- Email: [email protected]
CORRELATION BETWEEN THE CLINICAL, NEUROIMAGING CHARACTERS AND THE CEREBROSPINAL FLUID TAP TEST RESPONSE IN CHINESE IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS PATIENTS
Poster Presentations: Sunday, July 16, 2017
P1-298
RESEARCHING DEMENTIA-RELATED SLEEP PROBLEMS USING ACTIWATCHES: PRELIMINARY INSIGHTS FROM THE DREAMS START STUDY
Brendan Hallam1,*, Kirsi M. Kinnunen1,*, Lucy A. Webster1, Penny Rapaport1, Claudia Cooper1, Julie Barber2, Rossana Horsley3, James Pickett4, Simon D. Kyle5, Colin A. Espie5, Gill Livingston1, 1 Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom; 2Department of Statistical Sciences, Faculty of Mathematical & Physical Sciences, University College London, United Kingdom; 3Alzheimer’s Society Volunteer Network, London, United Kingdom; 4Alzheimer’s Society, London, United Kingdom; 5Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom. *equal contributions. Contact e-mail: [email protected] Background: People with dementia often have sleep disturbances,
which can be distressing for both the person with dementia and family members whose sleep is disturbed. There are no management strategies with demonstrated efficacy, although there are strategies and medications used, with anticipated benefits extrapolated from the general population. One of the problems is how to measure sleep in a population with difficulties in remembering and reporting their own experiences. The DREAMS-START study of people with dementia living in their own homes uses acti-watches to measure an individual’s sleep, activity and light exposure, as part of developing and testing a manualised intervention to improve sleep disturbances. Here, we report on the acceptability and feasibility of using acti-watches to investigate sleep. Methods: We ask people with dementia and sleep problems to wear an acti-watch on their wrist for 14 days at baseline before randomisation to six sessions of DREAMS START intervention or their usual treatment, and again three months later. The outcomes were: the average number of days the acti-watch was worn, the percentage of participants wearing the watch for the full 14 days, the percentage wearing it for 7 days, and narrative accounts of any difficulties experienced. Results: To date, we have baseline data from 36 participants (we will report on all 60 at the conference). They were 36.1% male and ethnically diverse: 14 white British (39%); 9 white other (25%); 13 black or minority ethnic (36%), with a mean age of 81 years (SD¼8.0, ranging from 6894). The median Clinical Dementia Rating was 2 (ranging from 0.5 to 3). Twenty-seven participants (75%) wore the watch for the full 14 days; 94% wore it for 7 days. The overall median wear time was 14 days (ranging from 3 to 14); the table shows the median times according to dementia severity and age. No major difficulties were encountered. Reasons for temporarily removing the watch included personal hygiene activities. Conclusions: Our preliminary results suggest that acti-watches are a useful objective method for studying sleep problems, across a diverse range of people with dementia living in the community.
Global CDR
N
Median (Min-Max)
Very mild Mild Moderate Severe Age range 60-69 70-79 80-89 90+
4 12 18 2
14.0 (3-14) 14.0 (8-14) 14.0 (6-14) 14.0 (N/A)
4 11 13 8
14.0 (13-14) 14.0 (6-14) 14.0 (3-14) 13.5 (8-14)
P1-299
P367
AN EVALUATION OF PREDICTORS AND COGNITIVE DECLINE ASSOCIATED WITH PERSISTENT AND TRANSIENT PSYCHOTIC SYMPTOMS IN ALZHEIMER’S DISEASE
Byron Creese1, Clive Ballard1, Dag Aarsland2,3, Sverre Bergh4, Arvid Rongve5, Geir Selbaek6, 1University of Exeter Medical School, Exeter, United Kingdom; 2Stavanger University Hospital, Stavanger, Norway; 3King’s College London, London, United Kingdom; 4Innlandet Hospital Trust, Brumunddal, Norway; 5Helse Fonna, Haugesund, Norway; 6 Research Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. Contact e-mail: [email protected] Background: Psychotic symptoms in AD are complex, comprising both delusions and hallucinations and fluctuating over time. In clinical trials, epidemiology and basic science studies delusions and hallucinations are frequently analysed