New York, United States; 2Washington University School of Medicine, St Louis, Missouri, United States; 3Washington University, St. Louis, Missouri, United States. Background: Detection of mild cognitive impairment (MCI) and early-stage Alzheimer’s disease (AD) can be done either by comparing individual cognitive performance with normative values or assessing cognitive decline within an individual. The AD8 is a widely used, validated, 8-item dementia screening tool; endorsement of >2 questions suggests cognitive impairment. The AD8 may improve detection of MCI and early-stage dementia in clinical practice and enrollment into MCI clinical trials. Methods: 810 individuals (CDR 0, Controls¼528; CDR 0.5/MCI¼102; CDR 0.5/AD¼180) were evaluated at the Washington University Knight Alzheimer’s Disease Research Center. Participants underwent identical assessments including all items from the Uniform Data Set, Clinical Dementia Rating (CDR) and Sum Boxes (CDR-SB). The AD8 questions were embedded throughout the interview. Receiver operator characteristic curves assessed ability of the AD8 to discriminate between CDR 0, CDR 0.5/MCI and CDR 0.5/AD. Results: The sample’s mean age¼75 + 8y; education¼15 + 3y; 56% female. Informants largely were spouses (52%) or adult children (26%). Mean CDR-SB was higher in AD (2.5) vs. MCI (0.9, P<.001). In MCI, the most frequently endorsed CDR domains were Memory (93.2%), Judgment and Problem Solving (47.1%) and Home and Hobbies (21.6%); these domains were also most frequently endorsed in AD. Mean AD8 scores for CDR 0¼0.5, CDR 0.5/MCI¼2.9, and CDR 0.5/AD¼5.3. MCI informants most frequently endorsed problems with judgment (61%); repeats questions/statements/stories (56%); daily problems with memory (52%); and trouble operating tools/gadgets/ appliances (37%). The AD8 discriminated Controls from (1) any cognitive impairment (.946; 95% CI: .92-96); (2) CDR 0.5 MCI (.879; 95% CI: .84.92); and (3) CDR 0.5 AD (.985; 95%CI: .98-.99) using a cut-off score¼2. The AD8 also discriminated MCI from AD (.840; 95%CI: .79-.89) using

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a cut-off score¼5. Conclusions: The AD8 detected the very mildest forms of cognitive impairment due to AD: CDR 0.5/MCI and CDR 0.5/AD. Cutoff scores 2-5 suggest MCI and cut-off scores >5 suggest AD. Higher AD8 scores correlated with more impaired ratings in clinical, cognitive, functional and behavioral domains and MCI does indeed affect everyday functioning.Thus, if simple and efficient screening for MCI in applied settings is the goal the AD8 could be recommended on the basis of utility and brevity. P3-089

COMMUNITY LIFE WITHDRAWAL WITH MCI PROGRESSION

Jeffrey Kaye, Nora Matteck, Tamara Hayes, Daniel Austin, Hiroko Dodge, Oregon Health and Science University, Portland, Oregon, United States. Background: The development of MCI may be associated with decreased levels of activity or withdrawal from the world as cognitive decline progresses. This change may be difficult to detect by self-report methods. Unobtrusive home-based sensing technologies may allow the detection of subtle changes in activity indicative of MCI. Methods: Volunteers enrolled in the Intelligent Systems for Assessing Aging Change (ISAAC) cohort study were followed longitudinally in their homes outfitted with embedded motion and contact sensors to detect 24/7 activity patterns. Time out of the home was the primary outcome of interest. Sensor data was used to sum the total time (in hours) out of house per month per participant. This time was divided by the number of valid days with monitored data per month to get average hours out of home per day per subject-month. Data were analyzed using a mixed effect model with random intercept and time effects adjusted for age, gender, education, Cumulative Illness Rating Scale and Geriatric Depression Scale score at baseline. Results: Data from 148 participants (28 with MCI; 10 with amnestic MCI), mean age, 84.2 6 5.0 were assessed for a mean of 2.8 6 1.2 years. During the first month after enrollment, participants spent a mean of 4.5 6 3.7 hours/day out of their home; there was no difference in time out of house between MCI and cognitively normal participants during the post-baseline month. In cognitively intact participants there was no longitudinal change in time out of home. MCI participants had a significantly greater decline in time out of home over time compared to cognitively intact participants. During the last month of monitored data, cognitively intact participants left their home 3.8 hours/per day on average; MCI participants left their home 2.9 hrs/day. Conclusions: With the progression of MCI increasingly less time is spent outside the home. This suggests a progressive narrowing of interaction with the outside world. This phenomenon may form a novel measure that can be used to unobtrusively detect early activity changes indicative of evolving MCI. P3-090

COMPROMISED CEREBRAL AUTOREGULATION IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT

Jie Liu1, Estee Brunk1, Yong-Sheng Zhu1, Kyle Armstrong1, Kristin Martin-Cook2, Linda Hynanc3, Myron Weiner3, Ramon DiazArrastia2, Benjamin D Levine1, Rong Zhang1, 1Institute for Exercise and Environmental Medicine,Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States; 2Alzheimer’s Disease Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States; 3 Alzheimer’s Disease Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States. Background: Cardiovascular risk factors appear to influence the development of Alzheimer’s disease (AD). However, the underlying mechanisms by which cerebrovascular dysfunction in particular contributes to AD is unknown. We tested the hypothesis that static cerebral autoregulation (sCA) is compromised in patients with amnestic mild cognitive impairment (MCI), a transitional state between normal cognitive aging and AD. Methods: 26 MCI patients (12 males, 67 6 6 yr) and 18 age-and education-matched normal control subjects (6 males, 68 6 7 yr) underwent cerebral autoregulation study. Mean Arterial blood pressure (MAP) was decreased stepwise by intravenous infusion of sodium nitroprusside (SNP) and then increased by phenylephrine. Transcranial and color duplex Doppler were used to measure cerebral blood flow (CBF) velocity of the middle cerebral artery (MCA, V MCA) and volumetric blood flow of the internal carotid (ICA, F ICA) and