together and on the basis of a single one-off assessment. We sought to investigate whether persistent delusions and hallucinations have a different pattern of association to transient symptoms at the clinical level in order to inform phenotyping. Methods: 1,109 AD patients from nursing home and prospective cohort studies with an evaluation of delusions and hallucinations (by NPI scale) at baseline and at 1 year were categorised into three groups: no symptoms, transient symptoms (present at one assessment) or persistent symptoms (present at both time points). Cognition was assessed by MMSE. Multinomial logistic regression was used to assess the contribution of dementia severity, sex and age in predicting group status and a generalised estimating equation was used to examine cognitive decline. Results: Persistent delusions were associated sex (males with lower risk: RR 0.24 p<0.001) while for transient symptoms there was no relationship with sex but older age was a significant risk factor (RR: 1.02, p¼0.04). Both persistent and transient hallucinations were associated with greater disease severity, but this magnitude of risk was more pronounced for persistent symptoms (transient symptoms: RR 1.68, p<0.001; persistent symptoms: RR 3.5, p<0.001). Younger age was a significant risk factor for persistent hallucinations only (RR: 0.95, p¼0.009). When compared to individuals without any delusions, cognitive decline was sharper in individuals with persistent but not transient delusions (mean difference -1.68, p¼0.002) while both persistent and transient hallucinations were associated with greater cognitive decline (-1.08, p¼0.031; -2.54, p¼0.006 respectively). Conclusions: Using a large cohort, we provide evidence that persistent psychotic symptoms may represent a more robust phenotype and highlight differences in clinical associations between delusions and hallucinations, with important implications for phenotype definition in a wide range of future studies. Future work should expand the clinical and biological variables examined.
P1-300
CORRELATION BETWEEN THE CLINICAL, NEUROIMAGING CHARACTERS AND THE CEREBROSPINAL FLUID TAP TEST RESPONSE IN CHINESE IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS PATIENTS
Caiyan Liu, Liling Dong, Chenhui Mao, Junji Wei, Bo Hou, Feng Feng, Bin Peng, Renzhi Wang, Liying Cui, Jing Gao, Peking Union Medical College Hospital, Beijing, China. Contact e-mail: [email protected]
P368
Poster Presentations: Sunday, July 16, 2017
Background: In order to be helpful for the diagnosis and prediction of the shunting surgery outcome in Chinese idiopathic normal pressure hydrocephalus patients, we herein were to explore the correlation between the clinical, neuroimaging characteristics and the cerebrospinal fluid tap test response. Methods: 43 iNPH patients in PUMCH from 2013-2015 were included. All patients were evaluated using MMSE, MOCA, ADL, iNPH scale, underwent 1.5T head MRI scan and a cerebrospinal fluid tap with removal of 30 ml of CSF .The evaluations prior to and posterior to CSF tap test included the 10m walking time and steps, TMT-A, digital symbol and STROOP test. Two experienced neurologists were responsible for the adjustment of the CSF tap test response. The clinical and neuroimaging parameters of iNPH patients were analyzed between the CSF tap test responders and non-responders. Results: Compared with non-responders, the patients of CSF tap test responders had more male patients (male: female 20:4 vs. 9:10, p¼ 0.021), longer walking disturbance history ((1040.136708.33) days vs. (597.066527.7) days, p¼ 0.035), lower baseline cognitive tests z score (-15.731616.537 vs. -4.23668.280, p¼ 0.041) and more periventricular white matter lesions (p¼ 0.033). Conclusions: We report some clinical and neuroimaging characters of iNPH patients which were a little different from those have been reported. Our limitation is that the shunting result hadn’t been analyzed because of the limited number of patients. However the results indicated that the patients with the longer duration, the lower cognitive tests score and the prominent white matter lesions should not be excluded for the shunting surgery.
P1-301
THE MINI EATING BEHAVIOR INVENTORY (MINI EBI): A 10-ITEM CLINICAL TOOL FOR THE EARLY DIAGNOSIS OF FRONTOTEMPORAL DEMENTIA
Carole Azuar1,2, Adriana Amaya Saratxaga3, Maeva Camus2, Thomas Mauras4, Richard Levy2,5, Aurelie Funkiewiez6, Isabelle Le Ber2,7, Bruno Dubois8,9, 1INSERM- Universite Pierre et Marie Curie, Paris 6, IHU-ICM, Paris, France; 2APHP- Groupe Hospitalier Pitie Salpetriere, Paris, France; 3APHP-Federation de Neurologie, Hopital Pitie Salpetriere, Paris, France; 4Centre Hospitalier Sainte Anne, Paris, France; 5INSERMUniversite Pierre et Marie Curie, Paris 6, IHU-ICM, Paris, France; 6 APHP-Groupe Hospitalier Pitie Salpetriere, Paris, France; 7ICM, Paris, France; 8Sorbonne Universities, Pierre et Marie Curie University, Paris 06, Institute of Memory and Alzheimer’s Disease (IM2A) & Brain and Spine Institute (ICM) UMR S 1127, Department of Neurology, Hopital Pitie-Salp^etriere, Paris, France; 9Institut de la Memoire et de la Maladie d’Alzheimer (IM2A), ICM, H^opital de la Pitie-Salp^etriere, AP-HP, Universite Paris 6, Paris, France. Contact e-mail: [email protected] Background: Changes in eating behaviors and food preference are very frequent in patients with frontotemporal dementia. Despite a specific pattern, this behavioral change is not used as a diagnosis tool. In this study we proposed a short version of a caregiver questionnaire named Mini Eating Behavior Inventory (Mini-EBI). Methods: The first EBI questionnaire consisted in 30 questions investigating four domains of eating behaviors (eating habits, food preference, table manners, and swallowing problems). This 30-item questionnaire allowed to distinguish frontotemporal dementia from Alzheimer’s disease with high sensitivity and specificity. The aim of this study was to test a 10-item version of the questionnaire, called Mini-EBI. Two groups of patients were stud-
ied using the Mini-EBI: 50 patients with frontal variant frontotemporal dementias (fv-FTD) and 40 patients with Alzheimer’s diseases (AD) confirmed by CSF biomarkers. Results: Results showed that the Mini-EBI scores were significantly different in the two groups with mean scores (6 SD) of 6.2 / 10 (6 1.9) in fv-FTD patients and 1 /10 (6 1.3) in AD patients. The ROC curves analyzes showed a high area under the curve (AUC ¼ 0.98, p<0.0001) and revealed a best cut-off value of > 3 /10 for fvFTD diagnosis, with 96.9 % sensitivity and 90.9 % specificity. Conclusions: The Mini-EBI, shown as a rapid and simple 10-item caregiver questionnaire, could be proposed as a new diagnosis tool distinguishing fv-FTD patients from AD patients.
P1-302
DISRUPTED INFRADIAN RHYTHMS IN MILD COGNITIVE IMPAIRMENT
Christina Reynolds1,2, Miranda Lim1,3, Nora Mattek1,2,4, Hiroko Dodge1,2,4,5, Jeffrey Kaye1,2,4, 1Oregon Health & Science University, Portland, OR, USA; 2Oregon Center for Aging & Technology (ORCATECH), Portland, OR, USA; 3VA Portland Medical Center, Portland, OR, USA; 4NIA-Layton Aging & Alzheimer’s Disease Center, Portland, OR, USA; 5University of Michigan, Ann Arbor, MI, USA. Contact e-mail: [email protected] Background: Sleep quality is closely linked with cognitive function.
Monitoring sleep patterns may offer insight into the early prognosis of aging adults at risk for dementia. Disrupted sleep has been documented in studies of adults with mild cognitive impairment. Sleep patterns are strongly influenced by circadian rhythms on a daily scale and also vary seasonally depending on day length and environmental temperature, with longer sleep periods observed during the winter months. In a uniquely longitudinal cohort study using in-home passive monitoring, we evaluated whether normal seasonal (infradian) rhythms are disrupted in individuals with MCI. Methods: Participants were 128 older adults; mean age, 85 years. Ninety-eight were cognitively intact and 30 had been diagnosed with MCI (22 non-amnestic MCI; 8 amnestic MCI) using standard psychometric and clinical criteria. All were enrolled in an ongoing longitudinal study using in-home passive monitoring technology. Infrared sensors were placed throughout each participant’s home to monitor movement and presence in each room of the home.
P1-298
RESEARCHING DEMENTIA-RELATED SLEEP PROBLEMS USING ACTIWATCHES: PRELIMINARY INSIGHTS FROM THE DREAMS START STUDY
Brendan Hallam1,*, Kirsi M. Kinnunen1,*, Lucy A. Webster1, Penny Rapaport1, Claudia Cooper1, Julie Barber2, Rossana Horsley3, James Pickett4, Simon D. Kyle5, Colin A. Espie5, Gill Livingston1, 1 Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom; 2Department of Statistical Sciences, Faculty of Mathematical & Physical Sciences, University College London, United Kingdom; 3Alzheimer’s Society Volunteer Network, London, United Kingdom; 4Alzheimer’s Society, London, United Kingdom; 5Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom. *equal contributions. Contact e-mail: [email protected] Background: People with dementia often have sleep disturbances,
which can be distressing for both the person with dementia and family members whose sleep is disturbed. There are no management strategies with demonstrated efficacy, although there are strategies and medications used, with anticipated benefits extrapolated from the general population. One of the problems is how to measure sleep in a population with difficulties in remembering and reporting their own experiences. The DREAMS-START study of people with dementia living in their own homes uses acti-watches to measure an individual’s sleep, activity and light exposure, as part of developing and testing a manualised intervention to improve sleep disturbances. Here, we report on the acceptability and feasibility of using acti-watches to investigate sleep. Methods: We ask people with dementia and sleep problems to wear an acti-watch on their wrist for 14 days at baseline before randomisation to six sessions of DREAMS START intervention or their usual treatment, and again three months later. The outcomes were: the average number of days the acti-watch was worn, the percentage of participants wearing the watch for the full 14 days, the percentage wearing it for 7 days, and narrative accounts of any difficulties experienced. Results: To date, we have baseline data from 36 participants (we will report on all 60 at the conference). They were 36.1% male and ethnically diverse: 14 white British (39%); 9 white other (25%); 13 black or minority ethnic (36%), with a mean age of 81 years (SD¼8.0, ranging from 6894). The median Clinical Dementia Rating was 2 (ranging from 0.5 to 3). Twenty-seven participants (75%) wore the watch for the full 14 days; 94% wore it for 7 days. The overall median wear time was 14 days (ranging from 3 to 14); the table shows the median times according to dementia severity and age. No major difficulties were encountered. Reasons for temporarily removing the watch included personal hygiene activities. Conclusions: Our preliminary results suggest that acti-watches are a useful objective method for studying sleep problems, across a diverse range of people with dementia living in the community.
Global CDR
N
Median (Min-Max)
Very mild Mild Moderate Severe Age range 60-69 70-79 80-89 90+
4 12 18 2
14.0 (3-14) 14.0 (8-14) 14.0 (6-14) 14.0 (N/A)
4 11 13 8
14.0 (13-14) 14.0 (6-14) 14.0 (3-14) 13.5 (8-14)
P1-299
P367
AN EVALUATION OF PREDICTORS AND COGNITIVE DECLINE ASSOCIATED WITH PERSISTENT AND TRANSIENT PSYCHOTIC SYMPTOMS IN ALZHEIMER’S DISEASE
Byron Creese1, Clive Ballard1, Dag Aarsland2,3, Sverre Bergh4, Arvid Rongve5, Geir Selbaek6, 1University of Exeter Medical School, Exeter, United Kingdom; 2Stavanger University Hospital, Stavanger, Norway; 3King’s College London, London, United Kingdom; 4Innlandet Hospital Trust, Brumunddal, Norway; 5Helse Fonna, Haugesund, Norway; 6 Research Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. Contact e-mail: [email protected] Background: Psychotic symptoms in AD are complex, comprising both delusions and hallucinations and fluctuating over time. In clinical trials, epidemiology and basic science studies delusions and hallucinations are frequently analysed together and on the basis of a single one-off assessment. We sought to investigate whether persistent delusions and hallucinations have a different pattern of association to transient symptoms at the clinical level in order to inform phenotyping. Methods: 1,109 AD patients from nursing home and prospective cohort studies with an evaluation of delusions and hallucinations (by NPI scale) at baseline and at 1 year were categorised into three groups: no symptoms, transient symptoms (present at one assessment) or persistent symptoms (present at both time points). Cognition was assessed by MMSE. Multinomial logistic regression was used to assess the contribution of dementia severity, sex and age in predicting group status and a generalised estimating equation was used to examine cognitive decline. Results: Persistent delusions were associated sex (males with lower risk: RR 0.24 p<0.001) while for transient symptoms there was no relationship with sex but older age was a significant risk factor (RR: 1.02, p¼0.04). Both persistent and transient hallucinations were associated with greater disease severity, but this magnitude of risk was more pronounced for persistent symptoms (transient symptoms: RR 1.68, p<0.001; persistent symptoms: RR 3.5, p<0.001). Younger age was a significant risk factor for persistent hallucinations only (RR: 0.95, p¼0.009). When compared to individuals without any delusions, cognitive decline was sharper in individuals with persistent but not transient delusions (mean difference -1.68, p¼0.002) while both persistent and transient hallucinations were associated with greater cognitive decline (-1.08, p¼0.031; -2.54, p¼0.006 respectively). Conclusions: Using a large cohort, we provide evidence that persistent psychotic symptoms may represent a more robust phenotype and highlight differences in clinical associations between delusions and hallucinations, with important implications for phenotype definition in a wide range of future studies. Future work should expand the clinical and biological variables examined.
P1-300
CORRELATION BETWEEN THE CLINICAL, NEUROIMAGING CHARACTERS AND THE CEREBROSPINAL FLUID TAP TEST RESPONSE IN CHINESE IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS PATIENTS
Caiyan Liu, Liling Dong, Chenhui Mao, Junji Wei, Bo Hou, Feng Feng, Bin Peng, Renzhi Wang, Liying Cui, Jing Gao, Peking Union Medical College Hospital, Beijing, China. Contact e-mail: [email protected]
P368
Poster Presentations: Sunday, July 16, 2017
Background: In order to be helpful for the diagnosis and prediction of the shunting surgery outcome in Chinese idiopathic normal pressure hydrocephalus patients, we herein were to explore the correlation between the clinical, neuroimaging characteristics and the cerebrospinal fluid tap test response. Methods: 43 iNPH patients in PUMCH from 2013-2015 were included. All patients were evaluated using MMSE, MOCA, ADL, iNPH scale, underwent 1.5T head MRI scan and a cerebrospinal fluid tap with removal of 30 ml of CSF .The evaluations prior to and posterior to CSF tap test included the 10m walking time and steps, TMT-A, digital symbol and STROOP test. Two experienced neurologists were responsible for the adjustment of the CSF tap test response. The clinical and neuroimaging parameters of iNPH patients were analyzed between the CSF tap test responders and non-responders. Results: Compared with non-responders, the patients of CSF tap test responders had more male patients (male: female 20:4 vs. 9:10, p¼ 0.021), longer walking disturbance history ((1040.136708.33) days vs. (597.066527.7) days, p¼ 0.035), lower baseline cognitive tests z score (-15.731616.537 vs. -4.23668.280, p¼ 0.041) and more periventricular white matter lesions (p¼ 0.033). Conclusions: We report some clinical and neuroimaging characters of iNPH patients which were a little different from those have been reported. Our limitation is that the shunting result hadn’t been analyzed because of the limited number of patients. However the results indicated that the patients with the longer duration, the lower cognitive tests score and the prominent white matter lesions should not be excluded for the shunting surgery.
P1-301
THE MINI EATING BEHAVIOR INVENTORY (MINI EBI): A 10-ITEM CLINICAL TOOL FOR THE EARLY DIAGNOSIS OF FRONTOTEMPORAL DEMENTIA
Carole Azuar1,2, Adriana Amaya Saratxaga3, Maeva Camus2, Thomas Mauras4, Richard Levy2,5, Aurelie Funkiewiez6, Isabelle Le Ber2,7, Bruno Dubois8,9, 1INSERM- Universite Pierre et Marie Curie, Paris 6, IHU-ICM, Paris, France; 2APHP- Groupe Hospitalier Pitie Salpetriere, Paris, France; 3APHP-Federation de Neurologie, Hopital Pitie Salpetriere, Paris, France; 4Centre Hospitalier Sainte Anne, Paris, France; 5INSERMUniversite Pierre et Marie Curie, Paris 6, IHU-ICM, Paris, France; 6 APHP-Groupe Hospitalier Pitie Salpetriere, Paris, France; 7ICM, Paris, France; 8Sorbonne Universities, Pierre et Marie Curie University, Paris 06, Institute of Memory and Alzheimer’s Disease (IM2A) & Brain and Spine Institute (ICM) UMR S 1127, Department of Neurology, Hopital Pitie-Salp^etriere, Paris, France; 9Institut de la Memoire et de la Maladie d’Alzheimer (IM2A), ICM, H^opital de la Pitie-Salp^etriere, AP-HP, Universite Paris 6, Paris, France. Contact e-mail: [email protected] Background: Changes in eating behaviors and food preference are very frequent in patients with frontotemporal dementia. Despite a specific pattern, this behavioral change is not used as a diagnosis tool. In this study we proposed a short version of a caregiver questionnaire named Mini Eating Behavior Inventory (Mini-EBI). Methods: The first EBI questionnaire consisted in 30 questions investigating four domains of eating behaviors (eating habits, food preference, table manners, and swallowing problems). This 30-item questionnaire allowed to distinguish frontotemporal dementia from Alzheimer’s disease with high sensitivity and specificity. The aim of this study was to test a 10-item version of the questionnaire, called Mini-EBI. Two groups of patients were stud-
ied using the Mini-EBI: 50 patients with frontal variant frontotemporal dementias (fv-FTD) and 40 patients with Alzheimer’s diseases (AD) confirmed by CSF biomarkers. Results: Results showed that the Mini-EBI scores were significantly different in the two groups with mean scores (6 SD) of 6.2 / 10 (6 1.9) in fv-FTD patients and 1 /10 (6 1.3) in AD patients. The ROC curves analyzes showed a high area under the curve (AUC ¼ 0.98, p<0.0001) and revealed a best cut-off value of > 3 /10 for fvFTD diagnosis, with 96.9 % sensitivity and 90.9 % specificity. Conclusions: The Mini-EBI, shown as a rapid and simple 10-item caregiver questionnaire, could be proposed as a new diagnosis tool distinguishing fv-FTD patients from AD patients.
P1-302
DISRUPTED INFRADIAN RHYTHMS IN MILD COGNITIVE IMPAIRMENT
Christina Reynolds1,2, Miranda Lim1,3, Nora Mattek1,2,4, Hiroko Dodge1,2,4,5, Jeffrey Kaye1,2,4, 1Oregon Health & Science University, Portland, OR, USA; 2Oregon Center for Aging & Technology (ORCATECH), Portland, OR, USA; 3VA Portland Medical Center, Portland, OR, USA; 4NIA-Layton Aging & Alzheimer’s Disease Center, Portland, OR, USA; 5University of Michigan, Ann Arbor, MI, USA. Contact e-mail: [email protected] Background: Sleep quality is closely linked with cognitive function.
Monitoring sleep patterns may offer insight into the early prognosis of aging adults at risk for dementia. Disrupted sleep has been documented in studies of adults with mild cognitive impairment. Sleep patterns are strongly influenced by circadian rhythms on a daily scale and also vary seasonally depending on day length and environmental temperature, with longer sleep periods observed during the winter months. In a uniquely longitudinal cohort study using in-home passive monitoring, we evaluated whether normal seasonal (infradian) rhythms are disrupted in individuals with MCI. Methods: Participants were 128 older adults; mean age, 85 years. Ninety-eight were cognitively intact and 30 had been diagnosed with MCI (22 non-amnestic MCI; 8 amnestic MCI) using standard psychometric and clinical criteria. All were enrolled in an ongoing longitudinal study using in-home passive monitoring technology. Infrared sensors were placed throughout each participant’s home to monitor movement and presence in each room of the home.